Lab Flashcards
Assessment: Trendelenburg’s Sign
Integrity of gluteus medius or unstable hip
Position: Trendelenburg’s Sign
Pt: Standing on one limb, affected sign
PT: Standing behind pt.
Method: Trendelenburg’s Sign
Observe alignment of the contralateral limb with the pelvis
Positive Test: Trendelenburg’s Sign
Pelvis on opposite side drops when the pt. stands on the affected limb
Biomechanics: Trendelenburg’s Sign
Gluteus medius (prime mover) and other hip abductors stabilize the pelvis on the femur
Assessment: Caudal Glide (Hip)
Joint mobility
Position: Caudal Glide (Hip)
Pt: Supin with hip in 30 flexion, 30 ABD, slight ER
PT: Walk-stance at end of table, facing pt., cradle limb in malleoli
Method: Caudal Glide (Hip)
Lean back, apply caudal mobilizing force on LE, gentle, gradual increase amplitude and depth if no pain.
Assess quality of movement and compare bilaterally
Assessment: Inferior Glide (Hip)
Joint mobility
Position: Inferior Glide (Hip)
Pt: Supine, hip and knee flexed to 90 supported by PT shld
PT: Support LE, wrap ulnar borders around proximal thigh
Method: Inferior Glide (Hip)
Apply caudal mobilizing force on proximal femur, gentle, gradual increase amplitude and depth if no pain.
Assess quality of movement and compare bilaterally
Biomechanics: Inferior Glide (Hip)
Increases hip joint space and loosens adhesions in the anterior direction
Assessment: Posterior Glide (Hip)
Flexion and IR
Position: Posterior Glide (Hip)
Pt: Supine with hip in resting position (i.e. 30 flex, 30 ABD, sligh ER)
PT: Mobilizing hand on anterior proximal femur
Method: Posterior Glide (Hip)
Mobilizing force straight down
Posterior glide is necessary for flexion and IR
Assessment: Anterior Glide (Hip)
Extension and ER
Position: Anterior Glide (Hip)
Pt: Side lying, pillow between knees, hip comfortably flexed
PT: Walk-stance perpendicular to side of exam table, palm against posterior lateral trochanter, other hand stabilizes pelvis
Method: Anterior Glide (Hip)
Apply anterior force parallel to joint surfaces, gentle, gradual increase amplitude and depth if no pain.
Assess quality of movement and compare bilaterally
Biomechanics: Anterior Glide (Hip)
Femoral head glides anteriorly during extension and ER
Assessment: Lateral Glide (Hip)
Lateral mobility
Position: Lateral Glide (Hip)
Pt: supine, leg extended, can have hip flexed to 90
PT: Stabilize lateral aspect of distal femur and medial aspect of proximal femur
Method: Lateral Glide (Hip)
Proximal hand applies a lateral force
Assessment: Hamstring Length (SLR)
Length of hamstrings
Position: Hamstring Length (SLR)
Pt: Supine, back neutral, knee extended, hip extended
Method: Hamstring Length (SLR)
PT passively brings leg up into increasing hip flexion
Positive Test: Hamstring Length (SLR)
< 80 of hip flexion indicates tightness in CT of posterior thigh
Assessment: Hip Flexor Length (Thomas Test)
Length of hip flexors
Position: Hip Flexor Length (Thomas Test)
Pt: sitting at EOB with distal legs supported by table (text); Laying with hips at EOB, legs dangling (picture)
PT: Lower pt. to supine while pt. holds knees to chest, Then hold pts. posterior leg with hand and palpate ASIS and PSIS with other hand. Pt will holds contralateral knee to chest
Method: Hip Flexor Length (Thomas Test)
Step 1: Lower leg to table while monitoring lower back
Step 2: If leg does not lower with knee flexed, reattempt with knee straight
Step 3: If leg does not lower with knee straightened, reattempt with knee flexed and abd hip,
Normal response: Hip Flexor Length (Thomas Test)
Leg lowers to table with knee flexed
Positive Test: Hip Flexor Length (Thomas Test)
Does not lower with knee straight = tight iliopsoas
Lowers with knee straight = tight rectus femoris
Lowers with knee flexed and hip abd = tight tensor fascia latae
Biomechanics: Hip Flexor Length (Thomas Test)
Hip flexors under examination are: iliopsoas, rectus femoris, and TFL
Hip should be able to reach neutral with spine flat if all hip flexors normal length
To bias rectus femoris = knee straight
To bias TFL = hip ABD
Assessment: IT band (Modified Ober test)
Length of iliotibial band
Position: IT band (Modified Ober test)
Pt: Side lying with leg on table having knee and hip flexed
PT: Behind pt., stabilize pelvis, and use other hand to support under leg with hand around knee cap
Method: IT band (Modified Ober test)
Bring leg into extension, ER (to prevent IR), then drop leg into adduction
Positive Test: IT band (Modified Ober test)
Leg drops less than 10 degrees from horizontal
Biomechanics: IT band (Modified Ober test)
A tight IT band/TFL will cause hip abduction and IR of the femur
Q: What are the 4 tests for hip muscular length?
