Lower Extremity Module (Lower Ex #1-3, Lower Ex Orthopedic Conditions, Gait, Lower Ex Special Tests)

Lower Extremity Special Tests

Hip
Hip Pathology
Special Test Position Action Positive Sign Indication
Supine
Nelaton’s Line
Imaginary line from ASIS to Ischial Tuberosity
“GIAN”
G. Troch (+) Greater Trochanter Palpated
Landmarks Palpate Greater Trochanter Hip Dislocation/Coxa Vara
I. Tube superior to line
Greater Trochanter
ASIS
Ischial Tuberosity
Nelaton’s Line
ASIS
Supine
Drop a line from ASIS to table that is
Bryant’s Triangle
perpendicular
“GAB”
Another Line from Greater Troch to 1st line Measure line and compare both
G.T. (+) Difference Hip Dislocation/Coxa Vara
sides
ASIS
Landmarks
Bryant’s Triangle
Greater Trochanter
ASIS
Flexion-Adduction (FAD)
Supine with hip and knee flexed Passive hip Adduction (+) LOM Hip Pathology
Test
Passive hip Extension with
McCarty’s Hip Flexion Sign
Supine with Hip Flexed a. ER (+) Reproduction of Sx Labral Pathology
“LOVE-Ral”
b. IR
Patrick’s Test
Figure 4 Test Foot (Test Leg) rests over the knee of the (+) Knee remains higher than
Passive Push the knee down SI Jt. Affectation/Iliopsoas Spasm
FABER good leg opposite that the opposite
Jansen’s

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 Lower Extremity Module (Lower Ex #1-3, Lower Ex Orthopedic Conditions, Gait, Lower Ex Special Tests)

Test for Muscle Tightness or Pathology

Special Test Position Action Positive Sign Indication
G. Medius Weakness of Stance
Trendelenburg Sign 1 leg stance (+) Opposite Pelvic Drop
Leg/Unstable Hip
Thomas Test Supine If there is Hip/Knee flexion
(+) ↑ Lumbar Lordosis Hip Flexion Contracture
“Ilio-Thomas & Friends” Hold one knee to chest (Good Leg) Push the knee of test leg down
Passive: SLR Hip Pathology
Sign of Buttock Abscess in Buttock
Supine (+) No ↑ Hip Flexion
“Hani” If there is limitation, Knee flexion Neoplasm
& further hip flexion Ischial Bursitis
Rectus Femoris Contracture Test
Method 1 Supine with legs dangling
Kendall’s Test Ask px to hold one knee to chest (+) Extension of Knee in C/L Leg Rectus Femoris Contracture
“Kontralateral Side” (Good leg)
Method 2
Passively perform knee flexion of
Ely’s Test Prone lying (+) Hip Flexion on Ipsilateral Side Rectus Femoris Tightness
Test Leg
“Epsilateral”
Hamstrings Contracture Test
Active Knee extension
Measure Popliteal Angle
Supine (between thigh and leg)
Hamstrings Method 1
Hip Flexed to 90° (+) <125° Tight Hamstrings
90-90 SLR
Knee Flexed to 90° Birth – 2 y/o = 180°
6 y/o = 155° (5+1=6)
Adult = 160°
Hamstrings Method 2
Hamstrings Contracture Test Long Sitting Active: reach for your toes (+) inability to reach the toes Tight Hamstrings on Straight Leg
“Method Toe”
Hamstrings Method 3
Short Sitting with legs dangling
Tripod Sign Passive knee extension (+) trunk backward leaning Tight Hamstrings
over the edge of examining table
“TRIpod”

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 Lower Extremity Module (Lower Ex #1-3, Lower Ex Orthopedic Conditions, Gait, Lower Ex Special Tests)

