1. Musculoskeletal Exam 2004-2005 Primary Care Sports Medicine Department of Family Practice Hennepin County Medical Center

2. Shoulder Bone and soft tissue anatomy (anterior view) Acromion Clavicle A-C Joint Coracoid Process Longhead of biceps tendon

3. Shoulder Bone and soft tissue anatomy (lateral view) Spine of scapula A-C joint Clavicle Greater tuberosity Lesser tuberosity Coracoidprocess Supraspinatus Insertion Infraspinatus Insertion Teres Minor Insertion Subscapular Insertion

4. Shoulder Bone and soft tissue anatomy (posterior view) Spine of scapula Scapula

5. Shoulder Range of Motion Flexion 0 - 180° Extension0 - 60° Abduction0 - 180° Adduction0 - 75° IR (add)0 – 90º ER (add)0 – 90º IR (abd)0 – 90º ER (abd)0 – 90º

6. Shoulder Range of motion Combination ROM (extension, adduction, and internal rotation)

7. Shoulder Strength testing Supraspinatus (“empty-can” sign) Evaluate for strength and presence of pain.

8. Shoulder Strength testing Infraspinatus (resisted external rotation in adduction) Evaluate for strength and presence of pain.

9. Shoulder Strength testing Teres minor and infraspinatus (resisted external rotation in abduction)

10. Shoulder Strength testing Subscapularis (resisted internal rotation) Evaluate for strength and presence of pain.

11. Shoulder Strength testing Subscapularis (“belly press”) If the elbow ends in the adducted position, the subscapularis is weak.

12. Shoulder Impingement tests Neer’s test Test is (+) if pain occurs.

13. Shoulder Impingement tests Hawkin’s tests Impingement Coracoid impingement Tests (+) if pain occurs.

14. Shoulder Stability tests Anterior “Apprehension” test When (+) and accompanied by recent acute trauma, suggests anterior dislocation.

15. Shoulder Stability tests Anterior Relocation test When (+), suggests chronic anterior instability.

16. Shoulder Stability tests Anterior “Load and shift” test Up to 25% anterior translation is considered normal.

17. Shoulder Stability tests Inferior “Sulcus sign”

18. Shoulder – Sulcus sign Without stress With stress (+) sulcus sign

19. Shoulder Stability tests Posterior Apply axial load.

20. Shoulder Stability tests Posterior “Load and shift” test Up to 25% posterior translation is considered normal.

21. Shoulder Tests for superior labral tears O’Brien’s test A positive test occurs when pain occurs only in the “thumb down” position.

22. Shoulder Tests for superior labral tears Anterior slide test The test is (+) when pain or a “pop” or “click” occurs at the anterior-superior shoulder or if the maneuver reproduces the patient’s pain.

23. Shoulder Tests for superior labral tears “Clunk” test The test is (+) if a “clunk” occurs or if the patient’s pain is reproduced.

24. Shoulder Acromioclavicular (AC) tests Palpation

25. Shoulder Acromioclavicular (AC) tests Crossed adduction test The test is (+) if the process of adduction causes pain at the AC joint.

26. Shoulder Longhead of biceps test Speed’s test Test is (+) if pain is reproduced at longhead of biceps in humeral groove.

27. Shoulder Scapular stabilizer tests Serratus anterior Test is positive if scapular “winging” exists.

28. Shoulder Scapular stabilizer tests “Wall push” Test is (+) if scapular “winging” is observed.

29. Knee Bone and soft tissue anatomy (anterior) Right knee Patella Patellar tendon Medial joint line MedialCollateralligament Tibial tubercle Lateral joint line LateralCollateralligament

30. Knee Bone and soft tissue anatomy (medial) Right knee flexed to 90° Medial joint line MCL Tibial tubercle Patella Medial femoral condyle

31. Knee Bone and soft tissue anatomy (lateral) Right knee flexed to 90° Patella Fibula Lateral joint line Patellar tendon LCL Lateral femoral condyle

32. Knee Range of motion Flexion 0 - 135° Extension0 - 15° Int Rotation0 – 20 to 30° Ext Rotation0 – 30 to 40°

33. Knee Tests of medial stability (MCL) Valgus stress test Test performed at 30° of flexion. Note “end point” and if joint opens compared to uninvolved side.

