OCS Flashcards
What is Boehlers angle? Normal?
Used for diagnosis of calcaneal fracture
30 is normal
< 20 indicates fracture
What is burkhart scapular or sick scapula classification?
I = inferior
II = Medial
III = Superior
IV = Lateral
(most to least common)
What is a hangman’s fracture
Spondylolisthesis of C2 and C3
What do beta blockers do?
Decrease HR
Decrease force of contraction
Will need to use borg exertion scale
MCL gapping
normal to very abnormal
Normal 1-2
Nearly normal 3-5
Abnormal 5-10
Very abnormal > 10
What’s grading on depression scale
0-2 none
3-5 mild
6-8 moderate
8-10 severe
What exercise should follow
Lumbar traction or cervical traction
Lumbar = prone press up
Cervical = DCF training
What is the brudzinski sign
Bilateral hips and knees will flex in response to cervical flexion
Common with meningitis
What is group I and Group II of TMJ?
Group I = muscle
Group II = Joint or disc
What motions does the clavicle do with OH reach?
Clavicle slides inferior and rolls posterior
What nerve is involved in scapular winging?
Flexion
Abduction
Flexion = long thoracic
Abduction = accessory nerve
What self mob to calcaneous is best to teach patients with plantar fascia?
Lateral self mob into eversion
What ligament is taut in
Supination
Pronation
Supination = palmar radioulnar
Pronation = dorsal radioulnar
What are end stage findings in OA
Osteophytes
Subchondral cysts
Sclerosis
What is the pain pattern of gait with posterolateral corner injury?
Sharp pain at terminal stance and with push off
What nerve innervates:
Obturator
Obterator
What nerve innervates:
Gracilis
Obterator
What nerve innervates:
Pectineus
Femoral
What nerve innervates:
Transverse Abs
Iliohypogastric
What nerve innervates:
quads/sartorius
Femoral
What nerve innervates:
Iliacus
Femoral
Clarks sign?
Patella PFPS
Sail sign
fat pad radical displacement
Galaezzi
Leg length discrepancy in babies with displasia
Jobes relocation
Anterior instability of the GHJ due to applying a posterior force on the shoulder with apprehensive test
Yocum test
SAPS test
Horizontal ADD and the examiner raises the elbow
(+) if pain present
Crank test
Labrum of the GHJ
What is stimson reduction for shoulder dislocation
Prone
Arm hangs off of the table
What portion of the patella has the most OA
Lateral
Whats a normal DCF result?
What about with neck pain?
38.95s normal
24.1s with pain
Painful arc range for:
A = SAI
B = ACdysfunction
SAI = 60/70 - 110/120
AC = 12-160
What position is best for strengthening the supraspinatus
full can
limits the action of the deltoid
What is cheralgia?
Paresthesia and burning on dorsal hand and wrist - finger tips are spared
Radial nerve
Wartenbergs syndrome
what is the most common elbow fx in pediatrics?
95% are extension
Supracondylar humeral fracture
What 2 ms can dynamically anterior translate the humeral head?
teres minor
Infraspinatus
How would you stretch the L levator scapula
Elevate the Left arm Sb the C/S to Right
Test cluster for ankylosing spondylitis
Night pain
AM stiffness for > 30 mins
Alternating buttock pain
improve with exercise
ESR,CRP are common in blood
2 anatomical features that may lead to myelopathy
Congenital narrow spinal canal
Large vertebrae body
nerve glide progression for CTS 1-6
Grasp
Extend fingers
Extend wrist
thumb extension
supinate
grab and stretch the thumb
Special test for posteromedial corner injury of the knee
Hughstons drawer sign
Anterior drawer position with ER to target medial
Valgus + Varus relationship to knee OA
Genu valgus - lateral OA
Genu varus - medial OA
What type of shoe wedge would offload medial knee OA
Lateral wedge - would put in valgus - would stress lateral and gap medial
What is MCID for NDI
Radiculopathy:
Mechanical:
7.5 radiculopathy
9.5 mechanical
What position should an orthotic for heel pain put patient into?
