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282 Cards in this Set
- Front
- Back
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Where do you measure for the true leg length discrepancy test?
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ASIS to the medial malleoli
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What indicates a positive test for leg length discrepency?
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unequal distances
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How do you determine if the discrepancy exists due to different length of tibia or femur?
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supine with knees flexed to 90 and feet flat: if one knee appears higher, one tibia is shorter. If one knee projects further anterior, the femur of that extremity is longer
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What is Craig test for?
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Femoral torsion
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Craig test position
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prone, knee flexed to 90.
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Procedure for Craig test
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Position LE until greater trochanter is most prominent laterally, then measure using goni. Stationary arm perpendicular to floor, moving arm in line with tibia.
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Normal torsion in children 4-7
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23-26 degrees
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Normal torsion in adults
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15 or 8-15
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Antetorsion
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angle of torsion greater than upper range of typical values
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Retrotorsion
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angle less than lower range of typical values
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What's the Q angle?
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angle between the tendon of the quads and patellar tendon at the center of the patella
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How is the Q angle maesured?
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goni midpoint in the center of patella, align one arm w/ the ASIS and the other with the tibial tuberosity.
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What is a normal Q angle?
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13 men, 18 women. Diff from lecture?
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Position for measuring tibial torsion
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supine, align femoral condyles in frontal plane and place your fingers over medial/lateral malleoli axis
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What do you measure in the tibial torsion (with the goni)
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angle between tibiofemoral joint axis and the horizontal.
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What is the normal tibial torsion?
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15-30 degrees of out toeing
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Medial tibial torsion (value)
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less than 15
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External tibial torsion (value)
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greater than 30
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Position for tibial varus measure
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seated at edge of bed, leg hanging
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Normal tibial varus angle
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4-6 degrees
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Goni alignment for tibial varus measure
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One arm in line with middle of anterior tibia, the other perpendicular to floor. Alternative: in STN align moving arm with distal 1/3 of tibia.
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Rearfoot varus
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intrinsic deformity where the calcaneus is inverted relative to the lower leg when foot is in STN
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Forefoot varus
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intrinsic deformity where forefoot is supinated with respect to the rearfoot when foot is in STN
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Rearfoot valgus
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Intrinsic deformity where calcaneus is everted relative to the lower leg when foot is in STN
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Forefoot valgus
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intrinsic deformity when forefoot is pronated with respect to the rearfoot when it's in STN
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Plantarflexed 1st ray
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intrinsic deformity on 1st ray (1st metatarsal and medial cuneiform) when it's in plantarflexion
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What is a apparent leg length discrepancy?
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no true bony inequality
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Position for apparent leg length discrepancy test
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supine, legs in neutral
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Where do you measure for apparent leg length discrepancy test
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from umbilicus to medial malleoli of ankle.
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Unequal distances on apparent leg length discrepancy test indicate
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Leg length discrepancy due to soft tissue restrictions causing pelvic obliquity or from adductor or flexor tightness
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Modified thomas test position
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supine, knees about 4 inches off edge of table.
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Procedure for modified thomas test
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patient raises one knee to chest (flexing), while keeping the other leg flat on table in original position.
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What do you do if the thigh raises off the table in the modified thomas test (to determine what's tight)?
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flex the knee. If knee flexes easily, the tight flexor is the iliopsoas
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What does it mean if the LE abducts and IR to gain hip extension?
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TFL is likely the tight hip flexor
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Position to test length of glut max
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sitting, maintain anterior pelvic tilt
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Procedure to test glut max length
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you or patient adduct their leg while maintaining anterior pelvic tilt. Stop if lose ant pelvic tilt or if feel a muscular end feel.
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Positive test, glut max length
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patient can't adduct to neutral (0). Will return to abduction and ER when release femur
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What does Ober's test test?
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IT band shortness
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Ober test position
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sidelying with involved leg on top of uninvolved.
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Ober test procedure
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abduct leg as far as possible, flex knee to 90, then extend hip. Slowly release patient's leg
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What constitutes a positive Ober's test?
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thigh remains abducted when the leg is released. Measure goniometrically using ASISs as fulcrum, stationary in line with ASISs, movable arm aligned with femur.
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Test for quad length position
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side-lying, femur in neutral and knee passively flexed.
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Test for quad length positive test
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knee flexion less than 140 degrees with a muscular end feel.
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How do you differentiate between rectus and vastus muscles?
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flex hip slightly while keepingknee fully flexed. If no longer have muscular end feel, rectus was tight.
