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Musculoskeletal / Maneuvers
Terms in this set (56)
Apley Scratch Test
Tests for limitations in motions of the upper extremity. Each motion is performed bilaterally to compare. Action 1: The subject is instructed to touch the opposite shoulder with his/her hand. This motion checks Glenohumeral adduction, internal rotation, horizontal adduction and scapular protraction.
Action 2: The subject is instructed to place his/her arm overhead and reach behind the neck to touch his/her upper back. This motion checks Glenohumeral abduction, external rotation and scapular upward rotation and elevation.
Action 3: The subject puts his/her hand on the lower back and reaches upward as far as possible. This motion checks glenohumeral adduction, internal rotation and scapular retraction with downward rotation
Empty Can Test
A positive test indicates a tear to the supraspinatus tendon or muscle and can also indicate a neuropathy of the suprascapular nerve. "The patient actively abducts the arm to 90 degrees with the thumbs up which makes the full can position. The examiner then provides downward pressure on the arm to test the patient's strength. The patient then elevates the arms to 90 degrees and horizontally adducts 30 degrees to the scapular plane with thumbs down to the empty can position. The examiner provides downward pressure to test the patient's strength in this position. A positive test for rotator cuff tear is more weakness in the empty can, patient complaint of pain, or both."
Infraspinatus strength test
This test assesses for infraspinatus strain. "The patient stands with the arm at the side with the elbow at 90 degrees and the humerus medially rotated to 45 degrees. The therapist applies a medial rotation force that the patient resists. Pain or the inability to resist medial rotation indicates a positive test for an infraspinatus strain."
Neer's impingement sign
Impingement or tear of the supraspinatous tendon, infraspinatous, and long head of biceps tendon. "The test is best performed with the patient in a relaxed standing position. The arm to be tested should be moved passively by the examiner. The patients arm of the shoulder to be tested is positioned such that the arm is relaxed at the side of the body and the elbow is fully extended. (press on scapula to prevent scapular motion with one hand). From the starting position the examiner internally rotates the patients arm and forcefully moves the arm through the full range of forward flexion or until reports of pain. The Neer test is considered positive if pain is reported in the anterior - lateral aspect of the shoulder."
Hawkins-Kennedy impingement sign
This test looks for supraspinatus tendon impingement. "The patient stands while the examiner forward flexes the arm to 90 degrees and then forcibly medially rotates the shoulder. The test may be performed in different degrees of forward flexion or horizontal adduction."
To test for supraspinatus tears.
"Patient is seated with examiner to the front. Examiner grasps the patient's wrist and passively abducts the patient's shoulder to 90 degrees. Examiner releases the patient's arm with instructions to slowly lower the arm. Test is positive if the patient is unable to lower his or her arm in a smooth, controlled fashion."
Gerber's lift-Off Sign
tests subscapularis muscle
put arm behind back and lift off of back
Napoleon or Belly Press
test subscapularis muscle
press in to abd
non-rotator cuff musculoskeletal shoulder pain
-pull arm straight down and you will see a divet at the shoulder where it is dislocating out.
non-rotator cuff musculoskeletal shoulder pain-
elbow out but towards you, holding shoulder jerk back
Tests for posterior instability/ torn posterior or posteroinferior labrum.
With the patient seated the examiner grasps the elbow with one hand and the scapular with the other and elevates the patient's arm to 90° of adduction and internal rotation. Following this the examiner provides an axial compression load to the humerus through the elbow maintaining the horizontally abducted position. The compression force is maintained as the examiner moves the arm into horizontal adduction. A positive test is indicated by sharp pain in the shoulder with or without a clicking sound
Resisted Wrist flexion
Medial epicondylitis- golfers elbow
Elbow in extension, patient makes a fist and deviates wrist radially. Resisted flexion of the wrist. Pain in the area of lateral epicondyle is a positive result.
resisted wrist extension
lateral epicondylitis- tennis elbow
Cozen's test- the therapist stabilizes the patient's elbow in 90 degrees of flexion with one hand while palpating over the lateral epicondyle. The other hand positions the patient's hand into radial deviation and forearm pronation while the patient is asked to resisted wrist extension in this position against manual resistance of the therapist. The test is considered positive if it produces pain or reproduction of other symptoms in the area of the lateral epicondyle.
valgus stress test
An assessment for one-plane medial instability (gapping of the tibia away from the femur on the medial side). The therapist applies a valgus stress at the knee while the ankle is stabilized in slight lateral rotation either with the hand or with the leg held between the examiner's arm and trunk. The knee is first in full extension, and then it is slightly (20-30 degrees) so that it is "unlocked".
varus stress test
lateral collateral ligament sprain. An assessment for one-plane lateral instability (i.e. the tibia moves away from the femur an excessive amount on the lateral aspect of the leg). The therapist applies a varus stress at the knee while the ankle is stabilized. The test is first done with the knee in full extension and then with the knee in 20-30 degrees of flexion.
medial or lateral meniscus tear
The test is performed with the patient in a relaxed supine position. The knee to be tested should be fully flexed. The examiner holds the sole of the foot with one hand and palpates the medial or lateral aspect of the tibio-fibular joint. This test is used to determine damage to either the lateral or medial meniscus. The examiner palpates the side of the joint being tested. When testing the medial meniscus the tibia starts the manoeuvre in internal rotation. When testing the lateral meniscus the tibia starts the manoeuvre in external rotation. To test the medial meniscus, the examiner palpates the postero-medial aspect of the knee while extending the knee and externally rotating the tibia. A valgus stress is also applied. To test the lateral meniscus, the examiner palpates the postero-lateral joint line while extending the knee and internally rotating the tibia. A varus stress is also applied.
