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Orthopedics > Physical Exam LE > Flashcards

Physical Exam LE Flashcards

1
Q 
HIP AND THIGH
Inspection
1. Anterior View? 2
2. Posterior View? 2
3. Gait? 2
A
  1. Anterior view:
    - thigh atrophy,
    - extremity alignment
  2. Posterior view:
    - atrophy,
    - Trendelenberg test
  3. Gait:
    - antalgic gait,
    - Trendelenberg (usually secondary)
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2
Q

HIP AND THIGH
Palpation
1. Supine? 3
2. Lateral? 2

A
  1. Supine:
    - adenopathy,
    - ASIS,
    - pelvic obliquity
  2. Lateral:
    - greater trochanter,
    - ischial tuberosity
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3
Q

HIP AND THIGH
Range of Motion – patient supine
Supine:
6

A
  • flex until pelvis moves 110-130,
  • Thomas test
  • Abduction (35-50) and adduction (25-35)
  • Internal and external rotation,
  • hip flexed to 90
  • Extension – patient prone
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4
Q 
HIP AND THIGH
Strength testing
1. Flexors? 2
2. Extensors? 3
3. Abductors? 1
4. Adductors? 3
A
    • pt sitting,
    • bring knee up against resistance
    • pt prone,
    • knee flexed,
    • bring leg off of table
  3. side lying
    • pt supine,
    • legs spread,
    • bring them together
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5
Q

HIP AND THIGH
Special Tests
1. Trendelenberg?
2. Stand on one leg?

A
  1. tests abductor strength

2. does pelvis stay level

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6
Q

HIP AND THIGH

What does the Faber/Patrick test analyze?

A
  1. tests for hip and SI joint pathology

figure 4, press down on knee – hip and SI

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7
Q

HIP AND THIGH
1. Piriformis- looking for?

  1. Motions?
A
  1. lateral hip discomfort

2. side lying, push upper knee against table

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8
Q

HIP AND THIGH
1. What does straight leg test for?

  1. Motion?
A
  1. Straight leg raising – hamstring flexibility and sciatic nerve tension
  2. Keep hand on pelvis
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9
Q 
KNEES AND LOWER LEG
Inspection
1. Anterior view? 2
2. Posterior view?
3. Squat? 2
A
    • atrophy,
    • varus/valgus of the knees
  2. atrophy thigh or calf
    • tests for knee flexion,
    • duck walk
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10
Q 
KNEES AND LOWER LEG
Palpation
1. Effusion? 2
2. Patella? 4
3. Tracking? 3
4. Joint line tenderness? 2
A
    • may need to milk suprapatellar pouch,
    • fluid wave
    • crepitation,
    • tendon rupture,
    • poles,
    • articular surface
    • start at 90,
    • fully extend,
    • Q angle
    • knee at 90,
    • MCL over mid medial joint
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11
Q

KNEES AND LOWER LEG

ROM? 2

A
  1. flexion and extension,

2. active and passive

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12
Q

KNEES AND LOWER LEG
Muscle testing
1. quadriceps? 2
2. hamstrings? 2

A
    • sitting,
    • extend bent knee
    • prone or sitting,
    • flex bent knee
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13
Q

KNEES AND LOWER LEG

Special Tests: 6

A
  1. Patellar apprehension
  2. Grind test
  3. McMurray test
  4. Valgus and Varus stress with knee bent
  5. Tests for ACL tear
  6. Test for PCL tear
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14
Q

KNEE AND LOWER LEG
Describe the following tests and who they are for:
1. Patellar apprehension?
2. Grind test
3. McMurray test
4. Valgus and Varus stress with knee bent

A
  1. Patellar apprehension – lateral subluxation with knee bent 30
    - In patients who had patellar subluxations/dislocations
  2. Grind test – for chondromalacia
    - knee extended, hand on patella, tighten quad against resistance
  3. McMurray test – for torn meniscus, straighten knee with foot
    - Externally rotated, medial – Internally rotated, lateral
  4. Valgus and varus stress with knee bent 30 degrees
    - Valgus give with MCL tear –
    - Varus give with LCL tear
    - Give in full extension – ACL also torn
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15
Q

