Physical Exam Course

While we agree that the test should be done in the plane of the scapula (about 30 degrees adduction), there's debate about the degree of forward flexion: 90 degrees or 30 degrees?

Both methods are acceptable, and you won't be penalized for choosing one over the other. However, it's crucial to justify your choice with evidence and logical reasoning. Personally, I prefer 90 degrees forward flexion, as this aligns with the original test description.

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Rationale for 90 degrees forward flexion

Jobe originally described this test in 1982 using 90 degrees forward flexion.

jobe1982.pdf567.6KB

In 1996, Kelly referred to the Jobe test as the "empty can test." Interestingly, her study found that the "full can test" better isolated the supraspinatus.

kelly1996.pdf730.1KB

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There are confusing descriptions in literature. Some describe Saturday night palsy as an injury of the radial nerve at the axilla (which should be correctly described as crutch palsy). This is Wrong.

• Saturday Night Palsy, also known as Honeymooner’s Palsy is a form of radial neuropathy that occurs from inadvertent compression of the nerve at the spiral groove of the humerus.
• This means that the triceps muscle will be intact because branches of the radial nerve that supply the triceps muscle originate before the spiral groove.
• The other muscles distally will be affected.
Saturday Night Palsy.pdf473.1KB
Origin of Saturday Night Palsy.pdf2107.7KB

• The most intuitive is when you are standing facing the patient’s face is to place them in this manner:
• Thumbs at bilateral ASIS
• Middle fingers at bilateral GT
• Index finger drop down perpendicular from ASIS

• Follow the scenario here in this patient:
• Step 1, patient lies supine. And in his natural state, we measure his Apparent Limb Length from the umbilicus / xiphisternum to the medial mealleolus. Here we measure a ALLD of 5cm.
• Step 2, We square the pelvis. The adduction contracture becomes apparent now because the leg is unable to be abducted and swings to the other side!
• We now need to place the normal leg in the same position as the leg with adduction contracture
• Step 3, when we measure the True Limb Length from the ASIS to the Medial malleolus (third picture), we see that the limb lengths are equal.

1. Terminology for knee effusion tests is not consistent in the literature. "Ballotment" has also been called the "cross fluctuance test."
2. By convention, it is accepted to mention them in the following sequence.
1. Fluid bulge test for small effusions
2. Cross fluctuance (ballotment test) for moderate effusions
3. Patella Tap test for Large effusions

No, this is not always true. Consider the following:

• In an exam setting, where a patient is unlikely to have a massive acute effusion, a negative fluid bulge test might allow us to skip the other two tests.
• However, in a clinical setting, this may not be the case. With moderate to large effusions, the fluid bulge test might be negative because the joint capsule is too distended for the test to be executed effectively. Therefore, if an effusion is suspected during inspection, one should thoroughly proceed with the other tests as necessary.

1. The Foot and Ankle Examination is the most diverse and, consequently, the most challenging to teach and execute. This variety means that if it appears in exams, examiners may have differing approaches. Therefore, it's essential to focus on the fundamentals.
2. In undergraduate exams, if this topic appears, most marks will likely be awarded for inspection and correctly diagnosing the deformity. While you're unlikely to be asked to perform special tests, it's reasonable to expect questions about the rationale behind these tests.
3. My videos are comprehensive and designed for completeness. They're executed at a postgraduate level. As such, you won't be expected to perform examinations in your exams with the same level of detail I demonstrate at the undergraduate level.
4. IMPORTANT: Refer to the master framework while watching all videos. Some segments—such as General Inspection while sitting, Grind test, Silfverskiöld test, and gross neurovascular assessment—are repeated in the explanation videos. Feel free to skip these portions, though they're included to maintain the flow and reinforce key concepts.
5. There are four conditions, each with two accompanying videos: a detailed explanation and a quick run-through. These conditions are Pes Planus, Hallux Valgus (often associated with Pes Planus), Pes Cavus, and Hallux Rigidus.

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Nick Harris, in his Orthopaedic Examination textbook, describes the Lesague’s Test as ”After lowering the leg, passive dorsiflexion of the foot increases root tension and reinforces a positive straight leg raise.” He referenced the paper Lasegue C. Considerations sur la sciatique. Arch Gen Med 1864;2:558 which DOES NOT describe the test in this way. THIS IS WRONG.

• The correct understanding is that the Lesague’s test is equivalent to the Straight Leg Raise Test. https://www.ncbi.nlm.nih.gov/books/NBK539717/
• The Bragard’s Sign/ Test is: ”After lowering the leg, passive dorsiflexion of the foot increases root tension and reinforces a positive straight leg raise.”