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VERTEBRAE

Vasalva-
+ if pain or peripheral sx
= disc herniation or space occupying lesion

Bakody's sign
a pt's tendency to support their arm in an elevated position, or rest it on top of their head
changes the pressure equilibrium in the spine
may be removing pressure from a pinched spinal nerve root

CERVIX

Vertebral Artery Test
extension, lateral flexion and rotation & hold 20-30 s
+ if blurred vision, nystagmus, dizzy, N/V, slurred speech, LOC or headache
= partial or complete block of vertebral artery.
Monitor pt for 20-30 minutes and if sx persist call 911 (DO NOT MANIPULATE)

Cervical Compression Test
+ if pain, parasthesias or numbness
= cervical disc herniation, spinal stenosis, osteophytes or SOL
(arm sx point to C6-C8 nerve root compression)

Cervical Distraction Test
Decreased pain= herniated disc, osteophytic compression or spinal stenosis
Increased pain= ligamentous sprain, facet capsular sprain or muscle strain

Soto Hall Test
flex head toward chest with pt supine with gentle pressure on sternum
+ localized pain= vertebral fracture, joint or ligament injury
+ radiating pain= cervicothoracic spain or disc derangement
+ flexion of knees or hips= +Brudzinski so meningitis, infection or abscess

THORAX

Adam’s test- patient bends forward while observing the spine
+ if rib hump or spine deviation
= scoliois

Adson’s test- head to affected side & extend with arm externally rotated and abducted, monitor pulse
+ if loss of pulse or parasthesias/ radiculopathy
= Thoracic Outlet Syndrome via anterior scalene
(Reverse Adson’s head faces away and indicates middle scalene TOS)

EAST’s test (Roos’)
elevated Arms Stress Test- open and close hand for 3 minutes
+ if inability to keep up pace, downward drift of arms, hand pain or parasthesia
= Thoracic Outlet Syndrome at costoclavicular joint

Wright’s test
passively abduct pt’s arms and feel radial pulses
+ if radial pulse disappears or pain occurs
= Thoracic Outlet Syndrome by hypertonic pec. minor muscle or enlarged coracoid process


SHOULDER

Speed’s test
arm extended and supinated, with resisted shoulder flexion at 120* while palpating the bicipital tendon
+ if pain or tenderness in groove
= bicipital tendonitis, tenosynovitis or tendonosis
also rotator cuff bursitis, impiongement or biceps strain

Yergason’s test
resisted supinate and externally rotate arm “hitchhiker maneuver”
+ if pain, weakness or tendon pops out of groove
= bicipital tendonitis, tenosynovitis or tear of the humeral ligament (esp if pop out)

Lippman’s test


Apley’s Scratch Test
scratch back- external rotation (C7), internal rotation (T7)
+ if pain
=Rotator Cuff Injury at supraspinatus or infraspinatus
=Tendonitis of supraspinatus or biceps
=adhesive capsulitis

Drop-Arm Test (Codman’s)
passively abduct arm to 150* and pt lowers slowly
+ if weak,, ratcheting, drop suddenly or lack of control
= Rotator Cuff Tear- <90* indicates supraspinatous, >90* indicates deltoid

Hawkin’s-Kennedy Test
quick internal rotation with elbow/shoulder at 90*
+ if pain
= supraspinatous impingement or tendonosis

Neer Test
stabilize scapula while passive maximal flexion and internal rotation of arm
+ if pain
= supraspinatous impingement (if + on external rotation indicates biceps impingement)

Glenohumeral apprehension test
try to dislocate joint anteriorly and see if pt freaks
external rotation while push humeral head anteriorly
+ if pain in front of shoulder or apprehension
= anterior glenohumeral instability or tight posterior capsule

ELBOW

Cozen's test (resistive) -- Pt may sit or stand, (text version) with arm at side and elbow at 90, pt makes fist, forearm is pronated, then extends and radially deviates the wrist while doc palpates lateral epicondyle and resists extension. (or from lab: waitress position and push up w/ examiner resistance)

Mill's test (stretch) -- Examiner palpates lateral epicondyle, extends elbow completely with elbow crease up, pronates forearm and flexes wrist fully (hand flops down), doc increases wrist flexion, stretching extensors and common extensor tendon. (+) = pain @ lateral epicondyle, radial nerve mb compressed.

Finger Extension Test -- Pt places hand palm down on flat surface and extends 3rd digit (middle finger). Examiner pushes down on middle finger at distal IP joint to evaluate digit strength. Stresses extensor digitorum muscle and tendon. (+) test = pain over lateral epicondyle.

Reverse Cozen’s and Reverse Mill’s indicate medial epicondylitis or Golfer’s elbow

Reverse Cozen's Test (resistive) = Pt may sit or stand, examiner passively supinates forearm, flexes elbow to 120 degrees, and slightly flexes the wrist with ulnar deviation (put patient in position of patting self on same side shoulder with palm down). Patient then maintains this position while doc has a stabilizing hand on the point of the elbow, and the other hand lifting the pts palm away from the shoulder.

