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
What are 2 tests for early signs of hip dysplasia?
- Passive hip ABD test | - Flexion ADD test
26
Describe the passive hip ABD test.
- Pt supine - Passively move hip into ABD - Assess restriction of ABD compared to unaffected side
27
Describe the flexion adduction test.
- 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
28
What are the 5 commonly performed hip mobilizations?
- Short axis distraction - Inferior glide/ long axis distraction - Posterior glide - Anterior glide - Lateral glide
29
Describe a short-axis distraction of the hip.
- 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
30
Describe an inferior glide/ long axis distraction.
- Pt supine - Grip both sides of thigh proximal to knee - Grasps lower leg with elbow against body - Lean backwards to distract the hip
31
Describe an inferior glide of the hip in 90 degrees flexion.
- Patient supine - Leg propped on PT shoulder - Hands linked over proximal femur - Lean backwards to distract hip - Counterpressure through shoulder
32
Describe a posterior glide of the hip.
- 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
33
Describe a ventral glide of the hip.
- 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
34
Describe a lateral/medial femoral rotation mobilizaitons if the hip.
- 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
35
What are the Pittsburgh knee rules?
``` - Blunt trauma or fall AND Inability to take 4 steps immediately/ in clinic OR Age 50 ```
36
What are the Ottawa knee rules?
- 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
37
What are 10 functional tests that may be performed when evaluating the knee?
- 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
38
What are 4 functional tests of the knee that can quantified?
- Single hop for distance - Triple hop for distance - Crossover triple hop for distance - Timed 6 meter hop
39
What are 4 special tests for meniscal tears?
- McMurrary test - Apley test - Ege's test - Dynamic test (figure 4 adduction)
40
Describe the McMurray test.
- 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
Describe Apley's test.
- 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
Describe Ege's Test.
``` - 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
Describe the Dynamic Test (figure 4 adduction).
- 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
Describe Thessaly Test/ Disco test. What two positions may it be performed in.
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
What are 3 ACL competence tests?
- Lachman's test - Anterior drawer test - Pivot-shift test
46
Describe Lachman's test.
- 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
Describe the anterior drawer tests. What two positions may it be performed in?
- 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
Describe the pivot-shift test of the knee.
- 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
What are 4 tests for PCL competence?
- Posterior drawer - Godfrey's Sag - Reverse Pivot-Shift - Reverse Lachman
50
Describe a posterior drawer.
- 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
Describe Godfrey's Sag.
- 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
Describe reverse pivot-shift.
- 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
Describe Reverse Lachman's Test.
- 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
What are 2 tests for the collateral ligaments of the knee?
- Valgus stress | - Varus stress
55
Describe a valgus stress test of the knee.
- 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
Describe a varus stress test of the knee.
- 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
Describe a test for patellar subluxation/ dislocaiton.
- 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
Describe the test for patellofemoral pain.
- 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
What is a special test used to assess knee swelling? Describe it.
- Patellar ballotterment - Tap on middle of patella - Assess if there is a clicking of the patella against the femur
60
Describe tibiofemoral distraction.
- 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
Describe a dorsal tibial glide.
- Pt supine - Knee flexed to comfort - Sit on foot - Hands grip proximal tibial - Push tibia posteriorly
62
Describe a ventral tibial glide.
- Pt Prone - Towel roll under distal tibia - Stabilize femur (cross over with arm) - Glide tibia ventrally through proximal tibia
63
Describe a dorsal femoral glide.
- Pt supine - Towel under proximal tibia - One hand stabilizes tibia - Other hand applies dorsal pressure through distal femur
64
Describe a medial tibial glide.
- 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
Describe a lateral tibial glide.
- Pt sidelying on affected side - Towel under femur - Distract with malleoli - Laterally glide through tibia
66
Describe a cranial, caudal, medial, and lateral patellofemoral glide.
- Prop Pt's leg under PT's knee | - Cup the patella with the webspaces of both hands, and mobilize into limited direction
67
How can it be determined if a cranial glide of the patella is necessary?
- Flex knee to end range and see if patella can still glide upwards - Can be combined with a tilt
68
Describe a cranial and dorsal glide of the proximal tibiofibular joint.
