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Orthopedics > Orthopedic Tests - Final > Flashcards

Orthopedic Tests - Final Flashcards

1
Q

PE - Reflex Grading

A

4+ Hyperreflexia (may have sustained clonus)
3+ Hyperreflexia (may be upper half of normal)
2+ Normal (lower half of normal)
1+ Hyporeflexia (trace response or with reinforcement)
0 Areflexia (no muscle contraction with reinforcement)

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2
Q

PE - Tenderness Grading

A

+1/4 Tenderness with no physical response
+2/4 Tenderness with grimace and/or flinch
+3/4 Tenderness with withdrawal (positive “jump” sign)
+4/4 Withdrawal to non-noxious stimuli

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3
Q

PE - Motor Grading

A

5/5 Muscle completes ROM against gravity with full resistance
4/5 Muscle completes ROM against gravity with some resistance
3/5 Muscle completes ROM against gravity but without resistance
2/5 Muscle completes ROM with gravity eliminated
1/5 Slight contractility; no joint motion; inability to complete ROM with gravity eliminated
0/5 No evidence of muscle contraction

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4
Q

Lumbar Spinous Percussion Test

A

Assess for vertebral fracture, metastatic dz, disc impingement
(+) - pain, lingering pain
Doc percusses lumbar sp’s one at a time.

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5
Q

Muscle Testing - Iliopsoas

A

L1/2
Pt seated. Ask pt to lift knee. Apply downward force above knee while pt resists.
BILATERAL.

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6
Q

Muscle Testing - Quadriceps

A

L3
Pt seated. Doc pushes lower leg just proximal to ankles while pt resists. Other hand at knee to stabilize.
BILATERAL.

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7
Q

Muscle Testing - Tibialis Anterior

A

L4
Pt seated. Pt foot dorsiflexed, w/ knee slightly bent. Doc pulls down on foot while pt resists.
BILATERAL.

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8
Q

Muscle Testing - Extensor Hallucis Longus

A

L5
Pt supine. Doc pushes/pulls down on big toe while pt resists, keeping toe straight up.
BILATERAL.

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9
Q

Muscle Testing - Flexor Hallucis Longus

A

S1
Pt supine. Doc pushes up on big toe, while pt curls toe and resists. One hand on top of foot for stability.
BILATERAL.

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10
Q

Muscle Testing - Peroneus Longus / Brevis

A

L5
Pt supine. Pt everts foot and resists while doctor attempts to invert foot. One hand on opposite side of leg above ankle for stability.
BILATERAL.

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11
Q

Muscle Testing - Gastrocnemius / Soleus

A

S1
Pt standing. Ask pt to come up onto their toes 10x per leg.
Alt - pt supine. Foot in neutral. Doc presses up on bottom of foot while pt resists.
BILATERAL.

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12
Q

Reflex Testing - Patellar

A

L4
Pt seated w/ legs off of table.
Doc strikes immediately distal to inferior border of patella.
BILATERAL.

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13
Q

Reflex Testing - Medial Hamstrings

A

L5
Pt seated w/ one leg up on table, slightly bent. Strike 1” above joint line, directly on hamstring tendons (semimembranosus, semitendinosus)
BILATERAL.

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14
Q

Reflex Testing - Achilles

A 
S1
Pt seated w/ leg off of table.
Doc strikes achilles tendon.
ALT - Pt standing w/ one knee on table. 
Doc strikes tendon
BILATERAL.
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15
Q

Babinski Sign

A

Assess for UMNL (cauda equina syndrome, myelopathy, spinal cord injury, stroke)
Pt supine.
Doc runs sharp end of reflex hammer superiorly along lateral border of feet and then medially toward big toe.
Absent - flexion of big toe / no response
Present - extension of big toe w/ fanning of toes

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16
Q

Valsalva Maneuver

A

Assess for herniated disc or SOL
(+) - increase/presentation of peripheral sxs
Pt asked to “bear down” / “blow up balloon”, 2-3 secs

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17
Q

Bechterew’s Test (Seated Straight Leg Raise)

A

Assess for sciatic nerve irritation (L4/5, S1)
Pt seated.
Doc asks pt to actively straighten one leg at a time. Add neck flexion or slumped posture to increase sensitivity. If (-), ask pt to raise both legs.
(+) - pain/numbness/tingling down posterior thigh, pain in low back

