MSK testing Flashcards
(163 cards)
1
Q
Description:
- pain and stiffness upon rising
- improves during the day
- increases with bending
- constant discomfort with exacerbation
- “sore and nagging”
A
DJD/osteoarthritis
2
Q
Description:
- stiff upon rising w/ pain improving within 60 minutes
- loss of motion + pain
- sharp pain with certain movements
- movement in pain-free ranges reduce symptoms
- stationary positions increase symptoms
A
Facet joint dysfunction
3
Q
What increases pain caused by facet joint dysfunction?
A
stationary positions
4
Q
What increases pain caused by DJD?
A
- repetitive bending activities
- morning pain
5
Q
What position decreases pain caused by spinal stenosis?
A
FLX and rest
6
Q
What is the ROM for shoulder ER?
A
0-90
7
Q
What is the ROM for shoulder IR?
A
0-70
8
Q
What is the ROM for shoulder EXT?
A
60
9
Q
What is ROM for elbow FLX?
A
0-150
10
Q
What is ROM for PRON?
A
0-80
11
Q
What is ROM for SUP?
A
0-80
12
Q
What is ROM for wrist FLX?
A
0-80
13
Q
What is ROM for wrist EXT?
A
0-70
14
Q
What is ROM for RD?
A
0-20
–> hard end feel
15
Q
What is ROM for UD?
A
0-30
–> firm end feel
16
Q
What is ROM for 1st CMC ABD?
A
0-70
17
Q
What is ROM for 1st CMC FLX?
A
0-15
18
Q
What is ROM for 1st CMC EXT?
A
0-20
19
Q
What is ROM for 1st MCP FLX?
A
0-50
20
Q
What is ROM for thumb IP FLX ?
A
0-80
21
Q
What is ROM for MCP 2-5 FLX?
A
0-50
22
Q
What is ROM for DIP 2-5 FLX?
A
0-100
23
Q
What is ROM for DIP 2-5 Hyperextension?
A
0-10
24
Q
What is ROM for hip FLX?
A
0-120
25
What is ROM for hip EXT?
0-30
26
What is ROM for hip ABD?
0-45
27
What is ROM for hip ADD?
0-30
28
What is ROM for hip IR?
0-45
29
What is ROM for hip ER?
0-45
30
What is ROM for knee FLX?
0-135
31
What is ROM for DF?
0-20
32
What is ROM for PF?
0-50
33
What is ROM for midtarsal INV/SUP?
0-35
34
What is ROM for midtarsal EV/PRON?
0-15
35
What is ROM for subtalar INV?
0-5
36
What is ROM for subtalar EV?
0-5
37
What is ROM for Cx FLX?
0-90
38
What is ROM for Cx EXT?
0-70
39
What is ROM for Cx SB?
0-45
40
What is ROM for Cx ROT?
0-90
41
What is ROM for thoracic FLX?
0 to 20-45
42
What is ROM for thoracic EXT?
0 to 25-45
43
What is ROM for thoracic SB?
0 to 20-40
44
What is ROM for thoracic ROT?
0 to 35-50
45
What is ROM for lumbar FLX?
0 to 40-60
46
What is ROM for lumbar EXT?
0 to 20-35
47
What is ROM for lumbar SB?
0 to 15-20
48
What is ROM for lumbar ROT?
0 to 3-18
49
What are the 2 tests used for detection of GH joint **ANTERIOR** instability?
1. Apprehension test
2. Relocation test
50
What are the 2 tests used for detection of GH joint **POSTERIOR and INFERIOR** instability?
1. Jerk Test
2. Sulcus Sign
51
Explain the apprehension test for GH joint. What is a (+) test?
Detection: GH joint ANTERIOR instability
1. supine with ABD: 90
2. take shoulder into ER
(+) pain
52
Explain the relocation test for the GH joint. When is it indicated? What is a (+) test?
**Detection**: GH joint ANTERIOR instability
**Indication**: (+) apprehension test
1. supine with ABD: 90 and ER
2. posteriorly translate humeral head
(+) **decreases** pain from apprehension test
53
Explain the Jerk test for the GH joint. What is a (+) test?
