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MSK > MSK Practical > Flashcards

MSK Practical Flashcards

1
Q

Observation Questions

A

-prefering to sit, stand or move
-changing position often
-ADL assistance
-visible discomfort
-observations match Hx
-eye contact

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2
Q

When to Scan

A
  1. No obvious MOI
  2. Proximal Cause for Distal S/s
  3. Non-mechanical sounding Sx
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3
Q

LQ Scan

A
  1. Vitals***
  2. Observation: posture, plumb line
  3. Gait: look for gross abnormalities
  4. Functional MMts: squats***
  5. Balance Testing***
  6. Clear the spine**
  7. SI Joint Provocation**
  8. Myotomes: include functional testing (heel and toe walking)
  9. Dermatomes
  10. DTR: patellar, med hamstring, achilles
  11. UMN Testing: Babinski, clonus***
  12. Neurodynamic Testing: SLR, slump test**
  13. LE ROM: FABER, flx, DF/PF, toe flx/ext
  14. Pulses (optional)
  15. Lymph Nodes (optional)
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4
Q

Physical Examination Components

A
  1. Pt Hx
  2. Systems Review
  3. Observation
  4. Scanning Exam (if needed)
  5. AROM>PROM>RROM & Flexibility
  6. Muscle
  7. Joint Play
  8. Palpation
  9. Special Tests
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5
Q

Normal End Feels

A

Bony/Hard: bone on bone
-elbow ext
-hard ending
-no joint play

Elastic: muscle tendon unit
-stretches with recoil
-wrist flextion causing finger flexion
-muscle adhesions= passive stretch

Soft: soft tissue
-elbow flexion

Capsular: produced by capsule or ligaments
-with pain= 1-2 Oscillation
-Adhesions= 3 sustained and 3-4 oscillation mobilization

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6
Q

Abnormal End Feels

A

Springy: articular surface
-rebound sensation
-knee flexion with displaced meninscus

Boggy: viscous fluid in joint
-squishy sensation
-blood in joint or sepsis

Spasm: reactive muscle reaction
-unyielding spasm
-recent trauma or tear
-no joint play

Empty: pain stops you
-no joint play if with assessment

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7
Q

Grade I Oscillatory Mobilization Grades

A

-small amplitude
-0-25%
-beginning of available joint play
-Pain
-acute stage

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8
Q

Grade II Oscillatory Mobilization Grades

A

-large amplitude
-25-75%
-middle joint play
-acute and sub acute stage
-pain

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9
Q

Grade III Oscillatory Mobilization Grades

A

-large amplitude
-50-100%
-end of joint play
-joint adhesions
-Subacute and chronic stages

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10
Q

Grade IV Oscillatory Mobilization Grades

A

-small amplitude
-75-100%
-end of joint play
-intense
-joint adhesion
-chronic stage

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11
Q

Grade V Oscillatory Mobilization Grades

A

-high velocity low amplitude thrust
-quick movement that exceeds resistance
-100+%
-Subacute to chronic stages

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12
Q

Grade I Sustained Mobilization Grades

A

-loosen to neutralize joint pressure
-no stress on capsule
-decrease compression
-used with gliding motion

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13
Q

Grade II Sustained Mobilization Grades

A

-take up slack to separate joint surfaces
-eliminate joint play
-determine joint sensitivity

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14
Q

Grade III Sustained Mobilization Grades

A

-stretch
-large distraction w/ 6 sec hold
-increase mobility
-treat hypomobility
-joint adhesions

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15
Q

Oscillatory Joint Mobilizations

A

-pain dominant
-III-IV for stiffness

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16
Q

Contraindications for Manual Therapy

A

-infection
-Fever
-Cancer
-Acute Circulatory Condition
-Open Wound
-Fracture
-Hematoma
-Advanced DM
-Hypersensitivity
-Abnormal Endfeel
-RA
-Cellulitis
-Constant, Severe pain
-Extensive radiation of pain
-Condition not evaluated

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17
Q

Precautions for Manual Therapy

A

-Joint effusion or inflammation
-RA (non-exacerbation)
-Osteoporosis
-Pregnancy (over spine)
-Dizziness
-Steroid or anti-coagulant

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18
Q

Examination to Treatment w/ Mobilizations

A
  1. Baseline Assessment
    -pain, s/s, ROM, Strength
  2. Determine Grade
    -impairment, stage, irritability
  3. Contraindications and Precautions
  4. Take up Slack
    -assess joint play
  5. Arthrokinemattics and Pt Position
  6. Only 1 Surface Moves
  7. Re-assess after Treatment
    -pain, s/s, ROM, Strength
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19
Q

Convex on Concave

A

-roll and glide in opposite direction
-pt move with glide

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20
Q

Concave on convex

A

-roll in glide in same direction
-pt move with glide

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21
Q

Joint Play (Spine)

A

-Hypomobile, Normal, Hypermobile
-Only skip if they have normal, pain free motion

  1. Know joint surface shape
  2. Determine hand placement
    3.Grade Motion compared to other side and expected motion
  3. Assess Pain/no pain and mobility
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22
Q

Neurodynamic Mobility Exam

A

-Subjective (Pain, spasms, paresthesias)
-Observation
-Palpation
-ROM
-Resisted testing
-Nerve provocation test

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23
Q

3 Signs of a Positive NTPT

A
  1. Reproduces Pt s/s
  2. Movement of distant body part causes responses
  3. Test differences from L to R
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24
Q

Straight Leg Raise

A

-test for sciatic n

  1. actively raise leg
  2. passively raise leg
  3. DF
  4. Pt lift head

Pain in 0-30: acute/severe MSK
Pain in 30-70: nerve issue
Pain >70: not positive
Crossed SLR sign: opposite s/s, disc protrusion

Sensitizers:
-Tibial: DF > Eversion > Toe Ext
-Sural: DF > Inversion
-Common fib: PF > Inversion

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25
Q

Slump Test

A

-test neuromobility

  1. Hands behind back
  2. Head and neck flexed
  3. Lumbar flx
  4. Straighten knee
  5. overpressure
  6. DF of ankle
  7. Pt moves head
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26
Q

Indication for Neurodynamic Mobilizations

A

-Neurological s/s
-Antalgic Postures
-Active or passive mmt Dysfunction
-Tenderness to palpation over superficial neural tissues

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27
Q

Contraindications for Neurodynamic Mobilizations

A

-Recent repair
-Malignancy
-Active Inflammatory Disorders
-Acute Inflammatory Demyelinating Disorders

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28
Q

Precautions for Neurodynamic Mobilizations

A

-irritable conditions
-SC signs
-Nerve root signs
-Severe night pain w/ no Dx
-recent paresthesia or anesthesia
-Mechanical spine pain w/ peripheralization s/s

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29
Q

Neurodynamic Mobilization Techniques: Tension

A

-load opposite ends of nerve
-both “on” or “off”
-when glides no longer help

ex: head flx and ankle DF, the head ext and ankle PF

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30
Q

Neurodynamic Mobilization Techniques: Gliding

A

-load one end of nerve while relieving stress on opposite end
- 1 “on” and 1 “off” then switch

ex: head flx and ankle PF, the head ext and ankle DF

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31
Q

Neurodynamic Mobilization Techniques: Stretching

A

-load opposite ends of nerve and hold
-7-30s
-both “on” or “off”
-most agressive

ex: head flx and ankle DF (hold), the head ext and ankle PF (hold)

