Physical Medicine Part 3 Flashcards
1
Q
What is the indication for the Bounce Home Test?
A
Meniscus lesions
2
Q
What is the technique for Bounce Home Test?
A
Pt supine w/knee fully flexed; cup pt’s heel or hold ankle in examiner’s hand. Pt’s knee allowed to passively extend
3
Q
What is a positive for Bounce Home Test?
A
- Extension incomplete
- Rubbery end feel
- Pain in patella
4
Q
What is the interpretation of a positive Bounce Home Test?
A
- Probable torn meniscus
2. Chondromalacia patella and hyperextended knee
5
Q
What is the indication for Lachman’s Test?
A
Ligamentous instability
6
Q
What is the technique for Lachman’s Test?
A
Pt supine; examiner holds pt’s knee btwn full extension and 30 degrees of flexion; stabilize femur w/ “outside” hand and move the proximal aspect of the tibia forward w/ the “inside” hand
7
Q
What is the positive for Lachman’s Test?
A
Mushy or soft end feel when tibia is moved forward on femur
8
Q
What is the interpretation of a positive Lachman’s Test?
A
- Injury to the anterior cruciate ligament
- Posterior oblique ligament
- Arcuate-popliteus complex
9
Q
What is indication for Murray Test (Reduction Click)?
A
Meniscus lesion
10
Q
What is the technique for Murray Test (Reduction Click)?
A
Pt supine; examiner flexes pt’s hip and knee and then internally and externally rotates knee; change angle of knee flexion and repeat until entire range of flexion has been tested
11
Q
What is the positive for Murray Test (Reduction Click)?
A
Snap or click sound, pain
12
Q
What is the interpretation of a positive Murray Test (Reduction Click)?
A
Meniscus fragment in joint
Ext. rotation = medial meniscus lesion
Int. rotation = lateral meniscus lesion
13
Q
What is the indication for Patellar Femoral Grinding Test (Clark’s Test)?
A
Patellofemoral dysfunction
14
Q
What is the technique for Patellar Femoral Grinding Test (Clark’s Test)?
A
Pt seated or supine; press on patella while pt slowly contracts their quads
15
Q
What is the positive for Patellar Femoral Grinding Test (Clark’s Test)?
A
Grinding under patella
16
Q
What is the interpretation of a positive for Patellar Femoral Grinding Test (Clark’s Test)?
A
Chondromalacia patella
17
Q
What is the indication for Valgus/Varus Stress - Medial and Lateral Collateral Ligament (MCL and LCL) Tests?
A
One-plane medial or lateral instability
18
Q
What is the technique for Valgus/Varus Stress - Medial and Lateral Collateral Ligament (MCL and LCL) Tests?
A
Pt supine; initially pt’s knee is in full extension, and the examiner applies varum/valgus stresses, then the pt slightly flexes the knee and the stresses are repeated. Repeat a third time w/ fairly great knee flexion
19
Q
What is a positive Valgus/Varus Stress - Medial and Lateral Collateral Ligament (MCL and LCL) Tests?
A
Pain in medial or lateral knee
20
Q
What is the interpretation of a positive Valgus/Varus Stress - Medial and Lateral Collateral Ligament (MCL and LCL) Tests?
A
Sprained MCL = Valgus stress
Sprained LCL = Varus stress
Higher chance of catching milder injuries w/ slight flexion
More severe injuries will cause pain in full knee extension
21
Q
What is the indication for Bulge Test for Minor Knee Joint Effusion?
A
Trauma, infection, degenerative joint disease, RA, gout, pseudo gout
22
Q
What is the technique for Bulge Test for Minor Knee Joint Effusion?
A
Pt seated; milk medial side of patella, pushing superiorly, then stroke inferiorly on lateral side of patella.
23
Q
What is the positive for Bulge Test for Minor Knee Joint Effusion?
A
Fluid wave on distal medial side of patella
24
Q
What is the interpretation of a positive Bulge Test for Minor Knee Joint Effusion?
A
Minor joint effusion
25
What is the indication for Ballotable Patella Test for Major Knee Joint Effusion?
Trauma, INFXN, degenerative joint dz, RA, gout, pseudo gout
26
What is the technique for Ballotable Patella Test for Major Knee Joint Effusion?
