Orthopedics- Knee, foot and ankle lab

Question 1

Describe patellar apprehension test, what a (+) is and what it could indicate

Answer 1

pt supine, leg straight, quads relaxed, gently and slowly push patella laterally and observe for signs of verbal or nonverbal apprehension or reflex of quads contraction
(+)= pt feels patella will pop out of place, either won’t let you do it, facial apprehension or quads contraction
could indicate instability, subluxation, tracking d/o or patellofemoral dysfxn

Question 2

Describe the functional tests for the knee, what is a (+)

Answer 2

weight bearing movements like stepping up, squatting

(+)= anterior knee pain w/activity

Question 3

Describe Resisted Knee Extension test, what is a (+), what it could indicate

Answer 3

pt seated, perform manual muscle test of quads muscle (don’t let pt extend knee)
(+)= anterior knee pain during test
could indicate quadriceps pathology

Question 4

Describe Valgus stress test, what is it testing, what is a (+), what does it indicate?

Answer 4

pt supine, legs straight, quads relaxed, knee in neutral, stabilizes medial ankle and apply L to M force, attempting to open the knee joint on the medial side, repeat w/knee at 30 deg of flexion also
(+) in neutral= MCL plus ACL, PCL or posterior medical capsule sparin/rupture
(+) in 30 deg= MCL plus PCL or posterior medial capsule sprain/rupture

Question 5

Describe Varus stress test, what it’s testing, what is a (+), what does it indicate?

Answer 5

pt supine, legs straight, quads relaxed, knee in neutral (and 30 deg secondarily), stabilize lateral ankle and apply M to L force attempting to open the knee joint on the lateral side
(+) test neutral= LCL plus ACL, PCL or posterior lateral capsule rupture/sprain
(+) test 30 deg flexion= LCL sprain/rupture plus posterior lateral capsule sprain/rupture

Question 6

Describe Anterior drawer test for the knee, what it is testing, what is a (+), what a (+) could indicate?

Answer 6

pt supine, knee flexed to 90 deg, foot on table, stabilize leg by sitting on dorsum of foot and place hands behind the proximal tibia, pull proximal tibia anteriorly trying to displace it forward
(+)= pain or motion > 5mm of anterior motion indicates ACL sprain or rupture

Question 7

Describe Posterior drawer test for the knee, what it is testing, what is a (+), what it indicates

Answer 7

pt supine, knee flexed to 90 deg, foot on table, stabilize leg by sitting on dorsum of foot and place thenar eminences on proximal tibia, push proximal tibia posteriorly trying to displace it backwards
(+)= pain or motion > 5 mm of posterior motion could indicate posterior cruciate ligament sprain or rupture

Question 8

Describe Lachman’s test, what a (+) is, what a (+) indicates

Answer 8

pt supine, knee flexed to 20 deg
anterior: stabilize femur just proximal to patella w/one hand and pull the tibia anteriorly w/ the other hand trying to displace it forward on the femur
(+)= pain w/excessive motion of tibia anteriorly > 5mm w/o firm end-point, indicates ACL sprain/rupture
posterior: stabilize femur just proximal to patella w/one hand and push the tibia posteriorly w/the other hand trying to displace it backward on the femur
(+)= pain w/excessive motion of tibia posteriorly > 5 mm w/o firm end-point, indicates PCL sprain/rupture

Question 9

What is the most specific test for an ACL tear?

Answer 9

Lachman’s test

Question 10

Describe Joint line tenderness test, what a (+) is, what it could indicate

Answer 10

pt seated w/foot on table or off table, feel w/thumbs in soft spot of knee below patella, follow around to condyles, also bring pts knee to butt while prone and feel w/in soft spot of knee again
(+)= pain w/either of the motions; could indicate a meniscal tear or other intra-articular pathology

Question 11

Describe Ege’s test, what a (+) is, what it could indicate

Answer 11

pt standing w/feet 10-15” apart
for medical meniscus have pt fully externally rotate legs and then do a slow squat
for lateral meniscus have pt fully internally rotate legs and then do a slow squat
(+)= pain inside joint or instability to squat past parallel, could indicate meniscal tear/damage respective to the way the feet are positioned

Question 12

Describe Thessaly test, what is a (+), what it could indicate

Answer 12

perform first on unaffected side!!!
pt stands flat footed on one leg w/knee in neutral then if no (+) w/knee flexed 20 deg while examiner helps pt balance, pt then rotates femur on tibia internally and externally 3 times while maintaining knee flexion
(+)= pain at jt line w/or w/o catching/locking
could indicate medial or lateral meniscus tear

