Orthopedic Tests - Midterm Flashcards
Motor Testing - Biceps
C6 - Musculocutaneous nerve
Pt flexes elbow 90˚.
Doc pushes down on wrist.
BILATERAL.
Motor Testing - Deltoids
C5 - Axillary nerve
Pt abducts shoulder 90˚.
Doc pushes down on elbow.
BILATERAL.
Motor Testing - Triceps
C7 - Radial nerve
Pt abducts shoulder 90˚, extends elbow 90˚.
Doc stabilizes elbow, pushes in on wrist.
BILATERAL.
Motor Testing - Wrist Extensors
C6 - Radial nerve
Pt extends wrist, balls up fist.
Doc pulls down on dorsum of hand.
BILATERAL.
Motor Testing - Wrist Flexors
C7 - Median/Ulnar nerve
Pt extends wrist, balls up fist.
Doc pushes up on fist.
BILATERAL.
Motor Testing - Finger Extensors
C7 - Ulnar/Median nerve
Pt extends elbow, pronates forearm. Doc pushes down on fingers while pt resists.
BILATERAL.
Motor Testing - Finger Flexors
C8 - Ulnar/Median nerve
Pt grips doc’s pointer/middle fingers.
BILATERAL.
Motor Testing - Finger Abductors / Adductors
T1 - Ulnar Nerve
Abd- Doc pushes in on pt’s pinky/ring fingers.
Add - Doc places fingers between pt’s while pt squeezes fingers.
BILATERAL.
PE - Reflex Grading
4+ Hyperreflexia (may have sustained clonus)
3+ Hyperreflexia (may be upper half of normal)
2+ Normal (lower half of normal)
1+ Hyporeflexia (trace response or with reinforcement)
0 Areflexia (no muscle contraction with reinforcement)
PE - Tenderness Grading
+1/4 Tenderness with no physical response
+2/4 Tenderness with grimace and/or flinch
+3/4 Tenderness with withdrawal (positive “jump” sign)
+4/4 Withdrawal to non-noxious stimuli
PE - Motor Grading
5/5 Muscle completes ROM against gravity with full resistance
4/5 Muscle completes ROM against gravity with some resistance
3/5 Muscle completes ROM against gravity but without resistance
2/5 Muscle completes ROM with gravity eliminated
1/5 Slight contractility; no joint motion; inability to complete ROM with gravity eliminated
0/5 No evidence of muscle contraction
Reflex Testing - Biceps
C5
Doc supports pt’s arm, strikes own thumb on biceps tendon.
Biceps contracts, elbow flexes.
BILATERAL.
Reflex Testing - Brachioradialis
C6
Doc strikes hammer 4 inches proximal to base of thumb.
Brachioradialis contracts, forearm supinates.
BILATERAL.
Reflex Testing - Triceps
C7
Pt abducts shoulder 90˚, internally rotates forearm.
Doc supports arm, strikes just above olecranon fossa.
Triceps contracts, forearm extends.
BILATERAL.
Sensory Testing - C5
Over deltoid tuberosity (lateral arm)
BILATERAL, pt’s eyes closed, always follow dull w/ sharp
Sensory Testing - C6
Thumb, lateral/distal forearm
BILATERAL, pt’s eyes closed, always follow dull w/ sharp
Sensory Testing - C7
Middle finger
BILATERAL, pt’s eyes closed, always follow dull w/ sharp
Sensory Testing - C8
Pinky finger
BILATERAL, pt’s eyes closed, always follow dull w/ sharp
Sensory Testing - T1
Medial forearm at level of elbow
BILATERAL, pt’s eyes closed, always follow dull w/ sharp
Reflex Testing - Causes of Hyporeflexia
technique error, LMNL
Reflex Testing - Causes of Hyperreflexia
hyper-reactor, UMNL, nerve root irritation
Spinous Percussion Test
Assess for vertebral fracture, metastatic dz, disc impingement
(+) - pain, lingering pain
Doc percusses cervical / thoracic sp’s one at a time.