Detection: Posterior and inferior instability
1. Seated w/ 90 ABD and IR
2. Load humerus and horizontally ADD arm
(+) sudden jerk or clunk as the humeral head subluxes off of the glenoid.
54
What is a (+) test for the sulcus sign?
Presence of a sulcus inferior to the acromion combined with increased symptoms
Detects: posterior and inferior GH instability
55
What are the 4 tests used to detect subacromial impingement?
1. Hawkins-Kennedy
2. Neer
3. Painful Arc
4. Empty can
56
Describe Hawkins-test. What is a (+) test?
1. Seated or standing
2. Passive FLX to 90 and then IR
(+) pain in shoulder region
57
Describe Neer test. What is a (+) test?
1. Seated
2. Passive IR followed by full ABD
(+) pain in shoulder region
58
At what degree is a painful arc test indicative of impingement?
between 60-120 degrees of ABD
59
Describe the empty-can test. What is a (+) test?
1. seated
2. 90 ABD
3. provide downward Resistance
4. Assume empty-can position (30 degrees horizontal ADD and full IR)
5. provide downward resistance
(+) pain in supraspinatus tendon and/or weakness while in the position
60
What are the 5 tests used to detect RTC pathology?
1. drop arm
2. External ROT lag sign
3. Internal ROT lag sign
4. hornblower's sign
5. infraspinatus muscle test
61
Explain the external ROT lag sign
90 ABD with full ER while sitting or standing
(+) unable to hold ER
62
Explain the internal ROT lag sign.
Seated with hand behind back in full IR
(+) if patient is unable to hold arm in position
63
Describe Hornblower's sign.
1. Passive FLX of arm in scapular plane to 90 degrees + 90 degrees elbow FLX
2. pt ER arm while resisting PT
(+) unable to perform ER
64
What are the 2 tests used to detect AC joint dysfunction?
1. Passive Horiz. ADD test
2. Paxinos sign
65
Describe Paxinos sign.
1. patient seated with arm at side
2. place thumb under posterolateral acromion with index finger under the middle portion of clavicle
3. apply pressure
(+) pain at AC joint
66
What are 6 tests used for detection of a SLAP tear?
1. Active compression (o'brien's) test
2. Yergasons
3. Speeds (biceps straight arm)
4. Biceps load II
5. Anterior slide test
6. compression-rotation test
67
Describe active compression (o'Brien's test).
1. standing with 90 FLX and full elbow EXT
2. horizontal ADD 10-15 degrees with Full IR
4. apply downward force
5. Re-position to full ER and apply downward force
(+) joint pain and/or clicking in IR but resolved with ER
68
Describe biceps II load test.
1. supine with 90 FLX and full forearm SUP + ER
2. apply downward resistance
(+) pain
69
Describe Anterior slide test (GH joint).
1. standing with hands on hips (thumbs posterior)
2. stabilize scapula and apply an anterior/superior force at the elbow.
(+) pain and/or clicking
70
Describe yergason's test.
1. sitting w/ elbow at 90 FLX and forearm pronation
2. pt to resist supination and ER of the shoulder
(+) popping of the biceps tendon in the groove and/or pain at the LHOB
71
Describe speed's test (Biceps straight arm).
1. sitting or standing with full shoulder EXT and SUP
2. patient resists shoulder FLX
(+) anterior shoulder pain
72
What are 2 tests used to detect TOS?
1. Adson's test
2. Roos elevated arm test
73
Describe Adson's test.
detects: TOS
1. Find Radial pulse while patient is seated
2. ROT head towards UE
3. EXT and ER the UE while extending the head/neck
(+)neurovascular symptoms present in UE; diminished pulse
74
Describe Roos Elevated arm test.
detects: TOS
1. Patient is standing with full ER while 90 ABD and slight horiz. ABD... elbows are placed at 90 degrees
2. pt slowly opens/closes hands for 3 minutes
(+) neurovascular symptoms present in the UE; diminished pulse
75
What does the elbow extension test rule out?
r/o Fx or joint injury
(+) if unable to fully extend elbow
76
What does the elbow FLX test detect?
