Clinical Science 3 Flashcards
Schober’s test =
- Schober’s test assesses the amount of lumbar Flexion (limited)
- A markis made at the level of the posterior iliac spine on the vert column, ( aprox L5)
- Therapist then places one finger 5cm below this mark, adn another finger 10 cm above the mark
- Pt actively touches toes
- iF the increase in distance between the two fingers on the Pt’s spine is less than 5cm, this indicates limited lumbar Flexion
Hoover’s Test =
Malingering Test
Cervical spine loose packed position:
Midway between Flexion & Extension
Cervical spine close pack position:
Extension
Thoracic & Lumbar spine loose pack position:
Midway btw Flexion & Extension
Thoracic and Lumbar closed pack position:
Extension
Which way does the cervical/t-spine vertebrae translate on right side Flexion?
Side bending is coupled with axial rotation on the SAME side
Which way do lumbar vertebrae translate on right side Flexion?
Side bending is coupled with axial rotation in the OPPOSITE side
Cervical Spine ligaments that we test:
Alar, Transverse, Apical
Most Common direction of disc Herniation:
Posterolateral
S/sx of a slipped disc include:
P and numbness, MC on one side of the body
P that extends to your arms and/or legs
P that worsens at night
P that worsens after standing/sitting
P when walking short distances
Unexplained mm weakness
Tingling, aching, or burning sensations in the affected area
Nerve that passes between L4 and L5
L5
L5 nerve impingement =
Foot drop
If the L5 near root is impinged, where is the impingement located?
Between L4 and L5
If S1 nerve root is impinged, where is the impingement?
L5/S1
May cause loss of the ankle reflex
Common S/sx assoc. with Facet lock / Facet jt pain :
- Mm spasm which can pull the spine out of alignment adn cause back pain
- Often Pt’s will report just bending over to tie shoes, adn suddenly not being able to take move
- The usual acute joint attack of back pain involving facet joint occurs suddenly with no warning
Piriformis Syndrom:
- Pain behind hip adn buttocks
- Electric shock pains traveling Down the back of the lower extremity
- numbness in the lower extremity
- tenderness with pressure on the piriformis mm (often causes Pain when sitting on hard chairs)
BAck strain S/Sx
Pain that worsens with movement Mm cramping/spasm Sudden uncontrolled mm contractions Decreased function and/or ROM of joint Difficulty walking, bending forward/sideways, standing straight
Lumbago:
Pain in the mm joints of the low back
Rule of 3 in the T-spine
T 1-3. T12. SAME
T 4-6. T11. 1/2 segment ABOVE
T 7-9. T10. Full segment ABOVE
SPondyllisthesis
Forward displacement of the vertebra, especially L5
MC occurs after break or Fx
Backward displacement = Retrolisisthesis
Spondylolysis
Defect of the Pars Interarticularis of the vertebral arch
Spondylitis
INflammation of the joints of the vertebrae
What’s indicative of Intrathorasic / Intrathorasic-Abdominal Pain while pooping?
Herniated Disc
Trauma
Tumor
Osteophyte in lumbar canal
(Valsalva Test)
Trendelenburgs Gait:
Weak Glut Med (and Min)
NO stabilization through stance phase = excess Lat movement to standing side
If boy side are weak = side to side swing “Chorus Girl Swing”
Also seen in congenital hip dislocation/ Coxa Vera
Lurch Gait:
Weak Glut Max
Thorax lurches Posteriorly in Initial Contact (heel strike)
Trendelenburg Test, positive =
Slouching hip of the affected aside while opposite foot is OFF the ground
A woman walk in with shoulder Pan that came on gradually. She is experiencing night pain and Pain with ABduction. What could this be and what special test are indicated?
Frozen Shoulder
Do an Impingement Test + Adhesive Capsulitis ABduction Test
A man presents with Neuro signs in left arm, what special test would you perform?
Distraction/Compression
Spurlings,
Upper Limb Tension Test
What is a step deformity?
AC Separation
What is a Sulcus Sign?
