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Chiro Essentials Neuromusculoskeletal Disorders > General, Ortho, Neuro > Flashcards

General, Ortho, Neuro Flashcards

1
Q

What do you look for posture wise in the lateral projection?

A

EAM, anterior body of C7, acromion process, middle of GH joint, anterior 1/3 of sacrum, center of greater trochanter, just bhind center of knee, 1” anterior to lateral malleolus

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2
Q

Describe kyphosis-lordosis

A

Hourglass appearance of spine, head forward, neck hyperextended, thoracic spine flexed more than usual and lumbar spine is hyerextended so pelvis is tilted anteriorly, knees slightly hyperextended

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3
Q

Describe sway back

A

Head held forward, neck in slight extension, thoracic spine backward, lumbar spine flattened, pelvis tilted posterior, hip joints hyperextended along w/knees

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4
Q

Describe military back

A

Had neutral, lumbar spine is hyperextended and pelvis is tilted anteriorly

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5
Q

Parts of the stance phase?

A

Heel strike (0%), foot flat (15%), push off (30%), acceleration (45%)

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6
Q

Parts of the swing phase?

A

toe-off (60%), swing through (75%), heel strike 100%

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7
Q

RLA phases of gait for stance and swing?

A

Stance: initial contact, loading response, mid-stance, terminal stance
Swing: pre-swing, initial swing, mid-swing, terminal swing

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8
Q

Hip flexors act during what part of the gait? Weakness results in?

A

Acceleration

Abnormal acceleration and swing w/thrusting of the trunk backwards to passively swing the leg

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9
Q

Hip extensors act during what part of the gait? Weakness results in?

A

Heel strike

Forward lurch of trunk on heel strike and patient compensates w/excessive lordosis

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10
Q

Hip abductors act during what part of the gait? Weakness results in?

A

Stance phase

Trendelenburg (lurching) gait-superior gluteal nerve

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11
Q

Hip adductors act during what part of the gait? Weakness results in?

A

Heel strike, toe off

Abnormal rotation of the leg and pelvis

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12
Q

Knee extensors act during what part of the gait? Weakness results in?

A 
Heel strike, acceleration
Knee buckles (especially walking downstairs)
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13
Q

Knee flexors act during what part of the gait? Weakness results in?

A

Deceleration, heel strike

Knee snaps out too hard at end of swing and knee buckles w/heel strike

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14
Q

Foot dorsiflexors act during what part of the gait? Weakness results in?

A

Swing phase, heel strike

Foot drop, steppage gait, foot slap w/heel strike

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15
Q

Foot plantar flexors act during what part of the gait? Weakness results in?

A

Toe push-off

Short step on affected side w/poor push off

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16
Q

Describe antalgic gait

A

Pt favours one leg by putting as little weight as possible on it in order to reduce the pain on that side

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17
Q

Describe choreic gait

A

Jerky twitching dancing gait in Huntington’ and rheumatic fever

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18
Q

Describe deteriorating tandem gait

A

Worsening tandem walk while counting from 50 backwards is an early sign of Alzheimer’s disease

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19
Q

Describe drunken gait

A

Classic wide-based staggering gait seen in cerebellar disease

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20
Q

Describe festinating gait

A

Shuffling (propulsion gait) w/tendency to accelerate as the pt leans forward seen in Parkinson’s

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21
Q

Describe hemplegic gait

A

Spastic leg extended and rotated internally, foot inverted and plantar flexed, limb swung out to keep foot off ground seen in CVA

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22
Q

Describe scissor gait

A

Stiff shuffling movement w/legs crossing over due to increased adductor tone seen in cerebral palsy or paraplegia

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23
Q

Describe sensory ataxic gait

A

Wide-based uneven gait w/high steps and slapping of feet on ground seen in pt w/dorsal column path as in tabes dorsalis, Vit B12 def, diabetes mellitus

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24
Q

Describe steppage gait

A

Pt has to excessively flex hip and knee to allow drop foot to clear the ground when walking seen w/foot drop (peripheral neuropathy)

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25
Q

Describe waddling (lurching) gait

A

Pt leans to same side as weight is placed, due to paralysis of gluteus medius and minimus muscles and may be seen in pts with hip replacements; aka Trendelenburg gait in Duchenne muscular dystrophy and pts w/hip replacements

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26
Q 
Neck ROM:
Flexion
Extension
Abduction
Adduction
Rotation
A 
Flexion: 60
Extension 70
Abduction 45
Adduction 0
Rotation 80
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27
Q 
Thoracic ROM:
Flexion
Extension
Abduction
Adduction
Rotation
A 
Flexion: 50
Extension: 30
Abduction: 0
Adduction: 0
Rotation: 30
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28
Q 
Lumbar ROM:
Flexion
Extension
Abduction
Adduction
Rotation
A 
Flexion: 80
Extension: 35
Abduction: 25
Adduction: 0
Rotation: 0
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29
Q 
Shoulder ROM:
Flexion
Extension
Abduction
Adduction
Rotation
A 
Flexion: 180
Extension: 50
Abduction: 180
Adduction: 50
Rotation: 90
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30
Q 
Elbow ROM:
Flexion
Extension
Abduction
Adduction
Rotation
A 
Flexion: 140
Extension: 0
Abduction: 0
Adduction: 0
Rotation: 90 (pronation/supination)
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31
Q 
Wrist ROM:
Flexion
Extension
Abduction
Adduction
Rotation
A 
Flexion: 90
Extension: 70
Abduction: 20
Adduction: 55
Rotation:0
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32
Q 
MCP ROM:
Flexion
Extension
Abduction
Adduction
Rotation
A 
Flexion: 90
Extension: 10
Abduction: 20
Adduction: 0
Rotation: 0
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33
Q 
PIP ROM:
Flexion
Extension
Abduction
Adduction
Rotation
A 
Flexion: 90
Extension: 0
Abduction: 0
Adduction: 0
Rotation: 0
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34
Q 
DIP ROM:
Flexion
Extension
Abduction
Adduction
Rotation
A 
Flexion: 60
Extension: 0
Abduction: 0
Adduction: 0
Rotation: 0
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35
Q 
Hip ROM:
Flexion
Extension
Abduction
Adduction
Rotation
A 
Flexion: 120
Extension: 30
Abduction: 45
Adduction: 30
Rotation: 40 internal, 45 external
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36
Q 
Knee ROM
Flexion
Extension
Abduction
Adduction
Rotation
A 
Flexion: 150
Extension: 0
Abduction: 0
Adduction: 0
Rotation: 0-5
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37
Q 
Ankle ROM:
Flexion
Extension
Abduction
Adduction
Rotation
A 
Flexion: plantar 40
Extension: dorsi 20
Abduction: 0
Adduction: 0
Rotation: 30 inversion, 20 eversion
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38
Q 
1st MTP ROM:
Flexion
Extension
Abduction
Adduction
Rotation
A 
Flexion: 45
Extension: 70-90
Abduction: 0
Adduction: 0
Rotation: 0
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39
Q

Flexors at the shoulder?

Extensors?

A

Flex: pec major, deltoid
Ext: lat, deltoid, teres major

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40
Q

Medial and lateral rotators of the shoulder?

A

Medial: Pec major, lat dorsi, teres major
Lateral: Infraspin

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41
Q

Adductors and abductors of the shoulder?

A

Adductor: Pec major, lat dorsi, teres major
Abductor: Deltoid, supraspin

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42
Q

What does biceps do at the elbow? Triceps?

A

Biceps: Flexion and supination (medial rotation)
Triceps: extension, adductors

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43
Q

What does flexor carpi radialis at the elbow? ulnaris?

A

Radialis: Flexion, abductor
Ulnaris: flexion, adduction

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44
Q

What do flexor digitorum profudnus and superficialis do at the MCP? Extensor digitorum?

A

FDP/S: Flexion

ED: extension

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45
Q

Psoas action at the hip? Piriformis?

A

Psoas: flexion, lateral rotation
Piriformis: lateral rotation

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46
Q

What are the action of gut max and med at the hip?

A

Max: extension, adduction
Med: Abduction

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47
Q

What extends the knee? flexes?

A

Extends: Quads
Flex: gastrocs and biceps femoris

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48
Q

Plantarflexors at the ankle? Dorsiflexors?

A

Plantar: Gastroc, post tib, peroneus/fibularis
Dorsiflex: Ant tib

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49
Q

Inverters of the ankle? Everters?

A

Ant and post tib invert

Peroneus/fibularis evert

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50
Q

Is atrophy of the muscle an upper or lower motor neuron lesion?

A

Lower

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51
Q

Bent 4th or 5th fingers and palmar ridge are indicative of what pathology?

A

Dupuytren’s contracture

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52
Q

Bouchard’s nodes are found at what joint? Part of what pathologies?

A

Proximal interphalangeal joints

OA or RA

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53
Q

A cold painful large joint with crepitus could be what pathology?

A

OA

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54
Q

Crepitus over moving tendons could indicate?

A

Scleroderma

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55
Q

Fasciculation is part of an upper or lower motor neuron lesion?

A

Lower

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56
Q

Gottron’s papules are? Indicative of what pathology?

A

Lumps on the knuckles

Dermatomyositis

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57
Q

Haygarth’s nodes are found where? Part of what pathology?

A

Metacarpophalangeal joints

RA

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58
Q

Heberden’s nodes are found where? Part of what pathology?

A

Distal interphalangeal joints

OA

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59
Q

Heliotrope discolouration of eyelids is part of what pathology?

A

Dermatomyositis

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60
Q

Interossei wasting could indicate damage to what nerve?

A

Ulnar nerve

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61
Q

Pseudohypertrophic calves is an indicator of?

A

Duchenne’s muscular dystrophy

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62
Q

Spatulate (spade-like) hands are indicative of?

A

Acromegaly

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63
Q

Tapered tight finger tips are part of?

A

Scleroderma

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64
Q

Thenar eminence wasting is indicative of damage to what nerve?

A

Median

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65
Q

Inability to clash paper between extended fingers is a sign of ?

A

Ulnar nerve palsy

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66
Q

Inability to extend wrist against resistance is a sign of?

A

Radial N palsy

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67
Q

Unable to oppose the thumb to the pinky is a palsy of what nerve?

