Transcript External Rotation

Musculoskeletal Exam
2004-2005
Primary Care Sports Medicine
Department of Family Practice
Hennepin County Medical Center
Shoulder
Bone and soft tissue anatomy (anterior view)
A-C Joint
Acromion
Clavicle
Coracoid Process
Longhead of biceps tendon
Shoulder
Bone and soft tissue anatomy (lateral view)
A-C joint
Clavicle
Spine of
scapula
Supraspinatus Insertion
Infraspinatus Insertion
Greater tuberosity
Teres Minor Insertion
Coracoid
process
Subscapular Insertion
Lesser tuberosity
Shoulder
Bone and soft tissue anatomy (posterior view)
Spine of scapula
Scapula
Shoulder
Range of Motion
Flexion
Extension
Abduction
Adduction
IR (add)
ER (add)
IR (abd)
ER (abd)
0 - 180°
0 - 60°
0 - 180°
0 - 75°
0 – 90º
0 – 90º
0 – 90º
0 – 90º
Shoulder
Range of motion
Combination ROM
(extension,
adduction, and
internal rotation)
Shoulder
Strength testing
Supraspinatus
(“empty-can” sign)
Evaluate for strength
and presence of pain.
Shoulder
Strength testing
Infraspinatus
(resisted external
rotation in adduction)
Evaluate for strength
and presence of pain.
Shoulder
Strength testing
Teres minor and
infraspinatus
(resisted external
rotation in abduction)
Shoulder
Strength testing
Subscapularis
(resisted internal
rotation)
Evaluate for strength
and presence of pain.
Shoulder
Strength testing
Subscapularis
(“belly press”)
If the elbow ends
in the adducted
position, the
subscapularis
is weak.
Shoulder
Impingement tests
Neer’s test
Test is (+) if pain
occurs.
Shoulder
Impingement tests
Hawkin’s tests
Impingement
Coracoid
impingement
Tests (+) if pain
occurs.
Shoulder
Stability tests
Anterior
“Apprehension” test
When (+) and
accompanied by
recent acute trauma,
suggests anterior
dislocation.
Shoulder
Stability tests
Anterior
Relocation test
When (+), suggests
chronic anterior
instability.
Shoulder
Stability tests
Anterior
“Load and shift” test
Up to 25% anterior
translation is
considered normal.
Shoulder
Stability tests
Inferior
“Sulcus sign”
Shoulder – Sulcus sign
With stress
Without stress
(+) sulcus sign
Shoulder
Stability tests
Posterior
Apply axial load.
Shoulder
Stability tests
Posterior
“Load and shift” test
Up to 25% posterior
translation is
considered normal.
Shoulder
Tests for superior labral tears
O’Brien’s test
A positive test occurs
when pain occurs
only in the “thumb
down” position.
Shoulder
Tests for superior labral tears
Anterior slide test
The test is (+) when
pain or a “pop” or
“click” occurs at the
anterior-superior
shoulder or if the
maneuver reproduces
the patient’s pain.
Shoulder
Tests for superior labral tears
“Clunk” test
The test is (+) if a
“clunk” occurs or if
the patient’s pain is
reproduced.
Shoulder
Acromioclavicular (AC) tests
Palpation
Shoulder
Acromioclavicular (AC) tests
Crossed adduction test
The test is (+) if the
process of adduction
causes pain at the AC
joint.
Shoulder
Longhead of biceps test
Speed’s test
Test is (+) if pain is
reproduced at
longhead of biceps in
humeral groove.
Shoulder
Scapular stabilizer tests
Serratus anterior
Test is positive if
scapular “winging”
exists.
Shoulder
Scapular stabilizer tests
“Wall push”
Test is (+) if scapular
“winging” is
observed.
Knee
Bone and soft tissue anatomy (anterior)
Right
knee
Patella
Medial
Collateral
ligament
Lateral
Collateral
ligament
Medial joint line
Lateral joint line
Tibial tubercle
Patellar tendon
Knee
Bone and soft tissue anatomy (medial)
Right knee
flexed to 90°
Patella
Tibial tubercle
Medial femoral
condyle
Medial joint line
MCL
Knee
Bone and soft tissue anatomy (lateral)
Right knee
flexed to 90°
Patellar tendon
Patella
Lateral
femoral condyle
LCL
Lateral joint line
Fibula
Knee
Range of motion
Flexion
0 - 135°
Extension
0 - 15°
Int Rotation 0 – 20 to 30°
Ext Rotation 0 – 30 to 40°
Knee
Tests of medial stability (MCL)
Valgus stress test
Test performed at 30°
of flexion. Note “end
point” and if joint
opens compared to
uninvolved side.
