Msk: Upper And Lower Quarter Screening & Examination

Front 1

When are screening exams performed?

Back 1

when the patient's primary subjective complaint is related to an extremity or a part of the spine

Front 2

what should be examined if there is an UE complaint? What if there is a LE complaint?

Back 2

if UE complaint: cervical and thoracic spine should be examined

if LE complaint: lumbar spine and pelvis should be examined

Front 3

what are components of the lower quarter screening exam in standing?

Back 3

1. postural assessment

2. active forward, backward, and lateral bending of lumbar spine

3. standing flexion test/ Gillet's test

4. Toe Raises (S1, tibial nn)

5. heel walking (L4, L5 deep fibular nerve)

Front 4

what are the components of the lower quarter screening exam in sitting?

Back 4

1. sitting flexion test

2. active rotation of the lumbar spine

3. passive OP if symptom free

4. resisted hip flexion (L1, L2, femoral nn)

5. resisted knee ext (L3, L4, femoral nn)

6. Resisted ankle DF (L4, L5 deep fibular nn)

7. resisted big toe ext (L5 deep fibular nn)

8. resisted ankle eversion (L5, S1 superficial peroneal nn)

9. DTR: patellar (L3, L4) and Achilles tendon (S1, S2)

Front 5

What are the components of the lower quarter screening exam in supine?

Back 5

1. dermatome sensory testing

2. SLR (L4, L5; S1)

3. Passive ROM of hip

4. Sciatic nn tension test

Front 6

What are the components of the lower quarter screening exam in prone?

Back 6

1. Femoral nn tension test

2. Babinski reflex test (UMN)

Front 7

What are the components of the upper quarter screening exam?

Back 7

1. Postural assessment

2. AROM cervical spine

3. Passive OP if symptom free

4. Vertebral artery test

5. Quadrant test

6. resisted mm tests cervical spine rotation (C1)

7. Resisted shoulder elevation (C2, C3, C4)

8. Resisted shoulder abduction (C5)

9. Active shoulder flexion, abduction, IR, ER

10. Resisted elbow flexion (C6)

11. Resisted elbow ext (C7)

12. AROM of elbow

13. Resisted wrist flexion (C7)

14. Resisted wrist ext (C6)

15. Resisted thumb ext (C8)

16. Resisted finger abduction (T1)

17. Babinski Reflex test (UMN)

Front 8

What is the accessory mobility scale?

Back 8

-complete joint play/ testing of joint mobility when the joint capsule is most relaxed or in the loose packed position

0 Ankylosed joint

1 considerable limitation/hypomobility

2 slight limitation/hypomobility

3 Normal

4 slight hypermobility

5 considerable hypermobility

6 Pathologically Unstable

Front 9

What are the 4 possible findings of resisted mm testing? and what does each indicate?

Back 9

1. strong and painless: no pathology in contractile tissue

2. Strong and painful: minor structural lesion of the muscle-tendon unit

3. Weak and painless: complete rupture of muscle-tendon unit or neuro deficit present. Further testing is needed

4. WEak and painful: partial disruption of muscle-tendon unit. Pain response due to serious pathology or concurrent neurological deficit

Front 10

How can you differentiate the action of a one-joint muscle from that of a multi-joint muscle?

Back 10

place the multi-joint mm at a disadvantage

-if a muscle that crosses two or more joints produces simultaneous movement at all of the joints it crosses, it soon reaches a length at which it cannot generate full mm force = active insufficiency

Front 11

What is active insufficiency?

Back 11

Decrease in torque produced by a muscle when the full ROM is attempted simultaneously at all joints crossed by the multi-joint mm

ex: hand grasp with wrist in full flexion

Front 12

What is passive insufficiency?

Back 12

-when 2-joint or multi-joint muscles are of insufficient extensibility to allow full ROM to be produced simultaneously at all joints crossed by these muscles.

-passive tension developed in these stretched muscles is sufficient to either cause motion or to limit motion:

ex: cause motion: full wrist flexion causes fingers to extend due to insufficient length of finger extensors stretched over flexed wrist

ex: limit motion: finger flexion with wrist flexion is limited by length of finger extensors; or

-rectus femoris limits active knee flexion with hip extended

-HS limits active knee ext if hip in position of flexion

Front 13

what are the MMT grades?

Back 13

Normal = 5/5 can move into test position against gravity with maximal resistance

Good = 4/5 Same as normal but can only resist moderate pressure

Fair + = 3+/5 Same as Good but can resist only mild pressure

Fair = 3/5 full range against gravity, no resistance

Fair - = 3-/5 Same as fair but gradual release against gravity

Poor + = 2+/5 Moves against gravity in small ROM

Poor = 2/5 Full ROM in gravity eliminated position

Poor - = 2-/5 can only initiate ROM with gravity eliminated

Trace = 1/5 Fasciculation or palpable mm contraction but unable to move

Zero= 0 No visible or palpable mm contraction

Front 14

What are components of the Neurological examination?

Back 14

1. resisted muscle testing

2. sensory testing

3. DTRs

4. Neural tension tests

5. UMN testing (babinski and ankle clonus)

Front 15

Describe signs and symptoms that differentiate UMN vs LMN lesions

Back 15

Front 16

When is further testing required during the sensory testing portion of the neurological exam?

Back 16

-if light touch is different between sides or there is a decr in LT over a specific area then further testing is required

-such as pin prick (superficial pain), vibration, two-point discrimination, or proprioception

Front 17

What is the grading scale for DTRs?

Back 17

4+ = Hyperactive reflex with clonus (indicates UMN disorder)

3+ = Hyperreflexia (brisk): palpable (mod-strong) contraction with exaggerated joint movement (still within normal variation)

2+ = Normal = palpable ctx with visible extremity movement

1+ = hyporeflexia (sluggish) palpable mm ctx with no extremity movement (indicative of LMN disorder)

0 = Areflexia (absent) no visible or palpable mm ctx

Front 18

What is the purpose of neural tension tests?

