orthopedic clinical signs and tests

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This is a summary collection of orthopedic clinical signs and and clinical tests

listed in one table

Region: Test / Sign: Description
  commemorative sign: any sign of a previous disease.
  antecedent sign: any precursory indication of a malady.
  cogwheel phenomenon: jerky motions produced on testing a muscle's strength; the jerks are neither rhythmic nor equal and represent malingering or protection from pain; cogwheel s.
  somatic sign: any sign presented by trunk or limbs rather than sensory apparatus.
  Dupuytren sign: for determining sarcomatous bone; a crackling sensation on compression of that area is noted.
  Gower sign: for progressive muscular dystrophy and tabes dorsalis; abrupt intermittent oscillation of iris under light is the indication of ongoing process.
  Hueter sign: for indication of fracture; absence of the transmission of osseous vibration in fractures as heard by a stethoscope, where the fibrous material is interposed between the fragments.
  Langer line: the normal tension lines of skin commonly used to define direction of scar, as to how the scar runs with or across those lines.
  objective sign: one that can be seen, heard, measured, or felt by the diagnostician to confirm or deny an ongoing symptom; physical s.
  quadriceps test: for hyperthyroidism or debilitating condition; while standing, the patient is asked to hold leg up and straight out; a disease is present if patient cannot maintain this position for 1 minute.
  Raynaud phenomenon: pallor or blueness of fingers, toes, or nose brought about by exposure to cold and less commonly by other stresses.
  cafe-an-lait spots: for neurofibromatosis; hyperpigmented areas of skin indicate this ongoing problem; von Recklinghausen disease.
Back Soto-Hall sign: for lesions in back abnormalities; with the patient supine, flexion of the spine beginning at the neck and going downward will elicit pain in the area of the lesion.
Back Mennell sign: for spinal problems; examiner's thumb is taken over the posterosuperior spine of sacrum outward and inward for noting tenderness, which may be caused by sensitive deposits in gluteal aspect of posterosuperior spine; ligamentous strain and sensitivity.
Back Minor sign: for sciatica; patient rises from sitting position, supporting himself on healthy side, placing hand on back, and bending affected leg, revealing pain.
Back Naffziger sign: for sciatica or herniated nucleus pulposus; nerve root irritation is produced by external jugular venous compression by examiner.
Back Patrick test: for pain in lumbosacral area or hip; see Fabere s. and fadire t.
Back postural fixation: a sign noted on range of motion of the back; any postural deformity (stiffness) noted does not reverse with range of motion.
Back spine sign: for poliomyelitis; the patient is unable to flex the spine anteriorly because of pain.
Back sponge test: for detecting lesions of the spine; the examiner passes a hot sponge up and down the spine, and the patient feels pain over the lesion.
Back Lasegue straight leg raising (SLR) test: for determining nerve root irritation; the supine patient elevates his leg straight until there is back or ipsilateral extremity pain or until the pain is increased with dorsiflexion of the foot; Lasegue s.
Back Turyn sign: for sciatica; when examiner bends the patient's great toe dorsally, pain is felt in the gluteal region.
Back Lorenz sign: for ankylosing spondylitis (Marie-Strumpell disease); ankylotic rigidity of the spinal column, esp. thoracic & lumbar segments.
Back Vanzetti sign: for sciatica; the pelvis is horizontal in the presence of scoliosis. In other scoliotic conditions the pelvis is inclined.
Back fadire test: forced position of the hip causing pain; the letters stand for flexion adduction internal rotation in extension; Patrick t., fadir s.
Back Valsalva maneuver: for determining nerve root irritability within the spinal canal. This maneuver is also used for many other unrelated reasons. The patient takes a deep breath and then on bearing down, such as one does when lifting a heavy object, notes pain.
Back Babinski sign: for testing sciatic nerve pain; also for loss or lessening of the Achilles tendon reflex in sciatica, distinguishing it from hysteric sciatica.
Back Abbott method: for scoliosis of the spine; traction is applied to produce overcorrection, followed by casting.
