This test is performed by placing the base of the vibrating tuning fork against the patient's mastoid bone, then 1-2 cm from the patient' auditory canal
A) Rinne test
In Rinne test, the counting or timing of the interval between the two sounds determines the length of time that sound is heard by air conduction. Air conducted sound should be heard twice as long as bone-conducted sound.
The examiner alternately places the vibrating tuning fork against the patient's mastoid process and against the examiner's mastoid bone until one of them no longer hears a sound.
D) Schwabach test
The examiner and patient should hear the sound for equal amounts of time.
The examiner places the base of a vibrating tuning fork on the midline vertex of the patient's head, and the patient should hear the sound equally well in both ears.
D) Weber test
Sensorineural hearing loss implies that the patient experiences a reduction of all sounds rather than difficulty in interpreting sounds. Conductive hearing loss indicates that the patient has difficulty interpreting the sounds.
A) Both statements are false.
Conductive hearing loss implies that the patient experiences a reduction of all sounds rather than difficulty in interpreting sounds. Sensorineural or perceptual hearing loss indicates that the patient has difficulty interpreting the sounds.
Which of the following is not true about the neurological control test of the upper limb?
C) If the examiner notes that one arm tends to move or drift outward and downward, the test is considered positive for an expanding intracranial lesion on the side similar to the side with the drift.
If the examiner notes that one arm tends to move or drift outward and downward, the test is considered positive for an expanding intracranial lesion on the side opposite to the side with the drift.
Which of the following is not true about the neurological control test of the lower limb?
A) None of these
Which of the following is not true about the Romberg test?
C) A positive test may be indicative of an expanding extracranial lesion, a disease of the posterior column of the spinal cord, or a proprioceptive problem.
A positive test may be indicative of an expanding intracranial lesion, a disease of the posterior column of the spinal cord, or a proprioceptive problem.
Test/s for expanding extracranial lesions
B) Neither
Romberg test and neurological control test are both used to determine the presence of expanding intracranial lesions.
The examiner applies firm compression to the brachial plexus by squeezing the plexus under the thumb or fingers.
C) Brachial plexus compression test
Pain at the site is not diagnostic; the test is positive only if pain radiates into the shoulder or upper extremity. It is positive for mechanical cervical lesions having a mechanical component.
Bradley and colleagues advocate doing the Spurling's test in three stages, each of which is increasingly provocative. Which of the following is not true about these stages?
B) The second stages involves compression with the head in rotation.
The second stages involves compression with the head in extension. The unaffected side is tested first, followed by the affected side. If symptoms are produced, the examiner does not need to proceed to the next stage.
Which of the following is not true about Spurling's test?
A) None of these
The test positions narrow the intervertebral foramen so the following conditions may lead to symptoms:
1. Stenosis
2. Cervical spondylosis
3. Osteophytes
4. Trophic, arthritic, or inflamed facet joints
5. Herniated disc
6. Vertebral fractures
Upon performing the Spurling's test, the patient felt radicular symptoms on his arm opposite the side to which his head was taken. This is called a reverse Spurling's sign and is indicative of:
D) Both of these
Reverse Spurling's sign is indicative of muscle spasm in conditions, such as tension myalgia and whiplash-associated disorders.
With this test, the patient side flexes the head and rotates it to the same side. The test is repeated to the other side. A positive test in indicated if pain radiates into the arm.
D) Maximum cervical compression test
If the head is taken into extension, side flexion, and rotation, then compression is applied, the intervertebral foramina close maximally to the side of movement and symptoms are accentuated. This position may also compress the vertebral artery.
Which of the following is not true about the Jackson's compression test?
A) The test is positive if pain radiates into the opposite arm, indicating pressure on a nerve root.
The test is positive if pain radiates into the samearm, indicating pressure on a nerve root. The pain distribution can give some indication of which nerve root is affected.
The patient sits and rotates the head to the affected side and pulls the chin down into the hollow above the clavicle by flexing the cervical spine.
D) Scalene cramp test
If pain increases, it is usually in the trigger points of the scalenes toward which the head rotates. Radicular signs may indicate plexopathy or thoracic outlet symptoms.
Which of the following is not true about the shoulder abduction test?
B) The test is used to test for radicular symptoms, especially involving the C3 or C4 nerve roots.
The test is used to test for radicular symptoms, especially involving the C4 or C5 nerve roots. Abduction of the arm decreases the length of the neurological pathway and decreases the pressure on the lower nerve roots.
Which of the following is not true about Tinel sign for brachial plexus lesions?
B) None of these
Which of the following is not true about the Elvey test?
D) This test only stresses neurological tissues.
Although this test stresses neurological tissues, it also stresses some contractile and inert tissues. Differentiation among the types of tissues depends on the signs and symptoms presented below.
True or False: An upper limb neurodynamic test is considered pathological (positive) if there is tingling to the fingers supplied by the appropriate nerve (nerve bias).
False
An upper limb neurodynamic test is considered normal (negative) if there is tingling to the fingers supplied by the appropriate nerve (nerve bias).
True or False: An upper limb neurodynamic test is considered pathological (positive) if a sensitizing test in the contralateral quadrant alters the symptoms.
False
An upper limb neurodynamic test is considered pathological (positive) if a sensitizing test in the ipsilateral quadrant alters the symptoms.
In valsalva test, the examiner asks the patient to take a deep breath and hold it while bearing down, as if moving the bowels. A positive test is indicated by increased pain, which may be caused by decreased intrathecal pressure.
C) Only the first statement is true.
A positive test is indicated by increased pain, which may be caused by increased intrathecal pressure. This increased pressure within the spinal cord usually results from a space-occupying lesion, such as a herniated disc, a tumor, stenosis, or osteophytes.
Which of the following is not true about Lhermitte's sign?
B) The patient actively flexes his or her head and one hip simultaneously with the leg kept straight.
The examiner passively flexes the patient's head and one hip simultaneously with the leg kept straight.
True or False: Vertebral and internal carotid artery testing is an important component of the cervical spine assessment in cases where end range mobilization and manipulation treatment techniques are contemplated.
True
This is applicable especially if the techniques involve a rotatory component (greater than 45°) and the upper cervical spine (C0 to C3).
True or False: Vascular clearing tests for the cervical spine are often more effective if performed in supine.
False
Vascular clearing tests for the cervical spine are often more effective if performed in sitting because the blood must flow against gravity; however, the supine position allows greater passive range of movement.
True or False: Movements to the right tend to have more effect on the right vertebral artery, and movements to the left tend to have more effect on the left artery.
False
Movements to the right tend to have more effect on the left vertebral artery, and movements to the left tend to have more effect on the right artery.
Which of the following is not true about Barre's test?
D) The patient sits with the shoulders forward flexed to 90°, elbows straight and forearms supinated, palms up and eyes closed, holding the position for 10 to 20 seconds.
The patient stands with the shoulders forward flexed to 90°, elbows straight and forearms supinated, palms up and eyes closed, holding the position for 10 to 20 seconds.
With eyes closed, the patient stands with shoulders forward flexed to 90°, elbows straight, and forearms supinated. This position is held for 10 to 20 seconds. The test is considered positive if one arm slowly falls with simultaneous forearm pronation. The cause is thought to be:
A) Diminished blood flow to brainstem
This test is known as Barre test.
This test has two parts and is used to differentiate dizziness or vertigo caused by articular problems from that caused by vascular problems.
D) Hautant's test
The patient sits and forward flexes both arms to 90° with eyes closed. If the arms move, the cause is nonvascular. The patient is then asked to rotate, or extend and rotate the neck, and holding this position with eyes closed. If the arms move, the cause is vascular impairment to the brain. Each position should be held for 10-30 seconds.
Which of the following is not true about Naffziger test?
B) The patient is seated, and the examiner stands in front of the patient with his or her fingers over the patient's jugular veins.
The patient is seated, and the examiner stands behind the patient with his or her fingers over the patient's jugular veins.
Each of the static vertebral artery tests is increasingly provocative; and if symptoms occurs with the first test, there is no need to progress to the next test. Which of the following is not true about the order of such tests?
D) None of these
If step 2 is positive, it is called Barre-Lieou sign. Step 3 is also known as DeKleyn's test.
In this test, the patient stands with shoulders forward flexed to 90°, elbows straight and forearm supinated. The patient then closes his or her eyes and marches in place while holding the extended and rotated head to one side, then to the opposite side.
A) Underburg's test
The test is considered positive if there is drooping of the arms, loss of balance, or pronation of the hands. A positive result indicates decreased blood supply to the brain.
Which of the following is not true about vertebral artery test?
C) With the patient in sitting, the examiner passively takes the patient's head and neck into extension and side flexion.
With the patient in supine, the examiner passively takes the patient's head and neck into extension and side flexion.
Which of the following is not true about dizziness test?
C) If the patient experiences dizziness in both cases, the problem lies within the semicircular canals of the inner ear.
If the patient experiences dizziness in both cases, the problem lies in the vertebral arteries, because in both cases the vertebral artery may be "kinked", decreasing the blood flow to the brain. Meanwhile, if the patient experiences dizziness only when the head is rotated, the problem lies within the semicircular canals of the inner ear.
Which of the following is not true about Hallpike-Dix test?
A) The examiner stands in front of the patient with one hand supporting the head or neck and the other hand supporting the trunk.
The examiner stands behind the patient with one hand supporting the head or neck and the other hand supporting the trunk.
This test is used to determine subluxation of the atlas on the axis and should be performed with extreme caution.
A) Sharp-Purser test
If the transverse ligament that maintains the position of the odontoid process relative to C1 is torn, C1 will translate forward (sublux) on C2 on flexion.
Which of the following is not true about apprehension test for anterior shoulder dislocation?
A) This test is primarily designed to check for atraumatic instability of the shoulder.
This test is primarily designed to check for traumatic instability of the shoulder.
The relocation part of the apprehension (crank) test for anterior shoulder instability is sometimes referred to as:
B) Both of these
True or False: If apprehension predominated when doing the crank test and disappears with the relocation test, the diagnosis is glenohumeral instability, subluxation, or dislocation.
True
If pain predominated when doing the crank test and disappears with the relocation test, the diagnosis is pseudolaxity or anterior instability either at the glenohumeral joint or scapulothoracic joint with secondary impingement or a posterior SLAP lesion.
Which of the following is not true about Dugas test?
D) The patient is asked to place the hand on the opposite shoulder and then attempt to elevate the elbow.
The patient is asked to place the hand on the opposite shoulder and then attempt to lower the elbow to the chest.
This test is designed to check primarily for atraumatic instability problems of the glenohumeral joint.
D) Load and shift test
Which of the following is not true about the load and shift test?
A) With anterior translation, if the humeral head is not centered, posterior translation will be less than the anterior translation, giving a false negative test.
With anterior translation, if the humeral head is not centered, posterior translation will be greater than the anterior translation, giving a false negative test. If the head is properly centered first, anterior translation is possible, but posterior translation is virtually absent because of the tight posterior capsule that accompanies anterior instability.
In load and shift test, up to 50% of humeral head translation, with the head riding up to the glenoid rim and spontaneous reduction is considered grade ___:
C) I
After performing the load and shift test on a patient, the examiner observed that the humeral head has more than 50% translation and feels as though it is riding over the glenoid rim but spontaneously reduces. What is the grade of anterior glenohumeral translation?
C) Grade II
Normal hypermobile shoulders may show grade II translation in any direction.
What grade in load and shift test does the humeral head remain dislocated following anterior translation of the humeral head?
B) Grade III
Grades I and II have spontaneous reduction of the humeral head following anterior translation. There is no grade IV.
True or False: For anterior direction, translation of 50% of the diameter of the humeral head is considered normal..
False
For anterior direction, translation of <25% of the diameter of the humeral head is considered normal; whereas, for posterior direction, translation of 50% of the diameter of the humeral head is considered normal.
Which of the following is not true about Rockwood test for anterior shoulder instability?
B) With the arm at the patient's side, the examiner laterally rotates the shoulder; passive lateral rotation is repeated with the arm abducted to 60°, 90°, and 120°.
With the arm at the patient's side, the examiner laterally rotates the shoulder; passive lateral rotation is repeated with the arm abducted to 45°, 90°, and 120°. These different positions are performed because the stabilizers of the shoulder vary as the angle of abduction changes.
The patient lies supine and places the hand behind the head. The examiner places one hand (clenched fist) against the posterior humeral head and pushes up while extending the arm slightly. A look of apprehension or pain indicates a positive test for anterior instability. A clunk or grinding sound may indicate a torn anterior labrum.
D) Rowe test
Which of the following is not true about circumduction test?
A) As the arm moves into flexion and abduction from above, it is vulnerable to posterior subluxation if the patient is unstable posteriorly.
As the arm moves into flexion and adduction from above, it is vulnerable to posterior subluxation if the patient is unstable posteriorly. If the examiner palpates the posterior aspect of the patient's shoulder as the arm moves downward in a forward flexion and adduction, the humeral head will be felt to sublux posteriorly.
Which of the following is not true about jerk test?
A) A positive test for recurrent anterior instability is the production of a sudden jerk or clunk as the humeral head slides off the back of the glenoid.
A positive test for recurrent posterior instability is the production of a sudden jerk or clunk as the humeral head slides off the back of the glenoid.
The patient lies supine with the shoulder off the edge of the examining table. The examiner uses one hand to flex, adduct, and medially rotate the arm while pushing the humerus posteriorly. The examiner then abducts and laterally rotates the arm.
A) Miniaci test
For this test to be positive, the patient should become apprehensive with the first maneuver and a clunk must be heard as the humerus reduces during the second maneuver.
What is the starting position of the patient in Norwood stress test for posterior instability?
B) The patient lies supine with the shoulder abducted 60° to 100° and laterally rotated 90° and with the elbow flexed to 90°.
The examiner then brings the patient's arm into horizontal adduction to the forward flexed position. At the same time, the examiner feels the humeral head slide posteriorly with the fingers.
True or False: In performing the Norwood stress test for posterior shoulder instability, Cofield and Irving recommend medially rotating the forearm approximately 20° after the forward flexion then pushing the forearm posteriorly to enhance the effect of the test.
False
In performing the Norwood stress test for posterior shoulder instability, Cofield and Irving recommend medially rotating the forearm approximately 20° after the forward flexion then pushing the elbow posteriorly to enhance the effect of the test.
The patient is in supine lying or sitting position. The examiner elevates the patient's shoulder in the plane of the scapula to 90° while stabilizing the scapula with the other hand. The examiner then applies a posterior force on the patient's elbow. While applying the axial load, the examiner horizontally adducts and medially rotates the arm.
C) Posterior apprehension test
A positive result is indicated by a look of apprehension or alarm on the patient's face and the patient's resistance to further motion or the reproduction of the patient's symptoms.
True or False: The posterior drawer test of the shoulder is similar to Norwood stress test without the horizontal adduction.
True
The examiner stands at the level of the shoulder and grasps the patient's proximal forearm with one hand, flexing the patient's elbow to 120° and the shoulder to between 80° and 120° of abduction and between 20° and 30° of forward flexion. With the other hand, the examiner stabilizes the scapula by placing the index and middle fingers on the spine of the scapula and the thumb on the coracoid process. The examiner then rotates the upper arm medially and forward flexes the shoulder between 60° and 80° while taking the thumb of the other hand off the coracoid process and pushing the humeral head posteriorly.
The patient lies supine. The examiner holds the patient's arm at the wrist, abducts the arm 90°, and forward flexes it 30°. The examiner places the other hand close to the humeral head, then pulls up on the arm at the wrist while pushing down on the humeral head with the other hand.
C) Push-pull test
If more than 50% posterior translation occurs or if the patient becomes apprehensive or pain results, the examiner should suspect posterior instability.
Which of the following is not true about Feagin test?
B) The patient stands with the arm abducted to 90° and the elbow flexed and resting on top of the examiner's shoulder.
The patient stands with the arm abducted to 90° and the elbow extended and resting on top of the examiner's shoulder.
True or False: If both the sulcus sign and Feagin test are positive, it is a greater indication of multidirectional instability rather than just laxity.
True
However, it should only be considered positive if the patient is symptomatic (e.g. pain/ache on activity, shoulder does not "feel right" with activity).
