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6 ORTHO > 2nd HALF LAB > Flashcards

2nd HALF LAB Flashcards

1
Q

Explain the “Initial Examination Procedure” of testing nerve roots:

A

“This is my pinwheel, it’s pointy and prickly and feels something like this, is that ok?”

  1. C4 on right compared to C4 on left (dermatome above)
  2. C5 on right compared to C5 on left (dermatome package)
  3. C6 on right compared to C6 on the left (dermatome below)
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2
Q

Explain the Secondary Examination Procedure with nerve roots:

A

FIRST

  1. C4 on the right side compared to C5 on the right side
  2. C5 of right side compared to C6 of right side

SECOND

  1. C4 of left side compared to C5 of left side
  2. C5 of left side compared to C6 of left side

“Can you feel this? AND does it feel like this?

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3
Q

C5 NERVE ROOT

A
  • DISC LEVEL: C4
  • MUSCLE TESTS (2):
    1. Shoulder Abduction: Deltoid (axillary nerve)
    2. Forearm Flexion: Biceps (musculocutaneous nerve)
  • REFLEX: Biceps
  • SENSATION: Lateral Arm
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4
Q

C6 NERVE ROOT

A
  • DISC LEVEL: C5
  • MUSCLE TEST (1):
    1. Wrist Extension: Extensor carpi radialis longus and brevis, and extensor carpi ulnaris (radial nerve)
  • REFLEX: Brachioradialis
  • SENSATION: Anterior Lateral Forearm, palm, thumb, and 2nd digit
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5
Q

C7 NERVE ROOT

A
  • DISC LEVEL: C6
  • MUSCLE TESTS (3):
    1. Elbow Extension: Triceps (Radial Nerve)
    2. Wrist Flexion: Flexor carpi radialis (Median Nerve), Flexor ulnaris (ulnar nerve)
    3. Finger Extension: Extensor digitorum communis, extensor indicis profundus, extensor digiti minimi (Radial nerve)
  • REFLEX: Triceps
  • SENSATION: 3rd digit, middle of palm
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6
Q

C8 NERVE ROOT

A
  • DISC LEVEL: C7
  • MUSCLE TEST (1):
    1. Finger Flexion: Flexor digitorum superficialis, flexor digitorum profundus, lumbricals (median and ulnar nerves)
  • REFLEX: NONE*
  • SENSATION: 4th and 5th digits, antero-medial hand and forearm
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7
Q

T1 NERVE ROOT

A
  • DISC LEVEL: T1
  • MUSCLE TESTS (2):
    1. Finger Abduction: Dorsal Interossei (ulnar nerve)
    2. Finger Adduction: Palmer Interossei (ulnar nerve)
  • REFLEX: NONE**
  • SENSATION: Antero-medial arm (distal aspect of arm to proximal aspect of forearm)
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8
Q

L4 NERVE ROOT

A
  • DISC LEVEL: L3
  • MUSCLE TEST (1):
    1. Foot Dorsiflexion and Inversion: Tibialis Anterior (deep fibular/peroneal nerve)
  • REFLEX: Patellar Tendon
  • SENSATION: Medial aspect of leg, medial foot, medial aspect of big toe
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9
Q

S2 NERVE ROOT

A
  • DISC LEVEL: S1
  • SENSATION: Posterior aspect of thigh over popliteal fossa on to posterior medial calf
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10
Q

L5 NERVE ROOT

A
  • DISC LEVEL: L4
  • MUSCLE TESTS (4):
    1. Foot Dorsiflexion: Tibialis anterior, Extensor digitorum longus
    2. Big Toe Dorsiflexion: Extensor hallucis longus (deep fibular/peroneal nerve)
    3. Toes 2, 3, 4 dorsiflexion: Extensor digitorum longus and brevis (deep fibular/peroneal nerve)
    4. Hip and Pelvis Abduction: Gluteus medius and minimus (superior gluteal nerve)
  • REFLEX: NONE*
  • SENSATION: Lateral leg, dorsum of foot, and middle third toes
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11
Q

