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NMS3 Orthos Part 2
| Question | Answer |
|---|---|
| What are the orthos for the patella? | Patella ballotement, Fouchet's Sign, Patella grinding test, Clarke's Sign, Patella apprehension test, dreyer's sign. |
| What are the orthos for the meniscus? | Bounce home, McMurry, Steinmann's, Apley's Compression Test, |
| What are the orthos for the Cruciate Ligaments? | Drawer, Lachman's, Slocum's, |
| What are the orthos for the medial/lateral collateral ligaments? | Adduction stress test, abduction stress test, Apley's Distraction test, |
| Patella Ballotement | with knee extended Dr applies pressure to the patella. Pos: floating sensation of patella=swelling in knee. |
| Fouchet's Sign | Supine, leg extended. Dr uses flat of hand to compress patella against femur. Pos: Pain or point tenderness at margin of patella. Neg: then press and rub patella transversely against the femur. Pos: audible/palpatble grinding or pain. |
| What does a postive fouchet's sign indicate? | Patellar tracking disorder, Peripatellar syndrome, Patellofemoral dysfunction. |
| Patella Grinding test: | Supine, leg extended. Dr used flat of hand to compress patella against femur and move medially and laterally. Pos: Pain under=chondromalacia. Pain over=Prepatellar bursitis. |
| Clark Sign: | Supine, leg extended. Dr compresses quads at superior pole of patella. Pt gently contracts quads. Pos=Pain in patella or failure to hold contraction. = Chondromalacia. |
| Patella apprehension test: | Seated or supine. Quads relaxed. Knee flex to 30 deg. Dr slowly pushes patella laterally watching patient. Pos: Patient senses patella is going to dislocate so they contract quad. |
| Dreyer's sign | Supine. Leg extented, pt raises leg while keeping knee strait. If unable to do so, stablize the quad tendon by grasping just above the knee. Pos=pain decreases=patellar fracture |
| Bounce Home | Supine. Dr holds ankle with one hand and supports knee with other hand. Dr lets knee go allowing full extension. Pos: Knee doesnt fully extend or a rubbery end feel is felt=Meniscus tear. |
| McMurray | Supine with knee flexed heel to buttock. Dr internally rotates and extends then externally rotates and extends tibia. Pos: palpable or audible click/snap=torn meniscus. Internally rotation=lateral. External rotation= medial. |
| Steinmann's | Supine. Dr palpates medial/lateral joint for pain. Keeping finger on painful point the patients knee is flexed. Pos: Pain moves posterior on flexion and anterior on extension=meniscal tear. |
| Apley's Compression test/Grinding test | Prone. Dr flexes knee to 90 deg. Dr stabilizes Pt thigh with their knee. grasps ankle placing a downward pressure while internally and externally rotating leg. Pos: pain/crepitus on either side of the knee=Meniscus injury to that side. |
| Drawer test | Supine knee flexed 90. Dr sits on foot. Hamstring must be relaxed. Dr grasp tibia with both hands and stresses the joint AP/PA. Pos: >6mm of movement. PA increase=partial or complete tear of Anterior cruciate lig. AP increase=Posterior cruciate lig. |
| Lachman's | Supine knee flexed 30. Dr forces tibia anterior while thigh is stabilized. Pos: Anterior movement of tibia= ACL, and post oblique ligament |
| Slocum's | Supine knee flexed 90, internally rotated 30. Dr sits on foot to stabilize, grabs tibia with both hands and stress joint anterior. Pos:Excessive tibial movement or/and soft end feel=Torn ACL, posteriolateral capsule, fibular collateral ligament or IT band |
| Adduction stress test | Supine-mostly extended slight flexion. Dr holds ankle/calcaneus and applied medial-lateral(varus) stress. Pos: pain at lateral collaterals |
| Abduction stress test | Supine-extended with slight flexion. Dr holds ankle/calcaneus and applies Lateral-medial (valgus) stress. Pos: Pain at medial collaterals. |
| Apley's Distraction test | Prone with knee flexed. Dr stabilizes thigh with their knee and grasps the ankle pulling upward while internally and externally rotating the leg. Pos: Pain= non specific ligament injury or instability of medial/lateral collateral ligaments. |
| Apley's 4 parts combination/differentiation test. | Prone. Dr strongly internally rotates foot and leg and flexes knee past 90 (cruciates). Dr strongly externally rotates etc (Collaterals). Dr compression test (menisci). Dr does distraction test (collaterals). |
| Lateral pivot shift/ Test of McIntosh | Supine. Dr flexes 5 deg, applies L-M valgus while internally rotating the ankle/tibia. Dr bends knee while maintaining stress. Pos: PT feels knee give away, or tibia jogs backward.= ACL, Postlateral capsule, arcuate-popliteus complex, LCL, or ITB |
| Wilsons | Supine. Dr flexes knee 90. tibia internally rotated and knee extended. at 30 deg the pain in knee increases, the tibia then is externally rotated. POS: pain decreases with external rotation=possible osteochondritis dissecans of knee. |
| ANKLE | |
| Squeeze Test | Seated/Supine. Dr wraps both hands around distal leg and squeezes. Pos:Deep pain=injury to syndesmosis. |
