MSK - COMPS

Stress Fracture (hip)

Sx: Dull at first then worsens over time , Local pain Impairment: Local tenderness , Swelling Aggravates: WB activities

Ballottement (Reagan's) Test

wrist/hand - Lunotriquetral Ligament Integrity (instability) test: grasp lunate, dorsal and palmar glide on lunate while stabilizing the pisiform and triquetrum positive: provocation and laxity compared B mod sn, poor sp

mod allen test

wrist/hand - vascular compromise test: ID ulnar and radial arteries, pt open/close hand several times and then make a closed fist. compress ulnar a. and have pt open hand. observe palm and then release the ulnar a. and observe capillary refill. perf same with radial a. positive: abn refill norm: change in color from white to normal appearance on palm of hand

Spine related infection

Fever: Tuberuclosis osteomyelitis (+LR 13.5) Fever: Pyogenic osteomyelitis (+LR 25.0) Fever: spinal epidural abscess (+LR 41.5, -LR .17) note: keep in mind infection may not fit the typical pattern that you see and everything makes it worse

Elbow extension test

elbow- fracture test: ext elbow positive: unable to ext elbow excellent sn, mod/good sp

Swan neck deformity

flexed DIP, extended PIP, flexed MCP deformed position of the finger, in which the joint closest to the fingertip is permanently bent toward the palm while the nearest joint to the palm is bent away from it (DIP flexion with PIP hyperextension) vai abnormal stress on the volar plate

Ely's test

hip - ms length rectus femoris test: pt prone, flex knee positive: hip of tested limb flexes

Volar Intercalated Segment Instability (VISI), - palmar sublux of lunate

Sx:Ulnar wrist , Clicking , Tenderness , Instability Impairment: Decreased ROM, (+) Reagan's Ballotment test Aggravates: Pain with pronation/ulnar dev , WB on wrist , Repetitive work

plantar fasciitis

an inflammation of the plantar fascia on the sole of the foot

Medial Subtalar Glide Test

ankle - lateral lig test: hold talus in subtalar neutral (stabilize just below malleolus) and translate the calcaneus medially on fixed talus with the other hand positive : increased laxity on one side

Anterior Oblique Sling (javalin thrower)

External oblique, internal oblique, transversus abdominis via the rectus sheath, & contralateral adductor muscles via the adductor-abdominal fascia.

Trigeminal neuralgia

Sx: Unilateral, Facial pain, Sharp, shooting, stabbing Impairment: Abnormal neuro screen Aggravates: Talking, chewing

Dupuytren's contracture

Sx:4th digit most common, Tension/pressure, (usually painless) Impairment: Decreased ext ROM in MCP/PIP, Grip weakness, Tightening of palmar fascia Aggravates: Trying to straighten affects joint

osteomalacia

characterized by decalcification of bones due to vit D deficiency s/s: severe pain, fractures, weakness, deformities meds: Ca2+, vit D, Vit D injections in form calciferol (vit D2) children known as rickets

osteochonditis dissecans

condition that develops in joints, most often in children and adolescents. It occurs when a small segment of bone begins to separate from its surrounding region due to a lack of blood supply

Coxa Vara and Coxa Valga

coxa vara: (<125) 105 coxa valga : (>125) 140 norm: 125 (birth 150) norm: anteversion: 12-14 (infant 40) excessive anteversion: >20 (squinting patella retroversion: <12

Degenerative Joint Disease (Osteoarthritis)

deg of articular cartilage with hypertrophy of subchondral bone and joint capsule of WB joints men and woman <50 F >M ≥50 primary vs secondary slow prog with pain initially episodic and triggered activity eventually pain, stiff become chronic s/s: pain, swelling, loss ROM, bony deformity common joints: finger DIP, PIP, CMC; cervical, lumbar, hips, knee, MTP of great toe Book: pain and stiff morning, pain eases with 4-5 hrs thru morning, pain increases with rep bending activities, constant awareness of discomfort with episodes of exacerbation, pain more sore and nagging

Flexion-Internal Rotation Test

hip - Intra Articular Irritability, impingement test test: patient in 90/90 in supine. hold knee with one hand and support the leg with your forearm so bringing the other arm under and around to hold the leg close to you. bring the leg into flex, IR not add positive: reproduce pain w/ or w/out click

Boutonniere's deformity

injury to the tendons that straightens the middle joint of your finger. The result is that the middle joint of the injured finger will not straighten, while the fingertip bends back.

noble compression test

knee - IT band friction syndrome test: supine, knee flex 90, pressure 1-2 cm proximal to lateral femoral epicondyle. pressure maintained, patient's knee passively extended positive: pain over lateral femoral condyle

Patellar apprehension test

knee - patellofemoral instability test: Patient is supine, knee flex 30, quads relaxed and patella is passively glided laterally. positive: apprehension or quad contract via pt to prevent patella from dislocating

leg discrepancies

lay supine → bridge → passively apply B mild distal traction on the legs → measure comparing thumbs under the medial malleolus. supine to sit test: different length when comes supine to sit (true) but if different then it may be due to the pelvis being rot

Femoral nerve traction test

lumbar - femoral n compression test: pt lies on non painful side, trunk neutral, head flexed slightly, lower limbs hip and knee flexed. top hip (painful hip) knee ext, passively ext hip. if no s/s then flex knee of painful limb and repeat. positive: neurological pain in ant thigh

Standing flexion test

pelvic - forward flex test: ilium should rise cranial (slight ant rot) → are they symmetrical (comparing B). norm: begin and end symmetrical norm: begin and end asymmetrical (moved the same amount) note: can also do in a seated position to make sure that PSIS both are level at start

migraine

severe, recurring, unilateral, vascular headache specific type of headache characterized by severe head pain, sensitivity to light, dizziness, and nausea

Olecranon-Manubrium Percussion Test

shoulder - fracture test: auscultate sternum, tap on olecranon. positive: affected side diminished quality of sound high sp & sn

torticollis

spasmodic contraction of the neck muscles, causing stiffness and twisting of the neck; also called wryneck

Carpal Tunnel Syndrome

Sx:Numbness/tingling, Median nerve distribution Impairment: Thenar eminence atrophy, Decreased ROM, + Phalen's, Tinel Aggravates: Repetitive movements, fine motor dexterity Alleviates: Flicking hand

Squeeze test

ankle - integrity of distal tibiofibular syndesmosis test: pt seated, knee flexed 90, compression between middle and distal third of pt leg positive: pain reproduced at the syndesmosis

medial talar tilt stress test

ankle - lateral lig (calcaneofibular lig) test: S/L, stabilize just above malleolus, moving hand grasp calcaneus, inversion with med glide of calcaneus thrust positive: increased laxity, pain note: can do same test but with abd to look at medial ligaments (deltoid lig)

anterior drawer test - ankle

ankle - lig instability ant talofibular lig test: supine, foot off edge, ankle 20 PF, translate talus ant while stabilizing the lower leg positive: excessive ant translation and/or pain

Polymyalgia Rheumatica (PMR)

>50 yrs proximal muscle pain >40 ESR anemia worse morning treatment low-dose prednisolone inflammatory disorder of the muscles and joints characterized by pain and stiffness in the neck, shoulders, upper arms, and hips and thighs

T4 syndrome

Sx: Paresthesia in all fingers, Arms feel heavy, Tight pain, Unilateral or bilateral Impairment: Thoracic hypomobility , Decreased grip strength Aggravates: Prolonged sitting, WB on UE, heavy lifting Alleviates: shaking hand Interventions: PA mobs, Supine flexion gliding

Metatarsalgia

Sx: Sharp/burning, Metatarsals 2, 3, 4 Impairment: Increased pain w/ mid-stance and propulsion , Decreased DF ROM, Pes cavus , Midfoot & 1st MTP hypomobility Aggravates: Walking/running, WB on MTP heads, Stairs

DISH

Sx: Stiffness, Thoracic spine pain (can occur in various joints) Impairment: Decreased ROM, Decreased joint accessory motion, Difficulty with STS (hard w/ chair without arms) Aggravates: Heavy breathing, Sitting/standing unsupported, Thoracic flex/ext Alleviates: Supported sitting or standing

Facet

Sx: Unilateral (can overlap 1-2 levels above or below), Sharp or dull pain, Impairment: Hypomobility/ stiffness of involved segments (hypo w/ PAs), + lumbar quadrant test Aggravates: coupled/end range motions , Alleviates: lying down, walking Interventions: Facet opening manual therapy, PAs, Supine flexion gliding. book: stiff upon rising but eases in hour, loss of motion accompanied by pain, pt will describe pain as sharp with certain movements, movement in pain free range usually reduces symptoms, stationary positions increase symptoms

Glenohumeral instability (ant dislocation = direct force to humerus during shoulder abd/ER)

Sx:Shoulder girdle , Diffuse pain, Positional instability Impairment: + Apprehension test, Ant release/ surprise test, Laxity in direction of dislocation , Aggravates: Overhead activities

FABER or Patrick's Test

hip - Intra Articular Irritability test: flex, abd, ER hip. ("figure 4 test") contra stabilize ASIS. let knee fall out and down towards table. see how far knee is from table, then apply overpressure positive: interarticular: complain of ant or lat hip pain SI/lumbar: posterior or side pain mod sn, mod/good sp

Hip Scour Test

hip - Intra Articular Irritability aka degenerative joint disease if hip test: supine, with hip/knee 90/90. move knee into ER & abd to IR & add (almost circular). compressive load on femur via knee joint. move knee into ER & abd to IR & add (almost circular) again. positive: provoke symptoms in hip, and potentially refer pain to knee/elsewhere

abdominal ms screen

t6-T12 could be implicated for cord involvement if coordination diff test: LE 90/90 (take hip flexor out). lift shoulder blades off table and have pt hold position as you apply resistance. can also do with rot

meniscal tear

tear of one of the two C-shaped cartilage structures that serve to cushion and stabilize the knee joint, usually caused by a twisting force

tinel's sign

test: tap on the nerve in question, positive: paresthesias/tingling along the n distribution (ex: median over the wrist for carpal tunnel)

Fibromyalgia

chronic condition with widespread aching and pain in the muscles and fibrous soft tissue disorder characterized by widespread musculoskeletal pain accompanied by fatigue, sleep, memory and mood issues. Researchers believe that fibromyalgia amplifies painful sensations by affecting the way your brain processes pain signals

Pubic Symphysis Palpation

superior and inferior force on the opposite side creating a sheering force → looking for provocation. can hold for 30s specificity = good sensitivity = good

Finkelstein's test

wrist/hand - APL/EPB tenosynovitis (de Quervain's tenosynovitis) test: wrist hang off table in passive ulnar deviation. can apply overpressure. can also oppose thumb as apply overpressure. positive: pain in wrist, oft painful with no pathology so compared B high sp & sn

Press Test

wrist/hand - TFCC tear test: sit in chair with arm rests, have them push through arm rests to lift rear off chair positive: pain over the ulna or TFCC 100% sp & sn

Reactive Arthritis [Reiter's syndrome]

"Can't see, can't pee, can't climb a tree"

