NMS: Orthopedic Exams
Magnusson's
At the beginning of each case history the patient is asked to point to the site of pain in the back; the examiner marks it with a skin marking pencil, later on the patient is again asked to point to the site of pain. Positive sign occurs when the patient does not point to the same site indicating malingering
Jackson's Compression test
The patient is seated the doctor laterally flexes the patient's head to the right and applies downward pressure. The doctor then performs the same on the other side. Positive sign is radicular pain or localized pain indicates nerve root compression or facet syndrome (IVF)
Bonnet's sign
With the patient supine the doctor stands on the side being tested, and internally rotates leg, adducts leg, and then performs SLR. Positive sign is radicular pain to the limb indicating piriformis syndrome
Thomas test
With the patient supine the thigh is flexed with the knee bent to the abdomen. Positive sign is opposite thigh/knee rises off table indicating hip flexion contracture.
Soto Hall Sign
With the patient supine, the doctor places one hand on the sternum while passively flexion the patient's head toward the chest. Positive sign is localized pain which indicates fracture if the pain is anterior or ligament damage if the pain is posterior
Which of the following is NOT a common risk factor for patellofemoral syndrome? a. Increased Q angle b. Excessive foot supination c. Weakness of the vastus medialis obliquus d. Excessive tightness of the iliotibial tract
b. Excessive foot supination
You suspect a patient has scoliosis. What evaluation procedure would you do, and what are you looking for? a. Forward flexion, kyphosis b. Forward flexion, rib humping c. Lateral bending, rib pain d. Lateral bending, rib stiffness
b. Forward flexion, rib humping
Tarsal tunnel syndrome
pain and burning on sole of foot, median plantar nerve involved
Jumper's knee
patellar tendonitis
Laguerre's test
(Patrick Fabere in the air) With the patient supine the doctor flexes, abducts, and laterally rotates hip. Doctor then applies pressure over the opposite ASIS with one hand and with the other hand presses down on the knee. Positive sign is pain in hip indicating hip joint lesion
Scapular motion
*Abduction* occurs at the glenohumeral joint and scapulothoracic articulation in a 2:1 ratio...A decreased ratio indicates adhesive capsulitis. *Elevation*- trapezius and levator scapulae *Retraction*- rhomboid major and minor *Protraction*- serratus anterior
Genu Varum vs Valgum
*VARUM* bow legs *VALGUM* knock knee
Rotator cuff muscles
*supraspinatus* a) abduction b) suprascapular nerve c) inserts at the greater tubercle *infraspinatus* a) external rotation b) suprascapular nerve c) inserts at the greater tubercle *teres minor* a) external rotation b) axillary nerve c) inserts at the greater tubercle *subscapularis* a) internal rotation b)subscapular nerve c) inserts at the lesser tubercle "SITS Cheer"
Bragard's sign
After pain is elicited with SLR the leg is lowered below the point of discomfort and the foot is sharply dorsiflexed. Positive sign is pain in the affected leg indicating sciatica
what is the most common ligamentous injury in the knee
ACL
Well leg raiser
AKA Fajerstazn's. SLR with dorsiflexion of the foot is performed on the asymptomatic side of a sciatic patient. Positive sign is pain down the symptomatic side indicating a medial disc lesion
Chondromalacia Patella
AKA Patellofemoral Tracking disorder, Runner's Knee. Patella is being pulled laterally by the vastus lateralis muscle. Walking downstairs is most provocative. Causes retropatellar DJD. Tests include Clark's and Fouchet's
Medial epicondylitis
AKA little leaguer's elbow, golfer's elbow; affects the flexor carpi ulnaris, pain with flexion of wrist at medial portion of elbow. Treatment is transverse massage, ultrasound underwater, and counterforce brace.
Lateral epicondylitis
AKA radio humeral bursitis, tennis elbow; affects the extensor carpi radialis brevis, pain with extension of wrist and pronation of the elbow. Treatment is transverse massage, ultrasound underwater, and counterforce brace.