Back 18

by stretching the peripheral nerves with specific body movements, the mobility of the spinal dura and nerve roots can be tested

Front 19

What (in general) nerve does the SLR test bias? What are the variations?

Back 19

sciatic nerve

1. Passive SLR with DF and eversion = tibial nn

2. Passive SLR with PF and inversion = peroneal nn

3. Passive SLR with DF and inversion = sural nn

DET PIP DIS

Front 20

What neural tension test biases the femoral nerve/

Back 20

Prone knee bend

Front 21

What neural tension test biases the spinal dura?

Back 21

passive neck flexion

Front 22

How is ankle clonus test performed?

Back 22

Position leg in slight knee flexion and rapidly DF ankle

(+) test if series of involuntary mm contractions

Front 23

how is the babinski test performed?

Back 23

stroke the plantar aspect of the foot from the lateral side of the heel to the base of the great toe with a blunt instrument

(+) great toe DFs and other toes fan out

Front 24

What test should be performed before any manual treatment of the cervical spine?

Back 24

vertebral artery test and must be repeated as ROM increases

Front 25

What is the vertebral artery test?

Back 25

-assesses integrity of the vertebrobasilar vascular system

-pt in supine and progress as below

1. extend head and neck for 30 secs. if no change progress to next step

2. extend head and neck with rotation left the for 30 sec then repeat with right rot for 30 sec

(+) test provokes referring symptoms (Right rot will decr contralat artery and reproduce L symptoms and vice versa)

- pt should report tinnitus, dizziness, nausea, throbbing, confusion, or unsual sensation. and Clinician obesrves for pupillary constriction or dilation and nystagmus which indicate VA compression

Front 26

What should be done if the Vertebral artery test is positive?

Back 26

avoid mobilization and cervical spine movements into ext and rot at ranges that produce symptoms

-notify physician of test findings

Front 27

What cervical motions test intervertebral foramen vs VA and vice versa?

Back 27

IVF: decreased space with extension (blood flow normal with isolated ext)

VA: ext + rot = bilat decr with > decr on contral side aa. (IVF > decr on ipsilat side)

pg. 193 of McGee

Front 28

What is the quadrant test for the cervical spine?

Back 28

= spurling's test/foraminal compression (identifies compression of cervical nerve roots)

-perform if pt c/o nerve root symptoms which are diminished or absent at time of exam (i.e. UE symptoms)

Front 29

Quadrant test and alternatives

Back 29

Maximum cervical compression test = (ext + rot + SB + compression)

spurling's = foraminal compression (SB head to uninvolved side and add compression straight down. repeat on opposite side)

Front 30

How is Spurling's test performed and positive results?

Back 30

SB head to uninvolved side and add compression straight down.

-repeat on opposite side

(+) test = pain radiates into arm toward which head is side flexed which indicates pressure on a nerve root (cervical radiculitis)

(-) = neck pain with no radiating pain

Front 31

How is the maximum cervical compression test performed?

Back 31

aka maximum cervical compression test

-identifies compression of neural structures at IVF and/or facet dysfunction

- patient in sitting

-passively move head into SB and rot toward non painful and add ext then compression

-repeat on painful side

(+) = pain and/or paresthesia in dermatomal pattern on same side as SB and rot

or localized pain in neck if facet dysfunction

Front 32

When is the distraction test indicated?

Back 32

when pt c/o radicular symptoms in hx and presents with radicular sx during the exam

-indicates compression of neural structures at the IVF or facet joint dysfunction

Front 33

How to perform the distraction test?

Back 33

supine

hold pt under chin and occiput and flex neck whiled distraction force of about 14 pounds applied

(+) = decr in symptoms in neck (facet condition) or decr in UE pain (indicating nerve root compression)

Front 34

What is the purpose of Hautant's test?

Back 34

-to differentiate vascular vs vestibular causes of dizziness/vertigo

Front 35

Describe positive Hautant's test.

Back 35

2 steps

1. sitting with shoulders flexed to 90 and pulms up. Have pt close eyes for 30 sec. If arms lose position = (+) vestibular condition

2. sitting with shoulders flexed to 90 and palms up. close eyes and have pt extend head and neck with R Rot and then L Rot holding in each for 30 sec. (+) for vascular cause if arms lose position

Front 36

What is the purpose of the transverse ligament stress test?

Back 36

test integrity of tranverse ligament of C-spine

-prevents anterior movement of atlas on axis and posterior movement of axis on atlas

Front 37

What is a positive test for transverse ligament stress test?

Back 37

-supine

-head on table

-glide C1 anterior

Normal end feel = firm

(+) = soft end-feel, dizziness, nystagmus, lump sensation in throat, nausea

Front 38

What is the purpose of the anterior shear test?

Back 38

assess integrity of upper c-spine ligaments and capsule

Front 39

how is anterior shear test performed and positive test?

Back 39

-supine with head on table

-glide C2-C7 anterior

normal end-feel = firm

(+) = ligament laxity, dizziness, nystagmus, lump sensation in throat, nausea

Front 40

What is positive Shoulder abduction test?

Back 40

(+) = decr in UE symptoms when pt places one hand on top of head

Indicates compression of neural structures in IVF

Front 41

What is Lhermitte's sign?

Back 41

identifies dysfunction of SC and/or UMN lesion

-long sitting

-passively flex head and one hip while keeping knee in ext, repeat with other hip

(+) pain down the spine and into upper or lower limb = indicates dural or meningeal irritation in spine or possible cervical myelopathy

Front 42

What is the Romberg Test?

Back 42

standing

close eyes for 30 seconds

(+) for UMN lesion if excessive sway or lose of balance

Front 43

What is the standing flexion test?

Back 43

-tests iliosacral motion to determine joint dysfunction (motion restriction of innominate)

-palpate both PSIS and ask pt to bend forward

Normal = both PSIS move superior and anteriorly

(+) side with motion restriction is the one that move furthers or first cranially and is considered blocked

Front 44

What is the slump test?

