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Файл:Ординатура / Хирургия / Библиотека им академика М.И. Перельмана / Книга_3067_Библиотеки_им_академика_М_И_Перельмана
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30
Ankle and Foot
• Inspect
• Deformities, nodules, swelling,
calluses or corns, medial and lateral
malleolus
• Palpate
• Achilles tendon, anterior ankle, heel
(posterior and inferior calcaneus),
plantar fascia, medial and lateral
malleolus, metatarsophalangeal joint
(MTP)
• ROM (4)
• Plantarflexion, dorsiflexion, inversion,
eversion
• Strength (3)
• Plantarflexion, dorsiflexion, extensor
hallucis longus
Morton’s
neuroma
Plantar
wart
Hammer toe Bunion
Patella
Lateral
collateral
ligament
Lateral
meniscus
Fibula
Femur
Posterior
cruciate
ligament
Medial
collateral
ligament
Medial
meniscu
s
Anterior
cruciate
ligament
Tibia
https://t.me/med1917
31
Spurling: Do not laterally flex
neck past 30°
18 Advanced Shoulder
Referred Cervical Pain
• Spurling (cervical root disorder)
• Positive = pain/radiation
1.
Lateral
flexion to
affected
side
2.
Rotate head
away from
affected side
3. Press down
firmly
Biceps Tendon Tests
• Resisted supination
• Positive = anterior shoulder pain
1. Bend elbow
90°
2.
Ask patient
to supinate
forearm while
you resist
• Biceps tendon palpation
• Positive = pain/tender
Support
patient’
s
forearm
durin
g
palpation
Numbness and tingling down
affected arm
SLAP lesion: Superior labrum
anterior and posterior
Biceps tendon: Palpating the
normal biceps tendon may be
uncomfortable. Palpate left
and right biceps tendons to
determine if one side is more
painful than the other.
https://t.me/med1917
32
Neer: Remember to stabilize
scapula
Empty Can
• Imagine pouring out a
canned drink
• Remember to ask patient
to forward-flex arm 30°
Shoulder Impingement Tests
• Neer
• Subacromial impingement
• Positive = shoulder pain
• Hawkins
• Supraspinatus tendon impingement
• Positive = lateral shoulder pain
• Empty can
• Supraspinatus
• Positive = shoulder pain
1.
Max pronation
– thumb to floor
2. Fully flex
shoulder
1.
Flex
shoulder
and elbow
90°
2.
Internally
rotate shoulder
1. Point thumb
to floor
2.
Push arm down
https://t.me/med1917
33
Rotator Cuff
• External rotation lag
• Tests supraspinatus infraspinatus
• Positive = arm drops
• Drop arm
• Test for rotator cuff tear
• Positive = arm drop/pain
• Belly press
• Subscapularis muscle tear
• Positive = cannot perform
1.
Ask to “Hold this position”
2.
Release arm
1.
Ask to “Hold this position”
2. Release arm
1. Ask to “Press firmly against belly”
2. Ask to “Move elbow forward”
https://t.me/med1917
34
Apprehension: Protect the
shoulder. Do not subluxate/
dislocate the patient’s
shoulder.
Shoulder Instability Tests
• Apprehension
• Test anterior glenohumeral instability
• Positive = apprehension/guarding
about anterior dislocation of
shoulder
• Acromioclavicular (AC) joint
tenderness
• Positive = pain/tender
1.
Support
forearm
2. Palpate
AC joint
1. Position patient SUPINE
2. Externally
rotate shoulder
https://t.me/med1917
35
Lateral epicondylitis tests:
Positive tests may also
indicate radial nerve
involvement
19 Advanced Elbow
Lateral Epicondylitis (Tennis Elbow)
• Cozen’s test
• Active ROM
• Positive = pain at lateral epicondyle
1. Palpate lateral epicondyle
2.
Resist patient
as they extend
wrist
• Mills test
• Passive ROM
• Positive = pain at lateral epicondyle
Medial Epicondylitis (Golfer’s Elbow)
• Medial epicondylitis test
• Passive ROM
• Positive = pain at medial epicondyle
1. Palpate lateral epicondyle
2.
Extend elbow + flex wrist
1. Palpate medial epicondyle
2. Extend elbow + extend wris
t
https://t.me/med1917
36
First Extensor Compartment:
Tendons of abductor pollicis
longus and extensor pollicis
brevis. These tendons form
the lateral border of the
anatomical snuff box.
20 Advanced Wrist
Carpel Tunnel Syndrome
• Phalen test
• Positive = pain, pins and needles
along radial nerve distribution
• Tinel sign
• Positive = pain, pins and needles
along radial nerve distribution
• Finkelstein test
• Positive = pain over first extensor
compartment
1. Push backs of hands together
2. Hold for 60 seconds or reproduction of pain
1. Use your finger/reflex hammer to lightly
tap carpel tunnel
1. Patient flexes thumb and wraps fingers
around thumb
2.
Patient ulnarly deviates wrist to stretch firs
t
extensor compartment
https://t.me/med1917
37
Straight Leg Raise: Passive
dorsiflexion at 30°
21 Advanced Lower Back
Lumbar Spine
• Straight leg raise test
• Positive = pain/radiation at 35–70°
flexion
Hip (Side Lying)
• Palpate iliotibial band
• Positive = pain/tender
• Ober test
• Positive = restricted adduction
1.
Raise leg
70°
35°
IT band
Gerdy’s tubercle
1.
Stabilize PSIS
2. Abduct and
extend hip
3. Lower
leg toward
table
https://t.me/med1917
38
FADDIR
• Flexion
• ADDuction
• Internal
• Rotation
FABER
• Flexion
• ABduction
• External
• Rotation
22 Advanced Hip
Hip (Supine)
• FADDIR/anterior impingement
• Positive = pain
1. Flex hip while internally
rotating + adducting hip
• FABER/Patrick/Figure 4
• Sacroiliac joint dysfunction
• Positive = restricted movement/pain
• Log roll test
• Positive = increased external
rotation
1.
Figure 4 position
2. Push knee down
1. Internally/externally rotate hip
https://t.me/med1917
39
Remember to sit on patient’s
foot to anchor it
23 Advanced Knee
Anterior Cruciate Ligament
• Anterior draw
• Positive = excess motion/pain
1. Pull tibia
anteriorly
• Lachman
• Positive = excess motion/pain
Posterior Cruciate Ligament
• Sag
• Positive = tibia sags down
2. Observe
tibial tuberosity
for posterior
displacement
1. Support
patient’s heels
• Posterior draw
• Positive = excess motion/pain
1. Push tibia
posteriorly
2. Pull tibia
anteriorly
1. Stabilize femur
https://t.me/med1917
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