MSK Exam LE Flashcards
1
Q
Special tests for hip pathology
A
- Hip scour test: looks for DJD, supine with hip flexed & adducted, move into abduction while maintaining flexion, may add compressive load
- Patrick FABER test: identifies dysfunction of hip, supine passively flex, abduct, & ER leg so foot is resting just above knee on opposite leg; slowly lower leg down to table
2
Q
Special tests for hip labral lesions
A
- FADDIR/FADIR test: identifies anterior superior impingement, iliospoas tendinopathy, & anterior labral tear
- Supine, take involved limb passively into full flexion, abduction, & ER then into a full flexed, adducted, and IR position
3
Q
Muscle length tests for the hip
A
- Thomas test: identifies tightness of hip flexors; supine with one leg maximally flexed while the other remains flat on the table
- Ober’s test: identifies tightness of the TFL & IT band; sidelying with lower limb flexed, passively extend & abduct testing limb & slowly lower limb toward table
- Ely’s test: identifies tightness of rectus femoris; prone & flex knee; pos. if hip of tested limb flexes
- 90-90 HS test:identifies tightness of HS; poos. if knee lacks 10º or greater of knee extension
- Piriformis test: supine, foot of tested limb passively placed lateral to opposite limb’s knee with tested hip adducted; pos. if unable to pass over rested knee
- Trendelenburg sign: identifies gluteus medius weakness, stand on one leg; pos. if ipsilateral hip drops when lower limb support is removed while standing
4
Q
Difference between a true versus functional leg length discrepancy
A
- True: caused by an anatomical difference in bone lengths (either tibia or femur)
- Functional: not anatomical in origin and are the result of compensation due to abnormal position or posture
5
Q
How to measure for a leg length discrepancy
A
- Supine with pelvis aligned with lower limbs & trunk
- Measure distance from ASIS to lateral malleolus or medial malleolus on each limb several times for consistency & compare results
- Unequal girths of thigh musculature can skew results if measuring to medial malleolus
- A difference in measurements indicates a true leg length discrepancy
6
Q
Describe the patellar-pubic percussion test
A
- Identifies for a hip fracture
- Supine, examiner percusses each patella separately while auscultating the pubic symphysis with a stethoscope
- Pos. test is decreased percussion note on the affected side
7
Q
Special tests for anterior knee instability
A
- Lachman: test ACL, supine with knee flexed 20-30º, stabilize femur & passively translate tibia anteriorly
- Anterior drawer test: test ACL, supine with hip flexed to 45º and knee flexed 90º; passively translate tibia anteriorly
8
Q
Special tests for posterior knee instability
A
- Posterior drawer test: test PCL, supine hip flexed 45º and knee flexed 90º, passively translate tibia posteriorly
- Posterior sag sign: tests PCL, supine hip flexed 45º and knee flexed 90º, observe to see whether the tibia “sags” posteriorly
9
Q
Special tests for medial-lateral instability of the knee
A
- Valgus stress test: test MCL, supine apply a medial stress at the knee both at 0º and 30º of knee flexion
- Varus stress test: test for LCL, supine apply a lateral stress at the knee both at 0º and 30º oof knee flexion
10
Q
Describe the pivot shift test
A
- Test ACL
- Supine with knee extended and hip flexed/abducted 30º with slight IR
- Hold knee with one hand and foot with the other
- Place a valgus force through knee and flex knee
- Pos. if tibia relocates during the test, as knee is flexed tibia clunks backward at ~30-40º
11
Q
Special tests for meniscus tear
A
- McMurray test: supine with knee maximally flexed, passively IR and extend the knee (test lateral meniscus) and passively ER and extend the knee (test medial meniscus)
- Thessaly test: standing on symptomatic leg holding examiners hands, pt rotates body/leg IR and ER with he knee flexed 5º and at 20º
