Irene Gold Part 4 Clinical Orthopedics Exam with verified
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detailed solutions ||
What is the terrible triad?
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If you injure one of these three ligaments, you could injure the other three which would
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result in a much longer recovery.
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1. ACL
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2. MCL
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3. Medial meniscus
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Apprehension Test ||
1. Patient seated with intern behind. Patient looking at intern.
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2. Intern slowly brings shoulder to 90 degrees abduct and then externally rotates while
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stabilizing shoulder. ||
3. Perform test bilaterally
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Positive Test: Positive is if patient shows apprehension or alarm. Indicates chronic shoulder
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dislocation (joint laxity/instability) || ||
Medial/Lateral Stability Test of ankle and foot || || || || || ||
Patient is seated or supine. Dr grasps the patients foot and passively inverts and everts it
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Positive: excessive gapping || ||
,Indicates: anterior talofibular or calcaneofibular ligament tear (inversion), and deltoid
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ligament tear (eversion) || ||
Refer for surgery. Grade III sprain.
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Posterior Dislocation Apprehension Test
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1. Patient lays prone
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2. With elbow bent at 90 degrees, point elbow towards ceiling.
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3. Intern places hand behind shoulder and his/her other hand on the elbow.
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4. Intern presses downward on patients elbow
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Positive Test: Pain, laxity, or a look or apprehension indicates ligament issues.
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Relocation Test Seated || ||
1. Done if Apprehension test was positive.
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2. Same as Apprehension test except stabilize the anterior capsule with internal hand.
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Positive Test: If patient experiences less pain, it is positive and indicates anterior instability.
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Sulcus Sign ||
1. Patient Seated wtih hand internally rotated
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2. Intern applies inferior traction/pull down by grasping at distal humerus/elbow
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3. Intern palpates or observes over inferior aspect of acromion process.
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,4. Perform test bilaterally.
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Positive Test: Sulcus or dimpling appearing superior to humeral head/inferior to lateral
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acromion indicates multidirectional instability.
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Load and Shift || ||
1. Patient seated, supine, or side lying
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2. Intern stabilize superior shoulder with inside hand with outside/contact hand on anterior
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and posterior humeral head.
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3. Intern compresses humeral head into glenoid then moves the head anterior and posterior
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4. Perform test bilaterally
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Positive Test: Increased movement and/or popping, grinding, or slapping indicates
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instability of glenohumeral joint and possible labrum damage.
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Dugas Test ||
1. Patient is seated, intern instructs the patient to touch opposite shoulder with their hand
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and then to lower the elbow to their chest.
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2. Perform test bilaterally.
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Positive Test: Inability to touch elbow to chest is positive for shoulder dislocation.
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Apley's Scratch Test (Apley's Test)
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1. Patient standing or sitting
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, 2. Patient places hand of affected shoulder behind their head and try to touch opposite
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superior angle of scapula || || ||
3. Patient then places their hand behind their back and try to touch the inferior angle of
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opposite scapula. ||
Positive Test: Positive is pain or decreased ROM. Indicates degenerative tendonitis of rotator
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cuff (usually supraspinatus)
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Dawbarn's Sigh ||
Subacromial Bursa Test || ||
Deep palpation by doctor over subacromial bursa. If it elicits pain, the arm is passively
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moved (without moving fingers) into abduction.
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Positive: If the palpation over the subacromial bursa is reduced, this indicates subacromial
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bursitis.
Subacromial Push-Button Sign || ||
1. Patient seated
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2. Apply pressure to subacromial bursa. Apply bilaterally.
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Positive Test: Increase in pain indicates subacromial bursitis.