Plantar flexion and inversion
Temportal arteritis vs optic neuritis
Temporal = sudden, significant eye pain with palpation
Optic = pain with eye movement
CPR for MT for ankle sprain
Navicular drop > 5mm
Symptoms worse in standing
symptoms worse in PM
Distal tib/fib hypomobile
What should ionto tx consist of when there are calcium deposits
Acetic acid
What is the acute conservative tx of syndesmotic ankle sprain
2 weeks
PRICE
NWB, crutches
Post splint slight PF
What motions are most limited with distal radial Fx
supination and pronation
Their movement is dependent on radius aligment
With radial head fractures what 2 motions should be limited in the beginning?
flexion
pronation
What resists varus and ER in posterolateral corner injury
Varus - LCL
Popliteus and popliteal ligament resist the ER
What fractures are likely with
High arch?
Flat foot?
high arch - tibia femur
Low arch - metatarsal
What fractures are common with leg length discrepancy?
Longer limb = tibia, METS, femur
Shorter = fibula
What make up the orders of the carpal tunnel?
Pisiform/hamate to scaphoid/trapezium
Carpals are floor
Flexor retinaculum roof
What is a:
Night stick fx
Monteggia fx
Night stick is mid ulna
Monteggia is proximal ulna fx with dislocation of radial head and needs Sx
Most common decompression Sx for lumbar spine?
Stenosis?
Decompression = discetomy
Stenosis = laminoplasty
Cervical traction guidelines
15-24 degrees of flexion
60s on | 20s off
50% pull
10-12 lbs, 40lbs max
15 mins, 6 sessions, 3 wks
Cluster for those likely to respond to cervical traction
> 55 y/o
+ ULTT
+ Shld AB
+ distraction
Peripheralize with PA
Qualifications to being an ACL coper
<2 episode of giving out
80% hop test
80% KOOS ADL
GRPS > 60%
>70% quad strength
Joint mechanics of lateral deviation at TMJ
Ipsilateral rotation
Contralateral translation
Ex = Right lateral deviation
Right rotation
Left translation into right
What happens to the disc as it becomes late stage displacement
The disc is more anterior in the late stage
What nerve entrapment may present like lateral epi?
Radial tunnel syndrome
What structure takes on more stress if the MCL is injured?
ACL
What artery supplies the posterolateral corner?
Popliteal artery
Biceps special test
A = most SN
B = most SP
SN = Bear hug/upper cut
SP = speeds
Differences btw men and females knee with OA
Females
- more OA pain
- disability
- more advanced imaging
- more PF OA
Men
- higher volume of cartilage
More knee OA facts
Night pain will increase as OA advances
QF strength has greatest effet on outcomes
Adductors; iliopsoas, and TFL should all be stretched
At what degree do the carpals start moving together?
45 extension
What muscle and posture are associated with TMJ hypermobility?
Lateral pterygoid
forward head posture
What 3 nerves may be injured with anterior dislocation of the shoulder?
Axillary
Long thoracic
suprascapular
LEFS MCID
Increase by 9 points
ODI MCID
Decrease by 12%
QuickDASH MCID
Decrease by 18 points
DHI MCID
Decrease by 18 points
NDI MCID
Decrease by 7.5 points
KOOS MDC pain
6.1
KOOS MDC symptoms
8.5
KOOS MDC ADL
8
KOOS MDC QoL
7.2
Acute LBP w/o LE pain would benefit from?
Manipulation or exercise
vascular claudification relief?
Seen with standing alone due to calf pain
Neurogenic claudification relief?
Seen with sitting and have a shopping cart sign and pain above the knees.
Flank pain and reasoning for it
Nonmuscloskeletal and pain that doesn’t worsen w/ mvmt
1 predictor of cancer?
PMH of cancer
Sciatic pain risk factors
HTN
Smoking
Overweight
Cardiovascular issues
Lumbar traction is beneficial in those with?
(+) crossed leg syndrome
Nerve root compression
Peripheralization of symptoms
Acute LBP w/ mobility deficits have?
Restricted spinal ROM
symptom reproduction w/ provocation at involved segments
Acute LBP w/ mvmt coordination impairments and aLBP w/ radiating pain have?
Symptom reproduction at initial/midrange AROM or PROM
Focus on mvmts that limit pain or increase pain-free mvmt in mid-rage
Subacute LBP w/ mobility, mvmt coordination impairments, radiating pain will benefit from?
Mvmts to target mid to end range w/in pain
Chronic LBP w/ mvmt coordination impairments, radiating pain will benefit from?
