NMS practical 1- Orthopedic tests

Question 1

What are the 3 categories of ROM you can assess?

Answer 1

Active, passive, Resisted

Question 2

Normal Cervical flexion and extension?

Answer 2

Chin to chest (within 2 finger widths) or 50-60 degrees; 60-75 degrees of extension (able to look at ceiling)

Question 3

Cervical lateral flexion?

Answer 3

45 degrees (halfway to shoulder)

Question 4

Cervical rotation ROM?

Answer 4

80 degrees, chin to mid clavicular line

Question 5

Cervical Flexion assessment guidelines?

Answer 5

Patient seated- sit tall, legs together, feet flat on floor
One inclinometer on SP of T1
One inclinometer on superior occiput
Adjust to zeros
Instruct patient to move chin to chest
Document difference between inclinometers

Question 6

Cervical Extension assessment guidelines?

Answer 6

Patient seated- sit tall, legs together, feet flat on floor
One inclinometer on the spine of scapula
One inclinometer on superior occiput
Adjust to zeros
Instruct patient to lift chin to ceiling keeping trunk straight
Document difference between inclinometers

Question 7

How would you assess for cervical rotation?

Answer 7

1. Patient supine, make sure headrest is in neutral
2. Place one inclinometer in the middle of the patient’s forehead
3. Adjust inclinometer to read zero degrees
4. Instruct the patient to turn their head slowly as far a possible
5. Record and document the degrees at the end range position

Question 8

How would you assess Thoracic spine ROM using 2 inclinometers?

Answer 8

Patient standing, ask them to stand tall, feet together
One inclinometer at C&-T1, 2nd at T12-L1
Ask the patient to move through chosen ROM

Flexion- 20-45
Extension- 25-35
Lat Flexion- 20-40
Rotation- 35-50

Question 9

How would you assess thoracic flexion?

Answer 9

• Patient standing, ask them to stand tall and feet together
• Place one inclinometer over the spinous process of T1
• Adjust inclinometer to read zero degrees
• Place a second inclinometer over the spinous process of L1
• Adjust inclinometer to read zero degrees
• Instruct the patient to bow forward keeping their low back straight
• Record the degrees of both inclinometers at end range
• Document the difference between the two inclinometers

Question 10

How would you assess thoracic extension?

Answer 10

1. Patient standing, stand tall, feet together
2. Place one inclinometer over the spinous process of T1
3. Place a second inclinometer over the spinous process of L1
4. Adjust inclinometers to read 0
5. Instruct the patient to bend backwards keeping their low back straight
6. Record the degrees of both inclinometers at end range
7. Document difference between the two inclinometers

Question 11

How do you assess Thoracic lateral flexion?

Answer 11

1. Patient standing, stand tall, feet together
2. Place one inclinometer over the spinous process of T1
3. Place a second inclinometer over the spinous process of L1
4. Adjust inclinometers to read 0
5. Instruct the patient to bend to one side as far as possible
6. Record the degrees of both inclinometers at end range
7. Document difference between the two inclinometers

Question 12

Explain how to assess thoracic rotation

Answer 12

1. Patient is in a low quadruped position resting their hips on their heels and upper body on their forearms. Get them as closed packed as possible
2. Place one inclinometer over the spinous process of T1
3. Place a second inclinometer over the spinous process of L1
4. Adjust the inclinometers to read zero degrees
5. Instruct the patient to bend to one side as far as possible
6. Record the degrees of both inclinometers at end range
7. Document difference between the two inclinometers

Question 13

How do you assess Lumbar flexion?

Answer 13

• Patient standing, instruct them to stand tall, feet together
• Place one inclinometer over the spinous process of L1
• Place a second inclinometer over the spinous process of S2
• Adjust inclinometers to read zero degrees
• Instruct the patient to bow forward keeping their legs straight
• Record the degrees of both inclinometers at end range
• Document the difference between the two inclinometers

Question 14

How do you assess Lumbar extension?

Answer 14

• Patient standing, instruct them to stand tall, feet together
• Place one inclinometer over the spinous process of L1
• Place a second inclinometer over the spinous process of S2
• Adjust inclinometers to read zero degrees
• Instruct the patient to bend backwards
• Record the degrees of both inclinometers at end range
• Document the difference between the two inclinometers

Question 15

How do you assess lumbar lateral flexion

Answer 15

1. Patient standing, instruct to stand tall, feet together
2. Place one inclinometer over the spinous process of L1
3. Place a second inclinometer over the spinous process of S2
4. Adjust inclinometers to read zero degrees
5. Instruct the patient to bend to one side as far as possible
6. Record the degrees of both inclinometers at end range
7. Document difference between the two inclinometers

Question 16

Name that test-
Procedure:
* Practitioner passively rotates the patient’s head as far as possible to patient’s comfort
* Instruct patient to bring their chin to their chest
* 20 degrees of occipital flexion is considered normal
Interpretation:
* If the patient can successfully nod their head 20 degrees, the lower cervical spine is most likely responsible for the restriction
* If the patient cannot nod their head 20 degrees, the upper cervical spine is most likely responsible for the restriction

This test is used when a cervical flexion restriction is identified and helps to differentiate between upper and lower cervical dysfunction.

