Ortho Exams Week 1

Question 1

What are the 2 shoulder screening tests?

Answer 1

apley’s test (apley’s scratch test) and mazion’s shoulder rock test

Question 2

What is the patient position for apley’s test (apley’s scratch test)?

Answer 2

seated or standing

Question 3

What test is this?
-start with unaffected side
-patient is instructed to reach behind the head with their arm and touch the superior angle or the opposite scapula “wing bone”
-patient then reaches behind their back with same arm but now touches the inferior angle of opposite scapula
-now patient reaches across the chest with same arm and reaches for the opposite shoulder/scapula
-repeat with problem shoulder

Answer 3

apley’s test (apley’s scratch test)

Question 4

What are the positive signs for apley’s test (apley’s scratch test)?

Answer 4

increased pain or reduced ROM compared to the other arm

Question 5

What does a positive sign indicate with apley’s test (apley’s scratch test)?

Answer 5

1) general shoulder problems
2) degenerative tendonitis of rotator cuff, usually supraspinatus
3) OA
4) adhesive capsulitis
5) impingement

Question 6

What is the patient position for mazion’s shoulder rock test?

Answer 6

seated or standing

Question 7

What test is this?
-patient places the palm of their hand on the opposite shoulder and rests arm on their chest
-patient then actively moves arm up to touch forehead without moving their head down
-repeat with affected shoulder

Answer 7

mazion’s shoulder rock test

Question 8

What are the positive signs for mazion’s shoulder rock test?

Answer 8

pain/inability to perform in ipsilateral shoulder or arm

Question 9

What does a positive sign indicate for mazion’s shoulder rock test?

Answer 9

1) dislocation
2) capsular or muscle tightness

Question 10

What are the 4 shoulder dislocation tests?

Answer 10

1) bryant’s sign
2) calloway’s test
3) hamilton’s ruler test
4) duga’s test

Question 11

What is the patient position for bryant’s sign?

will not be on practical

Answer 11

seated

Question 12

What test is this?
-with the patient’s shoulders fully exposed, the doctor compares L/R axillary folds
-if the dislocation is posterior then the patient will have difficulty rotating the shoulder (FOOSH injury)

will not be on practical

Answer 12

bryant’s sign

Question 13

What is a positive sign for bryant’s sign?

will not be on practical

Answer 13

one axillary fold will be lower than the other

Question 14

What does a positive sign indicate for bryant’s sign?

will not be on practical

Answer 14

shoulder dislocation

Question 15

What is the patient position for calloway’s test?

will not be on practical

Answer 15

seated

Question 16

What test is this?
-the doctor measures the circumference of the shoulder from the acromion to the acromion

will not be on practical

Answer 16

calloway’s test

Question 17

What is a positive sign for calloway’s test?

will not be on practical

Answer 17

the dislocated shoulder circumference measurement is greater than the unaffected shoulder by 1+ inches

Question 18

What does a positive sign for calloway’s test indicate?

will not be on practical

Answer 18

shoulder dislocation

Question 19

What is the patient position for Hamilton’s ruler test?

will not be on practical

Answer 19

seated

Question 20

What test is this?
-the doctor places a straight edge ruler against the acromial tip and lateral epicondyle of elbow

will not be on practical

Answer 20

Hamilton’s ruler test

Question 21

What is a positive sign for Hamilton’s ruler test?

will not be on practical

Answer 21

the ruler touches the acromion and lateral epicondyle at the same time= shoulder dislocation

Question 22

What does a positive sign for Hamilton’s ruler test indicate?

will not be on practical

Answer 22

shoulder dislocation

Question 23

What is the patient position for duga’s test?

Answer 23

seated

Question 24

What test is this?
-the patient rests hand of affected arm on opposite shoulder
-patient attempts to rest elbow on chest
-doctor will lightly push patient’s elbow against chest and then up to lift it from the chest

Answer 24

duga’s test

Question 25

What are the positive signs for duga's test?

Answer 25

patient is unable to rest their elbow on chest or lift elbow from chest

Question 26

What does a positive sign for duga's test indicate?

Answer 26

shoulder dislocation

Question 27

What are the 2 shoulder stability tests?

Answer 27

1) anterior apprehension test 2) load and shift test

Question 28

What is the patient position for anterior apprehension test?

Answer 28

supine or seated against back of chair

Question 29

What test is this? -doctor is standing in front of patient and stabilizes the unaffected shoulder -doctor passively abducts patient shoulder to 90 degrees and then flexes elbow to 90 degrees while externally rotating shoulder -next, the shoulder is horizontally abducted and the humeral head is pulled gently forward while the doctor watches the patient's face -repeat with affected shoulder

Answer 29

anterior apprehension test

Question 30

What are the positive signs of anterior apprehension test?

Answer 30

-patient shows pain or alarm in facial expression -resists further ROM for fear of dislocation, laxity, instability

Question 31

What does a positive sign for anterior apprehension test indicate?

Answer 31

shoulder instability

Question 32

How is shoulder instability confirmed after an anterior apprehension test?

Answer 32

relocation and release test (exact opposite of anterior apprehension test, it should feel good)

Question 33

What is the patient position for load and shift test?

Answer 33

seated

Question 34

What test is this? -with the patient relaxed, doctor stabilizes the scapula and then "load" the glenohumeral joint by pressing the humeral head into the fossa -the humeral head is then pushed forward, backward, and inferiorly relative to the glenoid

Answer 34

load and shift test

Question 35

What are the positive signs of load and shift test?

Answer 35

-excessive joint play (humeral head moves further than 50% beyond glenoid rim compared to good side) -sulcus sign (dimple) at the glenohumeral joint

Question 36

What does a positive sign for load and shift test indicate?