Question 13

Describe Anterior drawer test for the ankle, what a (+) is, what it could indicate

Answer 13

pt supine or seated, place one hand on anterior tibia and the other hand on the posterior calcaneus, pull foot anteriorly, observe for ligamentous laxity, perform in neutral and plantar flexion
(+)= anterior glider > 3-4 mm or greater than non-affected side could indicate anterior talofibular ligament instability
testing extensor retinaculum also

Question 14

Describe Posterior drawer test for the ankle, what a (+) is, what it could indicate

Answer 14

pt seated, foot on table, stabilize dorsum of foot with one hand and grip the posterior tibia w/the other hand, pull the tibia anteriorly, observe for ligament laxity
(+)= increased anterior glide of the tibia could indicate posterior ankle ligament instability
testing flexor retinaculum also

Question 15

Describe Kleiger’s Rotational stress test, what is a (+), what can it indicate

Answer 15

pt supine, stabilize tibia w/one hand and rotate foot laterally w/other hand by holding the calcaneus like a doorknob to stress the deltoid ligament, observe for ligament laxity
(+)= ligament laxity, clunking or pain; could possibly indicate sprain of distal ankle syndesmosis (anterior and posterior tibiofibular ligaments and interosseus membrane) and/or deltoid ligament laxity

Question 16

Describe Talar tilt test, what is a (+), what could it indicate

Answer 16

pt supine, stabilize tibia w/one hand and invert the foot w/the other hand, repeat test w/eversion, observe for ligamentous laxity
(+)= increased motion or pain w/inversion or eversion; >10 deg of motion as compared to non-affected side
if (+) w/ inversion could indicate lateral ankle ligament sprain/rupture or anterior and posterior talofibular ligaments or calcaneofibular ligaments
if (+) w/eversion could indicate medial ankle ligament sprain/rupture, deltoid ligament

Question 17

Describe Lelli’s test, what a (+) is, what it could indicate

Answer 17

fist under pts calf, pt is supine, put down above the knee

(+)= no extension of the knee with force applied above knee, could indicate ACL sprain/rupture

Question 18

Desribe Thompson test, what a (+) is, what it could indicate

Answer 18

pt prone, squeeze calf at it’s widest point and observe for presence of plantar flexion w/calf squeeze
(+)= no plantar flexion (complete rupture of Achilles tendon) or local pain (gastroc or soleus strain)

Question 19

Describe Morton’s foot squeeze, what a (+) is and what it could indicate

Answer 19

pt supine or seated, squeeze foot around metatarsal heads, observe for foot pain or discomfort
(+)= pain in foot, could indicate Morton’s neuroma, metatarsal joint arthritis, fracture of metatarsal heads, stress fracture

Question 20

Describe Tinel’s test for the ankle, what is a (+), what could it indicate

Answer 20

pt prone, seated or supine, percuss over medial ankle behind the medial malleolus and over the dorsum of the ankle near the neck of talus, tap for ~ 10 sec
(+)= tingling, paresthesia or electrical sensations
could indicate tarsal tunnel syndrome if test performed at medial malleolus
if (+) near dorsum of the ankle could indicate deep fibular nerve compression

Question 21

What are Ottawa’s knee rules? (5)

Answer 21

1. 55 yo or older
2. isolated tenderness of the patella (no bone tenderness of the knee other than the patella)
3. tenderness at head of the fibula
4. inability to flex to 90 degs
5. inability to bear weight both immediately and in office (4 steps, unable to transfer weight twice)

Question 22

What are Ottawa’s ankle rules? (3)

Answer 22

1. bone tenderness along distal 6 cm of posterior edge of tibia or tip of medial malleolus
2. bone tenderness along the distal 6 cm of the posterior edge of the fibula or tip of the lateral malleolus
3. inability to bear weight for 4 steps

Question 23

What are Ottawa’s foot rules? (4)

Answer 23

1. pain in midfoot (anterior to talus, posterior to phalanges) and any one of the following:
2. bone tenderness at base of 5th MT
3. bone tenderness at navicular bone
4. inability to bear weight for 4 steps

Question 24

List the MAJOR criteria for Well’s Clinical Prediction Rule for a DVT (6) & list the MINOR criteria (5)
what is a (+)?

Answer 24

MAJOR
1. active CA w/in last 6 mos
2. paralysis
3. recently bedridden
4. localized tenderness
5. thigh and calf swollen
6. family hx of DVT 
MINOR
1. hx of recent trauma
2. pitting edema
3. dilated superficial veins
4. hospitalized w/in last 6 mos
5. erythema 
(+) is >3 major criteria and >2 minor criteria