20 SECTION 1 Evaluation

Table 1-9 Musculoskeletal Provocative Maneuvers

Test Description Reliability (%)
Cervical Spine Tests
Spurling/neck compression A positive test is reproduction of radicular symptoms distant from the neck with passive lateral Sensitivity: 40-60
test flexion and compression of the head. Specificity: 92-100
Shoulder abduction (relief) A positive test is relief or reduction of ipsilateral cervical radicular symptoms with active Sensitivity: 43-50
sign abduction of the ipsilateral arm with the hand on the head. Specificity: 80-100
Neck distraction test A positive test is relief or reduction of cervical radicular symptoms with an axial traction force Sensitivity: 40-43
applied by the examiner under the occiput and the chin while the patient is supine. Specificity: 100
Lhermitte sign A positive test is the presence of electric-like sensations down the extremities with passive Sensitivity: 27
cervical forward flexion. Specificity: 90
Hoffmann sign A positive test is flexion-adduction of ipsilateral thumb and index finger with passive snapping Sensitivity: 58
flexion of the distal phalanx of the middle finger. Specificity: 78
ginibisasepitsyaratiarteri
Thoracic Outlet Tests m .
pectoralis 1310 Kasi )
radians
I
Adson test A positive test is a decrease or obliteration of the ipsilateral radial pulse with inspiration, chin Specificity: 18-87
toienarahkita
tahannatas
↳ scalenitrigonum elevation, and head rotation to the ipsilateral side. Sensitivity: 94
adatpenbananga Wright hyperabduction → pectoral A positive test is obliteration of the palpated radial pulse at the wrist when the ipsilateral arm is Sensitivity: 4036
test elevated to 90 degrees. Specificity: 84
Roos test global Ctidakmelihatlokasi ) A positive test reproduces the patient’s usual upper limb symptoms within 3 minutes of Sensitivity: 3036
bokatutvptanganrsmenit moderate opening and closing of the fist with the arms and elbows flexed to 90 degrees. Specificity: 84
Costoclavicular test A positive test is indicated by a reduction in the radial pulse with shoulder retraction and Sensitivity: 5336
depression as well as chest protrusion for 1 minute. Specificity: 88
→ abduksibahvco -30 )
Supruspina Rotator Cuff/Supraspinatus Tests
tntraspina Empty can/supraspinatus A positive test is pain or weakness in the ipsilateral shoulder with resisted abduction of the Sensitivity: 79
feresminor test shoulder, which is in internal rotation, with the thumb pointing toward the floor, and a
forward angulation of 30 degrees.
Specificity: 38-50

Drop arm test A positive test is noted if the patient is unable to return the arm to the side slowly or has Sensitivity: 2775
opaintollardt> tendinitis supraspinalvs severe pain after the examiner abducts the patient’s shoulder to 90 degrees and then asks the Specificity: 88
µ
go olangsongjatoh → tear
patient to slowly lower the arm to the side.
↳
dioopotipelanpelanmenunnkantangan
Rotator Cuff/Infraspinatus and Teres Minor Tests
Patte test A positive test is pain or inability to support the arm or rotate the arm laterally with the elbow Sensitivity: 36-71
at 90 degrees and the arm at 90 degrees of forward elevation in the plane of the scapula. This Specificity: 71-91
indicates tears of the infraspinatus and/or teres minor muscles.
Lift-off test A positive test is the inability to lift the dorsum of the hand off the back with the arm internally Sensitivity: 50
rotated behind the back as starting position. This indicates a disorder of the subscapularis. Specificity: 84-95
Scapular Tests
Lateral scapular slide test This test allows for identification of scapulothoracic motion deficiencies with the contralateral Sensitivity: 28-50
side as an internal control. The reference point used is the nearest spinous process. A Specificity: 48-58
scapulothoracic motion abnormality is noted if there is at least a 1-cm difference. The first
position of the test is with the arm relaxed at the side. The second is with the hands on the
hips with the fingers anterior and the thumb posterior with about 10 degrees of shoulder
extension. The third position is with the arms at or below 90 degrees of arm elevation with
maximal internal rotation at the glenohumeral joint. These positions offer a graded challenge
to the functioning of the shoulder muscles to stabilize the scapula.
Isometric pinch test This test is used to evaluate scapular muscle strength. The patient is asked to retract the scapula Unavailable
into an “isometric pinch.” Scapular muscle weakness can be noted as a burning pain in less
than 15 seconds. Normally, the scapula can be held in this position for 15 to 20 seconds with
no discomfort.
Scapular assistance test A positive test is when symptoms of impingement, clicking, or rotator cuff weakness are Unavailable
improved when assisting the lower trapezius by manually stabilizing the upper medial border
(of the scapula) and rotating the inferomedial border as the arm is abducted or adducted.
Scapular retraction test The test involves manually positioning and stabilizing the entire medial border of the scapula, Sensitivity: 10094
which indicates trapezius and rhomboid weakness. The test is positive when there is increased Specificity: 33
muscle strength or decreased pain or signs of impingement with the scapula in the stabilized
position.
Biceps Tendon Tests Heksisupinasi
Yergason test The test is done with the elbow flexed to 90 degrees, with the forearm in pronation. The Sensitivity: 37
examiner holds the patient’s wrist to resist supination and then directs active supination be Specificity: 86
4) kalonyerididaerlhbisep
to made against his or her resistance. Pain that localizes in the bicipital groove indicates a
Tendinitis bisipitalis disorder of the long head of the biceps. It can also be positive in fractures of the lesser
tuberosity of the humerus.

