Malingering and hip LE tests

Question 1

What is malingering?

Answer 1

Faking a complaint

Question 2

What do you do if your findings and their complaints don’t match (malingering)?

Answer 2

Refer out

Question 3

How should a case be recorded if you suspect malingering?

Answer 3

Might be a psychogenic or emotional component to their complaint
The patient findings do not correlate with my clinical expectation

Question 4

What are reasons or indications for malingering?

Answer 4

History or exam correlation
Pain drawings
Personal gain (worker’s comp)
Emotional needs
Patient says and writes two different things

Question 5

What orthopedic tests are used for malingering?

Answer 5

Hoover’s test
Plantar flexion test
Axial loading test
Petryn flip test
Magnuson’s test

Question 6

How is a Hoover’s test performed?

Answer 6

With the patient supine, the examiner raises the heel and asks the patient to lift the affected leg. Downward pressure should be felt on the unaffected side as the patient attempts to lift the symptomatic leg

Question 7

What is a positive finding for Hoover’s test?

Answer 7

ABSENCE of downward pressure on the UNAFFECTED side

Question 8

What is indicated by a positive finding for Hoover’s test?

Answer 8

Malingering

Question 9

If a Hoover’s test is performed and a patient cannot lift their right leg which they claim is hurting. You note no pressure on the other leg, how is this recorded and what is indicated?

Answer 9

Positive Hoover’s test indicating malingering

Question 10

What is a Hoover’s test used for?

Answer 10

Malingering for a patient indicating lower limb weakness or paralysis

Question 11

How is a Plantar Flexion test performed?

Answer 11

Doctor performs a straight leg raise to the point of pain, lowers it, then PLANTAR FLEXES the foot

Question 12

What is a positive finding for a Plantar Flexion test?

Answer 12

Complaint of exacerbation of sciatic pain

Question 13

What is indicated by a positive finding for a Plantar Flexion test?

Answer 13

Malingering

Question 14

What is a Plantar Flexion test used for?

Answer 14

Malingering in a patient reporting sciatic-like pain

Question 15

How is an axial loading test performed?

Answer 15

Patient standing, the examiner applies approximately 2 pounds of axial pressure to the top of the head

Question 16

What is a positive result for an axial loading test?

Answer 16

Report of exacerbation of low back or leg pain

Question 17

What is indicated by a positive result for an axial loading test?

Answer 17

Malingering

Question 18

What is an Axial Loading Test used for?

Answer 18

Malingering in a patient reporting low back or sciatic pain

Question 19

How is Petryn’s Flip Test performed?

Answer 19

Doctor performs passive knee extension on the affected leg without prior warning to the patient. Best performed incidental to other exam procedures

Question 20

What is a positive result for Petryn’s Flip Test?

Answer 20

NO exacerbation of leg pain

Question 21

What is indicated by a positive result for Petryn’s Flip Test?

Answer 21

Malingering

Question 22

When is a Petryn’s Flip Test performed?

Answer 22

Malingering in a patient reporting sciatic-like pain

Question 23

What LE orthopedic tests are used for malingering in a patient complaining of sciatic pain?

Answer 23

Plantar Flexion Test
Axial Loading Test
Petryn Flip Test

Question 24

How is Magnuson’s test performed?

Answer 24

The patient is questioned regarding the site of pain. Then other examination procedures are introduced by way of distraction. The patient is requested to point to the area of pain again.

Question 25

What is a positive finding for Magnuson's test?

Answer 25

Inconsistency in localizing the same site of pain

Question 26

What is indicated by a positive finding for Magnuson's test?

Answer 26

Malingering

Question 27

How can a patient with a hip condition present to your office?

Answer 27

Gait abnormality Pain standing or sitting Foot flare or internal rotation Clicking in hip Knee, SI, foot, ankle, or spine symptoms

Question 28

What can be used to measure leg length insufficiency?

Answer 28

Radiograph Tape measure Muscle tests Allis/Galeazzi's test

Question 29

What are possible signs that may indicate a leg length deficiency or insufficiency?

Answer 29

Unequal shoulder or pelvis height PI ilium (SI extension restriction) on side of long leg Knee or shoulder issues without trauma Adjustments that do not hold Difficult to adjust

Question 30

What three areas can a snapping hip syndrome occur?

Answer 30

Psoas major Labrum IT band

Question 31

A patient with a prone long leg will likely have a ____________ ilium or an SI ______________ restriction on the longer side?

Answer 31

PI, Extension

Question 32

An actual leg length check is more accurate than an apparent leg length check (TRUE/FALSE)?

Answer 32

t

Question 33

What is Allis/Galeazzi's sign?

Answer 33

Patient is supine, knees flexed and the HEELS EVEN on the examining table. Doctor observes from the inferior and bilaterally for evidence of asymmetry in the tibia or femur length AFTER the patient has been adjusted

Question 34

What is a present finding for Allis/Galeazzi's sign?

Answer 34

Knee height and tibial length differences for determination of congenital hip dislocation, tibial, or femoral shortening

Question 35

When is an Allis/Galeazzi's sign performed?

Answer 35

After the patient has been adjusted

Question 36

What is indicated by a present Allis/Galeazzi's sign?

Answer 36

Anatomical leg length deficiency

Question 37

When performing an Allis/Galeazzi's sign where does the doctor stand to observe tibial inequality?

Answer 37

Anterior

Question 38

When performing an Allis/Galeazzi's sign where does the doctor stand to observe femoral inequality?

Answer 38

Lateral

Question 39

What is an actual leg length measurement?

