Lab Maneuvers Flashcards by Alicia Allen

Q

knee - posterior drawer test

A

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Q

knee - traction

A

don’t use text

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Q

ligament stress test - tibionavicular

A

-

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Q

ankle - Posterior drawer test

A

-

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Q

hip - inferior glide

A

for hip abduction

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Q

Talocrural dorsal (post) glide

A

for DF

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Q

ligament stress test - tibiocalcanear lig

A

-

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Q

knee - posterior sag test

A

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Q

knee - thessaly test

A

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Q

ligament stress test - tibiotalar post

A

-

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Q

knee - stutter test

A

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Q

HIP - ext/abd/IR combined movement

A

-

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Q

ligament stress test - cfl

A

-

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Q

ankle/foot - observation

A

Single leg stance

Proprioception
Foot hyper-pronation/hyper-supination

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Q

hip - functional tests and observations

A

In NWB & WB, looking for

Swelling, bruising which condition?
Misalignment which condition?
Bony/joint deformity Any bump? which condition?
Atrophy which muscle?
LLD
-Weber-Barstow manoeuvre q ”True leg length
-Femoral length
-Tibial length

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Q

ligament stress test - tibiotalar ant

A

-

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Q

hip - how to palpate femoral head (ant and post), piriformis, ITB, adductors

A

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Q

knee - patella apprehension test

A

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Q

Talocrural anterior glide

A

for PF

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Q

Talocrural compression

A

-

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Q

knee - anterior glide

A

don’t use text

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Q

knee ACL stress test - lachmans

A

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Q

ligament stress test - ATFL

A

-

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Q

knee ACL stress test - anterior drawer

A

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ankle - alternative anterior drawer test

-

knee - mcconnel test

ankle - special test - windlass

ankle - functional tests

slides 12-15

ankle - special test - homan's sign

ankle - Anterior drawer test

-

dorsi in WB – ligament stress test - for inf tib/fib

The inf TF lig restricts splaying of the mortise during DF in WB If Inf TF lig sprain, pt will complain of pain or pinching in the front of the ankle & will have splaying of the mortise with DF in WB _Test result: (+)ve test = sprain inf TF ligament if:_ Acute phase: -↓ pain with compression (& may have ↑ ROM because less pain) OR - Δ \> 2mm in circumference around malleoli from neutral to full DF OR Chronic phase (chronic hypermobility/instability): - ↓ROM when applying compression with DF in WB

Q angle measurement

Talocrural traction

-

MTP joint (DF, PF, ABD, ADD, traction and compression)

_Flexion:_ plantar glide phalanx _Extension:_ dorsal glide phalanx _Abd/add:_ relative to 2nd ray Abd: Phalanx 1: lat glide (away from 2nd ray), Phalanx 3-4-5: lat glide Add: Phalanx 1: med glide (toward 2nd ray), Phalanx 3-4-5: med glide

ligament stress test - ptfl

-

quick screening test for hip

for prone legs apart one - compare how far it goes one side compared to the other - screen test

hip - anterior glide

- for extension and/or ER

knee - mcmurray test

Both McMurray’s test & joint line tenderness consistently show moderate utility in detecting & ruling out meniscal tears

ankle - special test - thompson's test

knee - LCL stress test

-

HIP - FABER combined movement

-

knee - patellar glide (laterally/medially and sup/inf)

- text p 145

knee - apley's compression test

HIP - flexion/adduction (+IR/ER) combined movement

-

ankle - special test - ant-lat impingement test

Pt sitting position Pht Lat hand: grasps calcaneum (fingers around calc tuberosity & thumb over ant-lat part of ankle (gutter)) Med hand: grasps forefoot to control ankle movt 1. Apply thumb pressure over the ant-lat ankle with foot in full PF (looking for pain reproduction – painful area) 2. Bring ankle in full DF without any pressure 3. Repeat ankle Full DF while applying thumb pressure over painful area (+)ve: if pain provoked with pressure from thumb is \> in DF than PF Molloy-Bendall impingement test :94.8% sensitive 88% specific

IP joint (toes) glide

knee - posterior glide

-

knee - MCL stress test

_Pht: supine with leg relaxed_ _Pht: Facing pt_ Lat hand: Lat aspect of knee (TF jt line) Med hand: grasp ankle Apply a valgus stress - Full extension (hyperextension if they have it) - assessing post fibres - 30 flexion - assessing ant structures more bc more stress on them in this position - 90 flexion

hip - posterior glide

- for flexion and/or IR

knee - posterior glide (moving femur)

