Tuesday, May 29, 2007

Knee - Anterior Drawer Test

The Anterior Drawer Test for the knee is used to examine the integrity of the anterior cruciate ligament. The patient is placed supine on the table with the knee in 90 degrees of flexion and the hip flexed approximately 45 degrees. The examiner places her hands around the proximal tibial with her thumbs crossing the anterior joint line. The patient's foot is anchored in a neutral position by the examiner's thigh. The examiner tells the patient to relax her hamstrings. This suggestion is enhanced through a light tapping with the examiners fingers on the tendons of the hamstrings just behind the knee. Once the patient is relaxed the examiner attempts to pull the tibia anteriorly. Instability is determined by examining bilaterally and comparing the amount of excursion present.

Knee - Apley's Distraction Test

Apley's distraction test is commonly performed in conjunction with Apley's compression test. The patient starting position is the same (prone with the knee flexed to 90 degrees). The examiner will apply traction to the lower leg while rotating the tibia medially and laterally. Pain with this maneuver can indicate a ligamentous injury of the knee.

Knee - Apley's Compression Test

Apley's Compression test is used to assess the menisci of the knee. The patient is place prone on the exam table with her knee flexed to 90 degrees. The examiner applys a downward compressive force through the lower leg while laterally rotating the lower leg. Pain with this maneuver can indicate an injury of either meniscus.

Tuesday, February 27, 2007

Thursday, February 15, 2007

Knee - Lachman's Test

The Lachman's test (aka Ritchie test) is the preferred method of assessing for instability of the anterior cruciate ligament.  The patient is supine on the table with their knee flexed approximately 20-30 degrees.  The examiner grasps the medial proximal tibia with one hand and the distal thigh with the other.  The examiner then applies a posteromedial to anterolateral force to the knee, essentially pulling the tibia anteriorly on the femur.  The amount of translation is compared bilaterally to determine the presence and/or extent of instability.  Alternative methods have been developed to accomodate examiners with small hands and for use with patients with large extremities.

Knee - Slocum Anterior Drawer

The Slocum Drawer test is used to assess for medial and lateral rotary instabilities of the knee.  The exam is administered similarly to the anterior drawer test with the exception that the tibia is rotated medially and laterally to assess for anterolateral and anteromedial instability respectively.  The knee is placed in approximately 90-degrees of flexion with the foot flat on the table.  Thirty-degrees of medial rotation is applied to the tibia by rotating the foot and the examiner pulls anteriorly on the tibia to assess for anterolateral rotary instability.  To examine anteromedial rotary instability the tibia is laterally rotated approximately 15-degrees and the tibia is once again pulled anteriorly.  Results are compared bilaterally.

Knee - Patellar Apprehension Test

The Acute Patella Injury Test (aka Apprehension Test) is used to assess the possibility that the patient may have sustained a patellar dislocation which spontaneously reduced.  This test provokes the same sensations which would have been present when the dislocation occured and therefore will elicit a reactive contraction of the quadriceps muscles by the patient in an attempt to avoid a recurrance of the dislocation.  This reaction is referred to as an apprehension sign.  The patient lies supine on the table with the knee in 20-30 degrees of flexion and the quadriceps relaxed.  The examiner carefully glides the patella laterally observing for the apprehension sign.  A positive test is the presence of this reaction by the patient.

Knee - Posterior Sag Test

The posterior sag test (also known as the gravity drawer test, drop back sign, or Godfrey's test) is used to assess posterior cruciate ligament laxity.  The patient is supine with her hips and knees bent to ninety-degrees.  The examiner supports the patient's legs at the ankles and observes for an indication that the tibia has shifted posteriorly (toward the table) as compared to the uninvolved knee.

Knee - McMurray's Test

The McMurray test is a test used to determine the presence of a meniscal tear.  While the patient is supine on the exam table the examiner grasps the knee, placing one hand over the top of the knee with her thumb over one joint line and her index and middle finger over the opposite joint line.  The examiner begins with the knee in full flexion and then medially and laterally rotates the tibia while paying attention for an audible click.  The examiner then laterally rotates the tibia and extends the knee beyond 90 degrees.  An audible click while preforming this maneuver can indicate a torn medial meniscus.  To examine the lateral meniscus the examiner will return the knee to full flexion and apply a medial rotation to the tibia prior to extending the knee once again.

