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6 Orthopedics > Midterm Practical > Flashcards

Midterm Practical Flashcards

1
Q

Straight Leg Raise Test

A

Sn = .92
Sp = .28

Complete the following actions
1. Ankle DF
2. Hip IR and Hip adduction
3. Cervical flexion

reproduction should occur with 30-70° of flexion

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2
Q

Slump Test

A

Patient sits upright with hands clasped behind back and knees together

introduce motion in this order
1. THoracic spinal flexion
2. Neck flexion
3. Knee extension
4. Ankle DF
5. Release neck flexion

SN = .84-1.0
SP = .7-1.0
+LR = 3.0-11.9

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3
Q

Results of slump test

A

assess ROM and pain resonse before, during and after each added movement

apply overpressure IF indicated

if symptoms decrease with release of neck flexion, this may implicate adverse neural dynamics as a possible source of symptoms

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4
Q

Joint play options for hip

A

long axis distraction
long axis compression
lateral distraction

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5
Q

Special tests for muscle length

A

Thomas = hip flexor
Ely = rectus femoris
Ober = ITB

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6
Q

FABER test

A
  1. patient supine
  2. PT stabilizes at contralateral ASIS
  3. Foot of limb to be tested placed just proximal to opposite patella
  4. Testing limb overpressured into abduction/ER
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7
Q

Positive FABER

A

testing intra-articular issues
positive if it recreates their anterior/groin pain

SN = .57
SP = .71
+LR = 1.9

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8
Q

FADIR Test

A
  1. passively flex, adduct, IR to end range

Indicative of FAI

adding compression with less adduction = indicative of labral tear

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9
Q

FADIR Positive

A

Positive if it recreates their S/S
SN = .78
SP = .10
-LR = 2.3

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10
Q

Pubic Patellar Percussion Test

A

an abnormal PPPT should be suspected of having bony pathology

Positive means that there is an ABNORMAL bony pathology, not a specific test

looking for a dull/diminished sound

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11
Q

Olecranon-Manubrium Percussion

A

for shoulder injuries like dislocations, clavicular fractures

elbows are flexed at 90°

stethoscope bell over manubrium, direct percussion of each olecranon process

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12
Q

Step Down Test Scoring

A

0-1 = good
2-3 = moderate
≥ 4 = poor

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13
Q

Arm strategy

A

patient removes the hands from the waist
1 point is given

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14
Q

Trunk movement

A

patient leans the trunk to either side
1 point is given

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15
Q

Pelvic plane

A

if one side of the pelvis is rotated in the transverse plane or elevated in the frontal plane compared with the other side

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16
Q

Knee position

A
  1. if knee of the tested limb moves medially in the frontal plane and the tibial tuberosity corssed an imaginary vertical line positioned directly over the second toe fo the tested foot. 1 point
  2. If the knee moves medially and the tibial tuberosity crossed an imaginary vertical line positioned directly over the medial border of the tested foot, 2 points
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17
Q

Maintenance of a steady unilateral stance

A

subject has to support body weight on the non-tested limb or the foot of the tested limb moved during testing
1 point is given

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18
Q

Angle >15° femoral torsion

A

increased anteversion leads to squinting patellae and pigeon toed walking, twice as common in girls

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19
Q

Angle < 8° femoral torsion

A

retroversion

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20
Q

Normal femoral torsion

A

at birth, angle is 30°, which decreases to 8-15°

21
Q

Craig’s Test

A

for femoral torsion, amount of anteversion

can be associated with FAI, hip OA

22
Q

Prone Instability Test

A

anterior apprehension test

proximal hand on posterior GT applying anterior force as other hand passively ERs the limb

positive if anteriorly painful

SN = .34
SP = .98

23
Q

Ligamentum Teres Test

A
  1. Approx 70° flexion, 30°< full abduction
  2. passively IR and ER rotate through full ROM

pain in either position = positive

Sn = .9
Sp = .85

24
Q

Hip De-rotation test

A

theoretically creates tension and compression of GT and ITB

position patient in 90°flexion and full ER
have them attempt to push into IR

positive for lateral hip pain/weakness

SN = .88, SP = .97, +LR = 32.6

25
Q

Hip distraction position

A

ER
30° flexion
30° abduction

26
Q

Adductor Squeeze test Scores

A

0-2/10 pain = no risk
3-5/10 pain = mild risk
6-10/10 pain = high riskA

27
Q

Adductor Squeeze

A
  1. Supine, hips not flexed with arms in-between ankles
  2. Supine, 45° of hips flexion, arms in-between knees
  3. Supine, 90° flexion, arms in-between knees
28
Q

Posterior Glide

A

Helps to increase flexion and IR

Patient = supine with hips at end of table. patient assists in stabilization by holding contralateral limb against chest. Initially hip to be mobilized is in resting position, progress to end of range

Therapist = stand on medial side of pts thigh, pelvis facing lateral. Belt around distal shoulder and under patients thigh. Distal hand between belt and patients thigh. Proximal hand on anterior of proximal thigh

Mobilizing = keep elbows extended and flex your knees as your provide anterior to posterior force with proximal hand

