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.