NMS OSCE 3 - Exam Process

How to perform Allen’s Test?

1. Pt seated with elbow flexed and forearm supinated.

2. Have patient quickly open and close fist 5 times.

3. Close hand tightly

4. Dr use thumbs to occlude radial and ulnar arteries.

5. Pt open hands while Dr. maintains pressure.

6. Release pressure over radial artery, note refill time (good >5 secs)

7. Repeat procedure but release compression over ulnar artery.

8. Compare refill bilaterally.

9. Any pain?

How to perform Adson’s Test?

1. Palpate radial pulse - rate, rhythm, amplitude.

2. Maintain palpation; abduct and externally rotate patient’s arm.

3. Pt rotate head toward side being tested.

4. Extend neck as far as possible.

5. Inhale deeply - hold for 10 seconds.

6. Any pain?

How to perform Modified Adson’s Test?

1. Palpate radial pulse - rate, rhythm, amplitude.

2. Maintain palpation; abduct & externally rotate patient’s arm.

3. Pt rotate head away from side being tested.

4. Extend neck as far as possible.

5. Inhale deeply - hold for 10 seconds.

6. Any pain?

How to perform Halstead’s Test

1. Palpate radial pulse

2. Apply downward traction on extremity - asymptomatic side 1st.

3. Pt extends neck.

4. If no pulse change - rotate head to opposite side.

5. Any pain?

How to perform Allen’s Maneuver?

1. Dr palpate radial pulse - asx side 1st.

2. Patient’s elbow flexed to 90°.

3. Abduct and externally rotate patient’s shoulder.

4. Pt rotate head away.

5. Any pain?

How to perform Roo’s Test?

1.        Have patient seated.

2.        Abduct arms & flex elbows to 90°.

3.        Externally rotate shoulders.

4. Patient repeatedly open/close fists for up to 3 minutes.

5. Any pain?

How to perform Wright’s Test?

1. Pt seated with arms hanging at side.

2. Palpate radial pulse.

3. Passively abduct arm to 180°.

4. Note angle when radial pulse diminishes.

5. Repeat on other side.

6. Any pain?

How to perform Costoclavicular (Eden’s) Test?

1. Patient stands or sits upright.

2. Palpate radial pulse.

3. Patient pulls shoulders & arms back and down.

4. Patient flexes chin to chest.

5. Note changes in pulse.

6. Any pain?

How to perform Dawbarn’s Test?

1. Patient seated with arm at side.

2. Deeply palpate bursa for localized tenderness.

3. Passively abduct patient’s shoulder.

4. Repeat on other side.

5. Any pain?

How to perform Apley’s Test?

1. Patient seated.

2. Patient reach behind head, touch superior angle of scapula, repeat with other hand.

3. Patient reach behind back, touch opposite inferior angle of scapula, repeat with other hand.

4. Any pain?

How to perfrom Supraspinatus Press Test (Empty Can/Jobe Test)?

1. Patient abducts shoulder to 90° and resists doctor’s downward force.

2. Medially rotate shoulders, repeat.

3. Repeat on other side.

4. Any pain?

How to perform Codman’s Sign (Drop Arm Test)?

1. Patient seated, doctor passively abducts arm.

2. Doctor will suddenly remove support at some point above 90°.

3. Repeat on other side.

4. Any pain?

How to perform Full Can Test?

1. Patient abducts shoulder to 90° with thumbs up.

2. Resists downward force from the doctor.

3. Repeat on other side.

4. Any pain?

How to perform Neer Impingement Test?

1. Patient seated, arms at side, doctor stabilizing scapula.

2. Patient arm slightly abducted, pronate, and passively move fully through forward flexion.

3. Repeat on symptomatic side.

4. Any pain?

How to perform Hawkins-Kennedy Test?

1. Patient seated,.

2. Forward flex arm to 90°, bend elbow to 90° in front.

3. Forcefully medially/internally rotate shoulder/arm.

4. Repeat on other side.

5. Any pain?

How to perform Painful Arc Test?