Osteochondritis Dessicans
AVN, knee locks out in extension, test is Wilson's sign
A patient is placed prone on an exam bench. The knee is flexed to 90 degrees, loaded axially in a proximal direction, and then the leg is internally rotated (Apley's compression test). This is a test to check the integrity of the: a. ACL b. Lateral meniscus c. Medial meniscus d. PCL
b. Lateral meniscus
Minor's sign
Ask patient to rise from a seated position. Positive if the patient supports their body with the uninvolved side balancing on good side, indicating sciatica
Barlow's
BABY. Done with the baby's hip in adduction, in which gentle posterior pressure is placed on each hip one at a time. Positive sign is a deep-sounding "thunk" as the ball subluxes out of the socket indicating congenital hip dysplasia
O'Donohue's test
Can be performed on any joint. Patient actively moves against resistance, and then the doctor passively moves the part through a full range of motion. Positive sign is pain indicating a sprain in the pain is during passive ROM, strain if pain is during active ROM
Wright's test / Hyperabduction Maneuver
Patient seated while doctor palpates radial pulse. Each arm is individually abducted to 180 degrees. The doctor notes angle at which radial pulse diminishes or disappears. Positive if pulses are lost with more than 10 degree difference indicating pectoralis minor syndrome involving the axillary artery *TOS -pec minor*
Grade 3 Ankle Sprain
Complete tear, surgical case, refer to orthopedist
Reverse Cozen
Patient seated with arm close to body, patient makes a fist and flexes wrist with supination. Doctor resists flexion of wrist while supporting at elbow. Positive for pain at medial elbow indication medial epicondylitis
Roo's test
Patient seated, both arms are at 90 degrees then patient abducts and externally rotates them. The patient then repeatedly opens and closes the fists for 2-5 minutes. Positive sign is reproduction of the symptoms or unusual discomfort indicating thoracic outlet syndrome
Homan's sign
Patient supine in the 90/90 position, doctor squeezes calf and dorsiflexes the foot simultaneously. Positive sign is deep calf pain indicating deep vein thrombosis
Abduction Stress Test/Valgus Stress test
Patient supine, doctor applies valgus stress to knee while abducting the foot in full extension and at 30 degrees flexion. Positive sign is increased pain indicating medial collateral ligament involvement
Adduction Stress Test/ Varus Stress test
Patient supine, doctor applies varus stress to knee while adducting the foot in full extension and at 30 degrees flexion. Positive sign is pain or increased laxity indicating lateral collateral ligament involvement
Kernig's sign
Patient supine, doctor flexes the hip and knee to 90/90 position and then attempts to extend knee. Positive sign is patient resisting extension, resistance causes kicking motion, indicates meningeal irritation
Brudzinski sign
Patient supine, doctor passively flexes the patient's head approximating the chin to the chest. Positive sign is buckling of the patient's knees indicating meningeal irritation
Anterior Foot Drawer test
Patient supine, doctor places hand around anterior aspect of lower tibia while grasping calcaneus in the palm of the other hand and then pulls calcaneus forward. Positive sign is talus sliding forward indicating anterior talofibular ligament instability
Ason's test, costoclavicular test, and Wright's test assess for vascular occlusion in the thoracic outlet by which sign? a. Decrease in or loss of the radial pulse amplitude b. Decrease in radiating symptoms from the shoulder down the arm c. Increase in radial pulse amplitude
Decrease in or loss of the radial pulse amplitude
Dawbarn's sign
Deep palpation by the doctor over the subacromial bursa elicits pain. Without moving the fingers the arm is passively abducted. Positive is reduction of pain indicating subacromial bursitis
Libman's
Doctor applies finger pressure over mastoid process, pressure increased until patient expresses discomfort, used to determine pain threshold of the patient
Yeoman's test
Doctor stabilizes SI joint testing, with the other hand doctor flexes leg of affected side and hyperextends the thigh by lifting knee off the table. Positive sign is pain in the SI joints indicating an SI lesion.
Hibb's test
Doctor stabilizes the pelvis on the side they are standing, with the other hand the doctor grasps the ankle of opposite leg and flexes knee to 90 degrees. The doctor slowly pushes the leg away laterally producing internal rotation of the hip. Positive sign is pain in the SI joints indicating SI lesion
Mannkopf's sign
Doctor takes the patient's resting pulse, then applies pressure over the painful area and takes the pulse again. Positive is an increase of 10 bpm indicating the patient is NOT malingering
Slocum's test
Patient supine, knee is flexed to 90 degrees, foot is put in internal/external rotation. Doctor stabilizes foot and gasps the leg with thumbs palpating the knee joint, then pulls on the tibia applying P-A stress in the knee. Positive sign is pain or joint laxity indicating ACL & MCL if external positive, or ACL & LCL if internal positive.
