Cervical intervertebral foramen squeeze test: the patient is sitting, the examiner’s fingers are embedded in each other, the palm surface of the hand is pressed against the top of the patient’s head or forehead, the palm side of the two forearms are clamped on both sides of the patient’s head for protection, without making the head and neck crooked, while flexing the cervical spine to the affected side or the healthy side, also can be before flexion and after extension, if there is increased radiating pain in the neck or upper limbs, it is positive. The test is mostly seen in neurogenic cervical spondylosis or cervical disc herniation. The test is to narrow the intervertebral foramen, thus increasing the irritation to the cervical nerve roots, so that pain or radiating pain occurs.
Lateral flexion intervertebral foramen squeeze test: the patient is seated, the head is slightly tilted back and flexed to the affected side, the jaw is turned to the healthy side, and the examiner places both hands on the top of the patient’s head and squeezes downward. The test is positive if it causes pain in the neck and radiates to the affected hand. This is most commonly seen in C5 disc herniation, when the pain radiates to the thumb, hand and forearm. It is best not to do this test if cervical tuberculosis or unstable fractures are suspected in order to prevent spinal cord injury.
Posterior intervertebral foramen squeeze test: the patient takes a sitting position with the head slightly tilted back, the examiner crosses his hands on the top of the patient’s head and then squeezes downward. If it causes neck pain and radiates to the affected upper limb, it is positive. Positive results are seen in cervical spondylosis. For suspected cervical spine tuberculosis or unstable fracture, it is best not to do this test to prevent spinal cord injury.
Cervical intervertebral foramen separation test: The examiner holds the patient’s lower chin with one hand and the occiput with the other hand, then gradually pulls the head upward, and if the patient feels a reduction in pain in the neck and upper extremities, it is considered positive. This test can pull open the narrow intervertebral foramen, reduce the pressure on the joint capsule around the small joints of the cervical spine, relieve muscle spasm, and reduce the extrusion and irritation of nerve roots, thus reducing pain.
Vertebral artery distortion test: used to check vertebral artery type cervical spondylosis, the patient is seated, head and neck are relaxed, the examiner stands behind the patient, holds both hands on both sides of the patient’s headrest, and turns the patient’s head to one side while tilting back, if vertigo appears, it is positive.
Top of the head snap test: the patient sits upright, the doctor presses the top of the patient’s head with one hand flat, and taps the back of the palm of the hand pressed on the top of the patient’s head with the other hand, if the patient feels pain and discomfort in the neck or pain and numbness in the upper limbs, it is positive. Check for cervical spondylosis or cervical spine injury. When cervical spine injury is suspected, the percussive force and squeezing pressure on the top of the head should not be too heavy to avoid aggravating the injury.
Flexion neck test: used to check spinal cord type cervical spondylosis, the patient lies flat, the upper limbs are placed on both sides of the trunk, the lower limbs are straightened, the patient is made to raise the head and flex the neck, if there is radioactive numbness in the upper and lower limbs, it is positive.
Swallowing test: The patient sits upright and is asked to make swallowing movements, and it is positive if there is difficulty in swallowing or neck pain. If the patient can correctly state that there is pain when swallowing food on a regular basis, this is also a positive sign. It is often used to check whether the neck lesion affects the swallowing activity.
Brachial plexus nerve pull test: The patient is sitting with head slightly flexed, the examiner stands on the side of the patient being examined and pushes the head to the opposite side with one hand while holding the wrist on that side with the other hand for relative traction, at this time the brachial plexus nerve is pulled, if the affected limb shows radiating pain and numbness, it is positive. This is mostly seen in patients with neurogenic cervical spondylosis.
Adelson’s test: If the patient is seated, touch the radial artery with the finger, and at the same time extend the upper limb and externally rotate it, then ask the patient to inhale deeply and rotate the head and jaw to the affected side, if the radial artery pulsation is weakened or disappears and neck, shoulder and back pain appears, it is positive. It is common in cervical rib and anterior oblique muscle syndrome and thoracic outlet syndrome, but also in cervical spondylosis, cervical medullary tumor and brachial plexus nerve compression caused by neck tumor. It needs to be differentiated.
