ORTHOPEDIC ABBREVIATIONS

MEANING

AC

acromioclavicular

ACL

anterior cruciate ligament

AFO

ankle-foot orthosis

AKA

above-knee amputation

ANA

antinuclear antibody

BKA

below-knee amputation

C-spine

cervical spine

C1-C7

cervical vertebrae

CMC

carpometacarpal (joint)

CTS

carpal tunnel syndrome

DC (physician)

Doctor of Chiropractic

DDD

degenerative disk disease

DEXA

dual-energy x-ray absorptiometry

DIP

distal interphalangeal (joint)

DJD

degenerative joint disease

DO (physician)

Doctor of Osteopathy

DTRs

deep tendon reflexes

EMG

electromyogram

ESR

erythrocyte sedimentation rate

FROM

full range of motion

fx

fracture

FWB

full weight bearing

HNP

herniated nucleus pulposus

IM

intramuscular

IP

interphalangeal

IT

iliotibial

LE cell

lupus erythematosus cell

LP

lumbar puncture

L-spine

lumbar spine

L1-5

lumbar vertebrae

LS

lumbosacral (spine)

MCL

medial collateral ligament

MCP

metacarpophalangeal (joint)

MTP

metatarsophalangeal (joint)

NSAID

nonsteroidal anti-inflammatory drug

ORIF

open reduction internal fixation

ortho

orthopedics

PCL

posterior cruciate ligament

PIP

proximal interphalangeal joint

PT

physical therapy

RA

rheumatoid arthritis

RF

rheumatoid factor

ROM

range of motion

ROMI

range of motion intact

sed rate

erythrocyte sedimentation rate

SI

sacroiliac (joint)

SLE

systemic lupus erythematosus

TENS unit

transcutaneous electrical nerve stimulation

THR

total hip replacement

T-spine

thoracic spine

T1-T12

thoracic vertebrae

tib-fib

tibial-fibular

TMJ

temporomandibular joint

UE

upper extremity

 



Spinal X-Rays This test only shows bone abnormalities. Of little value for disc or subtle bone injury. Also called Plain Films.

 

Computerized Axial Tomography (CT Scan) This is a sophisticated x-ray system which can produce three dimensional pictures of the spine.

 

Magnetic Resonance Imaging (MRI) This system does not use harmful x-rays and is 90-95% accurate in producing findings for soft tissue conditions such as herniated discs of the spine and/or joint abnormalities.

 

Myelogram Radioactive dye is injected into the cauda equina sac under x-ray.

 

Bone Scan Radioactive dye is injected then x-rayed. Increased uptake of the dye occurs in bone tumors, bones with recent fracture or in active arthritis.

 

Discogram Radioactive Dye is injected into the cervical or lumbar intervertebral disc, then x-rayed. This test is used to confirm if degenerative disc disease seen on MRI scan causes back or neck pain.

 

Arthrogram Radioactive dye is injected into a joint, such as the shoulder and is most commonly used to diagnose rotator cuff tears.

 

 

Diagnostic Tests Orthopedic Physical: Neck

Adson Test

The arm being tested is held in a dependent position while the head is rotated from side to side. The test is positive for thoracic outlet syndrome if there is an obliteration of the radial pulse.

Allen's Test

While the patient raises one arm and makes a fist the examiner compresses the radial and ulnar arteries. Once the arm is lowered and the hand opened, the examiner releases one of the arteries then repeated releasing the other artery. If there is no flushing of the hand upon release of one of the arteries, the test is positive indicating a vascular occlusion of the released artery.

Compression Test

The examiner places their hands on the top of the patient's head and presses down causing a narrowing of the neural foramen. The test is positive if increased pain is noted and indicates nerve root irritation.

Spurling Test

Patient is asked to look up, turn the neck to one side while gentle downward pressure is applied to the head. The test is positive indicating a pinched cervical nerve when the patient reports pain and tingling.



Diagnostic Tests Orthopedic Physical: Back

Bragard Sign

The lower extremity is flexed at the hip with the knee stiff until the patient experiences pain then the foot is dorsiflexed. Increased pain is a positive sign indicating nerve involvement.

