Lab Final Extra

Question 1

Complaint of tendinitis in shoulder flexion

Answer 1

Speed test

Pt seated with forearm supinated, and elbow flexed to 45 degrees. Ex places his/her fingers on pt’s bicipital groove with opposite hand on pts forearm. Patient flexes shoudler, maintain supination and completely extend teh elbow as doc applies resistance

Pain and or tenderness in the bicipital groove

Indicates bicipital tendinitis

Question 2

Locking and grinding of the knee

Answer 2

Test for synovial knee plica (patellar bowstring)

Pt side lying with involved side up. Knee in 30 degrees flexion. Ex grasps lateral aspect of patella with superior hand and pushes it medially. Inferior hand internally rotates tibia. Knee is then extended fully and flexed again to 30. Can be repeated with a lateral pull on the patella and lateral tibial rotation.

Popping, snapping, clunking, grinding, or stuttering of the patella

Indicates medial patella pain is medial knee synovial plica syndrome. Lateral patella pain is lateral knee synovial plica syndrome.

Question 3

Posterior elbow pain

Answer 3

Valgus overload test of the elbow

Elbow placed into 90 degrees of flexion. Ex places valgus stress into elbow while passively extending the elbow fully (dynamic extension)

Pain in the posterior elbow with a reproduction of a locking or catchign sensation or an inability to fully extend the elbow due to pain

Indicates posterior elbow impingement syndrome

Question 4

Painless knee

Answer 4

Godfrey sag sign

Pt lies supine with the involved knee flexed to 90 and hip flexed to 90. Ex grasps distal tib/fib adn asks pts to perform a gentle hamstring contraction (bring heel to buttock). Ex then observes proximal anterior tibio-femoral joint

Proximal tibia sags posteriorly due to lack of static posterior constriant

Indicates tear or sprain of the posterior cruciate ligament.

This test is done to confirm injury to this ligament if drawer proves inconclusive

Question 5

CAM hip

Answer 5

Hip impingement sign

Pt supine with hip flexed to 90. Hip is then adducted across midline of the body and ex forcefully internally rotates the hip.

Sharp anterior catching hip pain

Indicates hip impingement syndrome

Question 6

Anterior shoulder instability

Answer 6

Anterior slide test

Pt seated ex instructs pt to place hands on waist with thumbs pointing posterior. With one hand stabilize scapula and clavicle and with opp hand grasp humerus and place an anterior to superior force into the shoulder. Pt will then push back against examiner.

Popping, cracking, and crepitus is noticed with pain on the antero-superior aspect of the shoulder

Indicates superior or anterior glenoid labrum tear

Question 7

Acute anterior knee instability

Answer 7

Lachman test

Pt supine, ex puts pts knee at 30 degree angle of flexion then grasps both prosimal end of tibia with one hand and distal end of femur with the other and attempts to pull tibia forward in order to feel joint play.

Gapping with the tibia moving away from the femur

Indicates anterior cruciate ligament or posterior oblique ligament instability

Question 8

Heel pain radiating along foot toward big toe

Answer 8

Test for Plantar fascitis

Pt prone knee 90. Ex forcefully dorsiflexes pts ankle and then big toe creating stretch. Ex then palpates along the medial longitudinal arch while maintaining stretch.

Sharp pain along the medial longitudinal arch indicates plantar fascitis

Question 9

Lateral hip pain and thigh pain

Answer 9

Modified ober test

Pt side lying with involved side up. Bottom leg flexed to allow stability. Pt moved to edge of table and uses their thigh to stabilize pts sacrum and pelvis. Involved legs knee is extended completely adn hip is extended slightly. Ex then lowers the involved leg off side of table.

Hip and lateral thigh remains in abduction. The patient experiences lateral thigh pain upon this maneuver

Indicates tight TFL (possible contracture) with possible IT Band syndrome

Question 10

Lateral elbow pain

Answer 10

Cozen test

Pt seated, ex instructs pt to make a fist and place wrist into extension. Ex instructs patient to resist.

Pain over the lateral epicondyle

Indicates lateral epicondylitis (tennis elbow)

Question 11

Labrum injury

Answer 11

O’Brien sign aka active compression test

Pts shoulder is placed in flexion 90 degrees and then into full internal rotation and 10 to 15 degrees of horizontal adduction (cross chest). Ex exerts downward force against pts upward resistance. Repeat test with arm supinated.

Pain felt deeply in position 1 indicates labrum tesar

Pain felt superficially (position 2) indicates AC joint problem

Question 12

High ankle injury

Answer 12

Distal tibio-fibular squeeze test

Ex squeezes the distal third of the tibo-fibular joint for 3-5 seconds

Pain is reproduced while squeezing or pain is worse when releasing the tib/fib distally as it springs back

Indicates high ankle sprain of the tibio-fibular ligament and/or the interosseous syndesmosis.

