NMS 2 Flashcards
Trendelenburg test
patient stands and raises one foot and then the other while the doctor observes the butt
positive: butt on foot that is elevated drops
indicates: hip abductor weakness on stance leg side
ely’s sign
patient side lying, involved side up. doctor places one hand on plevis. thigh is abducted and extended. the doctor then alows the leg to drop into adduction
positive: knee stays elevated
indicates: TFL contracture
barlow’s
bone with baby’s hip in adduction, in which gentle posterior pressure is placed on each hip, one at a time
positive: deep sounding “thunk” as ball subluxates out of socket
ortolani’s
infant supine. legs are abducted and externally rotated
positive: palpable or audible click
indicates: congenital hip dislocation
allis
patient supine. patient flexes both knees to 90 degrees with feet placed flat on table and both maleoli are approximated. doctor compares height of knees
positive: significant difference
indicates; posterior displaced femoral head or femur shortening
thomas test
while the patient is supine the thigh is flexed with knee bent upon the abdomen
positive: oppostive thigh/knee rises off table
indicates hip flexion contracture (psoas)
laguerre’s test (patrick fabre in air)
patient supine, doctor flexes, abducts and laterally rotates hip. doctor then aplies pressure over oppositve ASIS with one hand and with other hand presses down knee
positive: pain inhip
indicates: hip joint lesion, SI lesion
patrick’s test (fabre’s)
patient supine. thigh is flexed, abducted, externally rotated and extended while downward pressure is placed on opposite ASIS and same knee
positive: pain inhip
indicates: hip lesion
yeoman’s
doctor stabilizes SI joint esting with other hand. doctor flexes leg of affected side and hyperextends the thigh by lifting knee off table
nachlas test
leg flexed to 90. heel approxiated to same butt. doctor stabilzes side they are testing
positive: pain in SIjoint
indicates: SI lesion or if pain is on anterior thigh: femoral nerve stretch
hibb’s
doctor stabilizes pelvis on side they are standing. with other and, doctor grasps the ankle of the opposite leg and flexes kee to 90 degrees. doctor slowly pushes leg laterally away producing internal rotation of the hip
pain in femur- hip pathology
iliac compression
patient is in side-lying position with involved side up. doctor’s hands are placed over the upper part of the iliac crest. doctor exerts donward pressure
lewin-gaenslen’s
patient lies on unafffected side and pulls lower knee to chest. doctor stands behind patient stabilizes pelvis and hyperextends the top thigh
hip abduction stress test
patient is lying on non affected side. patient actively abducts leg, then doctor exerts downward pressure proximal to knee
positive: pain at PSIS
indicates: SI joint problems, glute medius weaknesss
minor’s sign
ask patient to rise from seated position
positive: patient will support body with uninvolved side balancing on good side
indicates: sciatica
becterew’s sitting test
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
positive: pain or leaning back
indicates: disc, posteromedial disc if pain when good leg raised
neri’s bowing
when bending forward from waist the knee flexes on side of involvement
positive: knee bucking
indicates: tight hamstring (disc problem, SI sprain/strain, lumbosacral lesions)
kemp’s
patient seated/standing and supported by doc. doctor rotates patient’s trunk from the original position and circumducts the trunk otward the affected side and then away from the affected side
positive: sciatic pain down involved side
indicates: posteromedial disc(kemp’s away from pain), posterolateral disc(kemp’s into pain, localized pain(facet)
belt test AKA supported adam’s test
patient bends forward and the examiner notes when the pain occurs. then while doctor is behind the patient the doctor grasps the ASIS and braces their hip into the sacrum. the patient then flexes again and ROM is noted.
