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NPTE exam > Musculoskeletal Exam > Flashcards

Musculoskeletal Exam Flashcards

1
Q

DJD/OA sxs

A
  • pain/stiffness upon rising
  • pain eases through morning (4-5 hrs)
  • pain increases w/ repetitive bending
  • constant discomfort w/ exacerbation
  • subjective pain=soreness and nagging
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2
Q

Facet joint Dysfunction sxs

A
  • stiff upon rising, eases w/in 1 hour
  • loss of motion w/ pain
  • sharp pain w/ certain movements
  • movement in pain free range decreases sxs
  • stationary positions increase sxs
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3
Q

Discal w/ nerve root compromise sxs

A
  • no pain in (semi/) reclined position
  • pain increases w/ WB
  • pain = shooting, burning, stabbing
  • altered strength or ADL ability
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4
Q

Spinal stenosis sxs

A
  • pain related to position
  • flex = good extension=bad
  • pain= numbness, tightness, cramping
  • walking increases pain
  • pain may persist for hours after resting position
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5
Q

Vascular claudication sxs

A
  • pain present in all spinal positions
  • pain increased with physical activity
  • pain is relieved by rest
  • pain = numbness
  • pain has decreased or absent pulses
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6
Q

Neoplastic disease sxs

A
  • pain =gnawing, intense, penetrating
  • pain is not resolved by position, time, or activity level
  • night pain causing waking
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7
Q

MRI T1 vs T2

A

T1- demonstrates fat within tissues, assess bony anatomy

T2- suppresses fat, demonstrates tissues w/ high water content, assess soft tissue structures

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8
Q

Yeragson’s test

A
  • tests for integrity of transverse shoulder ligament, bicep tendonosis/tendonopathy
  • pt sitting, shoulder at neutral against trunk, elbow 90 with pronation, therapist resists shoulder ER and supination
  • tendon of biceps will pop out of groove
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9
Q

Speed’s test (bicep straight arm)

A

-bicep tendonosis/tendonopathy
-UE at 90 shoulder flexion, full elbow ext, supination, therapist resists shoulder flexion
+ = pain in long head of biceps tendon
-90% sensitivity

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10
Q

Neer’s impingement

A

-impingement of supraspinatus and long head of biceps
-pt sitting, shoulder is passively full IR then abduction
+ = pain in shoulder
-88.7% sensitivity

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11
Q

Supraspinatus test (empty can)

A
  • tear or impingement of supraspinatus

- shoulder at 90, resist abduction, then fully IR and resist at scaption

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12
Q

Drop arm test

A
  • tear or full rupture of rotator cuff
  • passively abduct arm to 120, tell pt to slowly adduct it
  • 97.2% specificity
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13
Q

Posterior internal impingement test

A

-IDs impingement b/w rotator cuff and greater tuberosity or posterior glenoid and labrum
-supine, passively move shoulder to 90 abd, full ER, 15-20 horizontal adduction
+ = posterior shoulder pain

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14
Q

Clunk test

A

-glenoid labrum tear
-supine shoulder in full abduction, push humerus anteriorly while ER
+ = clunk

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15
Q

Anterior apprehension sign

A

-past history of anterior shoulder dislocation
-supine with 90 abduction, slowly take shoulder into ER
+ = pt doesnt allow or like movement

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16
Q

Posterior apprehension sign

A
  • past history of posterior shoulder dislocation

- supine with 90 scaption, stabilize scapula, apply posterior force through elbow while IR and horizontal adduction

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17
Q

SC shear test

A

-dysfunction of AC joint
-pt sitting with arm at side, pt compresses AC joint
+ = pain in AC joint

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18
Q

Adson’s test

A

-thoracic outlet syndrome
-find radial pulse, then have pt rotate towards tested arm, then perform shoulder ext and ER
+ = neuro or vascular sxs

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19
Q

Costoclavicular syndrome (military brace test)

A
  • thoracic outlet syndrome

- same as adson’s

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20
Q

Wright (hyperabduction test)

A

-thoracic outlet syndrome
-find pulse, move UE into ext and ER, have pt deep breath then rotate away from tested UE
+ = neuro or vascular changes

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21
Q

Roos elevated arm test

A
  • thoracic outlet syndrome
  • UE 90 90 position with some ER, have pt open and close fist for 3 mins
  • neuro or vascular changes
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22
Q

Hawkin’s Kennedy test

A
  • SIS
  • 90 shoulder flexion 90 elbow flex, passively IR shoulder,
  • 92% specificity
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23
Q

