OSCE Flashcards

Question

hoovers

Answer 1

This test is designed to see if the client is malingering or exaggerating their complaint of low back pain. Procedure: Client is supine; the therapist takes each of the client’s heels in the palm of a hand. Ask the client to raise each of their legs, one at a time. When the client tries to raise one leg, you should feel a downward pressure in the palm of your hand holding the opposite leg. If you do not feel such a pressure, then the test is positive and the client is not actually trying to lift their leg.

Answer 2

This test is performed on the leg that does not have any symptoms traveling down the back of the leg (i.e the unaffected or well leg). A positive sign is the reproduction of signs and symptoms in the patient’s affected leg. This points to a space-occupying lesion pressing on the nerve root(s) that govern the affected limb. Procedure: Client is supine, slowly raise their well leg until either it reaches the end range or you reproduce their chief complaint of neurological symptoms down the leg on the table. A positive for the well leg raise usually points to a posteromedial disc herniation due to the dural tension pulling the nerve towards the space-occupying lesion (or herniation) medial to the nerve(s).

Answer 3

Tests the strength and/ or innervation of the hip abductors (specifically gluteus medius, L5 of the stance leg) used when stabilizing the ipsilateral pelvis on the femur during the stance phase of ambulation. The patient is asked to stand on one foot, if the pelvis drops on the opposite side the test is positive. Perform on the opposite side first so the patient understands what to do.

Answer 4

Patient is lying supine. Therapist places his/her hands over the patient's anterior superior iliac spines with the elbow slightly bent. Take up the slack and initiate a “down and in” rocking motion at a 45-degree angle on one of the ASIS’s at a time. A positive is pain felt in the region of the sacroiliac joint, meaning that the posterior sacroiliac ligaments are injured. An immediate translation of the pressure on one ASIS into the other implies the ASIS being pressured is locked.

Answer 5

Patient is lying supine. Therapist crosses arms and places hands over the patient's anterior superior iliac spines and applies pressure down and out so the anterior superior iliac spines move apart. A positive is unilateral gluteal or posterior leg pain, indicating anterior sacroiliac ligaments injury. Be aware of the amount of pressure you’re applying on the anterior hips since the anterior muscles are commonly tight.

Answer 6

Patient is lying supine. Therapist crosses arms and places hands over the patient's anterior superior iliac spines and applies pressure down and out so the anterior superior iliac spines move apart. A positive is unilateral gluteal or posterior leg pain, indicating anterior sacroiliac ligaments injury. Be aware of the amount of pressure you’re applying on the anterior hips since the anterior muscles are commonly tight.

Answer 7

Patient is side lying. The therapist places their hands over the iliac crest and pushes toward the table/plinth. The test is designed to increase the pressure in the sacroiliac joint and may indicate a possible sacroiliac lesion of the posterior ligaments. Note only needs to be done on one side because both SI’s are being tested at the same time.

Answer 8

Patient is side lying. The therapist places their hands over the iliac crest and pushes toward the table/plinth. The test is designed to increase the pressure in the sacroiliac joint and may indicate a possible sacroiliac lesion of the posterior ligaments. Note only needs to be done on one side because both SI’s are being tested at the same time.

Answer 9

Patient is lying supine at the edge of the table/plinth. Both knees are flexed to their chest, the outer leg is allowed to drop over the edge of the table, while the inner knee is kept held to the chest. This forces the ipsilateral innominate to anteriorly rotate (sagittal plane) while the contra-lateral sacroiliac joint is stabilized by the flexed hip. Indicates a sacroiliac joint dysfunction on the ipsilateral side, hip pathology or a L4 nerve root lesion.

Answer 10

The patient is lying supine with the knee flexed to 90 degrees. Instruct the patient to lift their buttocks off the table then drop back to the table. (This allows the musculature to relax around the pelvis). The therapist passively extends the legs and palpates the apex of the medial malleoli to determine which leg lies longer on the table. The patient then rises to a long sitting position, while the therapist watches the movement of the malleoli carefully and then rechecks the relative position of the malleoli in the long sitting position. Note if one leg appears to shoot back and forth during the movement of sitting up. Using the right side as the affected side: If the ilium is posteriorly rotated (sagittally), the leg will appear to lengthen when the patient sits up, from the shortened position it appeared to be in when they were lying supine. If the ilium is anteriorly rotated (sagittally), the leg will appear to shorten when the patient sits up, from the lengthened (or same length) position it appeared to be in when they were lying supine. This may be caused by iliosacral dysfunction/anterior-posterior sagittal rotation or lumbar muscle spasm in the presence of lumbar pathology. Starts short and finishes long = posterior sagittal rotation Starts long and finishes short = anterior sagittal rotation

