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81 Cards in this Set
- Front
- Back
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Describe the Allen's Test |
1. Occlude Radial & Ulnar arteries 2. Pt makes fists repeatedly 3. Note Blanching 4. Release ulnar side only
Positive: lack of return to normal color = Ulnar artery insufficiency |
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Describe the Apprehension Test |
Anterior shoulder subluxation Abduct arm to 90 degrees Externally rotate the arm Anterior pressure is applied to the posterior shoulder
Positive: look of apprehension or fear on the pt's face |
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Describe the Cervical Compression & Distraction Test |
Compression- Method Slightly extend the head Apply downward force Positive: Pain Distraction - Method Place on hand under chin, other under occiput Lift up Positive: relief of pain |
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Describe the Drop Arm Test |
Checks for Rotator Cuff tear [supraspinatus m. tendon]
Abduct pt arm to 90 degrees. Ask patient to slowly lower the arm to their side. On the way down, lightly tap the arm.
Positive: pt's arm drops or cannot be adducted slowly. |
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Describe the Hawkins - Kennedy Test |
elevate arm to 90 deg flexion, flex elbow to 90 deg, internally rotate the humerus
Positive: increase in pain = impingement syndrome |
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Describe the Jerk Test |
Flex Elbow & Arm to 90 degrees Apply a posterior force onto the shoulder via the elbow
Positive: posterior subluxation or dislocation of the shoulder |
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Describe the Ligamentous Stability Testing at the Elbow |
Flex elbow a few degrees Use one hand cupped over the olecranon Palpate for medial & lateral epicondyles Apply Valgus & Varus stress on the elbow
Positive: Abnormal gapping @ elbow joint |
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Define Valgus stress: |
In a valgus alignment, the distal segment deviates laterally with respect to the proximal segment. |
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Define Varus stress: |
In a varus alignment, the distal segment deviates medially with respect to the proximal segment. |
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Describe the Long Finger Flexor Tests |
Tests: Flexor Digitalorum Superficialis muscles Isolate the proximal IP joint [e.g. lock metacarpal & first bend] Ask the patient to flex their finger Tests: Flexor Digitorum Profundus muscles Isolate the distal IP joint Ask the patient to flex their finger |
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Describe the Near Tests |
Near Tests: Rotator cuff impingement or tear Internally Rotate the pt's arm Flex it to 150 degrees
Positive: Increased Pain |
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Describe Phalen's Sign |
irritation of the median nerve [freq. carpal tunnel syndrome]
Place both wrists into maximum flexion with dorsal hands together Hold position for >= 1 minute
Positive: Parasthesia of 1 thru 4.5 digits |
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Describe Spurling's Test |
Tests: Nerve root impingement
Extend, Rotate, & side-bend the pt head to one side with light compression
Positive: Pain |
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Describe the Sulcus Test |
Tests: inferior shoulder subluxation
Palpate the space between the humerus & acromion. Grasp pt's forearm & Pull downward
Positive: Abnormally widening space between the humerus & the acromion |
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Describe the Supraspinatus Test | empty can test |
Tests: rotator cuff injury or supraspinatus tendonitis Hold hand as if it has a can in it. Flex arm 30 degrees Abduct arm 90 degrees as if they are emptying out the can Hold this position Positive: inability to hold this position |
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Describe the Tennis Elbow Test |
Tests: lateral epicondylitis
Flex pt's elbow Have pt make a fist Move their wrist into extension Ask pt to resist as you move the wrist into flexion
Positive: pain at the lateral epicondyle |
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Describe the Tinel's Sign at the Elbow |
Tests: Ulnar nerve irritation or entrapment
Locate the groove between the medial epicondyle & the olecranon Tap on this groove
Positive: tingling sensation in the Ulnar n. distribution |
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Describe the Tinel's Sign at the Wrist |
Tests: Median nerve irritation [e.g. carpal tunnel syndrome]
Tap on pt's flexor retinaculum
Positive: Parasthesias of the #1-4.5 digits |
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Describe the Yergason Test |
Tests: stability of the biceps brachii tendon in the bicipital groove Palpate biceps brachii tendon in the bicipital groove Pt to externally rotate their arm against your resistance Positive: tendon starts to pop out of the groove Tests: Tendonitis Have patient attempt to supinate their forearm against resistance Positive: pain in the bicipital groove |
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Describe the Bicipital Groove |
Bicipital groove = intertubercular sulcus
Location of the tendon of the long head of the biceps brachii.
