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406 Cards in this Set
- Front
- Back
what does TART stand for?
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Tissue texture changes
Assymetry Restriction Tenderness |
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the furthest point to which the patient can move a given joint
|
physiologic barrier
|
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the furthest point at which the physician can move any given joint
|
anatomic barrier
|
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somatic dysfunction occurs when what barrier is present?
|
restrictive barrier
|
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Acute or chronic TTA:
edematous, erythematous, boggy with increased moisture, hypertonic muscles |
acute
|
|
Acute or chronic TTA:
asymmetry without compensation |
acute
|
|
Acute or chronic TTA:
restriction present and pain with movement |
acute
|
|
Acute or chronic TTA:
severe, sharp tenderness |
acute
|
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Acute or chronic TTA:
decreased or no edema, no erythema, cool dry skin, slight tension, decreased tone, flaccid, ropy, fibrotic |
chronic
|
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Acute or chronic TTA:
asymmetry present with compensation in other parts of body |
chronic
|
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Acute or chronic TTA:
restriction present, decreased or no pain |
chronic
|
|
Acute or chronic TTA:
tenderness that is dull, achy, burning |
chronic
|
|
what is Fryettes first law?
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if the spine is in the neutral position (no flexion/extension), and if sidebending is introduced, rotation would occur to the opposite side
|
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what is Fryettes second law?
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when the spine is non-neutral (flexed/extended) and rotation is introduced, sidebending will occur to the same side
|
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which parts of the spine does Fryette's laws I and II apply to?
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thoracic and lumbar
|
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what is the orientation of the superior facets in the cervical spine?
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BUM (backward, upward, medial)
|
|
what is the orientation of the superior facets in the thoracic spine?
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BUL (backward, upward, lateral)
|
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what is the orientation of the superior facets in the lumbar spine?
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BM (backward, medial)
|
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name this contraction:
muscle contraction that results in the approximation of the muscle's origin and insertion without a change in tension; operators force is less than patients force |
isotonic contraction
|
|
name this contraction:
muscle contraction that results in the increase of tension without an approximation of origin and insertion; operators force is equal to patients force |
isometric contraction
|
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name this contraction:
muscle contraction against resistance while forcing the muscle to lengthen; operators force is greater than patients force |
isolytic contraction
|
|
name this contraction:
muscle contraction that results in approximation of origin and insertion |
concentric contraction
|
|
name this contraction:
lengthening of the muscle during contraction due to an external force |
eccentric contraction
|
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what is the difference between direct and indirect treatments?
|
direct moves into the barrier, indirect moves away from the barrier
|
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what type of treatment(s) are indicated for elderly and hospitalized patients?
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indirect or gentle direct/articulatory techniques
|
|
which treatment is contraindicated in patients with osteoporosis or metastatic cancer?
|
HVLA
|
|
what treatment works best for acute neck strain/sprain?
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indirect
|
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what do you need to treat prior to treating psoas syndrome?
|
lumbar spine, thoraco-lumbar spine
|
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what do you need to treat before the cervical spine?
|
the ribs and upper thoracic spine
|
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what do you need to treat before treating rib dysfunctions?
|
the thoracic spine
|
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what do you need to treat before treating the extremities?
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spine/sacrum/ribs (axial skeleton)
|
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which cervical vertebrae are atypical?
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C1 and C2
|
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which scalenes elevate the first rib during forced inhalation?
|
anterior and middle scalenes
|
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which scalene elevates the second rib during forced inhalation?
|
posterior scalene
|
|
which muscle divides the neck into anterior and posterior triangles?
|
the SCM
|
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shortening or restrictions of which neck muscle results in torticollis?
|
the SCM
|
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which ligament of the neck is weakened with RA and Down's resulting in increased risk of atlanto-axial subluxation?
|
transverse ligament
|
|
what is the most common cause of cervical nerve root pressure?
|
degeneration of the Joints of Luschka plus hypertrophic arthritis of the intervertebral synovial (facet) joints
|
|
what is the primary motion of the OA? how does sidebending occur with this joint?
|
primarily flexion/extension; sidebending and rotation occur opposite when flexed/extended
|
|
what type of motion occurs at the atlanto-axial joint?
|
rotation only
|
|
what type of sidebending/rotation relationship is there in C2 to C7?
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sidebending and rotation occur to the same side (coupled)
|
|
which treatments are indicated for an acute injury to the cervical spine?
|
indirect fascial techniques or counterstrain
|
|
symptoms of opoid withdrawal
|
N/V, abdominal pain, diarrhea, restlessness, arthralgias, myalgias
|
|
symptoms of beta-blocker overdose
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AV block, bradycardia, hypotension, wheezing, cardiogenic shock
|
|
treatment for beta-blockers
|
first treat with atropine and fluids, then glucagon to reverse beta-blockers
|
|
ethylene glycol has what effect on calcium and kidneys?
|
associated with hypocalcemia and calcium oxalate deposits in the kidneys
|
|
treatment for ethylene glycol poisoning
|
fomepizole or ethanol
|
|
first line treatment for anaphylaxis with intact airway
|
subcutaneous epinephrine
|
|
what should you do with positive fingerstick test for lead?
|
repeat serum lead level since the fingerstick test has a high rate of false positive
|
|
acute iron intoxication stages are...?
|
1. GI upset/disturbance
2. shock, metabolic acidosis 3. hepatic failure 4. bowel obstruction from GI scarring |
|
what features are seen with opoid overdose that you don't see with a benzo overdose?
|
opoid overdoses have respiratory depression and pupillary constriction that benzos don't have
|
|
treatment for Torsades
|
discontinue the offending agent and give MgSO4
|
|
when should you check the acetominophen levels in case of overdose?
|
4 hours after consumption
|
|
when do you need to being N-acetylcysteine with an acetominophen overdose?
|
within 8 hours of consumption
|
|
what is lye?
