Practical Flashcards
SLR
Position: supine
Action: medially rotates and adducts the hip, then passively flexes the hip, keeping the hip medially rotated and adducted and the knee straight until the patient complains of pain or tightness. Slowly lets the hip extend passively until there is no pain or tightness. Then passively dorsiflexes the ankle then has the client flex their neck to see if pain returns
PR: pain radiates down leg on that side L4-S3 dermatome
Indicates: Nerve root impingement L4-S3
PKB
Position: prone
Action: passively flexes knee as far as possible so that patient’s heel rests against buttock. Holds 45 sec
PR: Pain in lumbar area and/or radiation down buttock and into medial/posterior leg along L2 or L3 or L4 dermatomes or femoral nerve distribution
Indicates: L2 or L3 or L4 nerve root lesion OR femoral nerve irritation
Kemp’s
Position: standing
Action: Examiner stands behind patient and passively rotates, side flexes, and extends the patients spine with one hand, while stabilizing the opposite pelvis with the other hand. Apply downward pressure through shoulders using both hands
PR: local pain on the side that is rotated, side flexed and extended
Indicates: Facet joint sprain
Slump
Position: sitting with hands behind back and chin up
Action: Ask patient to slump while examiner holds chin and head erect. If no symptoms, apply overpressure through neck or thoracic spine. If no symptoms, extend one of the patient’s knees. If no symptoms, passively dorsiflex patient’s ankle. If symptoms are reproduced, add neck extension at to see if symptoms decrease. (this confirms positive response)
PR: Reproduction of patient’s symptoms along affected dermatome
Indicates: Dural or nerve root impingement
Weber-Barstow/Rocobado leg discrepancy test
Position: supine with knees bent and feet flat (heels lined up)
Examiner: Lift and plunk. Examiner stands at feet and looks at the height of the knees, then stands beside patient and looks to see if one knee is further forward than the other
PR: one knee further forward or one knee higher than the other
Indicates: Femur is longer or tibia is longer
Sign of the Buttock
Position: Supine
Action: examiner keeps patient’s knee straight and passively flexes the patient’s hip. If pain occurs, flex knee without moving the hip
PR: pain in the buttock remains even when knee of flexed
Indicates: FISSON
Fractured sacrum
Ischial bursitis
Septic bursitis
Septic SI arthritis
Osteomyelitis of upper femur
Neoplasm of ilium or upper femur
Trendelenburg
Patient: standing
Examiner: asks patient to stand on one leg. Patient places hands on shoulders for balance
PR: pelvis on opposite side falls
Indicates: weakness of gluteus medius or unstable hip on affected side
Log roll
Patient: supine w/ both legs straight
Examiner: Passively rotates femur medially and laterally as far as possible and compares
PR: Restriction and/or pain in the hip (could have excessive mobility and/or pain)
Indicates: Hip joint pathology. If mobility is excessive on affected side - likely due to capsular instability
(if click occurs with this test, most often there is a labral tear but could be loose body or capsular instability)
Lateral snapping hip sign
Patient: supine
Examiner: Supports patient’s hip in abduction, flexion and lateral rotation. Patient actively extends hip into medial rotation (examiner supports legs weight)
PR: Snaps on the lateral side of the hip (must snap to be positive)
Indicates: tight IT band or glute max tendon
Internal snapping hip sign
Patient: supine
Examiner: Supports patient’s hip in abduction, flexion and lateral rotation. Patient actively extends hip (examiner supports legs weight)
PR: Snaps anteriorly/internally at the hip (must snap to be positive)
Indicates: Iliopsoas tendon snapping over femoral head or iliopectineal eminence (could be iliofermoral ligament over femoral head)
(if also sharp pain in groin and anterior thigh may indicate labral tear or loose body)
Thomas test
Patient: supine
Examiner: patient hugs non-test knee to chest. Examiner checks for excessive lumbar curve. Test leg should be relatively flat on table (there may be a small space)
PR: straight leg raises off table and/or excessive lumbar curve (if hip abducts on straight leg, due to tight TFL)
Indicate: Tight hip flexors/hip flexion contracture (iliopsoas)
Rectus femoris
Patient: starts in standing with one knee hugged to chest and buttock against table
Examiner: lowers patient to supine so that non-test leg is still hugged to chest and test leg is dangling. If knee is less than 90 degrees, examiner passively flexes knee and palpates to see if rec fem is tight
Modification: patient in supine, test knee bent and foot off side table) Must fully flex hip when lying on table.
PR: Knee is less than 90 dregrees of flexion and rec fem is tight on palpation
Indicates: Tightness of rec fem (if palpated), or tight joint capsule
TFL / J-sign
Patient: same as rec fem test
Examiner: lowers patient patient to supine so that non-test leg is still hugged to chest and test leg is dangling
PR: hip abducts
Indicates: tightness of TFL/IT band
Piriformis
Patient: side lying with test leg up
Examiner: patient’s bottom leg is slightly flexed at hip and knee for stability. Examiner flexes test hip to 60 degrees and applies downward pressure. Examiner stabilizes pelvis
PR: Pain in muscle if piriformis is tight/strained. Pain in buttock and or down post leg to back of knee if sciatic nerve is pinched
Indicates: piriformis strain, piriformis syndrome if pai down leg
Faber’s
Examiner: Place heel of test leg above knee of non-test leg, then slowly lower test leg in abduction. Stabilize opposite ASIS. Can gently push down on knee.
PR: Leg remains above non-test leg
Indicates: Hip joint pathology (lateral pain), iliopsoas spasm (groin pain) or sacroiliac joint pathology (posterior pain)
Ober’s
Patient: side lying with test leg striaght
Examiner: patient hugs bottom leg to chest for stability. Examiner passively abducts and extends test leg, stabilizing pelvis. Then slowly lowers the leg to table, preventing crest from dropping towards thigh
PR: top leg remains abducted and does not fall to table
Indicates: tightness of TFL/IT band
Gaenslen’s
Patient: side lying with lower leg to chest (holding posterior thigh)
Examiner: Stabilize the pelvis while extending the hip. Patient hugs bottom leg
PR: Pain in SI joint, hip joint or along the L4 nerve root distribustion (lateral thigh, anterior and posteriomedial lower shin, medial malleolus to anterior big toes)
Indicates: Ipsilateral sacroiliac joint lesion, hip pathology or L4 nerve root lesion
