Hip and Knee Assessment Techniques

This set of flashcards focuses on key concepts and terms related to hip and knee assessment techniques, including testing methods and anatomical references.

Ipsilateral Distal Femur

The femur (thigh bone) located on the same side of the body as the limb that is being examined or tested. This term is often used in tests requiring unilateral limb assessment.

End Feel

The characteristic sensation perceived by the examiner at the very end of a joint's passive range of motion. It indicates the type of structure limiting further movement and can be normal (e.g., bone-on-bone, tissue stretch, soft tissue approximation) or abnormal (e.g., empty, springy block, spasm, boggy).

Hip Flexor Length Test (Thomas Test)

A special orthopedic test used to assess the flexibility and length of hip flexor muscles, primarily the iliopsoas and rectus femoris. The presence of lumbar lordosis or the tested leg lifting off the table when the contralateral hip is flexed to the chest may indicate tightness.

Scour Test

Also known as the Quadrant Test or Hip Impingement Test, this special orthopedic test is used to evaluate for intra-articular hip pathologies such as labral tears, articular cartilage damage, and osteoarthritis. It involves applying an axial load while adducting and abducting the hip through a range of flexion, looking for pain or clicking.

FABER Test

An acronym for Flexion, Abduction, and External Rotation. This special orthopedic test is used to assess hip joint dysfunction, including sacroiliac joint pathology, hip impingement, or iliopsoas spasm. A positive test is indicated by pain in the hip or groin, or restricted range of motion compared to the contralateral side, especially when the figure-4 position is held.

Lachman Test

A highly sensitive and specific special orthopedic test used to assess the integrity of the anterior cruciate ligament (ACL). The test is performed with the knee in 20-30 degrees of flexion, and a positive result is indicated by excessive anterior tibial translation relative to the femur, often with a soft or absent end-feel.

Manual Muscle Testing (MMT)

A systematic method used in physical examination to assess the strength and function of individual muscles or muscle groups. It typically involves manual resistance applied by the examiner against an attempted movement by the patient, with strength graded on a scale (e.g., 0-5 or 0-10).

Valgus Stress Test

A special orthopedic test used to assess the integrity and stability of the medial collateral ligament (MCL) of the knee. It involves applying a valgus (outward) force to the joint while stabilizing the limb, looking for excessive gapping or pain, which may indicate ligamentous laxity or tear.

Palpation

A diagnostic technique involving the use of hands and fingertips to physically examine the body, discerning characteristics such as texture, temperature, size, shape, consistency, and presence of tenderness, swelling, or crepitus in anatomical structures, particularly muscles, bones, and joints.

Talar Tilt Test

A special orthopedic test used to assess the integrity of the calcaneofibular ligament (CFL) and, to a lesser extent, the anterior talofibular ligament (ATFL) of the ankle. It involves stabilizing the tibia and fibula while tilting the talus into adduction (inversion) or abduction (eversion) to test the respective ligaments for excessive laxity or pain.

PROM (Passive Range of Motion)

The arc of movement at a joint achieved by an external force without muscle activation from the patient. Its assessment helps determine joint integrity, capsular and ligamentous restrictions, and pain response.

AROM (Active Range of Motion)

The arc of movement at a joint achieved by the patient's own muscle contraction without external assistance. Its assessment provides insight into muscle strength, joint mobility, and neuromuscular control.

RROM (Resisted Range of Motion)

Assessment of muscle strength throughout the range of motion by applying resistance against the patient's active movement. It helps identify painful arcs, muscle weakness, or tendinopathy.

Goniometry

The scientific measurement of joint angles and ranges of motion (ROM) in the body, typically using an instrument called a goniometer.

Normal End Feel: Soft Tissue Approximation

A 'soft' normal end feel where further movement is stopped by the approximation of soft tissues, such as knee flexion when the calf touches the thigh.

Normal End Feel: Tissue Stretch (Firm)

A 'firm' normal end feel characterized by an elastic resistance, typically felt when stretching capsules or ligaments, such as in ankle dorsiflexion.

Normal End Feel: Bone-on-Bone (Hard)

A 'hard' normal end feel occurring when bone contacts bone, providing an abrupt, unyielding stop, such as in knee extension.

Abnormal End Feel: Empty

An 'empty' abnormal end feel where there is significant pain before the end of the range is reached, and no resistance is felt by the examiner. Often indicates serious pathology like a fracture or abscess.

Abnormal End Feel: Springy Block

A 'springy block' abnormal end feel, characterized by a rebound sensation. Often indicative of an internal derangement, such as a meniscal tear in the knee.

Abnormal End Feel: Spasm

A 'spasm' abnormal end feel where resistance is involuntary muscle contraction, preventing further movement. Can indicate pain or protective guarding.

