NBCE Part 4 Boards - Orthopedics

Foraminal Compression Test

The patient is seated and actively rotates head from side to side. Then the doctor exerts downward pressure and the head is rotated to each side with pressure.

Positive Radicular Pain -> Nerve Root Compression

Positive Local Pain -> Foraminal Encroachment

Jackson's Compression Test

The patient is seated and the doctor laterally flexes the patient head to the left and the right and applies downward pressure.

Postive Radicular Pain -> Nerve Root Compression

Distraction Test

The patient is seated and the doctor holds under the mastoid and pulls the patient's head superior, removing the weight of the head.

"What did you experience?"

Decreased Pain -> Nerve Root Compression

Increased Pain -> Sprain/Strain

O'Donohue's Test is for....

Determining whether it is a SPRAIN or STRAIN

O'Donohue's Test Performed

1) Patient actively moves part against resistance.

2) Then the doctor moves part passively through a full ROM.

Pain Active: STRAIN (damage in mm tissue)

Pain Passive: SPRAIN (damage I'm ligamentous tissue)

Valsalva's Maneuver

The doctor asks the patient to take a deep breath and hold while bearing down.

Postive Radicular Pain -> SOL

Maximal Cervical Compression Test

Patient is seated and actively rotated and extended head. If no pain the patient is asked to maximally laterally flex head in the same direction. Repeat on the other side. No compression applied.

Postive Radicular pain -> Nerve Root Compression

Shoulder Depression Test

Patient is seated, the doctor depressed the patient's shoulder while laterally flexing the cervical spine away from the shoulder. Repeat on other side.

Postive Pain -> Nerve Root Adhesion

Soto Hall Sign

Patient supine and the doctor places one hand on the patient's stream and passively flexes the patient's head towards his/her chest.

Positive localized pain -> ant: fracture/ post: ligament tear

Bakody's Test AKA Shoulder Abduction Test

Patient is seated and placed affected arm's palm on top of their head. The elbow should be at the level of the head.

Postive Relief of Pain -> IVF encroachment

Thoracic Outlet Syndrome AKA

Neurovascular Compression Syndrome

Allen's Test

Patient is seated with their elbow flexed and forearm supinated. Ask patient to pump their hand while doctor occludes the radial and ulnar arteries until hand whitens. The patient the opens hand and doctor releases on artery, recording fill time (until hand regains color). Repeat for other artery.

Postive for delay more than 10 seconds -> occlusion of the tested artery

Costoclavicular Maneuver AKA

Eden's Test

Eden's Test Performed

Patient is seated and doctor palpated for the radial pulse. Patient brings shoulder down and back and then flexes chin to their chest.

Positive if alteration to amplitude of radial pulse -> compression between first rib and clavicle

Adson's Test AKA

Scalenus Anticus Test

Scalenus Anticus Test Performed (MUST KNOW)

Patient is seated and doctor abducts, extends and externally rotates arm while taking the radial pulse. Patient rotates head TOWARDS the tested side and extends head. Patient takes a deep breath and holds it.

Postive if alteration to amplitude of radial pulse -> Scalenus Anticus Syndrome (Cervical "Halstead" rib)

Modified Adson's Test AKA

Scalenus Medius Test

Scalenus Medius Test Performed (MUST KNOW)

Patient is seated and doctor abducts, extends and externally rotates arm while taking the radial pulse. Patient rotates head AWAY from the tested side and extends head. Patient takes a deep breath and holds it.

Positive if alteration to amplitude of radial pulse -> Scalenus medium syndrome (Subclavian Artery)

Wright's Test AKA

Hyperabduction Maneuver

Hyperabduction Maneuver Performed (MUST KNOW)

Patient is seated and doctor palpated radial pulse. Both arms are abducted 180degrees. The doctor notes at what angle the radial pulse diminishes or disappears.

Positive f pulses are lost greater than 10degrees difference -> Pectorals Minor Syndrome (Axillary Artery)

Reverse Bakody Maneuver

Patient is seated and patient actively placed palm on top of their head.

Positive is pain is increased -> TOS

Halstead's Test

Patient is seated and extends their head backwards. The examiner exerts downward traction and slight abduction on arm while taking patient's pulse.