What structures does Finkelstein's evaluate?
Extensor pollicus brevis and abductor pollicis longus
Naffzinger's test
Have the patient sit erect while the doctor holds digital pressure bilaterally over the jugular veins or puts a blood pressure cuff around the patient's neck and pumps to 40 mmHg, holds for about 30 seconds. If no pain, the patient is instructed to cough. Contraindicated with vascular compromise. Positive for pain which indicates *space occupying lesion*.
Modified Adson's test / Scalenus Medius test
If Adson's tst is negative the patient rotates head to the opposite side extends head and takes a deep breath. Positive sign is alteration in the amplitude of radial pulse indicating occlusion of the subclavian artery, scalenus medius syndrome TOS - scalenus medius
Grade 2 Ankle Sprain
Incomplete or partial rupture, lots of swelling, bruising, almost no range of motion
Which test is designed to entrap cervical nerve roots by narrowing the IVF and compressing facet joints at the same time? a. Bakody's sign b. Cervical distraction test c. Jackson's compression test d. Soto Hall test
Jackson's compression test
Lewin-Gaenlen's test
Patient lays on unaffected side and pulls lower knee to chest. Doctor stands behind patient, stabilizes pelvis and hyperextends the top tigh. Positive sign is pain in the SI joints indicating an SI lesion
Thompson's Test/ Simmond's Test
Patient prone with feet hanging off table, doctor flexes knee to 90 degrees and squeezes calf. Positive sign is no plantar flexion of the foot indicating achilles tendon rupture
Lewin Supine test
Lewin Supine test
terrible triad
MCL ACL MM
Apley's compression test
Patient prone with knee flexed to 90 degrees, the doctor anchors the thigh of the patient and grasps proximal to foot and applies downward pressure and rotates leg internally and externally. Heel points toward side being tested. Positive sign is pain in knee indicating meniscal tear.
Apley's Distraction test
Patient prone with knee flexed to 90 degrees, the doctor anchors the thigh of the patient and grasps proximal to the foot and applies upward pressure and rotates leg internally and externally. Heel points toward side being tested. Positive sign is pain in the knee indicating collateral ligament tear
Schepelmann's sign
Patient raises both arms over head while seated and laterally bends to both sides. Pain on the concave side indicates intercostal neuralgia, pain on the convex side indicates pleurisy or myofascitis
Dejerine's Triad
Patient reports that pain is brought on by coughing, sneezing, or straining at the stool indicates a space occupying lesion
Rotator cuff tear/tendonitis
Of the four tendons the *supraspinatus* is most frequently torn, the tear usually occurs at its point of insertion onto the humeral head at the greater tuberosity. Diagnosis is done with MRI and treatment is codman's exercises
Apley's Test / Apley's Scratch test
Patient seated and instructed to actively put hand behind the head and touch the opposite superior angle of the scapula, then place hand behind back and touch the opposite inferior angle of the scapula. Positive for pain or decreased range of motion indicating degenerative tendonitis of rotator cuff
Medial/Lateral Stability test
Patient seated or supine, doctor grasps the patient's foot and passively inverts and everts it. Positive sign is excessive gapping, during inversion this indicates anterior talofibular or calcaneofibular ligament tear, during eversion this indicates deltoid ligament tear
Lhermitte's sign
Patient seated or supine, patient actively/passively flexes head toward chest. Positive sign is sharp electric shock like sensation down the spine into the extremities indicating multiple sclerosis, myelopathy, or other demyelinating cord lesions
Bikele's sign
Patient actively abducts the shoulder to 90 degrees with the elbow flexed to 90 degrees and then extends the shoulder and the patient extends the elbow. Positive with resistance and increased radicular pain indicating thoracic outlet syndrome, brachial plexus neuritis, or meningeal irritation.
Spurling's test
Patient actively maximally rotates and laterally flexes head to the affected side. The doctor delivers a vertical blow to the top of the patient's head. (Can be done bilaterally or with the neck hyperextended.) Positive sign is pain in the neck, shoulder, or arm which indicates a space occupying lesion *IVF*
Halstead's test
Patient extends the head back. The examiner slightly abducts arm then applies downward traction on arm while taking pulse. Positive if alteration in the amplitude of radial pulse indicating a cervical rib.
