OPP Extensive LAB Year 1

McMURRAY'S TEST

* Test for meniscal tears •Pt supine with knee flexed •For medial meniscus: -DO externally rotates the tibia and applies valgus pressure at the knee while bringing knee into extension •For lateral meniscus: -DO internally rotates the tibia and applyies a varus pressure at the knee while bringing knee into extentsion •Positive = clicking

PATELLAR GRIND TEST

* Test for posterior patellar articulatory surface, possible chondromalacia •Patient is supine, knees extended, examiner pushes patella toward table while patient contracts quadriceps muscle •Positive if recreates pain

Ankle Drawer Test

* Test integrity of the anterior and posterior talofibular ligaments (also med/lat and sup/deep deltoid) •Test anterior talofibular ligament: -Pt supine, stabilize distal tibia, grasp posterior heel, pull anterior with posterior tibial counterforce •Test posterior talofibular ligament: -Switch hands and force

BOUNCE HOME

* Tests for Mensical tears or motion restriction due to effusion •Patient supine, hold heel, flex knee allowing knee to "bounce home" into full extension •Positive = incomplete extension of knee or slight bounce on extension

PATELLA FEMORAL GRINDING (APPREHENSION) TEST

* Tests quality of the articulating surfaces of the patella and the trochlear groove of the femur • •Pt supine •DO pushes patella distally in trochlear groove •Pt tightens his quadriceps •Patellar movement should be smooth and gliding • •Positive test - any roughness, crepitation as patella moves, pt complains of pain/discomfort -Seen in patients who c/o pain with climbing stairs, getting up from chair, and in pts who have chondromalacia

sacrum: MOTION TEST ABOUT TRANSVERSE AXIS

- hand over sacrum with fingers pointing cephalad - apply alternating pressure with tips of fingers and heel of hand - assess the quality and quantity of motion and note which is freer

Indirect action

- into the freedom of motion

MOTION ABOUT OBLIQUE AXIS

- pads of index and middle fingers, one on PSIS and the other on the sacral base - heel of active hand in contact with the ILA on the contralateral side - apply downward (anterior) pressure on the ILA of sacrum about an oblique axis - assess both sides - if sacral base has rotated forward and become restricted, posterior motion of the sacral base at the sulcus is restricted.

Active

- patient does the work

Passive

- physician does the work

Direct Action

- the restrictive barrier is engaged

Ø occipital bone Ø occipital protuberance(inion) Ø superior nuchal line Ø mastoid process Ø transverse process C1 Ø spinous process C2 Ø vertex Ø sagittal suture Ø lateral masses (articular pillars) Ø vertebra prominens (C7) Ø orbits Ø angle of mandible Ø Temporomandibular joints (TMJ) Ø Supraorbital ridges

...

point to your Ø Greater trochanter Ø Femur Ø Tibia Ø Fibula Ø Patella Ø Tibial-femoral joint space Ø Popliteal creases/fossae Ø Anterior tibial tubercle Ø Malleoli (medial, lateral) Ø Fibular head Ø Calcaneus Ø Tarsals Ø Metatarsals Ø Phalanges

....

point to your Ø spinous processes Ø transverse processes Ø costotransverse joints Ø rib angle Ø ribs 11 and 12 o 12th rib (QL attachment) Ø sternum o suprasternal notch o manubrium o sternal angle (angle of Louis) o body o xiphoid process

....

Unilateral Linear Stretch Applied to Both Ends of Muscle,

1. Patient position: supine 2. Physician position: standing at the head of the table 3. Technique: a. Physician places one forearm on the side of the neck to be treated, under the patient's head, with the hand on the patient's contralateral shoulder. Head is fully supported. b. The physician places her other hand on the patient's head, on the side to be treated. c. The physician slowly and gently lifts the head up, forward-bending the neck. The head is rotated away to give a stretch on the muscles opposite the rotation. d. Repeat and move further into the barrier.

cervical stretching

1. Patient position: supine 2. Physician: standing at the head of the table 3. Technique: a. Physician crosses forearms under the patient's occiput and neck so that the patient's head is fully supported on the physician's forearms and the physician's hands are pressing down on the patient's contralateral shoulders. b. Physician lifts arms creating a lever-fulcrum effect that puts linear traction on both ends of the muscles. Neck is bent forward, controlling the force. c. Hold position for a few seconds and slowly bring back to neutral. d. Repeat and move further into barrier.

