NMS pmr-ortho exam1
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- Straight Leg Testing
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*L5 or S1 radiculopathy
* pain that radiates down back of leg
* pain that radiates down back of thigh ONLY is hamstring tightness
- passively flex hip while keeping knee straight
.. internal rotation of hip and passive dorsiflexion will increase posterior leg pain!!
.. contralateral s.l.r is also suggestive for radiculopathy - Lachman's Exam
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*Tests for cruciate instability* - ACL
- grasp femur above knee and tibia below knee at 30 degrees
- toggle knee back and forth
[Drawer Test] *PCL*
- flex knee to 90 degrees
- sit on foot to stabilize
- pull backwards and forwards - Patellar Apprehension Exam
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*Recurrent dislocating or sublexation of patella*
- extend knee
- apply lateral pressure to medial border of patella
* if pt tightens quad involuntarily to resist maneuver or have expressed apprehension = + test - Meniscal Testing
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*Posterior medial meniscus is most common tear*
- bend knee and palpate along joint line
- complete flex to extension and bounce knee WHILE CUPPING HEEL
- fully flex knee then slowly extend knee with tibia medially rotated (foot turned in)..and then do it again with tibia laterally rotated (foot turned out)
*mcmurray: pain with full flexion
*bounce: pain with full extension - Milgram's Maneuver
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*intrathecal pathology*
- have patient lay down and hold legs straight and raise them into a position about 2 inches from table
- have them hold as long as they can
*STRETCHES iliopsoas muscle and the anterior abdominal muscles and INCREASES intrathecal pressure - Patrick-FABER test
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*Detects pathology of hip and SI joint*
- Flex hip, Abduct hip, then Externally rotate above opposite knee (make a 4)
- to stress *SI* joint, extend ROM by pushing down on knee joint and contralateral ASIS - Anterior Drawer Test for Ankle
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*Test for anterior stability of ankle - ANTERIOR TALOFIBULAR LIGAMENT* - most commonly injured due to INVERSION
- translate the talus anterior to the tibia with patient sitting off edge of table
- a dimple or suction occasionally occurs over the ligament - Talar Tilt Test for Ankle
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*Tests calcaneofibular ligmanet* - 2nd most injured ligament in foot
- flex knee to relax gastrocnemius (sitting, supine, or side laying..tilt ankle toward table)
- ADduct ankle (inward motion) - Testing Collateral Ligaments
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*Tests MCL and LCL*
- for LCL: place a VARUS stress on the knee (Rum makes your knees spread) - for MCL: place a VALGUS stress on the knee
(0 degress..not as specific for ACL and PCL too; 30 degrees more specific to MCL and LCL)
*Laxity in full extension often suggests a combination injury involving the collateral ligament and possible cruciate ligament as well*
10 = 3 - Schober's Test
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*Restricted flexion of the lower lumbar spine* - can be found in ANKYLOSING SPONDYLITIS
- mark 10 cm from base of S1 (dimples of Venus), then have patient flex and see new distance
- normal measurement is GREATER than 14 cm - Trendelenburg
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*weakness of ipsilateral gluteus medius (an ABductor)
- have patient stand on 1 leg
- observe iliac crest on both sides.. if contralateral iliac crest drops lower than ipsilateral.. this suggests weakness of ipsilateral gluteus medius - Homan's Test
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*Deep vein thrombosis in the calf*
- Patient lays down and doc passively dorsiflex the pt's ankle
- pain in the calf and posterior knee suggests deep venous thrombosis - Quadriceps
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Innervated by femoral nerve
- L2, L3, L4 roots - Anterior Tibialis
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Innervated by peroneal nerve
- L4, L5 roots
- Have patient stand on heel and dorsiflex ankle
- Apply pressure to dorsum of foot and push the foot to the ground with a straight arm - Extensor Hallucis Longus and Brevis
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Innervated by the peroneal nerve
- L5 nerve root
- rest heel of foot on thigh or have patient in seated position
- have patient extend MTP joint of big toe (toes to your noes)
- student applies pressure on the proximal phalynx to flex toe - Gluteus Medius
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Innervated by superior gluteal nerve
- L5 nerve root
- Have pt ABduct leg and then student ADducts leg while pt is on side - Gastrocnemius
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Innervated by tibial nerve
- S1 root
- Patient stands and puts 1 finger on table to balance
- student makes sure patient keeps their knee straight
- patient plantar flexes 10 times (goes up on toes)