Podcast
Questions and Answers
Which of the following best describes the primary purpose of orthopedic special tests?
Which of the following best describes the primary purpose of orthopedic special tests?
- To assess the integrity of musculoskeletal structures. (correct)
- To measure range of motion.
- To identify bone fractures.
- To evaluate muscle strength.
A positive Apprehension test suggests:
A positive Apprehension test suggests:
- Posterior shoulder instability.
- Anterior shoulder instability. (correct)
- Rotator cuff tear.
- Ulnar nerve compression.
The Relocation test aims to:
The Relocation test aims to:
- Evaluate medial collateral ligament integrity of the elbow.
- Assess inferior shoulder instability.
- Confirm lateral epicondylitis.
- Reduce apprehension and increase external rotation in anterior shoulder instability. (correct)
What does the Sulcus Sign indicate?
What does the Sulcus Sign indicate?
The Clunk test is used to identify:
The Clunk test is used to identify:
A positive Varus Stress Test of the elbow indicates injury to which ligament?
A positive Varus Stress Test of the elbow indicates injury to which ligament?
The Moving Valgus Stress Test is specific for assessing:
The Moving Valgus Stress Test is specific for assessing:
Which condition is assessed using Cozen's Test?
Which condition is assessed using Cozen's Test?
Tinel's Sign at the elbow assesses:
Tinel's Sign at the elbow assesses:
Phalen's test is used to diagnose:
Phalen's test is used to diagnose:
Finkelstein's test is most indicative of:
Finkelstein's test is most indicative of:
Watson's test (scaphoid shift test) is used to assess:
Watson's test (scaphoid shift test) is used to assess:
Froment's sign indicates:
Froment's sign indicates:
Which of the following does the Allen's test evaluate?
Which of the following does the Allen's test evaluate?
The Thompson test assesses the integrity of which tendon?
The Thompson test assesses the integrity of which tendon?
Pain in the bicipital groove during Speed's test indicates:
Pain in the bicipital groove during Speed's test indicates:
The primary finding in Adson's test that suggests thoracic outlet syndrome is:
The primary finding in Adson's test that suggests thoracic outlet syndrome is:
Which of the following is not a typical symptom reproduced by the Roos test (Elevated Arm Stress Test) in patients with thoracic outlet syndrome?
Which of the following is not a typical symptom reproduced by the Roos test (Elevated Arm Stress Test) in patients with thoracic outlet syndrome?
Wright's Test assesses for thoracic outlet syndrome by:
Wright's Test assesses for thoracic outlet syndrome by:
Direct pressure applied over the carpal tunnel for up to 30 seconds is a test for:
Direct pressure applied over the carpal tunnel for up to 30 seconds is a test for:
The Anterior Release Test is performed after which other shoulder test?
The Anterior Release Test is performed after which other shoulder test?
During the Load and Shift Test, what action does the examiner perform to assess glenohumeral translation?
During the Load and Shift Test, what action does the examiner perform to assess glenohumeral translation?
What specific motion is resisted in the Golfer's Elbow Test?
What specific motion is resisted in the Golfer's Elbow Test?
In Mill's Test, what movements are combined by the examiner to elicit pain in lateral epicondylitis?
In Mill's Test, what movements are combined by the examiner to elicit pain in lateral epicondylitis?
The Reverse Phalen's Test involves which wrist position?
The Reverse Phalen's Test involves which wrist position?
During the Grind Test, what actions are performed by the examiner?
During the Grind Test, what actions are performed by the examiner?
The Yergason's Test is performed to assess:
The Yergason's Test is performed to assess:
Laxity during varus or valgus stress applied to a finger joint indicates:
Laxity during varus or valgus stress applied to a finger joint indicates:
Ulnar Nerve Compression Test (at Guyon's Canal) involves:
Ulnar Nerve Compression Test (at Guyon's Canal) involves:
Which nerve's function is primarily being assessed when performing the Median Nerve Compression Test?
Which nerve's function is primarily being assessed when performing the Median Nerve Compression Test?
Which three specific findings, evaluated together, are most indicative of a positive Roos test?
Which three specific findings, evaluated together, are most indicative of a positive Roos test?
What anatomical structure could potentially cause ulnar nerve compression at the wrist, leading to a positive Ulnar Nerve Compression Test?
What anatomical structure could potentially cause ulnar nerve compression at the wrist, leading to a positive Ulnar Nerve Compression Test?
What is the underlying biomechanical principle that explains why the Relocation Test reduces apprehension in patients with anterior shoulder instability?
What is the underlying biomechanical principle that explains why the Relocation Test reduces apprehension in patients with anterior shoulder instability?
A patient presents with suspected scapholunate ligament injury. Besides Watson's test, which additional test would provide the MOST specific information to confirm this diagnosis?
A patient presents with suspected scapholunate ligament injury. Besides Watson's test, which additional test would provide the MOST specific information to confirm this diagnosis?
In the context of advanced neurovascular testing for the upper limb, what specific modification to Adson's test would MOST effectively isolate compression caused by the scalene muscles as opposed to other structures in the thoracic outlet?