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Test for length of gastroc/soleus position and procedure
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patient seated, leg off table, fully extend knee. Passively dorsiflex the foot (both). Flex knee to 90 (soleus) and passively dorsiflex. Note endfeel for both.
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Tighter endfeel with knee extended on ankle dorsiflexion test indicates
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tight gastroc.
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Tight endfeel in both knee extended and flexed on ankle dorsiflexion test indicates
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Tightness of both gastroc and soleus
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Lower quarter screening (LQS) in standing
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observation
gait postural assessment quick squat test active trunk motions (w/ over pressures) Vertical "quick" compression (heel bounce) Toe walking Heel walking |
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LQS sitting
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Vertical compression and distraction
Trunk rotation with overpressure Lumbar quadrant test w/ overpressure Hip IR-ER AROM Myotomes DTRs Dermatomes Neuro tests: sitting passive knee extension, slump test, bowstring, clonus, babinski |
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LQS supine
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Passive neck flexion (kernig's test)
SI gapping/compression Passive hip motion w/ overpressure Hip scouring SLR Babinski |
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Prone
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Femoral N stretch (Ely's test)
Sacral thrust Myotome (s1-2) hip extension Quadriped rocking back |
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What does normal squat movement consist of?
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Hip flexes, knee flexes to 45, heels stay in contact with floor, knee in line with 2nd toe, STJ pronates
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What does toe walking assess?
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S1 myotome
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What does heel walking assess?
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L4-5 myotome
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What does pain with vertical compression indicate?
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impingement due to narrowing of foramen
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Why would you perform the lumbar quadrant test
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If you're unclear about ruling out involvement of lumbar spine.
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What do you do in the lumbar quadrant test?
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Forward flex, sidebend, rotate thoracic spine. Do the same motions, but in extension.
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L1-2 myotome test
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psoas major
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L3-4 myotome
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Quads
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L4 myotome
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anterior tib
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L5 myotome
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extensor hallucis longus
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S1 myotome
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gastroc
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L3-4 DTR
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patellar
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S1 DTR
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achilles
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DTR scale
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0- no relfex (LMN damage)
1- diminished/sluggish 2- average/normal 3- exaggerated/hyperreflexive 4- pathological/clonus (UMN damage) |
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What does sitting passive knee extension test?
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neural extensibility of the lumbar spinal NN and sciatic N. Compare to myotome test of quads. Differentiate from hamstring pain due to tightness.
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Sitting passive knee extension positioning:
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patient sitting, hips and knees at 90, passively extend knee.
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On sitting passive knee extension test, if therapist notes muscular endfeel, what do you do next?
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slightly flex knee and dorsiflex foot. Pain with this indicates neural problem. Also use contract/relax.
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What does the slump test test?
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neural mobility
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What are the steps of the slump test?
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slump
Therapist applies thoracic compression Therapist flexes the patient's neck and applies slight overpressure. Client actively extends knee, therapist finishes extension passively. Therapist passively dorsiflexes foot. Release neck and let them extend head. |
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What indicates a positive slump test?
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Cervical extension relieves sx.
Pain or paresthesia with any of the movement. |
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What do you do in the Bowstring test and what does it indicate?
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Twang the common peroneal N.
Pain radiating up to the back indicates a problem in the lumbar spine, typically a disc problem. |
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What do you do in the clonus test?
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performa quick stretch of the gastroc-soleus muscles.
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What's a positive Passive neck flexion (Kernig's test)?
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Dural stretch/mobility test is positive w/ pain along the central spinal region (dural restriction)
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Pushing the ASIS's away from each other does what to the SI?
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compresses SI posterior, gaps them anterior
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Pushing ASIS's together does what to teh SI?
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gaps posterior, compresses anterior
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What indicates a positive SI gapping/compression test?
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pain
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What does hip scouring assess for?
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joint pathology like arthritis, osteochondral defects, avascular necrosis, or acetabular defects.
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Hip scour procedure:
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passively flex hip and knee to 90, compress femur into acetabulum, slowly move in clockwise/counterclockwise movement. Pain is a positive finding, typically in anterior groin.
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SLR procedure
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supine w/ hips and knees extended, slowly raise test leg until person feels tightness/pain. When the person feels pain, slightly lower leg and dorsiflex foot.
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Positive SLR test
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pain persists after PT backs off and dorsiflexes foot. Likely indicates sciatic N irritation or dural restriction.
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What must the therapist differentiate between when using the SLR test and how?
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sciatic N involvement- pain along the course of the N.
