This document provides descriptions and explanations of various special tests used to evaluate different parts of the cervical spine, shoulder, elbow, hip, knee, and ankle. For each body part, it lists related tests and provides brief descriptions of how to perform each test and what positive findings indicate. For example, for the shoulder it describes tests for the rotator cuff like the empty can test, and for the labrum it explains tests like the anterior drawer and clunk tests. The level of detail provided helps clinicians appropriately select and perform special tests to evaluate various musculoskeletal structures.
This document describes various clinical tests used to evaluate shoulder instability and impingement. It provides 10 tests for anterior shoulder instability, 8 tests for posterior instability, 3 tests for inferior/multidirectional instability, and 6 common impingement tests. The tests involve passively moving and loading the shoulder joint while assessing for pain, apprehension, or abnormal translation of the humeral head. A positive test is typically indicated by reproduction of the patient's symptoms.
Muscle energy technique ( MET) of various major muscles of upper and lower limbs including :- Gastrocnemius and soleus, Medial hamstrings (semi-membranous, semi-tendinosus as well as gracilis) , Short adductors (pectineus, adductors brevis, magnus and longus), Rectus Femoris, Psoas, Tensor Fascia Lata, Piriformis, Hamstrings, Quadratus lumborum, Pectoralis Major. Latissimus dorsi, Subscapularis , Upper Trapezius, Scalene , Sternocleidomastoid , Levator scapulae , Supraspinatus, Infraspinatus, Biceps brachii, Erector Spinae, Cervical spine extensors. Hope you find it useful
The document describes several orthopedic tests used to evaluate various parts of the body. It provides brief descriptions of each test, including the positioning of the patient and examiner, the maneuvers performed during the test, and what the results of the test indicate. The tests cover regions of the body like the spine, shoulders, hips, knees, ankles, and others.
This document provides information on assessing and training balance and respiratory systems for Parkinson's disease. It includes scales and tests for evaluating static and dynamic balance, as well as environmental assessments. Balance training exercises are outlined, such as single limb stance, eye tracking, and body circles. Respiratory assessments and treatments are described, including breathing exercises, positioning, and techniques to improve coughing.
The document describes how to examine the motor system, including inspection and palpation of muscles, assessment of tone, testing movement and power, examining reflexes, and testing coordination. Key points covered include how to assess muscle bulk, fasciculation, involuntary movements, tone, power in different joints, deep tendon reflexes, plantar reflexes, abdominal reflexes, and tests of coordination like finger-to-nose. Sensory system examination is also outlined, covering testing of nerves like the median, radial, ulnar, common peroneal and lateral cutaneous nerve of thigh. Meningeal irritation signs and disorders of movement, stance and gait are briefly discussed.
This document provides protocols for performing Cox Technic spinal manipulation on the lumbar, cervical, and thoracic spine. It describes how to position the patient, perform tolerance testing to determine appropriate levels of distraction, and apply specific manipulation techniques for each spinal region. The lumbar protocol involves flexion distraction adjustments with optional trigger point therapy. The cervical protocol uses long axis distraction with or without additional ranges of motion. Thoracic adjustments can be performed using the lumbar or cervical table sections with axial distraction. Safety and patient tolerance are emphasized throughout.
Motor examination of individual muscledrsudeepcrpf
This document provides guidance on performing a motor examination of individual muscles. It discusses various principles such as fixing proximal joints before testing movements. It then examines specific muscles throughout the body, including techniques for testing muscle strength such as having the patient perform movements against resistance. Key muscles of the upper limb, lower limb, trunk and intrinsic hand muscles are examined.
This document describes various clinical tests used to evaluate shoulder instability and impingement. It provides 10 tests for anterior shoulder instability, 8 tests for posterior instability, 3 tests for inferior/multidirectional instability, and 6 common impingement tests. The tests involve passively moving and loading the shoulder joint while assessing for pain, apprehension, or abnormal translation of the humeral head. A positive test is typically indicated by reproduction of the patient's symptoms.
Muscle energy technique ( MET) of various major muscles of upper and lower limbs including :- Gastrocnemius and soleus, Medial hamstrings (semi-membranous, semi-tendinosus as well as gracilis) , Short adductors (pectineus, adductors brevis, magnus and longus), Rectus Femoris, Psoas, Tensor Fascia Lata, Piriformis, Hamstrings, Quadratus lumborum, Pectoralis Major. Latissimus dorsi, Subscapularis , Upper Trapezius, Scalene , Sternocleidomastoid , Levator scapulae , Supraspinatus, Infraspinatus, Biceps brachii, Erector Spinae, Cervical spine extensors. Hope you find it useful
The document describes several orthopedic tests used to evaluate various parts of the body. It provides brief descriptions of each test, including the positioning of the patient and examiner, the maneuvers performed during the test, and what the results of the test indicate. The tests cover regions of the body like the spine, shoulders, hips, knees, ankles, and others.
This document provides information on assessing and training balance and respiratory systems for Parkinson's disease. It includes scales and tests for evaluating static and dynamic balance, as well as environmental assessments. Balance training exercises are outlined, such as single limb stance, eye tracking, and body circles. Respiratory assessments and treatments are described, including breathing exercises, positioning, and techniques to improve coughing.
The document describes how to examine the motor system, including inspection and palpation of muscles, assessment of tone, testing movement and power, examining reflexes, and testing coordination. Key points covered include how to assess muscle bulk, fasciculation, involuntary movements, tone, power in different joints, deep tendon reflexes, plantar reflexes, abdominal reflexes, and tests of coordination like finger-to-nose. Sensory system examination is also outlined, covering testing of nerves like the median, radial, ulnar, common peroneal and lateral cutaneous nerve of thigh. Meningeal irritation signs and disorders of movement, stance and gait are briefly discussed.
This document provides protocols for performing Cox Technic spinal manipulation on the lumbar, cervical, and thoracic spine. It describes how to position the patient, perform tolerance testing to determine appropriate levels of distraction, and apply specific manipulation techniques for each spinal region. The lumbar protocol involves flexion distraction adjustments with optional trigger point therapy. The cervical protocol uses long axis distraction with or without additional ranges of motion. Thoracic adjustments can be performed using the lumbar or cervical table sections with axial distraction. Safety and patient tolerance are emphasized throughout.
Motor examination of individual muscledrsudeepcrpf
This document provides guidance on performing a motor examination of individual muscles. It discusses various principles such as fixing proximal joints before testing movements. It then examines specific muscles throughout the body, including techniques for testing muscle strength such as having the patient perform movements against resistance. Key muscles of the upper limb, lower limb, trunk and intrinsic hand muscles are examined.
This document provides information about various yoga asanas (poses) including their names, procedures, and benefits. It begins by defining yoga and asanas. It then categorizes asanas into three groups based on body position: standing, sitting, and lying. Examples of asanas are provided for each group, along with descriptions of how to perform the poses and their health benefits. Precautions are also mentioned. The document aims to educate about different types of asanas and their characteristics.
Zaid Hjab
The term thoracic outlet syndrome (TOS) encompasses numerous scenarios
of compression (neurological and vascular) in the thoracic outlet region of the
shoulder girdle. The syndrome can be divided into two sub classify cations: TOS
caused by neurological factors and TOS caused by vascular problems. Neurological
and vascular conditions also may be observed together.
This document outlines the steps for assessing a patient's respiration including pre-procedure, procedure, and post-procedure steps. The pre-procedure involves greeting the patient, providing privacy, and positioning them comfortably. During the procedure, the rate and characteristics of respiration are counted and noted for one minute. Finally, the post-procedure involves informing the patient of findings, documenting readings, and reporting any abnormalities.
