Pathologies and their relevant tests Flashcards
Labral tear
Physical exam: FADIR, FABER Flexion internal rotation - no pain pain. Good for ruling out (sensitivity). Pain on Thomas test
Patient Interview: Painful clicking in hip
Intra articular pathology (non specific)
FABER and Scour test (FADIR)-pain, screening tool. Thomas test - pain and reduced range, high sensitivity and specificity (positive likely to indicate injury).
Femoral fracture
Patellar pubic percussion - reduced percussion on side of pain.
Gluteal tendinopathy
Trendelenburg - drop in NWB pelvis.
Resisted hip abduction, resisted hip internal rotation - weakness and pain.
Three most useful tools with good specificity (hip abd has high sensitivity)
Resisted external deretoation test and single leg stance hold for 30 - Pain. Both have low clinical utility but can be useful screening tool.
Hip OA
Squatting aggravates symptoms (low LR-), lateral pain on active hip flexion (low LR- and high LR+) Scour test positive, pain with active hip ext, passive internal rotation <25 (low LR+)
ACL injury
Physical exam: Lachmans test - wanted soft end feel on tibial translation (specific and sensitive). Anterior draw test - >5mm tibial translation (specific). Pivot shift - anterior subluxation of tibia (specific, need intack MCL and ITB)
Patient Interview: Immediate (0-2 hr) swelling, audible pop or tear
MUST DO SAG SIGN to interpret this test (start further back may be perceived more movement)
PCL injury
Interview: Pain in posterior knee, pain with kneeling. Minimal swelling as it is extra synovial.
PE: Posterior sag sign (high specificity and can be highly sensitive). Posterior draw - >5 mm tibial translation (highly specific and can be highly sensitive) Reverse Lachman’s test - soft end feel on tibial translation (specific and moderately sensitive).
Meniscal tear
Interview: Delayed swelling (6-24hr) with effusion. Clicking or locking. Giving away. Some patient may describe a tearing sensation.
PE: McMurray’s test - palpable or audible click/pain (positive finding can point to meniscal, but neg cannot rule out). Joint line tenderness (45-90) - patients pain (positive finding is specific and sensitive). Apleys test - Pain (little worse than McMurrays in that is is somewhat specific and sensitive)
MCL
Interview: If the sprain is quite deep then immediate swelling can occur but if it is superficial then no swelling.
PE: Valgus stress test at 30 - pain is best factor but laxity is also very sensitive (grade of tear will determine laxity).
LCL
Varus stress test at 30 - looking for pain and laxity
Acute injuries
Specific/sudden MOI which often involves high force load.
Traumatic event which occurred at specific time point.
Amount of dysfunction is directly linked with injury severity (speed/amount of swelling can also indicate this)
Ligament injury PI
Specific/sudden MOI which often involves high force load.
Traumatic event which occurred at specific time point.
Amount of dysfunction is directly linked with injury severity (speed/amount of swelling can also indicate this)
Ligament injury PE
Ligament stress test (pain reproduction, end feel and laxity)
Grade 3 may have les pain, particular on stress test, due to limited nociceptors (only if isolated ligament strain, ACL sees this) but normally other tissues provoke pain inn presence of G3
Palpation over specific ligament (pain)
Swelling around ligament
Test for joint effusion if intra-articular (swipe/sweep test)
Fracture PI
High impact load (intrinsic or extrinsic)
Pain local to specific bony area
+/- pain with ice
Audible ‘break’ (crack or pop)
Inability or limited ability to WB
Quick onset and significant swelling, bruising, highly vascular
+/- deformity (only if on scene, this will be fixed soon after)
Fracture PE
Pain on palpation of bone, at suspected fracture site
Ottawa ankle/knee rule
Tapping, vibration, compression away from fracture site causing pain
Meniscal PI
WB on planted foot with rotation/twisting
Instability/giving away
Joint effusion (swelling at joint)
Clicking, locking, catching with movement (more major tear)
Onset of swelling (indicates severity)
Pain at joint line
Ability to WB could indicate severity
Meniscal PE
Clicking, locking with AROM
MacMurray’s, Appleys, Thessaly’s (WB test) test causes pain
Joint effusion test (swipe/sweep)
Joint line palpation causes pain
Dislocation PI
Quick onset of swelling high pain and loss of function
Felt or heard popping noise/sensation
Joint effusion
MOI- landing, direction change, accelerate/decelerate
Apprehension
Instability/giving away
Dislocation PE
Patella apprehension test (gentle lateral glide and check for apprehension)
Pain on palpation (mainly medial patella facet)
Joint effusion/swipe test (going into knee joint)
Quads inhibition and pain on contraction
Muscle PI
High force/load contraction or stretch MOI
Pain local to muscle
Level of dysfunction (both at time of injury and clinical presentation) will indicate grade
Often intrinsic force (large contraction)
Often not much swelling as it can freely flow
+/- bruising at muscle location
Aggravated by muscle contraction
Muscle PE
Pain reproduced with palpation, stretch and contraction
Palpable gap on grade 4
Overuse injury
No specific MOI
Gradual onset/Worsening of pain
Sudden increase in training load
Tendinopathy PI
Pain location at tendon
Pain after exercise, may warm up during and then pain again after exercises
Morning stiffness/pain when first get up
History of postures or activities that excessively compressively or tensile load tendon (sitting crossed legged all the time for lateral glutes, hill training often Achilles)
Tendinopathy PE
Pain reproduced on palpation
Thickening of tendon
Pain reproduced with tendon/muscle contraction and compression/stretch
Labral tears PI
Deep pain, typically anterior hip or groin
Pain with WB and rotation
May have clicking, clunking and catching
History or repetitive twisting or EOR activities
Labral tears PE
FADIR/scour test causing pain
FABER pain
Thomas test pain
Pain with ROM flexion/rotation
PFP PI
Pain around patella – location may be vague Pain on palpation of medial and lateral patellar facets Pain aggravated by running, hills, stairs and persistent knee flexion +/‐ crepitus
PFP PE
Pain on palpation of medial and lateral patellar facets
Joint crepitus with glides Decreased +/‐ pain on PFJ glides Pain reproduced with squat/stairs
Stress/reaction fracture PI
History of repetitive of high load
Pain in area of bone
May have night pain
Delayed onset pain (also in tendons)
Relative energy deficiency in sport
Stress/reaction fracture PE
Tenderness on palpation (local bone)
+/- Vibration, compression distally or proximally (better for acute as the fracture is bigger)