Dural stretch- pain in lower back Tight hamstrings SI involvement- typically unilateral in SI region |
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Babinski test procedure:
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stroke lateral and up then across to the medial top of foot (plantar surface)
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Positive Babinski
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upward-going great toe w/ flaring toes-UMN lesion
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Femoral N stretch (Ely's) procedure
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patient prone, therapist passively flexes knee to 90, then passively extends hip.
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Positive femoral N stretch test
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pain in the anterior thigh. Differentiate between tight hip flexors.
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Sacral thrust procedure
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patient prone on elbows, therapist places base of one hand on mid sacrum and gently compresses downward.
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What does pain suggest in sacral thrust?
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sacral torsion
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S1-2 myotome
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hip extension
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Normal movement iin quadruped:
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hips flex, lumbar spine remains flat, no pelvic motion, no pain.
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ROM hip abduction
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0-45
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Hip abduction prime mover
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glut med in synergy w/ TFL
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Adduction hip ROM
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0-10
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Hip flexion ROM
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0-125
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Hip flexion prime mover
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iliopsoas
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Hip extension ROM
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0-10
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Hip extension prime mover
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glut max
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hip IR ROM
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0-45
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Hip ER ROM
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0-45
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Knee flexion/ext ROM
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0-140
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Hip anterior glide occurs with:
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extension and lateral rotation
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Hip posterior glide occurs with:
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flexion and IR
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Hip inferior glide occurs with:
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abduction
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Hip superior glide occurs with:
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adduction
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Hip distraction supine procedure
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Hip 90, knee/lower leg on shoulder, distract inferiorly
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Hip distraction in S/L procedure
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Patient sidelying, sit behind them, stabilize pelvis, flex knee and cradle between your arm and body, rotate your trunk to distract
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Anterior hip glide procedure
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Patient supine, abduct hip slightly, hands below gluteal fold, elbows as fulcrum against table, lean back and glide hip anteriorly.
Patient prone w/ bolster above knee and push down toward table. |
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Posterior hip glide procedure
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prone, use strap around hip joint and pull up using your trunk.
Patient supine, hip flexed slightly, put your knee under their knee to bolster and push downward or create force couple with hand under their knee flexing hip and other hand pushing downward. Plow N 40 |
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What hip motions should be observed for Sahrmann's movement impairment syndrome?
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Supine SLR
Prone knee flexion Prone hip extension Quadruped rocking backward Squat Single-leg squat |
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Normal supine SLR
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greater trochanter maintains constant PICR during passive and active, hip flexes to 80
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Normal prone knee flexion
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knee flexes 120-135 w/o pelvic tilt, rotation, or lumbar extension
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Normal Prone hip extension (knee extended)
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Hip extends 10 degrees w/ slight lumbar extension, simultateous contraction of glut max and hamstrings, greater trochanter doesn't move or moves slightly posterior
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Normal Single-leg squat
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hip, knee, and foot stay relatively aligned; IDs hip weakness/tightness
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Cause of femoral anterior glide syndrome
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inadequate posterior glide of the femoral head during hip flexion
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Key findings in femoral anterior glide syndrome
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SLR- Greater trochanter migrates anterior and medial
Prone hip ext: hamstrings dominant Quadruped rocking: affected hip doesn't flex as much causing pelvic rotation |
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Short and/or stiff mm in femoral anterior glide syndrome
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TFL
Hamstrings |
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Long and/or weak mm in femoral anterior glide syndrome
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Long iliopsoas
Weak posterior glut med and glut max |
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Cause of femoral anterior glide syndrome w/ LR
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In hip extension, PICR deviates anterior and lateral.
Anterior capsule becomes stretched and posterior structures, esp. lateral rotators, become short. In hip flexion, posterior glide is insufficient. |
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Key findings in femoral anterior glide syndrome w/ ER
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Single-leg stance: hip rotates laterally
Supine hip flexion: lateral femoral rotation Hip extension: lateral rotation occurs and greater trochanter moves posteriorly Prone knee flexion: lateral femoral rotation Quadruped: patient unable to achieve 90 degrees hip flexion and affected hip doesn't flex as much as other hip. |
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Short/stiff mm in femoral anterior glide syndrome w/ lateral femoral rotation
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Short lateral hip rotators
Glut max and hamstrings may be short |
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Long/weak structures in femoral anterior glide syndrome witH LR
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Glut max may be weak
Iliopsoas, abductors, medial rotators are weak |
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Cause of hip adduction syndrome
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posterior glut med and lateral rotators are long and weak
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Key findings in hip adduction syndrome
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Single leg stance: hip adducts and medially rotates or trunk laterally flexes.