S1 NERVE ROOT

A
  • DISC LEVEL: L5
  • MUSCLE TESTS (3):
    1. Foot Plantarflexion: Gastrocnemius and Soleus (Tibial Nerve)
    2. Foot Plantar Flexion and Eversion: fibular/peroneus longus and brevis (superficial fibular/peroneal nerve)
    3. Hip Extension: Gluteus Maximus (Inferior gluteal nerve)
  • REFLEX: Achilles
  • SENSATION: Posterior aspect of the leg, lateral aspect of foot, and lateral aspect of little toe
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12
Q

BONY PALPATION: LUMBAR SPINE

A
  1. Lumbar Spinous Processes
  2. Sacral Tubercles
  3. Iliac Crest
  4. PSIS
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13
Q

SOFT TISSUE PALPATION: LUMBAR SPINE

A
  1. Paraspinal Muscles (palpate as a unit and individually) superficial layer
    • Spinalis
    • Longissimus
    • Iliocostalis
  2. Sciatic Nerve
  3. Gluteus Maximus
  4. Gluteus Medius
  5. Hamstrings
    • Biceps Femoris
    • Semitendinosus
    • Semimembranosus
  6. Anterior Abdominal Muscles
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15
Q

RANGE OF MOTION: LUMBAR SPINE

A
  • FLEXION: 25
  • EXTENSION: 30
  • LEFT LATERAL BENDING: 25
  • RIGHT LATERAL BENDING: 25
  • LEFT ROTATION: 30
  • RIGHT ROTATION: 30
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16
Q

HOOVER SIGN

A
  • POSITIVE: Lack of counter-pressure to opposite side
  • INDICATES: Lack of organic basis for paralysis (Malingering/hysteria). With organic hemiplegia, the patient will still exert downward pressure when attempting to raise paralyzed leg
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17
Q

STRAIGHT LEG RAISER (SLR)

A
  • POSITIVE: Radiating pain and/or dull posterior thigh pain
  • INDICATES: Sciatic radiculopathy or tight hamstrings.
    • Positive between 35-70 degrees equals possible discogenic sciatic radiculopathy
    • > 70 equals tight hamstrings
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18
Q

GOLDTHWAIT SIGN

A
  • POSITIVE: Localized pain, low back or radiating pain down the leg
  • INDICATES: Lumbo-sacral or sacroiliac pathology
    • Pain occuring after the lumbar spinouses move equals possible lumbo-sacral problem
    • Pain occuring before the lumbars move equals possible sacroiliac problem
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19
Q

BRAGARD SIGN

A
  • POSITIVE: Radiating pain in posterior thigh
  • INDICATES: Sciatic Radiculopathy
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20
Q

BUCKLING SING (CIPRIANO)

A
  • POSITIVE: Pain in the posterior thigh with sudden knee flexion (buckle)
  • INDICATES: Sciatic Radiculopathy
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21
Q

BOWSTRING SIGN

A
  • POSITIVE: Pain in the lumbar region or radiculopathy
  • INDICATES: Sciatic nerve root compression, helps rule out tight hamstrings
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22
Q

LASEGUE TEST

A
  • POSITIVE: Reproduction of sciatic pain before 60 degrees
  • INDICATES: Sciatica
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23
Q

MILGRAM TEST

A
  • POSITIVE: Inability to perform test and/or low back pain
  • INDICATES: Weak abdominal muscles or space occupying lesion
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24
Q

VALSALVA MANEUVER

A
  • POSITIVE: Radiating pain from site of lesion (usually recreating the complaint in cervical or lumbar area of the spine)
  • INDICATES: Space occupying lesion (e.g. disc pathology)
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25
Q

