Orthopedic Assessment Methods

MCL Sprain Laxity Demonstration

This is a great video showing how the medial side of the knee opens up when  the medial collateral ligament is sprained. Embedded Video Blogged with the Flock Browser

ACLR Animation

This is a nice short animation demonstrating a method for completing a Bone-Tendon-Bone Anterior Cruciate Ligament Reconstruction. Embedded Video Blogged with the Flock Browser

Posterior Cruciate Rupture

    This is a good video demonstrating a Posterior Cruciate Sprain. Embedded Video Blogged with the Flock Browser

Knee - Anterior Drawer Test

Click to Play The Anterior Drawer Test for the knee is used to examine the integrity of the anterior cruciate ligament. The patient is placed supine on the table with the knee in 90 degrees of flexion and the hip flexed approximately 45 degrees. The examiner places her hands around the proximal tibial with her thumbs crossing the anterior joint line. The patient's foot is anchored in a neutral position by the examiner's thigh. The examiner tells the patient to relax her hamstrings. This su...

Knee - Apley's Distraction Test

Click to Play Apley's distraction test is commonly performed in conjunction with Apley's compression test. The patient starting position is the same (prone with the knee flexed to 90 degrees). The examiner will apply traction to the lower leg while rotating the tibia medially and laterally. Pain with this maneuver can indicate a ligamentous injury of the knee.

Knee - Apley's Distraction Test

Click to Play Apley's distraction test is commonly performed in conjunction with Apley's compression test. The patient starting position is the same (prone with the knee flexed to 90 degrees). The examiner will apply traction to the lower leg while rotating the tibia medially and laterally. Pain with this maneuver can indicate a ligamentous injury of the knee.

Knee - Apley's Compression Test

Click to Play Apley's Compression test is used to assess the menisci of the knee. The patient is place prone on the exam table with her knee flexed to 90 degrees. The examiner applys a downward compressive force through the lower leg while laterally rotating the lower leg. Pain with this maneuver can indicate an injury of either meniscus.

Knee - Apley's Compression Test

Click to Play Apley's Compression test is used to assess the menisci of the knee. The patient is place prone on the exam table with her knee flexed to 90 degrees. The examiner applys a downward compressive force through the lower leg while laterally rotating the lower leg. Pain with this maneuver can indicate an injury of either meniscus.

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Knee - Lachman's Test

Click to Play The Lachman's test (aka Ritchie test) is the preferred method of assessing for instability of the anterior cruciate ligament.  The patient is supine on the table with their knee flexed approximately 20-30 degrees.  The examiner grasps the medial proximal tibia with one hand and the distal thigh with the other.  The examiner then applies a posteromedial to anterolateral force to the knee, essentially pulling the tibia anteriorly on the femur.  The amount of translation is comp...

Knee - Lachman's Test

Click to Play The Lachman's test (aka Ritchie test) is the preferred method of assessing for instability of the anterior cruciate ligament.  The patient is supine on the table with their knee flexed approximately 20-30 degrees.  The examiner grasps the medial proximal tibia with one hand and the distal thigh with the other.  The examiner then applies a posteromedial to anterolateral force to the knee, essentially pulling the tibia anteriorly on the femur.  The amount of translation is comp...

Knee - Slocum Anterior Drawer

Click to Play The Slocum Drawer test is used to assess for medial and lateral rotary instabilities of the knee.  The exam is administered similarly to the anterior drawer test with the exception that the tibia is rotated medially and laterally to assess for anterolateral and anteromedial instability respectively.  The knee is placed in approximately 90-degrees of flexion with the foot flat on the table.  Thirty-degrees of medial rotation is applied to the tibia by rotating the foot and the...

Knee - Patellar Apprehension Test

Click to Play The Acute Patella Injury Test (aka Apprehension Test) is used to assess the possibility that the patient may have sustained a patellar dislocation which spontaneously reduced.  This test provokes the same sensations which would have been present when the dislocation occured and therefore will elicit a reactive contraction of the quadriceps muscles by the patient in an attempt to avoid a recurrance of the dislocation.  This reaction is referred to as an apprehension sign.  The...

Knee - Posterior Sag Test

Click to Play The posterior sag test (also known as the gravity drawer test, drop back sign, or Godfrey's test) is used to assess posterior cruciate ligament laxity.  The patient is supine with her hips and knees bent to ninety-degrees.  The examiner supports the patient's legs at the ankles and observes for an indication that the tibia has shifted posteriorly (toward the table) as compared to the uninvolved knee.

Knee - McMurray's Test

Click to Play The McMurray test is a test used to determine the presence of a meniscal tear.  While the patient is supine on the exam table the examiner grasps the knee, placing one hand over the top of the knee with her thumb over one joint line and her index and middle finger over the opposite joint line.  The examiner begins with the knee in full flexion and then medially and laterally rotates the tibia while paying attention for an audible click.  The examiner then laterally rotates th...