Back 44

- sitting on edge of table with knees flexed and hands behind back

-pt slump sits while maintaining neutral head and neck. then add progressions below

1. passively flex pt head and neck. if no symptoms then

2. passively extend one of pt knees. If no sx then

3. Passively DF ankle of LE with extended knee

Repeat on other side.

if positioning reproduces patients symptoms and cervical ext relieves symptoms = (+) for increased tension in the neuromeningeal tract

Front 45

What is the Laseque's test?

Back 45

aka SLR

supine, passively flex hip of one LE with knee ext until pt complain of shooting pain into LE

-slowly lower until pain subsides, then DF ankle

-also can add neck flexion

(+) = reproduction of pathological neurological symptoms when foot is DF and when neck flexed

(+)= asymmetry between sides

(+) = reproduction of sx between 35-70 deg hip flexion

biases the sciatic and tibial nerves

Front 46

What is Cross (Well Leg) SLR?

Back 46

SLR on uninvolved reproduces patient's symptoms

-one leg is lifted and pt c/o pain in opposite LE = indication of space-occupying lesion (e.g. herniated disc, large IV disc protrusion)

-stretches ipsilateral and contralateral nerve root.

Front 47

What is the femoral nerve traction test?

Back 47

-identifies compression of femoral nerve anywhere along its course

-sidelying on nonpainful side with unaffected knee and hip slightly flexed (painful side is up)

-head/neck slighlty flexed

-with affected knee in ext, extend the hip approx 15 deg

-if no sx then flex knee

(+) = neurological pain radiate down anterior thigh

Front 48

What is the lumbar quadrant test?

Back 48

identifies compression of neural structures at IVF and facet dysfunction

1. in standing, for IVF test:

SB L, Rot L, and Ext = max closing of IVF on L

2. in standing for Facet dysfunction

SB L, Rot R, and Ext = max compression of facets on L

(+) = localized pain for facet dysfunciton

pain &/or paresthesia in dermatomal pattern for the involved nerve root

Front 49

What is the Prone knee bend test?

Back 49

aka femoral nerve stretch

-used to identify L1-L3 nerve root lesion (also stretches femoral nn)

-prone + passive knee flex + hip ex

(+) for nerve root involvement = unilat pain in lateral or posterior aspect of hip, into lumbar spine, or into anterior thigh

Front 50

What is Stork standing test?

Back 50

-identifies spondylolisthesis

-stand on one leg + lumbar ext and repeat on opp leg

(+) = LBP with ipsilateral LE on ground = unilat stress fracture of pars interarticularis

Front 51

What is the Bicycle test of van Gelderen?

Back 51

-identifies neurogenic claudication (spinal stenosis) vs intermittent claudication

-ride stationary bike sitting erect and time how long can ride at set pace

-repeat with slumped posture and time how long

-spinal stenosis (+) if can ride longer in slumped posture or if reproduces sx in erect posture which are relieved with slumped posture

Front 52

What is Gillet's test?

Back 52

-used to identify SI joint dysfunction

-thumb on PSIS and other thumb on sacrum at same level

-pt standing then asked to flex hip and knee on side you are palpating

-PSIS should move inferiorly

(+) = PSIS does not move or moves cranially which indicates ipsilateral motion restriction

If palpate PSIS on WBing side

-innominate should rotate posteriorly (PSIS move inferiorly)

(+) if PSIS on stance side moves cranially (ant rot) = decr motor control of lumbopelvic stabilizers

Front 53

What is Long-sitting test?

Back 53

-measures functional leg length

-determines if there is a posteriorly or anteriorly rotated innominate based on apparent leg length differences

-if LE longer in supine but shorter in sitting = (+) anterior innominate rotation on affected side

-if LE shorter in supine and appears longer in sitting = posterior innominate rotation

Front 54

What are the five test that indicate SIJ pain and how many have to be positive?

Back 54

3 out of 5 to indicate SIJ pain with high spec and sensitivity

1. Distraction/Gapping

2. Thigh thrust

3. Gaenslen's test

4. Sacral thrust

5. Compression

Front 55

What is the distraction/gapping test?

Back 55

SIJ dysfunction (1 of 5 cluster of tests)

-supine

-cross arm pressure to bilat ASIS in down outward direction

(+) = symptoms reproduced or increase in unilat gluteal or in posterior leg

Front 56

What is the thigh thrust test?

Back 56

SIJ dysfunction (1 of 5 cluster of tests)

supine with hiop flexed to 90

-push posteriorly directed force through femur

(+) = Pain incr or reproduced on thrusting

Front 57

What is Gaenslen's test?

Back 57

SIJ dysfunction (1 of 5 cluster of tests)

supine near edge of the table with affected leg hanging over edge of table

-other leg is flexed toward pt's chest

-firm pressure is applied to both the hanging leg and the leg flexed toward the chest

(+) = pain in the SIJ is reproduced or increased

Front 58

What is the sacral thrust test?

Back 58

SIJ dysfunction (1 of 5 cluster of tests)

in prone, examiner applies a force vertically downward to the apex of the sacrum

(+) = SIJ pain incr or is reproduced

Front 59

What is the compression test?

Back 59

SIJ dysfunction (1 of 5 cluster of tests)

sidelying with affected side up

hips are flexed approx 45 and knees flexed to 90

-vertically force applied downward on ASIS

(+) = SIJ pain increases or is reproduced

Front 60

What is the sitting flexion test?

Back 60

-identifies SIJ dysfunction

-Thumbs on PSIS in sitting

-pt crosses arms over chest with feet on floor and bends forward bringing elbows between knees

(+) = blocked joint moves first or further cranially

Front 61

What are the tests for impingement in shoulder?

Back 61

1. Neer's

2. Hawkins-Kennedy

3. Painful arc

Front 62

What are the tests for RC dysfunction/pathology?

Back 62

1. Supraspinatus muscle test

2. Infraspinatus Muscle test

3. Drop Arm Test

4. ER Lag Sign

5. IR Lag Sign

6. Lift off test

7. Belly Press test

Front 63

What are the special tests for AC joint dysfunction/ pathology?