if lesion is in pelvis, patient will have no pain while pelvis is stabilized
lesion is in the spine, pain will present in both situations
bonnet’s sign
when the patient supine the doctor stands on side being tested. doctor internally rotates leg, adducts leg, then performs SLR
positive: radicular pain into limb
indicates: piriformis syndrome
bowstring sign
doctor performs an SLR to the point of pain. knee is flexed slightly and placed on doctor’s shoulder. digital pressure is placed above the popliteal fossa and then in the popliteal fossa
positive: apin in lumbar region or radiculopathy
indicates: sciatica
lindner’s sign
patient’s head is pasivley flexed to chest
positive: pain in lumbar region radiating to sciatic nerve
indicates: root sciatica
goldthwait’s
patient supine with affected leg raised slowly while hand is under lumbosacral portion of spine. repeat on other side
positive: pain
indicates: 0-30:SI, 30-60:lumbosacral, 60-90: lumbar spine or contralateral SI
milgram’s
patient is supine with limbs extended. patient is aske dto elevate legs until 6 inches off table and hold for as long as possible
positive: pain
indicates SOL
WLR (fajerstazn’s)
SLR with dorsiflexion of foot is performed on asymptomatic side of sciatic patient
positive: pain down symptomatic side
indicates: medial disc lesion
turyn’s sign
while the patient is in the supine position, doctor dorsiflexes big toe
psotivie: pain in affected leg
indicates; sciatica
sicard’s sign
perform SLR, drop 5 degrees and dorsiflex big toe
postive: pain in affected leg
indicates: sciatica
braggard’s sign
after pain is elicited with SLR, the leg is lowered below the point of discomfort and the foot is sharply dorsiflexed
positive: pain in affected leg
indicates: sciatica
SLR
patient is supine with legs extended. doctor places one hand under heel and other over knee and slowly raises leg
postive: pain down affected side
indicates: sciatica, disc, lumbar lesion
finkelstein’s test
patietn is asked to make a fist with thumb tucked inside. fist is then ulnar deviated
evaluates: extensor pollicis brevis and abductor pollicis longus
positive: pain over anatomical snuff box
indicates: dequervain’s dx AKA stenosing tenosynovitis
froment’s
doctor places a piece of paper etween the patient’s thumb and index fingers and attempts to pull paper out
positive: unable to keep paper between fingers
indicates: ulnar nerve palsy
phalen’s sign
patient flexes the wrists maximally and hold position for up to 60 seconds by pushing both wrists together
positive: tingling into first 3 digits of hand
indicates: CTS
tinel sign at wrist
percuss over flexor retinaculum of wrist of the tunnel of guyon
positive: tingling into lateral 3 fingers or medial 2 fingers
indicates: CTS, ulnar nerve impingement
mill’s test
patient is instructed to extend the forearm, make a fist, flex the wrist and then maximally pronate forearm. this test can be performed pasively by doc
positive: pain lateral elbow
indicates: carpal tunnel syndrome or ulnar nerve impingement
reverse cozen
patient seated with arm close to body. patient makes a fist and flexes wrist with supination. doc resists flexion of wrist while supporting elbow
positive: pain in medial elbow
indicates: medial epicondylitis
cozen’s
patient’s elbow is flexed to 90 degrees with forearm pronated and fist dorsiflexed. doc stabilizes elbow and resists the patient’s dorsiflexion
positive: pain in lateral elbow
indicates: lateral epicondylitis
medial epicondylitis
AKA little leaguer’s elbow, golfer’s elbow
affects flexor carpi ulnaris
pain with flexion of wrist at medial position of elbow
lateral epicondylitis
AKA radiohumeral bursitis, tennis elbow
affects the extensor carpi radialis brevis
pain with extension of wrist and pronation of the elbow
yergason’s test
patient flexes elbow to 90 degrees while seated. doctor palpated bicipetal tendon and resists patient attempt to actively supinate the hand and flex elbow
positive: audible click or snap in the bicipital groove
indicates: bicipital tendon instability
dawbarn’s
deep palpation by doctor over the subaracromial bursa elicits pain. without moving fingers the arm is passively abducted
positive: reduction of pain
indicates: subacromial bursitis
dugas
patient places hand of affected shoulder on opposite shoulder and attempts to touch chest with elbow
positive: unable to perform
indicates: acute shoulder dislocation
apprehension
doctor abducts slowly externally rotates affected shoulder
positive: patient shows signs of apprehension of alarm
indicates: chronic shoulder dislocation
codman’s drop arm
examiner passively abducts arm to aboe 90 then suddenly removes support. makes deltoid suddenly contract causing increased pain
positive: inability to maintain arm position
indicates: supraspinatus tear
elevation of scapula is done by?
