Chapter 1: Special Tests of the Lower Extremity

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dmshaw9
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296533
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Chapter 1: Special Tests of the Lower Extremity
Updated:
2015-02-22 17:04:40
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Lower Extremity Special Tests
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NPTE Review
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NPTE: Chapter 1
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  1. Patrick's (FABER) Test
    • Identifies dysfunction of hip (i.e. mobility restriction)
    • Pt lies supine, passive flex, abd, and ER test leg so foot rests just above knee on opposite leg
    • Slowly lower testing leg down toward table surface
    • (+) = Involved knee unable to assume relaxed position and/or reproduction of painful symptoms
  2. Grind (Scouring) Test
    • Identifies DJD of hip joint
    • Pt supine with hip in 90 deg flex and knee maximally flexed
    • Place compressive load into femur via knee joint
    • (+) = Reproduce pain within hip joint (may refer elsewhere)
  3. Trendelenburg Sign
    • Identifies weakness of glut med or unstable hip
    • Pt standing, ask to stand on one leg - observe pelvis of stance leg
    • (+) = Ipsilateral pelvis drops when lower limb support is removed
  4. Thomas's Test
    • Identifies tightness of hip flexors 
    • (You know the test, Danielle) 
    • Con of test = does not differentiate between tightness in iliac us vs psoas major
  5. Ober's Test
    • Identifies tightness of TFL and/or ITB
    • (You know the test, Danielle)
  6. Ely's Test
    • Identifies tightness of rectus femoris
    • Pt prone with knee of testing leg flexed (monitoring sacrum for onset of motion)
    • Go until they feel tightness! (block compensations)
    • (-) = Able to fully flex
    • knee so heel touches buttock without creating flexion at hip
    • (+) = Rectus femoris tightness
    • indicated when heel unable to reach buttock or hip flexes prior to achieving full knee flexion
  7. 90-90 Hamstring Test
    • Identifies tightness of hamstrings
    • Pt supine with hip and knee of testing limb supported in 90 deg flexion
    • Passively extend knee of testing limb until barrier is encountered
    • (+) = Knee unable to reach 10 deg from neutral position (lacking 10 deg of ext)
  8. Piriformis Test
    • Identifies piriformis syndrome
    • Pt spine with foot of test leg passively placed lateral to opposite limb's knee
    • Testing hip adducted, observe position of testing knee relative to opposite knee
    • (+) = Testing knee unable to pass over resting knee and/or reproduction of pain in buttock and/or along sciatic nerve distribution
  9. Leg Length Test
    • Identifies true leg length discrepancy
    • Pt supine, measure distance from ASIS --> lat malleolus or medial malleolus
    • Unequal girth of thigh muscles can skew results if using medial malleolus landmark 
    • (+) = Difference in lengths between two limbs identifies true leg length discrepancy 

