lower extremity lab tests Flashcards
lumbar spine bony palpation
lumbar spine bony palpation
lumbar spinous processes (count out loud
sacral tubercles
iliac crest
posterior superior iliac spine
lumbar spine soft tissue palpation
lumbar spine soft tissue palpation
supine:
anterior abdominal muscles - half sit-up, palpate, pt. relax, quickly palpate
- instruct pt. to turn over
prone: paraspinal muslces - as unit - spinalis (spine - medial) - longissiums (middle) - iliocostalis (lateral) sciatic nerve gluteus maximus gluteus medius hamstrings - as unit - biceps femoris - lateral - semitendinosus - middle - semimembranosis - medial
straight leg raiser (SLR)
straight leg raiser (SLR)
+ radiating pain and/or dull posterior thigh pain indicates sciatic radiculopathy or tight hamstrings. + b/w 35-70 degrees indicates possible discogenic sciatic radiculopathy. + greater than 70 degrees indicates tight hamstrings
goldthwait sign (3 fingers)
goldthwait sign (3 fingers)
ask pt. to raise shirt to bottom of ribs
- contact lower back
+ localized pain, low back, or radiating pain down the leg indicates lumbo-sacral or sacroiliac pathology. pain occuring before the lumbars move is possible sacroiliac problem. pain occuring after the lumbar spinouses move is possible lumbo-sacral problem.
bragard sign
bragard sign
perform SLR
pt. feels pain
lower leg 5 degrees or until pain subside
dorsiflex foot
+ radiating pain in posterior thigh indicates sciatic radiculopathy
buckling sign
buckling sign
pt. supine
perform SLR
show buckle
+ pain in the posterior thigh with sudden knee flexion (buckle) indicates sciatic radiculopathy
bowstring sign
bowstring sign
pt. supine
ex. places pt.’s leg on shoulder
palpate
- muscle belly
- tendons
- popliteal fossa
+ pain in the lumbar region or radiculopathy indicates sciatic nerve root compression, helps rule out tight hamstrings
lasegue test
lasegue test
pt. supine
hip and leg bent to 90 degrees
slowly extend knee
+ reproduction of sciatic pain before 60 degrees indicates sciatica
milgram test
milgram test
pt. supine
ex. raises both legs 2-3”
instructs pt. to hold in place
30 sec or until point of pain
+ inability to perform test and/or low back pain indicates weak abdominal muscles or space occupying lesion
valsalva maneuver
valsalva maneuver
- instruct pt. to take deep breath
- hold
bear down as if you’re having a difficult bowel mvmt
+ radiating pain from site of lesion (usually recreating the complaints in cervical or lumbar area of the spine) indicates space occupying lesion (e.g. disc pathology)
bechterew test
bechterew test
- pt. seated
- ex. instructs pt. extend one knee @/time, then both together
- show positive
+ reproduction of radicular pain or inability to perform correctly due to tripod sign indicates sciatic radiculopathy
neri bowing test / sign
neri bowing test / sign
- instruct pt. to bend fwd @ waist
- stand by pt. spotting them
+ pain accompanied by flexion of the knee on the affected side and body rotation away from the affected side indicates positive with a variety of low back pathologies. hamstring tension on the pelvis may trigger the response.
