lower extremities

Question 1

quick test

Answer 1

test: lumbar
position: standing

Action:

1) pt squats down as far as possible and bounces a few times and return to standing position.
2) balance on one leg and go up and down on toes 4-5x

Positive finding:
pain in lower extremity

Diff Dx:
lower extremity pathology
“quickLE”

Question 2

quadrant (kemp’s) test

Answer 2

test: lumbar
position: standing

Action:
examiner stands 45 angle to pt.
place one forearm across pt’s shoulder
with other hand, make fist and place on pt’s small of back and pull lightly, pt will extend spine
and lat flex pt’s shoulder with examiner’s elbow
then take hands off shoulder, and lat rotate

Positive finding:
pain

Diff Dx:
lumbar facet dysfunction

Question 3

sitting root test, or modified slump

“slumping on root”

Answer 3

test: lumbar
position: seated

Action:
don’t have to hold head when asking pt to slouch and place chin on chest
then lift one leg (no dorsiflexion) at a time

Positive finding:
low back pain

Diff Dx:
sciatica

Question 4

prone knee bending Nachlas test

Answer 4

test: lumbar
position: prone

Action:
grab pt’s ankle, then bring heel to buttock, as far as possible, hip is not rotated

Positive finding:
pain in lumbar

Diff Dx:
L2 or 3 nerve root lesion
[if ASIS is tight, it will pull on rectus femoris, looks like buttocks comes off table]

Question 5

crossed femoral stretching test

Answer 5

test: lumbar
position: side lying

Action: "waltz"
examiner stands at foot of table
pt lies affected side down with knee in flexion, [test done only on affected side]
grab ankle and knee
step to side - extend hip and knee
step up - flexes knee
step back - 
and come back and place the leg down

Positive finding:
pain in groin and hip

Diff Dx:
L3 nerve root lesion

Question 6

straight leg raise (SLR) nerve traction test

aka Leseque’s

Answer 6

test: lumbar
position: supine

Action:
test unaffected leg first, test bilaterally
1) examiner places hand under pt’s knee and ankle
2) then examiner, using his thumb under ankle medially rotate the leg toward midline
2) then abduct the leg (bring it closer to midline)
3) then bring straight leg up -“any pain?”
4) ask pt to bring chin to chest (sotohall) - “any pain?”, then ask pt to place head back down
5) examiner takes hand off knee, and dorsiflex the foot by using that hand on medial side of the ball of foot (don’t dorsiflex toes)

Positive finding:
low back pain

Diff Dx:

1) sciatica or lumbar pathology = pain at 0-70
2) SI jt pathology = pain at 71-90
* opp of double leg raise

Question 7

Double Leg Raise

Answer 7

test: lumbar
position: supine

Action:
1) examiner with thumbs down, and with knees bended, lift both of the pt’s legs
2) flex pt’s hip until pt experiences pain or tightness
[if pt is taller than examiner, ask pt to come down and feet off the table]

Positive finding:
lower back pain

Diff Dx:
SI jt pathology at 0 - 70 degrees
lumbar pathology at >70 degrees
*opp of straight leg raise

Question 8

Gaenslen’s Test

Answer 8

test: pelvis & hip
position: supine

Action:
1) move pt closer to edge of table
2) reach across pt, and bend pt’s uninvolved knee and hip and ask pt to hold onto bended knee (pt is holding hip in flexion)
3) examiner place his thigh against the table
4) examiner places hand under knee and gently slide off the table, and ask if there is pain
(examiner is stabilizing pelvis and extends involved hip)

Positive finding:
pain in SI joint

Diff Dx:
SI joint pathology

Question 9

knee to shoulder test

aka SI rocking test or sacrotuberous ligament stress test

Answer 9

test: pelvis & hip
position: supine

Action:
1) examiner with one hand on tibial tuberosity and the other hand on ankle, flex pt’s knee and hip
2) examiner uses own body to push pt’s leg to opp shoulder
(SI jt is rocked by flexion and adduction of hip, moving knee toward opp shoulder)

Positive finding:
SI jt pain

Diff Dx:
SI jt pathology

Question 10

Gillet’s test

aka Sacral fixation test or Standing hip flexion test

Answer 10

test: pelvis & Hip
position: standing

Action:
must be done skin on skin
1) examiner puts thumb in PSIS (dimples on back), then other thumb on S2 spinous
2) on the PSIS thumb side, ask pt to raise this leg (hip & knee in flexion) by tapping with fingers on the side of this hip
3) thumb should drop down on the raised leg
*don’t hold tight, bc you want your thumb to fall

