Muskoskeletal Prac Viva

Thomas Test - hip flexor 'tightness' or a muscle length issue

Obers Test - muscle length test for ITB, TFL and lateral hip / knee structures

Scour Test - PPM used to assess intra-articular hip pathologies such as labral tears, OA or FAI

FABER - IMPINGEMENT: To detect causes of groin and butt pain such as impingement of the SIJ or FAI. Also really good for lateral hip pain such as GTPS

FADIR - IMINGEMENT: To detect anterior hip and groin pain pathologies such as FAI or anterior labral tears

Adductor Squeeze Test - myotendinous adductor muscle pain, adductor tendinopathy

This tests the length of the ITB, TFL and lateral hip/knee structures

1) Patient is sidelined, stabilise the pelvis (keeping him forward), flex patient knee to 90, abduct and extend hip until hip is in line with trunk.

2) Gently lower leg towards the bed and observe for loss of ROM

3) A positive test would show the inability to adduct hip to horizontal position and/or knee extension occurs

A passive physiological test used to assess intra-articular hip pathologies such as labral tears, arthritis or FAI.

1) Patient lies supine with physio on affected side
2) Take the hip into 90 degrees flexion or maximal end range, bringing the knee to the chest.
3)Then adduct hip without the pelvis lifted off the bed
4) Apply pressure through the femur towards the acetabulum
5) Scouring: The process of maintaining compression and moving the hip in an arc: IR + Adduction to ER + Abduction

The test is considered positive if it reproduces the patient's familiar hip pain, or if it causes clicking, catching, or reveals a restricted range of motion

It involves placing the patient's leg in a "figure-four" position; Flexion, ABduction, and External Rotation—followed by applying overpressure to the knee to provoke pain. Tests for impingement

1) Patient is supine with therapist on test side
2) The lateral malleolus of the test leg is placed over the patella of the opposite side
3) The pelvis is stabilised via the ASIS as the knee is passively lowered into abduction and ER

A positive test will reproduce the patients ipsilateral hip pain. Lateral pain = GTPS, groin pain = intra-articular hip, butt or SIJ pain = SIJ dysfunction

The FADIR (Flexion, Adduction, Internal Rotation) Test is a physical examination detecting hip pathologies such as femoroacetabular Impingement (FIA) or labral tears. It has 99% Sn for labral tears and thus is good for ruling it out

1) Patient lies supine with one knee flexed
2) Clinician flexes the hip to 90 degrees
3) Adducts the femur/hip moving the knee towards the opposite shoulder
4) Internally rotates the femur/hip pulling the ankle away from the body while the knee moves towards the midline

A positive test will reproduce groin pain, clicking, catching or locking. High Sn of 94% thus good for ruling out impingement

Very common in assessment of sports-related chronic groin pain as it tests load tolerance of the groin.

1) Patient lies supine with knees bent to 90 (although consider testing at neutral and 90)
2) Physio places soft object or fist between the patients knees
3) Patient squeezes their kness together as hard as possible pressing against the object/fist
4) Hold the contraction for a set time eg; 5 seconds

A positive test in indicated by adductorroin pain or reproduction of patients symptoms. Sn 43% and Sp 93%

FOR IRRITABLE CASES - THAT IS, PAIN EASILY PROVOKED

Hip Internal Rotation
- Grades I and II: Think about patient positioning for comfort – eg supine and sidelines pillow us. With the leg straight, roll it into IR

Hip External Rotation
- Grades I and II: patient positioning for comfort again, Patients leg most probably straight in loose-packed position and again roll the leg into ER

FOR NON-IRRITABLE PATIENTS - TYPICALLY CHRONIC OBSTRUCTION OF JOINT

Hip Internal Rotation
- Grades III and IV: Hip flexed to 90 if plausible, and take the patients leg into IR (should look like the FADDIR test) or can be performed prone

Hip External Rotation
- Grades III and IV: Hip flexed to 90 if again patient can do, take the patients leg into ER and small amplitude movements. Can also be performed prone with slight hip E (towel under thigh)

