Lower Quarter Screen Flashcards
Components History (Patient Interview ad Systems Review) Physical Exam Test and Measures Lumbar and SU joint screening exam Posture Exam Gait Analysis Structural Exam Flexibility Exam Functional Screens Specific joint exams of Hip, knee, and ankle ROM( A/PROM) Accessory Motions Special tests(ligamentous meniscal labral joint integrity) Palpation
What positions can the should you consider for exam efficiency?
Standing, Sitting, Supine, Sidelying, and Prone
Pain from the lumbar and SI joint regions can refer pain where?
Down the lower extremity
Why is a screen of the Lumbar and SI joint required in any lower extremity examination?
Because pain from the lumbar and SI joint regions can refer pain down to the lower extremity.
What is the proper action for lumbar and SI joint screening?
Patient performs active lumbar flexion and extension in standing…Overpressure is provided if no pain is present at end range.
What result would warrant further investigation of the lumbar spine and SI joint?
Pain at any point in the ROM with or without overpressure.
What part of the LE exam is performed in standing?
Posture Exam (static/dynamic) Limb length Equality Gait analysis(more to come)
What parts of the patients posture should be examined from the sagittal plane?
Head position, shoulder position, thoracic alignment, lumbar and pelvis relationship, knee alignment, and hallux alignment
What portions of the patients posture should be studied from the frontal plane?
Head position, trunk relative to hips, limb length inequality, knee alignment, distal leg alignment, and foot posture
Correct alignment for posture should be studied in what three views?
Anterior Frontal, Lateral Saggital, and Posterior Frontal
Alignment of the distal 1/3 of Leg Relative to verticle
Distal Leg varum begs the hindfoot to evert in order to bring the medial aspect of the foot to the ground.
How do you measure limb length equality in standing?
- measure in standing
- Palpate the following boney landmarks
ASIS/PSIS
Iliac Crests
Greater Trochanters - Use boards of known thickned (1/8) under shorter limb to level pelvis
What should be palpated when testing for a patients limb length equality in standing?
ASIS/PSIS
Iliac Crests
Greater Trochanters
What two boney landmarks are used when measuring True Limb Length?
ASIS
Medial Malleolous
What two landmarks should be measured when measuring apparent limb length?
Belly button to medial malleolus
How do you measure relaxed rearfoot to leg angle?
Mid calcaneal to mid distal 1/3rd of leg
What happens to the rearfoot to leg angle when positioning from relaxed standing foot posture to single leg stance?
In single leg stance you can see the maximum amount of rearfoot angle that they have during gait and any substitutions that they may be using to overcome this angle.
What is the navicular drop test?
A qualitative assessment of the inferior displacement of the navicular tubercle as patient shifts from NWB to FWB
How do you measure the feiss line?
A line is drawn from the distal tip of medial malleolus to the lateral aspect of the 1st MTP.
How do you assess the feiss line?
Assessment is made of where the navicular lies relative to the line?
If the Navicular lies above the feiss line what posture is indicated?
Supinated Posture is indicates if the navicular lies above the feiss line.
If the nevicular lies below the feiss line what posture is indicated?
Pronated Posture is indicated if the navicular falls below the feiss line.
What is the longitudinal arch angle?
The longitudinal arch angle is measured from the medial malleolus to the navicular tuberosity then to the first metatarsal head…the arch lies above the navicular tuberosity
What is the longitudinal arch good for?
staggard stance with equal weightbearing?
It is a good indicator of the arch angle of the foot during walking and running.
Pronated 150
What positions should the boney structure exam be performed in?
Standing, sitting, supine, and prone
What should be observed when performing the BSE in standing?
Look for any structural abnormalities seen in the posture exam, these findings will need to be confirmed with alignment tests.
What LE boney structures are viewed in sitting?
Patella Alta
What LE boney structures are viewed in supine?
Patella alignment and position
What LE boney structures are viewed in the prone position?
Femoral anteversion(Craig test)
Tibial Torsion
Forefoot to rearfoot alignment
1st ray position and mobility
The femoral anteversion of the hip is observed with what test?
The Craig Test
Excessive anteversion and retroversion are both linked to what motion?
Compensatory pronation
Femoral anteversion is associate with what syndrome?
Patellofemoral pain syndrome
What position is tibial torsion viewed in?
Tibial Torsion is viewed in the prone position
With a bent knee Looking at the angle between the position of the two malleoli and the femoral condyles
Tibial torsion that leads to excessive toe-out angle may drive what foot position?
Excessive pronation
Forefoot to rearfoot alignment has
Good visual reliability with visual estimation
Poor reliability with use of goniometer
How is forefoot to rearfoot alignment measured?
Place the foot in subtalar neutral and then dorsiflex the foot.
1st ray position
plantarflexed, neutral, or dorsiflexed
1st ray mobility
rigid, normal, hypermobile
There are no good realiability measures for
1st ray position and mobility
What part of the flexibility exam should be viewed in standing?
Trunk Flexion
What part of the flexibility exam should be viewed in sitting?
Seated hamstring length
What parts of the flexibility exam should be viewed in supine?
Straight leg raise
hamstring 90-90
Thomas test
Piriformis length test
What parts of the flexibility exam should be viewed in sidelying?
Passive adduction tests (obers)
What part of the flexibility should be viewed in prone?
Rectus femoris tests piriformis length tests triceps surae gastrocnemius soleus
