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63 Cards in this Set
- Front
- Back
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Rent test
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Torn rotator cuff/impingement
(+) = if eminence and rent are felt |
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Lift-off test
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torn rotator cuff
subscapularis (+) = is unable to lift arm off back |
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External rotation lag sign
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torn rotator cuff
supraspinatus infraspinatus (+) = if lag occurs w/ inability of pt to maintain arm near full ER |
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Drop sign
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torn rotator cuff
infraspinatus tear irreparable fatty degeneration of infraspinatus (+) = if lag occurs w/ inability of pt to maintain arm near full ER |
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Empty can test
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Torn rotator cuff
supraspinatus (+) = more weakness in empty can vs full can or if pt complains of pain |
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Supine impingement test
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impingement
non-specific RCT pathology (+) = pt reports a significant increase in shoulder pain |
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Internal rotation resisted strength
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impingement
(+) = if IR strength is weaker than ER strength |
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Neer's test
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impingement
(+) = if shoulder pain is present |
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Hawkins-Kennedy test
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impingement
(+) = pain is present |
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Biceps load test
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SLAP lesion
torn labrum instability proximal biceps involvement (+) = if concordant pain is reproduced during resisted elbow flexion |
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Yergason's test
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proximal biceps involvement
torn labrum instability (+) = if pt localizes concordant pain to the bicipital groove |
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Speed's test
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proximal biceps involvement
torn labrum instability (+) = if pt localizes concordant pain to the bicipital groove (slapping noise) |
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Crank test
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labral tear
SLAP lesion instability proximal biceps involvement (+) = if pain is produced w/ or w/o a click in the shoulder |
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Anterior release/surprise
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instability
(+) = if pt reports sudden pain, an increase in pain, or by reproduction of the pt's concordant sx |
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Patrick/FABER test
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pathology of hip or SI joint
(+) = pain in ant./lat. groin --> hip; pain in SI area --> SI joint |
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Leg length discrepancy
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apparent - umbilicus to medial malleolus
true - ASIS to medial malleolus (+) = more than 2.5cm difference many causes: pelvic obliquity, adductor or flexion deformity, femur length, tibia length |
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Thomas test
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tight iliopsoas or tight rectus femoris
(+) = if hip flexes --> tight iliopsoas; if knee extends --> tight rectus femoris follow up with Ely's test if both hip flexion and knee extension occur |
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SLR 90-90
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tight hamstrings
(+) = if pt cannot get within 20degrees of full extension |
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Ober's test
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tight TFL or tight ITB
(+) = if leg stays in position/doesn't immediately drop TFL - knee flexed, hip extended w/ slight abducted ITB - leg straight, hip abducted |
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Ely's (rectus femoris test)
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follow up to Thomas test
(+) = if pelvic rotates and lifts up from plinth |
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Tightness of hip rotators test
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pt in suine w/ hip and knee flexed to 90 degrees
lateral rotators - pt is asked to MR the hip by rotating the legs outward...if LR are tight, MR will be less than 30-40degrees and end feel with be muscle stretch rather than capsular stretch medial rotators - pt is asked LR the hip by rotating the leg inward...if MR are tight, LR will be less than 40-60degrees and end feel with be muscle stretch rather than capsular stretch |
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Sign of the buttock
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if hip flexion does not increase when knee is flexed, the lesion is in the buttock or the hip, NOT the sciatic nerve or hamstring
causes of (+) include ischial bursitis, a neoplasm, abscess in the buttock, hip pathology |
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STJ Neutral
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pt supine w/ feet extending over table
PT grasps pt's foot over the 4th and 5th MT heads, using thumb and index finger of one hand; palpate med and lat aspects of the talus. Apply light DF force and passively supinate and pronate until talar head protrudes equally on both sides. supination - talar head bulges laterally pronation - talar head bulges medially |
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Talar tilt stress test
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medial - evert foot
