T4-NM3- Orthos-UB-Should-Elbow-Wrist
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| Apprehension test? | Patient seated with doctor behind, patient looks back at doctor..shoulder is brought to 90 deg abd with ext rot, while stabilizing the shoulder from behind POS-px over ant capsule, look of aphrension, laxitiy compared to other side
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| Posterior Dislocation Aprehension test? | patient supine, shoulder flexed at 90 and internally rotated. Doctor applies a posterior force on elbow watching for apprehension, px, or resisitance IND=post dislocation trauma of humerus
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| Relocation test? | Only done if positive apprehension, stabilize capsule and reperform apprehension test POS=patient experiences relief of symptoms as compared to appreh test IND=decreased apprh ind anterior instability, and decreased px ind ant instability and cuff dx
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| Jobes test? | alt to relocation test, patient lies supine with shoulder in abduction and ext rot. Doc applies atop force on prox humerous while ext rotating the shoulder POS=decrease in px or apprehension
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| Sulcus sign? | hand in lap, doc applies inf trx by way of elbow POS=sulcus or dimple appears sup to humeral head IND=instability Measured=0, 1, 1-2, 3 (if greater than 2 cem)..test should be repeated at 45 deg abd IND=sulcus at 45 degrees ind lax glenohumeral ligament
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| Load and Shift test (drawer)? | patient seated, supine or side lying; doc stabilized shoulder, and outside hand presses ant-post on the prox hum head normal is ,25% of dia of hum head POS=too much movement, or grinding, poppling etc. IND=instability of glenhum joint or pos labrum damage
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| Dugas Test? | Patient seated, doc instructs patient to touch opposite shoulder with their hand, and then lower elbow to chest POS=inability to touch oppo shoulder or unable to lower arm to chest IND=dislocated shoulder
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| Apley’s scratch test? | doc instructs patient to place the hand of affected shoulder behind head and to sup angle of the opposite scapula, then patient tries to touch inf aspect of opposite scap POS=px worse in shoulder IND=degenerative tendinitis of the rotator cuff (supra)
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| Subacromial Push-Button Sign? | Patient seated, doc stands behind and adds pressure to the subacromial bursa POS=increase in px IND=subacromial bursitis
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| Subacromial Bursa test (Dawbarns)? | Patient seated, doc stands behind patient palp tendor area, anterolateral and inf to acromial process, doc keeps finger on site of pain, and passively abducts the arm to 90 degrees POS=px disappears IND=subacromial bursitis
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| Drop arm test (Codmans)? | patient seated, doc passively abduct arm >90 deg, then suddenly removes support causing the deltoid to contract POS=px and hunching of shoulder IND=rotator cuff tear or rupture of supraspinatus tendon
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| Alt drop test? | Doc passively abducts arm to greater than 90, and then patient slowly lowers it down POS=patient is unable to lower or has severe px IND=rotator cuff tear, or supra rupture, may mimic bursitis if test is neg but has pain over anterolateral shoulder
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| Empty can test? | elbow extended at 90 deg ab and neutral rotation, doc pushes arm down, arm moved into 30 deg hor flexion, and thumb pointed down, doc pushes down POS=weakness or px-alt is just putting the patient into abduction in scaption, with int rot and pushing down
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| Lift Off sign (Gerbers)? | Patient seated or standing places hand behind back (should not be px), patient tries to lift hand off of back POS=patient can’t IND=lesion of the subscapularis mus or tendon—strength can be tested by applying force against patient’s hand
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| Yergasons? | arm bent at elbow in 90 degrees, doc and resistance while pat tries to ext elbow and sup, alt is to sup and ext rotate POS=Px over bicip tendon and trans hum lig IND=inflam of biceps ten or tendonitis, popping ind lax trans humeral lig or shallow groove
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| Clunk test? | Patient supine, doc places one hand behind humeral head, other abducts shoulder and pushes anteriorly POS=clunk of grinding IND=ant tera of glenoid labrum
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| Crank Test? | Patient supine, doc passively brings arm into 160 flexion in scapular plane, doc applies axial force while internally and externally rotating arm POS=clicking with px IND=labrum tear
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| O’Brien Sign? | Patient stands with straight arm and shoulder at 90 flex and 10-15 degrees hor flex
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| Impingement Syndrome Test? | supine or seated patient with elbow flexed, doc applies superior pressure on elbow into subacromial/suprahumeral space POS=increased px IND=impingement syndrome