Gait: Trendelenberg limp |
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Short/stiff mm in hip adduction syndrome
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TFL short and may be strained from overuse.
IT band short/stiff |
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Long/weak mm in hip adduction syndrome
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Lateral rotators and post glut med are long and weak.
Glut max is weak. Quads may be weak. |
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Causes of Hip extension with knee extension syndrome
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overactive hamstrings, insufficient glut max during hip extension.
Insufficient use of quads in knee ext. Hamstrings may be strained from overuse. |
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Key findings in hip ext. w/ knee ext. syndrome
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Sit to stand: Knee appears to move back toward body rather than body rising over knee.
Prone hip ext: almost exclusive use of hamstrings, glut max contracts near end range Active knee extension: in sitting causes simultaneous hip extension |
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Short/stiff mm in hip ext. w/ knee ext. syndrome
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Hamstrings short (medial often more stiff than lateral)
Glut max and piriformis may be stiff |
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Long/weak mm in hip ext. w/ knee ext. syndrome
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Glut max and ERs are weak.
Quads may be weak |
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Associated conditions with hip LR syndrome
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shortened piriformis and sciatica
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Key findings in hip LR syndrome
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Rule out femoral retrotorsion
Pain w/ piriformis stretch |
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Short/stiff mm in hip LR syndrome
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ER, particularly piriformis are stiff
Hamstrings are short and stiff |
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Long/weak mm in hip LR syndrome
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Medial rotators are weak
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Patrick/FABERE test position
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patient supine, foot on opposite knee (figure 4). Hip flexed, abducted, ER. To screen SI, extend range placing one hand on flexed knee and other on ASIS of opp side and press down.
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Positive FABERE test
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inguinal pain indicates a general pathology of joint or surrounding mm. Increased pain posteriorly during extension indicates SI pathology.
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Glut med/trendelenburg test purpose
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evaluate strength of glut med on stance side
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glut med test procedure
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Patient stands on one leg. Observe level of PSISs. Non-stance side should elevate. If it doesn't or if it drops, glut med on stance side is weak
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What's Noble compression test for?
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IT band friction syndrome
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Noble compression test procedure
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Patient supine, knee flexed to 90 and hip flexed. Apply pressure over lateral femoral epicondyle or 1-2 cm proximal. If pain at 30 degrees knee flexion, test is positive.
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Ankle close-packed position
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dorsiflexion
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Dorsiflexion ROM
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0-20
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Plantarflexion ROM
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0-45
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Inversion ROM
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0-40
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Eversion ROM
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0-20
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Anterior talofibular ligament resits
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PF and inversion
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Test ATFL
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Palpate in sinus tarsi while inverting and plantarflexing. Pos test- pain and laxity
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Alternate test for ATFL
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Anterior drawer test
Patient supine, position foot over edge and grasp calcaneus. Gently grasp tib/fib and pull calcaneus forward. Also bend knee and stabilize foot at talus and push mortice posterior. |
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Calcaneofibular ligament resists
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Inversion
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Test for calcaneofibular ligament
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Inversion stress test
Patient seated, ankle neutral (PF/DF). Grasp calcaneus and tib/fib and apply direct inversion stress. Pos if tilts out from lateral malleoli. |
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Test deltoid ligament
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Eversion stress test
Patient seated, hand on calcaneus and tib/fib, directly evert. Pos if noticeable gap is produced inferior to medial malleoli |
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Purpose of anterior tibiofibular ligament
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maintains dome shape of mortise
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Test anterior tibiofibular ligament
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Side-to-side test
Grasp talus and mortise w/o squeezing, attempt to move talus from side to side. Should be minimal translation. Pos if talus translates greater in one direction. HIGH ANKLE SPRAIN |
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Test achilles rupture
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Thompson test
Prone or kneeling w/ feet over edge of table. W/ patient relaxed, squeeze calf. Positive test: absence of PF when muscle is squeezed. |
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Test for flat/pronated feet
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standing, Feiss line. If above, supinated; below, pronated
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Test for rigid or supple flat foot
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When patient PFs, there should be a greater arch if it is supple.
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Test for plantar fascitis
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Patient supine with knee extended.
Therapist maximally dorsiflexes foot while simultaneously dorsiflexing digits, esp. hallux. Palpate medial and lateral calcaneal tubercles w/ other hand. Pain indicates positive test. |
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Homan's sign
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1. Redness, edema, and increase in warmth of one calf compared to the other
2. Palpate slowly, but deeply along calf 3. Gently passively dorsiflex foot. If one is pos, rule out between musculature. If two are positive patient should be sent to physician. |
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Talocrural distraction
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Patient seated/supine w/ foot off bed. Grasp talus and pull away from tibia.
