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
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
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
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
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
6
Q
Neoplastic disease sxs
A
- pain =gnawing, intense, penetrating
- pain is not resolved by position, time, or activity level
- night pain causing waking
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
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
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
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
11
Q
Supraspinatus test (empty can)
A
- tear or impingement of supraspinatus
- shoulder at 90, resist abduction, then fully IR and resist at scaption
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
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
14
Q
Clunk test
A
-glenoid labrum tear
-supine shoulder in full abduction, push humerus anteriorly while ER
+ = clunk
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
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
17
Q
SC shear test
A
-dysfunction of AC joint
-pt sitting with arm at side, pt compresses AC joint
+ = pain in AC joint
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
19
Q
Costoclavicular syndrome (military brace test)
A
- thoracic outlet syndrome
- same as adson’s
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
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
22
Q
Hawkin’s Kennedy test
A
- SIS
- 90 shoulder flexion 90 elbow flex, passively IR shoulder,
- 92% specificity
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
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
25
Rent sign
-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
26
Crank test
-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
27
Biceps load 2
- SLAP lesion (glenohumeral labral tear)
- supine, 120 abd, 90 elbow flex, full supination, therapist resists elbow flexion
- 89% SN 97% SP
28
Bear Hug test
-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
29
Belly compression test
- subscapularis tear
- pt places hand on belly and then pushes while performing more IR
- 98% SP
30
Horizontal adduction test
-AC joint dysfunction or SIS
-passively 90 flexion and then full HAdd
+ = pain
82% SP
31
Elbow MCL and LCL tests
Place elbow in 0-20 flexion, valgus force tests MCL, varus force tests LCL
32
Lateral epicondylitits test
- sitting elbow at 90
| - resist wrist ext, radial deviation and pronation
33
Medial epicondylitis test
-elbow at 90, passively supinate, extend elbow and extend wrist
34
Pronator teres syndrome test
-IDs median nerve entrapment within pronator teres
-elbow 90 flexion, PT resists pronation and elbow ext
+ = numbness and tingling of ulnar nerve distribution
35
Elbow flexion test
-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
36
Finklestein's test
- De Quervain's tenosynovitis (abductor pollicis longus)
- make fist with thumb, move into ulnar deviation
- 81% sensitive
37
Bunnel Littler test
- 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
38
Tight retinacular test
- 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
39
Froments sign
- 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
40
Phalens test
- carpal tunnel compression of median nerve
- pt maximally flexes wrists for 1 minute against each other
- 77% SN
41
Allens test
- vascular compromise
- pt makes fist, compress ulnar artery and pt open hand observe vascular filling. Perform for radial artery
- 97% sp
42
Flick test
-carpal tunnel compression
-pt shakes hand
+ = reduction in wrist sxs
90% SN
43
Patricks (FABER) Test
-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
Grind (scour) test
- DJD of hip
| - 62% sensitive 75% specific
45
Trendelenburg
-94% specific
| + LR 3.64
46
Thomas test
- tightness of hip flexors
| - pt supine one LE held against chest by pt, opp LE straight on table,
47
Ober's test
- ITB/TFL tightness
| - S/L flex knee to 9 (modified knee straight), passively abduct and extend hip, lower limb and observe if horizontal
48
Ely's test
- Tightness of rectus femoris
| - prone, passively flex knee, if hip flexes then +
49
What is + 90-90 hamstring test
-if knee is unable to reach 10 from neutral extension (lacking 10 knee ext)
50
Craig's test
- 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
FADIR test
-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
Knee collateral ligament instability tests
- supine, support limb and 20-30 knee flexion
| - valgus force tests MCL, varus tests LCL
53
Lachman stress test
- ACL
- supine, knee flex 20-30, glide tibia anterior
- 48-100% sensitive, 46-100% specific
54
Pivot shift
-ACL
-supine knee straight, flex and abd hip 30, apply valgus force and flex knee
+ = clunking b/w 30-40 flexion
-good specificity
55
Posterior sag test
-PCL
-flex hip 45 and knee 90, notice if tibia "sags" posteriorly
100% specific
56
Posterior drawer
- PCL
- supine flex hip 45 and knee 90, apply posterior force to tibia
- 98% specific
57
Reverse lachman
- PCL
| - prone with knee flex 30, stabilize femur and apply posterior tibia force
58
Mcmurray's test
