Clinical Assessment D. Flashcards
Which orthopedic tests assess for both impingement on a nerve and a blood vessel?
Adsons
After performing passive range of motion on a patient’s elbow joint, which of the following findings indicates pathology in the joint?
Pronation empty end feel
After performing a deep tendon reflex for the S1 nerve root, the patient’s foot continues to plantar flex as though they are continuously tapping their foot, without stopping or subsiding. What grade will this deep tendon reflex be given?
Grade 5
Which dermatome crosses the chest and travels down the anterolateral arm to the wrist?
C5
During a gait cycle, there is a stance phase and a swing phase. What would becorrect for a person with no pathology when describing the proper timing between the two phases?
Stance phase occupies 60% of the gait cycle, while swing phase occupies 40% of the gait cycle
A patient describes symptoms of carpal tunnel syndrome, however, Phalen’s test and Reverse Phalen’s tests are both negative. What test of the forearm is NOT the most appropriate test to help identify the root cause of the symptoms?
Pinch Grip
Which thoracic outlet syndrome test will be positive if the cause of the symptoms is a hypertonic pectoralis minor?
Wrights
Which test identifies a lateral meniscus tear in the knee?
McMurrays with medial rotation
Which test, if positive, suggests tendinopathy of the supraspinatus muscle?
Empty Can
When performing Spurling’s test the patient states they feel a dull local pain on the side of their neck. The pain does not travel or radiate. How is this reaction classified?
This test is negative but notable
Which test, if positive, is a contraindication to treatment and require an immediate physician referral? Kendall, Finkelstein, Thompson, Gillets?
Thompson
Which of the following special tests, if negative, warrants a referral to a physician and possibly a contraindication to massage treatment? Homans, VA, Valsalva, Swallow
Swallow
What is an example of a closed ended questions?
Have you been diagnosed by a Dr?
(Yes or No questions)
During a gait assessment, if there is no pathology, the correct sequence of movement starting with heel strike is:
Heel Strike, Flat Foot, Midstance, Heel off, Toe off, midswing
While performing the toothpick test the therapist sees that the patient presents with an early deviation C curve to their right side. This most likely indicates that:
The patient has muscle tightness or spasm on the right side
Which observation of the upper limb resting neutrally, indicates if a patient has Erb’s palsy?
They have waiters tip deformity
What active free glenohumeral range of motion results is most likely to be seen in a person with subacute adhesive capsulitis?
90° of abduction, 60° of external rotation, 45° of internal rotation, 120° of flexion, 55° of extension
When performing a gait assessment the therapist notices that the patient has a right-sided high steppage gait and their right foot slaps onto the ground as they bring it down. What clinical impression is indicated by this observation alone?
The patient’s altered gait is possibly due to a sciatic nerve lesion or a common peroneal nerve lesion
Prior to performing any special orthopedic tests, what could be an indicator that a patient is most likely experiencing pronator teres syndrome rather than carpal tunnel syndrome?
Wrist movement is compromised
The Trendelenburg test evaluates both muscle strength and whether or not the superior gluteal nerve has been compromised. A patient standing on their right leg lifts their left leg, and the left hip drops. This is a positive result which indicates that:
Gluteus Med and Min on the right side is affected
With the patient seated and one forearm resting on the table in the pronated position, the therapist places one finger contact on the patient’s fingernail of the 3rd digit. The therapist asks the patient to attempt to extend their 3rd digit while preventing the patient from moving. What is the therapist testing for?
Lateral Epicondylitis
can be call Maudley’s test
Which test specifically assesses for an iliopsoas spasm or contracture?
Patrick’s
Fabers
Figure 4
While performing a strength test for the tibialis anterior muscle, the patient finds that they are only able to perform dorsiflexion of the foot when they are laying on their side. What grade does this patient get for their strength test?
Grade 2
What is the normal scapulothoracic rhythm?
For every 2° of humeral abduction the scapula should move 1°
Pain is identified in a patient’s iliofemoral joint upon hip flexion during an active free range of motion assessment. What is the purpose of performing a passive relaxed range of motion assessment?
To identify if the pain is potentially due to non-contractile tissues at the joint
When performing passive relaxed range of motion on a patient with suspected piriformis syndrome, which hip movement when they are in a prone position, will relieve their pain if they are positive for the condition?
