Orthopedic Conditions & Tests Flashcards
Test for Scoliosis (1)
Adams forward bend test
child bends forward w/ arms hanging in front, knees straight
assess spine symmetry
this is a screening procedure, not definitive diagnosis of spine curvature
Test for Leg Length Discrepency (2)
- Galleazi sign -
- supine, knees bent and feet flat on floor/table
- ASIS are held level, look to see if one knee is higher than the other
- may also be sign of hip joint integrity (if dislocated, knee will be lower on that side) - Tape measurement -
- supine w/ hips & knees extended
- measure distance from most prominent point of ASIS and medial malleolus
Test for DDH (4)
- for infants less than 12 weeks of age
- Ortalani maneuver (sign of entry) - “out”
- supine, infant leg is placed in neutral rotation, 90deg hip flexion, and gently abducted while lifting the leg anteriorly
- with abduction will feel a “clunk” as femoral head slides over posterior rim of acetabulum and into socket - Barlow maneuver (sign of exit) - “bad”
- supine win same position
- gently adduct the leg w/ gentle pressure directed posteriorly on knee
- palpable clunk is noted as the femoral head slides out of the socket - Galleazi sign
- Asymmetrical gluteal folds
Tests for DDH (1)
- for infants 3-12 months
- hip abduction
- supine, place hip in 90deg flexion w/ one hand stabilizing pelvis
- each hip should easily abduct to 75deg and adduct to 30deg past midline
- limitation can indicate DDH
Tests for DDH (1)
- once child is ambulatory
OBSERVATION - usually a limp and child may toe-walk on affected side
- positive trendelenburg sign
Hip & Knee ROM (5)
- Thomas test - for hip flexion contracture
- Ober test - for hip abduction contracture
- Popliteal angle test - measure physiological flexion in neonates
- supine w/ hip and knee flexed to 90, with opposite leg stabilized, extend the testing leg and measure angle between the thigh and leg when maximally extended - hamstring length - same as above but measure amount of ROM that is missing or lacking from full knee extension
- SLR
Femoral Torsion tests (2)
- sum of IR/ER
- Craigs (Ryders) test - same as adult
- must add 20deg of IR (-20 deg) to measurement to get accurate reading of femoral torsion - Hip IR and ER
- measured in prone w/ hip in neutral flex/ext
- sum of IR and ER is 120 up to age 2 and 95-110 after age 2
Excessive IR = femoral antetorsion
Excessive ER = femoral retrotorsion
Tibial torsion tests (2)
- tibial torsion test in child w/ forefoot disorder
- Thigh-foot angle
- prone, thighs parallel, neutral rotation, thighs extended and knees bent to 90
- ankle falls into neutral
- axis of goni placed over center of calcaneus, SA placed along visual bisection of thigh and MA placed along long axis of foot along 2nd metatarsal
- if foot points toward midline then its a negative value (internal tibial torsion)
- Normal range between 0-30deg - Trans-malleolar angle - if forefoot disorder
- same position
- line is drawn across plantar side of foot that connects medial and lateral malleoli
- second line bisects the calcaneus
- measure angle of the second line and the long axis of the femur
Foot-progression angle
- normal range
angle between longitudinal axis of foot and a straight line of progression of the body
in-toeing is expressed as negative value and out-toeing is expressed as positive
normal range throughout life = -3 to +20
Metatarsus adductus
child stands on photocopier and foot is copied
in MTA, forefoot is curved MEDIALLY, the hindfoot is in teh normal slight valgus position and there is FULL DF ROM
Graded as mild (I) mod (II) or severe (III)
Calcaneovalgus
positional deformity in which the forefoot is curved LATERALLY, hindfoot is in valgus, and tehre is FULL or EXCESSIVE DF ROM
dorsum of foot may be touching ant surface of leg
the foot will bend at the instep and is very rigid
this is known as “rocker bottom” deformity
Angular Deformity tests (2)
Genu valgus
- stand w/ knees touching, measure distance between medial malleoli OR
- stand/supine, goni over patella and prox arm over long axis of femur in line w/ ASIS w/ distal arm down long axis of tibia
Genu varus
- stand w/ medial malleoli touching, measure between femoral condyles OR
- use goni
DDH
- what is it
- etiology
- main limitation
- treatment (less than 6 mo, 6-12 mo) - orthotics
developmental dysplasia of the hip - upward and lateral displacement of the hip with delayed development of the acetabulum
Etiology - breech birth or hereditary
Main limitation = hip abduction (bilateral less than 60, normal is 75 for this age; or unilateral difference of 10)
Treatment
- 6 months or less: Pavlik harness - flexion and abduction (protective position)
- 6-12 months: Rhino orthotic - abduction orthosis that allows for more mobility; only IF ortolini positive
Talipes Equinovarus
- what is it
- mild vs severe
- foot shape
- DF ROM
- heel position
- treatment
club foot
Mild = due to fetal positioning Severe = underlying neuromuscular condition
Foot shape = kidney, shape w/ forefoot MEDIALLY deviated
- NO DF ROM
Heel position = hindfoot VARUS
Treatment
- serial cast w/ weekly progressions or surgical correction
Metatarsus Adductus
- foot shape
- heel position
- DF ROM
- Treatment
Foot shape = forefoot MEDIALLY deviated
- FULL DF ROM
Heel position = hindfoot valgus
Treatment depending on severity:
I: recovers spontaneously
II: stretching & corrective shoes
III: manipulation, serial casting and shoes
