Orthopedic Diagnosis Lab

Front 1

Bony palpation of the shoulder

Back 1

1. Sternoclavicular articulation
2. Clavicle
3. Acromioclavicular articulation
4. Acromion
5. Spine of the scapula
6. Body of the scapula
7. Scapulothoracic articulation
8. Coracoid process
9. Greater tuberosity of the humerus
10. Bicipital groove
11. Lesser tuberosity of the humerus

Front 2

Soft Tissue Palpation of the Shoulder

Back 2

1. Sternocleidomastoid
2. Anterior deltoid
3. Middle deltoid
4. Posterior deltoid
5. Biceps
6. Trapezius
7. Rhomboid minor
8. Rhomboid major
9. Supraspinatus
10. Infraspinatus
11. Teres minor
12. Subscapularis
13. Subacromial bursa
14. Subdeltoid bursa
15. Pectoralis major
16. Serratus anterior
17. Latissimus dorsi
18. Bicipital tendon
19. Axillary lymph nodes

Front 3

Shoulder Range of Motion

Back 3

1. Flexion - 180
2. Extension - 60
3. Abduction - 180
4. Adduction - 50
5. External rotation - 90
6. Internal rotation - 70
7. Scapular retraction
8. Scapular protraction
9. Scapular elevation

Front 4

Dugas' Test

Back 4

Instruct: Patient seated, examiner instructs patient to place the hand of the affected side on the opposite shoulder and then bring the affected elbow to the chest.

Positive: Inability to touch the opposite shoulder and/or inability of the elbow to touch the chest.

Indicates: Acute dislocation of the glenohumeral joint

Confirmation tests: Apprehension test, Radiography

Front 5

Anterior Apprehension Test

Back 5

Instruct: Bring the shoulder to 90 and the elbow to 90; stand behind patient with forearm to forearm, the medial hand supports at the scapula. Bring patient's forearm into external rotation. Look at patient's face

Positive: Patient will have a noticeable look of apprehension or alarm on their face with possible pain

Indicates: Chronic anterior dislocation of the glenohumeral joint.

Confirmation tests: Dugas' Test, Radiography

Front 6

Posterior Apprehension Test

Back 6

Instruct: Patient supine, bring humerus perpendicular to table and forearm parallel, grab arm and push into table and internally rotate forearm while watching patient's face

Positive: Patient will have a noticeable look of apprehension or alarm on their face with possible pain.

Indicates: Chronic posterior dislocation of the glenohumeral joint

Confirmation tests: Dugas' Test, Radiography

Front 7

Codman's Drop Arm Test

Back 7

Instruct: Patient seated with doctor standing behind, doctor abducts arm slightly past 90, asks them to hold arm and then slowly lowers it, doctor should be ready to catch it if it drops

Positive: Patient will not be able to lower the arm slowly or the arm drops suddenly

Indicates: Rotator cuff tear, usually supraspinatus

Confirmation tests: Apley's Scratch, Impingement Sign

Front 8

Dawbarn's Test

Back 8

Instruct: Patient seated. Palpate subacromial bursa which should be painful. Doctor abducts arm past 90

Positive: Decrease in pain and/or tenderness

Indicates: Subacromial bursitis

Confirmation tests: MRI

Front 9

Yergason's Test

Back 9

Instruct: Patient seated, doctor flexes patient's elbow to 90, pull down on arm and resist the patient's external rotation

Positives and Indications:
1. Localized pain and/or tenderness at the bicipital groove indicates bicipital tendinitis
2. Audible click or the biceps tendon subluxes or dislocates indicates instability of the biceps tendon possibly associated with a torn transverse humeral ligament.

Confirmation Tests: Abbott-Saunders Test, Speed's Test

Front 10

Abbott-Saunders Test

Back 10

Instruct: Patient seated. Palpate bicipital tendon, then fully abduct patient's straight arm, then externally rotate and slowly lower

Positive: Palpable and/or audible click.

Indicates: Subluxation or dislocation of the biceps tendon. Rupture of transverse ligament or tendon subluxation beneath subscapularis muscle belly.

Confirmation tests: Speed's Test, Yergason's Test

Front 11

Speed's Test

Back 11

Instruct: Palpate bicipital tendon, with patient's palm up and elbow flexed at 45, have them extend their arm toward the seam of the ceiling while you apply resistance on the forearm

Positive: Pain and/or tenderness in the bicipital groove

Indicates: Bicipital tendinitis

Confirmation tests: Abbott Saunders Test, Yergason's Test

Front 12

Apley's Test

Back 12

Instruct: Patient reaches above head to touch opposite superior scapula and behind back to touch opposite inferior scapula. Perform bilaterally.

Positive: Exacerbation of pain

Indicates: Degenerative tendinitis of rotator cuff tendons, usually suprasinatus

Front 13

Impingement sign

Back 13

Instruct: Patient seated. With arm pronated and slightly abducted, doctor brings arm into full GH flexion

Positive: Pain in the shoulder

Indicates: Overuse injury to the supraspinatus and possibly biceps tendon.

