Final Practical Flashcards
McMurrary Test
for meniscus tears
knee is passively flexed, ER< and axially loaded while brought into extension. Repeat in IR
Positive if palpable/audible click or pain
high spin, mod snout
Pivot Shift Test
for the ACL
patient is supine, examiner grasps at heel and passively flexes the hip to 45° keeping knee extended
examiner applies a valgus stress while IR the tibia. Knee is brought slowly into 30° flexion
positive = tibia jumps posteriorly, clunk
high spin, low snout
Reverse Pivot Shift Test
assess PLC
knee at 90°, rotates tibia in ER. apply valgus foce at proximal lateral tibia. Knee is extended
positive = visible or palpatory reduction would occur
high spin, low snout
Slocum Test
testing rotary instability
foot/tibia is placed in 30°of IR. Stabilize foot with your thigh and draw tibia forward. then foot is placed in 15° ER and drawn forward.
Positive Test for Slocum
- Placement in medial rotation = positive movement occurs on lateral side of knee
- Placement in lateral rotation = positive movement occurs on medial side
Structures tested in Slocum with foot in IR
ACL
posterolateral capsule
LCL
IT band
arcuate-popliteus complex
Structures tested in Slocum with foot in ER
MCL
posterior oblique ligament
posteromedial capsule
ACL
Moving Patellar Apprehension Test
patient is supine with ankle off exam table and knee fully extended. Examiner flexes the knee to 90° and back to extension while holding patella in lateral translation.
positive = patient exhibits apprehension during lateral glide and no apprehension during medial glide
high spin and snout
Thompson Test
patient is prone with lower leg off table. Examiner squeezes calf muscle and observes ankle motion
positive = lack of PF
high spin and snout
Talar Swing Test
Pt seated, legs over end of plinth
thumbs on neck of talus. guide knee into flexion which df ankle thumbs track talus posteriorly into mortise and foot should evert allow for full closed pack position
Treatment with Talar Swing Test
increase df and ER for fully closed pack position
Glide to point of resistance, than provide HR technique.
Ask pt to resist you as your provide pf and inversion. Hold 10 s. Relax, glide talus more post and lateral while DF ankle, repeat 3 times. Can do 3 sets of the program
Windlass Test for PF
NWB, knee flexed to 90°. Sitting is the best
ankle at 90°/neutral
extend 1st MTP while keeping IP in flexion to avoid motion limitation from short hallucis longus. Palpate plantar fascia
high spin, low snout
External Rotation Stress Test
pain over syndesmosis is elicited with ER and df of the foot with knee flexed to 90°
high spin
Oblique Midtarsal Joint Axis
stabilize neutral calcaneous with inside hand
move foot at distal 5th metatarsals
invert calcenous and then evert. Inversion should have less because it is locking the midtarsal joint
Longitudinal Midtarsal Joint Axis
stabilize calcaenous with outside hand
pivot MTJ by grasping navicular or cuneiform
lock the axis by inverting calcaneous and see if there is still motion
Medial glide of subtalar joint
should do for restricted joint motion ot increase inversion
post: sidelying with foot off end of plinth, rolled towel under table
giving downward force to the calcaneous after it has been placed in neutral
Lateral Glide of subtalar joint
used to increase eversion
sidelying with foot off the end of plinth table. rolled towel under later ankle
mobilizing the calcaneos in a downawrd motion
Anterior glide of talocrural joint
used for restricted joint motion, increases plantar flexion
mobilizing the calcaneous in an upwards direction/anterior force after being placed in motion barrier position
Posterior Glide of talocrural joint
used for restricted joint motion, and to increase DF
applying a towards mobilization to the navicular area of the top of the foot
Paper pull test
testing the strength of the flexor intrinsics of the 1st MTP
could be correlated with low heel rise height and low 1 MTP strength
Strength assessment of Ankle/Foot
PF: heel rise 20 reps, with consistent height. Plantar pressure through 1st met
DF: walk on heels
Subtalar: isolate everters and inverters
Midtarsal: doming
Big Toe: paper pull, toe curl, manual resistance
Functional tests for DF
stairs
squatting
knee to wall (rom)
walk on heels
Subtalar eval
prone, stabilize the tibia, cup the calcaneus and invert/evert
Plantarflexion Functional Tests
Calf raises (20 at least)
Walking at fast pace
Basic Foot Intrinsic
- Toe mobility
- Toe spread out
- Foot core
Toe mobility
- press little toes down and lift big toes up
- press the big toe down and lift little toes up (FL)
- keep big toe down and lift all little toes, bring small toe back down
if having difficulty, can use your hands to hold down. Also pair with mobilizing midfoot and forefoot
Foot doming
keep toes on floor, bring ball of foot towards the heel, making the foot shorter. Hold for 10 s
Errors of Doming
toe flexion
anterior tib over activation
supination
Basic foot intrinsics prescription
perform seated
do 10 of each, then repeat for a total of 5 minutes, 3-5 times a day
Intermediate Foot intrinsics
- Short foot in active standing
- Short foot in SLS
Short foot in active sitting
stand w/toes pointing forward, slightly out and dome feet
unlock the knees and squeeze you butt
tip pelvis to neutral, draw naval towards spine, pull shoulders down, draw chin in
Short foot in single leg
from active standing, pick up one leg while activating arch and doming foot
can progress to weight shifting and mini heel raise
variations: single leg deadlift, unstable surfaces, rotation
Advanced foot intrinsics
- short foot with hopping
- Box jumps
- Lateral/forward bounds
Short foot with hopping
perform a small hop and land back in active standing
perform barefoot, dome your feet, and land in a domed position
Hop laterally
focus on increasing distance, speed, and focus on soft landings with the dome
can change directions or do bilateral to single leg
Box jumps
start with 2-4 in
focus on landing light with dome
progress height of boxes or to jumping down