If pain is felt by the subject or if a 'click' is felt by the subject or examiner, the test is considered positive.
apley's grind test
medial or laeral meniscus tear. The patient lies in the prone position with the knee flexed to 90 degrees. The patient's thigh is then anchored to the examining table with the examiner's knee.
The examiner medially and laterally rotates the tibia, combined first with distraction, while noting any restriction, excessive movement, or discomfort. The process is repeated using compression instead of distraction. If rotation plus distraction is more painful or shows increased rotation relative to the normal side, the lesion is probably ligamentous. If the rotation plus compression is more painful or shows decreased rotation relative to the normal side, the lesion is probably a meniscus injury.
scaphoid fracture- swelling and tenderness in this area are typical with a scaphoid fx.
the schaphoid bridges 2 rows of wrist bones and takes 60% of total load to wrist. it doesnt have good blood supply. need ortho referral. Fx doesnt show up well on plain xray. bone is covered by articular cartilage (proximal pole) and has no soft tissue attachments so blood supply is thr the rest of the boe.
de Quervain Tenosynovitis, pain going up wrist area. tuck thumb in and fold fingers in to cause the pain.
carpal tunnel test
tapping on median nerve with hand flexed back
carpal tunnel test
holding pressure with thumb on median nerve
carpal tunnel test
with elbows out flex hands down with back together holding for 30 seconds
Anterior Drawer Test
anterior cruciate ligament sprain
To test for one-plane anterior instability
"The patient's knee is flexed to 90 degrees, and the hip is flexed to 45 degrees. In this position, the anterior cruciate ligament is almost parallel with the tibial plateau. The patient's foot is held on the table by the examiner's body with the examiner sitting on the patient's forefoot and the foot in neutral rotation. The examiner's hands are placed around the tibia to ensure that the hamstring muscles are relaxed. The tibia is then drawn forward on the femur. The normal amount of movement that should be present is approximately 6mm. If the test is positive (i.e., the tibia moves forward more than 6 mm on the femur), the following structure may have been injured to some degree: ACL, Posterolateral capsule, Posteromedial capsule,Medial collateral ligament (deep fibers),
Iliotibial band, Posterior oblique ligament,
Lachman test, anterior drawer test
anterior cruciate ligament sprain. best indicator of injury to the anterior cruciate ligament, especially the posterolateral band. The therapist holds the patients knee between full extension and 30 degrees of flexion.
The patient's femur is stabilized with one of the examiner's hands (the "outside hand) while the proximal aspect of the tibia is moved forward with the other ("inside") hand.
Posterior drawer test
posterior cruciate ligament PCL sprain
To test for Posterior cruciate ligament,
Medial collateral ligament, and
Posterior oblique ligament damage
The patient lies relaxed in the supine position.
The examiner passively flexes the knee more than 45 degrees while applying a varus stress, compression, and medial rotation of the tibia; in a "positive" knee, these movements cause subluxation of the medial tibial plateau posteriorly. The examiner then takes the knee into extension. At about 20 degrees to 40 degrees of flexion, the tibia shifts into the reduced position.
knee injury tests
Medial Collateral Ligament-varus
Lateral Collateral Lgament-valgus
medial or lateral meniscus-McMurrays, Apleys Grind
Anterior Cruciate Ligament- ant drawer test and Lachman test
Posterior Cruciate Ligament-posterior drawer test
nearly 70% sports related.
usually landing awkwardly, landing with kee straight after jumping, or changing directions suddenly.
women 3-7x more at risk and 5 years younger (wider pelvis, increased genu valgum (knock knee) increased ext tibial torsion (out toeing) smaller ACL, greater ligamentous laxity due to hormones; ? higher inc during ovulatory phase 5-12)
ottowa knee rule
isolated tenderness of patella
tenderness head of fibula
inability to flex >90 degrees
inability to bear weight (4 steps) both immediately after injury and in ED (regardless of limping)
patellofemoral pain syndrome PFPS
prob r/t mistracking knee cap. Doesnt allow appropriate amt of intermittent compression and may result in cartilage deterioration usualy on medial or inner part of patella. Q angle: normal <12degrees, abnormal 15 degrees. Adult women have wider pelvis which increases the Q angle. Pain near patella usually at medial aspect and below. Usually felt after sitting for a long period of time with knees bent. Running downhill and even walking down stairs can cause pain. Palpation pain over medial aspect of patella.
