Testing the integrity

Question 1

MCL tears, elbow

Answer 1

patient sitting upright. Abduct shoulder to 90 degrees, maximally flex the elbow. Apply a valgus torque to the elbow. Maintaining the valgus torque, quickly extend elbow to around 30 degrees. Positive test= sudden medial elbow pain and pain is maximal from 120 to 70 degrees.

Question 2

LCL tears, elbow

Answer 2

patient sitting upright. Fixate humerus, put it in external rotation. Palpate the radial collateral ligament. Flx elbow to 20 degrees and apply a varus force. Positive test= pain or soft end feel.

Question 3

Iliopsoas tightness

Answer 3

Thomas test. patient supine. Check for lumbar lordosis. Ask patient to bring their knee as far to their chest as possible and hold it. Positive test= the extended leg is lifting off the table. If the extended leg is abducting, indicates a tight iliotibial band

Question 4

MCL, knee

Answer 4

patient supine with legs fully extended. Use one hand to grab lower leg just proximal to ankle joint, use other hand to fixate femur. Slightly externally rotate the tibia and perform passive abduction to put stress on the MCL. Look for pain and excessive gapping on the medial side.

Question 5

LCL, knee

Answer 5

patient supine with legs fully extended. Half sit on the plinth with the patients leg over you. Use one hand to grab the lower leg just proximal to the ankle joint and fixate the femur with the other hand on the medial side. Apply lateral rotation with the first hand, perform passive adduction of the knee to put stress on the LCL. Do the same test again but with the knee is 20 to 30 degrees of flexion. Look for excessive gapping on the lateral side of the knee and pain

Question 6

Anterior drawer test

Answer 6

patient supine. Hip in 45 degrees and kne in 90 degrees of flexion. Fixate position by sitting on foot of patient. Palpate joint line with thumbs and wrap hands around the calf. Pull the tibia anteriorly in an expolsive movement. Positive test= tibia translates anteriorly without an abrupt stop or the end feel is soft and mushy.

Question 7

Posterior drawer test

Answer 7

patient supine. Hip in 45 degrees and knee in 90 degrees of flexion. Fixate position by sitting on foot of patient. Palpate the joint line and push the tibia posteriorly by more than 6mm or the end feel is soft and mushy.

Question 8

Patella tap test

Answer 8

patient supine with legs fully extended. Stroke distally until you find the suprapatella pouch and press downwards. With the other hand, stop just below the apex of the patella. While applying downward pressure, use finger from the more proximal hand and see if the patella is floating

Question 9

Achilles tendon rupture

Answer 9

Thompson test. patient prone with feet hanging off the edge of the plinth. Squeeze the calf twice and observe plantarflexion. If this is absent, this indicates a rupture to the tendon

Question 10

Talar tilt test

Answer 10

patient sitting with knee hanging off the edge of the plinth. To test the anterior talo-fibular, bring foot into plantaflexion and perform inversion. To test calcaneo-fibular, bring foot into anatomical position, then into inversion and eversion. To test posterior talo-fibular, bring foot into max dorsiflexion, then into inversion and everison. Look for pain

Question 11

Annular ligament

Answer 11

P/a glide. patient seated, arm on plinth. Fixate humerus with one hand and palpate joint line with thumb. Try to find radius with other hand. Give pressure into direction of patients chest

Question 12

Hip Flexion

Answer 12

Rectus femoris, iliacus, psoas major and sartorius.

supine. Bring hip into 60 degrees of flexion, support the lower leg and give resistance into extension

Question 13

Hip Extension

Answer 13

Gluteus maximus and hamstrings.

supine. Bring hip into 30 degrees of flexion and give resistance into flexion.

Question 14

Hip Adduction

Answer 14

Adductor longus, brevis, magnus and gracilis.
Put one hand distal to knee and one hand proximal to the knee, and ask patient to bring the legs together while giving resistance

Question 15

Hip Abduction

Answer 15

Gluteus medius and minimus.

Put one hand distal to the knee and one hand proximal to the knee. Ask patient to move leg outwards while resisting.