anterior innominate test aka mazion pelvic maneuver (advancement sign)
- pt. standing
- instruct pt. to advance 1 leg/time
- then to bend over - advanced knee straight
+ the inability to bend at the waist more than 45 degrees due to either/or radiating pain along the sciatic nerve, either unilateral or bilateral indicates sciatic neuralgia or radiculopathy, etc, possibly due to lumbar disc pathology
+ low back pain (lumbar or pelvic regions) indicates anterior (rotational) displacement of the ilium relative to the sacrum
lewin standing test
lewin standing test
- ex. instructs pt. to get in skiing position
- ex. pushes one knee into complete extension, the other, then both while in position
+ radiating pain down the leg causing flexion of the patient’s knee or knees indicating gluteal, lumbosacral, or sacroiliac pathologies
heel walk
heel walk
- instruct pt. to take 6 steps
(3 full gaits) on their heels
+inability to perform test indicates L4/L5 disc lesion
(L5 nerve root)
toe walk
toe walk
- instruct pt. to take 6 steps
(3 full gaits) on their toes
+ inability to perform test indicates L5-S1 disc lesion
(SI nerve root)
ely heel to buttock test
evans - aka ely sign
ely heel to buttock test
(evans - aka ely sign)
- pt. prone
- ex. flexes knee to 90
- ex. approximates heel to contralateral buttock
- ex. hyperextends thigh off table
+ inability to raise thigh indicates iliopsoas spasm
+ pain in the anterior thigh indicates inflammation of lumbar nerve roots
+ pain in the lumbar region indicates lumbar nerve root adhesions
trendelenburg test
trendelenburg test
- pt. stands on involved foot
- observe level of hips
+high iliac crest on supported side & low crest on side of elevated leg indicates weak gluteus medius muslce on the supported side
knee bony palpation
knee bony palpation
1) patella
2) medial tibial plateau
3) medial femoral condyle
4) lateral tibial plateau
5) lateral femoral condyle
6) tibial tuberosity
7) fibula head
knee soft tissue palpation
knee soft tissue palpation
quadriceps muscles
1) vastus medialis - medial
2) rectus femoris - center
3) vastus intermedius - deep center
4) vastus lateralis - push on IT band
5) prepatellar bursa - patella
6) infrapatellar tendon - superficial (above and below patella)
7) superficial infrapatellar bursa
8) medial meniscus
9) medial collateral ligament
10) pes anserine area
- sartorius
- gracilis
- semitendinosus
10) lateral meniscus
11) lateral collateral ligament
12) gastrocnemius muscle
mcmurray sign
mcmurray sign
pt. supine
- flex pt’s affected hip to 90 degrees and affected knee to 90 degrees
- internal / varus
- external / valgus
+ clicking sound, or pain by knee joint indicates tear of medial meniscus if positive on external rotation. tear of lateral meniscus if positive on internal rotation. the higher the leg is raised during extension when positive is elicited, the more posterior the meniscal injury
medial collateral ligament test aka: ‘aBduction stress test’ aka ‘valGus stress test’
medial collateral ligament test aka: ‘aBduction stress test’ aka ‘valGus stress test’
pt. supine
stablize lateral thigh of pt’s affected leg
gradually pushes laterally
(to open medial side of joint)
+ gapping and/or elicited pain above/at/or below joint line indicates tear and/or instability of the medial collateral ligament
Hip/pelvis bony palpation
Hip/pelvis bony palpation
anterior:
1) anterior superior Iliac spine- skin on skin
2) iliac crest- skin on skin
3) iliac tuberosity
4) greater trochanter
—ask pt. to flip over onto stomach
posterior
1) posterior superior iliac spine - skin on skin
2) ischial tuberosity- neutral hand
BEFORE COCCYX PALPATION
- I’m contacting your tail bone at the end of your spine
3) coccyx
hip/pelvis soft tissue palpation
hip/pelvis soft tissue palpation:
anterior: supine
* ask pt (show) to cover genitals
* put pt. into figure 4
femoral triangles borders:
1) sartorius
2) adductor longus
3) inguinal ligament
quadriceps muscles (group/individual palpate)
1) vastus medialis (medial)
2) rectus femoris (aiis) superficial midline
3) vastus intermedius (deep to rectus femoris) - move out of way
4) vastus lateralis- press on IT band to pop out
5) greater trochanteric bursa
—tell pt. to flip over onto stomach
posterior: prone
1) gluteus medius (from psis to greater trochanter) - hand on psis
