special tests 1
Quiz yourself by thinking what should be in
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| What motions are restricted after arthroscopic surgery of rotator cuff tears? | Not reaching out, not doing anything by reaching out in front to the side or to the back for 6 weeks. After 6 weeks activities below shoulder level are allowed. 6-12 weeks activites above shoulder level are allowed with PT supervision. | flexion-abducion-extension is limited.
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| Patient sitting, head is passively distracted. Symptoms (neck pain) decrease in neck. What is the problem? What is the name of the test? | a) facet condition b) intervertebral foramen compression c) vertebrobasillar vascular problem d) vestibular problem | a) facet condition
distraction test
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| Patient sitting. Passively side bend to LEFT, rotate to LEFT and then extend head and neck. This causes pain and parasthesia in LEFT dermatomal pattern for C4 (above clavicle). What is the problem? | a) C4 nerve root is compressed at LEFT b) C4 facet dysfunction at LEFT c) C4 facet dysfunction at RIGHT d) a) C4 nerve root is compressed at RIGHT | a) C4 nerve root is compressed at LEFT
Maximum cervical compression test
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| Patient sitting. Passively side bend to LEFT, rotate to LEFT and then extend head and neck. This causes pain and numbness going down to the left thumb. What is the problem? | a) C6 nerve root is compressed at LEFT b) C6 facet dysfunction at LEFT c) C7 facet dysfunction at RIGHT d) C7 nerve root is compressed at RIGHT | a) C6 nerve root is compressed at LEFT
Maximum cervical compression test
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| Patient sitting, head is passively distracted. Symptoms (upper limb pain/parasthesia) decrease in upper limb. What is the problem? What is the name of the test? | a) facet condition b) intervertebral foramen compression c) vertebrobasillar vascular problem d) vestibular problem | b) intervertebral foramen compression
distraction test
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| Patient sitting. Shouldes at 90 degrees and palms up. Patient closes eyes. After 10 seconds arms loose their position. What can the problem be? | a) vestibular problem b) vertebrobasillar vascular problem c) facet joint problem d) nerve root compression | a) vestibular problem
Hautants test
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| Patient sitting. Shouldes at 90 degrees and palms up. Patient closes eyes and is cued to rotate head and neck to left and right with extension. After 10 seconds arms loose their position. What can the problem be? | a) vestibular problem - b) vertebrobasillar vascular problem - c) facet joint problem - d) nerve root compression | b) vertebrobasillar vascular problem
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Hautant's test
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| Patient supine. Glide C1 anteriorly. The end feel is not firm but soft. Patient has dizziness, nausea, nystagmus (alternating smooth pursuit in one direction and saccadic movement in the other direction), lump sensation in throat. What is the problem? | a) facet joint problem b) nerve root compression c) laxity of transverse ligaments d) vertebrobasillar vascular problem | c) laxity of transverse ligaments
Transverse ligament stress test
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| Patient supine. Glide C2-C7 anteriorly. The end feel is not firm but soft. Patient has dizziness, nausea, nystagmus (alternating smooth pursuit in one direction and saccadic movement in the other direction), lump sensation in throat. What is the problem? | a) facet joint problem b) nerve root compression c) laxity of upper cervical ligaments and capsules d) vertebrobasillar vascular problem | c) laxity of upper cervical ligaments and capsules
Anterior shear test
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| Patient sitting. Head side bent to LEFT. Pressure is applied straight down on the head. No problem occurs. Same thing is done to the RIGHT. Pain / parasthesia occurs in RIGHT going down back of the hand to index, middle 1/2 of 4th finger. Problem? | a) C5 RIGHT nerve root compression b) C7 RIGHT facet joint problem c) C7 RIGHT nerve root compression d) C6 RIGHT nerve root compression | c) C7 RIGHT nerve root compression
Foraminal compression (Spurling's) test
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| Patient has pain/parasthesia of upper limb. Patient places RIGHT hand on top of head. Symptoms decrease. What is the problem? | a) structures are compressed within the intervertebral foramen on RIGHT b) LEFT facet joint problem c) vestibular dysfunction d) Structures compressed within the intervertebral foramen on LEFT | a) structures are compressed within the intervertebral foramen on RIGHT
shoulder abduction test
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| Patient in long sitting. Passively flex head and hip (with knee extended). Repeat with other hip. Pain occurs down the spine and into limbs. What is the problem? | a) vertebrobasillar problem b) facet joint problem c) spinal cord dysfunction and/upper motor neuron lesion d) spinal cord dysfunction and/lower motor neuron lesion | c) spinal cord dysfunction and/upper motor neuron lesion
Lhermitte's sign
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| Patient standing. When eyes are closed patient starts to sway excessively. What can the problem be? | a) upper motor neuron lesion b) lower motor neuron lesion c) facet joint problem d) nerve root compression | a) upper motor neuron lesion
Romberg's test
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| Patient sitting. Passively side bend to LEFT, rotate to LEFT and then extend head and neck. This causes pain and numbness going down to the left inner side of arm down to the pinky finger. What is the problem? | a) C8 nerve root is compressed at LEFT b) C8 facet dysfunction at LEFT c) C7 facet dysfunction at LEFT d) C7 nerve root is compressed at LEFT | a) C8 nerve root is compressed at LEFT Maximum cervical compression test
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| Patient sitting. Passively side bend to LEFT, rotate to LEFT and then extend head and neck. This causes pain and numbness on lower left cervical area. What is the possible problem? | a) C6 nerve root is compressed at LEFT b) C6 facet dysfunction at LEFT c) C7 facet dysfunction at RIGHT d) C7 nerve root is compressed at RIGHT | b) C6 facet dysfunction at LEFT
max cervical compression test
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| Patient sitting. Passively side bend to LEFT, rotate to LEFT and then extend head and neck. This causes pain and numbness going down from beneath clavicle and front shoulder to the left inner middle arm down and ends at wrist. What is the problem? | a) C5 nerve root is compressed at LEFT b) T1 nerve root is compressed at RIGHT c) C8 nerve root is compressed at LEFT d) C7 nerve root is compressed at LEFT | a) C5 nerve root is compressed at LEFT
max cerv compr test
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| Patient has a nagging soreness pain and stiffness upon rising. Pain eases through the morning and increases with repetitive bending activities. The discomfort gets exacerbated at times. What might the problem be? | a) Facet joint dysfunction b) DJD/osteoarthritis c) Spinal Stenosis d) Discal herniation | b) DJD/ osteoarthritis
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| Patient has stiffness upon rising. Pain eases within an hour. There is loss of motion accompanied by pain. Pain is sharp with certain movements. Movement in painfree range usually reduces symptoms. Stationary positions increase symptoms. Problem is... | a) facet joint dysfunction b) DJD/osteoarthritis c) spinal stenosis d) discal herniation | a) facet joint dysfunction
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| Patient has no pain when reclined (lying down) or semireclined but pain increases with weightbearing activities. The pain type is stabbing, shooting, burning. Strength is decreased and there is problem doing some ADLs. What might the problem be? | a) facet joint dysfunction b) DJD/osteoarthritis c) spinal stenosis d) discal problem with nerve root compression | d) discal problem with nerve root compression
