Physical Medicine Part 1 Flashcards
What is the indication for use of Adson’s and Reverse Adson’s ?
TOS
What is a contraindication for Adson’s and Reverse Adson’s?
Dislocated shoulder
How is Adson’s and Reverse Adson’s (Halstead) performed?
Pt points arm away from body 45 degree angle. Dr. stands behind and takes both radial pulses simultaneously, while pt lat rotates and extends neck either direction for 30 sec. (Adson’s maneuver is performed in the arm pt looks towards, whereas Reverse Adson’s is performed in the arm pt looks away from)
What is the positive sign for Adson’s and Reverse Adson’s (Halstead)?
Disappearance of pulse (related to tight scalenes)
What is the indication for cervical spine compression (Spurling’s, Foraminal Compression) Test?
Nerve root symptoms
What is a contraindication for cervical spine compression?
If pain is elicited, do not proceed
What is the technique for performing cervical spine compression?
Press straight down on patient’s head: bend head laterally to each side w/compression down in each position; then w/ lateral bending and extension combined.
What are the 3 positive cervical spine compression test responses?
- Straight down, unilat pain = severe nerve root inflammation
- Side bend pain (on side of compression) = nerve root compression
- Side bend pain (opposite side of compression) = nerve root contraction
What is the indication for Cervical Spine Distraction Test?
Radicular symptoms
What is a contraindication for cervical spine distraction test?
If pain is elicited, do not proceed
What is the technique for the cervical spine distraction test?
Place one hand on each side of the pt’s face, use occiput and sides of head to pull upward on their head
How is the cervical spine distraction test interpreted?
Pain: ligament or non-contractile tissue injury
Relief of pain: Nerve root impingement
What is the indication for East (Roos) test?
Neurological deficit, restriction of arterial flow to the arm
What is the technique for East (Roos) test?
Pt abducts arm to 90 degrees and lat. rotates shoulder. Pt then flexes elbow to 90 degrees so they are behind the frontal plane. Open and close hands slowly for 3 minutes.
What is positive East (Roos) test?
Profound weakness of the arm w/numbness and tingling of the hand or inability to keep arm in starting position for 3 minutes.
What does a positive East (Roos) test indicate?
TOS on affected side
What is the indication for Soto-Hall test?
Neck pain
What is the technique for Soto-Hall test?
Pt supine, examiner puts pressure on pt’s sternum, then progressively flexes neck, moving chin toward sternum
What is a positive Soto-Hall test and what does it indicate?
Neck pain; indicates cervical discopathy or herniation, meningitis, or spurring or fraction of affected vertebra
What is the indication for the Shoulder Depression Test?
Brachial plexus lesions
What is the technique for the shoulder depression test?
Apply downward pressure to shoulder while flexing pt.’s head to opposite side
What is a positive shoulder depression test?
Increased pain = irritation or nerve root compression
What is the indication for Valsalva?
Determine effect of increased pressure on spinal cord
What is a warning for use of valsalva?
Pt may become dizzy or my LOC from restriction of blood flow to brain during the test
What is the technique for valsalva?
Have pt take a deep breath, blow out breath into a closed mouth and simulate straining during BM.
What is a positive valsalva?
Pain in back
What does a positive valsalva indicate?
SOL (tumor, herniated disc, or osteophyte. (Note: detects lesions all along spinal canal, not just cervical)
What is the indication for Vertebral Artery (Cervical Quadrant) test?
Vertebral, basilar, or carotid artery stenosis or compression
What is a caution when performing the vertebral artery (cervical quadrant) test? Why is this important?
Pt may experience dizziness or nystagmus during this test - indicates compression of vertebral arteries
What is a positive vertebral artery (cervical quadrant) test?
Referring symptoms indicate involvement of the opposite artery
What are the 2 indications for Wright’s (Hyperabduction) test?
Brachial artery compression
TOS
What is a contraindication for Wright’s (hyperabduction) test?
Provocation for >1-2 minutes
What is the technique for Wright’s (hyperabduction) test?
While palpating both radial pulses, lift pt’s arms slowly into abduction up to 45 degrees, then 90 degrees, then beyond
What is the interpretation of a positive Wright’s (hyperabduction) test?
Tight/spastic pec minor tendon compressing brachial artery
Mneomonic: When you have the right answer you raise your hand
What is the indication for Adam’s Sign?
Scoliosis
What is a contraindication for performing Adam’s Sign?
Inability to forward flex
What is the technique for Adam’s Sign?
Feet together, knees straight, patient bends forward at hips and allows arms to drop vertically
What is a positive Adam’s Sign?
