New Physical Exam Skills Flashcards
ABI exam
Spurling test
A maneuver used to test for cervical spine radiculopathy. Performed by extending the neck to the side of the pain and applying downward pressure to the head.
The test is positive if the the limb pain/paresthesia can be reproduced.
Suggests cervical root compression over thoracic outlet or a more distal etiology of neuropathy.
Subacromial impingement syndrome
Compression of acromial structures between the humeral head and the acromion. Manifests as shoulder pain and dysfunction. Caused by repetitive overhead activities.
On exam:
- Positive Neer test
- Positive Hawkins test
- Positive lidocaine challenge (injection of 5 mL lidocaine provides relief)
Treat with conservative therapy – analgesia with NSAID and physical therapy.
Neer’s test
Provocation test for subacromial impingement syndrome
Passive elevation of the pronated arm above the level of the patient’s shoulder, while the shoulder joint is supported with the other hand. Pain indicates a positive test.
Hawkins Test
Provocation test for subacromial impingement syndrome
Patient stands upright with their affected elbow flexed and the arm at 180 degrees. The physician supports the shoulder with one hand and firmly rotates the affect arm below the horizontal with the other hand. Pain indicates a positive test.
Drop arm test
Test for a rotator cuff tear
Patient is asked to hold their arm straight out horizontally at 180 degrees. Then, they are asked to slowly and smoothly lower their arm to their side.
A patient with a rotator cuff tear will be be unable to complete the smooth pursuit and the arm will “drop” at some point, along with pain. This indicates a positive test.
Belly-press test
Patient puts the hand of their affected arm on their belly. They are then asked to push on their belly without moving their arm.
Failure to maintain the elbow anterior to the midaxillary line during this movement indicates infraspinatus tear.
Lift-off test
Patient places their hand on the small of their back with the palm facing out. The physician pulls the hand out and tells the patient to keep it where it is left.
Failure to keep the hand in place, and resultant falling of the hand back onto the small of the back, indicates a subscapularis tear.
Empty can test (aka Jobe test)
Patient holds their arms outright in the “empty can” position
Ths physician stabilizes the joint with one hand and presses down at the forearm with the other hand.
Pain and weakness indicates a supraspintatus tear.
Adduction and External Rotation test
The patient stands with their elbow flexed and forearm facing forward at the horizontal. The physician passively rotates their forearm to full external rotation, then releases.
Failure of the patient to maintain full external rotation indicates either a supraspinatus or infraspinatus tear
Hornblower’s Test
The patient places their affected arm in pitching position (probably already hard if they have a rotator cuff tear).
The physician places two fingers on the posterior aspect of the wrist and pushes the arm forward. The patient resists with external rotation. A positive test is indicated by failure to resist this force and elevation of the shoulder. This indicates a tear in the infraspinatus or teres minor (the external rotators).
Ottawa Ankle Rules (abbreviated)
X-ray if the patient has pain over a malleolus AND one of the following:
- Tenderness at the posterior border or tip of the lateral malleolus
- Tenderness at the posterior border or tip of the medial malleolus
- Inability to bear weight
