All Joint Competency Flashcards
Order of steps for joint exam
- Inspection
- Palpation
- ROM
- Strength testing
- Reflexes
- Pulses
- Sensation
- Specialty test
- OSE
Specialty test for suspected glenohumeral instability
Sulcus sign
Grasp pt’s elbow and apply inferior traction
+test = indention appears in area beneath acromion
Specialty test for suspected bicipital tendon pathology
Speeds test
Pt’s arm flexed at the shoulder with hand supinated. Slightly flex pt’s elbow. Resist at forearm while pt flexes and monitor bicipital tendon
+test = pain in bicipital groove
Specialty test for suspected rotator cuff pathology
Empty can test
Flex pt’s shoulders to 90 while horizontally abducting to 45. internally rotate both arms so thumbs point down. Press down on forearms while pt resists
+ test = pain or weakness
Specialty test for suspected rotator cuff impingement
Neer impingement test
Stabilize pt’s shoulder. With forearm pronated, passively flex shoulder to fully flexed position
+test = pain
Specialty test for suspected subscapularis weakness
Liftoff test
Pt’s arm in internal rotation and extension. Pt pushes arm into further internal rotation against physician resistance
+ test = weakness (inability to resist)
Specialty test for suspected AC joint pathology
Cross arm test
Physician passively adducts pt’s arm across their chest and rests pt’s hand on their opposite shoulder
+ test = pain in AC joint with end range adduction
Specialty test for suspected elbow MCL sprain
Valgus stress test
Arm slightly abducted and externally rotated. Forearm supinated and slightly flexed. Slight medial directed valgus stress applied to elbow joint
+test = pain/tenderness with palpation and valgus stress; increased laxity
Specialty test for suspected elbow LCL sprain
Varus stress test
Arm slightly abducted and internally rotated. Elbow flexed slightly. A slight varus stress is applied to elbow joint
+ test = pain or increased laxity in LCL
Specialty test for suspected ulnar nerve entrapment
Tinel’s test
Tap between olecranon and medial epicondyle in ulnar groove
+ test = eliciting tingling sensation down forearm within ulnar nerve distribution
Specialty test for suspected lateral epicondylitis
Tennis elbow test
Pt’s elbow flexed to 90 and forearm pronated with wrist neutral and plam facing down. Doc places one hand under proximal forearm for stabilization and the other hand over pt’s hand to resist movement. Pt EXTENDS wrist against resistance
+ test = pain/tenderness around lateral epicondyle, may radiate down lateral forearm
Specialty test for suspected medial epicondylitis
Golfer’s elbow test
Pt’s elbow flexed to 90 and forearm supinated with wrist neutral and palm facing up. Doc places one hand under proximal forearm for stabilization and the other hand over pt’s wrist to resist movement. Pt FLEXES wrist against resistance
+ test = pain/tenderness around medial epicondyle
Specialty test for suspected carpal tunnel syndrome
Tinel’s test
Tap over transverse carpal ligament (between thenar/hypothenar eminences) with fingertip while pt’s wrist is held in extension
+test = parasthesias/numbness/tingling/pain radiating to thumb, index, and middle finger (median n. distribution)
Specialty test for hip complaint: suspected labral pathology
Labral loading
Flex pt’s knee and hip to 90; load into the femur towards innominate
+test = pain
Specialty test for hip complaint: suspected central compartment pathology
Labral loading
Flex pt’s knee and hip to 90; load into the femur towards innominate
+test = pain
Specialty test for hip complaint: suspected peripheral compartment pathology, specifically rectus femoris contracture
Rectus femoris test
Pt supine. One hip flexed up to chest. Other leg is bent over edge of table.