-

hip - traction

-

hip - arc movement

note: for flex then add movement from yesterday - you can do an arc of movement from flex/add then moving into some ext medially and caudally (normal, smooth movement should have no pain - could have pain or a catchment sensation in someone with issues) To treat pain: 1) can do a scooping movement over that bump (movement in small circles up and down the arc) 2) can do a hammer movement - at painful spot - push into ark (is perpendicular to arc)

Lx spine ROM/OP - flex

**\*\*Assess: Quantity, Quality, Pain, EF!!** Will help you identify if you have a: - Hypomobility - Hypermobility OR - Instability Should be done: - If not enough information from AROM/OP - To confirm your hypothesis after AROM/OP & (PAs)

Lx spine ROM/OP - ext

**\*\*Assess: Quantity, Quality, Pain, EF!!** Will help you identify if you have a: - Hypomobility - Hypermobility OR - Instability Should be done: - If not enough information from AROM/OP - To confirm your hypothesis after AROM/OP & (PAs)

Lx spine ROM/OP - side flex

**\*\*Assess: Quantity, Quality, Pain, EF!!** Will help you identify if you have a: - Hypomobility - Hypermobility OR - Instability Should be done: - If not enough information from AROM/OP - To confirm your hypothesis after AROM/OP & (PAs)

Lx Spine ROM/OP - rotation

**\*\*Assess: Quantity, Quality, Pain, EF!!** Will help you identify if you have a: - Hypomobility - Hypermobility OR - Instability Should be done: - If not enough information from AROM/OP - To confirm your hypothesis after AROM/OP & (PAs)

Lx spine RISOM - flex, ext, rotation, side flex

Lx spine - how to R/O LE

Lx spine palpation - femoral, popliteal, tibial, dorsalis pedis artery

Lx spine - passive accessory (PA) glide

* **_Finding L5_** – palpate for psis – from there move on medial part of sacrum (let fingers slide down the sacrum (fingers curled), the first depression you feel will be L5 * Make sure fingers are very light * **_For glide_** – pt supine push anteriorly * If you are assessing R side, PT is on the L side – don’t need to use pillow under stomach * Hand 1: for palpation - hypothenar eminence (pinkie side of hand) – pisiform (not the side of hand!!) * Hand 2: for pushing down on other hand (place on top of other hand) * Look for the feel first – is it the same at every level? * Assess unaffected side first

Lx spine scan

- slides 1-17 (Lab Lx Scan PART 1)

Lx spine - combined "H" in flexion

**\*\*Assess: Quantity, Quality, Pain, EF!!** Will help you identify if you have a: - Hypomobility - Hypermobility OR - Instability Should be done: - If not enough information from AROM/OP - To confirm your hypothesis after AROM/OP & (PAs)

Lx spine - combined "I" in flexion

**\*\*Assess: Quantity, Quality, Pain, EF!!** Will help you identify if you have a: - Hypomobility - Hypermobility OR - Instability Should be done: - If not enough information from AROM/OP - To confirm your hypothesis after AROM/OP & (PAs)

Lx spine - combined "H" in extension

**\*\*Assess: Quantity, Quality, Pain, EF!!** Will help you identify if you have a: - Hypomobility - Hypermobility OR - Instability Should be done: - If not enough information from AROM/OP - To confirm your hypothesis after AROM/OP & (PAs)

Lx spine - combined "I" extension

**\*\*Assess: Quantity, Quality, Pain, EF!!** Will help you identify if you have a: - Hypomobility - Hypermobility OR - Instability Should be done: - If not enough information from AROM/OP - To confirm your hypothesis after AROM/OP & (PAs)

Lx spine - PPIVM - flex and ext

PPIVM : Passive physiological intervertebral movement - Intervertebral = at each segment (Z joint) - Done if from your Lx Scan, your hypothesis is an hypomobility - Will help you confirm the level of hypomobility \* for ext same thing as flex but bring Lx spine into unilateral ext (applying an **ant-sup force at pelvis**) * Extension on L: Pt side lying L and 1 hand pushing on greater trochanterish area (push up and anteriorly), second hand feeling spinus process * Flexion on L: Pt L side lying (push down and anteriorly – hand position hand on pt greater trochanter to greater traction – can also use arm on greater trochanter instead of hand * Do up until t10

Lx spine - prone instability test

Pt: lays only half way up the bed, with the hips flexed, the trunk muscles relaxed & the feet resting on the floor Pht: will do a PA over the most symptomatic SP If provocation of pain is reported....

