Hip/Knee/Ankle SPE Flashcards
1
Q
What are some of the structures you can observe and palpate on the hip joint?
A
ASIS Iliac crest Greater trochanter Pubic tubercles PSIS Ischial tuberosity Sacroiliac joint Inguinal ligament Femoral artery Sartorius m. Adductor longus m. Sciatic n.
2
Q
Action of iliopsoas m.
A
Hip flexor
3
Q
Action of sartorius m.
A
Hip flexor (also abduction and external rotation)
4
Q
Action of rectus femoris m.
A
Hip flexor
5
Q
Action of adductor longus m.
A
Hip adductor
6
Q
Action of gluteus medius m.
A
Hip abductor (and external rotation)
7
Q
Action of gluteus maximus m.
A
Hip extensor (also abduction and external rotation)
8
Q
Action of hamstrings mm.
A
Hip extensors (biceps femoris m., semitendinosus m., semimembranosus m.)
9
Q
Action of tensor fascia lata m.
A
Hip flexor (and abduction)
10
Q
Normal ROM for hip flexion
A
90 degrees with knee extended, 120-135 degrees with knee flexed
11
Q
Normal ROM for hip extension
A
15-30
12
Q
Normal ROM for abduction of the hip
A
45-50 with knee extended
13
Q
Normal ROM for adduction of the hip
A
20-30
14
Q
Normal ROM for internal rotation of the hip
A
30-40
15
Q
Normal ROM for external rotation of the hip
A
40-60
16
Q
When performing strength testing on the hip, what are 5 possible muscles you can test?
A
Iliopsoas m.
Gluteus maximus m.
Gluteus medius m. + gluteus minimis m.
Adductor longus m.
17
Q
Which muscle would you strength test for hip flexion?
A
Iliopsoas m.
Femoral n. L2-L4 + ventral rami of L1-L2
18
Q
Which muscle would you strength test for hip extension?
A
Gluteus maximus m.
Inferior gluteal n. L5, S1-S2
19
Q
What muscle would you strength test for abduction of the hip?
A
Gluteus medius and minimis mm.
Superior gluteal n. L5, S1
20
Q
Which muscle would you strength test for hip adduction?
A
Adductor longus m.
Obturator n. L2-4
21
Q
What are the 5 grades on the strength testing scale?
A
0/5 = no contraction detected
1/5 = barely detectable trace of contraction
2/5 = active movement w/o gravity
3/5 = active movevment against gravity
4/5 = active movement + gravity + resistance
5/5 = active movement + full resistance w/o fatigue
22
Q
What is “normal” on the strength grading scale?
A
+5/5 = active movement against full resistance without evidence of fatigue
23
Q
What dermatomes and nerves are you checking with sensation testing in the hip region?
A
Dermatomes L1-3
Nerves:
Anterior femoral cutaneous n.
Lateral femoral cutaneous n.
Posterior femoral cutaneous n.
24
Q
What are the central compartmental structures in the hip?
A
Labrum
Ligamentum teres
Articular surfaces
25
What are the peripheral compartmental structures of the hip joint?
Femoral neck
| Synovial lining
26
What are the lateral compartmental structures of the hip joint?
```
Gluteus medius
Gluteus minimis
Piriformis
IT band
Trochanteric bursae
```
27
What are the anterior/iliopsoas compartmental structures of the hip joint?
Iliopsoas insertion
| Iliopsoas bursae
28
What is the log roll orthopedic test for the hip and what is a positive result?
Nonspecific to central and peripheral compartments
Roll patient's leg into internal and external rotation
Postive test = pain --> central or peripheral compartment pathology
29
What is the classic sign that someone has a hip injury in the central compartment? What does this typically indicate?
