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Ortho Exam - MT1

QuestionAnswer
How does VSC typically show on a patient? Local pain
Local pain could be from what 6 things? VSC; DJD/spondylosis/osteoarthritis; Degenerative Disc Disease; Traumatic injury; Mild Sprain/Strain; Meniscoid block
Sclerotomal pain could be from what 2 things? Facet joint involvement; Myofascial trigger point referral;
Sclerotomal pain appears in the absence of what test? Dejerene's triad
Intrathecal pressure symptoms is created by what? Space between the dura mater and the spinal cord/brain tissue is pressurized and contains cerebrospinal fluid that helps to protect and nourish the tissue
Intrathecal pressure symptoms display as what pattern? Dermatomal pattern
Dermatomal findings are created by what? A space occupying lesion creating pressure on the spinal cord or nerve root will increase intrathecal pressure
Dermatomal findings can be created from what 3 things? Tumor; Disk involvement (eg. herniation); Stenosis;
Radiculopathy could form by what three things? Lateral tumor, disk, or IVF stenosis
A key to all dermatomal findings is the presence of what? 1, 2, or 3 of Dejerene's triad
What are the 3 tests for intrathecal pressure? Dejerene's triad; Valsalva Maneuver; Nafzigger's test;
What are the different positive, false positive, and incidental findings for the three intrathecal pressure tests? Positive - dermatomal pattern is recreated; False positive - local symptom or diffuse non-dermatomal symptom; Incidental - anywhere else;
Dejeren's Triad - explain the 5 things needed to know about this test 1. Pt - sits 2. Dr - observe 3. Demo - ask if symptoms occur when 1-cough, 2-sneeze, or 3-strain; 4. Findings True + - pt says yes; dermatomal False + - local Incidental - elsewhere 5. Significance - space occupying lesion
Valsalva Maneuver - Explain the 5 things needed to know about this test 1. Pt - sits 2. Dr - observe 3. Demo - Have patient breath in, hold and bear down 4. Findings True + - dermatomal False + - local Incidental - elsewhere 5. Significance - space occupying lesion
Naffzigger's Test aka Jugular Compression - Explain the 5 things needed to know about this test 1. Pt - sits 2. Dr - stands behind 3. Demo - compress jugular veins up to 30-40 secs, pt coughs; NOT done on geriatric or atherosclerotic pts 4. Findings True + - dermatomal False + - local Incidental - elsewhere 5. Significance - space occupying l
Bakody's Sign aka Shoulder Abduction Relief Sign - Explain the 5 things needed to know about this sign 1. Pt - hand on head 2. Dr - observe 3. Demo - NA 4. Findings True + - Relieves arm pain & paresthesia False + - Relief of other pain Incidental - elsewhere 5. Significance - Nerve root compression from cervical disk herniation
Rust's Sign - Explain the 5 things needed to know about this sign 1. Pt - Hand support neck 2. Dr - observe 3. Demo - NA 4. Findings True + - Severe injury False + - NA Incidental - NA 5. Significance - Cervical instability: fracture, dislocation, severe sprain/strain. X-ray before other tests
Cervical Compression Test aka Foraminal Compression Test - Explain the 5 things needed to know about this sign 1. Pt - sits 2. Dr - behind 3. Demo - Full ROM on head including neutral. Downward pressure 4. Findings True + - Dermatome False + - Local Incidental - elsewhere 5. Significance - SOL
Jackson's Test - Lateral flexion of cervical compression test - Explain the 5 things needed to know about this test 1. Pt - sits 2. Dr - behind 3. Demo - Bilaterally laterally flex head and compress 4. Findings True + - Dermatome False + - Local Incidental - elsewhere 5. Significance - SOL
Maximum Cervical Compression Maneuver - Explain the 5 things needed to know about this maneuver 1. Pt - sits 2. Dr - behind 3. Demo - Rotate & extend head with no compression (opt: look down) 4. Findings True + - Dermatome False + - Local Incidental - elsewhere 5. Significance - SOL
Spurlings Test - Explain the 5 things needed to know about this test - NOT DONE AT LCCW 1. Pt - sits 2. Dr - behind 3. Demo - Maximum cervical compression maneuver with one hand compression 4. Findings True + - Dermatome False + - Local Incidental - elsewhere 5. Significance - SOL
Modified Spurlings Test 1. Pt - sits 2. Dr - behind 3. Demo - Maximum cervical compression maneuver with TWO hands compression 4. Findings True + - Dermatome False + - Local Incidental - elsewhere 5. Significance - SOL
Cervical Distraction Test 1. Pt - sits 2. Dr - behind/beside 3. Demo - Hand under chin/other occiput OR fingers under mandible/thumbs under occiput 4. Findings True + - Relief dermatome False + - Relief local Incidental - elsewhere 5. Significance - SOL
