Lab Final Extra Flashcards
Complaint of tendinitis in shoulder flexion
Speed test
Pt seated with forearm supinated, and elbow flexed to 45 degrees. Ex places his/her fingers on pt’s bicipital groove with opposite hand on pts forearm. Patient flexes shoudler, maintain supination and completely extend teh elbow as doc applies resistance
Pain and or tenderness in the bicipital groove
Indicates bicipital tendinitis
Locking and grinding of the knee
Test for synovial knee plica (patellar bowstring)
Pt side lying with involved side up. Knee in 30 degrees flexion. Ex grasps lateral aspect of patella with superior hand and pushes it medially. Inferior hand internally rotates tibia. Knee is then extended fully and flexed again to 30. Can be repeated with a lateral pull on the patella and lateral tibial rotation.
Popping, snapping, clunking, grinding, or stuttering of the patella
Indicates medial patella pain is medial knee synovial plica syndrome. Lateral patella pain is lateral knee synovial plica syndrome.
Posterior elbow pain
Valgus overload test of the elbow
Elbow placed into 90 degrees of flexion. Ex places valgus stress into elbow while passively extending the elbow fully (dynamic extension)
Pain in the posterior elbow with a reproduction of a locking or catchign sensation or an inability to fully extend the elbow due to pain
Indicates posterior elbow impingement syndrome
Painless knee
Godfrey sag sign
Pt lies supine with the involved knee flexed to 90 and hip flexed to 90. Ex grasps distal tib/fib adn asks pts to perform a gentle hamstring contraction (bring heel to buttock). Ex then observes proximal anterior tibio-femoral joint
Proximal tibia sags posteriorly due to lack of static posterior constriant
Indicates tear or sprain of the posterior cruciate ligament.
This test is done to confirm injury to this ligament if drawer proves inconclusive
CAM hip
Hip impingement sign
Pt supine with hip flexed to 90. Hip is then adducted across midline of the body and ex forcefully internally rotates the hip.
Sharp anterior catching hip pain
Indicates hip impingement syndrome
Anterior shoulder instability
Anterior slide test
Pt seated ex instructs pt to place hands on waist with thumbs pointing posterior. With one hand stabilize scapula and clavicle and with opp hand grasp humerus and place an anterior to superior force into the shoulder. Pt will then push back against examiner.
Popping, cracking, and crepitus is noticed with pain on the antero-superior aspect of the shoulder
Indicates superior or anterior glenoid labrum tear
Acute anterior knee instability
Lachman test
Pt supine, ex puts pts knee at 30 degree angle of flexion then grasps both prosimal end of tibia with one hand and distal end of femur with the other and attempts to pull tibia forward in order to feel joint play.
Gapping with the tibia moving away from the femur
Indicates anterior cruciate ligament or posterior oblique ligament instability
Heel pain radiating along foot toward big toe
Test for Plantar fascitis
Pt prone knee 90. Ex forcefully dorsiflexes pts ankle and then big toe creating stretch. Ex then palpates along the medial longitudinal arch while maintaining stretch.
Sharp pain along the medial longitudinal arch indicates plantar fascitis
Lateral hip pain and thigh pain
Modified ober test
Pt side lying with involved side up. Bottom leg flexed to allow stability. Pt moved to edge of table and uses their thigh to stabilize pts sacrum and pelvis. Involved legs knee is extended completely adn hip is extended slightly. Ex then lowers the involved leg off side of table.
Hip and lateral thigh remains in abduction. The patient experiences lateral thigh pain upon this maneuver
Indicates tight TFL (possible contracture) with possible IT Band syndrome
Lateral elbow pain
Cozen test
Pt seated, ex instructs pt to make a fist and place wrist into extension. Ex instructs patient to resist.
Pain over the lateral epicondyle
Indicates lateral epicondylitis (tennis elbow)
Labrum injury
O’Brien sign aka active compression test
Pts shoulder is placed in flexion 90 degrees and then into full internal rotation and 10 to 15 degrees of horizontal adduction (cross chest). Ex exerts downward force against pts upward resistance. Repeat test with arm supinated.
