Prac exam

Question 1

Hip instability orthopaedic tests

Answer 1

Dynamic stabilisers may be overcompensating so perform first:
- Thomas test
- Ober test

Other tests:
- A/P Apprehension
- Dial/log roll test
- FABER
- AB-HEER
- Anterior apprehension test (HEER)
- prone external rotation/instability

Question 2

What functional assessment ALWAYS needs to be included in patient evaluation

Answer 2

1. Squatting
2. Going up and down stairs one and two at a time
3. Crossing the legs
4. Running straight ahead, deceleration, and twisting
5. One-legged hop
6. Jumping

Question 3

Differential diagnosis for hip instability

Answer 3

• General ligament laxity
  (use Beighton criteria)

Question 4

Osteoarthritis OA Orthopaedic tests

Answer 4

• ROM
• Log roll
• Long axis distraction
• Scour test

Question 5

How to differentiate between Hip OA and FAI with two tests?

Answer 5

FAI: Warwick agreement triad of symptoms. hip pain, clicking/catching/stiffness, giving away.
clinical features: restricted ROM and + impinge signs.

• FABER test may create pain for a hip or SIJ problem and adductors.
• Hip = +ve for instability, FAI, or Labral
• SIJ or medial thigh = adductors
• Scour (Quadrant) Test used for OA (leathery end-feel)

Question 6

Femoro-acetabular impingement
(FAI) orthopaedic tests

Answer 6

• ROM
• FADDIR
• Log roll
• Functional tests (squatting, stairs climbing)

Question 7

Differential diagnosis for FAI

Answer 7

Acute hip pain, red flags to rule out:
- tumour
- infection
- septic arthritis
- osteomyelitis
- fracture
- AVN

Chronic pain:
- Inguinal pathology
- Adductor pathology
- Pubalgia

Question 8

Types of FAI

Answer 8

1. Cam lesion (men+) Impingement originates from abnormal thickening of the femoral head-neck junction
2. Pincer lesion (women+)
   The impingement originates from over-coverage of the acetabulum
3. Mixed type
   Cam more in younger
   Pincer more in women as a result of acetabular labral tear

Question 9

Acetabular
labral tears orthopaedic tests

Answer 9

1. FABER test
2. Scour test
3. THIRD test
4. Resisted SLR
5. FADIR test
6. Log roll test
7. Fitzgerald test
8. Long-axis distraction
9. General ligament laxity
10. Hip ROM

Question 10

Best tests for intra-articular acetabular labral tears?

Answer 10

1. FABER test
2. Scour test
3. THIRD test
4. Resisted SLR

Question 11

Best tests for extra-articular acetabular labral tears?

Answer 11

5. FADIR test
6. Fitzgerald test

Question 12

Snapping hip syndrome orthopaedic tests

Answer 12

• 90-90 SLR
• Bent-knee stretch (proximal hamstrings)
• Thomas/Modified
• Fair Test (piriformis)
• Ober/Modified Ober
• Active Iliopsoas snapping
• Bicycle
• 30 sec single leg stance

Question 13

External snapping hip examination findings

Answer 13

Positive Ober test,
Snap with Ober test,
Pain over greater trochanter

Question 14

When the history, signs/symptoms are consistent with a labral tear pathology, potential impingement, capsular laxity, and articular cartilage degeneration should be considered, and the following tests should be performed:

Answer 14

• Hip ROM
• General ligament laxity (Beighton’s scale (joint laxity))
• Impingement test (FADDIR)
• Fitzgerald test
• Log roll test
• Long-axis femoral distraction

Question 15

Greater Trochanteric Pain Syndrome (Gluteal Tendinopathy) orthopaedic tests

Answer 15

• FABER test
• 30s Single leg stance
• FADER-R
• hip lag sign
• Ober/Modified Ober
• Resisted external de-rotation test
• Resisted hip abduction

Question 16

Greater Trochanteric Pain Syndrome (Gluteal Tendinopathy) Differential diagnosis

Answer 16

• Trochanteric bursitis
• L2/3 lumbar radiculopathy
• Lumbar facet syndrome
• Subcostal and iliohypogastric entrapment neuropathies

Question 17

Collateral and ACL instability Ortho tests

Answer 17

• Painful joint line palpation
• Decreased ROM
• Varus/valgus stress test (0-30)
• +ve anterior drawer test
• +ve lever sign
• +ve pivot shift
• +ve Lachman test
• Stroke test for plural effusion
• apley’s distraction

Question 18

PCL and posterolateral instability ortho tests

Answer 18

1. Posterior drawer test
2. Dial test (30 &90 deg)
   positive at only 30 degrees is PLC Injury, but at both 30 and 90 indicates both a PLC and PCL injury
3. The quadriceps active test
4. Posterior sag sign/instability
5. Reverse pivot shift

Question 19

Iliotibial band syndrome orthotests

Answer 19

1. Noble test
2. Modified Ober test
3. Ober test
4. Modified Thomas test
5. One legged 30 Knee flexion stance

Question 20

OSTEOCHONDRITIS DISSECANS

Answer 20

Wilsons test

Question 21

PATELLAR DISORDERS

Answer 21

1. Clark test
2. Patellofemoral grind
3. Patellar tilt
4. Patellar apprehesion
5. Retropatellar palpation
6. Single leg squat test

Question 22

MENISCAL INJURY

Answer 22

1. Joint line palpation
2. Valgus - varus stress test
3. Apley’s compression
4. Mcmurray’s
5. Thessaly
6. Ege’s

Question 23

Ankle instability

Answer 23

1. Anterior drawer
2. Anterolateral drawer
3. Talar tilt
4. External (lateral) rotation stress
5. Squeeze test

Question 24

Ankle Impingment sign test

Answer 24

1. Impingment
2. anterior drawer
3. Silfverkiold test
4. Single leg squat

Question 25

Nerve entrapement tests

Answer 25

1. Tinel sign 2. Compression eversion test 3. Triple compression test

Question 26

Fasciitis test

Answer 26

1. Windlass test

Question 27

Metatarsophalangeal neuroma

Answer 27

1. Morton's test

Question 28

Gastrocnemius tightness test

Answer 28

1. Thompson 2. Silverskiold

Question 29

The **Cluster of Sutlive for Hip OA** are

Answer 29

4 of 5 findings for the diagnosis of OA hip 1. Lateral pain with active hip flexion 2. Pain with active hip extension 3. Passive internal rotation ≤ 25° 4. (Self-reported or functional AROM*): squatting aggravates symptoms 5. Scour test with adduction causes lateral hip or groin pain

Question 30

Hyperextension-external rotation apprehension (HEER) Ve+ result

Answer 30

+ve anterior hip pain, apprehension or reproduction of the patient’s symptoms. Indicative of anterior instability or anterior labral pathology

Question 31

Posterior Apprehension Test - Ve+

Answer 31

+ve pain or apprehension Indicative of posterior instability

Question 32

Ve+ Dial/log roll Test

Answer 32

+ve the affected leg externally rotates > 450, or there is no mechanical endpoint. Indicate instability (mainly anterior). (both legs must be compared)