Lab Maneuvers 2 Flashcards
Tx spine ROM and OP
**make sure for oske that you do AROM only first them apply your OP!
- pg 93/94
Tx Spine RISOM
Tx Spine - R/O UE
Tx Spine compression
p 110
Tx spine traction
p 110
Tx spine dermatomes
Tx spine myotomes
NOTE: there are no myotomes at the trunk level and above C5 (recall: in the SCI lecture the motor level will be the same as the sensory level)
Tx spine reflexes
Tx Spine UMN exam
Tx spine neuromeningeal exam: what are the 3 tests?
SLR (see Lx spine)
ULNT 1 (see Cx spine)
Slump test
Tx spine - how to do SLR and ULNT1 test
Tx spine - how to do slump test
Tx spine - how to do palpation/PA’s
slides 21 - 26
Tx spine - review how to assess IU muscles
Tx spine - sitting arm lift (SAL) test
Part 2:
Pht:
-Thumbs on SPs & index fingers along the ribs
-Ask pt to repeat movt several times with arm that felt heavier to lift
-Palpates the ribs individually
(+)ve = rib translation or rotation
= lack of control of that segment = failed load transfer
Pht
- Stabilize the ring (segment) that was translating/rotating
- Ask pt to repeat sitting/prone arm lift with arm that felt heavier q Look for any changes in easiness to do the test
Tx spine - prone arm lift (PAL) test
Part 2:
Pht:
-Thumbs on SPs & index fingers along the ribs
-Ask pt to repeat movt several times with arm that felt heavier to lift
-Palpates the ribs individually
(+)ve = rib translation or rotation
= lack of control of that segment = failed load transfer
Pht
- Stabilize the ring (segment) that was translating/rotating
- Ask pt to repeat sitting/prone arm lift with arm that felt heavier q Look for any changes in easiness to do the test
Cx spine - observation
Posture spine: Ax in standing & in sitting
-FHP remember may cause different dysfunction/condition
-Head neutral position, tilted, rotated to one side
Shoulder levels: Often dominant arm slightly lower, Rounded ↔ FHP
- Height of shoulder (R handed = typically R side lower)
- looks for ms bulk
- creases at back from forward head posture
Posture normal versus FHP
From the front: The chin should be in line with the manubrium
From the side: The ear should be in line with the shoulder & forehead vertical
Hypermobility
- May see cutaneous creases
Lateral stenosis
- May have a neck position that open the IVF (flex/contralateral SF)
Disc pathology
- May look like a torticollis
Cx spine - ROM
**make sure for oske that you do AROM only first them apply your OP!
- PROM
- Side rotation: Stabilize w forearm and grip occiput from front for OP
- Side flexion: One hand on shoulder (stabilize) other push head away
- Forward flex: 1 hand at C7/T1, 1 on head
- Extension: 1 hand on sternum (stabilize), other hand on forehead – don’t spend too much time there and be very gentle
Cx spine - RISOM and R/O LE
Cx spine - compression and traction
Cx spine - dermatomes
Ax superficial TACTILE sensation = Light touch
- Using cotton ball, Kleenex or finger
- Touch lightly the skin (avoid pressure)
Ax superficial PAIN sensation = sharp/dull touch
- Using a new paperclip
1/ Light touch on an unaffected area of your pt’s skin, demonstrate what you will be doing
- Pt supine, eyes close
- Ax distal aspect of dermatome first (more pure dermatome)
- If (+)ve, then Ax distal to proximal
- Compare side to side then if (+)ve → across one side
- You should ask:
1) Does it feel the same? As you touch both side
2) Do you feel anything? As you Ax affected dermatome