Back Goldthwaite sign: for distinguishing lumbosacral from sacroiliac pain; with the patient supine, his leg is raised with one hand, while the examiner's other hand is placed under the patient's lower back; leverage is then applied to the side of the pelvis. If pain is felt by the patient before the lumbar spine is moved, the lesion is a sprain of the SI joint; if pain is not felt until after the the lumbar spine is moved, the lesion is in the SI or lumbosacral articulation.
Back Anghelescu sign: for testing tuberculosis of the vertebrae or other destructive processes of the spine; in the supine position the patient places weight on his head and heels while lifting his body upward; inability to bend the spine indicates an ongoing disease process.
Back Bekhterev test: for nerve root irritability in sciatica; while sitting up in bed, the patient is asked to stretch out both legs; with sciatica he cannot sit up in bed this way, he can only stretch out each leg in turn.
Back Bragard sign: for nerve or muscular involvement; with the knee stiff, the lower extremity is flexed at the hip until the patient experiences pain; the foot is then dorsiflexed. Increase in pain points to nerve involvement; no increase in pain indicates muscular involvement.contralateral straight leg raising test: for sciatica; when the leg is flexed, the hip can also be flexed, but not when the leg is held straight. Flexing the sound thigh with the leg held straight causes pain on the affected side; Fajersztajn crossed sciatic s.
Back Coopernail sign: for fracture of pelvis; ecchymosis of the perineum, scrotum, or labia indicates a pelvic fracture.
Back Dejerine sign: for symptoms of a herniated nucleus pulposus (HNP); a Valsalva maneuver produces aggravation of symptoms of radiculitis by coughing, sneezing, and straining at stool.
Back Demianoff sign: for differentiation of pain originating in the lumbosacral muscle from lumbar pain of any other origin; the pain is caused by stretching of the lumbosacral muscle.
Back Erichsen sign: for sacroiliac disease; when the iliac bones are sharply pressed toward each other, pain is felt in the sacroiliac area.
Back FABER sign: for testing lower back or sacroiliac joint disorder by using a forced position of the hip; the letters stand for flexion abduction external rotation in extension; Patrick t., faber t., figure of 4 t.
Back Gaenslen sign: for lumbosacral disease; pressure on hyperextended thigh with the hip held in flexion elicits pain, indicating a lumbosacral problem.
Back Amoss sign: for painful flexure of the spine; pain is produced when the patient places his hands far behind him in bed and tries rising from supine position to sitting position.
Feet Helbing sign: for flatfoot; medialward curving of the Achilles tendon as viewed from behind.
Feet Keen sign: for Pott fracture of the fibula; if fracture exists, there is increased diameter around the malleoli area of the ankle.
Feet Marie-Foix sign: for central nervous system disorder; withdrawal of the lower leg on transverse pressure of the tarsus or forced flexion of toes, even when the leg is incapable of voluntary movement.
Feet Morton test: for metatarsalgia or neuroma; transverse pressure across heads of the metatarsals causes sharp pain in the forefoot. 
Feet Mulder's clunk for Morton neuroma – palbable 'clunk' when compressing the metatarsal heads in the transverse direction & applying pressure to the affected web space
Feet Nelson's toe spread sign: for Morton neuroma; disproportional spreading of the toes, comparing one foot with the other.
Hand prehension: the ability to grasp with the fingers and thumb.
Hand Finkelstein sign: for synovitis; bending the thumb into the palm to determine synovitis of the abductor pollicis longus tendon to wrist.
Hand pulp pinch: the strength in the position one would use to pick up a piece of paper.
Hand circumduction maneuver: a maneuver for the thumb; any general test or motion involving a rotation action of a group of joints; a range of motion examination.
Hand Allen test: for occlusion of radial or ulnar artery; if compression of one vessel stops blood supply to the hand, the opposite vessel is occluded.
Hand Froment paper sign: for ulnar nerve loss; flexion of the distal phalanx of the thumb-with a sheet of paper held between the thumb and index finger, the thumb flexes on the side of the index finger.
Hand Wartenberg sign: for ulnar palsy; a sign noting the position of abduction assumed by the little finger. In describing the functional capacity of the hand, certain motions are peculiar to that anatomy. key pinch: the strength in the ability to grasp, as in holding a key; lateral pinch.
