Lower Body Part 2 Flashcards
(118 cards)
1
Q
Belt Test:
AKA ‘Supported Adam’s Sign’ Test is used to differentiate an SI joint problem from a lumbar problem
Procedure
A
Part I: Patient flexes the dorso-lumbar spine actively. Examiner notes the point at which the symptoms are produced or aggravated. Part II: Have the doctor support the patient by grasping both ASIS’s with his/her hands and then bracing the sacrum with their hip or thigh, and locking the SI
allowing them to flex the lumbar spine.
2
Q
Belts test
Pathomechanics:
A
Unsupported flexion allows hip, SI joint and lumbar spine motion. Supported flexion allows only lumbar spine motion.
3
Q
Belts Test
Indications
A
In lumbar symptoms, you will produce or aggravate symptoms in both supported and unsupported test. Pelvic symptoms are not aggravated or reproduced in supported flexion.
4
Q
Gaenslen’s Test:
Assesses for SI joint pathology.
Procedure
A
Patient is supine on the table; doctor will stand, on the symptomatic side. Move the patient’s leg over to the edge of the table on the affected side. Have the patient flex the hip and the knee on the unaffected side. Have patient grasp the knee to keep it in flexion. Drop the symptomatic leg off the table, so that the ilium is extended. Doctor will then put pressure on the knee in flexion, and the thigh in extension.
5
Q
Gaenslen’s Test:
Pathomechanics
A
Flexion side flexes the ilium and causes sacral extension on the side being tested. (Similar to the knee-raising test from Kinetic Palpation), the extension of the ilium on the symptomatic leg, will produce compression of the ilium onto the sacrum.
6
Q
Gaenslen’s Test:
Indications
A
Aggravation or reproduction of symptoms on the leg extension side(symptomatic side) indicates SI joint lesion.
7
Q
Yeoman’s Test:
Assesses for compression of posterior superior SI joint
and stretching of the anterior inferior sacral iliac ligament on the anterior inferior part of the SI joint on the affected side.
Procedure
A
Patient is prone. Examiner will stand on the tested side and flex the leg at the knee to 90 degrees. Doctor will grasp the anterior knee with the inferior hand, and with the heel of the superior hand, stabilize the affected posterior SI joint (ipsilateral). Doctor lifts the knee, which will extend the thigh.
8
Q
Yeoman’s Test:
Pathomechanics
A
Flexion of the knee tightens the quads muscle to assist in ipsilateral ilium extension, which is being performed on hip extension. This causes compression of the ipsilateral ilium surface onto the sacrum. It also places a stretch on the anterior sacro-iliac ligament.
9
Q
Yeoman’s Test:
Indications
A
Reproduction or aggravation of posterior SI joint symptoms
indicates SI joint surface pathology. Deep pelvic pain on the anterior side of the SI joint would indicate SI joint anterior sacro-iliac ligament.
10
Q
Iliac Compression Test:
Assesses for SI joint lesions, inflammation, and subluxation, a compression test of the ilium onto the sacrum
Procedure:
A
Patient is lying on their side with the affected side up. Doctor will grasp the superior ilium and rocks it posterior and medial.
11
Q
Iliac Compression Test
Pathomechanics
A
Compresses the ilium onto the sacrum.
12
Q
Iliac Compression Test
Indication
A
Reproduction or aggravation of SI joint pain on the side being compressed indicates SI joint lesion.
13
Q
Hibb’s Test:
Assesses for SI joint posterior capsule lesions on the affected side
Procedure:
A
Patient is prone. Doctor flexes the knee approximating the heel to the buttock. Add internal rotation of the thigh by pushing the ankle laterally.
14
Q
Hibbs Test
Pathomechanics
A
Internal rotation of the thigh internally rotates the ilium on the side tested, therefore stretching the posterior SI ligaments. (This will also stretch the piriformis muscle and compress the sciatic nerve, which pierces the muscle.)