2) gluteus maximus- hand on psis
3) sciatic nerve- 1/2 b/w gr. troch / ischial tuberosity
4) cluneal nerves- in b/w iliac crest and psis
hamstrings (palpating group and individually)
1) semimembranosus (medial) ish tub—> pea anserine
2) semitendinosus (middle)- ish tub—> med tibial condyle
3) biceps femoris (lateral)
anterior: supine
* ask pt (show) to cover genitals
* put pt. into figure 4
femoral triangles borders:
1) sartorius
2) adductor longus
3) inguinal ligament
quadriceps muscles (group/individual palpate)
1) vastus medialis (medial)
2) rectus femoris (aiis) superficial midline
3) vastus intermedius (deep to rectus femoris) - move out of way
4) vastus lateralis- press on IT band to pop out
5) greater trochanteric bursa
—tell pt. to flip over onto stomach
posterior: prone
1) gluteus medius (from psis to greater trochanter) - hand on psis
2) gluteus maximus- hand on psis
3) sciatic nerve- 1/2 b/w gr. troch / ischial tuberosity
4) cluneal nerves- in b/w iliac crest and psis
hamstrings (palpating group and individually)
1) semimembranosus (medial) ish tub—> med tibial condyle
2) semitendinosus (middle)- ish tub—> pes anserine (medial)
3) biceps femoris (lateral)
leg length discrepancy
leg length discrepancy
pt. supine
measure from asis to med malleolus- both sides - change sides
ask pt to raise shirt to above belly button
measure from umbilicus to med mallelous- both sides
+ different measurements indicates true = bony abnormality above or below level of trochanteric difference (anatomical short leg)
+ apparent = pelvic obliquity (tilted pelvis)
Allis sign / galeazzi sign
Allis sign / galeazzi sign
pt. supine
instruct pt. to place feet flat on table
place hands on top of knee, and anterior
+ difference in height and anteriority knees indicates 1) if one knee is lower = ipsilateral congenital hip dislocation or tibial discrepancy (anatomical short leg)
+ if one knee is anterior = ipsilateral congenital hip dislocation or femoral discrepancy (contralateral anatomical short leg)
Thomas test
Thomas test
pt. supine ask pt. to raise shirt to bottom ribs state you'll be contacting lower back contact lower lumbars in middle ask pt. to bring knee to chest / both sides
+ lumbar spine maintains lordosis (should flatten) and hip or leg flexes indicating contracture of hip flexors (iliopsoas)
Anvil test
Anvil test
pt. supine
tell pt. you’re tapping their heel with heel of hand
lift leg slightly
tap (strike hard) heel
+ localized pain in the long bone or in hip joint indicates possible fracture of long bone or hip joint pathology
Patrick test (aka FABRE sign)
Patrick test (aka FABRE sign)
pt. supine
place pt in figure 4
1 hand asis and other hand proximal to knee
+ pain in the hip region indicates hip joint pathology
Laguerre test
aka FABRE in the Air
Laguerre test
(aka FABRE in the Air)
pt. supine lift leg slide into cubital crease stabilize on contralateral asis place pt in figure 4 1 hand asis and other hand proximal to knee
+ pain in the hip region indicates hip joint pathology
+ pain in the sacroiliac joint indicates mechanical problem of the sacroiliac joint
Gaenslen Test
Gaenslen Test
pt. in supine position
ask pt to scoot edge table
asis - off table so leg can completely hang off
place hip against table facing away from pt.
stabilize shoulder or asis
pressure on thigh 3” above knee
+ pain on the affected sacroiliac joint stressed into extension indicates general sacroiliac joint lesion, anterior sacroiliac ligament sprain or inflammation of the sacroiliac joint
Lewin-Gaenslen Test
Lewin-Gaenslen Test
pt. laying on side
instruct pt. to use bottom hand as pillow
straighten spine/ slight flexion of bottom leg
instruct pt. to bring bottom knee to chest
bend top knee
stabilize above crest on quadtratus lumborum (lumbars) & distal femur
bring leg back
+ pain on the affected sacroiliac joint stressed into extension indicates general sacroiliac joint lesion, anterior sacroiliac ligament sprain, or inflammation of the sacroiliac joint
Hibb Test
Hibb Test
pt. prone bring knee to 90 deg pause bring knee - maximal flexion to buttocks push lateral on thigh - internally rotate
+ pain in the hip region indicates hip joint pathology (lateral)
+ pain in the buttock/pelvic regions indicates sacroiliac joint lesion (posterior)
