Trunk, Low Back&Abdomen

Question 1

Vocal Fremitus Test

Answer 1

To asses Area of bronchial congestion dt emphysema, chronic bronchitis
Hands over Thorax
Client Say Nasal Voice- nity- Nine
Positive- vibration decreased over lungs and brochitis = congestion dt infected mucus which pleural lobe is invlove

Question 2

Mediate Percussion test

Answer 2

To asses Lung density for presence of mucus
Prone supine
Non-dominant hand flat on thorax along intercostal space
Tip of dominat hand finge tap firmly on finger on thorax
Positve - Duller over areas of congestion and more resonant over hyperinflated lungs

Question 3

Trunk and hip flexion , AF rom

Answer 3

To asses Length of Gastrocs , Ham , lower and upper back extensor
Sit on floor - both knee extend - and bend forward from hip to touch Toes
SHORTNESS Gastrocs=unable to touch toes dt ankle plantarflexion
SHORTNESS Hamstrings=unabilities to touch toes with Posterior Pelvic tilt
EXCESSIVE Length Hamstrings= reach past toes with Anterior pelvic tilt
SHORTNESS lower back Extensor= cant touch toes and lower spine remain vertical
EXCESSIVE length lower back Extensor= Increase Curve of Lumbar spine
EXCESSIVE Length upper back muscles shows increase curve of t-spine

Question 4

Functional or Structural Scoliosis test

Answer 4

Determine whether spinal curve are functional or structural
Client standing
Stand behind obseve spinal process for visible curve
Instruct clt perform AFROM lateral bending to both side and in flexion
Positive funtional - if curve correct or reverse to Convex side
Positive structural= curve does not correct when lateral bending
Flexion = positive for funtional if curve or rib humping correct , no correction = positive for structural

Question 5

Forward bending test

Answer 5

Combination of two test lateral bending witth flexion

Intruct standing clt to bend forward , allow arm to hang and then to lateral side

Question 6

Scoliosis Small hemipelvis

Answer 6

To asses a small pelvis that may contribute to a structural scoliosis
Clt seated
Observe Iliac crest and acromioclavicular joint level bilateral Noting lateral tilt and scoliotic curve
Place an ischial Lift( Thin Book ) under lower side
Positive= curve neutralize for funtional dt small Hemipelvis
If the lift place under the high side , funtional scoliosis will worsen

Question 7

Scoliosis short leg test

Answer 7

To asses short leg contribute to scoliosis

Clt standing
Observe ac joint iliact crest
Place foot lift under short leg
Positive = curve neutralize for funtional scoliosis

Question 8

Motion Palpation test

Answer 8

To asses ROM of spine for hypomobile or hypermobile
Clt standing
Finger tips in Laminar groove lateral to the Spinous process
Instruct clt to move slowly through flexion-ext - sidebending-rotation
Positive= hypomobile segment move as one unit with leathery end feel
Hypermobile move more than segment above or below them
Perform entire spine

Question 9

Static palpation of the spine

Answer 9

To explore minor rotation - flexion- extension of the vertebrae
Palpate along the spinous process
Use index and middle fingers of one hand - one finger on each side of tip of spinous process
Use moderate downward pressure
Finger slide inferiorly
Positive = spinous process are not Symmetrical
Supine for c spine
T1 as referance point

Question 10

Anterior Spinous Challenge Test PR

Answer 10

To determine the location of a minor vertebral dearrangement either hypomobile or hypermobile
Thumb slow pressure in an anterior direction
Positive= client reports local mild pain with the pressure at the specific vertebral level

Question 11

Lateral Spinous challenge Test , PR

Answer 11

To determine the location of minor intervetebral dearrangement
Thumb on lateral border of the spine

Question 12

Rib motion test

Answer 12

To asses motion of the rib
Place relax hand over various aspect of thorax moving superior to inferior
On inhalation- rib stop moving relative to the other ribs is a depressed rib
On Exhalation - rib does not move relative to pther is Elevated rib
Inhalation rib group dysfuntion -key rib is superior
Exhalation- key rib is inferior

Question 13

Rib palpation test

Answer 13

To asses the position of individual ribs
Prone
Palapte rib angles bilaterally with Flat hands
Posterior sublaxed rib has less pronounce contour
Anterior sublaxed rib has more pronounced contour

Question 14

Lavatores costarum Fixation

Answer 14

To asses individual levetore costarums mm which may be affected thoracic injuries restrict rib motion
Located the affected rib
Rotate head to Unaffected side
Staybilize SP process immediately superior to the affected rib with pressure that is directed anteriorly toward the opposite side
Other palm apply pressure inforelaterally directed to posterior angle of the rib
Positive= Levatores Costarum Restriction end feel is leathery and clt report Tenderness
Negative= elastic end feel with no tenderness

