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ORTHO (Integrated) > Lab Maneuvers > Flashcards

Lab Maneuvers Flashcards

1
Q

knee - posterior drawer test

A
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2
Q

knee - traction

A
  • don’t use text
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3
Q

ligament stress test - tibionavicular

A

-

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4
Q

ankle - Posterior drawer test

A

-

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5
Q

hip - inferior glide

A
  • for hip abduction
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6
Q

Talocrural dorsal (post) glide

A
  • for DF
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7
Q

ligament stress test - tibiocalcanear lig

A

-

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8
Q

knee - posterior sag test

A
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9
Q

knee - thessaly test

A
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10
Q

ligament stress test - tibiotalar post

A

-

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11
Q

knee - stutter test

A
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12
Q

HIP - ext/abd/IR combined movement

A

-

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13
Q

ligament stress test - cfl

A

-

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14
Q

ankle/foot - observation

A

Single leg stance

  • Proprioception
  • Foot hyper-pronation/hyper-supination
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15
Q

hip - functional tests and observations

A

In NWB & WB, looking for

  • Swelling, bruising which condition?
  • Misalignment which condition?
  • Bony/joint deformity Any bump? which condition?
  • Atrophy which muscle?
  • LLD
  • -Weber-Barstow manoeuvre q ”True leg length
  • -Femoral length
  • -Tibial length
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16
Q

ligament stress test - tibiotalar ant

A

-

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17
Q

hip - how to palpate femoral head (ant and post), piriformis, ITB, adductors

A
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18
Q

knee - patella apprehension test

A
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19
Q

Talocrural anterior glide

A
  • for PF
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20
Q

Talocrural compression

A

-

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21
Q

knee - anterior glide

A
  • don’t use text
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22
Q

knee ACL stress test - lachmans

A
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23
Q

ligament stress test - ATFL

A

-

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24
Q

knee ACL stress test - anterior drawer

A
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25
Q

ankle - alternative anterior drawer test

A

-

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26
Q

knee - mcconnel test

A
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27
Q

ankle - special test - windlass

A
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28
Q

ankle - functional tests

A

slides 12-15

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29
Q

ankle - special test - homan’s sign

A
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30
Q

ankle - Anterior drawer test

A

-

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31
Q

dorsi in WB – ligament stress test - for inf tib/fib

A

The inf TF lig restricts splaying of the mortise during DF in WB
If Inf TF lig sprain, pt will complain of pain or pinching in the front of the ankle & will have splaying of the mortise with DF in WB

Test result: (+)ve test = sprain inf TF ligament if:

Acute phase:
-↓ pain with compression (& may have ↑ ROM because less pain) OR

  • Δ > 2mm in circumference around malleoli from neutral to full DF OR

Chronic phase (chronic hypermobility/instability):

  • ↓ROM when applying compression with DF in WB
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32
Q

Q angle measurement

A
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33
Q

Talocrural traction

A

-

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34
Q

MTP joint (DF, PF, ABD, ADD, traction and compression)

A

Flexion: plantar glide phalanx

Extension: dorsal glide phalanx

Abd/add: relative to 2nd ray

Abd: Phalanx 1: lat glide (away from 2nd ray), Phalanx 3-4-5: lat glide

Add: Phalanx 1: med glide (toward 2nd ray), Phalanx 3-4-5: med glide

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35
Q

ligament stress test - ptfl

A

-

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36
Q

quick screening test for hip

A

for prone legs apart one - compare how far it goes one side compared to the other - screen test

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37
Q

hip - anterior glide

A
  • for extension and/or ER
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38
Q

knee - mcmurray test

A

Both McMurray’s test & joint line tenderness consistently show moderate utility in detecting & ruling out meniscal tears

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39
Q

ankle - special test - thompson’s test

A
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40
Q

knee - LCL stress test

A

-

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41
Q

HIP - FABER combined movement

A

-

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42
Q

knee - patellar glide (laterally/medially and sup/inf)

A
  • text p 145
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43
Q

knee - apley’s compression test

A
44
Q

HIP - flexion/adduction (+IR/ER) combined movement

A

-

45
Q

ankle - special test - ant-lat impingement test

A

Pt sitting position

Pht

Lat hand: grasps calcaneum (fingers around calc tuberosity & thumb over ant-lat part of ankle (gutter))

Med hand: grasps forefoot to control ankle movt

  1. Apply thumb pressure over the ant-lat ankle with foot in full PF (looking for pain reproduction – painful area)
  2. Bring ankle in full DF without any pressure
  3. Repeat ankle Full DF while applying thumb pressure over painful area

(+)ve: if pain provoked with pressure from thumb is > in DF than PF

Molloy-Bendall impingement test :94.8% sensitive 88% specific

46
Q

IP joint (toes) glide

A
47
Q

knee - posterior glide

A

-

48
Q

knee - MCL stress test

A

Pht: supine with leg relaxed

Pht: Facing pt

Lat hand: Lat aspect of knee (TF jt line)

