Orthopedic Tests

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Always: Name Test Report Findings Indication Cervical Spine 1) Vertebrobasilar artery insufficiency a) Vertebrobasilar Artery Functional Maneuver pp. 154 1) Patient seated (1) Auscultate carotid and subclavian arteries for pulsations and/or bruits (a) Positive report findings indication of VBAI (b) Negative (2) Rotate and hyperextend patient’s head to one side (Maigne’s Position) approx 30 seconds per side (a) Use finger for patient to focus on and ask patient: (i) Dizziness (ii) Nausea (iii) Numbness (iv)or Double Vision? (b) Please Swallow dysphagia (c) Look for: (i) Dysarthria (difficulty speaking) (ii) Drop Attacks (iii) Nystagmus (iv)Ataxia (d) Positive report findings indication of VBAI confirmation tests (e) Negative repeat on other side b) Hautant’s pp. 102 1) Patient seated (1) Ask patient if they can hold arms out for a couple of minutes (2) Have patient hold arms out in front of them with palms up and close their eyes

Transcript of Orthopedic Tests

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Always: Name TestReport FindingsIndication

Cervical Spine

1) Vertebrobasilar artery insufficiencya) Vertebrobasilar Artery Functional Maneuver pp. 154

1) Patient seated(1) Auscultate carotid and subclavian arteries for pulsations

and/or bruits(a) Positive report findings indication of VBAI(b) Negative

(2) Rotate and hyperextend patient’s head to one side (Maigne’s Position) approx 30 seconds per side(a) Use finger for patient to focus on and ask patient:

(i) Dizziness(ii) Nausea(iii) Numbness(iv) or Double Vision?

(b) Please Swallow dysphagia(c) Look for:

(i) Dysarthria (difficulty speaking)(ii) Drop Attacks(iii) Nystagmus(iv) Ataxia

(d) Positive report findings indication of VBAI confirmation tests

(e) Negative repeat on other side

b) Hautant’s pp. 1021) Patient seated

(1) Ask patient if they can hold arms out for a couple of minutes(2) Have patient hold arms out in front of them with palms up and

close their eyes(a) Put patient in Maigne’s Position to one side – 30 seconds –

and ask:(i) Dizziness(ii) Nausea(iii) or Numbness

(b) Please Swallow dysphagia(c) Look for:

(i) Dysarthria (difficulty speaking)(ii) Drop Attacks(iii) Ataxia

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(d) Positive report findings indication of VBAI confirmation tests

(e) Negative repeat on other side

c) Underburg’s pp. 1461) Patient standing

(1) Ask patient if they can hold arms out for a couple of minutes(2) Have patient hold arms out in front of them with palms up and

close their eyes while they march in place(a) Put patient in Maigne’s Position to one side – 30 seconds –

and ask:(i) Dizziness(ii) Nausea(iii) or Numbness

(b) Please Swallow dysphagia(c) Look for:

(i) Dysarthria (difficulty speaking)(ii) Drop Attacks(iii) Ataxia

(d) Positive report findings indication of VBAI confirmation tests

(e) Negative repeat on other side

d) Barre-Lieou pp. 761) Patient seated

(1) Ask patient to slowly rotate head from side to side and ask:(i) Dizziness(ii) Nausea(iii) Numbness(iv) or Double Vision?

(b) Please Swallow dysphagia(c) Look for:

(i) Dysarthria (difficulty speaking)(ii) Drop Attacks(iii) Nystagmus(iv) Ataxia

(d) Positive report findings indication of VBAI confirmation tests

(e) Negative repeat on other side

e) Hallpike pp. 981) Patient lying supine w/ head extending off the end of the

examination table(a) Put patient in Maigne’s Position to one side – 30 seconds –

and ask:(i) Dizziness

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(ii) Nausea(iii) Numbness(iv) or Double Vision?

(b) Please Swallow dysphagia(c) Look for:

(i) Dysarthria (difficulty speaking)(ii) Drop Attacks(iii) Nystagmus(iv) Ataxia

(d) Positive report findings indication of VBAI confirmation tests

(e) Negative repeat on other side

f) DeKleyn’s pp. 861) Patient in supine position w/ head off end of table

(a) Put patient in Maigne’s Position to one side – 30 seconds – and ask:(i) Dizziness(ii) Nausea(iii) Numbness(iv) or Double Vision?

