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neuromusculoskeletal orthos

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test
steps and interpretation
show passively flex neck of supine patient to chest. If patients hips and knees flex = meningitis  
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show patient sits while doctor presses on vertex of the head. Subluxation, arthritis, facet degeneration  
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cervical distraction   show
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show seated pt coughs, strains and sneezes. Pain = space occupying lesion  
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Kernig   show
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Rinne   show
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show Place vibrating tuning fork on vertex of pt's head and ask where the sound is loudest. sound should be equal in both ears.  
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show Pt supine. Doc raises extended leg, internally rotates foot and adducts extended limb = piriformis syndrome  
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Bowstring   show
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Braggard   show
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Double leg raise   show
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show Pt supine legs extended. Doc grabs heel with other hand on the knee, Flex hip while knee is flexed, slowly extend knee while leg is elevated. if ext is limited due to pain = sciatic nerve of nerve root irritation  
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show Pt supine. stabilize thighs or legs on table and ask pt to sit up without using hands. Pain or inability = sciatica or lumbosacral pathology  
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Lindner   show
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show Pt supine. Pt raises both extended legs so heels are 6 inches off the table and holds them of 30 seconds. disc lesion or raised intrathecal pressure  
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Sicard   show
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show Pt supine. raise leg off table. Pain 0-35 extradural nerve root irritation, 35-70 disc herniation causing sciatica, 70< lumbosacral joint disease (no further stretch on nerve)  
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Well leg raise aka Fajersztajn   show
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Ely   show
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Femoral nerve stretch   show
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Nachlas   show
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adam supported aka belt test   show
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show Pt's backache caused by disc herniation lateral to nerve root, pt leans away from side with lesion. if herniation is medial to nerve root pt leans to side with lesion. Post central disc herniation pt stands straight and stiff in slight flexion.  
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show standing lean pt back into lumbar extension bracing SI joint and moving with hand on shoulder. pain = facet syndrome, pain into thigh and leg = nerve root compression due to a disc  
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show mark 5cm below PSIS and 10cm above psis midline. pt bends forward and doc measures the difference between the 2 marks and subtracts 15. if increase is less than 5 = ankylosing spondylitis  
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Bechterew   show
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Kemp   show
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show seated pt asked to stand. if pt supports himself by placing his hand on his knee while keeping affected side bent over = lumbosacral pathology  
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erichsen   show
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show pt points to area of pain medial and inferior to PSIS = sacroiliac pathology  
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show pt supine with affected side close to edge of table. Passively flex hip and knee of unaffected side towards pt. allow affected leg to hang off table slightly. apply pressure to both knees. pain = sacroiliac pathology  
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show pt supine. raise affected leg with one hand while other hand is under lumbar region. pain before l-spine begins to move 0-30 SI joint pathology, pain 30-60 lumbosacral joint pathology, 60-90 lumbar region pathology  
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show Pt. prone. One hand on dorsum of iliac bone to stabilize patients pelvis. Flex opposite knee to 90 and slowly push pt's leg laterally. SI pain = sacroiliac pathology, pain in hip = hip pathology  
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show pt lies on unaffected side, doc applies pressure to ilium. pain = SI pathology  
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Patrick Fabere   show
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Yeoman   show
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show Pt seated. pt extends arms out in front with palms up. pt closes eyesand extends and rotates it to one side and then to the other side. if pt's arms drift or dizziness or blurriness occur or nystagmus = vertebrobasilar insufficiency  
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Rhomberg   show
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show pressure on a specific point on a muscle causes the muscle to suddenly contract = trigger point in mypfascial pain syndrome  
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show pressure on specific point on muscle causes patient to make a facial grimace = tender point in fibromyalgia  
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show touching anal margin lightly will cause anus to pucker, lack of contraction = cauda equina syndrome  
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Babinski   show
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Chvostek   show
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show pt grips paper between any 2 fingers of effected hand. If unable to hold grip = ulnar nerve palsy  
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show child sits on floor and then stand. if child places hands on thighs to stand = duchenne's muscular dystrophy  
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Hoffman   show
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Lhermitte   show
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show seated pt holds tips of thumb and index finger together as if pinching, doc attempts to pull fingers apart with index finger. if pt cannot hold tip to tip and uses pulp to pulp = damage to anterior interosseous branch of median nerve  
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Bakody   show
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brachial plexus tension   show
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show doc pushes upward on occiput. pain is reduced = nerve root compression or facet joint pathology. pain = sprain/strain  
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Dejerine's triad   show
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Jackson compression   show
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Kernig   show
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maximum cervical compression   show
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show seated pt attempts to flex, extend, laterally bend and rotate neck while doctor resists movement. PROM pain = muscle strain, AROM pain = ligamentous sprain  
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show pt is supporting head with both hands = cervical fracture or severe sprain  
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show push down shoulder of the affected side of the seated patient while laterally flexing neck to opposite shoulder. pain on depressed side = adhesions to either dural sleeve or spinal nerve roots or the adjacent structures in the joint capsule on same side  
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show doc places hand on supine pts sternum, doc flexes head towards chest. Localized pain in posterior neck = vertebral fracture, ligamentous sprain, meningeal irritation or subluxation  
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spurling   show