- SLR (hamstring)
- Thomas (hip flexor)
- Modified Ober (IT band)
- Hip IR/ER
Q: What are the 6 hip special tests?
- Scour
- Femoral-acetabular impingement test
- FABER
- Piriformis
- Craig’s
- Ely’s
Assessment: Scour Test (flexion and adduction)
Pathology in the articulating surface of the hip joint as with OA, Labral tear, Bursitis
Position: Scour Test
Pt: Supine, hip flexed 90 with knee bent and hip adducted
PT: Standing, facing pt., grasp knee with both hands
Method: Scour Test
Apply an axial load while moving the patient from adduction to abduction
Positive Test: Scour Test
Grinding or snapping
Location should indicate cause
Assessment: FABER
ROM of hip and pain
Position: FABER
Pt: Supine with foot resting on top of the knee of the opposite leg (Hip flexion, ABD, ER)
PT: Standing on side of table one hand on ASIS of contralateral hip and other handon bent knee
Method: FABER
Apply pressure to ABD the hip on the test side and pressure to stabilize the hip on the contralateral hip
Positive Test: FABER
Knee does not lower to the level of the opposite hip
Assessment: Piriformis Test
Piriformis involvement
Position: Piriformis Test
Pt: Sidelying with test hip flexed 60 and knee flexed
PT: Facing pt., one hand stablizing the hip, the other on knee
Method: Piriformis Test
Apply downward force on the knee
Positive Test: Piriformis Test
Sciatica pain or tightness of piriformis
Movement of the hip under PT hand
Assessment: Craig’s Test
Measure of femoral anteversion
Position: Craig’s Test
Pt: Prone, knee flexed to 90
PT: Standing on side, holding ankle and palpating greater trochanter
Method: Craig’s Test
Passively IR/ER the hip until the greater trochanter is in its most lateral position (parallel to table), then measure angle between lower leg and vertical
Normal Test: Craig’s Test
8-15 degree angle
Biomechanics: Craig’s Test
Excessive anteversion = IR, toe in
Excessive retroversion = ER, toe out
Assessment: Ely’s Test
Length of rectus femoris
Position: Ely’s Test
Pt: Prone, legs together
PT: Standing on the side, hand on ankle and on pelvis (posterior or anterior)
Method: Ely’s Test
Passively flex knee, stabilizes pelvis
Positive Test: Ely’s Test
Anterior pelvic til or limited knee flexion = tight rectus femoris
Functional Test: Lift foot onto 20 cm step/return (hip flexion>ext)
- 5-6 reps
- 3-4 reps
- 1-2 reps
- 0 reps
- Functional
- Functional Fair
- Functional Poor
- Nonfunctional
Functional Test: Sit in chair and stand (hip ext>flexion)
- 5-6 reps
- 3-4 reps
- 1-2 reps
- 0 reps
- Functional
- Functional Fair
- Functional Poor
- Nonfunctional
Functional Test: Standing, lift leg to balance keeping pelvis straight (hip ABD)
- Hold 1-1.5 min
- Hold 30-59 sec
- Hold 1-29 sec
- Cannot Hold
- Functional
- Functional Fair
- Functional Poor
- Nonfunctional
Functional Test: Walk sideways 6m (Hip ADD/ABD)
- 6-8m one way
- 3-6m one way
- 1-3m one way
- 0m
- Functional
- Functional Fair
- Functional Poor
- Nonfunctional
Functional Test: Tested leg off floor, IR nonWB hip OR ER nonWB hip
- 10-12 reps
- 5-9 reps
- 1-4 reps
- 0 reps
- Functional
- Functional Fair
- Functional Poor
- Nonfunctional
Q: In standing which should be higher, PSIS or ASIS and by how much?
PSIS
men = 5 degrees higher
women = 10-15 degrees higher
Assessment: Bending Forward
- Hip Compensation
- Knee flexion/hyperextension
Normal: Bending Forward
Hip flex to 90 followed by back bend
Positive Test: Bending Foward
Hip flex < 90 followed by back bend = tight hamstrings and hip flexors
Q: What is the purpose of passive hip movement in single leg stance?