Pt supine, w/ leg in neutral position; compress patella into patellofemoral groove and rapidly release
27
What is a positive Ballotable Patella Test for Major Knee Joint Effusion?
Patella feels like it is floating (intra-articular swelling) or click or stopping point noted when patella strikes patellofemoral groove (extra-articular
28
What is the interpretation of a positive Ballotable Patella Test for Major Knee Joint Effusion?
Major joint effusion
29
What is the indication for Anterior Drawer Test (Leg/Ankle)?
Ligamentous instability; sports related injuries from supination or inversion
30
What is the technique for Anterior Drawer Test (Leg/Ankle)?
Pt supine w/ heels off end of table; stabilize tibia and fibula, hold foot in 20 degrees plantar flexion, move ankle anteriorly; repeat w/ foot in dorsiflexion
31
What is a positive Anterior Drawer Test (Leg/Ankle)?
Excessive anterior motion or any rotary component
32
What is the interpretation of a positive Anterior Drawer Test (Leg/Ankle)?
Excessive anterior motion (usu. worse in dorsiflexion): medial and lateral talofibular ligament lesion
Rotary component: torn ligament on side that ankle turns away from
33
What is the indication for Posterior Drawer Test (Leg/Ankle)?
Ligamentous instability; sports related injuries from supination or inversion
34
What is the technique for Posterior Drawer Test (Leg/Ankle)?
Pt supine with heels off end of the table; have pt flex knee, stabilize tibia and talus, push tibia and fibula posteriorly on talus
35
What is a positive Posterior Drawer Test (Leg/Ankle)?
Excessive posterior movement of tibia and fibula on talus
36
What is the interpretation of a positive Posterior Drawer Test (Leg/Ankle)?
Medial and lateral talofibular ligament insufficiency/lesion
37
What is the indication for Dorsiflexion Test?
Limited ROM of ankle
38
What is the technique for Dorsiflexion Test?
Pt seated or supine; flex pt's knee and attempt to dorsiflex ankle. Extend pt's knee and attempt to dorsiflex ankle
39
What is a positive Dorsiflexion Test?
Inability to dorsiflex ankle
40
What is the interpretation of a positive Dorsiflexion Test?
Ankle dorsiflexes w/ knee flexed: gastrocnemius hypertonicity
Ankle will not dorsiflex in any position: coleus hypertonicity
41
What is the indication for Homan's Sign?
Pallor, welling, loss of dorsalis pedis pulse, w/ pain in the calf
42
What is the technique for Homan's Sign?
Pt supine; w/ knee extended, passively, abruptly dorsiflex pt's foot; often performed during SLR test
43
What is the positive for Homan's Sign?
Pain in calf region
44
What is the interpretation for positive Homan's Sign?
DVT (poor positive and negative predictive value)
45
What is the indication for Talar Tilt Test?
Ligamentous instability
46
What is the technique for Talar Tilt Test?
Pt supine or side-lying w/ foot flexed; test normal side first for comparison by holding foot in 90 degree anatomic position; talus is then tilted from side to side into adduction and abduction
47
What is the positive for Talar Tilt Test?
Comparison of affected side w/ normal side; plantar flexion tests the ANT. talofibular ligament; adduction stresses the calcaneofibular ligament and the ANT talofibular ligament; abduction stresses the deltoid ligament
48
What is the interpretation of a positive Talar Tilt Test?
Torn calcaneofibular ligament
49
What is the indication for Achilles Tendon Squeeze Test (Thompson's Test)?
Achilles tendon pain; palpable defect in tendon
50
What is the technique for Achilles Tendon Squeeze Test (Thompson's Test)?
Pt prone; squeeze gastrocnemius toward midline on each side
51
What is a positive Achilles Tendon Squeeze Test (Thompson's Test)?
Lack of plantar flexion of ankle during squeeze
52
What is the interpretation of a positive Achilles Tendon Squeeze Test (Thompson's Test)?
Ruptured Achilles tendon
53
What is the indication for Tibial Torsion Test?
Toeing in when standing
54
What is the supine technique for Tibial Torsion Test?
