Musculoskeletal Examination 2nd Edition Jeffrey M. Gross,

Chapter 14 Gait Figure 14.19 The uncompensated Trendelenburg gait is injury or disease. For example, a fracture that unites characterized by adduction of the hip, which appears as if the the femur in a shortened position will result in an patient is moving the trunk away from the weight-bearing side absolute shortening of the extremity. A femoral pro- during the stance phase. This results from weakness of hip sthesis that is too long for the patient will result in abduction. an absolute lengthening of the extremity. Relative leg length discrepancy is due to postural abnormalities such as scoliosis, sacroiliac dysfunction, joint contractures, varus and valgus abnormalities, and neuromuscular dysfunction. For example, a hip flexion or knee flexion contracture causes a relative shortening of the extremity. An equinus deformity causes a relative lengthening of the extremity. When the discrepancy is greater than 13/4 in., the patient attempts to lengthen the short limb by walk- ing on the ball of the foot. When the short limb is in the stance phase, the patient must swing through the long limb without catching the toe on the ground. The patient does this by hip hiking or circumduct- ing the extremity on the swing-through side (see Figures 14.15 and 14.16). When the leg length differ- ence is less than 13/4 in., the patient will drop the pelvis on the affected side to functionally lengthen the short extremity. This is accompanied by lowering of the shoulder height on the same side. 445

Appendices Appendix 1 Physical findings in abnormal conditions of the musculoskeletal system. Muscle tendon injury Tender without swelling, mild spasm First-degree, mild No ecchymosis Second-degree, moderate No palpable defect Active contraction and passive stretch are painful Third-degree, complete Tender with swelling Ligament injury Mild to moderate ecchymosis First-degree, mild Moderate spasm Possibly palpable discontinuity Second-degree, moderate Extremely painful with passive stretching and attempted contraction Joint motion limited Third-degree, complete Bone injury Extreme tenderness with swelling Contusion May be severe bleeding and possible compartment syndrome with loss of sensation and pulse distally Palpable defect with bunching up of muscle tissue Complete loss of muscle function No change in pain with passive stretch Minimal or no swelling Local tenderness Increase in pain with passive and active range of motion Minimal bruising No instability or functional loss expected Moderate swelling with ecchymosis Very tender, more diffusely tender Range of motion very painful and restricted due to swelling Instability may be recognized Functional loss may result Severe swelling and ecchymosis or hemarthrosis Structural instability with abnormal increase in range of motion Possibly less painful than second-degree tear Localized tenderness With or without ecchymosis Subcutaneous swelling No palpable discontinuity 446

Appendices Fracture Localized to diffuse tenderness Stress fracture Deformity and/or instability Inflammatory joint disease Palpable discontinuity in accessible areas Ecchymosis Possible neurovascular compromise Localized tenderness with overlying swelling and redness Increased pain with vibration or ultrasound applied to bone Certain locations are very common (i.e., tibia, fibula, metatarsals, femur) Swelling, redness of joint, frequently symmetric Synovitis, systemic disease common May see subcutaneous nodules on extensor surface Severe joint deformities are common Valgus deformities are common Extensor tendon ruptures may be noted Compression neuropathy with loss of sensation and muscle strength may be noted Muscle weakness and restricted range of motion Pain worsens with activity Noninflammatory joint disease Acute swelling and redness, asymmetrical involvement Hypertrophic joint without destruction Common pattern “capsular,” which is painful on range of motion Weakness and tightness of muscles crossing involved joints Pain lessens with activity Stiffness in the morning; fusion of joint may eventually occur Varus deformity may occur Metabolic joint disease Abnormal crystals in the joint fluid Very painful, red and swollen joints Loss of range of motion Systemic disease common Joint destruction may be severe Nerve compression or radiculopathy Pain, weakness, sensory loss, reflex loss and parasthesias in the dermatomal and/or myotomal distribution of the affected nerve; degree of loss of function may be mild or complete Stretching the nerve may increase pain Tapping over the nerve may result in distal tingling (Tinel’s sign), especially if regeneration is occurring Myofascial pain (trigger points) Tenderness in a characteristic location of certain muscles Palpation of this location causes referred pain to a distant site A taut band, or sausage-like piece of muscle can often be palpated and may cause a twitch of the muscle when plucked like a guitar string The affected muscle is usually unable to relax fully and therefore passive stretch is limited and painful Neoplasm Unremitting pain, often awakens patient from sleep, no comfortable position to relieve pain Palpable mass if accessible and advanced Fracture (pathological) if bone involved Fever, weight loss, and fatigue Possible neurovascular compromise 447

Appendices Infection Swelling, redness, warmth, and tenderness Fever and fatigue Reflex sympathetic dystrophy Loss of joint range or motion with characteristic fluid findings in affected joint Acute: Less than Painful compression, active and passive range of motion of involved muscle 3 months after injury Pain, warmth, swelling, redness Subacute: 4–12 months Light touch is very painful after injury Increased hair growth Mild stiffness of joints Chronic: More than 1 year after injury Pain is extremely severe Increased joint stiffness with loss of range of motion Passive range of motion is very painful Cool and pale or cyanotic discoloration Less swelling Less pain (usually) Periarticular fibrosis Marked limitation in range of motion No swelling Pale, dry, and shiny skin Appendix 2 Range of motion of the extremities. JOINT MOTION RANGE (DEGREES) Shoulder Flexion 0 –180 Elbow Extension 0 – 60 Forearm Abduction 0 –180 Wrist Internal (medial) rotation 0 –70 External (lateral) rotation 0 –90 Thumb Carpometacarpal Flexion 0 –150 Metacarpophalangeal Extension 0 Interphalangeal Pronation 0 –80/90 Supination 0 –80/90 Extension 0 –70 Flexion 0 –80 Radial deviation 0 –20 Ulnar deviation 0 –30 Abduction 0 –70 Adduction 0 Opposition Tip of thumb to base or tip of fifth digit Flexion 0 –50 Extension 0 Flexion 0 –90 Extension 0 –20 448

Appendices Digits 2–5 Flexion 0 –80 Metacarpophalangeal Extension 0 – 45 Abduction/Adduction 0 –20 Proximal interphalangeal Flexion 0 –110 Distal interphalangeal Extension 0 Hip Flexion 0 –90 Extension 0 –20 Knee Ankle Flexion 0 –120 Extension 0 –30 Subtalar Abduction 0 – 45 Forefoot Adduction 0 –30 Toes External (lateral) rotation 0 – 45 First metatarsophalangeal Internal (medial) rotation 0 – 45 First interphalangeal Second to fifth Flexion 0 –135 metatarsophalangeal Extension 0 Dorsiflexion 0 –20 Plantar flexion 0 –50 Inversion 0 –35 Eversion 0 –15 Inversion 0 –5 Eversion 0 –5 Inversion 0 –35 Eversion 0 –15 Flexion 0 – 45 Extension 0 –70 Flexion 0 – 40 Flexion 0 – 40 Extension 0 – 40 449

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Index Page numbers in italics refer to figures; adduction reflexes—418 those in bold refer to tables. carpometacarpal joint—256, 258, 258 resistive testing—411–17 fingers—270, 271, 279 structural integrity tests—423–6 abdominal muscles—105, 106 active—250 subjective examination—384–5 abduction hip—325 ankle jerk—127, 129, 418, 418 active—304, 306 annular ligament—204, 205 carpometacarpal joint—256, 258, 258 passive—308, 310, 310 anserine bursa—347 fingers—270, 271, 279 resistive—319, 320, 321 antagonists—11 metacarpophalangeal joint—254–5, 256 antalgic gait active—250 shoulder—182 foot and ankle—440, 441 hip—317–19, 318, 319, 325 active—162, 163, 163 hip—443 resistive—173–5, 175 knee—442–3 active—304, 306 thumb—251, 275–6, 277, 279 antecubital (cubital) fossa—200, 200 passive—308, 309 toes—401, 402 anterior calcaneal facet—381 metacarpophalangeal joint—254–5, 256 anterior cruciate ligament—9, 336, 337, shoulder—182 adductor brevis—319, 320 active—162, 162, 163 adductor longus—300, 300, 319, 320 337, 338 passive—165, 165 adductor magnus—319, 320 insufficiency—341 resistive—172–3, 173, 174 adductor pollicis—275, 277 anterior drawer sign—357, 357, 423–4, thumb—251, 274–5, 275, 276, 279 adductor tubercle—345, 346 toes—401, 402 adductors of hip—319, 320 424 great toe—419 Adson’s maneuver—191, 193 anterior instability (Rockwood) test—184, abductor pollicis brevis—274, 275 agonists—11 abductor pollicis longus—248, 274, 275 alignment tests 186 abductors of hip—317, 318 anterior interosseous nerve entrapment— accessory movement testing—31 ankle and foot—426–7 ankle and foot—407–11 hip—331–3 225, 227 cervical and thoracic spine—62–5, 63, Allen’s test—288, 289 anterior superior iliac spine anatomical snuff-box—242, 244, 248 64 anconeus—217 palpation—104, 105, 296, 297 elbow—211–15 angle of femoral anteversion—332, 332 test for true leg length—331 hip—312 angle of Louis (sternal angle)—51, 53 anterior talofibular ligament—393–4, 395 knee—356 –9 ankle—380–432, 434 Apley (grinding; distraction) test—373, 375 lumbosacral spine—113–15, 114 abnormal gait—440–2 Apley scratch test—163, 163 shoulder—167–70, 168 active movement testing—400, 401 apparent leg length discrepancy—332, 332 wrist and hand—259– 61 alignment tests—426–7 apprehension sign—144 Achilles tendon (tendocalcaneus) dermatomes—418, 419 apprehension test palpation—396, 397 extension—419 anterior shoulder dislocation (Crank Thompson test for rupture—423, 424 flexibility test—421, 422 acromioclavicular joint—143, 144, 144 flexion—419 test)—184–5, 187 cross-flexion test—189, 189 functional anatomy—380–1 patellar dislocation—373, 376 mobility testing—169, 169 mobility testing—407–11 arterial pulses—32 palpation—148, 148 mortise structure/function—380, 434, articular cartilage—6, 7 shear test—189, 189 articular pillar—34, 43, 45, 45 acromion 434 atlas (C1)—34, 34, 35 abduction of humerus—144, 144 neurological examination—417–21 transverse process—42, 43 palpation—148, 148 neurological tests—421–3 axilla actin—11 observation—384 dermatomes—183 active movement testing—29 overuse syndrome—385 palpation—153– 4, 154 ankle and foot—400, 401 palpatory examination—385–401 axillary nerve—181 cervical and thoracic spine—57, 59– 62 axis (C2)—34 elbow—208 dorsal aspects—390–2 spinous process—43, 43 hip—303–5 lateral aspect—393–5 knee—354 medial aspect—385–90 Babinski’s response—32, 127, 423, 423 lumbosacral spine—106, 110, 110–11 plantar surface—397–9 backward bending—116, 116 shoulder—156, 162, 162, 163, 163 posterior aspect—395–7 temporomandibular joint—88–93 passive movement testing—401, 403–11 cervical and thoracic spine—60, 61 wrist and hand—250–1 posture examination—19, 20 lumbosacral spine—110, 111 acute single supratolerance load—2, 3 radiological views—427, 431, 432 Baker’s cyst—353, 353 Adam’s apple—51 referred pain patterns—421, 421 ballotable patella—376, 377 barrel chest—25, 26 benediction deformity—235, 283, 284 Bennett’s fracture—244 453

