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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| cervical compression | show 🗑
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| show | pt seated. doc applies upward pressure on occiput. If pain is relieved nerve root compression of facet joint pathology. If pain increases sprain/strain.
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| show | seated pt coughs, strains and sneezes. Pain = space occupying lesion
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| show | pt supine with hips and knees flexed, doctor extends knee. Pain or causes other knee to buckle = meningeal irritation, meningitis, subarachnoid hemmorrhage
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| show | Place tuning fork over mastoid process, pt says when the sound is no longer heard (Bone Conduction) Place vibrating tuning fork 1" from the ear and repeat (Air conduction)If BC>AC conduction loss otitis media. AC and BC decreased nerve conduction deficit
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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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| show | Pt supine. Lift affected leg with knee flexed and place on Doc's shoulder. apply firm pressure on hamstring muscles and then in popliteal fossa. irritation of roots of sciatic nerve.
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| show | If SLR test, lower the leg 5 degrees below pained dorsiflex foot. pain = irritation of the roots of the sciatic nerve
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| show | SLR on each leg separately noting which angle pain was produced. Raise both legs together noting angle of pain. If the angle of pain of both legs raised is less than single SLR = lumbosacral joint involvement
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| Lasegue | show 🗑
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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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| Milgram | show 🗑
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| show | If SLR is positive, lower leg just below point of pain. quickly extend big toe of affected foot. Pain = sciatic nerve root compression
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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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| show | Pt prone. stabilize hip by placing one hand on ilium, passively flex knee and extend hip. if ext hip causes pain along anterior thigh = femoral nerve irritaion
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| Nachlas | show 🗑
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| show | Doc asks pt to bend forward and notes pain. Doctor braces hips against pt's sacrum by holding ASIS' pt bends forward. If pain after second maneuver = lumbar problem. If pain is absent during second maneuver = pelvic problem
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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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| Kemps | show 🗑
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| Schober | show 🗑
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| Bechterew | show 🗑
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| Kemp | show 🗑
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| Minor | show 🗑
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| erichsen | show 🗑
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| fortin finger test | show 🗑
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| Gaenslen | show 🗑
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| Goldwaith | show 🗑
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| Hibbs | show 🗑
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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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| Hautant | show 🗑
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| Rhomberg | show 🗑
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| twitch or jump | show 🗑
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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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| anal wink | show 🗑
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| show | hold lower aspect of leg of a supine patient and stroke the lateral part of the plantar foot from heel to the ball of the foot. If big toe extends and other toes tan out = upper motor neuron lesion in upper limb
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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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| show | hold middle finger of patient proximal to the distal interphalangeal joint. Doctor nips fingernail of middle finger of patient between thumb and index finger. if causes adduction of thumb and slight flexion = upper motor neuron lesion in same limb
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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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| cervical distraction | show 🗑
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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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| show | instruct seated pt to rotate the neck to the shoulder and extend the head to the affected side, if no pain instruct pt to flex neck while in rotation. perform bilaterally, pain in affected arm = nerve root compression or facet involvement.
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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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| Rust | show 🗑
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| shoulder depression | show 🗑
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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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| valsava | show 🗑
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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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| show | ask pt to stand.
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| Morton's squeeze | show 🗑
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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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| tinel | show 🗑
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| valgus stress test | show 🗑
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| varus stress test | show 🗑
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| show | pt makes fist and pronates and extends, doctor applies resistance. pain = lateral epicondylitis
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| mill | show 🗑
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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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| valgus stress elbow | show 🗑
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| varus stress elbow | show 🗑
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| anvil | show 🗑
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| show | pt supine. flex hip and thigh into right angles. hold heel and abduct and externally rotate patients thigh. pain = hip lesion, iliopsoas spasm or sacroiliac lesion
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| ober | show 🗑
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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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| trendelenburg | show 🗑
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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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| show | pt prone. anchor pts thigh with knee. bring knee into 90 flexion apply pressure while internally and externally rotating. pain = meniscus tear
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| show | pt prone. doc stabilize thigh with knee. apply upward pressure internally and externally rotating pain = LCL or MCL damage, relief = meniscus tear
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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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| lachman | show 🗑
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| McMurray | show 🗑
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| noble | show 🗑
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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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| show | passive Flexion, Adduction and Internal Rotation of hip causes pain = piriformis syndrome
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| show | passive hip adduction and internal rotation causes pain = piriformis syndrome
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| show | pt supine, raise straight leg to 10, dorsiflex ankle squeeze calf of pt. pain = DVT, ruptured plantaris tendon, or ruptured Baker's cyst
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| pace | show 🗑
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| show | pt seated with arms hanging down in neutral position, doc pulls down on arm. if visible separation = ac joint separation
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| show | pt seated. passively abduct arm just above shoulder. tell pt to let arm down slowly after you let go. pain or hunching deltoid = rotator cuff injury = tear in supraspinatus tendon
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| dawbarn | show 🗑
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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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| impingement (painful arc) | show 🗑
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| mazion shoulder maneuver | show 🗑
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| neer | show 🗑
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| show | st standing. ask pt tp extend elbow , supinate the forearm, flex the arm and hold that position. attempt to push forearm down. pain in bicipital groove = bicipital tendonitis.
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| yergason | show 🗑
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| allen test | show 🗑
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| bracelet | show 🗑
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| show | passively flex DIP, then extend finger and passively flex MCP and DIP. if no change in degree of flexion = restriction of fibrous capsule of DIP joint. if increase in flexion=contraction of lumbrical muscle
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| finkelstein | show 🗑
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| phalen | show 🗑
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| press | show 🗑
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| show | hands in prayer position. hold position at least 1 minute. tingling or paresthesia into thumb, index or middle finger= carpal tunnel syndrome
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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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| show | pt's shoulders back and downward, palpate radial pulses of both arms before and during maneuver. pt flexes neck to chest. radial pulse disappears = costoslavicular type TOS
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| halsted | show 🗑
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| show | immerse pts fingers in water 3 mins. if skin doesn't wrinkle positive sign = loss of sympathetic innervation as in complex regional pain syndrome
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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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| show | pt abducts arms to 90 and bends elbows to 90. open and close fists repeatedly for 3 minutes. reproduces symptoms or arm starts to fall = TOS
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| Wright, hyperabduction test | show 🗑
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