non-traumatic joint pain: lower extremity

lateral ankle sprain of ATFL

most common ankle sprain

valgus/varus stress

test for MCL/LCL

McMurray and Thessaly

tests for meniscal tear

anterior drawer ankle test

test for tear or laxity of anterior talo-fibular ligament

Squeeze test (ankle)

test for syndesmosis ankle sprain (high ankle sprain)

L2-3

nerve root of hip flexion

L4

nerve root of knee extension

L5

nerve root of hip abduction

S1

nerve root of hip extension

L3-4

dermatome of anterior knee

L5-S1

dermatome of posterior/lateral knee

L4

dermatome of medial ankle

L5

dermatome of dorsum/great toe

S1

dermatome of lateral foot/sole

T10-L2

sympathetics of the lower extremity

Q angle

degree of angle when measureing from midpatella to ASIS and tibial tubercle. normal q angle is 13 degrees for man and 18 degrees for a woman.

J sign

lateral patellar deviation during terminal knee extension

gluteus medius weakness (L5, superior gluteal n.), trochanteric pain.

Trendelenburg gait suggests

Steppage gait

A gait pattern in which the feet and toes are lifted through hip and knee flexion to excessive heights; usually secondary to dorsiflexor weakness. The foot will slap at initial contact with the ground secondary to the decreased control.

L4-L5 radiculopathy or common peroneal neuropathy\\

ddx of steppage gait

circumduction gait

A gait pattern characterized by a circular motion to advance the leg during swing phase; this may be used to compensate for insufficient hip or knee flexion or dorsiflexion.

meniscal tear, post-op stiffness, spasticity.

ddx of circumduction gait

cerebellar or sensory neuropathy

ddx of ataxic/wide-based gait

ober test

pain or resistance to adduction of leg parallel to the table in neutral position

test for iliotibial band sydrome

thomas test

tests for Hip flexion contracture (iliopsoas; rectus femoris)

lachman test

application of anterior and posterior force to the proximal posterior tibia to determine the stability of the ACL and PCL

-correct proximal somatic dysfunctions first

priorities for lower extremity OMT

ottawa rules

X-rays required if there is any pain in malleolar zone and any bone tenderness at lateral or medial edge of malleolus

OR X-rays required if there is any pain in mid-foot zone and any bone tenderness at base of fifth metatarsal or the navicular

apley test

helps differentiate between meniscal tears and ligamentous lesions.

-positive for meniscal tears

anterior dysfunction (restricted posterior motion)

fibular head dysfunction associated with ankle dorsiflexion injury

posterior dysfunction (restricted anterior motion)

fibular head dysfunction associated with ankle inversion sprain

Patient supine, knee flexed to 90.

Physician induces dorsiflexion + eversion (to encourage anterior glide).

Patient plantarflexes/inverts against resistance

muscle energy for posterior fibular head

Patient supine, knee flexed to 90.

Physician induces plantarflexion + inversion (to encourage posterior glide).

Patient dorsiflexes/everts against resistance.

muscle energy for anterior fibular head

Patient prone, knee flexed, fine-tune with hip rotation.

counterstrain position for hamstring (posterior thigh points )

Patient prone, knee flexed, ankle plantarflexed

counterstrain position for gastrocnemius tenderpoint

patellofemoral syndrome

anterior knee pain, worse with prolonged sitting ("theater sign"), stairs, squatting.

Pain with patellar grind test.

Maltracking or lateral patellar glide.

Weak hip abductors/quadriceps imbalance.

exam findings associated with patellofemoral syndrome

malalignment, muscle imbalance (weak VMO, tight IT band), overuse.

etiology of patellofemoral syndrome

Conservative first-line: activity modification, NSAIDs, ice.

Physical therapy: strengthen quadriceps (esp. VMO), gluteus medius, core. Stretch IT band, hamstrings, hip flexors.

Supportive: patellar taping, orthotics for overpronation.

management of patellofemoral syndrome

correct hip/pelvic/ankle dysfunctions that alter patellar tracking.

-indirect MFR of patella

OMT recommended for patellofemoral syndrome

plantar fasciitis

-Heel pain, worst with first steps in the morning or after rest.

-Improves with activity, worsens with prolonged standing.

pain localized at medial calcaneal tubercle (heal)

where is the pain localized in plantar fasciitis

windlass test

Purpose: test for Plantar fascitis

Procedure:Pt is seated. -NWB: pt sits and examiner stabilizes the ankle while 1st MTP joint is extended, while allowing the IP jt to flex

+Result:pain is reproduced at end range of MTP extension

anteromedial calcaneus

plantar fascia origin

avoid prolonged standing, high-impact running until symptoms improve.

activity modification in management of plantar fascitis

Plantar fascia stretch (pull toes dorsiflexed).

Calf stretch (gastrocnemius & soleus).

Towel stretch in morning before first steps.

stretching routines recommended in management of plantar fasciitis

Medial Calcaneal Tubercle

tenderpoint of plantar fascia

Patient prone, knee flexed.

Physician plantarflexes ankle and compresses calcaneus toward forefoot (shortening fascia).

Hold 90 sec → slowly return to neutral.

counterstrain for plantar fascia