Spine And Lower Extremity Flashcards
Where do you test for edema?
Dorsum of foot
Behind medial malleolus
Shins
What is stasis dermatitis?
A result of chronic venous insufficiency with incompetent valves and high pressure in capillaries.
Tissue damage and brawny edema
What is a positive bulge sign and what does it suggest?
If you stroke the medial side of the knee upwards, and then stroke the lateral side downwards, and you see a Bulge of fluid on the medial side.
Suggests Minor*** effusion
What direction of hip ROM does the Patrick’s Test/FABER test evaluate?
Hip abduction
What is the Adams Forward bending test?
Patient bends forward and you inspect for limb length discrepancy as well as scoliosis
What is a positive posterior drawer sign
Excessive laxity suggests a PCL tear
What are the ankle and foot motions that you must test ROM for in the practical? Which ones are required to do strength testing?
Dorsiflexion* and plantar flexion*
Inversion* and eversion*
Toe flexion and extension
(* denotes ones you must strength test)
What nerve root:
Weakness of plantar flexion of foot and big toe
S1
When palpating the lower leg, what does a palpable “cord” suggest
Thrombosed vein
Are bakers cysts painful
If they leak fluid or rupture
What vertebral level is the straight leg raising test most sensitive for?
L5-S1
How do you test the lateral meniscus with McMurrays test
Internally rotate at the heel
Flex and extend the knee while providing varus stress
What nerve root:
Trouble with “squat and rise” test
L4
How often are popliteal arteries bilateral
50% of the time
What is the most common aneurysm of the peripheral vascular system?
Popliteal artery aneurysm
What is a positive seated SLR test/“flip sign”
When you passively extend their knee, they will “flip back” due to pain
What is kyphosis?
Thoracic convexity is too extreme
“Hunchback”
What is pes planus
Flat foot
What are the landmarks of the ankle and foot that you must palpate for the practical
Achilles’ tendon
Medial malleolus
Lateral malleolus
Calcaneus
Tarsals
Metatarsals
MTP joints
IP joints
What does the McMurray Test for
Meniscus **
What test is this:
Stabilize distal tibia
Grasp calcaneus and pull forward
Anterior drawer test of ankle
What is the best position for the patient to be in in order to test hip extension?
While standing (Do not have to do for practical)
How do you document edema?
Grade and how far up the leg it goes
“3+ pitting edema to mid-calf”
What is varus?
“Bow legs”
RUM makes your knees spread apart
What nerve root:
Pt can not walk on toes
S1
What is this test:
Patient in supine position, knee flexed 20-30 degrees
Stabilize distal femur in one hand, while attempting to displace tibia anteriorly with the other
Lachman
What is the galeazzi test?
Patient lies supine with knees flexed 90 and feet together and flat on table
Check to see if the patellae are the same height
What is a positive trendelenberg test?
If the patient stand on their right leg and their left hip drops.
Indicates weak hip on the RIGHT side.
(Or vice versa)
What nerve root:
Ankle jerk reflex diminished
S1
Who is most likely to get a popliteal artery aneurysm
Males
Over 65
What ROM tests must be done in the hip?
Which ones require strength testing for the practical?
Abduction* and adduction*
Flexion* and extension
Internal and external rotation
(* denotes the ones you must also strength test)
How do you palpate a bakers cyst?>
Extend the knee
What two pulses do you need to check on the feet?
Dorsalis pedis
Posterior tibialis
What is a positive McMurrays test
Clicking and popping with flexion and extension
Where should your hands be when you do the FABER test?
One on patients knee and the other on their other hip**
*MUST stabilize their pelvis
What position is the patient in when you test hip flexion?
Supine
What is lordosis
Extreme lumbar concavity
What does a positive seated SLR/“flip sign” indicate?
Spinal nerve compression/irritation
What is this:
Dilated, tortuous, superficial veins that result from defective structure and function of the valves
Venous insufficiency
What does it mean to inspect for patellar tracking during the inspection of the knee?
Making sure the patella goes straight up and down
Can you do hip and knee ROM testing at the same time while the patient is supine, as long as you verbalize it?
Yes
How do you test the medial meniscus with mcmurray test
Externally rotate at heel
Flex and extend the knee while providing valgus stress to knee
What are the 3 names for the FABER test?
FABER
Patrick Test
Figure of Four
What are you looking for when the patient bends forward and touches their toes?
Scoliosis
Where is the dorsalis pedis pulse?
Dorsum of foot
Over 1st-2nd metatarsals
What nerve root:
Numbness on bottom of foot and on back of calf?
S1
What exam do we use to assess for hypertrophy or atrophy of leg muscles
Circumference measuring exam
What is scoliosis?
Spine is curved laterally
How do you do the valgus stress test?
Stabilize lateral joint line**
Place other hand on distal tibia
ABduct the tibia in relation to the femur
DO IT TWICE 0 and 30 degrees of flexion
Evalaute the medial joint space
What does “pitting” edema mean
The indentation stays there
What is a positive anterior drawer sign of the knee
Anterior translation of the tibia without a firm endpoint
What does a positive posterior sag sign suggest?
PCL tear
How do you do the straight leg raising test/ Lasegues test
Pt supine and you lift their straightened leg straight up
Looking for radiating** pain in the affected limb
dorsiflexing ankle may increase pain response
How do you do the varus stress test?
Stabilize the medial** joint line
Put other hand on distal tibia
ADduct the tibia in relation to the femur
DO IT TWICE at 0 and 30 degrees of knee flexion
Evaluate lateral joint space
What grade would you give a bounding pulse
4+
When do you start the inspection of the hip and thigh?