BECHTEREW TEST

A
  • POSITIVE: Reproduction of radicular pain or inability to perform correctly due to tripod sign
  • INDICATES: Sciatic radiculopathy
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26
**NERI BOWING TEST** (Neri Sign)
* **_POSITIVE_**: Pain accompanied by flexion of the knee on the affected side and body rotation away from the affected side * **_INDICATES_**: Positive with a variety of low back pathologies. Hamstring tension on the pelvis may trigger the response
27
**ANTERIOR INNOMINATE aka MAZION PELVIC MANEUVER (ADVANCEMENT SIGN)**
* **_POSITIVE_**: The inability to bend at the waist more than 45 degrees, because of either/or 1. Radiating pain along the sciatic nerve, either unilateral or bilateral 2. Low back pain (lumbar or pelvic regions) * **_INDICATES_**: 1. Sciatic neuralgia or radiculopathy, etc., possibly due to lumbar disc pathology 2. Anterior (rotational) displacement of the ilium relative to the sacrum
28
**LEWIN STANDING TEST**
* **_POSITIVE_**: Radiating pain down the leg causing flexion of the patient's knee or knees * **_INDICATES_**: Gluteal, lumbosacral or sacroiliac pathologies
29
**HEEL WALK**
* **_POSITIVE_**: Inability to perform the test * **_INDICATES_**: L4-L5 disc lesion (L5 nerve root)
30
**TOE WALK**
* **_POSITIVE_**: Inability to perform test * **_INDICATES_**: L5-S1 disc lesion (S1 nerve root)
31
**ELY HEEL TO BUTTOCK TEST** (Evans calls this Ely sign as an a.k.a.)
**_POSITIVE_**: 1. Inability to raise the thigh 2. Pain in the anterior thigh 3. Pain in the lumbar region **_INDICATES_**: 1. Iliopsoas spasm 2. Inflammation of lumbar nerve roots 3. Lumbar nerve root adhesions
32
**BONY PALPATION: HIP AND PELVIS**
**_ANTERIOR_** 1. ASIS 2. Iliac Crest 3. Iliac Tubercle 4. Greater Trochanter **_POSTERIOR_** 1. PSIS 2. Ischial tuberosity 3. Coccyx
33
**SOFT TISSUE PALPATION: HIP & PELVIS**
1. Femoral Triangle Borders * Sartorius * Adductor Longus * Inguinal Ligament 2. Quadriceps Muscle (palpate as a unit and individually) * Vastus Lateralis * Vastus Medialis * Vastus Intermedius * Rectus Femoris 3. Greater Trochanteric Bursa 4. Gluteus Medius 5. Gluteus Maximus 6. Sciatic Nerve 7. Cluneal Nerves 8. Hamstrings * Biceps femoris * Semitendinosus * Semimembranosus
36
**RANGE OF MOTION:** **HIP AND PELVIS**
* Flexion ***120*** * Extension ***30*** * Abduction ***45*** * Adduction ***45*** * Internal Rotation ***45*** * External Rotation ***45*** * Flexion and Adduction * Flexion, Abduction, and External rotation
37
**LEG LENGTH DISCREPANCY**
**_POSITIVE_**: * Different Measurements **_INDICATES_**: * True = bony abnormality above or below level of trochanter difference (anatomical short leg). * Apparent = pelvic Obliquity (Tilted pelvis)
38
**ALLIS SIGN**
**_POSITIVE_**: * Difference in height and anteriority of the knees **_INDICATES_**: 1. If one knee is **lower** = ipsilateral congenital hip dislocation or tibial discrepancy (anatomical short leg) 2. If one knee is **anterior** = ipsilateral congenital hip dislocation or femoral discrepancy (contralateral anatomical short leg)
39
**THOMAS TEST**
**_POSITIVE_**: * Lumbar spine maintains lordosis (should flatten) and hip or leg flexes **_INDICATES_**: * Contracture of the hip flexors (iliopsoas)
40
**ANVIL TEST**
**_POSITIVE:_** * Localized pain in long bone or in hip joint **_INDICATES:_** * Possible Fracture of long bones, or hip joint pathology
41
**PATRICK TEST aka FABERE sign**
**_POSITIVE_**: * Pain in the hip region **_INDICATES_**: * Hip joint pathology
42
**LAGUERRE TEST**
**_POSITIVE_**: 1. Pain in the hip joint 2. Pain in the sacroiliac joint **_INDICATES:_** 1. Hip joint pathology 2. Mechanical problem of the sacroiliac joint
43