15
Q
Hibb’s Test
Indications
A
Reproduction or aggravation of posterior SI joint symptoms
indicates posterior SI joint ligament pathology. Reproduction or aggravation of deep buttock pain radiating down the posterior leg along the course of the sciatic nerve indicates sciatic nerve entrapment, sometimes known as ‘Piriformis Syndrome’. This is a peripheral nerve problem, not a nerve root problem.
16
Q
Hip Flexion
A
Iliopsoas, femoral nerve L1-3
17
Q
Hip Extension
A
Gluteus maximus, inferior gluteal nerve L5-S2.
Semitendonosus, tibial branch of the sciatic nerve L4-S2, Semimembranosous, tibial branch of the sciatic nerve L5-S2
Long head of biceps femorus, tibial branch of sciatic S1-3.
18
Q
Hip Abduction
A
Gluteus medius, superior gluteal nerve L4-L1.
19
Q
Hip Adduction
A
Adductor magnus, obturator nerve and sciatic nerve L3-S1
Adductor brevis and longus, obturator nerve L3-4.
Pectineus, femoral nerve L2-4.
Gracilis, obturator nerve L3-4.
20
Q
Hip Internal Rotation
A
Gluteus minimus, superior gluteal nerve L4-S1.
TFL, superior gluteal nerve L4-S1.
21
Q
Hip External Rotation
A
Obturator externus, obturator nerve L3-4.
Obturator internus, sacral plexus L4-S1
Gamelus, superior and inferior, sacral plexus L4-S2,
Gluteus maximus, inferior gluteal nerve L5-S2.
22
Q
Hip Caudal Glide:
Assesses the Pathomechanics hip joint and the joint capsule.
Procedure:
A
Patient is supine. Grasp the distal end of the femur with both hands, and distract the femur (pull down).
23
Q
Hip Caudal Glide
Pathomechanics
A
Distracts the hip joint, thus separating the acetabulum and the femoral head, and stretches the ligaments. Muscles are in neutral unless there is a spasm.
24
Q
Hip Caudal Glide
Indications
A
Aggravation or reproduction of symptoms within the hip, it
would indicate a joint capsule problem (capsalgia). If the test relieves their symptoms, then it is probably a surface pathology (arthralgia).
25
Hip Compression Test:
Assesses for hip joint internal dysfunction or pathology
Procedure:
Patient is supine. Hip and knee are flexed so that the foot can be placed flat on the table. Grasp the distal femur with both hands and push the femur toward the pelvis.
26
Hip Compression Test
| Pathomechanics
Pathomechanics: Compresses the hip joint.
27
Hip Compression Test
Indications
Aggravation or reproduction of symptoms indicates a hip joint surface pathology. (Coxal arthralgia)
28
Lateral Distraction:
Assesses for internal hip surface or joint capsule
Procedure
Patient is supine. Grasp the upper thigh with both hands of the affect hip and laterally distract.
29
Lateral Distraction
| Pathomechanics
Distracts or separates the hip joint surface and stretches the capsule.
30
Lateral Distraction
Indications
Indications: Same as the distraction test.
31
Anvil Test:
Assesses hip joint surface and can be an indicator of femoral
Procedure:
Patient is supine. Examiner will strike the inferior calcaneus of the affected hip with their fist after the leg is slightly flexed the lower leg.
32
Anvil Test
Pathomechanics
Pathomechanics: The strike on the calcaneus will send a momentary compressive shock wave through the leg to the pelvis.
33
Anvil Test
Indications
Aggravation or reproduction of hip symptomotology would
be hip joint pathology or may indicate a fracture. In the thigh, lower leg, or heel would suspect joint pathology or fracture.
34
Patrick’s Test:
AKA Fabere-Patrick Test. Assesses for hip joint pathology, and also assesses for SI joint pathology.
Procedure
Patient is supine. Doctor will grasp the ankle and the knee.