Index biceps brachii—215, 216, 219, 220 bullfrog eyes—341, 342 cervical spine—34–5, 35, 37, 37–81 palpation—151, 152, 201, 201 bunion—435, 436 active movement testing—57, 59–62 resistive testing—216 Bunnell-Littler test—286, 287 distraction test—79 Speed’s test—189, 190 bursa—13–14 extension—67 trigger points and referred pain flexion—65, 66, 67 patterns—208 calcaneal—397, 397 herniated disc—39 Yergason’s test—189, 190 gastrocnemius-semimembranosus—353, Lhermitte’s sign—79, 79 mobility testing—62–5 biceps femoris—351, 351, 362, 363, 353 neurological examination—68–78 364 knee—344–5, 346 brachial plexus—68–9 olecranon—13, 196, 199, 206, 207 root level determination—70, 72–8 trigger points—353 retrocalcaneal—396, 397 upper limb tension test—68–9, 70, 71 biceps reflex (jerk)—73, 221, 221 bursitis—14 observation—37– 8 biceps tendon buttock sign—306 palpatory examination—39–45 anterior bony structures—49–54 long head—143, 144 C1 see atlas anterior soft-tissue structures—54–6 palpation—201, 201 C2 see axis posterior bony strucutres—41–6 rupture—145 C3-C6 spinous processes—45– 6, 46 posterior soft-tissue structures—47–9 bicipital groove—148–9, 149 C5 nerve root level—68 passive movement testing—62–5, 63, 64 biological system—2 radiological views—80, 81, 81 body chart—16–17, 17, 19 biceps reflex—221 referred pain patterns—79, 80 Boley gauge—91 evaluation—70, 72, 73 resistive testing—65–8 bone—6–7, 7 C6 nerve root level—68 Spurling test—78, 78–9 injury—446 –7 brachioradialis reflex—221 subjective examination—38–9 bony structures palpation evaluation—73, 74 trigger points—56, 56–7, 57, 58, 59 ankle and foot C7 nerve root level—68 vertebral artery test—79, 80 evaluation—73, 75 dorsal—390 –1 triceps reflex—223 cervical traction—64, 64 lateral—393 C7 spinous process—43, 43 Charcot–Marie–Tooth disease—351 medial—385– 6 C8 nerve root level—68 chest observation—25, 26 plantar surface—397– 8 evaluation—73, 76 Childress’ sign (duck walk test)—373 posterior—395–7 café au lait spot—39, 98 chondroblast—7 cervical and thoracic spine calcaneal bursa—397, 397 chondrocyte—7 anterior—49–54 calcaneal valgus—19, 20 chondromalacia patellae—339, 343 posterior—41–7 calcaneal varus—19 chronic repetitive submaximal tolerance elbow calcaneofibular ligament—394, 395 lateral—202, 204 calcaneonavicular (spring) ligament—381, load—2, 3 medial—201 clavicle—53, 54, 141, 147, 147 posterior—205– 6 383, 435 claw finger—240 hip—296– 8, 300–1 calcaneus—381, 382, 435 claw hand—283, 284 knee claw toe—23, 399, 400 anterior—341– 4 medial tubercle—397–8, 398 clunk test—188, 188 lateral—347–50 palpation—395, 396 coccydynia—101 medial—345 calcium hydroxyapatite—6 coccyx—35, 101, 101 lumbosacral spine cancellous (trabecular) bone—6, 7 collagen—5, 6 anterior—104 cane, hip abductor assistance—440, 440 posterior—98–101 capitate—244, 245 bone—6 shoulder capsular ligaments—144 cartilage—7 anterior—146 –9 capsular pattern—109, 112 ligament—8 –9 posterior—151–3 elbow—209 tendon—13 temporomandibular joint—85, 86 fingers—251 type I/type II—5, 6 wrist and hand foot and ankle—401 common peroneal nerve—351, 351 dorsal—244 –7 forearm—209, 251 compartments of hand palmar—236 hip—306 I—248, 248 radial—242– 4 knee—355 II—248, 248 ulnar—241–2 capsular Y ligament—293 III—248–9, 249 Bouchard’s nodes—240 carotid artery palpation (carotid pulse)— IV—249, 249 bounce home test—373, 375 V—249, 249 boutonnière deformity—240 51, 55–6, 56 VI—250, 250 brachial artery carotid tubercle—51, 52 compensated Trendelenburg (lurch) gait— palpation—200, 201 carpal tunnel—234–5, 239, 240, 281 traumatic compression—200 carpal tunnel syndrome—236, 239, 275, 443, 444 brachial plexus—68, 69, 181 compression and distraction—32 postfixed—68 280, 282 conditioning—2, 3, 4 prefixed—68 carpals—234, 234 congenital hip dysplasia—295 brachial plexus tension test (upper limb carpenter’s knee—345 coracoacromial ligament—144, 144 carpometacarpal joint, first coracobrachialis—170, 171 tension test; Elvey’s test)—68–9, 70, coracoid process—148, 149 71 abduction and adduction—256, 258, cortical bone—6 brachialis—215, 216 258 Craig test—332–3, 333 brachioradialis—215, 216 cremasteric reflex—127, 130–1, 131 palpation—204 traction—261, 262 cross-flexion test—189, 189 resistive testing—216 cartilage—7– 8, 8 crossover test—371 brachioradialis reflex—73, 221, 222 caudal glide (longitudinal distraction) of shoulder—167, 168 center of gravity—434 normal gait—437, 437, 439 cervical muscles—65, 67, 67 454

Index cubital (antecubital) fossa—200, 200 dorsal tubercle of radius (Lister’s subtalar (hindfoot)—404, 405, 415, 416, cubitus valgus—198 tubercle)—244, 245 419 cubitus varus (gunstock deformity)— dorsalis pedis pulse—391–2, 392 evertors of foot—415, 415 198 dorsiflexion of ankle/foot—419 extension cuboid—381, 382 active—400, 401, 402 cervical palpation—393, 394 passive—401, 403, 403 active—60, 61 cuboid-metatarsal joint—408–9, 409 resistive—413, 413, 414 intervertebral mobility testing—62 cuneiform—381, 382, 386, 387 double support—438 passive—62 cuneiform-metatarsal joint—410, 410 dowager’s hump—28 resistive—67, 67 cutaneous innervation of lower limb—123 drop arm test—190, 191 drop foot—391 elbow—206, 221 de Quervain’s disease—248, 274, 275, 284, duck walk test (Childress’ sign)—373 active—208 285 Dupuytren contracture—239 passive—209, 210, 210 resistive—217, 218 deep fascia—14 eccentric contraction—11 deep infrapatella bursa—345, 345 effusion in knee—376 fingers—279 deep tendon (stretch) reflexes—31 elastin—8, 9 active—250 deltoid (medial collateral) ligament—386, elbow—141, 196–232 interphalangeal joint—256, 257 resistive—268, 268–9, 269 388, 388 active movement testing—208 deltoid muscle—170, 171, 172, 172 dermatomes—223 hip—325 extension—206, 221 active—304, 305 palpation—150–1, 151 flexion—206, 221, 227 passive—308, 309 trigger points—159 functional anatomy—196–7 resistive—315, 316, 317, 317 dermatomes—128 golfer’s elbow (medial epicondylitis) cervical—68, 70, 73 knee—365 elbow—223 test—229, 230 active—354 hand and wrist—280, 280 inflammatory disease—200 passive—355, 356 hip—324, 326 mechanisms of injury—196, 199 resistive—364, 364 knee—367 mobility testing—211–15 lower extremity—122 neurological examination—220– 8, 221 lumbosacral spine lower leg—418, 419 active—110, 111 lumbar—122, 122 entrapment neuropathies—223–8 passive—113 sacral—129 observation—197– 8 resistive—119, 119–20 shoulder—181, 183 palpatory examination—198, 200–7 thoracic—78 metacarpophalangeal joint—254, 255 upper arm and forearm—223 anterior aspect—200–1 metatarsophalangeal joint—406–7, 407 diabetes mellitus—384 lateral aspect—202, 204 in one-leg standing—137, 137 dislocation medial aspect—201–2 shoulder—182 elbow—196 posterior aspect—205–7 shoulder—181 passive movement testing—208–15 active—162, 163 radiological views—231, 232, 232 passive—165, 165 appearance—185, 185 referred pain patterns—229, 231 resistive—172, 172 apprehension test (Crank test)— reflexes—221–3 thumb—259, 259, 273, 273–4, 274, 279 resistive testing—215–20 active—251 184–5, 187 sensation—223, 224, 225 toe—419 distal interphalangeal crease—237 subjective examination—198 active—401, 402 distal interphalangeal joint tennis elbow test (lateral epicondylitis) resistive—417, 417, 418 trunk—119, 119–20 extension—256, 257 test—228–9, 230 wrist flexion—255– 6, 257, 266, 266 trigger points—207, 208, 209 active—250 traction—261, 261 elbow flexion test—227 passive—251, 252 distal palmar (transverse) crease—237 elevation, scapular—177–8, 178 resistive—263–5, 265 distal wrist crease—237 muscles, innervation and root levels— extension moment—439 distraction—32 extensor carpi radialis brevis—248, 248 cervical spine—79 182 palpation—204 sacroiliac—136, 137 Elvey’s test (brachial plexus tension test; resistive testing—263, 265 temporomandibular joint—94 extensor carpi radialis longus—248, 248 dominant eye, use in physical upper limb tension test)—68–9, 70, palpation—204 71 resistive testing—263, 265 examination—18 Ely’s test—328, 329 extensor carpi ulnaris—250, 250 dorsal artery of foot—391–2, 392 empty can (supraspinatus) test—191, 192 resistive testing—263– 4, 265 dorsal cutaneous ulnar nerve entrapment— empty end feel—30 extensor digiti minimi—249, 249 end feel (end point)—29 resistive testing—268, 268 282–3 endomysium—11 extensor digitorum dorsal glide entrapment neuropathies—280–3 palpation—204 elbow—223– 8 resistive testing—268, 268 cuboid-metatarsal joint—408–9, 409 epimysium—11 extensor digitorum brevis—392, 392, 417, fibula at superior tibiofibular joint—407, equinus deformity—441, 442, 443 Erb-Duchenne palsy—181, 185 417 408 erector spinae (sacrospinalis muscle)—102, extensor digitorum communis—249, 249 first cuneiform-metatarsal joint—410, 102, 119 extensor digitorum longus—417 eversion, foot and ankle—419 410 active—400, 401, 402 tendon palpation—391, 392 humeral head—168, 169 forefoot—406, 406 extensor hallucis brevis—417, 417 metacarpals—260–1, 261 passive—403– 4, 404, 405, 406, 406 extensor hallucis longus—391, 391, 417, metatarsals—410, 410 radial head—215, 215, 260 417, 418 radius—215, 215, 260 extensor indicis—249, 249, 268, 268 dorsal interossei—269, 270 455

