Clinical Exams Flashcards
Head + neck exam
Vitals - Ht, wt, BMI, BP, HR, RR, sats, temp, glucose
Look - ears, nose, mouth, C spine
Feel - facial bones, skull, C spine
Move - C spine
Neurological - cranial nerve exam
1: Olfactory
2: Optic - pupil size, response, acuity, fields
3, 4 + 6: Oculomotor, trochlear + abducens
5: Trigeminal
7: Facial
8: Vestibulocochlear
9 +10: Glossopharyngeal + vagus
11. Accessory
12: Hypoglossal
Special tests
Eye trauma
Fundoscopy
Cornea (fluorescein stain, cobalt blue light)
IOP
Concussion
VOMS
Rombergs
How to examine cerebellum
Finger to nose
Pronate/ supinate clap
Gait
Pronator Drift - close eyes, arms extended out straight palms up
Romberg
Cranial nerve exam
1: Olfactory - any changes to sense of smell?
2: Optic - pupil size, shape, symmetry, visual acuity using snellen chart, pupillary reflexes (direct + consensual), accommodation reflex, color vision using Ishihara plates, visual fields + neglect, fundoscopy
3, 4 + 6: Oculomotor, trochlear + abducens - H movement
5: Trigeminal - sensory (ophthalmic, maxillary, mandibular), masseter palpation, open jaw against resistance, jaw jerk and corneal reflex
7: Facial - change to taste? change to hearing? Raise eyebrows, close eyes, blow out cheeks, big smile, pursed lips
8: Vestibulocochlear - whisper test, Rinne’s (tuning fork on mandible, when no longer able to hear, move in front of ear - air should be louder than bone), Weber’s (tuning fork midline of forehead, sound should be equal - sound louder on affected ear = conductive, sound louder on intact ear = sensorineural), turning test (march on spot w/ arms outstretched in front + eyes closed - vestibular lesion pt turns towards side of lesion)
9 +10: Glossopharyngeal + vagus - problems with swallowing? Inspect uvula, ask pt to cough, ask pt to swallow
11. Accessory - inspect trap + SCM, shrug shoulders against resistance, turn head against resistance
12: Hypoglossal - inspect tongue, protrude tongue, push tongue against resistance in cheek
How to examine for ?concussion
Compare to baseline
Orientation - where are we, what happened, who am I, what year is it
Vestibulo-ocular testing
Move eyes from side to side (finger to finger) + up and down
Keep eyes focused on examiner then turn head side to side and up and down
Peripheral nerve exam
Sensation to upper deltoid (C4), lateral elbow (C5), tip of thumb (C6), tip of middle finger (C7), tip of little finger (C8), medial elbow (T1), medial side of knee (L3), medial malleolus (L4), 1st webspace (L5), lateral heel (S1)
Power - deltoid (C5), biceps (C5/6), wrist extension (C6/7), triceps (C7), middle finger flexion (C8), fingers splayed (T1), test quads (L3/4) by squatting, tibialis anterior (L4) by heel walking, Trendelenburg test for hip adductors (L5), test gastrocnemius with toe walk (S1/2)
Reflexes - biceps jerk (C5/6), brachioradialis (C6), triceps (C7), patella tendon (L3/4), achilles tendon (S1/S2), abdo reflexes (upper muscles = T7-T10, lower T10-L1)
How to do C spine exam
Vitals - Ht, wt, BMI, BP, HR, RR, sats, temp, glucose
Look
Feel
Move - C spine + shoulder
Neurological
Sensation to upper deltoid (C4), lateral elbow (C5), tip of thumb (C6), tip of middle finger (C7), tip of little finger (C8), medial elbow (T1)
Power - deltoid (C5), biceps (C5/6), wrist extension (C6/7), triceps (C7), middle finger flexion (C8), fingers splayed (T1)
Reflexes - biceps jerk (C5/6), brachioradialis (C6), triceps (C7)
Check radial pulses
Special tests
Spurlings test
How to do lumbar spine exam