Question 13

Supraspinatus weakness

Answer 13

Empty can test

Shoulder abducted 90 in scaption plane with forearm extended and in 40 degrees forward flexion. Shoulder is placed in maximal internal rotation with thumb pointing down. Ex instructs pt to push back and out while ex pushes down and in.

Inability to perform the test and/or pain with resistance to abduction downward pressure stressing the supraspinatus muscle an dtendon insertion

Indicates tear or rupture to the supraspinatus muscle or tendon with possible suprascapular neuropathy

Question 14

Synovial plica knee

Answer 14

Test for synovial knee plica

Pt side lying with involved side up. Knee in 30 degrees flexion. Ex grasps lateral aspect of patella with superior hand and pushes it medially. Inferior hand internally rotates tibia. Knee is then extended fully and flexed again to 30. Can be repeated with a lateral pull on the patella and lateral tibial rotation.

Popping, snapping, clunking, grinding, or stuttering of the patella

Indicates medial patella pain is medial knee synovial plica syndrome. Lateral patella pain is lateral knee synovial plica syndrome.

Question 15

Gluteal insufficiency

Answer 15

Trendelenburg test

Pt stands on foot of involved side of hip problem. Observe level of the hips

High iliac crest on supported side and low crest on side of elevated leg

Indicates weak gluteus medius muscle on the supported side

Question 16

Posterior elbow pain

Answer 16

Valgus overload test of the elbow

Elbow placed into 90 degrees of flexion. Ex places valgus stress into elbow while passively extending the elbow fully (dynamic extension)

Pain in the posterior elbow with a reproduction of a locking or catchign sensation or an inability to fully extend the elbow due to pain

Indicates posterior elbow impingement syndrome

Question 17

Infraspinatus/teres minor weakness

Answer 17

Patte test (horn-blower sign)

Pt will place shoulder of affected side in forward flexion to 90. Shoulder is then slightly abducted 15-20 degrees. Elbow is bent to 90 with palm facing the patient. Ex will place their hand at the distal forearm on teh dorsal surface. Pt will then externally rotate against resistance.

Pain or inability to actively externally rotate against resistance due to weakness

Indicates infraspinatus or teres minor tendinopathy

Question 18

Posterior knee instability

Answer 18

Godfrey sag sign

Pt lies supine with the involved knee flexed to 90 and hip flexed to 90. Ex grasps distal tib/fib adn asks pts to perform a gentle hamstring contraction (bring heel to buttock). Ex then observes proximal anterior tibio-femoral joint

Proximal tibia sags posteriorly due to lack of static posterior constriant

Indicates tear or sprain of the posterior cruciate ligament.

This test is done to confirm injury to this ligament if drawer proves inconclusive

Question 19

Sharp, anterior hip pain

Answer 19

Hip impingement sign

Pt supine with hip flexed to 90. Hip is then adducted across midline of the body and ex forcefully internally rotates the hip.

Sharp anterior catching hip pain

Indicates hip impingement syndrome

Question 20

Medial epicondylitis

Answer 20

Reverse mills test

Elbow is extended and forearm supinated. Wrist is fully passively extended. Test is designed to confirm golfers elbow test

Extend wrist then pull arm into extension

Reproduction of pain in the medial elbow

Indicates medial epicondylitis or golfers elbow

Question 21

Can’t jog because of lateral knee pain

Answer 21

Noble test

Pt sits on table with feet on table, involved knee flexed to 60. Ex places their superior thumb over the lateral femoral condyle with firm pressure where the IT band runs past the knee. Ex then passively extends the knee to full extension and then flexes knee back to 60 while maintaining firm pressure with thumb over the lateral femoral condyle.

Worse pain through 30-40 degrees of flexion/extension (painful arc of the knee) of the knee

Indicates IT band syndrome or lateral knee impingement syndrome

Question 22

Rotator cuff instability

Answer 22

Patte test (horn-blower)

Pt will place shoulder of affected side in forward flexion to 90. Shoulder is then slightly abducted 15-20 degrees. Elbow is bent to 90 with palm facing the patient. Ex will place their hand at the distal forearm on teh dorsal surface. Pt will then externally rotate against resistance.

Pain or inability to actively externally rotate against resistance due to weakness

Indicates infraspinatus or teres minor tendinopathy

Question 23

Deep anterior hip pain catching sensation

Answer 23

Hip impingement

Pt supine with hip flexed to 90. Hip is then adducted across midline of the body and ex forcefully internally rotates the hip.

