Joint Specific Examinations Upper Extrem. and Spine Flashcards
Describe the supine straight leg test
- patient lies supine on table and examiner lifts each straight leg until maximal hip flexion is reached or patient complains of increased pain
- note the angle necessary to reproduce pain
- tests for nerve root impingement (sciatica)
Describe the sitting straight leg test
- patient sits on exam table with legs over edge
- examiner straightens leg until knee is fully extended
- tests for nerve root impingement (sciatica)
Describe the crossover straight leg test
- this is the straight leg test, but pain (if present at all) is felt in the contralateral leg
- tests for nerve root impingement
Describe the dorsiflexion test
- With leg elevated to the point of pain, dorsiflex the ankle
- this increases sciatic tension
- note where pain is felt and how far it radiates
- tests for nerve root impingement
- AKA “Lasegue’s Test”
Describe Kernigs Test
- flex hip and knee to 90’ at chest
- then attempt to extend the knee
- (this motion is like a hamstring stretch)
- this is actually a meningeal irritation test, but we’re using to increase sciatic tension to test for nerve root impingement
Describe the Yergason’s Test
- patient’s shoulder is in anatomical position with elbow flexed to 90’ and the forearm pronate
- while you have a hand on patient’s biceps tendon, have patient flex and supinate against resistance
- Positive: feel a snapping or popping; means patient has a tear, laxity, or bicipital tendinitis
Describe Speed’s test
- patient’s arm is flexed to 90’ with elbow extended and supinated
- patient holds position against downward resistance
- positive = pain; indicates bicipital tendinitis
Describe the Drop-Arm Test
- patient passively abducts fully-extended arm to 90’
- release the arm and ask patient to hold it there
- can also apply downward pressure
- tests for rotator cuff strength
Describe the Apprehension test?
- patient’s arm is slowly abudcted and externally rotated
- Positive: patient feels apprehension; may indicate an anterior glenohumeral instability
Describe the relocation test
- patient lies supine with shoulder flexed to 90’, abducted to 90’, externally rotated, and elbow flexed to 90’
- posteriorly directed force is applied on the anterior aspect of the patient’s shoulder
- positive: apprehension; confirms impression of anterior shoulder instability
describe the throwers test
- similar to apprehension test, but done with posterior resistance on patient’s palm
- do this when a patient has had a dislocation and you’re suspecting a HAGL tear
- positive: reproduces anterior capsule pain; indicates anterior capsular laxity
Describe the Rowe test
- patient’s arm is passively pulled inferiorly as it hangs by patient’s side
- positive: sulcus sign; indicates multidirectional joint laxity
describe the empty can test
- have patient forward flex shoulder, abduct about 45’, and internally rotate so thumbs are pointing down (emptying cans) against resistance
- positive: pain; may indicate tendon irritation, impingement, or tear of the supraspinatus muscle
describe the Hawkins impingement test
- patient forward flexes shoulder and elbow to 90’ so forearm is parallel to the body and the floor
- passively internally rotate the shoulder while keeping the arm in the forward flexed position
- positive: pain; may indicate rotator cuff, A/C joint, subacromial bursa, or coracoid ligament pathology
describe the neer impingement sign
- patients passively flexes shoulder to complete end point of movement while stabilizing the patient’s scapula with the other hand
- positive: pain
- tests for rotator cuff, A/C joint, subacromial bursa, or coracoid ligament pathology
Describe Yocum’s test
- patient places the hand of the affected side on the shoulder of the unaffected side, then raises the elbow with out elevating the shoulder
- tests for shoulder impingement
Describe the O’brien’s test
- patient forward flexes shoulder to 90’ with elbow extended, then brings the arm an additional 15’ toward the midline
- patient then maximally internally rotates (thumb down) and externally rotates (palm up)
- patient then resists a downward force
- positive: pain
- Tests for A/C or glenoid labrum pathology
describe the passive cross-chest adduction test and what it tests for
- arm is passively brought into maximal cross-chest adduction
- positive: pain; may indicate A/C pathology or posterior capsular tightness
describe the gerber subscapularis liftoff test
- patient rests the back of their hand on the bottom of their lower back and lifts off against resistance
- tests for subscapularis tear or rupture
Describe Patte’s test
-AKA “hornblower’s test”
-patient abducts shoulder and flexes elbow to 90’ and resists external rotation
-Tests for weakness with external rotation
possible infraspinatus/teres minor tear
Describe the Lhermitte test
- patient maximally flexes the cervical and thoracic spine
- if numbness/tingling occurs bilaterally, then patient has some stenosis
what does the “valsalva test” test for?
may make cervical radiculopathies worse
what might a positive swallowing test indicate?
