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32 Cards in this Set
- Front
- Back
- 3rd side (hint)
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Spinal stenosis |
Red rose Rose for muscle Red for blood Stem for artery |
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Spondylolisthesis |
One side of the flower breaks And falls down So go to the side By stork test Extension exercises bad for the person pushes the spine in opposite directions |
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Dress and knee pain |
When you push dress from back the quad push causing knee pain |
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HamString injury |
When quad muscle too tight Husband(Andy acl) torns as Queen wife pulls in front |
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Shoulder insurability |
1st Scapula muscles
Retractors Rhomboids
2nd Front Pectoral stretch
3rd stone
Sits Cuff muscle strengthing |
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Shoulder and scapula strengthing RC strengthing |
MusclesShoulder like bottle capMuscles aroundThe rim is the capsulebottle capMuscles aroundThe rim is the capsuleActive passiveAnd structural Active passiveAnd structural And structural Scapular triangleLike y Humeral sits |
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Lumbar abd |
Like ball and box 2 above psis and 1 below The ball front and Back extensors Also triangle box
Bone like triangles Spine palpation also h and I instability for side border and at the end is lumbar torsion test for facet the two points and apex the spinous prcess
Round oblique
Box sides quadratus lumborum Back multifidus
Abdominal Isometrics Concentric Eccentric Isometrics at shoulderCurl upsDynamic lowering |
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Shoulder exercises |
Ball Capsule Posterior Anterior Box Ins and outies Flexion Abduction Add Triangle Scapular muscles Flying Y a U shape on prone |
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History |
6
Their house present sins Severity vas or global rating of change scale or McGill questionnaire
0 5 10 Irritability
Then treatment can be slow or aggressive
Nature Nerve Bone deep very localized svere Vascular Muscle not localized cramping Lig joint capsule localized and deep
Mechanical complaints Clicking catching Patellofemoral
Locking meniscal pathology
Popping ligament giving away
Somatic deep aching not localized moves around or diffuse
Muscular superficial
Stage aggrevate and relieving factor
Now start where it migrated to Onset when did it start
- trauma or nontrauma Macro vs microtrauma Sudden or onset
How thief came in Mechanism of action
Body chart Timing
cnstant or Intermittent Constant acute inflammation Night pain tumor stress fracture
Morning oaConstant no change systemic disorder oaConstant no change systemic disorder Constant no change systemic disorder Person lives or comes in BT
Parents house past- medical Work house environment history Occupational history Social restaurant house
Identification Age Sex Race Handedness Height et bmi type
Primary language Barrier to learn Learning preference-visual audio kinesthetic written video Unique goals
Associated symptoms Red flags Bowel and bladder. Saddle paresthesia Fainting Drop attacks Heaviness in chest
Imaging study photo of house
Prior rehab or current rehab People who are helping
Pt Medications Injection
Fim What he does out of house Sf36 Dash Oswestry pain indices LefsOswestry pain indicesGive them brief history and Finally ask them if it reflects their problem LefsOswestry pain indicesGive them brief history and Finally ask them if it reflects their problem Give them brief history and Finally ask them if it reflects their problem Give them brief history and Finally ask them if it reflects their problem |
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Objective examination |
Weakness Malalignmnt Stiffness
Examination First
Active ROM contractile Sust
Passive ROM non contractile And end range of motion Overpressure End field Empty pain Springy block intra articular Soft hypermobility Bone elbow Firm give hypomotility Hard no give stiffness
However with biceps pathology Flexion no pain. Extension pain bc stretch Adhesive capsule both active and passive ROM affected
Examine above and below joint If nose affected look at ear and mouth
Cardinal planes and combined planes Accessory mobility testing Spin roll glide R 1/ r2 Grded as Normal hypomotility hypermobility
Joint problems Capsule patterns
Hip flex abd Int rot eyeliner Knee flex ext Ankle pf df Shoulder half lense ext rot abd internal rot Elbow flex extend Wrist flex extend Spine hair ext side bend rotation equally
Most to least limited
Impairment testing/ observation
Nose position length
Alignment Spine posture pelvis scapula patella leg length foot With pain abnormal alignment
Flexibility Ant pelvic tilt Quad tight
Thomas test If opposite leg flexed too much puts the pelvis in extreme posterior pelvic tilt And hip in abduction puts leg in abduction . One joint Knee extension Hip touches the table normal Thn out of bed 50 30 tightness 2 joint 2. One joint right 2 joint normal 1. One joint Knee extension Hip touches the table normalThn out of bed5030 tightness 2 joint2. One joint right 2 joint normalKnee extension lack 10 degree out of bed 90 knee normal2 joint3. Knee extension Thigh 10 degree offKnee flexion 50 30 tightness40 tight in 2 joint muscle Knee extension lack 10 degree out of bed 90 knee normal 2 joint 3. Knee extension Thigh 10 degree off Knee flexion 50 30 tightness 40 tight in 2 joint muscle 2) ober test Thigh drop to horizontal Modified with knee straight drop below horizontal Better Look at for femur internal rotation Hip flex Pelvic drop laterally 3) strength testing Near the concordant or chief complaint Strong and painless contractile not involved String and painful minor contractile
Weak and painful major lesion contractile Weak and painless complete rupture with neuro disorder All painful capsules sinister pathology Painful on repetition Intermittent claudication
Tone of muscle Break test slowly and gradually build up tight and weak so we can correct alignment Come to conclusion that what areas are tight and weak so we can correct alignmentSpecial tstPalpationNeurological test tight and weak so we can correct alignmentSpecial tstPalpationNeurological test tight and weak so we can correct alignmentSpecial tstPalpationNeurological test Special tst Palpation Neurological test Rule out and guess the pathology Rule out and guess the pathology Rule out and guess the pathology Rule out and guess the pathology Rule out and guess the pathology Rule out and guess the pathology Rule out and guess the pathology Rule out and guess the pathology Rule out and guess the pathology |
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Clinical reasoning Hypothesis testing |
Feedforward processing Apply past knowledge Like for oa patient
Feedback processing Using logic
5 subjective 3 objective
Hypothesis deductive reasoning
So we need to reassess
Avoid error Clinical reasoning By not looking at doctors diagnosis and just ask open ended not leading questions
Hypothesis testing 1.Diagnosis 2.Evaluation and management
Lateral elbow pain Common extensor origin Onset gradual repetitive microtrauma
Ass symptoms pain tenderness weakness agg gripping twisting easing rest Quality superficial cramp poor local pain Location lateral epicondyle ROM 0-100 active 5 less than passive Active and passive ROM In opposite direction
stretch test Cozens test contractile contractile contractile Muscle wrist extension.
ecrb ecrl 2.
