Musculoskeletal Tests
Shoulder tests
| Structure | Test | Technique | Abnormals |
| Acromioclavicular Joint (AMC) | Crossover test | Adduct the pts arm across the chest
Palpate and compare both joints for swelling or tenderness. |
Localized tenderness w/ adduction—inflammation or arthritis of the AMC |
| Overall shoulder rotation | Apley scratch test | Touch the opposite scapula using two motions (above head and reaching up toward head) | Difficulty suggests rotator cuff disorder |
| Rotator Cuff | Neer’s impingement sign | Press on scapula with one hand, and raise the pts arm with the other. | Pain is a positive indicator of possible rotator cuff tear |
| Rotator Cuff | Hawkins’s impingement sign | Flex pt shoulder and elbow 90° w/ palm facing down. With one hand on forearm and one on arm, rotate the arm internally. | Pain is positive indicator of possible rotator cuff tear |
| Rotator Cuff | Empty can test
Test supraspinatus strength |
Elevate the arms 90° and internally rotate the arms with the thumbs pointing down, as if emptying a can. Ask the pt to resist as you place downward pressure on the arms | Weakness positive test indicator of possible rotator cuff tear |
| Rotator Cuff | Infraspinatus strength | Ask the patient to place arms at the side and flex the elbows to 90° with the thumbs turned up. Provide resistance as the pt presses the forearms outward | Weakness positive test indicator of possible rotator cuff tear or bicipital tendinitis |
| Rotator Cuff | Forearm supination | Flex the pts forearm to 90° at the elbow and pronate the pts wrist. Provide resistance when the pt supinates the forearm | Pain positive test indicating inflammation of the long head of the biceps tendon and possible rotator cuff tear |
Elbow Tests
| Palpate the olecranon process and epicondyles | Note any displacement of the olecranon; or tenderness of epicondyles
The olecranon is displaced posteriorly in posterior dislocation of the elbow and supracondylar fracture. |
| Tennis elbow | Tenderness in lateral epicondylitis (pain with dorsiflexion—hands against resistance when palms face floor) |
| Pitcher’s or Golfers elbow | tenderness in medial epicondylitis (palmer flexion pain against resistance) |
| Palpate the grooves between the epicondyles and the olecranon | Note any tenderness, swelling, or thickening. |
| Palpate the synovium | examination between the olecranon and the epicondyles |
| Palpate the Ulnar Nerve | felt posteriorly between the olecranon process and the medial epicondyle |
Carpal tunnel tests
| Carpal tunnel | A channel beneath the palmar surface of the wrist and proximal hand. The canal contains the sheath and flexor tendons of the forearm muscles and the median nerve. Holding the tendons and tendon sheath in place is a transverse ligament, the flexor retinaculum. The median nerve lies between the flexor retinaculum and the tendon sheath. It provides sensation to the palm and the palmar surface of most of the thumb, the second and third digits, and half of the fourth digit. It also innervates the thumb muscles of flexion, abduction, and opposition. |
| Thumb abduction
Most sensitive |
Thumb abduction
|
Test abduction by having pt to raise the thumb straight up as you apply downward pressure | Weakness is positive test—the abductor policies longus is innervated only by the median nerve. Weak thumb abduction, hand symptoms diagrams, and decrease sensation roughly double the likelihood of carpal tunnel dx |
| Tinel’s sign | median nerve compression | Tap lightly over the course of the median nerve in the carpal tunnel | Aching and numbness in the median nerve distribution is a positive test |
Hand tests
| Hand grip strength | Hand Grip
(wrist joints, finger flexors, intrinsic muscles and joints of the hand) |
Ask pt to grasp your second and 3rd fingers. | ↓ strength is a positive test for weakness of the finger flexors and/or intrinsic muscles of the hand
Wrist pain and grip weakness in de Quervain’s tenosynovitis. ↓ grip strength in arthritis, carpal tunnel syndrome, epicondylitis, and cervical radiculopathy |
| Finkelstein’s test | Thumb movemt
(Test thumb fxn with c/o wrist pain) |
