Orthopedic Assessmts
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| Appley's Scratch (shoulder) | Right arm - lateral rot., flex. & abduct; Left arm - medial rot., extension & abduct. | pain; restricted ROM; capsular pattern/end feel
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| Apprehension/Crank Test (shoulder) | anterior GH dislocation; GH instability; supine, passive abduct arm 90 deg. & laterally rot. slowly | pain, apprehension; LOOK AT PATIENT'S COUNTENANCE
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| Drop Arm (Codman's) Test | rotator cuff tears; standing, passive abduct GH 90 deg., patient actively lowers arm to side SLOWLY | returns arm quickly; severe pain
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| Painful Arc | subacrom. bursitis, calcium depos. or peritonitis/tendinosis; active elevation thru abduct | pain; 45-60 degrees NO PAIN; 60-120 deg. PAIN/PINCHED; 120 deg., DIMINISHED PAIN; 160-180 deg., PAIN
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| Posterior Apprehension/Stress Test (shoulder) | supine or seated; passive elevate (or abduct) GH to 90 deg. while stabilizing scap.; apply posterior force on patient's elbow; examiner horizont. adduct & medial rot. arm | patient's look of apprehension & resistance; poster. instability or dislocation of humerus
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| Speed's (Biceps or Straight Arm) Test | examiner resist shoulder forward flexion while patient's forearm supinated then pronated w/ elbow full extension | increased tenderness/pain; indicative of bicipital paratenonitis or tendinosis; if profound weakness on resist. supinatn - severe 2nd or 3rd deg. rupture strain of distal biceps suspected
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| Supraspinatus (Empty Can or Jobe) Test | passive abduct to 90 deg. (neutral), examiner apply inferior resist. . Then medially rotate and angled 30 deg. forward w/thumbs down, apply same resistance | weakness, pain; indicative of tear of supraspinatus tendon/muscle or neuropathy of suprascapular nerve
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| Yergason's (Shoulder) | torn transverse humeral lig.; Examiner's thumb on bicipital groove, patient's elbow flex 90 deg., stabilize against thorax & w/ forearm pronated. Examiner resists supination while patient laterally rot. arm against resistance | during supinatn & lateral rotn, tendon "pop out"; tenderness
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| Lateral Epicondylitis #1 (Cozen's, Tennis Elbow) Test (elbow) | examiner 's thumb stabilize patient's elbow. Patient make fist, pronate forearm & radially deviate & extend wrist while examiner resist motion | sudden severe pain of lateral epicondyle
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| Lateral Epicondylitis #2 (Mill's, Tennis Elbow) | examiner's thumb on patient's lat. epicondyle while passively pronates patient's forearm, flexes wrist fully & extends elbow | pain over lat. epicondyle; also places stress on radial nerve; if compression of radial nerve, symptoms similar to tennis elbow; electrodiagnostic studies to differentiate the two
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| Lateral Epicondylitis #3 | examiner resist extension of 3rd digit of hand distal to prox. interphalang. jt, stressing extensor digitorum & tendon | pain over lateral epicondyle
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| Medial Epicondylitis (Golfer's Elbow) Test | examiner palpate patient's medial epicond., patient's forearm passively supinated, elbow & wrist passively extended | pain over medial epicondyle
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| Tinel's Sign (elbow) | tap ulnar nerve in groove between olecranon process & medial epicondyle | tingling in ulnar distribution of forearm & hand distal to compression; indicative of point of regeneration of sensory fibres of nerve -> most distal point of abnormal sensation is limit of nerve regeneration
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| Allen Test (wrist/hand) | patient open & close hand several times as quick as possible then squeeze hand tightly. Examiner's thumb & index finger compress over radial & ulnar arteries while patient opens hand. Release one artery at time to see flushing of hand | comparison to see which artery provides major blood supply to hand
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| Bunnel-Littler (Finochietto-Bunnel) Test (wrist/hand) | MCP jt held slightly extended, examiner flexes prox. IP jt if possible | inability to flex prox. IP jt -> tight intrinsic muscle/contracture of jt capsule.