- 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
Apley's test
- 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
Hughston/s plica test
-supine knee flexed and IR tibia, glide patella medial, palpate medial femoral condyle, flex/extend knee
+ = popping or pain
61
Patellar apprehension test
- IDs history of patella dislocation
- supine, glide patella laterally
- 8.3 + LR
62
Clarke's sign
-patellofemoral dysfunction
-supine knee extended, push posterior to superior pole of patella, ask pt to quad set
+ = pain
63
Ballotable patella test (patella tap)
-infrapatella effusion
-supine knee ext, tap central patella
+ = perception of patella floating
64
Fluctuation test
- Knee joint effusion
| - supine knee ext, apply posterior force to superior then inferior patella
65
Q angle measurement
normal = 13 men, 8 women
| -measure angle b/w quad muscle and patellar tendon
66
Noble compression test
-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
Tinel's sign knee
- common fibular nerve dysfunction
| - tap region posterior to fibular head
68
Wilson test
-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
Neutral subtalar position
- IDs abnormal rearfoot positioning
- prone, palpate top of talus on both sides, dorsiflex foot, move through supination/pronation
- neutral = palpate equal prominences
70
Ankle anterior drawer test
- ATLF instability
- supine w/ heel off table, 20 PF, apply anterior force to foot
- 78% SN 75% SP
71
Talar tilt test
- Calcaneofibular instability
| - S/L knee slight flex, neutral ankle, adduct foot to test CF ligament, abduct foot to test deltoid ligament
72
Thomson's squeeze test
-Achilles tendon integrity
-prone, foot off table, squeeze calf muscle, ankle should PF
+ = no movement of foot
73
Tinel's sign ankle
-posterior tibial nerve dysfunction
-tap posterior to medial malleolus, tap anterior ankle for deep fibular nerve
-
74
Morton's test
- Stress fracture or neuroma in forefoot
| - grasp metatarsals and squeeze
75
Kleiger test
-Distal tibiofibular syndesmosis integrity
-edge of table knee 90, apply ER force to foot while holding tibia neutral
+ = sxs or visible joint gapping
76
Windlass test
-WB, stand on step w/ toes over edge. PT extends 1st MTP
-NWB knee 90 same thing
+ = reproduction of plantar surface sxs
77
Vertebral artery test
- 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
Flexion rotation test
-IDs cervical headaches
-full passive flexion then rotation
+ = reproduction of sxs or loss of 10 motion side to side
-86% SN
79
Transverse ligament test
-supine head on table, anterior glide of C1, should have firm end feel
80
Anterior shear test
- integrity of upper cervical ligaments and capsules
| - Glide C2-C7 anterior should have firm end feel
81
Foraminal compression (spurling's)
- cervical nerve root dysfunction
- SB to uninvolved side, compress head, then opp.
- 92% specific
82
Maximal cervical compression test
- IDs compression of neural structures
| - sitting, SB and rotate to noninvolved side then ext
83
Distraction test
- cervical nerve root compression
- passively distract head in sitting
- 100% specific
84
Shoulder abduction test (cervical)
-IDs compression of neural w/ intervertebral foramen
-sitting, pt places one hand on top of head, the opp.
+ = decreased sxs
-80% specific
85
Lhermitte's sign
-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
Alar ligament test
-seated, pincer grip C2 spinous process w/ slight flexion, then passive sidebend and rotate neck
+ = inability to palpate C2 movement
87
Modified sharp purser test
- transverse ligament integrity
- seated, pincer grip C2 spinous process, slight flexion, apply posterior force through forehead, assess for excess translation
- 96% specific
88
Lasegue test (SLR)
97% sensitive
89
Lumbar quadrant test
- to close L intervertebral foramen SB L, rotate L then extend
- to close L facet joints SB L, rotate R, then extend
90
Stork standing test
-Spondylolisthesis
-stand on one leg and extend L spine, repeate
+ = pain w/ ipsilateral leg on ground
91
Bicycle (van Gelderens test)
- differentiates intermittent claudication and spinal stenosis
- pt rides seated stationary bike w/ erect spine, then repeat w/ slump position
92
Well SLR
Normal SLR, but contralateral side is position
| -97% specific
93
Gillet's test
- 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
Ipsilateral anterior rotation test
- 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
Gaenslen's test
-SIJ dysfunction
-S/L, bottom leg knee to chest, upper leg extend hip
+ = pain in SIJ
96
Long sitting (supine-sit test)
-IDs SIJ dysfunction causing leg length discrepancy
-assess limb length in supine, then come to sitting
+ = reversal of limb length in different position
97
Goldthwait's test
- 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
Side lying Iliac compression test (SIJ compression)
-IDs SIJ dysfunction
-painful side up, apply force through iliac crest for 30s
+ = pain
- 69% SP and SN
99
Supine iliac gapping (SIJ distraction)
- SIJ dysfunction
| - supine, apply distraction force through ASIS
100
TMJ compression
- evaluates for pain w/ compression of retrodiscal tissues
| - compress mandible
