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neuromusculoskeletal orthos

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test
steps and interpretation
Brudzinski   show
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cervical compression   show
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cervical distraction   show
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show seated pt coughs, strains and sneezes. Pain = space occupying lesion  
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show pt supine with hips and knees flexed, doctor extends knee. Pain or causes other knee to buckle = meningeal irritation, meningitis, subarachnoid hemmorrhage  
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show Place tuning fork over mastoid process, pt says when the sound is no longer heard (Bone Conduction) Place vibrating tuning fork 1" from the ear and repeat (Air conduction)If BC>AC conduction loss otitis media. AC and BC decreased nerve conduction deficit  
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show Place vibrating tuning fork on vertex of pt's head and ask where the sound is loudest. sound should be equal in both ears.  
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Bonnet   show
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show Pt supine. Lift affected leg with knee flexed and place on Doc's shoulder. apply firm pressure on hamstring muscles and then in popliteal fossa. irritation of roots of sciatic nerve.  
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show If SLR test, lower the leg 5 degrees below pained dorsiflex foot. pain = irritation of the roots of the sciatic nerve  
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show SLR on each leg separately noting which angle pain was produced. Raise both legs together noting angle of pain. If the angle of pain of both legs raised is less than single SLR = lumbosacral joint involvement  
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Lasegue   show
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Lewin's supine   show
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show Pt supine. passively flex patients head and then neck to chest. Pain along L-spine and along sciatic nerve distribution = sciatica due to herniation especially with a lateral disc herniation  
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Milgram   show
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show If SLR is positive, lower leg just below point of pain. quickly extend big toe of affected foot. Pain = sciatic nerve root compression  
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SLR   show
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Well leg raise aka Fajersztajn   show
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show Pt prone. doc flexes knee and puts heel to opposite buttocks (iliopsoas pathology or inflamed roots of the femoral nerve). after knee flexion thigh is hyperextended. If cannot be hyperextended = hip lesion  
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show Pt prone. stabilize hip by placing one hand on ilium, passively flex knee and extend hip. if ext hip causes pain along anterior thigh = femoral nerve irritaion  
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Nachlas   show
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adam supported aka belt test   show
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antalgic lean   show
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Kemps   show
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Schober   show
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Bechterew   show
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show pt seated, actively does motion. pain increases and radiates to thigh = nerve root compression disc herniation, localized pain = facet joint pathology  
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Minor   show
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erichsen   show
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show pt points to area of pain medial and inferior to PSIS = sacroiliac pathology  
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show pt supine with affected side close to edge of table. Passively flex hip and knee of unaffected side towards pt. allow affected leg to hang off table slightly. apply pressure to both knees. pain = sacroiliac pathology  
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show pt supine. raise affected leg with one hand while other hand is under lumbar region. pain before l-spine begins to move 0-30 SI joint pathology, pain 30-60 lumbosacral joint pathology, 60-90 lumbar region pathology  
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Hibbs   show
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show pt lies on unaffected side, doc applies pressure to ilium. pain = SI pathology  
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show pt supine. place lateral malleolus of one limb over the patella of the opposite limb and apply downward pressure. SI pathology  
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show Pt prone. one hand over affected SI joint, flex knee of affected side, place hand under thigh and lift knee off table. pain = injury of anterior sacroiliac ligament  
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show Pt seated. pt extends arms out in front with palms up. pt closes eyesand extends and rotates it to one side and then to the other side. if pt's arms drift or dizziness or blurriness occur or nystagmus = vertebrobasilar insufficiency  
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show Pt stands with feet close together and eyes open. doctor stands behind patient to catch them if necessary. pt closes eyes, if pt sways after eyes close = dorsal column pathology (tabes dorsals) if pt sways with eyes open = cerebellar damage  
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twitch or jump   show
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show pressure on specific point on muscle causes patient to make a facial grimace = tender point in fibromyalgia  
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show touching anal margin lightly will cause anus to pucker, lack of contraction = cauda equina syndrome  
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Babinski   show
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show pt seated. doc taps facial n. where it passes through parotid gland in from of ear and below zygomatic bone. if same side of face twitches = hypocalcemia, hypoparathyroidism  
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show pt grips paper between any 2 fingers of effected hand. If unable to hold grip = ulnar nerve palsy  
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gower   show
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show hold middle finger of patient proximal to the distal interphalangeal joint. Doctor nips fingernail of middle finger of patient between thumb and index finger. if causes adduction of thumb and slight flexion = upper motor neuron lesion in same limb  
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Lhermitte   show
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pinch grip   show
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Bakody   show
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brachial plexus tension   show
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show doc pushes upward on occiput. pain is reduced = nerve root compression or facet joint pathology. pain = sprain/strain  
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Dejerine's triad   show
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Jackson compression   show
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Kernig   show
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maximum cervical compression   show
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O'donohgue   show
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show pt is supporting head with both hands = cervical fracture or severe sprain  
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shoulder depression   show
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Soto-hall   show
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show pt seated. doc pushes down on head, pt then rotated and flexes to affected side, doc places hand on head and delvers vertical blow. pain = nerve root irritation by cervical spondylosis or disc herniation  
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show ask pt to hold breath and bare down as in going to the bathroom. pain in neck and upper limb = SOL, herniated disc, intraspinal tumor or a large hematoma  
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show grasp tibia of affected ankle of the supine patient with one hand and the calcaneus with the other hand. push down on tibia and pull the calcaneus upwards. talus slides anteriorly = tear anterior talofibular ligament  