C-sign; patient characteristically points to source of pain by cupping just above the trochanter with thumb and index finger
Indicates labral pathology
30
Explain the test, a positive result, and what this indicates:
Labral loading (hip)
Flex patient's knee and hip to 90 degrees, load into the femur towards the innominate
+ test = pain --> labral or cartilaginous pathology
31
Explain the test, a positive result, and what this indicates:
Labral distraction (hip)
Distract patient's femur away from innominate
+ test = improvement of pain --> labral or cartilaginous pathology
32
Explain the test, a positive result, and what this indicates:
Scour (hip)
Flex and externally rotate patient's hip. Load into socket and articulate through annular ROM
+ test = pain --> labral or articular cartilage pathology
33
Explain the test, a positive result, and what this indicates:
Apprehension: Faber (hip)
Patient's hip is flexed, abducted, and externally rotated; physician induces further external rotation by applying posterior force at the knee
+ test = anterior subluxation of hip or apprehension/pain --> labral pathology or impingement
34
Explain the test, a positive result, and what this indicates:
Ely's test (hip)
Patient prone; passively flex patient's knees
+ test = ipsilateral hip raises off table --> rectus femoris contracture
35
Explain the test, a positive result, and what this indicates:
Rectus femoris test (hip)
Patient supine. One hip flexed up to the chest, other leg bent over edge of table
+ test = knee flexion less than 90 degrees --> rectus femoris contraction ipsilaterally
36
Explain the test, a positive result, and what this indicates:
Jump sign (hip)
Patient is seated, pressure is applied to greater trochanter
+ test = patient withdraws with pressure --> trochanteric bursitis
37
Explain the test, a positive result, and what this indicates:
Straight leg raise (hip)
Raise the leg with knee extended, nonspecific test
+ test = lateral pain with less than 15 degree extension --> lateral compartment pathology
38
Explain the test, a positive result, and what this indicates:
Ober's test (hip)
Patient lateral recumbent with physician standing behind patient; physician abducts the top leg and then lowers leg to the table while stabilizing hip
+ test = inability to adduct --> IT band contracture
39
Explain the test, a positive result, and what this indicates:
Piriformis test (hip)
Patient supine with hip andknee flexed, one ankle crossed over contralateral knee; patient abducts against resistance
+ test = pain over posterior aspect of greater trochanter --> piriformis spasm/pathology
40
Explain the test, a positive result, and what this indicates:
Trendelenburg (hip)
Patient standing with physician behind; patient lifts one foot off ground
+ test = weakness; inability to hold hips level --> contralateral gluteus medius weakness (superior gluteal n.)
Example: patient lifts right foot, right hip drops = left gluteus medius/superior gluteal n. Pathology
41
Explain the test, a positive result, and what this indicates:
Patricks: FABER (hip)
Patient is flexed, abducted, and externally rotated. With physician bracing contralateral ASIS, patient externally rotates and abducts against resistance, then patient internally rotates/adducts against resistance
+ test = pain or weakness --> gluteus medius or iliopsoas path
42
Explain the test, a positive result, and what this indicates:
Psoas test (hip)
Flex hip to 30 degrees while pt further flexes against resistance
+ test = pain/inability/snapping --> psoas contracture/path
43
Explain the test, a positive result, and what this indicates:
Thomas test
Patient supine and pulls knees to chest; one leg is lowered to the table to test flexibility of hip flexors
+ test = inability to fully extend/extended leg raises off table --> hip flexor contraction
44
If a patient presents with pain in the central or peripheral compartments and you want to perform a NONSPECIFIC orthopedic test to determine if this is the case, what simple test might you do?
Log roll
45
If a patient presents with a positive C-sign, they likely suffer from a pathology of the central compartment. What other tests on the central compartment might you perform?
Labral loading
Labral distraction
Scour
Apprehension: FABER
46
If a patient presents with pain near the femoral neck or synovial lining of the hip joint, what special orthopedic tests might you perform?
Ely's test
Rectus femoris test
[these are peripheral compartment complaints]
47
If a patient presents complaining of injury or pain to the gluteus medius, gluteus minimis, piriformis, IT band, or trochanteric bursae, what special orthopedic tests might you perform?
These are lateral compartment structures, so:
```
Jump sign (trochanteric bursitis)
Straight leg raise
Ober's test (IT band contracture)
Piriformis test
Trendelenburg sign (superior gluteal n. path)
Patrick's FABER
```
48
If a patient presents with complaints concerning the anterior compartment structures of the hip, including the iliopsoas, what special orthopedic tests might you perform?
Patrick's FABER (have patient internally rotate and adduct against resistance)
Psoas test
Thomas test
49
If a patient presents with complaints of medial or lateral knee pain and/or instability and you suspect MCL or LCL injury, what orthopedic tests might you perform?
Valgus/Varus stress tests
50
Explain the test, a positive result, and what this indicates:
Valgus stress test (knee)
Patient supine and examiner supports the patient's lower leg, with the knee flexed to 30 degrees. Examiner's hands are placed on medial and lateral aspects of knee. While providing lateral resistance to knee, move lower leg so that ankle shifts laterally while holding the distal femur in place. Assess for laxity, quality of end point, and pain.
