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24 Cards in this Set
- Front
- Back
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O'Brien Sign
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The patients shoulder is placed in flexion to 90 degrees and then into full internal rotation and 10 to 15 degrees of horizontal adduction (cross chest). Examiner exerts a downward force against the patient’s upward resistance. Repeat the test with the arm supinated.
Deep pain indicates labrum tear, superficial pain indicates acromioclavicular joint problem |
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Anterior Slide Test
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Anterior Slide test
Patient seated and the examiner instructs patient to place hands on the waist with the thumbs pointing posterior. With one hand stabilize the scapula and clavicle and with the opposite hand, grasp the humerus and place an anterior to superior force into the shoulder. The patient will then push back against the examiner. Popping, cracking and crepitus is noticed with pain on the antero-superior aspect of the shoulder indicating Superior or anterior glenoid labrum tear. |
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Jobe Relocation Test
AKA... |
Anterior apprehension with Relocation
The patient lies supine on an examination table. The shoulder is placed into the apprehension position (arm to the square). The examiner attempts to reproduce a sense of instability/apprehension by externally rotating the shoulder in a controlled manner. If apprehension is reproduced, the examiner then places the heel of their hand on the proximal anterior gleno-humeral joint and gently pushes in an anterior to posterior direction (relocation). Relief upon relocation confirms anterior instability of the GH joint (rules out tendinitis as false positive for anterior apprehension test.) |
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Painful Arc Test
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The patient is instructed to elevate their arm from their side slowly (ACTIVELY) up to 180 degrees of full abduction.
Pain worse between 70 degrees and 110 degrees of shoulder abduction indicates Impingement syndrome with supraspinatus pathology Pain worse at 160 degrees or above of shoulder abduction indicates A/C joint involvement |
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Neer Test
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The patients shoulder is placed into passive forward flexion to end range.
End range pain as the greater tuberosity jams up against the anterior-inferior border of the acromion indicates Impingement with overuse injury of the supraspinatus muscle or biceps tendon. |
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Hawkin Kennedy Test
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Pt forearm parallel to his chest, doc stabilizes scapula from behind and comes under humerus with other arm to grab pt forearm. Passive internal rotation of the shoulder in 90 degrees of forward flexion with the elbow flexed to 90 degrees while the scapula is stabilized posteriorly.
"The supraspinatus tendon is jammed up against the anterior surface of the Coraco-acromial ligament due to narrowing of the subacromial space. Posterior pain implicates stretch of the Teres Minor and Infraspinatus tendons. Local pain indicates supraspinatus tendinitis and impingement. Anterior pain indicates anterior impingement syndrome, posterior pain indicates posterior impingement syndrome. |
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Patte Test
AKA... |
Hornblower sign
The patient will place the shoulder of the affected side in forward flexion to 90 degrees. The shoulder is then slightly abducted (15-20 degrees). The Elbow is bent to 90 degrees with the palm facing the patient (Hornblower position). The examiner will place their hand at the distal forearm on the dorsal surface. The patient is then instructed to externally rotate against the examiners resistance. Pain or inability to actively externally rotate against resistance due to weakness indicates infraspinatus or Teres minor tendinopathy |
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Empty Can Test
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Shoulder abducted 90 degrees in the scaption plane and 40 degrees forward flexion. The shoulder is placed in maximal internal rotation with the thumb pointing downward. Doc presses down and in, pt resists up and out
Resistance to the abduction and downward pressure stresses the supraspinatus muscle and tendon insertion indicating tear, rupture to the supraspinatus muscle or tendon with possible suprascapular neuropathy. |
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Lift Off Test
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The patient will place the back of their hand in the small of their back (Palm facing posterior) and attempt to lift the hand off the back.
Inability to actively lift the hand off or away from the back indicates supraspinatus tendinopathy |
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Sulcus Sign with Load & Shift
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Patient seated with the elbow flexed to 90 degrees and the shoulder in the neutral position for rotation. Grasp the wrist with one hand and with the other, place a downward force on the forearm.
This motion attempts to dislocate the shoulder inferiorly. A sulcus that appears antero-laterally indicates inferior shoulder instability and possibly inferior dislocation. A grade of +1 sulcus indicates less than 1cm, +2 indicates 1-2 cm’s and +3 indicates more than 3cm’s |
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Mazion Shoulder Maneuver
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The examiner asks the patient to place the hand of the affected shoulder on the unaffected shoulder and bring the elbow toward the chest (like a Dugas position). The patient will then actively raise the elbow toward the forehead.
Inability to actively raise the elbow to the forehead due to pain and/or stiffness indicates early stage adhesive capsulitis or non inflammatory capsular adhesions |
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Maximum Elbow Flexion Test
AKA... |
Compression test
The patient is asked to place their elbows in maximum elbow flexion for up to 3 minutes to close down the cubital tunnel. Reproduction of parasthesias into the ulnar nerve distribution with possible weakness on handshake (power grip) indicates cubital tunnel syndrome (ulnar nerve entrapment at the cubital tunnel). |
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Valgus overload test of the elbow
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The elbow is placed into 90 degrees of flexion. The examiner then places a valgus stress into the elbow while passively extending the elbow fully (dynamic extension).