(b) Please Swallow dysphagia(c) Look for:

(i) Dysarthria (difficulty speaking)(ii) Drop Attacks(iii) Nystagmus(iv) Ataxia

(d) Positive report findings indication of VBAI(e) Negative repeat on other side

2) Fracturea) Spinal Percussion pp. 137

1) With patient seated, support the head and flex cervical spine exposing spinous processes as much as possible(1) Percuss spinous processes

(a) Positive findings(i) Localized pain Fracture or severe sprain(ii) Radiating pain IVD syndrome

(2) Percuss paravertebral soft tissues(a) Positive findings

(i) Pain muscular strain & highly sensitive myofascial trigger points

b) Rust’s Sign pp. 128 1) Patient presents w/ markedly splinted cervical spine and holds

weight of head w/ both hands. Patient cannot tolerate pain of

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removing hands. The most significant sign of a patient w/ a cervical spine fx.(1) gross instability of upper cervical spine d/t fracture, severe

sprain, RA, or severe cervical subluxation(2) Patient cannot rise from supine position w/o lifting head w/

hands(a) gross instability of upper cervical spine d/t fracture,

severe sprain, RA, or severe cervical subluxation

3) Spinal Myelopathy – should present bilaterallya) Dejerine’s Sign pp. 83

1) Coughing, sneezing, or straining during defecation aggravates radiculitis symptoms. A triad of conditions.

2) Demonstrate and have patient:(1) Sneeze upper T’s and C’s(2) Cough mid T’s(3) Bear down in a crunch lumbar

(a) Indicates a space-occupying lesion obstructing spinal fluid flow(i) Herniated or protruding IVD(ii) Spinal cord tumor(iii) Spinal compression fracture

b) Valsalva Maneuver pp. 1501) Last part of Dejerine’s2) Patient is seated w/ arms flexed at elbows

(1) Instruct patient to take a deep breath and hold it while bearing down abdominally(a) Positive radicular pain(b) Indication space-occupying lesion compressing nerve

root (herniated disc, tumor, osteophytes)

c) Naffzinger’s pp. 1181) This is a dangerous maneuver2) Patient is seated

(1) Occlude jugular veins bilaterally for 30 to 40 seconds(2) Have patient cough deeply

(a) Positive radicular pain nerve root compression(b) Positive local pain site of sprain or strain(c) Always positive in presence of cord tumors, especially

spinal meningiomas

d) Lhermitte’s pp. 1121) Patient is seated

(1) Passively flex the head and neck

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(a) Positive sharp, radiating pain or parathesia along the spine & into one or more extremeties dural irritation (myelopathy)

4) Neuropathya) Distraction pp. 88 – assessment for cervical nerve root compression,

IVF encroachment, & facet capsulitis1) With patient seated, have them lean back against your chest2) Cup the base of occiput w/ both hands and lift up – 30 seconds

(1) Positive relief of localized or radicular pain(2) Confirmed if symptoms return when weight of head is returned

to neck

b) Maximum Cervical Compression pp. 114 – assessment for cervical nerve root syndrome or facet syndrome (concave testing) and cervical muscular strain (convex testing)1) With patient seated, place the head in Maigne’s position – 30

seconds(1) Positive pain on concave side nerve root or facet

syndrome(2) Positive pain on convex side MM strain

c) Foraminal Compression pp. 94 – assessment for cervical nerve root encroachment1) With patient seated:

(1) Apply compression w/ head in neutral position (2 seconds)(2) Apply compression w/ head rotated left, then right