Vitals - Ht, wt, BMI, BP, HR, RR, sats, temp, glucose
Gait
Look
Feel
Move - C spine, lumbar spine, hips
Neurological
Achilles reflex (S1/S2)
Power - quads (L3/4) by squatting, tibialis anterior (L4) by heel walking, Trendelenburg test for hip adductors (L5), test gastrocnemius with toe walk (S1/2)
Get pt sitting, then flex hip against resistance and test iliopsoas muscle (L2) + extensor hallucis longus (L5)
Patella tendon (L3/4)
Sensation - medial side of knee (L3), medial malleolus (L4), 1st webspace (L5), lateral heel (S1)
Check pulses in feet
Special tests
Radiculopathy = Slump test
Sciatica =SLR
Ankylosing spondylitis = Schobers, Reduced chest expansion
Cauda equina =DRE, perineal sensation
SI joint pathology = FABER, Stork test
Facet joint = Extension + rotation
Shoulder exam
Vitals - Ht, wt, BMI, BP, HR, RR, sats, temp, glucose
Look
Feel - C spine, shoulder + elbow
Move - C spine, shoulder + elbow
Neurological
Spurlings
Sensation to upper deltoid (C4), lateral elbow (C5), tip of thumb (C6), tip of middle finger (C7), tip of little finger (C8), medial elbow (T1)
Power - deltoid (C5), biceps (C5/6), wrist extension (C6/7), triceps (C7), middle finger flexion (C8), fingers splayed (T1)
Reflexes - biceps jerk (C5/6), brachioradialis (C6), triceps (C7)
Check radial pulses
Special tests
Rotator cuff
- Supraspinatus - empty can
- Infraspinatus + teres minor - resisted ext rotation
- Subscapularis - Gerbers lift off
Impingement
- Painful arc
- Hawkins
- Neers
Biceps tendinopathy
- Uppercut
- Yergason’s
- Speed (already done with testing of power in biceps)
AC pathology
- Cross arm adduction
- Hawkins
Labral pathology
- Yergason’s
- O’Brien’s
- Speed (already done with testing of power in biceps)
Instability
- Apprehension test
- Sulcus sign
What is Spurlings test for?
cervical radiculopathy
Painful arc test
Impingement
pain at 30-60 degrees, dissipates at 120 degrees
Speed test
arm straight, forward flexion to 90 degrees, palm up, resisted downwards pressure + palpate bicipital tendon
pain = bicipital tendonitis, labral tear
Empty can test
push at deltoids (supraspinatus)
Hawkins’ test
shoulder flexed to 90, bend elbow to 90 degrees, internally rotate humerus (causing greater tuberosity to bump against acromion)
pain = impingement, AC or rotator cuff pathology
Cross arm adduction
compresses AC joint
Resisted external rotation
infraspinatus + teres minor
Gerber’s lift off
subscapularis
Apprehension test
lying supine, abduct arm to 90 degrees w/ elbow flexed then slowly externally rotate - place hand over proximal humerus
if apprehension improves - test = positive
Yergason’s
Resisted supination + palpate biceps tendon
biceps tendonitis/ labrum
Neers test
The examiner should stabilize the patient’s scapula with one hand, while passively flexing the arm while it is internally rotated. If the patient reports pain in this position, then the result of the test is considered to be positive
subacromial nerve impingement
Sulcus sign
apply downwards traction, sulcus sign = inferior instability
Impingement test w/ LA
inject subacromial bursa w/ lidocaine = sx improvement = impingement not tear
Compression rotation test
patient supine, pts arm abducted to 90 degrees + elbow flexed to 90 degrees, examiner applies axial force to humerus
positive = pain/ clicking = labral tear?)
O’Brien test
pt standing, arm forward flexed to 90 degrees w/ elbow in full extension. With adducted arm to 10 degrees and internally rotated humerus, examiner applies downward force to arm as pt resists. Pt then supinates arm and repeats resistance.