Knee
Test of lateral stability (LCL)
Varus stress test
Test performed at 30°
flexion. Note “end
point” and if joint
opens compared to
uninvolved side.
Knee
Test for meniscal injury
Palpate for joint line
tenderness.
Knee
Test for meniscal injury
McMurray’s test
Note pain and/or
“click” or subluxing
meniscus.
Knee
Test for meniscal injury
Spring (“bounce”) test
Test is (+) if pain
occurs along joint line
when knee “bounces”
into extension.
Knee
Test for anterior stability (ACL)
Lachman’s test
Note “end point” and
or anterior translation
of tibia.
Knee
test for anterior stability (ACL)
Lachman’s test
(modification)
Knee
Test for anterior stability (ACL)
Lachman’s test
(Modification)
Knee
Tests for anterior stability
Anterior drawer
Note anterior tibial
translation and
presence or absence
of “end point”.
Knee
Tests for posterior instability
Recurvatum test
Presence of unilateral
recurvatum suggests
injury to
posterolateral corner.
Knee
Tests for posterior stability
Posterior sag
Knee
Tests for posterior stability
Posterior drawer
Note position of tibial
plateau in
relationship to lateral
femoral condyle.
Knee
Tests for posterior stability
Quadriceps active test
Test is (+) if tibia
translates in anterior
direction when
quadriceps contract.
Knee
Patellofemoral tests
Patellar
pseudocompression
test
Test is (+) if pain is
present.
Knee
Patellofemoral tests
Compression test
Test is (+) if active
contraction and
compression cause
pain.
Knee
Patellofemoral tests
Palpate medial and
lateral patellar facets.
Tenderness along
superior and medial
aspect of patella may
suggest medial plica
syndrome.
Knee
Test for patellar dislocation
Patellar apprehension
test
Test is (+) if test
causes pain and/or
fear that patella might
dislocate.
Elbow
Bone and soft tissue anatomy (lateral view)
Right elbow
Lateral epicondyle
Olecranon
Elbow
Bone and soft tissue anatomy (anterior view)
Lateral epicondyle
Medial
epicondyle
Elbow
Bone and soft tissue anatomy (posterior view)
Right
elbow
Medial epicondyle
Ulnar
groove Olecranon
Lateral
epicondyle
Elbow
Range of motion
Flexion
0 - 140°
Extension
0 - 10°
Hyperextension?
Pronation
0 - 90°
Supination 0 - 90°
Elbow
Medial epicondylitis
Tender to palpation
over medial
epicondyle.
Pain with resisted
wrist flexion.
Elbow
Lateral epicondylitis
Tender to palpation
over lateral
epicondyle.
Pain with resisted
wrist extension.
Pain with resisted
middle finger
extension.
Elbow
Ulnar collateral ligament injury
Valgus stress to
medial epicondyle
Test is (+) when
stress causes pain
and/or instability.
Elbow
Ulnar collateral ligament injury
“Milk maid’s” test
Test is (+) when
maneuver causes
pain.
Wrist/Hand
Bone and soft tissue anatomy
Right wrist
(dorsal view)
2nd dorsal
compartment (red)
Site of intersection
syndrome
(“squeaker’s wrist”)
1st dorsal
compartment (black)
Site of deQuervain’s
Ulnar styloid
TFCC
Radial styloid
Wrist/Hand
Bone and soft tissue anatomy
Right wrist
(radial view)
2nd dorsal
compartment
1st dorsal compartment
Anatomical snuffbox
Wrist/Hand
Bone and soft tissue anatomy
Right wrist
(ulnar view)
Ulnar styloid
TFCC
Wrist
Range of motion
Flexion
0 - 80°
Extension
0 - 70°
Ulnar deviation
0 - 30°
Radial deviation
0 - 15°
Wrist
Carpal tunnel syndrome
Tinel’s sign
Test is (+) if
paresthesias are
produced.
