Lower limb Flashcards
(13 cards)
Syndesmosis pain
Squeeze test
• tibiofibular syndesmosis
- grasp patients leg midway up calf and perform compression
+ pain in area of syndesmosis
Cross Legged
• tibiofibular joint dysfunction/ syndesmosis
- patient seated. Cross leg over other. Gap in syndesmosis will be irritated
+ pain in area of syndesmosis
External rotation test
• tibiofibular syndesmosis in joint
- patient seated. Hold counter tension in shin rotate ankle with counter tension in other hand.
+ tibiofibular joint dysfunction (over interosseous membrane
Achilles
Hoffa’s
•Achilles tendon
- lie face down. Foot will be in dorsiflexiob
+ no tension seen in foot
Thompson’s (Simmons)
• patient seated or prone. Squeeze gastroc muscle. Foot will come up slightly.
+ no tilt in Achilles’ tendon. No plantar flexion. No movement
F-ve : soleus May not be ruptured. Can still get movement.
Ankle
Talar tilt
• calcaneofibular ligament (lateral)
- patient supine. Stabilise foot. Pull ankle inwards (invert ankle)
+ pain over local area of ligament
Anterior drawer
• anterior talofibular ligament (lateral)
- patient supine, stabilise ankle. Putt ankle anteriorly
+ pain over local ligament. If Rupture will see ligament come forward
Knee meniscus
Thessaly (disco test)
• meniscus lesion/tear
- patient stand on one leg. 20deg flexion in knee. Rotate body in and out
+ won’t be able to since pain
McMurray’s
• meniscus lesion/tear
- patient supine with knee and hip in max flexion. Hold foot and knee in max external/internal rotation. Passively extend knee into 90deg flexion and rotate at intervals
+ pain with external & abduction - medial
+ pain with internal - lateral
+ clicking ( lateral condyle of femur
Knee stability
Valgus
• medial collateral ligament
- patient supine. Hold knee at tibia head, palpate joint cavity. Abduct (apply pressure lateral to medial)
+ pain over medial ligament if tear
+ instability if rupture (increase movement)
Varus
• lateral collateral ligament
- patient supine, hold knee at tibia head, palpate joint cavity. Adduct (apply pressure medial to lateral)
+ pain over lateral ligament if tear
+ instability if rupture (increase movement)
Patella
Patella apprehension •patello-femoral joint - patient supine. Hold patella and gently push with thumbs, medial to lateral \+ contract quads to stabilise kneecap \+ apprehension and don’t want you to do \+ previous dislocation or instability
Patella grind
• patello-femoral
- patient supine. Hold either side of patella and twist (grind)
+ irritability/pain in joint
ACL & PCL
Anterior drawer
• ACL
- patient supine, hip flexed (45deg), knee flexed (90deg). Sit in foot. Pull tibia anteriorly
+excess movement of tibia with ‘thunk’ at end
Lachman’s
•ACL
- patient supine. Hold knee b/t 20-30deg flexion. Sl rotate tibia, apply anterior tibial force (pull forward)
+ pain, ‘clunk’, extra movement
Posterior drawer
•PCL
- patient supine. Hip flexed (45deg), knee flexed (90deg). Sit on floor. Push tibia head from anterior to posterior
+ no resistance. Rupture of PCL. ‘Sag’
Posterior sag
•PCL
- patient supine, Leg and knee in 90deg flexion. Observe
+ tibia will sag (drop) so see step - PCL rupture
Hip
Thomas
• hip extension (iliopsoas)
- patient supine. Ask to bring knee to chest and add stretch
+ if knee flexes (may or may not have pain)
F: anterior thigh muscle stretch
Trendelenberg’s
• abductors (pelvic and glut medius)
- ask patient to stand. Lift one leg ( bend at knee) and hold.
+ if drop on leg lift side.
Patrick’s FABERE
• hip joint at acetabulum
- lay supine, flex knee rest ankle on other knee, one hand on ilium on opposite side, push knee down towards bed and see if pain.