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Codman's Test ||
(Drop Arm Test) || ||
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detailed solutions ||
What is the terrible triad?
|| || || ||
If you injure one of these three ligaments, you could injure the other three which would
|| || || || || || || || || || || || || || || ||
result in a much longer recovery.
|| || || || ||
1. ACL
||
2. MCL
||
3. Medial meniscus
|| ||
Apprehension Test ||
1. Patient seated with intern behind. Patient looking at intern.
|| || || || || || || || ||
2. Intern slowly brings shoulder to 90 degrees abduct and then externally rotates while
|| || || || || || || || || || || || || ||
stabilizing shoulder. ||
3. Perform test bilaterally
|| || ||
Positive Test: Positive is if patient shows apprehension or alarm. Indicates chronic shoulder
|| || || || || || || || || || || || ||
dislocation (joint laxity/instability) || ||
Medial/Lateral Stability Test of ankle and foot || || || || || ||
Patient is seated or supine. Dr grasps the patients foot and passively inverts and everts it
|| || || || || || || || || || || || || || ||
Positive: excessive gapping || ||
,Indicates: anterior talofibular or calcaneofibular ligament tear (inversion), and deltoid
|| || || || || || || || || ||
ligament tear (eversion) || ||
Refer for surgery. Grade III sprain.
|| || || || ||
Posterior Dislocation Apprehension Test
|| || ||
1. Patient lays prone
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2. With elbow bent at 90 degrees, point elbow towards ceiling.
|| || || || || || || || || ||
3. Intern places hand behind shoulder and his/her other hand on the elbow.
|| || || || || || || || || || || ||
4. Intern presses downward on patients elbow
|| || || || || ||
Positive Test: Pain, laxity, or a look or apprehension indicates ligament issues.
|| || || || || || || || || || ||
Relocation Test Seated || ||
1. Done if Apprehension test was positive.
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2. Same as Apprehension test except stabilize the anterior capsule with internal hand.
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Positive Test: If patient experiences less pain, it is positive and indicates anterior instability.
|| || || || || || || || || || || || ||
Sulcus Sign ||
1. Patient Seated wtih hand internally rotated
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2. Intern applies inferior traction/pull down by grasping at distal humerus/elbow
|| || || || || || || || || ||
3. Intern palpates or observes over inferior aspect of acromion process.
|| || || || || || || || || ||
,4. Perform test bilaterally.
|| || ||
Positive Test: Sulcus or dimpling appearing superior to humeral head/inferior to lateral
|| || || || || || || || || || || ||
acromion indicates multidirectional instability.
|| || ||
Load and Shift || ||
1. Patient seated, supine, or side lying
|| || || || || ||
2. Intern stabilize superior shoulder with inside hand with outside/contact hand on anterior
|| || || || || || || || || || || ||
and posterior humeral head.
|| || || ||
3. Intern compresses humeral head into glenoid then moves the head anterior and posterior
|| || || || || || || || || || || || ||
4. Perform test bilaterally
|| || ||
Positive Test: Increased movement and/or popping, grinding, or slapping indicates
|| || || || || || || || || ||
instability of glenohumeral joint and possible labrum damage.
|| || || || || || ||
Dugas Test ||
1. Patient is seated, intern instructs the patient to touch opposite shoulder with their hand
|| || || || || || || || || || || || || || ||
and then to lower the elbow to their chest.
|| || || || || || || ||
2. Perform test bilaterally.
|| || ||
Positive Test: Inability to touch elbow to chest is positive for shoulder dislocation.
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Apley's Scratch Test (Apley's Test)
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1. Patient standing or sitting
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, 2. Patient places hand of affected shoulder behind their head and try to touch opposite
|| || || || || || || || || || || || || || ||
superior angle of scapula || || ||
3. Patient then places their hand behind their back and try to touch the inferior angle of
|| || || || || || || || || || || || || || || || ||
opposite scapula. ||
Positive Test: Positive is pain or decreased ROM. Indicates degenerative tendonitis of rotator
|| || || || || || || || || || || ||
cuff (usually supraspinatus)
|| || ||
Dawbarn's Sigh ||
Subacromial Bursa Test || ||
Deep palpation by doctor over subacromial bursa. If it elicits pain, the arm is passively
|| || || || || || || || || || || || || || ||
moved (without moving fingers) into abduction.
|| || || || ||
Positive: If the palpation over the subacromial bursa is reduced, this indicates subacromial
|| || || || || || || || || || || || ||
bursitis.
Subacromial Push-Button Sign || ||
1. Patient seated
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2. Apply pressure to subacromial bursa. Apply bilaterally.
|| || || || || || ||
Positive Test: Increase in pain indicates subacromial bursitis.
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Codman's Test ||
(Drop Arm Test) || ||