Pain in the posterior elbow with a reproduction of a locking or catching sensation or an inability to fully extend the elbow due to pain indicates posterior elbow impingement syndrome |
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Reverse Mills test
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Extend the wrist, then the elbow. The elbow is extended and the forearm is supinated. The wrist is then fully passively extended. The test is designed to confirm the golfers elbow test.
Reproduction of pain in the medial elbow ndicates Medial epicondylitis or Golfers elbow |
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Froment's Paper Sign (alternate)
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The examiner asks a patient to hold a piece of paper in their hand between the thumb and index finger with the thumb adducted. The examiner then attempts to pull the paper from the patient’s grasp while they attempt to resist.
The patient is seen to flex the thumb thereby recruiting the median nerve to compensate for apparent weakness indicating weakness or palsy of the adductor pollicus muscle – innervated by the ulnar nerve. Look for wasting of the dorsal thumb web. |
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Craig Test for Anteversion
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The patient lies prone with the involved side’s knee flexed to 90 degrees. With the examiners hand grasping the distal tib/fib, the hip is internally rotated until the greater trochanter comes parallel to the table (foot pushed laterally).
Internal rotation of the hip in excess of 30 degrees in order for the greater trochanter to attain a parallel position indicates a structural anteversion. |
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Hip Impingement
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Hip to 90, knee fully flexed, adduct, int. rotation of hip (foot out) The patient is supine with hip flexed to 90 degrees. The hip is then adducted across the midline of the body and the examiner forcefully internally rotates the hip.
Sharp anterior catching hip pain indicates hip impingement syndrome |
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Modified Ober Test
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Pt on side at 90, knee extended, pull leg up and off table, and let other leg rest. The patient is side lying with the involved side up. The bottom leg is flexed to allow stability. The patient is moved to the edge of the table and uses their thigh to stabilize the patient’s sacrum and pelvis. The involved legs knee is extended completely and the hip is extended slightly. The examiner then lowers the involved leg off the side of the table.
Positive: The hip and lateral thigh remains in abduction (does not angle down towards the floor). Lateral thigh pain during this maneuver indicates tight TFL (possible contracture) with possible IT band syndrome. |
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Patellar Bowstring
AKA... |
Test for synovial knee Plica
Abduct, push, patella L-M, int. rot., flex/ext The patient is side lying with the involved side up. The knee is placed in 30 degrees flexion. The examiner grasps the lateral aspect of the patella with the superior hand and pushes it medially. The inferior hand internally rotates the tibia. The knee is then extended fully and flexed again to 30 degrees. The test can be repeated with a lateral pull on the patella and lateral tibial rotation. Popping, snapping, clunking, grinding or stuttering of the patella with medial patella pain is medial knee synovial plica syndrome, with lateral patella pain is lateral knee synovial plica syndrome. |
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Noble Test
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The patient sits on the table with the involved knee flexed to approximately 60 degrees. The examiner places their superior thumb over the lateral femoral condyle with firm pressure where the IT band runs past the knee. The examiner then passively extends the
knee to full extension and then flexes the knee back to 60 degrees while maintaining firm pressure with the thumb over the lateral femoral condyle. This can be repeated a few times Worse pain through 30/40 degrees of flexion/extension (painful arc of the knee) of the knee indicates: IT band syndrome or lateral knee impingement syndrome |
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Godfrey "Sag" Sign
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The patient lies supine with the involved knee flexed to 90 degrees and the hip flexed to 90 degrees. The examiner grasps the distal tib/fib and asks the patient to perform a gentle hamstring contraction (bring heel to buttock). The examiner then observes the proximal anterior tibio-femoral joint.
The proximal tibia “sags” posteriorly due to lack of a static posterior constraint indicating tear or sprain of the posterior cruciate ligament. This test is done to confirm injury to this ligament when Drawer test proves inconclusive. |
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Fat Pad Squeeze Test of the Heel
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The examiner depresses the patient’s fad pad forcefully and elicits a painful localized response. The examiner then squeezes the heel and fat pad together thereby creating a cushioning effect of the fat pad. Then the forceful depression is repeated while
maintaining the squeeze. If the pain diminishes during this procedure or feels less tender, then fat pad syndrome is ruled in. If pain remains the same or is worse, consider plantar fasciitis, heel spur or calcaneal stress fracture. |
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Test for Plantar Fasciitis
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The examiner forcefully dorsiflexes the patient’s ankle and then forcefully extends the great toe creating a stretch effect. The examiner then palpates along the medial longitudinal arch while maintaining the passive stretch.
Sharp pain along the medial longitudinal arch indicates plantar fasciitis |
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Distal Tibio-Fibular Squeeze Test
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The examiner squeezes (L-M) the distal third of the tibio-femoral joint for 3-5 seconds.
Pain reproduced while squeezing or pain worsened when releasing the tib/fib distally as it springs back indicates High ankle sprain of the tibio-femoral ligament and/or the interosseous syndesmosis |