Answer 39

ASIS to the medial malleolus

Question 40

What is an apparent leg length measurement?

Answer 40

Umbilicus to the medial malleolus

Question 41

What is a significant finding for an apparent or actual leg length measurement?

Answer 41

Greater than 3 mm difference between right and left leg

Question 42

What muscle is the primary hip flexor?

Answer 42

Iliopsoas

Question 43

What muscle is responsible for lumbar lordosis?

Answer 43

Iliopsoas

Question 44

What orthopedic test can differentiate between a tight two joint hip flexor or tight iliopsoas muscle?

Answer 44

Thomas Test

Question 45

How is a Thomas Test performed?

Answer 45

Patient is instructed to sit close to the edge of the table. Patient flexes and holds one knee towards their chest. Then the patient is assisted into supine position while holding their knee until the low back is flat on the table. To differentiate between RF or TFL vs Iliopsoas tightness, perform passive extension of the knee which puts slack into the 2-joint hip flexors without affected the psoas

Question 46

What is a positive finding for a Thomas Test?

Answer 46

Hip flexion, which brings the thigh off of the examining table

Question 47

What is indicated by a positive finding for a Thomas Test?

Answer 47

Contracture of the hip flexors (RF, TFL) If thigh approximates table with passive knee extension the shortness is in the TFL or RF IF not, there is a short psoas

Question 48

If a Thomas Test is performed and the patients thigh approximates the table with passive knee extension, how is this recorded and what is indicated?

Answer 48

Positive Thomas Test indicating a tight TFL/ITB or RF

Question 49

If a Thomas Test is performed and the patients thigh does NOT approximate the table with passive knee extension, how is this recorded and what is indicated?

Answer 49

Positive Thomas Test indicating a tight iliopsoas

Question 50

What are other names for Patrick's test?

Answer 50

Fabere or sign of four

Question 51

How is a Patricks/Fabere/Sign of Four Test preformed?

Answer 51

Patients hip is flexed, abducted, and externally rotated so that the ankle of the side being tested is crossed superior to the opposite knee (Have patient make a four with their legs). Doctor may apply pressure to the femur downward toward the floor while stabilizing the opposite ASIS

Question 52

What is a positive finding for a Patricks/Fabere/Sign of Four Test?

Answer 52

Inability to perform motions or report of pain at the femoroacetabular joint

Question 53

What is indicated by a positive finding for a Patricks/Fabere/Sign of Four Test?

Answer 53

Femoracetabular joint lesion

Question 54

What orthopedic tests are specific to indicating a femoroacetabular joint lesion?

Answer 54

Patricks/Fabere/Sign of Four Test Laguerre's Test

Question 55

How is Laguerre's Test performed?

Answer 55

Performed as per Patricks but with the hip flexed to 90 degrees and overpressure on the knee to increase external rotation of the hip performed in multiple degrees of hip flexion

Question 56

What is a positive finding for Laguerre's Test?

Answer 56

Report of pain at the FA joint

Question 57

What is indicated by a positive finding for Laguerre's Test?

Answer 57

Femoroacetabular joint lesion

Question 58

What are the origin and attachment site for the TFL?

Answer 58

Iliocristalis tubercle to Gerdy's tubercle

Question 59

How is Ober's Test performed?

Answer 59

With the patient in side-lying position and the femur lined up along the mid axillary line, the doctor holds the ilium down firmly with one hand and grasps the flexed knee with the other. Doctor moves the upper leg into flexion, then abducts and extends the hip back to a neutral position in mid axillary line. Lower the leg slowly toward the table while supporting the medial knee

Question 60

What is a positive finding for Ober's test?

Answer 60

Inability to ADduct the hip back to its neutral position

Question 61

What is indicated by a positive finding for Ober's test?

Answer 61

IT band contracture

Question 62

What orthopedic test is used to determine a tight iliotibial band?

Answer 62

Ober's Test

Question 63

How is Trendelenberg's test performed?

Answer 63

With patient standing and examiner behind the patient, instruct the patient to flex one knee up toward the chest

Question 64

What is a positive finding for Trendelenberg's test?

Answer 64

Observe the gluteal fold on the flexed side for downward deviation as well as lateral translation of the weight bearing hip

Question 65

What is indicated by a positive finding for Trendelenberg's test?

Answer 65

Weakness of gluteus medius or minimus on standing leg side

Question 66

What orthopedic test can determine weakness of the gluteus medius and minimus?

Answer 66

Trendelenberg's test

Question 67

What is the action of gluteus medius and minimus?

Answer 67

Abduction and medial rotation of the hip

Question 68

What gaits are associated with gluteus medius pathology?

Answer 68

Trendelenberg gait Gluteus medius lurch

Question 69

Hibb's test can be done for what complaints?

Answer 69

Hip and SI

Question 70

A patient has a dim feeling of numbness overt their vastus medialis. What peripheral nerve is likely affected and what gait may they present with?

Answer 70

Obturator nerve; possible circumduction gait due to weakness of ADductors

Question 71

What nerve root should be considered if a patient has trouble lifting their toes?

Answer 71

L5

Question 72

What LE orthopedic test is a differential diagnosis test with the patient supine?

Answer 72

Goldthwaite

Question 73

What LE orthopedic test(s) is/are a differential diagnosis test with the patient standing?

Answer 73

Belt test/Supported Adams/Supported Bending Forward

Question 74

What LE orthopedic test(s) is/are a differential diagnosis test with the patient prone?

Answer 74

Nachlas and Ely's Heel to Buttock Test