Front 14

Bony palpation of elbow

Back 14

1. Medial epicondyle
2. Medial supracondylar line of the humerus
3. Groove of the ulnar nerve
4. Trochlea
5. Olecranon
6. Olecranon fossa
7. Lateral epicondyle
8. Lateral supracondylar line of the humerus
9. Radial head

Front 15

Soft tisue palpation of elbow

Back 15

1. Biceps
2. Triceps
3. Brachial Artery
4. Supracondylar lymph nodes
5. Ulnar nerve
6. Medial Collateral Ligament
7. Olecranon bursa
8, Lateral Collateral ligament
9. Pronator teres
10. Flexor carpi radialis
11. Palmaris longus
12. Flexor carpi ulnaris
13. Brachioradialis
14. Extensor carpi radialis longus
15. Extensor carpi radialis brevis

Front 16

Range of motion (active and passive)

Back 16

1. Elbow flexion 150
2. Elbow extension 0
3. Forearm supination 80
4. Forearm pronation 80

Front 17

Medial Collateral Ligament Test

Back 17

Instruct: Patient's arm supinated and slightly flexed. Stabilize lateral elbow joint line and apply pressure at medial forearm to gap the medial elbow joint.

Positive: Excessive gapping and pain

Indicates: Medial collateral ligament instability

Confirmation Test: MRI

Front 18

Lateral Collateral Ligament Test

Back 18

Instruct: Patient's arm supinated and slightly flexed. Stabilize medial elbow joint line and apply pressure at lateral forearm to gap the lateral elbow joint.

Positive: Excessive gapping and pain

Indicates: Lateral collateral ligament instability

Confirmation Test: MRI

Front 19

Tinel's Elbow Sign

Back 19

Instruct: With the pointy end of a Taylor Reflex Hammer, tap in the ulnar groove

Positive: Pain and/or tenderness at the site being tapped and paresthsia in the ulnar nerve distribution area (fingers 4,5)

Indicates: neuroma of the ulnar nerve

Confirmation Test: Nerve conduction testing

Front 20

Cozen's Test

Back 20

Instruct: Patient makes a fist and extends wrist. Patient resists as doctor tries to move wrist into flextion

Positive: Pain over the lateral epicondyle

Indicates: lateral epicondylitis

Confirmation test: MIlls Test

Front 21

Mill's Test

Back 21

Instruct: Doctor takes patient's hand and moves fingers, wrists, then elbows into flexion. Then doctor interally rotates hand and brings it down.

Positive: Pain over the lateral epicondyle

Indicates: Lateral epicondylitis (Tennis Elbow)

Confirmation Test: Cozen's; Test

Front 22

Golfer's Elbow Test

Back 22

Instruct: Patient's arms are extended and supinated. With patient's hand in a fist pointing downward (flexed), the doctor tries to pull the fist into extesnion

Positive: Pain over the medial epicondyle

Indicates: Medial epicondylitis

Confirmation Tests: Cozen Test, Milll's Test

Front 23

Bony palpation of the wrist and hand

Back 23

1. Radial styloid process
2. Scaphoid (navicular)
3. Lister's tubercle
4. Lunate
5. Capitate
6. Ulnar styloid process
7. Pisiform
8. Hook of Hamate
9. Triquetrium
10. Trapezium
11. Trapezoid
12. Metacarpals
13. Phalanges

Front 24

Soft tissue palpation

Back 24

1. Radial artery
2. Ulnar artery
3. Palmaris longus tendon
4. Carpal tunnel region
5. Thenar eminence
6. Hypothenar eminence
7. Palmar aponeurosis
8. Tissue surrounding proximal interphalangeal joints
9. Tissue surrounding distal interphalangeal joints
10. Distal tufts of fingers

Front 25

Tinel's Wrist Sign

Back 25

Instruct: With wrist supinated, tap in carpal tunnel region with pointed edge of Taylor reflex hammer

Positive: Reproduction of pain, tenderness, and/or paresthesia in the median nerve distribution area (thumb, 2nd, 3rd, and lateral half of the 4th digit)

Indicates: Carpal Tunnel Syndrome

Front 26

Phalen's Sign

Back 26

Instruct: At the level of the shoulder's hold the backs of your hands together at maximal wrist flexion. Hold until point of pain or 60 secs. 58, 59, 60, relax

Positive: Reproduction of pain and or paresthesia in the median nerve distribution area (thumb, 2nd, 3rd, and lateral half of the 4th digit)

Indicates: Carpal tunnel syndrome

Front 27

Reverse Phalen's Sign aka Prayer Sign

Back 27

Instruct: At the level of the shoulder's have patient hold palmar side of hand together in maximum wrist extension for 60 seconds or until the point of pain

Positive: Reproduction of pain and or paresthesia in the median nerve distribution area (thumb, 2nd, 3rd, and lateral half of the 4th digit)

Indicates: Carpal tunnel syndrome

Front 28

Finkelstein's Test

Back 28

Instruct: Have patient make a fist with thumb in middle across palmar surface. Extend elbow and ulnar deviate.

Positive: Pain distal to the radial styloid process

Indicates: Stenosing tenosynovitis of the abductor policis longus and extensor pollicis brevis tendons (DeQuervain's Disease)

Confirmation Tests: Blood Testing, MRI

Front 29

Allen's Test

Back 29

Instruct: One hand supinated resting on leg with the other hand above the heart, pumping open and shut. After 60 secs of pumping, occlude arteries, have patient open hand, release one artery. Repeat for all 4 arteries

Positive: A delay of more than 10 secs (Evans 5 secs) in returning a reddish color to the hand.

