Comp Eval: Hip/Foot Flashcards by Carson Church

6-221 Bimanual reinforced interphalangeal grasp/anterior talus pull; long axis distraction

-PP: Supine with pelvic piece raised or pt holding table
-DP: Face cephalad at foot of table
-CH: Use either hand interphalangeal contact with middle finger on dome of talus
-IH: Reinforce middle finger contact, thumbs of both hands on plantar surface of foot
-VEC: LAD

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6-222 Reinforced web/anterior talus push anterior to posterior glide

-PP: Supine with heel off end of table
-DP: Face cephalad at end of table
-CH: Outside hand establishes web contact on talar dome, grasp foot with thumb and fingers
-IH: reinforce CH or grasp distal tibia for stabilization
-VEC: A to P

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6-223 Reinforced middle interphalangeal/talus pull; lateral to medial glide (eversion) or medial to lateral glide (inversion) with long axis distraction

-PP: Supine with foot off end of table
-DP: Face cephalad at end of table
-CH: Middle finger contact to talar dome, establish inversion/ eversion
-IH: grasp posterior aspect of calcaneus (note the picture does not show this)
-VEC: L to M or M to L with LAD

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6-224 Web/talus, mid-hypothenar (knife- edge)/calcaneus; long axis distraction with either inversion or eversion

-PP: Supine, pelvic piece raised or pt holding table
-DP: At foot of table facing affected ankle
-CH: Cephalad hand web contact on talar dome, forearm along the line of tibia
-IH: grasp distal tibia and knife edge to superior aspect of calcaneus
-VEC: LAD

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6-225 Reinforced web/talus push; posterior to anterior glide

-PP: Prone with foot off table
-DP: Foot of table facing cephalad
-CH: Caudal hand web contact on posterior talus
-IH: Cephalad hand stabilizing distal tibia
-VEC: P to A

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6-227 Interlaced bimanual grasp/calcaneus; lateral to medial glide; medial to lateral glide; anterior to posterior glide; posterior to anterior glide

-PP: Prone with knee flexed to ~45o
-DP: Face cephalad at foot of table with pt foot resting on chest/abdomen
-CH: Praying hands position, interlaced fingers
-VEC: A-P, P-A, L-M, or M-L

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6-228 Hypothenar/cuboid with forefoot distraction; plantar to dorsal glide

-PP: Prone, knee bent to 90o
-DP: Stand between pt legs facing affected side at its medial aspect
-CH: Cephalad hand pisiform/hypothenar on plantar aspect of cuboid, wrap fingers around foot
-IH: caudal hand cradles dorsum of foot with interlaced fingers
-VEC: Plantar to Dorsal

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6-229 Hypothenar/navicular (cuneiforms) with forefoot distraction; plantar to dorsal glide

-PP: Prone, knee bent to 90o
-DP: Stand at affected side facing lateral aspect of foot
-CH: Cephalad hand pisiform/hypothenar on plantar aspect of navicular, wrap fingers around foot
-IH: caudal hand cradles dorsum of foot with interlaced fingers
-VEC: Plantar to Dorsal

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6-230 Reinforced thumbs/cuneiform (cuboid, navicular with forefoot distraction; plantar to dorsal glide

-PP: Prone, knee flexed ~45o
-DP: At foot of table facing cephalad
-CH: Inside hand thumb contact on cuneiform, wrap fingers around foot
-IH: Thumb reinforces
-VEC: Plantar to dorsal (snapping type thrust)
*Don’t take to full plantar flexion

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6-231 Reinforced hypothenar/navicular (cuboid, cuneiforms); anterior to posterior glide

-PP: Supine with knee and hip flexed to rest foot on table -DP: Face cephalad at foot of table
-CH: pisiform contact of either hand on tarsal
-IH: Reinforced pisiform
-VEC: Dorsal to Plantar
*A drop section could also be used

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Reinforced middle interphalangeal/ cuneiform (cuboid, navicular) pull; anterior to posterior

-PP: Supine with leg straight
-DP: Face cephalad at foot of table
-CH: use either hand middle finger
-IH: reinforce contact and wrap hands to plantar surface of foot
-VEC: Plantar to Dorsal

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6- 237 Web metatarsal/finger grasp phalanx; medial to lateral glide with pendular distraction

-PP: Supine
-DP: Face cephalad at foot of table
-CH: Outside hand grasp proximal phalanx between you index and middle finger
-IH: Inside hand web contact over medial aspect of metatarsophalangeal joint
-VEC: M to L; use gravity to create LAD and use pendular motion to mobilize joint initially and shallow thrust M to L with IH

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6-233 Bimanual web/ tarsals; long axis distraction

PP: Supine, leg externally rotated and abducted off table DP: On affected side face caudal with patient lateral foot resting on doctor’s thigh CH: web contact over navicular IH: web contact over proximal metatarsal VEC: Distraction using thigh as fulcrum

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6-234 Bilateral thenar/metatarsals grasp shear; anterior to posterior, posterior to anterior

PP: supine DP: Face cephalad at foot of table CH: thumb-thenar contact on metatarsal IH: thumb-thenar contact on adjacent metatarsal VEC: Shear A to P or P to A

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6-235 Thumb/metatarsal/thumb phalanx shear; plantar to dorsal glide

PP: Supine, unaffected leg on table DP: Face cephalad at end of table CH: Outside hand applies thumb contact to plantar aspect of metatarsal IH: Inside hand thumb contact on dorsal aspect of phalanx just distal to metatarsal contact VEC: Plantar to Dorsal using thumbs to shear