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Talocrural AP glide
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Stabilize tib/fib. Grasp talus and distract, then pull up or push down using body weight.
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AP glide of fibula on tibia
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Stabilize tibia, hook base of fibula and pull ant/push post. Helps dorsiflexion
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Subtalar distraction
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Distract calcaneus and navicular from talus
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Subtalar rocking
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Use web space posterior over calcaneus and anterior over talus and push them towards each other. Allows normal dorsiflexion
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Medial/lateral tilt of calcaneus
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Stabilize talus, invert/evert calcaneus. Help pronation/supination.
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AP midtarsal glide
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Stabilize navicular, grasp metatarsals, move metatarsals anterior and posterior
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Rotation/ringing of midtarsal
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Stabilize navicular, rotate metatarsals around longitudinal axis of foot
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Distal intermetatarsal AP glide
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Move one metatarsal anterior, then posterior on the adjacent metatarsal
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Rotation of distal intermetatarsal
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Move one metatarsal in a rotatory fashion in relation to the adjacent
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IP AP glide
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stabilize metatarsal and move phalanx at a perpendicular angle
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IP rotation
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Rotate phalanx in relation to proximal joint
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IP medial/lateral tilt
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Perform like varus/valgus stress test
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Cuboid whip manipulation for cuboid syndrome: testing to determine if necessary
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Palpate dorsolateral aspect of cuboid to elicit pain in cuboid syndrome.
Midtarsal adduction test is performed to implicate cuboid syndrome. Stabilize subtalar joint w/ proximal hand and adduct forefoot with distal. Midtarsal supination test is performed to implicate cuboid syndrome. Stabilize STJ w/ proximal hand and supinate forefoot w/ distal. |
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Cuboid whip manipulation
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Begin patient in prone and knee flexed 70-90 degrees, ankle near neutral.
Interlock fingers over dorsum and position thumbs on plantar aspect of cuboid. Move knee into extension and PF foot while maintaining above position of hands. |
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100 percent miracle technique for PF loss (talocrural) procedure
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Patient lies on plinth knee flexed to 90 and heel of foot on surface.
Place hypothenar border of right hand proximal to joint line and wrap thumband fingers insecurely around leg. Place web space of L hand over talus, thumb and index slope distal so they lay below malleoli. Stand in lunge position w/ R elbow locked. Using body weight glide tib/fib posterior as far as you can. W/o releasing posterior glide of tib/fib, glide talus anteriorly w/ L hand. Have patient slightly PF anke. 5-10 reps |
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97% miracle technique for DF loss
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Patient stand w/ foot on low chair.
Place strap around self and posterior distal tib/fib 4 cm superior to achilles insertion. Web spaces of both hands on talus and push posteriorly on talus. Pull tib/fib forward with strap as patient flexes forward over foot. 5-10 reps |
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What's ortoloni's sign used for?
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detect a hip that's dislocated, but reducible. Used first few weeks of birth.
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Ortoloni's sign procedure
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Infant in supine, gently grasp femur and flex hip and knee to 90.
Gently apply traction and abduct thigh. Resistance to abduction and LR will be felt around 30-40 degrees. Positive sign is a palpable click, clunk, or jerk indicating hip moved back into acetabulum. Restriction of abduction may indicate irreducible d/l. |
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What does Barlow's sign assess?
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A hip that's reduced but dislocatable.
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Barlow's sign procedure
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Gently grasp femur
Flex hip and knee to 90 and abduct slightly Adduct hip while applying pressure in posterior direction. Palpate for movement of femoral head out of socket of acetabulum. If femur subluxes, do Ortoloni's sign |
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Adams forward bend test screens for...
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scoliosis
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Adams forward bend test procedure
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Child slowly beds forward w/ feet together and knees straight while dangling arms
Look for imbalances of rib cage or other deformities along back. |
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General LE scales
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Lower extremity activity scale
Lower extremity functional scale Western ontario and McMaster Universities Osteoarthritis index |
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General hip scale
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Harris Hip Rating scale
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Knee Scale
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Lysholm Knee Scoring Scale
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Ankle scales
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Ankle Joint Functional Assessment Tool
Disability Subsection of the Foot Function Index |
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Types of tests for Lower Extremity Functional Profile
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Balance test
Excursion test Lunge tests Step-up/down tests Jump tests Hop tests Functional hop tests Single-leg squat test |
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Lower extremity agility tests
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Figure-of-eight runs
Carioca run Shuttle run or line drill test Barrow zig-zag run |
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Lower extremity power tests
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Jump and hop tests
Vertical jump Wingate bicycle test Margaria-Kalamen power test |
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Ptosis associated with CN...