Abnormal End Feel: Boggy (Soft)

A 'boggy' abnormal end feel, characterized by a soft, 'wet sponge' sensation. Often indicative of significant edema or synovial effusion within the joint.

Joint Play

Small, involuntary movements within a joint (arthrokinematic movements) that are necessary for full physiological range of motion and joint health, assessed with passive accessory movements.

Capsular Pattern

A specific, proportional pattern of restriction of passive range of motion in a joint, indicative of pathology affecting the entire joint capsule (e.g., osteoarthritis, capsulitis).

Non-Capsular Pattern

A pattern of restriction in joint range of motion that does not match the characteristic capsular pattern, often indicating a localized problem such as a ligament sprain, internal derangement, or extra-articular lesion.

Hip PROM: Flexion

Passive range of motion for the hip where the thigh moves towards the abdomen, typically reaching 0-120^\circ.

Hip PROM: Extension

Passive range of motion for the hip where the thigh moves posteriorly away from the abdomen, typically reaching 0-30^\circ.

Hip PROM: Abduction

Passive range of motion for the hip where the thigh moves laterally away from the midline, typically reaching 0-45^\circ.

Hip PROM: Adduction

Passive range of motion for the hip where the thigh moves medially towards or past the midline, typically reaching 0-30^\circ.

Hip PROM: Internal Rotation

Passive range of motion for the hip where the thigh rotates inward, typically reaching 0-45^\circ.

Hip PROM: External Rotation

Passive range of motion for the hip where the thigh rotates outward, typically reaching 0-50^\circ.

Knee PROM: Flexion

Passive range of motion for the knee where the lower leg bends towards the thigh, typically reaching 0-150^\circ.

Knee PROM: Extension

Passive range of motion for the knee where the lower leg straightens, typically reaching 0^\circ (hyperextension possible up to 10^\circ).

Ankle PROM: Dorsiflexion

Passive range of motion for the ankle where the foot moves upward towards the shin, typically reaching 0-20^\circ.

Ankle PROM: Plantarflexion

Passive range of motion for the ankle where the foot moves downward away from the shin, typically reaching 0-50^\circ.

Ankle/Foot PROM: Inversion

Passive range of motion for the ankle/foot where the sole of the foot turns inward, typically reaching 0-35^\circ.

Ankle/Foot PROM: Eversion

Passive range of motion for the ankle/foot where the sole of the foot turns outward, typically reaching 0-20^\circ.

MMT Grading Scale: Grade 0 (Zero)

MMT score indicating no muscle contraction observed or palpated.

MMT Grading Scale: Grade 1 (Trace)

MMT score indicating a faint contraction observed or palpated, but no joint movement.

MMT Grading Scale: Grade 2 (Poor)

MMT score indicating full range of motion in a gravity-eliminated position, but unable to move against gravity.

MMT Grading Scale: Grade 3 (Fair)

MMT score indicating full range of motion against gravity, but unable to take any added resistance.

MMT Grading Scale: Grade 4 (Good)

MMT score indicating full range of motion against gravity with moderate resistance, but not maximal.

MMT Grading Scale: Grade 5 (Normal)

MMT score indicating full range of motion against gravity with maximal resistance, considered normal strength.

MMT: Iliopsoas (Hip Flexion)

Manual Muscle Test for the iliopsoas, assessed by resisting hip flexion in a seated or supine position.

MMT: Gluteus Maximus (Hip Extension)

Manual Muscle Test for the gluteus maximus, assessed by resisting hip extension in a prone position.

MMT: Gluteus Medius (Hip Abduction)

Manual Muscle Test for the gluteus medius, assessed by resisting hip abduction in a side-lying position.

MMT: Hip Adductors (Adductor Longus/Brevis/Magnus, Pectineus, Gracilis)

Manual Muscle Test for hip adductors, assessed by resisting hip adduction in a side-lying position.

MMT: Hip External Rotators (Piriformis, Gemelli, Obturators, Quadratus Femoris)

Manual Muscle Test for hip external rotators, assessed by resisting external rotation in a seated or supine position.

MMT: Hip Internal Rotators (Gluteus Minimus, TFL)

Manual Muscle Test for hip internal rotators, assessed by resisting internal rotation in a seated or supine position.

MMT: Quadriceps (Knee Extension)

Manual Muscle Test for the quadriceps femoris, assessed by resisting knee extension in a seated position.

MMT: Hamstrings (Knee Flexion)

Manual Muscle Test for hamstrings, assessed by resisting knee flexion in a prone position.

MMT: Tibialis Anterior (Ankle Dorsiflexion/Inversion)

Manual Muscle Test for tibialis anterior, assessed by resisting ankle dorsiflexion and inversion.