Detects the presence of cubital tunnel syndrome.
1. patient is supine with full ER, elbow FLX, and wrist EXT
2. hold for one minute
3. perform on both sides
(+) pain at medial aspect of the elbow with N/T in ulnar distribution
77
What does the pinch grip test detect?
Detects entrapment of the anterior interosseous nerve
1. patient pinches their thumb and index finger together
(+) patient in unable to pinch tip-tip
(possible compensation: pulp-pulp)
78
What test is used to detect triangular fibrocartilage complex pathology (TFCC)?
**Ulnomeniscotriquetral dorsal glide test**
1. seated with forearm PRON
2. dorsal force over ulna with thumb
+
posterior force over the pisotriquetral complex with index finger
(+) excessive pain and/or laxity
79
What is the watson test (scaphoid shift test) used for?
Detects carpal instability
1. seated with forearm PRON, wrist UD and slight EXT
2. Actively RD and FLX the wrist while stabilizing the Metacarpals
(+) pain over scaphoid with a clunk once pressure is released
80
What is Eichhoff's test used for?
Identifies De Quervain's tenosynovitis
1. Make a fist with thumb in the fingers
2. Examiner pulls wrist into UD
(+) pain in wrist -- must compare to other side due to pain in the area possibly not being caused by a pathology
81
What is De Quervain's tenosynovitis?
Tendonitis of the abductor pollicis longus and/or extensor pollicis brevis
82
What is Finkelstein's test used for?
Identifying De quervains tenosynovitis
1. Examiner passively pulls the wrist and thumb unto UD while providing traction
(+) pain in wrist -- must compare to other side due to pain in the area possibly not being caused by a pathology
83
What is the Wrist hyperflexion and ABD of the thumb test used for?
(WHAT test)
Identified De quervain's tenosynovitis.
1. Wrist hyperFLX with full thumb ABD and IP/MCP EXT
2. Apply resistance against examiner's index finger
(+) wrist pain
84
What is phalen's test used for?
Detection of carpal tunnel
1. Max FLX in both wrists holding them together for 1 minute
(+) N/T into hand within the median nerve distribution
85
What does tinel's sign detect?
Detects carpal tunnel
--> tap location of where the median nerve passes through the carpal tunnel
(+) repoduction of N/T in median nerve distribution
86
What is the Bunnel-Littler Test?
Identifies tight capsules/intrinsic mm tightness at PIP joints
Stabilize MCP joint in slight EXT with PIP FLX
THEN
FLX the MCP and PIP joints
(+) findings:
- If FLX is limited in both cases = tight capsule
- If more PIP FLX w/ MCP FLX = tight intrinsic muscles
87
What does the Tight Retinacular test detect?
Detects tightness around the PIP joints
Stabilize PIP with DIP FLX
THEN
PIP FLX with DIP FLX
(+) findings:
- limited FLX in both = tight capsule
- more DIP FLX with PIP FLX = tight retinacular ligaments
88
What is the modified allen test used for?
Vascular compromise within the UEs (radial and ulnar arteries)
--> detecting if there is lack of blood flow via refill time
89
What does the FABER (Patrick test) detect?
Hip dysfunction/restriction
90
What does FADIR test detect?
1. Anterior-superior impingement
2. iliopsoas tendinopathy
3. Anterior labral tear
91
What does the thomas test identify?
Hip flexor tightness
92
What does Ober's test detect?
ITB and TFL tightness
1. S/L with hip and knee FLX
2. Passively extend and ABD hip
3. slowly lower to table
---MODIFIED OBER has same steps except the knee is in full EXT during the test
(+) limb being tested remains above horizontal
93
What does ely's test detect?
Rectus femoris tightness
1. Prone
2. start to FLX knee
(+) if the hip on the testing leg leaves the table/flexes
94
What is a true LLD?
LLD caused by an anatomical difference in bone length
95
(true/false) A functional LLD is caused by an anatomical difference
FALSE
96
What is functional LLD a result of?
Compensation due to abnormal position and/or posture
97
What is a patellar pubic percussion test used for?
