CMT Orthopedic Special Tests & Differential Diagnosis 2 — Questions and Answers
Question 1: A positive Thomas test, in which the tested leg rises off the table when the contralateral hip is fully flexed, indicates tightness of the:
- Hip abductors
- Hip flexors (Correct answer)
- Sacroiliac ligaments
- Iliotibial band
Correct answer: Hip flexors
The Thomas test eliminates lumbar lordosis; if the tested leg lifts off the table, the hip flexors (primarily iliopsoas and rectus femoris) are too tight to allow full hip extension.
Question 2: The McMurray test is designed to assess pathology of the:
- Anterior cruciate ligament
- Knee menisci (Correct answer)
- Posterior cruciate ligament
- Medial collateral ligament
Correct answer: Knee menisci
McMurray's test uses tibial rotation combined with knee flexion and extension to reproduce a click or pain arising from a torn meniscus between the femoral condyle and tibial plateau.
Question 3: A positive anterior drawer test at the ankle, in which the talus translates anteriorly in the mortise, indicates laxity of the:
- Calcaneofibular ligament
- Anterior talofibular ligament (Correct answer)
- Deltoid ligament complex
- Posterior talofibular ligament
Correct answer: Anterior talofibular ligament
The anterior drawer test stresses the anterior talofibular ligament (ATFL), the most commonly injured lateral ankle ligament, by translating the talus forward in the mortise.
Question 4: Ober's test, performed in sidelying with the hip extended and then adducted, evaluates tightness of the:
- Hip flexor complex
- Iliotibial band and tensor fasciae latae (Correct answer)
- Hip adductors
- Hamstring muscle group
Correct answer: Iliotibial band and tensor fasciae latae
Ober's test assesses IT band and TFL tightness; inability of the leg to adduct and drop to the table indicates restricted lateral thigh soft tissue extensibility.
Question 5: During a Trendelenburg test, the contralateral pelvis drops when the patient stands on one leg. This finding indicates weakness of the:
- Ipsilateral hip flexors
- Contralateral hip abductors
- Ipsilateral hip abductors (gluteus medius) (Correct answer)
- Contralateral quadriceps
Correct answer: Ipsilateral hip abductors (gluteus medius)
When the contralateral pelvis drops during single-leg stance, the ipsilateral hip abductors (gluteus medius) are too weak to maintain a level pelvis on the weight-bearing side.
Question 6: The Lachman test is considered the most sensitive clinical examination for:
- Posterior cruciate ligament tears
- Anterior cruciate ligament tears (Correct answer)
- Lateral meniscus tears
- Medial collateral ligament tears
Correct answer: Anterior cruciate ligament tears
Performed at 20-30° of knee flexion, the Lachman test relaxes the hamstrings and maximizes anterior tibial translation, giving it the highest sensitivity for ACL tears among manual tests.
Question 7: A positive FABER (Patrick's) test that reproduces posterior hip or buttock pain most likely indicates pathology of the:
- Hip flexors or iliopsoas
- Hip joint or sacroiliac joint (Correct answer)
- Lumbar disc
- Greater trochanteric bursa
Correct answer: Hip joint or sacroiliac joint
FABER (Flexion, ABduction, External Rotation) simultaneously stresses both the hip joint and sacroiliac joint; pain reproduction in either location implicates pathology at that site.
CMT Orthopedic Special Tests & Differential Diagnosis 2
A positive Thomas test, in which the tested leg rises off the table when the contralateral hip is fully flexed, indicates tightness of the: