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
Causes of whiplash
musculoligamental sprain or strain form forced HYPERFLEXION-HYPEREXTENSION injury to the neck,
Physical signs of whiplash
localized paracervical tenderness, decreased eck range of motion, perceived weakness of upper extrememies. Causes of cervical cord compression such as frature, herniation, head injury, or altered consciousness are exclused
Pattners of Cervical Radiculopahty- from nerve root compression
sharp burning or tingling pain in the neck and ONE ARM with associated parasthesias and weakness. Sensory symptoms often in myotomal pattern, deep in muscle, rather than dermatomal pattern
Possible causes of cervical radiculopathy
dysfunction of cervical spinal nerve, neve roots, or both from foraminal encroachment of the spinal nerve (~75%), herniated cervical disck (~25%).
Rarely from tumor, syrinx, MS. Mechanisms may invovle hypoxia of nerve root and dorsal ganglion, release of inflammatory mediators
Phsyical signs of Cervical Radiculopathy - from nerve rot compression
C7 nerve root affected most often (45%-60%), which weakness in TRCIPS and FINGER FLEXORS and extensors. C6 nerve root invovlement also common, with weaknes in bicpes brachioradialis, wrist extensors
Pattern of cervical myelopathy-from cervical cord compression
Neck pain with bilateral weaness and parasthesis in both upper and lower extremities, often with urinary freqquency. Hand clumsiness, palmar parestheis, and gait changes may be subtle. Neck flexion often exacerbates symptoms.
Causes of myelopahty
usually from cervical Spondylosis, defined as cervical degenerative disc disease from spurs, protrustion of ligametum flavum, and/or disc herniation (~80%); also from cervical stenosis form osteophytes, ossfiiation of ligamentum flavum. Large central or paracentral disc hernation may also compress cord
Phsyical signs of cervical myelopahty from cernical cord compression
Hyperrflexia; clonus at wrist, knee or ankle; entensor plantar reflexes ((positive babinski sign); and gait distrubances. Lhermittes sign: neck flexion with resulting sensation of electrical shock radiating down spine. Confirmation of cervical myelopathy warrants neck immobilizationa dn neurosurgical evaluation
Babinski Sign
Positive –> Cervical Myelopahty form cervical cord compression
An upward response (extension) of the hallux is known as Babinski response, Babinski sign, or Koch sign, named after Joseph Babinski (1857–1932), a French[1] neurologist of Polish origin. The presence of the Babinski sign can identify disease of the spinal cord and brain in adults, and also exists as a primitive reflex in infants.[2][3]
Lhermitte’s sign
Positive test- Cervical Myelopahty from cervical cord compression
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Lhermitte’s sign, sometimes called the Barber Chair phenomenon, is an electrical sensation that runs down the back and into the limbs. In many patients, it is elicited by bending the head forward.[1] It can also be evoked when a practitioner pounds on the posterior cervical spine while the neck is flexed; this is caused by involvement of the posterior columns.
Inflammatory bowel disease ass. with arthritis
Behcet’s syndome
Theater Sign
Knee!
PTFD! patellafemoral tracking disorder
Pain at the front/inner side of the knee is common in young adults, especially soccer players, gymnasts, cyclists, rowers, tennis players, ballet dancers, basketball players, horseback riders, volleyball players, and runners. The pain of chondromalacia patellae is typically felt after prolonged sitting, like for a movie, and so it is also called “movie sign” or “theater sign.”[5] Snowboarders and skateboarders are prone to this injury, particularly those specializing in jumps where the knees are under great stress. Skateboarders most commonly receive this injury in their non-dominant foot due to the constant kicking and twisting that is required of it during skateboarding.[6]
The condition may result from acute injury to the patella or from chronic friction between the patella and the groove in the femur through which it passes during motion of the knee.[7] Possible causes include a tight iliotibial band, neuromas, bursitis, overuse, malalignment, core instability, and patellar maltracking.
