Neuromusculoskeletal (NMS) Diagnosis (Irene Gold) Part II and III Flashcards
What is the clinically word for loss of smell?
Anosmia
What is the term for a distorted sense of smell?
Parosmia
How is the optic nerve tested for Visual acuity?
Snellen Eye Chart
What two cranial nerves are tested with the Direct Light Reflex?
CN II (2) and III (3)
What three things happen to the eyes during the Accommodation test?
Eyes Converge
Pupils Constrict
Lens Convex
What are the two muscles of the eye that have Parasympathetic control?
Ciliary muscles (lens shape) Constrictor Papillae
What is the clinically term for deviation of one or both eyes?
Strabismus
What is the cause for a patient to have ptosis; drooping of an eyelid?
Weakness or paralysis of the Levator Palpebrae
Jaw Jerk reflex test what Cranial nerve?
CNV (5), both sensory and motor
What two directions does the Superior oblique muscle move the eye?
Down and In
How is the sensory component of Cranial nerve V tested?
Touch with cotton wisp:
Forehead
Cheekbone
Chin
What two cranial nerves are tested with the Corneal Reflex?
CN V (5) Afferent CN VII (7) Efferent
What is a normal finding of the Corneal Reflex?
Both eyes blinking
Tearing of the eyes
What is the name of the test, when the mandible is lightly tapped with a reflex hammer?
Jaw jerk reflex
What is a positive finding of the Jaw Jerk reflex?
Jaw draws upwards
What two Cranial nerves are tested during the Oculocardiac reflex?
CN V (5) Afferent CN X (10) Efferent
What is the normal finding of the Oculocardiac reflex?
A decrease in heart rate when pressure is applied to the eye
What part of the tongue is motor and given general sensation by Cranial nerve V?
Anterior 2/3
What three things does the Anterior 2/3 of the tongue determine?
Hot
Cold
Pain
What three muscle of mastication help to close the jaw, and are innervated by cranial nerve V?
Temporalis
Internal Pterygoid
Masseter
(TIM)
What muscle innervated by cranial nerve V, opens the jaw?
External Pterygoid
What is another name for Trigeminal Neuralgia?
Tic Douloureaux
Can lead to Cranial Nerve V Palsy
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.
Trigeminal Neuralgia
What cranial nerve is anterior 2/3 of the tongue for tastes such as Sweet, Sour, Salty?
CNVII (7) Facial
What cranial nerve indicates the bitter taste?
CN IX (9)
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
What are two treatments for Bell’s Palsy?
Eye Patch
Artificial tears
Is Bell’s Palsy an Upper or Lower Motor Neuron Lesion?
What Cranial nerve is effected?
LMNL CN VII (7) Facial
What are two findings that distinguish Bell’s Palsy from a Stroke?
Ipsilateral Motor loss of entire face
Forehead does not wrinkle
How are you able to tell a Stroke from Bell’s Palsy?
Contralateral motor loss below the eye
Able to wrinkle the forehead
What Cranial Nerve and type of Lesion is a Stroke?
CN VII (7) Facial UMNL
What reflex will be decreased in a person with a stroke?
Corneal Reflex
Of the two conditions; Bell’s Palsy and Stroke, which one will not have control of their saliva?
Stroke
What is the care plan for a patient with a stroke?
Co-Care with a Neurologist and adjust
What three exams can you perform to see if a patient has a Vestibular/Balance issue?
Mittelemeyer
Romberg’s
Barany Caloric Test
What three test can be done to see if a patient has a Cochlear/Hearing problem?
Weber/Rinne
Whisper
Auditory Acuity/Watch Test
What are two other names for Meniere’s Disease?
Central Vertigo
Endolymphatic Hydrops
What are three symptoms of Endolymphatic Hydrops?
Episodic rotational vertigo
Hearing Loss
Tinnitus (Ringing in the ears)
What two cranial nerves are tested in the Gag/Pharyngeal, Uvula, Carotid Reflexes?
CN IX (9) Afferent ) CNX (10) Efferent
By massaging what artery in the neck can you make the heart rate drop?
Carotids
What muscle elevates the pharynx and larynx; also dilates the pharynx to allow for swallowing?
Stylopharyngeus
What cranial nerve is responsible for allowing us to speak (Phonation)?
CN X (10) Vagus
What muscles are sensory or Cranial Nerve X?
Epiglottis
Laryngeal muscles; swallowing (Palate, Pharynx)
What three reflex are motor of the Vagus (C.N. X)?
Gag
Carotid
Uvular
What side will the Palate and Uvula deviate if there is a lesion?
Opposite side
Towards the strong side
What two muscles are innervated by Cranial Nerve XI (Spinal Accessory Nerve)?
Trapezius
SCM
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
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
When testing reflexes, what are two guidelines to follow?
Perform Bilaterally
Test the normal (unaffected) side first
What is Westphal’s Sign?
An absence of any of the Deep Tendon Reflexes (DTR)
In what reflex is a Westphal’s sign most often seen?
Patellar Reflex (LMNL)
What is the name that produces more of a reflex by cortical distraction?
Jendrassik’s Maneuver AKA Reinforcement Test
What is the score on the Wexler Scale (DTR) for “Absent with Reinforcement”?
0+
When would a 1+ be seen on the Wexler Scale (DTR)?
Hypoactive with no reinforcement or Normal with reinforcement
What is a normal score on the Wexler Scale (DTR)?
2+
What type of lesion will you see a 3+,4+ and 5+ on the Wexler Scale (DTR)?
UMNL
What would indicate a 5+ on the Wexler Scale (DTR)?
Hyperactivity with sustained clonus
What is the score given on the Wexler Scale (DTR) for Hyperactivity with transient clonus?
4+
When is a 3+ score given on the Wexler Scale (DTR)?
Hyperactivity
What Nerve and Nerve Root are tested in the Jaw Jerk Reflex?
N-Trigeminal
NR- CN V (5) Both sensory and motor
In the Biceps Reflex what Nerve and Nerve Root are tested?
N-Musculoculocutaneous
NR- C5
When testing the Brachioradialis Reflex what Nerve and Nerve Root are tested?
Nerve- Radial
Nerve Root-C6
When testing the Triceps Reflex what Nerve and Nerve Root are tested?
Nerve- Radial
Nerve Root-C7
When testing the Patellar AKA Knee Jerk Reflex what Nerve and Nerve Root are tested?
Nerve-Femoral
Nerve Root-L4
When testing the Medial Hamstring Reflex what Nerve and Nerve Root are tested?
Nerve-Sciatic
Nerve Root-L5
When testing the Achilles AKA Ankle Jerk Reflex what Nerve and Nerve Root are tested?
Nerve-Tibial
Nerve Root-S1
What is the name of the superficial reflex that has the doctor stroke the inner thigh and the testicle raises ipsilateally?
Cremasteric Reflex (L1)
What are the Afferent and Efferent nerves when the Cremasteric and Geigel Reflexes is done?
Afferent- Femoral Nerve
Efferent- Genitofemoral Nerve
How is the Plantar Reflex performed?
Stoke up on the sole of the foot, from heal to toe
What is a positive finding of a Plantar Reflex?
Curing of the toes
Pulling away of the foot
What in the name of Afferent and Efferent nerve stimulated when the Plantar reflex is done?
Tibial for both
What is a normal finding for the Abdominal Reflex?
Umbilicus moves towards the side being stroked
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
How is the Beevor’s Reflex test performed:
Patient does a partial sit-up and the doctor observes the umbilicus
What is a normal finding for the Beevor’s Reflex?
Umbilicus will stay midline
What is another name for an Upper Motor Neuron Lesion (UMNL)?
Myelopathy
Which type of Lesion includes the Brain and Spinal cord, but not the Anterior Horn Cells?
UMNL
What area must be effected for a Lower Motor Neuron Lesion (LMNL) to be present?
Anterior Horn Cells out to the Myoneural junction
What type of paralysis is seen in an Upper Motor Neuron Lesion (UMNL)?
Spastic
What type of Deep Tendon Reflexes (DTR) are seen in a patient with an Upper Motor Neuron Lesion (UMNL)?
Hyperactive
Are Pathological Reflexes Absent or Present in an Upper Motor Neuron Lesion (UMNL)?
Present; Babinski
In what type of lesion will you see Clonus present?
UMNL
What are four characteristics of an Upper Motor Neuron Lesion that will be Absent?
Superficial Reflexes
Reaction of degeneration
Atrophy
Fasciculations
When is Flaccid paralysis seen?