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| Pt has pain side bending,ipsilateral rotating and extending. Pain is related to position:Flexed pos decrease & extended pos increase pain. Has Numbness, tightness and cramping. Walking brings on symptoms that persist hours after assuming resting position. | a) DJD b) facet joint disorder c) spinal stenosis d) discal nerve root compression | c) spinal stenosis
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| Patient has pain that is consistent in all spinal positions. The pain is brought on by physical exertion. Pain is described as numbness and is relieved promptly (çabukça- derhal) by rest (1-5 minutes). Pulse of pt is decreased or absent. Problem? | a) Facet joint dysfunction b) vascular claudication c) spinal stenosis d) neoplastic disease | b) vascular claudication
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| Patient has intense, gnawing, penetrating pain that does not get resolved by changes in the activity level, position or time of day. Pain will wake the patient. What can the problem be? | a) Vascular claudication b) spinal stenosis c) neoplastic disease d) osteoarthritis | c) neoplastic disease
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| Patient is prone. A posterior/anterior force is applied through each rib. Same test is done sidelying. | 1- What is being tested? .2- What are positive findings? .3- What is the name of the test? | 1- evaluates rib mobility .
2- pain, excessive motion or restriction of rib .
3- rib springing test
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| Patient is prone. Post/anterior glides/springs are applied to thoracic vertebrae. | 1- what is being tested? 2- what are positive findings? 3- what is the name of the test? | 1- intervertebral joint mobility in thoracic spine
2- pain, excessive movement &/ restricted movement
3- thoracic springing
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| Patient slump sitting on edge of table with knees flexed. a) passively flex head and neck -if no symptoms continue to next step b) passively extend knee -if no symptoms continue to next step c) passively dorsiflex ankle of limb with extended knee | 1- what is being tested? 2- what are positive findings? 3- what is the name of the test? | 1- identifies dysfunction of neurologic structures supplying the lower limb
2- pathologic neurologic findings
3- Slump test
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| Patient supıne wıth legs restıng on table. Hip of one leg is flexed with knee extended until patient complains of shooting pain into lower limb. Slowly lower limb until pain subsides, then passively dorsiflex foot. | 1- What is being tested? 2- What are positive findings? 3- What is the name of the test? | 1- identified dysfunction of neurologic structures that supply lower limb
2- reproduction of pathological neurologic symptoms when foot dorsiflexed
3- Lasegue's (straight leg raising) test
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| Patient lies on non-painful side with trunk in neutral, head flexed slightly and lower limbs hip and knee flexed. Passively extend hip while knee of painful limb is in extension. If no reproduction of symptoms flex knee of painful leg. | 1- what is being tested? 2- what are positive findings? 3- what is the name of the test? | 1- identifies compression of femoral nerve anywhere along its course
2- neurologic pain in anterior thigh
3- femoral nerve traction test
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| Patient sitting. Patient is instructed to take a deep breath and hold while they "bare down" as if having a bowel movement. | 1- what is being tested? 2- what are positive findings? 3- what is the name of the test? | 1- identifies a space occupying lesion
2- increased low back pain or neurologic symptoms into lower extremity
3- Valsalva maneuver
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| Patient supine or sitting. Bottom end of a standard reflex hammer is glided along plantar surface of patients foot. | 1- what is being tested? 2- what are positive findings? 3- what is the name of the test? | 1- upper motor neuron lesion
2- extension of big toe and splaying (abduction) of other toes
3- Babinski test
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| Patient standing. side bend LEFT, rotate LEFT, maximally extend. which structure gets maximally stressed? | a) LEFT intervertebral foramen b) LEFT facet joint c) RIGHT intervertebral foramen d) RIGHT facet joint | a)intervertebral foramen
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| Patient standing. side bend LEFT, rotate LEFT, maximally extend. Pain goes down middle of the left leg, over the knee cap to the toe. What can the lesion be? | a) left L4 nerve compression at intervert. foramen b) left L3 facet joint dysfunction c) left L5 nerve compression at intervert. foramen d) left S1 nerve compression at intervert. foramen | a) left L4 nerve compression at intervert. foramen
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| Patient standing. side bend LEFT, rotate LEFT, maximally extend. Pain goes down lateral side of the left leg, down to calf, heel and middle finger and plantar surface of foot. What can the lesion be? | a) left L4 nerve compression at intervert. foramen b) left L5 facet joint dysfunction c) left L5 nerve compression at intervert. foramen d) left S1 nerve compression at intervert. foramen | c) left L5 nerve compression at intervert. foramen
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| Patient standing. side bend LEFT, rotate LEFT, maximally extend. Pain goes down lateral-middle back of left leg, to the 5th finger . What can the lesion be? | a) left L4 nerve compression at intervert. foramen b) left S1 nerve compression at intervert. foramen c) left L5 nerve compression at intervert. foramen d) left S2 nerve compression at intervert. foramen | b) left S1 nerve compression at intervert. foramen
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| Patient standing. side bend LEFT, rotate LEFT, maximally extend. Pain goes down inner back of the left leg, . What can the lesion be? | a) left L4 nerve compression at intervert. foramen b) left S1 nerve compression at intervert. foramen c) left L5 nerve compression at intervert. foramen d) left S2 nerve compression at intervert. foramen | d) left S2 nerve compression at intervert. foramen
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| Patient standing. side bend LEFT, rotate LEFT, maximally extend. Pain goes over left VMO down medial of knee cap and ends medially mid calf between heel and knee. What can the lesion be? | a) left L1 nerve compression at intervert. foramen b) left L2 nerve compression at intervert. foramen c) left L3 nerve compression at intervert. foramen d) left L4 nerve compression at intervert. foramen | c) left L3 nerve compression at intervert. foramen
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| Patient standing. side bend LEFT, rotate LEFT, maximally extend. Pain goes down anterior groin. What can the lesion be? | a) left L5 nerve compression at intervert. foramen b) left L2 nerve compression at intervert. foramen c) left S1 nerve compression at intervert. foramen d) left S2 nerve compression at intervert. foramen | b) left L2 nerve compression at intervert. foramen
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| Patient standing. side bend LEFT, rotate LEFT, maximally extend. Pain goes down to over genital area. What can the lesion be? | a) left L1 nerve compression at intervert. foramen b) left S2 facet joint dysfunction c) left L3 nerve compression at intervert. foramen d) left L4 nerve compression at intervert. foramen | a) left L1 nerve compression at intervert. foramen
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| Patient has lateral lumbar disc protrusion between L4-L5. Which nerve is affected? | a) L3 b) L4 c) L5 d) S1 | c) L5 lumbar disc protrusion does not usually affect nerve existing above disc. Therefore L4 and L3 are not affected.