If MCP jts slightly flexed, prox. IP jt flexes fully if intrinsic musc. tight, but not fully flexed if capsule tight
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| Finkelstein Test (wrist/hand) | patient makes fist w/ thumb inside fingers, examiner stabilizes forearm & deviates wrist toward ulnar side tests for tendons & muscles; determine presence of Quervain's or Hoffmann's disease -> paratenonitis of thumb | pain over abductor pollicis longus & extensor pollicis brevis tendons at wrist --> indicative of paratenonitis of these 2 tendons
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| Murphy's Sign (wrist/hand) | for lunate dislocation; patient make fist, if head of 3rd metacarpal level w/ 2nd & 4th metacarpals, test is positive | if head of 3rd metacarpal level w/ 2nd & 4th metacarpals, test is positive
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| Phalen's (Wrist Flexion) Test (wrist/hand) | for carpal tunnel synd. (CTS); passively flex patient's wrist maximally & hold position for 1 min. by pushing patient's wrist together | tingling in thumb, index & middle and lateral half of ring finger; compression of median nerve
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| Reverse Phalen's (Prayer) Test (wrist/hand) | for carpal tunnel synd. (CTS); patient brings palms in full contact and bring hands down towards waist (Prayer position) | same symptoms as Phalen's; indicative of pathology of median nerve
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| Tinel's Sign (at wrist) | neurological dysfx; tap over carpal tunnel at wrist | tingling or paresthesia into thumb, index & middle & lateral half of ring finger (median nerve distribution); indicative of CTS
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| Knuckle Test (TMJ) | for TMJ (functional opening of mouth); patient place 2 to 3 flexed fingers within mouth | if unable to fit 2 to 3 digits within mouth; pain, clicking of condyles
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| Chvostek Test (TMJ) | TMJ, pathology of CN VII (facial) nerve; tap parotid gland | muscle twitch
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| Jaw Reflex (TMJ) | TMJ, test for CN V (trigeminal) nerve; place thumb on patient's chin while their mouth is open relaxed. Patient closes eyes while examiner taps thumbnail for jaw reflex of closing mouth | dermatomal pain patterns; lack of jaw reflex
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| Costovertebral Expansion Test (chest) | chest expansion; Patient do full exhale while examiner measures, then patient fully inhale while measurement taken again; measure chest at: axilla, level of 4th intercostal space & T10 rib | normal measurement difference between inspiration & expiration is 3 to 7.5 cm.
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| Distraction Test (c/spine) | for radicular symptoms; seated, examiner places one hand under patient's chin & other hand under occiput, then slowly lifts patient's head. May also be tested with arms abducted while traction | pain relieved or decreased when tractioned
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| Spurling's (Foraminal Compression) Test | for nerve root compression; patient bends head to unaffected side first then affected side. Examiner carefully presses straight down on head | pain radiates into arm of affected side during compression; indicative of cervical radiculitis
RADICULITIS: pain in dermatomal distribution of nerve root affected
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| Hautant's Test | differentiates vertigo caused by articular problems from vascular problems; seated, forward flex both arms to 90 deg., eyes closed. Watch for loss of arm position. Repeat with extension, rotation of neck. | hold positions for 10 - 30 sec. only. If arms waver in neutral w/ eyes closed --> non-vascular. If arms waver with head in extension rotation --> vascular impairment of brain
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| Lhermitte's Sign | for spinal cord & UMNL; patient in long leg sitting on table, examiner passively flex patient's head & one hip simult. while other leg kept straight. | sharp pain down spine & into lower or upper limbs; indicative of dural or meningeal irritation in spine or cervical myelopathy
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| Shoulder Abduction (Relief) Test | for radicular symptoms esp. C4, C5 nerve roots; seated or supine, patient actively elevates arm through abduction (hand/forearm rest on top of head) | decrease in or relief of symptoms indicate compression in any of: herniated disc, epidural vein, nerve root at C4/C5 or C5/C6; pain due to pressure in interscalene triangle
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| Shoulder Depression Test | for brachial plexus lesions (w/ more than one nerve root affected); passively flex patient's head to one side while applying downward pressure on opposite shoulder | increased pain indicative of irritation or compression of nerve roots or foraminal encroachments ie. osteophytes/adhesions around dural sleeves of nerve, jt capsule or hypermobile jt capsule on stretched side
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| Valsalva Test | for pressure on spinal cord; ask patient to take deep breath & hold while bearing down | increased pain caused by intrathecal pressure ie. space occupying lesion, herniated disc, tumor or osteophytes
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| Vertebral Artery (Cervical Quadrant) Test | for vascular signs, nerve compression in lower c/spine; supine, passively extend & side flex head/neck. Then rotate to same side, hold for approx. 30 sec. | provokes referring symptoms if opposite artery affected. Watch for nystagmus, look at patient's eyes
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| Antalgia Sign (L/Spine) | An abnormal gait where one favors one of the legs because of pain | This is often due to a ruptured lumbar disc, a bad hip, a bad knee or a bad ankle.