Indicates: Radial or ulnar artery insufficiency. The artery held (occluded) by the examiner is not the artery being tested.

Confirmation: Vascular assessment

Front 30

Bunnel-Littler Test

Back 30

Patient presents with difficulty flexing the PIP joint

Instruct: Doctor places MCP joint in extension and tries to flex the PIP joint. If no flexion, then flex MCP and try to flex the PIP

If flexion of the proximal interphalangeal joint cannot be achieved, it indicates joint capsule contracture

If flexion of the proximal interphalangeal joint is achieved, it indicates tight intrinsic muscles

Confirmation Tests: Retinacular Test, Blood testing, Radiography

Front 31

Retinacular Test

Back 31

Patient presents with difficulty flexing the DIP joint

Instruct: Doctor places PIP joint in neutral and tries to flex the DIP joint. If no flexion, then flex PIP and try to flex the DIP

If flexion of the distal interphalangeal joint cannot be achieved, it indicates joint capsule contracture

If flexion of the distal interphalangeal joint is achieved, it indicates a tight retinacular ligament

Confirmation Tests: Blood testing, Radiography

Front 32

Range of motion of wrist and hand

Back 32

1. Wrist flexion 80
2. Wrist extension 70
3. Wrist ulnar deviation 30
4. Wrist radial deviation 20
5. Finger abduction
6. Finger adduction
7. Thumb flexion (MCP)
8. Thumb extension (MCP)
9. Finger flexion (MCP)
10. Finger extension (MCP)
11. Finger Opposition

Front 33

Bony palpation of cervical spine

Back 33

1. Hyoid bone
2. Thyroid cartilage
3. First cricoid ring
4. Mandible
5. Occiput
6. Mastoid Processes
7. Inion (IOP)
8. Superior nuchal line
9. Spinous processes of cervical vertebrae
10. Facet joints

Front 34

Soft tissue palpation of cervical vertebrae

Back 34

1. Sternocleidomastoid muscle
2. Anterior lymph node chain
3. Posterior lymph node chain
4. Supraclavicular fossa
5. Carotid pulse
6. Thyroid gland
7. Trapezius muscle
8. Greater occipital nerves
9. Superior nuchal ligament

Front 35

Range of Motion in Cervical Spine

Back 35

1. Flexion 50
2. Extension 60
3. Lateral bending left 45
4. Lateral bending right 45
5. Left rotation 80
6. Right rotation 80

Front 36

Foraminal Compression Test

Back 36

Instruct: Stand behind patient, clasp hands and exert gradually increasing downward pressure on their head. Patient looks straight, left, and right

Exacerbation of localized cervical pain indicates foraminal encroachment without nerve root compression or facet pathology

Exacerbation of cervical pain with a radicular component indicates foraminal encroachment with nerve root compression or facet pathology

Confirmation Tests: shoulder depression test, cervical distraction test, reflex and sensory testing, radiography, MRI, nerve conduction testing

Front 37

Cervical Distraction Test

Back 37

Instruct: Using the entire thumb, hook under the base of the occiput (just medial to mastoid pcs), place index finger on temple and gradually exert upward pressure

Diminished ar absence of local pain indicates foraminal encroachment

Diminished or absence of radicular pain indicates nerve root compression

Increase of cervical pain indicates muscular strain, ligamentous sprain, myospasm, or facet capsulitis

Confirmation Tests: Foraminal Compresion Test, Shoulder Depression Test, Reflex and Sensory Testing, Radiography, MRI, Nerve Conduction Testing

Front 38

Spinal Percussion Test

Back 38

Instruct: Put patient in slight cervical flexion and tap on spinous process and associated lateral musculature bilaterally with a Taylor Reflex Hammer

Local pain indicates possible fractured vertebrae, ligamentous involvement if there's spinous pain, and muscular involvement if there's muscular pain

Radiating pain indicates possible disc pathology

Front 39

Shoulder Depression Test

Back 39

Instruct: Patient laterally flexes, put knife edge one inch above patients ear to stabilize and push down on shoulder

Localized pain on the side being tested indicates dural sleeve adhesion and muscular adhesion/contracture, or spasm, or ligamentous injury

Radicular pain on either side: if it's on the side being tested, it indicates neurovascular bundle compression, dural sleeve adhesions, or Thoracic Outlet Syndrome. If it's on opposite side being tested, it indicates foraminal encroachment with nerve root compression.

Confirmation Tests: Cervical Distraction, Foraminal Compression Test, Sensory and Reflex Testing, and MRI

Front 40

Valsalva Maneuver

Back 40

Instructs: Take a deep breath and hold, bear down as if you're having a difficult bowel movement, relax

Positive: local or radiating pain from site of lesion

Indicates: Space occupying lesion

Confirmation Tests: Swallowing Test, Shoulder Depression Test, Cervical Distraction, Foraminal Compression Test, Sensory and reflex Testing, MRI

Front 41

Swallowing Test

Back 41

Instruct: Watch the patient's anterior neck region while they swallow

Positive: Difficulty in swallowing

Indicates: Space-occupying lesion at anterior portion of cervical spine; possibly esophogeal or pharyngeal injury, anterior disc defect, muscle spasm, or osteophytes, etc.