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| Patient standing. side bend LEFT, rotate RIGHT, maximally extend. which structure gets maximally stressed? | a) LEFT intervertebral foramen b) LEFT facet joint c) RIGHT intervertebral foramen d) RIGHT facet joint | b) LEFT facet joint
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| 1- What test is used to differentiate between compression of neural structures at the intervertebral foramen FROM facet dysfunction? 2- What are positive findings for each? | 1- Quadrant test | 2- Pain &/ parasthesia in dermatomal pattern for involved nerve root is a positive finding for compression of neural structures at the intervertebral foramen. Localized pain is is a positive finding for facet dysfunction.
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| Patient stands on one leg. When cued into trunk extension there is pain in low back with ipsilateral leg on ground. What is the problem? What is the name of the test? | a) osteoarthritis b) spondylolisthesis c) nerve root entrapment d) vascular claudication | b) spondylolisthesis
Stork Standing Test
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| Patient has LEFT lateral shift of trunk. PT is standing on left side, wraps his arms around pt's pelvis and stabilizes trunk with his shoulders. When upper trunk and pelvis are pulled into proper alignment neurologic symptoms occur. Problem? Test name? | a) scoliosis b) neurologic dysfunction causing lateral shift c) spinal stenosis d) spondylolisthesis | b) neurologic dysfunction causing lateral shift
McKenzie's side glide test
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| Patient has back pain. Is able to ride a stationary bike at set pace/speed in erect position for 5 minutes and has symptoms after that. But when same thing is done slumped patient can ride for 30 minutes. What is the problem? | a) spinal stenosis b) intermittent claudication c) DJD d) vascular claudication | a) spinal stenosis
Bicycle (Van Gelderen) test
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| Patient sitting, shoulder in neutral stabilized against trunk, elbow at 90 degrees and forearm pronated. Forearm supination and shoulder external rotation is resisted. What is being tested? What happens when positive? Name of test? | 1- integrity of transverse ligament is tested and may also identify bicipital tendinitis. 2- tendon of biceps long head pops out of groove may also reproduce pain in long head of biceps tendon. | Yergason's test
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| Pt is sitting/standing w/upper limb in full extension and forearm suppinated. Shoulder flexion resisted. May also place shoulder in 90 flexion and push upper limb into extension causing eccentric contraction of biceps. Reproduces pain in l/ head of biceps | A.) Bicipital Tendonitis or Tendonosis B.) Transverse ligament rupture C.) Rotator cup rupture D.) Rotator cup impingement | A.) Bicipital Tendonitis or Tendonosis
Speed's test (biceps straight arm)
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| P sitting shoulder is passively internally rotated then fully abducted. Pain occurs within shoulder region. What can the problem be? | A.) Impingement of long head of biceps and supraspinitus tendon B.) Slap tear C.) Rotator cuff rupture D.) Glenoid Labrum tear | A.) Impingement of long head of biceps and supraspinitus tendon
Neer Impingement test
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| P sitting shoulder internal rotation- 30 horizontal adduction- resist abduction. Pain occurs in supraspinitus tendon. When test is done without rotation and horizontal adduction, there is no pain. What is the lesion? | A.) SLAP tear B.) Labrum tear C.) Supraspinitus tendon impingement D.) Bicipital Tendonitus | C.) Supraspinitus tendon impingement
Superspinitus (empty can) test
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| P sitting with shoulder passively 120 abd. Patient instructed to slowly bring arm down to side. Arm falls down to the side and then what can the lesion be? | A.) Bicipital tendonitus B.) Glenoid Labrum Tear C.) Anterior shoulder dislocation D.) Rotator cuff rupture/tear | D.) Rotator cuff rupture/tear
Drop arm test
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| P suppine with shoulder in full abd. Push humeral head anterior while rotating humerous externally. A clunk sound is heard. Lesion? | A.) Anterior shoulder dislocation B.) Posterior shoulder dislocation C.) Glenoid Labrum Tear D.) Rotator cuff tear | C.) Glenoid Labrum Tear
Clunk test
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| P suppine. Moves shoulder into 90 abd.- max ext. rot. - 15-20 hor add. Pain occurs in posterior shoulder. Lesion? | A.) Anterior shoulder dislocation B.) Impingement between rot. cuff and tub maj or post. gleniod and labrum C.) Bicipital Tendonitus D.) Transverse ligament rupture | B.) Impingement between rot. cuff and tub maj or post. gleniod and labrum
Posterior internal impingement test
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| P suppine. Shoulder 90 add. Slowly take shoulder into external rotation. Patient does not like this motion. What can this diagnose? And what does this motion produce? | A.) Anterior Shoulder dislocation B.) Posterior Shoulder dislocation C.) A C Joint dysfunction D.) Thorasic outlet problem | A.) Anterior Shoulder dislocation
The motion stimulates anterior dislocation.
