GLOSSARY

Condensed List of Orthopedic Tests

ADAM’S SIGN: If a patient has scoliosis and bends over, there may be straightening of the scoliosis, in which case the test is not positive. If the curve does not straighten when the patient bends over, the test is “positive”.

ADSON’S TEST: The patient is asked to take and hold a deep breath, the neck is extended, and the patient is asked to turn his head from one side to the other. Downward traction on the patient’s arm will cause an obliteration of the pulse (in which case the test is positive). A variation of this test is the HYPERABDUCTION TEST, which employs the same principles but during which the arm is hyper abducted in order to bring about the absent radial pulse of the brachial plexus parathesias.

BABINSKI SIGN: Unilateral diminished ankle jerk reflex (such as in SI nerve root compression due to HNP).

BABINSKI TEST: Stroking the bottom of the foot causes the little toes to fan and the great toe to expand or dorsiflex (a sign of the upper motor neuron lesion such as in multiple sclerosis). PSEUDO-BABISNKI TEST: The is also a positive Babinski Test but in a patient in whom the small toes are paralyzed, so that only the great toe extends such as in polio or other paralytic disorder along with upper motion neuron lesion).

BERNHARDT’S SIGN: This is the perverted thigh sensation which occurs in meralgia paresthetica.

BONNETT’S SIGN: Back or leg pain in sciatica when the thigh is adducted.

BARCELET TEST: Compression of the distal radius and ulna causes the rheumatoid patient to have pain.

BRAGARD’S SIGN: Dorsiflexion of the foot causes the patient increased sciatica or back pain (in the case of spinal nerve root compression).

BRUDZINSKI’S TEST: Flexion of the neck causes foot, ankle or thigh flexion in the patient with meningitis.

BURN’S TEST: A patient kneeling on a stool will be able to bend to reach the floor even if he has sever spinal disease (the theory is that the patient’s spine is flexed and remains so even though he bends to reach the floor. The sciatic nerve is relaxed and therefore not painful for the patient).

CHADDUCK (OPPENHEIM AND GASTROCNEMIUS TEST: These tests are all variants of the Babinski Test and all suggest upper motor neuron lesion.

CHVOSTEK’S SIGN: Tapping the facial nerve causes the muscles it supplies to contract (such as in low calcium tetany). TROUSSEAUS’S SIGN is a variant of this test in the forearm. In TROUSSEAU’S TEST a blood pressure cuff is inflated on the patient’s arm, muscle spasm occurs rapidly due to low calcium tetany.

CODMAN’S SIGN: In ruptured MT cuff, no pain upon passive abduction of the arm, but when the arm is let loose and the deltoid contracts, there is severe pain.

COMOLLI’S SIGN: In fractured scapula, triangular swelling, outlining the scapular structure indicates that it has been fractured.

DEJERINE’S SIGN: Increased sciatica in cough, sneeze, or having a bowel movement.

DAWBARNS’S SIGN: In bursitis there is pain and when the patient’s arm is passively abducted, the pain goes away.

DELMEGE’S SIGN: Deltoid flattening seen in Phthisis (TBC).

DEMIANOFF’S SIGN: Positive straight leg raising (also FORST’S TEST).

DUGAS SIGN: Inability to put hand of the injured shoulder on the opposite shoulder with the elbow close to the chest.

DUPREYTREN’S SIGN: A crackling sensation over sarcomatous bone.

ELY’S TEST: With the patient recumbent and prone, flex the knees; if the patient is unable to do so or if the hip rises from the table, it is a positive test for hip flexion contracture, hip or back disease.

FAJERSZTAJN’S SIGN: If the thigh is flexed the leg will flex in sciatica, but the leg will not flex if the thigh is extended.

FINKLESTEIN’S TEST: With the thumb inside the palm, the wrist and the hand are ulnarly deviated, causing pain in the abductor tendons of the thumb at the radial styloid (DeQuervian’s Disease).

FROMENT’S SIGN: Nonflexion of the thumb occurs in the patient’s attempt to hold an object between this thumb and opposing fingers.

GAENSLENS’ SIGN: With the good knee flexed, patient sits, the other hyperextends and causes back pain.