Index extensor pollicis brevis—248, 273, 274 first rib flexor carpi radialis extensor pollicis longus—248, 249, 273, palpation—53, 54 palpation—202, 239, 240 structures of thoracic outlet—192 resistive testing—262, 263 273 ventral-caudal glide—65, 66 extensor retinaculum—247, 247 flexor carpi ulnaris—202 extensors of hip—315, 315 flat back—27, 27 palpation—237, 237 external oblique—118 flat foot (pes planus)—19, 23, 24, 27, 426, resistive testing—262, 263 external occipital protuberance (inion)— 426 flexor digitorum brevis—415, 416 40, 41 flexibility test flexor digitorum longus—388, 388, 389, external rotation ankle and foot—421, 422 389, 413, 415, 416 hip—325 hip—327– 8 flexor digitorum profundus active—305, 307 knee—368 passive—311, 311 flexible flat foot—426, 426 palpation—238 –9 resistive—319, 322, 323 flexion resistive testing—266, 266 ankle—419 flexor digitorum superficialis—238–9, 266, shoulder—182 active—162, 163, 163 resistive—411, 411–12, 412, 413, 267, 268 passive—166–7, 167 413 flexor hallucis brevis—415, 416 radiological views—194 flexor hallucis longus—389, 389, 413, 415 resistive—176–7, 177 cervical spine flexor pollicis brevis—272, 273 active—60, 61, 62 flexor pollicis longus—272, 273 Fabere (Patrick’s) test—136, 137, 330, 331 passive—62, 63 flexors facet joints—34, 43, 45, 45 resistive—65, 66, 67 Fairbanks (apprehension) test—373, 376 ankle—411, 411, 413, 413 fascia—14 elbow—206, 221 cervical spine—65 fasciitis—14 active—208 elbow—216 fast-twitch fiber—11, 12 passive—209, 210, 210 fingers—266, 267 femoral artery—299, 299 resistive—215, 215–16, 216 hip—313 femoral head ventral glide—312, 314 knee—362, 363 femoral nerve—299, 299 fingers—279 shoulder—171 femoral nerve (prone knee bending) test— active—250 thumb—272 interphalangeal joint—255– 6, 257 toes—415, 416 32 passive—253– 4, 255, 255– 6, 257 trunk—118 femoral pulse—299, 299 resistive—266, 266 wrist—202 femoral stretch test—133, 135 foot—380–432, 434 femoral triangle—298, 298 foot abnormal gait—440–2 femoral vein—299, 299 active—401 active movement testing—400, 401 femur—336 metatarsophalangeal joint—406, 407 alignment tests—426–7 passive—406, 407 arches—381, 382 anteversion plantar flexion—400, 401, 402, 403, bones—381, 382, 383 angle—332, 332 403 columns—383, 384 Craig test—332–3, 333 resistive—411, 411–12, 412, 413, 413 dermatomes—418, 419 flexibility tests—421, 422 condyles—336, 336 hand—270, 270 functional anatomy—381–4 fibrocartilage—7, 9 metacarpophalangeal joint—253– 4, mobility testing—407–11 fibroelastic cartilage—7, 8 255 neurological examination—417–21 fibrosis—14 neurological tests—421–3 fibula—380 hip—325 observation—384 active—304, 305 overuse syndromes—385 dorsal and ventral glide at superior passive—307–8, 308 palpatory examination—385–401 tibiofibular joint—407, 408 resistive—313, 314, 315, 315 dorsal aspect—390–2 head palpation—349, 349–50 intervertebral mobility testing—62, 63 lateral aspect—393–5 ventral glide at inferior tibiofibular joint knee—365 medial aspect—385–90 plantar surface—397–9 407, 408 active—354 posterior aspect—395–7 fifth metatarsal—393, 394 gait—438 toes—399– 401 finger flexor jerk—73 passive—355, 355 passive movement testing—401, 403–11 finger pads—241 resistive—362–3, 363 posture examination—19, 23, 26, 27 fingers—234 lumbar spine radiological views—427, 430, 431 active—110, 110 referred pain patterns—421, 421 abduction—270, 271, 279 passive—112, 112–13 reflexes—418 active movement testing—250 resistive—117 resistive testing—411–17 adduction—270, 271, 279 shoulder—182 structural integrity tests—423–6 extension—279 active—156, 162, 162, 163 subjective examination—384–5 flexion—279 passive—164, 164 foot drop—413 palpation—240–1, 247 resistive—170–2, 171 foot slap—441, 442 passive testing—253–9 thumb—258–9, 259, 259, 273, 273, 279 forearm resistive testing—265–70 active—251 dermatomes—223 Finkelstein’s test—284, 284 toes—419 pronation—217, 219, 219, 221 first carpometacarpal joint—256, 258, 258 active—401, 402 supination—219–20, 220 first cricoid ring—51, 52 resistive—411, 415, 416, 417 forefoot—381, 382, 384 first cuneiform-metatarsal joint—410, 410 trunk—117, 118 columns—383, 384 first metacarpal—243– 4, 244 wrist deviations from normal alignment—426 first metatarsal joint—386, 387 active—250 first metatarsophalangeal joint passive—251, 252 palpation—386, 387 resistive—262–3, 263, 264 traction—411, 411 flexion moment—438 flexion (proximal palmar) crease—237 456

