Joint Examination Tests Shoulder

Appleys scratch Horn Blower Int/ext rot. Hand behind back/over shoulder, measure position of fingers Tests Teres Minor Pt abducts arm to 90, and flexes welbow then tries to externally rotate their forearm

Subscapularis Stress, drop Inferior sulcus sign

Lift off/ winging scapula with arm behind back. Positive = pain in subscapular area plus 1 side wings more than other A/S, S/C, Press downjoint not in line, piano key sign at distal end clavicle Pull down on Pts arm. Space between acromion and head = G/H instability. Many asymptomatic pts have some degree of instability

Subacromial Impingment Tests

Painful Arc Ask patient to abduct arms to 180 degrees Positive = pain in subacromial area between 60 & 120 degrees Interpretation = Supraspinatus tendon Arm horizontal 90 anglehorizontal adductionint rotpain shoulder area. Pushes lateral facet of greater tubercle in the acromion Positive = pain in subacromial area Interpretation = Sub acromion impingement of either: bursa or supraspinatus tendon Neers (Scarf) Flexion of straight arm or int rot arm horizontal/bend arm 90pain on motion, especially near end range. Positive = pain in subacromial area Interpretation = Impingement of supraspinatous or long head of biceps between acromion & greater tuberosity. Subaracromion bursa Empty Can Test Palpate ant bursa with extended shoulder, compare both shoulders Pts arms abducted to 90 degrees in the plane of the scapulae with full internal rotation so that thumbs push down. Pts reistis downward pressure Positive = pain in subacromial area &/or weakness

Hawkings Kennedy

Interpretation = issue with supraspinatus tendon Yergasons Competence of the transverse ligament of the bicipital groove. Flexed elbow 90passively ext rot, palpate bicipital groove medial movement/snap over greater tuberosity.

Speeds

Long head of biceps tendon rupture or SLAP tear Pt holds arm outstretched (GH flexed to 90 degrees, palm up). Push down on patients arm. Positive = pain in bicipital groove (biceps) or GH (SLAP tear)

Elbow
Stress test Tennis elbow test Test ligaments by reinforced gapping Palpate lat epicondyle. Pt flexes elbow, makes fist &s extend wrist. Resisted

Medial epicondyle test Pronator teres syndrome

Medial epicondylitis. Resist wrist flexion of stretched arm Active resisted pronation, resist palmar flexion

Wrist
Fibrocartilage test Phalens Finkelsteins Triangular fibrocartilage test. Sit, push off chair seat with extended wrist. Median nerve. Press flexed or extended wrists together. Add Thumb compression on nerve. For de Quervains tenosynovitis. Nodule in tendon of Abd Pol long,/ Ext Pol Brevis. Make a fist with the thumb inside and move hand in an ulnar direction Positive pain over Abd Policis Longus & Brevis

Tinnels Watsons

Compression of Rad or Median nerve. Tap repeatedly on nerve with an extended wrist to stretch and narrow it further. Hold scaphoid and lunate between thumb and index. Pt ad/uln deviate wristinstability

Hip
Trendelenberg Thomas Integrity of abductors. Non-specific (OA/SI/LSp..) Standing lift one knee, balance abnormal if ipsilateral PSIS drops (poss weak right Glut med) also test proprioception. Tight hip flexors/ Fixed flexion deformity of hip (Severe OA). Supine flex good leg to eradicate lumbar lordosisbad leg move up, (knee flex), or firm bony resist when pressing leg down to extend.

Thomas (variation) Kendalls Obers

As above but bad knee hanging of table. Leg abduct tight ITB. Knee ext >90tight Quads Rectus femoris contracture. As Thomas variation but both legs over the foot end Ilio-tibial band. Pt Side lies, lower leg slightly flexed to stabilize pelvis. Passively abduct and slightly ext hip (ITB passes over greater trochanter)leg should pass the edge of the table

Hamstring Lat trunk stability

Like straight leg raise. Supine, one knee on chest, passively stretch other leg straightPt should be able to touch toes. Or activelymove thigh to vertical ,Pt extend leg actively Side lying, bending with elbows under shoulders. With straight legs, lift pelvis off table.