This document discusses various chest mobilization techniques used in physical therapy to improve chest wall mobility and ventilation. Some key techniques described include rib torsion, lateral stretching, and trunk rotation. Chest mobilization can help increase the length of intercostal muscles and improve biomechanics of chest movement. Specific exercises mentioned involve flexion/extension, lateral flexion, and trunk rotation while sitting. Counterrotation and butterfly techniques are also outlined to reduce neuromuscular tone and increase thoracic mobility. Controlled breathing can also be incorporated into walking exercises.
Tilt table is a padded table that can be elevated from horizontal position to vertical position. It is used in a therapeutic setting for physiological accommodation to upright position, facilitate early weight bearing, cardiovascular conditioning etc.
The document discusses various surgical patient positioning techniques and their physiological effects. It describes positions such as supine, lithotomy, lateral, prone, Trendelenburg's, and sitting. Positioning must balance exposure for surgery with risks like nerve injury and hypotension. Careful positioning and monitoring are important to prevent complications.
1. The document provides instructions and information for several yoga poses including Uttanasana, Janusirsasana, Bhujangasana, Ardha Chakrasana, Ushtrasana, Matsyasana, and Trikonasana.
2. For each pose, it describes the positioning of the body, provides steps to perform the pose, and discusses the health benefits as well as any contraindications or precautions.
3. The poses include standing, sitting, forward bending, backward bending, twisting, balancing, and side-bending positions to provide a well-rounded yoga routine.
Nurse /doctor will insert two lubricated, gloved fingers into your vagina with one hand, while the other hand presses gently on the outside of your lower abdomen. During this part of the exam, your doctor will check the size and shape of your uterus and ovaries, noting any tender areas or unusual growths.
Incisions and position in general surgery by dr chandrakant sabaleCHANDRAKANT SABALE
This document discusses surgical incisions and patient positioning in general surgery. It provides details on:
1. Types of incisions like vertical, transverse, oblique and their uses in different abdominal and pelvic surgeries.
2. Principles of incision placement and closure.
3. Langer's lines and their importance in wound healing.
4. Common patient positions used in surgery like supine, lateral, lithotomy and their advantages.
Sesión tren superior embarazadas nivel 2nerea vazquez
This document provides a workout session for pregnant women focusing on the upper body. The session includes a warm-up with gentle movements and static stretches. The main part consists of 6 exercises using elastic bands, such as pulling the band from the chest while standing or flexing the knees while holding the band with the feet. Each exercise is done for 15 repetitions with 45 seconds of rest between sets over 4 rounds. The session ends with static stretching of all muscles worked. Safety precautions are noted.
This document discusses proper patient positioning and its importance in maintaining body alignment, preventing injury, and providing stimulation. It outlines various positions like supine, lateral, and prone, assessing risk factors. Complications from improper positioning like pressure ulcers and contractures are described. Supportive devices and techniques for safely moving patients are also covered. The goal is to position patients in a way that keeps their body parts correctly aligned and functional while minimizing stress.
The document discusses the benefits of proning for COVID-19 patients experiencing breathing difficulties. Proning, or turning a patient face down, improves oxygen circulation and lung ventilation. It can increase oxygen levels and breathing comfort, especially for patients in home isolation with oxygen levels below 94%. The document provides instructions for self-proning and proning with assistance, highlighting the need for regular monitoring of vital signs and caution in certain medical conditions.
1. The document discusses various patient positioning techniques and their purposes such as protecting functional ability, avoiding injury, preventing complications of immobility, and promoting oxygenation.
2. Key positions discussed include Fowler's position, semi-Fowler's position, high-Fowler's position, protected supine, side-lying, SIM's or semi-prone, prone, dorsal lithotomy, Trendelenburg, and reverse Trendelenburg.
3. Nurses must consider a patient's restrictions and needs when positioning, use supports, and alter positions minimally every two hours or as required to prevent complications.
The document outlines testing and treatment procedures for vestibular disorders. It discusses oculomotor and vestibular testing including convergence, smooth pursuit, saccades, nystagmus, head impulse test, and head shaking tests. For BPPV, it describes the Dix-Hallpike maneuver and roll test. Treatment procedures covered include canalith repositioning, barbecue roll, liberatory maneuver, deep head hanging, Appiani maneuver, Casani maneuver, forced prolonged positioning, and Brandt-Daroff habituation exercises.
La Unión Europea ha acordado un paquete de sanciones contra Rusia por su invasión de Ucrania. Las sanciones incluyen restricciones a las importaciones de productos rusos de alta tecnología y a las exportaciones de bienes de lujo a Rusia. Además, se congelarán los activos de varios oligarcas rusos y se prohibirá el acceso de los bancos rusos a los mercados financieros de la UE.
Children are disproportionately affected by humanitarian crises, with nearly 250 million living in conflict-affected countries. In 2016 alone, 43 million children in 63 countries required humanitarian assistance. Humanitarian crises threaten children's access to education, health care, and protection from violence and exploitation. Protecting children's rights and well-being in humanitarian contexts is critical to building resilient, sustainable societies and business environments. The interests of business and children are linked, as future generations must have their rights promoted to ensure long-term prosperity and stability.
This document provides information about various yoga asanas (poses) including their names, procedures, and benefits. It begins by defining yoga and asanas. It then categorizes asanas into three groups based on body position: standing, sitting, and lying. Examples of asanas are provided for each group, along with descriptions of how to perform the poses and their health benefits. Precautions are also mentioned. The document aims to educate about different types of asanas and their characteristics.
Zaid Hjab
The term thoracic outlet syndrome (TOS) encompasses numerous scenarios
of compression (neurological and vascular) in the thoracic outlet region of the
shoulder girdle. The syndrome can be divided into two sub classify cations: TOS
caused by neurological factors and TOS caused by vascular problems. Neurological
and vascular conditions also may be observed together.
This document outlines the steps for assessing a patient's respiration including pre-procedure, procedure, and post-procedure steps. The pre-procedure involves greeting the patient, providing privacy, and positioning them comfortably. During the procedure, the rate and characteristics of respiration are counted and noted for one minute. Finally, the post-procedure involves informing the patient of findings, documenting readings, and reporting any abnormalities.
This document discusses various chest mobilization techniques used in physical therapy to improve chest wall mobility and ventilation. Some key techniques described include rib torsion, lateral stretching, and trunk rotation. Chest mobilization can help increase the length of intercostal muscles and improve biomechanics of chest movement. Specific exercises mentioned involve flexion/extension, lateral flexion, and trunk rotation while sitting. Counterrotation and butterfly techniques are also outlined to reduce neuromuscular tone and increase thoracic mobility. Controlled breathing can also be incorporated into walking exercises.
Tilt table is a padded table that can be elevated from horizontal position to vertical position. It is used in a therapeutic setting for physiological accommodation to upright position, facilitate early weight bearing, cardiovascular conditioning etc.
The document discusses various surgical patient positioning techniques and their physiological effects. It describes positions such as supine, lithotomy, lateral, prone, Trendelenburg's, and sitting. Positioning must balance exposure for surgery with risks like nerve injury and hypotension. Careful positioning and monitoring are important to prevent complications.
1. The document provides instructions and information for several yoga poses including Uttanasana, Janusirsasana, Bhujangasana, Ardha Chakrasana, Ushtrasana, Matsyasana, and Trikonasana.
2. For each pose, it describes the positioning of the body, provides steps to perform the pose, and discusses the health benefits as well as any contraindications or precautions.
3. The poses include standing, sitting, forward bending, backward bending, twisting, balancing, and side-bending positions to provide a well-rounded yoga routine.
