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NPTE Muskuloskeletal > Special Tests UE & LE > Flashcards

Special Tests UE & LE Flashcards

1
Q

Hawkins-Kennedy

A

For: subacromial impingement

  • Seated/standing, passively flex shoulder to 90, elbow at 90, maximally IR.
  • May be performed in various degrees of flexion/horizontal adduction.

+reproduction of pain in shoulder region

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2
Q

Near Test

A

For: subacromial impingement

Seated, shoulder passively IR, then abducted to 180.

+reproduction of pain in shoulder region.

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3
Q

Painful arc

A

For: Subacromial impingement

Active abduction of shoulder and reports start/stop of any pain.

+if pain reported between 60-120 degrees abduction.

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4
Q

Empty can test

A

For/aka: supraspinatus test of tendon or muscle

  1. Seated with shoulder abducted to 90, no rotation, resist shoulder abduction.
  2. Repeat in empty can position within scapular plane (30 degrees horizontal adduction).

+ reproduces pain in supraspinatus tendon or weakness in empty can position.

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5
Q

Drop arm test

A

For: rotator cuff pathology

  • Seated, shoulder passively abducted to 120 degrees
  • Pt instructed to slowly bring arm to side, guard arm in case of give-way

+patient is unable to lower arm slowly back to side

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6
Q

External rotation lag sign

A

For: rotator cuff pathology

Seated or standing, passive abduct shoulder to 90, and ER rotate to end range. Then release.

+if patient unable to maintain ER position

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7
Q

Infraspinatus muscle test

A

For: infraspinatus rotator cuff pathology

Seated or standing, resist ER with arm neutrally rotated and abducted to the trunk

+patient gives way

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8
Q

Hornblower test

A

For: rotator cuff pathology

  • Standing, passively elevate arm to 90 in the scapular plane, flex elbow to 90.
  • Pt. ER against resistance.

+unable to ER arm

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9
Q

Internal Rotation lag sign

A

For: rotator cuff pathology (subscapularis)

Seated, hold pt’s hand behind back in lumbar religion in full IR. Release.

+if unable to maintain IR position when arm released.

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10
Q

Apprehension Test

A

For: anterior instability of the Glenohumeral joint (SLAP, biceps tendon ect)

Supine, shoulder at 90 degrees abduction. Slowly ER to full motion.

+look of/feels apprehension/alarmed. Resists further motion. (Apprehension>pain)

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11
Q

Relocation Test

A

For: Anterior instability of Glenohumeral joint

After positive apprehension test, perform PA glide on head of humerus.

+patient loses apprehension or pain decreases.
Relocation does not typically change pain with primary impingement.

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12
Q

Jerk/Clunk Test (posterior)

A

For: posterior and inferior instability of the Glenohumeral joint

Seated, shoulder flexed to 90 and IR. Axially load humerus and horizontally adduction arm.

+production of jerk or clunk as humeral head subluxes off back of glenoid

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13
Q

Sulcus Sign

A

For: inferior and posterior insatability of the Glenohumeral joint

Standing, arm at side. Arm is pulled dismally.

+presence of sulcus (2 finger widths) inferior to the acromion combined with reproduction of symptoms.

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14
Q

Horizontal adduction test

A

For: Acromioclavicular joint (AC)

Standing, shoulder flexed to 90. Arm actively or passively fully adducted across the body.

+localized pain over the AC joint

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15
Q

Paxinos Sign

A

For: AC joint

Seated, arms relaxed at sides. PT places thumb under posterolateral aspect of the acromion and the index/long fingers of the same hand over the middle part of the clavical and applies pressure with both thumbs(anterosuperior) and fingers (inferior).

+pain localized in the AC joint

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16
Q

Active Compression (O’Brien) test

A

For: SLAP (superior labrum anterior to posterior) lesion

Standing, arm flexed to 90 and elbow fully extended.

  1. Arm horizontally adducted 10-15 degrees, fully IR, and downward force applied.
  2. Arm returned to start position fully ER and downward force applied.

+test is joint pain or painful clicking produced in the first part of the test and eliminated in the 2nd.
Must differentiate between GH v. AC joint symptoms

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17
Q

Biceps Load II test

A

For: SLAP lesions

Supine, shoulder abducted to 120, elbow flexed to 90, forearm supinated.
Shoulder is fully ER if apprehension appears the patient is asked to flex the elbow against resistance.

