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ortho/neuro t3
ortho t3
| Question | Answer |
|---|---|
| bakody sign | seated. patient presenting with neck and arm discomfort presents with the involved arm abducted and placed on the top of the head; they state that this relieves their arm pain. radicular pain decreases when are is in this position=nerve root compromise |
| Dejerine's Sign (triad of dejerine) | patient reports that coughing, sneezing or straining at the stool causes an increase in nerve root or cord compression signs. Space occupying lesion (SOL) |
| Lhermitte's sign (seated) | neck is passively flexed, sharp electric shock sensation down the spine and into upper or lower extremity = cord myelopathy |
| Naffziger test (seated) | examiner holds digital pressure over the jugular veins bilaterally for 30-40 seconds; the patient is instructed to cough Radicular pain = space occupying lesion |
| allen's test (seated) | do prior to other TOS tests. patient seated, arm lying on their thigh, rapidly open/close fist. radial and ulnar arteries are occluded, release 1@ time.asses collateral circ. Delay of normal color=reduction collat. circ > TOS test may not be accurate. |
| adson's test (seated) | radial pulse is palpated with the arm hanging at the side. patient rotate and extend head to side of palpation/take deep breath in. decrease in pulse strength = compression of neurovascular bundle b/t middle & anterior scalenes |
| costoclavicular maneuver (seated) | examiner palpates the radial pulse. patient flexes head while examiner extends shoulder. Reduction in strength of pulse = neurovascular compression b/t clavicle and first rib |
| wright's test or hyperabduction maneuver (seated) | radial pulse is palpated w/ arm resting @ side and plapation continues as arm abducted to 180 degrees. reduction in pulse as arm raised = neurovascular compression under pectoralis minor. Reduction in pulse above 120 degrees may be physiologic not path. |
| Roos Test (seated) | patient holds arms at 90 degrees of abductgion and external rotation. open and close fists repeatedly until symptoms occur or for 3 min. Reproduction of complaints = neurovascular compression but does not indicate source of compression |
| Halstead maneuver (seated) | radial pulse is palpated and traction is applied to the arm while patient extends their head. Reduction in pulse = neurovascular compression by a cervical rib or by anterior scalenes |
| valsalva maneuver (seated) | patient is instructed to place their thumb in mouth and blow as if they were trying to blow up balloon. radicular pain = space occupying lesion |
| rust's sign (any position) | patient holds their head while moving, particularly while changing position. indicates severe sprain or instability of the neck |
| Brudzinski's sign (supine) | patient's head is passively flexed. sign is positive if flexion of both knees occurs = meningitis |
| Brachial plexus tension test (seated) | examiner supports the arms while the patient fully abducts and gradually externally rotates the arms. elbows are flexed and neck is flexed. reproduce radicular symptoms = C5 nerve root syndrome |
| spinal percussion test (seated) | neck is flexed and the spinous processes are percussed with reflex hammer. positive pain finding = indicate spinous process fracture or underlying disease processes |
| libman's sign (seated) | examinar applies pressure to the mastoid processes. this will provide and indication of patient's pain threshold. Malingering test |
| Mannkopf's sign (any position) | examiner establishes the resting pulse rate. the area of complaint is then stimulated. increase in pulse = normal response. no change in pulse = suggest nonorganic pain |
| magnuson's test | patient is asked to point to the area of pain. later in exam the patient is instructed to point to the area of complaint. findings should be consistent. a significant change in location of pain may be suggestive of nonorganic pain |
| adam's position | patient with scoliosis bends forward at the waist. the curve straightens and no significant rib hump is present = negative sign suggests a functional scoliosis. deformity is present = positive sign suggesting a structural scoliosis |
| amos's sign | the patient attempts to sit up from a supine or side lying position. localized thoracolumbar/thoracic pain = ankylosing spondylitis, severe sprain or intervertebral disc lesion |
| beevor's sign | the supine patient flexes their head. when the abdominal muscles contract the umbilicus should remain in its location. if umbilicus migrates = muscle weakness is present suggesting a T10 cord compression |
| schepelmann's sign | seated patient laterally flexes to each side. pain on concave side = intercostal neuralgia. pain on the convex side = intercostal myofascitis |
| costovertebral stress (seated) | patient asked to rotate torso & stress is applied at rib angle. pain = on side of costovertebral /costosternal irritation. loss of movement = fixation of the costotransverse/costovertebral articulation in P to A translation (caliper movement) |
| chest expansion test | place thumbs and index fingers around the posterior chest surface. thumbs should separate equally on full inspiration. Diminished chest expansion = ankylosing spondylitis, intercostal neuralgia, pulmonary pathology. unequal chest expansion = atelectasis |
| rib compression test (seated) | examiner compresses rib cage while patient takes a deep breath. symptom relief = intercostal neuralgia w/ hypomobile costotransverse articulation. localized pain = lesion at location of pain |
| lateral chest compression | side to side compression of rib cage is applied. Tenderness at costosternal junction = inflammatory rxn of costosternal articulation. pain in back = costotransverse/costovertebral lesion. localized pain @ lat. border of ribs = fracture |
| sternal (AP) compression test | A to P compression of rib cage is applied with one hand on sternum and other hand on the back. tenderness @ costosternal junction = inflammation @ costosternal articulation. Pain in back = costotransverse/costovertebral lesion. local pain = fracture |
| Rib springing test (prone) | examiner places double thenar contacts over the rib cage. on full expiration apply body force and gently springs ribs on costovertebral joints. lack spring/pain over costotransverse artic = loss of caliper/bucket handle motion, intercostal mm strain. |
| C5 MSR | M: deltoid. S: lateral deltoid R: biceps |
| C6 MSR | M: Biceps, wrist extensors. S: lateral antebrachium to thumb/index web R: brachioradialis |
| C7 MSR | M: triceps, wrist flexors. S: middle finger. R: triceps |
| C8 MSR | M: finger flexors. S: ulnar aspect of hand and antebrachium. R: finger flexors |
| T1 MSR | M: finger abductors/adductors. S: medial antebrachium and elbow. R: N/A |
| grading of mm stretch reflexes | 0/4 or 5 = no response (areflexia; LMN lesion). 1/4 or 5 = diminished response (hypoflexia). 2/4 or 5 = normal. 3/4 or 5 = brisk (hyperreflexia). 4/4 or 5 = transient or sustained clonus (hyperreflexia with ____ beats of clonus, indicative of UMN lesion) |
Created by:
slalomGS