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CCE Q8
clinical goodies
| Question | Answer |
|---|---|
| Neutral cervical compression | + radicular pain = IVF encroachment, possibly due to a disc herniation, tumor, or other SOL |
| Lateral cervical compression | + radicular pain = IVF encroachment, possibly due to a disc herniation, tumor, or other SOL |
| flexion cervical compression | + radicular pain = IVF encroachment, possibly due to a disc herniation, tumor, or other SOL |
| extension cervical compression | + radicular pain = IVF encroachment, possibly due to a disc herniation, tumor, or other SOL |
| distraction | + relief of pain = relief of radicular pain IVF encroachment of the c-spine, possibly due to a disc herniation, tumor, or other SOL = relief of local pain indicates muscle strain or ligament sprain |
| should depression | + radicular pain on the contralateral side of lateral flexion = nerve root depression/irritation or foraminal encroachment (osteophytes, dural sleeve adhesions) or brachial plexus stretch injury |
| valsalva | + radicular pain (anywhere) = space occupying lesion |
| Allen's | + greater than 3sec return of pink color to the palms = occlusion of radial or ulnar artery |
| Adson's | + diminished pulse strength on the side that the head is turned towards, reproduction of ischemic pain, tingling, numbness or paresthesias of the involved upper extremity = TOS, scalenus anticus syndrome |
| Halstead's | + diminished pulse strength on the side that the head is turned away from, reproduction of ischemic pain, tingling, numbness or paresthesias of the involved upper extremity = TOS, scalenus medius syndrome |
| Eden's | + diminished pulse strength on side pulse is being monitored, reproduction of ischemic pain, tingling, numbness or paresthesias of the involved upper extremity = TOS, costoclavicular syndrome |
| Hyperaduction | + diminished pulse strength on side pulse is being monitored, reproduction of ischemic pain, tingling, numbness or paresthesias of the involved upper extremity = TOS, pectoralis minor syndrome |
| Roos | + reproduction of ischemic pain, tingling, numbness or paresthesias of the upper extremities =TOS sensitive, but not specific |
| Apley's scratch | - both quantity and quality are noted -normal value is no greater distance than 2.5cm (1inch) from side to side |
| Painful Arc | -mid-range pain may indicate rotator cuff tendonitis -end-range pain may indicate impingement syndrome or acromioclavicular joint dysfunction |
| Empty Can test | + pain in the supraspinatus region, with or without full resistance. inability to hold testing position = supraspinatus tendonitis or supraspinatus tear |
| Lag sign | + inability to hold their arm or jerking motion = indicating a tear |
| Load and shift | + translation beyond 25% of the humeral head diameter anteriorly or beyond 50% posteriorly = anterior or posterior glenohumeral instability |
| Neer's | + anterior shoulder pain = impingement syndrome of possibly any of the following: supraspinatus, long head of biceps, infraspinatus, bursae |
| Kennedy-Hawkins | + anterior shoulder pain = impingement syndrome of possibly any of the following: supraspinatus, long head of biceps, infraspinatus, bursae |
| lift-off test | + inability to lift arm and/or abnormal during test = weakness or torn muscle |
| Speed's | + anterior shoulder pain located in the biceps muscle or tendon, especially in the inter-tubercular groove, giving way due to pain = biceps tendonitis or strain |
| Apprehension sign | + patient guarding, discomfort or a look of apprehension on the patients face = recurrent anterior dislocation of the glenohumeral joint |
| Relocation sign | + loss of apprehension and/or pain, greater external rotation before return of apprehension and pain = confirmation of recurrent anterior dislocation of the glenohumeral joint |
| Crank test | + patient guarding, discomfort or a look of apprehension on the patients face = recurrent posterior dislocation of the glenohumeral joint |
| Valgus stability | + excess medial joint gapping = MCL tear or instability |
| Varus stability | + excess lateral joint gapping = LCL tear or instability |
| Cozen's | + the pt demonstrates tenderness upon palpation of the extensor tendons while performing the test, pt is unable to hold the wrist in extension against resistance due to pain = lateral epicondylitis |
| Mill's | + the pt demonstrates tenderness upon palpation of the lateral epicondyle while performing the test = lateral epicondylitis |
| Reverse cozen's | + the pt demonstrates tenderness upon palpation of the flexor tendons while performing the test, pt is unable to hold the wrist in flexion against resistance due to pain = medial epicondylitis |
| Reverse Mill's | + the pt demonstrates tenderness upon palpation of the medial epicondyle while performing the test = medial epicondylitis |
| Passive elbow flexion | + pain , tingling, or paresthesias radiating into the forearm and fourth and fifth fingers = cubital tunnel syndrome |
| Watson's | + shifting of the scaphoid over the posterior rim of the distal radius or patient report of pain = ligamentous laxity of the scaphoid ligaments |
| Ballottement | + excess lunate motion, crepitus or pain with lunate shear = ligamentous laxity or instability of the lunatotriquetral interosseous membrane |
| ulnar deviation/pronation | + inability and pain = midcarpal instability |
| finkelstein's | + sharp pain in the anatomical snuff box (located on the radial side of the wrist) = stenosing tenosynovitis of the abductor pollicus longus and the extensor pollicus brevis |
| Bunnel-littler | + inability to flex the PIP with either flexion or extension of the MCP indicates joint capsule contracture. Inability to flex the PIP with the MCP in extension indicates tight intrinsic hand muscles (lumbricals or interossei) |