+if apprehension remains the same or shoulder becomes more painful with elbow resistance.

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18
Q

Anterior Slide Test

A

For: SLAP lesion

Seated, hands on waist, thumbs posterior. With scapula stabilized and anterior-superior force is applied to elbow.

+pain or click reproduced deep in shoulder.

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19
Q

Compression-rotation test

A

For: SLAP lesion

Supine, shoulder passively abducted to 20-90 degrees. Axial compression applied while passively circumducting the GH joint.

+pain, clicking, or catching sensation produced.

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20
Q

Yergason’s Test

A

For: to test for integrity of transverse ligament, bicipital tendinosis/tendon op Athey, and SLAP lesions

Sitting, shoulder in neutral stabilized against trunk, elbow at 90, forearm pronated. Resist supination and ER of shoulder.
“Singing in the rain”

+tendon of biceps long head will “pop out” of groove. May also reproduce pain in long head of biceps tendon.

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21
Q

Speed’s Test

A

For/aka: “biceps straight arm”, test for bicipital tendinosis/tendonopathy and SLAP lesions

  • Sitting or standing, with upper limb in full extension and forearm supinated. Resist shoulder flexion.
  • May also place shoulder in 90 degrees flexion and push upper limb into extension, causing eccentric contraction of biceps.

+pain in anterior shoulder (groove)

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22
Q

Upper Limb Tension Test:

Median and Anterior Interosseous Nerve Bias

A 
Shoulder: depressed an abducted (110)
Elbow: Extended
Forearm: supinated
Wrist: extended
Digits: extended
CSpine: contralateral flexion
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23
Q

Upper Limb Tension Test:

Median, Axillary, and Musculocutaneous Nerve Bias

A 
Shoulder: depression and abduction (110), ER
Elbow: extension
Forearm: supination
Wrist: extension
Digits: extension
Cspine: contralateral side flexion
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24
Q

Upper Limb Tension Test:

Radial Nerve Bias

A 
Shoulder: depression and abduction (10), IR
Elbow: extension
Forearm: pronation
Wrist: flexion and ulnar deviation
Digits: flexion
Cspine: contralateral side flexion
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25
Q

Upper Limb Tension Test:

Ulnar Nerve Bias

A 
Shoulder: depression and abduction (10-90) with hand to ear (owl/waiter’s position), ER
Elbow: flexion
Forearm: supination
Wrist extension and radial deviation
Digits: extension
Cspine: contralateral side flexion
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26
Q

Adson’s Test

A

For: Thoracic Outlet Syndrome (TOS), Identifies structures that pass through thoracic inlet

Seated, Find radial pulse of UE being tested. Rotate head toward UE. Passively extend, and ER shoulder while extending the head.

+neurological or vascular symptoms (loss of pulse) reproduced in UE.

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27
Q

ROOS

A

For: TOS, identifies structures that pass through thoracic inlet

Standing, shoulder fully ER, abducted to 90, and slight horizontally abducted, elbows flexed to 90. “Goal posts”.
- Open and close hands for 3 minutes.

+Neuro and or vascular symptoms (pulse disappears) reproduced in UE.

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28
Q

Elbow extension test

A

For: rule out fx, or joint injury

+patient unable to fully extend elbow

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29
Q

Varus/Valgus stress test (elbow)

A

For: Ligamentous instability (UCL, RCL elbow)

Sitting/supine, entire UE is supported and stabilized. Elbow at 20 to 0 degrees flexion.

  1. Valgus force for UCL
  2. Varus force for RCL

+primary finding is laxity but pain may be noted.

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30
Q

Moving Valgus stress test (elbow)

A

For: ligamentous stability of the elbow

Standing or supine, arm abducted elbow fully flexed. Maintain Valgus stress and quickly extend patient’s elbow.

+reproduction of pain from 120-70 of elbow flexion indicates partial tear of UCL

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31
Q

Biceps rupture/“Popeye’s” Sign

A

For: biceps rupture, proximal long head

Distal bunching of the muscle with complete loss of function

32
Q

Elbow flexion test

A

For: ID cubical tunnel syndrome (Neuro dysfunction)

Supine, performed bilaterally with shoulder in full ER and the elbow actively held in maximal flexion with wrist extension for one minute.

