127 Msk: Upper And Lower Quarter Screening & Examination

Front 1

When are screening exams performed?

Back 1

when the patient's primary subjective complaint is related to an extremity or a part of the spine

Think "spine - screen"

Front 2

what should be examined if there is an UE complaint? What if there is a LE complaint?

Back 2

if UE complaint: cervical and thoracic spine should be examined

if LE complaint: lumbar spine and pelvis should be examined

Front 3

what are components of the lower quarter screening exam in standing?

Back 3

1. postural assessment

2. active forward, backward, and lateral bending of lumbar spine

3. standing flexion test/ Gillet's test

4. Toe Raises (S1, tibial nn)

5. heel walking (L4, L5 deep fibular nerve)

Front 4

what are the components of the lower quarter screening exam in sitting?

Back 4

1. sitting flexion test

2. active rotation of the lumbar spine

3. passive OP if symptom free

4. resisted hip flexion (L1, L2, femoral nn)

5. resisted knee ext (L3, L4, femoral nn)

6. Resisted ankle DF (L4, L5 deep fibular nn)

7. resisted big toe ext (L5 deep fibular nn)

8. resisted ankle eversion (L5, S1 superficial peroneal nn)

9. DTR: patellar (L3, L4) and Achilles tendon (S1, S2)

Front 5

What are the components of the lower quarter screening exam in supine?

Back 5

1. dermatome sensory testing

2. SLR (L4, L5; S1)

3. Passive ROM of hip

4. Sciatic nn tension test

Front 6

What are the components of the lower quarter screening exam in prone?

Back 6

1. Femoral nn tension test

2. Babinski reflex test (UMN)

Front 7

What are the components of the upper quarter screening exam?

Back 7

1. Postural assessment

2. AROM cervical spine

3. Passive OP if symptom free

4. Vertebral artery test

5. Quadrant test

6. resisted mm tests cervical spine rotation (C1)

7. Resisted shoulder elevation (C2, C3, C4)

8. Resisted shoulder abduction (C5)

9. Active shoulder flexion, abduction, IR, ER

10. Resisted elbow flexion (C6)

11. Resisted elbow ext (C7)

12. AROM of elbow

13. Resisted wrist flexion (C7)

14. Resisted wrist ext (C6)

15. Resisted thumb ext (C8)

16. Resisted finger abduction (T1)

17. Babinski Reflex test (UMN)

Front 8

What is the accessory mobility scale?

Back 8

-complete joint play/ testing of joint mobility when the joint capsule is most relaxed or in the loose packed position

0 Ankylosed joint

1 considerable limitation/hypomobility

2 slight limitation/hypomobility

3 Normal

4 slight hypermobility

5 considerable hypermobility

6 Pathologically Unstable

Front 9

What are the 4 possible findings of resisted mm testing? and what does each indicate?

Back 9

1. strong and painless: no pathology in contractile tissue

2. Strong and painful: minor structural lesion of the muscle-tendon unit

3. Weak and painless: complete rupture of muscle-tendon unit or neuro deficit present. Further testing is needed

4. WEak and painful: partial disruption of muscle-tendon unit. Pain response due to serious pathology or concurrent neurological deficit

Front 10

How can you differentiate the action of a one-joint muscle from that of a multi-joint muscle?

Back 10

place the multi-joint mm at a disadvantage

-if a muscle that crosses two or more joints produces simultaneous movement at all of the joints it crosses, it soon reaches a length at which it cannot generate full mm force = active insufficiency

Front 11

What is active insufficiency?

Back 11

Decrease in torque produced by a muscle when the full ROM is attempted simultaneously at all joints crossed by the multi-joint mm

ex: hand grasp with wrist in full flexion

Front 12

What is passive insufficiency?

Back 12

-when 2-joint or multi-joint muscles are of insufficient extensibility to allow full ROM to be produced simultaneously at all joints crossed by these muscles.

-passive tension developed in these stretched muscles is sufficient to either cause motion or to limit motion:

ex: cause motion: full wrist flexion causes fingers to extend due to insufficient length of finger extensors stretched over flexed wrist

ex: limit motion: finger flexion with wrist flexion is limited by length of finger extensors; or

-rectus femoris limits active knee flexion with hip extended

-HS limits active knee ext if hip in position of flexion

Front 13

what are the MMT grades?