An increase to tolerance to end range sustainability
ALBP w/ related (referred) LE pain will benefit from?
Centralizing symptoms while overcoming high irritability with interventions
A or sub LBP w/ cognitive and affective tendencies and chronic LBP w/ generalized pain are?
Not a common pain path of mvmt
Therefore rely on education and counseling rather than normalizing the mvmt
Chronic LBP w/ mvmt coordination have?
LE pain
Presence of 1 or more symptoms
Chronic LBP w/ mvmt coordination symptoms
Pain worsens with sustained postures
L/S hyper-mobility
T/S and pelvic deficits of mobility
Decreased pelvic and trunk ms endurance
Mvmt impairments while performing work tasks
Flat back syndrome or lumbago due to disc displacement symptoms
worsens with flexion
pain in buttock, thigh or leg
pain centralized w/ repeated mvmts
lateral trunk shift, reduced lumbar lordosis and limited extension
LBP or strain w/ cognitive or affective tendencies symptoms
2+ responses to primary care evaluation of mental disorders for depressive symptoms
High score on FABQ
High score on pain
When to order imaging for LBP?
If lasting 1 month or less and no red flags then imaging is not required.
Aberrant mvmts
Painful arc w/ flexion or return from flexion
Instability catch
Grower’s sign
Reversal of lumbopelvic rhythm
What is reversal of lumbopelvic rhythm?
Return from flexion they bend knees and use hip extension for anterior pelvic tilt to full stand
When to SLR test?
Best results on those w/ pain inferior to gluteal fold
good to identify pain below 45 degrees
Trunk flexors strength test and endurance test
Bilateral SLR
If low back does not maintain contact on the table while lowering the legs then pt has a higher risk of LBP and chronic LBP
Trunk extensors test
Prone with hands to the side and pt extends low back to elevate the chest off of table by 30 degrees
Timed test and cut off is 31 sec for males and 33 for females
TrA test
Prone over a cuff inflated to 70mmHg
Draw in the stomach w/o pelvic motion and breathe normally for 10 seconds
Max decrease in pressure recorded
4mmHg change is normal while a 2mmHg is indicative fo LBP
Hip extensor testing
Bridge position and maintain it for 76.7 sec w/ LBP and 127.9 w/o LBP
Hip OA CPG
Lateral or anterior hip pain w/ weight bearing
24 degrees of hip IR and 15 degrees of hip flexion difference compared to opposite side
< 1 hour morning stiffness
> 50 years of age
30s sit to stand MDC and ICC
3.5
.88 (intrarater reliability)
4 square step test MDC
1.8-2.0s
Step test 6” tap test 15s MDC
3s
Timed single leg stance MDC
8.08 and in 2 attempts
Non-arthritic hip CPG
HOS
Copenhagen hip and groin outcome score
International hip outcome tool
HOS (hip outcome score)
9 points higher is MCID
Copenhagen hip and groin outcome score (HAGOS)
higher is better
5.2 MCID
International hip outcome tool (iHOT - 33)
Higher is better
6 point MCID
Trendelenburg sign
Performs SLS w/ leg flexed 30 degrees and held for 30s
Then the pt raises flexed hip pelvis
Positive if unable to hold for 30s
Positive if no elevation on the non-stance leg
Positive if stance leg ADDs to drop below non-stance leg
Lumbar plexus pneumonic
I Irregularly Get Lunch On Fridays
I Irregularly Get Lunch On Fridays
Iliohypogastric
Ilioinguinal
Gentiofemoral
Lateral Femoral cutaneous
Obturator
Femoral
Iliohypogastic info
T12-L1
Sensory) lateral gluteal
M) Internal Oblique & transverse abs
Ilioingunial info
L1
S) Anterior & medial thigh scrotum and labia
M) Internal Oblique TrA
Gentiofemoral L1-2 info
S) scrotum and Labia
M) cremaster
Lateral Femoral cutaneous Info
L2-3
S) lateral thigh
Obturator info
L2-4
M) Adductors
Obturator info
L2-4
M) Adductors
Femoral info
S) anterior thigh w/ branch into saphenous nerve for patella sensation
M) quad, sartorius, articularis genu
Lumbar stenosis therapy approach
Manual,
exercises,
Body weight supported TM
Medial aspect of the LE/LQ has
Saphenous vein and nerve
Saphenous nerve dynamic test
Place the hip in flexion, knee extension, dorsiflexion, and eversion
When will you see a acetabalar labral cyst?
