NMS orthopedic tests

Question 1

What does a positive Rust sign indicate?

Answer 1

Severe sprain, rheumatoid arthritis, fracture, severe cervical subluxation

Question 2

Rust sign reporting statement:

Answer 2

Rust’s sign is present; this result suggests severe upper cervical instability.

Question 3

Clinical indication for rust sign

Answer 3

• Suggests ligament, muscle damage or possible fracture.

- Note: X-ray patient before performing any other tests.

Question 4

What is Libman’s sign?

Answer 4

Examiner applies thumb pressure to the mastoid process and gradually increases the pressure until the patient states that it is becoming noticeably uncomfortable.

Question 5

What is the reporting statement for libman’s sign?

Answer 5

Libman’s sign demonstrates an unusually low, high, or normal threshold for pain in the patient.

Question 6

Clinical indication for libman’s:

Answer 6

It is useful for interpretation of palpation findings in later exams.

Question 7

What is Rust’s sign?

Answer 7

Patient spontaneously grasps the head with both hands when lying down or when rising from a recumbent position.

Question 8

What is Bakody sign?

Answer 8

The patient will be in a seated position and will place the hand of the affected extremity on top of their head, raising the elbow to the level of the ear.

Question 9

What is the purpose of Bakody sign?

Answer 9

This is a position that the patient will assume if they have severe radicular symptoms.

Question 10

What is the function of Bakody?

Answer 10

This decreases the traction of the lower part of the brachial plexus, and thus pain diminishes. This is a positive Bakody sign/test.

Question 11

Findings for Bakody

Answer 11

• This is a sign that the patient has symptoms of a nerve root irritation. This is as effective as the compression tests and causes the patient a lot less pain.
• NOTE THE LOCATION OF THE PAIN; IT WILL HELP TO IDENTIFY THE ETIOLOGY OF THE PAIN.

Question 12

Reverse Bakody sign findings

Answer 12

The pain of the patient’s chief complaint is exacerbated. This indicates a thoracic outlet syndrome from interscalene compression. REVERSE IS WORSE

Question 13

Negative Bakody sign findings

Answer 13

The patient experiences no change in the pain or there is no pain complaint in the neck and/or arm.

Question 14

Clinical indication of negative Bakody

Answer 14

Differentiate a nerve root (IVF) encroachment from a thoracic outlet syndrome (TOS).

Question 15

Bikele’s sign procedure

Answer 15

The patient is asked to abduct the shoulder to 90 degrees, and then the elbow is put into full extension.

Question 16

Purpose of Bikele’s sign

Answer 16

The patient is being placed in a position that will traction the brachial plexus and its nerve roots.

Question 17

Function of Bikele’s sign

Answer 17

Stressing the brachial plexus

Question 18

Findings for Bikele’s sign

Answer 18

The pain is radicular in nature and goes into the arm. NOTE THE LOCATION OF THE PAIN; IT WILL HELP TO IDENTIFY THE ETIOLOGY OF THE PAIN.

Question 19

Procedure for Brachial Plexus Tension test

Answer 19

The patient is asked to abduct both shoulders to 90 degrees, and place the hands behind the head. The doctor then pulls the elbows back.

Question 20

Purpose for Brachial Plexus Tension test

Answer 20

The patient is being placed in a position that tractions the brachial plexus and its nerve roots.

Question 21

Function for Brachial Plexus Tension test

Answer 21

Stressing the brachial plexus

Question 22

Findings for Brachial Plexus Tension test

Answer 22

The pain is radicular in nature and goes into the arm. NOTE THE LOCATION OF THE PAIN; IT WILL HELP TO IDENTIFY THE ETIOLOGY OF THE PAIN.

Question 23

Other names for Dejerine’s sign

Answer 23

Dejerine’s Triad and Triad of Dejerine

Question 24

Procedure for Dejerine’s sign

Answer 24

Coughing, sneezing and straining during defecation may cause aggravation of radiculitis symptoms. This aggravation is due to the mechanical obstruction (SOL) such as a herniated or protruding IVD, spinal cord tumor or spinal compression fracture.

Question 25

Reporting statement for Dejerine’s sign

Answer 25

Dejerine’s sign is present and suggests a space occupying mass at the C__ level. The course of the radiculitis helps identify the location of the lesion.

Question 26

When is Dejerine’s sign present?

Answer 26

When a SOL exists. (Herniated or protruding intervertebral disc, spinal cord tumor, spinal compression fracture)

Question 27

Clinical indication for Dejerine’s sign

Answer 27

Any sudden increase in intra-thoracic and intra-abdominal pressure blocks the venous flow from the epidural space through the intervertebral veins or a retrograde flow of blood because these veins do not contain valves. The pressure increase causes a distention of the veins in the epidural space, the nerve roots, which may result in pain. NOTE THE LOCATION OF THE PAIN; IT WILL HELP TO IDENTIFY THE ETIOLOGY OF THE PAIN.

Question 28

In what age range would you suspect a disc problem?

Answer 28

25-55

Question 29

Procedure for Valsalva’s maneuver

Answer 29

The doctor stands in front of the seated patient and the patient is asked to take in a breath and bear down as if they were laboring during a strenuous defecation. Patients may become dizzy due to a decreased cerebral blood supply.

Question 30

Purpose for Valsalva’s maneuver

Answer 30

To test for the presence of a SOL within the spinal column that is communicating with the spinal cord meninges.

Question 31

Function of Valsalva’s maneuver

Answer 31

The patient is placing exhalation force against a closed glottis. This increases intra-thecal pressure within the spinal cord.

Question 32

Findings for Valsalva’s maneuver

Answer 32

A sharp accentuation of pain at the level of the lesion usually indicates a SOL.
NOTE THE LOCATION OF THE PAIN; IT WILL HELP TO IDENTIFY THE ETIOLOGY OF THE PAIN.

Question 33

What is the procedure for the Swallowing test?

Answer 33

While seated, the patient is instructed to swallow.

Question 34

Presence of pain or a difficulty swallowing indicates what?

Answer 34

SOL, ligamentous sprain, Muscular strain, Fracture, Disc protrusion, Tumor, Osteophyte at the anterior portion of the cervical spine.

Question 35

Purpose of swallowing test

Answer 35

To evaluate for the indications of the test

Question 36

Reporting statement for Swallowing test

Answer 36

A positive swallowing test indicates that dysphagia is present.

Question 37

Clinical indication for Swallowing test

Answer 37

This result suggests esophageal irritation due to direct trauma or a retroesophageal space occupying lesion.

Question 38

Procedure for Naffziger’s test

Answer 38

The doctor stands behind a seated patient and occludes the external jugular veins at the level of the clavicles for 10-15 seconds. The doctor then asks the patient to cough.

Question 39

Purpose of Naffziger’s test

Answer 39

To create a pooling of the venous sinuses that will cause an increase in cerebral spinal fluid pressure. (intra-thecal)

Question 40

Function of Naffziger’s test

Answer 40

The backing up of venous flow along with the cough accentuates the intra-thecal pressure.

Question 41

Findings for Naffziger’s test

Answer 41

A sharp accentuation of pain at the level of the lesion.

Question 42

What type of patient should you NOT do Naffziger’s test on?

Answer 42

High risk cardiovascular patients.