Dislocated AC joint, humerus appears dropped from shoulder
Colle’s Fracture
Wrist fracture involving a break of the distal end of the Radius
“Dinner Fork” appearance
25% of Colles Fx have Complex Regional Pain Syndrom (CRPS)
@ 9 weeks, most Pain resolves
What is Reflex Sympathetic Dystrophy?
Also called Complex Regional Pain Syndrom CRPS
Condition characterized by diffuse Pain, swelling, limited mvmt that follows injury such as a Fx to arm or leg.
S/Sx are always out of proportion to the injury and can linger long after the site has healed.
Nursemaids Elbow involves:
Subluxation of head of radius from it’s encirclement of the Annular Lig
Radial subluxation
Prox humeroradial dislocation
Bouchard’s Nodes:
Sign of RA or OA
Hard bony outgrowths or gelatinous cysts on PIP jts of fingers / toes
Heberden’s Nodes
Hard, bony swellings that can develop in the DIPs
Sign of OA
OK sign - Pinch Test - Median Nerve / Ant Int Oss Nerve
Lesions of the Ant Int Oss nerve may cause weakness of:
FPL
FDP
FDS
Pronation Quadraus mm
Histology of the Carpal Tunnel:
- Carpal Tunnel is an osteofibrous canal situated in the wrist
- Goes from the carpal bones+flexor retinaculum
- Contains Median Nerve + 9 tendons:
FPL, FDS, FDP
If asked to make the “OK” sign, patients who make a triangle instead exposes:
Weak FPL +FDP leading to weakness of the Flexion of distal phalanges of thumb and index finger
= impairment of pincer mvmt + difficulty picking up sm items
If you’ve torn your meniscus, you may experience the following signs on your knee:
"Popping" Inflam, stiffness Pain w twisting/rot mvmts Difficult straightening knee fully "Blocked" feeling when moving knee / Locked in place
Terrible Triad:
Injury to ACL, MCL, Medial Menicus
Housemaids Knee, aka:
Pre patellar Bursitis
If a soccer player gets kicked in the back of the knee, what is most likely to be injured?
ACL Injury
If a patient can’t straighten the knee, it’s most likely a:
Bucket Handle Tear (Med. Meniscal Injury)
If someone if experiencing Pain going up stairs it is likely:
Patella Femoral Pain Syndrom
Pain from posterior surface of the patella articulating with the femur out of alignment
Hallmarks of Runners Knee:
No Pain on Knee Extension
“Click” sound with extension
Due to mm imbalance of Strong Vastus Lateralis (pulls knee Lat)
Vs
Weak Vastus Medialis (need to strengthen)
What is a Reverse Q Angle?
Patella tracks Laterally and may sublux
Pt needs to strengthen ADDuctors
Stretch ITB + Vast Lat
Screw Home Mechanism=
External Rot of Tibia on Femur in last 20* of Extension
(Locking Mechanism)
Open Chain: Tib Ext Rot on Femur + Ant glide to become more congruent on Femur
Closed Chain: Femoral Int Rot on Tibia
An Inversion Sprain of the Ankle commonly affects the:
Anterior Talofibular Ligament
A tear to the Spring Ligament of the foot would cause:
Pronation (Drop Arch)
Myotome C1-2
Neck FLX/EXT
Myotome C3
Neck side FLX
Myotome C4
Shoulder elevation
Myotome C5
Shoulder ABduction
Myotome C6
Elbow FLX / Wrist EXT
Myotome C7
Elbow EXT / Wrist FLX
Myotome C8
Ulnar Deviation
Thumb EXT
Finger FLX + ABduction
Myotome T1
ABduction / ADDuction of Intrinsics
Myotome L1-2
Hip FLX
Myotome L3
Knee EXT
Myotome L4
Ankle Dorsi FLX
Myotome L5
Big Toe EXT
Myotome S1
“Poo on shoe”
Ankle Plantar FLX, Eversion, Hip EXT, Knee FLX
Myotome S2
Knee FLX
Myotome S3
Foot Intrinsics
