Ortho LAB Flashcards
1
Q
forearm pronation ROM
A
80
2
Q
phalen sign AND reverse phalen aka prayer
A
phalen- dorsum of hands touching with elbows at shoulder level wrists flexed at max for 60 or point of pain
THEN
reverse phalen/prayer- palms flexed together at max for 60 sec or pain present
- positive:reproduction of pain and/or parathesia in the median nerve distr area 1,2,3 and lateral 1/2 of 4
- indicates: median neuritis, possible carpal tunnel
3
Q
Foraminal Compression Test
A
stand behind patient. dr locks fingers and compresses head with gradual downward pressure in neutral, right/left rotation
positive: exacerbation of localized cervical pain
indicator: foraminal encroachment or facet pathology without nerve root compression
positive: exacerbation of cervical pain with a radicular component
indicator: foraminal encroament or facet pathology with nerve root compression
4
Q
Patrick aka?
A
fabere
pt supine. dr flexes abducts and externally rotates hip, figure 4. extend hip by pushing above knee while stabilizing ASIS
positive: pain in hip region
indicates: hip joint pathology
5
Q
Goldthwait sign
A
dr places 3 fingers on lumbar interspinous spaces. dr does leg raise
positive: localized pain in low back or radiating pain down the leg
indicator: lumbo-sacral or sacroiliac pathology. pain occuring after the lumber spinouses move = possible lumbosacral problem. pain occuring before the lumbar spinouses move = possible sacroiliac problem
6
Q
Codman/ Drop Arm
A
- dr gently abducts pts arm slightly past 90d, asks patient to hold, and pt drops arm slowly
- positive: pt will not be able to lower arm slowly or arm drops suddenly
- indication: rotator cuff tear, usually supraspinatus
7
Q
Leg Length Discrepancy
A
measure true length: from ASIS to medial mall. and measure apparent leg length from umbilicus to med mall
positive: different measurement for true length
indicates: bony abnormality above or below level of trochanter difference/ anatomical short leg
positive: difference in length of apparent length
indicates: pelvic obliquity/tilted pelvis
8
Q
Mills test
A
- pt forearm supinated and flexed at elbow. dr flexes pts fingers and wrist(ENTIRE TEST) and dr internally rotates forearm all the way until arm is straight, keeping finger and wrist flexion entire test
- positive: pain over lateral epi
- indicates: lateral epicondylitis/ tennis elbow
9
Q
Heel walk
A
pt walks on heels
- positive: inability to perform test
- indicates: L4-5 disc lesion, L5 nerve root
10
Q
Testing nerve root C5
A
disc level: 4
muscles tests: deltoid innervated by axillary N
biceps innervated by MC Nerve
reflex: biceps, strike thumb
sensation: lateral arm (one above and below)
11
Q
Bragard Sign
A
dr performs SLR on patient and then lowers leg until pain disappears, then dorsiflexes foot
positive: radiating pain in posterior thigh
indicating: sciatic radiculopathy
12
Q
Rigid or Supple Flat Foot test
A
pt seated, then stands. observe foot arch
- positive: absence of medial longitudinal arch in both positions
- indicates: rigid flat feet
- positive: presence of medial longitudinal arch while seated, but the medial longitudinal arch is lost when standing
- indicates: supple flat feet
13
Q
lumbar lateral flexion
A
25
14
Q
wrist ulnar deviation ROM
A
30
15
Q
forearm supination ROM
radio-ulnar joint
A
80
16
Q
Hibb test
A
pt prone. bring heel to ipsilateral buttock. stand on opposite side and stablize at flank. externally rotate leg away from you
positive: pain in the hip region
indicator: hip joint pathology
positive: pain in the buttock/pelvic region
indicator: sacroiliac joint lesion
17
Q
Soto-Hall
A
supine, flexes head toward chest while having downward pressure on sternum, hand knife edge fingers flexed
positive: generalized pain in cervical region, which may extend down to level of T2
indicates: nonspecific test for structural integrity of cervical region
18
Q
Speed test
A
palpate bicipital groove, pt forearm supinated and elbow flexed 45d. ask patient to fully extend arm while applying resistance
- positive: pain and/or tenderness in the bicipital groove
- indication: bicipital tendonitis
19
Q
wrist flexion ROM
A
80
20
Q
Shoulder extension ROM
A
60
21
Q
Cervical Distraction test
A
upward cervical traction of head
positive: diminished or abscence of local cervical pain
indicator: foraminal encroachment
positive: diminished or abscence of radicular pain
indicating: nerve root compression
positive: increase in cervical pain
indicator: muscular strain, ligamentous sprain, myospasm, facet capsulitis
22
Q
Kernig sign
A
supine, dr passively flexes hip and knee 90, then extend knee completely
positive: inability to fully extend the leg and/or pain usually in the neck region
indicates: meningeal irritation/ meningitiis
23
Q
Neri Bowing Test
A
pt bend forward at waist
- positive: pain accompanied by flexion of the knee and body rotation away on the affected side
- indicates: positive with a variety of low back pathologies. Hamstring tension on the pelvis may trigger a response
24
Q
Yeargason
A
-pt flexes elbow 90d with tumbs up. dr applies inferior traction to shoulder and resistance to pts arching motion.