12
Q
Describe the patellar apprehension test
A
- Test for patellofemoral instability
- Supine, knee flexed to 30º, quads relaxed
- Passively translate patella laterally
- Pos. if pt expresses apprehension or contracts quads to prevent patella from dislocating
13
Q
Describe the patellar tilt test
A
- Supine with knee extended
- Lift lateral edge of patella from the lateral femoral condyle
- Pos. if patella is not able to be lifted to at least a neutral angle with respect to the horizontal plane
14
Q
Describe the noble compression test
A
- Test for IT band friction syndrome
- Supine, knee flexed 90º with hip flexion
- Apply pressure 1-2cm proximal to lateral femoral condyle
- With pressure maintained passively extend pt’s knee
- Pos. if pt experiences pain over the lateral femoral condyle
15
Q
Describe the brush (stroke) test
A
- Test for swelling
- Supine, knee in full extension
- Start at medial tibiofemoral joint and stroke upward 2-3x toward the supra patellar pouch
- Then stroke downward on the distal lateral thigh just superior to the supra patellar pouch toward lateral joint line
- Pos. if fluid is observed on the medial knee
16
Q
What is the grading scale for the brush (stroke) test
A
- 0 = no wave produced on down stroke
- Trace = small wave
- 1+ = larger bulge
- 2+ = spontaneous return after upstroke
- 3+ = unable to move effusion out of medial knee
17
Q
What are the Ottawa knee rules for referral for an x-ray
A
- All OR statements
- Age >55
- Isolated patellar tenderness without other bony tenderness
- Tenderness of the fibular head
- Inability to flex knee to 90º
- Inability to bear weight immediately after injury & in the emergency department
18
Q
Special tests for ankle instability
A
- Anterior drawer test: test anterior talofibular ligament; supine foot off edge of table & ankle in 20º PF; translate talus anterior while stabilizing the lower leg
- Talar tilt: test calcaneofibular ligament; sidelying knee slightly flexed & ankle in neutral; move foot maximally into adduction and abduction (deltoid lig.)
- Medial subtalar glide test: hold talus in subtalar neutral with one hand and translate the calcaneus medially on the fixed talus with the other hand
19
Q
Special tests for syndesmosis instability
A
- ER stress (Kleiger) test: test distal tibiofibular syndesmosis; seated knee flexed 90º & ankle in neutral; apply ER force to foot while holding tibia in neutral; pos. if visible joint gapping
- DF ER stress test: test distal tibiofibular syndesmosis; seated knee flexed 90 and ankle in max DF; apply ER force to foot while holding tibia in neutral; pos. if visible joint gapping
- Squeeze test: test distal tibiofibular syndesmosis; seated knee flexed 90º; apply compression b/w middle & distal 1/3 of pt’s leg; pos. if pain reproduced at syndesmosis
20
Q
Describe the Thompson’s test
A
- Test for achilles rupture
- Prone with foot off edge of bed
- Squeeze calf muscle, ankle should PF under normal conditions
- Pos. if no movement of foot occurs while squeezing calf
21
Q
Special tests for plantar fasciitis
A
- Windlass test: pain with extension of the great to and ankle DF
- Weight bearing test: stay on step with toes positioned over the edge & equal WBing; passively extend the pt’s 1st MTP
- Non-weight-bearing test: seated with knee flexed 90º; stabilize ankle & passively extend the pt’s 1st MTP
- Pos. is reproduction of plantar surface symptoms
22
Q
What are the Ottawa ankle and foot rules for referral for x-ray
A
- Do NOT use on patients under 18 years of age
- X-ray required if any pain in the malleolar zones and any of the following
- Bone tenderness from posterior edge/tip of lateral malleolus extending 6cm proximally
- Bone tenderness from posterior edge/tip of medial malleolus extending 6cm proximally
- Inability to take 4 complete steps both immediately & in the emergency department
- Bone tenderness at base of 5th metatarsal
- Bone tenderness of navicular
