CODO Final Flashcards
What are typical potential findings for inspection of an injured limb?
What is an additional inspection for the lower extremity?
Skin changes, bruising, swelling, redness, symmetry, atrophy, deformity, contour
additionally:
gait
Iliac crest heights
leg length
What are you checking for during palpation?
Feeling anatomical landmarks
tenderness, heat, swelling, masses, crepitus
Describe the standard for grading strength.
0-5 scale
0/5 - no muscle contraction detected
1/5 - muscle contract with no movement
2/5 - able to move, not against gravity
3/5 - against gravity
4/5 - against gravity AND resistance
5/5 - normal
Describe the standard for grading DTR’s.
4 point scale
0 No response
1+ Diminished
2+ Normal
3+ Brisker than normal
4+ Clonus
What are the DTRs for the lower extremity?
What root are you testing?
Patella - L4
Achilles - S1
fuck a L5
What are the major peripheral nerves for sensory testing of the lower extremity?
What nerves are you testing?
Sciatic: L4-S3
Peroneal nerve: L5-S2
Lateral femoral: cutaneous L2-L3
Describe the distribution of the peripheral peroneal nerve.
Describe the distribution of the lateral femoral cutaneous nerve.
What commonly causes numbness in this area?
Obesity, tight clothes, and pregnancy commonly compresses this nerve
How would you test L4 root and/or L3-L4 disk?
Reflex?
Strength? Muscle(s)?
Sensation?
Patella reflex
Inversion of the foot, checking anterior tibialis
Sensation of the medial leg and medial foot
How would you test L5 root and/or L4-L5 disc?
Reflex?
Strength testing? What muscle(s)?
Sensation?
No reflex
Strength of toe lift, extensor hallucis longus
Sensation of lateral leg and dorsum of the foot
How would you test S1 root and/or L5-S1 disc?
Reflex?
Strength? Muscle(s)?
Sensation?
Achilles reflex
Strength of eversion. Peroneus longus and brevis.
Sensation of lateral foot
What anatomic landmarks should be palpated when examining the hip?
Pelvic structures
ASIS, PSIS, iliac crest
sacroiliac joint
ischial tuberosities
Hip
greater trochanter
piriformis tenderpoint
iliotibial band
Other
sciatic nerve (1/2 between ischial tuberosity and greater trochanter)
What are the motions of the hip?
What are the normal ranges (in degrees)?
Flexion 120
Extension 30
Abduction 45-50
Adduction 20-30
Internal rotation 35
External rotation 45
When performing strength testing of the hip…
What motions?
What nerve roots are you testing?
What muscle(s)?
Flexion: L1, L2, L3
Primary - Iliopsoas (femoral nerve)
Secondary - Rectus femoris
Extension: S1
Primary - Gluteus maximus (inferior gluteal nerve)
Secondary - Hamstrings
Abduction: L5
Primary - Gluteus medius (superior gluteal nerve)
Secondary - Gluteus minimus
Adduction: L2, L3, L4
Primary - Adductor longus (obturator nerve)
Secondary - Adductor brevis, Adductor magnus, Pectineus, Gracilis
List the special tests for the hip.
What are they checking for?
- Straight leg raise: lumbar radiculopathy
- Piriformis test: piriformis syndrome
- Patrick’s/FABER: differentiate SI pain from hip joint
- Ober: IT band syndrome
- Trendelenburg: weak hip abductors
Describe how to perform a straight leg raise?
What is a positive test?
What is this checking for?
Patient’s knee is extended, lower extremity is passively raised/flexed at the hip
+ pain radiating in the sciatic distribution below the knee
Checking for lumbar radiculopathy (sciatica)
Describe how to perform a piriformis test.
What is a positive result?
What is this checking for?
Patient lies on unaffected side, pelvis stabilized with one hand.
Affected knee and hip flexed, knee if passivlely addicted across midline with other hand
+ pain in sciatic distribution
Tests for piriformis syndrome
Describe how to perform a Patrick’s/FABER test.
What is a positive test?
What is this checking for?
FABER: “flexed, abducted, externally rotated”
The affected limb is flexed at the knee and hip, with ankle resting on contralateral knee, forming a “4” shape. Pressure is placed on contralateral ASIS and ipsilateral knee, forcing external rotation.
+ is reproduction of pain
positive result is indicative of hip pathology, as this motion stresses femoral-acetabular joint
Describe how to perform Ober’s test.
What is a positive result?
What is this checking for?
Patient lies on unaffected side, with painful limb up. Knee is flexed and abducted. Leg is abruptly dropped.
+ patient doesn’t let thigh fall quickly
Checking for IT band