Final Flashcards
Lumbar Bony Palpation
Iliac crest
PSIS
Lumbar spinous processes
Sacral tubercles
Lumbar Soft Tissue Palpation
Anterior abdominal muscles Paraspinal muscles (palpate as a unit) - Spinalis - Longissimus - Iliocostalis Gluteus Maximus Gluteus Medius Sciatic Nerve Hamstrings - Biceps femoris - Semitendinosus - Semimembranosus
Lumbar Range of Motion
Flexion 25* Extension 30* Left lateral bending 25* Right lateral bending 25* Left rotation 30* Right rotation 30*
Hoover Sign - Instruction
Pt supine, examiner instructs pt to lift the affected leg while the examiner places one hand under the heel of the non-affected leg (healthy side).
Hoover Sign - Positive/Indicates
P: Lack of counter-pressure on the healthy side.
I: Lack of organic basis for paralysis (Malingering/hysteria). With organic hemiplegia, the patient will still exert downward pressure when attempting to raise paralyzed leg.
Straight Leg Raiser - Instruction
Pt supine, examiner raises pt’s leg slowly to 90 degrees or to the point of pain.
Straight Leg Raiser - Positive/Indicates
P: Radiating pain and/or dull posterior thigh pain.
I: Sciatic radiculopathy or tight hamstrings. Positive between 35-70 degrees would indicate possible discogenic sciatic radiculopathy. Positive of greater than 70 degrees would indicate tight hamstrings.
Goldthwait Sign - Instruction
Pt supine, examiner places the fingers of their superior hand under the interspinous spaces of the pt’s lower lumbar vertebrae. Examiner then raises one of the pt’s extended legs.
Goldthwait Sign - Positive/Indicates
P: Localized pain, low back or radiating pain down the leg.
I: Lumbo-sacral or sacroiliac pathology. Pain occurring after the lumbar spinouses move would indicate possible lumbo-sacral problem. Pain occurring before the lumbars move would indicate possible sacroiliac problem.
Bragard Sign - Instruction
Pt supine, examiner performs a (SLR) on the pt. Examiner lowers the raised leg 5 degrees from the point of pain and fully dorsiflexes pt’s foot.
“During a straight leg raise the patient would feel pain. I would then lower the leg five degrees or until the pain went away. I would then fully dorsiflex the foot….” then go into positive.
Bragard Sign - Positive/Indicates
P: Radiating pain in posterior thigh.
I: Sciatic radiculopathy.
Buckling Sign - Instruction
Pt is supine, examiner performs a SLR on the pt.
See positive/indicates for verbals.
Buckling Sign - Positive/Indicates
P: Pain in the posterior thigh with sudden knee flexion.
I: Sciatic radiculopathy.
“I would be performing a straight leg raise and the patient would experience pain in the posterior thigh with sudden knee flexion (make the pt’s knee flex with non-supporting hand). This would indicate sciatic radiculopathy.
Bowstring Sign - Instruction
Pt is supine, examiner places pt’s leg on their shoulder and first applies pressure to the hamstring muscle if pain is not elicited then apply pressure to the popliteal fossa.
Bowstring Sign - Positive/Indicates
P: Pain in the lumbar region or radiculopathy.
I: Sciatic nerve root compression, helps rule out tight hamstrings.
Lasegue Test - Instruction
Pt supine. Hip and leg bent to 90 degrees. Slowly extend the knee (keeping hip at or close to 90 degrees).
Lasegue Test - Positive/Indicates
P: Reproduction of sciatic pain before 60 degrees.
I: Sciatica.
Milgram Test - Instruction
Pt supine, examiner raises both of pt’s legs 2-3 inches off the table and instructs pt to hold legs off the table for 30 seconds.
Milgram Test - Positive/Indicates
P: Inability to perform test and/or low back pain.
I: Weak abdominal muscles or space occupying lesion.
