Orthopedic examination 2

Question 1

bragard’s

Answer 1

after pain is elicited with SLR, the leg is lowered below the point of discomfort and the foot is sharply dorsiflexed
positive: pain in affected leg
indicates primary sciatica

Question 2

sicard’s

Answer 2

performed SLR, drop 5 degrees and dorsiflex big toe
positive: pain in affected leg
indicates sciatica

Question 3

turyn’s sign

Answer 3

while patient is in the supine position, the doctor dorsiflexes the big toe
positive is pain in affected leg
indicates sciatica

Question 4

WLR

Answer 4

SLR with dorsiflexion of the foot is performed on the asymptomatic side of a sciatic patient
positive: pain down symptomatic side
indicates medial disc lesion

Question 5

Milgram’s

Answer 5

patient is supine with limbs expended. patient is asked to elevated legs until 6in off table and hold for as long as possible (30 seconds)
positive pain
indicates SOL

Question 6

leg lowering test

Answer 6

patient supine. doctor picks up patient’s legs to 90 degrees and asks the patient to lower legs slowly to the table

positive: LBP
indicates: SOL

Question 7

double leg raise/bilateral straight-leg raising test

Answer 7

doctor performs SLR test on each side noting degree of pain. doctor raises both legs and notes degree of pain

positive: pain occurs earlier when both legs raised
indicates: lumbosacral joint lesion

Question 8

goldthwait’s

Answer 8

patient supine with affected leg raised slowly while hand is under lumbar portion of spine. repeat on other side

positive: pain
indicates: 0-30 SI joint, 30-60 lumbosacral, 60-90 lumbar spine or contralateral SI joint

Question 9

lindner’s

Answer 9

patient’s head is passively flexed to chest
positive: pain in lumbar spine radiating to sciatic nerve
indicates root sciatica

Question 10

bowstring’s

Answer 10

doctor performs an SLR to the point of pain. the knee is flexed slightly and placed on the doctor’s shoulder. digital pressure is placed over the posterior thigh and then in the popliteal fossa
positive is pain in the lumbar region or radiculopathy
indicates sciatica

Question 11

bonnet’s sign

Answer 11

with the patient supine the doctor stands on side being tested. doctor internally rotates leg, adducts leg, and then performed SLR
positive is radicular pain into the limb
indicates piriformis syndrome

Question 12

becterew’s sitting

Answer 12

patient seated. patient attempts to extend each leg one at a time. doctor places one hand on the side being tested to resist hip flexion by the patient. the patient then attempts to extend both legs together with both thighs stabilized by the doctor
postive is pain or leaning back
indicates disc (posteromedial if pain when goot leg raised

Question 13

minor’s sign

Answer 13

ask patient to rise from seated position
positive: patient with support body with uninvolved side balancing on good side
indicates sciatica

Question 14

kemp’s

Answer 14

patient seated/standing adn supported by the doctor. doctor rotates the patient’s trunk from the original position and circumducts the trunk toward the affected side and then away from the affected side
positive: sciatic pain down the involved side/localized pain
indicates disc and facet

Question 15

heel walk

Answer 15

patient is instructed to walk across the room for a minimum of 7 steps on their heels while doctor walks beside ready to catch the patient
positive is unable to perform
indicates L5 lesion

Question 16

toe walk

Answer 16

patient is instructed to walk across the room for a minimum of 7 steps on their toes while doctor walks bedside ready to catch the patient
positive is unable to perform
indicates S1 lesion

Question 17

belt test/supported adam’s test

Answer 17

patient bends forward and the examiner notes when the pain occurs. then while doctor is behind the patient the doctor grasps the ASIS and braces their hip into the sacrum. patient then flexes against and ROM is noted
positive: pain in both situations, pain only with first situation
indicates lumbar lesion or SI lesion

Question 18

gaenslen’s

Answer 18

patient supine with involved side near edge of examining table. opposite knee and thigh are fully flexed and fixed against the abdomen by patient. involved leg is gradually extended off table by examiner. doctor then applies downward pressure against clasped knee and knee of extended hip
positive is SI pain
indicates SI lesion

