Orthopedic Tests

Always:

Name Test Report Findings Indication

Cervical Spine 1) Vertebrobasilar artery insufficiency a) Vertebrobasilar Artery Functional Maneuver pp. 154 1) Patient seated (1) Auscultate carotid and subclavian arteries for pulsations and/or bruits (a) Positive  report findings  indication of VBAI (b) Negative  (2) Rotate and hyperextend patient’s head to one side (Maigne’s Position) approx 30 seconds per side (a) Use finger for patient to focus on and ask patient: (i) Dizziness (ii) Nausea (iii)Numbness (iv)or Double Vision? (b) Please Swallow  dysphagia (c) Look for: (i) Dysarthria (difficulty speaking) (ii) Drop Attacks (iii)Nystagmus (iv)Ataxia (d) Positive  report findings  indication of VBAI  confirmation tests (e) Negative  repeat on other side b) Hautant’s pp. 102 1) Patient seated (1) Ask patient if they can hold arms out for a couple of minutes (2) Have patient hold arms out in front of them with palms up and close their eyes (a) Put patient in Maigne’s Position to one side – 30 seconds – and ask: (i) Dizziness (ii) Nausea (iii)or Numbness (b) Please Swallow  dysphagia (c) Look for: (i) Dysarthria (difficulty speaking) (ii) Drop Attacks (iii)Ataxia

(d) Positive  report findings  indication of VBAI  confirmation tests (e) Negative  repeat on other side c) Underburg’s pp. 146 1) Patient standing (1) Ask patient if they can hold arms out for a couple of minutes (2) Have patient hold arms out in front of them with palms up and close their eyes while they march in place (a) Put patient in Maigne’s Position to one side – 30 seconds – and ask: (i) Dizziness (ii) Nausea (iii)or Numbness (b) Please Swallow  dysphagia (c) Look for: (i) Dysarthria (difficulty speaking) (ii) Drop Attacks (iii)Ataxia (d) Positive  report findings  indication of VBAI  confirmation tests (e) Negative  repeat on other side d) Barre-Lieou pp. 76 1) Patient seated (1) Ask patient to slowly rotate head from side to side and ask: (i) Dizziness (ii) Nausea (iii)Numbness (iv)or Double Vision? (b) Please Swallow  dysphagia (c) Look for: (i) Dysarthria (difficulty speaking) (ii) Drop Attacks (iii)Nystagmus (iv)Ataxia (d) Positive  report findings  indication of VBAI  confirmation tests (e) Negative  repeat on other side e) Hallpike pp. 98 1) Patient lying supine w/ head extending off the end of the examination table (a) Put patient in Maigne’s Position to one side – 30 seconds – and ask: (i) Dizziness

(b) (c)

(d) (e)

(ii) Nausea (iii)Numbness (iv)or Double Vision? Please Swallow  dysphagia Look for: (i) Dysarthria (difficulty speaking) (ii) Drop Attacks (iii)Nystagmus (iv)Ataxia Positive  report findings  indication of VBAI  confirmation tests Negative  repeat on other side

f) DeKleyn’s pp. 86 1) Patient in supine position w/ head off end of table (a) Put patient in Maigne’s Position to one side – 30 seconds – and ask: (i) Dizziness (ii) Nausea (iii)Numbness (iv)or Double Vision? (b) Please Swallow  dysphagia (c) Look for: (i) Dysarthria (difficulty speaking) (ii) Drop Attacks (iii)Nystagmus (iv)Ataxia (d) Positive  report findings  indication of VBAI (e) Negative  repeat on other side 2) Fracture a) Spinal Percussion pp. 137 1) With patient seated, support the head and flex cervical spine exposing spinous processes as much as possible (1) Percuss spinous processes (a) Positive findings (i) Localized pain  Fracture or severe sprain (ii) Radiating pain  IVD syndrome (2) Percuss paravertebral soft tissues (a) Positive findings (i) Pain  muscular strain & highly sensitive myofascial trigger points b) Rust’s Sign pp. 128 1) Patient presents w/ markedly splinted cervical spine and holds weight of head w/ both hands. Patient cannot tolerate pain of