|
sodium hydroxide cleaning solution
|
|
what needs to be done in of ingestion of a strong alkalinic solution and why?
|
must get upper GI imaging and endoscopy since it leads to almost instantaneous damage due to liquefactive necrosis of the esophagus leading to perforation
|
|
treatment for diphenhydramine overdose and why?
|
treat with physostigmine to counteract the anti-cholinergic effects
|
|
treatment for organophosphate intoxication
|
remove clothes, wash the skin to prevent further absorption, give atropine to reverse effects
|
|
T1-T3 spinous processes are located where in reference to the transverse process?
|
at the level of corresponding transverse process
|
|
T4-T6 spinous processes are located where in reference to the transverse process?
|
located one-half segment below corresponding transverse process
|
|
T7-T9 spinous processes are located where in reference to the transverse process?
|
located at the level of the transverse process of the vertebrae below
|
|
spine of scapula corresponds to which spinous process
|
T3
|
|
inferior angle of the scapula corresponds with which spinous process?
|
T7
|
|
sternal notch is at the level of which vertebrae?
|
T2
|
|
nipple is located at which dermatome
|
T4
|
|
umbilicus is located at which dermatome
|
T10
|
|
what is the main motion of the thorax?
|
rotation
|
|
the intercostal muscles do what to the ribs during inspiration?
|
elevated the ribs
|
|
the upper ribs (ribs 1-5) have which type of motion?
|
pump-handle motion
|
|
the middle ribs (ribs 6-10) have which type of motion?
|
bucket-handle motion
|
|
the lower ribs (ribs 11 and 12) have which type of motion
|
caliper motion
|
|
the pump-handle ribs will be displaced which direction with inhalation/exhalation dysfunctions
|
anteriorly
|
|
the bucket-handle ribs will be displaced which direction with inhalation/exhalation dysfunctions
|
laterally
|
|
with inhalation dysfunctions which rib is the "key rib"
|
the lowest rib in the dysfunction
|
|
with exhalation dysfunctions which rib is the "key rib"
|
the uppermost rib of the dysfunction
|
|
where does the posterior longitudinal ligament begin to narrow?
|
starts narrowing at L1
|
|
narrowing of which ligament makes the lumbar discs more susceptible to herniation
|
posterior longitudinal ligament
|
|
iliac crest is at what vertebral disc level
|
L4-L5
|
|
what is spina bifida occulta
|
no herniation through defect, often only physical sign is hairy patch and is rarely associated with neurological deficit
|
|
spina bifida meningocele
|
herniation of the meninges through the defect
|
|
spina bifida meningomyelocele
|
herniation of meninges and the nerve roots through the defect with associated neurological deficits
|
|
90% of herniations occur with which disc
|
L4-L5 disc
|
|
a lumbar herniation will affect the nerve root for the vertebrae above or below?
|
below; i.e. L3/L4 herniation will affect L4 nerve root
|
|
what is the gold standard test for a herniated nucleus pulposus
|
MRI
|
|
is HVLA contraindicatd with a herniated nucleus pulposus?
|
it is a relative contraindication
|
|
a flexion contracture of the iliopsoas is often associated with what vertebral dysfunction?
|
a non-neutral dysfunction of L1 or L2
|
|
is HVLA indicated with spondylolisthesis?
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it is contraindicated
|
|
what is spondylolisthesis?
|
anterior displacement of one vertebrae in relation to the one below
|
|
name the grading for a spondylolisthesis?
|
grade I = 0-25%
grade II = 25-50% grade III = 50-75% grade IV = >75% |
|
positive vertebral step-off sign = ??
|
likely spondylolisthesis
|
|
what image is used to diagnose a spondylolisthesis?
|
lateral x-ray
|
|
what image is used to diagnose a spondylolysis?
|
oblique x-ray
|
|
what curve of the thoracic spine will compromise respiratory function?
|
>50%
|
|
what curve of the thoracic spine will compromise cardiovascular function?
|
>75%
|
|
most common cause of anatomical leg length discrepency
|
hip replacement
|
|
what is the innominate composed of?
|
three fused bones: the ilium, the ischium, the pubis bone
|
|
what are the true pelvic ligaments? (sacroiliac ligaments)
|
anteior, posterior and interosseus sacroiliac ligaments
|
|
which ligament divides the greater and lesser sciatic foramen?
|
sacrospinous ligament
|
|
which muscles make up the pelvic diaphragm?
|
levator ani
coccygeus muscles |
|
which way does the sacral base move during inhalation and exhalation?
|
during inhalation the sacral base moves posterior; during exhalation it moves anterior
|
|
which way does the sacral base move during craniosacral flexion/extension?
|
during craniosacral flexion the sacral base moves posteriorly (counternutation); with extension the sacral base moves anterior (nutation)
|
|
respiratory motion moves the sacral base about which axis?
|
superior transverse axis
|
|
craniosacral motion moves the sacral base about which axis?
|
superior transverse axis
|
|
postural motion moves the sacral base about which axis?
|
middle transverse axis
|
|
when a person bends forward the sacral base moves which direction?
|
it moves anteriorly at first, then at terminal flexion it moves posteriorly
|
|
when a person steps forward with the right leg which sacral axis will be engaged? and stepping forward with the left foot?
|
when stepping forward with the right leg the left sacral axis is engaged; when stepping forward with the left foot the right sacral base is engaged
|
|
dynamic motion occurs about which axis on the sacrum?
|
the right or left oblique axis
|
|
innominate motion occurs about which sacral axis?
|
inferior transverse axis
|
|
a positive standing flexion test with an innominate rotation points to the problem being on the ipsilateral or contralateral side?
|
ipsilateral side
|
|
when L5 is sidebent, the sacral oblique axis is engaged on the same side of opposite side?
|
same side
|
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when L5 is rotated, the sacrum rotates the same/opposite way on an oblique axis?
|
rotates opposite
|
|
the seated flexion test is positive on the same/opposite side as the oblique axis?