Answer 11

To perform this test, the patient stands while the examiner palpates the posterior superior iliac spine (PSIS) with one thumb and palpates the base of the sacrum with the other thumb medial to the PSIS. The patient is then instructed to stand on one leg while pulling the hip of the side being palpated into 90° or more of hip flexion. The test is then repeated on the other side and compared bilaterally[4][5]. The examiner should compare each side for quality and amplitude of movement[6]. In a normally functioning pelvis, the pelvis of the side being palpated should rotate posteriorly, causing the PSIS to drop or move inferiorly. There should also be symmetry in amount of movement between both the left and right SIJ. The test is positive when the PSIS on the ipsilateral side (same side of the body) of the knee flexion moves minimally in the inferior direction, doesn’t move or is associated with pain. A positive test is an indication of sacroiliac joint hypomobility

Answer 12

The patient is lying supine. The leg being tested is flexed and the foot is placed on the knee of the opposite leg so the patient is in a figure 4 position. (Avoid the malleolus being directly on the patella.) The leg being tested is then abducted toward the table and allowed to relax. This primarily tests the flexibility of the adductor muscles but pain in the inguinal region can indicate a hip joint pathology and pain the in region of the sacroiliac joint can indicated a SI joint lesion. Faber = F Ab ER = Flexion, abduction, external rotation

Answer 13

patient is seated or standing • both arms are at 90 degrees of shoulder abduction and externally rotated • patient actively brings both elbows to 90 degrees of flexion • patient slowly opens and closes the hand for 3 minutes Positive sign: the inability to maintain the upper limb position, ischemic pain, numbness or paresthesia of the limb, or heaviness of the arm.

Answer 14

palpate the radial pulse on the side being tested § ask your patient to take a deep breath and hold it § passively fully abduct the patient’s arm (do not allow elevation)

Answer 15

palpate the radial pulse on the side being tested § ask your patient to stand with the shoulders down and back in an exaggerated military stance § get your patient to take a deep breath Positive sign: a diminishment of pulse and reproduction of signs and symptoms.

Answer 16

palpate the radial pulse on the side being tested § slightly extend the shoulder and apply a downward traction § ask your patient to take a deep breath and hold, while actively extending and ipsilaterally rotating the neck Positive sign: a diminishment of pulse and reproduction of signs and symptoms.

Answer 17

§ palpate the radial pulse on the side being tested § slightly extend the shoulder and apply a downward traction § ask your patient to take a deep breath and hold, while actively extending and contralaterally rotating the neck Positive sign: a diminishment of pulse and reproduction of signs and symptoms

Answer 18

§ palpate the radial pulse on the side being tested § slightly extend the shoulder and apply a downward traction § ask your patient to take a deep breath and hold, while actively extending and contralaterally rotating the neck Positive sign: a diminishment of pulse and reproduction of signs and symptoms

Answer 19

patient is high seated with shoulder flexed to 20 degrees and elbow fully extended  therapist palpates the lateral epicondyle  patient makes a fist, pronates the forearm and slightly extends the wrist  therapist resists the patients attempt to extend their wrist Positive sign: a sudden severe pain in the area of the common extensor tendon

Answer 20

patient is high seated with shoulder flexed to 20 degrees and elbow fully extended  therapist palpates the lateral epicondyle  patient makes a fist, pronates the forearm and slightly extends the wrist  therapist resists the patients attempt to extend their wrist Positive sign: a sudden severe pain in the area of the common extensor tendon

Answer 21

patient is high seated with shoulder flexed to 20 degrees and elbow fully extended  therapist palpates the lateral epicondyle  patient makes a fist, pronates the forearm and slightly extends the wrist  therapist resists the patients attempt to extend their wrist Positive sign: a sudden severe pain in the area of the common extensor tendon

Answer 22

patient’s forearm is supinated and wrist slightly flexed  therapist palpates the medial epicondyle  therapist resists the patient’s attempt to flex their wrist Positive sign: a sudden severe pain in the area of the common flexor tendon.

