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199 Cards in this Set
- Front
- Back
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Tests for muscle hypertonia
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Clonus, Deep tendon reflexes, Tone across the elbow
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Clonus tests (2)
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Wrist extension, Ankle dorsiflexion (extension) = transient or sustained clonus is UMNL
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Deep tendon reflex test ARM
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Biceps muscle reflex = hypereflexia or clonus means UMNL.
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Deep tendon reflex test LEG
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Patellar reflex = hyperreflexia or clonus (+3, +4, +5) means UMNL
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Cerebellar motor testing vs. UMNL testing?
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Cerebellar has hypOtonia vs. UMNL has hypERreflexia or clonus/spasticity
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Dysarthria & cerebellar-ocular reflex problems
*what part of the Cerebellum? |
Dysarthria (slurred speech) and weak cardinal fields for extraocular eye mm = cerebellar VERMIS lesion
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3 signs of cerebellar lesions
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Dysmetria (finger to nose to doc's finger), Dysdiadocokinesia, Ataxia
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Holmes-Thomas
The arm should come HOME |
REBOUND test, push down on outstretched arm, should return. If not, cerebellar lesion.
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Tone Across the Elbow test
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Clasp-knife rigidity is initial resistance from full flexion into extension = UMNL. No lower extremity version.
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Lead pipe & Cog wheel rigidity vs. Clasp-knife rigidity
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Lead pipe and cog wheel indicate BASAL GANGLIA/extra pyramidal vs. clasp knife as UMNL
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Dysmetria test w/ doc finger
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Patient finger to patient nose to doc's finger. Look for overshoot/undershoot. Pt use 4th or 5th digit.
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Nystagmus test
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pt follows doc finger and holds lateral gaze 8-10 sec. Nystagmus = cerebellar vermis lesion
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Dysmetria test w/ patient finger only
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Patient touches 4th or 5th finger to nose slowly. Uses both hands. Over/undershoots = cerebellar lesion
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Intention tremor is NOT
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dysmetria. Intention tremor is a steady oscillation, not an over/undershoot.
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Babinski-Weil
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pt walk forward, then backward. If lean to same side on way wack, cerebellar. If lean to opposite, CN VIII.
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Mittlemeyer's
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MARCH for Vestibulocochlear! If pt rotates or leans while marching in place 10 sec, VIII lesion.
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Pitchfork test for CNV III
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Weber: fork at bregma, lateralize to blocked side. Rinne: fork on mastoid (count) then next to ear (count should be 2x as long as mastoid count). Air conduction block or CN VIII damage.
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Swivel chair test
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VIII vs. cervicogenic headache: Pt in swivel chair rotates head only = dizzy then VIII. Doc hold head & pt rotates body only, if dizzy then cervicogenic.
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OPP!enheimer's test
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Doc knocks patient shin w/ knuckles.
If Upgoing Toe Sign (UGTS), then UMNL |
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Schaffer's beer test
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for UMNL: Doc holds pt Achilles' and squeezes. If UGTS, then UMNL.
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Babinski's test
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for Plantar reflex: Sharp end of hammer along foot upward. If UGTS, then UMNL.
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Hoffman's sign
*think what you saw when you shadowed Dr. Inzerillo, DC, MD, at the Geneva rehab - he did this to 2 patients who had had a stroke |
OK test!
Hold pt middle finger and strike nail downward. If pt makes OK sign w/ index & thumb = UMNL |
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Rossilomo's upper extremity test
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Quick brisk taps w/ hammer to palm at middle finger. Flexion = UMNL (Ross grabbing Limo's wheel')
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Rossilomo's lower extremity test
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Grabbed the wheel, now press the gas...hammer strike at ball of 3rd toe. If flexion, then UMNL (pressing the gas)
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Gordon's gin test for lower extremity
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Already reached for the gin, now grab the gams! Doc squeezes pt calf (gam). If UGTS, then UMNL.
