Physical Examination of MSK

Mainly on identifying the special tests

What is grade 5 muscle strength

Normal → Full ROM against gravity and maximal resistance

What is grade 4 muscle strength

Good → Full ROM against gravity and moderate resistance

What is grade 3 muscle strength

Fair → Full ROM against gravity BUT no resistance

What is grade 2 muscle strength

Poor → Full ROM achieved only when gravity is ELIMINATED

What is grade 1 muscle strength

Trace → Visible/palpable contraction noted

What is grade 0 muscle strength

No contraction identified

This describes what

Apprehension test → arm in this position and force to posterior humeral head → Positive = pain/apprehension = shoulder problem

What test is this

Relocation/Fowler’s test → done after Apprehension test → if pain persist = shoulder impingement, full pain free = instability

What test is this

Sulcus sign → Downward traction on arm → If unstable see sulcus between acromion and humeral head

What is this

Neer’s sign test → pain on this action at 70-120 degrees = shoulder impingement

What test is this

Hawkin’s test → pain on IR indicates shoulder impingement

What test is this

Yocum → pain when raising elbow indicate shoulder impingement

What test is this

Painful arc → pain when abducting 60-120 degree indicate supraspinatus tendinitis

What is this

Drop arm test → drop arm after abduction → if completely drop at 60 degree = complete rupture of supraspinatus, if slow = inflammation/injury of supraspinatus

What is this

Jobe/Empty can test → Pain = supraspinatus tendinitis, weakness = supraspinatus tear

What is this

Lift off test → testing ability to internal rotate arm → pain on action = subscapularis disorder

What test is this

Patte test → forced internal rotation → Pain or inability to support arm/rotate laterally = teres minor and infraspinatus injury

What is this

Yergason’s test → supination against resistance (pronation) → pain in bicipital groove = pathology of long head bicep

What is this

Speed’s test → Pain on bicipital groove when resisting downward force → bicep tendon pathology

What is this

Cozen’s test → pain at lateral epicondyle = Tennis elbow

What is this

Mill’s test → pain on lateral epicondyle = tennis elbow

What is this

Pain on forced wrist extension at medial epicondyle = golfer elbow → involvement of FCR tendon

What is this

Valgus stress test of arm → test medial collateral ligament → positive if you feel gapping on medial elbow

What is this

Varus stress test of arm → test lateral collateral ligament → positive if you feel gapping on lateral elbow

What is this

Finkelstein → pain = De Quervain’s tenosynovitis = APL, EPB problem

What is this

Carpal compression test → within 15sec to 2 minutes positive if you feel numbness = carpal tunnel

What is this

Modified Phalen → numbness and paresthesia of 1-3rd and half of 4th finger in 1 min → carpal tunnel

What is this

Tinel sign → numbness of finger when pressing from nerve regeneration in Carpal tunnel

What is this

Froment → positive = adductor pollicis weakness from ulner nerve injury

what is this

Ok sign → lt = abnormal = weakness of FDP (2,3), FPL, PQ → anterior interosseous syndrome

Lower extremity inspection

Look for Pelvic tilt, lordosis, gluteal folds, gait abnormalities, varus/vulgus, joint swelling/edema/atrophy etc

What tests are these

Valgus and varus stress test → test medial and lateral collateral ligament

What test is this

Anterior drawer → test for ACL tear

What is this

McMurray test → hold at ankle and flex knee → rotate → valgus → varus → Look for MCL/LCL injury

What is this

Apley/Grinding test → MCL/LCL injury

What test is this

Anterior drawer for the ATFL of foot

what is this

Spurling’s test → pressing on neck in this position causes radicular symptom → cranial nerve root compression

What is this

Hoffman’s test → positive if after flick of middle finger there will be flexion of other finger → UMN sign

What is straight leg raising test

Extend leg until there is pain → If pain is at posterior thigh below knee at 30-70 degree = sciatica/radiculopathy