orthapedic tests

Question 1

what is distraction of spine

Answer 1

thumbs under mastoid process’ and hand on mandibe and pull up

t+l spine- hands holding own shoulders hook under elbows and pull up

indications are: radiculopathy or local pain

positive test: relief of pain

suggested diagnosis: nerve root encroachment or facet related pain

false positive: pain in neck, could be ligamentous or muscular

Question 2

compression test

Answer 2

palms of hands on head and pushing down. for c spine

t+l spine- push down on shoulder

indications are radiculopathy and local pain

positive test: symptom reproduction

Diagnosis: facet irritation, facet joint syndrome, faceto-genic pain

Question 3

spurlings test

Answer 3

head to sidebend , compress, add rotation compress, add extension compress

indications are radiculopathy

positive test: symptom reproduction

diagnosis: nerve route stenosis

Question 4

what is fracture screening with vibration and percussion

Answer 4

use tuning fork and place around site of pain then on site of pain.

indications for it should be constant unrelenting pain and bone pain and bruising

positive test- lingering pain

suggested diagnosis- fracture

Question 5

distraction of t spine

Answer 5

have patient place one hand on each shoulder. use bottom elbow as a grip and pull up from lunge position

indications to use it- redicular or local t spine pain

positive test- relief

suggested diagnosis- nerve root impingment or facet irritation

false positive- pain- ligamentous or muscular issue

Question 6

seated kemps test

Answer 6

similar to sperling- compress on shoulders then side bend and compress then rotate and compress and extend and compress

indications when to use- local t spine pain or radiculopathy

positive test- symptom reproduction

suggested diagnosis- nerve root impingment- facetogenic pain, facet irritation

Question 7

what is the lumbar quadrant test

vs standing kemps

Answer 7

reach down in front to left and right with left hand and right hand and also behind

make it more invasive by reaching opposite hand with opposite leg

standing kemps tests the same thing but only goes down the back of both legs

indication- lumbar ridiculopathy, local thoracic pain, referred facet pain

positive test- symptom reproduction

suggested diagnosis- lumbar ridiculopathy facet irritation, NRI

Question 8

straight leg raise test

Answer 8

with straight leg lift leg when at 30 degrees if pain starts it is lumbar ridiculopathy and stretch on dura mater it can be confirmed by brecards- lift big toe and secards- dorsi flex

if there is no pain until 60-70 degrees then is not radiculopathy but sij issue

indications- lumbar radiculopathy or sij pain

positive test- mentioned above

sujested diagnosis- NRI or sij syndrome

ALWAYS DO ASYMPTOMATIC SIDE FIRST

if both sides cause symptoms then its red flag

Question 9

slump test

Answer 9

have patients slouch and place hand on head with light pressure.

have patient lift leg up or gently raise leg for them

indications- lumbar ridiculopathy

positive test- symptom reproductions

suggested diagnosis- NRI

Question 10

what is the laslet cluster

Answer 10

a group of 6 tests that help to diagnose ‘SIJ dysfunction’

they are:
distraction
thigh thrust
compression
sacral thrust
gaenslen test
drop test

Question 11

distraction of SIJ

Answer 11

place hands on asis and push down to decompress anterior 1/3 SIJ

indications- local sij pain, LBP, buttock pain

positive test- symptom reproduction

suggested diagnosis: ‘sij dysfunction’

Question 12

thigh thrust

Answer 12

place hands under sacrum on and lift leg in the air and push knee down into couch

indications- local sij pain, LBP, buttock pain

positive test- symptom reproduction

suggested diagnosis: ‘sij dysfunction’

Question 13

compression of SIJ

Answer 13

side lying push down on illium

indications- local sij pain, LBP, buttock pain

positive test- symptom reproduction

suggested diagnosis: ‘sij dysfunction’

Question 14

sacral thrust

Answer 14

prone push down into the middle of sacrum

indications- local sij pain, LBP, buttock pain

positive test- symptom reproduction

suggested diagnosis: ‘sij dysfunction’