Hand bracelet test: for early rheumatoid arthritis involving the distal radioulnar joint; compression of the lower ends of the ulna and radius elicits moderate lateral pain.
Hand Fowler maneuver: a maneuver for testing rheumatoid arthritis; tight intrinsic muscles in ulnar deviation of the digits and a heavy, taut, ulnar band are demonstrated when the digit is held in its normal axial relationship.
Hand Kanavel sign: for infection of a tendon sheath; there is a point of maximum tenderness in the palm 1 inch proximal to the base of the little finger.
Hand Phalen test and maneuver: for carpal tunnel syndrome; impingement on the median nerve is determined by holding the wrist flexed or extended for 30 to 60 seconds.
Hand Maisonneuve sign: for Colles fracture; there is marked hyperextensibility of the hand.
Hip Ortolani sign: for congenital dislocated hip; an audible click is heard when the hip goes into the socket; noted in infancy; if the sign is elicited; the dislocation should be corrected at that time to avoid hip dysfunction later.
Hip Galeazzi sign: for congenital dislocation of the hip; the dislocated side is shorter when both thighs are flexed to 90 degrees, as demonstrated in infants; in an older patient a curvature of the spine is produced by shortened leg.
Hip Jansen test: for osteoarthritis deformans of the hip; the patient is asked to cross the legs with a point just above the ankle resting on the opposite knee. If significant disease exists, this test and motion are impossible.
Hip Langoria sign: for symptoms of intracapsular fracture of the femur; relaxation of the extensor muscles of the thigh is present.
Hip Leadbetter maneuver: for slipped capital femoral epiphysis; a maneuver to get the epiphysis in place.
Hip Allis sign: for femoral neck fracture; relaxation of the fascia between the crest of the ilium and the greater trochanter.
Hip Trendelenburg test: for muscular weakness in poliomyelitis, ununited fracture of the femoral neck, rheumatoid arthritis, coxa vara, and congenital dislocations. With the patient standing, weight is removed from one extremity. If gluteal fold drops on that side, it signifies muscular weakness of the opposite weight-bearing hip and weakness of the abductor of the weight-bearing hip. Also called Trendelenburg sign.
Hip Nelaton line: (x-ray and physical examinations): for detecting dislocation of the hip; a line from the anterosuperior iliac spine to the ischial tuberosity, which normally passes through the greater trochanter.
Hip Ely test: for determining tightness of the rectus femoris or contracture of the lateral fascia of the thigh; with patient in prone position, flexion of the leg on the thigh causes buttocks to arch away and leg to abduct at the hip joint.
Hip anvil test: for early hip joint disease or diseased vertebrae; a closed fist striking a blow to the sole of the foot with leg extended produces pain in the hip or vertebrae.
Hip Thomas sign: for hip joint flexion contracture; when the patient is walking, the fixed flexion of the hip can be compensated by lumbar lordosis. With the patient supine and flexing the opposite hip, the affected thigh raises off the table; Striimpell sign., Thomas test.
Hip Chiene test: for determining fracture of the neck of the femur by use of a tape measure.
Hip piston sign: for congenital dislocation of the head of the femur; if positive, there is up-and-down movement of the head of the femur; Dupuytren s.
Hip Desault sign: for intracapsular fracture of the hip; alternation of the arc described by rotation of the greater trochanter, which normally describes the segment of a circle but in this fracture rotates only as the apex of the femur rotates about its own axis.
Hip Ludloff sign: for traumatic separation of the epiphysis of the lesser trochanter; swelling and ecchymosis are present at the base of Scarpa triangle, together with inability to raise the thigh when in sitting position.
Knee Apley test: for differentiating ligamentous from meniscal injury; tibial rotation on femur with traction or compression with the patient prone and knee flexed; Apley s.
Knee McMurray circumduction maneuver for noting joint menisci tears or tags; there is cartilage clicking medially or laterally on manipulation of the knee; McMurray s.
Knee bayonet sign: lateral placement of infrapatellar tendon with a valgus knee produces a bayonet appearance in the quadriceps patellar tendon complex.
