Musculoskeletal Exam 2004-2005

1. Musculoskeletal Exam2004-2005 Primary Care Sports Medicine Department of Family Practice Hennepin County Medical Center

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

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

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

5. Flexion 0 - 180° Extension 0 - 60° Abduction 0 - 180° Adduction 0 - 75° IR (add) 0 – 90º ER (add) 0 – 90º IR (abd) 0 – 90º ER (abd) 0 – 90º ShoulderRange of Motion

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

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

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

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

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

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

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

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

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

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

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

17. Inferior “Sulcus sign” ShoulderStability tests

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

19. Posterior Apply axial load. ShoulderStability tests

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

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

22. 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. ShoulderTests for superior labral tears

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

24. Palpation ShoulderAcromioclavicular (AC) tests

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

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

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

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

29. KneeBone and soft tissue anatomy (anterior) Right knee Patella Medial Collateral ligament Lateral Collateral ligament Medial joint line Patellar tendon Lateral joint line Tibial tubercle

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

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

32. Flexion 0 - 135° Extension 0 - 15° Int Rotation 0 – 20 to 30° Ext Rotation 0 – 30 to 40° KneeRange of motion

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

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

35. Palpate for joint line tenderness. KneeTest for meniscal injury

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

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

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

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

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

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

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

43. Posterior sag KneeTests for posterior stability

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

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

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

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

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

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

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