Lab Flashcards
(187 cards)
1
Q
Assessment: Trendelenburg’s Sign
A
Integrity of gluteus medius or unstable hip
2
Q
Position: Trendelenburg’s Sign
A
Pt: Standing on one limb, affected sign
PT: Standing behind pt.
3
Q
Method: Trendelenburg’s Sign
A
Observe alignment of the contralateral limb with the pelvis
4
Q
Positive Test: Trendelenburg’s Sign
A
Pelvis on opposite side drops when the pt. stands on the affected limb
5
Q
Biomechanics: Trendelenburg’s Sign
A
Gluteus medius (prime mover) and other hip abductors stabilize the pelvis on the femur
6
Q
Assessment: Caudal Glide (Hip)
A
Joint mobility
7
Q
Position: Caudal Glide (Hip)
A
Pt: Supin with hip in 30 flexion, 30 ABD, slight ER
PT: Walk-stance at end of table, facing pt., cradle limb in malleoli
8
Q
Method: Caudal Glide (Hip)
A
Lean back, apply caudal mobilizing force on LE, gentle, gradual increase amplitude and depth if no pain.
Assess quality of movement and compare bilaterally
9
Q
Assessment: Inferior Glide (Hip)
A
Joint mobility
10
Q
Position: Inferior Glide (Hip)
A
Pt: Supine, hip and knee flexed to 90 supported by PT shld
PT: Support LE, wrap ulnar borders around proximal thigh
11
Q
Method: Inferior Glide (Hip)
A
Apply caudal mobilizing force on proximal femur, gentle, gradual increase amplitude and depth if no pain.
Assess quality of movement and compare bilaterally
12
Q
Biomechanics: Inferior Glide (Hip)
A
Increases hip joint space and loosens adhesions in the anterior direction
13
Q
Assessment: Posterior Glide (Hip)
A
Flexion and IR
14
Q
Position: Posterior Glide (Hip)
A
Pt: Supine with hip in resting position (i.e. 30 flex, 30 ABD, sligh ER)
PT: Mobilizing hand on anterior proximal femur
15
Q
Method: Posterior Glide (Hip)
A
Mobilizing force straight down
Posterior glide is necessary for flexion and IR
16
Q
Assessment: Anterior Glide (Hip)
A
Extension and ER
17
Q
Position: Anterior Glide (Hip)
A
Pt: Side lying, pillow between knees, hip comfortably flexed
PT: Walk-stance perpendicular to side of exam table, palm against posterior lateral trochanter, other hand stabilizes pelvis
18
Q
Method: Anterior Glide (Hip)
A
Apply anterior force parallel to joint surfaces, gentle, gradual increase amplitude and depth if no pain.
Assess quality of movement and compare bilaterally
19
Q
Biomechanics: Anterior Glide (Hip)
A
Femoral head glides anteriorly during extension and ER
20
Q
Assessment: Lateral Glide (Hip)
A
Lateral mobility
21
Q
Position: Lateral Glide (Hip)
A
Pt: supine, leg extended, can have hip flexed to 90
PT: Stabilize lateral aspect of distal femur and medial aspect of proximal femur
22
Q
Method: Lateral Glide (Hip)
A
Proximal hand applies a lateral force
23
Q
Assessment: Hamstring Length (SLR)
A
Length of hamstrings
24
Q
Position: Hamstring Length (SLR)
A
Pt: Supine, back neutral, knee extended, hip extended
25
Method: Hamstring Length (SLR)
PT passively brings leg up into increasing hip flexion
26
Positive Test: Hamstring Length (SLR)
\< 80 of hip flexion indicates tightness in CT of posterior thigh
27
Assessment: Hip Flexor Length (Thomas Test)
Length of hip flexors
28
Position: Hip Flexor Length (Thomas Test)
Pt: sitting at EOB with distal legs supported by table (text); Laying with hips at EOB, legs dangling (picture)
PT: Lower pt. to supine while pt. holds knees to chest, Then hold pts. posterior leg with hand and palpate ASIS and PSIS with other hand. Pt will holds contralateral knee to chest
29
Method: Hip Flexor Length (Thomas Test)
Step 1: Lower leg to table while monitoring lower back
Step 2: If leg does not lower with knee flexed, reattempt with knee straight
Step 3: If leg does not lower with knee straightened, reattempt with knee flexed and abd hip,
30
