OSCE Station 1 and 2 practice Flashcards
patient is suffering pain the in the buttock
Pins and Needles / numbness
Feels worse when sitting for a long time, sitting to standing.
What tests do you do?
Deep gluteal syndrome FAIR - Flex/Add/IR Active pififormis stretch test Seated piriformis stretch Beatty test Freiberg sign
patient is suffering from buttock pain lateral to ischium
+/- post thigh pain
takes shorter stride as long strides causes pain in back of thigh what tests do you perform?
ischiofemoral impingement
IFI test - side lying
extension and adduction
deep localised pain in the region of the ischial tuberosity worse in am, running ( high speed or uphill), Deep hip flexion (lunging, deep squat)
proximal hamstring tendinopathy Pain with stretch’ (tensile load) tests Puranen-Ovrava test Bent- Knee Stretch test Modified Bent Knee Stretch Test
lateral hip pain
aggravated - sleeping on affected side, weight bearing(walking - single leg stance)
pain on palpation
what tests will be conducted
greater trochanter pain syndrome
FABER/Patrick test
Patient with anterior groin pain also describe clicking, catching, locking, stiffness, restricted range of motion or giving way
Pain aggravated by prolonged sitting, driving, climbing stairs, sport activities,
Reduced strength and ROM of flexion and adduction what tests do you do?
Femoroacetabular impingement
FADDIR
Scour/Quadrant
Painful flexion and IR
Patient with deep seated pain, dull ache or sharp with movement or loading
Pain aggravated by long walking, pivoting, prolonged sitting, forced adduction, running
+/- Clicking with hip MR/ LR
+/- Locking
+/- Giving way/Instability what tests do you do?
labral tear anterior and posterior labral tear tests Scour/Quadrant test FADDIR Thomas
Patient related to anterior groin pain
Sudden pain in groin with abduction/external movement e.g turning in soccer
Pain ± limitation on active/passive abduction of thigh but resisted adduction
Palpation
Localised tenderness
adductor groin strain look into history
Quadrant/Scour
patient in supine
flex hip as much as possible with hands interlocked over the knee
slowly scoop knee in arch from one shoulder to the opposite shoulder
positive scour test
reproduction of pain
femur is not maintained in neutral
FADDIR
Patient in supine both legs in extended
hip in 90 degree hip flexion
passive adduction
IR till end of range
positive FADDIR test
tests for what
groin pain reproduced
femoroacetabular impingement
anterior labral tear test
patient in supine
Flexion + ABd + ER
then
Slowly extend while ADD + IR
posterior labral tear test
supine contralateral leg straight
Flex/ADD/IR
then slowly into
EXT/ADD/ER
FABER test
Supine
Flex hip
Place heel of foot below patella and tibial tuberosity
stabilise opposite hip
apply pressure on knee of flexed hip to put into abduction
seated piriformis stretch test
patient seated
hip flexed at 90 degrees and knees extended
palpate 1cm lateral to ischium
IR w/ foot
active piriformis test
side lying
patient pushes heel down w/ ER against resistance
FAIR test tests for
deep gluteal syndrome
FAIR test
side lying
upper leg has hip flex.
upper most knee is IR using heel and ADD
IFI test
sidelying position
upper leg is extended and adducted towards plinth
FADER test
supine
hip flexion/ADD/ER
FADER-R test
supine
hip flexion/ADD/ER/ resisted IR
FADER test tests for
gluteal tendinopathy
single leg stance tests for
gluteal tendinopathy
Thomas test
flex hip of affected leg
stabilise unaffected leg
examine lumbopelvic position
obers test
side lying
upper most in 10-20 deg hip ext.
stabilise pelvis
lower uppermost leg to plinth
A patient suffering from back pain and thigh pain, hears clicking, catching, locking, stiffness, restricted ROM and stiffness and pain worsens when sitting for a long time, driving
what may the patient suffer from
and what tests do you use
Femoroacetabular impingement syndrome
Quadrant/Scour
FADDIR
FAIS can predispose to ..
hip OA
Labral tear
Patient is suffering from deep seated anterior groin pain and butt pain and is aggravated long walks and prolonged sittings, clicking and locking.
pain aggravated - long waling, prolonged sitting, forced adduction
what does the patient have and how is it tested
anterior or posterior labral tear test
FABER/Patrick test
Patient suffering from pain in but and lateral side of hip.
Pain when
walking, running, ascending, descending stairs or crossing legs.
Pain during night and stiffness in morning. What is it?
