THE HIP CHEAT SHEET

ROM & Accessory Motions Positions & Patterns Special Tests

Action ROM Acc. Motions Resting: 30° FLX, 30° ABD, slight ER Test Tests For Positive Test
Flexion 110-120° Post. glide, Inf. glide, Close-packed:: EXT, IR, ABD Ely’s Test Rectus Femoris flexibility Ipsi hip FLX during passive knee FLX
distraction Capsular pattern: FLX > ABD > IR Thomas Test Hip flexor flexibility Contra. LE cannot be kept EXT during test
Extension 10-15° Ant. glide, distraction Normal femoral shaft angle: 120-135° 90/90 Hams Hamstring flexibility Inability to reach knee EXT w/in 20°/syx
Abduction 30-50° Inf. glide, distraction
Normal femoral torsion angle: 8-15° reproduction
Adduction 30° Distraction Tripod Hamstring flexibility Compensatory EXT of trunk or hips
ER 40-60° Ant. glide, distraction FABER Adductor flexibility/probs w/ ant. capsule, SI joint Test knee high relative to table
IR 30-40° Post. glide, distraction Ober’s Test TFL/IT band flexibility Inability of leg to adduct to table
Piriformis Piriformis flexibility or irritability Syx. Reproduction
Craig’s Test Femoral anteversion/retroversion Anteversion > 15°, Retroversion < 8°
Scour Hip joint pathology Syx. Reproduction & crepitus
Trendelenburg Sagittal hip stability Hip drop on non-WBing extremity

Functional Activities Common Conditions

Activity ROM Required Condition Causes Findings Specific Special Tests Specific Treatment
Gait 10-15° EXT, 30-40° FLX, Coxa Vara Femoral neck shaft angle < 120° • Pronated subtalar joint
10° ER, 3-5° IR, 5°ADD • Leg IR
Shoe tying 124° FLX (19° in frontal • Short ipsilateral leg
plane, 15° in transverse) • Anterior pelvic rotation
Sitting 104° FLX, 20° frontal plane • Ipsilateral subtalar supination
Squatting 115° FLX, 20° ABD, 20° IR • Contralateral genu recurvatum
Ascend stairs (step up) 67° FLX, 16° ADD/ABD, 18° Coxa Valga Femoral neck shaft angle > 135° • Supinated subtalar joint
ROT • Leg ER
Descend stairs (step down) 36° FLX • Long ipsilateral leg
Foot on opposite thigh 120° FLX, 20° ABD, 20° ER • Posterior pelvic tilt
Single-leg stance • Ipsilateral subtalar supination
• Ipsilateral genu recurvatum
Femoral Anteversion Excessive t0rsion angle of hip • Toeing in Craig’s test > 15°
LE Dermatomes • Subtalar pronation
• Medial femoral & tibial torsion
Femoral retroversion Decreased torsion angle of hip • Toeing-out Craig’s test < 8°
• Subtalar supination
• Lateral femoral & tibial torsion
Developmental Abnormal relationship of femoral • Instability of femoral head in socket • Ortolani • Position or “seat” hip joints
Dysplasia (DDH) head to acetabulum • Structural asymmetry (asym. thigh/glut • Barlow • Restrict EXT & ADD
folds, apparent limb length • Double diaper/Pavlik harness
discrepancy) • Surgical corrections
• Restricted ROM (ABD 75°, ADD 30°)
Legg Calve Perthes Epiphyseal ischemia & necrosis of • Pain (often knee pain) • Monitoring
femoral head • Effusion • Maintain ROM
• Antalgic/Trendelenburg gait • Maintain glut strength
• Restricted ROM (ABD, IR, FLX, EXT)
Slipped Capital Sliding/shearing of physis causing • Toe-out • In-situ pinning
Femoral Epiphysis posterior/inferior movement of • Hip ER
(SCFE) epiphysis • Antalgic gait
• Flexion of hip causes ER
• Restricted ROM (ER)
Bursitis Inflammation of bursae • Aching pain from lateral thigh to knee • Control inflammation
• Increased pain w/ipsi sidelying, • Protect healing tissues
climbing stairs, prolonged
sitting/standing/walking
Hip strain • Traumatic hx
• AROM aggravates
• RROM weak & painful
• Pain w/ palpation
Swelling, ecchymosis
LE Myotomes Hip osteoarthrosis Progressive destruction of articular
•
• Hx of insidious complaints, loss of • Scour • Treatment of primary
Segment Action cartilage ADLs problems
L2 Hip flexion • Age >= 50 yoa, commonly • Pain control
L3 Knee extension • Decreased & painful ROM (esp. IR & • Maintain mobility
L4 Ankle dorsiflexion FLX) • Maintain stability of pelvis
L5 Great toe extension • Lateral/anterior hip pain, especially • Manual therapy (joint mobs)
S1 Ankle plantar flexion during WBing
• AM stiffness