Answer 23

patient is seated with elbow flexed to 90 degrees  therapist resists pronation as the elbow is passively extended Positive sign: tingling or paresthesia in the median nerve distribution

Answer 24

patient is asked to pinch the tips of their index finger and thumb together (can be done with a piece of paper in between) Positive sign: the patient is unable to perform the task – this may indicate a compression of the anterior interosseous nerve (branch of the median nerve) between the two heads of pronator teres – it can also indicate a nerve pathology

Answer 25

``` patient is supine § therapist brings the lower extremity into the SLR position § apply ankle dorsiflexion § apply hip adduction § apply hip internal rotation § apply cervical flexion ```

Answer 26

patient is prone (with a neutral spine) § therapist applies knee flexion § apply hip extension (important not to extend the spine may result in nerve root pressure causing a false positive)

Answer 27

Test Application 1) slowly abduct patient’s arm to 90o , ask re pain 2) laterally rotate the shoulder, ask re pain Positive sign: patient looks or feels alarmed/apprehensive and resists further motion (i.e. apprehension is greater than the complaint of pain) - A patient could feel pain or pinching in the posterior aspect of the shoulder. This can be positive for a posterior impingement as well.

Answer 28

Test Application 1) slowly abduct patient’s arm to 90o , ask re pain 2) laterally rotate the shoulder, ask re pain Positive sign: patient looks or feels alarmed/apprehensive and resists further motion (i.e. apprehension is greater than the complaint of pain) - A patient could feel pain or pinching in the posterior aspect of the shoulder. This can be positive for a posterior impingement as well.

Answer 29

Test Application 1) therapist places the hand of the affected shoulder in their axilla, holding the patient’s hand with their arm so that the patient remains relaxed 2) affected shoulder is slightly abducted, forward flexed, and laterally rotated 3) therapist stabilizes the patient’s scapula with the opposite hand (fingers on the spine of the scapula and thumb on the coracoid process) 4) using the arm holding the patient’s hand, the therapist grasps the patient’s upper arm and draws the humerus forward Positive sign: click and/or apprehension, excessive movement (as compared to the unaffected side)

Answer 30

Jerk Test (Magee, Palmer) Test Application 1) patient sits with arm medially rotated (no extra rotation added by therapist) and flexed to 90o 2) therapist grasps patient’s elbow and axially loads the arm 3) while maintaining the axial load, the therapist horizontally adducts the arm 4) return the arm to the starting position Positive sign: sudden clunk/jerk of the arm as it subluxes (there may be a 2nd clunk when the arm is returned to the starting position)

Answer 31

Jerk Test (Magee, Palmer) Test Application 1) patient sits with arm medially rotated (no extra rotation added by therapist) and flexed to 90o 2) therapist grasps patient’s elbow and axially loads the arm 3) while maintaining the axial load, the therapist horizontally adducts the arm 4) return the arm to the starting position Positive sign: sudden clunk/jerk of the arm as it subluxes (there may be a 2nd clunk when the arm is returned to the starting position)

Answer 32

Neer Impingement Test (Magee, Palmer) Test Application 1) therapist medially rotates the patient’s arm then fully elevates the arm in scaption (this jams the greater tuberosity against the anteroinferior border of the acromion) Positive sign: local pain (which indicates subacromial impingement)

Answer 33

Hawkins-Kennedy Impingement Test (Magee, Palmer) Test Application 1) therapist flexes the patient’s arm to 90o then forcibly internally rotates the shoulder while horizontally adducting Positive sign: local pain (which indicates subacromial impingement) Note: if the arm is horizontally adducted before the medial rotation, the test is called the Coracoid Impingement Sign (Magee)

Answer 34

also called Labral Test (Palmer) Test Application 1) therapist places one hand over the patient’s posterior shoulder (humeral head) 2) therapist’s other hand holds the humerus above the elbow 3) therapist fully abducts the patient’s arm then pushes anteriorly with the hand over the humeral head while externally rotating the arm Positive sign: a clunk or grinding sound (indicates a torn labrum

Answer 35

Test Application 1) patient is seated 2) therapist cups one hand over the anterior deltoid with the heel of the hand on the clavicle 3) therapist cups the other hand over the scapula with the heel of the hand on the scapular spine 4) therapist squeezes the heels of their hands together Positive sign: excessive movement at the AC joint (pain localized to the AC joint is also possible)

Answer 36

Horizontal Adduction (Magee) ▪ also called Acromioclavicular Crossover Test, Acromioclavicular Crossbody Test (Magee) Test Application 1) using the affected arm, the patient reaches across their body to the opposite shoulder 2) this test can be done passively as well – flex the shoulder before horizontally adducting Positive sign: pain localized to the AC joint (pain localized to the SC joint is also possible indicating injury/pathology)

Answer 37

