LAB VERBALS FINAL Flashcards
Bony Palpation: SHOULDER
- Sternoclavicular Articulation
- Clavicle
- Coracoid Process
- Acromioclavicular Articulation
- Acromion
- Greater Tuberosity of the Humerus
- Bicipital Groove
- Lesser Tuberosity of the Humerus
- Spine of the Scapula
- Body of Scapula
- Scapulothoracic Articulation
Soft Tissue Palpation: SHOULDER
- Rotator Cuff Muscle: Supraspinatus, Infraspinatus, Teres Minor, Subscapularis
- Subacromial Bursa
- Subdeltoid Bursa
- Axillary Borders: Pectoralis Major, Serratus Anterior, Axillary Lymph Nodes, Latissimus Dorsi, Bicipital Tendon
- Prominent Muscles of Region: Sternocleidomastoid, Biceps, Deltoid as a whole, (anterior, middle and posterior portion of deltoid), Trapezius, Rhomboid (minor and major)
RANGE OF MOTION: SHOULDER
- Flexion: 180
- Abduction: 180
- External Rotation: 90
- Internal Rotation: 70
- Extension: 60
- Adduction: 50
Scapular retraction, elevation, protaction
Yergason Test (Cipriano)
POSITIVE:
- Localized Pain and/or tenderness at the bicipital groove
- Audible click or the biceps tendon subluxes or dislocates
INDICATES:
- Bicipital Tendinitis
- Instability of the biceps tendon possibly associated with a torn transverse humeral ligament
Abbott-Saunders Test
POSITIVE:
- Palpable and/or audible click
INDICATES:
- Subluxation or dislocation of the biceps tendon due to a rupture of the transverse humeral ligament or tendon subluxation beneath subscapularis muscle belly/tendon
SPEED TEST
POSITIVE:
- Pain and/or tenderness in the bicipital groove
INDICATES:
- Bicipital Tendinitis
APLEY TEST:
POSITIVE:
- Exacerbation of pain
INDICATES:
- Degenerative tendinitis of rotator cuff tendons (usually supraspinatus)
IMPINGEMENT SIGN:
POSITIVE:
- Pain in the shoulder
INDICATES:
- Overuse injury to the supraspinatus and possibly biceps tendon
DUGAS TEST
POSITIVE:
- Inability to touch the opposite shoulder and/or inability of the elbow to touch the chest
INDICATES:
- Acute dislocation of the shoulder (glenohumeral joint)
ANTERIOR APPREHENSION TEST
POSITIVE:
- Patient will have a noticeable look of apprehension or alarm on their face with possible pain
INDICATES:
- Chronic anterior dislocation of the shoulder (glenohumeral joint)
POSTERIOR APPREHENSION TEST
POSITIVE:
- Patient will have a noticeable look of apprehension or alarm on their face with possible pain
INDICATES:
- Chronic Posterior dislocation of the glenohumeral joint
DROP ARM TEST/ aka CODMAN DROP ARM TEST
POSITIVE:
- Patient will not be able to lower the arm slowly or the arm drops suddenly
INDICATES:
- Rotator cuff tear, usually supraspinatus
DAWBARN TEST
Deep palpation of shoulder elicits well-localized tender area, by subacromial bursa
POSITIVE:
- Decrease in pain and/or tenderness
INDICATES:
- Subacromial bursitis
BONY PALPATION OF THE ELBOW
- Medial Epicondyle
- Medial Supracondylar line of the humerus
- Groove of the ulnar nerve
- Trochlea
- Olecranon
- Olecranon fossa
- Lateral Epicondyle
- Lateral Supracondylar line of the humerus
- Radial head
SOFT TISSUE PALPATION of ELBOW
- Biceps muscle
- Triceps muscle
- Suprcondylar Lymph Nodes
- Brachial Artery
- Medial Collateral Ligament
- Lateral Collateral Ligament
- Ulnar Nerve
- Olecranon Bursa
- Wrist flexor muscles (Palpate as a unit and individually)
- Pronator Teres
- Flexor Carpi Radialis
- Palmaris Longus
- Flexor Carpi Ulnaris
- Elbow Flexors muscles “mobile wad of three” (palpate as a unit and individually)
- Brachioradialis