Heel and Toe Walk Test

The patient walks on their heels indicating L4-L5 nerve root irritation if they are unable to perform this activity. If unable to walk on their toes this indicates lumbar nerve root irritation.

Lasegue Sign

The patient is able to flex the hip with the knee bent without experiencing pain. The examiner then raises the straightened leg by the heel. The test is positive if there is pain indicating nerve root irritation.

Patrick Test

A test to distinguish sciatica from lumbosacral or hip pain. With the patient lying supine, the examiner places the ankle of the affected side over the patella of the opposite leg and pressure is placed on the flexed knee. Patients with sciatica will not experience pain while those with lumbosacral or hip disorders will.

Straight Leg Raising Test

Patient lifts leg with the knee remaining straight, a positive test will result in pain along the sciatic nerve suggesting nerve root irritation.

Waddell Test

Five or more tests for malingering in patients complaining of back pain. The tests include tenderness, simulation (axial loading and rotation), straight leg raising, regional disturbances (weakness or sensory disturbances) and overreaction. The Waddell test is positive if the patient has positive results and complains of pain in three or more of the five tests, suggesting the complaints are non-organic.



Diagnostic Tests Orthopedic Physical: Shoulders

Apprehension Test

The patient's arm is extended, held abducted and externally rotated. The patient will be apprehensive in a positive exam, motion will be painful to patients with anterior subluxing or dislocating shoulder.

Drop Arm Test

The arm is lifted to a fully abducted position then lowers the arm slowly towards their side. The test is indicative of a rotor cuff tear if the patient cannot actively control lowering the arm past 90 degrees.

Impingement Test

The examiner forcefully abducts and internally rotates the shoulder causing the greater tuberosity of the humerus to impinge the undersurface of the acromion. A positive test could indicate an impingement syndrome or rotator cuff tendonitis.

 

Diagnostic Tests Orthopedic Physical: Hands

Finkelstein Sign

The thumb is folded into the palm of the hand and fingers are closed around it while the wrist is gently pushed down. The test is positive when there is pain in the thumb side of the wrist. Pain indicates synovitis of the abductor pollicis longus tendon to the wrist also known as DeQuervain's Tenosynovitis.

Phalen's Test

The wrist is flexed as far as it will go and held for one minute which compresses the median nerve that runs through the carpal tunnel at the wrist. The test is positive for carpal tunnel syndrome if the patient experiences paresthesia or pain.

Tinel's Sign

The test suggests positive findings for carpal tunnel syndrome when the patient reports tingling sensation when the examiner taps the area over the median nerve.

 

Diagnostic Tests Orthopedic Physical: Hips

Ely Test

With the patient lying prone, the examiner flexes the leg on the thigh, bringing the heel towards the buttocks. The test is positive if the pelvis is arched away from the table, indicating tightness of the rectus femoris, contracture of the lateral fascia of the thigh, or femoral nerve irritation.

Thomas Sign

With the patient supine and flexing the opposite hip, the affected hip will rise from the table. If this occurs, the test is positive indicating hip joint flexion contracture.

Trendelenburg Test

The examiner stands behind the patient while they lift one leg then the other. If the pelvis drops downward on the non-weight bearing side the test is positive suggesting muscle weakness of the weight-bearing hip.

 

 

Diagnostic Tests Orthopedic Physical: Knees

 

Apley Test

While prone the patient compresses their knee at 90 degrees, the examiner rotates the tibia in both directions. The test is repeated with the knee joint under distraction (pulling the patient's foot upward). If the patient experiences pain on compression, the test indicates a meniscal injury; pain upon distraction suggests a ligamentous injury.

Drawer Sign

With the patient supine and knee flexed 90 degrees, the proximal tibia is pulled anteriorly and then pushed posteriorly. Excessive movement while being pulled suggests a torn anterior cruciate ligament. Excessive movement while being pushed suggests a torn posterior cruciate ligament.

Lachman Test

This test is performed with the patient supine and the knee flexed to 20 degrees. The examiner pulls the tibia anteriorly. A torn anterior cruciate ligament is indicated by a "give" reaction.