Important Hip Ligaments CPR: Squatting aggravating factor, active

Ligament Function FLX
lateral hip pain, active EXT

Iliofemoral Limits hip EXT pain, scour + ADD
lateral hip or groin
pain, PROM IR <= 25°
Ischiofemoral Limits hip IR, ER, EXT
Hip labral tear Tear of hip labrum (antero-superior • Associated w/ femoral acetabular • Scour
Pubofemoral Limits hip hyperABD
w/ twist-pivot ER force in hypertext, impingement, capsular laxity, • ROM
posteriorly w/ hyperFLX/squatting) acetabular cartilage degeneration, • FABER
dysplasia
• Anterior groin pain (posterior or lateral
possible)
• Clicking, locking, catching, instability,
giving way, stiffness
Femoral Acetabular May be CAM (fem. head overgrowth • Anterior groin pain w/ FLX + ADD + IR • Impingement test (90°
Impingement /
anterior/superior labral/chondral FLX + max IR)
Instability (FAI) lesions), Pincer (acetabular • FABER
overgrowth & anteversion

posteroinferior chondral lesions),
mixed
Meralgia Impingement of lateral femoral • Tingling, numbness, pain in lateral
Parasthetica cutaneous nerve (seatbelt, obesity, thigh
pregnancy, neuroma)
Leg Length Different leg lengths • Hip, knee, low back pain
Discrepancy • Can be corrected with heel lift inside
shoe
 THE KNEE CHEAT SHEET
ROM & Accessory Motions Positions & Patterns Special Tests Tissue Healing
Action ROM Acc. Motions End Feel Resting: 25° FLX Test Tests For Positive Test Type Healing Time
Flexion 0-135° Post. glide (tib on Tissue Close-packed: Full EXT, ER of tibia Valgus at 0 & 20° Medial knee Excessive medial gapping compared to Tendon
fem) approx. Capsular pattern: FLX > EXT gapping/MCL integrity unaffected knee Tendinitis 3 – 7 wks
Extension 0-15° Ant. glide (tib on Tissue stretch Tibiofemoral shaft angle: 6° Varus at 0 & 20° Lateral knee Excessive lateral gapping compared to Laceration 5 wks – 6 mos
fem) Q angle: Men: 18° Women: 22° gapping/LCL integrity unaffected knee Muscle
Tib IR 20-30° Tissue stretch Anterior Drawer Anterior tibial Excessive ant. tibial translation compared to Exercise-induced 0-3 days
Tib ER 30-40° Tissue stretch translation at knee unaffected knee Grade I 0-14 days
Posterior Drawer Posterior tibial Excessive ant. tibial displacement compared to Grade II 4 days – 3 mos
translation at knee unaffected knee Grade III 3 wks – 6 mos
Salter Harris Classifications Godfrey (Sag) Identify PCL/post. Tibial “sagging” posteriorly on femur compared Ligament
Type Description Incidence struct.injury to unaffected knee Grade I 0-3 days
I Transverse fracture through physis 6% Lachman Identify ACL injury Soft end-feel & excessive tibial displacement Grade II 3 wks – 6 mos
II Fracture through physis and metaphysis, sparing epiphysis 75% compared to unaffected knee Grade III 5 wks – 1 yr
III Fracture through physis and epiphysis, sparing metaphysic 8% Lateral Pivot Shift Knee anterolateral Sudden tibial jump/reduction at ~30-40° Ligament graft 2 mos – 2 yrs
IV Fracture through physis, metaphysic, and epiphysis 10% rotary instability
Bone 5 wks – 3 mos
V Compression fracture of physis (decrease in perceived space b/t 1% Crossover Knee anterolateral Reproduction of syx and excessive
Articular cartilage repair 2 mos – 2 yrs
epiphysis and diaphysis on X-ray) rotary instability anterolateral displacement of tibia on femur
VI Injury to peripheral portion of physis and resultant bony bridge 1% compared to unaffected knee
formation, which may produce angular deformity (avulsion) Noble’s IT band friction Reproduction of syx at ~30° FLX as ITB slides
syndrome under epicondyle
McMurray’s Medial & lateral Reproduction of syx + palpable click/pop
meniscal lesions
Apley’s Diff. b/t meniscal & Ligamentous: pain w/ distraction + rotation
ligament lesions Meniscal: pain w/ compression + rotation

