Neuromusculoskeletal (NMS) Diagnosis (Irene Gold) Part II and III Flashcards
1
Q
What is the clinically word for loss of smell?
A
Anosmia
2
Q
What is the term for a distorted sense of smell?
A
Parosmia
3
Q
How is the optic nerve tested for Visual acuity?
A
Snellen Eye Chart
4
Q
What two cranial nerves are tested with the Direct Light Reflex?
A
CN II (2) and III (3)
5
Q
What three things happen to the eyes during the Accommodation test?
A
Eyes Converge
Pupils Constrict
Lens Convex
6
Q
What are the two muscles of the eye that have Parasympathetic control?
A
Ciliary muscles (lens shape) Constrictor Papillae
7
Q
What is the clinically term for deviation of one or both eyes?
A
Strabismus
8
Q
What is the cause for a patient to have ptosis; drooping of an eyelid?
A
Weakness or paralysis of the Levator Palpebrae
9
Q
Jaw Jerk reflex test what Cranial nerve?
A
CNV (5), both sensory and motor
10
Q
What two directions does the Superior oblique muscle move the eye?
A
Down and In
11
Q
How is the sensory component of Cranial nerve V tested?
A
Touch with cotton wisp:
Forehead
Cheekbone
Chin
12
Q
What two cranial nerves are tested with the Corneal Reflex?
A
CN V (5) Afferent CN VII (7) Efferent
13
Q
What is a normal finding of the Corneal Reflex?
A
Both eyes blinking
Tearing of the eyes
14
Q
What is the name of the test, when the mandible is lightly tapped with a reflex hammer?
A
Jaw jerk reflex
15
Q
What is a positive finding of the Jaw Jerk reflex?
A
Jaw draws upwards
16
Q
What two Cranial nerves are tested during the Oculocardiac reflex?
A
CN V (5) Afferent CN X (10) Efferent
17
Q
What is the normal finding of the Oculocardiac reflex?
A
A decrease in heart rate when pressure is applied to the eye
18
Q
What part of the tongue is motor and given general sensation by Cranial nerve V?
A
Anterior 2/3
19
Q
What three things does the Anterior 2/3 of the tongue determine?
A
Hot
Cold
Pain
20
Q
What three muscle of mastication help to close the jaw, and are innervated by cranial nerve V?
A
Temporalis
Internal Pterygoid
Masseter
(TIM)
21
Q
What muscle innervated by cranial nerve V, opens the jaw?
A
External Pterygoid
22
Q
What is another name for Trigeminal Neuralgia?
A
Tic Douloureaux
Can lead to Cranial Nerve V Palsy
23
Q
What condition is describe as:
“Extreme, sporadic, sudden burning or shock like pain that last anywhere from a few seconds to as long as two minutes per episode.”
Pain is lightening like, repetitive excruciating pain. Happening several times per day, one onside of the face/cheek.
A
Trigeminal Neuralgia
24
Q
What cranial nerve is anterior 2/3 of the tongue for tastes such as Sweet, Sour, Salty?
A
CNVII (7) Facial
25
What cranial nerve indicates the bitter taste?
CN IX (9)
26
What condition is described as:
"Unilateral Facial Paralysis caused by trauma, virus or immune mediated response and is not permanent.
Pain is initially seen behind the ipsilateral ear, twitching, weakness/paralysis, drooping of the eyelid, corner of the mouth, dry eye and decreased taste sensation."
Bell's Palsy
27
What are two treatments for Bell's Palsy?
Eye Patch
| Artificial tears
28
Is Bell's Palsy an Upper or Lower Motor Neuron Lesion?
| What Cranial nerve is effected?
```
LMNL
CN VII (7) Facial
```
29
What are two findings that distinguish Bell's Palsy from a Stroke?
Ipsilateral Motor loss of entire face
| Forehead does not wrinkle
30
How are you able to tell a Stroke from Bell's Palsy?
Contralateral motor loss below the eye
| Able to wrinkle the forehead
31
What Cranial Nerve and type of Lesion is a Stroke?
```
CN VII (7) Facial
UMNL
```
32
What reflex will be decreased in a person with a stroke?
Corneal Reflex
33
Of the two conditions; Bell's Palsy and Stroke, which one will not have control of their saliva?
Stroke
34
What is the care plan for a patient with a stroke?
Co-Care with a Neurologist and adjust
35
What three exams can you perform to see if a patient has a Vestibular/Balance issue?
Mittelemeyer
Romberg's
Barany Caloric Test
36
What three test can be done to see if a patient has a Cochlear/Hearing problem?
Weber/Rinne
Whisper
Auditory Acuity/Watch Test
37
What are two other names for Meniere's Disease?
Central Vertigo
| Endolymphatic Hydrops
38
What are three symptoms of Endolymphatic Hydrops?
Episodic rotational vertigo
Hearing Loss
Tinnitus (Ringing in the ears)
39
What two cranial nerves are tested in the Gag/Pharyngeal, Uvula, Carotid Reflexes?
```
CN IX (9) Afferent )
CNX (10) Efferent
```
40
By massaging what artery in the neck can you make the heart rate drop?
Carotids
41
What muscle elevates the pharynx and larynx; also dilates the pharynx to allow for swallowing?
Stylopharyngeus
42
What cranial nerve is responsible for allowing us to speak (Phonation)?
CN X (10) Vagus
43
What muscles are sensory or Cranial Nerve X?
Epiglottis
| Laryngeal muscles; swallowing (Palate, Pharynx)
44
What three reflex are motor of the Vagus (C.N. X)?
Gag
Carotid
Uvular
45
What side will the Palate and Uvula deviate if there is a lesion?
Opposite side
| Towards the strong side
46
What two muscles are innervated by Cranial Nerve XI (Spinal Accessory Nerve)?
Trapezius
| SCM
47
What is the name of the condition that is caused by a spasm (Lateral Flex to the same side and Rotate to the Opposite side) of the Sternocleidomastoid (SCM)?
Torticollis
| Wry Neck
48
If there is a lesion of Cranial Nerve XII (Hypoglossal) and the patient sticks out their tongue which side will it deviate to?
Deviates to the side of the lesion
49
When testing reflexes, what are two guidelines to follow?
Perform Bilaterally
| Test the normal (unaffected) side first
50
What is Westphal's Sign?
An absence of any of the Deep Tendon Reflexes (DTR)
51
In what reflex is a Westphal's sign most often seen?
Patellar Reflex (LMNL)
52
What is the name that produces more of a reflex by cortical distraction?
Jendrassik's Maneuver AKA Reinforcement Test
53
What is the score on the Wexler Scale (DTR) for "Absent with Reinforcement"?
0+
54
When would a 1+ be seen on the Wexler Scale (DTR)?
Hypoactive with no reinforcement or Normal with reinforcement
55
What is a normal score on the Wexler Scale (DTR)?
2+
56
What type of lesion will you see a 3+,4+ and 5+ on the Wexler Scale (DTR)?
UMNL
57
What would indicate a 5+ on the Wexler Scale (DTR)?
Hyperactivity with sustained clonus
58
What is the score given on the Wexler Scale (DTR) for Hyperactivity with transient clonus?
4+
59
When is a 3+ score given on the Wexler Scale (DTR)?
Hyperactivity
60
What Nerve and Nerve Root are tested in the Jaw Jerk Reflex?
N-Trigeminal
| NR- CN V (5) Both sensory and motor
61
In the Biceps Reflex what Nerve and Nerve Root are tested?
N-Musculoculocutaneous
| NR- C5
62
When testing the Brachioradialis Reflex what Nerve and Nerve Root are tested?
Nerve- Radial
| Nerve Root-C6
63
When testing the Triceps Reflex what Nerve and Nerve Root are tested?
Nerve- Radial
| Nerve Root-C7
64
When testing the Patellar AKA Knee Jerk Reflex what Nerve and Nerve Root are tested?
Nerve-Femoral
| Nerve Root-L4
65
When testing the Medial Hamstring Reflex what Nerve and Nerve Root are tested?
Nerve-Sciatic
| Nerve Root-L5
66
When testing the Achilles AKA Ankle Jerk Reflex what Nerve and Nerve Root are tested?
Nerve-Tibial
| Nerve Root-S1
67
What is the name of the superficial reflex that has the doctor stroke the inner thigh and the testicle raises ipsilateally?
Cremasteric Reflex (L1)
68
What are the Afferent and Efferent nerves when the Cremasteric and Geigel Reflexes is done?
Afferent- Femoral Nerve
| Efferent- Genitofemoral Nerve
69
How is the Plantar Reflex performed?
Stoke up on the sole of the foot, from heal to toe
70
What is a positive finding of a Plantar Reflex?
Curing of the toes
| Pulling away of the foot
71
What in the name of Afferent and Efferent nerve stimulated when the Plantar reflex is done?
Tibial for both
72
What is a normal finding for the Abdominal Reflex?
Umbilicus moves towards the side being stroked
73
What are the Afferent and Efferent nerves being stimulated in the Abdominal and Beevor's Reflexes?
Afferent AND Efferent:
| Upper T7-T9 and Lower T10-T12
74
How is the Beevor's Reflex test performed:
Patient does a partial sit-up and the doctor observes the umbilicus
75
What is a normal finding for the Beevor's Reflex?
Umbilicus will stay midline
76
What is another name for an Upper Motor Neuron Lesion (UMNL)?
Myelopathy
77
Which type of Lesion includes the Brain and Spinal cord, but not the Anterior Horn Cells?
UMNL
78
What area must be effected for a Lower Motor Neuron Lesion (LMNL) to be present?
Anterior Horn Cells out to the Myoneural junction
79
What type of paralysis is seen in an Upper Motor Neuron Lesion (UMNL)?
Spastic
80
What type of Deep Tendon Reflexes (DTR) are seen in a patient with an Upper Motor Neuron Lesion (UMNL)?
Hyperactive
81
Are Pathological Reflexes Absent or Present in an Upper Motor Neuron Lesion (UMNL)?
Present; Babinski
82
In what type of lesion will you see Clonus present?
UMNL
83
What are four characteristics of an Upper Motor Neuron Lesion that will be Absent?
**Superficial Reflexes**
Reaction of degeneration
Atrophy
Fasciculations
84
When is Flaccid paralysis seen?
LMNL
85
What kind of Deep Tendon Reflexes (DTR) will be seen in a Lower Motor Neuron Lesion (LMNL)?
Hypoactive/Absent
86
In a Lower Motor Neuron Lesion (LMNL) what finding will you see in the following characteristics:
Pathological Reflexes
Clonus
Superficial Reflexes
Absent
87
What three characteristics of a Lower Motor Neuron Lesion (LMNL) will be Present?
**Reaction of Degeneration**
Atrophy
Fasciculations
88
What three Visceral Organ Reflexes will be absent in both Upper Motor (UMNL) and Lower Motor Neuron Lesions (LMNL)?
Ciliospinal
Oculocardiac
Carotid Sinus
89
How is the Ciliospinal Reflex performed?
Pinch the neck, noting the dilation of the eyes
90
What reflex is done by pressing on the eye and decreasing the heart rate by 10 beats per minute?
Oculocardiac
91
By pressing on the Carotid artery what two things will decrease/slow?
Slow the heart rate
| Decease the pressure
92
What pathological reflex is performed by stroking the lateral aspect of the foot up to the great toe?
Babinski
93
What is a positive finding of the Babinski reflex?
Dorsiflexion of the great toe with splaying of the other toes
94
What four other pathological reflexes all have the small positive findings as the Babinski reflex?
Chaddock
Oppenheim
Gordon's Calf
Schaefer
95
What pathological reflex is performed by stroking the lateral malleolus to the fifth toe?
Chaddock
96
How is Oppenheim's pathological reflex performed?
Stroke down the Tibial crest to the ankle
97
What is the name of the pathological reflex that is being performed when the calf is squeezed below the knee?
