Exams 1-?

Question 1

Gait: Heel to toe

Answer 1

Cerebella function test -
Start with patient standing, looking for balance. Then get patient to walk, putting the heel of one foot directly in front of the toes of the other foot. Looking for:
- ability to recreate successfully - their balance and coordination.

Question 2

Romberg Test (Romberg’s sign)

Answer 2

Pathological reflex -
have patient standing with feet together and hands across their chest. You are testing balance. If patient is successful, get them to close their eyes and test their balance. Stand close enough to catch patient if necessary.
- positive is indicative of sensory ataxia

Question 3

Rapid alternative movements

Answer 3

Cerebella function test -
Patient is seated, you stand in front of patient, patient’s hands are face down on their thighs. Ask patient to flip their hand upright on their thigh and back again and increase the movement and pace for a while. Then get them to do other side.
You are looking for:
- quality of movement
- jerkiness
- tremor

Question 4

Finger to nose

Answer 4

Cerebella function test -
Have patient seated on table and stand in front of patient. Direct patient to extend arms out to their sides and point index fingers out. Ask them to bring one finger in to touch their nose and then extend their arm back out, then alternate and bring other finger in to touch their nose. Ask them to keep doing this action and increase pace.
You are looking for:
- quality of movement
- any tremor
- can they touch their nose or not

Question 5

Heel to shin

Answer 5

cerebella function test -
Patient can be supine on table. guide patient leg up so their heel is resting on the bottom of shin. Get patient to slide the heel up and down their shin bone. Can be done standing or seated but better supine.
Looking for:
- quality of movement
- Any jerkiness
- Ability to perform movement correctly

Question 6

Finger escape (finger escape sign)

Answer 6

Pathological reflex -
Patient seated on table and you are stood in front of them. Patient have arms/hands face down and extend their hands and fingers as tight as they can.
Positive sign is when:
little finger escape laterally (abducts) from the rest of the hand and it should occur within 30 seconds
Positive test indicative of:
- Lower motor neuron lesion

Question 7

Chaddock (Chaddock’s sign)

Answer 7

Pathological reflex -
Patient is lying supine, and you take your blunt object down underneath the lateral malleolus and draw a line down along the skin surface (between plantar and dorsal surfaces of foot) along the border of foot.
You are looking for:
- Babinski sign which is movemnnt of the great toe, and fanning of toes.
- positive babinski sign is often indicative of an upper motor neuron lesion

Question 8

Hoffman’s reflex

Answer 8

Pathological sign -
Patient is seated, you are standing in front or to side of patient. need to be grasping hand or foot. Stabilise rest of hand as you run your nail along the nailbed of the patient.
You are aiming to reproduce a noxious stimulus (pain) through the nailbed.
Positive sign of this test:
- Hyperreflexia (overactive or overresponsive bodily reflex)
- hyperreflexia is often indicative of an upper motor neuron lesion.

Question 9

Rossilimo test (sign)

Answer 9

Pathological reflex test -
Tap or Percuss along the ball of the patients foot and even pads of their toes, can include a tapping upwards motion.
A positive test = hyperreflexia as we’ll as flexion of the small toe.
Positive test indicates a upper motor neuron lesion.

Question 10

Babinski sign

Answer 10

Pathological reflex test -
Patient supine, grasp and stabilise end of patient’s foot with hand and use end of hammer to trace along lateral aspect of plantar foot surface, up and around to halfway through metatarsal pads. Repeat several times, can increase pressure. Looking for reaction of the toes, especially great toe.

• positive babinski sign is often indicative of an upper motor neuron lesion

Question 11

Cranial no exam

Answer 11

To be done

Question 12

Full myotomes assessment

Answer 12

To be done

Question 13

Passive neck flexion

Answer 13

Patient laying supine on table, you stand above and to the side. Practitioner cups occipital while putting a hand on the chest to anchor chest. Get patient to tuck chin as you lift the patient’s head closer to their chest.
Positive sign = pain down the neck, into the thoracic. Even possible patient hip flexion to relieve pressure.

Question 14

Axial cervical compression (axial compression test/cervical compression test)

Answer 14

Patient to sit up tall as practitioner interlaces fingers on top of patient’s head. Press down straight S to I with both hands.