2/ Superficial PAIN sensation
Should be Ax after light touch on the area that had decreased sensation
- Pht should touch pt’s skin with curve & prickly sides
- Pt should say if the pht touched with the curve or prickly part
- Should wait 2 sec in between each stimulus to avoid summation
Grading
0 = no sensation 1 = decreased sensation 2 = Normal sensation
Cx spine myotome
- Pt in sitting position
- Pt’s ms should be in a shortened position, close to resting position
- Pht use an isometric contraction
- Compare side to side (at the same time or one after the other)
- The command should be “don’t let me move you”
- Hold 5 seconds
- Testing for weakness & fatigue (fading/progressive weakness with reps contractions)
- Repeat 5 times to confirm fatigability
- if (+)ve use an alternative muscles
Grading:
0 = No contraction
1 = Ms contraction without movt 2 = Movt without gravity
3 = Movt with gravity
4 = Movt against resistance
5 = Normal ms strength
Cx spine - reflexes
- Pt should be relax
- Pt’s tested limb should be well supported
- Pht should hold reflex hammer with a weak/floppy handling (to allow reflex hammer to balance freely)
- The stimulus should be quick & brisk & directly on the tendon
- Can use the Jendrassik manoeuvre
- Clench teeth/press hands together as you stimulate the tendon
Grading
0: Absent
1: Diminished
2: Average
3: Exaggerated
4: Clonus, very brisk
Hyporeflexia = Lesion of spinal n root or peripheral n (PHTH-623)
Hyperreflexia = UMN lesion
Abnormal deep tendon reflexes are not clinically relevant unless they are found with sensory or motor abnormalities
Cx spine - how to test for UMN lesions
Cx spine - Upper Limb Neurodynamic Tension (ULNT1)
Normal (negative) result:
Deep ache or stretch in cubital fossa
Deep ache or stretch into ant & radial aspect of F/A & radial aspect of hand
Tingling to the fingers supplied by appropriate nerve
Stretch in anterior shoulder area
Above responses increased with contralateral Cx SF
Above responses decreased with ipsilateral Cx SF
Pathological (positive) result:
Production of patient’s symptoms (but not always)
A sensitizing test in the ipsilateral quadrant alters the symptoms
Different symptoms btw right & left (contralateral quadrant)…important
Cx spine - PA
In prone or supine:
Facet joints: They form the articular pillar q1 inch (2.5cm) to SP
Radial and ulnar pulses
Cx spine - shoulder abduction test
Cx spine - what are the 4 radiculopathy screening tests?
Cx spine - spurling A test
Cx spine - Muscle flexibility Upper Trap
Cx spine - Muscle flexibility levator scapula
Cx spine - Muscle flexibility scalene
HEP:
Pt: Seated
- Stab 1st/2nd rib(Ant scalene – do slight Cx ext (Cr-vx flex)
- Add contralateral SF & ipsilateral rotation
Cx spine - Muscle flexibility SCM
Cx spine - Muscle flexibility lat dorsi
Cx spine - Muscle flexibility pec major
Cx spine - Muscle flexibility pec minor
HEP
- Pt seated
- Hand behind head (HBH)
- Combined with breathing out
Cx spine - ms strength middle and lower traps
Cx spine - ms strength rhomboid
Cx spine - ms strength serratus anterior
Cx spine - stability test of IU ms (short flexors ms)
Short neck Flexors:
- Longus Colli
- Longus Capitis
*Can use PBU to have an objective measure
HEP:
Similar principles as for the lumbar spine
Train tonic endurance of deep neck flexors
Exercise should be pain free
Incorporate in functional activities
GH joint - observation (don’t forget 4 point palpation!)