Positive finding:
PSIS moving up

Diff Dx:
SI jt hypomobility

Question 11

trendelenburgs test

Answer 11

test:
position:

Action:

1) place thumb on each PSIS and ask pt to raise leg (examiner tap the side of leg you want pt to raise leg)
2) examiner observes pt’s pelvis (whole pelvis should be tilted up on the raised leg side, so higher)

Positive finding:
PSIS drops down on raised leg side

Diff Dx:
weak gluteus medius myo on weight bearing side (standing leg)

Question 12

Patrick’s / Fabere’s test

Answer 12

F/ab/e/r     [aka figure 4]
F lexion
AB duction
E xternal
R otation

test: pelvis & hip
position: supine

Action:

1) examiner places pt’s foot on contralateral knee (just proximal) - “4” - flexion, abduction, external rotation of hip
2) superior hand goes on ASIS (use back of hand to find ASIS
3) examiner place palm on ASIS to stabilize
4) with other hand (only 3 fingers), slowly and gently push down on knee
* make sure foot is either above or below patella

Positive finding:
pain in hip jt

Diff Dx:
hip jt pathology

Question 13

stinchfield test

“stinky leg”

Answer 13

test: pelvis & hip
position: prone

Action:

1) have pt raise straight leg to about 30 degrees
2) examiner push down on leg, while pt resists

Positive finding:
pain in hip

Diff Dx:
hip joint pathology

Question 14

Thomas Test

Answer 14

test: pelvis & hip
position: supine

Action:

1) 1st check for lumbar lordosis
2) then flex one of pt’s hip by brining pt’s knee to chest and pt holds it

Positive finding:
hip & knee flex slightly
*if examiner can put hand underneath knee
*possibly tight jeans

Diff Dx:
hip flexion or hip jt or psoas CONTRACTURE

Question 15

Rectus Femoris Contracture Test

Answer 15

test: pelvis & hip
position: supine

Action:

1) pt lies on table with knees hanging off table (make sure backs of legs are not touching the table)
2) examiner flexes pt’s knee and bring it toward chest and pt holds it
3) examiner pushes hanging foot back down - feel rubber band

Positive finding:
watch for extension of other knee, examiner can passively hold knee in flexion

Diff Dx:
rectus femoris contracture

Question 16

piriformis test

Answer 16

test: pelvis & hip
position: side lying

Action:
1) pt test leg is side up
2) pt flexes hip to 60 w/ knee flexed, hook leg behind the thigh, “flamingo leg”
3) examiner stabilizes hip w/ one hand and applies downward traction to knee
(*examiner - don’t cross hands, also roll pt’s pelvis back to raise knee)

Positive finding:
piriformis muscle pain / tightness (hurts at site)
or piriformis syndrome (radiating pain)

Diff Dx:
piriformis pain - tight piriformis
piriformis syndrome - radiating pain

Question 17

Femoral Nerve traction Test

Answer 17

test: lumbar
position: side lying

Action:
affected side up, hip and knee in flex, lumbar neutral and head flexed, then extended knee while ext hip approx 15, then flex knee

Positive finding:
pain in anterior thigh

Diff Dx:
femoral nerve neuropathy

Question 18

Well Leg Raise Test

Fajersztain

Answer 18

test: lumbar
position: supine

Action:
test unaffected leg only
1) place pt’s hip in medial rotation and adduction, with knee in extension.
2) examiner flexes the hip until pt complains of tightness in back or back of leg.
3) examiner slowly drops leg till pt feels no pain or tightness

Positive finding:
low back pain

Diff Dx:
medial disc herniation

Question 19

prone knee bending test and Ely’s test

Answer 19

test: pelvis & hip
position: prone

Action:
flex pt’s knee bring heel toward buttock, as far as possible.
do not push too hard.