Answer 16

Active Supine Occipito-Atlantal Cervical Flexion test

Question 17

Active Supine Occipito-Atlantal Cervical Flexion test- how is it performed?

Answer 17

Procedure:
* Practitioner passively rotates the patient’s head as far as possible to patient’s comfort
* Instruct patient to bring their chin to their chest
* 20 degrees of occipital flexion is considered normal
Interpretation:
* If the patient can successfully nod their head 20 degrees, the lower cervical spine is most likely responsible for the restriction
* If the patient cannot nod their head 20 degrees, the upper cervical spine is most likely responsible for the restriction

This test is used when a cervical flexion restriction is identified and helps to differentiate between upper and lower cervical dysfunction.

Question 18

Cervical Flexion Rotation Test- how is it performed?

Answer 18

Procedure:
* Practitioner passively flexes the cervical spine maximally and supports the patient’s head in this position
* Instruct the patient to rotate head to one side
* Rotation should be 45 degrees
* Repeat test on other side Interpretation:
* Pain during the first 45 degrees is indicative of upper cervical involvement
* If the patient can successfully rotate their head 45 degrees, the lower cervical spine is
most likely responsible for the restriction
* If the patient cannot rotate their head 45 degrees, the upper cervical spine is most likely responsible for the restriction

Question 19

Name this test-
Procedure:
* Practitioner passively flexes the cervical spine maximally and supports the patient’s head in this position
* Instruct the patient to rotate head to one side
* Rotation should be 45 degrees
* Repeat test on other side Interpretation:
* Pain during the first 45 degrees is indicative of upper cervical involvement
* If the patient can successfully rotate their head 45 degrees, the lower cervical spine is
most likely responsible for the restriction
* If the patient cannot rotate their head 45 degrees, the upper cervical spine is most likely responsible for the restriction

Answer 19

CERVICAL FLEXION ROTATION TEST

Question 20

What are the two common testing protocols?

Answer 20

1.Test the unaffected side first to establish a comparison of results

2. Any response of pain should be followed by a line of questioning.
   * Where is the pain?
   * What kind of pain?
   * Rate (quantify) the pain?
   * Does the pain radiate?

Question 21

When pain is a finding, what is your follow up?

Answer 21

What
Where
Rate
Radiate

Question 22

Name this test-
Procedure:
* Patient is sitting
* Patient performs active range of motion. Examiner makes note of any painful motions
* Examiner then moves the patient’s head passively through each range of motion
* Examiner make note of any painful motions
* The patient maintains head in a neutral position while examiner applies overpressure in all three planes of motion forcing isometric contractions
Interpretation of Findings:
* Pain during active or resisted range of motion signifies muscle strain
* Pain during passive range of motion signifies ligamentous sprain

Answer 22

O’Donoghue Maneuver

Question 23

How do you perform O’Donoghue Maneuver?

Answer 23

Procedure:
* Patient is sitting
* Patient performs cervical active range of motion. Examiner makes note of any painful motions
* Examiner then moves the patient’s head passively through each range of motion
* Examiner make note of any painful motions
* The patient maintains head in a neutral position while examiner applies overpressure in all three planes of motion forcing isometric contractions
Interpretation of Findings:
* Pain during active or resisted range of motion signifies muscle strain
* Pain during passive range of motion signifies ligamentous sprain

Question 24

What test is this?
Procedure:
* Patient is seated
* Patient is looking forward
* The clinician applies axial compression downward on the head with the head in neutral.
Interpretation of Findings:
* A positive test is radiating pain into the arm(s) or local pain in the spine
* Test is indicative of nerve root compression due to foraminal stenosis, osteophytes; a space occupying lesion (i.e. herniated disc, fracture, tumor), or facet encroachment.

Answer 24

Cervical/Axial Compression Test

Question 25

How does one perform the Cervical/Axial Compression Test?

Answer 25

Procedure:
* Patient is seated
* Patient is looking forward
* The clinician applies axial compression downward on the head with the head in neutral.
Interpretation of Findings:
* A positive test is radiating pain into the arm(s) or local pain in the spine
* Test is indicative of nerve root compression due to foraminal stenosis, osteophytes; a space occupying lesion (i.e. herniated disc, fracture, tumor), or facet encroachment.

Question 26

What is the Jackson Cervical Compression Test?

Answer 26

Procedure:
* Patient is seated
* Patient is looking forward
* The clinician laterally flexes the patient’s head towards the side of testing
* The clinician applies axial compression to the head
* The test is then repeated with the head laterally flexed toward the involved side
Interpretation of Findings:
* A positive test is radiating pain into the arm which the head is laterally flexed towards
* Test is indicative of nerve root compression due to foraminal stenosis, osteophytes, space occupying lesion, herniated disc, fracture
* Local neck pain on the side the head is flexed towards is indicative of facet joint encroachment.

