Lab Practical Flashcards
Yeoman
Patient prone, dr flexes patient’s leg to ipsilateral butt then extends thigh
P: Pain DEEP in the SI joint
I: Sprain of the anterior SI ligaments
Deep voice: Yo man, put my leg down!
Dawbarn
Patient seated, palpate shoulder for tender spot (subacromial bursa), note tenderness, continue pressure while abducting extended arm past 90*.
P: Decrease in pain and/or tenderness
I: Subacromial bursitis
Fromet Paper Sign
DON’T TEST THUMB/INDEX
Patient tries to hold paper squeezed b/w fingers
P: The patient is unable to maintain grip on paper
I: Ulnar nerve paralysis
Accommodation reflex
State what you are observing for and what neurological structure is being evaluated
Move object to and away from patient, they focus on it.
Convergence of eyes w/ pupillary constriction
Afferent: Optic (CN II)
Efferent: Oculomotor (CN III)
Int Center: Occipital cortex
Weber Test
State what you are observing for and what neurological structure is being evaluated
Place handle of 512 Hz vibrating tuning fork on midline of skull
“can you hear this? and is it equal in both ears or more loud in one or the other?”
( - ) Normal: Sound is equal in both ears
( + ) Conductive deafness: Sound lateralizes to the bad ear
( + ) Sensorineural deafness: Sound lateralizes to the good ear
Palpate the peripheral pulses of the neck and upper extremity Left Side Only
State the definition of the amplitude of a pulse
rhythm
rate
contour
2-3 seconds Carotid Subclavian Brachial Radial Ulnar
amplitude- height or intensity of pulse
rhythm- regularity of heart pattern
rate- number of pulsations per min
contour- pulse wave, should be rounded or smooth
You suspect your patient has a kidney stone perform a test to confirm this state the positive finding for this test, no indication required
Murphy’s Punch
Palm of hand over posterior costovertebral angle (T10-T12), strike back of hand w/ ulnar surface of fist.
Should thud w/ no pain or tenderness
Pain indicates inflamed kidney (nephritis - stones, infection, etc)
Muscle Test the S1 nerve root
Dr instructs patient how to position for muscle test.
Plantar flexion: Gastrocnemius and soleus (Tibial N.)
Plantar flexion and eversion: Peroneus longus & brevis (Superficial Peroneal N.)
Hip extension: Gluteus maximus (Inferior Gluteal N.) knee bent
Reflex of the C7 Nerve Root
Triceps (broad end of hammer)
L4-L5-S1 Dermatome evaluation
L4: Medial leg, behind med malleolus, up med side of big toe
L5: Antero-lateral tibia, dorsum of foot, 3 middle toes
S1: Lateral leg, behind lat malleolus and up pinky toe
Bony palpation of the elbow (right side only)
Medial epicondyle Medial supracondylar line of humerus Lateral epicondyle Lateral supracondylar line of humerus Groove of Ulna Trochlea Olecranon Olecranon fossa Radial head
Wright test
AKA Hyper-abduction Maneuver
Patient seated, find radial pulse, bring arm out to tension and hyper abduct slowly
P: Pain &/or paresthesia, decreased or absent pulse, pallor.
I: Compression of axillary artery by pectorals minor or coracoid process. Thoracic Outlet Syndrome
Perform a a test to evaluate for a SacroIliac pathology
Lewin Standing: Goldwait test Laguerre test Gaenslen test Lewin-Gaenslen test Hibb test Pelvic rock test (pain in either hip joint, SI joint lesion) Nachlas test Yeoman Test Minor sign
Shoulder depressor test
Patient seated, actively laterally flexes, support head and press down on shoulder for 3 seconds.
P: Localized pain on side being tested INDICATES Dural sleeve adhesion, Muscular adhesion or contracture, Muscle spasm, or Ligamentous injury
P: Radiating pain on side being tested INDICATES Neurovascular bundle compression, Dural sleeve adhesions, or TOS
P: Radiating pain on opposite side being tested INDICATES Foraminal encroachment w/ nerve root compression
Graphesthesia
State what you are observing for and what neurological structure is being evaluated
Eyes closed, pt identifies #’s or letters traced on palm of hand (tell them which category is used and angle for THEIR perspective)
Observing for pt’s ability to identify traced outline; testing integrity of Somatosensory cortex
Mitral maneuver no verbalization required
Patient lies on back, place BELL @ mitral area (mid-clavicle), patient then leans 45* towards their left side, “Take a deep breath & hold”
Female: drop left arm off table and use right arm to cover both breasts.
Respiratory excursion
State the normal finding and 2 conditions associated with an abnormal finding
Patient seated, from behind tissue pull w/ ball of hand T8-T10, thumbs along S.P.’s; 3 deep breaths; watch thumbs diverge.
LAG indicates pathology such as Pneumonia, Bronchitis, Fractured rib, Collapsed lung
Muscle test the C5 nerve root
Dr instructs pt how to position arm
Shoulder abduction: Deltoid (Axillary N.)
Forearm flexion: Biceps (Musculocutaneous N.)