Sharp anterior catching hip pain

Indicates hip impingement syndrome

Question 24

Clicking sensation in bicep tendon

Answer 24

Abbott saunders

Pt seated, ex fully abducts and externally rotates pts affected arm. Ex places fingers on pts bicipital groove and then slowly lower pts affected arm to their side.

Palpable and/or audible click

Indicates subluxation or dislocation of the biceps tendon due to a rupture of the transvers humeral ligemnt or tendon subluxation beneath subscapularis muscle belly/tendon

Question 25

Anterior arm pain with weakness

Answer 25

Maximum elbow flexion test/compression test Pt is asked to place elbows in maximum elbow flexion for up to 3 minutes to close down the cubital tunnel. Reproduction of paresthesia’s into the ulnar nerve distribution with possible weakness on handshake (power grip) Indicates cubital tunnel syndrome (ulnar nerve entrapment at the cubital tunnel)

Question 26

Knee instability in popliteal fossa

Answer 26

Godfrey sag sign Pt lies supine with the involved knee flexed to 90 and hip flexed to 90. Ex grasps distal tib/fib adn asks pts to perform a gentle hamstring contraction (bring heel to buttock). Ex then observes proximal anterior tibio-femoral joint Proximal tibia sags posteriorly due to lack of static posterior constriant Indicates tear or sprain of the posterior cruciate ligament.

Question 27

Patellar pain with snagging sensation

Answer 27

Synovial plica knee Pt side lying with involved side up. Knee in 30 degrees flexion. Ex grasps lateral aspect of patella with superior hand and pushes it medially. Inferior hand internally rotates tibia. Knee is then extended fully and flexed again to 30. Can be repeated with a lateral pull on the patella and lateral tibial rotation. Popping, snapping, clunking, grinding, or stuttering of the patella Indicates medial patella pain is medial knee synovial plica syndrome. Lateral patella pain is lateral knee synovial plica syndrome.

Question 28

Swelling and bruising around distal tib/fib

Answer 28

Distal tibio-fibular squeeze test Ex squeezes the distal third of the tibo-fibular joint for 3-5 seconds Pain is reproduced while squeezing or pain is worse when releasing the tib/fib distally as it springs back Indicates high ankle sprain of the tibio-fibular ligament and/or the interosseous syndesmosis.

Question 29

Instability of bicep tendon

Answer 29

Yergason Test (cipriano) Pt seated, ex flexes pts elbow to 90. Ex stabilizes pts elbow with one hand and exerts slight inferior traction. Uses other hand and adds resistance to distal portion of radius. Ex offers resistance while pt externally rotates humerus and slightly supinates forearm. Localized pain and/or tenderness in the bicipital groove indicates bicipital tendinitis Audible click or biceps tendon subluxes or dislocates indicates instaiblity of the biceps tendon possibly associated with a torn transverse humeral ligament

Question 30

Heel pain while walking

Answer 30

Fat pad squeeze Test of the heel Pt prone. Ex depresses pts fat pad forcefully and elicits a painful localized response. The ex then squeezes the heel and fat pad together creating a cushioning effect of fat pad. Then forceful depression is repeated while maintaining the squeeze. Pain diminishes during this procedure or feels less tender Lessening of pain rules in fat pad syndrome. If pain remains the same or is worse consider plantar fascitis, heel spur or calcaneal stress fracture.

Question 31

Painful giving way of the knee

Answer 31

Apley compression Pt prone. Ex flexes pts affected knee to 90. Stabilize pts thigh with your knee. Place downward pressure on pts distal tib/fib in neutral and then while internally and externally rotated. Patient points to side of pain Pain on medial side indicates medial meniscus tear. Pain on lateral side indicates lateral meniscus tear.

Question 32

Differentiate between AC joint and a labrum tear

Answer 32

O’Brien sign aka active compression test Pts shoulder is placed in flexion 90 degrees and then into full internal rotation and 10 to 15 degrees of horizontal adduction (cross chest). Ex exerts downward force against pts upward resistance. Repeat test with arm supinated. Pain felt deeply in position 1 indicates labrum tesar Pain felt superficially (position 2) indicates AC joint problem

Question 33

Decrease ROM and stiffness in shoulder

Answer 33

Mazion shoulder maneuver Dugas but elbow towards forehead actively Inability to actively raise elbow to forehead due to pain and/or stiffness Indicates early stage adhesive capsulitis or non inflammatory capsular adhesions

Question 34

Knee pain on prolonged sitting (cinema sign)