- positive: localized pain and/or tenderness at bicipital groove
- indication: bicipital tendonitis
- positive: audible click or biceps tendon subluxes or dislocates
- indication: instability of biceps tendon possibly associated with torn transverse humeral lig
25
lateral collateral ligament test/ adduction stress test
| elbow
- extend pts arm flexed 10d at elbow, apply pressure (varus) to forearm
- positive: excessive gapping and pain
- indicates: lateral collateral lig instability
26
allen test
pt rests on hand palm up, other hand is raised above heart level and opens/closes fist for 60 sec. dr constricts both ulnar and radial arteries and then lowers pts arm wrist closed to rest on thigh. dr instructs pt to open fist and dr releases pressure to one artery and notes filling time. repeat constricting the other artery comparing to other hand (exaggerate comparing of hands)
- positive: delay of more than 10 sec (5 for evans) in returning a reddish color to the hand
- indicates: radial or ulnar insufficiency. the artery occluded by dr is not the artery being tested
27
Morton Test
-supine. grasp forefoot with hand and apply squeeze pressure across metatarsal heads
- positive: pain in forefoot
- indicates: metatarsalgia or neuroma (usually the 3/4 metatarsal interspace)
28
Swallowing test
get low to watch patient swallow
positive: difficulty swallowing
indicator: space-occupying lesion at anterior portion of cervical spine. possibly esophageal or pharyngeal injury, anterior disc defect, muscle spasm or osteophytes, ect
29
Hip internal rotation
45
30
Hip extension
30
31
Drawer TEST
-flex hip and knee until foot flat on table. sit on foot, grasp behind knee, push then pull
- positive: gapping more than 6mm (tibia moves posterior) when the leg is pushed
- indicates: torn posterior cruciate ligament
- positive: gapping more than 6mm (tibia moves anterior) when the leg is pulled
- indicates: torn anterior cruciate ligament
32
Lachman Test
-flex knee to 30 deg, grasp both proximal tibia and distal end of femur with other hand, attempt to pull tibia forward in order to feel joint play
- positive: gapping with the tibia moving away from the femur
- indicates: anterior cruciate ligament or posterior oblique ligament instability
33
Hip flexion
120
34
```
Lateral Collateral Ligament Test
aka
Adduction Stress Test
aka
Varus Stress Test
knee
```
-stabilize medial thigh, grasp proximal to lateral ankle and gradually push medially
- positive: gapping and/or elicited pain above/at/or below joint line
- indicates: torn lateral collateral ligament
35
Soft Tissue-Knee
- quadriceps
- vastus lateralis
- vastus medialis
- vastus intermedius
- rectus femoris
- infrapatellar tendon
- prepatellar bursae
- superficial infrapatellar
- medial meniscus
- lateral meniscus
- pes anserine area
- sartorius
- gracilis
- semitendinosus
- popliteal fossa
- lateral collateral lig
- med collateral lig
- grastrocnemius
36
finger movements
abduction
adduction
thumb and finger flex/ext
opposition
37
C7 nerve root
disc level: C6
muscle tests:
- elbow extension: triceps (radial)
- wrist flexion: flexor carpi radialis (median) and flexor carpi ulnaris (ulnar)
- finger extension: extensor digitorum communis, extensor indicis profundus, extenosr digiti minimi (radial nerve)
Reflex: triceps, broad end of hammer, relax
Sensation: middle finger
38
Apley Distraction Test
pt prone, knee flexed to 90, your knee holds down pt thigh, grasp distal tibia and pull leg. once straight, int rot., and ext rot.
