Orthopedic Dx

pain during passive ROM
INDICATING ligamentous sprain (passive ROM=ligaments)

pain during resisted ROM
INDICATING muscle/tendon strain (active ROM= muscles/tendons)

inability to fully extend the leg due to pain and/or just pain (usually in the neck region)
INDICATING meningeal irritation/ meningitis

generalized pain in the cervical region which may extend down to T2 level
INDICATING non-specific test for structural integrity of the cervical region

difficulty in swallowing
INDICATING a space-occupying lesion at anterior portion of the cervical spine. Possibly esophageal or pharyngeal injury, anterior disc defect, muscle spasm, or osteophytes.

local or radiating pain from site of lesion
INDICATING a space-occupying lesion

localized pain on the side being tested
INDICATING localized pain: Dural sleeve adhesion and Muscular adhesion/contracture, or spasm, or ligamentous injury.

radicular pain on either side
INDICATING
(on same side) NV bundle compression, dural sleeve adhesion, or thoracic outlet syndrome.
(on opposite side) foraminal encroachment with nerve root compression.

local pain
INDICATING possible Fx vertebrae- pain on SP is ligamentous-pain on muscle is muscular.

Radiating Pain
INDICATING possible disc pathology

diminished or absence of pain
INDICATING foraminal encroachment (local pain diminishes) OR Nerve root compression (radicular pain diminishes)

increase of cervical pain
INDICATING muscular strain, ligamentous sprain, myospasm, or facet capsulitis.

exacerbation of localized cervical pain
INDICATING foraminal encroachment or facet pathology without nerve root compression

exacerbation of cervical pain WITH a radicular component
INDICATING foraminal encroachment WITH nerve root compression or facet pathology.

Flexion- 60
EXT- 75
L/R lat FLX- 45
L/R rotation- 80

a delay of more than 10 seconds (Evans 5 sec) in the returning of reddish color to the hand
INDICATING radial or ulnar artery insufficiency. The artery being held by the examiner is not the artery being tested.

flexion of the DIP joint cannot be achieved
INDICATING joint capsule contracture

flexion of the DIP joint is achieved
INDICATING a tight retinacular ligament

flexion of the PIP joint cannot be achieved
INDICATING a joint capsule contracture

flexion of the PIP joint is achieved
INDICATING tight intrinsic muscles

pain distal to the radial styloid process
INDICATING stenosing tenosynovitis of the abductor pollicis longus and extensor pollicis brevis muscle tendons (AKA DeQuervain's disease)

reproduction of pain and/or paresthesia in the median nerve distribution area (1,2,3,4 digits)
INDICATING carpal tunnel syndrome

reproduction of pain, tenderness, and/or paresthesia down the median nerve distribution area
INDICATING carpal tunnel syndrome

flexion- 80
ext- 70
ulnar dev- 30
radial dev- 20
Finger Abduction
Finger Adduction
Opposition
Thumb Extension
Thumb Flexion

pain over the medial epicondyle
INDICATING medial epicondylitis

pain over the lateral epicondyle
INDICATING lateral epicondylitis (AKA Tennis Elbow)

Pain over the lateral epicondyle
INDICATING lateral epicondylitis (AKA Tennis Elbow)

pain and/or tenderness at the site being tapped and paresthesia in the ulnar nerve distribution area (digits 4&5)
INDICATING Neuroma of the Ulnar nerve

excessive gapping and pain
INDICATING lateral collateral ligament instability.

excessive gapping and pain
INDICATING Medial Collateral Ligament instability

flexion- 150
ext- 0
supination- 80
pronation- 80

pain in the shoulder
INDICATING overuse injury to the supraspinatus and possibly the biceps tendon.

