CPR Flashcards
Lumbar Manipulation
- Pain less than 16 days
- No symptoms distal to the knee
- FABQ(work) less than 19
- PROMHip IR greater than 35 deg (either hip)
- +Lumbar Spring Test (hypomobile + pain)
Child’s study - pretest 44%·
Less than 4 of 5 = + LR 13.2 à posttest prob success 95%
Greater than 3 of 5 = - LR 0.10 à posttest prob success 7%
Cervical Myelopathy
- Gait deviation
- Hoffman’sTest
- Inverted supinator sign
- Babinski sign
- Age less than 45
Pre-test prob 35%
Less than 1 - LR.18 = Posttest prob 43%
Greater than 3 + LR 30.9 = post test Prob 94%
Cervical Radiculopathy
- ULTTA
- Cervica lRotation (involved) less than 60 deg
- Spurling’s
- Distraction(up to 30#)
Pretest prob 53%
3 0f 4 = 85% post test
4 of 4 = 90% posttest
Secondary Shoulder Impingement
- Hawkins-Kennedy
- Painful Arc Sign
- Infraspinatus Muscle Test
- Pretest Prob 65%
- 3 of 3 → + LR 10.56 → Post test Prob 95%
- 2 of 3 → + LR 5.03 → Post test Prob 90%
Rotator Cuff Tears
Best confirmed with MR-arthrogram
`1. Drop Arm
2. Painful arc sign
3. Infraspinatus Muscle test
- Pretest Prob 39%
- 3 of 3 → + LR 15.57 → posttest prob 91%
- 2 of 3 → + LR 3.57 → posttest prob 69%
Lateral Epicondylagia Tx with MWM (mobilization with movement)
- Age less 49 → + LR 2.6 → 91% success
- Affected UE pain free grip greater 25# → + LR 2.3 →90% success
- Unaffected UE PF grip greater 75.5# → + LR 2.1 → 89% success
Pretest Prob 79%
3 of 3 → + LR ∞ → 100% success
2 of 3 → + LR 3.7 → 93% success
1 of 3 → + LR 1.8 → 87% success
Carpal Tunnel Syndrome Diagnosis
- Age Greater than 45
- Reports shaking hands relieves symptoms
- Wrist Ratio index > .76 (AP / ML wrist measure)
- Reduced Median sensory field first digit
- Symptom Severity Scale Score > 1.9
• Pretest Prob 34%
# + Sen -LR Spec + LR Post %
>2 .98 .14 .14 1.1
>3 .98 . 04 .54 2.1
>4 .77 .28 .83 4.6 70%
5 .18 .83 .99 18.3 90%
CANADIAN CERVICAL SPINE RULES
High Risk Factors Present?
- Age > 65
- Dangerous Mechanism of Injury (i.e. fall > 1m or 5 stairs, axial load to head, high-speed motor vehicle accident, motorized recreational vehicle, bicycle collision)
- Paresthesias in extremities
Low Risk Factors that allow safe assessment of range of motion?
- Simple rear-end motor accident
- Normal sitting posture in emergency department
- Ambulatory at any time since injury
- Delayed onset of neck pain and absence of midline tenderness
Is the patient able to actively rotate the neck > 45 degrees to the right and the left?
If there is (1) High Risk Factors or (2) Low Risk Factors and the inability to actively rotate the neck > 45 degrees to the right and the left, radiographs are indicated.
DVT (wells Criteria)
- Active Cancer (treatment ongoing or within previous 6 months): + 1 Point
- Paralysis, paresis or recent plaster immobilization of the LE: + 1 Point
- Recently bedridden for 3 days or more, or major surgery within the previous 12 weeks requiring anesthesia: + 1 Point
- Localized tenderness along the distribution of the deep venous system: + 1 Point
- Entire leg swelling: + 1 Point
- Calf Swelling at least 3cm larger than asymptomatic leg (measured 10cm below tibial tub): + 1 Point
- Pitting Edema confined in symptomatic leg: + 1 Point
- Collateral superficial veins (nonvaricose): + 1 Point
- Previous DVT: + 1 Point
- Alternative diagnosis at least as likely as a DVT: – 2 Points
> 3: High Probability
1-2: Moderate Probability
0: Low Probability
Scaphoid Fx
- Axial Load of Thumb o Sn .89 / - LR .02 o Sp .98 / + LR 49 - Scaphoid Shift/ Watson’s test o Sn .69 / - LR .47 o Sp .66 / + LR 2.0
Lumbar Stabilization
- PITS Test - Prone instability test
- Aberant motions present
- Mean SLR Greater than 91
- Age Less than 40
• Pretest prob 33%
• Greater 3 → + LR 4.0 Posttest Prob 67%
•
LBP Tx with Pilates-based Exercises
- Total Trunk Flexion Greater 70 deg
2, Duration of symptoms Less 6 month - No symptoms in legs for greater 1 week
- BMI Greater 25
- Mean hip rotation > 25 deg (either hip)
- Pretest prob 54%
- 3 of 5 → + LR 10.64 → posttest prob 93%