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3
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Facial droop/asymmetry associated w/ CN...
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7
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Hoarse voice associated w/ CN
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10
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Articulation of words associated w/ CNs
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5,7,10, 12
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Abnormal eye position associated w/ CNs
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3,4,6
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Abnormal/assymmetrical pupils
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2, 3
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Tests for optic (CN2)
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Test visual acuity
Screen visual fields by confrontation Test pupillary reactions to light Test pupillary reaction to accomodation |
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Test visual acuity
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Use glasses/lenses
Position patient 20 ft in front of Snellen eye chart Patient covers one eye at a time Read progressively smaller letters until can't go further. Record smallest line read successfully Repeat w/ other eye |
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Screen visual fields by confrontation
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2 ft in front of patient and have them look into your eyes.
Hold hands 1 foot away from patient's ears and wiggle a finger on one hand. Ask patient to indicate what finger they see move. Repeat 2-3 times to test both temporal fields. If abnormality suspected, test the 4 quadrants of each eye asking patient to cover opp eye with card. |
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Test pupillary reaction to light
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Dim room lights
Ask patient to look into distance Shine bright light obliquely into pupil. Look for both direct and consensual (other eye) reaction. If abnormal, test accomodation |
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Test pupillary reaction to accomodation
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hold finger 10 cm from nose
Ask them to alternate looking into distance and at your finger Observe response in each eye |
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Tests for Oculomotor (CN3)
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Observe for ptosis
Test extraocular movements Test pupillary reactions to light. |
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Test extraocular movements
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Stand/sit 3-6 ft from patient
Ask patient to follow finger w/o moving head Check gaze in 6 cardinal directions using cross or H pattern Pause during upward and lateral gaze to check for nystagmus Check convergence by moving finger toward bridge of nose |
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Test Trochlear (CN4
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Extraocular inward and down movement
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Tests for Trigeminal (CN5)
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Test temporal and masseter muscle strength
Test 3 divisions for pain sensation. If find abnormality, test 3 divisions for temperature sensation and light touch. Test corneal reflex |
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Test corneal reflex
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Ask patient to look up and away
From other side, touch cornea lightly with fine wisp of cotton. Look for normal blink reaction in both eyes |
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Test abducens (CN 6)
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Test extraocular movement- lateral
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Test Facial (CN7)
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Observe for facial droop/asymmetry
Ask patient to raise eyebrows, close both eyes to resistance, smile, frown, show teeth, and puff out cheeks. Test corneal reflex |
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Test acoustic (CN8)
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Screen hearing
Test for lateralization (Weber) Compare air and bone conduction (Rinne) |
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Screen hearing
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Face patient, hold out arms w/ fingers near each ear
Rub fingers together on one side Ask patient to tell you when and on which side they hear rubbing. Note asymmetry |
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Test for lateralization
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w/ 512 Hz or 1024 Hz tuning fork start vibration by tapping on hand.
Place base of tuning fork on top of patient's head. Ask where sound appears to come from (usually midline) |
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Compare air and bone conduction
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Start tuning fork vibration
Place base against mastoid bone When patient no longer hears the sound, hold end of fork near their ear (air conduction normally greater than bone) |
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Test vagus (CN10)
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Is voice hoarse or nasal
Ask patient to swallow Ask patient to say "ah" and watch movement of soft palate and pharynx Test gag reflex |
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Test accessory N (CN 11)
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Look for atrophy/asymmetry of traps
Ask patient to shrug against resistance Ask patient to turn head against resistance- watch/palpate SCM |
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Test hypoglossal (CN 12)
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Listen to articulation of words
Observe tongue as it lies in mouth Ask patient to protrude tongue and move it from side to side. |
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Coordination and gait tests
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Rapid alternating movements
Point to point movements Romberg Gait |
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Testing rapid alternating movement
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Patient strikes one hand on thigh, raises hand, and turns it over then strikes it back down as fast as possible.
Tap distal thumb with tip of index as fast as possible. Tap hand w/ ball of each foot as fast as possible |
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Point to point movement tests
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Patient touch your index finger then their nose alternately several times. Move your finger as perform.
Hold your finger still so patient can touch it w/ one arm and finger ourstreched. Ask patient to move their arm and return to your finger w/ eyes closed. Patient place one heel on opposite knee and run it down the shin to big toe, then w/ eyes closed. |
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Romberg
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Patient stand w/ feet together and eyes closed 5-10 seconds w/o support.