Answer 34

Patella femoral grinding test aka clarke sign Pt supine. Affected knee extended. Ex uses web of hand to move patella inferior. Pt tighten quads as ex continues to hold patella. Retropatellar pain and patient is unable to hold the quadriceps contraction Indicates degenerative changes of the patellar facets and/or within the trochlear groove (chondromalacia patella)

Question 35

Hip pain and low back pain distinguish from one another

Answer 35

Hibb test Prone. Ex stabilize pelvis on near side, grasp opp side ankle and flex knee 90. Ex maximally flexes knee and then slowly internally rotates thigh Pain in hip region indicates hip joint pathology Pain in buttock/pelvic region indicates sacroiliac joint lesion BElt test Pt standing. Patient bends forward and note low back pain. Support pts sacrum and hold iliac crests. Pt bend forward LBP while bending with sacrum stabilized and unstabilized indicates lumbar involvement. Pain during sacrum non-stabilized bending, and no pain during sacrum stabilized bending indicates pelvic involvement

Question 36

Instability and slipping out sensation in the shoulder

Answer 36

Sulcus sign with load and shift Pt seated with elbow flexed to 90 and shoulder in neutral. Grasp distal humerus with one hand and traction down on humerus. If sulcus appears then shift head of humerus in the fossa from posterior to anterior Attempts to dislocate shoulder inferiorly. A sulcus taht appears on the antero-lateral will indicate shoudler instability and is graded. Indicates inferior shoulder instability and possible inferior dislocation. +1=<1cm, +2=1-2cm, +3=>3cm

Question 37

Meniscus injury in the supine

Answer 37

Mcmurray sign Pt supine. Ex flexes pts affected hip to 90 and affected knee to 90. Grasps distal tibia and applies external rotation to knee. Ex places hand on lateral aspect of affected knee and applies a valgus stress maintains this and extends leg. Repeat with internal rotation and varus stress Clicking sound or pain by knee joint Indicates tear of medial meniscus if positive on external rotation Tear of lateral meniscus if positive on internal rotation. The greater the angle of the knee when flexed when positive is elicited, the more posterior the meniscal injury.

Question 38

Clumsiness adn weakness when gripping a pen to write

Answer 38

Fromet paper sign OR OK sign paper between thumb and tip of index in ok sign Ex asks pt to hold a piece of paper in their hand between thumb and index finger with thumb adducted. Ex then attempts to pull paper from patients grasp Pt seen to flex thumb thereby recruiting the median nerve to compensate for apparent weakness Indicates weakness or palsy of the adductor pollicus muscle innervated by the ulnar nerve. Look for wasting of the dorsal thumb web.

Question 39

Supraspinatus injury

Answer 39

Empty can test Shoulder abducted 90 in scaption plane with forearm extended and in 40 degrees forward flexion. Shoulder is placed in maximal internal rotation with thumb pointing down. Ex instructs pt to push back and out while ex pushes down and in. Inability to perform the test and/or pain with resistance to abduction downward pressure stressing the supraspinatus muscle an dtendon insertion Indicates tear or rupture to the supraspinatus muscle or tendon with possible suprascapular neuropathy

Question 40

Stress fracture of the hip

Answer 40

Anvil test Pt supine, ex elevates affected leg while keeping knee extended. Ex makes fist and strikes affected leg’s inferior calcaneus Localized pain in long bone or hip joint Indicates possible fracture of long bones or hip joint pathology

Question 41

Weakness on power grip

Answer 41

Maximum elbow flexion test/compression test OR fromet Pt asked to place elbows in maximum elbow flexion for up to 3 minutes to close down cubital tunnel. Reproduction of paresthesia’s into ulnar nerve distribution with possible weakness on handshake (power grip) Indicates cubital tunnel syndrome

Question 42

Sharp anterior shoulder pain only when working overhead

Answer 42

Anterior slide test Pt seated ex instructs pt to place hands on waist with thumbs pointing posterior. With one hand stabilize scapula and clavicle and with opp hand grasp humerus and place an anterior to superior force into the shoulder. Pt will then push back against examiner. Popping, cracking, and crepitus is noticed with pain on the antero-superior aspect of the shoulder Indicates superior or anterior glenoid labrum tear

Question 43

Shoulder external rotation

Answer 43

Patte test (horn-blower) Pt will place shoulder of affected side in forward flexion to 90. Shoulder is then slightly abducted 15-20 degrees. Elbow is bent to 90 with palm facing the patient. Ex will place their hand at the distal forearm on teh dorsal surface. Pt will then externally rotate against resistance. Pain or inability to actively externally rotate against resistance due to weakness Indicates infraspinatus or teres minor tendinopathy

Question 44

Anterior instabiltiy of the shoulder

Answer 44

Anterior apprehension with relocation - jobe relocation test Pt supine. Shoulder placed into apprehension position. Ex attempts to reproduce sense of instability/apprehension by externally rotating shoudler in a controlled manner. If apprehension is reproduced, ex then places heel of hand on proximal anterior GH joint and gently pushes in A-P direction(relocation) The patient sense releif upon relocation Indicates confirms anterior instability of the GH joint and rules out tendinitis as a false posivie for anterior apprehension test.