+ test = increased laxity, soft or absent endpoint, and pain --> MCL disruption (or joint capsule injury if positive at 0 degrees)
51
Explain the test, a positive result, and what this indicates:
Varus stress test (knee)
Examiner and patient in same position as the valgus stress test. While providing medial resistance, examiner moves lower leg so that the ankle shifts medially. This test is done at 30 degrees of flexion
+ test = increased laxity, soft or absent endpoint, pain --> LCL disruption (or joint capsule injury if positive at 0 degrees)
52
What are some anatomical structures that you might examine in your observation/palpation of someone's knee?
```
Medial tibial plateau
Medial femoral condyle
Lateral tibial plateau
Lateral femoral condyle
Medial/lateral joint lines
Medial meniscus
Medial collateral ligament region
Lateral meniscus
Lateral collateral ligament
Head of fibula
Patella
Popliteal fossa
Quadriceps
Infrapatellar tendon
Sartorius, gracilis, semitendinosus tendons
Anserine bursa
Prepatellar bursa
```
53
What are 3 abnormal postures you might observe in your examination of someone's knees?
Genu valgum = knock-kneed
Genu varus = bow-legged
Genu recurvatum = knee hyperextension
54
What types of strength testing might you perform on a knee exam?
Flexion = hamstrings
Extension = quadriceps
Internal/external rotation = accessory motion of tibia/fibula as it articulates with femur
55
What is normal ROM for knee flexion?
145-150
56
What is normal ROM for knee extension?
0
57
What is normal ROM for knee internal/external rotation?
10
58
What dermatomes are associated with sensation testing of the knee?
L3-5
S1
S2
59
What spinal cord region is the patellar reflex primarily associated with?
L4
60
If a patient presented with knee pain and you wanted to test the anterior stability of the joint, what tests might you perform?
Anterior drawer test
| Lachman's test
61
What is a positive result of the anterior drawer test of the knee and what does this indicate?
Excessive translation when compared to other knee (Remember to test bilaterally!)
Indicates ACL insufficiency
62
Explain the test, a positive result, and what this indicates:
Lachman's test
Patient supine. Examiner places cephalad hand on distal thigh, superior to patella. Caudad hand grasps the proximal tibia. Flexing the knee to 15-30 degrees, the examiner uses caudad hand to pull tibia anteriorly while cephalad hand stabilizes the thigh
Positive test: increased laxity, soft or absent endpoint
Indicates: ACL Insufficiency
63
If a patient presented with knee pain and you wanted to test the posterior stability of the joint, what tests might you perform?
Posterior drawer test
| Reverse Lachman's test
64
If a patient presented with knee pain and you were suspicious of an injury to the meniscus, what tests might you perform?
McMurray's test
Apley's Grind Test-Compression
Apley's Grind Test-Distraction
65
Explain the test, a positive result, and what this indicates:
McMurray's test (knee)
Patient supine with hip and knee flexed. Examiner uses caudad hand to control ankle and cephalad hand on distal femur. Examiner rotates tibia into internal rotation and applies varus stress, then continues leg into extension. Examiner then rotates tibia into external rotation and applies valgus stress, then continues leg into extension.
+ test = pain or clicking during extension --> medial or lateral meniscus tear
66
Explain the test, a positive result, and what this indicates:
Apley's grind test - compression (knee)
Patient prone with knee flexed to 90 degrees. Examiner uses downward force on foot to provide a compressive force on meniscus, while rotating the foot internally and externally
+ = pain with rotation and/or compression --> meniscal injury, possible collateral ligament injury, or both
67
Explain the test, a positive result, and what this indicates:
Apley's grind test - distraction
Patient in same positioin as for compression. Examiner stabilizes thigh, then applies upward traction to leg while rotating it (traction reduces meniscal presure but increases ligamentous strain)
+ = pain with distraction and rotation
Indicates: possible collateral ligament damage
68
What tests might you perform on a patient that you suspect might have damage to a patellar ligament?
How are these tests done?
Patellar laxity and apprehension tests
Laxity: push patella laterally, assessing ROM
Apprehension: pain/discomfort/sense of instability with laxity test
69
What are 3 tests that can be done to assess patellar cartilage?
