PCM test

Question 1

Temporomandibular joint examination order

Answer 1

1. Locate joint anterior to tragus.
2. Palpate for smooth range of motion, swelling, tenderness, snapping or clicking. Palpate muscles of mastication – masseters, temporal muscles, pterygoid muscles.
3. Assess ROM with opening/closing mouth,
   protrusion/retraction and lateral or side-to-side motion. 3 fingers able to be inserted in openmouth

Question 2

Shoulder examination order

Answer 2

1. Locate and palpate
2. Assess range of motion.
3. Assess acromioclavicular joint
4. Assess rotator cuff injury
5. Assess for bicipital tendonitis

Question 3

Shoulder locate and palpate

Answer 3

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.

Question 4

Shoulder range of motion

Answer 4

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”

Question 5

Apley scratch test

Answer 5

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

Question 6

“Crossover test”

Answer 6

test AC joint; adduct arm across the chest

Question 7

Neer’s impingement test

Answer 7

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

Question 8

Hawkin’s impingement sign

Answer 8

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

Question 9

Empty can test (supraspinatus strength)

Answer 9

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

Question 10

Test infraspinatus strength

Answer 10

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

Question 11

Test forearm supination

Answer 11

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

Question 12

Dropped arm sign

Answer 12

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

Question 13

Elbow examination order

Answer 13

1. Locate and palpate ulna, olecranon process and bursa, medial and lateral epicondyles, ulnar nerve. Note tenderness, swelling, warmth, redness, nodules.
2. Assess range of motion: flexion/extension and supination/pronation

Question 14

Elbow flexion instructions

Answer 14

“Bend your elbow”

Question 15

Elbow extension instructions

Answer 15

“Straighten your elbow”

Question 16

Elbow supination instructions

Answer 16

“Turn your palms up, as if carrying a bowl of soup”

Question 17

Elbow pronation instructions

Answer 17

“Turn you palms down”

Question 18

Wrist joints and hands examination order

Answer 18

1. Observation
2. Palpation
3. Assess range of motion
4. Assess sensation

Question 19

Wrist joints and hands observation

Answer 19

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

Question 20

Wrist joints and hands palpation

Answer 20

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

Question 21

Wrist joints and hands ROM

Answer 21

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

Question 22

Wrist joints and hands sensation

Answer 22

Assess sensation in fingers on palmar and dorsal surface of hand

Question 23

Wrist flexion

Answer 23

With palms down, point your fingers toward the floor

Question 24

Wrist extension

Answer 24

With palms down, point your fingers toward the ceiling

Question 25

Wrist adduction

Answer 25

With palms down, bring your fingers toward the midline

Question 26

Wrist abduction

Answer 26

With palms down, bring your fingers away from the midline

Question 27

Hand grip strength

Answer 27

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

Question 28

Finkelstein’s test

Answer 28

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)

Question 29

Tests for carpal tunnel

Answer 29

Tinel’s test and Phalen’s test

Question 30

Tinel’s test

Answer 30

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

Question 31

Phalen’s test

Answer 31

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.

Question 32

Finger flexion and extension

Answer 32

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.”

Question 33

Finger abduction and adduction

Answer 33

Ask the patient to spread the fingers apart (abduction from dorsal interossei) and back together (adduction from palmar interossei). Check for smooth, coordinated movement.

Question 34

Thumb ROM exercises

Answer 34

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

Question 35

Cervical spine examination order

Answer 35

1. Locate sternocleidomastoid muscles
2. Palpate spinous processes
3. 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

Question 36

Spine examination order

Answer 36

1. With patient standing, inspect patient posture, ability to stand and ease of gait. Evaluate spinal
   curvature for scoliosis, kyphosis, lordosis.
2. Palpate spinous processes for tenderness and paravertebral muscles for tenderness and spasm. Palpate over sacroiliac joint.
3. Assess range of motion: flexion/extension of spine, lateral bending and rotation.
4. Perform straight leg raise for back pain.

Question 37

Spine ROM

Answer 37

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

Question 38

Straight leg raise

Answer 38

tests the spine; usually pain in 30-60 degree arc, to be positive must have radicular pain radiating down the entire ipsilateral limb