In the context of advanced neurovascular testing for the upper limb, what specific modification to Adson's test would MOST effectively isolate compression caused by the scalene muscles as opposed to other structures in the thoracic outlet?
During a shoulder evaluation, an examiner performs the Apprehension, Relocation, and Anterior Release tests, all of which are positive. However, upon further examination, the patient exhibits signs of multidirectional instability. Which additional test would be MOST beneficial in confirming the presence of inferior instability?
During a shoulder evaluation, an examiner performs the Apprehension, Relocation, and Anterior Release tests, all of which are positive. However, upon further examination, the patient exhibits signs of multidirectional instability. Which additional test would be MOST beneficial in confirming the presence of inferior instability?
A patient experiences considerable pain in their elbow. During Mill's Test, the examiner passively manipulates the patient's arm but notes that the patient strongly resists full elbow extension due to intense discomfort before the test can be fully completed. Simultaneously, the patient reports a clicking sensation near the radial head. Given the interference caused by the onset of premature pain during the procedure, which alternative special test would be MOST appropriate to perform in place of Mill's to evaluate the lateral epicondyle?
A patient experiences considerable pain in their elbow. During Mill's Test, the examiner passively manipulates the patient's arm but notes that the patient strongly resists full elbow extension due to intense discomfort before the test can be fully completed. Simultaneously, the patient reports a clicking sensation near the radial head. Given the interference caused by the onset of premature pain during the procedure, which alternative special test would be MOST appropriate to perform in place of Mill's to evaluate the lateral epicondyle?
Flashcards
Apprehension Test
Apprehension Test
Abduct and externally rotate the arm while the patient is supine. Apprehension or resistance indicates anterior shoulder instability.
Relocation Test
Relocation Test
Apply posterior force to the humeral head after a positive apprehension test. Relief indicates anterior instability.
Anterior Release Test
Anterior Release Test
After the relocation test, release the posterior force. Reproduction of apprehension indicates anterior instability.
Sulcus Sign
Sulcus Sign
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Load and Shift Test
Load and Shift Test
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Clunk Test
Clunk Test
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Varus Stress Test
Varus Stress Test
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Valgus Stress Test
Valgus Stress Test
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Moving Valgus Stress Test
Moving Valgus Stress Test
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Cozen's Test
Cozen's Test
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Mill's Test
Mill's Test
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Golfer's Elbow Test
Golfer's Elbow Test
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Tinel's Sign (Elbow)
Tinel's Sign (Elbow)
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Phalen's Test
Phalen's Test
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Reverse Phalen's Test
Reverse Phalen's Test
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Tinel's Sign (Wrist)
Tinel's Sign (Wrist)
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Finkelstein's Test
Finkelstein's Test
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Watson's Test
Watson's Test
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Grind Test
Grind Test
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Froment's Sign
Froment's Sign
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Allen's Test
Allen's Test
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Thompson Test
Thompson Test
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Speed's Test
Speed's Test
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Yergason's Test
Yergason's Test
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Ligament Instability Tests
Ligament Instability Tests
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Adson's Test
Adson's Test
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Roos Test
Roos Test
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Wright's Test
Wright's Test
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Median Nerve Compression Test
Median Nerve Compression Test
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Ulnar Nerve Compression Test
Ulnar Nerve Compression Test
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Study Notes
- Orthopedic special tests are maneuvers that assess musculoskeletal structures.
- The upper limb, including the shoulder, elbow, wrist, and hand, can be diagnosed using these tests.
- These tests evaluate instability, tendon and ligament integrity, and neurovascular function.
Shoulder Instability Tests
- Evaluates the integrity of the glenohumeral joint and surrounding ligaments.
Apprehension Test
- Patient lies supine while the arm is abducted and externally rotated - examiner moves the arm into a position that may cause apprehension.
- A positive test includes apprehension or resistance, indicating anterior shoulder instability.
Relocation Test
- After the apprehension test, apply a posterior force to the anterior aspect of the humeral head.
- Relief of apprehension and increased external rotation indicates anterior instability.
Anterior Release Test
- Patient is supine, arm abducted and externally rotated, release the posterior force on the humeral head after the relocation test.
- Reproduction of apprehension indicates anterior instability.
Sulcus Sign
- Examiner applies an inferior traction force to the arm while the patient is seated or standing.
- A visible or palpable depression (sulcus) below the acromion could indicate inferior shoulder instability.
Load and Shift Test
- Stabilize the scapula and clavicle with one hand, grip the humeral head with the other.
- Load the humeral head into the glenoid fossa, and then shifted anteriorly and posteriorly to assess glenohumeral translation
- Excessive translation indicates instability.
Clunk Test
- Patient lies supine, and the arm is abducted and externally rotated while applying an anterior force to the humeral head.
- A clunking sound or sensation as the humeral head subluxates indicates a glenoid labrum tear.
Elbow Assessment Tests
- Assess the stability and integrity of the elbow joint and its surrounding ligaments.