Loading joint to see if symptoms are reproduced with certain movements
Stretching: UE: Supine or Sidelying: Shoulder Flexion/Elevation (3)
- Scapula is stabilized: 120 degrees of shoulder flexion/elevation
- Humerus externally rotated
OR
- Stabilize pelvis for full flexion/elevation
Stretching: UE: Supine or Sidelying: Shoulder ER (4)
- Abduction or elevation plane
- 90 elbow flexion; initially 30 or 45 of elevation
- Stabilize shoulder with one hand and elbow forearm with another hand
- Externally rotate the shoulder
Stretching: UE: Supine or Sidelying: Shoulder Horz ABD (4)
- Pec. major stretching
- Pt in the edge of the table
- Begin with shoulder in 60 to 90 degrees of abduction/pt’s elbow flexed.
- Stabilize anterior shoulder and grab the distal humerus
Stretching: UE: Supine or Sidelying: Elbow extension (2)
- Watch for shoulder and elbow compensations
- Stabilize shoulder/humerus with one hand/ apply the extension force on the forearm, use towel to support the humerus.
Stretching: UE: Supine or Sidelying: Wrist Extension
Forearm pronated on the treatment table; use a towel to support the forearm. Grasp the patient’s palmar aspect of the hand. If the contracture in flexion is severe, place the pt’s hand over the edge of the table.
Stretching: UE: Sitting: Shoulder Horz ABD (3)
- Pec. major stretching
- Therapist behind the patient, both grabs both patient’s elbow with shoulder at 90
- Apply shoulder horizontal abduction (contract-relax technique when needed)
Stretching: LE: Supine: Hip Flexion (3)
- Hamstrings stretching
- Flex the hip with knee in extension
- Stabilize the opposite thigh (hand or towel)
Stretching: LE: Supine: Hip Extension (3)
- Thomas test position (stretch the psoas, rectus femoris, TFL)
- Extend the hip holding (stabilizing) the contralateral hip in total flexion
- Apply hip adduction and knee flexion when necessary
Stretching: LE: Sidelying: Hip ABD/Extension (3)
- Stretch the TFL: Ober test position
- Adduction/ extension of the hip in neutral rotation; stabilize pelvis
- Flex knee if to increase the stress.
Stretching: LE: Prone: Hip ER/IR (2)
- Knee bent at 90o, stabilize contralateral hip
- Apply either external or internal rotation
Stretching: LE: Prone: Knee Extension (Stretch Knee Flexors) (2)
- Supporting the knee with a towel; therapist grasp the tibia in external rotation and stabilize the posterior thigh with the other hand.
- Apply knee extension
Stretching: LE: Supine: Ankle DF (4)
- Stretch gastrocnemius (knee extended),
- Stretch Soleus (knee bent)
- Therapist grasp the heel with one hand (forearm on the foot sole) and stabilize tibia with the other hand
- Apply dorsiflexion with the subtalar joint in neutral position
Global Postural Reeducation/Stretching: Supine/Standing (4)
- Opening hips
- Arms Down
- Exhaling practice (90% exhaling)
- Keep spine in place/do not move (just breath)
Global Postural Reeducation/Stretching: Supine legs againt wall (2)
- Closing hips
- Arms up or down
Global Postural Reeducation/Stretching: Standing (2)
- Closing hips
- Arms down (Ballet dancer)
Assessment: Patellar Tap Test
Swelling inside the joint
Assessment: Girth Measurements
Atrophy and swelling
Landmarks: Girth Measurements
For swelling = at joint line
15 cm above or below joint line (muscle swelling/atrophy)
Measure while in 30 knee flexion
Knee Palpation (Looking to reproduce symtpoms) (8)
- Look at position of patella
- Fibular head for tenderness
- Joint Line for menisci
- MCL, medial joint
- LCL, lateral joint
- Patellar tendon
- Fat pads
- Pes Anserine
Modified Quad MMT: Quad Set (4)
Hold for 10 sec
Look for:
- Contraction
- Patellar tracking (want superior/lateral motion)
- VMO
Modified Quad MMT: SLR
Watch for extensor lag
Q: What aggravates knee fat pads?
Inferior tilted patella
T/F: In general, the patella is slightly medially seated.