Friday, January 26, 2007

Shoulder - Sulcus Sign

The sulcus sign is an examination to determine the extent and/or presence of inferior instability of the glenohumeral joint.  This test can be administered with the patient either seated or standing with his arm relaxed at her side.  The examiner palpates the shoulder by placing her thumb and fingers on the anterior and posterior aspects of the humeral head.  The examiner grasps the patient's elbow with her other hand and applies a downward distraction force.  A positive test will result in a sulcus being formed between the acromion and the humeral head as the humeral head moves inferiorly while the force is being applied.

Wednesday, January 24, 2007

Shoulder - Empty Can Test

The empty can test is used to assess for the presence of injury/pathology to the supraspinatus.  This test is also known as the supraspinatus strength test.  The patient is either seated or standing with his arms in a position of scapation (approximately 30-degrees of horizontal adduction with the shoulders abducted to 90-degrees).  The patient attempts to resist downward overpressure being applied by the examiner.  A positive result occurs when the patient is unable to resist the force.

Shoulder - Apprehension Test

The shoulder Apprehension test is also known as the Fowler test or the Jobe relocation test.  The examination is used to assess for shoulder instability.  This examination is best partnered with the shoulder relocation test.  The apprehension test (AKA crank test) is used to assess for an anterior shoulder dislocation.  The patient lies on the table supine with the shoulder abducted 90-degrees and maximum external rotation.  The examiner typically will support the humerus with one hand while applying overpressure to the external rotation of the shoulder.  A positive test will result in the patient reacting to the movement by preventing further rotation or appearing apprehensive.  It is at this point that the relocation test is typically administered.

Tuesday, January 09, 2007

Shoulder - Adson's Test

Adson's test is used to assess for the presence of Thoracic Outlet Syndrome at the scalene triangle. The patient is examined standing. The examiner palpates the radial pulse while moving the upper extremity in abduction, extension, and external rotation. The patient then is asked to rotate her head toward the involved side while taking a deep breath and holding it. A positive exam will result in a diminished or absent radial pulse.

Monday, January 08, 2007

Ankle - Anterior Drawer Test

The Anterior Drawer Test is used to assess for instability of the ankle. Laxity is typically due to a sprain of the anterior talofibular ligament. To administer the test the examiner stabilizes the lower leg of the patient with one hand while the other hand cups the heel. An anterior force is applied to the heel while attempting to move the talus anteriorly in the ankle mortise. This test is administered bilaterally and results are compared.

Ankle - Talar Bump Test

The heel percussion test (AKA bump or tap test) is used to differentiate a tibial stress fracture from medial tibial stress syndrome. The examiner stabilizes the patient's lower leg on the table and brings the foot into a relaxed neutral position. The examiner then applies a percussive force to the plantar surface of the heel toward the lower leg. A positive result of this exam will be the illicitation of localized pain at the point of the suspected fracture.

Ankle - Lower Leg Compression Test

Pott's Compression (AKA squeeze) test is used to assess for the presence of a fracture of the lower leg. The examiner places the pads his or her hands on either side of the upper portion of the leg, one being located just distal to the head of the fibula and the other being at the same level on the medial border of the tibia. The examiner then pushes his or her hands together to squeeze the tibia and fibula together. If the athlete reports a pain at the distal tibia or distal fibula the exam is considered positive.

Ankle - Kleiger's Test

This test is used to determine if there is instability caused by a sprain of the Deltoid ligament of the ankle. The patient is examined in a seated position with his or her knee flexed over the end of the table and foot relaxed non-weight bearing. The examiner grasps the foot and rotates it laterally in the mortise of the ankle. Increased instability compared bilaterally with or without pain is an indication of a positive test. The examiner may also palpate a talar displacement.

Ankle - Talar Tilt Test

The talar tilt test is used to examine the integrity of the calcaneofibular or the deltoid ligament. The patient is seated confortably on the end of an exam table. Possible alternate positions can be sidelying or supine. The examiner grasps the foot and places it in anatomical position while stabilizing the tibia and fibula. To test the calcaneofibular ligament the examiner will adduct and invert the calcaneous into a varus position. The deltoid ligament is examined by abducting and everting the calcaneous into a valgus position. A positive test will result in laxity and/or pain.

Ankle - Thompson Test

The Thompson test is used to examine the integrity of the Achilles' tendon. With the patient lying prone on the table with his or her foot extended beyond the end of the table the examiner squeezes the calf. A normal non-injured response to this maneuver is slight plantarflexion of the ankle. Lack of ankle movement can indicate a rupture of the Achilles' tendon.