Testing

Question 1

4 special tests for subscapularis tear

Answer 1

1. bear-hug test: patient places the palm of the affected side on the opposite shoulder, with the fingers extended, elbow in front of body, examiner applies an external rotation to the patient’s forearm, patient with internal rotation, positive with pain or weakness
2. belly-press test: patient with elbow 90 degree flex, palm below the xiphoid process, patient int rot to press palm against the abdomen, positive for subscapularis muscle dysfunction if the patient compensates the movement through wrist flexion, shoulder adduction and shoulder extension
3. internal rotation lag sign: patient seated, examiner behind patient pulls arm in max int rot behind the back with dorsal side hand on lumbar region, one hand passively move patient’s elbow into 20 deg ext other hand supporting elbow, patient maintains pos, positive more than 5 deg ext rot
4. Gerber’s lift-off test: patient standing, examiner behind patient, patient places the back hand in the mid lumbar spine area away from body, patient int rots while examiner places force onto hand into back, positive if weakness, pain or compensation with elbow and shoulder ext

Question 2

paxino’s sign

Answer 2

1. test AC joint sprain
2. patient sitting upright and relaxed, create translation in AC joint by pressing acromion and coracoid together and monitor for pain

Question 3

O’Brien’s/active compression

Answer 3

1. low sensitivity test for AC and labral issues depends on where pain is (AC = specific pt, labral = broad deep pain)
2. patient upright, 90 deg shoulder flexion, elbow straight and crossflex 10-15 deg and internally rotate shoulder to point thumb down; place hand on forearm and put downward pressure while patient resists; repeat with ext rotation GH (thumb up)
3. positive for AC joint injury if pain with int rot improves with ext rot and point specific pain; glenoid labral tear if pain deep or clicking sound

Question 4

ACL test

Answer 4

1. Lachman’s test: laying supine, leg abducted off table with thigh on but leg off, bend knee 20-30 deg flexion with foot between examiner’s leg, use one hand to steady femur and other hand compresses gastroc and put thumb on tibial tuberosity and pull ant in parallel dir of femur; working ACL should stop motion forward and feel firm
2. Anterior drawer: laying supine, 90 deg knee flexion, hold femur down with one hand, other hand compresses gastroc and put thumb on tibial tuberosity and pull ant in parallel dir of femur; working ACL should stop motion forward and feel firm

Question 5

posterior drawer knee

Answer 5

1. tests PCL
2. laying supine, 90 deg knee flexion, place the thenar eminences of both hands against the anterior tibia, and push post in parallel dir of femur, on either side of the patellar tendon
3. working PCL should stop motion inward and feel firm

Question 6

McMurray’s of the knee

Answer 6

patient lying supine, bring knee into deep flexion to compress meniscus, externally rotate (medial) or internally rotate (lateral) to bias a side; feel for the meniscus as you extend the leg; a pop, jump or squishy feeling may indicate injury

Question 7

valgus stress test of knee

Answer 7

1. test MCL
2. abduct the hip so that the leg is hanging off the bed with the thigh on it, stand on lateral side of the leg with hip perpendicular to the femur at the knee and hold thigh in 20-30 deg flexion with hand at distal end of tibia and pull the tibia toward you, hold down the femur with the other hand and rotate the femur towards the medial side to apply valgus stress

Question 8

varus stress test of the knee

Answer 8

1. test LCL
2. abduct the hip so that the leg is hanging off the bed with the thigh on it, stand on the medial side of the leg with hip perpendicular to the femur at the knee and hold thigh in 20-30 deg flexion with hand at distal end of tibia, pull the tibia toward you, hold down the femur with the other hand and rotate the femur towards the lateral side to apply varus stress

Question 9

hamstring strength and injury tests

Answer 9

1. medial side: semimembranosus and semitendinosus; patient in prone; knee flexed 90 deg, rotate tibia internally to bias medial side, one hand on the thigh, ask patient to resist as you try to ext their leg with other; test bilat strength
2. lateral side: biceps femoris; patient in prone; knee flexed 90 deg, rotate tibia externally to bias medial side, one hand on the thigh, ask patient to resist as you try to ext their leg with other; test bilat strength
3. popliteal angle test: laying supine, one hand holding femur 90 hip flexion, hold distal tibia with other hand and ext their leg to max; measure popliteal angle (normal is around 145 deg; if less could be injury or stiffness)

Question 10

FADIR

Answer 10

test for hip impingement by flexing, abducting, and internally rotation hip; ask for pain or limited motion

Question 11

ankle taping

Answer 11

1. pre-tape assessment: history, skin sensitivities and integrity, distal circulation
2. position ankle in neutral and place heel pad over Achilles and lace pad over ant bend of ankle
3. start powerflex where gastroc begins to taper, circling lat to med with half tape width overlap
4. at top of lat malle start figure 8 across dorsal side to med midfoot, plantar side to base of metatarsal, across top of medial malle, behind Achilles and finish at lat malle; X across top of foot
5. heel lock 1 more posterior than 8 to MLA, across plantar side, up lat side to Achilles to med malle
6. heel lock 2 from med malle more posterior than 8 across lat side, up to Achielles to med malle; X on bottom of heel
7. cover windows and circle back up leg with half tape overlap
8. victory tape stirup 1 cup heel and pull up with even tension across both malleoli to top of base layer, 2nd stirup half tape width behind 1st, 3rd stirrup half tape width in front 1st, secure with one circle at top, apply one fig 8 and 2 heel locks, individual circles from top to malleoli overlaping by half
9. check for effectiveness and distal circulation and feedback from athelete