Index passive eversion—406, 406 hallux valgus—23, 24, 386, 387, 435, 436 palpatory examination—296–302 passive inversion—405, 405 hamate—241, 242 bony structures—296– 8, 300–1 forefoot valgus/varus—426–7, 428 hammer toe—23, 24, 400, 401 soft-tissue structures—298–300, forefoot-heel alignment test—426–7, 428 hamstring jerk—127, 366, 366–7 301–2 forward bending hamstrings—315, 317, 319, 338, 362, 364, cervical and thoracic spine—60, 61 passive movement testing—305–12 lumbosacral spine—110, 110 365 posture examination—19, 23, 25, 26 forward head posture—28 trigger points—353 radiological views—333, 333, 334 Fowler relocation test—185 hand—141, 234–91 referred pain patterns—327 fracture active movement testing—250–1 resistive testing—313–24 Bennett’s—244 dermatomes—280, 280 stability and structural integrity tests— elbow—196 Finkelstein’s test—284, 284 Jones—393 flexion—270, 270 328, 330–1 sacrum—306 functional anatomy—234–5 subjective examination—295 stress, lower leg and foot—425 joint flexibility and stability tests—287–9 trigger points—302, 302, 303, 304 freeway space assessment—92, 92 mobility testing—259–61 Hoffman reflex—32 Froment’s sign—276, 278 muscles, innervation and root levels— Homan’s sign—421, 422 funny bone—201 Hoover test—133 279 housemaid’s knee—345 Gaenslen’s sign—135, 136 neurological examination—279–83 Hughston (jerk) test—371, 371, 372 gait—434– 45 observation—235 humeroradial bursa—204 palpatory examination—236–50 humeroradial joint—196, 197 abnormal—437, 440–5 traction—213, 214, 215 foot and ankle—440–2 dorsal aspect—244–50 humeroulnar joint—196, 197 hip—443– 4 palmar aspect—236– 41 traction—211, 212 knee—442–3 radial (lateral) aspect—242–4 humerus—141, 196 observation—440, 441 ulnar (medial) aspect—241–2 acromion process relationship—144, 144 passive movement testing—251–61 dorsal glide—168, 169 definition—437 fingers—253–9 greater tuberosity—148, 149 leg length discrepancy—444–5 mobility testing—259–61 movement limitation with biceps tendon normal—437, 437– 40, 438 radial deviation—253, 253 stance phase—438 ulnar deviation—253, 254 rupture—145 swing phase—438 wrist extension—251, 252 ventral glide—167–8, 168 gamekeeper’s thumb—261, 262 wrist flexion—251, 252 hyaline cartilage—7 gastrocnemius—352, 352, 411, 411 Phalen’s test—282, 283 hyaluronic acid—6, 7 gastrocnemius-semimembranosus bursa— radiological views—291 hyoid bone—49, 50 referred pain patterns—289, 290 hypothenar eminence—238 353, 353 resistive testing—265–79 gemellus inferior—319, 322 distal interphalangeal joint flexion— ilia (innominate bones)—35 gemellus superior—319, 322 iliac crest—98, 98, 296, 296 genu recurvatum—19, 25, 27, 340 266, 266 iliac tubercle—296, 296 genu valgum—19, 20, 25, 340 finger extension—268, 268–9, 269 iliacus—313, 314 genu varum—19, 20, 25 interossei—269, 269–70, 270 Gerdy’s tubercle—349, 349 proximal interphalangeal joint flexion trigger points—304 Gillet (marching; stork) test—115–16, 116 iliocostalis lumborum—109, 119 glenohumeral joint—143, 144, 144 266, 267, 268, 268 iliocostalis thoracis—108, 119, 119 glenoid—141, 143, 144, 167 thumb—273–9 iliopsoas muscle—122 gluteus maximus—293, 315, 315, 317, 319 subjective examination—235–6 iliotibial band—293, 294, 294–5, 328, Tinel’s test—280, 282 trigger points—302 Hawkins supraspinatus impingement test— 350, 350–1 gluteus medius—293, 317, 318, 322, immobilization—6 190–1, 191 impingement syndromes 439– 40 head position—22, 23, 25, 26, 28, 29, 37 trigger points—303 Heberden’s nodes—240 shoulder—144–5, 146 gluteus minimus—293, 323, 323 heel-strike—438, 439, 439 supraspinatus tendon tests—190–1, 191 goiter—51 Helfet test—373, 376 infection—448 golfer’s elbow (medial epicondylitis)— hindfoot—381, 382 inferior glenohumeral ligament—144, 201 deviations from normal alignment— 144 test—229, 230 426 inferior instability test—188, 188 goniometer—29 inferior lateral angle—100, 101 gout—440 passive eversion—404–5, 405 inferior tibiofibular joint gracilis—319, 320, 347, 362, 364, 365 passive inversion—404, 405 gravity test (posterior drawer test)—358, hindfoot valgus/varus—426, 427 fibular ventral glide—407, 408 hip—293–334, 434 palpation—390, 390 358 abnormal gait—443–4 inflammatory disease—447 greater occipital nerve—48, 49 active movement testing—303–5 elbow—200 greater trochanter—297– 8, 298 alignment tests—331–3 inflammatory reaction—2–3 greater tuberosity of humerus—148, 149 congenital dysplasia—295 infrahyoid muscle—87, 88 grinding/distraction test of Apley—373, dermatomes—324, 326 infrapatellar ligament—344, 345 flexibility tests—327–8 infrapatellar nerve injury—367, 368 375 flexion moment—439 infraspinatus—176, 177 grip evaluation—289, 289 functional anatomy—293, 293–5 trigger points—158 ground substance—5– 6 mechanics—293, 293– 4, 294 infraspinatus tendon—143, 151, 155, growth-plate cartilage—7 mobility testing—312 gunstock deformity (cubitus varus)—198 neurological examination—324–7 156 Guyon’s canal—234–5, 242, 283, 283 observation—295 inguinal ligament—299, 299, 325 inion—40, 41 457

Index innervation flexion—365, 439 lateral (radial) aspect of wrist and hand— ankle and foot—419, 420, 421 functional anatomy—336–9 242– 4 elbow—221, 224, 225 joint effusion tests—376 hand and wrist—279 ligaments—8, 9 lateral (radial) compartment of hand— hip—326, 326 meniscal damage tests—371, 373 239– 41 knee—365, 367 mobility testing—356–9 muscles—12 neurological examination—365–7 lateral rotation observation—339– 40 cervical spine—67, 67 innominates (ilia)—35 palpatory examination—341–53 knee—356, 356 intercostobrachial nerve—184 shoulder—182 intermediate fiber—12 anterior aspect—341–5 internal oblique—118 lateral aspect—347–51 lateral tibial plateau—349, 349 internal rotation medial aspect—345–7 lateral tibial tubercle—349, 349 posterior aspect—351–3 latissimus dorsi—118, 153, 154, 172, 172, hip passive movement testing—354–9 active—305, 307 patellofemoral joint tests—373 175 passive—310, 310–11 posture examination—19, 20, 23, 26, 27 laxity—31 resistive—322– 4, 323, 324 radiological views—377, 378, 378 leg referred pain patterns—368, 368 shoulder reflexes—366 –7 lateral rotation—365 active—163, 163 resistive testing—359–65 medial rotation—365 muscles, innervation and root levels— stability—337–8, 339 nerve distribution—367 182 stability and structural integrity tests— leg length discrepancy—19, 20, 25, 331, passive movement testing—165– 6, 166 368 –71 331 radiological views—194 subjective examination—340 abnormal gait—444–5 resistive—175, 175– 6, 176 trigger points—353, 353, 354 alignment tests—331, 331, 332, 332 knee jerk—366, 366 apparent—332, 332 interossei—269, 269–70, 270 Koch model—293, 293 true leg length measurement—331, 331 interosseous nerve entrapment—225, 227 kyphosis—20, 22, 28, 29 leg-heel alignment test—426, 427 interphalangeal creases—237 levator scapulae—177, 178 interphalangeal joint L1 root level testing—122, 124 palpation—49 L2 root level testing—122, 124 trigger points—157 extension—256, 257 L3 root level testing—125, 125, 127 Lhermitte’s sign—79, 79 flexion—255– 6, 257, 266, 266, 267, L4 root level testing—126, 127 ligament—8, 8–10, 9 L5 root level testing—127, 128 injury—446 268, 268 Lachman test—369, 369 ligament of Struthers—223–4 foot—384 Larsen–Johansson disease—343 ligamentum flavum—9 palpation—247 Lasegue’s (straight-leg raise) test—32, ligamentum nuchae—48–9, 50 intervertebral mobility ligamentum teres—293 cervical spine—62–3, 63, 64 131–3, 132 limping—439 lumbar spine—113–15, 114 lateral bending of cervical spine—68, 68 Lister’s tubercle (dorsal tubercle of intrathecal pressure—135 lateral border of scapula—152, 153 intrinsic minus hand (claw hand)—283, lateral collateral ligament—204, 204, 336, radius)—244, 245 long bone—6, 7 284 337, 337, 350, 350 long saphenous vein—389–90, 390 inversion, foot and ankle—419 lateral distraction longissimus thoracis—109, 119, 119 longitudinal arch of foot—381, 382 active—400, 401, 402 hip—312, 313 longitudinal distraction forefoot—405, 405 shoulder—167, 168 passive—403, 404, 404–5, 405 lateral epicondyle—202, 206 hip—312, 312 subtalar (hindfoot)—404–5, 405, 413, lateral epicondylitis (tennis elbow)—202 shoulder—167, 168 test—228–9, 230 lordosis—26, 35 414, 415, 415, 419 lateral (external) rotation Losee test—371 inversion stress test—425, 425 hip lower abdominal skin reflex—127, 130, invertors of foot—413, 414 ischial tuberosity—100–1, 101, 301, 301 active—305, 307 130 isciorectal abscess—306 passive—311, 311 lower extremity—434–7 isometric contraction—11, 30 resistive—319, 322, 323 shoulder ankle and foot—380–432 jaw closing—95, 95 passive—166–7, 167 active movement testing—401 jaw jerk—95, 95 resistive—176–7, 177 alignment tests—426–7 jaw opening—94–5, 95 lateral femoral condyle—347, 348 dorsal palpatory examination—390–2 jaw posture—23 lateral femoral cutaneous nerve—325, 327 flexibility test—421, 422 Jendrassik’s method of reinforcement—31 lateral femoral epicondyle—347, 348 lateral palpatory examination—393–5 jerk (Hughston) test—371, 371, 372 lateral gapping medial palpatory examination— Jobe relocation test—185 elbow—213, 214 385–90 joint effusion in knee—376 knee—358, 360 mobility testing—407–11 Jones fracture—393 lateral glide neurological examination—417–21 jumper’s knee—344, 364 tibia—359, 361 observation—384 ulna—212 passive movement testing—401, Keinböck’s disease—244 lateral malleolus—393, 393 403–11 knee—336–78, 434 lateral meniscus—349, 350 plantar surface palpatory lateral pterygoid—86–7, 95 examination—397–9 abnormal gait—442–3 trigger points—88 posterior palpatory examination— active movement testing—354 395–7 dermatomes—367 radiological views—427, 430, 431, extension—365 432 flexibility tests—368 referred pain patterns—421, 421 458