Pain felt deeply in position 1 indicates labrum tesar
Pain felt superficially (position 2) indicates AC joint problem
High ankle injury
Distal tibio-fibular squeeze test
Ex squeezes the distal third of the tibo-fibular joint for 3-5 seconds
Pain is reproduced while squeezing or pain is worse when releasing the tib/fib distally as it springs back
Indicates high ankle sprain of the tibio-fibular ligament and/or the interosseous syndesmosis.
Supraspinatus weakness
Empty can test
Shoulder abducted 90 in scaption plane with forearm extended and in 40 degrees forward flexion. Shoulder is placed in maximal internal rotation with thumb pointing down. Ex instructs pt to push back and out while ex pushes down and in.
Inability to perform the test and/or pain with resistance to abduction downward pressure stressing the supraspinatus muscle an dtendon insertion
Indicates tear or rupture to the supraspinatus muscle or tendon with possible suprascapular neuropathy
Synovial plica knee
Test for synovial knee plica
Pt side lying with involved side up. Knee in 30 degrees flexion. Ex grasps lateral aspect of patella with superior hand and pushes it medially. Inferior hand internally rotates tibia. Knee is then extended fully and flexed again to 30. Can be repeated with a lateral pull on the patella and lateral tibial rotation.
Popping, snapping, clunking, grinding, or stuttering of the patella
Indicates medial patella pain is medial knee synovial plica syndrome. Lateral patella pain is lateral knee synovial plica syndrome.
Gluteal insufficiency
Trendelenburg test
Pt stands on foot of involved side of hip problem. Observe level of the hips
High iliac crest on supported side and low crest on side of elevated leg
Indicates weak gluteus medius muscle on the supported side
Posterior elbow pain
Valgus overload test of the elbow
Elbow placed into 90 degrees of flexion. Ex places valgus stress into elbow while passively extending the elbow fully (dynamic extension)
Pain in the posterior elbow with a reproduction of a locking or catchign sensation or an inability to fully extend the elbow due to pain
Indicates posterior elbow impingement syndrome
Infraspinatus/teres minor weakness
Patte test (horn-blower sign)
Pt will place shoulder of affected side in forward flexion to 90. Shoulder is then slightly abducted 15-20 degrees. Elbow is bent to 90 with palm facing the patient. Ex will place their hand at the distal forearm on teh dorsal surface. Pt will then externally rotate against resistance.
Pain or inability to actively externally rotate against resistance due to weakness
Indicates infraspinatus or teres minor tendinopathy
Posterior knee instability
Godfrey sag sign
Pt lies supine with the involved knee flexed to 90 and hip flexed to 90. Ex grasps distal tib/fib adn asks pts to perform a gentle hamstring contraction (bring heel to buttock). Ex then observes proximal anterior tibio-femoral joint
Proximal tibia sags posteriorly due to lack of static posterior constriant
Indicates tear or sprain of the posterior cruciate ligament.
This test is done to confirm injury to this ligament if drawer proves inconclusive
Sharp, anterior hip pain
Hip impingement sign
Pt supine with hip flexed to 90. Hip is then adducted across midline of the body and ex forcefully internally rotates the hip.
Sharp anterior catching hip pain
Indicates hip impingement syndrome
Medial epicondylitis
Reverse mills test
Elbow is extended and forearm supinated. Wrist is fully passively extended. Test is designed to confirm golfers elbow test
Extend wrist then pull arm into extension
Reproduction of pain in the medial elbow
Indicates medial epicondylitis or golfers elbow
Can’t jog because of lateral knee pain
Noble test
Pt sits on table with feet on table, involved knee flexed to 60. Ex places their superior thumb over the lateral femoral condyle with firm pressure where the IT band runs past the knee. Ex then passively extends the knee to full extension and then flexes knee back to 60 while maintaining firm pressure with thumb over the lateral femoral condyle.
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
Rotator cuff instability
Patte test (horn-blower)
Pt will place shoulder of affected side in forward flexion to 90. Shoulder is then slightly abducted 15-20 degrees. Elbow is bent to 90 with palm facing the patient. Ex will place their hand at the distal forearm on teh dorsal surface. Pt will then externally rotate against resistance.
Pain or inability to actively externally rotate against resistance due to weakness
Indicates infraspinatus or teres minor tendinopathy
Deep anterior hip pain catching sensation
Hip impingement
Pt supine with hip flexed to 90. Hip is then adducted across midline of the body and ex forcefully internally rotates the hip.