Reflex of the S1 nerve root
Achilles tendon (broad end of hammer; foot in slight dorsiflexion proximal portion of tendon)
L3-L4-L5 Dermatome evaluation
L3: Lateral to medial above knee
L4: Medial leg, post med. malleolus, up medial big toe
L5: Anterolateral tibia, foot dorsum, middle 3 toes
Cervical spine bony palpation
Anterior: Hyoid, Thyroid cartilage, 1st cricoid ring, Mandible
Posterior: Occiput, Mastoids, Inion (EOP), Superior nuchal line, S.P’s of cervicals, Facet joints
Lachman Test
Patient supine, knee in slight (30*) flexion, dr grabs proximal tibia & distal femur, pull tibia forward to feel jt play
P: Gapping w/ tibia moving away from the femur
I:Anterior cruciate ligament or posterior oblique ligament instability
Cozen Test
Pt seated, show: “put your wrist in this position(EXTENSION), I will try to pull down, resist,” one hand over fist, other below wrist, Hold for > 3 seconds
P: Pain over the lateral epicondyle
I: Lateral epicondylitis (Tennis Elbow)
Maximal Foraminal Compression Test
Pt seated w/ dr standing behind, pt hyperextends head then turns head one direction (while extended), Bilateral.
P: Pain on concave side
I: Foraminal encroachment w/ or w/o nerve root compression.
Abdominal reflex
State what you are observing for and what neurological structure is being evaluated
Use smooth edge of reflex hammer to lightly stroke abdomen in all 4 quadrants, starting @ umbilicus and going out diagonally
Umbilicus deviation to stroked side. Absence is normal only if bilateral (Beevor sign)
Afferent: Upper T7-T10; Lower T11-T12
Integrating Center: Spinal cord T7-T12
Efferent: Upper T7-T10; Lower T11-T12
Perform a test to identify a sensorineural hearing loss State what you are observing for and what neurological structure is being evaluated
Weber (512 Hz tuning fork, center of skull, sound even?)
or
Rinne ((512 Hz fork on mastoid, no longer heard move to ear, should hear twice as long as on bone)
-evaluating cochlear portion of vestibularcochlear nerve, CN VIII
Obturator Sign
State the pathological finding and the associated indication
Pt supine, instruct pt to flex hip and knee to 90*, dr supports knee (superior hand) and ankle (inf hand), Pt internally/externally rotates HIP against resistance of dr.
P: Increased pain
I: Ruptured appendix or pelvic abscess
Auscultate the abdomen for bruits
State the pathological finding, no indication requred
Using BELL, auscultate:
Aorta (one inch up, one inch LEFT of umbilicus)
Renal arteries (2” up, 2” R and L) HOLD BREATH
Common Iliac arteries (2” down. 2” R and L)
Pathological findings are bruits: signs of turbulent blood flow.
Muscle Test the L4 nerve root
Foot Dorsiflexion & Inversion BILATERALLY!
Tibialis Anterior muscle (Deep peroneal nerve)
Reflex of the C5 nerve root
Biceps (Musculocutaneous N.)
Thumb tractions tendon inferior, strike thumb w/ point of hammer
C6-7-8 Dermatome
C6: Lateral forearm and palmar side of thumb and index
C7: Palmar side of middle finger
C8: Medial forearm and palmar side of pinky & ring finger
Bony Palpation of the shoulder (right side only)
Sternoclavicular articulation, Clavicle, Coracoid process, Acromioclavicular articulation, Acromion, Greater tuberosity of humerous, Lesser tuberosity…, Bicipital groove, Spine of scapula, Body of scapula, Scapulothoracic articulation (pt puts their ipsilateral hand in back waist band)
ThomPson test
Patient Prone, leg up to 90* by examiner, dr squeezes belly of calf (look at foot - expect plantar flexion)
P: Absence of foot plantar flexion motion
I: Achilles tendon ruPture
Perform an orthopedic test to evaluate tarsal tunnel syndrome in your patient
Tinel Foot Sign
Dr taps medial plantar nerve (post to med. malleolus) w/ point of hammer
P: Paresthesia radiating into the foot
I: Tarsal tunnel syndrome
Anterior apprehension test
Patient seated, dr abducts arm and flexes elbow to 90*, externally rotate arm (Look @ their face, don’t grab wrist, support hand behind GH)
P: Noticeable look of apprehension or alarm on face w/ possible pain
I: CHRONIC anterior dislocation of GH joint
Dysmetria of the upper extremity
State what you are observing for and what neurological structure is being evaluated
Index finger test (nose to finger, 4 quadrants) OR Heal-Shin (seated, heel down shin)
Looking for tremors or lack of coordination
Tests Cerebellum
Psoas sign
State what you are observing for and what the finding would indicate
Patient supine, dr’s superior hand on ipsilateral iliac crest (fingers down), inferior hand on thigh, patient raises straight leg against resistance. RIGHT SIDE ONLY
P: Increase in pain
I: Appendicitis
Millgrams test
Patient supine, DR raises both legs 2-3” asks patient to hold in this position for 30 secs
P: Inability to perform test and/or low back pain
I: Weak abdominal muscles or space occupying lesion
Aortic maneuver
Pathological finding
Patient seated, use DIAPHRAGM at right sternal border (aortic area) or left sternal border (Erbs point), ask patient to take deep breath in and learn forward while exhaling completely.