A

Median N

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68
Q

Wasted lateral leg compartment is a sign of what syndrome?

A

Charcot-Marie-Tooth syndrome

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69
Q

Acromegaly:
Cause?
Presentation?
Management?

A

Excessive GH after growth plates fused; due to pituitary adenoma
Large spatulate hands, latern-shaped jaws, overhanging brows, increased hat size, headaches, visual problems (like bitemporal hemianopia), enlarged sella, arrow-head appearance of terminal phalanges, heel pad >23 mm on lateral x-ray of foot
Refer to endocrinologist

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70
Q

Ankylosing Spondylitis:
Cause?
Presentation?
Management?

A

Chronic inflammatory condition of SI joints and axial skeleton marked by bone formation at ligament and tendon attachments
Low back pain >3 months, better w/exercise not rest, limitation of lumbar spine movement in sagittal and coronal planes, bilateral sacroiliac tenderness, decreased chest expansion w/inspiration, X-rays show shiny corners, marginal syndesmophytes, dagger sign, bamboo spine, ESR and alkaline phosphatase elevated in active phase, HLA B27 +
Co-manage w/rheumatologist

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71
Q

Charcot Marie Tooth Diease:
Cause?
Presentation?
Management?

A

Hereditary motor and sensory neuropathy w/peroneal (fibularis) muscle atrophy
Wasted fibularis, foot drop, high arch, claw toes
Neurologist

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72
Q

Dermatomyositis:
Cause?
Presentation?
Management?

A

Autoimmune inflammatory disease affecting muscle and skin
Fatigue, heliotrope discolouration of eyelids and muscle fatigue, CK-MM/LDH elevated, ANA+
Dermatologist –> muscle and skin biopsy

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73
Q

Duchenne’s muscular dystrophy:
Cause?
Presentation?
Management?

A

X-linked chromosomal abnormality w/deficient dystrophin
Proximal muscle weakness, pseudohypertrophic calf muscles, +Gower’s sign, waddling gait
Refer to pediatrictian -> Muscle biopsy

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74
Q

Dupuytren’s Contracture:
Cause?
Presentation?
Management?

A

Contracture of palmar fascia; seen with diabetes mellitu, cirrhosis and chronic phenytoin use
4th/5th fingers bent toward palm w/longitudinal palmar ridge
Co-manage w/hand surgeon

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75
Q

Ehlers-Danlos syndrome:
Cause?
Presentation?
Management?

A

Inherited CT w/defective collagen
Hypermobile joints, skin that easily stretches and is damaged, kyphoscoliosis
Refer to pediatrician

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76
Q

Gout:
Cause?
Presentation?
Management?

A

Metabolic condition characterized by deposition of uric acid crystals in joints
Sudden onset of severe joint pain, big toe swelling, tophi, soft tissue swelling, bony erosions w/overhanging edges, - birefringent needs crystals in aspirated synovial fluid
Co-manage w/rheumatologist, advice on avoidance of alcohol, purine rich foods and fluids

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77
Q

Lyme disease:
Cause?
Presentation?
Management?

A

Infection of skin, nerves, muscles, joints caused by Borrelia burgdorferi transmitted by deer tick
Stage 1: presents w/flu-like illness w/erythema migrans
Stage 2: Bell’s palsy, peripheral neuropathy
Stage 3: Chronic arthritis and muscle pains
Refer to rheumatologist Lyme-ELISA confirmatory

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78
Q

Marfan’s:
Cause?
Presentation?
Management?

A

Hereditary condition resulting in defective fibrillin production
Presents w/tall, thin body habitus, hypermobile joints, lens dislocation, aortic incompetence, mitral valve prolapse, dissecting thoracic aorta
Refer to internist

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79
Q

Osteoarthritis:
Cause?
Presentation?
Management?

A

Progressive degeneration of articular cartilage
Pain in weight bearing joints (knee, hip, spine), morning stiffness lasting <1 hr, pain worse w/use and towards end of day, joint space narrowing, subchondral sclerosis, marginal osteophyets, subchondral cysts
Co-manage w/orthopedist, advice on weight loss, exercise, nutritional supplements with glucosamine

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80
Q

Osteomyelitis:
Cause?
Presentation?
Management?

A

Bacterial infxn of bones; commonly associated w/IV drug use and Staph aureus
Fever, nearby joint swollen, warm, red, leukocytosis, elevated neutrophils, soft tissue swelling w/Brodie’s abscess, involucrum, sequestrated bone
Refer to hospital for MRI

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81
Q

Osteoporosis:
Cause?
Presentation?
Management?

A

Progressive metabolic bone disease in which generalized decreased bone density, seen more commonly in postmenopausal women and men after 70’s
Decreased height, increased kyphosis, dowager hump, increase risk of fx, accentuated trabecular, Wade’s triangle, serum calcium and phosphate normal, DEXA score >2.5
Co-manage w/orthopedist, prevention aimed at risk reduction-smoking cessation, regular weight-bearing exercises and increased Ca2+ and Vit D

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82
Q

Rheumatic Fever:
Cause?
Presentation?
Management?

A

Autoimmune disorder triggered by strep pyogenes (heart, skin, joints)
Syndenham’s chorea, polyarthritis, erythema marginatum, carditis, subcutaneous nodules, ASOT/ESR elevated and PR interval prolonged
Refer to hospital

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83
Q

Rheumatoid Arthritis:
Cause?
Presentation?
Management?

A

MC autoimmune disorder; seen MC in middle aged females
Bilateral PIP, MCP and wrist pain w/morning stiffness lasting >1 hr, RF raised, with ESR and anti-CCP, symmetrical bilateral intra-articular erosions, periarticular osteoporosis w/ulnar deviation of MCP joints
Co-manage w/pulmonologist

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84
Q

Scleroderma:
Cause?
Presentation?
Management?

A

Chronic autonomic CT disorder characterized by fibrosis; MC in females
Thickened shin skin over fingers, sensitivity to cold, joint pains w/tendon crepitus, SoB, fatigue, dysphagia; calcinosis cutis, raynaud’s, esophageal hypomotility, sclerodactyly, telangiectasia (CREST), anti scl-70 +
Co-manage w/pulmonologist

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85
Q

Scoliosis is ok for Chiropractic w/in how many degrees? Bracing? Surgery?

A

10-20
20-40
>40

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86
Q

Septic Arthritis:
Cause?
Presentation?
Management?

A

Acute infection of one joint caused by bacterial infection seen in IV drug use; Staph aureus is the MC causative organism
Fever, severe acute joint pain w/swelling and marked decrease in ROM, leukocytosis and high neutrophils, WBC in joint aspiration and bacteria
Hospital

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87
Q

Pott’s disease/TB of spine:
Cause?
Presentation?
Management?

A

Infection by mycobacterium tuberculosis
Fatigue, gibbus, psoas abscess, destruction of anterior vertebral body, lesions in apex of lungs
Refer to infectious disease specialist

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88
Q

C5 dermatome, muscle test, reflex?

A

Lateral arm
Deltoid (abduct shoulder)
Biceps brachii

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89
Q

C6 dermatome, muscle test, reflex?

A

Lateral forearm to thumb
Biceps brachii (flex elbow)
Brachioradialis

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90
Q

C7 dermatome, muscle test, reflex?

A

Middle finger
Triceps (extend elbow)
Triceps

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91
Q

C8 dermatome, muscle test, reflex?

A

5th finger to inner forearm
FDP (flex fingers)
None

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92
Q

T1 dermatome, muscle test, reflex?

A

Medial elbow
Abduct little finger
None

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93
Q

T2 dermatome, muscle test, reflex?

A

Axilla
N/A
N/A

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94
Q

T4 dermatome, muscle test, reflex?

A

Nipple
N/A
N/A

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95
Q

T7 dermatome, muscle test, reflex?

A

xiphoid region
N/A
N/A

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96
Q

T10 dermatome, muscle test, reflex?

A

Umbilical region
N/A
N/A

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97
Q

T12 dermatome, muscle test, reflex?

A

Suprapubic region
N/A
N/A

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98
Q

L1 dermatome, muscle test, reflex?

A

Inguinal region
N/A
Cremasteric

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99
Q

L2 dermatome, muscle test, reflex?

A

Anterior thigh
Iliopsoas (flex hip)
Cremasteric

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100
Q

L3 dermatome, muscle test, reflex?

A

Lateral thigh
Quadriceps femoris (Squat and rise)
Patellar

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101
Q

L4 dermatome, muscle test, reflex?

A

Medial leg to big toe
Tibialis Anterior (dorsiflex and invert ankle)
Patellar

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102
Q

L5 dermatome, muscle test, reflex?

A

Dorsum of foot
Extensor hallucis longus (extend big toe, heel walk)
Hamstring

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103
Q

S1 dermatome, muscle test, reflex?

A

Lateral foot
Gastrocnemius or fibularis longus (toe walk)
Achilles

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104
Q

Reflex grading on the Wexler scale

A 
0 - no response
1 - diminished response
2 - normal
3 - Brisk response
4 - Very brisk response w/clonus
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105
Q

Muscle grading on the Van Allen scale

A

0 - no muscular contraction
1 - Barely detectable flicker of contraction
2 - Full ROM but not against gravity
3 - Full ROM against gravity not resistance
4 - Full ROM against gravity and some resistance
5 - Full ROM against gravity and resistance

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106
Q

Nerve roots for the anal wink reflex?

A

S3, 4

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107
Q

Criteria for an upper motor neuron lesion?

A

Spastic paralysis, increased tone, increased reflexes w/clonus, no atrophy or fasciculation, present Babinski and hoffmann reflexes

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108
Q

Criteria for a lower motor neuron lesion?

A

Flaccid paralysis, decreased tone and reflexes, atrophy and fasciculations present, absent babinski/hoffmann reflexes

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109
Q

Spinal cord reflexes are carried by what tract?

A

Lateral corticospinal tract

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110
Q

Removal of inhibition of what neuron causes spastic paralysis seen in an upper motor neuron lesion?

A

Renshaw cell

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111
Q

Abulia is? Could indicate what pathology?

A

Inability to make decisions

Stroke, damage to basal ganglia

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112
Q

An absent corneal reflex could indicate damage to what cranial nerves?

A

CN V (afferent) CN VII (efferent)

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113
Q

Agnosia is? Could indicate what pathology?

