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Lab Handout
PTRS 833
Musculoskeletal Examination/Intervention
Scoliosis
 Adams forward bend test (for scoliosis): The child bends forward with his/her arms hanging in front and
knees straight. The therapist stands behind and then in front of the child to assess spine symmetry.
This is a screening procedure and is not a definitive diagnosis of spine curvature. Bend slowly, explain
the procedure to the family/patient. In scoliosis you will see a hump on one side at the level of the
convexity.
Leg Length Discrepency
 Galleazi sign: Child is supine with knees bent and feet flat on the table or floor. ASIS’s are held level.
Look to see if one knee is higher than the other. If so, leg length may need to be measured. The
Galleazi sign may also be an indication of hip joint integrity—if a child has a dislocated hip, the femur
will slide backward and the knee on that side will be lower. If one knee is lower than the other, that is
probably the side that is shorter. To measure leg length discrepancies, use a tape measure. Go from
ASIS to medial malleoli. Look for iliac crest height differences in standing or is one knee bent and the
pelvis level?
 Tape measurement: Child lies supine with hips and knees extended. Measure the distance from the
most prominent point on the ASIS and the medial malleolus. Repeat on the other side and compare
measurements. It is important that the child lie quietly during leg length measurements.
Developmental dysplasia of the hip (DDH)
The Ortalani and Barlow maneuvers are performed to detect DDH in newborn infants less than 12 weeks of
age. Done when you see there is a leg length difference, to see if there is a hip subluxing. Most common in first
born females, or when mom has a hx of DDH. Fetal position allows baby’s acetabulum to form properly.
 Ortalani maneuver (sign of entry): accurate for the 1st 6mo of life. The child is supine. The examiner
places the tips of the long and index fingers over the greater trochanter with the thumb along the medial
thigh. The infant’s leg is positioned in neutral rotation with 90 degrees of hip flexion, and is gently
abducted while lifting the leg anteriorly. With abduction one can feel a clunk as the femoral head slides
over the posterior rim of the acetabulum and into the socket. Bring legs out, (think Ortalani- Out)
 Barlow maneuver (sign of exit): accurate for the 1st 6 mo of life. Maintaining the same position as
above, the leg is gently adducted while gentle pressure is directed posteriorly on the knee. A palpable
clunk is noted as the femoral head slides over the posterior rim of the acetabulum and out of the
socket. Bring legs in.
 Galeazzi’s test (see above)
 Asymmetric hip folds
Hip abduction is assessed to detect DDH in infants ages 3-12 months.
 Hip abduction: The child is in supine. The examiner places the hip in 90 degrees flexion with one hand
stabilizing the pelvis. Each hip should easily abduct to 75 degrees and adduct to 30 degrees past
midline. Limitation in hip abduction is indicative in DDH. Looking for quality of motion bilaterally
Once a child is ambulatory, DDH can usually be identified through observation. There is usually a limp and the
child may toe-walk on the affected side. There is a positive Trendelenberg sign when the child is asked to
stand on the affected leg.
Hip/Knee Range of Motion
Bones grow faster in length than muscles can grow to keep up.
 Thomas test (hip flexion contracture): Child is supine bring both knees to chest. lower one leg and foot
so that it is hanging off the table. The opposite hip is flexed toward the abdomen and held there to
flatten the lumbar spine. The resulting angle between the tested thigh and the table is the amount of
hip flexion contracture.
 Ober test (hip abduction contracture): Child is in sidelying with the bottom hip flexed toward the chest.
The top knee is in extension or flexed 90 degrees. The top hip is pulled into extension and allowed to
fall into adduction. If the hip cannot adduct, there is a hip contracture. Stabilize the pelvis with your top
hand
 Popliteal angle test (measure of physiological flexion in neonates): Infant is supine with hip and knee of
measured lower extremity flexed to 90 degrees. The other hip is stabilized against the surface while
Lab Handout
PTRS 833
Musculoskeletal Examination/Intervention
the knee of the testing leg is extended. Measure the angle between the thigh and leg when the knee is
maximally extended. To measure, one arm along the femur, one along the tibia with axis at the knee.
 Hamstring length: Same as above but measure the amount of ROM that is missing or lacking from full
knee extension. To start, thigh should be perpendicular to table, to measure, one arm along femur, one
along tibia, with axis at the knee. Subtract from 180.