Reverse Mill's Test (stretch of medial forearm with arm extended) Pt extends elbow, supinates forearm (turns palm up) and extends wrist. Doc increases wrist extension to stretch the common flexor tendon. (This test can also be done with wrist flexed and doc pushing toward extension)

Valgus Stress Test = two part test in which examiner attempts to bend elbow medially. Patient's forearm is supinated for both, test at full extension (not hyperext) and with elbow flexed 30 degrees. Tests for medial collateral ligament laxity and pain.

Varus Stress Test = same as valgus except direction of examiner pressure is lateral to stress the lateral collateral ligament.

Tinel's Sign = Tapping over ulnar nerve in cubital tunnel of elbow or radial nerve in carpal tunnel of wrist. (+) = shooting electrical pain or paresthesia distal to tap. (24% of normal individuals have a (+) elbow test!!)

Froment's sign = When pinching a piece of paper using thumb and index finger, pt cannot pinch with straight thumb; there is a bend in the thumb at the IP joint indicating ulnar nerve compromise (thumb adductor innervated by ulnar nerve, IP flex uses long flexor of thumb, innervated by median nerve)

Elbow Flexion Test = the best diagnostic test for cubital tunnel syndrome. Pt may be seated or standing. Pt flexes elbow past 90, supinates forward and extends wrist and holds this position for up to 5 minutes. ("Waitress" position as if carrying tray). Shoulder abduction increases closure of tunnel. (+) = discomfort or paresthesia in a minute or less, indicates ulnar compression within cubital tunnel.

WRIST

Tinel's Sign = Tapping over ulnar nerve in cubital tunnel of elbow or radial nerve in carpal tunnel of wrist. (+) = shooting electrical pain or paresthesia distal to tap. (24% of normal individuals have a (+) elbow test!!)

PHALEN's Test = very sensitive test for Carpal Tunnel Syndrome (two versions) 1) pt hold hands back to back in front of abdomen, forearms level(ish) and fingers pointing downward, with maximal wrist flexion for 1 minute, or 2) examiner hold wrist flexion for 1 minute. (+) = numb/tingle in median nerve distribution, increased anterior wrist pain, weakness of thumb opposition (additional sensitivity for CTS with examiner pressure over carpal tunnel during wrist flexion)

Thumb Abduction Strength Test = pt hold palm to doc, attempts to lift thumb from palm while doc resists thumb abduction. Also view thenar pads (lateral 2 lumbricals, opponens pollicis, abductor pollicis breivs, flexor pollicis brevis) for atrophy. (+) = weakness of thumb abduction, indicates median nerve neuropathy.

Finkelstein's Test = make fist with thumb inside, ulnar deviate and extend wrist by patient or examiner (+ = lateral wrist pain->tenosynovitis of thumb mm: ext. pollicus longus and abd. poll. long

Bracelet Test = doc puts hand around posterior wrist and compresses the sides, lateral compression around distal radius and ulna (or just below, depending on which image or person you ask) (+) = lunate disloc, scaphoid fx, lig laxity, RA or DJD at wrist

Scaphoid test = Examiner grab pts thumb with examiner's thumb pressed into pts snuffbox, directly on scaphoid bone, (+) = pain at scaphoid

** remember for boards:
--anatomical snuffbox bordered by tendons of extensor pollicis longus, extensor pollicis brevis, and abductor pollicis longus.
--floor of snuffbox: scaphoid, trapezium, 1st metacarpal, styloid process of radius, radial artery

ALPHABETICAL LISTING OF ALL THE ORTHO TESTS
(with my memory aid word additions)

Apley's scratch
Becherew's sitting kick
Bragards SLR foot
Brudzinski's nod
Clarke's trap
Codman's arm drop
Cozen's cycle
Demianoff's density
Ely's cross kick
Fajersztajn's fake
Finkelstein's fist
Froment's snitch
Gaenslen's spread
Harkins-Kennedy flop
Hibbs heel out
Homan's surprise
Kemp's kink
Kernig's sky kick
Kleiger's eversion
Lachmann's push pull 30
Lewin-Gaenslen's side spread
Lindner's limber
MacMurray's meniscus
Mennel's mash
Mill's gorilla
Morton's footshaker
Nachlas' buttkick
Neer's salute
Patrick's jig
Phalen's flop
Piriformis heel in
Reverse Cohen's attagirl
Reverse Mill's sashay
Sicard's SLR toe
Smith-Pedersen's slink
Speed's lift
Thessaly twist
Thomas march
Thompson's frogtoe
Tinel's tap
Turyn's toe only
Valgus knock
Varus bowlegged
Yeoman's haul
Yergason's hitch

Comments

( 2 comments — Leave a comment )
neptunia67
Jul. 9th, 2011 02:41 pm (UTC)
So many tests! How will you remember them all?
liveonearth
Jul. 9th, 2011 03:48 pm (UTC)
Not sure yet. Working on that very question. =-]
( 2 comments — Leave a comment )

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