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Advanced Physical Dx > Hip and Knee Exam > Flashcards

Hip and Knee Exam Flashcards

(90 cards)

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1
Q

What are common symptoms of hip and knee complaints?

A

Pain
Instability
Swelling
Locking

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2
Q

What needs to be inspected on the knee?

A 
Integrity of skin
Color
Effusion
Prior surgery
What is the resting knee position
Muscular atrophy
Patella Position
Deformity?
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3
Q

Define genu valgum

A

Knock kneed

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4
Q

Define genu varum

A

bow legged

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5
Q

Define genu recurvatum

A

“hyperextended” knee due to curvature of the bones

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6
Q

Define patella alta

A

patella is resting more above the femur

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7
Q

Define patella baja

A

patella is resting more above the tibia

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8
Q

What areas need to be palpated on the knee?

A 
Patella and patellar tendon
Quad insertion on superior patella
Tibial tuberosity (Osgood-Schlatter’s, bursitis)
Peri-patellar structures (medial/lateral condyle of distal femur)
Joint line (meniscus tear)
Pes Anserine bursa
IT Band
Effusion
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9
Q

What ROM needs to be assessed on knee exams?

A

Flexion: 140-145 degrees
Extension: 0-10 degrees of hyperextension

Check for pain on ROM and/or crepitation

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10
Q

What strength needs to be assessed on knee exams?

A

Hamstring
Quads
1) can they initiate and perform extension
2) can they maintain extension against resistance

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11
Q

What does the apprehension test assess?

A

Evaluates for patella subluxation

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12
Q

How is the apprehension test performed?

A

Apply pressure to medial patella and push lateral

Positive test is painful over medial aspect of knee

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13
Q

What does an increased Q angle indicate?

A

An increased Q angle is an indicator for patellar subluxation as well as PFS (patellofemoral syndrome)

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14
Q

What is a normal Q angle for males and females?

A

Nl is 14 for males
Nl is 17 for females
Common in female adolescents

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15
Q

What does the patellar grind test assess?

A

chondromalacia patella

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16
Q

What is a positive patellar grind test?

A

pain at patella when pt contracts quad muscle as the examiner grasps superior aspect of patella w/ thumb and index finger

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17
Q

What does the Lachman’s test assess?

A

Anterior Cruciate Ligament

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18
Q

How is Lachman’s test performed?

A 
One hand distal femur
Stabilize femur
Other on proximal tibia
Distract proximal tibia
Anterior/posterior
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19
Q

What is a positive Lachman’s test?

A

+ test = laxity

Always COMPARE sides!

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20
Q

What does the Anterior drawer test assess?

A

ACL

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21
Q

How is the anterior drawer test performed?

A

Knee flexed to 80 degree
Foot stabilized
Grip proximal tibia
Anterior force to/fro

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22
Q

What is a positive anterior drawer test?

A

+ test laxity

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23
Q

What does the pivot shift test assess?

A

Integrity of the ACL

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24
Q

What does the posterior drawer test assess?