A

Inability to recognize sight, sounds, words

Stroke, dementia or severe head injury

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114
Q

Akinesthesia is? Could indicate damage to what tract?

A

Loss of proprioception

Dorsal column

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115
Q

Anascoria is? Could indicate damage to?

A

Unequal pupil size

CN III’s sympathetics or parasympathetics

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116
Q

Aphasia is? Could indicate damage to

A

Unable to express oneself w/words

Broca’s speech area (Brodmann areas 44 and 45)

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117
Q

Apraxia is? Could indicate damage to?

A

Inability to perform learned movement

Cerebellum

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118
Q

Asthenocoria is? Is present in what pathology?

A

Sluggish pupil light reflex (Arroyo’s sign)

Addison’s

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119
Q

Ataxia is? Could indicate damage to?

A

Loss of balance

Cerebellar, vestibular/dorsal column damage

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120
Q

Athetosis is? Could indicate damage to?

A

Slow snake like movements

Damage to putamen in basal ganglia

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121
Q

Bielschowsky’s sign is? Could indicate damage to?

A

Head tilt to opposite side

CN IV palsy (S.O. muscle)

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122
Q

Bitemporal hemianopia is? Could indicate damage to?

A

Both temporal halves blind

CN II damage at optic chiasm or pituitary tumor

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123
Q

Cape like loss of pain and temperature is indicative of a?

A

Syringomyelia

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124
Q

What is Cushing’s triad? Caused by what?

A

High BP, low pulse, irregular respiration

Raised intracranial pressure

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125
Q

Dysarthria test? Damage to what?

A

Say KuLaMi

K = CN X, L = CN XII and M = CN V

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126
Q

What is Homan’s sign? Present with?

A

Flexion of thumb after flicking middle finger

UMN lesion in upper limb

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127
Q

Homonymous hemianopia is? Damage is where?

A

Same halves on both sides missing

Damage to contralateral optic radiation

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128
Q

Loss of gag reflex is indicative of damage to?

A

CN IX (afferent) and X (efferent)

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129
Q

Loss of stereognosis is? Damage to?

A

Recognize objects by feeling

Dorsal column

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130
Q

Mittelmeyer test is? If positive could indicate damage to

A

March on spot w/eyes closed

Vestibular N damage (side turned to)

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131
Q

Pill rolling/resting tremor is seen in what pathology?

A

Parkinson’s

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132
Q

Decerebrate rigidity is? Seen with brainstem lesions below what?

A

Upper limbs in extension

Red nucleus

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133
Q

Decorticate rigidity is? Seen with brainstem lesions above what?

A

Upper limbs in flexion

Red nucleus

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134
Q

Clasp knife rigidity is seen with?

A

Upper motor neuron lesion

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135
Q

Scanning speech, intention tremor, nystagmus =

A

MS

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136
Q

Sign of benediction is indicative of?

A

Median nerve damage

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137
Q

Synesthesia is? Caused by?

A

Perceiving sounds as different colours

Unknown; hereditary (?)

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138
Q

Titubation not in time with the pulse is a sign of?

A

Cerebellar disease

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139
Q

Tongue deviates to one side is indicative of damage to?

A

Ipsilateral CN XII palsy/damage

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140
Q

Postural tremors are seen with?

A

Hyperthyroidism

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141
Q

UMN/LMN lesions in >=3 limbs diagnosis?

A

ALS

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142
Q

Uvula deviation is indicative of?

A

Damage to CN X on opposite side

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143
Q

Inability to adduct thumb is what nerve damaged? Extend? Oppose?

A

Ulnar
Radial
Median

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144
Q

Cricothyroid is innervated by?

A

Superior laryngeal N

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145
Q

Palatoglossus is innervated by?

A

Pharyngeal plexus of CN X

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146
Q

Stylopharyngeus is innervated by?

A

Glossopharyngeal N

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147
Q

Arm flexors are supplied by what N (roots)?

A

Musculocutaneous N (C5, 6, 7)

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148
Q

Arm extensors are innervated by what N (roots)?

A

Radial (C5-T1)

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149
Q

Flexor muscles of the thigh are supplied by what N (roots)?

A

Femoral N (L2-4)

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150
Q

Adductors of the thigh are supplied by what N (roots)?

A

Obturator N (L2, 3, 4)

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151
Q

Extensor compartment of the thigh are supplied by?

A

Sciatic N

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152
Q

Lateral compartment of the leg muscles are supplied by what Nerve?

A

Superficial peroneal/fibular N

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153
Q

Posterior compartment of the leg muscles are supplied by what nere?

A

Tibial N

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154
Q

Muscles of the anterior compartment of the leg and dorsum of foot are supplied b what N?

A

Deep peroneal/fibular N

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155
Q

Mucles of the sole of the foot are supplied by what nere?

A

Lateral and medial plantar branches of the tibial nerve

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156
Q

Gluteus maximus is supplied by what N (roots)?

A

Inferior gluteal N (L5-S2)

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157
Q

Acoustic Neuroma:
Caused by?
Presents as?
Management?

A

Benign tumor of Schwann cells affecting the vestibular part of CN VIII - part of Type II neurofibromatosis
Facial palsy, ipsilateral deafness
Refer to neurosurgeon –> CT scan

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158
Q

Amyotrophic Lateral Sclerosis:
Caused by?
Presents as?
Management?

A

Rapidly progressive degenerative NM condition resulting in LMN lesions in upper limbs and UMNL’s in lower limbs
Muscle weakness, clumsy movements along w/dysphagia and dysarthria of 3/4 limbs, , patchy sclerosis of SC and periventricular plaques in brain with Dawson’s fingers on MRI
Co-manage w/neurologist

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159
Q

Bell’s Palsy:
Caused by?
Presents as?
Management?

A

Unilateral LMN of CN VII caused by HHV Type I or associated w/Lyme disease
Inability to smile and wrinkle forehead on one side w/ipsilateral loss of taste and hyperacusis on same side
Co-manage w/neurologist; chiropractic adjustments and nutritional supplements

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160
Q

Charcot Marie Tooth Disease:
Caused by?
Presents as?
Management?

A

Hereditary motor and sensory neuropathy w/peroneal muscle atrophy
Wasted peroneal muscles, foot drop, high arch and claw toes along w/loss of touch in feet and legs (hands and arm)
Co-manage w/neurologist

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161
Q

Erb’s Palsy:
Caused by?
Presents as?
Management?

A

Traction trauma during vertex delivery to upper roots (C5/6) of brachial plexus
Extension, forearm pronated, wrist flexed
Co-manage w/neurologist

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162
Q

Huntington’s:
Caused by?
Presents as?
Management?

A

Hereditary neurological condition affecting basal ganglion, onset in 3rd decade
Jerky involuntary movements, chorea, mental deterioration
Co-manage w/neurologist

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163
Q

Klumpke’s paralysis:
Caused by?
Presents as?
Management?

A

Traction injury during breech delivery to lower roots (C8/T1) of brachial plexus/distraction injury in catching themselves
Claw hand
Co-manage w/neurologist

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164
Q

Multiple Sclerosis:
Caused by?
Presents as?
Management?

A

Chronic demyelinating neurological disease of unknown origin MC in western European lineage
Transient weakness, tingling in limb, scanning speech, intention tremor, nystagmus, visual problems, white foci in SC and periventricular tissue of brain on MRI
Co-manage w/neurologist

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165
Q

Subarachnoid Hemorrhage:
Caused by?
Presents as?
Management?

A

Rupture of one of vessels in Circle of Willis; often seen in berry aneurysms
Sudden onset of worst headache ever w/orw/o change in LoC, neck stiffness, no fever, + Kernig’s and Brudzinski’s
Hospital –> Lumbar puncture, CT scan

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166
Q

Describe how to do the abdominal reflex?

A

Light stroking of the four quadrants of the abdomen causes anterior abdominal wall to contract (T7-10 above umbilicus; T11-L1 below umbilicus)

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167
Q

Describe how to do the carotid sinus reflex?

A

Massaging carotid sinus decreases HR (afferent portion, CN IX and efferent portion: CN X)

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168
Q

Describe how to do the ciliospinal reflex?

A

Painfully pinching back of neck may cause pupil on same side to dilate (Afferent portion: C1-5, efferent: cervical spinal N)

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169
Q

Describe how to do the Corneal reflex?

A

Blowing puff of air on cornea of the open eye will result in blinking of eye (afferent CN V; efferent CN VII)

170
Q

Describe how to do the cremasteric reflex?

A

Stroking inner aspect of upper thigh causes ipsilateral testis to be elevated (L1 and 2)

171
Q

Describe how to do the gag reflex?

A

Touching soft palate of throat cause pt to gag (CN IX/X)

172
Q

Describe how to do the oculocardiac reflex?

A

Massaging eyeballs will decrease HR (afferent: CN V1, efferent: para via CN X)

173
Q

Describe how to do the plantar reflex?

A

Stroking outer aspect of plantar surface of foot from posterior to anterior and medial causes big toe and other toes to plantarflex

174
Q

Describe how to do the uvular reflex?

A

Touching uvula causes it to be elevated (afferent: CN IX, efferent: CN X)

175
Q

Describe how to do the babinski reflex?

A

Stroking outer part of plantar aspect of foot from posterior to anterior and medial results in up-going big toe and flaring of the toes

176
Q

Describe how to do the chaddock reflex?

A

Stroke skin over lateral malleolus will cause an up-going big toe and flaring of other toes

177
Q

Describe how to do the Ganda reflex?

A

Downward pressure on 4th toe and suddenly releasing it with a snap causes dorsiflexion of the big toes

178
Q

Describe how to do the Glabella reflex?

A

Tapping the glabella repeatedly will cause continuous blinking of the eyes as long as the glabella is being tapped

179
Q

Describe how to do the Gordon’s calf reflex?

A

Squeezing mid calf causes up-going big toe and flaring of other toe

180
Q

Describe how to do the Gordon’s finger reflex?

A

Compression of pisiform may result in flexion of all fingers or just flexion of thumb and index finger

181
Q

Describe how to do the Hoffman reflex?

A

Flicking middle finger of pt will cause adduction of thumb and slight flexion of index finger

182
Q

Describe how to do the Oppenheim reflex?