Lx spine - active straight leg raise (basic scan)

_Normal_ = optimal Lx-Sx functional load transfer - Leg raised = effortless bilaterally - Lx-Sx region = stable (no movt) - Need good activation of IU & OU ms _Abnormal_ - One leg: feels heavier to lift - Lx-Sx region: unstable (movt in ext, flex, rotation, SF of spine) _Grading system (active leg lifting)_ 0= not difficult at all 1= minimally difficult 2 = somewhat difficult 3= fairly difficult 4= very difficult 5= unable to do Optimal ASLR = the only joint moving is the hip & “it is not difficult at all”

Lx spine - ASLR testing inner unit muscle stimulation (3)

Lx spine - ASLR testing outer unit muscle stimulation - anterior sling

(+)ve test if applying compression(s) or activating sling(s) which: - Makes it easier to lift the leg (affected) - More stable Lx-Sx spine (Good sensitivity & specificity with pt SI pain post-portum) Meaning: - When test results are (+)ve, the assumption is that a lack of motor control exists for dynamic stabilization of the pelvic - Load transfer (stability of the Lx-Sx spine) can be helped via the ms that were (+)ve on Ax

Lx spine - ASLR testing outer unit muscle stimulation - posterior sling

(+)ve test if applying compression(s) or activating sling(s) which: - Makes it easier to lift the leg (affected) - More stable Lx-Sx spine (Good sensitivity & specificity with pt SI pain post-portum) Meaning: - When test results are (+)ve, the assumption is that a lack of motor control exists for dynamic stabilization of the pelvic - Load transfer (stability of the Lx-Sx spine) can be helped via the ms that were (+)ve on Ax

Lx spine - assess transferse abdominal ms

Pt: spine in neutral position Pht: palpate IU ms Ax IU ms activation (tension) without any OU ms contraction Ask pt to breathe in & on the breath out gently activate IU ms using one of the strategies (identify the best strategy for your pt), Then breathe normally _Normal:_ Able to activate IU ms alone Deep, slow tension of IU ms No substitution from OU ms contraction (No Lx or pelvic movts, No fast contraction) With IU ms activation should be able to breathe normally Activation -10x10sec (Ax how many reps pt can do) _Abnormal: Substitution strategies_ OU ms contraction (causing post rot of pelvis, Lx spine flex/ext) Bulging of abdomen (= Internal oblique ms contraction) Depression rib cage (= rectus abdo ms contraction) Hold breath Not able to hold 10sec, 10x **\*\*exercises slides 19/20**

Lx spine - assess the multifidus ms

Pt: spine in neutral position Pht: palpate IU ms Ax IU ms activation (tension) without any OU ms contraction Ask pt to breathe in & on the breath out gently activate IU ms using one of the strategies (identify the best strategy for your pt), Then breathe normally Normal: Able to activate IU ms alone Deep, slow tension of IU ms No substitution from OU ms contraction (No Lx or pelvic movts, No fast contraction) With IU ms activation should be able to breathe normally Activation -10x10sec (Ax how many reps pt can do) _Abnormal: Substitution strategies_ OU ms contraction (causing post rot of pelvis, Lx spine flex/ext) Ant rotation of pelvis, gripping of buttock ms (= OU ms contraction) Hold breath Not able to hold 10sec, 10x

Lx Spine - assess the pelvic floor ms

Lx spine - exercises for strenghtening IU and OU ms

You cannot strengthen a ms your brain cannot activate Normal = activation of IU ms before contraction of OU ms Can use PBU as an objective measurement First GOAL: activate each IU ms (without any OU ms contraction) Practice activation of each IU ms in different positions (sit, stand, squat) Then practice co-activation of all IU ms Progress by adding OU ms (next semester) move \* Practice in different positions: 4 point kneeling, Sitting, Standing, Squatting