Posterior
- Scoliosis, Scapula (Lower, protracted, Winging, Spine of scap - Any atrophy above (supraspinatus) below (infraspinatus))
Anterior
- Shoulders level, Clavicle asymmetry, Atrophy (pect, deltoid), LH biceps atrophy
Humeral head position (relative to acromion)
- Can use the four (4) Point Palpation to Ax it (One hand on acromion anteriorly & posteriorly, One hand on humeral head anteriorly & posteriorly)
- Normal (ant-post) = 1/3 anterior
- Abnormal: > 1/3 anterior or posterior, Inferior max 1 finger = inferior hypermobility/instability
Scapula normal position
- Inferior angle: around T7
- Sup angle: T2
- Look for any: Superior/inferior rotation, Internal rotation = Winging, Ant tilt, Winging, Lat distance med scap & SP (protraction)
GH joint ROM/OP - flexion
Done in standing
With every movts look at:
- HH movt
- Scap movt
- Any Tx or Lx extension (compensation)
GH joint ROM/OP - extension
Done in standing
With every movts look at:
- HH movt
- Scap movt
- Any Tx or Lx extension (compensation)
GH joint ROM/OP - adbuction
Done in standing
With every movts look at:
- HH movt
- Scap movt
- Any Tx or Lx extension (compensation)
GH joint ROM/OP - synamic scapula assessment
Done in standing
With every movts look at:
- HH movt
- Scap movt
- Any Tx or Lx extension (compensation)
GH joint ROM/OP - IR
Done in standing
With every movts look at:
- HH movt
- Scap movt
- Any Tx or Lx extension (compensation)
GH joint ROM/OP - ER
Done in standing
With every movts look at:
- HH movt
- Scap movt
- Any Tx or Lx extension (compensation)
GH joint ROM/OP - horizontal add
Done in standing
With every movts look at:
- HH movt
- Scap movt
- Any Tx or Lx extension (compensation)
GH joint ROM/OP - horizontal abd
Done in standing
With every movts look at:
- HH movt
- Scap movt
- Any Tx or Lx extension (compensation)
GH joint ROM/OP - Apley scratch test
GH joint ROM/OP - HBB test
GH joint PROM - flexion
To do if:
- AROM limited
- GH pain with no AROM limitation (There could be some compensation from Scapula or Tx spine/ribs and Therefore need to Ax all GH PROM)
- Use goniometer to measure limitation (obj info)
Always assess contralateral side first
Done in supine
Stabilise scapula (sup or lat border)
Move humerus
Ax end feel (EF)
GH joint - prom abduction
To do if:
- AROM limited
- GH pain with no AROM limitation (There could be some compensation from Scapula or Tx spine/ribs and Therefore need to Ax all GH PROM)
- Use goniometer to measure limitation (obj info)
Always assess contralateral side first
Done in supine
Stabilise scapula (sup or lat border)
Move humerus
Ax end feel (EF)
GH joint - prom ext
To do if:
- AROM limited
- GH pain with no AROM limitation (There could be some compensation from Scapula or Tx spine/ribs and Therefore need to Ax all GH PROM)
- Use goniometer to measure limitation (obj info)
Always assess contralateral side first
Done in supine
Stabilise scapula (sup or lat border)
Move humerus
Ax end feel (EF)
GH joint - prom ER
To do if:
- AROM limited
- GH pain with no AROM limitation (There could be some compensation from Scapula or Tx spine/ribs and Therefore need to Ax all GH PROM)
- Use goniometer to measure limitation (obj info)
Always assess contralateral side first
Done in supine
Stabilise scapula (sup or lat border)
Move humerus
Ax end feel (EF)
GH joint - prom IR
To do if:
- AROM limited
- GH pain with no AROM limitation (There could be some compensation from Scapula or Tx spine/ribs and Therefore need to Ax all GH PROM)
- Use goniometer to measure limitation (obj info)
Always assess contralateral side first
Done in supine
Stabilise scapula (sup or lat border)
Move humerus
Ax end feel (EF)
GH joint - RISOM
GH joint - palpation: greater tuberosity, bicipital groove, lesser tuberosity
GH joint - palpation: supraspinatus tendon
GH joint - palpation: infraspinatus tendon
GH joint - palpation: teres minor tendon
GH joint - palpation: subscapularis tendon
GH joint - posterior glide
*Pt always in supine!
GH resting position
- Anterior glide (ER/Ext)
- Posterior glide (IR/Flex)
- Inferior glide (Abd)
- Traction/compression
GH joint - anterior glide
*Pt always in supine!
GH resting position
- Anterior glide (ER/Ext)
- Posterior glide (IR/Flex)
- Inferior glide (Abd)
- Traction/compression
GH joint - inferior glide
*Pt always in supine!
GH resting position
- Anterior glide (ER/Ext)
- Posterior glide (IR/Flex)
- Inferior glide (Abd)
- Traction/compression
GH joint - traction and compression
*Pt always in supine!
GH resting position
- Anterior glide (ER/Ext)
- Posterior glide (IR/Flex)
- Inferior glide (Abd)
- Traction/compression
GH joint: antero-superior HBB with ER
GH joint: apprehension test
GH joint: relocation test
* to be done with apprehension test!!