Ask pt to grasp the thumb against the palm then move the wrist toward the midline in ulnar deviation | Pain during this maneuver is de Quervain’s tenosynovitis form inflammation of the abductor pollicis longus and extensor pollicis brevis tendons and tendon sheaths |
Knee tests
| Bulge sign | Minor effusion | Knee extended place L hand ↑knee apply pressure on the Suprapatellar pouch, displacing or “milking” fluid ↓. Stroke ↓on the medial aspect of knee and apply pressure to force fluid into the lateral area. Tap the knee just behind the lateral margin of the patella w/ R hand. | A fluid wave or bulge on the medial side between the patella and the femur is considered a positive bulge sign consistent with an effusion. |
| Balloon Sign | Major Effusion | Place the thumb and index finger of | When the knee joint contains a lot effusion, suprapatellar compression ejects fluid into the spaces next to the patella. A palpable fluid wave signifies a + “balloon sign.” A returning fluid wave into the suprapatellar pouch confirms an effusion. |
| Balloting the patella | Large Effusions | R hand on each side of the patella; with L hand, compress the | Palpable fluid returning into the pouch further confirms the presence of a large effusion. A palpable patellar click with compression may also occur, but yields more false positives. |
| McMurray Test | Medial meniscus
& lateral meniscus |
Pt supine, grasp the heel and flex the knee. Cup your other hand over knee joint w/ fingers and thumb along the medial and lateral joint line. From the heel, rotate the lower leg internally and externally. Then push on the lateral side to apply a valgus stress on the medial side of the joint. At the same time, rotate the leg externally and slowly extend it. | A click or pop along the medial joint with valgus stress, external rotation, and leg extension suggests a probable tear of the posterior portion of the medial meniscus. |
| Abduction or Valgus Stress Test | Medial collateral
ligament (MCL) |
Patient supine and knee slightly flexed move the thigh about 30° laterally to side of the table. Place one hand against lateral knee to stabilize the femur and the other hand around the medial ankle. Push medially against the knee and pull laterally at the ankle to open the joint on the medial side | Pain or a gap in the medial joint line points to ligamentous laxity and a partial tear of the medial collateral ligament. Most injuries are on the medial side. |
| Adduction or Varus Stress Test | Lateral collateral
ligament (LCL) |
Thigh and knee in the same position change your position so you can place one hand against the medial surface of the knee and the other around the lateral ankle. Push medially against knee and pull laterally at ankle to open the knee joint on lateral side | Pain or a gap in the lateral joint line points to ligamentous laxity and a partial tear of the lateral collateral ligament. |
| Anterior Drawer Sign. | Anterior cruciate
ligament (ACL) |
Supine, hips flexed and knees flexed to 90º and feet flat on the table, cup your hands around knee w/ thumbs on the medial and lateral joint line and fingers on the medial and lateral insertions of the hamstrings. Draw the tibia forward and observe if it slides forward (like a drawer) from under the femur. Compare the degree of forward movement with that of the opposite knee | A few degrees of forward movement are normal if equally present on the opposite side.
A forward jerk showing the contours of the upper tibia is a positive anterior drawer sign and making a tear of the ACL 11.5 X more likely. |
| Lachman Test | Anterior cruciate
ligament (ACL) |
Place the knee in 15° of flexion and external rotation. Grasp the distal femur with one hand and the upper tibia with the other. With the thumb of the tibial hand on the joint line, simultaneously move the tibia forward and the femur back. Estimate the degree of forward excursion. | Significant forward excursion indicates an ACL tear |
| Posterior Drawer Sign | Posterior cruciate ligament (PCL) | Same position as Anterior drawer test. Push the tibia posteriorly and observe the degree of back | Isolated PCL tears are rare |