- Flexion, ABduction, External Rotation, Extension
+ hip joint pain in flexed side
FAIR (FADIR) • hip joint at acetabulum lay supine, flex knee, push knee towards other knee and lower. - Flexion, ADduction, Internal Rotation \+ hip joint pain in flexed side
Scour
• hip joint at acetabulum, labrum
- flex knee, hold over patella and at achillies tendon, adduct, internal and external rotation then middle then adduct and slowly extend while internal external rotation
+ pain in hip, rubbing articular surfaces, clicking or rubbing
F: if pain in butt then SIJ
Pelvis 3/6
Sacroiliac distraction
• anterior sacroiliac ligaments
- patient supine, exert anterior pressure on iliac wings with arms crossed. Push anterior to posterior
+ pain in SIJ (backside)
Thigh thrust
• SIJ
- patient supine, opposite leg flexed at knee and abducted towards examiner, grasp knee and palpate SIJ on opposite side. Exert pressure anterior to posterior
+ pain in SIJ (backside)
Gaenslen’s
• SIJ
- patient supine, Leg off table, flex other knee and a duct towards patient
+ pain in SIJ (backside)
Sacroiliac compression. (Side-lying)
• indicates sacroiliac disease (posterior part more)
- patient lying lateral. Apply downward pressure of ilium (building pressure) (b/t ASID and trochanter)
+ pain in SIJ (backside)
Sacral thrust
• SIJ
- patient prone, apply pressure downwards with two hands over iliac crest
+ pain in SIJ
Finger Fortin • SIJ - ask patient to point with single finger to where pain is \+ will point to SIJ \+
Orthopaedic Test of lumbar spine
Slump
• patient seated, flex head, extend patients knee and dorsiflex foot. Is there any pain?
+ pain in lumbar spine or traveling down leg
F: tight hamstring may produce sharp, pulling pain but will not travel below knee
Well leg raise (WLR) and straight leg raise (SLR)
• sciatic nerve stretch
- patient lying down. Lift knee at ankle, other hand resting gently over knee to feel if they want to bend
+ Pain at 40-60deg
+ usually indicates disc protrusion
+ WLR will either aggravate or relieve
Femoral nerve stretch
•anterior thigh
- patient prone, lift flexed knee
+ sharp, tingling pain along distribution
Valsalva
• lumbar
- ask patient to unblock ears, put thumb in mouth and blow like a balloon
+ pain in lumbar region
Lumbar quadrant (Kemp’s)
• lumbar pain
- patient seated with arms across chest, push knuckle over articulated facets on each side of lumbar column. Extend, rotate and laterally flex to each side
+ lumbar pain
Muscle stretch reflex
0 - no contraction \+ (+1) - mild contraction \++ (+2) - normal \+++ (+3) - hyper - v. Brisk \++++ (+4) - v brisk with clonus
Quadriceps - L4 - femoral nerve
Patella tendon
Hamstrings - L5 - tibial
Membranous/tendinosus
Gastroc Soleus - S1 - tibia
Achilles
Dermatomes
Crude touch - anterior and lateral spinothalamic - dull end safety pin
Light touch - posterior (dorsal) column - cotton ball
Temp - lateral spinothalamic
Vibration - posterior (dorsal) column - tuning fork on finger nail
Nociception - lateral spinothalamic - sharp end safety pin
Proprioception - posterior (dorsal) column - hold sides of finger, move up or down
L1-3 L4 L5 S1 S2 S3-4
Posterior femoral cutaneous N
Lateral femoral cutaneous N
Genitofemoral N
Obturator N
Saphenous N (femoral)
Common Peroneal N
Superficial Peroneal N
Deep Peroneal N
Sural N
Tibial N
Medial and lateral plantar N
Myotomes
5 Normal - hold against gravity and 5-10sec of sustained pressure
4 Good - hold against gravity, resist some additional pressure
3 Fair - can hold up against gravity
2 Poor - some activity, cannot hold up against gravity
1 Trace - palpable, visual contraction - atrophy
0 Zero - completely paralysed, no movement
L4
L5
S1
