Orthopedic Tests: Lower Extremity

Front 1

Allis/Galeazzi's Sign
(Hip Conditions)

Back 1

With the patient supine, knees flexed and the heels even on the examining table, observe from the inferior and bilaterally for evidence of asymmetry in tibia and/or femur length (Test is performed after the patient has been adjusted)

(+): Knee height and tibial length differences for determination of congenital hip dislocation, tibial or femoral shortening

Indication: anatomical leg length deficiency

Front 2

Thomas' Test
(Clinical Significance of Psoas)

Back 2

1. Patient is instructed to sit close to the edge of examining table, flex and hold one knee toward chest. Then the patient is assisted into supine position (while holding the knee) until the low back is flat on the table
2. Thomas' test may be further used to differentiate shortness of 2-joint hip flexors vs. iliopsoas. This is done by PASSIVE extension of the knee, which puts slack into the 2 joint hip flexors without affecting the length of iliopsoas

(+) Hip flexion, which brings the thigh off of the examining table

Indication
1. Contracture of hip flexors
2. If the thigh now approximates the table with passive knee extension, the shortness is in 2-joint flexors (TFL/ITB or recuts femoris). If not, it suggests a short psoas

Front 3

Patrick's Test/Fabere/Sign of Four

Back 3

The hip is flexed, abducted and externally rotated, so that the ankle of the side being tested is crossed superior to the opposite knee. Doctor may apply pressure to the femur downward toward the floor while stabilizing the opposite ASIS

(+): Any inability to perform these motions or report of pain at the FA joint

Indication: femoroacetabular joint lesion (anterior)

Front 4

Laguerre's Test

Back 4

Performed as per Patrick's, but with the hip flexed to 90° and over pressure on the knee to increase external rotation at the hip
Perform again in multiple degrees of hip flexion

(+): report of pain at the FA joint

Indication: femoroacetabular joint lesion

Front 5

Ober's Test

Back 5

With patient in side-lying position and the femur lined up along the midaxillary line, Dr holds ilium down firmly with one hand and grasps the flexed knee (of the superior side) with the other. Dr moves the upper leg into flexion, then abduct and extend the hip back to a neutral position in midaxillary line. Lower the leg slowly toward the table, while supporting the medial knee

(+): Inability to adduct the hip back to it's neutral position (Dr. continues to lower the femur to the table and the femur "hangs up" without support)

Indication: iliotibial band contracture

Front 6

Trendelenberg Test

Back 6

While standing (with the examiner standing behind the patient) instruct the patient to flex one knee up toward the chest

(+): Observe the gluteal fold on the flexed side for downward deviation as well as lateral translation of weight bearing hip

Indication: weakness of gluteus medius/minimus on standing leg

Front 7

Drawer Test/Sign

Back 7

First, observe for SAG SIGN
Asymptomatic leg first. Patient supine and knee flexed, the examiner stabilizes the foot/ankle and firmly pulls the tibia forward and then pushes the tibia posteriorly

(+) Excessive motion upon either translation as compared to the opposite side or pain in the central knee joint

Indication:
- Excessive anterior tibial motion: anterior cruciate damage
- Excessve posterior tibial motion: posterior cruciate damage

Front 8

Lachman's Test

Back 8

The patient is supine, with the knee flexed to 30°. The examiner stabilizes the femur with one hand and exerts P to A stress on the tibia

(+): Excessive anterior translation of the tibia and/or pain in the central knee

Indication: anterior cruciate damage

Front 9

Abduction/Valgus Stress Test

Back 9

The lower leg is abducted while the lower femur is stabilized, opening up the medial knee joint. Perform the test in full extension and repeat in slight flexion on the well side first

(+): Pain or excessive motion at the medial knee

Indication: medial collateral ligament damage

Front 10

Adduction/Varus Stress Test

Back 10

The lower leg is adducted while the lower femur is stabilized, opening up the lateral knee joint. Perform the test in full extension and repeat in slight flexion on the well side first

(+): Pain or excessive motion at the lateral knee

Indication: lateral collateral ligament damage

Front 11

Noble's Test

Back 11

With the patient in a supine position, the doctor places a thumb over the lateral femoral condyle as the patient repeatedly flexes and extends the knee. Pain symptoms are usually most prominent with the knee at 30° of flexion

(+): reproduction of pain in the iliotibial band tract

Indication: iliotibial band tendonitis

Front 12

Apley's Compression/Grinding Test

Back 12

Patient prone with knee flexed to 90°. Compress the tibia firmly down into the examining table while rotating the tibia internally. Repeat the compression with external rotation of the tibia

(+): Report of pain or clicking at medial/lateral meniscus

Indication
- External rotation: damage to posterior horn of medial meniscus
- Internal rotation: damage to posterior horn of lateral meniscus