Amoss sign
Patient is asked to go from a side lying position to a seated position. Positive sign is localized thoracolumbar pain and/or lack of range of motion indicating ankylosing spondylitis, intervertebral disc syndrome or severe sprain/strain
Iliac compression
Patient is in side-lying position with involved side up. The doctor's hands are placed over the upper part of the iliac crest and hyperextends the top thigh. Positive sign is pain in the SI joints indicating a SI lesion
Burn's bench test
Patient is instructed to kneel on a table 18 inches from floor, bend forward at the trunk, and touch the floor. Doctor holds the patient's ankles. Positive sign is if the patient refuses to perform the test indicating malingering
Ely's test
Patient is prone. The heel is approximated to the opposite buttock and hyperextended. Positive sign is pain, indicating hip lesion or iliopsoas irritation or inflammed lumbar nerve roots.
Maximum Cervical Compression test
Patient is seated and actively rotates, laterally flexes, and hyperextends the neck to the right. If there is not pain the patient is asked to maximally laterally flex the neck. Repeat on the other side. No compression is applied. Positive sign is radicular pain or localized pain indicating nerve root compression or facet syndrome (IVF)
Goldthwait's sign
Patient is supine with affected leg raised slowly while hand is under lumbosacral portion of the spine. Repeat on the other side. Positive sign is: pain if the pain is at 0-30 degrees indicates SI joint involvement, pain between 30-60 degrees indicates the lumbosacral joint, pain 60-90 indicates lumbar spine or contralateral SI joint.
Clark's sign/ Patellar Grinding test
Patient is supine with knee extended, doctor applies S-I pressure on the superior pole of the patella and then asks the patient to contract the quadriceps. Positive sign is retropatellar pain or inability to sustain the contraction indicating chondromalacia patella
Bounce home test
Patient is supine with knee flexed completely, the knee is then dropped into extension. Positive sign is incomplete extension indicating torn meniscus
Posterior Sag sign
Patient is supine with knees flexed to 90 degrees and hips flexed to 45 degrees. The doctor compares the prominence of the tibial tuberosities. Positive sign is tibial dropping back or sagging on the femur indicating a PCL tear
Gaenslen's test
Patient is supine with the involved side near the edge of the examining table. The opposite knee and thigh are fully flexed and fixed against the abdomen by the patient. The involved leg is gradually extended off the table by the doctor. The doctor then applies downward pressure against clasped knee and knee of the extended hip. Positive sign is pain the SI joint indicating an SI lesion
Noble Compression test
Patient is supine with the leg in the 90/90 position, the doctor applies pressure to the lateral femoral condyle while extending the knee. Positive sign is pain over the area of pressure indicating TFL syndrome
Hoover's sign
Patient is supine, doctor places one hand under each of the patient's heels and asks the patient to lift the affected limb. Positive sign is when the doctor does not feel the unaffected side pressing downward indicating malingering
Lachman's test
Patient is supine, knee flexed to 30 degrees, the doctor stabilizes the femur with one hand and pulls the tibia forward with the other hand. Positive sign is soft end feel indicating ACL instability
Drawer test
Patient is supine, knee flexed to 90 degrees and hip to 45 degrees. Doctor stabilizes foot on table, tibia is then drawn forward/posterior. Positive sign is pain or joint laxity indicating ACL if PA positive, or PCL if AP positive
Apprehension test (patella)
Patient is supine, the doctor displaces the patella medial to lateral. Positive sign is if it feels like the patella will dislocate and the patient contracts quads or has a look of apprehension indicating chronic patellar dislocation
