Musculoskeletal

Question 1

thumb abduction test

Answer 1

tests integrity of medial nerve by isolating straight of abductor polices brevis muscle

patient places hand palm up, raise thumb perpendicular, apply downward pressure on thumb

weakness - carpal tunnel

Question 2

Phalen test

Answer 2

tests integrity of medial nerve

patient holds both wrists in fully palmar flexed position with dorsal surfaces pressed together for 1 minute

numbness and paresthesia in distribution of median nerve = carpal tunnel

note: reverse Phalen test: wrists in full extension

Question 3

Tinel sign

Answer 3

tests integrity of medial nerve

strike patient’s wrist with index or middle finger where medial nerve passes under flexor retinaculum

tingling radiation from first to hand in pattern of median nerve = positive tine sign / suggestive of carpal tunnel

Question 4

Neer test

Answer 4

evaluates rotator cuff muscles

passive test; forward flex patients strait arm with thumb pointing down (inward rotation) up to 150 degrees

increased shoulder pain = rotator cuff inflammation or tear

Question 5

Hawkins test

Answer 5

evaluates rotator cuff muscles

passive test; abduct arm to 90 degrees, flex below at 90 degrees, internally rotate arm to its limit

increased shoulder pain = rotator cuff inflammation or tear

Question 6

Supraspinatus strength

Answer 6

rotator cuff muscle

patient place arm in 90 degrees abduction, 30 degrees forward flexion, and internally rotated (thumb points down); apply downward pressure on arm against patient resistance

pain = inflammation or tear in muscle

Question 7

subscapularis strength

Answer 7

rotator cuff muscle

hold arm at side, elbow flexed to 90 degrees, and rotate arm medially against resistance

pain = inflammation or tear in muscle

Question 8

infraspinatus and teres minor strength

Answer 8

rotator cuff muscle

hold arm at side, elbow flexed to 90 degrees, and rotate arm laterally against resistance

pain = inflammation or tear in muscle

Question 9

strait leg raising test

Answer 9

part of lower spine assessment; tests for nerve root irritation or lumbar disc herniation at L4, L5, and S1 levels

patient supine with neck flexed; ask patient to raise leg keeping it extended (Jackie said was passive test)

radicular pain below knee = disk herniation

crossover pain in affected leg (when unaffected leg is raised) = sciatic nerve impingment

Question 10

femoral stretch test

Answer 10

part of lower spine assessment; tests for nerve root inflammaton at L1, L2, L3, and sometimes L4 levels

patient lies prone and extend leg behind them at hip

pain = positive sign for nerve root irritation

Question 11

Thomas test

Answer 11

used to detect flexion contractures of hip that may be masked by excessive lumbar lordosis

patient supine, fully extend one leg flat on table and flex other leg with the knee to chest; observe ability to keep extended leg flat on table

lifting extended leg = hip flexion contracture in extended leg

Question 12

Trendelenburg test

Answer 12

detects weak hip abductor muscles

ask patient to stand and balance first on one foot then the other; observe hip level from behind

iliac crest drops on side of lifted leg = hip abductor muscles on weight-bearing side are weak

Question 13

ballottement

Answer 13

determined presence of excess fluid or effusion in knee

with knee extended, apply downward pressure on supra patellar pouch with web of one hand; push patella sharply downward against femur with fingers of other hand; release pressure against patella, but keep fingers lightly touching

effusion = tapping or clicking when patella is pushed against femur; patella will also float out when released

Question 14

bulge sign

Answer 14

used to determine present of excess fluid in knee

with patient’s knee extended, milk the medial aspect of knee upward 2 -3 times, then milk lateral side of patella

bulge of returning fluid to the hollow area medial to the patella = excess fluid

Question 15

McMurray test

Answer 15

used to detect torn medial or lateral meniscus

patient supine, one knee flexed, thumb and finger on either side of joint space and other hand on heel, fully flex knee

