Orthopedic Tests NMS II Flashcards
Adam’s Position
Pt. Flexes at waist puts hand in prayer position reaches to floor
Amoss Sign
Pt. rises from side position to upright and uses upper body strength
Beevor’s Sign
pt. does abdominal crunch THEN a leg lift
Chest Expansion
Dr. Measures around patients chest at 4th intercostal, pt. exhales and inhales maximally
Forestier Bowstring
Observe ROM on pt. laterally bending from side to side
Rib Motion
Doctor places both hand on pt’s chest at sternocostal angle while pt. is supine. both above and below breast, observe motion of ribs
Schepelmann’s Sign
pt. seated arms extended over head and laterally bends to Lt and Rt
Antalgia Sign
Antalgic lean
Straight Leg Raiser (SLR)
raise straight leg off of table until pain is made or increased, note angle
Bragard’s Sign
+Straight Leg Raiser test, lower leg 5º then dorsiflex foot
Sicard’s Sign
NAME?
Seated Straight Leg Raiser
sit w/ straight back extend knee, if no pain Dr. applies downward pressure just above knee and pt. lifts LEG off of table
Slump Test
Pt. seated w/ back maximally slumped, DORSIFLEX then extend knee
$ “Well Leg Raiser”
Perform SLR on Asymptomatic side
Fajerstajn’s
+CSLR, lower leg 5º and dorsiflex foot (same as Bragards)
Cox Sign
During SLR pt. raises ipsilateral hip.
Ely’s Test
prone pt. doctor will touch heel of foot to opposite butt cheek
Femoral Nerve Traction Test
pt. lying on unaffected side bottom leg straight, top leg bent at knee, extend thigh back on affected side.
Heel Toe Walking Test
Pt. is told to walk on heels
Kemps Test
GOLD STANDARD
Lasegue Test
pt. supine dr. flexes hip and knee to 90º then extends the leg
Lindner’s Sign
pt. seated/supine flexes pt. chin to chest
Milgram’s Test
pt. lying, hold feet 6” off table hold 30s
Minor’s Sign
pt. uses upper body to move from seated to standin, same as Amos but sitting
Nachlas test
Pt. prone, dr. touches heel off foot to same butt cheek
Quick Test
pt. support, then does 5 deep squats with bouncing at bottom
Bilateral Leg Lowering Test
pt. supine flex hips to 90º lower the legs and stop at about 45º
Belt Test
Pt. bends to touch toes, then Dr. braces pt’s hips and sacrum pt. bends forward again > 1st part pain, 2nd part NO pain > SI; > pain both parts > L
Erichsen Test GOLD STANDARD
pt. prone, dr. compresses join by pushing PSIS (fixing EX)> Pain SI joint > SI issue
Gaenslen’s
pt. supine, dr brings unaffected knee up to chest, then hyperextends affected leg>SI pain or radiating pain to thigh or groin > SI sprain/instability
Goldthwait/Smith Peterson Test
pt. supine, dr. palpates L5 and S1 and elevates affected leg> pain before L5 S1 separation > SI problem> pain after L5 S1 separation > L problem
Hibb’s
pt. prone, flexed knee 90º push foot laterally stabilize opposite sacrum> pain > SI lesion
Iliac Compression Test
pt. on unaffected side, dr. compresses iliac crest on affected side into table> Pain > sprain of post. SI lig. SI inflammation, sublux.
Lewin Gaenslen
pt. lies on unaffected side pulls unaffected knee to chest. Dr. hyperextends affected thigh> pain or tightness > SI sprain or arthritis
Yeoman’s
pt. prone, dr. pushes on sacrum and lifts flexed knee off of table> pain > SI joint lesion (ant. lig.)> tightness > Femoral nr. irritation, iliopsoas. rectus femoris irritation
Anterior Innominate Test
pt. puts unaffected 2-3 feet forward til back foot comes up.> pain > lxn of pain is SI or L pain
Actual Leg Length
Pt. supine measure from ASIS to medial malleolus > 6mm difference > hip joint or long bone deficiency
Apparent Leg Length
pt. supine, measure from umbilicus to medial malleolus > 6 mm difference > Spinal or Pelvic sublx.
