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Musculoskeletal I (second exam/practical) > LE Tests > Flashcards

LE Tests Flashcards

1
Q

What 4 tests are used to assess joint mobility and integrity of the hip?

A
  • Lateral/medial translation
  • Distraction
  • Compression
  • Anteroposterior/ posteroanterior glides
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2
Q

What are 4 quick tests to assess ROM at the hip?

A
  • Place foot on standard step
  • Forward bend
  • Squatting
  • Sitting with leg crossed
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3
Q

What are 7 functional tests of the hip?

A
  • Squatting
  • Reciprocal stairs
  • Crossing the ankle to the opposite knee in sitting
  • Stars 2 at a time
    Running: (Straight plane/ decelerating)
  • One legged hop
  • Jumping
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4
Q

What exercise is used commonly in treating hamstrings? Describe it.

A
  • Stomach-lying hip extension
  • Prone with pillow under torso
  • Activate abdominals, squeeze “seat muscles”
  • Barely lift thigh off floor
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5
Q

Describe the capsular pattern of hip hypomobility.

A
  • 50 - 500 degrees of limitation of femoral abduction
  • 0 degrees of femoral rotation from neutral
  • 90 degrees of limitation of femoral flexion
  • 10 - 30 degrees limitaiton of femoral extension
  • Femoral ER and adduction are normal
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6
Q

Describe the 6 components of examination of a patient with a hip impairment.

A
  • Posture: Asymmetry in standing
  • Gait: (trendelenberg, hip excursion/ ROM, Avoidance
  • Clear LSS, Knee
  • ROM
  • Flexibility
  • MMT
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7
Q

Describe the sign of the buttock.

A
  • Limited SLR

- Hip and knee flexion are limited and painful

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8
Q

What 6 pathologies are indicated by the sign of the buttock?

A
  • Osteomyelitis
  • Septic arthritis/ bursitis
  • Ischiorectal abscess
  • Rheumatic fever with bursitis
  • Neoplasm of the femur or ilium
  • Fractured sacrum
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9
Q

What are 2 functional scales of the hip?

A
  • LEFS

- Harris hip function scale

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10
Q

What 4 impairments/ pathologies do the hip scour and hip quadrant test for?

A
  • Labrum integrity
  • Capsulitis
  • OA
  • Femoral acetabular impingement syndrome
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11
Q

Describe a hip scour.

A
  • Patient supine
  • PT flexes Pt’s knee, provides axial load through femur
  • PT performs sweeing compression and lateral rotation movement from ER to IR
  • Assess pain or apprehension at any point during the test.
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12
Q

Describe a hip quadrant.

A
  • Pt supine
  • PT flexes Pt’s knee, provides axial load through knee
  • ERs, ABDs, and FLXs hip
  • PT moves patient into IR, ADD, and FLX, with axial load
  • Assess reproduction of hip symptoms
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13
Q

What 3 tests assess a tear of the gluteus medius?

A
  • Trendelenburg’s sign
  • Resisted hip ABD
  • Passive IR
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14
Q

Describe trendelenburg’s sign.

A
  • Pt stands in front of examiner
  • Pt stands on one leg
  • PT evaluatews degree of drop of contralateral pelvis once the leg if lifted
  • Compare to opposite side (abnormal drop confirms)
  • Confirm diagnosis by watching patient ambulate
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15
Q

Describe resisted hip ABD.

A
  • Pt sidelying on unaffected side
  • Pt ABDs to 45 degrees
  • PT resists abduction just distal to knee
  • Assess reproduction of symptoms
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16
Q

Describe passive IR.

A
  • Pt supine
  • Hip FLX to 90 degrees
  • PT moves hip into IR
  • Assess reproduction of pain (positive for tear of gluteus medius)
  • Assess limitation of IR (positive OA)
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17
Q

How is OA assessed?

A
  • Range of motion plane assessment.
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18
Q

Describe ROM plane assessment for OA.

A
  • Pt prone; knee flexed; move hip into EXT

Pt supine:

  • Hip FLX to 90 degrees; move into IR and ER
  • Hip FLX maximally
  • Assess hip ABD
  • For all tests: assess limitation in ROM as well as reproduction of symptoms
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19
Q

What is the special test for ITB restriction?

