Lower Extremity II Flashcards
What are the two main goals of a joint evaluation?
- If the pain is from the joint itself, or referred.
2. Find the specific tissue that is generating the pain/symptom
L1 supplies what area?
Skin of the outer and upper buttock and hip
L2 and L3 supply what skin area?
Posterior buttock
S1-S2 supply what skin area?
Lower buttock, posterior upper thigh
Non-activity related pain may be what?
Referred pain from the viscera
Innervation to the hip joint is from what spinal level(s)? Where will pain from this area radiate to?
L3, sometimes L4
Upper and inner part of the buttock
Gluteal bursae refer pain where?
L4, L5
Psoas bursa refer pain wher?
L2, L3
SIJ typically refers to what?
Back of the leg
Innervation to the hip joint itself is primarily from L3. Therefore, pain often refers where?
Upper and inner part of the buttock
What are the important HPI bits of info for hip pain? (besides obvious)
- Weight bearing activities
- Specific activities
What is the trendelenburg sign?
Falling of the hip d/t weak gluteus medius/minimus
What is piriformis syndrome?
The sciatic nerve is compressed or otherwise irritated by the piriformis muscle causing pain, tingling and numbness in the buttocks and along the path of the sciatic nerve descending the lower thigh and into the leg.
What are the seven principles for joint PE?
- Inspect
- ROM
- Resistance/str testing
- Ligaments
- Joint surfaces
- Special tests
- Palpation
What does AROM evaluate?
General function/pain
What does PROM evaluate?
end feel
Evaluate ligaments and contractile tissues
What is the first area that should be assessed with examination of the hip?
Lumbar spine
What are the two AROM of the hip?
Squat up/down
Gait
What does the FABER test evaluate?
SI joint vs hip pathology
What does the SLR evaluate?
Sciatic pain
What is the thomas test?
Evaluation of tight psoas
What is the ely test?
Prone pt lift leg straight, causes lift of the hip. tight psoas
What are the two things you are evaluating when inspecting the hip?
Posture
Muscle and other contours
What are the two bits assessed with AROM of the hip?
Gait
Squat up and down
Lurching gait may indicate what?
Weakness of the gluteus minimus/medius or leg length discrepancy
What are the spinal nerve levels that the SLR evaluates?
L4, L5, S1
What is a positive SLR?
Pain in the sciatic distribution of the leg
What is the normal ROM of hip flexion?
140 degrees
What is a buttock sign?
Passive hip flexion is as (or more) limited and as painful as SLR
What does a buttock sign indicate?
Septic bursitis, ischio-rectal abscess, lesion of the sacrum
How do you assess passive internal rotation of the hip?
Pt is supine, flex knee and hip to 90, internally rotate
What is the normal internal rotation of the hip? External?
Internal = 45 External = 60
What are we looking for with testing the hip?
Looking for the presence of the capsular pattern of RROM.
What is the cause of capsular pattern of RROM?
Lesions of the fibrous capsule of the synovial membrane gives rise to painful passive ROm
Capsular pattern of RROM is what (flexion, abduction, adduction, rotation)?
Marked limitation of:
- Flexion/internal rotation
- abduction
-NO limitation of adduction/external rotation
What are the hip flexors?
- psoas
- Iliacus
- Rectus femoris
Painless weakness indicates what?
Nerve root lesions
What are the main hip extensors?
Hamstrings
Gluteus maximus
How do you assess resisted leg adduction?
Place fist between the knees, and have then squeeze
What are the primary adductors of the leg?
Pectineus
Adductor brevis/longus
Gracilis
What are the lateral/external rotators of the hip?
Gluteus maximus Piriformis Superior gemellus Inferior gemellus Obturator internus Obturator externus Quadratus femoris
(Gotta Pee, GO GO Quick)
When examining the hip, where should you always start? Why?
Lumbar spine for SDs and neurological issues
What are the two quick ways to assess ROM of the hip?
Squatting
Gait
What are the major arteries in the legs that you want to palpate when performing an examination of the hip?
Femorals
What is the Ely test?
If the heel cannot touch the buttocks, then the rectus femoris is tight
What is the Thomas test?
Flexion of the hip causes a contralateral leg flexion from a tight psoas
Painless weakness of the hamstrings is likely due to a lesion of what nerve root?
S1 or S2
What are the main flexors of the knee?
Quads
Hip pain with flexion of the knee is usually due to pathology of what muscle?
Rectus femoris
Painless weakness with the knee flexors is a lesion at what spinal level?
L3
Why is palpation done after AROM and PROM?
Many tissues overlying one another make this kind of palpation difficult to interpret without the basic exam first
What are the three classic history bits for a meniscal tear?
- Joint swelling
- Clicking
- Give way or buckling of the knee
What does Apley’s test assess for?
Ligaments
What does Apley’s distraction test assess for?
Meniscal injuries
What is the patellar grind test? What does it assess for?
- Compress the knee
- Assesses for chondromalacia
What are the two motions of the fibula?
Anterolateral
Posteromedial
What is supine thigh traction?
Pulling anteriorly on the tibia with the pt supine, to allow for venous and lymphatic drainage