Functional Activities Common Conditions

Activity Condition Causes Findings Specific Specific Treatment
Walking Special Tests
Ascending/descending stairs Genu valgum Excessive tibiofemoral shaft angle • Pes planus
Squatting towards midline • Excessive subtalar pronation
Running “green light/red light” [miserable malalignment = genu valgum, femoral • Lateral tibial torsion/patella sublux
anteversion, pes planus]
Vertical jump
Genu varum Excessive tibiofemoral shaft angle away • Pes cavus
Figure 8, carioca
from midline • Excessive subtalar supination
Jumping and going into full squat
• Medial tibial torsion/patella sublux
Hard cuts, twists, pivots
Single-leg hop for time Meniscal tear Rotation w/ varus or valgus loading Conservative if no catching/ locking: control swelling,
• Joint line pain, limping • McMurray’s
Triple hop restore PROM, nonWBing strengthening of quads
• ↓ FLX ( >10°) or EXT ( > 5°) • Apley’s
Crossover hop Repair: Ltd WBing, immobilizer, 1st 4 wks avoid WBing
• Swelling (synovial)
Agility hop • Crepitus, clicking, locking in FLX activity > 45° FLX, OKC quad strength
Stairs hop test Pt Education: Avoid squat, pivot, cut, run
Noyes hop MCL sprain Valgus force • Medial knee pain Valgus stress ↓ pain & swelling, restore normal ROM, Strengthen knee
Cincinnati Knee rating • Swelling & tenderness, giving way mm
Lower Extremity Functional Scale (LEFS) • Popping or snapping at time of injury
Knee Injury and OA Outcome Score (KOOS) LCL sprain Varus force, generally w/ tibia IR; severe • Lateral knee pain Varus stress ↓ pain & swelling, restore normal ROM, Strengthen knee
blow can also injure cruciates, ITB, • Swelling & tenderness, giving way mm
meniscus, peroneal nn • Popping or snapping at time of injury
LE Dermatomes ACL injury Contact (foot plant ER + valgus force) or • Rapid swelling at joint line Lachman’s Non-surg: Restore joint mob, ↑ quad strength/endurance,
non-contact (full EXT + femur ADD + IR) • Pop + severe pain & disability agility, bracing, activity mod
[“Unhappy triad” = ACL, MCL, & med. meniscus] • Joint effusion & ↓ ROM w/in 24 hrs Surg: Immediate WB, ROM, return to fxn
PCL injury Blow to front of tibia • Knee swelling Godfrey (Sag) Surg: Slow progression of ROM (esp FLX), look out for
• Joint pain & instability laxity, avoid resisted FLX > 70-90°
IT Band Friction Friction of ITB against lateral femoral Pain at lateral femoral epicondyle or radiating Noble’s STM, foam roller, stretching
Synd. epicondyle due to overuse down lat. line to insertion on tibia Compression
(Runner’s Knee)
Patellar Frequent intense physical activity, Pain initially present only at beginning of or just
tendonitis overweight, tight mm, mm imbalance, after intense workout, increases w/ increasing
alignment, patella alta intensity; progresses to constant pain or ache
that can make sleep difficult
Baker’s cyst Herniation of the joint capsule into • Swelling in popliteal fossa
popliteal fossa due to joint effusion • May or may not be painful
OCD Pain, swelling, instability, locking, catching
Patellofemoral Increased compressive forces b/t patella • Tight lateral patellar retinaculum VMO & glut med strengthening, flexibility, orthotics,
pain syndrome & femur, irritation of synovium & • Abnormal patellar tracking, tilt, rotation McConnell taping
retinacular structures, hypermobile patella • Abnormal Q angle
Osgood-Schlatter Repetitive strain on tibial tuberosity Pain & swelling at tib. tuberosity; worsens
w/activity, imp. w/rest