``` Test Application (3 steps) 1) patient actively flexes shoulder to 90o with forearm supinated 2) patient resists an isometric force given by therapist at 90o —(therapist pushes into extension while patient resists into flexion) 3) therapist provides a force into extension while patient resists BUT lets the therapist overpower them creating an eccentric contraction of biceps Positive sign: pain localized to the bicipital groove indicating possible bicipital tenosynovitis, tendonitis, tendonosis. (note: this test can also be positive with a labral tear – pain would be more localized to the proximal attachment of the long head) ```

Answer 38

tests for arthritic changes/problems in the GH joint Test Application 1) patient is sidelying, affected side up 2) therapist compresses the humeral head into the glenoid fossa while the patient internally and externally rotates the shoulder Positive sign: reproduction of symptoms (think symptoms of arthritis)

Answer 39

Test Application 1) starting position: patient’s elbow flexed to 90o, arm is stabilized against the body, forearm pronated 2) therapist palpates the bicipital groove 3) therapist resists supination while the patient laterally rotates against resistance (think brandishing a sword) Positive sign: the biceps tendon pops out during the resisted motions (indicating a torn transverse humeral ligament (localized pain without the popping out suggests biceps tenosynovitis)) -Note the top hand is best positioned over the bicipital groove.

Answer 40

also called Supraspinatus Test (Palmer), Jobe Test (Magee) Test Application 1) therapist abducts patient’s arm to 90o then applies resistance to abduction 2) the shoulder is then medially rotated and moved into the position of scaption (horizontally adducted ~30o) 3) therapist applies resistance to adduction Positive sign: weakness with pain indicates a supraspinatus tear, weakness without pain indicates nerve damage (suprascapular nerve) Note: some suggest positioning the thumb up (‘full can’)

Answer 41

Test Application 1) patient laterally rotates, flexes, abducts one arm while medially rotating, extending, adducting the other arm 2) switch 3) the difference between each side is compared Positive sign: significant difference between each side (if a difference exists, the affected/restricted range(s) must be identified Note: Magee suggests this test be performed during AF/AROM because it combines movements

Answer 42

Drop Arm Test (Magee, Hoppenfeld) ▪ also called Codman’s Test (Magee) Test Application 1) therapist abducts patient’s arm to 90o then asks the patient to slowly lower the arm to their side OR 1) patient abducts arms to 90o 2) therapist then adds a surprise force into adduction to see if patient can resist and control this action Positive sign: patient is unable to return the arm to their side (or control the force into adduction) slowly or has pain when doing so

Answer 43

Drop Arm Test (Magee, Hoppenfeld) ▪ also called Codman’s Test (Magee) Test Application 1) therapist abducts patient’s arm to 90o then asks the patient to slowly lower the arm to their side OR 1) patient abducts arms to 90o 2) therapist then adds a surprise force into adduction to see if patient can resist and control this action Positive sign: patient is unable to return the arm to their side (or control the force into adduction) slowly or has pain when doing so

Answer 44

Sulcus Sign (Magee, Palmer) ▪ also called Test for Inferior Shoulder Instability (Magee) Test Application 1) patient stands with the arm at their side and shoulder muscles relaxed (neutral rotation) 2) therapist grasps the patient’s forearm (just below the elbow) and pulls the arm distally 3) repeat the test at 20o – 50o of abduction Positive sign: presence of a sulcus sign in the symptomatic patient (ie. pain is likely present) ▪ grading (measurement of the inferior margin of the acromion to the humeral head) ▪ 1: < 1 cm ▪ 2: 1-2 cm ▪ 3: > 2 cm

Answer 45

Sulcus Sign (Magee, Palmer) ▪ also called Test for Inferior Shoulder Instability (Magee) Test Application 1) patient stands with the arm at their side and shoulder muscles relaxed (neutral rotation) 2) therapist grasps the patient’s forearm (just below the elbow) and pulls the arm distally 3) repeat the test at 20o – 50o of abduction Positive sign: presence of a sulcus sign in the symptomatic patient (ie. pain is likely present) ▪ grading (measurement of the inferior margin of the acromion to the humeral head) ▪ 1: < 1 cm ▪ 2: 1-2 cm ▪ 3: > 2 cm

