Hip&knee

Question 1

Apparent leg length

Answer 1

Supine, measure umbilicus to medial malleolus
Looking for spinal or pelvic subluxation
Look for difference grater than 6mm
(This test adds L3-5 discs)

Question 2

Alli’s sign (Galeazzi’s sign)

Answer 2

Supine, feet flat on table.
Doctor stands at foot of table and looks for difference in knee height. Then stand at side of table to look for difference in knee placement.
Looking for ipsilateral femoral leg discrepancy
(Protrusion acetabuli, hip dislocation, hip fracture)

Question 3

Anvil test

Answer 3

Supine, doc lifts straight leg and hits the heel with docs fist
Looking for pain from heel to acetabulum.
Heel pain: calcareous
Hip pain: arthritis, fracture, infection

Question 4

Gauvain’s sign

Answer 4

Affected side up, doc places sup hand on abdominal muscles, inf hand grabs just above ankle. Abduct leg, internally/externally rotate thigh.
Looking for AVN, infection, fracture, gout
Findings: ipsilateral contraction of abs, pain in hip, referred pain to groin or ant thigh

Question 5

Hip telescoping test

Answer 5

Supine, doc passively flex hip and knee to 90*. Grasp hip joint with one hand and around knee joint with inf hand/arm. Doc then compress and distracts femur from table
Looking for hip dislocation/ hip dysplasia

Question 6

Patrick’s test

Answer 6

Supine, doc stands on unaffected side, ask patient to make 4 with legs (bend affected side), doc stabilizes ASIS on good side and applies downward pressure on affected side knee.
Looking for hip pathology: DJD, OA, RA, SCFE, AVN, Fracture, sprain/strain

Question 7

Obers test

Answer 7

Affected side up, doc behind stabilize pelvis, abduct and extend leg at thigh, with knee bent, slide hand from knee to ankle keeping knee bent to allow the leg to adduct.
Look for: thigh remains abducted, drops with spastic jerk, iliotibial contraction, pain

Question 8

Thomas test

Answer 8

Supine, actively pull unaffected knee to chest while keeping other straight on table.
Looking for flexion or shortening of iliopsoas on affected side.
Lumbar spine maintains lordosis or can’t keep leg flag on table

Question 9

Trendelenburg’s test

Answer 9

Stand on affected foot, raise other off the ground. Doc looks for pelvic unleveling from behind.
Looking for paralysis or weakness of hip abductors on affected side or hip dysplasia

Question 10

Abduction Valgus stress test

Answer 10

Supine, doc stabilizes ankle, pushes Lat to med at the knee

Looking for MCL strain or rupture

Question 11

Apley’s compression test

Answer 11

Prone, knee bent to 90*, doc press down on foot and med/Lat rotate foot
Looking for meniscus tears
Internal rotation: lateral meniscus
External rotation: medial meniscus

Question 12

Patella Ballottement test

Answer 12

Supine, doc presses on patella moving it side to side looking for boggy sensation
Looking for retro patellar effusion or intraarticular knee swelling

Question 13

Bounce home test

Answer 13

Supine, doc lifts leg and bends knee 20*, then allows knee to drop into full extension
Looking for meniscal tear
May be unable to fully extend knee

Question 14

Clark’s sign

Answer 14

Supine, doc places S-I pressure on patella, ask patient to flex quads
Looking for chondromalacia patella or degeneration of joint

Question 15

McMurray sign

Answer 15

Look in book

Question 16

Lateral pivot shift maneuver

Answer 16

Supine, doc applies internal rotation and Valgus stress while flexing knee
Looking for ACL tear
Feels like knee is going to pop or give out

Question 17

Lachman test

Answer 17

Supine, knee flexed 25-30*, doc holds femur down and lifts tibia up (like drawer test).
Looking for strain/rupture of ACL

Question 18

Actual leg length

Answer 18

Supine, measure from ASIS to medial malleolus
Looking for a hip joint to long bond deficiency
Look for a difference greater than 6mm