Question 19

lewin gaenslen’s

Answer 19

patient lies on unaffected side and pulls lower knee to chest. doctor stands behind patient, stabilized pelvis and hyperextends the top thigh
positive is SI pain
indicates SI lesion

Question 20

iliac compression

Answer 20

patient is side-lying position with involved side up. doctor hands are placed over the upper part of the iliac crest. doctor exerts downward pressure
positive is SI pain
indicates SI lesion

Question 21

hip abduction stress

Answer 21

patient lying on non affected side. patient actively abducts leg, then doctor exerts downward pressure proximal to knee
positive is pain at PSIS or weakness
indication: SI joint problems; gluteus medius weakness

Question 22

femoral nerve traction

Answer 22

patient is side lying with involved side up with spine straight an head slightly flexed. while knee is extended, doctor brings the hip into 15 degrees of extension. if no pain, increase extension and flex knee
positive: pain on anterior thigh
indicates L2,3,4 nerve root lesion

Question 23

hibb’s

Answer 23

doctor stabilized pelvis on side they are standing. with other hand, doctor grasps the ankle of opposite leg and flexes knee to 90 degrees. doctor slowly pushes leg laterally away producing internal rotation of the hip

positive: SI pain
indicates: SI lesion

Question 24

nachlas

Answer 24

leg flexed to 90 degrees. hell is approximated to same buttock. doctor stabilizes the side they are testing

positive: SI pain
indicates: SI lesion

Question 25

yeoman’s

Answer 25

doctor stabilizes SI joint testing with other hand. doctor flexes leg of affected side and hyperextends the thigh by lifting knee off table
positive: SI pain
indicates SI lesion

Question 26

prone hyperextension test

Answer 26

patient is prone while doctor stabilizes the lumbosacral area. doctor lifts leg into hyperextension while knee remains extended
positive is localized lumbar pain with anterior thigh pain
indicates L3,4 nerve root lesion

Question 27

patrick’s

Answer 27

patient supine. thigh flexed, abducted, externally rotates and extended while downward pressure is placed on the opposite ASIS and same knee

positive: pain in hip
indication: hip lesion

Question 28

laguerre’s/patrick fabre in air

Answer 28

patient supine. doctor flexes, abducts and laterally rotates hip. doctor then applies pressure over the opposite ASIS with one hand and with other hand presses down the knee
positive: pain in hip
indicates hip joint lesion

Question 29

thomas test

Answer 29

while patient is supine the thigh is flexed with knee bent upon abdomen
postive: opposite thigh/knee rises off table
indicates hip flexion contracture

Question 30

anvil

Answer 30

while patient is supine doctor elevates the leg and strikes the heel with their fist
positive: pain in hip
indicates hip pathology (heel, tibia, fibula, femur fracture)

Question 31

ely’s

Answer 31

patient prone. heel approximated to buttock after flexion of knee. approximated to opposite buttock and hyperextended

positive: hip elevates, pain
indicates: hip flexor contracture, hip lesion

Question 32

trendelenburg

Answer 32

patient stands and raises one hip into flexion toward chest
positive: buttock on foot that is elevated drops
indicates gluteus medius weakness on stance leg side

Question 33

apley’s distraction

Answer 33

pt prone with knee flexed to 90 degrees. doctor anchors thigh of pt and grasps proximal to foot and applies upward pressure and rotates leg internally and externally. heel points toward side being tested
positive: pain in knee
indicates collateral ligament tear

Question 34

apley’s compression

Answer 34

pt prone with knee flexed to 90 degrees. doctor anchors thigh of pt and grasps proximal to foot and applies downward pressure and rotates leg internally and externally. heel points toward side being tested
positive: pain in knee
indicates meniscal tear

Question 35

drawer test

Answer 35

patient supine. knee flexed to 90 and hip to 45. doctor stabilizes foot on table. tibia is then drawn
forward/posterior
positive: pain or joint laxity
indicates (anterior) ACL, (posterior) PCL