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32
Q

LBP Subjective Hx

A

Pain: location/movement, MOI/onset, time, description, behavior, intensity, better/worse, 24h bahavior

Pt Demopgraphics: age, race, hobbies, work, participation, impact of s/s, psychosocial considerations

General Health: Prior Hx, Co-morbidites, surgeries, Pregnancies, Medications

Red Flag Qs: Neural involvement, fracture, infection, cancer (Constant pain, intense pain, weight loss), AAA

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33
Q

Lumbar ROM Values

A

Flexion: 70-90
Extension: 40-50
Rotation: 20-40
LSB: 25-35

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34
Q

Evaluation Steps of LBP

A
  1. Subjective Hx
  2. Scan/Not (neuro, no MOI, not MSK)
  3. Observation
  4. ROM
  5. Strength
  6. Special Tests
  7. Repeated Measures (if needed)
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35
Q

Piriformis Syndrome

A

-Dx of exclusion

S/s:
-hx of trauma so SIJ or glute
-pain around SIJ or piriformis
-worse with lifting, sitting
-palpable tension
-+ SLR
-(+) provocation pain
-(+) LE paresthesias
-Glute atrophy

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36
Q

End Plate Fx S/s

A

-trauma or MOI
-Acute pain
-(-) SLR
-(+) compression test

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37
Q

Internal Disc Disruption S/s

A

-separation of inner layers
-LBP or referred hip pain
-(-) SLR

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38
Q

Disc Protrusion/Prolapse S/s

A

-contained
-some AF and PLL intact
-LBP or referred hip
-pain with cough or sneeze
-(-) SLR

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39
Q

Disc Extrusion of Sequestration S/s

A

-uncontained
-LBP
-Pain with cough/sneeze
-True Sciatica (radicular pain)
-(+) SLR

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40
Q

Spinal Stenosis S/s

A

-narrowing spinal canal (vascular or neurogenic)
-congenital development or acquired
S/s: butt pain, limping, lack of sensation, dec walking ability

Central:
-spinal canal dec
-claudication, butt pain

Lateral:
-narrowing of facets
-can impinge nerve roott

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41
Q

Facet Dysfunction S/s

A

-hypomobility at a facet joint

S/s:
-localized pain
-specific AROM deficits
-hyper mobility at another level

Tx:
-manual therapy > mobility > strengthening

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42
Q

Lumbar Instability S/s/Tx

A

-loss of passive restraints to movement
-lack of NM control

S/s:
-catching in back
-inconsistent symptoms
-(+) Prone instability

Tx:
-strengthening/stabilization
-recurrence is common

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43
Q

Manual Therapy Classification

A

CPR:
-No sx distal to knee
- <16 days (acute/subacute)
-FABQ score <19 (fear avoidance beliefs)
-1 hypomobile segment
-1 hip >35deg internal rotation (loss of ER)

Tx:
-HVLAT
-ROM

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44
Q

Stabilization Classification

A

CPR:
- <40 yrs old
- Post parum/SLR >91 deg (flexible)
- Instability catch or aberrant movements during flx/ext
-(+) Prone instsbility test
-Postpartum:
(+) posterior pelvic pain provocation, ASLR, mod Trendelenburg
OR
Pain w/ palpation of long dorsal SI ligament or pubic symphysis

Tx:
-isolated contraction of deep stabilizers (TA, Multifidi)
-Strengthen large spinal stabilizers (ES, Obliques)
-Hooklying to Side Plank

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45
Q

Extension Direction-Specific Classification

A

CPR:
-Sx distant to Butt
-Sx centralize with extension
-sx peripheralize with flexion
-directional preference for extension (standing/walking)

Tx:
-End range exetnsion
-mobilize to promote extension
-Avoid flexion

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46
Q

Flexion Direction-Specific Classification

A

CPR
- >50yrs
-Directtional preference for flexion
-Lumbar Spinal stenosis

Tx:
-mobilize or manip spine
-strength and flexibility exercises
-body weight supported treadmill

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47
Q

Lateral Shift Direction-Specific Classification

A

CPR
-visible frontal plane shift
-directional preference for lateral translation movements

Tx:
-exercises to correct shift (manual glide from PT or leaning on walls)
-traction

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48
Q

Traction Classification

A

CPR
-Sx decrease w/manual or auto traction

don’t respond to anything else
*(+) Crossed SLR *
Peripheralization of multipple directions

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49
Q

Joint Manipulation Contraindications

A

-Serious pathology
-fracture*
-lack of skill
-Ligament rupture*
-No working hypothesis
-Worsening neuro function*
-Unremmitting night pain*
-Severe multi directional spasms
-UMN Lesions*

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50
Q

SIngle Limb Stance (SLS)

A

Note:
-abnormal postural sway
-assistance
-Sx
-side ot side diff
-(+) Trendelenberg Sign
-Poor balance (<30s)

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51
Q

Single Limb Squat

A

Note:
-depth
-assistance
-Sx
-side ot side diff
-(+) Trendelenberg Sign
-Poor balance (<30s)

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52
Q

Functional Tasks

A

-Lifting
-Squatting
-Bending
-Twisting

-assess quality and duration of movement prior to pain

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53
Q

Repeated Movements Testing

A

-Radiating S/s ONLY

Extension: 80%
-prone to standing
-10 reps
-want centralization

Flexion:
-Supine to standing
-10 reps
-want centralization

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54
Q

Sorenson Test

A

-muscle endurance and strength test
-stopped at 4 mins if continue

5: hands across chest 20-30s)
4: Hands at side (15-20)
3: Hands at siide (10-15)
2: Hands at side (1-10)

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55
Q

Dynamic Abdominal Endurance Test

A

-muscle endurance and strength test

5: hands behind neck (20-30s)
4: Hands crossed on chest (15s)
3: Arms straight (10-15)
2: Hands straight toward knees (1-10)
1: Unable to raise more than head

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56
Q

Flexibility Tests

A

-Psoas
-Rec Fem
-Piriformis (>90 IR)
-Hamstring

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57
Q

Prone Knee Bend

A

-Neuroprovocation Test
-tests femoral nerve

  1. Pt prone
  2. PT papssively flexes knee
  3. (+)= S/s 80-100 degs
  4. (-)
    - Absense of s/s
    -<80 deg knee joint dysfunction
    ->100 deg RF or spine dysfunction
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58
Q

Spinal Joint Play

A

-hypo, hyper, normal

Central (CPA):
-palpate SPs
-pisiform and push
-INCLUDE SACRUM

Unilateral (UPA):
-palpate opposite TP
-Thumbs and push

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59
Q

Prone Instability Test

A

-when you suspect instability
-hypermobile joint play

  1. Pt in prone with legs off
  2. Relaxed, PT push on symptomatic joint segments
  3. if painful, have Pt lift legs and push again
    -(+): pain gets better
  4. Repeat on each hypermobile section from joint play
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60
Q

Stoop Test

A

-for intermittent claudication****
-bike or walking

  1. Start upright and time until Sx occur
  2. Stoop until Sx occur

(+): Sx improve w Stopped posture (takes longer to produce)