McMurray Sign
Patient supine, the doctor flexes the thigh and leg to 90 degrees and places one hand on the knee while the other hand grasps the patient's heel. The doctor externally rotates the leg, and then slowly extends the knee. The doctor then internally rotates the leg and brings it into extension with a valgus stress to the joint. Positive sign is painful click or snap heard indicating lateral meniscus with internal rotation or medial meniscus with external rotation
Cozen's test
Patient's elbow is flexed to 90 degrees with the forearm pronated and fist dorsiflexed. Doctor stabilizes the elbow and resists the patient's dorsiflexion. Positive for pain in the lateral elbow indicating lateral epicondylitis
Lindner's sign
Patient's head is passively flexed to the chest. Positive sign is pain in the lumbar spine radiating to sciatic nerve, indicating root sciatica
Tinel's sign at the wrist
Percuss over the flexor retinaculum of the wrist and the tunnel of Guyon. Positive with tingling into the lateral 3 fingers or medial 2 fingers indicating carpal tunnel syndrome or ulnar nerve impingement
Sicard's sign
Perform a SLR, drop 5 degrees and dorsiflex the big toe. Positive sign is pain in affected leg indicating sciatica
Chest expansion test
Tape measure placed around the 4th intercostal space, the patient exhales completely, measurement taken, then the patient inhales deeply, measurement taken. Normal is 1.5-3 inches. Positive for men is less than 2 inches, women is less than 1.5 inches, indicating ankylosing spondylitis
Hip abduction stress test
The patient is lying on non-affected side, and actively abducts leg, then the doctor exerts downward pressure proximal to knee. Positive sign is pain at the PSIS indicating SI joint problems and/or gluteus medius weakness
Wilson's test
The patient is seated and actively extends the flexed knee with the tibia internally rotated. When 30 degrees is reached the pain increases and is relieved by externally rotating the tibia. Positive sign is a decrease in pain indicating osteochondritis dessicans
Apprehension test
The doctor abducts and slowly externally rotates the affected shoulder. Positive sign is if the patient shows signs of apprehension or alarm indicating chronic shoulder dislocation
Valsalva Maneuver
The doctor asks the patient to take a deep breath and hold while bearing down. Positive sign is radicular pain indicating a *space occupying lesion*
Costoclavicular Maneuver / Eden's test
The doctor palpates the radial pulse while drawing the patient's shoulder down and back. The patient flexes the chin to chest. Positive sign is alteration in the amplitude of the radial pulse indicating compression between the first rib and clavicle TOS
Bowstring sign
The doctor performs a SLR to the point of pain. The knee is flexed slightly and placed on the doctor's shoulder. Digital pressure is placed above the popliteal fossa and then in the popliteal fossa. Positive sign is pain in the lumbar region or radiculopathy indicating sciatica
Froment's Paper sign
The doctor places a piece of paper between the thumb and index fingers and attempts to pull the paper out. Positive sign is when the patient is unable to keep the paper between their fingers indicating ulnar nerve palsy
Codman's drop arm test
The examiner passively abducts arm to above 90 then suddenly removes support. This makes the deltoid suddenly contract causing increased pain. Positive sign is inability to maintain arm position indicating tear of the supraspinatus
Belt test / Supported Adam's test
The patient bends forward and the examiner notes when the pain occurs. Then while the doctor is behind the patient he/she grasps the ASIS and braces their hip into the patient's sacrum. The patient then flexes again and ROM is noted. Positive sign is pain. If the lesion is in the pelvis the patient will have no pain while the pelvis is stabilized. If the lesion is in the spine the patient will have pain in both situations.