Thoracic jerk test: The doctor will feel the radial artery of the affected limb and ask the patient to stand upright and try to turn the shoulder downward to make a thoracic jerking motion, if the radial artery pulsation decreases or disappears, it is positive. It is commonly used to check thoracic outlet syndrome.
Upper extremity abduction test: The physician feels the radial artery of the affected extremity and abducts the affected extremity passively, if the pulsation of the radial artery decreases or disappears, the test is positive.
Upper extremity abduction fist test: Ask the patient to abduct both upper extremities by 90° and rotate them outward, and make a continuous rapid fist clenching and unfolding action with both hands. If the affected upper limb rapidly develops pain, weakness and automatic descent from the distal side to the proximal side; while the healthy side does not show symptoms and is maintained for more than 1 minute, it is positive. Examination of thoracic outlet syndrome.
Excessive downward pull test of the upper limb: If the affected limb is asked to carry a heavy object or pull downward on the affected limb, and the affected limb shows numbness and pain or nerve and vascular symptoms such as purple and dark coldness, it is positive. It is commonly used to examine thoracic outlet syndrome.
Special shoulder examination
Shoulder hitch test: also known as Duggar’s sign. The elbow joint of the affected limb is flexed and the elbow joint of the affected limb is close to the chest wall when the hand is placed on the opposite shoulder. If the elbow joint is not close to the chest wall, or if the elbow joint is close to the chest wall and the affected hand cannot rest on the opposite shoulder, or both, it is a positive sign. This indicates shoulder dislocation.
Straight ruler test: In normal people, the peak of the shoulder is located on the medial side of the line between the lateral epicondyle of the humerus and the greater tuberosity of the humerus. If the lower end is close to the lateral epicondyle of the humerus and the upper end is in contact with the shoulder peak, this is a positive sign, indicating shoulder dislocation.
Shoulder abduction pain arc test: In the range of 60-120° of shoulder abduction, pain in the shoulder due to friction between the supraspinatus tendon and the subacromial peak is a positive sign, and the pain in this specific area is called the pain arc. It is seen in supraspinatus tendonitis.
Supraspinatus tendon rupture test: When the shoulder is abducted in the range of 30° – 60°, the deltoid muscle contracts with force, but cannot abduct and lift the upper arm, the more abducted and forceful, the more elevated the shoulder is. However, when the passive abduction reaches above this range, the patient can actively raise the upper arm. Initial active abduction deficit is a positive sign, suggesting supraspinatus tendon rupture.
Biceps tendon resistance test: The patient flexes the elbow for forearm resistance rotation backward, causing pain in the intertrochanteric groove area of the humerus as a positive sign. This is seen in long head biceps tendinitis.
Drop arm test: The patient takes a standing position, first straightens the affected upper limb, passively abducts it to 90°, removes the doctor’s help, and makes it slowly drop the upper limb. If the upper extremity cannot be slowly lowered and there is a sudden straight drop to the side of the body, the test is positive. Check for shoulder tendon cuff rupture.
Special examination of the elbow
Elbow triangle: In a normal elbow joint in full extension, the lateral epicondyle, medial epicondyle and ulnar eminence of the humerus are in a straight line. When the elbow joint is flexed at 90°, the three bony prominences form an isosceles triangle, called the elbow triangle. This triangular point relationship changes when the elbow joint is dislocated. It is used for the examination of elbow dislocation, and the differentiation of elbow dislocation from supracondylar humerus fracture.
Wrist extensor tension test: The patient’s elbow is straightened, the forearm is rotated forward, and passive flexion of the wrist is made, causing pain at the humeral epicondyle is a positive sign, seen in humeral epicondylitis.
Forearm test: 1. The patient sits opposite to the physician with the upper limb straightened forward. 2. The physician holds the elbow with one hand and the wrist with the other hand and makes the forearm inward, the hand holding the elbow pushes the elbow joint outward, if there is a rupture of the lateral collateral ligament, the forearm can show inward motion.
If the hand holding the wrist makes the forearm abduct and pulls the elbow joint inward, there is an abduction movement of the forearm, then there is a medial collateral ligament injury, and both are positive for this test. Examination of lateral collateral ligament injury of the elbow joint.