- positive: patient will point to side of pain
- indicates: pain on the medial side indicates medial collateral ligament tear. pain on lateral side indicates lateral collateral ligament tear
39
Thompson test
pt prone, leg flexed 90. dr squeezes bell of calf
- positive: absence of foot plantar flexion motion
- indicates: achilles tendon rupture
40
Valsalva
patient takes deep breath and holds while bearing down as if straining during a bowel movement
positive: radiating pain from site of lesion usually recreating the complaint in cervical or lumbar area of the spine
indicates: space occupying lesion for example disc pathology
41
Toe walk
pt walks on toes
- positive: inability to perform test
- indicates: L5-S1 disc lesion (S1) nerve root
42
Lasegue test
pt supine with knee and hip bent at 90. do SLR keeping hip at 90.
positive: reproduction of sciatic pain before 60 degrees
indicating: sciatica
43
Golfer Elbow test
- pt extends arm out straight and flexes fist down (arm pronated). pt resists upward pressure of wrist
- positive: pain over medial epi
- indicates: medial epicondylitis/ golfers elbow
44
bowstring sign
dr places pt leg on shoulder with hip and knee at 90. applies pressure to hamstring muscle, ligaments, and popliteal fossa
positive: pain in the lumbar region or radiculopathy
indicates: sciatic nerve root compression, helps rule out tight hamstrings
45
cervical rotation ROM
80
46
Pelvic Rock aka iliac compression
pt on side. dr contacts 1/2 b/t iliac & trochanter and pushes downward and VERY subtly rocks
positive: pain in either sacroiliac joint
indicates: sacroiliac joint lesion
47
Spinal Percussion
introduce hammer, 10 degree flexion, support head
pt head in slight flexion, percuss each SP and musculature bilaterally (4 spots)
positive: local pain
indicator: possible fractured vertebrae, ligamentous involvement(spinous pain), and muscular involvement (muscular pain)
positive: radiating pain
indicating: possible disc pathology
48
Shoulder internal rotation ROM
70
49
elbow extension ROM
0
50
```
Medial Collateral Ligament Test
aka
Abduction Stress Test
aka
Valgus Stress
knee
```
- 10 degree flexion
- stabilize lateral thigh and grasp proximal to medial ankle push laterally
- positive: gapping and/or elicited pain above/at/or below joint line
- indicates: torn medial collateral ligament
51
hoppenfeld aka
ankle dorsiflexion test
- pt experiences difficulty dorsiflexing foot
- pt seated, examiner tries to dorsiflex with knee extended then flexed
- positive: foot cannot dorsiflex with knee extended but is able to with knee flexed
- indicates: contracture of the gastrocnemius muscle
- positive: foot cannot dorsiflex in either knee position
- indicates: contracture of soleus muscle
52
Laguerre test
(fabere in the air)
ankle in crick of elbow, reach to ASIS
positive: pain in the hip joint
indicates: hip joint pathology
positive: pain in sacroiliac joint
indicates: mechanical problem of the sacroiliac joint
53
Apley test
- affected hand behind head to touch top of opposite shoulder, then pt hand behind back to touch bottom opposite shoulder
- positive: exacerbation of pain
- indication: degenerative tendonitis or rotator cuff tendons usually supraspinatus
54
Lewin Standing test
ask pt to bend at waist and knees slightly and support them at sacrum while extending one knee at a time then both
- positive: radiating pain down the leg causing flexion of the patients knee/s
- indicates: gluteal, lumbosacral, or sacroiliac pathologies
55
nachlas test
pt prone. take heel of affected leg and bring it to the ipsilateral buttock while stabilizing pelvis
positive: pain in buttock and/or pain in lumbar region
indicates: sacroiliac joint lesion or lumbar pathology
56
Ankle Dorsiflexion
20
57
subtalar inversion
5
58
Bony Palpation- Elbow
- medial epi
- medial supracondylar line
- groove for ulnar nerve
- trochela
- olecranon process
- olecranon fossa
- lateral epi
- lateral supracondylar line
- radial head
59
Lewin-Gaenslen test
pt on side. flex inf leg. grasps sup leg and bring into ext while stablizing SI