Question 27

What test is this?
Procedure:
* Patient is seated
* Patient is looking forward
* The clinician laterally flexes the patient’s head towards the side of testing
* The clinician applies axial compression to the head
* The test is then repeated with the head laterally flexed toward the involved side
Interpretation of Findings:
* A positive test is radiating pain into the arm which the head is laterally flexed towards
* Test is indicative of nerve root compression due to foraminal stenosis, osteophytes, space occupying lesion, herniated disc, fracture
* Local neck pain on the side the head is flexed towards is indicative of facet joint encroachment.

Answer 27

Jackson Cervical Compression Test

Question 28

Name this test-
Procedure:
* Patient is seated
* Patient is instructed to extend their head
* Laterally flex toward the affected side
* Compress axially (S-I)
* Repeat the procedure to the side of complaint
Interpretation of Findings:
* The patient notes any pain or paresthesia and the distribution thereof.
* This maneuver closes the intervertebral foramina on the side of the lateral flexion and reproduces the patient’s pain or radiculopathy indicating nerve root compression

Answer 28

Modified Spurling’s

Question 29

how do you perform Modified spurling’s? what does it indicate?

Answer 29

Procedure:
* Patient is seated
* Patient is instructed to extend their head
* Laterally flex toward the affected side
* Compress axially (S-I)
* Repeat the procedure to the side of complaint
Interpretation of Findings:
* The patient notes any pain or paresthesia and the distribution thereof.
* This maneuver closes the intervertebral foramina on the side of the lateral flexion and reproduces the patient’s pain or radiculopathy indicating nerve root compression

Question 30

How is the Maximum Cervical Compression Test performed?

Answer 30

Procedure:
* Patient is seated
* Patient is instructed extend, laterally flex, and
rotate towards the side of testing
* The test is performed bilaterally
Interpretation of Findings:
* Pain on the concave side indicates nerve root (radiating symptoms) or facet involvement (local pain).
* Pain on the convex (muscle stretch) side indicates muscular strain

Question 31

What test is this?
Procedure:
* Patient is seated
* Patient is instructed extend, laterally flex, and
rotate towards the side of testing
* The test is performed bilaterally
Interpretation of Findings:
* Pain on the concave side indicates nerve root (radiating symptoms) or facet involvement (local pain).
* Pain on the convex (muscle stretch) side indicates muscular strain

Answer 31

Maximum Cervical Compression Test

Question 32

What test is this?

Patient is laying supine and is passive through this test.
Procedure-
1. examiner depresses the patient’s scapula/shoulder. Pins in place with medial hand
Using their lateral hand the examiner grips the patient’s palm/fingers.
2. Shoulder abduction
3. Forearm supination, wrist and finger extension
4. Shoulder ER
5. Elbow Extension
6. Contralateral side bend
7. Ipsilateral side bend

Interpretation of findings-
Positive test is a reproduction of the patient’s symptoms. Indicates median nerve entrapment (C5-C7)

Answer 32

Upper Limb Tension Test (ULTT)

Question 33

How do you perform the Upper Limb Tension Test (ULTT)? What does it indicate?

Answer 33

Patient is laying supine and is passive through this test.
Procedure-
1. examiner depresses the patient’s scapula/shoulder. Pins in place with medial hand
Using their lateral hand the examiner grips the patient’s palm/fingers.
2. Shoulder abduction
3. Forearm supination, wrist and finger extension
4. Shoulder ER
5. Elbow Extension
6. Contralateral side bend
7. Ipsilateral side bend

Interpretation of findings-
Positive test is a reproduction of the patient’s symptoms. Indicates median nerve entrapment (C5-C7)

Question 34

What test is this?
Procedure:
* Patient is seated
* Examiner stands behind patient
* Examiner grasps beneath the mastoid processes and lifts vertically.
Interpretation of Findings:
* This pressure removes the weight of the patient’s head from the neck.
* Generalized, increased pain indicates muscle spasm or sprain/strain.
* Relief of pain indicates intervertebral foraminal encroachment or facet capsulitis. Secondary indications are nerve root compression or pressure on apophyseal joints.

Answer 34

Cervical Distraction Test

Question 35

How do you perform the Cervical Distraction Test? What does it indicate?

Answer 35

Procedure:
* Patient is seated
* Examiner stands behind patient
* Examiner grasps beneath the mastoid processes and lifts vertically.
Interpretation of Findings:
* This pressure removes the weight of the patient’s head from the neck.
* Generalized, increased pain indicates muscle spasm or sprain/strain.
* Relief of pain indicates intervertebral foraminal encroachment or facet capsulitis. Secondary indications are nerve root compression or pressure on apophyseal joints.

Question 36

What test is this?