Yergason's test
The patient flexes the elbow to 90 while seated. The doctor palpates the bicipital tendon and resists the patient's attempt to actively supinate the hand and flex the elbow. Positive sign is an audible click or snap in the bicipital groove indicating bicipital tendon instablity
Phalen's sign
The patient flexes the wrists maximally and holds position for up to 60 seconds by pushing both wrists together. Positive sign is tingling into the first 3 digits of the hand indicating carpal tunnel syndrome
Finkelstein's test
The patient is asked to make a fist with the thumb tucked inside. The first is then ulnar deviated. Positive sign is pain over the anatomical snuff box indicating DeQuervain's aka stenosing tenosynovitis
Mill's test
The patient is instructed to extend the forearm, make a fist, and flex the wrist, and then maximally pronate the forearm. This test can be passively performed by the doctor. Positive sign is pain in lateral elbow indicating lateral epicondylitis
Allen's test
The patient is seated with elbow flexed and forearm supinated, ask the patient to pump the hand, keep closed while the examiner occludes the radial and ulnar arteries until the hand is blanched. The patient slowly opens the hand while the doctor open one artery and records filling time. Repeat for other artery. Positive is delay of more than 10 seconds for the blood to return, indicates occlusion of the corresponding artery TOS
Lasegue's sitting
The patient is sitting upright at the edge of a table or chair without a backrest. The doctor faces the patient and usually under the guise of "checking circulation" extends the patient's legs below the knee, one at a time, so that the limb is parallel to the floor. Positive sign is no pain when there has been a positive SLR indicating malingering
Straight leg raising test
The patient is supine with legs extended. The doctor places one hand under heel and the other over the knee and slowly raises the leg. Positive sign is pain down the affected leg indicating sciatica, disc involvement, or lumbar lesion
Millgram's test
The patient is supine with limbs extended, the patient is asked to elevate legs until they are 6 inches off the table and hold for as long as possible (60 seconds). Positive sign is pain indicating the presence of a space occupying lesion
Patrick's test/ FABERE
The patient is supine with the thigh flexed, abducted, externally rotated and extended while downward pressure is placed on the opposite ASIS and same knee. Positive sign is pain in hip indicating hip lesion
Dugas' test
The patient places the hand of the affected shoulder on the opposite shoulder and attempts to touch the chest with the elbow. Positive sign is if the patient is unable to perform the test which indicates acute shoulder dislocation
Kemp's test
The patient seated/standing and supported by the doctor. The doctor rotates the patient's trunk from the original position and circumducts the trunk toward the affected side and then away from the affected side. Positive sign is sciatic pain down the involved side, indicating posteromedial disc involvement if the positive is away from pain, if the positive is into pain indicates posterolateral disc involvement
Rust sign
The patient spontaneouly grasps the head with both hands when rising from the recumbent position. Indicates cervical instability due to sprain/strain, fracture, or RA
Trendelenburg test
The patient stands and rises one foot and then the other while the doctor observes the buttocks. Positive sign is when the buttock drops on the side that the foot is elevated indicating hip abductor weakness on the stance leg side.
Dreyer's test
The supine patient is asked to raise their extended leg and is unable to do so. The doctor applies pressure to the quads and the patient can lift the leg. Positive sign is if the patient can only lift the leg with pressure at the quadriceps indicating a fractured patella.
what is the most commonly injured muscle in the knee
Vastus Medialis
Gower's sign
When arising from supine position, patient turns to prone position and then climbs up on themselves. Indicates muscular dystrophy
Neri's bowing
When bending forward from the waist the knee flexes on the side of involvement. Positive sign is knee buckling, indicating tight hamstrings
Turyn's sign
While patient is in the supine position the doctor dorsiflexes the big toe. Positive sign is pain in the affected leg indicating sciatica
Reverse Bakody Maneuver
While seated the patient actively places palm on top of the head. Positive if pain is increased TOS
Bakody's test / Shoulder Abduction test
While seated the patient actively places the palm of the affected arm on top of the head, the elbow should be at the level of the head. Positive sign: is relief of pain, Indicates: IVF encroachment
Foraminal Compression test
While seated the patient actively rotates their head side to side, the doctor exerts downward pressure from the neutral position. The head is then rotated to each side with pressure. Positive sign is radicular pain or localized pain, Indicates: nerve root compression or facet syndrome
Forrestier's Bowstring Sign
While standing the patient performs side bending to both sides. Positive sign is muscle tightening on the concave side indicating ankylosing spondylitis
Ortolani's
With INFANT supine, the legs are abducted and externally rotated. Positive sign is a palpable or audible click indicating congenital hip dislocation
Ely's sign
With patient prone the heel is approximated to the buttock with flexion of the knee. Positive sign is pain, indicating contracture of the rectus femors. If the pain is radicular pain it indicated lumbar nerve root adhesions
Ober's test
With patient side-lying with the involved side up the doctor places one hand on the pelvis, thigh is abducted and extended, the doctor then allows the leg to drop into adduction. Positive sign is the knee staying elevated indicating contracture of the tensor fascia lata
Nachlas
With the patient prone the leg is flexed to 90 degrees and heel is approximated to same buttock. The doctor stabilizes the side they are testing. Positive sign is pain in the SI joint indicating SI lesion, pain in the lumbosacral joints indicating lumbosacral lesion(s), pain in the anterior thigh indicates femoral nerve stretch
Distraction test
With the patient seated the doctor exerts upward pressure on the patient's head removing the weight of the patient's head from the neck. If pain is decreased indicates nerve root compression (IVF), if pain is increased indicates *sprain/strain*,
Adson's test / Scalenus Anticus test
With the patient seated, doctor slightly abducts, extends and externally rotates the arm while take the radial pulse. Patient rotates head toward tested side and extends head. Patient takes a deep breath. Positive sign is alteration in amplitude of radial pulse indicating the presence of a cervical rib TOS - scalenus anticus
Bectrew's sitting test
With the patient seated, he/she attempts to extend each leg one at a time. The doctor places one hand on the side being tested to resist hip flexion by the patient. The patient then attempts to extend both legs together with both thighs stabilized by the doctor. Positive sign is pain or leaning back indicating disc, if pain when good leg is raised posteriormedial disc involvement is indicated
Shoulder Depression test
With the patient seated, the doctor depresses the patient's shoulder while laterally flexing the cervical spine away from that shoulder. Repeat on the other side. Positive sign is pain indicating nerve root *adhesion*
Allis
With the patient supine he/she flexes both knees to 90 with the feet placed flat on the table and both malleoli approximated. The doctor compares the height of the knees. Positive sign is significant difference in the height of the knees indicating posterior displaced femoral head or femur shortening.
