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Liberty You will find in this section hot NEW articles which we feel are of national importance to all folks.  These in-depth scientific forensic works are brought to you as a free service from AAJTS.  If you wish to become a member of the Academy and receive weekly Articles, join now!


The Orthopedic examination has basic portions:

1.     History

2.     Clinical Examination

3.     Radiographic Imaging and Reading.



The history is the record of the patient’s incident whether accidental or unplanned form the day the time and a step-by-step development until the time of history taking.  This includes any doctors seen, medications taken, changes in pains or any thing relating to the injury.  Generally find out what happened and what was injured, to whom, where it happened, why it happened, and ho it happened and the mechanic of the injury or etiological events leading to the patients condition (In this text I have included various examples of in-depth questions to ask specifically relative to the type of claim i.e., Workers Compensation or Industrial, Auto-accident and so forth). 

Next ask about pain correlations.  Where is your pain/are your pains?  Have the patient point with their own fingertips to the spot in pain.  Ask the patient to describe the characteristics of the pain such as “aching”, “burning”, “sharp”, and “dull”.  These characteristics tell us what tissue injuries may be involved. 

In cases of workers compensation or personal injury always have the patient write the history in their own words after the first visit.  Of course you still take a complete history upon the initial visit.  The history in their own words and writing provides insurance for you in the event of deposition and discovery, or actual court proceedings. 

The next section is past medical history (Please review actual reports or audits I have included in the text) any unusual childhood illness.  Any past surgeries or tumors benign or malignant.  Any previous industrial or personal injuries. 

Ask the following:

·        Age – may determine treatment

·        Present Occupation

·        Previous occupation

·        Hobbies or recreational activities

·        Previous injuries

·        History of any fractures or dislocations.

·        History of any hospitalization for spinal or extremity injuries.

·        Any past accidents whether industrial or non-industrial

·        Any allergies

·        Any medications taken and the response 

Again, always take the history in the patient’s own words or at the least as related by the patient. 

Taking the patients height, weight, blood pressure, respiration, and pulse follows the history.  Note the patient’s race, body build (ectomorphic, endomorphic, mesomorphic, obese) and attitude.



The Clinical examination consists of three basic sections:

·            Examination of the Part complained of

·            Investigation of possible sources of pain and referred        symptoms

·           General Examination of the body as a whole 

The area of examination must be exposed with the proper lighting.  An Orthopedic inspection is performed checking the bones for alignment, deformities or shortening.  This is followed by examination of the soft tissues for shape and contours making sure to make a bilateral comparison.  Note any skin discolorations including cyanosis, pigmentations, etc.  Ask and check for nay signs of scars or sinuses, such as scars from previous surgeries.  Palpate the part complained of checking the bones, skin, temperature, and soft tissues for signs of spasm, atrophy or wasting any areas of local tenderness fasciculation’s or an abnormal tissue consistency.  Measurement of the extremities (see examination sheets provided in this text) for any unusual differences in muscular girth is commenced.  Exact knowledge of atrophied musculature will tell the level of nerve tissue damage.

Range of motion both active and passive is initiated with pain responses noted as to degree and occurrence of pain or manifestations.  Note any creptations during the active and passive motion.  In cervicothoracic injuries ROM for the cervicothoracic spine, shoulder, elbow, wrist and hand is commenced.  In lumbosacral injuries, Lumbosacral rom as well as hip, knee, and ankle are commenced.  Always note the degree of patient pains upon motion as mild, slight, moderate, and severe and note the motion eliciting the pain. 

Measure the strength and power of the muscle that are responsible for each movement of the joint.  This is classified into”

0=No contraction (zero)

1=Flicker of contraction (trace)

2=Slight power sufficient to move the joint (poor)

3=Power sufficient to move the joint against gravity (fair)

4=Power to move the joint against gravity plus added resistance (good)

5=Normal power full range of motion vs. gravity with full resistance.  Investigation of any possible courses of referred symptoms is noted.  For example, a patient has shoulder pain.  Investigate the brachial plexus.  A pain in the lower portion of the scapula could indicate a possible gall bladder disease especially on the right side.  This is especially true in susceptible individuals (Obese female over forty). 

Your localization and objective testing will reveal weakness and its level.  You can elicit pain response with your muscle testing, which can reveal muscle, or joint (depending on were the pain is located) what is precluding an active contraction or work activity. 