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61
Q

Waddell’s Test

A

-for non-organic Sx
-need 3 or +/5

  1. Stimulation
    -gently compress head, Pt response
    -trunk rotation at hips, Pt response
  2. Regional
    -sensory weakness or weakness in whole area and not pattern
  3. Tenderness
    -superficial brush on skin in non-surgical area
  4. Distraction
    -look for inconsistencies
    -SLR: distraction no response, response when brought to their attention
    -Bending
    -Limping
  5. Over-Reaction
    -less reliable
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62
Q

Sidelying Lumbar Gapping

A
  1. Pt Sidelying
  2. Palpate L5-L4
  3. Flex sup leg until movement at L5
  4. Rotate Arm/trunk until Movement at L3
  5. Rotate in opposite directions

add HVLAT for manipulation

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63
Q

Million Dollar Roll

A

1.Pt Supine
2.Banana shape with Pt on outside of curve
3.Roll trunk toward PT
4.Place resistance on opp ASIS
5. Rote in opposite directions

add HVLAT for manipulation

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64
Q

Lumbar Gapping MET

A
  1. Pt Sidelying
  2. Palpate L5-L4
  3. Flex sup leg until movement at L5
  4. Rotate Arm/trunk until Movement at L3
  5. Rotate in opposite directions
  6. Have Pt try to unwind against PT
    -hold for 6 sec, relax, go further
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65
Q

Opening Restriction MET

A

Opening on down side

  1. Pt Sidelying
  2. Palpate L5-L4
  3. Flex BOTH legs until movement at L5
  4. Rotate Arm/trunk DOWN until Movement at L3 (flexion bias)
  5. Lift BOTH legs
  6. Ask Pt to gently push into hands
    -hold for 6s, relax, go further
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66
Q

Closing Restriction MET

A

Closing on up side

  1. Pt Sidelying
  2. Palpate L5-L4
  3. Flex SUP leg until movement at L5
  4. Rotate Arm/trunk UP until Movement at L3 (extension bias)
  5. Lift SUP leg
  6. Ask Pt to gently push into hands
    -hold for 6s, relax, go further

-might not be great IR

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67
Q

Adduction Isometric for Anterior pelvic/SIJ Pain MET

A

-Pt in hooklying
-PT pushes against medial knees to resist add the switch to resisit abduction (can use chest)
-Pt pushes against for 3 seconds 3x

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68
Q

Possible LBP DDx

A

-Instability (Stabilization)
-Hypomobility (Manual Therapy)
-Piriformis Syndrome
-Disc Pathology
-Spinal Stenosis
-Foraminal Stenosis
-Facet Dysfunction

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69
Q

Subjective Hx of SIJ Dysfunction

A

-Fortin Sign: pain over PSIS**
-Pain with transitional movements**
-Pain with SLS activities**
-Pain at end range of Active SLR
-Prolonged sitting/standing
-(-) Neuro
-No s/s below knee

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70
Q

SIJ Joint Diagnoses: Hypomobility

A

Innominate Rotation
-anterior rot on one side and posterior on the other
-ASIS OR PISIS different heights and superficialness

Upslip
-ASIS, PSIS, ISCH tub ALL up on one side
-leg forced up

Downslip
–ASIS, PSIS, ISCH tub ALL down on one side
-rare
-leg pulled down

Pubic Lesion
-superior or inferior

Tx:
-manual
-core exercises

MOI:
-unilateral forces
-falls
-back lifting
-swinging

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71
Q

SIJ Joint Diagnoses: Joint Arthritis (Sacroilitis)

A

S/s:
-pain in post sacrum or groin
-radiating into thigh
-increase SLS pain
-Turning in bed pain
-lumbar extension painful
-(+) SI stress tests
-(+) Compression test with SI Belt

Tx:
-NSAIDs, ice, core exercises and LE exercises

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72
Q

SIJ Joint Diagnoses: Pelvic Girdle Instability

A

-suspect hypermobility or nothing from other tests

Form Closure:
-assessed 1st with ASLR
-passive stability malfunction (joint shape, ligaments, bony stability)
-Tx: SI Joint compression belt

Force Closure:
-assessed 2nd with ASLR
-active stability malfunction (muscles and fascia)
-Tx: core stabilization exercises

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73
Q

SIJ Joint Diagnoses: Piriformis Syndrome

A

S/s:
-persistent low back pain into butt and thigh
-(+) pain provocation of piriformis
-(+) pain w/ sitting or squatting
-persistent hip ER
-Difficuly lying
-(+) LE paresthesias

Tx: manual, stretching, core exercises

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74
Q

Evaluation Order of SIJ Dysfunction

A
  1. Do Hip and/or Lumbar Exam
  2. Confirm Presence of SIJ dysfunction with Provocation
  3. Determine side of Hypomobiltiy (mobility/functional tests)
  4. Determine Pathology
  5. Determine if Form or Force are a component
  6. Select Intervention (treat lumbar or hip dysfunction first, then SIJ hypomobility first)
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75
Q

Lumbar Disc Joint Clearing Tests

A

(+) pain with coughing and sneezing
Decreased pain with walking

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76
Q

Lumbar Spine Joint Clearing Tests

A

(-) pain with coughing and sneezing
(+) pain with extention or flx
(+) pain with PA joint glides

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77
Q

Hip Joint Clearing Tests

A

(+) Trendelenburg signs
(+) Pain or decreased ability to squat
(+) Sign of buttock test

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78
Q

SI Joint Clearing Tests

A

(+) Fortin’s Sign
(+) Joint gapping or compression tests
(+) TTP at SI ligs
(+) Pain/weakness with SLS

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79
Q

Mobility Exercises (SIJ)

A

-foam roll
-AROM
-Stretches

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80
Q

Stability Exercises (SIJ)

A

-AROM
-Spinal Stability
-Pelvic Floor Strength**
-Glute Strength**

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81
Q

SI Belt Application

A
  1. Pt flexes hip and crease is where bottom of belt will go
  2. Middle seam goes in mid back
  3. Pull belt traps snugly
  4. Pt exercises or performs ADLa for s/s reduction

belt goes on skin

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82
Q

Possible SIJ DDx

A

-Hypomobility
-Joint Arthritis
-Pelvic Girdle Instability
-Piriformis Syndrome

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83
Q

SIJ Provocation/Stress Tests

A

-statistically the best
-reproduce pain

-FABER
-Distraction
-Compression
-Thigh Thrust
-Sacral Thrust
-Gaenslen’s Test

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84
Q

SIJ Alignment/Positional Tests

A

-Questionable reliabiliy/validity

-Iliac Crest Height
-ASIS Height
-PSIS Height
-Isch Tub Height

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85
Q

Mobility/Functional Tests

A

-questionable reliability/validity
-More movement=Hypomobile segment

-Standing Flexion Test
-Seated Flexion Test
-Stork Gilet Marching
-Supine to Long Sit Test

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86
Q

Evaluation Order of SIJ Dysfunction

A
  1. Do Hip and/or Lumbar Exam
  2. Confirm Presence of SIJ dysfunction with Provocation
  3. Determine side of Hypomobiltiy (mobility/functional tests)
  4. Determine Pathology
  5. Determine if Form or Force are a component
  6. Select Intervention (treat lumbar or hip dysfunction first, then SIJ hypomobility first)
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87
Q