(a) Positive localized pain IVF encroachment(b) Positive radicular pain pressure on nerve root

d) Jackson Compression pp. 106 – assessment for cervical nerve root compression resulting from a space-occupying lesion, subluxation, inflammatory edema, exostosis of DJD, tumor, or IVD herniation1) With patient seated, laterally flex head and apply axial

compression(1) Positive localized pain radiating down the arm

e) Spurling’s pp 138 – assessment for cervical nerve root compression syndrome1) With patient seated, this can be added to any passive

compression test.2) During passive compression, release one hand and use it to

pound quickly on top of the hand still applying compression(1) Positive localized or radicular pain d/t nerve root

compression

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f) Bakody, Reverse Bakody Maneuver pp. 70 – assessment for cervical nerve root compression1) With patient in seated position, have them abduct the afflicted

arm and place their hand on top of their head – 30 seconds(1) Positive relief of radicular pain

g) Bikele’s Sign pp. 78 – assessment for brachial plexus neuritis and meningitis1) With patient seated, have them abduct arm and attempt to reach

behind them, stopping them when the trunk begins to rotate(1) Positive radicular pain

h) Shoulder Depression pp. 120 – assessment for cervical muscular strain (isometric) and cervical ligamentous sprain (passive range of motion)1) With patient seated, passively flex the head to one side and hold

there, then depress the opposite shoulder(1) Positive

5) Muscular / Ligamentous Lesiona) O’Donoghue Maneuver pp 120 KNOW IT WELL!! Can be used at

most any ligamentous joint / region in the body.1) With patient seated, examiner holds pt. head in neutral position

while pt. attempts to rotate against isometric resistence.(1) Positive muscle strain (SCM, scalenes, sub-occipital group)

2) Examiner rotates head to comfortable end range plus a little more(1) Positive ligament or incidental finding of a tight muscle

6) Meningeal Irritationa) Soto-Hall Sign pp 132

1) Place patient in supine position on examining table with legs fully extended and arms placed on chest.

2) Examiner supports pt. head w/ one hand while stabilizing patient’s chest/hands w/ the other hand.

3) Passively flex the neck while keeping the shoulders against the table.(1) Positive shooting pain down the spine meningitis (febrile,

flu-like symptoms, stiff, achey, etc.)(2) Positive reflex flexion of knees or twitch of quads

meningitis (Bradzinski response)

SHOULDER

1) Subclavian artery occlusiona) George’s Screening Procedure pp 230 – a barrage screening, not a

VBAI screening

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1) With patient seated, auscultate the subclavian arteries bilaterally2) Assess the character (amplitude) of the radial pulse bilaterally3) Take blood pressure bilaterally

(1) Positive difference of 10mm Hg or more between systolic possible subclavian artery occlusion or distal artery occlusion

2) Localized unspecified pathologic process a) Mazion’s Shoulder Maneuver pp 242

1) With patient seated, have patient place hand of symptomatic shoulder on opposite shoulder and raise elbow unassisted(1) Positive localize pain whatever is there

3) Rotator cuff tear/tendonitis – typically the smaller muscle in an area is the one that will show paina) Supraspinatus Press pp 258 – m/c injured rotator cuff M

1) With patient seated, have him hold arm straight out while you push down proximal to elbow at least 5 seconds(1) Positive failure or pain near insertion

b) Apley’s Scratch pp 200 – a range of motion assessment1) With patient seated, have him reach over the shoulder and

opposite from bottom reaching toward each other2) Count out the vertebrae (ie. Superior T2 left and inferior T10 right)

(1) Normal T4 to T8 – mid-thoracics

c) Codman’s Sign pp 214 – AKA: Drop arm test1) With patient seated, hold their arm up in the air and drop it asking

them to stop it before it hits the table

d) Impingement Sign pp 2361) With patient seated, pronate the arm then passively elevate the

arm w/o touching the shoulder(1) Positive early engagement of shoulder prior to 120 degrees

torn supraspinatus tendon

4) Transverse humeral ligament tear / Bicipital tendonitisTHL leads to Bicipital Tendonitis

a) Abbott-Saunders Test1) With patient in seated position, palpate and find the bicipital

groove2) With a light contact on the biciptial groove, pronate and abduct

the arm as high as possible, then supinate and adduct the arm. Make sure the humerus rotates during pronation and supination.(1) Positive feel the bicipital tendon snap out of the groove

transverse humeral ligament tear leading to bicipital tendonitis if unilateral and symptomatic