LMNL
What kind of Deep Tendon Reflexes (DTR) will be seen in a Lower Motor Neuron Lesion (LMNL)?
Hypoactive/Absent
In a Lower Motor Neuron Lesion (LMNL) what finding will you see in the following characteristics:
Pathological Reflexes
Clonus
Superficial Reflexes
Absent
What three characteristics of a Lower Motor Neuron Lesion (LMNL) will be Present?
Reaction of Degeneration
Atrophy
Fasciculations
What three Visceral Organ Reflexes will be absent in both Upper Motor (UMNL) and Lower Motor Neuron Lesions (LMNL)?
Ciliospinal
Oculocardiac
Carotid Sinus
How is the Ciliospinal Reflex performed?
Pinch the neck, noting the dilation of the eyes
What reflex is done by pressing on the eye and decreasing the heart rate by 10 beats per minute?
Oculocardiac
By pressing on the Carotid artery what two things will decrease/slow?
Slow the heart rate
Decease the pressure
What pathological reflex is performed by stroking the lateral aspect of the foot up to the great toe?
Babinski
What is a positive finding of the Babinski reflex?
Dorsiflexion of the great toe with splaying of the other toes
What four other pathological reflexes all have the small positive findings as the Babinski reflex?
Chaddock
Oppenheim
Gordon’s Calf
Schaefer
What pathological reflex is performed by stroking the lateral malleolus to the fifth toe?
Chaddock
How is Oppenheim’s pathological reflex performed?
Stroke down the Tibial crest to the ankle
What is the name of the pathological reflex that is being performed when the calf is squeezed below the knee?
Gordon’s Calf
How is Schaefer’s pathological reflex test done?
Squeeze the Achilles tendon
What pathological reflex is tested by tapping on the ball of the foot/tip of the toes?
Rossolimo
What is a positive response to Rossolimo’s reflex?
Plantar flexion of the great toe with curing of the other toes
How is Hoffman’s pathological reflex performed?
Doctor extends middle phalanx and flicks distal phalanx inferior (Two F’s in Hoffman’s= Forceful FIick)
What is a positive response to Hoffman’s reflex?
Flexion and adduction of the thumb and flexion of the fingers
What other pathological reflex has the same positive response as Hoffman’s?
Tromner’s
How is Tromner’s pathological reflex performed?
Doctor sharply taps the tips of the middle three fingers (T in Tromner’s= Tap)
What pathological reflex is being described:
“Doctor strokes the pisiform of the patient”?
Gordon’s Finger
What is a positive finding to the Gordon’s Finger reflex?
Flexion of the wrist and fingers or thumb and index finger
How is Chaddock’s Wrist pathological reflex performed?
Doctor strokes the distal ulnar side of the forearm near the wrist
What is a positive finding to the Chaddock’s Wrist reflex?
Flexion of the wrist with extension and fanning of the fingers
What is a Normal (5) muscle grade?
Complete range of motion against gravity with full resistance
What muscle grade is given if there is “Complete range of motion against gravity with some resistance”?
Good (4)
What is the definition of a Fair (3) muscle grade?
Complete range of motion against gravity
When is a muscle grade of Poor (2) given?
Complete range of motion with gravity eliminated
What muscle grade is given when there is “evidence of slight contractility with no joint movement”?
Trace (1)
What is the muscle grade given when there is “No evidence of contractility”?
Zero (0)
What are the two motor/body activity carried out by the C5 nerve root?
Arm Abduction
Forearm Flexion
What two muscles are innervated by the C5 nerve root?
Biceps Brachii (Deep Tendon Reflex for C5)
Middle Deltoid
Where is the dermatome/sensory level of C5 nerve root?
Lateral arm
What disorder is seen in both the C5 and C6 nerve roots?
Erb’s Palsy (Waiter Tip)
C6= Wrist Drop
What are the motor/body activity carried out by the C6 nerve root?
Wrist extension (C6= Motor Cycle Chicks)
What are the two motor/body activity carried out by the C7 nerve root?
Wrist Flexion
Finger Extension
What are the motor/body activity carried out by the C8 nerve root?
Finger flexion
C8 “Grap All 8
What are the two motor/body activity carried out by the T1 nerve root?
Finger Abduction
Finger Adduction
What are the motor/body activity carried out by the T5-T12 nerve roots?
Trunk Flexion
What are the motor/body activity carried out by the L1-L3 nerve roots?
Hip flexion
What are the three motor/body activity carried out by the L2-L4 nerve roots?
Hip flexion
Hip adduction
Knee extension
What are the two motor/body activity carried out by the L4 nerve root?
Inversion
Dorsiflexion
What are the three motor/body activity carried out by the L5 nerve root?
Toe extension
Heel walk
Hip abduction
What are the three motor/body activity carried out by the S1 nerve root?
Eversion
Plantar Flexion
Hip Extension
What are the motor/body activity carried out by the S2-S4 nerve roots?
Anal Wink
What three muscles are innervated by the C6 nerve root?
Extensor Carpi Ulnaris
Extensor Carpi Radialis
Brachialis (DTR C6)
What three muscles are innervated by the C7 nerve root?
Flexor Carpi Ulnaris
Flexor Carpi Radialis
Triceps (DTR C7)
What three muscles are innervated by the C8 nerve root?
Flexor Digitorum Superficialis
Flexor Digitorum Profundus
Lumbricals
What two muscles are innervated by the T1 nerve root?
Dorsal Interossei
Palmer Interossei
What muscle is innervated by the T5-T12 nerve roots?
Rectus Abdominus
What muscle is innervated by the L1-L3 nerve roots?
Illiopsoas
What two muscles are innervated by the L2-L4 nerve roots?
Quadriceps
Adductors
What muscle is innervated by the L4 nerve root?
Tibialis Anterior
What four muscles are innervated by the L5 nerve root?
Extensor Digitorum
Extensor Hallucis Longus
Gluteus Medius
Gluteus Minimums
What three muscles are innervated by the S1 nerve root?
Peroneus Longus
Peroneus Brevis
Gluteus Maximus
What two muscles are innervated by the S2-S4 nerve roots?
Levator Ani
Coccygeus
Where is the dermatome/sensory level of C6 nerve root?
Lateral forearm
Digits 1 and 2
Where is the dermatome/sensory level of C7 nerve root?
3rd digit, middle finger
Where is the dermatome/sensory level of C8 nerve root?
Medial Forearm
Digits 4 and 5
Where is the dermatome/sensory level of T1 nerve root?
Medial Elbow
Where is the dermatome/sensory level of T5-T12 nerve root?
Respective vertebral level
Where is the dermatome/sensory level of L1-L3 nerve roots?
L1- Inguinal Ligament
L2- Oblique below L1
L3- Oblique across the knee
Where is the dermatome/sensory level of L4 nerve root?
Medial aspect of leg and foot
Where is the dermatome/sensory level of L5 nerve root?
Lateral aspect of the leg across the dorsum of the foot and big toe
Where is the dermatome/sensory level of S1 nerve root?
Lateral aspect of foot and plantar surface of foot
Where is the dermatome/sensory level of S2-S4 nerve roots?
Perianal
What disorder is seen in both the L4 and L5 nerve roots?
Foot Drop
What disorder is seen in C7 nerve root?
Klumpke’s Paralysis (LMNL)
Radial Nerve
What disorder is seen in C8-T1 nerve roots?
Klumpke’s Paralysis (LMNL)
Radial Nerve
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
What disorder is seen in S2-S4 nerve roots?
Cauda Equina
What is the motor/body action carried out by the Axillary Nerve?
Arm Abduction
What is the motor/body action carried out by the Musculocutaneous Nerve?
Elbow Flexion
What is the motor/body action carried out by the Medial Plantar Nerve?
Toe Extension
What is the motor/body action carried out by the Sciatic Nerve?
Flexion of the knee
What is the motor/body action carried out by the Obturator Nerve?
Hip Adduction
What are three motor/body actions carried out by the Radial Nerve?
Wrist extension
Finger extension
Thumb Abduction
What are the two motor/body actions carried out by the Media Nerve?
Thumb pinch
Opposition of the thumb
What are the two motor/body actions carried out by the Ulnar Nerve?
Abduction of the 5th Digit
Adduction of the thumb
What are the two motor/body actions carried out by the Dorsal Scapular Nerve?
Elevation of the Scapula
Retraction of the Scapula
What is the motor/body action carried out by the Long Thoracic Nerve?