Charcot-Marie-Tooth disease

- Involves peripheral nerves - Marked by progressive weakness, primarily in peroneal (fibular) and distal leg muscles - Occurs teenage years or earlier symptoms: Weakness in your legs, ankles and feet. Loss of muscle bulk in your legs and feet. High foot arches. Curled toes (hammertoes) Decreased ability to run. Difficulty lifting your foot at the ankle (footdrop) Awkward or higher than normal step (gait)

HALLUS RIGIDUS/LIMITUS:

- WHO: females, B>uni, >50 y/o - WHAT: o Rigidus: arthritic changes to first MTP joint o Limitus: structural/ soft tissue tightness - WHERE: 1st MTP joint - AGGRAVATING: run, jump, tip-toe à Sharp pain with WB - ALLEVIATING: rest, NSAIDS - 24-HOUR PATTERN: OA-style morning stiffness, dull at rest, sharp with loading

Clinical Prediction Rule Carpal Tunnel Syndrome

1. >45 up 2. shaking hands relieves symptoms 3. Wrist ratio index > .67 (Using calipers the AP width/ lateral width) 4. Reduced median sensory field of the first digit (using a straight paper clip, reduced sensation of digit 1 as compared to thenar eminence equals a positive test) 5. SSS score > 1.9 (The Brigham and Women's Hospital Hand Severity Scale)

spine related tumor

1. History of Cancer (+LR 23.7) 2. Unexplained weigth loss (+LR 3.0) 3. Failure of conservative intervention to improve within 30 days (+LR 3.0)

Abdominal Aneurysm

Abdominal Girth >100 cm (+LR 2.5, -LR .14) Palpation of abnormal abdominal pulse (+LR 2.0) Smoking History (OR 5.07) Family History (OR 1.94) Age over 70 (OR 1.02) Non Caucasian (OR 1.02)

pes cavus

Abnormally high arch of the foot

Pancost tumor

Non small cell lung CA in the top R or L apex of the lung- sxs: horner's syndrome, compress nerves or vessels -develops in apex of lung (in neck) -symp chain is also here -can damage symp chain resulting in horner syndrome

Bankart lesion

Sx:Same as SLAP plus Catching/slipping of shoulder Impairment: + Apprehension test, Ant release/surprise test , Hypermobile ant GH glide , Pain w/ IR Aggravates: Overhead movement

Trochanteric Bursitis

DEF: "snapping hip syndrome" bursitis of the greater trochanter; tendonitis of gluteus muscle insertion or IT band; more common in women runners with a large Q-angle MOI: overuse; direct blow S/S: pain; point tenderness; inflammation; "snapping hip" Tx: PRICEMM, correct biomechanical abnormalities; stretch IT band

Psoriatic arthritis

DIP joint involvement, rash w/ silvery scale on elbows and knees, pitting nails and swollen fingers.

subacromial bursitis

Inflammation and swelling of subacromial bursa over the shoulder cause limited ROM and pain with motion. Localized swelling under deltoid muscle may increase by partial passive abduction of the arm. Caused by direct trauma, strain during sports, local or systemic inflammatory process, or repetitive motion with injury.

Gillet Test: sagittal plane

Pelvic - SIJ movement screening (post movement of ilium relative to sacrum) test: shift weight to one side & raise one knee. normal: asymmetrical diff (ilium posterior rot due to flexed hip compared to the stance side. can keep 1-2 fingers on table for balance.

Achilles Tendinopathy

RF: fluoroquinolone use Burning pain or stiffness 2-6 cm above the posterior calcaneus

menell's test

SIJ - (pelvic girdle pain (PGP) CPG) test: supine, axial load (holding ankle and foot in neutral). they can hold on to table positive: provocation symptoms (SEN 0-.70, SP: 1)

Distraction Test

SIJ - gapping test test: supine, find ASIS, cross arms and palm pressing down and out (think to separate it). hold 30s. can add thrust at the end if still have not provoked it positive: provocation of symptoms

Athletic pubalgia

Sx: Lower abs/groin pain, Dull/diffuse/deep pain, Proximal adductor pain Impairment: Recurrence of pain even after long rest period , Weakness in hip add/flex, Pain w/ resisted sit-up/hip flexion, Tenderness of inguinal canal/pubic tubercle Aggravates: Sudden acceleration/ twisting/cutting, Sit-ups, Coughing/sneezing, Valsalva

Turf Toe

Sx: MTP joint, Stiffness , Ecchymosis around MTP, Dorsal/med joint line tenderness , Dull ache throughout day Impairment: injury d/t hyperext of hallux MTP with axial load, results in:, Weakness in hallux flex, Reduced hallux ext ROM , Pain w/ hallus MTP movements Aggravates: Walking, Stairs , STS

Tarsal Tunnel Syndrome

Sx: Med ankle/heel/med plantar foot, Burning, Numbness/tingling , Worse @ night Impairment: + Tinel test, Triple Compression Stress test, Pain w/ DF/eversion, Pes planus/hindfoot valgus, Diminished 2-point discrimination on plantar foot Aggravates: Extended periods of walking/running/standing, Pressure over tibial nerve

Adult Acquired Flat Foot Deformity (Post tib dysfunction)

Sx: Med foot Impairment: Heel valgus, Pes planus , Forefoot abd (too many toes sign), Cannot do single heel raise Aggravates: Standing on toes, Stairs , Walking

Hallux Valgus

Sx: Medial eminence, Soreness/stiff at 1st MTP Impairment: Pain w/ terminal stance - preswing , Impaired MTP accessory motion, Angle (mild <20, mod 20-40, severe <40) Aggravates: WB activities, Tight shoes, Heels

VBI

Sx: "HAND", Posterior neck, Occipital headache Impairment: + vertebral artery test Aggravates: Head rotation and extension Alleviates: Neutral head position

Intra-articular injury, (Labral tear, osteochondral lesion, loose bodies, lig teres rupture)

Sx: Ant hip pain, Popping/locking/snapping Impairment: + FADIR, FABER, Feeling of instability Aggravates: Squatting (feels unstable)

PFPS

Sx: Ant knee, Pain behind/around patella, Crepitus , Knee giving out Impairment: Pain during squat, Abnormal patellar tracking (usually lat), Weakness in knee ext, hip abd/ER, (ROM usually not decreased) Aggravates: WB activities , Prolonged sitting, STS, Stairs, Kneeling , Running

Plica Syndrome

Sx: Ant/med knee pain, Nonspecific/dull pain, Popping or snapping w/ knee flex (btwn 30-60 degrees) Impairment: Tenderness @ med knee, Weakness of quads, Medial plica can be palpable , Aggravates: Activities that load patellafemoral joint, Stairs, Squatting , Kneeling

Thoracolumbar Junction syndrome , (maigne syndrome)

Sx: Back/iliac crest, Unilateral, Impairment: Hypersensitivity to palpation, IBS Aggravates: Compressive loads, + rotation (ext + rotation)

SIJ dysfunction

Sx: Btwn post iliac crest & gluteal folds, Stabbing/burning Impairment: Hyper or hypomobile SIJ, Weakness of surround muscles Aggravates: walking (large strides, prolonged standing, turning in bed

TMJ dysfunction

Sx: Head & jaw pain, Dull or ache pain Impairment: Clicking in jaw, Difficulty talking, chewing, swallowing

Patellar Tendinopathy

Sx: Inf pole of patella, Sharp pain when aggravated, Dull pain w/ rest Impairment: Sore when starting activity, Quad/calf atrophy , Decreased DF ROM, Aggravates: Loading for jumps, Squat, Running

Patellofemoral Dislocation/Sublux

Sx: Lat femoral condyle/lat patellar facet, ant knee, Initial acute sharp pain, Ache , Swelling Impairment: Lat knee displacement , Medial patella border tenderness, Decreased knee flex/ext ROM, Decreased quad length , Weakness in hip abd/ER Aggravates: WB activities, Stairs, Squatting, Jumping, Cutting

Sinus Tarsi Syndrome, (inversion ankle sprain)

Sx: Lat foot , Tenderness over sinus tarsi, Deep ankle pain Impairment: Ligament laxity, Pain over sinus tarsi @ PF w/ supination, Rearfoot instability Aggravates: Descending stairs, Walking/running , Pivoting/cutting

Chopart's Sprain

Sx: Lat foot, Pain over talonavicular/ calcaneocuboid joint , Swelling/tenderness over midtarsal joint Impairment: Pain during stance phase , Hypermobility @ Chopart's joint Aggravates: WB activities , Inversion/eversion of midfoot

Ankylosing Spondylitis

Sx: Local symptoms, Stiffness (especially in AM or long periods of rest) Impairment: Decreased ROM, Vision/ breathing impairments Aggravates: long periods of rest followed by movement

Bursitis (knee)

Sx: Local to bursa , Swelling, Redness, Warmth Impairment: Soft tissue restriction , Palpable mass, Local tenderness , Decreased knee flex/ext ROM Aggravates: Activities that put load to tendons that cross bursa

ULTT

ULTT 1: median n bias block shoulder, arm 90 elbow flex abd shoulder 110 ER shoulder supination ext elbow wrist ext finger ext (esp 1,2) ulnar deviation cervical spine contralateral side flexion Note: can be used for cervical neck pain with radiating pain ULTT 2: radial n bias shoulder depression , wrist neutral, elbow ext pronate forearm flex wrist adn ulnar deviate IR shoulder shoulder ext shoudler abd 10 ULTT3: ulnar n bias abd to 110 ER shoulder little elbow flex pronate forearm ext wrist + 4,5 digits bring into more elbow flexion note: ulnar waiter's position

myofascial pain syndrome

a chronic pain disorder that affects muscles and fascia throughout the body

Tendinosis/Tendinopathy

common tendon: supraspinatus, common extensor tendon of elbow, patella, achilles, gluteus medius inflam infiltrates tx with steroids, NSAIDS, acetaminophen PT: ROM soft tissue mobilization, oscillations for pain/ms guarding joint movement tx via manual therapy or exercises prog resistance exercise focus eccentrics endurance/aerobics pain ruction: cryotherapy, thermotherapy, hydrotherapy, sound agents

Acetabular Labral Tear

damage to cartilage and tissue in the hip socket. In some cases, it causes no symptoms. In others it causes pain in the groin. It can make you feel like your leg is "catching" or "clicking" in the socket as you move it

colle's fracture

distal radius is broken by FOOSH most common UE injury 5-8 week immobilize median n complication possible with edema

Bony Apprehension Test

shoulder - anterior instability test: supine, seated. standing stabilize top shoulder. other hand at 90 flexed elbow. abd the arm ≥45 & ER ≥45 positive: apprehension with movement good sp & sn

push up sign

elbow - PLRI (lat ulnar collateral lig injury) test: prone with elbow 90 on table/floor, supinated, arms abd greater than shoulder width. have pt push up. positive: apprehension or dislocation, instability with overhead athletes with lateral structures potentially 100% sn when combined with chair sign

chair sign

elbow - PLRI (lat ulnar collateral lig injury) test: seated, elbow flexed 90, supinated, arms abd greater shoulder width. lift rear off chair with arms. positive: apprehension or dislocation, instability with overhead athletes with lateral structures potentially sn good (small sample size)

ulnar collateral ligament injury (UCL)

repetitive stress damages the inside of the elbow, compromising stability. UCL injuries are most common in athletes who play "overhead" sports, such as volleyball and baseball, which require using the arms in an overhead position.