removing hands. The most significant sign of a patient w/ a cervical spine fx. (1)  gross instability of upper cervical spine d/t fracture, severe sprain, RA, or severe cervical subluxation (2) Patient cannot rise from supine position w/o lifting head w/ hands (a)  gross instability of upper cervical spine d/t fracture, severe sprain, RA, or severe cervical subluxation 3) Spinal Myelopathy – should present bilaterally a) Dejerine’s Sign pp. 83 1) Coughing, sneezing, or straining during defecation aggravates radiculitis symptoms. A triad of conditions. 2) Demonstrate and have patient: (1) Sneeze  upper T’s and C’s (2) Cough  mid T’s (3) Bear down in a crunch  lumbar (a) Indicates a space-occupying lesion obstructing spinal fluid flow (i) Herniated or protruding IVD (ii) Spinal cord tumor (iii)Spinal compression fracture b) Valsalva Maneuver pp. 150 1) Last part of Dejerine’s 2) Patient is seated w/ arms flexed at elbows (1) Instruct patient to take a deep breath and hold it while bearing down abdominally (a) Positive  radicular pain (b) Indication  space-occupying lesion compressing nerve root (herniated disc, tumor, osteophytes) c) Naffzinger’s pp. 118 1) This is a dangerous maneuver 2) Patient is seated (1) Occlude jugular veins bilaterally for 30 to 40 seconds (2) Have patient cough deeply (a) Positive  radicular pain  nerve root compression (b) Positive  local pain  site of sprain or strain (c) Always positive in presence of cord tumors, especially spinal meningiomas d) Lhermitte’s pp. 112 1) Patient is seated (1) Passively flex the head and neck

(a) Positive  sharp, radiating pain or parathesia along the spine & into one or more extremeties  dural irritation (myelopathy) 4) Neuropathy a) Distraction pp. 88 – assessment for cervical nerve root compression, IVF encroachment, & facet capsulitis 1) With patient seated, have them lean back against your chest 2) Cup the base of occiput w/ both hands and lift up – 30 seconds (1) Positive  relief of localized or radicular pain (2) Confirmed if symptoms return when weight of head is returned to neck b) Maximum Cervical Compression pp. 114 – assessment for cervical nerve root syndrome or facet syndrome (concave testing) and cervical muscular strain (convex testing) 1) With patient seated, place the head in Maigne’s position – 30 seconds (1) Positive  pain on concave side  nerve root or facet syndrome (2) Positive  pain on convex side  MM strain c) Foraminal Compression pp. 94 – assessment for cervical nerve root encroachment 1) With patient seated: (1) Apply compression w/ head in neutral position (2 seconds) (2) Apply compression w/ head rotated left, then right (a) Positive  localized pain  IVF encroachment (b) Positive  radicular pain  pressure on nerve root d) Jackson Compression pp. 106 – assessment for cervical nerve root compression resulting from a space-occupying lesion, subluxation, inflammatory edema, exostosis of DJD, tumor, or IVD herniation 1) With patient seated, laterally flex head and apply axial compression (1) Positive  localized pain radiating down the arm e) Spurling’s pp 138 – assessment for cervical nerve root compression syndrome 1) With patient seated, this can be added to any passive compression test. 2) During passive compression, release one hand and use it to pound quickly on top of the hand still applying compression (1) Positive  localized or radicular pain d/t nerve root compression