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Chaddock's upper extremity test
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Doc squeezes pt wrist, if they splay fingers (to grab the haddock), then UMNL
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Chaddock's lower extremity test
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They grabbed the haddock, now draw a “C” for Chaddock in the sand. Doc draws 'C' around lateral malleolus. If UGTS, then UMNL
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Dysdiadochokinesia upper test PIANO MAN
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Have patient stand to max cerebellum, touches thumb to each finger 10 sec. Uncoordination = cerebellar lesion
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Dysdiadochokinesia upper test HAND JIVE, BABY
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Grease: hand jive
Patient flips hands on dorsal then palmar surfaces, repeating alternately 10 sec. *Uncoordination or inability to do it = cerebellar lesion |
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Dysdiadochokinesia lower MARCHING in PLACE
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seated, rapidly marching STOMP! 10 sec. Uncoordination = cerebellar lesion
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Dysdiadochokinesia lower FOOT TAPPIN'
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sitting patient alternately taps toes rapidly 10 sec. Uncoordination = white person w/ no rhythm or cerebellar lesion
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Tromner's tap...(it will only be called Tromner's on the test)
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Two finger tap on patient's 4th or 5th. Patients' fingers curl/flex indicates UMNL
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Gordon's gin test for upper extremity
*press the button if you would like more gin, please |
Doc presses PISIFORM briskly – if fingers splay (reaching for Gordon's gin), then UMNL
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There are no changes in _______ in an UMNL
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SENSATION
There IS increased muscle tone (hypERtonia) w/ weakness (SPASTIC is UMNL) and hypERreflexia or clonus. |
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Dysmetria lower test HEEL to OPPOSITE KNEE down shin
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Heel to opposite knee down shin, stay on track. Under/overshoot = cerebellar lesion
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Dysmetria test Patient TOE to doc finger
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patient follows doc finger w/ toe. Over/undershoot = cerebellar lesion
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Extra pyramidal means
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basal ganglia: choreaform motion, Mask-like facies, Lead pipe & Cog wheel, Hemi-ballistic movement, Resting/pill rolling tremor
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What are the tone across the elbow tests?
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Lead pipe and cog wheel for basal ganglia lesion (Parkinson's)
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Constant resistance during tone across elbow test
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Lead pipe rigidity = basal gang
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Staccato wheel-like motion during tone across the elbow test
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Cog wheel rigidity = basal gang
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Balance problem worse in the dark w/ numbness or burning on bottom of feet
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M.S., B12 or B1 deficiency (burning is B1), Lyme's, HIV, Extramedullary lesion
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Why always do balance tests w/ eyes closed?
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Dark dorsal fin = JAWS! Dorsal column lesions are worse in the dark.
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Positional change of digits test EYES CLOSED
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Kinesthesia: Patient CLOSES EYES...test if can tell whether finger being moved towards head or foot, then test toes. Lack of sense location = dorsal column lesion
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Abaides' test (Tell me when the pressure abates) EYES CLOSED
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Deep pressure test squeeze Achilles' tendon once w/ more pressure then once w/ less. Inability to detect deep = dorsal column lesion
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Bernacki's funny bone test EYES CLOSED
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Test deep vs. light pressure over ulner nerve area on inside of elbow. Inability to detect deep= dorsal column lesion
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Upper extremity test for pallesthesia EYES CLOSED
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Tuning fork on tips MIDDLE FINGER each hand. Pt tell when feel and don't feel VIBRATION. If cannot detect vibration = dorsal column lesion
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Lower extremity test for pallesthesia EYES CLOSED
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Tuning fork on tip of GREAT TOE each foot. Inability to detect VIBRATION = dorsal column lesion
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Stereognosis
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EYES CLOSED, object placed in patient hand. Identify i.e. paperclip, pen, etc. No = dorsal column lesion
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Graphesthesia
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EYES CLOSED. Draw simple pattern like X or O on patient palm, AND on patient foot. Do all 4 limbs. No = dorsal column lesion
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If patient cannot name the object in stereognosis but only describe
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Parietal lobe lesion
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Rhomberg's pOsition
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eyes OPEN, patient stands w/ feet together, arms out. Swaying and loss of pronation = cerebellum
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Rhomberg's TEST for kinesthesia
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Let the eyes REST: eyes CLOSED patient w/ feet together, hands out. Loss of position = dorsal column lesion (mild to strong +)
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SNOUT test
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UMNL Elvis test tap pt upper lip, if curls then UMNL. Sneer from tapping phrenulum (upper lip)
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GLABELLA test
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Wincing when tapped on glabella = UMNL (or sinus infection!)
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4 SUPERFICIAL reflexes to test
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Corneal (cotton) for blink, Gag for soft palate rise, Abdominal for umbilicus towards stimulus, Plantar/Babinski's for UGTS (abnormal)
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****Lower extremity tests:
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next:
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Huntington reflex
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icing for too long triggers vasodilation and makes condition worse
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1,2 Betcherew!
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Raise bad leg, raise good leg, raise BOTH. Pain in post hip OR TRIPODING of arms for support. If can't raise good higher than bad, L/S lesion (or SI to bad side)
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Medial disc lesion is
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M-INT so Medial is lean INTo
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Lateral disc lesion is
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Lay Away! Lateral lesion causes patient to lean away from lesion because lesion above nerve and leaning away pulls nerve further under and away.
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Linder's test would irritate a Lateral lesion. Why?
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Because pulling up on the head causes cord and nerves to rise/cephalad, pulling nerve root up under lesion (bumping it's head)
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SLR
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It's the opposite of 1,2, Betcherew!