Back 13

Normal = 5/5 can move into test position against gravity with maximal resistance

Good = 4/5 Same as normal but can only resist moderate pressure

Fair + = 3+/5 Same as Good but can resist only mild pressure

Fair = 3/5 full range against gravity, no resistance

Fair - = 3-/5 Same as fair but gradual release against gravity

Poor + = 2+/5 Moves against gravity in small ROM

Poor = 2/5 Full ROM in gravity eliminated position

Poor - = 2-/5 can only initiate ROM with gravity eliminated

Trace = 1/5 Fasciculation or palpable mm contraction but unable to move

Zero= 0 No visible or palpable mm contraction

Front 14

What are components of the Neurological examination?

Back 14

1. resisted muscle testing

2. sensory testing

3. DTRs

4. Neural tension tests

5. UMN testing (babinski and ankle clonus)

Front 15

Describe signs and symptoms that differentiate UMN vs LMN lesions

Back 15

Front 16

When is further testing required during the sensory testing portion of the neurological exam?

Back 16

-if light touch is different between sides or there is a decr in LT over a specific area then further testing is required

-such as pin prick (superficial pain), vibration, two-point discrimination, or proprioception

Front 17

What is the grading scale for DTRs?

Back 17

4+ = Hyperactive reflex with clonus (indicates UMN disorder)

3+ = Hyperreflexia (brisk): palpable (mod-strong) contraction with exaggerated joint movement (still within normal variation)

2+ = Normal = palpable ctx with visible extremity movement

1+ = hyporeflexia (sluggish) palpable mm ctx with no extremity movement (indicative of LMN disorder)

0 = Areflexia (absent) no visible or palpable mm ctx

Front 18

What is the purpose of neural tension tests?

Back 18

by stretching the peripheral nerves with specific body movements, the mobility of the spinal dura and nerve roots can be tested

Front 19

What (in general) nerve does the SLR test bias? What are the variations?

Back 19

sciatic nerve

1. Passive SLR with DF and eversion = tibial nn

2. Passive SLR with PF and inversion = peroneal nn

3. Passive SLR with DF and inversion = sural nn

DET PIP DIS

Front 20

What neural tension test biases the femoral nerve/

Back 20

Prone knee bend

Front 21

What neural tension test biases the spinal dura?

Back 21

passive neck flexion

Front 22

How is ankle clonus test performed?

Back 22

Position leg in slight knee flexion and rapidly DF ankle

(+) test if series of involuntary mm contractions

Front 23

how is the babinski test performed?

Back 23

stroke the plantar aspect of the foot from the lateral side of the heel to the base of the great toe with a blunt instrument

(+) great toe DFs and other toes fan out

Front 24

What test should be performed before any manual treatment of the cervical spine?

Back 24

vertebral artery test and must be repeated as ROM increases

Front 25

What is the vertebral artery test?

Back 25

-assesses integrity of the vertebrobasilar vascular system

-pt in supine and progress as below

1. extend head and neck for 30 secs. if no change progress to next step

2. extend head and neck with rotation left the for 30 sec then repeat with right rot for 30 sec

(+) test provokes referring symptoms (Right rot will decr contralat artery and reproduce L symptoms and vice versa)

- pt should report tinnitus, dizziness, nausea, throbbing, confusion, or unsual sensation. and Clinician obesrves for pupillary constriction or dilation and nystagmus which indicate VA compression

Front 26

What should be done if the Vertebral artery test is positive?

Back 26

avoid mobilization and cervical spine movements into ext and rot at ranges that produce symptoms

-notify physician of test findings

Front 27

What cervical motions test intervertebral foramen vs VA and vice versa?

Back 27

IVF: decreased space with extension (blood flow normal with isolated ext)

VA: ext + rot = bilat decr with > decr on contral side aa. (IVF > decr on ipsilat side)

pg. 193 of McGee

Front 28

What is the quadrant test for the cervical spine?

Back 28

= spurling's test/foraminal compression (identifies compression of cervical nerve roots)

-perform if pt c/o nerve root symptoms which are diminished or absent at time of exam (i.e. UE symptoms)

Front 29

Quadrant test and alternatives

Back 29

Maximum cervical compression test = (ext + rot + SB + compression)

spurling's = foraminal compression (SB head to uninvolved side and add compression straight down. repeat on opposite side)

Front 30

How is Spurling's test performed and positive results?