|
opposite side the oblique axis
|
|
sacral springing motion is present when the sacrum has moved anterior/posterior?
|
present when the sacrum moves anterior
|
|
sacral springing motion is restricted when the sacrum has moved anterior/posterior?
|
restricted when sacrum has moved posterior
|
|
lumbosacral spring test is positive if the sacral base has moved anterior/posterior?
|
posterior
|
|
with a forward sacral torsion the rotation is the same/opposite side of the axis?
|
rotation is the same as the side of the axis
|
|
with a backward sacral torsion the rotation is the same/opposite side of the axis?
|
rotation is opposite the side of the axis
|
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the seated flexion test is same/opposite the axis of rotation?
|
the seated flexion test is opposite the side of the axis of rotation
|
|
due to birth mechanics, which dysfunction is common in the post-partum patient?
|
bilateral sacral flexion
|
|
springing at both sulci/bases are restricted + springing at both ILA/apex are present = ??
|
bilateral sacral flexion
|
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the standing flexion test is used for which dysfunction?
|
innominate dysfunction
|
|
the seated flexion test is used for which dysfunction?
|
sacral torsions
|
|
how is the Cobb score for scoliolosis measured?
|
it is measured at the intersection of perpendicular lines drawn from the most superior and inferior vertebrae affected
|
|
best initial imaging for scoliosis
|
PA/lateral x-ray
|
|
mild scoliosis is best treated how?
|
with Konstancin exercises and OMM
|
|
scoliosis with respiratory compromise is an indication for what?
|
surgical repair
|
|
which rib should you target with inhalation dysfunctions?
|
target the lowest rib
|
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what is Nursemaids elbow?
|
radial head subluxation
|
|
how does a patient with a radial head subluxation typically present?
|
with the elbow in slight flexion and pressed up against their body to reduce strain
|
|
treatment for radial head subluxation
|
treat by flexing elbow to 180 degrees with supination at the same time
|
|
where are somatic dysfunctions associated with the heart located posteriorly?
|
at T1-T5
|
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the medial mallelous is sensory innervated by which nerve root?
|
L4
|
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the lateral mallelous is sensory innervated by which nerve root?
|
S1
|
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the dorsum of the foot and great toe are sensory innervated by which nerve root?
|
L5
|
|
the gastrocnemius muscle is innervated by which nerve root?
|
S1
|
|
the tibalis anterior is innervated by which nerve root? and loss of innervation to this muscle will result in what?
|
L4; foot drop
|
|
the Thomas sign is useful for diagnosing what?
|
psoas syndrome
|
|
which condition unique to females must be ruled out prior to diagnosing psoas syndrome?
|
salpingitis
|
|
what does a fibular head that is stuck posteriorly and resists anterior springing indicate?
|
posterior fibular head dysfunction
|
|
common foot position associated with a posterior fibular head dysfunction and how do you treat it?
|
tends to invert and plantarflex; treat it by putting the patient in the prone position, everting and dorsiflexing
|
|
what nerve is at risk for injury with a posterior fibular head dysfunction?
|
common peroneal nerve
|
|
test to assess medial meniscus injury
|
McMurray test
|
|
what is the only bone connecting the upper extremity to the axial spine?
|
clavicle
|
|
name the muscles of the rotator cuff and their actions
|
SITS
Supraspinatus - abduction Infraspinatu - external rotation Teres minor - external rotation Subscapularis - internal rotation |
|
the subclavian artery passes where in relation to the scalenes?
|
between the anterior and middle scalene; therefore contraction may compromise blood flow
|
|
where does the subclavian vein pass in relation to the scalenes?
|
anterior to the anterior scalene; therefore contraction of the scalenes does not compromise blood flow
|
|
where does the subclavian artery become the axillary artery?
|
at the lateral border of the first rib
|
|
where does the axillary artery become the brachial artery?
|
inferior border of teres minor
|
|
the radial artery supplies which palmar arch?
|
the deep palmar arch
|
|
the ulnar artery supplies which palmar arch?
|
the superficial palmar arch
|
|
the right upper extremity lymph drains where?
|
into the right/minor duct
|
|
the left upper extremity lymph drains where?
|
into the left/main duct
|
|
what is the most common somatic dysfunction of the shoulder?
|
internal/external rotation restriction
|
|
a positive arm drop test indicates what?
|
supraspinatus tear
|
|
prolonged shoulder immobilization can lead to what problem? and which OMM treatment should you use to treat this?
|
adhesive capsulitis/frozen shoulder syndrome; treat with Spencer techniques
|
|
humeral dislocations commonly occur in which direction
|
anterior and inferior
|
|
what causes winging of the scapula?
|
weakness of the anterior serratus muscle due to long thoracic nerve injury
|
|
what is the most common brachial plexus injury? damage to which nerve roots causes this?
|
Erb-Duchenne's palsy; C5/C6 nerve roots
|
|
which nerve is the most common nerve injured in the upper extremity?
|
radial nerve
|
|
which nerve is damaged with crutch palsy?
|
radial nerve
|
|
wrist drop is caused by injury to which nerve
|
radial nerve
|
|
primary flexors of the wrist and hand originate where and are innervated by which nerve?
|
originate at the medial epicondyle and are innervated by the median nerve
|
|
primary extensors of the wrist and hand originate where and are innervated by which nerve?
|
originate at the lateral epicondyle and are innervated by the radial nerve
|
|
the primary supinators of the forearm are which muscles innervated by which nerves?
|
biceps (musculocutaneous nerve) and the supinator (radial nerve)
|
|
which muscles pronate the forearm and are innervated by which nerve?
|
primary pronators are the pronator teres and pronator quadratus, innervated by the median nerve
|
|
muscles of the thenar eminence are innervated by which nerve?
|
median nerve
|
|
the hypothenar eminence and interossi muscles are innervated by which nerve?
|
ulnar nerve
|
|
what is the normal carrying angle for men? women?