Oftentimes a forensic evaluation of muscle strength is not considered complete absent a functional analysis.  Thus the patient should be asked to perform maneuvers.  For example arising from a squatted position or stepping onto a chair gives a good indication of proximal leg strength.  Minor’s sign can be noted if the patient must use their arms on their legs when arising form the squat.  Bouncing while in the Squat position or the “Bounce Home Test” will indicate the integrity of the feet, ankles, knees, hip joints as well as the low back.  A patient that must push off a chair from a seat position to arise may have spasm quadriceps weakness.  Handgrip strength or dynamometer testing (test of three).  Patients with weakness about the pelvic girdle may arise from the supine position by first turning prone, then kneeling and slowly pushing themselves erect by standing bent forward and using the arms to climb up the thighs (again a + Minor’s sign).   

Examine the spinal cord and peripheral nerve integrity with spinal level correlation through testing the deep tendon reflexes.  Grade them into classifications: 

0=No reflex activity

1=diminished activity

2=normal activity

3=quick activity

4=hyper active 

                             Segmental Level Correlations

Biceps   - 2+        Cervical 5, 6

Bra/rad  - 2+        Cervical 5, 6

Triceps  - 2+        Cervical 7, 8

Knee    ­  - 2+       Lumbar 2,3,4

Ankle    -  2+         Sacral 1,2

If sensation is disturbed, its anatomic pattern should be recognized.  For example it is well established that a stocking and glove distribution can be due to peripheral nerve where a radiating pain or radiculopathy is usually due to the nerve roots.  In any event the finding of motor weakness and reflex change can determine the anatomic localization of disease or trauma.  This occurs through your synthesis of the data noted and correlated with your knowledge of the afferent nerves, the synaptic connections within the spinal cord, and the motor nerves, as well as the descending motor pathways.  Thus much like the EMG, you can determine much about the integrity of the disc, the motor neuron, the cord and tissue synaptic connections and the sensory pathway to the cord. 

Examine the superficial reflexes when they correlate with appropriate level of investigation. 

Abdominal   2+ Upper              Thoracic 8,9,10

                     2+ Lower              Thoracic 10, 11, 12


Cremasteric 2+                         Lumbar 2,3

Plantar          2+                         Lumbar 4,5, Sacral 1,2


The following table will aid in the diagnosis of upper motor neuron lesions from lower motor neuron lesions through your finding from your reflex testing. 

SYSTEMS           UMNL                  LMNL


DT Reflexes        Hyperactive           Diminished or absent

Atrophy                 Absent                  Present

Fasciculation’s    Absent                  Present

Tonus                    Increased              Decreased or absent

It must be noted that Fasciculation’s (see Nerve Studies) are the most common extraneous movements seen.  They come in the form of brief, fine and irregular twitches of the muscle visible under the skin.  These

Fasciculation’s are indicative of disease of the lower motor neuron but sometimes can occur in normal muscle, particularly in the calf muscles of our geriatric populations. 

In cervicothoracic or upper extremities injuries have the patient perform bilateral dynamometer testing for grip strength.  The test is repeated three times by each hand.  Note the injured hand and the handedness of the patient (right vs. left). 

Have the patients walk away from you and towards you and watch their gait for abnormalities. 

Ask them to demonstrate a squat for you.  Note whether they are able to perform the squat or unable to perform.  Note whether the squat was done well. 

Ask them to heal walk/and toe walk for you to determine L5/S1 integrity (heel walk=dorsiflexion of the toes and ankle which is primarily L5 and minor L4 and toe walk is the calf muscles primarily the S1 nerve root)  Note whether the patient has done it well or done poor or not at all.  Inability to walk on the toes indicates alterations in sacral first nerve root integrity as well as possible lumbar disc fifth involvement.  Inability to walk on the heels indicates lumbar fifth nerve root integrity as well as the lumbar disc fourth. 

Check the patient’s extremity pulses and check for venous stasis.

Radial                    4+/4+

Femoral                 4+/4+

Popliteal                4+/4+

Dorsal Pedis         4+/4+

Posterior Tibial     4+/4+ 

4+ is considered normal for peripheral bilateral vascular pulses.  Note any edema by area and check for tenderness of the extremity.  Check homan’s sign (see orthopedic tests) bilaterally.