Radiohumeral or superior radioulnar joint problem
Onset sudden or gradusl Ass none Agg movement and rest reduce well localized
Location radio capitellar JT or radial head
palpation radial head ROM active and passive ROM equal and painful in same Or capsules in same Or capsules
3. Posterior interrosous nerve Onset gradual or sudden
Ass symptom weakness Ag easing gripping supination rest Timing night Quality radiating
Location radial head or radial tunnel Special test mills test stretch testCozens test contractileMuscle wrist extension. Palpation ecrb ecrl 2. Radiohumeral or superior radioulnar joint problemOnset sudden or graduslAss noneAgg movement and rest reduceQuality dull boring well localizedLocation radio capitellar JT or radial headSpecial test palpation radial headROM active and passive ROM equal and painful in same Or capsules3. Posterior interrosous nerveOnset gradual or suddenAss symptom weaknessAg easing gripping supination restTiming nightQuality radiating Location radial head or radial tunnelROM opp directionSpecial test ul t t Muscle 3 Rd finger extension and forearm supination5.C5-6 radjculopathyLnset gradual or suddnWeakness and paresthesiaAgg cervical and shoulder ROM and easing hand placing top of head Quality sharp burning Location c5-6 dermatomeROM cervical ROM limitedSpecial tesg distraction neck compression test Positive ultt Neurological sensation strength Palpation over nerve trunkAlternative pathology 1.Fascia Anconeus compartment syndrome2. Bone Radial head fractureAvn of radial head 3. Organ mills test stretch testCozens test contractileMuscle wrist extension. Palpation ecrb ecrl 2. Radiohumeral or superior radioulnar joint problemOnset sudden or graduslAss noneAgg movement and rest reduceQuality dull boring well localizedLocation radio capitellar JT or radial headSpecial test palpation radial headROM active and passive ROM equal and painful in same Or capsules3. Posterior interrosous nerveOnset gradual or suddenAss symptom weaknessAg easing gripping supination restTiming nightQuality radiating Location radial head or radial tunnelROM opp directionSpecial test ul t t Muscle 3 Rd finger extension and forearm supination5.C5-6 radjculopathyLnset gradual or suddnWeakness and paresthesiaAgg cervical and shoulder ROM and easing hand placing top of head Quality sharp burning Location c5-6 dermatomeROM cervical ROM limitedSpecial tesg distraction neck compression test Positive ultt Neurological sensation strength Palpation over nerve trunkAlternative pathology 1.Fascia Anconeus compartment syndrome2. Bone Radial head fractureAvn of radial head 3. Organ
ROM opp direction Palpation ecrb ecrl 2. Radiohumeral or superior radioulnar joint problemOnset sudden or graduslAss noneAgg movement and rest reduceQuality dull boring well localizedLocation radio capitellar JT or radial headSpecial test palpation radial headROM active and passive ROM equal and painful in same Or capsules3. Posterior interrosous nerveOnset gradual or suddenAss symptom weaknessAg easing gripping supination restTiming nightQuality radiating Location radial head or radial tunnelROM opp directionSpecial test ul t t Muscle 3 Rd finger extension and forearm supination5.C5-6 radjculopathyLnset gradual or suddnWeakness and paresthesiaAgg cervical and shoulder ROM and easing hand placing top of head Quality sharp burning Location c5-6 dermatomeROM cervical ROM limitedSpecial tesg distraction neck compression test Positive ultt Neurological sensation strength Palpation over nerve trunkAlternative pathology 1.Fascia Anconeus compartment syndrome2. Bone Radial head fractureAvn of radial head 3. Organ Special test ul t t Muscle 3 Rd finger extension and forearm supination
5. Quality dull boring well localizedLocation radio capitellar JT or radial headSpecial test palpation radial headROM active and passive ROM equal and painful in same Or capsules3. Posterior interrosous nerveOnset gradual or suddenAss symptom weaknessAg easing gripping supination restTiming nightQuality radiating Location radial head or radial tunnelROM opp directionSpecial test ul t t Muscle 3 Rd finger extension and forearm supination5.C5-6 radjculopathyLnset gradual or suddnWeakness and paresthesiaAgg cervical and shoulder ROM and easing hand placing top of head Quality sharp burning Location c5-6 dermatomeROM cervical ROM limitedSpecial tesg distraction neck compression test Positive ultt Neurological sensation strength Palpation over nerve trunkAlternative pathology 1.Fascia Anconeus compartment syndrome2. Bone Radial head fractureAvn of radial head 3. Organ radjculopathy Lnset gradual or suddn Special test palpation radial headROM active and passive ROM equal and painful in same Or capsules3. Posterior interrosous nerveOnset gradual or suddenAss symptom weaknessAg easing gripping supination restTiming nightQuality radiating Location radial head or radial tunnelROM opp directionSpecial test ul t t Muscle 3 Rd finger extension and forearm supination5.C5-6 radjculopathyLnset gradual or suddnWeakness and paresthesiaAgg cervical and shoulder ROM and easing hand placing top of head Quality sharp burning Location c5-6 dermatomeROM cervical ROM limitedSpecial tesg distraction neck compression test Positive ultt Neurological sensation strength Palpation over nerve trunkAlternative pathology 1.Fascia Anconeus compartment syndrome2. Bone Radial head fractureAvn of radial head 3. Organ Weakness and paresthesia
Agg cervical and shoulder ROM and easing hand placing top of head Quality sharp burning Location c5-6 dermatome
ROM cervical ROM limited C5-6 radjculopathyLnset gradual or suddnWeakness and paresthesiaAgg cervical and shoulder ROM and easing hand placing top of head Quality sharp burning Location c5-6 dermatomeROM cervical ROM limitedSpecial tesg distraction neck compression test Positive ultt Neurological sensation strength Palpation over nerve trunkAlternative pathology 1.Fascia Anconeus compartment syndrome2. Bone Radial head fractureAvn of radial head 3. Organ Special tesg distraction neck compression test Agg cervical and shoulder ROM and easing hand placing top of head Quality sharp burning Location c5-6 dermatomeROM cervical ROM limitedSpecial tesg distraction neck compression test Positive ultt Neurological sensation strength Palpation over nerve trunkAlternative pathology 1.Fascia Anconeus compartment syndrome2. Bone Radial head fractureAvn of radial head 3. Positive ultt Neurological sensation strength Palpation over nerve trunk
Alternative pathology 1.Fascia Anconeus compartment syndrome 2. Bone Radial head fracture Avn of radial head
3. Synovium Posterolateral impingement Ergonomics Backhand tennis Racket geip small Strings too tight Playing wet heavy ball Repetivid activities like screwdriver painting typing stiffness stiffness Wrist Wrist affecting elbow Wrist flexors tight Give them prognosis How long it will take Example high irritability we have to go slowly
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Rate of healing Consist Time acute subacute chronic Healing time Individual tissue Positive and negative food |
Consist Proteoglycn protein Gag water Hyaluronic acid Inflammation 4-6 days 1 week acute phase Healing and repairing Pain less and loading joint 2- 3rd week Maturing and remodelling At rest no pain And adl
1 year - 2 year First two week 50% healed 6 th week- 80% healed 12 th seek 100% healed Strengthing takes till year Chronic pain Beyond 6 months Collagen tissue immature Because overload and reinjury Tendon and ligament insertion 15-18 months 80% normal strength Ligament or else 8-9 weeks 100% Muscle 6 weeks to 6 months 90% Bone 12 weeks 100% Cartiage 6 months type 1 and 2 Scar tissue type 3 to type 1 but with less vascularity Diet helps Protein Votmin A liver carrot Vitamin b 1 5 VI tamin c Zinc Magnesium Copper Negative Smoking Steriod Alcohol Food sensitivities milk caffeine gluten GI symptoms |
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Treatment |
Hj |
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Treatment |