A

PCL

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25
How is the posterior drawer test performed?
Knee flexed to 80 degree Foot stabilized Grip proximal tibia Apply sudden firm push back
26
What is a positive posterior drawer test?
Positive test laxity
27
What does the posterior sag test assess?
PCL
28
What does the varus test assess?
LCL stability
29
What does the valgus test assess?
MCL stability
30
How is the varus tests performed?
Perform in full extension AND at 30 degree Stabilize lower thigh with one hand Apply laterally directed stress at knee/ankle
31
What is a positive varus/valgus test?
Positive test: laxity
32
How is the valgus test performed?
Perform in full extension AND at 30 degree Stabilize lower thigh with one hand Apply medially directed stress at knee/ankle
33
What does McMurray's test evaluate?
Meniscus
34
How is McMurray's test performed?
One hand holds heel, the other holds knee Make a ‘C’ with your hand Put thumb over posterior aspect of knee Middle finger over anterior joint line Alternate Varus and Valgus stress while ranging knee to hyperflexed position
35
What is a positive McMurray's test?
Positive test is joint line pain and click heard or felt during maneuver
36
What are the etiologies of patellar dislocation?
Traumatic vs atraumatic Sudden pop Pain and inability to bear weight
37
What are the exam findings for patellar dislocation?
knee flexed Effusion Tenderness along medial patella Positive apprehension sign
38
What are the etiologies of patellar tendonitis?
Over use activity | Pain inferior pole of patellar
39
What are the exam findings for patellar tendonitis?
No effusion +/- Crepitus Tight quads
40
How is the meniscus injured?
``` Vulnerable to twist & compression Trivial trauma (degenerative) ```
41
What is the common history with a torn meniscus?
+/- trauma | Problems with ambulating stairs or squatting or changing directions
42
What are the sxs asst. with a torn meniscus?
``` Joint line tenderness (sharp pain) Effusion Instability Lack of extension … knee could be locked Pain with flexion and squat ```
43
What is one of the most common knee injuries? Who is more likely? What is the etiology?
ligaments Gender difference in injury rates F>M Noncontact Contact
44
When does an ACL injury occur?
the bones of the leg twist in opposite directions under full body weight
45
What are the sxs of acl injuries?
“Popping” sound at the time of injury Rapid Swelling Pain Instability – “knee goes out on me”
46
What are acl injuries asst. with?
Associated with meniscus tear, bone bruise and a quicker onset of osteoarthritis
47
What is the function of the PCL?
Primary stabilizer of the knee
48
How is the pcl injured?
Fall on a bent knee | MVA – Dashboard injury
49
What are the sxs of pcl injuries?
Mild to Moderate Pain in the back of the knee Swelling Knee Instability – may more easily hyperextend
50
What collateral ligament tears are more common?
MCL more than LCL
51
What is the etiology of collateral ligament tears?
Direct Blow | When the lower leg is forced sideways, either toward the other knee or away from the other knee
52
How are collateral ligament tears graded?
I-III
53
What are the sxs of collateral ligament injuries?
Pain over the ligament Swelling Decreased ROM Instability
54
What is the most common type of arthritis?
Most common type of arthritis | Affects over 10 million Americans
55
Define OA
Chronic condition characterized by degeneration of cartilage at joint
56
What are the risk factors for OA?
``` Age Obesity Injury or Overuse Genetics Muscle Weakness Other Diseases ```
57
What are the sxs of OA?
Pain when moving the knee Joint stiffness Grinding or catching when moving the knee Pain when walking up and down stairs or getting up from a chair Weakened large thigh muscles Deterioration of alignment, posture and walking due to pain and stiffness.
58
What are the common symptoms of a hip pt?
Pain | Stiffness
59
What needs to inspected in a hip exam?
With patient standing Inspect from the front and from behind for any pelvic tilting or rotational deformity Note any abnormalities of bony or soft tissue contours Observe the contour of the buttock for any abnormality (gluteus maximus atrophy or atonia) Examine Gait Note antalgic gait (to avoid pain, time spent on injured limb during stand phase is minimized)
60
What needs to be palpated in a hip exam?
``` Greater Trochanter Pubic rami Ischial Tuberosity IT band ASIS bilaterally ```
61
What ROM needs to be assessed for a hip exam?
Flexion/Extension ( 110-120 ) ( 10-15 ) Internal/External rotation (30-40) ( 40-60 ) Abduction/Adduction ( >45 ) ( 30) Numbers are generalized for healthy adults
62
What strength needs to be assessed for a hip exam?
Flexor Strength Extensor Strength Adductor Strength Abductor Strength
63
What is acceptable leg length discrepancy? How is it measured?
Measure each leg from anterior superior iliac spine (ASIS) to the medial malleolus Acceptable leg length discrepancy: +/- 1 cm
64
What is the trendelenberg test used for? How is it performed?
Checks for hip abductor strength/superior gluteal nerve innervation Pt stands on one leg, flexes hip of other leg
65
What is a positive trendelenberg test?
Pelvis drops toward unaffected side | Walking limp noted on affected side
66
What does Patrick's (FABER) test assess?
Flexion, Abdcution, ER of hip
67
When is a Patrick's test positive? What does it indicate?
Test is positive when the tested leg remains above the opposite leg Positive test indicates an affected hip or sacroiliac joint, or that iliopsoas spasms exist Pain = early OA
68
When is a Patrick' test negative?
Test is negative when test leg is at least parallel with the opposite leg
69
What is Thomas test used for?
Hip flexion contracture
70
What is a positive test, and what does it suggest?
Elevation of the opposite thigh suggests a loss of extension in that hip and a fixed flexion deformity
71
What are the etiologies of hip injuries?
Trauma Inflammatory Congenital Degenerative
72
What are the sxs for arthritis?
pain an decreased mobility
73
What are the tests for arthritis?
No blood test | AP Pelvis x-ray
74
What is the tx for arthritis?
NSAID’s, pain meds mainstay of treatment | Mod-severe OA  THA
75
What are etiologies of hip OA?
Gradual onset Wear and tear Congenital deformity Trauma
76
What are the sxs fo hip oa?
Groin pain | Stiffness
77
What are the etiologies of hip fx?
Typcially secondary to fall in an elderly pt | Trauma from MVA or fall from a height
78
What are the sxs of hip fx?
Groin pain Pain with ROM LE shortening LE externally rotated
79
What is the tx for hip fx?
Surgery
80
What test can be used in a hip fx?
checking IR and ER | elicits severe pain in hip fracture patient
81
What are the etiologies of hip dislocation?
Secondary to trauma ex: MVA | May occur in pts with Hip replacement
82
What is a sequlae of hip fx?
avascular necrosis
83
What are the sxs of hip dislocation?
Severe pain LE shortening Internal rotation
84
How is hip dislocation tx?
Often reducible without Sx
85
What is traochanteric bursitis? Who is it more common in?
tenderness directly over the greater trochanter | F>M
86
How is trochanteric bursitis treated?
ITB stretching/PT/ NSAID’s if no response, cortisone injection
87
What is snapping hip syndrome?
Snapping Hip Syndrome (sometimes called dancer’s hip) May feel like hip is unstable and may give out May cause pain and interfere with performance of athletes Usually an annoyance
88
What are the sxs of meralgia paresthetica?
Tingling, numbness and burning pain outer thigh
89
What is meralgia paresthetica?
damage to the lateral femoral cutaneous nerve
90
What are the etiologies meralgia paresthetica? how is it treated?
Tight clothing, obesity, wt gain, pregnancy | Conservative tx

Advanced Physical Dx (9 decks)

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