Confirmation Tests: Valsalva Test, Sensory and Reflex Testing, MRI

Front 42

Soto-Hall Sign

Back 42

Instruct: Patient supine, take a knife edge hold over sternum and press down while fully flexing the neck with the other hand

Positive: Generalized pain in the cervical region which may extend down to the level of T2

Indicates: Non-specific test for structural integrity of cervical region

Confirmation Tests: O'Donoghue Test, Spinal Percussion Test, Swallowing Test, Valsalva Test, Sensory and Reflex Testing, MRI

Front 43

Kernig's Sign

Back 43

Instruct: Patient supine, passively flex patients hip and knee to 90, extend fully at knee

Positive: Pain, usually in the neck region, and/or inability to fully extend the leg

Indicates: Meningeal irritation or meningitis

Confirmation Tests: Brudzinski Sign, Lumbar Tap

Front 44

O'Donoghue Maneuver

Back 44

Instruct: With a hand on the forehead and base of the occiput, passively take the patient through 6 ROM's in the cervical spine. Then repeat with resistance (inch above ear for lateral flexion, at sygomatic arch for rotation)

Pain during passive range of motion indicates ligamentous sprain (Passive ROM stresses ligaments)

Pain during resisted range of motion indicates muscle or tendon strain (Active ROM stresses muscles and tendons)

Front 45

Nerve Root C5

Back 45

"The disc level is C4"

Shoulder abduction: "deltoid innervated by the axillary nerve
Forearm flexion: "biceps innervated by the musculocutaneous nerve"

Reflex: biceps

Sensation: C4,C5,C6 dermatomes

Front 46

Nerve Root C6

Back 46

"The disc level is C5"

Wrist extension - "extensor carpi radialis longus and brevis, and extensor carpi ulnaris innervated by the radial nerve"

Reflex: brachioradialis

Sensation: C5,C6,C7 dermatomes

Front 47

Nerve Root C7

Back 47

"The disc level is C6"

Elbow extension - "triceps innervated by the radial nerve"
Wrist flexion - "flexor carpi radialis innervated by the median nerve and flexor carpi ulnaris innervated by the ulnar nerve"
Finger extension - "extensor digitorum communis, extensor indicis profundus, and extensor digiti minimi innervated by the radial nerve"

Reflex: triceps

Sensation: C6,C7,C8 dermatomes

Front 48

Nerve Root C8

Back 48

"The disc level is C7"

Finger flexion - "flexor digitorum superficialis, flexor digitorum profundus, and lumbricals innervated by the median and ulnar nerves

Reflex: none

Sensation: C7,C8,T1 dermatomes

Front 49

Nerve Root T1

Back 49

"The disc level is T1"

Finger abduction - "dorsal interossei innervated by the ulnar nerve"
Finger adduction - "palmar interossei innervated by the ulnar nerve"

Reflex: none

Sensation: C8,T1,T2 dermatomes

Front 50

Bony palpation of the lumbar spine

Back 50

1. Iliac crest
2. PSIS
3. Lumbar spinous processes
4. Sacral tubercles

Front 51

Soft tissue palpation of the lumbar spine

Back 51

1. Anterior abdominal muscles - relaxed and flexed
2. Paraspinal muscles (spinalis, longissimus, iliocostalis)
3. Gluteus Maximus
4. Gluteus Medius
5. Sciatic nerve
6. Hamstrings (biceps femoris, semitendinosus, semimembranosus)

Front 52

Range of Motion in Lumbar Spine

Back 52

1. Flexion 25
2. Extension 30
3. Left lateral bending 25
4. Right lateral bending 25
5. Left rotation 30
6. Right rotation 30

Front 53

Hoover's Sign

Back 53

Instruct: With patient supine and hand under the heel of the healthy leg, ask patient to lift the affected leg.

Positive: Lack of counter-pressure on the healthy side

Indicates: Lack of organic basis for paralysis (malingering/hysteria). With organic hemiplegia, the patient will still exert downward pressure when attempting to raise paralyzed leg.

Front 54

Straight Leg Raiser

Back 54

Instruct: With patient supine, raise leg slow to 90 or until point of pain

Positive: Radiating pain and/or dull posterior thigh pain

Indicates: Sciatic radiculopathy or tight hamstrings. Positive between 35 and 70 degrees indicates a possible discogenic sciatic radiculopathy

Confirmation Tests: Bechterew's Test, Bragard's Test, Lasegue Test, Lewin Standing Test

Front 55

Goldthwait's Sign

Back 55

Instruct: With patient supine, place three fingers in interspinous spaces of lower lumbar and raise patient's leg with the other hand

Positive: Localized pain in the low back or radiating pain down the leg

Indicates: Lumbo-sacral or sacroiliac pathology. Pain occurring after the lumbar spinouses move indicates a possible lumbosacral problem. Pain occurring before the lumbars move indicates a possible sacroiliac problem

Confirmation Tests: Belt Test, Gaenslen Test

Front 56

Bragard's Sign

Back 56

Instruct: With the patient supine, examiner performs a Straight Leg Raiser to the point of pain, then lowers it 5 degrees and sharply dorsiflexes the ankle.