Acute Pain dominant Price regimen Contractile isometrics for pumping swelling Non contractile prom mobilization graded Movement for the ab and below joint Alignment Taping bracing Subacute Stiffness dominant Mobilization Manipulation Neurophysiology Mechanoreceptor Resetting gto Gste control SSympathoexcitatory Immediately relief Gste controlSSympathoexcitatory Immediately relief Pop is heard when there is a sudden change in joint intra articular fluid pressure SSympathoexcitatory Immediately relief Pop is heard when there is a sudden change in joint intra articular fluid pressure SSympathoexcitatory Immediately relief Pop is heard when there is a sudden change in joint intra articular fluid pressure Pop is heard when there is a sudden change in joint intra articular fluid pressure Heard due to speed Vaccum effect when pulls gas Pop as cavitations Done 2 times only without pop Saddle Cmc Ellipsoidal MCP Non contractile Capsule Physiological motions Met pnf contract relax Repetitive movments Mwm Sustained holds or position Creep the structure Dynamic splint Accessory motion Mob Resting position Shoulder abd 55 ext rot 30 Ulnohumeral 90 flex Wrist neutral and slight dorsiflexion First cmc neutral thumb Hip 30 flesx abd 30 ext rotation 20 Knee 25 flex Ankle neutral Tarsal semiflex Mtp and spine neutral Amplitude G 1 small pain G2/ large pain G3 lsrge to limit stiffness G 4 small to liimit end range high velocity Oscillatory 1-5 rep 5-60 sec hold Static hold 1-5 rep 5&30 sec hold Stiffness Low load duration 20 mins Instability / weakness Radiohumeral forearm neutral half sup and pron and 25 flexWrist neutral and slight dorsiflexionFirst cmc neutral thumb IP semi flexHip 30 flesx abd 30 ext rotation 20Knee 25 flexAnkle neutralTarsal semiflexMtp and spine neutral Amplitude G 1 small pain G2/ large painG3 lsrge to limit stiffness G 4 small to liimit end range G 5 high velocity Oscillatory 60-120 min 1-5 rep5-60 sec hold Static hold 1-5 rep 5&30 sec holdStiffness Low load duration20 mins Instability / weakness Post activity pain Full motion ( eye)Or by using other joints to complete motion. Soft end field Flexibility increased StrengthingPositioningHip extensor With independent activation. Hold 10 sec 10 rep 2* hourly Progress Isometrics holdTonic hold like planks with synergic muscles trunk curl upsSquats lunges superman bird dog planks Bird dog to standing Multiple muscles togetherStabilization Dynamic like therapy ballIntegrative training And drop on ground for Weight bearing Post activity pain flexWrist neutral and slight dorsiflexionFirst cmc neutral thumb IP semi flexHip 30 flesx abd 30 ext rotation 20Knee 25 flexAnkle neutralTarsal semiflexMtp and spine neutral Amplitude G 1 small pain G2/ large painG3 lsrge to limit stiffness G 4 small to liimit end range G 5 high velocity Oscillatory 60-120 min 1-5 rep5-60 sec hold Static hold 1-5 rep 5&30 sec holdStiffness Low load duration20 mins Instability / weakness Post activity pain Full motion ( eye)Or by using other joints to complete motion. Soft end field Flexibility increased StrengthingPositioningHip extensor With independent activation. Hold 10 sec 10 rep 2* hourly Progress Isometrics holdTonic hold like planks with synergic muscles trunk curl upsSquats lunges superman bird dog planks Bird dog to standing Multiple muscles togetherStabilization Dynamic like therapy ballIntegrative training And drop on ground for Weight bearing Full motion ( eye) IP semi flexHip 30 flesx abd 30 ext rotation 20Knee 25 flexAnkle neutralTarsal semiflexMtp and spine neutral Amplitude G 1 small pain G2/ large painG3 lsrge to limit stiffness G 4 small to liimit end range G 5 high velocity Oscillatory 60-120 min 1-5 rep5-60 sec hold Static hold 1-5 rep 5&30 sec holdStiffness Low load duration20 mins Instability / weakness Post activity pain Full motion ( eye)Or by using other joints to complete motion. Soft end field Flexibility increased StrengthingPositioningHip extensor With independent activation. Hold 10 sec 10 rep 2* hourly Progress Isometrics holdTonic hold like planks with synergic muscles trunk curl upsSquats lunges superman bird dog planks Bird dog to standing Multiple muscles togetherStabilization Dynamic like therapy ballIntegrative training And drop on ground for Weight bearing Or by using other joints to complete motion. Soft end field Flexibility increased Strengthing Hip extensor G 5 high velocity Oscillatory 60-120 min 1-5 rep5-60 sec hold Static hold 1-5 rep 5&30 sec holdStiffness Low load duration20 mins Instability / weakness Post activity pain Full motion ( eye)Or by using other joints to complete motion. Soft end field Flexibility increased StrengthingPositioningHip extensor With independent activation. Hold 10 sec 10 rep 2* hourly Progress Isometrics holdTonic hold like planks with synergic muscles trunk curl upsSquats lunges superman bird dog planks Bird dog to standing Multiple muscles togetherStabilization Dynamic like therapy ballIntegrative training And drop on ground for Weight bearing With independent activation. 60-120 min 1-5 rep5-60 sec hold Static hold 1-5 rep 5&30 sec holdStiffness Low load duration20 mins Instability / weakness Post activity pain Full motion ( eye)Or by using other joints to complete motion. Soft end field Flexibility increased StrengthingPositioningHip extensor With independent activation. Hold 10 sec 10 rep 2* hourly Progress Isometrics holdTonic hold like planks with synergic muscles trunk curl upsSquats lunges superman bird dog planks Bird dog to standing Multiple muscles togetherStabilization Dynamic like therapy ballIntegrative training And drop on ground for Weight bearing 120 min 1-5 rep5-60 sec hold Static hold 1-5 rep 5&30 sec holdStiffness Low load duration20 mins Instability / weakness Post activity pain Full motion ( eye)Or by using other joints to complete motion. Soft end field Flexibility increased StrengthingPositioningHip extensor With independent activation. Hold 10 sec 10 rep 2* hourly Progress Isometrics holdTonic hold like planks with synergic muscles trunk curl upsSquats lunges superman bird dog planks Bird dog to standing Multiple muscles togetherStabilization Dynamic like therapy ballIntegrative training And drop on ground for Weight bearing 120 min 1-5 rep5-60 sec hold Static hold 1-5 rep 5&30 sec holdStiffness Low load duration20 mins Instability / weakness Post activity pain Full motion ( eye)Or by using other joints to complete motion. Soft end field Flexibility increased StrengthingPositioningHip extensor With independent activation. Hold 10 sec 10 rep 2* hourly Progress Isometrics holdTonic hold like planks with synergic muscles trunk curl upsSquats lunges superman bird dog planks Bird dog to standing Multiple muscles togetherStabilization Dynamic like therapy ballIntegrative training And drop on ground for Weight bearing Hold 10 sec 10 rep 2* hourly Progress Instability / weakness Post activity pain Full motion ( eye)Or by using other joints to complete motion. Soft end field Flexibility increased StrengthingPositioningHip extensor With independent activation. Hold 10 sec 10 rep 2* hourly Progress Isometrics holdTonic hold like planks with synergic muscles trunk curl upsSquats lunges superman bird dog planks Bird dog to standing Multiple muscles togetherStabilization Dynamic like therapy ballIntegrative training And drop on ground for Weight bearing Isometrics hold Tonic hold like planks with synergic muscles trunk curl ups PositioningHip extensor With independent activation. Hold 10 sec 10 rep 2* hourly Progress Isometrics holdTonic hold like planks with synergic muscles trunk curl upsSquats lunges superman bird dog planks Bird dog to standing Multiple muscles togetherStabilization Dynamic like therapy ballIntegrative training And drop on ground for Weight bearing Squats lunges superman bird dog planks bird dog planks
Bird dog to standing Multiple muscles together Stabilization
Dynamic like therapy ballIntegrative training And drop on ground for Weight bearing Manipulation |
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Cervical spine |
Foramina diameter Flexion. Increase Extension decrease Ipsilateral side bending and rotation 8 spinal nerve root C 4 -5 C 5 nerve root affected Facet joint C 2 first palpation Ligaments Ligamentum nuchae Controls flexion 45 degreesC 2 first palpation Ligaments Ligamentum nuchae Controls flexionLigamentum flavum Spinal stenosis Controls extensionPll Widest in cervical spine All Ligamentum flavum C 2 first palpation Ligaments Ligamentum nuchae Controls flexionLigamentum flavum Spinal stenosis Controls extensionPll Widest in cervical spine All C 2 first palpation Ligaments Ligamentum nuchae Controls flexionLigamentum flavum Spinal stenosis Controls extensionPll Widest in cervical spine All Spinal stenosis Controls extension Pll Widest in cervical spine All Alar ligament Tectorial membrane Cruciate ligament ascending descending transverse Disk Endplate and disc Biomechanics Upper cervical spine Yes nodding Biconcave Axis at ear Side bending Axis nose Mia lps Mia has nice lps C1-2 Biconvex Rotation Lower cervical spine Cervicothoracic spine C1-2 rotation Anterior displacment of same side Posterior displacement of superior articulate facet opposite side C2-3 6-7 Flex extend up and forward down and backward Side bending Nd rotation |
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Pathophysiology of cervical spine |