Nurse /doctor will insert two lubricated, gloved fingers into your vagina with one hand, while the other hand presses gently on the outside of your lower abdomen. During this part of the exam, your doctor will check the size and shape of your uterus and ovaries, noting any tender areas or unusual growths.
Incisions and position in general surgery by dr chandrakant sabaleCHANDRAKANT SABALE
This document discusses surgical incisions and patient positioning in general surgery. It provides details on:
1. Types of incisions like vertical, transverse, oblique and their uses in different abdominal and pelvic surgeries.
2. Principles of incision placement and closure.
3. Langer's lines and their importance in wound healing.
4. Common patient positions used in surgery like supine, lateral, lithotomy and their advantages.
Sesión tren superior embarazadas nivel 2nerea vazquez
This document provides a workout session for pregnant women focusing on the upper body. The session includes a warm-up with gentle movements and static stretches. The main part consists of 6 exercises using elastic bands, such as pulling the band from the chest while standing or flexing the knees while holding the band with the feet. Each exercise is done for 15 repetitions with 45 seconds of rest between sets over 4 rounds. The session ends with static stretching of all muscles worked. Safety precautions are noted.
This document discusses proper patient positioning and its importance in maintaining body alignment, preventing injury, and providing stimulation. It outlines various positions like supine, lateral, and prone, assessing risk factors. Complications from improper positioning like pressure ulcers and contractures are described. Supportive devices and techniques for safely moving patients are also covered. The goal is to position patients in a way that keeps their body parts correctly aligned and functional while minimizing stress.
The document discusses the benefits of proning for COVID-19 patients experiencing breathing difficulties. Proning, or turning a patient face down, improves oxygen circulation and lung ventilation. It can increase oxygen levels and breathing comfort, especially for patients in home isolation with oxygen levels below 94%. The document provides instructions for self-proning and proning with assistance, highlighting the need for regular monitoring of vital signs and caution in certain medical conditions.
1. The document discusses various patient positioning techniques and their purposes such as protecting functional ability, avoiding injury, preventing complications of immobility, and promoting oxygenation.
2. Key positions discussed include Fowler's position, semi-Fowler's position, high-Fowler's position, protected supine, side-lying, SIM's or semi-prone, prone, dorsal lithotomy, Trendelenburg, and reverse Trendelenburg.
3. Nurses must consider a patient's restrictions and needs when positioning, use supports, and alter positions minimally every two hours or as required to prevent complications.
The document outlines testing and treatment procedures for vestibular disorders. It discusses oculomotor and vestibular testing including convergence, smooth pursuit, saccades, nystagmus, head impulse test, and head shaking tests. For BPPV, it describes the Dix-Hallpike maneuver and roll test. Treatment procedures covered include canalith repositioning, barbecue roll, liberatory maneuver, deep head hanging, Appiani maneuver, Casani maneuver, forced prolonged positioning, and Brandt-Daroff habituation exercises.
La Unión Europea ha acordado un paquete de sanciones contra Rusia por su invasión de Ucrania. Las sanciones incluyen restricciones a las importaciones de productos rusos de alta tecnología y a las exportaciones de bienes de lujo a Rusia. Además, se congelarán los activos de varios oligarcas rusos y se prohibirá el acceso de los bancos rusos a los mercados financieros de la UE.
Children are disproportionately affected by humanitarian crises, with nearly 250 million living in conflict-affected countries. In 2016 alone, 43 million children in 63 countries required humanitarian assistance. Humanitarian crises threaten children's access to education, health care, and protection from violence and exploitation. Protecting children's rights and well-being in humanitarian contexts is critical to building resilient, sustainable societies and business environments. The interests of business and children are linked, as future generations must have their rights promoted to ensure long-term prosperity and stability.
The document discusses subcontracting processes in SAP. It describes the purpose as managing subcontracting by reducing stock and costs while increasing efficiency. Key steps include converting purchase requisitions to purchase orders, shipping components to subcontractors, posting goods receipts with component consumption, invoice verification, and billing. The document provides diagrams of the subcontracting process flow and interactions between various roles.
Insights Success is the Best Business Magazine in the world for enterprises, being a platform it focuses distinctively on emerging as well as leading fastest growing companies, their confrontational style of doing business and way of delivering effective and collaborative solutions to strengthen market share. Here, we talks about leader’s viewpoints & ideas, latest products/services, etc. Insights Success magazine reaches out to all the ‘C’ Level professional, VPs, Consultants, VCs, Managers, and HRs of various industries.
This document provides instructions for manually testing the hip muscles psoas major and iliacus. It describes the testing positions, where to apply resistance, and substitutions to watch for. For psoas major and iliacus, the testing position is short sitting with hands on the table edge. Resistance is applied to the proximal knee. Side-lying on a powder board is also described. Palpation and substitution details are provided. Instructions for manually testing the sartorius muscle are also given, including testing positions, where to apply resistance, and a gravity-minimized position.
El documento describe un proyecto escolar sobre dragones realizado por los estudiantes. A través de diversas actividades como la recopilación de información, la elaboración de un dragón chino, la pintura de dragones y cuentacuentos sobre dragones, los estudiantes aprendieron sobre estos seres míticos y se divirtieron.
This document provides instructions for 14 passive mobilization exercises targeting the upper and lower limbs. The exercises include movements like finger flexion/extension, wrist flexion/extension, elbow flexion/extension, shoulder flexion/extension and abduction/adduction, toe flexion/extension, ankle dorsiflexion/plantarflexion, foot eversion/inversion, hip and knee flexion/extension, hamstring stretching, hip abduction/adduction, and hip internal/external rotation. For each exercise, the caregiver is instructed to gently move the specified body part through its range of motion and repeat the movement a specified number of times.
Limb-length discrepancy can be caused by structural, functional, or environmental factors that result in one leg being longer or shorter than the other. Symptoms of discrepancy include an awkward gait, back pain, and compensatory scoliosis. Discrepancies are classified as mild (<3cm), moderate (3-6cm), or severe (>6cm). Treatment depends on the magnitude of discrepancy and may include shoe lifts for mild cases, growth modulation for moderate, and limb lengthening or shortening surgery for severe discrepancies. The goal of treatment is to alleviate symptoms and prevent long-term complications.
Special Tests for Lower Leg, Ankle, and FootJulie Jane
This document describes various physical examination tests for the lower leg, ankle, and foot. It provides procedures and implications for tests that assess the neutral position of the talus, leg and foot alignment, tibial torsion, ligamentous instability, and other conditions. Key tests include those for the anterior drawer test of the ankle, tibial torsion in sitting and supine positions, leg-heel alignment, and Feiss line to assess for flat foot. The document contains detailed steps for examiners to accurately perform various physical exams of the lower extremity.
This document describes various special tests used to evaluate the cervical spine and shoulders. It provides the patient position, positive sign, clinical significance, and procedure for each test. Some of the tests described include Spurling's test and Jackson's test for the cervical spine, load and shift test and apprehension test for the shoulder, and supraspinatus test and drop arm test to assess the rotator cuff. The document serves as a reference for physical therapists and other clinicians to choose the appropriate orthopedic tests based on the patient's symptoms and medical history.
The document discusses normal and abnormal human gait. It defines gait as locomotion produced by coordinated movements of the body segments. The phases and components of the gait cycle are described in detail, including stance, swing, initial contact, loading response, mid-stance, terminal stance, pre-swing, initial swing, mid-swing and terminal swing. Temporal and distance variables that characterize gait are also outlined, such as stance time, single limb support time, double support time, stride length and step length. Factors that can influence gait variables are age, gender, height, joint mobility and muscle strength.
