Joint Specific Examinations Lower Extremity Flashcards
1
Q
Describe the Trendelenberg Test
A
- with patient standing, make sure their pelvis is level
- ask patient to stand on one leg
- positive: pelvis will fall on the unsupported side
- tests for gluteus medius strength
2
Q
Describe the Log Rolling Test
A
- while patient is supine, roll their leg in internal and external rotation
- tests for ROM
- internal rotation is first to be lost with hip arthritis
3
Q
Describe the Stinchfield’s test
A
- Have patient do an active straight leg test while supine
- positive: pain in hip
- tests for hip pathology like DJD, infection, or fx
- (localizes to hip, as opposed to low back pain)
4
Q
Describe the Thomas Test
A
-while patient lies supine, have them flex both hips and knees to their chest
release one leg at a time, allowing leg to extend to the table
-this flattens the lumbar back, taking it out of the equation
-positive: “contracture” of the released leg
-tests for contractures that prevent the leg from fully extending
5
Q
FABER test (Patrick’s test)
A
- flex, abduct, and externally rotate patient’s hip while they lie supine
- positive: pain
- checks for SI joint pathology as source of lumbar pain
6
Q
FADIR test
A
- place limb into flexion, adduction, and internal rotation
- positive: anterolateral hip pain
- checks for femoroacetabular impingement (hip impingement)
7
Q
Piriformis Test
A
- have patient lie in decubitus position with examined side up
- flex hip to 45’ and knee to 90’ (so that it “hangs” over the other limb)
- stabilize patient’s pelvis (preventing pelvic rotation) and press the flexed knee toward exam table
- positive: localized pain suggests piriformis tightness or tendonitis
- positive: diffuse, radiating pain indicates piriformes syndrome
8
Q
Ober Test
A
- patient lies in decubitus position with examined side up
- patient’s knee flexed to 90’, hip abducted to 40’, and hip is extended to its limit
- stabilize pelvis
- positive: limited ROM indicates contracture of the iliotibial tract
9
Q
Patellar Apprehension test
A
- have patient lie supine and abduct their limb so that the knee is flexed over the side of the table
- push the patella as far laterally as possible while slowly flexing the knee with the other hand
- positive: apprehension indicates imminent pateller disolcation
10
Q
Passive Patellar Grind Test
A
- press the patella against the femur while passively flexing the knee with the other hand
- Positive: pain; degree of flexion in which pain and crepitus is felt may clue to the area of articular cartilage damage
11
Q
Bounce Home Test
A
- patient lies supine and extends the knee as far as they can
- hold the heel and proximal tibia and gently and slowing extend the knee a bit farther
- positive: sharp pain at medial femoral condyle and medal ibial plateau
- tests for bucket handle tears of meniscus and ACL tear
- if torn ACL stump prevents extension, pain is described as central and deep
12
Q
Lachman’s test
A
- patient is supine with knees 20-30’ flexed
- place thumb over tibial tubercles and wrap other fingers around the calf
- the other hand’s thumb presses against the femur through the quadriceps tendon while other fingers wrap around thigh
- pull forward on the tibia and push backward on the femur
- assess amount of anterior translation
- positive: anterior translation >2mm; indicates ACL damage
13
Q
Quad Active Drawer Test
A
- patient is supine with knees 90’ flexed
- grasp tibia just below joint line and ask patient to flex their quads
- positive: the posteriorly subluxed tibia is seen shifting anteriorly into reduction
14
Q
How do you test for knee LCL strength?
A
-Apply varus stress to an “unlocked” knee (flex knee to 10-20’ to relax)
15
Q
How do you test for knee MCL strength?
A
-apply valgus stress to an “unlocked” knee (flex the knee 10-20’ to unlock)
16
Q
Pivot Shift Test
A
- have patient lie supine
- apply axial load, valgus stress, and external rotation on knee
- positive: knee “jumps” into a reduced position; indicates nonfunctional or ruptured ACL
17
Q
McMurray’s test
A
- patient lies supine and flexes knee as far as possible
- grasp patient’s hindfoot, externally rotate the foot, place a varus stress on the knee, and passively extend the knee while palpating the medial joint line (tests for medial meniscus tear or dysfunction)
- grasp hindfoot, internally rotate the foot, apply valgus force on the knee, and passively extend the knee while palpating the lateral joint line (tests for lateral meniscus tear or dysfunction)
18
Q
Apley’s Compression
A
- patient lies prone and flexes knee to 90’
- distraction: grasp patient’s foot, stabilize thigh, and pull upward on the foot to distract the knee
- alternately externally and internally rotate the foot
- push downward on the patient’s knee while alternately internally and externally rotating the foot
- compression pain with external rotation = medial meniscal tear
- compression pain with internal rotation = lateral meniscal tear
19
Q
What is the posterior tibialis responsible for?