Cervicogenic headache

Sx: HA, Unilateral , Cognitive symptoms Impairment: Weak neck flexor endurance , , +cervical flexion and rotation Aggravates: Prolonged postures, pressure, quick movements

WAD

Sx: Head/neck pain, Dull ache , HA Impairment: Muscle guarding , AROM>PROM, + cranial-cervical flexion test, Weak neck flexor endurance Aggravates: Quick movements, palpation, prolonged static posture

ITB Friction Syndrome

Sx: Lat femoral condyle, Gerdy's tubercle , Sharp , Local pain/discomfort Impairment: Pain @ end of run w/ progressive earlier occurrence, Weakness in hip muscles, TFL tightness Aggravates: Stairs, Running (increased/outside on uneven surfaces), Squatting, Sustain knee flexion

Spondylosis/ DDD/ OA

Sx: Local symptoms, Aching , Stiffness Impairment: Decreased ROM Aggravates: standing for long time, carrying objects, axial loading Interventions: PAs,

Spondylolisthesis

Sx: Local tenderness, Radicular pain , Impairment: Reduced AROM, (common in L5/S1), Muscle spasms, Movement coordination impairments Aggravates: extension, standing

Nursemaid's Elbow

risk factor: Children aged 6 months to 5 years More common in females than males Children above the 75th percentile for weight typical impairments: Decreased elbow and forearm ROM Arm held in pronation and flexion at the child's side Typically, minimal impairments after successful reduction tissue differentiation test: Attempt to reduce Radiographs Measurement of the radio-coronoid distance Ultrasonography ROM diff dx: Fracture Lateral elbow ligament sprain Osteochondritis dissecans of the radial head

Keinbock Disease

risk factors: Acute or repetitive microtrauma Insufficient arterial anastomoses Impaired venous drainage Negative ulnar variance Atypical lunate shape Osteoporosis typical Impairments: Dorsal wrist pain Decreased wrist ROM Decreased wrist strength Decreased grip strength Swelling over the dorsal aspect of the hand Pain with axial loading tissue differentiation test: MMT Goniometry Observation Palpation X-ray diff dx: Osteonecrosis of scaphoid or capitate Carpal tunnel syndrome Lunate bone contusion Ulnocarpal impaction syndrome Arthritis

boxer's fracture

-fracture of the 5th metacarpal -requires ulnar gutter splint casted 2-4 weeks

Cervical Myelopathy

-if SOL directly affects spinal cord -central tumor, canal stenosis, central disc -symptoms can be global or bilateral (may involve several dermatomes) degenerative condition caused by compression on the spinal cord that is characterized by clumsiness in hands and gait imbalance. treatment is typically operative as the condition is progressive

Frozen Shoulder (Adhesive Capsulitis)

1) prefreezing 1-3m 2) freezing 3-9m 3) frozen 9-14m 4) thawing 12-15m

subacromial impingement

1. Hawkins-Kennedy passive flex 90 and then IR maximally. positive: pain or weakness high sp, mod sn 2. infraspinatus/ER test similar to MMT, resist ER. Positive: pain or weakness high sp, low sn 3. neer passively IR and full abd arm. positive: pain in shoulder good sn, fair/good sp 4. painful arc abd arm & report start/stop pain range. positive: pain 60-120 high sp, mod sn cluster: hawkins, infraspinatus, painful arc impingement: ≥2 positive, RTC: all 3 positive

anterior shoulder instability

1. anterior release/surprise test supine with 90 elbow flex, dorsal glide on head of humerus, then abd 90 and ER 90. then slowly release the shoulder. positive: instability or apprehension high sp & sn 2. apprehension test/relocaiton test bring 90 elbow flex, 90 shoulder abd, 90 ER. then dorsal glide on head of humerus. positive: feels better with dorsal glide good sp & sn com tests for instability: apprehension + relocaiton : glenoid labrum tear apprehension + relocaiton : ant instability

SLAP tear or labral pathology

1. biceps load test II* supine with 90 elbow flex, bring arm to 120 abd and 90 ER. resist elbow flex high sp & sn 2. active compression (O'Brien) test 3. ant slide test 4. compression rot combo SLAP: high sn (choose 2): comp-rot, apprehension test, active compression test high sp (choose 1): yergason test, biceps load II test, speed test *learned this in class

Ottowa ankle and Foot rules

1. pain posterior aspect of lateral or medial malleoli 2. anterior talus pain 3. bone tenderness at medial or lateral malleoli 4. inability to WB immediately or in ER foot X-ray instead of ankle x-ray 5. bone tenderness at base of 5th met 6. bone tenderness at navicular 7. inability to WB immediately or in ER sn 98, sp 20 bernese ankle rule: can also assess

myelopathy CPR

Cook cluster 1. Age >45 2. Gait deviation 3. Inverted supinator 4. Hoffman's 5. Babinski Additional things could see: - Hyperreflexia - Clonus

Ankle sprain grades

Grade 1: *Slight stretching* to the ligament and very minimal damage. *Able to ambulate*. Grade 2: *Partial tear* of the ligament. Laxity is noted. *Painful weight bearing*. Grade 3: *Complete tear* of the ligament. Severe pain and swelling. Instability noted and *unable to bear weight*.

Canadian C-Spine Rules

High risk people 1. age > 65 2. dangerous mechanism 3. Paresthesias in the extremities If YES then get an X RAY IF NO to Above then: 1. absence of midline tenderness 2. simple rear end MVA 3. sitting position in ER 4. ambulatory at any time 5. delayed onset of neck pain If NO to these then XRAY IF YES to above proceed to ROM measurement 1. able to rotate neck 45 degrees both ways If NO to this then XRAY If YES to this that no films needed Sensitivity, % (95% CI): 100 Specificity, % (95% CI): 42.5

Spinal Compression Fracture

History of major trauma (+LR 12.8) Age over 75 ((+LR 3.7) tests: 1. percussion test: pt standing and want to set it up so can see their facial expression (mirror maybe) start top → bottom asking subjective report of pain looking fro facial response Positive: sharp, sudden fracture like pain sensitivity: good specificity: good 2. supine test: supine with one pillow positive is when they are unable to lay supine without pain need to cluster with subjective and other tests sensitivity: good specificity: good 3. roman's CPR: 1. age >52 2. no presence of leg pain 3. BMI <22 4. does not regularly exercise 5. female gender 1/5: sn good, sp poor + LR (1.4) 4/5 sn poor, sp good + LR (9.6)

Slipped Capital Femoral Epiphysis (SCFE)

Movement of the femoral neck upward and forward. RF: Male, obese hypothyroid, tall, multifactorial fracture through the growth plate (physis), which results in slippage of the overlying end of the femur (metaphysis)

Nutation vs counternutation & ipsidirectional vs ipsidirectional lumbopelvic rhythm

Nutation: post pelvic tilt, ant sacral tilt Counternutation: post sacral tilt, ant pelvic tilt ipsidirectional: lumbar and pelvis rot same direction (post pelvic tilt W/ lumbar flex) ipsidirectional: lumbar and pelvis rot opp direction (ant pelvic tilt w/ lumbar ext

Nerve entrapment - median nerve

Occurs within pronator teres and under superficial head of FDS with repetitive gripping. Aching pain with weakness of forearm muscles, positive Tinnel's sign, paresthesias in median distribution. Rx: Acetaminophen, NSAIDs, neurotonin (for neuropathic pain) Initially rest, avoid aggravating activities, modalities etc. Protective padding, splints, to maintain slackened position of nerve. Then, strengthening, endurance, coordination, biomechanical correction, functional training, self-management techniques.

Gaenslen's Test

SIJ - Pubic Symphysis Provocation Tests test: (like thomas test) prone with butt at edge of table, over press both legs (bent and the one that is off the table) (rotary force). hold 30s. can add thrust at the end if still have not provoked it. positive: provocation of symptoms mod sp & sn

Compression test

SIJ - Pubic Symphysis Provocation Tests test: S/L, find ASIS on top, with both hands, bodyweight shift down to the table(compression), compare B. hold 30s. can add thrust at the end if still have not provoked it positive: provocation of symptoms sn mod, sp low

Sacral Thrust Test

SIJ - Pubic Symphysis Provocation Tests test: prone, find ASIS → PSIS, find S3 area, stack palms over area and wight shift down to table (compression). hold 30s. can add thrust at the end if still have not provoked it positive: provocation of symptoms mod sn & sp

cervical radiculopathy CPR

Wainner's CPR 1. Cervical rotation < 60 degrees 2. Positive Spurling's test 3. Positive distraction test 4. Positive upper limb tension sign (median bias #1) 2/4 Sn fair, Sp moderate, +LR 0.88, -LR 1.08 3/4 Sn fair, Sp good, +LR 6.1, -LR 0.64 4/4 Sn poor, Sp good, +LR 30.3, -LR 0.76

(Septic) Sacroiliitis

Who: 1-2 cases/year. M/F unknown. More common in children/young adults. IBD x3. So many RF! What: inflammation of one or both SI joints. RED FLAG. septic is rare, non septic is liked to other conditions. Where: SI joint, lumbar spine, glutes, may radiate in posterolateral thighs and hip/groin region Nature: no standard clinical presentation MOI: gradual and progressive or acute intermittent, chronic? Aggravating: running, walking squatting (putting pressure), sitting. Alleviating: antibiotics, muscle relaxants, PT, Estim, rest, alternating ice and heat, rest, exercise. 24-hour: Picture: T&M: palpation, fever, FABER, laslet cluster.

