Simple Tests for Diagnosis of Orthopaedic Conditions

Part 2

 

Before any 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 series of tests are completed, imaging is often used to confirm physical examination findings. In this second installment (see part 1 by clicking here), we examine orthopaedic tests including: too many toes sign; the squeeze test; Hawkin’s test; Neer test; the shoulder apprehension test; Lachman test; McMurray test; and Watson test.

Too Many Toes Sign

The too many toes sign is a forefoot examination used to measure abduction of the forefoot. This refers to deviation away from the midline of the body. For this test, the physician will examine the patient’s foot and ankle from behind. In a normal examination, the physician would only be able to see the fifth toe – the ankle would be in neutral alignment. If the foot is flatter than the other (the arch of the foot has dropped toward the floor) the fourth and third toe on that foot may also be seen. This examination shows the forefoot has moved away from the big toe and away from the midline.

 

Squeeze Test

The squeeze test is an ankle examination used to identify high ankle sprains. To perform the test, the physician will ask the patient to pull his or her foot toward their shinbone (dorsiflexion). Next, the physician will place one hand on the tibia and the other on the fibula and squeeze them together. If there is pain over the space between the two bones the exam suggests tibiofibular syndesmosis injury.

Hawkin’s Test (Figure 1)

Figure 1

The Hawkin’s test is an examination of the shoulder used to diagnose shoulder impingement of the rotator cuff muscles. In this test, the physician will flex the patient’s arm to 90 degrees, bend the elbow to 90 degrees and then rotate the humerus internally while stabilizing the scapula. This will drive the greater tuberosity under the coracoacromial arch impinging the supraspinatus tendon. Hawkins Test: used to diagnose shoulder impingement of the rotator cuff muscles.




Figure 2

Neer Test (Figure 2)

A second examination of the shoulder used to diagnose shoulder impingement of the posterior cuff is the Neer test. Here, the physician will passively forward flex the shoulder overhead to 180 degrees while stabilizing the scapula. Any pain noted during movement is a positive test.

Shoulder Apprehension Test

A third examination used to assess shoulder instability is the shoulder apprehension test. Here, the patient will be asked to lie in a supine position. With the shoulder abducted 90 degrees, the physician will hold the patient’s wrist and apply forward pressure from behind the shoulder. If there is pain felt when the shoulder is externally rotated, the exam is positive.

Lachman Test (Figure 3)

Figure 3

The Lachman test is a knee examination used to diagnose a torn ACL. For this examination, the patient will be asked to lie on his or her back with the knee bent at a 30-degree angle. The physician will then hold the end portion of the patient’s thigh with one hand and the top of the shin with the other. Pressure is then applied to the back of the proximal tibia below the knee. Here, the physician will determine if the knee joint is loose; a sign of an ACL injury.


McMurray Test (Figure 4)

A second examination of the knee used to diagnose tears in the meniscus is the McMurray test. To conduct this test, the patient will be placed in the supine position. The physician will then place one hand over the top of the knee with his or her thumb over one joint line and an index and middle finger over the opposite joint line. With the knee in forward flexion, the physician rotates the tibia medially and laterally. The tibia is then laterally and medially rotated and xtended beyond 90 degrees. A test is positive if a click is heard or felt.