Lower Limb Assessment Techniques

Question 1

How can you assess muscle and tendon tissue?

Answer 1

AROM/PROM differential diagnosis
Length
Strength
Isometric 
Palpate for tenderness

Question 2

What is the sweep test?

Answer 2

Simple test for knee joint effusion (this should not be confused with oedema which is the generalised swelling of tissues caused by inflammation, allergy, heart failure and other conditions.
Effusion specifically describes the swelling of a joint

Question 3

What assessments to do relative to the hip?

Answer 3

Subjective- Special questions and past medical history 
Objective- observation 
Active movement
Passive movement
Isometric testing
Accessory testing
Special tests
Gait 
Functional activities 
Balance
Palpation

Question 4

What is Ober’s test?

Answer 4

It is an assessment of the ITB/TFL for contracture/shortening
The pelvis should be fixed and the knee extended, abduct the hip and and extend allow to drop down
A positive test causes pain or is obviously tighter than the opposite limb

Question 5

What is the Trendelenburg test/ sign

Answer 5

It tests for the inability of muscles to maintain pelvic position. It tests the gluteus muscles
You can perform on the normal side first then abnormal .
The patient stands upright and then on one leg and if the pelvis remains straight= negative test
A positive test shows weakness in gluteus medium/minimus and weakness on stance when the leg drops and is in pain

Question 6

What to look out for in a knee assessment?

Answer 6

Mechanism of injury (MOI)
AGGS/EASES
Special questions
Clicking 
Locking
Giving way 
Swelling

Question 7

What are the ligament and specific knee structural tests?

Answer 7

Patella femoral joint
Me is cal
Ligaments
Positive ligament tests are hyper mobile, different end feel and may have pain

Question 8

What is the Mcmurry’s test?

Answer 8

The mcmurray’s test tests for a torn meniscus.
Supine lying
Flex knee fully
Laterally rotate the tibia and extend knee to 90 degrees (tests medial meniscus tear)
Medially rotate the tibia and extend knee to 90 degrees (tests for lateral meniscus tear)
A positive test means a click can be heard
Pain is less diagnostic

Question 9

What is Apley’s test?

Answer 9

Apley’s test tests for a torn meniscus 
Prone lying 
The knee is set at 90 degrees
Thigh is fixed with the physios 
Distract the tibia then rotate both medially and laterally
Repeat with a compression
A positive test shows pain 
If the distraction caused increased pain then it is ligamentous

Question 10

What is Clarke’s test?

Answer 10

Patella grind test- can be used to test for anterior knee pain.
Compression of patella against trochlea
Contraction of quads isometrically
A positive test looks for pain recreation and feeling any grinding, clicking or alterations in symptoms
This should be compared with the other limb, check this at different degrees of flexion

Question 11

What does a positive patella glide test look like?

Answer 11

Less hypomobile and more hypermobile

Question 12

What is the anterior Draw test

Answer 12

The anterior draw test tests for ACL
Foot is held in 20 degrees of PF
Stabilise at the foot and place an AP force to the lower tibia
A positive test shows excessive translation of the fibulae backwards and a sulcus sign

Question 13

What is the Talar tilt test

Answer 13

The Talar tilt test is a test for the lateral ankle ligaments ( ATFL primarily)
Supine/side lying
Knee remains slightly flexed
The foot is held in plantargrade
The tibia is fixed and the other hand is used to forcefully adduct the calcaneum
A POSITIVE TEST shows excessive movement of the calcaneum
A stress X-ray should be done if it is more than 20 degrees

Question 14

What is the Thompson’s test (simmonds, squeeze test)

Answer 14

The Thompson’s test tests for Achilles/calf rupture.
The patient sits in prone lying with the foot over the end of the plinth
The patient must be relaxed
Squeeze the calf
A POSTIVE test is the absence of movement of the foot into plantarflexion

Question 15

What to look for when assessing the Achilles’ tendon?

Answer 15

Resting position of the foot (flexion or extension)
End feel and ROM
Tendon palpation
Visibility of the tendon
Squeeze test

Question 16

What is Homan’s sign?

Answer 16

HOMANS test tests for DVT (deep vein thrombosis)
Supine position and passively extend the knee and DF ankle
Palpate the calf for tenderness
Pain in the calf is indicative of DVT, however this must be taken in with other findings as many disorders will give a positive test.

Question 17

What does the mcmurrays test consist of?

Answer 17

Mcmurrays test is used to determine the presence of a meniscal tear within the knee.
With the patient supine, the examiner holds the knee and palpate the joint line
Flex the knee, internally rotate the tibia+ varus stress+ extension = lateral meniscus
Flex the knee, externally rotate the tibia+valgus stress + extension =medial meniscus
Positive test= pain,snnapping, audible clicking or locking can indicate a compromised meniscus

Question 18

What happens during the modified Thomas test?

Answer 18

It is used to measure the flexibility of the hip flexors (rectus femoris, pectineus, gracillis, tfl and sartorius)
The patient lays supine and flexes the hip up to a knee tuck. The examiner checks for excessive lumbar lordosis. If the patients extended leg remains flat on the table= negative test. If the patients extended leg or sacrum lifts off the table and they are unable to control it , test is positive

Question 19

What is the anterior drawer test do?

Answer 19

It tests for mechanical instability of hypermobility in the talocrural joint (upper ankle joint)
The patient is supine, ankle joint in 20 degrees of flexion, heel rests on the palm of the examiners hand. The examiner stabilises the tibia and fibula with the other hand whilst drawing the calcaneus anteriorly. A weakening of the end feel confirms a positive test or rupture of the anterior talofibular ligament