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6-236 Thumb index grasp/phalanx; long axis distraction

PP: Supine, affected foot off end of table DP: Face cephalad, at foot of table CH: Use either hand thumb grasps phalange, index finger curled underneath IH: grasps foot to stabilize VEC: LAD over the index contact and dorsal to plantar distractive thrust

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6-238 Thumb index grasp/phalanx; long axis distraction, internal and external rotation, anterior to posterior or posterior to anterior glide, lateral to medial or medial to lateral glide

PP: Supine DP: Face Cephalad at foot of table CH: grasp distal member of the phalange IH: grasp proximal member of joint to be adjusted VEC: A to P; P to A; internal or external rotatio

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Squeeze Test

Deep pain indicates injury to syndesmosis (post ankle sprain)

Anterior Drawer of ankle

Anterior movement of the calcaneus compared with other side indicates anterior talofibular ligament laxity

Morton’s Test

Sharp pain in the forefoot indicating metatarsalgia or neuroma

Strunsky’s Sign

Pain in the transverse arch of the foot indicates metatarsalgia

Homan’s Sign

Deep pain in the posterior leg or calf indicates thrombophlebiti s

Metatarsal Tap

Pain indicates metatarsalgia

Tinel’s Foot Sign

Paresthesia radiating to the foot or tingling indicates irritation to the posterior tibial nerve possibly in the tarsal tunnel or Ta r s a l tunnel syndrome

Inversion Stress Ankle (Lateral Stability Test) Increased inversion compared with other side indicates anterior talofibular and /or calcaneofibular ligament tear

Increased inversion compared with other side indicates anterior talofibular and /or calcaneofibular ligament tear

Eversion Stress Ankle (Medial Stability Test)

Increased eversion compared with other side indicates a tear of the deltoid ligament

Thompson’s Test

Foot does not plantar flex indicating an Achilles tendon rupture

Achilles Tap Test

Pain and a loss of plantarflexion indicates a rupture of the Achilles tendon

Hoffa Test (Hoffa Sign)

Achilles tendon is less taught, palpates loose fragments, and the foot is in a dorsiflexed position on the affected side is a significant indication for a fractured calcaneus

Bimanual Grasp/Distal Tibia Pull; Long axis distraction (Fig. 6-153)

PP: Supine DP: At foot of table CH: Both hands grasp distal tibia above ankle Procedure: Have patient hold table or raise pelvic piece. This can also be performed with a towel wrapped around the patient’s ankle VEC: Long axis Distraction (test + impulse)

Bimanual Grasp/Proximal Femur; Internal or External Rotation (Fig. 6-155 and 6-156)

PP: supine with hip and knee flexed to 90o DP: Stand on side of involvement, facing cephalad, patient’s leg on inside shoulder CH: Cephalad hand and caudal hand to proximal aspect of femur Procedure: Patient’s leg/knee on inside shoulder flexed, induce internal or external rotation, lift leg slightly VEC: Internal or External Rotation with impulse thrust

Bimanual Grasp/Proximal Femur; Inferior Glide in Flexion (Fig. 6-158)

Hypothenar/Trochanter Push; LAD (Fig. 6-159)

PP: Side posture position, affected side up DP: Stand on side of patient, thigh to thigh CH: Caudal hand pisiform hypothenar contact posterosuperior aspect of greater trochanter IH: Cephalad hand on patient’s shoulder VEC: LAD down line of femur

Hypothenar/Proximal Femur, Palmar/Distal Femur Grasp; Anterior to Posterior Glide (Fig. 6-157)

PP: Supine with hip and knee flexed slightly DP: On opposite side of table of involved leg CH: Cephalad hand knife edge over anterior proximal femur IH: Caudal hand distal femur with fingers in popliteal fossa P: Flex hip and deliver shallow thrust VEC: A to P

Hypothenar/Proximal Femur, Palmar Distal Femur Grasp; Posterior to Anterior Glide (Fig. 6-160)

PP: Prone DP: At side of table on involved side CH: Cephalad hand knife edge to posterior aspect of proximal femur IH: Caudal hand grasps distal femur on medial side P: Draw hip into extension by lifting knee. Deliver thrust. Can also be done on a drop table. VEC: P to A

Anvil Test

Local pain in the leg or thigh may indicate femoral, tibial, or fibular fracture. Pain in the calcaneus may indicate calcaneal fracture

Allis Sign

The patient has a short leg this indicates which bone is short femur or tibia

Patrick’s Test (FABERE)

Pain in the hip indicates Coxa pathology

Laguerre test

Positive test produces pain within sacroiliac joint. Pain felt within the iliofemoral joint indicates possible hip pathology

Thomas Test

Contralateral leg is unable to lay flat on the table lumbar spine stays in a lordosis as they pull their knee to their chest = flexion contracture of the iliopsoas muscle

Gaenslen’s

Positive test = pain in the sacroiliac area Dull, anterior thigh pain could indicate tight hip flexors Radiating symptoms down the thigh could indicate lumbar disc involvement If test is negative, a lumbosacral lesion is suspected

Lewin-Gaenslen test

Positive test produces pain within the sacroiliac joint Dull, ache along the anterior thigh of the extended leg indicates tight hip flexors

Ober’s Test

Thigh remains abducted as opposed to internally rotating and adducting indicates iliotibial band contracture

Trendelenburg Test

Iliac crest drops on the raised leg side indicative of weak hip abductors on the contralateral side (gluteus medius)