midterm tests

Question 1

log roll

Answer 1

Nonspecific to central and peripheral compartments

Roll the patient’s leg into internal & external rotation

(+) Test= Pain with motion

*A negative test does not exclude hip pathology
Indicates: central or peripheral compartment pathology

Question 2

C-sign

Answer 2

ctr compartment

Patient characteristically points to the source of pain with two fingers or cups just above the trochanter with the thumb and index finger

Indicates: Labral pathology

Question 3

labral loading

Answer 3

ctr compartment

Flex the patient’s knee and hip to 90 degrees, load into the femur towards the innominate

(+) Test= pain in hip or low back

Indicates: Labral or cartilaginous pathology

Question 4

labral distraction

Answer 4

ctr compartment

Distract patient’s femur away from innominate

(+) Test= Improvement of pain

Indicates: Labral or cartilaginous pathology

Question 5

scour

Answer 5

ctr compartment

Flex and externally rotate patient’s hip. Load into socket and articulate through annular range of motion.

(+) Test= Pain

Indicates: Labral or articular cartilage pathology

Question 6

apprehension: FABER

Answer 6

ctr compartment

Pt hip flexed, abducted, externally rotated. Doctor induces further external rotation by applying a posterior force at the knee

(+) Test= anterior subluxation of hip or apprehension/pain, impingement

Indicates: Anterior labral pathology

Question 7

Ely’s test

Answer 7

peripheral compartment

Patient prone, passively flex patient’s knees

+ Ipsilateral hip raises off table

Indicates: Rectus femoris contracture

Question 8

Rectus Femoris Test

Answer 8

peripheral compartment
Patient supine. One hip flexed up to the chest. The other leg
bent over the edge of the table

(+) Test= knee flexion < 90° while thigh flat on the table

Indicates: Rectus femoris contraction ipsilaterally

Question 9

Jump Sign

Answer 9

lateral compartment

Patient is seated, pressure is applied to greater trochanter

(+) Test= patient withdraws or “jumps” with pressure

Indicates: Trochanteric bursitis

Question 10

Straight Leg Raise Test

Answer 10

lateral compartment

Raise the leg with knee extended, nonspecific test

(+) Test= Pain

Indicates:
Pain from 15°‐30° – Lumbar disc etiology
Pain laterally >15° – Lateral compartment pathology (As the
IT band passes over the greater trochanter)

Question 11

Ober’s Test

Answer 11

lateral compartment

Patient lateral recumbent with doctor standing behind the
patient. Doctor abducts the top leg and then lowers leg to the
table while stabilizing hip.

(+) Test= Inability to aDduct

Indicates: IT band contracture

Question 12

Piriformis Test

Answer 12

lateral compartment

Patient supine with hip and knee flexed, one ankle crossed
over contralateral knee. Patient abducts against resistance.

(+) Test= pain over posterior aspect of greater trochanter

Indicates: Piriformis spasm or pathology

Question 13

Trendelenburg

Answer 13

Patient standing with doctor behind. Patient lifts one foot off
ground.

(+) Test= weakness / inability to hold hips level

Indicates: Contralateral gluteus medius weakness
(Superior gluteal nerve)
[ex: Patient lifts right foot, right hip drops = Left gluteus medius/Superior gluteal nerve pathology

Question 14

Patrick’s : FABER, lateral

Answer 14

lateral compartment

Patient’s hip is flexed, aBducted and externally rotated.
Doctor braces contralateral ASIS, patient externally rotates/aBducts against resistance.

(+) Test= Pain or weakness

Indicates: Gluteus medius pathology

Question 15

Patrick’s: FABER*, anterior

Answer 15

anterior/iliopsoas compartment

Patient’s hip is flexed, aBducted and externally rotated.
Doctor braces contralateral ASIS. Patient internally rotates/aDducts against resistance.

(+) Test= Anterior or medial groin pain/weakness

Indicates: Iliopsoas insufficiency or pathology

Question 16

Psoas Test

Answer 16

anterior/iliopsoas compartment

Flex hip to 30° while patient further flexes against resistance

(+) Test= pain/inability or snapping

Indicates: Psoas contracture or pathology

Question 17

Thomas Test

Answer 17

anterior/iliopsoas compartment

Patient supine and pulls knees to chest. One leg is lowered to
the table to test the flexibility of the hip flexors.

