lower extremity lab tests

Question 1

lumbar spine bony palpation

Answer 1

lumbar spine bony palpation

lumbar spinous processes (count out loud
sacral tubercles
iliac crest
posterior superior iliac spine

Question 2

lumbar spine soft tissue palpation

Answer 2

lumbar spine soft tissue palpation

supine:
anterior abdominal muscles - half sit-up, palpate, pt. relax, quickly palpate
- instruct pt. to turn over

prone: 
paraspinal muslces
 - as unit
 - spinalis (spine - medial)
 - longissiums (middle)
 - iliocostalis (lateral)
sciatic nerve
gluteus maximus
gluteus medius
hamstrings 
 - as unit
 - biceps femoris  - lateral
 - semitendinosus - middle
 - semimembranosis - medial

Question 3

straight leg raiser (SLR)

Answer 3

straight leg raiser (SLR)

+ radiating pain and/or dull posterior thigh pain indicates sciatic radiculopathy or tight hamstrings. + b/w 35-70 degrees indicates possible discogenic sciatic radiculopathy. + greater than 70 degrees indicates tight hamstrings

Question 4

goldthwait sign (3 fingers)

Answer 4

goldthwait sign (3 fingers)

ask pt. to raise shirt to bottom of ribs
- contact lower back

+ localized pain, low back, or radiating pain down the leg indicates lumbo-sacral or sacroiliac pathology. pain occuring before the lumbars move is possible sacroiliac problem. pain occuring after the lumbar spinouses move is possible lumbo-sacral problem.

Question 5

bragard sign

Answer 5

bragard sign

perform SLR
pt. feels pain
lower leg 5 degrees or until pain subside
dorsiflex foot

+ radiating pain in posterior thigh indicates sciatic radiculopathy

Question 6

buckling sign

Answer 6

buckling sign

pt. supine
perform SLR
show buckle
+ pain in the posterior thigh with sudden knee flexion (buckle) indicates sciatic radiculopathy

Question 7

bowstring sign

Answer 7

bowstring sign

pt. supine
ex. places pt.’s leg on shoulder
palpate
- muscle belly
- tendons
- popliteal fossa

+ pain in the lumbar region or radiculopathy indicates sciatic nerve root compression, helps rule out tight hamstrings

Question 8

lasegue test

Answer 8

lasegue test

pt. supine
hip and leg bent to 90 degrees
slowly extend knee

+ reproduction of sciatic pain before 60 degrees indicates sciatica

Question 9

milgram test

Answer 9

milgram test

pt. supine
ex. raises both legs 2-3”
instructs pt. to hold in place
30 sec or until point of pain

+ inability to perform test and/or low back pain indicates weak abdominal muscles or space occupying lesion

Question 10

valsalva maneuver

Answer 10

valsalva maneuver

• instruct pt. to take deep breath
• hold
  bear down as if you’re having a difficult bowel mvmt

+ radiating pain from site of lesion (usually recreating the complaints in cervical or lumbar area of the spine) indicates space occupying lesion (e.g. disc pathology)

Question 11

bechterew test

Answer 11

bechterew test

• pt. seated
• ex. instructs pt. extend one knee @/time, then both together
• show positive

+ reproduction of radicular pain or inability to perform correctly due to tripod sign indicates sciatic radiculopathy

Question 12

neri bowing test / sign

Answer 12

neri bowing test / sign

• instruct pt. to bend fwd @ waist
• stand by pt. spotting them

+ pain accompanied by flexion of the knee on the affected side and body rotation away from the affected side indicates positive with a variety of low back pathologies. hamstring tension on the pelvis may trigger the response.

Question 13

anterior innominate test aka mazion pelvic maneuver (advancement sign)

Answer 13

• pt. standing
• instruct pt. to advance 1 leg/time
• then to bend over - advanced knee straight

+ the inability to bend at the waist more than 45 degrees due to either/or radiating pain along the sciatic nerve, either unilateral or bilateral indicates sciatic neuralgia or radiculopathy, etc, possibly due to lumbar disc pathology
+ low back pain (lumbar or pelvic regions) indicates anterior (rotational) displacement of the ilium relative to the sacrum

Question 14

lewin standing test

Answer 14

lewin standing test

• ex. instructs pt. to get in skiing position
• ex. pushes one knee into complete extension, the other, then both while in position

+ radiating pain down the leg causing flexion of the patient’s knee or knees indicating gluteal, lumbosacral, or sacroiliac pathologies