Fortin’s Sign

A

-pain localized with one finger over PSIS
->2 times

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88
Q

Primary SI Gapping (Distraction) Test

A

-provocation tests
-anterior SI joint stress test
-push on ASISs

(+) Reproduction of s/s

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89
Q

Primary SI Compression Test

A

-provocation tests
-in sidelying press down on hip
-painful side up

(+) Reproduction of s/s

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90
Q

Sacral Thrust Test (PA Glide)

A

-provocation tests
-Palapate sacrum
-apply force downward over S3
-repeat multiple times (<6)

(+) Reproduction of pt pain over SIJ or posterior ligs

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91
Q

Gaenslen’s Test

A

-provocation tests
-Thomas Test position, testing leg down
-flex non-testing leg and assess s/s
-PT presses top leg into flx and bottom into ext

(+) reproduction of pt pain at SIJ or pubic symphysis

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92
Q

FABER Test

A

-provocation tests
-pt supine, PT on ipsi side of leg
-hip in flx, ER, abduction
-press into contra ASIS and knee

(+) reproduction of pt pain at posterior pelvis or butt

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93
Q

Thigh Thrust Test

A

-provocation tests
-PT on contra side of testing leg
-PT hand under sacrum
-Pt hip flx and adducted
-PT pushes hip past sacrum

(+) reproduction of pt pain at SIJ

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94
Q

(+) SIJ Dysfunction CPR

A
  1. Compression
  2. Distraction
  3. Sacral Thrust*
  4. Gaeslen Test
  5. Thigh Thrust

3 or more/5 (+) = dysfunction

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95
Q

(-) SIJ Dysfunction CPR

A
  1. Compression
  2. Distraction
  3. FABER*
  4. Gaeslen Test
  5. Thigh Thrust

3 or less /5 (+) = no dysfunction

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96
Q

Pubic Stress Test for Anterior Pain

A

-provocation tests
-PT uses heel of hand 1 superior aspect of pubic ramiu and 1 hand at inferior
-slow downward opposite pressure
-switch sides

(+) reproduction of pain over pubic symphysis or anterior pelvis

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97
Q

Sign of Buttock Test

A

-provocation tests
-sign of serious pathology (hip absess, fracture, infection, cancer)
-nerve on slack and pain still there

  1. Passive SLR (+)
  2. Return to neurtral and bend hip and knee
  3. Passive bent leg raise (+) and same ROM
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98
Q

Alignment Palpation Sites

A

-ASIS
-PSIS
-Pubic Tubercle
-Sacral Base Depth
-Inferior Lateral Angle
-Isch tubs

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99
Q

Seated Flexion Test

A

-Mobility/functional test
-Pt seated
-PSIS found then Pt bends over
-PSISs should move superiorly equally
-rules out Leg length diff or hamstring tightness**

(+) Don’t move equally, affected (hypomobile) side moves more than unaffected

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100
Q

Long Sitting (Suine to sit) Test

A

-Mobility/functional test
-Pt supine
-palpate medial malleoli on both ankles
-Pt sits up, Med mals should come down equally

(+) malleoli don’t move equally
longer limb= posterior innominate
Shorter limb= anterior innominate

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101
Q

Standing Flexion Test

A

-Mobility/functional test
-Pt standing
-PSIS found then Pt bends over with knees extended
-PSISs should move superiorly equally

(+) Don’t move equally, affected (hypomobile) side moves more than unaffected

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102
Q

Gillet’s (Stork) Test

A

-mobility/functional test
-Pt in standing with testing leg down and opp hip flexed
-P palpates PSIS and contra sacrum
-Pt flexes opp hip
-PSIS should move inferiorly to sacrum

(+) PSIS doesn’t move inferiorly to sacrum (hypomobile) OR causes SI joint pain

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103
Q

Active SLR Test

A

Form Closure Test

Step 1. Pt actively lifts leg
(+) reproduces SIJ pain OR abberant movements during
1 must be positive to move on to 2 and 3

Step 2: PT compresses pelvis laterally and Pt lifts leg
(+) Pt has less pain OR fewer abberant movements

-Tx: SI compression belt

Step 3: Pt contracts core then lifts leg
-PT can reisist contra shoulder to help
(+) Pt can perform ASLR with less pain OR few abberant movements

Tx: stabilization exercises

104
Q

Sidelying SI Gapping Manipulation

A
  1. Pt sidelying with hips flexed 90 deg, shoulders stacked ( PT behind pt)
  2. Pt rotated by pulling “table arm” across Pt
  3. Pelvis remains stable with PT hand
  4. Pt then rotated more to take up slack while pushing hip medially
  5. Quick thrust to manip,
105
Q

Long Axis Traction Manipulation (SI)

A

-2 person technique
-Pt prone with legs off table in closed packed (ext, abd, IR)
-PT grabs affected LE and lifts up and out
-other PT stabilizes sacrum
-PT takes of slack on leg then quickly pulls

106
Q

Prone Sacral PA Mobilization

A

-Palapate sacrum
-assess glide of sacrum
-apply force downward over base (counternutated) or apex (nutated)

107
Q

Prone Joint Mobilization to Restore Anterior Innominate Rotation

A

-Pt prone with unaffect LE relaxed or off table
-PT extends affected legwhile stabilizing ipsi PSIS
-Mobilize joint into anterior rotation if stuck in posterior
-maintain extension

108
Q

Supine w/ Hip Flexed and Extended Isometric Hold MET

A

-Pt supine with hips and knees flexed
-PT puts hand on ipsi knee and contra posterior thigh
-Simultaneously push into flexion and extention
-Pt reissts for 6 sec

-Resist flexion: brings pelvis ant
-Resist extension: brings pelvis post

brings both sides closer together

109
Q

Hip Joint (OP/CP)

A

-synovial joint
-Designed for stability and less mobility
-Convex head of femur and concave acetabulum
-Femoral head faces Medially, anteriorly, superiorly

Resting Position: Flx 30, Abd 30, Slight ER
Closed Packed: Full ext, IR, ABD
Capsular Pattern: Flx, Abd, IR (sometimes IR first)

110
Q

Normal ROM Hip

A

Flx: 110-120
Ext: 10-15(20)
IR: 30-40
ER: 40-60
Abd: 30-50
Add: 25-30

111
Q

Arthrokinematics of Hip

A

Flexion: sup spin, post glide
Extension: inf spin, ant glide
Abd: inf glide, med glide
Add: sup glide, lat glide
IR: posterior glide
ER: anterior glide

112
Q

Legg-Calve-Perthes

A

Age: 2-13yrs
-avascular necrosis
-Males >

S/s:
-gradual onset, ache in hip, thigh, knee

Observation:
-short limb
-higher g troch
-quad atrophy
-adductor spasm
-antalgic gait

ROM:
-limited abduction
-ext

Intervention:
-ROM and positioning

113
Q

Slipped Femoral Capital Epiphysis

A

Age: 10-17 yrs males, 8-15yrs female
-ice cream falling off cone
-Male>

S/s:
-gradual onset
-vague pain in knee, suprapatellar, thigh and hip

Observation:
-short limb, usually obese, quad atrophy
-adductor spasm
-hip abducted and ER

ROM:
-limited IR, abd, flex

Gait: antalgic acutely, Trendelenburg chronically

114
Q

Altman’s Clinical Criteria (Hip)

A

-do you have hip OA?

