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54 Cards in this Set

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L5
Extension of MP, dorsiflex big toe.
Reflex - no reflex
Sensation - lateral side of leg and dorsum of foot. Tibia cres, dividing line beween the L5 and L4 dermatomes.
S1
Eversion & (plantar flexion) of foot.
Reflex - Achilles tendon reflex
Sensation - lateral malleolus and the lateral & plantar surface of foot.
Babinski Test
plantar surface of foot from calcaneus along later. - toes flaxes. + Big toe extends and other toes planter flex and splay - upper motor neuron.
Normal in newbors

Disc L3-L4
Root L4
Muscles - Tibialis Anterior
Relex - Patellar reflex
Sensation - Medial Leg & Medial foot.
Disc L4-L5
Root - L5
Muscles - Extensor Hallicus Longus
Reflex - None
Sensation - Lateral leg & Dorsum of foot
Disc L5-S1
Root - S1
Muscles - Peroneus Longus & Brevis
Reflex - Achilles Reflex
Sensation - Lateral foot
Bragard's Test
- At the pain point, lower the leg slightly, and then dorsiflex the foot.
- Negative - no sciatic pain (d/t tight hamstring)
- Positive - reproduce sciatic pain (sciatic nerve involvement)
Hoover Test
- Malingering test
- Normal: when trying to raise involved leg, pressure on calcaneus of the opposite (unaffected) leg.
- Malingering: no or v. little pressure on teh opposite side of affection.
Naclas Test
(Prone kneed bending test)
What are we testing
-Used to test for a tight rectus femoris, upper lumbar joint lesion, upper spine nerve root lesion, hypomobile sacroilic joint.
Naclas Test
(Prone kneed bending test)
How we test.
-Pt. prone. Flex effected kneed as far as possible so that the patient's heel rests against the ipsilateral buttock.
Naclas Test
(Prone kneed bending test)
Results
*pain radiating down to the anterior thigh - problem in the rectus femoris(inf. of femoral nerve root)
*pain in the lumbar spine - problem in the lumbar spine.
*Pain in sacroiliac area - sacroiliac disorder.
Milgram Test
*Raise straight legs 2" and hold for 30 sec.
* positive - can't do
* intrathecal or exrathecal pathology, space occupying pathology -> herniated disc
Valsalva Maneuver
*Take deep breath and hold. Bear down for a BM.
*Positive - cause intrathecal pressure - > herniated disc
Patrick or FABERE test
How to perform
* Prone - foot of involved side is placed on top of opposite knee.
* hip joint is flexed, abducted and externally rotated.
*Extend hip by applying downward pressure on knee, with the contralateral side of pelvis fixed.
Patrick or FABERE test
Results
Positive - Pain during this test -> a coax pathologic condition or sacroiliac join pathology (relatively uncommon)
- Not done with patient with hip prosthesis.
Ischial Tuberasity
The projection located in the middle of the buttock, almost at the level of the gluteal fold - felt easier if the hip is flexed - also known as the bones one sits on or "sitz" bones attachment site for hamstring muscles.
NAVEL
Femoral Nerve - femoral Artery - femoral Vain - empty - Lymph node
from lateral to medial.
Sciatic nerve
Midway b/w the greater trochanter and the ischial tuberosity; it may pass beneath or through the pisiformis muscle; a pisiformis muscle spasm, trauma, or herniated lumber disc can irritate the nerve that radiates down the leg.
Muscle involved with sciatica
Pisiformis muscle
Adductor muscles
The medial muscles of the hip including the Gracilis, Pectineus, Adductor longus Bravis and Magnus ; adductor longus is the most superficial and accessible to palpation.
Abductor muscles
the lateral muscles of the hip - the primary muscle is the gluteus medius.
Hip Muscle test - Abduction
Primary - adductor longus (obturator nerve, L2,3,4)
Secondary - adductor brevis/accuctor magnus/pectineus/gracilis
Pt. sits on side of table, prac. resists pt's outward motion.
Trendelenburg Test - hip
Observe Pt's walk - look for drop on the opposite side to the problem.
Positive - Iliac crest level high on standing side/low on the side of elevated leg.
Thomas Test
Hip
PROM test - passiv eflexion of the iliofemoral joint; bring pt. knee to chest, look for opposite leg to lift off table. Sign for hip flexor contracture = shortened hip flexor muscles - psoas, iliopsoas, iliacus.
Thomas Test - SI joint
while performing place hand under lower back feel for lordosis (should have flattened)
Negative - lordosis same or bigger = problem in SI joint on that side.
Patrick's Test
Hip
other name
FABERE - Flexion, Abduction, External Rotation, Extention
Patrick's Test
Hip
the test
Pt. Supine - make a "tree pose" with bad side. Apply slight pressure on opposite ASIS - extension.
Abnormal - pain in hip, limited movement.
Yeoman's Test - hip
Pt. prone, passively extend leg - lift it, put pressure with other hand across the SI joint.
- Anterior thigh paresthesia = femoral nerve root inflammation.
-Lumbar pain = lumbar involvement.
- Pain localized to SI = pathology in the anterior SI ligament.
Muscles involved in pelvic interior lift
Anterior tilt - ASIS moves anteriorly and inferiorly.
Hip flexors = Iliopsoas, rectus femoris.
Lumbar extensor = erector spinae
Muscles involved in pelvic posterior tilt
Abdominal muscles = rectus abdominus
Hip extensors - hamstrings, gluteus maximus
Test for joint stability