AAA

Who: M>W RF: history of smoking What: dilation, saccular worst prognosis (vs. fusiform = more common). Where: below renal arteries, very few along iliac arteries. Nature: intermittent, dull, throbbing ache with varied intensities MOI: insidious with worsening, may go undetected if asymptomatic Aggravating: symptomatic: difficulty pushing, pulling, lifting heavy objects, voiding/coughing/sneezing Alleviating: surgery, antihypertensives, life-style modifications 24-hour: difficulty falling asleep at night, intermittent discomfort that is not always activity dependent

Spinal Neoplasm

Who: patients > 50y/o (metastatic tumor BLT K&P), younger individuals (more rare) What: cancer within portion of spine Where: typically located in anterior elements of spine, younger patients have benign elements in posterior spine Nature: undescriptive pain, radiculopathy, neurological signs and symptoms, spinal abnormalities (pathological fractures) MOI:insidious, can progress quickly within past week, or slowly over the past year. *BB symptoms possible Aggravating: sleeping, sitting, standing, walking Alleviating: none..typically constant 24-hour: constant, worse at night book: pain described as gnawing, intense or penetrating, pain not resolvable at all, pain will wake pt at night

Paget's disease

a bone disease of unknown cause characterized by the excessive breakdown of bone tissue, followed by abnormal bone formation bone interferes with your body's normal recycling process, in which new bone tissue gradually replaces old bone tissue. Over time, the disease can cause affected bones to become fragile and misshapen. Paget's disease of bone most commonly occurs in the pelvis, skull, spine and legs. Symptoms: Hearing loss; Bone fracture

Equinus

abnormal position of the foot in which the toes are lower than the heel, causing toe-walking Equinus is a condition in which the upward bending motion of the ankle joint is limited. Someone with equinus lacks the flexibility to bring the top of the foot toward the front of the leg. Equinus can occur in one or both feet.

knee lig strain

acl involve sudden stops or changes in direction, jumping and landing — such as soccer, basketball, football and downhill skiing pcl tibia from moving backwards too far mcl direct blow to knee, can disrupt meniscus too lcl direct blow to knee,

Windlass Test

ankle/foot- windlass effect on plantar fascia (can use to rule in plantar fasciitis) test: choose position based on irritability supine: ankle neutral, knee 90 flex. stabilize proximal to 1st met head. max ext of 1 MTP joint WB: step on stool/step, toes over the edge. passively ext 1 MTP. positive: pain or limited/no rise of arch

mallet finger

avulsion of the terminal tendon and is splinted in full extension for 6 weeks injury to the thin tendon that straightens the end joint of a finger or thumb. Although it is also known as "baseball finger," this injury can happen to anyone when an unyielding object (like a ball) strikes the tip of a finger or thumb and forces it to bend further than it is intended to go.

elbow flexion test

elbow - cubital tunnel syndrome test: sitting/supine, anatomical position. B perf, flex elbow fully, ER shoulder, fully ext wrist, hold position for up to 3 min positive: symptoms along ulnar n good sp, mod/good sn

pressure provocation test

elbow - cubital tunnel syndrome (olecranon andmed epicondyle and go proximal) test: 20 elbow flex, 2 fingers and gently press in and hold for 60s positive: symptoms along ulnar n good sp, fair/good sn

Valgus/Varus Stress Test

elbow - ligamentous instability elbow test: sitting, shoulder flex to 90, part 1: test elbow fully ext, part 2: test elbow flexed to 20. positive: compression pain laterally, and distraction pain medially, increased laxity medially

moving valgus stress test

elbow - medial collateral lig tear test: sitting/standing, 90 shoulder abd, elbow fully flexed, max ER. hold valgus stress while ext elbow positive: pain 120-70 while ext elbow mod sp, 100% sn

flexor hallucis tendinopathy

gradual onset of pain underneath the bony bump on the inside of the ankle and along the inside of the foot. The initial signs often disappear with movement, massage or heat over the inside of the ankle and, therefore, are often ignored.

Thomas Test

hip - ms length (tightness hip flexors) test: at edge of table, bring B knees to chest, release one leg. see if leg level with table. straighten leg to see if gets lower. positive: leg not level with table (iliopsoas or quad). leg lower more when ext fully then = iliopsoas. alt: supine on table. one leg ext and one knee to chest. If ext leg hip flexes then positive and know iliopsoas tight

ober test

hip - ms length TFL and/or iliotibial band test: pt S/L. both hip/knee 90/90. ext and then abd top leg. lower limb toward table once parallel with lower leg again. modified: test top leg with it extended positive: top leg stays above horiz (hip)

Trendelenburg test

hip - ms weakness of glute med or unstable hip test: The patient stands and rises one foot and then the other while the doctor observes the buttocks. Positive: buttock drops on the side that the foot is elevated indicating hip abductor weakness on the stance leg side.

Patellar-Pubic Percussion Test

hip - pelvic fracture test: stethoscope on the pubic symphysis and tap on patella or tuning fork on the patella. can have the patient hold the stethoscope positive: hear diminished sound on painful side

Sign of the Buttock

hip - serious pathology tumor, bursitis or abscess test: SLR, go till stop b/c of pain, bend knee and see if can go further with bent knee positive: pain will keep you from moving forward still higher sp

90-90 hamstring test

hip - tight ms hamstring test: patient supine and hip and knee of testing limb is supported in 90° flexion. Passively extend knee of testing limb until a barrier is encountered positive: lacking 10° or more of extension

SLR & crossed SLR

hip/lumbar - Neurodynamic Mobility sciatic n (lasegue's test) test: test their DF, knee and hip ROM first. then keep knee ext and passively raise the leg to 70 hip flex. point out where the tightness is. add chin tuck = worse or better = neural OR add DF: increase symptoms on post knee and post thigh then thinking nerve related (b/c did not change length of hami) add chin tuck = worse or better = neural OR add contra knee bend. worse or better = neural OR no pain or pain in calf with DF then lower leg and see if pain gets better. same = calf ms (b/c neural on slack now), better = neural crossed SLR test: go to uninvolved side → it actually recreates positive: normal symptoms = crossed SLR. can be b/c hypersensitive or just severe note: ID herniated nucleus pulposis or neural tension/radiculopathy compare B high sn

osteomyelitis

inflammatory response within bone caused by an infection usually caused by Staphylococcus aureus but could be another organism more common in children and immunosuppressed adults than healthy adults; more common in males than females med tx: antibiotics, proper nutrition is important, surgery may be indicated if infection spreads to joints

Quadrant test

lumbar - neural structures at the intervertebral foramen and facet dysfunction test: pt standing, intervertebral foramen: cue patient into side bending left, rot left and ext to maximally close intervertebral foramen on the left. repeat on the other side. facet dysfunction: cue patient into side-bending left, rot right and ext to maximally compress facet joint on left. repeat on other side. positive: pain and/or paresthesia in the dermatomal pattern for the involved n root, or localized pain if facet available

well's CPR for DVT

major criteria: active cancer in last 6 months paralysis recently bed ridden localized tenderness (in venous distribution in the posterior calf- start popliteal fossa and work down medial calf) thigh and calf of affect leg is swollen - tape measurement strong family history minor criteria: recent trauma pitting edema in affect legs dilated superficial veins hospitalized in last 6 months redness, erythema positive = >3 major criteria and >2 minor criteria

osteoporosis

metabolic disease depletes bone mineral density/mass, predisposing individual to fracture F x10 vs M primary or postmenopausal osteoporosis directly related to decrease of estrogen senile osteoporosis occurs due to decrease in bone cell activity secondary to genetics or acquired abnormalities meds: Ca2+, Vit D, estrogen, calcitonin, biophosphonates

elbow dislocation

mostly posterior - defined by position of olecranon relative to humerus posteriolateral MC and occur as the result of hyperextension of elbow from a fall on outstretched UE posterior dislocations frequently cause avulsion fractures of medial epicondtyle secondary to traction pull of medial collateral ligment. with complete dislocation, UCL will rupture plain x-ray clinical signs: rapid swelling, severe pain at elbow and deformity anterior very rare, occurs due to direct trauma to dorsum of forearm in a semi-flexed position. It is an orthopedic emergency. Early proper diagnosis and concentric reduction of the joint is key for normal functional outcome of joint and prevention of any deformity. Posterior lateral rotary instability (PLRI) In 75% of patients younger than 20 years old, PLRI is the result of an elbow dislocation that injures the LCL complex. In adults, PLRI is more commonly caused by a varus extension stress to the elbow without dislocation, often initially diagnosed as a sprain.

Piriformis Syndrome

piriformis ER of hip at <60 hip flex 90 flex priformis IR and abd hip can be from over pronotion Excessive use of the gluteal muscles in some athletes (e.g., ice skaters, cyclists, rock climbers) can lead to hypertrophy or spasm of the piriformis muscle, which can compress the sciatic nerve. In individuals with a proximal split of the sciatic nerve (~12%), the common fibular nerve can become compressed as it passes through piriformis. s/s: restricted IR pain palp referral pian to post thigh weakness in ER, positive piriformis test dx eclusion

CRPS (Chronic Regional Pain Syndrome)

risk factors: Female Post-menopausal Migraine Distal radius fracture, ankle dislocation, or intra-articular fx Anesthesia lasting longer than 120 min Osteoporosis ACE inhibitor therapy Typical Impairments Muscle atrophy and weakness Contracture Joint stiffness and limited ROM Allodynia and hyperalgesia Decreased grip strength Gait deviations tissue differentiation test: Observation Palpation Sensory testing CRPS diagnostic criteria (high sensitivity) diff dx Bony soft tissue injury Fx Arthritis Compartment syndrome Infection Peripheral nerve damage Arterial insufficiency GBS Lyme disease RA MS Thoracic outlet syndrome

Panner's Disease

risk factors: Male Adolescent younger athletes Overhead sports typical Impairments:Decreased ROM at the elbow but no changes in pronation/supination Decreased strength of the elbow tissue differentiation test: ROM Palpation MMT Radiograph

Bursitis

risk factors: direct trauma to anterior knee falling on a flexed knee frequent kneeling •infection •inflammatory conditions Typical Impairments •Decreased ROM •Decreased local strength •Pain at end range of motion that compresses the bursa (prepatellar bursitis = extreme knee flexion) tissue differentiation test: ROM •Circumferential measurements •Palpation in the area diff dx •Infection •Inflammation

Unilateral Standing

stand on 1 ft → provocation of symptoms (with WB side). can hold for 30s specificity = high sensitivity = poor

Breathing Assessment with Excursion assessment

thoracic Test: palp for upper rib ROM, lower rib ROM while pt takes deep breaths. ROM with AROM Arm Elevation: assess mobility with arm elevation to 90 Flexion Ribs 1-7 and Abduction Ribs 8-12

compression/distraction thoracic test

thoracic - Passive Loading/ Unloading (facet/disc likes unloading usually) compression test: seat, load straight down on spine, make sure pt does not hinge distraction test: seated, approach from behind, grab around elbows or thread through to forearms. First take up slack in shoulder girdle then apply distraction force through spine. pt can lean into you. can also do this in position they prefer less (ex rot)

Cyriax Release Test

thoracic - Thoracic outlet syndrome test: short sitting, cradle arms from behind, wrists neutral. PT squats down to elevate shoulders and becomes human recliner chair, have pt lean back into you at 15o recline. all passive for the patient. hold 1-3 min positive: symptoms in 1 min >sp but still not bad at 3 min

first rib spring

thoracic - restricted first rib test: joint accessory glide of 1st rib essentially. T1 same width of C1, so can find frankenstein nobs of C1 and drop straight down to T1(image).going to go lateral to that because want to be on the ribs not the transverse process of T1. want to assess motion of rib with out any other contributing factors, so Side bend and rot towards side testing to put scalenes on slack. caudal, medial and slightly ventral force towards that ribs. check that end feel and compare B

Ulnomeniscotriquetral Dorsal Glide

wrist/hand - Triquetral Instability & TFCC tear test: forearm pronated. Finger on pisiform/triquetrum on the palmar side. Thumb on dorsal end of the ulna and oppose motion by pressing the ulna to the table and moving triquetrum up to the ceiling. positive: provocation and laxity compared B mod sn, poor sp

phalen's sign

wrist/hand - carpal tunnel tests: back of hands together and have them hold position. usually about 1 min, but can be couple min positive: paresthesias/tingling in median n distribution