Question 45

Bursitis in the shoulder

Answer 45

Dawbarn test Pt seated, ex applies pressure below affected acromial process with fingertips. Note for pain or tenderness. Ex continues to apply pressure while abducting arm past 90. Decrease in pain and/or tenderness indicates subacromial bursitis

Question 46

Locking and grinding in the elbow

Answer 46

Valgus overload test of the elbow Elbow placed into 90 degrees of flexion. Ex places valgus stress into elbow while passively extending the elbow fully (dynamic extension) Pain in the posterior elbow with a reproduction of a locking or catchign sensation or an inability to fully extend the elbow due to pain Indicates posterior elbow impingement syndrome

Question 47

Lateral knee pain

Answer 47

Noble test Pt sits on table with feet on table, involved knee flexed to 60. Ex places their superior thumb over the lateral femoral condyle with firm pressure where the IT band runs past the knee. Ex then passively extends the knee to full extension and then flexes knee back to 60 while maintaining firm pressure with thumb over the lateral femoral condyle. Worse pain through 30-40 degrees of flexion/extension (painful arc of the knee) of the knee Indicates IT band syndrome or lateral knee impingement syndrome

Question 48

Clunking and locking in the shoulder instability

Answer 48

Sulcus sign with load and shift Pt seated with elbow flexed to 90 and shoulder in neutral. Grasp distal humerus with one hand and traction down on humerus. If sulcus appears then shift head of humerus in the fossa from posterior to anterior Attempts to dislocate shoulder inferiorly. A sulcus taht appears on the antero-lateral will indicate shoudler instability and is graded. Indicates inferior shoulder instability and possible inferior dislocation. +1=<1cm, +2=1-2cm, +3=>3cm

Question 49

Anterior/posterior shoulder impingement

Answer 49

Hawkin kennedy test Passive internal rotation of shoulder in 90 of forward flexion with elbow flexe dto 90 while scapula is stabilized posteriorly The supraspinatus tendon is jammed up against the anterior surface of teh coraco-acromial ligament due to narrowing of the subacromial space. Posterior pain implicates stretch of the teres minor and infraspinatus tendons. Local pain indicates supraspinatus tendinitis and impingement. Anterior pain is anterior impingement syndrome, posterior pain is posterior impingement syndrome.

Question 50

Deep anterior shoulder pain with occasional locking

Answer 50

O’Brien sign aka active compression test Pts shoulder is placed in flexion 90 degrees and then into full internal rotation and 10 to 15 degrees of horizontal adduction (cross chest). Ex exerts downward force against pts upward resistance. Repeat test with arm supinated. Pain felt deeply in position 1 indicates labrum tesar Pain felt superficially (position 2) indicates AC joint problem

Question 51

Swelling and difficulty weight bearing due to recent knee injury

Answer 51

Bounce home test Pt supine, ex flexes pts knee and grasps pts heel and knee of affected leg. Pulls leg slowly into extension Knee does not go into full extsension Indicates diffuse swelling of teh knee, accumulation of fluid, due to possible torn meniscus.

Question 52

Posterior elbow pain

Answer 52

Valgus overload test of the elbow Elbow placed into 90 degrees of flexion. Ex places valgus stress into elbow while passively extending the elbow fully (dynamic extension) Pain in the posterior elbow with a reproduction of a locking or catchign sensation or an inability to fully extend the elbow due to pain Indicates posterior elbow impingement syndrome

Question 53

Pain on the heel radiates to big toe

Answer 53

Test for Plantar fascitis Pt prone knee 90. Ex forcefully dorsiflexes pts ankle and then big toe creating stretch. Ex then palpates along the medial longitudinal arch while maintaining stretch. Sharp pain along the medial longitudinal arch indicates plantar fascitis

Question 54

Leg length discrepancy

Answer 54

Allis Pt supine, ex instructs pt to place both feet flat on bench while flexing both knees to 90 Difference in height and anteriority of knees If one knee is lower = ipsilateral congenital hip dilocation or tibial discrepancy (anatomical short leg) If one knee is anterior = ipsilateral congenital hip dislocation or femoral discrepancy (contralateral anatomical short leg)