f) Bakody, Reverse Bakody Maneuver pp. 70 – assessment for cervical nerve root compression 1) With patient in seated position, have them abduct the afflicted arm and place their hand on top of their head – 30 seconds (1) Positive  relief of radicular pain g) Bikele’s Sign pp. 78 – assessment for brachial plexus neuritis and meningitis 1) With patient seated, have them abduct arm and attempt to reach behind them, stopping them when the trunk begins to rotate (1) Positive  radicular pain h) Shoulder Depression pp. 120 – assessment for cervical muscular strain (isometric) and cervical ligamentous sprain (passive range of motion) 1) With patient seated, passively flex the head to one side and hold there, then depress the opposite shoulder (1) Positive  5) Muscular / Ligamentous Lesion a) O’Donoghue Maneuver pp 120  KNOW IT WELL!! Can be used at most any ligamentous joint / region in the body. 1) With patient seated, examiner holds pt. head in neutral position while pt. attempts to rotate against isometric resistence. (1) Positive  muscle strain (SCM, scalenes, sub-occipital group) 2) Examiner rotates head to comfortable end range plus a little more (1) Positive  ligament or incidental finding of a tight muscle 6) Meningeal Irritation a) Soto-Hall Sign pp 132 1) Place patient in supine position on examining table with legs fully extended and arms placed on chest. 2) Examiner supports pt. head w/ one hand while stabilizing patient’s chest/hands w/ the other hand. 3) Passively flex the neck while keeping the shoulders against the table. (1) Positive shooting pain down the spine  meningitis (febrile, flu-like symptoms, stiff, achey, etc.) (2) Positive  reflex flexion of knees or twitch of quads  meningitis (Bradzinski response) SHOULDER 1) Subclavian artery occlusion a) George’s Screening Procedure pp 230 – a barrage screening, not a VBAI screening

1) With patient seated, auscultate the subclavian arteries bilaterally 2) Assess the character (amplitude) of the radial pulse bilaterally 3) Take blood pressure bilaterally (1) Positive  difference of 10mm Hg or more between systolic  possible subclavian artery occlusion or distal artery occlusion 2) Localized unspecified pathologic process a) Mazion’s Shoulder Maneuver pp 242 1) With patient seated, have patient place hand of symptomatic shoulder on opposite shoulder and raise elbow unassisted (1) Positive  localize pain  whatever is there 3) Rotator cuff tear/tendonitis – typically the smaller muscle in an area is the one that will show pain a) Supraspinatus Press pp 258 – m/c injured rotator cuff M 1) With patient seated, have him hold arm straight out while you push down proximal to elbow at least 5 seconds (1) Positive  failure or pain near insertion b) Apley’s Scratch pp 200 – a range of motion assessment 1) With patient seated, have him reach over the shoulder and opposite from bottom reaching toward each other 2) Count out the vertebrae (ie. Superior T2 left and inferior T10 right) (1) Normal  T4 to T8 – mid-thoracics c) Codman’s Sign pp 214 – AKA: Drop arm test 1) With patient seated, hold their arm up in the air and drop it asking them to stop it before it hits the table d) Impingement Sign pp 236 1) With patient seated, pronate the arm then passively elevate the arm w/o touching the shoulder (1) Positive  early engagement of shoulder prior to 120 degrees  torn supraspinatus tendon 4) Transverse humeral ligament tear / Bicipital tendonitis THL leads to Bicipital Tendonitis a) Abbott-Saunders Test 1) With patient in seated position, palpate and find the bicipital groove 2) With a light contact on the biciptial groove, pronate and abduct the arm as high as possible, then supinate and adduct the arm. Make sure the humerus rotates during pronation and supination. (1) Positive  feel the bicipital tendon snap out of the groove  transverse humeral ligament tear leading to bicipital tendonitis if unilateral and symptomatic