Gordon's Calf
98
How is Schaefer's pathological reflex test done?
Squeeze the Achilles tendon
99
What pathological reflex is tested by tapping on the ball of the foot/tip of the toes?
Rossolimo
100
What is a positive response to Rossolimo's reflex?
Plantar flexion of the great toe with curing of the other toes
101
How is Hoffman's pathological reflex performed?
Doctor extends middle phalanx and flicks distal phalanx inferior (Two F's in Hoffman's= Forceful FIick)
102
What is a positive response to Hoffman's reflex?
Flexion and adduction of the thumb and flexion of the fingers
103
What other pathological reflex has the same positive response as Hoffman's?
Tromner's
104
How is Tromner's pathological reflex performed?
Doctor sharply taps the tips of the middle three fingers (T in Tromner's= Tap)
105
What pathological reflex is being described:
| "Doctor strokes the pisiform of the patient"?
Gordon's Finger
106
What is a positive finding to the Gordon's Finger reflex?
Flexion of the wrist and fingers or thumb and index finger
107
How is Chaddock's Wrist pathological reflex performed?
Doctor strokes the distal ulnar side of the forearm near the wrist
108
What is a positive finding to the Chaddock's Wrist reflex?
Flexion of the wrist with extension and fanning of the fingers
109
What is a Normal (5) muscle grade?
Complete range of motion against gravity with full resistance
110
What muscle grade is given if there is "Complete range of motion against gravity with some resistance"?
Good (4)
111
What is the definition of a Fair (3) muscle grade?
Complete range of motion against gravity
112
When is a muscle grade of Poor (2) given?
Complete range of motion with gravity eliminated
113
What muscle grade is given when there is "evidence of slight contractility with no joint movement"?
Trace (1)
114
What is the muscle grade given when there is "No evidence of contractility"?
Zero (0)
115
What are the two motor/body activity carried out by the C5 nerve root?
Arm Abduction
| Forearm Flexion
116
What two muscles are innervated by the C5 nerve root?
**Biceps Brachii** (Deep Tendon Reflex for C5)
| Middle Deltoid
117
Where is the dermatome/sensory level of C5 nerve root?
Lateral arm
118
What disorder is seen in both the C5 and C6 nerve roots?
Erb's Palsy (Waiter Tip)
| C6= Wrist Drop
119
What are the motor/body activity carried out by the C6 nerve root?
```
Wrist extension
(C6= Motor Cycle Chicks)
```
120
What are the two motor/body activity carried out by the C7 nerve root?
Wrist Flexion
| Finger Extension
121
What are the motor/body activity carried out by the C8 nerve root?
Finger flexion
| C8 "Grap All 8
122
What are the two motor/body activity carried out by the T1 nerve root?
Finger Abduction
| Finger Adduction
123
What are the motor/body activity carried out by the T5-T12 nerve roots?
Trunk Flexion
124
What are the motor/body activity carried out by the L1-L3 nerve roots?
Hip flexion
125
What are the three motor/body activity carried out by the L2-L4 nerve roots?
Hip flexion
Hip adduction
Knee extension
126
What are the two motor/body activity carried out by the L4 nerve root?
Inversion
| Dorsiflexion
127
What are the three motor/body activity carried out by the L5 nerve root?
Toe extension
Heel walk
Hip abduction
128
What are the three motor/body activity carried out by the S1 nerve root?
Eversion
Plantar Flexion
Hip Extension
129
What are the motor/body activity carried out by the S2-S4 nerve roots?
Anal Wink
130
What three muscles are innervated by the C6 nerve root?
Extensor Carpi Ulnaris
Extensor Carpi Radialis
Brachialis (DTR C6)
131
What three muscles are innervated by the C7 nerve root?
Flexor Carpi Ulnaris
Flexor Carpi Radialis
Triceps (DTR C7)
132
What three muscles are innervated by the C8 nerve root?
Flexor Digitorum Superficialis
Flexor Digitorum Profundus
Lumbricals
133
What two muscles are innervated by the T1 nerve root?
Dorsal Interossei
| Palmer Interossei
134
What muscle is innervated by the T5-T12 nerve roots?
Rectus Abdominus
135
What muscle is innervated by the L1-L3 nerve roots?
Illiopsoas
136
What two muscles are innervated by the L2-L4 nerve roots?
Quadriceps
| Adductors
137
What muscle is innervated by the L4 nerve root?
Tibialis Anterior
138
What four muscles are innervated by the L5 nerve root?
Extensor Digitorum
Extensor Hallucis Longus
Gluteus Medius
Gluteus Minimums
139
What three muscles are innervated by the S1 nerve root?
Peroneus Longus
Peroneus Brevis
Gluteus Maximus
140
What two muscles are innervated by the S2-S4 nerve roots?
Levator Ani
| Coccygeus
141
Where is the dermatome/sensory level of C6 nerve root?
Lateral forearm
| Digits 1 and 2
142
Where is the dermatome/sensory level of C7 nerve root?
3rd digit, middle finger
143
Where is the dermatome/sensory level of C8 nerve root?
Medial Forearm
| Digits 4 and 5
144
Where is the dermatome/sensory level of T1 nerve root?
Medial Elbow
145
Where is the dermatome/sensory level of T5-T12 nerve root?
Respective vertebral level
146
Where is the dermatome/sensory level of L1-L3 nerve roots?
L1- Inguinal Ligament
L2- Oblique below L1
L3- Oblique across the knee
147
Where is the dermatome/sensory level of L4 nerve root?
Medial aspect of leg and foot
148
Where is the dermatome/sensory level of L5 nerve root?
Lateral aspect of the leg across the dorsum of the foot and big toe
149
Where is the dermatome/sensory level of S1 nerve root?
Lateral aspect of foot and plantar surface of foot
150
Where is the dermatome/sensory level of S2-S4 nerve roots?
Perianal
151
What disorder is seen in both the L4 and L5 nerve roots?
Foot Drop
152
What disorder is seen in C7 nerve root?
Klumpke's Paralysis (LMNL)
| Radial Nerve
153
What disorder is seen in C8-T1 nerve roots?
Klumpke's Paralysis (LMNL)
| Radial Nerve
154
What disorder is seen in L1-L3 nerve roots?
Meralgia Paresthetica
Lateral Femoral Cutaneous; mainly L2 and L3
Lat, Fem, Cut; She is 23 and to Cut(e) Fem me
155
What disorder is seen in S2-S4 nerve roots?
Cauda Equina
156
What is the motor/body action carried out by the Axillary Nerve?
Arm Abduction
157
What is the motor/body action carried out by the Musculocutaneous Nerve?
Elbow Flexion
158
What is the motor/body action carried out by the Medial Plantar Nerve?
Toe Extension
159
What is the motor/body action carried out by the Sciatic Nerve?
Flexion of the knee
160
What is the motor/body action carried out by the Obturator Nerve?
Hip Adduction
161
What are three motor/body actions carried out by the Radial Nerve?
Wrist extension
Finger extension
Thumb Abduction
162
What are the two motor/body actions carried out by the Media Nerve?
Thumb pinch
| Opposition of the thumb
163
What are the two motor/body actions carried out by the Ulnar Nerve?
Abduction of the 5th Digit
| Adduction of the thumb
164
What are the two motor/body actions carried out by the Dorsal Scapular Nerve?
Elevation of the Scapula
| Retraction of the Scapula
165
What is the motor/body action carried out by the Long Thoracic Nerve?
Protraction of the Scapula
166
What are the two motor/body actions carried out by the Femoral Nerve?
Hip Flexion
| Knee Extension
167
What are three motor/body actions carried out by the Peroneal Nerve?
Foot Dorsiflexion
Inversion
Eversion
168
What two muscles are innervated by the Axillary Nerve?
Deltoid
| Teres Minor
169
What three muscles are innervated by the Radial Nerve?
Wrist Extensors
Finger Extensors
Triceps
170
What three muscles are innervated by the Musculocutaneous Nerve?
Biceps
Brachialis
Coracobrachilis
171
What four muscles are innervated by the Median Nerve?
Wrist Flexors
Thumb Flexors
Thumb Abductors
Thenar
172
What three muscles are innervated by the Ulnar Nerve?
Finger Abductors
Finger Adductors
Thumb Adductors
173
What two muscles are innervated by the Dorsal Scapular Nerve?
Rhomboids
| Levator Scapula
174
What muscle is innervated by the Long Thoracic Nerve?
Serratus Anterior
175
What muscles are innervated by the Obturator Nerve?
Hip Adductor muscles
176
What two muscles are innervated by the Femoral Nerve?
Illiopsoas
| Quadriceps
177
What muscle is innervated by the Sciatic Nerve?
Hamstrings
178
What three muscles are innervated by the Peroneal Nerve?
**Tibialis Anterior**
Toe Extensors
Peroneals
179
What muscles are innervated by the Medical Plantar Nerve?
Toe Flexor Muscles
180
What is the dermatome/sensory pattern of the Axillary Nerve?
Lateral Arm
181
What is the dermatome/sensory pattern of the Radial Nerve?
Dorsal web between thumb and index finger
182
What is the dermatome/sensory pattern of the Musculocutaneous Nerve?
Lateral Forearm
183
What is the dermatome/sensory pattern of the Median Nerve?
Distal Radial hand
| 2nd digit
184
What is the dermatome/sensory pattern of the Ulnar Nerve?
Distal Ulnar Hand
| 5th Digit
185
What is the dermatome/sensory pattern of the Lateral Femoral Cutaneous Nerve?
Lateral Thigh
186
What is the dermatome/sensory pattern of the Saphenous Nerve?
Medial Leg
| Anteromedial Knee
187
What is the dermatome/sensory pattern of the Obturator Nerve?
Medial Thigh
188
What is the dermatome/sensory pattern of the Femoral Nerve?
Anteromedial Thigh
| Anteromedial Leg
189
What is the dermatome/sensory pattern of the Sciatic Nerve?
Anterior Leg
Posterior Leg
Sole of the foot
Dorsum of the foot
190
What is the dermatome/sensory pattern of the Peroneal Nerve?
Anterior Leg
| Dorsum of the foot
191
What disorder is seen with Axillary Nerve involvement?
Glenohumeral Dislocation
192
What three disorders is seen with Radial Nerve involvement?
Wrist Drop
Crutch Palsy
Erb's Palsy
193
What three Nerves have an Impingement disorders when they are involved?
Musculocutaneous
Obturator
Femoral
194
What three disorders is seen with Median Nerve involvement?
Carpel Tunnel
Ape Hand
Pronator Teres
195
What disorder is seen with Ulnar Nerve involvement?
Claw Hand
196
What disorder is seen with Dorsal Scapular Nerve involvement?
Flaring of the Scapula
197
What disorder is seen with Long Thoracic Nerve involvement?
Winging of the Scapula
198
What disorder is seen with Lateral Femoral Cutaneous Nerve involvement?
Meralgia Paresthetica (L2,L3)
199
What disorder is seen with Sciatic Nerve involvement?
Piriformis Syndrome (15%)
200
What disorder is seen with Peroneal Nerve involvement?
Fibular Head Fracture
201
What disorder is seen with Median Plantar Nerve involvement?
Tarsal Tunnel Syndrome
202
What type of pain is along a sensory distribution of a nerve root?
Dermatogenous
203
What is the definition of Myotogenous pain?
Pain that originates within a muscle
204
What type of pain is described as "Pain that arises from structures derived from embryological sclerotomes"?
Scleratogenous
205
What kind of pain occurs along the course of a dermatome due to nerve root irritation?
Radicular
206
What is the name of the pain that is "Pain along scleroderm of origination involving more then one kind of tissue"?
Referred (Shared Pathways)
207
What are the four characteristics of Muscle pain?
Cramping
Spasm
Aching
Dull
208
What are the four characteristics of Nerve pain?