Table 1-9 Musculoskeletal Provocative Maneuvers (Continued)
Test
Speed test
Shoulder Impingement Tests
Neer’s sign test
internal Mali Heksikeatas
→
G) nyeribanvdepan
Hawkin test
shoulder flexion + elbow flexion
internal rotation
Yocum test
Shoulder Stability Tests
Apprehension test
Fowler’s sign
Load and shift test
Labral Disorder Tests
Active compression test
(O’Brien)
Crank test
Compression-rotation test
Acromioclavicular Joint Tests
Apley scarf test
laporannya → terbatasatau ga
Lateral and Medial Epicondylitis Tests
Resisted wrist extension
Resisted wrist flexion and
pronation
Elbow Stability Tests
Posterolateral rotatory
instability
Varus stress
CHAPTER 1 The Physiatric History and Physical Examination 21
Description Reliability (%)
A positive test is pain in the bicipital groove with resisted anterior flexion of the shoulder with Sensitivity: 68-69
extension of the elbow and forearm supination. Specificity: 14-55
The test is positive if pain is reproduced with forward flexion of the arm in internal rotation or Sensitivity: 75-88
in the anatomic position of external rotation. The pain is thought to be caused by Specificity: 31-51
impingement of the rotator cuff by the undersurface of the anterior margin of the acromion
or coracoacromial ligament. Sama a) a pilih 1
This test is positive if there is pain with forward flexion of the humerus to 90 degrees with
forcible internal rotation of the shoulder. This drives the greater tuberosity under the
{ Sensitivity: 83-92
Specificity: 38-56
coracoacromial ligament resulting in rotator cuff impingement. shoulder im ping Mont syndrome
This test is positive if there is pain with raising the elbow while the ipsilateral hand is on the Sensitivity: 7978
contralateral shoulder. Specificity: 40
The test is positive if there is pain or apprehension while the shoulder is moved passively into Sensitivity: 69
maximal external rotation while in abduction followed by forward pressure applied to the Specificity: 50
posterior aspect of the humeral head. This test can be done either in the standing or supine
position.
The examiner performs the apprehension test and at the point where the patient feels pain or Sensitivity: 30-68
apprehension the examiner applies a posteriorly directed force to the humeral head. If the Specificity: 44-100
pain persists despite the posteriorly applied force, it is primary impingement. If there is full
pain-free external range, it is a result of instability.
The scapula is stabilized by securing the coracoid and the spine of the scapula with one hand Sensitivity: 91
with the patient in a sitting or supine position. The humeral head is then grasped with the Specificity: 93
other hand to glide it anteriorly and posteriorly. The degree of glide is graded mild, moderate,
or severe.
The patient is asked to forward flex the affected arm 90 degrees with the elbow in full Sensitivity: 32-100
extension. The patient then adducts the arm 10 degrees to 15 degrees medial to the sagittal Specificity: 13-98.5
plane of the body with the arm internally rotated so the thumb is pointed downward. The
examiner then applies downward force to the arm. With the arm in the same position, the
palm is then supinated and the maneuver is repeated. The test is considered positive if pain is
elicited with the first maneuver and is reduced or eliminated with the second maneuver.
With the patient in an upright position, the arm is elevated to 160 degrees in the scapular plane. Sensitivity: 46-91
Joint load is applied along the axis of the humerus with one hand while the other performs Specificity: 56-100
humeral rotation. A positive test is when there is pain during the maneuver during external
rotation with or without a click, or reproduction of the symptoms. The test should be
repeated in the supine position when the muscles are more relaxed.
With the patient supine, the shoulder is abducted to 90 degrees, and the elbow flexed at 90 Sensitivity: 80
degrees. A compression force is applied to the humerus, which is then rotated, in an attempt Specificity: 19-49
to trap the torn labrum with reproduction of a snap or catch.
A positive test is pain at the acromioclavicular joint with passive adduction of the arm across Sensitivity: 7723
the sagittal midline attempting to approximate the elbow to the contralateral shoulder. Specificity: 79
For lateral elbow pain, the test is positive if pain is worsened with extension of the wrist against Unavailable
resistance.
This test is positive if medial epicondylar pain is reproduced with forced wrist extension as the Unavailable
patient maintains the elbow in 90 degrees of flexion, with the forearm supinated with the
wrist flexed. A positive test indicates involvement of the flexor carpi radialis tendon. Medial
elbow pain is most exacerbated with the elbow flexed.
This test is used to uncover a dislocated radiohumeral joint, which manifests as an obvious Unavailable
dimpling of the skin, generally at a maximum of 40 degrees of elbow flexion. The test is
accomplished starting with the patient’s forearm in full supination with the elbow in full
extension, the examiner slowly flexes the elbow while applying valgus and supination moments
and an axial compression force, producing a rotary subluxation of the ulnohumeral joint.
This test is positive if there is excessive gapping on the lateral aspect of the elbow joint. The Unavailable
arm is placed in 20 degrees of flexion with slight supination beyond neutral. The examiner
gently stresses the lateral side of the elbow joint.
Continued on following page
 22 SECTION 1 Evaluation

