ECR Musculoskeletal Tests Flashcards Preview

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Flashcards in ECR Musculoskeletal Tests Deck (74):
1

"Drop arm test"

ROTATOR CUFF TEAR


ask patient to fully abduct arm to shoulder level and lower it slowly. If patient cannot hold arm fully abducted at shoulder level, --> positive for ROTATOR CUFF TEAR

2

Apley Scratch Test

tets overall shoulder rotation
Difficulty with these motions suggests ROTATOR CUFF DISORDER

ask patient to touch opposite scapula to test
1) abduction and external rotation or
2) adduction and internal rotation

3

Neer's impingment sign

Pain during this maneuver is positive --> ROTATOR CUFF TEAR

Press on scapula to prevent scapular motion with one hand, and rasie the patient's arm with the other. This compresses teh greater tuberosity of the humerus against the acromion

4

Hawkin's Imingment Sign

pain is POSITIVE for ROTATOR CUFF TEAR

flex patient's shoulder and elbowto 90 degrees with palm facing down,. Then with one hand on the forearmand one on the arm, rotate the arm internally. This compresses teh greater tuberosity agaisnt the CORACOACROMIAL LIGAMENT

5

What does the Neer's Impingment sign compress?

greater tuberosity of humerus against the acromion

6

What does Hawkin's impingment sign compress?

greater tuberosity agaisnt the coracoacromial ligament

7

"Empty Can Test"

Weakness is POSITIVE for possible ROTATOR CUFF TEAR; Tests SUPRASPINATUS STRENGTH

. Elevate arms to 90 deg. and internally rotate arms with thumbs poinging down , as if emptying a can . Ask pt to resist as you place downard pressure on the arms

8

Ask patient to place arms at side and flex the elbows to 90 degrees with the thumbs turned up. Provide resistance as teh patient presses forearm outward

Weakness is POSITIVE for ROTATOR CUFF TEAR or BICIPTIAL TENDINITIS
-Tests wekenss in INFRASPINATUS STRENTH

9

Test forearm supination. Flex patients forearm to 90 deg at elbow and pronate the patient's wrist. Provide resistance when aptient supinats forearm

Pain is a POSITIVE for inflammation of LONG HEAD OF BICEPS TENDON and possible ROTATOR CUFF TEAR

10

Raise your arms in front of you and overhead

Tests Shoulder Flexion

11

Raise your arms behind you

Tests Shoulder Extension

12

Raise you arms out to the side and overhead

Tests Shoulder Abduction

13

Cross your arm in front of your body

Shoulder Adduction

14

Place one hand behind your back and touch your shoulder blade

Internal rotation of shoulder

15

Raise your arm to shoulder level; bend your elbow and rotate your forearm toward the celign

External rotation

16

Place one hand behind your neck or bend as if you are brushing your hair

External rotation

17

Shoeber's Test

Schober's test is a test used in rheumatology to measure the ability of a patient to flex his/her lower back.
Procedure

The examiner makes a mark approximately at the level of L5 (fifth lumbar vertebra). The examiner then places one finger ~5 cm below this mark, and another, second, finger, ~10 cm above this mark. The patient is asked to touch his/her toes. By doing so, the distance between the two fingers of the examiner increases. However, a restriction in the lumbar flexion of the patient reduces this increase; if the distance increases less than 5 cm[1], then there is an indication that the flexion of the lower back is limited.

18

Tinel's Test (Tinel's sign)

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Tinel sign
Classification and external resources

Transverse section across the wrist and digits. (The median nerve is the yellow dot near the center. The carpal tunnel is not labeled, but the circular structure surrounding the median nerve is visible.)
ICD-10 G56.0
ICD-9 354.0
OMIM 115430
DiseasesDB 2156
MedlinePlus 000433
eMedicine orthoped/455 pmr/21 emerg/83 radio/135
MeSH D002349

Tinel's sign is a way to detect irritated nerves. It is performed by lightly tapping (percussing) over the nerve to elicit a sensation of tingling or "pins and needles" in the distribution of the nerve. It takes its name from French neurologist Jules Tinel (1879-1952).[1][2][3]

For example, in carpal tunnel syndrome where the median nerve is compressed at the wrist, Tinel's sign is often "positive" causing tingling in the thumb, index, and middle finger. Tinel's sign is sometimes referred to as "distal tingling on percussion" or DTP. This distal sign of regeneration can be expected during different stage of somatosensory recovery.[4]

19

What is Phalen's Test?