W/ positive FADIR,
Limited hip flexion/IR and extension
Pain with sitting
What view will see a scotty dog?
Oblique view
What is Isthmic II A?
Pars interarticularis Fx that is caused by fatigue failure
What is Isthmic II B?
Pars interarticularis Fx due to it being elongated
Dysplastic?
Spondylolisthesis due to contgenital defect
What grade will spondylolisthesis surgery respond to?
Grade 3-4
Grade 3 = 51-75%
How long can Whiplash last?
2 years but not beyond that
Describe Lhermitte’s sign
Electrical sensation that radiates into the back and extremities w/ cervical flexion
Suggestive of spinal cord pathology
What is the best view to see cauda equina?
MRI
Morel - Lavallee lesion
Post traumatic hemolymphatic collection of fluid,
Separation of subcutaneous tissue from the deep fascia due to blunt force trauma.
What is transverse myelitis?
Demyelinating pathology not acute
When is an epidural abscess seen with?
Infection
Schmorl’s node
Protrusion of the nucleus pulposus through a vertebral body and end plate.
Disc herniation
Nucleus pulposus extrudes through the annulus fibrosus and when annulus fibrosus fragment into the epidural space.
Spondylolisis
Fx of the pars interarticularis resulting in scotty dog sign w/ the Fx being the neck of the dog
Stabilization criteria
< 40 years
SLR > 91 degrees
Aberrant motion present
Positive prone instability test
CPR for Cervicothoracic manipulation and shoulder pain
Pain free shoulder flexion < 120
Shoulder IR < 53 @ 90 ABD
(-) Neer’s
No medication
Symptoms < 90 days
Specificity for CPR of Cervical radiculopathy 2/3/4
2 = .56
3 = .94
4 = .99
CPR for lumbar manipulation
FABQ < 19
Symptoms < 16 days
No symptoms past the knee
1 hypomobile lumbar spine segment
1 hip with > 35 degrees of IR
CPR for Full thickness rotator cuff tear
Drop arm sign
Painful arc sign
Infraspinatus muscle test
CPR for carpal tunnel
Shaking hands to relieve symptoms
Wrist ratio > .67
Symptom severity scale > 1.9
Diminished sensation in median sensory field 1 thumb
> 45 years old
When to seek MD assist with Peds cases
Radicular symptoms involving anterior or anterior medial thigh
Exa of when to seek MD attention
Chronic smoker w/ LBP and with non mechanical factors such as inability to achieve a comfy position
Cauda equina syndrome
Progressive neurological deficits
Bilateral LE radiculopathy
Urinary retention
Hypo-reflexive
Ms stretch reflexes
Decreased sphincter tone
Surgery needed within 72 hours is max.
Most common level for disc herniation
L4-5
L5-S1
Anterior branch of obturator Nerve
Innervates adductor longus and gracillis
Sensation to medial thigh
Posterior branch of Obturator Nerve
Innervates obturator externus Adductor magnus
Ankylosing Spondylitis
Morning stiffness
Better with movement
Gross limitation of side bending
Septic arthritis
No symptom relief after a week and elevated WBC > 1200mm and ESR > 39mm/hr
Gilmore groin pain
Type of athletic pubalgia and seen with ingional ligament
Known as slap shot gut or sports hernia
Patella pubic test
Ruling out a femoral neck Fx
Seen in females, amenorrhea and insidious onset
Extension base injury of the cervical spine in youth
Causes spondylolysis of the pars interarticularis and then can progress to spondylolisthesis
SCFE patients have?
Increased ER due to slippage
Decreased IR
What innervates the facet joints?
Medial branch of dorsal rami
Centralization occurance from least to most
Lumbar flexion
Extension
Side glides
What is used to diagnose spinal stenosis?
Myelography
What is considered absolute spinal stenosis?
AP diameter of <10mm
Criteria for 86% of failing core stability exercises
Negative prone instability test
absence of abberrant movement
9 or greater score on FABQ
What to think of when no change with repeated motion testing?