Back 30

SB head to uninvolved side and add compression straight down.

-repeat on opposite side

(+) test = pain radiates into arm toward which head is side flexed which indicates pressure on a nerve root (cervical radiculitis)

(-) = neck pain with no radiating pain

Front 31

How is the maximum cervical compression test performed?

Back 31

aka maximum cervical compression test

-identifies compression of neural structures at IVF and/or facet dysfunction

- patient in sitting

-passively move head into SB and rot toward non painful and add ext then compression

-repeat on painful side

(+) = pain and/or paresthesia in dermatomal pattern on same side as SB and rot

or localized pain in neck if facet dysfunction

Front 32

When is the distraction test indicated?

Back 32

when pt c/o radicular symptoms in hx and presents with radicular sx during the exam

-indicates compression of neural structures at the IVF or facet joint dysfunction

Front 33

How to perform the distraction test?

Back 33

supine

hold pt under chin and occiput and flex neck whiled distraction force of about 14 pounds applied

(+) = decr in symptoms in neck (facet condition) or decr in UE pain (indicating nerve root compression)

Front 34

What is the purpose of Hautant's test?

Back 34

-to differentiate vascular vs vestibular causes of dizziness/vertigo

Front 35

Describe positive Hautant's test.

Back 35

2 steps

1. sitting with shoulders flexed to 90 and pulms up. Have pt close eyes for 30 sec. If arms lose position = (+) vestibular condition

2. sitting with shoulders flexed to 90 and palms up. close eyes and have pt extend head and neck with R Rot and then L Rot holding in each for 30 sec. (+) for vascular cause if arms lose position

Front 36

What is the purpose of the transverse ligament stress test?

Back 36

test integrity of tranverse ligament of C-spine

-prevents anterior movement of atlas on axis and posterior movement of axis on atlas

Front 37

What is a positive test for transverse ligament stress test?

Back 37

-supine

-head on table

-glide C1 anterior

Normal end feel = firm

(+) = soft end-feel, dizziness, nystagmus, lump sensation in throat, nausea

Front 38

What is the purpose of the anterior shear test?

Back 38

assess integrity of upper c-spine ligaments and capsule

Front 39

how is anterior shear test performed and positive test?

Back 39

-supine with head on table

-glide C2-C7 anterior

normal end-feel = firm

(+) = ligament laxity, dizziness, nystagmus, lump sensation in throat, nausea

Front 40

What is positive Shoulder abduction test?

Back 40

(+) = decr in UE symptoms when pt places one hand on top of head

Indicates compression of neural structures in IVF

Front 41

What is Lhermitte's sign?

Back 41

identifies dysfunction of SC and/or UMN lesion

-long sitting

-passively flex head and one hip while keeping knee in ext, repeat with other hip

(+) pain down the spine and into upper or lower limb = indicates dural or meningeal irritation in spine or possible cervical myelopathy

Front 42

What is the Romberg Test?

Back 42

standing

close eyes for 30 seconds

(+) for UMN lesion if excessive sway or lose of balance

Front 43

What is the standing flexion test?

Back 43

-tests iliosacral motion to determine joint dysfunction (motion restriction of innominate)

-palpate both PSIS and ask pt to bend forward

Normal = both PSIS move superior and anteriorly

(+) side with motion restriction is the one that move furthers or first cranially and is considered blocked

Front 44

What is the slump test?

Back 44

- sitting on edge of table with knees flexed and hands behind back

-pt slump sits while maintaining neutral head and neck. then add progressions below

1. passively flex pt head and neck. if no symptoms then

2. passively extend one of pt knees. If no sx then

3. Passively DF ankle of LE with extended knee

Repeat on other side.

if positioning reproduces patients symptoms and cervical ext relieves symptoms = (+) for increased tension in the neuromeningeal tract

Front 45

What is the Laseque's test?

Back 45

aka SLR

supine, passively flex hip of one LE with knee ext until pt complain of shooting pain into LE

-slowly lower until pain subsides, then DF ankle

-also can add neck flexion

(+) = reproduction of pathological neurological symptoms when foot is DF and when neck flexed

(+)= asymmetry between sides

(+) = reproduction of sx between 35-70 deg hip flexion

biases the sciatic and tibial nerves

Front 46

What is Cross (Well Leg) SLR?