Anterior apprehension sign/fulcrum test (if suppine)/crank test (if standing)
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| P suppine. Shoulder 90 abd. with scapula stabilized by table. Place a posterior force through shoulder via force on P's elbow while simultaneously moving shoulder into medial rotation and horizontal add. P does not allow this motion. Lesion? | A.) History of Anterior shoulder dislocation B.) History of Posterior shoulder dislocation C.) Supraspinitus tear D.) Infraspinitus tear | B.) History of Posterior shoulder dislocation
Posterior apprehension sign
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| P sitting with arm resting at side. Examiner clasps hands and places one hand on spinal scapula and heel of other hand on clavical. Squeeze hands together, causing compression of AC joint. Pain is reproduced in AC joint. What can the problem be? | A.) AC Separation B.) T4 rib fracture C.) Rotator cuff tear D.) Bicipital tendonitus | A.) AC Separation
Acromial Clavical shear test
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| P sitting. Find radial pulse of extremity being tested. Rotate head toward extremity being tested. Then extend and ext. rotate shoulder while extending the head. Pulse disappears and neurological symptoms are reproduced in upper extremity. Lesion? | A.) Vascular claudication B.) Osteoarthritis C.) Pathology of thorasic inlet D.) Thorasic discal herniation | C.) Pathology of thorasic inlet
Addson's test
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| P sitting. Find radial pulse. Move involved shoulder down and back. Pulse disappears and neurologic symptoms are reproduced in upper extremity. Lesion? | A.) Anterior shoulder dislocation B.) AC joint dysfunction C.) Thoracic inlet pathology D.) Thoracic nerve root compression | C.) Thoracic inlet pathology
Military brace test
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| P sitting. Find radial Pulse. Move shoulder into max abd and ext rot. Taking a deep breath and rotating head to opposite side causes disappearance of pulse and neurologic symptoms in upper extremity. Lesion? | A.) Anterior shoulder dislocation B.) AC joint dysfunction C.) Thoracic inlet pathology D.) Thoracic nerve root compression | C.) Thoracic inlet pathology
Wright (hyper abd)
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| P standing. Shoulders full ext. rot., 90 abd and slightly hor abd. Elbows 90 flexed and P opens/closes hands for 3 minutes slowly. Pulse disappears and neurologic symptoms reproduced in upper extremity. Lesion? | A.) Rotator cuff impingement B.) Thoracic inlet pathology C.) Glenoid Labrum Tear D.) Rotator cuff rupture | B.) Thoracic inlet pathology
Roos elevated arm test
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| P is supine. Entire lower limb is supported and stabilized and knee is placed in 20-30 flexion. Valgus force is applied. Laxity is present. Which structure is affected? | a)Medial collateral ligament b)Lateral – collateral ligament c)ACL d)PCL | a)Medial collateral ligament
Collateral Ligament instability test
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| P is supine. Entire lower limb is supported and stabilized and knee is placed in 20-30 flexion. Varus force is applied. Laxity is present. Which structure is affected? | a)Medial collateral ligament B.)Lateral – collateral ligament C.)ACL D.)PCL | b) Lateral – collateral ligament
Collateral Ligament instability test
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| P supine knee flexed 20-30. Stabilized femur. Passively glide tibia anteriorly. Tibia glides excessively to the anterior. Which structure has a pathology? | a)Medial collateral ligament b)Lateral – collateral ligament c) ACL d) PCL | c) ACL
Lachman’s stress test
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| P sup – knee ext. Hip flex - 30 abd. with slight int rot. Hold knee with one hand and foot with the other hand. Place valgus force through knee and flex knee. As knee is being flexed, the tibia klunks backward at approx 30-40. Which structure has path.? | a)Medial collateral ligament b)Lateral – collateral ligament c) ACL d) PCL | c) ACL
The tibia at the beginning of test was subluxed and was reduced by pull of ilio-tibia band and knee was being flexed. There is ligament laxity as indicated by tibia relocating during the test.
Pivot shift (anterial lateral rotary instability)
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| P supine. Hip flexed 45 and knee flexed 90. Tibia sags posterially while in this position. Which structure has a pathology? | a)Medial collateral ligament b)Lateral – collateral ligament c)ACL d)PCL | d)PCL
Posterior sag test
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| P supine. Hip flexed 45 and knee flexed 90. Passively glide tibia posteriorly following the joint plane. Excessive posterior joint glide is present. Which structure has a pathology? | a)Medial collateral ligament b)Lateral – collateral ligament c)ACL d)PCL | d)PCL
Posterior drawer test
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| P prone. Knees flexed 30. Stabilize femur and passively try to glide tibia posterior. Ligament laxity is present. Where is the pathology? | a)Medial collateral ligament b)Lateral – collateral ligament c)ACL d)PCL | d)PCL
Reverse lachman test
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| P supine. Knee maximal flexion. Passively internally rotate and extend the knee. A click sound is heard and/or pain in knee joint is present. Which structure has the pathology? | a)Lateral meniscus b) Medial meniscus c) ACL d) LCL | a) Lateral meniscus
McMurray test
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| P supine. Knee maximal flexion. Passively externally – laterally rotate and extend the knee. A click sound is heard and/or pain in knee joint is present. Which structure has the pathology?c) | a) Lateral meniscus b) Medial meniscus c) ACL d) LCL | b) Medial meniscus
McMurray test
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| P prone. Knee flexed 90. Stabilize P’s thigh to table with your knee. Passively distract the knee joint and slowly rotate tibia internally. Pain or decrease motion occurs during distraction. Where can the pathology be? | a) Laterial meniscus b) Medial meniscus c) Ligament pathology d) Q angle increase | c) Ligament pathology
Apley test
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| P prone. Knee flexed 90. Stabilize P’s thigh to table with your knee. Passively compress the knee joint and slowly rotate tibia internally. Pain or decrease motion occurs during distraction. Where can the pathology be? | a) Laterial meniscus b) Medial meniscus c) Ligament pathology d) Q angle increase | a) Laterial meniscus
Apley test
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| P prone. Knee flexed 90. Stabilize P’s thigh to table with your knee. Passively compress the knee joint and slowly rotate tibia externally. Pain or decrease motion occurs during distraction. Where can the pathology be? | a) Laterial meniscus b) Medial meniscus c) Ligament pathology d) Q angle increase | b) Medial meniscus
Apley test