- Extensor Carpi Radialis Longus
- Extensor Carpi Radialis Brevis
Range of motion: ELBOW
- Elbow Flexion: 150
- Elbow Extension: 0
- Forearm Supination (radio-ulnar joint): 80
- Forearm Pronation: 80
MEDIAL COLLATERAL LIGAMENT TEST
POSITIVE:
- Excessive gapping & pain
INDICATES:
- Medial Collateral ligament tear and/or instability
LATERAL COLLATERAL LIGAMENT TEST
POSITIVE:
- Excessive gapping & pain
INDICATES:
- Lateral collateral ligament tear and/or instability
TINEL ELBOW SIGN
” This is my Taylor Reflex Hammer it feels something like this, is that ok? “
POSITIVE:
- Pain and/or tenderness at the site being tapped and paresthesia in the ulnar nerve distribution area (fingers 4,5)
INDICATES:
- Neuroma of the ulnar nerve
COZEN TEST
POSITIVE:
- Pain over the lateral epicondyle
INDICATES:
- Lateral Epicondylitis (Tennis Elbow)
MILLS TEST
POSITIVE:
- Pain over the lateral epicondyle
INDICATES:
- Lateral Epicondylitis (Tennis elbow)
GOLFER ELBOW TEST
POSITIVE:
- Pain over the medial epicondyle
INDICATES:
- Medial Epicondylitis
BONY PALPATION: CERVICAL SPINE
ANTERIOR ASPECT:
- Hyoid Bone
- Thyroid Cartilage
- First Cricoid Ring
- Mandible
POSTERIOR ASPECT:
- Occiput
- Inion (EOP)
- Superior Nuchal Line
- Mastoid Processes
- Spinous processes of Cervical Vertebrae
- Facet Joints
SOFT TISSUE PALPATION: CERVICAL SPINE
- Sternocleidomastoid muscle
- Anterior lymph node chain
- Posterior lymph node chain
- Thyroid gland
- Carotid Pulse
- Supraclavicular Fossa
- Trapezius Muscle
- Greater Occipital Nerves
- Superior Nuchal Ligament
RANGE OF MOTION: CERVICAL SPINE
ACTIVE AND PASSIVE
- Flexion 50
- Extension 60
- Lateral Bending Left 45
- Lateral Bending Right 45
- Left Rotation 80
- Right Rotation 80
FORAMINAL COMPRESSION
POSITIVE:
- Exacerbation of localized cervical Pain
- Exacerbation of cervical pain with a radicular component
INDICATES:
- Foraminal Encroachment or facet pathology without nerve root compression
- Foraminal Encroachment or facet pathology with nerve root compression
CERVICAL DISTRACTION TEST
POSITIVE:
- Diminished or absence of local cervical pain
- Diminished or absence or radiating pain
- Increase of cervical pain
INDICATES:
- Foraminal encroachment without nerve root compression
- Foraminal encroachment with nerve root compression
- Muscular strain, ligamentous sprain, myospasm or facet capsulitis
SPINAL PERCUSSION TEST
” This is my Taylor reflex hammer it feels something like this “
POSITIVE:
- Local Pain
- Radiating
INDICATES:
- Possible fractured vertebrae, ligamentous involvment (spinous pain), and muscular involvment (muscular pain)
- Possible disc pathology
SHOULDER DEPRESSION TEST
POSITIVE:
- Localized pain on the side being tested
- Radicular pain on either side
INDICATES:
- Localized Pain: Dural sleeve adhesion, and muscular adhesion/contracture, or spasm, or ligamentous injury
- Radiating Pain: On side being tested neurovascular bundle compression, dural sleeve adhesions, or Thoracic Outlet Syndrome. On opposite side being tested foraminal encroachment with nerve root compression
VALSALVA MANEUVER
POSITIVE: Radiating pain from site of lesion (usually recreating the complaint in cervical or lumbar area of the spine)
INDICATES: Space occupying lesion (e.g. disc pathology)
SWALLOWING TEST
POSITIVE: Difficulty in swallowing
INDICATES: Space-Occupying lesion at anterior portion of cervical spine. Possibly esophageal or pharyngeal injury, anterior disc defect, muscle spasm or osteophytes etc.