Back 46

SLR on uninvolved reproduces patient's symptoms

-one leg is lifted and pt c/o pain in opposite LE = indication of space-occupying lesion (e.g. herniated disc, large IV disc protrusion)

-stretches ipsilateral and contralateral nerve root.

Front 47

What is the femoral nerve traction test?

Back 47

-identifies compression of femoral nerve anywhere along its course

-sidelying on nonpainful side with unaffected knee and hip slightly flexed (painful side is up)

-head/neck slighlty flexed

-with affected knee in ext, extend the hip approx 15 deg

-if no sx then flex knee

(+) = neurological pain radiate down anterior thigh

Front 48

What is the lumbar quadrant test?

Back 48

identifies compression of neural structures at IVF and facet dysfunction

1. in standing, for IVF test:

SB L, Rot L, and Ext = max closing of IVF on L

2. in standing for Facet dysfunction

SB L, Rot R, and Ext = max compression of facets on L

(+) = localized pain for facet dysfunciton

pain &/or paresthesia in dermatomal pattern for the involved nerve root

Front 49

What is the Prone knee bend test?

Back 49

aka femoral nerve stretch

-used to identify L1-L3 nerve root lesion (also stretches femoral nn)

-prone + passive knee flex + hip ex

(+) for nerve root involvement = unilat pain in lateral or posterior aspect of hip, into lumbar spine, or into anterior thigh

Front 50

What is Stork standing test?

Back 50

-identifies spondylolisthesis

-stand on one leg + lumbar ext and repeat on opp leg

(+) = LBP with ipsilateral LE on ground = unilat stress fracture of pars interarticularis

Front 51

What is the Bicycle test of van Gelderen?

Back 51

-identifies neurogenic claudication (spinal stenosis) vs intermittent claudication

-ride stationary bike sitting erect and time how long can ride at set pace

-repeat with slumped posture and time how long

-spinal stenosis (+) if can ride longer in slumped posture or if reproduces sx in erect posture which are relieved with slumped posture

Front 52

What is Gillet's test?

Back 52

-used to identify SI joint dysfunction

-thumb on PSIS and other thumb on sacrum at same level

-pt standing then asked to flex hip and knee on side you are palpating

-PSIS should move inferiorly

(+) = PSIS does not move or moves cranially which indicates ipsilateral motion restriction

If palpate PSIS on WBing side

-innominate should rotate posteriorly (PSIS move inferiorly)

(+) if PSIS on stance side moves cranially (ant rot) = decr motor control of lumbopelvic stabilizers

Front 53

What is Long-sitting test?

Back 53

-measures functional leg length

-determines if there is a posteriorly or anteriorly rotated innominate based on apparent leg length differences

-if LE longer in supine but shorter in sitting = (+) anterior innominate rotation on affected side

-if LE shorter in supine and appears longer in sitting = posterior innominate rotation

Front 54

What are the five test that indicate SIJ pain and how many have to be positive?

Back 54

3 out of 5 to indicate SIJ pain with high spec and sensitivity

1. Distraction/Gapping

2. Thigh thrust

3. Gaenslen's test

4. Sacral thrust

5. Compression

Front 55

What is the distraction/gapping test?

Back 55

SIJ dysfunction (1 of 5 cluster of tests)

-supine

-cross arm pressure to bilat ASIS in down outward direction

(+) = symptoms reproduced or increase in unilat gluteal or in posterior leg

Front 56

What is the thigh thrust test?

Back 56

SIJ dysfunction (1 of 5 cluster of tests)

supine with hiop flexed to 90

-push posteriorly directed force through femur

(+) = Pain incr or reproduced on thrusting

Front 57

What is Gaenslen's test?

Back 57

SIJ dysfunction (1 of 5 cluster of tests)

supine near edge of the table with affected leg hanging over edge of table

-other leg is flexed toward pt's chest

-firm pressure is applied to both the hanging leg and the leg flexed toward the chest

(+) = pain in the SIJ is reproduced or increased

Front 58

What is the sacral thrust test?

Back 58

SIJ dysfunction (1 of 5 cluster of tests)

in prone, examiner applies a force vertically downward to the apex of the sacrum

(+) = SIJ pain incr or is reproduced

Front 59

What is the compression test?