Procedure:
* Patient is seated
* The patient rotates the head to the uninvolved side.
* The examiner then carefully presses straight down on the head
* The test is repeated with the head rotated to the involved side.
Interpretation of Findings:
* The test is positive if pain radiates into the arm
* A positive test indicates nerve root compression.

Answer 36

Foraminal Compression test

Question 37

How do you perform the Foraminal Compression test? what does it indicate?

Answer 37

Procedure:
* Patient is seated
* The patient rotates the head to the uninvolved side.
* The examiner then carefully presses straight down on the head
* The test is repeated with the head rotated to the involved side.
Interpretation of Findings:
* The test is positive if pain radiates into the arm
* A positive test indicates nerve root compression.

Question 38

How do you perform the shoulder abduction relief test? What is another name for it?

Answer 38

Procedure:
* While in the seated position, the patient actively places the palm of the affected extremity on top of the head, raising the elbow to a height approximately level with the head
Interpretation of Findings:
* By elevating the suprascapular nerve, traction of the upper trunk of the brachial plexus is relieved
* Overall, this maneuver decreases stretching of the compressed nerve root.
* The sign is present when the radiating pain is lessened or disappears with this maneuver.
* The test is as reliable as Spurling test and is less painful for the patient to endure.
* A cervical nerve root compression is suggested by a positive Bakody sign

Question 39

What test is this?
Procedure:
* While in the seated position, the patient actively places the palm of the affected extremity on top of the head, raising the elbow to a height approximately level with the head
Interpretation of Findings:
* By elevating the suprascapular nerve, traction of the upper trunk of the brachial plexus is relieved
* Overall, this maneuver decreases stretching of the compressed nerve root.
* The sign is present when the radiating pain is lessened or disappears with this maneuver.
* The test is as reliable as Spurling test and is less painful for the patient to endure.
* A cervical nerve root compression is suggested by a positive sign

Answer 39

shoulder abduction relief test aka Bakody’s sign

Question 40

What test is described below?

Procedure:
* With the patient seated, the examiner laterally flexes the cervical spine away from that shoulder then depresses the patient’s shoulder on the affected side
Interpretation of Findings:
* This sign is positive if radicular pain is produced or aggravated. This indicates adhesions of the dural sleeves, spinal nerve roots, or adjacent structures of the joint capsule of the shoulder.

Answer 40

Shoulder Depression Test

Question 41

How do you perform the shoulder depression test? It indicates what?

Answer 41

Procedure:
* With the patient seated, the examiner laterally flexes the cervical spine away from that shoulder then depresses the patient’s shoulder on the affected side
Interpretation of Findings:
* This sign is positive if radicular pain is produced or aggravated. This indicates adhesions of the dural sleeves, spinal nerve roots, or adjacent structures of the joint capsule of the shoulder.

Question 42

What test is this?

Procedure:
* With the patient seated and the head slightly flexed, the examiner percusses the spinous processes and associated musculature of each of the cervical vertebra with a neurologic reflex hammer
Interpretation of Findings:
* Evidence of localized pain indicates a possible fractured vertebra.
* Evidence of radicular pain indicates a possible disc lesion.
* Because of the nonspecific nature of this test other conditions will also elicit a positive pain response.
* A ligamentous sprain will cause pain when the spinous processes are percussed.

Answer 42

Spinal Percussion Test

Question 43

How do you perform the Spinal Percussion Test? What does this indicate?

Answer 43

Procedure:
* With the patient seated and the head slightly flexed, the examiner percusses the spinous processes and associated musculature of each of the cervical vertebra with a neurologic reflex hammer
Interpretation of Findings:
* Evidence of localized pain indicates a possible fractured vertebra.
* Evidence of radicular pain indicates a possible disc lesion.
* Because of the nonspecific nature of this test other conditions will also elicit a positive pain response.
* A ligamentous sprain will cause pain when the spinous processes are percussed.

Question 44

What is Rust Sign?

Answer 44

If the patient spontaneously grasps the head with both hands when lying down or when arising from a recumbent position, this is a positive sign that indicates instability due to possible sprain, rheumatoid arthritis, fracture, or severe cervical subluxation

Question 45

How do you perform a Valsalva Maneuver? What does a positive sign indicate?

Answer 45

Procedure:
* The patient inhales deeply and holds their breath, while bearing down abdominally

Interpretation of Findings:
* A positive test is indicated by increased pain caused by increased intrathecal pressure.
* Increased intrathecal pressure is usually caused by a space- occupying lesion (herniated disc, tumor, osteophytes).
* The test should be performed with care and caution. Procedure can block the blood supply to the brain.

Question 46

What test is this?
Procedure:
* The patient inhales deeply and holds their breath, while bearing down abdominally

Interpretation of Findings:
* A positive test is indicated by increased pain caused by increased intrathecal pressure.
* Increased intrathecal pressure is usually caused by a space- occupying lesion (herniated disc, tumor, osteophytes).
* The test should be performed with care and caution. Procedure can block the blood supply to the brain.