Med hand: grasp ankle
Apply a valgus stress

  • Full extension (hyperextension if they have it) - assessing post fibres
  • 30 flexion - assessing ant structures more bc more stress on them in this position
  • 90 flexion
49
Q

hip - posterior glide

A
  • for flexion and/or IR
50
Q

knee - posterior glide (moving femur)

A

-

51
Q

hip - traction

A

-

52
Q

hip - arc movement

A

note: for flex then add movement from yesterday - you can do an arc of movement from flex/add then moving into some ext medially and caudally (normal, smooth movement should have no pain - could have pain or a catchment sensation in someone with issues)

To treat pain:

1) can do a scooping movement over that bump (movement in small circles up and down the arc)
2) can do a hammer movement - at painful spot - push into ark (is perpendicular to arc)

53
Q

Lx spine ROM/OP - flex

A

**Assess: Quantity, Quality, Pain, EF!!

Will help you identify if you have a:

  • Hypomobility
  • Hypermobility OR
  • Instability

Should be done:

  • If not enough information from AROM/OP
  • To confirm your hypothesis after AROM/OP & (PAs)
54
Q

Lx spine ROM/OP - ext

A

**Assess: Quantity, Quality, Pain, EF!!

Will help you identify if you have a:

  • Hypomobility
  • Hypermobility OR
  • Instability

Should be done:

  • If not enough information from AROM/OP
  • To confirm your hypothesis after AROM/OP & (PAs)
55
Q

Lx spine ROM/OP - side flex

A

**Assess: Quantity, Quality, Pain, EF!!

Will help you identify if you have a:

  • Hypomobility
  • Hypermobility OR
  • Instability

Should be done:

  • If not enough information from AROM/OP
  • To confirm your hypothesis after AROM/OP & (PAs)
56
Q

Lx Spine ROM/OP - rotation

A

**Assess: Quantity, Quality, Pain, EF!!

Will help you identify if you have a:

  • Hypomobility
  • Hypermobility OR
  • Instability

Should be done:

  • If not enough information from AROM/OP
  • To confirm your hypothesis after AROM/OP & (PAs)
57
Q

Lx spine RISOM - flex, ext, rotation, side flex

A
58
Q

Lx spine - how to R/O LE

A
59
Q

Lx spine palpation - femoral, popliteal, tibial, dorsalis pedis artery

A
60
Q

Lx spine - passive accessory (PA) glide

A
  • Finding L5 – palpate for psis – from there move on medial part of sacrum (let fingers slide down the sacrum (fingers curled), the first depression you feel will be L5
    • Make sure fingers are very light
  • For glide – pt supine push anteriorly
  • If you are assessing R side, PT is on the L side – don’t need to use pillow under stomach
  • Hand 1: for palpation - hypothenar eminence (pinkie side of hand) – pisiform (not the side of hand!!)
  • Hand 2: for pushing down on other hand (place on top of other hand)
    • Look for the feel first – is it the same at every level?
    • Assess unaffected side first
61
Q

Lx spine scan

A
  • slides 1-17 (Lab Lx Scan PART 1)
62
Q

Lx spine - combined “H” in flexion

A

**Assess: Quantity, Quality, Pain, EF!!

Will help you identify if you have a:

  • Hypomobility
  • Hypermobility OR
  • Instability

Should be done:

  • If not enough information from AROM/OP
  • To confirm your hypothesis after AROM/OP & (PAs)
63
Q

Lx spine - combined “I” in flexion

A

**Assess: Quantity, Quality, Pain, EF!!

Will help you identify if you have a:

  • Hypomobility
  • Hypermobility OR
  • Instability

Should be done:

  • If not enough information from AROM/OP
  • To confirm your hypothesis after AROM/OP & (PAs)
64
Q

Lx spine - combined “H” in extension

A

**Assess: Quantity, Quality, Pain, EF!!

Will help you identify if you have a:

  • Hypomobility
  • Hypermobility OR
  • Instability

Should be done:

  • If not enough information from AROM/OP
  • To confirm your hypothesis after AROM/OP & (PAs)
65
Q

Lx spine - combined “I” extension

A

**Assess: Quantity, Quality, Pain, EF!!

Will help you identify if you have a:

  • Hypomobility
  • Hypermobility OR
  • Instability

Should be done:

  • If not enough information from AROM/OP
  • To confirm your hypothesis after AROM/OP & (PAs)
66
Q

Lx spine - PPIVM - flex and ext

A

PPIVM : Passive physiological intervertebral movement

  • Intervertebral = at each segment (Z joint)
  • Done if from your Lx Scan, your hypothesis is an hypomobility
  • Will help you confirm the level of hypomobility

* for ext same thing as flex but bring Lx spine into unilateral ext (applying an ant-sup force at pelvis)

  • Extension on L: Pt side lying L and 1 hand pushing on greater trochanterish area (push up and anteriorly), second hand feeling spinus process
  • Flexion on L: Pt L side lying (push down and anteriorly – hand position hand on pt greater trochanter to greater traction – can also use arm on greater trochanter instead of hand
  • Do up until t10
67
Q

Lx spine - prone instability test

A

Pt: lays only half way up the bed, with the hips flexed, the trunk muscles relaxed & the feet resting on the floor

Pht: will do a PA over the most symptomatic SP If provocation of pain is reported….

