Physical Exam LE Flashcards
HIP AND THIGH Inspection 1. Anterior View? 2 2. Posterior View? 2 3. Gait? 2
- Anterior view:
- thigh atrophy,
- extremity alignment - Posterior view:
- atrophy,
- Trendelenberg test - Gait:
- antalgic gait,
- Trendelenberg (usually secondary)
HIP AND THIGH
Palpation
1. Supine? 3
2. Lateral? 2
- Supine:
- adenopathy,
- ASIS,
- pelvic obliquity - Lateral:
- greater trochanter,
- ischial tuberosity
HIP AND THIGH
Range of Motion – patient supine
Supine:
6
- 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
HIP AND THIGH Strength testing 1. Flexors? 2 2. Extensors? 3 3. Abductors? 1 4. Adductors? 3
- pt sitting,
- bring knee up against resistance
- pt prone,
- knee flexed,
- bring leg off of table
- side lying
- pt supine,
- legs spread,
- bring them together
HIP AND THIGH
Special Tests
1. Trendelenberg?
2. Stand on one leg?
- tests abductor strength
2. does pelvis stay level
HIP AND THIGH
What does the Faber/Patrick test analyze?
- tests for hip and SI joint pathology
figure 4, press down on knee – hip and SI
HIP AND THIGH
1. Piriformis- looking for?
- Motions?
- lateral hip discomfort
2. side lying, push upper knee against table
HIP AND THIGH
1. What does straight leg test for?
- Motion?
- Straight leg raising – hamstring flexibility and sciatic nerve tension
- Keep hand on pelvis
KNEES AND LOWER LEG Inspection 1. Anterior view? 2 2. Posterior view? 3. Squat? 2
- atrophy,
- varus/valgus of the knees
- atrophy thigh or calf
- tests for knee flexion,
- duck walk
KNEES AND LOWER LEG Palpation 1. Effusion? 2 2. Patella? 4 3. Tracking? 3 4. Joint line tenderness? 2
- 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
KNEES AND LOWER LEG
ROM? 2
- flexion and extension,
2. active and passive
KNEES AND LOWER LEG
Muscle testing
1. quadriceps? 2
2. hamstrings? 2
- sitting,
- extend bent knee
- prone or sitting,
- flex bent knee
KNEES AND LOWER LEG
Special Tests: 6
- Patellar apprehension
- Grind test
- McMurray test
- Valgus and Varus stress with knee bent
- Tests for ACL tear
- Test for PCL tear
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
- Patellar apprehension – lateral subluxation with knee bent 30
- In patients who had patellar subluxations/dislocations - Grind test – for chondromalacia
- knee extended, hand on patella, tighten quad against resistance - McMurray test – for torn meniscus, straighten knee with foot
- Externally rotated, medial – Internally rotated, lateral - 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
KNEE AND LOWER LEG
1. What are the Tests for ACL tear? 3
- Test for PCL tear? 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
- Test for PCL tear – posterior drawer
- Knee bent at 90, posterior sag, no end point
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
- alignment of foot and toes,
- 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
FOOT AND ANKLE
What are we palpating?
- Medial malleolus
- Posterior heel
- Lateral malleolus
- Anterior ankle
- Plantar fascia
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
- Medial malleolus:
- tinel’s,
- post tib - Posterior heel:
- Achilles,
- pump bump,
- Hagland’s - Lateral malleolus:
- peroneal tendons - Anterior ankle:
- joint line,
- anterior talofibular ligament - Plantar fascia:
- calcaneal insertion,
- windlass effect
FOOT AND ANKLE
- Range of motion: foot at ___?
- Dorsiflexion: what angle?
- Plantar flexion
- Inversion and eversion (subtalar): Tell the pt to do what?
- Supination and pronation: Do what?
- 90
- (10 – 20)
- (35 – 50)
- foot at 90, cup and move heel
- (rotation of foot along long axis)
FOOT AND ANKLE
Muscle testing for which?
5
- Posterior tib
- Peroneals
- Anterior tib
- Gastroc-soleus
- EHL, FHL
FOOT AND ANKLE How would we test the following muscles: 1. Posterior tib 2. Peroneals 3. Anterior tib 4. Gastroc-soleus 5. EHL, FHL
- Posterior tib – invert plantar flexed foot against resistance
- Peroneals – evert dorsiflexed foot against resistance
- Anterior tib – dorsiflex against resistance
- Gastroc-soleus – stand on tip toes
- EHL, FHL – against resistance, start with toe at 90
FOOT AND ANKLE
Special tests?
4
- Anterior drawer
- Varus stress
- Interdigital neuroma
- Thompson test
How would you do the following tests:
- Anterior drawer? How would this be positive?
- Varus stress? How would this be positive?
- Interdigital neuroma? How would this be positive?
- Thompson test?
- Anterior drawer: ankle slightly down, push heel forward v tibia
- Excessive give and no solid end point with ant talo-fib laxity - Varus stress: invert foot while holding ankle at 90
- Excessive give with calcaneo-fibular laxity - Interdigital neuroma: pain between MT heads with vertical pressure
- Pain with horizontal compression of forefoot - Thompson test: squeeze calf, plantar flexion of foot if Achilles intact