ECR Musculoskeletal Tests Flashcards
“Drop arm test”
ROTATOR CUFF TEAR
ask patient to fully abduct arm to shoulder level and lower it slowly. If patient cannot hold arm fully abducted at shoulder level, –> positive for ROTATOR CUFF TEAR
Apley Scratch Test
tets overall shoulder rotation
Difficulty with these motions suggests ROTATOR CUFF DISORDER
ask patient to touch opposite scapula to test
1) abduction and external rotation or
2) adduction and internal rotation
Neer’s impingment sign
Pain during this maneuver is positive –> ROTATOR CUFF TEAR
Press on scapula to prevent scapular motion with one hand, and rasie the patient’s arm with the other. This compresses teh greater tuberosity of the humerus against the acromion
Hawkin’s Imingment Sign
pain is POSITIVE for ROTATOR CUFF TEAR
flex patient’s shoulder and elbowto 90 degrees with palm facing down,. Then with one hand on the forearmand one on the arm, rotate the arm internally. This compresses teh greater tuberosity agaisnt the CORACOACROMIAL LIGAMENT
What does the Neer’s Impingment sign compress?
greater tuberosity of humerus against the acromion
What does Hawkin’s impingment sign compress?
greater tuberosity agaisnt the coracoacromial ligament
“Empty Can Test”
Weakness is POSITIVE for possible ROTATOR CUFF TEAR; Tests SUPRASPINATUS STRENGTH
. Elevate arms to 90 deg. and internally rotate arms with thumbs poinging down , as if emptying a can . Ask pt to resist as you place downard pressure on the arms
Ask patient to place arms at side and flex the elbows to 90 degrees with the thumbs turned up. Provide resistance as teh patient presses forearm outward
Weakness is POSITIVE for ROTATOR CUFF TEAR or BICIPTIAL TENDINITIS
-Tests wekenss in INFRASPINATUS STRENTH
Test forearm supination. Flex patients forearm to 90 deg at elbow and pronate the patient’s wrist. Provide resistance when aptient supinats forearm
Pain is a POSITIVE for inflammation of LONG HEAD OF BICEPS TENDON and possible ROTATOR CUFF TEAR
Raise your arms in front of you and overhead
Tests Shoulder Flexion
Raise your arms behind you
Tests Shoulder Extension
Raise you arms out to the side and overhead
Tests Shoulder Abduction
Cross your arm in front of your body
Shoulder Adduction
Place one hand behind your back and touch your shoulder blade
Internal rotation of shoulder
Raise your arm to shoulder level; bend your elbow and rotate your forearm toward the celign
External rotation
Place one hand behind your neck or bend as if you are brushing your hair
External rotation
Shoeber’s Test
Schober’s test is a test used in rheumatology to measure the ability of a patient to flex his/her lower back.
Procedure
The examiner makes a mark approximately at the level of L5 (fifth lumbar vertebra). The examiner then places one finger ~5 cm below this mark, and another, second, finger, ~10 cm above this mark. The patient is asked to touch his/her toes. By doing so, the distance between the two fingers of the examiner increases. However, a restriction in the lumbar flexion of the patient reduces this increase; if the distance increases less than 5 cm[1], then there is an indication that the flexion of the lower back is limited.
Tinel’s Test (Tinel’s sign)
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Tinel sign
Classification and external resources
Transverse section across the wrist and digits. (The median nerve is the yellow dot near the center. The carpal tunnel is not labeled, but the circular structure surrounding the median nerve is visible.) ICD-10 G56.0 ICD-9 354.0 OMIM 115430 DiseasesDB 2156 MedlinePlus 000433 eMedicine orthoped/455 pmr/21 emerg/83 radio/135 MeSH D002349
Tinel’s sign is a way to detect irritated nerves. It is performed by lightly tapping (percussing) over the nerve to elicit a sensation of tingling or “pins and needles” in the distribution of the nerve. It takes its name from French neurologist Jules Tinel (1879-1952).[1][2][3]
For example, in carpal tunnel syndrome where the median nerve is compressed at the wrist, Tinel’s sign is often “positive” causing tingling in the thumb, index, and middle finger. Tinel’s sign is sometimes referred to as “distal tingling on percussion” or DTP. This distal sign of regeneration can be expected during different stage of somatosensory recovery.[4]
What is Phalen’s Test?
CARPEL TUNNEL
The patient is asked to hold their wrist in complete and forced flexion (pushing the dorsal surfaces of both hands together) for 30–60 seconds. The lumbricals attach in part to the flexor digitorum profundus tendons. As the wrist flexes, the flexor digitorum profundus contracts in a proximal direction, drawing the lumbricals along with it. In some individuals, the lumbricals can be “dragged” into the carpal tunnel with flexor digitorum profundus contraction. As such, Phalen’s maneuver can moderately increase the pressure in the carpal tunnel via this mass effect, pinching the median nerve between the proximal edge of the transverse carpal ligament and the anterior border of the distal end of the radius. By compressing the median nerve within the carpal tunnel, characteristic symptoms (such as burning, tingling or numb sensation over the thumb, index, middle and ring fingers) conveys a positive test result and suggests carpal tunnel syndrome.
Straight Leg Test
Posiitve To test Sciatica (Radicular Low Back Pain)
When apitent in supine position, raise patient’s relaxed and straightened leg at hip, then dorsiflex foot Lift leg up. If aptient has low back apin with nerve pain that radiates down leg, –> Sciatica in S1
What is Chronic Back Stiffness- Anylosing spondylitis
ANKYLOSING SPONDYLTIS, INFLAMMATORY POLYARTHRITIS, MOST common in younger than 40 year old men
What is Diffuse idiopathic hyperstosis (DISH)
affects men? women, greater than 50 years old
Physical signs of chronic back stiffness (DISH and Ankylosing spondylitis)
Loss of normal lordosis, muscle spasms, limited anterior and lateral flexion. Improves with exercis. Lateral immobility of the spine, esp in the thoracic area
Nocturnal Back Pain, Unrelieved by rest
Metastatic Malignancy to the spine from canver of prostsate, breast, lung, thyroid, and kidney and multiple myeoma
What are phsyical signs of nocturnal back pain
variable
Pain Referred from Abdomen or Pelvis
usally a deep, aching pain, level varies with sournce, ~1% of back pain
What are caues of referred pain from abdomen or pelvis
Peptic ulcer, pancreatitis, pancreatic cancer, chornic prostatitis, endometriosis, dissecting aortic aneurysm, retroperitoneal tumor, and other causes
What are physical signs or visceral pain
spinal movements are not painful and range of motion is not affected. Look for signs of rimary disorder
What is pattern of mechanical neck pain WHIPLASH
aching paracervical pain and stiffness,often beginning day after injury. Occipital headache, dizziness, malaise, and fatigue may be prsent. Chronic whiplash syndoem if sympsoms last more than 6 months, presen in 20-40% of injuries