68
Q

Lx spine - active straight leg raise (basic scan)

A

Normal = optimal Lx-Sx functional load transfer

  • Leg raised = effortless bilaterally
  • Lx-Sx region = stable (no movt)
  • Need good activation of IU & OU ms

Abnormal

  • One leg: feels heavier to lift
  • Lx-Sx region: unstable (movt in ext, flex, rotation, SF of spine)

Grading system (active leg lifting)

0= not difficult at all

1= minimally difficult

2 = somewhat difficult

3= fairly difficult

4= very difficult

5= unable to do

Optimal ASLR = the only joint moving is the hip & “it is not difficult at all”

69
Q

Lx spine - ASLR testing inner unit muscle stimulation (3)

A
70
Q

Lx spine - ASLR testing outer unit muscle stimulation - anterior sling

A

(+)ve test if applying compression(s) or activating sling(s) which:

  • Makes it easier to lift the leg (affected)
  • More stable Lx-Sx spine (Good sensitivity & specificity with pt SI pain post-portum)

Meaning:

  • When test results are (+)ve, the assumption is that a lack of motor control exists for dynamic stabilization of the pelvic
  • Load transfer (stability of the Lx-Sx spine) can be helped via the ms that were (+)ve on Ax
71
Q

Lx spine - ASLR testing outer unit muscle stimulation - posterior sling

A

(+)ve test if applying compression(s) or activating sling(s) which:

  • Makes it easier to lift the leg (affected)
  • More stable Lx-Sx spine (Good sensitivity & specificity with pt SI pain post-portum)

Meaning:

  • When test results are (+)ve, the assumption is that a lack of motor control exists for dynamic stabilization of the pelvic
  • Load transfer (stability of the Lx-Sx spine) can be helped via the ms that were (+)ve on Ax
72
Q

Lx spine - assess transferse abdominal ms

A

Pt: spine in neutral position
Pht: palpate IU ms
Ax IU ms activation (tension) without any OU ms contraction

Ask pt to breathe in & on the breath out gently activate IU ms using one of the strategies (identify the best strategy for your pt), Then breathe normally

Normal:

Able to activate IU ms alone

Deep, slow tension of IU ms

No substitution from OU ms contraction (No Lx or pelvic movts, No fast contraction)

With IU ms activation should be able to breathe normally

Activation -10x10sec (Ax how many reps pt can do)

Abnormal: Substitution strategies

OU ms contraction (causing post rot of pelvis, Lx spine flex/ext)

Bulging of abdomen (= Internal oblique ms contraction)

Depression rib cage (= rectus abdo ms contraction)

Hold breath

Not able to hold 10sec, 10x

**exercises slides 19/20

73
Q

Lx spine - assess the multifidus ms

A

Pt: spine in neutral position
Pht: palpate IU ms
Ax IU ms activation (tension) without any OU ms contraction

Ask pt to breathe in & on the breath out gently activate IU ms using one of the strategies (identify the best strategy for your pt), Then breathe normally

Normal:

Able to activate IU ms alone

Deep, slow tension of IU ms

No substitution from OU ms contraction (No Lx or pelvic movts, No fast contraction)

With IU ms activation should be able to breathe normally

Activation -10x10sec (Ax how many reps pt can do)

Abnormal: Substitution strategies

OU ms contraction (causing post rot of pelvis, Lx spine flex/ext)

Ant rotation of pelvis, gripping of buttock ms (= OU ms contraction)

Hold breath
Not able to hold 10sec, 10x

74
Q

Lx Spine - assess the pelvic floor ms

A
75
Q

Lx spine - exercises for strenghtening IU and OU ms

A

You cannot strengthen a ms your brain cannot activate

Normal = activation of IU ms before contraction of OU ms

Can use PBU as an objective measurement

First GOAL: activate each IU ms (without any OU ms contraction)

Practice activation of each IU ms in different positions (sit, stand, squat)

Then practice co-activation of all IU ms

Progress by adding OU ms (next semester) move

* Practice in different positions: 4 point kneeling, Sitting, Standing, Squatting

76
Q

Neurological Exam - dermatomes Ax procedure

A

*work distal to proximal, 2 seconds btw each stimulus

*ask “do you feel anything - then does it feel the same on both sides”?