Special wrist examination
Clenched fist ulnar deviation test: also known as Finkelstein’s sign. The patient makes a fist with the thumb flexed and holds the thumb in the palm. Then, the wrist joint is passively ulnar deviated, causing significant pain at the radial styloid process as a positive sign, which is seen in radial styloid process stenosis tenosynovitis.
Wrist triangle cartilage squeeze test: the wrist joint is in neutral position; then the wrist joint is passively deflected to the ulnar side and squeezed longitudinally, if there is pain in the lower ulnar radial joint, it is a positive sign, which is seen in wrist triangle cartilage injury and ulnar styloid fracture.
Wrist flexion test: the doctor holds the patient’s wrist and presses the thumb at the transverse wrist, while asking the affected wrist to flex, if the numbness and pain of the affected hand increases and radiates to the middle finger and index finger, it is positive. This indicates carpal tunnel syndrome.
Pinch – grip sign: Ask the affected hand to pinch the tip of the thumb and index finger and form a ring. If the hand can form a ring, it is negative; if it cannot form a ring and becomes a chicken head shape, it is positive. Check for interosseous palmar nerve entrapment syndrome.
Special examination of the chest
Thoracic squeeze test: The examiner places both hands on the sternum and thoracic vertebrae, squeezes the thorax back and forth, and then places both hands on both sides of the thorax and squeezes them toward the middle, which can cause severe pain at the fracture of the examinee, which is called positive thoracic squeeze test.
Pick-up test: Let the child stand and ask him/her to pick up objects on the ground. Normal children can be slightly bent at both knees, bending over to pick up things; if there is a lesion in the lumbar region, the hip and knee flexion can be seen, the lumbar region is straight, one hand holding the knee and squatting, one hand picking up items on the ground, this test is positive. It is often used to check whether there is any impairment in the anterior flexion function of the spine in children.
Prone dorsiflexion test: The child is lying prone. The lower extremities together, the doctor hands lift the feet, so that the waist over-extension, the normal spine is curved back extension state. If there is a lesion, the thighs and pelvis leave the bed at the same time as the abdominal wall, and the spine is tonic.
Hip flexion test (supine hip flexion test): the patient is in the supine position, legs together, and asked to flex the hip and knee joints as much as possible, the examiner can also push the knee with two hands to make the hip and knee joints flex as much as possible, so that the hip leaves the bed, the lumbar passive forward flexion, if pain occurs in the lumbosacral area, that is positive.
If the unilateral hip and knee flexion test is performed, the patient’s lower limb on one side is straightened, and the examiner uses the same method to make the other hip and knee flex as much as possible, then the lumbosacral and sacroiliac joints can move with it, and if there is pain, it is positive.
If there is pain, it is positive. It means that there is flashing and twisting, strain injury, or lesion of lumbar intervertebral joint, lumbosacral joint or sacroiliac joint. However, the test is negative in patients with lumbar disc herniation.
Straight leg elevation test: the patient is supine, the two lower limbs are straight and close together, the examiner holds the patient’s ankle with one hand, holds the knee with the other hand to keep the lower limb straight, gradually elevates the patient’s lower limb, the normal person can elevate 70°-90° without any discomfort; if it is less than the above angle that the lower limb has conductive pain or numbness, it is positive. Most often seen in patients with sciatica and lumbar disc herniation.
Straight leg elevation and strengthening test (foot dorsiflexion test): If the straight leg of the patient’s lower limb is elevated to the height where the pain begins, the examiner fixes the lower limb with one hand to keep the knee straight, and the other hand dorsiflexes the patient’s ankle, the radiating pain is aggravated and the straight leg elevation and ankle dorsiflexion test (also called “strengthening test”) is positive. This test is used to identify whether the pain is caused by nerve compression or lower extremity muscles.
Straight leg elevation test on the healthy side: if the doctor performs a straight leg elevation on the healthy side, the test is positive if there is sciatic nerve radiating pain in the affected lower limb. Check for lumbar disc herniation.
