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Important Clinical Signs and Tests

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Important Clinical Signs and Tests IMPORTANT CLINICAL SIGNS AND TESTS UPPER LIMB ❖ Impingement at shoulder: ▪ Neer’s test ▪ Hawkin’s kennedy test ❖ Supraspinatous testing (most common tendon rupture): Jobe’s empty can sign, Drop arm test (Codman) ❖ Subscapularis testing: ▪ Gerber’s Belly press test/ Napoleon sign ▪ Lift off test ▪ Bear hug test (for upper third fibers of subscapularis) ❖ Infraspinatous (and Teres Minor) testing: External rotation lag sign (mainly Infra), Horn Blower sign (mainly Teres), Drop sign (mainly Infra) ❖ Axillary nerve testing (in shoulder dislocation or fracture neck humerus): Regiment batch sign ❖ Shoulder instability - Anterior instability: Anterior apprehension test, Jobe’s relocation test, Andrews test, fulcrum test, Crank test and Surprise test (most accurate); Mnemonic— Andrews surprised his friend Jobes by hitting from behind, so hard with a fulcrum that, it produced a crank sound dislocating shoulder anteriorly. - Posterior instability: Posterior drawer / Jerk test/ Posterior apprehension test, posterior Clunk test, Jahnke test, Jerk (provocative) test, push pull test, circumduction test; Mnemonic—typical scene in a bus: piche se (posterior) janke jerk and push pullkia and last main circumduction hi kardia. - Inferior instability: Sulcus sign - Anterior shoulder dislocation clinical tests: ▪ Dugas test ▪ Callway test ▪ Hamilton ruler ▪ Bryant test ❖ SLAP (superior labral tear from anterior to posterior) tear at shoulder: O’brien’s test, Biceps load tests I and II, Dynamic labral shear, Upper cut test ❖ Elbow dislocation : bowstring of triceps ❖ Tennis Elbow : ▪ Cozen’s test ▪ Moudsley’s test ▪ Mill’s maneuvre ❖ Biceps tendinitis: ▪ Speed’s test ▪ Yergasson’s test ❖ VIC: Volkman’s sign ❖ Piano key sign: Distal radio ulnar joint instability (E.g. Madelung deformity, Malunited colles fracture etc.) ❖ Dequervain’s syovitis: Finkelstein test ❖ Scaphoid fracture: Watson’s test ❖ Flexor tenosynovitis: Kanavel’s signs ❖ Finsterer sign: Keinbock’s disease ❖ Opera glass deformity of hand: Psoriasis NEUROLOGY ❖ Tinel’s sign & motor march: Signs of nerve regeneration ❖ Serratus anterior/ Rhomboides/ trapezius palsy: winging of scapula ❖ Erb’s palsy: porter tip hand ❖ Claw hand: ▪ Klumpke’s paralysis ▪ Ulnar nerve palsy ▪ Combined median & ulnar nerve palsy ❖ Radial nerve palsy: Wrist drop; in PIN palsy there is Finger drop (loss of extension at MCP joints) ❖ Ulnar nerve palsy: ▪ Book test (Froment sign) for adductor pollicis ▪ Card test for Palmar interossei ▪ Egawa’s test for Dorsal interossei ▪ Clawing in medial two digits ❖ Median nerve palsy: ▪ Pointing sign/ Clasping sign/ Pope’s sign (tests deep flexors) ▪ Pen test for Abductor pollicis brevis ▪ Ape thumb deformity due to paralysis of Abductor pollicis brevis ▪ Schaeffer's test for Palmaris Longus ❖ Carpal tunnel syndrome: ▪ Phalen’s test (conventional test) ▪ Durkan’s direct nerve compression test (most sensitive/ best) ▪ Hand diagram (most specific) ▪ Semmes weinstein monofilament test ❖ Sciatic / Common peroneal nerve palsy > Deep peroneal nerve palsy: foot drop ❖ Mudler’s click: Morton’s neuroma ❖ Tests for Thoracic outlet syndrome ▪ Adson’s test ▪ Halstead manoeuvre ▪ Wright’s test/ hyperabduction test ▪ Military posturing ▪ Roos test ❖ Patency of radial & ulnar artery: Allen’s test ❖ Signs of Nerve root compression : ▪ SLR (passive) ▪ Well leg / cross leg SLR (large disc) ▪ Laseague’s test ▪ Braggard sign ▪ Bowstring sign of Mcnab ▪ Hoover test and Waddell’s signs: For malingering ❖ Modified Schober’s test: For testing lumbar spine flexion (as in Ankylosing spondylitis) ❖ Scoliosis: Adam’s test for determining fixity of a curve LOWER LIMB ❖ Signs of supra-trochanteric shortening (Neck femur fracture, hip dislocation acute or chronic): ▪ Nelaton’s line (can detect shortening in bilateral conditions) ▪ Chinese line ▪ Shoemaker’s line ▪ Bryant’s triangle ❖ Fixed flexion deformity at the hip: Thomas test ❖ Ilio-tibial band contracture : Ober’s test ❖ Posterior dislocation of hip: Vascular sign of Narath ❖ Desault sign: Intracapsular fracture Neck Femur ❖ SCFE: Axis deviation ❖ AVN hip: Sectoral sign ❖ Perthes disease: Caffey’s sign ❖ Siffert Katz sign: Blount’s disease ❖ CDH (leg length discrepancy): Allis’s/ Galaezzi test ❖ Unstable hip (CDH, Non-union NOF fracture, Neglected dislocation of hip): Telescopy positive; Gluteus medius weakness: Trendelenburg test ❖ Iliopsoas tendinitis: Ludloff sign ❖ SI joint involvement (Ankylosing Spondylitis): ▪ Gaenslen’s test ▪ Patric / FABER test ▪ Pump handle test ❖ Ankylosing Spondylitis with cervical spine involvement: Fletche test ❖ CDH screening: ▪ Ortolani’s test ▪ Barlow’s test (better) ❖ Osteochondritis Dissecans knee: Wilson’s test ❖ Chondromalacia patellae: Movie/ theatre/ cinema sign ❖ Pes cavus: Coleman block test ❖ Tendo Achilles rupture (second most common tendon rupture): Simmonds Thompson test, Matles test ❖ Tests for Ligament Injuries of knee - For Collateral ligament injuries- Stress tests (Varus stress test for LCL and Valgus stress test for MCL tear) - most specific for collaterals when done at 30o of knee flexion, Apley’s distraction test - For ACL - Anterior drawer, Lachman test that is done at 15o of knee flexion (most sensitive). Most specific test is Pivot shift test. - For PCL- Posterior drawer (best), Godfrey’s posterior sag, Quadriceps active test - For Meniscus- Mcmurray test, Bounce home test, Apley’s grinding test, Thessalay’s test (currently being proposed as best screening test), Duck waddle test (Childress sign), Joint line tenderness (Best/ most specific test for meniscal injury) ❖ Tests for Knee instability include: - Antero lateral instability (more common) (main component is ACL tear) - Pivot shift test - Postero-lateral instability (main component is PCL tear) - Reverse Pivot shift test, Dial test [Dial test is performed at both 90o and 30o knee flexion. At 30o positive test indicates postero lateral corner (PLC) injury while at 90o it indicates PCL plus PLC injury] MISCELLANEOUS ❖ Chvostek’s sign: Tetany ❖ Beighton’s criteria: Generalized ligamentous laxity ❖ Sausage digits and arthritis mutilans: Psoriatic arthritis ❖ Scurvy: Pseudo-paralysis of parrot ❖ Trident hand: Achondroplasia ❖ Blue sclera/ Dentonogenesis imperfect: Osteogenesis imperfecta .
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