b) Transverse Humeral Ligament Test 1) With patient in seated position, palpate and find the bicipital groove 2) Abduct the arm and let the forearm hang, then rotate the forearm up and down (1) Positive  feel the bicipital tendon snap out of the groove  transverse humeral ligament tear leading to bicipital tendonitis if unilateral and symptomatic c) Speed’s Test – Bicipital Tendonitis 1) With the patient seated, begin with the arm adducted, elbow flexed to 90 degrees, and pronated. 2) Have the patient push out against resistance while supinating their forearm – block @ elbow and hold just proximal to wrist (1) Positive  pain @ shoulder and inability to perform the test might indicate bicipital tendonitis. If they can perform the test, it rules out Bicipital Tendonitis d) Yergason’s (normally combine w/ Speed’s) – Bicipital Tendonitis 1) With the patient seated, begin with the arm adducted, shoulder flexed to 90 degrees, and pronated. 2) Using wrestler’s grip, have patient flex elbow bringing hand to shoulder while (1) Positive  pain @ shoulder and inability to perform the test might indicate bicipital tendonitis. If they can perform the test, it rules out Bicipital Tendonitis (2) If the pain is more in Speed’s than Yergason’s with both tests positive, THL is intact or BT is at least relocating to the groove when it is being put under pressure. (3) If Yergason’s is more painful than Speed’s, then the THL is torn and the bicipital tendon is not relocating to the groove when it is being put under pressure. 5) Bursitis a) Dawbarn’s Sign 1) With the patient seated, palpate and locate the acromion. 2) Palpate distal to the acromion anterior, lateral, and posterior for tenderness. 3) No tenderness  test is over. 4) If tenderness is found, maintain a pressure and abduct the arm (1) Positive  pain goes away or decreases drasticall  possible bursitis. 6) Dislocation a) Bryant’s Sign

1) With the patient seated, look for an axillary fold to be inferior on one side b) Sulcus Sign 1) With the patient seated, the anterior roundness of the shoulder will be replaced by a sulcus. c) Calloway’s Test 1) With the patient seated, take measurements around the axillary fold vertically about ½” inside of the acromion and compare the sides. (1) Positive  increase of 10cm or more on one side  dislocation d) Hamilton’s Test 1) With the patient seated, place a straight edge against the lateral epicondyle and see if it can also touch the lateral edge of the acromion. e) Dugas’ Test 1) With the patient seated, have the patient put their hand on the opposite shoulder. 2) The examiner presses the elbow toward the sternum while the patient maintains the contact with the shoulder f) Apprehension – for propensity to dislocate 1) With the patient seated, abduct the arm to 90 degrees and flex the elbow vertically to 90 degrees 2) Place the other hand on the scapula and pull back on the wrist just before paraphysiological endplay (1) Positive  patient exhibits pain or stops you or muscles tighten up guarding the shoulder  unstable shoulder 7) Thoracic Outlet Syndrome a) Reverse Bakody 1) With patient in seated position, have them place one hand on their head b) Costoclavicular Maneuver – Checks All 3 Thoracic Outlets 1) With the patient seated, take radial pulse in one arm with arm in lap 2) Repeat with arm extended backward with head flexed 3) Repeat on other side (1) Positive  decrease or absence in pulse amplitude or reproduction of pain symptoms  implication of TOS

c) Halstead Maneuver – Checks All 3 thoracic Outlets 1) With the patient seated, take radial pulse in one arm with arm in lap 2) Repeat with arm flexed and tractioned forward with head extended 3) Repeat on other side (1) Positive  decrease or absence in pulse amplitude or reproduction of pain symptoms  implication of TOS d) Adson’s, Modified Adson’s 1) With patient in seated position, take radial pulse while standing on the ipsilateral side of the patient (1) Have patient look toward you and extend head back (Maigne’s) (2) Have patient take a deep breath and hold it (3) Begin assessing pulse after deep breath (a) Positive  decrease or absence in pulse amplitude or reproduction of pain symptoms  implication of medial TOS (4) For Modified Adson’s  have patient turn their head the other way e) Wright’s (AKA: Hyperabduction maneuver) 1) With the patient seated, slightly abduct the arm while checking the radial pulse 2) Elevate the arm very, very slowly (1) Should loose about 50% between 90 and 120 degrees (2) Positive  sudden loss of pulse  possible TOS f) Allen Maneuver 1) With the patient seated, raise the arm to 90 degrees with elbow flexed to 90 degrees. Assess radial pulse and have patient turn head away. (1) Positive  decreased pulse when patient turns away  possible Medial TOS g) Shoulder compression 1) With the patient in the seated position, find the coracoid process and place hand over that area. Block the scapula with the other hand and compress down on the should (1) Positive  pain  Lateral TOS h) Roos’ – Never Start w/ this if you suspect TOS, good screening tool – very low false negatives 1) With the patient seated, put both his arms at 90/90 and have him open and close hands for 3 minutes (1) Pain, cramping, ischemia  TOS

