Orthopedic exmination

Question 1

foraminal compression test

Answer 1

patient rotates head from side to side, then put pressure on head from neutral and the rotated positions.
positives include local pain and radicular pain
indicates nerve root compression and foraminal encroachment

Question 2

jackson’s compression test

Answer 2

patient laterally flexes head and applies downward pressure
positives include local pain and radicular pain
indicates nerve root compression and foraminal encroachment

Question 3

distraction

Answer 3

doctor lifts patient’s head from the base of the skull
positives include decreased pain and increased pain
indicates nerve root compression or a sprain/strain

Question 4

O’Donohue’s

Answer 4

patient actively moves head against resistance, then doctor passively moves the part through a full ROM
positive includes pain
indicates sprain (passive), strain (active)

Question 5

valsalva

Answer 5

doctor asks patient to take a deep breath and hold it while bearing down
positive includes radicular pain
indicates SOL

Question 6

maximum cervical compression

Answer 6

patient seated and actively rotates head and hyperextends the neck to the right. if no pain the patient is asked to maximally laterally flex the neck. repeat on other side. NO COMPRESSION APPLIED
positives include radicular pain
indicates nerve root comrpession

Question 7

shoulder depression

Answer 7

with patient seated, the doctor depresses the patient’s shoulder while laterally flexing the cervical spine away from that shoulder. repeat on other side
positives include pain
indicates nerve root adhesion

Question 8

soto hall

Answer 8

patient supine, doctor places one hand on sternum while passively flexing the patient's head to ward the chest
positive includes localized pain
indicates fracture (anterior), ligament (posterior)

Question 9

bakody’s test (shoulder abduction test)

Answer 9

while seated, the patient actively places affected arm on the top of the head. elbow should be at the level of the head
positive includes relief of pain
indicates IVF encroachment

Question 10

allen’s test

Answer 10

patient is seated with elbows flexed and forearm supinated, ask the patient to pump the hand while the examiner occludes the radial and ulnar arteries until hand is blanches. the the patient slowly opens the hand while the doctor opens one artery and records filing time
positive includes delay of more than 5 seconds for the blood to return
indicates occlusion of the corresponding artery

Question 11

costoclavicular

Answer 11

doctor palpates radial pulse while patient draws their shoulder down and back. patient then flexes bringing the chin to the chest
positive is alteration in amplitude of radial pulse
indicates compression between first rib and clavicle

Question 12

adson’s

Answer 12

when patient seated, doctor slightly abducts, extends and externally rotates the arm while taking the radial pulse. patient rotates head toward tested side and extends head. patient takes deep breath and holds
positive includes alteration in amplitude of radial pulse
indicates scalenus anticus syndrome, cervical rib

Question 13

modified adson’s

Answer 13

if adson’s was negative, the patient rotates head to the opposite side, extends head and takes a deep breath and holds it while the doctor takes the radial pulse
positive includes alteration in amplitude of the radial pulse
indicates subclavian artery, scalenus medius syndrome

Question 14

wright’s test

Answer 14

patient seated while doctor palpates radial pulse. each arm is abducted to 180 degrees. the doctor notes angle at which radial pulse diminishes or disappears
positive is if pulses are lost with more than 10 degrees difference
indicates pectoralis minor syndrome or axillary artery

Question 15

reverse bakody

Answer 15

while seated, patient actively places palm on top of head
positive is increase in pain
indicates TOS

Question 16

halstead’s

Answer 16

patient extends head back. examiner exerts downward traction and slight abduction on arm while taking pulse
positive is alteration in amplitude of radial pulse
indicates cervical rib

Question 17

roo’s

Answer 17

bring arms to 90-90
positive is alteration in amplitude of radial pulse
indicates cervical rib

Question 18

apley’s

Answer 18

patient seated and instructed to actively put hand behind head and touch opposite superior angle of scapula, then place hand behind back and touch opposite angle of scapula
positive is pain or decreased ROM
indicates degenerative tendonitis of rotator cuff (supraspinatus)

Question 19

codman’s drop arm

Answer 19

examiner passively abducts arm to above 90 then suddenly removes support. this makes the deltoid suddenly contract causing increased pain
positive is inability to maintain arm position
indicates supraspinatus tear

Question 20

apprehension

Answer 20

doctor abducts and slowly rotates the affected shoulder while stabilizing it
positive is patient shows signs of apprehension or alarm
indicates chronic shoulder dislocation

Question 21

dugas

Answer 21

patient places hand of affected shoulder on opposite shoulder and attempts to touch the chest with the elbow
positive is unable to perform
indicates shoulder dislocation

Question 22

yergason’s

Answer 22

patient flexes elbow to 90 while seated
doctor palpates the biceps tendon and resists patient’s attempt to actively supinate the hand and flex the elbow
positive is an audible click or snap in the bicipital groove
indicates bicipital tendon instability, if just pain then bicipital tendonitis