A

Rung thumb along anteromedial aspect of tibia will cause upgoing big toe and flaring of others

183
Q

Describe how to do the Rossolimo reflex?

A

Tapping tips of toes causes excessive flexion of toes

184
Q

Describe how to do the Schaffer reflex?

A

Squeezing Achilles cause up-going big toe and flaring of other toes

185
Q

Describe how to do the Snout reflex?

A

Tapping closed lips above midline repeatedly will cause lips to pout

186
Q

Describe how to do the Tromner reflex?

A

Tapping palmar aspect of tips of middle and index fingers cause flexion of all four fingers and thumb

187
Q

Halfway between angle of jaw and mastoid process you find the?

A

TVP of C1

188
Q

Hyoid bone is at the level of?

A

C3

189
Q

Upper border of the thyroid cartilage is at the level of?

A

C4

190
Q

Lower border of the thyroid cartilage is at the level of?

A

C5/6

191
Q

Last moveable SP on flexion 70% of the time? 30%?

A

C7

T1

192
Q

Root of spine of scapula is at what vertebral level?

A

T3

193
Q

Burn’s space is at what vertebral level??

A

T2

194
Q

Manubriosternal level is at what vertebral level?

A

T4/5

195
Q

Inferior scapular angle lying down is at what vertebral level?

A

T6

196
Q

Inferior scapular angle sitting up is at what vertebral level?

A

T7

197
Q

Xiphisternal angle is at what vertebral level?

A

T9

198
Q

Xiphoid process is at what vertebral level?

A

T10

199
Q

Iliac crest or umbilicus is at what vertebral level?

A

L4

200
Q

PSIS is at what vertebral level?

A

S2

201
Q

1/3 along a line btw ASIS and umbilicus is where you find?

A

Base of the appendix

202
Q

Meeting point of right linea semilunaris and 9th rib is where you find?

A

Fundus of gallbladder

203
Q

Btw 9-11th ribs in the left midaxillary line is where you find?

A

Spleen

204
Q

1/2 btw ASIS and pubic symphysis in the groin is where you find?

A

Femoral A

205
Q

1/2 btw ischial tuberosity and greater trochanter is where you find?

A

Sciatic N

206
Q

1/2 btw the mastoid process and sternoclavicular joint is where you find?

A

Carotid A bifurcation

207
Q

1 finger’s breath medial to bicipital tendon in elbow is where you find?

A

Brachial A

208
Q

1 finger’s breath posterior and below medial malleolus is where you find?

A

Posterior tibial pulse

209
Q

Just lateral to flexor carpi radialis tendon is where you find?

A

Radial pulse

210
Q

Just lateral to the extensor hallicus longus tendon is where you find?

A

Dorsalis pedis

211
Q

A C5/6 disc herniation will affect which nerve root?

A

C6

212
Q

An L4/5 disc herniation will affect which nerve root?

A

L5

213
Q

Describe Budzinski test and interpretation:

A

Passively flex neck of supine patient towards the chest. If the patient’s hips and knees flex in response to action = meningitis

214
Q

Describe Cervical compression test and interpretation:

A

Ask pt to sit up and bend head backwards while you press down on vertex. If pain = subluxation, arthritis, facet degeneration

215
Q

Describe Dejerine’s triad and interpretation:

A

Ask seated pt to cough, strain, sneeze if pain increases = space occuyping lesion

216
Q

Describe Kernig’s test and interpretation:

A

With pt lying supine w/hips and knees partly flexed attempt to extend knee. If pain or other knee flexes involuntarily = meningeal irritation (meningitis or subarachnoid hemorrhage)

217
Q

Describe Rinne test and interpretation:

A

Place vibrating 512 tuning fork over mastoid and ask pt to say when sound is no longer heard (bone conduction). Then place vibrating tuning fork 1” from ear and repeat (air conduction) Normal AC>BC if BC>AC conduction loss (otitis media) if AC and BC are decreased on one side it is nerve conduction deficit

218
Q

Describe Weber test and interpretation:

A

Place 512 vibrating tuning fork on vertex of patient’s head and ask patient to state where sound loudest. If patient chooses one ear = problem w/one ear (not necessarily the ear they chose)

219
Q

If a headache is worse in the morning + Dejerine’s triad one should suspect?

A

Brain tumor

220
Q

Occipital headache radiating to eyes + tender occipital N one should suspect?

A

Occipital neuralgia

221
Q

Overweight female + bilateral papilledema after tetracycline use =

A

Pseudotumor cerebri

222
Q

Brain Tumor:
Caused by?
Presents as?
Management?

A

SOL in cranium
H/A worse w/coughing/straining/sneezing, diplopia (CN VI), deafness (CN VIII), dysphagia (CN X), irrational thoughts (frontal lobe), blurred vision, papilledema
Neurologist –> CT scan/MRI

223
Q

Cervicogenic Headache:
Caused by?
Presents as?
Management?

A

Discomfort in head originating from cervical spine
Head pain radiating to eyes, related to specific neck movements, decreased passive neck movements w/taut and tender muscles
Chiropractic management is very effective

224
Q

Cluster Headache:
Caused by?
Presents as?
Management?

A

Syndrome of recurrent paroxysmal episodes of sudden severe unilateral headaches occur over a period of weeks at the same time every day, triggered by alcohol or afternoon naps
Red eye, nasal congestion, runny nose on same side as headache
Co-manage w/neurologist and headache specialist

225
Q

Classic migraine:
Caused by?
Presents as?
Management?

A

Syndrome of recurrent unilateral throbbing headaches preceded by aura of flashing lights; may be triggered by tyramine in aged cheese and red wines
Nausea and vomiting, photophobia, phonophobia, aggravated by activity
Co-manage w/headache specialist

226
Q

Common Migraine:
Caused by?
Presents as?
Management?

A

Syndrome of recurrent unilateral throbbing headaches that aren’t preceded by aura of flashing lights
Nausea, vomiting, photophobia, phonophobia, worse w/activity
Co-manage w/headache specialist

227
Q

Influenza:
Caused by?
Presents as?
Management?

A

Respiratory tract infection from influenza virus spread by droplets or aerosol dispersal
Abrupt onset of fever, headache, myalgia, stuffy nose, may worsen into a pneumonia in very young and elderly
Serology, chiropractic, rehydration, nutritional supplements, children and elderly to hospital if SOB, high fever, change in LOC

228
Q

Arnold’s/Occipital Neuralgia:
Caused by?
Presents as?
Management?

A

Occipital headache due to compression of greater occipital N (dorsal ramus C2)
Pain btw occiput and atlas radiating to behind eye on affected side
Chiropractic care helpful

229
Q

Tension type headache:
Caused by?
Presents as?
Management?

A

Chronic recurrent daily bitemporal headaches bilateral and squeezing in nature
Headaches are not aggravated by activity; not associated w/nausea, vomiting, photophobia
Adjust, advice on stress reduction

230
Q

Trigeminal Neuralgia:
Caused by?
Presents as?
Management?

A

Disorder of trigeminal N producing pain with cold/touch/wind
Severe excruciating, lancinating pain for few seconds to 2 minutes along distribution of trigeminal N, usually mandibular division, MRA reveal aberrant A near one division of N
Co-manage w/neurologist

231
Q

CPPD:
Caused by?
Presents as?
Management?

A

Joint disease of calcium pyrophosphate deposition in articular cartilage, common in DM, hemachromatosis, hyperparathyroidism
Asymptomatic - painful joints (knee, wrist, hip, shoulder), linear calcification in articular cartilage on film and + birefringent rhomboid crystals on aspiration
Co-manage w/rheumatologist

232
Q

Enteropathic arthritis:
Caused by?
Presents as?
Management?

A

Joint disease with specific inflammator bowel disease (Crohn’s, UC)
Painful knees, ankles, SI joints, recurrent diarrhea, elevated ESR, HLA-B27+
Co-manage w/rheumatologist

233
Q

Gonococcal arthritis:
Caused by?
Presents as?
Management?

A

Infective monoarthritis caused by N. Gonorrhea, spread by blood
Hot swollen painful joint following thick purulent urethral discharge, leukocytosis, elevated neutrophils, aspiration shows WBCs and gram - diplococci
Hospital

234
Q

Describe Bonnet test and interpretation:

A

Pt supine, raise extended leg, internally rotate foot, adduct extended limb. If pain radiates into leg = piriformis syndrome

235
Q

Describe Buerger test and interpretation:

A

Elevate leg until it becomes pale. Return leg from raised position and let it have over side of bed. Pink colour return slowly. May become red due to dilation of artrioles in attempt to get rid of metabolic waste that has built up = Buerger’s disease, peripheral vascular diseae, arterial insufficiency

236
Q

Describe Freiberg test and interpretation:

A

Pt supine, passively abduct and internally rotate hip on side w/pain to passively stretch pririformis muscle if pain = piriformis syndrome

237
Q

Describe Homan test and interpretation:

A

Pt supine, raise straight leg 10o, dorsiflex ankle and queeze calf. If pain DVT, ruptured plantaris tendon, ruptured Baker’s cyst

238
Q

Describe Pace test and interpretation:

A

Pt ext rtn and abduct hip while you resist these movements if pain = piriformis syndrome

239
Q

Buerger’s disease/Thromboangitis obliterans:
Caused by?
Presents as?
Management?

A

Young male smokers; inflammation of medium size arteries and veins
Intermittent claudication, weak peripheral pules, anti-inflammatories useless, + Buerger’s test
Co-manage w/vascular specialist –> angiography confirms

240
Q

Cellulitis:
Caused by?
Presents as?
Management?

A

Superficial skin infxn caused by Staph aureus/Strep pyogenes
Painful, red, hot swollen leg well defined edges, leukocytosis and raised neutrophils on CBC
Hospital or medical practitioner for antibiotics

241
Q

Compartment Syndrome:
Caused by?
Presents as?
Management?

A

Trauma to muscles in ant/lat compartment of leg causing ischemia
Pain and swelling, numbness, later loss of affected peripheral pulse (dorsalis pedis)
Refer to hospital –> Intracompartmental pressure confirms

242
Q

Difference between lateral and medial disc bulge?

A

Lateral: lean away from affected side
Medial: lean towards affected side

243
Q

Peripheral vascular disease:
Caused by?
Presents as?
Management?