Positive: Radiating pain in posterior thigh

Indicates: Sciatic radiculopathy

Confirmation Tests: Bechterew Test, Lasegue Test, SLR Test

Front 57

Buckling Sign

Back 57

Instruct: With patient supine, perform a SLR on the patient

Positive: Pain in the posterior thigh with sudden knee flexion (buckle)

Indicates: Sciatic radiculopathy

Confirmation Tests: Bechterew's Test, Bragard Test, Lasegue Test, Lewin Standing Test

Front 58

Bowstring Sign

Back 58

Instruct: With examiner seated next to supine patient, rest their leg on your shoulder and palpate down the hamstrings to the popliteal fossa.

Positive: Pain in the lumbar region or radiculopathy

Indicates: Sciatic nerve root compression and helps rule out tight hamstrings

Confirmation Tests: Heel Walk Test, Toe Walk Test, Milgram's Test, Neri Bowing Test

Front 59

Nerve Root L4

Back 59

"The disc level is L3"

Foot dorsiflexion and inversion: "tibialis anterior innervated by deep peroneal nerve"

Reflex: Patellar Tendon

Sensation: L3, L4, L5 dermatomes

Front 60

Nerve Root L5

Back 60

"The disc level is L4"

Foot dorsiflexion: "tibialis anterior and extensor hallicus longus innervated by deep peroneal nerve"
Big toe dorsiflexion: "extensor hallucis longus innervated by deep peroneal nerve"
Toes 2,3,4 dorsiflexion: "extensor digitorum longus and brevis innervated by deep peroneal nerve"
Hip and Pelvis abduction: "gluteus medius and minimus innervated by superior gluteal nerve"

Reflex: none

Sensation: L4,L5,S1 dermatomes

Front 61

Nerve Root S1

Back 61

"The disc level is S1"

Foot Plantarflexion: "Gastrocnemius and soleus innervated by tibial nerve"
Foot plantar flexion and eversion: "peroneus longus and brevis innervated by superficial peroneal nerve"
Hip extension: "gluteus maximus innervated by inferior gluteal nerve"

Reflex: Achilles

Sensation: L5,S1,S2 dermatomes

Front 62

Nerve Root S2

Back 62

"The disc level is S1"

Sensation: S1,S2 dermatomes

Front 63

Lasegue Test

Back 63

Instruct: Patient supine, bring hip and knee to 90 and slowly extend the knee while keeping the hip at 90

Positive: Reproduction of sciatic pain before 60 degrees

Indicates: Sciatica

Confirmation Tests: Bechterew's Test, Bragard Test, Lewin Standing Test, SLR Test

Front 64

Milgram's Test

Back 64

Instruct: Patient supine, raise both legs of patient 2-3 inches off table and have patient hold leggs off table for 30 secs

Positive: Inability to perform test and/or low back pain

Indicates: weak abdominal muscles or space occupying lesion

Confirmation Tests: Bowstring Test, Heel Walk Test, Toe Walk Test, Kemp Test, Neri Bowing Test

Front 65

Valsalva Maneuver

Back 65

Instruct: Take a deep breath, hold it, and bear down as if you're having a difficult bowel movement

Positive: Local or radiating pain from site of lesion

Indicates: Space occupying lesion

Confirmation Test: swallowing test, shoulder depression test, cervical distraction, foraminal compression test, sensory and reflex testing, MRI

Front 66

Bechterew's Test

Back 66

Instruct: Patient seated, extend knee one at a time and then together

Positive: Reproduction of radicular pain or inability to perform correctly due to tripod sign

Indicates: Sciatic radiculopathy

Confirmation Tests: Bragard's Test, Lasegue Test, Lewin Standing Test, Straight Leg Raising Test

Front 67

Neri Bowing Test aka Neri Sign

Back 67

Instruct: Bend forward from the waist

Positive: Pain accompanied by flexion of the knee on the affected side and body rotation away from the affected side

Indicates: Positive with a variety of low back pathologies. Hamstring tension on the pelvis may trigger the response.

Confirmation Tests: Bowstring Sign, Heel Walk Test, Toe Walk Test, Kemp Test, Milgram's Test

Front 68

Anterior Inonminate Test
AKAs?

Back 68

aka Mazion Pelvic Maneuver or Advancement Sign

Instruct: step forward with on leg 2-3 ft; with advanced knee straight, bend forward and touch your toes

Positive: The inability bo bend at the waist more than 45 degrees because of either/or:

Indicates:
1. radiating pain along the sciatic nerve, either unilateral or bilateral, indicates sciatic neuralgia or radiculopathy, etc., possible due to lumbar disc pathology
2. low back pain in the lumbar or pelvic regions indicates anterior or rotational displacement of the ilium relative to the sacrum

Front 69

Lewin Standing Test

Back 69

Instruct: slightly bend forward at waist and slightly flex the knees, examiner pushes knee into extension one at a time and then both together

Positive: Radiating pain down the leg causing flexion of the patient's knee or knees

Indicates: Gluteal, lumbosacral, or sacroiliac pathologies

Confirmation Tests: Bechterew's Test, Bragard's Test, Lasegue Test, SLR Test

Front 70

Heel Walk

Back 70

Instruct: Patient walks on heels

Positive: Inability to perform test

Indicates: L4-L5 disc problem (L5 nerve root)

Confirmation Tests: Bowstring Test, Kemp Test, Milgram's Test, Neri-Bowing Test

Front 71

Toe Walk

Back 71

Instruct: Patient walks on toes

Positive: Inability to perform test

Indicates: L5-S1 disc problem ((S1 nerve root)