positive: pain on affected SI joint stressed into extension
indicates: general sarcroiliac joint lesion, anterior sacroiliac ligament sprain, inflammation of the SI joint
60
Soft tissue Palpation Cervical
```
SCM
anterior/posterior chain
thyroid gland
carotid pulse
supraclavicular fossa
trapezius
greater occipital N
superior nuchal lig
```
61
Dugas Test
- patient places one hand on opposite shoulder and then presses elbow into chest, bilateral
- positive: inability to touch opposite shoulder and/or inability to press elbow into chest
- Indication: acute dislocation of glenohumeral joint
62
Posterior Apprehension Test
- pt lays supine, dr flexes shoulder and flexes elbow so that the arm is perpendicular to table. Dr applies gradual pressure to humerous and internally rotates, dr looks at face entire time
- positive: look of apprehension or pain in face with possible pain
- indicates: chronic posterior dislocation of GH
63
lumbar extension
30
64
Cozen test
place arm and fist into extension, pt resists and dr places gradual pressure on wrist
- positive: pain over lateral epi
- indicates: lateral epicondlylitis/ tennis elbow
65
cervical flexion ROM
50
66
Ely Sign
prone. passively flex the knee toward ipsilateral buttock
positive: hip on side being tested will flex causing the buttock to raise off the table
indicates: rectus femoris or hip flexor contracture
67
Yeoman test
prone. examinar flexes patients leg to ipsilateral buttock and then extend thigh
positive: pain deep in SI joint
indicates: sprain of the anterior sacroiliac ligaments
68
Shoulder Depression test
dr laterally flexes head while pushing down on shoulder
positive: localized pain on the side being tested
indicating: dural sleeve adhesion, and muscular adhesion/contracture, or spasm, or ligamentous injury
positive: radicular pain on side being tested
indicating: neurovascular bundle compression, dural sleeve adhesion, or thoracic outlet syndrome
positive: radicular pain on opposite being tested
indicating: foraminal encroachment with nerve root compression
69
Soft Tissue- Hip/Pelvis
```
sartorius
adductor longus
inguinal lig
vastus lateralis/medialis/intermedius
rectus femoris
greater trochanteric bursa
glut med
glut max
sciatic
cluneal nerves
biceps femoris
semitendinosus
semimembranosus
```
70
Homans Sign
- pt presents with deep boring pain with no MOI
- raise leg 12in off table, dorsiflex foot
*some sources do not recommend squeezing calf due to danger of thrombus formation possibly being released into venous system.
- positive: deep pain in calf
- indicates: deep vein thrombophlebitis
71
Bony Palpation- Shoulder
- SC joint
- clavicle
- coracoid process
- AC joint
- acromion
- greater tuberosity
- bicipital groove
- lesser tuberosity
- spine of scapula
- body of scapula
- ST articulation
72
Thomas test
pt supine and dr instructs pt to bring one knee to chest and hold with general contact in lumbar region
positive: lumbar spine maintains lordosis, it should flatten and opposite hip or leg flexes
indicator: contracture on the hip flexors (iliopsoas)
73
C6 nerve root
disc level: C5
muscle tests: extensor carpi radialis longus and brevis, extensor carpi ulnaris (radial nerve)
Reflex: brachioradialis, use broad side
sensation: anterior lateral forearm plus thumb and index ( one above and below)
74
Allis sign/ Galeazzi
-normally a pediatric test for 1mo-2yr, can be used on adults
pt supine, dr instructs to bend knee at 90 and place feet flat on table look at top and bottom of knees
positive: diff in height and anteriority of the knees
indicates: if one knee is lower = ipsilateral congenitial hip dislocation or tibial discrepancy/ anatomical short leg
positive: if one knee is anterior = ipsilateral congenitial hip dislocation of femoral discrepancy or contralateral anatomical short leg
75
Shoulder external rotation ROM
90
76
T1 nerve root
Disc level: T1
Muscle test:
- finger abduction: dorsal interossei (ulnar)
- finger adduction: palmer interossei (ulnar)
There is no reflex.