Physiotherapists utilize sacroiliac joint special tests to diagnose pain or dysfunction within the joint connecting the sacrum and ilium in the pelvis. These tests focus on specific movements or palpation techniques that provoke discomfort or uncover irregularities in the joint. Common assessments like Gaenslen's, FABER, and the compression test aid in evaluating pain response, joint mobility, stability, and integrity. By identifying sacroiliac joint issues through these tests, physiotherapists can tailor treatment plans to alleviate pain and restore functionality for their patients.
This document describes several orthopedic tests used to evaluate the cervical spine:
1) Cervical compression, distraction, and shoulder abduction tests evaluate nerve root dysfunction by reproducing symptoms. Positive findings include pain or paresthesia in specific dermatomal patterns.
2) Cervical flexion, rotation, and Soto Hall tests evaluate joint dysfunction by stressing cervical structures. Positive findings include decreased range of motion or reproduction of symptoms.
3) Deep neck flexor endurance and Jull's tests evaluate muscle endurance by having patients maintain chin retraction positions. Failure indicates weak deep neck flexors.
4) Resisted muscle and shoulder depression tests evaluate strains by inducing isometric contractions
The document summarizes the steps for examining the shoulder, including:
Inspection of the anterior, posterior, and lateral sides. Palpation of structures like the acromioclavicular joint, coracoid process, and long head of the biceps tendon. Assessment of muscle strength for scapular stabilizers. Evaluation of shoulder movements and special tests for conditions like instability, impingement, rotator cuff tears, and more. The examination provides a thorough overview of evaluating the structures and function of the shoulder.
The document provides descriptions of various physical examination tests for different parts of the body including the low back, cervical spine, shoulder, knee, and other areas. It describes how to perform tests like the straight leg raise test for the low back, Spurling's test and cervical distraction for the cervical spine, Neer's impingement sign and Hawkins-Kennedy test for the shoulder, Lachman test and posterior drawer test for the knee ligaments, and McMurray's test for the meniscus. The tests are used to evaluate for conditions like nerve root irritation, radiculopathy, impingement, and ligament injuries.
The document summarizes the glenohumeral joint and rotator cuff. It describes the anatomy of the joint and rotator cuff muscles. It then discusses rotator cuff pathology, symptoms, physical exam maneuvers, and special tests to assess the rotator cuff including the empty can test, lift-off test, and external rotation lag sign.
This document provides an overview of assessing the elbow, including:
1) Descriptions of the elbow joint anatomy and common injuries or complaints.
2) Details on subjective and objective examination techniques like inspection, palpation, range of motion testing, special tests, and neurological assessment.
3) Explanations of specific tests for common conditions like tennis elbow, golfer's elbow, ulnar nerve entrapment, and ligament injuries.
Muscle Testing of Neck & Scapula
Prof. Satyen Bhattacharyya
Associate Professor: BIMLS, Bardhaman
Chief Physio: Fit O Fine
Director: Well O Fit Healthcare PVT. LTD.
Neck Manual Muscle Testing
Neck Flexion
Origin: Anterior and superior manubrium and superior medial third of clavicle
Insertion: Lateral aspect of mastoid process and anterior half of superior nuchal line
Nerve supply: Axillary Nerve
Note
Factors Limiting Motion:
1- Tension of posterior longitudinal ligament, ligamenta flava, and interspinal and supraspinal ligaments
2- Tension of posterior muscles of neck
3- Apposition of lower lips of vertebral bodies anteriorly with surfaces of subjacent vertebrae
4- Compression of intervertebral fibrocartilages in front
Fixation:
1- Contraction of anterior abdominal muscles
2-Weight of thorax and upper extremities
Normal & Good
Position: Supine.
Stabilization: Stabilize lower thorax.
Desired Motion: Patient flexes cervical spine through range of motion.
Resistance: Is given on forehead
Note
If there is a difference in strength of the two Sternocleidomastoideus muscles, they may be tested separately by rotation of head to one side and flexion of neck.
Resistance is given above ear.
Fair & Poor
Position: supine.
Stabilization: Stabilize lower thorax.
Desired Motion: Patient flexes cervical spine through full ROM for fair grade and through partial range for poor.
Trace & Zero
The Sternocleidomastoideus muscles maybe palpated on each side of neck as patient attempts to flex.
Muscles contribute to Neck Extension
Splenius capitis
Origin: Lower ligament nuchae, spinous processes and supraspinous ligaments T1-3
Insertion: Lateral occiput between superior and inferior nuchal lines
Nerve supply: Greater occipital nerve
Trapezius (superior fibers)
Origin: Base of the skull & posterior
ligaments of the neck
Insertion: Posterior aspect of the lateral 3rd of clavicle
N. supply: Greater occipital nerve
Splenius cervicis
Origin: Spinous processes and supraspinous ligaments of T3-T6
Insertion: Posterior tubercles of transverse processes of C1-C3
Action: Neck Extension
Nerve supply:
Semispinalis capitis
Origin: Transverse processes of first 6 or 7 thoracic and 7th cervical vertebrae & Articular processes of fourth, fifth and sixth cervical vertebrae
Insertion: Between superior & inferior nuchal lines of occipital bone
Nerve supply: Greater occipital nerve
Note
Factors Limiting Motion:
1-Tension of anterior longitudinal ligament of spine
2-Tension of ventral neck muscles
3-Approximation of spinous processes
Fixation:
1-Contraction of spinal extensor muscles of thorax and depressor muscles of scapulae and clavicles
2- Weight of trunk and upper extremities
Normal & Good
Position: Prone with neck in flexion.
Stabilization: Stabilize upper thoracic area and scapulae.
Desired Motion: Patient extends cervical spine through ROM.
Resistance: Is given on occiput.
Fair & Poor
Position: Prone with neck flexed.
Stabiliza
This document describes various orthopedic tests for evaluating shoulder conditions like tendinitis, bursitis, instability, and rotator cuff and biceps tendon injuries. Key tests include the Neer impingement test for overuse injuries, the drop arm test for rotator cuff tears, and Yergason's test and Abbott-Saunders test for biceps tendon subluxation or rupture. Positive findings on physical exam combined with the patient's history and symptoms can help diagnose underlying shoulder issues.
This document describes various orthopedic tests for evaluating shoulder conditions like tendinitis, bursitis, instability, and rotator cuff and biceps tendon injuries. Key tests include the Neer impingement test for overuse injuries, the anterior apprehension test for anterior dislocations, Speed's test for biceps tendinitis, and the drop arm test for rotator cuff tears. Positive findings on these physical exams, such as pain or weakness, help diagnose underlying shoulder issues.
1. The document describes various orthopedic tests used to evaluate common shoulder conditions like tendinitis, bursitis, instability, and rotator cuff and biceps tendon injuries.
2. Key tests include tests for supraspinatus tendinitis like the painful arc test, and tests for bicipital tendinitis like Speed's test and Lippman's test.
3. Other tests evaluate subacromial bursitis, anterior and posterior shoulder instability, rotator cuff tears using the drop arm test, and biceps tendon instability with Yergason's test and Abbott-Saunders test.
Knee Joint Assessment Tests and MobilizationsM Sohail Raza
This document describes various special tests and mobilization techniques for the knee joint. It outlines tests to assess the integrity of ligaments like the ACL, PCL, MCL and LCL. These include anterior drawer, posterior drawer, valgus stress, varus stress, Lachman's and pivot shift tests. It also describes tests for meniscal injuries like McMurray's test. The document concludes by explaining knee joint mobilization techniques like anterior glide, posterior glide, and rotational glides of the tibia.
This document provides an overview of learning objectives and techniques for performing a musculoskeletal examination of the shoulder, elbow, wrist, hand, knee, ankle and foot. It reviews pertinent history taking questions and physical exam findings for each area. Special tests are described to evaluate specific structures like the rotator cuff, meniscus and ligaments. Case studies are presented to demonstrate the application of the physical exam techniques.