Flex the knee and the hip. Abduct the hip. Externally rotate the hip, and then lay the ankle on the opposite knee (making a figure 4). Stabilize the contralateral ASIS and push down on the ipsilateral knee. As the patient relaxes, they extend the hip.
35
Patrick’s Test
Pathomechanics
Torsioning and stretching of the hip joint capsule with flexion, abduction, and external rotation. The extension compresses the femoral head into the acetabulum. Also it externally rotates the ilium, which will compress the ilium onto the sacrum.
36
Patrick’s Test
Indications
Reproduction or aggravation of hip symptoms especially in the groin area is the joint capsule. In the posterior part of the hip is the joint surface. It can also be pain in the SI joint.
37
Leguerre’s Test:
Modified Patrick’s test.
Procedure:
Same procedure as Patrick’s test with the figure 4, except
there is no extension, the doctor will hold the leg up and take their inferior hand and put it under the ankle. Place their superior hand on the knee of the side being tested, and externally rotating
the hip.
38
Leguerre’s Test
| Pathomechanics
Same as Patrick’s, mostly torsioning the hip capsule and not compressing the femoral head into the acetabulum
39
Leguerre’s Test
Indications
Same as Patrick’s, pain around the hip joint indicates capsule pain
40
Trendelenburg’s Test:
Assesses for a weak gluteus medius, which adducts the hip.
a. Procedure
Patient is standing. Patient will then raise the leg on the
unaffected side, flexing the hip and the knee in knee rising. Doctor will then observe the level of the iliac crest.
41
Trendelenburg’s Test:
Pathomechanics
When doing the knee rising, the standing leg gluteus medius has to contract to stabilize the hip on that side, allowing the patient to stand on that leg.The patient's raising leg flexes the ilium and elevates the ilium higher than the non-flexed side.
42
Trendelenburg’s Test
Indications
In a patient with hip joint pathology the gluteus medius on
that side can become weak. When performing Trendelenburg's test the weak gluteus medius allows the pelvis to shift laterally on the standing side and the pelvis to drop on the knee risingside. Painful Trendelenburg's Test indicates hip pathology; non-painful gluteus medius weakness could be neurological or muscle pathology.
43
Ober’s Test:
Assesses for ilio-tibial band contracture.
Procedure
Patient lies on their side with the affected side up. Doctor places one hand on the up side ilium to stabilize the patient. Grasp the patient’s lower leg and flex the knee to 90 degrees. Then abduct and extend the hip. While in extension, relax and allow the hip to adduct.
44
Ober’s Test
Pathomechanics
In hip joint pathology you can end up with IT band contractures. When this maneuver is performed, the hip will stay in abduction if there is contracture.
45
Ober’s Test
Indication
If the maneuver is performed and the hip remains in abduction, or lowers in a ratchet (jerky)motion it indicates hip joint pathology (IT band).
46
Thomas Test:
Assesses for flexion contractures involving the iliopsoas
Procedure
Patient is supine. Doctor stands on the same side as the
| unaffected leg. Doctor will flex the knee and the hip, approximating the knee to the abdomen.
47
Thomas Test
Pathomechanics
When you flex the hip and approximating the knee to the abdomen, then eventually the SI joint is flexed, the sacrum is extended causing the lumbar spine to flex into a kyphosis. Spasm of the iliopsoas muscle doesn't allow this motion.
48
Thomas Test
Indications
Maintenance of a lordotic curve and flexion of the contralateral hip with this test indicates a contracture of the iliopsoas muscle
49
Leg Length:
Assesses a leg length for inequality.
Procedure:
Patient is supine. Take a tape measure and measure same side ASIS to medial malleolus. Perform this on both legs.
50
Leg Length Test
Pathomechanics
Short leg will measure less.
51
Leg Length
Indications
Indicates actual leg length deficiency.
52
Deep Palpation: To assess for muscle tendon pain.
