MSK Special Tests Flashcards
Patellar tap
Screen for presence of moderate-large effusion
- Fully extend knee, empty suprapatellar pouch by sliding L hand down thigh to upper burder of patella
- Keep L hand in position & use R hand to press downwards on patella with fingertipes
- If fluid present, will feel distinct tap as patella bumps against femur
Sweep test
Identify small joint effusions
- Fully extend knee, empty suprapatella pouch by sliding L hand down thigh to upper border of patella
- Stroke medial side of knee joint to move any excess fluid across to lateral side of joint
- Stroke lateral side of knee joint which will cause any excess fluid to move back across to emptied medial side of joint. Causes appearance of bulge or ripple on medial side of joint indicating effusion
Posterior sag sign
PCL rupture
-Flex knee to 90, inspect lateral aspect for evidence of posterior sag
Important to identify before proceeding to anterior draw test, as PCL tear can result in false positive anterior drawer sign
Anterior drawer test
ACL rupture
-Flex knee to 90
-Wrap hands around proximal tibia with fingers around back of knee joint
-Fix lower limb in position & position thumbs over tibial tuberosity
-Pull tibia anteriorly & feel for any anterior movement on femur
Posterior drawer test
PCL rupture
-Flex knee to 90
-Wrap hands around proximal tibia with fingers around back of knee joint
-Fix lower limb in position & position thumbs over tibial tuberosity
-Pull tibia posteriorly & feel for any posterior movement on femur
Lachman’s test
ACL rupture
-Flex knee to 30
-Hold lower leg with dominant hand with thumb on tibial tuberosity & fingers over calf
-With non-dominant hand, hold thigh just above patella
-Use dominant hand to pull tibia forwards on femur while other hand stabilises femur & look for movement of tibia on femur
Varus stress test
LCL rupture
-Extend knee fully & hold ankle between your elbow & side
-Position R palm over medial aspect of knee & L palm lower down over lateral aspect of lower limb, with fingers reaching upwards to palpate lateral knee joint line
-Push steadily outward with R hand whilst pushing inwards with L palm
Valgus stress test
MCL rupture
-Extend knee fully & hold ankle between your elbow & side
-Position L palm over lateral aspect of knee & R palm lower down over medial aspect of lower limb, with fingers reaching upwards to palpate medial knee joint line
-Push steadily inward with L hand whilst pushing inwards with R hand
McMurray’s test
Meniscal tear - medial described, lateral opposite
-Flex knee fully & hold pt’s R knee with L hand, with thumb over medial aspect & fingers over lateral aspect of joint lines
-Hold pt’s R foot by sole using R hand
-Create valgus stress on knee joint with L hand by applying outward pressure as if trying to abduct whilst fixating & externally rotating foot. At the same time, slowly extend knee
-Click & discomfort suggestive of pathology
Leg length discrepancy
True leg length = ASIS -> medial malleolus
Apparent leg length = umbilicus -> medial malleolus
Apparent difference e.g. lateral pelvic tilt
Thomas’ test
Fixed flexion deformity
-Pt supine, place hand below lumbar spine with palm facing upwards (prevents masking by increasing lumbar lordosis)
-Passively flex hip & look for raising of contralateral thigh (affected hip)
Do NOT perform if had hip replacement as can cause dislocation
Trendelenburg’s test
Hip abductor weakness
-With pt upright, stand in front of them & ask them to place their hands on your forearms or shoulders for stability
-Position fingers on both pt’s iliac crests
-Ask pt to stand on 1 leg & observe for evidence of lateral pelvic tilt
Tinel’s test
Median nerve compression (carpal tunnel)
-Tap over carpal tunnel
Phalen’s test
Carpal tunnel syndrome
-Hold wrists in max forced flexion (pushing dorsal surfaces of both hands together) for 60s
Empty can test/Jobe’s test
Supraspinatus weakness
-Abduct arm to 90 & angle arm forwards by ~30 so shoulder is in plane of scapula
-Internally rotate so thumb points down towards the floor
-Push down on arm while pt resists
