Special Test of the Lower Extremities

PT 3 Lecture by Ma’am Michaela Valenzuela

I. THE HIP

Conditions of the hip

 Snapping hip syndrome- common; may be symptomatic or not

o External snapping- tight ITB, gluts max tendons (lateral pain)
o Internal snapping- iliopsoas tendon over the lesser trochanter or anterior acetabulum
or iliofemoral ligament over the femoral head (anterior pain)
o Intraarticular snapping- labral tears (groin pain; felt more suring pivoting)
o Usually asymptomatic
o May lead to degeneration of soft tissue because of constant contact

Special Tests for Hip Pathology

 Patrick’s/ FABER/ Figure 4 Test- pt in “de quatro” position (action of the Sartorius muscle; cross
legs of men)
 Flexion Adduction test- in N hips, can still adduct while in flexion; in Abn hips, cannot do flexion
and adduction at the same time
o Grading- the lesser the pt can adduct the hip, the greater the problem
 Trendelenberg’s sign- standing on one foot (tested limb); + if the other hip drops
 Stinchfield resisted hip flexion test- SLR then resist; + with pain
 Torque test- hip in extension, IR then apply posterior pressure

Special test for Labral Tears

 FADIR test- do Patrick’s then do opposite (FABER to EADIR); testing for the anterior aspect of
the labrum
 Posterior Labral tear test- FADIR then do the opposite (FADIR to EABER)

Special Test for Femoral Anteversion

*Femoral Anteversion- femoral head makes an angle relative to the femoral condyle at an angle of 8-15
degrees; may cause intoeing.

 Craige’s Test- prone pt, knee bent 90 degrees; ideally, leg is in vertical; palpate for the greater
trochanter. Do leg IR or ER until the greater trochanter is parallel to the plinth. + if less or more
than the normal range/angle.

Congenital Hip Dislocation

*Congenital dysplasia of the hip- dislocated since birth

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* Developmental dysplasia- unstable; eventually dislocates

-causes: Bony deformities, relaxin from the mother during delivery

-associated with tight hip adductors of the baby (often complaint is difficulty in putting the diaper of the
baby because parents cannot abduct the hips)

- PT’s job is to identify whether the hip is already dislocated or just unstable

 Ortolani’s sign- grab child’s thigh, perform abduction while middle and index fingers are placed
posteriorly (for palpating), then push anteriorly; + with clicking (this means that the hip is indeed
DISLOCATED because the clicking means that PT has Relocated the femur into the acetabulum)
 Barlow’s test- step1: ortolani’s sign; step 2: thumb push femoral head posteriorly; + if with
excessive movements. When PT removes the load, will recoil ( this means that the hip is at HIGH
RISK FOR DISLOCATION or UNSTABLE)
 Galleazi’s sign- if pt’s hip already dislocated posteriorly; have the pt in hooklying position,
observe for the height of the knees; + if knee height is not even
 Telescoping sign- place child in 90 deg hip flexion and knee flexion in supine; + if femur is able to
ride up excessively
 Abduction test- abduct hip; + if limited

Test for Leg Length Discrepancy

 Weber Barstow Maneuver- pt in supine, palpate for medial malleolus (should be equal), ask pt
to do pelvic bridging; if malleoli are not aligned anymore, do measurements

Test for Muscle Tightness or Pathology

 Sign of the Buttock- SLR; ROM will be limited because of tight hamstrings; ask pt to bend knee
to increase hip flexion; if knees are already flexed but pt still cannot do hip flexion, pt may have
ischial bursitis or abscess
 Thomas test- for hip flexors; supine with legs extended, one leg try to posteriorly tilt (perform
knee to chest motions); if tight hip flexors, extended leg will be pulled (+)
 Kendall test- similar to Thomas test but do this at the edge of the plinth (dangling legs); if tight
Rectus Femoris, will have extension of the knee of the dangled leg (+)
 Ely’s test- pt in prone, flexed knee; + if the hip raised