A 7-month-old infant is brought to your office with a congenital torticollis. Which condition of the hip should also be ruled out in this child? a. Congenital hip dislocation b. Transient synovitis c. Legg-Calve-Perthes d. Slipped femoral capital epiphysis
a. Congenital hip dislocation
Which of the following test is LEAST likely to be positive for a shoulder tendonitis? a. Dawbarn's sign b. Codman's sign c. Apley's scratch test d. Supraspinatus press test
a. Dawbarn's sign
In a patient older than 60 years, which two tests are most predictive of a rotator cuff tear? a. Supraspinatus weakness and external rotation weakness b. Codman's sign and Apley's scratch test c. Apley scratch test and supraspinatus press test d. Dawburn's sign and Codman's sign
a. Supraspinatus weakness and external rotation weakness
A 10-year old boy has had a significant limp for 3 days and does not play with his friends any more. There is no history of a fall, and past medical history is unremarkable except for a mild upper respiratory infection a week ago. Examination reveals limited hip flexion, abduction, and external rotaion of the involved side. The remaining orthopedic and neurologic exams are normal. What is the most likely diagnosis? a. Transient hip synovitis b. Congenital hip dysplasia c. Legg-Calve-Perthes d. Slipped femoral capital epiphysis
a. Transient hip synovitis
Osgood Schlatter's
an avulsion of the tibial tuberosity in athletes doing repetitive knee extension, tibial apophysitis, in 10-16 year olds, pinpoint pain and swelling, use a Cho-pat brace
Which test will most likely be negative in the presence of biceps tendinitis? a. Transverse humeral ligament test b. Codman's sign c. Yergason's test d. Speed's test
b. Codman's sign
According to the AHCPR Guidelines, which one of the following is NOT an indication for referring a patient with a lumbar disc herniation for decompressive surgery? a. Acute and debilitating sciatica b. Acute and debilitating lower back pain c. Persistent sciatica with no improvement over a 1-month period or rapidly progressive d. Obvious signs of specific nerve root involvement associated with a disc herniation at the same level and on the same side on imaging
b. Acute and debilitating lower back pain
For what is Fajersztajn's sign (well leg raise test) indicative of when it reproduces symptoms in the contralateral back and down the contralateral leg and when it relieves symptoms in the contralateral back and down the contralateral leg? a. Lateral disc protrusion, medial disc protrusion b. Medial disc protrusion, lateral disc protrusion c. Medial disc protrusion, subrhizal disc protrusion d. Subrhizal disc protrusion, lateral disc protrusion
b. Medial disc protrusion, lateral disc protrusion
What is the loose-packed position for the thoracic facet joints? a. Midway between left and right rotation b. Midway between flexion and extension c. Full extension d. Full flexion
b. Midway between flexion and extension
What is the normal Q-angle range? a. 0 to 5 degrees b. 6 to 10 degrees c. 12 to 18 degrees d. 20 to 30 degrees
c. 12 to 18 degrees
An L4 disc pathology can lead to weakness of which muscle? a. Peroneus longus b. Quadriceps c. Extensor hallicus longus d. Gluteus maximus
c. Extensor hallicus longus
Noble's compression test would be positive for what condition? a. Meniscal injuries b. Antermedial knee instability c. Iliotibial band syndrome d. Patellofemoral
c. Iliotibial band syndrome
A 22-year-old male tennis player complains of acute right knee pain. He felt a pop in his knee and experienced excruciating pain after his body twisted to the right while his foot was fixed on the ground. He could not continue playing and his knee swelled within 8 hours. What orthopedic tests are likely to be positive? a. Posterior drawer test b. Varus stress test c. Lachman's test d. Patellofemoral tests