Detection of hip Fx
1. Supine
2. Tap each patella separately while auscultating the pubic symphysis w/ a stethoscope
(+) decreased percussion sound on the affected side
98
Describe the anterolateral instability: pivot-shift test of the knee. What does it detect?
Detects ACL damage
1. supine with knee EXT, hip FLX/ABD 30 degrees, and slight IR
2. Place valgus force on knee while flexing the knee
(+) tibia relocates as the knee is being flexed
99
What are the 2 tests used for detection of meniscal tears?
1. Thessaly
2. McMurray's
100
Describe the McMurray Test for the lateral meniscus.
Detects lateral meniscus tear
1. supine with maximal knee FLX
2. passively EXT and IR the knee
(+) clicking/popping at the knee
101
Describe the McMurray test for the medial meniscus.
Detects medial meniscus tear
1. supine with maximal knee FLX
2. Passively EXT and ER the knee
(+) clicking/popping at the knee
102
Describe the Thessaly test.
Detects meniscal tear
1. patient stands on symptomatic leg holding a stable surface
2. Patient IR and ER the body and leg
Trial 1: knee @ 5 degrees FLX
Trial 2: knee @ 20 degrees FLX
(+) clicking/popping in knee
103
Describe Patellofemoral instability test/Patellar apprehension test.
1. supine w/ 30 degrees knee FLX
2. laterally translate patella
(+) pain
104
What is the noble compression test used for?
IT band friction syndrome
1. supine w/ 90 degrees knee FLX and slight hip FLX
2. apply continuous pressure proximally to the femoral lateral epicondyle
3. extend the knee
(+) pain over lateral femoral condyle
105
What does the anterior drawer test of the talocrural joint test?
Anterior talofibular ligament (ATFL)
1. patient supine with ankle off edge and 20 degrees PF
2. translate talus anteriorly while stabilizing the tibia and fibula
(+) excessive translation and/or pain
106
What does the talar tilt test assess?
Integrity of calcaneofibular ligament
1. S/L with knee slightly flexed and the ankle in neutral
2. Move foot into max ADD (calcaneofibular ligament) and ABD (Deltoid ligament)
(+) laxity and/or pain
107
what is the Kleiger Test ( Ankle ER stress test) used for?
Tests the distal tibiofibular joint
1. seated with knee 90 degrees and neutral ankle
2. apply ER to foot while stabilizing the tibia
(+) gapping and/or pain
108
What are the 3 tests for testing the integrity of the distal tibiofibular syndesmosis/joint?
1. Kleiger
2. DF-ER stress test
3. Squeeze test
109
What is thompson's test used for?
Achilles tendon rupture detection
1. Prone with foot off of table
2. squeeze calf mucles
-----> should see PF in normal cases
(+) no PF
110
What is the windlass test used for?
Detection of plantar fasciitis
111
What are the ottawa ankle rules?
1. TTP at malleoli
2. inability to take 4 steps immediately and in the ED
112
(true/false) Ottawa foot, knee, and ankle rules determine if an XR is indicated
true
113
What are the ottawa foot rules?
1. TTP at 5th MT
2. TTP over navicular
3. Inability to take 4 steps immediately and in the ED
114
Do NOT use Ottawa ankle rules in those < ___ y/o
<18 y/o
115
What are the ottawa knee rules?
1. unable to be to 90 deg
2. > 55 y/o
3. isolated patellar tenderness
4. TTP of fibular head
5. inability to WB immediately after injury and in ED
116
What combination of tests can be used for identification of impingement AND RTC tear?
1. Hawkins-kennedy
2. painful arc
3. infraspinatus mm test
2 positives = impingement
3 positives = RTC tear
117
Describe the vertebral artery test and what it's used for.
Used to test integrity of vertebrobasilar vascular system
1. supine with head supported over the end of the table
2. passive ext and hold for 30 seconds
3. --> no s/s = progress to passive ROT and SB with EXT in both directions
4. hold for 30 seconds on each side.
## Footnote
Causes reduction of the lumen of the artery resulting in decreased blood flow to the contralateral intracranial vertebral artery
118
What are symptoms of decreased integrity of the vertebrobasilar vascular system?