Thoracic/Lumbar Bilateral Thumb Pressure Prone (parallel stretch)

1. Patient prone, physician standing at head 2. Begin at transverse process of T1, place thumbs/thenar eminences over paravertebral musculature 3. Press gently anteriorly and caudad to stretch musculature 4. Continue down thoracic paraspinal muscles then repeat from bottom and moving up Reevaluate

Lumbar Prone Pressure with Counter Leverage (perpendicular)

1. Patient prone, physician standing at side 2. Place one hand on lumbar paravertebral musculature, opposite from side your standing 3. Inform patient that you will be touching their ASIS: Caudad hand reaches around front of hip to ASIS 4. Apply ventral and lateral force with cephalad hand while caudad hand gently lifts ASIS off the table 5. Repeat at each lumbar vertebral level 6. Repeat on the other side Reevaluate

Thoracic Prone Pressure w/ Counter Pressure (parallel stretch)

1. Patient prone, physician standing side 2. Place hands in opposite directions along paravertebral musculature, have patient turn their head away from your cephalad pointed hand 3. Apply pressure ventrally, moving each hand in the direction fingers are pointing 4. Work up and down thoracic muscles 5. Reevaluate

Cervical Contralateral Traction (Perpendicular Stretch)

1. Patient supine, physician seated at head 2. Place cephalad hand on forehead and other hand on paravertebral musculature on opposite side from where you're standing 3. Pull ventrally with bottom hand and use hand on forehead to gently turn head in opposite direction 4. Make sure you use proper body mechanics (lean away with body) and induce minimal extension 5. Reevaluate

Cervical Cradling with Traction (Parallel Stretch)

1. Patient supine, physician seated at head 2. Place fingers on paravertebral musculature, over the articular pillars of the cervical spine. Avoid the spinous processes 3. Press ventrally/anteriorly to engage the soft tissues and pull cephalad for longitudinal stretch 4. Work up and down the cervical spine Reevaluate

Suboccipital Release

1. Patient supine, physician seated at head 2. Rest occiput in your hands, then place finger pads in upper cervical region and slide up until they hook underneath the occiput 3. Apply pressure anteriorly and cephalad and sustain pressure for 30 seconds to a minute, or until you feel tissues release and the patient's head falls into your hands Reevaluate

Scapulothoracic Release (for a right scapula)

1. The patient lies on their left side, lateral recumbent position, and the physician stands facing the patient at the side of the table. 2. The physician's right hand is placed over the patient's right shoulder, anchoring the clavicle with the webbing of the thumb/index finger. The physician's finger pads contact the superior medial angle of the scapula. 3. The physician's left hand is placed under the patient's right arm, and the physician's finger pads are placed at the inferior angle of the scapula. 4. The physician adds a gentle compression into the tissues to gain access and control of the patient's scapulothoracic articulation and its related myofascial components. The physician next takes the scapula inferior/caudal and superior/cephalad and evaluates the ease-bind barrier relationship 5. Next, the physician carries the scapulothoracic articulation toward the spinal midline and then draws the scapula laterally and assesses these ease-bind barriers 6. The physician determines the motion of restriction and the holds it there for 20-60 seconds, or until a release is felt. 7. To facilitate the reaction, a "Release Enhancing Maneuver" (REM) may be produced by having the patient inhale fully, hold the breath for 5 to 10 seconds and then exhale. 8. When a release is palpated, the physician should do a passive stretch into the barrier