Answer 46

Valsalva maneuver

Question 47

What is Dejerine sign?

Answer 47

Procedure:
* Coughing, sneezing, and straining during defecation may aggravate radiculitis symptoms
Interpretation of Findings:
* This aggravation results from the mechanical obstruction of spinal fluid flow.
* Is present when one of the following space occupying lesions exists: herniated or protruding intervertebral disc, spinal cord tumor, or spinal compression fracture.
* The course of the radiculitis helps identify the location of the lesion

Question 48

What test is this?
Procedure:
* Coughing, sneezing, and straining during defecation may aggravate radiculitis symptoms
Interpretation of Findings:
* This aggravation results from the mechanical obstruction of spinal fluid flow.
* Dejerine sign is present when one of the following space occupying lesions exists: herniated or protruding intervertebral disc, spinal cord tumor, or spinal compression fracture.
* The course of the radiculitis helps identify the location of the lesion

Answer 48

Dejerine sign

Question 49

Lhermitte Sign is what?

Answer 49

Procedure:
* The patient is seated on the examining table
* The patient’s head is passively flexed
Interpretation of Findings:
* Electric shock sensation down the neck indicates multiple sclerosis
* A sharp pain radiating down the spine and into the upper or lower limbs is a positive finding for cord pathology
* Dural irritation, tumor, or dens fracture all possible implications.

Question 50

Name this test-
Procedure:
* The patient is seated on the examining table
* The patient’s head is passively flexed
Interpretation of Findings:
* Electric shock sensation down the neck indicates multiple sclerosis
* A sharp pain radiating down the spine and into the upper or lower limbs is a positive finding for cord pathology
* Dural irritation, tumor, or dens fracture all possible implications.

Answer 50

Lhermitte Sign

Question 51

What is Brudzinski Sign? What does it indicate?

Answer 51

Procedure:
* The patient is supine
* examiner passively flexes the patient’s head
Interpretation of Findings:
* The sign is present if flexion of both knees occurs
* The sign is often accompanied by flexion of both hips and is present with meningitis.

Question 52

What test is this describing?

Procedure:
* The patient is supine
* examiner passively flexes the patient’s head
Interpretation of Findings:
* The sign is present if flexion of both knees occurs
* The sign is often accompanied by flexion of both hips and is present with meningitis.

Answer 52

Brudzinski Sign

Question 53

What is Soto-Hall Sign?

Answer 53

Procedure:
* The patient is placed supine
* The examiner places one hand on the sternum of the patient and exerts slight pressure so that no flexion can take place at either the lumbar or thoracic regions of the spine
* The examiner places the other hand under the patient’s occiput and flexes the head toward the chest
Interpretation of Findings:
* The test is used primarily when fracture of a vertebra is suspected.
* A positive result (noticeable local pain)indicates subluxation, exostoses, disc lesion, sprain or strain, vertebral fracture, or meningeal irritation (an elevated temperature must exist for corroboration).

Question 54

Name this test-
Procedure:
* The patient lies supine
* Chin is maximally retracted by the patient
* Maintaining chin tucked instruct the patient to lift their head and neck approximately 2 to 5 cm (1 inch) above the examining table.
* The examiner places a hand on the table under the patient’s head (occiput).
* The examiner watches the skin folds resulting from the chin tuck and neck flexion. As soon as the skin folds separate (due to loss of chin tuck) or the patient’s head touches the examiner’s hand, the test is terminated.
Interpretation:
* Establish a strength/endurance baseline. Inability to maintain position for at least 39 seconds for males, 29 seconds for females indicates weak deep neck flexor group.

Answer 54

DEEP NECK FLEXOR ENDURANCE TEST

Question 55

How do you perform the deep neck flexor endurance test?

Answer 55

Procedure:
* The patient lies supine
* Chin is maximally retracted by the patient
* Maintaining chin tucked instruct the patient to lift their head and neck approximately 2 to 5 cm (1 inch) above the examining table.
* The examiner places a hand on the table under the patient’s head (occiput).
* The examiner watches the skin folds resulting from the chin tuck and neck flexion. As soon as the skin folds separate (due to loss of chin tuck) or the patient’s head touches the examiner’s hand, the test is terminated.
Interpretation:
* Establish a strength/endurance baseline. Inability to maintain position for at least 39 seconds for males, 29 seconds for females indicates weak deep neck flexor group.

Question 56

What is proper positioning and technique is mmt testing the Deep Neck Flexors?

Answer 56

Patient Position:
* Supine
* Shoulders in 90 degrees of abduction and external rotation and elbows at 90 degrees of flexion
* Patient lifts head with the chin tucked (occipital flexion) towards sternum
Pressure:
* Contact patient’s forehead * Apply A-P pressure

++ Chin needs to stay tucked

Question 57

How do you perform a MMT for the SCM and Scalenes?