Positive if patient becomes unstable (vestibular or proprioceptive prob) |
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Sciatic N formed by what levels?
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L4-S3
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Sciatic Motor innervation:
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hamstrings and all mm of leg and foot
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Sensory innervation of sciatic:
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posterior compartment of thigh and distal division
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where is sciatic N palpable?
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Between ischial tuberosity and greater trochanter
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Where does lateral femoral cutaneous N travel and sometimes become trapped?
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Under inguinal ligament
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Motor supply of lateral femoral cutaneous:
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none
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Sensory supply of lateral femoral cutaneous N:
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Sensory area over lateral aspect of thigh
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Palpation of lateral femoral cutaneous N
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Patient supine, LE hanging off table to accentuate tension in N.
Palpate inferior aspect of ASIS and precede 1-2 cm medial. |
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Femoral N formed by what level?
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L2-4
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Motor innervation of femoral N
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Iliopsoas, quads, and sartorius
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Sensory innervation of femoral N
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anterior and medial aspect of thigh, medial aspect of leg and foot.
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Palpation of femoral N
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Lateral to femoral A, inferior to inguinal ligament
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Saphenous is a branch of what N?
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femoral
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Motor supply of saphenous
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none
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Sensory supply of saphenous:
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medial surface of skin from thigh down to medial side of proximal foot
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Palpation of saphenous
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Unlikely the branches are large enough to palpate. Located between tendons of sartorius and gracilis at level of medial knee joint line
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Crossed SLR/Well leg test/Contralateral limb test
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PSLR in asymptomatic LE produces symptoms in contralateral (symptomatic) limb. Only positive if PSLR on opposite side is severely limited and irritable.
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Treatment of irritable N
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US-pulsed
non-provoking initially Grades 1-2 (miatland) Movement is life? Anti-tension postures Avoiding activities that provoke symptoms Rest |
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Treatment of non-irritable N
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US- thermal
Non-provoking initially (gr 1-2) Grades 3-4 To point of tesnion, not pain HEP Rest |
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N treatment progression
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Incraese length of time
Number of oscillations Increase amplitude Increase mobilization of NS Point of application moved closer to involved area Treat non-neural structures (anytime during treatment) |
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What ligament does the valgus stress test test? (knee)
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MCL
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Valgus stress test procedure
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Patient supine
Slightly flex knee 20-30 degrees (primary structures) One hand on lateral thigh, other medially over tibia, apply valgus stress. Compare degree of gapping to opposite and palpate end feel. Positive test if greater gapping that opposite, if tibia and femur clunk when released, or pain along course of ligament. If positive, perform in full extension. |
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Varus stress test tests what ligament?
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lateral collateral ligament
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Varus stress test procedure
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Patient supine
Slightly flex knee 20-30 degrees One hand medial aspect of thigh, other laterally over tibia, apply varus stress. Compare degree of lateral gapping bilaterally. Be sure to prevent hip rotation Test is positive if: gapping on lateral joint space is greater than opposite side, if tibia and femur clunk, or pain along course of ligament. Perform in full extension. |
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What does the anterior drawer test test?
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ACL
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Is the anterior drawer test more or less sensitive than Lachman?
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less b/c IT band adds additional stability in this position
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Anterior drawer test procedure:
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Patient supine w/ hip flexed to 45, knee to 90, foot flat on table.
Use both hands to grasp tibia medially and laterally w/ thumbs over anterior joint line. Take up the slack and move the tib forward on the femur Palpate end feel and compare bilateral. |
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Positive anterior drawer test:
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excessive anterior tibial translation on the femur w/o a firm, ligamentous endfeel.
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Posterior drawer test tests what ligament?
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PCL
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Posterior drawer test position
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Patient supine, hip flexed 45, knee flexed 90, foot flat on table.
Grasp tibia medial and lateral w/ both hands, thumbs over anterior joint line. Take up slack and push tibia backward on femur. Palpate endfeel, compare bilateral. |
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Positive posterior drawer test:
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excessive posterior translation of tibia on femur w/o ligamentous end feel
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What does Lachman's test?
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ACL
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Lachman test position:
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patient supine, grasp femur w/ one hand and slightly ER LE.
Grasp tibia w/ other hand, flex knee to 15-20. Palpate hamstrings to assure they're relaxed. Briskly pull tibia forward on femur Palpate end feel bilateral. |
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Positive Lachman's test:
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If there's excessive anterior translation of the tibia on the femur w/o firm, ligamentous end-feel.