Protraction of the Scapula
What are the two motor/body actions carried out by the Femoral Nerve?
Hip Flexion
Knee Extension
What are three motor/body actions carried out by the Peroneal Nerve?
Foot Dorsiflexion
Inversion
Eversion
What two muscles are innervated by the Axillary Nerve?
Deltoid
Teres Minor
What three muscles are innervated by the Radial Nerve?
Wrist Extensors
Finger Extensors
Triceps
What three muscles are innervated by the Musculocutaneous Nerve?
Biceps
Brachialis
Coracobrachilis
What four muscles are innervated by the Median Nerve?
Wrist Flexors
Thumb Flexors
Thumb Abductors
Thenar
What three muscles are innervated by the Ulnar Nerve?
Finger Abductors
Finger Adductors
Thumb Adductors
What two muscles are innervated by the Dorsal Scapular Nerve?
Rhomboids
Levator Scapula
What muscle is innervated by the Long Thoracic Nerve?
Serratus Anterior
What muscles are innervated by the Obturator Nerve?
Hip Adductor muscles
What two muscles are innervated by the Femoral Nerve?
Illiopsoas
Quadriceps
What muscle is innervated by the Sciatic Nerve?
Hamstrings
What three muscles are innervated by the Peroneal Nerve?
Tibialis Anterior
Toe Extensors
Peroneals
What muscles are innervated by the Medical Plantar Nerve?
Toe Flexor Muscles
What is the dermatome/sensory pattern of the Axillary Nerve?
Lateral Arm
What is the dermatome/sensory pattern of the Radial Nerve?
Dorsal web between thumb and index finger
What is the dermatome/sensory pattern of the Musculocutaneous Nerve?
Lateral Forearm
What is the dermatome/sensory pattern of the Median Nerve?
Distal Radial hand
2nd digit
What is the dermatome/sensory pattern of the Ulnar Nerve?
Distal Ulnar Hand
5th Digit
What is the dermatome/sensory pattern of the Lateral Femoral Cutaneous Nerve?
Lateral Thigh
What is the dermatome/sensory pattern of the Saphenous Nerve?
Medial Leg
Anteromedial Knee
What is the dermatome/sensory pattern of the Obturator Nerve?
Medial Thigh
What is the dermatome/sensory pattern of the Femoral Nerve?
Anteromedial Thigh
Anteromedial Leg
What is the dermatome/sensory pattern of the Sciatic Nerve?
Anterior Leg
Posterior Leg
Sole of the foot
Dorsum of the foot
What is the dermatome/sensory pattern of the Peroneal Nerve?
Anterior Leg
Dorsum of the foot
What disorder is seen with Axillary Nerve involvement?
Glenohumeral Dislocation
What three disorders is seen with Radial Nerve involvement?
Wrist Drop
Crutch Palsy
Erb’s Palsy
What three Nerves have an Impingement disorders when they are involved?
Musculocutaneous
Obturator
Femoral
What three disorders is seen with Median Nerve involvement?
Carpel Tunnel
Ape Hand
Pronator Teres
What disorder is seen with Ulnar Nerve involvement?
Claw Hand
What disorder is seen with Dorsal Scapular Nerve involvement?
Flaring of the Scapula
What disorder is seen with Long Thoracic Nerve involvement?
Winging of the Scapula
What disorder is seen with Lateral Femoral Cutaneous Nerve involvement?
Meralgia Paresthetica (L2,L3)
What disorder is seen with Sciatic Nerve involvement?
Piriformis Syndrome (15%)
What disorder is seen with Peroneal Nerve involvement?
Fibular Head Fracture
What disorder is seen with Median Plantar Nerve involvement?
Tarsal Tunnel Syndrome
What type of pain is along a sensory distribution of a nerve root?
Dermatogenous
What is the definition of Myotogenous pain?
Pain that originates within a muscle
What type of pain is described as “Pain that arises from structures derived from embryological sclerotomes”?
Scleratogenous
What kind of pain occurs along the course of a dermatome due to nerve root irritation?
Radicular
What is the name of the pain that is “Pain along scleroderm of origination involving more then one kind of tissue”?
Referred (Shared Pathways)
What are the four characteristics of Muscle pain?
Cramping
Spasm
Aching
Dull
What are the four characteristics of Nerve pain?
Shooting
Radiating
Burning
Tingling
What are the two characteristics of Circulation pain?
Throbbing
Pulsating
What are the six characteristics of Bone Cancer pain?
Constant Deep Boring Nocturnal Progressive Unremitting
What are the three characteristics of Scleratogenous pain?
Poorly localized
Dull
Ache
What is the characteristic of Myofascial pain?
Trigger Point
What are the two pain referral sites for a Gallbladder issue?
Right Shoulder
Inferior Scapula
What is the pain referral site for a Pancreas issue?
Spine at T10 level (Epigastric)
What are the three pain referral sites for a Heart issue?
Left Shoulder
Medial Left arm
Left Jaw/Side of the face
What is the pain referral site for a Intestinal issue?
Periumbilical
What is the pain referral site for a Kidney issue?
Flank
What is the pain referral site for a Ureter issue?
Groin
What is the pain referral site for a Bladder issue?
Suprapubic Area
What are the two pain referral sites for a Appendix issue?
Epigastric- Early
Right Lower Quadrant (RLQ)- Late
Where is the site of Carpal Tunnel Syndrome?
Under the Flexor Retinaculum
What are five causes of Carpal Tunnel Syndrome?
Trauma Obesity Hypothyroidism Rheumatoid Arthritis Fluid Retention during pregnancy
In Carpal Tunnel Syndrome where is the numbness and tingling usually located?
First three digits
What three signs may indicate Carpal Tunnel Syndrome?
Thenar Atrophy
Nocturnal Pain
Weak Opponens Pollicis (Ape Hand Appearance)
What two orthopedic exams will be positive in a patient with Carpal Tunnel Syndrome?
Tinel’s test at the wrist
Phalen’s Test
What are three treatments for a patient with Carpal Tunnel Syndrome?
Adjust (Lunate A-P)
Cock up splint
Vitamin B6
What condition of the Median Nerve/Anterior Interosseous Nerve is seen between the heads of the Pronator Teres at the elbow?
Pronator Teres Syndrome
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
What causes Pronator Teres Syndrome?
Hypertonic Muscles i.e. Mechanics and Carpenters; work with a screwdriver, similar motion
What movements will cause pain in a patient with Pronator Teres Syndrome?
Pronation
Wrist flexion
What muscle of the hand will be atrophied in a patient with Pronator Teres Syndrome?
Thenar (Palm)
What orthopedic test will be positive in a patient with Pronator Teres Syndrome?
Pinch Grip Test
What are the two treatments for Pronator Teres Syndrome?
Trigger Point Therapy
Spray and Stretch
What are the two sites where the Ulnar Nerve can become trapped?
Tunnel of Guyon (Under the hook of the hamate) Cubital Tunnel (Elbow)
What are two causes of Ulnar Nerve Entrapment?
Direct Trauma
Repetitive Microtrauma
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)
Of the two entrapments; Tunnel of Guyon and Cubital Tunnel, which one will have weak wrist flexion on the ulnar side?
Cubital Tunnel Entrapment
What is the name of the condition that happens from a lower brachial plexus injury from childbirth?
Klumpke’s Palsy (C8-T1)
What does Klumpke’s Palsy look like?
Claw hand deformity with flexion of the wrist (Crumple Arm)
What is the description of the condition of Wrist Drop?
Unable to extend elbow and wrist
Radial Nerve Involvement
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
What is the site that causes Saturday Night/ Crutch Palsy?
Spiral Groove
Radial Nerve Involvement
What are three causes of Saturday Night/Crutch Palsy?
Trauma
Lead Poisoning
Pressure from crutches
What reflex will be decreased in a patient with Radial Nerve involvement?
Triceps
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
What are three causes of Winging Scapula?
Trauma
Iatrogenic
Idiopathic
What nerve is injured to cause Scapular Winging?
Long Thoracic Nerve
What muscle has paralysis in Scapular Winging?
Serratus Anterior
What nerve is damaged to cause Flaring of the Scapula?
Dorsal Scapular Nerve
What muscle has paralysis in Flaring of the Scapula?
Rhomboids
Where is the site of Meralgia Paresthetica?
Pelvic Brim under the inguinal ligament
What are three causes of Meralgia Paresthetica?
External pressure (Utility Belt i.e. Cops or Construction)
Obesity
Tight Jeans
What kind of symptoms are present with Meralgia Paresthetica?
