Final Exam Flashcards
Plantar Fasciitis
Focal heel tenderness at the attachment site of the plantar fascia.
McMurray Test
With the patient supine, grasp the heel and flex the knee. Cup your other hand over the knee joint with fingers and thumb along the medial joint line. From the heel, externally rotate the lower leg, then push on the lateral side to apply a valgus stress on the medial side of the joint. At the same time, slowly extend the lower leg in external rotation. The same maneuver with internal rotation of the foot stresses the lateral meniscus.
If a click is felt or heard at the joint line during flexion and extension of the knee, or if tenderness is noted along the joint line, further assess the meniscus for a posterior tear.
A palpable click or pop is a positive test for a tear of the posterior portion of the medial meniscus. The tear may displace meniscal tissue, causing “locking’ on full knee extension.
Valgus Stress Test (Abduction)
With the patient supine and the knee slightly flexed, move the thigh about 30 degrees laterally to the side of the table. Place one hand against the lateral knee to stabilize the femur and the other hand around the medial ankle. Push medially against the knee and pull laterally at the ankle to open the knee joint on the medial side.
Pain or a gap in the medial joint line is a positive test for an MCL injury.
Varus Stress Test (Adduction)
With the thigh and knee in the same position as the valgus stress test, change your position so that you can place one hand against the medial surface of the knee and the other around the lateral ankle. Push laterally against the knee and pull medially at the ankle to open the knee joint on the lateral side (varus stress).
Pain or a gap in the lateral joint line points is a positive stress test for LCL injury.
Anterior Drawer Sign
With the patient supine, hips flexed and knees flexed to 90 degrees and feet flat on the table, cup your hands around the knee with the thumbs on the medial and lateral joint line and the fingers on the medial and lateral insertions of the hamstrings. Draw the tibia forward and observe if it slides forward (like a drawer) from under the femur.
A forward jerk showing the contours of the upper tibia is a positive test, or anterior drawer sign, with a positive LR of 11.5 for an ACL tear.
Lachman Test
Place the knee in 15 degrees of flexion and external rotation. Grasp the distal femur on the lateral side with one hand and the proximal tibia on the medial side with the other. With the thumb of the tibial hand on the joint line, simultaneously pull the tibia forward and the femur back. Estimate the degree of forward excursion.
Significant forward excursion is a positive test for an ACL tear (positive LR of 17.0)
Posterior Drawer Sign
Position the patient and place your hands in the positions described for the anterior drawer test. Push the tibia posteriorly and observe the degree of backward movement in the femur.
If the proximal tibia falls back, this is a positive test for PCL injury.
Tinnel Test
Carpal Tunnel
Aching and numbness when tapping lightly over the course of the median nerve in the carpal tunnel.
Thumb Abduction
Ask the patient to raise the thumb straight up as you apply downward pressure.
Weakness is a positive test.
Phalen Sign
Ask the patient to hold the wrists in flexion for 60 seconds with the elbows fully extended. Alternatively, ask the patient to press the backs of both hands together to form right angles. These maneuvers compress the median nerve.
Numbness and tingling in the median nerve distribution within 60 seconds is a positive test.
Heberden’s Nodes
Hard dorsolateral nodules on the DIP joints. Common in RA.
Bouchard nodes
Hard nodules on the PIP joints.
Ankle Sprain Tests
Talar tilt test
Most involve foot inversion and injury to the weaker lateral ligaments. Anterior drawer laxity.
Subluxation
A partial dislocation.
Misalignment of the vertebrae
Ankylosis
Stiffness of a joint d/t abnormal adhesion and rigidity.