A
-inversion of foot
20
Q
How do you test the strength of the posterior tibialis muscle or tendon integrity?
A
-ask patient to invert foot against resistance while stabilizing the lateral aspect of their leg
21
Q
What does posterior tibialis weakness indicate?
A
-Injury or dysfunction of posterior tibialis or L5 nerve root
22
Q
What is the anterior tibialis responsible for?
A
-dorsal flexion of the foot
23
Q
How do you test for anterior tibialis muscle strength or tendon integrity?
A
-have patient flex toes (eliminating help from toe extensors), then invert and dorsiflex the foot against resistance
24
Q
What does weakness with the anterior tibialis test indicate?
A
-lesion of L4 nerve root or dep peroneal nerve
25
How do you test for Peroneus Brevis strength?
- grasp the anteromedial aspect of leg and apply resistance to lateral aspect of 5th MT
- position foot in plantar flexion (eliminating lateral toe extensor activity) and ask patient to ever foot against resistance
26
How do you test for peroneus longus strength?
-plantarflex the first ray while having the patient evert foot against your resistance
27
How do you test for extensor hallicus longus strength?
- grasp dorsal and plantar aspect fo midfoot medially and apply resistance to dorsal aspect of great toe
- have patient extend the great toe against resistance
28
What does weakness of the extensor hallucis longus indicate?
-deep peroneal nerve or L5 dysfunction
29
How do you test the strength of the Flexor Hallucis Longus?
- grasp dorsal and plantar aspect of midfoot while applying plantar resistance to great toe
- ask patient to plantar flex their great toe against resistance
30
What does weakness of the flexor hallucis longus indicate?
-tibial nerve or S1 nerve root dysfunction
31
What is the easiest and most specific way to assess S1 nerve root dysfunction?
Flexor hallucis longus
32
What is the easiest and most specific muscle to assess L5 nerve root dysfunction?
-extensory hallucis longus
33
How can you assess for only anterior talofibular ligament damage?
-anterior drawer test
34
Tilt test
- stabilize tibia, grasp the calcaneus, and invert the hindfoot
- Positive: excessive motion
- tests for anterior talofibular and calcaneal fibular ligaments
35
How do you assess Metatarso-phalangeal (MTP) joint stability?
- stabilize foot and grasp the proximal phalanx of each toe
- move the joint in a plantar and dorsal direction
- positive: instability may indicate chronic synovitis or long-standing claw toe deformity
- positive: pain may indicate active synovitis
36
Which toe is most often affected by synovitis?
2nd toe
37
How can you test for Interdigital (Morton) Neuroma?
-apply upward pressure between adjacent MT heads
-then compress the MTs from side to side with the free hand
-positive: pain
-
38
Where are interdigital neuromas most commonly located?
- between the 3rd and 4th MT hads
- occasionally between the 2nd and 3rd
- rarely between the others
39
Kleiger Test
- patient is seated with knees flexed to 90'
- grasp and stabilize the leg from behind with one hand
- dorsiflex the ankle and externally rotate the foot with the other hand
- positive: pain (determine specific location)
- indicates syndesmosis fx
40
Squeeze Test
- squeeze the tibia and fibula together
| - positive: ankle pain; indicates syndesmotic interruption
41
Thompson Test
- patient lies prone with knee flexed to 90'
- squeeze the medal and lateral aspect of the mid-calf together
- foot should plantar flex
- positive: foot does not plantar flex; indicates Achilles tendon damage/rupture
42
Eversion Stress Test
- patient is seated and knee flexed to 90'
- evert the hindfoot (with hand on the calcaneus so you don't ever the midfoot)
- positive: pain over deltoid ligament and increased eversion compared to other side
- indicates possible injury to the mid portion of the deltoid ligament or possible avuslion fx of medial malleolus
43
Inversion Stress Test
- patient is seated with knee flexed to 90'
- invert the hindfoot with hand over calcaneus
- positive: pain or increased inversion
- indicates moderate to severe injury to calcaneofibular ligament