Front 13

McMurray's Test

Back 13

With the patient supine, and examiner's hand over the joint margins of the lateral knee, flex the knee and internally rotate the tibia as you extend the knee and maintain a valgus stress

Repeat the maneuver rotating the tibia externally as you extend the knee

The higher the knee is raised (more flexion) the more posterior is the site of meniscal injury

(+): audible or palpable "click" or "snap" in the joint or report of pain at medial/lateral meniscus

Indication
- Internal rotation: damage to posterior horn of lateral meniscus
- External rotation: damage to posterior horn of medial meniscus

Front 14

Patellar Apprehension Test

Back 14

With the patient either seated os rupine and the knee slightly flexed, manually displace the patella laterally. Observe!

(+) Patient apprehension, withdrawal of the knee or voluntary contraction of the quadriceps

Indication: recurrent patellar dislocation

Front 15

Patellar Scrape/Clarke's Sign and Fouchet's Sign

Back 15

Patellar Scrape/Clarke's Sign
While gently holding down the patella, have the patient contract the quadriceps

Fouchet's Sign
Compression or transverse friction of the patellar against the femoral condyles with the flat of the hand elicits pain

Present: any grinding or pain deep to the patella or under doctor's hand contact upon movement

Indication: chondromalacia patella or retropatellar arthritis

Front 16

Dreyer's Sign

Back 16

Patient is supine and is asked to raise the affected leg off the table. If the patient is unable to perform this, the examiner then firmly encircles the lower thigh (over the quads) with his/her hands. The patient then attempts again to raise leg

Present: the ability to flex the hip with this stabilization

Indication: patellar fracture (or suprapatellar tendon rupture)

Front 17

Buerger's Test

Back 17

The patient dorsiflexes and plantarflexes the elevated foot for a minimum of 1 minute up to 2 minutes. Observe for blanching of the foot. the leg is then lowered off the table and the foot is observed for color change and refilling/collapse of superficial veins

(+): Blanching of the foot or venous collapse with the foot elevated, or a failure to complete the test due to fatigue or cramping of the muscles, or a delay normal foot color or venous filling for longer than 1 minute after lowering LE into a dependent position

Indication: arterial insufficiency into the foot

Front 18

Homan's Test

Back 18

Patient is supine. Dr dorisflexes the foot with the knee extneded which compresses deep leg beins

(+): increased acute calf pain

Indication: thrombophlebitis/phlebitis

Front 19

Moses Test

Back 19

Patient is prone with knee flexed to 90°. Compression of the calf of the affected leg results in deep calf pain

(+): deep leg pain

Indication: thrombophlebitis/phlebitis

Front 20

Anterior/Posterior Drawer/Draw Sign
(Ankle Conditions)

Back 20

Stabilize the tibia with one hand, and with the other, draw the patient's calcaneus (and talus) anteriorly, then push it posteriorly

Present: excessive gapping or pain with either motion

Indication
- Excessive anterior motion: anterior talofibular damage (also deltoid less frequently)
- Excessive posterior motion: posterior talofibular damage (also deltoid less frequently)

Front 21

Lateral/Medial Stability Tests
(Ankle Conditions)

Back 21

Grasp the patient's foot and invert it passively. Repeat with the foot in eversion

(+): any excessive gapping or pain with the motion

Indication
- Excessive lateral gap: damage to talofibular and calcaneofibular ligaments
- Excessive medial gap: damage to deltoid ligament

Front 22

Tinel Tap for Posterior Tibial Nerve
(Ankle Conditions)

Back 22

Tap with reflex hammer over the tarsal tunnel

Present: sustained pain or paresthesia into the plantar aspect of the foot

Indication: intrinsic neuropathy or peripheral entrapment of the posterior tibial nerve (medial plantar nerve) due to subluxation, sprain, or excessive pronation

Front 23

Morton's Test

Back 23

Reduce the transverse arch and compress the sides of the foot toward the midline of the foot and note any pain produced

(+): any pain produced in metatarsals

Indication: Morton's neuroma (textbook), metatarsalgia due to fracture or subluxation (reality)

Front 24

Simmond's/Thompson's/Achilles' Integrity Test

Back 24

Patient is prone with the knee flexed 90°. Squeeze the belly of the gastroc/soleus muscle

(+): absence of plantar flexion of foot

Indication: rupture of Achille's tendon

Front 25

Duchenne's Sign

Back 25

With the patient supine, the examiner stabilizes the tibia with one hand while applying pressure to the 1st metatarsal head. The patient actively plantar flexes the foot

Present: inversion of the lateral aspect of the foot (medial border dorsiflexes while lateral border plantar flexes, according to Evans)

Indication: paralysis/paresis of the peroneus longus and brevis due to superficial peroneal damage