Iliotibial band friction syndrome- chronic inflammation of the ITB

 Ober’s test- same with stretching the ITB; pt in sidelying, extended hip, adducted hip (by
gravity); + if thigh does not adduct
 Noble Compression test- compress ITB at the femoral condyle, ask pt to do flexion and
extension, pt may do heel slides; + with pain
 Adduction abduction test- imaginary vertical line through the LE, ASIS to ASIS horizontal line, N
if 90 degrees; + if more or less than 90 degrees

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  Gluteus muscle weakness
o Maximus-
o Medius and Minimus- do trendelenberg’s sign
 Test for Hamstrings contracture Method 1- do 90 degrees flexion of hip and knee, attempt to
extend the knee, N should be able to extend knees (20 degrees from the vertical can still be
considered normal); + if cannot extend knees to full ROM (20 degrees leeway)
 Hamstrings Contracture Method 2- + if pt cannot reach toe
 Hamstrings contracture Method 3 (tripod sign)- pt sitting dangling, PT extends the knee; + if pt
leans back and do posterior pelvic tilt as UE support and hold on to the plinth
 Bent knee stretch for proximal hamstrings- similar to 90-90 SLR; supine, hip bend maximally
then 90 degrees knee flexion; + with pain in the butt area (origin of hamstrings)
 Taking Off the Shoe Test (TOST)- specific to the biceps femoris; ask pt to take of shoes using the
medial arch of the other foot; tested foot should be in slight ER; + if there is already excessive ER
and the knees are already bent and yet the pt cannot take the shoes off
 Phelp’s test- for tight gracilis
 Gluteal Skyline test- prone, check for the prominence of the butt; + if asymmetry in height is
observed (means that there may be atrophy of the butt muscles or there is a problem with the
nerve innervations)

Test for Stress Fracture

 Fulcrum test- sitting dangling, PT’s forearm under the thigh, apply a downward compression

Neurologic Affectation

 Straight Leg Raising- nerves of the posterior aspect are affected (check FED, FEDEE, FEDI, FEPI
table)
 Prone knee bending- nerves of the anterior aspect are affected

II. THE FOOT

Observational Tests of the Foot

 Fick angle- angle between the second metatarsal to the vertical; N is 12 degrees; any increase
will indicate out toeing
 Type of Forefoot- length of the metatarsal leads to different types of foot
o Index plus- 1st metatarsal is longer than the rest
o Index minus- 1st metatarsal is shorter than the 2nd (longest)
o Index plus minus- 1st and 2nd metatarsals are equal in length
o Square foot- 1st and 2nd toes are of equal height

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 o Morton’s or Greek foot- 2nd toe is taller
o Egyptian foot- most common, 1st toe is the tallest
 Deformities
o Claw
o Hammer
o Mallet
o Hallux Valgus
 Arches of the foot

Special tests of the Foot

 Neutral Position of the Talus

o Can be done in standing (palpate for the talus, then perform trunk rotation; foot will be
pronated and supinated), supine or sitting
o Navicular drop test- palpate for the navicular, measure distance of navicular from the
floor, rotate trunk then measure again; measurement should not be more than 10 mm
(navicular collapsed if >10)
 Test for alignment
o Leg heel alignment- aligned calcaneus and distal leg; N is vertical to varus of the heel
about 2-8 degrees
o Forefoot heel alignment
 Test for tibial torsion
o Can be done in sitting, supine or prone
o Too many toes sign

Conditions of the ankle and foot

*Ankle Sprain

-Inversion more common d/t unequal projection of the malleoli

-Eversion may also happen

-Effect- proprioception deficits

-Grading (1- stretch, 2- partial tear, 3- full tear)

-Tests done immediately after the injury because if inflammation sets in, may have false
negative

 Anterior Drawer test- stabilize lower leg and pull talus forward; + if with excessive laxity
o If purely forward- bad prognosis
o If forward then rotated- better than the first; one side is still intact
 Prone anterior Drawer test
 Talar Tilt

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Test for Syndesmosis injury – distal aspect of the leg affected (proximal ankle sprain)