Run the Waltenberg pinwheel down the dermatome patterns and note whether they are intact or not.  Locate any areas of numbness.  Often, a slow and careful assessment of the dermatomes using a Pin can be more accurate although more time consuming.  It is said, “anything worth doing is worth doing well”. 

Segmental Level of peripheral Nerves. 

C2 – Area under the chin

C3 – Area in the front and back of the neck

C4 – Shoulder area

C6 – Thumb area

C7 – Chiropractic index finger

C8 – Ring and little fingers

T4 – Nipples line

T10 – Umbilical line

L1 – Inguinal area

L3 – Knee area

L5 – Anterior ankle and foot containing big toe plus two.

S1 – Heal and little toe plus one. 

In cases where you suspect possible head trauma run a ENT examination checking the ears, eyes, nose and throat for any possible bleeding (see Neurological Diagnostic Modalities).  Of course check the pupils of the eyes for ipsilateral dilation, or bilateral dilation or constriction.  Check the retina for any possible hemorrhage or internal cranial edema. 

The general examination of the body as a whole includes a psychological make-up of the patient such as attitudes, etc.  Perhaps the patient only dreamed the incident and their physical complaint would be better served by a psychologist or psychiatrist. 

Other specific orthopedic tests would be performed and depending on a cervical spine injury or lumbosacral injury specific orthopedic test would be correlated with other special testing. 

Radiographic imaging would also be correlated with the subjective and objective reported thus far. 

When you have taken the complete history, past medical history, review any past medical records and take a complete physical of areas of complaint, neurological, orthopedic and x-ray imaging you will be able to correlate all the know objective, subjectives, ad special tests with the history and conclude the correct diagnosis and subsequent treatments. 

The following are orthopedic tests utilized for clarification and differential diagnosis of neuro-musculo-skeletal conditions.

1.    Adson’s Test

Procedure:     With the patient seated, establish the radial pulse.  Have the patient extend their head and rotate to the side on which the pulse is being taken.  Have the patient take a deep breath and bear down.  Extend the arm 45 degrees. 

Significance:  Radial pulse diminished or obliterated indicates THORACIC OUTLET SYNDROME.


2.    Brudzinski’s Sign

Procedure:     Begin by gently flexing the patient’s neck onto their chest.  If the patient has a moderate disorder this may feel excruciating.  In minimal to slight to moderate conditions forcibly flex the patient’s neck onto their own chest. 

Significance:  If the patient’s hips or legs demonstrate a flexion motion this indicates Meningitis or Disc Poliomyelitis, meningeal irritation or even subarachnoid hemorrhage.


 3.    Compression Tests (a-also known as Cervical Compression Test, b-also known as Hammer Test)

a.  Procedure:          With the patient seated gently press down on the top of their head. 

Significance:  Pain indicates Intervertebral                          Foraminal Encroachment.


b.  Procedure:          With the patient seated barely press down on the top of their head with your little finger. 

Significance:  Malingering


4.   Depression Test (Also Known as Shoulder Depression Test)

Procedure:  Have the seated patient laterally flex their neck.  Depress their shoulder on the opposite side. 

Significance:  Pain indicates Radicular Adhesion in the IVF’s.


5.     Distraction Test (Also known as Cervical Distraction Test)

Procedure:  With the patient seated gently lift cephalad the patient's head to remove its weight from their neck. 

Significance:  1.  Relief of patient’s pain indicates Intervertebral Foraminal Encroachment.

                         2.  Pain indicates spasticity of the cervicothoracic para- spinal musculature.


6.   GSRT (Global Sustained Rotational Test, named the Neff Test by Rene’ Calliet in 1982)

Procedure:     With the patient seated or supine take your middle finger and make a contact with the atlas.  Gently rotate the patient’s head and neck to the full range of motion just entering the manipulative range but not in the interim or through it.  Observe for nystagmus blood shoot eyes that were not there prior to the test, nausea, dizziness, or vertigo.  If negative extend the head and hold thirty seconds and observe for manifestations i.e. nystagmus etc

Significance:  Potential for cervicobasilar infarction or Stroke via interfacial bands and kinks, bony exostoses with lateralization about the intervertebral artery, and possible plaque with thrombosis or embolism. 

