PTLE 2026 MSK LE Special Tests

A set of 100 flashcards covering lower extremity special tests, hip/knee/ankle pathology, and gait analysis based on lecture notes.

What is the procedure for Nelaton’s Line?

The patient is supine; a line is drawn from the ASIS to the ischial tuberosity while palpating the greater trochanter.

What is a positive result for Nelaton’s Line test?

The greater trochanter lies superiorly from the line, indicating hip pathology or coxa vara.

What is the positive finding for Bryant’s Triangle?

A decreased distance from the greater trochanter to the junction of perpendiculars on the affected side compared to the normal side.

What does the Flexion-Adduction Test assess for in the hip?

General hip pathology, indicated by discomfort, pain, or loss of motion (LOM).

What are the positive signs for the McCarthy Hip Extension Test?

Reproduction of symptoms such as a click, crepitus, pain, or bridging, indicating labral pathology.

What are the alternative names for Patrick’s Test?

FABER, Figure-4, and Jansen’s Test.

A positive Patrick’s Test indicates which pathologies?

$SI$ joint pathology or Iliopsoas spasm.

What is a positive result for the Hip Scour (Quadrant) Test?

Pain or bumps in movement, indicating hip pathology or hip $OA$.

What does the Trendelenburg Sign indicate when the opposite pelvis drops?

Gluteus medius weakness or an unstable hip on the stance leg side.

What is the general sign for congenital hip dislocation?

Asymmetric gluteal folds.

How is Ortolani’s Test performed?

Patient is supine with bilateral hips and knees flexed; apply gentle traction, passively abduct the hip, and apply pressure on the greater trochanter.

What is the positive finding for Ortolani’s Test?

A click, clunk, or jerk, often called an Ortolani’s click.

When is it best to perform Ortolani’s Test?

A few weeks after birth.

What is the positive finding for Barlow’s Test?

A click, indicating a dislocatable hip or developmental dysplasia of the hip ($DDH$).

How is the Galeazzi Sign (Alli’s Test) interpreted?

Unequal height of the knees, where the lower knee is the affected side, indicating unilateral hip dislocation.

What is the best age range to perform the Galeazzi Sign?

$3-18$ months.

What are the alternative names for the Telescoping Test?

Dupytren’s or Piston Test.

A positive Abduction Test (Heart Sign) indicates what?

Loss of motion ($LOM$) indicating hip dislocation.

Which congenital hip test is best for older children?

Abduction Test / Heart Sign.

What is a positive Thomas Test for iliopsoas contracture?

The lower leg knee flexes or rises from the bed, or there is increased lordosis.

What is the positive finding for Kendall’s Test?

The lower leg knee bends, indicating rectus femoris contracture.

How is Ely’s Test performed to test rectus femoris?

The patient is prone and the knee is flexed.

What is a positive Ely’s Test?

The hip rises off the bed.

What popliteal angle measurement indicates a positive $90-90$ SLR test?

$$<125^\text{o}$$

What is the positive result for the Hamstring Contracture Test in long sitting?

Unable to reach the toes.

What is the Tripod Sign?

Passive knee extension in short sitting causes the trunk to bend backwards, indicating hamstring contracture.

What is a positive Ober’s Test result for ITB tightness?

The leg remains abducted after being lowered.

At what range of knee extension does the Noble Compression Test produce pain?

$$0-30^\text{o}$$

What does a positive Piriformis Test indicate?

Piriformis Syndrome.

How is Phelp’s Test performed to test for Gracilis contracture?

Bilateral hips are passively abducted as far as possible in prone, then the knees are flexed and further abduction is attempted.

What are the indications of a positive Sign of the Buttocks?

Hip pathology, abscess in the buttocks, neoplasm, or ischiogluteal bursitis.

What does sharp pain during the “Taking off the shoe” Test indicate?

Biceps femoris strain.

What structures are involved in a positive Abduction (Valgus) Stress Test with the knee in full extension?

$ACL$, $PCL$, $POL$, $MCL$, $PMC$, semimembranosus, and medial quadriceps.

