lower extremities Flashcards
quick test
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”
quadrant (kemp’s) test
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
sitting root test, or modified slump
“slumping on root”
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
prone knee bending Nachlas test
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]
crossed femoral stretching test
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
straight leg raise (SLR) nerve traction test
aka Leseque’s
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
Double Leg Raise
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
Gaenslen’s Test
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
knee to shoulder test
aka SI rocking test or sacrotuberous ligament stress test
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
Gillet’s test
aka Sacral fixation test or Standing hip flexion test
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
trendelenburgs test
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)
Patrick’s / Fabere’s test
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
stinchfield test
“stinky leg”
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
Thomas Test
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
Rectus Femoris Contracture Test
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
piriformis test
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
Femoral Nerve traction Test
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
Well Leg Raise Test
Fajersztain
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
prone knee bending test and Ely’s test
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
Ober’s test
TFL contracture test
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
Hibb’s Test - Prone Gapping Test
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
Apley’s Compression Test
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
Apley’s Distraction Test
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
Valgus and Varus stress test
ligamentous instability test of knee
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