Neck flexion test: The patient can be laid down with all limbs naturally flattened, and the examiner can rest one hand on the patient’s occiput and press the other hand on the patient’s chest. The patient’s neck is slowly flexed, and the test is considered positive if it can trigger lumbar pain and radiating pain in the lower limbs.
The principle of this test is: flexing the neck so that the occipital area leaves the bed, which can make the spinal cord rise about 2 cm, and make the dura and nerve roots are stretched, which increases the tension of the nerve roots that have already been lesioned.
Sitting neck flexion test: The patient sits with legs straight, then flexes the neck forward. If there is radiating pain in the lower limbs, or if the patient involuntarily flexes the knees to relieve the pulling pain, it is positive. Positive is seen in disc herniation or sciatic nerve compression.
Supine jerk test: To diagnose disc herniation by increasing the pressure in the spinal canal and stimulating the nerve roots to produce pain in 4 steps.
Step 1: The patient lies on his back, puts both hands on the abdomen or both sides of the body, takes the head and pillow and both heels as the pressure point, and jerks the abdomen and pelvis upward with force, which is positive if the patient feels lumbar pain and conduction leg pain on the affected side. If the conduction leg pain is not obvious, proceed to the next step of the examination.
Step 2: The patient maintains a supine posture, inhales deeply and then pauses to breathe, and puffs hard until the face is flushed for about 30 seconds, which is positive if there is conductive leg pain.
Step 3: In the supine tummy position, cough hard, if there is conductive leg pain, it is positive.
Step 4: In the supine erect position, the examiner gently presses the internal jugular vein bilaterally with the hand, and the test is positive if there is conduction pain on the affected side.
Femoral nerve pull test: meaningful for high-grade lumbar disc herniation. The patient lies prone, the affected knee is flexed, the lower leg is lifted so that the hip joint is in hyperextension, and the presence of anterior thigh pain is considered positive. In lumbar 2 to 3 and lumbar 3 to 4 disc herniation is positive, while lumbar 4 to 5 lumbar 5 sacral 1 this test is negative.
Schober test: make the patient stand upright, make a mark at the level of the iliac crest in the midline of the back as zero, make a mark 125px downward and another mark 250px upward, then make the patient bend over (keep both knees upright) and measure the distance between the two marks, if the increase is less than 100px, it is positive. A positive result indicates a decrease in lumbar spine mobility, which is seen in the middle and late stages of ankylosing spondylitis.
Special examination of the pelvis
Pelvic extrusion and separation test: the patient is supine, the doctor uses two hands to press on both sides of the anterior superior iliac spine of the pelvis and squeeze inward relative to each other for the extrusion test; two hands press on both sides of the pelvis on the medial iliac crest and press outward and downward for the separation test. The test is positive if it causes increased pain at the injury site and is commonly associated with fractures of the pelvic ring.
Sacroiliac joint separation test: also known as the “4” test. The patient is placed in a supine position with the affected lower limb bent at the knee and hip, and the outer ankle of the affected lower limb is placed on the contralateral knee in a cross-legged position. The doctor holds the contralateral iliac crest with one hand and squeezes the affected knee outward with the other hand, if there is a lesion in the sacroiliac joint, there will be pain in that area, which is a positive sign. In the same way, the opposite side is examined again. This test should be done to rule out hip lesions.
Bedside test: also known as Gaylord’s sign. The patient is placed in the supine position, and the patient is placed against the edge of the bed with the hip protruding slightly from the edge of the bed and the thigh hanging down. The lower limb of the healthy side is flexed at the knee and hip, close to the abdominal wall, and the patient holds the knee with both hands to fix the lumbar spine. The doctor holds the iliac spine with one hand to fix the pelvis and presses down on the thigh at the bedside with the other hand to extend the hip joint as far back as possible. If pain occurs in the sacroiliac joint, it is a positive sign, indicating a sacroiliac joint lesion.
Oblique wrench test: the patient lies on his back, the leg on the healthy side is straight, the leg on the affected side is bent at the hip and the knee is bent at 90° each, the doctor holds the knee with one hand and presses the shoulder on the same side with the other hand, then presses the thigh inward and presses the knee downward with force, if the sacroiliac joint is painful, it is positive.