Table 1-9 Musculoskeletal Provocative Maneuvers (Continued)

Test Description Reliability (%)
Jobe test (valgus stress) This test is positive if there is excessive gapping on the medial aspect of the elbow joint. The Unavailable
elbow is placed in 25 degrees of flexion to unlock the olecranon from its fossa. The examiner
gently stresses the medial side of the elbow joint.
Moving valgus stress test The examiner maintains a constant moderate valgus torque to a maximally flexed elbow and Sensitivity: 10071
then rapidly extends the elbow. A positive test occurs if medial elbow pain is reproduced at Specificity: 75
the medial collateral ligament and is at maximum between 120 degrees and 70 degrees.
Carpal Ligament and Joint Tests
Reagan test (lunotriquetral The lunate is fixed with the thumb and index finger of one hand while the other hand displaces Sensitivity: 64
ballottement test) the triquetrum and pisiform first dorsally then palmarly. Specificity: 44
Watson test (scaphoid With the forearm slightly pronated, the examiner grasps the wrist from the radial side, placing Sensitivity: 69
shift test) his thumb on the palmar prominence of the scaphoid and wrapping his fingers around the Specificity: 64
distal radius. The examiner’s other hand grasps at the metacarpal level, controlling wrist
position. Starting in ulnar deviation and slight extension, the wrist is moved radially and slightly
flexed, with constant pressure on the scaphoid.
Shear test to assess the The examiner’s contralateral fingers are placed over the dorsum of the lunate. With the lunate Unavailable
lunate triquetral supported, the examiner’s ipsilateral thumb loads the pisotriquetral joint from the palmar
ligament aspect, creating a shear force at the lunate-triquetral joint.
Ulnocarpal stress Pronation and supination of the forearm with ulnar deviation of the hand generally evokes the Unavailable
wrist symptoms.
Finkelstein test This test is positive if there is pain at the styloid process of the radius as the patient places the Sensitivity: 812
thumb within the hand, which is held tightly by the fingers, followed by ulnar deviation of the Specificity: 50
hand.
Thumb basilar joint grind The basal joint grind test is performed by stabilizing the triquetrum with the thumb and index Sensitivity: 3020
test finger and then dorsally subluxing the thumb metacarpal on the trapezium while providing Specificity: 96.7
compressive force with the other hand.
Median Nerve Tests at the Wrist
Carpal compression test This test consists of gentle, sustained, firm pressure to the median nerve of each hand Sensitivity: 87
simultaneously. Within a short time (15 seconds to 2 minutes) the patient will complain of Specificity: 90
reproduction of pain, paresthesia, and/or numbness in the symptomatic wrist(s).
Phalen test (wrist flexion) This test is positive if there is numbness and paresthesia in the fingers. The patient is asked to Sensitivity: 67-88
hold the forearms vertically and to allow both hands to drop into flexion at the wrist for Specificity: 20-86
approximately 1 minute.
Wrist extension test The patient is asked to keep both wrists in complete dorsal extension for 1 minute. If numbness Sensitivity: 43
(reverse Phalen test) and tingling were produced or exaggerated in the median nerve distribution of the hand Specificity: 74
within 60 seconds, the test is judged to be positive.
Tinel’s sign at the wrist This test is positive if there is numbness and paresthesia in the fingers. It is done by extending Sensitivity: 25-44
the wrist and tapping in a proximal to distal direction over the median nerve as it passes Specificity: 94-98
through the carpal tunnel, from the area of the distal wrist crease, 2 to 3 cm toward the area
between the thenar and hypothenar eminences.
Lumbar Spine Motion Tests
Schober test The first sacral spinous process is marked, and a mark is made about 10 cm above this mark. Unavailable
The patient then flexes forward, and the increased distance is measured.
Modified Schober test A point is drawn with a skin marker at the spinal intersection of a line joining the dimples of Specificity: 95
Venus (S1). Additional marks are made 10 cm above and 5 cm below S1. Subjects are asked to Sensitivity: 25
bend forward, and the distance between the marks 10 cm above and 5 cm below S1 is
measured.
Lumbar Disk Herniation Tests
pastiest Straight-leg raise llasseg The supine patient’s leg is raised with the knee extended until the patient begins to feel pain Sensitivity: 72-97
<3 nerve involvement OTLBP and the type and distribution of the pain as well as the angle of elevation are recorded. The Specificity: 11-66
G) radiating pain n /Sonia / schiaticckarenaaaasepitandilumball
.
test is positive when the angle is between 30 degrees and 70 degrees and pain is reproduced
down the posterior thigh below the knee.
Crossed straight-leg raise The supine patient’s contralateral leg is raised with the knee extended until the patient begins to Sensitivity: 23-29
feel pain in the ipsilateral leg, and the type and distribution of the pain as well as the angle of Specificity: 88-100
elevation are recorded. The test is positive when the angle is between 30 degrees and 70
degrees and pain is reproduced down the ipsilateral posterior thigh below the knee.
Bowstring sign After a positive straight-leg raise, the knee is slightly flexed while pressure is applied to the tibial Sensitivity: 71
nerve in the popliteal fossa. Compression of the sciatic nerve reproduces leg pain.
Slump test The patient is seated with legs together and knees against the examining table. The patient Sensitivity: 8460
slumps forward as far as possible, and the examiner applies firm pressure to bow the patient’s Specificity: 83
back while keeping sacrum vertical. The patient is then asked to flex the head, and pressure is
added to the neck flexion. Lastly, the examiner asks the patient to extend the knee, and
dorsiflexion at the ankle is added.
 4- Sigard anis SIR
→

