Midterm Flashcards
Dugas Test - Instruction
Pt seated, examiner instructs pt to place the hand of the affected side on the opposite shoulder and then bring the affected elbow to the chest.
Dugas Test - Positive/Indicates
P: Inability to touch the opposite shoulder and/or inability of the elbow to touch the chest.
I: Acute dislocation of the shoulder (glenohumeral joint).
Anterior Apprehension Test - Instruction
Pt seated, examiner abducts the pt’s shoulder, flexes the pt’s elbow and then gradually externally rotates to the pt’s shoulder.
Anterior Apprehension Test - Positive/Indicates
P: Patient will have a noticeable look of apprehension or alarm on their face with possible pain.
I: Chronic anterior dislocation of the shoulder (glenohumeral joint).
Posterior Apprehension Test - Instruction
Pt supine, examiner flexes pt’s shoulder, flexes pt’s elbow and internally rotates the pt’s shoulder. Examiner places his/her hand on the pt’s distal humerus and gradually applies increasing posterior pressure.
Posterior Apprehension Test - Positive/Indicates
P: Patient will have a noticeable look of apprehension or alarm on their face with possible pain.
I: Chronic posterior dislocation of the shoulder (glenohumeral joint).
Codman Drop Arm Test - Instruction
Pt seated, examiner passively abducts pt’s arm to slightly over 90 degrees and removes support, if pt can maintain arm, then instructs pt to slowly lower their arm.
“Doctor abducts pt’s arm slightly past 90*.”
Codman Drop Arm Test - Positive/Indicates
P: Patient will not be able to lower the arm slowly or the arm drops suddenly.
I: Rotator cuff tear, usually supraspinatus.
Dawbarn Test - Instruction
Pt seated, examiner applies pressure below the affected acromial process with his/her fingertips. Note for pain or tenderness. Examiner continues to apply pressure while abducting the pt’s arm past 90 degrees.
“If pt experiences pain with deep palpation, I would abduct the arm to slightly past 90* and repalpate.”
Dawbarn Test - Positive/Indicates
P: Decrease in pain and/or tenderness.
I: Subacromial bursitis.
Yergason Test - Instruction
Pt seated, examiner flexes pt’s elbow to 90 degrees. Examiner stabilizes pt’s elbow with one hand and exerts slight inferior traction. Examiner uses their other hand and grasps slightly above pt’s wrist. Examiner offers resistance while pt is instructed to externally rotate his/her humerus and slightly supinate the forearm.
Yergason Test - Positive/Indicates
P1: Localized pain and/or tenderness at the bicipital groove.
I1: Bicipital tendinitis.
P2: Audible click or the biceps tendon subluxes or dislocates.
I2: Instability of the biceps tendon possibly associated with a torn transverse humeral ligament.
Abbott-Saunders Test - Instruction
Pt seated, examiner fully abducts and externally rotates the pt’s affected arm. Examiner places his/her fingers on the pt’s bicipital groove and then slowly lowers the pt’s affected arm to their side.
Abbott-Saunders Test - Positive/Indicates
P: Palpable and/or audible click.
I: Subluxation or dislocation of the biceps tendon, rupture of transverse ligament, or tendon subluxation beneath subcapularis muscle belly.
Speed Test - Instruction
Pt seated with forearm supinated and elbow flexed to 45 degrees. Examiner places his/her fingers on pt’s bicipital groove with their opposite hand on the pt’s forearm. Instruct the pt to flex his/her shoulder, maintain supination and completely extend the elbow as the doctor applies resistance.
Speed Test - Positive/Indicates
P: Pain and/or tenderness in the bicipital groove.
I: Bicipital tendinitis.
Apley Test - Instruction
Pt seated. Have him/her place the affected hand behind the head and touch the opposite superior angle of the scapula = Apley scratch superior.
Then pt is instructed to place the hand behind the back to touch the inferior angle of the scapula = Apley scratch inferior.
Apley Test - Positive/Indicates
P: Exacerbation of pain.
I: Degenerative tendinitis of rotator cuff tendons (usually Supraspinatus).
Impingement Sign - Instruction
Pt seated with arms at side, examiner slightly abducts pt’s arm (hand should be pronated) and moves it fully through flexion (will jam greater tuberosity and anterior/inferior surface of the acromion).
