Upper Quarter CPR's

Question 1

How do you manually stretch the upper traps

Answer 1

• Contralateral side bend away
• Ipsilateral rotation toward
• Slight neck flexion

Question 2

How do you manually stretch the elevator scapula

Answer 2

• Contralateral side bend away
• Contralateral rotation away
• Slight neck flexion

Question 3

How do you manually stretch the SCM (sternocleidomastoid)

Answer 3

• Contralateral side bend away
• Ipsilateral rotation toward
• Slight neck extension

Question 4

Describe the Alar Ligament Stress Test

Answer 4

• Palpate C2 spinous process
• Use a key pinch grip on the C2 spinous process or a wider grip to pinch both C2 transverse processes (find C1 transverse processes and fall off onto C2)
• Method #1: rotate patient’s head and you should feel the spinous process rotate into the opposite finger
• Method #2: hold fast on the C2 spinous process while rotating the patient’s head and you should feel a capsular end feel & no more than 21º rotation of the head
• Positive test is if the patient has more than 21º of rotation when held in place (method #2)
• Test in neutral first then flexion and extension for a full test

Question 5

What are the special tests included in the cluster/CPR for partial rotator cuff tear

Answer 5

• Painful arc: typically expect pain b/w 60-120º that goes away as arm reaches above head
• Hawkin’s Kennedy: ABD arm to 90º and horizontally ADD across chest then internally rotate looking for reproduction of pain
• Infraspinatus test: arm at side of patient with elbow bent to 90º and perform a MMT of the infraspinatus by asking the patient to externally rotate looking for reproduction of pain

Question 6

What does DAN’s stand for

Answer 6

• Ds: Diplopia, dizziness, dysphagia, dysarthria, drop attacks
• As: ataxia of gait, anxiety
• Ns: numbness (ipsilateral face and/or contralateral body), nystagmus

Question 7

Cervical radiculopathy CPR

Answer 7

• Positive Spurling’s
• Positive relief of symptoms in neck distraction
• Cervical rotation <60º on ipsilateral side
• Positive ULTTA

Question 8

Cervical myelopathy CPR

Answer 8

• Gait deviation
• Hoffman’s test (positive)
• Inverted supinator sign (positive)
• Babinski test (positive = toes extend)
• Age >45 years

Question 9

C-spine manipulation intervention criteria

Answer 9

• Symptoms <38 days
• Side to side cervical rotation difference >10º
• Pain with PA spring testing mid C-spine (C3-C7)
• Positive expectation manipulation would help

Question 10

Cluster/CPR for full thickness rotator cuff tear

Answer 10

• Positive drop arm test (supraspinatus specifically): ABD pt arm to 90º in a neutral rotation; Positive = unable to hold position
• Positive painful arc
• Positive infraspinatus muscle test

Question 11

Describe drop sign test

Answer 11

• Test for rotator cuff tear (infraspinatus specifically)
• Place pt’s arm in 90º ABD and 90º elbow flexion
• Get pt into end range while holding their wrist
• Let go of wrist and patient should be able to sustain the position
• Positive if patient’s arm falls forward/is unable to hold the position

Question 12

Describe external rotation lag sign

Answer 12

• Test for rotator cuff tear (supraspinatus and infraspinatus specifically)
• Place pt’s arm in about 70º abduction with 90º elbow flexion
• Place patient into max external rotation with fingers tips wrapped around their wrist
• Let go of their wrist and patient should be able to hold the position
• Positive if patient’s arm falls forward/is unable to hold the position

Question 13

Describe horn blowers test

Answer 13

• Test for rotator cuff tear (teres minor and infraspinatus specifically)
• Place the pt’s arm in 90º abduction and 90º elbow flexion
• Have the patient resist internal rotation in this position and they should be able to sustain this
• Positive if patient is unable to sustain against the resistance

Question 14

Shoulder pain intervention with crevice-thoracic OMPT (manipulations/mobilizations at CT junction) CPR

Answer 14

• Pain frère shoulder flexion <127º
• Shoulder IR <53º at 90º abduction
• Negative Neer’s impingement: depress the scapula and maximally internally rotate the pt’s arm and lift into full forward shoulder flexion; positive = pain reproduction
• Not taking pain medications for the shoulder
• Duration of symptoms ≤90 days

Question 15

Illness script for shoulder adhesive capsulitis diagnosis

Answer 15

• Capsular pattern of limitation ER>ABD>IR
• Think 50 year old shoulder
• Females > males
• Those with Endocrine disorders (DM, Thyroid) more susceptible

Question 16

Carpal tunnel diagnostic CPR

Answer 16

• Age >45 years old
• Wrist ratio index >0.67 (AP width ÷ ML width)
• Symptom severity scale scorer >1.0
• Reduced median sensory field digit 1
• Shaking hands relieves symptoms

Question 17

Lateral epicondylalgia intervention use of MWM (manual therapy technique) CPR/criteria

Answer 17

• Age >49 years old
• Pain free grip strength (PFGS) on affected side >112N (approximately 25 lbs)
• PFGS on unaffected side <336N (~75 lbs)