Sharp anterior catching hip pain
Indicates hip impingement syndrome
Clicking sensation in bicep tendon
Abbott saunders
Pt seated, ex fully abducts and externally rotates pts affected arm. Ex places fingers on pts bicipital groove and then slowly lower pts affected arm to their side.
Palpable and/or audible click
Indicates subluxation or dislocation of the biceps tendon due to a rupture of the transvers humeral ligemnt or tendon subluxation beneath subscapularis muscle belly/tendon
Anterior arm pain with weakness
Maximum elbow flexion test/compression test
Pt is asked to place elbows in maximum elbow flexion for up to 3 minutes to close down the cubital tunnel.
Reproduction of paresthesia’s into the ulnar nerve distribution with possible weakness on handshake (power grip)
Indicates cubital tunnel syndrome (ulnar nerve entrapment at the cubital tunnel)
Knee instability in popliteal fossa
Godfrey sag sign
Pt lies supine with the involved knee flexed to 90 and hip flexed to 90. Ex grasps distal tib/fib adn asks pts to perform a gentle hamstring contraction (bring heel to buttock). Ex then observes proximal anterior tibio-femoral joint
Proximal tibia sags posteriorly due to lack of static posterior constriant
Indicates tear or sprain of the posterior cruciate ligament.
Patellar pain with snagging sensation
Synovial plica knee
Pt side lying with involved side up. Knee in 30 degrees flexion. Ex grasps lateral aspect of patella with superior hand and pushes it medially. Inferior hand internally rotates tibia. Knee is then extended fully and flexed again to 30. Can be repeated with a lateral pull on the patella and lateral tibial rotation.
Popping, snapping, clunking, grinding, or stuttering of the patella
Indicates medial patella pain is medial knee synovial plica syndrome. Lateral patella pain is lateral knee synovial plica syndrome.
Swelling and bruising around distal tib/fib
Distal tibio-fibular squeeze test
Ex squeezes the distal third of the tibo-fibular joint for 3-5 seconds
Pain is reproduced while squeezing or pain is worse when releasing the tib/fib distally as it springs back
Indicates high ankle sprain of the tibio-fibular ligament and/or the interosseous syndesmosis.
Instability of bicep tendon
Yergason Test (cipriano)
Pt seated, ex flexes pts elbow to 90. Ex stabilizes pts elbow with one hand and exerts slight inferior traction. Uses other hand and adds resistance to distal portion of radius. Ex offers resistance while pt externally rotates humerus and slightly supinates forearm.
Localized pain and/or tenderness in the bicipital groove indicates bicipital tendinitis
Audible click or biceps tendon subluxes or dislocates indicates instaiblity of the biceps tendon possibly associated with a torn transverse humeral ligament
Heel pain while walking
Fat pad squeeze Test of the heel
Pt prone. Ex depresses pts fat pad forcefully and elicits a painful localized response. The ex then squeezes the heel and fat pad together creating a cushioning effect of fat pad. Then forceful depression is repeated while maintaining the squeeze.
Pain diminishes during this procedure or feels less tender
Lessening of pain rules in fat pad syndrome. If pain remains the same or is worse consider plantar fascitis, heel spur or calcaneal stress fracture.
Painful giving way of the knee
Apley compression
Pt prone. Ex flexes pts affected knee to 90. Stabilize pts thigh with your knee. Place downward pressure on pts distal tib/fib in neutral and then while internally and externally rotated.
Patient points to side of pain
Pain on medial side indicates medial meniscus tear. Pain on lateral side indicates lateral meniscus tear.
Differentiate between AC joint and a labrum tear
O’Brien sign aka active compression test
Pts shoulder is placed in flexion 90 degrees and then into full internal rotation and 10 to 15 degrees of horizontal adduction (cross chest). Ex exerts downward force against pts upward resistance. Repeat test with arm supinated.