Single hip posterior extension test: the patient lies prone, the two lower limbs are straight together, the doctor presses the central part of the sacrum with one hand, holds the lower thigh of the affected side with the elbow of the other hand, lifts the affected limb upward with force and makes it extend excessively, if the sacroiliac joint is painful, it is positive. Check whether there is any lesion in the sacroiliac joint.
Hip abduction and external rotation test: also known as “4” test, the patient is in supine position, the knee joint of the examined lower limb is flexed, the hip joint is flexed, abducted and externally rotated, and the foot is placed on the knee joint of the other side, so that both lower limbs are in a “4” shape. The examiner places one hand on the medial side of the flexed knee joint and the other hand on the front of the anterior superior iliac spine of the opposite side, then presses down with both hands. This indicates a sacroiliac joint lesion.
Hip flexion test: the patient lies on his back, the doctor holds the ankle, makes both lower limbs together, and is action straight leg hip flexion action, if less than 60° is positive. Check for hip contracture.
Sitting cross-leg test: Ask the patient to sit and cross the legs, those who cannot complete it are positive. Check for gluteus contracture.
Ober sign: The patient lies on his side, with the healthy side underneath, and the hip and knee are flexed. The examiner fixes the pelvis with one hand and holds the ankle of the affected limb with the other hand, making the knee flex 90°, followed by hip flexion, abduction and then straightening. At this time, relax the hand holding the ankle, so that the affected limb falls naturally, normal people should fall behind the healthy limb, if it cannot fall (or fall in front of the healthy limb), it is positive. Check for iliotibial tract contracture.
Special examination of the hip
Hip flexion contracture test: also known as Thomas’ sign. The patient is placed supine and the hip and knee on the healthy side are flexed as far as possible with the thighs close to the abdominal wall so that the lumbar area touches the bed to eliminate the compensatory effect of increased lumbar pronation. Then let him straighten the lower limb of the affected side, if the affected limb then stretches and cannot be straightened and placed flat on the bed, it is a positive sign. This indicates that the hip joint has a flexion contracture deformity, and the angle of flexion deformity is recorded.
Hip hyperextension test: It is also called the lumbar muscle twin test. The patient is in prone position, the knee on the affected side is flexed at 90°, and the doctor lifts the lower limb by holding the ankle with one hand to hyperextend the hip joint. If the pelvis is also lifted. This is a positive sign. It means that the hip joint cannot be hyperextended. This sign may be present in lumbar muscle abscess and early hip tuberculosis.
One-legged independence test: also known as the flexion-drenberg sign. This test is to check the weight-bearing function of the hip joint. First, the patient’s lower limb on the healthy side should be independent on one leg, and the affected leg should be lifted, and the hip fold (pelvis) on the affected side should rise as negative. If the lower limb of the affected side is allowed to stand on one leg and the leg of the healthy side is elevated, the hip crease (pelvis) of the healthy side is seen to fall, which is a positive sign. This indicates hip instability or weakness of the gluteus medius and minimus muscles on the weight-bearing side. Any disease that causes weakness of the gluteus medius can have a positive sign.
Lower extremity shortening test: also known as Ellis’ sign. The patient lies on his back, with the hip and knee joints flexed bilaterally and the heel flat on the bed, and the knee apex is normally equal on both sides, but if one side is lower than the other, it is a positive sign. This indicates shortening of the femur or tibiofibula or dislocation of the hip joint.
Telescope test: also known as the overlapping sign. The patient is in supine position, the doctor fixes the pelvis with one hand, holds the affected side of the N fossa with the other hand, makes the hip joint slightly flexed, pushes and pulls the thigh longitudinally up and down, if the affected limb has the feeling of moving up and down, it is a positive sign. This indicates that the hip joint is unstable or dislocated, and is often used in the examination of congenital dislocation of the hip joint in children.
Frog test: the child lies on his back, bend the bilateral hip and knee joints at 90°, and then make the bilateral hip abduction and external rotation movements in a moth-eaten position. If one or both thighs cannot fall flat on the bed surface, it is a positive sign, indicating that the hip abduction is limited. It is used for the examination of pediatric congenital hip dislocation.