SI Joint Pain
- SI Distraction
- SI compression
- Thigh Trust
- Gaenslen’s
- Sacral thrust
- FABER
- Pretest prob 32%
- 3 pos → + LR 7 → posttest 59%
- 3 of 6 → Sn 94%, Sp 78%
Cervical Pain
Mobilization / Manipulation of T Spine
- Symptoms less 30 days
- No symptoms distal to shoulder
- Looking up does not aggravate symptoms
- FABQ(PA) less 12
- Diminished upper thoracic spine kyphosis
- Cervical extension ROM less 30 deg
- Pretest prob 54%
- 3 of 6→ 86%
- 4 of 6 → 93%
HVLA to Cervical Spine
- Symptoms less 38 days
- expectation of HVLA with help (pt believes)
- AROM rotation side/side differs greater 10 degrees
4 . Pain with PA mid cervical spine
- Pretest prob 39%
- 3 of 4 → + LR 13.5 → posttest prob 90%
Cervical Traction
- Peripheralization with c4-c7 mobility testing
- Age greater 55
- (+) Shoulder abduction test
- (+) ULTT A
- (+) cervical distraction test
- Pretest prob 44%
- 3 of 5 → + LR 4.81 → Posttest 79%
- 4+ of 5 → + LR 23 → Posttest 94.8%
Hip OA
- Self-reported “squat” as an aggravating factor
- AROM hip extension causes pain
- AROM hip flexion causes lateral hip pain
- Scour test with Adduction causes lateral hip and or groin pain
- PROM hip IR
Hip OA (Clusters)
1 - (Sn 86%, SP 75%)
- Hip Pain
- IR Greater 15 deg
- Pain with IR
- Morning stiffness
Knee OA Clusters
2
Sen 89%, Spec 88% (all groups)
#1
– knee pain & crepitus with active motion
- Morning stiffness 38
– knee pain & crepitus with active motion
- Morning stiffness greater 30 min
- Boney enlargement
– knee pain
- Boney Enlargement
Manual therapy – HVLA SIJ mob for Patellofemoral Pain
- Difference in hip IR >14 deg
- Ankle dorsiflesion >16 deg
- Navicular Drop Greater 3mm
- No stiffness with sitting >30 min
- Squatting is most painful activity
- Pre-test probability 45%
- 3/5 present → + LR 18.4 / - LR 0.33
- 4/5 present → 100% success
Taping for Patellofemoral Pain
- Patellar tilt (K=0.49)
- Tibial Varum Greater 5 degress (ICC = 0.66)
- Pre-test success – 52%
- 2/2 present → + LR 4.4 / - LR 0.53
- Post test success – 83%
Orthotics for PFPS
Vicenzino, et al:
- Age over 25 years
- Height less than 165 cm
- Worst pain less than 53.25 mm (100 mm visual analogue scale)
- Mid-foot width difference greater than 10.96 mm
2+ +LR = 2.2 59%
3+ +LR = 8.8 85%
Maitalnd Hip Mobilizatoins for Knee OA
- Hip/ groin pain or paresthesia
- Anterior Thigh pain
- Pain with hip distraction
- Knee flexion PROM
Ankle Instability/Stabilization treatment
- Symptoms worse when standing
- Symptoms worse in the evening
- Navicular Drop > 5.0 mm
- Distal Tibiofibular Joint hypomobility
- Pre-test prob: 75%
- 3 of 4 → +LR 5.90 → post test 95%
Ottawa Ankle Rules
Pain in malleolar or midfoot area and Either:
1. Inability to bear weight immediately after injury AND in the ED (taking 4 steps)
OR
- Bone tenderness at the posterior edge of tibia or fibula or tip of medial or lateral malleolus
- Bone tenderness at the navicular or proximal base of 5th metatarsal
Ottawa Knee Rules
- Age greater 55
- Tenderness at the head of the fibula
- Isolated tenderness of the patella during palpation
- Inability to flex the knee to 90 degrees
- Inability to bear weight immediately and upon ER evaluation
Meniscus Pathology
- History of catching or locking reported by the patient
- Joint line tenderness
- Pain with forced hyperextension (modified bounce home test)
- Pain with maximal passive knee flexion
- Pain or audible click with McMurray manuver
3+ + LR 3.14
4+ + LR 4.28
5+ + LR 11.20
C/T Manipulation for Shoulder Pain
- Less 90 days of symptoms
- No meds for shoulder pain
- (-) Neers
- Pain free flexion Less 127 deg
- IR Less 53 deg @ 90 deg GH abduction
- Pretest Prob 61%
- 3+ of 5 → + LR 5.3 → Posttest Prob 89%
Cervical Radiculoptahy Predictors for Success
- Age Less 54 years
- Dominant UE not affected
- Looking down does NOT increased Sx
- Multimodal Tx (greater 50% of time = Manual therapy, Deep cervical flexor strengthening, cervical traction
- Pretest 53%
- 3 of 4 → posttest prob 85%
- 4 of 4 → posttest prob 90%