Normal response: Hip Flexor Length (Thomas Test)
Leg lowers to table with knee flexed
31
Positive Test: Hip Flexor Length (Thomas Test)
Does not lower with knee straight = tight iliopsoas
Lowers with knee straight = tight rectus femoris
Lowers with knee flexed and hip abd = tight tensor fascia latae
32
Biomechanics: Hip Flexor Length (Thomas Test)
Hip flexors under examination are: iliopsoas, rectus femoris, and TFL
Hip should be able to reach neutral with spine flat if all hip flexors normal length
To bias rectus femoris = knee straight
To bias TFL = hip ABD
33
Assessment: IT band (Modified Ober test)
Length of iliotibial band
34
Position: IT band (Modified Ober test)
Pt: Side lying with leg on table having knee and hip flexed
PT: Behind pt., stabilize pelvis, and use other hand to support under leg with hand around knee cap
35
Method: IT band (Modified Ober test)
Bring leg into extension, ER (to prevent IR), then drop leg into adduction
36
Positive Test: IT band (Modified Ober test)
Leg drops less than 10 degrees from horizontal
37
Biomechanics: IT band (Modified Ober test)
A tight IT band/TFL will cause hip abduction and IR of the femur
38
Q: What are the 4 tests for hip muscular length?
1. SLR (hamstring)
2. Thomas (hip flexor)
3. Modified Ober (IT band)
4. Hip IR/ER
39
Q: What are the 6 hip special tests?
1. Scour
2. Femoral-acetabular impingement test
3. FABER
4. Piriformis
5. Craig's
6. Ely's
40
Assessment: Scour Test (flexion and adduction)
Pathology in the articulating surface of the hip joint as with OA, Labral tear, Bursitis
41
Position: Scour Test
Pt: Supine, hip flexed 90 with knee bent and hip adducted
PT: Standing, facing pt., grasp knee with both hands
42
Method: Scour Test
Apply an axial load while moving the patient from adduction to abduction
43
Positive Test: Scour Test
Grinding or snapping
Location should indicate cause
44
Assessment: FABER
ROM of hip and pain
45
Position: FABER
Pt: Supine with foot resting on top of the knee of the opposite leg (Hip flexion, ABD, ER)
PT: Standing on side of table one hand on ASIS of contralateral hip and other handon bent knee
46
Method: FABER
Apply pressure to ABD the hip on the test side and pressure to stabilize the hip on the contralateral hip
47
Positive Test: FABER
Knee does not lower to the level of the opposite hip
48
Assessment: Piriformis Test
Piriformis involvement
49
Position: Piriformis Test
Pt: Sidelying with test hip flexed 60 and knee flexed
PT: Facing pt., one hand stablizing the hip, the other on knee
50
Method: Piriformis Test
Apply downward force on the knee
51
Positive Test: Piriformis Test
Sciatica pain or tightness of piriformis
Movement of the hip under PT hand
52
Assessment: Craig's Test
Measure of femoral anteversion
53
Position: Craig's Test
Pt: Prone, knee flexed to 90
PT: Standing on side, holding ankle and palpating greater trochanter
54
Method: Craig's Test
Passively IR/ER the hip until the greater trochanter is in its most lateral position (parallel to table), then measure angle between lower leg and vertical
55
Normal Test: Craig's Test
8-15 degree angle
56
Biomechanics: Craig's Test
Excessive anteversion = IR, toe in
Excessive retroversion = ER, toe out
57
Assessment: Ely's Test
Length of rectus femoris
58
Position: Ely's Test
Pt: Prone, legs together
PT: Standing on the side, hand on ankle and on pelvis (posterior or anterior)
59
Method: Ely's Test
Passively flex knee, stabilizes pelvis
60
Positive Test: Ely's Test
Anterior pelvic til or limited knee flexion = tight rectus femoris
61
Functional Test: Lift foot onto 20 cm step/return (hip flexion\>ext)
1. 5-6 reps
2. 3-4 reps
3. 1-2 reps
4. 0 reps
1. Functional
2. Functional Fair
3. Functional Poor