SOTO-HALL SIGN
POSITIVE: Generalized pain in the cervical region, which may extend down to the level of T2
INDICATES: Non-specific test for structural integrity of cervical region
KERNIG SIGN
POSITIVE: Inability to fully extend the leg and/or pain (usually in the neck region)
INDICATES: Meningeal irritation/meningitis
O’ DONOGHUE MANEUVER
POSITIVE:
- Pain during passive range of motion
- Pain during resisted range of motion
INDICATES:
- Ligamentous sprain. (Passive ROM stresses ligaments)
- Muscle/tendon strain. (Active ROM stresses muscles and tendons)
Bony Palpation Wrist and Hand
Radial Syloid Process
Ulnar Styloid Process,
Lister’s Tubercle,
Scaphoid (navicular),
Lunate, Triquetrium,
Pisiform,
Trapezium,
Trapezoid,
Capitate,
Hamate,
Hook of Hamate,
Metacarpals,
Phalanges
Soft Tissue Palpation: Wrist and Hand
Ulnar Artery,
Radial Artery,
Palmaris Longus Tendon,
Carpal Tunnel Region,
Thenar Eminence,
Hypothenar Eminence,
Palmar Aponeurosis,
Tissues surrounding proximal interphalangeal joints,
Tissues surrounding distal interphalangeal joints,
Distal tufts of fingers
Range of Motion: Wrist and Hand
Wrist Flexion 80,
Wrist Extension 70,
Wrist Ulnar Deviation 30,
Wrist Radial Deviation 20,
Finger Abduction,
Finger Adduction,
Finger Flexion,
Finger Extension,
Thumb Flexion,
Thumb Extension,
Finger Opposition
Tinel Wrist Sign
” This is my Taylor reflex hammer, it feels something like this, is that ok? “
POSITIVE: Reproduction of pain, tenderness, and/or paresthesia in the median nerve distribution area (1st, 2nd, 3rd, and the lateral 1/2 of the 4th digit)
INDICATES: Median Neuritis, possibly Carpal Tunnel Syndrome
PHALEN SIGN AND REVERSE PHALEN SIGN
aka Prayer Sign
Elbows same level as shoulders for 60 seconds
POSITIVE: Reproduction of pain and/or paresthesia in the median nerve distribution area (thumb, 2nd, 3rd, and the lateral 1/2 of the 4th digit)
INDICATES: Median Neuritis, possibly Carpal Tunnel Syndrome
FINKELSTEIN TEST
POSITIVE: Pain distal to the radial styloid process
INDICATES: Stenosing tenosynovitis of the abductor pollicis longus and extensor pollicis brevis tendons (DeQuervain’s Disease)
ALLEN TEST
57, 58, 59, 60 …… both hands pumping, bring them down both closed, open at same time, then let off of one artery and compare (TURN HEAD)
POSITIVE: A delay of more than 10 seconds (Evans 5 sec) in returning a reddish color to the hand
INDICATES: Radial or Ulnar Artery insufficiency. The artery held (occluded) by the examiner is not the artery being tested
RETINACULAR TEST
Patient presents with difficulty flexing the DIP joint
POSITIVE:
1) Flexion of the distal interphalangeal joint cannot be achieved
2) Flexion of the distal interphalangeal joint is achieved
INDICATES:
1) Joint Capsule Contracture
2) Tight Retinacular Ligament
BUNNEL - LITTLER TEST
Patient presents with difficulty flexing the PIP joint
POSITIVE:
- Flexion of the proximal interphalangeal joint cannot be achieved
- Flexion of the proximal interphalangeal joint is achieved
INDICATES:
- Joint Capsule Contracture
- Tight intrinsic muscles
Explain the “Initial Examination Procedure” of testing nerve roots:
“This is my pinwheel, it’s pointy and prickly and feels something like this, is that ok?”
- C4 on right compared to C4 on left (dermatome above)
- C5 on right compared to C5 on left (dermatome package)
- C6 on right compared to C6 on the left (dermatome below)
Explain the Secondary Examination Procedure with nerve roots:
FIRST
- C4 on the right side compared to C5 on the right side
- C5 of right side compared to C6 of right side
SECOND
- C4 of left side compared to C5 of left side
- C5 of left side compared to C6 of left side
“Can you feel this? AND does it feel like this?
S2 NERVE ROOT
- DISC LEVEL: S1
- SENSATION: Posterior aspect of thigh over popliteal fossa on to posterior medial calf