|
men 5 degrees
women 10-12 degrees |
|
a carrying angle of >15 degrees is called what?
|
abduction of the ulna
|
|
a carrying angle of <3 degrees is called what?
|
adduction of the ulna
|
|
what is the radial head motion with supination/pronation?
|
when pronated, radial head moves posteriorly
when supinated, radial head moves anteriorly |
|
gold standard test for carpal tunnel syndrome
|
EMG
|
|
tennis elbow occurs on which epicondyle?
|
lateral
|
|
golfers elbow occurs on which epicondyle?
|
medial
|
|
what is this deformity called?
|
swan neck deformity
|
|
what is this deformity called?
|
boutonniere deformity
|
|
what disease are swan-neck and boutonniere deformities associated with?
|
RA
|
|
claw hand results from damage to which nerves?
|
median and ulnar injury resulting in loss of intrinsic hand muscles
|
|
contraction of the palmar fascia results in what?
|
Dupuytrens contracture
|
|
contracture of the last two hand digits with atrophy of the hypothenar eminence is called what and due to damage to which nerve?
|
Bishops deformity; due to ulnar nerve damage
|
|
wrist-drop occurs due to damage to which nerve?
|
radial nerve
|
|
which scalene attaches to the 2nd rib?
|
posterior scalene
|
|
which scalene attaches to the 1st rib?
|
anterior and middle scalenes
|
|
DeQuervains tenosynovitis is diagnosed with what test?
|
Finkelsteins test
|
|
DeQuervains tenosynovitis involves tendonitis to which muscle tendons?
|
abductor pollicis longus
extensor pollicis brevis |
|
the head of the femur glides which direction with external rotation of the hip?
|
glides anteriorly
|
|
the head of the femur glides which direction with internal rotation of the hip?
|
glides posteriorly
|
|
spasms of which two muscles cause an external rotation somatic dysfunction?
|
piriformis or iliopsoas
|
|
which direction will the fibular head glide with foot pronation?
|
glides anteriorly
|
|
which direction will the fibular head glide with foot supination?
|
glides posteriorly
|
|
dorsiflexion + eversion + abduction of the ankle = ?
|
pronation
|
|
plantarflexion + inversion + adduction of the ankle = ??
|
supination
|
|
the femoral nerve innervates which muscles?
|
quadriceps, iliacus, sartorius, pectineus
|
|
the femoral nerve does sensory to what part of the LE?
|
anterior thigh and medial leg
|
|
the tibial nerve provides motor output to which muscles?
|
hamstrings except biceps femoris, most plantar flexors
|
|
the tibial nerve gets sensory input from where?
|
lower leg and plantar aspect of foot
|
|
the peroneal nerve gives motor output to which muscles?
|
short head of biceps, dorsiflexors of the foot, toe extensors
|
|
the peroneal nerve recieves sensory input from where?
|
lower leg and dorsum of foot
|
|
the normal angle of the head of the femur is what?
|
120-135 degrees
|
|
if the angle of the head of the femur is >135 the condition is called?
|
coxa valga
|
|
if the angle of the head of the femur is <120 the condition is called?
|
coxa vara
|
|
name the grades for a sprain
|
first degree - no tear resulting in good tensile strength and no laxity
second degree - partial tear resulting in decreased tensile strength and mild laxity third degree - complete tear resulting in no tensile strength and severe laxity |
|
which compartment of the leg is most commonly affected by compartment syndrome?
|
anterior
|
|
what is O'Donahue's terrible triad?
|
injury to the ACL, MCL, MM
|
|
the ankle is more stable in dorsi/plantar flexion?
|
dorsiflexion
|
|
which foot arch is most prone to somatic dysfunction and which bones make up that arch? who is it commonly seen in?
|
most commonly the transverse arch; consists of the navicular, cuboid, cuneiforms; seen in long distance runners
|
|
what are the three main lateral stabilizing ligaments of the ankle?
|
anterior talofibular ligament
calcaneofibular ligament posterior talofibular ligament |
|
which ankle ligament is most commonly injured?
|
anterior talofibular ligament
|
|
what are the three types of lateral ankle ligament injuries?
|
type I - anterior talofibular ligament
type II - anterior talofibular + calcaneofibular ligament type III - anterior talofibular + calcaneofibular ligament + posterior talofibular ligament |
|
which ligament stabilizes the medial ankle?
|
deltoid ligament
|
|
what is the plantar aponeurosis?
|
a strong, dense, connective tissue that originates at the calcaneous and attaches to the phalanges
|
|
which levels provide sympathetic input to the lower extremities?
|
T11-L2
|
|
entrapment of which nerve and where result in hypothenar atrophy?
|
ulnar nerve entrapment at the wrist (Guyon's canal)
|
|
which landmarks do you use to assess leg length discrepancy?
|
ASIS and medial mallelous
|
|
what size heel lift should you start with when correcting a short leg in an elderly patient post-total hip replacement?
|
start with a 1.5mm heel lift then increase if necessary
|
|
where is the anterior chapman's point for the kidney?
|
1" superior and 1" lateral to the umbilicus
|
|
where is the anterior chapmans point for the adrenals?
|
2" superior and 1" lateral to the umbilicus
|
|
when doing lymphatic drainage treatment, where do you start first?
|
treat the thoracic inlet/outlet first; unless you unblock this everything peripheral to it will be blocked
|
|
what is the J-sign used to diagnose?
|
patellofemoral syndrome
|
|
what is patellofemoral syndrome? how does it present?
|
typically presents with anterior knee pain that worsens with prolonged sitting or ambulation up/down stairs; look for J-sign; aka chondromalacia patellae
|
|
what treatment can you use for thoracic lymphatic return when the thoracic pump/inlet release are contraindicated?
|
pectoral traction
|
|
which lymphatic treatments are contraindicated with rib fractures?
|
thoracic pump, thoracic inlet release
|
|
where is the anterior Chapman's point for the prostate?