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| Hoover Test (L/Spine) | for malingering, leg strength; supine, examiner cups hands on both calcaneous, patient to actively lift one leg while other remains staight | if pressure not felt on straight leg, patient not trying or is malingering. If pressure felt greatly on straight leg, lifting leg is weak.
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| Prone Knee Bending (Nachlas) Test (L/Spine) | L2/L3 nerve root lesion, femoral nerve; prone, passively flex knee bringing heel to buttock. Ensure hip not rotated. | unilateral neurological pain in lumbar area, buttock &/or posterior thigh. Pain in anterior thigh indicative of tight quads or stretch of femoral nerve
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| Quadrant Test (L/spine) | for jt dysfx, facet jt irritation; patient stands with examiner standing behind, patient extends & rests occiput on examiner's shoulder. Apply overpressure in extension while patient side flexes & rotates to side of pain | symptoms reproduced, narrowing of IVF & stress on facet jt
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| Quick Test (L/spine) | for ankles, knees, hips & sacrum; patient squats, bounce 2-3x & return to standing position |
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| Straight Leg Raise (Lasegue's) test (L/Spine) | disc hern., space-occupying lesion; supine, passively medially rot., adduct leg w/knee extended, then passively flex patient's hip until pain or tightness in back or back of leg | if pain in back -> disc hern., or path. causing pressure is more central.
if pain in leg -> pressure lateral
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| Straight Leg Raise (Bragard's) Test (SLR) | Possible lesion in lumbosacral, SI jts, or hamstring area; same positioning as SLR (Lasegue's), drop leg slight until pain or tightness is experienced in the back of the leg or in the back. Drop patient’s leg back until no pain, then dorsiflex ankle | Painful ankle dorsiflexion
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| Trendelenberg's Test | Gluteus medius weakness, decreased nerve innerv. or unstable hip; standing, patient asked to lift the unaffected leg while standing on affected leg | Pelvis lowers on non-weight bearing extremity more than on the weight bearing extremity.
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| Well SLR Test | disc hernation; passively flex patient's hip while keeping knee in extension. | pain in opposite leg (not tested)
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| Gapping (Transverse Anterior Stress) Test | sprain of anterior SI lig.; supine, examiner applies crossed-arm pressure to ASIS by pushing down & out. | only if unilateral gluteal or posterior leg pain produced
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| Approximation Test | SI lesion or sprain of posterior SI lig., or both conditions; sidelying, examiner place hands over upper part of iliac crest & apply downward pressure | Discomfort or laxity increase; or increased pressure felt in SI jt.
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| Prone Gapping (Hibb's) Test | Posterior sacroiliac ligament sprain; prone, examiner stabilize pelvis & flex knee to 90 deg. & medially rotate hip. Palpate SI jt on rotated hip side. Compare opening bilaterally. | Discomfort or laxity increase
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| Gaenslen’s Test | SI jt dysfunctn, jt lesion, hip pathology or L4 lesn; Supine lye close to edge of table, allowing one leg to hang over table Patient pulls knee on table up to chest while examiner stabilizes patient & applies downward pressure to leg hanging off table. | Discomfort or pain in SI region
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| Gillet's (Sacral Fixation, Ipsilateral Posterior Rotation) Test | Hypomobile SI jt; standing, examiner stands behind patient to palpate bilateral PSIS. Patient brings up one leg & pulls knee to chest | SI jt on side where the knee is flexed only moves a little bit or moves up
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| Ipsilateral Prone Kinetic Test | hypomobility of ilium with posterior rotation (outflare); prone, examiner place one thumb on PSIS, patient asked to actively extend ipsilateral leg. PSIS should move superiorly & laterally | PSIS lack mvmt
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| Leg Length Test | SI jt lesion, (counter)nutation of ilium on sacrum; supine, ASIS levelled perpendicular to lower limbs, examiner measures from ASIS to medial or lateral malleolous (ipsilateral). Repeat on other side. Normal difference of 1-1.3 cm | difference of length bilaterally exceeds normal measurement.