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b) Transverse Humeral Ligament Test1) With patient in seated position, palpate and find the bicipital

groove2) Abduct the arm and let the forearm hang, then rotate the forearm

up and down(1) Positive feel the bicipital tendon snap out of the groove

transverse humeral ligament tear leading to bicipital tendonitis if unilateral and symptomatic

c) Speed’s Test – Bicipital Tendonitis1) With the patient seated, begin with the arm adducted, elbow

flexed to 90 degrees, and pronated.2) Have the patient push out against resistance while supinating

their forearm – block @ elbow and hold just proximal to wrist(1) Positive pain @ shoulder and inability to perform the test

might indicate bicipital tendonitis. If they can perform the test, it rules out Bicipital Tendonitis

d) Yergason’s (normally combine w/ Speed’s) – Bicipital Tendonitis1) With the patient seated, begin with the arm adducted, shoulder

flexed to 90 degrees, and pronated.2) Using wrestler’s grip, have patient flex elbow bringing hand to

shoulder while (1) Positive pain @ shoulder and inability to perform the test

might indicate bicipital tendonitis. If they can perform the test, it rules out Bicipital Tendonitis

(2) If the pain is more in Speed’s than Yergason’s with both tests positive, THL is intact or BT is at least relocating to the groove when it is being put under pressure.

(3) If Yergason’s is more painful than Speed’s, then the THL is torn and the bicipital tendon is not relocating to the groove when it is being put under pressure.

5) Bursitisa) Dawbarn’s Sign

1) With the patient seated, palpate and locate the acromion.2) Palpate distal to the acromion anterior, lateral, and posterior for

tenderness.3) No tenderness test is over.4) If tenderness is found, maintain a pressure and abduct the arm

(1) Positive pain goes away or decreases drasticall possible bursitis.

6) Dislocationa) Bryant’s Sign

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1) With the patient seated, look for an axillary fold to be inferior on one side

b) Sulcus Sign 1) With the patient seated, the anterior roundness of the shoulder

will be replaced by a sulcus.

c) Calloway’s Test1) With the patient seated, take measurements around the axillary

fold vertically about ½” inside of the acromion and compare the sides.(1) Positive increase of 10cm or more on one side

dislocation

d) Hamilton’s Test 1) With the patient seated, place a straight edge against the lateral

epicondyle and see if it can also touch the lateral edge of the acromion.

e) Dugas’ Test1) With the patient seated, have the patient put their hand on the

opposite shoulder.2) The examiner presses the elbow toward the sternum while the

patient maintains the contact with the shoulder

f) Apprehension – for propensity to dislocate1) With the patient seated, abduct the arm to 90 degrees and flex the

elbow vertically to 90 degrees2) Place the other hand on the scapula and pull back on the wrist

just before paraphysiological endplay(1) Positive patient exhibits pain or stops you or muscles

tighten up guarding the shoulder unstable shoulder

7) Thoracic Outlet Syndromea) Reverse Bakody

1) With patient in seated position, have them place one hand on their head

b) Costoclavicular Maneuver – Checks All 3 Thoracic Outlets1) With the patient seated, take radial pulse in one arm with arm in

lap2) Repeat with arm extended backward with head flexed3) Repeat on other side

(1) Positive decrease or absence in pulse amplitude or reproduction of pain symptoms implication of TOS

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c) Halstead Maneuver – Checks All 3 thoracic Outlets1) With the patient seated, take radial pulse in one arm with arm in

lap2) Repeat with arm flexed and tractioned forward with head

extended3) Repeat on other side

(1) Positive decrease or absence in pulse amplitude or reproduction of pain symptoms implication of TOS

d) Adson’s, Modified Adson’s1) With patient in seated position, take radial pulse while standing

on the ipsilateral side of the patient(1) Have patient look toward you and extend head back (Maigne’s)(2) Have patient take a deep breath and hold it(3) Begin assessing pulse after deep breath

(a) Positive decrease or absence in pulse amplitude or reproduction of pain symptoms implication of medial TOS