Knee British test: for knee pain and/or injury; compression of patella during active quadriceps contraction as knee is extended elicits pain.
Knee camelback sign: an unusually prominent infrapatellar fat pad of the knee and hypertrophy of the vastus lateralis.
Knee double camelback sign: prominence of a high-riding patella and infrapatellar fat pad, producing the appearance of a camel back.
Knee drawer sign: for ligamentous instability or niptured cruciate ligaments; with the patient supine and knee flexed to 90 degrees, the sign is positive if knee is not displaced abnormally in a posterior direction with knee pulled forward. Also called an anterior drawer sign, meaning the anterior cruciate is lax or ruptured.
Knee Lachman test: with the patient supine and the knee flexed to 20 degrees, the tibia is pulled anteriorly. A "give" reaction or mushy end point indicates a torn anterior cruciate ligament.
Knee patellar retraction test: for synovitis; compression of patella causes pain when the patient attempts to set the quadriceps muscles with the knee in full extension.
Knee pivot shift sign: usually sports related; when the knee is brought to full extension, there is a sudden forward shift of the lateral side of knee.
Knee Slocum test: for rotatory instability of the knee; the examiner pulls on the upper calf of a supine patient with the knees flexed 90 degrees.
Knee thumbnail test: for patellar fracture; fracture is felt as a sharp crevice when the examiner's thumbnail is passed over the subcutaneous surface of the patella.
Knee grimace test: for knee pain or crepitus; if compression of the patella elicits pain or crepitus is noted, the patient will grimace.
Lower Limb tourniquet test: for phlebitis of the leg; toumique is applied to the thigh and pressure gradwincreased until the patient complains of pain ir the calf; result is compared with the effect on the Opposite leg.
Lower Limb anterior tibial sign: for spastic paraplegia; involuntary extension of the tibialis anterior muscle when thigh is forcibly flexed on the abdomen.
Lower Limb Cleeman sign: for distal fracture of femur with overriding of the fragments; shows creasing of the skin just above the patella
Lower Limb Homans sign: lower calf examination for thrombophlebitis; discomfort in the body of the calf on forced passive dorsiflexion of the foot indicates thrombosis in the leg.
Lower Limb Ober test: for tensor fascia femoris contracture (tightness); if fascia lata mechanism is tight, knee cannot extend fully when thigh is abducted.
Lower Limb Payr sign: early sign of impending postoperative thrombosis, indicated by tenderness when pressure is placed over the inner side of the foot.
Lower Limb Schlesinger sign: for extensor spasm at the kne joint; with patient's leg held at the knee joint an flexed strongly at the hip joint, there will follo~ an extensor spasm at the knee joint with extr~ supination of the foot.
Lower Limb Addis test: for determination of leg length discrepancy; with patient in prone position, flexing the knees to 90 degrees reveals the potential discrepancies of both tibial and femoral lengths.
Metabolic Tensilon test: for myasthenia gravis; a chemical test for denoting muscle strength or weakness; injection of edrophonium chloride (Tensilon) will reverse the symptoms in patients whose muscle weakness is caused by myasthenia gravis.
Metabolic Chvostek sign: for determining low serum calcium leading to tetany; tapping of cheek near the facial nerves causes the muscles to twitch or gointo spasm; Chvostek t., Chvostek-Weiss s., Weiss s., Schultze-Chvostek s.
Metabolic lead line: a blue line seen in the gums of a patient with lead poisoning; Burton s.
Neck Rust sign: for caries or malignant disease of the cervical vertebrae; the patient supports his head with his hands while moving his body.
Neck anvil test: for vertebral disorders; a closed fist striking blow on top of the head elicits pain in the vertebra(e).
Neck Allen maneuver for same diagnosis as Adson in., except the forearm is flexed at right angle with the arm extended horizontally and rotated externally at the shoulder, with the head rotated to the contralateral shoulder.
Neck Adson maneuver for scalenus anticus syndrome, noted on obliteration of radial pulse; upper limb to be tested is held in dependent position while head is rotated to the ipsilateral shoulder.
Neck Spurling test: for cervical spine and foraminal nerve encroachment; compression on the head with extension of the neck causes radicular pain into the upper extremities.
