Orthopedics Samuel Moya

Elbow

1) EPICONDYLITIS

A) Kaplan’s Sign (lateral epicondylitis/ Tennis elbow)

a. Pt. seated
b. Have the patient grab your forearm and squeeze
c. Then you grip their forearm below the lateral epicondyle and have
them squeeze your forearm again
d. If their grip is stronger when you grip their forearm this is a
positive test for lateral epicondylitis
e. Testing for strength test with incidental pain
B) Mills’ (lateral epicondylitis)
a. Looking for PAIN response at lateral epicondyle
b. Pt. seated
c. Start with pt. elbow flexed (in curl position) then max flex their
wrist and internally rotate the wrist to maximum. Finally lockout
their elbow.
d. Make sure you don’t touch their epicondyle region b/c you might
get premature pain
C) Cozen’s
a. Pt. seated
b. Place pt. arm in supination with wrist in extension
c. Dr. tries to flex the wrist as the patient resists
d. Looking for PAIN at lateral epicondyle
e. Hold position for 5 secs
D) Golfer’s Elbow
a. PT. seated with arm supinated and wrist is in flexion
b. Dr. tries to passively extend the wrist
c. Looking for pain at the medial epicondlye
d. Hold position for 5 secs

2) LIGAMENTOUS INSTABILITY
A) Ligamentous instability
1. testing medial and lateral collateral ligaments
2. pt. is seated with arm extended (almost max) in supination
3. Dr. stress the elbow joint in varus and valgus direction
4. feeling for ligamentous laxity
5. pain is an incidental finding

3) NEUROPATHY
6. Tinel’s sign
a) Seated
b) Dr. raises the pt. arm to a 90 degree angle
c) Using a hammer tap around the ulnar nerve until you get an
ulnar reflex (jumping of the arm)
Orthopedics Samuel Moya

d) Then you tap around the lateral epicondyle looking for a

radial nerve response. You are actually hitting a radial nerve
branch. Have to swing the hammer harder than ulnar nerve
test
e) Looking for an extreme pain that lasts a good time after test
(+) test
f) (+) test- neuropathy of that nerve

7. Elbow flexion
a) Seated with arm fully flexed actively squeezing that bicep
b) Hold for 30 secs
c) Ask the pt if they have any type of PAIN, NUMBNESS,
TINGLING
d) (+) test equals ulnar nerve problems

FOREARM, WRIST, AND HAND

1. Vascular obstruction
a. Allen’s test
i. Pt. seated with arm supinated
ii. DR. occludes the radial and ulnar arteries looking for
blanching followed by redness when you release the arteries
iii. Ask pt. to make a fist when you occlude the arteries
iv. Looking for how fast the hand becomes red again
v. 5 seconds is normal time for the hand to turn red again
vi. Pain, tingling is secondary findings
vii. Cold hands and numbness is a positive finding though b/c it
does indicate vascular insuffiency

2. Localized unspecified pathologic process

a. Wringing
i. Ask the patient to wring a cloth in both directions
ii. Used to localize a wrist pain
iii. Non-specific test
iv. Need to ID a carpal bone that is in the area of the pain

3. Osteopathy
a. Finsterer’s
i. Pt. seated
ii. Bend the phalangies to make the metacarpophangeal joint
taught
iii. Hit the metacarpophangeal joint
iv. Looking for pain in wrist as you strike the MP joint
v. Pain in the carpals is a positive test. Pain in the Metacarpals
would also make it a positive test
4. Infectious/Inflammatory
Orthopedics Samuel Moya

a. Cascade
i. Overlapping of the phalanges= (+) test
ii. Ask the pt. place the finger flat on the palms but not in a fist.
Looking to see if the fingers line up straight
iii. If the fingers overlap it is a positive test indicating Rheumatoid
arthritis
b. Bunnel-Littler
i. Testing PIP joint using the MC joint
ii. If the PIP joint extends when you extend the MC joint move on
to the test
iii. Push the MC joint back and then flex the PIP if it flexes easily
it’s a negative test
iv. If positive you then flex the MC joint then you try to flex the
PIP again if it flexes easier than in step 2 this is a positive test
v. Tight capsule- the finger remains tight in both positions
vi. Testing interossie muscles
vii. If PIP flex easier in second part of test= interossie mm.
tightness
c. Bracelet
i. Elevate the pt.s arm and squeeze the pt’s. wrist and look for
elongation of the wrist
ii. Looking for pain and lose of elasticity of the wrist (the wrist is
not elongating)
iii. Pain= (+) test for arthritis

