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
PSIS
Position: standing
Examiner: Find PSIS by finding dimples, dropping down 2-3 inches pushing in and then up to hook under them. Move thumbs laterally until they are 8-10 inches apart. Ask patient to flex.
Normal response: No movement initially, the both PSIS elevate at the same time
Positive response: If one elevates immediately or one doesn’t elevate as much as the other after the initial lag
Indicates: hypomobility of the innominate bone on that side
Sacral sulcus
Position: standing
Examiner: Find iliac crests and most posteriorly until thumbs are 6 inches apart. Ask patient to extend then flex
Normal response: On extension both thumbs deepen equally. On flexion both thumbs move posteriorly equally
Positive response: The side that does not deepen or move posteriorly as much is the affected side
Indicates: hypomobility of the sacrum on that side
Gillet’s
Patient: standing
Examiner: Palpate S2 and PSIS, ask patient to bring hip on test side to 90*
Normal response: PSIS drops in relation to S2
Positive response: PSIS goes up in relation to S2
Indicates: hypomobility of the innominate bone on that side
Gapping
Patient: supine
Examiner: Applies outward pressure to ASIS with crossed arms
PR: Reproduces unilateral gluteal or posterior leg pain
Indicates: Sprain of anterior sacroiliac ligament
Squish
Patient: supine
Examiner: Place both hands on patient’s ASIS and iliac crests, then push down and in at 45 degree angle
PR: reproduces pain (often lateral, posteriorlateral or posteriormedial thigh pain)
Indicates: Sprain of posterior sacroiliac ligament
Varus for the knee
-Sitting with knee slightly flexed/almost straight
-Examiner stabilizes medial femur and applies varus stress to lateral tibia (pushes medially)
-Pain and/or laxity
-Indicates lateral collateral ligament sprain/tear
Valgus stress for the knee
-Sitting with knee slightly flexed/almost straight
-Examiner stabilizes lateral femur and applies valgus stress to medial tibia (push lateral)
-Pain and/or laxity
-Indicates medial collateral ligament sprain/tear
Anterior drawer sign for the knee
-Supine with hips at 45 degrees, knees flexed to 90 degrees and feet on table
-Examiner medially rotates tibia slightly and sits on patient’s foot to stabilize. Examiner draws tibia forward.
-Pain and/or laxity
-Indicates anterior cruciate ligament sprain or tear
Posterior drawer sign for the knee
-Supine with hips at 45 degrees, knees flexed to 90 degrees and feet on table
-Examiner medially rotates tibia slightly and sits on patient’s foot to stabilize. Examiner pushes tibia backwards.
-Pain and/or laxity
-Indicates posterior cruciate ligament sprain or tear
Apley’s compression
-Prone with knee flexed to 90 degrees
-Examiner presses down through tibia/fibula and then medially and laterally rotates tibia while maintaining compression
-PR: pain in medial, lateral, or centre of knee with compression and rotation
-Indicates meniscus injury
Apley’s distraction
-Prone with knee flexed to 90 degrees
-Examiner anchors patient’s thigh to table (using examiner’s knee). Examiner lifts tibia/fibula and them medially and lateral rotates maintaining distraction
-PR: pain on medial or lateral side of knee with distraction and rotation
-Indicates: ligament sprain
McMurray
-Supine with knee completely flexed (heel to buttock)
-Examiner medially rotates tibia then extends knee (keeping medial rotation throughout)
-Examiner laterally rotates tibia then extends knee (keeping lateral rotation throughout)
-Pain and/or snaps or clicks
-Medial rotation and extension indicates torn lateral meniscus
-Lateral rotation and extension indicates torn medial meniscus
Clarke’s
-Supine with knee extended, 30 degrees, 60 degrees then 90 degrees of flexion to test all facets
-Examiner holds top of patella with web of hand. Asks patient to extend their knee in each position
-Pain and/or inability to hold contraction
-Indicates patellofemoral dysfunction
Q angle
-Supine with knee straight
-Examiner places dots in the center of the patella and center of the tibial tuberosity. Examiner uses the ASIS and center of the patella as reference points for one line of the angle, drawing line from center of patella downwards. Examiner draws line from dot on center of patella to dot on center of tibial tuberosity for the other line of the angle. Measure angle. Normal is 13-18 degrees
-PR: less than 13 degrees or greater than 18 degrees
-If less than 13 indicates a greater risk of patellofemoral dysfunction
-If greater than 18 degrees indicates risk of lateral dislocation of patella
Anterior drawer of the ankle
Position: supine with heels of table
Action: Stabilize tib/fib and place ankle in 20 degrees of plantar flexion. Pinch talus if not tender and pull it forward. If too tender, grasp it posteriorly and push it forward.
PR both sides injured: excessive forward motion and/or pain on both sides.
Both sides injured indicates: Medial (deltoid) and lateral collateral ligament sprains or tears
PR if medial side injured: Pain on medial side and/or twist laterally.
Medial side injured indicates: deltoid ligament sprain or tear
PR if lateral side injured: pain on lateral side and/or twists medially
Lateral side injured indicates: anterior talofibular ligament and anterolateral capsule sprain or tear
Talar tilt
Position: Side lying with hip and knee flexed (relaxed)
Action: Examiner places ankle in 90 degree position. Place both thumbs on lateral calcaneus and index finger of both hands under medial malleolus and tilts talus laterally and medially.
Repeat with ankle in full plantar flexion but both thumbs on lateral talus and index fingers under medial malleolus.
PR: pain and/or laxity on medial side with lateral tilt at 90 degrees
Indicates: deltoid ligament sprain or tear
PR: pain and/or laxity on lateral side with medial tilt at 90 degrees
Indicates: calcaneofibular ligament sprain or tear
PR: Pain and/or laxity on lateral side with medial tilt and full plantarflexion
Indicates: anterior talofibular ligament sprain
Homan’s sign
Position: supine
Action: Passively dorsiflexes ankle with knee extended
PR: Severe pain in the calf
Indicates: DVT
Morton’s squish
Position: supine
Action: Grasps foot around metatarsal heads and squeezes
PR: Pain in foot
Indicates: stress fracture or neuroma
Tinel’s sign at anterior ankle
Position: supine with ankle supported in slight plantarflexion
Action: Taps top of foot just lateral to first cuneiform/first metatarsal joint (deep peroneal nerve) and behind medial malleolus (all branches of tibial nerve, but especially medial plantar
PR: tingling or paraesthesia distally
Indicates: nerve entrapment
Tinel’s sign behind malleolus
Figure 8 ankle measurement for swelling
Position: supine
Action: Take measuring tape and start on anterior ankle midway between tib ant and lateral malleolus, go medially just distal to navicular tuberosity, across arch of foot proximal to base of 5th MT. Continues across anterior ankle and goes just below and distal to medial malleolus and then posteriorly then below lateral malleolus and back to start. TAKE AVERAGE OF 3 MEASUREMENTS
PR: larger measurement on affected side in comparison to unaffected side
Indicates: swelling
L2 myotome
Hip flexion
L3 myotome
Knee extension
L4 myotome
Ankle dorsiflexion
L5 myotome
Big toe extension
S1 myotome
Ankle eversion
S1-S2 myotome
Knee flexion
