Apley’s compression & distraction test
- Patient is in the prone position with the knee flexed to 90 degrees.
- The patient’s thigh is then rooted to the examining table with the examiner’s knee. The examiner laterally and medially rotates the tibia, combined with distraction, while noting any excessive movement, restriction or discomfort.
- The process is then repeated using compression instead of distraction.
Ligamentous = If rotation plus distraction is more painful or shows increased rotation relative to the normal side.
Meniscus injury = If the rotation plus compression is more painful or shows decreased rotation relative to the normal side.
Torn meniscus
Meniscus = two C-shaped pieces of cartilage that act like a cushion between your shinbone (tibia) and thighbone (femur) (menisci).
Torn meniscus = one of the most common knee injuries. Any activity that causes you to forcefully twist or rotate your knee, especially when putting your full weight on it, can lead to a torn meniscus.
A torn meniscus causes pain, swelling and stiffness. The patient also might feel a block to knee motion and have trouble.
McMurray test
- With the patient supine the examiner holds the knee and palpates the joint line with one hand, thumb on one side and fingers on the other, whilst the other hand holds the sole of the foot and acts to support the limb and provide the required movement through range.
- From a position of maximal flexion, extend the knee with internal rotation (IR) of the tibia and a VARUS stress, then return to maximal flexion and extend the knee with external rotation (ER) of the tibia and a VALGUS.
Internal rotation (IR) + Varus stress
External rotation (ER) + Valgus stress
IR of the tibia + Varus stress = lateral meniscus
ER of the tibia + Valgus stress = medial meniscus
Positive (+): Pain or audible clicking can indicate a compromised meniscus.
ACL injury
ACL injury = a tear or sprain of the anterior cruciate ligament (ACL) — one of the major ligaments in knee.
ACL injuries most commonly occur during sports that involve sudden stops or changes in direction, jumping and landing — such as soccer, basketball, football and downhill skiing.
Symptoms: knee swelling, instability, and pain
Anterior Drawer Test
For: ACL (Pull!)
- The patient lies supine with their hips flexed to 45 degree, his/her knees flexed to 90 degrees. The examiner sits on the toes of the tested extremity to help stabilize it.
- The examiner grasps the proximal lower leg, just below the tibial plateau or tibiofemoral joint line, and attempts to translate the lower leg anteriorly.
Positive (+): if there is a lack of end feel or excessive anterior translation relative to the contralateral side.
A positive test indicates ACL (anterior cruciate ligament) injury.
PCL injury
Causes: the posterior cruciate ligament can tear if your shinbone is hit hard just below the knee or if you fall on a bent knee.
These injuries are most common during: Motor vehicle accidents (A “dashboard injury” occurs when the driver’s or passenger’s bent knee slams against the dashboard, pushing in the shinbone just below the knee and causing the PCL to tear).
Posterior Drawer test
- The patient is supine and the knee to be tested is flexed to approximately 90 degrees. The examiner then sits on the toes of the tested extremity to help stabilize.
- The examiner grasps the proximal lower leg, approximately at the tibial plateau or joint line, and attempts to translate the lower leg posteriorly.
Positive (+): The test is considered positive if there is a lack of end feel or excessive posterior translation.
Unhappy triad
- ACL
- Medial collateral ligament (MCL)
- (Medial) meniscus
Romberg’s test
- The patient is asked to stand with his two feet together. The arms are held next to the body.
- The clinician asks the patient to first stand quietly with eyes open, and subsequently with eyes closed. The patient tries to maintain his balance.
***For safety, it is essential that the observer stand close to the patient to prevent potential injury if the patient were to fall.
Positive(+): when the patient is unable to maintain balance with their eyes closed. Losing balance can be defined as increased body sway, placing one foot in the direction of the fall, or even falling.
Cervical spine compression
It is a medical maneuver used to assess nerve root pain.
- The examiner turns the patient’s head to the affected side while extending and applying downward pressure to the top of the patient’s head.
- If the nerve root is inflamed, it will be irritated and pain travels down the arm or shoulder.
Positive (+): when the pain arising in the neck radiates in the direction of the corresponding dermatome ipsilaterally.
Dermatome
The area of the skin of the human anatomy that is mainly supplied by branches of a single spinal sensory nerve root.
Cervical distraction
- Patient lies supine and the neck is comfortably positioned. Examiner grasps the patient’s head by placing each hand around the patient’s mastoid processes.
- Pull the head towards your torso, applying a distraction force.
Positive (+): A positive test is the reduction or elimination of symptoms with traction.
= this is for nerve root compression.
Cauda equina syndrome
Symptoms: Weakness/numbness of lower extremities, sharp stabbing pain in leg or lower back, urinary/bowel incontinence or dysfunction that causes retention of urine.
-> Cauda equina syndrome is due to narrowing of the spinal canal and compression of nerves in the lumbar spine.
***Life threatening and needs referral to emergency room.
DX: MRI, CT
Plantar fasciitis
One of the most common causes of heel pain. It involves inflammation of a thick tissue on the bottom of foot that connects heel bone to toes (plantar fascia).
- > > Plantar fasciitis commonly causes stabbing pain that usually occurs with first steps in the morning. As the patient get up and move, the pain normally decreases, but it might return after long periods of standing or when the patient stand up after sitting.
- > > Plantar fasciitis is more common in runners. People who are overweight and those who wear shoes with inadequate support also have an increased risk of plantar fasciitis.
Sensory innervation
Ulnar nerve: fifth and medial half of fourth finger.
Median nerve: the thumb, index, middle and half of ring finger.
Gait analysis
- Stance: heel strike, placing the foot flat, shifting the weight and push off (= swing back)
- Swing: when the foot moves forward and has no weight (= swing forward)
- Stand phase is weight bearing phase and most problems occur during this phase.
Trendelenburg gait
- In Trendelenburg gait, abductor function is poor when weight-bearing on the affected side, so the contralateral hemipelvis falls.
- This effect may be reduced by a truncal lurch over the affected hip.
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Class 1 (1/7/21)26
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Class 2 (1/14/21)14
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Class 3 (1/21/21)17
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Class 4 (1/28/21)25
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midterm review (formula 2)62
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Class 5 (2/4/21)48
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Class 7 (2/18/21) Part 114
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Class 7 (2/18/21) Part 221
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Class 7 (2/18/21) Part 373
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Class 8 (2/25/21) - Pediatrics77
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Class 8 (2/25/21) - Geriatrics36
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Class 8 (2/25/21) - Ocular disorders46
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Class 9 (3/4/21) - eating disorder16
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Class 9 (3/4/21) - PTSD and thermias25
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Class 9 (3/4/21) - Chronic fatigue syndrome6