{
ibujañsajadidorsotleksi CHAPTER 1 The Physiatric History and Physical Examination 23
-

Me"""
dermatom
yangterlibat
Table 1-9 Musculoskeletal Provocative Maneuvers (Continued)
Test Description Reliability (%)
Ankle dorsiflexion test After a positive straight-leg raise, the leg is dropped to a nonpainful range, and the ipsilateral Sensitivity: 78-94
14 (Bragard sign) lansvtan SIR ankle is dorsiflexed, reproducing the leg pain. A) Kawada radiating pain
Femoral nerve stretch test With the patient prone, the knee is dorsiflexed. Pain is produced in the anterior aspect of the Sensitivity: 84-95
thigh and/or back.
Sacroiliac Joint Disorder Tests
Standing flexion test This test is performed with the patient standing, facing away from the examiner with the Sensitivity: 1757
patient’s feet approximately 12 inches apart so that the patient’s feet are parallel and Specificity: 79
approximately acetabular distance apart. The examiner’s thumbs are then placed on the
inferior aspect of each posterior superior iliac spine (PSIS). The patient is asked to bend
forward with both knees extended. The extent of the cephalad movement of each PSIS is
monitored. Normally, the PSIS should move equally. If one PSIS moves superiorly and
anteriorly compared with the other, this is the side of restriction.
Seated flexion test This test is performed with the patient seated with both feet on the floor. The examiner stands Sensitivity: 957
or sits behind the patient with the eyes at the level of the iliac crests and the examiner’s Specificity: 93
thumbs are placed on each PSIS; the patient is instructed to flex forward. The test is positive
if one PSIS moves unequally cephalad with respect to the other PSIS. The side with the
greatest cephalad excursion implies articular restriction and hypomobility. While the patient is
seated, the innominates are fixed in place, thus isolating out iliac motion.
Gillet test (One-leg Stork This test is performed with the patient standing, facing away from the examiner, with the feet Sensitivity: 857
test) approximately 12 inches apart. The examiner’s thumbs are placed on each PSIS. The patient is Specificity: 93
then asked to stand on one leg while flexing the contralateral hip and knee to the chest.
Compression test The examiner places both hands on the patient’s anterior superior iliac spine (ASIS) and exerts Sensitivity: 6955
a medial force bilaterally to implement the test. The compression test is more frequently Specificity: 69
performed with the patient in a side-lying position. The examiner stands behind the patient
and exerts a downward force at the upper part of the iliac crest.
Gapping test (Distraction) This test is performed with the patient in a supine position. The examiner places the heel of Sensitivity: 11-2189
both hands at the same time on each ASIS, pressing downward and laterally. Specificity: 90-100

contra Patrick Patrick (FABERE) test With the patient supine on a level surface, the thigh is flexed and the ankle is placed above the Sensitivity: 7113
melinatsacnilitis patella of the opposite extended leg. As the knee is depressed, with the ankle maintaining its Specificity: 100
-4¥ position above the opposite knee, the opposite ASIS is pressed, and the patient will complain
lttkalonyeri
9µW ,
a) nyerikontra lateral
of pain before the knee reaches the level obtained in normal persons.
Gaenslen test The patient lies supine, flexes the ipsilateral knee and hip against the chest with the aid of both Sensitivity: 50-5355
hands clasped about the flexed knee. This brings the lumbar spine firmly in contact with the Specificity: 71-77
table and fixes both the pelvis and lumbar spine. The patient is then brought well to the side