GIRDLE TEST: In splanchnoptosis, holding the pendulous abdomen will relieve the abdominal pain.

GOLDTHWAIT’S SIGN: With the patient supine, the examiner’s hand is held in the small of the back, legs are raised and if there is pain before LS spine movement is felt, then it is from DI joint disease. If there is LS spine movement, then it must be LS JOINT DISEASE.

GRAEFE’S SIGN (VON GRAEFE’S SIGN): Lid lag of hyperthyroidism.

GRASETT, GAUSEL OR HOOVER TEST: If the patient has a paretic or sciatic limb, while straight leg raising, he will exert more pressure on the heels of the good leg, in an effort to raise the bad one (a positive Hoover Test).

GUBLER’S SIGN: Swelling of the wrist in lead poisoning.

GUTTMANN’S SIGN: Auscultatory humming over the goiter in hyperthyroidism.

HEFKE-TURNER’S SIGN: Increased teardrop of the obturator bone in hip disease.

HELBING’S SIGN: Medical curing-in of the hell-cord in valgus feet.

HOFFMAN’S SIGN or DIGITAL SIGN: Snapping the fingernail caused abduction of the thumb (Upper Motor Neuron Lesion).

HUNTINGTON’S SIGN: Patient places legs over the side; if he coughs and the legs and thighs become flexed then this is suggestive of a palliospinal neural damage.

ITARD-CHOLEWA SIGN: Anesthesia of the tympanic membrane in otoscerosis.

JANSEN’S TEST: The patient is told to cross his legs at the ankles. It is impossible if the patient has disease of one or both hips.

JENDRASSIK’S SIGN: Paralysis of the extraocular eye muscles in hyperthyroidism.

JENDRASSIK’S MANEUVER: Obtaining a knee kick reflex by having the patient pull his hands together (reinforcement maneuvers). SCHRIEBER’S MANEUVER is also a deep tendon knee kick reflex reinforcement maneuver which is performed by stroking the patient’s inner thigh while tapping the patellar ligament with a reflex hammer.

JOFFROY’S SIGN: Absence of the forehead muscles upon elevation of the eyes in Graves Disease.

KANAVEL’S SIGN: Increased tenderness of the palm, one inch proximal to the base of the little finger in tendon sheath infection.

KEEN’S SIGN: Increased diameter of the ankle in Pott’s Fracture (Trimalleolar Fracture).

KEHR’S SIGN: Increased and severe pain of the left shoulder in ruptured spleen.

KEHRER’S SIGN: Pressure over the occipital nerve causes the patient to jerk his head back and to the side and may be evidence the patient has a brain tumor.

KEMP SIGN: Sciatica is aggravated by having the patient bend back and obliquely on the side of the lesion.

KERNIG’S SIGN: Unless the patient flexes his hips and knees, he cannot sit (in meningitis).

KERR’S SIGN: The texture of the skin changes below the level of the spinal cord Transection.

LANGORIA’S SIGN: Relaxation of the extensors of the thigh muscle in intrascapular fracture of the hip.

LASEGUE’S TEST: Flexion of the affected limb’s hip is not painful, but extending the knee while the hip is flexed is painful (for the patient with sciatica and spinal cord nerve root compression).

LEBHARDT-JACQUELLIN-SCHLESINGER’S SIGN OR NERI’S SIGN: Flexion of the spine causes knee flexion in upper motor neuron disease.

LEWIN SIGN: If the patient has lumbosacral disease with sciatic, he will stand with the leg flexed on the side of the lesion (the Rask Test is a variant of this).

LUBMAN’S TEST: This is a test of the patient’s pain threshold. The examiner pressures the tip of the mastoid and judges the patient’s response.

LICHTNEIM TEST: If the patient is able to utter the number of syllables in a polysyllabic word, but not pronounce the word, then his cortex must be less involved in disease than the association fibers.

L’HEURMITTS SIGN: This professor in France found that in Spinal Cord Lesion of the neck, upon flexion of the neck and patient had parenthesis or formication of the peripheral nerves distal to the nerve injury. If the formication goes proximal, then it is known as REVERSE TINEL’S SIGN.