Scoliosis is not improved w/ forward flexion
What is the indication for Bechterew’s Test?
Sciatic pain
What is a contraindication for Bechterew’s Test?
Radicular pain preventing performance of the test
What is the technique for Bechterew’s Test?
While seated w/flexed neck, pt extends one knee at a time; if no symptoms, pt extends both legs simultaneously
What is a positive Bechterew’s Test? What does this indicate?
Symptoms appear in back or leg
Indicates tension on the sciatic nerve
What is the indication for Braggard’s Test?
Extradural sciatic nerve irritation
What is the technique for Braggard’s Test?
During straight leg raise, back off a few degrees from point of shooting pain and then dorsiflex foot of leg that is raised
What is a positive Braggard’s Test? What is the cause?
Shooting pain down sciatic nerve distribution
Cause: IV disc herniation or nerve traction injury
What is the indication for Burn’s Bench Test?
Suspected malingering
What is the technique for Burn’s Bench Test?
Have pt bend forward and touch floor w/ fingers while examiner holds their ankles
What is a positive Burn’s Bench Test?
Pt not able to perform test or overbalances
What is the indication for Gaenslen’s Test?
Suspected SI joint problem
What is the technique for Gaenslen’s Test?
Pt supine, bring knee of affected side’s leg (still on table) to chest. Examiner can apply downward pressure on knee of suspected leg that is hanging off the table.
What does a positive Gaenslen’s Test indicate?
- SI lesion
- Hip pathology
- L4 nerve root lesion
What is the indication for Hibb’s Test?
SI ligament pain
What is a contraindication for Hibb’s Test?
Pathology in hips or less than full ROM
What is the technique for Hibb’s Test?
Pt prone, flex knee then internally (medially) rotate hip by moving lower leg laterally while stabilizing pelvis
What is a positive indicator of Hibb’s Test and what does that mean?
Pain.
Means: 1. unstable spinal segment (spondylolithesis, w/pain at segment affected)
2. facet syndrome (L5-S1 junction pain)
3. SI ligament sprain
4. Extruded IV disc
5. Capsular entrapment
6. Contralateral SI pain and inflammation
What is the indication for Hoover’s Test?
Malingering; discrepancy between symptoms and reported pain
What is the technique for Hoover’s Test?
Pt supine, one palm under each heel, ask pt to flex one hip
What is positive Hoover’s Test?
Non-active leg doesn’t press down into your palm
What is indication for Kemp’s (Quadrant) Test?
Lateral disc lesion
What is the technique for Kemp’s (Quadrant) Test?
Pt standing, rotate and extend flexed torso to same side, then press anteriorly on lumbar sponsors processes.
What is a positive interpretation of Kemp’s (Quadrant) Test?
Local pain = facet syndrome, low back strain/sprain
Pain radiating down the leg = disc herniation
What is the indication for Kernig’s Test?
Meningeal irritation or radicular pain to extremity
What is the technique for Kernig’s Test?
Passively flex knee and hip 90 degrees, then attempt to extend the knee while keeping the hip stable
What is a positive Kernig’s Test?
Attempt to extend knee is resisted due to pain and muscle spasm
What does a positive Kernig’s Test indicate?
Meningeal irritation (meningitis, herniated disc, or caudal equina syndrome). Resistance w/out accompanying pain indicates tight hamstrings
What is the indication for Lindner’s test?
Sharp diffuse pain
What is the technique for Lindner’s test?
Pt supine, legs fully extended, examiner flexes pt’s neck.
What is a positive for Lindner’s test?
Pain leg, lumbar, or cervical spine
What is the interpretation of a positive Lindner’s test?
Radicular or sciatic pain means disc lesion at the level of pain
What is the indication for Milgram’s test?
Lumbar instability
What is a caution when performing Milgram’s test?
Use the test w/caution because of high stress load to lumbar spine.
What is a contraindication to performing Milgram’s test?
Suspected disc rupture - performing the test can worsen the condition
What is the technique for Milgram’s test?
Pt actively raises both extended legs approx 2” off the table for 30 sec.
What is a positive Milgram’s test?
Inability to hold feet off the table for the full 30 sec.
What are 3 interpretations of a positive Milgram’s test?
- Disc herniation
- Lumbar strain/sprain
- Weak abdominal or hip flexor muscles
What is the indication for Minor’s sign?
Sciatic radiculopathy
What is the technique for Minor’s sign?
Pt rises from a sitting position by supporting body WT on the unaffected side, placing one hand on the back
What is a positive Minor’s sign?