Pain felt deeply in position 1 indicates labrum tesar
Pain felt superficially (position 2) indicates AC joint problem
Decrease ROM and stiffness in shoulder
Mazion shoulder maneuver
Dugas but elbow towards forehead actively
Inability to actively raise elbow to forehead due to pain and/or stiffness
Indicates early stage adhesive capsulitis or non inflammatory capsular adhesions
Knee pain on prolonged sitting (cinema sign)
Patella femoral grinding test aka clarke sign
Pt supine. Affected knee extended. Ex uses web of hand to move patella inferior. Pt tighten quads as ex continues to hold patella.
Retropatellar pain and patient is unable to hold the quadriceps contraction
Indicates degenerative changes of the patellar facets and/or within the trochlear groove (chondromalacia patella)
Hip pain and low back pain distinguish from one another
Hibb test
Prone. Ex stabilize pelvis on near side, grasp opp side ankle and flex knee 90. Ex maximally flexes knee and then slowly internally rotates thigh
Pain in hip region indicates hip joint pathology
Pain in buttock/pelvic region indicates sacroiliac joint lesion
BElt test
Pt standing. Patient bends forward and note low back pain. Support pts sacrum and hold iliac crests. Pt bend forward
LBP while bending with sacrum stabilized and unstabilized indicates lumbar involvement.
Pain during sacrum non-stabilized bending, and no pain during sacrum stabilized bending indicates pelvic involvement
Instability and slipping out sensation in the shoulder
Sulcus sign with load and shift
Pt seated with elbow flexed to 90 and shoulder in neutral. Grasp distal humerus with one hand and traction down on humerus. If sulcus appears then shift head of humerus in the fossa from posterior to anterior
Attempts to dislocate shoulder inferiorly. A sulcus taht appears on the antero-lateral will indicate shoudler instability and is graded.
Indicates inferior shoulder instability and possible inferior dislocation. +1=<1cm, +2=1-2cm, +3=>3cm
Meniscus injury in the supine
Mcmurray sign
Pt supine. Ex flexes pts affected hip to 90 and affected knee to 90. Grasps distal tibia and applies external rotation to knee. Ex places hand on lateral aspect of affected knee and applies a valgus stress maintains this and extends leg. Repeat with internal rotation and varus stress
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 greater the angle of the knee when flexed when positive is elicited, the more posterior the meniscal injury.
Clumsiness adn weakness when gripping a pen to write
Fromet paper sign OR OK sign paper between thumb and tip of index in ok sign
Ex asks pt to hold a piece of paper in their hand between thumb and index finger with thumb adducted. Ex then attempts to pull paper from patients grasp
Pt seen to flex thumb thereby recruiting the median nerve to compensate for apparent weakness
Indicates weakness or palsy of the adductor pollicus muscle innervated by the ulnar nerve. Look for wasting of the dorsal thumb web.
Supraspinatus injury
Empty can test
Shoulder abducted 90 in scaption plane with forearm extended and in 40 degrees forward flexion. Shoulder is placed in maximal internal rotation with thumb pointing down. Ex instructs pt to push back and out while ex pushes down and in.
Inability to perform the test and/or pain with resistance to abduction downward pressure stressing the supraspinatus muscle an dtendon insertion
Indicates tear or rupture to the supraspinatus muscle or tendon with possible suprascapular neuropathy
Stress fracture of the hip
Anvil test
Pt supine, ex elevates affected leg while keeping knee extended. Ex makes fist and strikes affected leg’s inferior calcaneus
Localized pain in long bone or hip joint
Indicates possible fracture of long bones or hip joint pathology
Weakness on power grip
Maximum elbow flexion test/compression test OR fromet
Pt asked to place elbows in maximum elbow flexion for up to 3 minutes to close down cubital tunnel.
Reproduction of paresthesia’s into ulnar nerve distribution with possible weakness on handshake (power grip)
Indicates cubital tunnel syndrome
Sharp anterior shoulder pain only when working overhead
Anterior slide test
Pt seated ex instructs pt to place hands on waist with thumbs pointing posterior. With one hand stabilize scapula and clavicle and with opp hand grasp humerus and place an anterior to superior force into the shoulder. Pt will then push back against examiner.
Popping, cracking, and crepitus is noticed with pain on the antero-superior aspect of the shoulder
Indicates superior or anterior glenoid labrum tear
Shoulder external rotation
Patte test (horn-blower)
Pt will place shoulder of affected side in forward flexion to 90. Shoulder is then slightly abducted 15-20 degrees. Elbow is bent to 90 with palm facing the patient. Ex will place their hand at the distal forearm on teh dorsal surface. Pt will then externally rotate against resistance.
