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PCM II Exam 2 > All Joint Competency > Flashcards

Flashcards in All Joint Competency Deck (33):
1

Order of steps for joint exam

1. Inspection
2. Palpation
3. ROM
4. Strength testing
5. Reflexes
6. Pulses
7. Sensation
8. Specialty test
9. OSE

2

Specialty test for suspected glenohumeral instability

Sulcus sign


Grasp pt’s elbow and apply inferior traction

+test = indention appears in area beneath acromion

3

Specialty test for suspected bicipital tendon pathology

Speeds test


Pt’s arm flexed at the shoulder with hand supinated. Slightly flex pt’s elbow. Resist at forearm while pt flexes and monitor bicipital tendon

+test = pain in bicipital groove

4

Specialty test for suspected rotator cuff pathology

Empty can test


Flex pt’s shoulders to 90 while horizontally abducting to 45. internally rotate both arms so thumbs point down. Press down on forearms while pt resists

+ test = pain or weakness

5

Specialty test for suspected rotator cuff impingement

Neer impingement test


Stabilize pt’s shoulder. With forearm pronated, passively flex shoulder to fully flexed position

+test = pain

6

Specialty test for suspected subscapularis weakness

Liftoff test


Pt’s arm in internal rotation and extension. Pt pushes arm into further internal rotation against physician resistance

+ test = weakness (inability to resist)

7

Specialty test for suspected AC joint pathology

Cross arm test


Physician passively adducts pt’s arm across their chest and rests pt’s hand on their opposite shoulder

+ test = pain in AC joint with end range adduction

8

Specialty test for suspected elbow MCL sprain

Valgus stress test


Arm slightly abducted and externally rotated. Forearm supinated and slightly flexed. Slight medial directed valgus stress applied to elbow joint

+test = pain/tenderness with palpation and valgus stress; increased laxity

9

Specialty test for suspected elbow LCL sprain

Varus stress test


Arm slightly abducted and internally rotated. Elbow flexed slightly. A slight varus stress is applied to elbow joint

+ test = pain or increased laxity in LCL

10

Specialty test for suspected ulnar nerve entrapment

Tinel’s test


Tap between olecranon and medial epicondyle in ulnar groove

+ test = eliciting tingling sensation down forearm within ulnar nerve distribution

11

Specialty test for suspected lateral epicondylitis

Tennis elbow test


Pt’s elbow flexed to 90 and forearm pronated with wrist neutral and plam facing down. Doc places one hand under proximal forearm for stabilization and the other hand over pt’s hand to resist movement. Pt EXTENDS wrist against resistance

+ test = pain/tenderness around lateral epicondyle, may radiate down lateral forearm

12

Specialty test for suspected medial epicondylitis

Golfer’s elbow test


Pt’s elbow flexed to 90 and forearm supinated with wrist neutral and palm facing up. Doc places one hand under proximal forearm for stabilization and the other hand over pt’s wrist to resist movement. Pt FLEXES wrist against resistance

+ test = pain/tenderness around medial epicondyle

13

Specialty test for suspected carpal tunnel syndrome

Tinel’s test


Tap over transverse carpal ligament (between thenar/hypothenar eminences) with fingertip while pt’s wrist is held in extension

+test = parasthesias/numbness/tingling/pain radiating to thumb, index, and middle finger (median n. distribution)

14

Specialty test for hip complaint: suspected labral pathology

Labral loading


Flex pt’s knee and hip to 90; load into the femur towards innominate

+test = pain

15

Specialty test for hip complaint: suspected central compartment pathology

Labral loading


Flex pt’s knee and hip to 90; load into the femur towards innominate

+test = pain

16

Specialty test for hip complaint: suspected peripheral compartment pathology, specifically rectus femoris contracture

Rectus femoris test


Pt supine. One hip flexed up to chest. Other leg is bent over edge of table.