Impingement Sign - Positive/Indicates
P: Pain in the shoulder.
I: Overuse injury to the supraspinatus and possibly biceps tendon.
Medial Collateral Ligament Test (Abduction Stress Test) - Instruction
Pt seated, examiner stabilizes the lateral aspect of the arm and places an abduction (valgus) pressure on the medial forearm.
-slight flexion 5-10*
Medial Collateral Ligament Test (Abduction Stress Test) - Positive/Indicates
P: Excessive gapping & pain.
I: Medial collateral ligament instability.
Lateral Collateral Ligament Test (Adduction Stress Test) - Instruction
Pt seated, examiner stabilizes the medial aspect of the arm and places an adduction (varus) pressure on the pt’s lateral forearm.
Lateral Collateral Ligament Test (Adduction Stress Test) - Positive/Indicates
P: Excessive gapping & pain.
I: Lateral collateral ligament instability.
Tinel Elbow Sign - Instruction
Pt seated, with a Taylor reflex hammer, examiner taps over the groove between the medial epicondyle and the olecranon process.
Tinel Elbow Sign - Positive/Indicates
P: Pain and/or tenderness at the site being tapped and paresthesia in the ulnar nerve distribution area (fingers 4, 5).
I: Neuroma of the ulnar nerve.
Cozen Test - Instruction
Pt seated, examiner instructs pt to make a fist and place wrist into extension. Examiner instructs pt to resist as examiner tries to push extended wrist into flexion.
Cozen Test - Positive/Indicates
P: Pain over the lateral epicondyle.
I: Lateral epicondylitis (Tennis Elbow).
Mills Test (Maneuver) - Instruction
Pt seated at rest with forearm supinated. In a smooth continuous motion the doctor passively maximally flexes the pt’s fingers and wrist. While maintaining wrist and figer flexion, the doctor passively extends the pt’s elbow (the forearm is now pronated).
Mills Test (Maneuver) - Positive/Indicates
P: Pain over the lateral epicondyle.
I: Lateral epicondylitis (Tennis Elbow).
Golfer Elbow Test - Instruction
Pt seated, examiner instructs pt to extend the elbow and pronate hand. Examiner instructs pt to flex the wrist against resistance.
Golfer Elbow Test - Positive/Indicates
P: Pain over the medial epicondyle.
I: Medial Epicondylitis.
Tinel Wrist Sign - Instruction
Pt seated with wrist supinated, examiner taps over the palmar (volar) surface of the wrist. (Flexor retinaculum - over carpal tunnel region).
Tinel Wrist Sign - Positive/Indicates
P: Reproduction of pain, tenderness and/or paresthesia in the median nerve distribution area (thumb, 2nd, 3rd, and lateral 1/2 of the 4th digit).
I: Median neuritis, possibly Carpal Tunnel Syndrome.
Phalen Sign AND Reverse Phalen Sign (Prayer Sign) - Instruction
Pt seated, examiner instructs pt to flex both wrists to maximum degree and approximate until point of pain or 60 seconds.
Prayer sign = maximally extend wrist (palms together), elbows same level as shoulders for 60 seconds.
“Pt to hold position for 60 seconds or until point of pain.”
Phalen Sign AND Reverse Phalen Sign (Prayer Sign) - Positive/Indicates
P: Reproduction of pain and/or paresthesia in the median nerve distribution area (1st, 2nd, 3rd, and lateral 1/2 of the 4th digit).
I: Median neuritis, possibly Carpal Tunnel Syndrome.
Finkelstein Test - Instruction
Pt seated, examiner instructs pt to place his/her thumb across the palmar surface of the hand and make a fist. Have pt flex elbow and instruct pt to ulnar deviate his/her hand.
Finkelstein Test - Positive/Indicates
P: Pain distal to the radial styloid process.
I: Stenosing tenosynovitis of the abductor pollicis longus and extensor pollicis brevis tendons (DeQuervain’s Disease).
Bunnel-Littler Test - Instruction
Pt seated, examiner places metacarpophalangeal joint in extension and tries to flex the proximal interphalangeal joint. If no flexion is possible then there is either a joint capsule contracture or tight intrinsic muscles. To differentiate, examiner places the metacarpophalangeal joint in a few degrees of flexion and attempts to move the proximal interphalangeal joint into flexion.