1. Adductor Compartment: Palpate up in the medial thigh.
2. Hip Abductors: Lateral thigh palpation.
3. Hip Extensors: Buttock and medial hamstrings
4. Hip Flexors: Iliopsoas.
53
Knee
Range of Motion (Active, Passive, Resistive)
Flexion (135):
Primer movers: Biceps femorus, innervated by tibial branch of sciatic nerve to the long head, L4-S1 roots, Peroneal branch to the short head, L4-S2. Patient can be examined prone or standing for active testing.
54
Knee
ROM
Extension
Prime mover is the quadratus femorus muscle. Innervated by the femoral nerve, L2-4 nerve roots, Lumbar plexus. Active can be done standing or seated. Passive and resistive would be done seated.
55
Varus Stress Test:
(Adduction stress test)
Procedure:
Patient is supine or seated. Stand on the side being tested.
Doctor will grasp the lateral ankle with one hand and the medial distal femur with the other hand. Stabilize the femur and push the ankle medially, can be done in extension and in slight flexion.
56
Varus Stress Test:
Pathomechanics
Stretching the lateral collateral ligament with this maneuver
57
Varus Stress Test:
Indications
Aggravation or reproduction of lateral knee symptoms at the location of the lateral collateral ligament would indicate ligament pathology (a sprain). If there is excessive varus angle, you may have damage to the collateral ligament that has left it lax or
avulsed.
58
Nobel's Compression Test:
Assesses for Iliotibial Band contractures(syndrome) on patients with lateral knee pain
Procedure:
With the patient supine the examiner stands on the side being tested flexing the hip and knee to 90 degrees then contact the lateral femoral condyle with his superior thumb compressing the distal tendon of the Iliotibial band. Then the examiner will extend the knee and hip lowering the leg.
59
Nobel's Compression Test:
Pathomechanics
This procedure will stretch the Iliotibial band as the leg is lowered
60
Nobel's Compression Test:
Indications
Severe pain under the thumb as the leg reaches about 30 degrees of extension indicates Iliotibial band contracture and friction rub against the lateral condyle of the femur.
61
Valgus Knee Pain:
(Abduction stress test)
Procedure
Procedure is the same, only the hands are switched. Contact the medial ankle with one hand, and lateral distal femur with the other. Stabilize the thigh and push the leg into abduction.
62
Valgus Knee Pain:
Pathomechanics
Stretches the medial collateral ligament
63
Valgus Knee Pain:
Indications
Aggravation or reproduction of medial knee symptoms at the location of the medial collateral ligament would indicate ligament pathology (a sprain). If there is excessive valgus angle, you may have damage to the collateral ligament that has left it lax or
avulsed.
64
Clarke’s Sign:
Assesses for chondromalacia patella.
Procedure
Patient is supine, with their knee extended. The doctor will compress the quadriceps muscle at the superior poll of the patella with the thumb web of the hand. Ask the patient to contract the quadriceps muscle as the examiner resists the superior
movement of the patella.
65
Clarke’s Sign
Pathomechanics
Contraction of the quadriceps muscle while resisting patellar movement compresses the patella against the femoral condyle.
66
Clarke’s Sign
Indications
Aggravation or reproduction of retro patellar symptoms or a failure of the patient to contract the quadriceps due to symptoms indicates a chondromalacia development (softening of the cartilage on the backside of the patella).
67
Fouchet’s Sign:
Assesses for patellar tracking disorder
Procedure:
Patient is supine, with the knee extended. The examiner will use the palm of their hand and place it over the patella with slight compression. If it does not produce symptoms, the doctor will move the patella medial and lateral in a rocking motion.
68
Fouchet’s Sign:
Pathomechanics
When there is a tracking problem due to muscle imbalances, you can irritate the patella due to uneven wear.
69
Fouchet’s Sign:
Indications
Point tenderness with retro-patellar symptoms upon
| compression indicates a tracking disorder. Crepitus upon movement would also indicate a tracking disorder.