Rotate leg so that patella points anteriorly, palpate apices of malleoli, form angle of line btwn malleolar apices and parallel to floor through heel
55
What is the prone technique for Tibial Torsion Test?
Knee flexed 90 degrees, note angle foot makes w/ tibia
56
What is positive for supine Tibial Torsion Test?
>18 degrees = toe-out torsion
<13 degrees = toe-in
Numbers different in children
57
What is positive for prone Tibial Torsion Test?
If angle formed is >18 degrees suggest tibial torsion
58
What is the indication for the Forefoot Adduction Test?
Excessive forefoot adduction in infants
59
What is the technique for the Forefoot Adduction Test?
Pt sitting on caretaker's lap; stabilize infant's body by holding calcaneus w/one hand, then attempt to move forefoot to medial neutral position
60
What is a positive Forefoot Adduction Test?
Unable to move foot into a neutral position
61
What is the interpretation of a positive Forefoot Adduction Test?
Casting may be necessary to correct structural foot defect
62
What is the indication for Forefoot Squeeze test (Morton's Test)?
Pain around metatarsal heads
63
What is the technique for Forefoot Squeeze test (Morton's Test)?
Pt supine; grasp foot around metatarsal heads and squeeze heads together
64
What is a positive Forefoot Squeeze test (Morton's Test)? What is the interpretation?
Pain; stress fracture or neuroma
65
What is the indication for the Test for Rigid or Supple Flat Feet?
Trauma, muscle weakness, ligament laxity, pronated foot
66
What is the technique for the Test for Rigid or Supple Flat Feet?
Pt standing, standing on toes, then seated; observe medial longitudinal foot arch of pt in all 3 positions
67
What is the interpretation of a positive Test for Rigid or Supple Flat Feet?
Arch absent in all positions = rigid flat feet
Arch absent only while standing (present standing on toes or seated) = supple flat feet (correctable w/ longitudinal arch supports)
68
What is the indication for Cervical Spine Osseous Manipulation - Modified Rotary Break?
TOS, HA, chronic muscle hypertonicity in neck, fixed segments, decreased joint motion, thixotropic changes (i.e. thickening/"stickiness" of synovial fluid due to pressure).
69
What is a contraindication for Cervical Spine Osseous Manipulation - Modified Rotary Break?
Positive George's test (Sx during extreme neck extension w/rotation), hx of stroke, radiographically-verified cervical weakness in pt w/ RA, after head trauma w/ possibility of C1-C2 instability, dens fracture, any fracture of vertebrae, joint hyper mobility, osteoarthritis, osteoporosis, IV disc herniation
70
What is the technique for Cervical Spine Osseous Manipulation - Modified Rotary Break?
Pt supine. Find fixed segment. Contact w/ side of first finger, the higher up in the neck, the nearer the MCP - on articular pillar pulling back on skin to take up slack. Inactive hand curls around head w/ thumb on cheek to support head. Rotate head away and side bend toward point of contact. Impulse toward the barrier (into resistance). Thrust vector almost straight across the C1, gradually tilting slightly from C2-C6 until at C7 thrust is toward shoulder
71
What is the indication for Cervical Spine Osseous Manipulation - Sitting Break?
TOS, HA, chronic muscle hypertonicity in neck, fixed segments, decreased joint motion, thixotropic changes (i.e. thickening/"stickiness" of synovial fluid due to pressure).
72
What is the contraindication for Cervical Spine Osseous Manipulation - Sitting Break?
Positive George's test (Sx during extreme neck extension w/rotation), hx of stroke, radiographically-verified cervical weakness in pt w/ RA, after head trauma w/ possibility of C1-C2 instability, dens fracture, any fracture of vertebrae, joint hyper mobility, osteoarthritis, osteoporosis, IV disc herniation
73
What is the technique for Cervical Spine Osseous Manipulation - Sitting Break?
Pt prone w/ some neck flexion. Find fixed segment. Contact w/ side of first finger on articular pillar (knife edge). Inactive hand's palm on occiput. Impulse toward barrier. This thrust is a little risky due to increased rotational component.
74
What is the indication for Cervical Spine Osseous Manipulation - Prone Break?
TOS, HA, chronic muscle hypertonicity in neck, fixed segments, decreased joint motion, thixotropic changes (i.e. thickening/"stickiness" of synovial fluid due to pressure).