Valsalva Maneuver
Assess for herniated disc or SOL
(+) - increase/presentation of peripheral sxs
Pt asked to “bear down” / “blow up balloon”, 2-3 secs
Cervical Compression Test
Assess for radiculopathy/radiculitis, disc herniation, spinal stenosis, SOL, osteophytes
(+) - pain, paresthesia, numbness to upper extremity/between shoulder blades
Pt sitting up straight, neutral position. Doc slowly pushes down on top of head
Spurling’s Test
Assess for nerve root impingement
(+) - pain
Pt lat flex head toward symptomatic side. Doc slowly pushes down on top of head
Soto Hall / Brudzinski Test
Assess for meningitis, fracture, joint/ligament injury, facet syndrome, disc derangement, sprain
(+) - pain, Brudzinski sign
Pt supine. One hand on top of sternum. Other doc hand underneath pt head/neck. Doc flexes head toward chest w/ pressure on sternum.
Forward Bending Test (Adam’s Test)
Assess for scoliosis
(+) - unilateral asymmetry
Pt bends forward. Doc stands behind observing symmetry.
Upper Limb Tension Test for Median Nerve
Assess for nerve impingement, adhesions, radiculitis, neurogenic TOS
(+) pain, reproduction of sxs
Pt supine. Shoulder depression, shoulder abd 90˚, ext rot 90˚, forearm supination, wrist/finger extension, elbow extension, contralat/ipsilat flexion of head
Maximum Foraminal Compression Test
Assess for nerve root impingement
(+) - pain
Pt rotates/extends/lat flexes head. Doc slowly pushes down on top of head
Cervical Distraction Test
Assess for ligament sprain (increased pain) or herniated disc/spinal stenosis (decreased pain)
(+) - pain or relief of pain
Pt seated. Doc lifts pt’s head (thumbs under occiput, thenar eminence under mastoid process)
Shoulder Depression Test
Assess for irritation/compression of nerve root/spinal nerve/brachial plexus, osteophytes, adhesions/sprains
(+) pain, parethesia, numbness
Pt seated. Doc depresses shoulder and lat flexes head. Doc DOES NOT push on head once lat flexed.
Adson’s Test
Assess for TOS w/ involvement of ant. scalene.
(+) - loss of pulse, numbness/tingling
Pt seated/standing. Doc locates radial pulse. Pt rotates/extends head to affected side. Doc ext rotations/extends pt’s arm. Pt takes deep breath. Pulse is observed.
Reverse Adson’s Test
Assess for TOS w/ involvement of mid. scalene.
Same as Adson’s test but pt turns head away from affected side. This test is done following a negative Adson’s test.
Allen Test
Assess distal arterial dz, differentiate TOS from arterial compromise
(+) - pt’s hand takes > 15 secs to return its color
Doc places thumbs on ulnar/radial arteries. Pt’s arm is flexed and hand is held upright. Pt’s hand is extended while one thumb is removed and color changes are observed.
Muscle Test - Infraspinatus / Teres Minor
Assess for rotator cuff injury (infraspinatus / teres minor)
(+) - pain, weakness
Pt seated. Arms at side, elbows flexed 90˚. Doc places hands on outside of pt’s hands and resists external rotation.
Eden’s Test
Assess for costoclavicular TOS
(+) - loss of pulse
Pt seated. Palpate radial pulses bilaterally. Doc extends pt’s arms. Pt’s shoulders back, chest out, chin to chest, hold breath, bear down.
Muscle Test - Subscapularis
Assess for rotator cuff injury (subscapularis)
(+) - pain, weakness
Pt seated. Arms at side, elbows flexed 90˚. Doc places hands on inside of pt’s hands and resists internal rotation.
Roos’ Test
Assess costoclavicular TOS
(+) - pain, numbness, tingling, slowing down, drifting arms
Pt seated. Pt bilaterally abducts shoulders 90˚, flexes elbows 90˚. Open/close hands rapidly for 2 min.