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| P supine. Knee flexed. Tibia internally rotated. Passively glide the patella medially while palpating the medial femoral condial. While passively flexing and extending the knee, popping and/or pain is present. What can the pathology be? | a) Meniscal tear b) Plica dysfunction c) ACL tear d) LCL tear | Plica dysfunction
Hughston’s Plica test
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| P supine. Patella is glided laterally. P does not allow or does not like this motion. What is being tested? | a) Plica dysfunction b) Q angle decrease c) History of patella dislocation d) History of ACL reconstruction | History of patella dislocation
Patella apprehension test
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| P supine. Knee in extension. Resting on table. Push posterior on superior pole of patella, then ask P to perform an active contraction of the quadriceps muscle. Pain is produced in knee. What is the pathology?) | a) Q angle increase b) Patella Femoral dysfunction c) History of patella dislocation d) Osgood-Schlater’s disease | b) Patella Femoral dysfunction
Clarke’s sign
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| P supine with knee in extension, resting on table. Apply a soft tap over the central patella Patella feels like floating (dancing patella sign). What is the pathology? | a) Infra patellar effusion b) Patella femoral dysfunction c) Patella dislocation d) Patella fracture | a) Infra patellar effusion
Patellar tap test/ Ballotable Patella
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| P supine with knee in extension, resting on table. Place one hand over supra petalla pouch and the other over anterior aspect of knee joint. Alternate pushing down with one hand at a time. Fluctuation and movement of fluid is noted during the test. What | a) Infra patellar effusion b) Patella femoral dysfunction c) Patella dislocation d) Knee joint effusion | d) Knee joint effusion
Fluctuation test
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| Q angle is 20 degrees for a male patient. What does this indicate? | a)History of meniscule tear b) Knee dysfunction c) Knee joint effusion d) PCL tear | b) Knee dysfunction
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| P supine. Hip 45 flexed and knee 90 flexed. Apply pressure to lateral femoral epicondial and then extend knee. P complains of pain over lateral femoral epicondial at approximately 30 degree flexion. What can the pathology be? | a)PCL pathology b) Posterior glide of tibia c) IT band friction syndrome d) DJD | IT band friction syndrome
Noble compression test
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| Tap region where common fibular nerve passes through posterior to fibula head. There is tingling and/or parasthesia into leg, following fibular nerve distribution. What is the pathology? | a) Dysfunction of common fibular nerve posterior to fibular head b) Upper motor neuron lesion c) Compression of femoral nerve along its course d) Dysfunction of common peroneal nerve along its course | d) Dysfunction of common fibular nerve posterior to fibular head
Tineal’s sign
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| P standing. Place thumb under PSIS, other thumb on center of sacrum (thumbs are at same level and eyes are level with thumbs. Pt flexes hip and knee (knee to chest. PSIS moves in an inferior direction. Name of the test? is the findıng +?What does it asses | a) Gillet’s + b) Gaenslen’s - c) Ipsilateral anterior rotation test + d) Gilets – | a) Gilet’s – - -
Assesses posterior movement of ilium relative to sacrum
Positive if there is no identified movement of PSIS as compared to sacrum
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| P Standing. Place thumb under PSIS, other thumb on center of sacrum (both thumbs are at same level) PT’s eyes are level with thumbs. Pt extends hip. PSIS moves in a superior direction. name of the test? Is the finding positive? What does it assess? | a) Gillet’s + b) Gaenslen’s + c) Ipsilateral anterior rotation test - d) Goldthwait’s test – | Ipsilateral anterior rotation test – - -
Assesses anterior movement of ilium relative to sacrum - - -
Positive if there is no identified movement of PSIS as compared to sacrum
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| p Sidelying at edge of table. Bottom leg knee to chest (max knee & hip flex) Upper limb is passively extended. Pt feels pain in upper SIJ. What can the problem be? Which structure is being stressed? Name of test? | a) Spondylolisthesis b) SIJ dysfunction c) Intermittent claudication d) Spinal Stenosis | a) SIJ dysfunction - - -
SIJ associated with uppermost limb is being stressed
Gaenslen’s test +
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| P Supine. Trunk, pelvis and lower limbs are aligned. Medial malleoli are not symmetric (one longer than other). When pt is long sitting the asymmetry is reversed. What can be causing the leg length discrepancy? | a) Achilles tendon tightness b) ITB tightness c) SIJ dysfunction d) Lumbar spine dysfunction | c) SIJ dysfunction - - -
Long sitting (supine to sit) test identifies SIJ dysfunction that may be cause of leg length discrepancy
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| P Supine. PT’s fingers in between spinous processes of lumbar spine. With the other hand perform a passive straight leg raise. Pain present prior to palpation of movement in lumbar segments. What is the dysfunction related to? | a) Lumbar spine b) SIJ c) Pubis d) ITB | b) SIJ - - -
Goldthwait’s test differentiates between dysfunction in lumbar spine versus SIJ
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| P Pt sitting or supine . Support/stabilize patients head with one hand and with the other push mandible superior causing a compressive load to the TMJ. Name of test and what is positive finding? | a) Cervical pain b) TMJ pain c) TMJ excessive motion d) Radiating pain down to arm | b) TMJ pain - - -
TMJ compression test evaluates for pain with compression of the retrodiscal tissues
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| P supine with foot supported on table. Grasp around metatarsal heads and squeeze. Pt feels pain in forefoot. What can the problem be? | a) calcaneofibular ligament strain b) calcaneal fracture c) anterior talofibular d) forefoot stress fracture/neuroma | d) forefoot stress fracture/neuroma - - -
Morton's test
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| P supine. Foot supported on table. Tap over region posterior to medial malleolus. There is tingling and/or parasthesia. What structure has a pathology? | a) Posterior tibial nerve dysfunction - b) Deep fibular nerve dysfunction - c) Sup. peroneal nerve dysfunction - d) Common peroneal nerve dysfunction - | a) Posterior tibial nerve dysfunction -
Tinel's sign
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| P supine. Foot supported on table. Tap over region under dorsal retinaculum (anterior to ankle joint). There is tingling and/or parasthesia. What structure has a pathology? | a) posterior tibial nerve dysfunction - b) deep fibular nerve dysfunction - c) common fibular nerve dysfunction - d) lateral femoral cutaneous nerve dysfunction | b) deep fibular nerve dysfunction -