MMT: Gastrocnemius/Soleus (Ankle Plantarflexion)

Manual Muscle Test for gastrocnemius and soleus, assessed by resisting ankle plantarflexion (calf raise).

MMT: Peroneals (Ankle Eversion)

MMT for peroneus longus and brevis, assessed by resisting ankle eversion.

MMT: Extensor Digitorum Longus (Toe Extension)

Manual Muscle Test for toe extensors, assessed by resisting toe extension.

MMT: Flexor Digitorum Longus (Toe Flexion)

Manual Muscle Test for toe flexors, assessed by resisting toe flexion.

Ligamentous Laxity

Excessive looseness or instability in a joint due to stretched or torn ligaments, often assessed with stress tests. It implies a reduction in the ligament's ability to provide stability.

Meniscus

A C-shaped or oval fibrocartilage structure within certain joints, primarily the knee, that functions to deepen the joint, absorb shock, and distribute load. Menisci are often assessed for tears using tests like McMurray's or Apley's.

Labrum

A ring of specialized fibrocartilage that deepens the socket of ball-and-socket joints, such as the hip (acetabular labrum), contributing to joint stability and proprioception. Often assessed for tears.

Impingement

A condition where soft tissues (e.g., tendons, bursae) are compressed or 'pinched' between bony structures during movement, leading to pain, inflammation, and restricted range of motion. Common in the hip (femoroacetabular) and ankle (e.g., anterior ankle impingement).

Tendinopathy

A general term for disorders of the tendons. It encompasses conditions like tendinitis (acute inflammation) and tendinosis (chronic degeneration without inflammatory cells), characterized by pain, swelling, and impaired function.

Bursitis

Inflammation of a bursa, which is a small, fluid-filled sac that acts as a cushion between bones, tendons, muscles, and skin, reducing friction during movement. Symptoms include localized pain, tenderness, and swelling.

Osteoarthritis (OA)

A common degenerative joint disease characterized by the breakdown of joint cartilage and underlying bone, leading to pain, stiffness, swelling, and reduced range of motion. It is often referred to as 'wear and tear' arthritis.

Rheumatoid Arthritis (RA)

A chronic, systemic autoimmune disease that primarily attacks the lining of the joints (synovium), causing painful swelling, joint deformity, and erosion of bone and cartilage.

Radiculopathy

A condition caused by the compression or irritation of a nerve root where it exits the spinal cord. Symptoms include pain, numbness, tingling, and/or weakness radiating along the distribution of the affected nerve pathway (e.g., lumbar radiculopathy affecting the hip, knee, or ankle region).

Trendelenburg Test

A special orthopedic test to assess gluteus medius weakness or hip pathology. The patient stands on one leg for 30 seconds; if the unsupported side of the pelvis drops, it indicates weakness of the gluteus medius on the stance leg (positive Trendelenburg sign).

Sign of the Buttock

A special orthopedic test used to differentiate between hip pathology and gluteal bursitis or sacroiliac pathology. If passive hip flexion with the knee bent is limited, and remains limited with passive hip flexion with the knee extended, it suggests pathology posterior to the hip joint (e.g., abscess, tumor, severe bursitis) rather than just hamstring tightness.

FADIR Test (Flexion Adduction Internal Rotation)

A special orthopedic test for femoroacetabular impingement (FAI) and labral tears of the hip. The examiner passively moves the patient's hip into maximal flexion, adduction, and internal rotation. Reproduction of groin pain, particularly with a 'C' sign, indicates a positive test.

Galeazzi Sign (Allis Test)

A special orthopedic test used primarily in pediatric assessments for hip dislocation or significant leg length discrepancy, especially in congenital hip dysplasia. The patient lies supine with hips and knees flexed and feet flat. Unequal knee heights indicate a positive test.

Anterior Drawer Test (Knee)

A special orthopedic test for anterior cruciate ligament (ACL) integrity. With the knee flexed to 90^\circ and foot stabilized, the examiner pulls the tibia anteriorly on the femur. Excessive anterior translation or a soft end-feel indicates a positive test.

Posterior Drawer Test (Knee)

A special orthopedic test for posterior cruciate ligament (PCL) integrity. With the knee flexed to 90^\circ and foot stabilized, the examiner pushes the tibia posteriorly on the femur. Excessive posterior translation or a soft end-feel indicates a positive test.

Varus Stress Test (Knee)

A special orthopedic test for lateral collateral ligament (LCL) integrity. The examiner applies a varus (inward) force to the knee at both 0^\circ and 20-30^\circ of flexion, while stabilizing the tibia. Excessive gapping or pain on the lateral side indicates a positive test.