Lateral Transverse Glide

Longitudinal Caudal Glide (Distraction)

Longitudinal Cephald Glide (Compression)

Antero-posterior and Postero-anterior (APs and PAs)

Testing for hypomobility, particularly FAI and hip OA

For non-irritable presentations. Position patient supine lying in hip flexion. Manually or with seatbelt restrain patient
- Use elastics, seatbelt or manually pull patients hip laterally to increase flexion and/or IR ROM due to capsular tightness (Grades III and IV)
- Manually: Wrap forearm from 'under to in' and pull laterally with forearm

Grades I and II: Pull patients leg towards you at the end of the plinth. Grab around ankle or above knee anteriorly

Grades III and IV: Patients hip flexed to 90, again coming from 'under to in' wrap forearm around inguinal ligament area and rest leg on shoulder, provide a distraction force

AP GLIDE:
- Position patient supine or sidelined
- Apply force over anterior aspect of greater trochanter
- Grades I and II is pressure application with your thumbs
- Grades III and IV is the heel of your hand

PA GLIDE:
- Position patient prone or sidelined
- Apply force over posterior aspect of greater trochanter
- Grades I and II is pressure application with your thumbs
- Grades III and IV is the heel of hand

Primary Flexors: Iliopsoas (iliacus and psoas major), Rectus femoris, Sartorius.

Primary Extensors: Gluteus maximus, Hamstrings (biceps femoris, semitendinosus, semimembranosus), Adductor magnus (posterior head).

IR: gluteus minimus (anterior fibers), gluteus medius (anterior fibers), and tensor fasciae latae (TFL)

ER: Hip external rotator (ER) muscles (piriformis, gemelli, obturators, quadratus femoris, gluteus maximus/medius)

Select Grade (3 or 4, most probably 3)

2-5 repetitions

long reps of 30-60 seconds

More rapid rhythm (about 2-3 oscillations per second)

treating multiple times a week (2-3)

Select Grade (1 or 2)

1-2 Repititions

Short reps of 20-30 seconds

Slow, smooth rhythm (about 1/2 - 1 oscillations per second)

Treat daily

Intra-articular effusion or Bulge sweep sign Test

MCL Stress Test

LCL Stress Test

Lachmanns Test

Anterior Drawer Test

Posterior Drawer Test

Posterior Sag Test

Apleys Grind

McMurrays Test

Thessaly's Test

Patella apprehension test

- Patient Is supine
- The examiner first strokes upward along the medial side of the knee to shift the fluid towards the suprapatellar pouch
- Then, the examiner compresses the suprapatellar pouch and pushes downward (distally) on supero-lateral aspect forcing fluid distally into the lateral knee
- A positive sign is the visible return of fluid into the medial recess, indicating joint effusion

- Have patient lying supine
- Examiners hand on lateral aspect of knee joint to fixate femur and ankle to lift leg
- Externally rotate the tibia and passively abduct the leg, being sure to test with knee at 0 degrees flexion and with the knee flexed to 30 degrees.
- Apply valgus force by pushing the hand on the outside of the knee and pulling the ankle laterally
- +ve Look for excessive gapping on the medial side and the reproduction of pain
- If the test is positive in slight flexion but negative in full extension a partial MCL tear is suscpected.
- If the test is positive in both full extension and slighr flexion, a complete MCL rupture with other pathology is assumed

- Is the reverse hand positions of the MCL test + Applying varum stress
- Therefore, Hand on medial thigh to stabilise femur and other hand around ankle applying a varum force while having the tibia laterally rotated to stress the LCL
- Test at both 0- and 20-30-degrees flexion

- Best ACL Test (highly sensitive and specific)
- Patient is supine with knee flexed to 20 degrees and hamstrings/leg relaxed
- One of the examiners hands stabilises the distal femur with the other hand under the proximal tibia
- Tibia is passively translated anteriorly (PA glide through the line of the tibial tuberosity)
- A negative test will result in a firm/sudden end-feel
- A positive test will result in excessive anterior translation and a softradual end feel (compared to unaffected side)
- Its recommended to test for PCL tear first as this could skew results

