Orthopedic tests for OSCE : shoulder, elbow, wrist, hip, pelvis Flashcards
knowledge of the OSCE test components for 2nd year Osteopathy exam at SCU
Shoulder: Describe The Neer Impingement test
- Pt is seated or standing
- elbow extended, Shoulder is taken into internal rotation
- Shoulder is abducted to 180 d
Shoulder: what is a positive for the Active Compression test of O’Brien?
If the patient reports pain on internal rotation but this is eliminated/reduced external rotation
Shoulder: What does the Sulcus Sign test for?
Laxity in G H joint
Describe the Apprehension (Crank) test
1) The patient is lying supine on the treatment table.
2) The practitioner takes the patient’s shoulder into abduction and slowly introduces external
rotation. This is best achieved by supporting the upper limb at the flexed elbow with one
hand and at the wrist with the other hand.
- This test MUST be done slowly. If there is instability and the test is done too quickly the
humerus may dislocate.
Shoulder: what is the goal of the Apprehension (crank test)?
It shows Global instability of G H joint
Shoulder: Describe the Jobe Relocation and Surprise Test
- Pt Supine
- 90 deg abduction
- Slow external rot’n
- Apply posterior trans force to the head of the humerus
- Sudden release of posterior pressure
Shoulder: describe the Jerk test
1) The patient is seated on the treatment table.
2) The practitioner takes the involved upper limb of the patient and passively flexes the shoulder to 90 degrees with the elbow bent to 90 degrees.
3) The practitioner then grasps around the elbow and applies an axial load through the humerus in a posterior direction.
4) This axial load is maintained while the practitioner adducts the arm across the patient’s body. A sudden ‘jerk’ or shift may occur, indicating translation of the humeral head on the
glenoid.
5) The practitioner releases the load and abducts the arm back toward the starting position. If a shift of the humeral head occurred previously the practitioner may observe a ‘relocation’ of
the humeral head in the form of a second ‘jerk’ as the arm is returned to this position.
Shoulder describe the sulcus sign
Purpose
This test is used to assess for laxity in the glenohumeral joint
Procedure
1) The patient is seated or standing with the arm to be tested relaxed by the side in neutral
2) The practitioner grasps the patient’s forearm just below the elbow and applies a traction force inferiorly.
Interpretation
The presence of a sulcus in the subacromial region of the shoulder may indicate glenohumeral joint laxity, or instability in the inferior region of the glenohumeral joint.
Shoulder: What is a positive sign of the Jerk test?
translation of humeral head on G H joint may show “clunk” or jerk on adduction or abduction (return) of arm
Shoulder: Describe the Hawkins-Kennedy test
- Pt is seated
- Arm is flexed & elbow flexed at 90
- Clinician arm is under pt arm and placed on the shoulder
- Clinician internally rotates patient shoulder via the wrist.
Shoulder: Describe the horizontal Adduction test
This test is used to assess for acromioclavicular joint pain
Procedure
1) The patient is standing or sitting
2) The patient’s upper limb is taken across the body (reaching the hand to the opposite shoulder) as far as possible.
Interpretation
This test is considered positive if the patient reports pain localised around the acromioclavicular joint
Shoulder: What does the Horizontal Adduction test find?
Acromioclavicular joint pain
Shoulder: Describe Hornblowers Sign Test
- Pt sitting. Clinician behind and side
- Shoulder adducted 90d in scapular plane and elbow flexed 90d
- Pt moves arm into external rotation against resistance
Shoulder: Describe the Active Compression of O’Brien test
1) The patient is standing in front of the practitioner
2) The practitioner takes the patient’s shoulder to 90 degrees of flexion with the elbow fully extended.
3) The shoulder is adducted 10-15 degrees and medially rotated (so the thumb ends up pointing downward).
4) The practitioner stands behind the patient and applies a downward force to the patient’s upper limb and the patient resists the force.
5) The pressure is released and the patient’s arm is returned to the starting position but the shoulder is taken into external rotation instead.
6) The practitioner then applies a downward force once again while the patient resists.
Shoulder: Describe the empty can test
1) The patient is seated or standing in front of the patient.
2) The patient’s shoulders are taken into abduction at 90 degrees in the scapular plane (with the elbows extended).
3) The shoulders are medially rotated so the thumb is pointing down.
4) The practitioner applies a downward force over the patient’s distal forearm while the patient resists the force.
Shoulder: What is a positive sign in the Empty Can (Jobe) Test?
Patient reports pain in shoulder, or there is asymmetrical weakness
Shoulder: Describe the external rotation lag sign test
1) The patient is seated or standing in front of the practitioner.
2) The patient’s shoulder is taken into approximately 90 degrees of abduction with the elbow flexed to 90 degrees.
3) The practitioner takes the patient’s arm toward maximum external rotation and the patient is asked to hold that position.
Shoulder: What does the External Rotation Lag Sign Test find?
Rotator cuff tear (supraspinatus or infraspinatus)
Shoulder: Describe the Lift Off (Gerber’s) test
1) The patient is standing in front of the practitioner
2) The patient is asked to place their hand on their back pocket or mid-lumbar.
3) The patient is then asked to ‘lift’ the hand away from the pocket/lumbar.
4) If the patient is able to lift the hand away then the practitioner applies a resistance to the hand attempting to ‘push’ it back toward the pocket or lumbar.
Shoulder: What is a positive sign for the Lift Off (Gerbers) Test
unable to lift the hand away from the pocket/lumbar.
The application of pressure back on the patient’s hand is to examine the strength of the subscapularis muscle and how the scapula acts under loading.