The patient stands forward flexed 45° at the waist with the arms relaxed and pointing at the floor. The examiner places one hand over the shoulder so that the index and middle fingers sits over the anterior aspect of the humeral head and the thumb sits over the posterior aspect of the humeral head. The examiner then pulls the arm down slightly. To test for anterior instability, the humeral head is pushed anteriorly with the thumb while the arm is extended 20° to 30° from the vertical position. To test for posterior instability, the humeral head is pushed posteriorly with the index and middle fingers while the arm is flexed 20° to 30° from the vertical position.
D) Rowe
For inferior instability, more traction is applied to the arm, and the sulcus sign is evident.
Which of the following is not true about sulcus sign?
B) The patient sits with the arm by the side and shoulder muscles relaxed.
The patient stands with the arm by the side and shoulder muscles relaxed.
The sulcus sign may be graded by measuring from the inferior margin of the acromion to the humeral head. Which of the following is not true about such grading?
A) None of these
In sulcus sign, the best position to test for inferior instability is at _____ of abduction with neutral rotation.
D) 20° to 50°
According to Park, et. al, the combination of following tests gave the best probability of impingement.
C) Hawkins-Kennedy test, painful arc sign, and positive infraspinatus test
According to Park, et. al, the combination of the following tests gave the best probability for full thickness rotator cuff tears.
D) Painful arc sign, drop arm test, and infraspinatus test
The patient stands while the examiner forward flexes the arm to 90° and then forcibly medially rotates the shoulder.
A) Hawkins-Kennedy impingement test
The test may also be performed in different degrees of forward flexion (vertically "circling the shoulder") or horizontal adduction (horizontally "circling the shoulder"). Pain indicates a positive test for supraspinatus paratenonitis/tendinosis or secondary impingement.
True or False: Coracoid impingement sign is the same as the Hawkins-Kennedy test but involves horizontally adducting the arm across the body 10° to 20° before doing the medial rotation.
True
This test is more likely to approximate the lesser tuberosity of the humerus and the coracoid process; whereas the Hawkins-Kennedy test pushes the supraspinatus tendon against the anterior surface of the coracoacromial ligament and coracoid process.
True or False: Yocum test is a modification of the Hawkin's Kennedy test in which the patient's hand is placed on the opposite shoulder and the examiner depresses the elbow.
False
Yocum test is a modification of the Hawkin's Kennedy test in which the patient's hand is placed on the opposite shoulder and the examiner elevates the elbow. Pain indicates a positive test.
Which of the following is not true about the Zaslav test?
B) If the patient has a good strength in medial rotation but not in lateral rotation, it is indicative of an internal impingement.
If the patient has a good strength in lateral rotation but not in medial rotation, it is indicative of an internal impingement. Meanwhile, if the patient exhibits more weakness on lateral rotation, it is indicative of a classic external anterior impingement.
Zaslav test is also known as internal (medial) rotation resistance strength test.
Which of the following is not true about Neer impingement test?
B) This test causes the lesser tuberosity to jam against the anteroinferior border of the acromion.
This test causes the greater tuberosity to jam against the anteroinferior border of the acromion.
Which of the following is not true about reverse impingement sign?
C) If the pain increases when repeating the movements with the humeral head depressed, it is considered as positive test for mechanical impingement under the acromion.
If the pain decreases or disappears when repeating the movements with the humeral head depressed, it is considered as positive test for mechanical impingement under the acromion. Reverse impingement sign is also known as impingement relief test.
Which of the following is not true about active compression test of O'Brien?
B) If the pain on the joint line or painful clicking is production inside the shoulder in the first part of the test, which is further increased in the second part, the test is considered positive for labral abnormalities.
If the pain on the joint line or painful clicking is production inside the shoulder in the first part of the test and eliminated or decreased in the second part, the test is considered positive for labral abnormalities.
The patient is sitting with the hands on the waist, thumbs posterior. The examiner stands behind the patient and stabilizes the scapula and clavicle with one hand. With the other hand, the examiner applies an anterosuperior force at the elbow.
C) Anterior slide test
If the labrum is torn (SLAP lesion), the humeral head slides over the labrum with a pop or crack with pain on the joint line, and the patient complains of anterosuperior pain.
The patient is in the supine or seated position with the shoulder abducted to 120° and laterally rotated with the elbow flexed to 90° and the forearm supinated. The examiner then performs an apprehension test on the patient by taking the arm into full lateral rotation. If apprehension appears, the examiner stops the lateral rotation and holds the position. The patient is then asked to flex the elbow against the examiner's resistance at the wrist.
B) Kim test II
Kim test II is also known as biceps load test. If the patient's apprehension decreases or the patient feels more comfortable, the test is negative for a SLAP lesion. If the apprehension remains the same or the shoulder becomes more painful, the test is considered positive for SLAP lesions in the presence of recurrent dislocations.
This test determines whether a SLAP lesion is present. The patient, in standing, abducts and laterally rotates the arm to 90° with the elbow extended and forearm supinated. The examiner then applies an eccentric adduction force to the arm.
D) Biceps tension test
A reproduction of the patient's symptoms is a positive test. The examiner should also to a Speed's test to rule out biceps pathology.
The patient lies supine. The examiner places one hand on the posterior aspect of the shoulder over the humeral head. The examiner's other hand holds the humerus above the elbow. The examiner fully abducts the arm over the patient's head. The examiner then pushes anteriorly with the hand over the humeral head while the other hand laterally rotates the humerus.
B) Clunk test
A clunk or grinding sound indicates both a positive test and a tear of the labrum.
The patient is in supine or sitting with the arm at the side and the elbow flexed to 90°. If the patient is in supine, the arm should not rest on the table. The examiner then laterally rotates the arm to tightness and takes the arm into 90° abduction in the scapular plane. Maintaining the flexed elbow, the examiner then abducts the arm to 120° and takes the arm into maximum horizontal abduction. While maintaining this position, the examiner applies a shear load to the joint by maintaining the horizontal abduction.
A) O'Driscoll's SLAP test
O'Driscoll's SLAP test is also known as dynamic labral shear test.
This test is designed to check for SLAP lesions and is though to re-create the peel-back mechanism of the superior labrum.
A) Resisted supination external rotation test
This test determines the stability of the scapula during glenohumeral movements. The patient sits or stands with the arm resting at the side. The examiner measures the distance from landmarks on scapula to their corresponding vertebral levels as the patient holds certain arm positions.
D) Lateral scapular slide test
Which of the following is not true about measuring the distance in lateral scapular slide test?
A) Measure the distance from the base of the spine of the scapula to the spinous process of T3 or T4.
Measure the distance from the base of the spine of the scapula to the spinous process of T2 or T3 (most common).
In lateral scapular slide test, the patient is tested holding the following positions, except:
A) 90° abduction with lateral rotation
90° abduction with medial rotation
True or False: In lateral scapular slide test, the distance measured from each position should not vary more than 1 to 2 cm from the original measure.
False
The distance should not vary more than 1 to 1.5 cm (0.5 to 0.75 inch) from the original measure.
Which of the following is not true about the scapular assistance test?
A) As the patient actively abducts or forward flexes the arm, the examiner stabilizes and pushes the superior medial border of the scapula up and laterally while keeping the scapula retracted.
As the patient actively abducts or forward flexes the arm, the examiner stabilizes and pushes the inferior medial border of the scapula up and laterally while keeping the scapula retracted.
Which of the following is not true about scapular isometric pinch or squeeze test?
D) The patient is in a standing position and is asked to actively "pinch" or protract the scapulae together as hard as possible and to hold the position for as long as possible.
The patient is in a standing position and is asked to actively "pinch" or retract the scapulae together as hard as possible and to hold the position for as long as possible.
In wall pushup test, the patient will be asked to perform how many repetitions of wall pushups?
D) 15-20
Any weakness of the scapular muscles or winging usually shows up with 5-10 pushups.
What joint does the horizontal adduction test examine?
D) Acromioclavicular
With the patient in a sitting position, the examiner passively forward flexes the arm to 90° and then horizontally adducts the arm as far as possible. If the patient feels localized pain over the acromioclavicular joint, the test is positive. Horizontal adduction test is also known as acromioclavicular crossoveror crossbody test.
This test may be used to evaluate the different glenohumeral ligaments.
D) Crank test
If the crank test is done with the arm by the side, the superior glenohumeral ligament is primarily tested; at 45-60° abduction, the middle glenohumeral ligament, coracohumeral ligament, and anterior band of inferior glenohumeral ligament are primarily tested; over 90° abduction, the inferior glenohumeral ligament is primarily tested.
Which of the following is not true about Napoleon test?
A) While pushing the hand into the abdomen, the patient attempts to bring the elbow backward to the scapular plane, causing greater medial shoulder rotation.
While pushing the hand into the abdomen, the patient attempts to bring the elbow forward to the scapular plane, causing greater medial shoulder rotation.
Napoleon test is also known as belly-press or abdominal compression test.
In performing the belly-press test, all of the following is indicative of a tear of the subscapularis muscle, except:
B) None of these
The patient sits and abducts the arm to 90° with the elbow flexed to 90°. The patient then medially and laterally rotates the arm at the shoulder. This test is positive if crepitus occurs.
D) Abrasion sign
If crepitus occurs, it is a sign that the rotator cuff tendons are frayed and are abrading against the under surfaces of the acromion process and coracoacromial ligament.
The patient stands with the hand of the test shoulder on top of the other shoulder with the fingers extended and the elbow in front of the body. The examiner stands in front of the patient and tries to lift the hand away from the shoulder, applying a perpendicular lateral rotation force while the patient resists the movement. The examiner's other hand stabilizes the patient's elbow.
A) Bear-hug test
If the patient cannot hold the hand on top of the shoulder because of weakness, it is considered a positive test for subscapularis strain.
Which of the following is not true about Codman's test?
A) A partial tear (1° or 2° strain) is more common in younger people and occurs when a strong downward, concentric load is applied to the arm during abduction.
A partial tear (1° or 2° strain) is more common in younger people and occurs when a strong downward,eccentric load is applied to the arm during abduction.
The examiner stands by the test side and passively places the patient's elbow in 90° flexion with the arm in 45° lateral rotation. The patient is then asked to isometrically laterally rotate the arm against resistance and then relax.
D) Dropping sign
If the patient is not able to maintain the laterally rotated position and the arm drops back to the neutral position, the test is considered positive for an infraspinatus tear.
While standing, the patient lifts a 2 to 3 kg weight over the head. The arm is laterally rotated fully and lowered to the side in the coronal plane. A positive test is indicated by discomfort or pain in the bicipital groove.
C) Gilchrest's sign
A positive test indicates bicipital paratenonitis or tendinosis. In some cases, an audible snap or pain may be felt at between 90° and 100° abduction.
Normally, if elbow flexion is resisted when the forearm is pronated, some supination occurs as the biceps attempts to help the brachioradialis muscle flex at the elbow. This supination movement is called Heuter's sign, and its absence indicates that the distal biceps tendon has been disrupted.
C) Only the second statement is true.
Normally, if elbow flexion is resisted when the forearm is pronated, some supination occurs as the biceps attempts to help the brachialis muscle flex at the elbow.
Which of the following is not true about Patte test?
D) This is designed to test the strength of the infraspinatus.
A positive test in indicated when the patient is unable to laterally rotate the arm and indicates a tear of teres minor.
McClusky offered a second way to do the Patte test. The patient is standing with the arms by the side and then is asked to bring the hands to the mouth. With a massive posterior rotator cuff tear, the patient is unable to do this without abducting the arm first. This abduction with hands to the mouth is called:
D) Hornblower's sign
The patient is seated or in standing position with the arm by the side and the elbow flexed to 90°. The examiner passively abducts the arm to 90° in the scapular plane, then laterally rotates the shoulder to end range. For a positive test, the patient cannot hold the position and the hand springs back anteriorly toward the midline.
A) Lateral rotation lag sign
Lateral rotation lag sign is also known as infraspinatus "spring back" test. The examiner will also find increased passive medial rotation on the affected side.
The patient is in a standing position with the arms elevated in the plane of the scapula to 160°. Against the resistance of the examiner, the patient is asked to medially rotate and extend the arm downward as if climbing a ladder. Which muscle is being tested?
B) Latissimus dorsi
Which of the following is not true about lift-off sign?
C) None of these
Inability to lift the hand away from the back indicates a lesion of the subscapularis muscle. Inability to resist the force applied by the examiner indicates weakness of the subscapularis muscle.
If the patient's hand is passively medially rotated as far as possible and the patient is asked to hold the position, it will be found that the hand moves toward the back. This is known as the:
A) All of these
True or False: In performing the lift off sign, Stefko, et al. reported that maximum isolation of the subscapularis was achieved by placing the hand against the posterosuperior border of the scapula (maximum medial rotation test) and then attempting the lift off.
False
The hand should be placed against the posteroinferior border of the scapula. In other test positions for lift off, teres major, latissimus dorsi, posterior deltoid or rhomboids may compensate for a weak subscapularis.
The patient sits or stands while the examiner holds the arm flexed to 90° with one hand. With the other hand, the examiner palpates the biceps tendon 7 to 8 cm below the glenohumeral joint and moves the tendon from side-to-side in the bicipital groove.
B) Lippman's test
A sharp pain is a positive test and indicates bicipital paratenonitis or tendinosis.
Which of the following is not true about Ludington's test?
A) The biceps tendon will be felt on the affected side but not on the unaffected side if the test is positive.
The biceps tendon will be felt on the unaffected side but not on the affected side if the test is positive. A positive result indicates a ruptured long head of the biceps tendon.
The patient lies supine and clasps the hands together behind the head. The arms are then lowered until the elbow touches the examining table. A positive test occurs if the elbows do not reach the table and indicates tightness of which muscle/s?
A) Pectoralis major
Tightness of the pectoralis minor can be tested by having the patient in a supine lying position with arm forward flexed 30°. The examiner places the heel of the hand over the coracoid process and pushes it toward the examining table retracting the scapula.
C) Both statements are true.
Tightness of the pectoralis minor can lead to increased scapular protraction and tilting of the inferior angle of the scapula posteriorly.
The punch out test examines the strength of which muscle?
A) Serratus anterior
The patient is in a standing position and forward flexes the arm to 90°. The examiner applies a backward force to the arm. If the serratus anterior is weak or paralyzed, the medial border of the scapula wings.
In performing the Speed's test, which motion is resisted by the examiner?
C) Shoulder flexion
In Speed's test, the examiner resists the shoulder forward flexion by the patient while the patient's forearm is first supinated, then pronated, and the elbow is completely extended.
True or False: A positive straight-arm test elicits increased tenderness in the bicipital groove especially with the arm supinated.
True
Straight-arm test is also known as Speed's or biceps test. A positive test is indicative of bicipital paratenonitis or tendinosis.
True or False: Yergason's test is more effective than Speed's test in detecting bicipital paratenonitis or tendinosis.
False
Speed's test is more effective than Yergason's test in detecting bicipital paratenonitis or tendinosis because the bones move over more of the tendon.
Which of the following is not true about Jobe test?
D) A positive test indicates a tear of the supraspinatus muscle tendon or muscle, or neuropathy of the subscapular nerve.
It should be neuropathy of the suprascapular nerve.
The patient lies prone and places the hand on the opposite posterior iliac crest. The patient is then asked to extend and adduct the medially rotated arm against resistance. Which muscle is being examined?
D) Teres minor
This is known as the teres minor test. Pain or weakness indicates a positive test for teres minor strain.
Which of the following is not true about strength testing of the trapezius?
A) To test for all three parts of the trapezius, the patient sits down and places the hands together over the head; then the examiner stands behinds the patients and pushes the elbows backward.
To test for all three parts of the trapezius, the patient sits down and places the hands together over the head; then the examiner stands behinds the patients and pushes the elbows forward.
The upper cut test examines which muscle?
C) Biceps brachii
The patient stands with the shoulder in neutral by the side with the elbow flexed to 90°. The forearm is supinated and the hand is in a fist. The examiner puts a hand over the first to resist the patient's movement. The patient then actively and quickly brings the hand up and toward the chin doing a "boxing upper cut punch." A positive test is indicated by pain or painful pop over the anterior shoulder and is an indication of a biceps injury.
This test is primarily designed to check the ability of the transverse humeral ligament to hold the biceps tendon in the bicipital groove.