Question 55

Tendinitis in the shoulder while flexing

Answer 55

Speed test Pt seated with forearm supinated, and elbow flexed to 45 degrees. Ex places his/her fingers on pt’s bicipital groove with opposite hand on pts forearm. Patient flexes shoudler, maintain supination and completely extend teh elbow as doc applies resistance Pain and or tenderness in the bicipital groove Indicates bicipital tendinitis

Question 56

Lockign and grinding of the knee

Answer 56

Synovial plica Pt side lying with involved side up. Knee in 30 degrees flexion. Ex grasps lateral aspect of patella with superior hand and pushes it medially. Inferior hand internally rotates tibia. Knee is then extended fully and flexed again to 30. Can be repeated with a lateral pull on the patella and lateral tibial rotation. Popping, snapping, clunking, grinding, or stuttering of the patella Indicates medial patella pain is medial knee synovial plica syndrome. Lateral patella pain is lateral knee synovial plica syndrome.

Question 57

Knee pain and prolonged sitting

Answer 57

Patella femoral grinding test aka clarke sign Pt supine. Affected knee extended. Ex uses web of hand to move patella inferior. Pt tighten quads as ex continues to hold patella. Retropatellar pain and patient is unable to hold the quadriceps contraction Indicates degenerative changes of the patellar facets and/or within the trochlear groove (chondromalacia patella)

Question 58

Twisted ankle

Answer 58

Distal tibio-fibular squeeze test Ex squeezes the distal third of the tibo-fibular joint for 3-5 seconds Pain is reproduced while squeezing or pain is worse when releasing the tib/fib distally as it springs back Indicates high ankle sprain of the tibio-fibular ligament and/or the interosseous syndesmosis.

Question 59

CAM

Answer 59

Hip impingement sign Pt supine with hip flexed to 90. Hip is then adducted across midline of the body and ex forcefully internally rotates the hip. Sharp anterior catching hip pain Indicates hip impingement syndrome

Question 60

Test collateral ligament knee old

Answer 60

Apley distraction Pt prone, ex flexes pts affected knee to 90. Ex places knee on affect thigh, ex grasps pts distal tib/fib and pulls the leg in neutral, int rot, and ext rot Patient will point to side of pain Pain on medial side indicates medial collateral ligament tear. Pain on lateral side indicates lateral collateral ligament tear. Q

Question 61

Lateral knee pain new

Answer 61

Noble test Pt sits on table with feet on table, involved knee flexed to 60. Ex places their superior thumb over the lateral femoral condyle with firm pressure where the IT band runs past the knee. Ex then passively extends the knee to full extension and then flexes knee back to 60 while maintaining firm pressure with thumb over the lateral femoral condyle. Worse pain through 30-40 degrees of flexion/extension (painful arc of the knee) of the knee Indicates IT band syndrome or lateral knee impingement syndrome

Question 62

Locking and clunking of shoulder

Answer 62

Anterior slide test Pt seated ex instructs pt to place hands on waist with thumbs pointing posterior. With one hand stabilize scapula and clavicle and with opp hand grasp humerus and place an anterior to superior force into the shoulder. Pt will then push back against examiner. Popping, cracking, and crepitus is noticed with pain on the antero-superior aspect of the shoulder Indicates superior or anterior glenoid labrum tear

Question 63

Tibiofibular ligament knee

Answer 63

Distal tibio-fibular squeeze test Ex squeezes the distal third of the tibo-fibular joint for 3-5 seconds Pain is reproduced while squeezing or pain is worse when releasing the tib/fib distally as it springs back Indicates high ankle sprain of the tibio-fibular ligament and/or the interosseous syndesmosis.

Question 64

Tarsal tunnel new

Answer 64

Test for Plantar fascitis Pt prone knee 90. Ex forcefully dorsiflexes pts ankle and then big toe creating stretch. Ex then palpates along the medial longitudinal arch while maintaining stretch. Sharp pain along the medial longitudinal arch indicates plantar fascitis

Question 65

Problem with internal rotation - juvenile genu valgus

Answer 65

Craig test for Anteversion (knee) Pt prone involved side knee flexed 90. Ex grasp distal tib/fib, hip internally rotated until greater trochanter comes parallel to table If hip is internally rotated in excess of 30 degrees inorder for greater trochanter to attain parallel position, pt is considered to have a structural anteversion.

Question 66

Diffuse swelling

Answer 66

Bounce home test Pt supine, ex flexes pts knee and grasps pts heel and knee of affected leg. Pulls leg slowly into extension Knee does not go into full extsension Indicates diffuse swelling of teh knee, accumulation of fluid, due to possible torn meniscus.