Unit 2 – 6 lectures, 39 orthopedic tests and signs. Orthopedic evaluation of the elbow; forearm, wrist, and hand; and thoracic spine. Presented by region, then condition, then tests and signs. The practical lab exams are scheduled as follows: LAB A - Tuesday, Oct 24th, 2006, 9:00 - LB-2. LAB B – Wednesday, Oct 25th, 2006, 10:00 – R207 ELBOW 1) EPICONDYLITIS a. Kaplan’s Sign (lateral epicondylitis / Tennis elbow) i. Pt. seated ii. Have the pt grab your forearm and squeeze and relax iii. Then grip their forearm below the lateral epicondyle and have them squeeze your forearm again iv. Increased grip strength  lateral epicondylitis 1. Pain is incidental finding A) Mills’ Test (lateral epicondylitis) a. Looking for PAIN response at lateral epicondyle b. Pt. seated c. Start with pt. elbow flexed (in curl position) then max flex their wrist and internally rotate the wrist to maximum. Finally lockout their elbow. d. Make sure you don’t touch their epicondyle region b/c you might get premature pain B) Cozen’s Test a. Pt. seated b. Place pt. arm in supination with wrist in extension c. Dr. tries to flex the wrist as the patient resists d. Looking for PAIN at lateral epicondyle e. Hold position for 5 secs C) Golfer’s Elbow Test a. PT. seated with arm supinated and wrist is in flexion b. Dr. tries to passively extend the wrist c. Looking for pain at the medial epicondlye d. Hold position for 5 secs 8) LIGAMENTOUS INSTABILITY A) Ligamentous instability 1. testing medial and lateral collateral ligaments 2. pt. is seated with arm extended (almost max) in supination 3. Dr. stress the elbow joint in varus and valgus direction

4. feeling for ligamentous laxity (greater than 0 degrees) 5. pain is an incidental finding 3) NEUROPATHY B) Tinel’s sign 1. Seated 2. Dr. raises the pt. arm to a 90 degree angle 3. Using a hammer tap around the ulnar nerve until you get an ulnar reflex (jumping of the arm) 4. Then you tap around the lateral epicondyle looking for a radial nerve response. You are actually hitting a radial nerve branch. Have to swing the hammer harder than ulnar nerve test 5. Looking for an extreme pain that lasts a good time after test 6. (+) test- neuropathy of that nerve C) Elbow flexion 1. Seated with arm fully flexed actively squeezing that bicep 2. Hold for 30 secs 3. Ask the pt if they have any type of PAIN, NUMBNESS, TINGLING 4. (+) test equals ulnar nerve problems FOREARM, WRIST, AND HAND 1. VASCULAR OBSTRUCTION a. Allen’s test i. Pt. seated with arm supinated ii. DR. occludes the radial and ulnar arteries looking for blanching followed by redness when you release the arteries iii. Ask pt. to make a fist when you occlude the arteries iv. Looking for how fast the hand becomes red again v. 5 seconds is normal time for the hand to turn red again vi. Pain, tingling is secondary findings vii. Cold hands and numbness is a positive finding though b/c it does indicate vascular insuffiency 2. LOCALIZED UNSPECIFIC PATHOLOGIC PROCESS a. Wringing i. Ask the patient to wring a cloth in both directions ii. Used to localize a wrist pain iii. Non-specific test iv. Need to ID a carpal bone that is in the area of the pain