B) Yergason's test
With the patient's elbow flexed to 90° and stabilized against the thorax and with the forearm pronated, the examiner resists supination while the patient also laterally rotates the arm against resistance.
True or False: If the biceps tendon pops out of the bicipital groove during the supination and lateral rotation movement, it is indicative of a positive Yergason's test.
True
If the biceps tendon pops out, it is indicative of a torn tranverse humeral ligament. Tenderness in the bicipital groove alone without the dislocation may indicate bicipital paratenonitis/tendinosis.
In performing the Tinel sign at the shoulder, the area of the brachial plexus below the clavicle in the area of the scalene triangle is tapped. A positive sign is indicated by a tingling sensation in one or more of the nerve roots.
C) Only the second statement is true.
It should be above the clavicle.
True or False: The upper limb tension tests put tension on the upper limb neurological tissues even in normal individuals.
True
Therefore, reproduction of the patient's symptoms, rather than stretching, constitutes a positive sign.
True or False: In performing thoracic outlet tests, looking for diminution of pulse is more important than reproduction of symptoms.
False
In performing thoracic outlet tests, looking for reproduction of symptoms is more important than diminution of pulse because the pulse may be diminished even in a "normal" individual.
The examiner locates the radial pulse. The patient's head is rotated to face the test shoulder. The patient then extends the head while the examiner laterally rotates and extends the patient's shoulder. The patient is instructed to take a deep breath and hold it.
B) Adson maneuver
A disappearance of the pulse indicates a positive test.
This test for thoracic outlet syndrome theoretically increases the scalenus angle and the tension of the anterior and middle scalenes, thereby compromising the interscalene triangle.
D) Adson's test
The examiner palpates the radial pulse and then draws the patient's shoulder down and back. A positive test is indicated by an absence of the pulse and implies possible thoracic outlet syndrome.
A) Costoclavicular syndrome test
Costoclavicular syndrome test is also known as the military brace test.
The examiner finds the radial pulse and applies a downward traction on the test extremity while the patient's neck is hyperextended and the head is rotated to the opposite side.
A) Halstead maneuver
Absence or disappearance of pulse indicates a positive test for thoracic outlet syndome.
This thoracic outlet test is particularly effective in patients who complain of symptoms while wearing a backpack or heavy coat.
B) Costoclavicular syndrome test
Costoclavicular syndrome test is also known as the military brace test.
The patient elevates both arms above horizontal and is asked to rapidly open and close the hands fifteen times. If fatigue, cramping, or tingling occurs during the test, the test is positive for vascular insufficiency and thoracic outlet syndrome.
B) Provocative elevation test
Provocative elevation test is a modification of the Roos test, which is also known as the elevated arm stress test.
Which of the following is not true about Roos test?
A) None of these
Minor fatigue and distress are considered negative tests.
All of the following are other names of Roos test, except
B) None of these
The patients sits, and the examiner grasps the patient's arms from behind and passively elevates the shoulder girdle up and forward into full elevation. This position is held for 30 seconds or more. Arterial relief is evidenced by stronger pulse, more pink skin color, and increased hand temperature, whereas venous relief is evidenced by decreased cyanosis and venous engorgement.
C) Shoulder girdle passive elevation
This test involves hyperabducting the arm so that the hand is brought over the head with the elbow and arm in the coronal plane with the shoulder laterally rotated.
B) Wright test
Wright test is used to detect compression in the costoclavicular space and is similar to the costoclavicular syndrome test.
The examiner flexes the patient's elbow to 90° while the shoulder is extended horizontally and rotated laterally. The patient then rotates the head away from the test side. The examiner palpates the radial pulse, which becomes absent or disappears when the head is rotated away from the test side.
D) Allen maneuver
Allen maneuver is also known as modified Wright maneuver.
To test for valgus instability, the patient's arm is stabilized with one of the examiner's hands at the elbow and the other hand placed above the patient's wrist. An adduction force at the distal forearm is applied to test the medial collateral ligament while the ligament is palpated.
A) Only the first statement is true.
An abduction force at the distal forearm is applied to test the medial collateral ligament while the ligament is palpated. Regan and Morrey advocated to perform the valgus test with the humerus in full lateral rotation.
True or False: With the patient's elbow slightly flexed (20-30°) and stabilized with the examiner's hand, an adduction or varus force is applied by the examiner to the distal forearm to test the lateral collateral ligament.
True
Regan and Morrey advocated doing the varus test with the humerus in full medial rotation.
The patient sits with the elbow flexed to 90° or more and the forearm supinated. The examiner grasps the patient's thumb under the forearm and pulls its imparting a valgus stress to the elbow.
C) Milking maneuver
Reproduction of symptoms indicates a positive test and a partial tear of the medial collateral ligament.
In biceps squeeze test, the patient's elbow is flexed to between 60 and 80°. The examiner then squeezes the biceps muscle belly, and if the biceps tendon is ruptured, the patient's forearm will not supinate.
B) Both statements are true.
Which of the following is not true about hook test?
B) None of these
If no cord-like structure can be hooked, the test is positive for a rupture of the distal biceps.
Which of the following is not true about Cozen's test?
A) The patient is then asked to actively make a fist, supinate the forearm, and radially deviate and extend the wrist while the examiner resists the motion.
It should be pronate the forearm.
This test for lateral epicondylitis also puts stress on the radial nerve and, in the presence of compression of the radial nerve, causes symptoms similar to those of tennis elbow.
A) Mill's test
Electrodiagnostic studies help differentiate the two conditions.
When performing the Mill's test, the examiner passively performs the following motions on the patient while palpating the lateral epicondyle, except:
D) Wrist ulnar deviation
Pain over the lateral epicondyle of the humerus indicates a positive test.
In Maudsley's test, the examiner resists the extension of the third digit of the hand proximal to the proximal interphalangeal joint, stressing the extensor digitorum muscle and tendon. A positive test in indicated by pain over the lateral epicondyle of the humerus.
B) Only the second statement is true.
It should be distal to the proximal interphalangeal joint.
IWhich of the following is/are true about golfer's elbow test?
C) A positive sign is indicated by pain over the medial epicondyle of the humerus.
While the examiner palpates the medial epicondyle, the patient's forearm is passively supinated and the examiner extends the elbow and wrist. Golfer's elbow test is also known as the medial epicondylitis test.
Which of the following is true about plica impingement test in the elbow?
B) Both of these
The test for anterior radiocapitellar plica is known as flexion-pronation plica test; whereas the test for posterior radiocapitellar plica is known as extension-supination plica test.
In active radiocapitellar compression test, the examiner applies an axial load to the elbow in full extension; then the patient is asked to actively supinate and pronate the forearm while the compression is maintained. Pain in the lateral compartment of the elbow is a positive test may indicate osteochondritis dissecans of the radial head.
B) Only the first statement is true.
A positive active radiocapitellar compression test indicates osteochondritis dissecans of the capitellum.
Which of the following is not true about elbow flexion test?
C) Tingling or paresthesia in the median nerve distribution of the forearm and hand indicates a positive test.
Tingling or paresthesia in the ulnar nerve distribution of the forearm and hand indicates a positive test. The test helps to determine whether a cubital tunnel syndrome is present. The test may be modified by the examiner by applying direct pressure over the ulnar nerve with the index and middle finger between the posteromedial olecranon and the medial epicondyle (elbow flexion compression test or cubital tunnel compression test).
Which of the following is not true about pinch grip test?
B) This finding may indicate entrapment of the anterior interosseous nerve as it passes through the carpal tunnel.
This finding may indicate entrapment of the anterior interosseous nerve, a branch of the median nerve, as it passes between the two heads of the pronator teres muscle.
In the test for pronator teres syndrome, the patient sits with the elbow flexed to 90° and the examiner strongly resists pronation as the elbow is extended. Tingling or paresthesia in the anterior interosseous nerve distribution in the forearm indicates a positive test.
D) Only the first statement is true.
Tingling or paresthesia in the median nerve distribution in the forearm and hand indicates a positive test.
What nerve is being tapped in performing Tinel sign at the elbow?
A) Ulnar
In Tinel's sign, the area of the ulnar nerve groove (between the olecranon process and medial epicondyle) is tapped.
True or False: In Tinel's sign, a positive sign is indicated by a tingling sensation in the ulnar distribution of the forearm and hand distal to the point of nerve compression.
True
The test indicates the point of regeneration of the sensory fibers of a nerve. The most distal point at which the patient feels the abnormal sensation represents the limit of nerve regeneration.
The patient sits with his or her hands resting on the table. The examiner passively spreads the fingers apart and asks the patient to bring them together again.
D) Wartenberg sign
Inability to squeeze the little finger to the remainder of the hand indicates a positive test for ulnar neuropathy.
The patient sits facing the examiner. The examiner holds the forearm with one hand. The thumb of the examiner's other hand is placed over the palmar aspect of the capitate while the fingers of that hand hold the patient's hand in neutral and apply a counter pressure when the examiner pushes the capitate posteriorly with the thumb.
A) Dorsal capitate displacement apprehension test
Reproduction of the patient's symptoms, apprehension, or pain indicates a positive test. A click or snap may also be heard when pressure is applied.
The examiner holds the patient's wrist flexed and asks the patient to actively extend the fingers against resistance-loading the radiocarpal joints.
B) Shuck test
Pain would indicate a positive test for radiocarpal or midcarpal instability, scaphoid instability, inflammation, or Kienböck disease.
The patient's forearm is pronated with the hand held in support by the examiner. The examiner moves the patient's hand from radial to ulnar deviation while axially compressing the carpus into the radius and applying an anterior directed force to the capitate.
B) Lichtman test
If the distal carpal row jumps or snaps dorsally (from its subluxed position palmarly) and reproduces the patient's symptoms, the test is considered positive. Lichtman test is also known as midcarpal shift test as it is used to detect midcarpal instability.
Which of the following does not apply when performing ligamentous instability test on the fingers?
C) None of these
The results are compared for laxity with those of the uninvolved hand, which is tested first.
The examiner supports the metacarpal shafts with one hand. With the other hand, the examiner pushes the metacarpal heads dorsally, then palmarly. Pain localized to the carpometacarpal joints in a positive test.
D) Linscheid test
Linscheid test is used to detect ligamentous instability of the second and third carpometacarpal joints.
The examiner grasps the triquetrum between the thumb and second finger of one hand and the lunate with the thumb and the second finger of the other hand. The examiner then moves the lunate up and down (anteriorly and posteriorly), noting any laxity, crepitus, or pain.
B) Reagan's test
Reagan's test is also known as the lunotriquetral ballotement test.
The patient is seated with the elbow flexed in neutral rotation and resting on the examining table. With one hand, the examiner grasps the patient's wrist so that the thumb rests in the patient's palm and the fingers are placed over the dorsum of the proximal row of carpals to support the lunate. The thumb of the examiner's opposite hand loads the pisotriquetral joint on the palmar aspect, applying a shearing force to the lunotriquetral joint.
C) Lunotriquetral shear test
Pain, crepitus, or abnormal movement are considered positive tests.
True or False: Both the lunotriquetral ballotement test and the lunotriquetral shear test are used to determine the integrity of the lunotriquetral ligament.
True
Pain, crepitus, or laxity are considered positive tests.
The patient is asked to make a fist. If the head of the third metacarpal is level with the second and fourth metacarpals, the test is positive and is indicative of a lunate dislocation.
D) Murphy's sign
Normally, the third metacarpal would project beyond or further distally the second and fourth metacarpals.
The patient sites with both arms in pronation. The examiner stabilizes the patient's arm with one hand so that the examiner's index finger can push down on the distal ulna. The examiner's other hand supports the patient's hand.
C) "Piano keys" test
The results are compared with the nonsymptomatic side. A positive test is indicated by a difference in mobility and the production of pain and/or tenderness.
The "piano keys" test is used to determine the integrity of which joint?
B) Distal radioulnar
Which of the following is not true about scaphoid stress test?
B) This test is a modification of the Wilson test, done actively by the patient.
This test is a modification of the Watson test, done actively by the patient.
True or False: A positive sitting hands test indicates the presence of significant wrist synovitis or wrist pathology.
True
The patient places both hands on the arms of a stable chair and pushes off, suspending the body while using only the hands for support. This test places a great deal of stress at the wrist.
True or False: Supination lift test is used to determine pathology in the triangular fibrocartilage complex.
True
The patient is seated with elbows flexed to 90° and forearms supinated. The patient is asked to place the palms flat on the underside of a heavy table (or flat against the examiner's hands). The patient is then asked to lift the table (or push up against the resisting examiner's hands). Localized pain on the ulnar side of the wrist and difficulty applying force are positive indications for a dorsal TFCC tear.
True or False: Bunnel-Littler test tests the structures around the proximal interphalangeal joint.
False
Haines-Zancolli test tests the structures around the proximal interphalangeal joint.
In Haines-Zancolli test, the PIP joint is held in neutral position while the DIP joint is flexed by the examiner. If the DIP joint does not flex, the retinacular (collateral) ligaments or the PIP capsule are tight.
B) Both statements are true.
If the PIP joint is flexed and the DIP joint flexes easily, the retinacular (collateral) ligaments are tight and the capsule is normal.
True or False: A positive thumb grind test is indicative or degenerative joint disease in the metacarpophalangeal or metacarpotrapezial joint.
True
The examiner holds the patient's hand with one hand and grasps the patient's thumb below the metacarpophalangeal joint with the other hand. The examiner then applies axial compression and rotation to the metacarpophalangeal joint.
Which of the following is not true about thumb ulnar collateral ligament laxity or instability test?
A) None of these
If the ligaments is only partially torn, the laxity would be less than 30° to 35°. In this case, the laxity would still be greater than the unaffected side (normal laxity in extension is about 15°) but not as much as with a complete tear.
Which structure is being examined by the Sharpey's test?
B) Triangular fibrocartilage complex
Sharpey's test is also known as triangular fibrocartilage complex load test. The examiner holds the patient's forearm with one hand and the patient's hand with the other hand. The examiner then axially loads and ulnarly deviates the wrist while moving it dorsally and palmarly.
Which structure/s are being examined in the ulnar fovea sign test?
B) Both of these
In ulnar fovea sign test, the examiner presses a thumb or finger into the interval or depression between the ulnar styloid process and the flexor carpi ulnaris tendon between the anterior surface of the ulnar head and the pisiform. The test is considered positive if the patient's pain is replicated or the area is very tender compared to the unaffected side.
All of the following tests examine the triangular cartilaginous disc, except:
A) Sharp test
It should be Sharpey's test, which is also known as triangular fibrocartilage complex load test.
In ulnar impaction test, the patient is seated with the elbow flexed to 90° and the wrist in ulnar deviation. The examiner holds the patient's forearm with one hand and then applies an axial compression force through the third and fourth metacarpals.
B) Only the first statement is true.
Axial compression force is applied through the fourth and fifth metacarpals. A positive test is indicated by pain and may be related to a TFCC injury or ulnar impaction syndrome.
True or False: A positive Watson test is indicative of scaphoid fracture if pain occurs without the "thunk".
True
Watson test is also known as the scaphoid shift test.
This test examines the central slip of the extensor hood.
D) Boyes test
The examiner holds the finger to be examined in slight extension at the PIP joint. The patient is then asked to flex the DIP joint. If the patient is unable or has difficulty flexing the DIP joint, it is considered a positive test.
This test examines the structures around the metacarpophalangeal joint.
D) Finochietto-Bunnel test
Finochietto-Bunnel test is also known as Bunnel-Littler test or intrinsic-plus test.
If the Bunnel-Littler test is positive, which is indicated by inability to flex the PIP joint while the MCP joint is held in slight extension, there is tight intrinsic muscle or contracture of the joint capsule. If the MCP joint is slightly flexed, the PIP joint flexes fully if the intrinsic muscles are tight, but it does not fully flex if the capsule is tight.
D) Both statements are true.
Bunnel-Littler test is also known as Finochietto-Bunnel test or intrinsic-plus test.
Which of the following is not true about Finkelstein test?
A) It is used to determine the presence of Hoffa's disease.
Finkelstein test is used to determine the presence of Hoffman or de Quervain disease, a paratenonitis in the thumb.