c. Lachman's test
Which of these tests would be positive in the presence of L4 radicular symptoms? a. Spinal percussion test b. Yeoman's test c. Lasegue's test d. Ely's test
c. Lasegue's test
A 7-year-old boy complains of groin and anteromededial knee pain. He had a bad fall some time ago. You notice he had a slight limp walking into the office. Physical examination is unremarkable but for decreased hip abduction and internal rotation bilaterally and a positive left FABERE (Patrick's test). What is the MOST likely diagnosis? a. Posttraumatic fracture b. Congenital hip dysplasia c. Legg-Calve-Perthes d. Slipped femoral capital epiphysis
c. Legg-Calve-Perthes
Which test evaluates the integrity of the menisci of the knee? a. Dugas' test b. Apley's distraction c. McMurray's test d. Drawer test
c. McMurray's test
Which of the following is NOT part of a screening examination for a rheumatologic condition? a. Spinal mobility b. Range of movement of the lower extremities c. Motion palpation d. Gait and postural analysis
c. Motion palpation
Which of the following has the highest specificity rate in diagnosing lumbar disc herniation? a. Ipsilateral straight leg raising b. Crossed straight leg raising c. Quadriceps weakness d. Sensory loss
c. Quadriceps weakness
A positive result for which test indicates deep vein thrombophlebitis? a. Homer's test b. Hochman's test c. Hoffman's test d. Homan's test
d. Homan's test
Which test would not be positive in the presence of symptoms orginating from the cervical facets? a. Pain relief with cervical distraction b. Positive maximal cervical compression test c. Positive Jackson't test d. Pain increasing with cervical distraction
d. Pain increasing with cervical distraction
Which of the following BEST illustrates a positive straight leg raise? a. Reproduction of the patient's lower back pain at an angle of 80 degrees of SLR b. Reproduction of the patient's lower back pain at an angle of 30 degrees of SLR c. Reproduction of the patient's posterior thigh and leg pain at an angle of 70 degrees of SLR d. Reproduction of the patient's posterior thigh and leg pain at an angle of 40 degrees of SLR
d. Reproduction of the patient's posterior thigh and leg pain at an angle of 40 degrees of SLR
Which muscle does NOT upwardly rotate the scapula? a. Upper trapezius b. Lower trapezius c. Anterior serratus d. Rhomboid major
d. Rhomboid major
A space-occupying lesion locates at the anterior cervical spine could be found when performing which orthopedic test? a. Foraminal compression test b. Halstead's maneuver c. Valsalva's maneuver d. Swallowing test
d. Swallowing test
Pes planus
flat foot, talar head displaces medially and plantarward, treatment is exercise and orthotics
Plantar Fasciitis
heel spur pain when walking in morning, improves as the day progresses
Most common sprain in ankle
inversion sprain
TFL syndrome
lateral knee pain caused by shortened TFL, seen in runners and made worse by walking or running up/down hills or up/down stairs
Metatarsal stress fracture
march fracture
Talipes Equinovarus
most common birth defect where heel is elevated and foot is turned inward also called clubfoot at birth
Grade 1 Ankle Sprain
no ligamentous tear, slight swelling and decreased range of motion
Achilles tendon rupture
positive Thompson's test/ Simmond's test, MOI usually trauma
ligament tear (in knee) finding
swelling and pain occur immediately following the injury (intra-articular)
meniscal tear of the knee
swelling will occur 12-24 hours post injury and the patient is unable to lock out (joint line)
Morton's neuroma
tumor on the nerve most commonly found between the 3rd and 4th metatarsal heads
Pes cavus
very high arch, toes in flexion, treat with orthotics, and stretch out, these patients are prone to March fracture