Straight Leg Raise: elevate the good leg first, then bad leg. Sharp, shooting pain down back of leg or worse LE sx = traction of sciatic nerve/root or hamstring. Not definitive |
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Turyn's test
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Turyn's TOE test: Dorsiflex great toe. Sharp, shooting pain down back of leg or worse LE pain = sciatic nerve/root traction or irritation
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Ely's test
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Heel to OPPOSITE buttock while patient face down. Adds external rotation and extension on lumbar facets. Hip, SI, Iliopsoas, Femoral n. root problem.
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Bowstring sign
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SLR then support their calf on your shoulder. If pain REDUCED w/ knee FLEXION, then press semimem, semiten, and popliteal fossa (sciatic) to locate hamstring
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If you did the Bowstring test seated, what is it called?
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Deyerle's sign
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Piriformis stretch test
*Do you stabilize the SI or not? Why or why not? |
STABILIZE opposite SI to remove it from test
For sciatic entrapment via piriformis or just a tight piriformis mm: Pt prone, , and crank nearest heel slowly to opposite buttock from the 90 deg. flexed knee. Shooting pain = piriformis entrapment of sciatic, Tightness or tenderness = tight piriformis (and the other external rotators of hip) |
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why is Piriformis stretch test different from Hibbs?
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Piriformis stretch test means you STABILIZE opposite SI.
Hibbs is SAME side stabilization while pushing/pulling heel to outside edge (ipsilateral) of table to create INTERNAL rotation of the hip |
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Hibb's test *which kind of rotation do you create?
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*****Do not stabilize on Hibbs internal test - you want to see if the hip causes pain during internal rotation. Stabilizing it would be helping it.
Pt prone, doc brings foot to hip and pushes/pulls towards outside (ipsilateral) side of table, creating strong INTERNAL rotation of hip. If not localized to hip pain, then SI lesion if pelvic pain. |
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Nachlas' test for rectus femoris and TFL tightness
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Nach, Nach! Your foot against your hip, same side. + is pain. Ely's hunching of painful hip may only be present during Nach, Nach! Test
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Adam's test
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Structural vs. functional scoliosis. Pt bends at waist, if scoliosis disappears, then function. Resolution is functional!
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Allis-Galezzi's test
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LEG LENGTH difference. Patient supine, knees bent. Doc observe dif b/w knee heights and from side for one leg forward.
(+) means Tibial or femoral shortening possibly due to congenital hip dysplasia/CHD |
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Lachmann's test
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try to UnLach their knee. Pt supine, flex knee 30*, hold femur down and pull tibia up towards ceiling. Excess movement = ACL damage
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Yeoman's test
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Yo! Man! That hurts! Pt prone, doc elevates leg via bent knee hold while pressing on same side SI. Indicates SI sprain if pain
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A-P drawer ankle
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Too much gapping either way: Anterior talo-fibular and deltoid ligament damage. Posterior talo-fibular and deltoid ligament damage. Either lift or press ankle w/ pt supine
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Goldthwaite
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Pt supine, doc hand under low back, lift leg. [+] on same side before L/S opens is ipsi SI, or pain after LS is lumbar lesion
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Smith-Peterson
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After [+] Goldthwaite, do SLR on good side w/o palpating lower back. Raise higher than [+] bad Goldthwaite leg. If pain, then Goldthwaite leg SI. If can only raise to same level as 'bad' Goldthwaite leg, then L/S lesion
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Double leg raise
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SLR each leg individually then together. Pain will reproduce at half the height when raised together = L/S joint
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Fabare-Patrick
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Sign of 4: Pt supine, bring their heel to opposite knee and apply downward pressure while stabilizing opposite ASIS. Pain at femeroacetabular joint
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LaGuerre's Test
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Fabere in the Air: Just like Fabere but hip flexed to 90* and overpressure to increase external rotation. Do at several levels. Pain at FA joint is [+]
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Lateral and Medial ankle stability
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Grasp ankle: Invert to test talofibular and calcaneal lateral ligaments, Evert to test Deltoid ligament. Excessive gapping is [+]
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Tinel tap on Tarsal tunnel
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Posterior tibial n. entrapment (medial plantar n.) Tap firmly w/ 2 fingers behind medial malleolus. Pain or sustained paresthesia plantar is intrinsic neuropathy or peripheral entrapment of posterior tibial n.
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Bonnet's test
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Bon net for piriformis trapping: Say, “this may make your pain worse,” then SLR, External rotate takes pain away, then Internal rotate increases pain w/ adduction.