The patient flexes the thumb maximally onto the hypothenar eminence and actively extends the index finger as far as possible. If limited index finger extension and pain are noted, the sign is positive for paratenonitis at the interconnection between the flexor pollicis longus and flexor indices.
B) None of these
It should be Linburg's sign. The interconnection between the flexor pollicis longus and flexor indices is an anomalous tendon condition seen in 10 to 15% of hands.
Which of the following is not true about sweater finger sign?
C) It occurs most often to the index finger.
It occurs most often to the ring finger.
In carpal compression test, the examiner holds the pronated wrist in both hands and applies direct, even pressure over the median nerve in the carpal tunnel for up to 30 seconds. To make the test more sensitive, the wrist may be extended to 60° before applying the pressure.
D) Both statements are false.
In carpal compression test, the examiner holds the supinated wrist in both hands and applies direct, even pressure over the median nerve in the carpal tunnel for up to 30 seconds. To make the test more sensitive, the wrist may be flexed to 60° before applying the pressure.
The patient flexes the middle digit and then alternately deviates the finger radially and ulnarly. If the patient is unable to do this, the interossei are affected.
B) Egawa's sign
A positive sign is indicative of ulnar nerve palsy.
The patient attempts to grasp a piece of paper between the thumb and index finger. When the examiner attempts to pull away the paper, the terminal phalanx of the thumb flexes.
C) Froment's "paper" sign
The terminal phalanx of the thumb flexes due to paralysis of the adductor pollicis muscle, indicating a positive test.
The hyperextension of the thumb's MCP joint seen in Froment's test is called
D) Jeanne's sign
Both Froment's "paper" sign and Jeanne's sign, if positive, are indicative of ulnar nerve paralysis.
Which nerve is being examined by the hand elevation test?
D) Median
The patient raises both hands over the head and maintains the position for at least 3 minutes. A positive test is indicated if symptoms are reproduced in the median nerve distribution in less than 2 minutes.
Which of the following is not true about Ninhydrin sweat test?
B) After the waiting period, the fingertips are pressed with light pressure against a good-quality bond paper that has not been touched.
After the waiting period, the fingertips are pressed with moderate pressure against a good-quality bond paper that has not been touched.
True or False: The Ninhydrin sweat test is considered positive if the paper's color changed from white to purple.
False
The Ninhydrin sweat test is considered positive for a nerve lesion if the paper's color did not change from white to purple.
In Phalen's test, the examiner extends the patient's wrists maximally and holds this position for 1 minute. A positive test is indicated by tingling in the thumb, index, middle, and lateral half of the ring finger and is indicative of carpal tunnel syndrome.
A) Only the second statement is true.
In Phalen's test, the examiner flexes the patient's wrists and holds this position for 1 minute.
In reverse Phalen's test, the examiner extends the patient's wrist while asking the patient to grip the examiner's hand. The examiner then applies direct pressure over the carpal tunnel for 1 minute.
B) Both statements are true.
The reverse Phalen's test is also described by having the patient put both hands together and bringing the hands down toward the waist while keeping the palms in full contact, causing extension of the wrist. Doing the test this way does not put as much pressure on the carpal tunnel.
True or False: The tethered median nerve stress test is more likely to be positive in chronic conditions.
True
For the tethered median nerve stress test, the patient stands or sits with the elbow flexed and forearm supinated with wrist in slight extension. The examiner then hyperextends the index finger at the DIP joint. If anterior radiating forearm pain is felt, the test is considered positive for median nerve pathology.
True or False: Upon performing the Tinel sign at the wrist, the tingling or paresthesia must be felt distal to the point of pressure for a positive test.
True
The Tinel sign gives an indication of the rate of regeneration of sensory fibers of the median nerve. The most distal point at which the abnormal sensation is felt represents the limit of nerve regeneration.
True or False: In Weber's two-point discrimation test, the patient is required to respond accurately on 8 or 9 of 10 trials before the distance is narrowed and the test repeated.
False
In Weber's two-point discrimation test, the patient is required to respond accurately on 7 or 8 of 10 trials before the distance is narrowed and the test repeated. The Weber's two-point discrimination test is also known as the Moberg's two-point discrimination test.
True or False: Shrivel test is positive for denervation if the skin over the pulp of the finger is wrinkled following immersion in warm water for 5 to 20 minutes.
False
Shrivel test is positive for denervation if the skin over the pulp of the finger is not wrinkled following immersion in warm water for 5 to 20 minutes.
This test determines the patency of radial and ulnar arteries and determines which artery provides the major blood supply to the hand.
D) Allen test
The patient is asked to open and close the hand several times as quickly as possible and then squeeze the hand tightly. The examiner's thumb and index finger are placed over the radial and ulnar arteries, compressing them. The patient then opens the hand while the pressure is maintained over the arteries. One artery is tested by releasing the pressure over that artery to see if the hand flushes. The other artery is then tested in a similar fashion.
To test distal blood flow, the examiner compresses the nail bed and notes the time taken for color to return to the nail. Normally, when the pressure is release, color should return to the nail bed within 5 seconds.
D) Only the first statement is true.
Normally, when the pressure is release, color should return to the nail bed within 3 seconds. If return takes longer, arterial insufficiency to the fingers should be suspected.
Which of the following is not true about Babinski test?
C) A positive Babinski test or reflex suggests an upper motor neuron lesion if present on only one side.
A positive Babinski test or reflex suggests an upper motor neuron lesion ifpresent on both sides and may be evident in lower motor neuron lesions if seen only on one side.
The examiner carries out a straight leg raising test, and pain results. While maintaining the thigh in the same position, the examiner flexes the knee slightly (20°), reducing the symptoms. Thumb or finger pressure is then applied to the popliteal area to re-establish the painful radicular symptoms.
D) Bowstring test
Bowstring test is also know as cram test or popliteal pressure sign. This test indicates tension or pressure on the sciatic nerve and is a modification of the straight leg raising test.
If the Bowstring test is performed with patient in sitting instead of in supine position, it is called:
D) Deyerle's sign
Deyerle's sign is also known as sciatic tension test.
The patient is supine with the hands cupped behind the head. The patient is instructed to flex the head onto the chest. The patient raises the extended leg actively by flexing the hip until pain is felt. The patient then flexes the knee, and if the pain disappears, it is considered a positive test.
A) Brudzinski-Kernig test
Brudzinski originally described the neck flexion aspect of the test, and Kernig described the hip flexion component.
True or False: The mechanics of the Brudzinski-Kernig test are similar to those of the straight leg raising test except that the patient performs the movements actively.
True
Pain is a positive sign and may indicate meningeal irritation, nerve root involvement, or dural irritation.
Which of the following is not true about compression test?
C) If radicular pain into the anterior leg is produced, the test is thought to be positive for a possible disc herniation.
If radicular pain into the posterior leg is produced, the test is thought to be positive for a possible disc herniation.
The patient lies on the unaffected side with the unaffected limb flexed slightly at the hip and knee. The patient's back should be straight, not hyperextended. The patient's head should be slightly flexed. The examiner grasps the patient's affected limb and extends the knee while gently extending the hip approximately 15°. The patient's knee is then flexed on the affected side. What nerve is being stretched in this test?
C) Femoral
This test is called femoral nerve traction test. Neurological pain radiates down the anterior thigh if the test is positive.
In femoral nerve traction test, pain in the groin and hip that radiates along the anterior medial thigh indicates an L2 nerve root problem. Meanwhile, pain extending to the midtibia indicates an L4 nerve root problem.
C) Only the first statement is true.
Pain in the groin and hip that radiates along the anterior medial thigh indicates an L3 nerve root problem.
True or False: Femoral nerve traction test is similar to Ober's test.
True
If the iliotibial band is tight, the test leg does not adduct but remains elevated away from the table.
This test is a combination of the classic Lasègue test and the sitting root test.
B) Flip sign
While the patient is sitting, the examiner extends the patient's knee and looks for symptoms. The patient is then placed supine, and a unilateral straight leg raising test is performed.
True or False: For the flip sign to be positive, at least one of the tests must cause pain in the sciatic nerve distribution.
False
For the flip sign to be positive, both of the tests (SLR in sitting and supine) must cause pain in the sciatic nerve distribution. If only one test is positive, the examiner should suspect problem in the lumbar spine.
Which of the following is not true about gluteal skyline test?
C) A positive test indicates damage to the superior gluteal nerve or pressure on the L4, L5, and S1 nerve roots.
A positive test indicates damage to the inferior gluteal nerve or pressure on the L5, S1, and S2 nerve roots.
Which nerve is being examined in the knee flexion test?
B) Sciatic
The patient, who has complained of sciatica, is in a standing position. The patient is asked to bend forward to touch the toes. If the patient bends the knee on the affected side while forward flexing the spine, the test is positive for sciatic nerve root compression. Likewise, if the patient is not allowed to bend the knee, spinal flexion is decreased.
Which of the following is not true about Naffziger test?
B) If coughing causes pain in the upper back, the spinal theca is being compressed, leading to increased intrathecal pressure.
If coughing causes pain in the low back, the spinal theca is being compressed, leading to increased intrathecal pressure.
The examiner runs a fingernail along the crest of the patient's tibia. A positive test is indicated by a positive Babinski sign and suggests an upper motor neuron lesion.
D) Oppenheim test
A negative Oppenheim test is indicated by no reaction or no pain.
The patient lies prone while the examiner passively flexes the knee as far as possible so that the patient's heel rest against the buttock.
A) Nachlas test
Nachlas test is also known as prone knee bending test.
True or False: In prone knee bending test, if the examiner is unable to flex the patient's knee past 90° because of a pathological condition in the knee, the test may be performed by passive extension of the hip while the knee is flexed as much as possible.
True
A positive Nachlas test radiates pain to the following areas, except:
B) None of these
Unilateral neurological pain in the lumbar area, buttock, posterior thigh, or sometimes the anterior thigh may indicate an L2 or L3 nerve root lesion.
Pain in the anterior thigh during prone knee bending test indicates:
B) Both of these
Pain in the anterior thigh indicates tight quadriceps muscles or stretching of the femoral nerve. If the rectus femoris is tight, taking the heel to the buttock may cause anterior torsion to the ilium, which could lead to sacroiliac or lumbar pain.
This test is a modification of the slump test. The patient sits with a flexed neck. The knee is actively extended while the hip remains flexed at 90°.
D) Sitting root test
Increased pain indicates tension on the sciatic nerve.
Most common neurological test for the lower limb
D) Slump test
The following are procedure of the slump test. Arrange them accordingly.
A. The patient is asked to "slump" the back into thoracic and lumbar flexion.
B. With the other hand, the examiner holds the patient's foot in maximum dorsiflexion.
C. While this position is held, the patient is asked to actively flex the cervical spine.
D. The examiner maintains the patient's chin in the neutral position to prevent neck and head flexion.
E. The examiner uses the hand of the same arm to apply overpressure in the cervical spine.
F. The examiner uses one arm to apply overpressure across the shoulders to maintain flexion of the thoracic and lumbar spines.
G. While the examiner holds these positions, the patient is asked to actively straighten the knee as much as possible.
A, D, F, C, E, B, G
The test is repeated with the other leg and then with both legs at the same time.
Some clinicians modify the test to make the knee extension of the test passive. Once the patient is positioned with the three parts of the spine in flexion, the examiner first passively extends the knee. If symptoms do not result, then the examiner passively dorsiflexes the foot. A positive test would indicate the same lesion.
Which nerve is being stressed during the basic prone knee bending test?
A) Femoral nerve
Which nerve is being stressed during prone knee extension?
D) Saphenous nerve
Which of the following positions is not included in basic prone knee bending?
B) Hip: extension
The hip should be in neutral.
Which of the following positions is not included in PKB2?
B) Hip: Extension and abduction
The hip should be in extension and adduction. This modification of the prone knee bending test specifically stresses the lateral femoral cutaneous nerve.
With the patient in the supine position, the hip medially rotated and adducted and the knee extended, the examiner flexes the hip until the patient complains of pain or tightness in the back of the leg.
A) Both of these
If the pain is primarily in the back, it is more likely a disc herniation from pressure on the anterior theca of the spinal cord, or the pathology causing the pressure is more central. If the pain is primarily in the leg, it is more likely that the pathology causing the pressure on neurological tissues is more lateral.
All of the following structures are being stressed during the slump test, except?
C) None of these
The patient sits on the examining table and is asked to flex the spine and sag the shoulders while the examiner holds the chin and head erect. The patient is asked if any symptoms are produced. If no symptoms are produced, the examiner may:
D) All of these
If you want to stress the obturator nerve during the slump test, what modification/s should you do to the procedures of the test?
D) Hip should be flexed and abducted
This slump test modification is known as ST2.
What nerve is being stressed during the side lying slump test?
A) Femoral
What is the difference between the slump test and the long sitting slump test?
A) Cervical spine position
In slump test, the cervical spine is flexed only; whereas in long sitting slump test, the cervical spine is in flexed and rotated towards the test side.
Which of the following is not true about the basic SLR?
A) Nerve bias: tibial nerve
The nerve bias are sciatic and tibial nerves.
SLR modification which stresses the common peroneal nerve?
D) SLR4
Which of the following is not true about SLR2?
C) Ankle: eversion
It should be foot: eversion.
The neck flexion movement in straight leg raising test has also been called
A) Hyndman's sign
The neck flexion movement has also been called Hyndman's sign, Brudzinski sign, Linder sign, and Soto-Hall test.
The ankle dorsiflexion movement in SLR is called:
A) Bragard's test
Sicard's test involves straight leg raising and then extension of the big toe. Meanwhile, Bragard's test involves only extension of the big toe.
A) Only the first statement is true.
Turyn's test involves only extension of the big toe.
With unilateral straight leg raising, which nerve roots are normally completely stretched at 70°.
D) L5, S1, and S2
During straight leg raising, pain after 70° is probably joint pain from:
B) Both of these
If one leg is lifted and the patient complains of pain on the opposite side, it is an indication of a space-occupying lesion. This test is known as:
B) All of these
Other names of this test are sciatic phenomenon and crossover sign.
True or False: A positive crossover sign in SLR indicates a large intervertebral disc protrusion, usually medial to the nerve root and a poor prognosis for conservative treatment.
True
True or False: In Valsalva maneuver, the symptom may be accentuated by having the patient first flex the hip to a position just short of that causing pain.
True
The patient lies prone. With one hand, the examiner gently applies pressure to the posterior aspect of the lumbar spine. With the other hand, the examiner passively flexes the patient's knees until the heels touch the buttocks.
C) Pheasant test
If this hyperextension of the spine causes the patient to feel pain in the leg, the test is considered positive and indicates an unstable spinal segment.
The patient stands with the examiner standing to one side. The examiner grasps the patient's pelvis with both hands and places a shoulder against the patient's thorax. Using the shoulder as a block, the examiner pulls the pelvis toward the examiner's body. The position is held for 10 to 15 seconds, and then the test is repeated on the opposite side.
C) McKenzie's slide glide test
A positive test is indicated by increased neurological symptoms on the affected side.
True or False: When performing a McKenzie's slide glide test on a patient with scoliosis, the side opposite to which the scoliosis curves should be tested first.
False
When performing a McKenzie's slide glide test on a patient with scoliosis, the side to which the scoliosis curves should be tested first.
The patient lies supine and actively lifts both legs simultaneously off the examining table for 5 to 10 cm, holding this position for 30 seconds.
B) Milgram's test
The test is positive if the limbs or affected limb cannot be held for 30 seconds or if symptoms are reproduced in the affected limb. This test should always be performed with caution because of the high stress load placed on the lumbar spine.
The patient stands on one leg and extends the spine while balancing on the leg. The test is repeated with the patient standing on the opposite leg.
A) Stork standing lumbar extension test
Stork standing lumbar extension test is also known as one-leg standing lumbar extension test. A positive test is indicated by pain in the back and is associated with a pars interarticularis stress fracture. If the stress fracture is unilateral, standing on the ipsilateral leg causes more pain.
The stork standing lumbar extension test detects which spine condition?
A) Spondylolisthesis
The patient stands with the examiner standing behind. The patient extends the spine while the examiner controls the movement by holding the patient's shoulders. The examiner may use his or her shoulders to hold the occiput and take the weight of the head. Overpressure is applied in extension while the patient side flexes and rotates to the side of pain. The movement is continued until the limit of range is reached or until symptoms are produced.