SI dysfunction
Other diagnosis
LBP and work return
6 months of LBP = 40% of return to work
1 year of LBP = 20% of return to work
2 years of LBP = 0% of return to work
Lumbar stenosis CPG
Bilateral symptoms
Pain w/ walking and standing
Relief w/ sitting
Leg pain greater than back pain
> 48 years old
Hip capsular pattern
IR - ABD - flexion
“Sign of the buttock”
Buttock large and swollen and TTP
SLR limited and painful
Limited trunk flexion
Hip flexion with knee flexion is painful
Empty end feel on hip flexion
Non-capsular patter of the hip
Weak and painful hip MMTs
Present “Sign of the buttock” what could be seen?
Osteomyelitis, Neoplasm and sacral Fx
Never L4-5 disc extrusion
Best test for radiographic instability at the lumbar spine
Passive lumbar extension test
Passive lumbar extension test
Prone patient where the examiner raises the legs passively and then the patient should feel increased pain/back is about to come off/ or increased pressure in the back.
Trunk flexion stabilizer endurance ratio to trunk extension
1 for young men
.79 for young women
What to do next if symptoms are increased with flexion or extension
Sideglides
Is urinary retention or incontinence a symptom of cauda equina?
Urinary retention is a symptoms Incontinence is NOT
Cauda equina is commonly seen w/?
Sacral plexus injury
What causes slackening of the posterior SI ligament?
Tight latissmus Dorsi and glute max
Nutation
Sacrum rotates anteriorly and ilium rotates posteriorly
Counternutation
Sacrum rotates posteriorly while Ilium rotates anteriorly
Collagen fibers and their types
Type I = Common exa is scar tissue
Type II = Resists compressive forces exa. nuclear matrix/pulposus
Type III = Not common but seen w/ type I in muscles and other visceral structures
Type IV = bones cells membranes and skin
Primary stabilizers of the spine are?
TrA and Multifidus
FABQ score shows?
That a higher score is indicative of fear
FABQ > 34
Increased risk of prolonged work restictions by 20-58%
Proximal hamstring tendinopathy presents as
Deep localized pain at IT and pain with hip flexion and ADD activities
SIJ Distraction
Sn = .6
Sp = .81
SIJ Compression
Sn = .69
Sp = .69
SIJ Thigh Thrust
Sn = .88
Sp = .69
SIJ Gaenslen’s
Sn = .50
Sp = .77
SIJ sacral Thrust
Sn = .63
Sp = .75
3/5 SIJ tests completed
Sn = .91
Sp = .78
2/4 SIJ tests completed
Sn = .88
Sp = .78
What are observational studies
Cohort and case control
Case control studies
Retrospective and subjects already of interest looking for risk factors
Levels of evidence for Interventional studies Level 1
High quality RCT with or without statistically significant difference with narrow confidence intervals
Levels of evidence for Interventional studies Level 2
Less quality RCT with < 80% follow up, no blinding or improper randomization
Levels of evidence for Interventional studies Level 3
Case control studies, retrospective comparative study, a systematic review of level 3 studies
Signs of upper cervical ligamentous instability
Headaches, feeling of heaviness, age, clumsy gait
When to use anti-pronation taping?
Acute phase of plantar heel pain for 3 weeks
When to use night splints for plantar heel pain?
Best used for those that have pain for greater than 6 months
Define ratio
Highest level of measurement in which there are equal intervals between score units and true zero point (Height and weight)
Cannot be negative
Define interval
Level of measurement in which values have equal intervals but no true zero point (Temperature)
Can be negative
Define Ordinal
Level of measurement where scores are ranked (functional scales, educational degree, work status)
Define nominal
Level of measurement for classification variables.
Variables are mutually exclusive with no inherent rank order (yes/no, resident/non-resident, smoker/nonsmoker)
Define parametric tests
Used for ratio and interval data
Define non-parametric tests
Used for ordinal or nominal data
What is a Mann Whitney U Test
Test whether 2 groups are likely to derive from the same population
Ordinal data (Full duty, light duty, not working)
Define the Wilcoxin test
Nonparametric test that compares 2 groups to see if they are statistically different from each other.
Ordinal
Define Kruskal Wallis test
Compares 3 or more groups to assess if 3 variables are the same or provide a different structure
Define an Independent variable
Variable that is presumed to cause, explain or influence a dependent variable; controlled or manipulated by researcher
Define Dependent variable
A response variable that is assumed to depend on or be caused by another variable
Define independent t-test
Is there a difference between males and females for shoulder AROM using Goniometer?