Shooting
Radiating
Burning
Tingling
209
What are the two characteristics of Circulation pain?
Throbbing
| Pulsating
210
What are the six characteristics of Bone Cancer pain?
```
Constant
Deep
Boring
Nocturnal
Progressive
Unremitting
```
211
What are the three characteristics of Scleratogenous pain?
Poorly localized
Dull
Ache
212
What is the characteristic of Myofascial pain?
Trigger Point
213
What are the two pain referral sites for a Gallbladder issue?
Right Shoulder
| Inferior Scapula
214
What is the pain referral site for a Pancreas issue?
Spine at T10 level (Epigastric)
215
What are the three pain referral sites for a Heart issue?
Left Shoulder
Medial Left arm
Left Jaw/Side of the face
216
What is the pain referral site for a Intestinal issue?
Periumbilical
217
What is the pain referral site for a Kidney issue?
Flank
218
What is the pain referral site for a Ureter issue?
Groin
219
What is the pain referral site for a Bladder issue?
Suprapubic Area
220
What are the two pain referral sites for a Appendix issue?
Epigastric- Early
| Right Lower Quadrant (RLQ)- Late
221
Where is the site of Carpal Tunnel Syndrome?
Under the Flexor Retinaculum
222
What are five causes of Carpal Tunnel Syndrome?
```
Trauma
Obesity
Hypothyroidism
Rheumatoid Arthritis
Fluid Retention during pregnancy
```
223
In Carpal Tunnel Syndrome where is the numbness and tingling usually located?
First three digits
224
What three signs may indicate Carpal Tunnel Syndrome?
Thenar Atrophy
Nocturnal Pain
Weak Opponens Pollicis (Ape Hand Appearance)
225
What two orthopedic exams will be positive in a patient with Carpal Tunnel Syndrome?
Tinel's test at the wrist
| Phalen's Test
226
What are three treatments for a patient with Carpal Tunnel Syndrome?
Adjust (Lunate A-P)
Cock up splint
Vitamin B6
227
What condition of the Median Nerve/Anterior Interosseous Nerve is seen between the heads of the Pronator Teres at the elbow?
Pronator Teres Syndrome
228
In a patient with Pronator Teres Syndrome where are the three areas they will experience pain and paresthesia?
Palmar (Volar) aspect of the forearm
Lateral palm
Lateral digits
229
What causes Pronator Teres Syndrome?
Hypertonic Muscles i.e. Mechanics and Carpenters; work with a screwdriver, similar motion
230
What movements will cause pain in a patient with Pronator Teres Syndrome?
Pronation
| Wrist flexion
231
What muscle of the hand will be atrophied in a patient with Pronator Teres Syndrome?
Thenar (Palm)
232
What orthopedic test will be positive in a patient with Pronator Teres Syndrome?
Pinch Grip Test
233
What are the two treatments for Pronator Teres Syndrome?
Trigger Point Therapy
| Spray and Stretch
234
What are the two sites where the Ulnar Nerve can become trapped?
```
Tunnel of Guyon (Under the hook of the hamate)
Cubital Tunnel (Elbow)
```
235
What are two causes of Ulnar Nerve Entrapment?
Direct Trauma
| Repetitive Microtrauma
236
What three signs will a patient present with that has Ulnar Nerve Entrapment?
Pain
Tingling/Numbness of the last 2 digits
Weakness of the Adductor Pollicis (Claw Hand Deformity)
Hypothenar atrophy (Pisiform)
237
Of the two entrapments; Tunnel of Guyon and Cubital Tunnel, which one will have weak wrist flexion on the ulnar side?
Cubital Tunnel Entrapment
238
What is the name of the condition that happens from a lower brachial plexus injury from childbirth?
Klumpke's Palsy (C8-T1)
239
What does Klumpke's Palsy look like?
Claw hand deformity with flexion of the wrist (Crumple Arm)
240
What is the description of the condition of Wrist Drop?
Unable to extend elbow and wrist
| Radial Nerve Involvement
241
What is the name of the condition that has arm in "Adduction, Internal Rotation, and Flexion of the Wrist"?
Erb's Palsy AKA Waiter's Tip Deformity
| Radial Nerve Involvement
242
What is the site that causes Saturday Night/ Crutch Palsy?
Spiral Groove
| Radial Nerve Involvement
243
What are three causes of Saturday Night/Crutch Palsy?
Trauma
**Lead Poisoning**
Pressure from crutches
244
What reflex will be decreased in a patient with Radial Nerve involvement?
Triceps
245
In a patient with Radial Nerve involvement where will there be decreased sensation? (Three areas)
Posterior Arm
Posterior Forearm
Posterolateral three and a half (3.5) fingers
246
What are three causes of Winging Scapula?
Trauma
Iatrogenic
Idiopathic
247
What nerve is injured to cause Scapular Winging?
Long Thoracic Nerve
248
What muscle has paralysis in Scapular Winging?
Serratus Anterior
249
What nerve is damaged to cause Flaring of the Scapula?
Dorsal Scapular Nerve
250
What muscle has paralysis in Flaring of the Scapula?
Rhomboids
251
Where is the site of Meralgia Paresthetica?
Pelvic Brim under the inguinal ligament
252
What are three causes of Meralgia Paresthetica?
External pressure (Utility Belt i.e. Cops or Construction)
Obesity
Tight Jeans
253
What kind of symptoms are present with Meralgia Paresthetica?
Burning pain over the anterolateral thigh
254
What are two treatments for Meralgia Paresthetica?
Weight loss
| Loose fitting clothes
255
Where are three sites of Sciatic pain?
Pelvis
Hip
Popliteal Fossa
256
What are five causes of Sciatica?
```
Trauma
Traction
Wallet Pressure
Piriformis contracture
Muscle spasm
```
257
Where will a patient with Sciatica have pain?
Posterior:
Buttock
Thigh
Leg, to the floor
258
What two leg movements will be decreased in a patient with Sciatica?
Weak knee flexion
| Decreased Achilles Reflex
259
What is one possible differential diagnosis for Sciatica?
Facet involvement, **Facet will NEVER cross the knee**
260
What nerve is involved in Tarsal Tunnel Syndrome?
Medial Plantar Nerve; Branch from the Tibial Nerve
261
What three symptoms would a patient with Tarsal Tunnel Syndrome present with?
Burning Paresthesia
Decreased sensation on the soles of feet
Weak muscles of the foot
262
What two motions will cause pain in Tarsal Tunnel Syndrome?
Walking
| Standing
263
What are three treatments for Tarsal Tunnel Syndrome?
Adjust
Orthotic support
Foot in slight inversion
264
What is another name for Morton's Neuroma?
Intermetatarsal Neuroma
265
What are five causes of Intermetatarsal Neuroma?
- Freiberg's Disease; avascular necrosis of a metatarsal, usually the 2nd one
- Repetitive Microtrauma
- Narrowed toed shoes
- Rheumatoid Arthritis (RA)
- Foot Deformities
266
Where does a patient with Morton's Neuroma have pain? (Two places)
Toes
| Dorsum of the foot
267
What is one possible way to decrease pain in Morton's Neuroma?
Shoes with a bigger toe box
268
What orthopedic test will be positive for Intermetatarsal Neuroma?
Morton's Squeeze Test
269
What is the common site to have a Common Peroneal Nerve problem?
Fibular Head
270
What is the cause of Common Peroneal Nerve issues?
Trauma
271
What is the treatment for Common Peroneal Nerve complaints?
Adjust
| Refer if there is a fracture
272
What two symptoms and where is the pain located in a patient with Common Peroneal Nerve issues?
Pain in the lateral leg
Weak Peroneal muscles
Foot drop
273
What nerve is involved in Anterior Compartment Syndrome?
Deep Peroneal Nerve (Medial Leg)
274
What condition has similar signs and symptoms to Deep Peroneal Nerve?
Charcot Marie Tooth
275
What four muscles can the Deep Peroneal Nerve effect?
Tibialis Anterior
Extensor Hallucis Longus
Extensor Digitorum Longus
Peroneus Tertius
276
What is the treatment for Deep Peroneal Nerve issues?
Medical Emergency
277
What is the name of the finger condition that is a "deformity in which the fingertip is curled in and cannot be straightened itself"?
Mallet Finger
278
What is the cause of the Mallet Finger Deformity?
Injury
279
What two finger conditions are seen in Rheumatoid Arthritis (RA)?
Swan Neck Deformity
| Boutonniere Deformity
280
What is the finger deformity described by the following "Hyper-flexion of the Distal Interphalangeal (DIP) and hyper-extension of the Proximal Interphalangeal (PIP)"?
Swan neck deformity
281
How is the Boutonniere Deformity described?
Hyper-extension of the Distal Interphalangeal (DIP) and hyper-flexion of the Proximal Interphalangeal (PIP)
282
What finger condition has "an abnormal thickening underneath the skin of the palm and fingers"?
Dupuytren's Contracture
283
What two fingers are affected with Dupuytren's Contracture?
Last two finger, curl into the palm
| Middle finger may be involved in later
284
What is the name of the finger condition that has a finger "Locked in a flexed position"?
Trigger Finger
285
What causes Trigger Finger?
**Tendons** of the flexed finger become inflamed or swollen
286
How is Trigger Finger corrected?
Finger is straightened by person, swollen tendon is forced into the sheath, causing a popping or snapping sound
287
What are the two inflamed tendons seen in De Quervain's Tenosynovitis?
* *Extensor Pollicis Brevis**
| * *Abductor Pollicis Longus**
288
How is De Quervain's Tenosynovitis treated?
Bracing of the thumb and wrist
289
What orthopedic exam will be positive for De Quervain's Tenosynovitis?
Finkelstein's Test
290
What three functions does the Cerebrum help with?
Sensory Interpretation
Motor Interpretation
Language
291
What are five conditions that may effect the Cerebrum?
```
Stoke (Cardiovascular Accident; CVA)
Cerebral Palsy
Alcoholism
Alzheimer's
Tumor
```
292
What two functions are controlled by the Cerebellum?
Balance
| Coordination
293
What are four possible problems that will be seen in a patient that has a Cerebellar issue?
Dysmetria (Past Pointing)
Dyssynergia (Lack of Coordination)
Diadochokinesia (Rapid Alternating Movements)
Unable to perform Tandem Gait
294
What are three conditions that are seen in Cerebellar Issues?
Multiple Sclerosis (MS)
Alcoholism
Cerebral Palsy
295
What three sensation is determined by the Posterior Columns?
Two point discrimination
Vibration (128 tuning fork on the distal joint)
Position Sense
296
When performing Romberg's test, when are the Posterior Columns tested?
When the patient closes their eyes
297
What four conditions are seen when the Posterior Columns are affected?
Multiple Sclerosis (MS)
Tabes Dorsalis
Leprosy
Diabetes Mellitus
298
What tract has to deal with Voluntary Movement and flexors of the hands and feet?
Corticospinal (Pyramidal) Tract
299
What tract is involved in an Upper Motor Neuron Lesion (UMNL)?
Corticospinal (Pyramidal) Tract
300
What two sensations are sensed by the Lateral Spinothalamic tract?
Pain
| Temperature
301
What tract is involved in a Syringomyelia?
Lateral Spinothalamic Tract
302
What Tract is the sensation of Crude Light Touch?
Anterior Spinothalamic Tract
303
What tract deals with balance reflexes and postural muscles?
Vestibulospinal Tract
304
What two conditions can be seen if a patient has an issue with their Vestibulospinal Tract?
Benign Paroxysmal Positional Vertigo (BPPV)
| Labyrinthitis
305
What is the function of the Rubrospinal Tract?
Muscle tone and synergy to the proximal flexors of the extremities
306
What spinal tract deals with "Muscle tone and synergy to voluntary extensor muscles"?