McMurray's Test

The patient is supine. The examiner rotates the foot outward and slowly extends the knee from a fully flexed position. The test is repeated but with the foot rotated inward. The test is positive if a "clicking" is noted while extending the knee. A "click" with the foot rotated outward indicates a tear of the medial meniscus, while a "click" with the foot rotated inward indicates a lateral meniscus tear.

Pivot Shift Test

This test is for a torn anterior cruciate ligament. The examiner internally rotates the leg with the knee fully extended. With valgus stress, the knee is gradually flexed. The test is positive if the knee shifts at 30 to 40 degrees.

Slocum Test

This test is for rotatory instability of the knee. The patient is supine with the knee flexed 90 degrees, and the foot internally rotated. The examiner sits on the patient's foot and pulls the proximal tibia anteriorly. This test is repeated with the foot externally rotated. Excessive motion of the joint indicates a rotatory instability of the knee.

 

 

Common Orthopedic Tests

 

Reprinted with Permission from Grand Valley State University

 

Neck/C-spine

Brachial Plexus tension test, Distraction Test, Foraminal Compression Test, Shoulder Abduction Test, Shoulder Depression Test, Valsalva Test, Adson Maneuver, Allen Maneuver

 

Shoulder

Apprehension Test for Anterior Shoulder Dislocation, Apprehension Test for Posterior Shoulder Dislocation, Drop-arm Test, Impingement Test, Neer Test for shoulder impingement, Hawkin's test for shoulder impingement, Ludington's Test, Speed's Test (Biceps Test), Supraspinatus test, Inferior Sulcus sign, Yergason's biceps tendonitis Test, Yergason's test for subluxing biceps tendon

 

Elbow

Elbow Flexion Test, Golfer's Elbow Test, Ligamentous Instability Tests (Valgus/Varus stress),

Tennis Elbow Tests

Hand/Wrist

Allen test, Phalen's (wrist flexion) test, Tight Retinacular Ligament test, Tinel's sign

 

Low Back/Pelvis

Bowstring test (cram test or popliteal pressure sign), Hoover's sign test, Kernig's sign, Prone Knee Flexion test (also called reverse Lasegue test), Straight Leg Raising test, Gillet test - palpation of anterior superior iliac spines (patient sitting), Pelvic Rock Test, Gaenslen's test, Side-lying Iliac Compression test

 

Knee

Ober's test, Abduction (Valgus stress) test, Adduction (Varus Stress) test, Anterior/Posterior Drawer (Sign) Test, Posterior Sag Sign (Gravity Drawer Test, Lachman's Test, Stiman's Test, McMurray's Test, Apley Grind/Distraction Test, Bounce Home or Spring test, Patellar Apprehension Test, Brush or Stroke (Wipe) Test, Clarke's Sign, Wilson Test, Patello-Femoral Grind test

 

Ankle

Anterior Drawer Sign, Homan's Sign, Talar Tilt, Eversion stress test, "Clunk" test for tib-fib ligament sprain, Thompson Test, Compression test, Percussion/thump test

 

 

Descriptions of the Common Orthopedic Tests

 

Neck/C-spine

 

Brachial Plexus tension test: Test designed to detect nerve root compression. The patient lies supine and slowly abducts and externally rotates the shoulder just to the point of pain. The forearm is then supinated and the wrist is flexed, with the examiner supporting the shoulder and forearm. The test is positive if the patient's symptoms are reproduced or increased.

 

Distraction Test: A test designed to identify nerve root compression. The examiner places one hand under the patient's chin and the other under the occiput. The head is slowly lifted (distraction), and the test is positive if pain is decreased.

 

Foraminal Compression Test: A test designed to identify nerve root compression. The patient laterally

flexes his or her head. The examiner carefully presses down (compresses) on the head. The test is positive if pain radiates into the arm toward the flexed side.