lateral - invert foot (+) = for ligament laxity if there is excessive movement compared to the opposite side |
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Anterior drawer of the ankle
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anterior talus displacement relative to the tibia
(+) = if excessive translation, laxity is typically due to sprain of the anterior talofib ligament |
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Forefoot heel alignment
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pt lies supine w/ feet extending over end of table
PT positions the STJ in neutral position; while maintaining this position, the examiner pronates the mid tarsal joints maximally then observes the relation b/t the vertical axis of the heel and the plane of the second thru forth MT heads. If the medial side of the foot is raised, the pt has forefoot varus. If the lateral side of the foot is raised, the pt has forefoot valgus. |
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SC Joint
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only bony connection of UE to trunk
motions: - elevation (45degrees) and depression (15degrees) - protraction and retraction (15degrees each) - rotation (30degrees) |
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SC joint ligamentous support
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anterior and posterior SC ligaments - check AP movements of clavicle head
costoclavicular ligament - checks AP movement of head and elevation of head interclavicular ligament - checks excessive downward movement of clavicle AP - protraction and retraction |
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AC joint functions
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- maintain the relationship b/t the clavicle and the scapula in early stages of elevation of the UE --> flex or abduction
- allow the scapula additional range of rotation on the thorax in the latter stages of elevation |
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AC joint motions
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-scapular rotation (upward and downward)
-winging (of vertebral body) -tipping (of inferior angle) -last two produce a sliding movement of the acromion on the clavicle |
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AC ligamentous support
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-superior and inferior AC ligaments - check posterior dislocation of the clavicle
-coracoclavicular ligament - checks backward motion of scapula, assists in transmission of compression forces from scapula to clavicle |
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Scapulothoracic articulation
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- not a true anatomic joint
- forms a closed kinematic chain w/ the other 2 joints as the scapula slides along the ribs - movement in 1 joint invariably causes motion in the others |
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Scapulothoracic articulation
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motions: elevation, depression, abduction, adduction, upward and downward rotation
stability due to: atmospheric pressure, structures that maintain integrity of AC and SC joints, muscles attached to the thorax and scapula |
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Ultimate function of Scapulothoracic articulation
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- orients the glenoid fossa for optimal contact w/ the maneuvering arm
- provides a stable base for the controlled rolling and gliding of the articular surface of the humeral head |
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GH joint
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- serves the mobility needs of the hand
- capsule is large and loose - capsule is taut superiorly and lax inferiorly in the resting position - laxity is important for the large excursion of the jt surfaces - little stability is provided w/o reinforcing ligaments and muscles |
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Shoulder joint ligaments
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- GH ligament becomes taut as UE moves into elevation, becomes taut as UE moves into LR--esp the superior band, and becomes lax as UE moves into MR
- coracohumeral ligament: anterior band tenses as UE moves into extension, posterior band tenses as UE moves into flexion, MR at the end of flexion will slacken the bands |
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Coracoacromial arch
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- coracoid process (ant) + acromion process (post) + coracoacromial ligament (sup)
- serves as a protection from direct trauma to the humeral head as well as to sensitive muscles, tendons, and bursae overlying the humeral head - prevents superior dislocation of the humeral head |
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Stability of GH joint
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muscles as ligamentous force:
- during abduction, the deltoid and supraspinatus muscles serve as prime movers - deltoid muscles provide an upward translatory force to counteract the downward translatory force of gravity - RC muscles serve an important role to keep the humeral head from impacting the coracoacromial arch |
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Scapulohumeral Rhythm
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- coordinated effort of the GH joint, scapulothoracic articulation, SC joint, and AC joint for smooth and large ROM of the UE to occur
- ratio of 2 GH motion : 1 scapulothoracic motion - 120degrees GH motion: 60 degrees of scapulothoracic motion |
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Purpose of Scapulohumeral Rhythm
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- increases congruency of keeping humeral head aligned with glenoid fossa
- maintains glenoid fossa in optimal position to receive head of humerus, thus increasing ROM - permits muscles acting on humerus to maintain a good length-tension relationship |
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Scapulothoracic and GH joint contributions
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- during first 30degrees of elevation: setting phase, little movement of scapula