Answer 57

Patient Position:
* Supine
* Shoulders in 90 degrees of abduction and external rotation and elbows at 90 degrees of flexion
* Head turned to side opposite of testing
* Patient lifts head off table keeping shoulders flat
Pressure:
* Contact temporal region
* Apply A-P and L-M pressure

Question 58

How do you perform a MMT for the Posterolateral Neck Extensors?

Answer 58

Patient Position:
* Prone
* Shoulders in 90 degrees of abduction and external rotation and elbows at 90 degrees of flexion
* Patient looks toward the side of testing
Pressure:
* Contact the posterolateral occiput * Apply L-M and P-A pressure

Muscles tested-
Ipsilateral- splenius capitis and cervicis, semispinalis
capitis and cervicis, cervical spinal erectors
Contralateral- Upper Trapezius

Question 59

How do you perform an isolated MMT for the upper Trapezius?

Answer 59

Patient Position:
* Seated or prone
* Head turned to side opposite of testing
* Patient elevates same side shoulder, approximating occiput and acromion process
Pressure:
* Contact #1
* posterior occiput
* Apply P-A and L-M pressure
* Contact #2
* Acromion process
* Apply S-I pressure(depressing shoulder)

Question 60

What test is this describing?
The patient is seated and instructed to make a tight fist to express blood from the palm. The examiner uses finger pressure to occlude the radial and ulnar arteries
* The patient opens and closes the fist to express any remaining blood The examiner releases the arteries one at a time
* The sign is negative if the pale skin of the palm flushes immediately after an artery is released.
* The sign is positive if the skin of the palm remains blanched for more than 5 seconds.

Answer 60

Allen’s Test for patency of radial and ulnar arteries

Question 61

What are the 4 Thoracic Outlet Syndrome Tests?

Answer 61

Roos Test
Adson’s test
Wright’s Test (hyperabduction test)
Costoclavicular Maneuver

Question 62

what is the Scalenus Anticus/Adson’s test?

Answer 62

Procedure:
* The examiner locates the radial pulse of the involved extremity
* The patient’s head is extended and rotated to the involved
extremity
* The examiner externally rotates and extends the patient’s shoulder.
* The patient is instructed to inhale deeply and hold their breath
Interpretation of Findings:
* Loss of the pulse and/or reproduction of patient’s arm symptoms is considered a positive test indicative of compression of the neurovascular bundle between the middle and anterior scalenes

Question 63

what test is described below?

Procedure:
* The examiner locates the radial pulse of the involved extremity
* The patient’s head is extended and rotated to the involved
extremity
* The examiner externally rotates and extends the patient’s shoulder.
* The patient is instructed to inhale deeply and hold their breath
Interpretation of Findings:
* Loss of the pulse and/or reproduction of patient’s arm symptoms is considered a positive test indicative of compression of the neurovascular bundle between the middle and anterior scalenes

Answer 63

Scalenus Anticus/Adson’s test

Question 64

HYPERABDUCTION MANEUVER (WRIGHT’S TEST). please perform

Answer 64

Procedure:
* The patient is seated, with both arms hanging at the sides.
* The examiner palpates the patient’s radial pulse
* Both arms, one at a time, are passively abducted to 180 degrees
* The examiner notes the angle of abduction at which the radial pulse diminishes or disappears on the affected side
* The examiner compares the results with those on the unaffected side.
Interpretation of Findings:
* A true positive is reproduction of the patient’s arm complaints
* The test is significant for neurovascular compromise of the axillary artery, as seen in hyperabduction TOSs.
* The mechanics of the test stretches on the Pectorilis Minor
* Many patients have cessation of the radial pulse on abduction without hyperabduction syndrome being present. (false positive)

Question 65

Name this test-
Procedure:
* The patient is seated, with both arms hanging at the sides.
* The examiner palpates the patient’s radial pulse
* Both arms, in turn, are passively abducted to 180 degrees
* The examiner notes the angle of abduction at which the radial pulse diminishes or disappears on the affected side
* The examiner compares the results with those on the unaffected side.
Interpretation of Findings:
* A true positive is reproduction of the patient’s arm complaints (Souza)
* The test is significant for neurovascular compromise of the axillary artery, as seen in hyperabduction TOSs.
* The mechanics of the test stretches on the Pectorilis Minor
* Many patients have cessation of the radial pulse on abduction without hyperabduction syndrome being present. (false positive)

Answer 65

Wright’s Test/Hyperabduction Maneuver

Question 66

How do you perform the costoclavicular maneuver?