Special Tests for Lateral Epicondylitis

1.Forearm pronated and flat on table 2.Fist with extended wrist 3.Patient to resist flexion 4.Pain at the Lateral Epicondyle mean inflammation

normal lumbar side bending

25-30

normal lumbar backward bending

30-45

Fibular Head Motion Testing

4. Interpretation: (a) Increased anterior glide with decreased posterior glide signifies an anterior fibular head. Increased posterior glide with decreased anterior glide, signifies a posterior fibular head

Muscle chart

5 - normal: complete ROM with gravity and wull resistance 4 - good: complete ROM against gravity and some resistence 3 - fair: complete ROM against gravity 2 - poor: complete ROM with no gravility 1 - trace: evidence of slight contractility, no joint motion 0 - zero: no evidence of contractility

normal lumbar fwd bending

70-90

what angle does scoliosis compromise respiratory function

>50

what angle does scoliosis compromise cardiovascular function

>90

•Ankle drawer test lig

Anterior Talofibular Ligament

•Lateral Stability (Ankle)

Anterior Talofibular Ligament Calcaneofibular Ligament

test for cruciate lig

Anterior and Posterior Drawer test

vertebra prominens

C7

Drop Arm Test

DO position: standing Patient position: seated 1. Instruct patient to ABduct their arm to 90° 2. Ask pt to slowly lower their arm + test = pt unable to lower arm slowly, arm drops ALTERNATIVE: 1. Instruct pt to ABduct their arm to 90° 2. Doc slowly taps down on patients abducted upper extremity + test = pt unable to keep arm abducted à arm drops Indicates tear in rotator cuff

`Scapular Traction w/ Respiratory Assist

DO position: standing facing patient Patient position: lying on side with the side to be treated upward 1. ABduct patient's arm & place caudad hand between the patient's arm & trunk 2. Grasp patient's scapula at the superior medial edge with the cephalad hand & inferior angle with the caudad hand 3. Instruct patient to inhale & and follow the inhalation lifting the scapula laterally 4. As the patient exhales resist the scapula 5. When patient inhales again follow with traction to the next barrier 6. Repeat 3 times, end with a passive stretch

Shoulder ER

DO position: standing to side of patient Pt position: seated 1. ABduct pt's arm to 90° and flex elbow to 90° 2. Grasp pt's wrist with one hand; monitor the shoulder/scapula with the other hand 3. Guide pt's shoulder into external rotation by rotating the pt's hand and forearm backward without allowing the upper arm to move up or down 4. Repeat with other arm and compare sides Normal ROM is 90

Shoulder IR

DO position: standing to side of patient Pt position: seated 1. Abduct pt's arm to 90° and flex the elbow to 90° 2. Grasp pt's wrist with one hand; monitor the shoulder/scapula with the other hand 3. Guide pt's shoulder into internal rotation by rotating the pt's hand and forearm forward without allowing the upper arm to move up or down 4. Repeat with the other arm and compare sides Normal ROM is 80°

Shoulder flexion

DO position: standing to side of patient Pt position: seated 1. Grasp pt's arm with one hand 2. Monitor pt's shoulder/scapula with other hand 3. Guide pt's shoulder into flexion 4. Repeat with other arm and compare sides Normal ROM is 180°

Shoulder ADduction

DO position: standing to side of patient Pt position: seated 1. Grasp pt's arm with one hand 2. Monitor shoulder/scapula with other hand 3. Guide pt's shoulder into Adduction 4. Repeat with other arm and compare Normal ROM is 40°

Shoulder ABduction

DO position: standing to side of patient Pt position: seated 1. Grasp pt's arm with one hand 2. Monitor shoulder/scapula with other hand 3. Turn pt's arm outward with palm facing up, and guide pt's shoulder into ABduction 4. Repeat with other arm and compare sides Normal ROM is 180°

•Medial Stability (Ankle)

Deltoid Ligament

ROM ankle

Dorsiflexion: (20o) Plantar Flexion (50o)

Shoulder Extension

Extension DO position: standing to side of patient Pt position: seated 1. Grasp pt's arm with one hand 2. Monitor pt's shoulder/scapula with other hand 3. Guide pt's shoulder into extension 4. Repeat with other arm and compare sides Normal ROM is 40°