Index resistive testing—411–17 L3 root level—125, 125 medial femoral condyle—345, 346 structural integrity tests—423– 6 L4 root level—126, 127 medial gapping subjective examination—384–5 L5 root level—127, 128 toe palpation—399– 401 lumbar plexus—120, 120–1 elbow—213, 214 cutaneous innervation—123 lumbosacral plexus—121, 121, 122 knee—358, 359 gait—434– 45 S1 root level—127, 129 medial glide abnormal—440 –5 S2-S4 root levels—127 tibia—359, 361 definition—437 observation—97 ulna—213, 213 normal—437, 437– 40, 438 palpatory examination—98–106 medial hamstring jerk—127, 128 hip—293–334 anterior bony structures—104, 105 medial longitudinal arch—27, 27 abnormal gait—443– 4 anterior soft-tissue structures—105– 6, medial malleolus—385, 386 active movement testing—303–5 medial meniscus—346, 347 alignment tests—331, 331, 332, 332 106 medial pterygoid—86–7, 95 flexibility tests—327– 8 posterior bony structures—98–101, medial rotation mobility testing—312 hip—325 neurological examination—324–7 99, 100, 101 observation—295 posterior soft-tissue structures— active—305, 307 palpatory examination—296–302 passive—310, 310–11 passive movement testing—305–12 101–2, 102, 103 resistive—322–4, 323, 324 radiological views—333, 333, 334 side-lying soft-tissue structures—104 knee—356, 356 referred pain patterns—327 passive testing—111–17 shoulder resistive testing—313–24 physiological movements—112 muscles, innervation and root level— stability and structural integrity tests— radiological views—137, 138, 139 referred pain patterns—107, 108, 109 182 328, 330–1 resistive testing—117–20 passive—165– 6, 166 subjective examination—295 sacroiliac joint tests—136, 136–7, 137 resistive—175, 175– 6, 176 trigger points—302, 302, 303, 304 slump test—133, 134 medial tibial plateau—345, 346 knee—336 –78 straight-leg raise test—131–3, 132 medial tubercle of calcaneus—397–8, 398 abnormal gait—442–3 subjective examination—97 median nerve—235 active movement testing—354 tests to increase intrathecal pressure— entrapment—280, 281, 282 flexibility tests—368 elbow—223, 226 ligaments—8, 9 135 pronator teres—224–5, 226, 227 mobility testing—356–9 trigger points—106, 107, 108, 109 palpation—200, 201 neurological examination—365–7 Valsalva’s maneuver—135, 136 stretch test—68–9, 70 observation—339– 40 lunate—244, 245 medullary canal (marrow cavity)—6 palpatory examination—341–53 lurch (compensated Trendelenburg) gait— meniscal damage tests—371, 373 passive movement testing—354–9 menisci—336, 336, 337, 338 patellofemoral joint tests—373 443, 444 meralgia paresthetica—325, 327 radiological views—377, 378, 378 lymph node palpation, neck—55, 55 metabolic joint disease—447 referred pain patterns—368, 368 metacarpals resistive testing—359– 65 Macintosh (pivot shift) test—338, 369, first—243– 4, 244 stability and structural integrity tests— 370, 371 palmar and dorsal glide—260–1, 261 palpation—246, 246 368 –71 McMurray’s test—371, 373, 374 metacarpophalangeal joint subjective examination—340 magnetic resonance imaging abduction and adduction—254–5, 256 tests for joint effusion—376 extension—254, 255 tests for meniscal damage—371, 373 cervical spine—81 thumb—259, 259 trigger points—353, 353, 354 lumbosacral spine—138, 139 flexion—253– 4, 255 posture examination—19–20, 432 shoulder—194 thumb—258–9, 259 anterior view—23, 23–5, 24, 25 malleolus—385, 386 palpation—246, 246 lateral view—26 mallet finger—249 traction—261, 261 posterior view—19, 19–20, 20 mandible ulnar glide—261, 262 sitting—29 active movements metatarsal heads—398, 398 lower lateral cutaneous nerve—184 metatarsals—381, 381, 384 lumbar plexus—120, 120–1 lateral deviation—91–2, 92 fifth—393, 394 lumbar spine—35 mouth closing—90 first metatarsal joint—386, 387 capsular pattern—109, 112 mouth opening—89–90, 91 mobility testing—410, 410 lumbosacral disc herniation—131, 131, protrusion—90–1, 92 metatarsophalangeal joint measurement—93, 93 first, traction—411, 411 132 palpation—86, 86 palpation—386, 387 lumbosacral plexus—121, 121, 122 manual muscle testing—31 microfibrils—5 lumbosacral spine—97–139 marching (Gillet; stork) test—115–16, 116 microfractures—7 marrow cavity (medullary canal)—6 midabdominal skin reflex—130, 130 active movement testing—106, 110, masseter—87, 87, 95 midcarpal joint traction—260, 260 110 –11 trigger points—89 middle compartment of hand—238–9 mastoid process—41, 42 midfoot—381, 382 dermatomes—124, 125, 126 medial border of scapula—151–2, 152 mobility testing femoral stretch test—133, 135 medial collateral (deltoid) ligament—386, ankle and foot—407–11 Hoover test—133 central posteroanterior spring on spinous mobility testing—112, 112–15 388, 388 neoplasms—98 medial collateral ligament, elbow—196, process—113–14, 114 neurological examination—120–31 cervical and thoracic spine—62–5, 63, 64 201, 203, 336, 337, 337, 346–7, elbow—211–15 L1 root level—122, 124 347 L2 root level—122, 124 medial compartment of hand—237–8 medial cutaneous nerve—184 medial epicondyle—201, 202, 206 medial epicondylitis (golfer’s elbow)—201 test—229, 230 459

Index mobility testing (cont.): nerve compression—447 patient history—16, 17, 18 hip—312 nerve stretch testing—32 resisted movement testing—30 knee—356 –9 neurofibromatosis—98 sprain—8–9, 10 lumbosacral spine—112, 112–15 neurological examination—31 palm—236– 41, 237 shoulder—167–70, 168, 169, 170 palmar aponeurosis—239 temporomandibular joint—94 ankle and foot—417–21, 419 palmar glide of metacarpals—260–1, 261 wrist and hand—259– 61 cervical spine—68–78 palmar interossei—269, 269 palmaris longus—202, 238, 239 modified Helfet test—373, 376 brachial pelxus—68–9 palpatory examination—32 moment—434, 438 root level determination—70, 72–8 ankle and foot—385–401 Monteggia fracture—196 upper limb extension test—68–9 Morton’s neuroma—425, 425– 6 elbow—220– 8, 221 dorsal aspects—390–2 Morton’s toe—399, 399 entrapment neuropathies—223–8 lateral aspect—393–5 Moulder’s click—426 hip—324–7, 325 medial aspect—385–90 mouth closure—90 knee—365, 365–7 plantar surface—397–9 lumbosacral spine—120–31 posterior aspect—395–7 jaw jerk reflex—95, 95 L1 root level—122, 124 toes—399– 401 mouth opening—89–90, 91 L2 root level—122, 124 cervical and thoracic spine—39–56 movement diagram—29, 30 L3 root level—125, 125, 127 anterior bony structures—49–54 L4 root level—126, 127 anterior soft-tissue structures—54–6 lumbosacral spine active movement— L5 root level—127, 128 posterior bony structures—41–6 110, 111 lumbar plexus—120, 120–1 posterior soft-tissue structures—47–9 lumbosacral plexus—121, 121, 122 elbow—198, 200–7 movement testing S1 root level—127, 129 anterior aspect—200–1 active—29 S2–S4 root levels—127 lateral aspect—202, 204 passive—29–30 shoulder—181–2, 182 medial aspect—201–2 mobility (acccessory)—31 wrist and hand—279, 279–83 posterior aspect—205–7 resisted—30 –1 neurological tests, ankle and foot—421–3 hip—296 –302 noninflammatory joint disease—447 bony structures—296–8, 300–1 multidirectional instability test—188, 188 normal gait—437, 437– 40, 438 soft-tissue structures—298–300, 301–2 multifidi—108, 118 Noyes test—371 knee—341–53 muscle tendon injury—446 anterior aspect—341–5 muscle testing Ober’s test—328, 328 lateral aspect—347–51 observation—16 medial aspect—345–7 L1 root level—122 posterior aspect—351–3 L2 root level—122, 124 abnormal gait—440, 441 lumbosacral spine—98–106 L3 root level—125, 125 ankle and foot—384 anterior bony structures—104 L4 root level—126, 127 cervical and thoracic spine—37–8 anterior soft-tissue structures—105 L5 root level—127, 128 elbow—197– 8 posterior bony structures—98–101 S1 root level—127, 129 hip—295 posterior soft-tissue structures—101–2 S2–S4 root levels—127 knee—339– 40 side-lying soft-tissue structures—104 muscles—10, 10–12, 11, 12 lumbosacral spine—97 shoulder—146 –56 ankle and foot—419 posture—18 –19 anterior bony structures—146–9 elbow—221 shoulder—145 anterior soft-tissue structures—149–51 fascicle arrangements—12 temporomandibular joint—83–4 lateral soft-tissue structures—154–6 fiber types—11, 12 wrist and hand—235 medial soft-tissue structures—153–4 hand and wrist—279 obturator externus—319, 322 posterior bony structures—151–3 hip—325 obturator internus—319, 322 posterior soft-tissue structures— knee—365 occiput—41, 41 shoulder—182 occlusive arterial disease—388 151–3, 154–6 musculocutaneous nerve—181 odontoid—34, 35 temporomandibular joint musculoskeletal system olecranon—205, 206 components—5–14 olecranon bursa—13, 196, 199, 206, 207 anterior aspect—86–7 olecranon fossa—205, 206 posterior aspect—85–6 bone—6–7, 7 Oppenheim’s test—423, 423 wrist and hand—236–50 cartilage—7– 8, 8 opponens digiti minimi—278, 278 dorsal aspect—244–50 fascia—14 opponens pollicis—278, 278 palmar aspect—236–41 ligaments—8, 8–10, 9 opposition—258, 258, 278, 278–9 radial aspect—242–4 muscle—10, 10–12, 11, 12 Osgood–Schlatter disease—344 ulnar aspect—241–2 synovium and bursae—13, 13–14 Osler’s nodes—241 Pancoast’s tumour—193 tendons—13, 13 osteoarthritis—4, 5, 9 paradigms—3, 4–5, 5 function—2– 4 cervical spine—35 carpal tunnel syndrome—236 musculotendinous junction—13 hip—295, 443 chronic impingement syndrome of the myofascial pain of shoulder girdle—156 knee—338 myofibril—11 overbite measurement—92, 93 shoulder—146 myosin—11 overjet measurement—92–3, 93 congenital hip dysplasia—295 overuse syndrome of foot and ankle—385 herniated cervical disc—39 nails—23, 247 inflammatory disease of the elbow—200 Nakajima test—371 pain knee ligament injury—341 narrow walking base—438 inflammatory—3 neoplasm of the lumbar spine—98 navicular (scaphoid)—234, 242, 243, 381, mechanical overload—7 overuse syndrome of the foot and passive movement testing—30 382 ankle—385 navicular tubercle—386, 386 temporomandibular joint syndrome—85 neck, anterior-posterior relationships—37, 37 neoplasm—447 460

