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Comp Eval-Thoracic Flashcards

1
Q

Adam’s Position

A

• If the scoliosis, hyperkyphosis
or kyphoscoliosis is present
standing but reduces when
patient flexes forward
suspect the scoliosis is
functional – adaptation of the
spine and soft tissue
• If the scoliosis, hyperkyphosis
or rib hump is present
standing and does not
reduce with forward flexion
suspect a structural
deformity – hemivertebra,
compression fracture or
idiopathic scoliosis

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2
Q

Chest Expansion

A

• The normal chest expansion
for a man is 2+ inches and a
woman is 1+ inch
• A decrease in chest
expansion indicates an
ankylosing condition –
ankylosing spondylitis
• **you are testing for
EXPANSION hence the
name CHEST EXPANSION

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3
Q

Forestier’s Bowstring

A

• Normally the contralateral
musculature demonstrates
tightening
• Patients with Ankylosing
spondylitis will
demonstrate ipsilateral
tightening and contracture
of the paraspinal
musculature

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4
Q

Schepelmann’s Sign

A

• Pain created on concavity
side – suspect intercostal
neuritis
• Pain created on the
convexity side – suspect
intercostal myofascitis
but must be
differentiated from
pleurisy

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5
Q

Rib Compression

A

• A/P
• Pain or point tenderness
indicates fracture, contusion, or costochondral separation
• Lateral
• Pain or point tenderness
indicates fracture

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6
Q

Sternal Compression

A

• Localized severe pain
along the lateral border
of the ribs indicates
fracture
• Differentiate a fracture
from a contusion –
contusions do not
usually cause pain
during rib motion

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7
Q

Prone Unilateral Hypothenar/Transverse Push

A

• PP: Prone
• DP: Fencer or square stance facing
cephalad, side of adjustive contact • CH: Hypothenar of caudal hand on
Transverse Process (TP) (fingers
running parallel to the spine)
• IH: Pisiform in anatomical snuff box
of CH, with fingers around wrist.
• Vector: P-A

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8
Q

Prone Unilateral Hypothenar/Transverse Push (LF)

A

• PP: Prone • DP: Fencer or square stance facing
caudal, side of adjustive contact
• CH: Hypothenar of cephalic hand on
Transverse Process (TP) (fingers
running parallel to the spine)
• IH: Pisiform in anatomical snuff box,
with fingers around wrist.
• Vector: P-A and S-I • CLOSING THE WEDGE

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9
Q

Prone Bilateral Hypothenar, Thenar/Transverse Push-Rotation

A

• PP: Prone, patient permission to open gown
and contact
• DP: Modified fencer or square stance facing
patient, superior segment side of contact,
leaning anterior and tractioning contacts apart
• CH: Caudal hypothenar contact on superior
Transverse Process (TP)
• IH: Cephalad thenar or hypothenar with a
broad stabilizing contact on inferior Transverse
Process (TP) (contralateral side reaching
across the spine) . Internally rotate against
transverse process with torque, fingers along
spine
• Vector: P-A with stabilizing
T7 LR, RRR
• CH: P-A, IH: stabilizing

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10
Q

Prone Unilateral Hypothenar/Spinous Push (Rotation Malposition or Rotation with Ipsilateral Lateral Flexion)

A

• PP: Prone
• DP: Square or fencer stance facing caudal, side
of contact, at cephalad end of the table
• CH: Hypothenar of cephalad hand on lateral
surface of superior Spinous Process (SP) on the
side of rotation. Then, torque hand 45 degrees
so that little finger CROSSES the Spine.
• Left hand counterclockwise torque, right
hand clockwise torque
T6 RR and RLF, LRR and LLFR
• IH: Hypothenar in anatomical snuff box,
stabilize contact. • Vector: P-A and L-M with clockwise or
counterclockwise torque

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11
Q

Prone Knife Edge/Spinous Push - Extension

A

• PP: Prone
• DP: Fencer stance facing cephalad,
center of gravity caudal to contact
• CH: Mid-knife edge contact on
inferior Spinous Process (SP)
• IH: Calcaneal reinforcement with
fingers pointing cephalad
• Vector: I-S with enough P-A to stay on Spinous Process (SP)

