Special Tests for Lower Extremity Flashcards
Name the special test:
- Detects gluteus medius muscle weakness
- While observing the PSIS levels, have the patient stand on one leg
- The test is positive if the PSIS on the unsupported side descends.
Trendelenburg Test
Name the special test:
- Detects hip and sacroiliac pathology
- Patient is supine with affected hip in flexion, abduction and external rotation with foot on opposite knee
- Stabilize pelvis with hand on contralateral ASIS and press down on thigh of affected side
- A positive test results in pain to the hip or sacroiliac joint
Faber test
Name the special test:
- Performed to detect acetabular or femoral neck pathology such as osteoarthritis or osteonecrosis
- With patient supine, internally and externally rotate the relaxed lower extremity
- Pain in the hip or groin, particular with internal rotation is positive
Log roll test
Name the special test:
- Tests for a tight piriformis impinging the sciatic nerve
- With patient lying on the unaffected side and the knee and hip flexed to 90 degree, stabilize the pelvis with one hand and use the other hand to apply flexion, adduction and internal rotation pressure at the knee by pushing into the exam table
- If the test is positive then pain will be produced in the buttock and even down the leg
Piriformis Test
Name the special test:
- Test for labral pathology, loose body, or other internal derangement of the hip
- With patient supine and the hip flexed and adducted, use the patient’s knee and thigh to apply a posterolateral force through the hip as the femur is rotated in the acetabulum
- Passively flex, adduct and internally rotate the hip while longitudinally compressing to scour inner aspect of the joint
- abduct and externally rotate the hip while maintaining flexion with longitudinal compression
-Pain or grating sensation or sensation is positive
Scour test
Name the special test:
- With patient supine and contralateral hip and knee maintained in full extension, instruct patient to flex hip to 90 degree
-While maintaining this position, actively extend knee fully
- If patient is unable to obtain within 10 degree of full knee extension are considered to have hamstring tightness
Hamstring Flexibility
Name the special test:
- Detects flexion contractures or tightness of the hip
- With your hand under the small of the patients back, have him fully flex his hips (notice his lumbar curve should flatten into your hand). Instruct the patient to hold onto his knee as you passively extend the other leg
- The test is positive if the hip does not fully extend or lumbar curve arches (lordosis)
Thomas Test
Describe the following:
- Genu valgum
- Genu Varum
- Genu recurvatum
Name the special test:
-Tests for Patellar instability
-With patient supine and knee relaxed and slightly flexed, use thumbs to displace patella laterally.
- Positive would be absence of a firm end feel or patient apprehension
Patellar apprehension sign
Name the special test:
- Assesses for cartilage degeneration
- Patient is supine with knee extended.
- Place one hand superior to patella and push inferiorly
- Ask patient to tighten quadriceps
- Positive would be pain and/or grinding sound
Patellar Grind Test (Clarke)
Name the special test:
- Evaluates the health of the menisci
- With patient supine, flex knee to the maximally pain free position. Hold leg in that position while externally rotating the foot and then gradually extend the knee while maintaining the tibia in external rotation
- Stresses medial meniscus
- The same maneuver performed while rotating the foot internally will stress the lateral meniscus
- Joint line clicking and or pain is positive for possible meniscus tear
McMurray Test
Name the special test:
- evaluates the integrity of the lateral collateral ligament
- evaluates the integrity of the medial collateral ligament
- With the patients knee flexed 30 degrees or fully extended, apply varus or valgus stress on the knee.
- The test is positive if the patient complains of pain and/or there’s instability.
Varus and Valgus stress test
Name the special test:
- Detects instability of the anterior cruciate ligament.
With the patients knee flexed 30 degrees, grasp his proximal tibia with one hand and stabilize his distal femur with the other. Pull his lower leg sharply creating anterior translation of the tibia on the femur.
- Focus on the amount of bony translation of the tibia relative to the femur and the presence or absence of a firm end point upon reaching full anterior translation
- The absence of a firm end point is indicative of an anterior cruciate ligament tear
- Increased anterior translation indicated partial or complete tear
Lachman’s Test
Name the special test:
- Assess posterior cruciate ligament stability
With patient supine and foot supported on the table, flex the knee to 90 degrees.
- Grasp the proximal tibia with both hands and place your thumbs on top of the medial and lateral tibial plateaus
- Push the tibia posteriorly
- If the PCL is injured the proximal tibia falls back
Posterior Drawer
Name the special test:
- Tests for posterior cruciate ligament laxity
With patient supine, flex the hip and knee of the affected knee to 90 degrees
- With one hand support the knee with your thumb and index fingers placed in the medial and lateral joint line
- The other hand grasp the calcaneus firmly
- Have the patient attempt to actively extend the knee while you prevent knee joint movement
- If the PCL is lax then the tibia will sag down when the knee is at rest
Sag Test
Name the special test:
-Detects iliotibial band (ITB) contractures or tightness
Have the patient lie on his unaffected side. Flex the knee of the affected side to 90 degrees and passively abduct and hyperextend the hip while stabilizing the pelvis.
-The test is positive with patients inability to lower knee to table or they complain of pain at the ITB insertion site.
Ober test
Name the special test:
- Detects anterior instability of the ankle joint.
- Grasp the patient’s heel with one hand and stabilize his tibia anteriorly with the other, then pull the heel towards you.
- The test is positive if the talus slides anteriorly under the ankle mortise. You may also hear an audible “clunk
Anterior drawer test
Name the special test:
- Evaluates laxity of the calcanofibular ligament
- With patient seated and the knee flexed at 90 degrees use one hand to stabilize the medial aspect of the leg just above the medial malleolus
- Place the other hand on the inferolateral aspect of the calcaneus and invert the hindfoot
- If the patient does not have an end point then the test is positive for a CFL tear
Inversion (VARUS) Stress Test
Name the special test:
- Assesses the integrity of the achilles tendon.
- With the patient laying prone and foot off the table, squeeze his calf muscles.
- The test is positive if positive if the foot doesn’t move into plantar flexion.
Thompson Test