7.    Soto Hall Test

Procedure:     Flex the neck of the supine patient while pressing gently on the upper sternum. 

Significance:  Pain indicates Fracture, Discopathy, Supraspinatous Ligament tear, or dural sleeve adhesions.


8.    Swallowing Test

Procedure:     Have the seated patient swallow. 

Significance:  If the patient has pain or difficulty swallowing this indicates a possible Infection, Osteophytes, Hematoma or tumor in the anterior portion of the cervical spine.

 9.    Valsalva Maneuver

Procedure:     Have the patient in a seated position hold their breath and bear down. 

Significance:  Pain may indicate a Discopathy, Spinal Cord Tumor, or any Space Occupying Lesion.



A shoulder examination must contain four tests; three for dislocation and instability as well as a soft tissue testing. 

10.  Drawer tests – Anterior

Procedure:  The shoulder to be tested is abducted between 80 and 120forward flexed 0 and 20and laterally rotated, 0 and 30.  The examiner places one hand on the shoulder and the other on the relaxed upper arm and draws the humorous forward. 

Significance:  Movement may be accompanied by click and/or apprehension.


11.   Posterior:  

Procedure:      Examiner pulls up on the arm at the wrist while pushing down on the Humerus with the other hand.  

Significance:   If more than 50% posterior translation @   patient is  apprehensive patient has posterior instability.          


12.   Inferior      

Procedure:               Also known as the Sulcus Sign Test.  The patient sits with the arm by the side.  The Examiner grasps the patient’s forearm below the elbow and pushes the arm distally. 

Significance:            Presence of Sulcus sign=Inferior                                          instability.         


13.  A/C Shear 

Procedure:  Patient seated examiner cups hands over the deltoid muscle with one hand on the clavicle and one hand on the spine of the scapula then squeezes the heels of the hands together.   

Significance:   Pain or abnormal movement = acromioclavicular joint pathology.  

14.  Speed Test:       

Procedure:               Examiner resists shoulder forward shoulder flexion with the patient's forearm supinated and the elbow is completely extended.   

Significance:            Increased tenderness in the bicipital groove is indicative of bicipital tendonitis.  ST is more effective than Yergason's because ST moves bone over the tendon during the test.  

15. Supraspinatous     Shoulder is abducted 90 with no rotation, and resistance to abduction is provided by the examiner.  The shoulder is then medically rotated and angled forward 30 so that the patient's thumbs point toward the floor.  Resistance to abduction is again given while the examiner looks for weakness or pain.   

Significance:       Supraspinatous muscle or tendon tear,

                              neuropathy of the suprascapular nerve.  

16.   Brachial Plexus      C5-C7 nerve roots and median nerve-Arm is abducted and laterally rotated behind the coronal plane with the shoulder girdle fixed in depression.  The elbow is then passively extended with the wrist held in extension and the forearm in Supination.   

Significance:       Pain, ache, tingling in the thumb and first three fingers = median nerve tension or nerve root tension.


17.   Codman's Arm Drop  Patient to fully abduct arm and lower it  slowly.   

        Significance:                 If arm drops to side (patient is unable to lower it slowly) it indicates ROTATOR CUFF TEAR.


18Dugus Test           Patient to touch opposite shoulder with hand.  If patient is unable to touch opposite shoulder, it indicates DISLOCATION.


19.  Apprehension       Flex, abduct and externally rotate patient's arm. 

        Significance:                 As external rotation begins to exceed 90 a look of apprehension on the patient's face indicates CHRONIC TENDENCY TOWARDS DISLOCATION.


20.   Yergason’s Test   

Procedure:    Gently flex the patient s elbow 90 degrees.  With one hand pull down on the elbow and stabilize it while moving the patients wrist laterally with the other hand (to externally rotate the patients arm)

Significance:  If the biceps tendon slips out of the bicipital groove, which at times is palpable, and/or the patient experiences pain in the region, it indicates a TEAR OF THE TRANSVERS HUMERAL LIGAMENT.  Often time’s pain alone indicates tendonitis of the long head of the biceps tendon.




Procedure:          Gently extend and pronate the arm of the patient and extend their wrist.  Stabilize the elbow and attempt to flex the wrist while the patient resists. 

