Clinical Skills Year 2 Term 1

Front 1

What causes a loss of normal lumbar lordosis (concave)?

Back 1

Paravertebral muscle spasms in the lower back.

Front 2

What causes increased thoracic kyphosis?

Back 2

Result of insufficiency fractures of the throacic spine in osteoporosis.
Trauma
Vertebral osteomyeloitis

Front 3

What can cause someone to have a stooped posture?

Back 3

Back pain
Osteoporosis
Hip flexion contracture

Front 4

What is the Schoberg's test?

Back 4

Tests to see if the lumbar vertebrae are opening during flexion.
From the level of the posterior superior iliac spines, mark 5 cm distal and 10 cm proximal. As they bend forward to touch their toes, this 15cm should stretch to 22cm.

Front 5

What is the normal L-spine extension? What would cause pain in the is movement?

Back 5

30 degrees
Facet joint arthritis.

Front 6

What soft sign can be used to test if the patients pain is coming from their back or being amplified?

Back 6

Place their hands on the hips and manually rotate in a circle - motion stemming from the hips. If the pain still occurs then either the pain isn't in their back, they have hip problems as well or they are exaggerating.

Front 7

What is the tripod test?

Back 7

Looks for nerve root impingement
In sitting, extend the knee and watch to see if the patient leans back on hands in response to pain.

Front 8

What all problems can be cause back pain (referred)?

Back 8

Pancreatitis
Cholescystitis
Perforated peptic ulcer
Aortic aneurysm
Metastatic prostate cancer

Front 9

What are some lumbar spine nerve root impignement signs?

Back 9

1) Tripod test
2) Straight leg raise
3) Crossed leg raise
4) Lesque's test

Front 10

How will a patient with a painful hip walk?

Back 10

The will shift their weight to the side of the painful hip during stance phase as to shift the weight overtop of the hip so as to decrease muscle contraction and therefore decrease pain.
Trendelenberg sign

Front 11

Why should you palpate the spine if someone is complaining of hip pain?

Back 11

Lower back pain frequently refers to the hip.

Front 12

What test can you perform to determine if there is a femoral nerve root impignement sign?

Back 12

Femoral stretch test
While prone, bend knee 90 degrees and extend the hip.
Pain should be felt down the front of the leg.

Front 13

What can cause a discrepency in length when measure the "true" leg length?

Back 13

True leg length is from the ASIS to the medial malleolus. If one is shorter, this indicates that there is arthritis in one of the legs, or the tibia or fibula bone is shorter.

Front 14

What can cause an "apparent leg length" discrepancy?

Back 14

Pelvic tilt (contracture)
Structural deformity of the spine

Front 15

In a baby, if the skin folds in the groin are assymetric, what does that usually indicate?

Back 15

Congenital dislocated hip.

Front 16

What palpation test can you perform to differentiate between true hip pain rather then pain referred from the back or the knee?

Back 16

Find the middle of the inguinal ligament. Measure 2cm distally and then 2cm laterally and press here. If pain is felt here then it is true hip pain.

Front 17

When testing ROM of the hip, how can you prevent the lumbar spine from moving as well?

Back 17

Have the patient maximally flex both hips causing the lumbar lordosis to flatten against the bed.
While the patient holds the contralateral thigh flexed - ROM the other leg. If the contralateral leg starts to move then you are involving the pelvis

Front 18

What is the normal ROM of the hip?

Back 18

Lock and load the hip by preforming the ROM with the contralateral hip flexed to 90 degress to prevent movement through the spine.
1) Flex - 120
2) Extend - ?
3) Internally rotate (foot goes lateral) - 35
4) Externally - 45
5) Abduct - 45-50
6) Adduct - 20-30

Front 19

What test can you perform to test for congenital hip dislocation?

Back 19

Ortolani & Barlow maneuvers.
Maximally flex the the contralateral hip.
Adduct the other hip and then apply pressure posteriorly to try and sublux the joint.
Gently abduct the hip to see if there is a clunk.

Front 20

What does the AP and lateral compression test for? What is another test that test for the same thing?

Back 20

Pain in the sacroiliac joint
Pelvic fracture (trauma)
Press posteriorly and then medially (lateral compression) to see if you elicit pain or crepitus
Faber test

Front 21

What complications can arise if you an adult has in-toeing due to femoral anteversion (inward twisting of the femur)?