Index parotid gland—56, 56 pes cavus—19, 23, 27 posterior thorax—37 parson’s knee—345 pes planus (flat foot)—19, 23, 24, 27, 426, posterior tibial artery—388, 389 passive movement testing—29–30, 31 posterior tibial nerve 426 ankle and foot—401, 403–11 phalanges of foot—381, 381, 383, 384 entrapment—422, 423 cervical and thoracic spine—62–5, 63, 64 Phalen’s test—282, 283 palpation—388, 389 elbow—208 –15 physical examination—16–32 posterior tibial pulse—388, 389 hip—305–12 posteroanterior central pressure on spinous knee—354 –9 definition—2 lumbosacral spine—111–17 objective—18 –32 process—64, 64 shoulder—164, 164–70, 165, 166, 167 observations—16 posteroanterior spring temporomandibular joint—93– 4 purpose—2 wrist and hand—251– 61 subjective—16 –18 sacrum—117 physiological movements spinous process—113–14, 114 accessory movements—259– 61 ankle and foot—401, 403–7 transverse process—114, 114 fingers—253–9 cervical and thoracic spine—62 posteroanterior unilateral pressure on radial deviation—253, 253 elbow—210 –11 ulnar deviation—253, 254 hip—307–11 transverse process—64–5, 65 wrist extension—251, 252 knee—355– 6 posterolateral disc herniation—132 wrist flexion—251, 252 lumbosacral spine—112 postfixed brachial plexus—68 patella—336–7, 337, 338 shoulder—164, 164–7, 165, 166, 167 posture examination—18–19 mobility testing—359, 361, 362 temporomandibular joint—94 palpation—341, 342, 343, 343 wrist and hand—251–9 anterior view—23, 23–5 Q angle—339, 340 pinch evaluation—289, 290 head position—22, 23, 25, 26, 28, 29, 37 squinting—24, 25, 333 pinprick test—31 hip—19, 25 patella alta—341, 342 piriformis—317, 319, 322 lateral view—26, 26–9, 27, 28, 29 patella baja—341, 342 palpation—104, 104, 301–2, 302 posterior view—19, 19–22, 20 patella-nail syndrome—247 trigger points—303 sitting—29 patellar ligament—344, 345 piriformis test—322, 323 thorax—23, 25 patellofemoral arthritis (Waldron) test— pisiform—241, 242 upper extremity—22 pivot shift (Macintosh) test—338, 369, prefixed brachial plexus—68 373 Preiser’s disease—242 patellofemoral articulation—336, 336 370, 371 primary toe-strike—442 patellofemoral compression syndrome— plantar aponeurosis—398–9, 399 pronation plantar fascia—398–9, 399 elbow—196, 198, 208, 210–11, 211, 221 341 plantar flexion—400, 401, 419 foot—381, 383, 435, 435 patellofemoral joint tests—373 forearm—217, 219, 219 pathological limit—29 ankle—411, 411–12, 412 pronator quadratus muscle—217, 219 pathological reflex testing—32 active—400, 401, 402 pronator teres—202, 217, 219 patient history see subjective examination passive—403, 403 pronator teres syndrome—224–5, 226, 227 Patrick’s (Fabere) test—136, 137, 330, 331 prone knee bending (femoral nerve) test— pectineus—319 gait—438 pectoralis major—173, 175, 175 plantar glide 32 protraction, scapular—179, 179–80, 180, palpation—150, 151 cuboid-metatarsal joint—408–9, 409 trigger points—161 first cuneiform-metatarsal joint—410, 181 pectoralis major jerk test—181, 181 muscles, innervation and root level—182 pectoralis minor—192 410 proximal digital crease—237 pectus carinatum—25 metatarsals—410, 410 proximal interphalangeal crease—237 pectus excavatum—25 plantar reflex—127 proximal interphalangeal joints Pellegrini-Stieda disease—347 plantar surface extension—256, 257 pelvis—434 innervation—421 flexion—255– 6, 257, 266, 267, 268, 268 gait—438 palpation—397–9 traction—261, 261 overview—34 –5 plates (volar ligaments)—384 proximal palmar (flexion) crease—237 posture examination—20, 23, 26, 27 platysma—53, 147 proximal radioulnar joint—196 radiological views—333 plicae—343 proximal wrist crease—237 perichondrium—14 tests—373 psoas—313, 314 perimysium—11, 14 Plummer-Vinson syndrome—247 palpation—105– 6, 106 periosteum—6, 9, 14 poliomyelitis—440, 443 trigger points—304 peripheral nerves popliteal artery—352 psoriasis—247 hip—326 popliteal fossa—352, 352 pterygoid muscles—86–7, 87, 95 leg—367 popliteal nerve—352 pubic tubercles—104, 105, 297, 297 lower leg and foot—420 popliteal pulse—352 pump bump—397 upper arm and forearm—224, 225 popliteal vein—352 wrist and hand—280, 281 popliteus—349, 362, 364, 365 Q angle—339, 340, 340, 435, 436, 436 peritendon (tendon sheath)—13 posterior cruciate ligament—336, 337, measurement—343, 343 peroneal nerve—133 peroneal nerve compression—421, 422 337, 338 quadratus femoris—322 peroneus brevis—415, 415 posterior cutaneous nerve of arm—184 quadratus lumborus—102, 103 peroneus brevis tendon—395, 395 posterior cutaneous nerve of forearm—184 quadriceps—364 peroneus longus—415, 415 posterior drawer test—187, 187, 358, 358 peroneus longus tendon—395, 395 posterior glide of tibia—357–8, 358 extension movement—439 peroneus tubercle—393, 394 posterior interosseous nerve syndrome flexibility testing—368, 369 pes anserinus—347, 348 palpation—344 (supinator syndrome)—228, 229 thigh girth measurement—344 posterior superior iliac spine—99, 100, trigger points—354 weakness—443, 444 300, 301 quadriceps reflex—125, 126, 127 posterior talofibular ligament—395 461

Index radial artery—239 elbow—215–20 sacral sulcus—100 radial compartment of hand—239– 41 hip—313–24 sacroiliac distraction test—136, 137 radial deviation knee—359– 65 sacroiliac joint lumbosacral spine—117–20, 118, 119 hand—250 shoulder—170– 80 examination—115, 115–17 wrist—253, 253 palpation—99–100, 100, 300, 301 radial head abduction—172–3, 173 tests—136, 136–7, 137 palpation—204, 204 adduction—173–5, 175 ventral and dorsal glide—215, 215 extension—172, 172 Patrick’s (Fabere) test—330, 331 radial longitudinal (thenar) crease—237 flexion—170–2, 171 sacrospinalis muscle (erector spinae)—102, radial nerve lateral (external) rotation—176–7, entrapment at elbow—228, 229 102 stretch test—69, 71 177 sacrotuberous ligament—102, 103 radial pulse—239 medial (internal) rotation—175, sacrum—35, 116, 117 radiculopathy—447 radiocarpal joint, traction—260, 260 175– 6, 176 posteroanterior spring—117, 117 radiological views scapular elevation—177–8, 178 saphenous vein—389–90, 390 ankle and foot—427, 430, 431, 432 scapular protraction—179–80, 180, sarcomere—11 cervical spine—80, 81, 81 sartorius—300, 300, 313, 347, 362, 364, elbow—231, 232, 232 181 hip—333, 333, 334 scapular retraction—178–9, 179 365 knee—377, 378, 378 temporomandibular joint—94–5 Saturday night palsy—228, 229 lumbosacral spine—137, 138, 139 wrist and hand—262–79 scaleni muscles—38 shoulder—193, 194 distal interphalangeal joint flexion— wrist and hand—291 palpation—55, 55 radioulnar joint—196 266, 266 trigger points—56, 58 radius—196, 260 fingers extension—268, 268–9, 269 scaphoid (navicular)—234, 242, 243, 381, dorsal tubercle (Lister’s tubercle)—244, interossei—269, 269–70, 270 proximal interphalangeal joint 382 245 scaphoid-lunate dissociation (Watson) fracture—196 flexion—266, 267, 268, 268 styloid process—242, 243 thumb—273–9 test—287, 288, 289 ventral and dorsal glide—215, 215 wrist extension—263–5, 265 scapula—141, 143 range of motion—448–9 wrist flexion—262–3, 263, 264 abnormal gait retinacular test—287, 287 abducted—22, 22 retraction, scapular—178, 178–9, 179 elevation—177–8, 178, 182 foot and ankle—441–2 muscles, innervation and root level—182 lateral border—152, 153 hip—444 retrocalcaneal bursa—396, 397 medial (vertebral) border—46–7, 48, knee—443 retrocalcaneal bursitis—412 active movement testing—29 reverse Lachman test—369, 370 151–2, 152 rectus abdominis—105, 106, 107, 117, rheumatoid arthritis—4, 240, 384 mobility testing—169–70, 170 rhomboideus muscles—153, 153, 178, 178 palpation—46 –7 118, 118 trigger points—160 posture examination—19, 22, 22, 25 rectus femoris—313, 364, 364 ribs—54, 54 protraction—179, 179–80, 180, 181, referred pain patterns first—53, 54, 192 ventral-caudal glide—65, 66 182 abdominal region/lumbosacral spine— rigid flat foot—426, 426 retraction—178, 178–9, 179, 182 107, 108, 109 Rockwood (anterior instability) test—184, spine—46, 47, 151, 152 winged—22, 22 ankle and foot—421, 421 186 scapulohumeral rhythm—143, 162 cervical spine—79, 80 Roos test—193, 193 scapulothoracic articulation—143 elbow—229, 231 root levels Schober test—110 hip—327 sciatic nerve—104, 104, 302, 302 knee—368, 368 ankle and foot—419 sciatica—302, 435 shoulder—193, 194 elbow—221 scoliosis—20, 21, 25 temporomandibular joint—83 hand and wrist—279 scratch test—32 wrist and hand—289, 290 hip—325 semimembranosus—323, 352, 362, 363 reflex sympathetic dystrophy—448 knee—365 semispinalis capitis—48 reflexes shoulder—182 semispinalis cervicis—48 ankle and foot—418 rotation semispinalis muscles—118 elbow—221–3 cervical spine—60–1, 61 semitendinosus—323, 347, 362, 363 jaw jerk—95, 95 trigger points—353 knee—366 –7 active—60–1, 61 sensation testing—31 L1 root level—122 intervertebral mobility testing—63, 64 ankle and foot—418, 421 L2 root level—122 knee—365 elbow—223, 224, 225 L3 root level—125, 127 passive movement testing—356, 356 hip—324–5, 326 L4 root level—126, 127 resistive testing—364–5, 365 knee—367 L5 root level—127 lumbosacral spine—110, 111 L1 root level—122, 124 S1 root level—127, 129 pelvic—20, 438, 439 L2 root level—122, 124 shoulder—181 trunk—118, 118–19 L3 root level—125, 125 superficial—127 rotator cuff—143–4, 154–5, 155 L4 root level—126, 127 relocation test—185 rotatores—118 S1 root level—127, 129 resistive testing—30–1 rounded shoulder—28, 29 S2–S4 root levels—127 ankle and foot—411–17 rounded thoracic kyphosis—29 shoulder—181–2, 183, 184 cervical and thoracic spine—65– 8 wrist and hand—280, 280, 281 S1 root level—127 serratus anterior—154, 155, 179, 179 S2–S4 root levels—127 sesamoid bones—398, 398 sacral base—100, 100 shear test, acromioclavicular joint—189, 189 shin splints—413, 415, 435 462