Valsalva Maneuver - Instruction
Pt seated, examiner instructs pt to take a deep breath and hold while bearing down as if straining during a bowel movement.
Valsalva - Positive/Indicates
P: Radiating pain from site of lesion (usually recreating the complaint in cervical or lumbar area of the spine).
I: Space occupying lesion (e.g. disc pathology).
Bechterew Test - Instruction
Pt seated, examiner instructs pt to extend one knee at a time alternately, then both together.
“Can I have you sit on the bench with your hands in your lap (makes it easier to spot tripod)? Can you raise this leg? Can you raise that leg? Can you raise them both together?”
Bechterew Test - Positive/Indicates
P: Reproduction of radicular pain or inability to perform correctly due to tripod sign.
I: Sciatic radiculopathy.
Neri Bowing Test (Neri Sign) - Instruction
Examiner instructs pt to bend forward from the waist.
Neri Bowing Test (Neri Sign) - Positive/Indicates
P: Pain accompanied by flexion of the knee on the affected side and body rotation away from the affected side.
I: Positive with a variety of low back pathologies. Hamstring tension on the pelvis may trigger the response.
Anterior Innominate Test (Mazion Pelvic Maneuver) (Advancement Sign) - Instruction
The pt is standing. Examiner instructs pt to advance one leg forward approximately 2-3 feet. Pt is then instructed to bend forward from the waist and touch the advanced foot with both hands (advanced knee should be straight).
Anterior Innominate Test (Mazion Pelvic Maneuver) (Advancement Sign) - Positive/Indicates
The inability to bend at the waist more than 45 degrees, because of either/or:
P1: Radiating pain along the sciatic nerve, either unilateral or bilateral.
I1: Sciatic neuralgia or radiculopathy, etc., possibly due to lumbar disc pathology.
P2: Low back pain (lumbar or pelvic regions).
I: Anterior (rotational) displacement of the ilium relative to the sacrum.
Lewin Standing Test - Instruction
Examiner instructs pt to bend forward slightly at the waist with knees slightly flexed. Examiner first brings one knee into complete extension. Next the examiner brings the other knee into complete extension. Finally the examiner brings both knees into complete extension.
Lewin Standing Test - Positive/Indicates
P: Radiating pain down the leg causing flexion of the pt’s knee or knees.
I: Gluteal, lumbosacral or sacroiliac pathologies.
Heel Walk - Instruction
Pt walks on heels.
Heel Walk - Positive/Indicates
P: Inability to perform test.
I: L4-L5 disc lesion (L5 nerve root).
Toe Walk - Instruction
Pt walks on toes.
Toe Walk - Positive/Indicates
P: Inability to perform test.
I: L5-S1 disc lesion (S1 nerve root).
Ely Heel to Buttock Test (Ely Sign) - Instruction
Pt prone, examiner flexes the knee of the pt’s affected leg to 90 degrees. Examiner then approximates the heel of the affected leg to the contralateral buttock and hyperextends the thigh off the table.
Ely Heel to Buttock Test (Ely Sign) - Positive/Indicates
P1: Inability to raise the thigh.
I1: Iliopsoas spasm.
P2: Pain in the anterior thigh.
I2: Inflammation of lumbar nerve roots.
P3: Pain in the lumbar region.
I3: Lumbar nerve root adhesions.
Hip and Pelvis Bony Palpation
Anterior - Iliac crest - ASIS - Iliac tubercle - Greater trochanter Posterior - PSIS - Ischial tuberosity - Coccyx
Hip and Pelvis Soft Tissue Palpation
Femoral triangle borders - Sartorius - Adductor Longus - Inguinal ligament Quadriceps muscles - Vastus Lateralis - Vastus Medialis - Vastus Intermedius - Rectus Femoris Greater trochanteric bursa Gluteus Medius Gluteus Maximus Sciatic nerve Cluneal nerves Hamstrings - Biceps femoris - Semitendinosus - Semimembranosus
Hip and Pelvis Range of Motion
Flexion 120* Extension 30* Abduction 45* Adduction 45* Internal rotation 45* External rotation 45* Flexion and Adduction Flexion, Abduction and External Rotation
Leg Length Discrepancy - Instruction
Pt supine, (True) examiner takes a cloth measuring tape and measures from ipsilateral ASIS to the medial malleolus of the same leg. Examiner then measures from contralateral ASIS to the medial malleolus of the opposite leg. (Apparent) Examiner takes a cloth tape measure and measures from the umbilicus to the medial malleolus of one leg and then measures from the umbilicus to the medial malleolus of the opposite leg.