TKA Total knee arthroplasty Main goal: restoration of ROM. Utilize prolonged low-load
LE Myotomes stretching, patella-femoral joint mobs, monitor for
DVT/infection, maximize quad strength ASAP.
Segment Action
L2 Hip flexion
L3 Knee extension Articular cartilage Trauma or degeneration Post-surg: Minimize knee ROM & monitor for DVT during
L4 Ankle dorsiflexion injury initial phase; ltd WBing for 3-4 wks; restricted running for 9
L5 Great toe extension months; early ROM & NWB exercise
S1 Ankle plantar flexion

MCL Sprain Grades Meniscal Facts Restraints to Motion

Grade Description • Avascular in inner 2/3 Action Restraints
I Incomplete tear; minimal syx; pain w/ • Partly vascular and fibrous in outer 1/3 Ant. translation ACL, MCL, LCL, mediolateral capsule, ITB
pressure on MCL, quick return to sport • Aid ligaments & capsule in preventing hyperextension Post. translation PCL, MCL, LCL, mediolateral capsule
(10 days-2 weeks) • Minimal innervation Valgus gapping MCL, ACL, PCL, post. capsule in full EXT
II Incomplete tear; instability when • Often injured by rotation w/varus or valgus loading Varus gapping LCL, ACL, PCL, post. capsule in full EXT
cutting/pivoting; pain, swelling more • Medical Meniscus Tibial ER MCL, LCL
significant (3 weeks) o C-Shaped, thicker posteriorly, excursion of 2 mm Tibial IR ACL, PCL
III Complete tear; significant pain/swelling; • Lateral Meniscus
instability, giving out; knee o O-Shaped, equal thickness, excursion of 10 mm, not attached to
brace/immobilizer necessary; healing >= tibia, less prone to injury
6 wks
 THE ANKLE & FOOT CHEAT SHEET
ROM & Accessory Motions Positions & Patterns Special Tests
Action ROM Acc. Motions Distal Tib-Fib Joint:
Test Tests For Positive Test
Plantarflexion 50° Ant. glide (talus on tibia), Resting: PF
Close-packed: Maximum DF Anterior drawer Integrity of anterior talofibular ligament Excessive movements
distraction Talar tilt Integrity of calcaneofibular ligament Excessive tilting
Dorsiflexion 20° Post. glide (talus on tibia) , Capsular pattern: Pain on stress
Squeeze test Integrity of distal tib-fib joint Reproduction of syx
distraction Thompson’s test Integrity of Achilles tendon Absence of ankle PF
Talocrural Joint:
Supination 45-60° Homan’s sign DVT Calf pain reproduction
Resting: 10° PF, midway b/t INV & EV
Pronation 15-30° Morton’s test Metatarsal neuroma or fracture Reproduction of syx
Close-packed: Maximum DF
Hallux extension 70° (MTP) Capsular pattern: PF > DF Windlass test Stress of plantar fascia Reproduction of syx
Hallux flexion 45° (MTP)
(all end-feels tissue-stretch) Subtalar Joint:
Resting: Midway between ROM extremes
Close-packed: SUP
Functional Activities Capsular pattern: Varus > valgus
Activity
Walking (10° DF, 20-25° PF)
Squatting (both ankles DF symmetrically) Common Conditions
Standing on toes (both ankles PF symmetrically) Condition Causes Findings Specific Special Tests Specific Treatment
Squat & bounce at end of squat 5th MT avulsion fx Avulsion of peroneus brevis
SLS tendon due to inversion
Standing on toes, one foot at a time Jones fx Transverse fx proximal shaft MT 5 NWBing
Ascending & descending stairs (20° DF needed) Lisfranc Injury Severe dorsal or plantar • Usually obvious displacement Surgery
Walking on toes dislocation at midfoot-forefoot
Running straight ahead junction
Running, twisting, & cutting Lateral ankle sprain Varus force causes injury to lateral • See Ottawa Ankle Rules • Anterior drawer
Jumping ankle ligaments • Talar tilt
Jumping and going into a full squat Achilles tendon rupture
Shin splints
Turf toe HyperEXT resulting in sprain of 1st • Pain & swelling which increases
Ottawa Ankle Rules MT; may be result of single or during push-off & jumping
repetitive trauma
• Tenderness over lateral malleolus to 6 cm proximally Plantar fasciitis Increased stress on fascia, • Pain in antero-medial heel, along
• Tenderness over medial malleolus to 6 cm proximally excessive PRON, inflexible medial longitudinal arch
longitudinal arch, tight gastroc- • Increased pain in morning, loosens
• Tenderness over navicular soleus complex, shoes w/poor after first few steps
• Tenderness over base of 5th metatarsal support • Increased pain w/forefoot
• Inability to weight-bear both immediately and in ER dorsiflexion
Deep vein thrombosis Blood clot in the vein • Lower leg swelling Homan’s sign (although not Immediate referral
• Lower leg warmth & redness a GOOD test)
LE Dermatomes • Lower leg pain, often worse when
standing & walking
Tarsal tunnel syndrome Tendon fibrosis and enlargement; • Dysesthesias/hypoesthesia/pain on Tinel sign at tarsal tunnel
fracture; anatomic anomaly & plantar surface
ganglion cycsts; excessive • Increased night pain & WBing
pronation • Intrinsic mm weakness

