Lab Practical 2 Flashcards
Ankle dorsiflexion ROM
20 degrees
firm
ankle plantar flexion ROM
50 degrees
firm
inversion ROM
30-35 degrees
firm
eversion ROM
10-15degrees
hard
subtalar inversion ROM
5-15 degrees
firm
subtalar eversion ROM
5-10 degrees
hard
MTP flexion ROM
30-45 degrees
firm
MTP extension ROM
50-70 degrees
ankle dorsiflexion goniometer placement
fulcrum: lateral malleolus
proximal arm: lateral midline of the fibula up to head of fibula
distal arm: parallel to the lateral aspect of the 5th metatarsal
ankle plantarfelxion goniometer placement
fulcrum: lateral malleolus
proximal arm: lateral midline of the fibula up to the head of fibula
distal arm: parallel to the lateral aspect of the 5th metatarsal
ankle inversion goniometer placement
fulcrum: anterior ankle between malleoli
proximal arm: anterior midline of leg along tibial tuberosity
distal arm: anterior midline of second metatarsal
ankle eversion goniometer placement
fulcrum: anterior ankle between malleoli
proximal arm: anterior midline of leg along tibial tuberosity
distal arm: anterior midline of second metatarsal
subtalar inversion goniometer placement
fulcrum: posterior ankle between malleoli
proximal arm: posterior midline of leg
distal arm: posterior midline of calcaneus
subtalar eversion goniometer placement
fulcrum: posterior ankle between malleoli
proximal arm: posterior midline of leg
distal arm: posterior midline of calcaneus
MTP flexion goniometer placement
fulcrum: over the dorsal aspect of the MTP joint
Proximal arm: over the dorsal midline of metatarsal
distal arm: over the dorsal midline of proximal phalanx
MTP extension goniometer placement
fulcrum: over the dorsal aspect of the MTP joint
Proximal arm: over the dorsal midline of metatarsal
distal arm: over the dorsal midline of proximal phalanx
knee distraction prone
prone with strap over thigh
towel roll under distal thigh
pull from ankle
loose pack: 25 degrees
knee distraction seated
sitting on edge of table
loose pack: 25 degrees
pull down along long axis
knee anterior glide
prone with distal thigh supported towel roll
loose pack: 25 degrees flexion
push anteriorly below knee and distract from ankle
knee posterior glide
seated
apply distraction and push on tibia
knee glide with ER or IR
prone
towel under knee/right above knee cap
what glide to do if trouble with extension
ER
what glide to do if trouble with flexion
IR
knee posterior glide supine
supine
bent knee
sit on the foot
push tibia posteriorly at joint line
valgus stress test in extension
supine
knee extended
abduct leg
hand on medial ankle and lateral knee
push knee medially
positive valgus stress test in extension
damage to MCL, posterior oblique ligament, posteromedial capsule, ACL, PCL
valgus stress test in 30 degrees flexion
supine
abduct leg
knee flexed 20-30 degrees
hand on medial ankle and lateral knee
apply medial force to knee
positive valgus stress test in flexion
MCL, PCL
varus stress test in extension
supine with knee extended
abduct leg
hand on lateral ankle and medial knee
laterally rotate ankle
push on knee in lateral direction
positive varus stress test in extension
damage to LCL, lateral capsule, PCL
varus stress test 30 degrees flexion
supine with leg abducted
knee flexed to 30 degrees
hold lateral ankle and medial knee
apply lateral force to knee
positive varus stress test in flexion
damage to LCL
anterior drawer test
supine with knees flexed to 90 degrees
place thumbs on anterior aspect of joint lines at knee
pull tibia anteriorly
positive anterior drawer test
damage to ACL
posterior drawer test
supine with knees flexed to 90 degrees
placee thumbs on anterior aspect of joint lines
push tibia posteriorly
positive posterior drawer test
damage to PCL, posterior oblique ligament, ACL
Lachmans Test
supine with hip slightly flexed and knee flexed 30 degrees
thigh under patients leg
stabilize distal femur and pull proximal tibia anteriorly
Apley’s compression test
prone with the knee flexed to 90 degrees
put long axis compression through tibia into femur
one hand on ankle to apply compression and other hand on foot to IR and ER
positive apley’s compression test
pain or clicking with rotation
damage to meniscus
apley’s distraction test
prone with knee flexed to 90 degrees
wrap both hands around distal tibia and place long axis distraction on the tibia and IR and ER
positive apley’s distraction test
pain or greater rotation
testing for collateral and cruciate ligaments
may provide relief if meniscus injury
mcmurrays test
supine
hold leg and hold heel while bending knee and flexing hip
bring knee laterally and rotate tibia medially while extending knee
positive mcmurrays test
palpable clicking or popping in joint with pain
meniscus tear
pivot shift test
supine
lift involved leg and hold at heel and proximal tibia below knee
apply valgus (lateral) pressure at knee while internally rotating the tibia and move knee into flexion
ankle talocrural distraction
supine with belt over tibia
grab foot just below ankle joint
pull towards to distract
ankle talocrural posterior glide alternative
patient has leg on chair
belt around distal tibia and PT waist
belt pulls tibia anteriorly while patient flexes knee
how to increase ankle dorsiflexion
posterior glide of talus
how to increase ankle plantarflexion
anterior glide of talus
ankle talocrural anterior glide
prone
towel under distal tibia
one hand under distal tibia and other pressing down onto heel
distract and then push down
distal tibiofibular anterior glide improves
PF and eversion
distal tibiofibular posterior glide improves
DF and inversion
distal tibiofibular anterior glide
prone
towel under distal tibia
one hand under tibia to stabilize
one hand pushing down on fibula
supine
one hand under tibia and one hand over fibula
push down on fibula
distal tibiofibular posterior glide
supine
towel under distal tibia
one hand under tibia and one hand over fibula
push down on fibula
subtalar distraction
supine
towel under ankle
stabilize ankle anteriorly
pull heel outwards
subtalar medial glide of calcaneous
prone
towel under distal tibia
stabilize ankle posteriorly
push heel medially
subtalar lateral glide of calcaneous
prone
towel under distal tibia
stabilize ankle posteriorly
push heel laterally
what does subtalar medial glide of calcaneous increase?