- drop attacks
- dizziness
- dysphasia
- dysarthria
- diplopia
- ataxic gait
- numbness
- nausea
- nystagmus
- severe HA
- LOC
- decreased hearing
- facial paralysis
119
What is the flexion rotation test of the neck used for?
Provocation for AO dysfunction and/or cervicogenic HA
120
Describe the FLX ROT test of the neck.
1. max FLX and ROT to each side
(+) reproduction of HA and/or 10% ROM decrease
121
What is Lhermitte's sign used for?
Spinal cord dysfunction and/or UMN lesion.
122
Describes Lhermitte's sign
1. long sitting
2. Passive unilateral hip FLX and head FLX (Keep knee in ext)
3. repeat on other hip
(+) pain down spine and extremities
123
Describe the modified-sharp purser test.
Used for testing the integrity of transverse ligament and AA stability
1. seated
2. passive FLX of upper cx spine while gripping C2
3. apply posterior translation and EXT through the forehead
(+) excessive linear translation and/or myelopathic s/s increased with FLX and decreased with EXT
124
What are s/s of cervical instability?
- severe muscle spasm
- **lump in throat**
- lip/facial paresthesia
- severe HA
- dizziness
- n/v
- soft-end feel
- nystagmus
- pupil changes
125
What test is used to assess rib mobility?
rib springing
## Footnote
1. pt prone and give AP force to each rib
2. s/L with AP force in each rib BUT be careful with ribs 11 and 12
126
What is the straight leg raise test used for?
Identifies dysfunction of femoral nerve
127
Describe how to perform femoral nerve traction test.
1. pt is laying on unaffected side with slight head, hip, and knee FLX
2. Passively EXT hip
----> Make sure symptomatic side knee stays in EXT
3. If no pain persists, flex the knee on the symptomatic side
| (+) anterior thigh pain
128
129
What can valsalva maneuver help identify?
space-occupying lesion
| (+) LBP or neuro s/s in LE
130
Describe the prone instability test.
Used for testing lumbar spine stability
1. patient prone at the end of the table while applying PA force on each segment
2. when a painful segment is found, have the patient lift their legs slightly off the ground
3. perform PA glides again
| (+) decreased pain during PA springs with legs raised
131
What is the spinal quadrant test used for?
identifying compression of neural structures in the interverebral foramen and facet dysfunction
## Footnote
**Intervertebral foramen**: Patient performs SB, ROT, and max EXT to the same side to maximally close the intervertebral foramen -- repeat on other side
**Facet dysfunction**: SB, contralateral ROT, max EXT to compress facet joint (joint that SB it going towards)
132
What is Gower's sign?
Thigh climbing when emerging from FLX
| Lumbar instability
133
What does the Van Gelderen's test (bicycle test) help differentiate?
intermittent claudication vs. spinal stenosis
134
Describe Van Gelderen's test and interpretation of results.
1. pt on stationary bike with erect posture as long as they can go
--> time the patient at a set speed
2. Have pt then ride bike with a slumped position at the same speed
## Footnote
(+) spinal stenosis = pt able to ride the bike longer while in a slumped position
135
What does a crossed-SLR test help identify?
Herniated nucleus puplosus or neural tension/radiculopathy
## Footnote
neutral SLR to point of provocation on non-involved LE
(+) LBP during SLR of **non-involved LE**
136
What is the schober test used for?
Assesses the mobility of the lumbar spine
137
What is Gillet's test used for? Describe the test.
Assesses posterior movement of the ilium in relation to the sacrum
1. pt is standing with thumb *Under* the PSIS of the side being tested
2. Other thumb is level with the other but is placed on the middle of the sacrum
3. Have pt FLX the hip and knee
4. Assess the movement of the PSIS via thumb location deviation (*PSIS should move inferiorly*)
| (+) no movement of the PSIS in relation to the sacrum
138
Describe Gaenslen's test.
Identifies SIJ dysfunction
1. S/L with max hip and knee FLX of superior LE
2. passively EXT the hip creating stress on the SIJ associated with the LE being tested.
| (+) SIJ pain
139
What does the long-sitting supine -->sit test look for?