Watson (scaphoid shift) test

wrist/hand - scaphoid/lunate instability test: place thumb AP on scaphoid tubercle and passively ext and ulnar deviation of thumb. hten try to move wrist into radial deviation and plamar flexion. positive: not intact can move wrist pretty far or clunk, compare B mod SN & Sp

CPR impingement

1. tenderness with palpation anterior lateral ankle 2. anterior lateral ankle swelling 3. pain with forced DF 4. pain with sg leg squat on affected side 5. pain with activities 6. absence of ankle instability 6 components: ⅚ + high spec and mod sen

Osgood-Schlatter

Sx: Ant knee, Stiffness, Children Impairment: Boney bump on tibial tuberosity, Decreased ROM/strength , Tenderness over tibial tuberosity Aggravates: WB activities

Legg-Calves-Perthes, (Avascular Necrosis: Pediatrics)

Sx: Children, Ant hip/med thigh/groin Impairment: Antalgic gait, Atrophy of hip muscles, Decreased hip abd/IR ROM, Leg length discrepancy Aggravates: WB activities

Cervical spondylosis

This type of condition is typically since in patient whose age is 50 yrs old or more, and may be either acute or chronic. On observation, there is minimal or no cervical spine movement. Torticollis may be present. AROM is limited with pain, and PROM is limited (symptoms may be exacerbated). Resisted isometric movement is normal, except if there is nerve root compression. Myotome may be affected. Special tests perfromed that were positive to confirm diagnosis were, Spurling's test, Distraction test, ULTTs and shoulder abduction test. Sensory function and reflexes: dermatomes affected and reflexes are affected. There is tenderness on palpation over appropriate vertebra or facet, and radiography revals narrowing osteophytes. Based on the above description, what kind of lesion may be suspected given the series of (+) special tests performed?

meniscus integrity tests

1. McMurry test: Move from max flex to extension of knee for both ER and Valgus force, palpation of joint line (medial meniscus) IR and Varus force with palpation of joint line (lateral meniscus) positive: thud, click, popping, catching or pain along the joint line note: inside pain = medial meniscus, outside pain = lateral meniscus 2. joint line tenderness 3. apley test: part 1: passive comrpession. asymptomatic then can add rot. part 2: distraction positive: worst with compression and less with distraction. 4. Thessaly test: pt standing on symptomatic knee, knee flexed 5 , rotates body and leg IR & ER. repeat with knee flex 20. note pain with positive: click or pain in knee joint greater LR with multiple tests: - combo hx and physical exam (joint effusion, joint line tenderness, McMurry test, Hyperflexion text, Squat test) - joint line tenderness + McMurry test - joint line tenderness + Thessaly test

Hip OA Clinical Prediction Rule (CPR)

1. Self-reported squatting as an aggravating activity 2. Active hip flexion causing lateral hip pain 3. Scour test with adduction causing lateral hip or groin pain 4. Active hip extension causing pain 5. Passive internal rotation ≤ 25 degrees

ACL ligament stability tests

1. lachman: knee 30 flex. ant pull one hand good sn 2. ant drawer test: knee 90 flex. ant pull two hands good sn 3. pivot shift test: knee ext, valgus force. maintain valgus force while bending knee. looking for tibia pull posterior from passive tension of the IT band pulling it. thud of clunk.(IT band functions as a knee flexor and will posteriorly translate tibia. If ACL is deficient, will feel clunk) mod pivot shift: pt supine, knee 30 flex. PT grab heel and provide IR force with inferior hand. valgus force with proximal hand. gradually flex knee

Proximal humeral fracture - Hill-Sachs lesion

A small defect usually located on the posterior aspect of the articular cartilage of the humeral head and caused by the impact of the humeral head on the glenoid fossa as the humerus dislocates. Humeral neck : Occur with fall onto outstretched arm, elderly Greater tuberosity: Fall onto shoulder, middle-aged/eldery X-ray Rx: Acetaminophen, NSAIDS, generally doesn't need surgery (stable fracture), functional training, restore biomechanics (manual therapy, exercise) EARLY PROM IMPORTANT TO PREVENT ADHEISIONS

hip impingment

Cam impingement occurs because the ball-shaped end of the femur (femoral head) is not perfectly round. This interferes with the femoral head's ability to move smoothly within the hip socket. Pincer impingement involves excessive coverage of the femoral head by the acetabulum.

Posterior oblique sling (golfer)

Latissimus Dorsi & Contralateral Glut Max Glut Maximus & Tensor Fascia Lata & iliotibial band (ITB). Glut max & TLF invest into sacrotuberous ligament Equals closure of the SIJ.

Ape hand deformity

Hand deformity secondary to a median nerve injury in the proximal forearm or at the wrist, presents with atrophy of the thenar eminence and inability to abduct and oppose the thumb Intervention includes orthotic positioning to maintain palmar abduction and opposition

SIJ Pain Provocation clusters

Laslett 1: (2/4 positive tests = +LR 4.0): Thigh Thrust, Distraction, compression, Sacral Thrust Laslett 2: Thigh Thrust, distraction, compression, sacral thrust, gaenslen's (⅗ positive tests = +LR 4.16) Van der Wurff's Cluster: distraction, compression, thigh thrust, Patrick (FABER) sign, Gaenslen's (⅗) sensitivity = good specificity = good

Scheuermann's Disease

Mild form of scoliosis and kyphosis developing during adolescence Osteochondrosis of the spine because of abnormal epiphyseal plate behavior that allows for herniation of the disk into the vertebral body, giving a characteristic wedge-shaped appearance. Scheuermann's disease is a self-limiting skeletal disorder of childhood. Scheuermann's disease describes a condition where the vertebrae grow unevenly with respect to the sagittal plane; that is, the posterior angle is often greater than the anterior.

Bell's Palsy

Sx: Rapid onset, Twitching, paralysis of facial muscles, Drooping of eyelid and corner of mouth , Face/jaw pain Impairment: Difficulty with chewing , Dysarthria , Difficulty making symmetrical facial expression, Loss of taste sensation on front 2/3 Alleviates: Heat, massage

CRPS

Sx:Distal to site of injury, Constant pain, Skin color changes, Temp changes, Sensitivity to touch Impairment: Allodynia/ Hyperalgesia, Edema, Muscle atrophy

neurogenic claudication

Who: over 65? Increased prevalence 70-79 What: buttock or leg pain/aching/tingling...effect of posture is hallmark sign. Associated with lumbar spinal stenosis Where: typically complain more of back pain than leg pain. Gluteal or leg pain sometimes radiates below the knee- one or both legs Nature: deep muscular pain, weakness in lower limbs. Numbness, tingling, burning, sharp needles, fatigue, poor balance MOI: insidious onset, progressive. ischemia of nerve root, and disturbance of blood flow Aggravating: ambulation Alleviating: rest, flexion (shopping cart sign) 24-hour: worse in morning, activity dependent book: pain consistent in all spinal positions, pain w/ physical exertion, relieved promptly with rest (1-5 min), pain described as numbness, decreased or absent pulses ususally

Thompson test

ankle - achilles tendon rupture test: prone, foot off edge, squeeze calf positive: no movement of foot (shoulder PF) --> referral to orthopedic surgeon

forced DF test

ankle - ant ankle impingement test: drop off lateral fibular, forceful DF while applying force on the talus

Fibular translation test

ankle - high ankle sprain test: S/L, stabilize ankle and using palm of hand move the fibula distal head, more thrust motion than glide motion

Gilliard's cluster

thoracic/cervical - Thoracic outlet syndrome all 5x: 1. hyperabduction 2. Wright 3. Roos 4. adson 5. tinel ⅖: spec: poor, sen:good ⅗: spec: poor, sen: good ⅘: spec:poor, sen: mod 5/5: spc: mod, sen: mod

Rib springing with or without blocking the thoracic spine

thoracic - Thoracic spine vs Costotransverse/ Costervertebral differentiation test: prone, Places mobilization hand along rib and stabilization hand on Transverse process of corresponding Thoracic vertebra but on contralateral side. begin upper ribs with post/ant force. part 1: spring rib without stabilization of thoracic spine part 2: stabilization force to Tspine and then spring rib positive: excessive or restriction of rib movement Pain with unsupported thoracic spine = pain may be generated from T-spine facet or costotransverse/costovertebral joints Pain with stabilized rib spring= pain more likely from costotransverse/costovertebral joints

cervical rotation lateral flexion test

thoracic - restricted first rib (potentially why someone might have thoracic outlet issues) test: short sitting, rot, side bend ear to chest maintaining that rot. testing side is the side that is opp of way turning the pt head (so the pt is turning head away from testing side)

Slump Test

thoracic/lumbar - neurodynamic mobility (potential disc pathology test: want to place tension on dura, less on the peripheral n part 1: long sitting with knees bent, then have her slouch down and then ext head (look up) vs down part 2: no symptoms can apply axial load part 3: can rot of spine and the test head up vs down note: disc does not like the sheer rot force, so if herniated winding them up can place more tension on dura part 4: side bend with head up vs down part 5: flex, sidebend, rot up vs down part 6: maintain slouch still but ext one leg and even provide tension through DF in foot. then provide even more tension by flexing the hip part 7: no change? while slouched with one leg ext. can winder her up with L rot (esp if did not like it before). apply axial load (no more than 3-4 lbs). then can flex the hip. make sure to test B part 8: maintain slouch still but ext both leg. can wind her up in both ways in that position as well positive: provocation of symptoms, asymmetry of movement, cervical radiating pain, whether their able to provoke with sensitizing agent either distally or proximally note: position depends on where symptoms are typically seen by the patient

Dorsal Capitate Displacement Apprehension

wrist/hand - Capitate Instability test: palm up, Make capitate sandwich and stabilize it against the table. Grab all the metacarpals with your other hand. Provide force on the palmar aspect of the hand positive:Provocation of symptoms (pain or apprehension) and laxity compared to the other side no metrics

compartment syndrome

- WHO: runners, females> (chronic), males> (acute), ~32yo - WHAT: development of inelastic fascial sheath, increased volume of muscle with exertion due to edema, excessive muscle hypertrophy, causing ischemia. - WHERE: numbness and tingling, tightness in the leg (can be lateral, medial, or posterior) - AGGRAVATING: repetitive loading - ALLEVIATING: rest - 24-HOUR: activity- dependent

POSTERIOR TIBIALIS TENDON DYSFUNCTION

- Who: obese, middle-aged women - What: progressive weakening of tendon o chronic overuse, can be associated with inflammatory diseases. insidious onset, progressive. - Where: posteromedial (usually unilateral) along the tendon, especially from the proximal aspect of medial malleolus to the arch of the foot - Aggravating factors: stairs, running, tip toes, uneven surfaces, unsupportive footwear (sandals, heels) - Alleviating factors: rest - 24-hour pattern: activity-dependent

spinal stenosis indicators and tests (cooks CPR)

1. Bilateral symptoms, 2. Leg pain > back pain 3. Pain during walking/standing 4. Pain relief upon sitting 5. >40 years old ≤1/5 sensitivity: good specificity: poor 4/5 sensitivity: poor specificity good Treadmill test Bicycle test

Pregnancy related Posterior Pelvic Pain

1. Lunge test sp good, sn fair 2. deep squat sp good, sn poor 3. active straight leg raise: raise affected leg 6 in off table. symptomatic → provide compression force at ilium and do the SLR again. positive: less pain with compression alternative: can do it with belt on ilium. ask how difficult to raise leg 0-5 (5 being difficult). leg raise too easy can apply force at the ankle positive: decreased in challenge in lifting leg note: can do all a couple times if lower irritability

Ottowa Knee Rules

1. age > 55 2. isolated tenderness of the patella 3. tenderness of the fibular head 4. inability to flex knee to 90 5. cannot WB more than 4 steps consecutively a immediately and in the ER positive: if any one of these are present for radiograph 100% SN for ID of Fx If NONE are (+) then you DONT need an Xray

Ulnar Nerve Entrapment

Claw Hand Tunnel of Guyon (under hook of hamate) Cubital Tunnel (elbow) Direct trauma or repetitive microtrauma. Pain, tingling, and numbness, in ulnar nerve distribution. Weakness of the adductor pollicis. Hypothenar Atrophy Adjust, tape, and support.