Gluteal Tendinopathy
Single leg stance
FADER/ FADER-R
FABER
Average ROM for hip flexion
120
Average ROM for hip extension
30°
Average ROM for hip abduction
45
Average ROM for hip medial rotation
45
Average ROM for hip lateral rotation
45
Average ROM for knee flexion
135/140
Average ROM for knee extension
10
Average ROM for foot dorsiflexion
20
average ROM for foot plantarfleion
50
accessory glides involved in hip flexion
AP
Lateral distraction
accessory glides involved in hip extension
PA
accessory glides involved in hip abduction
Long Cuad
accessory glides involved in hip lateral rotation
PA
accessory glides involved in hip medial rotation
AP
accessory glides involved in knee flexion
AP
accessory glides involved in knee extension
PA
accessory glides involved in ankle dorsiflexion
AP
accessory glides involved in ankle plantarflexion
PA
Positioning needed for hip flexion/extension
Centre the axis of the goniometer over the lateral aspect of hip joint using middle of the greater trochanter as a bony reference point
Align the stationary arm over the lateral midline of the pelvis
Align the movable arm over the lateral midline of the femur, in line with lateral epicondyle
positioning needed for hip abduction
Centre axis over ASIS of side to be measured
Align the stationary arm with an imaginary horizontal line extending from one ASIS to other ASIS (this means that even if lumbar side-flexion is allowed happen it will not affect hip measurement).
Align movable arm parallel to anterior midline of femur using midline of patella for reference
describe end feel for hip abduction
Firm due to capsule and ligamentous tension and possibly tension in adductor muscle group
describe end feel for hip flexion
soft because of contact between anterior thigh and abdominal muscle bulk or firm because of posterior capsular tension and glut max muscle.
describe end feel for hip extension
Firm due to anterior joint capsule & ligament tension. May also be firm
due to muscular tightness in anterior hip muscles.
describe positioning for hip medial/lateral rotation
Centre axis over anterior aspect of patella
Align the stationary arm so that it is vertical i.e. perpendicular to floor or ceiling
Align movable arm with anterior midline of lower leg, using crest of tibia and a point mid-way between 2 malleoli for reference.
describe end feel for hip medial rotation
Firm due to posterior capsule and ligamentous tension and possibly tension in deep hip and gluteal muscles
describe end feel for hip lateral rotation
Firm due to anterior capsule and ligamentous tension and possibly
tension in anterior portion of gluteal muscles and adductors
describe positioning for knee flexion/extension
Centre the axis of the goniometer over the lateral femoral epicondyle
Align the stationary arm over the lateral midline of the femur using the greater
trochanter as a reference point
Align the movable arm over the lateral midline of the fibula using the lateral
malleolus and fibular head as reference points
describe end feel for knee flexion
soft because of contact between posterior calf and thigh muscle bulk.
describe end feel for knee extension
firm because of posterior joint capsule and ligament tension (including collateral & cruciate ligaments)
describe goniometer alignment of ankle dorsiflexion/plantarflexion
Centre the axis of the goniometer over the lateral malleolus
Align the stationary arm over the lateral midline of the fibula using the fibular head for reference
Align the movable arm parallel to the 5th metatarsal
start at 90
describe end feel of ankle dorsiflexion
firm because of posterior joint capsule and ligament tension and Achilles tendon resistance
describe end feel of ankle plantarflexion
firm because of anterior joint capsule and ligament tension and anterior
muscle resistance. Alternatively, may be hard due to bony contact between talus and
posterior margin of tibi
Normative ROM for foot inversion
40
Normative ROM for foot eversion
20
describe goniometer alignment for foot inversion/eversion
Centre the axis of the goniometer over anterior aspect of ankle; midway
between malleoli
Align the stationary arm over the anterior midline of the lower leg using the tibial tuberosity as a reference point
Align the movable arm over the anterior midline of the 2nd metatarsal
Deep gluteal syndrome and FAIR test causes the compression of what nerve
sciatic nerve
below piriformis and above obturator internus
aetiology of deep gluteal syndrome
piriformis syndrome hypertrophy - increased tone
quadratus femoris and ischiofemoral space narrowing
avulsion fracture, muscle, strain or contusion
differential diagnosis of deep gluteal syndrome
lumbar spine nerve root compression
pelvic tumour
spinal stenosis
SIJ dysfunction
how is deep gluteal syndrome differential diagnosis
CT, MRI, EMG, Ultrasound
what is ischiofemoral impingement or IFI
Impingement of Quadratus Femoris muscle between lesser trochanter and ischium.