2 groups and continuous data
Define dependent/Paired t-test
Is there a difference in lumbar AROM pre and post lumbar manipulation for 200 subjects
2 tests and continuous data
Define Chi Squared test
Categorical data (yes/no) Association
Typically displayed in a 2 by 2 table
Is there an association between being diabetic (yes/no) and having a neuropathy (yes/no)
What is a type 1 error?
States that there is a difference and to reject the null hypothesis when there is no difference
What is a type 2 error?
States that there is no difference and to accept the null hypothesis when there is actually a difference.
What does it mean if a special test has Sn = 92% and Sp = 24%
Low risk of false negative and high risk for false positive
What is type of special test is best for screening?
A high sensitive test
High sensitivity means
Few false negatives
High specificity means
Few false positives
Low sensitivity means
High false negatives
Low specificity means
High false positives
What is the cognitive stage?
Not intuitive
requires instruction and guidance
Inconsistent
Movements are slow and inefficient
What is the associative stage?
Individual is moving towards independence
Movements are more fluid
Can make adjustments based on environmental factors
Best interventions for gluteal tendinopathy
Isometrics on Hip ABDs and avoiding ITB standing stretch
Cervicogenic HAs reproduction
Cervical rotation and do not involve an aura or vision changes
Migraine symptoms
Pulsating/pounding HA, unilateral in nature, 4-72 hours of a headache
Nausea w/ HA
4/5 of these = +LR of 24
C1 - 2 cavitation will produce?
Multiple audible pop bilaterally 3-4 pops
Sharp Purser test
Transverse ligament test
Validated in those with RA and Down syndrome
Dangerous to use after a traumatic mechanism
Cervical flexion rotation test
High Sp and Sn for cervical joint dysfunction in neck pain and cervicogenic HA
Who has increased risk for upper cervical instability?
RA, DS history of cervical spine trauma
Internal Carotid artery dissection is common with?
Hypoglossal cranial nerve dissected
How to test for alar ligament instability
Neck tongue syndrome
Rotate head and if there is numbness along half of their tongue then it is positive
What is horner’s syndrome?
Disrupted nerve pathway on one side from the brain to the face and eye
Common with carotid artery dissection
When should you use premanipulative holds?
For assessing pt’s comfort levels
When not to use Sharp purser test
When pt has paresthesia in hands with cervical flexion
Purpose of transverse ligament
Preventing the dens of the atlas from pressing on the spinal cord with cervical flexion
Where are the joints of luschka?
C3-7
Characteristic of cervical intervertebral disc
Thick anteriorly and thin posteriorly
Vertebral artery gets compressed when?
PROM cervical rotation to the right the artery is compressed b/w 1st and 2nd cervical vertebra on the left
Absolute contraindications of manual
Osteomyelitis
Nerve root compression w/ increased neuro deficits
Influenza and fever
Relative contraindications to manual are?
Pregnancy
Radiculopathy past the elbow will benefit from?
Centralization than manipulation
Cervical manipulation CPR
Symptoms < 38 days
Side to side difference of > 10 degrees rotation
Positive outlook on manipulation
Pain with PA on mid cervical
Lowest risk of cervical manipulation is at?
Mid to lower cervical
What is involved with a cervical artery dissection?
Vertebrobasilar artery resulting in posterior arterial system perfusing the hindbrain
Internal carotid artery which is the anterior arterial system perfusing the cerebral hemispheres and eyes
Cervical artery dissection reproduces symptoms with
Cervical rotation and trunk rotation while the head is stable causing dizziness
Vestibular is positive with what rotation
cervical rotation but not with trunk rotation
Hindbrain ischemia will affect?
CN I & II
Internal carotid artery dysfunction will involve?
CN XII Hypoglossal
CN IX Glossopharyngeal
CN X Vagus
CN XI Spinal accessory
Common S/S of Horner’s syndrome
Drooping eyelid
Sunken eye
Small constricted pupil
Facial dryness
Pancost tumor is?
Lung cancer at the superior aspect of the lung and compresses C8-T1 nerve root
Seen in 50 y/o
Smoking history
Shld pain
What is the best intervention for nerve root irritation?