Question 15

heel walk

Answer 15

heel walk

• instruct pt. to take 6 steps
  (3 full gaits) on their heels

+inability to perform test indicates L4/L5 disc lesion
(L5 nerve root)

Question 16

toe walk

Answer 16

toe walk

• instruct pt. to take 6 steps
  (3 full gaits) on their toes

+ inability to perform test indicates L5-S1 disc lesion
(SI nerve root)

Question 17

ely heel to buttock test

evans - aka ely sign

Answer 17

ely heel to buttock test
(evans - aka ely sign)

• pt. prone
• ex. flexes knee to 90
• ex. approximates heel to contralateral buttock
• ex. hyperextends thigh off table

+ inability to raise thigh indicates iliopsoas spasm
+ pain in the anterior thigh indicates inflammation of lumbar nerve roots
+ pain in the lumbar region indicates lumbar nerve root adhesions

Question 18

trendelenburg test

Answer 18

trendelenburg test

• pt. stands on involved foot
• observe level of hips

+high iliac crest on supported side & low crest on side of elevated leg indicates weak gluteus medius muslce on the supported side

Question 19

knee bony palpation

Answer 19

knee bony palpation

1) patella
2) medial tibial plateau
3) medial femoral condyle
4) lateral tibial plateau
5) lateral femoral condyle
6) tibial tuberosity
7) fibula head

Question 20

knee soft tissue palpation

Answer 20

knee soft tissue palpation

quadriceps muscles

1) vastus medialis - medial
2) rectus femoris - center
3) vastus intermedius - deep center
4) vastus lateralis - push on IT band
5) prepatellar bursa - patella
6) infrapatellar tendon - superficial (above and below patella)
7) superficial infrapatellar bursa
8) medial meniscus
9) medial collateral ligament
10) pes anserine area
- sartorius
- gracilis
- semitendinosus
10) lateral meniscus
11) lateral collateral ligament
12) gastrocnemius muscle

Question 21

mcmurray sign

Answer 21

mcmurray sign

pt. supine
- flex pt’s affected hip to 90 degrees and affected knee to 90 degrees
- internal / varus
- external / valgus

+ clicking sound, or pain by knee joint indicates tear of medial meniscus if positive on external rotation. tear of lateral meniscus if positive on internal rotation. the higher the leg is raised during extension when positive is elicited, the more posterior the meniscal injury

Question 22

medial collateral ligament test aka: ‘aBduction stress test’ aka ‘valGus stress test’

Answer 22

medial collateral ligament test aka: ‘aBduction stress test’ aka ‘valGus stress test’

pt. supine
stablize lateral thigh of pt’s affected leg
gradually pushes laterally
(to open medial side of joint)

+ gapping and/or elicited pain above/at/or below joint line indicates tear and/or instability of the medial collateral ligament

Question 23

Hip/pelvis bony palpation

Answer 23

Hip/pelvis bony palpation

anterior:
1) anterior superior Iliac spine- skin on skin
2) iliac crest- skin on skin
3) iliac tuberosity
4) greater trochanter

—ask pt. to flip over onto stomach

posterior
1) posterior superior iliac spine - skin on skin
2) ischial tuberosity- neutral hand
BEFORE COCCYX PALPATION
- I’m contacting your tail bone at the end of your spine
3) coccyx

Question 24

hip/pelvis soft tissue palpation

Answer 24

hip/pelvis soft tissue palpation:

anterior: supine
* ask pt (show) to cover genitals
* put pt. into figure 4

femoral triangles borders:

1) sartorius
2) adductor longus
3) inguinal ligament

quadriceps muscles (group/individual palpate)

1) vastus medialis (medial)
2) rectus femoris (aiis) superficial midline
3) vastus intermedius (deep to rectus femoris) - move out of way
4) vastus lateralis- press on IT band to pop out
5) greater trochanteric bursa

—tell pt. to flip over onto stomach

posterior: prone
1) gluteus medius (from psis to greater trochanter) - hand on psis
2) gluteus maximus- hand on psis
3) sciatic nerve- 1/2 b/w gr. troch / ischial tuberosity
4) cluneal nerves- in b/w iliac crest and psis

hamstrings (palpating group and individually)

1) semimembranosus (medial) ish tub—> pea anserine
2) semitendinosus (middle)- ish tub—> med tibial condyle
3) biceps femoris (lateral)

anterior: supine
* ask pt (show) to cover genitals
* put pt. into figure 4

femoral triangles borders:

1) sartorius
2) adductor longus
3) inguinal ligament

quadriceps muscles (group/individual palpate)

1) vastus medialis (medial)
2) rectus femoris (aiis) superficial midline
3) vastus intermedius (deep to rectus femoris) - move out of way
4) vastus lateralis- press on IT band to pop out
5) greater trochanteric bursa

—tell pt. to flip over onto stomach

posterior: prone
1) gluteus medius (from psis to greater trochanter) - hand on psis
2) gluteus maximus- hand on psis
3) sciatic nerve- 1/2 b/w gr. troch / ischial tuberosity
4) cluneal nerves- in b/w iliac crest and psis

hamstrings (palpating group and individually)

1) semimembranosus (medial) ish tub—> med tibial condyle
2) semitendinosus (middle)- ish tub—> pes anserine (medial)
3) biceps femoris (lateral)

Question 25

leg length discrepancy

Answer 25

leg length discrepancy pt. supine measure from asis to med malleolus- both sides - change sides ask pt to raise shirt to above belly button measure from umbilicus to med mallelous- both sides + different measurements indicates true = bony abnormality above or below level of trochanteric difference (anatomical short leg) + apparent = pelvic obliquity (tilted pelvis)

Question 26

Allis sign / galeazzi sign

Answer 26

Allis sign / galeazzi sign pt. supine instruct pt. to place feet flat on table place hands on top of knee, and anterior + difference in height and anteriority knees indicates 1) if one knee is lower = ipsilateral congenital hip dislocation or tibial discrepancy (anatomical short leg) + if one knee is anterior = ipsilateral congenital hip dislocation or femoral discrepancy (contralateral anatomical short leg)

Question 27

Thomas test

Answer 27

Thomas test ``` pt. supine ask pt. to raise shirt to bottom ribs state you'll be contacting lower back contact lower lumbars in middle ask pt. to bring knee to chest / both sides ``` + lumbar spine maintains lordosis (should flatten) and hip or leg flexes indicating contracture of hip flexors (iliopsoas)

Question 28

Anvil test

Answer 28

Anvil test pt. supine tell pt. you're tapping their heel with heel of hand lift leg slightly tap (strike hard) heel + localized pain in the long bone or in hip joint indicates possible fracture of long bone or hip joint pathology

Question 29

Patrick test (aka FABRE sign)

Answer 29

Patrick test (aka FABRE sign) pt. supine place pt in figure 4 1 hand asis and other hand proximal to knee + pain in the hip region indicates hip joint pathology

Question 30

Laguerre test | aka FABRE in the Air

Answer 30

Laguerre test (aka FABRE in the Air) ``` pt. supine lift leg slide into cubital crease stabilize on contralateral asis place pt in figure 4 1 hand asis and other hand proximal to knee ``` + pain in the hip region indicates hip joint pathology + pain in the sacroiliac joint indicates mechanical problem of the sacroiliac joint

Question 31

Gaenslen Test

Answer 31

Gaenslen Test pt. in supine position ask pt to scoot edge table asis - off table so leg can completely hang off place hip against table facing away from pt. stabilize shoulder or asis pressure on thigh 3" above knee + pain on the affected sacroiliac joint stressed into extension indicates general sacroiliac joint lesion, anterior sacroiliac ligament sprain or inflammation of the sacroiliac joint

Question 32

Lewin-Gaenslen Test

Answer 32

Lewin-Gaenslen Test pt. laying on side instruct pt. to use bottom hand as pillow straighten spine/ slight flexion of bottom leg instruct pt. to bring bottom knee to chest bend top knee stabilize above crest on quadtratus lumborum (lumbars) & distal femur bring leg back + pain on the affected sacroiliac joint stressed into extension indicates general sacroiliac joint lesion, anterior sacroiliac ligament sprain, or inflammation of the sacroiliac joint

Question 33

Hibb Test

Answer 33

Hibb Test ``` pt. prone bring knee to 90 deg pause bring knee - maximal flexion to buttocks push lateral on thigh - internally rotate ``` + pain in the hip region indicates hip joint pathology (lateral) + pain in the buttock/pelvic regions indicates sacroiliac joint lesion (posterior)

Question 34

Ober Test

Answer 34

Ober Test ``` pt. on side instruct pt to use bottom arm as pillow stabilize iliac crest (top) hold distal end femur bring leg up - slight knee flexion (holding it downward) aBduct leg extend the leg support knee, then drop under upper thigh (tell pt. to relax) remove hand under thigh ``` + affected thigh remains in abduction (normal biomechanics, thigh/hip will aDduct) indicates contraction of the iliotibial band or tensor fascia lata. (usually secondary to synovitis of the hip, secondary to trauma of teh gluteus medius and maxiumus)