Neurologic Moro reflex: for testing normal early neurologic development or the failure to progress neurologically; the infant is placed on a table, then the table is forcibly struck from either side, causing the infant's arms to be thrown out as in an embrace; should disappear as infancy progresses.
Neurologic pronation sign: for central nervous disorders; there is a strong tendency for the forearm to pronate; Strumpell s.
Neurologic Leichtenstern sign: for cerebrospinal meningitis; tapping lightly on any bone of the extremities causes patient to wince suddenly.
Neurologic Len sign: for hemiplegia; passive flexion of the hand and wrist of the affected side shows no normal flexion at the elbow.
Neurologic Lhermitte sign: for cervical cord injuries or cord degeneration; transient dysesthesia and weakness are noted in all four limbs when the patient flexes the head forward.
Neurologic long tract sign: any sign that one would see in affection of either sensory or motor tracts in the spinal cord; Babinski reflex, Romberg t.
Neurologic Mendel-Bekhterev reflex: for organic hemiplegia; using a percussion hammer, the examiner notes flexion of the small toes if the dorsal surface of the cuboid bone is struck.
Neurologic Morquio sign: for epidemic poliomyelitis; the supine patient resists attempts to raise trunk to a sitting position until the legs are passively flexed.
Neurologic Piotrowski sign: for organic disease of the central nervous system; percussion of tibialis muscle produces dorsiflex ion and supination; anticus sign or reflex.
Neurologic pseudo-Babinski sign: in poliomyelitis the Babinski reflex is modified so only the big toe is extended, because all foot muscles except dorsiflexors of the big toe are paralyzed.
Neurologic Queckenstedt sign: for detecting a block in the vertebral canal; compression of veins in the neck on one or both sides produces rapid rise in pressure of cerebral spinal fluid of a healthy person and quickly disappears. But in a patient with blockage in vertebral canal, pressure of cerebrospinal fluid is little or not at all affected by this sign.
Neurologic radialis sign: for nerve impairment; inability to close the fist without marked dorsal extension of the wrist; Strumpell s.
Neurologic Raimiste sign: for paretic condition; patient's hand and arm are held upright by examiner; a sound hand remains upright on being released, but a paretic hand flexes abruptly at the wrist.
Neurologic Romberg test: for differentiation between peripheral and cerebellar ataxia; increase in clumsiness in movements and in width and uncertainty of gait when patient's eyes are closed indicate peripheral ataxia; no change indicates cerebellar type. (NOTE: Romberg sign is similar in testing but used for noting tabes dorsalis.)
Neurologic Sarhb sign: for locomotor ataxia; analgesia of peroneal nerve is noted.
Neurologic Schreiber maneuver: for patellar reflex testing; rubbing the inner side of the upper part of thigh enhances the reflex.
Neurologic stairs sign: in locomotor ataxia there is difficulty or failure of ability to descend stairs.
Neurologic station test: for coordination disturbance; feet are planted firmly together; if the body sways, lack of coordination is indicated.
Neurologic tendon reflexes: for testing continuity of normal muscle to spinal cord to muscle reflex arc. Any tendon may be so tested, but the most common are the deep tendon reflexes (DTRs):
Neurologic Oppenheim sign: for pyramidal tract disease; dorsal extension of the big toe is present when the medial side of the tibia is stroked in a downward direction.
Neurologic Huntington sign: for lesions of the pyramidal tract; patient is supine, with legs hanging over the examining table, and is asked to cough; if coughing produces fiexion of the thigh and extension of the leg in the paralyzed limb, a lesion is indicated.
Neurologic contralateral sign: see Brudzinski s.
Neurologic doll's eyes sign: for testing normal or abnormal brain function; the normal coordinated eye motions seen when passively turning the head of an unconscious patient; Cantelli s.
Neurologic Ely test: for L-3 and L-4 nerve root irritation; flexing thigh with patient prone causes back and/or thigh pain; femoral nerve stretch t., Ely s.
Neurologic fan sign: for central nerve problems; stroking the sole of the foot with a needle causes toes to spread; part of Babinski reflex examination.