4. Nonfunctional
62
Functional Test: Sit in chair and stand (hip ext\>flexion)
1. 5-6 reps
2. 3-4 reps
3. 1-2 reps
4. 0 reps
1. Functional
2. Functional Fair
3. Functional Poor
4. Nonfunctional
63
Functional Test: Standing, lift leg to balance keeping pelvis straight (hip ABD)
1. Hold 1-1.5 min
2. Hold 30-59 sec
3. Hold 1-29 sec
4. Cannot Hold
1. Functional
2. Functional Fair
3. Functional Poor
4. Nonfunctional
64
Functional Test: Walk sideways 6m (Hip ADD/ABD)
1. 6-8m one way
2. 3-6m one way
3. 1-3m one way
4. 0m
1. Functional
2. Functional Fair
3. Functional Poor
4. Nonfunctional
65
Functional Test: Tested leg off floor, IR nonWB hip OR ER nonWB hip
1. 10-12 reps
2. 5-9 reps
3. 1-4 reps
4. 0 reps
1. Functional
2. Functional Fair
3. Functional Poor
4. Nonfunctional
66
Q: In standing which should be higher, PSIS or ASIS and by how much?
PSIS
men = 5 degrees higher
women = 10-15 degrees higher
67
Assessment: Bending Forward
1. Hip Compensation
2. Knee flexion/hyperextension
68
Normal: Bending Forward
Hip flex to 90 followed by back bend
69
Positive Test: Bending Foward
Hip flex \< 90 followed by back bend = tight hamstrings and hip flexors
70
Q: What is the purpose of passive hip movement in single leg stance?
Loading joint to see if symptoms are reproduced with certain movements
71
Stretching: UE: Supine or Sidelying: Shoulder Flexion/Elevation (3)
1. Scapula is stabilized: 120 degrees of shoulder flexion/elevation
2. Humerus externally rotated
OR
3. Stabilize pelvis for full flexion/elevation
72
Stretching: UE: Supine or Sidelying: Shoulder ER (4)
1. Abduction or elevation plane
2. 90 elbow flexion; initially 30 or 45 of elevation
3. Stabilize shoulder with one hand and elbow forearm with another hand
4. Externally rotate the shoulder
73
Stretching: UE: Supine or Sidelying: Shoulder Horz ABD (4)
1. Pec. major stretching
2. Pt in the edge of the table
3. Begin with shoulder in 60 to 90 degrees of abduction/pt’s elbow flexed.
4. Stabilize anterior shoulder and grab the distal humerus
74
Stretching: UE: Supine or Sidelying: Elbow extension (2)
1. Watch for shoulder and elbow compensations
2. Stabilize shoulder/humerus with one hand/ apply the extension force on the forearm, use towel to support the humerus.
75
Stretching: UE: Supine or Sidelying: Wrist Extension
Forearm pronated on the treatment table; use a towel to support the forearm. Grasp the patient’s palmar aspect of the hand. If the contracture in flexion is severe, place the pt’s hand over the edge of the table.
76
Stretching: UE: Sitting: Shoulder Horz ABD (3)
1. Pec. major stretching
2. Therapist behind the patient, both grabs both patient’s elbow with shoulder at 90
3. Apply shoulder horizontal abduction (contract-relax technique when needed)
77
Stretching: LE: Supine: Hip Flexion (3)
1. Hamstrings stretching
2. Flex the hip with knee in extension
3. Stabilize the opposite thigh (hand or towel)
78
Stretching: LE: Supine: Hip Extension (3)
1. Thomas test position (stretch the psoas, rectus femoris, TFL)
2. Extend the hip holding (stabilizing) the contralateral hip in total flexion
3. Apply hip adduction and knee flexion when necessary
79
Stretching: LE: Sidelying: Hip ABD/Extension (3)
1. Stretch the TFL: Ober test position
2. Adduction/ extension of the hip in neutral rotation; stabilize pelvis
3. Flex knee if to increase the stress.
80
Stretching: LE: Prone: Hip ER/IR (2)
1. Knee bent at 90o, stabilize contralateral hip
2. Apply either external or internal rotation
81
Stretching: LE: Prone: Knee Extension (Stretch Knee Flexors) (2)
1. Supporting the knee with a towel; therapist grasp the tibia in external rotation and stabilize the posterior thigh with the other hand.