Question 15

gaenlens test

Answer 15

supine- one leg grabbed and pulled to chest other leg dropped off side of couch. apply gentle pressure separating legs more

very provocative dont use in very acute cases

indications- local sij pain, LBP, buttock pain

positive test- symptom reproduction

suggested diagnosis: ‘sij dysfunction’

Question 16

drop test

Answer 16

standing on tip toes and drop down onto heel

indications- local sij pain, LBP, buttock pain

positive test- symptom reproduction

suggested diagnosis: ‘sij dysfunction’

Question 17

scours test

Answer 17

lift knee up and hip and move hip around clock wise and anti clockwise

indications are- hip pain, locking and crepitus

positive test crepitus and pain

suggested diagnosis- OA, capsulitis, FAI, labral tear

Question 18

Faber patrick test

Answer 18

put hip into flex, abb, ER foot on opposite thigh, push on asis and knee

indications- hip pain, clicking, locking

positive- groin pain, reproduction of symptoms

suggested diagnosis- hip OA, capsulitis, FAI, CAM

patricks sign is SIJ pain

Question 19

FADIR test

Answer 19

Flex, add, IR the hip in swooping motion from FABER position

indications- pain, clicking locking

positive test- pain symptom reproduction

suggested diagnosis- FAI, CAM, OA, psoas tendonopathy

Question 20

obers test

Answer 20

side lying- bottom leg bent, top leg straight. lower bottom leg to couch. more provocative lower leg off couch

indication- trochanteric pain ITB pain

positive test- trochanteric pain hip pain, hip doesnt fall to couch and limited movement

suggested diagnosis- musclues pulling on ITB, trochanteric bursitis

Question 21

thomas test

Answer 21

active test- get patient to hug knee

indications- groin pain, tightness in thigh

positive test- limited rom and other leg raising off couch

sugested diagnosis- tightness of rectus femoris

Question 22

labral tear tests (3)

Answer 22

anterior capsule- raise leg off couch- push leg into couch patient resist it

posterior capsule:

gaenslens test but only push on leg off couch

lift knee and hip to 90 move hip to slight adduction and IR and push down through knee

indication- pain locking clicking

positive test- symptom reproduction

suggested diagnosis- labral tear

Question 23

apley scratch test

Answer 23

active exam- reach over shoulder to back and under can also do it at same time

indications- shoulder pain, locking

positive- pain or restriction

suggested diagnosis- rotator cuff pathology, ac joint pathology, labral tear

Question 24

yergansons test

Answer 24

have arm pronated and elbow at 90 - have patient make motion of opening door and resist

indications- long head bicep clicking or pain, joint locking

positive test:1- clicking, jumping of bicep tendon or pain
2a/b- joint pain

sugested diagnosis-

1- transverse humeral lig damage
2a- biceps tendonopathy
2b- labral tear

Question 25

speeds test

Answer 25

have arm supinated and shoulder at 90 indications- clicking, bicep pain positive test- 1- bicep pain 2- gh locking suggested diagnosis: 1 biceps tendonopathy 2 labral tear

Question 26

painful arc test

Answer 26

have patient perform adduction arom without flipping hand indications- ac joint pain- anterior lateral posterior shoulder pain positive test- pain suggested diagnosis: 0-30- supraspinatus tear 60-120- 'sub acromium impingement syndeome' 170-180- ac joint pathology

Question 27

hawkins kenedy test

Answer 27

pinch on humerus have elbow and shoulder at 90 IR arm by pushing on wrist start neutral then move to in scaption then infront of body indications- sub acromial pain, ant shiulder pain positive- pain sugested diagnosis- sub acromium inpingment syndrome

Question 28

empty can test

Answer 28

have arm out to side and ' empty can on the floor' indications- sub acromial pain, anterior shoulder pain positive- pain suggested- SAIS

Question 29

passive neers

Answer 29

place hand on their shoulder IR arm then flex shoulder also ER indications- sub acromial pain, anterior shoulder pain, biceps pain positive- pain suggested- IR= SAIS ER= biceps long head impingement

Question 30

obriens

Answer 30

IR arm and resist the patients flex- adduct arm and do the same indications- sub acromial pain, shoulder pain, locking clicking instability positive- pain suggested- labral tear, SAIS, ACjoint pathology