Positive = pain w/ internal rotation, reduced w/ external rotation
SLAP or AC lesions
Upper cut test
forearm supinated, elbow flexed to 90 degrees, hand in fist. Pt brings first towards chin against resistance.
Pain = biceps tendinopathy
Elbow exam
Vitals - Ht, wt, BMI, BP, HR, RR, sats, temp, glucose
Look
Feel - shoulder, elbow, wrist
Move - shoulder, elbow, wrist
Neurological
Spurlings test
Sensation to upper deltoid (C4), lateral elbow (C5), tip of thumb (C6), tip of middle finger (C7), tip of little finger (C8), medial elbow (T1)
Power - deltoid (C5), biceps (C5/6), wrist extension (C6/7), triceps (C7), middle finger flexion (C8), fingers splayed (T1/ ulnar), make a fist (median nerve), thumbs up (radial nerve), make circle with thumb + forefinger (anterior interosseous branch of medial nerve)
Reflexes - biceps jerk (C5/6), brachioradialis (C6), triceps (C7)
Check radial pulses
Special tests
Medial epicondylitis = Resisted wrist flexion (already done with power testing)
Lateral epicondylitis = Resisted wrist extension (already done with power testing), Resisted middle finger extension (pain)
PIN compression = Resisted middle finger extension (weakness)
UCL pathology = Valgus stress test (laxity, pain)
Radial tunnel syndrome = Tinel’s over radial tunnel (3–4 cm distal to the lateral epicondyle)
Cubital tunnel syndrome = Tinel’s over ulnar nerve at the cubital tunnel (between medial epicondyle and olecranon)
Distal biceps tendon pathology = Pain or weakness with supination
Hand + wrist exam
Vitals - Ht, wt, BMI, BP, HR, RR, sats, temp, glucose
Look
Feel - elbow, wrist, hand
Move - elbow, wrist, hand
Neurological
Spurlings test
Sensation to upper deltoid (C4), lateral elbow (C5), tip of thumb (C6), tip of middle finger (C7), tip of little finger (C8), medial elbow (T1), radial edge of palmar aspect 2nd digit (median), ulnar edge of palmar aspect 5th digit (ulnar), 1st webspace dorsal aspect (radial)
Power - wrist extension (C6/7), triceps (C7), middle finger flexion (C8), fingers splayed (T1/ ulnar), make a fist (median nerve), thumbs up (radial nerve), make circle with thumb + forefinger (anterior interosseous branch of medial nerve)
Radial + ulnar pulses
Special tests
Scaphoid # = Anatomic snuffbox pain
TFCC = Grind test
De Quervains = Finkelstein test
Carpal tunnel = Tinels, Phalens
UCL = Stress test
Scapholunate ligament injury = Watsons test
Flexor digitorum profundus = Flex each finger DIP with PIP immobilised
Flexor digitorum superficialis = Flex each PIP with each MCP immobilised
Flexor pollicis longus = Flex thumb IP joint with thumb MCP joint immobilised
Mallet finger = Extension of DIP against resistance
Finger special tests
Flexor pollicis longus
Flexor digitorum profundus
Flexor digitorum superficialis tendon
UCL test
Extension of DIP against resistance
Functional tests: writing, picking up small objects, grip strength
Hip exam
Vitals - Ht, wt, BMI, BP, HR, RR, sats, temp, glucose
Gait
Look
Feel - lumbar spine, hip, knee
Move - lumbar spine, hip, knee
Resisted movement - adduction, abduction, flexion
Neurological
Sensation - medial side of knee (L3), medial malleolus (L4), 1st webspace (L5), lateral heel (S1)
Patella reflex + achilles reflex
Power - quads (L3/4) by squatting, tibialis anterior (L4) by heel walking, Trendelenburg test for hip adductors (L5), test gastrocnemius with toe walk (S1/2)
Special tests - leg length, FADIR, FABER, SLR
Flexion deformity
- Thomas test
IT band syndrome
- Obers (tightness)
- Noble compression test
Adductor strain
- Already tested with resisted adduction
- FADIR
Psoas strain