Pain or inability to actively externally rotate against resistance due to weakness
Indicates infraspinatus or teres minor tendinopathy
Anterior instabiltiy of the shoulder
Anterior apprehension with relocation - jobe relocation test
Pt supine. Shoulder placed into apprehension position. Ex attempts to reproduce sense of instability/apprehension by externally rotating shoudler in a controlled manner. If apprehension is reproduced, ex then places heel of hand on proximal anterior GH joint and gently pushes in A-P direction(relocation)
The patient sense releif upon relocation
Indicates confirms anterior instability of the GH joint and rules out tendinitis as a false posivie for anterior apprehension test.
Bursitis in the shoulder
Dawbarn test
Pt seated, ex applies pressure below affected acromial process with fingertips. Note for pain or tenderness. Ex continues to apply pressure while abducting arm past 90.
Decrease in pain and/or tenderness indicates subacromial bursitis
Locking and grinding in the elbow
Valgus overload test of the elbow
Elbow placed into 90 degrees of flexion. Ex places valgus stress into elbow while passively extending the elbow fully (dynamic extension)
Pain in the posterior elbow with a reproduction of a locking or catchign sensation or an inability to fully extend the elbow due to pain
Indicates posterior elbow impingement syndrome
Lateral knee pain
Noble test
Pt sits on table with feet on table, involved knee flexed to 60. Ex places their superior thumb over the lateral femoral condyle with firm pressure where the IT band runs past the knee. Ex then passively extends the knee to full extension and then flexes knee back to 60 while maintaining firm pressure with thumb over the lateral femoral condyle.
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
Clunking and locking in the shoulder instability
Sulcus sign with load and shift
Pt seated with elbow flexed to 90 and shoulder in neutral. Grasp distal humerus with one hand and traction down on humerus. If sulcus appears then shift head of humerus in the fossa from posterior to anterior
Attempts to dislocate shoulder inferiorly. A sulcus taht appears on the antero-lateral will indicate shoudler instability and is graded.
Indicates inferior shoulder instability and possible inferior dislocation. +1=<1cm, +2=1-2cm, +3=>3cm
Anterior/posterior shoulder impingement
Hawkin kennedy test
Passive internal rotation of shoulder in 90 of forward flexion with elbow flexe dto 90 while scapula is stabilized posteriorly
The supraspinatus tendon is jammed up against the anterior surface of teh 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 is anterior impingement syndrome, posterior pain is posterior impingement syndrome.
Deep anterior shoulder pain with occasional locking
O’Brien sign aka active compression test
Pts shoulder is placed in flexion 90 degrees and then into full internal rotation and 10 to 15 degrees of horizontal adduction (cross chest). Ex exerts downward force against pts upward resistance. Repeat test with arm supinated.
Pain felt deeply in position 1 indicates labrum tesar
Pain felt superficially (position 2) indicates AC joint problem
Swelling and difficulty weight bearing due to recent knee injury
Bounce home test
Pt supine, ex flexes pts knee and grasps pts heel and knee of affected leg. Pulls leg slowly into extension
Knee does not go into full extsension
Indicates diffuse swelling of teh knee, accumulation of fluid, due to possible torn meniscus.
Posterior elbow pain
Valgus overload test of the elbow
Elbow placed into 90 degrees of flexion. Ex places valgus stress into elbow while passively extending the elbow fully (dynamic extension)
Pain in the posterior elbow with a reproduction of a locking or catchign sensation or an inability to fully extend the elbow due to pain
Indicates posterior elbow impingement syndrome
Pain on the heel radiates to big toe
Test for Plantar fascitis
Pt prone knee 90. Ex forcefully dorsiflexes pts ankle and then big toe creating stretch. Ex then palpates along the medial longitudinal arch while maintaining stretch.