;¥=
of the table, and the opposite thigh is slowly hyperextended with gradually increasing force by
.
pressure of the examiner’s hand on the top of the knee. With the opposite hand, the
examiner assists the patient in fixing the lumbar spine and pelvis by pressure over the
(e) patient’s clasped hands. The hyperextension of the hip exerts a rotating force on the
kalonyen
sacroiliaca joint corresponding half of the pelvis in the sagittal plane through the transverse axis of the
sacroiliac joint. The rotating force causes abnormal mobility accompanied by pain, either local
or referred on the side of the lesion.
Shear test This test consists of the patient lying in the prone position, and the examiner applies pressure Sensitivity: 6355
to the sacrum near the coccygeal end, directly cranially. The ilium is held immobile through Specificity: 75
the hip joint as the examiner applies counter pressure against legs in the form of traction
force directed caudad. The test is considered positive if the maneuver aggravates the patient’s
typical pain.
Fortin finger test The patient is asked to point to the region of pain with one finger. It is positive if the patient Unavailable
can localize the pain with one finger to an area inferomedial to the PSIS within 1 cm and the
patient consistently pointed to the same area over at least two trials.
Hip Tests
Thomas test → untukliat The patient lies supine while the examiner checks for excessive lordosis. The examiner flexes Unavailable
It) K1 kaki kontraktvr one of the patient’s hips, bringing the knee to the chest, flattening out the lumbar spine while
satunyaikvt m .
iliopsoat the patient holds the flexed hip against the chest. If there is no flexion contracture, the hip
keangkat
being tested (the straight leg) remains on the examining table. If a contracture is present, the
patient’s leg rises off the table. The angle of the contracture can be measured.
Ely test surah The patient lies prone while the examiner passively flexes the patient’s knee. Upon flexion of Sensitivity: 56-5963
tengkvrap ikakiditekuklflelai
-

the knee, the patient’s hip on the same side spontaneously flexes, indicating that the rectus Specificity: 64-85
hip sampaipantutltdiangicat femoris muscle is tight on that side and that the test is positive. The two sides should be
tested and compared.
Continued on following page
24 SECTION 1 Evaluation

Table 1-9 Musculoskeletal Provocative Maneuvers (Continued)

Test Description Reliability (%)
Ober test → nilai pemendekan The patient lies on one side with the thigh next to the table flexed to obliterate any lumbar Unavailable
to iliotibial Faria
miring trs kaki
lordosis. The upper leg is flexed at a right angle at the knee. The examiner grasps the ankle
gang hip dan diang Kat
at at Fleksi lightly with one hand and steadies the patient’s hip with the other. The upper leg is abducted
terutditurunin -1 (t) Kaidu widely and extended so that the thigh is in line with the body. If there is an abduction
Mela yang contracture, the leg will remain more or less passively abducted.
Piriformis test The patient is placed in the side-lying position with the non–test leg against the table. The Sensitivity: 8830
patient flexes the test hip to 60 degrees with the knee flexed while the examiner applies Specificity: 83
downward pressure to the knee. Pain is elicited in the muscle if the piriformis is tight.
Trendelenburg test The patient is observed standing on one limb. The test is felt to be positive if the pelvis on the Sensitivity: 72.7
opposite side drops. A positive Trendelenburg test is suggestive of a weak gluteus muscle or Specificity: 76.9
an unstable hip on the affected side.
