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Flashcards in Lower Extremity II Deck (57):
1

What are the two main goals of a joint evaluation?

1. If the pain is from the joint itself, or referred.

2. Find the specific tissue that is generating the pain/symptom

2

L1 supplies what area?

Skin of the outer and upper buttock and hip

3

L2 and L3 supply what skin area?

Posterior buttock

4

S1-S2 supply what skin area?

Lower buttock, posterior upper thigh

5

Non-activity related pain may be what?

Referred pain from the viscera

6

Innervation to the hip joint is from what spinal level(s)? Where will pain from this area radiate to?

L3, sometimes L4

Upper and inner part of the buttock

7

Gluteal bursae refer pain where?

L4, L5

8

Psoas bursa refer pain wher?

L2, L3

9

SIJ typically refers to what?

Back of the leg

10

Innervation to the hip joint itself is primarily from L3. Therefore, pain often refers where?

Upper and inner part of the buttock

11

What are the important HPI bits of info for hip pain? (besides obvious)

-Weight bearing activities
-Specific activities

12

What is the trendelenburg sign?

Falling of the hip d/t weak gluteus medius/minimus

13

What is piriformis syndrome?

The sciatic nerve is compressed or otherwise irritated by the piriformis muscle causing pain, tingling and numbness in the buttocks and along the path of the sciatic nerve descending the lower thigh and into the leg.

14

What are the seven principles for joint PE?

1. Inspect
2. ROM
3. Resistance/str testing
4. Ligaments
5. Joint surfaces
6. Special tests
7. Palpation

15

What does AROM evaluate?

General function/pain

16

What does PROM evaluate?

end feel
Evaluate ligaments and contractile tissues

17

What is the first area that should be assessed with examination of the hip?

Lumbar spine

18

What are the two AROM of the hip?

Squat up/down
Gait

19

What does the FABER test evaluate?

SI joint vs hip pathology

20

What does the SLR evaluate?

Sciatic pain

21

What is the thomas test?

Evaluation of tight psoas

22

What is the ely test?

Prone pt lift leg straight, causes lift of the hip. tight psoas

23

What are the two things you are evaluating when inspecting the hip?

Posture
Muscle and other contours

24

What are the two bits assessed with AROM of the hip?

Gait
Squat up and down

25

Lurching gait may indicate what?

Weakness of the gluteus minimus/medius or leg length discrepancy

26

What are the spinal nerve levels that the SLR evaluates?

L4, L5, S1

27

What is a positive SLR?

Pain in the sciatic distribution of the leg

28

What is the normal ROM of hip flexion?

140 degrees

29

What is a buttock sign?

Passive hip flexion is as (or more) limited and as painful as SLR

30

What does a buttock sign indicate?

Septic bursitis, ischio-rectal abscess, lesion of the sacrum

31

How do you assess passive internal rotation of the hip?

Pt is supine, flex knee and hip to 90, internally rotate

32

What is the normal internal rotation of the hip? External?

Internal = 45
External = 60

33

What are we looking for with testing the hip?

Looking for the presence of the capsular pattern of RROM.

34

What is the cause of capsular pattern of RROM?

Lesions of the fibrous capsule of the synovial membrane gives rise to painful passive ROm

35

Capsular pattern of RROM is what (flexion, abduction, adduction, rotation)?

Marked limitation of:
- Flexion/internal rotation
-abduction

-NO limitation of adduction/external rotation

36

What are the hip flexors?

-psoas
-Iliacus
-Rectus femoris

37

Painless weakness indicates what?

Nerve root lesions

38

What are the main hip extensors?

Hamstrings
Gluteus maximus

39

How do you assess resisted leg adduction?

Place fist between the knees, and have then squeeze

40

What are the primary adductors of the leg?

Pectineus
Adductor brevis/longus
Gracilis

41

What are the lateral/external rotators of the hip?

Gluteus maximus
Piriformis
Superior gemellus
Inferior gemellus
Obturator internus
Obturator externus
Quadratus femoris

(Gotta Pee, GO GO Quick)

42

When examining the hip, where should you always start? Why?

Lumbar spine for SDs and neurological issues

43

What are the two quick ways to assess ROM of the hip?

Squatting
Gait

44

What are the major arteries in the legs that you want to palpate when performing an examination of the hip?

Femorals

45

What is the Ely test?

If the heel cannot touch the buttocks, then the rectus femoris is tight

46

What is the Thomas test?

Flexion of the hip causes a contralateral leg flexion from a tight psoas

47

Painless weakness of the hamstrings is likely due to a lesion of what nerve root?

S1 or S2

48

What are the main flexors of the knee?

Quads

49

Hip pain with flexion of the knee is usually due to pathology of what muscle?

Rectus femoris

50

Painless weakness with the knee flexors is a lesion at what spinal level?

L3

51

Why is palpation done *after* AROM and PROM?

Many tissues overlying one another make this kind of palpation difficult to interpret without the basic exam first

52

What are the three classic history bits for a meniscal tear?

-Joint swelling
-Clicking
-Give way or buckling of the knee

53

What does Apley's test assess for?

Ligaments

54

What does Apley's distraction test assess for?

Meniscal injuries

55

What is the patellar grind test? What does it assess for?

-Compress the knee
-Assesses for chondromalacia

56

What are the two motions of the fibula?

Anterolateral
Posteromedial

57

What is supine thigh traction?

Pulling anteriorly on the tibia with the pt supine, to allow for venous and lymphatic drainage