(4) For Modified Adson’s have patient turn their head the other way

e) Wright’s (AKA: Hyperabduction maneuver)1) With the patient seated, slightly abduct the arm while checking

the radial pulse2) Elevate the arm very, very slowly

(1) Should loose about 50% between 90 and 120 degrees(2) Positive sudden loss of pulse possible TOS

f) Allen Maneuver1) With the patient seated, raise the arm to 90 degrees with elbow

flexed to 90 degrees. Assess radial pulse and have patient turn head away.(1) Positive decreased pulse when patient turns away

possible Medial TOS

g) Shoulder compression1) With the patient in the seated position, find the coracoid process

and place hand over that area. Block the scapula with the other hand and compress down on the should(1) Positive pain Lateral TOS

h) Roos’ – Never Start w/ this if you suspect TOS, good screening tool – very low false negatives1) With the patient seated, put both his arms at 90/90 and have him

open and close hands for 3 minutes(1) Pain, cramping, ischemia TOS

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Unit 2 – 6 lectures, 39 orthopedic tests and signs. Orthopedic evaluation of the elbow; forearm, wrist, and hand; and thoracic spine. Presented by region, then condition, then tests and signs. The practical lab exams are scheduled as follows:LAB A - Tuesday, Oct 24th, 2006, 9:00 - LB-2.LAB B – Wednesday, Oct 25th, 2006, 10:00 – R207

ELBOW

1) EPICONDYLITISa. Kaplan’s Sign (lateral epicondylitis / Tennis elbow)

i. Pt. seatedii. Have the pt grab your forearm and squeeze and relax

iii. Then grip their forearm below the lateral epicondyle and have them squeeze your forearm again

iv. Increased grip strength lateral epicondylitis1. Pain is incidental finding

A) Mills’ Test (lateral epicondylitis)a. Looking for PAIN response at lateral epicondyleb. Pt. seatedc. Start with pt. elbow flexed (in curl position) then max flex

their wrist and internally rotate the wrist to maximum. Finally lockout their elbow.

d. Make sure you don’t touch their epicondyle region b/c you might get premature pain

B) Cozen’s Testa. Pt. seatedb. Place pt. arm in supination with wrist in extensionc. Dr. tries to flex the wrist as the patient resistsd. Looking for PAIN at lateral epicondylee. Hold position for 5 secs

C) Golfer’s Elbow Testa. PT. seated with arm supinated and wrist is in flexionb. Dr. tries to passively extend the wristc. Looking for pain at the medial epicondlyed. Hold position for 5 secs

8) LIGAMENTOUS INSTABILITY

A) Ligamentous instability1. testing medial and lateral collateral ligaments2. pt. is seated with arm extended (almost max) in supination3. Dr. stress the elbow joint in varus and valgus direction

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4. feeling for ligamentous laxity (greater than 0 degrees)5. pain is an incidental finding

3) NEUROPATHYB) Tinel’s sign

1. Seated2. Dr. raises the pt. arm to a 90 degree angle 3. Using a hammer tap around the ulnar nerve until you get an

ulnar reflex (jumping of the arm)4. Then you tap around the lateral epicondyle looking for a

radial nerve response. You are actually hitting a radial nerve branch. Have to swing the hammer harder than ulnar nerve test

5. Looking for an extreme pain that lasts a good time after test 6. (+) test- neuropathy of that nerve

C) Elbow flexion 1. Seated with arm fully flexed actively squeezing that bicep2. Hold for 30 secs3. Ask the pt if they have any type of PAIN, NUMBNESS,

TINGLING4. (+) test equals ulnar nerve problems

FOREARM, WRIST, AND HAND

1. VASCULAR OBSTRUCTIONa. Allen’s test

i. Pt. seated with arm supinatedii. DR. occludes the radial and ulnar arteries looking for

blanching followed by redness when you release the arteries

iii. Ask pt. to make a fist when you occlude the arteriesiv. Looking for how fast the hand becomes red againv. 5 seconds is normal time for the hand to turn red again

vi. Pain, tingling is secondary findingsvii. Cold hands and numbness is a positive finding though

b/c it does indicate vascular insuffiency

2. LOCALIZED UNSPECIFIC PATHOLOGIC PROCESS

a. Wringing i. Ask the patient to wring a cloth in both directions

ii. Used to localize a wrist painiii. Non-specific testiv. Need to ID a carpal bone that is in the area of the pain

