Orthopaedics Flashcards
Hip pain ddx
Anterior (within hip joint)
- neck fracture
- septic arthritis
- labral tear
- arthritis
- avascular necrosis
Lateral
- trochanteric bursitis
- snapping hip
Posterior
- hamstring insertion
- radiculopathy radiating to hip
- piriformis syndrome
- SI pathology
Nobel test
Manoeuvre
- compress ITB with thumb proximal to knee
- extend knee
Correlation
-pain with extension = tight ITB
Ober test
Manoeuvre
- patient on side
- place arm under lower leg
- extend hip
- lower leg down to level of other knee
Correlation
-cannot lower to other knee = tight ITB
Thomas’ test
Manoeuvre
- Flex both knee up to stomach
- Patient holds knees
- Lower one leg out straight
Correlation
-Cannot lay leg out flat = fixed flexion of hip
FABER test
Manoeuvre
- Flex hip, abduct hip, externally rotate hip
- stabilise other side of hip with hand
- press down on knee
Correlation
-posterior hip pain = SI pathology (sacroilitis)
FAIR test
Manoeuvre
- lay on side
- flex hip, adduct hip and internally rotate
Correlation
-sciatica type pain = pirifonmis syndrome
Pivot shift
Manoeuvre
- Patient supine
- hold heel with one and and proximal fibula with other
- apply valgus force and internally rotate tibia
- flex knee
Correlation
- ACL laxity if tibia/fibia drops down (reduces) at approx 45 degrees
- ITB pulling on tibia
Thessalys
Manoeuvre
- patient standing on one leg, knee slightly flexed
- rotate patient both direction
Correlation
- pain with rotation to contralateral = medial meniscus
- pain with rotation to ipsilateral = lateral meniscus
McMurrays
Manoeuvre
- patient supine
- maximally flex knee
- IR of tibia, varus force, extension
- ER of tibia, valgus force, extension
Correlation
- IR of tibia, varus force, extension = lateral meniscus
- ER of tibia, valgus force, extension = medial meniscus
Patellar apprehension test
Manoeuvre
- leg extended
- varus force on patellar while flexing knee
Correlation
-patient apprehension = patellar laxity
Clarkes test
Manoeuvre
- leg straight
- grasp patellar with web of thumb from above
- patient extends knee fully
Correlation
-pain in knee = patellofemoral syndrome/osteoarthitis
Schober test
Manoeuvre
- Mark spot on spine in line with posterior iliac spine (L%)
- Mark spot 10cm above and 5cm below
- Patient bends forward to touch toes
Correlation
-Increase <5cm = limited flexion
Straight leg raise
Manoeuvre
- lying supine
- raise straight leg as far as possible
Correlation
- normal range = approx 90
- limited by pain (approx 30-60) = radiculopathy at L5-S1
- provocation with dorsiflexion at lower angle confirms
femoral nerve stretch
Manoeuvre
- patient prone
- flex knee, extend hip and plantar flex
Correlation
-pain in thigh/groin = lumbar radiculopathy at L2-L4
tripod sign
Manoeuvre
- patient seated at edge of bed
- extend knee
Correlation
- patient sits back and supports self with both arms
- pain in the back and down the leg
- indicative of radiculopathy