*pain assessed after light touch

Grading: (From American Spinal Injury Association)

0 = If no sensation
1 = Decreased sensation
2 = Normal sensation

Overall neurological exam results:

Sensation testing alone does not seem to be useful for radiculopathy

When tested in isolation, weakness with MMT & reduced reflexes = radiculopathy

When changes in reflexes, ms strength, & sensation are found in conjunction with a (+)ve SLR, Lx radiculopathy is highly likely

77
Q

Neurological Exam - myotome Ax procedure

A

* compare side to side and if possible assess the 2 sides silmultaneously

* HOLD 5 SECONDS!

* repeat 5 times to confirm the fatiguability

* if +’ve use the 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

Overall neurological exam results:

Sensation testing alone does not seem to be useful for radiculopathy

When tested in isolation, weakness with MMT & reduced reflexes = radiculopathy

When changes in reflexes, ms strength, & sensation are found in conjunction with a (+)ve SLR, Lx radiculopathy is highly likely

78
Q

Neurological exam - reflex Ax procedure

A

Grading

0: Absent
1: Diminished
2: Average
3: Exaggerated
4: Clonus, very brisk

Hyporeflexia = Lesion of spinal n root

Hyperreflexia = UMN lesion

Abnormal deep tendon reflexes are not clinically relevant unless they are found with sensory or motor abnormalities

Overall neurological exam results:

Sensation testing alone does not seem to be useful for radiculopathy

When tested in isolation, weakness with MMT & reduced reflexes = radiculopathy

When changes in reflexes, ms strength, & sensation are found in conjunction with a (+)ve SLR, Lx radiculopathy is highly likely

79
Q

How to perform the UMN lesion tests (3)

A

1) Clonus
- knee slightly flexed, push ankle abruptly into DF, > 5 beats is positive
2) Babinski (plantar response)
- see image
3) Oppenheimer
- stroking of ant-med surface of tibia: (+) = Extension first toe with spaying of the other toes

80
Q

Lx spine - traction

A

Results:

Traction & compression – Ax disc patho or VB Fx (+)ve =

Compression = ↑ pain

Traction = ↓ pain

81
Q

Lx spine - compression

A

Results:

Traction & compression – Ax disc patho or VB Fx (+)ve =

Compression = ↑ pain

Traction = ↓ pain

82
Q

Lx spine - ASIS GAP

A

Ax level of reactivity of the SIJ & provokes SIJ pain

  • Ligament tears (acute phase)
  • Systemic arthritis (RA, SA)
83
Q

Lx spine - ASIS compression

A

Ax level of reactivity of the SIJ & provokes SIJ pain

  • Ligament tears (acute phase)
  • Systemic arthritis (RA, SA)
84
Q

Lx spine - what are the red flag signs for cauda equina?

A
85
Q

Lx spine how to treat disc pathologies

A

LX traction

Indication for spinal traction in a prone position:

  • Spinal nerve root compression = neuro exam (+)ve
  • Peripheralization of the leg pain with Lx extension
  • Positive crossed SLR test (45)
  • L/E pain that centralizes with Lx traction

Positional distraction

  • Would allows frequent intermittent unloading of the effected n root
  • Can be done in clinic & at home
  • For the intervention to be effective: Pt should feel relief of pain shortly after the placement in the position, Rx: 10-20 mins; 3-6x/day
86
Q

SI Joint - ASIS gap test

A
87
Q

SI Joint - ASIS compression test

A
88
Q

SI joint - thigh thrust

A
89
Q

SI joint - Gaenslen’s test

A
90
Q

SI joint - sulcus thrust

A
91
Q

SI joint - leg length palpation test

A
92
Q

SI joint forward bending test

A
93
Q

SI joint - standing flexion kinetic test

A

1) is for SI joint dysfunction
2) is for confirming SI hypermobility/instability

94
Q

SI joint - PROM nutation

A
95
Q

SI joint - PROM counternutation

A
96
Q

SI joint - PROM iliac posterior rotation

A
97
Q

SI joint - PROM iliac anterior rotation

A
98
Q

SI joint - ASLR

A
99
Q

treatment for SI joint problems

A
  • see slides 38-45
100
Q

Lx spine - neurodynamic assessment SLR

A
101
Q

Lx spine - femoral nerve sheath mobility

A
102
Q

how to use joint mobs as a treatment

A

Grades I & II: Manage pain & spasm – neurophysiological effect

Grades III & IV: Used to improve range of motion within the joint

103
Q

SI joint - palpation for hypomobility

A
104
Q

Lx spine - how to test centrilization/peripheralization

A

–

105
Q

Lx spine - how to treat/correct reducable posterior derrangement syndrome

A

slides 24-30

ORTHO (Integrated) (12 decks)

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