B) Quadrant test
This position causes maximum narrowing of the intervertebral foramen and stress on the facet joint to the side on which rotation occurs.
The Schober test is used to measure the amount of which lumbar motion?
A) Flexion
The Schober test may be used to measure the amount of flexion occurring in the lumbar spine.
In Schober test, the examiner marks the S1 spinous process by drawing a horizontal line across the patient's back. A second line is marked 15 cm above the first line.
B) Both statements are false.
In Schober test, the examiner marks the L5 spinous process by drawing a horizontal line across the patient's back. A second line is marked 10 cm above the first line.
Which of the following is not true about the modified Schober test?
D) A second line is drawn 5 cm above the first line and a third line is drawn 10 cm below the first line.
A second line is drawn 5 cm below the first line and a third line is drawn 10 cm above the first line.
A point is marked midway between the two PSISs, then a mark is drawn 15 cm superiorly. The patient is asked to flex forward and the distance between the two marks is measured.
D) Modified modified Schober test
In Little's modification of the Schober test, the patient extends the spine after the completion of the flexion movement, and the distance between the marks is noted.
The patient lies prone while the examiner stabilizes the pelvis and extends each of the patient's hips in turn with the knees extended. The examiner then extends each of the patient's leg in turn with the knee flexed.
B) Yeoman's test
A positive test is indicated by pain in the lumbar spine during both parts of the test.
The patient lies supine. The patient flexes the head against resistance, coughs, or attempts to sit up with the hands resting behind the head. The sign is positive if the umbilicus does not remain in a straight line when the abdominals contract.
C) Beevor's sign
Which of the following is not true about Beevor's sign?
C) None of these
Which of the following is not true about the bicycle test of van Gelderen?
D) If the pain increases during the second part, the test is positive.
Bicycle test of van Gelderen is used to determine neurogenic intermittent claudication. If pain into the buttock and posterior thigh occurs, followed by tingling in the affected lower extremity during the first part, the test is positive. If the pain subsides during the second part, the test is positive.
All of the following are tests for intermittent claudication, except:
C) None of these
When the patient with neurogenic intermittent claudication walks briskly, pain ensues in the buttock and lower limb within a distance of 50 m. To relieve the pain, the patient extends backward.
A) Only the first statement is true.
To relieve the pain, the patient flexes forward. This is known as the stoop test.
Which of the following is not true about the treadmill test?
D) Two trials are conducted - one at 1.5 mph and one at the patient's preferred walking speed.
Two trials are conducted - one at 1.2 mph and one at the patient's preferred walking speed.
The patient is asked to kneel on a chair and then bend forward to touch the floor with the fingers.
A) Burns test
The test is positive for malingering if the patient is unable to perform the test or the patient overbalances.
The patient lies supine. The examiner places one hand under each calcaneus while the patient's legs remain relaxed on the examining table. The patient is then asked to lift one leg of the table, keeping the knees straight.
C) Hoover test
If the patient does not lift the leg or the examiner does not feel pressure under the opposite heel, the patient is probably not really trying or may be a malingerer.
True or False: In Hoover test, if the lifted limb is weaker, pressure under the normal heel increases.
True
Pressure under the normal heel increases because of the increased effort to lift the weak leg.
The patient lies supine, and the examiner performs a passive unilateral straight leg raising test. If there is unilateral restriction, the examiner then flexes the knee to see whether the hip flexion increases.
C) Sign of the buttock
If the hip flexion increases when the knee is flexed, it is a positive sign of the buttock test. However, if the hip flexion does not increase when the knee is flexed, it is a negative sign.
A) Both statements are false.
If the hip flexion increases when the knee is flexed, it is a negative sign of the buttock test and indicates a problem in the lumbar spine or hamstrings. However, if the hip flexion does not increase when the knee is flexed, it is a positive sign and indicates pathology in the buttock behind the hip joint, such as bursitis, tumor, or abscess.
True or False: A patient with a positive sign of the buttock test should also exhibits a capsular pattern of the hip.
False
A patient with a positive sign of the buttock test should also exhibits a noncapsular pattern of the hip.
The patient lies supine while the examiner applies a crossed-arm pressure to the ASIS. The patient pushes down and out with the arms. The test is positive only if unilateral gluteal or posterior leg pain is produced, indicating sprain of the anterior sacroiliac ligaments.
D) Gapping test
Gapping test is also known as transverse anterior stress test or distraction provocation test.
The patient is in the side lying position, and the examiner's hands are placed over the upper part of the iliac crest, pressing toward the floor. The movement causes forward pressure on the sacrum. An increased feeling of pressure in the sacroiliac joints indicates a possible sacroiliac lesion and/or sprain of the posterior sacroiliac ligaments.
B) Approximation test
Approximation test is also known as transverse posterior stress test.
True or False: To perform the prone gapping test, the patient's hips must have full ROM and be pathology free.
True
Prone gapping test is also known as Hibb's test.
The patient lies prone, and the examiner stabilizes the pelvis with his or her chest. The patient's knee is flexed to 90° or greater, and the hip is medially rotated as far as possible. While pushing the hip into the very end of medial rotation, the examiner palpates the sacroiliac joint on the same side.
C) Hibb's test
Hibb's test is also known as prone gapping test. This test is repeated on the other side, with the examiner comparing the degree of opening and quality of movement at each sacroiliac joint.
The patient lies prone on a firm surface while the examiner places the base of his or her hand at the apex of the patient's sacrum. Pressure is then applied to the apex of the sacrum, causing a shear of the sacrum on the ilium.
C) All of these
This test may indicate a sacroiliac joint problem if pain is produced over the joint.
Which ligament is being stressed during the sacroiliac rocking (knee-to-shoulder) test?
D) Sacrotuberous ligament
Sacroiliac rocking (knee-to-shoulder) test is also known as sacrotuberous ligament stress test.
The patient lies supine while the examiner passively flexes the hip on the test side to 90°. Using one hand to palpate the sacroiliac joint, the examiner thrusts down through the knee and hip on the test side.
C) All of these
Pain in the sacroiliac joint on thrusting is a positive test.
The patient lies supine. The examiner places the heel of one hand over the superior pubic ramus of one pubic bone and the heel of the other hand over the inferior pubic ramus of the other pubic bone. The examiner then squeezes his or her hands together. What structure is being stressed in this test?
B) Symphysis pubis
This test is called superoinferior symphysis pubis stress test.
All of the following are indications of the Nachlas test, except:
A) Tight quadriceps femoris
It should be tight rectus femoris. Nachlas test is also known as prone knee bending test.
True or False: Lasègue’s test places a stress on the sacroiliac joints.
True
Although the Lasègue’s (straight leg raising) test is primarily considered a test of the neurological tissue around the lumbar spine, this test also places a stress on the sacroiliac joints.
True or False: Pain occurring after 70° of straight leg raising is usually indicative of joint problem.
True
However, in hypermobile person, joint pain is often not experienced until after 120° of hip flexion. Therefore, it is more important to watch for the production of the patient's symptoms than for the actual ROM.
The patient is asked to stand on one leg. When the patient is standing on one leg, the weight of the trunk causes the sacrum to shift forward and distally with forward rotation. The ilium moves in the opposite direction.
A) Flamingo test
Pain in the symphysis pubis or sacroiliac joint indicates a positive test for lesion in whichever structure is painful.
In flamingo maneuver, the sacrum on the weight-bearing side shifts forward and caudally with forward rotation. The ilium of the same side moves in the opposite direction.
C) Both statements are true.
On the non-weight-bearing side, the opposite occurs, but the stress is greatest on the stance side.
True or False: The stress on the symphysis pubis or sacroiliac joint during the flamingo test may be increased by having the patient hop on one leg.
True
The patient lies on the side with the upper leg (test leg) hyperextended at the hip. The patient holds the lower leg flexed against the chest. The examiner stabilizes the pelvis while hyperextending the hip of the uppermost leg.
B) Gaenslen's test
Pain indicates a positive test and this may be caused by an ipsilateral sacroiliac joint lesion, hip pathology, or an L4 nerve root lesion.
True or False: Gaenslen's test is sometimes done with the patient in supine, but this position may limit the amount of hyperextension available.
True
The patient is positioned so that the test hip extends beyond the edge of the table. The patient draws both legs up onto the chest and then slowly lowers the test leg into extension.
While the patient stands, the sitting examiner palpates the PSISs with one thumb and the other thumb parallel with the first thumb on the sacrum. The patient is then asked to stand on one leg while pulling the opposite knee up toward the chest. This causes the innominate bone on the same side to rotate posteriorly.
C) All of these
If the sacroiliac joint on the side on which the knee is flexed moves minimally or up, the joint is said to be hypomobile or "blocked", indicating a positive test.
The patient lies supine. To test the left sacroiliac joint, the examiner flexes, abducts, and laterally rotates the patient's left hip, applying an overpressure at the end of the ROM. The examiner must stabilize the pelvis on the opposite side by holding the opposite ASIS down.
A) Laguere's sign
Pain in the left sacroiliac joint constitutes a positive test.
This test should be performed with caution for patients with hip pathology, because hip pain may ensue.
C) Laguere's sign
The patient is asked to sit on a hard, flat surface. The examiner palpates the PSISs and compares their heights. If one PSIS, usually the painful one, is lower than the other, the patient is asked to flex forward while remaining seated. If the lower PSIS becomes the higher one on forward flexion, the test is positive.
D) Piedallu's sign
Because the affected joint does not move properly and is hypomobile, it goes from a low to a high position.
True or False: Upon performing supine-to-sit test, there is anterior innominate rotation of the affected side if the lower limb on this side appears longer when a patient lies supine but shorter when sitting.
False
The opposite occurs with posterior innominate rotation. This test is also known as long sitting test.
The patient sits on an examining table with the knee bent to 90° and a neutral spine. The patient is asked to rotate left and right fully and the examiner notes the ROM available. The patient is then asked to forward flex the arms to 90° and laterally rotate and adduct the arms so the little fingers touch each other and palms face up. Holding this arm position, the patient is again asked to rotate left and right as far as possible. The motion will be restricted if the following structure/s are tight.
A) Both of these
While the patient is balancing on one leg, the examiner watches the movement of the pelvis. If the pelvis on the side of the non-stance leg rises, the test is considered negative.
D) Trendelenburg sign
If the pelvis on the side of the non-stance leg rises, the test is considered negative, because the gluteus medius muscle on the opposite (stance) side lifts it up as it normally does in one-legged stance. If the pelvis on the side of the non-stance leg falls, the test is considered positive and is an indication of weakness or instability of the hip abductor muscles, primarily the gluteus medius on the stance side.
With the patient lying supine, the examiner drops an imaginary perpendicular line from the ASIS of the pelvis to the examining table. A second imaginary line is projected up from the tip of the greater trochanter of the femur to meet the first line at a right angle. This line is measured, and the two sides are compared.
B) Bryant's triangle
Differences may indicate conditions such as coxa vara or CDH. This measurement can be done with radiographs, in which cases the lines may be drawn on the radiograph.
This test measures the femoral anteversion or forward torsion of the femoral neck.
B) Craig's test
Anteversion of the hip is measured by the angle made by the femoral neck with the femoral condyles. At birth, the mean angle is approximately 30°; in the adult, the mean angle is 8° to 15°. Increased anteversion leads to squinting patellae and toeing-in.
The patient lies prone with the knee flexed to 90°. The examiner palpates the posterior aspect of the greater trochanter of the femur. The hip is then passively rotated medially and laterally until the greater trochanter is parallel with the examining table or reaches its most lateral position. The angle of the lower leg with the vertical is then measured.
C) Craig's test
This test is also called the Ryder method for measuring anteversion or retroversion.
The patient lies in supine with the hips in neutral. The examiner medially rotates the limb and releases it allowing the leg to go into lateral rotation. If the patient's leg passively rotates greater than 45° from vertical in the axial plane and if, on testing, there is no mechanical end point, the test is positive for hip instability.
B) Dial test of the hip
Which of the following is not true about flexion-adduction test?
A) In pathological hips, the knee will pass over the opposite hip without rolling the pelvis.
Normally, the knee will pass over the opposite hip without rolling the pelvis. In pathological hips, adduction is limited and accompanied by pain or discomfort.
The patient lies supine. The examiner flexes and adducts the patient's hip so that the hip faces the patient's opposite shoulder and resistance to the movement is felt. As slight resistance is maintained, the patient's hip is taken into abduction while maintaining flexion in an arc of movement. As the movement is performed, the examiner looks for any irregularity in the movement, pain, or patient apprehension.
B) Hip scour test
This test causes impingement of the femoral neck against the acetabular rim and pinches several hip muscles.
The following muscles are being pinched during hip scour test, except:
D) Adductor magnus
The hip scour test pinches the adductor longus, pectineus, iliopsoas, sartorius, and/or tensor fascia lata.
The patient lies supine with both hips flexed. The examiner then takes the good hip and extends it from the flexed position, first with the hip in lateral rotation, and then repeats the test with the hip in medial rotation. The non-test leg is kept in flexion.
C) McCarthy hip extension sign
A positive test would be the reproduction of the patient's pain.
Which of the following is not true about Nelaton's line?
D) If the greater trochanter is palpated well below the line, it is an indication of a dislocated hip or coxa vara.
If the greater trochanter is palpated well above the line, it is an indication of a dislocated hip or coxa vara. The two sides should be compared.
Which of the following is not true about Patrick's test?
D) A negative test is indicated by the test leg's knee remaining above the opposite straight leg.
A positive test is indicated by the test leg's knee remaining above the opposite straight leg. A negative test is indicated by the test leg's knee falling to the table or at least being parallel with the opposite leg.
Patrick's test is also known as:
A) All of these
True or False: A positive figure-4 test is indicative of iliopsoas spasm or sacroiliac joint lesion.
True
Figure-4 test is also known as Patrick's test, FABER test, and Jansen's test.
Anteroposterior impingement test is indicated for the following conditions, except:
C) Acetabular anteversion
It should be acetabular retroversion. In this test, the patient lies supine with the hip flexed to 90°. The examiner then medially rotates and adducts the hip which leads to impingement of femoral neck against the acetabular rim.
Posteroinferior impingement test is indicated for the following conditions, except:
B) Coxa vara
It should be coxa profunda or coxa protrusion (global acetabular over coverage).
The child lies supine with the hips and knees flexed to 90°. The examiner then passively abducts both legs, noting any asymmetry or limitation of movement.
A) Harts' sign
In addition, if one hip is dislocated, the child often demonstrates asymmetry of fat folds in the gluteal and upper leg area because of the "riding up" of the femur on the affected side.
True or False: Ortolani's test is a modification of Barlow's test used for DDH.
False
Barlow's test is a modification of Ortolani's test used for DDH.
The infant lies supine with the legs facing the examiner. The hips are flexed to 90°, and the knees are fully flexed. Each hip is evaluated individually while the examiner's other hand steadies the opposite femur and the pelvis. The examiner's middle finger of each hand is placed over the greater trochanter, and the thumb is placed adjacent to the inner side of the knee and thigh opposite the lesser trochanter. The hip is taken into abduction while the examiner's middle finger applied forward pressure behind the greater trochanter. If the femoral head slips forward into the acetabulum with a click, clunk, or jerk, the test is positive. The examiner then uses the thumb to apply pressure backward and outward on the inner thigh. If the femoral head slips out over the posterior lip of the acetabulum and then reduces again when the pressure is removed, the hip is classified as unstable.
D) Barlow's test
In this case, the hip is not dislocated but is dislocatable.
The Barlow's test may be used for infants up to _____ months of age.
B) 6
Barlow's test should not be repeated too often, because it may result in a dislocated hip as well as articular damage to the femoral head.
This test is only good for assessing unilateral CDH or unilateral DDH.
B) Galleazi sign
Galleazi sign is also known as Allis test.
Allis test may be used in children from ______ months of age.
A) 3 to 18
Allis test is also known as Galleazi sign.
The child lies supine with the knees flexed and the hips flexed to 90°. A positive test is indicated if one knee is higher than the other.
A) Galleazi sign
Galleazi sign is also known as Allis test.
Which of the following is not true about Ortolani's sign?
B) The examiner may feel a click, clunk, or jerk, which indicates a positive test and that the hip is dislocated; in addition, increased abduction of the hip is obtained.