Answer 46

tests for deQuervain’s disease  a tenosynovitis occurring in the first dorsal carpal tunnel  affects abductor pollicis longus and extensor pollicis brevis  patient is seated with arm and wrist in neutral position  patient flexes their thumb and makes a fist around it with their fingers  therapist asks if there is any pain  if this position is ok, therapist asks the patient to ulnar deviate/adduct their wrist Magee pg. 472 Positive sign: a sudden severe pain at the wrist where the tendons pass – pain may shoot down into the thumb and up into the muscle bellies (more severe presentation)

Answer 47

tests for carpal tunnel syndrome  have the patient flex both wrists simultaneously by pushing their dorsal surfaces together  hold for one minute Positive sign: tingling or paresthesia into the thumb and the first two and a half fingers caused by pressure on the median nerve

Answer 48

another test for carpal tunnel syndrome  have the patient extend both wrists simultaneously by pushing their palmar surfaces together (pray position)  hold for one minute Positive sign: tingling or paresthesia into the thumb and the first two and a half fingers caused by pressure on the median nerve

Answer 49

patient is asked to pinch the tips of their index finger and thumb together (can be done with a piece of paper in between) Positive sign: the patient is unable to perform the task – this may indicate a compression of the anterior interosseous nerve (branch of the median nerve) between the two heads of pronator teres – it can also indicate a nerve pathology

Answer 50

test for circulation in the hand by the ulnar and radial arteries  patient raises their hand above their head and open and closes their fist quickly (a few times)  patient then squeezes their fist tightly so that venous circulation is forced out of the palm  the therapist places their thumb over the radial artery and their index finger over the ulnar artery occluding them  therapist maintains the pressure while the patient opens their fist  the palm should be pale  the therapist releases the pressure on one artery while maintain the pressure on the other  the palm should flush immediately if circulation is normal,  repeat the test for the other artery, and then the other hand Positive sign: if it the palm does not react or flushes slowly the released artery is partially or completely occluded

Answer 51

used when a patient is unable to flex a PIP joint  this test evaluates the tightness of the intrinsic muscle of the hand (lumbricals and interossei) compared to joint capsule contracture (inability of a finger to curl into the palm)  the therapist holds an MCP slightly extended and tries to flex a PIP Positive sign: an inability to flex the PIP resulting from tight intrinsic hand muscles or joint capsule contractures Magee pg. 471  to differentiate between these two possible causes, continue the test by:  slightly flexing the MCP (relaxing the intrinsic hand muscles)  attempt to flex the PIP Positive sign: if the PIP now flexes, restriction of the intrinsic hand muscles are the cause of restriction (first part of the test) – if the PIP still doesn’t flex, PIP joint capsule contracture is the cause of restriction

Answer 52

used when a patient is unable to flex a PIP joint  this test evaluates the tightness of the intrinsic muscle of the hand (lumbricals and interossei) compared to joint capsule contracture (inability of a finger to curl into the palm)  the therapist holds an MCP slightly extended and tries to flex a PIP Positive sign: an inability to flex the PIP resulting from tight intrinsic hand muscles or joint capsule contractures Magee pg. 471  to differentiate between these two possible causes, continue the test by:  slightly flexing the MCP (relaxing the intrinsic hand muscles)  attempt to flex the PIP Positive sign: if the PIP now flexes, restriction of the intrinsic hand muscles are the cause of restriction (first part of the test) – if the PIP still doesn’t flex, PIP joint capsule contracture is the cause of restriction

Answer 53

Patient lies on the side not being tested. The lower leg is flexed at the hip and knee for stability. The therapist abducts the upper leg as far as possible and slightly extends the hip so the tensor fascia latae and the iliotibial band are taut over the greater trochanter. Stabilize the pelvis at the iliac fossa and release the leg. A positive occurs when the leg remains above the height of the table. May be repeated with the knee flexed to isolate the tensor fascia latae. (The picture shows TFL isolation).

Answer 54

Patient is lying prone. The therapist passively flexes the knee and notes when the buttock starts to rise. It should be possible to flex the knee to 90 degrees before the buttock rises. Indicates pathology (tight, contracture or injury) to rectus femoris. Watch closely in the first 30 degrees of knee flexion.