Positive finding:
pain in SI joint

Diff Dx:
SI joint dysfunction

Question 20

Ober’s test

TFL contracture test

Answer 20

test: pelvis & hip
position: side lying

Action:

1) pt lies on side with knees slightly bent
2) examiner place one hand under the ankle and other under knee
2) lift up and abducts and extend leg (makes a circle to activate TFL)
3) place leg behind the other bended leg

Positive finding:
leg remains in Abduction

Diff Dx:
TFL contracture

Question 21

Hibb’s Test - Prone Gapping Test

Answer 21

test: pelvis & hip
position: prone

Action:

1) use back of fingers to find PSIS
2) place hand over psis
3) grab ankle and flex pt’s knee to 90 or greater,
4) medially rotate hip as far as possible
5) palpate SI jt of ipsilateral side
6) performed bilat and compare to contralateral SI jt

Positive finding:
decreased movt of SI jt; SI jt becomes hypermobile

Diff Dx:
SI jt dysfunction

Question 22

Apley’s Compression Test

Answer 22

test: knee
position: prone

Action:

1) examiner flexes pt’s knee to 90
2) place one hand on heel, other other on ball of foot
3) push down on pt’s heel while internally rotating, then externally rotating the foot
* compressing the knee, testing meniscus

Positive finding:
pain in knee

Diff Dx:
ext rotation pain = lateral meniscal tear
int rotation pain = medial meniscal tear
*toes pt to dx

Question 23

Apley’s Distraction Test

Answer 23

test: knee
position: prone

Action:

1) examiner grab under dorsum of foot and under calcaneus (like soup hands)
2) lift up on pt’s foot, but stabilize pt’s knee so examiner places own superior shin against the table and place knee on pt’s thigh
3) keep lifting as you internally and externally rotate

Positive finding:
pain in medial or lateral knee

Diff Dx:
pain upon external rotation - LCL tear
pain upon internal rotation - MCL tear

Question 24

Valgus and Varus stress test

ligamentous instability test of knee

Answer 24

test: knee
position: supine

Action:

1) examiner’s superior hand contacts pt’s lateral knee, inferior hand grabs ankle
2) pt’s knee in full extension
3) apply valgus or medial stress at knee w ankle in slight external rotation
4) switch hands, and apply varus or lateral stress at knee w ankle stabilized.

Positive finding
excessive medial or lateral deviation of knee

Diff Dx:
valgus - medial instability of MCL ligament weakened or torn- knock knee

varus - lateral instability of LCL ligament weakened or torn - bowlegged

Question 25

Anterior Drawer Test or Drawer sign of knee

Answer 25

test: knee
position: supine

Action:

1) flex pt’s hip and knee until their foot is flat on table
2) examiner stabilizes pt’s foot by sitting on it.
3) examiner place both hands behind proximal tibia (behind pt’s knee), place thumb on eye of knee
4) examiner then draw tibia forward on femur, by leaning back gently, use body weight when pulling

Positive finding
tibia moves anterior >6mm

Diff Dx:
Anterior Cruciate Ligament (ACL) laxity

Question 26

Posterior Draw Test of Knee

Answer 26

test: knee
position: supine

Action:

1) flex pt’s hip and knee until their foot is flat on table
2) examiner stabilizes pt’s foot by sitting on it
3) double web contact on tibia tuberosity, place fingers on joint space
4) then lean in gently when pushing

Positive finding
Tibia moves posterior

Diff Dx:
posterior cruciate ligament laxity

Question 27

slocum test

Answer 27

test: knee
position: supine

Action:

1) flex pt’s hip and knee until their foot is flat on table
2) examiner stabilizes pt’s foot by sitting on it
3) grab both sides of pt’s tibia (at St 35)
4) lean back
5) try to see if one hand comes more anterior than the other dx

Positive finding
excessive anterior movt of tibia on medial or lateral side

Diff Dx:
anterolateral rotary instability
anteromedial rotary instability

Question 28

Houston’s Posteromedial and Posterolateral Drawer Sign

Answer 28

test: Knee
position: supine

Action:

1) flex pt’s hip and knee until their foot is flat on table
2) examiner stabilizes pt’s foot by sitting on it
3) grab both sides of pt’s tibia (at St 35)
4) lean in and push, if one hand comes more posterior than the other dx

Positive finding
excessive posterior movt of tibia on medial or lateral side

Diff Dx:
posteromedial rotary instability
posterolateral rotary instability

Question 29

McMurray’s Test

Answer 29

test: knee
position: supine

Action:

1) flex knee 90 degree and hip 90 degree
2) examiner holds heel with thumb on lateral side of foot, and fingers on medial side of foot (wrap whole hand around heel)
3) examiner holds under the knee with superior hand
4) examiner stand at corner of table
5) internally rotate the foot, then push medially on the knee, keeping the medial pressure, bring the leg straight out
6) do the same but with foot externally rotated
7) repeat on other leg