 

Shoulder Abduction Test: A test designed to identify extradural compression, such as a herniated disk, epidural pain compression, or nerve root compression most commonly at C5 or C6. The patient is in a sitting or lying position. The patient's arm is abducted actively or passively so that the hand or forearm of the patient rests on the patient's head. The test is positive if there is a decrease in symptoms.

 

Shoulder Depression Test: A test designed to detect nerve root compression or dural adhesions to the nerve or joint capsule. The examiner flexes the patient's head to one side while applying downward pressure on the opposite shoulder. The test is positive if the pain is increased.

 

Valsalva Test: A test designed to detect a space-occupying lesion in the cervical spine, such as a herniated disk or an osteophyte. The examiner instructs the patient to take a deep breath and hold the breath, as if the patient is having a bowel movement. The test is positive if symptoms are reproduced or increased.

 

Adson Maneuver: A test designed to determine the presence of thoracic outlet syndrome. The patient turns his or her head toward the shoulder on the side being tested. The examiner externally rotates and extends the shoulder while the patient extends his or her head. The test is positive if the radial pulse disappears while the patient holds a deep breath.

 

Allen Maneuver: A test designed to identify the presence of thoracic outlet syndrome. With the patient seated, the examiner flexes the patient's elbow to 90 degrees while the patient's shoulder is abducted 90 degrees and externally rotated. The examiner then palpates the radial pulse while the patient rotates his or her head away from the test side. The test is positive if the pulse disappears.

Shoulder

 

Apprehension Test for Anterior Shoulder Dislocation: A test designed to determine whether a patient has a history of anterior dislocations. With the patient supine, the examiner slowly abducts and externally rotates the patient's arm. The test is positive is the patient becomes apprehensive and resists further motion.

 

Apprehension Test for Posterior Shoulder Dislocation: A test designed to determine whether a patient has a history of posterior dislocations. With the patient supine, the examiner slowly flexes the patient's arm to 90 degrees and the patient's elbow to 90 degrees. The examiner then internally rotates the patient's arm. A posterior force is then applied to the patient's elbow. The test is positive if the patient becomes apprehensive and resists further motion.

 

Drop-arm Test: A test designed to determine presence of a torn rotator cuff. With the patient seated, the examiner abducts the patient's shoulder to 90 degrees. The test is positive if the patient is unable to lower the arm slowly to his or her side in the same arc of movement or has severe pain when attempting to do so.

 

Impingement Test: A test designed to identify inflammation of tissues within the subacromial space. The patient's upper extremity is moved into internal rotation and horizontal flexion (a.k.a. horizontal adduction) by the examiner. This maneuver is thought to decrease the space between the head of the humerus and acromion process. The test is positive if the patient reports pain.

 

Neer Test for shoulder impingement: A test to identify impingement of the supraspinatus tendon in the curacao-acromial arch. To do this test the examiner internally rotates the shoulder and then brings the shoulder into flexion. Pain reproduced over the curacao-acromial arch indicates a positive test.

 

Hawkin's test for shoulder impingement: Another test to demonstrate impingement of structures in the Corace-acromial arch. To perform Hawkin's test the examiner brings the patient's arm into 90 degrees of flexion with the elbow bent to 90 degrees. The arm is then forced into internal rotation. Pain over the curacao-acromial arch would indicate a positive test.

 

Ludington's Test: A test designed for determining whether there has been a rupture of the long head of the biceps tendon. The patient is seated and clasps both hands on top of his or her head, supporting the weight of the upper limbs. The patient then alternately contracts and relaxes the biceps muscles. The test is positive if the examiner cannot palpate the long head of the biceps tendon of the affected arm during the contractions. Speed's Test (Biceps Test): A test designed to determine whether bicipital tendonitis is present. With the forearm supinated and elbow fully extended, the patient tries to flex the arm against resistance applied by the examiner. The test is positive if the patient reports increased pain in the area of the bicipital groove.

 

Supraspinatus test: A test designed to identify a tear in the supraspinatus tendon. The seated patient's upper limbs are positioned horizontally at 30 degrees anterior to the frontal plane and internally rotated. The examiner applies a downward force on the patient's limbs. The test is positive if pain and weakness are present on the involved side.

