Signs/ Tests

Question 1

Rovsing’s sign

Answer 1

Appendicitis
Referred rebound tenderness
Press deeply on the LLQ then quickly withdraw your fingers

Question 2

Psoas Sign

Answer 2

Appendicitis

Place your hand just above the patient’s R knee and ask patient to raise that thigh to your hand

Question 3

Obturator Sign

Answer 3

Appendicitis

Flex the patient’s R thigh at the hip with the knee bent and rotate the leg internally at the hip

Question 4

Murphy’s Sign

Answer 4

Acute cholecysitis
Hook your left thumb under the costal margin at the point where the lateral border of the rectus muscle intersects with the costal margin.

Question 5

Apley scratch test

Answer 5

Ask the patient to touch the opposite scapula

Difficulty suggests rotator cuff disorder or adhesive capsulitis

Question 6

Neer’s Impingement

Answer 6

Press on scapula with one hand and raise the patient’s arm with the other.
Pain indicates possible inflammation or rotator cuff tear

Question 7

Hawkin’s impingement

Answer 7

Flex the patient’s shoulder and elbow to 90 degrees with palm facing down. Then with one hand on the forearm and one on the arm rotate the arm internally.
Pain indicates possible rotator cuff tear or inflammation

Question 8

Supraspinatus strength (empty can test)

Answer 8

Elevate arms to 90 degrees and internally rotate the arms with thumbs pointing down. Ask patient to resist you as you place downward pressure on the arms.
Weakness indicates possible rotator cuff tear

Question 9

Infraspinatus strength

Answer 9

Ask the patient to place arms at side and flex elbows to 90 degrees with thumbs up. Provide resistance as teh patient presses the forearms outward.
Weakness indicates possible rotator cuff tear or bicipital tendinitis

Question 10

Forearm supination

Answer 10

Flex patient’s forearm to 9 degrees at elbow and pronate the patient’s wrist. Provide resistance when the patient supinates the forearm.
Pain indicates inflammation of long head of biceps tendon and possible rotator cuff tear

Question 11

Drop arm sign

Answer 11

Ask patient to fully abduct the arm to shoulder level (or 90 degrees) and lower it slowly. If the arm drops quickly indicates a rotator cuff tear.

Question 12

Hand Grip Strength

Answer 12

Ask patient to grasp your second and third fingers. Decreased strength is a positive test for weakness of the finger flexors and/or intrinsic muscles of the hand.

Question 13

Finkelstein’s test

Answer 13

Ask patient to grasp the thumb against the palm and then move the wrist toward the midline in ulnar deviation
Pain during this maneuver identifies de Quervain’s tenosynovitis from inflammation of the abductor pollicis longus and extensor pollicis brevis tendons. Can also be CTS

Question 14

Tinsel’s sign

Answer 14

Meidan nerve compression

Tap lightly over the course of the median nerve

Question 15

Phalen’s sign

Answer 15

Median nerve compression
Ask patient to hold the wrists in flexion for 60 seconds (have patient press backs of both hands together at right angles)

Question 16

Bulge sign (knee)

Answer 16

Minor Effusions
With the knee extended place the left hand above the knee and apply pressure on the suprapatellar pouch, milking the fluid downward. Stroke downward on the medial aspect of the knee and apply pressure to force fluid into the lateral area. Tap the knee just behind the lateral margin of teh patella with the R hand

Question 17

Balloon sign (Major effusions)

Answer 17

Place thumb and index finger of right hand on each side of the patella. With the left hand, compress the suprapatellar pouch against the femur. Feel for fluid entering into the spaces next to the patella under your right thumb and index finger.

Question 18

Ballotting the patella

Answer 18

To asses large effusion
Compress the suprapatellar pouch and push the patella sharply against the femur. Watch for fluid return to the suprapatellar pouch

Question 19

Integrity of Achilles tendon

Answer 19

Place patient prone with knee and ankle flexed at 90 degrees and squeezes the calf
Watch for plantar flexion

Question 20

McMurrary Test

Answer 20

Grasp the heel and flex the knee
Cup your other hand over the knee joint with fingers and thumb along the medial joint line
From the heel, externally rotate the lower, then push on the lateral side to apply a valgus stress on the medial side of the joint. At the same time slowly extend the lower leg in external rotation

If click if felt or heard- meniscal tear possible

Question 21

Abduction (or Valgus) Stress test (MCL)

Answer 21

Move the thigh 30 degrees laterally to the side of the table. Place one hand against the lateral knee to stabilize the femur and the other hand around the medial ankle. Push medially against the knee and pull laterally at the ankle

Question 22

Adduction (or Varus) Stress Test (LCL)

Answer 22

Same leg position as valgus test but hand on medial knee and lateral ankle. Push laterally against the knee and pull medially at the ankle to open the knee on the lateral side.