Term
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Definition
Goal: Determine nerve root compression
Physician: Standing behind patient.
Method: Sidebend, extend, and add compression along C spine.
Postive: Pain in area of impingment.
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Term
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Definition
Goal: Determine irritation of long head of biceps brachii
Physician: Standing facing the patient.
Method: With the patients elbox extended, have patient forward flex the shoulder against resistance with the forearm supinated.
Postive: Pain and tenderness of biceps tendon. |
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Term
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Definition
Goal: Determine irritation of supraspinatus muscle
Physician: Standing in front.
Method: Internally rotate and flex should in scapular plane.
Postive: Pain in area of impingment ( greater tuberosity)
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Term
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Definition
Goal: Determine status of supraspinatus muscle
Physician: Standing in front of patient.
Method: Flex arm to 90, flex elbow to 90, then medially rotate the shoulder, which pushes the supraspinatus m. in to the coracoacromial ligament.
Postive:Pain |
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Term
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Definition
Goal: Determine Tear of supraspinatus m.
Physician: Front of the patient.
Method: Abduct the arm 90, forward flex to scapular plane, internally rotate ( thumbs down) and then apply downward pressure to lateral arm.
Postive: Pain or inability to overcome the pressure. Weakness without pain is most like C5/C6 injury. |
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Term
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Definition
Goal: ID anterior/inferior instability secondary to shoulder dislocation, by reproducing the inducing mechanism.
Patient: Have the flex elbow to 90, abduct to 90, externally rotate to 90.
Physician: Add more external rotation and or anterior directed force from the posterior aspect of glenohumeral joint. |
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Term
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Definition
Goal: ID inferior instability of glenohumeral joint.
Patient: Seated with arms at side.
Physician: Apply downward force along long axis of arm.
Positive: Loss of shoulder contour and sulcus developed over lateral aspect of shoulder. |
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Term
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Definition
Goal: ID tear of rotator cuff.
Patient: Seated or standing.
Physician: On the affected side, abduct arm to 90 and then patient asked to slowly lower arm back.
Positive: The arm drops suddenly or feels like its going to drop suddenly. Negative test should not rule out tear. |
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Term
| Posterior Drawer Sign ( Shoulder) |
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Definition
Goal: ID posterior instability of glenohumeral joint.
Patient: supine.
Physician: On the affected side, one hand flexes elbow to 120, abduct to 80-120, and 20-30 of forward flexion. Stabilize the scapula with one hand with the fingers on the spine of scapula and the thumb on coracoid process. With other hand, produce a posterior translation of humeral head.
Positive: increased posterior translation. |
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Term
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Definition
Goal: ID decreased range of motion of shoulder.
Patient: 1) Forward flex to touch opposite shoulder.
(adduction, forward flexion, internal rotation)
2) Forward flex to touch opposite thoracic spine.
( forward flexion, abduction, external rotation)
3) Extend the hand to touch the back of hand to the same thoracic spine. (adduction, extension, internal rotation)
Physician: Add more external rotation and or anterior directed force from the posterior aspect of glenohumeral joint. |
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Term
| Anterior Drawer Test ( Shoulder) |
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Definition
Goal: ID anterior instability of glenohumeral joint.
Patient: Supine.
Physician: Standing on side of the affected side. Place the shoulder in 80- 120 abduction, 0-20 forward flexion, 30 lateral rotation, stabilize the shoulder with one hand with the finertips on the spine of the scapula and the thumb on the coracoid process. The other hand produces an anterior translation.
Positive: Increased anterior translation. |
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Term
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Definition
Goal: Assess structural integrity of the ACL
Technique: Examiner grasps the distal femur in one hand and the proximal tibia with the other hand. Knee is then flexed to ~30 degrees. Examiner then applies an anterior pull to the tibia.
Positive: Lack of solid endpoint, as well as increased anterior translation as compared to the unaffected side. |
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Term
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Definition
Goal: Assess integrity of the PCL
Technique: patient supine with affected knee at 90 degrees and hip at 45 degrees. Examiner grasps the tibia posterior to the hamstring insertions. The examiner sits on the foot to stabilize the lower leg. A posterior translatory force is induced and the amount of posterior tibial translation is noted.
Positive: Increase in posterior translation compared to the unaffected knee and/or no solid end feel are indicative of a PCL tear. |
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Term
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Definition
Goal: Assess integrity of the ACL.
Technique: Patient supine with affected knee at 90 degrees and hip at 45 degrees. The examiner grasps the tibia posterior to the hamstring insertions. The examiner sits on the foot to stabilize the lower leg. A forward translatory force is induced and the amount of anterior tibial translation is noted.
Positive: Increase in anterior translation compared to the unaffected knee and/or no solid end feel are indicative of an ACL tear. |
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Term
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Definition
Goal: Assess the integrity of the medial ligaments of the knee.
Technique: patient supine. Examiner places one hand on the lateral aspect of the knee and one hand on the medial aspect of the distal leg. The knee is in extension, but not locked. The examiner then places a lateral force to the lower leg. The amount of joint space opening and pain are assessed. The examiner then flexes the knee to 20-30 degrees and repeats the lateral force.
Positive: An increase joint space gaping and/or pain is indicative of a tibial collateral ligament tear. If there is an increase in joint space gaping with the knee in extension, a rupture of the tibial collateral ligament and other ligament injury must be considered. |
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Term
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Definition
Goal: Assess the integrity of the lateral ligaments of the knee.
Technique: patient supine. Examiner places one hand on the medial aspect of the knee and one hand on the lateral aspect of the distal leg. The knee is in extension, but not locked. The examiner then places a medial force to the lower leg. The amount of joint space opening and pain are assessed. The examiner then flexes the knee to 20-30 degrees and repeats the medial force.
Positive: An increase joint space gaping and/or pain is indicative of a fibular collateral ligament tear. If there is an increase in joint space gaping with the knee in extension, a rupture of the fibular collateral ligament and other ligament injury must be considered. |
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Term
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Definition
Goal: Identify a meniscal injury to the knee.
Technique: Patient supine. Examiner grasps the fingers of one hand over the joint line of the knee and grasps the ankle with the other hand. The knee is maximally flexed. The examiner then medially rotates the leg and slowly extends the knee. This procedure is then repeated, except the lateral rotation of the leg is used.
Positive: A click or snapping sensation with associated pain during medial rotation is indicative of a lateral meniscus tear. Similar findings when the leg is laterally rotated may indicate a torn medial meniscus. |
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Term
| Apleys Compression/distraction test |
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Definition
Goal: Assess for a possible meniscal tear of the knee.
Technique: Patient prone with knee flexed to 90 degree. Examiner first applies a compressive force down the foot and ankle into the knee. The examiner then internally and externally rotates the leg. The examiner then applies a distractive force to the leg and repeats the internal and external rotation of the leg.
Positive: If the patient experiences pain with compression that is relieved with distraction, the patient may have a tear in the meniscus of the knee. If the patient has pain with both maneuvers, the injury is probably ligamentous. |
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Term
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Definition
Goal: assess for chondromalacia of the patella.
Technique: patient supine. examiner places a hand with the dorsal web space adjacent to the superior aspect of the patella. A slight caudal force is applied to the patella. The patient is then instructed to forcibly contract the quadriceps muscle.
Positive: Reproduction of pain and/or the sensation of the grinding under the patella are indicative of chondromalacia. |
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Term
| Patellar Apprehension test |
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Definition
Goal: Assess for subluxation of the patella.
Technique: Patient supine with knee extended. The examiner attempts to translate the patella laterally.
Positive: Pain, patient apprehension during maneuver, or subluxation of the patella. |
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