Question 12

inversion stress test x3

Answer 12

1. test lat ankle ligaments, dorsi test PTF, neutral test CF, plantar test ATF
2. hand on heel, forearm on plantar side, other hand on tibia to stabilize ankle, put into inversion + dorsi, plantar, and neutral to end range; ask for pain or limited motion

Question 13

eversion stress test x3

Answer 13

1. test med ankle ligaments, dorsi test PTT, neutral test TC, plantar test ATT and TN
2. hand on heel, forearm on plantar side, other hand on tibia to stabilize ankle, put into inversion + dorsi, plantar, and neutral to end range; ask for pain or limited motion

Question 14

Hawkins Kennedy

Answer 14

1. tests subacromial impingement
2. Athlete seated, raises GH 90 deg flexion with elbow flexed 90 deg, tester internally rotates the shoulder to end range; one hand placed under the elbow to
   act as a pivot point, while the other hand grasps the distal end of the forearm, pulling it
   downwards to rotate the shoulder to point of pain or point when scapula begins to rise
3. positive for impingement if this reproduces the athlete’s pain: beneath the acromion
   anteriorly and/or laterally, with possible referral into the deltoid

Question 15

empty/full can

Answer 15

1. supraspinatus pathology
2. Athlete seated upright in a chair, actively abducts GH 90 deg and internally rotates the shoulder to thumbs-down position, tester applies downward pressure against the distal end of the forearm
   while the athlete resists isometrically; repeat this process in the “full” can (ext rot) position, thumb up
3. positive if pain or weakness local to supraspinatus insertion

Question 16

speed’s test

Answer 16

1. bicep tendinopathy and labral tear
2. Athlete seated in a chair (not table edge), shoulder flexed 90 deg, elbow full ext, shoulder externally rotated and forearm supinated, palm faces up; tester -places one hand across the top of the shoulder girdle to stabilize and other hand on distal end of the model’s forearm to apply downward force for isometric contraction of shoulder flexors (bicep); repeat with 45 deg of GH ext for ECC contraction
3. look for pain or weakness, clicking for labrum

Question 17

valgus stress test for elbow

Answer 17

1. test medial ulnar collateral ligaments sprain
2. Athlete seated at the edge of the table, tester stands facing the athlete, lateral to their arm, tester places one hand (top hand) on the lateral aspect of the distal humerus, just above the elbow, second hand (bottom hand) is placed against the distal end of the forearm on the ulnar side, the athlete’s elbow should be supported in a slightly flexed position, although this angle can vary, tester stabilizes the humerus while abducting the distal end of the forearm, creating a valgus stress at the elbow
3. pain or laxity is positive for dmg to complex

Question 18

McMurray’s for the wrist

Answer 18

1. integrity of the triangular fibrocartilage complex (ligaments and cartilage complex between lunate, triquetrum, and ulnar head for compression)
2. Athlete seated or standing, elbow flexed 90 deg and forearm in mid-prone (thumb up), tester uses one hand to stabilize the athlete’s forearm, other hand holds the
   athlete’s hand with handshake grasp and ulnar deviates wrist to end range to compress TFCC while circumducting the wrist like the McMurray’s test for knee
3. pain with clicking or clunking suggests presence of TFCC tear

Question 19

valgus test of thumb

Answer 19

1. test integrite of ulnar collateral ligament of thumb
2. athlete rest forearm on table in mid prone pos, tester apply pressure against shaft of metatarsal 1 and other hand put thumb into extension and abduction at MCP joint to produce valgus stress
3. pain or laxity indicate dmg

Question 20

lateral epicondyle passive test

Answer 20

1. tests ECRB
2. athelte seated, elbow flexed to 90 deg, forearm pronated, wrist flexed to end range with fist closed; palpate lateral epicondyle while stabilizing flexed elbow, other hand on closed fist; passively extend elbow while keeping wrist flexed
3. look for pain at lat epicondyle

Question 21

Lateral epicondyle active test

Answer 21

1. tests ECRB
2. athelte seated, elbow flexed to 90 deg, forearm pronated, wrist neutral with fist closed, support forearm, apply toward for isometric extension; if negative repeat with wrist flexed
3. look for pain at lat epicondyle

Question 22

apprehension relocation

Answer 22

1. test ant GH instability
2. athlete supine with elbow flexed to 90 deg, examiner puts one hand on the humeral head and other than holds athlete forearm, abduct GH to 90 deg and ext rot joint as far as possible and stop when apprehension, pain, or at end of ROM
3. to relocate shoulder, press humeral head posteriorly and adduct arm back to side, ask if pushing posteriorly alleviate apprehension or pain
4. positive with pain and apprehension