Answer 55

Sometimes called the quadrant test, it tests the articular surfaces of the head of the femur and the surface of the acetabulum. Note any grating or sound coming with the movement as it may indicate the presence of osteoarthritic changes. The patient is lying supine with the hip flexed and adducted so the knee (which is also flexed) faces the opposite shoulder. The therapist maintains linear/longitudinal force down the femur while abducting and laterally rotating the femur (tests the outer aspect of the hip joint). Return to the start position and while maintaining the linear/longitudinal force down the femur adduct and internally rotate the femur (tests the inner aspect of the hip joint.)

Answer 56

Sometimes called the quadrant test, it tests the articular surfaces of the head of the femur and the surface of the acetabulum. Note any grating or sound coming with the movement as it may indicate the presence of osteoarthritic changes. The patient is lying supine with the hip flexed and adducted so the knee (which is also flexed) faces the opposite shoulder. The therapist maintains linear/longitudinal force down the femur while abducting and laterally rotating the femur (tests the outer aspect of the hip joint). Return to the start position and while maintaining the linear/longitudinal force down the femur adduct and internally rotate the femur (tests the inner aspect of the hip joint.)

Answer 57

Sometimes called the quadrant test, it tests the articular surfaces of the head of the femur and the surface of the acetabulum. Note any grating or sound coming with the movement as it may indicate the presence of osteoarthritic changes. The patient is lying supine with the hip flexed and adducted so the knee (which is also flexed) faces the opposite shoulder. The therapist maintains linear/longitudinal force down the femur while abducting and laterally rotating the femur (tests the outer aspect of the hip joint). Return to the start position and while maintaining the linear/longitudinal force down the femur adduct and internally rotate the femur (tests the inner aspect of the hip joint.)

Answer 58

Tests the integrity of the anterior cruciate ligament, especially the posterior lateral band. • Patient is positioned lying supine. • Allows you to test for damage to the ligament even if the patient is unable to flex the knee as the test is done with the knee in its resting position and prevents the hamstrings from going into spasm. • The patient's femur is stabilized with one hand while the other hand moves the proximal aspect of the tibia forward. • A positive is pain and/or increased movement or a soft mushy end feel in comparison to the unaffected leg. Note: A False Negative may occur if the femur is not properly stabilized, if a meniscal lesion blocs tracnslation or if the tibia is internally rotated.

Answer 59

• Tests the medial collateral ligament and medial capsule., i.e. the primary stabilizing structures on the medial side. • Patient is lying supine or high seated • The knee is tested in its resting position (between 25 and 30 degrees of flexion) and at full extension. • The therapist applies a valgus stress (pushes on the lateral aspect of the knee at or just above the lateral knee joint line so that the knee moves medially). White the opposite hand stabilizes the lower leg or applies a counterforce just superior to the medial malleolus so that the lower leg moves laterally. • Therapist should note any increased joint opening and/or pain compared to the unaffected knee. • With the knee extended the posteromedial capsule and the medial collateral ligament are tested. When the knee is slightly flexed, primarily the anterior superficial fibers of the medial collateral ligament are tested. (These fibers are tautest at 30 degrees and are commonly injured first.)

Answer 60

Tests primarily the posterior horns of the meniscus • Patient is lying supine • Therapist grasps the patient's heel and rests the plantar aspect of their foot on your forearm • The free hand grasps around the knee with the fingers on the medial joint line and the thumb on the lateral joint line. • Fully flex the knee, then internally and externally rotate the tibia on the femur, next extend the knee to almost full extension with the tibia externally extended (the heel turned in) and a valgus force applied. Repeat the extension movement with the tibia internally rotated and varus force applied. • With the tibia externally rotated and a valgus stress applied you are testing the medial meniscus. • With the tibia internally rotated and a varus stress applied you are testing the lateral meniscus. • A positive is pain and/or a palpable or audible click (preferably all of them) * Remember: Heel in/push in = medial meniscus Heel out/pull out = lateral meniscus

Answer 61

Tests the integrity of the posterior cruciate ligament • Patient is supine, with hips and knees 90/90. Look to see if the tibial tuberosity is visible, or has it dropped back or sagged? Note: Posterior displacement is more obvious between 90-110° of knee flexion. The point of the sag sign test is to rule out injury to the PCL prior to testing the ACL. If you perform the Anterior Drawer Test (above) on a patient with a damaged PCL, the knee will be starting from a posterior (rather than neutral) position. Performing the anterior pull will give excessive movement - seeming like a positive for injury to the ACL, but in fact you're just taking up the slack (in the ACL) to get the knee back to neutral.