Ober Test
Ober Test
pt. on side instruct pt to use bottom arm as pillow stabilize iliac crest (top) hold distal end femur bring leg up - slight knee flexion (holding it downward) aBduct leg extend the leg support knee, then drop under upper thigh (tell pt. to relax) remove hand under thigh
+ affected thigh remains in abduction (normal biomechanics, thigh/hip will aDduct) indicates contraction of the iliotibial band or tensor fascia lata. (usually secondary to synovitis of the hip, secondary to trauma of teh gluteus medius and maxiumus)
Pelvic Rock test aka “Iliac Compression test”
Pelvic Rock test aka “Iliac Compression test”
pt. on side
use bottom hand as pillow
straighten pt’s legs…some flexion
+ pain in either sacroiliac joint indicates sacroiliac joint lesion
Nachlas test
knock, knock, knock
Nachlas test
pt prone bring knee to 90 degrees look for ely's sign pause bring heel to buttock
+ pain in the buttock and/or pain in the lumbar region indicates sacroiliac joint lesion or lumbar pathology
Yeoman’s test
yo, man, put my leg down
Yeoman’s test
pt. prone
flex pt. leg (bend knee)
same side buttocks
extend thigh off table
+ pain deep in the sacroiliac joint indicates sprain of the anterior sacroiliac ligaments
Ely sign (Ely test)
Ely sign (Ely test)
pt. prone
examiner flexes knee toward same side buttock
bring knee to 90 deg and stop
+ hip on side being tested will flex causing the buttock to raise off the table indicating rectus femoris or hip flexor contracture
Ely Heel to Buttock Test
Evans - Ely sign (aka
Ely Heel to Buttock Test
(Evans - Ely sign (aka)
pt. prone
examiner flexes knee to 90 degrees for ely’s sign
pause
heel to buttock on opposite buttock and hyperextend thigh off table
+ inability to raise thigh indicates iliopsoas spasm
+pain in the anterior thigh indicates inflammation of lumbar nerve roots
+ pain in the lumbar region indicates lumbar nerve root adhesions
Trendelenburg test
Trendelenburg test
pt. is standing examiner kneels standing behind pt. holding pt's hips pt. lifts leg pt. bends knee foot 8-10" off ground *thumbs on psis * hands around iliac crest
+ high iliac crest on supported side and low crest on side of elevated leg indicates weak gluteus medius muscle on the supported side
Lateral Collateral ligament test
(aka ADduction stress test
aka Varus stress test)
Lateral Collateral ligament test
(aka ADduction stress test
aka Varus stress test)
pt. supine
examer stabilizes medial thigh of pt’s leg
gradually push medially (opening lateral side of joint)
+ gapping and/or elicited pain above/at/or below joint line indicates tear and/or instability of lateral collateral ligament
Bounce Home test
Bounce Home test
pt. supine flex pt's knee raise leg 30 degrees place hand underneath knee remove pressure keep hand loosely underneath knee for support
+ kneee does not go into full extension (slight flexion remains) indicates diffuse swelling of the knee, accumulation of fluid, due to possible torn meniscus
Drawer test
Drawer test
pt. supine hip at 45, knee at 90 bring pts. foot flat on table ask permission to sit on foot sit on pt's foot examiner grasps behind flexed knee push and pulling into affected knee
+ gapping greater than 6mm
when leg is pushed, (tibia moves posterior), indicating torn posterior cruciate ligament
+gapping greater than 6mm
when leg is pulled, (tibia moves anterior), indicating torn anterior cruciate ligament
Lachman test
Lachman test
pt. supine
ex. brings pt.’s knee to 30 degree angle
use thenars - anterior
push femur
clasp behind knee - posterior
pull tibia
+ gapping with the tibia moving away from the femur indicating anterior cruciate ligament or posterior oblique ligament instability
Apprehension test for Patella
Apprehension test for Patella
pt. supine stand on OPPOSITE SIDE stabilize on thigh LOOK at patient's FACE use 2 thumbs push patella laterally once
+ apprehension, distress of facial expression, contractions of quadriceps to bring patella back in line indicates chronic patella dislocation or pre-disposition to dislocation
Patella Femoral Grinding test
aka “Clarke sign”
Patella Femoral Grinding test
aka “Clarke sign”
pt. supine knee extended face pt. use web of hand to place distal to patella instruct pt. to push knee to table