Question 31

krank test

Answer 31

seated- compress humerus through gh and place hand on head, rotate humuerus using elbow hold indications- pain locking, clicking, apprehnsion positive- symptom reproduction suggested- labral tear

Question 32

load and shift

Answer 32

GH ant and post sheer- push down through GH whlst doing it indications- pain, locking, clicking, catching positive- symptom reproducton suggested- labral tear- oa

Question 33

apprehension test shoulder

Answer 33

put knee as balance and ER shoulder until apprehension- support shoulder anteriorly see if there is more movement indications- instability- apprehension, dislocation positive- apprehension suggested- GH instability

Question 34

anterior/ posterior drawer test shoulder

Answer 34

lying down- anterior posterior sheer like in accessory indication- pain, locking, instability positive- reproduction suggested- instability, gh pathology, gh lig sprain

Question 35

AC compression test

Answer 35

active or passive- adduct shoudler then flex elbow and adduct more indication- ac pain, ac clicking locking or catching positive- pain on ac suggested diagnosis- ac joint pathology

Question 36

cozens test

Answer 36

stablise the lateral epicondyle have patient extend hand against your force- arm mus be pronated indications- pain and swelling on lateral epicondyle positive- pain suggested diagnosis- lateral epicondylitis

Question 37

reverse cozens test

Answer 37

supinated arm- put finger over medial epicondyle to stablise- flex and ulnar deviate wrist with clenched fist and resist the patients flexion indication- psin and swelling in medial epicondyle positive- pain suggested- medial epicondylitis

Question 38

mills test

Answer 38

fully extend elbow and fully pronate arm then flex the patients wrist indications- pain and swelling on lat epicondyle positive test- pain suggested diagnosis- lateral epicondylisits

Question 39

reverse mills

Answer 39

arm at 90- stablise supinated arm. extend wrist whilst gradually extending elbow indications- pain and swelling postive- pain suggested- medial epicondylitis

Question 40

tinels test elbow and wrist

Answer 40

tap inbetween the medial epicondyle and olecranon process indication- pain/ parasthesia along ulnar nerve root positive test sypmtom reprodution suggested diagnosis- ulnar nerve compression

Question 41

pronator teres stress test

Answer 41

have arm in neutral position at 90 have patient pronate whilst you resist indications- pain, parasthesia in median nerve distribution positive- reproduction of symptoms suggested diagnosis- median nerve compression

Question 42

tinels sign test

Answer 42

purcuss on the carpel tunnel location and also along the route of median nerve from index finger to elbow indications- parastesia, pain in median/ ulnar nerve positive test- reproduction of symtoms sugested diagnosis- carpel tunnel/ giyons canal comression

Question 43

phalens test

Answer 43

active test push dorsal sides of hands against each other indications- parasthesia or pain on median nerve route positive- reproduction of symptoms suggested diagnosis- carpel tunnel

Question 44

reverse phalens

Answer 44

palmar sides of hands pushed against eachother indications- paresthsia and pain alsong median nerve positive test- reproduction of symptoms suggested diagnsosis- carpel tunnels

Question 45

finklestiens test

Answer 45

have thumb run inside palm and wrap fingers around it then ulnar deviate wrist indications- pain over base of thumb and lateral wrist and forearm positive test- pain suggested diagnosis- tenosynovitis

Question 46

Allens test-

Answer 46

find ulnar and radial artery pulse and hold it get patient to squeeze fist then let go of one side and wait for blood to re fill repeat both sides indications- parsthesia, pallor, coldness positive test- skin blanching remains for longer than 5 seconds suggested diagnosis- periphiral arterial disease

Question 47

TFCC compression test

Answer 47

support radius and ulnar close to the joint line then ulnar deviate the hand ALWAYS TEST FOR # indications- pain clicking or instability at ulnar border positive- pain suggested diagnosis- TFCC sprain

Question 48

bellottmans test

Answer 48

milk pattela- push fluid superiorly and inferiorly to pattella then tap pattella indications- pain and swelling positive test- resistence/ spongey feel suggested diagnosis- knee joint effusion