Exacerbation of pain
INDICATING degenerative tendonitis of the rotator cuff tendons (usually suprapsinatus)

pain and/or tenderness in the bicipital groove
INDICATING Bicipital Tendonitis

palpable and/or audible click
INDICATING subluxation or dislocation of the biceps tendon (rupture of the transverse ligament or a tendon subluxation beneath subscapularis muscle belly.)

localized pain and/or tenderness in the bicipital groove
INDICATING tendinitis

Audible click or the biceps tendon subluxes or dislocates
INDICATING instability of the biceps tendon possibly associated with a torn transverse humeral ligament

decrease in pain and/or tenderness
INDICATING subacromial bursitis

patient will not be able to lower the arm slowly or the arm drops suddenly
INDICATING rotator cuff tear (usually supraspinatus)

patient will have a noticable look of apprehension on their face with possible pain
INDICATING chronic posterior dislocation of GH joint

patient will have a noticable look of apprehension on their face with possible pain
INDICATING chronic anterior dislocation of GH joint

inability to touch the opposite shoulder and/or inability of the elbow to touch the chest
INDICATING Acute dislocation of the GH joint

Muscle (motor), Reflex, sensation (dermatome)- in that order

C4

Shoulder Abduction- deltoid (axially nerve)
Forearm flexion- biceps (musculocutaneous nerve)

Biceps Reflex

lateral arm

C5

Wrist extension- ECRL,ECRB, ECU (radial nerve)

Brachioradialis (broad end hammer)

anterolateral forearm, palm, thumb and 2nd digit

C6

Elbow extension- triceps (radial nerve)
Wrist flexion- FCR (median nerve), FCU (ulnar nerve)
finger extension- ext. digitorum communis, Ext indicis profundus, ext digiti minimi (radial nerve)

Triceps Reflex

3rd digit and middle of the palm

C7

Finger flexion- flexor digitorum superficialis, flexor digitorum profundus, lumbricals (median and ulnar nerves)

No reflex test for C8

4th and 5th digits, anteromedial hand and forearm

T1

finger abduction- dorsal interossei (ulnar nerve)
finger adduction- palmar interossei (ulnar nerve)

No reflex test for the T1 nerve root

anteromedial arm (distal aspect of arm to proximal aspect of the forearm)

lumbar SP, sacral tubercles, iliac crests, and PSIS (bilateral)

paraspinal muscles (palpate as unit
sciatic nerve
Gluteus Maximus
Gluteus Medius
Hamstrings- biceps femoris, semitendinosus, semimembranosus
Anterior abdominal muscles (with half sit-up)

Positive= lack of counter pressure on healthy side
Indicates= lack of organic basis for paralysis (malingering/hysteria).
With organic hemiplegia, the patient will still exert downward pressure when attempting to raise the paralyzed leg.

Radiating pain and/or dull posterior thigh pain INDICATING sciatic radiculopathy OR tight hamstrings. Positive between 35 and 70 degrees = possible discogenic sciatic radiculopathy

localized pain, low back or radiation pain down the leg INDICATING lumbo-sacral or sacroiliac problem. Pain occuring before the lumbars move = possible SI problem. Pain occuring after the lumbar SP moves= possible lumbo-sacral problem.

radiating pain in the posterior thigh INDICATING sciatic radiculopathy

pain in the posterior thigh with sudden knee flexion (buckle) INDICATING sciatic radiculopathy

pain in the lumbar region or radiculopathy INDICATING sciatic nerve root compression, helps rule out tight hamstrings

reproduction of sciatic pain before 60 degrees INDICATING sciatica

inability to perform test and/or low back pain INDICATING weak abdominal muscles or space occupying lesion

radiating pain from the sit of lesion (usually in cervical or lumbar region) INDICATING space occupying lesion

reproduction of radicular pain or inability to perform test correctly due to tripod sign INDICATING sciatic radiculopathy

pain accompanied by flexion of the knee on the affected side and body rotation away from the affected side INDICATING positive with a variety of low back pathologies. Hamstring tension on the pelvis may trigger the response.

inability to perform test INDICATING L4-L5 disc problem (L5 nerve root)

inability to perform test INDICATING L5-S1 disc problem (S1 nerve root)

Mazion Pelvic Maneuver (advancement sign)