+ retropatellar pain and the pt. is able unable to hold the quadricepts contraction indicating degenerative changes of the patellar facets and/or within the trochlear groove (chondromalacia patella)k
Patella Ballottment test
Patella Ballottment test
pt. supine knee extended A-P pressure over patella can blot with several fingers or use flat hand to press down
+ a floating sensation of the patella indicates a large amount of swelling in the knee
Apley Compression test
Apley Compression test
pt. prone ask pt. to place knee on back of their thigh bring knee to 90 degrees *place your knee on back pt's thigh clasp hands pushing down on leg 1) neutral release 2) rotate interally push release 3) rotate externally push release
+ patient points to side of pain indicates pain on medial side is medial meniscus tear. pain on the lateral side indicates lateral meniscus tear
Apley Distraction test
Apley Distraction test
pt. prone bring knee to 90 degrees ask pt to place knee on back of their thigh place knee on pt's thigh pull up - neutral release rotate internally pull up release rotate externally pull up release
+ patient will point to side of pain indicating pain on medial side indicates medial collateral ligament tear. pain on lateral side indicates lateral collateral ligament tear
Foot and Ankle Bony palpation
Foot and Ankle Bony palpation
calcaneous medial malleolus (tibia) lateral malleolus (fibula) talus navicular tubercle navicular sustentaculum tali 3 cuneiforms 5 metarsals - count 5 metarsalphalangeal joints - count phalanges
Foot and Ankle Soft tissue
Foot and Ankle Soft tissue
1) plantar aponeurosis
2) achilles tendon
3) spring ligament -
(behind med. malleolus)
4) deltoid ligament
(underneath med. malleolus)
5) tibialis anterior tendon - 1st mt base
(point up and in)
6) peroneous brevis tendon
(point up and out - lateral side - goes into 5th metatarsal)
7) tibialis posterior tendon
(point down and in - behind medial malleoulus)
8) anterior talofibular ligament
(b/w talus & fibula - medial)
(short horizontal ligament)
9) posterior tibial artery
(3-5 sec behind medi mall)
10) dorsal pedal artery
(3-5 sec @ crease anterior talus)
Drawer sign
aka Anterior Drawer sign of the Ankle
Drawer sign
(aka Anterior Drawer sign of the Ankle)
pt. supine instruct pt. to scoot down table fist width from med. malleolus hold under calcaneous stabilize distal tibia push anterior to posterior hands - same position for pushing & pulling pull posterior to anterior
+ translation with the talus moving away from or towards the tibia indicates with foot pulled/tibia pushed, tear/instability of the anterior talofibular ligament
+ with foot pushed/tibia pulled, tear/instability of posterior talofibular ligament
Ankle Dorsiflexion test
active
Ankle Dorsiflexion test
(active)
“pt. presents with inability to dorsiflex their foot”
pt. sits at end of table state -'pt. cannot dorsiflex foot' stabilize calcaneous hand underneath foot extend leg - try to dorsiflex foot let leg down - dorsiflex foot
+ foot cannot dorsiflex w/ knee extended, indicates contracture of gastrocnemius (2 joint muscle) muscle
+ foot cannot dorsiflex in either knee position indicates contracture of solueus muscle
Rigid or Supple Flat Feet test
Rigid or Supple Flat Feet test
pt. seated show pt. areas being observed place fingers inside arch (should be to PIP) ask pt. to stand place fingers inside ea. arch (should be to DIP)
+ absence of medial longitudinal arch in both positions indicates Rigid Flat Feet
+ presence of medial longitudinal arch while seated with a loss of medial longitudinal arch while standing indicates supple flat feet
Homan’s Sign
Homan’s Sign
pt. supine
examiner raises pt’s leg 12” off table w/ knee in extension
ex. then dorsiflexes foot
“some sources say to squeeze the calf, we will not be doing that today”
+ deep pain in the calf indicates deep vein thrombophlebitis
Thompson test
prone, pump, plantarflexion
Thompson test
(prone, pump, plantarflexion)
pt. prone flex knee to 90 hold anterior to support lightly grab/squeeze ex squeezes belly of gastrocs
+ absence of foot plantarflexion motion indicates achilles tendon rupture
Morton test
hamburger squeeze
Morton test
(hamburger squeeze)
+ sharp pain in the forefoot indicates metatarsalgia or neuroma (usually at the 3rd and 4th metatarsal interspace)
