Tests & Signs in Orthopedics

• Thurston Holland Sign: presence of a amall separated fragment of bone from growth plate, occurring in salter harris type II injuries. This is also known as Shiny Corner Sign.

• Vaccum Sign: DDD (Degenerative Disc Dz)
• Posterior Fat Pad Sign/ Sail Sign: intercondylar # humerus
• Kanavel Sign: tenosynovitis
• OK sign: absent in AIN Syndrome, due to decreased thumb flexion
• Murphy sign: Make fist, observe height of MCP's, If 3rd MC (normally elevated) is flat with 2nd & 4th MC, suggests lunate dislocation
• Bunnel-Littler Sign: Extend MCP, passively flex PIP, Tight or inability to flex PIP, improved with MCP flexion indicates tight intrinsic muscles

• White Slide Method: for compartment syndrome in past

• Trethowan’s Sign: SUFE
• Mushroom Shaped head/ Coxa Plana: perthe’s dz
• Jack Test: pes planus
• Thompson’s test/ Simmond’s test: Spont TA rupture
• Obrian Needle Test: TA rupture
• Ober’s Test: IlioTibial Band Contracture Test
• SUBLIMUS test: FDS function
• Watson’s Test: scapholunate dislocation
• Terry Thomas Sign: scapholunate dislocation
• Drop Arm test: Rotator cuff tear
• Lift Off test: Subscapularis tear
• Speed’s Test/ Yergason’s Test: A pain produced on supination of the forearm against resistance. Seen in Bicipital Tendinitis
• Neer’s Impingement Sign: impingement syndrome
• Hawkin’s Sign: impingement syndrome
• O’brien’s Active compression test: SLAP Lesion ( labrum injury)
• Pinch Grip test: AIN Pathology

·         Phalen's test: Place the backs of both of your hands together and hold the wrists in forced flexion for a full minute. (Stop at once if sharp pain occurs) . If this produces numbness or "pins and needles" along the thumb side half of the hand, you most likely have Median nerve entrapment (Carpal Tunnel Syndrome). Examination by a health care professional familiar with these conditions is the way to be sure of the diagnosis and get proper treatment.

·         Adson test/ ROOS TEST: The examiner takes the patient's radial pulse while the patient takes a deep breath and rotates his/her head toward the affected side. Positive: If the pulse is diminished. Suggests thoracic outlet syndrome.

·         Anterior drawer sign-ankle: The examiner pushes the tibia backward and pulls the heel forward. Positive: If the ankle slides forward. Suggests a torn anterior talofibular ligament.

·         Anvil test: With the patient lying down with the knee straight the examiner strikes the bottom of the foot with a closed fist. Positive: Pain in the hip. Indication of early hip joint disease.

·         Apley test: The patient is on his stomach and the knee is bent to 90 degrees. The examiner rotates the tibia in both directions and pushes downward. Repeat the test while pulling the patient's foot upward. Positive: If the patient complains of pain during compression, suggests meniscal injury. Complaints of pain with distraction indicate a ligamentous injury.

·         Apprehension test: The examiner attempts to gently move the patella laterally (dislocate it) and watches the patient's face. Positive: If the facial expression is one of apprehension and distress. Suggests the patella has a tendency to dislocate laterally.

·         Axial loading (Waddell): Downward pressure is put on the head or shoulders by the examiner. Positive: Produces low back pain.

·         Bench test: The patient kneels on a bench approximately 12 inches high and is asked to bend over and touch the floor. This can be done by bending only at the hips. Positive: When the patient claims he cannot do this because of back pain. Indicates nonorganic back pain or symptom magnification.

·         Bracelet test: The examiner grasps the patient's wrist and applies pressure tot he distal ends of the ulna and radius. Positive: Complaints of pain in patients with rheumatoid arthritis involving the radioulnar joint.

·         Contralateral straight leg raising test: With the patient lying flat on his back, the examiner raises the patient's non-involved leg with the knee straight. Positive: Back pain or leg pain in the involved leg is experienced. Indicates nerve root irritation and possible disc herniation.