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show pt in supine position. push head of pt's first metatarsal bone with your thumb and have the patient push down (plantar flex) on thumb. if lat side plantar flexes and medial side dorsiflexes duchene's sign is present = lesion of superficial peroneal nerve  
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Helbing's sign   show
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show squeeze metatarsals of the affected foot of patient from lateral to medial. interdigital (morton's) neuroma or metatarsalgia  
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Thompson   show
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show percuss area behind the medial malleolus of affected side. pain = tarsal tunnel syndrome  
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valgus stress test   show
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varus stress test   show
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show pt makes fist and pronates and extends, doctor applies resistance. pain = lateral epicondylitis  
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show passively flex patient's forearm, fingers and wrist, then passively pronate and extend elbow. lateral epicondylitis  
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occult elbow fracture   show
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reverse cozen   show
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show attempt to abduct pts elbow, MCL dammage  
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varus stress elbow   show
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anvil   show
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Laguerre   show
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ober   show
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ortolani   show
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show pt supine. bend hip and knee of the unaffected side towards the abdomen. pt brings knee to chest and hold. if opposite knee comes off the table or lunar lordosis remains = flexion deformity of hip or tight flexors like iliopsoas  
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trendelenburg   show
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abduction (valgus)stress knee   show
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show pt supine knees extended. doc hand over medial joint line and ankle. attempt to adduct leg. pain - LCL injury  
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show pt prone. anchor pts thigh with knee. bring knee into 90 flexion apply pressure while internally and externally rotating. pain = meniscus tear  
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show pt prone. doc stabilize thigh with knee. apply upward pressure internally and externally rotating pain = LCL or MCL damage, relief = meniscus tear  
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show pt in supine position and have them flex knees at 90 degrees. sit on pts feet and push tibia posterior and pull it anteriorly. perform on both legs excessive movement >6mm torn cruciate ligament  
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show pt supine. flex affected knee at 30 degrees. grab proximal end of tibia and pull tibia anteriorly. excessive movement = ACL tear  
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show pt supine. grasp pts ankle and fully flex knee on affected side such that the heel is close to the buttock. place hand over knee and externally rotate and slowly extend knee keeping hip partially flexed. thud or click = medial meniscus damage. int=lat men  
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show flex pt hip at 90. apply thumb pressure to lateral femoral epicondyle and extend pts knee. pain at 30 of flexion = IT band syndrome  
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show elevate straight leg of supine patient at 45, 3 mins. lower limb and ask pt to sit up with both legs dangling over table. when leg raised, dorsal of foot blanches and veins collapse or takes more than 2 mins for circulation to return = poor circulation  
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show pt marches 120steps for 60 seconds . note when leg cramps begin. if cramps before minute is up = peripheral arterial disease or burger's disease  
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FAIR maneuver   show
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show passive hip adduction and internal rotation causes pain = piriformis syndrome  
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show pt supine, raise straight leg to 10, dorsiflex ankle squeeze calf of pt. pain = DVT, ruptured plantaris tendon, or ruptured Baker's cyst  
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pace   show
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acromioclaviclar traction   show
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show pt seated. passively abduct arm just above shoulder. tell pt to let arm down slowly after you let go. pain or hunching deltoid = rotator cuff injury = tear in supraspinatus tendon  
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show palpate pts shoulder for tender spots. hold tender spot and abduct pts arm. if pain is relieved = subaromial bursitis  
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dugas   show
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Empty can aka Jobe aka supraspinatus press test   show
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Hawkins-kennedy   show
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show pt seated. slightly abduct arm and move shoulder through full flexion. pain= injury to supraspinatus tendon  
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show ask pt to place palm of the affected upper limb over the top of the opposite shoulder. pain = adhesive capsulitis  
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show passively elevate arm into forward flexion. pain = impingement syndrome  
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speed   show
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show pt seated. ask pt to flex elbow to 90 and hold forearm in pronated position. instruct pt to supinate forearm while you hold the pt's hand in that fixed position. pain or click of the inter tubercular groove of humerus = tenosynovitis long head of biceps  
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show pt makes fist of affected hand. occlude both ulnar and radial arteries at wrist. release ulnar artery, then radial artery. if color is blanched more than 5 seconds = arterial embolism  
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bracelet   show
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show passively flex DIP, then extend finger and passively flex MCP and DIP. if no change in degree of flexion = restriction of fibrous capsule of DIP joint. if increase in flexion=contraction of lumbrical muscle  
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show pt makes fist with thumb in fingers and ulnar debates wrist. if pain over abductor policis longs and extensor policis braves = de quervain's tenosynovitis  
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show inverted praying hands and hold position at least 1 minute. tingling paresthesia radiates into thumb, index or middle finger = carpel tunnel syndrome  
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press   show
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show hands in prayer position. hold position at least 1 minute. tingling or paresthesia into thumb, index or middle finger= carpal tunnel syndrome  
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tinel   show
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show compress region of palm of the wrist just distal to distal crease with both thumb in an anteroposterior direction. hold with thumbs 15secs to 2 mins. tingling or paresthesia = carpal tunnel syndrome  
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show palpate radial pulse. ask patient to looks towards the affected side and extend neck, cervical rib or scalenus type TOS  
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eden, costoclavicular   show
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halsted   show
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show immerse pts fingers in water 3 mins. if skin doesn't wrinkle positive sign = loss of sympathetic innervation as in complex regional pain syndrome  
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show ask pt to place palm of hand on top of head with elbow level with head. pain = scalenus anterior type of TOS  
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show pt abducts arms to 90 and bends elbows to 90. open and close fists repeatedly for 3 minutes. reproduces symptoms or arm starts to fall = TOS  
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show palpate pt's radial pulse on side being tested. doc abducts pts arm to 180 while palpating the pulse. note angle that pulse disappears. repeat on other side. if pulse disappears on one side and not the other = pectorals minor type of TOS  
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