- from 30-90degrees (1:2): scapula moves approx 1degree for every 2degrees of GH motion...changes when weight is added to the hand (variable) - from 90-180degrees: 1:1 |
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SC and AC joint contributions
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- first 30degrees of scapulothoracic movement: clavicle elevates at SC joint, swinging scapula through arc of motion, with axis at base of spine of scapula
- last 30degrees of scapulothoracic movement: clavicle rotates, flipping lateral end of clavicle up, remaining scapular rotation has axis at AC joint - raising arm to horizontal: 60degrees GH and 30degrees scapulothoracic motion, scapular movement is produced by clavicular elevation at SC joint - raising the arm from horizontal to upright: same degree of motion, scapular movement is produced by clavicle rotation and AC motion |
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Foot arches
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1. Medial Longitudinal
* Stability achieved by: Long and Short Plantar ligaments, Plantar Fascia, Spring Ligament * Muscular Stability: Tibialis Anterior, Tibialis Posterior, Peroneus Longus and FDL 2. Lateral Longitudinal Arch: * Stability Achieved by: Calcaneocuboid (bifurcate) ligament, plantar calcaneocuboid ligament and the long plantar ligaments. 3. Transverse Arch * Stability achieved by: Deep transverse metatarsal ligament |
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Functions of foot during gait cycle
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1. Shock Absorption
* Heel Strike: calcaneus is 4 degrees inverted, LE is externally rotated. The foot begins to pronate to allow for shock absorption. The foot is said to be a mobile adaptor. 2. Torque Convertor * STJ converts lower extremity IR/ER into pronation/supination. * At midstance the foot should be pronated. At Heel off the foot should be supinating to begin the locking process for longitudinal arch stability. 3. Rigid Lever * Midstance to Toe off- the foot becomes a rigid beam for propulsion. |
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Determinants of gait
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1. Pelvic Rotation – 4 degrees to each side
* lengthens the stride 2. Pelvic Tilt – 5 degrees * Trendelenberg , Tunnel walking 3. Knee Flexion in Stance * 15 degrees, further lowers the arc 4. Lateral Displacement of the Pelvis * Smooths the arc, movie theater walking |
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Biomechanical eval
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NonWeight Bearing
Prone Position * Calcaneal inversion/eversion * Rearfoot position in STJ neutral * Forefoot Position in STJ neutral * 1st ray position Supine Position * Ankle Joint ROM * 1st Ray Motion * Motion of the forefoot, midfoot and rearfoot WeightBearing * HAT alignment * Foot position in weightbearing * Navicular drop with single leg stance * Double leg squat * Single leg squat * Knee/Tibia alignment * Gait assessment |
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Forefoot varus
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Forefoot varus is a fixed, osseus congenital deformity in which the forefoot is inverted relative to the rearfoot when the subtalar joint is in the neutral position and the OAMTJ is locked / pronated.
An acquired positional deformity in which the forefoot is inverted relative to the rearfoot may also develop as a consequence of STJ pronation. This condition termed, “forefoot supinatus”, may be reducible, but tends to become more rigid over time. Orthosis Management During stance, ground reactive force to the lateral forefoot and the influence of gravity will cause the inverted medial forefoot to come down to the supporting surface (ground). To allow for this compensatory motion to occur, the subtalar joint pronates with calcaneal eversion. Treatment is provided with appropriate medial forefoot wedging (posting) to restore normal alignment. |
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Forefoot valgus
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Forefoot valgus is a fixed, osseus congenital deformity in which the forefoot is everted relative to the rearfoot when the subtalar joint is in the neutral position and the OAMTJ is locked / pronated.
Compensated Forefoot Valgus A rigid forefoot valgus is one in which there is inadequate MTJ ROM to compensate, so the STJ must supinate to bring the forefoot to the ground Orthosis Management During stance, ground reactive force to the medial forefoot and the influence of gravity will cause the everted forefoot to come down to the supporting surface (ground). To allow for this compensatory motion to occur, the subtalar joint supinates with calcaneal inversion. Orthosis management is provided with appropriate lateral forefoot posting as shown with the lateral wedge and corrected orthosis to restore normal alignment. |
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Rearfoot varus
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Rearfoot varus is a fixed, osseous congenital deformity in which the tibia has formed in a varus position OR the subtalar joint has formed in a position in which the calcaneus is inverted when the subtalar joint is in the neutral position and the OAMTJ is locked
rearfoot varus = tibial varum and / or subtalar varus Compensated Rearfoot Varus sufficient STJ ROM is available to bring medial border of forefoot to the ground with the rearfoot everting to vertical (perpendicular to ground) Orthosis Management During stance, ground reactive force to the lateral rearfoot and the influence of gravity will cause the rearfoot to pronate with calcaneal eversion to a perpendicular stance position. Orthosis management is provided with the prescribed amount of medial rearfoot posting to align the rearfoot to its neutral alignment. In the example shown, the STJ neutral position is 5° inverted as maintained with medial wedge and the correctly balanced orthosis. |
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Tuber varus
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Tuber varus is a congenital osseous deformity in which there is an isolated structural inversion of the tuber calcanei.