A

Atherosclerotic narrowing of BV of lower limb
intermittent claudication worse on exertion and better resting along w/hair loss in legs and feet
(May present w/Leriche syndrome: intermittent claudication, decreased peripheral pulses bilaterally and impotence)
Co-manage w/vascular surgeon –> angiography

244
Q

Piriformis syndrome:
Caused by?
Presents as?
Management?

A

Radiating leg pain due to compression of sciatic N as it passes through piriformis muscle
Radiating leg pain, + SL, Bonnet’s, Freiberg’s, Pace’s might be positive
Adjust and stretch

245
Q

Describe Bowstring test and interpretation:

A

Left affected leg of supine pt w/knee flexed until above shoulder and apply firm pressure on hamstring and popliteal fossa. If either causes leg/back pain = NR compression

246
Q

Describe Braggard test and interpretation:

A

SLR then lower limb 5o below where pain felt and dorsiflex foot if pain increases = irritation of sciatic N roots

247
Q

Describe double leg raise test and interpretation:

A

Raise each leg of supine pt separately noting angle pain is produced then both together, if angle less than lumbosacral joint involvement

248
Q

Describe Lasegue test and interpretation:

A

Grasp heel of affected extended limb of supine pt in one hand and place other hand on knee, flex hip while knee flexed, extend knee while leg elevated if limited ROM b/c pain = sciatic N or NR irritation

249
Q

Describe Lewin’s supine test and interpretation:

A

Stabilize thighs on table and ask pt to sit p w/o hands, pain/inability = sciatica or lumbosacralpathology

250
Q

Describe Lindner test and interpretation:

A

Passively flex pt head then neck to chest of pt, if pain along lumbar spine/back of thigh and leg = sciatica due to disc herniation (esp lateral)

251
Q

Describe Milgram test and interpretation:

A

Ask supine pt to raise both extended legs so heels 6” off table and hold for 30s if pain/inability = disc lesion OR raised intrathecal P

252
Q

Describe Sicard test and interpretation:

A

If SLR + lower leg below pain extend big toe of affected foot if duplicates pain = sciatic NR compression

253
Q

Describe SLR test and interpretation:

A

Place one hand below heel of supine pt’s extended limb and other hand on knee, lift leg note angle pain happens if between 0-35o extradural NR irritation (piriformis syndrome), 35-70o disc herniation, >70o lumbosacral jt disease

254
Q

Describe Well Leg Raise/Fajersztajn test and interpretation:

A

Raise asymptomatic leg of pt and dorsiflex foot if pain inaffected leg = disc comp of roots of sciatic N (medial disc protrusion on contralateral side) or dural sleeve adhesions

255
Q

Describe Ely test and interpretation:

A

Flex knee of prone pt to bring heel to touch opposite buttock, if inability to flex iliopsoas pathology or inflammed roots of femoral N if after full knee flexion can’t hyperextend hip = hip lesion

256
Q

Describe Femoral N stretch test and interpretation:

A

Stabilize hip place one hand on ilium of prone pt, passively flex knee and extend hip, if ext of hip causes pain along anterior thigh = femoral N irritation

257
Q

Describe Nachlas test and interpretation:

A

Passively flex knee f prone pt to same buttock while exerting downward pressure on pelvis to prevent buckling at hips if pain = lumbosacral pathology

258
Q

Describe Adam supported/Belt test and interpretation:

A

Ask standing pt to bend forward once and then while bracing your hip on pt’s sacrum and holding onto their ASIS’s
If pain after second maneuver lumbar issue if pain disappears after second maneuver pelvic problem

259
Q

How does the pt stand w/a posterior disc herniation?

A

Slightly flexed (extension causes pain)

260
Q

Describe Kemp’s test and interpretation:

A

Grab opposite shoulder of affected pelvis and lean pt backward into lumbar extension, aim shoulder to affected side where weight-bearing pressure on facet is greatest, if localized pain facet problem if radiation into thigh and leg NR compression due to disc

261
Q

Describe Schober test and interpretation:

A

Mark 2 spots 5 cm below PSIS and 10 cm above ask pt to bend forward and touch toes w/o bending knee and measure distance subtract 15 if <5cm = AS

262
Q

Describe one-legged standing lumbar extension test and interpretation:

A

Have pt stand on one leg w/extension of spin, stand behind to support pt if necessary. If aggravates LBP part fracture or facet (unilateral) or lumbar (bilateral) instability

263
Q

Describe Bechterew test and interpretation:

A

Ask pt to extend affected leg and exert downward pressure on thigh if pain radiates = disc lesion/sciatica

264
Q

Describe Minor test and interpretation:

A

Ask seated pt to stand up if pt has to support himself by placing one hand on healthy thigh/knee keeping affected side bent over = lumbosacral pathology

265
Q

Describe Erichsen test and interpretation:

A

Place hands over dorsum of iliac bone of prone pt and thrust bilaterally to midline if pain over SI = SI joint problem

266
Q

Describe Fortin Finger test and interpretation:

A

Pt point to where pain is, if medial and inferior to PSIS = SI pathology

267
Q

Describe Gaenslen test and interpretation:

A

Pt lie facing upward w/affected side close to edge of table flex hip and knee of unaffected side to abdomen of pt w/one hand, allow affected leg to hang off end of table, place other hand on knee of affected side and apply downward pressure on both knees, if increase in pain in SI region = SI pathology

268
Q

Describe Goldthwait test and interpretation:

A

Slowly raise affected leg of supine pt w/one hand while other under lumbar region if btw 0-30o SI pathology, 30-60o LS joint pathology, 60-90 lumbar pathology

269
Q

Describe Hibbs test and interpretation:

A

One hand firmly on dorsum of iliac bone, flex opposite knee 90o and push pt leg laterally causes internal rotation of head of femur if pain in SI SI pathology and hip could be hip pathology

270
Q

Describe Iliac compression test and interpretation:

A

Have pt lie on unaffected side and apply downward pressure on ilium to check for SI pathology

271
Q

Describe Patrick - Fabere test and interpretation:

A

Place external malleolus of one limb over patella of opposite limb w/pt supine and apply downward pressure, if pain in SI then SI pathology

272
Q

Describe Yeoman test and interpretation:

A

W/pt prone place one hand over affected SI jt flex knee of affected side place other hand under affected thigh and lift knee off table, if increases pain in SI could be injury of anterior SI ligament

273
Q

Describe Gillet (stork) test and interpretation:

A

Palpate both PSIS(s) while standing on both feet then w/one leg raised if PSIS on tested side fails to move PI there is sacroiliac fixation

274
Q

Facet Syndrome:
Caused by?
Presents as?
Management?

A

Irritation of zygapophyseal joint due to injury or degeneration
Back pain worse on lateral bending and extension, + Kemp’s

275
Q

Multiple Myeloma:
Caused by?
Presents as?
Management?

A

Neoplastic plasma cell disease, MC in older men
LBP @night, fatigue w/recurrent infxn, x-ray shows generalized osteopenia, multiple lytic lesions, rain-drop skull, serum electrophoresis shows M spike and increased IgG levels, Benc Jones protein in urine hypercalcemia, reversed albumin/globulin ratio
Co-manage w/internist

276
Q

Describe Hautant test and interpretation:

A

W/pt seated extend arms in front w/palms facing up, pt close eyes and extend and rotate head to opposite side if arms drift or pt complains of dizziness or blurred vision or nystagmus = VBAI

277
Q

Describe Romberg test and interpretation:

A

Pt stand w/feet together and eye open, stand to side and behind to catch pt and ask to close eyes if sway after eye closed = dorsal column pathology if before cerebellum problem

278
Q

Cerebellar disorder:
Caused by?
Presents as?
Management?

A

Damage to cerebellum due to degenerative disease or alcohol abuse
Ataxia, tendency of drifting to side where damage is worse, dysdiadochokinesia, past-pointing, intention tremor
Co-manage w/neurologist

279
Q

Friedreich’s ataxia:
Caused by?
Presents as?
Management?

A

Inherited disease causes progressive damage to cerebellum, dorsal columns of spinal cord and heart
Early twenties ataxia, areflexia, loss of vibration sense and heart failure
Co-manage w/neurologist

280
Q

Parkinson’s:
Caused by?
Presents as?
Management?

A

Chronic neurologic disease of substantia nigra and basal ganglia
Shuffling gait, mask-like fascies, pill-rolling tremor, bradykinesia, microphagia
Co-manage w/neurologist

281
Q

Wilson’s disease:
Caused by?
Presents as?
Management?

A

Genetic disease associated w/defective copper transport resulting in accumulation of excess copper accumulating in brain, prancreas, testis, liver, heart, eyes
Decreased libido, Kayser-Fleischer rings in periphery of cornea, low levels of ceruloplasmin
Co-manage w/internist

282
Q

Dengue Fever:
Caused by?
Presents as?
Management?

A

Flavi virus infection spread by Aedes aegypti mosquitoes
Fever, headache, severe muscle and joint pain (break bone fever), saddle back, feel bad 3-4 days relapse 2-3 days
Refer to M.D.

283
Q

Dermatomyositis:
Caused by?
Presents as?
Management?

A

Inflammatory autoimmune disease affecting muscle and skin
Heliotrope discolouration of eyelids, Gottron’s pupules on knuckles and fatigue, raised CK-MM and LDH
Co-manage w/dermatologist

284
Q

Polymyalgia Rheumatica:
Caused by?
Presents as?
Management?

A

Chronic inflammatory autoimmune disease affecting proximal muscles, MC women >60, underlying giant cell arteritis pathology
Pronounced stiffnes of neck, shoulder, upper back muscles which improves with activity, temporal headache (temporal arteritis), elevated ESR
Co-manage w/rheumatologist

285
Q

Trichinosis:
Caused by?
Presents as?
Management?