 

Inferior Sulcus sign: This tests for global instability of the gleno-humeral joint. To perform this test the examiner stands beside the patient with the patient's arm hanging at his side. The examiner the gives inferiority directed traction to the shoulder (pulls down on the elbow) A positive test would be one where there is a noticeable inferior slide of the humeral head or where there is a marked increase in the space between the humeral head and the acromion.

 

Yergason's biceps tendonitis Test: A test designed to identify tendonitis of the long head of the biceps. The seated patient's arm is positioned at his or her side with the elbow flexed to 90 degrees. Supination of the forearm against resistance produces pain in the biceps tendon in the area of the bicipital groove.

 

Yergason's test for subluxing bicep tendon: This test indicates a rupture or stretching of the retinaculum holding the bicep tendon (long head) in the bicipital groove with subluxation of the tendon out of the groove. To perform this test the examiner bends the elbow to 90 degrees with the shoulder relaxed. The examiner then pulls inferiorly on the elbow putting traction on the shoulder joint and then attempts to externally rotate the shoulder. The free hand should palpate over the biceps groove feeling for a subluxation of the tendon from the groove. Subluxation of the tendon would indicate a positive test.

Elbow

 

Elbow Flexion Test: A test designed to identify cubital tunnel syndrome. The patient is asked to hold his or her elbow fully flexed for 5 minutes. The test is positive if tingling or paresthesia are felt in the ulnar nerve distribution of the forearm and hand.

 

Golfer's Elbow Test: A test designed to identify the presence of inflammation in the area of the medial epicondyle. The patient flexes the elbow and wrist, supinates the forearm, and then extends the elbow. The test is positive if the patient complains of pain over the medial epicondyle.

 

Ligamentous Instability Tests (Valgus/Varus stress): Tests designed to assess the integrity of the lateral and medial collateral ligaments of the elbow. The examiner holds the patient's arm so that the examiner is supporting elbow and wrist. The examiner tests the lateral collateral ligament by applying an adduction or varus force to the distal forearm with the patient's elbow held in 20 to 30 degrees of flexion. The medial collateral ligament is similarly tested by the application of an abduction or valgus force at the distal forearm. The test is positive if pain or altered mobility is present.

 

Tennis Elbow Tests: The following tests are designed to test for the presence of inflammation in the area of the lateral epicondyle.

1. The patient flexes the elbow to approximately 45 degrees and fully supinates the forearm while making a fist. The patient is then asked to pronate the forearm and radially deviate and extend the wrist while the examiner resists these motions. For a positive test, pain is elicited in the area of the lateral epicondyle.

2. The examiner pronates the patient's arm, fully extends the elbow, and fully flexes the wrist. For a positive test, pain is elicited in the area of the lateral epicondyle.

Hand/Wrist

 

Allen test: A test designed to determine the patency of the vascular communication in the hand. The examiner first palpates and occludes the radial and ulnar arteries. The patient is then asked to open and close his or her fingers rapidly from three to five times to cause the palmar skin to blanch. Pressure is then released from either the radial or ulnar artery, and the rapidity with which the hand regains color is noted. The test is repeated with release of the other artery. A positive test indicates that there is a diminished or absent communication between the superficial ulnar arch and the deep radial arch.

 

Phalen's (wrist flexion) test: A test designed to determine the presence of carpal tunnel syndrome. The examiner, who maintains this position by holding the patient's wrists together for one minute, maximally flexes the patient's wrists. The test is positive is paresthesia are present in the thumb, index finger, and the middle and lateral half of the ring finger.

 

Tight Retinacular Ligament test: A test designed to determine the presence of shortened retinacular ligaments or a tight DIP joint capsule. The examiner holds the patient's PIP joint in a fully extended position while attempting to flex the DIP joint. If the DIP joint does not flex, the test is positive for either a contracted collateral ligament or joint capsule. The test is positive for a tight retinacular (collateral) ligament and a normal joint capsule if, when the PIP joint is flexed, the DIP joint flexes easily.

 

Tinel's sign: A test designed to detect carpal tunnel syndrome. The examiner taps over the carpal tunnel of the wrist. The test is positive if the patient reports paresthesia to the wrist.