Index shoulder—141, 143–94 side bending cervical spine acromioclavicular shear test—189, cervical and thoracic spine—60, 61, axis (C2)—43, 43 189 62–3, 63 C3–C6—43, 44 active movement testing—156, 162, intervertebral mobility testing—62–3, 63 C7—43, 43 162–3, 163 lumbosacral spine—110, 111, 113, 113 Adson’s maneuver—191, 193 lumbar spine—98–9, 99 anterior instability (Rockwood) test— sinus tarsi—390–1, 391 palpation—43, 44, 45–6, 46 184, 186 SIT muscles—154 posteroanterior central pressure (ventral clunk test—188, 188 sitting forward-flexion test—116–17, 117 cross-flexion test—189, 189 sitting posture—29 glide)—64, 64 dermatomes—181, 183 skeletal muscle—10, 10–12, 11, 12 thoracic spine—45– 6, 46 dislocation—181 skier’s thumb—261 apprehension (Crank) test—184–5, skin rolling—32 T1—43 187 skull—38 transverse pressure—65, 66, 114, 115 drop arm test—190, 191 Slocum test—371, 372 splenius capitis trigger points—57 flexion—170–2, 171 slow-twitch fiber—11, 12 spondylosis test—137, 137 functional anatomy—143, 143–5 slump test—32, 133, 134 sprain—9, 10 Hawkins supraspinatus impingement snapping shoulder—151 Sprengel’s deformity—22, 23 test—190–1, 191 soft-tissue structures palpation spring (calcaneonavicular) ligament—381, impingement syndromes—144–5, 146 inferior instability and multidirectional ankle and foot 383 instability test—188, 188 lateral—393–5 Spurling test—78, 78–9 innervation—184 medial—386, 388–90 squinting patella—24, 25, 333, 341, 342 lateral (external) rotation—176–7, 177 plantar surface—398–9 stability and structural integrity tests medial (internal) rotation—175, 175– 6, posterior—397 176 hip—328, 330–1 mobility testing—167–70, 168, 169, cervical and thoracic spine knee—368 –71 170 anterior—54 – 6 stance phase—438 neurological examination—181–2 posterior—47–9 standing forward-bending test—115, 115 motor—181, 182 step length—438 sensation—181–2, 183, 184 elbow steppage gait—413, 441, 441 observation—145 anterior—200 –1 sternal angle (angle of Louis)—51, 53 palpatory examination—146–56 lateral—204 –5 sternoclavicular joint—141, 143 anterior bony structures—146–9 medial—201–2 mobility testing—168–9, 169 anterior soft-tissue structures— posterior—206 –7 palpation—51, 53, 147, 147 149–51 sternocleidomastoid—38, 149–50, 150 lateral soft-tissue structures—154– 6 hip—298–300, 301–2 palpation—54–5, 55 medial soft-tissue structures—153– 4 knee resistive testing—67, 67 posterior bony structures—151–3 trigger points—56, 58 posterior soft-tissue structures— anterior—344 –5 stork (Gillet; marching) test—115–16, 116 151–3, 154– 6 lateral—350 –1 straight-leg raise test—32, 131–3, 132 passive movement testing—164, 164–70, medial—346 –7 strain—9, 12 165, 166, 167 posterior—351–3 stress fracture—7 posterior drawer test—187, 187 lumbosacral spine lower leg and foot—425 posture examination—19, 22, 22, 23, 25, anterior—105– 6, 106 stretch (deep tendon) reflexes—31 26 posterior—101–2, 102, 103 stride length—438 radiological views—193, 194 side-lying—104, 104 structural integrity tests—29 referred pain patterns—193, 194 shoulder ankle and foot—423–6 reflexes—181 anterior—149–51 hip—328, 330–1 relocation test—185 lateral—154 – 6 knee—368 –71 resistive testing—170– 80, 171 medial—153– 4 posture—18–19 abduction—172–3, 173, 174 posterior—151–3, 154–6 student’s elbow—206 adduction—173–5, 175 temporomandibular joint—85–7 subacromial bursa—144, 155–6, 156 extension—172, 172 wrist and hand subacromial space—144, 145 Roos test—193, 193 dorsal—247–50 subacute bacterial endocarditis—241 rounded—28, 29 palmar—237– 41 subdeltoid (subacromial) bursa—144, scapular elevation—177– 8, 178 radial—244 scapular protraction—179, 179– 80, ulnar—242 155– 6, 156 180, 181 soleus—411, 411 subjective examination—16–18 scapular retraction—178, 178–9, 179 Speed’s test of biceps—189, 190 Speed’s test of biceps—189, 190 spina bifida occulta—39, 98 ankle and foot—384–5 subjective examination—145– 6 spinal accessory nerve injury—182 cervical and thoracic spine—38–9 supraspinatus test—191, 192 spinalis thoracis—119 elbow—198 trigger points—156, 157, 158, 159, 160, spine hip—295 161 cervical see cervical spine knee—340 Wright’s maneuver—191, 193 compression and distraction—32 lumbosacral spine—97 Yergason’s test of biceps—189, 190 lumbosacral see lumbosacral spine questions—18 overview—34 –5 shoulder—145– 6 shoulder shrug (scapular elevation)— posture examination—19, 20, 22, 22, 23, temporomandibular joint—84 177– 8, 178 wrist and hand—235–6 26, 27 suboccipital muscles scapular—46, 47, 151, 152 palpation—48, 49 thoracic see thoracic spine trigger points—57, 59 spinous process—34 subscapularis—175 central posteroanterior spring—113–14, trigger points—160 subscapularis tendon—143 114 463

