Lower limb

Question 1

Syndesmosis pain

Answer 1

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

Question 2

Achilles

Answer 2

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.

Question 3

Ankle

Answer 3

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

Question 4

Knee meniscus

Answer 4

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

Question 5

Knee stability

Answer 5

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)

Question 6

Patella

Answer 6

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

Question 7

ACL & PCL

Answer 7

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

Question 8

Hip

Answer 8

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
• lay supine, flex knee, push knee towards other knee
- Flexion, ABduction, External Rotation, Extension
+ hip joint pain in flexed side

FAIR (FADIR)
• lay supine, flex knee, push knee towards other knee
- Flexion, ADduction, Internal Rotation
+ hip joint pain in flexed side

Scour
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