Wright’s Test
Assess for hypertonic pec minor or enlarged coracoid process, hyperabduction syndrome
(+) - pulse disappears/symptoms recreated at smaller angle
Pt seated. Doc palpates radial pulses bilaterally, brings arm to side/behind back. Doc raises arms, noting when pulses stop.
Breath Pattern Test
Pt places one hand on abd, one hand on upper chest. Doc observes movement during deep breath (diaphragmatic vs thoracic breathing)
Crank Test
Assess for glenoid labrum lesion
(+) - pain/catching/grinding in shoulder
Pt seated. Pt shoulder abducted ~160˚, elbow flexed 90˚. Doc pushes down on elbow while rotating forearm internally/externally to end range.
O’Brien’s Test (Pts 1 & 2) / AC Compression Test (Pt 1 only)
Assess for AC joint sprain and labral tear
(+) - deep internal joint pain w/ internal rotation and reduced pain with external rotation (labral tear)
(+) - superficial pain at AC joint
Part 1 - Pt shoulder flexed 90˚, internally rotated (thumb down), horizontally adducted 15˚. Pt resists doc’s downward push.
Part 2 - Same, but with external rotation (palm up)
Speed’s Test
Assess for bicipital tendonitis/tendonosis, SLAP lesion, rotator cuff bursitis, impingement syndrome, strain/rupture of biceps muscle
(+) - pain/tenderness/movement in bicipital groove
Pt seated. Pt elbow extended, forearm supinated. Pt flexes shoulder against resistance to 120˚ while doc palpates biceps tendon. Pt allows shoulder extension back to neural while providing resistance.
Drop Arm (Codman’s Arm Drop) Test
Assess for rotator cuff injury (supraspinatus)
(+) - pain, weakness, sudden drop of arm
Pt’s arm are bilaterally abducted 150˚ in scapular plane. Pt is told to slowly lower arms back down.
Empty Can Test
Assess for rotator cuff injury (supraspinatus) and impingement syndrome
(+) - pain, weakness
Pt shoulder flexed 90˚, internally rotated (thumb down). All in scapular plane - 30˚ ant to frontal plane. Doc applies downward pressure.
Gerber Lift-off Test
Assess for rotator cuff injury (subscapularis)
(+) - inability to lift-off
Pt’s arm placed in small of back. Pt lifts arm off of back actively and against resistance.
Hawkins-Kennedy Test
Assess for impingement syndrome (esp. supraspinatus)
(+) - pain
Pt shoulder flexed 90˚, elbow flexed 90˚. Shoulder abducted 10-20˚. Doc stabilizes elbow while internally rotating shoulder at wrist.
Neer Impingement Test
Assess for impingement syndrome (biceps - external and supraspinatus - internal)
(+) - pain, esp. near end-range
Doc does maximal passive flexion of pt’s arms with both internal (thumb down) and external (palm up) rotation.
AC Crossbody Adduction + Resisted Extension Tests
Assess for AC/SC joint dysfunction or ligament sprain
(+) - localized pain to AC/SC joint
Pt’s shoulder flexed 90˚, elbow flexed 90˚. Doc passively brings arm across chest to other shoulder. Pt then actively does the same. Doc then resists while pt horizontally abducts arm back to starting position.
Shoulder Apprehension Test
Assess for labral/rotator cuff tear, ant glenohumeral instability.
(+) - pain in front of shoulder, dislocation
Pt supine. Pt shoulder/elbow flexed 90˚. Doc passively externally rotates arm while pushing humeral head forward.
Shoulder Relocation Test
Following apprehension test, doc pushes posteriorly on humeral head while returning pt’s arm to neutral.
Painful Arc
Assess for impingement syndrome.
(+) - pain between 60-120˚
Pt actively abducts shoulder through full ROM in scapular plane.
Phalen’s Test
Assess for carpal tunnel syndrome
(+) - numbness/tingling along median nerve, ant wrist pain, weak thumb opposition
Pt max flexes wrists w/ back of hands touching in front of trunk
Modified Phalen’s Test
Assess for carpal tunnel syndrome
(+) - numbness/tingling along median nerve, ant wrist pain, weak thumb opposition
Doc holds wrist in flexion for up to 1 min
Median Nerve Compression Test
Assess for carpal tunnel syndrome
(+) - median nerve sxs
Forearm/wrist in neutral position. Double thumb compression just distal to crease of wrist.
