LE Dx skills

Question 1

Muscle strength graded on scale of __________

Answer 1

1 to 5

–0 = no muscular contraction detected

–1 = a barely detected trace of contraction

–2 = active mvmt of body part with gravity eliminated

–3 = active movement against gravity

–4 = active movement against gravity and some resistance

–5 = active movement against full resistance without evident fatigue = NORMAL!

Question 2

Reflexes graded on scale of

Answer 2

–4+ = hyperactive, very brisk

–3+ = brisker than average

–2+ = average, normal

–1+ = somewhat diminished, low normal

–0 = no response, absent

Question 3

Hip Exam

Answer 3

Gait (observe normal and special), Inspection, Palpation, ROM (active then passive), strength testing, special testing

Question 4

Hip ROM

Answer 4

• Flexion: supine, patient bends knee to chest
• Extension: prone, patient lifts leg off table
• Abduction: patient on side, straight leg away from midline
• Adduction: supine or edge of table, cross leg over top of other
• Internal rotation: supine, flex hip, foot laterally
• External rotation: supine, flex hip, foot medially

Question 5

Anterior hip/groin pain

Answer 5

Intra-articular pathology (ie. OA, hip labral tears)

Question 6

Posterior hip pain

Answer 6

piriformis syndrome, sacroiliac joint dysfunction, lumbar radiculopathy (ischofemoral impingement and vascular claudication)

Question 7

Lateral hip pain

Answer 7

greater trochanteric pain syndrome

Question 8

Trendelenburg sign

Answer 8

drop in other hip when standing on one leg

Hip labral tear, transient synovitis, Legg-Calvé-Perthes disease, SCFE

Question 9

FABER test

Answer 9

Hip - Patrick test

Flex, abduct, external rotation

Question 10

FADIR Test

Answer 10

Hip - Impingement

Flex, adduct, internally rotate

Question 11

Ober test

Answer 11

Patient is on their side on edge of table with the back to the examiner. Examiner faces patient’s feet, braces body against patient’s back, lift and extend the hip. Hold knee and foot.

No drop –> Tighter ITB

Drop = GOOD

Question 12

Knee Joint Exam

Answer 12

• Gait Exam
• Inspection
• Palpation-assess for effusion (fluid)
• Range of Motion- active tested before passive
• Strength Testing
• Special Tests

Question 13

Q angle

Answer 13

• Q angle is the angle formed by a line drawn from the ASIS to central patella and a second line drawn from central patella to tibial tubercle;
• • an increased Q angle is a risk factor for patellar subluxation;
• • normally Q angle is 14 deg for males and 17 deg for females;

Question 14

Varus vs valgus

Answer 14

varus - knees further out than ankles

valgus - ankles farther out than knees

Question 15

Knee ROM

Answer 15

• Flexion 0-135
• Extension 0-15
• (hyperextension is called genu recurvatum)

–Medial rotation of the tibia on the femur (normal range is 20-30 degrees)

–Lateral rotation of the tibia on the femur (normal range is 30-40 degrees)

Question 17

Pain factors

Answer 17

Timing, location, duration, severity (quality, effusion?)

Question 18

Patellar apprehension test

Answer 18

With fingers placed at the medial aspect of the patella, the physician attempts to sublux the patella laterally. If this maneuver reproduces the patient’s pain or a giving-way sensation, patellar subluxation is the likely cause of the patient’s symptoms.

Question 19

Anterior Drawer Test

Answer 19

Test ACL

patient assumes a supine position with the injured knee flexed to 90 degrees. The physician fixes the patient’s foot in slight external rotation (by sitting on the foot) and then places thumbs at the tibial tubercle and fingers at the posterior calf. With the patient’s hamstring muscles relaxed, the physician pulls anteriorly and assesses anterior displacement of the tibia (anterior drawer sign).

Question 20

Lachman’s test

Answer 20

ACL

patient in a supine position and the injured knee flexed to 30 degrees. The physician stabilizes the distal femur with one hand, grasps the proximal tibia in the other hand, and then attempts to sublux the tibia anteriorly. Lack of a clear end point indicates a positive Lachman test.

Question 21

Posterior drawer test

Answer 21

PCL

patient assumes a supine position with knees flexed to 90 degrees. While standing at the side of the examination table, the physician looks for posterior displacement of the tibia (posterior sag sign). Next, the physician fixes the patient’s foot in neutral rotation (by sitting on the foot), positions thumbs at the tibial tubercle, and places fingers at the posterior calf. The physician then pushes posteriorly and assesses for posterior displacement of the tibia.

Question 22

How to test ACL?

Answer 22

Anterior drawer, lachmans

Question 23

How to test PCL?

Answer 23

Posterior drawer

Question 24

Valgus stress test

Answer 24

Test Medial collateral ligament

Abduct, flex 30 deg, pull leg laterally while pushing knee in (valgus)

Question 25

Varus stress test

Answer 25

Lateral collateral ligament

Abduct, flex 30 deg, pull foot medially while pushing knee out

Question 26

McMurray’s test

Answer 26

Test lateral and medial menisci

Flex –> extend w/ valgus and varus stress

Positive: click/pop w/ associated pain at same time

Question 27

Ottawa Knee Rules

Answer 27

X ray indicated if

1. isolated patellar tenderness or tenderness at head of fibula
2. Inability to bear weigh to flex knee to 90

>55 years

Question 28

Ankle exam

Answer 28

• Gait Exam
• Inspection
• Palpation
• Range of Motion- active tested before passive
• Strength Testing
• Special Tests

Question 29

Anterior Drawer Test (Ankle)

Answer 29

tests for ankle stability - especially injuries to anterior talofibular ligament

•supine, patient’s foot relaxed, examiner stabilizes the tibia and fibula, foot in 20 degrees flexion, draw the talus forward. Knee can be 90 flexion.

Question 30

Talar tilt test

Answer 30

•tests for a torn calcaneofibular ligament.

Patient supine or on side: foot relaxed, knee flexed around 60-90 degrees, examiner puts foot in anatomic position, then tilts the talus side-to-side.

Question 31

Thompson test

Answer 31

Thompson test checks for a torn Achilles tendon. Squeeze calf and see foot move; no movement is abnormal and may indicate torn Achilles

Question 32

Ottawa Ankle Rules

Answer 32

Ankle Xrays indicated if:

*Bone tenderness at the distal 6 cm of tibia or fibula posterior edge or tip of the lateral OR medial malleoli

*Inability to bear weight both immediately and in the office/ER

Question 33

Ottawa foot rules

Answer 33

*Bone tenderness at the base of the 5th metatarsal OR over the navicular bone

*Inability to bear weight immediately and in the office/ER

Question 34

Grading of ankle sprains

Answer 34

1 - no rupture

2- partial tear

3 - complete rupture

Question 35

Most ankle sprains are to

Answer 35

lateral ligaments