Question 67

Popping, grinding new

Answer 67

Synovial plica Pt side lying with involved side up. Knee in 30 degrees flexion. Ex grasps lateral aspect of patella with superior hand and pushes it medially. Inferior hand internally rotates tibia. Knee is then extended fully and flexed again to 30. Can be repeated with a lateral pull on the patella and lateral tibial rotation. Popping, snapping, clunking, grinding, or stuttering of the patella Indicates medial patella pain is medial knee synovial plica syndrome. Lateral patella pain is lateral knee synovial plica syndrome.

Question 68

Lateral knee pain going down the stairs

Answer 68

Noble test Pt sits on table with feet on table, involved knee flexed to 60. Ex places their superior thumb over the lateral femoral condyle with firm pressure where the IT band runs past the knee. Ex then passively extends the knee to full extension and then flexes knee back to 60 while maintaining firm pressure with thumb over the lateral femoral condyle. Worse pain through 30-40 degrees of flexion/extension (painful arc of the knee) of the knee Indicates IT band syndrome or lateral knee impingement syndrome

Question 69

Instability and labrum tear at shoulder

Answer 69

O’Brien sign aka active compression test Pts shoulder is placed in flexion 90 degrees and then into full internal rotation and 10 to 15 degrees of horizontal adduction (cross chest). Ex exerts downward force against pts upward resistance. Repeat test with arm supinated. Pain felt deeply in position 1 indicates labrum tesar Pain felt superficially (position 2) indicates AC joint problem

Question 70

Patient with knee pain while running

Answer 70

Noble test Pt sits on table with feet on table, involved knee flexed to 60. Ex places their superior thumb over the lateral femoral condyle with firm pressure where the IT band runs past the knee. Ex then passively extends the knee to full extension and then flexes knee back to 60 while maintaining firm pressure with thumb over the lateral femoral condyle. Worse pain through 30-40 degrees of flexion/extension (painful arc of the knee) of the knee Indicates IT band syndrome or lateral knee impingement syndrome

Question 71

Differentiate between ant/post pain

Answer 71

Hawkin kennedy test Passive internal rotation of shoulder in 90 of forward flexion with elbow flexe dto 90 while scapula is stabilized posteriorly The supraspinatus tendon is jammed up against the anterior surface of teh coraco-acromial ligament due to narrowing of the subacromial space. Posterior pain implicates stretch of the teres minor and infraspinatus tendons. Local pain indicates supraspinatus tendinitis and impingement. Anterior pain is anterior impingement syndrome, posterior pain is posterior impingement syndrome.

Question 72

Test for subscapularis tendinopathy

Answer 72

Lift off test Pt will place back of hand in small of their back and attempt to lift hand off the back Inability to actively life hand off or away from the back Indicates subscapularis tendinopathy

Question 73

Patietn with snapping, cracking, popping

Answer 73

Plica Pt side lying with involved side up. Knee in 30 degrees flexion. Ex grasps lateral aspect of patella with superior hand and pushes it medially. Inferior hand internally rotates tibia. Knee is then extended fully and flexed again to 30. Can be repeated with a lateral pull on the patella and lateral tibial rotation. Popping, snapping, clunking, grinding, or stuttering of the patella Indicates medial patella pain is medial knee synovial plica syndrome. Lateral patella pain is lateral knee synovial plica syndrome.

Question 74

Knee locking after injury (crepitus soudn)

Answer 74

Apley compression Pt prone affected leg to 90. Stabilize pts thigh. Place downward pressure on distal tib/fib in neutral int and ext rot. Patient points to side of pain Pain on medial side is medial meniscus tear. Pain on lateral side indicates lateral meniscus tear.

Question 75

Pain in the knee with rotation

Answer 75

Mcmurray sign Pt supine. Ex flexes pts affected hip to 90 and affected knee to 90. Grasps distal tibia and applies external rotation to knee. Ex places hand on lateral aspect of affected knee and applies a valgus stress maintains this and extends leg. Repeat with internal rotation and varus stress Clicking sound or pain by knee joint Indicates tear of medial meniscus if positive on external rotation Tear of lateral meniscus if positive on internal rotation. The greater the angle of the knee when flexed when positive is elicited, the more posterior the meniscal injury.

Question 76

Problem tucking in shirt

Answer 76

Lift off test Pt will place back of hand in small of their back and attempt to lift hand off the back Inability to actively life hand off or away from the back Indicates subscapularis tendinopathy

Question 77

Rupture achilles tendon

Answer 77

Thompson Pt pron with leg flexed to 90. Ex squeezes belly of calf muscle of affected leg Absence of foot plantar flexion motion Indicates achilles tendon rupture.

