MSK Lower Extremity

low back pain with bowel/bladder dysfunction

cauda equina syndrome

categories of low back pain

nonspecific, nerve root entrapment, pain from underlying disease

S1/2 nerve entrapment

cauda equina syndrome

back pain red flags

<20, >50, hx CA, trauma, wt loss, fever/chills/night sweats, pain at night or rest, IVDU, active infection or immunosuppression, long term steroids, incontinence, saddle anesthesia

action with back pain red flags

imaging before 6w

low back pain yellow flags

fear/avoidance of activity, belief that pain is severely disabling, depressed mood, pessimistic about tx that involves active participation

neurogenic claudication

symptoms exacerbated w/walking, standing, or maintaining postures but relieved with sitting or lying

shopping cart sign

relief of pain with bending over on a shopping cart but reappears when standing

spinal stenosis key features

shopping cart sign, neurogenic claudication

IPROMS exam

inspection, palpation, range of motion, special tests

scheuermann kyphosis

“humpback”

scoliosis

curvature of the spine present in 3 plans

drop foot

inability to dorsiflex, sign of neuro, muscular, or anatomical problems

drop foot causes

peroneal nerve compression, L5 compression, tumor/cyst, bony overgrowth, muscular dystrophy, ALS, MS, stroke

ROM actions

flexion, hyperextension, lateral bending, rotation of trunk

flexion degrees

75-90 degrees

hyperextension degrees

30 degrees

lateral bending degrees

35 degrees

rotation of trunk degrees

30 degrees

nerve root impingement tests

straight leg raise, crossover, slump

straight leg raise test positive

reproduction of radicular symptoms in lower extremity

crossover test positive result

reproduction of radicular symptoms in lower extremity

scoliosis special test

adam’s forward bending

adam’s forward bending positive result

trunk asymmetry or rib hump

straight leg raise test

pt supine, support leg at heel and do neutral dorsiflexion, raise leg 0-60°

crossover test

move noninvolved leg and raise it to point of symptom reproduction

slump test

pt sit with arms behind back and legs together and slump forward as far as possible then while flexed, extend knee and provider moves foot to dorsiflexion

adam’s forward bending

pt stands, and then slowly bends forward at the waist with arms pressed together

nerve compression dorsiflexion of big toe

L5

C sign

shape of hand when describing deep interior hip pain and suggests intra-articular hip pathology

SI joint test

patrick and FABER

log roll test positive

pain in hip

trendelenburg test positive

pelvis drops towards contralateral side

positive trendelenburg test meaning

gross abductor weakness

windshield wiper test positive

decreased range of motion/pain

positive windshield wiper test meaning

hip osteoarthritis

FADIR test positive

pain/symptom reproduction

positive FADIR test meaning

impingement syndrome

scheuermann kyphosis

scoliosis

drop foot

hip dislocation

FABER test

flexion, abduction, and external rotation of leg

log roll test

roll leg into internal and external rotation

trendelenburg test

stand on affected leg and lift foot off ground, positive if pelvis drops

windshield wiper test

swing foot in and out sitting on the table

FADIR test

flexion, adduction, and internal rotation

baker’s cyst

mcmurray’s sign positive

joint line tenderness or clicking/catching

positive mcmurray’s sign meaning

meniscus tear

valgus stress test positive

medial joint line tenderness or opening

positive valgus stress test meaning

MCL sprain

varus stress test positive

lateral joint line tenderness or opening

positive varus stress test meaning

LCL sprain

lachman’s test positive

joint laxity or anterior tibial translation

anterior drawer test positive

increased laxity or forward translation of tibia

positive lachman’s test meaning

ACL tear

positive anterior drawer test meaning

ACL tear

posterior drawer test positive

excess posterior tibial translation

positive posterior drawer test meaning

PCL tear

mcmurray’s sign

flex hip and knee and internally and externally rotate knee

valgus stress test

flex knee 30° and put hand on lateral aspect with other hand on inside of ankle and push outward while supporting knee

varus stress test

flex knee 30° and put hand on medial aspect with other hand on outside of ankle and push outward while supporting knee

lachman test

grasp femur above lateral side of knee, flex knee slightly, and pull up sharply on tibia from medial side

anterior drawer test

pt lays down with knee flexed and foot on table, put thumbs against tibial plateau and use fingers to pull forward on tibia

posterior drawer test

pt lays down with knee flexed and foot on table, put thumbs against tibial plateau and use thumbs to push against tibia

claw toe

hammer toe

mallet toe

thompson test positive

no plantar flexion with maneuver

positive thompson test meaning

achilles tendon rupture

ankle anterior drawer test posititve

increased anterior translation of the foot

positive ankle anterior drawer test meaning

ATFL sprain

talar tilt test positive

increased laxity or internal rotation

positive talar tilt test meaning

CF ligament sprain

thompson test

squeeze calf muscle and watch for plantarflexion

ankle anterior drawer test

hold foot against forearm, use one hand on tibia and other hand pulls ankle forward from heel

talar tilt test

hold tibia and invert/evert calcaneus