CRAM REVISION Flashcards
how is gillet test/ipsilateral kinetic test conducted
Start in iliac crest - L4/L5
PSIS - dimples - go below PSIS for inferior aspect of PSIS
Allow patient for lumbar flexion (ask patient to touch their toes can bend their knees )
One thumb on inferior aspect of PSIS , other thumb on sacrum
Hip flexion - normal response inferior PSIS drops inferiorly - posterior innominate rotation
Hip extension normal response. - inferior PSIS moves superiorly - anterior innominate rotation
how is gaenslens test conducted
One leg lying over the bed other leg pushes knee to their chest
Apply pressure on both legs
how is the compression test conducted
Separate front of innominate in SIJ apply compression force on SIJ
Cross my arms find medial ASIS and use palms of hands to separate them
how is the gapping test conducted
Push the front of innominates together causes a distraction force on SIJ
Place palms of hands lateral to ASIS push towards each other
how is the piriformis flexibility test conducted in supine
patient in supine
get patient to do knee and hip flexion against plinth on onel leg
external rotation with heel of foot on opposite knee
get patient to push the bottom leg to their chest
how is a piriformis flexibility test conducted in prone
Image below shows how it can be done in prone
Neutral hip flexion and neutral femur
Stretched by medial rotation
how is the ASLR conducted
Patient in supine
Ask patient to place their hands on their ASIS position it yourself
Place your hand around 20cm above their leg
Ask the patient to get the leg to touch your hand
what structural integrity is assessed using the ASLR
What structures takes load in SLR - lumbar spine vertebrae, sacroiliac joint, pelvic ring
how is the ASLR with form closure conducted?
Ask patient to place their hands on their ASIS position it yourself
Place your hand around 20cm above their leg
Ask the patient to get the leg to touch your hand
Place hand on both innominates or side of the ASIS and press towards each other
Ask patient to raise their leg
what is the grading interpretation of the ASLR conducted
0 = not difficult at all
1 = minimally difficult
2 = somewhat difficult
3 = fairly difficult
4 = very difficult
5 = unable to do
SIJ POSH test
Ask for knee flexion and 90 degree hip flexion
Stabilise contralateral ASIS - to prevent pelvic rolling
Apply downward pressure on on the patella
how is the dorsal ligament of SIJ palpated
PSIS - look for dimples
palpate inferior and medial
Patient in prone
apply transverse pressure similar to the DTF
When is MET rotation indicated
using supine to longsit test
when conducting a supine to longsit test what would indicate anterior innominate rotation
longer leg
what muscle energy technique if the patient was to correct anterior innominate rotation
patient can be in supine
ask patient to drive knee into their chest directed into their ipsilateral shoulder
place one hand on the plinth other hand on the medical aspect of their knee
ask patient to push against you using their hips extension not by straightening knee - hold 6 seconds
6 new boundaries
what muscle energy technique is used to correct posterior innominate rotation
patient in prone
palpate PSIS to promote anterior rotation - using dimples
knee flexion
passive hip extension while cupping the knee in your hand on the contralateral side of the patient
ask patient to dig knee into plinth
hold for 6 seconds 6 boundaries
how would you get a patient to be able to correct posterior innominate rotation independently as a HEP
instructions as mentioned
get towels under their knee
ask patient to dig knee into towel
how would you get patient to correct anterior innominate rotation METS independently as a HEP
supine
knee to chest in direction of ipsilateral axilla
get them to dig into their own shoulder resisting against their own hands
hold 6 seconds
how to conduct posterior innominate rotation sidelying
patient sidelying
placing hand on ASIS
forearm resting on ischial tuberosity
initiate rotation should induce passive hip flexion
how to conduct posterior innominate rotation sidelying in end of range
patient sidelying
patient in full knee extension and 90 degree hip flexion
hold leg between your iliac crest and forearm
placing hand on ASIS
forearm resting on ischial tuberosity
initiate rotation should induce passive hip flexion
how is thoracic rotation PPIVM conducted
patient side lying
ask patient to cross arms and place hands on contralateral shoulder
ensure no scapular retraction or protraction occurs
palpate the desired spinal level use forearm to stabilise the spine
using the patients elbow as a torque to gently rotate lifting the elbow upwards
how is thoracic side flexion occur in sitting
position plinth at level of hip
ask patient to cross arms and place hands on contralateral shoulder
ensure no scapular protraction or retraction occur
grasp one hand on shoulder
place other hand on vertebral space making an L shape
position yourself in a squat
work in lever lift the hand on the shoulder upwards
lower the hand on the vertebrae as you squat