Reticulospinal Tract
307
What spinal tract crosses at the medullary pyramids and travels to the flexors of the extremities?
Lateral Corticospinal Tract
308
What does the Ventral Corticospinal tract effect?
Crosses at the segmental level
| Goes to the flexors of the trunk
309
What condition is a "cyst of the central canal of the spinal canal"?
Syringomyelia
310
Where is the congenital weak area of the spine that is seen with Syringomyelia?
C5-C6
311
What is the common finding of Syringomyelia?
Loss of pain and temperature over the shoulders in a cape like distribution
312
What condition is a demyelination of the central nervous system (CNS)?
Multiple Sclerosis
313
What cells are responsible for myelination of the Central nervous system (CNS)?
Oligodendrocytes
314
What population is often affected by Multiple Sclerosis (MS) and Myasthenia Gravis?
Females aged 20-40
315
What can cause an increase in the exacerbation of Multiple Sclerosis (MS)?
Moving from cold to warm climates
316
What are the signs and symptoms of Multiple Sclerosis (MS)?
Diplopia
Scotomas (Partial Loss of vision or blind spot)
Transient Blindness
Optic Neuritis (Retrobulbar Neuritis)
Pain
Vertigo
Upper Motor Neuron Lesion (UMNL) in legs, causing distal weakness
317
What is the name of the positive orthopedic exam in Multiple Sclerosis (MS)?
Lhermitte's Test
318
What are the three components of Charcot's Triad, in Multiple Sclerosis (MS) patients?
SIN
Scanning Speech
Intention Tremor
Nystagmus
319
What are two ways to Diagnosis Multiple Sclerosis (MS)?
```
MRI (Best)
Cerebrospinal Fluid (CSF) exam; Increase in Proteins
```
320
What is always affected first in Myasthenia Graves?
Motor Cranial Nerves
321
In the condition of Myasthenia Graves what is makes it an Autoimmune Disorder?
The body makes antibodies against the acetylcholine receptors
322
What condition is a dysfunction of the Myoneural junction and is a weakness of the cranial nerves that later effects the proximal muscles?
Myasthenia Graves
323
What are the early signs of Myasthenia Graves?
Ptosis
Diplopia (Double Vision)
Dysarthria
**Fatigue of muscles** (Especially after exercise)
Muscle weakness varies during the day; **worse at day's end**
324
What test is done on patients with Myasthenia Graves?
ACHr test
325
What test is done to diagnosis Myasthenia Graves?
Tensilon Test
326
What type of drug is used to treat Myasthenia Graves?
Cholinesterase Inhibiting Drugs
327
What is the name for Lou Gehrig's Disease?
Amyotrophic Lateral Sclerosis (ALS)
328
What is first effected in Amyotrophic Lateral Sclerosis (ALS)?
Hands
329
Who usually has Amyotrophic Lateral Sclerosis (ALS)?
Males less than 40 years of age
330
What part of the spine is effected in Amyotrophic Lateral Sclerosis (ALS)?
Corticospinal tract
| Anterior horn
331
What is a differential diagnosis of Amyotrophic Lateral Sclerosis (ALS)?
Lateral Canal Stenosis
332
What are the signs/symptoms of Amyotrophic Lateral Sclerosis (ALS)?
Fasciculations
Spasticity
Increase in Deep Tendon Reflexes (DTR)
333
What kind of lesions are seen in Amyotrophic Lateral Sclerosis (ALS)?
Lower Motor Neuron Lesion (LMNL) in the arms
| Upper Motor Neuron Lesion (UMNL) in the legs
334
What is another name for Posterolateral Sclerosis (PLS)?
Combined System Disease
335
What areas of the spinal cord are effected in Combined Systems Disease?
Degeneration of:
Posterior Columns
Corticospinal Tracts
336
A deficiency in what Vitamin leads to Posterolateral Sclerosis (PLS)?
```
B12 (Pernicious Anemia)
Stomach Issue (Gut or Colon)
```
337
What test will be positive in Combined Systems Disease?
Shilling Test
338
What kind of paresthesia is seen in Posterolateral Sclerosis (PLS)?
Glove and Stocking
| Neurological Symptoms are irreversible
339
What is the name of the condition that has a "hemisection (partially severed) spinal cord; usually caused by injury"?
Brown Sequard
340
In Brown Sequard, what is effected Ipsilateral and what is effected Contra-lateral?
Ipsilateral:
Motor function
Dorsal Columns
Contra-Lateral:
Loss of:
Pain
Temperature
341
What condition is described as "A non-progressive motor disorder of the cerebral cortex due to anoxia to the brain prenatally or during birth trauma"?
Cerebral Palsy
342
What type of Gait, Paralysis and two types of Movements are seen in patients with Cerebral Palsy?
```
Gait: Scissored (Tight Adductors)
Paralysis: Spastic
Movements:
Athetoid (Most Common)
Choreiform
```
343
What is another name for Parkinson's Disease?
Paralysis Agitans
344
What condition is "Chronic progressive associated with loss of dopamine in the Substantia Nigra causing Basal Ganglionic dysfunction"?
Parkinson's Disease
345
What tract is effected in Paralysis Agitans?
**Extrapyramidal Tract**
346
At what age is Parkinson's usually seen?
Over the age of 50, with a gradual onset
347
What are the signs and symptoms of Paralysis Agitans?
```
Resting tremor (Pill rolling)
Mask like face
Festinating gait
Cogwheel/Lead pipe rigidity
Forward stooped posture
Bradykinesia (Slow walking)
```
348
What condition is "Inflammatory polyneuropathy of the **Peripheral Nervous System (PNS)**, linked to recent immunization or recent flu infection"?
Guillain-Barre Syndrome
349
What kind of paralysis is Guillain-Barre Syndrome?
Ascending; begins in the legs. Sensory symptoms
350
When can Guillain-Barre Syndrome become a medical emergency?
If it reaches the diaphragm
351
What condition is seen in tertiary syphilis, effecting the posterior columns?
Tabes Dorsalis
352
What kind of pupil will be seen in a patient with Tabes Dorsalis?
Argyll Robertson's- pupil accommodates but no response to direct light
353
What kind of gait may be present in Tabes Dorsalis?
Slappage Gait
354
What two body functions are effected in Tabes Dorsalis?
Coordination
| Balance
355
What condition is seen in Boys aged 3-7, that is a recessive sex linked disorder?
Muscular Dystrophy (Erb's Duchenne)
356
What kind of gait is seen in Muscular Dystrophy?
Waddling gait, weakness of proximal leg muscles
357
What three postural signs will you see in a patient with Muscular Dystrophy, besides gait?
Toe walking
Hyperlordosis (Pot-Belly Stance)
Pseudohypertrophy of the calves
358
What orthopedic exam can help diagnosis Muscular Dystrophy?
Gower's Sign
359
In the condition of Muscular Dystrophy what will be the lab findings?
Large increase in CPK (CK-MM)
| Decrease in Creatinine
360
What condition is "mental deterioration and amnesia"?
Alzheimer's
361
What is the most definitive diagnosis for Alzheimer's?
Autopsy
362
What is the most common age of on set for the condition of Huntington's Chorea?
35-44
363
What kind of disease is Huntington's Chorea?
Neurodegenerative genetic disorder
364
What are the thing affected in Huntington's Chorea?
Muscle coordination
Cognitive decline
Dementia
365
What is the name of the condition that is "Hereditary and affects both moth and sensory nerves"?
Charcot Marie Tooth Disease
366
What are the three typical signs and symptoms of a patient that has Charcot Marie Tooth Syndrome?
Weakness of the foot and lower leg muscles
Foot Drop paired with a High Steppage Gait
Frequent trip and falls
367
What muscles of the lower leg are affected over time in Charcot Marie Tooth Syndrome?
Peroneal Muscles
368
What percentage of the gait cycle is Stance phase?
60%
369
What are the three phases of the Stance Phase?
```
Heel Strike (When heel hits the ground)
**Most stretch on the Sciatic Nerve**
```
```
Foot Strike (When heel of the foot is on the ground)
Toe Off (When up on toe and about to kick off)
```
370
What percentage of the gait cycle is in Swing Phase?
40%
371
What is the definition of Swing Phase?
Leg is swinging, no weight
372
What are the two parts of Swing Phase?
Early Swing
| Late Swing
373
What two muscle cause Acceleration of the thigh?
Illiopsoas
| Rectus Femoris
374
What muscle can sprinters easily tear off the Anterior Inferior Spine due to it's cartilaginous apophysis attachment?
Rectus Femoris
375
The hamstring assist in what part of the gait cycle?
Deceleration
376
What type of athlete is prone to pulling their hamstring?
Stop quickly
Forceful kicking
Hamstring is pulled of the ischial tuberosity
377
The Heel Strike fires what group of muscles?
Dorsiflexors (Tibialis Anterior innervated by the Deep Fibular (Peroneal) Nerve))
378
What muscle eccentrically contracts to absorb energy of the knee to prevent bucking, during the Heel Strike phase of the Gait Cycle?
Quadriceps
379
During Foot Strike of the Gait Cycle what muscles contact to hold the body up right?
Abductors
380
What muscles contract to move the body forward during the Foot Strike phase?
Plantar Flexors= Triceps Surae
Gastrocnemius
Soleus
Plantaris
381
During the Toe Off phase of the Gait Cycle what muscle concentrically contracts to help the body move ahead by elongating the lower limb?
Quadriceps
382
How is a Propulsion/Festinating/Shuffling gait described?
Forward leaning posture with small shuffling steps
383
What condition is seen to have a Propulsion/Festinating/Shuffling gait?
Parkinson's Disease
384
How is a Scissored gait described?
Knee's crossed at midline while walking (Tight Adductors)
385
What condition is a Scissored gait often seen in?
Cerebral Palsy
386
How is a Trendlenburg gait described?
Weak Gluteus Medias, causing lurching and drastic pelvic tilting on the affected side
387
What condition is a Waddling gait often seen in?
Muscular Dystrophy
388
What three conditions is a Steppage gait often seen in?
Anterior Compartment Syndrome
Foot Drop
**L4 Lesion**/ Paralysis of the Tibialis Anterior
389
What condition is a Slappage/Sensory Ataxia gait often seen in?
Posterior Columns Disease
| Difficult walking in the dark
390
What two conditions is a Circumduction/Hemiplegic gait often seen in?
Stroke; swinging; unilaterally
| Spastic Hemiplegia
391
What condition is a Spastic gait often seen in?
Upper Motor Neuron Lesion (UMNL)
392
What condition is a Drunken/Motor Ataxic gait often seen in?
Cerebellum issues (Wide based gait)
393
Where does 50% of flexion and extension occur in the cervical spine?
Occiput-C1
394
At what level does 50% of rotation occur in the cervical spine?
C1-C2
395
What is another name for Bakody's Test?
Shoulder Abduction Test
396
How is Bakody's Test performed?
Patient is seated, actively places affected arm/palm on top of their head. Elbow should be at the level of their head
397
What is considered a Positive Bakody's Test?
Relief of pain
398
What does Bakody's Test indicate?
Intervertebral Foramen (IVF) Encroachment
399
How is Foraminal Compression Test performed?
Patient is seated actively rotates head side to side.
Doctor presses down in a neutral position.
Rotate head to each side and apply downward pressure
400
How is Jackson's Compression Test performed?
Patient is seated, doctor lateral flexes patient's head to one side and applies downward pressure. Repeat on other side.
401
How is Maximum Cervical Compression Test performed?
**Never Touch the Patient**
Patient is seated, actively rotate, laterally flex and extend to one side. **Do NOT come back to Neutral**
If no pain have the patient maximally laterally flex. Repeat on the other side.
**No Compression/Downward pressure applied**
402
How is Distraction Test performed?
Patient seated, doctor exerts upward pressure on patient's head removing the weight of the patients head for the neck.
