LE Dx skills Flashcards
Muscle strength graded on scale of __________
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!
Reflexes graded on scale of
–4+ = hyperactive, very brisk
–3+ = brisker than average
–2+ = average, normal
–1+ = somewhat diminished, low normal
–0 = no response, absent
Hip Exam
Gait (observe normal and special), Inspection, Palpation, ROM (active then passive), strength testing, special testing
Hip ROM
- 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
Anterior hip/groin pain
Intra-articular pathology (ie. OA, hip labral tears)
Posterior hip pain
piriformis syndrome, sacroiliac joint dysfunction, lumbar radiculopathy (ischofemoral impingement and vascular claudication)
Lateral hip pain
greater trochanteric pain syndrome
Trendelenburg sign
drop in other hip when standing on one leg
Hip labral tear, transient synovitis, Legg-Calvé-Perthes disease, SCFE
FABER test
Hip - Patrick test
Flex, abduct, external rotation
FADIR Test
Hip - Impingement
Flex, adduct, internally rotate
Ober test
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
Knee Joint Exam
- Gait Exam
- Inspection
- Palpation-assess for effusion (fluid)
- Range of Motion- active tested before passive
- Strength Testing
- Special Tests
Q angle
- 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;
Varus vs valgus
varus - knees further out than ankles
valgus - ankles farther out than knees
Knee ROM
- 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)
Pain factors
Timing, location, duration, severity (quality, effusion?)
Patellar apprehension test
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.
Anterior Drawer Test
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).
Lachman’s test
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.
Posterior drawer test
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.
How to test ACL?
Anterior drawer, lachmans
How to test PCL?
Posterior drawer
Valgus stress test
Test Medial collateral ligament
Abduct, flex 30 deg, pull leg laterally while pushing knee in (valgus)
Varus stress test
Lateral collateral ligament
Abduct, flex 30 deg, pull foot medially while pushing knee out
McMurray’s test
Test lateral and medial menisci
Flex –> extend w/ valgus and varus stress
Positive: click/pop w/ associated pain at same time
Ottawa Knee Rules
X ray indicated if
- isolated patellar tenderness or tenderness at head of fibula
- Inability to bear weigh to flex knee to 90
>55 years
Ankle exam
- Gait Exam
- Inspection
- Palpation
- Range of Motion- active tested before passive
- Strength Testing
- Special Tests
Anterior Drawer Test (Ankle)
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.
Talar tilt test
•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.
Thompson test
Thompson test checks for a torn Achilles tendon. Squeeze calf and see foot move; no movement is abnormal and may indicate torn Achilles
Ottawa Ankle Rules
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
Ottawa foot rules
*Bone tenderness at the base of the 5th metatarsal OR over the navicular bone
*Inability to bear weight immediately and in the office/ER
Grading of ankle sprains
1 - no rupture
2- partial tear
3 - complete rupture
Most ankle sprains are to
lateral ligaments