Allen’s maneuver

A

-thoracic outlet syndrome
-sitting, bring arm to 90 90 and full ER, palpate pulse and pt turns head towards UE
+ = decreased radial pulse

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24
Q

Active compression

A

-labral tear or AC lesion
-90 flexion 10 HAdd, thumb down, PT pushes down, also perform with thumb upp
+ AC = pain w/ thumb down and decreased w/ thumb up
+ labral = painful clicking in joint w/ thumb down, which decreases w/ thumb up
AC= 95% specific
Labral= good specific and sensitive

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25
Q

Rent sign

A

-RCT or rotator cuff impingement
-palpate acromion, extend shoulder and IR/ER
+ = greater tuberosity is prominent and depression of 1 finger if Rotator cuff is torn
-95% specific and sensitive

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26
Q

Crank test

A

-tests shoulder ligaments and anterior instability, may Id labral tear
-passively perform 160 scaption, apply AP force through forearm and perform IR/ER
+ = pain w/ or w/o click9ing
-90% SN 85% SP

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27
Q

Biceps load 2

A
  • SLAP lesion (glenohumeral labral tear)
  • supine, 120 abd, 90 elbow flex, full supination, therapist resists elbow flexion
  • 89% SN 97% SP
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28
Q

Bear Hug test

A

-subscapularis tear
-pt places hand on opp shoulder, PT applies ER force, pt has to keep hand on shoulder
+ = pt cannot keep hand
92% SP

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29
Q

Belly compression test

A
  • subscapularis tear
  • pt places hand on belly and then pushes while performing more IR
  • 98% SP
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30
Q

Horizontal adduction test

A

-AC joint dysfunction or SIS
-passively 90 flexion and then full HAdd
+ = pain
82% SP

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31
Q

Elbow MCL and LCL tests

A

Place elbow in 0-20 flexion, valgus force tests MCL, varus force tests LCL

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32
Q

Lateral epicondylitits test

A
  • sitting elbow at 90

- resist wrist ext, radial deviation and pronation

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33
Q

Medial epicondylitis test

A

-elbow at 90, passively supinate, extend elbow and extend wrist

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34
Q

Pronator teres syndrome test

A

-IDs median nerve entrapment within pronator teres
-elbow 90 flexion, PT resists pronation and elbow ext
+ = numbness and tingling of ulnar nerve distribution

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35
Q

Elbow flexion test

A

-cubital tunnel syndrome
-supine- full elbow flex, full shoulder ER, and wrist ext, hold for 1 minute
+ = pain at medial elbow or numbness ulnar distribution

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36
Q

Finklestein’s test

A
  • De Quervain’s tenosynovitis (abductor pollicis longus)
  • make fist with thumb, move into ulnar deviation
  • 81% sensitive
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37
Q

Bunnel Littler test

A
  • intrinsic tightness at PIP
  • slight MCP ext, flex PIP, then flex MCP
  • if flexion is limited in both = capsular tightness
  • if flexion limited with MCP ext then tight intrinsics
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38
Q

Tight retinacular test

A
  • IDs tightness at PIP
  • Stabilize PIP, flex DIP , then flex PIP
  • If flexion limited in both = capsular tightness
  • if flexion limited with stable PIP then tight retinacular ligaments
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39
Q

Froments sign

A
  • ulnar nerve dysfunction
  • pt grasps paper between thumb and 2nd digit, pull paper out. Watch for thumb IP flexion to compensate for adductor pollicis weakness
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40
Q

Phalens test

A
  • carpal tunnel compression of median nerve
  • pt maximally flexes wrists for 1 minute against each other
  • 77% SN
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41
Q

Allens test

A
  • vascular compromise
  • pt makes fist, compress ulnar artery and pt open hand observe vascular filling. Perform for radial artery
  • 97% sp
42
Q

Flick test

A

-carpal tunnel compression
-pt shakes hand
+ = reduction in wrist sxs
90% SN

43
Q

Patricks (FABER) Test

A

-IDs hip dysfunction/ mobility restriction
-Passively flex, abduct, ER LE so foot rests on opp. knee
+ = knee unable to assume relaxed position or pain
-60% SN

44
Q

Grind (scour) test

A
  • DJD of hip

- 62% sensitive 75% specific

45
Q

Trendelenburg

A

-94% specific

+ LR 3.64

46
Q

Thomas test

A
  • tightness of hip flexors

- pt supine one LE held against chest by pt, opp LE straight on table,

47
Q

Ober’s test

A
  • ITB/TFL tightness

- S/L flex knee to 9 (modified knee straight), passively abduct and extend hip, lower limb and observe if horizontal