This document provides stretching techniques for various neck muscles. It describes the positioning of the patient and therapist's hands for each muscle. The techniques involve rotating, bending or flexing the neck in different directions while applying pressure with the hands in opposing directions to stretch the target muscle. 18 different neck muscles are listed with their specific stretching methods.
The document describes various upper limb orthopedic tests used to evaluate shoulder, elbow, and wrist pathology. It provides details on how to perform tests such as the drop arm test for the shoulder, Cozen's test and Mill's test for tennis elbow, Golfer's elbow test, and Phalen's test and Tinel's test for carpal tunnel syndrome. The tests are used to reproduce symptoms, evaluate range of motion, and detect injuries or conditions like rotator cuff tears, shoulder dislocation, lateral epicondylitis, medial epicondylitis, and carpal tunnel syndrome.
Assessment of shoulder injuries in primary care Monis Khan
1. The document discusses common shoulder injuries seen in primary care including AC joint separations, clavicular fractures, shoulder dislocations, and proximal humeral fractures.
2. It provides details on the mechanism of injury, physical exam findings, appropriate imaging, management guidelines, and potential complications for each condition.
3. Special tests are described to clinically assess the rotator cuff muscles and identify injuries to the supraspinatus, infraspinatus, teres minor, and subscapularis.
Clinical approch to rheumatological examinationAshraf Okba
This document provides guidance on performing a rheumatological examination, including inspection, palpation, and testing range of motion of various joints. The examination involves assessing gait, the upper and lower limbs, shoulders, elbows, wrists, hips, knees, ankles and feet, spine, and temporomandibular joint. For each body part, the document outlines what to inspect for, how to palpate for tenderness and swelling, and which movements to test. The goal is to identify any abnormalities, deformities, limitations in range of motion, or sites of tenderness that could indicate rheumatological conditions.
The document outlines the process for examining a patient's shoulder, including:
1) Inspecting for deformities, swelling, atrophy, and other abnormalities.
2) Palpating bony landmarks and soft tissues to check for tenderness.
3) Testing the full range of motion both actively and passively while observing for pain.
4) Performing special tests to isolate specific structures like the rotator cuff muscles and labrum.
5) Examining other joints and the neck for full evaluation of the shoulder.
6) Ordering relevant x-rays to assess for fractures or other bone abnormalities.
This document summarizes the steps for examining a patient's shoulder, including inspection from multiple angles to identify scars, swelling, alignment and muscle wasting. It describes palpating various parts of the shoulder joint. Range of motion and special tests are outlined to assess the rotator cuff, impingement, AC joint, biceps, deltoid, serratus anterior and instability. Specific tests described include Neer's sign, Hawkin's sign, Jobe's test, belly-press test, apprehension test and relocation test. The examination provides a thorough evaluation of the shoulder to identify any injuries or limitations.
This document provides guidance on evaluating a patient presenting with shoulder pain or dysfunction. It outlines important aspects of the history to obtain including age, hand dominance, occupation, nature of pain, instability, weakness, and stiffness. The physical exam involves inspection of the shoulder, palpation for tenderness, and assessment of both active and passive range of motion compared to the uninjured side. Neurovascular status and special tests target specific structures like the rotator cuff muscles or assess for labral tears or joint instability. Common tests described are the empty can test, internal rotation lag sign, swinging doors test, and anterior apprehension test.
1. Special Test Quick Reference
John Little, SPT
Wheeling Jesuit University
Cervical Spine
● Ligamentous
○ Sharp Purser
○ Aspinall Transverse Ligament Test
○ Alar Ligament Test
● Nerve
○ Spurling’s Test
○ Bakody’s Sign
○ Tinel Sign
● Artery Insufficiency
○ Vertebral Artery Test
Shoulder
● Rotator Cuff
○ Drop Arm Test
○ Empty Can
○ Lift Off Test
● Labral
○ Jerk Test
○ Anterior Drawer
○ O'brien's Test
○ Biceps Load Test
○ Clunk Test
● Bicep
○ Speed’s Test
○ Yergason’s Test
● Instability
○ Load and Shift Test
○ Sulcus Sign
○ Jerk Test
○ Apprehension Test
○ Labral Crank Test
● AC Joint
○ AC Shear
2. ● Impingement
○ Hawkins-Kennedy
○ Coracoid Test
○ Neer Impingement Test
Elbow
● Medial Epicondylitis
○ Golfer’s Elbow Test
● Lateral Epicondylitis
○ Mills Test
○ Cozen Test
○ Maudsley’s Test
Hip
● Muscular Tightness
○ Thomas Test
○ Ely Test
○ Ober Test
○ Nobel Compression Test
● Pathology/Labral Tear
○ Scour
○ FABER
Knee
● ACL
○ Anterior Drawer
○ Lachman Test
● PCL
○ Posterior Sag/Godfrey Sign
○ Posterior Drawer
○
● MCL
○ Valgus Stress Test
● LCL
○ Varus Stress Test
● Meniscus
○ McMurray Test
○ Thessaly Test
○ Apley’s Compression
○ Bounce Home
3. ● Patella
○ Patellar Apprehension
○ Clark’s Sign
○ McConell Test
Ankle
● Ligamentous
○ Anterior Drawer
○ Talar Tilt
○ Kleiger’s Test
● Achilles Tendon
○ Thompson Test
● Syndesmosis
○ Squeeze Test
○ Kleiger’s Test
○ Heel Thump
4. Special Test Explanation
John Little, SPT
Wheeling Jesuit University
Cervical Spine
● Ligamentous
○ Sharp Purser
■ Identify subluxation of C1 on C2, which may be result from a reduction in
integrity of the transverse ligament.
■ Patient sits with head and neck at neutral. Therapist stands to side of
patient placing one hand on pt’s forehead. The second hand in “golf tee”
hand position of thumb and index finger located at spinous process of C2
vertebra.
■ Therapist flexes the pt’s head on the neck and applies a posteriorly
directed force through the forehead as the C2 vertebra is stabilized.
■ Positive if reduction of C1 on C2 is noticed, there is a soft end feel, or
patient reports symptoms including esophageal pressure and other
neurological related cord compression symptoms.
○ Aspinall Transverse Ligament Test
■ To test the integrity of the transverse ligament when the Sharp-Purser test
is negative.
■ Patient supine with head and neck at neutral. The therapist stands at the
head of the patient with one hand at the patient’s chin to maintain head
and neck flexion. The other hand is at C2.
■ The therapist flexes the head and neck. Then, an anterior force directed by
the hand at C2.
■ Positive if end feel is soft or patient reports symptoms including
esophageal pressure and other neurologically related cord compression
symptoms.
○ Alar Ligament Test
■ To test the integrity of the alar ligament.
■ Patient supine with head and neck neutral. The therapist supports the
occiput with both hands while the index fingers palpate the spinous
process of the axis.
■ The occiput is side bent slightly to each side.
■ Positive if there is a delay in movement of the spinous process of the axis,
which rotates ipsilateral to the direction of side bending.
5. ● Nerve
○ Spurling’s Test
■ To test for the presence of a cervical radiculopathy
■ Patient sitting with neck passively positioned into extension, ipsilateral
side bending, and ipsilateral rotation.
○ This is performed in neutral for the lower quadrant sign.
○ For upper quadrant sign, the patient first performs cervical
protraction using a “chin poke” maneuver designed to isolate
forces to the upper cervical segments.
■ The therapist applies a gentle compression force consisting of triplanar
overpressure.
■ Positive if there is a reproduction in patient’s presenting symptoms.