  1. Hip pain
  2. IR <15deg
  3. Pain with IR
  4. Morning stiffness up to 60min
  5. Age >50yrs
115
Q

Sutlive CPR

A

-what are the odds you have hip OA
3/5 present= 68%
4/5 present= 91%

  1. Self-reported squatting is aggravating
  2. SCOUR test w/ ADD causes groin or lat hip pain
  3. Active hip flx causes lat pain
  4. Active hip ext causes hip pain
  5. Passive hip IR less than or equal to 25deg
116
Q

Hip OA

A

->50yrs
-hip pain

Observation:
-decreased stance time
-morning stiffness
-painful squatting

ROM:
-Dec IR
-Decreased >2 planes of motion
-flex causes latt pain

117
Q

Osteitis Pubis/ Symphysiolysis

A

-inflammation of pubic tubercles
-during surgery or pregnancy

118
Q

ITB Syndrome

A

-gradual onset; overuse
-Ober’s test

S/s:
-lat hip, thigh, knee pain
-snapping IT band over greater troch

Tx:
-activity modification
-stretching
-footwear

119
Q

Trochanteric Bursitis

A

-pain over greater troch w/ resisted abd
-pain on greater troch

120
Q

Meralgia Paresthesia

A

-Brittany spears
-gradual onset, obese, pregnancy

S/s:
-pain and paresthesia of ant lat thigh
-lateral femoral cutaneous

Tx: Nerve glides

121
Q

Gluteus Med Tendinopathy/Tear

A

-post menopausal, >50yrs
-Aggravating factors: stair climbing and sleeping on side
-muscle wasting

Diffx:
-troch bursitis
-hip OA

Testing Cluster:
-FABER
-external de-rotation tests
-palpation of glute med
-SLS
-Load dependent pain

Tx:
1. isometrics
2. Isotonics
3. Energy Storage
4. Sport Specific

122
Q

Femoroacetabular Impingement

A

-FAI, labral pathology

Cam Impingement:
-related to femoral head and neck morphology
-early contact
-damages labrum

Observations: Anteversion, coxa vara

Pincer Impingement:
-acetabular abnormalities

Observations: retroversion

Pain locations:
-Anterior-medial: flx/IR positioning
-Posterior: flx/abd/ER positioning
(ischtub pain)

123
Q

Femoral Neck Stress Fracture

A

-not on Xray
-unable to passively rotate hip
-Patella Percussion Test

ROM: cannot passively rotate hip

124
Q

Avascular Necrosis

A

-30-50yr
-Male>

S/s:
-50% sharp pain, 50% intermittent
-Limp gait

ROM:
-decreased

125
Q

Degenerative Join Disease

A

->40yr
-Female>
-insidious onset, pain with weight-bearing

Observation:
-often obese
-joint crepitus
-muscle atrophy of glutes

ROM: limp

Radiographic: increased density, osteophytes

126
Q

Hip Subjective Hx

A

-H/o LBP
-Hip problems as a child
-Clicking/popping/catching (w/ or w/o pain)
-OA
-Surgical Hx

127
Q

Examination Order of Hip

A
  1. Hx
  2. Observation
  3. Gait/Squat/SLS
  4. Scan/Not
  5. Hip ROM > Back ROM > Knee ROM
  6. MMT
  7. Flexibility
  8. Joint Play
  9. Palpation
  10. Special Tests
128
Q

Possible DDx of Hip

A

-OA
-Avascular Necrosis
-Degenerative Joint Disease
-Legg-Calve-Perthes
-SCFE
-Stress Fx
-FAI
-Bursitis
-Muscle Lesion
-Glute Med Lesions

129
Q

Long Axis Hip Manipulation (Hip)

A

-Open pack: 30 flx/ 30 abd/ ER
-pull on leg

targets entire capsule

130
Q

Inferior Glide Mobilization

A

-Open pack
-for loss of flx

  1. Pt in supine, hip flx
  2. PT on table, leg over shoulder
131
Q

Anterior Glide Mobilization

A

-Open pack
-loss of extension

  1. Pt prone, leg in ext and abd (other leg off table if needed)
  2. PT hand on isch tub and lift knee up
  3. Push on isch tub
  4. Progress with more hip ext and knee flx
132
Q

Lateral Glide Mobilization

A

-Open Pack
-lack of ADD

  1. Pt in supine, knee flexed 30
  2. PT pulls down and out laterally (can use belt or hands)
  3. Can add more ADD during progression

Progression: AP Lat Mobilization

133
Q

Observations of Hip Pain

A

-discomfort
-Antalgic gait
-foot drop
-Stand in OPP
-Weight shifts
-leg length discrepancy

134
Q

Hip Joint Clearing Tests

A

-(+) Trendelenburg
-(+) Inability or pain with squat
-(+) Sign of buttock

135
Q

FABER Test

A

-provocation tests
-pt supine, PT on ipsi side of leg
-hip in flx, ER, abduction
-press into contra ASIS and knee

(+) reproduction of pt ain at posterior pelvis or butt

136
Q

Sign of Buttock Test

A

-provocation tests
-sign of serious pathology (hip absess, fracture, infection, cancer)
-nerve on slack and pain still there

  1. Passive SLR (+)
  2. Return to neurtral and bend hip and knee
  3. Passive bent leg raise (+) and same ROM
137
Q

Hip ROM/MMT Directions

A

-Flx/Ext
-Abd/ADD
-IR/ER

AROM > Overpressure > PROM

all must be measured
test back and knee

138
Q

Hip Flexibility Tests

A

-Ober’s
-Modified Thomas
-Elys
-Piriformis
-Hamstrings

139
Q

Joint Play: Long Axis Distraction (Hip)

A

-Open pack: 30 flx/ 30 abd/ ER
-pull on leg to assess joint

  1. Pt supine, flx/abd/ER
  2. PT holds above talocrural

targets entire capsule

140
Q

Joint Play: Posterio-Inferior Glide

A

-inferior/posterior capsule
-for loss of flx

  1. Pt in supine, hip flx
  2. PT on table, leg over shoulder
  3. PT scoops and pulls out and down
141
Q

Joint Play: Anterior Glide (Hip)

A

-target anterior capsule
-loss of extension

  1. Pt prone, leg in ext and abd (other leg off table if needed)
  2. PT hand on isch tub and lift knee up
  3. Push on isch tub
142
Q

Joint Play: Lateral Traction

A

-Open Pack
-targets lateral capsule

  1. Pt in supine, knee flexed 30
  2. PT pulls inferolateral
  3. Can add more ADD during
143
Q

Labral Special Tests

A
  1. Fitzgerald Test
  2. FADIR Test
  3. Hip Quadrant
  4. Hip Scour
  5. FABER
144
Q