Right after the abdomen/inguinal exam becasue the patient is already supine
What is the most useful test for diagnosing an ACL tear?
Lachman
Do you test hip adduction/abduction actively or passively
Passively.
You move the patients leg
When testing hip flexion, can you do them both at the same time
No
What motions do you have to test ROM and strength testing for in the knee?
Flexion and extension
If you find pulsatile swelling behind the knee, what do you think it is
Popliteal artery aneurysm
What parts of the spine do you need to palpate
Spinous processes
Paravertebral muscles
What knee landmarks do you need to palpate for the practical
Quadriceps tendon
Patella
Patellar tendon
Medial and lateral joint lines
Tibial tiberosity
How do you test for ballottement of the patella?
Compress the suprapatellar pouch and press down on the patella. Feel for fluid under the patella and look for fluid returning to the suprapatellar pouch
What does the Thompson test test for
Achilles’ tendon tear
What grade would a diminished, weak, but still palpable pulse get
1+
What does the pelvic compression test evaluate?
Pelvic stability
Little value
If a patient has a tender/painful area, should you palate it right away?
No, always palpate tender areas last
What is the clinical presentation of venous insufficiency?
Dull ache or pressure sensation after prolonged standing
Pain gets better with elevation
Ankle edema and ankle ulcers
Thrombosis
What is pes cavus
High arch of the foot
What is the range of grades for edema
0-4+
What disease is associated with pes cavus (high arch)
Charcot-Marie Tooth disease
What skin temperature and cap refill time would be expected with peripheral artery insufficiency?
Cool skin
Delayed cap refill (more than 2 seconds)
How do you perform the Thompson test?
Have patient kneel on stool or lie prone with foot hanging off table
Squeeze their calf
Observe for plantar flexion
What are the 2 tests to test for leg length discrepancy?
Galeazzi
Comparing measured distance from ASIS to medial malleolus
Do you need to actually examine the inguinal region for nodes, pulses, and hernias?
No just verbalize
If you see one arm or leg that is way more swollen than the other, what should you suspect?
Lymphedema
What nerve root:
Knee jerk reflex diminished
L4
What nerve root:
Weakness with extension of quadriceps
L4
What is a positive FABER/Patrick test?
SI joint pain
How do you palpate the popliteal pulse?
Knee should be flexed
Press DEEP
What is the other name for the Straight Leg Raising test?
Lasegue’s Test (Sign)**
What does the anterior drawer test of the knee test for?
ACL tear
What is a bakers cyst
A synovial fluid test in the popliteal space
How do you grade the amplitude of pulses?
0 absent unable to palpate
1+ diminished, weaker than expected
2+ brisk, normal
3+ increased
4+ bounding
What nerve root:
Pain down lateral side of leg
L5
What is a normal grade of pulse
2+
What does the Apley Compression test test for
Meniscus injury
What are you doing with your hands for the anterior drawer test of the knee
Pushing in with thumbs on the joint lines
Pulling with your fingers on the hamstring insertions
PUlling tibia forward and checking for excessive forward movement
What is valgus?
“Knock knees”
GUM makes your knees stick together
What are the two ways venous insufficiency can present
Varicose
Stasis dermatitis
How do you test for an MCL injury
Valgus stress test
How do you do the apley compression test
Patient supine
Flex knee to 90 degrees
Pres down on foot and grind it back and forth
Then do it again with a distraction
What is Brawny edema and what is it caused by?
Non pitting edema
Caused by stasis dermatitis/venous insufficiency
What are the two ways that ROM must be tested
Actively
Passively
Why do neuropathic ulcers get so bad
The diabetic patients cant feel them
What are the landmarks you must palpate in the hip and thigh?
Iliac crest*
Anterior superior iliac spine
Pubic symphysis*
Greater trochanter
Ischial tuberosity*
Quadriceps
Hamstrings
Femur
(* denotes ones you just verbalize for practical)
Where should you auscultation for bruits if you suspect peripheral artery disease
Abdominal aorta
Femoral artery
Popliteal artery
What does the FADIR test for?
Impingement
What does the posterior drawer sign test for
PCL tear
How do you test for an injury to the LCL
Varus Stress Test
What are these signs of if you see them in the feet/ankles:
Pallor
Dependent rubor
Distal hair loss
Atrophic skin, nail changes
Ulcers
Necrosis/gangrene
Peripheral artery insufficiency
What ROM directions do you need to test in the spine
Flexion
Extension
Rotation
Lateral bending
What nerve root:
Pain down front of leg
L4
What causes venous insufficnecy
Incompetent valves
What test do you use for minor knee effusions vs large effusions
Minor: bulge sign
Large: Ballottement
What is a positive Thompson test?
Foot does not plantar flex when you squeeze their calf
Where is the posterior tibial pulse?
Behind and slightly below the MEDIAL malleolus
Do you need to do ROM and strength testing on both sides?
Yes, always compare bilaterally
What does the straight leg raising test test for?
Lumbosacral radiculopathy
And/or
Sciatic neuropathy
What is the most SENSITIVE test for diagnosing an ACL tear
Pivot test (Must be done under sedation)
What pulses do you need to check for if you suspect peripheral artery insufficiency??
Femoral
Popliteal
Dorsalis pedis
Tibial
What never root:
Weakneess with dorsiflexion of foot and big toe
L5
What are the subdivisions of the lower extremity?
Hip
Thigh
Leg
Ankle
Foot
- hindfoot
- mid Foot
- forefoot
What nerve root:
Pain down back of leg
S1
What nerve root:
Difficulty walking on heels
L5