GH joint - sulcus sign test
GH joint - posterior apprehension test
GH joint - compression rotation test
Better diagnostic utility when using specific combination of 3 tests:
1) By selecting 2 highly sensitive tests (true positive)
- Compression rotation test
- O’Brien test
2) And 1 highly specific test (true negative)
- Biceps load II
User can be fairly confident in both ruling out & in SLAP lesions
GH joint - O’Brien’s test
Better diagnostic utility when using specific combination of 3 tests:
1) By selecting 2 highly sensitive tests (true positive)
- Compression rotation test
- O’Brien test
2) And 1 highly specific test (true negative)
- Biceps load II
User can be fairly confident in both ruling out & in SLAP lesions
GH joint - biceps load 2 test
Better diagnostic utility when using specific combination of 3 tests:
1) By selecting 2 highly sensitive tests (true positive)
- Compression rotation test
- O’Brien test
2) And 1 highly specific test (true negative)
- Biceps load II
User can be fairly confident in both ruling out & in SLAP lesions
GH joint - Hawkin’s-Kennedy test
Both Hawkins-Kennedy & Neer tests would be minimally helpful for both ruling in & out subacromial impingement
The presence of a painful arc during elevation may additionally be helpful in identifying impingement
Impingement would not identify which structure is at fault would only identify which movt/mechanism is at fault
GH joint - Neer’s impingement test
Both Hawkins-Kennedy & Neer tests would be minimally helpful for both ruling in & out subacromial impingement
The presence of a painful arc during elevation may additionally be helpful in identifying impingement
Impingement would not identify which structure is at fault would only identify which movt/mechanism is at fault
GH joint - posterior impingement test
Both Hawkins-Kennedy & Neer tests would be minimally helpful for both ruling in & out subacromial impingement
The presence of a painful arc during elevation may additionally be helpful in identifying impingement
Impingement would not identify which structure is at fault would only identify which movt/mechanism is at fault
GH joint - full can test
Remember:
Special tests done
- To isolate the involved structure
- Help to confirm the diagnosis
- But the result of a single test is usually not enough
GH joint - empty can test
Remember:
Special tests done
- To isolate the involved structure
- Help to confirm the diagnosis
- But the result of a single test is usually not enough
GH joint - drop arm test
Remember:
Special tests done
- To isolate the involved structure
- Help to confirm the diagnosis
- But the result of a single test is usually not enough
GH joint - external rotation lag sign (ERLS)
Remember:
Special tests done
- To isolate the involved structure
- Help to confirm the diagnosis
- But the result of a single test is usually not enough
GH joint - internal rotation lag sign
Remember:
Special tests done
- To isolate the involved structure
- Help to confirm the diagnosis
- But the result of a single test is usually not enough
Elbow - ROM (flex, ext, pron, sup)
-
Elbow (UH joint) - anterior/posterior glides
Anterior glide: Apply an anterior force through the long axis of ulna
Posterior glide: Apply a posterior force through the long axis of ulna
Elbow (UH joint) - lateral medial glides
Lateral glide: Apply a lateral force to proximal ulna
Medial glide: Apply a medial force to proximal ulna (Lat border of olecranon)
Elbow (UH joint) - traction/compression
Elbow (RH joint) - ant/post glide
Pt supine in elbow resting position (Full extension & supination versus 30 flex)
Pht:
Btw pt’s trunk & arm; cradle pt’s F/A
Cranial hand: stabilize distal humerus (against the table)
Caudal hand grasp radial head (thumb ant & fingers post)
Elbow (RH joint) - traction/compression
Elbow (RU joint) - glides
Elbow - valgus stress test
Pht
- Facing pt
- Proximal hand: on lateral aspect of distal humerus or joint line
- Distal hand: hold distal F/A (in full supination)
- Tested at different angle of elbow extension-flexion
- Pht apply a valgus stress by turning your torso
Findings:
- Gr I sprain: No gap, normal EF & pain