403
How is Shoulder Depression Test performed?
Patient is seated, doctor presses down on shoulder of patient while laterally flexing cervical spine away from shoulder. Perform on other side.
404
How is Soto Hall Sign performed?
Patient is supine, doctor places one hand on sternum while passively flexing patient's head toward chest.
405
What is considered a Positive Foraminal Compression Test?
Radicular Pain/Localized Pain
406
What is considered a Positive Jackson's Compression Test?
Radicular Pain/Localized Pain
407
What is considered a Positive Maximum Foraminal Compression Test?
Radicular Pain/Localized Pain
408
What is considered a Positive Distraction Test and what does it indicate, for both an increase and decrease in pain?
Decrease in Pain= Nerve root Compression/Space Occupying Lesion (SOL)
Increase in Pain=Sprain/Strain
409
What is considered a Positive Shoulder Depression Test?
Pain
410
What is considered a Positive Soto Hall Sign?
Localized Pain
411
What does Foraminal Compression, Jackson's Compression, Maximal Foraminal Compression Test indicate?
Nerve Root Compression/ Facet Syndrome
412
What does Shoulder Depression Test indicate?
**Nerve Root Adhesions**
413
What does Soto Hall Sign indicate? (Two things)
```
Compression Fracture (Anterior Pain)
Ligament Damage (Posterior Pain) (Sprain/Strain)
```
414
What four orthopedic exams can be performed to indicate a Space Occupying Lesion (SOL)?
Valsava's Maneuver
Naffziger's Test
Milligram's
Dejerine's Triad
415
How is Spurling's Test performed?
**Most aggressive for closing off Intervertebral Foramen (IVF)**
Patient actively maximally rotates and laterally flexes head to the affected side. Doctor delivers a vertical blow to the top of the head.
(Can be done bilaterally or with the neck in hyperextension)
416
How is Naffziger's Test performed?
Patient is seated while doctor applies digital pressure over the jugular veins bilaterally.
Can place blood pressure cuff around patient's neck and pump to 40 mm Hg and hold for ~30 seconds (NOT RECOMMENDED)
If patient has no pain, instruct them to cough
417
How is Valsava's Maneuver performed?
Doctor ask the patient to bare down like they are having a bowel movement
418
What is considered a Positive Spurling's Test?
Pain in the neck, shoulder or arm
419
What is considered a Positive Valsava's Maneuver Test?
Radicular Pain
420
What is considered a Positive Naffziger's Test?
Pain
421
What is a contraindication to Naffziger's Test?
Vascular Compromise
422
What is another name for Thoracic Outlet Syndrome (TOS)?
Neurovascular Compression Syndrome
423
Who should you refer a patient to if they have a Cervical Rib?
Orthopedist
424
How do you perform Allen's Test?
Patient seated with elbow flexed and forearm is supinated, ask the patient to pump the hand, keep closed while doctor occludes the radial and ulnar arteries until hand is blanched. Patient slowly opens the hand while doctor opens one artery and records filling time. Repeat on other artery.
425
What is a Positive Allen's Test?
Delay of more than 10 seconds for blood to return
426
What does a Positive Allen's Test indicate?
Occlusion of corresponding artery
427
How is Adson's Test performed?
Patient seated, doctor slightly abducts, extends and externally rotates the arm while taking the radial pulse.
Patient rotates the head towards the side being tested and extends head. Patient than takes a deep breathe.
428
What is another name for Adson's Test?
Scalenus Anticus Test
429
What is a Positive Adson's Test?
Alteration in **amplitude** of Radial Pulse
430
What does a Positive Adson's Test indicate?
Cervical Ribs
431
What is another name for Modified Adson's Test?
Scalenus Medius Test
432
How is Modified Adson's Test performed?
If Adson's test was NEGATIVE. Patient rotates their head to the opposite side, extends head and takes a deep breathe.
433
What is a Positive Modified Adson's Test?
Alteration in **amplitude** of the Radial Pulse
434
What does a Positive Modified Adson's Test indicate?
Subclavian Artery
| Scalenus Medius Syndrome
435
What is another name for the Costoclavicualar Maneuver?
Eden's Test
436
How is Eden's Test performed?
Doctor palpates the radial pulse while drawing the patients shoulder down and back. The patient then flexes the chin to chest.
437
What is a Positive Eden's Test?
Alteration in the **amplitude** of the Radial Pulse
438
What does a Positive Eden's Test indicate?
Compression between the first rib and clavicle
439
What is another name for Wright's Test?
Hyperabduction Maneuver
440
How is Wright's Test performed?
Patient seated while the doctor palpates the radial pulse. Each arm is individually abducted to 180 degrees.
-Doctor notes angle at which radial pulse diminishes or disappears.
441
What is a Positive Wright's Test?
**Lower Arm is the affected arm** (+)
If pulses are lost with more than 10 degrees different between arms
442
What does a Positive Wright's Test indicate?
Pectoralis Minor Syndrome
| *Axillary Artery*
443
What does a Reverse Bakody's Maneuver look like?
Seated patient actively places hand on top of head
444
What is a Positive Bakody's Maneuver?
Increase Pain
445
How is Halstead's Test performed?
Patient extends head back. Doctor slightly abducts the arm then applies downward ("Hal Down on the arm") traction on the arm while taking pulse.
446
What is a Positive Halstead's Test?
Alteration in the amplitude of Radial Pulse
447
What does a Positive Halstead's Test indicate?
Cervical Rib; Refer to an Orthopedist
448
How is Bikele's Sign performed?
Patient actively abducts the shoulder to 90 degrees with the elbow flexed to 90 degrees and then extends the shoulder. Now patient extends the elbow.
449
What is a Positive Bikele's Sign?
Resistance and increased radicular pain
450
What three things are indicated by a Positive Bikele's Sign?
Thoracic Outlet Syndrome (TOS)
Brachial Plexus Neuritis
Meningeal Irritation
451
How is Roo's Test performed?
Patient is seated. Both arms are at 90 degrees then patent abducts and externally rotates them.
The patient then repeatedly open and closes the fists for 3-5 minutes.
452
What is a positive Roo's Test?
Reproduction of symptoms or unusual discomfort
453
What does an Positive Roo's Test indicate?
Thoracic Outlet Syndrome (TOS)
454
Which one of the four rotator cuff **tendons** is most frequently torn?
Supraspinatus
455
Where is the Supraspinatus Muscle usually torn from?
Insertion point; the humeral head of the greater tuberosity
456
What is the best diagnosis for a Rotatory cuff tear?
MRI
457
What is the recommended treatment for Rotor Cuff injuries?
Codman's Exercises
458
What is the action of the Supraspinatus muscle?
Abduction
459
What is the nerve supply to the Supraspinatus muscle?
Suprascapular Nerve
460
Where does the Supraspinatus muscle insert?
Greater Tubercle of the humerus
461
What is the action of the Infraspinatus muscle?
External Rotation of the arm
462
What is the nerve supply to the Infraspinatus muscle?
Suprascapular Nerve
463
What is the insertion of the Infraspinatus muscle?
Greater Tubercle of the humerus
464
What is the action of the Teres Minor muscle?
External Rotation of the arm
465
What is the nerves supply of the Teres Minor muscle?
Axillary Nerve
466
What is the insertion of the Teres Minor Muscle?
Greater Tubercle of the humerus
467
What is the nerve supply of the Subscapularis muscle?
Subscapular Nerve
468
What is the action of the Subscapularis muscle?
Internal Rotation of the arm
469
What is the insertion of the Subscapularis muscle?
Lesser tubercle of the humerus
470
At what two joints does abduction of the shoulder occur?
Glenohumeral
| Scapulothoracic articulation
471
What is the appropriate ratio of movement between the Glenohumeral joint and the Scapulothoracic articulation when the shoulder is abducted?
2:1
472
What does a decrease ration of the Glenohumeral joint and Scapulothoracic articulation indicate?
Adhesive Capsulitis AKA Frozen Shoulder
473
What two muscles elevate the scapula?
Trapezius
| Levator Scapula
474
What two muscles retract the scapula?
Rhomboid (Major and Minor)
475
What muscle protracts the scapula?
Serratus Anterior
476
How is Apley's Scratch Test performed?
Patient is seated and instructed to actively put hand behind the head and touch the opposite superior angle of the scapula.
-Then place hand behind the back and touch the opposite inferior angle of the scapula
477
What is a Positive Apley's Scratch Test?
Pain or decreased Range of Motion (ROM)
478
What does a Positive Apley's Scratch Test indicate?
Degenerative Tendonitis of Rotator Cuff
479
How is Codman's Drop Arm Test performed?
Doctor passively abducts arm to about 90 degrees, then suddenly removes support.
-This causes deltoid to contract suddenly causing an increase in pain
480
What is a Positive Codman's Drop Arm Test?
Inability to maintain arm position
481
What does a Positive Codman's Drop Arm Test indicate?
Supraspinatus Tear
482
How is the Apprehension Test performed?
Doctor abducts and slowly externally rotates the affected shoulder.
483
What is a Positive Apprehension Test?
Patient shows sign of alarm
484
What does a Positive Apprehension Test indicate?
Chronic Shoulder Dislocation
485
How is Dugas' Test performed?
Patient places the hand of the affected shoulder on the opposite shoulder and attempts to touch the chest with the elbow
486
What is a Positive Dugas' Test?
Unable to perform
487
What does a Positive Dugas' Test indicate?
Acute Shoulder Dislocation
488
How is Dawbarn's Sign performed?
Test **Da-Bursa**
Deep palpitation by the doctor over the subacromial bursa elicits pain. Without moving the fingers the arm Is passively abducted.
489
What is a Positive Dawbarn's Sign?
Reduction of Pain
490
What does a Positive Dawbarn's Sign indicate?
Subacromial Bursitis; Most common Hydroxyapatite Deposition Disease (HADD)
491
How is Yergason's Test?
Patient flexes the elbow to 90 degrees while seated. Doctor palpates the bicipital tendon and resists the patient's attempt to actively supinate the hand and flex the elbow.
492
What is a Positive Yergason's Test?
**NOT positive for pain**
Audible click or snap in the bicipital groove
493
What does a Positive Yergason's Test indicate?
**Bicipital Tendon Instability**
494
What are two other names for Lateral Epicondylitis?
Radio Humeral Bursitis
| Tennis Elbow
495
What muscle is affected in Lateral Epicondylitis?
Extensor Carpi Radialis Brevis
496
What movements will cause pain in the condition of Lateral Epicondylitis?
Wrist extension
| Pronation of the elbow
497
What are two other names for Medial Epicondylitis?
Little leaguers Elbow
| Golfer's Elbow
498
What muscle is affected in Medial Epicondylitis?
Flexor Carpi Ulnaris
499
What movement will cause pain in the condition of Medial Epicondylitis?
Flexion of the wrist, medial portion of the elbow
500
What are three treatment/case management for both Lateral and Medial Epicondylitis?
Transverse Massage
Underwater ultrasound
Counterforce brace
501
How is Cozen's Test performed?
Patient's elbow is flexed to 90 degree with the forearm pronated and fist dorsiflexed.
Doctor stabilizes the elbow and resists the patient's dorsiflexion.
502
What is a Positive Cozen's Test?
Pain in the lateral elbow
503
What does a Positive Cozen's Test indicate?
Lateral Epicondylitis
504
How is Reverse Cozen's Test performed?
Patient is seated with arm close to the body. Patient makes a fist and flexes wrist with supination. Doctor resist flexion of wrist while supporting the elbow.
505
What is a Positive Reverse Cozen's Test?
Pain In the medial elbow
506
What does a Positive Reverse Cozen's Test indicate?
Medial Epicondylitis
507
How is Mill's Test Performed?
Patient is instructed to extend the forearm, make a fist, flex the wrist and then maximally pronate the forearm.