- Patient lying supine with the knee flexed to 90
- Examiner sits lightly on the patients foot to stabilise the tibia and help hamstring muscles relax. Palpate hamstring to ensure muscle relaxation has occurred
- Examiner places hands over gastrocnemius heads around the proximal tibia with thumbs over joint line.
- An posterior to anterior gliding movement or the drawing of the tibia forward then takes place
- +ve will show the anterior displacement exceeding 5mm or a ‘soft and spongey end feel’

- Essentially the reverse of the anterior drawer test
- Performed in neutal, tibial ER and IR
- Most sensitive test for PCL deficiency, therefore good for ruling out

- Patient lying supine with knee flexed to 90 and hip to 45 degrees, rest non-test side foot on a stool
- Observe the position of the patella and the tibial tubercle from the side
- +ve will show the tibia displaced posteriorly on the femur
- 100% Specific (meaning no false positives or people without posterior sag presenting to have posterior sag, thus good for diagnosing PCL injury

- Patient is lying prone with hip slightly extended (towel under thigh/waist) and knee flexed to 90
- Examiner places their knee on distal femur to stabilise it (if necessary)
- Apply downward pressure on tibia then rotate the lower leg internally, then externally
- Repeat tibial rotation with downwards distraction
- If rotation with the downwards pressure produces pain or painful clicking, then a tear of the meniscus is indicated. If pain is produced on rotation with upwards distraction, then the injury is ligamentous.
- If pain on internal rotation = lateral meniscus, pain on external rotation = medial meniscus
- Low Sn but higher Sp

- The patient must be able to perform near to full range flexion for McMurray’s test
- Have the patient lying supine with their knee fully flexed
- Palpate the joint line for tenderness
- Medial Meniscus = have the lower leg externally rotated and maintain this position as the patient extends the knee
- Lateral Meniscus = have the lower leg internally rotated and maintain this position as the patient extends the knee
- +ve will be pain provocation and a palpable/audible click – BE AWARE OF PATELLOFEMORAL PAIN
- really high Sp and moderate Sn

Thessaly Test (Meniscus)
- Holding onto the examiners hands the patient should slightly flex knee (about 5 degrees), fully rotate body on fixed leg x3 each direction.
- Repeat this in 20 degrees flexion
- +ve will present pain at joint line or feeling of locking or catching
- Greater sensitivity (especially at 20°) than other meniscus tests but prone to produce false positives due to other conditions like OA.

Tibiofemoral Extension / Abduction

Tibiofemoral Extension / Adduction

Tibiofemoral Flexion / Abduction

Tibiofemoral Flexion / Adduction

Tibiofemoral AP and PA

Tibiofemoral Joint longitudinal Caudad (distraction)

Superior tibiofibular joint AP and PA

Patellofemoral Joint Glides

- Patient is supine with the examiner standing by the patient’s ankle
- The examiner rests the lower leg and ankle on their quad
- Heel of hand directly over lateral joint line of the knee with the forearm at right angles to the femur and tibia. Apply a valgus (inwards) force to the lateral knee while abducting the leg
- The other over the medial condyle of the tibia
- GRADE IV – examiner holds under the patient’s heel and places other hand anteriorly over joint line. Perform extension-abduction movements.
- The examiner lifts the patients heel to produce extension and abduction movements

- Patient is supine with the examiner standing by the patient’s ankle
- The examiner rests the lower leg and ankle on leg while they place the heel of their hand directly over the medial joint line at right angles and the other over the lateral condyle (REVERSE OF PREVIOUS).
- The examiner provides varus or outward/lateral pressure to the knee while adducting the leg

- Flex the hip to 90 and fully flex the knee, supporting the knee with the far hand
- Grasp around the ankle with one hand so that the fingers can push posteriorly around the calcaneus, while using the other over the knee anteriorly to mobilise.
- Oscillate in a diagonal movement into flexion abduction whilst maintaining medial rotation of the tibia.
- This is the same set-up for Flexion-Adduction except lateral rotation is maintained