Piriformis
Sidelying
Piriformis Test Upper leg is flexed Passively push knee down (+) Pain in muscle Piriformis Syndrome
Hip Flexed to 60°
Iliotibial Band
Sidelying Passive: abd, extend hip, slowly
Ober’s Test (+) hip remains abducted Contracture of TFL (ITB)
Lower leg flexed for stabilization lower
Put pressure over lateral femoral
Supine with hip and knee flexed to epicondyle (+) Pain at 30° of knee flexion at
Noble Compression Test ITB Friction Syndrome
90° Ask px to actively extend the knee lateral femoral epicondyle
while maintaining pressure
Biceps Femoris
Standing ER to 90°
Taking Off Shoe Test (TOST)
Heel of Test leg is against the Knee flexed to 20°-25° (+) pain in muscle Biceps Femoris Muscle Strain
“Biceps Toast!”
Medial Arch of the good leg Remove shoe of test leg
Passively hip abd with knee’s
straight
Phelps Test Prone (+) ↑ Hip abduction Contracted Gracilis
If theres LOM, flex the knee and
further abd the hip
Pediatric Special Tests
Dislocated Hip/Congenital
Passive slight traction, hip
Supine Dysplasia of the Hip
Ortolani’s Sign abduction, pressure over (+) Click, Clunk, Jerk
Hips and Knees flexed
greater trochanter
(B) Hips, first few weeks only
Stabilize the pelvis Dislocatable
Passive Hip/Developmental Dysplasia
Supine
Barlow’s Test 1. Hip ABD and P° over G.T. (+) Click of the Hip
Hip and Knees flexed
2. Push thigh out and back
3. Remove P° 1 hip at a time, Birth to 6mos

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 Lower Extremity Module (Lower Ex #1-3, Lower Ex Orthopedic Conditions, Gait, Lower Ex Special Tests)

GaLleazi Sign
unilateral hip dislocation
Allis Test
Supine with hips and knees (+) if 1 knee is higher CDH/DDH
One Capital L one Lower L
flexed dislocated hip is the lower one must be unilateral affectation
for Unilateral
3-18 months
Double L in Galleazi for Allis
Telescoping Sign
Piston Test Supine with hip and knee flexed Passively push thigh down, pull (+) Excessive Motion -->
Hip Dislocation
Dupuytren’s Test (90-90) thigh up “Telescoping” or “Pistoning”
“DPT”
Abduction Test Supine with both hips and (+) LOM Hip Dislocation
Passively Abduct Hip
Hart Sign knees flexed (+) Asymmetric Gluteal Folds CDH/DDH

Knee
Special Test Position Action Positive Sign Indication
Swelling
(+) Bulge at Medial Distal Border
of Patella
Brush, Stroke, Bulge Test Medial Side of Patella – Stroke Proximally
Mild swelling
Wipe Test Lateral Side of Patella – Stroke Distally
Normal – 1-7mL
(+) – 4-8mL
Patellar Tap Test (+) Floating of Patella Large Amount of Swelling
Tap the Patella
Ballotable Patella (Dancing Patella Sign) 40-50 mL
Meniscal Pathology
Passively IR and ER Tibia with Distraction (+) pain + ↑ motion Ligamentous Lesion
Apley’s Test Prone with Knee flexed 90
Passively IR and ER Tibia with Compression (+) pain + ↓ motion Meniscus Injury
Loose Fragment in Lateral
Passively extend knee with IR Tibia (+) Click
Supine with full knee Meniscus
McMurray Test
flexion Loose Fragment in Medial
Passively extend knee with ER Tibia (+) Click
Meniscus

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 Lower Extremity Module (Lower Ex #1-3, Lower Ex Orthopedic Conditions, Gait, Lower Ex Special Tests)

(+) Incomplete knee extension

Supine with full knee
Bounce Home Test Passive knee extension with rubbery/springy block end Torn Meniscus
flexion
feel

P A P
P
P
M O L
O
L
C L C
A A
P P
O O
L L

BF

POL – Posterior Oblique Ligament

APOL – Arcuate Popliteus Complex
PMC – Posteromedial Capsule
PLC – Posterolateral Capsule