Burning pain over the anterolateral thigh
What are two treatments for Meralgia Paresthetica?
Weight loss
Loose fitting clothes
Where are three sites of Sciatic pain?
Pelvis
Hip
Popliteal Fossa
What are five causes of Sciatica?
Trauma Traction Wallet Pressure Piriformis contracture Muscle spasm
Where will a patient with Sciatica have pain?
Posterior:
Buttock
Thigh
Leg, to the floor
What two leg movements will be decreased in a patient with Sciatica?
Weak knee flexion
Decreased Achilles Reflex
What is one possible differential diagnosis for Sciatica?
Facet involvement, Facet will NEVER cross the knee
What nerve is involved in Tarsal Tunnel Syndrome?
Medial Plantar Nerve; Branch from the Tibial Nerve
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
What two motions will cause pain in Tarsal Tunnel Syndrome?
Walking
Standing
What are three treatments for Tarsal Tunnel Syndrome?
Adjust
Orthotic support
Foot in slight inversion
What is another name for Morton’s Neuroma?
Intermetatarsal Neuroma
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
Where does a patient with Morton’s Neuroma have pain? (Two places)
Toes
Dorsum of the foot
What is one possible way to decrease pain in Morton’s Neuroma?
Shoes with a bigger toe box
What orthopedic test will be positive for Intermetatarsal Neuroma?
Morton’s Squeeze Test
What is the common site to have a Common Peroneal Nerve problem?
Fibular Head
What is the cause of Common Peroneal Nerve issues?
Trauma
What is the treatment for Common Peroneal Nerve complaints?
Adjust
Refer if there is a fracture
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
What nerve is involved in Anterior Compartment Syndrome?
Deep Peroneal Nerve (Medial Leg)
What condition has similar signs and symptoms to Deep Peroneal Nerve?
Charcot Marie Tooth
What four muscles can the Deep Peroneal Nerve effect?
Tibialis Anterior
Extensor Hallucis Longus
Extensor Digitorum Longus
Peroneus Tertius
What is the treatment for Deep Peroneal Nerve issues?
Medical Emergency
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
What is the cause of the Mallet Finger Deformity?
Injury
What two finger conditions are seen in Rheumatoid Arthritis (RA)?
Swan Neck Deformity
Boutonniere Deformity
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
How is the Boutonniere Deformity described?
Hyper-extension of the Distal Interphalangeal (DIP) and hyper-flexion of the Proximal Interphalangeal (PIP)
What finger condition has “an abnormal thickening underneath the skin of the palm and fingers”?
Dupuytren’s Contracture
What two fingers are affected with Dupuytren’s Contracture?
Last two finger, curl into the palm
Middle finger may be involved in later
What is the name of the finger condition that has a finger “Locked in a flexed position”?
Trigger Finger
What causes Trigger Finger?
Tendons of the flexed finger become inflamed or swollen
How is Trigger Finger corrected?
Finger is straightened by person, swollen tendon is forced into the sheath, causing a popping or snapping sound
What are the two inflamed tendons seen in De Quervain’s Tenosynovitis?
- *Extensor Pollicis Brevis**
* *Abductor Pollicis Longus**
How is De Quervain’s Tenosynovitis treated?
Bracing of the thumb and wrist
What orthopedic exam will be positive for De Quervain’s Tenosynovitis?
Finkelstein’s Test
What three functions does the Cerebrum help with?
Sensory Interpretation
Motor Interpretation
Language
What are five conditions that may effect the Cerebrum?
Stoke (Cardiovascular Accident; CVA) Cerebral Palsy Alcoholism Alzheimer's Tumor
What two functions are controlled by the Cerebellum?
Balance
Coordination
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
What are three conditions that are seen in Cerebellar Issues?
Multiple Sclerosis (MS)
Alcoholism
Cerebral Palsy
What three sensation is determined by the Posterior Columns?
Two point discrimination
Vibration (128 tuning fork on the distal joint)
Position Sense
When performing Romberg’s test, when are the Posterior Columns tested?
When the patient closes their eyes
What four conditions are seen when the Posterior Columns are affected?
Multiple Sclerosis (MS)
Tabes Dorsalis
Leprosy
Diabetes Mellitus
What tract has to deal with Voluntary Movement and flexors of the hands and feet?
Corticospinal (Pyramidal) Tract
What tract is involved in an Upper Motor Neuron Lesion (UMNL)?
Corticospinal (Pyramidal) Tract
What two sensations are sensed by the Lateral Spinothalamic tract?
Pain
Temperature
What tract is involved in a Syringomyelia?
Lateral Spinothalamic Tract
What Tract is the sensation of Crude Light Touch?
Anterior Spinothalamic Tract
What tract deals with balance reflexes and postural muscles?
Vestibulospinal Tract
What two conditions can be seen if a patient has an issue with their Vestibulospinal Tract?
Benign Paroxysmal Positional Vertigo (BPPV)
Labyrinthitis
What is the function of the Rubrospinal Tract?
Muscle tone and synergy to the proximal flexors of the extremities
What spinal tract deals with “Muscle tone and synergy to voluntary extensor muscles”?
Reticulospinal Tract
What spinal tract crosses at the medullary pyramids and travels to the flexors of the extremities?
Lateral Corticospinal Tract
What does the Ventral Corticospinal tract effect?
Crosses at the segmental level
Goes to the flexors of the trunk
What condition is a “cyst of the central canal of the spinal canal”?
Syringomyelia
Where is the congenital weak area of the spine that is seen with Syringomyelia?
C5-C6
What is the common finding of Syringomyelia?
Loss of pain and temperature over the shoulders in a cape like distribution
What condition is a demyelination of the central nervous system (CNS)?
Multiple Sclerosis
What cells are responsible for myelination of the Central nervous system (CNS)?
Oligodendrocytes
What population is often affected by Multiple Sclerosis (MS) and Myasthenia Gravis?
Females aged 20-40
What can cause an increase in the exacerbation of Multiple Sclerosis (MS)?
Moving from cold to warm climates
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
What is the name of the positive orthopedic exam in Multiple Sclerosis (MS)?
Lhermitte’s Test
What are the three components of Charcot’s Triad, in Multiple Sclerosis (MS) patients?
SIN
Scanning Speech
Intention Tremor
Nystagmus
What are two ways to Diagnosis Multiple Sclerosis (MS)?
MRI (Best) Cerebrospinal Fluid (CSF) exam; Increase in Proteins
What is always affected first in Myasthenia Graves?
Motor Cranial Nerves
In the condition of Myasthenia Graves what is makes it an Autoimmune Disorder?
The body makes antibodies against the acetylcholine receptors
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
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
What test is done on patients with Myasthenia Graves?
ACHr test
What test is done to diagnosis Myasthenia Graves?
Tensilon Test
What type of drug is used to treat Myasthenia Graves?
Cholinesterase Inhibiting Drugs
What is the name for Lou Gehrig’s Disease?
Amyotrophic Lateral Sclerosis (ALS)
What is first effected in Amyotrophic Lateral Sclerosis (ALS)?
Hands
Who usually has Amyotrophic Lateral Sclerosis (ALS)?
Males less than 40 years of age
What part of the spine is effected in Amyotrophic Lateral Sclerosis (ALS)?
Corticospinal tract
Anterior horn
What is a differential diagnosis of Amyotrophic Lateral Sclerosis (ALS)?
Lateral Canal Stenosis
What are the signs/symptoms of Amyotrophic Lateral Sclerosis (ALS)?
Fasciculations
Spasticity
Increase in Deep Tendon Reflexes (DTR)
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
What is another name for Posterolateral Sclerosis (PLS)?
Combined System Disease
What areas of the spinal cord are effected in Combined Systems Disease?
Degeneration of:
Posterior Columns
Corticospinal Tracts
A deficiency in what Vitamin leads to Posterolateral Sclerosis (PLS)?
B12 (Pernicious Anemia) Stomach Issue (Gut or Colon)
What test will be positive in Combined Systems Disease?
Shilling Test
What kind of paresthesia is seen in Posterolateral Sclerosis (PLS)?
Glove and Stocking
Neurological Symptoms are irreversible
What is the name of the condition that has a “hemisection (partially severed) spinal cord; usually caused by injury”?
Brown Sequard
In Brown Sequard, what is effected Ipsilateral and what is effected Contra-lateral?
Ipsilateral:
Motor function
Dorsal Columns
Contra-Lateral:
Loss of:
Pain
Temperature
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
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
What is another name for Parkinson’s Disease?