-dysphagia indicates anterior cervical mass
describe spurling’s test
- patient’s head is axially compression with various amounts of cervical flexion, extension, lateral bending, and rotation
- Tests for cervical spine compression
describe the adson’s test
- Patient’s arm is abducted to 30 with elbow fully extended while examiner palpates radial pulse
- patient then turns their head toward the shoulder and away
- if pulse goes away or pain is reproduced, this indicates thoracic outlet syndrome
describe the Wright’s maneuver
- patient’s shoulder and elbow are flexed to 90’ with shoulder abducted and fully externally rotated while pulse is palpated
- if pulse goes away or pain is reproduced, this indicates thoracic outlet syndrome
what tests are performed when TOS is suspected?
Adson’s, Wright’s, and Roo’s
how do you test for elbow ligament stability?
-have patient slightly bend elbow so that it’s unlocked and apply vaus and valgus stress to the collateral ligaments
describe the dynamic ligament stability tests
-valgus stress is applied to elbow while going through a range of flexion and extension
what tests can you perform when cubital tunnel is suspected?
tinel and elbow flexion test
describe the radial tunnel syndrome test and the positive result
- palpate four fingerbreadths distal to the lateral epicondyle over the extensor mass
- resist extension of the long fiber by pressing down on the MCP joint
- pain in proximal extensor mass with radiation toward wrist and shoulder positive for radial tunnel syndrome
how would you test for pronator syndrome?
-resist patient pronation for 60 seconds and look for reproduction of symptoms/pain
how would you test for anterior interosseous syndrome?
- look for weakness of the FPL and FDP
- have patient make “OKAY” sign by touching the thumb and index fingertips together (not the finger PADS)
how would you test for lateral epicondilitis (tennis elbow)?
- palpate just distal to the lateral epicondyle, over the common extensor insertion
- have patient make a fist and extend wrist against resistance
how would you test for medial epicondilitis (golf elbow)?
- palpage just distal to the medial epicondyle, over the common flexor insertion
- have patient make a fist and flex his wrist against resistance
how would you test for FDP strength?
-block patient’s finger so they can only flex the DIP
how would you test for FDS strength?
- hold all fingers but the one testing and have patient flex their finger
- ensure that the DIP is “floppy”
what test is used to ensure circulation through the radial and ulnar arteries at the wrist?
allen’s test
describe Phalen’s test, including positive findings
- have patient hold back of hands together with their fingers pointing down for 1 minute
- pain or tingling in median nerve distribution is positive for carpal tunnel syndrome
what tests can be performed when carpal tunnel syndrome is suspected?
Phalen’s test, tinel’s sign, and Durkan’s carpal tunnel compression test
What is “froment’s sign”?
- when having a patient hold a piece of paper in their pincher grasp, the pinch should be flat
- if not, the median nerve is taking over, suggesting ulnar nerve palsy
Describe Finkelsteins test
- put thumb in fist and ulnarly deviate the wrist
- pain over the first dorsal compartment over the radial styloid is positive for de Quervain’s tenosynovits
what is intersection syndrome?
-inflammation where the APL and EPB cross the ECRL and ECRB
how would you test for intersection syndrome?
- pronate the forearm and mreaure four fingerbreadths proximal to Lister’s tubercle
- palpation will cause pain and resisted dorsiflexion will make it worse
what does instability with varus and valus stress on the phalangeal joints indicate?
a collateral ligament tear
describe Watson’s test
- patient rests arm on table with forearm vertical
- examiner pinches scaphoid as the wrist is passively brought from ulnar to radial deviation
- if scaphoid remains in your pinching grasp without moving, this suggests a scapholunate ligament tear
what test would you perform if you suspected CMC DJD?
grind test/shuck test