(+) Test= Inability to fully extend/extended leg raises off table

Indicates: Hip flexor contraction

Question 18

valgus test of the knee

Answer 18

Patient supine and examiner supports the patient’s lower leg, with the knee flexed to 30°. Examiner’s hands are placed on the medial and lateral aspects of the patient’s knee. While providing lateral resistance at the knee, move the lower leg so that the ankle shifts laterally while holding the distal femur in place.

+ Increased laxity, soft or absent endpoint, and pain

Indicates:MCL disruption (If + at 0° with knee fully extended, indicates more serious injury, possibly joint capsule)

Question 19

varus test of knee

Answer 19

Examiner and patient in same position as the valgus stress test. While providing medial resistance, examiner moves the lower leg so that the ankle shifts medially. This test is done at 30° flexion and neutral (0°).

+Increased laxity, soft or absent endpoint, and pain

Indicates:LCL disruption (If positive at 0° with knee fully extended, indicates more serious injury, possibly joint capsule)

Question 20

anterior drawer of knee

Answer 20

supine with knee flexed to 90°. Examiner sits on the patient’s foot and grasps the proximal tibia with both hands, pulling the tibia anteriorly.

+Excessive translation when compared to the other knee

Indicates: ACL insufficiency

Question 21

lachamans test

Answer 21

Examiner places cephalad hand on the distal thigh, superior to patella. Caudad hand grasps the proximal tibia. Flexing the knee to 15-30°, the examiner uses his caudad hand to pull the tibia anteriorly while the cephalad hand stabilizes the thigh.

+ Increased laxity, soft or absent end point

Indicates: ACL insufficiency

Question 22

posterior drawer

Answer 22

supine with knee flexed to 90°. Examiner sits on the patient’s foot and grasps the proximal tibia with both hands, translating the tibia posteriorly.

+Excessive translation, particularly when compared to the opposite side

Indicates: PCL deficiency, posterior capsular injury or disruption.

Question 23

reverse lachmans

Answer 23

supine. Examiner places cephalad hand on the distal thigh, superior to patella. Caudad hand grasps the proximal tibia. Flexing the knee to 15-30°. The proximal hand stabilizes the femur while the distal hand pushes the tibia posterior.

+ increased laxity, soft or absent end point when compared to the opposite joint

Indicates: PCL deficiency/post capsule deficiency

Question 24

mcmurrays test

Answer 24

Patient is supine, with hip and knee flexed. Examiner uses caudad hand to control the ankle and cephalad hand placed on distal femur.
o Examiner rotates the tibia into internal rotation and applies a varus stress, then continues the leg into extension
o Examiner rotates the tibia into external rotation and applies a valgus stress, then continues the leg into extension

+Pain or a painful click during extension

Indicates: Possible medial or lateral meniscus tear

Question 25

appley grid compression test

Answer 25

Patient prone with knee flexed to 90°. Examiner uses downward force on the foot to provide a compressive force on the meniscus, while rotating the foot internally and externally. +Pain with rotation and/or compression Indicates: Possible meniscal injury (collateral ligament injury, or both)

Question 26

appley grind distraction test

Answer 26

Patient in same position as for the compression. Examiner stabilizes the thigh, then applies upward traction to the leg while rotating it (traction reduces meniscal pressure, but increases ligamentous strain) +Pain with distraction and rotation Indicates: Possible collateral ligament damage

Question 27

patellar laxity test

Answer 27

of patellar ligaments One hand above and one hand below the joint. Thumbs placed against the medial side of the patella. Examiner pushes the patella laterally, assessing ROM. +sense of apprehension or instability Indicates: possible previous patellar dislocation or severe instability.

Question 28

patellar apprehension test

Answer 28

of patellar ligaments When testing laxity to the point of restriction, ask the patient if the maneuver provokes any discomfort or sense of instability. +sense of apprehension or instability Indicates: possible previous patellar dislocation or severe instability.