Significance:       Excessive motion indicates a TEAR OF THE COLLATERAL LIGAMENT (Valgus stress = medial collateral ligament: Varus stress = lateral collateral ligament)



Procedure:          With the patient’s arm pronate, have them flex the wrist.  Then have the patient attempt to supinate the forearm against the doctor’s resistance. 

Significance:       Pain at the lateral Epicondyle indicates  LATERAL EPICONDYLITIS.  Pain at the                        medial Epicondyle indicates MEDICAL                    EPICONDYLITIS AKA Golfers Elbow



Procedure:      With the patients elbow extended, grasp their wrist and distal Humerus.  Apply first a Valgus stress, and then a Varus stress to the elbow.

 Significance:   Excessive motion indicates a TEAR OF  THE COLLATERAL LIGMENT (Valgus stress=medial     collateral ligament:  Varus stress=lateral collateral               ligament.



Procedure:      Tap ulnar nerve in groove between olecranon and medial Epicondyle. 

Significance:      Hypersensitivity indicates NEURITIS,      NEUROMA OR A REGENERATING NERVE. 


           25.   FINKELSTEIN’S TEST

Procedure:   Have the patient make a fist with the thumb tucked inside.  Gently force the wrist into ulnar deviation. 

Significance:    Pain in the anatomical snuffbox of the         patients hand indicates STENOSING TENOSYNOVITIS   AKA DE QUERVAINS’ DISEASE.


26.   Ligamentous Instability tests.  

Procedure:    The Patient's arm is stabilized with the examiners hand on the elbow   and the wrist.  The elbow is Slightly flexed 30-30.  An adduction or Varus Forces is applied to test the lateral collateral ligament.  Then the examiner places an abduction or Valgus force to test the medial collateral ligament.  Some advocate Varus done with arm in full medial rotation and Valgus done in full lateral rotation.

Significance:    Pain upon stress indicates collateral ligament tear . 


27.   Pronator Teres Syndrome Test

Procedure:          Elbow flexed to 90 degrees.  Examiner resists pronation as the elbow is extended.   

Significance:       Tingling or Paresthesia in median nerve distribution indicates median nerve  entrapment.


28.   PINCH GRIP TEST                 

Procedure:   Thumb and first finger should touch tip to tip.

Significance: If pads of finger and thumb touch then pathology to the anterior interosseous nerve brach of the median nerve.  Thus entrapment of the anterior interosseous nerve as it passes between the two heads of the Pronator Teres muscle.



Procedure:     Flex the wrist of the patient to the maximum degree possible and hold there for a minute.

Significance:    Pain and Paresthesia in the hand           indicates CARPAL TUNNEL SYNDROME: 


Procedure:          Tap the median nerve of the patient at their flexor Retinaculum. 

Significance:       Pain and Paresthesia in the wrist and/or   hand indicates CARPAL TUNNEL SYNDROME.



Procedure:          Extend the wrist of the patient to the maximum degree possible and hold there for a minute.

Significance:       Pain and Paresthesia in the wrist and/or  hand indicates CARPAL TUNNEL SYNDROME




Procedure:    Hold the metacarpophalangeal joint of the patient in a few degrees of extension and try to move the proximal interphalangeal joint into flexion.  If this cannot be done, flex the metacarpophalangeal joint a few degrees aNd try again to flex the PIP joint.  

Significance:   Delay in the appearance of the “flush” indicates PARTIAL OR COMPLETE OBSTRUCTION OF ONE OF THE ARTERIES. 


Procedure:   Hold the metacarpophalangeal joint of the patient in a few degrees of extension and try to move the proximal interphalangeal joint into flexion.  If this cannot be done, flex the metacarpophalangeal joint a few degrees and try again to flex the PIP joint.

Significance:   If the PIP can be flexed in the second position, it indicates TIGHTNESS OF THE INTRINSIC MUSCLES of the patients HAND.  If the PIP cannot be flexed in either situation it indicates PIP JOINT CAPSULE CONTRACTION. 


Procedure:    Hold the PIP joint of the patient in a neutral position and try to flex the DIP joint.  If this cannot be done, flex the PIP joint a few degrees and repeat. 

          Significance:   If the DIP joint can be flexed in the second position only, it indicates TIGHTNESS OF THE INTRINSIC MUSLES OF THE HAND OR THE RETINACULAR LIGAMENTS.  If the DIP joint cannot be flexed in either position, it indicates the patient has DIP JOINT CAPSULE CONTRACTURE.