48
Q

Ely’s test

A
  • Tightness of rectus femoris

- prone, passively flex knee, if hip flexes then +

49
Q

What is + 90-90 hamstring test

A

-if knee is unable to reach 10 from neutral extension (lacking 10 knee ext)

50
Q

Craig’s test

A
  • IDs abnormal femoral anteversion angle
  • pt prone, knee 90, palpate greater trochanter, and IR/ER hip, stop when GT feels most lateral. measure angle of leg relative to table
  • <8 = retroverted, > 15= anteverted
51
Q

FADIR test

A

-IDs anterior-superior impingement, iliopsoas tendonopathy, anterior labral tears
-take hip from full flex, abd, and ER to full flex, add, and IR
+ = pain with or without click
-78% sensitive

52
Q

Knee collateral ligament instability tests

A
  • supine, support limb and 20-30 knee flexion

- valgus force tests MCL, varus tests LCL

53
Q

Lachman stress test

A
  • ACL
  • supine, knee flex 20-30, glide tibia anterior
  • 48-100% sensitive, 46-100% specific
54
Q

Pivot shift

A

-ACL
-supine knee straight, flex and abd hip 30, apply valgus force and flex knee
+ = clunking b/w 30-40 flexion
-good specificity

55
Q

Posterior sag test

A

-PCL
-flex hip 45 and knee 90, notice if tibia “sags” posteriorly
100% specific

56
Q

Posterior drawer

A
  • PCL
  • supine flex hip 45 and knee 90, apply posterior force to tibia
  • 98% specific
57
Q

Reverse lachman

A
  • PCL

- prone with knee flex 30, stabilize femur and apply posterior tibia force

58
Q

Mcmurray’s test

A
  • Meniscal tear
  • supine w/ max knee flexion. IR tibia and extend knee to test lateral meniscus, ER tibia to test medial
  • 93% specific for both
59
Q

Apley’s test

A
  • Meniscal vs ligament
  • prone knee 90, distract knee and IR/ER, then compress knee and IR/ER
  • if pain worse w/ compression than meniscus, if worse with distraction then ligament
60
Q

Hughston/s plica test

A

-supine knee flexed and IR tibia, glide patella medial, palpate medial femoral condyle, flex/extend knee
+ = popping or pain

61
Q

Patellar apprehension test

A
  • IDs history of patella dislocation
  • supine, glide patella laterally
  • 8.3 + LR
62
Q

Clarke’s sign

A

-patellofemoral dysfunction
-supine knee extended, push posterior to superior pole of patella, ask pt to quad set
+ = pain

63
Q

Ballotable patella test (patella tap)

A

-infrapatella effusion
-supine knee ext, tap central patella
+ = perception of patella floating

64
Q

Fluctuation test

A
  • Knee joint effusion

- supine knee ext, apply posterior force to superior then inferior patella

65
Q

Q angle measurement

A

normal = 13 men, 8 women

-measure angle b/w quad muscle and patellar tendon

66
Q

Noble compression test

A

-ITB friction syndrome
-supine, flex hip to 45 and knee 90, apply pressure to lateral femoral condyle and extend knee
+ = pain at pressure at 30 knee flexion

67
Q

Tinel’s sign knee

A
  • common fibular nerve dysfunction

- tap region posterior to fibular head

68
Q

Wilson test

A

-IDs osteochondritis dissecans of medial femoral condyle
-sitting edge of table, pt actively ext knee with tibial IR
+ = pain at 30 w/ IR but no pain 30 ER

69
Q

Neutral subtalar position

A
  • IDs abnormal rearfoot positioning
  • prone, palpate top of talus on both sides, dorsiflex foot, move through supination/pronation
  • neutral = palpate equal prominences
70
Q

Ankle anterior drawer test

A
  • ATLF instability
  • supine w/ heel off table, 20 PF, apply anterior force to foot
  • 78% SN 75% SP
71
Q

Talar tilt test

A
  • Calcaneofibular instability

- S/L knee slight flex, neutral ankle, adduct foot to test CF ligament, abduct foot to test deltoid ligament

72
Q

Thomson’s squeeze test

A

-Achilles tendon integrity
-prone, foot off table, squeeze calf muscle, ankle should PF
+ = no movement of foot

73
Q

Tinel’s sign ankle

A

-posterior tibial nerve dysfunction
-tap posterior to medial malleolus, tap anterior ankle for deep fibular nerve
-