3. OSTEOPATHY a. Finsterer’s i. Pt. seated ii. Bend the phalangies to make the metacarpophangeal joint taught iii. Hit the metacarpophangeal joint iv. Looking for pain in wrist as you strike the MP joint v. Pain in the carpals is a positive test. Pain in the Metacarpals would also make it a positive test 4. INFECTIOUS / INFLAMMATORY a. Cascade i. Overlapping of the phalanges= (+) test ii. Ask the pt. place the finger flat on the palms but not in a fist. Looking to see if the fingers line up straight iii. If the fingers overlap it is a positive test indicating Rheumatoid arthritis b. Bunnel-Littler i. Testing PIP joint using the MC joint ii. If the PIP joint extends when you extend the MC joint move on to the test iii. Push the MC joint back and then flex the PIP if it flexes easily it’s a negative test iv. If positive you then flex the MC joint then you try to flex the PIP again if it flexes easier than in step 2 this is a positive test v. Tight capsule- the finger remains tight in both positions vi. Testing interossii muscles vii. If PIP flex easier in second part of test= interossius mm. tightness c. Bracelet i. Elevate the pt.s arm and squeeze the pt’s. wrist and look for elongation of the wrist ii. Looking for pain and lose of elasticity of the wrist (the wrist is not elongating) iii. Pain= (+) test for arthritis 5. MUSCULAR / LIGAMENTOUS a. Test for Tight Retinacular Ligament i. Testing DIP ii. Force PIP in full extension and see what happens with DIP iii. PIP in extension then you try to flex the DIP iv. If tight DIP throughout the test= tight capsule

v. If loser in one step than the other= retinacular ligaments vi. Report: have to describe exactly what is happening with each joint that you test b. Finkelsteins i. Testing for Dequervains disease (stenosing tenosynovitis AKA paratenonitis of the extensor pollicis longus tendons) ii. Ask the pt to tuck their thumb into their fist and passively ulnar deviate the wrist making sure to stress the wrist iii. Looking for extreme pain with minimal ulnar deviation of the wrist 1. Common to have false positives c. Carpal Lift i. Place the pt’s. hand flat on a hard surface and ask them to lift their fingers one at a time ii. Then you resist them as they try to raise their fingers one at a time. Looking for the tendons to pop up as they try to raise their fingers iii. Looking for carpal or metacarpal pain iv. Pain= (+) test 1. Need to identify the carpals d. Maisonneuve’s i. Extend the patients wrist and look for pain in the distal part of the wrist ii. If you go past 90 degrees with extreme pain it indicates a radius Fx (collies fx) 6. NEUROPATHY OR PALSY a. Froment’s Paper i. Pt seated ii. Pull paper from between adducted fingers keeping fingers level iii. No resistance  Ulnar nerve neuropathy b. Wartenberg’s i. Have pt squeeze a ball or your arm ii. Look for use of 5th digit iii. Lack of 5th digit  ulnar nerve neuropathy c. Pinch Grip i. Have pt pinch 1st and 2nd tips together hard ii. Test by pulling them apart

iii. Lack of strength or inability to perform with tips  neuropathy of the anterior interrosseous branch of the median nerve d. Phalen’s i. Have pt place dorsum of hands together and lower elbows until the wrists separate ii. Have pt push wrists back together iii. Numbness or paresthesia (quickly)  carpal tunnel syndrome e. Reverse Phalen’s i. Have pt place palms of hands together and raise elbows until the wrists separate ii. Have pt push wrists back together iii. Numbness or paresthesia (quickly)  carpal tunnel syndrome f. Tinel’s i. Percuss the median nerve ii. Severe or prolonged tingling or shooting pain  median nerve neuropathy g. Interphalangeal Neuroma i. Have pt make a fist ii. Roll a pen between the MCP’s iii. Pain  neuroma 1. Generally from repetitive trauma (boxing with taped hands) 2. Palpate for a nodule h. Shrivel i. Have pt soak hands in warm water for 30 minutes ii. Lack of pruning  denervation (acute – w/in 3 weeks) THORACIC SPINE A) SCOLIOSIS 1) Adams position i. Ask pt. to stretch out their arms and touch their palms ii. Ask pt. to bend over and you stand behind them to see the horizontal plane of the back