○ Bakody’s Sign
■ Specifically C4/C5 nerve roots
■ Patient is sitting or lying down
■ Examiner passively or the patient actively elevates the arm through
abduction so that the hand or forearm rests on top of the head
○ Abduction of the arm decreases the length of the neurological
pathway and decreases the pressure on the lower nerve roots
■ Decrease of relief of symptoms indicated a cervical extradural
compression problem
■ If pain increases with positioning of the arm, it implies that pressure
increasing in the interscalene triangle
○ Tinel Sign
■ Patient sits with the neck slightly side flexed
■ Examiner taps the area of the brachial plexus with a finger along the nerve
trunks in such a way that the different nerve roots are tested
■ Pure local pain implies that there is an underlying cervical plexus lesion
■ Tingling sensation in the distribution of a neve, means the lesion is
anatomically intact and some recovery is occurring
■ If pain is elicited in the distribution of the peripheral nerve, this is positive
for a neuroma
● Artery Insufficiency
○ Vertebral Artery Test
■ To assess for vertebrobasilar ischemia/insufficiency.
■ Patient supine with head and neck in neutral. Therapist standing at the
patient’s head supporting the occiput with one hand as the other hand
provides a fulcrum at the upper cervical region.
■ The therapist first extends, then side bends and rotates the pt’s head
ipsilaterally until there is max motion in each plane. The position is held
for 15 to 30 seconds with eyes open as the therapist looks for presence of
6. any signs or symptoms. Repeat on opposite side following 30 sec to 1 min
rest.
■ Positive if the following signs occur: nystagmus, pupil dilation, slurred
speech, diminished responsiveness, apparent distress. Positive if following
symptoms occur: dizziness, tinnitus, nausea, blurred vision, any additional
unpleasant sensations.
Shoulder
● Rotator Cuff
○ Drop Arm Test
■ Examiner abducts the patient’s shoulder to 90 degrees and then asks the
patient to slowly lower the arm to the side in the same arc of movement
■ Positive test= patient is unable to return the arm to the side slowly or has
severe pain when attempting to do so
■ indicates tear in rotator cuff complex
○ Empty Can
■ Patient’s arm is abducted to 90 degrees with neutral rotation, and examiner
provides resistance to abduction
■ Shoulder is then medially rotated and angled forward 30 degrees (empty
can position) so that patient’s thumb points towards floor in the plane of
the scapula
■ positive test= weakness or pain
■ indicates a tear of the supraspinatus tendon or muscle, or neuropathy of
suprascapular nerve
○ Lift Off Test
■ Patient stands and places dorsum of hand on back pocket or against
midlumbar spine. Patient then lifts hand away from back.
■ Inability to do so indicates a lesion of subscapularis muscle
■ Abnormal motion in scapula may indicate scapular instability
● Labral
○ Jerk Test
■ Pt sits with arm medially rotated and forward flexed to 90 degrees
■ Examiner grasps patient’s elbow and axially loads humerus in proximal
direction
■ While maintaining axial loading, examiner moves arm horizontally
(horizontal adduction) across the body
■ + test for recurrent posterior instability is production of sudden jerk or
clunk as humeral head slides off (subluxes) the back of the glenoid
7. ■ When arm is returned to original 90 degrees abduction position, 2nd jerk
may be felt as head reduces
■ Positive signs also indicate positive test for posteroinferior labral tear
○ Anterior Drawer
■ Pt supine.
■ Place pt’s hand of affected shoulder in your axilla, holding the patient’s
hand with the arm so that the patient remains relaxed.
■ Shoulder to be tested is abducted b/w 80-120 degrees, forward flexed up
to 20 degrees, and laterally rotated up to 30 degrees
■ Examiner then stabilizes the patient’s scapula with opposite hand, pushing
spine of scapula forward with index and middle fingers
■ Examiner’s thumb exerts counter pressure on patient’s coracoid process
■ Using arm that is holding patient’s hand, examiner places their hand
around the patient’s relaxed upper arm and draws humerus forward
■ Movement may be accompanied by a click, by patient apprehension, or
both
■ Positive test indicates anterior instability depending on amount of anterior
translation
■ Click may indicate labral tear or slippage of humeral head over glenoid
rim
○ O'brien's Test
■ Assesses for SLAP lesion
■ The patient sits with the test shoulder in 90 degrees of forward flexion, 40
degrees of horizontal adduction, and maximal internal rotation.
■ The examiner stands with one hand grasping the subject’s wrist.
■ The patient horizontally adducts and flexes the test shoulder against the
examiner’s manual resistance.
■ The test is then repeated with the subject’s arm in an externally rotated
position.
■ Positive Sign: Pain or popping in the internally rotated position (but not in
the externally rotated position) is a positive test.
○ Biceps Load Test
■ Assesses integrity of superior labrum
■ Patient is supine with shoulder abducted to 90 degrees and externally
rotated, and forearm is supinated.
■ Therapist passively externally rotates the shoulder until the patient
becomes apprehensive.
8. ■ Rotation is stopped and the therapist resists elbow flexion while in this
position.
■ Positive Test: If apprehension decreases or the patient feels more
comfortable, the test is negative for a SLAP lesion. If pain stays the same
or worsens and apprehension remains, the test is considered positive
○ Clunk Test
■ Tests labrum
■ Pt lies supine
■ Examiner places one hand on the posterior aspect of the shoulder over the
humeral head.
■ Examiner’s other hand holds the humerus above the elbow
■ Examiner fully abducts the arm over the patient’s head. Then the examiner
pushes anteriorly with the hand over the humeral head (a fist may be used
to apply more anterior pressure) while the other hand rotates the humerus
into lateral rotation
■ Positive Sign: A clunk or grinding sound indicates both a positive test and
a tear of the labrum. The test may also cause apprehension if anterior
instability is present
● Bicep
○ Speed’s Test
■ Examiner resists shoulder forward flexion by the patient while the
patient’s forearm is first supinated, then pronated, and the elbow is
completely extended
■ Positive test= elicits increased tenderness in the bicipital groove especially
with the arm supinated and is indicative of bicipital paratenonitis or
tendinosis
○ Yergason’s Test
■ designed to check ability of transverse humeral ligament to hold biceps
tendon in bicipital groove
■ With patient’s elbow flexed 90 degrees and stabilized against the thorax
and with the forearm pronated, examiner resists supination while the
patient also laterally rotates the arm against resistance
■ If examiner palpates the biceps tendon in the bicipital groove during
supination and lateral rotation movement, the tendon will be felt to pop
out of the groove if the transverse humeral ligament is torn
● Instability
○ Load and Shift Test
■ Checks atraumatic instability problems of glenohumeral jt
■ Pt sits with no back support and with hand of test arm resting on thigh
9. ■ Sit with good posture!
