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.
|
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. |
|
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. |
|
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.