+pain present at medial aspect of the elbow and numbness and tingling in the ulnar distribution not he involved side.

33
Q

Pinch Grip test

A

For: identify entrapment of the anterior interosseous nerve

Ask pt. to pinch tips of index fingers and thumb

+unable to pinch tip to tip; compensatory pulp to pulp pinch is present.

34
Q

Ulnomeniscotriquetral dorsal glide test

A

For: ligament, capsule, and joint instability (wrist)

Seated, arm pronated. Posterior directed force applied with examiner’s thumb over ulna dorsal and index finger over pisotriquetral complex anteriorly.

+excessive pain or laxity indicates triangular fibrocartilage complex (TFCC) pathology

35
Q

Watson (scaphoid shift) test

A

For: ligamentous instability of wrist (scaphoid)

Seated, elbow resting on table, forearm pronated, wrist placed in full ulnar deviation with pronated with slight extension, while stabilizing metacarpals. Place pressure on distal pole of scaphoid while radially deviation and slightly flexing the pt’s hand.

+Painful “shift” of the scaphoid with a “clunk” when pressure is removed indicates carpal instability.

36
Q

Interphalangeal joint/varus/Valgus stress tests

A

For: ligamentous, capsular, and joint instability

Finger supported and stabilized. Varus/Valgus forces applied to PIP, and DIP of all digits.

+primary laxity, pain may be noted

37
Q

Eichhoff’s test

A

For: identifies de Quervain’s tenosynovitis (tendonitis of the abductor pollicis longus and/or extensor pollicis brevis) (pregnant or nursing women)

Makes a fist with thumb flexed in fingers, and moves wrist into ulnar deviation.

+reproduced pain in wrist, often painful with no pathology, compare to uninvolved side.

38
Q

Finkelstein’s test

A

For: de Quervain’s tenosynovitis (tendonitis of the abductor pollicis longus, and/or extensor pollicis brevis

PT passively pulls wrist and thumb into ulnar deviation and applied longitudinal traction.

+reproduces pain in wrist, painful with no pathology, compare to uninvolved side.

39
Q

Wrist Hyperabduction and abduction of thumb test (WHAT)

A

For: identifying de Quervain’s tenosynovitis (tenonitis of the abductor pollicis longus and/or extensor pollicis brevis)

Pt’s wrist is hyperflexed with the thumb abducted to full MCP and IP extension. Apply resistance against PT’s index finer.

+reproduces pain the wrist

40
Q

Phalen’s (wrist flexion) test

A

For: neurological dysfunction/compression or entrapment of the median nerve (carpal tunnel)

Maximally flexes both wrists holding them against each other for up to 1 minute.

+reproduces tingling and/or parenthesis into hand rolling median nerve distribution.

41
Q

Two point discrimination test

A

For: identifies level of sensory inner action within hard that correlates with functional ability to perform certain tasks involving grasp.

Use a caliper/paper clip. Apply to palmar aspect of fingers to assess patient’s ability to distinguish between two points of the device. Record smallest difference patient can sense two points.

Normal discrimination of two points <6mm. >6mm abnormal.

42
Q

Tinel’s Sign

A

For: idenfies carpal tunnel compression of median nerve (can also be done over tunnel of Guyon/near ulnar nerve elbow.)

Tap religion where median nerve passes through carpal tunnel.

+reproduces tingling/parathesia into hand following median nerve distribution.

43
Q

Modified Allen Test

A

For: “vascular compromise”

  1. ID radial and ulnar arteries at the wrist by patient opening and closing wrist several times.
  2. Compress ulnar a. And have patient open hand. Observe change in color/refilling. Repeat with radial a.

+abnormal blood filling. -normal filling of palm going from white to red/normal color.

44
Q

Bunnel-Littler test

A

For: identifies joints or intrinsic tightness of the PIP

  1. MCP stabilized in slight extension, PIP is flexed. 2. Then MCP is flexed and PIP is flexed.

+if flexion is limited in both=capsule is tight. If there is more PIP flexion with MCP flexion then intrinsic muscles are tight.

45
Q

Tight retinacular test

A

For: identifying tightness of proximal IP joints (PIP)

PIP is stabilized in neutral while DIP is flexed. Then PIP and DIP is flexed.

