Midterm

Question 1

Headache, stiff neck, fever

Answer 1

Kernig:
( + ) inability to fully extend the leg and/or pain (usually in the neck region)
( i ) meningeal irritation, or meningitis

Brudzinski:
*patient supine, doctor flexes patient’s head to their chest
( + ) involuntary knee flexion
( i ) meningeal irritation, or meningitis

Question 2

Localized cervical pain when turning head

Answer 2

Foraminal Compression:

a. ( + ) exacerbation of localized cervical pain
a. ( i ) foraminal encroachment or facet pathology without nerve root compression
- - - - - - - - - - - - - -
b. ( + ) exacerbation of cervical pain with a radicular element
b. ( i ) foraminal encroachment or facet pathology with nerve root compression

Question 3

Pain shooting in arm upon lateral flexion

Answer 3

Jackson Compression:

a. ( + ) exacerbation of localized cervical pain
a. ( i ) foraminal encroachment or facet pathology without nerve root compression
- - - - - - - - - - - - - - - -
b. ( + ) exacerbation of cervical pain with a radicular component
b. ( i ) foraminal encroachment with nerve root compression

Question 4

Pain when straining

Answer 4

Valsalva:
( + ) radiating pain from site of lesion (usually recreating the complaint in cervical or lumbar area of the spine)
( i ) space-occupying lesion such as disc pathology

Milgram’s:
( + ) inability to perform test and/or low back pain
( i ) weak abdominal muscles or space occupying lesion

Question 5

Chest pain when bending to the side

Answer 5

Schepelmann Sign:
*arms fully abducted above head, laterally flex both sides
( + ) pain on the concave side
( i ) intercostal neuritis

( + ) pain on the convex side
( i ) fibrous inflammation of the pleura or possible intercostal myofascitis

Question 6

Weakness doing crunches

Answer 6

Milgram’s:
( + ) inability to perform test and/or low back pain
( i ) weak abdominal muscles or space occupying lesion

Question 7

Tingling Hand

Answer 7

Fromet Paper:
* Patient is instructed to hold a piece of paper between any two adducted fingers, doctor tries to remove the paper.
( + ) patient is unable to maintain grip on the paper
( i ) ulnar nerve paralysis

Question 8

Hypothenar weakness

Answer 8

Fromet Paper:
* Patient is instructed to hold a piece of paper between any two adducted fingers, doctor tries to remove the paper.
( + ) patient is unable to maintain grip on the paper
( i ) ulnar nerve paralysis

Question 9

Pain in feet

Answer 9

Toe walk:
( + ) inability to perform test
( i ) L5-S1 disc lesion (S1 nerve root)

Question 10

Posterior thigh pain

Answer 10

(Any sciatic test)

Bragard:
( + ) radiating pain in posterior thigh
( i ) sciatic radiculopathy

Question 11

Medial or lateral disc protrusion

Answer 11

Crossover/Fajersztajn
* patient supine, perform SLR on unaffected leg until 75 degrees or point of pain, if no pain, dorsiflex foot

+ pain down affected leg (crossover sign)
i medial disc protrusion

+ decrease in pain down affected leg
i lateral disc protrusion

Question 12

Piriformis pain

Answer 12

Bonnet Sign
*patient supine, examiner strongly internally rotates and adducts the affected leg across the midline and then performs a SLR
( + ) pain in posterior thigh or leg
( i ) immediate pain is sciatic neuropathy from piriformis syndrome

Question 13

Pain at medial side of foot

Answer 13

Tinel Foot Sign
*Doctor taps posterior to the medial malleolus (region of the medial plantar nerve)
( + ) paresthesia radiating into the foot
( i ) tarsal tunnel syndrome

Question 14

Tight shoe pain

Answer 14

Morton’s:
( + ) sharp pain in the forefoot
( i ) metatarsalgia or neuroma, usually at the 3rd and 4th metatarsal interspace

Question 15

Scalenus anticus or cervical rib

Answer 15

Halstead
+ PPPP, pain, paresthesia, pallor, loss of pulse
i neruovascular bundle compression due to scalenus anitcus or cervical rib