Sensation: antero-medial arm (distal aspect of arm to proximal aspect of forearm)
77
Anterior Innominate Test
| aka?
aka mazion aka advancement
*dr gives full instructions first, and stands by side for stability
pt takes a step forward(2-3ft) and then bends forward from waist and touch foot with both hands (advanced knee straight)
- positive: the inability to bend at the waist more than 45degrees because of radiating pain along the sciatic nerve either unilateral or bilateral
- indicates: sciatic neuralgia or radiculopathy ect possibly due to lumbar disc pathology
- positive: inability to bend at the waist more than 45degrees because of low back pain, lumbar or pelvic regions
- indicates: anterior or rotational displacement of the ilium relative to sacrum
78
Hoover sign
- used to differentiate organic versus hysterical leg paralysis
- pt supine, dr holds underneath heel of healthy side and asks pt to lift affected leg
- positive: lack of counter pressure on healthy side
- indicates: lack of organic basis for paraylsis (malingering/hysteria). With organic hemiplegia, the patient will still exert downward pressure when attempting to raise paralyzed leg.
79
wrist radial deviation ROM
20
80
shoulder abduction ROM
180
81
Ely Heel to Buttock Test
pt prone, dr flexes knee to 90 then approximates to opposite buttock and hyperextends thigh off table. stabilize iliac crest
- positive: inability to raise thigh
- indicates: iliopsoas spasm
- positive: pain in anterior thigh
- indicates: inflammation of lumbar nerve roots
- positive: pain in lumbar region
- indicates: lumbar nerve root adhesion
82
Soft Tissue Foot/Ankle
- tibialis posterior tendon
- spring ligament
- tibialis anterior tendon
- deltoid ligament
- fibular/peroneus brevis
- achilles tendon
- plantar aponeurosis
- anterior talofibular ligament
- posterior tibial artery
- dorsal pedal artery
83
Hip abduction
45
84
Milgram test
pt supine, dr raises both legs 2 inches and asks pt to hold for 30 sec
- positive: inability to perform test and/or low back pain
- indicates: weak abdominal muscles or space occupying lesion
85
trendelenburg test
pt stands on foot and observe level of hips
positive: high iliac crest on supported side and low crest of side of elevated leg
indicates: weak gluteus medius muscle on supported side
86
retinacular test
pt present with inability to flex the distal interphal joint
proximal interphalangeal joint in nuetral and tries to flex the distal interphalan joint.
- positive:flexion of the distal interphalangeal joint cannot be achieved -indicates: joint capsule contracture
- positive: flexion of the distal interphalangeal joint is achieved -indicates: tight retinacular ligament
87
Lumbar- soft tissue palpation
- anterior abdominal muscles (once relaxed, once half sit up, ASIS and up)
- paraspinal muscles M -> L (spinalis, longissimus, iliocostalis)
- glut max (SI to greater trochanter)
- glut med (greater trochanter to iliac crest)
- sciatic nerve (between trochanter and ischial tube)
- semimembranosus
- semitendinosis
- biceps femoris
88
straight leg raiser
pt supine, raise leg slowly to 90 or to point of pain
positive: radiating pain and/or dull posterior thigh pain
indicator: sciatic radiculopathy or thight hamstrings. positive between 35-70 = possible dicogenic sciatic radiculopathy. greater than 70degrees is tight hamstrings
89
Buckling sign
dr performs SLR, puts leg into buckle for testing purposes
positive: pain in the posterior thigh with sudden knee flexion (buckling)
indicating: sciatic radiculopathy
90
C8 nerve root
Disc level: C7
Muscle Test: finger flexion- flexor digitorum superficialis, flexor digitorum profundus, lumbricals (median and ulnar nerves)
There is no reflex
Sensation: 4th and 5th digits, antero-medial hand and forearm
91
Patella Ballottment Test
-pt supine w/ knee extended. A-P pressure applied over patella
- positive: a floating sensation of the patella
- indicates: a large amount of swelling in the knee
92
lumbar rotation
30
93
O'Donoghue Maneuver
-note this test can be used at any joint