A

Parasitic disease caused by eating raw/undercooked pork or game meat infected w/Trichinella spiralis
Muscle pain, fever, periorbital edema, splinter hemorrhages, elevated eosinophils and CK-MM, ELISA for larva antigen is diagnostic
Co-manage w/internist

286
Q

Describe Chvostek test and interpretation:

A

Pt seated tap facial N as it passes through parotid in front of ear and below zygomatic if same side of face twitches hypocalcemia in hypoparathyroidism

287
Q

Describe Lhermitte test and interpretation:

A

Passively flex pt neck to chest if sharp electrical pains shoot into arms/legs could be cervical myelopathy, MS, dural irritation

288
Q

Describe pinch grip test and interpretation:

A

Seated pt hold tips of thumb and index finger as if pinching attempt to pull tips apart if you can damage to anterior interosseous br of median N

289
Q

Anterior Interosseous N syndrome:
Caused by?
Presents as?
Management?

A

Damage of ant interosseous br of median N as it passes through the forearm
Weakness in flexor pollicis longus muscle and flexor digitorum profundus, + pinch grip test
Co-manage w/neurologist

290
Q

Crutch/Saturday Night Palsy:
Caused by?
Presents as?
Management?

A

Compressive injury of radial N in axilla by improper crutch use or sleeping w/arm draped over bench
Wrist drop/inability to extend elbow, patch of anesthesia btw thumb and index finger dorsally
Co-manage w/neurologist - decreased nerve conduction velocity

291
Q

Guillain-Barre syndrome:
Caused by?
Presents as?
Management?

A

Acute immune mediated demyelinating polyradiculopathy predominantly affecting motor system preceded by viral infection/vaccination
Gradual symmetric motor weakness initially of distal muscles in legs and ascends to affect muscles of arms and diaphragm, increased protein and less WBC in CSF
Refer to hospital - ventilation may be needed

292
Q

Poliomyelitis:
Caused by?
Presents as?
Management?

A

Acute viral inflammation of anterior horn of gray matter in spinal cord
Mild flu like illness which may be followed by flaccid paralysis of a group of muscles in upper or lower limb
Refer to hospital

293
Q

Posterolateral sclerosis/subacute combined degeneration of the spinal cord:
Caused by?
Presents as?
Management?

A

Damage to posterior columns and dorsolateral tracts by Vit B12 deficiency
Fatigue, muscle weakness, hyperactive deep tendon reflexes w/sensory ataxia along w/burning feet and paresthesis, Babinski, Romberg may be positive, B12 low and there will be macrocytic normchromic anemia w/hypersegmented neutrophils
Co-manage w/neurologist

294
Q

Describe Bakody test and interpretation:

A

Ask seated pt to place palm of affected extremity flat on top of head if reduces pain NR compression or irritation due to IVF encroachment if pain exacerbated + reverse bakody for anterior scalene TOS

295
Q

Describe Brachial plexus tension test and interpretation:

A

Passive abduction of arms, elbows extend, shoulders externally rotate pt flexes elbow if pain irritation of roots of brachial plexus

296
Q

Describe Jackson test and interpretation:

A

Seated pt extend and rotate head to affected side, place downward pressure if exacerbates pain NR compression by space occupying lesion/subluxation

297
Q

Describe Cervical distraction test and interpretation:

A

Seated pts head and neck neutral, doc distracts neck by exerting upward pressure on occiput and chin. Distraction reduces pain = NR compression/facet joint if increases pain = strain/sprain

298
Q

Describe maximum cervical compression test and interpretation:

A

Seated pt rotate neck to shoulder and extend head to affected side if no pain flex while in rotation if pain radiates into affected arm NR compression/facet involvement if pain opposite = muscular strain

299
Q

Describe O’Donohgue test and interpretation:

A

Seated pt to flex, extend, laterally bend and rotate neck against resistance and then passively if pain in resisted muscle strain if passive ligamentous sprain

300
Q

Describe Rust sign and interpretation:

A

If pt holds up head in both hands cervical fracture or severe sprain

301
Q

Describe shoulder depressor test and interpretation:

A

Push down on shoulder and pt lat flexes neck to opposite shoulder if pain on depressed side adhesions to dural sleeve or spinal NR or joint capsule structrues

302
Q

Describe Soto-Hall test and interpretation:

A

One hand on sternum of supine pt to prevent thoracic or lumbar flexion, doc places other hand under occiput and flexes neck to chest if localized pain in posterior neck vertebral fracture, sprain, meningeal irritation, subluxation

303
Q

Describe Spurling test and interpretation:

A

St pt’s head and neck neutral, doc pushes down, rotate and flex head to affected side and warn of taping, if exacerbates NR irritation (cervical spondylosis or disc herniation)

304
Q

Burner/stinger:
Caused by?
Presents as?
Management?

A

Distraction traction injury to brachial plexus involving C5/6 Nr from neuropraxia
Burning/stinging pain, numbness in neck, radiation into shoulder/arm, weakness in adduction, external rotation, flexion of shoulder
Refer to neurologist if conservative chiropractic care w/ice, anti-inflammatory nutritional supplements doesn’t help

305
Q

Whiplash:
Caused by?
Presents as?
Management?

A

Hyperextension injury to neck seen in rear-end collisions
Neck pain, decreased ROM in neck, neck stiffness, occipital headache, dysphagia, soft tissue swelling in retrophrayngeal space >6mm @C2 and >22mm @C6
Ice, rest, anti-inflammatory nutritional supplements initially, cautious adjustments, pain free ROM exercises

306
Q

Describe anterior drawer of foot test and interpretation:

A

Grasp tibia of supine pt and calcaneus with other hand, push tibia down and pull calcaneus up if talus slides anteriorly tear in anterior talofibular ligament

307
Q

Describe duchenne’s sign and interpretation:

A

Pt supine, push head of 1st metatarsal w/thumb and have pt push down, normal = medial and lateral borders plantarflex, when only lateral border plantar flexes and medial dorsiflexes Duchenne’s sign is present indicative of superficial fibular N lesion

308
Q

Describe Helbing’s sign and interpretation:

A

Ask pt to stand, look at Achilles tendon if medial curvature excessive foot pronation in pes planus

309
Q

Describe Morton’s test and interpretation:

A

Squeeze heads of metatarsals together if pain Morton’s neuroma or metatarsalgia

310
Q

Describe Thompson test and interpretation:

A

Pt prone, passive flex knee and squeeze calf if no plantar flexion complete rupture of Achilles tendon

311
Q

Describe Tinel at ankle test and interpretation:

A

Percuss area behind malleolus of affected side if pain tarsal tunnel syndrome

312
Q

Describe Varus stress at ankle test and interpretation:

A

Grab calcaneus while other hand stabilizes pt’s leg evert ankle if pain deltoid ligament damage (eversion sprain)

313
Q

Describe Valgus stress at ankle test and interpretation:

A

Grab calcaneus while other hand stabilize pt’s leg invert ankle if pain anterior talofibular of calcaneofibular ligament damage (inversion sprain)

314
Q

Achilles tendon rupture:
Caused by?
Presents as?
Management?

A

Traumatic injury causing a complete or partial tear in the Achilles tendon
Pop and severe pain behind ankle, unable to plantarflex ankle, +Thompson test
Refer to orthopedist –> MRI confirmation

315
Q

Bedroom Fracture:
Caused by?
Presents as?
Management?

A

Traumatic injury to one of toes
Swollen toe, break in phalanx on x-ray
Orthopedist if distal fragment is displaced

316
Q

Bunion:
Caused by?
Presents as?
Management?

A

Osseous cartilaginous enlargement of medial eminence of head of 1st metatarsal, MC in females w/fam hx
Hallus valgus deformity, X-ray shows deformity + soft tissue swelling
Refer to podiatrist

317
Q

Complex regional pain syndrome/reflex sympathetic dystrophy/Sudeck’s atrophy:
Caused by?
Presents as?
Management?

A

Exaggerated neruovascular response to trauma, MC in females and feet, 5% all traumatic injuries
Severe chronic burning pain, ab swelling, atrophy of skin over affected area, x-ray shows osteopenia
Co-manage w/neurologist

318
Q

Erythomelalgia/Burning feet syndrome:
Caused by?
Presents as?
Management?

A

Uncommon peripheral neurovascular pain disorder may be familial or triggers w/autoimmune disease or side effect of med
Pain and redness of hands and feet
Co-manage w/neurologist

319
Q

Jones’/Dancer’s Fracture:
Caused by?
Presents as?
Management?

A

Trauma injury to 5th met, seen in dancers
Pain and swelling over lateral side of foot, X-ray shows transverse break of base of 5th met
Refer to the hospital

320
Q

March fracture:
Caused by?
Presents as?
Management?

A

Stress fx of shaft of 2-4th metatarsal due to repetitive marching trauma
Pain in foot worse on walking w/tenderness on compression of affected bone
Co-manage w/podiatrist

321
Q

Morton’s neuroma has pain worse with what part of walking?

A

Push off

322
Q

When is pes planus normal?

A

Considered normal in a 1 year old child

323
Q

Plantar fasciitis:
Caused by?
Presents as?
Management?

A

Condition of foot related to plantar fascia, more in women in sedentary occupations and high-heel shoes; over-pronation of foot
Pain at plantar fascia attachment on calcaneus worse w/pronation of foot, x-ray may show calcaneal spur (origin of adductor digiti minimi)
Stretch calf muscles, royce night splints, anti-inflammatory nutritional supplements, podiatrist

324
Q

Pott’s ankle fractures:
Caused by?
Presents as?
Management?

A

Trauma to ankle affecting lateral malleolus
Pain, swelling, discolouration of ankle, x-ray shows fracture lateral and/or medial malleolus, posterior tubercle of distal tibia
Refer to hospital

325
Q

What nerve is affected in tarsal tunnel syndrome?

A

Posterior tibial N

326
Q

Describe Cozen test and interpretation:

A

Seated pt clench fist, pronate and extend wrist, grasp pt elbow and attempt to flex pt wrist. Lateral epicondylitis

327
Q

Describe Mill test and interpretation:

A

Passively flex pt forearm, fingers, wrist and extend wrist and hold in this position. If action causes pain in region of lateral epicondyle lateral epicondylitis.

328
Q

What is the motion restricted by an occult elbow fracture?

A

Full extension

329
Q

Describe reverse Cozen test and interpretation:

A

Ask pt to flex wrist and forearm and hold forearm in supination. Attempt to force pt’s wrist into extension while the patient resists doctor’s efforts. If originating in medial epicondyle = golfer’s elbow, medial epicondylitis

330
Q

Describe valgus stress test at elbow and interpretation:

A

Stabilize arm of pt with one hand grasp wrist of pt and extend elbow attempt to abduct if pain Medial collateral ligament damage

331
Q

Describe varus stress test at elbow and interpretation:

A

Stabilize arm of pt w/one hand. Grasp wrist of pt and extend elbow, adduct elbow if pain lateral collateral ligament damage

332
Q

What motion is limited in a lateral collateral ligament sprain of the elbow?