|
anterior along the superior margin of the IT band
|
|
sidebending at L5 engages the oblique axis on the same/opposite side?
|
same side
|
|
what levels provide autonomic innervation for the uterus/cervix?
|
T10-L2
|
|
ureteral stones can cause which viserosomatic syndrome?
|
psoas syndrome
|
|
preferred treatment for acute cervical strain
|
indirect techniques
|
|
how do you do a Spurlings test?
|
extend the next, sidebend towards the side being tested and add compression
|
|
treatment for plantar fasciitis
|
ice, strengthening, stretching exercises, orthotics if persistent
|
|
what anatomic/physiological elements is the primary respiratory mechanism composed of?
|
1. inherent motility of the brain/spinal cord
2. flucutation of the CSF 3. movement of the intracranial and intraspinal membranes 4. articular mobility of the cranial bones 5. involuntary mobility of the sacrum between the ilia |
|
what is the cranial rhythmic impulse rate?
|
10-14 cycles per minute
|
|
what are the four factors that decrease the rate and quality of the CRI?
|
1. stress
2. depression 3. chronic fatigue 4. chronic infections |
|
what are the four factors that increase the rate and quality of the CRI?
|
1. vigorous physical exercise
2. systemic fever 3. OMT to the craniosacral mechanism |
|
name the four dural attachments
|
foramen magnum, C2, C3, S2
|
|
the involuntary mobility of the sacrum occurs on which axis between the ilia?
|
occurs about a transverse axis that runs through the superior transverse axis of the sacrum
|
|
which articulation of the cranium is the keystone of all cranial movement?
|
sphenobasilar synchondrosis (SBS)
|
|
when the midline bones of the cranium go into flexion what happens to the paired bones?
|
flexion of the midline bones corresponds to external rotation of the paired bones
|
|
name the midline bones of the cranium
|
sphenoid, occiput, ethmoid, vomer
|
|
flexion at the SBS will cause which movement of the sacrum?
|
counternutation
|
|
name the four movements that occur with craniosacral flexion
|
1. flexion of the midline bones
2. sacral base posterior (counternutation) 3. decreased AP diameter of the cranium 4. external rotation of the paired bones |
|
extension of the SBS will cause which movement of the sacrum?
|
extension at the SBS --> nutation of sacrum (sacral flexion)
|
|
name the four movements that occur with craniosacral extension
|
1. extension of the midline bones
2. sacral base anterior (nutation) 3. increased AP diameter of the cranium 4. internal rotation of the paired bones |
|
how does a compression strain of the SBS affect the CRI and what causes this?
|
often caused by trauma to the back of the head; severely decreases the CRI
|
|
what injury can cause poor suckling in the newborn?
|
occipital/condylar compression along with dysfunctions of CN IX and X at the jugular foramen
|
|
vagal somatic dysfunction can be caused by which cranial dysfunctions?
|
OA, AA, C2 dysfunction
|
|
dysfunction of which cranial nerve can cause tinnitus, vertigo, hearing loss?
|
CN VIII
|
|
what is the goal of craniosacral treatment?
|
to reduce venous congestion, mobilize articular restrictions, balance the SBS and enhance the rate/amplitude of the CRI
|
|
what is the goal of the venous sinus technique?
|
to increase blood flow through the venous sinuses so that blood may exit the skull through the jugular foramen
|
|
what is the purpose of CV4/bulb decompression?
|
to enhance the amplitude of the CRI
|
|
what is the purpose of the V spread?
|
to separate restricted or impacted sutures
|
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what is the purpose of the vault hold?
|
to address SBS strains
|
|
what is the purpose of the lift technique?
|
frontal and parietal lifts are commonly used to aid in the balance of membranous tension
|
|
what are two absolute contraindications to craniosacral treatment?
|
acute intracranial bleed or increased ICP
|
|
what are two relative contraindications to craniosacral treatment?
|
known history of seizures, traumatic brain injury
|
|
treatment position for anterior cervical tenderpoint
|
treat by placing head in flexion with rotation and sidebending away from lesion
|
|
which nerve root is the biceps DTR testing?
|
C5
|
|
which DTR tests C6?
|
brachioradialis
|
|
C5 provides motor output to which muscles?
|
biceps, deltoid
|
|
respiratory disease would show viserosomatic changes at which levels?
|
T2-T7
|
|
pancreatic disease would show viserosomatic changes at which levels?
|
T5-T9
|
|
where is the supraspinatous ligament located?
|
it is the strong, fibrous superficial band running from C7 to the sacrum along the spinous processes
|
|
name the contraindications to using the pedal pump
|
DVT, lower extremity fractures, recent abdominal surgery
|
|
where would the viserosomatic changes for ulcerative colitis be and why?
|
T12-L2 because UC affects the distal colon
|
|
name visceral spinal cord level for: head and neck
|
T1-T4
|
|
name visceral spinal cord level for: heart
|
T1-T5
|
|
name visceral spinal cord level for: respiratory system
|
T2-T7
|
|
name visceral spinal cord level for: upper GI tract
|
T5-T9
|
|
name visceral spinal cord level for: middle GI tract
|
T10-T11
|
|
name visceral spinal cord level for: lower GI tract
|
T12-L2
|
|
name visceral spinal cord level for: appendix
|
T12
|
|
name visceral spinal cord level for: kidneys
|
T10-T11
|
|
name visceral spinal cord level for: bladder
|
T11-L2
|
|
name visceral spinal cord level for: penis
|
T11-L2
|
|
name visceral spinal cord level for: arms
|
T2-T8
|
|
name visceral spinal cord level for: legs
|
T11-L2
|
|
name the corresponding nerve and ganglion: upper GI tract
|
greater splanchnic nerve
celiac ganglion |
|
name the corresponding nerve and ganglion: middle GI tract
|
lesser splanchnic nerve
superior mesenteric ganglion |
|
name the corresponding nerve and ganglion: lower GI tract
|
least splanchnic nerve
inferior mesenteric ganglion |
|
parasympathetic innervation to all viscera above the diaphragm = which nerve?