Back 59

SIJ dysfunction (1 of 5 cluster of tests)

sidelying with affected side up

hips are flexed approx 45 and knees flexed to 90

-vertically force applied downward on ASIS

(+) = SIJ pain increases or is reproduced

Front 60

What is the sitting flexion test?

Back 60

-identifies SIJ dysfunction

-Thumbs on PSIS in sitting

-pt crosses arms over chest with feet on floor and bends forward bringing elbows between knees

(+) = blocked joint moves first or further cranially

Front 61

What are the tests for impingement in shoulder?

Back 61

1. Neer's

2. Hawkins-Kennedy

3. Painful arc

Front 62

What are the tests for RC dysfunction/pathology?

Back 62

1. Supraspinatus muscle test

2. Infraspinatus Muscle test

3. Drop Arm Test

4. ER Lag Sign

5. IR Lag Sign

6. Lift off test

7. Belly Press test

Front 63

What are the special tests for AC joint dysfunction/ pathology?

Back 63

1. Horizontal Adduction test

2. Resisted Horizontal Extension test

3. O'Brien's Sign

4. Paxinos Sign

5. Palpation of the AC joint

Front 64

What are tests for the GH labrum?

Back 64

1. Crank Test

2. Biceps Load I Test

3. Biceps Load II Test

4. Pain Provocation Test

5. Compression Rotation Test

6. O'Brien's Active Compression Test

7. Resisted supination ER test

Front 65

What are special test for cubital tunnel syndrome?

Back 65

1. Pressure provocative test

2. Flexion Test

3. Tinel's sign

Front 66

What are special tests for MCL tears at the elbow?

Back 66

1. Valgus stress at 30, 60, 70, 90 deg of elbow flexion

2. Moving Valgus Stress Test

Front 67

What are special tests for lateral epicondylitis?

Back 67

1. Tennis Elbow Test

2. Mill's Test

Front 68

What are special tests for wrist and hand ligamentous instability?

Back 68

1. Thumb Ulnar Collateral Ligament Test

2. Test for Tight Retinacular Ligaments

3. Lunatetriquetral ballottement test

Front 69

What are special tests for integrity of wrist and hand tendons and muscles?

Back 69

1. Finkelstein's Test

2. Sweater finger sign for rupture of the FDP tendon

3. Bunnel-Littler Test

Front 70

What are tests for neurological dysfunction in the wrist and/or hand?

Back 70

1. Tinel's sign

2. Phalen's test

3. Reverse Phalen's Test

4. Carpal Compression Test

5. Froment's Sign

Front 71

What are special tests for circulation in the wrist and hand?

Back 71

1. Allen's test

2. digit blood flow (nail bed compression)

Front 72

What are special tests of hip pathology?

Back 72

1. Patrick's (FABER) test

2. Flexion Adduction IR (FADIR) Impingement Test

3. Scour Test

4. Trendelenberg Sign

Front 73

What are Ligamentous test of the knee?

Back 73

1. Lachman's Test

2. Anterior Drawer Test

3. Pivot-Shift Test

4. Valgus Stress Test

5. Varus Stress TEst

6. Posterior Drawer

Front 74

What are tests for Meniscus in the knee?

Back 74

1. McMurray's Test

2. Apley Test

3. Thessaly Test

4. Bounce Home Test

5. Joint Line Tenderness

Front 75

What are tests for patellar instability?

Back 75

Patellar apprehension test

Front 76

What are tests for Patellofemoral syndrome?

Back 76

1. McConnell Test

2. Passive Patellar Tilt Test

3. Clarke's Sign (Patellar compression test)

Front 77

What are tests for IT band friction syndrome?

Back 77

Noble compression test

Front 78

What are tests for ligamentous instability at the ankle?

Back 78

1. anterior drawer test

2. Talar tilt

3. Squeeze test for syndesmosis injury

Front 79

What is the the test for Achilles rupture?