The examiner may feel a click, clunk, or jerk, which indicates a positive test and that the hip is reduced; in addition, increased abduction of the hip is obtained.
This test for hip dislocation is valid only for the first few weeks after birth.
C) Ortolani's sign
In addition, Ortolani's sign is only for dislocated and lax hips, not for dislocation that are difficult to reduce.
Which of the following is not true about telescoping sign?
D) With the dislocated hip, little movement occurs with this action.
With the normal hip, little movement occurs with this action. With the dislocated hip, however, there is a lot of relative movement. This excessive movement is called telescoping or pistoning.
True or False: If one hip is fixed in abduction or adduction as a result of contracture or some other cause, the normal hip should be abducted or adducted an equal amount to ensure accurate leg length measurement.
True
The lower limbs must be in comparable positions relative to the pelvis, because abduction of the hip brings the medial malleolus closer to the ASIS on the same side and adduction of the hip takes the medial malleolus farther from the ASIS on the same side.
True or False: Measuring leg length from ASIS to lateral malleolus is less likely to be affected by the muscle bulk.
True
Leg length measurement taken from ASIS to medial malleolus may be altered by muscle wasting or obesity.
The patient lies supine with the ASISs level. If a contracture is present, the affected leg forms an angle of more than 90° with a line joining each ASIS. Which muscle group is most likely to be tight in this case?
D) Hip abductors
Normally, hip adduction should be about 30° before the ASIS moves. If the ASIS moves before this, the abductors are tight if a muscle stretch end feel is felt.
True or False: If the examiner attempts to balance the lower limb with the pelvis in a patient with contracture of the hip abductors, the pelvis will shift down on the affected side or up on the unaffected side.
True
Meanwhile, if the examiner attempts to balance the lower limb with the pelvis in a patient with contracture of the hip adductors, the pelvis shifts up on the affected side or down on the unaffected side.
The patient lies prone, and the examiner passively flexes the patient's knee. On flexion of the knee, the patient's hip on the same side spontaneously flexes.
C) Ely's test
Ely's test is also known as tight rectus femoris, method 2.
The patient lies supine while the examiner flexes the hip and knee of the test leg maximally. The examiner then slowly extends the knee. Pain in the hamstring at the ischial origin indicates a positive test.
A) Bent-knee stretch test
Bent-knee stretch test primarily examines the proximal hamstrings.
Which of the following is not true about hamstrings contracture, method 1?
C) Both of these
The above statements describe hamstrings contracture, method 2, which is also known as hamstrings contracture test. Inability to reach the toes while keeping the knee extended is an indication of tight hamstrings on the straight leg.
Which muscle group is being tested in the pelvis drop test?
A) Hip lateral rotators
Pelvis drop test is also known as lateral step down maneuver. In this test, a 20-cm stoop or step is placed in front of the patient. The patient is asked to place one foot on the stool and stand up straight. The patient then slowly lowers the non-weight-bearing leg to the floor. The test is positive if on lowering, the patient's arms abduct, trunk inclines forward, weight-bearing hip adductors or medially rotates, and/or pelvis flexes forward or rotates backwards. It is an indication of an unstable hip or weak lateral rotators.
Which of the following is not true about 90-90 straight leg raising test?
C) None of these
90-90 straight leg raising test is also known as the hamstrings contracture, method 1.
What is the normal popliteal angle at birth?
D) 180°
Popliteal angle is formed between one line along the femoral shaft and another line along the tibial shaft. From birth until 2 years of age, it is 180°; by 6 years of age, it decreases to 155° and remains fairly constant after that.
This test is used to determine whether iliotibial band friction syndrome exists near the knee.
A) Noble compression test
Iliotibial band friction syndrome is a chronic inflammation of the iliotibial band near its insertion, adjacent to the femoral condyle.
Which of the following is not true about Noble compression test?
C) The examiner applies pressure with the thumb to the lateral femoral condyle or 1 to 2 cm distal to it.
The examiner applies pressure with the thumb to the lateral femoral condyle or 1 to 2 cm proximal to it.
The Ober's test is used to assess the contracture of which muscle?
D) Tensor fasciae latae
Ober's test assesses the tensor fasciae latae (iliotibial band) for contracture.
Which of the following is not true about Ober's test?
D) If neurological signs (i.e. pain, paresthesia) occur during the test, the examiner should consider pathology affecting the superior gluteal nerve.
If neurological signs (i.e. pain, paresthesia) occur during the test, the examiner should consider pathology affecting the femoral nerve, especially if the knee of the test leg is flexed.
The patient lies prone with the knees extended. The examiner passively abducts both of the patient's legs as far as possible. The knees are then flexed to 90°, and the examiner tries to abduct the hips farther. If abduction increases, the test is considered positive.
B) Phelps' test
Phelps' test examines contracture of the gracilis muscle.
Which of the following is not true about piriformis test?
B) If the piriformis muscle is pinching the sciatic nerve, pain results in the hip and sciatica may be experienced by the patient.
If the piriformis muscle is pinching the sciatic nerve, pain results in the buttock and sciatica may be experienced by the patient.
True or False: Resisted lateral rotation of the hip will cause the same sciatica elicited during the piriformis test.
True
In about 15% of the population, the sciatic nerve, all or in part, passes through the piriformis muscle rather than below it. These people are more likely to suffer from piriformis syndrome.
This test for ITB contracture is commonly done in children.
D) Prone lying test for iliotibial band contracture
In this test, the patient lies prone while the examiner stands on the opposite side to the leg being tested. The examiner holds the ankle of the test leg and maximally abducts it at the hip, while the other hand applies on the same side as the test leg. While maintaining the hip in neutral rotation and the knee flexed to 90°, the examiner then adducts the hip until there is a firm end feel. The angle is measured relative to the body's vertical axis.
The patient lies supine with the knees bent over the end or edge of the examining table. The patient flexes one knee onto the chest and holds it. The angle of the test knee should remain at 90° when the opposite knee is flexed to the chest.
A) Kendall test
Kendall test is also known as rectus femoris contracture, method 1. If the test knee extends slightly, a contracture is probably present.
A positive sign of the buttock test may indicate the presence of the following conditions, except:
C) Trochanteric bursitis
It should be ischial bursitis.
A positive "taking off the shoe" test indicates strain of which muscle?
D) Biceps femoris
For the "taking off the shoe" test, the patient stands wearing shoes. The patient is asked to remove the shoe on the affected side with the help of the shoe on the opposite side by putting the heel of the affected side into the medial longitudinal arch of the stance (good) leg to pry the shoe off. In this position, the affected hip is laterally rotated about 90° with 20° to 25° flexion at the knee, leading to contraction of the biceps femoris on the affected side.
This test is used to assess the most common contracture of the hip.
C) Thomas test
The Thomas test is used to assess a hip flexion contracture, the most common contracture of the hip.
Which of the following is not true about Thomas test?
C) None of these
If a contracture of the hip flexors is present, the patient's straight leg rises off the table and a muscle stretch end feel will be felt. The angle of contracture can be measured. If the lower limb is pushed down onto the table, the patient may exhibit an increased lordosis.
True or False: If the test leg abducts as the other leg is flexed to the chest during the Thomas test, it is considered a positive test.
False
If the test does not lift off the table but abducts as the other leg is flexed to the chest during the Thomas test, it is called the "J" sign or stroke and is indicative of a tight iliotibial band on the extended leg side.
To test for tightness of hip lateral rotators, the patient is asked to medially rotate the hip by bringing the leg inward. If the lateral rotators are tight, medial rotation is less than 30° to 40°, and the end feel is muscle stretch rather than capsular stretch.
B) Only the second statement is true.
To test for tightness of hip lateral rotators, the patient is asked to medially rotate the hip by bringing the leg outward. To test for tightness of hip medial rotators, the patient is asked to laterally rotate the hip by bringing the leg inward.
True or False: To add difficulty to the Trendelenburg test and to test overall stability of the hip and pelvis, the patient may be asked to do a single leg hop.
False
To add difficulty to the Trendelenburg test and to test overall stability of the hip and pelvis, the patient may be asked to do a single leg hop. The normal result should be the same as a negative Trendelenburg test.
Which of the following is not true about tripod sign?
B) The patient actively extends one knee.
The examinerpassively extends one knee.
Which of the following is not true about valgus stress test?
C) None of these
It has been advocated that resting the thigh on the examining table enables the patient to relax more and is easier for the examiner. The knee rests on the edge of the table; the lower leg is controlled by the examiner's stabilizing thigh on the table, and the lower leg is abducted, applying a valgus stress to the knee.
In Hughston's valgus stress test, the examiner faces the patient's foot, placing his or her body against the patient's thigh to help stabilize the upper leg in combination with one hand, which can also palpate the joint line. With the other hand, the examiner grasps the patient's lateral aspect of the foot near the fifth and fourth toes and applies a valgus stress.
B) Only the first statement is true.
With the other hand, the examiner grasps the patient's big toe and applies a valgus stress. Similarly, a varus stress may be applied to test the lateral structures, but in this case, the examiner grasps the lateral aspect of the foot near the fifth and fourth toes.
If the tibia moves away from the femur an excessive amount when a valgus stress is applied when the knee is in extension, the following structures may have been injured to some degree, except:
C) Medial collateral ligament (deep fibers)
It should be medial collateral ligament (superficial and deep fibers).
The other structures that may have been injured are:
1. Posteromedial capsule
2. Anterior cruciate ligament
3. Posterior cruciate ligament
A positive finding on valgus stress test with knee in full extension is classified as major disruption of the knee. The examiner usually finds that one or more rotatory tests are also positive.
B) Both statements are true.
If the valgus stress test is positive when the knee is flexed to 20° to 30°, the following structures may have been injured to some degree, except:
B) Anterior cruciate ligament
It should be posterior cruciate ligament.
True or False: The extended part of the valgus stress test would be classified as the true test for one-plane medial instability.
False
The flexed part of the valgus stress test would be classified as the true test for one-plane medial instability.
Which of the following is not true about adduction test of the knee?
A) If the tibia is medially rotated in full extension before the test, the cruciate ligaments are uncoiled, and maximum stress is placed on the collateral ligaments.
If the tibia is laterally rotated in full extension before the test, the cruciate ligaments are uncoiled, and maximum stress is placed on the collateral ligaments.
If the varus stress test is positive with the knee in full extension, the following structures may have been injured to some degree, except:
C) Rectus femoris tendon
It should be biceps femoris tendon
Other structures that may have been injured are:
1. Posterolateral capsule
2. Anterior cruciate ligament
3. Posterior cruciate ligament
4. Iliotibial band
If the adduction test is positive when the knee is flexed to 20° to 30° with lateral rotation of the tibia, the following structures may have been injured to some degree, except:
A) Biceps femoris muscle
It should be biceps femoris tendon. Iliotibial band may also be injured.
True or False: A torn posterior cruciate ligament can lead to a false-positive anterior translation test if the patient is tested in supine position with the knee flexed.
True
A torn posterior cruciate ligament can lead to a false-positive anterior translation test if the patient is tested in supine position with the knee flexed, because the gravity causes the tibia to sag posteriorly.
The patient's knee is flexed to 90°, and the hip is flexed to 45°. The examiner holds the patient's foot down. The patient is asked to straighten the leg, and the examiner prevents the patient from doing so. If a posterior sag sign is evident before the patient contracts the quadriceps, the posterior cruciate ligament is torn. However, if there is no posterior sag present and if the tibia shifts forward more on the injured side than the non-injured side, the anterior cruciate ligament is torn.
D) Active drawer test
Active drawer test is also known as the quadriceps active test.
True or False: The quadriceps active test is a better expression of anterior cruciate insufficiency than of posterior cruciate insufficiency.
False
The quadriceps active test is a better expression of posterior cruciate insufficiency than of anterior cruciate insufficiency. This test is also known as active drawer test.
Which of the following is not true about anterior drawer test?
D) The patient's foot is held on the table by the examiner's body with the examiner sitting on the patient's midfoot and the foot in neutral rotation.
The patient's foot is held on the table by the examiner's body with the examiner sitting on the patient's forefoot and the foot in neutral rotation.
If the tibia moves forward more than 6mm on the femur during anterior drawer test, the following structures may have been injured to some degree, except:
A) Lateral collateral ligament
It should be medial collateral ligament (deep fibers)
Other structures that may have been injured are:
1. Anterior cruciate ligament (especially the anteromedial bundle)
2. Posterolateral capsule
3. Posteromedial capsule
True or False: If only the anterior cruciate ligament is torn, the anterior drawer test will be negative.
True
If only the anterior cruciate ligament is torn, the anterior drawer test will be negative, because other structures (posterior capsule posterolateral and posteromedial structures) limit movement.
All of the following can result to a false-negative anterior drawer test, except:
C) Torn medial meniscus (anterior horn)
It should be torn medial meniscus (posterior horn).
True or False: When performing the anterior drawer test, the examiner must ensure that the posterior oblique ligament is not torn or injured.
False
When performing the anterior drawer test, the examiner must ensure that the posterior cruciate ligament is not torn or injured. If it has been torn, it allows the tibia to drop or slide back on the femur, and when the examiner pulls the tibia forward, a large amount of movement occurs, giving a false-positive sign.
True or False: If, when doing the anterior drawer test, there is an audible snap or palpable jerk, when the tibia is pulled forward and the tibia moves forward excessively, a meniscus lesion is probably accompanying the torn anterior cruciate ligament.
True
The audible snap or palpable jerk is called Finochietto jumping sign.
If the posterior drawer test is positive, the following structures may have been injured to some degree, except:
D) None of these
Posterior cruciate ligament may have been injured as well.
If this structure is intact, a positive posterior drawer sign may not be elicited.
B) Arcuate-popliteus complex
If, when the tibia is pushed backward, the examiner forcefully rotates the tibia laterally and excessive movement occurs, the test is positive for posterolateral instability. This maneuver is called arcuate spin test.
True or False: The advantage of doing a sitting anterior drawer test is the elimination of posterior sag sign if the posterior cruciate ligament is also torn.
True
Sitting position eliminates the effect of gravity on tibia.
Other names of Lachman test
LRT
Lachman-Trillat test
Ritchie test
Trillat test
Best indicator of injury to the anterior cruciate ligament, especially the posterolateral band
B) All of these
A positive sign in Lachman test is indicated by:
B) Mushy" or soft end feel
It should be increased anterior translation with medial rotation of tibia and disappearance of infrapatellar tendon slope.
A positive Lachman test indicates that the following structures may have been injured to some degree, except:
A) None of these
Modification of Lachman test recommended for examiner with small hands
D) Modification 2
Modification 2 of Lachman test is also known as stable Lachman test. In this test, the patient lies supine with the knee resting on the examiner's knee. One of the examiner's hands stabilizes the femur against the examiner's thigh, and the other hand applies an anterior stress.
Modification of Lachman test which demonstrates greater anterior laxity than the classic version
B) Modification 3
Modification 3 of Lachman test is also known as drop leg Lachman test. In this test, the patient lies supine, and the leg to be examined is abducted off the side of the examining table and the knee is flexed to 25°. One of the examiner's hands stabilizes the femur against the table while the patient's foot is held between the examiner's knees. The examiner's other hand is then free to apply the anterior translation force.
Modification of Lachman test in which the patient lies prone
A) Modification 6
Modification 6 of Lachman test is also known as prone Lachman test. In this test, the examiner stabilizes the patient's foot betweehn his or her thorax and arm and places one hand around the tibia. The other hand stabilizes the femur.
Modification of Lachman test in which the gravity assists the anterior movement of the tibia
D) Modification 6
Modification 6 of Lachman test is also known as prone Lachman test. In this test, gravity assists the anterior movement of tibia, but it is more difficult to determine the quality of the end feel.
For both modifications 7 and 8 of Lachman test, the patient is asked to actively extend the knee, and the examiner watches for anterior displacement of tibia relative to the unaffected side. For modification 7, the patient's foot is held down on the table to increase the pull of the quadriceps.
A) Only the first statement is true.
For modification 8, the patient's foot is held down on the table to increase the pull of the quadriceps. In this case, the test has been called the maximum quadriceps test.
How many modifications does the Lachman test have?
D) 8
The method that works for the examiner and that the examiner can use competently should be selected.