Nerve Degenerative spondylosis . Posterior thinning of disc Intervertebral foramina Nerve root impingement Neck and upper extremity pain Deep aching pain Progress to spinal cord Cord compression. Unilateral or bilateral lower extremity Upper motor extremity signs Hyperreflexia Clonus Babinski Loss of finger dexterity Gait Hoffman Sensory Bowel and bladder Artery Vertebral artery. to basiliar artery DiZiness Diplopia Dysarthria Dysphagia Drop attacks Light headed Joint Djd at facet joint No radicular symptoms And restricted ROM Hypomotility Negative neuro exam Hypermobility Instability Neutral zone By segmental mobility testing Initial ROM Toe region Elastic zone End range Stress and. Strain Symptoms Intolerance to sustained posture Fatigue Neck gets locked Lying better than sitting Objective Motor strength Arom hypermobility Example torticollis Too quickly turn to right Traoing the capsule meniscoid At c2-3 And need to mobilize it So main hypermobility Subclavian artery to basiliar artery DiZiness Diplopia DysarthriaDysphagiaDrop attacks Light headedSyncopeJoint Djd Hypomotility due to osteophytes at facet jointNo radicular symptomsAnd restricted ROM HypomotilityNegative neuro exam HypermobilityInstabilityNeutral zone By segmental mobility testing Initial ROMToe region Elastic zone End range Stress and. Strain SymptomsIntolerance to sustained postureFatigueFrequent manipulationNeck gets locked Lying better than sitting Objective Motor strength Arom hypermobilityExample torticollis Too quickly turn to rightTraoing the capsule meniscoidAt c2-3 And need to mobilize itSo main hypermobilitySo needs cervical stabilityLigament ossified pll Hypertrophic and bone formation narrow spinal canal and central stenosisCruciate ligamentRaA s Downs syndromeWeak or LAX cruciate ligament and dens Red flags Numbness in head HeadachesMyelopathyUpper cervical painROM stiffness not willing to move Disk herniationSoft disc herniationWithout arthritic changesPain to shoulderScapula Not elbow Flexion causes painBone Fracture Crepitus palpationSevere pain on compression ROM limited Painful weakness in isometrics Jefferson c1 vertebraDens c2 or dens fractureClay shoveler 1 or more spinous processDeconditioned people with manual labor when extended fractures artery to basiliar artery DiZiness Diplopia DysarthriaDysphagiaDrop attacks Light headedSyncopeJoint Djd Hypomotility due to osteophytes at facet jointNo radicular symptomsAnd restricted ROM HypomotilityNegative neuro exam HypermobilityInstabilityNeutral zone By segmental mobility testing Initial ROMToe region Elastic zone End range Stress and. Strain SymptomsIntolerance to sustained postureFatigueFrequent manipulationNeck gets locked Lying better than sitting Objective Motor strength Arom hypermobilityExample torticollis Too quickly turn to rightTraoing the capsule meniscoidAt c2-3 And need to mobilize itSo main hypermobilitySo needs cervical stabilityLigament ossified pll Hypertrophic and bone formation narrow spinal canal and central stenosisCruciate ligamentRaA s Downs syndromeWeak or LAX cruciate ligament and dens Red flags Numbness in head HeadachesMyelopathyUpper cervical painROM stiffness not willing to move Disk herniationSoft disc herniationWithout arthritic changesPain to shoulderScapula Not elbow Flexion causes painBone Fracture Crepitus palpationSevere pain on compression ROM limited Painful weakness in isometrics Jefferson c1 vertebraDens c2 or dens fractureClay shoveler 1 or more spinous processDeconditioned people with manual labor when extended fractures So needs cervical stability Ligament ossified pll SyncopeJoint Djd Hypomotility due to osteophytes at facet jointNo radicular symptomsAnd restricted ROM HypomotilityNegative neuro exam HypermobilityInstabilityNeutral zone By segmental mobility testing Initial ROMToe region Elastic zone End range Stress and. Strain SymptomsIntolerance to sustained postureFatigueFrequent manipulationNeck gets locked Lying better than sitting Objective Motor strength Arom hypermobilityExample torticollis Too quickly turn to rightTraoing the capsule meniscoidAt c2-3 And need to mobilize itSo main hypermobilitySo needs cervical stabilityLigament ossified pll Hypertrophic and bone formation narrow spinal canal and central stenosisCruciate ligamentRaA s Downs syndromeWeak or LAX cruciate ligament and dens Red flags Numbness in head HeadachesMyelopathyUpper cervical painROM stiffness not willing to move Disk herniationSoft disc herniationWithout arthritic changesPain to shoulderScapula Not elbow Flexion causes painBone Fracture Crepitus palpationSevere pain on compression ROM limited Painful weakness in isometrics Jefferson c1 vertebraDens c2 or dens fractureClay shoveler 1 or more spinous processDeconditioned people with manual labor when extended fractures Hypomotility due to osteophytes at facet jointNo radicular symptomsAnd restricted ROM HypomotilityNegative neuro exam HypermobilityInstabilityNeutral zone By segmental mobility testing Initial ROMToe region Elastic zone End range Stress and. Strain SymptomsIntolerance to sustained postureFatigueFrequent manipulationNeck gets locked Lying better than sitting Objective Motor strength Arom hypermobilityExample torticollis Too quickly turn to rightTraoing the capsule meniscoidAt c2-3 And need to mobilize itSo main hypermobilitySo needs cervical stabilityLigament ossified pll Hypertrophic and bone formation narrow spinal canal and central stenosisCruciate ligamentRaA s Downs syndromeWeak or LAX cruciate ligament and dens Red flags Numbness in head HeadachesMyelopathyUpper cervical painROM stiffness not willing to move Disk herniationSoft disc herniationWithout arthritic changesPain to shoulderScapula Not elbow Flexion causes painBone Fracture Crepitus palpationSevere pain on compression ROM limited Painful weakness in isometrics Jefferson c1 vertebraDens c2 or dens fractureClay shoveler 1 or more spinous processDeconditioned people with manual labor when extended fractures at facet jointNo radicular symptomsAnd restricted ROM HypomotilityNegative neuro exam HypermobilityInstabilityNeutral zone By segmental mobility testing Initial ROMToe region Elastic zone End range Stress and. Strain SymptomsIntolerance to sustained postureFatigueFrequent manipulationNeck gets locked Lying better than sitting Objective Motor strength Arom hypermobilityExample torticollis Too quickly turn to rightTraoing the capsule meniscoidAt c2-3 And need to mobilize itSo main hypermobilitySo needs cervical stabilityLigament ossified pll Hypertrophic and bone formation narrow spinal canal and central stenosisCruciate ligamentRaA s Downs syndromeWeak or LAX cruciate ligament and dens Red flags Numbness in head HeadachesMyelopathyUpper cervical painROM stiffness not willing to move Disk herniationSoft disc herniationWithout arthritic changesPain to shoulderScapula Not elbow Flexion causes painBone Fracture Crepitus palpationSevere pain on compression ROM limited Painful weakness in isometrics Jefferson c1 vertebraDens c2 or dens fractureClay shoveler 1 or more spinous processDeconditioned people with manual labor when extended fractures Hypertrophic and bone formation narrow spinal canal and central stenosis Cruciate ligament Ra A s Downs syndrome Weak or LAX cruciate ligament and dens Red flags Frequent manipulationNeck gets locked Lying better than sitting Objective Motor strength Arom hypermobilityExample torticollis Too quickly turn to rightTraoing the capsule meniscoidAt c2-3 And need to mobilize itSo main hypermobilitySo needs cervical stabilityLigament ossified pll Hypertrophic and bone formation narrow spinal canal and central stenosisCruciate ligamentRaA s Downs syndromeWeak or LAX cruciate ligament and dens Red flags Numbness in head HeadachesMyelopathyUpper cervical painROM stiffness not willing to move Disk herniationSoft disc herniationWithout arthritic changesPain to shoulderScapula Not elbow Flexion causes painBone Fracture Crepitus palpationSevere pain on compression ROM limited Painful weakness in isometrics Jefferson c1 vertebraDens c2 or dens fractureClay shoveler 1 or more spinous processDeconditioned people with manual labor when extended fractures Numbness in head Headaches Myelopathy Upper cervical pain ROM stiffness not willing to move herniation Soft disc herniation Without arthritic changes Pain to shoulder Scapula Not elbow Flexion causes pain Bone Fracture Crepitus palpation Severe pain on compression Disk herniationSoft disc herniationWithout arthritic changesPain to shoulderScapula Not elbow Flexion causes painBone Fracture Crepitus palpationSevere pain on compression ROM limited Painful weakness in isometrics Jefferson c1 vertebraDens c2 or dens fractureClay shoveler 1 or more spinous processDeconditioned people with manual labor when extended fractures ROM limited Painful weakness in isometrics Jefferson c1 vertebra Dens c2 or dens fracture Clay shoveler 1 or more spinous process Deconditioned people with manual labor when extended fractures |
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Thoracic spine |
Mouth Common site for cancer Palpation T6 On top of t7 vertebra Rib like the gum on the tooth So we have the costovertebral joint with radiate ligament Physiological movement Flexion superior facet upward and forward Downward superior and backward Symptoms Inflammation Costochondritis Pain radiates to arm anterior pain Local tenderness