Back 63

1. Horizontal Adduction test

2. Resisted Horizontal Extension test

3. O'Brien's Sign

4. Paxinos Sign

5. Palpation of the AC joint

Front 64

What are tests for the GH labrum?

Back 64

1. Crank Test

2. Biceps Load I Test

3. Biceps Load II Test

4. Pain Provocation Test

5. Compression Rotation Test

6. O'Brien's Active Compression Test

7. Resisted supination ER test

Front 65

What are special test for cubital tunnel syndrome?

Back 65

1. Pressure provocative test

2. Flexion Test

3. Tinel's sign

Front 66

What are special tests for MCL tears at the elbow?

Back 66

1. Valgus stress at 30, 60, 70, 90 deg of elbow flexion

2. Moving Valgus Stress Test

Front 67

What are special tests for lateral epicondylitis?

Back 67

1. Tennis Elbow Test

2. Mill's Test

Front 68

What are special tests for wrist and hand ligamentous instability?

Back 68

1. Thumb Ulnar Collateral Ligament Test

2. Test for Tight Retinacular Ligaments

3. Lunatetriquetral ballottement test

Front 69

What are special tests for integrity of wrist and hand tendons and muscles?

Back 69

1. Finkelstein's Test

2. Sweater finger sign for rupture of the FDP tendon

3. Bunnel-Littler Test

Front 70

What are tests for neurological dysfunction in the wrist and/or hand?

Back 70

1. Tinel's sign

2. Phalen's test

3. Reverse Phalen's Test

4. Carpal Compression Test

5. Froment's Sign

Front 71

What are special tests for circulation in the wrist and hand?

Back 71

1. Allen's test

2. digit blood flow (nail bed compression)

Front 72

What are special tests of hip pathology?

Back 72

1. Patrick's (FABER) test

2. Flexion Adduction IR (FADIR) Impingement Test

3. Scour Test

4. Trendelenberg Sign

Front 73

What are Ligamentous test of the knee?

Back 73

1. Lachman's Test

2. Anterior Drawer Test

3. Pivot-Shift Test

4. Valgus Stress Test

5. Varus Stress TEst

6. Posterior Drawer

Front 74

What are tests for Meniscus in the knee?

Back 74

1. McMurray's Test

2. Apley Test

3. Thessaly Test

4. Bounce Home Test

5. Joint Line Tenderness

Front 75

What are tests for patellar instability?

Back 75

Patellar apprehension test

Front 76

What are tests for Patellofemoral syndrome?

Back 76

1. McConnell Test

2. Passive Patellar Tilt Test

3. Clarke's Sign (Patellar compression test)

Front 77

What are tests for IT band friction syndrome?

Back 77

Noble compression test

Front 78

What are tests for ligamentous instability at the ankle?

Back 78

1. anterior drawer test

2. Talar tilt

3. Squeeze test for syndesmosis injury

Front 79

What is the the test for Achilles rupture?

Back 79

Thompson's test

Front 80

What are the movement tests, postural analysis findings and example for an anterior innominate rotation - pelvic girdle dysfunction/

Back 80

Direction of motion restriction = posterior rotation

Movement test: Standing flexion test

Long sitting test

Posture Analysis:

-Iliac Crest/PSIS high, ASIS low in standing

-ASIS low in supine

-supine length length longer

-sitting length length shorter

example: L anterior innominate

(+) standing flexion and long sitting tests on the L

L PSIS high, L ASIS low in standing

L leg longer in supine

L leg shorter in long sitting

Front 81

What are the movement tests, postural analysis findings and example for an posterior innominate rotation - pelvic girdle dysfunction/

Back 81

Motion Restriction = Anterior rotation

Movement Test: Standing flexion test

Long sitting test

Postural Analysis:

ASIS higher, PSIS lower in standing

Supine leg length shorter

Long sitting leg length longer

Example: Left Posterior Innominate

(+) standing flexion and long sitting tests on L

= L ASIS high, PSIS low in standing

L leg shorter in supine

L leg longer in long sitting

Front 82

What is innominate upslip definition?

Back 82

vertical shear of an entire innominate in which the ASIS and iliac crest are up in comparison to the opposite side innominate (ASIS and PSIS on one side will be higher than opposite side)

Front 83

What are the movement tests, postural analysis findings and example for an upslip of innominate - pelvic girdle dysfunction/

Back 83

Movement Test: Standing Flexion Test

Postural analysis:

-ASIS and PSIS higher than contral side in standing

supine and long sitting leg length shorter than other side

Example: Left upslip innominate

L PSIS and ASIS higher in standing

L leg shorter in supine and long sitting

Front 84

What are the movement tests, postural analysis findings and example for a forward or backward sacral torsion - pelvic girdle dysfunction/

Back 84

Movement Test: Sitting flexion test

Postural Analysis:

-Sacral sulcus (base of sacrum and ilium) deep (in prone) & sacral inferior lateral angle (near apex) (ILA) posterior and down (shallow) on opposite side

example: forward or backward torsion

Sitting flexion test (+) on Right

Sacral sulcus deep on R and ILA posterior on L = L rotation of sacrum on R oblique axis (see notes and print out)

Front 85

How are sacral torsions named?

Back 85

Sitting flexion test: the (+) side is the hypomobile side. Opposite side is considered axis (so if L side is (+) then axis is R

-draw the upside down triangle

put (+) for the ILA or sulcus that is palpated as more deep/anterior and negative for the opposite side that is more posterior/shallow

-if the (+) is at the base/sulcus of sacrum then rotation is the same as the axis so, for example, it would be R rotation on R axis.

-if the (-) is at the base/sulcus, then rot is opposite to axis so would (-) on L base would be L rot on R axis

Front 86

What is Yergason's special test?

Back 86

-test for biceps muscle pathology (tendonosis/tendonopathy)/integrity of transverse ligament which holds biceps tendon in the bicepital groove

-sitting with shoulder in neutral and elbow flexed to 90 and stabilized against trunk with forearme pronated

-examiner resists supination with ER

-tendon of long head of biceps will pop out of groove if transverse humeral ligament is torn

-tenderness/pain without dislocation indicates bicipital tendionpathy

Front 87

What is Speed's Test?

