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Orthopedics > MT 1 > Flashcards

MT 1 Flashcards

1
Q

What are the elements of a High Index Neuro exam?

A 
Light touch
Pain
Vibration
Reflex
Motor
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2
Q

How do you test light touch?

A

use a soft item

with pt’s eyes closed, lightly brush each dermatome in question

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3
Q

How do you test for nociception?

A

use an instrument that can elicit sharp and dull pressure
w/ pts. eyes closed
poke dermatomes in question
alternate sharp and dull, but sharps are most important
dull is used as a control

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4
Q

For each muscle/tendon, what are the nerve roots?
biceps
brachioradialis
triceps

A

biceps- C 5
brachio- C 6
triceps- C 7

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5
Q

what are things you can do if you have trouble eliciting a reflex?

A

close eyes, put a slight stretch on muscle, light contraction of muscle, clench teeth

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6
Q

what is the name of the upper extremity pathologic reflex and how do you perform?

A

Hoffman’s
flick distal 3rd phalanx and observe for flexion of the thumb
Dynamic Hoffman’s
include cervical flexion/extension

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7
Q

motor testing of C5 nerve root tests which muscle?

A

deltoid

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8
Q

motor testing of C6 nerve root tests which muscles?

A

wrist extensors, biceps

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9
Q

motor testing of C7 nerve root tests which muscle?

A

triceps, wrist flexors, finger extensors

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10
Q

motor testing of C8 nerve root tests which muscle?

A

finger flexors

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11
Q

motor testing of T1 nerve root tests which muscle?

A

finger ab/adductors

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12
Q

what is Rust’s sign, and what does it mean if you see it?

A

part of observation of cervical spine
patient supporting head/neck
interpretation: cervical instability
need to refer for immediate imaging

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13
Q

what is Bakody’s sign, and what does it mean if you see it?

A

patient has hand over head

interpretation: cervical radiculopathy

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14
Q

what is the fracture screen for cervical spine pathology?

A

percuss on spinous processes

lingering pain on SPs can mean fracture, infection, or pathologic lesion –> imaging!

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15
Q

this maneuver increases intra theca pressure, and may result in radicular pain, indicating a space occupying lesion such as a tumor or herniation

A

Valsalva

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16
Q

________ ___________ is a test where you place an axial load on the top of the head onto spinous discs and facets. peripheral pain indicates ___________, and local pain indicates a __________ problem

A

cervical compression
radiculopathy (IVF)
facet

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17
Q

___________ Test is a lateralized load on discs and facets (pt head in flexion, while you apply pressure to top of the head).
peripheral pain indicates ____________
local pain on same side of flexion indicates _______
local pain on opposite side of flexion indicates ______

A

Spurling’s Test
radiculopathy (IVF)
local pain on same side = facet
local pain on opposite side = strain/sprain

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18
Q

_________ __________ __________ is a test where you position the pt’s head in ipsilateral rotation, lateral flexion, and extension and apply an axial load
peripheral pain indicates _________
local pain, same side indicates ________
local pain, opposite side indicates ________

A

Maximal cervical compression
peripheral pain= radiculopathy
local pain same side = facet
local pain opposite side = strain/sprain

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19
Q

________ ____________ is an axial unload.
decreased peripheral pain indicates _______
decreased local pain indicates ______
increased local pain indicates _______

A

cervical distraction
dec peripheral pain = radiculopathy
dec local pain = facet
inc local pain = strain/sprain

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20
Q

if pt has pain in his cervical spine, what tests could you perform to determine what the cause is?

A

spurling’s test,
maximal cervical compression
cervical distraction
shoulder depression

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21
Q

with shoulder depression,
peripheral pain indicates _____________
local pain indicates _________
contra lateral pain indicates _______

A

radiculopathy
strain/sprain
facet

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22
Q

pain with resisted range of motion indicates a ______

A

strain

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23
Q

pain with passive range of motion indicates a _______

A

sprain

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24
Q

_____ - ____ applies passive cervical flexion with sternal pressure
peripheral pain indicates ________
local pain indicates ___________
spinal pain with Brudzinski’s sign indicates ______

A

Soto-Hall
radiculopathy
strain/sprain
meningitis

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25
Q

what is the name of an observation test you can perform to examine the thoracic spine for deformities/scoliosis?

A

Forward Bending Test/ Adam’s sign

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26
Q

what test would you perform to screen for a fracture on the thoracic spine?

A

spinous percussion on SPs

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27
Q

This test involves shoulder depression, GH abduction, GH external rotation, forearm supination, wrist and finger extension and elbow extension, with contralateral and ipsilateral flexion of cervical spine

A

upper limb tension test

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28
Q

What is Adson’s test?

A

palpate pulse with one hand and extend arm back while stabilizing scalenes with other hand. Feel for decreased pulse indicating vascular occlusion, or paresthesia indicating nerve impingement

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29
Q

follow up for confirmation of Adson’s test

A

Reverse Adson’s test

have patient contralaterally rotate head

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30
Q

What is Eden’s test?