Answer 62

• Does not differentiate between either ligament. • Patient is positioned lying prone, with the leg being tested flexed to 90 degrees at the knee. • Therapist stabilizes the patient's posterior femur with their own knee, grasps around the lower leg just proximal to the malleoli and distracts the joint while internally and externally rotating the lower leg. • Positive is pain in either ligament.

Answer 63

Patient is positioned lying prone, with the leg being tested flexed to 90 degrees at the knee. • Therapist grasps the patients heel and pushes down compressing the joint while internally and externally rotating the lower leg. • A positive is pain and possibly a click. • Tests both menisci simultaneously, although patient may report pain more on one side of the knee than the other.

Answer 64

Patient is positioned supine with the patients heel in the palm of your hand. • Flex the patient's knee up and allow the knee to passively extend. • The knee should extend fully. • A positive occurs when the knee stops short and a rubbery resistance to full extension is felt, sharp pain on the joint line, which may radiate up or down the leg. Can also indicate a loose body within the joint or intracapsular joint swelling

Answer 65

Tests for minimal swelling- shows as little as a teaspoon of swelling, if present • Patient is positioned supine or long seated. • The therapist strokes 2 to 3 times along the medial aspect of the patella from below the joint line to above the patella to the suprapatellar area (thus pushing the exudate proximally). Using the opposite hand the therapist immediately strokes along the lateral aspect of the patella, from above the patella to below the joint line. Any swelling will appear just medial and inferior to the patella. * Note the speed that the swelling moves. The -viscosity (thickness) of the swelling, gives you an indication of what the swelling consists of. If the swelling moves quickly it is probably synovial fluid. If it moves slowly it probably contains blood. If blood is noted you may wish to refer this patient out to their general practitioner.

Answer 66

Tests for gross swelling • Patient is positioned supine or long stated. • Therapist applies pressure to the patella, pushing the patella posteriorly (push patella into the trochlear groove). A positive is noted when the patella is felt to pass through the swelling, pushing the fluid to the sides of the joint and then tap against the femoral condyles.

Answer 67

Tests for chondrornalacia patellae (softness of the articular cartilage). • This test will cause pain in a large percentage of the population even if they have no signs or symptoms and should be contraindicated unless specifically asked for at the CMTO exams. • Patient is supine or long seated. • Push the patella distally and trap the upper pole with the web space between the thumb and index finger. • Have the patient contract the quadriceps muscle thus forcing the patella under your web space. • A positive is pain and/or palpable crepitus

Answer 68

Tests for chondrornalacia patellae (softness of the articular cartilage). • This test will cause pain in a large percentage of the population even if they have no signs or symptoms and should be contraindicated unless specifically asked for at the CMTO exams. • Patient is supine or long seated. • Push the patella distally and trap the upper pole with the web space between the thumb and index finger. • Have the patient contract the quadriceps muscle thus forcing the patella under your web space. • A positive is pain and/or palpable crepitus

Answer 69

Tests for Iliotibial Band Friction Syndrome (sometimes referred to as “Runners Knee” which is chronic inflammation of the ITB near its insertion point). • Patient is supine, with the knee and the hip flexed to 90 degrees. • The therapist applies pressure just proximal to the lateral epicondyle, while the knee is either actively or passively extended and flexed. • Pain usually occurs at 30 degrees of flexion and is point specific, just proximal to the lateral condyle. *Magee text describes it as: Knee flexed to 90° with hip flexion. The therapist applies pressure to the lateral femoral condyle then the patient actively extends the knee. A positive is pain at 30° (since the ITB is most taut at this point).

Answer 70

Tests for Iliotibial Band Friction Syndrome (sometimes referred to as “Runners Knee” which is chronic inflammation of the ITB near its insertion point). • Patient is supine, with the knee and the hip flexed to 90 degrees. • The therapist applies pressure just proximal to the lateral epicondyle, while the knee is either actively or passively extended and flexed. • Pain usually occurs at 30 degrees of flexion and is point specific, just proximal to the lateral condyle. *Magee text describes it as: Knee flexed to 90° with hip flexion. The therapist applies pressure to the lateral femoral condyle then the patient actively extends the knee. A positive is pain at 30° (since the ITB is most taut at this point).

Answer 71

Tests the integrity of the anterior cruciate ligament. • Prior to doing an anterior drawer test, a sag sign (see below) should be performed to rule out a false positive and the hamstrings should be checked to see if they are in spasm as they may cause you to have a false negative. • Patient is lying supine in a hook-lying position with the knee flexed to 90 degrees. • Therapist sits on the patient's foot, grasps around the posterior aspect of the patient' s proximal tibia, and draws it forward in relation to the femur. • A positive is pain and/or increased movement in comparison to the unaffected leg.