The inability to bend at the waist more than 45 degrees, bc of (1) radiating pain along the sciatic nerve, either unilateral or bilateral
INDICATING sciatic neuralgia or radiculopathy, etc., possibly due to lumbar disc pathology

The inability to bend at the waist more than 45 degrees, bc of (2) low back pain (lumbar or pelvic regions)
INDICATING anterior (rotational) displacement of the ilium relative to the sacrum

Radiating pain down the leg causing flexion of the patients knee or knees
INDICATING Gluteal, lumbosacral or sacroiliac pathologies

inability to raise the thigh
INDICATING iliopsoas spasm

pain in the anterior thigh
INDICATING inflammation of the lumbar nerve roots

Pain in the Lumbar Region
INDICATING lumbar nerve root adhesions

L3

Foot Dorsiflexion & Inversion: Tibialis Anterior (deep peroneal nerve)

Patellar tendon

L4

Foot Dorsiflexion (name two muscles)-
Big Toe Dorsiflexion: extensor hallucis longus (deep peroneal nerve)
Toes 2,3,4 Dorsiflexion:extensor digitorum longus & brevis (deep peroneal nerve
Hip and Pelvis Abduction: Gluteus medius & minumus (superior gluteal nerve)

no reflex for the L5 nerve root

L5

Foot plantarflexion: Gastrocnemius and Soleus (Tibial Nerve)
Foot Plantar Flexion and Eversion (peroneus longus and brevis (superficial peroneal nerve)
Hip Extension: Gluteus Maxiumus (inferior gluteal nerve)

Achilles

S1

ASIS, Iliac crest, Iliac tubercle, Greater trochanter

PSIS, Ischial tuberosity, Coccyx

Femoral triangle borders (Sartorius, Adductor longus, Inguinal ligament)
Quadriceps muscles (Vastus lateralis, Vastus medialis, Vastus Intermedius, Rectus femoris)
Greater trochanteric bursa

Gluteus medius
Gluteus Maximus
Sciatic nerve
Cluneal nerves
Hamstrings (Bicep femoris, semimembranosus, semitendinosus)

Flexion 120
extension 30
abduction 45
adduction 45
internal rotation 45
external rotation 45
flexion and adduction
flexion abduction and external rotation

different measurements
INDICATING True= bony abnormality above or below level of trochanter difference (anatomical short leg)
Apparent= pelvic obliquity (tilted pelvis)

Difference in the height and anteriority of the knees
INDICATING
(1) inf one knee is lower = ipsilateral hip dislocation OR tibial discrepancy (anatomical short leg)
(2) If one knee is anterior = ipsilateral congenital hip dislocation or femoral discrepancy (contralateral short leg)

Lumbar spine maintains lordosis (should flatten) and opposite hip does not straighten
INDICATES Contracture of the hip flexors (iliopsoas)

Localized pain in long bone or in hip joint
INDICATING possible fx of long bones, or hip joint pathology.

AKA= FABERE sign
Pain in the hip region
INDICATING Hip joint pathology

pain in the hip joint
INDICATING Hip joint pathology

Pain in the sacroiliac joint
INDICATING Mechanical problem of the SI joint

Pain on the affected SI joint stressed into extension
INDICATING General sacroiliac joint lesion, anterior sacroiliac ligament sprain, or inflammation of the SI joint

Pain on the side of extension
INDICATING General sacroiliac joint lesion, anterior sacroiliac ligament sprain, or inflammation of the SI joint

pain in the hip region
INDICATING hip joint pathology

Pain in the hip/buttock region
INDICATING sacroiliac joint lesion

Affected thigh remains in abduction (normal biomechanics, the thigh/hip will adduct)
INDICATING Contraction of the Iliotibial Band or the Tensor Fascia Lata (usually secondary to synovitis of the hip, secondary to trauma of the gluteus medius and maximus.

AKA Iliac compression test
Pain in either SI joint
INDICATING SI joint lesion

Pain in the buttock and/or pain in the lumbar region
INDICATING SI joint lesion or Lumbar pathology

Pain deep in the SI joint
INDICATING sprain of the anterior SI ligaments

Hip on side being tested will flex causing the patients buttock to raise off of the table
INDICATING rectus femoris or hip flexor contracture.