Allis’ Sign/Galeazzi’s Sign
Pt. Supine with Knees and hips flexed o_^, observe from foot of the table, then side of table > height difference > femoral leg discrepancy (acetabular protrusion, hip dislxn, hip fx, tibial height(inferior view), femur height(lateral view))
Anvil Test
pt. supine, elevate straight leg then hit bottom of foot with fist > pain anywhere from heel to hip > calcaneous, tibia, fibula fx. (heel pain); arthritis, femoral neck fx, infection (hip pain)
Gauvain’s Sign
pt. affected side up, place one hand on abdominal muscles, grasp leg above ankles, abduct it and then internally, and externally rotate it. > contraction of ab muscles, pain in hip, referred pain to groin or ant. thigh > AVN, TB (before adolescence), fx, gout, OA
Hip Telescoping Test
pt. supine, dr. flexes hip and knee on affected side to 90º, wrap around grasp calf and thigh, grasp by hip, then push femur into table and distract from table > too much joint play, or palpable click > hip dislxn or hip dysplasia (Meditteranean, Scandinavian women)
Patrick’s/Patrick-Fabere(Flexion ABduction, External Rotation, Extension)
pt. supine, dr. on unaffected side, cross legs in figure 4 position dr. stabilizes ASIS on side he’s on then apply downward pressure on knee on affected side > pain, inability to perform > DJD, OA, RA, SCFE, AVN FX, Strain/Sprain
Ober’s Test
pt. lie with affected side up, dr. behind abduct, and extend thigh (keep knee at 90º), slide hand up to pelvis allowing knee to drop. > stays abducted painful, drops with spastic clonus > Iliotibial Contraction*position = hurts,
Thomas Test
pt. supine pt. pulls unaffected knee to chest while keeping other leg straight, dr. finishes pushing on unaffected leg. > L spine keeps lordosis, inability to keep opposite thigh flat > flexion contracture, shortening of iliopsoas
Trendelnburg’s Test
Pt. stands on affected leg and lifts unaffected leg off of ground. Dr. observes pelvis. > high hip on standing leg, low hip on lifted leg > paralysis of hip abductors (glut. medius), hip dysplasia, *congenital hip dislxn, glut paralysis/weakness, glut inhibition from pain in hip, glut insufficiency from coxa vara (135º coxa valga)
Ortolani’s Test
INFANT lies supine, dr. grasps thighs at lesser trochanter, flex and abduct thighs bilaterally. > click or clunk > congenital femoral dislxn or instability
Abduction (Valgus) Stress Test
pt. supine on edge of table w/ leg straight. Dr. stabilizes medial ankle and pushes L-M at knee > pain or incr. motion/gapping > MCL strain/rupture
Adduction (Varus) Stress test
pt. supine on edge of table w/ leg straight. Dr. stabilizes lateral ankle and pushes M-L at knee > pain or incr. motion/gapping > LCL strain/rupture
Apley’s Compression Test/Apley’s distraction/Apley’s Grinding
pt. prone. Dr. rotates foot medially or laterally then flexes knee to 90º and pushes down, then does distraction >pain > meniscal tear (heel points to which side)
Patella Ballottement Test
pt. supine w/ leg straight. Dr. pushes down on patella and moves it lateral and medial palpating motion, and boggy sensation. May percuss also > slow to return to position, increased movement, feels spongy > retropatellar effusion, intraarticular knee swelling
Bounce Home TestAGGRESSIVE TEST
pt. supine. dr lifts leg and bends knee to 20º then allows knee to drop into full extension > pain, inability, spongy end feel > meniscal tear
Clarke’s Sign
pt supine, dr applies S-I pressure on TOP of patella, pt. contracts quad > retropatellar pain, grinding > chondromalacia patella, degeneration of patellofemoral joint
McMurray Sign$ Golden Arches MM $
pt supine hip and knee flexed to 90º. Dr. stabilizes knee and grips heel, then rotates tibia externally while applying varus stress and extending leg. Repeated with internal rotation and valgus stress. >pain, crepitus/clicking > medial/lateral meniscus tear (heal points to which)
Lateral Pivot Shift Maneuver/Mcintosh Test
pt supine w/ hips @ 20º and knee flexed to 5º. Dr applies internal rotation, valgus stress, and flexes knee > feels like knee will pop out/give > ACL tear
Lachman Test
same as Drawer, knee flexed to 25-30º Dr. holds femur down as he lifts Tibia >pain w/ or w/o increased ACL translation, infrapatellar slope loss, mushy end feel > sprain/rupture of ACL, w/ normal translation Strain Grade 1, w/ increased translation Rupture Grade 2,3
Drawer Test
pt. supine knee flexed to 90º. Dr sits on pt’s foot and pulls tibia anteriorly then pushes it posterior. > pain w/ or w/o increased ACL or PCL translation > ACL/PCL sprain, pain w/ normal translation-Sprain, pain w/ increased translation-Rupture
Q-Angle Test
pt stands. draw line from ASIS to midpoint patella, and from tibial tuberosity through midpoint of patella. measure angle between lines 18º-patellofemoral dysfunction, patella valgum
Posterior Drawer Sign
pt. supine/seated. one hand behind tibia, one hand on ant. calcaneous, push foot post. > excess post. translation > post. talofib lig. instability
Calf Circumference Test
measure calf at widest point ~4” below patella. > increased/decreased diameter side to side > acute compartment synd./atrophy
Claudication Test
pt. walks/toe raises for one minute dr. times when pt. has pain >muscle weakness, cramp, color change > vascular claudication, atherosclerosis
Homan’s Sign”Ho position”
pt. supine. raise leg to 45* squeeze calf and quickly dorsiflex foot >persistent achy, or short dull calf pain >DVT gastroc soleus strain.