Leg Length Discrepancy - Positive/Indicates
P: Different measurements
I: true = bony abnormality above or below level of trochanter difference (anatomical short leg)
apparent = pelvic obliquity (tilted pelvis)
Allis Sign (Galeazzi Sign) - Instruction
Pt is supine, examiner instructs pt to place both feet flat (approximate great toes and medial malleoli bilateral) on the bench while flexing both knees to 90 degrees.
Allis Sign (Galeazzi Sign) - Positive/Indicates
P: Difference in height and anteriority of the knees.
I: 1. If one knee is lower = ipsilateral congenital hip dislocation or tibial discrepancy (anatomical short leg)
2. If one knee is anterior = ipsilateral congenital hip dislocation or femoral discrepancy (contralateral anatomical short leg)
Thomas Test - Instruction
Pt supine, examiner instructs pt to approximate each knee one at a time to his/her chest and hold.
Thomas Test - Positive/Indicates
P: Lumbar spine maintains lordosis (should flatten) and hip or leg flexes.
I: Contracture of the hip flexors (iliopsoas)
Anvil Test - Instruction
Pt supine, examiner elevates the affected leg while keeping the knee extended. The examiner then makes a fist and strikes the affected leg’s inferior calcaneus.
Anvil Test - Positive/Indicates
P: Localized pain in long bone or in hip joint
I: Possible fracture of long bones, or hip joint pathology.
Patrick Test (FABERE sign) - Instruction
Pt supine, examiner flexes, abducts and externally rotates the pt’s hip so that the ankle rests above or below the contralateral knee (figure 4). Examiner then extends the hip by pushing just proximal to the knee while stabilizing the contralateral ASIS.
Patrick Test (FABERE sign) - Positive/Indicates
P: Pain in the hip region.
I: Hip joint pathology.
Laguerre Test - Instruction
Pt is supine, examiner grasps the affected leg, flexes and eternally rotates the hip and abducts the thigh (this test is similar to Patrick except the ankle of the affected leg is not resting on the contralateral knee). Examiner applies pressure to the end range of motion while stabilizing the contralateral ASIS (rest ankle on forearm and with other hand reach under arm to stabilize).
Laguerre Test - Positive/Indicates
P1: Pain in the hip joint.
I1: Hip joint pathology.
P2: Pain in the sacroiliac joint.
I2: Mechanical problem of the sacroiliac joint.
Gaenslen Test - Instruction
Pt in the supine position with the affected side of the sacroiliac joint as close to the edge of the table as is possible. The pt then grasps the unaffected leg just below the knee and approximates the knee to his chest. The examiner then places a downward pressure on the affected thigh until it is lower than the edge of the table.
Gaenslen Test - Positive/Indicates
P: Pain on the affected SI joint stressed into extension
I: General sacroiliac joint lesion, anterior sacroiliac ligament sprain, or inflammation of the SI joint.
Lewin-Gaenslen Test - Instruction
Pt lying on his unaffected side, instruct pt to flex his inferior leg. Examiner grasps the superior leg and brings into extension while stabilizing the lumbosacral joint (extension of the leg stresses the sacroiliac joint and anterior joint ligaments on the side of leg extension).
Lewin-Gaenslen Test - Positive/Indicates
P: Pain on the affected SI joint stressed into extension.