MORCOVE TEST: Have the patient alternately stand on one leg then the other. If he has no muscle spasm of the sacrospinalis, it will alternately relax as he replaces the limb that he has just raised.

MENNELL’S SIGN: Pressure on the posterior superior iliac spine, one way or the other, causes SI joint pain and tests the ligaments of the SI joints.

MICHELE’S FLIP TEST: A variant of Bragard’s Sign. With the patient sitting, the knee is extended; if he has sciatica and low back pain, the test is positive.

MILL’S TEST FOR TENNIS ELBOW: With the wrist and fingers fully flexed and the forearm pronated, complete extension of the elbow is painful. In the Reversed Mill’s Test (for Anterior Inerosseous Nerve Entrapment), the wrist is dorsiflexed and the forearm supinated. Then the elbow is forcibly extended by the examiner. Should the patient’s anterior upper forearm pain be accentuated, it is some evidence of Anterior Nerve Entrapment.

MINOR’S SIGN: If the patient is sitting and has a ruptured disc, he will arise from the chair with his hand on his good thigh and his other hand on his back.

MOBIUS SIGN: Patient is unable to keep eyes converged in Grave’s Disease.

MORQUIO’S SIGN: A patient who is supine will not sit until his hips and knees are flexed. This is a variant of Kernig’s Sign and is a sign of meningeal irritation.

MORTON’S TEST: In metatarsalgia, compression of the transverse arch causes sharp pain and suggests March fracture of Morton’s Neuroma.

MOSCHCOWITZ TEST: Using an esmarck bandage, the limb is devascularized, then capillary filling is measured (delayed in the AS).

MURPHY’S TEST: The patient sits with his arms folded in front of him and the examiner jabs him just under the 12th rib, suggesting deep-seated pain, perhaps from the kidneys.

NACHLA’S SIGN: With the patient recumbent and prone, the knee is flexed and the hip is rotated putting a strain on the sacroiliac or lumbosacral joint (or hip joint for that matter).

NAFFIZIGER (1940) TEST: Compressing the jugular veins while recumbent increases intraspinal pressure and aggravates sciatica (also called Viet’s Sign- 1928).

OBER’S TEST: With the patient in the decubitus, the affected hip will not abduct when it is hyperextended (Opolio contracture of the tensor fascia femoris M).

PAGET’S TEST: A solid tumor is most hard in its center, whereas a cyst is most soft in its center.

PERTHES’ TEST: For varicose veins and their patency. The patient’s thigh is bandaged just above the knee and the patient is allowed to walk around. If there is deep vein competency of the valves the blood in the varicose veins will disappear. (One should not strip the superficial veins if the communicating veins have incompetent valves).

PHALENS’S SIGN: Flexion of the wrist reproduces the parenthesis and pain of median nerve compression at the wrist (Carpal Tunnel Syndrome). The Reverse Phalen maneuver involves hyperextension of the wrist with the resultant median nerve parenthesis.

PIOSTROWSKI’S SIGN: Percussion of the tibialis anterior causes the great toe to dorsiflex and the foot turns in and comes up- also called the Tibialis Sign and is evidence for upper motor neuron lesion.

PLUMMER’S SIGN: Inability to get up on a chair or climb stairs or Grave’s Disease.

POLITZER’S TEST: When the tuning fork is placed in front of the nares, during deglutination, it is heard only in the unaffected ear.

QUICKENSTEDT TEST: Compression of the jugular veins (or the Valsalva Maneuver) causes an increase of intracerebral spinal fluid pressure with increase in measured spinal fluid pressure (during spinal puncture). A positive QUICKENSTEDT TEST means that there is no increase from this maneuver and indicates a spinal block.

QUINCKE’S PULSE SIGN: Visible capillary pulse in aortic insufficiency.

THE RASK TEST: If the patient has lumbar spinal nerve root compression and he bends over, he will flex the knee ipsilateral to the lesion.