Bunnel-Littler Test - Positive/Indicates
P1: Flexion of the proximal interphalangeal joint cannot be achieved.
I1: Joint capsule contracture.
P2: Flexion of the proximal interphalangeal joint is achieved.
I2: Tight intrinsic muscles.
Retinacular Test - Instruction
Pt seated, examiner places proximal interphalangeal joint in neutral and tries to flex the distal interphalangeal joint. If no flexion is possible then there is either a joint capsule contracture or tight retinacular ligaments. To differentiate, examiner places the proximal interphalangeal joint in a few degrees of flexion and attempts to move the distal interphalangeal joint into flexion.
Retinacular Test - Positive/Indicates
P1: Flexion of the distal interphalangeal joint cannot be achieved.
I1: Joint capsule contracture.
P2: Flexion of the distal interphalangeal joint is achieved.
I2: Tight retinacular ligament.
Allen Test - Instruction
Pt seated, examiner instructs pt to raise his/her hand above the heart level of his/her head and to open and close his/her fist for 60 seconds. Examiner occludes both the radial and ulnar artery at the wrist and then lowers the pt’s arm with the fist closed and allows the fist to rest on pt’s thigh. Examiner instructs pt to open closed fist and releases digital pressure over one artery while keeping the other artery occluded. Record the filling time, while comparing color to the other hand. Then repeat procedure for other artery.
Allen Test - Positive/Indicates
P: A delay of more than 10 seconds (Evans says 5 sec) in returning a reddish color to the hand.
I: Radial or ulnar artery insufficiency. The artery occluded by the examiner is not the artery being tested.
Foraminal Compression Test - Instruction
Pt seated with examiner standing behind. Examiner clasps his/her hands over pt’s head and exerts gradual increasing downward pressure. Examiner repeats this procedure with the pt’s head rotated right and then left.
Foraminal Compression Test - Positive/Indicates
P1: Exacerbation of localized cervical pain.
I1: Foraminal encroachment or facet pathology without nerve root compression.
P2: Exacerbation of cervical pain with a radicular component.
I2: Foraminal encroachment or facet pathology with nerve root compression.
Cervical Distraction Test - Instruction
Pt seated. Examiner grasps the pt’s head with both hands and gradually exerts upward pressure keeping hands off TMJ and ears.
Cervical Distraction Test - Positive/Indicates
P1: Diminished or absence of pain.
I1: Foraminal encroachment (local pain diminishes, nerve root compression (Radicular pain diminishes).
P2: Increase of cervical pain.
I2: Muscular strain, ligamentous sprain, myospasm, facet capsulitis.
Spinal Percussion Test - Instruction
Pt seated with head in slight flexion, percuss each cervical spinous process(es) and the associated musculature with the pointed end of a reflex hammer.
Spinal Percussion Test - Positive/Indicates
P1: Local pain.
I1: Possible fractured vertebrae, ligamentous involvement (spinous pain), and muscular involvement (muscular pain).
P2: Radiating pain.
I2: Possible disc pathology.
Shoulder Depression Test - Instruction
Pt seated, examiner stabilizes pt’s laterally flexed head while pushing down on shoulder.
Shoulder Depression Test - Positive/Indicates
P1: Localized pain on the side being tested.
I1: Localized Pain: Dural sleeve adhesion, and muscular adhesion/contracture, or spasm, or ligamentous injury.
P2: Radicular pain on either side.
I2: 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 - Instruction
Pt seated, examiner instructs pt to take a deep breath and hold while bearing down as if straining during a bowel movement.
Valsalva Maneuver - Positive/Indicates
P: Radiating pain from site of lesion (usually recreating the complaint in cervical or lumbar area of the spine).
I: Space occupying lesion (e.g. disc pathology)
Swallowing Test - Instruction
Pt seated: examiner instructs the pt to swallow.
Swallowing Test - Positive/Indicates
P: Difficulty in swallowing.
I: 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 - Instruction
Pt supine, examiner flexes pt’s head toward his/her chest while exerting downward pressure on pt’s sternum with hypothenar eminence of inferior hand.
Soto-Hall Sign - Positive/Indicates
P: Generalized pain in the cervical region, which may extend down to the level of T2.
I: Non-specific test for structural integrity of cervical region.
