al examination

knee

Palpation

The Valgus and Varus tests, which check the

medial and lateral collateral ligaments the
physician one hand on the knee joint and the other
on ankle and moves the leg side-to-side.

Valgus

Varus

Clinical examination of the

knee

The anterior drawer test, which checks the anterior

cruciate ligament

For the anterior drawer test, the patient is in a supine

position. The hip is flexed 45 degrees, the knee is
passively held in 90 degrees of flexion with the tibia in
neutral rotation, and the patient is asked to relax. The
examiner stabilizes the lower extremity by gently sitting
on the foot. A gentle anterior force to the proximal tibia is
applied.
Negative - No anterior translation is present and a firm
stop can be felt
Positive anterior translation is present complete lesion
of the anterior cruciate ligament

Clinical examination of the

knee

The posterior drawer test, which checks the posterior

cruciate ligament

For the posterior drawer test, the patient is in a supine

position. The hip is flexed 45 degrees, the knee is
passively held in 90 degrees of flexion with the tibia in
neutral rotation, and the patient is asked to relax. The
examiner stabilizes the lower extremity by gently sitting
on the foot. A gentle posterior force to the proximal tibia is
applied.
Negative - No posterior translation is present and a firm
stop can be felt
Positive posterior translation is present complete lesion
of the posterior cruciate ligament

Clinical examination of the

knee
Lachman Test

For the Lachman test, the patient is in the supine position.

The knee is passively held in 30 degrees of flexion and the
patient is asked to relax. With one hand, the distal femur is
stabilized and with the other hand a gentle anterior force to
the proximal tibia is applied. Comparison with the
contralateral knee is mandatory.

Negative - No anterior translation is present and a firm

stop can be felt

Positive anterior translation is present complete lesion

of the anterior cruciate ligament

Clinical examination of the

knee

Palpation

Joint Line Tenderness

Palpation of the anterior or posterior joint line is

tender when a meniscal tear is present. When the
tenderness extends more to proximal or distal,
the collateral ligament can be the cause of pain
instead of the meniscus.

Resilient Extension Deficit

A resilient extension deficit is present when a part

of the torn meniscus luxates and mechanically
blocks further range of motion. The knee cannot
be extended and the stop is resilient. This clinical
sign is most often associated with a bucket handle
rupture of one of the menisci.

Clinical examination of the

knee

McMurray Test

For the McMurray test, the patient is

in dorsal decubitus position and is
asked to relax.

The medial meniscus is tested by

passive flexion, varus stress, and
external rotation of the lower leg.
During slow extension of the knee
while maintaining the varus stress
and external rotation, a snap on the
medial joint line may be palpated;
this indicates a positive test for a
medial meniscal tear

Clinical examination of the

knee
McMurray Test
The lateral meniscus is tested by
passive flexion, valgus stress,
and internal rotation of the lower leg.
During slow extension of the knee
while maintaining valgus stress and
internal rotation, a snap on the
lateral joint line may be palpated;
this indicates a positive test for a
lateral meniscal tear.

Clinical examination of the

knee

Apply Test
The patient lies in prone
position and asked to relax. The
knee is passively flexed 90
degrees. While giving
compression from the heel,
rotational forces are applied to
the knee.
Pain is localized to the site of
the meniscal lesion.

Clinical examination of the

knee

Baker's cyst

= popliteal cyst = benign swelling of

synovial bursa found behind the knee joint.
Open communication with the synovial sac
is often maintained
Can be palpated in the popliteal region
Arise from osteoarthritis or arthritis
(ex.rheumatoid arthritis), but also any
cause of intraarticular effusion

Palpation
Surface Anatomy
(Anterior)
AC joint

biceps

SC joint

Clavicle
SC Joint
Acromion process
AC Joint
Deltoid
Coracoid process
Pectoralis major
Trapezius
Biceps (long head)

Palpation
Surface Anatomy
(Posterior)
Supraspinatus

Infraspinatus
Inferior angle
of scapula

Scapular spine
Acromion process
Supraspinatus
Infraspinatus
Deltoid
Trapezius
Latissumus dorsi
Scapula
Inferior angle
Medial border

Range of Motion
Forward flexion:
160 - 180
Extension: 40 - 60
Abduction: 180
Adduction: 45
Internal rotation:
60 - 90
External rotation:
80 - 90

 External
rotation:
80 - 90

Forward flexion:
160 - 180
Extension: 40 - 60

Adduction: 45

Strength Testing
External rotation
ER the shoulder
Infraspinatus
Teres minor

Arms at the sides

Elbows flexed to 90
degrees
Externally rotates arms
against resistance

Strength Testing
Internal rotation
IR the shoulder
Subscapularis

Arms at the sides

Elbows flexed to 90
degrees
Internally rotates arms
against resistance

Other techniques

Subacromial Impingement
Syndrome
Impingement of:
Subacromial bursa
Rotator cuff muscles and
tendons
Biceps tendon

Between

Acromion
Coracoacromial ligament
AC joint
Coracoid process
Humeral head

Rotator cuff tendonosis

Impingement Signs
Neers Sign
Arm fully pronated
and placed in forced
flexion
Trying to impinge
subacromial
structures with
humeral head
Pain is positive test