74
Q

Morton’s test

A
  • Stress fracture or neuroma in forefoot

- grasp metatarsals and squeeze

75
Q

Kleiger test

A

-Distal tibiofibular syndesmosis integrity
-edge of table knee 90, apply ER force to foot while holding tibia neutral
+ = sxs or visible joint gapping

76
Q

Windlass test

A

-WB, stand on step w/ toes over edge. PT extends 1st MTP
-NWB knee 90 same thing
+ = reproduction of plantar surface sxs

77
Q

Vertebral artery test

A
  • integrity of vertebrobasilar vascular system
  • supine head over edge, eyes open, extend head and neck hold 30s, if no sxs then passive rotation and SB w/ ext both sides 30s holds.
  • causes reduction of lumen of vertebral artery to contralateral side
  • sxs= dizziness, nausea, syncope, dysarthria, dysphagia, hearing/vision loss,
78
Q

Flexion rotation test

A

-IDs cervical headaches
-full passive flexion then rotation
+ = reproduction of sxs or loss of 10 motion side to side
-86% SN

79
Q

Transverse ligament test

A

-supine head on table, anterior glide of C1, should have firm end feel

80
Q

Anterior shear test

A
  • integrity of upper cervical ligaments and capsules

- Glide C2-C7 anterior should have firm end feel

81
Q

Foraminal compression (spurling’s)

A
  • cervical nerve root dysfunction
  • SB to uninvolved side, compress head, then opp.
  • 92% specific
82
Q

Maximal cervical compression test

A
  • IDs compression of neural structures

- sitting, SB and rotate to noninvolved side then ext

83
Q

Distraction test

A
  • cervical nerve root compression
  • passively distract head in sitting
  • 100% specific
84
Q

Shoulder abduction test (cervical)

A

-IDs compression of neural w/ intervertebral foramen
-sitting, pt places one hand on top of head, the opp.
+ = decreased sxs
-80% specific

85
Q

Lhermitte’s sign

A

-IDs SC dysfunction or UMN lesion
-long sitting, passively flex pts neck and one hip w/ knee extended
+ = “electrical” pain down the spine and into limbs
-80% specific

86
Q

Alar ligament test

A

-seated, pincer grip C2 spinous process w/ slight flexion, then passive sidebend and rotate neck
+ = inability to palpate C2 movement

87
Q

Modified sharp purser test

A
  • transverse ligament integrity
  • seated, pincer grip C2 spinous process, slight flexion, apply posterior force through forehead, assess for excess translation
  • 96% specific
88
Q

Lasegue test (SLR)

A

97% sensitive

89
Q

Lumbar quadrant test

A
  • to close L intervertebral foramen SB L, rotate L then extend
  • to close L facet joints SB L, rotate R, then extend
90
Q

Stork standing test

A

-Spondylolisthesis
-stand on one leg and extend L spine, repeate
+ = pain w/ ipsilateral leg on ground

91
Q

Bicycle (van Gelderens test)

A
  • differentiates intermittent claudication and spinal stenosis
  • pt rides seated stationary bike w/ erect spine, then repeat w/ slump position
92
Q

Well SLR

A

Normal SLR, but contralateral side is position

-97% specific

93
Q

Gillet’s test

A
  • posterior movement of ilium related to sacrum
  • standing palpate tested side PSIS and center of sacrum, pt brings knee to chest of tested limb,
  • PSIS should move inferior
94
Q

Ipsilateral anterior rotation test

A
  • anterior movement of ilium relative to sacrum
  • standing palpate tested side PSIS and center of sacrum, pt extends hip of tested limb
  • PSIS should move superiorly
95
Q

Gaenslen’s test

A

-SIJ dysfunction
-S/L, bottom leg knee to chest, upper leg extend hip
+ = pain in SIJ

96
Q

Long sitting (supine-sit test)

A

-IDs SIJ dysfunction causing leg length discrepancy
-assess limb length in supine, then come to sitting
+ = reversal of limb length in different position

97
Q

Goldthwait’s test

A
  • differentiates b/w lumbar spine or SIJ
  • supine w/ one finger b/w lumbar spinous process, perform passive SLR with other hand
  • if pain prior to palpation of lumbar segments then SIJ
98
Q

Side lying Iliac compression test (SIJ compression)

A

-IDs SIJ dysfunction
-painful side up, apply force through iliac crest for 30s
+ = pain
- 69% SP and SN

99
Q

Supine iliac gapping (SIJ distraction)

A
  • SIJ dysfunction

- supine, apply distraction force through ASIS

100
Q

TMJ compression

A
  • evaluates for pain w/ compression of retrodiscal tissues

- compress mandible

NPTE exam (7 decks)

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