The clinical significance for this deformity is that an eccentric lateral moment to the calcaneus occurs at heel strike. This lateral imbalance may be associated with increased ankle sprain tendency Orthosis Management During stance, ground reactive force to the inverted lateral rearfoot and the influence of gravity will cause the structurally inverted rearfoot to further invert with STJ supination. Orthosis management is provided with adequate lateral “valgus” posting as shown to decompensate the effect of the lateral imbalance and sprain tendency. The calcaneus may still be inverted, but the eccentric lateral moment of force has been negated. |
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Ankle PF deformity
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Ankle equinus exists when there is less than 10° of ankle dorsiflexion is available during gait
Compensation for Equinus Shortening or tightness of the tendo-achilles complex will compensate during gait with STJ pronation and OMTJ dorsiflexion (MTJ Break) Orthosis Management During stance, ground reactive force to the plantargrade forefoot and the influence of gravity will cause the rearfoot to evert with compensatory subtalar joint pronation to slacken the tension on the taught triceps surae. Initial orthosis management is provided with adequate orthosis heel elevation to reduce symptomatology associated with the equinus stress. Once the painful complaints have subsided or the tendo achilles has been adequately stretched, the elevation posting may be reduced. |
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Combined claw
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CalcaneoCavus represents a combination deformity with posterior and anterior cavus components. The ankle joint is strongly dorsiflexed while the forefoot is markedly in an equinus attitude. Weakness, paralysis, or dystrophy of the calf muscles will produce a very similar deformity.
Compensation for CalcaneoCavus Compensation occurs with dorsiflexion of the hyperdeclinated forefoot that produces increased plantar fascial and tendo achilles stress. Clawing of the digits also occurs as a result of the posterior imbalance. Orthosis Management During stance, ground reactive force to the Hyperdeclinated forefoot and rearfoot will cause increased pressure to both the forefoot and rearfoot areas with associated pathology. Initial orthosis management is provided with adequate centroplantar foot support and cushioning where needed in the forefoot or rearfoot areas. Additional reinforcement material may be applied to the centroplantar arch area as shown to help reduce stress to |
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Forefoot equinus
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Anterior cavus is a fixed congenital deformity or acquired neurogenic disorder in which the forefoot is hyperdeclinated (plantarflexed) on the rearfoot.
Compensation for Anterior Cavus Compensation for anterior cavus occurs during stance and gait with ground reactive dorsiflexion of the hyperdeclinated forefoot. Subsequent STJ pronation may occur secondary to the “pseudoequinus stress” produced. Orthosis Management During stance, the ground reactive force to the Hyperdeclinated forefoot will cause increased pressure to the forefoot with increased plantar fascial stress. Global and lateral anterior cavus deformities tend to produce compensatory STJ pronation due the pseudoequinus stress while medial column deformities will compensate via STJ supination. Initial orthosis management is provided with appropriate cavus heel elevation to negate the effects of the pseudoequinus stress. Additional forefoot posting may be applied to decompensate the any medial or lateral cavus c |
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Posterior cavus
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Posterior cavus is a congenital osseous deformity in which the corpus calcanei is elongated or a plaque of bone occurs on the plantar calcaneal tuberosity. Neuromuscular disorders may also be responsible for the development posterior ankle dorsiflexion cavus conditions
Compensation for Posterior Cavus Compensation produces a forward shift of body balance and associated digital gripping deformities due to the anterior body imbalance. Heel pain with possible bursa formation may occur as a result of the prominent heel bone. Orthosis Management During stance, the ground reactive force to the Hyperdeclinated rerfoot will cause stress to the prominent heel and the patients weight to be shifted foreward. Initial orthosis management is provided with added elevation distal to the heel to create a “negative heel” effect. A central heel aperture or dell may be added to reduce centroplantar heel pain. |
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Met prime elevates (structural)
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Metatarsus Primus Elevatus is a fixed rigid congenital deformity in which the first metatarsal is dorsiflexed upon the first cuneiform.
Compensation for Met Primus Elevatus Compensation occurs with increased dorsiflexion at the hallux interphalangeal joint due to decreased available ROM at the first MTPJ (Hallux Limitus). The increased jamming stress to the dorsal joint often leads to painful arthritic changes if left untreated. Orthosis Management Due to the shift of body weight medially and forward with the compensation of the structurally elevated first metatarsal during stance, ground reactive forces will dorsiflex the metatarsal to the end range of motion. As a result, jamming to the first MTPJ will occur during gait. The use of the time-tested Morton’s platform will bring the ground up to the elevated metatarsal reducing the medial imbalance and will thus help to improve first ray function and reduce painful joint symptomatology. This will also help to prevent jamming |
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First ray elevatus (positional)
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Dorsiflexion deformities of the first ray may also be acquired secondary to pathological conditions such as STJ pronation that may produce hypermobility of the first ray, producing a positional type of first ray Elevatus with a noted sag “V” sign at the naviculo-cuneiform joint
Compensation for Met Primus Elevatus Compensation occurs with increased dorsiflexion at the hallux interphalangeal joint due to decreased available ROM at the first MTPJ (Hallux Limitus) Orthosis Management Unlike its structurally elevated counterpart, the positionally elevated first metatarsal due to pronation will also have added stress and jamming to the first MTPJ, but orthosis management should not support this malaligned position with a platform. Treatment should rather be directed at improving first ray realignment during casting and with specific orthosis modifications such as kinetic wedging or first ray cut-outs. |
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Met prime equinus
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Metatarsus Primus Equinus is a fixed rigid congenital deformity in which the first metatarsal is plantarflexed upon the first cuneiform. Positional first ray plantarflexion conditions may also develop as a result of neuromuscular disorders i.e. CMT Charcot Marie Toothe
Compensation for Met Primus Equinus Compensation occurs via STJ supination as ground reactive forces on the rigidly plantarflexed first metatarsal roll the foot laterally. Lateral ankle sprain tendency is commonly associated with this deformity Orthosis Management Due to the supinatory effect of the compensation for the structurally declinated metatarsal during stance, orthosis management should be directed at reducing the associated lateral imbalance and high sub- metatarsal head one pressure with appropriate off-loading and realignment techniques. The depressed first metatarsal should be accommodated with a cut-out that is deep enough to relieve pressure and decompensate the STJ supination. Any remainin |
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Metatarus adductus
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Metatarsus Adductus is a single plane deformity in which the metatarsal segments are adducted at Lisfrancs joint. While the deformity is osseous in nature, early therapeutic intervention 0-2years, may reduce or eliminate this deformity.