Knee - McMurray's Test

Click to Play The McMurray test is a test used to determine the presence of a meniscal tear.  While the patient is supine on the exam table the examiner grasps the knee, placing one hand over the top of the knee with her thumb over one joint line and her index and middle finger over the opposite joint line.  The examiner begins with the knee in full flexion and then medially and laterally rotates the tibia while paying attention for an audible click.  The examiner then laterally rotates th...

Shoulder - Sulcus Sign

Click to Play The sulcus sign is an examination to determine the extent and/or presence of inferior instability of the glenohumeral joint.  This test can be administered with the patient either seated or standing with his arm relaxed at her side.  The examiner palpates the shoulder by placing her thumb and fingers on the anterior and posterior aspects of the humeral head.  The examiner grasps the patient's elbow with her other hand and applies a downward distraction force.  A positive test...

Shoulder - Empty Can Test

Click to Play The empty can test is used to assess for the presence of injury/pathology to the supraspinatus.  This test is also known as the supraspinatus strength test.  The patient is either seated or standing with his arms in a position of scapation (approximately 30-degrees of horizontal adduction with the shoulders abducted to 90-degrees).  The patient attempts to resist downward overpressure being applied by the examiner.  A positive result occurs when the patient is unable to resis...

Shoulder - Apprehension Test

Click to Play The shoulder Apprehension test is also known as the Fowler test or the Jobe relocation test.  The examination is used to assess for shoulder instability.  This examination is best partnered with the shoulder relocation test.  The apprehension test (AKA crank test) is used to assess for an anterior shoulder dislocation.  The patient lies on the table supine with the shoulder abducted 90-degrees and maximum external rotation.  The examiner typically will support the humerus wit...

Shoulder - Adson's Test

Click to Play Adson's test is used to assess for the presence of Thoracic Outlet Syndrome at the scalene triangle. The patient is examined standing. The examiner palpates the radial pulse while moving the upper extremity in abduction, extension, and external rotation. The patient then is asked to rotate her head toward the involved side while taking a deep breath and holding it. A positive exam will result in a diminished or absent radial pulse.

Ankle - Anterior Drawer Test

Click to Play The Anterior Drawer Test is used to assess for instability of the ankle. Laxity is typically due to a sprain of the anterior talofibular ligament. To administer the test the examiner stabilizes the lower leg of the patient with one hand while the other hand cups the heel. An anterior force is applied to the heel while attempting to move the talus anteriorly in the ankle mortise. This test is administered bilaterally and results are compared.

Ankle - Talar Bump Test

Click to Play The heel percussion test (AKA bump or tap test) is used to differentiate a tibial stress fracture from medial tibial stress syndrome. The examiner stabilizes the patient's lower leg on the table and brings the foot into a relaxed neutral position. The examiner then applies a percussive force to the plantar surface of the heel toward the lower leg. A positive result of this exam will be the illicitation of localized pain at the point of the suspected fracture.

Ankle - Lower Leg Compression Test

Click to Play Pott's Compression (AKA squeeze) test is used to assess for the presence of a fracture of the lower leg. The examiner places the pads his or her hands on either side of the upper portion of the leg, one being located just distal to the head of the fibula and the other being at the same level on the medial border of the tibia. The examiner then pushes his or her hands together to squeeze the tibia and fibula together. If the athlete reports a pain at the distal tibia or distal...

Ankle - Kleiger's Test

Click to Play This test is used to determine if there is instability caused by a sprain of the Deltoid ligament of the ankle. The patient is examined in a seated position with his or her knee flexed over the end of the table and foot relaxed non-weight bearing. The examiner grasps the foot and rotates it laterally in the mortise of the ankle. Increased instability compared bilaterally with or without pain is an indication of a positive test. The examiner may also palpate a talar displaceme...

Ankle - Kleiger's Test

Click to Play This test is used to determine if there is instability caused by a sprain of the Deltoid ligament of the ankle. The patient is examined in a seated position with his or her knee flexed over the end of the table and foot relaxed non-weight bearing. The examiner grasps the foot and rotates it laterally in the mortise of the ankle. Increased instability compared bilaterally with or without pain is an indication of a positive test. The examiner may also palpate a talar displaceme...

Ankle - Talar Tilt Test

Click to Play The talar tilt test is used to examine the integrity of the calcaneofibular or the deltoid ligament. The patient is seated confortably on the end of an exam table. Possible alternate positions can be sidelying or supine. The examiner grasps the foot and places it in anatomical position while stabilizing the tibia and fibula. To test the calcaneofibular ligament the examiner will adduct and invert the calcaneous into a varus position. The deltoid ligament is examined by abduct...

Ankle - Thompson Test

Click to Play The Thompson test is used to examine the integrity of the Achilles' tendon. With the patient lying prone on the table with his or her foot extended beyond the end of the table the examiner squeezes the calf. A normal non-injured response to this maneuver is slight plantarflexion of the ankle. Lack of ankle movement can indicate a rupture of the Achilles' tendon.

Lower Leg - Homan Sign

Click to Play Homan's sign is used to determine the presence of a deep vein thrombophlebitis. The patient lies prone on the table with the knee fully extended. The examiner passively dorsiflexes the patient's ankle while palpating the calf. Pain in the calf and/or pain with palpation is considered a positive test.

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