29
Q

Anterior Glide

A

Increases extension and ER

pt: prone with trunk resting on table, asis at edge of table. opposite resting on floor

PT = standing on medial side of patient’s thigh, pelvis facing lateral. Belt around shoulder and pts thigh. Distal hand supports at ankle to avoid knee extension, Proximal hand posterior to provide posterior to anterior force just distal and lateral from ischial tuberosity

Mobilizing force = keep your elbows extended and flex your knees. apply force with proximal hand in anterior direction

30
Q

Prone PA Figure 4

A

increases extension, ER, abduction

pt = lying prone with involved extremity in figure 4 position. Can place knee off edge if they don’t have enough rotation

PT = on contralateral side with hand-over-hand position just distal and lateral from ischial tuberosity

mobilizing = in anterolateral direction to proximal femur

31
Q

Lateral Glide

A

for pain relief, general mobility

pt = supine with involved extremity in hook lying. pt places belt as close to hip crease as comfortable. towel placed between belt and thigh for comfort

PT = belt around lower hips, hands at knee to stabilize and provide counterforce for first position. proximal hand stabilizes at pelvis for second position. posterior weight shift through hip hinge

mobilizing = lateral glide by flexing knees into posterolateral direction

32
Q

Posterior glide self mob

A

for pain, loss of flexion

pt: supine with heavy band around uninvolved foot and around involved hip at the anterior hip crease. Hands support involved limb in flexion OR foot can rest on door jamb

Force = scoot towards door jamb, increase hip flexion, or press other limb into more extension and PF

33
Q

Hip abductor strengthening

A

lateral step up
clamshell
sideplank progression
lateral banded walks/crab walk

34
Q

Hip adductor strengthening

A

lying hip adduction
adduction with band
adductor squeeze bridge

35
Q

Hip Extensors Strengthening

A

bridge
bridge unilateral
hip thrusts
quadruped hip extension
standing hip extension
squatting

36
Q

Hip ER Strengthening

A

Clamshell
prone hip ER with band
standing hip ER with band
hip airplane

37
Q

Hip IR Strengthening

A

seated hip IR
prone hip IR
reverse clamshell

38
Q

Patellar Tap

A
  1. supine with knees extended
  2. 2-3 strokes with palm of suprapatellar pouch towards patella
  3. quick tap of patella posteriorly
  4. listen and feel for patella bouncing off femur with distinct impact
39
Q

Bulge sign/sweep test

A
  1. supine with knees extended
  2. 2-3 strokes with back of hand medially from distal to proximal. Stroke laterally from proximal to distal and watch for medial effusion
40
Q

Grades for Sweep Test

A

0 = no wave produced
Trace = small wave produced
1 = larger bulge on medial side
2 = medial effusion reutrns w/o lateral downstroke
3. so much fluid it doesn’t move

41
Q

Patellar Tilt Test

A

determine tightness of the retinaculum

pt = supine with legs extended and in neutral rotation

PT = palpate medial and lateral borders of patella with index fingers

can help see if there is a possibility of PFP

42
Q

Results of Patellar Tilt Test

A

normal to be slightly medially tilted

if digit palpating medial border is higher than lateral border, patella is considered laterally tilted

if digit palpating lateral border is higher than medial border, patella is medially tilted

43
Q

MCL Integrity/Valgus Stress

A

Purpose: test the integrity of MCL to resist valgus foces

Position = patient supine with LE supported and relaxed.

PT = apply a valgus force through the knee joint while applying abduction force at the foot/lower leg. Done at 0° and 30°

positive if there is excessive gapping, pain, lack of end feel. Laxity is expected at 30°

moderately high SN, moderately low SP

44
Q

LCL Intergrity/Varus Stress test

A

purpose = test the integrity of LCL to resist varus forces

pt = supine with LE supported and relaxed
PT = apply varus force with medial hand an adduction force at foot/lower leg. Do at both 0° and 30°

positive = excessive gapping, pain, lack of end feel

poor SN and Sp

45
Q

ACL integrity Lachman Test

A

Purpose = determine integrity of the ACL for resisting anterior translation

Position. = patient supine with knee passively flexed to 20°

PT = stabilize the thigh with proximal hand. Distal hand grasps the proximal tibia with thumb close to joint line. Fingers palpates hamstrings. Pull tibia anteriorly with approx 30 lbs of force

46
Q

ACL Lachman Results

A

Grade 1 <5 mm
Grade 2 < 5-10 mm
Grade 3 >10 mm

comparing to the other side for normal value

high spin and snout, +LR 4.26

47
Q

Modified Lachman Test

A
  1. patient supine with knee resting on bolster or examiner’s knee so approximately 20-30° of flexion
  2. Proximal hand stabilizes the femur against examiner’s hand and the other hand applies anterior translation force

Found to be comparable to Lachman test for examiners with small hands or patients with large LE

48
Q

Posterior Sag Sign

A
  1. Patient positioned at 45° hip flexion and 90° of knee flexion with foot flat
  2. Observe for normal tibial tuberosity prominence of approximately 1 cm in relation to femur
  3. Second position with LE supported 90/90 adds more gravitational pull

positive if prominence absent compared to other side

high spin and snout, high +LR

6 Orthopedics (17 decks)

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