A

Adduction of the extended elbow

333
Q

Management of lateral epicondylitis?

A

Rest, ice, compression, ultrasound, advice n change of tennis racket, wrist strengthening exercises

334
Q

Little league elbow:
Caused by?
Presents as?
Management?

A

Trauma to injury to elbow in children caused by repetitive baseball throwing, damage to epiphyseal plate of medial humeral epicondyle
Pain in medial elbow
Rest and ice and US

335
Q

Motion impaired by medial collateral ligament sprain of the elbow?

A

Abduction of the extended elbow

336
Q

Management of medial epicondylitis?

A

Rest, ice, ultrasound

337
Q

X-ray finding of occult elbow fracture?

A

Fat pad sign

338
Q

Posterior impingement syndrome:
Caused by?
Presents as?
Management?

A

Overuse and repetitive forced extensions of elbow w/tip of olecranon of ulna jamming into olecranon fossa
Pain in back of elbow especially when throwing or straightening elbow, x-ray spur formation on olecranon
Rehab exercises

339
Q

Describe Anvil test and interpretation:

A

Percuss heel of supine pt if jarring in hip fracture of neck of femur if localized pain in leg fracture in fibula or tibia if pain in thigh fracture of femur if heel pain calcaneal fracture

340
Q

Describe Laguerre test and interpretation:

A

Ask supine pt to flex thigh and knee at right angles, support foot of pt w/forearm and abduct and externally rotate pt’s thigh if pain in hip = hip lesion, iliopsoas spasm, sacroiliac lesion

341
Q

Describe Noble test and interpretation:

A

Pt seated knee flexed at 90 pressure on lateral femoral epicondyle and passively extend knee pain around 30o flexion is + for ITBS

342
Q

Describe Ober test and interpretation:

A

Pt lie on unaffected side, grasp pt’s ankle and stabilize pelvis flex knee at 90o passively abduct and allow knee to fall if leg abducts ITBS or trochanteric bursitis

343
Q

Describe Thomas test and interpretation:

A

Supine pt to bend hip and knee of unaffected side to abdomen and bring knee to chest and hold if opposite limb comes off table flexion deformity of hip or tight hip flexors

344
Q

What causes AVN of the hip?

A

Legg-Calve Perthe disease, elderly pt, long use of corticosteroids, diabetes, alcoholism

345
Q

What is Putti’s triad:

A

Small femoral epiphysis, lateral displacement of femur and increased inclination acetabular roof

346
Q

Who is most likely to get Legg-Calve-Perthes diease?

A

4-8 year old boys

347
Q

Meralgia Paresthetica:
Caused by?
Presents as?
Management?

A

Compression neuropathy involving lateral femoral cutaneous nerve seen in overweight persons
Pain and tingling over anterolateral thigh
Co-manage with neurologist, weight loss plan

348
Q

SCFE:
Caused by?
Presents as?
Management?

A

Possible Salter-Harris Type 1 fracture in overweight children btw 8-17 years
Painful true short leg with external rotation and limited flexion, abduction, medial rotation, frog leg x-ray shows downward slippage of epiphysis of head of femur and disruption of Kline’s line
Co-manage with orthopedist

349
Q

Subcapital femoral fracture:
Caused by?
Presents as?
Management?

A

Trauma caused by fall on hip in elderly
Pain, decreased ROM, limb in external rotation
911

350
Q

Transient hip synovitis:
Caused by?
Presents as?
Management?

A

Self limiting inflammation of synovial lining of hip joint, traumatic or viral
Painful limb, affected limb in flexion, abduction, external rotation with decreased medial rotation of hip
Refer to orthopedist

351
Q

Describe abduction/valgus of the knee test and interpretation:

A

Pt supine and legs fully extended place hand against lateral knee in line with joint while ankle grasped with other hand and attempt to abduct leg if pain over medial knee medial collateral ligament injury if no pain repeat at 30o

352
Q

Describe adduction/varus of the knee test and interpretation:

A

Supine and extended knees one hand over medial joint and ankle with other and attempt to adduct leg if pain over lateral knee lateral collateral ligament injury if not repeat at 30o flexion

353
Q

Describe Apley compression test and interpretation:

A

Pt lie prone w/legs extended and ankle over edge of table, anchor pt thigh w/knee grasp bottom of foot and hold leg above ankle and apply downward pressure and externally rotate knee at 90o then internally if pain/click meniscus tear

354
Q

Describe Apley distraction test and interpretation:

A

Pt prone, flex leg at 90o, stabilize thigh w/knee and pull up pt’s ankle while internally and externally rotate leg if pain M/LCL damage if reduction in pain meniscus tear

355
Q

Describe drawer at knee test and interpretation:

A

Pt supine and flex knees at 90o sit on feet of pt and grasp leg pull tibia anterior and push it posterior if >6mm movement torn cruciate ligament

356
Q

Describe Lachman test and interpretation:

A

Pt supine, knee flex 30o stabilize thigh wtih one hand grasp proximal tibia and pull forward if excessive anterior movement or mushy end feel ACL tear

357
Q

Describe McMurray test and interpretation:

A

Pt supine grasp ankle fully flex knee so heel close to buttock, place other hand over knee, rotate tibia internally and extend knee keeping hip partially flexed if click or pain lateral meniscus damage if external rotation causes pain medial meniscus damage

358
Q

Describe patellar apprehension test and interpretation:

A

Pt supine and knee fully extended push patella laterally if pt tightens quadriceps, test + for chondromalacia patella

359
Q

Describe Waldron test and interpretation:

A

Place hand over pt’s patella and ask pt to squat if pain/crepitus throughout maneuver,+ for chondromalacia patella

360
Q

ACL Damage:
Caused by?
Presents as?
Management?

A

Trauma to knee in young active males; part of O’Donoghue’s unhappy triad
Popping sound at time of injury, pain and swelling, + Lachman’s and anterior drawer signs
Refer to orthopedist –> MRI confirms

361
Q

Chondromalacia patella:
Caused by?
Presents as?
Management?

A

Soft tissue disorder due to poor patellar tracking, weak vastus medialis
Anterior knee pain worse on going down stairs; +patellar apprehension
Co-manage w/orthopedist; strengthen vastus medialis

362
Q

Genu recurvatum:
Caused by?
Presents as?
Management?

A

Knee condition due to knee joint laxity or weak quadriceps femoris
Hyperextended knee
Refer to orthopedist

363
Q

Genu valgum:
Caused by?
Presents as?
Management?

A

Knee condition in overweight children or teens
Knock knees
Refer to orthopedist

364
Q

Genu Varum:
Caused by?
Presents as?
Management?

A

Knee condition in rickets
Bow legs
Refer to orthopedist

365
Q

Lateral collateral ligament injury of the knee:
Caused by?
Presents as?
Management?

A

Adduction injury in football players; least commonly injured knee ligament
Pain, tenderness over lateral knee, pain worse on varus stress test and Apley distracion
3rd degree tears to orthopedist; rest, ice, compression

366
Q

Lateral meniscus tear:
Caused by?
Presents as?
Management?

A

Injury to knee due to external rotation of body while foot anchored to ground
Popping during injury; lateral/anterior knee pain which is worse on extension and internal rotation of flexed knee, McMurray’s test +
MRI confirm tear; refer to orthopedist

367
Q

Medial collateral ligament tear:
Caused by?
Presents as?
Management?

A

Abduction injury of knee in football players, MC injured ligament of the knee
Pain and tenderness over medial knee, pain worse w/valgus stress test, Apley distraction test
Rest, ice, compression, refer 3rd degree tears to orthopedist

368
Q

Osgood Schlatter’s disease:
Caused by?
Presents as?
Management?

A

Repetitive injury to knee seen teenage basketball players
Anterior knee pain w/tender swollen tibial tuberosity, X-ray show very prominent tibial tuberosity
Rest, ice, taping across tib tub and avoid provocative movements

369
Q

Osteochondritis dessicans:
Caused by?
Presents as?
Management?

A

Subarticular bone necrosis caused by blood deprivation,usually lateral medial epicondyle of femur
Pain, swelling, crepitus, locking, x-ray shows necrosis, joint mice
Co-manage with orthopedist –> MRI determines grade

370
Q

PCL damage:
Caused by?
Presents as?
Management?

A

Trauma to knee in young active males
Popping at time of injury, pain, swelling
Refer to orthopedist, MRI confirm injury

371
Q

Sindig-Larsen Johansson syndrome:
Caused by?
Presents as?
Management?

A

Repetitive injury to knee seen in young basketball and volleyball players btw 10-14 yrs
Pain, tenderness over inferior pole of patella, x-ray show calcification in patellar tendon near attachment to inferior pole of patella
Rest, ice, taping under patella helpful; avoid provocative movements help with recurrence

372
Q

Describe Bicycle test and interpretation:

A

Pt ride stationary bike, bend forward when leg pain experienced + for nerogenic claudication in central canal stenosis of lumber

373
Q

Describe Claudication test and interpretation:

A

Instruct pt to march in place 120 steps/min for 60 s note time pt complains of leg cramps if in one or both legs before minute is up peripheral vascular disease or Buergers disease

374
Q

Describe Fair test and interpretation:

A

Passive flexion, adduction and internal rotation of hip causes pain = piriformis syndrome

375
Q

Arterial embolism:
Caused by?
Presents as?
Management?

A

Sudden occlusion of peripheral A in leg due to embolus from nearby thrombus
Sudden onset of painful, pale, pulseless leg that is cold
Refer to hospital to arrange for confirmatory angiogram

376
Q

DVT:
Caused by?
Presents as?
Management?

A

Clot formation in deep leg vein due to venous stasis as with prolonged immobilization, leg vein trauma, hypercoagulability
Painful swollen leg, Homans sign +
Hospital –> US or venography confirmation

377
Q

Gonalgia Paresthetica:
Caused by?
Presents as?
Management?