Capsular Tightness Special Test

A

-FABER

145
Q

Fitzgerald Test

A

-anterior labral tear

  1. Pt in supine
  2. PROM from FABER to Ext/Add/IR

(+): reproduces s/s w/ or w/o click

146
Q

Quadrant Test

A

-FAI or Labrum

  1. Pt in supine
  2. PT PROM from FADIR to FABER

(+): reproduces s/s w/ or w/o click

147
Q

FADIR Test

A

-FAI or Labrum

  1. Pt in supine
  2. PT PROM into flx/add/IR

(+): reproduces s/s w/ or w/o click

148
Q

Hip Scour Test

A

-FAI, Labrum, acetabular dysfunction

  1. Pt in supine
  2. PT hugs knee and PROM from FADIR to FABER WITH COMPRESSION
  3. Can scallop for specific areas

(+): reproduces s/s w/ or w/o click

149
Q

FABER/Pattrick Test

A

-impingement, SIJ, capsular tightness

  1. Pt in supine
  2. PT PROM into flx/abd/ER

(+): reproduces s/s in ant hip or posterior hip

150
Q

Craig’s Test

A

-femoral anteversion/retroversion

  1. Pt in prone
  2. Move into IR/ER until Greater troch is parallel to table (most into hand)
  3. Measure ROM

-normal 10-15 IR

(+):
->15: anteverted
~10 IR: Normal
-<10: retroverted

151
Q

Patellar Pubic Percussion Test

A

-fx oof the hip or femur

  1. Stethoscope over pubic symphysis
  2. Tap on Patella on affected sound and compare

(+): diminished sound on involved side

152
Q

Posterio-Inferior Mobilization w/ Belt

A

-inferior/posterior capsule
-for loss of flx

  1. Pt in supine, hip flx
  2. PT stands with belt at hips
  3. PT pulls out and down
  4. Add more flexion to progress
153
Q

AP w/ Lateral Mobilization

A

-progressive mobilization
-more aggressive lat mobilization
-add adduction and IR (piriformis stretch position)
-target posterio-lateral capsule, ADD ROM
-use when (+) FABER, quadrant, or SCOUR

154
Q

PA Hip Mobilization w/ ABD and ER

A

-progressive mobilization
-target ER and ABD ROM
-use when (+) FABER

  1. Pt prone with hip flexed and abducted off of bed (progress to more ER)
  2. PT mobilize into ER
155
Q

Hip IR Mobilization

A

-progressive mobilization
-target posterior capsule and IR ROM

  1. Pt prone in IR
  2. PT maintains IR while mobilizing contra pelvis
156
Q

Causes of knee injuries

A
  1. Sprains, strains, tendinopathies
  2. Contusions
  3. Meniscal or ligamentous
157
Q

Tibio-Femoral: Open Packed Position

A

25 deg of flexion

158
Q

Tibio-Femoral: Closed Packed Position

A

Extension

159
Q

Tibio-Femoral: Capsular Pattern

A

Flexion > Extension

160
Q

Open Chain Arthokinematics

A

-Rolling and gliding same

161
Q

Closed Chain Arthrokinematics

A

-Rolling and gliding opposite

162
Q

Acute Knee Injuries

A

-ligaments
-Instabilities
-Meniscal and articular cartilage injuries

163
Q

Chronic Knee Injuries

A

-instabilities
-OA
-Patellofemoral pain
-Patellar Tendonopathy

164
Q

Valgus Force

A

-MCL
-ACL
-Med Meniscus
-Posteriormedial capsule

165
Q

Hyperextension Injury

A

-ACL
-Sometimes PCL
-Meniscus

166
Q

Flexion w/ Posterior Translation

A

-PCL

167
Q

Varus Force

A

-LCL
-Posterolateral capsule
-PCL

168
Q

ACL Tears

A

MOI:
Contact: hyperext, valgus force
Non-contact: deceleration valgus force near extension (cutting, popping)

S/s:
-hear/ feel a pop
-rapid swelling
-knee gives away
-loss of end range ext

Tests:
-Lachman’s
-Anterior Drawer
-6m Single Limb Timed Test

169
Q

PCL Tear

A

MOI:
-trauma with posterior tibial shear in flx or hypertext
-dashboard injury, sudden stopping

S/s:
-bruising or abrasion on tibia
-loss of knee extension
-localized knee posterior pain with kneeling or decelerating

Tests:
-Posterior Drawer
-Posterior Sag Sign
-Valgus Stress at 0 Deg

170
Q

MCL Tear

A

MOI:
-traumatic valgus force
-rotational trauma

S/s:
-normal ROM
-painful palpation
-medial knee pain

Tests:
-Valgus Stress Test 20-30 deg flx

heals well on it’s own

171
Q

LCL Tear

A

MOI:
-traumatic varus force

S/:
-swelling over LCL
-pain over LCL
-lack of LCL

Tests:
-Varus Stress at 30 deg flx

172
Q

Anteromedial Instabiltiy

A

-anterior and ER force
-MCL, Medical Meniscus, ACL

MOI:
-valgus force and tibial ER
-anterior sublux of medial tibial plateau

Tests:
-Anterior Drawer with ER

173
Q

Anterolateral Instability

A

-anterior and IR force
-ACL, LCL, Lateral mensiscus, ITB

MOI:
-valgus force and tibial IR
-anterior sublux of lateral tibial plateau
-ACL tear

Tests:
-Anterior Drawer Test with IR
-Pivot shift

174
Q

Posteromedial Instability

A

-Posterior and IR force
-valgus force
-PCL, MCL, Medial meniscus, Semimembranosis, ACL

MOI:
-force into extension and tibial IR
-valgus movement

Tests:
-Hughston’s Posteriormedial Drawer (posterior drawer with IR)

175
Q

Posterolateral Instability

A

-posterior and ER force
-Varus force
-PCL, LCL, Biceps femoris

MOI:
-laxity of PCL in addition to other structures
-tib posterior and ER

Tests:
-Dial Test/PLR Tests
-Posterolateral Drawer
-Reverse Pivot Shift

176
Q

Posterolateral Corner Injury

A

MOI:
-direct varus hit to tibial on an extended knee
-posterior force on flexed knee with tibial ER
-chronically after trauma to ACL or PCL

S/s:
-varus thrust gait
-posterolateral instability
-knee giving way
-common fib irritation

177
Q

Meniscal Injuries (MOI & CPR)

A

MOI:
-twisting
-valgus/ hyperextension force

CPR:
-catching or locking
-joint line tenderness
-twisting MOI
-pain with knee hyperextension or max flx
-pain or click w/ McMurrays test

> 4 positive

178
Q

Patellofemoral Pain Syndrome

A

MOI:
-trauma
-overuse
-patellar tracking
-muscle imbalance

Observations:
-dec quad strength, flexibility, coordination of quads
-over-pronation
-patellar position
-weight-bearing pain
-pain after sitting, squatting

Tx:
-hip strengthening
-quad strengthening

179
Q

Possible Knee DDx

A

-Cruciates
-Collaterals
-OA
-Patellar Tendinopathy
-PFPS

180
Q

Patellar Tendinopathy

A

-pain on tendon
-overuse common in jumping and running

Observation:
-pain with loading
-pain on tendon

Tx:
-load on tendon
-quad eccentrics

181
Q

Subjective Hx

A

-MOI
-pain/location/changes/time of day
-Swelling
-Noise
-Locking
-Giving out
-length of symptoms

182
Q

Rule out Non-MSK

A

PAD: claudication, cook extremities, decrease filling time
DVT: pain, warmth, swelling
Compartment Syn: swelling, absent pulses, neuro
Septic Arthritis: pain, swelling, infection signs
Cellulitis: skin warmth, redness, rash

