List of tests and manoeuvres G-O

Gerdy’s tubercle

The insertion of the lateral collateral ligament and iliotibial tract on to the tibia.

Half squat test

Gives an indication as to whether there is a functional valgus of the knees and functional overpronation of the feet.

Hawkins’ sign

An impingement sign for the subacromial bursa. The arm is circumducted and internally rotated.

Homans’ test

Homans’ test is a test for deep vein thrombosis in the calf. The gastrocnemius is relaxed by flexing the knee, and then the soleus and to some extent the gastrocnemius are stretched by the examiner dorsiflexing the ankle. Thrombosed deep veins will cause pain.

Hoover’s test

A test to check whether a patient is positively, or volitionally, showing rectus femoris weakness. Resisted contraction of the rectus femoris will provoke downward pressure onto the couch or testing hand of the contralateral leg.

Impingement test

For subacromial space inflammation and rotator cuff injuries. Shoulder pain on internally rotating the circumducted humerus. See Hawkins’ sign and Neer’s sign.

Jerk test

For anterior cruciate ligament tear, where the patient lies supine with the hip flexed to 60 degrees, the tibia in internal rotation, and a valgus stress is applied across the knee. Slowly extend the knee. Tibial subluxation and relocation is felt as a jerk. This fails in subtle anterior cruciate ligament tears.

Jump sign

For anterior cruciate ligaments when, during movement of extension and flexion, the femur may ride up on the posterior horn of the meniscus and then “jump” back into place. This suggests anterior cruciate ligament instability.

Kager’s triangle

The area of fat subtended between the anterior surface of the Achilles and soleus, the posterior surface of the tibia and flexor hallucis longus, and the calcaneum inferiorly. Soft tissue swellings that distort this area may be visualized on ultrasound, X ray, CT or MRI.

Kernig’s test

Neck flexion will stretch the proximal elements of the dura and produce pain if the dura is tethered. This test is often added to the straight leg raise and Laseque’s to constitute the slump test. It is also used to diagnose meningism.

Lachman’s test

A test for anterior cruciate ligament instability where the basic principle is to relax the restraining, posterior pull of the hamstrings on the tibia, thus allowing easier anterior translation. This test may be done by holding and supporting the patient’s femur, either on your own leg or on the edge of the examination couch, and then drawing the tibia anteriorly whilst holding the femur down.

Laseque’s test

Dorsiflexion of the foot is added to the straight leg raise to stretch the sciatic nerve further. This is a nerve root or sciatic nerve test, rather than a dural stress test. Thus hamstring and piriformis entrapment of the sciatic nerve has a positive straight leg raise and Laseque’s, but a negative slump test.

Lhermitte’s sign

A dural stress test, where the neck flexion or extension produce symptoms in the back and legs.

Ludloff’s sign

An inability to actively flex the hip whilst sitting is indicative of psoas weakness.

McKenzie extension exercises

These may be done whilst lying or standing, straight in line or with a side flexion. They should be used for flexion-orientated disc problems but not for extension-oriented problems. A trial of extension exercises should be undertaken to see if the pain peripheralizes down the leg, or leg pain is produced. If this occurs, then extension exercise should not be utilized. If the leg pain centralizes then the exercise is safe. This exercise can make the collar stud L5/S1 disc positively worse, but as the disc improves, and the collar stud deformity settles into the more normal hernial configuration of the disc, so extension exercises may be added. Facet joint, sacroiliac joint and lateral canal entrapments will be made worse.

McKenzie flexion exercises

Pulling the knees to the chest and stretching the low back into flexion will aid extension-oriented spinal problems, such as facet joints and the L5/S1 collar stud. The addition of gapping rotations(rolling the knees to one side, or hanging one leg over the other) will help the facet joint, lateral canal and sacroiliac joint. Creeping, unstable, flexion- orientated discs will be made worse.

McMurray’s test

A test for meniscal lesions, but impossible to perform with moderately tense effusions as this prevents the full knee flexion required for the test. It is a grinding test of the tibia onto the femur, with the patient lying supine. Forced internal and external rotation of the knee, through flexion into extension, with varus and valgus stress, is then applied via axial compression of the tibia. Results show about 60% positive, 5% false positives. A clunk and pain is the classical positive sign, whereas the deep fibres of the medial collateral ligament are painful without the clunk.

Nage’s test

Another test for assessment of anterior cruciate ligament instability.

Neer’s sign

An impingement test for the shoulder, which is passively flexed and internally rotated. See Impingement test.

Noble’s sign

For iliotibial tract syndrome. The iliotibial band flicks over the lateral femoral condyle at about 30 degrees of knee flexion, and this may be palpated. Pressure over this condyle whilst the knee is moved through flexion and extension produces pain at about 30 degrees of flexion.

Noye’s flexion rotation draw test

A test for anterior cruciate ligament tears. This is a gentle pivot shift. The 10-15 degrees flexed knee is supported at the tibia. This allows the femur to drop back and externally rotate. Increased flexion with downward pressure on the tibia, to drop the knee backwards, reduces the subluxation.

Ober’s test

To display tightness of the iliotibial band. The athlete lies on his or her side, knee slightly flexed; the hip is flexed, abducted and externally rotated, and then taken into extension. A tight iliotibial tract does not allow the knee to drop down level with, or below, the hip.

O’Donoghue’s triad

Trauma to the knee, resulting in damage to the medial collateral ligament, the meniscus(usually medial) and the anterior cruciate ligament.

One-legged hyperextension test

A test for spondylosis and extension-orientated back pain, in which the patient stands on one leg, raises the contralateral knee towards the chest, and leans backwards.

"Concise guide to sports injuries, 2^nd edition",Churchill Livingstone, Malcolm T.F. Read,  foreword by Bryan English