AC & SC disorders

Fall/collision onto shoulder with arm adducted Classified from 1st-3rd degree: 1: AC ligament stretched 2: AC ligament tear, clavicle may move if pushed 3: AC and CC ligs torn, AC joint displacement Or Rockwood classification system: Type I - Sprain of the AC ligaments. Type II - Complete rupture AC ligaments. Type III - Complete rupture AC and CC ligaments. Type IV - Complete rupture AC and CC ligaments. with displacement of clavicle posteriorly through Trapezius Type V - Complete rupture AC and CC ligaments with gross displacement of ACJ and detachment of Deltoid and Trapezius Type VI - Sub coracoid displacement X-ray, shear test Rx (acute): Position in neutral with sling, no elevation Rx: Surgery rare due to tendancy for ACJ to degenerate Acetaminophen, NSAIDS, functional training, restore strength and biomechanics (manual therapy, exercises)

Smith's fracture (reverse Colles' fracture)

Fracture of distal radius and ulnar styloid with an anterior displacement. It is caused by a direct blow to the dorsal forearm or falling onto flexed wrists, as opposed to a Colles' fracture which occurs as a result of falling onto wrists in extension.

Game keepers thumb

Gamekeeper's thumb (also known as skier's thumb or UCL tear) is a type of injury to the ulnar collateral ligament (UCL) of metacarpophalangeal (MCP) joint of the thumb. The UCL is torn at (or in some cases even avulsed from) its insertion site into the proximal phalanx of the thumb in the vast majority (approximately 90%) of cases. immobilize 6 weeks

peripheralization and centralization

Lumbar - back pain with related LE pain test: peripheralization and centralization with repeated movements (5-20) is associated with discogenic symptoms. Cook reports this with a utility score of 1 for it's diagnostic ability directions: flexion, ext, sidebend, rot

Chronic Exertional Compartment Syndrome (CECS) -LE

Sx: Ant lower leg, Burning, Pressure, Numbness/tingling, Bilateral Impairment: Pain 15mins into run that resolves within 30mins of rest, After activity: increased circumference, DF weakness, toe ext weakness, impaired sensation of 1st web space Aggravates: Increase in intensity of activity , Endurance exercises

Hip OA

Sx: Ant/lat hip pain, Morning stiffness, Aching pain Impairment: Hip IR < 24, IR and flexion 15 degrees less than contra side , Pain w/ passive hip IR, pain with squatting, age > 50 moderate ant or lat hip pain with wt bearing, am stiffness < 1hr, hip IR <24' or hip IR and flexion <15' of uninvolved, increased hip pain with passive hip IR Aggravates: WB activities,

Spinal Stenosis

Sx: Bilateral , Burning pain, Numbness/ paresthesia Impairment: Decreased ROM, Radiating pain, + 2-stage treadmill test, Cook's CPR Aggravates: standing upright, extension, walking Interventions: PAs, Flexion based exercises book: pain related to position, flex positions decrease pain, ext positions increase pain, numbness/tightness/cramping, walking any distance brings on symptoms, pain may persists for hours after assuming a resting position

Costochondritis

Sx: Chest pain, Unilateral (2-5th ribs), Ache or sharp pain Impairment: Hypomobility of rib in inspiration , Limited thoracic ext ROM Aggravates: deep breathing, UE/trunk movements Interventions: Rib mobs, Thoracic ext mobs,

Radiculopathy

Sx: Unilateral , Sharp pain, Numbness/ tingling, Symptoms in dermatome pattern Impairment: Radiating pain, + SLR, sensation tests, [Spurlings/Distraction/Med Nerve/Rotation 60 degrees (cervical radic)], Aggravates: spinal mobility, nerve tension tests Interventions: Traction

Rib Dysfunction

Sx: Unilateral, Local, Deep, dull ache, Stiffness Impairment: Pain with breathing, Hypomobility of costotransverse & costovertebral (PAs) Aggravates: deep breathing, trunk movements Interventions: Rib springing, Rib PAs, Rib separation

Medial Tibial Stress Syndrome

Sx: Vague/diffuse pain, Middle & distal thirds of medial border of tibia , Pain over 5cm in length Impairment: Pain w/ exertion (pain at beginning of activity then gradually subside in mins), Decreased DF ROM, Increased PF ROM, Navicular drop, Tenderness Aggravates: Running,

Medial Epicondylalgia, (Golfer's Elbow)

Sx:Medial epicondyle pain, Radiates w/ flexor-pronator mass Impairment: Weakness of wrist flex/pronation, Decreased grip strength Aggravates: Golfing, throwing sports

stress fracture

They're caused by repetitive force, often from overuse — such as repeatedly jumping up and down or running long distances. Stress fractures can also develop from normal use of a bone that's weakened by a condition such as osteoporosis.

Pelvic Girdle Pain and Pregnancy

Who: 56-72% of antepartum. RF: prior pregnancy, smoking, high BMI. What: prego-related pain in SIJ and pubic symphysis. Relaxin hormone 10x increase Where: between posterior iliac crest & gluteal fold in vicinity of SIJ. anterior from pubic symphysis - can radiate to posterolateral thigh/groin Nature: severe, sharp pain with muscle spasms. MOI: pregnancy Aggravating: sitting, cross-legged, sacral sitting, squatting, bending, twisting Alleviating: NSAIDs, rest, anterior pelvic tilt, stabilization belt 24-hour: morning, evening pain, activity/movement dependent. Picture: T&M: Fortin sign, SLR, Menell's, Laslett cluster...

Levator Ani Syndrome

Who: women, <45 RF: genetics, psych state, recurrent physical trauma, endocrine function What: nonrelaxing pelvic floor dysfunction - spasms in levator ani muscle Where: rectum Nature: chronic pain, lasting 12 weeks at least 20 minutes. Tenderness with palpation, unspecific functional pain if no tenderness. Can radiate up above pubis and all the way down to the feet. MOI: possible trauma from childbirth, may be due to infection/trauma/malignancy or disease, postural or gait abnormalities. Largely unknown. Possibly triggered by stressful events. Primary or secondary to pelvic neuropathology. Aggravating: sitting, defecation Alleviating: sitz bath, walking, lay down 24-hour: none Picture: T&M: palpation, digital rectal exam, ROM hip/back, myotome L2-S1, pelvic symmetry, reflex testing

Coccydynia

Who: women> (5x) RF: female, childbirth, obesity, rapid weight loss What: pain in coccyx Where: focal pain at coccyx that radiates into lower sacrum and perinuem Nature: dull, aching pain at rest. Sharp stabbing pain with aggravating activities. Sensation of pressure or urge to defecate. MOI: typically direct trauma (falling posteriorly), idiopathic or repetitive microtrauma Aggravating: direct pressure on coccyx (sitting), prolonged sitting, driving, coughing, toileting, suxual intercourse. Alleviating: use of coccygeal cushion, NSAIDs, laxatives 24-hour: constant ache, activity-dependent Picture: T&M: posture (sit to one side), observation, palpation Gold standard tx (90%): coccygeal cushion & NSAIDs

Femoral neck fracture

may compromise the vulnerable medial femoral circumflex artery which could lead to osteonecrosis of the femoral head. limp, frog leg lateral X-ray

FADDIR

hip - Intra Articular Irritability impingement test test: patient in 90/90 in supine. hold knee with one hand and support the leg with your forearm so bringing the other arm under and around to hold the leg close to you. bring the leg into flex, IR, & ADD positive: reproduce pain w/ or w/out click

Thigh Thrust

SIJ - Pubic symphysis provocation test test: supine with hip passively flexed to 90 on test side. use one hand palpate SIJ while apply compression 30s. can add thrust downward through knee and hip. positive: pain provocation sn high, sp mod

Osteochondritis Dissecans of talus (OCD)

Sx: Deep pain around talus, Swelling around ankle, Tenderness of talocrural joint , Crepitus w/ PROM Impairment: B/c of immobilization: Decreased ankle ROM, strength Aggravates: WB activities,

Femoroacetabular impingement

Sx: Deep pain, Ant/lat hip or groin, Stiffness, Popping/locking/snapping Impairment: + FADIR, FABER, Decreased hip flex/abd ROM, IR < 20 degrees w/ hip @ 90 flexion Aggravates: Getting in & out of car, Standing after prolonged sitting

Lisfranc Sprains

Sx: Medial foot, Pain over tarsometatarsal head, Sharp pain w/ WB, Swelling Impairment: Altered gait, Hypermobility @ Lisfranc joint Aggravates: WB activities , Movement of toes, pronation, abduction

Alar and TLA instability

Sx: Neck stiffness and pain, HA, Dizziness, Heavy head Impairment: + Modified sharp purser test, Alar ligament test Aggravates: Prolonged postures, neck rotation Alleviates: Head support

Thoracic Outlet syndrome

Sx: Numbness/ paresthesia (often in ulnar nerve distribution), Headaches, Radiating pain, Pain throughout day Impairment: Poor posture, Neurodynamic mobility deficits , Muscle tightness , + TOS tests Aggravates: Repetitive motion, overhead work, carrying Alleviates: support of UE Interventions: Nerve glides, Upper rib mobilization

Avascular Necrosis: Adults

Sx: PT not helping -> progressively worse, Usually no pain @ first then gets worse as time goes on, Deep/throbbing , Ant hip/med thigh/groin Impairment: Atrophy of hip muscles, Decreased hip abd/IR ROM, Aggravates: WB activities, Compression of joints

Sesamoiditis/ Sesamoid fracture

Sx: Plantar foot , Dull ache during activity , Sharp pain with pressure Impairment: Painful ROM of 1st MTP, Decreased ROM of 1st MTP, Pain w/ PF, Weakness in PF muscles Aggravates: Walking/running , Stairs , Jumping