183
Q

Ottawa Knee Decision Rule

A
  1. > 55
  2. Tenderness at head of fib
  3. Tenderness at Patella
  4. Inability to flex knee 90
  5. Inability to WB 4 steps

(+) 2/5= need imaging

184
Q

Knee Observations

A

-abrasion, bruising, atrophy, swelling
-LE rotation
-knee position
-flx or hyperextensionon
-tibial torsion
-foot position

185
Q

Knee Joint ROM

A

-Flex (0-140) then Ext (0-15)
-AROM > Over > PROM

186
Q

Knee MMT

A

-knee flx/ext
-Hip ROM
-Ankle DF and PF

187
Q

Flexibility Tests

A

-Ober’s
-Modified Thomas
-Prone Rectus (ELy)
-Gastroc Length
-Hamstring Length

188
Q

Joint Play/Mobilization: Knee Extension

A

Ext: ant roll AND glide (concave on convex)

  1. Pt supine (prone if dec ext)
  2. Towel under tibia
  3. Push femur posteriorly
    OR
    -Push tibia ant if in prone w/ knee flx

Mob:
-ad ER

189
Q

Joint Play/Mobilization: Knee Flexion

A

Flex: Post roll and glide

  1. Pt supine (sitting if distracting or dec)
  2. PT supporting femur
  3. PT Push tibia posteriorly

Mob:
-Ad IR

190
Q

Joint Play/Mobilization: Patellar Sup/Inf Glide

A

Crab hand: tiny
Bear Claw: big

  1. Pt in supine, slightly flexed
  2. Move patella up and down
191
Q

Joint Play: Patellar Medial/Lateral Glide

A

Claw hand

  1. Pt in Supine, slightly flexed
  2. Move patella side to side
192
Q

Joint Play: Proximal Tibiofibular Joint

A

-use if lacking last bit of flexion and has pain at fib head
-or frequent ankle sprains

AP Glide:
1. Pt supine in hooklying
2. Push posteriorly

PA Glide: treat in this position
1. Pt in quadruped
2. Push anteriorly

193
Q

Knee Exam Order

A
  1. Subjective Hx (MOI and pain description)
  2. Observation
  3. ROM (knee, hip, ankle)
  4. MMT (knee, hip, ankle)
  5. Joint Play
  6. Palpation (or before joint play)
  7. Special Tests
194
Q

Ligament Special Tests

A

ACL: Lachman, anterior drawer, pivot shift

PCL: Posterior Drawer, Posterior sag, valgus at 0

MCL: valgus stress test at 20

LCL: Varus stress test at 20

195
Q

Instability Special Tests

A

AMRI: Anterior drawer + ER
ALRI: anterior drawer + IR, pivot shift
PMRI: Posterior drawer + IR
PLRI: Posterior drawer + ER, reverse pivot shift, dial test

196
Q

Meniscus Special Tests

A

McMurray, Thessaly, Apley

197
Q

Patellar Special Tests

A

Patellar Grind Test
Patellar Apprehension

198
Q

Lachman Test

A

ACL
-less flx than Anterior drawer

  1. Pt supine, knee flexed slightly
  2. PT stabilizes femur and pulls tibia ant
  3. 1-2 reps
199
Q

Anterior Drawer Test

A

ACL
-more flx ~ 60

  1. Pt supine with knee flexed 60
  2. PT sits on foot
  3. Pull tibia anteriorly
200
Q

Posterior Drawer

A

PCL
-more flx ~ 60

  1. Pt supine with knee flexed 60
  2. PT sits on foot
  3. Find norm of tibia
  4. Push tibia posteriorly
201
Q

Posterior Sag Sign

A

PCL

  1. Pt supine
  2. PT flexes knee and hip ot 90 passively and looks for sag of tibia
202
Q

Valgus Stress Test

A

PCL (0 deg) , MCL (20 deg)

  1. Pt supine w/ leg at 0 then 20 deg flexion
  2. PT outside of leg holding medial tibia and lateral thigh (take up slack)
  3. PT provides valgus stress
203
Q

Varus Stress Test

A

Cruciates (0 deg), LCL (20 deg)

  1. Pt supine w/ leg at 0 then 20 deg flexion
  2. PT inside of leg holding lateral tibia and medial thigh (take up slack)
  3. PT provides varus stress
204
Q

Anterior Medial Rotary Instability Special Test

A

Anterior Drawer w/ ER

205
Q

Anterior Lateral Rotary Instability Special Test

A

anterior drawer + IR

206
Q

Posterior Medial Rotary Instability Special Test

A

Posterior drawer + IR

207
Q

Posterior Lateral Rotary Instability Special Test

A

Posterior drawer + ER

208
Q

Posterorlateral Instability Reverse Pivot Shift

A

PLRI

  1. Pt supine
  2. PT flexes knee to 90 while ER tibia (check for medial sublux
  3. PT slowly extends knee while adding valgus stress (reduction at full extension)
209
Q

McMurrays Test

A

-Meniscus
-NWB
-tells you which one is involved
-provocative

Medial:
1. Pt supine at 90/90
2. PT palpates or watches medial joint line
2. PT passively flexes knee
3. PT puts tibia into ER while extending knee

Lateral:
1. Pt supine at 90/90
2. PT palpates or watches lateral joint line
2. PT passively flexes knee
3. PT puts tibia into IR while extending knee

210
Q

Apley’s Test

A

-Meniscus test
-NWB

Distraction:
1. Pt prone with knee bent
2. PT stabilizes femur with leg
3. PT ER then distracts, IR then distracts

Better: meniscus
Worse: Ligament

Compression:
1. Pt prone with knee bent
2. PT stabilizes femur with leg
3. PT ER then comrpesses, IR then compresses

Worse: Mensicus

211
Q

Thessaly’s Test

A

-meniscus
-WB test
-5 deg of knee flx, then 20 deg

  1. Pt stands on one leg with leg bent 5/20 with PT support
  2. PT askes Pt to twist from side to side

(+): clock, pop, or reproduction of pain

212
Q

Patellar Apprehension

A

-lateral patellar subluxation

  1. Pt supine with leg off of plinth slightly flexed ~15
  2. Pt foot on PT leg
  3. PT lateral mobs patella

(+): Pt feels apprehensive about it subluxing

213
Q

Patellar Grind Test

A

-Chondromalacia, PF dysfunction

  1. Pt supine in full knee ext
  2. PT uses web space to push superir patella down
  3. Pt then contracts quad

(+): reproduction of patients pain

214
Q

Altman’s Criteria for Knee OA

A
  1. Knee Pain
  2. > 50
  3. Knee Crepitus
  4. Palpable bony enlargement
  5. Bony tenderness
  6. Morning stiffness <30mins
  7. No warmth
215
Q

Tibialis Posterior Action

A
  1. Plantarflexes
  2. Invert foot
  3. Supports medial longitudinal arch
216
Q

Ottawa Ankle and foot Fracture rules

A

Midfoot zone Rules:
-Inability to bear weight
-tenderness to base of 5th MT
-Tenderness to navivular

Malleolar zone rules:
-inability to bear weight
-tenderness to lateral malleolus
-tenderness to medial malleolus