- Patient lies supine with examiner feeling along fibula line on anterior leg
- With a towel under the patient’s knee, the examiner provides an AP pressure with their hands over the anterior superior tibiofemoral joint.
- Small oscillating movements are characteristic of grade II
- For grades III-IV the physiotherapist positions the patients leg in 70 degrees of knee flexion with the hand placement the same (the fingers spread around the knee/joint line)
- Used in the treatment of painful or sore knees

- Patient lies supine with towel beneath the femur/knee, similar to the grade II AP movement
- Examiners index fingers pass behind the proximal tibia with the thumbs wrapped around so the line the anterior side of the tibial plateau
- A Postero-anterior pressure is applied by pulling the tibia through the fingers
- Grades III-IV are performed with the patient prone with the patients knee flexed and lower leg resting on the examiners quad. The clinician makes contact with the back of the tibia and its lateral and medial condyle – the PA movement should go the anterior direction of the joint

- Another PAM good for relieving very painful knees and maximising joint surfaces
- The patients knee should be supported in a few degrees flexion with a towel placed underneath their femur
- The examiner grasps around the head of the tibia with both hands and pulls in a caudad direction (towards the patients’ feet), performing small oscillations pulling the head of the fibula in line with the shaft of the fibula

AP
- The patient lies supine with a towel under femur, just above knee. This will support and slightly flex the knee
- The examiners palm of hand should be in contact with the head of the fibula anteriorly providing pushing AP oscillating movements

PA
- The patient lies prone with feet off bed, the examiner raises the distal leg and rests it on their quad, putting the knee into slight flexion
- The examiner standing alongside the patient’s foot places the palms of their hands on the superior part of the fibular head as the physio provides a pushing downwards (PA) direction force

Talar Tilt Test

Anterior Drawer Test

Squeeze Test

Thompsons Test

CFL Test

- Patient lies supine lying or seated on edge of bed with the ankle neutral (for CFL), Plantarflexed (for ATFL) and dorsiflexed (for PTFL)
- Examiner firmly rotates the heel inwards (inversion) for ATFL and CFL or outwards (eversion) for deltoid ligament. Grasp around the calcaneus
- +ve = increased movements, altered end-feel (compare both sides), clunk or reproduction of pain
- Sn 50%, Sp 88%

- Tests for the integrity of ATFL and CFL
- Patient sits with foot over end of couch (or supine) and resting in 20 degrees of PF
- Tibia is held as the posterior aspect of the calcaneus is pulled forwards
- +ve is excessive translation, altered end feel, pain provocation or audible/palpable clunk
- Sn of 58-80% and Sp of 74-94%

- Tests for the integrity of syndesmosis – anterior and posterior inferior Tibiofibular ligaments + interosseous membrane.
- Patient is seated on plinth or side lying with the knee flexed
- The physio manually squeezes at midpoint of calf, pushing the tibia and fibula together (compressing calf together)
- This can be repeated at various levels
- +ve will reproduce pain
- Sn 30-100% Sp 14-93% and almost always in conjunction with # (fibula or post / medial maleoli)

- Used to detect a rupture of the Achilles tendon
- Patient lies prone with feet resting over the edge of the table
- Physio gently squeezes (pinches) the calf muscle, this should produce plantarflexion of the foot
- +ve is the absence of PF
- Sn 96% and Sp 93%

- The patient lies supine with the hip and knee flexed to 90, with the patients foot resting on the examiner’s chest
- The ankle should be dorsiflexed on the physios chest while a varus (inwards) force is applied
- This test is similar to the talar tilt test for the CFL

Inferior tibiofibular joint AP and PA

Talocrural Joint AP, PA and longitudinal caudad (distraction)

Subtalar Joint (STJ) Medial and lateral glides

Transverse-tarsal joint AP, PA, medial and lateral glides

Tarometatarsal AP and PA

Metatarsophalangeal Joints (MTP) AP, PA, Med / Lat glides and distractions / compression