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18
Q

Pelvic Distraction Test

A

Assess for sacroilliac pathology.
Ask pt if they’re ticklish. If yes, place pt’s hands over ASIS.
Pt supine. Doc crosses arms and places palms on ASIS. Lean w/ body wt and push ASIS posterior and lateral.
Alt - push straight down w/o crossing arms
Biomechanics: ant distracts / post compress, shearing if straight down
(+) - pain at the SI joint

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19
Q

Anvil Test

A

Assess for fracture (femur, tibia, fibula, calcaneus).
Pt supine w/ foot in neutral (90˚) position. Doc uses heel of hand to strike the heel of the pt’s foot. Strike 3 times with increasing force.
Biomechanics: compress hip joint
(+) - pain in any of the bones

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20
Q

Patrick’s Test (FABER)

A

Assess hip pathology (SI joint / capsule)
Pt supine. Doc crosses pt’s leg over the other above the level of knee. Doc places one hand at crossed knee and the other at opposite ASIS (pt’s hand below doc’s). Stabilizing the ASIS, the doc pushes down on the crossed knee, extending it.
FABER (flex, abd, ext rotation - hip)
Biomechanics: compress femoral head into acetabulum
(+) - pain at hip (trochanter, deep groin), SI joint (low back), or crossed leg stays above other leg w/ pressure

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21
Q

Yeoman’s Test

A

Assess for hip pathology (SI joint stabilized), lumbar pathology, and femoral nerve pathology (herniated disc, L2/3/4 irritation)
Pt prone. Flex pt knee to 90˚. Doc cups knee with one hand. Doc stabilizes SI joint by pushing down between PSIS and PIIS on symptomatic side with heel of hand. Use legs to lift hip into extension.
Biomechanics: hyperextend the hip
(+) - hip pain, anterior leg pain (if femoral nerve)

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22
Q

Belt Test

A

Assess for lumbar spine pathology (part 1/2) and SI pathology (part 1 only).
Pt standing.
Pt. 1 - Ask pt to bend forward and touch their toes.
Pt. 2 - Doc places hip against sacrum and holds onto SI joint. Ask pt to bend forward.
(+) - pain in low back

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23
Q

Sacral Thrust Test

A

Assess for SI joint pathology.
Pt prone. Doc places hand on apex of the sacrum, pushing post to ant.
Biomechanics: shearing at SI joints
(+) - pain at SI joint(s)

24
Q

Gaenslen’s Test

A

Assess for SI joint pathology.
Pt supine w/ one leg almost off of table. Ask pt to bring opposite knee up to chest. If leg off of table isn’t touching ground, push through. If it is, put one foot underneath ankle, allowing leg to extend.
Biomechanics: shearing SI joints in sagittal plane
(+) - pain in low back

25
Q

Thigh Thrust

A

Assess for SI joint pathology.
Pt supine. Flex leg to 90˚. Doc pushes through femur, A to P.
Biomechanics - shearing at SI joints
(+) - pain in low back

26
Q

Pelvic Compression Test

A

Assess for SI joint pathology.
Pt sidelying. Doc places hands on illium and pushes downward.
Biomechanics: compression of the pelvis; possible distraction at post. SI joint if push is ant.
(+) - pain at post SI joint

27
Q

Hip Scouring Test

A

Assess for hip pathology (cartilage defect in the acetabulum)
Pt supine. Flex leg to 90˚. Push down and move the leg in concentric circles, gradually widening the diameter.
(+) - pain, catching, clunking sound in the hip

28
Q

Valgus Stress Test (knee)

A

Assess for MCL + ACL/PCL instability and post/med capsule sprain. 30˚ flexion - MCL plus ACL and post/med capsule
Pt supine. Doc lifts and extends pt’s leg and stabilizes the ankle/foot against body w/ hand. Use broad palm of other hand to push medially against lateral border of knee. Repeat at 30˚.
Alt - Place leg between legs and use both hands.
(+) - increased laxity at medial knee

29
Q

Varus Stress Test (knee)

A

Assess for LCL + ACL/PCL instability and post/lat capsule sprain. 30˚ flexion - LCL + post/lat capsule
Pt supine. Doc lifts and extends pt’s leg and stabilizes the ankle/foot against body w/ hand. Use broad palm of other hand to push laterally against medial border of knee. Repeat at 30˚.
Alt - Place leg between legs and use both hands.
(+) - increased laxity at lateral knee