A
  • Ober test
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20
Q

Describe Ober test.

A
  • Pt sidelying on unaffected side
  • Preposition knee into FLX
  • Stabilize pelvis at iliac crest
  • Put Hip into slight EXT and ABD
  • Use goniometer or inclinometer
  • Measure amount of adduction/ abduction
  • Try to lower leg to mat (if not, positive test)
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21
Q

What 3 tests assess Anterior or Lateral Capsular restriction or hip flexor tightness?

A
  • Patrick/ FABER test
  • Thomas test
  • Prone hip extension test
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22
Q

Describe the Patrick/ FABER test.

A
  • Pt supine; assess resting symptoms
  • Affected side placed in figure four position, with lateral malleolus resting slightly proximal to the knee of the contralateral leg
  • PT provides gentle downward pressure on ipsilateral knee, and contralateral ASIS.
  • Assess pain near anterior or lateral capsule of hip
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23
Q

Describe the Thomas test.

A
  • Pt sits at the edge of the plinth; Pt lies back, pulling both knees to their chest
  • Unaffected leg held to chest, and other leg lowered into hip EXT; knee may extend
  • Pt rotates pelvis posteriorly
  • PT measures extension of hip and or knee with goniometer
  • Decreased EXT is a positive test
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24
Q

Describe the prone hip extension test.

A
  • Pt prone
  • Place belt around PSIS and proximal to gluteal fold
  • Unencumber hip extension
  • PT passively moves hip into EXT
  • Hip EXT measured with goniometer
  • Assess tightness of hip flexors
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25
Q

What are 2 tests for early signs of hip dysplasia?

A
  • Passive hip ABD test

- Flexion ADD test

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26
Q

Describe the passive hip ABD test.

A
  • Pt supine
  • Passively move hip into ABD
  • Assess restriction of ABD compared to unaffected side
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27
Q

Describe the flexion adduction test.

A
  • Pt supine
  • PT flexes knee 90 degrees maintaining Pt’s pelvis on plinth
  • PT attempts to ADD thigh towards opposite hip
  • If Pt unable to ADD past midline, it is a positive test
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28
Q

What are the 5 commonly performed hip mobilizations?

A
  • Short axis distraction
  • Inferior glide/ long axis distraction
  • Posterior glide
  • Anterior glide
  • Lateral glide
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29
Q

Describe a short-axis distraction of the hip.

A
  • Patient supine
  • Knee and Hip FLXed
  • PT supports tibia
  • PT places a mobilization around the proximal femur, padded with a pillow
  • PT leans back providing a lateral force vector on the femur
  • PT provides counter pressure through the knee
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30
Q

Describe an inferior glide/ long axis distraction.

A
  • Pt supine
  • Grip both sides of thigh proximal to knee
  • Grasps lower leg with elbow against body
  • Lean backwards to distract the hip
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31
Q

Describe an inferior glide of the hip in 90 degrees flexion.

A
  • Patient supine
  • Leg propped on PT shoulder
  • Hands linked over proximal femur
  • Lean backwards to distract hip
  • Counterpressure through shoulder
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32
Q

Describe a posterior glide of the hip.

A
  • Pt supine with hip flexed 90 degrees
  • Reach across Pt’s body and supper the hip anteriorly
  • Provide an axial force through a slightly adducted femur
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33
Q

Describe a ventral glide of the hip.

A
  • Pt prone
  • Place both hands over the proximal femur distal to the gluteal fold (may palpate the greater trochancter and move medially)
  • ER the hip
  • Lean into arms and provide ventral glide
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34
Q

Describe a lateral/medial femoral rotation mobilizaitons if the hip.

A
  • Pt prone
  • Stabilize the ipsilateral pelvis in lateral rotation, and the contralateral pelvis in medial rotation
  • FLX knee 90 degrees
  • Move into IR or ER
  • Mobilize at barrier
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35
Q

What are the Pittsburgh knee rules?

A 
- Blunt trauma or fall
AND
Inability to take 4 steps immediately/ in clinic
OR
Age 50
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36
Q

What are the Ottawa knee rules?