Back 79

Thompson's test

Front 80

What are the movement tests, postural analysis findings and example for an anterior innominate rotation - pelvic girdle dysfunction/

Back 80

Direction of motion restriction = posterior rotation

Movement test: Standing flexion test

Long sitting test

Posture Analysis:

-Iliac Crest/PSIS high, ASIS low in standing

-ASIS low in supine

-supine length length longer

-sitting length length shorter

example: L anterior innominate

(+) standing flexion and long sitting tests on the L

L PSIS high, L ASIS low in standing

L leg longer in supine

L leg shorter in long sitting

Front 81

What are the movement tests, postural analysis findings and example for an posterior innominate rotation - pelvic girdle dysfunction/

Back 81

Motion Restriction = Anterior rotation

Movement Test: Standing flexion test

Long sitting test

Postural Analysis:

ASIS higher, PSIS lower in standing

Supine leg length shorter

Long sitting leg length longer

Example: Left Posterior Innominate

(+) standing flexion and long sitting tests on L

= L ASIS high, PSIS low in standing

L leg shorter in supine

L leg longer in long sitting

Front 82

What is innominate upslip definition?

Back 82

vertical shear of an entire innominate in which the ASIS and iliac crest are up in comparison to the opposite side innominate (ASIS and PSIS on one side will be higher than opposite side)

Front 83

What are the movement tests, postural analysis findings and example for an upslip of innominate - pelvic girdle dysfunction/

Back 83

Movement Test: Standing Flexion Test

Postural analysis:

-ASIS and PSIS higher than contral side in standing

supine and long sitting leg length shorter than other side

Example: Left upslip innominate

L PSIS and ASIS higher in standing

L leg shorter in supine and long sitting

Front 84

What are the movement tests, postural analysis findings and example for a forward or backward sacral torsion - pelvic girdle dysfunction/

Back 84

Movement Test: Sitting flexion test

Postural Analysis:

-Sacral sulcus (base of sacrum and ilium) deep (in prone) & sacral inferior lateral angle (near apex) (ILA) posterior and down (shallow) on opposite side

example: forward or backward torsion

Sitting flexion test (+) on Right

Sacral sulcus deep on R and ILA posterior on L = L rotation of sacrum on R oblique axis (see notes and print out)

Front 85

How are sacral torsions named?

Back 85

Sitting flexion test: the (+) side is the hypomobile side. Opposite side is considered axis (so if L side is (+) then axis is R

-draw the upside down triangle

put (+) for the ILA or sulcus that is palpated as more deep/anterior and negative for the opposite side that is more posterior/shallow

-if the (+) is at the base/sulcus of sacrum then rotation is the same as the axis so, for example, it would be R rotation on R axis.

-if the (-) is at the base/sulcus, then rot is opposite to axis so would (-) on L base would be L rot on R axis

Front 86

What is Yergason's special test?

Back 86

-test for biceps muscle pathology (tendonosis/tendonopathy)/integrity of transverse ligament which holds biceps tendon in the bicepital groove

-sitting with shoulder in neutral and elbow flexed to 90 and stabilized against trunk with forearme pronated

-examiner resists supination with ER

-tendon of long head of biceps will pop out of groove if transverse humeral ligament is torn

-tenderness/pain without dislocation indicates bicipital tendionpathy

Front 87

What is Speed's Test?

Back 87

-identifies bicipital tendonosis/tendonopathy

-sitting or standing

-UE full ext and forearm supination resist shoulder flexion. Repeat with forearm in pronation

-can also do with shoulder at 90 deg flexion and push into ext -->eccentric biceps contraction

-do in supination and pronation

(+) = increased tenderness in bicipital groove/long head of biceps tendon esp with supination position

Front 88

What test is this ?

Back 88

Speed's Test for biceps tendinopathy

Front 89

What is the Neer's Test?

Back 89

-to identify impingement of long head of biceps and supraspinatus tendon under the acromion

-sitting

-shoulder passively IR then fully abducted

(+) reproduces pain in shoulder

Front 90

What test is this?

Back 90

Neer's test for impingement of Biceps tendon and supraspinatus

Front 91

What is the Hawkins-Kennedy Test?

Back 91

-identify impingement of supraspinatus

-standing

-passive forward shoulder flexion to 90 deg

-then forcibuly IR the shoulder

(+) = pain indicating supraspinatus tendinosis/tendinopathy

Front 92

What test is this?

Back 92

Hawkins-Kennedy Test for shoulder impingement

Front 93

LE MM Innervations

Back 93

Front 94

UE MM Innervations

Back 94