True, slight but not significant
Assessment: Femural-Acetabular Impingement Test
Anteriosuperior labral tear
Also stretches/tests piriformis
Position: Femural-Acetabular Impingement Test
Pt: Supine, flip flexed, abd, ER
PT: stand to side of pt. and support leg
Method: Femural-Acetabular Impingement Test
Move pt. into adduction, IR, with slight extension
Positive Test: Femural-Acetabular Impingement Test
Clicking, Pain
Posterior pain = Piriformis
Anterior pain = Labral tear
Q: In what plane is the Q angle observed?
Sagittal
Q: What can you determine by the angle of the popliteal lines?
IR/ER of the femur
High on outside = IR
Q: What would inhibit a full/deep squat?
Tight calfs
Assessment: Patellar Tap Test
Joint effusion (swelling inside the joint
Position: Patellar Tap Test
Pt. supine with knee slightly flexed
Method: Patellar Tap Test
Push/glide patella inferiorly, then tap, compare bilaterally
Positive Test:
Floating or bouncing sensation
Assessment: Posterior Sag
Posterior cruciate ligament integrity (tear)
Position: Posterior Sag
Pt: Supine, hip and knee flexed to 90, feet supported by PT
Alternative: Feet flat on table, hip and knee flexed
PT: at end of bed, supporting heels
Method: Posterior Sag
Observe the tibial plateaus, have pt. engage hamstrings to exaggerate the effect
Normal Response: Posterior Sag
Medial tibial plateau is 1 cm anterior to femoral plateau
Positive Test: Posterior Sag
Tibia drops/sags back
Assessment: Posterior Drawer
Posterior instability (PCL)
Position: Posterior Drawer
Pt: Supine, knee flexed 90, foot flat on table
PT: Sitting on foot, thenar eminences on tibial plateaus
Method: Posterior Drawer
Attempt to push tibia backward, compare bilaterally
Positive Response: Posterior Drawer
Excessive Posterior translation
Assessment: Anterior Drawer
ACL integrity
Position: Anterior Drawer
Pt: Supine, knee flexed 90, foot flat on table
PT: Sitting on foot, grasping the tibia with both hands
Method: Anterior Drawer
Attempt to pull the tibia forward, compare bilaterally
Positive Test: Anterior Drawer
Excessive anterior translation of the tibia
Q: Why is the Lachmans test better than the Anterior Drawer?
The Lachmans has the pt in 30 degrees of knee flexion - the angle at which all the ACL fibers are taut
Assessment: Lachman Test
ACL integrity
Position: Lachman Test
Pt: supine, knee flexed 15-30 degrees
PT: Standing, grasping lateral femur and medial tibia
Method: Lachman Test
Stabilize the femur while exerting an anterior force on the tibia, compare bilaterally
Positive Test: Lachman Test
Excessive anterior translation of the tibia
Assessment: Varus Stress Test
LCL integrity
Position: Varus Stress Test
Pt: Supine with knee flexed 5, and 20-30, lower leg off table thigh resting on the table
PT: Stabilize medial knee, grasp lateral ankle
Method: Varus Stress Test
Apply varus force at knee
Positive Test: Varus Stress Test
Excessive gapping of the lateral joint with/without pain
Assessment: Valgus Stress Test
MCL integrity
Position: Valgus Stress Test
Pt: Supine with knee flexed 5, and 20-30, lower leg off table thigh resting on the table
PT: Stabilize lateral knee, grasp medial ankle
Method: Valgus Stress Test
Apply valgus force at knee
Positive Test: Valgus Stress Test
Excessive gapping of the lateral joint with/without pain
Q: What should the end feel be for both the varus and valgus stress test?
Hard
Q: What is one way to assess the menisci apart from McMurray’s test?