Question 35

Pelvic Rock test aka "Iliac Compression test"

Answer 35

Pelvic Rock test aka "Iliac Compression test" pt. on side use bottom hand as pillow straighten pt's legs...some flexion + pain in either sacroiliac joint indicates sacroiliac joint lesion

Question 36

Nachlas test | knock, knock, knock

Answer 36

Nachlas test ``` pt prone bring knee to 90 degrees look for ely's sign pause bring heel to buttock ``` + pain in the buttock and/or pain in the lumbar region indicates sacroiliac joint lesion or lumbar pathology

Question 37

Yeoman's test | yo, man, put my leg down

Answer 37

Yeoman's test pt. prone flex pt. leg (bend knee) same side buttocks extend thigh off table + pain deep in the sacroiliac joint indicates sprain of the anterior sacroiliac ligaments

Question 38

Ely sign (Ely test)

Answer 38

Ely sign (Ely test) pt. prone examiner flexes knee toward same side buttock bring knee to 90 deg and stop + hip on side being tested will flex causing the buttock to raise off the table indicating rectus femoris or hip flexor contracture

Question 39

Ely Heel to Buttock Test | Evans - Ely sign (aka

Answer 39

Ely Heel to Buttock Test (Evans - Ely sign (aka) pt. prone examiner flexes knee to 90 degrees for ely's sign pause heel to buttock on opposite buttock and hyperextend thigh off table + inability to raise thigh indicates iliopsoas spasm +pain in the anterior thigh indicates inflammation of lumbar nerve roots + pain in the lumbar region indicates lumbar nerve root adhesions

Question 40

Trendelenburg test

Answer 40

Trendelenburg test ``` pt. is standing examiner kneels standing behind pt. holding pt's hips pt. lifts leg pt. bends knee foot 8-10" off ground *thumbs on psis * hands around iliac crest ``` + high iliac crest on supported side and low crest on side of elevated leg indicates weak gluteus medius muscle on the supported side

Question 41

Lateral Collateral ligament test (aka ADduction stress test aka Varus stress test)

Answer 41

Lateral Collateral ligament test (aka ADduction stress test aka Varus stress test) pt. supine examer stabilizes medial thigh of pt's leg gradually push medially (opening lateral side of joint) + gapping and/or elicited pain above/at/or below joint line indicates tear and/or instability of lateral collateral ligament

Question 42

Bounce Home test

Answer 42

Bounce Home test ``` pt. supine flex pt's knee raise leg 30 degrees place hand underneath knee remove pressure keep hand loosely underneath knee for support ``` + kneee does not go into full extension (slight flexion remains) indicates diffuse swelling of the knee, accumulation of fluid, due to possible torn meniscus

Question 43

Drawer test

Answer 43

Drawer test ``` pt. supine hip at 45, knee at 90 bring pts. foot flat on table ask permission to sit on foot sit on pt's foot examiner grasps behind flexed knee push and pulling into affected knee ``` + gapping greater than 6mm when leg is pushed, (tibia moves posterior), indicating torn posterior cruciate ligament +gapping greater than 6mm when leg is pulled, (tibia moves anterior), indicating torn anterior cruciate ligament

Question 44

Lachman test

Answer 44

Lachman test pt. supine ex. brings pt.'s knee to 30 degree angle use thenars - anterior push femur clasp behind knee - posterior pull tibia + gapping with the tibia moving away from the femur indicating anterior cruciate ligament or posterior oblique ligament instability

Question 45

Apprehension test for Patella

Answer 45

Apprehension test for Patella ``` pt. supine stand on OPPOSITE SIDE stabilize on thigh LOOK at patient's FACE use 2 thumbs push patella laterally once ``` + apprehension, distress of facial expression, contractions of quadriceps to bring patella back in line indicates chronic patella dislocation or pre-disposition to dislocation

Question 46

Patella Femoral Grinding test | aka "Clarke sign"

Answer 46

Patella Femoral Grinding test aka "Clarke sign" ``` pt. supine knee extended face pt. use web of hand to place distal to patella instruct pt. to push knee to table ``` + retropatellar pain and the pt. is able unable to hold the quadricepts contraction indicating degenerative changes of the patellar facets and/or within the trochlear groove (chondromalacia patella)k