This test can be performed passively by the doctor
508
What is a Positive Mill's Test?
Pain on the lateral Elbow
509
What does a Positive Mill's Test indicate?
Lateral Epicondylitis
510
How is Tinel's Sign at the Wrist performed?
Percuss over the flexor retinaculum of the wrist and the Tunnel of Guyon
511
What is a Positive of Tinel's sign at the Wrist?
Tingling into the lateral three finger or the medial two fingers
512
What does a Positive of Tinel's Sign at the Wrist indicate?
Carpal Tunnel Syndrome
| Ulnar Nerve Impingement
513
How is Phalen's Sign performed?
Patient flexes the wrists maximally and hold the position for up to 60 seconds by pushing both wrist together
514
What is a Positive Phalen's Sign?
Tingling into the first three digits of the hand
515
What does a Positive Phalen's Sign indicate?
Carpal Tunnel Syndrome
516
How is Froment's Sign performed?
Doctor places a piece of paper between the patients thumb and index fingers and attempts to pull the paper out
517
What is a Positive Froment's Sign?
Unable to keep paper between finger
518
What does an Positive Froment's Sign indicate?
Ulnar nerve palsy
519
How is Finkelstein's Test performed?
Patient is asked to make a fist with the thumb tucked inside. Then the fist is deviated in the ulnar direction.
520
What two muscles are being evaluated during Finkelstein's Test?
Extensor Pollicis Brevis
| Abductor Pollicis Longus
521
What is a Positive Finkelstein's Test?
Pain over the anatomical snuff box
522
What does a Positive Finkelstein's Test indicate?
De Quervain's Disease (Stenosing Tenosynovitis)
523
What is another name for De Quervain's Disease?
Stenosing Tenosynovitis
524
How is a Straight Leg Raiser (SLR) Test performed?
Patient is supine with legs extended. Doctor places one hone under the heel and the other over the knee and slowly raised the leg.
525
What is a Positive Straight Leg Raiser (SLR) Test?
Pain down the affected side
526
What are three possible indications from a Positive Straight Leg Raiser (SLR) Test?
Sciatica
Disc/Space Occupying Lesion (SOL)
Lumbar lesion
527
How is Bragard's Test Performed?
After pain with a Straight Leg Raiser (SLR), the leg is lowered below the point of discomfort and the foot is sharply dorsiflexed
528
What is a Positive Bragard's Test?
Pain in the affected leg
529
What does a Positive Bragard's Test indicate?
Sciatica
530
How is Sicard's Sign performed?
Perform a Straight Leg Raiser (SLR), lower the leg 5 degrees and dorsiflex big toe.
531
What is a Positive Sicard's Sign?
Pain in the affected leg
532
What does a Positive Sicard's Sign indicate?
**Sciatica**
533
How is Turyn's Sign performed?
While the patient is in the supine position, doctor dorsiflexes the big toe
534
What is a Positive Turyn's Sign?
Pain in the Gluteal region
535
What does a Positive Turyn's Sign indicate?
Sciatica
536
What is another name for the Well Leg Raiser (WLR)?
Fajerstazn's
537
How is a Well Leg Raiser (WLR) performed?
Straight Leg Raiser (SLR) with dorsiflexion of the foot performed on the asymptomatic side of a sciatic patient
538
What is a Positive Well Leg Raiser (WLR)?
Pain down Symptomatic (Sciatic) side
539
What does a Positive Well Leg Raiser (WLR) indicate?
Medial Disc Lesion
540
How is Millgram's Test performed?
Patient is supine with limbs extended. Patient is asked to elevate legs six (6) inches off the table and hold for as along as possible, up to 60 seconds
541
What is a Positive Millgram's Test?
Pain
542
What does a Positive Millgram's Test indicate?
Space Occupying Lesion (SOL)
543
How is Goldthwait's Sign performed?
Patient is supine with affected leg raised slowly while doctor's hand is under the lumbosacral portion of the spine.
544
What is a Positive Goldthwait's Sign?
Pain
545
What does a Positive Goldthwait's Sign indicate? (Three different indications)
0-30 degrees: Sacroiliac (SI) Joint
30-60 degrees: Lumbosacral Joint
60-90 degrees: Lumbar Spine or Contralateral SI Joint
546
How is Linder's Test performed?
Patient's head is passively flexed to the chest
547
What is a Positive Linder's Test?
Pain in the lumbar spine radiating to the sciatic nerve
548
What does a Positive Linder's Test indicate?
Root Sciatica
549
How is Bowstring's Test performed?
Doctor performs a Straight Leg Raiser (SLR) to the point of pain. The knee is flexed slightly and placed on the doctor's shoulder. Digital pressure is placed above the popliteal fossa and then in the popliteal fossa.
550
What is a Positive Bowstring's Test?
Pain in lumbar spine region or Radiculopathy
551
What does a Positive Bowstring's test Indicate?
Sciatica (BEST TEST)
552
How is Bonnet's Sign performed?
Patient supine, doctor stands on the side being tested. Doctor internally rotates leg, adducts leg and then performs a Straight Leg Raiser (SLR)
553
What is a Positive Bonnet's Sign?
Radicular Pain into the limb
554
What does a Positive Bonnet's Sign indicate?
Piriformis Syndrome
555
What is another name for Belt's Test?
Supported Adam's Test
556
How is Belt's Test Performed?
Patient bends forward and the doctor notes when the pain occurs.
Then doctor stands sideways behind the patient and grasps the Anterior Superior Iliac Spine (ASIS) and braces their hip into the sacrum.
The patient flexes again and range of motion is noted.
557
What is a Positive Belt's Test?
Pelvic Lesion: No pain when pelvis is stabilized
| Spine Lesion: Pain will be present with and without stabilization
558
How is Kemp's Test performed?
Patient seated/standing and supported by the doctor.
Doctor rotates the patient's trunk from the original position and circumducts the trunk towards the affected side and then away from the affected side.
559
What is a Positive Kemp's Test?
Sciatic Pain Down the involved side
560
What does a Positive Kemp's Test indicate?
Posteromedial Disc: Positive Kemp's away from pain
| Posterolateral Disc: Positive Kemp's into pain
561
How is Neri's Bowing Test performed?
When patient is bending forward at the waist the knee flexes on the side of involvement
562
What is a Positive Neri's Bowing Test?
Knee buckling
563
What does a Positive Neri's Bowing Test indicate? (Four Possibilities)
Tight Hamstrings
Lower Disc issue
Lumbosacral Issue
Sacroiliac Joint issue
564
How is Becterew's Test performed?
Patient seated. Patient attempts to extend each leg, one at a time. Doctor places one hand on the side being tested to resist hip flexion by the patient.
Patient then attempts to extend both legs together with both thighs stabilized by the doctor.
565
What is a Positive Becterew's Test?
Pain or Leaning Back
566
What does a Positive Becterew's Test indicate?
Disc
| Posteromedial disc if pain when good leg is raised
567
How is Minor's Sign performed?
Ask the patient to rise form a seated position
568
What is a Positive Minor's Sign?
Patient will support body with uninvolved side balancing on good side
569
What does a Positive Minor's Sign indicate?
Sciatica
570
```
What is the Positive findings for the following test:
Gaenslen's Test
Lewin-Gaenslen's Test
Iliac Compression Test
Hibb's Test
Yeoman's Test
```
Pain in the Sacroiliac (SI) Joint
571
```
What is the Indication for the following test:
Gaenslen's Test
Lewin-Gaenslen's Test
Iliac Compression Test
Hibb's Test
Yeoman's Test
```
Sacroiliac (SI) Lesion
572
What is the best test for the Sacroiliac (SI) joint?
Yeoman's Test
573
How is Yeoman's Test Performed?
Doctor stabilizes Sacroiliac (SI) joint testing with other hand. Doctor flexes the leg of the affected side and hyperextends the thigh by lifting knee off the table.
574
How is Gaenslen's Test Performed?
Patient is supine, involved side near the edge of the examining table. Opposite knee and thigh fully flexed and fixed against the abdomen of the patient.
The involved leg is gradually extended off the table by the doctor.
Doctor applies downward pressure against clasped knee and knee of the extended hip.
575
How is Lewin-Gaenslen's Test Performed?
Patient side lying on unaffected side and pulls lower knee to chest.
Doctor stands behind patient, stabilizes pelvis and hyperextends the top thigh
576
How is Iliac Compression Test Performed
Patient in side-lying position with involved side up.
Doctor hands are placed over the upper part of the iliac crest.
Doctor exerts downward pressure.
577
How is Hibb's Test Performed?
Doctor stabilizes pelvis on side they are standing. With other hand, doctor grasps the ankle of the opposite leg and flexes the knee to 90 degrees. The doctor slowly pushes the leg laterally away producing
**Internal rotation of the hip**
Sacroiliac (SI) Joint or Hip Pathology
578
How is Hip Abduction Stress Test Performed?
Patient is lying on non-effected side. Patient actively abducts the leg, the doctor the exerts downward pressure on the proximal knee.
579
What is a Positive Hip Abduction Stress Test?
Pain at the Posterior Superior Iliac Spine (PSIS)
580
What does a Positive Hip Abduction Stress Test indicate? (Two indications)
Sacroiliac (SI) joint problems
| Gluteus Medius Weakness
581
How is Nachlas Test Performed?
Patient's leg flexed to 90 degree. Heel is approximated to the same buttock. Doctor stabilizes the side they are testing
582
What is a Positive Nachlas Test?
Pain in the Sacroiliac (SI) Joint
583
What are two indications of Nachlas Test?
Sacroiliac (SI) joint lesion
| If pain in anterior thigh; Femoral Nerve Stretch
584
How is Patrick's FABERE Test Performed?
Patient supine. Thigh is Flexed, Abducted, Externally Rotated and Extended while downward press is placed on the opposite Anterior Superior Iliac Spine (ASIS) and same knee
585
What is a Positive Patrick FABERE Test?
Pain in the hip
586
What does a Positive Patrick FABERE Test indicate?
Hip Lesion
587
How is Laguerre's Test Performed?
**Patrick FABERE in the Air**
Patient supine. Thigh is Flexed, Abducted, Externally Rotated and Extended while downward press is placed on the opposite Anterior Superior Iliac Spine (ASIS) and same knee
588
What is a Positive Laguerre's Test?
Pain in the hip
589
What does a Positive Laguerre's Test indicate?
Hip Lesion
590
How is Thomas Test Performed?
Patient supine, thigh is flexed with the knee bent up to the abdomen.
591
What is a Positive Thomas Test?
Opposite knee/thigh rises off the table
592
What does a Positive Thomas Test Indicate?
Hip flexion contracture
593
How is Allis Test Performed?
Patient supine, both knees flexed to 90 degrees with feet placed flat on the table and both malleoli approximated.
Doctor compares the height of the knees
594
What is a Positive Allis Test?
Significant difference in knee height
595
What does a Positive Allis Test indicate?
On knee taller an one more forward=
Posterior displacement of the femoral heal
Short femur
If one leg is Taller= Tibial Problem
If one knee is Forward= Femur Problem
596
How is Ortolani's Test Performed?
Infant is supine. Leg are abducted and externally rotated
597
What is a Positive Ortolani's Test?
Palpable or Audible Click
598
What does a Positive Ortolani's Test indicate?
Congenital Hip Dysplasia
599
How is Barlow's Test Performed?
Infant supine, hip in Adduction, gentle posterior pressure on each hip, one at a time
600
What is a Positive Barlow's Test?
Deep sounding "Thunk" as the femoral head subluxates Out of the socket
601
What does a Positive Barlow's Test indicated?
Congenital Hip Dysplasia
602
How is Ober's Test Performed?
Patient is side lying, involved side up.
Doctor places on hand on the pelvis. Thigh is abducted and extended.
Doctor then allows the leg to drop into adduction
603
What is a Positive Ober's Test?