The Lachman test may be graded with a stress radiograph. Which of the following statements below does not apply?
B) A 10- to 15-mm anterior movement of tibia relative to the femur is classified as grade 3 injury.
A 10- to 16-mm anterior movement of tibia relative to the femur is classified as grade 3 injury. Whereas, a 16- to 20-mm anterior movement is classified as grade 4.
The patient lies supine, and the examiner holds both legs while flexing the patient's hip and knees to 90°. If there is posterior instability, a posterior sag of the tibia is seen. If manual posterior pressure is applied to the tibia, posterior displacement may increase.
A) Godfrey test
Godfrey test is also known as gravity test.
Which of the following is not true about posterior sag sign?
A) Normally, the medial tibial plateau extends 1 mm anteriorly beyond the femoral condyle when the knee is flexed to 90°; and if this "step" is lost, it is indicative of a torn posterior cruciate ligament.
Normally, the medial tibial plateau extends 1 cm anteriorly beyond the femoral condyle when the knee is flexed to 90°; and if this "step" is lost, it is indicative of a torn posterior cruciate ligament. If there is minimal or no swelling, the sag is evident because of an obvious concavity distal to the patella.
If the posterior sag sign is present, the following structures may have been injured to some degree, except:
D) None of these
Obviously, the posterior cruciate ligament will likely be affected as well.
Which ligament is being assessed during reverse Lachman test?
B) Posterior cruciate ligament
In reverse Lachman test, the patient lies prone with the knee flexed to 30°, and the examiner grasps the tibia with one hand while fixing the femur with the other hand. The examiner ensures that the hamstring muscles are relaxed. The examiner then pulls the tibia up, noting the amount of movement and the quality of the end feel. The examiner should be wary of a false-positive test if the anterior cruciate ligament has been torn, because the gravity may cause an anterior shift.
Which of the following is not true about Dejour test?
A) The patient lies supine, and the examiner holds the patient's leg with one arm against the body and the hand under the calf to lift the tibia while applying a varus stress.
The patient lies supine, and the examiner holds the patient's leg with one arm against the body and the hand under the calf to lift the tibia while applying a valgus stress.
Which of the following is not true about Slocum test?
D) If the test is positive, movement occurs primarily on the lateral side of the knee and is indicative of AMRI.
If the test is positive, movement occurs primarily on the lateral side of the knee and is indicative of ALRI.
In ALRI, the following structures may have been injured to some degree, except:
D) Posterior oblique ligament
Posterior oblique ligament is found in the medial side of the knee
Other structures that may have been injured in ALRI are:
1. Anterior cruciate ligament
2. Posterolateral capsule
3. Iliotibial band
To test for AMRI, the foot is placed in 30° of lateral rotation, and the tibia is drawn forward by the examiner. If the test is positive, the movement occurs primarily on the medial side of the knee.
D) Only the second statement is true.
To test for AMRI, the foot is placed in 15° of lateral rotation, and the tibia is drawn forward by the examiner. This part of the test is sometimes referred to as Lemaire's T drawer test.
In AMRI, the following structures may have been injured to some degree, except:
C) Medial collateral ligament (deep fibers)
It should be medial collateral ligament (especially the superficial fibers, although the deep fibers may also be affected).
If a stress radiograph is taken during the Slocum test, this may be used to grade the severity of the injury. Which of the following statements below does not apply?
A) All of these
A movement of 1 mm or less is considered a grade 1 injury; 1 to 2 mm, a grade 2 injury; and more than 2 mm, a grade 3 injury.
All the following tests assesses anterolateral rotatory instability, except:
C) Dejour test
Dejour test assesses anteromedial rotatory instability.
This is the primary test used to assess anterolateral rotatory instability of the knee and is an excellent test for ruptures (third-degree sprains) of the anterior cruciate ligament.
D) Test of Macintosh
Test of Macintosh is also known as lateral pivot shift maneuver.
Which of the following is not true about Hughston's posteromedial drawer sign?
D) None of these
A positive Hughston's posteromedial drawer sign indicates that the following structures have been injured to some degree, except:
B) Semitendinosus tendon
It should be semimembranosus tendon.
Other structures which may have been injured are:
1. Medial collateral ligament (superficial and deep fibers)
2. Posteromedial capsule
3. Medial meniscus
In active posterolateral drawer sign, the patient is asked to isometrically contract this muscle.
B) Biceps femoris
In active posterolateral drawer sign, the patient sits with the foot on the floor in neutral rotation. The knee is flexed to 80° to 90°. The patient is asked to isometrically contract the hamstrings, primarily the biceps femoris, while the examiner stabilizes the foot. A positive test for posterolateral instability is posterior subluxation of the lateral tibial plateau.
A positive Hughston's posterolateral drawer sign indicates that the following structures have been injured to some degree, except:
C) Biceps femoris muscle
It should be biceps femoris tendon. Posterior cruciate ligament and lateral collateral ligament may also be injured.
The patient lies supine. The examiner holds the test leg between the trunk and the arm while the index finger and thumb of the opposite hand are placed over the anterior joint line. A valgus stress is applied to the knee as it is passively flexed to 45°; then a varus stress is applied to the knee as it is passively extended, producing a circular motion to the knee. The motion is repeated, increasing the varus and valgus stresses with each rotation.
C) Anderson medial-lateral grind test
A distinct grinding is felt on the joint line if there is meniscus pathology.
Which of the following is not true about Apley's test?
B) If rotation plus distraction is more painful or shows excessive rotation relative to the normal side, the lesion is probably a meniscus injury.
If rotation plus distraction is more painful or shows excessive rotation relative to the normal side, the lesion is probably ligamentous. If rotation plus compression is more painful or shows decreased rotation relative to the normal side, the lesion is probably a meniscus injury.
In Bohler's sign, the patient lies in the supine position, and the examiner applies varus and valgus stresses to the knee. Pain in the ipsilateral joint line (valgus stress for medial meniscus) on stress testing is a positive sign for meniscus pathology.
A) Only the first statement is true.
Pain in the contralateraljoint line (valgus stress for lateral meniscus) on stress testing is a positive sign for meniscus pathology.
Which of the following is not true about "bounce home" test?
C) None of these
If the 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 or down the leg, the test is positive for meniscus lesion.
The patient lies supine, and the examiner flexes the patient's knee. The examiner then laterally rotates the tibia and extends the knee. Pain and tenderness on the medial joint line indicates medial medial meniscus pathology. If the examiner then medially rotates the tibia and flexes the knee, the pain and tenderness decrease.
D) Bragard's sign
Bragard's sign examines for medial meniscus pathology.
The patient lies supine, and the examiner positions the test leg in the figure-four position. The examiner palpates the joint line with the thumb and forefinger of one hand and places the other hand proximal to the ankle of the test leg. The patient is asked to isometrically straighten the knee while the examiner resists the movement. A positive test, signifying a meniscus lesion, is indicated by pain on the joint line.
C) Cabot's popliteal sign
This test has been described as a weight-bearing McMurray's test.
C) Ege's test
The patient stands with the knees in extension and the feet 30 to 40 cm away from each other. To test the medial meniscus, the patient laterally rotates each tibia maximally and squats causing the distance between the knees and lateral rotation to increase. The patient then stands slowly while leaving the feet laterally rotated. To test for the lateral meniscus, both tibias are medially rotated maximally while the patient squats and then stands up.
This test is similar to Bohler's sign except the the knee is flexed and extended while the varus and valgus stresses are applied.
A) Kromer's sign
A positive test is indicated by the same pain on the opposite joint line.
This test is the grandfather of meniscus tests of the knee.
A) McMurray test
However, the reliability and sensitivity of this test has been found to be low.
Which of the following is not true about McMurray test?
A) By repeatedly changing the amount of flexion and then applying the medial rotation to the tibia followed by extension, the examiner can test the entire anterior aspect of the meniscus from the anterior horn to the middle segment.
By repeatedly changing the amount of flexion and then applying the medial rotation to the tibia followed by extension, the examiner can test the entire posterior aspect of the meniscus from the posterior horn to the middle segment. The anterior half of the meniscus is not as easily tested because the pressure on the meniscus is not as great.
In the normal knee, the tibial tuberosity is in line with the midline of the patella when the knee is flexed to 90°. When the knee is extended is extended, however, the tibial tubercle is in line with the lateral border of the patella. If this change does not occur with the change in movement, rotation is blocked, indicating there is injury to the meniscus, there is possible cruciate injury, or the quadriceps muscles have insufficient strength to "screw home" the knee.
D) Modified Helfet test
If a patient experiences pain along the joint line, the patient is asked to lie in the supine position. The examiner flexes the knee to 90°, rotates it medially and laterally twice, and then fully flexes and rotates it both ways again. A positive sign is indicate by increased pain on rotation in either or both positions and is indicative of capsular irritation or a meniscus tear.
B) O'Donohue's test
This test for meniscus tear is indicated by point tenderness and pain on the joint line that appears to move anteriorly when the knee is extended and moves posteriorly when the knee is flexed.
B) Steinman's tenderness displacement test
Medial pain is elicited on lateral rotation, and lateral pain is elicited on medial rotation.
Which of the following is not true about Thessaly test?
A) The patient then flexes the knee to 5° and rotates the tibia on femur medially and laterally three times while maintaining the 5° flexion; the test is repeated at 20° flexion.
The patient then flexes the knee to 5° and rotates the femur on tibia medially and laterally three times while maintaining the 5° flexion.
Normally, plica are reabsorbed by the time of birth although remnants may be present in 20% to 50% of knees. Because an abnormal plica can mimic meniscus pathology, it is essential that the plica tests be performed as well as the meniscus tests if a meniscus or plica injury is suspected.
C) Both statements are true.
The patient lies in the supine position, and the examiner flexes the knee and medially rotates the tibia with one arm and hand while pressing the patella medially with the heel of the other hand and palpating the medial femoral condyle with the fingers of the same hand. The patient's knee is passively flexed and extended while the examiner feels for "popping" of the plica under the fingers.
C) Hughston's plica test
The popping indicates a positive test.
The patient lies on his or her side with the test leg uppermost. Using the heel of one hand, the examiner pushes the patella medially and holds it there. The examiner then flexes the patient's knee and medially rotates the tibia with the other hand. The patient's knee is then extended while the examiner feels for any sound.
C) Patellar bowstring test
Which of the following is not true about plica "stutter" test?
B) If the test is positive, the patella stutters or jumps somewhere between 90° and 45° of flexion during an otherwise smooth movement.
If the test is positive, the patella stutters or jumps somewhere between 60° and 45° of flexion during an otherwise smooth movement.
True or False: "Blood" swelling comes on very quickly (within 1 to 2 hours), and the skin becomes very taut.
True
On palpation, it has a "doughy" feeling and is relatively hard to touch. The joint surface feels warm. Usually, excess blood should be aspirated, or osteoarthritis may result from irritation of the cartilage.
True or False: Normally, synovial fluid swelling caused by joint irritation occurs in 1 to 2 hours.
False
Normally, synovial fluid swelling caused by joint irritation occurs in 8 to 24 hours. The feeling within the joint is a fluctuating or "boggy" feeling. The joint surface feels warm and tender. Swelling usually occurs with activity and disappears after a few days of inactivity.
With purulent swelling, the joint surface is hot to touch. Often it is red, and the patient has general signs of infection or pyrexia.
D) Both statements are true.
Which of the following is not true about brush, stroke, or bulge test?
D) None of these
Brush, stroke, or bulge test is also known as wipe test.
True or False: In wipe test, the wave of fluid may take up to 2 seconds to appear.
True
Wipe test is also known as brush, stroke, or bulge test.
Sturgill, et al. developed an effusion grading scale based on the stroke test. Which of the following is not true about such grading scale?
D) 3+: effusion spontaneously returns to medial side after upstroke (no downstroke necessary)
It should be 2+: effusion spontaneously returns to medial side after upstroke (no downstroke necessary).
Effusion grading scale of knee joint based on the stroke test: 1+
A) Larger bulge on medial side with downstroke
Effusion grading scale of knee joint based on the stroke test: 4+
C) None of these
The grading scale is only is from 0 to 3+.
The examiner places the palm of one hand over the suprapatellar pouch and the palm of the other hand anterior to the joint line with the thumb and index finger just beyond the margins of the patella. By pressing down with one hand and then the other, the examiner may feel the synovial fluid move from one hand to the other, indicating significant effusion.
C) Fluctuation test
Which of the following is not true about indentation test?
C) The patient lies supine, and the examiner passively flexes the good leg, noting an indentation on the medial side of the patellar tendon.
The patient lies supine, and the examiner passively flexes the good leg, noting an indentation on the lateral side of the patellar tendon.
In patellar tap test, with patient's knee extended or flexed to discomfort, the examiner applies a slight tap or pressure over the patella. When this is done, a floating of the patella should be felt.
B) Both statements are true.
Patellar tap test is also known as "ballotable patella". The floating of the patella is sometimes called the "dancing patella" sign.
Which of the following is not true about the modification of patellar tap test?
B) The examiner then strokes down on the prepatellar pouch with the other hand.
The examiner then strokes down on the suprapatellar pouch with the other hand.
The patient lies supine with the knee extended. The examiner carefully milks the fluid from the suprapatellar pouch distally. With the opposite hand, the examiner palpates adjacent to the patellar tendon (usually on the medial side) for fluid accumulation or a wave of fluid passing under the fingers.
B) Peripatellar swelling test
Reider calles this a palpable fluid wave.
If less swelling is evident during the peripatellar swelling test, Reider suggests the palpable fluid wave. The examiner strokes the fluid into the suprapatellar pouch and with one hand, the examiner pushes down on the suprapatellar pouch while watching the hollows on each side of the patella for a wave of fluid to pass.
B) Only the second statement is true.
If less swelling is evident during the peripatellar swelling test, Reider suggests the visible fluid wave. This test is simlar to the brush test.
Which of the following is not true about active patellar grind test?
A) None of these
Which of the following is not true about Clarke's sign?
C) If the test causes prepatellar pain and the patient cannot hold a contraction, the test is considered positive.
If the test causes retropatellar pain and the patient cannot hold a contraction, the test is considered positive. Clarke's sign is also known as patellar grind test.
Because the examiner can achieve a positive Clarke's sign on anyone if sufficient pressure is applied to the patella, the amount of pressure that is applied must be carefully controlled. The best way to do this is to repeat the procedure several times, increasing the pressure each time and comparing the results with those of the unaffected side.
B) Both statements are true.
Clarke's sign is also known as patellar grind test.
To test the different parts of the patella during the Clarke's sign, the knee should be tested in the following positions, except:
B) 45° flexion
It should be 30° flexion. 0° flexion is synonymous with full extension. Clarke's sign is also known as patellar grind test.
Which of the following is not true about the lateral pull test?
A) None of these
Normally, the patella moves superiorly, or superiorly and laterally in equal proportions with contraction of the quadriceps.
Which of the following is not true about McConnell test for chondromalacia patellae?
D) If the pain is increased with the patella held medially, the pain is patellofemoral in origin.
If the pain is decreased with the patella held medially, the pain is patellofemoral in origin.
Which of the following is not true about passive patellar tilt test?
A) The normal angle is 15°, and patients with angles more than this are prone to patellofemoral syndrome.
The normal angle is 15°, and patients with angles less than this are prone to patellofemoral syndrome.
The patient lies supine while the examiner places a fist under the patient's knee. The patient is asked to slowly extend the knee without pressing into the examiner's fist or lifting the leg away from the fist while trying to achieve full extension.
C) Vastus medialis coordination test
The test is considered positive if the patient cannot full extend the knee or has difficulty achieving full extension smoothly or tries to use the hip flexors or extensors to accomplish the task.
Which of the following is not true about Waldron test?
D) None of these
The patient lies supine with the knees extended. The examiner pulls the patella distally and holds it in this position. The patient is asked to contract the quadriceps. Pain indicates a positive test for chondromalacia patellae.
A) Zohler's sign
However, the test may be false positive in a large proportion of the normal population.
The patient lies in the supine position with the quadriceps muscles relaxed and the knee flexed to 30° while the examiner carefully and slowly pushes the patella laterally. If the patient feels the patella is going to dislocate, the patient contracts the quadriceps muscles to bring the patella back "into line." This action indicates a positive test.