Sharp pain along the medial longitudinal arch indicates plantar fascitis
Leg length discrepancy
Allis
Pt supine, ex instructs pt to place both feet flat on bench while flexing both knees to 90
Difference in height and anteriority of knees
If one knee is lower = ipsilateral congenital hip dilocation or tibial discrepancy (anatomical short leg)
If one knee is anterior = ipsilateral congenital hip dislocation or femoral discrepancy (contralateral anatomical short leg)
Tendinitis in the shoulder while flexing
Speed test
Pt seated with forearm supinated, and elbow flexed to 45 degrees. Ex places his/her fingers on pt’s bicipital groove with opposite hand on pts forearm. Patient flexes shoudler, maintain supination and completely extend teh elbow as doc applies resistance
Pain and or tenderness in the bicipital groove
Indicates bicipital tendinitis
Lockign and grinding of the knee
Synovial plica
Pt side lying with involved side up. Knee in 30 degrees flexion. Ex grasps lateral aspect of patella with superior hand and pushes it medially. Inferior hand internally rotates tibia. Knee is then extended fully and flexed again to 30. Can be repeated with a lateral pull on the patella and lateral tibial rotation.
Popping, snapping, clunking, grinding, or stuttering of the patella
Indicates medial patella pain is medial knee synovial plica syndrome. Lateral patella pain is lateral knee synovial plica syndrome.
Knee pain and prolonged sitting
Patella femoral grinding test aka clarke sign
Pt supine. Affected knee extended. Ex uses web of hand to move patella inferior. Pt tighten quads as ex continues to hold patella.
Retropatellar pain and patient is unable to hold the quadriceps contraction
Indicates degenerative changes of the patellar facets and/or within the trochlear groove (chondromalacia patella)
Twisted ankle
Distal tibio-fibular squeeze test
Ex squeezes the distal third of the tibo-fibular joint for 3-5 seconds
Pain is reproduced while squeezing or pain is worse when releasing the tib/fib distally as it springs back
Indicates high ankle sprain of the tibio-fibular ligament and/or the interosseous syndesmosis.
CAM
Hip impingement sign
Pt supine with hip flexed to 90. Hip is then adducted across midline of the body and ex forcefully internally rotates the hip.
Sharp anterior catching hip pain
Indicates hip impingement syndrome
Test collateral ligament knee old
Apley distraction
Pt prone, ex flexes pts affected knee to 90. Ex places knee on affect thigh, ex grasps pts distal tib/fib and pulls the leg in neutral, int rot, and ext rot
Patient will point to side of pain
Pain on medial side indicates medial collateral ligament tear.
Pain on lateral side indicates lateral collateral ligament tear. Q
Lateral knee pain new
Noble test
Pt sits on table with feet on table, involved knee flexed to 60. Ex places their superior thumb over the lateral femoral condyle with firm pressure where the IT band runs past the knee. Ex then passively extends the knee to full extension and then flexes knee back to 60 while maintaining firm pressure with thumb over the lateral femoral condyle.
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
Locking and clunking of shoulder
Anterior slide test
Pt seated ex instructs pt to place hands on waist with thumbs pointing posterior. With one hand stabilize scapula and clavicle and with opp hand grasp humerus and place an anterior to superior force into the shoulder. Pt will then push back against examiner.
Popping, cracking, and crepitus is noticed with pain on the antero-superior aspect of the shoulder
Indicates superior or anterior glenoid labrum tear
Tibiofibular ligament knee
Distal tibio-fibular squeeze test
Ex squeezes the distal third of the tibo-fibular joint for 3-5 seconds
Pain is reproduced while squeezing or pain is worse when releasing the tib/fib distally as it springs back
Indicates high ankle sprain of the tibio-fibular ligament and/or the interosseous syndesmosis.
Tarsal tunnel new
Test for Plantar fascitis
Pt prone knee 90. Ex forcefully dorsiflexes pts ankle and then big toe creating stretch. Ex then palpates along the medial longitudinal arch while maintaining stretch.
Sharp pain along the medial longitudinal arch indicates plantar fascitis
Problem with internal rotation - juvenile genu valgus
Craig test for Anteversion (knee)
Pt prone involved side knee flexed 90. Ex grasp distal tib/fib, hip internally rotated until greater trochanter comes parallel to table
If hip is internally rotated in excess of 30 degrees inorder for greater trochanter to attain parallel position, pt is considered to have a structural anteversion.