CARPEL TUNNEL



The patient is asked to hold their wrist in complete and forced flexion (pushing the dorsal surfaces of both hands together) for 30–60 seconds. The lumbricals attach in part to the flexor digitorum profundus tendons. As the wrist flexes, the flexor digitorum profundus contracts in a proximal direction, drawing the lumbricals along with it. In some individuals, the lumbricals can be "dragged" into the carpal tunnel with flexor digitorum profundus contraction. As such, Phalen's maneuver can moderately increase the pressure in the carpal tunnel via this mass effect, pinching the median nerve between the proximal edge of the transverse carpal ligament and the anterior border of the distal end of the radius. By compressing the median nerve within the carpal tunnel, characteristic symptoms (such as burning, tingling or numb sensation over the thumb, index, middle and ring fingers) conveys a positive test result and suggests carpal tunnel syndrome.

20

Straight Leg Test

Posiitve To test Sciatica (Radicular Low Back Pain)

When apitent in supine position, raise patient's relaxed and straightened leg at hip, then dorsiflex foot Lift leg up. If aptient has low back apin with nerve pain that radiates down leg, --> Sciatica in S1

21

What is Chronic Back Stiffness- Anylosing spondylitis

ANKYLOSING SPONDYLTIS, INFLAMMATORY POLYARTHRITIS, MOST common in younger than 40 year old men

22

What is Diffuse idiopathic hyperstosis (DISH)

affects men? women, greater than 50 years old

23

Physical signs of chronic back stiffness (DISH and Ankylosing spondylitis)

Loss of normal lordosis, muscle spasms, limited anterior and lateral flexion. Improves with exercis. Lateral immobility of the spine, esp in the thoracic area

24

Nocturnal Back Pain, Unrelieved by rest

Metastatic Malignancy to the spine from canver of prostsate, breast, lung, thyroid, and kidney and multiple myeoma

25

What are phsyical signs of nocturnal back pain

variable

26

Pain Referred from Abdomen or Pelvis

usally a deep, aching pain, level varies with sournce, ~1% of back pain

27

What are caues of referred pain from abdomen or pelvis

Peptic ulcer, pancreatitis, pancreatic cancer, chornic prostatitis, endometriosis, dissecting aortic aneurysm, retroperitoneal tumor, and other causes

28

What are physical signs or visceral pain

spinal movements are not painful and range of motion is not affected. Look for signs of rimary disorder

29

What is pattern of mechanical neck pain WHIPLASH

aching paracervical pain and stiffness,often beginning day after injury. Occipital headache, dizziness, malaise, and fatigue may be prsent. Chronic whiplash syndoem if sympsoms last more than 6 months, presen in 20-40% of injuries

30

Causes of whiplash

musculoligamental sprain or strain form forced HYPERFLEXION-HYPEREXTENSION injury to the neck,

31

Physical signs of whiplash

localized paracervical tenderness, decreased eck range of motion, perceived weakness of upper extrememies. Causes of cervical cord compression such as frature, herniation, head injury, or altered consciousness are exclused

32

Pattners of Cervical Radiculopahty- from nerve root compression

sharp burning or tingling pain in the neck and ONE ARM with associated parasthesias and weakness. Sensory symptoms often in myotomal pattern, deep in muscle, rather than dermatomal pattern

33

Possible causes of cervical radiculopathy

dysfunction of cervical spinal nerve, neve roots, or both from foraminal encroachment of the spinal nerve (~75%), herniated cervical disck (~25%).

Rarely from tumor, syrinx, MS. Mechanisms may invovle hypoxia of nerve root and dorsal ganglion, release of inflammatory mediators

34

Phsyical signs of Cervical Radiculopathy - from nerve rot compression

C7 nerve root affected most often (45%-60%), which weakness in TRCIPS and FINGER FLEXORS and extensors. C6 nerve root invovlement also common, with weaknes in bicpes brachioradialis, wrist extensors

35

Pattern of cervical myelopathy-from cervical cord compression

Neck pain with bilateral weaness and parasthesis in both upper and lower extremities, often with urinary freqquency. Hand clumsiness, palmar parestheis, and gait changes may be subtle. Neck flexion often exacerbates symptoms.