**GAENSLEN TEST**
**_POSITIVE:_** * Pain on the affected SI joint stressed into extension **_INDICATES:_** * General sacroiliac joint lesion, anterior sacroiliac ligament sprain, or inflammation of the SI joint
44
**LEWIN - GAENSLEN TEST**
**_POSITIVE:_** * Pain on the affected SI joint stressed into extension **_INDICATES_**: * General sacroiliac joint lesion, anterior sacroiliac ligament sprain, or inflammation of the SI joint
45
**HIBB TEST**
**_POSITIVE:_** 1. Pain in the hip region 2. Pain in the buttock/pelvic region **_INDICATES:_** 1. Hip joint pathology 2. Sacroiliac joint lesion
46
**OBER TEST**
**_POSITIVE:_** Affected thgih remains in abduction (Normal biomechanics, the thigh/hip will adduct) **_INDICATES:_** Contraction of the iliotibial band or tensor fascia lata, (usually secondary to synovitis of the hip, secondary to trauma of the gluteus medius and maximus)
47
**PELVIC ROCK TEST aka ILIAC COMPRESSION TEST**
**_POSITIVE:_** * Pain in either sacroiliac joint **_INDICATES:_** * Sacroiliac joint lesion
48
**NACHLAS TEST**
**_POSITIVE:_** * Pain in the buttock and/or pain in the lumbar region **_INDICATES:_** * Sacroiliac joint lesion, or Lumbar pathology
49
**YEOMAN TEST**
**_POSITIVE:_** * Pain deep in the SI joint **_INDICATES:_** * Sprain of the anterior sacroiliac ligaments
50
**ELY SIGN (ELY TEST - CIPRIANO)**
**_POSITIVE:_** * Hip on side being tested will flex causing the buttock to raise off the table **_INDICATES:_** * Rectus Femoris or hip flexor contracture
51
**ELY HEEL TO BUTTOCK TEST (cipriano)**
**_POSITIVE:_** 1. Inability to raise the thigh 2. Pain in the anterior thigh 3. Pain in the lumbar region **_INDICATES:_** 1. Iliopsoas spasm 2. Inflammation of lumbar nerve roots 3. Lumbar nerve root adhesions
52
**TRENDELENBURG TEST**
**_POSITIVE:_** * High iliac crest on supported side and low crest on side of elevated leg **_INDICATES:_** * Weak gluteus medius muscle on the supported side
53
**BONY PALPATION: KNEE ​**
1. Patella 2. Medial Tibial plateau 3. Tibial tubercle 4. Medial Femoral Condyle 5. Lateral Tibial Plateau 6. Lateral Femoral Condyle 7. Fibula head
54
**SOFT TISSUE PALPATION:** **KNEE**
1. Quadriceps muscles (Palpate as a unit and individually) * Vastus Lateralis * Vastus Medialis * Vastus Intermedius * Rectus Femoris 2. Infrapatellar Tendon 3. Bursae * Prepatellar * Superficial Infrapatellar 4. Medial Meniscus 5. Lateral Meniscus 6. Pes Anserine Area * Sartorius * Gracilis * Semitendinosus 7. Popliteal Fossa 8. Lateral Collateral Ligament 9. Medial Collateral Ligament 10. Gastrocnemius Muscle
55
**RANGE OF MOTION:** **KNEE**
* FLEXION : ***135*** * EXTENSION: ***0*** * INTERNAL ROTATION * EXTERNAL ROTATION
56
**McMURRAY SIGN**
**_POSITIVE:_** * Clicking sound or pain by knee joint **_INDICATES:_** * Tear of medial meniscus if positive on external rotation * Tear of lateral meniscus if positive on internal rotation * The greater the angle the knee is flexed when the positive is elicited, the more posterior the meniscal injury
57
**MEDIAL COLLATERL LIGAMENT TEST aka ABDUCTION STRESS TEST aka VALGUS STRESS TEST**
**_POSITIVE:_** * Gapping and/or elicited pain above/at/or below joint line **_INDICATES:_** * Tear and/or instability of the medial collateral ligament
58
**LATERAL COLLATERAL LIGAMENT TEST aka ADDUCTION STRESS TEST aka VARUS STRESS TEST**
**_POSITIVE:_** * Gapping and/or elicited pain above/at/or below the joint line **_INDICATES:_** * Tear and/or instability of the lateral collateral ligament
59
**BOUNCE HOME TEST**
**_POSITIVE:_** * Knee does not go into full extension (slight flexion remains) **_INDICATES:_** * Diffuse swelling of the knee, accumulation of fluid, due to possible torn meniscus
60