1. Patient standing.

2. Move unaffected shoulder through abduction - AROM.

3. Repeat on other side.

4. Any pain?

How to perform Apprehension Test?

1. Part 1 - patient seated, shoulder abducted, and externally rotated.

2. Doctor apply P-A force to GH joint.

3. Part 2 - patient supine, shoulder flexed and internally rotated.

4. Doctor apply A-P force on elbow while stabilizing scapula.

5. LOOK AT PATIENT’S FACE DURING BOTH!

6. Repeat on other side.

7. Any pain?

How to perform Dugas Test?

1. Patient seated, place hand on opposite shoulder.

2. Patient actively try to touch chest with elbow.

3. Repeat on other side.

4. Any pain?

How to perform Load & Shift Test (Joint Play)?

1. Patient seated with hand resting on thigh.

2. Push I-S, P-A for anterior capsule integrity.

3. Push I-S, A-P for posterior capsule integrity.

4. Pull S-I for integrity of inferior capsule while looking for sulcus sign.

5. Repeat on other side.

6. Any pain?

How to perform Relocation Test?

1. Patient supine, abduct and externally rotate shoulder.

2. Doctor apply A-P pressure on humeral head.

3. Repeat on other side.

4. Any pain?

How to perform Speed’s Test?

1. Patient seated.

2. Patient flex shoulder as doctor applies resistance.

3. While flexing shoulder, patient supinate forearm & extend elbow.

4. Repeat on other side.

5. Any pain?

How to perform Yergason’s Test?

1. Patient seated with elbow at 90° and arm by side.

2. Doctor put thumb over biceps tendon/intertubercular groove.

3. Patient supinate hand/forearm against resistance.

4. Patient resist elbow extension.

5. Repeat on other side.

6. Any pain?

How to perform O’Brien’s Test?

1. Patient standing, arm forward flexed to 90°, elbow extended & adduct 15° past midline.

2. Doctor apply downward pressure.

3. Repeat with palm supinated (thumb up) and doctor applying pressure.

4. Repeat on other side.

5. Any pain?

How to perform Biceps Load I?

1. Patient supine, 90° shoulder abduction, elbow flexed to 90°, forearm supinated, and maximally externally.

2. Have patient flex elbow against resistance.

3. Repeat on other side.

4. Any pain?

How to perform Biceps Load II?

1. Patient supine, 120° shoulder abduction, elbow flexed to 90°, forearm supinated, and maximally externally.

2. Have patient flex elbow against resistance.

3. Repeat on other side.

4. Any pain?

How to perform Lift Off (Gerber) Test?

1. Patient standing with hand behind their back, palm facing outward.

2. Instruct patient to lift their hand away from their back.

3. Repeat on other side.

4. Any pain?

How to perform the Lift Off Lag Sign?

1. Patient stands with dorsum of hand on the low back.

2. Doctor passively pulls hand away from the back.

3. Ask patient to hold their arm off their back.

4. Repeat on other side.

5. Any pain?

How to perform the Bear Hug Test?

1. Patient stands with hand on opposite shoulder. Fingers extended and elbow in front.

2. Try to lift hand from shoulder while patient resists while supporting the patient’s elbow.

3. Repeat on the other side.

4. Any pain?

How to perform the Belly Press Test?

1. Patient stands with hand on stomach and elbow out.

2. Doctor standing in front, apply A-P pressure to elbow.

3. Repeat on the other side.

4. Any pain?

How to perform the Horn Blowers Test?

1. Patient standing, doctor in front.

2. Doctor passively abduct shoulder to 90° & flex elbow to 90°.

3. Patient resists external rotation from doctor.

4. Repeat on the other side.

5. Any pain?

How to perform the External Rotation Lag Sign?

1. Patient standing, arm abducted 20°, elbow at 90°, shoulder laterally rotated.

2. Passively laterally rotate arm, let go of the patient’s arm, and ask them to hold the position.

3. Repeat on the other side.

4. Any pain?

How to perform the External Rotation Test?