5. Muscular/Ligamentous
a. Test for Tight Retinacular Ligament
i. Testing PIP and DIP
ii. Force PIP in full extension and see what happens with DIP
iii. PIP in extension then you try to flex the DIP
iv. If tight DIP throughout the test= tight capsule
v. If loser in one step than the other= retinacular ligaments
vi. Report: have to describe exactly what is happening with each
joint that you test
b. Finkelsteins
i. Testing for Dequervians disease (stenosing tenosynovitis AKA
paratenonitis of the extensor pollicis longus)
ii. Ask the pt to tuck their thumb into their fist and passively
ulnar deviate the wrist making sure to stress the wrist
iii. Looking for extreme pain with minimal ulnar deviation of the
wrist

c. Carpal Lift
i. Place the pt’s. hand flat on a hard surface and ask them to left
their fingers one at a time
Orthopedics Samuel Moya

ii. Then you resist them as they try to raise their fingers one at a
time. Looking for the tendons to pop up as they try to raise
their fingers
iii. Looking for carpal or metacarpal pain
iv. Pain= (+) test
d. Maisonneuve’s
i. Extend the patients wrist and look for pain in the distal part of
the wrist
ii. If you go past 90 degrees with extreme pain it indicates a
radius Fx (collies fx)

6. Neuropathy or palsy
a. Froment’s Paper
b. Wartenberg’s
c. Pinch Grip
d. Phalen’s
e. Tinel’s
f. Interphalangeal Neuroma
g. Shrivel

Thoracic spine
A) Scoliosis
1) Adams position
i. Ask pt. to strength out their arms and touch their palms
ii. Ask pt. to bend over and you stand behind them to see the
horizontal plane of the back
iii. Look very carefully at the horizontal plane of the back to see if
there is any deviations in the spine
iv. Diagnosis: describe the rib hump does it point to the right or
left. The vertebral body points in the direction of the convexity
of the hump. Name the scoliosis according to the convexity:
Dextroscoliosis and levoscoliosis.
Orthopedics Samuel Moya

B) Ankylosing spondylitis
1) Chest Expansion
i. Pt. seated upright
ii. Place the tape under the axillae
iii. Cross the tape and read the tape
iv. Ask the patient to take a normal breath then exhale totally and
measure and then totally inhale the difference in readings is
the chest expansion
v. Report in centimeters
vi. No such thing as a normal range
vii. This is just good for future reference has no real clinical
application at the time that you take it
2) Amoss’s
i. Pt. lying prone then ask them to lay down and then sit up again
ii. Looking to see if they have to bend in weird positions and use
extremitites
iii. Test for thoracic inflexability
3) Foresteir’s Bowstring
i. test for restriction of spine
ii. place your hand on the pts. back and ask them to laterally flex
and feel the muscles tension
iii. the contralateral side should get tighter and ipsilateral side
should become less tight
iv. (+) test= ipsilateral side becomes tighter than contralateral side

C) Infectious/inflammatory process
1) ***Anghelescu’s
i. Pt. lying down and ask them to do an opisthotons postion
ii. Approximates a opisthotons position (pt. arched so that only
the heels and back touch the ground)
iii. Tests for arthritis of the spine
2) Sponge
i. Pt. lying prone
ii. Wet a sponge or any device that creates moisture heat and
move it down the back starting for the neck down.
iii. You are looking for redness in back which indicates paraspinal
musculature inflammation

D) Costal fixation
1) Rib motion
i. Pt. prone
ii. Dr. places their fingers on the ribs and ask the pt. to take a
deep breath and exhale. You are looking for a lack of
movement in the ribs
Orthopedics Samuel Moya

iii. The rib causing the problem will be the most superior rib
during inhalation. In exhalation it will be the inferior most rib
that is the one causing lack of motion in a group of ribs lacking
motion.
2) Schepelmann’s
i. Start off in ROOS postion
ii. Have pt. laterally flex to both sides
iii. Looking for pain on either side
iv. Wrap around pain- intercostal neuritis usually on concave side
of motion
v. Convex side pain- muscle issues its pain running along the
length of the paraspinal muscles
vi. Local pain to back- subluxtion
vii. Pleurisy- deep, sheering, tearing pain on the convex side
viii. Does not differentiate b/w pleurisy and intercostal neuritis.
History will differentiate these two.
E) Myelopathy
1) Valsalva maneuver
2) Dejerine’s
3) Beevor’s

F) Neuropathy
1) First thoracic nerve root
2) Passive Scapular Approximation

G) Osteopathy
1) Spinal percussion
2) Sternal compression