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| Sacroiliac Rocking (Knee to Shoulder, Sacrotuberous Ligament Stress) Test | SI jt lesion, sacrotuberous lig. lesion; supine, passively flex patient's knee & hip fully, then adduct the hip. "Rock" SI jt by flexion & adduction of patient's hip (knee to opposite shoulder) | pain in SI jt
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| Supine-To-Sit (Long Sitting) Test | functional leg length discrep. due to pelvic dysfx (torsion/rotation); Supine w/legs straight. Examiner ensures malleoli are level & hold. Patient asked to sit up while examiner observes if one leg moves up farther than the other | Ipsilateral anteriorly rotated ilium -> leg appears longer in supine & shorter in long-sitting. Ipsilateral posteriorly rotated ilium
-> leg appears shorter in supine & longer in long-sitting. If one leg moves farther -> functional leg length discrep.
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| Torsion Stress Test | for lumbosacral jt, iliolumbar lig. & anter. SI lig & SI jt lesions/pathol.; prone, examiner palpate L5 sp. proc. with thumb holding it stable. Other hand around anter. ilium contralaterally & lifts contralat. ilium | pain or discomfort
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| 90-90 Straight Leg Raise (Hamstrings Contracture) Test | hamstring contracture, irritation of sciatic nerve; Supine, patient flex both hips 90 deg. while knees bent & stablize w/ hands behind knees. Patient actively extends one knee at a time. Normal flexibility, hamstrings & knee extension w/in 20 deg. of ext. | discomfort before end of normal range of motion. The pain is typically described as radiating into the distal leg. Below normal deg. of knee extension indicative of hamstring contracture
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| Ely's (Tight Rectus Femoris) Test | tight rect. femoris; prone, examiner passively flex patient's knee | upon passive flexion of knee, ipsilater hip "hikes" spontaneously, indicative of tight rect. femoris.
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| Galeazzi Sign (Allis) Test | for unilateral congenital dislocation or dysplasia of hip; supine, hips & knees flexed 90 deg. Compare knees bilaterally | one knee is higher
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| Hamstring Contracture Test | hamstring contracture; long sitting w/ one knee flexed against chest, other knee straight. Patient attempts to flex trunk & touch toes of extended leg w/ fingers. | unable to touch toes while keeping knee extended
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| Noble Compression Test | IT band friction syndrome; supine w/knee flexed to 90 deg. by hip flexion. Examiner applies pressure w/ thumb to lateral femoral epicondyle 1-2 cm prox. Patient slowly extends knee while pressure applied. | pain at approx. 30 deg. flexion, severe pain over lateral femoral condyle. Same pain as running
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| Ober's Test | TFL contracture; side lying w/ lower leg flexed at hip & knee for stability. Examiner passively abducts & extends patient's upper leg w/ knee straight or flexed to 90 deg. Examiner slowly lowers upper limb | leg remains abducted & does not fall to table.
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| Patrick's (Faber, Figure Four) Test | SI jt pathology; supine, examiner passively flexes, abducts, & externally rotates the involved leg placing foot on top of uninjured knee. Examiner slowly abducts test leg toward table | Test leg does not abduct below the level of the non injured side. Also tests for sacroiliac, iliopsoas, or hip joint abnormalities.
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| Piriformis Test | piriformis syndrome; sidelying, examiner stabilizes hip to 60 deg. w/ knee flexed & applies downward pressure to knee. | pain in piriformis; pain in buttock indicative of sciatic nerve impingement by piriformis muscle
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