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NMS3 Orthos Part 2

QuestionAnswer
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.
Created by: 774708205