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Erichsen's test
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Soft contact to both PSIS's w/ patient prone; apply firm inward pressure. SI joint pain
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Noble's test*
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Noble's kNee for IT test: pt supine, place your fingers on their IT. Ask them to bend then straighten leg. Pain at 30* flexion. IT band tendinitis
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Brudzinski's
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Headache w/ neck pain and fever = MENINGITIS
The BK Broiler = Brudzinki and Kernig's tests for meningitis |
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Kernig'z test
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Like Brudzinki's, trying to straighten out knee from flexed causes pain = MENINGITIS
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Lewin's STANDING test after they bow to the cow
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If Neri's bowing was [+], then the doc will try to straighten the bent knee of the pt who is leaning over touching toes. Bent knee is Neri's. Sciatic radiculopathy
*Bow to the cow is Neri's Bowing test |
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Neri's test
Neri had a hairy knee; he touched his toes and it came towards me! |
Bowing sign, patient flexes at waist as if to touch toes and pain causes one leg to bend either to relieve sciatic pain or tight hamstring.
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Drawer test
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Pt supine w/ bent knee. Doc pulls for ACL, pushes for PCL. If 'sag sign,' do not do posterior drawer (duh)
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Genu VALGUS test for knee (abduction)
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MEDIAL collateral ligament: Test in closed packed/straight leg, then open packed/bent. Pain or excess motion medially= MCL damage
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Genu VARUS test for knee
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Various additions: LATERAL collateral ligament. Test in closed packed by pulling outward, test in open packed w/ knee slightly bent and pull outward. Pain = LCL damage
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Apley's compression test
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Pt prone, bend knee and press down on heel w/ both hands. Heel pointing outward = internal rotation, lateral meniscus. Heel pointing inward towards buttocks = medial meniscus, external rotation
*Heel is pointing towards the meniscus you are testing! |
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McMurray's test
Dr. Bloom vs Dr. Ebbets: |
Bloom: patient supine. Bend their knee up w/ leg abducted (Indian style) and let it almost slap back to table. Click in abduction is lateral meniscus. Bend knee and push it across in adduction to the other knee, now let it almost slap back down to table. Click is medial meniscus.
Ebbets: Start w/ patient on back. WIND knee in and down to table for medial meniscus click, then WIND knee out and down for lateral meniscus click. (adjustment looks the same as the test we learned in his lower extremity tech class) |
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A patient presents w/ IT band tendinitis
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Do Noble's test
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Patellar apprehension test {:>0
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Manually displace patella to lateral outside. Quads will involuntarily contract or patient will hiss at you. Recurrent patellar dislocation
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Patellar scrape
Alternate eponymous name? What muscle needs to be contracted to perform this test? |
Clarke's test/grind: You press on patella while their leg is straight when lying on table. If actively contracting their quads hurts while you press, {+}
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Fouchet's sign NEVER do this one
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Press pretty hard (harder than Clarke's test for scrape) and if they scream...Chondromalacia patella or retropatellar athritis
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Dreyer's sign for Dad
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Ask patient to raise bad leg. If can't or is painful and difficult, then you encircle their quads right at the patella w/ your hands for support. When you remove your hands, they again cannot raise leg. This test is similar to a Chopat strap around the forearm. see pg 880 in Evans.
If able to lift, indicates patellar fx or suprapatellar tendon rupture |
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Ober's test
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Ober and Under: for IT band 'hanging'. Pt sidelying, doc grasps flexed upside knee and presses firmly on iliac crest. Flex hip, pull up (abduct), externally rotate then lower back to table. If hangs in air in abduction, IT band contraction
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Moses' test
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Moses was a diabetic w/ thrombophebitis, which a chiro discovered after squeezing his calf while he was prone and causing deep leg pain
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Morton's test
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Morton's neuroma: squeeze foot together (transverse arch). Chiro: metatarsalgia due to subluxation. Ortho: Morton's neuroma
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Simmond/Thompson test
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*don't do this. Squeeze Achilles to see if it ruptured. Better to allow pt to lay face down and see if one foot plantarflexed.
If you don't get sued for doing this test on a suspected rupture, you should. |
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Rib motion test
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Stand behind pt and palp intercostal spaces 2-5 pec minor area. Watch and feel if rib excursion
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SOTO-HALL
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S for Sternum, S for Support. Pt supine and you place one hand behind head to lift their head and one hand on sternum. Nonspecific for cervical/thoracic pain
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Ho-man's test
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Pt supine. You dorsiflex foot. If calf hurts, may indicate thrombophlebitis
HOMANS is DORSIFLEX, while Moses is calf squeeze. Both for thrombophlebitis/DVT. |
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Duchenne's drivers test
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Duchenne's driving test – doc presses into first metatarsal head (base of great toe). If pt toes curl around, paralysis, paresis of PERONEUS bros. So superficial peroneal n. damage. or S1
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Lewin's evil supine sit up
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Hold their legs and ask them to do a straight body sit up without using their arms. Ankylosing spondylitis, herniation, arthritis.