Trochanteric Pain Syndrome

Sx: Severe ache, Snapping sensation at lat hip, Pain at lat hip/greater trochanter Impairment: Pain worse w/ increased activities/reps, Weakness of hip abd, TFL, glut med/min tightness, Decreased hip ROM Aggravates: Sidelying in bed, WB activities , Stairs, STS

Morton's Neuroma

Sx: Shooting , Numbness/tingling, 3rd/4th digits, Feeling of walking on lump in ball of foot Impairment: Midfoot hypomobility, Aggravates: WB activities (esp. in heels/improper fitting shoes)

Baker's Cyst

Sx: Stiffness, Ache, Tightness originating from back of knee, Edema, Palpable mass Impairment: Decreased knee flex/ext ROM Aggravates: Knee flex/ext

Disc, (Annular tear, Herniation, Degeneration)

Sx: Unilateral (can refer @ segment and 1 above & below), Worse in morning, Ache or sharp pain Impairment: Lateral trunk shifted away from painful side, + slump test, compression test, distraction test , Weak spinal muscles , Aggravates: flexion, sitting, coughing/ sneezing, prolonged position Alleviates: extension, , walking Interventions: Correct lateral shift , Repeated extension movements (centralize) , Axial separation mobs book with nerve root compromise: no pain in reclined or semi-reclined position, pain increases with WB, shooting/burning/stabbing, may describe altered strength or ability to perf ADLs

Lumbar Instability

Sx: Unilateral , Catching, giving way Impairment: Hypermobility of involved segments, Movement coordination impairments , + prone instability test, passive lumbar extension test Aggravates: prolonged position, combined motions (flex/ext with rotation), Alleviates: lying down Interventions: Muscle activation training

Myositis Ossificans

Sx: Warmth, Swelling , Persistent tenderness, Low-grade fever Impairment: Joint stiffness , Decreased hip ROM , Pain w/ resisted contraction of injured muscle, Pain w/ stretching of injured muscle Aggravates: Walking, Hip movements

Scaphoid Dislocation/Fracture

Sx:Anatomical snuff box pain, Stiffness, Swelling , Tenderness Impairment: Decreased ROM of wrist and thumb, Pain with pronation Aggravates: Pinching, grasping, Thumb movements , Compressive load

Biceps Tendinopathy

Sx:Ant shoulder, Chronic overuse, Deep throbbing/ache , Radiate down arm, Pain @ rest Impairment: + Biceps Load II test, Tenderness over bicipital groove, Muscle weakness, (usually no ROM loss) Aggravates: Reaching overhead, back, Pulling/lifting , Tucking in shirt, Prolonged immobilization

SLAP lesion

Sx:Ant shoulder, Pain w/ activity , Clicking/popping , Instability Impairment: + Biceps Load II test, Apprehension test, Ant release/surprise test , Reduced IR > 20 compared to contra side, Pain w/ ER PROM @ 90 abd, Pain with arm elevation Aggravates: Overhead movement, Weighted shoulder movement

Impingement syndrome

Sx:Ant/lat arm, Persistent pain, Constant ache, Sharp pain w/ certain movements Impairment: Capsular tightness, Limited ROM, + Empty Can Test, Neer test, Painful Arc Sign, Hawkins-Kennedy Test, ER test Aggravates: Repetitive shoulder activities , Reaching overhead, Stretching

Rotator Cuff Pathology

Sx:Ant/lat shoulder , Local pain Impairment: + External Rotation Lag Sign, Lift off test, Drop Sign, Empty can test, Drop Arm test , Weakness in ER/abd, Altered shoulder kinematics Aggravates: Overhead movement, Lifting

OA of 1st CMC joint

Sx:Base of thumb, Stiffness in AM & w/ prolonged rest, (usually painless) Impairment: Pain with pinching, gripping, Weak grip, Decreased flex/abd MCP ROM Aggravates: Pinching, grasping, ADLs, Opposition

RA of hand

Sx:DIP, PIP, MCP, Aching, Stiffness, Bilateral , Weight loss, Fever Impairment: Decreased ROM, Decreased joint stability of MCP/IP, Deformities: Swan-Neck, Boutonniere, Ulnar deviation of MCP Aggravates: ADLs, Carpenter, construction, mechanic work

Kienbock Disease (osteonecrosis of lunate)

Sx:Dorsal wrist over lunate, Dull/ache @ rest, Sharp w/ movement Impairment: Grip weakness, Dorsal wrist swelling , Tenderness over lunate Aggravates: Compression w/ wrist ext (push up), End range wrist ext

Dorsal Intercalated Segment Instability (DISI), - dorsal sublux of lunate

Sx:Dorsal/radial wrist, Clicking/catching, Tenderness, Instability Impairment: Decreased ROM, (+) Watson's test Aggravates: Pain/weakness with grasping, WB on wrist , Repetitive work

Elbow Instability

Sx:Lat>med elbow pain, Vague pain, Clicking, locking during ext Impairment: Tenderness with palpation, Ligament instability Aggravates: Force through elbow, WB through UE, Overhead/rotation arm movements

Lateral Epicondylalgia (Tennis Elbow)

Sx:Lateral epicondyle pain, Radiates w/ common extensor mass Impairment: Weakness of wrist ext/supination, Decreased grip strength Aggravates: Gripping objects, Open/close doors, Writing

Adhesive Capsulitis

Sx:Pain , Stiffness Impairment: Limited GH PROM (esp. ER), Pain and end range PROM, Joint accessory motions limited Aggravates: Reaching activities , Dressing/grooming

De Quervain's tenosynovitis

Sx:Radial/1st dorsal compartment , Dull ache , "Creaking" pain Impairment: Tenderness over radial styloid, EPB/APL, Decreased ROM in thumb & wrist , + Finklestein's test, Aggravates: Movement of thumb/wrist, Gripping , Opening jars, turning keys

TFCC Injury,

Sx:Ulnar wrist , Btwn ECU & FCU tendons , Audible click/pop with pronation & supination Impairment: Instability of DRUJ, Pain with ulnar deviation , + Ulnomenisco- triquetral Dorsal Glide, Press Test Aggravates: Pronation/ supination, Wrist circumduction , Lifting heavy objects

mulder click test

ankle - motorn neuroma test test: grasp forefoot and palpate intermetatarsal space proximal to met head on the plantar surface.Squeeze the forefoot and feel for click/pain reproduction as thickened nerve is displaced from interspace. Sensitivity: .98 (Pastides et al)

DF-Eversion Test

ankle - tarsal tunnel test test: max DF and eversion and toe ext, then tap on tarsal tunnel Sensitivity: 0.81-0.92, Specificity: 0.99

Navicular Drop Test

ankle- navicular drop when pronated foot (drops norm but looking at how much) test: sub talar neutral, measure navicular from floor. stand naturally and measure again. positive: >1 cm (10 mm) hypermobile, <3 mm is hypomobile

tectorial membrane test

cervical - C1-C2 stability test: one hand in the suboccipital region using the thumb and 1st finger against the lower aspect of occiput. 3 fingers (while flexed) are places against the spinous processes of the cervical spine and block the spine. other hand provide post and upward force on mastoid process of patient to translate head posteriorly (take occiput up from the spine). thumb and first finger of the first hand provide a traction force positive: excessive translation between the occiput and C1-2 Sn high, Sp high

Median nerve compression test

wrist/hand - Pressure Provocation Test test: capitate sandwich and just hold it positive: paresthesias/tingling in median n distribution mod to high sp & sn

Thoracic Compression Fracture

- aka *burst fractures*; due to axial loading. - Multiple noncontiguous fractures are associated with burst fracture in nearly 50%, so finding a fracture should make one continue to look and not give up on the search. - Don't confuse the *normal 1.5 mm anterior tapering* of the anterior thoracic vertebral bodies for compression. - With compression, there is *loss of vertebral height* and usually *disruption of the posterior vertebral line*. If the body has lost stature, it may be impossible to tell if this is an acute fracture without old films for comparison. - *CT should be performed for full assessment* of the spinal canal in compression fracture cases because *neurological deficit occurs in 65% of patients*.

Cervical consdierations: before assessments (Is this patient appropriate for PT? How to navigate important safety concerns)

1. Recent Trauma? Do Canadian Cervical Spine Rules apply? Is it safe to evaluate cervical rotation ROM? 2. Do they have a health condition that requires you to assess ligament integrity? (RA and other inflammatory arthritides, long standing corticosteroid use, congenital health conditions associated with upper cervical instability such as Downs syndrome?) 3. Do they require an upper quarter neuro exam? (Any neurologic symptoms in the UE or LE?) 4. Do they have potential arterial disease that may limit the use of manual therapy or sustained cervical positions? (any history of dizziness, vertigo, black outs, drop attacks, and/or history of arterial disease?

Cervical arterial dysfunction /Sustained Positions testing

1. class learned: part 1: AROM cervical ext, rot B, combo rot and ext x10s each part 2: repeat w/ passive over pressure in same seq part 3: no s/s examine pt tolerance at end ROM that will be used in exam or intervention procedures. place at End ROM and hold for 10 s 2. Vertebral a test: supine with head supported off end of table. passively ext hold 30s. ext with rot and sidebending. hold each 30s. positive: drop attacks, dizziness, dysphasia, dysarthria, diplopia, ataxic gait, numbness, nausea, nystagmus note: always check their symptoms at rest. pt middle table. have pt count backwards from 10. have them return to neutral after the exam. looking for: no nystagmus, maintain quality speech, able to maintain eye on sg point (so know if nystagmus or not),, no memory loss.

rotator cuff tears

1. external rot lag sign supraspinatus/infraspinatus: 90 elbow flex, bring up to scapular plane 20, full ER, have pt hold position. positive: cannot hold position sp ranges, good sn 2. lift off test subscap tear: dorsum hand on back and have them lift hand off back and hold. positive: unable to lift hand off poor-good sn, mod-good sp 3. drop sign infraspinatus: 90 elbow flexion, 90 elevation scapular plane, then full ER, have pt hold position. positive: cannot hold mod/good sp, poor/good sn 4. drop arm test supraspinatus tear or subacromial impingement: passive abd arm to 90, pt slowly lower arm to side poor/mod sn, mod/good sp 5. empty can test full can: actively elevate to 90 abd, thumbs up, resist downward force. positive: pain, weakness empty can: actively elevate to 90 abd, move into scapular plane, thumb down, resist downward force. positive: pain, weakness fair/good sn & sp dx cluster: age >60, painful arc, drop arm test, infraspinatus/ER test = good clinical utility

pathological reflexes

1. hoffman: snap or flick pt middle finger positive: index and thumb fingers move of same hand 2. babinski: blunt stimulus run down the plantar surface of the foot positive: flare, ext of toes 3. shimizu: elbow bent to 90, forearm resting on the lap, rap the tip of the psine of scapula or the acromion in caudal direction positive: elevation of scapula or abduction of humerus 4. lhermitte's sign: passive neck flexion positive: "electric shock sign" goes through the body (B arms and potentially legs) indicative of referrals

thoracic outlet syndrome tests

1. hyperabduction short sitting, take radial pulse, move arms into field goal position, reassess pulse for changes poor/mod sp 2. wright test radial pusle in short sitting, bring arm up into field goal position, ext and rot head to the opposite side (look away) that you are assessing. mod/good sn 3. roos test (elevated arm stress test) field goal position, open and close hands, see how long they can hold position normal: 1-3 min poor/excellent sp, good sn 4. adson's test short sitting, 15 should abd while taking radial pulse, ext and rot head towards the side you are assessing, pt take deep breath and hold it. hold breath as long as can, can take another if needed poor/excellent sp, poor/mod sn