Question 16

Hip Internal rotation

Answer 16

Tensor fascia latae, gluteus medius and minimus, adductor longus, magnus and brevis, pectineus.
Flex hip to 90, ask patient to move ankle outwards while giving resistance

Question 17

Hip External rotation

Answer 17

Piriformis, gluteus maximus, medius and minimus

Flex hip to 90, ask patient to move ankle inwards while giving resistance.

Question 18

Knee flexion

Answer 18

Biceps femoris, semimembranosus, semitendinosus, sartorius, gracilis.
Put one hand proximal to the ankle joint, flex hip to 30 degrees, ask patient to bring heel to bum.

Question 19

Knee extension

Answer 19

Rectus femoris, vastus lateralis, vastus medialis and vastus intermedius, gastrocnemius, plantaris
Put one hand proximal to the ankle joint, place other hand under the leg and rest it on the other leg. Ask patient to extend the leg.

Question 20

Dorsiflexion

Answer 20

Tibialis anterior.

Knee flexed to 90. fixate the lower leg. Apply downward pressure on dorsum of the foot and ask patient to resist.

Question 21

Plantarflexion

Answer 21

gastrocnemius, plantaris, soleus, fibularis longus and brevis. Knee flexed to 90. fixate lower leg. Ask patient to bring foot towards the plinth, resist at the sole of the foot

Question 22

Inversion

Answer 22

Tibialis anterior, tibialis posterior. Fixate tibia. Ask patient to turn foot inwards, resist with hand wrapped around the sole of the foot.

Question 23

Eversion

Answer 23

Fibularis longus, brevis and tertius. Fixate tibia on the dorsal side (posterior) ask patient to turn foot outwards, resist this.

Question 24

Biceps Brachii

Answer 24

Forearm pronated and elbow extended. Resist supination and then resist flexion of the elbow, then ask patient to bring their hand towards their mouth to resist the shoulder flexion component

Question 25

Brachialis

Answer 25

Flex elbow to 90. Forearm pronated. Give resistance into extension.

Question 26

Brachioradialis

Answer 26

Flex elbow to 90. Forearm in neutral. Give resistance into extension

Question 27

Triceps Brachii

Answer 27

Flex elbow to 90. Forearm in neutral. Give resistance into flexion.

Question 28

Pronator teres

Answer 28

Flex elbow to 90. Forearm in neutral. Resist into supination

Question 29

Supinator

Answer 29

Flex elbow to 90. Forearm in neutral. Resist into pronation

Question 30

Wrist flexion

Answer 30

Flex elbow to 90. One hand on distal forearm, other hand across palmar aspect of hand. Give resistance into extension

Question 31

Wrist extension

Answer 31

Flex elbow to 90. One hand on distal forearm, one hand across dorsal aspect of hand. Give resistance into flexion

Question 32

Shoulder flexion

Answer 32

sitting upright. Give resistance into extension

Question 33

Shoulder extension

Answer 33

sitting upright. Give resistance into flexion

Question 34

Shoulder abduction

Answer 34

sitting upright. Put pressure at upper arm into adduction.

Question 35

Shoulder adduction

Answer 35

Sitting upright. Put pressure at upper arm into abduction

Question 36

Shoulder external rotation

Answer 36

Sitting upright, elbow flexed to 90. Put pressure at distal forearm/hand towards the body

Question 37

Shoulder internal rotation

Answer 37

Sitting upright, elbow flexed to 90. Put pressure at distal forearm/hand away from the body.

Question 38

Elevation

Answer 38

Place hands on both acromions, ask patient to shrug shoulders and resist this.

Question 39

Depression

Answer 39

Ask patient to shrug shoulders slightly with arms crossed. Put hands below their elbows and resist the depression

Question 40

Protraction

Answer 40

Put hands on humerus, just below humeral head, bring shoulders back and ask patient to resist.

Question 41

Retraction

Answer 41

Put hands on humerus, just below humeral head, push into protraction and ask patient to resist