High iliac crest on supported side and low crest on side of elevated leg
INDICATING weak gluteus medius muscle on the supported side

patella
Medial Tibial Plateau
Tibial Tubercle
Medial femoral condyle
lateral tibial plateau
Lateral Femoral condyle
Fibula Head

quadriceps muscles (4)
infrapatellar tendon
prepatellar bursa
superficial infrapatellar bursa
medial meniscus
lateral meniscus
Pes Anserine area (3 mcls)
popliteal fossa
LCL
MCL
gastrocnemius muscle

Flexion- 135
Extension- 0
Internal rotation
External rotation
(Make sure the hip is in flexion)

clicking sound or pain by knee joint
INDICATING Tear of the medial meniscus if positive on external rotation
Tear of lateral meniscus if positive on internal rotation
The higher the leg is raised when positive is elicited, the more posterior the meniscal injury.

AKA abduction (valgus) stress test
Gapping and or elicited pain above/at/or below joint line
INDICATING torn medial collateral ligament

AKA adduction (varus) stress test
Gapping and/or elicited pain above/at/or below joint line
INDICATING torn lateral collateral ligament

knee does not go into full extension (slight flexion remains)
INDICATING diffuse swelling of the knee, accumulation of fluid, due to possible torn meniscus

Gapping with the tibia moving away form the femur
INDICATING anterior cruciate ligament or posterior oblique ligament instability

Apprehension, distress of facial muscles, contraction of the quadriceps to bring the patella back in line
INDICATING chronic patella dislocation or pre-disposition to dislocation

Retropatellar pain and the patient is unable to hold the quadriceps contraction
INDICATING Degenerative changes of the patellar facets and/or within the trochlear groove (chondromalacia patella)

A floating sensation of the patella is a positive finding
INDICATING A large amount of swelling in the knee

Patient points to the side of pain
INDICATING Pain on the medial side is medial meniscus tear. Pain on the lateral side indicates lateral meniscus tear

Patient will point to the side of pain
INDICATING Pain on the medial side is a medial collateral ligament tear. Pain on the lateral side indicates lateral collateral ligament tear.

Calcaneus
Sustentaculum Tali
Medial Malleolus
Lateral Mallelus
Talus
Navicular
Cuboid
3 Cuneiforms
5 Metatarsals
Metatarsophalangeal Joints

Tibialis Posterior Tendon
Spring Ligament
Tibialis Anterior Tendon
Deltoid Ligament
Peroneus Brevis
Achilles Tendon
Plantar Aponeurosis
Anterior talofibular ligament
Posterior tibial artery
Dorsal pedal artery

Ankle Dorsiflexion 20
Ankle Plantarflexion 50
Subtalar Inversion 5
Subtalar Eversion 5
1st MTP joint flexion
1st MTP joint extension

AKA (anterior drawer sign of the ankle)
Translation with the talus moving away from or toward the tibia
INDICATING
(1) With tibia pushed/foot pulled; a tear/instability of the anterior talofibular ligament
(2) With tibia pulled/foot pushed; a tear/ instability of posterior talofibular ligament

(1) the foot cannot dorsiflex with knee extended, but is able to with knee flexed.
INDICATING contracture of the gastrocnemius muscle

(2) the foot cannot dorsiflex in either knee position
INDICATING contracture of the soleus muscle

(1) Absence of medial longitudinal arch in both positions
INDICATING Rigid Flat Feet

(2) Presence of the medial longitudinal arch while seated with a loss of medial longitudinal arch while standing
INDICATING Supple Flat Feet

Deep pain in the calf
INDICATING Deep vein thrombophlebitis (DVT)

Absence of foot plantarflexion motion
INDICATING Achilles tendon rupture

Sharp pain in the forefoot
INDICATING Metatarsalgia or neuroma (usually at the 3rd and 4th metatarsal interspace)