|
vagus nerve
|
|
parasympathetic innervation to the distal GI system = which nerve?
|
pelvic splanchnic nerves
|
|
which ligament divides the duodenum from the jejunum?
|
ligament of Treitz
|
|
which landmark divides the transverse colon from the descending colon?
|
splenic flexure of the large intestine
|
|
what provides sympathetic input to the GI tract before the ligament of Treitz?
|
T5-T9
|
|
what provides sympathetic input to the GI tract between the ligament of Treitz and splenic flexure?
|
T10-T11
|
|
what provides sympathetic input to the GI tract after the splenic flexure?
|
T12-L2
|
|
what does L3-L5 provide sympathetic input for?
|
nothing
|
|
in disease states there is too much sympathetic/parasympathetic input? how do you treat this?
|
sympathetic; treat with rib raising/paraspinal inhibition
|
|
what are the contraindications for rib raising/paraspinal inhibition?
|
spinal/rib fracture
recent spinal surgery |
|
what are the indications and contraindications for mesenteric inhibition?
|
indications = GI dysfunction, pelvic dysfunction
contraindications = aortic aneurysm, open surgical wound |
|
what is the purpose of treating Chapman's reflexes?
|
to decrease sympathetic tone to associated visceral tissues
|
|
condylar compression may cause what dysfunction in newborns?
|
suckling difficulties
|
|
name the anterior and posterior location of Chapmans point: appendix
|
anterior - tip of 12th rib on right
posterior - transverse process of T11 |
|
name the anterior and posterior location of Chapmans point: adrenals
|
anteriorly - 2" superior, 1" lateral to umbilicus
posterior - between spinous process and transverse process of T11 and T12 |
|
name the anterior and posterior location of Chapmans point: kidneys
|
anterior - 1" superior, 1" lateral to umbilicus
posterior - between spinous process and transverse process of T12 and L1 |
|
name the location of Chapmans point: bladder
|
periumbilical region
|
|
name the location of Chapmans point: colon
|
on the lateral thigh within the IT band from the greater trochanter to just above the knee
|
|
where is the trigger point that has been associated with SVTs?
|
in the right pectoralis muscle between the 5th and 6th rib near the sternum
|
|
what is the difference between tenderpoints and trigger points?
|
trigger points may refer pain when pressed; tenderpoints do not refer pain when pressed
|
|
permanent limitations of motion secondary to disease process or injury are referred to as what type of barrier?
|
pathological barrier
|
|
in a (forward/backward) sacral torsion, L5 has a good spring and the lumbosacral spring test is negative?
|
forward torsion
|
|
in a (forward/backward) sacral torsion, L5 does not have a good spring and the lumbosacral spring test is positive?
|
backward torsion
|
|
when a set of ribs have restricted motion when the patient exhales, this is what type of dysfunction?
|
inhalation dysfunction
|
|
when a set of ribs have restricted motion when the patient inhales, this is what type of dysfunction?
|
exhalation dysfunction
|
|
where is the anterior Chapman's point for the myocardium?
|
2nd intercostal space, near the sternum
|
|
a bilateral sacral (flexion/extension) has a restriction in springing motion at both ILAs
|
bilateral sacral flexion
|
|
what is Phalen's test?
|
tests for carpal tunnel syndrome by having the patient hold their hands in complete forced flexion for one minute and noting the distribution of numbness/tingling
|
|
with indirect myofascial treatment, the operator applies what kind of force?
|
compression along the long-axis of the muscle
|
|
with direct myofascial treatment, the operator applies what kind of force?
|
traction along the long-axis of the muscle into the restriction
|
|
"fine tuning" with myofascial treatment occurs by doing what?
|
adding twisting or transverse forces
|
|
what enhancers are used when doing myofascial treatment?
|
respiration, eye movement, muscle contraction
|
|
name the steps in myofascial treatments
|
1. palpate restriction
2. apply compression (indirect) or traction (direct) 3. add twisting or transverse forces 4. use enhancers 5. await release in the form of "melting" or "give-away" |
|
what is the goal of myofascial release?
|
improve lymphatic flow
|
|
what are the four diaphragms in the body that play a role in lymphatic return?
|
tentorium cerebelli
thoracic inlet abdominal diaphragm pelvic diaphragm |
|
which diaphragm plays the largest role in lymphatic return?
|
abdominal diaphragm
|
|
what are the four compensatory curves throughout the spine as noted by Zink?
|
occipitoatlantal junction
cervicothoracic junction thoracolumbar juction lumbosacral junction |
|
what is the Zink compensatory pattern in 80% of the population?
|
OA - rotated left
cervicothoracic - rotated right thoracolumbar - rotated left lumbosacral - rotated right |
|
which parts drain into the right lymphatic duct?
|
right UE, right hemicranium, heart, lobes of lungs (except LUL)
|
|
the left lymphatic duct traverses which fascia?
|
Sibson's fascia
|
|
how much lymph flows per day both in percent of ECF and volume?
|
10-20% of ECF, or 3L
|
|
the lymph system absorbs which compounds from the intestinal tract?
|
long chain fats, chylomicrons, cholesterol
|
|
what is the main cell found in lymph?
|
lymphocytes
|
|
the SNS affects the lymph capillaries in what way?
|
sympathetic input contracts the lymph capillaries
|
|
the cisterna chyli of the lymph system is innervated by which spinal nerve?
|
T11
|
|
which lymphatic treatment is particularly good in pediatric patients?
|
pedal pump
|
|
which lymphatic technique is indicated for sinus congestion or otitis media?
|
facial sinus pressure/Galbreath's technique
|
|
unless contraindicated, which lympathic technique should be done first?
|
thoracic inlet
|
|
what are the four relative contraindications for lymphatic treatment?
