Special Tests / Signs

Question 1

Fromet’s Test

Answer 1

• Touching thumb and index pads together
• Tests adductor pollicis (innervated by ulnar nerve)
• (+) = IP joint of thumb flexes during activity, meaning there is ulnar nerve involvement causing weakness of adductor pollicis

Question 2

Noble’s Test

Answer 2

• Provocative test of the IT band (other test that could be used is the Ober’s Test)
• Patient supine or sidelying with injured side up, slowly bend knee back and forth several times from 0-90 degrees while palpating and applying firm pressure on lateral epicondyle of femur
• (+) = palpable snapping, rubbing, or squeaky hinge-like crepitus, or localized pain that increases with pressure at or above epicondyle (often at 30 degrees of flexion)

Question 3

Kehr’s Sign

Answer 3

• Left shoulder pain caused by irritation of inferior surface of diaphragm due to bleeding from splenic rupture
• Technique — patient in supine with LE elevated (trendelenburg position) with gentle palpation of abdomen eliciting left shoulder pain
• (right shoulder pain typically signals liver or gallbladder irritation)

Question 4

Legg-Calve Perthes Disease (LCPD) Overview

Answer 4

• Avascular necrosis of femoral head
• Cause unknown
• Prognosis — 2-5 years progression, then it will stop and patient will recover

Question 5

Legg-Calve Perthes Disease (LCPD) Patient Profile

Answer 5

• Primarily males
• 3-12 years old (differentiating factor from SCFE)
• Insidious, gradual onset
• Pt is short in stature

Question 6

Legg-Calve Perthes Disease (LCPD) Signs & Symptoms

Answer 6

• Pain in groin and anterior medial thigh
• Aggravated by activity and relieved with rest
• Initially presents with a limp
• Trendelenburg gait/sign
• Psoatic limp (pain causes muscles to inhibit and stop working so other muscles compensate — hip flexion, ER, and adduction with exaggerated trunk involvement)

Question 7

Legg-Calve Perthes Disease (LCPD) Conservative Treatment

Answer 7

• Limit deformity and preserve femoral head
• We heal/shape bone through weight bearing and proper alignment
• WB recommended with femur in adduction and IR (put pt in splint or physically place pt there)
• Aquatic therapy
• Gait training
• ROM exercises

Question 8

Slipped Capital Femoral Epiphysis (SCFE) Overview

Answer 8

• Traumatic (sudden) unilateral condition
• Caused by weak femoral epiphyseal growth plates and excessive mechanical shear forces
• Later the onset, the worse the condition will be
• Most patients have surgical intervention

Question 9

Slipped Capital Femoral Epiphysis (SCFE) Patient Profile

Answer 9

• Primarily males
• 12-15 years old
• Obese / overweight
• Pain in groin and anterior medial thigh
• Pt doesn’t want to weight bear on limb, often holding leg in ER
• Presents with capsular pattern of hip (flexion, abduction, IR)

Question 10

Slipped Capital Femoral Epiphysis (SCFE) Signs/Symptoms

Answer 10

• Initially presents with limp
• Trendelenburg gait/sign
• Lurch gait (backward trunk lean)
• Risk factor — femoral retroversion (toe out)

Question 11

Slipped Capital Femoral Epiphysis (SCFE) Treatment

Answer 11

• Conservative treatment may happen before surgery
• Keep displacement to a minimum
• Maintain ROM
• Prevent degenerative arthritis
• NOOO weight bearing is recommended (because this can lead to osteonecrosis)
• Surgical treatment — internal surgical fixation with pinning

Question 12

Homans Sign

Answer 12

• Tests for DVT (also called DF sign test)
• Patient actively extends knee, examiner raises patient’s straight leg to 10 degrees, then passively/abruptly dorsiflexes the foot and squeezes calf with other hand
• (+) = deep calf pain and tenderness may indicate presence of DVT

Question 13

Tripod Sign

Answer 13

• Used to assess length of hamstring muscles
• Patient seated with knees flexed to 90 degrees over edge of table, examiner passively extends one knee, repeat bilat
• (+) = patient has to lean backward and extend trunk to relieve tension in hamstrings when knee is fully extended
• Side note —> important to exclude nerve root problem because this can cause a positive test as well, in that case the pt will complain of shooting pain down entire leg instead of muscular tension in the hamstrings

Question 14

Craigs Test

Answer 14

• Used to measure femoral anteversion or forward rotation of femoral neck
• Patient prone with tested leg bent to 90 degrees of knee flexion, then foot/ankle moved laterally
• Normal = at birth anteversion angle is 30 degrees which decreases to 8-15 degrees in adults
• Angle >15 degrees = increased anteversion leads to pigeon toed walking (more common in girls)
• Angle <8 degrees = retroversion

Question 15

Elys Test

Answer 15

• Used to assess rectus femoris muscle flexibility
• Patient prone, examiner has one hand on low back and other holding leg at heel, passively flex knee in rapid fashion, heel should touch buttocks, and then test bilat
• (+) = heel cannot touch buttocks, hip of tested side rises from the table, and patient feels pain or tingling in back or legs

Question 16

Purpose of Barlow & Ortolani Tests

Answer 16

• Instability of hip can be assessed
• These play a role in clinical screening for developmental hip dysplasia

Question 17

Barlow Test

Answer 17

• Examiner adducts hip while applying posterior force on knee
• This promotes dislocation

Question 18

Ortolani Test

Answer 18

• Examiner abducts hip while applying anterior force on femur
• This reduces hip joint (dislocated hip into acetabulum)