• rotate foot and knee outward (valgus stress), extend and flex knee - test medial
• rotate foot and knee inward (cars stress), extend and flex knee - tests lateral

palpable or audible click, grinding, pain, limited extension = positive sing for torn meniscus

Question 16

anterior and posterior drawer test

Answer 16

used to identify instability of ACL and PCL

patient supine, knee flexed 45-90 degrees, place foot flat on table, thumbs on either side of anterior tibia just distal to tibial tuberosity

• draw tibia forward (testing ACL)
• push tibia backward (testing PCL)

movement greater than 5mm = indicated injury

Question 17

Lachman test

Answer 17

evaluates ACL integrity

patient supine, flex knee 10-15 degrees with heel on table; one hand above knee to stabilize femur and one hand grips proximal tibia; pull tibial anteriorly

moment greater than 5mm = unexpected

note: be sure to compare to uninjured side

Question 18

varus (abduction) and valgus (adduction) test

Answer 18

used to identify instability of MCL and LCL

patient supine, knee extended; stabilize femur with one hand and hold able with other hand

• apply varus force (toward midline) to ankle and internal rotation
  
  • laxity = injury to LCL
• apply valgus force against ankle (away from midline) and external rotation
  
  • laxity = injury to MCL

Question 19

Murphy sign

Answer 19

test for cholecystitis (inflammation of gallbladder)

have patient take deep breath during deep palpation on left side, below liver margin, lateral to rectus abdominis muscle

pain and abrupt end to inspiration = positive Murphy’s sign; inflamed gallbladder touched examiners fingers

if no pain, but enlarged = common bile duct obstruction

Question 20

ascites

Answer 20

accumulation of fluid in peritoneal cavity; causes abdominal swelling

Question 21

rebound tenderness

Answer 21

used to assess for peritoneal inflammation; can be used for appendicitis

press fingers (90 degree angle to stomach) gently but deeply into abdomen in region remote form pain; rapidly withdraw hand
 - causes sharp, stabbing pain at site of peritoneal inflammation

positive Blumberg sign: sharp pain with rebound

positive McBurney sign: rebound tenderness in lower right quadrant; suggests appendicitis

Question 22

McBurney’s sign

Answer 22

assesses for appendicitis

positive sign: rebound tenderness in lower right quadrant; suggests appendicitis

Question 23

iliopsoas muscle test

Answer 23

performed when expect appendicitis (appendicitis would irritate lateral part of muscle)

patient supine, ask to raise (flex at hip) strait leg while you apply pressure downward

pain = positive psoas sign; indicates irritation of iliopsoas muscle

Question 24

obturator muscle test

Answer 24

performed when suspect ruptured appendix or pelvic abscess due to irritation of obturator muscles

patient supine, ask patient to flex right leg at hip and knee to 90 degrees; hold leg above knee, grasp ankle, and rotate leg laterally and medially

pain in right hypogastric region = positive sign; indicates irritation of obturator muscle

Question 25

ballottement

Answer 25

palpation technique used to assess an organ or mass; can be one handed (freely movable object will float up to fingers when press) or two handed (one hand on flank and one on anterior abdominal wall to grasp mass)

Question 26

peritonitis

Answer 26

inflammation of peritoneum (lining of stomach)
• Limited abdominal motion can indicate this
• Use rebound tenderness to assess

Question 27

peristalsis

Answer 27

movements from wave0like muscles contractions used to move food in abdomen

Question 28

spasm

Answer 28

a sudden, violent involuntary contraction of a muscle or a group of muscles attended by pain and interference with function, producing involuntary movement

Question 29

fasciculation

Answer 29

small local contraction of muscles, visible through the skin, representing a spontaneous discharge of a number of fibers innervated by a single motor nerve filament

Question 30

bowel sounds

Answer 30

Increased BS: diarrhea

Decreased BS: inflammation of the peritoneum

High pitched sounds: early obstruction