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Orthopedics > Orthopedic Tests - Midterm > Flashcards

Orthopedic Tests - Midterm Flashcards

1
Q

Motor Testing - Biceps

A

C6 - Musculocutaneous nerve
Pt flexes elbow 90˚.
Doc pushes down on wrist.
BILATERAL.

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2
Q

Motor Testing - Deltoids

A

C5 - Axillary nerve
Pt abducts shoulder 90˚.
Doc pushes down on elbow.
BILATERAL.

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3
Q

Motor Testing - Triceps

A

C7 - Radial nerve
Pt abducts shoulder 90˚, extends elbow 90˚.
Doc stabilizes elbow, pushes in on wrist.
BILATERAL.

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4
Q

Motor Testing - Wrist Extensors

A

C6 - Radial nerve
Pt extends wrist, balls up fist.
Doc pulls down on dorsum of hand.
BILATERAL.

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5
Q

Motor Testing - Wrist Flexors

A

C7 - Median/Ulnar nerve
Pt extends wrist, balls up fist.
Doc pushes up on fist.
BILATERAL.

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6
Q

Motor Testing - Finger Extensors

A

C7 - Ulnar/Median nerve
Pt extends elbow, pronates forearm. Doc pushes down on fingers while pt resists.
BILATERAL.

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7
Q

Motor Testing - Finger Flexors

A

C8 - Ulnar/Median nerve
Pt grips doc’s pointer/middle fingers.
BILATERAL.

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8
Q

Motor Testing - Finger Abductors / Adductors

A

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.

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9
Q

PE - Reflex Grading

A

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)

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10
Q

PE - Tenderness Grading

A

+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

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10
Q

PE - Motor Grading

A

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

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11
Q

Reflex Testing - Biceps

A

C5
Doc supports pt’s arm, strikes own thumb on biceps tendon.
Biceps contracts, elbow flexes.
BILATERAL.

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12
Q

Reflex Testing - Brachioradialis

A

C6
Doc strikes hammer 4 inches proximal to base of thumb.
Brachioradialis contracts, forearm supinates.
BILATERAL.

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13
Q

Reflex Testing - Triceps

A

C7
Pt abducts shoulder 90˚, internally rotates forearm.
Doc supports arm, strikes just above olecranon fossa.
Triceps contracts, forearm extends.
BILATERAL.

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14
Q

Sensory Testing - C5

A

Over deltoid tuberosity (lateral arm)

BILATERAL, pt’s eyes closed, always follow dull w/ sharp

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15
Q

Sensory Testing - C6

A

Thumb, lateral/distal forearm

BILATERAL, pt’s eyes closed, always follow dull w/ sharp

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16
Q

Sensory Testing - C7

A

Middle finger

BILATERAL, pt’s eyes closed, always follow dull w/ sharp

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17
Q

Sensory Testing - C8

A

Pinky finger

BILATERAL, pt’s eyes closed, always follow dull w/ sharp

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18
Q

Sensory Testing - T1

A

Medial forearm at level of elbow

BILATERAL, pt’s eyes closed, always follow dull w/ sharp

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19
Q

Reflex Testing - Causes of Hyporeflexia

A

technique error, LMNL

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20
Q

Reflex Testing - Causes of Hyperreflexia

A

hyper-reactor, UMNL, nerve root irritation

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21
Q

Spinous Percussion Test

A

Assess for vertebral fracture, metastatic dz, disc impingement
(+) - pain, lingering pain
Doc percusses cervical / thoracic sp’s one at a time.

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22
Q

Valsalva Maneuver

A

Assess for herniated disc or SOL
(+) - increase/presentation of peripheral sxs
Pt asked to “bear down” / “blow up balloon”, 2-3 secs

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23
Q

Cervical Compression Test

A

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

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24
Q

Spurling’s Test

A

Assess for nerve root impingement
(+) - pain
Pt lat flex head toward symptomatic side. Doc slowly pushes down on top of head

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25
Q

Soto Hall / Brudzinski Test

A

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.

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26
Q

Forward Bending Test (Adam’s Test)

A

Assess for scoliosis
(+) - unilateral asymmetry
Pt bends forward. Doc stands behind observing symmetry.

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27
Q

Upper Limb Tension Test for Median Nerve

A

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

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28
Q

Maximum Foraminal Compression Test

A

Assess for nerve root impingement
(+) - pain
Pt rotates/extends/lat flexes head. Doc slowly pushes down on top of head

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29
Q

Cervical Distraction Test

A

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)

30
Q

Shoulder Depression Test

A

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.

31
Q

Adson’s Test

A

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.

32
Q

Reverse Adson’s Test

A

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.