This tendon/sulcus is covered with the transverse humeral ligament. |
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List the tests for impingement syndrome |
Hawkins-Kennedy Test Empty Can Test |
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Describe Strength Testing |
0 - no contraction 1 - trace contraction 2 - full ROM but not against gravity 3 - full ROM against gravity 4 - full ROM against resistance but weak 5 - full ROM against full resistance |
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Describe deep tendon reflex scoring |
0 - no response 1+ Diminished or sluggish 2+ Normal 3+ more brisk than expected 4+ Brisk, hyperactive, consider pathologic |
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List the tests for Cervical Radiculopathy |
Spurling's Compression Test
Cervical Distraction test |
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Describe the tests for Thoracic Outlet syndrome |
ROOS/East Test CRLF
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Describe the ROOS/East Test |
Patient is seated with arms abducted & externally rotated to 90 degrees. Patient is instructed to rapidly open & close their hands for one minute.
Positive: reproduction of symptoms in the upper extremity is a positive test. |
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Describe the CRLF test |
Cervical Rotation | Lateral Flexion Patient is seated with head passively rotated away from the affected side. Examiner flexes patient's head (ear towards chest).
Positive: bony restriction blocks internal flexion |
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What test checks for scoliosis |
Adam's forward flexion test |
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List causes of shoulder pain |
Cervical radiculopathy Thoracic outlet syndrome Cervical myelopathy Impingement syndrome Rotator cuff tear Instability | dislocation | Labral lesions AC/SC dysfunction Adhesive capsulitis Biceps Tendon Rupture Non-Musculoskeletal causes |
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Describe the tests for Rotator cuff tear |
Drop Arm test
External Rotation resistance test |
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Describe the tests for Shoulder Instability, Dislocations, & Labral lesions |
Apprehension & Relocation - anterior Sulcus - inferior Jerk - posterior |
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Describe the Piano Key sign |
Acromioclavicular joint dysfunction |
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Describe a biceps tendon rupture |
Report a "pop" Popeye arm
Distally, resist elbow flexion. If no palpable biceps tendon is detected, refer to ortho ASAP.
Yergason's Test |
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List the common elbow disorders |
Lateral Epicondylitis - Cozen's Test Medial Epicondylitis - pain with resisted wrist flexion & forearm pronation Ulnar collateral ligament sprain - valgus stress test Cubital tunnel syndrome - Tinel's & full elbow flexion for 60 seconds Olecranon Bursitis - no test beyond visual/palpation assessment |
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Describe the Cozen's Test |
Palpate lateral epicondyle. Patient makes a fist with the forearm in pronation & radial deviation. Patient attempts wrist extension against resistance.
Positive: pain along lateral epicondyle |
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List the common wrist/hand disorders |
Carpal tunnel syndrome de Quervains Tenosynovitis Dupytren's Contracture Trigger finger/thumb Mallet finger Jersey Finger TFCC |
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List common tests for Carpal Tunnel Syndrome |
Tinel's & Phalen's |
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Describe the test for de Quervain's Tenosynovitis |
Finkelstein's
Patient makes a fist with the thumb inside the fingers. Examiner supports the forearm & gently ulnar deviates the patient's wrist.
Positive: reproduction of pain over EPB & APL tendons |
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Describe the test for Triangular Fibrocartilage Complex injury |
Press Test Patient is seated with both hands on the arms of a chair as they push up to suspend the body weight using only the hands.
