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Physical Exam Test MSK

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hizeyuwi's version from 2017-05-28 20:19

Special Testing

Question Answer
Hawkins Impingement testrotator cuff impingement, arm at 90˚ abduction and internal rotation
Neer impingement testrotator cuff impingement, internal rotation with forward elevation of a straight arm with the scapula stabilized
Empty can testrotator cuff, resisted FE with arm in IR with pain/weakness, isolation of supraspinatus
Drop arm testrotator cuff, full forward elevation, told to drop and hold at 90˚, unable to hold indicative of supraspinatus tear
ER lag testrotator cuff, passive ER and told to hold arm, if arm falls back towards the body then positive, infraspinatus tear
Belly pressrotator cuff, elbow on belly and told to push elbows away from body. Pull hands away- if unable to do do then subscapularis tear
Lift-off testrotator cuff, hands behind the back in a diamond shape, push against resistance, if unable then positive. Subscapularis tear
Apprehension testshoulder instability, patient supine with arm at 90˚ abduction and external rotation, positive anterior instability if pain/fear dislocation. Press back alleviate pain means positive test
Sulcis signshoulder instability, positive if loose shoulder. hypermobility
Cross chest adductionpain is positive for AC joint pathology, arm to 90 degrees, adduction across body compresses AC joint
Internal rotation behind the backAC joint
Supination against resistancebiceps tendonitis
Speeds testbiceps tendonitis, pain in bicipital groove with resisted palms up (straight arms)
Lateral epicondyle tendernesstennis elbow
Medial epicondyle tendernessgolfers elbow
Resisted elbow flexionbiceps and bracioradialis
Resisted elbow extensiontriceps
Resisted supinationsupinator and biceps
Resisted pronationpronator teres and pronator quadratus
Resisted wrist extension with elbow extensiontennis elbow
Cubital tunnelsubluxation of ulnar nerve with flexion/extension of elbow, tinnel sign, worse symptoms with elbow flexion
Anatomic snuff boxscaphoid injury, EPL and EPB are the boarders
Resisted wrist extensionECBL and ECRB
Resisted wrist flexionFCR, FCU
Phalen’s testcarpal tunnel, wrist flexion for 60 seconds reproduce pain
Median nerve compression testdirect pressure on median nerve at wrist cause carpal tunnel symptoms
Tender at 1st dorsal compartmentpositive for Drquervains tenosynovitis
Finkelsteins testDrquervains tenosynovitis- thumb in palm with passive ulnar deviation of the wrist
DIP joint movementFDP, flexor tendon laceration
PIP joint movementFDS, flexor tendon laceration
Trigger fingerpain in distal palmar crease, lock and click with pressure on A1 tendon
Internal rotation of the hiphip flex at 90 and knee flex at 90- leg is facing out
External rotation of the hiphip flex at 90 and knee flex at 90- leg is facing in
Posterior hip dislocationshort leg, slightly flexed, ADDucted, internally rotated
Anterior hip dislocationshort leg, slightly flexed, ADBucted, externally rotated
Trendelenberg testweakness of hip abductor, stand on affected leg the pelvis dips down toward side where the foot was lifted
Antalgic gaitdecrease time and stance phase of effected limb
Faber testflexion/abduction and external rotation of the hip, pain at SI joint
MCL attachmentmedial epicondyle → tibia
LCL attachmentlateral epicondyle → tibia
Pes anserinusSartorius, gracilis, semitendinosis
Resisted knee extensiontest quadriceps
Resisted knee flexiontest hamstrings
Valgus stress testtest MCL- stabilizes the femur with knee at both O and 30 degrees- push the lower leg laterally
Varus stress testtest LCL- stabilizes the femur with knee at both O and 30 degrees- push the lower leg medially
Lachmans testtest ACL with knee at 30˚, anterior drawer (stabilize thigh and pull leg forward)
Anterior drawer testtest ACL with knee at 90˚, stabilize thigh and pull leg forward
Posterior drawer testtest PCL with knee at 90˚, stabilize thigh and push leg back. Positive with > 1cm step off
Joint line tendernessmeniscus testing with knee at 90˚
McMurray’smeniscus testing, pain/click with appropriate test. Medial meniscus test with internal rotation and valgus load. Lateral meniscus test with external rotation and varus laod.
Patella ballottementcheck for effusion of knee joint.
Straight leg raiseextension mechanism. Active knee extension test. Tension on the siatic nerve when between 30-70 degrees → L5 if top of the foot effected, S1 if butt, posterior/lateral thigh and calf effected
Patellar apprehension testMPFL tear, lateral pressure on patella cause apprehension (fear of dislocation)
Pes planusflat foot. Appear with valgus heel
High archappear with varus heel
Dorsiflexionupward motion (toes to your nose)
Plantar flexiondownward (petal to the metal)
Resisted dorsiflexiontibialis anterior
Resisted plantar flexionachillies tendon
Resisted eversionperoneal test
Resisted inversionposterior tibialis
Resisted toe flexionFHL
Resisted toe extensionEHL
Ankle anterior drawerfor ankle sprain, test the anterior talofibular ligament (ATFL)
Thompson testAchilles tendon disruption, squeeze the calf should elicit plantar flexion of the foot
Claw/hammer toecheck flexibility, active ROM
Hoffman signflick the DIP joint of the middle finger. Response is UMN sign
Spurlings testturning the patient's head to the affected side and applying downward pressure to the top of the patient's head, positive if leads to radicular pain
Babinksi signUMN finding if the big toe goes up
Leg lengthASIS to medial malleolus
Neuro-meningea tension signirritability to nerve roots/spinal cord, head extended, rotated and lateral bending
Reverse straight leg raiselay on the stomach and extend the hip with knee at 90 degrees. Tension on femoral nerve ie L2-L4 (anterior hip)
Schober Testtest for Ankylosing spondylitis, limited lower lumbar ROM with forward bending
memorize