External Rotation
A patient with an acute grade 2 sprain of their right anterior talofibular ligament will likely present with what adaptation to the stance phase?
The right leg will be in the stance phase for 10% of the gait cycle
With a patient in the standing position, they are asked to extend their trunk and slide their palm down the back of their leg while the therapist applies downward pressure on the patient’s shoulders. If this test is positive, what is the clinical impression?
Lumbar facet irritation
When the rounded rubber portion of the reflex hammer touches the bottom of a patient’s foot, they are unable to identify if the object is dull or sharp, and are barely able to register a sensation at all. What has been demonstrated in this scenario?
A positive L5 dermatome test
A patient with noted hyperlordosis on postural assessment will have:
Short erector spinae and iliopsoas muscles, and long abdominals and gluteus maximus muscles
An assessment identifies that breast massage is indicated. What information is important to gain during the intake and assessment process?
Onset and frequency of breast pain
A patient complains of a dull aching pain in their knee, what structures are more likely involved with this type of pain description?
ligament and joint capsule
After the therapist has demonstrated the 3 knuckle test to the patient, what is the order of steps for the test?
Patient: washes hands, places one knuckle between their upper and lower rows of teeth, adds second knuckle, adds third knuckle
While performing an assessment of the glenohumeral joint, the therapist places the patient’s arm with the elbow flexed to 90°, stabilized against the thorax, and the forearm pronated. The therapist resists supination while the patient laterally rotates their arm against resistance. What test is the examiner most likely performing?
Yergasons
During Active Free Range of Motion (AF ROM) of the hand a patient flexes all of their fingers and their thumb, when attempting to open their hand after, the therapist notes that the patient is unable to straighten their pinky and ring fingers. What could this be an indication of?
Ulnar nerve lesion
A therapist applies a precise, quick tap to the medial hamstring tendon, which deep tendon reflex are they testing?
L5
Why would a therapist use the Rib Motion Test?
to assess for a depressed rib on inhalations
A patient arrives for treatment of their headache. They complain of pain in their forehead and point to the frontal area across their forehead. They state that the headache is worse when they bend forward to load the dishwasher. They also say that they are getting over a “head cold” and are still congested, they do not have a fever and have been cleared for massage. What would be an appropriate assessment plan for this patient?
Gentle palpation of the forehead to see if they have any sinus pain that could potentially be causing their headache
While performing a passive range of motion assessment for the elbow joint which one of the following would indicate an “abnormal” result?
Extension 10° with tissue approximation
Which of the following would be considered full active range of motion for the glenohumeral joint?
Lateral rotation 80-90°, medial rotation 60-100°, and extension 50-60°
Which of the following best describes an empty end feel?
A movement that stops or can not be completed due to pain
When performing a postural assessment, in the lateral view, where should the plumbline fall?
Slightly anterior to the lateral malleolus, slightly anterior to the midline of the knee, and slightly posterior to the axis of the hip
A patient lies supine on the table and the therapist takes the affected leg and brings the patient’s knee into no more than 30° flexion. Using the outside hand the therapist stabilizes the patient’s femur. With the other hand, the therapist applies an anterior translation of the tibia on the femur. What test is the therapist most likely performing?
Lachmans
Which of the following tests can be used to assess for medial epicondylitis? Cozens, maudsleys, mills, reverse mills?
Reverse Mills
When using a strength test to assess biceps brachii the therapist notes the grade of contraction as a 4 however the patient complains of pain while performing the test. What could this be an indication of?
1st ir 2nd degree muscle strain
When assessing the temporomandibular joint the therapist observes minimal jaw depression during intake and while assessing Range of Motion (ROM). Which of the following orthopedic tests can be used to help confirm the findings?
3 knuckle
A therapist asks a patient to bring the tips of the 1st and 2nd digits together and notices that the patient is unable to complete the task and instead touches the finger pads together and not the fingertips. What may be the cause for this?
An indication of anterior interosseous nerve pathology
(Pinch Grip test)
Which brachial plexus tests is used to assess for compression of the median nerve?
ULTT 1 and ULTT2
What is the stance phase of the gait cycle?
