Pathologies and their relevant tests

Question 1

Labral tear

Answer 1

Physical exam: FADIR, FABER Flexion internal rotation - no pain pain. Good for ruling out (sensitivity). Pain on Thomas test
Patient Interview: Painful clicking in hip

Question 2

Intra articular pathology (non specific)

Answer 2

FABER and Scour test (FADIR)-pain, screening tool. Thomas test - pain and reduced range, high sensitivity and specificity (positive likely to indicate injury).

Question 3

Femoral fracture

Answer 3

Patellar pubic percussion - reduced percussion on side of pain.

Question 4

Gluteal tendinopathy

Answer 4

Trendelenburg - drop in NWB pelvis.
Resisted hip abduction, resisted hip internal rotation - weakness and pain.
Three most useful tools with good specificity (hip abd has high sensitivity)
Resisted external deretoation test and single leg stance hold for 30 - Pain. Both have low clinical utility but can be useful screening tool.

Question 5

Hip OA

Answer 5

Squatting aggravates symptoms (low LR-), lateral pain on active hip flexion (low LR- and high LR+) Scour test positive, pain with active hip ext, passive internal rotation <25 (low LR+)

Question 6

ACL injury

Answer 6

Physical exam: Lachmans test - wanted soft end feel on tibial translation (specific and sensitive). Anterior draw test - >5mm tibial translation (specific). Pivot shift - anterior subluxation of tibia (specific, need intack MCL and ITB)
Patient Interview: Immediate (0-2 hr) swelling, audible pop or tear

MUST DO SAG SIGN to interpret this test (start further back may be perceived more movement)

Question 7

PCL injury

Answer 7

Interview: Pain in posterior knee, pain with kneeling. Minimal swelling as it is extra synovial.

PE: Posterior sag sign (high specificity and can be highly sensitive). Posterior draw - >5 mm tibial translation (highly specific and can be highly sensitive) Reverse Lachman’s test - soft end feel on tibial translation (specific and moderately sensitive).

Question 8

Meniscal tear

Answer 8

Interview: Delayed swelling (6-24hr) with effusion. Clicking or locking. Giving away. Some patient may describe a tearing sensation.

PE: McMurray’s test - palpable or audible click/pain (positive finding can point to meniscal, but neg cannot rule out). Joint line tenderness (45-90) - patients pain (positive finding is specific and sensitive). Apleys test - Pain (little worse than McMurrays in that is is somewhat specific and sensitive)

Question 9

MCL

Answer 9

Interview: If the sprain is quite deep then immediate swelling can occur but if it is superficial then no swelling.
PE: Valgus stress test at 30 - pain is best factor but laxity is also very sensitive (grade of tear will determine laxity).

Question 10

LCL

Answer 10

Varus stress test at 30 - looking for pain and laxity

Question 11

Acute injuries

Answer 11

Specific/sudden MOI which often involves high force load.
Traumatic event which occurred at specific time point.
Amount of dysfunction is directly linked with injury severity (speed/amount of swelling can also indicate this)

Question 12

Ligament injury PI

Answer 12

Specific/sudden MOI which often involves high force load.
Traumatic event which occurred at specific time point.
Amount of dysfunction is directly linked with injury severity (speed/amount of swelling can also indicate this)

Question 13

Ligament injury PE

Answer 13

Ligament stress test (pain reproduction, end feel and laxity)
Grade 3 may have les pain, particular on stress test, due to limited nociceptors (only if isolated ligament strain, ACL sees this) but normally other tissues provoke pain inn presence of G3

Palpation over specific ligament (pain)

Swelling around ligament

Test for joint effusion if intra-articular (swipe/sweep test)

Question 14

Fracture PI

Answer 14

High impact load (intrinsic or extrinsic)

Pain local to specific bony area

+/- pain with ice

Audible ‘break’ (crack or pop)

Inability or limited ability to WB

Quick onset and significant swelling, bruising, highly vascular

+/- deformity (only if on scene, this will be fixed soon after)

Question 15

Fracture PE

Answer 15

Pain on palpation of bone, at suspected fracture site

Ottawa ankle/knee rule

Tapping, vibration, compression away from fracture site causing pain

Question 16

Meniscal PI

Answer 16

WB on planted foot with rotation/twisting

Instability/giving away

Joint effusion (swelling at joint)

Clicking, locking, catching with movement (more major tear)

Onset of swelling (indicates severity)

Pain at joint line

Ability to WB could indicate severity

Question 17

Meniscal PE

Answer 17

Clicking, locking with AROM

MacMurray’s, Appleys, Thessaly’s (WB test) test causes pain

Joint effusion test (swipe/sweep)

Joint line palpation causes pain

Question 18

Dislocation PI

Answer 18

Quick onset of swelling high pain and loss of function

Felt or heard popping noise/sensation

Joint effusion

MOI- landing, direction change, accelerate/decelerate

Apprehension

Instability/giving away

Question 19

Dislocation PE

Answer 19

Patella apprehension test (gentle lateral glide and check for apprehension)

Pain on palpation (mainly medial patella facet)

Joint effusion/swipe test (going into knee joint)

Quads inhibition and pain on contraction

Question 20

Muscle PI

Answer 20

High force/load contraction or stretch MOI

Pain local to muscle

Level of dysfunction (both at time of injury and clinical presentation) will indicate grade

Often intrinsic force (large contraction)

Often not much swelling as it can freely flow

+/- bruising at muscle location

Aggravated by muscle contraction

Question 21

Muscle PE

Answer 21

Pain reproduced with palpation, stretch and contraction

Palpable gap on grade 4

Question 22

Overuse injury

Answer 22

No specific MOI
Gradual onset/Worsening of pain
Sudden increase in training load

Question 23

Tendinopathy PI

Answer 23

Pain location at tendon

Pain after exercise, may warm up during and then pain again after exercises

Morning stiffness/pain when first get up

History of postures or activities that excessively compressively or tensile load tendon (sitting crossed legged all the time for lateral glutes, hill training often Achilles)

Question 24

Tendinopathy PE

Answer 24

Pain reproduced on palpation

Thickening of tendon

Pain reproduced with tendon/muscle contraction and compression/stretch

Question 25

Labral tears PI

Answer 25

Deep pain, typically anterior hip or groin

Pain with WB and rotation

May have clicking, clunking and catching

History or repetitive twisting or EOR activities

Question 26

Labral tears PE

Answer 26

FADIR/scour test causing pain

FABER pain

Thomas test pain

Pain with ROM flexion/rotation

Question 27

PFP PI

Answer 27

Pain around patella – location may be vague Pain on palpation of medial and lateral patellar facets Pain aggravated by running, hills, stairs and persistent knee flexion +/‐ crepitus

Question 28

PFP PE

Answer 28

Pain on palpation of medial and lateral patellar facets

Joint crepitus with glides Decreased +/‐ pain on PFJ glides Pain reproduced with squat/stairs

Question 29

Stress/reaction fracture PI

Answer 29

History of repetitive of high load

Pain in area of bone

May have night pain

Delayed onset pain (also in tendons)

Relative energy deficiency in sport

Question 30

Stress/reaction fracture PE

Answer 30

Tenderness on palpation (local bone)

+/- Vibration, compression distally or proximally (better for acute as the fracture is bigger)