Question 15

Cervical distraction test

Answer 15

Patient sitting back straight, have hands palming their base occiput at side with thenar eminences (hands around ears). have shoulders leveraged, pushing down on their shoulders. Try and lift hand up towards ceiling, stretching neck up.
Positive test - This movement relieves pain.

Question 16

Maximum compression (maximum cervical compression test)

Answer 16

Patient seated. Patient to side bend (laterally flex) to side of pain, and rotate to side of pain also. If no patient still experiences no pain in this part of movement, you are to apply some downward compression (S to I) to that side of the head.
Looking to reproduce pain, specifically across the top of the shoulder and potentially down arm as well.

Question 17

Spurlings Test

Answer 17

Patient is to extend their head (head goes backwards) and then side bend (laterally flex) to side of pain, while rotating head to look opposite to the side of the pain. If patient does not yet experience pain in this position, apply downward compression to the head to reproduce pain across top of shoulder and down arm (radicular symptoms).

Question 18

Cervical Slump Test

Answer 18

Patient seated and hands behind their back. get them to put their chin to their chest in a slumped position with an exhale. Apply some overpressure through their thoracic and cervicals with a hand on their occiput. With other hand you dorsi flex their foot and passively extend their knee. If patient reports pain and/or discomfort through their cervicals, reduce pressure in the foot by allowing the foot by plantar flexing the foot. If the symptoms reduce and the pain eases, that is a NEGATIVE test, however if the symptoms do persist, that would indicate a POSITIVE test and indicate their are some impingements through the cervical area.

Question 19

ULTT - Median nn bias. (ULTT = Upper Limb Tension Test) (nn = nerve)

Answer 19

Patient is supine, and shuffled across so they’re lying on the edge of table (shoulder slightly off). First step is to put patient into shoulder depression, this involves putting fist into table above patient’s shoulder, with intent to compress shoulder down towards the patient’s feet. grab patient’s fingers in a way that your thumb faces theirs to take the hand (fingers AND thumb) into extension. This movement also creates extension of the wrist. Abduct the arm and externally rotate it before supinating the forearm and gradually extending arm to extend elbow while all other positions are still stretched. If patient is coping well you can get them to side bend away from you (contralateral) Make sure patient is comfortable at all steps.
Positive test would be to recreate pain of the median nerve.

Question 20

ULTT - Radial nn bias.

Answer 20

Patient supine. Patient laying diagonal on table so their shoulder is off the table. Use your hip to stabilise the patient and create the shoulder depression you need for the test. Patient tucks thumb into hand with fingers curled over (thumb and finger flexion. put your hand over theirs (outside hand) to bend their hand into flexion (wrist flexion). Create internal rotation of the shoulder, forearm pronation, and elbow extension. This movement is followed with ulna deviation and abduction of the shoulder (and arm). If patient is coping fine with this you can ask them to side bend their head away to see if that brings on the pain. You are stacking tension on the nerve at each point, so you need to check in at each point.

Question 21

ULTT - Ulna nn bias

Answer 21

Patient is supine at edge of table. Create shoulder depression with fist. Rest patients elbow on your outside thigh while you grip their fingers to take wrist and fingers into extension. Add radial deviation and forearm pronation and then adding lots of elbow flexion. Then add shoulder abduction so that patients hand reaches around to side of patient’s face.

Question 22

Painful arc

Answer 22

Pain provocation test-
Patient seated (can be standing). Stand in front to guide and watch. Arms start by side, then get them to abduct their shoulders and take their arms up above their head (hands can be supinated or pronated). Then patient lowers arms back down.
Reproduction of pain is likely between 60 and 120 degrees. You are testing to reproduce pain.

Question 23

Sulcus Sign (inferior sulcus sign)

Answer 23

Patient seated, stand close in front of them. 1 hand is placed on non injured shoulder. Other hand is on inferior part of the humerus towards the elbow. Action of hand is traction down of the humerus towards the table. Stabilise the torso with other shoulder.
You are looking for excessive translation of the humerus or gapping that occurs around the AC joint.