PCL ligament stability tests

1. post drawer test: knee 90 flex. post translation of tib 2. post sag sign: knee 90 flex. observe if tibia "sags" post. normally tibia ext 1 cm ant beyond femoral condyle so positive is loss of that step. 3. varus/valgus instability tests at 0 degrees: valgus/varus force at 0 and 30 knee flex. positive: laxity and/or pain, positive at 0 combined with other positive rotary tests = major disruption of knee

Upper cross syndrome

Sx: HA, Post neck pain, Stiffness Impairment: Poor posture , forward head posture, Increased cervical lordosis & thoracic kyphosis , Decreased ROM in neck, Neck muscular tightness/ weakness Aggravates: Prolonged positions Alleviates: Laying down, Frequent movement Interventions: Stretching of tight muscles , Posture education

Lower cross syndrome

Sx: Low back/hip/SIJ pain, Burning/numbness into LE Impairment: Decreased lumbar ROM, Abnormal standing static posture, Spinal muscular tightness/weakness Aggravates: Prolonged standing/walking, Forward bending Alleviates: Laying down, Frequent movement Interventions: Stretching of tight muscles , Posture education

Pudendal Neuralgia

Who: rare. Typically develops after 30. W>M. RF: OA, osteoporosis, post menopausal What: neuropathic condition due to compression of the pudendal n. Where: dorsal root ganglion S2-4 (contains S, M, autonomic fibers). Travels medial & caudal...supplies levator ani ms, etc. Nature: burning, urgency, paresthesias, having foreign body inside of them MOI: most common: compression occurs during pregnancy or child birth Stretch injury: childbirth Transection injury: pelvic reconstruction or genital prolapse Aggravating: prolonged sitting, sex, sleeping Alleviating: standing/lying down, sitting on toilet, muscle relaxants 24-hour: painless in morning, increases throughout day T&M: Nantes criteria for diagnosis (inclusion & exclusion criteria) Palpate pelvic floor ms Sensation Tinel's for pudendal Pudendal n block Outcome measures: pelvic floor etc., VAS, femal sex dysfunction...

Osteitis Pubis

Who: young athletes, high intensity sports, pregnancy and postpartum women. What:muscle imbalance between abdominal and hip adductor muscles (biomechanical overload, stress response, inflammation, pelvic pain) Where: pubic symphysis (anterior, medial groin pain) Nature: sharp unilateral or B, tenderness with palpation MOI: chronic condition worsening over time Aggravating: running, kicking, hip adduction, hip flexion Alleviating: rest 24-hour: activity-dependent Picture: T&M: palpation (dif dx? Sports hernia), pubic symphysis stress test

Radial nerve entrapment

Wrist Drop, Erb's Palsy, Saturday Night Palsy, Crutch Palsy Spiral Groove Trauma, lead poisoning, or pressure from crutches. Adjust, increase strength, or stretch muscle. Distal branches (Posterior Interosseus nerve) in radial tunnel due to throwing and OH activities Positive Tinels of radial, differentiate from LE, Lateral elbow pain Rx: Acetaminophen, NSAIDS, Neurontin, Rest/Unloading, STM, Neuromobilization (flossing, stretching, gliding), protective padding and night splints, functional training, taping, muscle balance restoration

alar lig test

cervical - alar lig stability test: sitting/supine, head slightly flex, stabilize C2 with pincer grip. palpate movement of C2 during passive upper cervical side bending and/or rot. positive: failure to "feel" movement of the C2 process during side flexion and rotation in conjunction with C1

joint position error testing

cervical - impaired motor pref (Cervical pain with movement coordination impairments) aka ability to relocate the head back to center after maximal or submaximal rotation in the transverse and sagittal planes. test: seated with eyes closed or blindfolded. target 90 cm in front of pt with pt in neutral head position. active head rot to one side and have them return to neutral. laser should be on target again. avg 3 or 6 trials positive/norm: < 4.5 degrees (horizontal) denotes normal cervical proprioception >4.5 degrees (> 6cm from center) (horizontal) indicates abnormal cervical proprioception

cervical extensor endurance test

cervical - impaired motor pref (Cervical pain with movement coordination impairments) test: prone, head off table, Belt placed around thoracic spine to decrease chance of thoracic extension. Instruct patient to perform upper cervical flexion (tuck chin) and maintain head in neutral and hold this position as long as possible positive: Head moves 5 degrees from horizontal Note: most have greater endurance of extensors than flexors

anterior neck flexor endurance test

cervical - impaired motor pref (Cervical pain with movement coordination impairments) test: supine, neutral head position, Position patient's head in upper cervical flexion, lifted approximately 2.5 cm off table (about 3 fingers) (place hand underneath head to help patient's awareness of position, patient's head should not be touching hand). Identify a skin fold on anterior lateral neck & draw a line on the skin fold (don't have to draw on pt). have them hold position. If patient's head touches examiner's hand or if patient loses the skin fold, instruct patient to hold head or tuck chin positive: Postitve test is undefined, however test is terminate if patient cannot maintain skin fold or hold head up >1 second. norms: Mean hold times 38.9 +/- 20.1 seconds for men and 29.4 +/- 13.7 seconds for women; 20-80 years of age note: 83% SCM and AS muscle activity and 17% is longus capitis and colli

cervical Flexion Rotation Test

cervical - neck pain with HA (provocation test for AA dysfunction or cervicogenic HA) test: supine, max flex cervical spine, then fully rotate head in each direction positive: anything less than 32 rot to one side often associated with HA. or loss of 10 motion from one side compared to the other sn 86, sp 20

Spurling's Test

cervical - neck pain with radiating pain (compression of foramina aka nerve root) test: sitting, apply pressure straight down. note: can have pt side bend and if still no symptoms then can apply axial downward pressure. positive: radicular symptoms Sn poor-good, Sp moderate-good

cervical distraction & compression test

cervical - neck pain with radiating pain (indicated compression of intervertebral foramen or facet joint dysfunction) distraction test: sitting, hands over ears on sides and stand up to provide distraction. positive: reduction of symptoms Sn fair, Sp good compression test: sitting, passively move head into side bend & rot toward non painful side, then ext. repeat toward non painful side. note: similar to VBI test positive: pain or paresthesia in dermal pattern, localized pain in neck if facet dysfunction

Craniocervical flexion test

cervical - patients with neck pain disorders; acute, subacute and chronic presentations. test: supine, pressure biofeedback behind head. pt dial to guide perf of test. pt do equivalent to the function of nodding to say "yes." stage 1: Analysis of performance of the craniocervical. flexion action.target pressure from 20 to 22 mm Hg. hold 2-3 s. This process is repeated through each 2-mm Hg increment of the test to 30 mmHg. note: apical breathing pattern? perf on exhale. note: should be negligible activity palpated or observed in the SCM or AS muscles until the last 1 or 2 stages of the test, if at all. potential compensations: 1. range of head rotation does not increase with progressive increments of the test 2. more a head retraction action 3. patient lifts the head in attempts to reach the target pressures 4. movement is performed with speed 5. palpable activity in the superficial flexor or hyoid muscles in the first three stages of the test 6. pressure dial does not return to the starting position stage 2: Testing isometric endurance of the deep cervical flexors at test stages that the patient is able to achieve with the correct craniocervical flexion action. patient performs the head nod action to first target the lowest level (22 mm Hg) and holds the position for 10s. perf x3 of 10s hold without substitutions then progress to next pressure target signs reduced endurance: 1. cannot hold pressure steady 2. superficial flexors overtly recruited 3. pressure held but jerky action Stage 3: For example if able to hold at 24 mm Hg and repeat that 6 times the number would be 4x6=24; therefore the most a person could get would be 100 if they tested at 10mm Hg and repeated the 10 second holds 10 times norm: asymptomatic subjects between 18-68 years of age showed a performance score of 65.8 +/- 27.5. Contraindications: Presence of neural tissue mechanosensitivity causing pain with movement of craniocervical flexion. This would delay the test in its current format until this sensitivity has resolved. The CCFT should not produce head or neck pain.

Mid cervical lateral shear testing

cervical - stability test: supine, lateral border of their metacarpalphalangeal joint is placed against the transverse process of selected mid-cervical level. opposite side of cervical spine, the opposite hand provides similar grip on mid-cervical level above or below the previous level.Apply a medial force with each hand positive: reduction of myelopathic symptoms during translation or excess displacement during movement

Modified Sharp Purser Test

cervical- transverse lig/atlanto axial stability test: sitting, passively slight flex upper cervical, apply firm pincer grip on C2. apply post translation and extension force thru forehead while assessing for excessive linear translation or reproductive of myelopathic symptoms positive: myelopathic symptoms with cervical flex, decrease in symptoms w/ AP translation or excess translation during post translation mod sn, high sp

AA lateral shear testing

cervical: AA stability (how atlas moves on axis) test: supine, "key fob" grip and stabilizes/contacts the C1 transverse process on 1 side.same form of grip on opposite side of neck at transverse aspect of C2. Apply a stress between the 2 grips incorporating a transverse shear force positive: reproduction of myelopathic symptoms during translation or excess displacement during the movement

Distal humerus fracture

complications can include loss of motion, myositis osifications, malalignment, neurovascular compromise, ligamenetous injury, CRPS. Supracondylar fracture must be examined quickly for neurovascular status, d/t high number of neurological (particularly radial nerve) and vascular structures. Lateral epicondyle fracture are fairly common in young people, typically require ORIF to ensure absolute alignment. X-ray

Pubic Compression Test

compression on one side to the table→ looking for provocation. can hold for 30s specificity = good sensitivity = mod

prone knee bending test

hip - Neurodynamic Mobility, more ant pain = femoral n test: stabilize PSIS then knee flex. add cervical ext and can even add pt on elbows for more ext. worse = neural positive:

2-stage treadmill test

lumbar - spinal stenosis test: stage 1: walk on treadmill on level plane for 2 min, 10 min rest break stage 2: walk at 15o angle for 10 min positive: worsening of symptoms after the incline is a positive sn mod, sp good

Passive Lumbar Extension Test

lumbar- movement coordination impairments test: prone, pt lifts the legs 30cm off the table, assess how low back feels positive: severe pain complaint, heavy feeling in the low back, back is coming off

Prone Instability Test (PIT)

lumbar- movement coordination impairments test: prone, with legs off side of table (hips and beyond are off the table like they are leaning on to the table), take provocative side and apply PA force, tell pain level, lift legs off the table, tell pain level again positive: reduction in pain symptoms as the patient raises legs note: if no symptoms with passive PA then not doing this test fair sn & sp