Hand Grip Test
tests fucntion of wrist joints, finger flexors, instrinsic muscles of hand
ask patient to grasp 2nd and 3rd finger
Finkelstein’s Test
de Quervain’s Tenosyntovitis from inflammation of ABdocutr poll longus
ask patient to rasp thumb against palm then move wrist toward midline in ulnar deviation
thumb abduction test
postiive- abducctor pollicis longus
Carpal tunnel disease
ask patient to raise thub stright up as you apply downward resistnce
tinel’s test
Carpal Tunnel
For median nerve
tap lightly over the course of median nerve
Phalen’s sign
Carpal Tunnel
bacwards praying position
Tenderness over tendon or inability to extend leg
partial or complete tear of patellar tendon
Pain with compression and with patellar movment during quadriceps contraction
chondromalacia or degenerative patella (patellafemoral syndrome)
Housemaid’s knee
prepatellar bursitis
from excessive kneeling
Answerine bursitis
from running
valgus knee deformity, fibromyalgias, osteoarthrtiites
Bulge sign (for minor effusions)
For Effusion
with knee extended, place left hand aboe knee and applyi pressure of suprapatellar pouch, displacing or milking fluid downard. Stroke downward on medial aspect of knee and appy pressure to force fluid into lateral area. Tap kee just behind lateral margn of patella with right hand
Balloon sign
major effusions in kenee
place thumb an index finer of right hand on each side of patella; with left hadn compress suprapatellar pouch agaisnt femur. feel fluid entering or balooing inot spaces next to patella under right thumg an dindex finger
Place patient in prone with knee and ankle flexed at 90 degrees. or ask patient to kneel on chiar. Squeeze flaf and watch for PLANTAR FLEXION at ankle
absence of plantar felxion is positive for RUPTURE O ACHILLES TENDON
sudden severe pain like gunshot wound, ecchymosis from calf into heeel, flat foted gait with absece of toe off
bend or flex your knee. Or squat down to floor
Knee flexion
straighten your leg.
Or. After you squat down to tfloor stand up
Knee extension
While sitting, swing your lower leg toward midline
internal rotation
whie sitting, sing your lower leg away from midelin
external rotation of knee
McMurray Test
if click or pop along medial joint –>tear of Posterior portion of MEDIAL MENISCUS
with pt supine, graps heel and flex knee. cup other hand over knee . From heel, rotate lower leg internally and externally Then push on lateral side to apply VALGUS STRESS on medial side of joint . At the same time, rotate leg and externally and slowly extend it
lateral meniscus when varus stress on lateral side
Abduction (Valgus) Stress Test
Pain or gap in medial joint line –> Medial Collateral Ligmetn Tear
pt suppin,e knee sligly flexed, move thigh 30 degrees laterally to side of table. Push medially agistn nee and pull laterally at ankel to open up knee joing on medial side (valgus stress)
Adduction or (Varus Stress Test)
pain or gap in lateral joint –> tear in LATERAL COLLATERAL LIGMENT
push lateral agasint knee and pull ankel medially to open knee joint on lateral side (varus stress)
Anterior Drawer Sign
ACL tear- froward jerk shows countours of upper tibia
Lachmann Test
Significan forward eusion is ACL Tear
place knee in 15 degree flexion and externally rotate . Grasp distal femur with one hand and upper tibia with other. With thumb of tibial hand on the joint line, simultaneously move tbia forward and femur back.
Posterior Drawer sign
PCL tear
McMurray Test
if click or pop along medial joint –>tear of Posterior portion of MEDIAL MENISCUS
with pt supine, graps heel and flex knee. cup other hand over knee . From heel, rotate lower leg internally and externally Then push on lateral side to apply VALGUS STRESS on medial side of joint . At the same time, rotate leg and externally and slowly extend it
McMurray Test
if click or pop along medial joint –>tear of Posterior portion of MEDIAL MENISCUS
with pt supine, graps heel and flex knee. cup other hand over knee . From heel, rotate lower leg internally and externally Then push on lateral side to apply VALGUS STRESS on medial side of joint . At the same time, rotate leg and externally and slowly extend it
McMurray Test
if click or pop along medial joint –>tear of Posterior portion of MEDIAL MENISCUS
with pt supine, graps heel and flex knee. cup other hand over knee . From heel, rotate lower leg internally and externally Then push on lateral side to apply VALGUS STRESS on medial side of joint . At the same time, rotate leg and externally and slowly extend it
Abduction (Valgus) Stress Test
Pain or gap in medial joint line –> Medial Collateral Ligmetn Tear
pt suppin,e knee sligly flexed, move thigh 30 degrees laterally to side of table. Push medially agistn nee and pull laterally at ankel to open up knee joing on medial side (valgus stress)
Adduction or (Varus Stress Test)
pain or gap in lateral joint –> tear in LATERAL COLLATERAL LIGMENT
push lateral agasint knee and pull ankel medially to open knee joint on lateral side (varus stress)
Anterior Drawer Sign
ACL tear- froward jerk shows countours of upper tibia
Lachmann Test
Significan forward eusion is ACL Tear
place knee in 15 degree flexion and externally rotate . Grasp distal femur with one hand and upper tibia with other. With thumb of tibial hand on the joint line, simultaneously move tbia forward and femur back.
Posterior Drawer sign
PCL tear
Apley Compression Test
Meniscal Tears!!
patient prone, knee 90 degrees. Medially and laterally rotate lower leg while applying tibial pressure.
inability to SQUAT
Medial Meniscus tear
Effustion/cartilage tear
Painful Arc Sign
Subacromial impingment syndrome
Abduct arm, 70-110 degrees okay ,then pain,keep lifting higher and pain disaapaears