Question 24

O’Briens test

Answer 24

Pain provocation test - (shoulder region)
Patient seated (can be standing). Ask patient to extend arm straight out in front of them, and horizontally adduct shoulder in around 10-15 degrees. Then pronate forearm to point thumb towards the ground. Ask patient to resist the downwards pressure that you are going to apply on the forearm.
If pain is reproduced in the patient’s shoulder region, then you get patient to supinate arm (palms to roof) and again apply pressure to floor for patient to resist. If no pain happens in this test, it is considered a positive test.

Question 25

Hawkins Kennedy

Answer 25

Pain provocation test - for shoulder
Patient seated (can be standing) while you are in front or behind patient. Weave your outside arm under patients outside arm to place your hand on their shoulder with their forearm resting on yours. other hand grasps patients wrist. Put downward pressure on patient’s wrist to internally rotate their humerus.
Looking to reproduce pain in GH (shoulder) region.

Question 26

Speeds test

Answer 26

Pain provocation test.
Patient seated and extending arm out in front of body at 90 degrees. Palpate with 1 hand at their GH joint while other hands rests on their wrist. Put downwards pressure on the patients wrist while patient resists.
Positive test is a reproduction of pain, likely in the bicipital groove.

Question 27

Empty can test

Answer 27

Pain provocation test - for shoulder
Patient seated (can stand) while you are in front or to side. Get patient to abduct their arm 30 degrees outwards and extended while pronating their hand to have thumb pointed down. Place hand on wrist end of forearm while you put downwards pressure with patient resisting.
Positive sign is pain provocation in the shoulder region, also may observe weakness in patient to resist the pressure.

Question 28

Cross-body/Scarf test

Answer 28

Pain provocation test - for shoulder region
Patient seated, ask them to lift arm and place on opposite shoulder. Stabilise the torso on same shoulder while placing other (inner) hand on the outside of their elbow and encourage more horizontal flexion of shoulder joint. Patient hand will slide behind their torso.

Question 29

Roo’s test

Answer 29

Thoracic outlet test -
Patient seated, ask them to abduct their arms and extend their fingers (|o|). ask patient to open and close their fingers, clenching down into a fist. Can do test for up to 3 minutes.
Trying to reproduce patients pain that includes numbness and tingling in the fingers, or discomfort of achiness that causes them to drop their arms down.

Question 30

Adson’s test

Answer 30

Tests - neurovascular bundle for thoracic outlet.
Patient seated, stand behind and locate radial pulse (2 fingers) and one hand stabilising shoulder. Take the patients hand back to the side of them extended out (__0) supinated to have palm facing upwards. Patient asked to tilt head towards their arm and extend head (head goes back). Ask patient to breathe in and hold breathe once breathed in. If their is a diminishing effect of radial pulse then this test is positive for thoracic outlet.

Question 31

Belly Press

Answer 31

Test for subscapularis -
Patient standing, get patient to put hand on stomach with elbow straight out to the side. Get the patient to press into their stomach. If the patient’s elbow lags inwards towards their back, then this is a positive sign for a torn subscapularis.

Question 32

Neer’s test

Answer 32

Testing for impingement in the rotator cuff - (non specific)
Patient seated, shuffled back to back of table (for convenience). internally rotate their outside arm at the distal part of forearm (grab from underneath). Use other hand to push down on the posterior aspect of the shoulder to keep the scapula from moving. You then internally rotate the arm as much as you can while raising their arm up above their head (flexing glenohumeral joint)
Looking for:
- reproduction of pain in subacromial space, lateral to where acromion is.

Question 33

Apprehension and Relocation test (for GH joint)

Answer 33

Patient supine, shuffled over until shoulder is off table. Support their upper arm on your leg, hold their wrist (outer hand). First part is apprehension, as you take the GH joint into external rotation (arm goes up |_o). if patient is worried that their shoulder is going to dislocate they will show apprehension on face or prevent you from continuing movement. Bring arm back up, and put A-P pressure on their anterior GH joint with inner hand to recreate the movement. Patient should be able to have GH joint be put into this external rotation as you stabilise front GH joint.