| Anterior Drawer | Seated with calcaneus off the table. Dr stablize tibia to table with one hand and cups calcaneus with other pulling it forward. Pos: Anterior movement more than other side=anterior talofibular ligament laxity. |
| Morton's Test | Seated/supine. Dr grasps foot around metatarsal heads and squeezes applying transverse pressure. Pos: Sharp pain to forefoot= metatarsalgia or neuroma. |
| Strunsky's Sign | Seated/supine with toes pointed up. Dr grasp toes of affected foot and suddently passively flexes the toes. Pos: Pain in transverse arch of foot=metatarsalgia. |
| Homan's Sign | Supine with knee extended. Dr dorsiflexes the foot and squeezes the calf. Pos:deep pain in the posterior leg or calf=thrombophlebitis. |
| Metatarsal Tap | Seated/supine with toes pointed up on table. Dr taps metatarsal heads on plantar aspect with reflex hammer. Pos:pain = metatarsalgia. |
| Inversion stress (lateral stability test) | lateral ankle up with foot off end of table. Dr stabilizes tibia and presses down on lateral talus/calcaneus inverting the ankle. Pos: Increase inversion= anterior talofibular and/or calcaneofibular ligament. |
| Eversion stress (Medial stability test) | Medial ankle up with foot off table. Dr stabilizes tibia and presses down on the medial calcaneus everting the ankle. Pos: increased eversion= tear of deltoid ligament. |
| Tinel's Foot sign | Medial ankle up. Dr taps over posterior tibial nerve. 3 branches; medial and lateral plantar and medial calcaneal. Pos: Paresthesias radiating to the foot or tingling=irritations to nerve possibly in tarsal tunnel. |
| Thompson's Test | Prone knee flexed 90. Dr grasps calf with both hands just proximal to the largest area and squeezes. Pos: foot does not plantar flex indicating an achilles tendon rupture. |
| Achilles Tap Test | Prone. Dr taps on achilles with reflex hammer. Pos: increase pain and loss of plantarflexion= rupture of the achilles tendon. |
| Hoffa Test (Hoffa sign) | Prone with feet off end of table. Dr palpates achilles and calcaneus. Pos: Dr finds achilles tendon less taught, and foot is in dorisflexed position. Dr may also palpate loose fragments behind malleoli= fractured calcaneus. |
| Helbing's Sign | Standing facing away. Pos: medial bowing of achilles tendon= loss of foot pronation. |
| Too Many toe sign | standing facing away. Toes visible lateral to heel are counted. 1-2 toes is normal. Pos: 3-4 toes=significant forefoot abduction or pronation. |
| HIP | |
| Anvil Test | Supine with leg extended. Dr elevates the affected leg and strikes the calcaneus. Pos: pain=may have fraction in that location. |
| Allis's sign. | Supine, knees flexed 90, feet flat, big toe and malleoli lined up. Dr observes from foot and each side of table. Pos: Leg length discrepancies. Femur or tibial. |
| Patrick's Test (Fabere) | Supine. Grasp affected leg and flex, abduct, externally rotate and extend. (heel over opp knee). Pressure applied to bent knee and contralateral pelvis. Pos: Pain= in hip coxa pathology. |
| Laguerre's Test | Supine. fabere in the air. Pos: SI pain. Pain in the hip indicates inflammatory process. Pain after trauma= fracture of acetabular cavitiy/rim. |
| Thomas Test | supine. Pulls unaffected hip up into flexion. Pos: If contralateral leg flexes. If quads are tight=hip flexers are short, quads relaxed= restriction of hip extention at the hip joint/capsule. Lordosis maintained and leg raises=short hipflexors. |
| Gaenslen's Test | Supine, affected leg off table, other leg flexed. Dr applies pressure to both legs. Pos: Pain in SI joint or referring down leg of SI lesion. Pain on extended leg= anterior SI ligament sprain or inflam process. |
| Ober's Test | Laying on unaffected side with lower knee flexed for stability. Dr caudal hand grasps distal tib/fib, flexes knee to 90, abduct and extent cephalad hand holds knee. Lets go of knee. Pos: thigh remains abducted=IT band tight. |
| Lewin-Gaenslen's Test | side, affected side up with lower knee flexed. Dr cephalad hand over pelvis caudal grasps ipsilateral leg and hyperextends. Pos: pain in SI= SI lesion. |
| Nachlas Test | Prone. Dr flexes knee and brings to ipsilateral buttock. Pos:pain in the SI or LS area or if pain radiates down thigh or leg. Si or LS disorder. |
| Ely's Test/Sign | Prone. Dr flexes knee to opposite buttock. Hip is then extended. pos: pain in anterior thigh, medial calf indicative of lumbar nerve root irritation. Upper lumbar pain=stretch lumbar nerve room adhesions. |
| Yeoman | Prone. Dr caudal hand on ipilateral medial distal femur, cephalad stabilizing pressure on SI joint. Thigh is hyperextended by lifting knee off table.. Pos: Pain in SI joint= SI joint leasion, anterior SI ligaments. |
| HIbb's Test | Prone. Dr cephalad hand stabilizes pelvis, caudal grabs ipsilateral ankle and max flexes knee and internally rotates femur. Pos: Pain in pelvis=SI lesion. Pain in hip= hip joint lesion. |
| Trendelenburgs | Standing. Patient raises foot off floor by flexing at hip. Dr observes level of pelvis from behind. Pos: Iliac crest drops on the raised leg side=weak hip abductors on contralateral side. |
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