ELBOW
Ulnar (MEDIAL)
collateral ligament is
critical in providing
medial support to
prevent elbow from
abducting when stressed
in physical activity
Many contact sports &
throwing activities place
stress on medial aspect of
joint, resulting in injury

6-18

Joints
Radial (LATERAL)
collateral ligament
provides lateral
stability & is rarely
injured
Annular ligament
provides a sling effect
around radial head
for stability
6-19

Joints
Elbow moves from 0 degrees of
extension to 145 to 150 degrees of
flexion

6-20

Joints
Radioulnar joint
Trochoid or pivot-type
joint
Radial head rotates
around at proximal ulna
Distal radius rotates
around distal ulna
Annular ligament
maintains radial head in
its joint

From Seeley RR, Stephens TD, Tate

P: Anatomy & physiology, ed 7, New
York, 2006, McGraw-Hill; Shier D,
Butler J, Lewis R: holes human
anatomy & physiology, ed 9, New
York, 2002, McGraw-Hill.

6-21

Joints
Radioulnar joint
Supinate 80 to 90 degrees from neutral
Pronate 70 to 90 degrees from neutral

6-22

Movements
Flexion
movement of forearm to
shoulder by bending the
elbow to decrease its
angle

Extension
movement of forearm
away from shoulder by
straightening the elbow to
increase its angle
6-23

Movements
Pronation
internal rotary
movement of radius on
ulna that results in
hand moving from
palm-up to palm-down
position

Supination
external rotary
movement of radius on
ulna that results in
hand moving from
palm-down to palm-up
position

6-24

Inspection
Normal carrying angle in adult
Male = 10-11 degrees valgus
Female = 13 degrees valgus

Not uncommon for throwers to have > 15

degrees valgus at elbow
Person with large elbow effusion will tend
to hold elbow flexed 70-80 degrees as this
corresponds to greatest volume of elbow
joint capsule

Inspection

13 degrees
Valgus

Inspection
Lateral recess, medial epicondyle,
antecubital fossa, olecranon tip
Prominence of the olecranon tip may
indicate posterior/posterolateral
dislocation or triceps avulsion
Ecchymosis anteriorly may indicate biceps
tendon rupture
Ecchymosis medially may indicate a
fracture of the medial epicondyle or
avulsion injury

Inspection

Inspection
Olecranon bursa should be insepcted
If enlarged may represent bursitis
Aseptic vs. septic

Olecranon
Bursitis

Elbow Injuries:
direct blow

Superficial location:
extremely susceptible to
injury

Signs and Symptoms

Pain, swelling, and point
tenderness
Swelling will appear almost
spontaneously without the
pain and heat

Palpation of medial side

Palpation Posteriorly

Lateral Side Palpation

Lateral epicondyle
Radial Head
Lateral olecranon
Soft spot

Stability Exam
No inherent stability to Elbow
At full extension, olecranon
tip/olecranon fossa articulation provides
some stability against varus/valgus
stresses
Radial head provides some stability
against valgus laxity
Pts with radial head fractures may have
increased valgus carrying angle

Clinical examination of the

hip
Inspection
The most important aspect of inspection is stance
and gait.
The patient's posture is observed in both the
standing and seated position.
Any splinting or protective maneuvers used to
alleviate stresses on the hip joint are noted.
Scars or deformities are noted
Vicious position or shortening of the lower limb

Clinical examination of the

hip
Measurements
Limb lengths should be measured from the anterior superior iliac spine to the medial malleolus

Thigh circumference, while a crude measurement, may reflect chronic conditions and muscle atrophy. It is important to measure the involved compared
with the uninvolved side.

Semne clinice si radiologice de

ascensiune trohanteriana

Scurtarea aparenta a membrului inferior

Triunghiul Ogston-Bryant si linia Nelaton-Roser

Linia Peter

Linia Schoemaker

Clinical examination of the

hip

Measurements
Range of motion
Internal rotation - 40
External rotation - 45
Flexion - 125
Extension - 10-15
Abduction - 45
Adduction - 30

Passive and active

Clinical examination of the

hip
Palpation
Bony proeminences
Spina iliaca antero-superior
Spina iliaca antero-inferior
Iliac crest
Greater trochanter
Any swellings or tenderness - Anteriorly in
Scarpas triangle, trochanteric region or
gluteal region
Tonus of muscles

Clinical examination of the hip

Palpation
GM - gluteus maximus origin, TFL - tensor fascia
lata; ITB - iliotibial band, IT - ischial tuberosity, SN sciatic nerve, GTB - greater trochanteric bursa, P
piriformis, SI - sacroiliac joint.

Clinical examination of the

hip
Trendelenburg test/sign:
Make sure pelvis is horizontal by palpating ASIS.
Ask patient to stand on one leg and then on the other.
Assess any pelvic tilt by keeping an index finger on each ASIS.
Normal (Trendelenburg negative): In the one-legged stance, the unsupported side of the pelvis remains at the same level
as the side the patient is standing or even rise a little, because of powerful contraction of hip abductors on the stance leg.
Abnormal (Trendelenburg positive): In the one-legged stance, the unsupported side of the pelvis drops below the level as
the side the patient is standing on. This is because of (abnormal) weakness of hip abductors on the stance leg. The latter
hip joint may therefore be abnormal.