Paralysis Agitans
What condition is “Chronic progressive associated with loss of dopamine in the Substantia Nigra causing Basal Ganglionic dysfunction”?
Parkinson’s Disease
What tract is effected in Paralysis Agitans?
Extrapyramidal Tract
At what age is Parkinson’s usually seen?
Over the age of 50, with a gradual onset
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)
What condition is “Inflammatory polyneuropathy of the Peripheral Nervous System (PNS), linked to recent immunization or recent flu infection”?
Guillain-Barre Syndrome
What kind of paralysis is Guillain-Barre Syndrome?
Ascending; begins in the legs. Sensory symptoms
When can Guillain-Barre Syndrome become a medical emergency?
If it reaches the diaphragm
What condition is seen in tertiary syphilis, effecting the posterior columns?
Tabes Dorsalis
What kind of pupil will be seen in a patient with Tabes Dorsalis?
Argyll Robertson’s- pupil accommodates but no response to direct light
What kind of gait may be present in Tabes Dorsalis?
Slappage Gait
What two body functions are effected in Tabes Dorsalis?
Coordination
Balance
What condition is seen in Boys aged 3-7, that is a recessive sex linked disorder?
Muscular Dystrophy (Erb’s Duchenne)
What kind of gait is seen in Muscular Dystrophy?
Waddling gait, weakness of proximal leg muscles
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
What orthopedic exam can help diagnosis Muscular Dystrophy?
Gower’s Sign
In the condition of Muscular Dystrophy what will be the lab findings?
Large increase in CPK (CK-MM)
Decrease in Creatinine
What condition is “mental deterioration and amnesia”?
Alzheimer’s
What is the most definitive diagnosis for Alzheimer’s?
Autopsy
What is the most common age of on set for the condition of Huntington’s Chorea?
35-44
What kind of disease is Huntington’s Chorea?
Neurodegenerative genetic disorder
What are the thing affected in Huntington’s Chorea?
Muscle coordination
Cognitive decline
Dementia
What is the name of the condition that is “Hereditary and affects both moth and sensory nerves”?
Charcot Marie Tooth Disease
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
What muscles of the lower leg are affected over time in Charcot Marie Tooth Syndrome?
Peroneal Muscles
What percentage of the gait cycle is Stance phase?
60%
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)
What percentage of the gait cycle is in Swing Phase?
40%
What is the definition of Swing Phase?
Leg is swinging, no weight
What are the two parts of Swing Phase?
Early Swing
Late Swing
What two muscle cause Acceleration of the thigh?
Illiopsoas
Rectus Femoris
What muscle can sprinters easily tear off the Anterior Inferior Spine due to it’s cartilaginous apophysis attachment?
Rectus Femoris
The hamstring assist in what part of the gait cycle?
Deceleration
What type of athlete is prone to pulling their hamstring?
Stop quickly
Forceful kicking
Hamstring is pulled of the ischial tuberosity
The Heel Strike fires what group of muscles?
Dorsiflexors (Tibialis Anterior innervated by the Deep Fibular (Peroneal) Nerve))
What muscle eccentrically contracts to absorb energy of the knee to prevent bucking, during the Heel Strike phase of the Gait Cycle?
Quadriceps
During Foot Strike of the Gait Cycle what muscles contact to hold the body up right?
Abductors
What muscles contract to move the body forward during the Foot Strike phase?
Plantar Flexors= Triceps Surae
Gastrocnemius
Soleus
Plantaris
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
How is a Propulsion/Festinating/Shuffling gait described?
Forward leaning posture with small shuffling steps
What condition is seen to have a Propulsion/Festinating/Shuffling gait?
Parkinson’s Disease
How is a Scissored gait described?
Knee’s crossed at midline while walking (Tight Adductors)
What condition is a Scissored gait often seen in?
Cerebral Palsy
How is a Trendlenburg gait described?
Weak Gluteus Medias, causing lurching and drastic pelvic tilting on the affected side
What condition is a Waddling gait often seen in?
Muscular Dystrophy
What three conditions is a Steppage gait often seen in?
Anterior Compartment Syndrome
Foot Drop
L4 Lesion/ Paralysis of the Tibialis Anterior
What condition is a Slappage/Sensory Ataxia gait often seen in?
Posterior Columns Disease
Difficult walking in the dark
What two conditions is a Circumduction/Hemiplegic gait often seen in?
Stroke; swinging; unilaterally
Spastic Hemiplegia
What condition is a Spastic gait often seen in?
Upper Motor Neuron Lesion (UMNL)
What condition is a Drunken/Motor Ataxic gait often seen in?
Cerebellum issues (Wide based gait)
Where does 50% of flexion and extension occur in the cervical spine?
Occiput-C1
At what level does 50% of rotation occur in the cervical spine?
C1-C2
What is another name for Bakody’s Test?
Shoulder Abduction Test
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
What is considered a Positive Bakody’s Test?
Relief of pain
What does Bakody’s Test indicate?
Intervertebral Foramen (IVF) Encroachment
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
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.
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
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.
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.
How is Soto Hall Sign performed?
Patient is supine, doctor places one hand on sternum while passively flexing patient’s head toward chest.
What is considered a Positive Foraminal Compression Test?
Radicular Pain/Localized Pain
What is considered a Positive Jackson’s Compression Test?
Radicular Pain/Localized Pain
What is considered a Positive Maximum Foraminal Compression Test?
Radicular Pain/Localized Pain
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
What is considered a Positive Shoulder Depression Test?
Pain
What is considered a Positive Soto Hall Sign?
Localized Pain
What does Foraminal Compression, Jackson’s Compression, Maximal Foraminal Compression Test indicate?
Nerve Root Compression/ Facet Syndrome
What does Shoulder Depression Test indicate?
Nerve Root Adhesions
What does Soto Hall Sign indicate? (Two things)
Compression Fracture (Anterior Pain) Ligament Damage (Posterior Pain) (Sprain/Strain)
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
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)
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
How is Valsava’s Maneuver performed?
Doctor ask the patient to bare down like they are having a bowel movement
What is considered a Positive Spurling’s Test?
Pain in the neck, shoulder or arm
What is considered a Positive Valsava’s Maneuver Test?
Radicular Pain
What is considered a Positive Naffziger’s Test?
Pain
What is a contraindication to Naffziger’s Test?
Vascular Compromise
What is another name for Thoracic Outlet Syndrome (TOS)?
Neurovascular Compression Syndrome
Who should you refer a patient to if they have a Cervical Rib?
Orthopedist
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.
What is a Positive Allen’s Test?
Delay of more than 10 seconds for blood to return
What does a Positive Allen’s Test indicate?
Occlusion of corresponding artery
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.
What is another name for Adson’s Test?
Scalenus Anticus Test
What is a Positive Adson’s Test?
Alteration in amplitude of Radial Pulse
What does a Positive Adson’s Test indicate?
Cervical Ribs
What is another name for Modified Adson’s Test?
Scalenus Medius Test
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.
What is a Positive Modified Adson’s Test?
Alteration in amplitude of the Radial Pulse
What does a Positive Modified Adson’s Test indicate?
Subclavian Artery
Scalenus Medius Syndrome
What is another name for the Costoclavicualar Maneuver?
Eden’s Test
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.
What is a Positive Eden’s Test?
Alteration in the amplitude of the Radial Pulse
What does a Positive Eden’s Test indicate?
Compression between the first rib and clavicle
What is another name for Wright’s Test?
Hyperabduction Maneuver
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.
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
What does a Positive Wright’s Test indicate?
Pectoralis Minor Syndrome
Axillary Artery
What does a Reverse Bakody’s Maneuver look like?
Seated patient actively places hand on top of head
What is a Positive Bakody’s Maneuver?
Increase Pain
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.
What is a Positive Halstead’s Test?
Alteration in the amplitude of Radial Pulse
What does a Positive Halstead’s Test indicate?
Cervical Rib; Refer to an Orthopedist
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.
What is a Positive Bikele’s Sign?
Resistance and increased radicular pain
What three things are indicated by a Positive Bikele’s Sign?
Thoracic Outlet Syndrome (TOS)
Brachial Plexus Neuritis
Meningeal Irritation
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.
What is a positive Roo’s Test?
Reproduction of symptoms or unusual discomfort
What does an Positive Roo’s Test indicate?
Thoracic Outlet Syndrome (TOS)
Which one of the four rotator cuff tendons is most frequently torn?