A
  • Age > 55
  • Tenderness at fibular head or patella
  • Inability to flex knee > 90 degrees secondary to pain
  • Inability to take 4 steps immediately/ in clinic
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37
Q

What are 10 functional tests that may be performed when evaluating the knee?

A
  • Walking
  • Ascending/ descending stairs
  • Squatting
  • Squat with bounce at end-range
  • Running straight
  • Running straight with quick stop
  • Vertical jump
  • Figure 8/ carioca runnning (grape vine)
  • Jumping with full squat
  • Hard cuts/ twists/ pivots
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38
Q

What are 4 functional tests of the knee that can quantified?

A
  • Single hop for distance
  • Triple hop for distance
  • Crossover triple hop for distance
  • Timed 6 meter hop
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39
Q

What are 4 special tests for meniscal tears?

A
  • McMurrary test
  • Apley test
  • Ege’s test
  • Dynamic test (figure 4 adduction)
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40
Q

Describe the McMurray test.

A
  • Pt supine
  • PT grasps heel and flexes knee to end range while thumb and index finger palpate the joint line
  • Rotate knee into IR or ER, and then extend the knee
  • Assess the presence of a thud or click
    (Targets posterior horns)
41
Q

Describe Apley’s test.

A
  • Pt prone
  • Knee over Pt’s thigh
  • Flex Pt’s knee 90 degrees
  • Distract knee, rotate tibia
  • Assess pain –> rotation sprain of soft tissue
  • Compress tibia into joint, and rotate
  • Assess pain –> Meniscal tear
42
Q

Describe Ege’s Test.

A 
- Feet shoulder width apart, knees extended
For medial meniscus:
- ER LE maximally
- Pt squats, and stands up
For lateral meniscus:
- IR LE maximally
- Slowly squat and stand up
  • For both: assess presence of pain or click
43
Q

Describe the Dynamic Test (figure 4 adduction).

A
  • Pt supine, hip ABD 45 degrees, FLX and ER 45 degrees, knee FLX to 90 degrees; lateral border of foot resting on exam table (figure 4)
  • PT palpates lateral joint line
  • Adducts hip while maintaining 90 degrees knee FLX
  • Assess sharp pain at end of hip ADD or provoked by joint line palpation
44
Q

Describe Thessaly Test/ Disco test. What two positions may it be performed in.

A

May be performed in 20 or 5 degrees knee flexion

  • Pt stands on one leg holding PT’s hands
  • Pt rotates to left and then to right
  • Assess joint line discomfort or sense of locking or catching
45
Q

What are 3 ACL competence tests?

A
  • Lachman’s test
  • Anterior drawer test
  • Pivot-shift test
46
Q

Describe Lachman’s test.

A
  • Pt supine, knee FLX 15 degrees
  • Stabilize distal femur with one hand and grasp behind proximal tibia with other
  • Anterior tibial force to proximal tibia
  • Assess amount of anterior translation compared to unaffected side
47
Q

Describe the anterior drawer tests. What two positions may it be performed in?

A
  • Pt supine, knee FLX to 90 degrees; foot flat
  • PT sits on Pt’s foot, grasps behind proximal tibia with thumbs palpating tibial plateau and index fingers palpating the tendons of the hamstring muscle group medially and laterally
  • Anterior force quickly applied by examiner
  • Assess tibia displacement when compared to unaffected side

Can be assess in 15 degrees ER, and 30 degrees IR

ER assesses anteriomedial
IR assesses posteriolateral

48
Q

Describe the pivot-shift test of the knee.

A
  • Pt supine
  • Grasp Pt’s heel with brachium and torso to flex knee 90 degrees
  • Palm of other hand medially rotates tibia subluxing lateral tibial plateau
  • Examiner slowly extends knee maintaining rotation of tibia
  • At full extension the tibial plateau will relocate
  • Assess the presence of a thud or click
49
Q

What are 4 tests for PCL competence?

A
  • Posterior drawer
  • Godfrey’s Sag
  • Reverse Pivot-Shift
  • Reverse Lachman
50
Q

Describe a posterior drawer.

