A 6 year old boy has a history of recurrent dislocation of the right shoulder. On examination, the orthopedician puts the patient in the supine position and abducts his arm to 90 degrees with the bed as the fulcrum and then externally rotates it but the boy does not allow the test to be performed. The test done by the orthopedician is
Ans. is 'a' ie apprehension test Apprehension sign :This is a test to detect an unstable shoulder.The shoulder is abducted and externally rotated.As the examiner loads the shoulder along the long axis of the arm, the pt. becomes apprehensive, and tries to resist any further movement by using his hand or by making the shoulder stiff by muscle spasm.Some other imp, testsMe Murrays test :Test to detect meniscal injury.With the pt. lying on a couch, the surgeon stands at the side of the injured limb. He grasps the foot firmly with one hand and the knee with the other.The knee joint is completely flexed, the foot is rotated externally and the leg abducted. The joint is now slowly extended keeping the leg externally rotated and abducted.As the torn cartilage gets caught during this manoeuvre the patient will experience pain or a click may be heard and felt.A similar test with the foot internally rotated and leg adducted is carried out for lateral meniscus tears.Aplev's grinding test :Test to detect meniscal injury.The pt. lies prone on the couch. Knee is flexed to 90deg. Surgeon applies compression along the long axis of the tibia while rotating it on the femur (grinding movement).Pain during this movement indicates a meniscal tear.Pain on lateral rotation indicates a medial meniscal tear while that on medial rotation indicates a lateral meniscal tear.Sulcus test - Test to detect inferior dislocation of shoulder.Tests associated with ant, dislocation of shoulderDugas test* - Inability to touch the opposite shoulderHamilton ruler test* - Because of flattening of the shoulder It's possible to place a ruler on the lateral side of the arm. This touches the acromion and lateral condyle of the humerus simultaneously.Callway's test* - In dislocation of the shoulder vertical circumference of axilla is increased compared to normal side.Note :this type of question where a clinical method is asked is entirely new. A new question in AIIMS always indicates that these type of questions are to be expected in near future. So go through the following tests alsoBarlows test - for CDH* Ortalanis test - for CDH* Drawers test - for Cruciate ligament injury* Lachmann test - for Ant cruciate ligament injury* Ober's test - for tight ilio-tibial band* (eg in polio)Pivot shift test - for anterior cruciate ligament injury*.Thomas test - for hip flexion deformity* Trendelberg test - for unstable hip due to any reason (295 Maheshwari 2nd ed.)Cozen's test - Test to detect tennis elbow (305 Maheshwari)Painful arc test - Test to detect subacromial impingement of the rotator cuff as a cause of shoulder pain (307 Maheshwari 2nd ed.)Arm drop sign - Sign suggestive of complete tear of the rotator cuff*
Apprehension test
Sulcus test
Dugas test
MC Murray's test
Dislocation of Shoulder