Compensation for Met Adductus Compensation for this “in-toed” foot deformity is generally through patient induced out-toeing. This intentional foot abduction causes STJ pronation with the classic Z-foot or Skew-foot pattern. Orthosis Management The uncompensated metatarsus adductus deformity with its distinctly adducted forefoot metatarsal segments will generally produce a lateral imbalance with STJ supination with possible lateral ankle sprain tendency. For this reason, orthosis management should be aimed at reducing the lateral imbalance via appropriate frontal plane valgus wedging and deepened heel cup with extended flanges for greater transverse plane control. For compensated pronated “Z-Foot” metatarsus adductus deformities should be decompe |
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Forefoot adductus
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Lesser Tarsus Adductus is a congenital structural adductus deformity of the midfoot which produces a “forefoot adductus” pattern during gait.
Compensation for Lesser Tarsus Adductus While milder cases of forefoot adductus may compensate by STJ pronation, moderate – severe cases can not compensate and may lead to foot supination malalignments. The associated lateral imbalance tends to invite lateral ankle sprain and lateral foot and limb stress. Orthosis Management The lesser tarsus adductus deformity is characterized by its “C” shaped lateral foot border. This eccentric concavity produces a significant centrolateral imbalance with lateral foot imbalance and compensatory STJ supination. Orthosis management should thus be aimed at reducing the centrolateral imbalance via appropriate lateral midfoot valgus wedging and deepened heel cup with extended flanges for greater transverse plane control. In cases where the fifth metatarsal base has an associated lesion or is painful, an ap |
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Midtarsal joint abductus
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Midtarsal joint abductus is an expected component of abnormal foot pronation and especially in “high axis” foot types. Other abducting MTJ influences may include; Kidner foot type, tibialis posterior dysfunction, peroneus brevis spasm and abnormal medial limb torsions
Clinical presentation will demonstrate a marked abduction of the forefoot with the “too many toes sign”. Significant medial ankle deviation may also be observed. |
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Midtarsal joint abductus orthotics
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Orthosis Management
Midtarsal joint abductus deformities are generally associated with tendon malinsertion deformities such as Kidner’s Foot orare the result of pathologic imbalance leading to an acquired adult flatfoot deformity. The most common cause being related to Tibialis Posterior dysfunction. Orthosis management requires aggressive realignment measures with extra deep heel cup and modifications such as the Kirby medial heel skive technique. |
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Calcaneal tuber adductus
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Tuber adductus is a congenital adductus of the posterior calcaneal process.
Clinical examination will demonstrate a protrusion of the medial heel with frontal plane viewing “peeking heel”. During stance and gait, there is an eccentric moment producing increased lateral shoe heel wear and ankle turning (sprain) tendency Orthosis Management During stance, ground reactive force to the adducted lateral rearfoot and the influence of gravity will cause the structurally adducted rearfoot to invert with compensatory STJ supination. Orthosis management is provided with adequate lateral “valgus” posting as to decompensate the effect of the lateral imbalance and sprain tendency. This condition is often associated with forefoot adductus “C-Foot” deformity and thus requires additional centrolateral orthosis wedging to overcome the supinatory lateral imbalance sprain tendency. |
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Distal radius fx - AAOS
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Radial shortening greater than 3 mm, articular step off greater than 2 mm, dorsal angulation less than 10 degress.
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