Shoulder Depression Test 1. Pt - sits 2. Dr - behind 3. Demo - Laterally flex pt's head away & depression shoulder 4. Findings True + - Multiple dermatomes/plexi False + - local Incidental - elsewhere 5. Significance - Dural adhesions
Lhermitte's Sign 1. Pt - sits 2. Dr - observe 3. Demo - Ask pt to flex neck 4. Findings True + - electric shock down spine & limbs False + - non-shock symptoms Incidental - elsewhere 5. Significance - Myelopathy, canal stenosis, central disk, MS, B12 deficient
Swallowing Test 1. Pt - sits 2. Dr - NA 3. Demo - Ask pt to swallow 4. Findings True + - Pain in front of throat False + - Pain around neck Incidental - elsewhere 5. Significance - Soft tissue trauma, whiplash, esophageal carcinoma, DISH
O'Donoghue's Test 1. Pt - sits 2. Dr - behind 3. Demo - ACTIVE:Pt moves full ROM ACTIVE RESISTED:Dr resists ROM PASSIVE:Dr moves head 4. Findings True +: ACTIVE:Strain PASSIVE:Sprain False + - Local Incidental - elsewhere 5. Significance - Sprain/strain
Soto-Hall Test 1. Pt: Supine 2. Dr: Beside/top of table 3. Demo: Pt: hands on chest. Dr: stabilizes chest; passively flexes head 4. Findings True +: Local False +: Radiate Incidental: elsewhere 5. Significance: Fracture, post strain/sprain, post vertebral spurs,
Brudzinski's Test 1. Pt: Supine 2. Dr: Beside/top of table 3. Demo: Dr flexes pt's head stretching dural sac/spinal cord 4. Findings True +: Buckling, headache, neck pain, fever False +: No buckling + 1 other Incidental: elsewhere 5. Significance: Meningitis, need l
Kernig's Test 1. Pt: Supine 2. Dr: Beside at hips 3. Demo: Dr flexes pt's hip/knee to 90 deg & extends leg 4. Findings True +: Kicking opposite leg, headache, neck pain, fever False +: Tight hamstrings Incidental: elsewhere 5. Significance: Meningitis, need labs
Thoracic Outlet tests are testing what two things? (What are they differentiating between?) Neuro-vascular bundle: Brachial plexus Vascular structures (subclavian artery) These can be impinged by osseous or muscular structures
Adson's & Modified Adson's Test are looking for an impingement between what two structures? Cervical rib & Anterior Scalene
Eden's & Costoclavicular Tests are looking for an impingement between what two structures? Clavicle & First rib
Wright's and Reverse Backody's Tests are looking for an impingement with what structure? Pectoralis Minor
Halstead's Test is looking for an impingement between what structures? Cervical rib, Anterior scalene, clavicle, first rib, pectoralis minor (general test)
What is the most common neurologic patter for TOS? Medial forearm and little finger (C8-T1/Ulnar nerve distribution)
The textbook positive for any Thoracic Outles testing is...? Decrease or change in radial pulse amplitude
Adson's Test 1. Pt: Sits 2. Dr: Stands on side 3. Demo: Find radial pulse at rest; hitch hiker thumb; pt looks AT dr, hold breath 10 sec 4. Findings True +: TOS False +: Local Incidental: elsewhere 5. Significance: Cervical rib/ant scalene
What is the medical terminology to describe Hitch Hiker's Thumb? abducts, extends & externally rotates arm
Modified Adson's Test 1. Pt: Sits 2. Dr: Stands on side 3. Demo: Find radial pulse at rest; hitch hiker thumb; pt looks AWAY from dr, hold breath 10 sec 4. Findings True +: TOS False +: Local Incidental: elsewhere 5. Significance: Cervical rib/ant scalene
Eden's Test - "one word = one arm" 1. Pt: Sits 2. Dr: Stands on side 3. Demo: Find radial pulse at rest; hitch hiker thumb; push down on shoulder, hold breath 10 sec 4. Findings True +: TOS False +: Local Incidental: elsewhere 5. Significance: Clavicle on 1st rib
Costoclavicular Test - "two words = two arms" 1. Pt: Sits 2. Dr: Stands on side 3. Demo: Find both radial pulses at rest; hitch hiker thumb; pt shoulders back & flex head 4. Findings True +: TOS False +: Local Incidental: elsewhere 5. Significance: Clavicle on 1st rib
Wright's Test - aka Hyperabduction Test 1. Pt: Sits 2. Dr: Stands on side 3. Demo: Find radial pulse at rest; hitch hiker thumb; abducts arm to 170-180 deg 4. Findings True +: TOS False +: Local Incidental: elsewhere 5. Significance: Pectoralis Minor
Reverse Bakody's Test 1. Pt: Sits or stands 2. Dr: NA 3. Demo: Put hand on head 4. Findings True +: TOS False +: Non-TOS in same arm Incidental: elsewhere 5. Significance: TOS
Halstead's Test 1. Pt: Sits 2. Dr: Stands on side 3. Demo: Find radial pulse at rest; hitch hiker thumb; traction arm; extend head 4. Findings True +: TOS False +: Local Incidental: elsewhere 5. Significance: Neurovascular bundle stress
Created by: LCCW