- Already tested with resisted hip flexion
- FADIR
Inguinal strain
- Resisted sit up
- FAI
- FADIR
Labral pathology
- FADIR
- FABER
SI joint pathology
- FABER (pain over SI)
- Pain with downwards pressure on flexed hip
- Stork test
Lumbar radiculopathy
- Slump test
Sciatica
- SLR
Piriformis syndrome
- FADIR
- SLR
OA
- FADIR
- FABER
- Pain + reduced ROM in internal rotation
Hamstring strain
- SLR (pain to knee)
- Resisted knee flexion (pain)
Gluteal tendinopathy
- FABER (pain lateral hip)
- Resisted abduction (pain)
- Ober’s (pain)
Knee exam
Vitals - Ht, wt, BMI, BP, HR, RR, sats, temp, glucose
Gait
Look - knee, feet + shoes
Feel - hip, knee, ankle
Move - hip, knee, ankle
Special tests
ACL + PCL = Sag sign, Lachmans
MCL + LCL = Valgus + varus stress in extension + slight flexion
Meniscus pathology = Thessaly, McMurrays
Patellofemoral pain syndrome = Pain with squatting (done in neuro exam), Clarke’s test
Patella tendon pathology = resisted knee extension
Quadriceps tendon pathology = Resisted knee extension
Patella instability or maltracking = J sign with squatting, Apprehension with patella movement
Stress # = Hop test
Neurological
Sensation - medial side of knee (L3), medial malleolus (L4), 1st webspace (L5), lateral heel (S1)
Patella reflex + achilles reflex
Power - quads (L3/4) by squatting, tibialis anterior (L4) by heel walking, Trendelenburg test for hip adductors (L5), test gastrocnemius with toe walk (S1/2)
Ankle + foot exam
Vitals - Ht, wt, BMI, BP, HR, RR, sats, temp, glucose
Gait
Look - knee, ankle + shoes
Feel - knee, ankle
Move - knee, ankle, toes
Neurological
Sensation - dorsum of foot (superficial peroneal nerve), 1st webspace (deep peroneal nerve), lateral border of heel (sural nerve), medial hallux (saphenous nerves), sole of foot (medial + lateral plantar nerves)
Power - resisted dorsiflexion + plantarflexion, inversion (tibialis posterior inversion strength) + eversion (peroneal strength), great toe extension + flexion
Achilles reflex
Special tests
Achilles
- Thompson squeeze test
- Pain/ weakness with toe walking
Lateral ankle sprain
- Talar tilt
- Anterior drawer test
High ankle sprain
- Squeeze test
Stress # = Hop test
Chronic compartment syndrome = Toe raises
PIN entrapment = Dorsi + plantarflex against resistance, feel pulses
Impingement test = forced dorsi + plantarflexion
If pt lost balance on Romberg’s w/ eyes open vs closed, what would this indicate?
Eyes open, lose balance = cerebellar injury
Eyes closed, lose balance = proprioception issue
How do you assess for and what would a rib hump indicate?
Inspect posteriorly, ask pt to touch toes. Rib hump = scoliosis
What is a lordosis vs kyphosis?
Lordosis - exaggerated inwards curve, kyphosis = excessive rounding of upper back
If a pt experienced pain with lateral C spine flexion, what would this indicate?
Brachial plexus injury
What does a Spurlings test indicate?
Nerve root compression/ radicular pain
What do cafe au lait spots indicate?
Neurofibromatosis
What does a patch of hair on lumbar spine indicate?
spina bifida
If a pt gets pain w/ forward flexion of lumbar spine, what does this indicate?
Discogenic pain
If a pt gets pain w/ extension of lumbar spine, what does this indicate?
Pars defect
What does a positive slump test indicate?
Radicular pain
What does a positive FABER indicate?
SIJ pathology, pars stress #, hip pathology
What does deltoid atrophy indicate?
C5 plexus injury
What does winging of the scapular indicate?
long thoracic nerve palsy or CN 11 palsy
If a pt gets pain w/ passively extending wrist + extending elbow, what does this indicate?