■ Stand behind pt and stabilize shoulder with 1 hand over clavicle and
scapula
■ With other hand, grasp head of humerus with thumb over posterior
humeral head and fingers over anterior humeral head
■ Run fingers along anterior humerus and thumb along posterior humerus to
feel where humerus is seated relative to glenoid
■ If fingers “dip in” anteriorly as they move medially but thumb doesn’t, it
indicates humeral head is sitting anteriorly
■ Normally humeral head feels more anterior when it is properly “seated” in
glenoid
■ The humerus is then gently pushed anteriorly or posteriorly (most
common) in glenoid if necessary to seat it properly in glenoid fossa
■ This is “load” portion
■ Then push the humeral head anteriorly (anterior instability) or posteriorly
(posterior instability) noting amount of translation and end feel. “Shift”
portion of test
■ ***With anterior translation, if head is not centered, posterior translation
will be greater than anterior, giving false negative test
○ Sulcus Sign
■ Pt stands with arm by side and shoulder muscles relaxed
■ Examiner grasps patient’s forearm below elbow and pulls arm distally
■ Presence of sulcus sign may indicate inferior instability or glenohumeral
laxity but should only be considered positive for instability if patient is
symptomatic (ex: pain/ache on activity, shoulder doesn’t feel “right” with
activity)
■ Bilateral sulcus sign is not as clinically significant as unilateral laxity on
affected side
■ Grade it by measuring from inferior margin of acromion to humeral head
● 1+ = distance of less than 1 cm
● 2+ = 1-2 cm
● 3+ = more than 2 cm
○ Jerk Test
■ Pt sits with arm medially rotated and forward flexed to 90 degrees
■ Examiner grasps patient’s elbow and axially loads humerus in proximal
direction
■ While maintaining axial loading, examiner moves arm horizontally
(horizontal adduction) across the body
■ + test for recurrent posterior instability is production of sudden jerk or
clunk as humeral head slides off (subluxes) the back of the glenoid
10. ■ When arm is returned to original 90 degrees abduction position, 2nd jerk
may be felt as head reduces
■ Positive signs also indicate positive test for posteroinferior labral tear
○ Apprehension Test
■ Also called crank test for anterior shoulder dislocation
■ Checks for traumatic instability problems causing gross or anatomical
instability of shoulder, although relocation portion of test is sometimes
used to differentiate instability and impingement
■ Abduct arm to 90 degrees and laterally rotate patient’s shoulder slowly
■ Apprehension = +
○ Labral Crank Test
■ This test is used to evaluate the different glenohumeral ligaments or for
anterior shoulder instability. This test may also be used to assess a labral
tear
■ With the subject standing, the examiner places the distal hand on the
subject’s elbow and the proximal hand on the subject’s proximal humerus
and then passively elevates the subjects shoulder to 160 degrees in the
scapular plane.
■ With the distal hand, the examiner applies a load along the long axis of the
humerus while the proximal hand externally and internally rotates the
humerus.
● AC Joint
○ AC Shear
■ While the pt is sitting, the examiner cups his hands over the deltoid with
one hand with one hand over the clavicle and one hand over the spine of
the scapula.
■ Squeeze the heels of the hands together
■ Abnormal movement indicates a positive test for AC joint pathology.
● Impingement
○ Hawkins-Kennedy
■ Pt stands while examiner forward flexes arm to 90 and then forcibly
medially rotates the shoulder
■ May also be performed in different degrees of forward flexion or
horizontal adduction
■ Positive: Pain
■ Indicative of: supraspinatus paratenonitis/tendinosis or secondary
impingement
11. ○ Coracoid Test
■ Same as Hawkins-Kennedy, but involves horizontally adducting arm
across body 10 to 20 degrees before doing medial rotation
■ More likely to approximate lesser tuberosity of humerus and coracoid
process
■ Positive: pain
○ Neer Impingement Test
■ Pt’s arm is passively and forcibly fully elevated in scapular plane with the
arm medially rotated by the examiner
■ Positive: If patient’s face show’s pain
■ Indicative of: overuse injury to supraspinatus muscle and sometimes to
biceps tendon
■ If positive with arm laterally rotated, examiner should check AC joint
Elbow
● Medial Epicondylitis
○ Golfer’s Elbow Test
■ The patient should be seated or standing and should have his/her fingers
flexed in a fist position.
■ The examiner palpates the medial epicondyle with one hand and grasps
the patient’s wrist with his/her other hand.
■ The examiner then passively supinates the forearm and extends the elbow
and wrist.
■ A positive test would be a complaint of pain or discomfort along the
medial aspect of the elbow in the region of the medial epicondyle
● Lateral Epicondylitis
○ Mills Test
■ The pt is seated.
■ While palpating the lateral epicondyle, the examiner passively pronates
the patient’s forearm, flexes the wrist fully, and extends the elbow
■ A positive sign would be pain over the lateral epicondyle of the humerus.
○ Cozen Test
■ Pt is seated.
■ The patient’s elbow is stabilized by the examiner’s thumb, which rests on
the patient’s lateral epicondyle
■ The patient is then asked to actively make a fist, pronate the forearm, and
radially deviate and extend the wrist while the examiner resists the motion.
■ A positive sign would be a sudden severe pain in the area of the lateral
epicondyle of the humerus
12. ○ Maudsley’s Test
■ Pt is seated.
■ The examiner resists extension of the third digit of the hand distal to the
proximal interphalangeal joint, stressing the extensor digitorum muscle
and tendon
■ A positive test is indicated by pain over the lateral epicondyle of the
humerus.
Hip
● Muscular Tightness
○ Thomas Test
■ Patient supine with the hips near the end of table.
■ Both hips and knees flexed and the thigh on the side opposite the thigh
held against the chest
■ Patient will slowly lower on lower limb down toward the table
■ Tight rectus femoris: knee will not be flexed to neutral
■ Tight Iliopsoas: lower limb does not lower to the table
○ Ely Test
■ Patient prone, examiner passively flexes the knee.
■ Tight rectus femoris: When the knee is flexed, the hip on the same side
flexes, indicating that the rectus femoris is tight on the same side.
○ Ober Test
■ Patient side-lying, lower leg flexed at hip and knee.
■ Stabilize pelvis and passively abduct and extend the patient’s upper leg
with the knee straight or flexed 90°
■ Slowly lower upper LE.
■ Tight TFL: The leg remains abducted and does not fall to the table.
○ Nobel Compression Test
■ Patient supine accompanied by hip flexion
■ Apply pressure to lateral femoral epicondyle or 1-2 cm proximal WHILE
patient slowly extends the knee while pressure is maintained
■ IT Band Friction Syndrome: 30° of flexion, patient has severe pain over
lateral femoral condyle
● Pathology/Labral Tear
○ Scour
■ Patient lies supine, examiner flexes and adducts patients hip so that hip
faces the patient’s contralateral shoulder resistance to movement is felt
■ Slight resistance is maintained while patient hip is taken into abduction in
a flexion arc movement
■ A positive sign would be any irregularities or patient apprehension
○ FABER
■ Patient lies supine.
■ Examiner places lower limb so that the contralateral foot is on top of the
knee.
13. ■ allow knee to fall parallel with contralateral leg (looks like a figure 4)
■ A positive test would be if the knee remains above the contralateral lower
limb, does not go parallel.
Knee
● ACL
○ Anterior Drawer
■ The purpose of this is to test the integrity of the ACL.
■ The patient is supine with the hip and knees flexed to 90.
■ The clinician is sitting on the pts involved foot with hand contact at the
proximal tibia with thumb over the anterior joint line to assess mobility
■ An anteriorly directed force is exerted thru the hand contacts.
■ A positive test would be excessive anterior translation of the tibia or less
that firm, abrupt end feel.
○ Lachman Test
■ The purpose is to test integrity of the ACL.
■ The patient is supine with hip and knee flexed to 30 degrees.