Shingles herpes zoster Reactive chicken pox Affects spinal gsnglis Radicular pain Itching Paresthesia Rash dermatome T 5-10 Structure Bone Schuermann disease Anterior wedge of vertebra Fixed kyphosis Stretch concave and strength convex Anklyosing spondylitis Arthritis Fusion and ossification Bamboo spine Diffuse back pain Morning pain decrease with movement Spinal stiffness No neuro signs Scoliosis Idiopathic 80% CP muscular dystrophy polio sci Affects ribs so respiratory problems fracture Pain with movement Tap test Difficulty breathing Prolonged steriod use Rib fracturePain with movement Tap test Difficulty breathing Prolonged steriod use Compression. FractureMostly Osteoporosis Anterior wedging Flexion most painMay be history of trauma Compression. Fracture Mostly Osteoporosis Anterior wedging Flexion most pain May be history of trauma Tap test positive Djd Tooth morning breath Morning stiffness Disc herniation Lower thoracic pain Bandlike pain Flexion most painful Slump test positive Thoracic outlet syndrome Tunnels made up of Muscle Bone. Bony tunnel Clavicle superior Inferior 1st rib Lateral g h JT Medial spine c7 Large c7 transverse Elevation 1 St rib Fracture clavicle G h JT arthritis Muscle tunnel Medial scalene Lateral pec minor Content Brachial plexus Subclavian and axillary aetery and vein 25-40 Common in females 1 St rib elevation Commo. Cause Scalene powerful contraction in breathing Elevated the rib O trauma at scalene muscle T 1 nerve root Arterial stage Ischemic Colness Pulse less Disc herniationRareLower thoracic painBandlike pain Flexion most painfulSlump test positive Thoracic outlet syndromeTunnels made up ofMuscleBone.Bony tunnelClavicle superior Inferior 1st rib Lateral g h JT Medial spine c7 Large c7 transverseElevation 1 St rib Fracture clavicle G h JT arthritis Muscle tunnel Medial scalene Lateral pec minor Content Brachial plexus Subclavian and axillary aetery and vein 25-40 Common in females 1 St rib elevation Commo. Cause Scalene powerful contraction in breathingElevated the rib O trauma at scalene muscle T 1 nerve root Arterial stage Ischemic Colness PainPulse less Subclavian artery nerve compression. Venous Cyanotic Ue swellingHeaviness Subclavian axillary vein Less commo ln Neurogenic Common True neurogenic C 8-t1 Pain ParesthesiaPositive emg Non specific neurogenic Dysfunction in bony and muscular tunnelIrritability of nerve Lateral neck and supraclavicular pain. Median and ulnar nerveBurning tingling numbness Arm over the headSide bending headRepetitive mocmen of handSleeping over headEasing support and holding close to bodyMostly poor posture4 common signs in tos Positive ultt Paradoxical breathingScalene Pec minor tendernessRoos adson militaryNot only pulse absent but also Numbness and tingling Subclavian artery nerve compression. RareLower thoracic painBandlike pain Flexion most painfulSlump test positive Thoracic outlet syndromeTunnels made up ofMuscleBone.Bony tunnelClavicle superior Inferior 1st rib Lateral g h JT Medial spine c7 Large c7 transverseElevation 1 St rib Fracture clavicle G h JT arthritis Muscle tunnel Medial scalene Lateral pec minor Content Brachial plexus Subclavian and axillary aetery and vein 25-40 Common in females 1 St rib elevation Commo. Cause Scalene powerful contraction in breathingElevated the rib O trauma at scalene muscle T 1 nerve root Arterial stage Ischemic Colness PainPulse less Subclavian artery nerve compression. Venous Cyanotic Ue swellingHeaviness Subclavian axillary vein Less commo ln Neurogenic Common True neurogenic C 8-t1 Pain ParesthesiaPositive emg Non specific neurogenic Dysfunction in bony and muscular tunnelIrritability of nerve Lateral neck and supraclavicular pain. Median and ulnar nerveBurning tingling numbness Arm over the headSide bending headRepetitive mocmen of handSleeping over headEasing support and holding close to bodyMostly poor posture4 common signs in tos Positive ultt Paradoxical breathingScalene Pec minor tendernessRoos adson militaryNot only pulse absent but also Numbness and tingling RareLower thoracic painBandlike pain Flexion most painfulSlump test positive Thoracic outlet syndromeTunnels made up ofMuscleBone.Bony tunnelClavicle superior Inferior 1st rib Lateral g h JT Medial spine c7 Large c7 transverseElevation 1 St rib Fracture clavicle G h JT arthritis Muscle tunnel Medial scalene Lateral pec minor Content Brachial plexus Subclavian and axillary aetery and vein 25-40 Common in females 1 St rib elevation Commo. Cause Scalene powerful contraction in breathingElevated the rib O trauma at scalene muscle T 1 nerve root Arterial stage Ischemic Colness PainPulse less Subclavian artery nerve compression. Venous Cyanotic Ue swellingHeaviness Subclavian axillary vein Less commo ln Neurogenic Common True neurogenic C 8-t1 Pain ParesthesiaPositive emg Non specific neurogenic Dysfunction in bony and muscular tunnelIrritability of nerve Lateral neck and supraclavicular pain. Median and ulnar nerveBurning tingling numbness Arm over the headSide bending headRepetitive mocmen of handSleeping over headEasing support and holding close to bodyMostly poor posture4 common signs in tos Positive ultt Paradoxical breathingScalene Pec minor tendernessRoos adson militaryNot only pulse absent but also Numbness and tingling Venous Cyanotic Ue swelling Heaviness Tunnels made up ofMuscleBone.Bony tunnelClavicle superior Inferior 1st rib Lateral g h JT Medial spine c7 Large c7 transverseElevation 1 St rib Fracture clavicle G h JT arthritis Muscle tunnel Medial scalene Lateral pec minor Content Brachial plexus Subclavian and axillary aetery and vein 25-40 Common in females 1 St rib elevation Commo. Cause Scalene powerful contraction in breathingElevated the rib O trauma at scalene muscle T 1 nerve root Arterial stage Ischemic Colness PainPulse less Subclavian artery nerve compression. Venous Cyanotic Ue swellingHeaviness Subclavian axillary vein Less commo ln Neurogenic Common True neurogenic C 8-t1 Pain ParesthesiaPositive emg Non specific neurogenic Dysfunction in bony and muscular tunnelIrritability of nerve Lateral neck and supraclavicular pain. Median and ulnar nerveBurning tingling numbness Arm over the headSide bending headRepetitive mocmen of handSleeping over headEasing support and holding close to bodyMostly poor posture4 common signs in tos Positive ultt Paradoxical breathingScalene Pec minor tendernessRoos adson militaryNot only pulse absent but also Numbness and tingling Subclavian axillary vein Less commo ln Neurogenic Common True neurogenic C 8-t1 Pain Positive emg Non specific neurogenic Irritability of nerve Lateral neck and supraclavicular pain. PainPulse less Subclavian artery nerve compression. Venous Cyanotic Ue swellingHeaviness Subclavian axillary vein Less commo ln Neurogenic Common True neurogenic C 8-t1 Pain ParesthesiaPositive emg Non specific neurogenic Dysfunction in bony and muscular tunnelIrritability of nerve Lateral neck and supraclavicular pain. Median and ulnar nerveBurning tingling numbness Arm over the headSide bending headRepetitive mocmen of handSleeping over headEasing support and holding close to bodyMostly poor posture4 common signs in tos Positive ultt Paradoxical breathingScalene Pec minor tendernessRoos adson militaryNot only pulse absent but also Numbness and tingling Median and ulnar nerve Burning tingling numbness Arm over the head Side bending head Repetitive mocmen of hand ParesthesiaPositive emg Non specific neurogenic Dysfunction in bony and muscular tunnelIrritability of nerve Lateral neck and supraclavicular pain. Median and ulnar nerveBurning tingling numbness Arm over the headSide bending headRepetitive mocmen of handSleeping over headEasing support and holding close to bodyMostly poor posture4 common signs in tos Positive ultt Paradoxical breathingScalene Pec minor tendernessRoos adson militaryNot only pulse absent but also Numbness and tingling Sleeping over head Dysfunction in bony and muscular tunnelIrritability of nerve Lateral neck and supraclavicular pain. Median and ulnar nerveBurning tingling numbness Arm over the headSide bending headRepetitive mocmen of handSleeping over headEasing support and holding close to bodyMostly poor posture4 common signs in tos Positive ultt Paradoxical breathingScalene Pec minor tendernessRoos adson militaryNot only pulse absent but also Numbness and tingling Irritability of nerve Lateral neck and supraclavicular pain. Median and ulnar nerveBurning tingling numbness Arm over the headSide bending headRepetitive mocmen of handSleeping over headEasing support and holding close to bodyMostly poor posture4 common signs in tos Positive ultt Paradoxical breathingScalene Pec minor tendernessRoos adson militaryNot only pulse absent but also Numbness and tingling Easing support and holding close to body Mostly poor posture 4 common signs in tos Positive ultt Paradoxical breathing Scalene Mostly poor posture4 common signs in tos Positive ultt Paradoxical breathingScalene Pec minor tendernessRoos adson militaryNot only pulse absent but also Numbness and tingling Pec minor tenderness Roos adson militaryNot only pulse absent but also Numbness and tingling Not only pulse absent but also Not only pulse absent but also Numbness and tingling but also Numbness and tingling |
Bilaterally |
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Tmj |
Above 3 bones Temporal bone ( temporalis muscle) Zygomatic arch ( Masseter ) Medial pterygoid closes the mouth
Both for jaw closure Sphenoid bone ( lateral pterygoid muscle ) Protrusion Upper portion. Lower portion Chewing Auricularis anterior and superior Wiggle ears Cranial nerve Ophthalmic nerve Maxillary. Mandibular nerve Eye forehead Sinus Diff pain back to ear Ear symptom Digastric muscle ham Anterior belly Trigeminal and other nerve Depress mandible Below 1 bone Ginglymoarthrordial joint G hindge A glide. Depression. Mouth opening Normal more 40 mm 40-30 fork 30 20 piecds 20 push food Protrusion 4-6 mm Lateral deviation 10 mm Close med pterygoid temp mast Open lat pterygoid digastric Retrusion stylohyoid geniohyoid. Mylohyoid Tmd Signs and symptoms Pain muscle of mastication And front of ear lateral face pain Join clicking popping crepitus Ass symptoms Headache Ear pain Dizziness inner ear and tmj attached Pressure. In middle ear Muscle hypertrophy Muscle atrophy Malocclusion Tmd classification Capsulitis / synovitis Macrotrauma Microtrauma chewing on jaw post op operation