Tinel's sign
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| P prone with foot off edge of table. Squeeze calf muscle. There is no movement of foot while squeezing calf. What structure is being tested? | a) anterior talofibular ligament b) Achilles tendon c) Tibiotalar joint d) Fibulotalar joint | b) Achilles tendon - - -
Thompson test - evaluates the integrity of Achilles tendon
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| P sidelying, knee slightly flexed and ankle in neutral. Move foot into adduction. Excessive adduction is present and/or pain occurs. What is the pathology? | a) deltoid ligament b) calcaneofibular ligament c) anterior talofibular ligament d) Aschilles tendon | b) calcaneofibular ligament - - -
Talar tilt test - identifies ligamentous instability
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| P sidelying, knee slightly flexed and ankle in neutral. Move foot into abduction. Excessive adduction is present and/or pain occurs. Where is the pathology? | a) deltoid ligament b) calcaneofibular ligament c) anterior talofibular ligament d) Aschilles tendon | a) deltoid ligament - - - Talar tilt - identifies ligamentous instability
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| P supine with heel just off of table in 20 plantar flexion. Stabilize lower leg and grasp foot. Pull talus anterior. Talus has excessive anterior glide and/or pain is noted. Which structure has a pathology? | a) Aschilles tendon b) calcaneofibular ligament c) anterior talofibular ligament d) deltoid ligament | c) anterior talofibular ligament - - -
Anterior drawer test - identifies ligamentous instability
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| P prone W/foot over edge of table. Palpate dorsal aspect of talus on both sides with one hand. Grasp lat. forefoot with other hand. Gently dorsiflex until resistance is felt. Gently move foot through arc of supination and pronation. what is being examined | a) whether Aschilles tendon rupture exists b) whether abnormal rearfoot to forefoot positioning is present c) whether deltoid ligament rupture is present d) whether plantar fasciitis is present | b) whether abnormal rearfoot to forefoot positioning is present - Neutral subtalar positionong test. Neutral position is point at which you feel foot fall off easier to one side or other. At this point rearfoot to forefoot and rearfoot to leg is compared.
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| What type of SI dysfunction does squatting/lifting/lowering cause? | a) anterior torsion of innominate b) posterior tortion of innominate c) sacral dysfunction | a) anterior torsion of innominate
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| What type of SI dysfunction does vertical thrust onto extended LE cause? | a) anterior torsion of innominate b) posterior tortion of innominate c) sacral dysfunction | b) posterior tortion of innominate
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| What type of SI dysfunction do long term postural abnormalities cause? | a) anterior torsion of innominate b) posterior tortion of innominate c) sacral dysfunction | c) sacral dysfunction
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| What type of SI dysfunction does a fall onto sacrum/coccyx cause? | a) anterior torsion of innominate b) posterior tortion of innominate | c) sacral dysfunction
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| What type of SI dysfunction does sprint starting position cause? | a) anterior torsion of innominate b) posterior tortion of innominate c) sacral dysfunction | b) posterior tortion of innominate
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| What type of SI dysfunction does pregnancy cause? | a) anterior torsion of innominate b) posterior tortion of innominate c) sacral dysfunction | a) anterior torsion of innominate
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| What type of SI dysfunction does a fall onto ischial tuberosity cause? | a) anterior torsion of innominate b) posterior tortion of innominate c) sacral dysfunction | b) posterior tortion of innominate
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| What type of SI dysfunction does unilateral standing cause? | a) anterior torsion of innominate b) posterior tortion of innominate c) sacral dysfunction | b) posterior tortion of innominate
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| What type of SI dysfunction does golfing/batting/tennis cause? | a) anterior torsion of innominate b) posterior tortion of innominate c) sacral dysfunction | a) anterior torsion of innominate
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| What type of SI dysfunction does carrying a load during ambulation cause? | a) anterior torsion of innominate b) posterior tortion of innominate c) sacral dysfunction | c) sacral dysfunction
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| What type of SI dysfunction does trauma during childbirth cause? | a) anterior torsion of innominate b) posterior tortion of innominate c) sacral dysfunction | c) sacral dysfunction
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| What type of SI dysfunction does loss of balance during ambulation cause? | a) anterior torsion of innominate b) posterior tortion of innominate c) sacral dysfunction | c) sacral dysfunction
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| What type of SI dysfunction does hip at 90 degrees with axial loading cause? | a) anterior torsion of innominate b) posterior tortion of innominate c) sacral dysfunction | a) anterior torsion of innominate
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| What type of SI dysfunction does sitting combined with rotation and lifting cause? | a) anterior torsion of innominate b) posterior tortion of innominate c) sacral dysfunction | c) sacral dysfunction
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| P supine. Passively flex, abd and ext rot leg so that foot is resting just above knee of opposite leg. Testing leg is slowly lowered down towards table surface there is reproduction of painful syndr and/or knee is unable to assume relaxed pos. Problem? | a) SIJ dysfunction (ant torsion of innominate) b) ITB friction c) Hip dysfunction (mobility restriction) d) SIJ dysfunction (sacral dysfunction) | c) Hip dysfunction (mobility restriction) - PAtrick (FABERE) test - identifies dysfunction of hip joint such as mobility restriction
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| P supine with hip in 90 flex and knee max flexed. When a compressive force is placed into femur via knee joint (therefore loading hip joint)pain is reproduced within hip joint. what can the problem be? | a) Tightness of hip flexors b) ITB tightness c) DJD of hip d) SIJ dysfunction | c) DJD of hip - - -
Grind (Scouring) test
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| P standing and asked to stand on one leg (opposite knee flexed) Pelvis of stance leg (ipsilateral pelvis) drops when lower limb support is removed while standing. | a) Hip flexors b) Gluteus medius c) Gluteus maximus d) lumbar extensors | b) Gluteus medius - - - Trendelenburg's sign identifies weakness of gluteus medius or unstable hip.