Patellar compression (grind) test (apply compressive load to patella while moving it medial/lateral, + test is pain --> chondromalacea)
Patella-femoral grinding (compression on patella + quadriceps activation, +test = crepitus or pain --> chondromalacea)
Patellar glide test (patient flexes/extends while physician feels for crepitus, + = crepitus, pain, catching --> damage to articular surface)
70
List all possible special orthopedic knee exams
```
Valgus/varus stress
Anterior drawer
Lachmans
Posterior drawer
Reverse lachmans
McMurrays
Apleys grind (compression+distraction)
Patellar laxity and apprehension testing
Patellar compression
Patella-femoral grinding
Patellar glide test
```
71
What are some general observations you might make while examining an ankle?
Asymmetry, varus/valgus posture, hyperpronation/supination
Skin changes
72
What are the components of the medial longitudinal arch of the foot?
Navicular
Cuneiforms 1-3
Talus
Metatarsals 1-3
73
What ligament is considered the primary stabilizer of the medial ankle?
Deltoid ligament
74
What are the key lateral landmarks of the ankle?
```
Lateral malleolus
Calcaneus
Cuboid
Metatarsals 4-5
Anterior talofibular ligament
Calcaneofibular ligament
Posterior talofibular ligament
```
75
What are the components of the lateral longitudinal arch of the foot?
Calcaneus
Cuboid
Metatarsals 4-5
76
What 3 ligaments are the primary stabilizers of the lateral ankle?
Anterior talofibular ligament
Calcaneofibular ligament
Posterior talofibular ligament
77
What are some circulation and sensation tests you can do on an ankle/foot exam?
Cap refill (want less than 3 sec)
Posterior tibial a. pulse
Dorsalis pedis pulse
Monofilament testing (diabetics)
Dermatome testing (L4, L5, S1)
78
Normal ROM for dorsiflexion of foot/ankle
15-20
79
Normal ROM for plantar flexion of foot/ankle
55-65
80
Normal ROM for subtalar inversion of foot
20
81
Normal ROM for subtalar eversion of foot
10-20
82
Normal ROM for pronation of foot
5
[this is combo of dorsiflexion, abduction, and eversion]
83
Normal ROM for supination of foot
20
[this is combo of plantarflexion, adduction, and inversion]
84
What muscles are the dorsiflexors of the ankle that you are evaluating during orthopedic strength testing?
```
Tibialis anterior (primary)
Extensor hallucis longus
Extensor digitorum longus
```
85
What are the plantar flexors of the foot that you are evaluating during orthopedic strength testing?
Gastroc/soleus (primary)
Peroneus longus/brevis
Flexor digitorum longus
Tibialis posterior
86
How would you utilize reflex testing in a patient presenting with ankle/foot complaints?
Achilles reflex testing!
Dorsiflex the ankle, strike the achilles tendon, watch for plantar flexion of ankle
87
What are all the orthopedic tests utilized for ankle/foot complaints?
```
Anterior drawer test
Talar tilt test
Eversion test
Squeeze test
Cross leg test
Thompson test
```
88
Explain the test, a positive result, and what this indicates:
Anterior drawer test (ankle/foot)
Grasp posterior calcaneus with one hand and distal tibia/fibula with other hand, monitoring anteriorly at anterior talus. Provide anterior force on calcaneus while stabilizing distal tibia/fibula. Normal springing should occur.
+ test = pain, no springing, excess motion/laxity --> ATF ligament pathology (lateral ankle sprain)
89
Explain the test, a positive result, and what this indicates:
Talar tilt test (ankle/foot)
Grasp distal tibia/fibula with one hand and inferior calcaneus with other, blockin motion of calcaneus on talus. Invert the talus to evaluate ROM
+ test = laxity, increased ROM, pain --> calcaneofibular ligament pathology, and some ATF
90
Explain the test, a positive result, and what this indicates:
Eversion test
Evert the foot and evaluate ROM
+ test = laxity, increased ROM, pain --> deltoid ligament pathology (medial ankle sprain)
91
Explain the test, a positive result, and what this indicates:
Squeeze test
Squueze distal tibia/fibula with both thenar eminences for 2-3 seconds, then rapidly release
+ = pain at syndesmosis --> high ankle sprain
92
Explain the test, a positive result, and what this indicates:
Cross leg test (ankle/foot)
Patient crosses affected ankle over opposite knee. Apply pressure to proximal fibula of affected leg
+ = pain at distal ankle --> syndesmosis pathology (high ankle sprain)
93
Explain the test, a positive result, and what this indicates:
Thompson test
Patient prone with foot off table. Squeeze the calf and watch for plantar flexion
+ = no plantar flexion --> achilles tendon rupture
