Special Tests: Hip, Knee, Ankle Name Structure How to Positive Image

Transcription

1 Special s: Hip, Knee, Ankle Name Structure How to Positive Image Hip Vascular s Arterial Pulse Palpation vascular compromisetrauma at fem, popliteal, or dorsalis pedis arteries femoral pulse palpated at mid-inguinal point, halfway between the pubic symphysis and ASIS, popliteal pulse can be palpated behind semi-flexed knee, dorsalis pedis artery palpated lateral to extensor hallucis longus tendon on dorsal foot, distal prominence part of navicular note pulse presence/strength, observe signs of skin pallor, note any decrease temp. in lower extremity on involved side Femoral Nerve Traction fem. nervemay be causing radiating anterior groin/hip pain patient lies on unaffected side with unaffected hip/knee flexed, affected hip/knee extended, affected hip maintained in 15deg of ext while knee is then moved passively into flexion pain, numbness, or tingling into ant. thigh of affected limb Muscle Function s Ely s Rect Femoris contracture Px prone, examiner passively brings px s heel to buttocks ipsilateral hip flexion, numbness, tingling into ant thigh Trendelenburg hip stability & contralateral glut. med weakness Px stands on one leg, examiner observes non-wt bearing hip non-wt bearing hip drops (weakness at wt-bearing hip abductors) Thomas flexibility of hip flexors Px lies supine, bring one knee up toward chest to pull knee to chest to flatten back 1. ext leg becomes flexed and knee rises- tight iliopsoas 2. ext leg rises off table- tight rec fem 3. abduction/lateral rotation- tight ITB Ober s ITB syndrome Px side-lying on unaffected side w bottom hip/knee flexed for stability, top leg in abduction & knee in ext throughout the test, place 1 hand on top pelvis then support leg w other hand, passively lower leg into add. pelvis moves before leg adducted, leg remains in abducted position

2 Noble Compression TFL and ITB syndrome Px supine & knee & hip flexed to 90deg, examiner applies pressure w thumb to lateral femoral epicondyle, while pressure maintained, patient slowly extends knee & hip can also be done standing to confirm pain at 30deg of flexion over lateral femoral condyle Piriformis tightness in piriformis patient side-lying on unaffected leg, position top leg w knee flex & hip in 60deg flex, stabilize pelvis and apply a downward pressure to knee pain in piriformis mm, sciatic pain Antenna tightness in piriformis px prone- knees together, knees at 90, passively let legs rotate outwards compare bilaterallytightness Orthopedic s Stress (Fulcrum ) femoral neck stress fx. Px sitting position on end of table or bench, examiner places forearm under thigh, other hand, applies a downward pressure to proximal knee pain- confirmation requires a bone scan AND warrants physician referral Patrick s (Faber) limited hip mobility, iliopsoas spasm, and/ or SI dysfunction Px supine w involved leg flexed at hip/ knee, foot crossed over opposide knee, one hand stab opposite ASIS, other hand medial side of knee of involved leg, passively allow leg into abduction by lowering knee to table thigh remains elevated above opposite leg indicating iliopsoas spasm, pain at SI joint Thomas *with ER or IR acetabular labrum Px supine, examiner bring one knee up toward chest, examiner slowly/ passively extends the subjects lower extremity with hips going to external (internal) rotation reproduces the Px s symptoms Resisted SLR acetabular labrum or interarticular lesion Px supine w Px actively raising the lower extremity to 30deg of hip flexion &knee extended, Px holds position while downward pressure at ankles, passively allow leg into abduction by lowering knee to table reproduces the px s symptoms anteriorly LLI s a. True LLI b. Apparent LLI visual discrepancy in leg lengths btw limbs Px supine, thumbs on Px medial malleoli, raise/lower hip, passively extend legs, compare a. true: ASIS to medial mallelus b. apparent: umbilicus to medial malleolus