traps
levator scapulae
retraction of scapula is done by?
rhomboid major and minor
protraction of scapula is done by?
serratus anterior
rotator cuf muscles of shoulder
supraspinatus
infraspinatus
teres minor
subscapularis
supraspinatus
abduction
suprascapular nerve
inserts at greater tubercle
infraspinatus
external rotation
suprascapular nerve
inserts at greater tubercle
teres minor
external rotation; axillary nerve
inserts at greater tubercle
subscapularis
internal rotation
subscapular nerve
inserts at lesser tubercle
roo’s
patient seated. both arms at 90 degrees then patent abducts and externally rotates them. patient then repeatedly opens and closes the fists for 3-5 minutes
positive: reproduction of symptoms or unusual discomfort
indicates: TOS
bikele’s
patient actively abducts shhould to 90 degrees with elbow flexed to 90 degrees and then extends the shoulder. now patient extends elbow
positive: resistance and increased radicular pain
indicates: TOS, brachial plexus neuritis, meningeal irritation
halstead’s
patient extends the head back. examiner slightly abducts arm then applies downward traction on arm while taking pulse
positive: alteration of amplitude of radial pulse
indicates: cervical rib
reverse bakody
while seated, patient actively places palm on top of head
positive: increase pain
wright’s
hyperabduction maneuver
patient seated while doctor palpates radial pulse. each arm is invididually abducted to 180 degrees. doctor notes angle at which radial pulse diminishes or disappears
positive: if pulses are los with more than 10 degree difference
indicates: pec minor syndrome, axillary artery
costoclavisular manuver
eden’s test
doc palpates radial pulse while drawing patient’s shoulder down and back. patient flexes chin to chest
positive: alteration in amplitude of radial pulse
indicates: subclavian atery, scalenus medius syndrome
modified adson test (scalenus medius test)
with patient seated, doctor slightly abducts, extends and externally rotates arm while taking a radial pulse. patient rotates head away from tested side and extends head. patient takes a deep breath
positive: alteration in amplitude of radial pulse
indicates: cervical rib
adson’s test (scalenus anticus test)
with patient seated, doctor slightly abducts, extends and externally rotates arm while taking a radial pulse. patient rotates head toward tested side and extends head. patient takes a deep breath
positive: alteration in amplitude of radial pulse
indicates: subclavian artery, scalenus medius syndrome
allen’s test
patient is eated with elbow flexed and forearm supinated, ask the patient to pump hand, keep closed while examiner occludes radial and ulnar arteries until hand is blanched. the patient slowly opsn the hand while doc opens one artery and records filling time. repeat with other artery
positive: delay of more than 10 second for blood to return
incidactes: occlusion of rcorresponding artery
naffziger’s
have patient sit erect while doctor holds digital pressure bilaterally over jugular veins or puts a BP cuff around patient’s neck and pumps to 40mmgh, holds for 30 second. if no pain patient is instructed to cough. contraindicated with vascular compromise
positive: pain
indicates: SOL
valsalva
doc asks aptient to take a deep breath and hold while bearing down
postivie: radicular pain
indication: SOL
spurling’s
patient actively maximally rotates and alterall flexes head to affect side. doc delivers a vertical blow to the top of patient’s head
positive: pain in neck,shoulder or arm
indication: SOL
soto hall
with patient supine,doctor places one hand on sternum while passively flexing patient’s head toward chest
postive: localized pain
indicates: fracture (anterior pain), ligament damage (posterior pain)
