March 31, 2016 Special Test Comments Shoulder Joint Apprehension Test Patient is seated or supine. Shoulder abducted to 90 and elbow flexed to 90. Force arm into external rotation. Doctor can provide anterior pressure on the proximal humerus. (+) Test= Patient apprehensive of repeat dislocation. Indicates: glenohumeral instability Sulcus Sign Grasp patients elbow and apply inferior traction (+) Test= Indention appears in are beneath the acromion Indicates: glenohumeral instability Yergason Test Patients arm at side with elbow flexed at 90. Examiner uses one hand to palpate bicipital groove and monitors there, while the other hand grasps the patients wrist. Have patient supinate and externally rotate against doctors resistance. (+) Test= Pain and/or tendon subluxation out of groove Indicates: unstable bicipital tendon/subluxation bicipital tendonitis Speeds Test Patients arm forward flexed 50 at the shoulder with hand supinated. Flex patients elbow to 15. Resist at forearm while patient forward flexes shoulder. (+) Test= Pain in bicipital groove Indicates: bicipital tendonitis of longhead biceps Neer Impingement Stabilize patients shoulder and passively flex shoulder to fully flexed position. (+) Test= Pain Indicates: subacromial bursa or rotator cuff impingement Hawkins Test Flex arm and elbow to 90. Passively rotate the humerus into internal rotation. While stabilizing, produce a counter-force at the elbow (chicken-wing) (+) Test= Pain Indicates: rotator cuff impingement Empty Can Test Elevate patients arms to 90 and internally rotate. Press down on forearms while patient resists. (+)= Pain or inability to resist Indicates: rotator cuff pathology (specifically supraspinatus) Drop-Arm Test Patient abducts arm to 90. Then slowly drop arm. (+) Test= Arm will drop or gentle tap on wrist will cause arm to drop Indicates: full thickness tear of supraspinatus Elbow/Wrist/Hand Joints Golfers Elbow test Anterior forearm/ flexor compartment Patients elbow is flexed to 90 and forearm is placed in supination with the wrist neutral and palm facing up. The examiner places one hand under the proximal forearm for stabilization and the other hand over the patients wrist to resist movement. Instruct the patient to flex the wrist (+) test= pain/tenderness around the medial epicondyle Indicates: medial epicondylitis Tennis Elbow test Posterior forearm/extensor compartment Patients elbow is flexed to 90 and forearm is placed in pronation with wrist neutral and palm facing down. Examiner places one hand under proximal forearm for stabilization and the other hand over the patients hand to resist movement. Instruct the patient to extend the wrist (+) test= pain/tenderness around lateral epicondyle, may radiate down lateral forearm Indicates: lateral epicondylitis Valgus Stress Test Arm slightly abducted and externally rotated. Forearm supinated and flexed to 30 deg. Slight medial directed valgus stress is applied to elbow joint. (+) test= pain/tenderness with palpation and valgus stress; increased laxity (degree of laxity correlates to degree of injury to UCL) Indicates: injury to UCL Varus Stress Test Arm slightly abducted and internally rotated. Elbow flexed to 15 deg. A slight varus stress is applied to the elbow joint (+) test= pain or increased laxity in LCL Indicates: injury to LCL Tinels Sign at wrist Can be elicited by tapping over the transverse carpal ligament (between thenar/hypothenar eminences) with either the tip of the examiners finger or reflex hammer with the patients wrist held in extension. (+) test= parasthesias/numbness/ tingling/pain radiating to thumb, index and middle finger (median n. distribution) Indicates: entrapment of Median nerve or Carpal Tunnel Syndrome Phalens Sign Place dorsal aspects of patients hands together and force into wrist flexion. Hold for 60 seconds (+) test= any reproduction of symptoms/parasthesias in the distribution of the median nerve Indicates: entrapment of Median nerve or Carpal Tunnel Syndrome Finkelsteins Test Examiner asks patient to make a fist encompassing their thumb and ulnar deviate the wrist. (+) test= increased pain in first dorsal compartment/ lateral wrist Indicates: DeQuervains tenosynovitis Hip Joint Central Compartment Scour Flex and externally rotate patients hip. Load into socket and articulate through annular range of motion. (omega sign) (+) Test= Pain Indicates: Labral or articular cartilage pathology Apprehension: FABER* 1- Patients hip is flexed, aBducted & externally rotated. Doctor induces further external (1 of 3 versions/steps) rotation by applying a posterior force at the knee. (+) Test= anterior subluxation of hip or apprehension/pain Indicates: Anterior labral pathology Can also be (+) with impingement. Peripheral Compartment Elys Test Patient prone. Passively flex patients knees. (+) test= Ipsilateral hip raises off table Indicates: Rectus femoris contracture Rectus Femoris Test Patient supine. One hip flexed up to the