Final Flashcards
(101 cards)
0
Q
Bechterew’s test
A
(seated straight leg raise) – Passively or actively extend one leg at a time
1
Q
Valsalva (lumbar)
A
Inc inter ab presssure- stasis, back flow. Distension in veins, looking mostly at nerve roots. Looking for pain and/or parastesia
2
Q
Test for sciatic nerve tension
A
Slump test
3
Q
Pos Bechterew’s
A
Symptoms down posterior thigh past knee indicate possible L4, L5, or S1 radiculopathy due to herniated disc, stenosis, osteophytes, tumors, infection or fracture
4
Q
What is a pos Kemp’s test?
A
Low back pain with or without pain radiating down leg
5
Q
Kemp’s test
A
trunk extension, lateral flexion and slight ipsilateral rotation around hand
6
Q
Straight leg raise (SLR)
A
passively elevate straight leg. Note angle of onset of pain
7
Q
What does pos Kemp’s test signify?
A
Nerve root compression if pain radiates
Local low back pain without radiating pain …muscle strain / ligamentous strain / facet irritation / capsular inflammation
8
Q
Slump test
A
patient sits upright, arms behind back
patient “slumps” with cervical extension
cervical spine is fully flexed and released
one knee maximally extended … cervical spine is fully flexed and released
dorsiflex ankle … cervical spine is fully flexed and released
If symptomatic changes …both legs may be extended simultaneously
9
Q
Hard pos with SLR
A
sharp, burning, electrical pain past knee with hip flexed 35°-70°
10
Q
What hard pos SLR indicates
A
Sciatic nerve irritation / L4-S1 nerve roots radiculitis from herniation, tumor, spinal canal stenosis, osteophytes
11
Q
What does neg SLR test indicate?
A
suggests nerve root is not involved / most likely sacroiliac or lumbar
12
Q
What is a negative for SLR test?
A
Negative test – no pain, pain in back, pain to buttocks
13
Q
Soft pos SLR
A
pain radiating into lower extremity but not past knee
14
Q
Sicard’s test
A
if passive SLR (+), lower leg 5°-10°or to below pain and dorsiflex big toe
15
Q
What soft pos indicates SLR
A
meaningful – other evidence of nerve root or sciatic n. is inflamed / compressed
insignificant – no other evidence supports a radicular syndrome
16
Q
Pos Sicard’s indicates
A
sciatic radiculopathy or nerve root compression
17
Q
Pos Sicard’s test
A
Duplication or increase of radicular leg pain
18
Q
Well leg raise (Fajersztajn) (XSLR)
A
straight leg raise of non-symptomatic leg
19
Q
What is a pos Bragard’s?
A
Duplication or increase of radicular leg pain
20
Q
What does a focal pt of pain in SLR suggest?
A
“alarm sign” suggesting a tumor in location of pain
20
Q
Pos Bragard’s indicates
A
sciatic radiculopathy: disc herniation, encroachment, space occupying lesion
22
Q
Bragard’s test
A
if passive SLR (+), lower leg 5°-10°or to below pain and dorsiflex foot
23
Q
Pos Well Leg Raise
A
Increased symptoms in the symptomatic leg
24
Pos well leg indicates
nerve root irritation: disc herniation, encroachment by osteophytes
25
Patellar reflex tests
L4
26
Hamstrings reflex test
L5
27
Achilles reflex tests
S1
28
Belt test
Part 1 – patient bends forward and touches toes
Part 2 – If pain is noted by the patient, the examiner stabilize sacrum against lateral thigh, grasp bilateral iliac crests and ask patient to “bend forward again as far as possible”
29
Pos Belt test and what it indicates
low back pain provoked during part 1 and part 2 indicates lumbar origin
pain with part 1 only indicates sacroiliac origin
30
Yeoman's test
flex knee to 90°, stabilize S-I by putting pressure over PSIS and PIIS lift knee to extend hip only, not low back.
31
Yeoman's test also stretches
Femoral n
32
Patrick’s test (FABER)
place leg in figure-4 position resting foot just above opposite knee, (flex knee, abduct and externally rotate hip). Use one hand to stabilize the opposite ASIS and the other hand to apply gentle downward pressure over the flexed knee to move the hip into extension.