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3. OSTEOPATHYa. Finsterer’s

i. Pt. seated ii. Bend the phalangies to make the metacarpophangeal

joint taughtiii. Hit the metacarpophangeal joint iv. Looking for pain in wrist as you strike the MP jointv. Pain in the carpals is a positive test. Pain in the

Metacarpals would also make it a positive test

4. INFECTIOUS / INFLAMMATORYa. Cascade

i. Overlapping of the phalanges= (+) testii. Ask the pt. place the finger flat on the palms but not in a

fist. Looking to see if the fingers line up straightiii. If the fingers overlap it is a positive test indicating

Rheumatoid arthritis

b. Bunnel-Littleri. Testing PIP joint using the MC joint

ii. If the PIP joint extends when you extend the MC joint move on to the test

iii. Push the MC joint back and then flex the PIP if it flexes easily it’s a negative test

iv. If positive you then flex the MC joint then you try to flex the PIP again if it flexes easier than in step 2 this is a positive test

v. Tight capsule- the finger remains tight in both positionsvi. Testing interossii muscles

vii. If PIP flex easier in second part of test= interossius mm. tightness

c. Bracelet i. Elevate the pt.s arm and squeeze the pt’s. wrist and look

for elongation of the wristii. Looking for pain and lose of elasticity of the wrist (the

wrist is not elongating)iii. Pain= (+) test for arthritis

5. MUSCULAR / LIGAMENTOUSa. Test for Tight Retinacular Ligament

i. Testing DIPii. Force PIP in full extension and see what happens with

DIPiii. PIP in extension then you try to flex the DIPiv. If tight DIP throughout the test= tight capsule

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v. If loser in one step than the other= retinacular ligamentsvi. Report: have to describe exactly what is happening with

each joint that you test

b. Finkelsteinsi. Testing for Dequervains disease (stenosing

tenosynovitis AKA paratenonitis of the extensor pollicis longus tendons)

ii. Ask the pt to tuck their thumb into their fist and passively ulnar deviate the wrist making sure to stress the wrist

iii. Looking for extreme pain with minimal ulnar deviation of the wrist

1. Common to have false positives

c. Carpal Lifti. Place the pt’s. hand flat on a hard surface and ask them

to lift their fingers one at a timeii. Then you resist them as they try to raise their fingers

one at a time. Looking for the tendons to pop up as they try to raise their fingers

iii. Looking for carpal or metacarpal painiv. Pain= (+) test

1. Need to identify the carpals

d. Maisonneuve’s i. Extend the patients wrist and look for pain in the distal

part of the wristii. If you go past 90 degrees with extreme pain it indicates

a radius Fx (collies fx)

6. NEUROPATHY OR PALSYa. Froment’s Paper

i. Pt seatedii. Pull paper from between adducted fingers keeping

fingers leveliii. No resistance Ulnar nerve neuropathy

b. Wartenberg’si. Have pt squeeze a ball or your arm

ii. Look for use of 5th digitiii. Lack of 5th digit ulnar nerve neuropathy

c. Pinch Gripi. Have pt pinch 1st and 2nd tips together hard

ii. Test by pulling them apart

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iii. Lack of strength or inability to perform with tips neuropathy of the anterior interrosseous branch of the median nerve

d. Phalen’si. Have pt place dorsum of hands together and lower

elbows until the wrists separateii. Have pt push wrists back together

iii. Numbness or paresthesia (quickly) carpal tunnel syndrome

e. Reverse Phalen’si. Have pt place palms of hands together and raise elbows

until the wrists separateii. Have pt push wrists back together

iii. Numbness or paresthesia (quickly) carpal tunnel syndrome

f. Tinel’s i. Percuss the median nerve

ii. Severe or prolonged tingling or shooting pain median nerve neuropathy

g. Interphalangeal Neuroma i. Have pt make a fist

ii. Roll a pen between the MCP’siii. Pain neuroma

1. Generally from repetitive trauma (boxing with taped hands)

2. Palpate for a nodule

h. Shrivel i. Have pt soak hands in warm water for 30 minutes

ii. Lack of pruning denervation (acute – w/in 3 weeks)