70
Knee Apprehension Test:
Assesses for lateral recurring patellar dislocation
Procedure:
With the patient supine and the symptomatic knee relaxed and flexed to 30 degrees the examiner will contact the medial patella with their thumbs and push the patella laterally.
71
Knee Apprehension Test
Pathomechanics
With laxity of the patellar tendon the dislocation is lateral and painful. This procedure will try to produce the dislocation.
72
Knee Apprehension Test
Indications
Production of pain on lateral movement of the patella or an
| apprehensive appearance on the patients face indicates a dislocation problem with the patella.
73
Patellar Ballottement Test for Effusion:
This test assesses for swelling on the knee
Procedure:
With the patient supine and the symptomatic leg is extended the examiner will press down or tap on the patella.
74
Patellar Ballottement Test for Effusion:
Pathomechanics
This procedure will push the patella down against the femoral condyles. If there is a lot of fluid build the patella will be pushed away from the femur when pushing down or tapping on the patella the fluid will be pushed from under the patella and be seen moving into the soft tissue around the patella.
75
Patellar Ballottement Test for Effusion:
Indications
Seeing fluid bulge around the patella during the procedure indicates effusion
76
Drawer Test:
Assesses for tears in the cruciate ligament, both anterior and posterior.
Procedure:
Patient is supine with the knee and hip flexed, so the patient
can put their foot flat on the table. Doctor will stabilize the patient’s foot by either sitting on it, or placing their knee upon it. Grasp the proximal tibia with both hands. Pull to do the anterior drawer sign, and push to do the posterior drawer sign of the knee.
77
Drawer Test
Pathomechanics
Cruciate ligaments stabilize the tibia from translating anterior or posterior (ACL & PCL)
78
Drawer Test
Indications
Test indicates cruciate tears when there is excessive tibial translation taking place, either anterior or posterior.
79
McMurray’s Sign:
Assesses medial and lateral meniscal tears. These can be cross tears or longitudinal tears.
Procedure:
Patient is supine. Doctor will be on the affected side being tested. Doctor’s inferior hand will grasp the ankle or heel. With the superior hand, take the thumb and chiro index finger and grasp the knee. Then flex the knee and the hip to 90 degrees. Then take the thumb and chiro index finger and palpate for the joint space. You will either externally rotate the tibia or internally rotate the tibia. The heel will point to the meniscus being tested. Then extend the patient’s knee.
80
McMurray’s Sign
Pathomechanics
With external rotation, as you extend the knee, you are running the medial condyle over the medial meniscus. With internal rotation, as you extend the knee, you are running the lateral condyle over the lateral meniscus.
81
McMurray’s Sign
Indications
Palpable or audible click while extending the knee is an
indication of mcmurray’s sign, and indicates meniscal tear. In the absence of clicks, it may just be internal knee symptoms or locking.
82
Apley’s Compression Test:
Assesses for the collateral ligament and meniscus of the knee.
Procedure
Patient is prone. Doctor stands on the side being tested.
Examiner flexes the knee to 90 degrees. Place one hand on the bottom of the foot and the other hand can grasp the ankle. Compress the knee as you rotate internally. Then compress the knee as you rotate externally. (2 parts)
83
Apley’s Compression Test
Pathomechanics
The heel points toward the meniscus being tested and also the collateral ligament that may be tested. The internal rotation and compression of the knee causes lateral meniscus is being run down (or compressed) on the lateral femoral condyle.At the same time the lateral collateral ligament is being stretched. The external rotation and compression, the medial meniscus is being run down (or compressed) on the medial femoral condyle, and stretching the medial collateral ligament.
84
Apley’s Compression Test
Indications
Aggravation or reproduction of internal knee symptoms with internal rotation and compression would be lateral meniscus. Lateral knee symptoms would be the lateral collateral ligament. Symptoms with external rotation and compression would be medial meniscus. Medial knee symptoms would be the medial collateral ligament, clicking while performing the test indicates meniscal tears.