| Retinacular | + inability to flex the DIP with either flexion or extension of the PIP indicates joint capsule contracture. Inability to flex the DIP with the PIP in extension, indicates tight retinacular ligaments |
| Standing kemp's | + radicular pain = dural mobility compromise |
| Supported Adam's | -reduction of pelvic pain with pelvic immobilization = SI joint sprain-strain or inflammation. -pain regardless of immobilization of the pelvis = lumbar lesion |
| heel raises | + one toe/forefoot does not rise off the ground as much as the other foot = L4/L5 nerve root lesion |
| toe raises | + the heel does not rise off the ground as much as the uninvolved side = L5/S1 nerve root lesion |
| seated kemp's | + radicular pain = dural mobility compromise |
| Becterew's | + radicular pain down the side of complaint or inability to perform due to pain = dural mobility compromise, posterolateral disc herniation |
| Murphy's kidney punch | + pain traveling to groin = possible pyelonephritis |
| SLR | + radicular pain down the back of the leg being raised, if experienced any time before 70 degrees of hip flexion = dural mobility compromise (peripheral entrapment neuropathy, piriformis syndrome) |
| Braggards | + radicular pain down the back of the leg being raised, if experienced any time before 70 degrees of hip flexion. this pain disappears with dropping the leg but reappears with dorsiflexion of the ankle = dural mobility compromise |
| Gaenslen's | + pain in the SI joint (of side being extended) = SI joint infection, inflammation, or sprain |
| Thomas | 1. hip flexed or thigh is elevated off of the table = short psoas 2. knee extended beyond 90 degrees= short rectus femoris 3. abduction of the hip and contour of lateral thigh= short TFL or ITB |
| Patrick's | + pain in the mid-groin area = hip pathology, such as OA |
| Yoeman's | + pain in the SI joint = SI joint infection, inflammation, or sprain |
| Prone press up | extension of the lumbar spine with aggravate disc herniation as well as facet syndrome |
| Trendelenberg | the patient's pelvis will drop down and away from the side of a gluteus medius lesion. the patient will "hike" their hip up and over the side of hip pathology, such as OA (or a possible gluteus medius lesion). |
| Leguere's | + pain in the SI joint on the ipsilateral side (the side of overpressure) = SI joint infection, inflammation, or sprain |
| Ober's | + inability for the thigh to proximate to the plane-line of the table. Thigh may also be in a position of abduction. = ITB contracture or tensor fascia lata shortness |
| Craig's | angle of leg relative to table when Greater Trochanter is parallel with table >15 degrees= anteversion, and <8 degrees= retroversion |
| Hibb's | +excess gapping or pain in the SI joint = laxity of the posterior SI ligaments |
| Femoral nerve stretch | + radicular pain down front of the thigh on the involved side = dural mobility compromise L2-L4 or femoral nerve compromise |
| Valgus testing | + excessive gapping on the medial joint line = MCL damage |
| Varus testing | + excessive gapping on the lateral joint line = LCL damage |
| Patella inhibition . | + retropatellar pain = chondromalacia |
| Lachman's | + excessive knee motion from posterior to anterior or laxity of the joint = ACL damage |
| Anterior drawer | + excess anterior motion of the tibia = anterior cruciate tear or posterior knee capsule tear |
| Posterior drawer | + excess posterior motion of the tibia = posterior cruciate tear or arcuate-popliteus complex tear |
| Slocum's | -Excess antero-lateral motion of the tibia = anterolateral instability: ACL, LCL, posterior lateral capsule -Excess anterior - medial motion of the tibia = anteromedial instability: ACL, MCL, posterior medial capsule |
| Pivot shift | + feeling of a clunk or jerk, "giving way" sensation = anterolateral rotary instability indicating potential damage to the ACL and/or LCL |
| McMurray's | -Palpable click in the lateral joint line (with internal tibial rotation and valgus stress) indicates lateral meniscal tear. -Palpable click in the medial joint line (with external tibial rotation and varus stress) indicates medial meniscal tear. |
| Dynamic test | + pain at the location of the lateral meniscus and/or sharp pain when the end position = lateral meniscus tear |
| Noble's | + pain over the lateral femoral condyle (during approximately 30 degrees of knee flexion) = ITB friction syndrome |
| Apley's Compression | + pain or clicking with compression = meniscal tear and or loose cartilaginous fragment |
| Apley's Distraction | + relief with distraction = meniscal tear and or loose cartilaginous fragment -pain with distraction= ligamentous lesion |
| Drawer test (ankle) | + gapping, laxity, excess motion at the ankle joint = ankle sprain or ligament tear, excessive gapping on the anterior lateral side indicates anterior talofibular ligament tear |
| Inversion stress test | + gapping, laxity, excess adduction/inversion motion at the ankle joint = ankle sprain or ligament tear, indicates damage to anterior talofibular ligament, calcaneofibular, posterior talofibular |
| Eversion stress test | + gapping, laxity, excess with abduction/eversion motion at the ankle joint = ligamentous laxity of the deltoid ligaments (tibionavicular, tibiocalcaneal, anterior tibitalar, posterior tibitalar ligaments) |
| Navicular drop test | +the navicular tubercle falls one third of the distance to the floor = flat foot |
| Syndesmosis test | + pain distal to the site of squeezing = syndesmosis injury |
| forefoot compression | + sharp and sometimes tingling pain between the metatarsals = Morton's neuroma |
| heel compression | + relief of pain = fat pad syndrome |
| Thompson test | + absence of planar flexion with tricep surae squeeze = achilles tendon rupture |
Created by:
lerch
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