NMS Flashcards
O’Donohue
can be performed on any joint
patient actively moves against resistance, and then doctor passively moves part through full ROM
positive: pain
indicates: sprain if pain during passive ROM/strain if pain during active ROM
Homan’s sign
don't do in real life patient supine in 90/90 position doctor squeezes calf and dorsiflexes the foot simultaneously positive: deep calf pain indicates: DVT
Dejerine’s triade
patient reporst pain is brought on by coughing, sneezing or straining at stool
indicates:SOL
Schepelmann’s
patient raises both arms over head while seated and laterally bends to both sides
positive/indications: pain on teh concave side is intercostal neuralgia; pain on convexity is is pleurisy or myofascitis, sprain/strain
rust sign
paitent spontaneously grasps head with both hands when rising from recumbent position
indicates: cervical instability due to sprain/strain, fracture, RA
libman’s
doctor applies finger pressure over mastoid process. pressure increased until patient feels discomfort
used to determine pain threshold of patient
lhermitte’s sign
patient seated or supine. patient actively/passively flexes head toward chest
positive: sharp electric shock like sensation down the spine into extremities
indicates: MS, myelopathy, other demyelinating cord lesions
Gower’s sign
when arising from supine position, patient turns to prone position and then climbs up on themselves
indicates muscular dystrophy
Kernig’s sign
patient supine. doctor flexes hip and knee 90/90 position and then attempts to extend knee
positive: patient resists extension; resistence causes kicking motion
Brudzinski’s sign
patient supine. doctor passively flexes patient’s head approximating the chin to chest
positive: buckling of knee
meningeal irritation
patient will present with fever, headache, photophobia, nuchal rigidity
evaluation of CSF: increase in protein indicates viral, decrease in glucose indicates bacterial
amoss sign
patient is asked to go from a side lying position to a seated position
positive: localized thoracolumbar pain &/or lack of ROM
indication: AS, IVD syndrome, severe sprain/strain
lewin supine test
patient supine, doctor supports legs on the table; patient is then asked to sit up without using hands
positive: unable to perform
forrestier’s bowstring sign
while standing the patient performs side bending to both sides
positive: muscle tightening on concave side
chest expansion test
tape measure placed around the 4th intercostal space. patient exhales completely, measurement taken then patient inhales deeply, measurement taken.
normal: 1.5-3 in
positive: <1.5” in women, <2in in men
mannkopf’s sign
doctor takes resting pulse rate. doctor then applies pressure over painfularea and takes pulse rate again
positive: increase of 10 beats per minute
indicates: not a malingerer
magnusson’s
at the beginning of the case history, patient is asked to point to the site of pain on the back; the examiner marks it with a skin pencil. later on, patient is again asked to point to the site of pain
positive: patient doesn’t point to the same spot
lasegue’s sitting
patient is sitting upright on the edge of a table or chair which has no backrest. the 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 that the limb is parallel with the floor
positive: no pain when there has been a +SLR
hoover’s sign
patient supine. doctor places one hand under each heel and asks patient to lift affected limg
positive: doctor doesn’t feel the unaffected side pressing downward
burn’s bench test
patient instructed to kneel on a table 18 inches from the floor, bend forward at the trunk, and touch the floor. doctor holds ankles
positive: patient refuses to perform
thompson’s test
AKA simmond’s sign
patient prone, feet hanging off table, doctor flexes knee to 90 degrees and squeezes calf
positive: no plantar flexion of foot
indicates: achilles tendon rupture
medial/lateral stability test
patient is seated or supine. doctor grasps the patient’s foot and pasively inverts and everts it
positive: excessive gapping
indicates: during inversion: ant. talofibular or calcaneofibular lig tear (add. stress test)
during eversion: deltoid lig tear (abd stress test)
anterior food drawer test
patient supine. doctor places hand around anterior aspect of lower tibia while grasping calcaneous in palm of other hand and then pulls calcaneusforward
positive: talus slides forward
indicates: anterior talofibular ligament instability
posteror ankle drawer test
posterior talofibular ligament instability
grade 1 sprain/strain
no ligamentous tear. slight swelling and decreased ROM
grade 2 sprain/strain
incomplete or partial rupture. lots of swelling, bruising, almost no ROM
grade 3 sprain/strain
complete tear
surgical case
refer to orthopedist
morton’s neuroma
tumor on the nerve MC found between 3 and 4 metatarsal heads
metatarsal stress fracture
march fracture
plantar fasciitis
heel spur pain when walking in morning
improves as day progesses
tarsal tunnel syndrome
pain and burning on sole of foot (medial plantar nerve)