THORACIC SPINE

A) SCOLIOSIS

1) Adams positioni. Ask pt. to stretch out their arms and touch their palms

ii. Ask pt. to bend over and you stand behind them to see the horizontal plane of the back

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iii. Look very carefully at the horizontal plane of the back to see if there is any deviations in the spine as they slowly raise up

iv. Mark the beginning and end of each rib hump noticedv. Diagnosis: describe the rib hump does it point to the

right or left. The vertebral body points in the direction of the convexity of the hump. Name the scoliosis according to the convexity: Dextroscoliosis and levoscoliosis. Ex: T11 cephalad to, thru, and including T6 on the right - Dextroscoliosis

B) ANKYLOSING SPONDYLITIS

1) Chest Expansioni. Pt. seated upright

ii. Place the tape under the axillaeiii. Cross the tape and read the tape in cmiv. Ask the patient to take a normal breath then exhale

totally and measure and then totally inhale the difference in readings is the chest expansion

v. Report in centimetersvi. No such thing as a normal range

vii. This is just good for future reference has no real clinical application at the time that you take it

1. Dimenished from previous ankylosing spondylitis

2) Amoss’s Sign i. Pt. lying prone then ask them to lay down and then sit

up againii. Looking to see if they have to bend in weird positions

and use extremititesiii. Test for thoracic inflexibility

3) Foresteir’s Bowstring i. test for restriction of spine

ii. place your hand on the pts. back and ask them to laterally flex and feel the muscles tension

iii. the contralateral side should get tighter and ipsilateral side should become less tight

iv. (+) test= ipsilateral side becomes tighter than contralateral side ankylosing spondylitis

C) INFECTIOS/INFLAMMATORY PROCESS1) ***Anghelescu’s

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i. Pt. lying down and ask them to do an opisthotons postion

ii. Approximates a opisthotons position (pt. arched so that only the heels and back of shoulders touch the ground)

iii. Tests for arthritis of the spine

2) Sponge i. Pt. lying prone

ii. Wet a sponge or any device that creates moisture heat and move it down the back starting for the neck down.

iii. You are looking for redness in back which indicates paraspinal musculature inflammation – be specific as to the muscles

D) COSTAL FIXATION1) Rib motion

i. Pt. proneii. Dr. places their fingers on the ribs and ask the pt. to

take a deep breath and exhale. You are looking for a lack of movement in the ribs

iii. The rib causing the problem will be the most superior rib during inhalation. In exhalation it will be the inferior most rib that is the one causing lack of motion in a group of ribs lacking motion. Also, possible ankylosing spondylitis.

2) Schepelmann’si. Start off in ROOS postion

ii. Have pt. laterally flex to both sidesiii. Looking for pain on either sideiv. Wrap around pain- intercostal neuritis usually on

concave side of motion or possible rib fxv. Convex side pain- muscle issues its pain running along

the length of the paraspinal musclesvi. Local pain to back- subluxtion

vii. Pleurisy- deep, sheering, tearing pain on the convex side

viii. Does not differentiate b/w pleurisy and intercostal neuritis. History will differentiate these two.

E) MYELOPATHY1) Valsalva maneuver2) Dejerine’s3) Beevor’s

i. Have pt lie supine exposing the umbilicusii. Have them do crunch followed by leg lift

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1. Deviation of umbilicus to the side during crunch myelopathy or neuropathy (T7 – T9) on opposite side.

2. deviation of umbilicus to the side during leg lift myelopathy or neuropathy (T10 – T12) on opposite side.

F) NEUROPATHY1) First thoracic nerve root2) Passive Scapular Approximation

i.

G) OSTEOPATHY1) Spinal percussion2) Sternal compression

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Unit 3 – 5 lectures, 37 orthopedic tests and signs. Orthopedic evaluation of the lumbar spine. Presented by region, then condition, then tests and signs. The practical lab exam is scheduled as follows:LAB A - Tuesday, Nov 7th, 2006, 9:00 - LB-2. LAB B - Wednesday, Nov 8th, 2006, 10:00 – R207Midterm written is scheduled for Tueday, Nov 7th, 2006 at 2:00 PM in L-206 (there is no midterm practical).