dr takes patients head and passively/slowly takes cervical region into all ROM. then active ROM
positive: pain during passive ROM
indicates: ligamentous sprain, passive ROM stresses ligamentes
positive: pain during resisted ROM
indicates: muscle/tendon strain , active ROM stresses muscles/tendons
94
Impingment sign
- pts arm pronated. bring to 15d out then fully abduct
- positive: pain in shoulder
- indicates: overuse injury to supraspinatus and possibly biceps tendon
95
cervical extension ROM
60
96
wrist extension ROM
70
97
finkelstein test
pt makes fist with thumb inside and flexes down
- positive: pain distal to radial styloid
- indicates: stenosing tenosynovitis of the abductor pollicis longus and extensor pollicis brevis tendons (dequervains disease)
98
Bechterew test
pt seated, dr asks them to "straighten out" each leg, then both
- positive: reproduction of radicular pain or inability to perform correctly due to tripod sign
- indicates: sciatic radiculopathy
99
Hip adduction
45
100
Tinel elbow sign
- introduce hammer, tap groove between medial epi and olecranon
- positive: pain and/or tenderness at site being tapped and paresthesia in the ulnar nerve distribution area, fingers 4/5
- indicates: neuroma of the ulnar nerve
101
Abbott-Saunders
- dr finds bicipital groove. dr FULLY abducts pts arm and externally rotates. then slowly lowers arm down at their midline.
- positive: palpable or audible click
- indicates: subluxation or dislocation of the biceps tendon, rupture of transverse ligament or tendon subluxation beneath subscapularis muscle belly
102
McMurray Sign
- flex knee to 90
- ext/int rotation tibia
- fully flex knee
- valgus/verus stress
- extend
- positive: clicking sound or pain by the knee joint
- indicates: tear of medial meniscus if positive on ext rot., tear of lateral meniscus if positive on int rot., the higher the leg is raised during extension when positive is elicited, the more posterior the meniscal injury
103
Tissue Palpation- Elbow
- ulnar nerve
- pronator teres
- flexor carpi radialis
- palmaris longus
- flexor carpi ulnaris
- medial collateral ligament
- supracondylar lymph
- brachial artery
- triceps
- lateral collateral
- biceps
- olecranon bursa
- brachioradialis
- extensor carpi radialis longus/brevis
104
Bony Palpation- Wrist/Hand
- radial styloid
- scaphoid
- lunate
- listers tubercle
- triquetrium
- pisiform
- trapezium
- trapezoid
- capitate
- hook of hamate
- ulnar styloid proces
- metacarpals
- phalanges
105
Drawer SIGN
pt supine, grasp prox to ankle with hand, around calcaneous with other hand. gradual pull, then gradual push
- positive: translation with the talus moving away from or toward the tibia.
- indicates: with tibia pushed/foot pulled, a tear/instability of the anterior talofibular ligament. with tibia pulled/foot pushed a tear/instability of posterior talofibular ligament
106
Lumber Bony Palpation
- iliac crest
- PSIS
- lumbar spinous process
- sacral tubercles
107
cervical lateral flex ROM
45
108
Ankle Plantar flexion
50
109
Soft Tissue- Wrist/Hand
- ulnar artery
- radial artery
- palmaris longus tendon
- carpal tunnel region
- thenar eminence
- hypothenar eminence
- palmar aponeurosis
- tissues of proximal interphalangeal joints
- tissues of distal interphalangeal joints
- distal tufts of fingers
110
tinel wrist sign
wrist supinated, dr taps palmar surface of wrist (flexor retinaculum)
- positive: reproduction of pain, tenderness and/or parathesia in the median nerve distribution area (thumb, 2,3, and lateral 1/2 of 4)
- indicates: median neuritis, possibly carpal tunnel
111
Anterior apprehension test
- dr abducts patients shoulder and flexes elbow at 90d, forearm to forearm, dr gradually externally rotates looking at pts face entire time
- positive: look of apprehension or alarm in face with possible pain
- indication: chronic anterior dislocation of GH
112
Gaenslen Test
scoot till SI is off table, extend leg off table and push down
positive: pain on the affected SI joint stressed into extension