Patrick (FABERE) test See earlier (Sacroiliac Joint Disorder Tests). See above
Stinchfield test With the patient supine and the knee extended, the examiner resists the patient’s hip flexion at Sensitivity: 5966
20 to 30 degrees. Reproduction of groin pain is considered a positive test indicating Specificity: 32
intraarticular hip dysfunction.
Anterior Cruciate Ligament Tests
Anterior drawer test The patient is supine, hip flexed to 45 degrees with the knee flexed to 90 degrees. The examiner Sensitivity: 22-70
sits on the patient’s foot, with hands behind the proximal tibia and thumbs on the tibial Specificity: 97
plateau. Anterior force is applied to the proximal tibia. Hamstring tendons are palpated with
index fingers to ensure relaxation. Increased tibial displacement compared with the opposite
side is indicative of an anterior cruciate ligament tear.
Lachman test The patient lies supine. The knee is held between full extension and 15 degrees of flexion. The Sensitivity: 859
femur is stabilized with one hand while firm pressure is applied to the posterior aspect of the Specificity: 94
proximal tibia in an attempt to translate it anteriorly.
Pivot shift test The leg is picked up at the ankle. The knee is flexed by placing the heel of the hand behind the Sensitivity: 35-95
fibula. As the knee is extended, the tibia is supported on the lateral side with a slight valgus Specificity: 98-100
strain. A strong valgus force is placed on the knee by the upper hand. At approximately 30
degrees of flexion, the displaced tibia will suddenly reduce, indicating a positive pivot shift test.
Posterior Cruciate Ligament Tests
Posterior sag sign The patient lies supine with the hip flexed to 45 degrees and the knee flexed to 90 degrees. In Sensitivity: 79
this position, the tibia “rocks back,” or sags back, on the femur if the posterior cruciate Specificity: 100
ligament is torn. Normally, the medial tibial plateau extends 1 cm anteriorly beyond the
femoral condyle when the knee is flexed 90 degrees.
Posterior drawer test The patient is supine with the test hip flexed to 45 degrees, knee flexed to 90 degrees, and foot Sensitivity: 90
in neutral position. The examiner sits on the patient’s foot with both hands behind the Specificity: 99
patient’s proximal tibia and thumbs on the tibial plateau. Posterior force is applied to the
proximal tibia. Increased posterior tibial displacement as compared with the uninvolved side is
indicative of a partial or complete tear of the posterior cruciate ligament.
Patellofemoral Tests
Patellar grind test The patient is supine with the knees extended. The examiner stands next to the involved side Unavailable
(compression test) and places the web space of the thumb on the superior border of the patella. The patient is
asked to contract the quadriceps muscle while the examiner applies downward and inferior
ganpasientaruhbawah pressure on the patella. Pain with movement of the patella or an inability to complete the test
is indicative of patellofemoral dysfunction.
Knee Meniscal Injury Tests
Joint line tenderness The medial joint line is easier to palpate with internal rotation of the tibia, allowing for easier Sensitivity: 63
palpation. Alternatively, external rotation allows improved palpation of the lateral meniscus. Specificity: 7743
McMurray test With the patient lying flat, the knee is first fully flexed; the foot is held by grasping the heel. The Sensitivity: 70
→ tangan leg is rotated on the thigh with the knee still in full flexion. By altering the position of flexion, Specificity: 7143
the whole of the posterior segment of the cartilages can be examined from the middle to the
engkel dipater kedaleml
1F →
-