Ortolani’s sign: The child is lying down with the affected limb flexed at the hip and knee. The examiner holds the knee with one hand and slowly abducts it, while the thumb of the other hand is placed in the lower part of the groin and the remaining four fingers are placed against the greater trochanter and pressure is gradually applied downward. If a sliding sound is felt and there is a bounce, the joint is dislocated. If the hip joint is allowed to retract inward again and there is sliding and outward bouncing, the femoral head is dislocated again, which is positive.
Measurement of femoral head position
The internal pull-through line is also called the iliopsoas nodal joint line. With the patient in supine position and the hip joint flexed at 45-60°, a line is drawn from the anterior superior iliac spine to the sciatic tuberosity, which passes through the top of the greater trochanter when normal. If the top of the greater trochanter is above or below this line, it indicates pathological changes.
Bryan’s triangle: With the patient in the supine position, a vertical line is drawn between the anterior superior iliac spine and the bed, a horizontal line is drawn between the apex of the greater trochanter and the vertical line, and a straight line is drawn between the anterior superior iliac spine and the apex of the greater trochanter, forming a right triangle. Compare the length of the bottom side of the triangle on both sides, if one side becomes shorter, it indicates that the large renal ridge on that side is displaced upward.
The patient is supine, both lower limbs are straight in neutral position, the anterior superior iliac spine on both sides is in a plane, and a straight line is connected from the apex of the anterior superior iliac spine and the greater trochanter on both sides, when normal, the two lines are extended to intersect at the umbilicus or umbilical midline. If the greater trochanter is displaced upward on one side, the extensions intersect below the umbilicus and deviate from the midline.
Special examination of the knee
Floating patella test: the affected limb is straightened, the doctor’s tiger mouth is placed above the patella with the palm of the hand pressed on the suprapatellar capsule, so that the fluid flows into the joint cavity, the other hand shows the finger to press the patella in a vertical direction, if the patella is felt to float and has the sensation of hitting the femoral condyle, it is a positive sign, indicating that there is fluid in the joint.
Drawer test: also known as push-pull test. The patient lies supine with the knee bent at 90° and the foot flat on the bed, the doctor sits in front of the affected foot and holds the calf with both hands in a backward and forward push-pull motion. Increased forward mobility indicates anterior cruciate ligament injury, increased backward mobility indicates posterior cruciate ligament injury, and can be compared on both sides.
The patellar test: the lower limb of the affected side is straightened, the doctor uses the thumb and index finger to push the patella toward the distal end and instructs the patient to contract the quadriceps muscle with force. If it causes pain in the patella, it is a positive sign. It is commonly seen in chondromalacia patellae.
Gyratory compression test: also known as McMurry’s sign. The patient lies supine with the affected leg flexed, the doctor presses one hand on the upper knee and holds the ankle with the other hand, causing extreme flexion of the knee joint, then abducts and internally rotates the lower leg. If the knee joint is straightened at the same time, if there is a popping sound and pain, it indicates a lateral meniscus injury; on the contrary, if there is a popping sound and pain when the lower leg is abducted and externally rotated and the knee joint is straightened at the same time, it indicates a medial meniscus injury.
Grinding and lifting test: Also known as Apollo’s sign. The patient lies supine, the knee is flexed at 90°, the doctor presses the lower leg against the lower thigh posteriorly for fixation, while holding the heel with both hands and applying pressure along the longitudinal axis of the lower leg, the abduction and external rotation or internal rotation of the lower leg is performed, if there is pain or popping sound, it is a positive sign, indicating lateral or medial meniscus injury; lifting the lower leg for abduction and external rotation or internal rotation and causing pain, indicating lateral collateral ligament or medial collateral ligament injury. The medial collateral ligament injury.
Lateral flexion and extension test: also known as gravity test. The patient lies on his side, the examined limb is on top, the doctor holds the patient’s thigh, and allows the knee to extend and flex, if there is a popping sound, it indicates a medial meniscus injury; if the knee is painful on the outside, it indicates a lateral collateral ligament injury. In the same way, the limb being examined under the extension and flexion activities, there is a popping sound for the lateral meniscus injury, and pain in the medial knee joint for the medial collateral ligament injury.