Positive: reproduction of the ulnar sided wrist pain |
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List the tests for the hip and their pathology |
FABER | Patrick test - intra-articular hip pathology
Scour Test - OA or labral tear
Trendelenburg test - hip abductor weakness on weight bearing leg side |
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Describe the FABER | Patrick Test |
With the patient supine, place the test leg in a “figure 4” position with the ankle just above the other knee. The examiner provides gentle downward pressure at both the knee on the involved side and the contralateral ASIS. Reproduction of groin/anterior hip pain represents a positive test. |
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Describe the Scour Test |
With the patient supine and the hip/knee flexed, the examiner provides an axial load through the femur. While maintaining the axial load, the examiner will move the hip through ER and IR. A positive test is suspicious for intra-articular pathology, possibly OA or labral tear. |
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Describe Legg-Calve-Perthes |
Idiopathic AVN of the femoral head that affects 1:1200 kids < 15 years old, Boys > girls.
Pain in hip, knee, groin, limited IR ROM
+Trendelenburg test |
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Describe the Trendelenburg Test |
The patient is standing with the examiner behind him. The examiner instructs the patient to stand on one leg. The examiner observes whether the pelvis “drops” on the lifted leg side which would indicate hip abductor weakness on the stance/weight bearing leg. |
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What three tests check for Extra-articular hip pathology |
Straight leg raise test
Slump
Femoral Nerve Tension Test |
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Describe the straight leg raise test |
With the patient supine, the examiner gently lifts the patient’s leg while maintaining knee extension and neutral dorsiflexion. A positive test is reproduction of the patient’s radicular symptoms. Confirmation can be made if slight knee flexion relieves symptoms or if added dorsiflexion increases symptoms. Must r/o tight hamstring musculature as limiting factor. |
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Describe the slump test |
The patient begins the test in a seated position with their back straight, head in a neutral position, and knees flexed at 90º. The examiner then has the patient slouch into trunk flexion while extending the knee into full extension. Adding ankle dorsiflexion and/or neck flexion is used to assess reproduction/alleviation of symptoms |
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Describe the Femoral Nerve Tension Test |
1. With the patient prone, the examiner stabilizes the patient’s pelvis at the PSIS and gently flexes the patient’s knee.
2. Reproduction of radicular symptoms is a positive test. 3. Tests for upper lumbar nerve root irritation (L1-L3) |
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Describe the Ober Test |
1. Patient is side lying with the symptomatic side on top.
2. The examiner positions the knee in moderate flexion (30-60º) and stabilizes the pelvis at the iliac crest with his other hand while bringing the test hip into extension. 3. The examiner then allows the test leg to drop towards the table, releasing the support at the knee while maintaining pelvis stabilization. 4. A positive test is if the test leg stays above a “parallel” line with the table surface. 5. Tests for a tight IT Band which could be a cause of trochanteric bursitis. |
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Describe the Thomas test |
1. The patient is supine near the end of the table with both knees pulled towards his chest.
2. While maintaining a posterior pelvic tilt, the symptomatic leg is lowered towards the table. 3. If the thigh does not reach the table, the patient likely has psoas tightness. 4. If the thigh reaches the table but the lower leg does not flex to 90º, the patient likely has rectus femoris tightness. |
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What syndrome is caused by compression of the femoral cutaneous nerve under the inguinal ligament? |
Meralgia parasthetica |
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Describe the Ottawa rules for knee radiographs |
If any of the following apply after a trauma, Xrays are warranted >= 55 Isolated tenderness to the patella Tenderness to the fibular head Active flexion of less than 90 degrees Inability to weight bear (4 steps) immediately after the injury |
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Describe patellofemoral syndrome |
1. Usually atraumatic
2. Often bilateral knee pain 3. Often described as “diffuse” anterior knee pain. When asked, patients are unable to point to a specific area. 4. Usually c/o “popping” or “clicking” and pain with prolonged knee flexion. 5. Must, must, must check biomechanics. Hyperpronation leads to internal tibial rotation and ultimately maltracking of the patella in the femoral groove. |
