Hip and Knee Exam Flashcards
What are common symptoms of hip and knee complaints?
Pain
Instability
Swelling
Locking
What needs to be inspected on the knee?
Integrity of skin Color Effusion Prior surgery What is the resting knee position Muscular atrophy Patella Position Deformity?
Define genu valgum
Knock kneed
Define genu varum
bow legged
Define genu recurvatum
“hyperextended” knee due to curvature of the bones
Define patella alta
patella is resting more above the femur
Define patella baja
patella is resting more above the tibia
What areas need to be palpated on the knee?
Patella and patellar tendon Quad insertion on superior patella Tibial tuberosity (Osgood-Schlatter’s, bursitis) Peri-patellar structures (medial/lateral condyle of distal femur) Joint line (meniscus tear) Pes Anserine bursa IT Band Effusion
What ROM needs to be assessed on knee exams?
Flexion: 140-145 degrees
Extension: 0-10 degrees of hyperextension
Check for pain on ROM and/or crepitation
What strength needs to be assessed on knee exams?
Hamstring
Quads
1) can they initiate and perform extension
2) can they maintain extension against resistance
What does the apprehension test assess?
Evaluates for patella subluxation
How is the apprehension test performed?
Apply pressure to medial patella and push lateral
Positive test is painful over medial aspect of knee
What does an increased Q angle indicate?
An increased Q angle is an indicator for patellar subluxation as well as PFS (patellofemoral syndrome)
What is a normal Q angle for males and females?
Nl is 14 for males
Nl is 17 for females
Common in female adolescents
What does the patellar grind test assess?
chondromalacia patella
What is a positive patellar grind test?
pain at patella when pt contracts quad muscle as the examiner grasps superior aspect of patella w/ thumb and index finger
What does the Lachman’s test assess?
Anterior Cruciate Ligament
How is Lachman’s test performed?
One hand distal femur Stabilize femur Other on proximal tibia Distract proximal tibia Anterior/posterior
What is a positive Lachman’s test?
+ test = laxity
Always COMPARE sides!
What does the Anterior drawer test assess?
ACL
How is the anterior drawer test performed?
Knee flexed to 80 degree
Foot stabilized
Grip proximal tibia
Anterior force to/fro
What is a positive anterior drawer test?
+ test laxity
What does the pivot shift test assess?
Integrity of the ACL
What does the posterior drawer test assess?
PCL
How is the posterior drawer test performed?
Knee flexed to 80 degree
Foot stabilized
Grip proximal tibia
Apply sudden firm push back
What is a positive posterior drawer test?
Positive test laxity
What does the posterior sag test assess?
PCL
What does the varus test assess?
LCL stability
What does the valgus test assess?
MCL stability
How is the varus tests performed?
Perform in full extension AND at 30 degree
Stabilize lower thigh with one hand
Apply laterally directed stress at knee/ankle
What is a positive varus/valgus test?
Positive test: laxity
How is the valgus test performed?
Perform in full extension AND at 30 degree
Stabilize lower thigh with one hand
Apply medially directed stress at knee/ankle
What does McMurray’s test evaluate?
Meniscus
How is McMurray’s test performed?
One hand holds heel, the other holds knee
Make a ‘C’ with your hand
Put thumb over posterior aspect of knee
Middle finger over anterior joint line
Alternate Varus and Valgus stress while ranging knee to hyperflexed position
What is a positive McMurray’s test?
Positive test is joint line pain and click heard or felt during maneuver
What are the etiologies of patellar dislocation?
Traumatic vs atraumatic
Sudden pop
Pain and inability to bear weight
What are the exam findings for patellar dislocation?
knee flexed
Effusion
Tenderness along medial patella
Positive apprehension sign
What are the etiologies of patellar tendonitis?
Over use activity
Pain inferior pole of patellar
What are the exam findings for patellar tendonitis?
No effusion
+/- Crepitus
Tight quads
How is the meniscus injured?
Vulnerable to twist & compression Trivial trauma (degenerative)
What is the common history with a torn meniscus?
+/- trauma
Problems with ambulating stairs or squatting or changing directions
What are the sxs asst. with a torn meniscus?
Joint line tenderness (sharp pain) Effusion Instability Lack of extension … knee could be locked Pain with flexion and squat
What is one of the most common knee injuries? Who is more likely? What is the etiology?
ligaments
Gender difference in injury rates F>M
Noncontact
Contact
When does an ACL injury occur?
the bones of the leg twist in opposite directions under full body weight
What are the sxs of acl injuries?
“Popping” sound at the time of injury
Rapid Swelling
Pain
Instability – “knee goes out on me”
What are acl injuries asst. with?
Associated with meniscus tear, bone bruise and a quicker onset of osteoarthritis
What is the function of the PCL?
Primary stabilizer of the knee
How is the pcl injured?
Fall on a bent knee
MVA – Dashboard injury
What are the sxs of pcl injuries?