|
1. osseus fractures
2. bacterial infections with fever >102 3. abscess or localized infection 4. certain stages of carcinoma |
|
acute spasm of the SCM leads to what?
|
torticollis
|
|
what two things can separate an innominate inflare from and outflare?
|
1. positive standing flexion test on affected side
2. ipsilateral resistance to compression of ASIS |
|
what nerve controls extension of the wrist and digits?
|
radial nerve
|
|
acute lumbar pain in a young, healthy patient without neurological findings is likely what?
|
acute lumbar strain
|
|
what part of the colon is mostly affected by Crohn's?
|
80% of the time it's the terminal ileum
|
|
OMT for asthma patient to reduce viscerosomatic/somatovisceral action
|
rib raising
|
|
how do you prevent and treat patellofemoral syndrome?
|
by strengthening the vastus medials
|
|
treatment to increase parasympathic action for a URI should be directed at what ganglion?
|
sphenopalatine
|
|
treatment to increase parasympathic action for upper GI dysfunction should be directed at what ganglion?
|
celiac ganglion
|
|
symptoms of complex regional pain syndrome type 1
|
constant pain, allodynia, joint stiffness, localized edema, increase hair growth, vasospasm, no evidence of nerve damage; aka reflex sympathetic dystrophy
|
|
symptoms of complex regional pain syndrome type 2
|
intense pain, widespread edema, decreased hair growth, cracked/brittle nails, increased osteoporosis, joint thickening, muscle atrophy, evidence of nerve damage; aka causalgia
|
|
which OMT technique is a passive indirect technique in which the tissue being treated is positioned at the point of balance, ease, away from the restrictive barrier
|
counterstrain
|
|
with counterstrain, if multiple tenderpoints exist, which one do you treat first?
|
treat the most tenderpoint first
|
|
what are Maverick Points?
|
approximately 5% of counterstrain tenderpoints do not disappear when positioned properly, these points need to be treated by moving the patient into the opposite position that one would intuitively use
|
|
success with counterstrain is marked by what level of improvement in tenderness?
|
>70% improvement
|
|
anterior cervical tenderpoints are treated in what position? (except C7)
|
sidebent and rotated away from the tenderpoint
|
|
anterior C7 tenderpoints are located where and how do you position them for treatment?
|
located lateral to the medial end of the clavicle where the SCM attaches; treat with flexion, sidebend towards and rotate away from tenderpoint
|
|
where are the posterior certical tenderpoints located and how do you position them for treatment?
|
located at the tip of the spinous process or on lateral sides of spinous processes; position with extension, slight sidebending and rotate away
|
|
where is the counterstrain inion located and how do you position it for treatment?
|
posterior C1 located at the occipital protuberance; position with marked flexion
|
|
where are the anterior thoracic counterstrain tenderpoints located and how do you position for treatment?
|
T1-T6: midline of sternum at rib attachment point
T7-T12: on rectus abdominus muscle 1" lateral to midline right or left treatment position: FSARA flex, side bend away, rotate away |
|
where are the posterior thoracic counterstrain tenderpoints located and how do you position them for treatment?
|
located on either side of the spinous process of on the transverse process; treat with ESARA (extend, rotate away, sidebend slightly away)
|
|
with counterstrain treatment for the ribs, how long should you hold the position for?
|
Jones recommends 120 seconds
|
|
wheres the anterior counterstrain tenderpoint for rib 1 and how do you position it for treatment?
|
located just below medial end of clavicle; position with flexion, sidebend and rotate towards
|
|
wheres the anterior counterstrain tenderpoint for rib 2 and how do you position it for treatment?
|
located 6-8cm lateral to sternum on right 2; position with flexion, sidebend rotate towards
|
|
wheres the anterior counterstrain tenderpoint for ribs 3-6 and how do you position it for treatment?
|
located along mid-axillary line corresponding to rib; position with sight flexion, sidebend and rotate towards
|
|
where are the counterstrain tenderpoints for the posterior ribs and how do you position them for treatment?
|
located at angle of corresponding rib; position with minimal flexion, sidebend away, rotate away (FSARA)
|
|
where are the anterior lumbar counterstrain tenderpoints and how do you position them for treatment?
|
L1: medial to ASIS
L2-L4: on AIIS L5: 1cm lateral to pubic symphysis on superior ramus position with patient supine, knees and hips flexed, rotate away |
|
where are the posterior lumbar counterstrain tenderpoints and how do you position them for treatment?
|
L1-L2: on either side of the spinous process or transverse process
L3-L4: iliac crest L5: PSIS L1-L4: position prone, extend, sidebent away, rotation either direction L5: position prone, knee/hip flexed, leg internal rotated and adducted |
|
where is the iliacus counterstain tenderpoint located and how do you position it for treatment?
|
located 7cm medial to ASIS; position supine with hip flexed and externally rotated
|
|
where is the piriformis counterstrain tenderpoint located and how do you position it for treatment?
|
7cm medial and slightly cephalad to greater trochanter; position prone, hip/knee flexed, thich abducted and externally rotated
|
|
how do you treat using facilitated positional release (FPR)?
|
region of body is placed into neutral position, diminishing tissue and joint tension in all planes with a compression/torsion force added for 3-4 seconds
|
|
cranial treatment for otitis media should be directed at which bone?
|
temporal bone
|
|
OMT for dysmenorrhea?
|
sacral inhibition
|
|
first line drug therapy for dysmenorrhea
|
NSAIDs
|
|
what type of treatment is post-isometric relaxation?
|
direct and active
|
|
where would viscerosomatic changes be for ulcerative colitis?
|
T12-L2
|
|
where is the Chapmans point for the pancreas?
|
lateral to the costal cartilage between ribs 7 and 8 on the right
|
|
which is more important with muscle energy: localization or intensity?
|
localization
|
|
which part of the muscle cells are you attempting to active/deactivate?
|
golgi tendon organs
|
|
with muscle energy how long should the contraction be held? how many times should you repeat the contration?