Question 29

patellar compression (grind) test

Answer 29

of patellar cartilage Patient supine and knee extended. Provide compressive load to the patella with one hand while moving the patella medial and lateral. +pain with compression Indicates: Possible inflammation, chondromalacia, or injury to the patellofemoral articular surfaces

Question 30

patellar femoral grinding

Answer 30

of patellar cartilage Compress patella caudally into trochlear groove and instruct patient to tighten quadriceps against resistance +crepitation or pain Indicates: roughness of articulating surfaces (ie: chondromalacia)

Question 31

patellar glide test

Answer 31

of patellar cartilge Patient sitting or supine will slowly extend and flex the knee, while physician notes quality of the articular motion. Placing hand lightly over the patella can increase sensitivity of the test +palpable or audible crepitus, pain, or catching of the patella Indicates: Possible damage to the articular surface

Question 32

monofilament test

Answer 32

monofilament is placed on the first and fourth pad of toes and at base of first, third and fifth plantar MTP joints with enough pressure to cause a slight bend of the monofilament. + if patient cannot feel the monofilament. Important component of diabetic foot exam.

Question 33

anterior drawer of foot

Answer 33

Doc grasps posterior calcaneus with one hand and cups distal tibia/fibula with the other hand, monitoring anteriorly at the anterior talus. Provide anterior force on calcaneus while stabilizing the distal tibia/fibula. Normal springing of calcaneus back to neutral should occur. (+) test = pain, no springing, excessive motion anterior/laxity = ATF ligament pathology/tear

Question 34

talar tilt test

Answer 34

Doc grasps distal tibia/fibula with one hand and the inferior calcaneus with the other, blocking motion of the calcaneus on the talus. Invert the talus to evaluate ROM. (+) test = laxity, increased ROM or pain =Calcaneofibular ligament pathology/tear and some ATF

Question 35

eversion test

Answer 35

Doc grasps distal tibia/fibula with one hand and grasps the midfoot from the plantar surface of the foot with the other hand. Doc everts the foot to evaluate ROM. (+) test = laxity, increased ROM or pain = deltoid ligament pathology

Question 36

squeeze test

Answer 36

Doc wraps hands around leg proximal to the ankle, contacting the distal tibia/fibula with both thenar eminences. Squeeze for 2-3 seconds – rapidly release. (+) test = pain at syndesmosis = syndesmosis pathology, high ankle sprain

Question 37

cross leg test

Answer 37

For evaluation of high ankle sprain o Patient seated o Patient crosses affected leg over opposite knee o Patient then applies pressure to proximal fibular of affected leg (+) test = pain at distal ankle = syndesmotic injury

Question 38

thompson test

Answer 38

Pt Prone with foot off the table. Doc squeezes the calf. (+) test = absence of plantar flexion = Achilles tendon rupture

Question 39

Homan’s sign

Answer 39

Pt laying or seated with knee extended. Doc dorsiflexes the foot. (Some add lateral compression of calf as well) + pain with dorsiflexion Indicates thrombophlebitis or acute deep venous thrombosis in the presence of edema, erythema, and increased warmth of the skin of the lower leg o Need to get a Venous Doppler to rule out clot

Question 40

Moses Sign

Answer 40

Pt seated or supine o Physician induces an anterior compression on the gastrocnemius muscle into the posterior aspect of the tibia (compresses the calf towards the tibia) +pain with anterior compression – not lateral compression Indicates deep vein thrombosis of the posterior tibial veins

Question 41

valgus stress test of elbow

Answer 41

arm slightly abducted and externally rotated. Forearm supinated and flexed (to approx. 30º).Slight medial directed valgus stress is applied to elbow joint. (+) Test pain/tenderness with palpation and valgus stress; increased laxity degree of laxity correlates to degree of injury to UCL

Question 42

varus stress test

Answer 42

arm slightly abducted and internally rotated. Elbow flexed (to approx. 15º). A slight varus stress is applied to the elbow joint (+) Test = pain or increased laxity in LCL

Question 43

Tinel test of elbow

Answer 43

Tap between olecranon and medial epicondyle in ulnar groove +) Test = eliciting tingling sensation down forearm within ulnar nerve distribution Indicates ulnar nerve entrapment, cubital tunnel syndrome

Question 44

Golfer’s Elbow test

Answer 44

Anterior forearm/flexor compartment Patient’s elbow is flexed to 90° and forearm in supination. The examiner places one hand under the proximal forearm for stabilization and the other hand over the patient’s wrist to resist movement. Instruct the patient to flex the wrist. (+) Test = pain/tenderness around the medial epicondyle Indicates medial epicondylitis