+ test = knee flexion <90

17

Specialty test for hip complaint: suspected lateral compartment pathology, specifically trochanteric bursitis

Jump sign


Pt seated; pressure applied to greater trochanter

+ test = pt withdraws with pressure

18

Specialty test for hip complaint: suspected lateral compartment pathology, specifically iliotibial band contracture

SLR


Pt supine. Passively flex pt’s ipsilateral hip with knee extended

+test = pain over lateral leg (especially at 15 degrees)

19

Specialty test for hip complaint: suspected lateral compartment pathology, specifically piriformis pathology

Piriformis test


Pt supine with hip and knee flexed, one ankle crossed over contralateral knee. Pt abducts against resistance

+ test = pain over posterior aspect of greater trochanter

20

Specialty test for hip complaint: suspected lateral compartment pathology, specifically gluteus medius pathology

Patricks: FABER (2)


Pt’s hip is flexed, abducted, and externally rotated. Doc braces contralateral ASIS, pt externally rotates/abducts against resistance

+test = pain or weakness

21

Specialty test for hip complaint: suspected anterior compartment pathology, specifically psoas injury

Psoas test


Flex hip to 30 degrees while pt further flexes against resistance

+ test = pain/inability or snapping

22

Specialty test for hip complaint: suspected anterior compartment pathology, specifically hip flexor injury

Thomas test


Pt supine and pulls knees to chest. One leg is lowered to table to test flexibility of hip flexors

+ test = inability to fully extend, or extended leg raises off table

23

Specialty test for knee complaint: suspected MCL injury

Valgus stress test


Pt supine with knee flexed to 30 degrees (can also test at 0 degrees). Doc supports lower leg, with hands placed on medial and lateral aspects of knee. While providing lateral resistance to knee, move lower leg so that ankle shifts laterally while holding the distal femur in place. Assess for laxity, quality of end point, and pain.

+test = increased laxity, soft or absent endpoint, pain

24

Specialty test for knee complaint: suspected LCL injury

Varus stress test

Examiner and pt in same position as valgus stress test. While providing medial resistance, physician moves lower leg so that ankle shifts medially. This is done at 30 degrees flexion and 0 degrees.

+ test = increased laxity, soft or absent endpoint, pain

25

Specialty test for suspected meniscus injury

McMurray’s test


Pt supine with hip and knee flexed. Doc uses caudad hand to control ankle and cephalad hand placed on distal femur. Doc rotates tibia into internal rotation and applies varus stress, then continues leg into extension. Doc rotates tibia into external rotation and applies valgus stress, then continues leg into extension.

+ test = pain or painful click during extension

26

Specialty test for suspected patellar injury

Patellar compression test


Pt supine and knee extended. Provide compressive load to patella with one hand while moving the patella medial and lateral

+ test = pain with compression

27

Specialty test for supsected ATF sprain

Anterior drawer


Grasp posterior calcaneus in one hand and distal tibia/fibula in other, monitoring anteriorly at anterior talus. Provide anterior force on calcaneus while stabilizing the distal tibia/fibula. Normal springing of calcaneus back to neutral should occur.

+test = pain, no springing, excessive motion/laxity

28

Specialty test for knee complaint: suspected ACL injury

Anterior drawer


Pt supine with knee flexed to 90. Doc sits on pt’s foot and grasps the proximal tibia with both hands, pulling tibia anteriorly

+ test = excessive translation when compared to other knee

29

Specialty test for knee complaint: suspected PCL injury

Posterior drawer


Pt supine with knee flexed to 90. Doc sits on pt’s foot and grasps proximal tibia with both hands, translating tibia posteriorly

+ test = excessive translation, particularly when compared to opposite side

30

Specialty test for suspected medial ankle sprain

Eversion test


Grasp distal tibia/fibula with one hand and plantar surface of midfoot with other hand. Evert the foot to evaluate ROM

+ test = laxity, increased ROM, pain

31

Specialty test for suspected high ankle sprain

Squeeze test


Wrap hands around leg proximal to ankle, contacting distal tibia/fibula with both thenar eminences. Squeeze tibia for 2-3 seconds then rapidly release

+ test = pain at syndesmosis

32

Specialty test for suspected achilles injury

Thompson test


Pt prone with foot off table. Squeeze the pt’s calf. The foot should plantar flex

+test = absence of plantar flexion

33

Specialty test for suspected DVT

Homan’s sign


Pt laying or seated with knee extended. Dorsiflex the pt’s foot. Lateral compression of calf may also be added.

+ test = pain with dorsiflexion