Confirmation Tests: Bowstring Test, Kemp Test, Milgram's Test, Neri-Bowing Test

Front 72

Ely's Heel to Buttock Test aka Ely's Sign

Back 72

Instruct: With superior hand, move heel to opposite buttock, with inferior hand grab anterior distal femur, rest ankle on shoulder and stabilize superior hand on iliac crest while elevating the femur

Inability to raise the thigh indicates iliopsoas spasm
Pain in the anterior thigh indicates inflammation of lumbar nerve roots
Pain in the lumbar region indicates lumbar nerve root adhesions

Confirmation Tests: Femoral Stretch Test

Front 73

Bony Palpation of hip and pelvis

Back 73

Anterior:
1. ASIS
2. Iliac crest
3. Iliac tubercle
4. Greater Trochanter
Posterior:
1. PSIS
2. Ischial tuberosity
3. Coccyx

Front 74

Soft Tissue Palpation of hip and pelvis

Back 74

1. Inguinal ligament
2. Adductor longus
3. Sartorius
4. Rectus Femoris
5. Vastus Intermedius
6. Vastus Medialis
7. Vastus Lateralis
8. Greater Trochanteric Bursa
9. Cluneal Nerves
10. Gluteus maximus
11. Gluteus medius
12. Sciatic nerve
13. Biceps femoris
14. Semitendinosus and Semimembranosus

Front 75

Range of motion of hip and pelvis

Back 75

1. Flexion 120
2. Extension 30
3. Abduction 45
4. Adduction 45
5. Internal rotation 45
6. External rotation 45
7. Flexion and adduction
8. Flexion, abduction, and external rotation

Front 76

Leg Length Discrepancy

Back 76

Instruct: True: measure from ASIS to medial malleolus of same leg on each leg. Apparent: Measure from umbilicus to medial malleolus of each leg

Positive: Different measurements

Indicates: True: bony abnormality above or below level of trochanter difference (anatomical short leg)
Apparent: pelvic obliquity (tilted pelvis)

Confirmation Test: Radiography

Front 77

Allis' Sign
AKA?

Back 77

aka Galeazzi Sign
Instruct: Patient supine, feet flat with medial malleolus and toes approximated exactly

Positive: Difference in height and anteriority of the knees

Indicates: 1. If one knee is lower, it indicates ipsilateral congenital hip dislocation or tibial discrepancy (anatomical short leg)
2. If one knee is anterior, it indicates ipsilateral congenital hip dislocation or femoral discrepancy (contralateral anatomical short leg)

Confirmation Test: Radiography

Front 78

Thomas Test

Back 78

Instruct: Patient supine, bring the knee to chest and hold. Palpate lower lumbars

Positive: Lumbar spine maintains lordosis (should flatten) and opposite hip does not straighten

Indicates: Contracture of the hip flexors (iliopsoas)

Front 79

Anvil Test

Back 79

Instruct: With patient supine, lift heel and strike it with the base of your hand

Positive: Localized pain in long bone or in hip joint

Indicates: Possible fracture of long bones or hip joint pathology

Confirmation Tests: Radiology

Front 80

Patrick's Test
AKA?

Back 80

aka Fabere Sign

Instruct: Put patient in Figure 4, support the contralateral ASIS and press down superior to knee

Positive: Pain in the hip region

Indicates: Hip joint pathology

Confirmation Tests: Lagueer's Test, Radiography

Front 81

Laguerre's Test

Back 81

Instruct: In inferior hand, put the lower leg of patient into the crick of your elbow and bring your hand to the opposite hip. Press down on leg.

Pain in the hip joint indicates hip joint pathology

Pain in the sacroiliac joint indicates a mechanical problem of the sacroiliac joint

Front 82

Gaenslen's Test

Back 82

Instruct: Patient supine, SI joint off table, support with knee at pt hip, pt pulls opposite knee to chest, support on same side and extend leg below surface of table

Postive: Pain on the affected sacroiliac joint stressed into extension

Indicates: General sacroiliac joint lesion, anterior sacroiliac ligament sprain, or inflammation of the sacroiliac joint

Confirmation Tests: Belt Test, Goldwaith Test, Yeoman Test

Front 83

Lewis-Gaenslen's Test

Back 83

Instruct: Patient lies on side and flexes inferior leg, Examiner grabs above knee or ankle and pulls the hip into extension while stabilizing same side

Positive: Pain on the affected SI joint stressed into extension

Indicates: General sacroiliac joint lesion, anterior sacroiliac ligament sprain, or inflammation of the sacroiliac joint

Confirmation Tests: Gaenslen's Test, Yeoman's Test

Front 84

Hibb's Test

Back 84

Instruct: Patient prone, stand on opposite side, bring ankle to buttock and push laterally while supporting on the contralateral side

Pain in the hip region indicates hip joint pathology

Pain in the buttock/pelvic region indicates sacroiliac joint lesion

Confirmation test: Laguerre's Test

Front 85

Ober's Test

Back 85

Instruct: Patient on side, bring the hip into slight extension and abduct

Positive: Affected thigh remains in abduction (Normal biomechanics, the thigh/hip will adduct)

Indicates: Contraction of the iliotibial band or tensor fascia lata (usually secondary to synovitis of the hip, secondary to trauma of the gluteus medius and maximus)

Confirmation Tests: Thomas Test, Trendelenberg's Test

Front 86

Pelvic Rock Test
aka...

