621 Exam 2

Knee Exam

100

What is the normal value for knee flexion ROM?

130-140 degrees

200

What measurement indicates a positive 90/90 test?

<30 degrees of knee extension

300

What is the grading scale for the stroke test?

0=no swelling

trace=small wave on medial side with downstroke

1+=larger bulge of fluid on medial side with downstroke

2+=effusion spontaneously returns to medial side after upstroke (no downstroke necessary)

3+=inability to move fluid on upstroke

400

In order to bias the biceps femoris, what way do you rotate the knee during a hamstring MMT?

Laterally

500

Explain how to perform the moving patellar apprehension test and what would indicate a positive test.

Step 1: examiner translates the patella laterally with thumb, holds the patella laterally while passively flexing the knee to 90 degrees, and returns the knee to full extension.

Step 2: examiner repeats the test with patella translated medially.

Positive test: apprehension or quadriceps contraction during step 1 AND no apprehension or quadriceps contraction during step 2

Knee Pathology

100

What are some signs/symptoms of osteoarthritis?

Dull pain that increases with joint use and decreases with rest, morning stiffness for <30 min, crepitus, loss of range of motion in a capsular pattern. 

200

Name 3 signs/symptoms specific to diagnosing a meniscal injury

Twisting on a fixed leg or tearing sensation at time of injury, delayed effusion (6-24 hours post injury), history of catching or locking, pain with forced hyperextension, pain with maximal passive flexion, joint line tenderness, pain or audible click with McMurray's test, positive Thessaly test in 20 degrees of flexion. 

300

What is a typical timeline for someone recovering from ACL reconstruction?

- Full ROM: extension at 2 weeks, flexion at 4-6 weeks.

- Discontinue crutches and brace around 4 weeks

- Clearance for return to jogging progression at 12 weeks (katie says they are almost never ready by this point)

- Initiation of change of direction drills at 5 months

- Full clearance for return to sport at 9+ months

400

What are the four categories of patellofemoral pain?

Patellofemoral pain with overuse/overload without other impairments, patellofemoral pain with muscle performance deficits (hips/quads), patellofemoral pain with movement coordination deficits (hypermobility of the foot/ankle complex), patellofemoral pain with mobility impairments (hypomobility of soft tissue, patella, foot/ankle complex)

500

What is the mechanism of injury of a muscle strain?

Muscle fibers can't maintain force output with coinciding demand. Often happens with a forceful eccentric activation of muscle while in a lengthened position

Foot/Ankle Exam

100

What is the normal range of motion for inversion at the hindfoot/subtalar joint?

15-25 degrees

200

How do you position a patient for a tibialis anterior MMT?

Short sitting, dorsiflexion, and inversion

300

What measurement demonstrates excessive pronation with the navicular drop test?

10 mm

400

What are the criteria of the Ottawa foot rule?

Bony pain in the midfoot zone and any one of the following: tenderness at the base of the 5th metatarsal, tenderness at the navicular bone, inability to bear weight both immediately after injury and in the ED for 4 steps. 

500

What are the landmarks used for the figure 8 ankle measurement?

Tibialis anterior tendon, lateral malleolus, navicular tuberosity, base of the fifth metatarsal, distal tip of the medial malleolus. 

Foot/Ankle Pathology

100

What is the order of ankle ligaments from most likely to least likely to be sprained?

ATFL>CFL>PTFL

200

What is the most likely mechanism of injury for a high ankle sprain?

External rotation force while in a dorsiflexed position. Likely a collision while foot is planted and in external rotation. The talus will force the fibula to separate from the tibia, rotate externally, and displace posteriorly, resulting in abnormal stress on the syndesmotic ligaments. 

300

What are the risk factors for plantar fasciitis?

Limited active and passive talocrural joint dorsiflexion, overly pronated feet, and high BMI in nonathletic individuals. 

400

What are the 6 possible criteria to predict anterolateral ankle impingement syndrome?

5/6 of the following:

1. anterolateral ankle joint tenderness

2. anterolateral ankle joint swelling

3. pain on forced dorsiflexion

4. pain on affected side with single leg squat

5. pain with activities

6. absence of ankle instability

500

What is an exam you can perform to determine if someone has plantar neuropathy?

Squeezing the metatarsal bones together eliciting pain due to increased pressure on the digital nerve. 

Hip Exam

100

What are the normal ROMs for external and internal rotation?

ER: 30-50 degrees

IR: 30-45 degrees

200

When performing a hip extension MMT/RT, how would you isolate the test for glute max bias?

Have the patient laying prone with knee flexed to 90 degrees. 

300

What 4 structures are tested using the Thomas test?

Rectus femoris, TFL, psoas, and joint capsule. 

400

What muscle does the Trendelenburg test assess?

Gluteus medius

500

What measurements indicate anteversion and retroversion for Craig's test?

Anteversion=>20 degrees IR

Retroversion=<5 degrees IR