Answer 66

Procedure:
* The radial pulse is palpated while the patient’s shoulders are drawn down and in extension
* The cervical spine is flexed maximally
Interpretation of Findings:
* If the pulse is lost, the test is positive.
* A true positive is reproduction of the patient’s arm complaints
* Compression between the 1st rib and the clavicle is suggested by a positive test

Question 67

What is the name of this test?
Procedure:
* The radial pulse is palpated while the patient’s shoulders are drawn down and in extension
* The cervical spine is flexed maximally
Interpretation of Findings:
* If the pulse is lost, the test is positive.
* A true positive is reproduction of the patient’s arm complaints
* Compression between the 1st rib and the clavicle is suggested by a positive test

Answer 67

Costoclavicular maneuver

Question 68

How do you perform the Roos Test (elevated arm Stress test)

Answer 68

Procedure:
* The patient stands and abducts the arms to 90°, laterally rotates the shoulder, and flexes the elbows to 90° so that the elbows are slightly behind the frontal plane.
* The patient then opens and closes the hands slowly for 3 minutes.
Interpretation of Findings:
* If the patient is unable to keep the arms in the starting position for 3 minutes or suffers ischemic pain, heaviness or profound weakness of the arm, or numbness and tingling of the hand during the 3 minutes, the test is considered positive for thoracic outlet syndrome on the affected side.
* Minor fatigue and distress are considered negative tests.

Question 69

What is the name of this test?
Procedure:
* The patient stands and abducts the arms to 90°, laterally rotates the shoulder, and flexes the elbows to 90° so that the elbows are slightly behind the frontal plane.
* The patient then opens and closes the hands slowly for 3 minutes.
Interpretation of Findings:
* If the patient is unable to keep the arms in the starting position for 3 minutes or suffers ischemic pain, heaviness or profound weakness of the arm, or numbness and tingling of the hand during the 3 minutes, the test is considered positive for thoracic outlet syndrome on the affected side.
* Minor fatigue and distress are considered negative tests.

Answer 69

Roos Test

Question 70

How do you perform Adam’s Test?

Answer 70

Procedure:
* Assessment for pathologic or Structural Scoliosis
* Forward bending is an attempt to gain a skyline view of different areas of the back
Interpretation of Findings:
* A functional scoliosis will resolve upon forward flexion
*A structural scoliosis will remain.
* Measurement of the degree of trunk inclination may be performed with an inclinometer such as a scoliometer
* A trunk angle greater than 7° is an indication of a structural curve of at least 20°

Question 71

What is the name of the following test?-
Procedure:
* Assessment for Pathologic or Structural Scoliosis
* Forward bending is an attempt to gain a skyline view of different areas of the back
Interpretation of Findings:
* A functional scoliosis will resolve upon forward flexion whereas…
* …A structural scoliosis will remain.
* Measurement of the degree of trunk inclination may be
performed with an inclinometer such as a scoliometer
* A trunk angle greater than 7° is an indication of a structural curve of at least 20°

Answer 71

Adam’s Test

Question 72

What is Forrestier’s test?

Answer 72

Procedure:
* The back musculature must be visible (patient gowned).
* Ask the patient to laterally flex both directions.

Interpretation of Findings:
* As the patient bends sideways, the spine should curve sideways in a smooth, even, sequential manner.
* The examiner should look for any tightness or abnormal angulation, which may indicate hypomobility or hypermobility at a specific segment.
* If the ipsilateral paraspinal muscles tighten or their contracture is evident, ankylosing spondylitis or pathology causing muscle spasm should be considered.

Question 73

What is Schepelmann sign?

Answer 73

Procedure:
* The patient raises the arms while standing
* Ask the patient to bend to each side (laterally).
Interpretation of Findings:
* Pain created on the concave side is indicative by intercostal neuritis
* Pain created on the convex side is indicative of intercostal myofascitis
* Intercostal myofascitis must be differentiated from the fibrous inflammation of pleurisy.

Question 74

Name the following test-
Procedure:
* The patient raises the arms while standing
* Ask the patient to bend to each side (laterally).
Interpretation of Findings:
* Pain created on the concave side is indicative by intercostal neuritis
* Pain created on the convex side is indicative of intercostal myofascitis
* Intercostal myofascitis must be differentiated from the fibrous inflammation of pleurisy.

Answer 74

Schepelmann sign

Question 75

What is the costovertebral stress test?

Answer 75

Procedure:
* The patient is asked to rotate their torso and stress is applied at the angle of the ribs
Interpretation of Findings:
* Pain may be induced on the same side of a costovertebral or costosternal irritation
* Loss of movement indicates fixation of the costotransverse and/or costovertebral articulation in posterior to anterior translation (caliper movement).

Question 76

What is this test called?
Procedure:
* The patient is asked to rotate their torso and stress is applied at the angle of the ribs
Interpretation of Findings:
* Pain may be induced on the same side of a costovertebral or costosternal irritation
* Loss of movement indicates fixation of the costotransverse and/or costovertebral articulation in posterior to anterior translation (caliper movement).

Answer 76

Costovertebral Stress Test

Question 77

How do you perform the chest expansion test?

