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
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
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
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
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
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)
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
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
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
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
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
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
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
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
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
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