What structures are tested in the Valgus Stress Test at $20-30^\text{o}$ knee flexion?

$PCL$, $POL$, $MCL$, and $PMC$ (medial ligaments except $ACL$).

How is the Hughston Valgus Stress Test performed?

Grasp the big toe and apply a valgus force with the knee in or moving through flexion and extension.

What structures are involved in a positive Adduction (Varus) Stress Test in full extension?

$ACL$, $APOL$, $LCL$, $PLC$, $PCL$, $ITB$, biceps femoris, and lateral quadriceps.

How is the Hughston Varus Stress Test performed?

Grasp the $4\text{th}$ and $5\text{th}$ toes and apply a varus force.

What is the best indicator for an ACL injury?

Lachman / Ritchie / Trillat Test.

What defines a positive Lachman Test?

Excessive movement and a mushy or soft end feel.

Which structures are injured if the Anterior Drawer Test of the knee is positive?

$ACL$, $POL$, $APOL$, $MCL$, $PMC$, $PLC$, and $ITB$.

What is the “step off sign” or “thumb sign” in knee assessment?

Positive Posterior Sag Sign (Gravity Drawer Test) where the tibia sags posteriorly.

Which ligaments are implicated in a positive Posterior Drawer Test?

$PCL$, $ACL$, $POL$, and $APOL$.

How is Godfrey’s (Gravity) Test performed?

Patient is supine with hips and knees at $90^\text{o}$ flexion; stabilize bilateral ankles and observe the tibia.

What does ALRI stand for in the Slocum Test?

Anterolateral Rotatory Instability.

What does AMRI stand for in the Slocum Test?

Anteromedial Rotatory Instability.

What ankle position is used for AMRI Slocum testing?

Ankle in $15^\text{o}$ of external rotation ($ER$).

What defines PMRI in the Hughston Drawer Sign?

Posteromedial Rotatory Instability, involving ankle internal rotation ($IR$).

What defines PLRI in the Hughston Drawer Sign?

Posterolateral Rotatory Instability, involving ankle external rotation ($ER$).

Which structures are involved in PLRI?

$ACL$, $APOL$, $LCL$, $PLC$, $PCL$, and biceps femoris.

What is the procedure for the Wipe (Bulge) Test?

Stroke proximally on the medial side (proximedial) and distally on the lateral side (distalateral).

A bulge on the medial and distal patella in the Wipe Test indicates how much swelling?

$$4-8\text{ mL}$$

What is the normal volume of synovial fluid in the knee?

$$1-7\text{ mL}$$

What is the finding of a positive Ballottement (Patellar Tap) Test?

Floating patella or “dancing patella” sign, indicating $40-50\text{ mL}$ of swelling.

In Apley’s Test, what does pain during distraction indicate?

Ligamentous injury.

In Apley’s Test, what does decreased rotation during compression indicate?

Meniscal injury.

How is the McMurray Test performed for the medial meniscus?

Externally rotate the tibia and perform passive knee extension.

How is the McMurray Test performed for the lateral meniscus?

Internally rotate the tibia and perform passive knee extension.

What common meniscal test is described as the “grandfather of all meniscal tests”?

McMurray Test.

What is the positive result for the “Bounce Home” Test?

Loss of motion ($LOM$) or a rubbery endfeel / springy block.

What defines a positive “Too many toes” Sign?

Observing more than 2\text{ & }\frac{1}{2} toes from a posterior view.

What are the associated findings with a positive “Too many toes” Sign?

Valgus heel, abducted forefoot, and laterally/externally rotated tibia.

What does the “dimple sign” or “suction sign” indicate in the ankle?

$ATFL$ tear during a positive Anterior Drawer Test.

Pain during ankle inversion in the Talar Tilt Test indicates what?

Calcaneofibular ligament tear.

How is Kleiger’s (ER Stress) Test performed?

Short sitting with the ankle dangling; perform passive external rotation of the tibia.

Pain at the medial ankle during Kleiger’s Test indicates injury to what?

Deltoid ligament.

What is a positive result for the Thompson Test?

No plantarflexion ($PF$) when the calf is squeezed, indicating an Achilles tendon tear.