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12
Q

Prone Knife Edge/Spinous Push - Flexion

A

• PP: Prone, head piece lowered
• DP: Fencer stance facing caudal,
at cephalad end of the table,
center of gravity over contact
• CH: Mid-knife edge contact on
superior interspinous space
• IH: Calcaneal reinforcement
with fingers pointing caudal
• Vector: P-A and S-I

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13
Q

Supine Opposite-Side Thenar/Transverse Drop (Figure 5-181F)
Rotation Malposition

A

• PP: Supine, arms crossed on shoulders, patient in flexed position
• DP: Modified fencer, opposite side of contact, tissue slack from below
• CH: Unilateral thenar contact on superior segment
• IH: Contacts the patient’s crossed arms
• Vector: A-P to induce rotation

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14
Q

Prone Knife Edge/Spinous Push – Extension

A

• PP: Prone
• DP: Fencer stance facing cephalad, center of gravity caudal to contact
• CH: Mid-knife edge contact on inferior Spinous Process (SP)
• IH: Calcaneal reinforcement with fingers pointing cephalad
• Vector: I-S with enough P-A to stay on Spinous Process (SP)

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15
Q

Prone Knife Edge/Spinous Push - Flexion

A

• PP: Prone, head piece lowered
• DP: Fencer stance facing caudal, at cephalad end of the table, center of gravity over contact
• CH: Mid-knife edge contact on superior interspinous space
• IH: Calcaneal reinforcement with fingers pointing caudal
• Vector: P-A and S-I

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16
Q

Supine Opposite-Side Thenar/Transverse Drop (Figure 5-181F)
Rotation Malposition

A

• PP: Supine, arms crossed on shoulders, patient in flexed position
• DP: Modified fencer, opposite side
of contact, tissue slack from below
• CH: Unilateral thenar contact on superior segment • IH: Contacts the patient’s crossed
arms
• Vector: A-P to induce rotation

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17
Q

Thumb/web axilla with knee extension; long axis distraction

A

PP: Supine, involved arm off table
DP: Bunny hop position, knees grasping distal humerus CH: Inside hand thumb/web contact in pt’s axilla with slight downward pressure to stabilize
IH: Outside hand digital contact over lateral aspect of the joint
VEC: LAD with knee extension

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18
Q

Bimanual thumb thenar grasp/proximal humerus with knee extension; anterior to posterior glide

A

-PP: Supine, glenohumeral joint off the table
-DP: Bunny hop position, knees grasping distal humerus -CH: Bilateral grasp on proximal humerus, thumbs/thenar in midline
-VEC: A-P shallow impulse with slight distraction with the knees

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19
Q

Interlaced digital/proximal humerus; superior to inferior glide in flexion
PP: Supine with involved arm raised to 90o DP: Standing on involve side in lunge position facing cephalad with pt elbow resting on INSIDE shoulder
CH: Grasp proximal humerus with interlaced fingers VEC: S-I; distract slightly with shallow S-I impulse

A

PP: Supine with involved arm raised to 90o
-DP: Standing on involve side in lunge position facing cephalad with pt elbow resting on INSIDE shoulder
CH: Grasp proximal humerus with interlaced fingers
VEC: S-I; distract slightly with shallow S-I impulse

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20
Q

6-51 Supine Index/ proximal humerus; superior to inferior glide in abduction

A

-PP: Supine with shoulder off table
-DP: Stand on side of table facing caudal
-CH: Index web contact on superior aspect of proximal humerus with cephalad hand
-IH: Caudal hand grasps distal humerus
-VEC: S-I with shallow impulse thrust

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21
Q

6-52 Bimanual thumb thenar grasp/proximal humerus with knee extension; internal and external rotation

A

-PP: Supine with arm in slight abduction off table
-DP: Face cephalad with knees straddling affected arm, squeezing distal humerus, holding arm in internal or external rotation
-CH: Bimanual grasp fingers interlaced on proximal humerus
-VEC: Shallow Internal or External rotation with LAD