Question 78

Pain in posterior elbow

Answer 78

Valgus overload test of the elbow Elbow placed into 90 degrees of flexion. Ex places valgus stress into elbow while passively extending the elbow fully (dynamic extension) Pain in the posterior elbow with a reproduction of a locking or catchign sensation or an inability to fully extend the elbow due to pain Indicates posterior elbow impingement syndrome

Question 79

Problem overhead

Answer 79

Anterior slide test Pt seated ex instructs pt to place hands on waist with thumbs pointing posterior. With one hand stabilize scapula and clavicle and with opp hand grasp humerus and place an anterior to superior force into the shoulder. Pt will then push back against examiner. Popping, cracking, and crepitus is noticed with pain on the antero-superior aspect of the shoulder Indicates superior or anterior glenoid labrum tear

Question 80

Q angle

Answer 80

Patella femoral grinding test aka clarke sign Pt supine. Affected knee extended. Ex uses web of hand to move patella inferior. Pt tighten quads as ex continues to hold patella. Retropatellar pain and patient is unable to hold the quadriceps contraction Indicates degenerative changes of the patellar facets and/or within the trochlear groove (chondromalacia patella)

Question 81

Hip impingement for OA

Answer 81

Hip impingement new Patrick old Hip impingement sign Pt supine with hip flexed to 90. Hip is then adducted across midline of the body and ex forcefully internally rotates the hip. Sharp anterior catching hip pain Indicates hip impingement syndrome Patrick Pain in the hip region indicates hip joint apthology

Question 82

Bankart lesion

Answer 82

Sulcus sign with load and shift Pt seated with elbow flexed to 90 and shoulder in neutral. Grasp distal humerus with one hand and traction down on humerus. If sulcus appears then shift head of humerus in the fossa from posterior to anterior Attempts to dislocate shoulder inferiorly. A sulcus taht appears on the antero-lateral will indicate shoudler instability and is graded. Indicates inferior shoulder instability and possible inferior dislocation. +1=<1cm, +2=1-2cm, +3=>3cm

Question 83

Insidious pain and swelling

Answer 83

Wilson test Pt supine. Knee flexed to 90. Knee extended with tibia rotated medially. Knee again flexed to 90 tibia laterally rotated and extended Knee pain increases near 30 degrees of knee flexion with tibia internally rotated. Pain disappears when tibia is externally rotated Indicates osteochondritis dessicans

Question 84

4th and 5th finger

Answer 84

Maximum elbow flexion test/compression test OR fromet Pt asked to place elbows in maximum elbow flexion for up to 3 minutes to close down cubital tunnel. Reproduction of paresthesia’s into ulnar nerve distribution with possible weakness on handshake (power grip) Indicates cubital tunnel syndrome

Question 85

Differentiate labrum tear from AC joint

Answer 85

O’Brien sign aka active compression test Pts shoulder is placed in flexion 90 degrees and then into full internal rotation and 10 to 15 degrees of horizontal adduction (cross chest). Ex exerts downward force against pts upward resistance. Repeat test with arm supinated. Pain felt deeply in position 1 indicates labrum tesar Pain felt superficially (position 2) indicates AC joint problem

Question 86

Patient had pain radiation from heel to big toe

Answer 86

Test for Plantar fascitis Pt prone knee 90. Ex forcefully dorsiflexes pts ankle and then big toe creating stretch. Ex then palpates along the medial longitudinal arch while maintaining stretch. Sharp pain along the medial longitudinal arch indicates plantar fascitis

Question 87

Elbow weakness with power grip

Answer 87

Maximum elbow flexion test/compression test OR fromet Pt asked to place elbows in maximum elbow flexion for up to 3 minutes to close down cubital tunnel. Reproduction of paresthesia’s into ulnar nerve distribution with possible weakness on handshake (power grip) Indicates cubital tunnel syndrome

Question 88

Test tibial collateral ligament

Answer 88

Varus stress test Pt supine, ex stabilizes medial thigh of pts affected leg. Ex grasps just proximal to lateral ankel of affected leg and graudally pushes medially Gapping and/or elicited pain above/at/or below the joint line Indicates tear or instability of the lateral collateral ligament

Question 89

Diffuse swelling of the knee after a hyperextension injury

Answer 89

Godfrey sag sign Pt lies supine with the involved knee flexed to 90 and hip flexed to 90. Ex grasps distal tib/fib adn asks pts to perform a gentle hamstring contraction (bring heel to buttock). Ex then observes proximal anterior tibio-femoral joint Proximal tibia sags posteriorly due to lack of static posterior constriant Indicates tear or sprain of the posterior cruciate ligament.