Morton’s neuroma Thickening of nerve sheath
(common plantar nn) where nerve
divides into branches, commonly
b/t 3rd & 4th met heads
Diabetic neuropathy Diabetes; damage to blood
vessels; mechanical injury to
nerves; autoimmune factors;
lifestyle factors
• Forefoot paresthesia/intermittent Morton’s squeeze test Surgery
pain
• Pain relieved w/NWBing
• Pain increases w/ compression
• Impaired sensation in feet/hands
• Slowed digestion of food in
stomach
• Carpal tunnel syndrome
• Other nn problems

Ankle Sprain Classifications

Grade Description
I – Mild Stable No hemorrhage, minimal swelling, point tenderness, -
anterior drawer, no varus laxity, 2-10 days to recovery
II – Moderate Stable Some hemorrhage, localized swelling (margins of
Achilles less defined), possible + anterior drawer, no
varus laxity, 10-30 days to recovery
III – Severe, 2-ligament, Diffuse swelling on both sides of Achilles tendon, early
Unstable hemorrhage, possible medial & lateral tenderness, +
anterior drawer, + varus laxity

LE Myotomes Important Ankle & Foot Ligaments

Segment Action
Ligament Function
L2 Hip flexion
Ankle - Lateral Collateral
L3 Knee extension
Anterior talofibular Limit ankle inversion
L4 Ankle dorsiflexion
Calcaneofibular Limit ankle inversion
L5 Great toe extension
Posterior talofibular Limit ankle inversion
S1 Ankle plantar flexion
Ankle - Medial (Deltoid)
Posterior tibiotalar Limit ankle eversion
Tibiocalcaneal Limit ankle eversion
Weber Fibula Fracture Classifications Tibionavicular Limit ankle eversion
Type Description Stability Anterior tibiotalar Limit ankle eversion
A Fracture below joint margin Stable Medial Foot
B Fracture begins at joint margin Moderately unstable Plantar calcaneonavicular (spring) Maintain longitudinal arch of foot
C Fracture begins above joint margin Completely unstable
*** Also used for bimalleolar & trimalleolar fractures