A

Compression neuropathy inferior patellar br of saphenous N
Pain over medial aspect of knee and lower thigh
Co-manage with neurologist

378
Q

Ruptured plantaris tendon:
Caused by?
Presents as?
Management?

A

Trauma to tendon of plantaris during running
Pop during injury and pain in calf, + Homan’s
Refer to hospital –> MRI confirmation

379
Q

Shin splints/Medial tibial stress syndrome:
Caused by?
Presents as?
Management?

A

Overuse of muscles in anterior compartment
Pain along medial aspect of tibia, bone scan confirm stress fractures
Rest, ice, gentle taping helpful with chiropractic adjustments, advice on changing footwear

380
Q

Sickle cell disease:
Caused by?
Presents as?
Management?

A

Genetic blood disorder which causes RBCs to sickle under hypoxic conditions
Limb, joint pain, anemia, splenomegaly, priapism, jaundice, peripheral blood smear shows sickled cells
Refer to hospital, hemoglobin electrophoresis will confirm diagnosis

381
Q

Describe AC traction test and interpretation:

A

Pt seated, arms hanging neutral, pull down on arm if separation of AC joint you have a separation

382
Q

Describe Codman/Drop arm test and interpretation:

A

Passively abduct seated pt’s extended arm to just above shoulder, let arm down slowly when you let go if pain and arm drops suddenly RTC injury (supraspinatus)

383
Q

Describe Dawburn test and interpretation:

A

Palpate shoulder for localized tenderness, then passively abduct pt’s arm if pain disappears subacromial bursitis

384
Q

Describe Dugas test and interpretation:

A

Seated pt place hand of affected side on opposite shoulder and attempt to touch chest with elbow if inability to do so anterior shoulder dislocation

385
Q

Describe Empty can/Jobe/Supraspinatus press test and interpretation:

A

Abduct pt shoulder to 90o w/elbow in extension ask pt to hold while you adduct arm ask pt to turn shoulder so thumb faces floor if pain suprapsinatus injury

386
Q

Describe Hawkins-Kennedy test and interpretation:

A

Raise seated pt arm to 90o shoulder flexion w/one hand while other stabilizes scapula then flex elbow at 90o and internally rotate arm if shoulder pain impingement or RTC tendonitis

387
Q

Describe Impingement/painful arc test and interpretation:

A

Slow abduction arm if pain btw 60-90o injury to supraspinatus tendon

388
Q

Describe Mazion shoulder maneuver and interpretation:

A

Ask pt to place palm of affected limb over opposite shoulder if pain adhesive capsulitis

389
Q

Describe Neer’s test and interpretation:

A

Passively elevate arm into forward flexion w/arm internally rotated if pain impingement syndrome

390
Q

Describe O’Briend test and interpretation:

A

Ask pt to flex and adduct shoulder w/thumb down and hold position while you push down on arm repeat w/thumb facing up if pain SLAP lesion

391
Q

Describe Speed test and interpretation:

A

Standing pt to extend elbow, supinate forearm, flex and hold push down if pain in bicipital groove = bicipital tendonitis

392
Q

Describe Yergason test and interpretation:

A

Seated pt flex elbow 90o and hold forearm in pronation supinate forearm while hold pt’s hand fixed if pain/click in intertubercular groove tenosynovitis of long head of biceps

393
Q

Management for bicipital tendonitis?

A

Rest, ice, US, transverse friction massage

394
Q

Describe Allen test and interpretation:

A

Tight fist occlude radial and ulnar A’s release ulnar then radial if skin blanched >5s arterial embolism

395
Q

T4 syndrome:
Caused by?
Presents as?
Management?

A

T4 hypomobility in females, poor posture, previous trauma
Unilateral, bilateral upper chest/arm pain with paresthesia in hand, forearm, springing off offending thoracic vertebra reproduce symptoms
Chiropractic adjustments helpful

396
Q

Describe Bracelet test and interpretation:

A

Mild to moderate pressure to medial and lateral aspects of distal ends of radius and ulna by encircling wrist with thumb and index finger if pain RA, fracture, sprain

397
Q

Describe Bunnel-Littler test and interpretation:

A

Passively flex distal interphalangeal joint after extending metacarpo-phalangeal joint, note degree of flexion of DIP, flex metacarpo-phalangeal joint and passively flex DIP joint if no change in degree of flexion, indicative of restriction of fibrous capsule of DIP joint if increase in flexion contraction of lumbrical related to that finger

398
Q

Describe Finkelstein test and interpretation:

A

Ask pt to make fist with thumb inside and bend in ulnar direction if pain over abductor pollicis longus and extensor pollicis brevis de Quervain’s tenosynovitis and intersection syndrome

399
Q

Describe Phalen test and interpretation:

A

Ask pt to flex both wrists and press dorsal aspects together and hold for one minute if tingling and paresthesia radiates into thumb index or middle fingers = CTS

400
Q

Describe Reverse Phalen/Prayer sign test and interpretation:

A

Ask pt to extend both wrists maximally and press palmar aspects of wrists together as if in prayer hold 1 min if tingling and paresthesia into thumb, index, middle finger CTS

401
Q

Describe Press test and interpretation:

A

Seated pt place both hands on arms of stable chair and push off to support body with only hands if pain in trist TFCC tear

402
Q

Describe Tinel at wrist test and interpretation:

A

Percuss middle wrist for median N if tingling and paresthesia distally CTS and tap pisiform for ulnar N enrapment in Guyon’s canal

403
Q

Describe wrist compression test and interpretation:

A

Compresion palm distal to crease w/both thumbs A-P, sustained pressure 15s-2 minutes if tingling and parestheia CTS

404
Q

Describe Adson test and interpretation:

A

Palpate radial pulse note amplitude rotate head to affected side and extend neck tak
e a deep breath if disappearing pulse cervical rib or anterior scalene TOS

405
Q

Describe Eden/costoclavicular test and interpretation:

A

Palpate radial pulse note amplitude draw shoulders back and down and flex neck if pulse disappears costoclavicular TOS

406
Q

Describe Halstead test and interpretation:

A

Palpate radial pulse apply downward traction and ask pt to look up if disappears anterior scalene TOS

407
Q

Describe O’Riain/Wrinkle test and interpretation:

A

Immerse pt’s fingers in water for three minutes, skin should wrinkle if not + test loss of sympathetic innervation as in CRPS

408
Q

Describe Roos test and interpretation:

A

Abduct arms to 90o bend elbows to 90o and open and close fists up to 3 minutes if symptoms reproduced TOS

409
Q

Describe Wright/hyperabduction test and interpretation:

A

Palpate pt radial pulse on side tested passively abduct arm to 180o while pule palpated note angle it disappears if 30o difference pec minor TOS

410
Q

Bennett’s fracture:
Caused by?
Presents as?
Management?

A

Trauma to 1st metacarpal bone, pain, swelling, decreased ROM of thumb, x-ray show fx of base of first met with subluxation of first carpo-metacarpal joint
Refer to hospital –> wrist in cockup wrist splint

411
Q

Bowler’s finger:
Caused by?
Presents as?
Management?

A

Due to chronic compression or irritation of N on inside of thumb seen in bowlers
Pain and paresthesia of thumb
Advise to splint, stop bowling temporarily, orthopedist if conservative care fails

412
Q

Boxer fracture:
Caused by?
Presents as?
Management?

A

Trauma to closed fist
Pain, swelling, decreased movement of hand, x-ray show fx below head of 2nd/3rd metacarpals if break is in metacarpal if in 4/5th ballroom

413
Q

Who do you see CTS in?

A

Overweight females, pregnancy, hypothyroidism

414
Q

Chauffeur/Hutchinson fracture:
Caused by?
Presents as?
Management?

A

Trauma to wrist
Pain, swelling, decreased ROM, x-ray shows break through articular surface of distal radius near styloid
Hospital –> cockup splint to immobilize wrist in partial extension

415
Q

Intersection syndrome:
Caused by?
Presents as?
Management?

A

Overuse in weight lifters and skiers
Pain, tenderness over area 4cm proximal to dorsal radial tubercle of Lister, crepitus where extensor carpi radialis longus/brevis intersect with abductor pollicis longus and extensor pollicis brevis

416
Q

Smith/reversed colles fracture:
Caused by?
Presents as?
Management?

A

Trauma to distal radius
Pain with movement and swelling in wrist, x-ray hows break through distal 1/3 of radius with anterior displacement of distal fragment
Refer to hospital, use splint to immobilize

417
Q

TFCC Tear:
Caused by?
Presents as?
Management?

A

Trauma injury to TFCC btw head of ulna and triquetral bones in wrist
Wrist pain worse w/supination/pronation or weight-bearing on wrist, calcification on film
Refer to orthopedist –> MRI/arthroscopy

418
Q

Ulnar N entrapment:
Caused by?
Presents as?
Management?

A 
Elbow tunnel (behind elbow), Guyon's canal syndrome or handlebar syndrome affects cyclists or people using stationary bikes
Pain along ulnar aspect of hand and little finger and clumsiness in hand, + Tinel's
Refer to hand surgeon if chiropractic care is not helpful
419
Q

Cheiralgia paresthetica/Wartenberg’s syndrome:
Caused by?
Presents as?
Management?

A

Compression of superficial radial N at wrist, may be caused by tight handcuffs
Numbness, paresthesia along lateral distal wrist, tapping over lateral aspect will reproduce symptoms
Refer to neurologist if chiropractic care not helpful

420
Q

Leprosy:
Caused by?
Presents as?
Management?

A

Nerve damage by mycobacterium leprae infection
Claw hand, loss of sensation, swollen ulnar nerve
Dermatologist

421
Q

B12 Deficiency:
Caused by?
Presents as?
Management?

A

Nerve damage in true vegans, patients following gastric bypass, patients with autoimmune destruction of parietal cells in stomach or inpatients w/Crohn’s disease of infestation w/tapeworm Diphyllobothrium Latum
Glove and stocking loss of sensation, tongue is red and smooth, + Romberg if subacute degeneration of spinal cord, raised homocyteine and methylmalonic acid levels
Refer to neurologist or hematologist

422
Q

Malingering tests:

A

Burn’s bench, Hoover, Lasegue, Libman, Magnuson, Mannkopf

Chiro Essentials Neuromusculoskeletal Disorders (1 decks)

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