**DRAWER TEST**
**_POSITIVE:_** 1. Gapping \> 6 mm (tibia moves ***posterior***) when the leg is pushed 2. Gapping \> 6 mm (tibia moves ***anterior***) when the leg is pulled **_INDICATES:_** 1. Torn ***posterior*** cruciate ligament 2. Torn ***anterior*** cruciate ligament
61
**LACHMAN TEST**
**_POSITIVE:_** * Gapping with the tibia moving away from the femur **_INDICATES:_** * Anterior Cruciate ligament or posterior oblique ligament instability
62
**APPREHENSION TEST FOR PATELLA**
**_POSITIVE:_** * Apprehension, distress or facial expression, contraction of quadriceps to bring patella back in line **_INDICATES:_** * Chronic patella dislocation or pre-disposition to dislocation
63
**PATELLA FEMORAL GRINDING TEST** **(aka Clarke Sign)**
**_POSITIVE:_** * Retropatellar pain and the patient is unable to hold the quadriceps contraction **_INDICATES:_** * Degenerative changes of the patellar facets and/or within the trochlear groove (chondromalacia patella)
64
**PATELLA BALLOTTEMENT TEST**
**_POSITIVE:_** * A floating sensation of the patella **_INDICATES:_** * A large amount of swelling in the knee
65
**APLEY COMPRESSION TEST**
**_POSITIVE:_** * Patient points to the side of pain **_INDICATES:_** * Pain on the medial side is medial meniscus tear. Pain on the lateral side indicates lateral meniscus tear
66
**APLEY DISTRACTION TEST**
**_POSITIVE:_** * Patient will point to side of pain **_INDICATES:_** * Pain on the medial side indicates medial collateral ligament tear. Pain on the lateral side indicates lateral collateral ligament tear
67
68
**BONY PALPATION:** **FOOT AND ANKLE**
1. Calcaneus 2. Sustentaculum Tali 3. Medial Malleolus 4. Lateral Malleolus 5. Talus 6. Navicular 7. Cuboid 8. 3 Cuneiforms 9. 5 Metatarsals 10. Metatarsophalangeal joints
69
**SOFT TISSUE PALPATION:** **FOOT AND ANKLE**
1. Tibialis Posterior tendon 2. Spring ligament 3. Tibialis anterior tendon 4. Deltoid ligament 5. Fibular/Peroneus brevis 6. Achilles tendon 7. Plantar Aponeurosis 8. Anterior Talofibular ligament 9. Posterior tibial artery 10. Dorsal pedal artery
70
**RANGE OF MOTION:** **FOOT AND ANKLE**
* Ankle Dorsiflexion ***20*** * Ankle Plantarflexion ***50*** * Subtalar Inversion ***5*** * Subtalar Eversion ***5*** * 1st MTP Joint Flexion * 1st MTP Joint Extension
74
**DRAWER SIGN**
**_POSITIVE:_** * Translation with the talus moving away from or toward the tibia **_INDICATES:_** 1. With tibia pushed/foot pulled; a tear/instability of the anterior talofibular ligament 2. With tibia pulled/foot pushed; a tear/instability of posterior talofibular ligament
75
**ANKLE DORSIFLEXION TEST** (Hoppenfeld)
**_POSITIVE:_** 1. The foot cannot dorsiflex with knee extended, but is able to with knee flexed 2. The foot cannot dorsiflex in either knee position **_INDICATES:_** 1. Contracture of the gastrocnemius muscle 2. Contracture of the soleus muscle
76
**RIGID OR SUPPLE FLAT FEET TEST**
**_POSITIVE:_** 1. Absence of medial longitudinal arch in both positions 2. Presence of medial longitudinal arch while seated with a loss of medial longitudinal arch while standing **_INDICATES:_** 1. Rigid Flat Feet 2. Supple Flat Feet
77
**HOMANS SIGN**
**_POSITIVE:_** Deep pain in the calf **_INDICATES:_** Deep vein thrombophlebitis
78
**THOMPSON TEST**
**_POSITIVE:_** * Absence of foot plantarflexion motion **_INDICATES:_** * Achilles tendon rupture
79
**MORTON TEST**
**_POSITIVE:_** * Sharp pain in the forefoot **_INDICATES:_** * Metatarsalgia or neuroma (usually at the 3rd and 4th metatarsal interspace)

6 ORTHO (16 decks)

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