Orthopedic exams Flashcards
hoovers
malingering
supine, place hands under heels and tell patient to lift the weakened leg
+ no downward pressure on uninvolved side
burns bench
malingering
kneeling on table, bend forward
+ refusal because of back pain
magnusons
malingering
ask patient to locate pain, distract, and ask again
+ if change location
mannkopfs
malingering
monitor pulse and press on painful site
+ no increase in pulse
anterior ankle drawer
anterior talo fibular lig
supine, stabilize tibia, pull CALCANEUS anteriorly
posterior ankle drawer
posterior talofib lig
supine, stabilize dorsum of foot, pull TIBIA anteriorly
godfrey sag sign
PCL
supine, patient bends knees, doctor lifts ankles off table
sag sign
PCL
supine, patient bends knees, doctor observes
extension posterior sag sign
PCL
supine, doctor lifts both legs by heels off table, comparing knee sag bilaterally
fairbanks test
knee or patellar apprehension
supine, knee extended, manually displace patella laterally and observe patients face
apleys test
menisci and collaterals
prone, patients knee flexed
compress down and twist
distract and twist
mcmurrays test
supine with hip and knee flexed
externally rotate and extend (MCL)
internally rotate and extend (LCL)
patellar tap test
effusion
supine, milk down to superor pole and press patella
+ based on feeling
ballotment test
major effusion
supine, compress patella, release
+ if rebound
clarkes test
CMP
supine, traction patella inferior and patient contracts quads
fouchets test
CMP
supine, compress patella, if no pain, rub sideways
if painful + perkins sign
lachmans test
BEST ACL TEST
supine, knee slightly flexed, stabilzie femur and pull PA on leg
slocums test
ACL, MCL, LCL, instability
anterior drawer test with rotation
drawer test for knee
supine with knee flexed
anterior pull PA (ACL)
posterior push AP (PCL)
ligament stability for the knee
supine, abduct for MCL and adduct for LCL
tinels test for knee
common peroneal nerve
seated or supine, tap over the lateral fibular head
apparent (functional) leg length
supine, compare measurement from umbilicus to each medial malleolus
actual (structural) leg length
supine, compare measurement from ASIS to each ipsilateral lateral malleolus
allis leg length test
supine with knees flexed and feet together, compare femur and tibia length
laguerres test
hip
supine, FABRE in the air
patricks or FABRE test
hip
supine, rest heel on opposite knee to make a 4
Thomas test
hip flexor contracture
supine, uninvolved knee to chest
+ involved side raises
anvil test
hip
supine, leg straight and strike heel
gauvains tests
TB of the hip
side lying, extend and rotate hip feeling abdominals
obers test
TFL contracture
side lying, abduct and extend hip and release
nobles test
IT band syndrome
supine with hip and knee flexed, press lateral femoral condyle with thumb while extending knee to 30*
ludloffs test
lesser trochanter fracture
seated, raise involved thigh off table
trendelenburgs test
gluteus medius weakness
standing, raise uninvolved foot off the floor
+ glutei drop
yeomans
SI
extend hip with SI stabilization
nachlas test
SI, lumbar spine
bring heel to buttock with SI stabilization
elys sign
psoas contracture
bring heel to buttock without stabilization of SI
+ buttock hunch
elys test
low back pain
bring heel to contralateral buttock without stabilization
squish test
aka gapping
aka SI distraction
SI
supine, hands on ASIS, facing get, push down SI at 45 degree angle
erichsens test
SI
prone, squeeze SI joints together bilaterally
pideallus test
aka seated flexion sign
SI
seated on flat surface, palpate PSIS, have patient bend forward and touch their toes
SI resisted abduction
SI
sidelying, abduct and extend patients leg, dr exerts downward force
double leg raiser
SI and lumbar spine
supine, SLR one side, and then the other, note what angle pain occurs at
then raise both legs and note what angle pain occurs at
Hibbs test
SI or hip
prone, flex the knee and internally rotate hip
iliac compressions
SI
sidelying, press down on SI
Lewin gaenslens
SI
side lying gaenslens, stabilize pelvis and extend hip
gaenslens test
best SI test
supine, knee to chest, involved side hip extension off edge of table
goldthwaits
level of lesion: SI or lumbar
supine, flex hip while palpating low back
supported Adams tests
aka belt test
pain better with support: SI
pain worse with support: lumbar
standing, flex trunk without/ with support
anterior innominate test
self explanatory
standing, advance uninvolved leg and flex trunk
Lewin standing test
tight hamstrings or lesion
standing, pull each knee into extension, then both, while stabilizing pelvis
neri bowing test
aka bowing, curtsy, buckle
standing, trunk flexion without/with knee flexion
beerys sign
aka chair sign
hamstring
sitting relieves discomfort
tripod sign
hamstring
seated, observed during bechterews
stork test
+ pain = pars instability
standing on one leg, patient leans back
femoral nerve traction test
side lying, dr grasps affected leg and extends hip while knee is bent
reversal sign
+ pain when coming up = facet
standing, bend forward, then come up
prone lumbar hyperextension test
lumbar strain sprain