chest. The other leg bent over the edge of the table. (+) test= knee flexion < 90 Indicates: Rectus Femoris contraction ipsilaterally Lateral Compartment Obers Test Patient lateral recumbent, with doctor standing behind the patient. Doctor abducts the extended top leg and then lowers leg to the table while stabilizing hip. OR Upper leg is set hanging off of the table while stabilizing hip to prevent rotation (+) Test= Inability to adduct Indicates: IT band contracture Trendelenburg Patient standing with doctor behind. Patient lifts one foot off ground. (+) Test= weakness / inability to hold hips level Indicates: Contralateral gluteus medius weakness (Superior Gluteal Nerve) [ex: Patient lifts right foot, right hip drops = Left Gluteus Medius/Superior Gluteal Nerve pathology] Patricks : FABER* 2 Patients hip is flexed, aBducted and externally rotated. (2 of 3 versions/steps) Doctor braces contralateral ASIS, patient externally rotates/aBducts against resistance. (+) test= Pain or weakness Indicates: Gluteus medius pathology Anterior/Iliopsoas Compartment Patricks: FABER* 3- Patients hip is flexed, aBducted and externally rotated. Doctor braces contralateral (3 of 3 versions/steps) ASIS. Patient internally rotates/aDducts against resistance. (+) Test= anterior or medial groin pain/weakness Indicates: iliopsoas insufficiency or pathology Thomas Test Patient supine at the end of the table and pulls knees to chest. One leg is lowered to the table to test the flexibility of the hip flexors. (+) test= Inability to fully extend at hip Indicates: hip flexor contraction Knee/Ankle/Foot Joints Apley compression (grind) test Patient prone with knee flexed to 90. Examiner uses downward force on the foot to provide a compressive force on the meniscus while rotating the foot internally and externally. (+) test= Pain with rotation and/or compression Indicates: Meniscal injury, collateral ligament injury, or both Apley distraction test Patient prone with knee flexed to 90. Examiner uses upward pulling force on the foot to provide a distraction on the meniscus while rotating the foot internally & externally. (+) test= Pain with distraction and rotation Indicates: collateral ligament damage Valgus stress test of knee Patient supine and examiner supports the patients lower leg on the examiners hip, with the knee flexed to 30 (also test at neutral). Examiners hands are placed on the medial and lateral aspects of the patients knee. While providing lateral resistance at the knee, move the lower leg so that the ankle shifts laterally while holding the distal femur in place. Assess for laxity, quality of end point, and pain. (+) test= Increased laxity, soft or absent endpoint, or pain Indicates: Medial collateral ligament (MCL) disruption - more severe injury indicated if also positive at 0 (i.e. posterior joint capsule/ACL/MCL) Varus Stress test of knee Examiner and patient in same position as the valgus stress test. While providing medial resistance, examiner moves the lower leg so that the ankle shifts medially. This test is done at 30 flexion and neutral (0). (+) test= Increased laxity, soft or absent endpoint, or pain Indicates: Lateral collateral ligament (LCL) disruption more severe injury indicated if also positive at 0 Anterior Drawer test Patient supine with knee flexed to 90. Examiner sits on the patients foot and grasps the proximal tibia with both hands, pulling the tibia anteriorly. (+) test= Excessive translation/laxity when compared to the other knee Indicates: ACL insufficiency Posterior Drawer test Patient supine with knee flexed to 90. Examiner sits on the patients foot and grasps the proximal tibia with both hands, translating the tibia posteriorly. (+) test= Excessive translation/laxity, particularly when compared to the opposite side Indicates: PCL deficiency, posterior capsular injury or disruption. Ankle (Anterior) Drawer test Doctor grasps posterior calcaneus with one hand and cups distal tibia/fibula with the other hand, monitoring anteriorly at the anterior talus. Provide anterior force on calcaneus while stabilizing the distal tibia/fibula. Normal springing of calcaneus back to neutral should occur. (+) test = pain, no springing, excessive motion anterior/laxity Indicates: ATF ligament pathology/tear Talar Tilt Test Doctor grasps distal tibia/fibula with one hand and the inferior calcaneus with the other, blocking motion of the calcaneus on the talus. Invert the talus to evaluate ROM. (+) test = laxity, increased ROM or pain Indicates: Calcaneofibular ligament pathology/tear and some ATF Squeeze Test (High Ankle Doctor wraps hands around leg proximal to the ankle, contacting the distal tibia/fibula Sprain) with both thenar eminences. Squeeze for 2-3 seconds rapidly release. (+) test = pain at syndesmosis Indicates: syndesmosis pathology Thompson test Patient prone with foot off the table. Doctor squeezes the calf. (+) test = absence of plantar flexion Indicates: Achilles tendon rupture