A
  • Pt supine, knee FLX 90 degrees, hip FLX 45 degrees, foot neutral
  • Examiner sits on Pt’s foot
  • Place both hands over proximal anterior tibia with thumbs on the joint lines
  • Thrust posteriorly

Check in ER or IR

51
Q

Describe Godfrey’s Sag.

A
  • Pt supine, knee FLX 90 degrees, hip FLX 90 degrees
  • Support leg under calf/ heel, suspending leg in the air
  • Assess if tibia sags posteriorly
52
Q

Describe reverse pivot-shift.

A
  • Pt supine, knee FLX 70 - 80 degrees, ER of foot and leg
  • Knee straightens using only the weight of the leg.
  • Axial load through leg with valgus stress at knee
  • As knee approaches 20 degrees FLX, a positive test will see the lateral tibial plateau move anteriorly from posterior subluxation and ER
53
Q

Describe Reverse Lachman’s Test.

A
  • Pt supine, knee FLX 20 - 30 degrees
  • Stabilize distal femur on anterior thigh, and grasp posterior prodximal tibia
  • Apply anterior tibial force, and then a posterior tibial force
  • Assess the presence of a soft or absent end-point in the posterior direction when compared to the contralateral side
54
Q

What are 2 tests for the collateral ligaments of the knee?

A
  • Valgus stress

- Varus stress

55
Q

Describe a valgus stress test of the knee.

A
  • Pt supine, hip slightly abducted, and extended so thigh is resting on surface of table
  • Knee FLX 30 degrees over side of table
  • Apply force lateral to medial on distal femur
  • Pull medial to lateral on medial malleolus with slight ER of the tibia
  • Assess again in full knee extension
  • Assess excessive medial opening with concordant pain when compared to opposite side
    At 30 degrees: MCL implicated
    A 0 degrees: PCL and/or joint capsule is implicated
56
Q

Describe a varus stress test of the knee.

A
  • Pt supine with hip abducted and knee extended so that it rests on the table
  • Flex knee 30 degrees and apply medial to lateral force at distal femur, and lateral medial force lateral malleolus with slight ER of the tibia
  • Repeat in full knee extension
    30 degrees: LCL implicated
    0 degrees: PCL and/or joint capsule implicated
57
Q

Describe a test for patellar subluxation/ dislocaiton.

A
  • Patellar apprehension
  • Pt supine with relaxed knee passivley FLX 30 degrees over side of examining table, foot resting on PT
  • PT presses both thumbs on medial aspect of patella to exert a lateral force
  • Assess if patient resists the lateral force or if pain is provoked
58
Q

Describe the test for patellofemoral pain.

A
  • Patella grind
  • Pt supine with both knees supported by pad or bolster
  • Cup superior border of patella, and displace it distally while patient is relaxed
  • Patient then contracts quadriceps
  • Assess if symptoms are reproduced
59
Q

What is a special test used to assess knee swelling? Describe it.

A
  • Patellar ballotterment
  • Tap on middle of patella
  • Assess if there is a clicking of the patella against the femur
60
Q

Describe tibiofemoral distraction.

A
  • Pt prone
  • Pillow placed into popliteal fossa
  • Elbows rest in fossa stabilizing femur
  • Grip malleoli with both hands with knee extended
  • Flex knee/ pull tibia up
61
Q

Describe a dorsal tibial glide.

A
  • Pt supine
  • Knee flexed to comfort
  • Sit on foot
  • Hands grip proximal tibial
  • Push tibia posteriorly
62
Q

Describe a ventral tibial glide.

A
  • Pt Prone
  • Towel roll under distal tibia
  • Stabilize femur (cross over with arm)
  • Glide tibia ventrally through proximal tibia
63
Q

Describe a dorsal femoral glide.

A
  • Pt supine
  • Towel under proximal tibia
  • One hand stabilizes tibia
  • Other hand applies dorsal pressure through distal femur
64
Q

Describe a medial tibial glide.

A
  • Patient side lying on unaffected side
  • Flex knee 20 degrees
  • Place pillow between legs
  • Brance leg on PT’s thigh
  • Distract with hand on distal malleolus
  • Medially glide with proximal hand slightly under the fibular head
65
Q

Describe a lateral tibial glide.