9) Lumbar Spinea) Spinal myelopathy

1) Valsalva Maneuver2) Dejerine’s

b) Fracture1) Spinal Percussion

c) Facet Syndrome1) Kemp’s

d) Meningeal Irritation1) Kernig 2) Brudzinski

e) Neuropathy1) Antalgia 2) Vanzetti’s3) Neri’s 4) Heel/Toe Walk 5) Minor’s 6) Lewin Punch7) Lasegue Sitting8) Deyerle’s9) Bechterew’s Sitting10)Lindner’s11)Turyn’s12)Straight-Leg-Raising13)Cox14)Sicard’s15)Bragard’s16)Bowstring17)Fajersztajn’s Well-Leg-Raise18)Millgram’s19)Lasegue Rebound20)Nachlas21)Ely’s22)Prone Knee-Bending23)Hyperextension24)Femoral Nerve Traction25)Matchstick

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f) Lumbar/Sacroiliac/Hip differential1) Quick 2) Bilateral Leg-Lowering3) Bilateral Leg-Raise4) Lasegue Differential5) Sign of the Buttock

g) Malingering1) Flip

Unit 4 – 5 lectures, 31 orthopedic tests and signs. Orthopedic evaluation of the cervical spine and shoulder. Presented by region, then condition, then tests and signs. The practical lab exam is scheduled as follows:LAB A - Tuesday, Nov 21st, 2006, 9:00 - LB2.LAB B – Wednesday, Nov 22nd, 2006, 10:00 – R207.

10)Pelvisa) Torsion

1) Sacral Apex2) Piedallu’s

b) Osteopathy1) Spinal Percussion2) Iliac Compression

c) Lumbar/Sacroiliac/Hip Differential1) Anterior Innominate 2) Erichsen’s3) Hibb’s4) Lewin-Gaenslen’s5) Gaenslen’s6) Laguerre’s7) Knee-To-Shoulder8) Goldthwait’s9) Belt

d) Muscular/Ligamentous Lesion1) Sacroiliac Resisted-Abduction2) Yeoman’s3) Gapping4) Squish

11)Hipa) Leg Length

1) Actual Leg-Length 2) Apparent Leg-Length

b) Dislocation1) Allis’2) Hip Telescoping

c) Infectious/Inflammatory Process1) Patrick’s (FABERE)

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2) Jansen’s 3) Gauvain’s

d) Meningeal irritation1) Guilland’s

e) Muscular/Ligamentous Lesion1) Trendelenburg’s 2) Phelp’s 3) Ober’s4) Thomas

f) Fracture1) Anvil2) Ludloff’s

Unit 5 – 5 lectures, 34 orthopedic tests and signs. Orthopedic evaluation of the cervical spine and shoulder. Presented by region, then condition, then tests and signs. The practical lab exam is scheduled as follows:LAB A - Friday, Dec 8th, 2006, Noon – LB2.LAB B – Friday, Dec 8th, 2006, 11:00 – L206.The Written Final will be scheduled by the registrar later in the trimester (there is no practical final).

12)Kneea) Dislocation

1) Q-Angle 2) Aprehension Test for the Patella3) Fouchet’s

b) Osteopathy1) Clarke’s2) Dreyer’s3) Wilson’s

c) Infectious/Inflammatory Process1) Patella Ballottment

d) Meniscal Tears1) Steinmann’s2) Bounce Home3) McMurray4) Payr’s 5) Childress Duck Waddle 6) Apley’s Compression

e) Muscular/Ligamentous Lesion1) Abduction Stress2) Adduction Stress3) Drawer4) Slocum’s5) Lachman6) Lateral Pivot Shift Maneuver

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7) Losee8) Noble Compression

13)Leg, Ankle, Foota) Vascular

1) Homans’2) Moses’3) Buerger’s4) Claudication 5) Perthes’

b) Osteopathy1) Strunsky’s2) Hoffa’s

c) Muscular/Ligamentous Lesion1) Thompson’s2) Drawer Sign of the Ankle3) Helbings’

d) Neuropathy1) Morton’s2) Duchenne’s3) Tinel’s Foot