A

palpate pulse on both arms and extend both arms back while patient sticks out chest and flexes head forward. Feel for decreased pulse indicating vascular occlusion, or paresthesia indicating nerve impingement

31
Q

What is Wright’s test?

A

palpate pulse on both arms, lift arms to 90 degrees and extend both arms back. Feel for decreased pulse indicating vascular occlusion, or paresthesia indicating nerve impingement.

32
Q

What is Roos Test?

A

Pt opens and closes fists 2x/sec for 3 mins, look for decreased pulse or paresthesia

33
Q

What is Allen test?

A

occlude radial and ulnar arteries for 1 min and check refill time of both
<5sec = normal
>15sec= peripheral arterial compromise

34
Q

what are the components of a fracture screen for the shoulder?

A

1) light palpation, percussion, vibration of clavicle, accordion and humeral neck
2) light torsion- pt presses in to your hand and you resist
3) Olecranon-Manubrium Percussion Test- listen on manubrium while tapping olecranon for a muffled difference in sound

35
Q

what is a test of active range of motion for the shoulder?

A

painful arc- active abduction of the shoulder, observing for pain in certain ranges

36
Q

what is the empty can test? what is the interpretation of pain?

A

ortho muscle test for shoulder
pt moves arms out in a diagonal in the scapular plane with thumbs up, raises arms to 150 degrees, then internally rotates arm so thumb is facing down and lowers arm to 90 deg, you apply over pressure
interpretation- supraspinatus tear/impigment

37
Q

what is the codman’s arm drop? what is the interpretation of pain?

A

raise patients arm to 120 degrees, then release suddenly and have patient catch arm and lower slowly
interpretation- supraspinatus tear/impigment

38
Q

what is the lift off test? what is the interpretation of pain?

A

patient places dorsum of hand on sacrum and attempts to push hand posteriorly off sacrum. examiner looks for inability or pain and may apply overpressure.
interpretation- subscapularis tear

39
Q

what is Speed’s test? What is the interpretation of pain?

A

Patient actively flexes straight arm against resistance while doc palpates bicipital groove
interpretation- bicipital tendonitis, impingment/labral tear/bursitis

40
Q

what is Hawkin’s- Kennedy test? What is the interpretation of pain?

A

Doc stabilizes shoulder, patient abducts arm with horizontal adduction and elbow flexion. Doc stabilizes elbow and applies internal rotation
interpretation- supraspinatus impingement

41
Q

What is Neer’s Test and what is the interpretation of pain?

A

Doc stabilizes the scapula and passively flexes patient’s shoulder with external rotation (palm up), and repeats with internal rotation (palm down)
interpretation-
pain with palm up = biceps impingement
pain with palm down= supraspinatus impingement

42
Q

what is passive cross body adduction test and what does pain mean?

A

doc passively adducts the arm in a horizontal plane across the patient
interpretation- AC pathology

43
Q

what is resisted cross body abduction and what does pain mean?

A

patient horizontally abducts arm against doc resistance

interpretation - AC pathology

44
Q

What is the anterior apprehension test and what does pain mean?

A

patient shoulder flexed and externally rotated, doc applies a posterior to anterior force on the GH joint
interpretation- anterior translation/dislocation/patient apprehension= GH instability

45
Q

what is the relocation test and what is the interpretation of your findings?

A

it is a follow up test to anterior apprehension if + was found
pt lying supine on table, shoulder flexed and externally rotated, apply an anterior to posterior force in the GH joint
interpretation- decrease in apprehension=GH instability

46
Q

What is O’Brien’s Test w/ AC compression, and interpretation of findings?

A

Pt holds arm in a flexed position with slight horizontal adduction and internal rotation while doc applies a downward force (AC compression test)
repeat with external rotation (palm up)
Interpretation:
pain over AC with thumb down = AC pathology
deep pain with thumb down = labral pathology
pain with palm up = biceps tendonitis

47
Q

what is the shoulder passive compression test and what are interpretations of findings?

A

pt supine and side lying, with elbow flexed. Doc passively abducts shoulder 30 deg, externally rotates shoulder and applies an axial load to the shoulder while grinding the elbow into flexion and extension
interpretation:
pain deep in shoulder = SLAP lesion

48
Q

what is the modified dynamic labral shear test? interpretation of findings?

A

pt standing. Doc passively abducts patient’s shoulder to 120 deg, externally rotates shoulder, and palpates posterior GH joint as doc moves shoulder to maximal horizontal abduction while moving shoulder between 60-120 deg of abduction
interpretation:
clicking/popping/pain = labral lesion

49
Q

what is the passive distraction test? interpretation of findings?

A

supine patient with forearm supinated and shoulder abducted to 150 deg, doc prevents humeral rotation while passively pronating forearm.
interpretation:
increased pain in shoulder= SLAP lesion

50
Q

what tests would you perform if you suspect GH instability?