Wrist
Carpal tunnel syndrome
Phalen’s sign
Test is (+) if
symptoms are
reproduced when
hands are held in that
position. May have to
maintain that position
for 30-60 seconds.
Wrist
de Quervain’s tenosynovitis
Finkelstein’s test
Test is (+) if pain is
produced by
maneuver.
Wrist
Intersection syndrome (Squeaker’s wrist”)
Swelling, tenderness,
and crepitation
(squeaking) over
intersection of 1st and
2nd dorsal
compartments with
radial and ulnar
deviation.
Wrist
Scaphoid fracture
Tenderness over
anatomical “snuffbox.
Tenderness over
scaphoid tubercle.
Wrist
Scapholunate dissociation
Tenderness over
scapholunate
interval.
Scaphoid shift (Watson
“click” test)
Test is (+) if pain/click
occur during
maneuver.
Hand
Skier’s thumb (Gamekeeper’s thumb)
Flex thumb 20°, apply
valgus stress to
thumb and compare
instability to
uninvolved side.
Test is (+) if
pain/instability occur.
Finger
Flexor tendon injury
Evaluation of flexor
digitorum
superficialis.
Finger
Flexor tendon injury
Evaluation of flexor
digitorum profundus.
Foot/Ankle
Bone and soft tissue anatomy
Right ankle
(anterior view)
Lateral malleolus
Anterior
talofibular
ligament (ATFL)
Anterior tibiofibular ligament
(syndesmotic ligament)
Medial malleolus
Foot/Ankle
Bone and soft tissue anatomy
Right ankle
(lateral view)
Posterior
talofibular ligament
Anterior tibiofibular
ligament
Lateral malleolus
ATFL
Calcaneofibular
ligament
Foot/Ankle
Bone and soft tissue anatomy
Right ankle
(medial view)
Medial malleolus
Tarsal navicular
Foot/Ankle
Bone and soft tissue anatomy
Right ankle
(posterior view)
Medial
malleolus
Achilles tendon
Lateral malleolus
Posterior
talofibular ligament
Foot/Ankle
Bone and soft tissue anatomy
Right foot
(plantar view)
Distal, medial
calcaneus (site
of pain of
plantar fasciitis)
Calcaneus
Foot/Ankle
Range of motion
Dorsiflexion 0 – 20º
Plantarflexion
0 – 50º
Inversion 0 – 45 to 60º
Eversion
0 – 15 to 30º
Foot/Ankle
Special tests: ATFL injury
Anterior drawer
Test is (+) if
movement of the tibia
is greater than
uninvolved side. (+)
test suggests tear of
anterior talofibular
ligament (ATFL).
Foot/Ankle
Special tests: (CFL injury)
Talar tilt
Test is (+) if there is
greater subtalar
motion compared to
uninvolved side. (+)
test suggests tear of
calcaneofibular
ligament (CFL).
Foot/Ankle
Special tests: Syndesmotic (“high”) sprain
External rotation test
Test is (+) if maneuver
produces pain at site
of syndesmotic
ligament (anterior
tibiofibular ligament).
Foot/Ankle
Special tests: Syndesmotic (“high”) sprain
“Squeeze” test
Test is (+) if maneuver
produces pain at site
of syndesmotic
ligament.
Back – Lumbar Spine
Range of motion
Forward flexion
0 – 40 to 60º
Extension
0 – 25 to 35º
Lateral flexion
0 – 15 to 20º
Rotation
0 – 3 to 18º
Back – Lumbar Spine
Herniated nucleus pulposus
Straight-leg raising test
Test is (+) if radicular
pain is reproduced by
holding leg 30 - 70°
flexion
Back – Lumbar Spine
Spondylolysis
Single-leg extension test
(“stork” test)
Test is (+) if pain
localizes with
extension.
Back – Lumbar Spine
Sacroiliac (SI) dysfunction
FABER test (Flexion,
Abduction, External
Rotation)
Test is (+) if pain is
reproduced at SI joint
on same side as pain.
Back – Lumbar Spine
SI dysfunction
Gaenslen’s test
Test is (+) if maneuver
reproduces SI pain.
The End