O&T - Upper and Lower limb Flashcards
Define measurement for apparent and true leg lengths
Apparent leg length: Umbilicus to medial malleolus (can be skewed by bad posture, deformity)
True leg length: ASIS to medial malleolus
Make sure the pelvis is square
Test for true leg length measurement?
Follow-up test for femur shortness?
Galeazzi Test
- Hip flex 45, Knee flex 90
- Inspection for tibia length and femur length
Bryant’s triangle test
- Measure distances between ASIS, Greater trochanter and junction of 2 perpendiculars
Define test for flexion contracture at hip.
Procedure
Thomas test
1) Place hand under lumbar spine space
2) Flex hip until lumbar lordosis is obliterated
3) Increase hip flexion and maintain, inspect for flexion contracture of opposite knee
4) Press on opposite knee to eliminate flexion contracture: Cannot eliminate = FIXED FLEXION CONTRACTURE
Define positive Trendelenburg sign
Drop of pelvis when lifting leg opposite to weak gluteus medius (hip abductor weakness)
e. g. left sided Trendelenburg gait:
- Abductor weakness on left causes right side pelvic drop
- Compensate by leaning to the left during mid- stance so leg can clear ground
Scars lateral or midline to patella.
Causes?
Lateral = Arthroscopy knee surgery Midline = Knee joint replacement surgery
2 leg curvature deformities in OA.
Which is more prevalent?
Genu varus (bow leg) - 90% Genu valgus (knock-knee) - 10%
3 indications for patella tap
Test for knee effusion:
- Hemarthrosis from ACL injury
- Infective and septic knee joint
- Chronic infection exacerbated by OA
Procedure for patella tap test
1) Slide hand down thigh, push down over the suprapatellar pouch, force effusion behind the patella
2) Exert firm pressure at upper pole of patella
3) Use index and middle finger of the other hand to push patella down
4) POSITIVE = Bouncing of patella
Progression of knee OA pain? Which location affected first?
Pain at medial joint line first
» Pain at lateral joint line
» Patella-femoral compartment pain last
2 tests for patella effusion
Bulge test
Patella tap/ ballottement test
Describe knee bulge test
1) Using 2 finger to mild down fluid from above the knee and maintain pressure
2) Use other hand to empty medial compartment of fluid
3) Then stroke the contralateral side
4) Observe any bulging of medial knee
Bulging = positive for effusion
Causes of fixed flexion contracture at knee?
- Osteophyte cause mechanical block
- Hamstring muscle injury/ contracture
- Prolonged inactivity
Test for knee integrity/ ACL injury?
Procedure?
Anterior Drawer Test
1) Hip flex 45, Knee flex 90
2) Index fingers on hamstring, thumb on patella
3) Pull tibia towards you
3) Feel end-point of tugging of ACL
POSITIVE TEST = large anterior movement of tibia with no resistance = ACL injury/ subluxation
Test for PCL injury?
1) Alignment of patella and tibial tuberosity
Normal = Tibial tuberosity is in front of patella edge
Abnormal = Tibial tuberosity is level or behind patella edge
2) Posterior drawer test
Same technique as Anterior drawer test but push tibia away form you
Normal: Step-off between medial femoral condyle and medial tibial plateau is maintained
Test for meniscal tears?
McMurray Test
1) Flex knee, Internally and externally rotate tibia on femur, check movement
2) Externally rotate leg, place valgus stress on knee
3) Slowly extend the knee
POSITIVE = Click sound when extending externally rotated and valgus leg = torn medial meniscus
Difference between flexion contracture and extensor lag
Flexion contracture = deformity that cannot be corrected passively
Extensor lag = Extension deficit that can be corrected passively = quadricep weakness
Symptoms of limb length discrepancy
Long limb: Steppage (hip and knee flexion) + Circumduction
Short limb: Knee extension + tiptoeing/ ankle plantarflexion
Dermatomes and myotomes
Refer to diagrams in lectures
Nerve palsies
Refer to MSS lectures
Pain on loading, relieved by rest
Joint stiffness
Deformity
Swelling
Most likely MSS condition?
OA
Pain at base of thumb Occurs with gripping and pinching Clicking sound with certain movement Swan neck deformity Tender over volar and radial aspect of thumb base
Most likely MSS condition?
Further investigation?
Carpometacarpal joint arthritis
Grinding sign positive
Pain on shoulder when arm is abducted past 90 degrees
Most likely MSS condition?
Impingement syndrome
Greater tuberosity of humerus compresses rotator cuff against acromion, causing pain and limited ROM
2 tests for Shoulder Impingement syndrome?
Hawkin’s and Neer’s test
Insidious onset, decreasing active and passive ROM of shoulder
Pain and tenderness at rotator cuff
Stiff fingers
Most likely MSS condition?
Frozen shoulder