 Straight-leg test
Torsional Deformity
Torsional profile: Foot progression angle, internal rotation of hip, external rotation of hip, thigh-foot angle and
foot shape are documented to determine if there are torsional deformities. The components that may
contribute to in-toeing are femoral anteversion, internal tibial torsion, and metatarsus adductus. The
components that may contribute to out-toeing are ER contractures of hip, femoral retroversion (rare), external
tibial torsion, and calcaneovalgus. The following tests may be done to determine which component of the
lower extremity is causing the deformity.
 Craig’s (Ryder’s) test (femoral torsion): Child may be prone, supine or sitting. The hip may be flexed or
extended, but the knee must be flexed to 90 degrees. The examiner holds the leg proximal to the ankle
and rotates the hip medially and laterally while palpating the greater trochanter. When the trochanter
reaches its most prominent lateral position, it is assumed that the head and neck of the femur are on
the frontal plan. The amount of hip rotation is measured at this point. Add 20 degrees of internal
rotation (-20 degrees) to your measurement to get an accurate measure of femoral torsion (internal
rotation= femoral antetorsion; external rotation=femoral retrotorsion).
 Hip internal and external rotation (femoral torsion): Should be measured in prone with the hip in neutral.
Excessive internal rotation is indicative of femoral antetorsion and excessive external rotation is
indicative of retrotorsion. The sum of hip IR and ER is 120 degrees up to age 2 and 95-110 degrees
after age two.
 Thigh-foot angle (tibial torsion): Child is in prone with the thighs parallel, in neutral rotation, the thighs
extended and the knees bent 90 degrees. The ankle is allowed to fall into a neutral position of 90
degrees. The axis of the goniometer is placed over the center of the calcaneus. The stationary arm is
placed along a visual bisection of the thigh. The moveable arm is placed on the long axis of the foot
along the second metatarsal. The resulting angle is measured. If the foot points toward midline
(internal tibial torsion), a negative value is given. Normal range is between 0-30 degrees throughout
childhood.
 Trans-malleolar angle (tibial torsion in children with forefoot disorder): The position is the same as
above. A line is drawn across the plantar side of the foot that connects the medial and lateral malleoli.
A second line, perpendicular to the first, that bisects the calcaneus is drawn. Measure the angle
between the second line (bisecting the calcaneus) and the long axis of the femur.
 Foot-progression angle: Angle between the longitudinal axis of the foot and a straight line of
progression of the body. Can be assessed using pedographs or estimated based on observation. Intoeing is expressed as a negative value and out-toeing is expressed as a positive value. Normal range
throughout life is -3˚ to +20˚.
 Metatarsus adductus: The child stands on a photocopier and the foot is copied. In MTA, the forefoot is
curved medially, the hindfoot is in the normal slight valgus position, and there is full dorsiflexion ROM.
Graded as I (mild), II (moderate), or III (severe).
 Calcaneovalgus: Positional deformity in which the forefoot is curved laterally, the hindfoot is in valgus,
and there is full or excessive dorsiflexion. The dorsum of the foot may be touching the anterior surface
of the leg. If calcaneovalgus is caused by a vertical talus , the forefoot is dorsiflexed and the hindfoot is
plantarflexed. The foot bends at the instep and is very rigid. This is known as a rocker-bottom
deformity.
Angular Deformity
 Genu-valgus: Child is in standing with the patella directly forward and the knees touching. Measure
the distance between the medial malleoli. OR Child is in standing or supine with the patellae facing
forward. The axis of the goniometer is over the patella and the proximal arm of the goniometer is
placed over the long axis of the thigh in line with the ASIS. The distal arm of the goniometer is placed
along the long axis of the tibia.
Lab Handout
PTRS 833
Musculoskeletal Examination/Intervention

Genu-varus: Child is in standing with the patella directly forward and the medial malleoli are touching.
Measure the distance between the femoral condyles. OR Child is in standing or supine with the
patellae facing forward. The axis of the goniometer is over the patella and the proximal arm of the
goniometer is placed over the long axis of the thigh in line with the ASIS. The distal arm of the
goniometer is placed along the long axis of the tibia