·         Distraction test: The examiner places one hand under the chin and the other hand under the back of the patient's head and gradually lifts the head (opposite of the compression test). Positive: Decrease in pain. Signifies that the patient has a disc pathology, arthritis or nerve root irritation. If distraction causes increased pain, it suggest the patient may have a cervical strain/sprain.

·         Drawer sign-knee: With the patient on his back, the knee is bent to 90 degrees with the foot planted on the table. The examiner pulls the tibia forward in the anterior drawer test. Positive: Excessive forward motion. Indicates a torn anterior cruciate ligament. Posterior drawer test: The examiner pushes the tibia backwards. Positive: Excessive motion in this direction suggests a torn posterior cruciate ligament. Drop arm test: The arm is lifted to a fully abducted (out and up) position. The patient is asked to slowly lower the arm to his side. Positive: The patient cannot control the arm movement and lets the arm drop when the arm is less than 90 degrees from his side. Indicates a rotator cuff tear.

·         FinKelstein sign: The thumb is bent toward the palm. Positive: If this maneuver causes pain. Indicates tenosynovitis of the abductor pollicis longus tendon or de Quervain's tenosynovitis.

·         Gaenslen sign: With the patient fiat on his back, the knee and hip of one leg are held in a bent position by the patient while the other leg, hanging over the edge of the table, is pressed downward by the examiner. Positive: Pain is produced. Indicates a sacroiliac problem.

·         Goldthwaite sign: With the patient flat on his back, the examiner places one hand under the patient's lower back and raises the patient's leg with the other hand. Positive: Pain. If the patient complains of pain before the lumbar spine is moved this indicates a sacroiliac sprain. If pain is felt after the lumbar spine is moved then it's an indication of a sprain of the L5 , S1 joint.

·         Heel walk test: The patient is asked to walk on his heels. Positive: The patient is unable. Suggests L4-5 nerve root irritation.

·         Toe walk test: The patient is requested to walk on his toes. Positive: The patient is unable to do the activity. Suggests L5 - S1 nerve root irritation.

·         Homan's sign: Passive dorsiflexion of the foot.Positive: Pain occurs in the calf. Indicates possible thrombosis (clots) of the veins in the calf.

·         Hoover test: With the patient lying on his back, the examiner's hand is placed under the patient's heel. The patient is asked to raise the opposite leg with the knee straight. A maximum attempt will result in downward pressure on the examiner's hand. Positive: Lack of effort implies malingering or symptom magnification.

·         Impingement test: The examiner forcefully abducts and internally rotates the shoulder. This motion causes the greater tuberosity of the humerus to impinge the undersurface of the acromion. Positive test indicates impingement syndrome (bursitis, rotator cuff problem or degenerative changes).

·         Jansen test:The patient is asked to rest his ankle on the opposite knee. Positive: Patient is unable to do this. Indicates significant osteoarthritis of the hip.

·         Lachman test: The patient lies on his back with the knee bent to 20 degrees. The examiner pulls the tibia forward and grades the amount of motion present. Excessive motion indicates a torn anterior cruciate ligament.

·         Pivot shift test: With the patient on his back, the examiner rotates the foot inward with the knee straight. The examiner puts a valgus (knock-knee) stress on the knee and gradually bends the knee. Positive: If the knee shifts at 30-40 degrees. Indicates a torn anterior cruciate ligament.

·         Roos maneuver: The patient raises his arms out to the side with palms facing forward. The patient holds this arm position while opening and closing the hands repeatedly for 3 minutes. Positive: Patient develops tingling and pain. Suggests possible thoracic outlet syndrome or carpal tunnel syndrome.

·         Spurling test: Compression on the head with the neck in a position of rotation and extension. Positive: Patient complains of radicular pain into the upper extremities. Indicates pressure on a nerve root.