C) Fairbank's apprehension test
The patient will also have an apprehensive look.
Which of the following is not true about functional test for quadriceps contusion?
B) This test may also be used to assess the tightness of the quadriceps (rectus femoris) muscles.
This test may also be used to assess the tightness of the quadriceps (vasti) muscles. If the range is limited and the end feel is muscle stretch, the vastus medialis, lateralis, and/or intermedius is tight.
Which of the following statements does not apply when determining the site of occurrence of leg length discrepancy?
A) Measure from high point on the iliac crest to the greater trochanter for coxa valga.
Measure from high point on the iliac crest to the greater trochanter for coxa vara. The examiner must also remember that torsion deformities to the femur or tibia can alter leg length.
Which of the following is not true about moving patellar apprehension test?
C) If the patella is translated medially and the knee flexed, there will be more apprehension or protective quadriceps contraction.
If the patella is translated medially and the knee flexed, there will be no apprehension or protective quadriceps contraction as the patella most commonly subluxes or dislocates laterally. For the test to be positive, both step 1 (apprehension) and step 2 (no apprehension) must occur.
Which of the following is not true about Q-angle?
B) Any angle less than 13° may be associated with chondramalacia patellae or patella baja.
Any angle less than 13° may be associated with chondramalacia patellae or patella alta. Q-angle is also known as patellofemoral angle.
If measured with the patient in the sitting position, the Q-angle should be 0°. While the patient is in a sitting position, the presence of the "bayonet sign," which indicates an abnormal alignment of the quadriceps musculature, patellar tendon or tibial shaft, should be noted.
B) Both statements are true.
Q-angle is also known as patellofemoral angle.
Which of the following is not true about tubercle sulcus angle?
A) A second horizontal line is drawn through the femoral condyles.
A second horizontal line is drawn through the femoral epicondyles. Tubercle sulcus angle is the Q-angle at 90°.
True or False: A-angle is a measurement which consists of a vertical line that divides the patella into two halves and a line drawn from the tibial tubercle to the apex of the inferior pole of the patella.
True
A-angle is not as commonly used as the Q-angle because of the difficulty in consistently finding appropriate landmarks.
Which of the following is not true about Wilson test?
B) This is a test for chondromalacia patellae.
This is a test for osteochondritis dissecans of the femoral condyle. The test is positive only if the lesion is at the classic site for osteochondritis dissecans of the knee, namely, the medial femoral condyle near the intercondylar notch.
Which of the following is not true about "too many toes" sign?
B) None of these
Which of the following is not true about anterior drawer test of the ankle?
B) A positive anterior drawer test may be obtained with a tear of only the anterior talofibular ligament, but anterior translation is greater if both ligaments are torn, especially if the foot is tested in plantar flexion.
A positive anterior drawer test may be obtained with a tear of only the anterior talofibular ligament, but anterior translation is greater if both ligaments are torn, especially if the foot is tested in dorsiflexion.
True or False: If straight anterior movement or translation occurs during anterior drawer test of the ankle, it indicates both medial and lateral ligament insufficiencies.
True
This finding, which is often more evident in dorsiflexion, means that the superficial and deep deltoid ligaments, as well as the anterior talofibular ligament and anterolateral capsule, have been torn.
True or False: When performing an anterior drawer test in an ankle with a lateral tear, the lateral side would translate forward causing lateral rotation of the talus and resulting in anterolateral rotatory instability.
False
When performing an anterior drawer test in an ankle with a lateral tear, the lateral side would translate forward causing medial rotationof the talus and resulting in anterolateral rotatory instability.
True or False: Cotton test is better than the lateral rotation stress test for determining syndesmotic instability on stress x-ray.
True
Cotton test is also known lateral stress test. In this test, the examiner stabilizes the distal tibia and fibula with one hand and applies a lateral translation force (not an eversion force) with the other hand to the foot. Any lateral translation (more than 3 to 5 mm) or clunk indicates syndesmotic instability.
Which of the following is not true about crossed leg test?
A) The patient sits in a chair with the affected leg crossed over the opposite knee so the midpoint of the tibia is resting on the opposite knee.
The patient sits in a chair with the affected leg crossed over the opposite knee so the midpoint of the fibula is resting on the opposite knee.
Which of the following is not true about dorsiflexion compression test?
C) An increase in pain on dorsiflexion or a decrease in dorsiflexion range indicates a positive test.
An decrease in pain on dorsiflexion or a increase in dorsiflexion range indicates a positive test.
Which of the following is not true about Kleiger test?
D) The test is positive for a syndesmosis ("high ankle") injury if pain is produced over the anterior or posterior talofibular ligaments and the interosseous membrane.
The test is positive for a syndesmosis ("high ankle") injury if pain is produced over the anterior or posterior tibiofibular ligaments and the interosseous membrane.
Which of the following is not true about heel thump test?
C) Pain along the shaft of fibula may indicate a stress fracture.
Pain along the shaft of tibia may indicate a stress fracture. Note that the examiner, using his or her fist, applies a firm thump on the heel so that the force is applied to the center of the heel and in line with the long axis of the tibia.
Which of the following is not true about prone anterior drawer test?
A) None of these
True or False: In performing the squeeze test of the leg, the examiner should apply compression over the malleoli rather than the shaft of tibia and fibula.
True
Pain in the lower leg may indicate a syndesmosis injury, provided that fracture, contusion, and compartment syndrome have been ruled out.
Which of the following is not true about talar tilt?
B) Eversion tests the deltoid ligament, primarily the tibionavicular, tibiocalcaneal, and anterior tibiotalar ligaments.
Eversion tests the deltoid ligament, primarily the tibionavicular, tibiocalcaneal, and posterior tibiotalar ligaments.
This test is designed to test the arterial blood supply to the lower limb.
A) Buerger's test
In this test, the patient lies supine while the examiner elevates the patient's leg to 45° for at least 3 minutes. If the foot blanches or the prominent veins collapse shortly after elevation, the test is positive for poor arterial blood circulation. The examiner then asks the patient to sit with the legs dangling over the edge of the bed. Id it takes 1 to 2 minutes for the limb color to be restored and the veins to fill and become prominent, the test is confirmed positive.
Which nerve is being assessed in the Duchenne test?
A) Superficial peroneal nerve
The patient lies supine with the legs straight. The examiner pushes up on the head of the first metatarsal through the sole, pushing the foot into dorsiflexion. The test is positive for a lesion of the superficial peroneal nerve or a lesion of L4, L5, or S1 nerve root if, when the patient is asked to plantar flex the foot, the medial border dorsiflexes and offers no resistance while the lateral border plantar flexes.
Which of the following is not true about Feiss line?
B) The examiner marks the apex of the medial malleolus and the dorsal aspect of the first metatarsophalangeal joint while the patient is not bearing weight.
The examiner marks the apex of the medial malleolus and the plantar aspect of the first metatarsophalangeal joint while the patient is not bearing weight.
Which of the following is not true about the severity of flatfoot deformity in accordance to Feiss line?
D) If it the tubercle rests on the floor, it represents a fourth-degree flatfoot.
If it the tubercle rests on the floor, it represents a third-degree flatfoot.
The patient lies prone with the feet extended over the edge of the examining table. The examiner palpates the Achilles tendon while the patient plantar flexes and dorsiflexes the foot. If one Achilles tendon (the injured one) feels less taut than the other, the test is considered positive for calcaneal fracture.
B) Hoffa's test
Passive dorsiflexion on the affected side is also greater.
In Homan's sign, the patient's foot is actively dorsiflexed with the knee extended. Pain in the calf indicates a positive test for deep vein thrombophlebitis.
C) Only the second statement is true.
The patient's foot is passively dorsiflexed with the knee extended.
The patient lies prone with the foot over the end of the examining table while the clinician stands near the end of the table. The patient is asked to actively flexed the knee to 90°. During the motion, the examiner watches the foot. Normally, it will be slightly plantar flexed. If the foot falls into neutral or slight dorsiflexion, the test is positive for a 3° strain (rupture) of the Achilles tendon.
B) Matles test
The patient lies supine. The examiner grasps the foot around the metatarsal heads and squeezes the heads together. Pain is a positive sign for stress fracture or neuroma.
B) Morton's test
When performing the test for peroneal tendon dislocation, where do you expect the tendon to sublux?
B) Behind the lateral malleolus
In this test, the patient is placed in prone on the examining table with the knee flexed to 90°. The posterolateral region of the ankle is inspected for swelling. The patient is then asked to actively dorsiflex and plantar flex the ankle along with eversion against the examiner's resistance. If the tendon subluxes from behind the lateral malleolus, the test is positive.
Thompson's test is also known as:
C) Simmond's test
Which of the following is not true about Thompson's test?
C) None of these
One should be careful not to assume that the Achilles tendon is not ruptured if the patient is able to plantar flex the foot while not bearing weight. The long flexor muscles can perform this function in the non-weight-bearing stance even with a rupture of the Achilles tendon.
Tinel's sign may be elicited in two places around the ankle. What are these places?
D) In front of the ankle and behind the medial malleolus
The anterior tibial branch of the deep peroneal nerve may be percussed in front of the ankle. Meanwhile, the posterior tibial nerve may be percussed as it passes behind the medial malleolus. In both cases, tingling or paresthesia felt distally is a positive sign.
Which of the following is not true about Windlass test?
D) Lack of extension may indicate hallux valgus.
Lack of extension may indicate hallux rigidus.
The patient lies prone while the examiner passively approximates the scapulae by lifting the shoulders up and back. Pain in the scapular area may be indicative of:
B) T1 nerve root problem
A positive passive scapular approximation test indicates T1 or T2 nerve root problem.
A positive Lhermitte's test is indicative of:
C) Both
In Romberg's test, the patient stands with feet together and eyes open. The test is positive when the patient sways or falls when the eyes are open.
D) Only the first statement is true.
The test is positive when the patient sways or falls when the eyes are closed.
The following statements describe the Romberg's test, except:
A) When inability to balance well is based on cerebral disease, vision is less able to correct for the difficulty in maintaining posture and subject will sway with eyes opened or closed.
When inability to balance well is based on cerebellar disease, vision is less able to correct for the difficulty in maintaining posture and subject will sway with eyes opened or closed.
The pain in the neck and low back areas produced in Brudzinki-Kernig test is relieved by:
C) Knee flexion
Excursion and increase in tension of lumbosacral roots may be accomplished by the following demonstrations, except:
B) Lateral rotation of the hip on straight leg raising
It should be medial rotation of the hip on straight leg raising.
This test is used to detect pathology in the hip and sacroiliac joint. Inguinal pain is a general indication that there is pathology in the hip joint or surrounding muscles.
D) FABERE test
The following statements are true about straight leg raising test, except:
C) At the point where the patient experiences pain, lower the leg slightly and then dorsiflex the foot - if there is no pain, the source is probably the sciatic nerve.
The following apply to distraction, except:
A) This test faithfully reproduces pain referred to the upper extremity from the cervical spine.
In performing the distraction test, the examiner securely grasps the patient's head by:
C) Both of these
True or False: In distraction test, determining the grade of pressure would be decided by the amount of pressure and pain relieved while performing the test.
True
An upper limb tension test is considered positive if the following are present, except:
B) There is tissue resistance or decrease in ROM on one side of the body as compared with the other.
The time a subject can maintain a horizontal, unsupported posture (a measure of mechanical capability and willingness) is a predictor for first-time occurrence of low back pain in men. This test is known as:
B) Sorensen
Sorensen test is also known as Biering-Sorensen test. To begin this test, an examination plinth, a stopwatch, and 3-4 straps are needed. The starting position is the client adopting a half-prone lying on a plinth with the superior edge of the iliac crest at the edge of the plinth and the arms crossed over the chest. The lower limbs are strategically stabilized with straps.
Which of the following does not describe the Biering-Sorensen test?
C) The patient adopts a half-prone lying position with the inferior edge of the iliac crest at the edge of the plinth and the arms crossed over the chest.
The patient adopts a half-prone lying position with the superior edge of the iliac crest at the edge of the plinth and the arms crossed over the chest.
The McKenzie system is a commonly used method of examining and treating patients who have low back pain. McKenzie has defined the following, except:
C) The lateral shift is considered to be clinically significant when a single glide test does not alter the location or intensity of the pain reported by the patient.
The following apply to distraction test, except:
C) Demonstrates the effect of neck rotation in relieving pain
The distraction test demonstrates the effect of neck traction in relieving pain.
The Beevor's test determines the integrity of the segmental innervation of which muscle/s?
B) Both
The Beevor's sign is seen in selective weakness of the _________ abdominal muscles, involving the movement of umbilicus.
C) Lower
The examiner runs a fingertip along the crest of the patient's tibia. A negative test is indicated by no reaction or no pain, whereas a positive test is indicated by the presence of Babinski sign. This test is called:
B) Oppenheim
Which of the following is not true about Halstead test?
D) The patient's neck is hyperextended and head rotated to the same side.
The patient's neck is hyperextended and head rotated to the opposite side.
A patient with recent trauma presents with restricted movement of the right hand. There is decreased motion at the third MCP joint. To differentiate as to whether this is a joint restriction or some other type of tightness, what examination procedure should be employed?
D) Bunnel-Littler test
A patient presents to the clinic with pain and decreased function of the right shoulder. A full tear of the rotator cuff musculature is suspected. The special test that would provide the most valid and reliable information confirming this suspicion would be the:
A) Both
If the rotator cuff musculature is fully torn, the arm will fall from a fully elevated position if it is unsupported.
Wrist flexion test
A) Phalen's test
Prayer test is also known as reverse Phalen's test or wrist extension test.
Test for radioulnar instability
C) Piano keys sign
Piano keys sign is performed by pushing the distal ulna down. Positive sign is excessive motion, indicating radioulnar instability.
A patient comes into clinic with complaints of lateral elbow pain. You performed a test in which the elbow was stabilized, and resistance was applied to middle finger extension. The test performed is known as:
A) Maudsley's test
Maudsley's test is the method 3 for lateral epicondylitis.
(+) sulcus sign and (+) Feagin test indicates
D) Multidirectional shoulder instability
(+) Wartenberg sign
C) Inability to move the little finger toward the other fingers
A positive Wartenberg sign is indicative of ulnar neuropathy.
Method 2 for medial epicondylitis
A) None of these
There is only one method for medial epicondylitis, whereas there are three methods for lateral epicondylitis.
Which of the following is true about Froment's paper sign?
D) (+) Jeanne's sign
Jeanne's sign is characterized by flexion of the distal thumb and hyperextension of 1st MCP joint.
Which of the following is not true about sweater finger test?
D) None of these
In Norwood stress test, the patient should be in the correct starting position. All of the following components are needed to complete the test, except:
A) 60°-100° of shoulder flexion
It should be 60°-100° of shoulder abduction.
This test for shoulder impingement pushes the supraspinatus tendon against the anterior surface of the coracoacromial ligament and coracoid process.
C) Hawkins-Kennedy test
To perform Hawkins-Kennedy test, the shoulder is positioned in:
A) Both
The patient stands while the examiner forward flexes the arm to 90 and then forcibly medially rotates the shoulder.
The clunk in jerk test indicates:
D) Posterior inferior labral tear
In performing Jerk test, the patient sits with the arm medially rotated and forward flexed to 90°. The examiner grasps the patient's elbow and axially loads the humerus in a proximal direction.
Push-pull test
D) Both of these
In push-pull test, the patient lies supine. The examiner then pulls up on the arm at the wrist while pushing down on the humerus with the other hand.
In isolation, what is the most sensitive and specific test for labral tears?
C) Biceps load test II
This test is performed in supine, and the arm is elevated to 120° and externally rotated to its maximal point, with the elbow in the 90° flexion and the forearm in the supinated position. The patient is asked to flex the elbow while resisting the elbow flexion by the examiner. The test is positive if the patient complains of pain during the resisted elbow flexion.
Finkelstein's test involves actively flexing the thumb into the palm while making a closed fist, while having the examiner passively deviate the wrist in an ulnar direction. A positive test is marked by significant discomfort in the region of the radial styloid and maybe more suggestive of APL than EPB dysfunction.
A) Only the first statement is true.
A positive Finkelstein's test is marked by significant discomfort in the region of the radial styloid and maybe more suggestive of EPB than APL dysfunction.