Posterior pelvis rotation Head forward Lordosis is lost

Flatback

Elbow Motion Testing

Flexion - 0 ˚- 135 ˚+ Extension - 0 ˚- (-5˚) Pronation - 0˚- 90 ˚ Supination - 0 ˚- 90 ˚

Wrist ROM

Flexion 0˚- 80˚ Flexor Carpi Radialis Extension 0˚- 70˚ Prime Mover: ECRB Radial deviation 0˚- 25˚ Extensor Carpi Radialis Longus Ulnar deviation 0˚- 35˚ Flexor Carpi Ulnaris

ROM knee

Flexion/ Extension: (135o/ 0 to -10o) Internal/ External Rotation: (10o bilaterally)

Finklestein's test

Fold your thumb into palm and close a fist around the thumb, then ulnar deviate the wrist - positive test if there is pain on deviation

Skin Drag Test:

Increased drag: Fine film of moisture • Decreased drag- Excessive Moisture.

Increased lordosis Increased kyphosis Anterior pelvis rotation Head forward

Kypholordosis

what level is the iliac crest

L4

Anterior pelvis rotation Head back

Military

LACHMAN TEST

More specific test of ACL than drawer test. •Pt is supine, knee flexed to 30 degrees, tibia pulled anterior while femur pushed posterior •Positive = Excessive motion of the tibia

carrying angle

Normal: Males 3˚-5˚ Females 10˚-15˚

scoliosis degrees

Normal: No curve, Mild:5-15 º, Moderate: 20-45º, Severe:>50º

Finger Motion Testing

PIP Flexion 0˚-100˚ Extension 0˚ DIP Flexion 0˚-90˚ Extension 0˚-(-20˚) MCP Flexion - 0˚-90˚ Extension - 0˚-(30˚- 45˚) Abduction - 0˚-20˚ Adduction - 0˚

Thumb Motion Testing

Palmar abduction 0˚- 70˚ MCP Flexion - 0˚- 50˚ Flexion - 0˚- 90˚ IP Extension - 0˚ Extension - 0˚- 20˚

Left scoliosis/levoscoliosis Right scoliosis/dextroscoliosis

RLSR

Scapular Protraction (reaching)

Serratus anterior long thoracic nerve C5, C6, C7 + test = Medial Scapular Winging Indicates weakness/palsy of Serratus anterior

ROM Foot

Subtalar: Inversion (5o) Eversion (5o) Midtarsal: Forefoot ADDuction (20o) Forefoot ABDuction (10o) First MTP: Flexion (45o) Extension (70-90o)

Posterior pelvis rotation Head forward Decreased lordosis

Swayback

what angle is spine of scapula

T3

what level is the inf angle of scapula

T7

how to test freyette lumbar for flexion and extension

TV position curl into a ball

Tinel's Test at the Elbow

Tapping to the notch between the olecranon and the medial epicondyle may elicit pain locally and especially along the medial forearm into the 4th and 5th digits.

Medial Epicondylitis (Golfer's elbow)

Test: Start with forearm supinated and flat on table Make a fist with a flexed wrist Patient resists extension force from physician Inflammation shows as pain at median epicondyle

APLEY GRIND TEST

Tests Medial and Lateral Meniscal Intergrity •Pt prone, knees flexed to 90º, gently kneel on thigh to stabilize. •DO pushes down to table while internally and externally rotating leg. •Positive = Pain in one of the movements above. •Distraction Test - distinguishes ligament vs meniscal pathology.