Positive if alteration in the amplitude of the radial pulse -> cervical rib

Rotator Cuff Injury...is muscle or tendon more commonly injured?

TENDONS

Which Rotator cuff tendon is most likely injured?

SUPRASPINATUS

How do you diagnosis and treat a Rotator Cuff Tear?

Diagnosis: MRI

Treatment: Codman's Exercises

Apley's Scratch Test

Patient is seated and actively moves hand behind head in attempt to touch the superior angle of the scapula. The patient then moves hand behind back to touch the inferior angle of the same scapula.

Positive decreased ROM -> Degenerative tendonitis of the Rotator Cuff

Cowman's Drop Arm Test

The doctor passively abducts the patient's arm to above 90 degrees and suddenly removes support. This will cause a firing of the deltoid muscle.

Positive: Patient unable to maintain arm position -> supraspinatous tear

Apprehension Test

The doctor abducts and slowly externally rotates the affected shoulder.

Positive: Patient shows signs of apprehension that the arm will re-injure -> Chronic Shoulder Dislocation

Dugas' Test

The patient places the hand of the affected shoulder on the opposite shoulder and attempts to touch the elbow to the chest.

Positive: unable to perform -> Shoulder Dislocation (Active & Acute)

Yergason's Test

The patient flexes their elbow to 90 degrees while seated. The doctor palpates the biceps tendon and actively resists the patient's attempt to actively supinate the hand and flex the elbow.

Positive: Audible click or snap in bicipital groove -> Bicipital Tendon Instability

Dawbarn's Sign

The doctor palpates the subacromial bursa and elicits pain. The doctor passively abducts patient's shoulder without moving his/her fingers off of the subacromial bursa.

Positive: Reduction of pain in second maneuver -> Subacromial Bursitis

Impingement Sign

The patient slightly abducts their arm and the doctor passively moves their arm through a full flexion. This causes a jam of the greater tuberosity against the lacrimal surface.

Positive: Pain -> Tendonitis (overuse of tendons)

Supraspinatus Press Test AKA

Empty Can Test

Empty Can Test Performed

Patient abducts shoulders to 90degrees and the doctor apple resistance. The patient flexes shoulders to 30 degrees and points thumbs downward and resistance is applied again. (Hold & push the proximal elbow).

Positive: Weakness -> Supraspinatus Tear

Speed's Test

Patient is seated with elbow slightly flexed and palm up. The doctor resists the patient's attempt to flex shoulder while extending and supinating the forearm.

Positive: Pain -> Bicipital Tendonitis

Subacromial Push Button Test

Doctor applies a deep pressure over the subacromial bursa.

Postive: Pain -> Supraspinatus degeneration OR Subacromial bursitis

Passive Shoulder Approximation

Patient is standing and the doctor asks patient to lift shoulders up and back (squeeze the shoulder blades together).

Positive: Pain in scapular region -> T1 or T2 Nerve Root problem on side of pain

Bryant's Test

Doctor observed patient standing and notes the heights of axillary folds.

Positive: lower axillary fold on involved side -> Shoulder Dislocation

Brachial Plexus Tension Test

Patient is seated. Patient places both hands behind his/her head and pulls elbows posteriorly.

Positive: Pain -> C5 Nerve Root Lesion and/or TOS

Lateral Epicondylitis AKA

Radiohumeral Bursitis

Radiohumeral Bursitis AKA

Tennis Elbow

Lateral Epicondylitis Affects

Extensor Carpi Radialis Brevis

Pain in extension of wrist and pronation of elbow (overhand swing)

Medial Epicondylitis AKA

Little Leaguer's Elbow

or

Golfer's Elbow

Medial Epicondylitis Affects

Flexor Carpi Ulnaris

Pain at elbow with flexion of the wrist

Cozen's Test

(C6 Biker Chicks)

Patient's elbow is flexed to 90degrees with forearm pronated and fist dorsiflexed. Doctor stabilizes patient's elbow and resists patient's dorsiflexed wrist.

Postive: Pain in the lateral elbow-> Lateral Epicondylitis

Reverse Cozen

Same except arm is supinated and doctor pulled on flexed wrist.