indicates: general sacroiliac joint lesion, anterior sacroiliac ligament sprain, inflammation of the SI joint
113
shoulder adduction ROM
50
114
Lumbar flexion
25
115
bunnel-littler test
pt presents with inability to flex prox interphal joint
dr places metacarpophalangeal joint in extension and tries to flex the proximal joint. then put metacarpophalangeal joint in slight flexion and attempt to flex proximal interphalangeal
- positive: flexion at proximal interphalangeal not achieved indicates: joint capsule contracture
- positive: flexion at prox inter is achieved, tight instrinsic muscles
116
subtalar eversion
5
117
Bony Palpation- Knee
- patella
- medial tibial plateau
- lateral tibial plateau
- tibial tubercle
- medial femoral condyle
- lateral femoral condyle
- fibula head
118
Nerve Root L5
disc level: L4
muscle tests:
- foot dorsiflexion- proneus tertius and extensor hallicus longus innervated by deep peroneal nerve
- big toe dorsiflexion- extensor hallucis longus innervated by deep peroneal
- toes 2,3,4 dorsiflexion- extensor digitorum longus/brevis innervated by deep peroneal
- hip and pelvis abduction(pt on side bring knee to 90 and hip to neutral)- gluteus medius and minimus innervated by superior gluteal nerve
There is no reflex
sensation: lateral leg, dorsum of foot, middle toes
119
Shoulder flexion ROM
180
120
Dawbarn
- deep palpation of subacromial bursa is tender, with continued pressure dr abducts arm past 90d
- positive: decrease in pain and/or tenderness
- Indicates: subacromial bursitis
121
Nerve Root L4
disc level: L3
muscle test: foot dorsiflexion/ inversion of tibialis anterior innervates by deep fibular/peroneal nerve
reflex: patellar tendon
sensation: medial leg/foot/toe
122
Nerve Root S1
disc level: L5
muscle tests:
- foot plantarflexion: gastrocnemius & soleus (tibial nerve)
- foot plantar flexion and eversion: fibular/peroneous longus & brevis (superficial peroneal nerve)
- hip extension: gluteus maximus (inferior gluteal N)
Reflex: achilles
Sensation: post leg, lat foot, lateral 5th toe
123
Bony palpation cervical spine
```
hyoid bone
thyroid cartilage
first cricoid ring
mandible
occiput
Inion
superior nuchal line
mastoid process
spinous processes
facet joints
```
124
Apley Compression Test
**not like video
-pt prone, flex knee to 90. stabilize post thigh with your knee. downward pressure on pts heel or distal tibia/fibula. once straight, once int rotation, once ext rotation
- positive: patient points to side of pain
- indicates: pain on medial side is medial meniscus tear. Pain on lateral side indicates lateral meniscus tear
125
Patella Femoral Grinding Test
aka
Clarke Sign
- web of hand at superior patella
- ask pt to tighten the quads
- positive: retropatellar pain and the patient is unable to hold the quadriceps contraction
- indicates: degenerative changes of the patellar facets and/or within the trochlear groove (chondramalacia patella)
126
elbow flexion ROM
150
127
Bounce Home Test
-flex pts knee, grasp heel, let knee gently drop into extension
- positive: knee does not go into full extension, slight flexion remains
- indicates: diffuse swelling of the knee, accumulation of fluid, due to possible torn meniscus
128
Apprehension Test for the Patella
* stand side opposite
- hand above knee, hand below knee, push patella laterally
- positive: apprehension, distressed facial expression, contraction of quadriceps to bring patella back in line
- indicates: chronic patella dislocation or pre-disposition to dislocation
129
Hip external rotation
45
130
Bony Palpation- Foot/Ankle
- calcaneous
- sustentaculum
- medial malleolus
- lateral malleolus
- talus
- navicular
- cuboid
- 3 cuniforms
- 5 metatarsals
- metatarsophalageal joints (flexed)
131
ST palpation of elbow
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Biceps
Supracondylar lymph
brachial artery
triceps
medial collateral lig
lateral collat
olecranon bursa
flexor muscles
brachioradialis
extensor carpi radialis longus and brevis
extensor muscles
pronator teres
flexor carpi radialis
flexor carpi ulnaris
palmaris longus
```