217
Q

High Ankle Sprain

A
  • at Tibiofibular syndesmosis
    -interosseous membrane
    -anterior talofibular lig

-during ER and DF

218
Q

Subtalar Joint in Gait

A

Loose Adaptor (swing): sup/pro/sup
Initial contact to loading response: sup to pro
Shock Absorber (weight acceptance): pronation
Midstance: pro to sup
Rigid Level (midstance to toe off): supination
Preswing to initial: sup to pro

219
Q

Pes Cavus

A

-high arch
-supinated
-decreased shock absortion
-ankle sprains common

220
Q

Pes Planus

A

-low arch
-decreaed rigid lever
-pronated
-hallux valgus

221
Q

Tarsal Tunnel

A

-tibial nerve > medial and lateral plantar nerves

222
Q

Anterior Ankle Nerves

A

-deep peroneal/fibular nerve
-goes to between big and 2nd toe
-common site for retinaculum compression

223
Q

Lateral Ankle Nerves

A

-superficial peroneal/fibular
-can be stretched by ankle sprain

224
Q

Compartment Syndrome

A

-tissue pressure increased by trauma
-muscle and nerve ischemia

S/s:
-swelling
-Pain
-no pulses

Tx:
-fasciotomy
-rest (for developing)

225
Q

Achilles Tendinopathy

A

S/s:
-pain at junction, tendon, at bony insertion

Tx:
-eccentric loading
-heavy load, low speed
-stretching
-patient education

226
Q

Posterior Tibialis Tendon Dysfunction

A

-degenerative and progressive condition

S/s:
Observation: loss of arch height, abduction

Mobility: limited and/or painful PF

Functional: abnormal gait, decreased push off, pain with WB or single leg balance

Strength: weak and painful SL heel raise, weakness with inversion and PF

227
Q

Cuboid Subluxation

A

-almost always plantar subluxation
-lateral ankle sprain
-COG in front of midtarsals
-“i feel like there’s a rock in my shoe”

Tx:
-Cuboid Whip
-Cuboid Squeeze

228
Q

Possible Ankle/Foot DDx

A

-Cuboid subluxation
-Planar fascitis
-Post Tib Tendon
-Achilles Tendonopathy
-Lateral Ankle Sprain
-Medial Ankle Sprain
-High Ankle Sprain
-Stress Fx

229
Q

Windlass Effect

A

-plantar fascia slack until ext of big toe during push off

  1. Check arch
  2. Lift big toe and check for arch
230
Q

Order of Foot/Ankle Exam

A

Pt Hx
Observation
Scanning Exam
Palpate**
ROM
Flexibility
MMT
Joint Play
Special Tests

231
Q

Subjective Hx Foot/Ankle Specific

A

-Activities?
-Flat feet or high arches
-Types of shoes
-Pop?
-Child bracing?
-Surgeries?
-OA?

232
Q

Palpation (Ankle)

A

-Achilles tendon
-Calcaneus
-Great Toe/phalanges
-Cuneiform
-Navicular
-Malleoli
-Deltoid ligament
-ATFL
-Shin
-Fibulari

233
Q

Foot/Ankle ROM

A

DF/PF: 20/50
Sup/Pro: 45-60/15-30 (measure at top of ankle)
Inv/Env: 20/10 (measure calcaneus)
Great toe Ext/Flx: 70/45

234
Q

Foot/Ankle MMT

A

-Gastroc/Soleus
-Tib ant/post
-Fibulars
-Hallucis Flex/ext
-Foot Intrinsics

235
Q

Joint Play: Proximal Tibio-Fibular

A

-AP glide or PA
-Lacking last ext or flx

Knee Joint:
-Flx: anterior
-Ext: posterior

Ankle Joint:
-DF: ER
-PF: IR

236
Q

Joint Play: Distal Tibio-fibular

A

-AP and PA
-For lacking DF

  1. Pt supine, foot PF
  2. Stabilize tibia and mobilize fibula
237
Q

Joint Play: Talocrual PA Glide

A

-improve PF

  1. Pt prone, slightly PF
  2. PT stabilizes Tibia
  3. Anterior mob through calcaneus
238
Q

Joint Play: Talocrual AP Glide

A

-improve DF

  1. Pt supine, slightly PF
  2. PT stabilizes tibia
  3. Posterior mob through anterior talus
239
Q

Joint Play: Subtalar Medial Glide

A

-improve eversion

  1. Pt sidelying
  2. Push medially
240
Q

Joint Play: Subtalar Lateral Glide

A

-improve inversion

  1. Pt sidelying
  2. Push laterally
241
Q

Joint Play: MTP and IP Dorsal Glide

A

-Distraction
-Extension

  1. Stabilize distal MT
  2. Mobilize dorsally
242
Q

Joint Play: MTP and IP Plantar Glide

A

-Flexion

  1. Stabilize distal MT
  2. Mobilize plantarly
243
Q

High (Syndesmotic) Ankle Sprain Special Tests

A

-Fibular translation test
-External Rotation test

244
Q

Lateral Ankle Special Tests

A

-Anterior Talus Displacement- Anterior Drawer
-Lateral Ligament Integrity - Medial Talar Tilt

245
Q

Anterior Ankle Impingement Special Tests

A

-Forced Dorsiflexion Test

246
Q

Midtarsal Joint Pronation Special Tests

A

-Navicular Drop Test
-Feiss Line

247
Q

Achilles Tendon Integrity Special Tests

A

-Thompson Test

248
Q

FIbular Translation Test

A

-high ankle sprain

  1. Pt supine
  2. PT mobs tibia and fibula

(+): ROS and/or increased displacement

249
Q

External Rotation Test

A

-high ankle sprain

  1. Pt supine; knee flexed to 90
  2. PT ER and DF ankle

(+): ROS or excessive movement

250
Q

Anterior Drawer (Ankle)

A

-stress ATFL
-Lateral ankle sprain

  1. Pt supine in PF
  2. PT give anterior glide of talus and calcaneus

(+): Excessive translation

251
Q

Medial Talar Tilt Stress Test

A

-stress CFL
-lateral ankle sprain

  1. Pt supine, foo in neutral
  2. PT stabilizes malleoli med mobilization at calcaneus

(+): excessive laxity

252
Q

Forced Dorsiflexion Test

A

-anterior ankle impingement

  1. Pt supine, knee flexed
  2. PT stabilizes distal tibia
  3. Forceful DF

(+): ROS

253
Q

Ankle Joint Mobs/Manips

A

-open packed positions

Proximal and Distal Tibiofibular Joint
Talocrual Joint
Cuboid (whip/squeeze)
Forefoot Joints Mobs

254
Q

Cuboid Manip/Mob

A
  1. Pt prone
  2. Foot in PF, INV, ADD
  3. PT thumb over thumb on plantar surface of cuboid
  4. Sharp Whip motion or squeeze
255
Q

AP with Progressive DF

A

-talocrual mobilization
-go the end range

  1. Pt in long sitting
  2. PT Stabilize tibia
  3. PT Mobilize in AP direction while using high to increase
256
Q

Mobilization with Movement: DF at TC

A
  1. Pt in squat or lunge
  2. AP mob at talus under tibia
    OR
    PA mob at distal tibia with belt
  3. During squat or lunge to increase

MSK (34 decks)

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