Diffuse swelling
Bounce home test
Pt supine, ex flexes pts knee and grasps pts heel and knee of affected leg. Pulls leg slowly into extension
Knee does not go into full extsension
Indicates diffuse swelling of teh knee, accumulation of fluid, due to possible torn meniscus.
Popping, grinding new
Synovial plica
Pt side lying with involved side up. Knee in 30 degrees flexion. Ex grasps lateral aspect of patella with superior hand and pushes it medially. Inferior hand internally rotates tibia. Knee is then extended fully and flexed again to 30. Can be repeated with a lateral pull on the patella and lateral tibial rotation.
Popping, snapping, clunking, grinding, or stuttering of the patella
Indicates medial patella pain is medial knee synovial plica syndrome. Lateral patella pain is lateral knee synovial plica syndrome.
Lateral knee pain going down the stairs
Noble test
Pt sits on table with feet on table, involved knee flexed to 60. Ex places their superior thumb over the lateral femoral condyle with firm pressure where the IT band runs past the knee. Ex then passively extends the knee to full extension and then flexes knee back to 60 while maintaining firm pressure with thumb over the lateral femoral condyle.
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
Instability and labrum tear at shoulder
O’Brien sign aka active compression test
Pts shoulder is placed in flexion 90 degrees and then into full internal rotation and 10 to 15 degrees of horizontal adduction (cross chest). Ex exerts downward force against pts upward resistance. Repeat test with arm supinated.
Pain felt deeply in position 1 indicates labrum tesar
Pain felt superficially (position 2) indicates AC joint problem
Patient with knee pain while running
Noble test
Pt sits on table with feet on table, involved knee flexed to 60. Ex places their superior thumb over the lateral femoral condyle with firm pressure where the IT band runs past the knee. Ex then passively extends the knee to full extension and then flexes knee back to 60 while maintaining firm pressure with thumb over the lateral femoral condyle.
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
Differentiate between ant/post pain
Hawkin kennedy test
Passive internal rotation of shoulder in 90 of forward flexion with elbow flexe dto 90 while scapula is stabilized posteriorly
The supraspinatus tendon is jammed up against the anterior surface of teh 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 is anterior impingement syndrome, posterior pain is posterior impingement syndrome.
Test for subscapularis tendinopathy
Lift off test
Pt will place back of hand in small of their back and attempt to lift hand off the back
Inability to actively life hand off or away from the back
Indicates subscapularis tendinopathy
Patietn with snapping, cracking, popping
Plica
Pt side lying with involved side up. Knee in 30 degrees flexion. Ex grasps lateral aspect of patella with superior hand and pushes it medially. Inferior hand internally rotates tibia. Knee is then extended fully and flexed again to 30. Can be repeated with a lateral pull on the patella and lateral tibial rotation.
Popping, snapping, clunking, grinding, or stuttering of the patella
Indicates medial patella pain is medial knee synovial plica syndrome. Lateral patella pain is lateral knee synovial plica syndrome.
Knee locking after injury (crepitus soudn)
Apley compression
Pt prone affected leg to 90. Stabilize pts thigh. Place downward pressure on distal tib/fib in neutral int and ext rot.
Patient points to side of pain
Pain on medial side is medial meniscus tear.
Pain on lateral side indicates lateral meniscus tear.
Pain in the knee with rotation
Mcmurray sign
Pt supine. Ex flexes pts affected hip to 90 and affected knee to 90. Grasps distal tibia and applies external rotation to knee. Ex places hand on lateral aspect of affected knee and applies a valgus stress maintains this and extends leg. Repeat with internal rotation and varus stress
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 greater the angle of the knee when flexed when positive is elicited, the more posterior the meniscal injury.
Problem tucking in shirt
Lift off test
Pt will place back of hand in small of their back and attempt to lift hand off the back
Inability to actively life hand off or away from the back
Indicates subscapularis tendinopathy
Rupture achilles tendon
Thompson
Pt pron with leg flexed to 90. Ex squeezes belly of calf muscle of affected leg
Absence of foot plantar flexion motion
Indicates achilles tendon rupture.
