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NMS3 Orthos Lab
| Question | Answer |
|---|---|
| Apprehension test. Anterior Apprehension test. | Seated. Dr stand behind. Patient looks at Dr. Dr abduction to 90 deg with external rotation while stablibizing form behind. Pos: pain, apprehension, laxity = anterior dislocation trauma of the humerus. |
| Posterior Apprehension test. | Supine with shoulder 90 flexed and internally rotated. Dr applies posterior force on the elbow watching the patient for signs of apprehension/pain, resistance. Ind: post. dislocation trauam of humerus. |
| Relocation test Done only if apprehension is positive. | supine with shoulder 90 flexed and externally rotated. Stabilize capsule with inside hand. Pos: relief of symptoms from apprehension test. Decreased apprehension-anterior instability. Decreased pain- anterior instability and cuff disease. |
| Sulcus sign | seated. Hand internally rotated laying in lap. Apply inferior traction to distal humerus. Palpate/observe inferior aspect of acromion process. Pos: sulcus/dimpling superior to humeral head and inferior to acromion=Multidirectional instability |
| Rotator Interval Capsule | |
| Load and shift test (Drawer test) | Seated or supine. Dr stabilize superior shoulder with inside hand. outside hand grasps humeral head.Compress humeral head into glenoid while moving A/P. Pos:abnormal A/P translation. laxity, popping, grinding=instability of G/H joint or labrum damage. |
| Dugas test | Seated. Touch opposite shoulder with elbow on chest. Pos: inability to touch.= anterior dislocation of humerus. |
| Apley's Scratch Test | Standing/Sitting. Try and touch the opposite superior and inferior angle of scapula. Pos: pain. Degenerative tendinitis of the rotator cuff, usually superspinatus tendon |
| Subacromial Push button sign | seated. applied pressure to subacromial bursa. Pain indicates subacromial bursitis. |
| Subacromial Bursa Test (Dawbarn's sign) | Seated. Applied pressure to tender area anterolateral and inferior to acromion. Abducts arm 90. Decrease pain indicates subacromial bursitis. |
| Drop Arm Test | Seated. Dropping arm pos: pain hunchign of shoudler= rotator cuff tear rupture of supraspinatus tendon. SLowly lowering arm. Unable to lower slowly=cuff tear rupture of supraspinatus tendon. |
| Empty can test | Standing. Elbow extended, 90 abduction neutral rotation. Dr pushed down. then 30 horiz flexion with thumb down. dr pushs down. Pos pain or weakness=weak or injured supraspinatus mm or tendon. |
| LIft off test | Seated/standing. hand behind back. patient moves posterior while dr resists. Pos is weakness/pain= injured or weak subscapularis mm or tendon |
| Yergason's | Seated with elbow flexed, patient supinatate and resists against extention = tenosynovitis of the trans ligament. Flex elbow. stablized by dr hand. Pt supinates and externally rotates against resistance. Pain=inflam bicept tendon popping=lax trans lig. |
| Clunk | Supine. DR hand behind humeral head. Dr full abducts shoulder. then pushing A->P on humoral head while externally rotating shoulder. Clunk or grinding sound pos=anterior tear of labrum. |
| Crank | Supine. SHoulder in 160 flexion in scapular plane. Dr applies axial force while inter/externally rotating the arm. Clicking with pain=labrum tear |
| O'Brien Sign | Standing. 90 deg shoulder flexion (elbow extend) 10-15 horiz flex. Internal rotate while dr pushes down. then exteneral rotate while dr pushes down. Pos=pain in 1, not/less in two. Deep shoulder px= labrum. superficial top of shoulder=AC. |
| Impingement syndrome test | Supine/seated. Pt flex elbow. S->I pressure on elbow into subacromial suprahumeral space. Pain=impingement. |
| Hawkins-Kennedy Test | Dr in front of pt. elbow shoulder at 90 flex. DR internally rotates shoulder by supporting elbow and pushing on wrist. Pain in anterior G/H joint= rotator cuff tendonitis. Pushes supra tendon against coracoacromial lig. |
| Neer's Test | Dr next to Pt forcefully flexes pt arm while depressing scapula. Pain in anterior g/h joint=rotator cuff tendonitis. compression of greater tub against acromion. |
| Impingment Relief Test/reverse Impingment | supine in apprehension postion. Dr pushes on humeral head S-I. Decrease pain=mechanical impingment under acromion. |
| Cozen's Test | Pt arm at side elbow flex at 90. Pt make fist, pronate, extend wrist. Dr flexes pt wrist against resistance. Stresses extensor carpi rad long/brev. pain in lateral epicondyle is pos. |
| Mill's Test | Pt arm at side, elbow flex 90. Pt pronate arm, flex wrist. supinate against resistance. Pain in lateral epicondyle is pos for lateral epicondylitis. |
| Kaplan's Sign | Pt standing arm flexed 90. Holding dynomometer with wrist slightly extended. pt squeezes. weak/pain in later epicondyle=lateral epicondylitis. Dr squeezes distal to Lat epi and repeat. Pain decreases-laterepicondylitis. Pain increases=myofascitis. |
| Pinch Grip Test | Pt pinch intex and thumb togehter tip to tip, if they do it pad to pad indicates impingement of anterior interossei branch of median n. |
| Medial Epicondylitits Test | Grasp hand like hand shake. supinate and extend wrist. pain in medial aspect of elbow is medial epicondylitis. |
| Tinel's | hand is supinated and wrist stabilized. tap along median nerve in carpal tunnel. pain/tingling of median nerve distal to wrist=median nerve compression in carpal tunnel. |
| Phalen's | FLex hand backs together and lower elbows to make sure wrists are fully flexed. hold for 60 sec. Pain/tingle long median never distrib=compression in carpal tunnel |
| Reverse Phalen's | Extend wrists have pt put hands togehter and raise elbows to full extension. Pain/tingle along median nerve distrib=carpal tunnel compression. |
| Finkelstein's | Fist over thumb and ulnar deviate wrist. pain in tunnel 1= deqervian's or stenosing tenosynovitis of tunnel 1. Abd poll long, extens poll brev. |
| Bracelet Test | Dr squeezes the distal radial/ulner joint. Pos: acute pain in wrist/forearm/hand= RA |
| Carpal Lift Test | Pt hand palm down on exam table. Dr holds finger down adn asks patient to extend finger. Pos=pain in wrist= carpal fx or sprain. |
| Bunnel_Littler | Extends MCP, Flexes (one at a time) PIP and DIP joints. If DIP and PIP wont flex=indicates tight intrinsic muscle of contracture of joint capsule. RA or Osteoarthritsis suspected |
| Shrivel Test | skin doesnt shrivel when put in warm water for 30 min. Indicates denervation. present first 90-120 days after injury |
| Froment's Sign | Grasp ppr between twofingers. failure to hold grip when pulled indicates ulnar nerve palsy. |
| Finsterer's Sign | grasp on object or clench of hand fails to show normal prominence of the 3rd metacarpal. tapping on 3rd metacarpal elicits pain on center of wrist=lunate avascular necrosis. Pulls on tunnel number 1. |
| Elbow stress test | elbow flexed. Pronate and stress, supinate and stress. extend elbow, and stress varus and valgus.for ligament damange. |
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