I: General sacroiliac joint lesion, anterior sacroiliac ligament sprain, or inflammation of the SI joint.
Hibb Test - Instruction
Pt prone, examiner stabilizes pelvis on near side while grasping the opposite ankle and flexing the knee to 90 degrees. The examiner maximally flexes the knee and then slowly internally rotates the thigh (pushing lateral on the leg). Compare bilateral.
Hibb Test - Positive/Indicates
P1: Pain in the hip region.
I1: Hip joint pathology.
P2: Pain in the buttock/pelvic region.
I2: Sacroiliac joint lesion.
Ober Test - Instruction
Pt on is/her side, examiner flexes the affected knee while abducting and extending the hip. Perform bilaterally.
Ober Test - Positive/Indicates
P: Affected thigh remains in abduction. (Normal biomechanics, the thigh/hip will adduct.)
I: Contraction of the iliotibial band or tensor fascia lata, (usually secondary to synovitis of the hip, secondary to trauma of the gluteus medius and maximus).
Pelvic Rock Test aka Iliac Compression Test - Instruction
Pt lies on their side. Examiner places both hands on the lateral portion of the pt’s ilium. Examiner pushes downward (lateral to medial0 on the pt’s ilium. Test bilaterally.
Pelvic Rock Test aka Iliac Compression Test - Positive/Indicates
P: Pain in either sacroiliac joint.
I: Sacroiliac joint lesion.
Nachlas Test - Instruction
Pt prone, examiner takes the heel of the affected leg and approximates it to the ipsilateral buttock while stabilizing the pelvis to prevent hip flexion.
Nachlas Test - Positive/Indicates
P: Pain in the buttock and/or pain in the lumbar region.
I: Sacroiliac joint lesion, or Lumbar pathology.
Yeoman Test - Instruction
Pt prone, examiner flexes pt’s leg to ipsilateral buttock and then extends thigh.
Yeoman Test - Positive/Indicates
P: Pain deep in the SI joint.
I: Sprain of the anterior sacroiliac ligaments.
Ely Sign (Ely Test) - Instruction
Pt prone, examiner passively flexes the pt’s knee toward the ipsilateral buttock.
No stabilization
Ely Sign (Ely Test) - Positive/Indicates
P: Hip on side being tested will flex causing the buttock to raise off the table.
I: Rectus femoris or hip flexor contracture
Trendelenburg Test - Instruction
Pt stands on foot of involved side of hip problem. Observe level of hips.
Trendelenburg Test - Positive/Indicates
P: High iliac crest on supported side and low crest on side of elevated leg.
I: Weak gluteus medius muscle on the supported side.
Knee Bony Palpation
Patella Tibial tubercle Medial tibial plateau Medial femoral condyle Lateral tibial plateau Lateral femoral condyle Fibula head
Knee Soft Tissue Palpation
Quadriceps muscles - Vastus Intermedius - Rectus Femoris - Vastus Medialis - Vastus Lateralis Bursae - Prepatellar - Superficial infrapatellar Infrapatellar tendon Lateral Collateral Ligament Lateral meniscus Medial collateral ligament Medial meniscus Pes anserine area - Sartorius - Gracilis - Semitendinosus Gastrocnemius muscle Popliteal fossa
Knee Range of Motion
Flexion 135*
Extension 0*
Internal rotation
External rotation
McMurray Sign - Instruction
Linkhorn’s Instruction:
- Flex the knee to 90*
- Ext or Int rotate the tibia
- Fully flex the knee
- Add valgus or varus stress at the knee
- Extend the knee
McMurray Sign - Positive/Indicates
P: Clicking sound or pain by knee joint.
I: Tear of medial meniscus if positive on external rotation.
Tear of lateral meniscus if positive on internal rotation.
The higher the leg is raised during extension when positive is elicited, the more posterior the meniscal injury.
