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Inquiring Minds Want to Know: Musculoskeletal

How My Doctor Moves Me

Paula Goode, CMT

 

Orthopedic surgeons use a variety of tests to help identify the specific nature of an injury or condition. As healthcare documentation specialists, we hear these terms quite often, but since we are not in the examining room, we don’t know how these maneuvers look. The following is a list of a few common maneuvers, or signs, that orthopedists use during a physical exam to help with establishing a diagnosis, as well as a brief description of how the maneuver is accomplished. Take a few minutes to read the descriptions, and then view the videos. You will find that you can ‘imagine’ the examination, and even anticipate what the diagnosis may be based on the tests performed.

 

Orthopedic Special Tests for the Knee

 

Ligamentous instability is laxity – or loosening – of the ligaments that support the knee. The anterior cruciate ligament (ACL) and posterior cruciate ligament (PCL) provide stability to the bone as it flexes and extends.

 

Anterior Drawer Test (testing for ligamentous stability): The patient is positioned supine with the hip flexed to 45 degrees and knee bent to 90 degrees. The examiner grasps the tibia just below the joint line and applies a force to pull the tibia anteriorly.  A positive test is increased anterior translation of the involved tibia compared with the uninvolved. 

 

Posterior Drawer Test (testing for ligamentous stability): Patient is supine with their hip flexed to 90 degrees and knee flexed to 90 degrees. The examiner applies a posterior force through the proximal tibia with their thumbs on the plateau. Compare side-to-side for laxity.

 

Pivot Shift Test (testing for ligamentous stability): The patient is positioned supine. The examiner applies a slight distraction to the leg just below the knee joint line, with a valgus and internal rotation force is applied to an extended knee.  While maintaining these forces, the knee is flexed past 30 degrees.

 

Lachman Test (testing for anterior cruciate ligament, or ACL, injury): Similar to the anterior drawer except the hip is relaxed and knee is flexed to 30 degrees.

 

Valgus and Varus Stress Tests: Patient is supine with their hip slightly abducted and knee flexed to 30 degrees. A valgus stress and varus stress is then applied to the medial and lateral compartments of the knee. A positive laxity with valgus stress is indicative of medial collateral ligament (MCL) tear and positive laxity with a varus stress is indicative of a lateral collateral ligament (LCL) tear.

 

McMurray Test: The patient lies on his or her back with the knee completely flexed. The examiner rotates the foot fully outward while slowly extending the knee: a painful click in outward rotation indicates a torn medial meniscus; a painful click in inward rotation indicates a torn lateral meniscus.

 

The following link is a video that demonstrates the different tests used for evaluating knee stability: 

https://www.youtube.com/watch?v=c3643PM0a2o

 

A few more common signs/tests:

 

Tinel’s sign (for suspicion of carpal tunnel syndrome): Examiner taps on the inside of the wrist over the median nerve. If the patient feels numbness or tingling, this could be indicative of carpal tunnel syndrome.

 

Phalen’s test (for suspicion of carpal tunnel syndrome): The patient hold’s their arms out in front of them and then flexes their wrists, letting the hands hang down for about 60 seconds. If there is tingling, numbness, or pain in the fingers within 60 seconds, this may be indicative of carpal tunnel syndrome.

 

Trendelenburg (used to assess hip stability): The patient is asked to stand on one leg for 30 seconds without leaning to one side. The patient is observed to see if the pelvis stays level during the one-leg stance. A positive Trendelenburg Test is indicated if during unilateral weight bearing the pelvis drops toward the unsupported side.

 

Adson’s test (examination for a thoracic outlet syndrome): With the patient in a sitting position, the hands resting on the thighs, the examiner palpates both radial pulses as the patient rapidly fills the lungs by deep inhalation and, holding the breath, hyperextends the neck and turns the head toward the affected side. If the radial pulse on that side is decidedly or completely obliterated, the result is positive.

 

View a Tinel’s sign video:  https://www.youtube.com/watch?v=3Megs3c8lZE  

 

View a Phalen’s test video:  https://www.youtube.com/watch?v=DZ9UGuA8oAE

 

View a Trendelenburg test video:  https://www.youtube.com/watch?v=HE0lk5MVFEg

 

View an Adson’s test video:  https://www.youtube.com/watch?v=YN1jdnWJ2iY

 

Disclaimer: Video links mentioned in this article are for informational purposes only and should not be seen as an endorsement by AHDI. Users are encouraged to complete independent research of these topics and use reputable resources for study.