how is rib 1 longitudinal caudad conducted
patient in supine
therapist seated in direct of head
palpate clavicle - palpate
push in direction on feet
how is cervical PPIVM side flexion conducted
patient - supine, head of table,
physio - supporting weight of patients with abdomen, palpate articular pillar between C2/C3, other hand support head, compare findings
movement - lateral flexion, feel for the opening and closing of the joint
how is cervical PPIVM rotation conducted
Physio - Palpate contralateral articular pillar, reinforced index finger, as joint opens during rotation, other hand support weight of occiput,
patient - supine, head lying off edge of bed
movement - on same hand while index finger on lamina produce produce cervical rotation away from palpating hand
positive findings of cervical PPIVM side flexion
increased resistance through motion,
muscle spasm,
decreased opening or closing of the joint,
pain provocation
how is the craniocervical flexion test conducted
place towel on occiput
place pressure biofeedback in 3rds
aim patient to nod target - 22, 24, 26, 28, 30 mmHg
observe any compensatory behaviours - retraction, SCM, scalene activity
determine the pressure the patient can hold steady with no palpable superficial muscle activity
measure enurace - 10secs hold, 10 reps
what is the normal reps and pressure that can be maintained by patient during craniocervical flexion test
26-30 mmHg 10 secs x 10reps
how is the cervical flexion/extension test conducted
Patient - side lying with head cradled in physios forearm, head on bed
therapist - facing patient, back elbow contacts front of facem forearm contacts side of head, palmar surface of hand contacts back of head one hand supporting head, other hand palpate C2 spinous process, forearm stabilise vertebral column, palpate interspinous space C2-C3
Movement - guide head into flexion
not as clinically useful
how is ULNT 1 conducted
ULNT 1 = median nerve
lie patient in supine
stand facing patient
grasp pt hand,
extend wrist and fingers fully straighten out thumb and fingers
abduct shoulder
supinate forearm
LR of shoulder
lateral cervical flexion
extend elbow
how is ULNT 2 conducted
ULNT 2 = radial nervePatient positioning - supine
physio - depress scapula with thigh,
extend elbow
Glenohumeral IR, elbow pronation
flex wrist - w/ patients thumb grasp in hand
how is ULNT 2 conducted
ULNT 2 = radial nervePatient positioning - supine
physio - depress scapula with thigh,
extend elbow
Glenohumeral IR, elbow pronation
flex wrist - w/ patients thumb grasp in hand
normal response for ULNT 1
Deep stretch or ache in cubital fossa (99%) extending down anterior & radial
aspect of forearm into radial side of hand
Tingling in thumb and first 3 fingers
Anterior shoulder stretch.
Ipsilateral cervical sideflexion decreases
responses
list sensitising manoeuvres that add further longitudinal stress on neural tissue for median nerve ULNT
Cervical side flexion
Scapula depression
What is the normal response for ULNT 2
stretch pain in –
Lateral aspect of upper arm.
Biceps
Dorsal aspect of hand
What are the desensitising manoeuvre for ULNT 2
ULNT 2 = radial nerve
Cervical spine ipsilateral
sideflexion
Shoulder abduction
how is ULNT 3 conducted
ULNT 3 =ulnar nerve
Patient in supine
cusp scapula with one hand, other hand on elbow
flex elbow
abduct shoulder
lateral rotate shoulder
pronate forearm
extend wrist and fingers - to face side of face
what is a normal response for ULNT 3
ULNT 3 = ulnar nerve
stretching discomfort in hypothenar eminence & medial 2 fingers
tingling in same region.
describe the Roos test
90 degree shoulder abduction
external rotation
repeated grasping and releasing of hand
what nerve roots make up the median nerve
C5-T1
what nerve roots make up the radial nerve
C5-T1
what nerve roots make up the ulnar nerve
C7-T1
How is the spurling test conducted?
Passively laterally flex neck towards the symptomatic side and apply downward overpressure (approx. 7kg).
what is the purpose of the spurling test
assess radicular pain
how can the spurling test be further sensitised
If no symptoms are reproduced at this stage, cervical extension and rotation can be added to lateral flexion
what is the diagnostic criteria needed for cervical radiculopathy
Positive ULNT1
Positive Spurling’s test
Limited cervical rotation to affected side (<60deg)
Positive distraction test
differential diagnosis of upper arm pain
C5/6 referred pain
Shoulder (GH jt) referred pain
C5 Radiculopathy
how is the distraction test performed in supine
Patient supine.
Therapist securely grasps the patient’s either by placing each hand around the patient’s mastoid processes/ one hand under chin and other on occiput, while standing at their head.
Slightly flex the patient’s neck and pull the head towards your torso, applying a distraction force
how is the distraction test performed in supine
Patient supine.
Therapist securely grasps the patient’s either by placing each hand around the patient’s mastoid processes/ one hand under chin and other on occiput, while standing at their head.