Knee stays elevated (Abducted)
604
What does a Positive Ober's Test indicate?
Tensor Fascia Lata (TFL) Contracture
605
How is Ely's SIGN Performed?
Patient Prone. The heel is approximated to the same buttock after flexion of the knee
* No Stabilization*
* *Sign-Same-pSoas**
606
What is a Positive for Ely's SIGN?
Pain
607
What does a Positive Ely's Sign indicate?
Rectus Femoris Contracture
| pSoas
608
How is Ely's TEST Performed?
Patient prone. The heel is approximated to the opposite buttock and hyperextended
609
What is a Positive Ely's TEST?
Pain
610
What does a Positive Ely's TEST indicate?
Hip Lesion
Illiopsoas irritation
Inflamed lumbar nerve roots
611
How is Trendelenburg's Test Performed?
Patient stands and raises one foot of the floor and then the other, while the doctor observes the buttock/pelvis
612
What is a Positive Trendelenburg's Test?
Buttock/Pelvis on the foot that is raised off the floor drops
Patient will have Low Back Pain (LBP)
613
What does a Positive Trendelenburg's test indicat3e?
Hip Abductors are week on stance (Grounded) led side
614
What Knee condition is described as "Swelling and pain immediately after and injury"?
Ligament Tear
615
How is a Meniscal Tear described?
Swelling occurs 12-24 hours after injury. Unable to lock out joint
616
What are two other names for Chondromalacia Patella?
Patellofemoral Tracking Disorder
| Runner's Knee
617
What muscle pulls the patella lateral in Runner's Knee?
Vastus Lateralis
618
What motion/action is most provocative in Patellofemoral Tracking Disorder?
Walking down stairs
619
What condition is caused by Chondromalacia Patella?
Retropatelar Degenerative Joint Disease
620
What two orthopedic test are performed to confirm Chondromalacia Patella?
Clark's
| Fouchet's
621
What knee condition is seen in athletes doing repetitive knee extensions?
Osgood Schlatter's
622
What bone is injured in Osgood Schlatter's Disease?
Avulsion fracture of the Tibial tuberosity
623
What are two things to know about Osteochondritis Dessicans? (Knee Condition)
```
Avascular Necrosis (AVN)
Knee Locks out of Extension
```
624
What orthopedic test is used to confirm Osteochondritis Dessicans?
Wilson's Sign
625
What is the name of the knee condition that is "Prepatellar bursitis after repetitive pressure on the knee"?
Housemaid's Knee
626
What is another name for Jumper's Knee?
Patellar Tendonitis
627
Where is the pain in Tensor Fascia Lata (TFL) Syndrome?
Lateral knee
628
What causes the pain in Tensor Fascia Lata (TFL) Syndrome?
A shortened Tensor Fascia Lata (TFL)
629
What population and movements make Tensor Fascia Lata (TFL) Syndrome worse?
Population: Runners
Movements: Walking or running up and down hill or stairs
630
What three orthopedic test are used to test/check the integrity of the collateral ligaments of the knee?
Abduction Stress Test (Valgus Stress Test)
Adduction Stress Test (Varus Stress Test)
Apley's Distraction Test
631
What is another name for Abduction Stress Test?
Valgus Stress Test
632
How is the Abduction Stress Test Performed?
Patient is supine. Doctor applies valgus stress to the knee while abducting the foot in full extension and at 30 degrees of flexion
633
What is a Positive Valgus Stress Test?
Increased Pain or Laxity
634
What does a Positive Abduction Stress Test indicate?
Medial Collateral Ligament Involvement
635
What is another name for Varus Stress Test?
Adduction Stress Test
636
How is the Adduction Stress Test Performed?
Patient is supine. Doctor applies Varus stress to the knee while adducting the foot in full extension and at 30 degrees flexion
637
What is a Positive Adduction Stress Test?
Increased Pain or Laxity
638
What does an Positive Adduction Stress Test indicate?
Lateral Collateral Ligament Involvement
639
How is Apley's Distraction Test Performed?
Patient is prone, knee flexed to 90 degrees. Doctor anchors the thigh of the patient and grasps proximal to the foot and applies upward pressure and rotates the leg internal and externally.
**Heel points to the side being tested**
640
What is a Positive Apley's Distraction Test?
Pain in the knee
641
What does a Positive Apley's Distraction Test indicate?
Collateral Ligament Tear
**Heel points to the side of torn ligament**
642
What four Orthopedic Test can be performed for the Cruciate Ligaments of the Knee?
Drawer Test
Slocum's Test
Lachman's Test
Posterior Sag Sign
643
How is Drawer Test Performed?
Patient is supine. Knee is flexed to 90 degrees and hip to 45 degrees. Doctor Stabilizes the foot on the table.
Tibia is then drawn forward and back
644
What is a Positive Drawer Test?
Pain or Joint Laxity
645
What does a Positive Drawer Test indicate?
Anterior (Pulling A-P) Anterior Cruciate Ligament (ACL) tear
Posterior (Pulling P-A) Posterior Cruciate Ligament (PCL) tear
646
How is Slocum's Test Performed?
**Rotary Instability**
Patient is Supine. Knee is flexed to 90 degrees foot is put into internal and external rotation.
Doctor stabilizes the foot and grasps the leg with thumbs palpating the knee joint.
Doctor pulls the tibia applying P-A stress in the knee
647
What is a Positive Slocum's Test?
Pain or Joint Laxity
648
What does a Positive Slocum's Test indicate?
External Rotation: Anterior Cruciate Ligament (ACL) AND Medial Cruciate Ligament (MCL)
Internal Rotation: Anterior Cruciate Ligament (ACL) AND Lateral Cruciate Ligament (LCL)
649
How is Lachman's Test Performed?
**Best test for the Anterior Cruciate Ligament (ACL)**
Patient supine. Knee is flexed to 30 degrees
Doctor stabilizes the femur with one hand and pulls the tibia forward with the other
650
What is a Positive Lachman's Test?
Soft End Feel
651
What does a Positive Lachman's Test indicate?
Anterior Cruciate Ligament (ACL) instability
652
How is Posterior Sag Sign Performed?
**Dashboard to Tibia in a motor vehicle accident**
Patient Supine. knees flexed to 90 degrees, hip flexed to 45 degrees
Doctor compares the prominence for the Tibial tuberosites
653
What is a Positive Posterior Sag Sign?
Tibial drops back (sags) on the femur
654
What does a Positive Posterior Sag Signe indicate?
Posterior Cruciate Ligament (PCL) tear
655
What three orthopedic test can be performed to test the Meniscus of the knee?
MuMurray Sign
Apley's Compression Test
Bounce Home Test
656
What is the best orthopedic exam for the Meniscus of the knee?
McMurray Sign
657
What is lacking to the Meniscus of the knee?
Nerve Supply
658
If a patient has a meniscus issue how long will it be after an injury until you see swelling?
12-24 hours
659
How is MuMurray Sign Performed?
Patient supine. Doctor flexes the thing and leg to 90 degrees.
Doctor places one hand on the knee, grasps the patient's heel.
Doctor Externally rotates the leg, and then slowly extends the knee.
Doctor then internally rotates the leg and brings it into extension with a valgus stress to the joint
660
What is a Positive MuMurray Sign?
Painful click or snap heard
661
What does a Positive MuMurray Sign indicate?
Lateral Meniscus: Internal Rotation
Medial Meniscus: External Rotation
662
How is Apley's Compression Test Performed?
Patient Prone with knee flexed to 90 degrees
Doctor anchors the thigh of the patient and grasp proximal to the foot and applies downward pressure and rotates the leg internally and externally.
*Heel Points to the side being tested*
663
What is a Positive Apley's Compression Test?
Pain in the knee
664
What does a Positive Apley's Compression Test indicate?
Lateral Meniscus: External Rotation
Medial Meniscus: Internal Rotation
**Heel Points to side of Pathology**
665
How is Bounce Home Test Performed?
Patient is supine, knee is flexed completely
| Knee is dropped into extension
666
What is a Positive Bounce Home Test?
Incomplete Extension
667
What does a Positive Bounce Home Test indicate?
Meniscus Tear
| 12-24 hours before you will see swelling
668
What two orthopedic tests can be to check the Patella?
Apprehension Test of the Patella
| Clarke's Sign AKA Patellar Grinding Test
669
What is another name for Clarke's Sign?
Patellar Grinding Test
670
How is Apprehension Test of the Patella Performed?
Patient supine.
| Doctor displaces patella medial to lateral
671
What is a Positive Apprehension Test of the Patella?
Patella will feel dislocated and the quadriceps contracts
| Look at face for alarm/apprehension
672
What does a Positive Apprehension Test of the Patella indicate?
Chronic Patellar Dislocation
673
How is Clarke's Sign Performed?
Patient supine, with knee extended
Doctor applies superior to inferior pressure on the superior pole of the patella and ask the patient to contract the quadriceps
674
What is a Positive of Clarke's Sign?
Retropatellar Pain
| Inability to sustain a contraction of the quadriceps
675
What does a Positive Clarke's Sign indicate?
Chondromalacia Patella
676
What are three additional orthopedic exams that can be done on the knee?
Wilson's Test
Dreyer's Test
Noble Compression Test
677
How is Wilson's Test Performed?
Patient is seated and actively extends and flexes knee with tibia internally rotated.
When 30 degrees is reached the pain increases and is relieved by external rotation of the tibia
678
What is a Positive Wilson's Test?
Decrease in Pain
| This test has been seen on Boards lately
679
What does a Positive Wilson's Test indicate?
Osteochondritis Dessicans (Avascular Necrosis)
680
How is Dreyer's Test Performed?
Patient supine. Asked to raise their extended leg, unable to do so.
Doctor applies pressure to the quadriceps muscle and patient can lift their leg
681
What is a Positive Dreyer's Test?
Patient can only lift their leg with pressure is applied to the quadriceps muscle
(This test has been seen on Boards lately)
682
What does a Positive Dreyer's Test indicate?
Fractured Patella
683
How is Noble Compression Test Performed?
Patient supine. Hip and knee are both flexed at 90 degrees
| Doctor applies pressure to the lateral femoral condyle while extending the knee
684
What is a Positive Noble Compression Test?
Pain over the area of Pressure
685
What does a Positive Noble Compression Test indicate?
Tensor Fascia Lata (TFL) Syndrome
AKA
Illiotibial Band Syndrome
686
What are three abnormalities of the foot?
Pes Planus
Talipes Equinovarus
Pes Cavus
687
What condition is commonly called "Flat Feet" and have the heads of the tarsals displaced medially and downward (Plantarward)?
Pes Planus
688
What are the two treatments for Pes Planus?
Exercise foot muscles, pull a towel in with toes
| Orthotics
689
What is another name for Club Foot?
Talipes Equinovarus
690
How is Talipes Equinovarus described?
Most common birth defect, heel is elevated and foot is turned inward
691
What is the condition of very high arches and toes are in flexion?
Pes Cavus
692
What is a treatment of Pes Cavus?
Orthotics
693
What is a patient with Pes Cavus prone to?
March/Stress Fracture
694
What is the name of the nerve tumor most commonly between the 3rd and 4th metatarsal head?
Morton's Neuroma
695
What is another name for a Metatarsal Stress Fracture?
March Fracture
696
What is the name of the condition that is often seen with pain in the morning and brought on by a heel spur?
Plantar Fasciitis
697
In the condition of Plantar Fasciitis when does the pain decrease?
Throughout the day
698
What is one possible treatment of Plantar Fasciitis?
Deep tissue massage
699
What is the name of the condition that has a burning pain on the sole of the foot (Medial Plantar Nerve)?
Tarsal Tunnel Syndrome
700
What two orthopedic test that can be used to check for Achilles Tendon Rupture?
Thompson's Test AKA Simmond's Test/Trauma
701
What is the most common sprain/strain of the ankle?