3 Knee Effusion s Brush Wipe intra-articular effusion starts below joint line on medial side of patella, stroke proximally to hip (2-3x), opposite hand on lateral side of patella will then stroke down wave of fluid will pass over to medial side, may take 2seconds to appear Valgus Stress medial ligament examiner positions Px s leg held under his trunk, knee placed in 30deg flexion (unlock it), examiner places a valgus stress on knee while ankle is stabilized pain (but not a pain provocation test), look for gaping/ instability, compare bilaterally Varus Stress lateral ligament examiner positions Px s leg held under his/her trunk, knee is place in 30deg of flexion (unlock it), examiner places varus stress on knee while ankle is stabilized pain (but not pain provocation test), look for gapping/ instability, compare bilaterally Lachman s ACL examiner stands on same side as leg, holds Px s leg btw full ext and 30deg flexion, femur stabilized with one hand (outside hand) while proximal part of tibia is slightly rotated laterally, translates forward on Px s femur mushy end feel, anterior translation of tibia on femur Anterior Drawer Px knee flexed to 90deg and hip flexed to 90deg, examiner stabilizes Px s foot on table (sit on it), hands placed around post tib to relax hamstrings, tibia is drawn forward mushy end feel, anterior translation of tibia on femur Posterior Sag Sign PCL just observation

4 Meniscal s McMurray s (medial) McMurray s (lateral) integrity of, diagnoses a meniscal tear knee held by one hand (at joint line), flexed to 90deg while foot held by sole with the other hand, examiner then places one hand on lateral side of the knee to stabilize joint and provide valgus stress, other hand rotates the leg externally while extending the knee knee held in one hand (at joint line), and flexed to 90deg while the foot is held by the sole with the other hand, examiner then places one hand on the medial side of the knee to stabilize joint and provide a varus stress, other hand rotates the leg internally while extending the knee pain or click is felt, tear in the medial pain or click is felt, tear in the lateral Thessaly examiner supports Px by holding hands while Px stands flatfooted on one leg (affected leg), Px rotates his knee/body while keeping wt-bearing knee in light flexion (5deg)- doing the twist, continue with knee in 20deg flexion medial or lateral joint-line discomfort Apley s Compression Px prone knee flexed to 90deg, thigh anchored to table with examiners knee, examiner medially and laterally rotates tibia with compression note: any restrictions, excessive movement or discomfort- if painful- meniscal Apley s Distraction ligaments Px lies prone, knee flexed to 90deg, thigh anchored to table with examiners knee, examiner medially and laterally rotates tibia with distraction note: restrictions, excessive movements or discomfort- if painful- ligamentous Bounce Home Px supine, heel in exam hands, Px s knee completely flexed and allowed to passively extend extension blocked and has springy (rubbery) end feel

5 Ankle s for Fracture Heel Tap (Bump) fx Px sitting or lying supine, involved foot off table, knee straight, examiner stabilize lower leg w one hand and bumps the calcaneus w the other, 2-3 times progressively more force pain (area of complaint) possible fx s for Instability Anterior Drawer at Ankle anterior instability btw talus/tibia- ATFL Px leg off table, foot in slight plantar flex, one hand on lower tib, other on calcaneus, draw calcaneus (and talus) anterior, tibia posteriorly clunk as talus moves forward Inv/Eversion Talar Tilt integrity of ATFL and/or deltoid ATFL-stress on lateral side by inverting calcaneus deltoid- stress on medial side by everting foot- stabilize Px leg around tibia and calcaneus inversion stress (+) if talus gaps/rocks ankle mortise eversion stress (+) gapping in ankle mortise joint inversion Kleiger s (external ROT) test deltoid lig sprain or syndesmosis involvement Px leg off table, examiner stabilize lower leg w one hand, gap medial aspect of foot supporting ankle in neutral, rotate foot laterally med/lat joint pain syndesmosis (anterior tib-fit) pain Varus/Valgus Stress at MTP ligaments supine, knees extended, examiner stabilize proximal bone, gap bone distal to joint to be tested near the middle of shaft then moves distal bone med/lat attempting to open up joint increase laxity or pain at MTPJ Muscle Tendon s Thompson achilles tendon Px foot off table, squeeze affected calf absence of plantar flexion of footrupture

6 Neurovascular s Tinel s at the ankle nerve compression at tarsal tunnel tap area over posterior tibial nerve with hammer (+) sign paresthesia radiating into foot Forefoot Squeeze interdigital neuroma gap foot and slowly place transverse pressure across MT head sharp pain in forefoot, click (mulder click) Homan s Sign/ DVT supine leg straight, examiner dorsiflex Px foot deep seated pain in post leg/calfpossible thrombophlebitis