CMT Orthopedic Special Tests & Differential Diagnosis 1 ā Questions and Answers
Question 1: The Hawkins-Kennedy test is performed to assess which condition?
- AC joint pathology
- Subacromial impingement (Correct answer)
- Biceps tendon rupture
- Glenohumeral instability
Correct answer: Subacromial impingement
The Hawkins-Kennedy test compresses the supraspinatus tendon under the coracoacromial arch by internally rotating the shoulder at 90Ā° of flexion, making it positive for subacromial impingement.
Question 2: A positive Phalen's testāwrist flexion held for 60 seconds reproducing paresthesia in the thumb, index, and middle fingersāmost strongly indicates:
- De Quervain's tenosynovitis
- Carpal tunnel syndrome (Correct answer)
- Cubital tunnel syndrome
- Guyon's canal syndrome
Correct answer: Carpal tunnel syndrome
Phalen's test increases pressure within the carpal tunnel, reproducing median nerve compression symptoms characteristic of carpal tunnel syndrome.
Question 3: Speed's test (resisted shoulder flexion with elbow extended and forearm supinated) is most specific for pathology of the:
- Supraspinatus tendon
- Long head of the biceps tendon (Correct answer)
- Acromioclavicular joint
- Inferior glenohumeral ligament
Correct answer: Long head of the biceps tendon
Speed's test stresses the long head of the biceps tendon at the bicipital groove; anterior shoulder pain reproduced at that site indicates biceps tendinopathy.
Question 4: A positive Tinel's sign elicited by tapping posterior to the medial epicondyle most likely indicates:
- Medial epicondylitis
- Ulnar nerve entrapment at the cubital tunnel (Correct answer)
- Median nerve entrapment at the pronator teres
- Radial nerve compression
Correct answer: Ulnar nerve entrapment at the cubital tunnel
Tapping over the ulnar nerve as it passes through the cubital tunnel posterior to the medial epicondyle produces tingling in the ring and small fingers, indicating cubital tunnel syndrome.
Question 5: Adson's test is most appropriate for screening which condition?
- Lateral epicondylitis
- Thoracic outlet syndrome (Correct answer)
- Cervical radiculopathy
- Wrist triangular fibrocartilage tear
Correct answer: Thoracic outlet syndrome
Adson's test assesses neurovascular compression at the thoracic outlet by monitoring the radial pulse during ipsilateral head rotation and neck extension to evaluate for subclavian artery or brachial plexus compromise.
Question 6: The O'Brien (Active Compression) test differentiates between which two conditions based on symptom location?
- Subacromial impingement and rotator cuff tear
- SLAP lesions and AC joint pathology (Correct answer)
- Biceps tendinopathy and subscapularis tear
- Shoulder instability and labral tear
Correct answer: SLAP lesions and AC joint pathology
Pain deep in the joint when the arm is pronated that decreases in supination indicates a SLAP lesion, while pain on top of the shoulder suggests AC joint pathology.
Question 7: A positive Finkelstein's testāpain with passive ulnar deviation of the wrist while the thumb is held in the palmāindicates:
- Trigger thumb stenosing tenosynovitis
- De Quervain's tenosynovitis (Correct answer)
- Carpal tunnel syndrome
- Dupuytren's contracture
Correct answer: De Quervain's tenosynovitis
Finkelstein's test stretches the abductor pollicis longus and extensor pollicis brevis tendons within the first dorsal compartment, reproducing pain characteristic of De Quervain's tenosynovitis.
CMT Orthopedic Special Tests & Differential Diagnosis 1
The Hawkins-Kennedy test is performed to assess which condition?