Index subserous fascia—14 mandibular measurements—93, 93 interphalangeal joint subtalar eversion—415, 416 observation—83– 4 extension—259, 259 overbite measurement—92, 93 flexion—259, 259 passive—404–5, 405 overjet measurement—92–3, 93 subtalar inversion—413, 414, 415, 415 palpation—85–7 metacarpophalangeal joint—234 extension—259, 259 passive—404, 405 anterior aspect—86–7 flexion—258–9, 259 subtalar (talocalcaneal) joint—381, 383 bony structures—85, 86 ulnar glide—261, 262 posterior aspect—85–6 traction—408, 409 soft-tissue structures—85–7 opposition—258, 258, 278, 278–9 sulcus sign—188 passive movement testing—93–4 resistive testing—273–9 superficial fascia—14 mobility testing—94, 94 thyroid cartilage—51, 51 superficial reflexes—127 physiological movements—94 tibia—336, 380 superior iliac spine (anterior) referred pain patterns—83 medial and lateral glide—359, 361 reflex testing—95, 95 posterior glide—357–8, 358 palpation—104, 105, 296, 297 resistive testing—94–5 ventral glide—342, 357 test for true leg length—331 subjective examination—84 tibial nerve—132 superior nuchal line—40, 41 trigger points—87– 8, 88, 89 tibial torsion—427, 429, 430 superior tibiofibular joint—407, 408 temporomandibular joint syndrome—85 tibial tuberosity—344, 344 supination tendinitis—5, 13 tibialis anterior—413, 413 elbow—196, 198, 208, 211, 211 tendocalcaneus see Achilles tendon tibialis anterior tendon—391, 391 forearm—219–20, 220 tendon—13 tibialis posterior—388, 388, 389, 389, 413, supinator muscles—219, 220 tendon sheath (peritendon)—13 supinator syndrome (posterior interosseous tennis elbow (lateral epicondylitis)—202 414 tennis elbow test—228–9, 230 tibiofemoral joint—336 nerve syndrome)—228, 229 tenosynovitis, hand and wrist—284, 285, tibiofibular joint—407, 408 supraclavicular lymph nodes—53, 55, Tinel’s sign—227, 228, 280, 282, 367, 368, 285 147– 8 tensor fasciae latae—293, 313, 318, 323, 421 supraclavicular nerve—184, 185 toe-strike—442 supracondylar ridge—200, 201, 202, 203 323, 364 toeing-in—427, 429 suprahyoid muscle—87, 88 trigger points—304 toes suprascapular nerve—181 teres major—172, 172, 175 supraspinatus (empty can) test—191, 192 teres minor—143, 176, 177 extension—417, 417, 418, 419 supraspinatus muscle trigger points—157 thenar crease—237 flexion—415, 416, 417, 419 supraspinatus tendon—143, 144, 151 thenar eminence—239–40 thigh girth measurement—344, 344 resistive—411 palpation—154–5, 156 Thomas test—19, 327, 327–8 palpatory examination—399–401 tests for impingement—190–1, 191 Thompson test—423, 424 tongue position—93, 94 supraspinous ligament—101–2, 102 thoracic dermatomes—78 torsion, tibial—427, 429, 430 suprasternal notch—51, 53, 146–7, 147 thoracic outlet—192 torticollis—25, 26 sustentaculum tali—385– 6, 386 thoracic outlet syndrome—55, 191, 193, tourniquet test—280, 282 swallowing—93 trabecular (cancellous) bone—6, 7 swan neck deformity—240 193 traction sway back deformity—27, 28 thoracic spine—23, 35, 37, 37– 81 cervical—64, 64 swing phase—438 elbow—211, 212 synergists—11 active movement testing—57, 62 first carpometacarpal joint—261, 262 synovial joint—7, 9, 13 distraction test—79 first metatarsophalangeal joint—411, synovitis—14 Lhermitte’s sign—79, 79 synovium—13–14 neurological examination—73, 77, 78 411 observation—37– 8 hip—312, 313 T1 nerve root level—68 palpation—45–56, 46, 47 humeroradial joint—213, 214, 215 evaluation—73, 77 knee—357, 357 anterior bony structures—49–54 midcarpal joint—260, 260 T1 spinous process—43 anterior soft-tissue structures—54–6 radiocarpal joint—260, 260 T2–T12 nerve root level evaluation—78 posterior bony structures—45–7 shoulder—167, 168 talipes equinus deformity—441, 442, 443 posterior soft-tissue structures—47–9 subtalar joint—408, 409 talocalcaneal joint see subtalar joint passive movement testing—63, 63–4, talocrural joint—408, 409 talocrural joint—408, 409 transmalleolar axis—380, 380 talus—380–1, 382, 434, 434–5 64 transverse arch of foot—381, 382, 398, resistive testing—65–8 palpation—390, 390 spinous processes—45– 6, 46 399 pronation—381, 383, 435, 435 Spurling test—78, 78–9 transverse (distal palmar) crease—237 tardy ulnar palsy—202 subjective examination—38–9 transverse pressure on spinous process— tarsal tunnel—389 vertebral artery test—79, 80 tarsal tunnel syndrome—389, 423 thoracic vertebrae—35 65, 114, 115 teeth examination—86 thumb transverse process—34 temporalis—86, 86, 95 abduction—274–5, 275, 276, 279 temporomandibular joint—83–95 active movement testing—250–1 cervical spine—45, 45 active movement testing—88–93 adduction—275– 6, 277, 279 lumbar spine—99, 99 carpometacarpal joint posteroanterior spring—114, 114 closing mouth—90 thoracic spine—46, 47 lateral mandibular deviation—91–2, abduction and adduction—256, 258, trapezius—177, 178, 178, 242, 243 258 palpation—47, 48, 150, 150 92 trigger points—56, 56, 57 opening mouth—89–90, 91 traction—261, 262 trapezoid—242, 243 protrusion of mandible—90–1, 92 extension—273, 273– 4, 274, 279 Trendelenburg gait—319, 437, 444, 445 swallowing—93 flexion—279 compensated—443, 444 freeway space assessment—92, 92 Trendelenburg test—294, 328, 330 functional anatomy—83 464

Index triangular fibrocartilage complex—242 tennis elbow test—228–9, 230 proximal interphalangeal joint triceps—217 trigger points—207, 208, 209 flexion—266, 267, 268, 268 overview—141, 141 palpation—206–7, 207 posture examination—22 radial deviation—253, 253 resistive testing—217, 218 shoulder—141, 143–94 radiological views—291 trigger points and referred pain—209 abduction testing—172–3, 173, 174 referred pain patterns—289, 290 triceps reflex—73 acromioclavicular shear test—189, subjective examination—235–6 trigger fingers—266, 267 thumb—273–9 trigger points—447 189 Tinel’s test—280, 282 cervical spine—56, 56–7, 57, 58, 59 active movement testing—156, 162, ulnar deviation—253, 254 elbow—207, 208, 209 wrist extension—251, 252 hip—302, 302, 303, 304 162–3, 163 wrist flexion—251, 252 knee—353, 353, 354 adduction testing—173–5, 175 upper lateral cutaneous nerve—184 lumbosacral spine—106, 107, 108, 109 Adson’s maneuver—191, 193 upper limb tension test (brachial plexus shoulder—156, 157, 158, 159, 160, 161 anterior instability (Rockwood) test— temporomandibular joint region—87– 8, tension test; Elvey’s test)—68–9, 70, 184, 186 71 88 apprehension (Crank) test—184–5, upper motor neuron signs—423, 423 triquetrum—241, 241 trochanter 187 valgus deformity of foot—413 brachial plexus neurological valgus stress—438 Craig test—333 palpation—297– 8, 298 examination—68 –9 elbow—213 trochlear groove—341, 343 clunk test—188, 188 forefoot—426–7, 428 tropocollagen—5 cross-flexion test—189, 189 hindfoot—426, 427 trunk drop arm test—190, 191 knee—347, 359, 361 extension—119, 119–20 extension testing—172, 172 Valsalva’s maneuver—135, 136 flexion—117, 118 flexion testing—170–2, 171 varus stress—438 rotation—118, 118–19 Hawkins supraspinatus impingement ankle—380, 380 tunnel elbow—213 carpal—234–5, 239, 240 test—190–1, 191 forefoot—426–7, 428 Guyon’s—234–5, 242, 283, 283 lateral (external) rotation testing— hindfoot—426, 427 tarsal—389, 422, 423 knee—359, 361 176–7, 177 vastus lateralis—344 ulna—196 medial (internal) rotation testing— vastus medialis—344 fracture—196, 199 vastus medialis obliquus atrophy—344 lateral glide—212, 213 175, 175– 6, 176 ventral glide—64, 64 medial glide—213, 213 mobility testing—167–70 femoral head—312, 314 styloid process—241, 241 neurological examination—70, 72–8 fibula observation—145 ulnar artery—238, 238, 239 palpatory examination—146–56 inferior tibiofibular joint—407, 408 ulnar aspect of wrist—241–2 passive movement testing—164, superior tibiofibular joint—407, 408 ulnar border—206, 207 humeral head—167–8, 168 ulnar compartment of hand—237– 8 164–70, 165, 166, 167 radial head—215, 215, 260 ulnar deviation posterior drawer test—187, 187 radius—215, 215, 260 radiological views—193, 194 tibia—342, 357 hand—250 referred pain patterns—193, 194 vertebrae—34, 34 wrist—253, 254 resistive testing—170– 80, 171 vertebral artery—35 ulnar glide of first metacarpophalangeal Roos test—193, 193 vertebral artery test—79, 80 scapular elevation—177–8, 178 vertebral (medial) border of scapula— joint—261, 262 scapular protraction—179, 179– 80, ulnar nerve—235 151–2, 152 180, 181 vicious cycle of injury—3, 4, 435, 436 entrapment—227, 228, 282, 283 scapular retraction—178, 178–9, 179 vitamin C—5 palpation—201, 203, 238 Speed’s test of biceps—189, 190 Volkmann’s ischaemic contracture—200 stretch test—69, 71 subjective examination—145–6 uncompensated Trendelenburg gait—444, supraspinatus test—191, 192 Waldron (patellofemoral arthritis) test— trigger points—156, 157, 158, 159, 373 445 upper abdominal skin reflex—127, 130 160, 161 Wartenberg’s sign—227 upper extremity upper limb tension test—68–9 Watson (scaphoid-lunate dissociation) Wright’s maneuver—191, 193 dermatomes—223 Yergason’s test of biceps—189, 190 test—287, 288, 289 elbow—196 –232 wrist and hand—234–91 weakness in gait active movement testing—250–1 active movement testing—208 distal interphalangeal joint flexion— ankle and foot—441, 441, 442 entrapment neuropathies—223– 8 hip—444 golfer’s elbow test—229, 230 266, 266 knee—443 mobility testing—211–15 finger extension—268, 268–9, 269 winged scapula—22, 22 motor testing—220, 221 finger passive movement testing— wipe test—376, 376 observation—197– 8 Wright’s maneuver—191, 193 palpatory examination—198, 200–7 253–9 wrist—141, 234–91 passive movement testing—208–15 Finkelstein’s test—284, 284 active movement testing—250–1 radiological views—231, 232, 232 interossei—269, 269–70, 270 dermatomes—280 referred pain patterns—229, 231 joint flexibility and stability tests— extension—279 reflexes—221–3 Finkelstein’s test—284, 284 resistive testing—215–20 287–9 flexibility and stability tests—287–9 sensation—223, 224, 225 mobility testing—259–61 subjective examination—198 neurological examination—279–83 observation—235 palpatory examination—236–50 passive movement testing—251–62 Phalen’s test—282, 283 465

Index wrist (cont.): radial (lateral) aspect—242–4 referred pain patterns—289, 290 flexion—279 ulnar (medial) aspect—241–2 resistive testing—262–5 functional anatomy—234–5 passive movement testing—251–61 mobility testing—259– 61 accessory movements—259–61 extension—263–5, 265 muscles, innervation and root level— fingers—253–9 flexion—262–3, 263, 264 279 radial deviation—253, 253 subjective examination—235–6 neurological examination—279– 83 ulnar deviation—253, 254 Tinel’s test—280, 282 observation—235 wrist extension—251, 252 wrist extensor-supinators—204, palpatory examination—236–50 wrist flexion—251, 252 dorsal aspect—244–50 Phalen’s test—282, 283 205 palmar aspect—236– 41 radiological views—291 wrist flexor-pronators—202, 203 Yergason’s test of biceps—189, 190 466