Low Back/Pelvis

 

Bowstring test (cram test or popliteal pressure sign): A test designed to identify the presence of sciatic nerve compression. The examiner first carries out a straight leg-raising test. The leg is raised to the point where the patient reports pain. The knee is slightly flexed to reduce the symptoms. Digital pressure is then applied to the popliteal fossa. The test is positive if pain is increased.

 

Hoover's sign test: A test designed to discriminate lower limb weakness from possible malingering. The patient relaxes in a supine position while the examiner places one hand under each heel. The patient is then asked to do a straight leg raise (knee extended). The test is positive if the patient is unable to lift the leg and there is no downward pressure from the opposite leg.

 

Kernig's sign: A test designed to identify meningeal irritation, nerve root involvement, or dural irritation. The patient lies in the supine position with hands cupped behind the head. The patient flexes his or her head into the chest (Brudzinski's sign) and raises the lower extremity with knee extended (Kernig's sign). The test is positive if radiating pain is elicited.

 

Prone Knee Flexion test (also called reverse Lasegue test): A test designed to identify L2 or L3 nerve root lesions. The patient lies prone while the examiner passively flexes the knee so that the patient's heel touches the patient's buttocks. The test is positive if the unilateral symptoms are elicited or increased in the lumbar area or anterior thigh. Pain in the anterior thigh may indicate a tight quadriceps muscle.

 

Straight Leg Raising test: A test designed to identify sciatic nerve root compression. With the patient supine, the examiner raises the patient's leg while stabilizing the knee in extension watching the patient's reaction. The examiner stops when the patient complains of back or leg pain (and not hamstring tightness). The examiner may also dorsiflex the ankle to further increase the traction on the sciatic nerve. Back pain suggests a central herniation, and the leg pain suggests a lateral disk protrusion. The test is repeated for both sides.

 

Gillet test - palpation of anterior superior iliac spines (patient sitting): A test designed to identify the presence of asymmetry of the sacroiliac joints that may be associated with subluxation or other pain-producing causes. The patient sits erect on a flat surface. The examiner who is standing or squatting in front of the patient, places his or her thumbs on the inferior margins of the anterior superior iliac spines (ASIS). Then examiner then moves the thumbs upward so that they are stopped by the bony prominence of the ASIS. The test is positive if one ASIS is higher than the other is.

 

Pelvic Rock Test: Used to identify pathology of the sacroiliac joint. The ASIS on each side of the pelvis are identified and then a medial force is applied to both of them attempting to force them together. Increased pain in the area of the sacroiliac joint is a positive sign.

 

Gaenslen's test: Another test to identify sacroiliac joint irritation. To perform this test the athlete lies supine on a table with one hip lying over the edge of the table. Both knees are drawn up to the chest then the hip and knee of the dependent hip are extended and allowed to drop below the level of the table. Increased pain in the sacroiliac joint indicates a positive test.

 

Side-lying Iliac Compression test: A test designed to identify the presence of sacroiliac joint dysfunction. The patient lies on his or her side. The examiner stands above the patient and, with elbows fully extended, interlocks her or his palms and places them over the most cephalad margin of the iliac crest. The examiner then exerts a downward and cephalad directed force on the crest. The test is positive if the patient's painful symptoms in the sacroiliac, gluteal, or crural regions are reproduced.

Knee

 

Ober's test: A test designed to determine the presence of a shortened (tight) iliotibial band. With the patient lying on one side, the lower limb closest to the table is flexed. The other lower limb, which is being tested, is abducted and extended. The knee of that limb is flexed to 90 degrees and is then allowed to drop to the table. If the limb does not, this indicates that the iliotibial band is shortened (tight).

 

Abduction (Valgus stress) test: A test designed to identify medial instability of the knee. The examiner applies a valgus stress to the patient's knee while the patient's ankle is stabilized in a slight lateral rotation. The test is first conducted with the knee fully extended and then repeated with the knee at 20-30 degrees of flexion. Excessive movement of the tibia away from the femur indicates a positive test. Positive findings with the knee fully extended indicate a major disruption of the knee ligaments. A positive test with the knee flexed is indicative of damage to the medial collateral ligament.