Spinal Cord

Question Answer
diaphragmC4
resisted adbuction (detoid) and bicepsC5
wrist extensors (ECRB and ECRL)C6
wrist flexor IFCR) and TricepsC7
finger flexors (FDS and FDP), interosseiC8
intrinsic muscles of the handT1
seat resisted hip flexionL2/3
tibialis anterior (ankle dorsiflexion)L4
resisted big tow extension (EHL)L5
resisted plantar flexion, toe walkingS1
memorize

Nerve action

Question Answer
wrist extensionradial n
adbuction and adduction of fingersulnar n
thumb oppositionmedian n
deltoid muscleaxillary n
biceps musclemusculocutaneous n
tibilis anterior, EDL, peroneal tertius, EHLDeep peroneal n
Fibularis longus and fubularis brevis (peroneal)superficial peroneal/fibular n
tibialis posterior, FDL, HFL, gastrocnemius, soleustibial n
memorize

Dermatomes

Question Answer
upper lateral armC5
radial forearm, thumb and index fingerC6
middle fingerC7
ulnar forearm, ring and pinky fingerC8
anterior thighL1-L3
medial calfL4
lateral calfL5
posterior calf, plantar calf, lateral footS1
memorize

Sensory

Question Answer
tumb webspaceradial n
little fingerulnar n
index fingermedian n
lateral armaxillary n
lateral forearmmusculocutanous
lateral and dorsal footsuperficial peroneal (fibular) n in the lateral compartment
1st webspace of the footdeep peroneal (fibular) n in the anterior compartment
sole of the foottibial n
memorize

Reflex

Question Answer
BicepsC5
BracioradialisC6
TricepsC7
Patellar tendonL4
Achilles tendonS1
memorize

Other PE things to know

Question Answer
Order to examhistory, inspection, palpation, ROM (active than passive), strength, special
Swellingfracture, acute tendon tear, soft tissue and muscle injury, infection, bursitis, effusions
Ecchymosisfracture or acute tendon tear, soft tissue and muscle injury/tear. Heaving bleeding
Erythemainjection (cellulitis, bursitis, joint infection)
Atrophychronic disuse, chronic tendon tear, neurogenic cause (nerve palsy, spinal/disk disease, neurogenic)
Localized painstructural abnormality such as arthritis
Diffuse painacute with swelling or chronic due to irritated tissue, infection, nonunion
AROM limitedpain, tendon disruption, neurologic
PROM limitedmechanical block to motion, degernative joint disease, dislocation, fracture into joint, large effusion, old malunion, frozen joint
Limit strengthpain, disuse, neurologic conditions, tendon disruption
memorize