Lateral collateral ligament injury test: Also known as knee separation test and lateral motion test. The patient extends the knee and fixes the thigh, the examiner holds the ankle with one hand and holds the knee with the other hand for lateral movement to check the medial or lateral collateral ligament, if there is injury, the examination can cause pain or abnormal activity when the ligament is pulled.
Meniscus gravity test: To check the lateral meniscus, take the affected side lying down, raise the affected thigh, make the lower leg leave the bed, ask the patient to make flexion and extension movement of the knee, if pain or popping occurs on the lateral side of the knee, it is positive. In the same way, the medial meniscus can be examined in the healthy side position and a comparative examination of the healthy limb can be performed. Check for meniscal injury or discoid meniscus.
Interlocking sign: The patient is placed in a sitting or supine position, and the patient is asked to flex and extend the knee joint several times, if the joint suddenly becomes painful and cannot be flexed or extended, it is positive. Check for meniscal injury.
Patella grinding test: squeeze the patella, or slide the patella up and down with a rough feeling and friction sound, accompanied by pain and discomfort, or push the patella to one side with one hand as much as possible, and press the patella directly with the other hand, if there is pain after the patella, it is positive. Chondromalacia patellae.
Single-leg squat test: the affected limb stands on one leg and gradually squats with knee tenderness and knee pain is positive, and the presence of grinding sounds under the patella is also positive. Check for chondromalacia patellae.
Knee hyperextension test: The patient lies supine with the knee joint straight and flat. The physician holds the ankle of the injured limb with one hand and presses the knee with the other hand to hyperextend the knee, with pain at the infrapatellar fat pad, which is positive. Examination of infrapatellar fat pad injury.
Patellar tendon relaxation pain test: The patient lies supine with the knee straight. The thumb of one hand is placed at the eye of the inner knee or the eye of the outer knee, the palm root of the other hand is placed on the back of the thumb of the previous thumb, the quadriceps muscle is relaxed (patellar tendon relaxation), and the thumb is gradually pressed downward with force, and there is significant pain at the pressure. Then make the patient contract the quadriceps muscle, repeat the above action with equal pressure, and if there is pain relief, it is positive. Examination of subpatellar fat pad injury.
Foot and ankle examination
Pinch calf triceps test: the patient sits with the foot hanging over the bed, the doctor pinches the calf triceps muscle belly with the hand, if it causes plantar flexion of the ankle, it is negative, if there is no plantar flexion of the ankle, it is positive. Check whether the Achilles tendon is ruptured.
Achilles tendon contracture test: patient sitting, if the knee joint is flexed, plantarflexion deformity is floundering muscle contracture. If the knee is straight and the foot is deformed in plantarflexion, it is a contracture of the gastrocnemius muscle. If the plantarflexion deformity occurs in both knee extension or flexion position, it is a bimuscular contracture. Check whether the Achilles tendon contracture is caused by a contracture of the hallux valgus muscle or a contracture of the gastrocnemius muscle.
Forefoot transverse squeeze test: the doctor holds the forefoot of the affected foot with his hand and presses firmly laterally, if there is severe pain, it is positive. Check for metatarsal fractures.
Heel axis measurement: the patient is in standing position and the longitudinal axis of Achilles tendon and the longitudinal axis of heel bone are made. If the two lines overlap, it is negative; if the two lines are at an angle, it is positive. Check whether there is inversion or valgus deformity of the foot.
Measurement of the arch index: the foot is placed flat on the floor, and the length from the heel to the tip of the second toe is measured as the length of the foot, and the distance from the highest part of the foot to the floor is the height of the arch. Normal index = arch height × 100 / foot length ≈ 29 to 31 index less than 29 is flat foot, more than 31 is high arch foot. Check whether the arch is normal.
Foot inversion and valgus test: inversion of the ankle joint causing lateral pain indicates lateral collateral ligament injury; valgus of the ankle joint causing medial pain indicates medial collateral ligament injury.