Neurologic finger to nose test: for cerebellar disease; when the patient attempts to put a finger on his nose and then to the examiner's finger, back and forth rapidly, any incoordination indicates test to be positive.
Neurologic Fournier test: for determining ataxic gait; it is noted with the patient moving about abruptly in walking, starting, and stopping.
Neurologic Frankel sign: for tabes dorsalis; noted by diminished tonicity of muscles about the hip joint.
Neurologic Guilland sign: for meningeal irritation; when the contralateral quadriceps muscle group is pinched, there is brisk flexion at the hip and knee joint.
Neurologic tibialis sign: for spastic paralysis of the lower limb; there is dorsiflex ion of the foot when the thigh is drawn toward the body; tibial phenomenon.
Neurologic Hoffmann sign: for testing digital reflex; nipping of three fingernails (index, middle, ring) produces flexion of terminal phalanx of thumb and second and third phalanx of some other finger; digital reflex. Indicative of a cervical myelopathy
Neurologic Babinski reflex: for loss of brain control to lower extremities; scraping the soles causes toes to pull up; Babinski s.
Neurologic Jendrassik maneuver: to enhance a patellar reflex; the reflex is tested when the patient hooks hands together with flexed fingers and pulls apart as hard as possible. 
Neurologic Kernig sign: for meningitis; in dorsal decubitus, the patient can easily and completely extend the leg; in sitting or lying down with thigh flexed upon the abdomen the leg cannot be completely extended.
Neurologic Kerr sign: for spinal cord lesions; alteration of the texture of the skin below the somatic level in eliciting location of lesions.
Neurologic Brudzinski sign: for meningitis; flexion of the neck forward results in flexion of the hip and knee; when passive flexion of the lower limb on one side is made, a similar movement will be seen in the opposite limb; neck s., contralateral s.
Neurologic Thomas sign: for cord lesions; pinching of the trapezius muscle causes goose bumps above the level of the cord lesion.
Neurologic Beevor sign: for functional paralysis; excursion of the umbilicus occurs when the patient attempts to sit up.
Neurologic Tinel sign: for noting a partial lesion or beginning regeneration of a nerve; tingling sensation of the distal end of a limb when percussion is made over the site of divided nerve as in carpal tunnel impingement on the median nerve of the hand; formication s., distal tingling on percussion (DTP) s
Neurologic Chaddock sign: for upper motor neuron loss (brain); the big toe extends when irritating the skin in the external malleolar region; indicates lesions of the corticospinal paths; external malleolus s., Chaddock reflex.
Neurologic Hirschberg sign: for pyramidal tract disease; internal rotation and adduction of foot on rubbing inner lateral side.
Shoulder Callaway test: for dislocation of the humerus; the circumference of the affected shoulder measured over the acromion and through the axilla is greater than that on the opposite, unaffected side.
Shoulder Codman sign: for rupture of the supraspinatus tendon; the arm can be passively abducted without pain, but when support of the arm is removed and the deltoid muscle contracts suddenly, pain occurs again.
Shoulder Comolli sign: for scapular fracture; shortly a injury, there is triangular swelling, reproduci the shape of the body of the scapula.
Shoulder Dawbarn sign: for acute subacromial bursiti with arm hanging by side, palpation over t. bursa causes pain; when the arm is pain disappears.
Shoulder Dugas test: for dislocation of the shoulder; placing hand of affected side on opposite shoulder bringing elbow to side of chest, a dislocation may be present if the patient's elbow will touch side of his chest; Dugas s.
Shoulder Hamilton test: for luxated shoulder; a rod applied to the humerus can be made to touch the lateral epicondyle and acromion at the same time to determine a dislocation.
Shoulder Kocher maneuver: for reducing anterior dislocations of the shoulder; done by abducting arm, externally rotating, adduction, and then internally rotating.
Shoulder Bryant sign: for dislocation of the shoulder with lowering of the axillary folds, as noted on visual examination.
Upper Limb Laugier sign: for a displaced distal radial fracture; condition in which the styloid process of radius and ulna are on same level.
Upper Limb Mills test: for tennis elbow; with wrist and fingers fully flexed and the forearm pronated, complete extension of the elbow is painful.


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