Medial Collateral Ligament Test (Abduction Stress Test, Valgus Stress Test) - Instruction
Pt supine, examiner stabilizes the lateral thigh of the pt’s affected leg. Examiner grasps just proximal to the medial ankle of he affected leg and gradually pushes laterally ( to open medial side of joint).
Medial Collateral Ligament Test (Abduction Stress Test, Valgus Stress Test) - Positive/Indicates
P: Gapping and/or elicited pain above/at/or below joint line.
I: Torn medial collateral ligament.
Lateral Collateral Ligament Test (Adduction Stress Test, Varus Stress test) - Instruction
Pt supine, examiner stabilizes the medial thigh of the pt’s affected leg. Examiner grasps just proximal to the lateral ankle of the affected leg and gradually pushes medially (opening the lateral side of the joint).
Lateral Collateral Ligament Test (Adduction Stress Test, Varus Stress test) - Positive/Indicates
P: Gapping and/or elicited pain above/at/or below joint line.
I: Torn lateral collateral ligament.
Bounce Home Test - Instruction
Pt supine, examiner flexes te pt’s knee and grasps the pt’s heel and knee of the affected leg. Examiner pulls affected leg slowly into extension (passively).
Bounce Home Test - Positive/Indicates
P: Knee does not go into full extension (slight flexion remains)
I: Diffuse swelling of the knee, accumulation of fluid, due to possible torn meniscus.
Drawer Test - Instruction
Pt supine, examiner flexes the hip and the knee of the pt’s affected leg until the foot is flat on the table. Examiner sits on the foot of the pt’s affected leg. Examiner grasps behind the pt’s flexed knee and exerts a pushing and pulling pressure into the affected knee.
Drawer Test - Positive/Indicates
P1: Gapping > 6 mm (tibia moves posterior) when the leg is pushed.
I1: Torn posterior cruciate ligament.
P2: Gapping > 6 mm (tibia moves anterior) when the leg is pulled.
I2: Torn anterior cruciate ligament.
Lachman Test - Instruction
Pt supine, examiner puts the pt’s knee at a 30* angle of flexion and from this angle the examiner grasps both the proximal end of the tibia with one hand and the distal end of the femur with the other, and attempts to pull the tibia forward in order to feel the joint play.
Lachman Test - Positive/Indicates
P: Gapping with the tibia moving away from the femur.
I: Anterior cruciate ligament or posterior oblique ligament instability.
Apprehension Test for the Patella - Instruction
Pt supine (or seated with quadriceps relaxed and resting over examiners leg at a 30 degree flexion), examiner pushes the patella laterally.
Apprehension Test for the Patella - Positive/Indicates
P: Apprehension, distress of facial expression, contraction of quadriceps to bring patella back in line.
I: Chronic patella dislocation or pre-disposition to dislocation.
Patella femoral Grinding Test (Clarke sign) - Instruction
Pt supine, affected knee extended examiner uses the web of the hand to move the patella to an inferior position. Examiner instructs pt to tighten the quadriceps muscles as the examiner continues to hold the patella in the inferior direction.
Patella Femoral Grinding Test (Clarke sign) - Positive/Indicates
P: Retropatellar pain and the patient is unable to hold the quadriceps contraction.
I: Degenerative changes of the patellar facets and/or within the trochlear groove (chondromalacia patella).
Patella Ballottment Test - Instruction
Pt supine with knee extended. Anterior to posterior pressure is applied over the patella.
Patella Ballottment Test - Positive/Indicates
P: A floating sensation of the patella.
I: A large amount of swelling in the knee.
Apley Compression Test - Instruction
Pt prone, examiner flexes pt’s affected knee to 90 degrees. Stabilize pt’s thigh with your knee, place downward pressure on the pt’s eel or distal tibia/fibula while internally and then externally rotating the pt’s leg.
Apley Compression Test - Positive/Indicates
P: Pt points to side of pain.
I: Pain on medial side is medial meniscus tear. Pain on the lateral side indicates lateral meniscus tear.