Procedure:          Stabilize the supine patient’s thighs upon the table and ask the patient to sit up. 

Significance:       Pain and/or inability to perform may indicate SCIATICA or LUMBAR ARTHRITIS



Procedure:          Observe the patient rising from the sitting position. 

Significance:       This may indicate sciatica if the patient supports Themselves on one side, keeping the affected side Bent over.



Procedure:    The standing patient is bent forward.  Flexion of The knee on the affected side indicates pain in the leg due to pull on the hamstrings and the pelvis. 

          Significance:   This may indicate sciatica if the patient supports themselves on one side, keeping the affected side bent over. 


Procedure:          With the patient in the supine position, raise their ‘  leg. 

Significance:       Sciatic pain at 0-30 degrees indicates Altered Sacroiliac joint Dynamics due to a hot disc assaulting the nerve. Sciatic pain at 30-60 degrees indicates Altered Lumbosacral Joint Dynamics due to a Sprain.   Sciatic pain at 60-90 degrees indicates Altered L1-L4 joint dynamics.

39.   Well Leg Raising Test

Procedure:          With the same patient supine, raise the uninvolved leg. 

Significance:       Sciatic distribution in the opposite leg Differentiates and demonstrates a Discopathy.



Procedure:          With the patient supine place on hand under their lumbar spine and raise their leg. 

Significance:       Pain BEFORE vertebral motion indicates altered sacroiliac joint Dynamics of SI Strain/Sprain. 

Pain AFTER vertebral movement begins indicates Altered Lumbosacral or Lumbar joint dynamics of Strain/Sprain.



Procedure:          Ask your patient to be seated and extend their legs. 

Significance:       If the Patient can extend only one leg at a time, and the ill leg from a Laseque test has difficulty being Raised this indicates a TRUE SCIATIC CONDITION.  If low back pain occurs during extension, this indicates a possible LUMBAR DISCOPATHY.  If the patient had a positive Laseque test but has no difficulty sitting ad raiding the ill leg suspect an alleged case of MALINGERING. 


Procedure:          With your patient in a supine position, flex their thigh 90 degrees and extend their leg.  Ask them to lower their leg and stop half way down. 

Significance:       If the patient’s leg drops or the patient is unable to stop, it indicates Discopathy.



Procedure:    With the patient standing, place one thumb on the 2nd sacral tubercle and other thumb on the Ilium at the same level.  Ask the patient to flex the thigh. 

Significance:    If the Ilium fails to move inferior it indicates a SACROILAC RESTRCTION-STRAIN/SPRAIN.



Procedure:     With the patient prone and their knee flexed 90 Degrees internally rotate the femur. 

Significance:       Increased pain indicates Altered Sacroiliac joint dynamics due to minimally a strain or sprain.



Procedure:          Perform the Braggard Test on the Uninvolved Leg. 

Significance:       Sciatic pain on the opposite side indicates DISCOPATHY



Procedure:          With the patient supine, place their lateral Malleolus on the opposite knee and depress the flexed knee.         

          Significance:       Pain in the Hip indicates OSTEOARTHRITIS OR INFLAMMATION OF THE INVOLVED HIP.


           47.   HIBB’S TEST

Procedure:          With the patient prone, extend and abduct the thigh and push the femur directly into the Acetabulum. 

Significance:       Pain indicates OSTEOARTHRITIS OF THE HIP OR SYNOVITIS.



Procedure:          With the patient prone, extend the thigh and push the femur directly into the Acetabulum. 

          Significance:       Pain indicates OSTEOARTHRITIS OF            THE HIP OR SINOVITES.


49.   ELY’S TEST

Procedure:    With the patient prone, grasp both ankles and flex the knees upon the thighs. 

          Significance:  If the patient reports pain in the lumbar or  lumbosacral area indicates ALTERED LUMBAR OR   LUMBOCARL JOINT DYNAMICS due to spastic internal  and external rotator of the leg.



Procedure:   With the patient supine, flex on thigh onto the abdomen and hold it there.  Next, hyperextend the other hip by slowly lowering the femur ff the table.  Gently apply downward pressure on the hyperextended thigh.

 Significance:   Pain indicates ALTERED SCROIIAC JOINT DYNAMICS AND SPRAIN.    



