Prac exam Flashcards
Hip instability orthopaedic tests
Dynamic stabilisers may be overcompensating so perform first:
- Thomas test
- Ober test
Other tests:
- A/P Apprehension
- Dial/log roll test
- FABER
- AB-HEER
- Anterior apprehension test (HEER)
- prone external rotation/instability
What functional assessment ALWAYS needs to be included in patient evaluation
- Squatting
- Going up and down stairs one and two at a time
- Crossing the legs
- Running straight ahead, deceleration, and twisting
- One-legged hop
- Jumping
Differential diagnosis for hip instability
- General ligament laxity
(use Beighton criteria)
Osteoarthritis OA Orthopaedic tests
- ROM
- Log roll
- Long axis distraction
- Scour test
How to differentiate between Hip OA and FAI with two tests?
FAI: Warwick agreement triad of symptoms. hip pain, clicking/catching/stiffness, giving away.
clinical features: restricted ROM and + impinge signs.
- FABER test may create pain for a hip or SIJ problem and adductors.
- Hip = +ve for instability, FAI, or Labral
- SIJ or medial thigh = adductors
- Scour (Quadrant) Test used for OA (leathery end-feel)
Femoro-acetabular impingement
(FAI) orthopaedic tests
- ROM
- FADDIR
- Log roll
- Functional tests (squatting, stairs climbing)
Differential diagnosis for FAI
Acute hip pain, red flags to rule out:
- tumour
- infection
- septic arthritis
- osteomyelitis
- fracture
- AVN
Chronic pain:
- Inguinal pathology
- Adductor pathology
- Pubalgia
Types of FAI
- Cam lesion (men+) Impingement originates from abnormal thickening of the femoral head-neck junction
-
Pincer lesion (women+)
The impingement originates from over-coverage of the acetabulum -
Mixed type
Cam more in younger
Pincer more in women as a result of acetabular labral tear
Acetabular
labral tears orthopaedic tests
- FABER test
- Scour test
- THIRD test
- Resisted SLR
- FADIR test
- Log roll test
- Fitzgerald test
- Long-axis distraction
- General ligament laxity
- Hip ROM
Best tests for intra-articular acetabular labral tears?
- FABER test
- Scour test
- THIRD test
- Resisted SLR
Best tests for extra-articular acetabular labral tears?
- FADIR test
- Fitzgerald test
Snapping hip syndrome orthopaedic tests
- 90-90 SLR
- Bent-knee stretch (proximal hamstrings)
- Thomas/Modified
- Fair Test (piriformis)
- Ober/Modified Ober
- Active Iliopsoas snapping
- Bicycle
- 30 sec single leg stance
External snapping hip examination findings
Positive Ober test,
Snap with Ober test,
Pain over greater trochanter
When the history, signs/symptoms are consistent with a labral tear pathology, potential impingement, capsular laxity, and articular cartilage degeneration should be considered, and the following tests should be performed:
- Hip ROM
- General ligament laxity (Beighton’s scale (joint laxity))
- Impingement test (FADDIR)
- Fitzgerald test
- Log roll test
- Long-axis femoral distraction
Greater Trochanteric Pain Syndrome (Gluteal Tendinopathy) orthopaedic tests
- FABER test
- 30s Single leg stance
- FADER-R
- hip lag sign
- Ober/Modified Ober
- Resisted external de-rotation test
- Resisted hip abduction
Greater Trochanteric Pain Syndrome (Gluteal Tendinopathy) Differential diagnosis
- Trochanteric bursitis
- L2/3 lumbar radiculopathy
- Lumbar facet syndrome
- Subcostal and iliohypogastric entrapment neuropathies
Collateral and ACL instability Ortho tests
- Painful joint line palpation
- Decreased ROM
- Varus/valgus stress test (0-30)
- +ve anterior drawer test
- +ve lever sign
- +ve pivot shift
- +ve Lachman test
- Stroke test for plural effusion
- apley’s distraction
PCL and posterolateral instability ortho tests
- Posterior drawer test
- Dial test (30 &90 deg)
positive at only 30 degrees is PLC Injury, but at both 30 and 90 indicates both a PLC and PCL injury - The quadriceps active test
- Posterior sag sign/instability
- Reverse pivot shift
Iliotibial band syndrome orthotests
- Noble test
- Modified Ober test
- Ober test
- Modified Thomas test
- One legged 30 Knee flexion stance
OSTEOCHONDRITIS DISSECANS
Wilsons test
PATELLAR DISORDERS
- Clark test
- Patellofemoral grind
- Patellar tilt
- Patellar apprehesion
- Retropatellar palpation
- Single leg squat test
MENISCAL INJURY
- Joint line palpation
- Valgus - varus stress test
- Apley’s compression
- Mcmurray’s
- Thessaly
- Ege’s
Ankle instability
- Anterior drawer
- Anterolateral drawer
- Talar tilt
- External (lateral) rotation stress
- Squeeze test
Ankle Impingment sign test
- Impingment
- anterior drawer
- Silfverkiold test
- Single leg squat
Nerve entrapement tests
- Tinel sign
- Compression eversion test
- Triple compression test
Fasciitis test
- Windlass test
Metatarsophalangeal neuroma
- Morton’s test
Gastrocnemius tightness test
- Thompson
- Silverskiold
The Cluster of Sutlive for Hip OA are
4 of 5 findings for the diagnosis of OA hip
1. Lateral pain with active hip flexion
2. Pain with active hip extension
3. Passive internal rotation ≤ 25°
4. (Self-reported or functional AROM*): squatting aggravates symptoms
5. Scour test with adduction causes lateral hip or groin pain
Hyperextension-external rotation apprehension (HEER) Ve+ result
+ve anterior hip pain, apprehension or reproduction of the patient’s symptoms. Indicative of anterior instability or anterior labral pathology
Posterior Apprehension Test - Ve+
+ve pain or apprehension
Indicative of posterior instability
Ve+ Dial/log roll Test
+ve the affected leg externally rotates > 450, or there is no mechanical endpoint. Indicate instability (mainly anterior).
(both legs must be compared)