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Shepelmann's test
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Do the wave: Lateral sidebend each way. M-INT medial into, LAY AWAY lateral lesion patient leans away from
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Belt test
*when do you do the belt test? What are you trying to determine? Which other test should you perform first? |
*FIrst ask patient to try to touch toes on their own. If they have "low back pain," ask them to show you where.
*To determine if SI is culprit, you are going to remove it from the exercise: Demo what you are going to do, then brace pt sacrum against your hip and hold their ASIS's while they lean forward. Pt touches toes. *Pain decrease is positive for SI because hurt when unsupported but better when supported by you putting your hip against their sacral apex. |
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Braggard's test
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Do bilaterally. SLR w/ dorsiflexion of foot. Sciatic nerve/root traction irritation
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Trendelenburg test
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Pt standing, brings one knee up to 90*. If supporting hip wangs out to side, then weak glute medius and minimus on standing leg side.
*people who sashay or really bada-boom bada-boom from side to side when they walk have a weak gluteus medius and minimus. |
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Thomas' test
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PSOAS: Pt to edge of table seated, grasps one knee and you help them lie back. Extended knee not touching table then [+] for iliopsoas and rectus. Now extend knee that is hanging, taking weight. If still doesn't touch table, then it's the iliopsoas.
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Sickard's test
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SLR then lower below angle of pain, dorsiflex foot (Braggard's) then dorsiflex great toe (Turyn's) = Sickard's if sharp shooting pain for sciatic n./root traction irritation
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Lewin-Gaenslen test
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Patient sidelying w/ downside knee grasped. Doc stands behind, palpates upside SI and while holding upside knee, extends leg behind. SI pain is positive for lesion.
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Mennell's test of 4
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Mennell's test of 4: Pt prone...doc pull apart PSIS's, push them together, move to side of patient and push L/S joint to table while lifting a leg by the quad, then pull ASIS upward while pushing isch tube down. The only test for pelvic flexion is this last part. [+] SI problem.
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Tibial n.
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Tibialis POSTERIOR: pt foot is down and in, doc tries to pull up and out (5/5). Reflex: Achilles (+2). Sensory pure patch: heel of foot (symmetrical)
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DEEP peroneal n.
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Motor: Extensor hallucis longus and brevis Patient lifts great toe, doc tries to push down (5/5). No reflex. Sensory pure patch: between great and 2nd toe where flip flop rubs. Can also test tibialis anterior, extensor digitorum or peroneus tertius.
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Obturator n.
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Adductors: Pt sidelying, V-lift both legs. Doc pushes downside leg below the knee to table while supporting upside leg (5/5). Sensory pure patch: adductor tubercle (symmetrical) No reflex.
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Common peroneal n.
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No motor. No reflex. Pure patch only: head of fibula (symmetrical)
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Superficial peroneal n.
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Motor: Peroneus longus and brevis, pt foot down and out, doc pulls up and in (5/5). No reflex. Sensory pure patch: outside leg compartment (symmetrical)
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Superior gluteal n.
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Motor: TFL. Pt supine, doc lifts and abducts and internally rotates their leg, asks them to hold while doc pushes in and down towards center table (5/5). Can do hip abductors or gluteus medius, too. No reflex, no pure patch.
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Inferior gluteal n.
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Motor: Gluteus Maxiumus. Pt prone, doc stabilizes low back of pt and asks pt to lift/donkey kick leg. Doc presses hamstrings down to table. Knee flexed 90* make sure hip extended up off table. No reflex, no sensory pure patch.
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Forestier's BOWSTRING sign
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Pt stands, doc opens back of gown. Pt lateral sidebends. Look for muscular tightening/spasm. Contracture ipsilateral side = Ankylosing spondylitis (not usual)
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Well leg raise***
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Doc SLR painful leg. Then SLR w/ dorsiflexion of ankle to WELL leg – should increase pain in ****bad**** leg. Nerve root MEDIAL disc lesion. W=M\
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Linder's lift
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for Lateral. L=L Pt supine, doc raises head and this pulls upward, causing nerve to bump its head on the lateral lesion. [+] pain worse in symptomatic leg.
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Miner's sign
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pt uses hands and arms to rise from seated position. Non specific for LBP
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Kemp's sign
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Jack Kemp= Like getting something off the floor you dropped while sitting at desk: contact pt's low back pain site while they are seated and bring their upper body into extension, lateral flexion and same side rotation, as though you were going to do a seated mammillary push. Radiating pain into legs is [+] for radiculopathy fm disc.
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Gaenslen's half gainer
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pt sitting close to side of table, grasps own knee and you lean then back. Slowly abduct the hanging leg off table and let swing/drop. If SI pain, lesion.