painful enlargement of the tibial tuberosity. Usually in active, rowing children involved in wt bearing sports. Most common cause of limp in children. May red, tender, enlargement may be permanent. Bone marrow is deposed into the tibia tuberosity after growth spurt. Stretching and rest symptoms will help resolve pain.
developmental hip dysplasia
the Barlowe identifies the unstable hip that is in a reduced position that the clinician can passively dislocate. the examiner will flex the hips and knees to 90 degrees. the manueuver is performed by bringing the thigh towards the midline (adduting the hip). the femoral head will be pushed out of the socket and the dislocation will be palpable. Ortolani- used confirm the barlowe. reduction is done by abduction of the hip and pushing the thigh anteriorly. the test is positive if an audible clunk is heard as the hip is reduced.
unequal leg length
A physical examination finding associated with various hip abnormalities (those associated with abduction muscle weakness or hip pain or congenital hip dislocation, hip rheumatic arthritis, osteoarthritis) in which the pelvis sags on the side opposite the affected side during single leg stance on the affected side; during gait, compensation occurs by leaning the torso toward the involved side during stance phase on the affected extremity
If there is a disorder the patient who stands on the affected leg will have the other side of the hip dropping out or backwards.
A positive test can indicate an unstable hip on the unsupported side or a weak gluteus medius muscle of the standing leg .
People who have a positive trentelenburg test mostly walks with 'dipping gate'
Waddell's Signs Test
inappropriate respone >3 suggests inorganic cause of pain. superficial tenderness, axia loading, simulated rotation, distracted straight leg raise
regional sensory change, overreaction
superficial tenderness- Waddells
skin discomfort on light palpation, skin roll
axial loading- Waddells
vertical loading on a standing patient's skull causes low back pain
Simulation rotation- Waddells
passive rotation of shoulders and pelvis in same plane causes low back pain
distracted straight leg raise- Waddells
discrepancy in findings between findings on supine and sitting straight leg raising tests
regional sensory change- Waddells
nondermal sensory loss
exaggerated, nonreproducible response to stimulus
tendon or muscle over-stretched
ottawa ankle rules
xray of foot is only required if one of the following is present:
bone tenderness at posterior edge of distal 6cm of medial malleolus
bone tenderness at posterior edge of the distal 6 cm of lateral malleolus
totally unable to bear weight both immediately after injury and for 4 steps in ED
ligament is over-stretched
Muscles of the shoulder
Supraspinatus, infraspinatus, teres minor, subscapularis
originates on scapula, insert on greater humoral tuberosity above clavicle
originates on scapula, inserts on greater humoral tuberosity below clavicle
teres minor muscle
originates on scapula, inserts on greater humoral tuberosity under infraspinatus
originates on scapula, inserts on lesser humoral tuberosity
rotator cuff injury
Symptoms are acute or insidious esp in elderly. pain, weakness, and loss of motion are most common symptoms. Pain exacerbated by overhead or above the shoulder activities. Night pain is a common complaint, esp when lying on affected shoulder.
tests for rotator cuff
empty can, infraspinatus strength, Neer's impingement sign, Hawkins-Kennedy, drop-arm, Gerbers Lift Off, Napoleon/belly press.
cross body adduction
for non-rotator cuff shoulder pain. AC joint arthritis; palpate directly over AC joint. do this maneuver to check. raise arm up to shoulder height and move towards opposite shoulder.
SPADI Shoulder Pain and Disability Index
Score 0-130. 13 pt change is significant. Rate how severe the pain is and with movement, and a disability scale on how difficult a task is.
Acute onset of arm pain in a young child following hyperextension of the elbow. Child will refuse to move the arm. Can mimic a fracture. History and child's age (usually <5) are most suggestive features. Radial head dislocation. In pulled elbow, the annular ligament around the radial head is dislodged when the arm is pulled partially dislocating into the radiocapitellar joint when the arm is released.
Little league elbow- avulsion/stress fx of medial epicondyle. Caused by repetitive throwing motion: acceleration of UE with elbow flexion and valgus stress. Progressive pain and tenderness to palpation at medial epicondyle. Decreased ROM.
neuropathic pain at base of toes, usually bet 3rd and 4th metatarsals
thickened tissue surrounding the interdigital nerve
symptoms: numbness and tingling; heat; pebble in my shoe; aching; radiation of pain into toes.
associated with injury, high heels, tight shoes or overpronation
treated with rest, wider shoes, metatarsal pads, orthotics, steroid and/or anesthetic injections
loss of ROM
early interv is important to keep it moving.
refer to PT for ROM exercises ASAP; rarely needs ortho
rupture of proximal biceps tndon
acute injury, audible snap
visible/palpable bulge with contraction
often needs surgical correction
THIS SET IS OFTEN IN FOLDERS WITH...
Upper Extremity and Shoulder Self-Study…
Upper Extremity Special Tests
PTA 205: Hand & Wrist Orthopedics
PTA 205: Elbow Orthopedics Lab
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