Tinel’s Test
Assess for carpal tunnel syndrome, cubital tunnel syndrome, neuropathy
(+) - numbness/tingling along median nerve or ulnar nerve
Doc firmly taps w/ finger pads on median nerve at crease of wrist or on ulnar nerve between medial epicondyle and ulna.
Finkelstein’s Test
Assess for tenosynovitis of extensor pollicis brevis and abductor pollicis longus
(+) - pain at lateral wrist
Pt make first w/ thumb tucked into fingers; moves into ulnar deviation
Scaphoid Fracture Test
Assess for scaphoid fracture
(+) - pain
Doc applies pressure in anatomical snuffbox over scaphoid bone
Active Ulnar Tension Test
Assess for ulnar neuropathy.
(+) - pain / weakness
Pt flexes elbow > 90˚, abducts shoulder, pronates forearm, and extends wrist. Hold 1 minute.
Watson Scaphoid Test
Assess for scaphoid instability
(+) - clunking sound
Doc pinches scaphoid bone between thumb and pointer finger while moving wrist into flexion/extension and ulnar/radial deviation
Bracelet Test
Assess for lunate dislocation, scaphoid fracture, ligament laxity, RA
(+) - pain
Doc applies lateral compressive force around distal radius and ulna
Elbow Fracture Test
Assess for elbow fracture
(+) - pain, inability to complete AROM
Pt does extension, flexion, pronation, supination of elbow
Cozen’s Test
Assess for lateral epicondylitis
(+) - pain
Pt seated. Pt makes fist, pronates elbow, extends wrist, flexes elbow, resists wrist flexion. Doc pulls down on fist while palpating lateral epicondyle
Mill’s Test
Assess for lateral epicondylitis
(+) - pain
Pt extends elbow, pronates forearm, flexes wrist. Doc palpates lateral epicondyle while flexing wrist into ulnar deviation
Reverse Cozen’s Test
Assess for medial epicondylosis
(+) - pain
Pt flexes shoulder 90˚, elbow 90˚, wrist 90˚. Doc supports elbow while pushing up on the palm of the pt’s hand.
Reverse Mill’s Test
Assess for medial epicondylosis
(+) - pain
Pt extends elbow, extends wrist. Doc supports elbow while pushing pt’s hand into radial deviation
Valgus Stress Test
Assess for elbow sprain / instability
(+) - pain
Pt extends elbow, supinates forearm. Doc stabilizes wrist while pushing in at lateral epicondyle. Repeat at 30˚ flexion.
Varus Stress Test
Assess for elbow sprain / instability
(+) - pain
Pt extend elbow, supinates forearm. Doc stabilizes wrist while pulling out at medial epicondyle. Repeat at 30˚ flexion.
Froment’s Pinch / Sign
Assess for cubital tunnel syndrome, ulnar neuropathy
(+) - “ok” sign
Pt is asked to press pads of pointer finger and thumb together, forming a “duck beak.”
Cluster Diagnosis for Subarcomial Impingement
Drop Arm test, Painful Arc sign, Hawkins-Kennedy test
Cluster Diagnosis for Full Thickness Rotator Cuff Tears
Drop Arm test, Painful Arc sign, Infraspinatus muscle
Cluster Diagnosis for Acromioclavicular Pathology
AC Cross Body, AC resisted extension, O’Brien’s w/ thumb down (AC compression test)
Cluster Diagnosis for Cervical Radiculopathy
Upper Limb Tension Test of median nerve, active cervical roation < 60˚, Distraction test, Spurling’s test
Canadian C-spine Rules for X-rays
Cognitive awareness / neurological symptoms, 65 or older, fearful of moving head when asked, axial load-based injury or dangerous mechanism, midline palpatory pain