Back 21

Patellofemoral tracking problems and knee pain.

Front 22

What type of pain can flat feet (planovalgus) be associated with?

Back 22

Anterior knee pain

Front 23

What is the most common finding for a meniscus tear?

Back 23

Joint line tenderness

Front 24

What would cause the medial patellar retinaculum?

Back 24

Acute patellar dislocation

Front 25

If someone has Osgood-Sclatter's where would there be pain on palpatation?

Back 25

Tibial tuberosity.

Front 26

Where would pain be felt during palpatation if their was injury to the medial or lateral collateral ligament?

Back 26

Lateral or medial epicondyles of the femur.

Front 27

What type of people get iliotibial band friction syndrome/

Back 27

Runners
The lateral epicondyle of the femur is sore on palpatation due to IT band friction during running.

Front 28

What are two test you can preform to reproduce the pain felt with patellofemoral syndrome?

Back 28

patellofemoral compression test
Patellofemoral grind test

Front 29

How much of a difference in quad size (wasting) can occur if someone has long standing knee pathology?

Back 29

1cm

Front 30

What type of pain can frequently refer to the knee, specially in children?

Back 30

Hip pain - also do a Hip ROM with knee pain

Front 31

What is normal ROM for the knee?

Back 31

Extension - 0 to -15 (hyperextended)
Flexion - 135 degrees (heel should touch buttocks)

Front 32

What test(s) can be done to look at MCL or LCL instability/tear?

Back 32

Valgus/varus force in full extension and knee flexed at 30degrees

Front 33

What tests can you perform to test for an anterior cruciate tear?

Back 33

Anterior drawer test
Lachman's test
Pivot test.

Front 34

What tests can you perform to test for posterior cruciate ligament tear?

Back 34

Posterior drawer test
Tibial sag
Lack of a bumper sign (tibia is usually 1cm anterior to the medial femoral condyle when knee is bent 90degrees)

Front 35

What indicates a positive for a medial or lateral meniscus tear with McMurray's maneuver?

Back 35

Clunk and pain

Front 36

What are two tests you can perform to test for mensici tears?

Back 36

McMurray's test
Grind test - while prone flex knee to 90 degress and internally and externally rotate the tibia on the femur feeling for crepitus
Most positive test is pain on the posterior joint line.

Front 37

What problem can cause you to see "too many toes" sign?

Back 37

Abduction problem - usually on can see the 4th and 5th toe.
Often indicates rupture of the tibialis posterior tendon which commonly occurs in RA.

Front 38

What can cause a splaying toes when weight is beared?

Back 38

Morton's neuroma
Usually occurs between teh 3rd and 4th toe

Front 39

When testing passive range of motion on the ankle, how do you lock out the subtalar joint? What is normal passive ankle range of motion?

Back 39

Invert the foot to lock the subtalar joint
Extension = 20
Flexion = 50

Front 40

What is the passive ROM of the subtalar joint?

Back 40

Lock the ankle by extending (dorsiflexing)
Inversion = 20 degrees
Eversion = 15

Front 41

What is the ROM of the Midtarsals?

Back 41

Pronate and supinate about 10-15 degrees each way

Front 42

What is the ROM of the MTP?

Back 42

Flexion = 45 degrees
Extension = 70-90

Front 43

What does the Windlass test, test for?

Back 43

It tests for plantar fascitis
Palpate the plantar fascia and then extend the big toe and see if more painful.

Front 44

What kind of gait will someone with a cervical spine disorder have?

Back 44

Wide base
Clumpsiness
slow speed
stiff legs

Front 45

What is the normal ROM for the neck?

Back 45

Flexion - chin 2 fingerbreadths from the chest
Extension - nose parallel with the floor
Rotation - 70-80degrees
Lateral flexion - 70

Front 46

What does Spurling's test look for?

Back 46

Cervical root compression
Have the patient extend their neck and then turn their head to the side that is effected - should reproduce the pain.
If not, add axial load to their head and see if pain is present.

Front 47

What does the Adson's test, test for?

Back 47

Thoracic outlet syndrome
Have the patient abduct, extend and externally rotate their arm while you palpate for the radial pulse.
Ask the patient to take a deep breath in and rotate their head to teh ipsilateral (same side). Note any change or absence of pulse indicates possible outlet syndrome.