iii. Look very carefully at the horizontal plane of the back to see if there is any deviations in the spine as they slowly raise up iv. Mark the beginning and end of each rib hump noticed v. Diagnosis: describe the rib hump does it point to the right or left. The vertebral body points in the direction of the convexity of the hump. Name the scoliosis according to the convexity: Dextroscoliosis and levoscoliosis. Ex: T11 cephalad to, thru, and including T6 on the right - Dextroscoliosis B) ANKYLOSING SPONDYLITIS 1) Chest Expansion i. Pt. seated upright ii. Place the tape under the axillae iii. Cross the tape and read the tape in cm iv. Ask the patient to take a normal breath then exhale totally and measure and then totally inhale the difference in readings is the chest expansion v. Report in centimeters vi. No such thing as a normal range vii. This is just good for future reference has no real clinical application at the time that you take it 1. Dimenished from previous  ankylosing spondylitis 2) Amoss’s Sign i. Pt. lying prone then ask them to lay down and then sit up again ii. Looking to see if they have to bend in weird positions and use extremitites iii. Test for thoracic inflexibility 3) Foresteir’s Bowstring i. test for restriction of spine ii. place your hand on the pts. back and ask them to laterally flex and feel the muscles tension iii. the contralateral side should get tighter and ipsilateral side should become less tight iv. (+) test= ipsilateral side becomes tighter than contralateral side  ankylosing spondylitis C) INFECTIOS/INFLAMMATORY PROCESS 1) ***Anghelescu’s

i. Pt. lying down and ask them to do an opisthotons postion ii. Approximates a opisthotons position (pt. arched so that only the heels and back of shoulders touch the ground) iii. Tests for arthritis of the spine 2) Sponge i. Pt. lying prone ii. Wet a sponge or any device that creates moisture heat and move it down the back starting for the neck down. iii. You are looking for redness in back which indicates paraspinal musculature inflammation – be specific as to the muscles D) COSTAL FIXATION 1) Rib motion i. Pt. prone ii. Dr. places their fingers on the ribs and ask the pt. to take a deep breath and exhale. You are looking for a lack of movement in the ribs iii. The rib causing the problem will be the most superior rib during inhalation. In exhalation it will be the inferior most rib that is the one causing lack of motion in a group of ribs lacking motion. Also, possible ankylosing spondylitis. 2) Schepelmann’s i. Start off in ROOS postion ii. Have pt. laterally flex to both sides iii. Looking for pain on either side iv. Wrap around pain- intercostal neuritis usually on concave side of motion or possible rib fx v. Convex side pain- muscle issues its pain running along the length of the paraspinal muscles vi. Local pain to back- subluxtion vii. Pleurisy- deep, sheering, tearing pain on the convex side viii. Does not differentiate b/w pleurisy and intercostal neuritis. History will differentiate these two. E) MYELOPATHY 1) Valsalva maneuver 2) Dejerine’s 3) Beevor’s i. Have pt lie supine exposing the umbilicus ii. Have them do crunch followed by leg lift

1. Deviation of umbilicus to the side during crunch  myelopathy or neuropathy (T7 – T9) on opposite side. 2. deviation of umbilicus to the side during leg lift  myelopathy or neuropathy (T10 – T12) on opposite side. F) NEUROPATHY 1) First thoracic nerve root 2) Passive Scapular Approximation i. G) OSTEOPATHY 1) Spinal percussion 2) Sternal compression

Unit 3 – 5 lectures, 37 orthopedic tests and signs. Orthopedic evaluation of the lumbar spine. Presented by region, then condition, then tests and signs. The practical lab exam is scheduled as follows: LAB A - Tuesday, Nov 7th, 2006, 9:00 - LB-2. LAB B - Wednesday, Nov 8th, 2006, 10:00 – R207 Midterm written is scheduled for Tueday, Nov 7th, 2006 at 2:00 PM in L-206 (there is no midterm practical). 9) Lumbar Spine a) Spinal myelopathy 1) Valsalva Maneuver 2) Dejerine’s b) Fracture 1) Spinal Percussion c) Facet Syndrome 1) Kemp’s d) Meningeal Irritation 1) Kernig 2) Brudzinski e) Neuropathy 1) Antalgia 2) Vanzetti’s 3) Neri’s 4) Heel/Toe Walk 5) Minor’s 6) Lewin Punch 7) Lasegue Sitting 8) Deyerle’s 9) Bechterew’s Sitting 10)Lindner’s 11) Turyn’s 12)Straight-Leg-Raising 13)Cox 14)Sicard’s 15)Bragard’s 16)Bowstring 17)Fajersztajn’s Well-Leg-Raise 18)Millgram’s 19)Lasegue Rebound 20)Nachlas 21)Ely’s 22)Prone Knee-Bending 23)Hyperextension 24)Femoral Nerve Traction 25)Matchstick