Supraspinatus
Where is the Supraspinatus Muscle usually torn from?
Insertion point; the humeral head of the greater tuberosity
What is the best diagnosis for a Rotatory cuff tear?
MRI
What is the recommended treatment for Rotor Cuff injuries?
Codman’s Exercises
What is the action of the Supraspinatus muscle?
Abduction
What is the nerve supply to the Supraspinatus muscle?
Suprascapular Nerve
Where does the Supraspinatus muscle insert?
Greater Tubercle of the humerus
What is the action of the Infraspinatus muscle?
External Rotation of the arm
What is the nerve supply to the Infraspinatus muscle?
Suprascapular Nerve
What is the insertion of the Infraspinatus muscle?
Greater Tubercle of the humerus
What is the action of the Teres Minor muscle?
External Rotation of the arm
What is the nerves supply of the Teres Minor muscle?
Axillary Nerve
What is the insertion of the Teres Minor Muscle?
Greater Tubercle of the humerus
What is the nerve supply of the Subscapularis muscle?
Subscapular Nerve
What is the action of the Subscapularis muscle?
Internal Rotation of the arm
What is the insertion of the Subscapularis muscle?
Lesser tubercle of the humerus
At what two joints does abduction of the shoulder occur?
Glenohumeral
Scapulothoracic articulation
What is the appropriate ratio of movement between the Glenohumeral joint and the Scapulothoracic articulation when the shoulder is abducted?
2:1
What does a decrease ration of the Glenohumeral joint and Scapulothoracic articulation indicate?
Adhesive Capsulitis AKA Frozen Shoulder
What two muscles elevate the scapula?
Trapezius
Levator Scapula
What two muscles retract the scapula?
Rhomboid (Major and Minor)
What muscle protracts the scapula?
Serratus Anterior
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
What is a Positive Apley’s Scratch Test?
Pain or decreased Range of Motion (ROM)
What does a Positive Apley’s Scratch Test indicate?
Degenerative Tendonitis of Rotator Cuff
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
What is a Positive Codman’s Drop Arm Test?
Inability to maintain arm position
What does a Positive Codman’s Drop Arm Test indicate?
Supraspinatus Tear
How is the Apprehension Test performed?
Doctor abducts and slowly externally rotates the affected shoulder.
What is a Positive Apprehension Test?
Patient shows sign of alarm
What does a Positive Apprehension Test indicate?
Chronic Shoulder Dislocation
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
What is a Positive Dugas’ Test?
Unable to perform
What does a Positive Dugas’ Test indicate?
Acute Shoulder Dislocation
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.
What is a Positive Dawbarn’s Sign?
Reduction of Pain
What does a Positive Dawbarn’s Sign indicate?
Subacromial Bursitis; Most common Hydroxyapatite Deposition Disease (HADD)
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.
What is a Positive Yergason’s Test?
NOT positive for pain
Audible click or snap in the bicipital groove
What does a Positive Yergason’s Test indicate?
Bicipital Tendon Instability
What are two other names for Lateral Epicondylitis?
Radio Humeral Bursitis
Tennis Elbow
What muscle is affected in Lateral Epicondylitis?
Extensor Carpi Radialis Brevis
What movements will cause pain in the condition of Lateral Epicondylitis?
Wrist extension
Pronation of the elbow
What are two other names for Medial Epicondylitis?
Little leaguers Elbow
Golfer’s Elbow
What muscle is affected in Medial Epicondylitis?
Flexor Carpi Ulnaris
What movement will cause pain in the condition of Medial Epicondylitis?
Flexion of the wrist, medial portion of the elbow
What are three treatment/case management for both Lateral and Medial Epicondylitis?
Transverse Massage
Underwater ultrasound
Counterforce brace
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.
What is a Positive Cozen’s Test?
Pain in the lateral elbow
What does a Positive Cozen’s Test indicate?
Lateral Epicondylitis
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.
What is a Positive Reverse Cozen’s Test?
Pain In the medial elbow
What does a Positive Reverse Cozen’s Test indicate?
Medial Epicondylitis
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
What is a Positive Mill’s Test?
Pain on the lateral Elbow
What does a Positive Mill’s Test indicate?
Lateral Epicondylitis
How is Tinel’s Sign at the Wrist performed?
Percuss over the flexor retinaculum of the wrist and the Tunnel of Guyon
What is a Positive of Tinel’s sign at the Wrist?
Tingling into the lateral three finger or the medial two fingers
What does a Positive of Tinel’s Sign at the Wrist indicate?
Carpal Tunnel Syndrome
Ulnar Nerve Impingement
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
What is a Positive Phalen’s Sign?
Tingling into the first three digits of the hand
What does a Positive Phalen’s Sign indicate?
Carpal Tunnel Syndrome
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
What is a Positive Froment’s Sign?
Unable to keep paper between finger
What does an Positive Froment’s Sign indicate?
Ulnar nerve palsy
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.
What two muscles are being evaluated during Finkelstein’s Test?
Extensor Pollicis Brevis
Abductor Pollicis Longus
What is a Positive Finkelstein’s Test?
Pain over the anatomical snuff box
What does a Positive Finkelstein’s Test indicate?
De Quervain’s Disease (Stenosing Tenosynovitis)
What is another name for De Quervain’s Disease?
Stenosing Tenosynovitis
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.
What is a Positive Straight Leg Raiser (SLR) Test?
Pain down the affected side
What are three possible indications from a Positive Straight Leg Raiser (SLR) Test?
Sciatica
Disc/Space Occupying Lesion (SOL)
Lumbar lesion
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
What is a Positive Bragard’s Test?
Pain in the affected leg
What does a Positive Bragard’s Test indicate?
Sciatica
How is Sicard’s Sign performed?
Perform a Straight Leg Raiser (SLR), lower the leg 5 degrees and dorsiflex big toe.
What is a Positive Sicard’s Sign?
Pain in the affected leg
What does a Positive Sicard’s Sign indicate?
Sciatica
How is Turyn’s Sign performed?
While the patient is in the supine position, doctor dorsiflexes the big toe
What is a Positive Turyn’s Sign?
Pain in the Gluteal region
What does a Positive Turyn’s Sign indicate?
Sciatica
What is another name for the Well Leg Raiser (WLR)?
Fajerstazn’s
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
What is a Positive Well Leg Raiser (WLR)?
Pain down Symptomatic (Sciatic) side
What does a Positive Well Leg Raiser (WLR) indicate?
Medial Disc Lesion
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
What is a Positive Millgram’s Test?
Pain
What does a Positive Millgram’s Test indicate?
Space Occupying Lesion (SOL)
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.
What is a Positive Goldthwait’s Sign?
Pain
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
How is Linder’s Test performed?
Patient’s head is passively flexed to the chest
What is a Positive Linder’s Test?
Pain in the lumbar spine radiating to the sciatic nerve
What does a Positive Linder’s Test indicate?
Root Sciatica
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.
What is a Positive Bowstring’s Test?
Pain in lumbar spine region or Radiculopathy
What does a Positive Bowstring’s test Indicate?
Sciatica (BEST TEST)
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)
What is a Positive Bonnet’s Sign?
Radicular Pain into the limb
What does a Positive Bonnet’s Sign indicate?
Piriformis Syndrome
What is another name for Belt’s Test?
Supported Adam’s Test
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.
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
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.
What is a Positive Kemp’s Test?
Sciatic Pain Down the involved side
What does a Positive Kemp’s Test indicate?
Posteromedial Disc: Positive Kemp’s away from pain
Posterolateral Disc: Positive Kemp’s into pain
How is Neri’s Bowing Test performed?
When patient is bending forward at the waist the knee flexes on the side of involvement
What is a Positive Neri’s Bowing Test?
Knee buckling
What does a Positive Neri’s Bowing Test indicate? (Four Possibilities)
Tight Hamstrings
Lower Disc issue
Lumbosacral Issue
Sacroiliac Joint issue
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.
What is a Positive Becterew’s Test?
Pain or Leaning Back
What does a Positive Becterew’s Test indicate?
Disc
Posteromedial disc if pain when good leg is raised
How is Minor’s Sign performed?
Ask the patient to rise form a seated position
What is a Positive Minor’s Sign?
Patient will support body with uninvolved side balancing on good side
What does a Positive Minor’s Sign indicate?
Sciatica
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
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
What is the best test for the Sacroiliac (SI) joint?
Yeoman’s Test
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.
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.
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
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.
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
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.