Back 87

-identifies bicipital tendonosis/tendonopathy

-sitting or standing

-UE full ext and forearm supination resist shoulder flexion. Repeat with forearm in pronation

-can also do with shoulder at 90 deg flexion and push into ext -->eccentric biceps contraction

-do in supination and pronation

(+) = increased tenderness in bicipital groove/long head of biceps tendon esp with supination position

Front 88

What test is this ?

Back 88

Speed's Test for biceps tendinopathy

Front 89

What is the Neer's Test?

Back 89

-to identify impingement of long head of biceps and supraspinatus tendon under the acromion

-sitting

-shoulder passively IR then fully abducted

(+) reproduces pain in shoulder

Front 90

What test is this?

Back 90

Neer's test for impingement of Biceps tendon and supraspinatus

Front 91

What is the Hawkins-Kennedy Test?

Back 91

-identify impingement of supraspinatus

-standing

-passive forward shoulder flexion to 90 deg

-then forcibuly IR the shoulder

(+) = pain indicating supraspinatus tendinosis/tendinopathy

Front 92

What test is this?

Back 92

Hawkins-Kennedy Test for shoulder impingement

Front 93

What is the supraspinatus test?

Back 93

"empty can" test

-identifies tear and or impingement of supraspinatus tendon or possible suprascapular nerve neuropathy

-90 deg of shoulder abduc and neutral rotation. Resist abduction

-then medially rotate shoulder and horizontal add 30 deg (so in plane of scapula and thumbs point down). Resist abd

(+) = weakness or pain indicating SPST or subscap neuropathy

Front 94

What test is this?

Back 94

Supraspinatus ("Empty Can") Test to test for impingement of supraspinatus tendon or subscap neuropathy

Front 95

What is the infraspinatus Test?

Back 95

-to identify IFST strain

arm at side with 90 deg elbow flexion and humerius IR to 45 deg

-apply medial rotation force while pt resists

(+) pain or weakness = IFST strain

Front 96

What test is this?

Back 96

Infraspinatus test to identify IFST strain

Front 97

What is the Drop-Arm Test?

Back 97

-identify RC tear

-examiner abducts arm to 120 deg and then asks pt to slowly lower the arm to the side

(+) = pt unable or has severe pain when attempting and indicates tear in RC

Front 98

What test is this? pg 334

Back 98

Drop-Arm Test to identify RC tear

Front 99

What is the External Rotation Lag sign?

Back 99

-identify IFST and Teres minor weakness or IFST or SPST tears

-Passive abduction of shoulder to 90 deg with elbow in 90 deg flexion.

-passively ER shoulder to end range.

-ask pt to hold

(+) = cannot hold position/hand springs forward/arm drops into medial Rot = weakness or tear of IFST and/or supraspinatus pg 336

Front 100

What is this test?

Back 100

ER Lag Sign/Test indicating weakness or tear of IFST and/or supraspinatus

Front 101

What is the IR Lag sign?

Back 101

-identifies subscapularis tear or weakness

-same position as lift-off test

-except arm is passively lifted off Low back and pt asked to hold position

(+) = hand moves toward the back/cannot hold position indicating weakness or pain in SUBscap

Front 102

what test is this?

Back 102

IR Lag sign identifies subscapularis tear or weakness

Front 103

What is the lift off test?

Back 103

-dorsum of hand on back pocket or against midlumbar spine.

-pt lifts hand away from back

(+) = inability to lift hand away indicating lesion of subscapularis mm

Front 104

What is the sulcus sign?

Back 104

-test for inferior shoulder instability

-standing with arm by side and shoulder mms relaxed

-grasp forearm below elbow and pull arm distally

(+) = space between inferior margin of acromion and humeral head but only positive if pt is symptomatic (pain/ache on activity, or shoulder does not "feel right" with activity)

-indicates inferior instability or glenohumeral laxity

+1 = <1 cm

+2 = 1-2 cm

+3 = >2 cm

Front 105

What test is this?

Back 105

Sulcus sign indicating inferior shoulder instability or GH laxity

Front 106

What is the Anterior Apprehension Test?

Back 106

-identifies past history of anterior dislocation of shoulder

-pt supine with shoulder in 90 deg abd.

-slowly passively ER shoulder

(+) = pt looks or feels apprehensive or alarmed and resists further motion (also may state that it feels like what it felt like when shoulder dislocated

Front 107

What test is this?

Back 107

Anterior Apprehension Test for anterior shoulder instability

Front 108

What is the Relocation Test for shoulder?

Back 108

test for anterior shoulder instability

-during end of Anterior apprehension test (90 deg abd with elbow flex to 90 and max ER)

-apply posterior translation stress to the head of the humerus

(+) = apprehension and pain decr indicating GH instability, subluxations, or dislocation

Front 109

What test is this?

Back 109

Relocation test for anterior shoulder instability

Front 110

What is the anterior drawer test of the shoulder?

Back 110

testing for anterior shoulder instability

-pt in supine, shoulder abducted 80-120, fwd flexed 20 deg, and ER up to 30 deg

-stabilize scapula with opposite hand, pushing spine of scapula forward with index and middle finger and thumb on coracoid process

-using arm closest to pt's feet, place hands around upper arm and draw humerus forward

(+) = click, apprehension or both indicating anterior instability

Front 111

What test is this?

Back 111

Anterior Drawer test for anterior instability of the shoulder

Front 112

What is the Jerk test for the shoulder?

Back 112

test for posterior instability

-pt in sitting with arm IR and forward flexed to 90 deg

-examiner grasps elbow and axially loads humerus in proximal direction

-maintaining axial loading, move arm into horizontal adduction across body

(+) = sudden jerk or cluck as humeral head slides off the back of the glenoid. When arm is returned to original 90 deg abd, 2nd jerk as head reduces = posterior instability

Front 113

What test is this?