Positive finding:
clicking sound in knee often w pain
(audible or palpable popping)

Diff Dx:
meniscal tear
*heel pts to dx, internal rotation - medial tear

Question 30

Bounce Home Test

Answer 30

test: knee
position: supine

Action:

1) examiner cups heel of pt’s foot (cradle pt’s ankle)
2) pt’s knee is completely flexed and knee is passively allowed to extend slowly

Positive finding:
knee remains in flexion

Diff dx:
torn meniscus

Question 31

Clarke’s sign patellar grind test

Answer 31

test: knee
position: supine

Action:

1) examiner presses down slightly proximal to upper pole of patella w/ a web hand contact
2) pt is relaxed w knee extended
3) pt is asked to contract the quadriceps while examiner pushes down with a controlled amount of pressure
4) best to repeat several times and compare to other side
5) can be done at 30, 60, 90 deg of flexion

Positive finding:
grinding and/or retropatellar pain

Diff dx:
patello-femoral dysfunction

Question 32

Mediopatellar plica test

Answer 32

test: knee
position: supine

Action:

1) examiner flexes affected knee to 30
2) then rotates and moves patella medially with thumb

Positive finding:
pain [when patella moves medially, this caused by pinching of edge of plica bt medial femoral condyle and patella]

Diff dx:
medial patellar plica inflammation

Question 33

Fairbank’s Apprehension Test Patellar dislocation

Answer 33

test: knee
position: supine

Action:

1) quadriceps is relaxed and knee is flexed to 30
2) examiner carefully & slowly pushes the patella laterally

Positive finding:
pt will contract quadriceps as they feel patella dislocate, and have apprehensive look

Diff dx:
patellar dislocation

Question 34

Noble compression test

illiotibial band friction syndrome

Answer 34

test: knee
position: supine

Action:

1) examiner flexes pt’s knee to 90 w hip flexed
2) apply pressure to lateral femoral condyle
3) maintain pressure as knee is extended

Positive finding:
pain in lateral femoral condyle

Diff dx:
IT band compression

Question 35

Wilson Test

Answer 35

test: knee
position: seated

Action:

• this is done by pt examiner only gives instructions
  1) pt knee flex over table
  2) knee is actively extended w tibia medially rotated
  3) at approx 30 flexion, knee pain increases
  4) pt is asked to stop, flex and laterally rotate tibia

Positive finding:
pain disappears
[w lateral rotation of tibia. pain must be at medial femoral condyle near intercondylar emminence]

Diff dx:
Osteocondritis Dissecans (OCD)

[type of cancer, only ortho test that can dx cancer]

Question 36

Anterior drawer test of ankle

Answer 36

test: lower leg, foot & ankle
position: supine

Action:

1) examiner stabilizes distal tibia & fibula
2) holds pt’s foot in 20 of plantar flexion
3) draws talus forward in ankle mortice

Positive finding:
excess anterior movt of talus

Diff dx:
anterior talofibular ligament sprain

Question 37

Talar Tilt

Answer 37

test: lower leg, foot & ankle
position: supine

Action:

1) foot in anatomic position
2) 90 talus is tilted from side to side into adduction and abduction

Positive finding:
excessive abduction or adduction

Diff dx:
excess abduction = deltoid ligament
excess adduction = calcaneofib and/or anterior talofibular ligament

Question 38

Thompson’s Test Achilles tendon ruptures test

Answer 38

test: lower leg, foot & ankle
position: prone

Action:

1) pt prone or kneels on a chair, feet over edge, pt relaxed
2) examiner squeezes calf

Positive finding:
absence of plantar flexion

Diff dx:
ruptured achilles tendon

Question 39

Tinel’s sign of ankle percussion sign

Answer 39

test: lower leg, foot & ankle
position: supine

Action:

1) tap at front of ankle = anterior tibial branch of deep peroneal nerve
2) tao post to medial malleolus = posterior tibial nerve

Positive finding:
tingling or paresthesia
pain, numbness, tingling

Diff dx:

1) deep peroneal neuropathy
2) posterior tibial neuropathy

Question 40

Morton’s Test

Answer 40

test: lower leg & foot & ankle
position: supine

Action:
examiner grasps foot around metatarsal hea

Positive finding:
metatarsal pain

Diff dx:
morton’s neuroma