36

Causes of myelopahty

usually from cervical Spondylosis, defined as cervical degenerative disc disease from spurs, protrustion of ligametum flavum, and/or disc herniation (~80%); also from cervical stenosis form osteophytes, ossfiiation of ligamentum flavum. Large central or paracentral disc hernation may also compress cord

37

Phsyical signs of cervical myelopahty from cernical cord compression

Hyperrflexia; clonus at wrist, knee or ankle; entensor plantar reflexes ((positive babinski sign); and gait distrubances. Lhermittes sign: neck flexion with resulting sensation of electrical shock radiating down spine. Confirmation of cervical myelopathy warrants neck immobilizationa dn neurosurgical evaluation

38

Babinski Sign

Positive --> Cervical Myelopahty form cervical cord compression

An upward response (extension) of the hallux is known as Babinski response, Babinski sign, or Koch sign, named after Joseph Babinski (1857–1932), a French[1] neurologist of Polish origin. The presence of the Babinski sign can identify disease of the spinal cord and brain in adults, and also exists as a primitive reflex in infants.[2][3]

39

Lhermitte's sign


Positive test- Cervical Myelopahty from cervical cord compression

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Lhermitte's sign, sometimes called the Barber Chair phenomenon, is an electrical sensation that runs down the back and into the limbs. In many patients, it is elicited by bending the head forward.[1] It can also be evoked when a practitioner pounds on the posterior cervical spine while the neck is flexed; this is caused by involvement of the posterior columns.

40

Inflammatory bowel disease ass. with arthritis

Behcet's syndome

41

Theater Sign

Knee!
PTFD! patellafemoral tracking disorder

Pain at the front/inner side of the knee is common in young adults, especially soccer players, gymnasts, cyclists, rowers, tennis players, ballet dancers, basketball players, horseback riders, volleyball players, and runners. The pain of chondromalacia patellae is typically felt after prolonged sitting, like for a movie, and so it is also called "movie sign" or "theater sign."[5] Snowboarders and skateboarders are prone to this injury, particularly those specializing in jumps where the knees are under great stress. Skateboarders most commonly receive this injury in their non-dominant foot due to the constant kicking and twisting that is required of it during skateboarding.[6]

The condition may result from acute injury to the patella or from chronic friction between the patella and the groove in the femur through which it passes during motion of the knee.[7] Possible causes include a tight iliotibial band, neuromas, bursitis, overuse, malalignment, core instability, and patellar maltracking.

42

Hand Grip Test

tests fucntion of wrist joints, finger flexors, instrinsic muscles of hand

ask patient to grasp 2nd and 3rd finger

43

Finkelstein's Test

de Quervain's Tenosyntovitis from inflammation of ABdocutr poll longus

ask patient to rasp thumb against palm then move wrist toward midline in ulnar deviation

44

thumb abduction test

postiive- abducctor pollicis longus

Carpal tunnel disease

ask patient to raise thub stright up as you apply downward resistnce

45

tinel's test

Carpal Tunnel

For median nerve
tap lightly over the course of median nerve

46

Phalen's sign

Carpal Tunnel

bacwards praying position

47

Tenderness over tendon or inability to extend leg

partial or complete tear of patellar tendon

48

Pain with compression and with patellar movment during quadriceps contraction

chondromalacia or degenerative patella (patellafemoral syndrome)

49

Housemaid's knee

prepatellar bursitis

from excessive kneeling

50

Answerine bursitis

from running
valgus knee deformity, fibromyalgias, osteoarthrtiites

51

Bulge sign (for minor effusions)

For Effusion

with knee extended, place left hand aboe knee and applyi pressure of suprapatellar pouch, displacing or milking fluid downard. Stroke downward on medial aspect of knee and appy pressure to force fluid into lateral area. Tap kee just behind lateral margn of patella with right hand

52

Balloon sign

major effusions in kenee

place thumb an index finer of right hand on each side of patella; with left hadn compress suprapatellar pouch agaisnt femur. feel fluid entering or balooing inot spaces next to patella under right thumg an dindex finger

