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NPTE Study Practice > MSK Exam Spine, Pelvis, TMJ > Flashcards

MSK Exam Spine, Pelvis, TMJ Flashcards

1
Q

Describe the vertebral artery test

A
  • Test the vertebrobasilar vascular system
  • Supine with head supported over the end of table and eyes open
  • Passively extend head, hold for 30s
  • If no sx progress to passive rotation and side bending with extension; hold each position for 30s
  • Causes reduction of lumen of vertebral artery resulting in decreased blood flow on contralateral side
  • Look for DAN’s sx
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2
Q

Signs and symptoms of damage to the vertbrobasilar artery

A
  • Dizziness/vertigo
  • Dysphagia (difficulty swallowing)
  • Dysarthria (difficulty with speech)
  • Diplopia (double vision)
  • Drop attacks
  • Ataxia (incoordination)
  • Numbness
  • Nausea
  • Nystagmus
  • DAN’s ^^^
  • Severe HA
  • Unconsciousness, disorientation, lightheadedness
  • Hearing difficulties
  • Facial paralysis
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3
Q

Describe the flexion rotation test

A
  • Provocative test for AA dysfunction and/or cervicogenic HA
  • Supine, passively perform max flexion of c-spine then fully rotate head in each direction
  • Pos. if reproduction of HA sx or loss of 10º ROM from one side compared to other
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4
Q

Describe the foramina compression/Spurling’s test

A
  • Identifies dysfunction of cervical nerve root
  • Seated with head side bent toward involved side
  • Apply pressure through head straight down
  • Pos. if pain and/or paresthesia in dermatomal pattern for involved nerve root
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5
Q

Describe the maximum cervical compression test

A
  • Identifies compression of neural structures at IV foramen and/or facet dysfunction
  • Seated, passively move head into side-bending & rotation toward non painful side, followed by extension
  • Repeat toward painful side
  • Pos. if pain and/or paresthesia in dermatomal pattern of involved nerve root
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6
Q

Describe the distraction test

A
  • Indicates compression of neural structures at the IV former and/or facet dysfunction
  • Seated with head passively distracted
  • Pos. if there is a decrease in symptoms in neck (facet) or a decrease in upper limb pain (neurological condition)
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7
Q

Describe the shoulder abduction test

A
  • Indicates compression of neural structures within IV foramen
  • Seated asked pt to place one hand on top of their head
  • Repeat with other hand
  • Pos. if there is a decrease in symptoms into upper limb
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8
Q

Describe Lhermitte’s sign

A
  • Identifies dysfunction of spinal coordination and/or an upper motor neuron lesion
  • Pt long sitting on table
  • Passively flex pt’s head
  • Pos. finding is “electrical” pain down spine and into upper or lower limbs
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9
Q

Describe the Alar ligament test

A
  • Seated passively flex the head slightly and apply a form pincer grip to C2 spinous process
  • Palpate movement at C2 during side-bending and rotation
  • Pos. if unable to palpate C2 movement in conjunction with C1
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10
Q

Describe the modified sharp purser test

A
  • Determines integrity of transverse ligament
  • Seated passively flex the neck slightly
  • Apply a firm pincer grip to C2 spinous process
  • Apply a posterior translation and extension force through the forehead while assessing for excessive linear translation or reproduction of myelopathic symptoms
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11
Q

Signs and symptoms oof cervical instability

A
  • Severe muscle spasm
  • Pt doesn’t want to move head (especially into flexion)
  • Lump in throat
  • Lip or facial paresthesia
  • Severe HA
  • dizziness
  • nausea
  • Vomiting
  • Soft-end feel
  • Nystagmus
  • Pupil changes
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12
Q

Describe rib springing

A
  • Evaluates rib mobility
  • Prone, begin at upper ribs applying a PA force though each rib
  • Then position pt in sidelying and repeat
  • Pos. finding is pain, excessive movement of rib, or restriction of rib
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13
Q

Describe thoracic springing

A
  • Evaluates intervertebral joint mobility in thoracic spine
  • Prone, apply a PA force to transverse processes of thoracic vertebra
  • Pos. finding is pain, excessive movement, and/or restriction of movement
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14
Q

Describe the slump test

A
  • Identifies dysfunction of neurological structures supplying the lower limb
  • Seated edge of table with knees flexed
  • Pt slump sits while maintaining neutral position of head/neck
  • Passively flex head/neck
  • Passively extend on of the pt’s knees
  • Passively DF ankle of extended limb
  • Repeat flow with opposite leg
  • Pos. finding is reproduction of pathological neurological symptoms
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15
Q

Describe the straight leg raise (Lasegue’s test) test

A
  • Identifies dysfunction of neurological structures that supply lower limb
  • Supine, passively flex hip of one leg with knee extended until pt complains of sx into lower leg
  • Slowly lower limb until sx subside then passively DF footo
  • Pos. finding is reproduction of pathological neurological sx when foot is DF
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16
Q

Describe the femoral nerve traction test

A
  • Identifies compression of femoral nerve anywhere along its course
  • Lay on non-painful side with trunk in neutral, head flexed slightly, & lower limb’s hip/knee flexed
  • Passively extend hip while knee of painful limb is in extension
  • If not reproduction of sx, flex knee of painful leg
  • Pos. finding is neurological pain in anterior thigh
17
Q

