Lower Quarter Screening

Question 1

LE Red flags

Answer 1

Previous hx of cancer

Previous hx of renal or urologic disease such as kidney stones, UTI

Trauma/Assault

Crohns disease, ulcerative colitis, diverticulitis

Pelvic inflammatory disease

Appendicitis

Recent pregnancy, childbirth, abortion

History of alcoholism (hip osteonecrosis)

Long term use of immunosuppressants (cancer, autoimmune disorder)

Heart disease

Receiving anticoagulation therapy

History of hematologic disease - sickle cell anemia or hemophilia

Past history of joint replacement

Question 2

Supine assessment

Answer 2

postural observation

palapation

Thorax and abdomen

LE palpation, SI test

AROM/PROM of LE, trunk (double knee to chest)

FABER

SLR (cx flex to inc dural tension)

Neuro screening

Question 3

Prone

Answer 3

Femoral tension test

Better for SI joints

Better view of postural considerations and limb

Question 4

Cancer

Answer 4

Mets

Bone tumors - osteoid osteoma, Ewings sarcoma

Question 5

Vascular

Answer 5

Arterial insufficiency

Abdominal aortic Aneurysm

Avascular necrosis

Question 6

Urogenital

Answer 6

Kidney impairment, kidney stones, UTI, Testicular cancer

Question 7

Neuromusculoskeletal

Answer 7

Lumbar spine - spondylosis, spinal stenosis, herniated disc

SI Joint, sacral, knee pathology

Femoral, inguinal, sports hernia

Bursitis (trochanteric, iliopectineal, iliopsoas, ischial)

Fasciitis, myofascial pain

Muscle impairment

Snapping hip syndrome

Tendinopathy

Question 8

Inflammatory/infectious conditions

Answer 8

Arthritis (RA, SLE, seronegative arthropathies, gout)

Septic, hip, SI arthritis

Abdominal or peritoneal inflammation

Tuberculosis

Metabolic disease

Osteomalaica (vitamin D deficiency)

Opsteporosis

DM

Question 9

Screening considerations

Answer 9

Sickle cell,

Hemophillia

Ectopic pregnancy

Femoral artery

Implant loosening

Intraoperative blood vessel injury

Bone loss

Development al hip dysplasia

Hip dislocation

Legg calve perthes

Question 10

Vascular Claudication

Answer 10

Bilateral, no burning

Sx: dec pulses, trophic changes in feet

Calf then move to LE (buttock to feet)

Aggs: Exertion, stairs, uphill, pain consistent all positions

Eases: standing still, sitting down, resting 5 min

Ages 40-60+

Cause: Atherosclerosis

Question 11

Neurogenic Claudication

Answer 11

Bilateral or unilateral burning and dyesthesia in back, buttocks, LEs

Sx: Normal pulses, + SLR, sciatica

Low back, buttock, thighs, calves, feet

Aggs: Spinal ext, walking, downhill

Eases: Sitting/lying, forward bend, flexion ext

Ages 40-60+

Cause: HNP, Neoplasm, osteophytes

Question 12

Peripheral neuropathy

Answer 12

Pain, aching, numb in feet: also motor changes, dec DTRs

Sx: normal pulses, + SLR, sciatica

Feet and hands in stocking, glove pattern

Aggs: Uncontrolled glucose levels, alcoholism

Eases: Pain meds, treat underlying cause

Cause: Depends on cause: DM, RA, SLE, AIDS, Cancer

Question 13

Restless Leg Syndrome

Answer 13

Variable pain, crawling sensation in LE, invol contractions

Sx: Sleep disturbances, paresthesias

Location: Feet, calves, legs

Aggs: Caffeine, pregnancy, iron deficiency

Eases: Eliminate triggers, Iron+, walk, mod exercise

Ages: Variable

Cause: Unknown (pharm side effect, ANS disorder)