33
Anvil Test
Patient supine with legs extended on the table. Examiner stabilizes ankle and percusses calcaneus briskly and vigorously
Start light, then thump
34
Pos Anvil test
If exquisite, local pain felt in the hip joint – possible acetabulofemoral joint pathology and/or fracture
35
Hip Scouring Test
Perform an axial load through the femur. While maintaining this axial load "sweep" the femur by performing circumduction in clockwise and counterclockwise directions. A positive test is pain reproduction.
36
Good screening for hip pathology
Hip Scouring Test
37
Distraction Test (SIJ)
The patient is supine and the practitioner places his/her hand over each ASIS. There are 2 alternating descriptions of how to direct the force. The one method with some evidence of validity has the line of force direct straight down producing more of a shear effect than true distraction
38
Compression Test (SIJ)
The patient is side lying, with the hips and knees bent for stability. The examiner’s hands are then placed one over the other and on the patient’s ilium. Using body weight, a compressive force is then placed through the ilium directed towards the floor. It is important to maintain a broad contact and to stabilize the patient from rolling backward with your hip/thigh.
39
Thigh Thrust Test
The patient is supine and the hip is flexed to 90 degrees, the knee is bent and the hip slightly adducted (to mimic the plane of the SIJ). The examiner then applies a posterior shearing force to the SIJ through the femur. Avoid excessively adducting during this exam.
40
Gaenslen’s Test
The patient is supine near the edge of the table so that the SI joint is close to or on the edge of the table. The patient is then instructed to approximate the opposite knee to his/her chest (flexing the hip and knee) which will also be firmly stabilized by the examiner.
On the side to be tested, the thigh should be unsupported, suspended off of the edge of the table. The examiner then applies pressure to the leg hanging off the edge of table forcing the hip into extension.
41
Sacral Thrust Test
The patient is prone. The examiner contacts the sacrum at about the S2-3 level with fingers pointed cephalad. The examiner applies a posterior to anterior force lasting 2-5 seconds. It is suggested that forces should be gradually applied at first before the thrust is added.
42
Active Straight Leg Raise (aSLR)
The examiner asks the patient to alternately raise one leg after the other to a height of 4 inches (10 cm). If there are no positive findings, the test can be augmented by having the patient raise their legs higher (up to 8 inches or 20cm) or having the examiner press down against the raised leg to increase the load.
If the test is positive for any of these signs, the examiner can try re-testing the patient with the pelvis stabilized by compressing pelvis (see 2nd picture), or by stabilizing the lumbosacral region by asking the patient to actively contract their abdominal muscles. (Richardson 2004)
43
biomechanics of distraction test (SIJ)
An anterior to posterior directed force will primarily cause a shearing at the SI joints bilaterally, stressing the joint surfaces and posterior ligaments. A more outward force will distract the anterior structures of the joints, while compressing the posterior.
44
Biomechanics of compression test of (SIJ)
The sacroiliac joints are forced together potentially re-creating the patient’s pain. If the load is directed more through the anterior aspect of the ilium, a distractive force may be created across the posterior joint and ligaments.
45
Biomechanics of thigh thrust test
The starting position helps to stabilize the hip joint so that when pressure is applied it tends to shear the sacroiliac joint from anterior to posterior.
46
Biomechanics of Gaenslen’s Test
Overpressure of the leg at end range in extension stresses the sacroiliac joint, anterior sacroiliac joint ligaments and hip; it also stretches the hip flexors (psoas and rectus femoris), anterior hip, leg and abdominal fascia and potentially stretches the femoral nerve along with the L2,3,4 nerve roots.
47
Biomechanics of sacrum thrust
Presumably, a shearing force along the sacroiliac joint that will stress both anterior and posterior SI joint ligaments as well as the interior structure of the SI joint is created. In the presence of joint pathology or dysfunction, pain generators in the anterior, posterior and interior supportive elements of the joint may be stimulated.
48
Patellar apprehension
Patient supine, legs straight, quadriceps relaxed
Gently and slowly push patella laterally and observe for signs of verbal or nonverbal (facial) apprehension or reflex quadriceps contraction
49
Pos patellar apprehension test
Patellar … instability, subluxation, tracking disorder, patellofemoral dysfunction
50
Functional patellofemoral tests
Weight bearing movements like stepping up or squats.