Neurological Exam - dermatomes Ax procedure

\*work distal to proximal, 2 seconds btw each stimulus \*ask "do you feel anything - then does it feel the same on both sides"? \*pain assessed after light touch Grading: (From American Spinal Injury Association) ``` 0 = If no sensation 1 = Decreased sensation 2 = Normal sensation ``` **_Overall neurological exam results:_** Sensation testing alone does not seem to be useful for radiculopathy When tested in isolation, weakness with MMT & reduced reflexes = radiculopathy When changes in reflexes, ms strength, & sensation are found in conjunction with a (+)ve SLR, Lx radiculopathy is highly likely

Neurological Exam - myotome Ax procedure

\* compare side to side and if possible assess the 2 sides silmultaneously \* HOLD 5 SECONDS! \* repeat 5 times to confirm the fatiguability \* if +'ve use the alternative muscles _Grading:_ 0 = No contraction 1 = Ms contraction without movt 2 = Movt without gravity 3 = Movt with gravity 4 = Movt against resistance 5 = Normal ms strength **_Overall neurological exam results:_** Sensation testing alone does not seem to be useful for radiculopathy When tested in isolation, weakness with MMT & reduced reflexes = radiculopathy When changes in reflexes, ms strength, & sensation are found in conjunction with a (+)ve SLR, Lx radiculopathy is highly likely

Neurological exam - reflex Ax procedure

_Grading_ 0: Absent 1: Diminished 2: Average 3: Exaggerated 4: Clonus, very brisk Hyporeflexia = Lesion of spinal n root Hyperreflexia = UMN lesion Abnormal deep tendon reflexes are not clinically relevant unless they are found with sensory or motor abnormalities **_Overall neurological exam results:_** Sensation testing alone does not seem to be useful for radiculopathy When tested in isolation, weakness with MMT & reduced reflexes = radiculopathy When changes in reflexes, ms strength, & sensation are found in conjunction with a (+)ve SLR, Lx radiculopathy is highly likely

How to perform the UMN lesion tests (3)

1) Clonus - knee slightly flexed, push ankle abruptly into DF, \> 5 beats is positive 2) Babinski (plantar response) - see image 3) Oppenheimer - stroking of ant-med surface of tibia: (+) = Extension first toe with spaying of the other toes

Lx spine - traction

Results: Traction & compression – Ax disc patho or VB Fx (+)ve = Compression = ↑ pain Traction = ↓ pain

Lx spine - compression

Results: Traction & compression – Ax disc patho or VB Fx (+)ve = Compression = ↑ pain Traction = ↓ pain

Lx spine - ASIS GAP

Ax level of reactivity of the SIJ & provokes SIJ pain - Ligament tears (acute phase) - Systemic arthritis (RA, SA)

Lx spine - ASIS compression

Ax level of reactivity of the SIJ & provokes SIJ pain - Ligament tears (acute phase) - Systemic arthritis (RA, SA)

Lx spine - what are the red flag signs for cauda equina?

Lx spine how to treat disc pathologies

_LX traction_ Indication for spinal traction in a prone position: - Spinal nerve root compression = neuro exam (+)ve - Peripheralization of the leg pain with Lx extension - Positive crossed SLR test (45) - L/E pain that centralizes with Lx traction _Positional distraction_ - Would allows frequent intermittent unloading of the effected n root - Can be done in clinic & at home - For the intervention to be effective: Pt should feel relief of pain shortly after the placement in the position, Rx: 10-20 mins; 3-6x/day

SI Joint - ASIS gap test

SI Joint - ASIS compression test

SI joint - thigh thrust

SI joint - Gaenslen's test

SI joint - sulcus thrust

SI joint - leg length palpation test

SI joint forward bending test

SI joint - standing flexion kinetic test

1) is for SI joint dysfunction 2) is for confirming SI hypermobility/instability

SI joint - PROM nutation

SI joint - PROM counternutation

SI joint - PROM iliac posterior rotation

SI joint - PROM iliac anterior rotation

SI joint - ASLR

treatment for SI joint problems

- see slides 38-45

Lx spine - neurodynamic assessment SLR

Lx spine - femoral nerve sheath mobility

how to use joint mobs as a treatment

Grades I & II: Manage pain & spasm – neurophysiological effect Grades III & IV: Used to improve range of motion within the joint

SI joint - palpation for hypomobility

Lx spine - how to test centrilization/peripheralization

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Lx spine - how to treat/correct reducable posterior derrangement syndrome

slides 24-30