prone, dr stabilizes ankles and patient attempts to extend torso off the table
bechterews test
sciatica, disc, hamstrings
seated with hands on knees, extend one knee, then the other, then both
soto test
relieves piriformis
supine, SLR with hip in abduction and external rotation
bonnets test
sciatica from pirformis
supine, SLR with hip in adduction and internal rotation
kemps test
localized pain = facet
patient standing or seated, rotate, laterally flex, and extend
bowstrings test
aka cram test and popliteal pressure sign
supine, SLR, relax knee, apply politeal pressure
+ radiculopathy
lindners sign
supine, flex upper trunk into C
+ radiculopathy = lateral disc
fajersztajns test
supine, WLR, down 5 degrees, dorsiflex foot
+ radiculopathy = medial disc
WLR
+ radiculopathy = medial disc
supine, lift uninvolved side
turyns test
supine, extend big toe
+ radic = SI or lumbar spine
sicards test
supine, SLR down 5 degrees, extend big toe
+ radic = SI or lumbar spine
braggards test
supine, SLR down 5 degrees, dorsiflex foot
+ radic = SI or lumbar spine
lasegues differential sign
supine, SLR until radiculopathy occurs, then doctor flexes knee
relieves pain = rules out hip problem
seated lasegues test
seated, extend knee on involved side
+ radic = SI or lumbar spine
lasegues test
aka SLR
supine, flex hip on involved side
+ radic = SI or lumbar spine
minors sign
patient pushes of univolved sid leg or chair arm when getting up
+ sciatica
amoss sign
supine or side lying, patient rises to a seated position
+ thoracic pain
lewin supine test
supine, stabilize legs as patient attemps to sit up
+ instability
chest expansion test
seated erect or standing, tape measure at T4 level, patient expires, then inspires
+ if less than 2 inches
forestiers bowstring test
standing, feel paraspinals, as patient laterally flexes
+ if ipsilateral contraction
tuning fork on ribs test
seated, prone, supine
locate pain, place 128 tuning fork on area
fracture = increase in local pain
spinous process tuning fork test
seated, prone
place 128 tuning fork on SPs
fracture = increase in local pain
spinous percussion test
seated or prone
percuss SPs
fracture = increase in local pain
schepelmanns test
seated or standing
laterally felx, clasping hands over head
ipsilateral pain - intercostal neuritis
contralateral pain - pleurisy or myofascitis
rib compression test
seated, from behind, squeeze forearms on side
fracture = increase in local pain
adams positions
adams test in 3 positions
standing, seating, kneeling
adams test
standing, examine spine as patient flexes forward with SHOES OFFF!
improvement - functional scoliosis
no improvement - structural scoliosisa
wrinke shrivel test
seated, place hand in tepid water for 5 min
+ if no pad wrinkle = denervation
finsterers test
seated, pronated fistm strike base of 3rd metacarpal
+ kienbocks
bracelet test
seated, grasp and compress distal radius and ulna
+ in RA, ganglion cyst, carpal tunnel
retinaculum test
seated, 1. with MCP extened, flex DIP
2. with MCP flexed, flex DIP
- if decreased DIP flexion = intrinsic muscle problem
- if decreased DIP flexion = DIP problem
bunnel littlers test
seated, 1. with MCP extened, flex PIP
2. with MCP flexed, flex PIP
- if decreased PIP flexion = intrinsic muscle problem
- if decreased PIP flexion = PIP problem
finkelsteins test
seated, bring thumb up in palm, make fist, and ulnar deviate
+ dequervains disease
froments test
seated, pull paper from between patients index and adducted thumb
+ ulnar nerve issue
pinch test
seated, bring index and thimb tips together
+ median nerve issue
reverse phalens test
aka prayers sign
seated, palms together, extend wrists
+ median nerve / carpal tunnel
phalens test
seated, dorsum of hands together, flexing wrists
+ median nerve / carpal tunnel
tinels of the wrist
seated, tap over flexors retinaculum
+ median nerve / carpal tunnel
tinels of the elbow
seated, tap between olecranon and medial epicondyle
+ ulnar nerve entrapment
ligament instability of the elbow
seated, abduct for MCL, and adduct for LCL
+ ligament instability
reverse cozens test
seated, resist patient wrist flexion
+ medial epicondylitis
cozens test
seated, resisted patient wrist extension
+ lateral epicondylitis
mills test
seated, pronate and flex patients wrist
+ lateral epicondylitis
passive scapular retraction approximation test
prone, lift shoulder blades and back
+ pain = T1/2 nerve root
codmans test
standing, abduct past 90*
+ rotator cuff
supraspinatus test
seated, thumb down, patient arm 90 of abduction, resist drs downward force
+ supraspinatus
supraspinatus arc test
standing, resist patients arm abudction through entire 180* of movement
supraspinatus = pain 10-20 degreees and 90-110 degrees deltoid = pain 20-90 degrees
impingement test
seated, passively fully flex patients arm
+ biceps or supraspinatus tear
speeds test
seated with arm extended, resist patient shoulder flexion
+ bicpital tendinitis
yergasons test
seated, resist patients elbow flexion and supination
+ bicep tendon instability
abott saunders test
seated, dr passively abducts arm, exernally rotate while palpating lesion, then lower arm
+ biceps