Question 34

Yergason’s test

Answer 34

Test transverse humeral ligament which holds the long bicep tendon in the bicipital groove. Have patient with arm 90 degrees of flexion at elbow in front of them, almost like holding 90% bicep curl. Have their hand pronated towards the floor. Hold their bicipital groove with one hand while holding onto their wrist (on top) with other hand, and get them to try and supinate their hand through your resistance. If you can feel the biceps tendon popping out of the groove, this indicates a tear of the transverse humeral ligament. Tenderness and pain without the pop indicates bicep tendinosis or slap lesions

Question 35

Functional assessment for hand

Answer 35

Group of movements for hand and finger movement -
- hand shake
- power fist (clench)
- finger span
- duck grip
- pincer grip (need piece of paper, try and pull off them) with EACH FINGER

Question 36

Valgus and varus stress test

Answer 36

Testing: lateral and medial colateral ligaments of the elbow.
patient supine laying at around edge of bench. Your body on inside of patients arm with stabilise arm closer to body and other hand pushing out/inwards to separate arm bones.

Question 37

Cozen’s test

Answer 37

Pain provocation at lateral epicondyle -
Patient seated, arm similar to bicep curl (90 degrees flexion), but with hand in a fist pronated (palm would be down). extend the patient’s wrist (upwards). use 1 hand to stabilise patients arm at elbow and other to put downwards pressure on top of patients hand and ask them to resist.
Positive sign:
-reproduction of pain at lateral epicondyle.

Question 38

Mill’s test

Answer 38

Pain reproduction test at lateral epicondyle.
Patient seated, arm flexed at elbow 90 degrees (like bicep curl) pronate and flex the wrist. Then extend elbow for pain provocation at lateral epicondyle

Question 39

Reverse Cozen’s test

Answer 39

Pain reproduction at medial epicondyle.
Patient seated with arm flexed at elbow 90 degrees (bicep curl-like). Supinate wrist and forearm, get patient to clench fist and flex their hand (upwards). Try and extend the wrist with patient attempting to resist the movement.
Positive test - Pain provocation at medial epicondyle.

Question 40

Reverse Mill’s test

Answer 40

Pain reproduction (passively?) at medial epicondyle.
Patient seated, flex their elbow 90 degrees and hand in supination (palm facing roof). Extend their wrist and then extend their elbow.
Positive test - Pain provocation at medial epicondyle.

Question 41

Modified milking manoeuvre

Answer 41

Testing medial collateral ligament.
Patient laying supine, abduct the shoulder and rest elbow on your thigh. Stabilise shoulder joint with one hand while grasping thumb into extension (thumb pointing down, looks like your a milking it). externally rotate the shoulder (it comes down adjacent to patients body) before sweeping forearm in flexion and extension.
Positive sign - pain provocation at medial epicondyle.

Question 42

Phalen’s test

Answer 42

Pain provocation test - for wrist
Patient seated and asked to touch the back of their wrists flat against each other, and then asking them to bring their elbows down towards the ground while back of hands still touching.
Positive test - pain reproduction at area wrist is being flexed.

Question 43

Reverse Phalen’s test

Answer 43

Pain provocation test - for wrist
Patient seated and get them to place palms together like they are praying. Then get them to draw their hands towards their lap while their elbows are being pressed out to the sides. They need to hold this position for up to 60 seconds to reproduce pain in the carpal tunnel or wrist flexor region.

Question 44

Tinel’s sign

Answer 44

Pain provocation test - for a nerve. (can be any nerve really). Median nerve in this case.
Patient seated with hand supinated and rested comfortably on their lap. Median nerve passes through the carpal tunnel so you percuss (tap) on area of the median nerve.
Positive test - Reproduce pain and discomfort, which in this case (being a nerve) would be numbness and tingling.

Question 45

Finkelstein’s test

Answer 45

Pain provocation test - for abductor and extensor tendons of the thumb
Patient seated, get them to tuck their thumb into palm and wrap their other fingers around it. This could already be a positive test for some people with pain provocation. You can also ask patient to ulnar deviate wrist and you can apply overpressure if needed.
Positive test - pain reproduction at abductor and extensor tendons of thumb.

Question 46

Elson’s - Tendon special tests

Answer 46

Test for central tendon (capacity) and central slips.
Central tendon attaches to PIP and slips on either side of the phalange and they insert onto the DIP together.
Get them to extend their finger against resistance which recruits central tendon. Laxity of DIP highlights this. Issue with Central tendon causes no laxity as central slips are utilized more.