Listening for high pitched murmurs
Reflex of C6 nerve root
Brachioradialis
Broad side of reflex hammer
Soft tissue of lumbar spine
- Anterior abdominal muscles (supine)
- Paraspinal muscles (unit and indiv) - I Love Spine (Lateral to medial): Iliocostalis, Longissimus, Spinalis
- Gluteus Maximus (sacrum to greater trochanter)
- Gluteus Medius (Greater trochanter to iliac crest)
- Sciatic nerve (Between greater troch and ischial tube)
- Hamstrings (unit and indiv) Biceps femoris (lateral), Semitendinosus (under gluts and median - not an adductor), Semimembranosus (most medial)
Hoover sign
(Hoover: patients SUCK because they LIE - malingering)
Patient supine, dr puts one hand under healthy leg and asks patient to lift opposite leg.
P: Lack of counter-pressure on the healthy side
I: Lack of organic basis for paralysis (malingering/hysteria)
Nachlas test
Pt prone, dr takes heel to ipsilateral butt WHILE stabilizing pelvis preventing hip flexion
P: Pain in buttock and/or pain in lumbar region
I: Sacroiliac joint lesion or lumbar pathology
Jackson compression test
Pt seated and THEY laterally flex their head, dr stands behind, clasp hands over head (w/ elbows on sides of head) and apply increasing downward pressure. Perform bilaterally.
P: Exacerbation of localized cervical pain
I: Foraminal encroachment w/o nerve root pressure or facet pathology
P: Exacerbation of cervical pain w/ a radicular component
I: Foraminal encroachment w/ nerve root compression
Perform a neurological test to evaluate the dorsal columns
State what you are observing for, no indication required
Pallesthesia
Light Touch
Joint Position Sense
Romberg Test
Stereognosis
State what you are observing for and what neurological structure is being evaluated
Pt identifies familiar objects w/ eyes closed w/ light touch
Observing ability to identify objects, indicates involvement of somatosensory cortex
Perform a test to evaluate for the presence of pneumonia State what you are observing for, no indication required
Patient seated, from behind tissue pull w/ ball of hand T8-T10, thumbs along S.P.’s; 3 deep breaths; watch thumbs diverge.
LAG indicates pathology such as Pneumonia, Bronchitis, Fractured rib, Collapsed lung
Rebound Tenderness
State the clinical significance of Rovsing and Blumberg signs
Pt supine, dr gently and deeply presses into abdomen w/ fingers extended and quickly releases.
Looking for the return to position (rebound) of the structures which were compressed.
Pain in any quadrant upon rebound = Blumberg’s Sign = Peritonitis
Pain in Rt lower quadrant (@ McBurney’s Pt) when rebounding in Lft lower quadrant = Rovsing’s Sign = Appendicitis
C7 - 8 - T1 Dermatome
C7: Middle finger (palmar side)
C8: Medial forearm, medial 2 digits
T1: Medial elbow joint
Bony palpation of the foot & ankle (right side only)
Medial malleolus, Lateral malleolus, Talus, Navicular, Cuboid, 3 Cuneiforms, 5 Metatarsals, Metatarsophalangeal joints, Calcaneus, Sustentaculum, Navicular tubercle
Laguerre’s Test
Pt supine, dr puts affected leg into figure 4 position (hip flexion, ext rotation, and abduction), stabilize contralateral ASIS while putting downward pressure on knee.
P: Pain in the hip joint
I: Hip joint pathology
P: Pain in the sacroiliac joint
I: Sacroiliac joint pathology
Perform a test to identify meningeal irritation/meningitis in your patient
Look for Kernig Sign
Pt supine, dr flexes pt’s hip and knee to 90* then extends leg completely
P: Inability to fully extend the leg and/or pain (usually in neck region)
I: Meningeal irritation/meningitis
Anterior Innominate Test akas?
AKA Mazion Pelvic Maneuver AKA Advancement Sign
Pt standing, dr instructs pt to step one leg forward 2-3 ft, pt then instructed to bend forward from the waist and touch front foot with both hands (front leg straight)
Inability to bend more than 45* from the waist due to
P: Radiating pain along sciatic nerve (unilateral or bilat)
I: Sciatic neuralgia or radiculopathy, etc. possibly due to lumbar disc pathology
OR
P: Low back pain
I: Anterior (rotational) displacement of ilium relative to sacrum
Evaluate the motor branch of CN VII
State what you are observing for, no indication required
Facial Nerve (CN VII) Inspect face for asymmetry (@ rest and in motion), ask pt to: Raise eyebrows, Close eyes tight, Puff out cheeks, Show teeth, Smile, Frown
Observing for symmetry of face muscles at rest and in motion