A

observation- sulcus sign
AROM - painful arc @ 45-120 deg
anterior apprehension
relocation test

51
Q

what tests would you perform if you suspect AC pathology?

A 
observation- step off deformity
AROM- painful arc @ 170-180 deg
passive X body adduction
resisted X body abduction
O Brien's test w/ AC compression
52
Q

what tests would you perform if you suspect supraspinatus tear/impingement/rotator cuff tear?

A

empty can test
codman’s arm drop
Hawkin’s-Kennedy
Neer’s test- pain with palm down

53
Q

what tests would you perform if you suspect a labral tear

A

Speed’s test
O Brien’s test w/ AC compression
Modified dynamic labral shear test

54
Q

what tests would you perform if you suspect biceps tendonitis/impingment

A

Speed’s test
Neer’s test (pain with palm up)
O Brien’s test (pain w/ palm up)

55
Q

what tests would you perform if you suspect a SLAP lesion?

A

shoulder passive compression test

Passive distraction Test

56
Q

what is the scaphoid fracture test? what would positive findings indicate?

A

compressive force applied over the scaphoid in the anatomical snuff
scaphoid fracture

57
Q

what is the bracelet test? what would findings indicate?

A

compressive force applied at the distal radius and ulna (around wrist)
fracture, ligamentous laxity/compromise

58
Q

what is Watson’s test? what do positive findings indicate?

A

stabilize the distal radius and scaphoid, and move hand back and forth
excessive movement or pain indicates a scaphoid fracture/instability

59
Q

what is thumb-index pinch? what do findings indicate?

A

actively place tips of index and thumb together

pain at the scaphoid indicates a scaphoid fracture

60
Q

what AROM are part of fracture screening for the wrist and hand?

A

active wrist extension
active forearm pronation
pain at the scaphoid indicates a scaphoid fracture

61
Q

what is cozen’s test and what do findings indicate?

A

forearm pronated with wrist extension and elbow flexion, examiner applies force into elbow extension and wrist flexion
pain at lateral epicondyle or muscle weakness indicates lateral epicondylitis
»»Testing the wrist extensors

62
Q

what is mill’s test and what do findings indicate?

A

passive stretch of the hand extensors, examiner passively extends elbow and flexes wrist
pain at the lateral epicondyle is indicative of lateral epicondylitis
»»stretching the wrist extensors

63
Q

what is long finger extension and what do findings indicate?

A

fingers extended, support hand, and do a resisted muscle test of the middle finger
pain at the lateral epicondyle or muscle weakness is indicative of lateral epicondylitis

64
Q

what is reverse Cozen’s test and what do findings indicate?

A

resisted muscle test of hand flexors
forearm supinated with wrist and elbow flexion, examiner applies a force into elbow extension and wrist extension
pain at the medial epicondyle or muscle weakness is indicative of medial epicondylitis
»»> testing the wrist flexors

65
Q

what is reverse Mill’s test and what do findings indicate?

A

passive stretch of hand flexors
examiner passively extends elbow and extends wrist
pain at the medial epicondyle is indicative of medial epicondylitis
»»stretching the wrist flexors

66
Q

what is the valgus stress test and what do findings indicate?

A

examiner applies a valgus force (lateral to medial) at 0 deg and 30 deg
pain at the medial elbow or excessive movement indicates a medial elbow sprain or instability

67
Q

what is the varus stress test and what do findings indicate?

A

examiner applies a varus force (medial to lateral) at 0 deg and 30 deg
pain at the lateral elbow or excessive movement is indicative of a lateral elbow sprain or instability

68
Q

what is tinel’s test and what do findings indicate?

A

gently tap over the course of a nerve, at the cubital tunnel (with finger pads), carpal tunnel and tunnel of guyon
shooting/electrical pain along the course of the nerve indicates peripheral neuropathy

69
Q

what is the active ulnar tension test and what do findings indicate?

A

patient actively abducts shoulder, flexes elbow, pronates forearm, and extends wrist and fingers
recreating of tingling/neurologic symptoms in an ulnar distribution indicates ulnar neuropathy

70
Q

what is phalen’s test and what do findings indicate?

A

patient places backs of hands together so that wrists are fully flexed and holds for 1 minute
numbness or tingling in a median N distribution indicative of carpal tunnel syndrome

71
Q

what is modified phalen’s test?

A

examiner flexes patient’s wrist and applies pressure over the carpal tunnel with fingers. hold for 1 minute.
numbness or tingling in a median nerve distribution is indicative of carpal tunnel syndrome

72
Q

what is the median nerve compression test?

A

a compressive force is applied over the carpal tunnel for 1 min
numbness or tingling in a median N distribution is indicative of carpal tunnel syndrome

73
Q

what is finklestein’s test and what do positive findings indicate?

A

patient makes a fist with thumb inside fingers and actively or passively ulnar deviates
pain at lateral (radial) wrist indicates radial tenosynovitis

Orthopedics (1 decks)

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