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| P supine. One hip & knee max. flexed to chest and held there. Opposite limb is unable to remain straight on table. Which muscles are tight? Name of test? Weakness of test? | a) hip flexors b) hamstrings c) hip extensors d) hip adductors | a) hip flexors - - - Thomas test - weakness of test is that it does not differentiate between tightness in iliacus versus psoas major
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| P side lying. Lower limb flexed at hip and knee. Passively extend and abd upper hip with knee 90 flexed. When upper limb slowly lowered it is unable to come to rest on table. Where is the tigtness? | a) Iliopsoas b) ITB & tensor facia lata c) Hip extensors d) Quadriceps femoris | b) ITB & tensor facia lata - - - Ober's test - - -
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| P prone. When knee of testing limb is flexed the hip of testing limb flexes also. Which muscle has tightness? | a) tensor facia lata b) gluteus medius c) Gluteus maximus d) rectus femoris | d) rectus femoris - - - Ely test
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| P supine. Hip and knee of testing leg is 90 flex both. When knee is passively extended it is unable to reach full extension (10 degrees lacking) Which structure is tight? | a) Rectus femoris b) Hamstrings c) Gluteus maximus d) Gastrosoleus | b) Hamstrings - - - 90-90 Hamstring test
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| P supine and foot of testing leg is passively placed lateral to opposite limb's knee. When testing hip is adducted it is unable to pass over resting knee and there is pain along sciatic nerve and reproduction of pain aroun buttock. What is the pathology? | a) sartorius dysfunction b) ITB tightness C) L4-5 nerve root compression d) piriformis syndrome | d) piriformis syndrome - - - piriformis test
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| P prone. knee 90 flex. Palpate greater torachanter and move hip through int/ext rot. When greater troch. feels most lateral angle of leg ralative to a line perpendicular with table surface is measured. The int rot angle is 25 degrees. What is the patholog | a) anteverted hip b) retroverted hip c) functional leg length discrepancy d) piriformis syndrome | a) anteverted hip - - - Craig's test - identifies abnormal femoral antetortion angle. normal is between 8-15 degrees.
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| P prone. knee 90 flex. Palpate greater torachanter and move hip through int/ext rot. When greater troch. feels most lateral angle of leg ralative to a line perpendicular with table surface is measured. The int rot angle is 5 degrees. What is pathology? | a) anteverted hip b) retroverted hip c) functional leg length discrepancy d) piriformis syndrome |
a) retroverted hip - - - Craig's test - identifies abnormal femoral antetortion angle. normal is between 8-15 degrees.
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| Which of these factors does NOT contribute to functional leg length discrepancies? | a) anatomical difference in bone lengths b) pronation of foot c) pelvic obliquity d) abnormal posture | a) anatomical difference in bone lengths - - cause true discrepancies. Measured distance from ASIS to lateral malleolus identifies true leg length discrepancy.
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| P standing. sh. 90 foreward flex,add 10-15 toward midline, elbow full ext. arm max int rot by pointing thumb downward. A)apply a uniform downward pressure to arm. B)do same with arm ful supinated, Pain in step A inc, step B decrease. Pathology? | a) AC joint abnormality b) labral pathology c) supraspinatus tendon injury d) thoracic inlet syndrome | a) AC joint abnormality - - - O'Brien test considered positive, if pain elicited in step A but improved or eliminated in step B. Pain localized to 'on top' of the shoulder is highly correlated with A-C joint abnormality
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| P standing. sh. 90 foreward flex,add 10-15 toward midline, elbow full ext. arm max int rot by pointing thumb downward. A)apply a uniform downward pressure to arm. B)do same with arm ful supinated, Pain in step B w/painful clicking 'inside' the sh. Patholo | a) AC joint abnormality b) labral pathology c) supraspinatus tendon injury d) thoracic inlet syndrome | b) labral pathology - - -Active Compression Test by O'Brien . useful to differentiate btw AC and Labral pathology.Pain localized 'on top' of the shoul is highly correlated with A-C abnormality, painful clicking 'inside' sh indicative of gl. labr. pathol.
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| P is sitting/supine. Entire upper limb is supported and stabilized and elbow placed in 20-30 flex. Valgus force is applied. Laxity and pain is noted. Which structure has instability? | a) ulnar collateral ligament b) radial collateral ligament c) annular d) quadrate | a) ulnar collateral ligament - - -
Ligament instability test identifies ligament laxity or restriction
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| P is sitting/supine. Entire upper limb is supported and stabilized and elbow placed in 20-30 flex. Varus force is applied. Laxity and pain is noted. Which structure has instability? | a) ulnar collateral ligament b) radial collateral ligament c) annular ligament d) distal radioulnar ligament | b) radial collateral ligament
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| P sitting with elbow in 90 flexion and supported/stabilized. Resist wrist extension, wrist radial deviation and forearm pronation with fingers fully flexed (fist) simultaneously. What is being tested? | a) lateral epicondylitis b) medial epicondylitis c) deQuervain's tenosynovitis d) carpal tunnel syndrome | a) lateral epicondylitis - - - Lateral epicondylitis ('tennis elbow') test
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| Patient sitting with elbow in 90 flex and supported/stabilized. Passively supinate forearm, extend elbow and extend wrist. What is being tested for? where does patient feel pain? | a) lateral epicondylitis b) medial epicondylitis c) deQuervain's tenosynovitis d) carpal tunnel syndrome | b) medial epicondylitis - - - Medial epicondylitis ('golfer's elbow') test identifies medial epicondylitis and reproduces pain at medial epicondyle.
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| When region of cubital tunnel is tapped. There is a tingling sensation on the 5th (pinky) finger. What has a pathology? | a) median nerve b) ulnar nerve c) radial nerve d) axillary nerve | b) ulnar nerve - - - Tinel's sign identifies dysfunction of ulnar nerve at olecranon
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| Pattient sitting with elbow 90 flex and supported/stabilized. Resist forearm pronation and elbow extension simultaneously. There is a tingling/parasthesia onto thumb index and second finger. Which structure is entrapped? | a) median nerve b) ulnar nerve c) radial nerve d) axillary nerve | a) median nerve - - - Pronator teres syndrome test - identifies a median nerve entrapment within pronator teres
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| P makes fist with thumb within confines of fingers Passively move wrist into ulnar deviation. Produces pain in wrist. What can the pathology be? | a) carpal tunnel compression b) ulnar nerve dysfunction c) deQuervain's tenosynivitis d) radial nerve dysfunction | c) deQuervain's tenosynovitis - - - Finkelstein test identifies paratendonitis of abductor pollicis longus and/or extensor pollicis brevis (deQuervain's tenosynovitis). Often painful with no pathology so must be compared to uninvolved side.
