Hip and Knee Q and A's Gindl Flashcards
Positive Fabere Patricks Test
-What does it indicate?
Acetabular hip pain, and or lack of motion
-Indicates hip joint pathology
What is part 3 of Fabere Patrick’s Test?
Dr. stabilizes the opposite ASIS and presses down on the femur to bring the hip into extension
What is the most common hip pathology in the elderly?
DJD causing arthritic pain
What are the 2 most common hip joint pathologies in the very young?
Legg-Calve-Perthes Disease
Slipped Capital Femoral Epiphysis
What is the most common cause of hip pain?
Subluxation
Positive Hibb’s Test
-What does it indicate?
Pain upon internal rotation at the hip
-Hip joint pathology
Positive Thomas Test
-What does it indicate?
Elevation of the straight leg (hip flexion on the side of the straight leg)
-Contracture of the hip flexors
A positive Thomas Test most commonly involves contracture of what hip flexor?
Iliopsoas
Positive Trendelenberg Test
-What does it indicate?
Weakness on the standing leg side (gluteus medius) while the raised leg side drops forward and down
-Deterioration/weakness of the pelvic stabilizer muscles (extensors or abductors)
How to check for fluid motion of the hip
Perform part 1 of Fabere Patricks Test. With the knee bent and the hip flexed press the femur in to the acetabulum. Feel for spinginess (end fell with bounce) vs. a hard end feel with the loss of motion.
Indications that Hip Traction is needed?
Loss of motion with Hibb’s or Fabere Patrick’s Tests or hip telescoping; Sharp or dull pain at the hip
Osteoarthritis
What is the most important thing about setting your contact for Hip Traction?
Triple Flexion (hip, knee, and pelvis each flexed to 90 degrees) is performed in order to place the Dr’s forearm under the ischial tuberosity. Dr. will stand opposite and inferior while reaching with the superior arm to place the posterior aspect of the forearm under the ischial tuberosity. The fingers of the Dr’s contact hand reach laterally, out from under the patient’s pelvis.
How to carefully keep your forearm away from the patient’s privates or pubis during hip traction?
Explain what you are about to do before you do it! Make sure that the doctor stance is inferior and that triple flexion is used to place the contact point under the ischial tuberosity. The Dr’s contact arm is at an oblique I-S angle with the fingers pointed laterally out from under the pelvis.
What do you do after setting your contact point for hip traction?
Bring the foot and leg down at an oblique angle until the thigh is tight against your forearm
How do you know that the hip joint is tractioning open during hip traction?
Two possibilities:
1) Visualize the hip joint
2) Dr places their forearm along the patient’s femur with the fingers palpating over the greater trochanter. The Dr’s elbow will squeeze the lateral aspect of the femur medially to open up the hip joint whoch the fingers should be able to feel
What is the most common tear of the knee ligaments?
1st = medial menisci
2nd = MCL
3rd = ACL
Positive anterior drawer sign
-What does it indicate?
Excessive motion P-A or increase in pain
-ACL tear
How do you stabilize for Anterior Drawer Sign?
Stabilize the patient’s anterior foot with your posterior thigh while the patient’s knee is flexed
Loss of motion on the Anterior Draw Sign indicates what knee subluxation?
Tibia P
What test would you run if you suspected a false negative on anterior draw sign?
Lachman’s
What test would you run after Anterior Draw Sign to verify a ACL damage and laxity?
Lachman’s
Positive Posterior Draw Sign
-What does it indicate?
Excessive motion A-P or increase in pain
-PCL tear. Not as common as ACL tear. Can perform Sag Sign to double check.
Positive Lachman’s Test
-What does it indicate?
Excessive motion P-A or increase in pain
-ACL tear
What is the orthopedic test of choice for the ACL?
Lachman’s
Why is Lachman’s preferred over anterior draw sign for ACL testing?
The greater angle of flexion (>90 degrees) does not stretch the quadriceps as much, and the condyles are not as deeply seated into the menisci
Positive Sag Sign
-What does it indicate?
The tibia sags posterior in relationship to the femur
-PCL tear
When should Sag Sign be performed?
Whenever you have a positive Anterior Draw Sign. If the PCL is torn and the tibia sags posterior it will appear and feel like it moves excessively P-A due to the laxity
Positive Apley’s Distraction
-What does it indicate?
Pain upon distraction
-Collateral ligament damage on the side of pain
What if pain decreases on Apley’s distraction what test would you run?
Apley’s compression suspecting a meniscal tear
Is Apley’s Distraction a subjective or objective test?
Subjective
Positive Valgus Stress test
-What does it indicate?
Increased pain and or excessive movement at the medial joint space (pushing from lateral to medial)
-Indicates MCL tear
What other test could you run to verify a positive Valgus stress test?
Apley’s Distraction with pain on the medial side
Is it normal to have a little bit of movement during Valgus stress test?
Yes. If there is no motion think Tibia AM, if there is excessive motion think MCL tear
What would be indicated if the pain was exacerbated during the Valgus stress test?
A partial MCL tear
What would be indicated if the pain remained the same during the valgus stress test?
A complete tear of the MCL
What other ligaments might be torn if the MCL is torn?
The medial meniscus and maybe the ACL
What would be indicated if there was no motion on the valgus stress test?
May be due to the tibia having rotated anterior on the medial side. This would pull the medial ligaments tight that attach to the femur. Thus restricting motion from lateral to medial
Positive Varus Stress Test
-What does it indicate?
Increased pain and or excessive movement at the lateral joint space
-LCL tear
Should you compare varus to valgus stress on the same knee?
NO! The two don’t always have the same laxity. Compare right knee varus to left knee varus and right knee valgus to left knee valgus.
What would be indicated if there was no motion on the Varus Stress test?
May be Tibia AL. This would pull the lateral ligaments tight that attach to the femur. Thus restricting motion from medial to lateral
What other test would you rin to verify a positive varus stress test?
Apley’s Distraction for the LCL damage
Positive Apley’s Compression
-What does it indicate?
Pain upon compression
-Meniscal damage on the side of pain
What if pain decreases on Apley’s Compression what test would you run?
Apley’s Distraction suspecting a collateral ligament tear
What test would you perform to verify pain on the medial side with Apley’s Compression?
McMurray’s Test