achilles tendon rupture
+ thompson’s AKA simmond’s trauma
pes planus
flat foot
talar head displaces medially and plantarward. exercise orthotics
talipes equinovarus
MC birth defect where heel is elevated and foot is turned inward. also called clubfoot at birth
pes cavus
very high arch toes in flexion. orthotics stretch out
prone to march fracture
noble compression test
patient is supine with leg in the 90/90 position. the doctor applies pressure to the lateral femoral condyle while extending the knee
positive: pain over the area of pressure
indicates: TFL syndrome
dreyer’s test
supine patient is asked to raise their extended leg and is unable to do so. the doctor applies pressure to the quads and the patient can lift the leg
positive: patient can only lift the leg with pressure at the quads
indicates: fractured patella
wilson’s test
the supine patient passively extends the flexed knee to 90 degrees with the tibia internally rotated and knee extended slowly. when 30 degrees is reached the pain increases and is relieved by externally rotating the tibia
positive: pain decreases
indicates: osteochondritis dessicans
clarke’s sign
AKA patellar grinding test
patient is supine with knee extended. doctor applies SI pressure on the superior pole of the patella and then asks the patient to contract the quadricepts
positive: retropatellar pain or inability to sustain the contraction
indicates: contromalacia patella
apprhension test (patella)
patient supine. doctor displaces the patella medial to lateral
positive: patella feels as if it will dislocate and patient will contract the quads, or look of
indicates: chronic patellar dislocation
bounce home test
patient is supine with knee flexed completely. knee is then dropped into extension
positive: incomplete extension
indicates: torn meniscus
apley’s compression test
patient prone with knee flexed to 90. doctor anchors the thigh of the patient and grasps proximal to foot and applies downward pressure and rotates leg internally and externally. heel points toward side being tested
positive: pain in knee
indicates: meniscal tear (medial or lateral
McMurray sign
patient supine. doctor flexes the thigh and leg to 90 degrees. the doctor places one hand on the knee, the other grasps the patient’s heel. doc externally rotates the leg, and then slowly extends the knee. doc then interally rotates the leg and brins it into extnesion with a valgus stress to the joint
positive: painful click or snap heard
indicates: internal rotaion checks lateral meniscus, external rotation checks medial meniscus
posterior sag sign
patient is supine with knees flexed to 90 degrees and hips flexed to 45 degrees. doctor compares the prominence of the tibial tuberosities
positive: tibia drops back (sags) on the femur
indicates: PCL tear
lachman’s test
patient is supine, knee flexed to 30 degrees, the doc stabilizes the femur with one hand and pulls the tibia forward with other hand
positive: soft end feel
indicates: ACL instability
slocum’s test
patient supine. knee is flexed to 90 degrees, foot is put in internal/external rotation. doctor stabilizes foot and grasps the leg with thumbs palpating the knee joint. doctor pulls tibia applying PA stress in knee
drawer test
patient supine. knee flexed to 90 degrees and hip to 45 degrees. doctor stabilizes foot on table. tibia is then drawn forward/posterior
positive: pain or joint laxity
indicates: anterior (pulling P-A) ACL
posterior (pushing A-P) PCL
apley’s distraction test
patient prone with knee flexed to 90 degrees. doctor anchors the thigh of the patient and grasps proximal to foot and applies upward pressure and rotates leg internally and externally. heel points toward side being tested
positive: pain in knee
indicates: collateral ligament tear
adduction stress test
varus stress test
patient supine. doctor applies varus stress to knee while adducting the foot in full extension and at 30 degrees flexion
positive: pain, increased laxity
indicates: LCL involved
abduction stress test
valgus stress test
patient supine. doctor applies valgus stress to knee while abducting the foot in full extension and at 30 degrees flexion
positive: pain increased
indicates: MCL involved
TLF syndrome
lateral knee pain caused from shortened TFL. seen in runners and made worse by walking or running up/down hills or down/up stairs
jumper’s knee
patellar tendonitis
housemaid’s knee
prepatellar bursitis after repetitive pressure on knee
osteochondritis dessicans
AVN, knee locks out on extension
wilson’s test
osgood schlatter’s
avulsion of the tibial tuberosity in athletes doing repetitive knee extension
chondromalacia patella
AKA patellofemoral tracking disorder, runner’s knee
patella is being pulled laterally by the vastus lateralis muscle. walking downstairs is most provocative
causes retropatellar DJD
tests: clark’s, fouchet’s
meniscal tear
swelling will occur 12-24 hours post injury
unable to lock out (joint line)
ligament tear
swelling and pain will occur immediately following injury (intra-articular)
