neuromusculoskeletal orthos
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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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