Exams 1-? Flashcards
Gait: Heel to toe
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.
Romberg Test (Romberg’s sign)
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
Rapid alternative movements
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
Finger to nose
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
Heel to shin
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
Finger escape (finger escape sign)
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
Chaddock (Chaddock’s sign)
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
Hoffman’s reflex
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.
Rossilimo test (sign)
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.
Babinski sign
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
Cranial no exam
To be done
Full myotomes assessment
To be done
Passive neck flexion
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.
Axial cervical compression (axial compression test/cervical compression test)
Patient to sit up tall as practitioner interlaces fingers on top of patient’s head. Press down straight S to I with both hands.
Cervical distraction test
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.
Maximum compression (maximum cervical compression test)
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.
Spurlings Test
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).
Cervical Slump Test
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.
ULTT - Median nn bias. (ULTT = Upper Limb Tension Test) (nn = nerve)
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.
ULTT - Radial nn bias.
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.
ULTT - Ulna nn bias
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.
Painful arc
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.
Sulcus Sign (inferior sulcus sign)
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.
O’Briens test
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.