Question 23

dawbarn’s

Answer 23

deep palpation by doctor over subacromial bursa (elicits pain). without moving the fingers the arm is passively abducted
positive is reduction of pain
indicates subacromial bursitis

Question 24

impingement

Answer 24

with patient’s arm slightly abducted, the doctor moves the shoulder through full flexion. this causes a jamming of the greater tuberosity against the acromial surface
positive is pain
indicates overuse of tendons

Question 25

supraspinatus/empty can test

Answer 25

patient’s shoulders abducted to 90, the doctor applies resistance. then the patient flexes the shoulders to 30 and points the thumbs downward and resistance is applied again
positive is weakness
indicates supraspinatus tear

Question 26

speed’s test

Answer 26

patient is seated with elbow slightly flexed palm up. doctor resists the patient’s attempt to flex shoulder while extending and supinating the forearm
positive is pain
indicates bicipital tendonitis

Question 27

subacromial push button

Answer 27

doctor applies deep pressure over the subacromial bursa
positive is pain
indication is supraspinatus degeneration, subacromial bursitis

Question 28

passive shoulder approximation

Answer 28

while patient is standing, the examiner approximates the scapulae by lifting the shoulders up and back
squeeze shoulder blades
positive is pain in the scapular area
indication is T1 or T2 nerve root problem on the side of pain

Question 29

bryant’s test

Answer 29

doctor observes the patient’s posture and notes the height’s of the axillary folds
positive is lower axillary fold on involved side
indicates shoulder dislocation

Question 30

brachial plexus tension test

Answer 30

hands behind head, pull back on elbows, tuck chin
positive is pain
indicates brachial plexus and cervical nerve root impingement

Question 31

radiohumeral bursitis

Answer 31

tennis elbow/lateral epicondylitis
affects the extensor carpi radialis brevis
pain with extension of wrist and pronation of elbow

Question 32

little leaguer’s elbow

Answer 32

medial epicondylitis/golfer’s elbow
affects flexor carpi ulnaris
pain with flexion of wrist at medial portion of elbow

Question 33

cozen’s

Answer 33

patient’s elbow is flexed to 90 degrees with forearm pronated and fist dorsiflexed. doctor stabilizes the elbow and resists patient’s wrist dorsiflexion
positive is pain in lateral elbow
indicates lateral epicondylitis

Question 34

reverse cozen’s

Answer 34

patient seated with arm close to body. patient makes a fist and flexes wrist with supination. doctor resists flexion of wrist while supporting at elbow
positive is pain in medial elbow
indicates medial epicondylitis

Question 35

mill’s

Answer 35

doctor passively flexes fingers, wrist, elbow and brings the elbow around and into maximum pronation and extension
positive is pain in lateral elbow
indicates lateral epicondylitis

Question 36

varus at elbow

Answer 36

push medial to lateral (adduction stress)

indicates LCL

Question 37

valgus at elbow

Answer 37

push lateral to medial (abduction stress)

indicates MCL

Question 38

tinel’s at elbow

Answer 38

tap in lateral groove (radial nerve)

tap in medial groove (ulnar nerve)

Question 39

tinel’s at wrist

Answer 39

percuss over the flexor retinaculum of the wrist and tunnel of guyon
positive tingling into lateral 3 fingers or medial 2 fingers
indicates carpal tunnel syndrome or ulnar nerve impingement

Question 40

phalen’s sign

Answer 40

patient flexes the wrists maximally and hold position for up to 1 minute by pushing both wrists together
positive is tingling into lateral 3 fingers of hand
indicates carpal tunnel syndrome

Question 41

reverse phalen’s

Answer 41

patient extends wrists maximally and holds that position for up to 1 minute by pushing the palms together
positive is pain at wrist or lateral 3 fingers tingling
indicates carpal tunnel syndrome

Question 42

pinch grip test

Answer 42

patient is asked to approximate tip of index finger to tip of thumb
positive is if they patient approximates the pads of the fingers together
indicated median nerve lesion

Question 43

froment’s paper

Answer 43

doctor places piece of paper between the patient’s thumb and index finger as well as between all other fingers, and attempts to pull paper out
positive is unable to keep paper between fingers
indicates ulnar nerve palsy

Question 44

finkelstein’s

Answer 44

patient is asked to make a fist with thumb tucked inside. fist is then ulnar deviated
positive: pain over anatomical snuff box
indicates dequervain’s disease (stenosing tenosynovitis)

Question 45

bracelet test

Answer 45

doctor applies moderate compression to the distal aspects of the radius and ulna
positive is pain
indicates RA

Question 46

SLR

Answer 46

patient is supine with legs extended. doctor places one hand under heel and other over knee and slowly raises leg
positive is pain down affected side
indicates sciatica, disc, or lumbar lesion

Question 47

lasegue

Answer 47

following a positive SLR test, doctor suddenly drops the patient’s leg
positive: increased pain
indicates sciatica, disc, or muscle spasm