Answer 36

directional shoulder instability and laxity (primarily tests the anterior capsule when pushing forward and the posterior capsule when pushing the head backward)

Question 37

What are the 3 shoulder labrum tests?

Answer 37

1) anterior slide test 2) crank test 3) o'brien's test

Question 38

What are the 2 AC joint compression tests?

Answer 38

1) o'brien's test 2) AC joint compression test

Question 39

What is the patient position for anterior slide test?

Answer 39

standing or seated

Question 40

What test is this? -patient rests their involved side hand on the posterior portion of the iliac crest and resists a superior to anterior pressure through the long axis of humerus applied by doctor

Answer 40

anterior slide test

Question 41

What is a positive sign of anterior slide test?

Answer 41

painful click, clunk, or popping sound

Question 42

What does a positive sign for anterior slide test indicate?

Answer 42

labrum tear

Question 43

What is the patient position for crank test?

Answer 43

supine or seated

Question 44

What test is this? -patient's arm is abducted 160-180 degrees with the elbow flexed -glenohumeral joint load is applied along the humeral axis coupled with internal and external shoulder rotation

Answer 44

crank test

Question 45

What is a positive sign for crank test?

Answer 45

clicking or clunking sound with pain (usually with external rotation)

Question 46

What does a positive sign for crank test indicate?

Answer 46

-labrum tear -joint pathology such as avascular necrosis/ osteonecrosis

Question 47

Which test is both a shoulder labrum test and AC joint compression test?

Answer 47

o'brien's test

Question 48

What is the patient position for o'brien's test?

Answer 48

standing or seated

Question 49

What test is this? -patient flexes shoulder to 90 degrees then adducts the arm 10-15 degrees with the shoulder fully internally rotated -the patient then resists downward pressure applied by doctor -repeat with shoulder fully externally rotated -repeat with affected shoulder

Answer 49

o'brien's test

Question 50

What is a positive sign for o'brien's test?

Answer 50

pain with internal rotation and diminished pain or no pain with external rotation

Question 51

What does a positive sign for o'brien's test indicate?

Answer 51

deep pain= labrum tear due to bicipital tendon attachment superficial pain= AC joint compression

Question 52

What is the patient position for AC joint compression test?

Answer 52

seated

Question 53

What test is this? -compress patient shoulder AC joint together from A->P and P->A

Answer 53

AC joint compression test

Question 54

What is a positive sign for AC joint compression test?

Answer 54

pain in AC joint

Question 55

What does a positive sign for AC joint compression test indicate?

Answer 55

-AC joint injury -arthritis -osteolysis of the distal clavicle

Question 56

Which test is coupled with o'brien's test?

Answer 56

AC joint compression test

Question 57

What are the 2 supraspinatus tear (rotator cuff tear) tests?

Answer 57

1) codman's sign (drop arm sign) 2) supraspinatus press test (empty can test)

Question 58

What is the patient position for codman's sign (drop arm sign)?

Answer 58

seated or standing

Question 59

What test is this? 1) patients arm is passively abducted to point above 90 degrees and dropped unannounced with the patient (previously informed) told to catch and hold it 2) patients arm is passively abducted to point above 90 degrees and asked to slowly lower it to their side

Answer 59

codman's sign (drop arm sign)

Question 60

What are the positive signs for codman's sign (drop arm sign)?

Answer 60

-pain in shoulder -inability to perform -hunching/ recruitment of additional muscles

Question 61

What does a positive sign for codman's sign (drop arm sign) indicate?

Answer 61

supraspinatus tendon tear/rupture

Question 62

What is the patient position for supraspinatus press test (empty can test)?

Answer 62

seated

Question 63

What test is this? -patient's arm is abducted to 90 degrees as if holding out a can -patient resists downward force from doctor -doctor moves patient arm to scaption position with full internal shoulder rotation (empties can) and again resists doctor

Answer 63

supraspinatus press test (empty can test)

Question 64

What is a positive sign for supraspinatus press test (empty can test)?

Answer 64

weakness or pain in the affected shoulder

Question 65

What does a positive sign for supraspinatus press test (empty can test) indicate?

Answer 65

tear of the supraspinatus tendon

Question 66

What are the 2 shoulder lag sign tests?

Answer 66

1) external rotation lag sign 2) internal rotation lag sign

Question 67

What is the external rotation lag sign testing?

Answer 67

infraspinatus and teres minor

Question 68

What is the internal rotation lag sign testing?

Answer 68

subscapularis

Question 69

What is the patient position for external rotation lag sign?

Answer 69

seated

Question 70

What test is this? -shoulder is held at 20-45 degrees of abduction in the scaption plane -elbow is passively flexed to 90 degrees and the shoulder is held in a position of full external rotation -patient is then instructed to hold the position while doctor holds elbow and releases wrist

Answer 70

external rotation lag sign

Question 71

What is a positive sign for external rotation lag sign?

Answer 71

the degree that the arm rotates from external to internal has a lag compared to unaffected shoulder (estimate lag in increments of 5 degrees)

Question 72

What does a positive sign for external rotation lag sign indicate?

Answer 72

full thickness tear/rupture of infraspinatus and/or teres minor

Question 73

What is the patient position for internal rotation lag sign?

Answer 73

seated

Question 74

What test is this? -patient places the back of their hand on their lower back and the doctor stabilizes shoulder while moving the patient's hand away from back -ask patient to hold position

Answer 74

internal rotation lag sign

Question 75

What is a positive sign for internal rotation lag sign?

Answer 75

the degree that the arm rotates from internal to external has a lag compared to unaffected shoulder (estimate lag in increments of 5 degrees)

Question 76

What does a positive sign for internal rotation lag sign indicate?

Answer 76

full thickness tear/rupture of subscapularis