Midterm Practical Flashcards
Straight Leg Raise Test
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
Slump Test
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
Results of slump test
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
Joint play options for hip
long axis distraction
long axis compression
lateral distraction
Special tests for muscle length
Thomas = hip flexor
Ely = rectus femoris
Ober = ITB
FABER test
- patient supine
- PT stabilizes at contralateral ASIS
- Foot of limb to be tested placed just proximal to opposite patella
- Testing limb overpressured into abduction/ER
Positive FABER
testing intra-articular issues
positive if it recreates their anterior/groin pain
SN = .57
SP = .71
+LR = 1.9
FADIR Test
- passively flex, adduct, IR to end range
Indicative of FAI
adding compression with less adduction = indicative of labral tear
FADIR Positive
Positive if it recreates their S/S
SN = .78
SP = .10
-LR = 2.3
Pubic Patellar Percussion Test
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
Olecranon-Manubrium Percussion
for shoulder injuries like dislocations, clavicular fractures
elbows are flexed at 90°
stethoscope bell over manubrium, direct percussion of each olecranon process
Step Down Test Scoring
0-1 = good
2-3 = moderate
≥ 4 = poor
Arm strategy
patient removes the hands from the waist
1 point is given
Trunk movement
patient leans the trunk to either side
1 point is given
Pelvic plane
if one side of the pelvis is rotated in the transverse plane or elevated in the frontal plane compared with the other side
Knee position
- 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
- 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
Maintenance of a steady unilateral stance
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
Angle >15° femoral torsion
increased anteversion leads to squinting patellae and pigeon toed walking, twice as common in girls
Angle < 8° femoral torsion
retroversion
Normal femoral torsion
at birth, angle is 30°, which decreases to 8-15°
Craig’s Test
for femoral torsion, amount of anteversion
can be associated with FAI, hip OA
Prone Instability Test
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
Ligamentum Teres Test
- Approx 70° flexion, 30°< full abduction
- passively IR and ER rotate through full ROM
pain in either position = positive
Sn = .9
Sp = .85
Hip De-rotation test
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
Hip distraction position
ER
30° flexion
30° abduction
Adductor Squeeze test Scores
0-2/10 pain = no risk
3-5/10 pain = mild risk
6-10/10 pain = high riskA
Adductor Squeeze
- Supine, hips not flexed with arms in-between ankles
- Supine, 45° of hips flexion, arms in-between knees
- Supine, 90° flexion, arms in-between knees
Posterior Glide
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
Anterior Glide
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
Prone PA Figure 4
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
Lateral Glide
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
Posterior glide self mob
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
Hip abductor strengthening
lateral step up
clamshell
sideplank progression
lateral banded walks/crab walk
Hip adductor strengthening
lying hip adduction
adduction with band
adductor squeeze bridge
Hip Extensors Strengthening
bridge
bridge unilateral
hip thrusts
quadruped hip extension
standing hip extension
squatting
Hip ER Strengthening
Clamshell
prone hip ER with band
standing hip ER with band
hip airplane
Hip IR Strengthening
seated hip IR
prone hip IR
reverse clamshell
Patellar Tap
- supine with knees extended
- 2-3 strokes with palm of suprapatellar pouch towards patella
- quick tap of patella posteriorly
- listen and feel for patella bouncing off femur with distinct impact
Bulge sign/sweep test
- supine with knees extended
- 2-3 strokes with back of hand medially from distal to proximal. Stroke laterally from proximal to distal and watch for medial effusion
Grades for Sweep Test
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
Patellar Tilt Test
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
Results of Patellar Tilt Test
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
MCL Integrity/Valgus Stress
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
LCL Intergrity/Varus Stress test
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
ACL integrity Lachman Test
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
ACL Lachman Results
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
Modified Lachman Test
- patient supine with knee resting on bolster or examiner’s knee so approximately 20-30° of flexion
- 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
Posterior Sag Sign
- Patient positioned at 45° hip flexion and 90° of knee flexion with foot flat
- Observe for normal tibial tuberosity prominence of approximately 1 cm in relation to femur
- 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