Question 45

tennis elbow test

Answer 45

Posterior forearm/extensor compartment Patient’s elbow is flexed to 90° and forearm is placed in pronation. Examiner places one hand under proximal forearm for stabilization and the other hand over the patient’s hand to resist movement. Instruct the patient to extend the wrist. (+) Test = pain/tenderness around lateral epicondyle, may radiate down lateral forearm indicate lateral epicondylitis

Question 46

Ok sign

Answer 46

On examination, if neuropathy of anterior interosseous n present, patient cannot make an “O” with thumb and forefinger pinched together

Question 47

tinel's sign of wrist

Answer 47

by tapping over the transverse carpal ligament (between thenar/hypothenar eminences) with either the tip of the examiner’s finger or reflex hammer with the patient’s wrist held in extension. +parasthesias/numbness/ tingling/pain radiating to thumb, index and middle finger (median n. distribution) Indicates entrapment of Median Nerve or Carpal Tunnel Syndrome.

Question 48

Phalen’s sign

Answer 48

Place dorsal aspects of patient’s hands together and force into wrist flexion. Hold for 60 seconds +any reproduction of symptoms/parasthesias in the distribution of the median nerve Indicates carpal tunnel syndrome

Question 49

Allen Test

Answer 49

Evaluates functioning of radial and ulnar arteries. Occlude both arteries while patient makes a fist. Have patientopen and close fist; palm should be pale. Release pressure on ulnar artery and observe for color return to hand within 5-10 seconds. Repeat with radial artery.

Question 50

Finkelstein Test

Answer 50

Examiner asks patient to make a fist encompassing their thumb and ulnar deviate the wrist. +increased pain in first dorsal compartment/lateral wrist; indicates DeQuervain’s tenosynovitis

Question 51

empty can test

Answer 51

Flex patient’s shoulders to 90° while also abducting approximately 45°. Then internally rotate both arms so thumbs are pointing down. Press down on forearms while patient resists. (+) Test = Pain or weakness Indicates rotator cuff pathology (specifically supraspinatus)

Question 52

drop arrm test

Answer 52

Patient abducts arm 90°‐180°. Then slowly drops arm. (+) Test = Arm will drop or gentle tap on wrist will cause arm to drop Indicates full thickness tear of supraspinatus

Question 53

apprehension test

Answer 53

Shoulder abducted to 90° and elbow flexed to 90°. Stabilize patient’s shoulder with one hand and force arm into external rotation with the other hand. (+) Test = Patient apprehensive of repeat dislocation Indicates glenohumeral instability

Question 54

sulcus sign

Answer 54

Grasp patient’s elbow and apply inferior traction (+) Test = Indentation appears in area beneath the acromion Indicates glenohumeral instability

Question 55

yergasons test

Answer 55

Patient’s arm at side with elbow flexed at 90°. Examiner uses one hand to palpate bicipital groove and monitors there, while the other hand grasps the patient’s wrist. Have patient supinate and externally rotate against doctor’s resistance. (+) Test = Pain and/or tendon subluxation out of groove Indicates unstable bicipital tendon/subluxation, bicipital tendonitis

Question 56

speeds test

Answer 56

Patient’s arm forward flexed (50°‐90°) at the shoulder with hand supinated. Slightly flex patient’s elbow. Resist at forearm while patient further flexes shoulder. (Resist cephalad motion) (+) Test = Pain in bicipital groove Indicates bicipital tendonitis of long head of biceps

Question 57

neer impingement test

Answer 57

Stabilize patient’s shoulder, forearm is pronated. Passively flexshoulder to fully flexed position. (+) Test = Pain Indicates subacromial bursa or rotator cuff impingement

Question 58

hawkins test

Answer 58

Flex shoulder to 90°, flex elbow to 90°, slightly aDduct, and passively rotate the humerus into internal rotation. This opposes the rotator cuff against the coracoacromial ligament and acromion. (+) Test = Pain Indicates rotator cuff (usually supraspinatus) or subacromial bursa impingement

Question 59

Apley Scratch Test

Answer 59

assess bialterally

Question 60

liftoff test

Answer 60

Place patient’s arm into internal rotation and aDduction. Patient extends arm into as doctor resists. (+) Test = Weakness (inability to resist) Indicates subscapularis weakness