Procedure:          Have the supine patient raise their extended legs two inches and hold for 30 seconds. 

Significance:       Pain or inability to hold position  indicates INCREASED INTRATHECAL PRESSURE AND/OR DISCOPATHY.



Procedure:          With the patient in the supine posture, compress the jugular veins for 30 seconds and then ask the patient to cough. 



Procedure:   With the patient supine, flex their thing on their hip 90 degrees with the knee flexed 90 degree.  Ask the patient to extend their knee. 

          Significance:   Inability to extend the knee past 135 degrees indicates MENIGEAL IRRITATION OR    MENINGITIS AND POLIOMYELITIS.



Procedure:    Have the patient kneel on a bench.  Grasp the ankles and ask the patient to touch the floor. 

Significance:       A claim that pain prevents this motion indicates MALINGERING.

 55.   FFEN TEST

Procedure:    Palpate a given area and ask the patient if this is painful.  Come back to it later and run a pin wheel down the dermatome over the area and ask the patient what they can feel or are they numb?

Significance:  Coached patients know they have pains ad have numbness.  Oftentimes if the patient is not truly experiencing the problem they get confused and forget what part is numb and which part is painful.  However it is not consistent for a patient to have severe palpable muscular pain and numbness of the same tissues at the same time.




Procedure:          Measure from the patients ASIS to their medial malleolus.  If discrepancy in length exists, flex hip and knees.  Observe whether the knee of one leg is higher or more anterior than the other. 

Significance:       One knee HIGHER indicates discrepancy in TIBIA LENGTH.  One knee ANTERIOR indicates discrepancy in FEMUR LENGTH.



Procedure:   Measure from the umbilicus to the medial malleolus. 

          Significance:   If this differs from leg to leg, and ASIS to malleolus measurements are equal, the discrepancy indicates PELVIC OBLIQUITY.



Procedure:          With the patient in the prone position, check their leg length at the medial malleoli.  If discrepancy exists, flex their knees and gently stretch by Dorsiflexion the feet and recheck.  Have the patient turn their head to the side and recheck. 

Significance:       If the short leg becomes the long leg on knee flexion, it indicates an ALTERED SACROILIAC JOINT.  If turning the head alters the leg length, it indicates ALTERED CERVICAL JOINT DYNAMICS.



Procedure:          With the patient on their side, abduct and extend their thigh and then drop it. 

          Significance:       If their leg fails to descend or descends in clonic anner, it indicates CONTRACTURE OF THE TENSOR FASCIA LATA TISSIE.



Procedure:     With the patient supine, flex one knee onto their abdomen. 

Significance:       Involuntary flexion of the opposite hip indicates HIP JOINT FLEXION CONTRACTURE.



Procedure:    With the physicians hands on the patient’s iliac rests, have the standing patient flex on hip. 

          Significance:   If their hip on the flexed side fails to raise, or if it falls, this indicates a WEAKNESS OF THE OPPOSIE GLUTEUS MEDIUS OR SACROILIAC JOINT SPRAIN.



Procedure:          With the patient in the supine position, tap their inferior Calcaneus. 

          Significance:       Pain indicates FEMORAL FRACTURE:





Procedure:          With the patient supine, push the patella distally.  Ask the patient to contract the quadriceps against resistance to the patella’s upward movement. 

Significance:       Palpable crepitus as the patella moves upward indicates ROUGHENING OF THE ARTICULAR SURFACE.



Procedure:        With the patient supine, flex their knee while rotating it both internally and externally.  Then extend the knee while continuing to rotate it. 

Significance:     A clicking sound during extension and rotation indicates that the damaged MENISCUS HAS SLIPPED BACK INTO PLACE.



Procedure:   With the patient supine, push the patella down into the Trochlear groove and quickly release it. 

          Significance:   If the patella rebounds (a blottable patella) this indicates JOINT EFFUSION. 



Procedure:       With the patient supine, push the patella from the Suprapatelar pouch to the infrapatelar area den then from lateral to medial.  Next tap the medial side of the knee just posterior to the patella. 

Significance:       If a fluid wave causes fullness on the lateral side of the joint, it indicates MINOR EFFUSION.



Procedure:    With the patient supine, push their patella laterally. 

Significance:       A look of apprehension on the patient’s face indicates a CHRONIC TENDENCY TOWARDS FREQUENT LATERAL DISLOCATION.