Back 86

Iliac Compression Test

Instruct: patient on side, halfway between greater trochanter and iliac crest, press lateral to medial with large palm with a little rocking

Positive: Pain in either sacroiliac joint

Indicates: sacroiliac joint lesion

Confirmation Test: Radiography

Front 87

Nachlas Test

Back 87

Instruct: Patient prone, approximate heel to same side buttock, stabilize on same side

Positive: Pain in the buttock and/or pain in the lumbar region

Indicates: Sacroiliac joint lesion or lumbar pathology

Confirmation Tests: Lewin Supine Test, Minor Sign, Spinal Percussion Test (lumbar)

Front 88

Yeoman's Test

Back 88

Instruct: Patient prone, heel to same side buttock with same side stabilization, grab bottom of knee and bring hip into extension

Positive: Pain deep in the sacroiliac joint

Indicates: Sprain of the anterior sacroiliac ligaments

Confirmation Tests: Gaenslen's Test, Lewin Gaenslen's Test

Front 89

Ely's Sign
aka...

Back 89

Ely's Test

Instruct: Patient prone, passively flex ankle to same side buttock

Positive: Hip on side being tested will flex causing the buttock to raise off the table

Indicates: Rectus femoris or hip flexor contracture

Confirmation Tests: Femoral Stretch Test

Front 90

Trendelenburg's Test

Back 90

Instruct: Patient stands on foot, observe level of hips

Positive: High iliac crest on supported side and low crest on side of elevated leg

Indicates: Weak gluteus medius muscle on the supported side

Confirmation Tests: Ober's Test, Thomas Test

Front 91

Ely's Heel to Buttock Test aka Ely's Sign

Back 91

Instruct: With superior hand, move heel to opposite buttock, with inferior hand grab anterior distal femur, rest ankle on shoulder and stabilize superior hand on iliac crest while elevating the femur

Inability to raise the thigh indicates iliopsoas spasm
Pain in the anterior thigh indicates inflammation of lumbar nerve roots
Pain in the lumbar region indicates lumbar nerve root adhesions

Confirmation Tests: Femoral Stretch Test

Front 92

Bony palpation of the knee

Back 92

1. Patella
2. Tibial tubercle
3. Medial tibial plateau
4. Medial femoral condyle
5. Lateral tibial plateau
6. Lateral femoral condyle
7. Fibula head

Front 93

Soft tissue palpation of the knee

Back 93

1. Rectus femoris
2. Vastus intermedius
3. Vastus medialis
4. Vastus lateralis
5. Prepatellar bursa
6. Superficial infrapatellar bursa
7. Infrapatellar tendon
8. Medial collateral ligament
9. Lateral collateral ligament
10. Medial meniscus
11. Lateral meniscus
12. Pes anserine area made up of sartorius, gracilis, and semitendinosus
13. Popliteal fossa
14. Gastrocnemius muscle

Front 94

Range of motion of knee

Back 94

Flexion 135
Extension 0
Internal rotation
External rotation

Front 95

McMurray Sign

Back 95

Instruct: knee and hip at 90, cup calcaneus and rotate knee, flex knee and hip more, take knee in same direction that heel's pointing, and extend knee (do both internal and external rot.)

Positive: Clicking sound or pain by knee joint

Indicates Tear of medial meniscus if positive on external rotation. Tear of lateral meniscus if positive on internal rotation. The higher the leg is raised when positive is elicited, the more posterior the meniscal injury

Confirmation Tests: Bounce Home Test, Apley's Compression Test, MRI

Front 96

Medial Collateral Ligament Test
aka's

Back 96

aka Abduction Stress Test or Valgus Stress Test

Instruct: patient supine, stabilize lateral knee and apply valgus stress at ankle

Positive: Gapping and/or elicited pain above/at/or below joint line

Indicates: Torn medial collateral ligament

Confirmation Tests: Apley's Distraction Test, Radiography, MRI

Front 97

Lateral Collateral Ligament Test (Knee)
aka's

Back 97

Adduction Stress Test or Varus Stress Test

Instruct: Between patients legs, stabilize medial knee, apply varus pressure

Positive: Gapping and/or elicited pain above/at/or below joint line

Indicates: Torn lateral collateral ligament

Confirmation Tests: Apley's Distraction Test, Radiography, MRI

Front 98

Bounce Home Test

Back 98

Instruct: Hold patients knee in slight flexion and drop it

Positive: Knee does not go into full extension (slight flexion remains)

Indicates: Diffuse swelling of the knee, accumulation of fluid, due to possible torn meniscus

Confirmation Tests: Apley's Compression Test, McMurray Test, MRI

Front 99

Drawer Test

Back 99

Instruct: Patient supine, sit on patient's foot with knee at 90, grab knee in both hands, thenars below tibial tuberosities, pull and push

Gapping > 6 mm (tibia moves posterior) when the leg is pushed indicates torn posterior cruciate ligament

Gapping > 6 mm (tibia moves anterior) when the leg is pulled indicates torn anterior cruciate ligament

Confirmation Test: Lachman Test

Front 100

Lachman Test

Back 100

Instruct: Bring distal leg of patient between your legs, wring leg with your hands above and below knee with the knee in 30 deg. of flexion, pull tibia toward you once

Positive: Gapping with the tibia moving away from the femur

Indicates: Anterior cruciate ligament or posterior oblique ligament instability

Confirmation Test: Drawer Test

Front 101

Apprehension Test for the Patella

Back 101

Instruct: Patient supine, with thumbs, push patella laterally while looking at the patient's face

Positive: Apprehension, distress of facial expression, and contraction of quadriceps to bring patella back in line

Indicates: chronic patella dislocation or pre-disposition to dislocation

Confirmation Test: MRI

Front 102

Clarke's Sign
aka...