Slightly flex the patient’s neck and pull the head towards your torso, applying a distraction force
what is a positive response to the distraction test
reduction of symptoms
how is passive neck flexion conducted
Hypothesized to provoke neurological tissue that may be responsible for clinical symptoms such as headaches, or pain in the arms and legs are of spinal origin and
why else may pain be provoked in patients with neck pain when performing passive neck flexion
Possible neuromeningeal mechanosensitivity in patients with neck pain.
list possible core rehab exercises
deep transverse abdominis activiation - dead bug (supine 90 degree hip flexion and 90 degree knee flexion) shoulder flexion 90 degree
plank position - intensify with hip extension, contralateral shoulder flexion and elbow extension
side plank -intensify with hip abduction
bird dog -
what core exercises test functional muscle control
SLS, bridge, reverse lunge, front plank, side plank
what core exercises work as manual muscle test
supine curl up, supine curl up with bilateral rotation
how to conduct lumbar side flecion PPIVM
Patient in side flexion/sidelying
PT in front facing patient
using left hand to rest on back and stabilise vertebrae from formarm to elbow
moving hand grasp patients uppermost innominate under ischial tuberosity
bring patient into hip flexion
compare opposite side
Describe lumbar rotation PPIVM
Side lying with his and knees flexed
physio - forearm resting on back, other hand holds hip fingers spread over ilium/greater trochanter
movement - stabilise thorax and pelvis rotated away from therapist. palpate relative movement of distal spinous process in relation to proximal one.
Describe lumbar rotation PPIVM
Side lying with his and knees flexed
physio - forearm resting on back, other hand holds hip fingers spread over ilium/greater trochanter
movement - stabilise thorax and pelvis rotated away from therapist. palpate relative movement of distal spinous process in relation to proximal one.
Describe lumbar flexion extension PPIVM
Patient position - side lying, hips and knees flexed
physio position - in front facing patient
moving hand grasps back of flexed knees posteriroly and hips will grasp knees anteriorly
palpating hand - feel space gap in flexio and narrow in extension
movement - flex hips by rocking the patients knees towards patients chest to flex and extend lumbar spine
Normal response to SLR NDT
ROM 50-120 degree hip flexion
posterior thigh, knee calf pulling
relieved by neck extension
What sensitising manoeuvres for SLR NDT
Hip Add
Hip MR
Passive neck flexion
Opposite SLR (B/L)
Ankle DF
PF/Inv
What type of stress is applied on SLR NDT
longitudinal stress on neural tissue - sciatic nerve
When would an SLR NDT be indicated
if patient presents with spinal or leg pain
used to highlight disc pathology in isolation
tests sciatic nerve - L4-S1
purpose of passive neck flexion
loads connective and conductive tissue of spinal cord
stresses cervical, thoracic and lumbosacral nerve root and cervical meningeal structures
red flags that can identified in passive neck flexion
foot P&N numbness
what desensitising manoeuvres for passive neck flexion
Hip and knee flexion
what desensitising manoeuvres for passive neck flexion
SLR
Cervical sideflexion
Upper limb BPPT
purpose of prone knee bend
test femoral nerve L2-L4
purpose of adding sensitising manoeuvres in prone knee bend
delineate neuropathodynamics from quads, psoas muscle tightness
when would PKB be indicated
lumbar pain
anterior hip pain
thigh and knee symptoms
sensitising manoeuvres for prone knee bend
Hip Extension
Hip Adduction
Slump (cervical and trunk flexion) in side lying
Hip rotation
Ankle DF / Ever
Bilateral PKB
indications for slump test
Spinal symptoms
Lumbar or thoracic radiculopathy
Sciatic tract symptoms
Provocative activities that indicate that slump may be aggravating e.g. pain aggravated by kicking, dance (leg kick) or driving (bucket seat).
contra indication for slump test
Irritable disorder
Unstable disc pathology
Recent progressing neuro changes
Cord or Cauda equine symptoms.
normal response to slump test
Trunk flexion – nil
Add cervical flexion – 50% normals report pain in T8/9 region – why?
Add knee extension – discomfort & pulling in posterior knee / thigh / hams and symmetrical restriction – most people can’t fully extend knee.
Add DF – intensifies above
Release neck – decreases all symptoms and increases knee extension possible.
how is grade III lumbar rotation PPIVM conducted
patient - Lying on side, with uppermost (left) leg flexed with foot hooked behind lower knee. Lower leg extended.
therapist - To apply rotation, therapist stands behind patient again and stabilises thorax at anterior aspect of left shoulder, while producing rotation via pelvis.
how is grade IV lumbar rotation PPIVM conducted
patient -Same as for Grade III except left leg is now allowed to drop over edge of bed. Stabilising pressure can alternately be provided through patient’s left hand on abdomen – this reduces strain on thoracic spine during technique
therapist -Same as for Grade III except different amplitude.