51
Pos patellofemoral functional test
anterior knee pain with activity.
52
Resisted Knee Extension
Patient seated, perform manual muscle test of quadriceps muscles.
53
Pos resisted knee extension
anterior knee pain
54
Valgus stress test (knee)
Patient supine, legs straight, quadriceps relaxed, knee in neutral (0°)
Stabilizes medial ankle and apply lateral-to-medial (valgus) force attempting to open the knee joint on the medial side. Repeated with the knee at 30° of flexion
55
pos valgus stress test (knee)
(+) test neutral ( 0°) … MCL PLUS ACL, PCL or posterior medial capsule sprain/rupture
(+) test 30° flexion … MCL PLUS PCL or posterior medial capsule sprain/rupture
56
Varus stress test
Patient supine, legs straight, quadriceps relaxed, knee in neutral (0°)
Stabilize lateral ankle and apply a medial-to-lateral (varus) force attempting to open the knee joint on the lateral side. knee at 30° of flexion
57
Pos varus stress test (knee)
(+) test neutral ( 0°) … LCL PLUS ACL, PCL or posterior lateral capsule sprain/rupture
(+) test 30° flexion …LCL sprain/rupture PLUS posterior lateral capsule sprain/rupture
58
Anterior drawer test (knee)
Patient supine, knee flexed to 90°, foot on table.
Stabilize leg by sitting on dorsum of foot and place hands behind the proximal tibia.
Pull proximal tibia anteriorly trying to displace it forward
59
Posterior drawer test
Patient supine, knee flexed to 90°, foot on table.
Stabilize leg by sitting on dorsum of foot and place thenar eminences on proximal tibia.
Push the proximal tibia posteriorly trying to displace it backward.
60
pos posterior drawer indicates
pain or motion > 5mm of anterior motion … posterior cruciate ligament sprain or rupture
61
pos anterior drawer indicates
pain or motion > 5mm of anterior motion … anterior cruciate ligament sprain or rupture
62
Lachman’s anterior test
Patient supine, knee flexed to 30°
Stabilize femur just proximal to patella with one hand and pull the tibia anteriorly with the other hand trying to displace it forward on the femur
63
pos lachman's anterior
pain with excessive motion of tibia anteriorly > 5mm without firm end-point
(+) Lachman’s anterior test…anterior cruciate ligament sprain/rupture
64
Lachman’s posterior test
Patient supine, knee flexed to 30°
Stabilize femur just proximal to patella with one hand and push the tibia posteriorly with the other hand trying to displace it backward on the femur
65
pos Lachman’s posterior test
pain with excessive motion of tibia posteriorly > 5mm without firm end-point
(+) Lachman’s posterior test…posterior cruciate ligament sprain/rupture
66
Ege’s Test
Patient standing, feet 10-15” apart
Medial Meniscus: full external rotation of legs with slow squat
Lateral Meniscus: fell internal rotation of legs with slow squat
67
What is a pos Ege's Test?
Positive is pain and/or click during test
68
Thessaly test
Patient performs test on unaffected side first.
Patient stands flat footed on one leg with knee in neutral first, then, if no positive, with knee flexed 20° while examiner helps patient balance. Patient then rotates the femur on the tibia internally and externally three times while maintaining knee flexion
69
What is a pos Thesselay test and what does it indicate?
Pain at joint line with or without catching/locking… medial or lateral meniscus tear
70
Anterior Drawer Test (ankle)
Patient supine or seated. Place one hand on the anterior tibia and the other hand on the posterior calcaneus. Pull the foot anteriorly. Observe for ligamentous laxity. Performed in … neutral position (90°) and plantar flexion (20°)
71
What is a pos anterior drawer (ankle) and what does it indicate?
increased anterior glide greater than 3-4 mm or greater than non-affected side ...
anterior talofibular ligament instability
72
Posterior Drawer Test
Patient seated, foot on table. Stabilize dorsum of foot with one hand and grip the posterior tibia with the other hand. Pull the tibia anteriorly. Observe for ligament laxity.
73
What is a pos posterior drawer (ankle) test and what does it indicate?
increased anterior glide of the tibia … posterior ankle ligament instability
74
Kleiger’s Rotational Stress Test
Patient supine. Stabilize tibia with one hand and rotate the foot laterally with the other hand to stress the deltoid ligament. Observe for ligament laxity.