Knee
Collateral L. - Balgus stress (medial), Varus stress (lateral)
Cruciate L. Anterior - draw tibia forward
Cruciate L. posterior - push tibia back.
Sensation testing
L2
Anterior of middle thigh, femoral nerve.
Sensation testing
L3
Anterior thigh, femoral nerve
Sensation testing
L4
Anterior portion of knee, medial side of leg, infrapatellar branches of saphenous nerve (only sensory branch of femoral nerve)
Sensation testing
S2
Mid-line of posterior thigh and popliteal fossa, posterior femoral cutaneous nerve of thigh.
McMurray Test - knee
Genenral
Torn meniscus - palpable+audible clicking in joint during knee flexion and extension.
Tenderness in palpation of the joint line.
McMurray Test - knee
Medial meniscus
flex knee and externally rotate the leg. pushing against the medial ankle and lateral knee (valgus stress).
McMurray Test - knee
Lateral meniscus
Flex the knee and internally rotate the leg; pushing against the lateral ankle and medial knee (varus stress).
Apley's compression (grindind)
torn meniscus - rotate tibia internally + externally on femur while compressing medial and lateral menisci.
Apley's distraction test
Distinguish meniscal & ligamentous problems - traction while rotating tibial internally & externally on femur.
L4
Dorsiflexion & (inversion) of ankle.
Deep Tendon Reflex.
Sensation medial side of leg
Sciatic nerve
Midway between the greater trochanter and the ischial tuberosity, it may pass beneath or through the piriformis muscle. A spasm of the piriformis, trauma, or a herniated lumbar disc can irritate the nerve so that pain radiates down the leg.
• Gluteus Medius
Originates from the surface of the illium just inferior to the crest from ASIS to PSIS and inserts at the lateral aspect of the greater trochanter of the femur; involved in hip adduction, test c/Trendelenburg test
• Anterior pelvic tilt
=shortened hiplxors c/shortened back extensors
• Posterior pelvic tilt
Shortened rectus abdominus c/shortened hamstrings
The Leg-neurologic exam
Muscle testing
-Extension—primary extensor =quadriceps (femoral nerve L2, L3, L4
-Flexion—primary flexor=hamstrings (tibial portion of sciatic nerve L5-S1)
-Internal & External rotation=no isolated test
The Leg-neurologic exam
Reflex testing
=patellar reflex (L2, L3, L4)
The Leg-neurologic exam
Sensation testing
-L2: anterior of middle thigh (femoral nerve)
-L3: anterior thigh (femoral nerve)
-L4: anterior portion of knee, medial side of leg (infrapatellar branches of saphenous nerve *the only sensory branch of the femoral nerve)
-S2: middle of posterior thigh and popliteal fossa (posterior cutaneous nerve of thigh)
Hindfoot Varus and Valgus
o Varus - inversion of the calcaneus when the subtalar joint is in the neutral postion. Subsequent deformity manifests as “clubfoot”
o Valgus- eversion of the calcaneus when the subtalar joint is in the neutral position. Decrease in plantar support; occurs in “flatfoot”
Bunion—Hallux Valgus
Medial deviation of the head of the first metatarsal in relation to the center of the foot. A callous develops over the medial side of the head of the metatarsal bone, and the bursa becomes thickened and inflamed, excessive bone (exostosis) forms. The result is a bunion
Hallux Rigidus
a condition in which dorsiflexion or extension of the big toe is limited because of osteoarthritis of the first metatrasophalangeal joint
Tom, Dick, an’ Harry
from medial to lateral Tibialis Posterior, Fleoxr Digitorum Longus, Posterior Tibial Artery and Nerve, Flexor Hallucis Longus
Foot Pronation
eversion+ abduction + dorsiflexion
Foot Supination
inversion + adduction + plantar flexion