Mild to Moderate Pain in the back of the knee
Swelling
Knee Instability – may more easily hyperextend
What collateral ligament tears are more common?
MCL more than LCL
What is the etiology of collateral ligament tears?
Direct Blow
When the lower leg is forced sideways, either toward the other knee or away from the other knee
How are collateral ligament tears graded?
I-III
What are the sxs of collateral ligament injuries?
Pain over the ligament
Swelling
Decreased ROM
Instability
What is the most common type of arthritis?
Most common type of arthritis
Affects over 10 million Americans
Define OA
Chronic condition characterized by degeneration of cartilage at joint
What are the risk factors for OA?
Age Obesity Injury or Overuse Genetics Muscle Weakness Other Diseases
What are the sxs of OA?
Pain when moving the knee
Joint stiffness
Grinding or catching when moving the knee
Pain when walking up and down stairs or getting up from a chair
Weakened large thigh muscles
Deterioration of alignment, posture and walking due to pain and stiffness.
What are the common symptoms of a hip pt?
Pain
Stiffness
What needs to inspected in a hip exam?
With patient standing
Inspect from the front and from behind for any pelvic tilting or rotational deformity
Note any abnormalities of bony or soft tissue contours
Observe the contour of the buttock for any abnormality (gluteus maximus atrophy or atonia)
Examine Gait
Note antalgic gait (to avoid pain, time spent on injured limb during stand phase is minimized)
What needs to be palpated in a hip exam?
Greater Trochanter Pubic rami Ischial Tuberosity IT band ASIS bilaterally
What ROM needs to be assessed for a hip exam?
Flexion/Extension ( 110-120 ) ( 10-15 )
Internal/External rotation (30-40) ( 40-60 )
Abduction/Adduction ( >45 ) ( 30)
Numbers are generalized for healthy adults
What strength needs to be assessed for a hip exam?
Flexor Strength
Extensor Strength
Adductor Strength
Abductor Strength
What is acceptable leg length discrepancy? How is it measured?
Measure each leg from anterior superior iliac spine (ASIS) to the medial malleolus
Acceptable leg length discrepancy: +/- 1 cm
What is the trendelenberg test used for? How is it performed?
Checks for hip abductor strength/superior gluteal nerve innervation
Pt stands on one leg, flexes hip of other leg
What is a positive trendelenberg test?
Pelvis drops toward unaffected side
Walking limp noted on affected side
What does Patrick’s (FABER) test assess?
Flexion, Abdcution, ER of hip
When is a Patrick’s test positive? What does it indicate?
Test is positive when the tested leg remains above the opposite leg
Positive test indicates an affected hip or sacroiliac joint, or that iliopsoas spasms exist
Pain = early OA
When is a Patrick’ test negative?
Test is negative when test leg is at least parallel with the opposite leg
What is Thomas test used for?
Hip flexion contracture
What is a positive test, and what does it suggest?
Elevation of the opposite thigh suggests a loss of extension in that hip and a fixed flexion deformity
What are the etiologies of hip injuries?
Trauma
Inflammatory
Congenital
Degenerative
What are the sxs for arthritis?
pain an decreased mobility
What are the tests for arthritis?
No blood test
AP Pelvis x-ray
What is the tx for arthritis?
NSAID’s, pain meds mainstay of treatment
Mod-severe OA THA
What are etiologies of hip OA?
Gradual onset
Wear and tear
Congenital deformity
Trauma
What are the sxs fo hip oa?
Groin pain
Stiffness
What are the etiologies of hip fx?
Typcially secondary to fall in an elderly pt
Trauma from MVA or fall from a height
What are the sxs of hip fx?
Groin pain
Pain with ROM
LE shortening
LE externally rotated
What is the tx for hip fx?
Surgery
What test can be used in a hip fx?
checking IR and ER
elicits severe pain in hip fracture patient
What are the etiologies of hip dislocation?
Secondary to trauma ex: MVA
May occur in pts with Hip replacement
What is a sequlae of hip fx?
avascular necrosis
What are the sxs of hip dislocation?
Severe pain
LE shortening
Internal rotation
How is hip dislocation tx?
Often reducible without Sx
What is traochanteric bursitis? Who is it more common in?
tenderness directly over the greater trochanter
F>M
How is trochanteric bursitis treated?
ITB stretching/PT/
NSAID’s
if no response, cortisone injection
What is snapping hip syndrome?
Snapping Hip Syndrome (sometimes called dancer’s hip)
May feel like hip is unstable and may give out
May cause pain and interfere with performance of athletes
Usually an annoyance
What are the sxs of meralgia paresthetica?
Tingling, numbness and burning pain outer thigh
What is meralgia paresthetica?
damage to the lateral femoral cutaneous nerve
What are the etiologies meralgia paresthetica? how is it treated?
Tight clothing, obesity, wt gain, pregnancy
Conservative tx