Moses Test
Pt. prone. flex knee to 90* and squeeze calf quickly >persistent achy, or short deep calf pain >ARTERIOSCLEROSIS OBLITERANS (diabetes), DVT, strain
Thompson’s Test
Pt. prone. flex knee to 90* and squeeze calf quickly >No plantar flexion, pain >RUPTURED ACHILLES TENDON, DVT, Strain
Duchenne’s Sign”touched up like a douche on the bottom of the foot”
apply upward force to head of 1st metatarsal against resistance >roll/inversion of the foot upon attempted plantar flexion > superficial peroneal nerve, L4-S1 lesion (FIBULARIS LONGUS paralysis)
Helbing’s Sign
Pt. stands dr. looks at achilles >Medial curve of achilles > overpronation from Cerebral Palsy, Obesity
Morton’s Test
squeeze the foot around metatarsal heads > pain btwn bone/in bone > Mortons neuroma btwn 2,3,4 metatarsals (3,4 MC)/Arthritis, stress Fx, metatarsalgia
Strunsky’s Sign”Strun the toes”
rapidly flex the pt’s toes several times >pain >metatarsalgia or OA
Tinel’s Foot Sign
tap posterior aspect of medial metatarsal >pain, paresthesia in arch, toe, or heel >Tarsal Tunnel syndrome (post. tibial, medial plantar, deep peroneal).
Anterior Drawer Sign
pt. seated or supine. place one hand on ant. tibia, one hand behind calcaneous. pull ant. > excess ant. translation > ant. Talofib lig. instability
Lasegue Rebound Test
Following a positive SLR the DR. Suddenly drops the pt’s leg. > sciatica, disc, mm spasm.
Turyn’s sign
Pt supine, dorsiflex the big toe>Sciatica
Leg lowering Test
Pt. Supine. Dr. Brings pt’s legs up to 90º and asks them to lower them slowly>LBP>sciatica
Double leg raise test AKA bilateral SLR
Perform SLR on each side noting the degree of pain and then raises both legs noting the degree of pain > pain occurs sooner with both legs raise > lumbosacral joint lesion.
Bowstring Sign
Dr. Performs a SLR to the point of pain. The knee is flexed slightly and then placed over the Dr’s shoulder, digital pressure is applied to the posterior thigh and then popliteal fossa > Lumbar pain, radiculopathy > Sciatica
Bonnett’s Sign
Pt. Supine dr on affected side. Dr. internally rotates, adducts leg and performs SLR > Radicular pain > Piriformis syndrome
Prone Hyperextension test
Pt. prone Dr. Stabilizes Lumbosacral area. Dr. Lifts leg into hyperextension while keeping the knee extended > localized L pain with anterior thigh pain > L3, L4 lesion.
Laguere test (patrick Fabere in the air)
Pt. Supine. Dr. Flexes abducts and laterally rotates hip. Apply pressure on opposite ASIS and downward pressure on the knee > hip pain > hip lesion
Neri’s sign
Pt. Leans forward at the waist > knees buckle > tight hamstrings
Noble Compression test
Dr. Places leg in 90/90 position, apply pressure to distal lateral femur and extend the knee > pain > TFL contracture
Magnusson’s test
Ask pt. To point to pain area. Mark with pencil, return later and ask them to point to it again. If they point to different spot> LIAR aka MALINGERER
Lewin Supine test
Pt. Supine dr holds ankles to table. Pt asked to sit up w/o using hands > unable >AS
Sternal compression test
Dr applies downward pressure on sternum with pt supine > pain localized at lateral rib border > Fx ribs