KNEE AND LOWER LEG
1. What are the Tests for ACL tear? 3

  1. Test for PCL tear? 1
A
  1. Tests for ACL tear – feel for motion and end point
  • Lachman test: anterior give at 30*, knee under thigh, ?end point
  • Anterior drawer: knee bent at 90, sit on foot, less sensitive
  • Pivot shift: extend ext’ly rotated bent knee, press fibular head
  1. Test for PCL tear – posterior drawer
    - Knee bent at 90, posterior sag, no end point
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16
Q 
FOOT AND ANKLE
What are we looking for on inspection with the following:
1. Anterior? 1
2. Medial? 1
3. Lateral view? 2
4. Posterior? 3
5. Gait? 5
6. Toes? 3
7. Plantar surface? 3
A
  1. alignment of foot and toes,
  2. assess the arch and midfoot
    • swelling,
    • calcaneal prominence
    • heel alignment,
    • too-many toes,
    • stand on toes (heel varus)
    • heel strike,
    • mid-stance,
    • toe-off,
    • swing phase
    • amount of external rotation of feet (0 – 20 degrees normal
    • bunions,
    • hammer and claw toes,
    • spread toes
    • warts,
    • callus,
    • ulcerations
17
Q

FOOT AND ANKLE

What are we palpating?

A
  1. Medial malleolus
  2. Posterior heel
  3. Lateral malleolus
  4. Anterior ankle
  5. Plantar fascia
18
Q 
FOOT AND ANKLE
What are we palpating on the following:
1. Medial malleolus? 2
2. Posterior heel? 3
3. Lateral malleolus? 1
4. Anterior ankle? 2
5. Plantar fascia? 2
A
  1. Medial malleolus:
    - tinel’s,
    - post tib
  2. Posterior heel:
    - Achilles,
    - pump bump,
    - Hagland’s
  3. Lateral malleolus:
    - peroneal tendons
  4. Anterior ankle:
    - joint line,
    - anterior talofibular ligament
  5. Plantar fascia:
    - calcaneal insertion,
    - windlass effect
19
Q

FOOT AND ANKLE

  1. Range of motion: foot at ___?
  2. Dorsiflexion: what angle?
  3. Plantar flexion
  4. Inversion and eversion (subtalar): Tell the pt to do what?
  5. Supination and pronation: Do what?
A
  1. 90
  2. (10 – 20)
  3. (35 – 50)
  4. foot at 90, cup and move heel
  5. (rotation of foot along long axis)
20
Q

FOOT AND ANKLE
Muscle testing for which?
5

A
  1. Posterior tib
  2. Peroneals
  3. Anterior tib
  4. Gastroc-soleus
  5. EHL, FHL
21
Q 
FOOT AND ANKLE
How would we test the following muscles:
1. Posterior tib
2. Peroneals
3. Anterior tib 
4. Gastroc-soleus 
5. EHL, FHL
A
  1. Posterior tib – invert plantar flexed foot against resistance
  2. Peroneals – evert dorsiflexed foot against resistance
  3. Anterior tib – dorsiflex against resistance
  4. Gastroc-soleus – stand on tip toes
  5. EHL, FHL – against resistance, start with toe at 90
22
Q

FOOT AND ANKLE
Special tests?
4

A
  1. Anterior drawer
  2. Varus stress
  3. Interdigital neuroma
  4. Thompson test
23
Q

How would you do the following tests:

  1. Anterior drawer? How would this be positive?
  2. Varus stress? How would this be positive?
  3. Interdigital neuroma? How would this be positive?
  4. Thompson test?
A
  1. Anterior drawer: ankle slightly down, push heel forward v tibia
    - Excessive give and no solid end point with ant talo-fib laxity
  2. Varus stress: invert foot while holding ankle at 90
    - Excessive give with calcaneo-fibular laxity
  3. Interdigital neuroma: pain between MT heads with vertical pressure
    - Pain with horizontal compression of forefoot
  4. Thompson test: squeeze calf, plantar flexion of foot if Achilles intact

Orthopedics (27 decks)

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