PCM test Flashcards
Temporomandibular joint examination order
- Locate joint anterior to tragus.
- Palpate for smooth range of motion, swelling, tenderness, snapping or clicking. Palpate muscles of mastication – masseters, temporal muscles, pterygoid muscles.
- Assess ROM with opening/closing mouth,
protrusion/retraction and lateral or side-to-side motion. 3 fingers able to be inserted in openmouth
Shoulder examination order
- Locate and palpate
- Assess range of motion.
- Assess acromioclavicular joint
- Assess rotator cuff injury
- Assess for bicipital tendonitis
Shoulder locate and palpate
acromion, greater tubercle of humerus, coracoid process and long head of biceps and observe for symmetry and palpate for tenderness, swelling. Locate and palpate sternoclavicular joint, palpate acromioclavicular joint during cross chest maneuver and palpate the subacromial bursa during shoulder extension.
Shoulder range of motion
flexion and extension by raising arms fully over head in one movement and then extended behind. Assess abduction and adduction of shoulder by raising arms in full arc out from body and over the head. Assess internal rotation with both arms placed at small of back. Assess external rotation with both arms placed behind neck. “Apley Scratch Test”
Apley scratch test
tests shoulder ROM (abduction and external rotation) patient puts arm behind shoulder and attempts to touch the opposite scapula; can test adduction and internal rotation if put arm behind back
“Crossover test”
test AC joint; adduct arm across the chest
Neer’s impingement test
test for rotator cuff injury; press on the scapula to prevent scapular motion with one hand, and raise the patient’s arm with the other. This compresses the greater tuberosity of the humerus against the acromion
Hawkin’s impingement sign
test for rotator cuff injury; flex the patient’s shoulder and elbow to 90 degrees with the palm facing down. Then, with one hand on the forearm and one on the arm, rotate the arm internally. This compresses the greater tuberosity against the coracoacromial ligament
Empty can test (supraspinatus strength)
test for supraspinatus strength; elevate the arms to 90 degrees and internally rotate the arms with the thumbs pointing down, as if emptying a can. Ask the patient to resist as you place downward pressure on the arms
Test infraspinatus strength
ask the patient to place arms at the side and flex the elbows to 90 degrees with the thumbs turned up. Provide resistance as the patient presses the forearms outward
Test forearm supination
flex the patient’s forearm to 90 degrees at the elbow and pronate the patient’s wrist. Provide resistance when the patient supinates the forearm
Dropped arm sign
ask the patient to fully abduct the arm to shoulder level (or up to 90 degrees) and lower it slowly. Note that abduction above shoulder level, from 90 degrees to 120 degrees, reflects action of the deltoid muscle
Elbow examination order
- Locate and palpate ulna, olecranon process and bursa, medial and lateral epicondyles, ulnar nerve. Note tenderness, swelling, warmth, redness, nodules.
- Assess range of motion: flexion/extension and supination/pronation
Elbow flexion instructions
“Bend your elbow”
Elbow extension instructions
“Straighten your elbow”
Elbow supination instructions
“Turn your palms up, as if carrying a bowl of soup”
Elbow pronation instructions
“Turn you palms down”
Wrist joints and hands examination order
- Observation
- Palpation
- Assess range of motion
- Assess sensation
Wrist joints and hands observation
Observe hands for symmetry, swelling, erythema, deformities of wrist, fingers, angulation
from radial or ulnar deviation. Observe thenar and hypothenar eminences. Note any thickening of
flexor tendons, flexion contractures
Wrist joints and hands palpation
Locate and palpate radiocarpal joint noting and swelling, bogginess or tenderness. Palpate
anatomical snuffbox, the 8 carpal bones and the 5 metacarpal bones and proximal, middle and distal phalanges. Palpate/compress MCP joints noting swelling, tenderness, nodules or bogginess. Palpate thumb and PIP and DIP joints for swelling, tenderness or nodules
Wrist joints and hands ROM
Assess range of motion of wrist: flexion/extension and ulnar and radial deviation. Assess grip strength of hand. Assess flexion/extension of fingers and abduction/adduction. Assess flexion/extension, abduction/adduction and opposition of thumb
Wrist joints and hands sensation
Assess sensation in fingers on palmar and dorsal surface of hand
Wrist flexion
With palms down, point your fingers toward the floor
Wrist extension
With palms down, point your fingers toward the ceiling
Wrist adduction
With palms down, bring your fingers toward the midline
Wrist abduction
With palms down, bring your fingers away from the midline
Hand grip strength
ask the patient to grasp your second and third fingers. This tests function of wrist joints, the finger flexors, and the intrinsic muscles and joints of the hand
Finkelstein’s test
test for DeQuervain’s tenosynovitis, thumb function; ask the patient to grasp the thumb against the palm and then move the wrist toward the midline in ulnar deviation (or down)
Tests for carpal tunnel
Tinel’s test and Phalen’s test
Tinel’s test
Test Tinel’s sign for median nerve compression by tapping lightly over the course of the median nerve in the carpal tunnel; positive if numbess or aching in fingers
Phalen’s test
ask the patient to press the backs of both hands together to form right angles for 60 seconds. These maneuvers compress the median nerve. Positive if hand/finger dysesthesias.
Finger flexion and extension
For flexion, to test the lumbricals and finger flexor muscles, ask the patient to “Make a tight fist with each hand, thumb across the knuckles.” For extension, to test the finger extensor muscles, ask the patient to “Extend and spread the fingers.”
Finger abduction and adduction
Ask the patient to spread the fingers apart (abduction from dorsal interossei) and back together (adduction from palmar interossei). Check for smooth, coordinated movement.
Thumb ROM exercises
Flexion - thumb move across palm to touch base of 5th finger; extension - move thumbs away from fingers; abduction - move thumb anteriorly away from palm; adduction - move thumb back toward palm; opposition - touch thumb to each of the other fingertips
Cervical spine examination order
- Locate sternocleidomastoid muscles
- Palpate spinous processes
- Assess ROM: flex neck by touching chin to chest; tilt head back to test extension; rotate head
side to side; test lateral bending by putting ear to shoulder
Spine examination order
- With patient standing, inspect patient posture, ability to stand and ease of gait. Evaluate spinal
curvature for scoliosis, kyphosis, lordosis. - Palpate spinous processes for tenderness and paravertebral muscles for tenderness and spasm. Palpate over sacroiliac joint.
- Assess range of motion: flexion/extension of spine, lateral bending and rotation.
- Perform straight leg raise for back pain.
Spine ROM
Flexion - bend forward and try to touch your toe; extension - bend back as far as possible; rotation - rotate from side to side; lateral bending - bend to the side from the waist
Straight leg raise
tests the spine; usually pain in 30-60 degree arc, to be positive must have radicular pain radiating down the entire ipsilateral limb