 

Adduction (Varus Stress) test: A test designed to identify lateral instability of the knee. The examiner applies a varus stress to the patient's knee while the ankle is stabilized. The test is done with the patient's knee in full extension and then with the knee in 20 to 30 degrees of flexion. A positive test with the knee extended suggests a major disruption of the knee ligaments, whereas a positive test with the knee flexed is indicative of damage to the lateral collateral ligament.

 

Anterior/Posterior Drawer (Sign) Test: A test designed to detect anterior and posterior instability of the knee (Anterior Cruciate Ligament / Posterior Cruciate Ligament). The patient lie supine with the knee flexed 90 degrees. The examiner sits across the forefoot of the patient's flexed lower limb. With the patient's foot in neutral rotation, the examiner pulls forward in the proximal part of the calf. Both lower limbs are tested. The test is positive if there is excessive anterior movement of the tibia with respect to the femur indicating an ACL lesion. Excessive posterior movement would indicate a PCL lesion.

 

Posterior Sag Sign (Gravity Drawer Test): A test designed to identify posterior instability of the knee. The patient lies supine with the knees flexed to 90 degrees and the feet supported. The test is positive if the tibia sags back on the femur.

 

Lachman's Test: Similar to the Anterior drawer test except the knee is flexed to 30 degrees and the drawer maneuver is attempted while the thigh is stabilized on the table. Excessive forward translation would indicate a torn ACL.

 

Stiman's Test: With the foot hanging off the edge of the table and the thigh stabilized on the table, the knee is forcefully internally and externally rotated. Pain would be a positive sign for meniscal tear.

 

McMurray's Test: Another useful test for meniscal lesions. To perform this test the patient lies supine while the examiner fully extends and flexes the knee while placing one hand over the joint line to feel for "clicks or pops". The test is then repeated with the foot internally rotated and again with the foot externally rotated. A "pop or click" that is reproducible is a positive test.

 

Apley Grind/Distraction Test: A test designed to detect meniscal lesions. The patient lies prone with the knee flexed to 90 degrees. The examiner applies a compressive force on the heel and rotates the tibia back and forth while palpating the joint line with the other hand feeling for crepitation. The test is positive if the patient reports pain or the examiner feels crepitation. This test is then repeated by applying a distractive force to the leg, and if pain is elicited it is indicative of a ligamentous injury rather than a meniscal injury.

 

Bounce Home or Spring test: Test designed to indicate irritation or tear of the meniscus. To perform this test the examiner flexes the knee to 30 degrees the knee is then allowed to passively drop into full extension. Inability of the knee to fully extend would indicate a bucket-handle type tear of the meniscus. Pain on full extension would indicate a smaller meniscus tear.

 

Patellar Apprehension Test: A test designed to identify dislocation of the patella. The patient lies supine with the knee resting in full extension. The examiner carefully and slowly displaces the patella laterally. If the patient looks apprehensive and tries to contract the quadriceps muscle to bring the patella back to neutral, the test is positive.

 

Brush or Stroke (Wipe) Test: This test is designed to identify a mild effusion in the knee. Starting below the joint line on the medial side of the patella, the examiner strokes proximally with the palm and fingers as far as the suprapatellar pouch. With the opposite hand, the examiner strokes down the lateral side of the patella. The test is positive if a wave of fluid appears as a slight bulge at the medial distal border of the patella.

 

Clarke's Sign: A test designed to identify the presence of chondromalacia of the patella. The patient lies relaxed with knees extended as the examiner presses down slightly proximal to the superior pole of the patella with the web of the hand. The patient is then asked to contract the quadriceps muscle as the examiner applies more force. The test is positive if the patient cannot complete the contraction without pain.

 

Wilson Test: A test designed to identify osteochondritis dissecans. The patient is seated with the lower leg in a dependent position. The patient extends the knee with the tibia medially rotated until the pain increases. The test is repeated with the tibia laterally rotated during extension. The test is positive if the pain does not occur when the tibia is laterally rotated (pain should be felt near 30 degrees).