Pain on motion, usually radiating
What are 7 interpretations of positive Minor’s sign?
- Sciatic radiculitis
- Sacroiliac lesions
- Lumbosacral strains and sprains
- Fractures
- Disc syndromes
- Dystrophies
- Myotonias
What is the indication for Nachlas Test (Prone Knee Bending)?
Neurodynamic test for disc herniation
What is the contraindication for Nachlas Test (Prone Knee Bending)?
Pathology that restricts movement; avoid rotation of hip
What is the technique for Nachlas Test?
Pt prone. Knee is flexed by examiner until the heel touches the ipsilateral buttock
What are 3 positives for Nachlas Test?
- Sharp pain in ipsilateral buttock or sacral area suggests sacroiliac disorder.
- Pain in lower back area or that is sciatic-like suggests a lower lumbar disorder, particularly L3-L4.
- Pain in the upper lumbar area, groin, or ANT thigh suggests tight quads or femoral nerve lesion.
What are 4 interpretations of a positive Nachlas Test?
- Tight rectus femoris
- Upper lumbar joint lesion
- Upper spine nerve root lesion
- Hypomobile SI joint
What is the indication for Pelvic Rock Test?
SI joint lesions
What is the technique for Pelvic Rock Test?
Pt side lying; compress iliac crests toward midline
What is a positive Pelvic Rock Test? What does it mean?
Pain; SI lesion on painful side
What is the indication for Lasegue’s SLR Test?
Neurological test of lower limb
What is a contraindication for Lasegue’s SLR Test?
Modify test to side-lying position if pt cannot lie supine
What is the technique for Laseque’s SLR Test?
Examiner passively raises one leg (flexing at the hip) until it reaches endpoint (70 degrees) or pt has pain. Place one hand on patella to keep knee from bending
What is a positive Lasegue’s SLR Test?
Shooting, sharp and tingling down back and leg (ipsilateral side), differentiate from tight hamstring feelings (ache in POST thigh) or low back pain (aching in low back). Note the degree of hip flexion where shooting pain begins
What is the interpretation of a positive Lasegue’s SLR Test?
- Pain beyond 70 degrees extension = lumbar
- Side w/ pain btwn 35-70 degrees extension = ipsilateral lateral disc herniation causing nerve root compression or impingement
- Radiating pain can indicate sciatica
To differentiate the source of pain with Lasegue’s SLR Test, what test should this be followed up with?
Soto Hall
What is the indication for Well Leg Raise (WLR) Fajersztajn’s Test?
Pain on opposite leg raised in SLR
What is a contraindication for Well Leg Raise (WLR) Fajersztajn’s Test?
Modify test to side-lying position if pt cannot lie supine
What is the technique for Well Leg Raise (WLR) Fajersztajn’s Test?
Pt supine; examiner raises leg opposite one they raised in SLR
What is a positive Well Leg Raise (WLR) Fajersztajn’s Test?
Pain down back and leg on contralateral side raised in SLR
What is the interpretation of Well Leg Raise (WLR) Fajersztajn’s Test?
Side with pain has medial herniation
What is the indication for Yeoman’s Test?
SI joint pathology
What are the 2 parts to the technique for Yeoman’s Test?
Part 1: w/ pelvis stabilized and knees extended, each of pt’s hips are extended
Part 2: each of pt’s hips are extended w/ knees flexed
What is a positive Yeoman’s Test?
Pain in lumbar spine or SI joint during the test
What does a positive Yeoman’s Test indicate?
Joint dysfunction
What is the indication for Apley’s Scratch Test?
Degenerative tendinitis
What is a contraindication for Apley’s Scratch Test?
Frozen shoulder; capsular tightness
What is the technique for Apley’s Scratch Test?
Pt attempts to touch finger tips in middle of their back. Test ext. rot. (top arm) and int. rot. (bottom arm), and action of rotator cuff muscles. Repeat on opposite side.
What is a positive Apley’s Scratch Test?
Inability to touch fingers behind back.
What is the interpretation of a positive Apley’s Scratch Test?
Tear, hypertonicity, tendonitis or weakness of rotator cuff structures
What is the indication for Drop Arm Test (Codman’s)?
Rotator cuff tear
What is the technique for Drop Arm Test (Codman’s )?
Pt standing or sitting; combine w/ AROM testing; abduct affected arm to 180 degrees, then start lowering back down in adduction.
What is the positive Drop Arm Test (Codman’s)?
Arm drops suddenly at 90 degrees during adduction
What is the interpretation of a positive Drop Arm Test (Codman’s)?
Rotator cuff tear (almost never bilateral)