Varus Stress Test
- A varus force (laterally directed) is applied to the slightly flexed elbow.
- Increased laxity or pain could indicate lateral collateral ligament (LCL) injury.
Valgus Stress Test
- A valgus force (medially directed) is applied to the slightly flexed elbow.
- Increased laxity or pain indicates medial collateral ligament (MCL) injury.
Moving Valgus Stress Test
- The patient's arm is abducted and externally rotated, and a valgus force is applied while extending the elbow from a fully flexed position.
- Pain reproduced between 70° and 120° of flexion indicates MCL injury.
Cozen's Test (Resisted Wrist Extension)
- The patient should make a fist, pronate the forearm, and extend the wrist against resistance from the examiner.
- Pain at the lateral epicondyle indicates lateral epicondylitis (tennis elbow).
Mill's Test
- Passively pronate the patient's forearm, flex the wrist, and extend the elbow.
- Pain at the lateral epicondyle indicates lateral epicondylitis.
Golfer's Elbow Test (Resisted Wrist Flexion)
- The patient flexes the wrist against resistance with the forearm supinated.
- Pain at the medial epicondyle indicates medial epicondylitis (golfer's elbow).
Tinel's Sign (Elbow)
- Tap over the ulnar nerve in the cubital tunnel.
- Tingling or paresthesia in the ulnar nerve distribution indicates ulnar nerve compression.
Wrist and Hand Evaluation
- Assess joint stability, tendon function, and nerve compression.
Phalen's Test
- The patient holds both wrists in a flexed position for around 60 seconds.
- Tingling or numbness in the median nerve distribution indicates carpal tunnel syndrome.
Reverse Phalen's Test
- The patient extends both wrists and holds them together for about 60 seconds.
- Tingling or numbness in the median nerve distribution indicates carpal tunnel syndrome.
Tinel's Sign (Wrist)
- Tap over the median nerve at the wrist.
- Tingling or paresthesia in the median nerve distribution may indicate carpal tunnel syndrome.
Finkelstein's Test
- The patient makes a fist with the thumb inside the fingers, and the examiner ulnarly deviates the wrist.
- Pain along the radial styloid process indicates De Quervain's tenosynovitis.
Watson's Test (Scaphoid Shift Test)
- Stabilize the scaphoid while passively moving the wrist from ulnar to radial deviation.
- Pain or a clunk indicates scaphoid instability or scapholunate ligament injury.
Grind Test
- Apply axial compression and rotation to a metacarpal.
- Pain indicates arthritis or other joint pathology.
Froment's Sign
- The patient holds a piece of paper between the thumb and index finger while someone pulls it away.
- Flexion of the thumb interphalangeal joint indicates weakness of the adductor pollicis muscle, suggesting ulnar nerve palsy.
Allen's Test
- The examiner compresses the radial and ulnar arteries at the wrist, then releases one artery while observing the color return to the hand.
- Delayed or absent color return indicates arterial insufficiency.
Tendon and Ligament Tests
- Assess specific tendons and ligaments for tears, inflammation, or other dysfunction.
Thompson Test (Achilles Tendon)
- Squeeze the calf muscle, which should plantarflex the foot.
- Absence of plantarflexion indicates Achilles tendon rupture.
Speed's Test (Biceps Tendon)
- The patient extends the arm, supinates the forearm, and flexes the shoulder against resistance.
- Pain in the bicipital groove indicates biceps tendinitis.
Yergason's Test (Biceps Tendon)
- The patient flexes the elbow to 90 degrees and supinates against resistance while palpating the bicipital groove.
- Pain or snapping in the bicipital groove indicates biceps tendinitis or instability.
Ligament Instability Tests (e.g., collateral ligaments of fingers)
- Applying varus or valgus stress to a finger joint will assess the integrity of the collateral ligaments.
- Laxity indicates ligament sprain or tear.
Neurovascular Tests
- Assess the function and integrity of nerves and blood vessels of the upper limb.
Adson's Test
- The patient extends their neck and rotates the head towards the examined side while taking a deep breath; monitor the radial pulse.
- A diminished or absent radial pulse indicates thoracic outlet syndrome.
Roos Test (Elevated Arm Stress Test)
- The patient abducts and externally rotates both arms to 90 degrees and repeatedly opens and closes their hands for 3 minutes.
- Pain, numbness, tingling, or weakness indicates thoracic outlet syndrome.
Wright's Test (Hyperabduction Test)
- Hyperabduct and externally rotate the patient's arm while monitoring the radial pulse.
- A diminished or absent radial pulse indicates thoracic outlet syndrome due to compression of the axillary artery.
Median Nerve Compression Test
- Apply direct pressure over the carpal tunnel for up to 30 seconds.
- Reproduction of symptoms indicates carpal tunnel syndrome.
Ulnar Nerve Compression Test (at Guyon's Canal)
- Apply direct pressure over Guyon's canal at the wrist.
- Reproduction of symptoms indicates ulnar nerve compression.
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