f) Lumbar/Sacroiliac/Hip differential 1) Quick 2) Bilateral Leg-Lowering 3) Bilateral Leg-Raise 4) Lasegue Differential 5) Sign of the Buttock g) Malingering 1) Flip Unit 4 – 5 lectures, 31 orthopedic tests and signs. Orthopedic evaluation of the cervical spine and shoulder. Presented by region, then condition, then tests and signs. The practical lab exam is scheduled as follows: LAB A - Tuesday, Nov 21st, 2006, 9:00 - LB2. LAB B – Wednesday, Nov 22nd, 2006, 10:00 – R207. 10)Pelvis a) Torsion 1) Sacral Apex 2) Piedallu’s b) Osteopathy 1) Spinal Percussion 2) Iliac Compression c) Lumbar/Sacroiliac/Hip Differential 1) Anterior Innominate 2) Erichsen’s 3) Hibb’s 4) Lewin-Gaenslen’s 5) Gaenslen’s 6) Laguerre’s 7) Knee-To-Shoulder 8) Goldthwait’s 9) Belt d) Muscular/Ligamentous Lesion 1) Sacroiliac Resisted-Abduction 2) Yeoman’s 3) Gapping 4) Squish 11) Hip a) Leg Length 1) Actual Leg-Length 2) Apparent Leg-Length b) Dislocation 1) Allis’ 2) Hip Telescoping c) Infectious/Inflammatory Process 1) Patrick’s (FABERE)

2) Jansen’s 3) Gauvain’s d) Meningeal irritation 1) Guilland’s e) Muscular/Ligamentous Lesion 1) Trendelenburg’s 2) Phelp’s 3) Ober’s 4) Thomas f) Fracture 1) Anvil 2) Ludloff’s Unit 5 – 5 lectures, 34 orthopedic tests and signs. Orthopedic evaluation of the cervical spine and shoulder. Presented by region, then condition, then tests and signs. The practical lab exam is scheduled as follows: LAB A - Friday, Dec 8th, 2006, Noon – LB2. LAB B – Friday, Dec 8th, 2006, 11:00 – L206. The Written Final will be scheduled by the registrar later in the trimester (there is no practical final). 12)Knee a) Dislocation 1) Q-Angle 2) Aprehension Test for the Patella 3) Fouchet’s b) Osteopathy 1) Clarke’s 2) Dreyer’s 3) Wilson’s c) Infectious/Inflammatory Process 1) Patella Ballottment d) Meniscal Tears 1) Steinmann’s 2) Bounce Home 3) McMurray 4) Payr’s 5) Childress Duck Waddle 6) Apley’s Compression e) Muscular/Ligamentous Lesion 1) Abduction Stress 2) Adduction Stress 3) Drawer 4) Slocum’s 5) Lachman 6) Lateral Pivot Shift Maneuver

7) Losee 8) Noble Compression 13)Leg, Ankle, Foot a) Vascular 1) Homans’ 2) Moses’ 3) Buerger’s 4) Claudication 5) Perthes’ b) Osteopathy 1) Strunsky’s 2) Hoffa’s c) Muscular/Ligamentous Lesion 1) Thompson’s 2) Drawer Sign of the Ankle 3) Helbings’ d) Neuropathy 1) Morton’s 2) Duchenne’s 3) Tinel’s Foot