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Brueger's test
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lower ex: pt raises leg and dorsiflexes/plantarflexes ankle over and over about 1 min. You support leg.
*I think you then let the leg drop gently to hang over the side of the table and watch their toes. How long take color return? Vascular insufficiency if more than 10 seconds to refill/return to normal color. |
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BEEVOR's Umbilical migration test
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Doc observes as pt does a partial crunch. If belly button moves in any direction, that is the overly strong direction = opposite direction is WEAK QUADRANT
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Femoral n.
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Motor: Sartorius. Doc pulls on supine pt's flexed and externally rotated knee, tries to straighten leg out. Can do quads or iliopsoas, too (5/5). Reflex: Patellar. Pure patch: anterior thigh along rectus femoris
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L1
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Motor: Iliopsoas. Pt supine extends and externally rotates leg and is told to hold as doc tries to push leg back to table. Stabilize opposite thigh. Pt can also sit on table and lift knee into doc's hand, providing resistance. (5/5). NO reflex. Sensory: top of thigh at bikini line/inguinal ligament (symmetrical)
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L2
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Motor: Iliopsoas. Pt supine extends and externally rotates leg and is told to hold as doc tries to push leg back to table. Stabilize opposite thigh. Pt can also sit on table and lift knee into doc's hand, providing resistance. (5/5). Reflex: SECONDARY patellar (+2). Sensory: middle of thigh (symmetrical)
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L3
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Motor: Pt sidelying, raises legs in V shape. Doc supports upper leg while pushing down on knee of lower leg to force leg to table. (5/5) Reflex: SECONDARY patellar (+2). Sensory: L3 across the knee (symmetry)
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L4
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Motor: Tibialis anterior. Pt foot up and in like kicking a ball, doc tries to pull down and out. Can do quads. (5/5). Refelx: patellar (+2). Sensory: down medial leg BEHIND medial malleolus to base of great toe.
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L5
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Motor: Extensor hallucis longus and brevis, pt lifts big toe and doc tries to push down (5/5). Can do extensor digitorum or aBductors. Reflex: Medial hamstring best performed in frog leg or prone (+2). Sensory: outside leg L5 on the side from fibular head to little toe across to 2nd toe. (symmetry)
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S1
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Motor: peroneus longus and brevis. Pt everts foot, doc tries to invert (5/5). Can do soleus/gastroc or glut max. Reflex: Achilles. Slightly dorsiflex ankle (+2). Sensory: outside rim of foot from heel to base of little toe. (symmetry)
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Upper extremity ortho tests
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upper
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Motor questions for upper extremity
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weakness? Dropping things? Difficulty turning doorknobs? Muscle twitching?
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Sensory questions for upper extremity
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numbness or tingling in hands/arms? Knock things over when reaching for them? Have you burned or hurt yourself without realizing it?
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Hyperesthesia found on sensory test
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may be early nerve root compression that's caused hypersensitivity
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C5
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Motor: Deltoid. Pt lifts arm to side,doc overpressures at elbow downward (do not touch deltoid) while supporting opposite shoulder. Stand behind. (5/5). Reflex: biceps (+2). Sensory: from deltoid lateral to lateral epicondyle of humerus (symmetrical)
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C6
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Motor: forearm extensors C6 Biker Chicks – doc pulls down on pts hyperextended wrist (5/5). Reflex: Brachioradialis (+2). Sensory: radial head to thumb AND index finger (symmetry)
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C7
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Motor wrist flexors C7 go to Heaven – doc pulls down on flexed wrist esp middle finger (5/5). Reflex: Triceps (+2). Sensory: palm middle finger from wrist to tip
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C8
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Motor: FINGER flexors form a C8 Crazy 8 w/ doc and pt fingers, doc tries to uncurl their fingers (5/5). Reflex: SECONDARY Brachioradialis (+2). Sensory: funny bone to little finger AND ring finger (symmetry)
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T1
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Motor: Interossei. Doc tries to pull fingers apart, Doc tries to push fingers together. No reflex. Sensory: inside of upper arm (symmetry)
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Ulnar n.
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Motor: ADDUCTOR POLLICIS use Froment's paper test but use your fingers in place of the paper. (5/5). Can do flexor carpi ulnaris w/ ulnar deviation. No reflex. Pure patch: outside nail pinky finger tip
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Median n.
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Motor is carpal tunnel so: Flexor pollicis brevis. Doc inserts two fingers under pt thumb and tries to lift thumb up. (5/5) Can do flexor carpi radialis w/ deviation. No reflex. Pure patch is tip of index where thumb key grip would strike. (symmetry)
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Musculocutaneous n.