Interphalangeal Joints (IP) AP, PA, Med / Lat glides and distractions / compression

- Patient is prone with knee flexed to 90
- Physio places the palms of both hands on the medial and lateral malleolus of the patient and provides pressure in opposing directions
- Push through Lateral malleolus and perform oscillating movements

- Patient is prone with knee at 90, physio holds the leg distally in one hand and below the medial malleolus on the other
- The movement is produced by the opposite action of both forearms for all grades with the top hand creating majority of the movement
- The hands will swap for AP and PA - that is, the top hand producing the most movement will be positioned accordingly for the AP or PA movement

- Patient is prone with leg at 90
- Physio grasps the neck of the talus with both hands and pulls up towards the ceiling (distraction)
- Physio grasps around the neck of the talus with one hand and places the heel of the other hand posteriorly over the calcaneus, pushing downwards into the plinth

- Patient is prone with leg at 90
- Physio places knee on plinth to support the weight of the patients shin
- The physio mobilises the hind foot by grasping around the calcaneus with one hand and supporting anteriorly around the talus with the other
- The hand around the heel provides lateral and medial movements to the STJ

- Patient lies prone with knee slightly flexed and resting on physios quad
- Palpating down the lateral border of the foot, feel for the cuboid (most prominent feature) and move inwards to the sole of the foot. Provide a PA force
- To perform an AP we fix the talus and calcaneus with one hand and palpate for the navicular tuberosity on the medial aspect of the foot. Grasp the navicular anteriorly and posteriorly with the thumb and index finger (pincer grip) and provide an AP directed glide

Just figure it out ay

Dont even bother asking me

Plantarflexion of the Talocrural Joint (TCJ)

Dorsiflexion of the talocrural joint (TCJ)

Inversion and Eversion – Subtalar Joint (STJ)

- Patient lies prone with the knee flexed to 90 degrees (Grades I and II) OR Patient lies prone with feet near the end of the plinth (Grades III and IV)
- G1&2: Physiotherapist stands by the patients knee holding the calcaneus posteriorly with one hand and anteriorly around the head of the talus with the other hand. Physio performs Plantarflexion

- G3&4: Physio stands by the patients’ feet, holding the foot in both hands with the thumbs facing proximally alongside the calcaneus. Raise the patient’s leg to 20 degrees of knee flexion while partially DORSIFLEXING the ankle. The leg is then dropped to provide oscillating PF movements, moving through end-range

- G1&2: Patient lies prone with the knee flexed to slightly more than 90 degrees while the physio places their knee on the bed to support the weight of the shin
- One hand grasps the calcaneus inferiorly while the other posteriorly as the physio moves the foot into DF (downwards)
- For Grades III and IV, the patient position remains the same except this time the physio used the heel of their hand to provide the downwards (DF) force

- Patient is lying prone with knee flexed to 90 degrees
- The physiotherapist stands by the knee supporting the shin
- The Physio grasps the calcaneus with bond hands producing Inversion or Eversion movements as a wrist movement
- Both Inversion and Eversion have the same set-up and hand positioning, except the movement is obviously apposing

- Gerber Lift Off Test

- Full can Test

- Empty can Test

- The inability to lift off their hand is thought to indicate subscapularis pathology
- The test is performed with the patients HBB to L3. Patient extends arm of back against physio resistance.
- Sn 50% and Sp 80%
- REMEMBER SUBSCAPULARIS = IR, ADD & E

- Patient abducts arm to 90 degrees in the scapular plane with arm externally rotated so the thumb points uowards (can also be performed in IR with the thumb pointing up - Empty Can)
- Clinician provides a downwards force to the distal forearm which the patient must resist.
- Pain or weakness is a positive finding for possible supraspinatus tendinopathy
- Sn 55-89%, Sp (54-82%)
- FULL CAN = ER
- EMPTY CAN = IR

Hawkins-Kennedy Test

Neer Test

Empty Can Test (Jobes Test)

Due to inherent inaccuracies of individual tests, combining tests can improve diagnostic accuracy, for example: +ve 3 tests in above three or painful arc and resisted ER