53

Place patient in prone with knee and ankle flexed at 90 degrees. or ask patient to kneel on chiar. Squeeze flaf and watch for PLANTAR FLEXION at ankle

absence of plantar felxion is positive for RUPTURE O ACHILLES TENDON

sudden severe pain like gunshot wound, ecchymosis from calf into heeel, flat foted gait with absece of toe off

54

bend or flex your knee. Or squat down to floor

Knee flexion

55

straighten your leg.
Or. After you squat down to tfloor stand up

Knee extension

56

While sitting, swing your lower leg toward midline

internal rotation

57

whie sitting, sing your lower leg away from midelin

external rotation of knee

58

McMurray Test

if click or pop along medial joint -->tear of Posterior portion of MEDIAL MENISCUS

with pt supine, graps heel and flex knee. cup other hand over knee . From heel, rotate lower leg internally and externally Then push on lateral side to apply VALGUS STRESS on medial side of joint . At the same time, rotate leg and externally and slowly extend it

lateral meniscus when varus stress on lateral side

59

Abduction (Valgus) Stress Test

Pain or gap in medial joint line --> Medial Collateral Ligmetn Tear

pt suppin,e knee sligly flexed, move thigh 30 degrees laterally to side of table. Push medially agistn nee and pull laterally at ankel to open up knee joing on medial side (valgus stress)

60

Adduction or (Varus Stress Test)

pain or gap in lateral joint --> tear in LATERAL COLLATERAL LIGMENT

push lateral agasint knee and pull ankel medially to open knee joint on lateral side (varus stress)

61

Anterior Drawer Sign

ACL tear- froward jerk shows countours of upper tibia

61

Lachmann Test

Significan forward eusion is ACL Tear

place knee in 15 degree flexion and externally rotate . Grasp distal femur with one hand and upper tibia with other. With thumb of tibial hand on the joint line, simultaneously move tbia forward and femur back.

61

Posterior Drawer sign

PCL tear

62

McMurray Test

if click or pop along medial joint -->tear of Posterior portion of MEDIAL MENISCUS

with pt supine, graps heel and flex knee. cup other hand over knee . From heel, rotate lower leg internally and externally Then push on lateral side to apply VALGUS STRESS on medial side of joint . At the same time, rotate leg and externally and slowly extend it

62

McMurray Test

if click or pop along medial joint -->tear of Posterior portion of MEDIAL MENISCUS

with pt supine, graps heel and flex knee. cup other hand over knee . From heel, rotate lower leg internally and externally Then push on lateral side to apply VALGUS STRESS on medial side of joint . At the same time, rotate leg and externally and slowly extend it

62

McMurray Test

if click or pop along medial joint -->tear of Posterior portion of MEDIAL MENISCUS

with pt supine, graps heel and flex knee. cup other hand over knee . From heel, rotate lower leg internally and externally Then push on lateral side to apply VALGUS STRESS on medial side of joint . At the same time, rotate leg and externally and slowly extend it

63

Abduction (Valgus) Stress Test

Pain or gap in medial joint line --> Medial Collateral Ligmetn Tear

pt suppin,e knee sligly flexed, move thigh 30 degrees laterally to side of table. Push medially agistn nee and pull laterally at ankel to open up knee joing on medial side (valgus stress)

64

Adduction or (Varus Stress Test)

pain or gap in lateral joint --> tear in LATERAL COLLATERAL LIGMENT

push lateral agasint knee and pull ankel medially to open knee joint on lateral side (varus stress)

65

Anterior Drawer Sign

ACL tear- froward jerk shows countours of upper tibia

66

Lachmann Test

Significan forward eusion is ACL Tear

place knee in 15 degree flexion and externally rotate . Grasp distal femur with one hand and upper tibia with other. With thumb of tibial hand on the joint line, simultaneously move tbia forward and femur back.

67

Posterior Drawer sign

PCL tear

68

Apley Compression Test

Meniscal Tears!!

patient prone, knee 90 degrees. Medially and laterally rotate lower leg while applying tibial pressure.

69

inability to SQUAT

Medial Meniscus tear

Effustion/cartilage tear

70

Painful Arc Sign

Subacromial impingment syndrome

Abduct arm, 70-110 degrees okay ,then pain,keep lifting higher and pain disaapaears