30
Q

Anterior Drawer Test (knee)

A

Assess for ACL sprain/rupture.
Pt supine w/ one leg flexed 90˚ w/ foot on table. Doc anchors the foot by sitting on dorsum. Doc places thumbs at tibial plateau, wraps hands around leg and pulls anteriorly.
(+) - increased laxity in anterior direction or pain

31
Q

Posterior Drawer Test (Knee)

A

Assess for PCL sprain/rupture.
Pt supine w/ one leg flexed 90˚ w/ foot on table. Doc anchors the foot by sitting on dorsum. Doc places thumbs at tibial plateau, wraps hands around leg and pushes posteriorly.
(+) - increased laxity in posterior direction or pain

32
Q

Lachmann’s Anterior and Posterior Test

A

Assess for ACL/PCL sprain/rupture
Pt supine w/ knee flexed 20˚. Doc places one hand above the knee on the side of the leg and one below the knee on the front of the leg. Doc pulls/pushes on tibia, while pushing/pulling on femur.
Biomechanics: shearing force on cruciate ligaments
(+) - increased laxity in anterior and/or posterior direction

33
Q

Anterior Drawer Test (foot)

A

Assess for ATFL instability.
Pt. supine w/ knee flex 90˚ and foot in neutral position. Doc grabs heel of foot with one hand and pulls it anteriorly while pushing the tibia posteriorly. Repeat at 20˚ (plantar flexion).
(+) - increased laxity / anterior glide of foot

34
Q

Posterior Drawer Test (foot)

A

Assess for PTFL instability.
Pt. supine w/ knee flex 90˚ and foot in neutral position. Doc grabs foot with one hand, pushing it posteriorly while pulling the tibia anteriorly. Repeat at 20˚ (plantar flexion).
(+) - increased laxity / anterior glide of tibia

35
Q

Kleiger’s Rotational Stress Test

A

Assess for high ankle sprain (ant/post tibiofibular ligaments and I/O membrane), deltoid ligament instability.
Pt supine w/ leg extended. Doc holds one hand below knee to stabilize. Doc grips calcaneus, pushes superiorly, and rotates it back and forth like a doorknob.
(+) - increased laxity, clunking, pain

36
Q

Talar Tilt Test

A

Assess ligament (inversion - calcaneofibular, ATFL, PTFL; eversion - deltoid)
Pt supine w/ leg extended. Doc stabilizes tibia with one hand while inverting the foot with the other. Repeat with eversion.
(+) - increased laxity

37
Q

Patellar Apprehension Test

A

Assess patellar instability.
Pt supine w/ leg extended. Doc pushes patella medially with two thumbs and laterally with two fingers.
(+) - verbal/nonverbal apprehension, quad contraction

38
Q

Clarke’s Test

A

Assess degenerative changes underneath the patella (chondromalacia patella).
Pt supine w/ leg extended. Doc places one hand just above patella and pushes down slightly and inferiorly. Ask patient to slowly pull back of knee into the table.
(+) - pain and/or crepitus at patella

39
Q

Thessaly’s Test

A

Assess meniscus for injury.
Pt standing. Begin with unaffected side to explain test. Ask patient to hold your hands and lift their leg. Ask patient to do three vigorous pivoting twists. Repeat at 20˚ flexion. Repeat on affected side.
(+) - pain at joint line of knee

40
Q

McMurray’s Medial/Lateral Meniscus Tests

A

Assess meniscus for injury
Pt supine. Doc flexes knee/hip to 90˚. Doc palpates medial joint line, externally rotates tibia, and extend leg. Repeat with lateral joint line and internal rotation of the tibia.
(+) - medial meniscus (painful clunk/click), lateral meniscus (clicks w/o pain or joint-line tenderness)

41
Q

Apley’s Compression and Distraction Tests

A

Assess meniscus for injury
Pt prone. Flex knee 90˚. Doc pushes down on bottom of foot and twists the tibia back and forth. Repeat with distraction. Doc places knee on pt’s hamstring above knee, pulls leg up, and twists tibia.
(+) - w/ distraction/compression = capsule/ligament injury
w/ compression only = meniscus injury