Pain over common extensor origin - lateral epicondylitis
If a pt gets pain w/ passively flexing wrist + extending elbow, what does this indicate?
Pain over common flexor origin - medial epicondylitis
What does a valgus stress test of the elbow indicate, and how to do it?
Valgus stress test = flexes elbow to 30 degrees, apply valgus stress. Positive if pain or instability (UCL sprain). Moving valgus test - apply valgus force as elbow is moved through flexion + extension. Pain between 70-120 degrees flexion is positive for UCL injury
What does pain around the abductor pollicis longus tendon indicate?
de Quervain’s tenosynovitis
Watsons test
thumb over scaphoid tubercle, fingers over dorsum of wrist, wrist into slight extension, move from ulnar to radial deviation - pain or clunk = injury to scapholunate ligament
TFCC special tests
Grind test - arm wrestle position, ulnar deviation, rotate - pain in ulnar aspect of wrist = TFCC injury
Supination test - extent of supination, flexion against resistance
Tests for de Quervain tenosynovitis
pain around the abductor pollicis longus tendon
Finkelstein test - grasp thumb of pt, sharply ulnar deviate hand - pain along distal radius
Carpal tunnel tests
tinels sign (tap over carpal tunnel), phalens (backs of hands together in forced flexion)
How to examine distal radial ulnar joint?
Make like an arm wrestle, compress distal radial ulnar joint and rotate
What is a Trendelenburg gait?
Weakness of hip abductor muscles causes pt to put weight on affected side and opposite pelvis drops. Pt may compensate by swinging shoulders towards affected side
What are the abductor tests?
lie on side, palpate gluteal muscles with leg in abduction, resisted abduction
What are the adductor tests?
external rotation and palpate adductor longis to bone
squeeze test (pt squeezes legs together while in extension)
What are the psoas tests?
hip flexion against resistance
palpate medial and deep to ASIS
Thomas test (hung one knee, leg hanging off bed)
What are the inguinal tests?
palpate lower rectus + conjoint tendon + superficial ring
resisted sit up
What tests assess for groin pathology?
FADIR, adductor tests
What tests for tight IT band?
Ober’s test - lying on side, knees flexed, superior leg abducted + moved posteriorly, then dropped - if not touching bed = tight IT band
What would normal shoe wear pattern look like?
normal wear pattern is from lateral heel along the lateral border of foot to big toe
What would pain in ankle during a deep squat indicate?
?Anterior impingement or dorsal spurs
What would pain w/ compression of the forefoot indicate?
Inflammatory disorder
What would pain w/ compression of the calcaneus indicate?
Calcaneal stress #
How to test Flexor pollicis longus
flex thumb IP joint with thumb MCP joint immobilised
How to test Flexor digitorum profundus
Flex each finger DIP with PIP immobilised
How to test Flexor digitorum superficialis tendon
flex each PIP with each MCP immobilised
How to test UCL in finger
stabilise metacarpal and apply stress to UCL (pain or laxity?)
How to test for ?mallet finger?
Unable to extend DIP against resistance
Thomas test
(fixed flexion deformity of hip) - flex knee + hips, pt holds one knee in place, then extend other leg back onto bed
Leg length measurement
Apparent - umbilicus to lower part of medial malleolus
True - ASIS to medial malleolus
Femoral stretch test
flex knee and passively extend hip
Ober’s test
lying on side, knees flexed, superior leg abducted + moved posteriorly, then dropped - if not touching bed = tight IT band
Tests for syndesmosis injury
point test for tenderness over syndesmosis, squeeze test mid calf, external rotation (pain medially = deltoid ligament injury, pain at syndesmosis = syndesmosis injury)
Posterior impingement test
lying prone: bring knee + ankle to 90 degrees
plantar flexion causing posterior ankle pain
Anterior impingement test
forced dorsiflexion causing pain anteriorly
Hopping
apprehension or pain - ?stress #