Positive: Pain in medial elbow->Medial Epicondylitis

Mill's Test

Doctor passively flexes patient's fingers, wrist, elbow and the brings elbow around and into max pronation and extension.

Positive: Pain in Lateral Elbow -> Lateral Epicondylitis

Reverse Mill's

Patients hand is flat, patient flexes and doctor resists.

Postive: Pain in Medial Elbow -> Medial Epicondylitis

Tinel's Sign (wrist)

Percuss over the flexor retinaculum (anterior portion of the wrist where a watch would sit) and the Tunnel of Guyon (most medial portion of above)

Postive: Tingling in the lateral 3 fingers (Carpal Tunnel Syndrome) of medial two fingers (Ulnar Impingement)

Phalen's Sign

The patient flexes writs maximally and holds position for one minute, pushing hands together.

Positive: tingling into lateral 3 fingers of hand -> Carpal Tunnel Syndrome

Pinch Grip Test

Ask the patient to put the tip of their thumb to the tip of their index finger.

Positive: if they put the pads of their thumb and forefinger together -> Ant. Interosseous N. Syndrome -> Median N. Lesion

Front's Paper Sign

Doctor places a piece of paper between the patient's thumb and index finger (all other fingers too) and attempts to pull it out.

Positive: Cannot hold paper-> Ulnar N. Palsy

Finkelstein's Test

Patient makes a fist with thumb inside fist; then fist is passively ulnar deviated.

Positive: Pain over the anatomical snuff box -> DeQuervain's Disease AKA Stenosing Tenosynovitis.

Stenosing Tenosynovitis

Bracelet Test

Doctor applies compression around patient's wrist like a bracelet.

Positive: Pain -> RA (if bilateral) or Strain/Sprain (if unilateral)

Straight Leg Test

Patient is supine. Doctor places one hand under heel and the other over the knee and slowly, passively raises patient's leg.

Positive: Pain down affected side -> Sciatica, Disc, lumbar lesion

Lasegue Rebound Test

Positive SLR + Drop

Positive: increased pain -> Sciatica, disc, and muscle spasm

Bragard's Sign

SLR + lower 5degrees + Foot flexed

Postitive: Pain in affected leg -> Sciatica

Sicard's Sign

SLR + lower 5degrees + Flex Big Toe

Positive: Pain in affected leg -> Sciatica

Turyn's Sign

Patient supine, Doctor flexes the big toe.

Positive: Pain in affected leg -> Sciatica

WLR AKA

Fajerstazn's

WLR/ Fajerstazn's

Doctor performs a SLR on asymptomatic side with dorsiflexion of the foot.

Positive: pain in symptomatic side ->medial disc lesion

Millgram's Test

Patient supine. Asked toe actively elevate legs off the table 6 inches. Hold for 30seconds.

Positive: Pain -> SOL

Leg Lowering Test

Patient supine. Doctor moves patient's legs passively to 90degrees and ask's patient to bring legs back down to the table.

Positive: LBP -> SOL

Bilateral SLR

SLR on L, SLR on R, SLR bilaterally

Positive: Pain occurs earlier on bilateral than unilateral -> Lumbosacral Joint Lesion

Goldthwait's Sign

SLR with hand under lumbar section of the spine.

Positive: Pain

0-30degrees: SI joint

30-60degrees: Lumbosacral joint

60-90degrees: Lumbar spine or contralateral SI joint

Linder's Sign

Passively flex patient's head to chest.

Positive: Pain the lumbar spine -> Root Sciatica

Bowstring Sign

SLR to point of pain + flex knee to Doctor's shoulder + pressure in popliteal fossa

Positive: Pain in lumbar region or radiculopathy -> Sciatica (BEST TEST)

Bonnet's Sign

Patient supine. Doctor internally rotates, abducts leg and the performs SLR .

Positive: Radicular pain -> Piriformis Syndrome

Becterew's Test

Patient seated. Doctor stabilizes thighs and patient attempts to extend both legs.

Positive: pain or leaning back -> Disc (posteromedial disc IF pain when good leg is raised)

Minor's Sign

Ask patient to rise from a seated position.

Positive: support body with good side -> sciatica

Kemp's Test

Patient seated. Doctor rotates patient's trunk and laterally bends towards and then away from affected side.