Answer 72

Tests the integrity of the posterior cruciate ligament • Patient is positioned as for Anterior Drawer test • Therapist sits on the patient's foot. and pushes on the anterior aspect of the patient's proximal tibia, and moves it backwards in relation to the femur. • A positive is pain and/or increased movement in comparison to the unaffected leg.

Answer 73

Tests for Patellofemoral Pain Syndrome by testing the quality of the articular cartilage between the posterior aspect of the patella and the femoral condyles. • Patient is high seated. • Patient's knee is fully extended OR Can also be performed with patient contracting quads first. • Therapist pushes the patella posteriorly against the femoral condyles. • Repeat at 30, 60, and 90 degrees of flexion • A positive is pain.

Answer 74

Tests for patella dislocation/subluxations • Patient is supine, with knee slightly flexed, up to 30° • The therapist then slowly and carefully pushes the patella laterally. • A positive is the patient showing signs of apprehension and/or contracting the quadriceps to bring the patella back into alignment.

Answer 75

Tests primarily the lateral collateral ligament, the posterolateral capsule and occasionally the biceps femoris muscle and the iliotibial band. • Patient is lying supine or high seated. • The knee is tested in its resting position (between 25 and 30 degrees of flexion) and at full extension. • The therapist applies a varus stress (pushes on the medial aspect of the knee at or just above the medial knee joint line so that the knee moves laterally). While the opposite hand stabilizes the lower leg or applies a counterforce just superior to the lateral malleolus so that the lower leg moves medially. • Therapist should note any increased joint opening and/or pain compared to the unaffected knee. With the knee extended the posterolateral capsule, and the lateral collateral ligament and occasionally the biceps femoris are tested. When the knee is slightly flexed, primarily the lateral collateral ligament and occasionally the iliotibial band is tested.

Answer 76

Tests for the presence of a neuroma (tumour or new growth of nerve cells) between the 3rd and 4th (sometimes 2nd and 3rd) metatarsal heads. Condition commonly called Morton’s Neuroma. Test: Long seated, therapist encircles both hands around the metatarsal heads and squeezes them together. POSITIVE= Sharp pain between the 3rd and 4th (or 2nd and 3rd) metatarsal heads.

Answer 77

Tests for the presence of a neuroma (tumour or new growth of nerve cells) between the 3rd and 4th (sometimes 2nd and 3rd) metatarsal heads. Condition commonly called Morton’s Neuroma. Test: Long seated, therapist encircles both hands around the metatarsal heads and squeezes them together. POSITIVE= Sharp pain between the 3rd and 4th (or 2nd and 3rd) metatarsal heads.

Answer 78

Testing for presence of Deep Vein Thrombosis (DVT) • Signs and symptoms that would lead you to this hypothesis: o Pain felt deep in the calf or popliteal fossa o Onset of pain after a period of immobilization o Constant aching, which worsens with activity such as walking or climbing stairs o Client may report being able to walk a certain distance then pain in the calf appears and grows until they rest, at which time the pain dissipates. If they continue their activity the pain reoccurs. Test: Patient prone, knees bent to 90°. DF the ankle and slowly extend the knee (increasing the pressure of the deep posterior compartment). POSITIVE= Excruciating pain, tender calf, pallor, swelling, loss of dorsal pedal pulse. *This test is not conclusive but may reinforce your suspicions. This would be considered a MEDICAL EMERGENCY and CI for massage due to risk of dislodging thrombus which could lead to a heart attack or stroke*

Answer 79

Testing the integrity of the ATFL which should be taut in all positions (keeping the talus from moving forward from the tibia) TEST: Grasp the calcaneus with one hand, with the clients sole resting on your forearm, the second hand stabilizes above the ankle joint while the first traction’s (distracts) the ankle slightly and draws the clients foot forward (anteriorly). POSITIVE= Pain, tenderness and laxity and/or a clunk For gross instability ATFL and CFL would be damaged

Answer 80

Tests the integrity of the Anterior Inferior Tibiofibular ligament Test: Long seated, foot in neutral, therapist pushes the talus superiorly between the tibia and fibula (forcing them apart and stressing the AITF ligament). Then add additional force by tapping once on the heel with the base of your hand. POSITIVE= Pain in the region of the ligament with the superior talus push or after the additional tap