Pain at rest Pain at palpation Pain with loading on contralateral side Bc ipsi contract and contra distraction Capsular fibrosis Hypomotility Opening less than25 mm Deviation towards the affected side No joint sounds Not painful just stiffness Tmd classified muscle disorders Pain on palpation. Hypermobility Click thud Causes subluxation Yawning eating Opening 60 mm more Trauma Dislocation Pain at rest Pain at palpationPain with loading on contralateral sideBc ipsi contract and contra distractionCapsular fibrosis Hypomotility Opening less than25 mm Deviation towards the affected side No joint soundsNot painful just stiffnessTmd classified3. Masticatory muscle disorders Pain on palpation.HypermobilityClick thud Causes subluxation Yawning eating Opening 60 mm moreTrauma Dislocation No pain but muscle guarding pain Anterior disc displacement Open straight deviates c shapes curve and comes back straight downReciprocal joint sounds.OsteoarthritisUnilateral involvedPain with palpationLimit opening Crepitus heard with stethoscopeRadiographR a Bilateral InvolvedBony ankylosis Fibrous ankylosis trauma or surgery Intracapsular Treatment Pain scale Jaw disability checklist Improve in 6-8 weeks .cannot be cured Pain at rest Pain at palpationPain with loading on contralateral sideBc ipsi contract and contra distractionCapsular fibrosis Hypomotility Opening less than25 mm Deviation towards the affected side No joint soundsNot painful just stiffnessTmd classified3. Masticatory muscle disorders Pain on palpation.HypermobilityClick thud Causes subluxation Yawning eating Opening 60 mm moreTrauma Dislocation No pain but muscle guarding pain Anterior disc displacement Open straight deviates c shapes curve and comes back straight downReciprocal joint sounds.OsteoarthritisUnilateral involvedPain with palpationLimit opening Crepitus heard with stethoscopeRadiographR a Bilateral InvolvedBony ankylosis Fibrous ankylosis trauma or surgery Intracapsular Treatment Pain scale Jaw disability checklist Improve in 6-8 weeks .cannot be cured Pain at rest Pain at palpationPain with loading on contralateral sideBc ipsi contract and contra distractionCapsular fibrosis Hypomotility Opening less than25 mm Deviation towards the affected side No joint soundsNot painful just stiffnessTmd classified3. Masticatory muscle disorders Pain on palpation.HypermobilityClick thud Causes subluxation Yawning eating Opening 60 mm moreTrauma Dislocation No pain but muscle guarding pain Anterior disc displacement Open straight deviates c shapes curve and comes back straight downReciprocal joint sounds.OsteoarthritisUnilateral involvedPain with palpationLimit opening Crepitus heard with stethoscopeRadiographR a Bilateral InvolvedBony ankylosis Fibrous ankylosis trauma or surgery Intracapsular Treatment Pain scale Jaw disability checklist Improve in 6-8 weeks .cannot be cured Pain at rest Pain at palpationPain with loading on contralateral sideBc ipsi contract and contra distractionCapsular fibrosis Hypomotility Opening less than25 mm Deviation towards the affected side No joint soundsNot painful just stiffnessTmd classified3. Masticatory muscle disorders Pain on palpation.HypermobilityClick thud Causes subluxation Yawning eating Opening 60 mm moreTrauma Dislocation No pain but muscle guarding pain Anterior disc displacement Open straight deviates c shapes curve and comes back straight downReciprocal joint sounds.OsteoarthritisUnilateral involvedPain with palpationLimit opening Crepitus heard with stethoscopeRadiographR a Bilateral InvolvedBony ankylosis Fibrous ankylosis trauma or surgery Intracapsular Treatment Pain scale Jaw disability checklist Improve in 6-8 weeks .cannot be cured Pain at rest Pain at palpationPain with loading on contralateral sideBc ipsi contract and contra distractionCapsular fibrosis Hypomotility Opening less than25 mm Deviation towards the affected side No joint soundsNot painful just stiffnessTmd classified3. Masticatory muscle disorders Pain on palpation.HypermobilityClick thud Causes subluxation Yawning eating Opening 60 mm moreTrauma Dislocation No pain but muscle guarding pain Anterior disc displacement Open straight deviates c shapes curve and comes back straight downReciprocal joint sounds.OsteoarthritisUnilateral involvedPain with palpationLimit opening Crepitus heard with stethoscopeRadiographR a Bilateral InvolvedBony ankylosis Fibrous ankylosis trauma or surgery Intracapsular Treatment Pain scale Jaw disability checklist Improve in 6-8 weeks .cannot be cured No pain but muscle guarding pain Anterior disc displacement No pain but muscle guarding pain Anterior disc displacement Open straight deviates c shapes curve and comes back straight downReciprocal joint sounds. Open straight deviates c shapes curve and comes back straight down Tmd classified3. Masticatory muscle disorders Pain on palpation.HypermobilityClick thud Causes subluxation Yawning eating Opening 60 mm moreTrauma Dislocation No pain but muscle guarding pain Anterior disc displacement Open straight deviates c shapes curve and comes back straight downReciprocal joint sounds.OsteoarthritisUnilateral involvedPain with palpationLimit opening Crepitus heard with stethoscopeRadiographR a Bilateral InvolvedBony ankylosis Fibrous ankylosis trauma or surgery Intracapsular Treatment Pain scale Jaw disability checklist Improve in 6-8 weeks .cannot be cured Tmd classified3. Masticatory muscle disorders Pain on palpation.HypermobilityClick thud Causes subluxation Yawning eating Opening 60 mm moreTrauma Dislocation No pain but muscle guarding pain Anterior disc displacement Open straight deviates c shapes curve and comes back straight downReciprocal joint sounds.OsteoarthritisUnilateral involvedPain with palpationLimit opening Crepitus heard with stethoscopeRadiographR a Bilateral InvolvedBony ankylosis Fibrous ankylosis trauma or surgery Intracapsular Treatment Pain scale Jaw disability checklist Improve in 6-8 weeks .cannot be cured Tmd classified3. Masticatory muscle disorders Pain on palpation.HypermobilityClick thud Causes subluxation Yawning eating Opening 60 mm moreTrauma Dislocation No pain but muscle guarding pain Anterior disc displacement Open straight deviates c shapes curve and comes back straight downReciprocal joint sounds.OsteoarthritisUnilateral involvedPain with palpationLimit opening Crepitus heard with stethoscopeRadiographR a Bilateral InvolvedBony ankylosis Fibrous ankylosis trauma or surgery Intracapsular Treatment Pain scale Jaw disability checklist Improve in 6-8 weeks .cannot be cured Tmd classified3. Masticatory muscle disorders Pain on palpation.HypermobilityClick thud Causes subluxation Yawning eating Opening 60 mm moreTrauma Dislocation No pain but muscle guarding pain Anterior disc displacement Open straight deviates c shapes curve and comes back straight downReciprocal joint sounds.OsteoarthritisUnilateral involvedPain with palpationLimit opening Crepitus heard with stethoscopeRadiographR a Bilateral InvolvedBony ankylosis Fibrous ankylosis trauma or surgery Intracapsular Treatment Pain scale Jaw disability checklist Improve in 6-8 weeks .cannot be cured Reciprocal joint sounds. 3. Masticatory muscle disorders Pain on palpation.HypermobilityClick thud Causes subluxation Yawning eating Opening 60 mm moreTrauma Dislocation No pain but muscle guarding pain Anterior disc displacement Open straight deviates c shapes curve and comes back straight downReciprocal joint sounds.OsteoarthritisUnilateral involvedPain with palpationLimit opening Crepitus heard with stethoscopeRadiographR a Bilateral InvolvedBony ankylosis Fibrous ankylosis trauma or surgery Intracapsular Treatment Pain scale Jaw disability checklist Improve in 6-8 weeks .cannot be cured Osteoarthritis Unilateral involved Pain with palpation Limit opening heard with stethoscope R a Bilateral Involved Bony ankylosis Fibrous ankylosis trauma or surgery Crepitus heard with stethoscopeRadiographR a Bilateral InvolvedBony ankylosis Fibrous ankylosis trauma or surgery Intracapsular Treatment Pain scale Jaw disability checklist Improve in 6-8 weeks .cannot be cured RadiographR a Bilateral InvolvedBony ankylosis Fibrous ankylosis trauma or surgery Intracapsular Treatment Pain scale Jaw disability checklist Improve in 6-8 weeks .cannot be cured Intracapsular Treatment Pain scale Jaw disability checklist Improve in 6-8 weeks .cannot be cured |
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Shoulder special test and scapula |
Internal impingement
Hawkin kenedy Neer test
External impignment
Painful Arc syndrome R c
do empty can/jobe test subacrominal impingement or RC pathology
then do
Full can impingement RC lesion Speeds internal rotation and desist flexion and external rotate resist extension bicepts pathology
Shoulder instability Anterior apprehension test / crank test And then release test Relocation test
Posterior instability Miniaci test Horizontal adduction and internal rotation and end position abduction. And external rotation. Load and shift Sulcus test And external rotation.