34. Knee Test of lateral stability (LCL) Varus stress test Test performed at 30° flexion. Note “end point” and if joint opens compared to uninvolved side.

35. Knee Test for meniscal injury Palpate for joint line tenderness.

36. Knee Test for meniscal injury McMurray’s test Note pain and/or “click” or subluxing meniscus.

37. Knee Test for meniscal injury Spring (“bounce”) test Test is (+) if pain occurs along joint line when knee “bounces” into extension.

38. Knee Test for anterior stability (ACL) Lachman’s test Note “end point” and or anterior translation of tibia.

39. Knee test for anterior stability (ACL) Lachman’s test (modification)

40. Knee Test for anterior stability (ACL) Lachman’s test (Modification)

41. Knee Tests for anterior stability Anterior drawer Note anterior tibial translation and presence or absence of “end point”.

42. Knee Tests for posterior instability Recurvatum test Presence of unilateral recurvatum suggests injury to posterolateral corner.

43. Knee Tests for posterior stability Posterior sag

44. Knee Tests for posterior stability Posterior drawer Note position of tibial plateau in relationship to lateral femoral condyle.

45. Knee Tests for posterior stability Quadriceps active test Test is (+) if tibia translates in anterior direction when quadriceps contract.

46. Knee Patellofemoral tests Patellar pseudocompression test Test is (+) if pain is present.

47. Knee Patellofemoral tests Compression test Test is (+) if active contraction and compression cause pain.

48. Knee Patellofemoral tests Palpate medial and lateral patellar facets. Tenderness along superior and medial aspect of patella may suggest medial plica syndrome.

49. Knee Test for patellar dislocation Patellar apprehension test Test is (+) if test causes pain and/or fear that patella might dislocate.

50. Elbow Bone and soft tissue anatomy (lateral view) Right elbow Lateral epicondyle Olecranon

51. Elbow Bone and soft tissue anatomy (anterior view) Medialepicondyle Lateral epicondyle

52. Elbow Bone and soft tissue anatomy (posterior view) Right elbow Medial epicondyle Lateralepicondyle Olecranon Ulnar groove

53. Elbow Range of motion Flexion 0 - 140° Extension0 - 10° Hyperextension? Pronation0 - 90° Supination0 - 90°

54. Elbow Medial epicondylitis Tender to palpation over medial epicondyle. Pain with resisted wrist flexion.

55. Elbow Lateral epicondylitis Tender to palpation over lateral epicondyle. Pain with resisted wrist extension. Pain with resisted middle finger extension.

56. Elbow Ulnar collateral ligament injury Valgus stress to medial epicondyle Test is (+) when stress causes pain and/or instability.

57. Elbow Ulnar collateral ligament injury “Milk maid’s” test Test is (+) when maneuver causes pain.

58. Wrist/Hand Bone and soft tissue anatomy Right wrist (dorsal view) Ulnar styloid Radial styloid TFCC 1 st dorsal compartment (black) Site of deQuervain’s 2 nd dorsal compartment (red) Site of intersection syndrome (“squeaker’s wrist”)

59. Wrist/Hand Bone and soft tissue anatomy Right wrist (radial view) Anatomical snuffbox 1 st dorsal compartment 2 nd dorsal compartment

60. Wrist/Hand Bone and soft tissue anatomy Right wrist (ulnar view) Ulnar styloid TFCC

61. Wrist Range of motion Flexion0 - 80° Extension0 - 70° Ulnar deviation 0 - 30° Radial deviation 0 - 15°

62. Wrist Carpal tunnel syndrome Tinel’s sign Test is (+) if paresthesias are produced.

63. Wrist Carpal tunnel syndrome Phalen’s sign Test is (+) if symptoms are reproduced when hands are held in that position. May have to maintain that position for 30-60 seconds.

