Ortho Physical Assessment Dr. Suh Final

Front 1

L5

Back 1

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.

Front 2

S1

Back 2

Eversion & (plantar flexion) of foot.
Reflex - Achilles tendon reflex
Sensation - lateral malleolus and the lateral & plantar surface of foot.

Front 3

Babinski Test

Back 3

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

Front 4

Disc L3-L4

Back 4

Root L4
Muscles - Tibialis Anterior
Relex - Patellar reflex
Sensation - Medial Leg & Medial foot.

Front 5

Disc L4-L5

Back 5

Root - L5
Muscles - Extensor Hallicus Longus
Reflex - None
Sensation - Lateral leg & Dorsum of foot

Front 6

Disc L5-S1

Back 6

Root - S1
Muscles - Peroneus Longus & Brevis
Reflex - Achilles Reflex
Sensation - Lateral foot

Front 7

Bragard's Test

Back 7

- 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)

Front 8

Hoover Test

Back 8

- 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.

Front 9

Naclas Test
(Prone kneed bending test)
What are we testing

Back 9

-Used to test for a tight rectus femoris, upper lumbar joint lesion, upper spine nerve root lesion, hypomobile sacroilic joint.

Front 10

Naclas Test
(Prone kneed bending test)
How we test.

Back 10

-Pt. prone. Flex effected kneed as far as possible so that the patient's heel rests against the ipsilateral buttock.

Front 11

Naclas Test
(Prone kneed bending test)
Results

Back 11

*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.

Front 12

Milgram Test

Back 12

*Raise straight legs 2" and hold for 30 sec.
* positive - can't do
* intrathecal or exrathecal pathology, space occupying pathology -> herniated disc

Front 13

Valsalva Maneuver

Back 13

*Take deep breath and hold. Bear down for a BM.
*Positive - cause intrathecal pressure - > herniated disc

Front 14

Patrick or FABERE test
How to perform

Back 14

* 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.

Front 15

Patrick or FABERE test
Results

Back 15

Positive - Pain during this test -> a coax pathologic condition or sacroiliac join pathology (relatively uncommon)
- Not done with patient with hip prosthesis.

Front 16

Ischial Tuberasity

Back 16

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.

Front 17

NAVEL

Back 17

Femoral Nerve - femoral Artery - femoral Vain - empty - Lymph node
from lateral to medial.

Front 18

Sciatic nerve

Back 18

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.

Front 19

Muscle involved with sciatica

Back 19

Pisiformis muscle

Front 20

Adductor muscles

Back 20

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.

Front 21

Abductor muscles

Back 21

the lateral muscles of the hip - the primary muscle is the gluteus medius.

Front 22

Hip Muscle test - Abduction

Back 22

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.

Front 23

Trendelenburg Test - hip

Back 23

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.

Front 24

Thomas Test
Hip

Back 24

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.

Front 25

Thomas Test - SI joint

Back 25

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.

Front 26

Patrick's Test
Hip
other name

Back 26

FABERE - Flexion, Abduction, External Rotation, Extention

Front 27

Patrick's Test
Hip
the test

Back 27

Pt. Supine - make a "tree pose" with bad side. Apply slight pressure on opposite ASIS - extension.
Abnormal - pain in hip, limited movement.

Front 28

Yeoman's Test - hip

Back 28

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.

Front 29

Muscles involved in pelvic interior lift

Back 29

Anterior tilt - ASIS moves anteriorly and inferiorly.
Hip flexors = Iliopsoas, rectus femoris.
Lumbar extensor = erector spinae

Front 30

Muscles involved in pelvic posterior tilt

Back 30

Abdominal muscles = rectus abdominus
Hip extensors - hamstrings, gluteus maximus

Front 31

Test for joint stability

Knee

Back 31

Collateral L. - Balgus stress (medial), Varus stress (lateral)
Cruciate L. Anterior - draw tibia forward
Cruciate L. posterior - push tibia back.

Front 32

Sensation testing
L2

Back 32

Anterior of middle thigh, femoral nerve.

Front 33

Sensation testing
L3

Back 33

Anterior thigh, femoral nerve

Front 34

Sensation testing
L4

Back 34

Anterior portion of knee, medial side of leg, infrapatellar branches of saphenous nerve (only sensory branch of femoral nerve)

Front 35

Sensation testing
S2

Back 35

Mid-line of posterior thigh and popliteal fossa, posterior femoral cutaneous nerve of thigh.

Front 36

McMurray Test - knee
Genenral

Back 36

Torn meniscus - palpable+audible clicking in joint during knee flexion and extension.
Tenderness in palpation of the joint line.

Front 37

McMurray Test - knee
Medial meniscus

Back 37

flex knee and externally rotate the leg. pushing against the medial ankle and lateral knee (valgus stress).

Front 38

McMurray Test - knee
Lateral meniscus

Back 38

Flex the knee and internally rotate the leg; pushing against the lateral ankle and medial knee (varus stress).

Front 39

Apley's compression (grindind)

Back 39

torn meniscus - rotate tibia internally + externally on femur while compressing medial and lateral menisci.

Front 40

Apley's distraction test

Back 40

Distinguish meniscal & ligamentous problems - traction while rotating tibial internally & externally on femur.

Front 41

L4

Back 41

Dorsiflexion & (inversion) of ankle.
Deep Tendon Reflex.
Sensation medial side of leg

Front 42

Sciatic nerve

Back 42

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.

Front 43

• Gluteus Medius

Back 43

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

Front 44

• Anterior pelvic tilt

Back 44

=shortened hiplxors c/shortened back extensors

Front 45

• Posterior pelvic tilt

Back 45

Shortened rectus abdominus c/shortened hamstrings

Front 46

The Leg-neurologic exam
Muscle testing

Back 46

-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

Front 47

The Leg-neurologic exam
Reflex testing

Back 47

=patellar reflex (L2, L3, L4)

Front 48

The Leg-neurologic exam
Sensation testing

Back 48

-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)

Front 49

Hindfoot Varus and Valgus

Back 49

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”

Front 50

Bunion—Hallux Valgus

Back 50

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

Front 51

Hallux Rigidus

Back 51

a condition in which dorsiflexion or extension of the big toe is limited because of osteoarthritis of the first metatrasophalangeal joint

Front 52

Tom, Dick, an’ Harry

Back 52

from medial to lateral Tibialis Posterior, Fleoxr Digitorum Longus, Posterior Tibial Artery and Nerve, Flexor Hallucis Longus

Front 53

Foot Pronation

Back 53

eversion+ abduction + dorsiflexion

Front 54

Foot Supination

Back 54

inversion + adduction + plantar flexion