Narrowing space of femur and ischium
aetiology of IFI
Coxa valgus
inter-trochanteric fracture
post THR
Hip OA
IFI means reduction in what movement
Ext, Add, ER
Imaging protocol analysis using of IFI
MRI
computed tomography - for injection of anesthetics or steroids
differential diagnosis of IFI
Strain or tear of QFM
tendinopathy of Iliopsoas or hamstring
iliopsoas bursitis
management of IFI
Correct faulty posture in hip ext/add/ER
gluteal muscle weakness
aetiology of proximal hamstring tendinopathy
compression of the tendon during hip flexion/adduction
greater trochanter pain syndrome involves pain in what muscles
Gluteus medius/ minimus
Tensor fascia lata
differential diagnosis of greater trochanter pain syndrome
trochanteric bursitis
myofascial pain rupture of gluteus medius
which action worsens adductor groin pain
abduction and external movements
types of FAIS
Cam impingement - femoral neck growth
Pincer impingement - Acetabulum growth
Combination of cam and pincer impingement
describe surgical management of FAIS
Surgery Femoral or Pelvic Osteoplasty
Described labrum structure
a fibrocartilaginous structure; 2-3mm thick.
Enhances hip joint stability.
Contains proprioceptive fibres
aetiology of labral tear
Traumatic Injury; twisting or pivoting FAIS Capsular laxity developmental dysplasia osteoarthritis
aetiology of FAIS
Morphological changes appear as young at age12-13
But symptoms may not appear until early adulthood
Related to growth plate changes
investigation for labral tear
arthroscopy
MRI/MRA
associated impairments with FAIS
- Decreased ROM into flexion/adduction
- Reduced hip adductor and hip flexor strength
- Altered biomechanics during squatting and stair climbing
Deep squat mechanics for FAIS
Reduced squat depth
•Decreased peak hip internal rotation
•More anteriorly tilted pelvis at the time of peak hip flexion. Decreased mean hip extensor moments
patient is suffering from a pivoting injury, feels like their knee can buckle from under them, immediately heard and pop or crack and had pain and swelling
What injury do you think they have and what special test do you use?
ACL injury
anterior drawer test
pivot shift test
lachman’s test
function of ACL
Primary stabiliser of the knee
Guides knee in locking mechanism
secondary stabiliser in valgus/varus strain
patient is suffering from blow to the flexed knee in a road traffic accident, little swelling, and pain in the back of the knee and calf has a positive drawer test and false positive Ant. drawer and Lachman. Patient has
PCL injury can also be caused by a hyperextension injury posterior drawer test sag test active quadriceps test
patient injured in sporting while pivoting, pain and tenderness, minimal swelling positive, valgus stress and minimal loss of ROM and reduced strength. patient has
valgus stress test MCL
function of medial collateral ligament
►Stabilises the medial side of knee
►Rotation and Valgus stresses
surgical management of ACL injury
autogenous graft using middle third of patellar tendon or gracilis or semitendinosis tendons
early mobilisation post repair
25 year old patient patient experiences sudden pain in the knee after a game which gets worse with activity and at night, locking experience and feels like may give way and has clicking noise and tearing sensation. Pain with squatting or kneeling. Patient has - and what tests do you perform
meniscal injury mcmurrays apleys distraction apleys compression Thessaly
reasons for menisectomy
Tear not amenable to repair
Failure of conservative
Vascularized region (outer 1/3)
Traumatic vertical /longitudinal or bucket handle tear
types of meniscal tear
horizontal -> flap tear
radial tear -> parrot beak tear
longitudinal-> bucket handle
function of meniscus
Absorb compressive forces
Aid symmetrical pressure distribution
Aid joint lubrication
Contribute to stability
imaging for collateral ligament
MRI
Ultrasound
imaging for meniscal injury
MRI is gold standard - high specificity and sensitivity
Patient is experiencing in the front of the knee, patella
pain w/ contraction of quads, worse in flexion minor/no swelling
pain eased/provoked with accessory PFJ glide test
Weak wasted - Vastus medialis obliques
What do you think it is and what test would you use?
patellofemoral pain
mcconnell
causes of forefoot/ phalanges fracture
falling object
Industrial accidents
Crush injury - STI
cause of tarsal fracture
Twisting injury
Easily missed X-Ray
cause of talus fracture
Twisting injury or violent dorsiflexion
cause medial ligament injury
eversion injury
mechanism of injury of ankle fracture
abduction
lateral rotation
adduction
mechanism of injury of patellar subluxation
non-contact injury. The most common mechanism of a patella dislocation in our series was that of an unbalanced individual with a flexed hip, sustaining a valgus force to their flexed knee with the tibia externally rotated.
mechanism of knee tibleau fracture
blow to knee
mechanism of injury of ACL
hyperextension
mechanism of injury of PCL
anterior tibia driven into femor
mechanism of injury of Patellar tendinopathy and patellofemoral ain
progressive overload
patient is facing pain on the front of the following leg, pain with active plantarflexion and after the morning, increased foot pronates during midstance patient has
medial tibial stress syndrome
mechanism of injury of medial tibial stress syndrome
improper training
mechanism of injury of meniscal tear
twisting force whilst knee is planted on the ground
mechanism of injury
repeated strain
a sudden change of direction, requiring a push-off, or landing from a jump.