Back 113

Jerk test for posterior shoulder instability

Front 114

What is the Posterior Apprehension Test?

Back 114

-identifies posterior instability of shoulder

-in sitting or supine

-elevate shoulder in plane of scap to 90 deg while stabilizing scapula

-apply posterior force through elbow

-maintain axial load and horizontally adduct and IR arm.

(+) = look of apprehension or alarm and resistance to motion or reproduciton of symptoms

-normal is translation of 50% of HH diameter or less

movement of HH posteriorly more than 50% of diameter = posterior instability

Front 115

What test is this?

Back 115

Posterior Apprehension Test for posterior shoulder instability

Front 116

What is the AC Horizontal Adduction Test?

Back 116

-identifies dysfunciton of AC joint

-sitting, passive forward shoulder flexion to 90 deg, then horizontally adduct arm as far as possible

(+) = localized pain over AC joint

Front 117

What test is this?

Back 117

AC Horizontal Adduction test for AC joint dysfunction

Front 118

What is the AC Shear Test?

Back 118

-identifies AC joint dysfunction (e.g. arthritis, separation)

-in sitting

-examiner cups his/her hands over deltoid mm with one hand on clavicle and one on spine of scap

-squeezes heels of hands together

(+) = abnormal mvmt and/or pain

Front 119

What test is this?

Back 119

AC Shear Test for AC joint dysfunction

Front 120

What is AC Resisted Horizontal Extension Test?

Back 120

-test for AC joint dysfunction

-90 deg Flex and IR

-examiner pushes elbow into horizontal add and pt pushes into horizontal abd

(+) = AC pain

Front 121

What test is this?

Back 121

AC Resisted Horizontal Extension Test

Front 122

What is the O'Brien's Sign?

Back 122

finding from Active Compression Test of O'Brien that indicates AC joint pathology

-Active Compression Test of O'Brien typically for identifying of Labral lesions

-standing position

-90 deg flexion, full elbow ext

-10-15 deg Horizontal ADD, full IR

-examiner stands behind and applies downward force to arm at wrist

-arm returned to start position and repeat with palm supinated and resistance is applied

(+) for AC joint pathology = pain over AC joint

(+) for labral lesion = pain on GH joint line or painful clicking inside shoulder in first part and eliminated or dec in 2nd part

Front 123

What test is this?

Back 123

Active Compression Test of O'Brien for labral lesions or AC joint dysfunction

Front 124

What is Paxinos Sign?

Back 124

identifies AC joint dysfunction

-examiner stands posterior to patient

-thumb on posterior acromion

-index and fingers over middle part of clavicle

-thumb pushes anteriosuperiorly and fingers push inferior and posterior

(+) = AC pain

Front 125

What test is this?

Back 125

Paxinos Sign for AC joint pathology

Front 126

What is the Crank Test?

Back 126

identify Glenoid Labral lesion/tear

supine or sitting

-Shoulder ABD in scap plane 160 deg and elbow 90 deg flexion

-apply axial load through elbow while ER and IR humerus

(+) = pain on rotation with or without a click or reproduction of pt's symptoms (e.g. catching sensation)

Front 127

What test is this?

Back 127

Crank Test for glenoid labral tear/lesion

Front 128

What is the Clunk Test?

Back 128

-testing for glenoid labral tear

-supine

-one hand on posterior aspect of HH

-other holds humerus above elbow

-fully abduct shoulder

-push anteriorly with hand over HH while other hand rotates humerus into ER

-can vary ABD by moving arm in different abd degrees while maintaining ER

(+) = clunk or grinding sound = tear of labrum

Front 129

What test is this?

Back 129

Clunk Test for glenoid labral tear

Front 130

What is the Biceps Load Test I?

Back 130

-to detect Glenoid Labral lesion

-supine or sitting

-shoulder 90 deg abd

-90 elbow flexion

-axial compression through elbow

-while maintaining axial load, arm elevated diagonally upward while other hand applies downward and backward force to proximal arm

(+) = sudden onset of posterior shoulder pain and click = posterioinferior labral lesion

Front 131

What is Biceps Load Test II?

Back 131

same as Biceps Load test I but 120 deg of abd

-to detect Glenoid Labral lesion

-supine

-shoulder 120 deg abd

-90 elbow flexion

-full ER or until apprehension

-ask pt to flex elbow while resisting at wrist

(-) for SLAP lesion= with resisted elbow flexion, apprehension decr or pt feels more comfortabel

(+) for SLAP lesion = apprehension remains the same or shoulder becomes more painful

Front 132

What test is this?

Back 132

Biceps Load Test I for labral lesion

Front 133

what test is this?

Back 133

Biceps Load Test II for SLAP lesions

Front 134

What is the Pain provocation test of shoulder?

Back 134

-to identify superior labral lesion (SLAP)

sitting

-arm abd to 90-100 deg

-ER arm by holding wrist

-take forearm into max supination and pronation

(+) = pain is provoke only in pronated position or more sever in pronated position = (+) for superior tear (SLAP)

Front 135

What test is this?

Back 135

Pain Provocation Test for superior tears of glenoid labrum (SLAP)

Front 136

What is the compression rotation test of the shoulder?

Back 136

-to test for glenoid labral tear

-supine

-passive shoulder abd 20-90 deg

-90 deg elbow flexion

-axial compression through elbow (pushing up through the elbow) while passively rotating humerus back and forth

(+) = pain, clicking or catching sensation = torn labrum

Front 137

What test is this?

Back 137

Compression Rotation Test for glenoid labral tear

Front 138

What is O'Brien's Active Compression Test?

Back 138

finding from Active Compression Test of O'Brien that indicates AC joint pathology

-Active Compression Test of O'Brien typically for identifying of Labral lesions

-standing position

-90 deg flexion, full elbow ext

-10-15 deg Horizontal ADD, full IR

-examiner stands behind and applies downward force to arm at wrist

-arm returned to start position and repeat with palm supinated and resistance is applied

(+) for AC joint pathology = pain over AC joint

(+) for labral lesion = pain on GH joint line or painful clicking inside shoulder in first part and eliminated or dec in 2nd part

Front 139

What is the Resisted Supination External Rotation Test?