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Motor: Biceps doc tries to extend pts bent arm from 90*. Can do coracobrachialis w/ arm in atomic elbow UFC while doc stands behind and tries to pull elbow down (5/5). Reflex: biceps (+2). Muscle cars and kiss my guns. Radials brach if you tri to run. Pure patch: lateral forearm over meat of extensors (symmetry)
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Radial n.
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Motor: Extensor digitorum. Pt hyperextends bent fingers doc tries to pull down (5/5). can do ECR long and brev of wrist, brachioradialis, triceps and anconeus. Reflex: Radials brake if you tri to run...Brachioradialis and triceps (+2). Pure patch: index and thumb web (symmetry)
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Axillary n.
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Motor: Deltoid pt holds arm in abduction of lateral delt while doc tries to push to table (5/5). Teres minor doc tries to internally rotate 90* arm. No reflex. Pure patch is on lateral deltoid.
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YERGASON'S test
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Bicipital groove test. Pt bends arm, doc tries to pronate and extend it, like set up for radial head adjustment. [+] is slip, pain or crepitus for bicipital tenosynovitis
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Impingement sign
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stand behind patient and put hand on AC joint. Slowly lift their arm to 90*. If prone abducted arm causes shoulder pain at acromion b/w 30-90*, supraspinatus impingement (+)
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Apprehension test
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stand behind and abduct arm to 90* like resting on a ledge. Go to externally rotate like they are waving to someone. Pain or withdraw = GH instability
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Bakody maneuver
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Asymptomatic first, then bad one. Pt places hand on top of head. If makes BETTER, then positive for nerve root compression
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Bakody REVERSE
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Makes it WORSE. Pt places hand on head. If makes worse UE pain, then positive for TOS by pectoralis minor on neurovascular bundle
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Traction test
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Seated pt, Doc places fingers on their radial pulse and has them lean AWAY. Decrease pulse patency = (+) cervical rib or scar tissue on scalenes [Zumpano quote]
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Codman's drop for ROTATOR CUFF stability
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Holds their arm out now doc takes full weight. Pause. Drop arm. Should return to original position. If motion is rachet-like = partial tear (+)
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O'Donahue's
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Pt actively moves joint by themselves first.
Doc provides slight overpressure/resistance on repeat. Pain = (+) muscle/tendon STRAIN due to isometric contraction result. "T" for sTrain for Tendon Now doc moves arm passively. Pain = (+) for ligament SPRAIN due to passive motion creating stretch. |
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Apley's test for upper extremity
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BACKSCRATCHER: pt tries to reach over shoulder to scratch scap. External rotation & aBductors. Pt tries to reach scap from below. Internal rotators & aDDuctors. Positive is pain for non-specific ROM test
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Shoulder depression test
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Stand behind patient and laterally flex head away from shoulder as you push down on shoulder.
NERVE ROOT STRETCH TEST (+) Exacerbates nerve sx radicular/root adhesion. |
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Supraspinatus press test
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Pour out your beer, your doctor is here! Doc applies downward pressure as pt pretends to pour out a beer. Loads supraspinatus. (+) for supra strain.
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Speed's test
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Thumbs up for speed! Pt arm straight out, thumb up. Doc applies downward pressure and attempts to pronate wrist. (+) pain BICIPITAL GROOVE for tenosynovitis
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Only test for adhesions of nerve root at IVF?
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Shoulder depression test
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Dawbarn's Push button test
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BURSA – When pt lets arm hang by side, pain. Doc stands behind, applies pressure to AC joint while lifting arm 120* allowing subacromial bursa to slide out. (+) is relief
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What is the first test you always perform when hunting TOS?
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Allen's for vascular compromise. Open and close fist repeatedly. Doc behind, holds both radial and ulnar pulses. Bring arm down, let one pulse go. See how it fills. Delay of greater than 10 sec = (+) vascular compromise.
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Always test the ________ side first!!
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asymptomatic
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Rust's sign
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emergency! Pt comes in holding head w/ worst headache of life and must support head w/ both hands. ER.
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Swallowing test
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Ask if swallowing is painful (odynophagia) or difficult (dysphagia). Arterial bleed behind retropharyngeal space after MVA. Anterior cervical osteophytes. Cn. Or CT diseases make swallowing difficult but not painful. Refer out or send to ER
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ABBOT-SAUNDERs test
Abbot and Costello were HUMERUS. |
Stand behind and palpate TRANSVERSE HUMERAL LIGAMENT for slippage as you start w/ their arm prone, then raise w/ supination, then return prone. (+) pain or slippage or click in bicipiital groove is tendon instability secondary to laxity of transverse humeral ligament
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Dugas test
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Pt crosses arm over body attempting to touch opposite shoulder. If arm won't lie flat on chest = (+) dislocated GH
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Golfer's elbow test
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Pt extends arm straight out and hyperextends wrist. Doc tries to bend wrist into flexion against resistance. Pain (+) over medial epicondyle (it is)
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Varus test elbow
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Pt arm extended supine, locked in closed packed, doc applies pressure to inside of elbow to test Lateral collateral elbow ligament stability. Then repeat w/ arm in open packed slightly.