Kernig Sign - Instruction
Pt supine, examiner passively flexes pt’s hip to 90 degrees and the pt’s knee to 90 degrees. Examiner extends pt’s leg completely.
Kernig Sign - Positive/Indicates
P: Inability to fully extend the leg and/or pain (usually in the neck region)
I: Meningeal irritation/meningitis.
O’Donoghue Maneuver - Instruction
Pt is seated, examiner grasps the pt’s head with both hands and passively and slowly takes the cervical region through a range of motion. The examiner then takes the cervical region through isometric contractions.
O’Donoghue Maneuver - Positive/Indicates
P1: Pain during passive range of motion.
I1: Ligamentous sprain. (Passive ROM stresses ligaments)
P2: Pain during resisted range of motion.
I2: Muscle/tendon strain. (Active ROM stresses muscles and tendons)
Shoulder Bony Palpation
Sternoclavicular articulation Clavicle Acromioclavicular articulation Acromion Spine of the scapula Body of the scapula Scapulothoracic articulation Coracoid process Greater tuberosity of the humerus Bicipital groove Lesser tuberosity of the humerus
Shoulder Soft Tissue Palpation
Prominent muscles - sternocleidomastoid - biceps - anterior portion of deltoid - middle portion of deltoid - posterior portion of deltoid - trapezius - rhomboid major - rhomboid minor Axillary borders - pectoralis major - serratus anterior - axillary lymph nodes - latissimus dorsi - bicipital tendon Subacromial bursa Subdeltoid bursa Rotator Cuff Muscles - supraspinatus - infraspinatus - teres minor - subscapularis
Shoulder Range of Motion
Flexion 180* Extension 60* Abduction 180* Adduction 50* External rotation 90* Internal rotation 70* Scapular retraction (attention) Scapular protraction (reaching) Scapular elevation (shoulder shrug)
Elbow Bony Palpation
Medial epicondyle Groove of the ulnar nerve Trochlea Olecranon process Olecranon fossa Lateral epicondyle Radial head Lateral supracondylar line of the humerus Medial supracondylar line of the humerus
Elbow Soft Tissue Palpation
Biceps Triceps muscle Brachial artery Supracondylar lymph nodes Medial collateral ligament Ulnar nerve Olecranon bursa Lateral collateral ligament Wrist flexor muscles (as a unit and individually) - pronator teres - flexor carpi radialis - palmaris longus - flexor carpi ulnaris Elbow flexor muscles (as a unit and individually) - brachioradialis - extensor carpi radialis longus - extensor carpi radialis brevis
Elbow Range of Motion
Elbow flexion 150*
Elbow extension 0*
Forearm supination (radio-ulnar joint) 80*
Forearm pronation 80*
Wrist and Hand Bony Palpation
Radial styloid process Scaphoid Lister's tubercle (Dorsal tubercle) Lunate Capitate Ulnar styloid process Triquetrium Pisiform Hook of hamate Trapezium Trapezoid Metacarpals Phalanges
Wrist and Hand Soft Tissue Palpation
Radial artery Ulnar artery Palmaris longus tendon Thenar eminence Hypothenar eminence Palmar aponeurosis Carpal tunnel region Tissues surrounding proximal interphalangeal joints Tissue surrounding distal interphalangeal joints Distal tufts of fingers
Wrist and Hand Range of Motion
Wrist flexion 80* Wrist extension 70* Wrist ulnar deviation 30* Wrist radial deviation 20* Finger abduction Finger adduction Thumb flexion (MCP) Thumb extension (MCP) Finger flexion (MCP) Finger extension (MCP) Finger Opposition
Cervical Spine Bony Palpation
Anterior - hyoid bone - thyroid cartilage - first cricoid ring - mandible Posterior - occiput - inion - superior nuchal line - mastoid processes - spinous processes of cervical vertebrae - facet joints
Cervical Spine Soft Tissue Palpation
Sternocleidomastoid muscle Anterior lymph node chain Posterior lymph node chain Thyroid gland Carotid pulse Supraclavicular fossa Trapezius muscle Greater occipital nerves Superior nuchal ligament
Cervical Spine Range of Motion
Flexion 50* Extension 60* Lateral bending left 45* Lateral bending right 45* Left rotation 80* Right rotation 80*