Palpate the joint line
Assessment: McMurry’s Test
Meniscal instability
Position: McMurry’s Test
Pt: Supine, knee in full flexion
PT: Grasp knee and around distal tibia
Method: McMurry’s Test
Lateral meniscus: apply IR to tibia and varus force at knee during extension
Medial meniscus: apply ER to tibia and valgus force at knee during extension
Positive Test: McMurry’s Test
Pain
Assessment: Apprehension Test
Lateral patella subluxation or dislocation
Position: Apprehension Test
Pt: Supine, quad relaxed (knee flexed ~30)
PT: Standing on opposite side of test leg, thumbs on medial patella
Method: Apprehension Test
Carefully/slowly glide patella laterally
Positive Test: Apprehension Test
Apprehension - facial or quad contraction, then positive for dislocation
Assessment: Apley’s Compression & Distraction
Compression = Mensicus integrity
Distraction = Ligament integrity
Position: Apley’s Compression & Distraction
Pt: Prone with knee flexed to 90
PT:
Compression: hand on heel and ankle
Distraction: Shin stabilizes pt. quad, hands around malleoli
Method: Apley’s Compression & Distraction
Compression: apply downward force while IR/ER tibia
Distraction: distraction joint while IR/ER tibia
Positive Test: Apley’s Compression & Distraction
Pain, clicking, reproduction of symptoms
Assessment: Critical Test
Patellofemoral pain
Position: Critical Test
Pt: Sitting EOB
PT: siiting beside pt. stabilize near knee, hold ankle
Method: Critical Test
Apply resistance at the ankle through varying degrees of knee flexion (5-90). If pain occurs at a given angle, glide the patella medially and reattempt resistance at that angle
Positive Test: Critical Test
Decreased pain with medial glide
PAM to Gain Knee Extension: 30-15 degrees extension
Patient prone; place a towel roll under femur and stabilize the femur; anteriorly glide tibia with external rotation using grade III or IV
PAM to Gain Knee Extension: 15-5 degrees extension
Patient supine; place a towel roll under tibia, posteriorly glide femur with internal rotation using grade III or IV. Emphasize internal rotation of femur
PAM to Gain Knee Extension: 5-0 degrees extension
Patient supine; hold-relax technique to engage hamstrings
Assessment: Anterior Drawer (Ankle)
Integrity of the anterior talofibular ligament
Position: Anterior Drawer (Ankle)
Pt: Sitting EOB
PT: Stabilize anterior tib/fib while grasping calcaneous posteriorly
Method: Anterior Drawer (Ankle)
Apply anterior force to calcaneous
Positive Test: Anterior Drawer (Ankle)
Excessive movement of the talus compared to the opposite side
Assessment: Talar Tilt
Integrity of the calcaneofibular ligament
Position: Talar Tilt
Pt: Sitting EOB
PT: Stabilize tib/fib anteriorly, grasp lateral talus and calcaneous with other hand
Method: Talar Tilt
Apply inversion force to talocrural and subtalar joints
Positive Test: Talar Tilt
Lateral gapping or pain as compared to the opposite side
Assessment: Homan’s Sign
Length of posterior compartment of calf
Position: Homan’s Sign
Pt: Supine, foot off bed
PT: Grasp plantar aspect of foot
Method: Homan’s Sign
Apply DF with knee extended
Positive Test: Homan’s Sign
Pain in calf
Assessment: Squeeze Test
Morton’s Neuroma, usually between 2-3 MT
Position: Squeeze Test
Pt: Supine
PT: Grasp foot around MT head
Method: Squeeze Test
Squeeze MT heads together
Positive Test: Squeeze Test
Increased pain between MTs
Assessment: Thompson’s Test
Integrity of Achilles tendon - rupture
Position: Thompson’s Test
Pt: Prone, foot off bed
Method: Thompson’s Test
Squeeze calf at middle of muscle belly
Positive Test: Thompson’s Test
decreased or absent PF reflex/response
Q: What pulse would you assess for compartment syndrome?
Pedal pulse
Q: Where do you take girth measurements for the ankle?
Start = between tibialis anterior tendon and lateral malleolus
To navicular bone
Pull across arch to base of 5th MT
Around ankle to distal tip of medial malleolus
Across achilles tendon
End = distal tip of lateral malleolus
Q: What does a posterior ankle glide assess?
DF
Q: What does distraction at the subtalar joint assess?
General mobility of the calcaneus
Q: What does an anterior ankle glide assess?
PF
Q: What does a medial subtalar joint glide assess?
Inversion
Q: What does a lateral subtalar joint glide assess?
Eversion
Indication: Longitudinal Caudal Mobilization
Lack of general ankle mobility
Position: Longitudinal Caudal Mobilization
Pt: Prone, knee flexed 90
PT: Knee stabilizing pt thigh, Grasp talus with both hands around the ankle
Method: Longitudinal Caudal Mobilization
Distract hindfoot combined with inv/ever and DF/PF
Indication: Cuboid Whip
Cuboid subluxation or decreased mobility of the calcaneocuboid joint
Position: Cuboid Whip
Pt: prone, knee flexed 75-80
PT: grasp dorsal foot with thumbs on plantar foot over cuboid
Method: Cuboid Whip
Slightly Df, them thrust into PF and knee extension
Indication: Thrust Manipulation of the Talus
Hypomobility after inverted ankle sprain
Position: Thrust Manipulation of the Talus
Pt: Supine, legs straight
PT: Grasp ankle anteriorly and laterally over the talus bone
Method: Thrust Manipulation of the Talus
Place pt. foot/ankle into sligh DF and eversion/ER. Apply thrust into slight eversion and DF