 

Patello-Femoral Grind test: This test indicates roughening or pitting of the articular surfaces of the patella and femoral condyles (chondromalacia). To perform this test the patient sits with the knee fully extended and supported on a table. The examiner moves the patella laterally and medially while applying slight downward pressure. The patella is then moved superiorly and inferiorly while applying slight downward pressure. Crepitus under the patella would indicate a positive test.

Ankle

 

Anterior Drawer Sign: A test designed to identify anterior ankle instability. The patient sits with the leg dangling over the table. The examiner stabilizes the distal tibia and fibula with one hand while the examiner's other hand holds the foot in 20 degrees of plantar flexion. The test is positive if, while drawing the talus forward in the ankle mortise, there is a straight anterior translation that exceeds that of the other side.

 

Homan's Sign: A test designed to detect deep vein thrombosis in the lower part of the leg. The ankle is passively dorsiflexed, and pressure is exerted in the belly of the calf muscle with the fingers. Any sudden increase of pain in the calf or popliteal space is noted as a positive test.

 

Talar Tilt: A test designed to identify lesions of the calcaneofibular ligament. The patient is sitting on a table with the leg in a dependent position and the knee flexed to 90 degrees. With the foot in a neutral position, the talus is tilted medially. The test is positive if the amount of inversion on the involved side is excessive.

 

Eversion stress test: Test designed to indicate stretch or tear of the deltoid ligament. Performed in the much the same way as the talar tilt test, patient sitting on a table, knee flexed to 90 degrees, foot in neutral position, except the talus is tilted laterally instead of medially. The amount of tilt is then compared to the uninjured side. An excessive amount of motion would be a positive test. This test and the talar tilt are often performed bilaterally under x-ray exam to give a better comparison.

 

"Clunk" test for tib-fib ligament sprain: This test indicates a severe sprain of the anterior tibio-fibular ligament and a widening of the joint mortise. To perform this test the distal tibia and fibula are stabilized with one hand and the calcaneus is grasped with the other hand. The calcaneus is then moved in a side to side motion attempting to contact the medial and lateral malleoli. A positive test would be indicated by a "clunk" as the talus hits the malleolus on one side and then the other.

 

Thompson Test: A test designed to detect ruptures of the Achilles tendon. The patient is placed in a prone position or on the knees with the feet extended over the edge of the bed. The middle third of the calf muscle is squeezed by the examiner. If normal plantar flexion response is not elicited, an Achilles tendon rupture is suspected.

 

Compression test: This test has two parts. First the tibia and fibula are squeezed together at the malleoli and the again at mid shaft and at the proximal ends of the bones. Referred pain back onto a spot on the fibula or tibia would indicate a possible fracture (can also be used at the forearm for radius/ulna fracture). The second part of this test checks for anterior tibio-fibular ligament sprain and spreading of the joint mortise. To check for this injury the tibia and fibula are squeezed together at the malleoli. This maneuver may decrease or may not change the amount of pain the patient has in the area of the anterior tib-fib ligament, but when pressure is released the mortise will spread and the patient will report an increase in their pain over the anterior tib-fib ligament.

 

Percussion/"thump" test: This test checks for possible fracture in the ankle joint or in the tibia or fibula. To perform this test the patient is seated on a table with the leg in a dependent position and the ankle at 90 degrees. The heel is then firmly percussed with an open hand. Pain referred back to a specific spot on one of the bones of the ankle or the shaft of the tibia or fibula would indicate a possible fracture. This test can also be performed on the following areas to check for fracture:

Phalanges/metacarpals: With patient's finger extended, percuss the end of the distal phalanx of the involved ray with your finger.

 

Spine: With the patient in forward flexion of the spine, percuss along the spinous processes with a closed fist.

 

Phalanges/metatarsals: With patient's toe extended, percuss the end of the distal phalanx of the involved ray with your finger.

 

Patella: With patient's knee extended, percuss the medial and lateral borders of the patella with your finger.