Answer 77

Procedure:
* The chest diameter is measured at the level of the fourth intercostal space (roughly at the xyphoid process).
* The first measurement is taken as the patient exhales maximally.
* A second measurement is made as the patient inhales deeply.
Interpretation of Findings:
* The normal difference between inspiration and expiration is 1.5 inches for females to 3 inches for males
* Decreases, in the absence of trauma, suggest ankylosing spondylitis

Question 78

What is the name of this test?
Procedure:
* The chest diameter is measured at the level of the fourth intercostal space (roughly at the xyphoid process).
* The first measurement is taken as the patient exhales maximally.
* A second measurement is made as the patient inhales deeply.
Interpretation of Findings:
* The normal difference between inspiration and expiration is 1.5 inches for females to 3 inches for males
* Decreases, in the absence of trauma, suggest ankylosing spondylitis

Answer 78

Chest Expansion test

Question 79

Perform the Posterior Respiratory Excursion test

Answer 79

Procedure:
* Chest expansion symmetry can be evaluated by placing the thumbs and index fingers around the posterior thorax surface
* Thumbs should start touching over the midline while the patient exhales
* The thumbs should then separate equally on full inspiration. Interpretation of Findings:
* Asymmetry may be seen in painful rib problems, collapsed lung (atelectasis) or pneumonia

Question 80

What is the name of the following test-
Procedure:
* Chest expansion symmetry can be evaluated by placing the thumbs and index fingers around the posterior thorax surface
* Thumbs should start touching over the midline while the patient exhales
* The thumbs should then separate equally on full inspiration. Interpretation of Findings:
* Asymmetry may be seen in painful rib problems, collapsed lung (atelectasis) or pneumonia

Answer 80

Posterior Respiratory Excursion test

Question 81

Perform the anterior rib motion test

Answer 81

Procedure:
* Assessment for Hypomobile Costal Structures
* As the supine patient inhales and exhales, the AP movement of the ribs is palpated
Interpretation of Findings:
* Restriction in motion is noted.
* Rib failing to move inferior during exhalation suggest a fixed elevated rib
* Rib failing to move superior during inhalation suggest a fixed depressed rib

Question 82

What is the name of the test for the following procedures-
Procedure:
* Assessment for Hypomobile Costal Structures
* As the supine patient inhales and exhales, the AP
movement of the ribs is palpated
Interpretation of Findings:
* Restriction in motion is noted.
* Rib failing to move inferior during exhalation suggest a
fixed elevated rib
* Rib failing to move superior during inhalation suggest a fixed depressed rib

Answer 82

Anterior Rib Motion Test

Question 83

What is the sternal compression test?

Answer 83

Procedure:
* While the patient is in the supine position, the examiner exerts downward pressure on the patient’s sternum
* Female patients should place their hands over breast tissue providing a barrier between the examiners hands and the patient’s sternum
Interpretation of Findings:
* Localized pain at the lateral border of the ribs indicates a rib fracture
* Pain reproduced along any part of the rib is indicative of rib fracture

Question 84

What is the name for the following test-
Procedure:
* While the patient is in the supine position, the examiner exerts downward pressure on the patient’s sternum
* Female patients should place their hands over breast tissue providing a barrier between the examiners hands and the patient’s sternum
Interpretation of Findings:
* Localized pain at the lateral border of the ribs indicates a rib fracture
* Pain reproduced along any part of the rib is indicative of rib fracture

Answer 84

Sternal Compression Test

Question 85

Lateral Chest (rib) compression test. How is it performed?

Answer 85

Procedure:
* Examiner contacts both lateral aspects of the rib cage and applies bilateral lateral to medial compression.

Interpretation of Findings:
* Pain at the costosternal junction- May indicate local inflammation

• Pain in the back- May indicate costotransverse or costovertebral lesions
• Localized pain at the lateral rib angle * May indicate a fracture

Question 86

What test is this?

Procedure:
* Examiner contacts both lateral aspects of the rib cage and applies bilateral lateral to medial compression.

Interpretation of Findings:
* Pain at the costosternal junction- May indicate local inflammation

• Pain in the back- May indicate costotransverse or costovertebral lesions
• Localized pain at the lateral rib angle * May indicate a fracture

Answer 86

Lateral Chest (rib) compression test

Question 87

PRONE (THORACIC) EXTENSION- What is it?

Answer 87

Assessment for structural hyperkyphosis
* To differentiate between the functional (postural) kyphosis and the structural kyphosis.

Procedure:
* The patient is instructred to lie prone with their arms behind their back
* Patient is instructed to extend their trunk, lifting their chest off the table
Interpretation of Findings:
* If the kyphosis persists it is a “structural” kyphosis

Question 88

Which test is the following describing? -
Assessment for structural hyperkyphosis
* A hyperkyphosis is common in adolescents for two major reasons:
* poor posture
* Scheuermann’s disease.
* To differentiate between the functional (postural) kyphosis and the structural kyphosis.
Procedure:
* The patient is instructred to lie prone with their arms behind their back
* Patient is instructed to extend their trunk, lifting their chest off the table
Interpretation of Findings:
* If the kyphosis persists it is a “structural” kyphosis

Answer 88

Prone (thoracic) Extension test