Regional Interdependence & Motor Control Ortho Tests

Question 1

Navicular Drop Test procedure:

Answer 1

• Position the patient in a fully weight bearing position through the lower extremity or choose to have them seated to off-load the foot.
• Position the foot/subtalar joint in a neutral position.
• Mark the location of the navicular tuberosity and measure its distance from the supporting surface (Floor).
• Ask patient to walk or relax then remeasure the same points.
• Compare bilaterally.

Question 2

Navicular Drop Test Interpretations:

Answer 2

Normal is 6-10mm
11-15mm excessive
>15 is abnormal

Question 3

Weight Bearing Wall Lunge Test procedure:

Answer 3

• Patient starts with toes 5 inches from the wall
• Patient then attempts to touch their knee to the wall while keeping their heel on the ground.
• The objective is to move the foot as far from the wall as possible while still being able to make contact with the wall with the heel down.

Question 4

Weight Bearing Wall Lunge Test interpretations:

Answer 4

Measurements
- Normal >10cm
- Restricted <10cm
Inclinometer
<40 degrees is considered restricted.
Any intervention to increase DF should create an improvement of >1.9cm

Question 5

Knee Extended Ankle Dorsiflexion Test procedure:

Answer 5

• Patient standing
• Patient attempts to step forward as far as possible with the non-testing foot while maintaining heel contact with the rear leg.
• Patient must keep the rear knee aligned in the sagittal plane.
• Angle is recorded by placing an inclinometer over the tibial. tuberosity.

Question 6

Knee Extended Ankle Dorsiflexion Test interpretations:

Answer 6

Normative data reveals 22.5 degrees with SD0.7

Question 7

Functional Heel Raise Test (Hubscher maneuver/ Jacks test) Procedure:

Answer 7

• Patient raises their heels to stand on their toes.

Question 8

Functional Heel Raise Test (Hubscher maneuver/ Jacks test) Interpretations:

Answer 8

• If the arch is present during the heel raise this is considered a “functional flat foot” – Able to supinate and stabilize the foot.
• If the arch does not appear during the heel raise the patient has a true flat foot or a collapsed arch. – Indicative of joint restriction, ruptured posterior tibialis, or structural difference.

Question 9

Non-weight-bearing toe extension test procedure:

Answer 9

• Place your thumb under the first metatarsal just proximal to the sesamoid bones. Press the first metatarsal up.
• Now press the phalanx of the first toe into extension and see at what angle this motion stops which is indicated by extension of the first metatarsal.

Question 10

Non-weight-bearing toe extension test interpretations:

Answer 10

Normal = 70-90 degrees
Hallux Rigidus = 40-60 degrees

Question 11

Tibial Torsion - Supin Assessment procedure:

Answer 11

• Knee is positioned so the posterior femoral condyles rest parallel to the table.
• One arm of the goniometer is aligned horizontally, parallel with the table.
• Other goniometer arm is positioned along the transmalleolar line.

Question 12

Tibial Torsion - Supine Assessment interpretations

Answer 12

Normal = 15-20 degrees of external torsion.
>20 degrees = external tibial torsion.
<15 degrees - internal tibial torsion.

Question 13

Prone Knee Flexion ROM procedure:

Answer 13

• Patient prone
• Inclinometer is positioned at the posterior aspect of the mid calf.
• Pelvis is stabilized
• Patients knee is passively flexed (heel to butt).
• Measure the angle at the point before lumbar spine begins to extend or the hip raises up.

Question 14

Prone Knee Flexion ROM interpretations:

Answer 14

Normal = 147.9 degrees SD of 1.6 degrees
Functional assessment: heel within one fist width of the butt.

Question 15

Trendelenburg test procedure:

Answer 15

• Patient standing
• Doctor tells patient to stand on one foot and typically raise the affected foot first.
• Doctor observes for unleveling of the pelvis (Specifically a drop on the lifted side).

Question 16

Trendelenburg test interpretations:

Answer 16

If the iliac rest drops on the raised side = weak hip abductors on the contralateral side
- Weak gluteus medius of stance leg.

Question 17

Prone Passive Hip Internal Rotation procedure:

Answer 17

• Patient prone with testing knee flexed
• Doctor stabilizes the pelvis and passively moves the patient’s foot laterally so the hip internally rotates.
• At the end range of motion measure the angle.
• Repeat on other side

Question 18

Prone Passive Hip Internal Rotation interpretations:

Answer 18

Minimum normal value = 30 degrees of internal rotation.

Question 19

Prone Passive Hip External Rotation procedure:

Answer 19

• Patient is prone w test side knee flexed.
• Stabilizing the pelvis, doctor passively moves the patients foot medially so the hip externally rotates.
• At the end range of motion measure the angle

Question 20

Prone Passive Hip External Rotation interpretations:

Answer 20

Minimum normal value = 40 degrees of external rotation

Question 21

Craig’s Test - Femoral Torsion procedure:

Answer 21

Normal position is to palpate the greater trochanter as being most lateral between 10-15 degrees of internal rotation.

Question 22

Craig’s Test - Femoral Torsion Interpretations:

Answer 22

Anteversion = >15 degrees internal rotation
Retroversion = <10 degrees of internal rotation

Question 23

Shoulder Flexion Test procedure:

Answer 23

Posterior View:
- Compare space between humerus and ears AND look for 60 degrees of scapular upward rotation.
Lateral View:
- Compare degrees of humerus flexion AND posterior scapular tilt along with interior angle at mid axillary line (Protraction)

Question 24

Shoulder Flexion Test Interpretations:

Answer 24

• If scapula passes the axillary hair test and posterior tilt test = Glenohumeral joint is the problem of the reduced ROM and should be evaluated further.
• If scapula fails Axillary hair test OR posterior tilt test = Scapulothoracic joint is partially responsible for the reduced ROM.

Question 25

Passive Lateral Rotation procedure:

Answer 25

• Patient supine on edge of table (testing side)
• Shoulder and elbow flexed at 90 degrees
• Passively move the patient into lateral rotation

Question 26

Passive Lateral Rotation limiting factors:

Answer 26

• Pec major and minor extensibility
• Latissimus dorsi extensibility
• Subscap extensibility
• Thoracic extension restriction
• Cervical extension restriction
• Stenoclavicular posterior rotation restriction OR subclavius extensibility problem.

Question 27

Passive Medial Rotation procedure:

Answer 27

• Patient lying supine on edge of table (on side of testing)
• Shoulder and elbow flexed at 90 degrees
• Passively move the patient into medial rotation

Question 28

Passive Medial Rotation limiting factors:

Answer 28

• Infraspinatus/teres minor extensibility problem
• Tight posterior capsule
• Sternoclavicular anterior rotation restriction

Question 29

Posterior Capsule Tightness procedure:

Answer 29

• Patient supine with arm in front of body. Arm and elbow flexed at 90 degrees.
• While palpating lateral edge of scapula, horizontally adducts the patients arm.
• As soon as scapula is felt moving, stop the adduction and take the measurement.

Question 30

Posterior Capsule Tightness interpretations:

Answer 30

• If the pathological side has less ROM and the end feel is capsular, capsular tightness is present.
• The capsular tightness should correlate well with decreased medial rotation provided the scapula is not allowed to move in compensation.