Ivar
posterior attachment. The leg is brought from its position of acute flexion to a right angle
"
Suara ce PDK
" while the foot is retained first in full internal rotation and then in full external rotation. When
Itt
the click occurs (in association with a torn meniscus), the patient is able to state that the
sensation is the same as experienced when the knee gave way previously.
Apley grind test With the patient prone, the examiner grasps one foot in each hand and externally rotates as far Sensitivity: 60
> compression as possible, then flexes both knees together to their limit. The feet are then rotated inward Specificity: 7043
→ ditekantrsdiputar and knees extended. The examiner’s left knee is then applied to the back of the patient’s thigh.
> distraction
The foot is grasped in both hands, the knee is bent to a right angle, and powerful external
ditañkterotdipotar rotation is applied. Next, the patient’s leg is strongly pulled up, with the femur being prevented
from rising off the couch. In this position of distraction, external rotation is repeated. The
examiner leans over the patient and compresses the tibia downward. Again, the examiner
rotates powerfully and if addition of compression produces an increase of pain, this grinding
test is positive and meniscal damage is diagnosed.
 Varus lateral → engkel ke dalem lutvt Ke Ivar
(O) → ,

valgus ( X) → wht ke dalem , engkel Keluar

-

CHAPTER 1 The Physiatric History and Physical Examination 25

(+1 apabilatibazmelengKung tidaKada tahanan

Table 1-9 Musculoskeletal Provocative Maneuvers (Continued)