- Gr II sprain: Gap, normal EF & pain
- Gr III sprain: Gap, soft EF with more or less pain
Position:
-Pt supine, Pht facing pt (Hold 5 sec)
Elbow - varus stress test
Pht
- Proximal hand: on medial joint line or distal humerus
- Distal hand: hold distal F/A (in full supination)
- Tested at different position of elbow extension & flexion
- Pht apply a varus stress by turning your torso
Findings:
- Gr I sprain: No gap, normal EF & pain
- Gr II sprain: Gap, normal EF & pain
- Gr III sprain: Gap, soft EF with more or less pain
Position:
-Pt supine, Pht facing pt (Hold 5 sec)
Elbow - lateral epicondylitis (passive test)
Elbow - lateral epicondylitis (active test)
Elbow - lateral epicondylitis (differential tissue test)
Elbow - medial epicondylitis (passive and active test)
wrist palpation - bony structures
wrist - distal RU joint (palmar and dorsa glide)
**looking for: neutral zone, R1, R2, any pain
Pt: Seated or supine & F/A in resting position
Pht:
- Standing, facing pt’s hand
- One hand: stabilizes ulna
- One hand: grasp pt’s distal radius
wrist - RC joint (palmar and dorsal glide)
**looking for: neutral zone, R1, R2, any pain
Pt: Seated, F/A resting on bed; wrist over edge & in RP
Pht:
- Standing, close to pt’ hand
- One hand: stabilize distal radius/ulna close to jt line
- One hand: grasp proximal row of carpals
wrist (RC joint) - radial and ulnar glide
**looking for: neutral zone, R1, R2, any pain
wrist (RU joint) traction and compression
**looking for: neutral zone, R1, R2, any pain
fingers - MCP joint (palmar, dorsal, medial, lateral glides)
Pt seated, FA on bed & joint in RP (slight flexion)
Pht: using a pinch grip with both hands
- For palmar & dorsal glides: on palmar/dorsal aspect of bones
- For radial & ulnar glides on radial/ulnar aspect of bones
- One hand: stabilize distal MC (♂), close to jt line
- One hand: grasp proximal phalanx (♀)
fingers - MCP joint (traction/compression)
Pt seated, FA on bed & joint in RP (slight flexion)
Pht: using a pinch grip with both hands
- For palmar & dorsal glides: on palmar/dorsal aspect of bones
- For radial & ulnar glides on radial/ulnar aspect of bones
- One hand: stabilize distal MC (♂), close to jt line
- One hand: grasp proximal phalanx (♀)
fingers - IP joint (palmar and dorsal glide)
Pt seated, with FA on bed & joint in resting position (slight flexion)
Pht: using a pinch grip with both hands
- One hand: stabilize proximal phalanx (♂), close to jt line
- One hand: grasp base of adjacent (distal) phalanx (♀)
fingers - IP joint (traction/compression)
Pt seated, with FA on bed & joint in resting position (slight flexion)
Pht: using a pinch grip with both hands
- One hand: stabilize proximal phalanx (♂), close to jt line
- One hand: grasp base of adjacent (distal) phalanx (♀)
wrist - distal ru ligament stress test
Findings:
Gr I sprain: Strong normal EF & pain
Gr II sprain: Solid Firm EF but much further into range & P
Gr III sprain: Sluggish or NO EF with more or less pain
Position:
- Pt seated
- Pht facing pt, look for NZ, EF & pain; hold 5sec
wrist - RCL and LCL ligament stress test
Wrist collateral ligaments
Pt: wrist in extension (just out of CPP)
Pht:
- One hand: stabilize distal radius/ulna
- One hand: grasps proximal & distal rows of carpal bones
Findings:
Gr I sprain: Strong normal EF & pain
Gr II sprain: Solid Firm EF but much further into range & P
Gr III sprain: Sluggish or NO EF with more or less pain
Position:
- Pt seated
- Pht facing pt, look for NZ, EF & pain; hold 5sec
wrist MCP collateral ligaments stress tests
Findings:
Gr I sprain: Strong normal EF & pain
Gr II sprain: Solid Firm EF but much further into range & P
Gr III sprain: Sluggish or NO EF with more or less pain
Position:
- Pt seated
- Pht facing pt, look for NZ, EF & pain; hold 5sec
finger DIP and PIP collateral ligament stress tests
Findings:
Gr I sprain: Strong normal EF & pain
Gr II sprain: Solid Firm EF but much further into range & P
Gr III sprain: Sluggish or NO EF with more or less pain
Position:
- Pt seated
- Pht facing pt, look for NZ, EF & pain; hold 5sec
wrist - finkelstein test
wrist - TFCC supination lift test
wrist - TFCC ulnar impaction test
wrist - TFCC load test