85
Apley’s Distraction Test:
Assesses for collateral ligament damage mostly. Also can relieve internal knee pain
Procedure:
Setup is the same as before. Instead you will grasp the ankle
with both hands. Place one of your knees on the back of the patient’s thigh to stabilize it on the table. Distract the leg and externally rotate then go back to neutral and distract the leg and internally rotate it. Distract and rotate at the same time. Heel will point to the side being tested.
86
Apley’s Distraction Test
Pathomechanics
When you distract you are separating the meniscus from the femoral condyles. With external rotation, it will stretch the medial collateral ligament. With internal rotation, it will stretch the lateral collateral ligament
87
Apley’s Distraction Test
Indications
If you relieve internal knee pain with distraction, then there is an internal knee problem (meniscus). If you aggravate or reproduce symptoms on the medial knee with distraction and external rotation, then it is the medial collateral ligament. If you aggravate or reproduce symptoms on the lateral knee with distraction and internal rotation, then it is the lateral collateral ligament.
88
Bounce Home:
Assesses for meniscal tears
Procedures
The patient is supine and relaxed; the examiner will completely flex the knee and then allow it to passively extend.
89
Bounce Home
Pathomechanics
When the knee is extending the femoral condyles are compressing against the menisci.
90
Bounce Home
Indications
The incomplete extension of the knee due to internal knee symptoms indicates meniscal injury.
91
Leg and Ankle Pain Screening Tests:
Range of Motion (Active, Passive, Resistive):
Plantar Flexion (50):
Gastrocnemius, tibial nerve branch of sciatic nerve, S1. Soleus, tibial branch of sciatic nerve, S1
92
Leg and Ankle Pain Screening Tests:
Range of Motion (Active, Passive, Resistive):
Dorsiflexion
Tibialis anterior, tibial nerve branch of sciatic nerve, L4.Extensor digitorum longus, deep peroneal nerve branch of sciatic, L5.
93
Leg and Ankle Pain Screening Tests:
Range of Motion (Active, Passive, Resistive):
Pronation
(Eversion): Peroneus longus and brevis, superficial peroneal n. S1
94
Leg and Ankle Pain Screening Tests:
Range of Motion (Active, Passive, Resistive):
Supination
(Inversion): Tibialis anterior, tibial nerve
95
Joint Play Movements:
Ankle
1. Long Axis Distraction: Patient is supine, grasp the calcaneus or the heel of the patient with one hand, and the dorsum of the foot with the other hand, and then distract checks for ligament laxity.
2. A-P/P-A Glide: Grasp the distal fibula and tibia with one hand, and the foot with the other hand. Push and then pull checks for ligament laxity or fixation
3. Rotation: Grasp the distal fibula and tibia with one hand, and the foot with the other. Rotate and check for ligament laxity
96
Anterior/Posterior Drawer Sign:
Assesses for the anterior talo-fibular ligament & posterior talo-fibular ligament damage.
Procedure:
Patient is supine. 1st-The Doctor will grasp the anterior tibia/fibula at the distal end with one hand, and grasp the posterior calcaneus with the other hand. Pull the calcaneus anteriorly. Next the doctor will grasp the posterior distal tibia/fibula with one hand and the dorsum of the foot with the other hand, stabilize the tibia/fibula and push the foot posterior.
97
Anterior/Posterior Drawer Sign
Pathomechanics
Pulling anterior on the ankle stretches the anterior talo-fibular ligament; pushing posterior stretches the posterior talo-fibular ligament.
98
Anterior/Posterior Drawer Sign
Indications
Excessive anterior movement of the foot would indicate tearing of the anterior talo-fibular ligament; excessive posterior movement of the foot indicates tearing of the posterior talo-fibular ligament.
99
Valgus Stress Test
(AKA Abduction Stress Test of the Ankle, causes EversionSprain)
a. Procedure:
This is a passive eversion of the ankle.