- Patient is examined in 90 degrees of shoulder flexion and 90 degrees of elbow flexion. The shoulder is then passively internally rotated to end-range by the physiotherapist
- A positive test is pain reproduction which might indicate shoulder impingement
- Sn 63-74% and Sp 40-89%

- Can be performed with the patient sitting or standing
- The clinician elevates or passively flexes the patients internally rotated shoulder while stabilising the scapula.
- +ve is the reproduction of pain
- Sn 54-81% and Sp (10-95%)

Apprehension Test

Relocation (Containment Test)

Inferior Drawer (sulcus) Test

+ve in apprehension and relocation is highly specific (98%) and sensitive (81%) for anterior instability - possible histpry or susceptbility to subluxation or dislocation of the GH joint

- This tests for the excessive laxity of the anterior joint
- Patient lies supine with line of shoulder at the edge of the plinth
- Abduct to 90 degrees, elbow at 90 and then externally rotate the arm to the point of onset of symptoms (may require overpressure).
- +ve is reported feeling of instability or apprehension
- It has high specificity (95%) meaning a positive result is strong evidence of instability, though sensitivity varies (66%)

- Again, at the point of symptoms (same as apprehension test – 90 Abd and lateral rotation), place the heel of your hand on the anterior aspect of the HOH to apply AP pressure then release.
- +ve is when the patient reports an easing of symptoms when the HOH is translated posteriorly and a recurrence of apprehension when the pressure is released. (the HOH translates posteriorly in the AP)
- This test can be further confirmation of anterior instability from the apprehension test and is to be used in conjunction with / at the same time
- High specificity (90%) and moderate sensitivity like the apprehension test (65%)

Yegasons

Obrien's Test

Speed

A Superior labral anterior-posterior (SLAP) lesion occurs predominantly either due to trauma such as a fall on an outstretched arm or repeated overload of the LH of the biceps

• Assesses for LHB or superior labral pathology
• Shoulder flexed 90 degrees, externally rotated, elbow extended, forearm supinated
• Resist forward flexion
• +ve is pain in bicipital groove

- Patient has elbow flexed to 90 and forearm in full pronation
- The clinician resists supination (patient actively supinates against resistance) whilst palpating in the bicipital groove.
- +ve is pain or subluxation of the tendon in the groove + Pathology of the LHB
- Highly Specific (95%) but low Sn (12%)

- Shoulder flexion 90 degrees with 10-20 degrees of horizontal adduction
- Isometric resistance of flexion by examiner in both IR and ER
- +ve is pain and more clicking in IR than ER.
- Deep pain = SLAP, Tip of shoulder = ACJ
- Moderate Sn (67%) and low Sp (37%)

Only use when signs and symptoms are minimal.
- Arm under the medial border of scapular with fingers over trapezius to prevent shrugging
- Holding the elbow flexed, abduct arm towards a position of full GH abduction
- Should be painless and not limited thus a +ve will present pain and limited
- Quadrant is starting at the locked position, applying abduction and ER through small arc (approx. 30) laterally to fully elevated position
- Good sensitivity for intra-articular problems

IR and ER performed supine with arm supported

HBB (combination of E, IR and add - should all be assessed individually) performed sidelined

PA

AP

Longitudinal Caudad

Lateral Glide

- Patient lies supine with arms by side
- Clinician supports the patients scapula with one hand and applies an AP / PA force through the HOH with the other

- Patient lies supine with arms either by side or in flexion.
- By side: Physio applies a lateral force to the humerus and a 90 degree angle, resting the forearm on the patients chest
- Flexion: Same thing except possibly be comfortable for patient, physio holds and provides lateral force through humerus while stabilising at the elbow joint

- Patient lies supine with arms by side
- Support the patients scapula with one hand and apply a force towards the patients feet, pushing through the HOH.
- This can alternativrly be done with the patients arms still by side by elbow flexed to 90 in neutral, phsyio grabs the elbow / distal humerus and provides a distraction force

