LE Tests Flashcards
What 4 tests are used to assess joint mobility and integrity of the hip?
- Lateral/medial translation
- Distraction
- Compression
- Anteroposterior/ posteroanterior glides
What are 4 quick tests to assess ROM at the hip?
- Place foot on standard step
- Forward bend
- Squatting
- Sitting with leg crossed
What are 7 functional tests of the hip?
- 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
What exercise is used commonly in treating hamstrings? Describe it.
- Stomach-lying hip extension
- Prone with pillow under torso
- Activate abdominals, squeeze “seat muscles”
- Barely lift thigh off floor
Describe the capsular pattern of hip hypomobility.
- 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
Describe the 6 components of examination of a patient with a hip impairment.
- Posture: Asymmetry in standing
- Gait: (trendelenberg, hip excursion/ ROM, Avoidance
- Clear LSS, Knee
- ROM
- Flexibility
- MMT
Describe the sign of the buttock.
- Limited SLR
- Hip and knee flexion are limited and painful
What 6 pathologies are indicated by the sign of the buttock?
- Osteomyelitis
- Septic arthritis/ bursitis
- Ischiorectal abscess
- Rheumatic fever with bursitis
- Neoplasm of the femur or ilium
- Fractured sacrum
What are 2 functional scales of the hip?
- LEFS
- Harris hip function scale
What 4 impairments/ pathologies do the hip scour and hip quadrant test for?
- Labrum integrity
- Capsulitis
- OA
- Femoral acetabular impingement syndrome
Describe a hip scour.
- 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.
Describe a hip quadrant.
- 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
What 3 tests assess a tear of the gluteus medius?
- Trendelenburg’s sign
- Resisted hip ABD
- Passive IR
Describe trendelenburg’s sign.
- 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
Describe resisted hip ABD.
- Pt sidelying on unaffected side
- Pt ABDs to 45 degrees
- PT resists abduction just distal to knee
- Assess reproduction of symptoms
Describe passive IR.
- 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)
How is OA assessed?
- Range of motion plane assessment.
Describe ROM plane assessment for OA.
- 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
What is the special test for ITB restriction?
- Ober test
Describe Ober test.
- 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)
What 3 tests assess Anterior or Lateral Capsular restriction or hip flexor tightness?
- Patrick/ FABER test
- Thomas test
- Prone hip extension test
Describe the Patrick/ FABER test.
- 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
Describe the Thomas test.
- 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
Describe the prone hip extension test.
- 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
What are 2 tests for early signs of hip dysplasia?
- Passive hip ABD test
- Flexion ADD test
Describe the passive hip ABD test.
- Pt supine
- Passively move hip into ABD
- Assess restriction of ABD compared to unaffected side
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
What are the 5 commonly performed hip mobilizations?
- Short axis distraction
- Inferior glide/ long axis distraction
- Posterior glide
- Anterior glide
- Lateral glide
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
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
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
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
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
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
What are the Pittsburgh knee rules?
- Blunt trauma or fall AND Inability to take 4 steps immediately/ in clinic OR Age 50
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
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
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
What are 4 special tests for meniscal tears?
- McMurrary test
- Apley test
- Ege’s test
- Dynamic test (figure 4 adduction)
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)
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
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
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
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
What are 3 ACL competence tests?
- Lachman’s test
- Anterior drawer test
- Pivot-shift test
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
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
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
What are 4 tests for PCL competence?
- Posterior drawer
- Godfrey’s Sag
- Reverse Pivot-Shift
- Reverse Lachman
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
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
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
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
What are 2 tests for the collateral ligaments of the knee?
- Valgus stress
- Varus stress
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
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
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
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
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
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
Describe a dorsal tibial glide.
- Pt supine
- Knee flexed to comfort
- Sit on foot
- Hands grip proximal tibial
- Push tibia posteriorly
Describe a ventral tibial glide.
- Pt Prone
- Towel roll under distal tibia
- Stabilize femur (cross over with arm)
- Glide tibia ventrally through proximal tibia
Describe a dorsal femoral glide.
- Pt supine
- Towel under proximal tibia
- One hand stabilizes tibia
- Other hand applies dorsal pressure through distal femur
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
Describe a lateral tibial glide.
- Pt sidelying on affected side
- Towel under femur
- Distract with malleoli
- Laterally glide through tibia
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
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
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)
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
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.
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
What are 4 special tests to assess syndesmosis injury?
- Fibular translation test
- Achille’s Tendon Integrity
- Syndesmosis Squeeze test
- ER Stress Test
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
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
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
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
Describe the achille’s tendon intengrity: Thompson Test.
- Pt supine
- PT squeezes calf of Pt’s leg
- Assess lack of plantarflexion response
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
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
What are the 2 subtalar neutral techniques?
- Calcaneal position technique
- Standing subtalar neutral position
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
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
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
Describe Morton’s test for neuroma.
- Pt supine or sitting
- Squeeze metatarsal heads from lateral to medial toward mid-line
- Assess reporduction of symptoms
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
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
What are 2 tests for Tarsal Tunnel?
- Tinel’s sign
- Provocation Test
Describe Tinel’s Sign for Tarsal Tunnel.
- Pt sidelying
- Tapping force on posteromedial ankle
- Assess tingling during test
Describe the provocation test for Tarsal Tunnel.
- Maximum eversion and dorsiflexion with extension of digits
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
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
Describe a cranial glide of the fibula on the tibia at the distal tibiofibular joint.
- Pt prone
- Push the lateral malleolus cranially
Describe Talocrural distraction.
- Pt supine
- Cross fingers over dorsum of foot at joint line
- Go into some dorsiflexion and eversion
- Distract
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
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
Describe distraction of the subtalar joint.
- Pt supine
- Tibiofibular joint stabilized from anterior aspect
- Heel cradled from posterior aspect
- Rock between the two grips
Describe a lateral glide/ eversion of the subtalar joint.
- Pt sidelying with affected side on table
- Support lateral malleolus
- Push laterally through heel
Describe a medial glide inversion of the subtalar joint.
- Pt sidelying with unaffected side on table
- Support medial malleolus
- Push medially through calcaneus
Describe 2 grips used for MTP/ IP mobilizations.
- Lock grip between 2nd and 3rd webspaces
- Full grip