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| Pt complains of tightness in hand. A- MCP joint is stabilized in slight extension while PIP joint is flexed. B- MCP joint is flexed and PIP joint is flexed. There is more PIP flex when MCP is flexed. Which structure has tightness? | a) capsule b) intrinsic muscles c) retinacular ligaments d) adductors | b) intrinsic muscles - - - Bunnel-Littler test identifies tightness in structures surrounding the MCP joint. If flex limited in both cases, then the capsule is tight. If fle limited only in B then intrinsic muscles are tight.
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| Pt complains of tightness in hand. A- MCP joint is stabilized in slight extension while PIP joint is flexed. B- MCP joint is flexed and PIP joint is flexed. A and B are equally limited. Which structure has tightness? | a) capsule b) intrinsic muscles c) retinacular ligaments d) adductors | a) capsule - - - Bunnel-Littler test identifies tightness in structures surrounding the MCP joint. If flex limited in both cases, then the capsule is tight. If fle limited only in B then intrinsic muscles are tight.
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| A- PIP is satabilized in neutral while DIP is flexed. B- PIP is flexed and DIP is flexed. There is more flexion in B. Which structure has tightness? | a) capsule b) retinacular ligament c) intrinsic muscles d) extensor muscles | b) retinacular ligament - - - Tight retinacular test identifies tightness around PIP joints. If limitation in A is same as B then the capsule has tightness.
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| When fingers are supported and stabilized valgus and varus force is applied to all DIP and PIP. What would be positive finding for a ligamentous instability test? | a) DIP pain b) PIP/DIP laxity and/or pain c) MCP pain d) MCP laxity and/or pain | b) PIP laxity and/or pain
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| P grasps paper between 1st and 2nd digits of hand. Paper is pulled out. What would be a positive froments sign? | a) IP flexion of thumb b) IP adduction of thumb c) extension of thumb d) extension of index finger | a) IP flexion of thumb - - - is compensation due to weakness of adductor policis. This may indicate ulnar nerve dysfunction.
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| When midline of wrist is tapped on the palmar side pt has tingling and/or parasthesia going down to first three fingers. What can the problem be? | a) carpal tunnel compression of median nerve b) ulnar nerve dysfunction c) radial nerve dysfunction d) vascular compromise at wrist | a) carpal tunnel compression of median nerve - - - Tinel's sign
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| P maximally flexes both wrists holding them against each other for one minute. There is parasthesia and/or tingling at the first 3,5 fingers. Which structure is being compressed? | a) radial nerve b) median nerve c) PIP capsules d) ulnar nerve | b) median nerve - - - Phalen's test - identifies carpal tunnel compression of median nerve.
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| What is the normal distance of two point discrimination? | a) 10 mm b) 6 mm c) 2 mm d) 12 mm | b) 6 mm - - - two point discrimination test identifies sensory innervation within hand which correlates with functional ability to perform certain tasks involving grasp.
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| A positive Allen test identifies... | a) nerve compression b) vascular compromise c) ligament dysfunction d) capsule dysfunction | b) vascular compromise - - - a) radial and b) ulnar arteries are ocluded with thumb while patient makes a fist. When thumb released there should be a change of white to normal. Abnormal filling will make Allen test +.
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| Shoulder depression and 110 abd, elboew ext, forearm sup, wrist ext, fingers and thumb ext, cervical spine contralateral side flexion. There is pain and tingling. What is being tested? | a) median nerve, anterior interosseous nerve, C5, C6, C7 b) median nerve, musculocutaneous nerve, axillary nerve c) radial nerve d) ulnar nerve, C8, T1 nerve roots | a) median nerve, anterior interosseous nerve, C5, C6, C7
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| Shoulder depression and 10 abd + lateral rotation, elbow ext, forearm supin, wrist ext, fingers and thumb ext, cervical spine contralateral side flexion. What is being tested for? | a) median nerve, anterior interosseous nerve, C5, C6, C7 b) median nerve, musculocutaneous nerve, axillary nerve c) radial nerve d) ulnar nerve, C8, T1 nerve roots | b) median nerve, musculocutaneous nerve, axillary nerve
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| Shoulder depression and 10 abd + medial rotation, elbow ext, forearm pron, wrist flexion and ulnar deviation, fingers and thumb flexion, cervical spine contralateral side flexion. What is being tested for? | a) median nerve, anterior interosseous nerve, C5, C6, C7 b) median nerve, musculocutaneous nerve, axillary nerve c) radial nerve d) ulnar nerve, C8, T1 nerve roots | c) radial nerve
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| Shoulder depression and abd (10 to 90) hand to ear + lateral rotation, elbow flexion, forearm supin, wrist extension and radial deviation, fingers and thumb ext, cervical spine contalateral side flexion. There is tingling. What is being tested? | a) median nerve, anterior interosseous nerve, C5, C6, C7 b) median nerve, musculocutaneous nerve, axillary nerve c) radial nerve d) ulnar nerve, C8, T1 nerve roots | d) ulnar nerve, C8, T1 nerve roots
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| In Manual Grading of Accessory joints Grade 3 means | a) ankylosed b) normal c) unstable d) hypermobility | b) normal
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| In Manual Grading of Accessory joints Grade 2 means | a) slight hypomobility b) normal c) unstable d) hypermobility | a) slight hypomobility
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| In Manual Grading of Accessory joints Grade 6 means | a) ankylosed b) normal c) unstable d) hypermobility | c) unstable
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| In Manual Grading of Accessory joints Grade 4 means | a) considerable hypermobility b) normal c) slight hypermobility d) hypermobility | c) slight hypermobility
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| In Manual Grading of Accessory joints Grade 5 means | a) considerable hypermobility b) normal c) slight hypermobility d) hypermobility | a) considerable hypermobility
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| In Manual Grading of Accessory joints Grade 0 means | a) ankylosed b) normal c) unstable d) hypermobility | a) ankylosed
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| In Manual Grading of Accessory joints Grade 1 means | a) ankylosed b) normal c) unstable d) considerable hypomobility | d) considerable hypomobility
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Review the information in the table. When you are ready to quiz yourself you can hide individual columns or the entire table. Then you can click on the empty cells to reveal the answer. Try to recall what will be displayed before clicking the empty cell.
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