Special Test Position Action Positive Sign Indication

One Plane Anterior Instability
Lachman Test ACL
0-30 Knee Flexion Passively pull tibia forward (+) mushy/soft end feel POL
Best indicator for ACL Injury APOL
ACL
hip flexed to 45 (N) 6mm Anterior Translation
Drawer’s Sign Passively pull tibia forward POL
Knee flexed to 90 (+) >6mm anterior translation
APOL
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 Lower Extremity Module (Lower Ex #1-3, Lower Ex Orthopedic Conditions, Gait, Lower Ex Special Tests)

PMC
PLC
ITB
MCL
One Plane Posterior Instability
(N) Medial Tibial Plateau -> anterior ACL
Supine
Posterior Sag Sign extension -> “STEP” = 1cm PCL
Hip Flexed to 45
Gravity Drawer Test (+) tibia sags back POL
Knee to 90
(+) Step-Off Sign (Thumb Sign) APOL
One Plane Medial Instability
Abduction (Valgus) Stress Test
Method 1 0 knee flexion All Medial + Medial Quads
Push Knee Medially
Method 2 30 knee flexion PCL
(+) Excessive Motion POL
Method 3 (Hughston) 0/30 knee flexion Pull Big Toe towards abduction MCL
PMC
One Plane Lateral Instability
Adduction (Varus) Stress Test
Method 1 0 knee flexion All Lateral + Lateral Gastrocs
Push Knee Laterally
Method 2 30 knee flexion APOL
LCL
(+) Excessive Motion
Push 4th & 5th toes towards BF
Method 3 (Hughston) 0/30 knee flexion
adduction PLC
ITB
Rotary Instability
AMRI Slocum ER + PMC, MCL, POL, APCL
Draw tibia forward
ALRI Ant. Trans. of Tibia Hip Flexed to 45 IR + ACL, APOL, LCL, PLC, ITB
(+) Excessive Motion
PLRI Hughston Knee to 90 ER + BF, PLC, LCL, APOL, PCL
Draw tibia backward
PMRI Post. Trans. of Tibia IR + PMC, MCL, POL, PCL, SM

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 Lower Extremity Module (Lower Ex #1-3, Lower Ex Orthopedic Conditions, Gait, Lower Ex Special Tests)

Ankle and Foot

Special Test Position Action Positive Sign Indication
Ligamentous Laxity
Anterior Drawer of Ankle 20 PF Passively pull talus forward (+) Suction/Dimple ATFL Tear
Inversion Calcaneofibular Tear
Talar Tilt Foot in Neutral Passive inversion/eversion PF + Inversion ATFL Tear
Eversion Deltoid Tear
(+) pain in medial ankle Deltoid Tear
KleigER
External Rotation of the Foot High Ankle Injury
External Rotation Stress Test (+) Pain in Ant&Post Tibio-Fibular Lig
Syndesmosis injury
Landmarks
Navicular Tubercle
Medial Malleolus
Plantar Aspect 1st MTP Jt. Mark all landmarks
Foot Flat
Feiss Line Grading Connect line through Medial (+) NT is below the line
Pes Planus
NT is palpated: Malleolus & MTP
1/3rd to Floor – 1st Degree FF
2/3rd to Floor – 2nd Degree FF
Rests on Floor – 3rd Degree FF
Thompson Test
Prone Squeeze Calf Muscle (+) No Plantarflexion Ruptured Achilles Tendon
Simmonds Test
Homan’s Sign Passive Dorsiflexion (+) Pain in Calf Muscles DVT
Too Many Toes Sign Valgus (heel)
Normal – 2 ½ Toes Visible
“TooVAL” Standing View from behind ABD (Forefoot)
(+) > 2 ½ toes visible
Valgus-Abd-Lateral Rot LR (Tibia)

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