Orthopedic Assessment Methods

The Slocum Drawer test is used to assess for medial and lateral rotary instabilities of the knee.  The exam is administered similarly to the anterior drawer test with the exception that the tibia is rotated medially and laterally to assess for anterolateral and anteromedial instability respectively.  The knee is placed in approximately 90-degrees of flexion with the foot flat on the table.  Thirty-degrees of medial rotation is applied to the tibia by rotating the foot and the examiner pulls anteriorly on the tibia to assess for anterolateral rotary instability.  To examine anteromedial rotary instability the tibia is laterally rotated approximately 15-degrees and the tibia is once again pulled anteriorly.  Results are compared bilaterally.

The sulcus sign is an examination to determine the extent and/or presence of inferior instability of the glenohumeral joint.  This test can be administered with the patient either seated or standing with his arm relaxed at her side.  The examiner palpates the shoulder by placing her thumb and fingers on the anterior and posterior aspects of the humeral head.  The examiner grasps the patient's elbow with her other hand and applies a downward distraction force.  A positive test will result in a sulcus being formed between the acromion and the humeral head as the humeral head moves inferiorly while the force is being applied.

The empty can test is used to assess for the presence of injury/pathology to the supraspinatus.  This test is also known as the supraspinatus strength test.  The patient is either seated or standing with his arms in a position of scapation (approximately 30-degrees of horizontal adduction with the shoulders abducted to 90-degrees).  The patient attempts to resist downward overpressure being applied by the examiner.  A positive result occurs when the patient is unable to resist the force.

The shoulder Apprehension test is also known as the Fowler test or the Jobe relocation test.  The examination is used to assess for shoulder instability.  This examination is best partnered with the shoulder relocation test.  The apprehension test (AKA crank test) is used to assess for an anterior shoulder dislocation.  The patient lies on the table supine with the shoulder abducted 90-degrees and maximum external rotation.  The examiner typically will support the humerus with one hand while applying overpressure to the external rotation of the shoulder.  A positive test will result in the patient reacting to the movement by preventing further rotation or appearing apprehensive.  It is at this point that the relocation test is typically administered.

The McMurray test is a test used to determine the presence of a meniscal tear.  While the patient is supine on the exam table the examiner grasps the knee, placing one hand over the top of the knee with her thumb over one joint line and her index and middle finger over the opposite joint line.  The examiner begins with the knee in full flexion and then medially and laterally rotates the tibia while paying attention for an audible click.  The examiner then laterally rotates the tibia and extends the knee beyond 90 degrees.  An audible click while preforming this maneuver can indicate a torn medial meniscus.  To examine the lateral meniscus the examiner will return the knee to full flexion and apply a medial rotation to the tibia prior to extending the knee once again.