Positive: Sciatica pain in involved side -> Disc

Local pain -> Facet

Heel Walk

minimum of 7 steps

Patient walks on heels

DOCTOR WALKS WITH PATIENT (in case they fall).

Positive: unable to perform -> L5 lesion

Toe Walk

minimum of 7 steps

Patient walks on toes

DOCTOR WALKS WITH PATIENT (in case they fall).

Positive: unable to perform -> S1 lesion

Belt Test AKA

Supported Adam's Test

Belt Test

1) Patient bend forward (note when pain occurs)

2) Doctor applies L-M pressure on SI joints and patient bends forward again

Positive: Pain in 1 & 2 -> Lumbar lesion

Pain in only 1 -> SI joint lesion

Stork Test

Patient stands making a yoga tree pose. Extends.

Positive: Pain -> Spondy or SI lesion

Gaenslen's Test

Patient supine with involved side near exam table edge. The opposite knee and thigh are fully flexed against abdomen of patient. Involved leg is slowly lowered off table by Doctor. The Doctor then applies downward pressure against clasped knee and extended hip.

Positive: SI pain -> SI lesion

Lewin-Gaenslen's Test

Patient lie on unaffected side and pulls (table contacting) lower knee to chest. Doctor stabilizes pelvis and hyper extends top thigh.

Positive: SI pain -> SI lesion

Iliac Compression

Patient lies on unaffected side. Doctor contacts upper iliac crest and exerts downward pressure.

Positive: SI pain -> SI lesion

Hip Abduction Stress Test (KNOW)

Patient lies on unaffected side. Patient actively abducts top leg and the doctor exert downward pressure on proximal to knee.

Positive:

Pain at PSIS -> SI lesion

Weakness ->Glut Med weakness

Femoral Nerve Traction Test (KNOW)

Patient lies on unaffected side. Patient extends knee and Doctor brings hip to 15degrees of extension...if no pain, increase extension and flex knee.

Positive: Pain in anterior thigh -> L2, L3, L4 N. root lesion

Hibbs Test

Patient is prone. Doctor stabilizes hip on side she is standing. Doctor take opposite ankle and flexes knee to 90degrees. Doctor slowly pushes leg laterally away producing internal rotation of the hip.

Positive: SI pain -> SI joint lesion

Nachlas Test

Pain prone. Heel is approximated to same buttock. Doctor stabilizes hip.

Positive: SI Pain-> SI lesion

Yeoman's Test

Doctor stabilizes SI joint. Flexes affected knee and hyperextends the thigh by lifting leg off the table.

Positive SI pain -> SI lesion

Prone Hyperextension Test (KNOW)

Patient is prone. Doctor stabilizes the lumbosacral area. Doctor lifts legs while the knee remains extended.

Positive: Localized lumbar pain with anterior thigh pain -> L3, L4 N root lesion

Patrick's Test AKA

Fabere's Test

Patrick Fabere

Patient is supine. Thigh is flexed, abducted and externally rotated and extended with downward pressure is placed on the opposite ASIS and same knee.

Positive: pain in hip -> hip lesion

Laguerre's Test

Patient is supine. Doctor flexes, abducts, and laterally rotates hip. Doctor than applies pressure over the opposite ASIS with one hand and other hand on knee.

Positive: pain in hip -> hip lesion

Thomas Test

Patient is supine. Thigh is flexed with the knee bent upon the abdomen.

Positive: Opposite thigh/knee rises off the table -> Hip flexure contracture

Anvil Test

Patient is supine. Doctor raises leg and strikes the heel with their fist.

Positive: pain in the hip -> hip pathology or fracture

Ely's Sign

Patient prone. Heel to buttock.

Postitive: hip elevated -> Hip flexor contracture

Ely's Test

Patient prone. Heel to opposite buttock.

Positive: Pain -> Hip Lesion

Trendelenburg's Test

Patient is standing and lifts on leg.

Positive: Hip falls on side that is lifted -> glut med weakness on standing side

Neri's Sign

Standing patient bends forward at waist.

Positive: Knee buckles -> Tight hamstrings

Lewin-Gaenslen's Test (KNOW)