+Flexion limited in 1 and 2=tight capsule. If more DIP flexion occurs with PIP flexion=retinacular ligaments tight.

46
Q

Hip scour test

A

For: identifies DJD of hip joint

Supine, with hip in 90 flexion and knee flexed fully. Add compressive load into femur through knee. (Can move in sweeping motions)

+reproduction of hip pain in joint and refer pain to the knee/other.

47
Q

Patrick (FABER/FADIR) test

A

For: labral lesions, anterior-superior impingement, iliopsoas tendinopthy, and anterior labral tears

Supine, LE is passively taken from full hip flexion, abduction, and ER (FABER) into flexed, adducted, and IR (FADIR).

+reproduction of pain with or without click

48
Q

Thomas Test

A

For: muscle length, identify tight hip flexors

Supine, one hip and knee fully flexed to chest and held. Opposite kept straight. (Have lay back after grabbing leg).

+unable to keep straight leg flat on table (hip) or knee extends. No differentiation between iliacus v. Psoas major.

49
Q

Ober’s test

A

For: muscle length, identifies tightness of the tensor fascia late and/or IT band.

Side lying, LE flexed at hip and knee. Passively extend and abduct upper hip with knee flexed to 90 and slowly flower limb into adduction/to table. Modified test starts with knee extended.

+if UE does not reach 0 degrees abduction/horizontal.

50
Q

Ely’s test

A

For: IDing tightness of rectus femoris

Prone, flex knee of tested limb.

+if hip of tested limb flexes,

51
Q

90-90 hamstring test

A

For: IDing hamstring tightness

Supine, hip and knee supported in 90 flexion. Passively extend knee until barrier is encountered.

+knee lacks 10 degrees or greater of knee extension (from 90) = <=80 degrees of knee flexion.

52
Q

Piriformis Test

A

For: IDs piriformis tightness/piriformis syndrome

Side lying, tested LE cross over body and pressed down off edge of table with pelvis/hip stabilize.

+reproduction of pain/parasthesias in buttock or along sciatic nerve. Or knee unable to be parallel/at the same leve.

53
Q

Trendelenburg Sign

A

For: IDs weakness of gluteus medius or unstable hip (joint)

Standing and asked to stand on one leg (flex opposite knee)

+stance side pelvis (same side) drops when LE support is removed

54
Q

Leg length

A

For: measure length of LEs to determine need for heel lift/evaluate scoliosis/risk of injury in certain populations/back pain

Supine, pt performs bridge. Measure ASIS to lateral malleolus or medial malleolus on BUEs ~3xs. (Unequal Upper LE mass can skew results if medial mal used.)

+difference of greater than .5 between legs = true leg length difference.

  • true difference caused by anatomical difference (bone length, tibia, or femur)
  • functional discrepancies not anatomical, are result of abnormal position or posture, eg. pronation of a foot or pelvic obliquity.
55
Q

Patellar-Pubic Percussion Test

A

For: hip fx,

Supine, examiner percusses each patella while auscultations the pubic symphysis with a stethoscope.

+decreased percussion on affected side.

56
Q

Lachman’s test

A

For: 1-plane anterior instability, integrity of the ACL

Supine, knee flexed to 20-30. Stabilize femur. PA mob of tibia.

+excessive anterior translation of tibia on femur v. Uninvolved limb/lack of firm end-feel.

57
Q

Anterior drawer test

A

For: ACL integrity,

Supine, hip flexed to 45, knee flexed to 90. Passive PA mob.

+excessive anterior translation of tibia on femur, lack of firm end feel.

58
Q

Posterior drawer test

A

For: PCL integrity

Supine, hip flexed to 45, knee flexed to 90, AP mob applied.

+excessive posterior translation of tibia on femur, lack of firm end feel.

59
Q

Posterior sag sign

A

For: PCL integrity

Supine, hip to 45, knee to 90 with support ankles.

+observe for posterior tibial “sag”

60
Q

Valgus stress test (knee)

A

For: MCL integrity of knee

Supine, knee supported and Valgus (medial) force applied at knee at 0 and 30 degrees. Ankle stabilized in lateral rotation.

+laxity/pain
+at 0 degrees extension indicates MAJOR disruption of the knee with 1 or > + rotary tests

61
Q

Varus stress test (knee)

A

For: integrity of LCL of knee

Supine, knee supported, varus (lateral) force applied at 0 and 30 degrees.