Apley Distraction Test - Instruction
Pt prone, examiner flexes pt affected knee to 90 degrees. Examiner places his/her knee on pt’s affected thigh for stabilization. Examiner grasps the pt’s foot or distal tibia/fibula and pulls the leg while internally and then externally rotating the tibia.
Apley Distraction Test - Positive/Indicates
P: Patient will point to side of pain.
I: Pain on the medial side indicates medial collateral ligament tear. Pain on the lateral side indicates lateral collateral ligament tear.
Foot and Ankle Bony Palpation
Medial malleolus Lateral malleolus Calcaneus Talus Cuboid Navicular 3 Cuneiforms 5 Metatarsals Metatarsophalangeal joints Sustentaculum Navicular tubercle
Foot and Ankle Soft Tissue Palpation
Achilles tendon Fibular/peroneus brevis Tibialis anterior tendon Tibialis posterior tendon Deltoid ligament Spring ligament Anterior talofibular ligament Dorsal pedal artery Posterior tibial artery Plantar aponeurosis
Foot and Ankle Range of Motion
Ankle Dorsiflexion 20* Ankle Plantarflexion 50* Subtalar Inversion 5* Subtalar Eversion 5* 1st MTP Joint Flexion 1st MTP Joint Extension
Drawer Sign (Anterior Drawer Sign of the ankle) - Instruction
Pt seated, examiner grasps just proximal to the ankle with one hand and around the calcaneus of the affected foot with the other hand. Examiner pulls (draws) the calcaneus anteriorly and pushes the tibia posteriorly, the reverse procedure by pulling the ankle anterior and calcaneus posterior.
Drawer Sign (Anterior Drawer Sign of the ankle) - Positive/Indicates
P: translation with the talus moving away from or toward the tibia.
I: 1. With tibia pushed/foot pulled; a tear/instability of the anterior talofibular ligament.
2. With tibia pulled/foot pushed; a tear/instability of posterior talofibular ligament.
Ankle Dorsiflexion Test - Instruction
“Pt experiences difficulty dorsiflexing the foot”
With the pt seated, the examiner tries to dorsiflex foot of affected leg; first with the knee extended, then again with the knee flexed.
Ankle Dorsiflexion Test - Positive/Indicates
P1: The foot cannot dorsiflex with knee extended, but is able to with knee flexed.
I1: Contracture of the gastrocnemius muscle.
P2: The foot cannot dorsiflex in either knee position.
I2: Contracture of the soleus muscle.
Rigid or Supple Flat Feet Test - Instruction
Pt is seated and then stands, examiner observes pt’s feet while seated and while standing.
Rigid or Supple Flat Feet Test - Positive/Indicates
P1: Absence of medial longitudinal arch in both positions.
I1: Rigid flat feet.
P2: Presence of medial longitudinal arch while seated with a loss of medial longitudinal arch while standing.
I2: Supple flat feet.
Homans Sign - Instruction
Pt supine, examiner raises pt’s leg about 12” off the table or 30* to 45* with knee in extension. Examiner then dorsiflexes the pt’s foot and squeezes the calf.
“There are sources that do not recommend squeezing the calf due to danger of thrombus formation possibly being released into the venous system.”
Homans Sign - Positive/Indicates
P: Deep pain in the calf.
I: Deep vein thrombophlebitis.
Thompson Test - Instruction
Pt prone with leg flexed to 90* by examiner. Examiner squeezes the belly of the calf muscle of the affected leg.
Thompson Test - Positive/Indicates
P: Absence of foot plantarflexion motion.
I: Achilles tendon rupture.
Morton Test - Instruction
Pt supine, examiner grasps the affected forefoot with one hand and applies transverse pressure across the metatarsal heads.
Morton Test - Positive/Indicates
P: Sharp pain in the forefoot.
I: Metatarsalgia or neuroma (sally at the 3rd and 4th metatarsal interspace).