Knee
Patellar grinding or Clarcs Retro patellar wear. Push patella post, Pt contract quad grinding, often discomfort

Retro-patellar effusion

Patellar tap Done only if full ext is comfortable. Push fluid from sup patellar pouch (milking) before pressing patella to femurtap may be heard, excess fluid. Fluid wave If full ext not possible. Stroke fluid up into supra patellar pouch, see it move to med side. Push patella quickly lat to teat lat tissuesquad guarding response (prev lat subluxation / dislocation) Gapping in full extension should not be possible. Medial gapping in: full ext, just off full ext, 30 degrees off full ext. Add ext rot for LCL Lat gapping. Lig is fairly lax and supported by ITB, biceps, arcuatepoliteal and post capsule. Leg 90. Pull Ant test ACL(+post med/lat capsule and deep medial collateral lig) Push post test PCL Modified anterior drawer. With internal tibial rot, more specific to ACL Anterior drawer test in 25 degrees of flexion. Slackening supporting tissues focus on ACL 90 degrees pull tibia. Test PCL + post restraining tissues. (hamstrings) Post supporting tissues. Supine, hip+knee 90, Tibial tuberosity slight lower than joint line Meniscal injury. Supine, knee flex, ext rot tib, compress tib/fem, extend legclick, lock, pain. Compress med side (varus) for medial meniscus (post horn) Lat side (valgus) for lat meniscus Meniscus. Prone flexed knee, compress, ext rot legpain (should ease on distraction) Central tear of meniscus. McMurrys with sweeping arches side to side whilst extending.

Apprehension test Ligament MCL LCL Ant Drawer Slocum Lachmans Post Drawer Sag test McMurrays

Appleys compression Sweeping test

Ankle
Thompsons Drawer Drawer + inversion Drawer + eversion Testing Diastasis For ruptured Achilles tendon. Prone, Squeeze calf musclesome plant flex, if healthy Antero lat instability. Supine with foot on table (pull/push) or off edge (shearing) Test calcaneo/fibular ligament Test deltoid ligament Move/shear tib/fib. Test for rupture of thickened lower interosseous

Other Tests
Best test for Thoracic Outlet Syndrome Roos EAST (elevation arm stress test) Pt holds hand above head for 3 min and repeatedly opens & closes hands. Positive = reproduction of symptoms

Other tests for TOS Scoliosis

Adsons, Phalens

Adams Test: bend forward hump on one side (if it doesnt change on bending forward, lying down or sitting then its more likely to be structural) SLRT / Lasegues
Patient lying supine, the examiner lifts the patient's leg while the knee is straight. Positive = pain down back of leg to the heel at angle between 30- 70 degrees*. Indicates dural tethering (can be caused anywhere along the nerve, due to SOL, inflammation, disc, scar tissue *Always record your finding other findings may be equally significant, tight hamstrings pain at 90 degrees = SI
The nerve roots are not brought to tension and stretched by the SLR until 35 to 70 degrees of angulation has been reached. If there is compromise of the normal space (i.e., disc bulge, inflammation) this space is used up and the pain will manifest more quickly. It is important to evaluate fully a patient with a positive SLR, as nerve root compression may mimic sacroiliac inflammation. Leg pain from 0 to 30 degrees suggests nerve root irritation. Sciatic pain beyond 60 degrees suggests to lumbosacral conditions. If pain does not cross the knee it can be hamstrings Crossed SLRT rasie the good leg. Positive is sciatic pain in other leg this is a highly specific test for sciatic radiculopathy due to disc herniation If the SLR is ever positive, further testing must be pursued to define the nature of the irritation. There are a few more simple steps that increase the diagnostic value of this maneuver: Bragards Sign: If the SLR is positive, lower the leg on the affected side to just below the point of pain and quickly dorsiflex the foot. If the pain is duplicated or increased, this suggests sciatic neuritis. Lift the Head: Once the leg is raised to the point at which symptoms are reproduced, instruct the patient to lift his or her head, bringing the chin to the chest. If this movement is limited or increases the pain in the lower back or leg

If you think it may be SI

Goldthwaite's Test: Slide your hand under the patient's lower back and feel the lumbosacral spinous processes. As you lift the leg to a point of pain, feel for motion between these segments. If pain is experienced before the spinous processes separate, this suggests the irritation is rooted in the sacroiliac joint. If the pain manifests with motion of the lumbar segment, the lesion is more likely in that area

Radiculopathy Definition

Nerve root irritation or compression typically from a

herniated disc NRI: Symptoms: Pain NRC: Weakness & PNs