The stance phase is 60% of the gait cycle and includes the phases of initial contact, foot flat, single leg stance, heel-off, toe-off
A marathon runner comes limping to the first aid tent and states they felt a sharp pain in their ankle and heard a popping sound. The therapist at the tent performs strength tests for gastrocnemius and soleus with a grade of 5 on the unaffected side and 1 on the affected side. What test to rule in the suspected condition should they use next?
Thompson
A patient comes to see a therapist for a 1-hour massage therapy treatment in the hopes that they can help with the heaviness and aching they are experiencing in their left shoulder. Postural assessment reveals head-forward carriage and hyperkyphosis. Active Free and Passive Relaxed Range of Motion (ROM) testing of the shoulder reveals some decreased movement. There is a reduction of rotation and lateral flexion of the neck as well as a complaint of pain during Active Free ROM. Which of the following tests would be most appropriate?
Adsons Test
A therapist has passively moved their patient’s arm in the sagittal plane. Which range of motion did the therapist perform on the patient?
Flexion
What is the purpose of range of motion testing?
To assist the therapist in narrowing down the more specific structures involved and specific limitations the patient is experiencing
When assessing Active Free Range of Motion (AF ROM) of the temporomandibular joint (TMJ) in a patient with full ROM, what would the therapist expect to see?
Depression of 35-55 mm from neutral
When assessing muscle strength the therapist finds the contraction is weak and painful on the affected side. What could this be an indication of?
A severe lesion around the joint possibly due to a fracture
In addition to a person displaying a painful facial expression, an antalgic gait may be characterized by which of the following?
More weight placed on the unaffected side results in decreased time in the stance phase of the gait cycle on the affected leg
A therapist attempting to assess the C6 myotome would ask their patient to perform which of the following?
Resisted Elbow flexion, wrist extension
Which of the following measurements would be considered a wide Q angle for a 25-year-old female?
A Q angle of 20°
A patient is seated at the edge of the table with their knees flexed to 90° and their legs relaxed off of the end of the table. Beginning with the unaffected side first and testing bilaterally the therapist sits in front of the patient and places their hand on the top of the patient’s foot. The therapist asks the patient to push their foot up towards the ceiling and hold it for 3-5 seconds while the therapist resists by pressing the top of the patient’s foot towards the floor. This is done once and then performed on the affected side. What test is the therapist likely performing?
L4 Myotome
Which of the following special tests would warrant a referral to a physician if it was negative? Braggards, Swallow, Deep tendon reflex, hoover?
Swallow
A therapist instructs a patient to open and close their hand rapidly 4-5 times and then hold the hand in a fist. What test is the therapist likely performing?
Allen Test
A patient arrives for treatment of shoulder pain. They inform the therapist that they have been experiencing the pain for a month now and they went to their doctor who diagnosed them with a frozen shoulder. What would be an appropriate assessment plan?
Perform Active Free Range of Motion (AF ROM) followed by Passive Relaxed Range of Motion (PR ROM) and Resisted Isometric Range of Motion (RI ROM)
During the patient interview, a patient asks the therapist to be careful when massaging their left thigh as they have been experiencing a slightly painful tingling sensation when their clothing touches the top of their left leg. Which of the following tests should the therapist consider performing?
L2 Dermatome test Bilaterally
Which of the following assessment findings may indicate that a patient has pes planus?
Trigger points in peroneus longus and brevis, shortened gastrocnemius and soleus muscles, a valgus orientation of the Achilles tendon, and a positive Feiss Line
When performing the talar tilt test, the therapist places the patient’s foot in an anatomical position (flexed to 90°). The therapist then brings the foot into inversion, resulting in pain and hypermobility when compared with the unaffected side. What clinical impression would be the most appropriate?
Possible calcaneofibular ligament pathology
What are the 4 T’s of palpation?
Temp, tone, tenderness, texture
The therapist places their hands around the metatarsophalangeal joints of a patient and squeezes tightly in order to see if it recreates the patient’s pain. What test is the therapist most likely performing?
Mortons
Which muscles would a therapist expect to be tight and lengthened in a patient with hyperkyphosis?
Thoracic erector spinae, infrahyoid and longus capitis