2. Apply knee extension
82
Stretching: LE: Supine: Ankle DF (4)
1. Stretch gastrocnemius (knee extended),
2. Stretch Soleus (knee bent)
3. Therapist grasp the heel with one hand (forearm on the foot sole) and stabilize tibia with the other hand
4. Apply dorsiflexion with the subtalar joint in neutral position
83
Global Postural Reeducation/Stretching: Supine/Standing (4)
1. Opening hips
2. Arms Down
3. Exhaling practice (90% exhaling)
4. Keep spine in place/do not move (just breath)
84
Global Postural Reeducation/Stretching: Supine legs againt wall (2)
1. Closing hips
2. Arms up or down
85
Global Postural Reeducation/Stretching: Standing (2)
1. Closing hips
2. Arms down (Ballet dancer)
86
Assessment: Patellar Tap Test
Swelling inside the joint
87
Assessment: Girth Measurements
Atrophy and swelling
88
Landmarks: Girth Measurements
For swelling = at joint line
15 cm above or below joint line (muscle swelling/atrophy)
Measure while in 30 knee flexion
89
Knee Palpation (Looking to reproduce symtpoms) (8)
1. Look at position of patella
2. Fibular head for tenderness
3. Joint Line for menisci
4. MCL, medial joint
5. LCL, lateral joint
6. Patellar tendon
7. Fat pads
8. Pes Anserine
90
Modified Quad MMT: Quad Set (4)
Hold for 10 sec
Look for:
- Contraction
- Patellar tracking (want superior/lateral motion)
- VMO
91
Modified Quad MMT: SLR
Watch for extensor lag
92
Q: What aggravates knee fat pads?
Inferior tilted patella
93
T/F: In general, the patella is slightly medially seated.
True, slight but not significant
94
Assessment: Femural-Acetabular Impingement Test
Anteriosuperior labral tear
Also stretches/tests piriformis
95
Position: Femural-Acetabular Impingement Test
Pt: Supine, flip flexed, abd, ER
PT: stand to side of pt. and support leg
96
Method: Femural-Acetabular Impingement Test
Move pt. into adduction, IR, with slight extension
97
Positive Test: Femural-Acetabular Impingement Test
Clicking, Pain
Posterior pain = Piriformis
Anterior pain = Labral tear
98
Q: In what plane is the Q angle observed?
Sagittal
99
Q: What can you determine by the angle of the popliteal lines?
IR/ER of the femur
High on outside = IR
100
Q: What would inhibit a full/deep squat?
Tight calfs
101
Assessment: Patellar Tap Test
Joint effusion (swelling inside the joint
102
Position: Patellar Tap Test
Pt. supine with knee slightly flexed
103
Method: Patellar Tap Test
Push/glide patella inferiorly, then tap, compare bilaterally
104
Positive Test:
Floating or bouncing sensation
105
Assessment: Posterior Sag
Posterior cruciate ligament integrity (tear)
106
Position: Posterior Sag
Pt: Supine, hip and knee flexed to 90, feet supported by PT
Alternative: Feet flat on table, hip and knee flexed
PT: at end of bed, supporting heels
107
Method: Posterior Sag
Observe the tibial plateaus, have pt. engage hamstrings to exaggerate the effect
108
Normal Response: Posterior Sag
Medial tibial plateau is 1 cm anterior to femoral plateau
109
Positive Test: Posterior Sag
Tibia drops/sags back
110
Assessment: Posterior Drawer
Posterior instability (PCL)
111
Position: Posterior Drawer
Pt: Supine, knee flexed 90, foot flat on table
PT: Sitting on foot, thenar eminences on tibial plateaus
112
Method: Posterior Drawer
Attempt to push tibia backward, compare bilaterally
113
Positive Response: Posterior Drawer
Excessive Posterior translation
114
Assessment: Anterior Drawer
ACL integrity
115
Position: Anterior Drawer
Pt: Supine, knee flexed 90, foot flat on table
PT: Sitting on foot, grasping the tibia with both hands
116
Method: Anterior Drawer
Attempt to pull the tibia forward, compare bilaterally
117
Positive Test: Anterior Drawer
Excessive anterior translation of the tibia
118
Q: Why is the Lachmans test better than the Anterior Drawer?