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| Hawkins-Kennedy? | Patient flexes shoulder with elbow bent at 90, doc internally rotates shoulder POS=px in ant glenohumeral joint IND=rotator cuff tendonitis
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| Neers Test? | Doc is next to patient and forefully flexes the patients arm while depressing the scapula POS=px in the anterior glenhumeral joint IND=rotator cuff tendonitis
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| Impingement Relief Test/Reverse Impingement? | Patient supine with arm in apprehension position, doc pushes humeral head from sup to inf POS=decrease in px IND=mech impingement under acromion
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| Cozen’s Test? | Patient’s arm is at their side with their wrist flexed at 90. Doc stabilizes forearm, and patient tries to resist against flexion, stresses ext carpi radialis longes and brevis Pos=Px in lateral condyle
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| Mill’s Test? | Patient’s arm is flexed at 90 deg, have patient pronate their arm and flex their wrist, doc stabilizes forearm, patient is instructed to supinate against resistance POS=pain in lateral epicondyle IND=lateral epicondylitis
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| Mill’s Test/Maneuver? | Flex and pronate wrist, and extend elbow in one motion
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| Kaplan’s Sign? | arm at 90 deg holding a dynamometer with their wrist ext, pat squeezes POS=weakness or px in lateral epicondyle IND=lateral epicondylitis, then grasp around and have them squeeze again POS=increase in strength or decrease in px IND=lateral epicondylitis
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| Pinch Grip test? | patient pinches their index finger and thumb together tip to tip,POS= if they can’t and can only do pad to pad IND=impingement of anterior interossei branch of median nerve
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| Medial Epicondylitis test? | grasp patient’s hand as if you are greeting them, supinate their wrist and extend it POS=px in the medial aspect of the elbow IND=medial epicondylitis
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| Tinels test? | hand is supinated and wrist is stabilized tap along the medial nerve in the carpal tunnel POS=px or tingling in the dis of the median nerve distal to the wrist IND=median nerve compression in the carpal tunnel
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| Phalens? | flex hands together and lower elbows to make sure wrist is fully flexed, hold for 60 seconds POS=px or tingling in the hand along median nerve IND=carpal tunnel compression of median nerve
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| Reverse Phalens? | ext wrists and put hands together, raise elbow until wrists are fully extended, hold for 60 POS=px or tingling along median nerve IND-carpal tunnel compression of median nerve
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| Finkelstein’s? | patient makes a fist around thumb and ulnar deviates POS=sharp pain in tunnel 1 IND=Deqervain’s or stenosin tenosynovitis of Tunnel 1
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| What is stressed with ulnar stress test? | ulnar deviation so radial collateral is stressed and tunnels 1-4
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| What is stressed with Radial stress test? | radial deviation so ulnar collateral ligament, tunnel 6 (extensor carpi ulnaris and flexor carpi ulnaris
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| Flexion stress test of wrist? | extensor tendonitis or sprain of posterior ligament structures
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| Extension stress test of writs? | flexor tendonitis or sprain of anterior ligament structures
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| Bracelet Test? | Doctor squeeze the distal radial and ulnar joints POS=Acute px in the wrist, forearm, and hand IND=rheumatoid arthrirtis
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| Carpal Lift Test? | Patient’s hand is palm down on the exam table, doctor holds a finger down and ask’s patient to extend that finger POS=px in the wrist IND=carpal frx or sprain
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| Bunnel-Littler test Method 1? | the doctor extends MCP joint, and flexes PIP joint. Then doc extends PIP joint and flexes DIP joint POS=either joint will not flex IND=tight intrinsic muscles or contracture of joint capsule
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| Bunnel-Littler Test Method 2? | pat ext MCP joint and doc move the PIP into flex POS=if PIP can’t be flexed IND=tight instrinsic mm, or contracture; 2=pat flexes MCP joint and PIP if PIP can now be flexed- the rest is intrisnisc muscles and ind inflam process such as osteoartiris or RA
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| Shrivel Test or O-Riain? | Patient’s fingers are placed in warm water (40 deg) for 30 min POS=if skin isn’t wrinkled IND=denervation
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| Froment’s Sign? | Pat grasps a piece of paper between two fingers POS=failure to maintain grip when paper is pulled away IND=ulnar nerve palsy, ALT is the patient puts tip of finger and tip of thumb together and doc pulls apart. if can't-ind of ulnar nerve palsy
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| Finsterer’s Sign? | tapping over the 3rd metacarpal POS=px in center of wrist IND=keinbock’s (avascular necrosis of the lunate
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