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Silfverskiold test Foot Equinus Positive when there is improved dorsiflexion of the ankle with flexion of the
knee. Negative when there is equivalent ankle dorsiflexion in both knee
flexion and extension.
Confusion test Foot Equinovarus patient is asked to flex the hip against resistance while seated, and the
ankle is inspected. In most children with cerebral palsy the anterior tibialis
fires while the hip is flexed; this is considered a positive confusion test
Popliteal angle Knee Flexion Contracture patient is positioned supine on an examining table and the hip is flexed to 90
degrees. The ipsilateral flexed knee is then extended, and the angle
between the vertical and where the tibia may be extended to is the popliteal
angle
Duncan-Ely test Rectus femoris spasticity positioning the patient prone and then flexing the knee to 90 degrees. If
there is spasticity in the rectus femoris, the ipsilateral buttock will rise from
the table as a result of hip flexion caused by the rectus
Rectus grab Rectus femoris spasticity With the patient supine on the examining table, the knee is rapidly flexed. If
resistance is felt, the rectus is spastic.
Thomas test Hip flexion contracture patient is positioned supine on the examining table. The opposite hip is fully
flexed to flatten the lordosis of the lumbar spine and lock the pelvis against
moving. The angle between the table and the hip in question is then
measured, as the hip will rise up in flexion off the table in the presence of a
contracture
Staheli test upper body of the patient prone on the table, with the hips dangling off the
edge of the table. The angle formed by the horizontal and the thigh, at the
point at which further hip extension causes the pelvis to move, is the hip
flexion contracture
Deformity Procedure
Adductor contracture Adductor release Wide based gait when combined with obturator neurectomy
Adduction contracture with growth (10-37% need of
reoperation)
Adductor transfer Less tolerated by patients; complicated with hip and pelvic
inequality if a clip detaches leading to hip subluxation
Hip flexion contracture Psoas tendon tenotomy Leads to loss of hip power in ambulatory patients
Decreased arc of motion
• Level IV study
• 31 cadavers
• Gravity induced equinus in 10-35%
Operative Plan
Deformity Procedure
Foot Equinus left Gastrocnemius recession left