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Describe Osgood-Schlatter's Disease |
1. Traction apophysitis at the tibial tubercle
2. Usually in active teens that are involved in jumping/running sports 3. May notice a “bump” at the tibial tubercle |
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Describe Pes Anserine bursitis |
1. Inflammation on the medial aspect of the knee
2. Area of attachment for the Sartorius, Gracilis, and Semitendionosis muscles 3. May be confused with a meniscus injury due to location…if joint line tenderness, suspect meniscus. If pain is distal to the joint line, suspect pes anserine bursitis. |
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Describe Osteoarthritis of the knee |
1. More common in middle age/elderly
2. May have history of previous trauma and/or surgery 3. AM stiffness that improves with light activity 4. May have bony enlargement around the knee 5. Weight bearing x rays may show sclerotic changes and/or joint space narrowing. |
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Describe Patellar Tendonitis |
1. Usually from overuse, especially eccentric loading (i.e. jumping)
2. Inferior pole of the patella is usually the most painful area. 3. Pain with resisted knee extension 4. Differential dx: patellofemoral syndrome, fat pad impingement, internal derangement |
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Describe ACL injuries and the relevant tests |
ACL tears are generally due to hyperextension of the knee or quick changes in direction. Contact injury to the outside of the knee can cause the “unhappy triad”…torn ACL, medial meniscus, and MCL. Lachman's & Anterior Drawer Test |
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Describe the Anterior Drawer Test |
1. The patient is supine with the involved knee flexed to 90º and their foot flat on the table.
2. The examiner sits on the patient’s foot and grasps behind the proximal tibia with the thumbs on the tibial tubercle. 3. An anterior tibial force is applied by the examiner. 4. A positive test is greater anterior tibial displacement compared to the uninvolved side. Tests for ACL tears |
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Describe Lachman's Test |
1. The patient is supine with the knee flexed 15-30º. (I use my knee underneath the patient’s knee to get the appropriate flexion)
2. The examiner stabilizes the distal femur with one hand and grasps the proximal tibia with the other. 3. The examiner then applies an anterior tibial force 4. A positive test is greater anterior translation when compared to the uninvolved side or an absence of a hard “end feel” 5. Tests for ACL tears |
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Describe PCL tears & the associated test |
Posterior Drawer Test 1. Caused by a fall on a flexed knee of posterior displacement of the tibia (dashboard injury in MVA) 2. Much less common than ACL tears |
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Describe the Posterior Drawer Test |
1. The patient is supine with the involved knee flexed to 90º and the foot flat on the table.
2. The examiner sits on the patient’s foot and with both hands grasps the proximal tibia with his thumbs on the tibial tubercle. 3. The examiner gives a posterior force to the proximal tibia and gauges posterior translation. 4. A positive test is more translation versus the uninvolved side or absence of a “hard” endfeel. 5. Test for PCL tear |
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What stress will cause MCL injury |
Valgus |
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What stress will cause LCL injury? |
Varus |
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Describe the Valgus Stress Test of the Knee |
1. The patient is supine and the examiner stands to the outside of the involved leg.
2. The examiner cradles the test leg by his side with one hand on the lateral aspect of the knee and the other holding the lower leg. 3. With the knee in 30º of flexion, the examiner applies a lateral → medial force at the knee. 4. A positive test is pain and/or laxity on the medial aspect of the knee. 5. Tests for MCL injury |
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Describe the Varus Stress Test of the knee |
1. With the patient supine, the examiner stands to the outside of the involved leg.
2. The examiner cradles the test leg by his side with one hand on the medial aspect of the knee and the other holding the lower leg. 3. With the knee in 30º of flexion, the examiner applies a medial → lateral force at the knee. 4. A positive test is reproduction of lateral knee pain and/or laxity. 5. Tests for LCL tear |
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Describe Apley's Distraction Test |
1. With the patient prone and their involved knee flexed to 90º, the examiner grasps the patient’s heel with one hand and the dorsum of their foot with the other.
