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