33
Q

Allen Test

A

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.

34
Q

Muscle Test - Infraspinatus / Teres Minor

A

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.

35
Q

Eden’s Test

A

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.

36
Q

Muscle Test - Subscapularis

A

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.

37
Q

Roos’ Test

A

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.

38
Q

Wright’s Test

A

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.

39
Q

Breath Pattern Test

A

Pt places one hand on abd, one hand on upper chest. Doc observes movement during deep breath (diaphragmatic vs thoracic breathing)

40
Q

Crank Test

A

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.

41
Q

O’Brien’s Test (Pts 1 & 2) / AC Compression Test (Pt 1 only)

A

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)

42
Q

Speed’s Test

A

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.

43
Q

Drop Arm (Codman’s Arm Drop) Test

A

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.

44
Q

Empty Can Test

A

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.

45
Q

Gerber Lift-off Test

A

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.

46
Q

Hawkins-Kennedy Test

A

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.

47
Q

Neer Impingement Test

A

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.

48
Q

AC Crossbody Adduction + Resisted Extension Tests

A

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.

49
Q

Shoulder Apprehension Test

A

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.

50
Q

Shoulder Relocation Test

A

Following apprehension test, doc pushes posteriorly on humeral head while returning pt’s arm to neutral.

52
Q

Painful Arc

A

Assess for impingement syndrome.
(+) - pain between 60-120˚
Pt actively abducts shoulder through full ROM in scapular plane.

53
Q

Phalen’s Test

A

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

54
Q

Modified Phalen’s Test

A

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

55
Q

Median Nerve Compression Test

A

Assess for carpal tunnel syndrome
(+) - median nerve sxs
Forearm/wrist in neutral position. Double thumb compression just distal to crease of wrist.

56
Q

Tinel’s Test

A

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.

57
Q

Finkelstein’s Test

A

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

58
Q

Scaphoid Fracture Test

A

Assess for scaphoid fracture
(+) - pain
Doc applies pressure in anatomical snuffbox over scaphoid bone

59
Q

Active Ulnar Tension Test

A

Assess for ulnar neuropathy.
(+) - pain / weakness
Pt flexes elbow > 90˚, abducts shoulder, pronates forearm, and extends wrist. Hold 1 minute.

60
Q

Watson Scaphoid Test

A

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

61
Q

Bracelet Test

A

Assess for lunate dislocation, scaphoid fracture, ligament laxity, RA
(+) - pain
Doc applies lateral compressive force around distal radius and ulna

62
Q

Elbow Fracture Test

A

Assess for elbow fracture
(+) - pain, inability to complete AROM
Pt does extension, flexion, pronation, supination of elbow

63
Q

Cozen’s Test

A

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

64
Q

Mill’s Test

A

Assess for lateral epicondylitis
(+) - pain
Pt extends elbow, pronates forearm, flexes wrist. Doc palpates lateral epicondyle while flexing wrist into ulnar deviation

65
Q

Reverse Cozen’s Test

A

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.

66
Q

Reverse Mill’s Test

A

Assess for medial epicondylosis
(+) - pain
Pt extends elbow, extends wrist. Doc supports elbow while pushing pt’s hand into radial deviation

67
Q

Valgus Stress Test

A

Assess for elbow sprain / instability
(+) - pain
Pt extends elbow, supinates forearm. Doc stabilizes wrist while pushing in at lateral epicondyle. Repeat at 30˚ flexion.

68
Q

Varus Stress Test

A

Assess for elbow sprain / instability
(+) - pain
Pt extend elbow, supinates forearm. Doc stabilizes wrist while pulling out at medial epicondyle. Repeat at 30˚ flexion.

69
Q

Froment’s Pinch / Sign

A

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.”

70
Q

Cluster Diagnosis for Subarcomial Impingement

A

Drop Arm test, Painful Arc sign, Hawkins-Kennedy test

71
Q

Cluster Diagnosis for Full Thickness Rotator Cuff Tears

A

Drop Arm test, Painful Arc sign, Infraspinatus muscle

72
Q

Cluster Diagnosis for Acromioclavicular Pathology

A

AC Cross Body, AC resisted extension, O’Brien’s w/ thumb down (AC compression test)

73
Q

Cluster Diagnosis for Cervical Radiculopathy

A

Upper Limb Tension Test of median nerve, active cervical roation < 60˚, Distraction test, Spurling’s test

74
Q

Canadian C-spine Rules for X-rays

A

Cognitive awareness / neurological symptoms, 65 or older, fearful of moving head when asked, axial load-based injury or dangerous mechanism, midline palpatory pain

Orthopedics (3 decks)

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