Question 36

lachman’s

Answer 36

patient supine, knee flexed to 30 degrees doctor stabilizes femur with one hand and pulls the tibia forward with other hand
positive: soft end feel
indicates ACL instability

Question 37

abduction/valgus stress test

Answer 37

patient supine. doctor applies valgus stress to knee while abducting foot in full extension and at 30 degrees flexion
positive pain increased
indicates MCL involvement

Question 38

adduction/varus stress test

Answer 38

patient supine. doctor applies varus stress to knee while adducting foot in full extension and at 30 degrees flexion
positive pain or increased laxity
indicates LCL involvement

Question 39

McMurray sign

Answer 39

patient supine. doctor flexes thigh and leg to 90. doctor places one hand on knee; other graps the patient’s heel. doctor externally rotates leg, then slowly extends knee. doctor internally rotates the leg and bring it into extension with valgus stress to joint
positive: painful click or snap heard
indicates (internal) lateral meniscus, (external) medial meniscus

Question 40

apprehension test

Answer 40

patient supine. doctor displaces patella medial to lateral

positive: look of apprehension
indicates: chronic patellar dislocation

Question 41

patellar grinding

Answer 41

patient supine with knees extended. doctor applies S-I pressure with thumb web at superior pole of patella and then asks the patient to contract the quads
positive: retro-patellar pain/cannot hold contraction
indicates chondromalacia patella

Question 42

noble compression test

Answer 42

doctor places leg in 90/90 position and applies pressure to distal lateral femur. doctor extends knee

positive: increased pain
indicates: TFL contracture

Question 43

Ober’s

Answer 43

patient side-lying, involved side up. doctor places one hand on pelvis. thigh is abducted and extended. doctor allows leg to drop into adduction

positive: knee stays elevated
indication: TFL contracture

Question 44

anterior foot drawer test

Answer 44

patient supine. doctor places hand around anterior aspect of lower tibia while grasping calcaneus in palm of other hand and pull calcaneus forward

positive: talus slides forward
indicates: anterior talofibular ligament instability

Question 45

posterior foot drawer test

Answer 45

patient supine. doctor places hand around posterior aspect of lower tibia while pushing the talus posterior
positive: talus slides backward
indicates posterior talofibular ligament instability

Question 46

medial/lateral stability test

Answer 46

patient is seated or supine. doctor grasps patient’s foot and passively inverts and everts it

positive: excessive gapping
indicates: (inversion) anterior talofibular ligament tear
(eversion) deltoid lig. tear

Question 47

morton’s squeeze

Answer 47

patient supine. doctor clasps hands around the metatarsal head and squeezes together.
positive: pain between 3-4 metatarsal heads
indicates morton’s neuroma

Question 48

tinel’s test

Answer 48

patient supine. doctor percusses posterior to medial malleolus
positive: pain and tingling on sole of foot
indicates tarsal tunnel syndrome

Question 49

thompson’s test/simmond’s test

Answer 49

patient prone, feet hanging off table. doctor flexes knee to 90 degrees and squeezes calf

positive: no plantar flexion
indicates: achilles tendon rupture

Question 50

burn’s bench test

Answer 50

patient instructed to knee on table 18 inches from floor, bend forward at the trunk, and touch the floor. doctor holds ankle
positive: patient refuses to perform

Question 51

hoover’s sign

Answer 51

patient supine. doctor places one hand under each heel and asks patient to lift affected limb
positive: doctor doesn’t feel unaffected side pressing downward

Question 52

magnusson’s

Answer 52

at beginning of case history, patient is asked to point to site of pain on back; examiner marks it with skin pencil. later on, patient is again asked to point to site of pain.
positive: patient doesn’t point to same spot

Question 53

mannkopf’s sign

Answer 53

doctor takes resting pulse rate. doctor then applies pressure over painful area and takes pulse rate again
positive: increase of 10 BPM
indicates they aren’t a malingerer