Front 48

What is an early sign of rotator cuff tear?

Back 48

Wasting of the spinatous muscles.

Front 49

What causes scapular winging?

Back 49

Long thoracic nerve injuries (C5-7) therefore no longer able to use serratus anterior to

Front 50

What ROM occurs with a rotator cuff injury?

Back 50

Full passive ROM with loss of active ROM with no neurological injury is characteristic of rotator cuff injuries.

Front 51

What are three signs/tests that you can perform to test for rotator cuff (RC) impingement syndrome?

Back 51

1) Painful Arc test - swishes subacromial bursa and RC against the acromion
2) Hawkins - pinches subacromial bursa and RC against the coracoid and coracoacromial ligament
3) Neer's - against the anterior acromion

Front 52

What shoulder tests will allow you to access the stability of the shoulder joint/ligaments?

Back 52

1) Sulcus test - while relaxed, pull the down and look for a sulcus just uder teh lateral edge of the acromion.
Indicates multi-direction shoulder instability
2) Apprehesion test - in supine, abduct and externally rotate the shoulder, as to almost sublux the joint anteriorly. The patient will become apprehensive if their is anterior joint instability (unidirectional)

Front 53

Which sign will test if the bicep tendon is unstable?

Back 53

Yergason's test

Front 54

What sign tests for AC joint degeneration?

Back 54

AC joint compression test.

Front 55

What is the normal carrying angle of the arm?

Back 55

5-10 degrees in men
10-15 in women

Front 56

What is the normal ROM for the elbow?

Back 56

Flexion - up to soft tissue apposition (~160 degrees)
Extension - zero unless lax ligaments nad hyperextend
Pronation/supination - 90 degrees (make sure elbow bent to 90 degrees)

Front 57

What is cubital tunnel syndrome?

Back 57

The ulnar nerve behind the medial epichondyle becomes irritated or has pressure and causes nerve numbness and weakness in the hand.
May have a positive Tinel's sign.

Front 58

What is Tinel's test?

Back 58

Test to see if nerves are irritated in their various tunnels.
1) Ulnar nerve - in the cubital tunnel syndrome
2) Median nerve = pronator syndrome
3) Radial nerve - radial tunnel syndrome

Front 59

What is the Wartenburg's sign?

Back 59

The little finger rests abducted, an early sign of an ulnar nerve injury

Front 60

What are Dupytren's contractures?

Back 60

Start as a nodule of tissue in the palm and then commonly cause contractures of the little and ring finger

Front 61

What does muscle wasting of the thenar eminence indicate? Hypothenar?

Back 61

Thenar eminence = severe carpel tunnel syndrome (median N).
Hypothenar = ulnar nerve injury or C8-T1 nerve root compression

Front 62

What ligament in the hand/forarm can commonly rupture in RA?

Back 62

Extensor pollucis longus and extensor tendons on the dorsum of the hand (i.e.extensor digitorum)

Front 63

What causes DeQuervain's tenosynvoitis?

Back 63

When the abductur pollucis longus and extensor pollucis brevis - when these 2 tendons get trapped in the first extensors comparment

Front 64

What is normal ROM of the wrist and hand?

Back 64

Wrist flexion - 80 degrees
Wrist extension - 70
Pronation/supination = 90
Radial deviation = 20
Ulnar deviation = 30
Test thumb opposition

Front 65

What does Allen's test, test for?

Back 65

Collateral circulation of the hand supplied by both the ulnar and radial nerve.
Make a fist and occulde both arteries. Open fist, skin should be blanched. Release only the ulnar artery - hand should turn pink if collateral circulation.
Repeat with radial artery.

Front 66

What two signs are there to test for carpel tunnel syndrome?

Back 66

1) Tinel's test - tap over median nerve - should cause tingling if inflammed.
2) Phalen's test - maximally flex wrist for minute 1 minute - should reproduce symptoms of carpel tunnel

Front 67

What test do you perform to test for DeQuervain's tenosynovitis (inflammed tendon sheaths in thumb)?

Back 67

Finkelstein's test
Make a fist with thumb tucked inside and passively ulnarly deviate. Pain in the first extensor compartment is a +ve sign.