Pain in posterior elbow
Valgus overload test of the elbow
Elbow placed into 90 degrees of flexion. Ex places valgus stress into elbow while passively extending the elbow fully (dynamic extension)
Pain in the posterior elbow with a reproduction of a locking or catchign sensation or an inability to fully extend the elbow due to pain
Indicates posterior elbow impingement syndrome
Problem overhead
Anterior slide test
Pt seated ex instructs pt to place hands on waist with thumbs pointing posterior. With one hand stabilize scapula and clavicle and with opp hand grasp humerus and place an anterior to superior force into the shoulder. Pt will then push back against examiner.
Popping, cracking, and crepitus is noticed with pain on the antero-superior aspect of the shoulder
Indicates superior or anterior glenoid labrum tear
Q angle
Patella femoral grinding test aka clarke sign
Pt supine. Affected knee extended. Ex uses web of hand to move patella inferior. Pt tighten quads as ex continues to hold patella.
Retropatellar pain and patient is unable to hold the quadriceps contraction
Indicates degenerative changes of the patellar facets and/or within the trochlear groove (chondromalacia patella)
Hip impingement for OA
Hip impingement new
Patrick old
Hip impingement sign
Pt supine with hip flexed to 90. Hip is then adducted across midline of the body and ex forcefully internally rotates the hip.
Sharp anterior catching hip pain
Indicates hip impingement syndrome
Patrick
Pain in the hip region indicates hip joint apthology
Bankart lesion
Sulcus sign with load and shift
Pt seated with elbow flexed to 90 and shoulder in neutral. Grasp distal humerus with one hand and traction down on humerus. If sulcus appears then shift head of humerus in the fossa from posterior to anterior
Attempts to dislocate shoulder inferiorly. A sulcus taht appears on the antero-lateral will indicate shoudler instability and is graded.
Indicates inferior shoulder instability and possible inferior dislocation. +1=<1cm, +2=1-2cm, +3=>3cm
Insidious pain and swelling
Wilson test
Pt supine. Knee flexed to 90. Knee extended with tibia rotated medially. Knee again flexed to 90 tibia laterally rotated and extended
Knee pain increases near 30 degrees of knee flexion with tibia internally rotated. Pain disappears when tibia is externally rotated
Indicates osteochondritis dessicans
4th and 5th finger
Maximum elbow flexion test/compression test OR fromet
Pt asked to place elbows in maximum elbow flexion for up to 3 minutes to close down cubital tunnel.
Reproduction of paresthesia’s into ulnar nerve distribution with possible weakness on handshake (power grip)
Indicates cubital tunnel syndrome
Differentiate labrum tear from AC joint
O’Brien sign aka active compression test
Pts shoulder is placed in flexion 90 degrees and then into full internal rotation and 10 to 15 degrees of horizontal adduction (cross chest). Ex exerts downward force against pts upward resistance. Repeat test with arm supinated.
Pain felt deeply in position 1 indicates labrum tesar
Pain felt superficially (position 2) indicates AC joint problem
Patient had pain radiation from heel to big toe
Test for Plantar fascitis
Pt prone knee 90. Ex forcefully dorsiflexes pts ankle and then big toe creating stretch. Ex then palpates along the medial longitudinal arch while maintaining stretch.
Sharp pain along the medial longitudinal arch indicates plantar fascitis
Elbow weakness with power grip
Maximum elbow flexion test/compression test OR fromet
Pt asked to place elbows in maximum elbow flexion for up to 3 minutes to close down cubital tunnel.
Reproduction of paresthesia’s into ulnar nerve distribution with possible weakness on handshake (power grip)
Indicates cubital tunnel syndrome
Test tibial collateral ligament
Varus stress test
Pt supine, ex stabilizes medial thigh of pts affected leg. Ex grasps just proximal to lateral ankel of affected leg and graudally pushes medially
Gapping and/or elicited pain above/at/or below the joint line
Indicates tear or instability of the lateral collateral ligament
Diffuse swelling of the knee after a hyperextension injury
Godfrey sag sign
Pt lies supine with the involved knee flexed to 90 and hip flexed to 90. Ex grasps distal tib/fib adn asks pts to perform a gentle hamstring contraction (bring heel to buttock). Ex then observes proximal anterior tibio-femoral joint
Proximal tibia sags posteriorly due to lack of static posterior constriant
Indicates tear or sprain of the posterior cruciate ligament.