dawbarns test
seated, press on bursa, then abduct arm while continuing pressure on bursa
decrease pressure during abduction = bursitis
calloways test
seated measure vertical shoulder curcumferences
+ increase in girth = dislocation
apprehension test of the shoulder
seated with arm in hostage position, stress humerus anteriorly
+ pain or apprehensive = dislocation
dugas test
seated, touch opposite shoulder and bring elbow down
+ dislocation
Marion shoulder rock test
seated, touch opposite shoulder and bring elbow up and down
+ pathology (vague)
apleys scratch test
seated, touch ipsilateral scapula behind head from superior to inferior
testing ROM
reverse bakodys test
seated, hand on head
+ increase in pain = TOS / cervical issue
Roos provocation
aka EAST or elevated arm stress test
seated, hostage position, pump hands
indicates vascular insuffeciency
allens maneuver
seated, flex elbow 90 degrees, extend arm, horizontal abduction, externally rotate arm, patient rotates head to each side, palpate pulse
TOS
wrights test
seated, passively hyperabduct each arm (well side first), palpate pulse
+ pectoralis minor
edens test
seated, shoulders down and back, break frontal plane, palpate pulse
+ costoclavicular
halsteads test
seated, extend head and traction arm down, palpate pulse
TOS
modified adsons test
seated, rotate away from involved side and extend, palpate pulse
+ scalenus medius / cervical rib
adsons test
seated, rotate towards involved side and extend, palpate pulse
+ scaleus anticus / cervical rib
bicycle/stoop test
cardivascular exercises upright until claudication, then stooped forward
+ relief of pain = neurogenic claudication
claudication test
standing, march in place
when pain occurs bend forward and see if it relieves pain
+ relief = neurogenic claudication
homans test
supine, dorsiflex foot only
+ thrombophlebitis
barre lieous test
seated, patient actively maximally rotate head side to side several times
+ VBAI
buergers test
supine, elevate leg to 45 degree, hold, lower leg and help patient sit up with both legs dangling
+ immediate blanching when elevated or more than 2 minutes for color to return when seated = lower arterial incompetency
allens test
seated, patient extends both hands palm up and squeezes one, doctor compresses radial and ulnar arteries, patient opens fist and doctor releases one artery (done to both arteries bilaterally)
upper arterial incompetency
barany nylen test
seated, turn head, then lay supine with head off table
+ nystagmus fatigues = benign positional vertigo
mittlemeyers test
standing, march in place eyes opened and then closed
+ rotate toward side of lesion
dizziness test
aka swivel chair test
seated, 1. patient rotates head, then 2. patient rotates body as dr holds head neutral
dizziness in 1 and 2 = cervicgoencic
dizziness in 1 only = vestibular
hall pikes test
supine, extend head off table, add rotation and lateral flexion, then unsupported extension
(rotate right checks for right side pathological occlusion or left side physiological occlusion)
+ VBAI = nausea, dizziness, nystagmus
dekleyns test
supine, supported rotation and extension of the head
+ VBAI = nausea, dizziness, nystagmus
maignes test
aka Vertebral basilar artery insufficiency test
steated, rotate and extend head
auscultate carotids if stethoscope is present
+ VBAI = nausea, dizziness, nystagmus
kernigs test
supine, hip and knee flexed to 90 degrees, extend knee
+ knee kicks = meningeal irritation
brudzinskis test
supine, flex neck
+ knees buckle = meningeal irritation
valsalva sign
seated, take a deep breath, hold, and bear down
increase pain = SOL (disc, fracture, tumor)
naffzigers test
seated, digitally compress both internal jugulars veins
SOL (disc, fracture, tumor)
milgrams test
supine, raise and hold legs 3 inches off the table
SOL (disc, fracture, tumor) or low back
dejerines triad
patient has pain when coughing, sneezing, or during a bowel movement
SOL (disc, fracture, tumor)
swallowing test
seated, instruct patient to swallow
SOL (disc, fracture, tumor)
rusts sign
patient hold their head
ADI instability
cervical compression test
seated, direct compression
IVF encroachment
jacksons test
seated laterally flex and compress
IVF encroachment
maximal cervical compression
seated, rotate and extend head
IVF encroachment
spurlings test
seated, rotate and extend head, then compress
Disc and IVF encroachment
bakodys test
seated, hand on head
+ decrease in pain = nerve root
shoulder depression test
seated or supine, lateral flexion stretch
increase pain = nerve root adhesions
cervical distraction test
seated, lift head and avoid TMJ
+ decrease pain = nerve root
+ increase pain = muscle strain
o donoghues test
varies, active, then passive ROM
active pain = strain
passive pain = sprain
L hermittes
seated, neck flexion
+ electric shock = MS or cervical myelopathy
sternal compression test
supine, cross arms on chest and apply pressure on sternum
+ pain = rib or thorax lesion
soto hall
supine, cross arms on chest with passive neck flexion and sternum stabilization
+ pain = cervical myelopathy
libmans test
seated, pressure on mastoid
used to assess pain threshold