A
  • Pt sidelying on affected side
  • Towel under femur
  • Distract with malleoli
  • Laterally glide through tibia
66
Q

Describe a cranial, caudal, medial, and lateral patellofemoral glide.

A
  • Prop Pt’s leg under PT’s knee

- Cup the patella with the webspaces of both hands, and mobilize into limited direction

67
Q

How can it be determined if a cranial glide of the patella is necessary?

A
  • Flex knee to end range and see if patella can still glide upwards
  • Can be combined with a tilt
68
Q

Describe a cranial and dorsal glide of the proximal tibiofibular joint.

A
  • Patient sidelying onto unaffected limb
  • Affected knee slightly bent
  • Use palm/ hypothenar eminence to push fibular head into targeted glide
  • Can also invert the ankle to pull the fibula distally

OR

  • Have patient lying prone and knee FLX 90 degrees
  • Push downwards through lateral malleolus (for cranial glide)
69
Q

Describe a dorsal and ventral glide of the fiblua on the tibia at the proximal joint.

A
  • Pt side lying on unaffected side
  • Affect knee bent slightly
  • Apply desired glide with thumb or hypothenar eminence
70
Q

Describe a flexion manipulation of the knee.

A
  • Pt supine with hip flexed
  • Flex knee
  • Push gastroc and soleus out of the way, and block the posterior movement of the tibia
  • Combine a quick osteokinematic thrust of knee flexion with a ventral thrust of the fibular head.
71
Q

What are 3 special tests used to assess the ligamentous structures of the ankle?

A
  • Inversion stress/ medial talar tilt
  • Eversion stress/ lateral talar tilt
  • Anterior drawer
72
Q

What are 4 special tests to assess syndesmosis injury?

A
  • Fibular translation test
  • Achille’s Tendon Integrity
  • Syndesmosis Squeeze test
  • ER Stress Test
73
Q

Describe an inversion stress/ medial tarsal tilt.

A
  • Pt supine or sitting
  • Pt grasps malleoli
  • Quick medial thrust applied to calcaneus
  • Assess laxity when compared to unaffected side
74
Q

Describe an eversion stress/ lateral talar tilt test.

A
  • Pt supine or sitting
  • Grasp malloli
  • Quick lateral thrust of calcaneus
  • Assess laxity when comapared to unaffected side
75
Q

Describe an anterior drawer of the ankle.

A
  • Pt lies in a supine position. Ankle prepositioned into slight plantar flexion
  • Stabilize malleoli
  • Cup the calcaneus, and pull the hind foot anteriorly
  • Assess excessive anterior translation when compared with the unaffected side

or

  • Supine, with knee bent and foot flat on the table
  • Thrust Distal tib-fib joint posteriorly
76
Q

Describe the fibular translation test.

A
  • Pt prone or sidelying
  • Apply anterior and posterior gliding forces onto the fibula at the distal tib-fib joint
  • Assess pain or displacement when compared to the contralateral side
77
Q

Describe the achille’s tendon intengrity: Thompson Test.

A
  • Pt supine
  • PT squeezes calf of Pt’s leg
  • Assess lack of plantarflexion response
78
Q

Describe the syndesmosis squeeze test.

A
  • Pt supine or sidelying
  • Examiner applies squeeze of fibula into tibia at mid-point of calf
  • Assess if proximal force causes distal pain
79
Q

Describe the external rotation stress test.

A
  • Pt supine; Knee flexed to 90 degrees
  • Examiner holds ankle in neutral and then applies an ER movement to the ankle
  • Assess reproduction of symptoms
80
Q

What are the 2 subtalar neutral techniques?

A
  • Calcaneal position technique

- Standing subtalar neutral position

81
Q

Describe calcaneal position technique.

A
  • Pt prone, with both feet overhanging the plinth
  • Bisect calcaneus by placing dots on the inferior and middle aspect of the calcaneus. Connect the dots with a line
  • Find subtalar neutral by palpating tali and finding a position where the medial and lateral aspects are palpated equally
  • Use a goniometer to measure the varus or valgus of the calcaneus
82
Q

Describe the 2 sets of Ottawa Ankle rules.