VALGUS TEST

Valgus Stress: •Pt's knee slightly flexed •DO applies valgus stress to open knee joint on medial side •Postive test: gapping of joint * Test integrity of MEDIAL collateral ligaments

VARUS TEST

Varus Stress: •Pt's knee slightly flexed •DO applies varus stress to open knee on lateral side •Postive test: gapping of joint * Test integrity of LATERAL collateral ligaments

test for MCL and LCL

Varus and Valgus Testing

name scoliosis based on

apex of curve

hip ROM

extension 0-30 flexion 0-90/120-135 AB 0-50/0-75 AD 0-30 IR 0-35 ER 0-45

functional scoliosis

goes away when bent to a side

Thomas Test:

iliopsoas · Patient supine with knees at the end of the table, physician stands at side of table · Ask patient to bring both legs up to chest and secure with arms, then to drop one leg · Place hand face up under lumbar spine to make sure there is no gap in their lumbar region and the table. · Assess the space beneath straightened leg · Compare both sides · Normal: Leg should be flat to the table, if not, the test is positive for a flexion contracture of the hip flexors. Any space underneath shows restriction (e.g. Flexion 35° from table)

where do you put your fingers when checking the PSIS

on the inferior slopes

parallel or perpendicular: Thoracic/Lumbar Bilateral Thumb Pressure Prone

parallel

medial malleoli level

place thumbs on inferior surface of medial malleoli apply slight tractions

point to your Ø Humerus o head of humerus o medial and lateral humeral epicondyles Ø ulna o olecranon of the ulna o styloid process of the ulna Ø radius o radial head o styloid process of the radius Ø hand o carpals o metacarpals o phalanges

radius - pinky ulna - thumb

point to your Ø scapula o borders of scapula o inferior angle scapula o spine of scapula Ø acromion process Ø clavicles Ø acromioclavicular (AC) joint Ø coracoid processes Ø glenohumeral joint

spine T3 inf angle T7

Apley scratch test

· Patient seated, physician standing · Patient reaches across chest and over shoulder to touch opposite scapula (internal rotation, adduction) · Reaches behind head to touch opposite scapula (external rotation, abduction) · Reaches behind back to touch opposite scapula (internal rotation, adduction)

Hawkins Test

· Patient seated, physician standing · Physician flexes patient's shoulder and elbow 90° · Physician internally rotates shoulder making sure it remains straight · Positive sign if pain upon int. rotation (indicates shoulder impingement)

a. Thoracic - Paraspinal self-stretch

· Patient sitting with feet apart. · Patient wraps/ intertwines their hands and arms and bends forward. · Hold and repeat.

a. Cervical - Levator scapula self-stretch

· Patient sitting with hand on side to be treated holding the chair. · Patient leans trunk away for stretch. The contact hand does not pull the head and neck. · Patient flexes, side bends, and rotates the head away and supports the head position with the other hand. · The stretch can be enhanced by a contraction of the lower trapezius muscle on the same side. · The stretch is held for 10-15 seconds and repeated three to five times with increasing side bending away each time.

Apprehension Test

· Patient standing, physician stands at side · Physician places hand closest to patient under the head of the humerus, and other hand holds patient's wrist · Patient's arm bent 90° and physician applies gentle anterior pressure to the head of the humerus and attempts to externally rotate the arm while monitoring patient's face · Positive sign if patient shows "apprehension" to this motion + test = sensation of impending dislocation Indicates shoulder instability

a. Lumbar- Quadratus lumborum self-stretch

· Patient stands with the arm of the involved side stretched overhead. · Patient laterally translates the pelvis toward the involved side as the trunk is side bent away from the involved side. · The position is sustained for 15-30 seconds and repeated two to three times. · The opposite side is stretched to symmetry.

Yergason Test

· Shake hands with your patient while you monitor at the bicipital groove · Have patient supinate their hand against your resistance, will feel the bicipital tendon "click" out of place •+ test = "snap" or pain in biciptal groove •Is diagnostic for bicipital tendonitis

Thoracic rotation T9-12/lumbar active/passive:

· The patient is seated with the arms crossed so that the elbows make a V formation. · Physician stands at the side of the patient and palpates the patient's transverse process of T12 and L1 to monitor rotation. · The patient is instructed to rotate the upper body (trunk) to the right to the functional and pain-free limitation of motion. This is repeated to the left. · Passive is when the physician takes the patient further into rotation after relaxation. · Normal - 30-45o