|
hold for 3-5 seconds, repeat 3-5x
|
|
which patients is muscle energy contraindicated with?
|
patients with low vitality; i.e. post-surgical, ICU
|
|
when treating the typical cervicals with ME, are rotation and sidebending coupled or opposite?
|
coupled
|
|
when using muscle energy, what muscle is used to treat dysfunctions at rib 1?
|
anterior/middle scalenes
|
|
when using muscle energy, what muscle is used to treat dysfunctions at rib 2?
|
posterior scalene
|
|
when using muscle energy, what muscle is used to treat dysfunctions at ribs 3-5?
|
pectoralis minor
|
|
when using muscle energy, what muscle is used to treat dysfunctions at ribs 6-9?
|
serratus anterior
|
|
when using muscle energy, what muscle is used to treat dysfunctions at ribs 10-11?
|
latissimus dorsi
|
|
when using muscle energy, what muscle is used to treat dysfunctions at rib 12?
|
quadratus lumborum
|
|
when treating sacral torsions with ME, how do you know which side to lay the patient on?
|
lay them on the side of the axis; axis side down
|
|
what are the absolute contraindications to HVLA treatment?
|
osteoporosis
osteomyelitis Potts disease fractures in the region bone metastasis severe RA Downs syndrome |
|
what are the relative contraindications to HVLA treatment?
|
acute whiplash
pregnancy post-surgical conditions herniated nucleus pulpulsus hemophilia anti-coagulation therapy vertebral artery ischemia (+Wallenberg's test) |
|
when using the Kirksville Krunch to treat a flexed lesion, where should you direct your thurst and in what direction?
|
aim towards the floor, thrust directly at the dysfunctional segment
|
|
when using the Kirksville Krunch to treat an extended lesion, where should you direct your thurst and in what direction?
|
aim 45 degrees cephalad; direct the thrust at the segment below
|
|
when using the Kirksville Krunch to treat a rib 2-10 lesion, where should you thrust?
|
place the thenar eminence under the posterior angle of the key rib
|
|
What does the Spurling/compression test help diagnose and how do you do the test?
|
tests for referred pain from cervical nerve root irritation; extend and sidebend the c-spine towards the side being tested and apply a downward force
|
|
What does the Wallenberg test help diagnose and how do you do the test?
|
tests for vertebral artery insufficency; hold the head in flexion for 10s, then extension for 10x, repeat by going R-->L and L-->R, a positive test occurs if the patient experiences dizziness, lightheadedness, nystagmus
|
|
What does the Adson's test help diagnose and how do you do the test?
|
tests for neurovascular compromise due to tight scalene muscles; ask patient to take deep breath in and turn head toward ipsilateral side, positive test if radial pulse decreased or absent
|
|
What does the Wright's test help diagnose and how do you do the test?
|
looks for neurovascular compromise due to petoralis minor at coracoid process; +test if radial pulse decreased/absent with arm hyperabduction and extension
|
|
What does the Costoclavicular (military posture test) test help diagnose and how do you do the test?
|
looks for neurovascular compromise due to clavicles and first rip; depress and extend shoulder; +test if decreased radial pulse
|
|
What does the Appley scratch test help diagnose and how do you do the test?
|
tests ROM of shoulder by reaching behind head to opposite shoulder and as high as possible up lower back
|
|
What does the drop arm test help diagnose and how do you do the test?
|
rotator cuff tears; arm cannot smoothly lower to side or drops off at 90 degrees
|
|
What does the Allens test help diagnose and how do you do the test?
|
tests adequacy of blood flow to hand via radial/ulnar arteries; slow flushing or no flushing at all indicates positive test
|
|
What does the Finkelstein test help diagnose?
|
test for tenosynovitis of the abductor pollicis longus and extensor pollicis brevis test at wrist; DeQuervains disease; positive result if pain is felt over tendons at wrist
|
|
describe the Phalen's test
|
used to diagnose carpal tunnel syndrome; extend wrists to 90 degrees against their two hands looking for distribution of symptoms
|
|
describe reverse Phalens test
|
opposite motion as Phalens, patient puts dorsum of hands together downward and tests what symptoms appear after one minute
|
|
describe Tinnels test
|
used to diagnose carpal tunnel syndrome; tap on nerve to see if leads to paresthesias
|
|
describe the hip-drop test
|
purpose is to evaluate sidebending (lateral flexion) of lumbar spine; positive test if drop of greater than 20 degrees
|
|
describe the straight leg raise test
|
helps evaluate sciatic nerve compression test; lift left until patient feels discomfort which should be 70-80 degrees
|
|
describe the seated flexion test
|
tests sacroiliac motion; somatic dysfunction is present on the side of the superior PSIS
|
|
describe the standing flexion test
|
tests iliosacral motion; somatic dysfunction is present on the side of the superior PSIS
|
|
describe the Trendelenberg test
|
tests gluteus medius muscle strength; positive test on the side of the leg that they are standing on if there is a hip drop
|
|
when will the lumbosacral spring test be positive?
|
in all dysfunctions in which the sacral base moves posterior
|
|
describe Obers test
|
detects a tight tensor fascia lata and IT band
|
|
describe Patricks test
|
aka FABERE test; tests for pathology of the sacroiliac and hip joints such as OA
|
|
describe the anterior/posterior drawer test
|
tests the ACL, PCL; positive if tibia moves excessively in one direction on a particular side
|
|
describe the Bounce test
|
tests for meniscal tears or joint effusions; test is positive if extension is incomplete or there isn't smooth motion through the end-point
|
|
describe the Lachmans test
|
similar to the drawer test, looks for stability of the ACL
|
|
describe the McMurrays test
|
detects tears in the posterior aspect of the menisci; look for palpable or audible click when applying a varus/valgus stress to the knee
|
|
describe the patellar grind test
|
tests for chondromalacia patellae or patello-femoral syndrome; test is positive if they experience pain below the patella
|