McMurray Test

A special orthopedic test for meniscal tears in the knee. The examiner performs various combinations of knee flexion, extension, valgus/varus stress, and internal/external tibial rotation. A palpable or audible click, pop, or reproduction of pain indicates a positive test.

Apley's Compression Test

A special orthopedic test for meniscal tears. The patient is prone with the knee flexed to 90^\circ. The examiner applies a downward compressive force through the heel while internally and externally rotating the tibia. Pain or clicking indicates a meniscal tear.

Apley's Distraction Test

A special orthopedic test used in conjunction with Apley's Compression Test to differentiate between meniscal and ligamentous injuries. The patient is prone with the knee flexed. The examiner applies a distracting force (pulling shin towards examiner) while rotating the tibia. If pain decreases from compression, it implicates the meniscus; if pain increases or remains, it implicates ligaments.

Thessaly Test

A dynamic special orthopedic test for meniscal tears, performed in a weight-bearing position. The patient stands on one leg with the knee flexed 20^\circ and internally/externally rotates the body on the foot. Locking, a feeling of instability, or joint line pain indicates a positive test.

Patellar Apprehension Test

A special orthopedic test for patellar instability or a history of patellar dislocation. With the knee in slight flexion, the examiner attempts to translate the patella laterally. The patient's apprehension, fear of dislocation, or quadriceps guarding indicates a positive test.

Anterior Drawer Test (Ankle)

A special orthopedic test for anterior talofibular ligament (ATFL) integrity. The examiner stabilizes the tibia and fibula while drawing the talus anteriorly. Excessive anterior translation or a soft end-feel indicates a positive test, suggestive of an ATFL sprain.

Squeeze Test (Syndesmotic Squeeze Test)

A special orthopedic test for syndesmotic (high ankle) sprains. The examiner squeezes the tibia and fibula together at mid-calf. Reproduction of pain distally at the ankle syndesmosis indicates a positive test.

Thompson Test

A special orthopedic test for Achilles tendon rupture. The patient is prone or kneeling with feet off the edge. The examiner squeezes the calf muscle. Absence of resultant plantarflexion of the foot indicates a positive test, suggesting a complete rupture.

Homan's Sign

A historical clinical sign for deep vein thrombosis (DVT). Pain in the calf on forced dorsiflexion of the foot with the knee extended. Note: This test is considered unreliable and potentially contraindicated due to the theoretical risk of dislodging an embolus; imaging is preferred for DVT diagnosis.

Straight Leg Raise (SLR) Test

A special neurological test for lumbar nerve root impingement/radiculopathy, particularly involving the sciatic nerve. The examiner passively flexes the patient's hip with the knee extended. Reproduction of radiating leg pain below the knee, typically between 30^\circ and 70^\circ of hip flexion, indicates a positive test.

Well Leg Raise (Crossed SLR)

A variation of the Straight Leg Raise test, considered more specific for disc herniation. The SLR is performed on the unaffected leg, and the reproduction of radiating leg pain in the affected leg indicates a positive test.

Slump Test

A special neurological test for neural tension/radiculopathy involving the lumbar spine or sciatic nerve. It involves a series of progressive spinal and lower limb movements (slumped sitting, neck flexion, knee extension, dorsiflexion) to place neural structures under tension. Reproduction of radiating leg pain or neurological symptoms indicates a positive test.

Femoral Nerve Stretch Test

A special neurological test for upper lumbar nerve root (L2-L4) irritation or femoral nerve compression. The patient is prone; the examiner passively extends the hip and flexes the knee. Reproduction of anterior thigh pain indicates a positive test.

Sacroiliac Joint (SIJ) Compression Test

A special orthopedic test for sacroiliac joint dysfunction. The patient is side-lying; the examiner applies a downward force to the superior ilium (top of the hip bone). Reproduction of pain localized to the SIJ indicates a positive test.

Sacroiliac Joint (SIJ) Distraction Test

A special orthopedic test for sacroiliac joint dysfunction. The patient is supine; the examiner applies an outward (distracting) force to both anterior superior iliac spines (ASIS). Reproduction of pain localized to the SIJ indicates a positive test.

Thigh Thrust Test / Posterior Pelvic Pain Provocation (PPPP) Test

A special orthopedic test for sacroiliac joint dysfunction. The patient is supine with one hip flexed to 90^\circ and adducted. The examiner applies a posterior-directed force through the femur. Localized SIJ pain indicates a positive test.

Gaenslen's Test

A special orthopedic test for sacroiliac joint dysfunction or hip pathology. The patient is supine at the edge of the table, one leg fully flexed to the chest, while the other leg is extended off the table. Pressure is applied to both legs, creating a shearing force at the SIJ. Pain in the SIJ or hip indicates a positive test.