Load and shift Sulcus test
Slap lesion Internal rotate and lift to 90 with resistance External rotate and lift to 90 add resistance Positive if pain is less than 2nd position
Shoulder ROM Apley scratch test Both hands touching the back with internal and external rotation
Lack of shoulder muscle strength
Muscle strength Behind muscle
Serratus anterior
Short lever hand and add resistance Observation for scapular winging
Subscapular muscle Lift off sign Back on dorsum of back on lumbar spine Lift off If can then add resistance
Scapula dyskinesia Sat scapular assisted test Fix clavicle with one hand In abduction assist the scapulae in inferior angle if pain less then lower trape and serrtus anterior weakness
S r t Scapular resisted test abduction and stabilize clavicle and spine of scapula Forearm fix on scapular And perform empty can test and resist Weakness in lower trap and serratus anterior |
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Elbow |
Flexion 140-150 Extension Pro and sup 90 without added adduction trip movement to supination. Passive end field Isometrics Elbow flez extension sup and pronation with wrist flexion and extension Joint play Varus Valgus Palpation on ligament below the olcron and flex to 30 Distraction Ulnarohumeral joint 70 flex 10 supination. and distal glide Radiohumeral joint Extension Distraction. Radiohumeral Joint line and thumb on radial head 5 supinationExtension Distraction. RadiohumeralJoint line and thumb on radial head PA glide to chest Across the flexors to radial head caudal PA glide to chest Across the flexors to radial head caudal Tennis elbow Cozen test Palpate lateral epicondyle Pron radial and wrist extension In extension apply resistance Dorsal and distal glide Radiohumeral joint 5 supinationExtension Distraction. RadiohumeralJoint line and thumb on radial head PA glide to chest Across the flexors to radial head caudal Tennis elbow Cozen testPalpate lateral epicondylePron radial and wrist extensionIn extension apply resistance Mills testHold the humerus Flex wrist prona and extension the elbow fully Pain positive testLateral epicondylitis test Extensor digitorum Hand on latersl epicondyleResist 3rd finger Medial epicondyle Golfers elbow Palpation on medial epicondyleExtend forearm and extension of wrist and stretch Dorsal and distal glide Radiohumeral joint 5 supinationExtension Distraction. RadiohumeralJoint line and thumb on radial head PA glide to chest Across the flexors to radial head caudal Tennis elbow Cozen testPalpate lateral epicondylePron radial and wrist extensionIn extension apply resistance Mills testHold the humerus Flex wrist prona and extension the elbow fully Pain positive testLateral epicondylitis test Extensor digitorum Hand on latersl epicondyleResist 3rd finger Medial epicondyle Golfers elbow Palpation on medial epicondyleExtend forearm and extension of wrist and stretch Mills test Hold the humerus Flex wrist prona and extension the elbow fully Pain positive test Palpate lateral epicondylePron radial and wrist extensionIn extension apply resistance Mills testHold the humerus Flex wrist prona and extension the elbow fully Pain positive testLateral epicondylitis test Extensor digitorum Hand on latersl epicondyleResist 3rd finger Medial epicondyle Golfers elbow Palpation on medial epicondyleExtend forearm and extension of wrist and stretch Lateral epicondylitis test Pron radial and wrist extensionIn extension apply resistance Mills testHold the humerus Flex wrist prona and extension the elbow fully Pain positive testLateral epicondylitis test Extensor digitorum Hand on latersl epicondyleResist 3rd finger Medial epicondyle Golfers elbow Palpation on medial epicondyleExtend forearm and extension of wrist and stretch Pron radial and wrist extensionIn extension apply resistance Mills testHold the humerus Flex wrist prona and extension the elbow fully Pain positive testLateral epicondylitis test Extensor digitorum Hand on latersl epicondyleResist 3rd finger Medial epicondyle Golfers elbow Palpation on medial epicondyleExtend forearm and extension of wrist and stretch Extensor digitorum Hand on latersl epicondyle Resist 3rd finger Medial epicondyle Golfers elbow Palpation on medial epicondyle Extend forearm and extension of wrist and stretch stretch |
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Wrist and hand |
Active passive Flex Extension Ulnar and radial deviation Cmc Fix on trapezium and flex the thumb Isometrics Join play radio carpal Towel and hand out of the table Distraction Ap and pa glide Medial and lateral glide And fingers also Phalen test Full flexion bilateral Tinels sign for carpal tunnel test Index finger towards the elbow on nedia n nerve Positive tingling on median nerve thumb index and middle finger Point at which paresthesia shows axon growth Allen test Radial and ulnar artery Open and close and squeeze hand fist and compression of both artery And release one of the artery Them again for the other artery To see the dominance Digital blood flow Capillary refill test Return in 3/sec Arterial insufficiency test For abductor pollius tendon Finkelstein test For abductor pollius tendon Extensor longus tendon Paratendonitis inflammed Ulnar deviation Extensor longus tendon Paratendonitis inflammed Ulnar deviation |
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Hip
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Gait cycle
Heel strike Loading response Midstance Terminal stance Pre swing Initial swing Midswing Terminal swing
Active range Flex x 120 Add 30 Abd 30-50 MidswingTerminal swingActive range Flex 120Add 30Abd 30-50 Ext Int flex to 90 40-60// 30-40 bring outwards and inwards Ext 10-15Passive range with end field Isometrics 0Add 30Abd 30-50 Ext Int flex to 90 40-60// 30-40 bring outwards and inwards Ext 10-15 0Add 30Abd 30-50 Ext Int flex to 90 40-60// 30-40 bring outwards and inwards Ext 10-15 Ext Int flex to 90 40-60// 30-40 bring outwards and inwards Ext 10-15 outwards and inwards Ext 10-15
Passive range with end field Isometrics Extension Ischium and extension Opp pelvis fix and abduction Figure 4 and adduct To 90 and external rotation and internal rotation
Isometrics Do not let me move you If pain in Extension external rotation adduction
Glut max affected
Flexion and extension Put to abt 30 degree
Joint play Abd external rotation flex Long lever
Short lever Flex abd ext rot Distract with hand
Lateral distraction Hand and joint line Traction perpendicular to greater trochanter Leg on the therapist shoulder
Quadrant test/hip scouring Add internal compression in short lever aand abduction external rotation compression in arc movement
Irregularity in movement And also instability
Hip abductor Hold on to the wall Lift on leg up Pelvis should rise not be on the same level
Elys test Rectus femoris contracture Hip and knee flexion tightness Thomas test Excessive lumbar lordosis Extended leg lifts off
Or if abducts then it band tightness
Rectus femoris / Kendall test The knee joint lifts from 90- 80 abv
Obers test Lower leg flexion Stabilization pelvis In extension Lower leg to table
Piriformis test Side lying Pelvis fix and knee bend and down pressure to the bed
Positive of pain in buttock or radiating pain down the leg
Slr 90-90 In flex and extension so comes close to 20 to extension
Backsaver sit and reach test
Positive if cannt reach the toes
Bent knee stretch test Proximal hamstring tightness One leg fixed and other hand reach Positive if cannt reach the toes Bent knee stretch test Proximal hamstring tightness And extend kneePain at ischial tuberosity Weber Barstow maneuver Scoilosis Foot pronation reach Positive if cannt reach the toes Bent knee stretch test Proximal hamstring tightness And extend kneePain at ischial tuberosity Weber Barstow maneuver Scoilosis Foot pronation
Pain at ischial tuberosity
And extend kneePain at ischial tuberosity Weber Barstow maneuver Scoilosis Foot pronation Weber Barstow maneuver
Scoilosis Foot pronation Foot pronation
Patrick Faber figure four test And press to treatment people Hip jt Si JT Iliopsoas spasm Anterior labral tear test Labral year Ext rot abd flex Arc in Int rot add extension With without click Or pain Going out side of eye Posterior labral tear test Flex add Int rotation Ext rot abd extension Going outside In side of eye Sign of buttock Abscess in buttock Iscbial Slr Flex kne and bend knee more If can't bend positive sign |
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Knee joint |
Active Flex 135 Extension 0 -15 Ask to Quad contract Patella in flex up and laterally Extension down and medially Int rot and external rotation In bring inward ankle 20-30 Ext 30-40 Bring ankle outward Passive Unaffected to affected limb Foot to buttock +flexion Patella Medial Lateral Superior Inferior glides Lift hip 30 Knee Int and external rotation 30 Isometric Knee and ankle Flex and ext Dorsi and plantarflexion Ankle included because muscles included Joint play Sitting and pull knee Anterior glide Sit on ankle Ap and from back pa glide Ap glide on fibula Grasp head of fibula Fix tibia And push backwards Patella tap test Large Swelling Up and down stroke and lockTake one finger and tap on it Take one finger and tap on it Take one finger and tap on it Brush/stroke/budget test Sma swelling Medial to up Lateral to down And then look for wave on medial side