What is a Positive Hip Abduction Stress Test?
Pain at the Posterior Superior Iliac Spine (PSIS)
What does a Positive Hip Abduction Stress Test indicate? (Two indications)
Sacroiliac (SI) joint problems
Gluteus Medius Weakness
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
What is a Positive Nachlas Test?
Pain in the Sacroiliac (SI) Joint
What are two indications of Nachlas Test?
Sacroiliac (SI) joint lesion
If pain in anterior thigh; Femoral Nerve Stretch
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
What is a Positive Patrick FABERE Test?
Pain in the hip
What does a Positive Patrick FABERE Test indicate?
Hip Lesion
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
What is a Positive Laguerre’s Test?
Pain in the hip
What does a Positive Laguerre’s Test indicate?
Hip Lesion
How is Thomas Test Performed?
Patient supine, thigh is flexed with the knee bent up to the abdomen.
What is a Positive Thomas Test?
Opposite knee/thigh rises off the table
What does a Positive Thomas Test Indicate?
Hip flexion contracture
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
What is a Positive Allis Test?
Significant difference in knee height
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
How is Ortolani’s Test Performed?
Infant is supine. Leg are abducted and externally rotated
What is a Positive Ortolani’s Test?
Palpable or Audible Click
What does a Positive Ortolani’s Test indicate?
Congenital Hip Dysplasia
How is Barlow’s Test Performed?
Infant supine, hip in Adduction, gentle posterior pressure on each hip, one at a time
What is a Positive Barlow’s Test?
Deep sounding “Thunk” as the femoral head subluxates Out of the socket
What does a Positive Barlow’s Test indicated?
Congenital Hip Dysplasia
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
What is a Positive Ober’s Test?
Knee stays elevated (Abducted)
What does a Positive Ober’s Test indicate?
Tensor Fascia Lata (TFL) Contracture
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**
What is a Positive for Ely’s SIGN?
Pain
What does a Positive Ely’s Sign indicate?
Rectus Femoris Contracture
pSoas
How is Ely’s TEST Performed?
Patient prone. The heel is approximated to the opposite buttock and hyperextended
What is a Positive Ely’s TEST?
Pain
What does a Positive Ely’s TEST indicate?
Hip Lesion
Illiopsoas irritation
Inflamed lumbar nerve roots
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
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)
What does a Positive Trendelenburg’s test indicat3e?
Hip Abductors are week on stance (Grounded) led side
What Knee condition is described as “Swelling and pain immediately after and injury”?
Ligament Tear
How is a Meniscal Tear described?
Swelling occurs 12-24 hours after injury. Unable to lock out joint
What are two other names for Chondromalacia Patella?
Patellofemoral Tracking Disorder
Runner’s Knee
What muscle pulls the patella lateral in Runner’s Knee?
Vastus Lateralis
What motion/action is most provocative in Patellofemoral Tracking Disorder?
Walking down stairs
What condition is caused by Chondromalacia Patella?
Retropatelar Degenerative Joint Disease
What two orthopedic test are performed to confirm Chondromalacia Patella?
Clark’s
Fouchet’s
What knee condition is seen in athletes doing repetitive knee extensions?
Osgood Schlatter’s
What bone is injured in Osgood Schlatter’s Disease?
Avulsion fracture of the Tibial tuberosity
What are two things to know about Osteochondritis Dessicans? (Knee Condition)
Avascular Necrosis (AVN) Knee Locks out of Extension
What orthopedic test is used to confirm Osteochondritis Dessicans?
Wilson’s Sign
What is the name of the knee condition that is “Prepatellar bursitis after repetitive pressure on the knee”?
Housemaid’s Knee
What is another name for Jumper’s Knee?
Patellar Tendonitis
Where is the pain in Tensor Fascia Lata (TFL) Syndrome?
Lateral knee
What causes the pain in Tensor Fascia Lata (TFL) Syndrome?
A shortened Tensor Fascia Lata (TFL)
What population and movements make Tensor Fascia Lata (TFL) Syndrome worse?
Population: Runners
Movements: Walking or running up and down hill or stairs
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
What is another name for Abduction Stress Test?
Valgus Stress Test
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
What is a Positive Valgus Stress Test?
Increased Pain or Laxity
What does a Positive Abduction Stress Test indicate?
Medial Collateral Ligament Involvement
What is another name for Varus Stress Test?
Adduction Stress Test
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
What is a Positive Adduction Stress Test?
Increased Pain or Laxity
What does an Positive Adduction Stress Test indicate?
Lateral Collateral Ligament Involvement
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
What is a Positive Apley’s Distraction Test?
Pain in the knee
What does a Positive Apley’s Distraction Test indicate?
Collateral Ligament Tear
Heel points to the side of torn ligament
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
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
What is a Positive Drawer Test?
Pain or Joint Laxity
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
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
What is a Positive Slocum’s Test?
Pain or Joint Laxity
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)
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
What is a Positive Lachman’s Test?
Soft End Feel
What does a Positive Lachman’s Test indicate?
Anterior Cruciate Ligament (ACL) instability
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
What is a Positive Posterior Sag Sign?
Tibial drops back (sags) on the femur
What does a Positive Posterior Sag Signe indicate?
Posterior Cruciate Ligament (PCL) tear
What three orthopedic test can be performed to test the Meniscus of the knee?
MuMurray Sign
Apley’s Compression Test
Bounce Home Test
What is the best orthopedic exam for the Meniscus of the knee?
McMurray Sign
What is lacking to the Meniscus of the knee?
Nerve Supply
If a patient has a meniscus issue how long will it be after an injury until you see swelling?
12-24 hours
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
What is a Positive MuMurray Sign?
Painful click or snap heard
What does a Positive MuMurray Sign indicate?
Lateral Meniscus: Internal Rotation
Medial Meniscus: External Rotation
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
What is a Positive Apley’s Compression Test?
Pain in the knee
What does a Positive Apley’s Compression Test indicate?
Lateral Meniscus: External Rotation
Medial Meniscus: Internal Rotation
Heel Points to side of Pathology
How is Bounce Home Test Performed?
Patient is supine, knee is flexed completely
Knee is dropped into extension
What is a Positive Bounce Home Test?
Incomplete Extension
What does a Positive Bounce Home Test indicate?
Meniscus Tear
12-24 hours before you will see swelling
What two orthopedic tests can be to check the Patella?
Apprehension Test of the Patella
Clarke’s Sign AKA Patellar Grinding Test
What is another name for Clarke’s Sign?
Patellar Grinding Test
How is Apprehension Test of the Patella Performed?
Patient supine.
Doctor displaces patella medial to lateral
What is a Positive Apprehension Test of the Patella?
Patella will feel dislocated and the quadriceps contracts
Look at face for alarm/apprehension
What does a Positive Apprehension Test of the Patella indicate?
Chronic Patellar Dislocation
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
What is a Positive of Clarke’s Sign?
Retropatellar Pain
Inability to sustain a contraction of the quadriceps
What does a Positive Clarke’s Sign indicate?
Chondromalacia Patella
What are three additional orthopedic exams that can be done on the knee?
Wilson’s Test
Dreyer’s Test
Noble Compression Test
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
What is a Positive Wilson’s Test?
Decrease in Pain
This test has been seen on Boards lately
What does a Positive Wilson’s Test indicate?
Osteochondritis Dessicans (Avascular Necrosis)
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
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)
What does a Positive Dreyer’s Test indicate?
Fractured Patella
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
What is a Positive Noble Compression Test?
Pain over the area of Pressure
What does a Positive Noble Compression Test indicate?
Tensor Fascia Lata (TFL) Syndrome
AKA
Illiotibial Band Syndrome
What are three abnormalities of the foot?
Pes Planus
Talipes Equinovarus
Pes Cavus
What condition is commonly called “Flat Feet” and have the heads of the tarsals displaced medially and downward (Plantarward)?
Pes Planus
What are the two treatments for Pes Planus?
Exercise foot muscles, pull a towel in with toes
Orthotics
What is another name for Club Foot?
Talipes Equinovarus
How is Talipes Equinovarus described?
Most common birth defect, heel is elevated and foot is turned inward
What is the condition of very high arches and toes are in flexion?
Pes Cavus
What is a treatment of Pes Cavus?
Orthotics
What is a patient with Pes Cavus prone to?
March/Stress Fracture
What is the name of the nerve tumor most commonly between the 3rd and 4th metatarsal head?
Morton’s Neuroma
What is another name for a Metatarsal Stress Fracture?