Back 139

-to check for SLAP lesions

-supine with scapula near edge of table

-examiner holds arm at elbow and hand

-90 abd, 65 deg elbow flexion, forearm neutral or slight pronation

-ask pt to max supinate hand while examiner resists

-while pt continues to supinate, examiner ER shoulder to ER

(+) = anterior or deep shoulder pain, clicking or catching in shoulder, or reproduction of symptoms

(-) = posterior shoulder pain, no pain, or apprehension

Front 140

What test is this?

Back 140

Resisted Supination External Rotation Test for identifying SLAP lesions

Front 141

What is the elbow flexion test?

Back 141

--to identify cubital tunnel (ulnar nerve) syndrome

-fully flex elbow with wrist extension and shoulder girdle 90 deg abd and depression

-hold for 3-5 min

(+) = tingling or paresthesia in ulnar nerve distribution of forearm and hand =cubital tunnel syndrome

Front 142

What test is this?

Back 142

Elbow Flexion test for cubital tunnel syndrome

Front 143

What is the Lateral Grip Test?

Back 143

test for median nn entrapment (anterior interosseous nn.)

-ask pt to pinch tips of index and thumb togther (make OK sign)

-pt is unable to meet tip to tip and has an abnormal pinch of the index finger and thumb = (+) for pathology to ant interosseous nn., possibly entrapment as it passes between the 2 heads of pronator teres mm.

Front 144

What is Tinel Sign at the Elbow?

Back 144

-tap ulnar nn in the groove between the olecranon process and medial epicondyle

(+) = tingling sensation in ulnar distribution of forearm and hand distal to point of compression

Front 145

What is the Valgus stress test for the elbow

Back 145

-tests for valgus instability (MCL tears)

-stabilize arm with one hand at the elbow, other hand is place above the wrist

-an abduction or valgus force (pushing wrist laterally/toward thumb) is applied to distal forearm while the ligament is palpated at the elbow

-do at 30, 60, 70, and 90 deg of elbow flexion

(+) = laxity, decreased mobility, or pain

Front 146

What test is this?

Back 146

Valgus Stress test for MCL of the elbow (valgus instability)

Front 147

What is the Moving Valgus Stress Test?

Back 147

-identifies partial tear of MCL

standing or supine with arm abducted and elbow full flexed

-while examiner maintains valgus stress at the hand, the examiner quickly extends the elbow

(+) = reproduction of pain between 70-120 deg = partial tear of MCL

Front 148

What test is this?

Back 148

Moving Valgus Stress Test for elbow MCL tear

Front 149

What is the test for pronator teres syndrome?

Back 149

sitting with elbow flexed to 90 deg

-examiner resists pronation as the elbow is extended

(+) = tingling or paresthesia in the median nn distribution of the hand and forearm = median nn entrapment

Front 150

What is tennis elbow test?

Back 150

3 tests

1. elbow stabilized by examiner. Pt. asks to make a fist, pronate forearm, and radially deviate and extend the wrist while examiner resists the motion

(+)= pain over lateral epicondyle

2. Mill's Test

3. Resist extension of the 3rd digit distal to the PIP (stressing ED

(+) = pain over lateral epicondyle

Front 151

What test is this?

Back 151

Tennis Elbow Test 1

Front 152

What Test is this?

Back 152

Tennis Elbow Test 3

Front 153

What is the Mill's Test?

Back 153

variation of tennis elbow test

-while palpating lateral epicondlye, passively pronate forearm, flex wrist and extend the elbow

(+) = pain over lateral epicondyle (may also be radial nerve compression)

Front 154

What test is this? pg. 409

Back 154

Mill's Test for lateral epicondylitis

Front 155

What is Golfer's Elbow Test?

Back 155

test for medial epicondylitis

-palpate medial epicondyle, while passivley supinate forearm and extending elbow and wrist

(+) = pain over medial epicondyle

Front 156

What is the Thumb Ulnar Collateral Ligament Laxity Test?

Back 156

-test for tears of Ulnar collat ligament

-examiner stabilizes 1st metacarpal

-takes thumb into extension

-and applies valgus stress to MCP (pushing proximal phalange of thumb laterally)

(+) for complete tear of ulnar collateral = >30-35 deg valgus movement

(+) for partial tear is <30-35 deg but > norm of 15 deg & > unaffected side

Front 157

What Test is this?

Back 157

Thumb Ulnar Collateral Ligament Laxity Test (test for gamekeeper's or skier's thumb

Front 158

What are the finger coupled actions?

Back 158

1. Active ext of PIP accompanied by ext of DIP (ORL stretched by PIP ext bc volar to PIP joint but ORL attaches dorsally to DIP causing ext of DIP)

2. Active or passive flexion of DIP accompanied by flexion of PIP (passive tension at distal site of ORL attachment transmits passive flexor force to proximal site of ORL that is volar to PIP axis)

3. Full flexion of PIP prevents DIP from being actively extended (loss of tension of terminal tendon and ORLs eliminating extensor force)

Front 159

What is the test for tight retinacular ligaments in the hand?

Back 159

-test for oblique retinacular ligament tightness to help determine whether DIP flexion restriction is due to ORL tightness or joint contracture

-with PIP held in neutral (ORL lengthened), passively flex DIP

-if DIP does not flex, ORL or PIP capsule are tight

-next, hold PIP in flexion and passively flex DIP

-greater DIP flexion when PIP flexed (ORL on slack) than when PIP extended = ORL tight

Front 160

What is the Lunotriquetral Ballottement TEst?

Back 160

-test to determine integrity of the lunotriquetrum ligament

-grasp triquetrum between thumb and 2nd finger of one hand and the lunate with thumb and 2nd finger of other hand.

-move the lunate up and down (ant and post)

(+) for lunotriquetral instability = laxity, crepitus, or pain

Front 161

What is Finkelstein's Test?