The Lachmans has the pt in 30 degrees of knee flexion - the angle at which all the ACL fibers are taut
119
Assessment: Lachman Test
ACL integrity
120
Position: Lachman Test
Pt: supine, knee flexed 15-30 degrees
PT: Standing, grasping lateral femur and medial tibia
121
Method: Lachman Test
Stabilize the femur while exerting an anterior force on the tibia, compare bilaterally
122
Positive Test: Lachman Test
Excessive anterior translation of the tibia
123
Assessment: Varus Stress Test
LCL integrity
124
Position: Varus Stress Test
Pt: Supine with knee flexed 5, and 20-30, lower leg off table thigh resting on the table
PT: Stabilize medial knee, grasp lateral ankle
125
Method: Varus Stress Test
Apply varus force at knee
126
Positive Test: Varus Stress Test
Excessive gapping of the lateral joint with/without pain
127
Assessment: Valgus Stress Test
MCL integrity
128
Position: Valgus Stress Test
Pt: Supine with knee flexed 5, and 20-30, lower leg off table thigh resting on the table
PT: Stabilize lateral knee, grasp medial ankle
129
Method: Valgus Stress Test
Apply valgus force at knee
130
Positive Test: Valgus Stress Test
Excessive gapping of the lateral joint with/without pain
131
Q: What should the end feel be for both the varus and valgus stress test?
Hard
132
Q: What is one way to assess the menisci apart from McMurray's test?
Palpate the joint line
133
Assessment: McMurry's Test
Meniscal instability
134
Position: McMurry's Test
Pt: Supine, knee in full flexion
PT: Grasp knee and around distal tibia
135
Method: McMurry's Test
Lateral meniscus: apply IR to tibia and varus force at knee during extension
Medial meniscus: apply ER to tibia and valgus force at knee during extension
136
Positive Test: McMurry's Test
Pain
137
Assessment: Apprehension Test
Lateral patella subluxation or dislocation
138
Position: Apprehension Test
Pt: Supine, quad relaxed (knee flexed ~30)
PT: Standing on opposite side of test leg, thumbs on medial patella
139
Method: Apprehension Test
Carefully/slowly glide patella laterally
140
Positive Test: Apprehension Test
Apprehension - facial or quad contraction, then positive for dislocation
141
Assessment: Apley's Compression & Distraction
Compression = Mensicus integrity
Distraction = Ligament integrity
142
Position: Apley's Compression & Distraction
Pt: Prone with knee flexed to 90
PT:
Compression: hand on heel and ankle
Distraction: Shin stabilizes pt. quad, hands around malleoli
143
Method: Apley's Compression & Distraction
Compression: apply downward force while IR/ER tibia
Distraction: distraction joint while IR/ER tibia
144
Positive Test: Apley's Compression & Distraction
Pain, clicking, reproduction of symptoms
145
Assessment: Critical Test
Patellofemoral pain
146
Position: Critical Test
Pt: Sitting EOB
PT: siiting beside pt. stabilize near knee, hold ankle
147
Method: Critical Test
Apply resistance at the ankle through varying degrees of knee flexion (5-90). If pain occurs at a given angle, glide the patella medially and reattempt resistance at that angle
148
Positive Test: Critical Test
Decreased pain with medial glide
149
PAM to Gain Knee Extension: 30-15 degrees extension
Patient prone; place a towel roll under femur and stabilize the femur; anteriorly glide tibia with external rotation using grade III or IV
150
PAM to Gain Knee Extension: 15-5 degrees extension