75
What is the contraindication for Cervical Spine Osseous Manipulation - Prone Break?
Positive George's test (Sx during extreme neck extension w/rotation), hx of stroke, radiographically-verified cervical weakness in pt w/ RA, after head trauma w/ possibility of C1-C2 instability, dens fracture, any fracture of vertebrae, joint hyper mobility, osteoarthritis, osteoporosis, IV disc herniation
76
What is the technique for Cervical Spine Osseous Manipulation - Prone Break?
Pt seated. Find fixed segment. Stand on side opposite fixation. Reach in front of pt, contact w/ palmar side of 1st or 2nd finger on articular pillar. Inactive hand cradles and supports head. Rotate head away and side bend toward fixation. Impulse toward barrier.
77
What is the indication for Coccyx Osseous Manipulation?
Idiopathic chronic coccyalgia; post-fx coccyalgia and coccygeal misalignment. Tend to have pain if sitting up straight (esp. on hard surfaces) but not usu. during BM. Glut muscles and piriformis may spasm to guard coccyx, causing sciatica. Local tenderness is sign. HA may occur due to spinal cord traction from film terminals. Hx of trauma usu. present. Childbirth doesn't usu. cause but may unveil problem.
78
What is the contraindication for Coccyx Osseous Manipulation?
Pt uncomfortable w/ rectal intrusion, coccygeal fracture (unhealed)
79
What is the technique for Coccyx Osseous Manipulation?
Pt side lies w/ upper leg flexed at hip and knee, well draped. Insert gloved, lubricated finger into rectum, massage the coccygeal ligaments from POST to ANT. Pin the coccyx btwn thumb and finger and gently but firmly traction INF and POST. There is NO thrusting motion in this "adjustment". Minor rectal bleeding may occur.
80
What is the indication for Elbow Osseous Manipulation?
Deviation of the olecranon medially (ulnar deviation) or laterally (radial deviation)
81
What is the contraindication for Elbow Osseous Manipulation?
Radial dislocation (nursemaid's elbow), fracture (esp. w/ Hx of falling and catching self w/ outstretched arm), osteoporosis, elbow arthritis
82
What is the technique for Elbow Osseous Manipulation?
For ulnar deviation, the impulse is laterally w/ mild extension. Overdoing this may injure the olecranon so be gentle. For radial deviation, medial stress w/ mild extension is used.
83
What is the indication for Foot and Toe Osseous Manipulation?
Fixation in MTP joint, chronic pain from joint fixation, often post-traumatic
84
What is the contraindication for Foot and Toe Osseous Manipulation?
Fractures, INFXN
85
What is the technique for Foot and Toe Osseous Manipulation?
Grasp the metatarsal and distract it quickly away from the toe (holding the toe in place while doing so). Include a component of lateral or other movement if restriction is in that plane.
86
What is the indication for Ankle Osseous Manipulation - Tarsal and Talotibial Technique?
Talotibial fixation (decreased ANT ankle glide commonly felt), pes planus causing tight planar fascia leading to tarsal fixations, crushing damage to foot which heels leaving tarsals INF fixed.
87
What is the contraindication for Ankle Osseous Manipulation - Tarsal and Talotibial Technique?
Ankle fracture, INFXN involving regional structures, excessive joint laxity, acute inflammation
88
What is the technique for Ankle Osseous Manipulation - Tarsal Technique?
Pt prone w/ feet hanging half way off the end of the table. Contact w/ both thumbs over fixed tarsal in question and index fingers along sides of heel and other fingers grasping the foot. Impulse created by flexing pt's knee then bringing the foot down against edge of the table (so that the middle of the top of the foot strikes). Force must be directed to the tarsal in question w/ the thumbs. This assumes INF fixation.
89
What is the technique for Ankle Osseous Manipulation - Talotibial Technique?
Pt. supine. Pt firmly anchored to table (to avoid being pulled toward practitioner). Contact w/ middle fingers crossed over the fixed joint w/ a firm INF and POST tissue pull. Thumbs positioned under sole of foot. Impulse vector created by moving the ankle into greater dorsiflexion while simultaneously pulling INF and POST (assuming an ANT fixation).