 Squeeze test
 External rotation stress test
 Point palpation
 Dorsiflexion compression test- compresses the talus
 Heel thump test- + with pain at the ankle (not at the heel)

Muscle and Tendon Affectation

 Thompson test for the Achilles tendon- squeeze gastrocnemius belly; N if pt plantar flexed
 Peroneal tendon dislocation test- similar to speeds test, eversion plantarflexion or dosiflexion

Other tests

 Feiss Line- for the medial longitudinal arch; malleoulus, navicular and the first metatarsal should
be in a straight line
 Hoffa’s test- for calcaneal fractures
 Tinel’s sign- for anterior and posterior tibial nerve
 Morton’s test- stress fractures at metatarsal
 Homan’s sign- for deep venous thrombosis; passive dorsiflexion of the foot
 Buerger’s Test- for the blood supply

III. THE KNEE

*Ligaments are primary stabilizers

- collateral (for varus and valgus forces) and cruciate (for anterior and posterior forces) ligaments

One Plane Instability

 Anterior translation- testing ACL, MCL, meniscus, ITB

 Posterior Translation- testing PCL, gastrocnemius, pes anserine and lateral collateral ligament
 Valgus Force- stressing MCL, pes anserine and medial meniscus
 Varus stress- stressing LCL, ITB, popliteus tendon, lateral meniscus

Rotatory Instability

 ER tibia and anterior translation- MCL, ACL, meniscus

 ER tibia and push posteriorly- LCL, popliteus tendon, lateral gastrocnemius,

Test for Medial Instability

 Valgus Stress test

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Tests for Anterior Instability

 Lachman test- high validity and reliability; pt in supine, flex knee in 20-30 degrees, then do
anterior translation of tibia
o Modification 1- assume sitting dangling (20 degrees of flexion)
o Stable Lachman test (modification 2)- advantageous for smaller PTs; similar to the
classic but put the leg of the pt on the thigh of the PT
o Drop leg lachman (modification 3)
o Modification 4
o Modification 5- rarely done because there is no stabilization
o Prone lachman (modification 6)- pt in prone
o No touch lachman (modification 7)
o Maximum quadriceps test (modification 8)
 Drawer test- pt in supine, 90 deg of knee flexion, translate tibia anteriorly
 90-90 anterior drawer test
 Sitting anterior drawer
 Active drawer test- pt contract quads
 Finochietto jumping sign- click with pain; + meniscus injury

Posterior Instability Tests

 Posterior Sag Sign- hooklying

 Reverse lachman test
 Posterior drawer test

Test for Anteromedial and Anterolateral Rotatory Instability

 Slocum test- same as drawer test but do ER ( if IR is done, this is a test for anterolateral
instability)

Test for Posteromedial and Posterolateral Signs

 Hughston’s posteromedial and posterolateral drawer sign- drawer test position, IR oe ER, pull
forward or backward

Test for Menicus Injury

 McMurray Test- rotate tibia ER or IR then perform flexion or extension

 Apley’s test- for ruling out; pt in prone, knee bent 90 degrees, pull up the tibia and twist
(cruciate ligaments); compress tibia or push down (meniscus)

Plica Test (Plica- embryonic remnant or an extra piece of tissue inside the knee; disrupts biomechanical
functions of the knee)

 Plica Stutter

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  Hughston’s Plica
 Patellar Bowstring

Test for Swelling (will not bulge but will cause LOM)

 Brush test
 Indentation test
 Patellar Tap test (ballotable)

Patellofemoral Pain Syndrome

- dysfunction of the patella as it slides to femur

- lateral tracking of the patella

- d/t weak VMO or tight lateral retinacular ligaments

- anterior knee pain, + theater sign

Tests for PFPS

 Vastus Medialis coordination test

 Clarke’s sign
 McConell test for Chondromalacia Patella
 Active Patellar grind test
 Waldron test

NOTE: Please do not completely rely on this. These are just side notes and the procedures are not
exact and are just based from our understanding of the lecture. Please still refer to the book. Thank
you.

ABBREVIATIONS:

 Pt/pt- patient
 N- Normal
 Abn- Abnormal

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