Test Description Reliability (%)
Ankle Stability Tests
Anterior drawer test With the patient relaxed, the knee is flexed and the ankle at right angles, the ankle is grasped on Sensitivity: 80-95
the tibial side by one hand, and the index finger is placed on the posteromedial part of the Specificity: 74-84
Ini haroonYa nipple Ksi 45° difiksasidengandiductuki talus and the middle finger lies on the posterior tibial malleolus. The heel of this hand braces
diataf ← ditarik ke anterior pasien the anterior distal leg. On pulling the heel forward with the other hand, relative
4) a da transIasi / Gerakan anteroposterior motion between the two fingers (and thus between talus and tibia) is easily
robeKan ACL
palpated and is also visible to both the patient and examiner.
Talar tilt The talar tilt angle is the angle formed by the opposing articular surfaces of the tibia and talus Unavailable
when these surfaces are separated laterally by a supination force applied to the hind part of
the foot.
Syndesmosis Tests
Syndesmosis squeeze test The squeeze test is performed by manually compressing the fibula to the tibia above the Sensitivity: 3026
midpoint of the calf. A positive test produces pain over the area of the syndesmotic ligaments. Specificity 93.5
Achilles Tendon Rupture Tests
Thompson test The patient lies in a prone position with the foot extending over the end of the table. The calf Sensitivity: 96
tengkurep,Kaki gaming muscles are squeezed in the middle one third below the place of the widest girth. Passive Specificity: 93
Pencetm .
gastrocnemius plantar movement of the foot is seen in a normal reaction. A positive reaction is seen when
there is no plantar movement of the foot and indicates rupture of the Achilles tendon.
Palpation test The examiner gently palpates the course of the tendon. A gap indicates an Achilles tendon Sensitivity: 73
rupture. Specificity: 89
Modified from Malanga GA, Nadler SF, editors: Musculoskeletal physical examination: an evidence-based approach, Philadelphia, Mosby, 2006.

Table 1-10 Types of “End Feels” in Range-of-Motion Testing

End Feel Normal Example(s) Abnormal Example(s)
Soft Soft tissue approximation Knee flexion Tissue change occurring sooner or Soft tissue edema
later than expected Synovitis
A change in a joint that normally has a
firm or hard end feel
Firm Muscular stretch Hip flexion Tissue change occurring sooner or Increased muscular tonus
Capsular stretch Metacarpophalangeal extension later than expected Contracture of capsular,
Ligamentous stretch Forearm supination A change in a joint that normally has a muscular, or ligamentous
soft or hard end feel structures
Hard Bone contacting bone Elbow extension Tissue change occurring sooner or Osteoarthritis
later than expected Loose bodies in the joint
A change in a joint that normally has a Fracture
soft or firm end feel
Empty Abnormal joint end feel — No end feel noted as a result of Acute joint inflammation
resistance caused by pain Bursitis
Abscess
Fracture
Psychogenic disorder
Modified from Norkin CC, White J: Measurement of joint motion: a guide to goniometry, ed 3, Philadelphia, FA Davis, 2003, with permission of FA Davis.

Joint play or capsular patterns assess the integrity of the
capsule in positions of minimal bony contact, sometimes
referred to as open-packed position.74 Active ROM (AROM)
or voluntary movement of a joint is insufficient to exploit
the full ROM for that joint. More extreme end ROM that
is not under voluntary control must be assessed by the
examiner through passive ROM (PROM) testing. There are
several types of end feels when the terminal feel of a joint
is evaluated through the extremes of its ROM (Table 1-10).
Soft end feel is commonly associated with tissue compres-
sion and is normal in extreme elbow or knee flexion
with PROM testing. If the sensation, however, is felt pre-
maturely (before the expected full PROM), the cause may
be pathologic, such as from inflammation or edema. If
tissue (muscle, capsule, or ligament) is stretched at the
end of ROM, the resultant end feel is one that is firm yet
slightly forgiving, such as with terminal passive metacar-
pophalangeal extension and hip flexion. Palpation of a
premature firm end feel can be a sign of increased tone or
capsular tightening. A hard end feel is felt as a result of
bony contact and is felt normally with elbow extension or
knee extension. If a hard end feel is felt prematurely or
inappropriately, it may indicate an arthritic joint or hetero-
topic ossification. An “empty” feel does not suggest a
mechanical restriction but is rather a limitation in ROM
due to muscle contraction generated by the patient to
guard against pain.
It is important to identify both hypomobile and hyper-
mobile joints. The former increase the risk for muscle
strains, tendonitis, and nerve entrapments, whereas the
latter increase the risk for joint sprains and degenerative
joint disease.74 An inflammatory synovitis, for example,