Shoulder: Describe the Painful Arc Sign test
- The patient is standing in front of the practitioner
- the patient is asked to abduct the arms in the coronal (frontal) plane toward end rang
Shoulder: Describe the Drop Arm Test. What is it testing?
- The patient is standing
- clinician elevates the upper limb to 90 degrees of glenohumeral abduction
- the patient takes the weight of the limb
a full-thickness tear in the rotator cuff
Shoulder: Describe the infraspinatus Muscle test
- The patient is sitting
- elbow flex to 90 degrees
- the patient is asked to push out against resistance
Shoulder: Describe Speeds Test.
- The patient is standing.
- The patient is asked to extend the elbow and supinate the forearm
- The patient flexes the shoulder to 90 degrees against resistance
Shoulder: Describe the Biceps load Test (Kim Test II)
1) The patient is lying supine on the treatment table
2) The patient’s shoulder is taken into 120 degrees of shoulder abduction
3) The patient’s elbow is then flexed to 90 degrees
4) The patient is asked to flex the elbow whilst the practitioner resists this movement
Shoulder: What is a positive sign for the Biceps load Test (Kim tests II)?
the patient reports pain at the anterior shoulder around the region of the long head biceps tendon. If pain or apprehension occur with the external rotation alone this may indicate instability in the glenohumeral joint.
Shoulder: Describe the nature of the Acromioclavicular Joint pain Cluster
Purpose
There are two clusters available for examining the likelihood of the acromioclavicular joint as a source of the patient’s pain.
Paxino’s sign
Procedure
1) The patient is seated on the treatment table with the practitioner standing behind
2) The practitioner places a thumb pad over the posterior aspect of the acromion and the pad
of the index and/or middle finger of the same hand over the anterior aspect of the midportion of the clavicle.
3) The practitioner applies a shearing force by approximating the two digits
Interpretation
This test is considered positive if the patient reports pain at the acromioclavicular joint
Shoulder: What does a positive finding for the Acromioclavicular Joint Pain Cluster mean?
the acromioclavicular joint as a source of the patient’s pain. If both the Paxino’s sign and active compression test of O’Brien are positive there is a positive likelihood ratio of 2.71.
This test cluster has a specificity of 95.8%
Shoulder: If the Paxino’s sign test shows negative what test should it be followed with to prove the determination?
Hawkins-Kennedy test
Wrist: Describe the Distal Radioulnar Joint Stability Test
- The patient is seated or standing
- The patient’s elbow is flexed to 90 degrees. The practitioner grasps around the distal ulnar (approximately 4cm proximal to the end to avoid pressing on sore structures). The other hand holds around the patient’s palm.
- The practitioner applies alternating anterior and posterior pressure to the distal ulna, allowing the bone to ‘spring back’ to the starting position with each movement. This is performed in neutral, full pronation, and full supination.
- The practitioner notes the stability of the joint indicated by the springing back of the ulna. The wrist is then radially deviated, and the movements are performed again
This result is compared to the other wrist
Wrist: describe the Scaphoid Compression Test
- The patient is seated or standing
- The practitioner holds the distal forearm with one hand and grasps around the patient’s thumb with the other hand.
- The practitioner applies longitudinal compression through the thumb toward the carpals.
Wrist: Describe the ulnomeniscotriquettral glide test
1) The patient is seated or standing.
2) The forearm is pronated and the practitioner supports the patient’s upper limb and places a
thumb on the dorsal surface of the distal ulna.
3) The index finger of the same hand is pressed on the palmar side of the pisotriquetral complex.
4) While maintaining an anterior force over the distal ulna the practitioner applies a posterior force through the index finger to introduce a shear force between the two structures.
Wrist: what does the Ulnomeniscotriquetral dorsal glide test for?
injury of the triangular fibrocartilage complex.
Wrist: Describe the Watson Test (Scaphoid Shift)
- The patient is seated beside the table, with the elbow on the side to be tested resting on the table and the forearm pronated.
- The practitioner is holding the hand on the side to be tested with one hand. The thumb on the other hand applies pressure on the scaphoid tubercle on the palmar side of the wrist to prevent anterior movement of the scaphoid during the test, while the fingers provide a counter pressure on the dorsal aspect of the forearm.
- The practitioner takes the patient’s wrist into full ulnar deviation and slight wrist extension while maintaining pressure over the scaphoid. 4) The examiner then takes the patient’s wrist into radial deviation and slight flexion while maintaining pressure on the scaphoid tubercle. 5) If the scaphoid and scapholunate joint are unstable the scaphoid will shift over the dorsal rim of the radius.
Wrist: What does the Finkelstein test reveal?
De Quervain’s tenosynovitis, or paratendinitis in the thumb.
Wrist Describe the Finkelstein test
1) The patient is asked to make a fist with the thumb inside the fingers.
2) The practitioner stabilises the forearm in one hand and holds the patient’s fist with the other hand.
3) The practitioner deviates the wrist toward the ulna
Wrist: Describe the carpel compression test
1) The patient’s forearm is supinated and held in the practitioner’s hands
2) The practitioner places one thumb over the other directly over the median nerve in the carpal tunnel and applies a downward pressure for 30-60 seconds.
Wrist: What is a positive sign for the carpal compression test?
the patient reports reproduction or worsening of symptoms in the hand (paraesthesia, numbness, pain) in the median nerve distribution.
Wrist: Describe the hand elevation test
The patient is asked to raise both hands over the head and maintain the position for 3 minutes.
Wrist: What does the hand elevation test reveal?
assess for carpal tunnel syndrome