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Alternate Lachman's positions
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Patients thigh supported on examiner's.
Patient's thigh supported by table w/ lower leg off table and knee flexed 15-20. Patient seated w/ knee flexed 15-20 and lower leg supported by examiner. Patient prone w/ knee flexed 15-20; examiner pushes tib anteriorly. Patient supine, knee supported by examiner's thigh in 15-20 degrees of flexion. Stabilize distal tibia and patient actively contracts. Observe proximal tibia for signs of anterior displacement |
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McMurray test tests...
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Meniscal pathology
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McMurray test procedure:
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Patient supine
Grasp patient's femur w/ one hand and tibia w/ the other Passively fully flex and extend patient's knee. Medial meniscus: fully flex knee while externally rotating tibia, apply valgus stress while extending knee. Lateral meniscus: Internally rotate tibia, apply varus stress while extending knee |
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Positive McMurray:
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Pop/click is palpable/audible within joint with patient report of symptom reproduction or catch of knee.
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In McMurray's you need to rule out popping from other sources such as:
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Patellofemoral joint or medial plica
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Apley's compression test is non-specific for:
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meniscal injury
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Apley's compression test procedure:
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Patient prone, flex knee to 90.
Compress joint through long axis of tibia, then IR/ER tibia |
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Apley's compression test is positive for meniscal tear if:
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Pop or click is noted.
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What is the "Bounce Home" test for?
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End feel of a knee that lacks full extension.
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Bounce Home procedure:
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Patient supine, relax surrounding muscles.
One or both hands on patient's heel. Passively flex knee about 15 degrees. Let knee passively extend and palpate end feel. |
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Rubber endfeel indicates ___, mushy end feel indicates ___ in the Bounce Home
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meniscus; joint effusion
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What does the Apprehension test test?
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Patellar stability
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Apprehension test procedure:
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patient supine
Gently push patella laterally Positive test if patient expresses sensation of instability, apprehension, or contracts quads to prevent further displacement |
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Clarke's sign is also called:
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Patellofemoral grinding test
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clarke's sign procedure:
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Patient supine, towel roll under knee so it's flexed 5 degrees.
Cup superior pole of patella with web and stabilize it by moving it distally. Patient contracts quads, allow patella to glide under your hand. |
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When is Clarke's sign positive?
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patient reports excessive pain
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Hughston plica test procedure:
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Patient supine
Flex patient's kneewith palm of hand pressing patella mediallly. Fingers of same hand apply pressure over medial femoral condyle. Passively flex/extend knee |
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Positive Hughston plica test:
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Popping, clicking, or pain over medial condyle usually between 45-60 degrees.
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Test for Minor Joint Effusion (sweep test) tests
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for minor swelling within joint capsule
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Test for minor joint effusion procedure:
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Patient supine, knee relaxed
Place web space superior to patella and push fluid downward and distally. Maintain pressure superiorly. |
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Positive Minor joint effusion:
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two bulges will appear on either side of patellar ligament and will move laterally and medially w/ pressure.
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Test for major joint effusion procedure:
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Patient supine, knee relaxed
Therapist pushes patella downward (ballots patella) w/ palm of hand anyd then releases pressure w/o moving hand. |
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Positive test for major joint effusion:
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if patella springs up due to increased joint capsule pressure secondary to edema.
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What are the joint play motions of the knee?
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Distraction, medial/lateral tilt, and medial/lateral patellar glide
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What are the component/accessory motions for knee flexion?
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Posterior glide of tibia on femur (anterior glide of femur on tibia)
Medial tibial rotation Caudal glide of patella Posterior glide of fibula on tibia |
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What are the component/accessory motions for knee extension?
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Anterior glide of tibia on femur (posterior glide of femur on tibia)
Lateral tibial rotation (screw home) Cephalad glide of patella Anterior glide of fibula on tibia Cephalad movement of fibula on tibia (during knee extension at heel strike) |
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Direction of force for tibial distraction:
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tibia moves away from femur at right angle
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Direction of force lateral tilt of knee:
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Impose valgus stress. Control IR of femur
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Direction of force medial tilt of knee:
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Impose varus stress. Control ER component of femur.
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Direction of force for anterior tibial glide
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Knee flexed about 5, tibia moves anterior on femur parallel to tibial plateau
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Direction of force for posterior tibial glide
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Knee flexed about 5, tibia moves posterior on femur parallel to tibial plateau
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Direction of force for rotation of tibia
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Lower leg off table, knee flexed, stabilize femur.
Rotatory forces applied to distal tibia. |