March Fracture
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
In the condition of Plantar Fasciitis when does the pain decrease?
Throughout the day
What is one possible treatment of Plantar Fasciitis?
Deep tissue massage
What is the name of the condition that has a burning pain on the sole of the foot (Medial Plantar Nerve)?
Tarsal Tunnel Syndrome
What two orthopedic test that can be used to check for Achilles Tendon Rupture?
Thompson’s Test AKA Simmond’s Test/Trauma
What is the most common sprain/strain of the ankle?
Inversion
What grade of Sprain/Strain has “No ligaments torn, but may have slight swelling or decreased range of motion”?
Grade 1
What is the treatment for a Grade 1 sprain/strain?
PRICE Protect Rest Ice Compress Elevate
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)
What are the characteristics of a Grade 3 sprain/strain?
Complete Tear
Surgical Case
Refer to and Orthopedist
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.
What is a Positive Anterior Foot Drawer Test?
Talus slides forward
What does a Positive Anterior Foot Drawer Test indicate?
Anterior Talofibular Ligament Instability
Calcanofibular Ligament
Posterior Talofibular Ligament
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.
What is a Positive Medial and/or Lateral Stability Test?
Excessive gapping on either side
What does a Positive Medial and/or Lateral Stability Test indicate?
During Inversion- Anterior Talofibular or Calcaneofibular ligament tear
During Eversion- Deltoid Ligament Tear
What is another name for Thompson’s Test?
Simmond’s Test
How is Thompson’s Test performed?
Patient Prone; feet hanging off the table
Doctor flexes knee to 90 degrees and squeezes the calf
What is a Positive Thompson’s Test?
No Plantar flexion of foot
What does a Positive Thompson’s Test indicate?
Achilles’ tendon Rupture
What are the five Malingering test?
Burn's Bench Test Hoover's Sign Lasegue's Sitting Test Magnusson's Test Mannnkopf's Sign
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
What is a Positive Burn’s Bench Test?
Patient refuses to preform test
How is Hoover’s Sign Performed?
Patient supine
Doctor places one hand under each heel and ask patient to lift affected limb
What is a Positive Burn’s Bench Test?
Doctor does not fell the unaffected side pressing downward
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
What is a Positive Lasegue’s Test?
No pain when there had been a Positive Straight Leg Raiser (SLR)
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
What is a Positive Magnusson’s Test?
Patient does not point to the originally spot of pain
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
What is a Positive Mannkopf’s Sign?
An increase in pulse rate of 10 beats per minute
What does a Positive Mannkopf’s Sign indicate?
Not a Malinger (Pulse Rate does not change)
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
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
What is a Positive Chest Expansion Test? (Both Genders)
Women: Less than a 1.5 inch difference
Men: Less than a 2 inch difference
How is Forrestier’s Bowstring Sign Performed?
Patient standing, have them bend to each side
What is a Positive Forrestier’s Bowstring Test?
Muscle tightness on the ConCave side
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
What is a Positive Lewin Supine Test?
Unable to perform a Sit-up without the use of their hands
How is Amoss Sign Performed?
Patient is asked to go from a side-lying to a seated position
What is a Positive Amoss Sign?
Localized thoracolumbar pain
Lack of Range of Motion
What are three things a Positive Amoss Sign Indicate?
Ankylosing Spondylitis
Intervertebral Disc Syndrome
Severe Sprain/Strain
What condition are all indicated by:
Chest Expansion Test
Forrestier’s Bowstring Test
Lewin Supine Test
Amoss Sign
Is it possible to diagnosis Ankylosing Spondylitis on x-Ray?
Yes
In a patient with Meningeal Irritation what are four symptoms will they present with?
Fever
Headache
Photophobia
Nuchal Rigidity
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
What two orthopedic exam Indicate Meningeal Irritation?
Brudzinski Sign
Kernig’s Sign
How is Brudzinski Sign Performed?
Patient supine
Doctor passively flexes the patient’s head approximating chin to chest
What is a Positive Brudzinski Sign?
Buckling of the patient’s knee
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
What is a Positive Kernig’s Sign?
Patient resists extension
Resistance causes a Kicking motion
How is Gower’s Sign Performed?
When patient is arising from a supine position, patient turns prone and then climbs up themselves
What does a Positive Gower’s Sign indicate?
Muscular Dystrophy
How is Lhermitte’s Sign Performed?
Patient seated or supine
Patient actively and passively flexes chin to chest
What is a Positive Lhermitte’s Sign?
Sharp electric shock like sensation don the the spine into the extremities
What three conditions does a Positive Lhermitte’s Sign indicate?
Multiple Sclerosis**
Myelopathy
Demyelination cord lesions
How is Libman’s Test Performed?
Doctor places thumbs on mastoid process, applies pressure until patient expresses discomfort
What is Libman’s Test used for?
Pain threshold of a Patient
Can also be used for a malingering test
How is Rust Sign performed?
Patient spontaneously grasp the head/neck with both hands when rising from a lying position
What are three indications of a Positive Rust Sign?
Cervical instability due to a sprain/strain
Fracture
Rheumatoid Arthritis (RA)
How is Schepelmann’s Sign Performed?
Patient raises both arms over head while seated and laterally bends to each side
What does a Positive Schepelmann’s Sign indicate?
Concave Side pain: Intercostal Neuralgia
Convex Side pain: Pleurisy or Myofascitis
How is Dejerine’s Triad Performed?
Patient has pain brought on by coughing, sneezing or bearing down
What does a Positive Dejerine’s Triad indicate?
Space Occupying Lesion (SOL)
How is Hofman’s Sign Performed?
Patient Supine
Hip and knee flexed to 90 degrees
Doctor squeezes and dorsiflexes the foot simultaneously
What is a Positive Homan’s Sign?
Deep Calf Pain
What does a Positive Homan’s Sign indicate?
Deep Vein Thrombosis (DVT)
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)
What is a Positive O’Donohue’s Test?
Pain in the joint/area being tested
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)
What rating on the Wexler Scale (Deep Tendon Reflexes) indicate a Lower Motor Neuron Lesion (LMNL)?
0+
1+
What function does a Afferent Nerve have?
Sensory
What is the function of a Efferent Nerve?
Motor
What nerve has Worse pain at night?
Median Nerve
What nerve innervates the lateral forearm and hand?
Median Nerve
What nerve innervates the medial forearm and hand?
Ulnar Nerve
What nerve innervates the posterior arm and hand?
Radial Nerve
What are four things that can cause Scleratogenous Pain?
Facet
Sacroiliac (SI) joint
Scapular–Thoracic articulation
Tempromandibular Joint (TMJ)
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
In what condition is it a contraindication of any heating modalities (i.e. Paraffin Baths)
Multiple Sclerosis
What area of the brain is effected with a Lateral Nystagmus?
Cerebellum
What area of the brain is effected if the patient has a Vertical Nystagmus?
Brain Stem
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
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
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
What is another name for Gillian-Barre Syndrome?
Laundry’s Paralysis
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
What condition will have difficulty walking upstairs?
Muscular Dystrophy
What is the name of the condition that has chronic wide spread pain?
Fibromyalgia
How is Fibromyalgia confirmed?
Pain at 11 of 18 tender points
What four symptoms are associated with Fibromyalgia?
Fatigue
Sleep disturbances
Joint Stiffness
Depression
What are five things that can cause a Space Occupying Lesion(SOL)?
Disc Intervertebral Foramen (IVF) encroachment Tumor Inflammation Subluxation
What type of lesion is a Space Occupying Lesion (SOL), said to be?
Lower Motor Neuron Lesion (LMNL)
If a patient has pain on Ulnar deviation what is being affected?
Triangular Fibrocartilage Complex
What orthopedic exam is paired with Nobel’s Compression Test?
Ober’s Test`
Cruciate Ligaments are name for what?
Where they attach to the tibia (Cross your fingers)
What is the most injured muscle of the Quadriceps?
Vastus Medialis
What knee ligament is the most injured ligament?
Anterior Cruciate Ligament
What meniscus is the most injured?
Medial Meniscus
What action causes and Unhappy Triad?
A blow to the lateral side of the knee, then planted into the ground
What three Structures are injured in an Unhappy Triad?
Medial Collateral Ligament
Anterior Cruciate Ligament
Medial Meniscus
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)
What two grading of Sprain/Strain can be seen by a Chiropractor?
Grade 1
Grade 2
Achilles tendon rupture is most commonly seen in patients who use what?
Corticosteroids