Inversion
702
What grade of Sprain/Strain has "No ligaments torn, but may have slight swelling or decreased range of motion"?
Grade 1
703
What is the treatment for a Grade 1 sprain/strain?
```
PRICE
Protect
Rest
Ice
Compress
Elevate
```
704
How is a Grade 2 Sprain/Strain described? (Three characteristics)
Incomplete or partial Rupture
Lots of swelling and bruising
Almost no range of motion (immobilize 2-3 weeks)
705
What are the characteristics of a Grade 3 sprain/strain?
Complete Tear
Surgical Case
Refer to and Orthopedist
706
How is the Anterior Front Drawer Test Performed?
Patient Supine. Doctor places hand around anterior aspect of the lower tibia while grasping calcaneus in the palm of the other hand and then pulls calcaneus forward.
707
What is a Positive Anterior Foot Drawer Test?
Talus slides forward
708
What does a Positive Anterior Foot Drawer Test indicate?
Anterior Talofibular Ligament Instability
Calcanofibular Ligament
Posterior Talofibular Ligament
709
How is the Medial and Lateral Stability Test Performed?
Patient is seated or supine.
| Doctor grasps the patient's foot and passively inverts and everts the foot.
710
What is a Positive Medial and/or Lateral Stability Test?
Excessive gapping on either side
711
What does a Positive Medial and/or Lateral Stability Test indicate?
During Inversion- Anterior Talofibular or Calcaneofibular ligament tear
During Eversion- Deltoid Ligament Tear
712
What is another name for Thompson's Test?
Simmond's Test
713
How is Thompson's Test performed?
Patient Prone; feet hanging off the table
| Doctor flexes knee to 90 degrees and squeezes the calf
714
What is a Positive Thompson's Test?
No Plantar flexion of foot
715
What does a Positive Thompson's Test indicate?
Achilles' tendon Rupture
716
What are the five Malingering test?
```
Burn's Bench Test
Hoover's Sign
Lasegue's Sitting Test
Magnusson's Test
Mannnkopf's Sign
```
717
How is Burn's Bench Test Performed?
Patient is instructed to kneel on a table 18 inches off the floor, bend forward at the trunk and touch the floor.
Doctor holds the ankle
718
What is a Positive Burn's Bench Test?
Patient refuses to preform test
719
How is Hoover's Sign Performed?
Patient supine
| Doctor places one hand under each heel and ask patient to lift affected limb
720
What is a Positive Burn's Bench Test?
Doctor does not fell the unaffected side pressing downward
721
How is Lasegue's Sitting Test Performed?
Patient is seated upright on the edge of the table/chair (with no back rest)
Doctor faces the patient and usually under the guise of "Checking circulation" extends the patient's legs below the knee, one at a time, so the limb is parallel with the floor
722
What is a Positive Lasegue's Test?
No pain when there had been a Positive Straight Leg Raiser (SLR)
723
How is Magnusson's Test Performed?
At the beginning of the Case History, patient is asked to point to the site of pain
Doctor marks it with a skin marking pencil/documents on paperwork
Doctor later ask patient to point to site of pain
724
What is a Positive Magnusson's Test?
Patient does not point to the originally spot of pain
725
How is Mannkopf's Sign Performed?
Doctor takes a resting pulse rate
| Doctor then applies pressure over the painful area and takes pulse rate again
726
What is a Positive Mannkopf's Sign?
An increase in pulse rate of 10 beats per minute
727
What does a Positive Mannkopf's Sign indicate?
Not a Malinger (Pulse Rate does not change)
728
What are four orthopedic exams that can be used to diagnosis Ankylosing Spondylitis?
Chest Expansion Test
Forresiter's Bowstring Sign
Lewis Supine Test
Amoss Sign
729
How is Chest Expansion Test Performed?
A tape measure placed around the 4th intercostal space.
Patient exhales completely, measurement is taken
Patient inhales completely, measurement is taken
**Normal 1.5-3 inches difference**
730
What is a Positive Chest Expansion Test? (Both Genders)
Women: Less than a 1.5 inch difference
Men: Less than a 2 inch difference
731
How is Forrestier's Bowstring Sign Performed?
Patient standing, have them bend to each side
732
What is a Positive Forrestier's Bowstring Test?
Muscle tightness on the ConCave side
733
How is Lewin Supine Test Performed?
Patient Supine
| Doctor supports the legs on the table. Patient in then asked to do a sit-up with out using their hands
734
What is a Positive Lewin Supine Test?
Unable to perform a Sit-up without the use of their hands
735
How is Amoss Sign Performed?
Patient is asked to go from a side-lying to a seated position
736
What is a Positive Amoss Sign?
Localized thoracolumbar pain
| Lack of Range of Motion
737
What are three things a Positive Amoss Sign Indicate?
Ankylosing Spondylitis
Intervertebral Disc Syndrome
Severe Sprain/Strain
738
What condition are all indicated by:
Chest Expansion Test
Forrestier's Bowstring Test
Lewin Supine Test
Amoss Sign
739
Is it possible to diagnosis Ankylosing Spondylitis on x-Ray?
Yes
740
In a patient with Meningeal Irritation what are four symptoms will they present with?
Fever
Headache
Photophobia
Nuchal Rigidity
741
In a patient with Meningeal Irritation, when evaluating the Cerebrospinal Fluid (CSF) what macronutrient will be seen in each type and will it be increased or decreased?
Viral: Increase in Proteins (Lymphocytes)
Bacterial: Decrease in Glucose
742
What two orthopedic exam Indicate Meningeal Irritation?
Brudzinski Sign
| Kernig's Sign
743
How is Brudzinski Sign Performed?
Patient supine
| Doctor passively flexes the patient's head approximating chin to chest
744
What is a Positive Brudzinski Sign?
Buckling of the patient's knee
745
How is Kernig's Sign Performed?
Patient Supine
| Doctor flexes the hip and knee to a 90/90 position and then attempts to extend the knee
746
What is a Positive Kernig's Sign?
Patient resists extension
| Resistance causes a Kicking motion
747
How is Gower's Sign Performed?
When patient is arising from a supine position, patient turns prone and then climbs up themselves
748
What does a Positive Gower's Sign indicate?
Muscular Dystrophy
749
How is Lhermitte's Sign Performed?
Patient seated or supine
| Patient actively and passively flexes chin to chest
750
What is a Positive Lhermitte's Sign?
Sharp electric shock like sensation don the the spine into the extremities
751
What three conditions does a Positive Lhermitte's Sign indicate?
Multiple Sclerosis**
Myelopathy
Demyelination cord lesions
752
How is Libman's Test Performed?
Doctor places thumbs on mastoid process, applies pressure until patient expresses discomfort
753
What is Libman's Test used for?
Pain threshold of a Patient
| Can also be used for a malingering test
754
How is Rust Sign performed?
Patient spontaneously grasp the head/neck with both hands when rising from a lying position
755
What are three indications of a Positive Rust Sign?
Cervical instability due to a sprain/strain
Fracture
Rheumatoid Arthritis (RA)
756
How is Schepelmann's Sign Performed?
Patient raises both arms over head while seated and laterally bends to each side
757
What does a Positive Schepelmann's Sign indicate?
Concave Side pain: Intercostal Neuralgia
Convex Side pain: Pleurisy or Myofascitis
758
How is Dejerine's Triad Performed?
Patient has pain brought on by coughing, sneezing or bearing down
759
What does a Positive Dejerine's Triad indicate?
Space Occupying Lesion (SOL)
760
How is Hofman's Sign Performed?
Patient Supine
Hip and knee flexed to 90 degrees
Doctor squeezes and dorsiflexes the foot simultaneously
761
What is a Positive Homan's Sign?
Deep Calf Pain
762
What does a Positive Homan's Sign indicate?
Deep Vein Thrombosis (DVT)
763
How is O'Donohue's Test Performed?
```
Patient actively moves any joint against resistance (Muscle being tested) and then
Doctor passively (Ligament being tested) move the joint through full range of motion (ROM)
```
764
What is a Positive O'Donohue's Test?
Pain in the joint/area being tested
765
What does a Positive O'Donohue's Test indicate?
Pain at Passive Range of Motion (ROM): Sprain (Ligament)
Pain at Active Range of Motion (ROM): Strain (Muscle)
766
What rating on the Wexler Scale (Deep Tendon Reflexes) indicate a Lower Motor Neuron Lesion (LMNL)?
0+
| 1+
767
What function does a Afferent Nerve have?
Sensory
768
What is the function of a Efferent Nerve?
Motor
769
What nerve has Worse pain at night?
Median Nerve
770
What nerve innervates the lateral forearm and hand?
Median Nerve
771
What nerve innervates the medial forearm and hand?
Ulnar Nerve
772
What nerve innervates the posterior arm and hand?
Radial Nerve
773
What are four things that can cause Scleratogenous Pain?
Facet
Sacroiliac (SI) joint
Scapular--Thoracic articulation
Tempromandibular Joint (TMJ)
774
What condition will be seen in a patient who was baking cookies and burned their skin on a hot pan but did not realize it until they smelled burning skin/flesh?
Syringomyelia
775
In what condition is it a contraindication of any heating modalities (i.e. Paraffin Baths)
Multiple Sclerosis
776
What area of the brain is effected with a Lateral Nystagmus?
Cerebellum
777
What area of the brain is effected if the patient has a Vertical Nystagmus?
Brain Stem
778
What is the name of the test performed on patients with Myasthenia Gravis that has a decreased response overtime due to Acetylcholine receptors?
Holly-Jolly EMG
779
In the condition of Brown Sequard, what side will have Motor and Sensory loss?
Motor Loss: Ipsilateral Side of lesion
| Sensory Loss: Contralateral Side of lesion
780
What "Type" of writing will you see in a patient with Parkinson's Disease?
Very small (Microgaphy), trying to hide they resting tremor in their hand
781
What is another name for Gillian-Barre Syndrome?
Laundry's Paralysis
782
What condition is seen in a patient who goes to the bathroom at night without turning on the lights?
Tabes Dorsalis
| Decreased light is very similar to closing the eyes, Posterior Columns problem
783
What condition will have difficulty walking upstairs?
Muscular Dystrophy
784
What is the name of the condition that has chronic wide spread pain?
Fibromyalgia
785
How is Fibromyalgia confirmed?
Pain at 11 of 18 tender points
786
What four symptoms are associated with Fibromyalgia?
Fatigue
Sleep disturbances
Joint Stiffness
Depression
787
What are five things that can cause a Space Occupying Lesion(SOL)?
```
Disc
Intervertebral Foramen (IVF) encroachment
Tumor
Inflammation
Subluxation
```
788
What type of lesion is a Space Occupying Lesion (SOL), said to be?
Lower Motor Neuron Lesion (LMNL)
789
If a patient has pain on Ulnar deviation what is being affected?
Triangular Fibrocartilage Complex
790
What orthopedic exam is paired with Nobel's Compression Test?
Ober's Test`
791
Cruciate Ligaments are name for what?
Where they attach to the tibia (Cross your fingers)
792
What is the most injured muscle of the Quadriceps?
Vastus Medialis
793
What knee ligament is the most injured ligament?
Anterior Cruciate Ligament
794
What meniscus is the most injured?
Medial Meniscus
795
What action causes and Unhappy Triad?
A blow to the lateral side of the knee, then planted into the ground
796
What three Structures are injured in an Unhappy Triad?
Medial Collateral Ligament
Anterior Cruciate Ligament
Medial Meniscus
797
What two findings of the knee will be present if there is a Meniscus tear?
Walking and the knee gives way
| Knee locks out (Bucket handle)
798
What two grading of Sprain/Strain can be seen by a Chiropractor?
Grade 1
| Grade 2
799
Achilles tendon rupture is most commonly seen in patients who use what?
Corticosteroids