+ test = knee flexion <90
Specialty test for hip complaint: suspected lateral compartment pathology, specifically trochanteric bursitis
Jump sign
Pt seated; pressure applied to greater trochanter
+ test = pt withdraws with pressure
Specialty test for hip complaint: suspected lateral compartment pathology, specifically iliotibial band contracture
SLR
Pt supine. Passively flex pt’s ipsilateral hip with knee extended
+test = pain over lateral leg (especially at 15 degrees)
Specialty test for hip complaint: suspected lateral compartment pathology, specifically piriformis pathology
Piriformis test
Pt supine with hip and knee flexed, one ankle crossed over contralateral knee. Pt abducts against resistance
+ test = pain over posterior aspect of greater trochanter
Specialty test for hip complaint: suspected lateral compartment pathology, specifically gluteus medius pathology
Patricks: FABER (2)
Pt’s hip is flexed, abducted, and externally rotated. Doc braces contralateral ASIS, pt externally rotates/abducts against resistance
+test = pain or weakness
Specialty test for hip complaint: suspected anterior compartment pathology, specifically psoas injury
Psoas test
Flex hip to 30 degrees while pt further flexes against resistance
+ test = pain/inability or snapping
Specialty test for hip complaint: suspected anterior compartment pathology, specifically hip flexor injury
Thomas test
Pt supine and pulls knees to chest. One leg is lowered to table to test flexibility of hip flexors
+ test = inability to fully extend, or extended leg raises off table
Specialty test for knee complaint: suspected MCL injury
Valgus stress test
Pt supine with knee flexed to 30 degrees (can also test at 0 degrees). Doc supports lower leg, with hands placed on medial and lateral aspects of knee. While providing lateral resistance to knee, move lower leg so that ankle shifts laterally while holding the distal femur in place. Assess for laxity, quality of end point, and pain.
+test = increased laxity, soft or absent endpoint, pain
Specialty test for knee complaint: suspected LCL injury
Varus stress test
Examiner and pt in same position as valgus stress test. While providing medial resistance, physician moves lower leg so that ankle shifts medially. This is done at 30 degrees flexion and 0 degrees.
+ test = increased laxity, soft or absent endpoint, pain
Specialty test for suspected meniscus injury
McMurray’s test
Pt supine with hip and knee flexed. Doc uses caudad hand to control ankle and cephalad hand placed on distal femur. Doc rotates tibia into internal rotation and applies varus stress, then continues leg into extension. Doc rotates tibia into external rotation and applies valgus stress, then continues leg into extension.
+ test = pain or painful click during extension
Specialty test for suspected patellar injury
Patellar compression test
Pt supine and knee extended. Provide compressive load to patella with one hand while moving the patella medial and lateral
+ test = pain with compression
Specialty test for supsected ATF sprain
Anterior drawer
Grasp posterior calcaneus in one hand and distal tibia/fibula in other, monitoring anteriorly at anterior talus. Provide anterior force on calcaneus while stabilizing the distal tibia/fibula. Normal springing of calcaneus back to neutral should occur.
+test = pain, no springing, excessive motion/laxity
Specialty test for knee complaint: suspected ACL injury
Anterior drawer
Pt supine with knee flexed to 90. Doc sits on pt’s foot and grasps the proximal tibia with both hands, pulling tibia anteriorly
+ test = excessive translation when compared to other knee
Specialty test for knee complaint: suspected PCL injury
Posterior drawer
Pt supine with knee flexed to 90. Doc sits on pt’s foot and grasps proximal tibia with both hands, translating tibia posteriorly
+ test = excessive translation, particularly when compared to opposite side
Specialty test for suspected medial ankle sprain
Eversion test
Grasp distal tibia/fibula with one hand and plantar surface of midfoot with other hand. Evert the foot to evaluate ROM
+ test = laxity, increased ROM, pain
Specialty test for suspected high ankle sprain
Squeeze test
Wrap hands around leg proximal to ankle, contacting distal tibia/fibula with both thenar eminences. Squeeze tibia for 2-3 seconds then rapidly release
+ test = pain at syndesmosis
Specialty test for suspected achilles injury
Thompson test
Pt prone with foot off table. Squeeze the pt’s calf. The foot should plantar flex
+test = absence of plantar flexion
Specialty test for suspected DVT
Homan’s sign
Pt laying or seated with knee extended. Dorsiflex the pt’s foot. Lateral compression of calf may also be added.
+ test = pain with dorsiflexion
