Simple Tests for Diagnosis of Orthopaedic Conditions

Simple Tests for Diagnosis of Orthopaedic Conditions

Dr.Ebraheim Examination/Evaluation educational videos

Part 1

Before studies are done or medications are prescribed, an orthopaedist begins with a thorough physical examination of the patient. During this process, the physician investigates the patient’s body with a series of tests to locate areas of pain or concern. Once the tests are completed, imaging is often used to confirm physical examination findings. Many tests are used to diagnose conditions of the hand and wrist, including Finkelstein and Phalen tests, Froment’s sign, “ok” sign and wrist drop.

Finkelstein’s Test (Figure 1)

Figure 1

Used to diagnose DeQuervain’s syndrome, an inflammation of the tunnel or sheath that surrounds two tendons controlling movement of the thumb, often caused by repeated motion of the wrist and hand. To perform the test, a patient is asked to make a fist with the thumb far enough inside to touch the little finger.

Next, the patient is instructed to move the wrist in the direction of the little finger.
If a patient experiences pain during this movement, DeQuervain’s tenosynovitis may be the cause.
 

Faber's Test (Figure 2)

Figure 2

An acronym for flexion, abduction, external rotation, this test examines the sacroiliac joint and evaluates back pain. During this test, a physician forces external rotation of the affected hip in the supine position which causes pain in the sacroiliac joint. In addition, there would be tenderness over the sacroiliac joint.

 

 

 

 

 

Phalen's Test (Figure 3)

 

An alternative test used to identify carpal tunnel syndrome. Here, the physician bends the patient’s wrists downward and pushes the backs of the hands together for approximately one minute.

Figure 3

A positive test is indicated by numbness, pain or tingling along the median nerve.

This test increases the pressure in the carpal tunnel and has the affect of pinching the median nerve between the proximal edge of the transverse carpal tunnel ligament and the anterior border of the distal end of the radius.

 

 

 

 

 

 

 

Froment’s Sign (Figure 4)

 

Figure 4

Another exam of the wrist and hand is the Froment’s sign. Patients are asked to hold an object (usually a piece of paper) between the thumb and palm (which is flat); the object is then pulled away.

A patient with a negative Froment’s sign will be able to maintain a hold on the object without problem. A patient with a positive test, however, will have trouble holding the paper and will compensate by flexing the flexor pollicis longus of the thumb.

This test is used to identify ulnar nerve palsy -- paralysis caused by damage or compression of the ulnar nerve.

 

 

 

Figure 5

“OK” Sign (Figure 5)

Patients with an injury to the anterior interosseus nerve cannot perform the “ok” sign, opposing the second finger and thumb. The anterior interosseous nerve is a branch of the median nerve that supplies the deep muscles of the front of the forearm

 

 

 

 

 

 

 

 

 

Wrist Drop (Figure 6)

Figure 6

 

A patient with a wrist drop cannot extend or raise the wrist. It is typically caused by damage to the radial nerve, which stimulates the muscles in the forearm.

 

 

 

 

 

Adson's Test (Figure 7)

 

Another test used to evaluate upper extremity region, specifically for thoracic outlet

Figure 7

syndrome, is the Adson test. Here, the physician palpates the radial pulse while moving the upper extremity in abduction, external rotation and extension. The patient is then asked to rotate his or her head toward the side being tested while taking a deep breath and holding it. If the patient shows a diminished or absent radial pulse, the exam is positive. Thoracic outlet syndrome refers to a group of disorders that affect the brachial plexus and subclavian artery. The brachial plexus refers to the nerves that pass into the arms from the neck.

 

Lift-Off Test

The Lift-off test is used to diagnose tears of the subscapularis tendon. The patient places the back of the hand on his or her back with the arm in internal rotation. The patient is then asked to lift the hand away from the back. The physician will push the hand toward the back to test the strength of the subscapularis if the patient is able to take the hand away from the back. If the patient is unable to lift the hand against the physician’s resistance, a tendon rupture or injury to the subscapularis is present.

 

Straight Leg Raise Test (Figure 8)

 

Figure 8

Another test used to evaluate back pain is the straight leg raise test. Which can determine whether a patient with low back pain has a herniated disk. The physician will place one hand under the ankle  and the other hand on the knee. The physician then lifts the ankle and flexes the thigh relative to the pelvis. A positive test will yield reproducible pain in the patient’s leg and lower back.

 

 

 

 

Thompson's Test (Figure 9)

Figure 9

The Thompson test is used to examine the Achilles tendon. Here, the patient is asked to lie prone on the examination table with the foot extended beyond the end of the table. The physician will then squeeze the calf. A non-injured response to this maneuver is a slight plantar flexion (movement which increases the angle between the foot and the leg). Lack of movement can indicate a rupture of the Achilles tendon.