What are 4 tests for rotator cuff tears?
Drop arm test: pt (or NP) raises both arms out to sides to 90 degress or more and pt tries to lower them steadily and slowly. Torn rotator cuff= affected arm drops suddenly/quickly
internal rotation: pt bends elbows to 90 degrees in front; NP tries to push them towards midline (adduct) against pt's resistance. Pt won't be able to resist.
Lift off- pt bends elbow behind back, touching back of hand to lumbar area and tries to lift hand off the back- won't be able to or will be painful
Empty can- pt extends arms out straight in front, arms parallel to ground, fists towards the ground (like they emptied out a can). NP pressed down against pt's resistance. Pt won't be able to resist
What is the McMurry test for and how is it done?
- test for medial or lateral meniscus tear/injury
- Place upper hand knee across the joint space, the other hand craddles the heel. Flex pt's knee maximally, then externally (laterally) rotate and straighten. An audible or palpable click/pain/grinding/lack of extension= medial tear. Then repeat with internal (medial) rotation to check for lateral tear.
Describe 4 tests for carpel tunnel syndrome
Tinel test- tap on carpul tunnel and a few inches above/below. Pos= numbness/tingling to medial nerve distribution area
pressure test- with 2 thumbs, hold steady pressure for 30-60 seconds on carpel tunnel. Pos= numbness/tingling to median nerve distribution area
Phalen test- have patient press backs of hands together (or reverse Phalen- prayer position), holding pressure for 30-60 sec. Pos=numbness/tingling
Thumb abduction: pt places palm up, thumb at 90 degress to it. NP presses down/abducting, against their resistance. Weakness=+ sign
What areas of the hand is served by the median nerve?
median nerve distribution of the hand:
and the radial side of the ring finger
describe 2 tests for rotator cuff impingement
- Neer test- "near to the ear"- pt internally rotates and raises arm straight up with elbow next to ear while NP puts pressure against scapula. pain = + sign
2. Hawkins (or Hawkins Kennedy) test- pt bends elbow 90 degress and abducts shoulder while NP supports and moves arm into internal rotation (passive test- NP does all the work). Pos test= pain
synarthrosis: any immovable joint (functional, not structural, classification) (Ex: crainial bones at suture lines)
syndesmosis: type of fibrous joint; joint space filled with dense irreg CT. Ex: distal tib-fib ligament; ex 2: tooth root and avelolar socket- periodontal ligament
synostosis: bony fusion joint; conversion of cartilaginous joint to solid mass of bone. Exs: epiphyseal lines; frontal bones- metopic suture fusion
synchondrosis: immovable joint filled with hyaline cartilage. Ex: epiphyseal plates (connect epiphysis and diaphysis)
What is the Lachman test for and how is it done?
Test for ACL injury
-first r/o an PCL injury to prevent a false postitive.
With the patient supine and knee bent at 30 degrees, place on hand above and lateral to the knee to stabilize the femur. The other hand is below knee, medially, on tibia. Try to pull the tibia anteriorly and twist out..
Postive test= soft end point; or 3-5 mm of movement more than opposite leg.
What 4 structures comprise the rotator cuff?
The tendons of the following muscles join around the humerus and scapula.
- teres minor
Describe the FABER test (and it's 2 other names) and it's use
- FABER stands for (of the hip joint):
- External Rotation
- also called the figure 4 test (looks like a 4 when done) or Patrick test
- used to distinguish hip and spinoiliac joint pathology from spine problems
- External Rotation
describe the Thomas test
-used to diagnos hip flexor (iliopsoas) tightness/contractures
-with patient supine, one leg is straight. Have pt hug their other knee to their chest. If the straight leg comes off the table significantly (can't be kept flat on the table), positive for hip flexor contracture (iliopsosas)
Compare/contrast OA and RA
- -asymetrical joint involvement
- -"wear and tear" degeneration of cartilage
- -joints enlarge, form osteophytes (but not swelling)
- -pain mainly with movement
- -pain improves with rest
- -stiffness is brief (~15 min) after waking or period of inactivity
- -DIP is involved (Heberden's nodules)
- -PIP involved (Brouchard's nodules)
- incidence increases with age
- risk factors: obesity, repetative movements, joint injury, age
- autoimmune attach of synovial lining
- prolonged (>30 min) morning stiffness
- joint pain/swelling/stiffness with movement and rest
- systemic symptoms- fever, fatigue
- incidence peaks at ages 35-50
- risk factors: genetics, smoking, hormonal (more common in women, more common onset in pregnancy)
- DIP spared, lumbar spine spared
- PIP involved (Brouchard's nodes)
differentiate between golfer's elbow and tennis elbos