Orthpedics NMS 1 Flashcards
1
Q
Rust’s Sign
A
- Positive: Patient cupping neck with both hands
- Indicates: Severe upper cervical instability
- Sprain / fracture / RA
2
Q
Libman’s Sign
A
- Thumb pressure to the mastoid process
- Tests for pain tolerance level
3
Q
Bakody’s Sign
A
- Seated: hand on head with elbow level with ear
- Positive: decreased pain
- Decreases tension on inferior brachial plexus
- efficacy = foraminal compression (but with less pain)
4
Q
Reverse Bakody Sign
A
- Seated: hand on head with elbow level with ear
- Positive: pain increases
- Thoracic outlet syndrome caused by scalene compression
5
Q
Bakody’s sign and Reverse Bakody’s Sign tests for what conditions?
A
Bakody’s Sign = IVF encroachment
Reverse Bakody’s sign = Thoracic outlet syndrome
6
Q
Bikele’s Sign
A
- Abduct shoulder 90 degrees + elbow/arm extension posteriorly
- Brachial plexus traction/stressing
- Radicular pain into arm
7
Q
Brachial Plexus Tension Test
A
- Place both hands behind/on head + elbows level w/ears
- Doctor pulls elbows back
- Traction/stress on brachial plexus and roots
- Radicular pain into arm
8
Q
Dejerine’s Sign
A
- Triad: Coughing/sneezing/straining increases symptoms
- Due to mechanical obstruction (space occupying lesion)
- Herniated/bluging disc, spinal cord tumor, compression fracture
- Venous flow reverses into epidural space (no valves)
9
Q
Valsalva’s Maneuver
A
- Breath in and bear down
- Tests for space occupying lesion via increase in pressure
10
Q
Swallowing Test
A
- While seated patient swallows
- Pain/difficulty = space occupying lesion, ligament sprain, fracture
11
Q
Naffziger’s Test
A
- From behind Dr. occludes ext. jugular veins at clavicle for 10-15 seconds. THEN patient coughs.
- Increases CSF/venous sinus pressure
- Sharp increase pain at lesion level (cranial)
12
Q
Barr’e-Lie’ou Test
A
- Rotate head as fast as can L/R.
- If patient has symptoms = positive
- Vertigo, visual disturbances, nausea, dizziness, nystagmus
- vascular insufficiency, cervicogenic vertigo, vestibular apparatus abnormality, unconsciousness
13
Q
Vertebrobasilar Artery Functional Maneuver
A
- 1st: Auscultate carotid and subclavian arteries
- If good: rotate and hyper extend head both sides (20 seconds)
- Positive = vertigo, dizziness, visual disturbances, nystagmus, unconsciousness
- Indicates = Ipsilateral vertebrobasilar insufficiency
14
Q
DeKleyn’s Test
A
- Patient supine rotates and hyper extends head
- Positive = vertigo, dizziness, visual disturbances, nystagmus, unconsciousness
- Indicates = Ipsilateral vertebrobasilar insufficiency
15
Q
Distraction Test
A
- Seated: Dr. exerts upward pressure on head for 30-60 seconds
- General increase in pain = muscle spasm
- Relief of pain = IVF encroachment/facet capsulitis
16
Q
Foraminal Compression Test
A
- Seated: pt. rotates head actively (note pain)
- Dr. then places pressure on head in neutral then rotates the head
- IVF closure w/downward pressure and rotation
- Localized pain = IVF encroachment
- Radicular pain = pressure on nerve root
17
Q
Jackson Compression Test
A
- Seated: pt. rotates and laterally flexes head (note pain)
- Dr. downward pressure in neutral/laterally flexed positions (note pain) 30 -60 seconds
- IVF encroachment or nerve root involvement
- contralateral pain = muscle strain
- Ipsilateral pain = facet or nerve root involvement
18
Q
Maximum Cervical Compression Test
A
- Seated: rotate, ipsilateral lateral bend, and extension (bilaterally)
- Pain concave side = nerve root encroach/face capsulitis
- Pain convex side = muscular strain
- IVF encroachment or nerve root involvement
19
Q
Spurling’s Test
A
- Seated: actively rotate and laterally flex head (note pain)
- No pain = continue
- Dr. downward pressure on head in neutral
- Dr laterally bends and extends patient’s neck with downward pressure for 30-60 seconds
- Strike top of head hand covering to soften blow
- IVF encroachment and nerve root involvement
20
Q
Lhermitte’s Test
A
- Seated: drop chin to chest; Dr. then passively flexes head
- Traction to posterior column of spinal cord
- Multiple sclerosis sign = shock sensation down neck and spine
21
Q
O’Donogue Maneuver
A
- Seated: cervical spine is actively moved through active ROM, passive ROM, and then resisted ROM.
- Resisted ROM pain = STRAIN muscular
- Passive ROM pain = SPRAIN ligament
22
Q
Kernig Sign
A
- Supine: Dr. flexes hip and knee to 90 degrees then attempts to extend the leg
- Positive: pain and increased HA during extension
- Meningeal irritation or inflammation
23
Q
Brudzinski Sign
A
- Supine: Dr. flexes the head
- Positive: Flexion of knees/hips
- Present with meningitis
24
Q
Shoulder Depression
A
- Seated: Dr. laterally flexes and stabilizes head while pushing down on ipsilateral shoulder
- Traction the brachial plexus and nerve roots
- Radicular symptoms: IVF fibrosis, dural adhesions, osteophytes, edema/compression at IVF
25
Q
Soto-Hall Test
A
- Supine: Dr. hand on sternum and Dr. passively flexes the head to the chest
- Dull/sharp pain cervical to thoracic: sprain/strain, avulsion fx, facet involvement
26
Q
Allen’s Test
A
- Seated: pump fist 5 times, occlude both Radial and Ulnar arteries, while patient clenches hand.
- Open hand then release one artery to observe filling of the hand
27
Q
Adson’s Test
A
- Seated: (Radial pulse noted) Dr. abducts and externally rotates arm.
- Patient rotates head toward tested arm, extends head, and holds breath for 10 seconds
- Positive: decreased amplitude or paresthesia
- Indicates: hypertrophy of scalene anticus or cervical rib compressing the neurovascular bundle
28
Q
Modified Adson’s Test
A
- Same as Adson’s except patient rotates away
- Tests for scalenus medius hypertrophy or cervical rib compressing the neurovascular bundle
29
Q
Halstead’s Test
A
-Seated: Radial pulse noted