2. The examiner uses his knee to hold the femur against the table while he pulls up on the patient’s lower leg and internally/externally rotates it. 3. A positive test is reproduction of medial or lateral knee pain. Tests for MCL/LCL injury |
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Describe Meniscus Tears & the two relavent tests |
1. Injured by twisting maneuvers
2. Can be degenerative in nature 3. Poor vascularity so healing is slow or incomplete 4. Tested with Apley’s Compression and McMurray’s Tests |
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Describe Apley's Compression Test |
1. The patient is prone with the involved knee flexed to 90º.
2. The examiner applies a compressive force through the patient’s heel while internally and externally rotating the patient’s lower leg. 3. A positive test is reproduction of the knee pain. 4. Tests for meniscus pathology |
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Describe McMurray's Test |
1. The patient is supine with the examiner to the outside of the test leg.
2. The examiner grasps the patient’s foot with one hand and flexes the patient’s knee to end range while the examiner uses the thumb and index finger of his other hand to palpate the lateral and medial joint line. 3. To test the medial meniscus, the examiner externally rotates the tibia and slowly extends the knee. 4. To test the lateral meniscus, the examiner internally rotates the tibia and slowly extends the knee. 5. A positive test is an audible or palpable “click” Tests for meniscus tears. |
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Describe the Ottawa Ankle Rules for Xrays |
Pain at the malleolus + one of the following pain over the posterior fibula pain over the posterior tibia inability to take 4 steps immediately after injury or at time of eval.
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Describe plantar fasciitis |
1. Heel pain generally felt where the plantar fascia inserts at the calcaneal tubercle
2. Classic symptoms: Pain 1st thing in the morning which is relieved after light activity. Worse in the evening after prolonged standing/walking. 3. Check biomechanics and DF ROM 4. Typically do well with custom orthotics |
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Describe Tarsal Tunnel Syndrome |
1. Entrapment of the Tibial Nerve on the medial aspect of the ankle
2. May cause numbness/tingling into the foot. 3. Tinel’s test may provoke symptoms 4. Check biomechanics |
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Describe Medial Tibial Stress Syndrome |
1. Pain in “deep” medial border of the tibia
2. Due to overuse/overtraining 3. Inversion strength testing is weak/painful 4. Check biomechanics. High correlation with Overpronation/pes planus 5. r/o stress fracture |
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Describe Morton's Neuroma |
1. Pain between 2nd and 3rd metatarsals
2. Associated with numbness in those toes 3. Pain is reproduced with squeezing the metatarsals 4. May have a loss of protective fat pad and decreased transverse arch of the foot. 5. More common in women who wear tight, narrow shoes |
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Describe Achilles Tendonitis |
1. Pain at either the insertion of the Achilles tendon at the calcaneus or at the musculotendinous junction
2. Initially may complain of pain that goes away with light activity. Chronic cases will have constant weight bearing pain. 3. Untreated cases may progress to a tendonosis and possible rupture 4. Check DF ROM…especially in women who wear high heels a lot 5. Check biomechanics |
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Describe Achilles Tendon Rupture & the associated test |
1. Sudden abrupt pain in posterior calf
2. Patient’s feel like they have been “hit with a bat” 3. Usually happens in stop and go sports (i.e. tennis, basketball) 4. Inability to push off leads to antalgic gait pattern 5. Exam: Thompson's Test |
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Describe the Thompson Test |
1. The patient is supine with his foot over the edge of the table in a relaxed position.
2. The examiner squeezes the calf of the test leg. 3. A normal response is seeing some plantar flexion of the foot. 4. An abnormal response is no visible plantar flexion. 5. Tests for Achilles Tendon rupture |
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Describe the Homan's sign |
1. The patient is supine.
2. The examiner applies a forceful dorsiflexion maneuver to the test leg. 3. A positive test is reproduction of popliteal or calf pain Used for DVT assessment |
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Describe Ankle Sprains |
1. Lateral ankle sprains are much more common
2. Inversion/Plantar flexion is main mechanism of injury 3. Anterior talofibular ligament is most commonly injured 4. Tested with anterior drawer test |
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Describe the anterior drawer test |
1. The patient is seated with the knee in a relaxed position.
2. The examiner positions the ankle in 10-15º plantar flexion. 3. With one hand stabilizing the distal tibia, the other hand cups the heel and provides an anterior force. 4. A positive test is excessive translation compared to the uninvolved side. 5. Tests for ATFL injury in ankle sprains |