- 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
Describe a dorsal and ventral glide of the fiblua on the tibia at the proximal joint.
- Pt side lying on unaffected side - Affect knee bent slightly - Apply desired glide with thumb or hypothenar eminence
70
Describe a flexion manipulation of the knee.
- 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
What are 3 special tests used to assess the ligamentous structures of the ankle?
- Inversion stress/ medial talar tilt - Eversion stress/ lateral talar tilt - Anterior drawer
72
What are 4 special tests to assess syndesmosis injury?
- Fibular translation test - Achille's Tendon Integrity - Syndesmosis Squeeze test - ER Stress Test
73
Describe an inversion stress/ medial tarsal tilt.
- Pt supine or sitting - Pt grasps malleoli - Quick medial thrust applied to calcaneus - Assess laxity when compared to unaffected side
74
Describe an eversion stress/ lateral talar tilt test.
- Pt supine or sitting - Grasp malloli - Quick lateral thrust of calcaneus - Assess laxity when comapared to unaffected side
75
Describe an anterior drawer of the ankle.
- 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
Describe the fibular translation test.
- 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
Describe the achille's tendon intengrity: Thompson Test.
- Pt supine - PT squeezes calf of Pt's leg - Assess lack of plantarflexion response
78
Describe the syndesmosis squeeze test.
- Pt supine or sidelying - Examiner applies squeeze of fibula into tibia at mid-point of calf - Assess if proximal force causes distal pain
79
Describe the external rotation stress test.
- 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
What are the 2 subtalar neutral techniques?
- Calcaneal position technique | - Standing subtalar neutral position
81
Describe calcaneal position technique.
- 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
Describe the 2 sets of Ottawa Ankle rules.
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
What are 3 tests for DVT and neuroma at the ankle/ calf?
- Homan's sign for DVT - Morton's test for neuroma - Well's Clinical Prediction Rule
84
Describe Morton's test for neuroma.
- Pt supine or sitting - Squeeze metatarsal heads from lateral to medial toward mid-line - Assess reporduction of symptoms
85
Describe Well's Clinical Prediction Rule.
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
Describe Homan's sign for DVT.
- Pt supine with knee slightly flexed (May use bolster or knee) - Apply forceful dorsiflexion - Assess popliteal and calf pain
87
What are 2 tests for Tarsal Tunnel?
- Tinel's sign | - Provocation Test
88
Describe Tinel's Sign for Tarsal Tunnel.
- Pt sidelying - Tapping force on posteromedial ankle - Assess tingling during test
89
Describe the provocation test for Tarsal Tunnel.
- Maximum eversion and dorsiflexion with extension of digits
90
Describe a dorsal glide of the fibula on the tibia at the distal tibiofibular joint.
- Supine or long sitting - Stabilize tibia - Thenar eminence over distal fib - Translate low amplitude
91
Describe a ventral glide of the fibula on the tibia at the distal tibiofibular joint.
- Pt prone - Stabilize under tibia - Push dorsally on lateral malleolus
92
Describe a cranial glide of the fibula on the tibia at the distal tibiofibular joint.
- Pt prone | - Push the lateral malleolus cranially
93
Describe Talocrural distraction.
- Pt supine - Cross fingers over dorsum of foot at joint line - Go into some dorsiflexion and eversion - Distract
94
Describe a MWM for dorsiflexion.
- 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
Describe a ventral glide of the talocrural joint.
- Pt prone - Pillow under distal tibia - Push through calcaneus - Tends to be used at end range plantar flexion
96
Describe distraction of the subtalar joint.
- Pt supine - Tibiofibular joint stabilized from anterior aspect - Heel cradled from posterior aspect - Rock between the two grips
97
Describe a lateral glide/ eversion of the subtalar joint.
- Pt sidelying with affected side on table - Support lateral malleolus - Push laterally through heel
98
Describe a medial glide inversion of the subtalar joint.
- Pt sidelying with unaffected side on table - Support medial malleolus - Push medially through calcaneus
99
Describe 2 grips used for MTP/ IP mobilizations.
- Lock grip between 2nd and 3rd webspaces | - Full grip