Question 49

clarkes test

Answer 49

put hand under knee and and above pattella. make patient engaged quads and stop pattella moving indications- retro pattela pain clicking or grinding positive test- retro pattela joint pain suggested diagnosis- chondromalacia patella, retro patella degeneration

Question 50

pattela apprehension

Answer 50

both thumbs medially on pattella and put to end feel but look for apprehension in face indications- recurrent pattela dislocation positive test- apprehension suggested diagnosis- history of patella dislocation or recurrent disloaction

Question 51

varus and valgus stress test

Answer 51

varus- mcl accessory test valgus LCL accessory test indications- instability, giving way, pain swelling positive test- laxity and pain suggested diagnosis- MCL/LCL sprain

Question 52

anterior posterior stress test knee

Answer 52

Anterior- ACL accessory test posterior- PCL accessory test indications- instability, giving way, pain and swelling positive test- laxity and pain suggested diagnosis- ACL/PCL sprain

Question 53

Lachmans test

Answer 53

put their knee under their knee to have thwir knee at 20 degrees and pull lower leg up anteriorly indications: instability, giving way, swelling positvie test- laxity and pain sugested diagnosis- ACL sprain

Question 54

joint line tenderness test

Answer 54

find joint line posteriorly and follow it round the joint line indications- instability, giving way, locking clicking positive test- pain suggested diagnosis- meniscal tear

Question 55

mc murrays test

Answer 55

test for posterior horn of meniscus medial test- fully flex knee- ER and apply valgus force on knee and slowly let dpwn lateral test- fully flex knee IR apply varus force on knee and slow let to extension Indications- instability, locking clicking giving way positvie test- reproduction of symptoms suggested diagnosis- posterior horn of meniscus test

Question 56

thesallys test

Answer 56

hold onto elbows have patient stand on one leg rotate the patient both directions 3 times onece thats done bend knee to 20 degrees and go again indications- instability giving way lcoking clicking positive test- reproduction of symptoms suggested diagnosis- meniscal tear

Question 57

Apleys compression and distraction test

Answer 57

hav patient prone and knee bend to 90. place knee on their thigh and lift underneath malleoui then apply ER and IR compression press down through heel and apply IR and ER indications- instability, giving way, locking clicking positive test- reproduction of symptoms suggeste diagnosis- compression- meniscal tear, OA distraction- ligamentous tear

Question 58

simons thompson test

Answer 58

foot of the end of the couch laying on belly and squeeze calf see if it plantar flexes indications- achillies pain, inability to plantar flex activley positive test- loss of movement suggested diagnosis- achillies tendon rupture

Question 59

talar tilt test

Answer 59

foot off the end of the bed and invert the foot through dorsi flexion, neutral and plantar flexion dorsi flexion tests, PTFL neutral tests, calcaneofibular plantar flexion, ATFL also can be done medially by everting the foot indications- inversion/eversion trauma and pain or laxity positive- pain/ laxity suggested diagnosis- lateral medial ankle sprain

Question 60

anterior posterior stress test ankle

Answer 60

foot off end of bed pull ankle up for anterior and push down to posteior indiciations- instability, giving way swelling positive test- laxity and or pain suggested- atfl ptfl

Question 61

mortons neuroma test

Answer 61

squeeze under foot squuezing meta tarsels together focussing on 2-3 and 3-4. indications- feeling of pebble in shoe, pain in foot and toes, tingling burning numbness positive test- reproduction of symptoms suggested diagnosis- mortons neuroma false positive- metatarsalgia, oa,

Question 62

windlass test

Answer 62

lift toes up in dorsiflexion and press down plantar fascia to heel indications- heel pain, plantar pain, walking on glass postive test- pain suggested diagnosis- plantarfasciaopathy

Question 63

tinels test ankle

Answer 63

find tarsel tunnel (tom dick and very nervous harry) by going inferior and posterior to med maleolus getting them to flex big toe to find tendon then tap on area indications- shooting pain, numbness tingling along tib nerve root positive test, reproduction of symptoms suggested diagnosis- tarsel tunnel syndrome