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22
Q

6-53 Bimanual thumb thenar grasp/proximal humerus; mobilization with distraction

A

-PP: Supine with affected arm outstretched on edge of table
-DP: In a lunge position facing head of table, pt forearm against your thorax
-CH: Bimanual grasp to proximal humerus
-VEC: General circumduction and distraction, use body weight for slight distraction

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23
Q

6-54 Bimanual grasp/hand; pendular abduction mobilization

A

-PP: Supine with affected arm off table; arm is slightly abducted and elbow flexed 90o
-DP: At side of table on involved side, facing patient
-CH: Bimanually grasp patient’s hand
-VEC: S-I with passive swinging; increasing the range of abduction as tolerated

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24
Q

6-55 Bimanual thumb thenar grasp/proximal humerus with knee extension; posterior to anterior glide

A

PP: Prone with involved glenohumeral joint off the table in slight abduction
DP: Facing patient in bunny hop position; knees gently squeezing distal humerus
CH: Bimanual grasp to proximal humerus; thumbs midline VEC: Shallow P-A impulse with slight distraction with knees

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25
6-56 Bimanual thumb thenar grasp/proximal humerus with knee extension; mobilization with distraction
PP: Prone with affected glenohumeral joint off side of table; arm hanging off table DP: Stand or kneel off side of table CH: Bimanual grasp; thumbs midline; fingers wrapped around into axilla VEC: General circumduction and slight distraction using figure 8 motion
26
6-57 Standing Interlaced digital/proximal humerus; superior to inferior glide in flexion
PP: Standing with feet shoulder width apart with arm in 90o flexion DP: Stand in front of patient on affected side with patient elbow on your INSIDE shoulder; shoulders align with pt height; CH: Use an interlaced digit contact on proximal humerus VEC: Shallow impulse S-I with slight distraction drawing away from pt
27
6-58 Standing Interlaced digital/proximal humerus; superior to inferior glide in abduction PP: Standing with feet shoulder width apart with arm in 90o abduction DP: Stand in front of patient on affected side with patient elbow on your INSIDE shoulder; shoulders align with pt height; CH: Use an interlaced digit contact on proximal humerus VEC: Shallow impulse S-I with slight distraction drawing away from pt
PP: Standing with feet shoulder width apart with arm in 90o abduction DP: Stand in front of patient on affected side with patient elbow on your INSIDE shoulder; shoulders align with pt height; CH: Use an interlaced digit contact on proximal humerus VEC: Shallow impulse S-I with slight distraction drawing away from pt
28
6-59 Reinforced palmer olecranon; anterior to posterior glide
-PP: Patient seated with arm in forward flexion; elbow bent -DP: Stand behind patient; stabilizing pt’s shoulder girdle against your torso -CH: Reinforced palmar contact to olecranon process -VEC: Shallow A-P impulse thrust in axis of humerus
29
6-60 Supine Index distal clavicle; superior to inferior glide
PP: Supine with arm abducted 90o DP: Facing caudal on involved side CH: Index contact to distal clavicle IH: Outside hand grasps mid shaft of humerus and slightly distracts humerus VEC: S-I with shallow impulse
30
6-61 Supine Covered thumb/distal clavicle; inferior to superior glide
PP: Supine with arm straight in slight abduction DP: Bunny hop position; knees grasping distal humerus CH: Outside hand thumb contact to inferior distal clavicle IH: Inside hand pisiform covers thumb contact VEC: Shallow I-S impulse thrust with slight knee extension to induce LAD
31
6-62 Supine Hypothenar distal clavicle with distraction; anterior to posterior glide
PP: Supine affected arm straight and forward flexed about 60o DP: On opposite side of table CH: Cephalad hand pisiform contact to anterior distal clavicle IH: Grasps pt forearm providing distraction anteriorly VEC: Shallow A-P impulse
32
6-63 Supine Digital/distal clavicle with distraction; posterior to anterior glide