Thoracic side bending: · T9-12 passive

· The patient is seated. · The physician stands behind the patient. · The physician's left hand may palpate the transverse process of T12 and L1 or the interspace between them to monitor motion. · The space between the physician's index finger and thumb is place on the patient's right shoulder at the AC region. · A gentle springing force is directed toward the vertebral body of T12 until the physician feels motion of T12 on L1. Create a vector with the forearm toward T12 body. Normal - 20-40o

Thoracic side bending: · T5-8 passive

· The patient is seated. · The physician stands behind the patient. · The physician's left hand palpates the transverse process of T8 and T9 or the interspace between them to monitor motion. · The webbing between the physician's index finger and thumb is placed ½ between the base of the neck and the acromion process · A gentle springing force is directed toward the vertebral body of T8 until the physician feels motion of T8 on T9. Vector is from forearm to T8. Repeat on both sides. Normal - 10-30o

Thoracic spine side bending: · T1-4 passive

· The patient is seated. · The physician stands behind the patient. · The physician's left index finger or thumb may palpate the transverse process of T4 and T5 or the interspace between them to monitor motion. · The webbing between the physician's right index finger and thumb is placed on the patient's right shoulder closest to midline at the level of T1. · The degree of passive side bending is noted on each side - normal is 5-25o

Lumbar side bending passive with active (Hip Drop Test):

· The patient stands in a neutral position, feet shoulder width apart. · Physician stands behind the patient to view the coronal plane; eyes at the level of the lumbar spine. · The patient attempts to maintain symmetric weight bearing on both legs and the quickly flexes the right knee, causing a right sacral base declination, hence causing the pelvis to compensate with a lateral translation to the left. · Repeat on the opposite side. · Note the degree of passive side bending. Normal - 25-30o

point to your Lumbar Spine and Abdomen Ø L1-5 Ø Iliolumbar ligament Ø Lumbosacral junction Ø Waist creases Innominates Ø Iliac crests Anterior superior iliac spine (ASIS) Ø Anterior inferior iliac spine (AIIS) Ø Pubic tubercles Ø Posterior superior iliac spine (PSIS) Ø Ischial tuberosities Sacrum-coccyx Ø Sacral base Ø Sacral sulci Ø Inferior lateral angles (ILAs) Ø Sacral apex Ø Coccyx Ø Gluteal lines

Ø Iliac crests (L4)

Red Reflex:

• Run fingers down back on either of spinous process. • Skin turns red and returns to original color. Acute Dysfunction- Red Chronic- Skin blanches

Galeazzi Test

•A & B - Tests for true leg length discrepancy •Pt. bends knees 90o and places feet flat on table with heels even •View knees anteriorly and laterally (both sides) for discrepancy •A higher knee indicates a longer tibia(A) •An anterior knee indicates a longer femur(B)

KNEE DIAGNOSTIC TESTS

•A/P DRAWER TEST •LACHMAN'S TEST •VALGUS / VARUS TEST •McMURRY'S TEST •APLEY GRIND TEST •BOUNCE HOME •PATELLAR GRIND TEST •PATELLA FEMORAL GRINDING (APPREHENSION) TEST

Trendelenburg Test:

•Evaluates gluteus medius •With pt. standing, observe PSIS dimples and pelvic height •Ask pt. to raise one leg and observe dimples/pelvis •A drop in height on the side of the lifted leg indicates a positive test for a weak gluteus medius of the stance leg

Patrick Test (FABERE)

•Pt. in supine position •Have pt. cross foot over opposite thigh •Doc applies stabilizing pressure at ASIS on side of extended leg •Doc then applies a force at the bent knee, toward the table while still stabilizing at ASIS •Pain in hip or sacroiliac joint is a positive test and indicates dysfunction at either site

Ober Test:

•Tests for contracture of iliotibial band •Have pt. lay on side with involved leg upward •Abduct leg to full ROM and flex knee to 90o, while keeping hip joint in neutral position •Release abducted leg •A negative test is indicated by the leg adducting back to starting position with little delay •A positive test is indicated by the leg remaining in the abducted position