+laxity/pain
+ at 0 indicaties MAJOR disruption of knee with 1 or > positive rotary tests.

62
Q

Pivot-shift test (knee)

A

For: Anterolateral instability, integrity of ACL

  1. Supine, knee in extension, hip flexed/abducted to 30 with slight IR.
  2. Hold knee and foot with each hand. Place Valgus force through knee.

+tibia relocating during test, as knee is flexed tibia clunks backward at ~30-40degrees.

63
Q

McMurray test

A

For: meniscus tear

Supine, knee maximally flexed.

  1. Passive IR and ext knee (lateral meniscus).
  2. Passive ER and ext knee (medial meniscus).

+reproduction of lick and/or pain in knee joint.

64
Q

Thessaly test

A

For: meniscus tear

Pt. Standing on symptomatic leg holding PT’s hands. Pt. Rotates body on leg to IR and ER with knee flexed at 5 and 20 degrees.

+reproduction of click/pain in knee joint.

65
Q

Patellar apprehension test

A

For: Patellofemoral instability,

Supine, knee flexed to 30, quadriceps relaxed. Passively translate patella laterally.

+expresses apprehension, or contracts quads to prevent patellar dislocation.

66
Q

Nobel compression test

A

For: IT band compression syndrome

Supine, knee flexed to 90 with hip flexion. Pressure applied 1-2 cm proximal to lateral femoral epicondyle, then pt’s knee passively extended.

+pain over lateral femoral epicondyle.

67
Q

Brush (stroke) test (knee)

A

For: Swelling of the knee,

Supine, full knee ext. Stroke upward from medial tib-fem joint 2-3x towards suprapatelar pouch. Then stroke downward from thigh to lateral joint line. (UP MEDIAL, DOWN LATERAL).

+fluid observed on medial knee. Quantified on 5pt scale.
0=no wave produced, trace/small wave produced
1+= larger bulge
2+=spontaneous return after upstroke
3+unable to move effusion out of medial knee

68
Q

Anterior drawer test (ankle)

A

For: ligamentous instability of anterior talofibular ligament (primary)

Supine, foot off edge of table, ankle 20 PF. Translate talus anteriorly stabilizing LE.

+excessive anterior talar translation and/or pain.

69
Q

Talar tilt

A

For: integrity of calcaneofibular ligament.

Side lying, knee slightly flexed, ankle in neutral (90?). Move foot into maximal adduction (stress calcaneofibular ligament) and abduction (stressed deltoid ligament)

+laxity/pain

70
Q

Medial subtalar glide test

A

For: ligamentous instability

Hold talus in subtalar neutral position with one hand, and translate calcaneous medically on fixed talus with the other hand.

+laxity/pain??

71
Q

External rotation stress (Kleiger) test

A

For: integrity of distal tibiofibular syndesmosis

Seated, knee flexed to 90, ankle in neutral. Apply ER force to foot while holding tibia in neutral.

+visible joint gapping, or concordant pain.

72
Q

Dorsiflexion-external rotation stress test

A

For: integrity of distal tibiofibular syndesmosis

Seated, knee flexed to 90, ankle DF maximally. Apply ER force to foot while holding tibia in neutral position.

+visible joint gapping or reproduction of pain.

73
Q

Squeeze test

A

For: integrity of distal tibiofibular syndesmosis (after ankle sprain)

Seated, knee flexed to 90. Apply compression between the middle and distal third fo patient’s leg.

+pain reproduced at syndesmosis.

74
Q

Thompson’s test

A

For: Achilles’ tendon rupture

Prone, foot off edge. Squeeze calf.
Normal = ankle PF
+no movement of foot

REG FLAG if + for immediate referral to an ortho surgeon for immobilization or surgical repair is recommended. Delayed diagnosis results in decreased outcomes.

75
Q

Windlass test

A

For: plantar fasciitis, ID’s windlass effect for PF

  1. WB test. Standing on step with toes positioned over edge of step and equal WB. Passively extend 1st MTP.
  2. Non-WB test. Seated knee flexed to 90. Stabilize ankle and passively extend 1st MTP.

+reproduction on plantar surface symptoms (non-WB test symptoms at end ROM)

NPTE Muskuloskeletal (2 decks)

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