■ The clinician is sitting at the foot of the table, one of the clinician's hands
stabilizes the distal femur as the other hand grasps the posterior tibia
■ Procedure: anteriorly directed force is applied to the proximal tibia
■ Interpretation: positive test if there is excessive anterior translation of the
tibia or less than a firm, abrupt end feel
● PCL
○ Posterior Sag/Godfrey Sign
■ Patient is supine
■ Examiner holds both legs while flexing the patient's hips and knees to 90
■ observe tibial tuberosity
■ A test is positive if there is posterior instability a posterior sag of the tibia
is seen
○ Posterior Drawer
■ Tests integrity of PCL
■ Patient is supine hip and knees flexed to 90
■ The clinician is sitting on the pts involved foot with hand contact at the
proximal tibia with thumbs over the anterior joint line to assess mobility
■ The force is posteriorly directed force exerted thru the hand contacts
■ A test is positive if there is excessive posterior translation of the tibia, or
less than a firm, abrupt end feel
● MCL
○ Valgus Stress Test
■ The pt is supine with the knee flexed to 0 or 30 degrees
■ The clinician is standing to the side of the pt
■ The force is medially directed, valgus force applied to the knee
■ A test is positive if there is medial joint line pain and/or laxity when
compared bilaterally
14. ● LCL
○ Varus Stress Test
■ The pt supine with the knee flexed to 0 or 30 degrees
■ The clinician is standing to the side of the pt
■ The force is laterally directed, varus force applied to the knee
■ A test is positive if there is lateral joint line pain and/or laxity when
compared bilaterally
● Meniscus
○ McMurray Test
■ Purpose: test integrity of the medial and lateral meniscus
■ Patient: supine
■ Clinician: standing to the side of the pt grasping just proximal to the ankle
with one hand as the other hand is positioned to apply force and palpate
the medial and lateral tibiofemoral joint line
■ Procedure: tibia is externally rotated, and a valgus force is applied as the
knee is passively brought into flexion and extension as the clinician
palpates the medial joint line for the medial meniscus. Internal tibial
rotation with a varus stress as the knee is flexed and extended with
palpation at the lateral joint line is performed to test the lateral meniscus
■ Interpretation: positive test if there is a palpable click, joint audible, or
pain over the joint line
○ Thessaly Test
■ Purpose: test integrity of the medial and lateral meniscus
■ Patient: unilateral standing on the involved leg with the knee in 20 degrees
flexion
■ Clinician: standing in front of the patient and holding the patient's arms
■ Procedure: the patient turns to the R and then L on the weight bearing leg
as you guide the motion
■ Interpretation: positive test if there is locking, catching, or pain at either
the medial or lateral joint line
○ Apley’s Compression
■ Purpose: meniscus lesion
■ patient in prone position with knee flexed 90 degrees
■ patients thigh is anchored to examining table with PT's knee
■ PT medially and laterally rotates the tibia, combined first with distraction,
while noting restriction, excessive movement or discomfort
■ distraction: stabilize femur. Correct hand placement to distract the TIBIA,
not just ankle. Cup the heel.
■ test repeated using compression instead of distraction
■ *compression tests meniscus; distractions test ligaments
15. ○ Bounce Home
■ Purpose: meniscus lesion
■ patient lies supine and heel of the patients foot is cupped in the PT's hand
■ patients knee is completely flexed and the knee is passively allowed to
extend
■ if extension is not complete, or has a rubbery end feel "springy block"
there is something blocking full extension. Most likely torn meniscus
■ Interpretation: if their knee is allowed to quickly extend in one movement
or jerk and the patient experiences a sharp pain on the joint line, which
may radiate up and down the leg, positive for meniscus lesion
● Patella
○ Patellar Apprehension
■ Patient lies supine with the thigh on examining table and examiner holding
leg in full extension off table. Examiner translates patella laterally using
examiner thumb, and examiner flexes knee to 90 degrees and then
extends leg.
■ A positive test is pain with translation or flexion.
○ Clark’s Sign
■ Purpose: assess the presence of a problem with the articulation between
the articular surface of the patella and the articular surface of the femoral
condyles
■ Examiner presses down slightly proximal to the upper pole or base of the
patella with the web of the hand as the patient lies relaxed with the knee
extended
■ Patient: asked to contract the quadriceps muscles while the examiner
pushes down
■ Interpretation: if the patient can complete and maintain contraction
without pain, the test is considered negative. If the test causes retropatellar
pain and the patient cannot hold a contraction, the test is considered
positive
■ Amount of pressure must be carefully controlled…. Increasing pressure
each time. Knee should be tested in 30, 60, and 90 degrees of flexion as
well as full extension
○ McConell Test
■ Purpose: test for chondromalacia patellae
■ Patient: sitting with femur laterally rotated
■ Procedure: patient performs isometric quadriceps contractions at 120, 90,
60, 30 and 0 degrees with each contraction held for 10 seconds
● If pain is produced, patient’s leg is passively returned to full
extension by examiner
● The patient’s leg is then fully supported on the examiner’s knee,
and the examiner pushes the patella medially
16. ● The medial glide is maintained while the knee is returned to the
painful angle and the patient performs an isometric contraction,
again with the patella held medially
■ Interpretation: if the pain is decreased, the pain is patellofemoral in origin.
Ankle
● Ligamentous
○ Anterior Drawer
■ Purpose: identify the capsuloligamentous integrity of the ankle joint, in
particular the integrity of the ATFL
■ Patient: supine with the ankle in 10-15 degrees of PF
■ Clinician: standing at the foot of the pt
■ Procedure: the lower leg is stabilized while the calcaneus is grasped and
translated anteriorly
■ Interpretation: test is positive if the talus translates anteriorly the extent to
which is graded on a scale where 0 indicates no laxity and 3 indicates
gross laxity
○ Talar Tilt
■ Purpose: identify the lateral ligament integrity of the talocrural and
subtalar joints
■ Patient: supine or side lying with the ankle in 10 to 15 degrees of PF
■ Clinician: sitting at the foot of the pt grasping the patient’s ankle at the
malleoli
■ Procedure: a medially directed thrust is applied to the calcaneus
■ Interpretation: the test is positive if there is increased laxity when
compared to the noninvolved side with a less firm end feel
■ Calcaneofibular ligament
○ Kleiger’s Test
■ Purpose: to identify the presence of the tibiofibular syndesmotic sprain
(high ankle sprain)
■ Patient: supine or sitting with the knee flexed to 90
■ Clinician: standing to the side of the pt with one hand supporting the lower
leg at the calf and the other supporting the foot
■ Procedure: hold the talocrural joint in neutral and apply an ER force to the
ankle
■ Interpretation: test is positive if there is a reproduction of pain proximal to
the talocrural joint
● Achilles Tendon
○ Thompson Test
■ Purpose: to identify the presence of an Achilles tendon rupture
■ Patient: prone with the foot off the edge of the table
■ Clinician: standing to the side of the pt
■ Procedure: while grasping the mid belly of the calf, a squeeze is applied
■ Interpretation: test is positive if the foot fails to PF when the squeeze is
applied
17. ● Syndesmosis
○ Squeeze Test
■ Purpose: to identify the presence of a tibiofibular syndesmotic sprain, aka
high ankle sprain
■ Patient: supine, side lying, or sitting
■ Clinician: standing at the foot of the patient with both hands grasping the
lower leg
■ Procedure: a manual squeeze is applied by both hands to the lower leg
■ Interpretation: test is positive if there is an onset of pain proximal to the
talocrural joint
○ Kleiger’s Test
■ Purpose: to identify the presence of the tibiofibular syndesmotic sprain
(high ankle sprain)
■ Patient: supine or sitting with the knee flexed to 90
■ Clinician: standing to the side of the pt with one hand supporting the lower
leg at the calf and the other supporting the foot
■ Procedure: hold the talocrural joint in neutral and apply an ER force to the
ankle
■ Interpretation: test is positive if there is a reproduction of pain proximal to
the talocrural joint
○ Heel Thump
■ Purpose: to assess the presence of a stress fracture , syndesmosis
■ Patient: in non-weight bearing with the ankle in neutral
■ Clinician: sitting or standing at the pts foot
■ Procedure: apply a firm force with the thenar eminence to the pts
calcaneus
■ Interpretation: test is positive if there's pain