RASK TEST FOR PATHOMIMOSIS (MALINGERING): The patient is found to have normal hip movement, yet when he attempts to bend over, he does so by flexing his spine to the fullest extent (see SHOBER’S TEST) and does not bend at the hip. Also there is no evidence of sciatic scoliosis (negative VANZETTI’S SIGN). In other words, we know the patient to have normal hip movement, yet he does not use his hips to bend over to reach the floor.

RINNE TEST: Air conduction should be better than bone conduction.

ROMBERG’S SIGN: Swaying to and from with eyes closed is supposed to be a positive sign.

ROSENTHAL’S SIGN: Increased pain in the spine with faradic stimulation is supposed to be evidence for spondylitis.

ROSSOLLIMO’S SIGN: Tapping the little toes up causes them to hyperflex in upper motor neuron lesions.

ROTHCHILD’S SIGN: Loss of the outer aspect of the eyebrows in hyperthyroidism.

RUST’S SIGN: If the patient holds his head when he moves his body, this is objective evidence of severe cervical spine destruction such as malignancy.

SHIRMER’S TEST: In sicca (or SJORGREN’S SYNDROME) the lack of tear production can be measured by placing a piece of filter paper beneath the lower lid. If the paper remains dry after 15 seconds the test is positive.

SHOBER’S TEST: 10 cm of lumbosacral spine are marked off with a greased pencil while the patient is erect. He is then asked to bend over. Lumbar spine movement above 13 cm is within normal limits. In hyperlordotic patients the range may be from 10 to 17 cm. (In spinal fusion there may be 3 cm or less of movement. In ankylosing spondylitis, movement may be only 2 cm).

SOTO-HALL SIGN: The patient is flat on his back and flexion of his neck causes pain in the area of spinal lesion. He may have to begin to flex his spine to make the test positive.

SPURLING’S TEST: In this test for cervical radiculopathy, the pain and parasthesis can be reproduced by vertical compression of the head upon the neck. The neck may be extended, flexed or bent laterally.

STANGE’S TEST: If the patient cannot hold his breath for 30 seconds, he is not a good anesthetic risk.

STILLER’S SIGN: Detachment of the 10th rib from the costal margin.

STRUMPELL’S SIGN: When the thigh is flexed, the foot dorsiflexes automatically (upper motor neuron lesion). When the wrist is hyperdorsiflexed, the patient is able to make a fist, whereas previously he could not (also UMN lesion).

STRUNSKY’S SIGN: The examiner suddenly flexes the patient’s toes and causes pain in the anterior arch.

SUTTON’S LAW: Proceed directly to the single most important test or study that will bring you to the proper diagnosis.

THOMAS TEST: Flexing the good hip will cause the bad hip to come up in hip flexion contracture.

TINEL’S SIGN: Tapping a nerve that is compromised will give rise to “formation” (as Tinel called it) or parenthesis. The finding suggests that the nerve injury may be reversible, if the problem is corrected.

TOMMASI’S SIGN: Loss of the posterior lateral hair of the lower limb in gout.

TORYN’S SIGN: In sciatica, if the toe is dorsiflexed, the patient will feel pain in the greater sciatic notch (buttocks).

TRENDELENBURG TEST: If the pelvis lists on the side of the leg that has been raised from the ground, then the test is positive and suggests gluteus medius weakness of a dislocated hip on that side.

UNSCHULD’S SIGN: Calf cramps in Diabetes.

VANZETTI’S SIGN: In sciatica the pelvis will be level and the scoliosis is due to sciatica, but congenital scoliosis will be associated with the pelvis list (or inclination).

VEDDER’S SIGN: The slightest calf pressure causes pain beriberi.

VILLARET’S SIGN: The great toe will flex upon tapping the Achilles tendon in sciatica.

VULPIUS TEST: In cerebral palsy, the feet will dorsiflex easier with the knee flexed.

WEBER’S TEST: Sound will lateralize to the side of the deafness when the tuning fork is placed on top of the head, suggesting conduction defect rather than nerve deafness.

WILTSE TEST: If the patient has severe disease of the spine, he will sit forward when asked. If she is malingering, he will not sit forward.

WINCKEBOCK PHENOMENON: Occluding the femoral or brachial pulse in the face of a tachycardia from ateriovenous aneurysm will slow the heart rate necessarily.