Week 5 - Lower Extremity Diagnostic Skills

Question 1

What is Lachman’s test and what does it check?

Answer 1

ACL injury - pull on the tibia and push on the femur - look at anterior displacement & increased displacement indicates an ACL injury

Question 2

What is a better way to do the Lachman’s test on larger patients (or for a smaller doctor)?

Answer 2

Put your knee under their knee and do Lachman’s test.

Question 3

Anterior Drawer Test

Answer 3

Foot is stabilized and bent. Then, the proximal tibia is pulled anteriorly - Use both thumbs

Question 4

Posterior Drawer Test

Answer 4

Foot is stabilized and bent. Posterior translation force is applied to the proximal tibia - Use both thumbs

Question 5

How to you test for medial and lateral meniscus swelling, inflammation, tears, etc.?

Answer 5

Palpate the knee joint line and watch for pain

Question 6

Valgus Stress Test

Answer 6

Tests the medial collateral ligament. Abduct the hip and flex the knee to 30 deg. Keep one hand cupped under knee, place one hand on anterior lower leg and pull outward while stabilizing at the knee. Knee will give if there is a problem with the medial ligament.

Question 7

Varus Stress Test

Answer 7

Tests the lateral collateral ligament. Abduct the hip and flex the knee to 30 deg. Keep one hand cupped under the knee medially and put other hand on lateral aspect of the ankle. Keep knee stable with one hand and push leg medially/inward using the hand at the ankle.

Question 8

McMurray’s Test

Answer 8

One hand on knee and one hand on heel. Lift the leg and bend the knee to 90 degrees. Fully flex knee, anteriorly rotate the tibia. Apply valgus force and extend knee to test medial meniscus. Also do the same for varus and lateral meniscus

Question 9

What is Thompson’s test?

Answer 9

It tests to make sure that the achillles tendon is intact. You squeeze the large portion of the gastrocnemius and watch the foot plantarflex.

Question 10

Faber test?

Answer 10

Tests hip joint abduction. Flexion, abduction and external rotation. Cross leg over knee and leg it sit. Then press down on the leg and hip joints.

Question 11

Fader test?

Answer 11

Test hip joint adduction. Flexion, adduction and internal rotate hip first. Push on knee. Test is positive if it creates anterior groin or anterior lateral hip pain.

Question 12

What are the Ottawa knee rules? When should you get an X-ray?

Answer 12

Need one of the three criteria in order to get an X-ray:

1. Isolated patellar tenderness or tenderness at head of fibula
2. Inability to bear weight (walk 2 steps) or flex knee to 90 degrees
3. > 55 years

Question 13

What are the Ottawa ankle rules? When should you get an X-ray?

Answer 13

Need two things:

1. Pain in the malleolar zone (bony prominance on each side)
2. And any of the following: Bone tenderness at posterior edge or tip of the lateral malleolus or the medial malleolus or the inability to bear weight (four steps)

Question 14

What are the Ottawa foot rules? When should you get an X-ray?

Answer 14

Need two things:

1. Patient has pain in the midfoot zone
2. And any of the following: Bone tenderness at base of fifth metacarpal or navicular bone or the inability to bear weight (four steps)