Apleys test Meniscus tear Prone Fix leg with own leg and medial and lateral rotation. And distraction Ligament affected Then compression Medial and lateral rotation Meniscus damage McMurray test Tibia rotate medially and extend Lateral meniscus. Tibia in lateral rotation... Medial meniscus. Positive click .lock. Pain Like cutting the hair in nose Thessaly test. Meniscus Stand and flex on knee Rotate on tibia 3 times on each side Pivot shift test Acl Extended to flex Tibia sublux on femur Positive clunk noise Anterior drawers test Acl test Sit on foot and pull the leg Posterior drawer test Pcl tear Same as anterior drawer but push backwards Posterior sag sign Both tibial tuberosiw In line If positive Slowly extend knee with hip 90 Shift back in anterior direction Lachman test Ant and posterior hand Push up and down from tibia and femur Varus and valgus stress test In 2 angles Leg on therapist lap fully extended And knee in 20-30 flexion |
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Spine |
Frontal plane Nose to sternum .shoulder Clavicle Nipple. Iliac crest Asis spine Trunk and arm length . Apex of patella . Varus and valgus position. Line from earlobe to pelvis Lumbar in Kyphosis Asis psis 15 degree Knee hypeeeztended Spine of scapula Psis glut fold Achilles tendon Slr 0-35 dura movement 35-70 sciatic More than 70 joint pain Neri sign Flex trunk
Flex ankle dorsiflex Slump test Slump trunk Head dorsiflex Ultt 1 Median nerve Leg dorsiflex Ultt 1Median nerve Shoulder depression abduction 10 extend elbow and fingersUltt ulnar 110 Extend Hand touching the earUltt 3 Radial Pronation Ultt ulnar Shoulder depression abduction 10 extend elbow and fingersUltt ulnar 110 Extend Hand touching the earUltt 3 Radial Pronation 110 Extend Hand touching the ear Ultt 3
Radial Pronation Pronation Pronation Pronation Pronation Depress with your hip AcroiumSpine of scapulaPsis glut foldKnee levelsAchilles tendon Slr 0-35 dura movement 35-70 sciatic More than 70 joint painNeri sign Flex trunk Bragard sign Flex ankle dorsiflex Slump test Slump trunk Head Leg dorsiflex Ultt 1Median nerve Shoulder depression abduction 10 extend elbow and fingersUltt ulnar 110 Extend Hand touching the earUltt 3 Radial Pronation Depress with your hip Cluster of wainner /cervical radioculopathy Ultt A Cervical spine assessment Movement actve Distraction test Spurling test Prone instability test HypermobilityProne Pa pressure see if painLift legs off ground and apply pressure if pain reduces Stability exercises needed Prone knee bending test Lumbar radioculopathyL2-3 femoral nerve Prone position. Flex knee Prone lying Knee levelsAchilles tendon Slr 0-35 dura movement 35-70 sciatic More than 70 joint painNeri sign Flex trunk Bragard sign Flex ankle dorsiflex Slump test Slump trunk Head Leg dorsiflex Ultt 1Median nerve Shoulder depression abduction 10 extend elbow and fingersUltt ulnar 110 Extend Hand touching the earUltt 3 Radial Pronation Depress with your hip Cluster of wainner /cervical radioculopathy Ultt A Cervical spine assessment Movement actve Distraction test Spurling test Prone instability test HypermobilityProne Pa pressure see if painLift legs off ground and apply pressure if pain reduces Stability exercises needed Prone knee bending test Lumbar radioculopathyL2-3 femoral nerve Prone position. Flex knee Prone lying Cluster of wainner /cervical radioculopathy Ultt A Cervical spine assessment Bragard sign Flex ankle dorsiflex Slump test Slump trunk Head Leg dorsiflex Ultt 1Median nerve Shoulder depression abduction 10 extend elbow and fingersUltt ulnar 110 Extend Hand touching the earUltt 3 Radial Pronation Depress with your hip Cluster of wainner /cervical radioculopathy Ultt A Cervical spine assessment Movement actve Distraction test Spurling test Prone instability test HypermobilityProne Pa pressure see if painLift legs off ground and apply pressure if pain reduces Stability exercises needed Prone knee bending test Lumbar radioculopathyL2-3 femoral nerve Prone position. Flex knee Prone lying Movement actve Distraction test Spurling test Prone instability test Hypermobility Prone pain Lift legs off ground and apply pressure if pain reduces Stability exercises needed Pa pressure see if painLift legs off ground and apply pressure if pain reduces Stability exercises needed Prone knee bending test Lumbar radioculopathyL2-3 femoral nerve Prone position. Flex knee Prone knee bending test Lumbar radioculopathy femoral nerve L2-3 femoral nerve Prone position. Flex knee Prone position. Flex knee Prone lying |
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Muse strength testing And length testing |
Mrc Grade 0 no movement no feeling movement Grade 1 trace or flicker of movement Grade 2-graviry eliminate rom full Grade 3 against gravity full rom Grade 4 ful ROM moderate resistance Grade 5 full ROM full resistance Lift off sign weakness o subscapular muscle Lateral rotation. Lag sign Lateralrotation weakness of teres minor and infraspinatus Hold In lateral rotation If arm comes to neutral or anterior positive test Lat Dorsi Ext add internal rotation. Scap and 90, flex Extend and medially rotate arm And palpste muscle Serratus anterior Flex the arm and apply pressure or on the wall Rhomboid weakness Palapste the medial border of scapula Ask to extend the arm and index finger gets pushed away strength normal Trap muscle Generally abduction to 110 and add resistance Shrug shoulder uppee frap Prone u shape Nd Abduction Prone 120 degree and resist extension Tightness Piriform test Side muscle Side lying Touch kne to bed Obers test Thomas test At hip Kendall test Thomas but knee Ely test Prone lying Hip and knee flexion both occurs the. Muscle tight Hamstring 90 90 Backsaver Stretch test Pec major and minor tightness Hand behind Nd the head Shoulder to bench Pressure at corcoid pressure Downward pressure If tight pec minor tightness Biceps tightness Patient out of bed And hand is stretched down Triceps Tightness Flex and lateral rotate the arm and flex forearm |
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Si joint |
Cluster of laslett 1Asis pressure Check for Bilateral si joint pain 2 Side lying vertical pressure 3Sacral thrust testHand on apex of sacrumPosterior force 4Hand on si Press leg down 5 Come to Side of bench Right side flex And opp leg extend down |
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Van der wurff cluster |
Distraction. Test Anterior part of ilium and seperate Side lying compression test Down Ward pressure Thigh thrust test One hip to 90 Palpate opp ilium Pressure down on flex hip Patrick or faber test Figure 4 And pressure Down the knee Gaeslen test Out of bed one leg out of bed one leg flexed Patrick test Figure 4 test Piriform test Side lying knee to bed |
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Patient history RPS form |
Name Age Date Reference from gp Screened for red flags If not gp then screen fed flGs and refer bck . Health seeking question Chief complains Body function At site like Red Swelling Pain Warmth Pain intensity nprs Rest 5/10 Load 9/10 Activities psc 3 specific activities in difficult Walking 5/10 Stair climbing 8/10 Making bed 4/10 Participation. Plsyyi g tennis Personal Martial status Coping strategies Stress Environment factor 4th floor Barriers or facilitators |
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Shoulder impingement |
Primary impingement Structural cause Subacromial External impingement Full can RC pathology Internal Secondary impingement RC pathology full can Scapular dyskinesia Sat SRT Instability Biceps or slap O brien O shape resistance DOwn add external rotation. And then internal rotation If less pain in 1st position positive Speed test G I r d |
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Thoracic outlet syndrome |
3 sites
Costoclavixulae
Eye brow
Scalene Muscle No venous tos
Subcoracoid BT pec minor tendon
Test Roos test All 3 interval of brachial plexus nerve Vascular Arterials Adson test Scalene muscle Extension abduction external rotation. Radial pulse palpate e tend head and breath and hold breath Eden test Military brace test CCostoclavicular SPACe Brachial plexus Compression clavicle Palpate pulse if less positive Wright test Hyperabduction test Crank position. Pec minor Palpate radial pulse Hyper abduction shoulder And palpate pulse |
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Osteoarthritis |
Bridge of nose is thinned Joint space is narrowed So weight reduction. Stretch ham glau quad Calf Strength Quad Arom Also at hip movements Orthosis Foot Knee brace Also assistive aid Cane Also Aquatic exercises |
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Cane |
Cane like a earring whole If one side damage then hold on opp side You can see it on the same side for knee and ankle Quad cane With distance small closer to you |
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