Intermittent mechanical traction
Heart referral
Over the left anterior chest wall and the left arm into the finger
Posterior along the CT junction
Pulmonary referral
Located anteriorly and posteriorly over the throat and cervical spine and into the left upper trap and lateral aspect of the left shoulder
Kidney referral
Around the circumference of the waist, greater Trochanter, groin and proximal medial thigh bilaterally.
Posteriorly lateral thigh and to the buttock towards the lateral leg but not the medial butt or posterior thigh
Bladder referral
Posteriorly gluteal cleft
Posteriorly medial thigh
Anteriorly midline to the umbilicus and distal to the AIIS
Ovaries referral
Lateral to the umbilicus
Liver and gallbladder referral
Right side of the neck and the lateral right shoulder
Posterior pain to the right scapula
Inferior angle of the right scapula and posteriorly right lateral truck on T9-12
Gallbladder referral
Right upper quadrant
Typically after eating
Stomach referral
Anterior along the midline and distally to the sternum medially from the right upper quadrant.
Superior to the umbilicus
Posterior midline of the t/s spine
Colon referral
Anterior pain midline and inferior to the umbilicus
Pancreas referral
Anterior pain left of the midline and posterior to the left side of the lumbar paraspinals above the belt line
Sciatic nerve entrapment
Piriformis - Ischial femoral impingement syndrome
Proximal hamstring muscle = Ischial tunnel syndrome
Sciatic and gluteal pain causes
Trauma to the glute and only able to sit for 30 mins
Ischial femoral impingement syndrome symptoms
Pain with gait from mid stance to terminal stance
Ischial tunnel syndrome
Pain radiating down the posterior thigh and the popliteal fossa with aggravating during running for knee flexion and hip flexion with heel strike
Ischial tunnel syndrome causes
Thickening of the hamstring or partial avulsion of the hamstring tendon
Modified Thomas test indicates decreased muscle length
Inability to extend the thigh below horizontal (Iliopsoas)
Knee flexion angle is less than 90 (Rectus Femoris)
Hip moves into an ABD position (TFL/ITB)
Ober test indicator of decreased muscle length
Hip remains in ABD position and does not fall below horizontal
Straight leg raise indicator of decreased muscle length
Inability to flex the hip beyond 70
Pain or neurologic symptoms from 30-70 of hip flexion is indicative of radiculopathy
Popliteal angle measurement
Knee flexion angle is greater than 20
Passive hip ABD 0 degrees muscle length test
Inability to ABD hip to at lease 40 (tight hip ADD)
Passive hip ABD at 90 hip flexion muscle length test
Inability to ABD hip to at least 40 (tight hip ADD)
MMT of Iliopsoas
Seated with hip flexion at end range and patient holds onto the edge of the table to stabilize trunk
Psoas major MMT
Supine with hip in 30 degrees of flexion and slight ABD/ER
Lachman SN and SP
85% Sn
94% Sp
Anterior drawer test Sn & Sp
49% Sn
58% Sp
Pivot shift test Sn & Sp
24% Sn
98% Sp
Pivot Shift test under anesthesia Sn & Sp
81.8% Sn
98.4% Sp
Pivot shift test technique
Carotid artery (artherosclerosis, stenosis, thrombosis, aneurysm, dissection) Symptoms?
Neck pain
Facial pain
HA
Cranial nerve signs,
TIA,
CVA
Carotid artery hypoplasia symptoms?
Frequently asymptomatic
Vertebral artery dissection symptoms?
Neck pain,
possible headache,
TIA,
CVA
Ataxia
Adhesive capsulitis primary S/S
Anterior lateral shoulder pain
Inability to sleep
Gradual loss of ROM due to pain
Female 40-65 years old
Diabetes or hypothyroidism
Primary OA of GHJ s/s
60 or older
Loss of motion and pain
crepitus with End range
Stiffness worse in the morning
SAPS s/s
Anterior/lateral should pain
pain at mid should range
pain worse at night
RTC tear s/s
Loss of strength
Pain that wakes pt up in the night
Worse at night
> 40 years old
AC joint arthropathy/ injury s/s
Pain on the top of the shoulder
Increased pain with end range shoulder elevation and add
History of weight lifting
Visible deformity at the top of the shoulder