A

If there is pain in the anterior aspect of the medial and lateral malleoli and anterior dome region and any of the following:

  • Bone tenderness at the posterior aspects of the medial malleolus
  • Bone tenderness at the lateral malleolus
  • In ability to weight-bear immediately after injury or in the emergency room

OR

Pain in the dorsal medial and lateral aspect of the mid-foot and any of the following:

  • Bone tenderness at base of the fifth metatarsal
  • Bone tenderness at the navicular
  • Inability to weight-bear immediately after the injury and in the emergency room
83
Q

What are 3 tests for DVT and neuroma at the ankle/ calf?

A
  • Homan’s sign for DVT
  • Morton’s test for neuroma
  • Well’s Clinical Prediction Rule
84
Q

Describe Morton’s test for neuroma.

A
  • Pt supine or sitting
  • Squeeze metatarsal heads from lateral to medial toward mid-line
  • Assess reporduction of symptoms
85
Q

Describe Well’s Clinical Prediction Rule.

A

Major criteria:

  • Active cancer within the last 6 months
  • Paralysis
  • Recently bedridden
  • Localized tenderness
  • Thigh and calf are swollen
  • Strong family history of DVT

Minor criteria:

  • History of recent trauma
  • Pitting edema
  • Dilated superficial veins
  • Hospitalized within last 6 months
  • Erythema

Positive Test:
> 3 of the major criteria
> 2 of the minor criteria

86
Q

Describe Homan’s sign for DVT.

A
  • Pt supine with knee slightly flexed (May use bolster or knee)
  • Apply forceful dorsiflexion
  • Assess popliteal and calf pain
87
Q

What are 2 tests for Tarsal Tunnel?

A
  • Tinel’s sign

- Provocation Test

88
Q

Describe Tinel’s Sign for Tarsal Tunnel.

A
  • Pt sidelying
  • Tapping force on posteromedial ankle
  • Assess tingling during test
89
Q

Describe the provocation test for Tarsal Tunnel.

A
  • Maximum eversion and dorsiflexion with extension of digits
90
Q

Describe a dorsal glide of the fibula on the tibia at the distal tibiofibular joint.

A
  • Supine or long sitting
  • Stabilize tibia
  • Thenar eminence over distal fib
  • Translate low amplitude
91
Q

Describe a ventral glide of the fibula on the tibia at the distal tibiofibular joint.

A
  • Pt prone
  • Stabilize under tibia
  • Push dorsally on lateral malleolus
92
Q

Describe a cranial glide of the fibula on the tibia at the distal tibiofibular joint.

A
  • Pt prone

- Push the lateral malleolus cranially

93
Q

Describe Talocrural distraction.

A
  • Pt supine
  • Cross fingers over dorsum of foot at joint line
  • Go into some dorsiflexion and eversion
  • Distract
94
Q

Describe a MWM for dorsiflexion.

A
  • Pt assumes lunge type position
  • Hold dorsal glide, and assist motion by IR the tibia
  • Can use gait belt to assist dorsal glide of talus by pulling tibiofibular joint forward
95
Q

Describe a ventral glide of the talocrural joint.

A
  • Pt prone
  • Pillow under distal tibia
  • Push through calcaneus
  • Tends to be used at end range plantar flexion
96
Q

Describe distraction of the subtalar joint.

A
  • Pt supine
  • Tibiofibular joint stabilized from anterior aspect
  • Heel cradled from posterior aspect
  • Rock between the two grips
97
Q

Describe a lateral glide/ eversion of the subtalar joint.

A
  • Pt sidelying with affected side on table
  • Support lateral malleolus
  • Push laterally through heel
98
Q

Describe a medial glide inversion of the subtalar joint.

A
  • Pt sidelying with unaffected side on table
  • Support medial malleolus
  • Push medially through calcaneus
99
Q

Describe 2 grips used for MTP/ IP mobilizations.

A
  • Lock grip between 2nd and 3rd webspaces

- Full grip

Musculoskeletal I (second exam/practical) (7 decks)

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