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show ask pt to hold breath and bare down as in going to the bathroom. pain in neck and upper limb = SOL, herniated disc, intraspinal tumor or a large hematoma  
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ant drawer of the foot   show
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show pt in supine position. push head of pt's first metatarsal bone with your thumb and have the patient push down (plantar flex) on thumb. if lat side plantar flexes and medial side dorsiflexes duchene's sign is present = lesion of superficial peroneal nerve  
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Helbing's sign   show
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show squeeze metatarsals of the affected foot of patient from lateral to medial. interdigital (morton's) neuroma or metatarsalgia  
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show pt prone. passively flex pt's knee of affected side and apply squeeze to calf of affected leg of pt. plantar flexion absent = complete rupture of achilles tendon  
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show percuss area behind the medial malleolus of affected side. pain = tarsal tunnel syndrome  
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show grab hold of calcaneus while other hand stabilizes patient's leg. attempt to evert pts ankle. pain = deltoid ligament sprain, eversion  
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varus stress test   show
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cozen   show
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show passively flex patient's forearm, fingers and wrist, then passively pronate and extend elbow. lateral epicondylitis  
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occult elbow fracture   show
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show pt flexes wrist and forearm and holds the forearm in supination. doctor tries to push wrist into extension while patient resists. pain = medial epicondylitis  
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show attempt to abduct pts elbow, MCL dammage  
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varus stress elbow   show
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anvil   show
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Laguerre   show
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show patient lies on unaffected side. doc stabilizes iliac crest. doc grabs pts ankle with other hand and flexes knee at 90 degrees. passively abducts leg allows the knee to fall,if leg remains abducted = it band syndrome or trochanteric bursitis  
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show infant supine. abduct and externally rotate hips while flexing the knees. if audible or palpable click = congenital hip dysplasia  
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thomas   show
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show pt standing with hands on the hips ask pt to lift 1 leg. if hip falls positive trendelenburg = weak glut medius, damage to superior gluteal nerve (lurching gait) Sign also seen in Legg-calve-perthes disease, muscular dystrophy, or glut med dysfunction  
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show pt supine. legs fully extended. doc hand on ankle and lateral knee and attempt to abduct the leg. pain = MCL injury  
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adduction (varus)stress knee   show
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apley compression   show
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apley distraction   show
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show pt in supine position and have them flex knees at 90 degrees. sit on pts feet and push tibia posterior and pull it anteriorly. perform on both legs excessive movement >6mm torn cruciate ligament  
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show pt supine. flex affected knee at 30 degrees. grab proximal end of tibia and pull tibia anteriorly. excessive movement = ACL tear  
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McMurray   show
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show flex pt hip at 90. apply thumb pressure to lateral femoral epicondyle and extend pts knee. pain at 30 of flexion = IT band syndrome  
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show elevate straight leg of supine patient at 45, 3 mins. lower limb and ask pt to sit up with both legs dangling over table. when leg raised, dorsal of foot blanches and veins collapse or takes more than 2 mins for circulation to return = poor circulation  
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show pt marches 120steps for 60 seconds . note when leg cramps begin. if cramps before minute is up = peripheral arterial disease or burger's disease  
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FAIR maneuver   show
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Freiberg   show
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Homan   show
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show resisted active hip external rotation and abduction elicits pain = piriformis syndrome  
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acromioclaviclar traction   show
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codman (drop arm)   show
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show palpate pts shoulder for tender spots. hold tender spot and abduct pts arm. if pain is relieved = subaromial bursitis  
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show pt seated. pt places hand of affected shoulder on opposite shoulder and touch elbow to chest. if unable to do this = anterior shoulder dislocation  
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Empty can aka Jobe aka supraspinatus press test   show
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Hawkins-kennedy   show
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show pt seated. slightly abduct arm and move shoulder through full flexion. pain= injury to supraspinatus tendon  
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show ask pt to place palm of the affected upper limb over the top of the opposite shoulder. pain = adhesive capsulitis  
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show passively elevate arm into forward flexion. pain = impingement syndrome  
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speed   show
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show pt seated. ask pt to flex elbow to 90 and hold forearm in pronated position. instruct pt to supinate forearm while you hold the pt's hand in that fixed position. pain or click of the inter tubercular groove of humerus = tenosynovitis long head of biceps  
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show pt makes fist of affected hand. occlude both ulnar and radial arteries at wrist. release ulnar artery, then radial artery. if color is blanched more than 5 seconds = arterial embolism  
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show squeeze medial and lateral aspects of distal ends of radius and ulna. pain = RA, fracture, severe sprain  
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bunnel-littler   show
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finkelstein   show
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show inverted praying hands and hold position at least 1 minute. tingling paresthesia radiates into thumb, index or middle finger = carpel tunnel syndrome  
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press   show
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reverse phalen   show
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tinel   show
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wrist compression   show
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show palpate radial pulse. ask patient to looks towards the affected side and extend neck, cervical rib or scalenus type TOS  
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eden, costoclavicular   show
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halsted   show
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O'Riain   show
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show ask pt to place palm of hand on top of head with elbow level with head. pain = scalenus anterior type of TOS  
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Roos, Elevated are Stress test   show
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Wright, hyperabduction test   show
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