    • True discrepancy = caused by anatomical difference in bone lengths
    • Functional discrepancy = not anatomical in origin, result of compensation due to abnormal position or posture
  10. Craig's Test
    • Identifies abnormal femoral antetorsion angle
    • Pt prone with knee flexed to 90
    • Palpate greater trochanter and slowly move hip through IR/ER
    • When greater trochanter feels most lateral, stop and measure angle of leg 
    • Normal angle = between 8-15 degrees of hip IR
    • Less than 8 degrees = retroverted hip
    • Greater than 15 degrees = anteverted hip
  11. Knee Collateral Ligament Instability Tests (Medial and Lateral Stability)
    • Identifies ligament laxity or restriction
    • Pt supine, knee placed in 20-30 degrees of flex
    • Valgus force tests MCL, varus forces tests LCL
    • (+) = Laxity and/or pain
  12. Lachman's Stress Test
    • Indicates integrity of ACL
    • Pt supine, testing knee flexed 20-30 degrees
    • Stabilize femur and passively try to glide tibia anterior
    • (+) = Excessive anterior glide of tibia
  13. Pivot Shift (Anterolateral Rotary Instability)
    • Indicates ACL integrity
    • Pt supine with testing knee in ext, hip flexed and abd 30 with slight IR
    • Hold knee with one hand and foot with other hand
    • Place valgus force through knee and flex knee
    • (+) = Ligament laxity as indicated by tibia relocating during test (as knee is flexed, tibia clunks backward at approx 30-40 deg - tibia was subluxed at beginning and then reduced by pull of ITB as knee flexed)
  14. Posterior Sag Test
    • Indicates integrity of PCL
    • Pt supine with testing hip flexed to 45 deg and knee flexed to 90
    • Observe to see whether tibia "sags" posteriorly
    • (+) = sag of tibia relative to femur
  15. Posterior Drawer Test
    • Indicates integrity of PCL
    • Pt supine and testing hip flexed to 45 deg and knee flexed to 90
    • Passively glide tibia posteriorly following joint plane
    • (+) = Excessive posterior glide
  16. Reverse Lachman
    • Indicates integrity of PCL 
    • Pt prone with knee flexed to 30 deg, stabilize femur and passively try to glide tibia posterior
    • (+) = Ligament laxity
  17. McMurray's Test
    • Identifies meniscal tears
    • Pt supine with testing knee in max flex
    • Passively IR and extend knee (tests lat meniscus)
    • Passively ER and extend knee (tests med meniscus)
    • (+) = Reproduction of click and/or pain in knee jt
  18. Apley Test
    • Helps differentiate between meniscal tears and ligamentous lesions
    • Pt prone with testing knee flexed to 90 degrees
    • Stabilize pts thigh to table with knee
    • Passively distract the knee joint, slowly rotate tibia internally and externally 
    • Repeat with compressive load
    • (+) = Pain or decreased motion during compression (meniscal dysfunction) or distraction (ligamentous dysfunction)
  19. Hughston's Plica Test
    • Identifies dysfunction of plica
    • Pt supine and testing knee flexed with tibia IR
    • Passively glide patella medially while palpating medial femoral condyle
    • Feel for popping as you passively flex and extend the knee
    • (+) = Pain and/or popping
  20. Patellar Apprehension Test
    • Indicates past history of patella dislocation
    • Pt supine with patella passively glided laterally
    • (+) = Pt does not allow and/or does not like patella to move in lateral direction
  21. Clarke's Sign
    • Indicates patellofemoral dysfunction
    • Pt supine with knee in ext resting on table
    • Push posterior on superior pole of patella, then ask pt to perform an active contraction of quads muscle
    • (+) = Pain produced in knee
  22. Ballotable Patella (Patellar Tap Test)
    • Indicates infrapatellar effusion
    • Pt supine with knee in ext resting on table
    • Apply soft tap over central patella
    • (+) = Perception of patella floating ("dancing patella" sign)
  23. Fluctuation Test
    • Indicates knee joint effusion
    • Pt supine, with knee in ext resting on table
    • Place one hand over supra patellar pouch and other over anterior aspect of knee joint
    • Alternate pushing down with one hand at a time
    • (+) = Fluctuation (movement) of fluid noted during test
  24. Q-Angle Measurement
    • Measurement of angle between quadriceps muscle and patellar tendon
    • Normal = 13 degrees for men and 18 degrees for women
    • Angles less than or greater than normal may be indicative of knee dysfunction and/or biomechanics dysfunctions within lower limb
  25. Noble Compression Test
    • Identifies whether distal ITB friction syndrome is present
    • Pt supine, hip flexed to 45 degrees and knee flexed to 90 degrees
    • Apply pressure to lateral femoral epicondyle then extend knee
    • (+) = Reproduces same pain over lateral femoral condyle (pt will complain of pain over lateral femoral epicondyle at approx 30 degrees flex)
  26. Tinel's Sign (Knee)
    • Identifies dysfunction of common fibular nerve post to fibular head following common fibular nerve distribution
    • Tap region where common fibular nerve passes through post to fibular head
    • (+) = Reproduces tingling and/or paresthesia into leg
  27. Neutral Subtalar Positioning
    • Examination identifies abnormal rearfoot to forefoot positioning
    • Pt prone with foot over edge of table
    • Palpate dorsal aspect of talus on both sides with one hand and grasp lateral forefoot with other
    • Gently DF foot until resistance is felt, then move foot through arc of supination and pronation 
    • Neutral position is point at which you feel foot fall off easier to one side or other (at this point, compare rearfoot to forefoot and forefoot to rearfoot)
  28. Anterior Drawer Test (Foot/Ankle)
    • Identifies ligamentous instability (particularly ATFL) 
    • Pt supine with heel off edge of table, ankle PF 20 degrees
    • Stabilize lower leg and grasp foot, pull talus anteriorly
    • (+) = Excessive anterior glide of talus and/or pain is noted
  29. Talar Tilt
    • Identifies ligamentous instability (particularly calcaneofibular ligament) 
    • Pt side-lying with knee slightly flexed and ankle in neutral
    • Move foot into adduction testing calcaneofibular ligament and into abd testing deltoid ligament
    • (+) = Excessive add or abd occurs and/or pain is noted
  30. Thompson's Test
    • Evaluates integrity of Achilles tendon
    • Pt prone with foot off edge of table, squeeze calf muscle
    • (+) = No movement of foot while squeezing calf
  31. Tinel's Sign (Foot/Ankle)
    • Identifies dysfunction of post tib nerve posterior to medially malleolus or deep fibular nerve ant to talocrural joint
    • Pt supine with foot supported on table
    • Tap over region of post tib nerve as it passes post to med malleolus
    • Tap over region of deep fibular nerve as it passes under dorsal retinaculum (ant to ankle joint) 
    • (+) = Reproduction of tingling and/or paresthesia into respective nerve distributions
  32. Morton's Test
    • Identifies stress fracture or neuroma in forefoot
    • Pt supine with foot supported on table
    • Grasp around met heads and squeeze
    • (+) = Pain in forefoot

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