1. Patient’s arm by side, flex elbow 90° with thumb up.

2. Patient attempt to externally rotate arm against resistance while holding elbow at side.

3. Repeat on the other side.

4. Any pain?

How to perform Lateral Rotation Lag Sign?

1. Patient stands, arms by side, elbow flexed to 90°.

2. Passively abduct arm and laterally rotate shoulder to end range.

3. Let go of patient’s arm, ask them to hold the position.

4. Repeat on the other side.

5. Any pain?

How to perform the Elbow Flexion Test?

1. Patient seated.

2. Patient flex elbows and hold for 5 minutes.

3. Any pain?

How to perform Tinel’s Test at Elbow?

1. Patient seated.

2. Tap 5x above and below medial epicondyle.

3. Repeat with lateral epicondyle.

4. Repeat on the other side.

5. Any pain?

How to perform Cozen’s Test (Tennis Elbow)?

1. Patient seated, fist clenched tightly with wrist pronated and extended.

2. Stabilize at elbow, resist wrist extension.

3. Repeat on the other side.

4. Any pain?

How to perform Golfer’s Elbow test?

1. Patient seated, elbow slightly flexed with hand supinated.

2. Have patient flex wrist and elbow against resistance.

3. Repeat on the other side.

4. Any pain?

How to perform Lift Test?

Note: combination of Cozen’s Test and Golfer’s Elbow test

1. Patient seated, fist clenched tightly with wrist pronated and extended.

2. Stabilize at elbow, resist wrist extension.

3. Repeat on the other side.

4. Any pain?

5. Patient seated, elbow slightly flexed with hand supinated.

6. Have patient flex wrist and elbow against resistance.

7. Repeat on the other side.

8. Any pain?

How to perform Mill’s Test?

1. Patient seated.

2. Passively flex elbow, wrist, and fingers.

3. Passively move arm into extension & pronation while stabilizing at elbow.

4. Repeat on the other side.

5. Any pain?

How to perform Ligament Instability Test?

1. Stabilize patient’s arm at elbow/wrist with elbow flexed 20-30°.

2. Apply adduction (varus) force to medial epicondyle - tests LCL.

3. Apply abduction (valgus) force to lateral epicondyle - test MCL.

4. Repeat on the other side.

5. Any pain?

How to perform Tinel’s Test at the wrist?

1. Have patient’s elbow flexed, forearm supinated, wrist/hand slightly extended.

2. Percuss over carpal tunnel with hammer 5x.

3. Repeat on the other side.

4. Any pain?

How to perform Phalen’s Test?

Note - 2 parts!

1. Have patient seated.

2. Part 1 (Phalens) - flex patient’s wrists and press together for 1 minute.

3. Part 2 (Reverse) - extend patient’s wrists and press together for 1 minute.

4. Any pain?

How to perform Froment’s Test?

1. Have patient grasp paper between thumb and index finger.

2. Try to pull paper while pt maintains grip.

3. Repeat on the other side.

4. Any pain?

How to perform Pinch Grip Test?

1. Have patient pinch tips of index & thumb together with paper between.

2. Try to pull the paper while patient maintains their grip.

3. Repeat on the other side.

4. Any pain?

How to perfrom Bunnell-Littler Test?

1. Patient’s elbow flexed, forearm pronated, slight wrist extension, and slight extension in MCPs.

2. Push PIPs into flexion.

3. Stabilize PIPs in extension and push DIPs into flexion.

4. Repeat on the other side.

5. Any pain?

How to perform Finkelstein’s Test?

1. Have patient make fist with thumb inside fingers.

2. Stabilize forearm and passively ulnar deviate the wrist.

3. Repeat on the other side.

4. Any pain?

How to perform Mannkopf’s Test?

1. Measure patient’s radial pulse.

2. Apply pressure while continuing to monitor radial pulse.

3. Repeat on the other side.

4. Any pain?