Question 47

Patella Ballottment test

Answer 47

Patella Ballottment test ``` pt. supine knee extended A-P pressure over patella can blot with several fingers or use flat hand to press down ``` + a floating sensation of the patella indicates a large amount of swelling in the knee

Question 48

Apley Compression test

Answer 48

Apley Compression test ``` pt. prone ask pt. to place knee on back of their thigh bring knee to 90 degrees *place your knee on back pt's thigh clasp hands pushing down on leg 1) neutral release 2) rotate interally push release 3) rotate externally push release ``` + patient points to side of pain indicates pain on medial side is medial meniscus tear. pain on the lateral side indicates lateral meniscus tear

Question 49

Apley Distraction test

Answer 49

Apley Distraction test ``` pt. prone bring knee to 90 degrees ask pt to place knee on back of their thigh place knee on pt's thigh pull up - neutral release rotate internally pull up release rotate externally pull up release ``` + patient will point to side of pain indicating pain on medial side indicates medial collateral ligament tear. pain on lateral side indicates lateral collateral ligament tear

Question 50

Foot and Ankle Bony palpation

Answer 50

Foot and Ankle Bony palpation ``` calcaneous medial malleolus (tibia) lateral malleolus (fibula) talus navicular tubercle navicular sustentaculum tali 3 cuneiforms 5 metarsals - count 5 metarsalphalangeal joints - count phalanges ```

Question 51

Foot and Ankle Soft tissue

Answer 51

Foot and Ankle Soft tissue 1) plantar aponeurosis 2) achilles tendon 3) spring ligament - (behind med. malleolus) 4) deltoid ligament (underneath med. malleolus) 5) tibialis anterior tendon - 1st mt base (point up and in) 6) peroneous brevis tendon (point up and out - lateral side - goes into 5th metatarsal) 7) tibialis posterior tendon (point down and in - behind medial malleoulus) 8) anterior talofibular ligament (b/w talus & fibula - medial) (short horizontal ligament) 9) posterior tibial artery (3-5 sec behind medi mall) 10) dorsal pedal artery (3-5 sec @ crease anterior talus)

Question 52

Drawer sign | aka Anterior Drawer sign of the Ankle

Answer 52

Drawer sign (aka Anterior Drawer sign of the Ankle) ``` pt. supine instruct pt. to scoot down table fist width from med. malleolus hold under calcaneous stabilize distal tibia push anterior to posterior hands - same position for pushing & pulling pull posterior to anterior ``` + translation with the talus moving away from or towards the tibia indicates with foot pulled/tibia pushed, tear/instability of the anterior talofibular ligament + with foot pushed/tibia pulled, tear/instability of posterior talofibular ligament

Question 53

Ankle Dorsiflexion test | active

Answer 53

Ankle Dorsiflexion test (active) "pt. presents with inability to dorsiflex their foot" ``` pt. sits at end of table state -'pt. cannot dorsiflex foot' stabilize calcaneous hand underneath foot extend leg - try to dorsiflex foot let leg down - dorsiflex foot ``` + foot cannot dorsiflex w/ knee extended, indicates contracture of gastrocnemius (2 joint muscle) muscle + foot cannot dorsiflex in either knee position indicates contracture of solueus muscle

Question 54

Rigid or Supple Flat Feet test

Answer 54

Rigid or Supple Flat Feet test ``` pt. seated show pt. areas being observed place fingers inside arch (should be to PIP) ask pt. to stand place fingers inside ea. arch (should be to DIP) ``` + absence of medial longitudinal arch in both positions indicates Rigid Flat Feet + presence of medial longitudinal arch while seated with a loss of medial longitudinal arch while standing indicates supple flat feet

Question 55

Homan's Sign

Answer 55

Homan's Sign pt. supine examiner raises pt's leg 12" off table w/ knee in extension ex. then dorsiflexes foot "some sources say to squeeze the calf, we will not be doing that today" + deep pain in the calf indicates deep vein thrombophlebitis

Question 56

Thompson test | prone, pump, plantarflexion

Answer 56

Thompson test (prone, pump, plantarflexion) ``` pt. prone flex knee to 90 hold anterior to support lightly grab/squeeze ex squeezes belly of gastrocs ``` + absence of foot plantarflexion motion indicates achilles tendon rupture

Question 57

Morton test | hamburger squeeze

Answer 57

Morton test (hamburger squeeze) + sharp pain in the forefoot indicates metatarsalgia or neuroma (usually at the 3rd and 4th metatarsal interspace)