42
Q

Morton’s Test

A

Assess for Morton’s neuroma, fracture.
Pt supine w/ leg extended. Doc squeezes slowly and evenly across metatarsal heads.
(+) - pain in foot

43
Q

Thompson Test

A

Assess for achilles tendon rupture, gastrocnemius strain.
Pt prone. Doc squeezes across widest point of calf and checks for plantar flexion.
(+) - absence of plantar flexion

44
Q

Tinel’s test (ankle)

A

Assess for tarsal tunnel syndrome (post. tibial nerve).
Pt supine w/ leg extended. Doc firmly taps just posterior and slightly inferior to medial malleolus.
(+) - neurological sxs (numbness, zinging, referred pain)

45
Q

Kemp’s Test

A

Assess for nerve root compression (w/ radiating pain), muscle/ligament strain, facet/capsular irritation
Pt seated. Doc places heel of one hand vertical and just lateral to lumbar spine and the other hand across the back at the level of the shoulders. The pt is brought into trunk extension, lateral flexion and slight ipsilateral rotation.
Biomechanics: max. narrows intervertebral foramen and compresses facet joint
(+) - low back pain w/ or w/o radiating pain

46
Q

Slump Test

A

Assess for sciatic nerve tension, lumbar disc herniation.
Pt seated upright w/ arms behind back.
1. Ask pt to “slump” w/o neck flexion.
2. Ask patient to fully flex cervical spine (release).
3. Extend one knee, flex cervical spine (release).
4. Extend foot, Dorsiflex foot, flex cervical spine (release).
5. If no sxs, both legs may be extended simultaneously.
When you release cervical spine flexion, maintain extension/dorsiflexion.
(+) - spinal/leg pain

47
Q

Straight Leg Raise Test (SLR)

A

Assess for sciatic nerve, L4-S1 nerve root irritation.
Pt supine. Doc passively elevates symptomatic straight leg from the table, making sure knee remains extended.
“hard” (+) = sharp/burning nerve pain between 35˚-70˚.
“soft” (+) = radiating pain into lower extremity but not past knee (significant only if other evidence of nerve root/sciatic pain).
0˚-35˚ = lumbar strain, piriformis spasm, sacroiliac pathology
>70˚ = sacroiliac or lumbar joint pain
Negative test = no pain, buttock/back pain
focal pain in leg/pelvis- suggestive of tumor

48
Q

Well Leg Raise Test AKA Fajersztajn AKA Crossed SLR

A

Assess for lumbar disc herniation (used w/ SLR)
Pt supine. Doc passively elevates non-symptomatic leg from table while monitoring response in symptomatic leg.
(+) leg sxs in symptomatic leg

49
Q

Sicard’s Test

A

Assess sciatic radiculopathy or nerve root compression vs musculoskeletal pain (used after + SLR)
Pt supine. Doc lowers leg 5-10˚ from where pain was elicited during SLR. Doc then dorsiflexes the great toe.
(+) - radicular leg pain

50
Q

Bragard’s Test

A

Assess sciatic radiculopathy or nerve root compression vs musculoskeletal pain (used after + SLR)
Pt supine. Doc lowers leg 5-10˚ from where pain was elicited during SLR. Doc then dorsiflexes the foot.
(+) - radicular leg pain

51
Q

Sensory testing - S1

A

Lateral side of lower leg, proximal to malleolus

BILATERAL, pt’s eyes closed, always follow dull w/ sharp

52
Q

Sensory testing - L5

A

Lateral side of lower leg, just distal to knee

BILATERAL, pt’s eyes closed, always follow dull w/ sharp

53
Q

Sensory testing - L4

A

Anterior thigh, just proximal to knee

BILATERAL, pt’s eyes closed, always follow dull w/ sharp

54
Q

Sensory testing -L3

A

Anterior thigh, halfway between hip and knee

BILATERAL, pt’s eyes closed, always follow dull w/ sharp

55
Q

SI Pathologies

A

SI joint dysfunction, SI sprain, Sacroilitis, Ankylosing spondylitis, piriformis spasm

56
Q

Hip Pathologies

A

Hip bursitis, hip sprain/strain, septic/infx arthritis, osteoarthritis, avascular necrosis, osteoporosis

Orthopedics (3 decks)

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