Varus and Valgus Stress Test - Collateral ligaments

Moving stress test - MCL

Epicondylagia - LCL and MCL

Tinel's Test - Ulnar Nerve

- Have patient standing and stabilise the humerus and externally rotate
- Palpating on either the MCL and LCL line
- Apply a valgus force for the MCL or a Varus force for LCL to the elbow in 20-30 flexion and supination
- +ve is reproduction of pain or heaps laxity
- Unknown Sn and Sp

- Have patient standing and in 90 abduction and elbow to 90 degrees
- Passively externally rotate the elbow and take elbow from elbow F 120 ̊ to 80 ̊ while maintaining valgus force (push back force)
- +ve medial pain or popping/clicking (Sn 100%, Sp 75%)

As with any myotendinous pathology, we can diagnose through three clinical tests:
- Palpate around tendon insertion point
- Muscle Length Test (Stretching) for the LCL (extensors) or MCL (flexors)
- Apply Resistance at mid-range (LCL = isometric contraction for extensor ECRB)

- Patient lies supine with arm and elbow flexed above head
- Physio taps nerve in the groove behind the medial epicondyle ("funny bone") – limited to superficial nerves or nerve close to the surface
- The nerve is tapped 4-6 times; avoid overzealous tapping (could contribute to a false +ve sign)
- +ve familiar pain, tingling, or electric shocks radiating down to the ring and small (pinky) finger, confirming irritation or entrapment of the ulnar nerve.

Radiohumeral AP and PA

Humero-ulnar joint Caudal / medial / lateral glide

Superior radio-ulnar AP and PA

Radio-humeral AP Glide
- Patient lies supine with elbow with slight flexion or whatever is most comfortable
- Physio stabilises humerus by wrapping hand under and around it
- Physio uses other hand to palpate and provide a AP force to the radial head

Radio-humeral PA Glide
- Patient lies supine with elbow pronated and resting on body
- The physio stabilises humerus again with hand
- Physio provides a PA glide by pushing through the radial head

- Patient prone with arm abducted to side and elbow bent over bed with towel under humerus
- Provide a downwards force on the back of the ulnar (olecranon process) towards the floor (caudal) or laterally / medially
- Usually this feels quite good and can be used as treatment

- Patient lies supine with elbow pronated and resting on body
- Same positioning as radio-humeral and same pressure except this time stabilise ulnar rather than humerus

Finkelstein's Test - De Quervain's Tenosynovitis an inflammation of the thumb tendons (abductor pollicis longus and extensor pollicis brevis)

Phalen's Test - Carpal tunnel syndrome

Tinel's Test - Carpal tunnel syndrome

Grind Test - CMC joint OA

Skier's Thumb ligament test - Ulnar collateral ligament injury or thumb MCP

- Have the forearm in a neutral position with the ulnar aspect of the hand handing off the edge of the table/surfac
- Thumb is held in flexion, followed by passive ulnar deviation
- +ve sharp, intense pain along the radial aspect of the wrist (near the thumb)

- Patient places dorsal aspects of hand together for 60 seconds i.e. having the patient hold both wrists in complete and forced flexion (pushing the dorsal surfaces of both hands together)
- +ve test is symptoms elicited in median nerve distribution eg; tingling or shocks
- Highly Sn and Sp (92% and 88%)

- This Tinel’ test is identical to the one for the elbow except the tapping is on the wrist
- +ve should elicit a ‘electric shock-like’ sensation
- high Sn and Sp for carpal tunnels syndrome (97% and 91%)

- Apply compression and rotation to the thumbs CMC joint
- +ve should reproduce thumb pain
- Good specificity but poor sensitivity (Sp 80-93%)

- Tests for ulnar collateral ligament injury or thumb MCP joint injury
- Have patient in 10 flexion and apply valgus (inwards) force to MCP joint (should look like flexion)
- +ve will reproduce pain, laxity or no end-feel if complete rupture. Often associated with avulsion fracture
- Good sensitivity and specificity (Sn 100% and Sp 88%)