SIJ dysfunction caused by functional LLD
140
Describe Goldthwait's test.
Used for differentiation between SIJ dysfunction and lumbar spine dysfunction
1. Supine with PT finger's between SPs of lumbar spine
2. PT passively performs SLR
## Footnote
(+) SIj dysfunction = pain prior to palpation of movement in the lumbar segments
141
Describe the S/L compression test.
Assesses for SIJ dysfuncrion
1. s/L with painful side superiorly
2. PT places hands on iliac crest and provides force --> can hold force for up to 30 seconds
| (+) pain provocation
142
What are activities that precipitate anterior torsion of the innominate (SIJ dysfunction)?
- squatting/lifting/lowering
- pregnancy
- hip at 90 degrees with axial loading
- golfing/batting/tennis
143
What are activities that precipitate posterior torsion of the innominate (SIJ dysfunction)?
- vertical thrust onto an extended LE
- starting position of sprinting
- falling onto ischial tuberosity
- unilateral standing
144
What are activities that precipitate Sacral dysfunction?
- chronic postural abnormalities
- fall onto sacrum/coccyx
- ambulating with weight
- trauma with childbirth
- loss of balance
- sitting with ROT and lifting
145
What test is used to identify achille's tendon rupture?
Thompson's test
146
What test is used to identify plantar fasciitis?
Windlass test
147
What tests are used for identification of instability of the ankle/foot?
1. talar tilt
2. anterior drawer
3. medial subtalar glide
148
What position of the LE joints places neural tension on the sciatic AND tibial nerve?
Hip FLX and ABD
Knee EXT
Ankle DF
149
What position of the LE joints places neural tension on just the tibial nerve?
Hip FLX
Knee FLX
Ankle DF
Foot EV
150
What position of the LE joints places neural tension on the sural nerve?
hip FLX
knee EXT
ankle DF
foot INV
151
What position of the LE joints places neural tension on the common fibular nerve?
Hip FLX and IR
Knee EXT
ankle PF
Foot INV
152
What position of the LE joints places neural tension on the spinal nerve roots?
Hip FLX
Knee EXT
Ankle DF
153
What are tests used to detect cervical myelopathy?
- clonus
- babinski
- Hoffman's
- DTRs
- inverted supinator sign
154
What is the CPR used for hip OA?
1. pain with squatting
2. lateral pain with active hip FLX
3. (+) scour test
4. Pain with active hip EXT
5. Passive IR < 25 degrees
155
What test is used for detection of a hip Fx?
Patellar-pubic percussion test
156
What test is used for detection of labral lesions in the hip?
FADIR
157
What ULTT is used to bias the median and anterior interosseous nerves? Describe.
**ULTT1**
Shoulder depression and 110 degrees ABD
Elbow EXT
SUP
Wrist/finger EXT
| contralaterally SB neck once in position to put further tension on nerve
158
What ULTT is used to bias the median, axillary, and musculocutaneous nerves? Describe.
**ULTT2**
Shoulder depression, ER, and 10 degrees ABD
Elbow EXT
SUP
Wrist and finger EXT
| contralaterally SB neck once in position to put further tension on nerve
159
What ULTT is used to bias the radial nerve? Describe.
**ULTT3**
Shoulder IR, depression, and 10 degrees ABD
Elbow EXT
PRON
Wrist FLX and UD
Finger FLX
| contralaterally SB neck once in position to put further tension on nerve
160
What ULTT is used to bias the ulnar nerve? Describe.
**ULTT4**
Shoulder ER, depression, and 10-90 degrees of ABD (hand to ear)
Elbow FLX
PRON
Wrist EXT and RD
Finger EXT
| contralaterally SB neck once in position to put further tension on nerve
161
What test is used to detect an elbow Fx?
Elbow EXT test
162
What combination of tests has a high SENSITIVITY for SLAP tears?
1. Compression-ROT test
2. Apprehension
3. active compression
163
What combination of tests have a high SPECIFICITY for SLAP tears?
1. Yergason
2. Speed test
3. biceps load II