75
What is a positive Kleiger’s Rotational Stress Test and what does it indicate?
Possible sprain of the distal ankle syndesmosis (anterior and posterior tibiofibular ligaments and the interosseus membrane) and/or deltoid ligament laxity.
76
Talar Tilt Test
Patient supine. Stabilize tibia with one hand and invert the foot with the other hand. Repeat test with eversion. Observe for ligamentous laxity.
77
What is a pos Talar Tilt Test and what does it indicate?
increased motion or pain with inversion or eversion
greater than 10° of motion as compared to the non-affected side …
inversion … lateral ankle ligament sprain or rupture … anterior and posterior talofibular ligaments … calcaneofibular ligament
eversion … medial ankle ligament sprain or rupture …deltoid ligament
78
Thompson Test
Patient prone. Squeeze the calf at its widest point and observe for the presence of plantar flexion with the calf squeeze
79
What is a pos Thompson test and what does it indicate?
no plantar flexion … complete rupture of Achilles tendon
| local pain …gastrocnemius or soleus strain
80
Modified Phalen’s
Examiner holds wrist flexion for 1 minute while compressing anterior wrist at carpal tunnel
82
Morton’s Foot Squeeze
Patient supine or seated. Squeeze foot around metatarsal heads. Observe for foot pain or discomfort.
83
Tinel’s Test (foot/ankle)
Patient prone, supine or seated. Percuss over the medial ankle behind the medial malleolus and over the dorsum of ankle near the neck of the talus observe for tingling, paresthesia, electrical sensations
84
What is pos Tinel's test of the ankle/foot and what does it indicate?
distal tingling, paresthesia, or electrical sensation …
medial ankle behind medial malleolus … tarsal tunnel syndrome (posterior tibial nerve)
dorsum of the ankle … deep fibular (peroneal) nerve compression
86
Scaphoid Fracture Tests
Examiner pinches “anatomical snuff box”
Active wrist extension
Active forearm pronation
Thumb and index pinch (“OK sign”)
87
Median Nerve Compression Test for CTS
Forearm and wrist in neutral position
Double thumb compression just proximal to transverse carpal ligament for 15 seconds – 2 minutes
Positive is median nerve sxs in hand.
88
Elbow fracture tests
Elbow extension test: patient supine and asked to extend elbow fully
Elbow flexion test: patient supine, ask them to fully flex elbow
Elbow pronation
Elbow supination
90
Mill’s Test (stretch)
elbow extended, forearm pronated, wrist fully flexed
91
What is a pos morton's foot squeeze and what does it indicate?
pain in the foot … Morton’s neuroma, metatarsal joint arthritis, fracture of metatarsal heads, stress fracture
92
Mill's and Cozen's test for what?
Lateral epicondylitis
93
Reverse Cozen’s Test (resisted)
elbow flexed 120, forearm supinated, wrist flexed
94
Wrist Fracture Tests
Bracelet Test – lateral compression around distal radius and ulna
95
reverse Cozen's and reverse Mill's test for what?
Medial epicondylitis
96
Finkelstein’s Test
make fist with thumb inside palm patient or examiner creates ulnar deviation
97
Valgus Stress Test (medial) (elbow)
Elbow fully extended
| Elbow flexed 30o
98
Varus Stress (lateral) (elbow)
Elbow fully extended
| Elbow flexed 30o
100
Active Ulnar Tension Test (AKA Elbow Flexion Test) and what does it test
elbow flexed past 90o, shoulder abducted and depressed, wrist extended and forearm pronated. (waiter holding a tray)
Cubital tunnel
101
Phalen’s Test
Back-to-back maximal wrist flexion for 1 minute
103
Watson Scaphoid Test for instability
Forearm and hand in neutral position with very slight pronation
Grasp scaphoid between thumb and index
Passively circumduct wrist starting in slight extension and ulnar deviation, ending in radial deviation with slight flexion.
Positive is a clunk when scaphoid is releases due to the scaphoid subluxating with movement and clunking back in place when released.
105
Froment’s pinch and what it tests
pinch thumb and index finger like a “duck beak” not an “OK sign” inability to do so indicates ulnar n. neuropathy
cubital tunnel
111
Cozen’s Test (resisted)
forearm pronated, wrist extended