eversion
what does subtalar lateral glide of calcaneous increase?
inversion
anterior drawer sign test
patient sitting on edge of table with knees flexed 90 degrees
foot relaxed in slight PF
one hand on anterior distal tibia to stabilize and other hand on posterior calcaneous and talus
apply anterior force
postitive anterior drawer sign test
anterior translation of talus
tear of anterior talofibular ligament
ankle lateral stability
sitting on edge of table with ankle slightly PF
knees flexed 90 degrees
one hand on medial aspect of tibia and other with calcaneus
push the calcaneus and talus into inversion
positive ankle lateral stability test
if talus rocks
tears of anterior and posterior talofibular and calcaneofibular ligaments
ankle medial stability test
sitting on edge of table with ankle neutral
knees flexed 90 degrees
one hand on lateral aspect of tibia and other with calcaneus
push the calcaneus and talus into eversion
positive ankle medial stability test
if talus rocks
tear of deltoid ligament
homan’s sign
supine with knee extended
passively and forcibly DF foot
positive homan’s sign
pain in calf
DVT/ blood clot
thompson test
prone with knees extended and feet over the edge
squeeze the gastrocnemius / soleus
positive thompson test
absence of PF
rupture of achilles tendon
knee flexion MMT
prone
testing knee flexed
stabilize posterior pelvis
apply pressure to posterior leg above ankle joint
biceps femoris: lower leg ER, toes out
semi: lower leg IR, toes in
knee flexion MMT gravity eliminated
side lying with test leg below
stabilize pelvis and support uppermost lower extremity
knee extension MMT
seated with towel under test knee
pt. stabilizes by holding sides of table
stabilize femur, pelvis or trunk as necessary
apply resistance to anterior aspect of LE just above ankle
knee extension MMT gravity eliminated
sidling with test leg below
stand behind pt. pelvis and stabilize and support upper leg
knee extensor muscles
rectus femoris
vastus lateralis
vastus intermedius
vastus medialis
knee flexor muscles
semimembranosus
semitendinosus
biceps femoris
ankle plantar flexion MMT
stand on one leg and lift heel off ground
gastrocnemius: knee extended
soleus: knee flexed
ankle plantar flexion MMT grading
5=25 reps
4/5= 10-24 reps
3/5= 1-9 reps
ankle plantar flexion MMT gravity eliminated
side lying with leg being tested on bottom
extend hip and knee, ankle neutral
foot dorsiflexion and inversion MMT
seated with legs off side of table, ankle neutral
stabilize posterior aspect of distal thigh
apply resistance on dorsal surface of medial side of foot in direction of plantar flexion and eversion
tibialis anterior motion
DF and inversion
foot inversion MMT
side lying on side to be tested
ankle slightly PF, foot extended over edge of tablee
stabilize over anterior medial aspect of tibia
apply resistance over medial aspect of foot in direction of eversion
foot inversion MMT gravity eliminated
supine with LE extendeed
ankle of test limb slightly PF
foot extended over table
foot dorsiflexion and inversion
supine
LE extended, ankle of test foot neutral
foot extended beyond edge of table
tibialis posterior action
inversion
ankle eversion MMT
side lying with limb to be tested above
ankle neutral, foot extended over table
stabilize medial aspect of distal leg
apply resistance against lateral border and plantar surface of foot in direction of inversion
peroneus longus: resistance on plantar surface of head of 1st metatarsal
peroneus brevis: resistance applied on lateral border of foot along shaft of fifth metatarsal
ankle eversion MMT gravity eliminated
supine with lower extremity extended
ankle of test leg neutral
foot beyond edge of table
action of Peroneus longus and brevis
ankle eversion
MTP flexion of 1st toe MMT
supine with ankle neutral
stabilize the great toe
apply resistance in direction of MTP extension
applied over plantar surface of proximal phalanx of big toe
MTP flexion of 1st toe MMT grading
3/5= pt. flexes joint through full ROM without resistance
2/5= pt. flexes joint through partial ROM
1 or 0/5= unable to move
MTP extension of 1st toe MMT
supine with ankle neutral
stabilize metatarsals
palpate extensor digitorum brevis and longus
apply resistance over dorsal of proximal phalanx of great toe in direction of MTP flexion
MTP extension of 1st toe MMT grading
3/5= pt flexes joint through full ROM
2/5= pt flexes joint through partial ROM
1/5= no motion but palpation is present
0/5= no motion present
IP flexion of 1st toe MMT
supine
stabilize proximal phalanges of great toe
apply resistance against distal phalanx of great toe
IP extension great toe MMT
supine with ankle neutral
stabilize proximal phalanx of great toe
palpate extensor halicus longus
apply resistance on dorsum of distal phalanx of great toe in direction of IP flexion
positive pivot shift test
damage to ACL
pain and subluxation of tibia