What does Homan’s Sign assess?

Deep Vein Thrombosis ($DVT$), indicated by pain in the calf during passive ankle dorsiflexion.

What is the most common complication of DVT mentioned?

Pulmonary embolism.

What defines the Gait Cycle?

The time interval from heel strike ($HS$) to heel strike of the same foot.

What are the percentages for the Stance and Swing phases?

Stance / $CKC$ is 60\text{%}; Swing / $OKC$ is 40\text{%}.

Which limb support period is more stable: single or double?

Double limb support (20\text{%} of the cycle).

What are the three criteria for stability in gait?

Large base of support ($BOS$), $COG$ is within the $BOS$, and lower $COG$.

How does gait change in the elderly?

Longer double limb support, high peak hip extension and knee flexion, and stride time almost equal to younger people.

What is the normal range for Step / Base Width?

$2-4\text{ in}$ or $5-10\text{ cm}$.

What conditions cause an increased Step Width?

Cerebellar pathology, late-stage diabetic polyneuropathy, and tight hip abductors.

What is the normal Stride Length value?

$$56\text{ in}$$

What is the Fick Angle and its normal value?

Angle of toe out / foot placement with respect to the line of progression; Normal = $7^\text{o}$.

Which way is the Lateral Pelvic Shift directed?

Directed to the stance limb/side; Normal = $2.5-5\text{ cm}$.

What is the normal value for Pelvic Rotation?

$8^\text{o}$ total ($4^\text{o}$ forward on the swing side, $4^\text{o}$ backward on the stance side).

What is the normal cadence for males and females?

Males = $111\text{ steps/min}$; Females = $117\text{ steps/min}$.

What is the normal walking speed/velocity?

$$3\text{ mph}$$

What corresponds to Initial Contact in the Ranchos Los Amigos terminology?

Heel Strike.

In the Midstance phase, what is the required ankle and knee position?

$5^\text{o}$ dorsiflexion ($DF$) and full extension.

What is the joint position for Toe Off (Preswing)?

Ankle $15^\text{o}$ $PF$, knee $40^\text{o}$ flex, hip $10^\text{o}$ extension.

What is the minimum ROM required of the 1st MTP joint for gait?

$60-70^\text{o}$ dorsiflexion ($DF$).

Who is considered the father of modern gait analysis?

Edward Muybridge.

Where is the Center of Gravity (COG) located in the body?

$2\text{ in}$ or $5\text{ cm}$ anterior to $S2$.

What shape is the normal pathway of COG displacement?

Figure of $8$ pathway.

What are the phases of Running Gait?

Stance (40\text{%}), Swing (30\text{%}), and Float (30\text{%}).

What are the characteristics of Antalgic Gait?

Shortened stance on the painful limb, shortened swing and step length on the normal limb, and decreased speed.

What causes vaulting in Arthrogenic Gait?

Right hip ankylosis causing exaggerated ankle $PF$ on the opposite limb.

What is a “toe-first gait” and when is it seen?

Short-leg gait where the shorter limb lengthens via ankle $PF$; seen in spastic $PF$, flaccid $DF$, $LLD$, or a painful heel.

What is the characteristic of Gluteus maximus Gait?

A backward lurch or hyperextension of the spine at Heel Strike ($HS$) to Initial Contact ($IC$).

What is the difference between compensated and uncompensated Gluteus medius Gait?

Compensated involves an ipsilateral lateral trunk lean; uncompensated shows a positive pelvic drop.

Waddling Gait is associated with which condition?

Muscular dystrophy.

What is the characteristic of Quadriceps Gait?

A forward lurch.

What is Steppage Gait and its cause?

Increased hip and knee flexion in swing to compensate for foot drop; associated with deep peroneal nerve injury.

What are Shuffling and Festinating Gaits associated with?

Late stage Parkinson’s Disease ($PD$).

What does the Double Tapping Sign indicate?

Posterior Column Deficit due to impaired proprioception.

Which task is categorized as a Functional Task of Walking?

Weight acceptance, single limb support, and limb advancement.