PP: Supine arm straight and flexed 60o in slight abduction DP: Stand on affected side facing cephalad between pt arm and table CH: Inside hand index and middle digital contact to posterior distal clavicle IH: Outer hand grasps pt distal forearm providing anterior distraction raising shoulder past 90o VEC: Shallow quick P-A impulse
33
6-64 Seated Web/distal clavicle; superior to inferior glide
PP: Seated with affected arm abducted DP: Stand behind patient on affected side CH: Web contact of inside hand on superior distal clavicle IH: Outside hand grasps distal forearm and lifts gently to distract/slightly abduct shoulder VEC: Shallow quick S-I impulse
34
6-65 Supine Hypothenar/proximal clavicle with distraction; anterior to posterior
PP: Supine; arm flexed to ~60o DP: Stand on affected side facing cephalad CH: Inside hand pisiform contact to anterior proximal clavicle IH: Outside hand grasps distal humerus at epicondyles; distracts shoulder anteriorly raising scapula off table VEC: Shallow A-P impulse
35
6-66 Supine Covered thumb proximal clavicle; superior to inferior glide
PP: Supine, pt’s head turned away, arm is abducted to 90o palm placed under head DP: At head of table facing caudal CH: Ipsilateral thumb on superior aspect of proximal clavicle IH: contralateral hand pisiform over thumb contact VEC: Shallow quick S-I impulse
36
6-67 Supine Covered thumb proximal clavicle; inferior to superior glide
PP: Supine; arm slightly abducted DP: Stand on affected side in bunny hop position grasping distal humerus CH: Outside hand thumb on inferior proximal clavicle IH: Inside hand pisiform reinforces thumb VEC: Shallow impulse I-S with slight distraction with knees
37
6-68 Supine Digital/ proximal clavicle with distraction; posterior to anterior
PP: Supine; arm flexed DP: Standing on affected side facing cephalad CH: Inside hand index and middle finger digit contact to posterior proximal clavicle IH: Outside hand grasps forearm; distracting shoulder anteriorly past 90o VEC: Shallow impulse P-A; lifting clavicle
38
6-69 Supine Thenar /distal clavicle, thenar manubrium; long axis distraction
PP: Supine with rolled towel running down spine under upper thoracic spine; affected arm abducted 90o DP: Stand on affected side; lunge position facing cephalad CH: Outside hand thenar on distal clavicle grasping deltoid IH: Inside hand thenar on manubrium of sternum; fingers laterally cross to contralateral clavicle VEC: Distraction; IH stabilizes manubrium with downward pressure; shallow impulse to distal clavicle
39
6-70 Seated Reinforced thenar/proximal clavicle; inferior to superior glide PP: Seated with arms relaxed DP: Stand behind pt CH: Contralateral hand thenar on inferior proximal clavicle IH: Ipsilateral hand calcaneal contact reinforces CH VEC: Shallow I-S impulse *Stabilize pt against chair or your body; lean pt back slightly
PP: Seated with arms relaxed DP: Stand behind pt CH: Contralateral hand thenar on inferior proximal clavicle IH: Ipsilateral hand calcaneal contact reinforces CH VEC: Shallow I-S impulse *Stabilize pt against chair or your body; lean pt back slightly
40
6-71 Seated Digital/proximal clavicle, thenar/manubrium; long axis distraction
PP: Seated with affected arm abducted 90o DP: Stand behind pt, slightly to side of involvement CH: Ipsilateral hand reaches under affected arm; digital contact with index and middle finger on proximal clavicle IH: Contralateral hand thenar contact on manubrium; forearm across contralateral clavicle VEC: Distraction; quick shallow impulse *IH stabilizes manubrium and pt shoulder into your torso; CH draws laterally with arm drawing affected shoulder posterior
41
6-72 Side Posture Bimanual thumb thenar/lateral scapula; lateral to medial glide PP: Side lying; affected side up with arm resting on side of body DP: Stand at side of table facing patient CH: Bimanual thumb/thenar to lateral border of scapula VEC: L-M shallow impulse *take out all passive movement first before impulse
PP: Side lying; affected side up with arm resting on side of body DP: Stand at side of table facing patient CH: Bimanual thumb/thenar to lateral border of scapula VEC: L-M shallow impulse *take out all passive movement first before impulse
42