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Valgus test elbow
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Pt arm extended supine, locked in closed packed. Doc applies pressure to lateral elbow to stress MEDIAL collateral ligament. Repeat in open packed position.
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Mill's test
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Like set up for a wind up pitch, pt starts w/ arm up, hand facing themselves and rotates into pronation w/ straight arm. (+) pain for lateral epicondylitis.
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Cozen's test
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COZY MILLS company test for lateral epicondylitis. Pt flexes arm 90* and doc supports elbow while pt pushes down and doc pushes up on pt fist. (+) is lateral epicondylitis.
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MILGRAM's stoic pilgrim test
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pt supine table tries to lift both legs. Space occupying lesion reproduction of pain due to pressure on thecal/intracranial sac, disc, tumor, edema.
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DeJerine in the latrine
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Do you have pain when coughing, sneezing or straining in the bathroom?
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If positive DeJerine in the latrine, then do?
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Valsalva's saliva test = Popeye test pt puts thumb in mouth and blows while bearing down. Pain = intrathecal (cord) and abdominal pressure means SOL
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Barbara EDEN's test
*instruction to patient? *what bone is pressing on what artery if pulse drops? |
Pt seated, doc palpates radial pulse and pt sticks out chest (brings shoulders back and down) while deep breath. (+) costoclavicular space entrapment if drop in pulse patency due to clavicle pressure on subclavian
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ALLEN's test
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Pt seated, opens and closes fist. Doc palpates radial and ulnar arteries both. Lowers hand and lets one go. Observes capillary refill. Should take less than 10 sec. (+) vascular compromise
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Soldier's position
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Doc behind and puts knee in pt back for support, while palpating radial pulse. Pulls back on pt arm and pushes down on shoulder. Decrease in pulse patency (+) subclavian or brachial plexus compression
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Hostage test
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Begin w/ doc to side, palpating radial pulse. Raise pt arm up to 90* w/ external rotation. (+) drop in pulse patency due to traction of PEC MINOR across nv
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Libmann's sign
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Libmann is always depressed. Poke him in the TMJ. If he moans or grimaces, emotional (+) for low tolerance
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Before you perform a test, always
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tell the patient that the pain might get worse. Then start on asymptomatic side!
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______ROM before _____
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ACTIVE before passive
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A _____ is present or absent. A _____ is (+) or (-)
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Sign, Test
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4 cervical compression steps
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Neutral, Rotary, Jackson's lateral flexion, Hyperextension (be careful on this one). Positive is sharp, shooting pain or radiating UE pain
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Maximum cervical compression test
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Tell them it may get worse. Rotate pt head to close IVFs, extend head, ask, “does that hurt?” After inquiring, slowly apply compression straight down. (+) is increased sharp shooter or radiating pain in UE
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Cervical distraction test
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Differential for radical root vs capsular adhesion/ligament. Place your thenar eminences on their mastoids and lift gently. Better = (+) for root. Worse = (+) for adhesive capsulitis or adhesions to nerve root
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ROOS
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Raise the ROOS! Both arms up, close and open fists 45 sec. (+) pain pallor or cramp = traction of pec MINOR across neurovascular bundle
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ADSON's
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Adson's Anterior scalene test: doc stands behind, place one hand on shoulder, one on their wrist for RADIAL pulse. Deep breath and hold. (+) decrease pulse patency = entrapment of subclavian by anterior scalene or cervical rib
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REVERSE Adson's
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Middle scalene test. Same as Adson's only pt looks AWAY from 'pain'. Deep breath. (+) drop in pulse patency or worse pain = MIDDLE scalene culprit
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Wright's test
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Wright's flying arm test – Begin from side, take pt radial pulse and slowly lift arm out in scapular plane to 120*. (+) decrease in pulse patency or UE pain increases means pec minor causing hyperabduction syndrome/TOS
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L'Hermitte's sign
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Shock-like dysthesias down spine into extremities whenever passive cervical flexion performed on patient (Soto-Hall, Budzinki's, etc.) or if actively drops head to chin in flexion. (+) cord compression or demyelination
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Local pain is considered to be a (-) test w/ a
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SOF (significant other finding)..
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BB&T is 2nd to None
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Biceps- Brachioradialis- Triceps -2nd Brachioradialis -None is C5 – C6 – C7 – C8 – T1
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Muscle cars and kiss my guns, Radials brake hard if you try to run.
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Musculocutaneous nerve = biceps reflex. Radial nerve = brachioradialis and triceps reflexes
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