Describe valsalva’s maneuver/test

A
  • Take deep breath and hold while bearing down
  • Increases pressure in middle ear and in the chest
  • Used when bracing to lift heavy objects
  • Can be used to identify a space occupying lesion
  • Pos. finding is increased LBP or neurological sx into lower extremity
18
Q

Describe the prone instability test

A
  • Tests instability of the lumbar spine
  • Prone with torso resting on table and legs off the edge with feet supported on the ground
  • Apply a PA springing throughout the lumbar spine until a painful spot is identified
  • Instruct pt to lift their legs a few inches off the ground then perform spring testing again on the painful segments
  • Pos. finding is decreased pain during PA springing with the legs raised compared to when the feet were supported on the ground
19
Q

Describe the quadrant test

A
  • Identifies compression of neural structures at the intervertebral foramen and facet dysfunction
  • Standing, cue pt into side bending left, rotation left, and extension to maximally close IV foramen on left
  • Repeat on other side
  • Facet dysfunction: cue pt into side bending left, rotate right, and extension to maximally compress facet joint on left; repeat on other side
  • Pos. finding is pain and/or paresthesia in dermatomal pattern
20
Q

What are the five possible movement patterns to be considered aberrant movement

A
  • Instability catch
  • Painful arc in flexion
  • Painful arc in return from flexion
  • Gower’s sign (walking hands up thighs to return to standing)
  • Reversal of lumbopelvic rhythm
21
Q

Describe the bicycle (Van Gelderen’s test)

A
  • Differentiates b/w intermittent claudication and spinal stenosis
  • Seated on stationary bike, pt rides while sitting erect
  • Record how long the pt can ride at a set speed/pace
  • After sufficient rest, have pt ride at same set speed/pace but in a slumped position
  • If pain is related to stenosis, pt should be able to ride bike longer while slumped
22
Q

Describe the crossed straight leg raise test

A
  • Identifies herniated nucleus pulposis or neural tension/radiculopathy
  • Supine with head, neck, and torso in neutral
  • Maintain neutral DF and knee extension and lift the leg to the point of sx
  • Perform on contralateral side
  • Pos. finding is reproduction of LBP during straight leg raise of the non-involved LE
23
Q

Describe the Schober test

A
  • Measures mobility of lumbar spine
  • Standing, examiner marks a point 5cm below and 10cm above S2
  • Distance is measured in upright position and then in full flexion
  • Difference between/w the 2 measurements is calculated and recorded to the nearest cm
24
Q

Describe Gillet’s test for SI

A
  • Assess posterior movement of the ilium relative to the sacrum
  • Standing, place thumb under PSIS of limb to be tested & place other thumb on center of sacrum at same level as thumb under PSIS
  • Ask pt to flex hip and knee of limb being tested as if bringing the knee to chest
  • Assess movement of PSIS
  • PSIS should move in an inferior direction
  • Pos. finding is no identified movement of PSIS as compared to sacrum
25
Q

Describe the thigh thrust test

A
  • Pain provocation test
  • Supine with hip passively flexed 90º on test side
  • Use one hand to palpate SIJ while thrusting downward through knee and hip
26
Q

Describe the Gaenslen’s test

A
  • Identifies SIJ dysfunction
  • Sidelying at edge of table while holding bottom leg in max hip and knee flexion
  • Stand behind pt, passively extend hip of uppermost limb
  • This places stress on SIJ associated with uppermost limb
  • Pos. finding is pain in SIJ
27
Q

Describe the long sitting test (supine to sit)

A
  • Identifies dysfunction of SIJ that may be cause of functional leg length discrepancy
  • Supine with correct alignment of trunk, pelvis, & lower limbs
  • Stand at edge of table near pt’s feet, palpating the medial malleoli to assess symmetry
  • Have pt come into long sitting position & assess leg length again, making a comparison between supine and long sitting
28
Q

Describe Goldthwait’s test

A
  • Differentiates bw dysfunction in lumbar spine versus SIJ
  • Supine with examiner’s fingers bw spinous processes of lumbar spine
  • Other hand passively performs a straight leg raise
  • If pain presents prior to palpation of movement in lumbar segments, dysfunction is related to SIJ
29
Q

Describe the sidelying compression est

A
  • Identifies SIJ dysfunction
  • Sidelying with painful side up and baseline sx are gathered
  • Place hands on the iliac crest & apply force through the ilium in the downward direction
  • Examiner may hold the position for 30s and apply continued force
  • Pos. test reproduces the pt’s chief complaint
30
Q

Describe the supine iliac distraction/gapping test

A
  • Identifies SIJ dysfunction
  • Supine and baseline sx are gathered
  • Examiner crosses arms and places each hand on the medial aspect of the pt’s ASIS and applies a posterior and lateral force
  • Examiner may hold position for 30s and apply continued force
  • Pos. finding is reproduction of pt’s chief complaint
31
Q

Describe the TMJ compression test

A

-Evaluates for pain with compression of the retrodiscal tissues
- Pt sitting or supine
- Support/stabilize pt’s head with one hand
- With the other hand push the mandible superiorly, cueing a compressive load to the TMJ
- Pos. finding is pain in TMJ

NPTE Study Practice (17 decks)

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