Back 102

Patella Femoral Grinding Test

Instruct: With the web of your thumb and index finger, cup the superior aspect of patella and ask pt to flex quads

Positive: Retropatellar pain and the patient is unable to hold the quadriceps contraction

INdicates: Degenerative changes of the patellar facets and/or within the trochlear groove (chondromalacia patella)

Confirmation Test: Radiography

Front 103

Patella Ballotment Test

Back 103

Instruct: Blot the front of the patella with tips of 4 fingers

Positive: A floating sensation of the patella

Indicates: a large amount of swelling in the knee

Confirmation Tests: Radiography, MRI

Front 104

Apley's Compression Test

Back 104

Instruct: Patient prone, stabilize above their knee with your knee, exert downward pressure on calcaneus and distal tibia: straight down, internal, external rotation

Positive: Patient points to side of pain

Indicates: Pain on medial side is medial mensicus tear. Pain on the lateral side indicates lateral meniscus tear

Confirmation Tests: McMurray Test, Bounce Home Test, MRI

Front 105

Apley's Distraction Test

Back 105

Patient prone, stabilize above their knee with your knee, exert upward pressure with both hands proximal to malleoli: straight up, internal, external rotation

Positive: Patient will point to side of pain

Indicates: Pain on medial side indicates medial collateral ligament tear. Pain on the lateral side indicates lateral collateral ligament tear

Confirmation Tests: Medial and Lateral Collateral Ligament Tests, Radiography, MRI

Front 106

Bony palpation of foot and ankle

Back 106

1. Medial malleolus
2. Sustentaculum Tali
3. Calcaneus
4. Lateral malleolus
5. Talus
6. Cuboid
7. Navicular
8. First, Second, Third Cuneiform
9. Five metatarsals
10. Metatarsophalangeal joints

Front 107

Soft Tissue Palpation of Foot and Ankle

Back 107

1. Peroneus brevis tendon
2. Tibialis posterior tendon
3. Tibialis anterior tendon
4. Achilles tendon
5. Spring ligament
6. Deltoid ligament
7. Anterior talofibular ligament
8. Posterior tibial artery
9. Dorsal pedal artery
10. Plantar aponeurosis

Front 108

Range of Motion of Foot and Ankle

Back 108

1. Ankle dorsiflexion 20
2. Ankle plantarflexion 50
3. Subtalar inversion 5
4. Subtalar eversion 5
5. 1st metatarsophalangeal joint flexion
6. 1st metatarsophalangeal joint extension

Front 109

Drawer Sign (Ankle)
aka...

Back 109

Anterior Drawer Sign of the Ankle

Instruct: cup calcaneus, grab anterior tibia proximal to ankle, push tib in and pull calcaneus down, then pull tib out and push calcaneus in

Positive: Translation with the talus moving away from or toward the tibia

Indicates:
1. With tibia pushed/foot pulled; a tear/instability of the anterior talofibular ligament
2. With tibia pulled/foot pushed; a tear/instability of posterior talofibular ligament

Confirmation Tests: MRI

Front 110

Ankle Dorsiflexion Test

Back 110

Instruct: Pt comes in unable to dorsiflex, try to dorsiflex first while seated with leg extended, then with leg flexed

If the foot cannot dorsiflex with knee extended but is able to with knee flexed, it indicates contracture of the gastrocnemius muscle

If the foot cannot dorsiflex in either knee position, it indicates contracture of the soleus muscle

Front 111

Rigid or Supple Flat Feet Test

Back 111

Instruct: Palpate arches of foot with patient seated and then standing

Absence of medial longitudinal arch in both positions indicated rigid flat feet.

Presence of medial longitudinal arch while seated with a loss of medial longitudinal arch while standing indicates supple flat feet

Front 112

Homans' Sign

Back 112

Instruct: Patient supine, raise extended leg about 12" off table or 45 deg, forcibly dorsiflex foot

Postive: Deep pain in the calf

Indicates: Deep vein thrombophlebitis. Squeezing the calf is recommended by some sources, yet other sources feel it is contra-indicated.

Confirmation Tests: Vascular Testing, Palpation

Front 113

Thompson's Test

Back 113

Instruct: Patient prone with knee flexed to 90, squeeze calf muscle, should plantar flex

Positive: Absence of foot plantarflexion motion

Indicates: Achilles tendon rupture

Confirmation Test: MRI

Front 114

Morton's Test

Back 114

Instruct: Patient supine, with webs of both hands, squeeze metatarsal heads

Positive: sharp pain in the forefoot

Indicates: metatarsalgia or neuroma (usually at the 3rd and 4th metatarsal interspace)