100
Valgus Stress Test
Pathomechanics
This will stretch the medial ligaments of the ankle
101
Valgus Stress Test
Indications
Production of symptoms at the medial ankle during this procedure indicates ligament damage or pathology of the tibial-calcaneal ligament, if there is ligament laxity you must check the contralateral ankle.
102
Varus Stress Test:
(AKA Adduction Stress Test of the Ankle)
Procedure:
This is a passive inversion of the ankle.
103
Varus Stress Test
Pathomechanics
This will stretch the lateral ligaments of the ankle
104
Varus Stress Test
Indications
Production of symptoms at the lateral ankle during this
procedure indicates ligament damage or pathology of the fibular-calcaneal ligament, if there is ligament laxity you must check the contralateral ankle.
105
Tinel’s Sign of Posterior Tibial Nerve:
Assesses tarsal tunnel syndrome, which is posterior to the inferior tip of the medial malleolus.
Procedure:
Patient is supine. Doctor stands on the side being tested. Put the patient’s leg in the figure 4, and strike the posterior tibial nerve at the tarsal tunnel inferior to the medial malleolus with a reflex hammer.
106
Tinel’s Sign of Posterior Tibial Nerve
Pathomechanics
It percussion compresses the posterior tibial nerve
107
Tinel’s Sign of Posterior Tibial Nerve
Indications
Reproduction of numbness and tingling indicates posterior tibial nerve pathology.
108
Homan’s Sign:
Assesses for phlebitis or thrombophlebitis of the deep veins of the calf muscles.
Procedure:
Patient is supine; doctor is on the side being evaluated.
Doctor grasps the bottom of the foot with his inferior hand, and grasps the calf muscles with the superior hand. As you dorsiflex the foot, you squeeze the calf.
109
Homan’s Sign
Pathomechanics
Dorsiflexion of the foot stretches the calf muscles and the veins. Squeezing the calf compresses the muscles and veins.
110
Homan’s Sign
Indications
Reproduction of calf symptoms indicates a phlebitis or thrombophlebitis.
111
Toes
ROM
Extension, Flexion, Abduction, Adduction
A. Flexion: Action takes place at the metatarsal phalangeal joints, performed by the lumbricals, interossei muscles, and flexor hallicus brevis, plantar nerve, S1.
B. Extension: Takes place at metatarsal phalangeal joints, performed by the extensor digitorum longus and extensor hallicus longus, deep peroneal nerve, L5.
C. Abduction: Occurs when the toes are extended.
D. Adduction: Occurs when the toes are flexed.
112
Toes
| Joint Play Movements:
A. Long Axis Distraction: Pull on the joints, can be used to check for endplay orjoint capsule ligaments.
B. Lateral Glide: Lateral and medial glide of the joints. Checks ligaments
C. Rotation: Internal and external rotation.
D. A-P/P-A Glide: Posterior and anterior translation.
113
Morton’s Test: Assesses for metatarsalgia or the possibility of Morton’s
Procedure
Patient is supine. Doctor will grasp the affected foot from the bottom at the level of the metatarsal heads. Then squeeze the foot.
114
Morton’s Test:
Pathomechanics
Squeezing the metatarsal bones together will entrap the nerves and irritate a neuroma. This mechanism will also squeeze the swollen metatarsal phalangeal joints together.
115
Morton’s Test:
Indications
Reproduction or aggravation of symptoms in the area of the metatarsal heads would be metatarsalgia, if it is between the metatarsals, then possibly a Morton’s neuroma (usually found between the 3rd & 4th metatarsals)
116
Strunsky’s Sign:
Assesses for metatarsalgia.
Procedure:
Can be done at individual toe or all the toes at the once. Procedure is sudden passive flexion of the toes.
117
Strunsky’s Sign:
Pathomechanics
An inflamed metatarsal phalangeal joint will be irritated by flexion, which compresses the joint and can stretch the joint capsule.
118
Strunsky’s Sign
Indications
Aggravation or reproduction of symptoms at the metatarsalphalangeal joint being flexed indicates metatarsalgia.