Procedure:    Tap the infrapatelar branch of the saphenous nerve at the medial side of the Tibial tubercle.

Significance:      Hypersensitivity indicates NEURITIS, NEUROMA OR A REGENERATING NERVE. 



Procedure:   With the patient’s knee flexed and foot stabilized Flat upon the table, move the patient’s proximal Tibia anterior and posterior. 

Significance:       Abnormal anterior movement indicates RUPTURE OF THE ANTERIOR CRUCIATE LIGAMENT.  abnormal posterior movement indicates RUPTURE OF THE POSTERIOR CRUCIATE LIGAMENT.



Procedure:          With the patient prone and their knee flexed 90 degrees, stabilize the leg and place direct pressure firmly on the heel directed through the tibia.  As the menisci are compressed between the tibia and femur, rotate the leg internally and externally. 

Significance:  Pain on the medial side of the knee indicates MEDIAL MINISCUS DAMAGE.  Pain on the lateral side of the knee is indicative of LATERAL MENISCUS DAMAGE.



         Procedure:     With the patient in the same positioin as for the compression test, traction the patients leg upwards while at the same time gently rotating it internally and externally.

Significance:  Pain indicates COLLATERAL LIGAMENT DAMAGE


Procedure:   With the patient supine, fully flex and externally Rotate their leg, while maintaining the rotation, Slowly extend the leg while palpating the joint space and applying posterior force to the knee.  Repeat with internal rotation. 

Significance:       A painful click on extension with EXTERNAL ROTATION indicates MEDIAL MENISCUS TEAR, with INTERNAL ROTATION, LATERAL MENISCUS TEAR. 


Procedure:    With the patient seated, slightly flex their knee and push laterally on the ankle and medially on their knee (Valgus stress).  Repeat while pushing medially on the ankle and laterally on the knee (Varus stress). 

Significance:   Palpable gapping on the medial side of the knee under VALGUS STRESS indicates MEDIAL COLLATERAL LIGAMENT TEAR.  Gapping on the lateral side of the knee under VARUS STRESS indicates LATERAL OLLATERAL LIGAMENT TEAR.





Procedure:  With the patient seated extend the leg and try to dorsiflex their ankle.  If Dorsiflexion is limited, flex their knee and repeat. 

Significance:      Limitation of motion in both positions indicates SOLEUS MUSLCE TIGHNESS.  LOM on knee extension only indicates GASTROCNEMIUS TIGHTNESS. 


Procedure:          Squeeze the patient’s calf muscles posterior to anterior. 

Significance:       Lack of slight plantar flexion indicates ACHILLES TENDON RUPTURE.



Procedure:          With the patient’s foot hanging free, pull their Calcaneus forward while pushing their distal tibia posteriorly. 

Significance:       Abnormal forward motion indicates ANTERIOR TALOFIBULAR LIGAMENT TEAR.



Procedure:          Passively invert the patients Calcaneus.

Significance:       Gapping and rocking of the Talus indicates TEAR of the ANTERIOR TALOFIBULAR and/or CALCANEOFIBULAR LIGAMENT.



Procedure:          With the patient supine dorsiflex the patient’s ankle.

Significance:       Calf tenderness indicates deep vein THROMBOPHLEBITIS.



Procedure:          With the patient supine, flex the knee.  Holding their ankle passively extend their knee. 

Significance:      If the patient's knee fails to fully extend and offers a rubbery resistance to further extension and ending in a sharp end point this indicates MENISCUS DAMAGE.



Procedure:          Have the patient first walk on his heals and then on his toes. 

Significance:    An inability to walk on the toes indicates a first sacral nerve root involvement (5th Lumbar Disc).  Whereas an inability to walk on the heels is indicative of a 5th lumbar nerve root involvement (4th lumbar disc). 

by Dr. Scott D. Neff, DC DABCO MPS-BT CFE DABFE FFABS FFAAJTS, 2010 Graduate Antigua School of Medicine, West indies made for the medical students of our times and as a dedication to the people of America and our world. ©

"Why does this magnificent applied science which saves work and makes life easier, bring us little happiness? The simple answer runs, because we have not yet learned to make sensible use of it." Albert Einstein 1931


© & TM 1998 American Academy for Justice Through Science. All rights reserved.

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