Orthopedic examination 3

Question 1

chest expansion test

Answer 1

tape measure placed around the 4th intercostal space. patient exhales completely, measurement taken, then patient inhales deeply, measurement taken. normal 1.5-3in
positive is <1.5” women, <2” men
indicates AS

Question 2

forrestier’s bowstring

Answer 2

while standing the patient performs side bending to both sides
positive: muscle tightening on concave side
indicates AS

Question 3

lewin supine test

Answer 3

patient supine, doctor hods the ankles on the table; the patient is then asked to sit up without using hands

positive: unable to perform
indicates: AS

Question 4

amoss sign

Answer 4

patient is asked to go from a side lying position to a standing position

positive: localized pain and/or lack of ROM
indicates: AS, severe IVD syndrome, sprain/strain

Question 5

brudzinski sign

Answer 5

patient supine. doctor passively flexes patient’s head approximating the chin to chest
positive: buckling of patient’s knees
indicates meningitis

Question 6

kernig’s sign

Answer 6

patient supine, doctor flexes the hip and knee to 90/90 position and then attempts to extend the knee

positive: patient resists extension; resistance causes kicking motion
indication: meningitis

Question 7

bikele’s

Answer 7

patient actively abducts the shoulder to 90 degrees with the elbow flexed to 90 degrees and then extends the shoulder. now the patient extends the elbow

positive: resistance and increased radicular pain
indicates: meningeal irritation, TOS, brachial plexus neuritis

Question 8

lhermitte’s

Answer 8

patient seated or supine. patient actively/passively flexes head toward chest

positive: sharp electric shock like sensation down the spine into extremities
indicates: MS, myelopathy

Question 9

sternal compression

Answer 9

doctor applies downward pressure on the sternum while patient is in supine position
positive: pain localized at lateral rib border
indicates rib fracture

Question 10

homan’s sign

Answer 10

with patient supine doctor puts leg in the 90/90 position, squeezes the calf, and dorsiflexes the foot
positive: deep pain
indicates DVT

Question 11

shepelmann’s

Answer 11

patient raises both arms over head while seated and laterally bend to both sides

positive: pain on concave side, pain on convexity
indication: intercostal neuralgia, pleurisy

Question 12

claudication test

Answer 12

doctor asks patient to march in place (2 steps/second)

positive: pain in calves
indication: intermittent claudication

Question 13

adam’s position/test

Answer 13

doctor observes the patient’s posture from behind then asks the patient to bend forward at the waist with their arms out in front. the doctor observes from behind as well as from the front

positive: if asymmetry changes, if asymmetry does not change
indicates: pathological/functional scoliosis, structural scoliosis

Question 14

rib compression test

Answer 14

doctor stands behind the patient and wraps arms around the patient’s chest, clasps the hands, and then extends the elbows or apply pressure with hands bilaterally on the lateral aspects of the rib cage

positive: localized pain
indication: costochrondritis

Question 15

spinal percusiion test

Answer 15

doctor percusses over each spinous process with a reflex hammer, then repeat this process in the musculature

positive: pain
indicates: vertebral fracture, ligament sprain, disc herniation, muscle strain

Question 16

spinal vibration test

Answer 16

doctor performs vibration with a 128Hz tuning fork over each spinous process
positive: pain
indicates vertebral fracture

Question 17

libman’s

Answer 17

doctor applies finger pressure over mastoid process. pressure increased until patient expresses discomfort
used to determine the pain threshold of the patient

Question 18

rust sign

Answer 18

patient spontaneously grasps head with both hands when rising from a recumbent position
indicates cervical instability

Question 19

dejerine’s sign

Answer 19

patient reports that pain is brought on by coughing, sneezing or straining at the stool
indicates an SOL

Question 20

beevor’s sign

Answer 20

doctor observes the patient’s umbilicus while they do a partial sit up

positive: umbilicus moves laterally
indicates: T10 NR lesion