Variation- seated - clasps both hand behind head - elbow as close together
One hand elevated clt elbow while using the elbow to rotate the client Thorax toward the unaffected side
Place other thumb to contact posterior angle of the affected rib
Apply pressure inferolaterally away from the spinous process
Positive = difficulties moving the rib angle inferolaterally

Question 15

Valsava test

Answer 15

To asses Space occupying lesion , such as Herniated Disc , Osterophyte or Tumor which would increase the pressure within spinal cord
Seated
Clt take a breath and hold it while bearing down as if moving the bowels
Postitive= reports pain in local site or radiating in dermatomal pattern
Use cuatiously with cardiac disorder, temperaly decrease blood supply to the brain may post dizziness

Question 16

Kemps test

Answer 16

To asses Nerve root compression dt disc herniation or facet joint irritation
Clt standing
Instruct slowly extend , sidebend, and rotate the Thorax and Lumbar Spine to affected side
( can be done by having clt run finger down affected leg as far as they can )
Postitive- indcate radiation pain or other neirological sign the affected leg
Local pain= facet joint
False Positive = may occur with severe mm spasm , need to comfirm with nerve root compression

Question 17

Quandrant test

Answer 17

Extend, side bend , rotate lumbar to affected side

Apply inferiorly directed overpressure

Question 18

Kernig’s test
( synonym) soto/ Hall test
Brudzinski test

Answer 18

To stretch dural tube and spinal cord to reproduce pain cause by nervye root involvement , meningeal irritation
Supine- clt cup hand behind their head
Instruct to flex head to chest and indicate if pain is present
Instruct flex hip with Knee extention
Positive= clt feel pain along spine and sometime referal pattern t the limb
When pain is Experience clt flex Knee or involuntary flex knee to reduce the stretch on dural tube and diminishing pain

Question 19

Slump test

Answer 19

If client Seated called Slump test
Allow lumbar and thoracic spine to Slump through full flexion
Instructed to flex the head to chest
Instruct clt extend knee and dorsiflex
Test unaffected side first
Positive= client feel pain along the spine sometime in referal pattern to a limb at any point in test
Pain is experience at the level of the lesion

Question 20

Straight leg raise or Lasegue’s test

include Braggard’s test , Fajerstan’s test , Freiburg Sign

Answer 20

To determine to cause of low back pain
Affected leg Adduction and Internal rotate
Grasp Calcaneues and flex hip/ Knee extend ( one hand can apply pressure on the anterior aspect of knee )
Flex clt hip till pain is felt , usually 70-80 degree of flexion
Slowly lower leg untill no pain
Then Dorsiflex , stetch the sciatic nerve( braggard’s)
- pain posterior thigh and knee on hip flexion= hamstring Tightness
-pain reported down leg on force dorsiflex = sciatic nerve involvement
-pain opposite leg = space occupying lesion

Well leg raise test or Fajerztan’s test

• pain report in lower back after70 degress of hip flexion without Dorsiflex to strech sciatic nerve = positive for lumbar or si joint dysfuntion only
• pain report in Buttock radiation down leg combine with limited ROM with internal rotation of extend thigh = freiburgs test= Short piriformis

Question 21

Rebound Tenderness test

Answer 21

Posibilities of apendicitis
Supine- knee , hip flexed
Appendix is locate Lower right Quarant of abs
2/3 of distance inferiorly along line draw from umbilicus and right ASIS
This area called” Mc burneys point
Slowly aplly pressure over point and quickly release the pressure
Postitive= clt feels severe pain when pressure is release = emergency medical referal

Question 22

QL length test

Answer 22

Length of QL 
Seated
Behind clt and landmark iliact crest
Instructed clt lateral bend the torso from side being test and vice versa
Note available range of both side 
Positive= restriction rom = shortness 
Variation- side lying 
Raise shoulder up from table 
Positive= rom reduces

Question 23

QL strength test ar

Answer 23

Prone
Lower limb to be tested 30 degree abduction and slight extention
Instruct to hold limb and pelvis in this position

Positive= weakness if clt is unable to hold the pelvis in the given position

Question 24

Abs Strength test AR

Answer 24

Test after neck, hip flexors is detemined
And length of hams and back extensor is asses to be sure that extensor mm shortness is not confuse with abs weakness
Clt supine
Knee extention
Do not hold down feet
Instruct to slow curl thrunk , flexing spine
Grade 5- hand clasp behind head
Grade 4- forarm crossed against chest
Grade 3- arm held out in front
Grade 2 arm held out in front

To asses abdominal obliques
Staybilize clt legs , extended
Right shoulder off= to test for Right external obliques and Left Internal Oblique
Left shoulder off= left external , right internal
Hands clasp behind the head