Back 161

-used to determine the presence of de Quervain or Hoffmann disease, a paratenonitis in the thumb.

-pt makes a fist with the thumb inside the fingers

-examiner stabilizes forearm and deviates wrist toward ulnar side.

(+) = pain over APL and EPB tendons at wrist and = paratenonitis of these 2 tendons. Compare to normal side bc can cause discomfort in normal individuals as well.

Front 162

What is sweater finger sign?

Back 162

-test for FDP rupture

-ask pt to make fist

-if distal phalanx of one finger does not flex = (+) for ruptures FDP

Front 163

What test/sign is this?

Back 163

sweater finger sign for FDP rupture

Front 164

What is the Bunnel-Littler Test?

Back 164

-test for tightness of hand intrinsic and extrinsic muscles

1. hold MCP in max ext (intrinsics stretched) then passively flex PIP

2. Then hold MCP in flexion and passivley flex PIP

(+) = if PIP flex is greater with MCP flexion then intrinsics are tight

If PIP flexion is still limited with MCP flexion (i.e. if MCP position does not change PIP flexion) then indicates tight joint capsule

-for extrinsic mm tightness testing

same procedure as above but PIP flexion will be greater with MCP extension (extrinsics on slack/finger extensors are not stretched as much)

Front 165

What is Phalen's Test?

Back 165

-flex the wrist maximally and hold for one min but pressing them together at wrist

(+) = tingling in thumb, 2nd and 3rd digit and lat half of 4th indicating pressure on median nn in carpal tunnel

Front 166

What is Reverse Phalen's test

Back 166

-extend wrist in prayer position and bring down toward waist keeping palms in full contact.

hold for 1 min

(+) = same symptoms as Phalen's test and indicates median nn compression

Front 167

What is the Carpel Compression Test?

Back 167

- to identify CTS

-examiner holds the supinated wrist in both hands and applies direct pressure over median nn in carpal tunnel for up to 30 sec.

(+) = production of pt's symptoms

Front 168

What is Froment's Sign?

Back 168

-paper sign (aka)

-test for ulnar nerve palsy

-pt attmpets to grasp piece of paper between thumb and index finger

(+) = when examiner pulls paper away, terminal phalanx of thumb flexes due to paralysis of adductor pollicis (FPL is intact due to innervation from median nn)

this indicates ulnar nerve paralysis

Front 169

What is Allen's Test?

Back 169

test for circulation in hand

-pt asked to open and close hand several times as quickly as possible and then squeeze hand tightly

-examiner's thumb and index finger placed over radial and ulnar arteries compressing them

-pt opens hand while pressure maintained over arteries

-one artery tested by releasing pressure over artery to see if the hand flushes

-repeat to test other artery

Front 170

What is Adson's Test?

Back 170

test for Thoracic outlet syndrome

-locate radial pulse

-pt head is rotated to face the test shoulder

--pt extends head while examiner ER and extends shoulder

-pt instructed to take deep breath and hold it

(+) = disappearance of pulse pg 345

Front 171

What is Costoclavicular syndrome test?

Back 171

aka Military brace

-test for TOS

-find radial pulse

-examiner draws shoulder down and back

(+) = disappearance of pulse

Front 172

What test is this?

Back 172

Costoclavicular syndrome test for TOS pg. 345

Front 173

What test is this?

Back 173

Adson's Test for TOS pg 345

Front 174

What is the Roos Test?

Back 174

aka Elevated arm stress test (EAST)

-pt stands and abducts arm to 90, ER shoulder, elbow flexion 90 deg

-pt opens and closes hands slowly for 3 min

(+) = pt unable to keep arms in position for 3 min or has ischemic pain, heaviness or profound weakness of arm, or numbness and tingling of the hand

Front 175

What is Wright Test?

Back 175

aka Hyperabduction test

test for TOS

-find radial pulse

-max ABD and ER of shoulder

-take a deep breath and then rotate head away from test side

(+) = pulse disappears or neurological symptoms are reproduced

Front 176

What is Allen's Manuever for TOS?

Back 176

-find radial pulse

-90 deg ABD, ER, and elbow flexion

-pt rotates head away from test side

(+) = pulse disappears when head is rotated pg 347

Front 177

What test is this?

Back 177

Wright (Hyperabduction) test for TOS

Front 178

What test is this?

Back 178

Allen's Test for TOS

Front 179

What is the order for Upper limb neuro tension test 1?

Back 179

Shoulder depression and 110 deg abd

Elbow ext

Forearm supination

wrist ext

finger and thumb ext

Cervical spine contralat side flexion

Front 180

what nerve does the ULNT1 bias?

Back 180

median nerve

anterior interosseous nn

C5, C6, C7

Front 181

What is the order for ULNT2?

Back 181

Shoulder depression and 10 deg ABD

Elbow ext

Forearm supination

wrist ext

finger and thumb ext

shoulder ER

cervical contral side flexion

Front 182

What nerve does ULTT 2 bias?

Back 182

median nn

musculocutaneous nn

axillary nn

Front 183

What is the order for ULNT3?

Back 183

Shoulder depression and 110 Deg abd

Elbow ext

forearm pronation

wrist flexion and ulnar deviation

finger and thumb flexion

Shoulder IR

cervical contralat side flexion

Front 184

What nerve does ULNT 3 bias?

Back 184

radial nn

Front 185

What is the order for ULNT 4?

Back 185

extend wrist and radially deviate

extend fingers

supinate or pronate forearm

fully flex elbow

depression shoulder

ER shoulder

shoulder abd (10-90 deg, hand to ear)

Front 186

What nerve does the ULNT4 bias?

Back 186

ulnar nn

C8 and T1 nerve roots

Front 187

What test is this?

Back 187

ULNT 1 - median nn bias

median nerve

anterior interosseous nn

C5, C6, C7

Front 188

What test is this?

Back 188

ULNT 2 median nn

musculocutaneous nn

axillary nn

Front 189

what test is this?

Back 189

ULNT 3

radial nn bias

Front 190

what test is this

Back 190

ULNT4

ulnar nn