neuromusculoskeletal orthos
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Brudzinski | show ๐
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cervical compression | show ๐
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cervical distraction | show ๐
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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 ๐
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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 ๐
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Lewin's supine | show ๐
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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 ๐
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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 ๐
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Well leg raise aka Fajersztajn | show ๐
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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 ๐
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adam supported aka belt test | show ๐
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antalgic lean | show ๐
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Kemps | show ๐
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Schober | show ๐
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Bechterew | show ๐
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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 ๐
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erichsen | show ๐
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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 ๐
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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 ๐
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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 ๐
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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 ๐
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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 ๐
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pinch grip | show ๐
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Bakody | show ๐
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brachial plexus tension | show ๐
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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 ๐
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Jackson compression | show ๐
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Kernig | show ๐
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maximum cervical compression | show ๐
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O'donohgue | show ๐
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show | pt is supporting head with both hands = cervical fracture or severe sprain
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shoulder depression | show ๐
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Soto-hall | show ๐
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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 ๐
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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 ๐
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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 ๐
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varus stress test | show ๐
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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 ๐
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reverse cozen | show ๐
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show | attempt to abduct pts elbow, MCL dammage
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varus stress elbow | show ๐
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anvil | show ๐
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Laguerre | show ๐
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ober | show ๐
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ortolani | show ๐
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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 ๐
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abduction (valgus)stress knee | show ๐
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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 ๐
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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 ๐
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acromioclaviclar traction | show ๐
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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 ๐
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Empty can aka Jobe aka supraspinatus press test | show ๐
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Hawkins-kennedy | show ๐
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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 ๐
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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 ๐
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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 ๐
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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 ๐
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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 ๐
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halsted | show ๐
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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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