6-73 Side Posture Crossed bilateral mid-hypothenar (knife –edge)/scapula; medial to lateral
PP: Side-lying with affected arm hanging forward in front of table DP: Standing on involved facing cephalad in a fencer stance CH: Caudal hand knife-edge to medial border of scapula; fingers over scapular spine IH: Cephalad hand calcaneal contact over lateral border of unaffected scapula VEC: M-L impulse thrust *draw out lateral movement passively before impulse
43
6-74 Side Posture Bimanual digital thenar grasp/scapula; rotation- inferior angle lateral to medial
PP: Side-lying affected side up; pt arm behind back DP: Stand at side of table, facing pt CH: Caudal hand thenar contact on lateral border of inferior angle of scapula IH: Cephalad hand thenar contact on superior aspect of spine of scapula; fingers pointing to inferior angle VEC: Clockwise rotation; impulse thrust driving inferior angle medially
44
6-75 Side Posture Bimanual digital thenar grasp/scapula; rotation- inferior angle medial to lateral PP: Side-lying affected side up; pt’s hand behind head DP: Standing on side of table facing pt CH: Caudal hand hypothenar contact on medial aspect of inferior angle of scapula IH: Cephalad hand digital contact along spine of scapula VEC: Counter-clockwise rotation impulse
PP: Side-lying affected side up; pt’s hand behind head DP: Standing on side of table facing pt CH: Caudal hand hypothenar contact on medial aspect of inferior angle of scapula IH: Cephalad hand digital contact along spine of scapula VEC: Counter-clockwise rotation impulse
45
Dugas
• Inability to touch opposite shoulder or unable to lower arm to chest indicates anterior dislocation of humerus.
46
Apley’s Scratch Test
• Exacerbation of pain in the shoulder indicates degenerative tendinitis of the rotator cuff usually supraspinatus tendon
47
Subacromial Push Button
• An increase in pain indicating a subacromial bursitis
48
Subacromial Bursa Test (Dawbarn’s Sign)
• Decrease in tenderness or pain indicating Subacromial bursitis
49
Apprehension Test
• Pain over anterior capsule the “look of apprehension” on patient’s face or laxity compared to the other side indicates anterior dislocation trauma of the humerus
50
Relocation (apprehension is positive)
• If patient experiences relief of symptoms that manifested during the apprehension test it indicates anterior instability. If no change in pain, or apprehension then possibility of another cause for the pain other than instability.
51
Sulcus Sign
• Sulcus or dimpling appearing superior to humeral head/inferior to lateral acromion indicates multidirectional instability
52
Load Shift (shoulder drawer test)
• Increased movement and/or popping, grinding or slapping indicates instability of glenohumeral joint and possible labrum damage
53
Arm Drop Test (Codman’s Test)
• Pain and hunching of shoulder indicating rotator cuff tear or rupture of the supraspinatus tendon
54
Empty Can (Supraspinatus Test)
• Weakness or pain indicates a lesion of the supraspinatus muscle or tendon
55
Lift Off Test
• Weakness and or pain indicates a lesion of the subscapularis muscle or tendon.
56
Yergson’s
• Pain or tenderness over bicipital tendon and the transverse humeral ligament. This Indicative of tenosynovitis of the transverse humeral ligament, inflammation of the biceps tendon or tendonitis. If popping occurs suspect a lax transverse humeral ligament or a congenital shallow bicipital grove.
57
Clunk
• Clicking or clunking with or without pain indicates labrum tear
58
Crank
• Clicking with or without pain indicates labrum tear
59
O’Brien’s Sign
• If the patient experiences deep pain in shoulder with internal rotation which is reduced or eliminated with external rotation it indicates a torn glenoid labrum
60
Hawkins-Kennedy
• Pain in the anterior glenohumeral joint is indicative of rotator cuff tendonitis and possible impingement of supraspinatus tendon
61
Neer’s Test
• Pain in the anterior glenohumeral joint is indicative of rotator cuff tendonitis
62
Impingement Relief
• Decrease in pain or alleviation indicates mechanical impingement under the acromion

Methods (15 decks)

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