64. Wrist de Quervain’s tenosynovitis Finkelstein’s test Test is (+) if pain is produced by maneuver.

65. Wrist Intersection syndrome (Squeaker’s wrist”) Swelling, tenderness, and crepitation (squeaking) over intersection of 1 st and 2 nd dorsal compartments with radial and ulnar deviation.

66. Wrist Scaphoid fracture Tenderness over anatomical “snuffbox. Tenderness over scaphoid tubercle.

67. Wrist Scapholunate dissociation Tenderness over scapholunate interval. Scaphoid shift (Watson “click” test) Test is (+) if pain/click occur during maneuver.

68. Hand Skier’s thumb (Gamekeeper’s thumb) Flex thumb 20°, apply valgus stress to thumb and compare instability to uninvolved side. Test is (+) if pain/instability occur.

69. Finger Flexor tendon injury Evaluation of flexor digitorum superficialis.

70. Finger Flexor tendon injury Evaluation of flexor digitorum profundus.

71. Foot/Ankle Bone and soft tissue anatomy Right ankle (anterior view) Medial malleolus Lateral malleolus Anterior talofibular ligament (ATFL) Anterior tibiofibular ligament (syndesmotic ligament)

72. Foot/Ankle Bone and soft tissue anatomy Right ankle (lateral view) Lateral malleolus ATFL Calcaneofibularligament Posterior talofibular ligament Anterior tibiofibular ligament

73. Foot/Ankle Bone and soft tissue anatomy Right ankle (medial view) Medial malleolus Tarsal navicular

74. Foot/Ankle Bone and soft tissue anatomy Right ankle (posterior view) Medial malleolus Lateral malleolus Achilles tendon Posterior talofibular ligament

75. Foot/Ankle Bone and soft tissue anatomy Right foot (plantar view) Calcaneus Distal, medial calcaneus (site of pain of plantar fasciitis)

76. Foot/Ankle Range of motion Dorsiflexion0 – 20º Plantarflexion 0 – 50º Inversion0 – 45 to 60º Eversion0 – 15 to 30º

77. Foot/Ankle Special tests: ATFL injury Anterior drawer Test is (+) if movement of the tibia is greater than uninvolved side. (+) test suggests tear of anterior talofibular ligament (ATFL).

78. Foot/Ankle Special tests: (CFL injury) Talar tilt Test is (+) if there is greater subtalar motion compared to uninvolved side. (+) test suggests tear of calcaneofibular ligament (CFL).

79. Foot/Ankle Special tests: Syndesmotic (“high”) sprain External rotation test Test is (+) if maneuver produces pain at site of syndesmotic ligament (anterior tibiofibular ligament).

80. Foot/Ankle Special tests: Syndesmotic (“high”) sprain “Squeeze” test Test is (+) if maneuver produces pain at site of syndesmotic ligament.

81. Back – Lumbar Spine Range of motion Forward flexion 0 – 40 to 60º Extension0 – 25 to 35º Lateral flexion 0 – 15 to 20º Rotation0 – 3 to 18º

82. Back – Lumbar Spine Herniated nucleus pulposus Straight-leg raising test Test is (+) if radicular pain is reproduced by holding leg 30 - 70° flexion

83. Back – Lumbar Spine Spondylolysis Single-leg extension test (“stork” test) Test is (+) if pain localizes with extension.

84. Back – Lumbar Spine Sacroiliac (SI) dysfunction FABER test (Flexion, Abduction, External Rotation) Test is (+) if pain is reproduced at SI joint on same side as pain.

85. Back – Lumbar Spine SI dysfunction Gaenslen’s test Test is (+) if maneuver reproduces SI pain.

86. The End