·         Straight leg raise (SLR): Lying: The patient is lying fiat on his back while the examiner raises the patient's leg with the knee straight and stops when pain is experienced down the leg. Positive: The patient complains of pain between 0-45 degrees with or without the ankle at 90 degrees. Sitting: If a patient has a positive straight leg raise when lying down, but a negative straight leg in sitting, this is considered a positive Waddell test (inappropriate) because it is inconsistent.

·         Superficial tenderness (Waddell): Pain with very light touch is a positive test. Light touch should not cause any pain unless there is a dermatological (skin) condition superficially (on the outside).

·         Tennis elbow test , COZEN TEST: The patient makes a fist and bends the wrist backwards. The examiner applies pressure on the wrist. Positive: Patient complains of pain at the elbow on the outer side.

·         Thomas test: TO RULE OUT FLEAION CONTRACTURE, The patient lies on his back. One leg is flexed so that the knee touches the chest and the lumbar spine is flattened. The angle taken by the other hip is the degree of tightness in the hip flexor muscles. The larger the degree, the more tightness in the hip flexor muscles.

·         ELY’s TEST: tight rectus femoris muscle, if hip flexes as the knee is flexed

·         Tinel sign: Tapping over the transverse carpal ligament produces pain, tingling or numbness in the distribution of the median nerve. Tinel sign means tapping on a nerve, so it can be done in other areas of the body, but usually associated with assessment of carpal tunnel syndrome.

·         Trendelenburg test: The examiner stands behind the patient and asks him to lift one leg and then the other. Positive: If the pelvis drops downward on the weighted side. Suggests hip weakness, a bony deformity of the femoral neck, or a dislocated hip joint. 

·         Valsalva test: The patient holds his breath and bears down as if he were moving his bowels. Positive: Causes radicular pain in the extremities. May indicate a herniated disc or tumor.

·         Waddell test: A group of five tests or signs utilized by physicians to detect malingering, symptom magnification syndrome, or psychological problems. This test is for patients complaining of low-back pain. Positive: If the patient demonstrates inconsistent or nonanatomical physical signs in three or more of the five tests.

·         Patrick Test (FABER) : SI joint pathology, Hip osteoarthritis presents with groin pain exacerbated by the Faber maneuver (also called the Patrick test), which is a mnemonic for Flexion, ABduction, and External Rotation.

·         Ortolani, Barlaw’s, Galleazi’s Test: DDH

·         Double line sign in MRI: AVN head femur

·         Crescent Sign : LCPD

·         Theater sign : Anterior knee pain, worse with sitting, PATELLOFEMORAL SYNDROME [PFS]

·         “Too many toes” sign: Standing, view foot posteriorly, “Too many toes” (more seen laterally than other side): acquired flat foot

·         To minimize the cases of Little League elbow, which is a medial epicondylitis that results from overuse and flexor-pronator strain. The throwing of a curve ball puts extra stress on the ulnar collateral ligament of the medial aspect of the elbow. Severe strain can result in partial separation of the apophysis, and, occasionally, bony avulsions can occur.

·         The “drop arm sign” may be positive in rotator cuff tear (abduct the arm to 180° and ask patient to bring it down slowly; at 90° the arm will drop quickly due to weakness).

·         Plantar fasciitis causes pain over the medial aspect of the plantar fascia. It usually starts slowly and is of long duration. The windlass test is positive (pain increases with ankle and great toe dorsiflexion).

·         Ischial bursitis (“weaver’s bottom,” so named because weavers had to sit for long periods of time, which led to ischial bursitis) causes pain in the buttock made worse with sitting and with hip flexion. Today, it is usually a problem for workers who operate heavy equipment on rough roads.

·         The Apley test is used to detect a torn meniscus. A positive test occurs when there is pain, clicking, or locking of the knee with rotation.

 
·         Both the ballottement test and the bulge sign detect a knee effusion. The balottement procedure is performed with the knee extended. Downward pressure is applied on the suprapatellar pouch and the patella is pushed backward against the femur. Pressure on the patella is then released and the patella floats out (fluid wave) with an effusion. A positive bulge test occurs when a bulge of fluid returns to the medial aspect of the knee with lateral tapping