Patient supine; place a towel roll under tibia, posteriorly glide femur with internal rotation using grade III or IV. Emphasize internal rotation of femur
151
PAM to Gain Knee Extension: 5-0 degrees extension
Patient supine; hold-relax technique to engage hamstrings
152
Assessment: Anterior Drawer (Ankle)
Integrity of the anterior talofibular ligament
153
Position: Anterior Drawer (Ankle)
Pt: Sitting EOB
PT: Stabilize anterior tib/fib while grasping calcaneous posteriorly
154
Method: Anterior Drawer (Ankle)
Apply anterior force to calcaneous
155
Positive Test: Anterior Drawer (Ankle)
Excessive movement of the talus compared to the opposite side
156
Assessment: Talar Tilt
Integrity of the calcaneofibular ligament
157
Position: Talar Tilt
Pt: Sitting EOB
PT: Stabilize tib/fib anteriorly, grasp lateral talus and calcaneous with other hand
158
Method: Talar Tilt
Apply inversion force to talocrural and subtalar joints
159
Positive Test: Talar Tilt
Lateral gapping or pain as compared to the opposite side
160
Assessment: Homan's Sign
Length of posterior compartment of calf
161
Position: Homan's Sign
Pt: Supine, foot off bed
PT: Grasp plantar aspect of foot
162
Method: Homan's Sign
Apply DF with knee extended
163
Positive Test: Homan's Sign
Pain in calf
164
Assessment: Squeeze Test
Morton's Neuroma, usually between 2-3 MT
165
Position: Squeeze Test
Pt: Supine
PT: Grasp foot around MT head
166
Method: Squeeze Test
Squeeze MT heads together
167
Positive Test: Squeeze Test
Increased pain between MTs
168
Assessment: Thompson's Test
Integrity of Achilles tendon - rupture
169
Position: Thompson's Test
Pt: Prone, foot off bed
170
Method: Thompson's Test
Squeeze calf at middle of muscle belly
171
Positive Test: Thompson's Test
decreased or absent PF reflex/response
172
Q: What pulse would you assess for compartment syndrome?
Pedal pulse
173
Q: Where do you take girth measurements for the ankle?
Start = between tibialis anterior tendon and lateral malleolus
To navicular bone
Pull across arch to base of 5th MT
Around ankle to distal tip of medial malleolus
Across achilles tendon
End = distal tip of lateral malleolus
174
Q: What does a posterior ankle glide assess?
DF
175
Q: What does distraction at the subtalar joint assess?
General mobility of the calcaneus
176
Q: What does an anterior ankle glide assess?
PF
177
Q: What does a medial subtalar joint glide assess?
Inversion
178
Q: What does a lateral subtalar joint glide assess?
Eversion
179
Indication: Longitudinal Caudal Mobilization
Lack of general ankle mobility
180
Position: Longitudinal Caudal Mobilization
Pt: Prone, knee flexed 90
PT: Knee stabilizing pt thigh, Grasp talus with both hands around the ankle
181
Method: Longitudinal Caudal Mobilization
Distract hindfoot combined with inv/ever and DF/PF
182
Indication: Cuboid Whip
Cuboid subluxation or decreased mobility of the calcaneocuboid joint
183
Position: Cuboid Whip
Pt: prone, knee flexed 75-80
PT: grasp dorsal foot with thumbs on plantar foot over cuboid
184
Method: Cuboid Whip
Slightly Df, them thrust into PF and knee extension
185
Indication: Thrust Manipulation of the Talus
Hypomobility after inverted ankle sprain
186
Position: Thrust Manipulation of the Talus
Pt: Supine, legs straight
PT: Grasp ankle anteriorly and laterally over the talus bone
187
Method: Thrust Manipulation of the Talus
Place pt. foot/ankle into sligh DF and eversion/ER. Apply thrust into slight eversion and DF
