Part 3 Board Review (pt. 6)

Migraine

Female = Associated with menses, Male = trauma

Unilateral or bilateral, 3-5 days (episode)

Aura-classic, light sensitive, nausea, throbbing

Provoked by alcohol, stress and tyramine

adjusting, nutrition and biofeedback

Cluster headache

males mostly, unilateral

1-2 hours, seasonal

Rhinorrhea, tearing, several per day, piercing

alcohol, 2 hours after sleep

adjust

Tension headache

band-like, temporal, occipital

afternoon or when stressed

achy, spasm

xray evaluation

Hypertension headache

older patients, generalized pain

usually in the morning, throbbing

increased BP and increased lipids

Co-care

metabolic headache

anyone, generalized pain

usually in the morning, throbbing, achy

serum studies

co-care

Sinusitis

anyone, pain above eye and cheek

repetitive pattern, tender, achy, discharge, fever

jarring or position may exacerbate

adjust and monitor

Giant Cell (temporal arteritis)

>50 years old, temporal pain usually unilateral

gradual and persistent, local throbbing, achy and fever

polymyalgia rheumatica, increased ESR

refer and adjust

Tumor

anyone, variable

progressive and nocturnal

variable symptoms

MRI and refer

Meningitis

anyone, general, constant

decreased flexion and fever

Brudzinski’s, kernigs and CSF culture

refer to ER

Subarachnoid hemorrhage (CVA)

anyone (younger), variable

progressive and steady, personality change, worst of my life

CT/angiography

MRA

refer (ER)

Subdural hemorrhage

anyone (older), variable, progressive and steady

personality chang , weakness

CAT scan

refer (ER)

Hypoglycemia headache (hyperinsulinemia)

anyone, general, 2 hours post-prandial

dizzy and weak

skipping meals, GTT, FBS

adjust, nutrition and monitor

Trigeminal neuralgia

older (male, alcoholic), cheek, jaw, lips and gums

15-45 seconds

sharp, short, severe

episodes, triggers, chewing, cold

adjust, nutrition

Glossopharyngeal neuralgia

anyone, ear and throat

15-45 seconds, sharp, short, severe

variable, adjust, nutrition

Thumb Extension

Radial (wrist drop)

Thumb Adduction, froment’s (finger abd and add)

Ulnar

Thumb flexion, opposition (pollicis), abd thumb

Median

Tennis elbow

lateral epicondylitis → wrist extensors (brevis)

Little leaguer’s elbow (golfer’s)

medial epicondylitis, wrist flexors

Terrible triad

MM, ACL, MCL

PCL

sag sign

Inversion sprain

anterior talofibular ligament

Shin splints

pain in calves, tenderness, mild swelling

compartment syndrome (NVE)

swollen, shiny calf, paresthesia, weakness (emergency)

Plantar fasciitis

Achilles tension leads to heel spurs

Morton’s neuroma

burning pain 2nd-4th metatarsals

pain refers to dorsal surface of foot

Tarsal tunnel

burning pain near sole and toes

MFS

trigger points, ice (Combo therapy → heat and ice)

Fibromyalgia

tender point 11/18, heat

SOL orthopedic tests

Valsalva, Naffziger’s (bilateral jugular veins, safer for pregnant females), milgrams

Dejerine’s triad

not a test

Cervical orthopedic tests: IVF encroachment

Compression, jackson’s, maximal cervical compression

Spurling’s

disc and IVF encroachment

Bakody’s

decrease pain → nerve root syndrome

Shoulder depressor (only traction test)

nerve root adhesions

Distraction

nerve root vs muscular

O’Donohue’s

Sprain vs strain

active vs passive

Lhermitte’s

cord degeneration (MS)

Soto hall

general

Adson’s

rotate head TOWARDS involved side

scalenus anticus

Modified Adson’s

Rotate to OPPOSITE side (aka halstead)

scalenus medius

Eden’s (aka costoclavicular) (TOS)

rib and clavicle

Wright’s

aka hyperabduction

pectoralis minor

Reverse bakody’s

increase in pain

positive reverse = worse

TOS in general

Allen’s maneuver and Roos

general TOS

Codman’s

Rotator cuff

apley’s

ROM

Apprehension

chronic dislocation

Dugas

Dislocation (kocher’s and milch’s maneuvers)

Dawbarn

bursitis

Yerguson’s

bicipital tendon instability (transverse humeral ligament)

abbott-saunders test

Speed’s test

tendonitis

Lateral epicondylitis

Cozen’s (resisted extension), mills (stretching extensors, (extensor brevis, TFM)

Medial epicondylitis

reverse cozen’s (resisting flexion) and (stretching flexors)

Elbow ligament stability

medial collateral ligament test = abduct (valgus stress)

Lateral collateral ligament test = adduct (varus stress)

Tinel’s sign at the elbow

between olecranon and medial condyle (ulnar)

Wrist: median nerve tests

tinel’s, phalen’s, pinch

Wrist: ulnar nerve

Froment’s

Finkelstein’s

dequervain’s

Bunnel Littler’s

muscles vs joints

LBP: radiculopathy tests

SLR, Braggard’s, Sicards

bowstring’s (disc)

Piriformis syndrome tests

Bonnet’s (neuropathy)

SOTO (Sciatica)

WLR and fajersztajn’s

medial disc

Lindner’s

lateral disc

Kemps

Localized = facet (sclerotogenous)

Radiating (nerve root, radiculopathy)

Bechterews

Sciatica (or hamstrings)

tests for tight hamstrings

tripod sign (or sciatica)

neri bowing’s

beery’s (aka chair test) (sitting relieves discomfort)

AS

forestier’s bowstring

lewin supine

chest expansion

Forestier’s bowstring

ipsilateral contraction during lateral flexion indicates AS

Lewin supine

attempt to sit up, difficulty indicates AS

Chest expansion

Male 2”, female 1.5”

decrease indicates

Belt test (aka supported adams)

lumbars vs SI support4ed by flexion

pain better = SI

Pain worse = lumbar

SI tests

iliac compression

lewin-gaenslen’s

gaenslen’s

Goldthwait’s (level of lesion SI → L/S → lumbars)

Mennell’s (aka erickson SI)

Hibbs (SI and Hip)

yeoman’s

Nachlas

posterior: general S1-L/S region

Anterior: femoral stretch

Ely’s sign

contracture (note buttock hunching)

ely’s test

hip, iliopsoas, lumbar nerve root adhesions (general test)

Hip tests

Anvils (fx)

FABERE

Laguerre’s (fabere in the air)

Thomas (psoas contracture)

Hibbs (hip and SI)

Ober’s and noble’s

TFL contracture

Trendelenburg

gluteus medius (contralateral) (QL spasm)

ortolani’s and barlow’s

hip dysplasia / dislocation (infant)

Knee: varus and valgus

adduction stress (lateral collateral ligament)

Abduction stress (medial collateral ligament)

Drawer test

AP → PCL

PA → ACL

Rotatory instability of the knee

aka slocums

ACL and collaterals

Lachman’s

ACL

Grinding

aka clark, patella scrape

chondromalacia patella

Effusion (ballottement)

acute, swelling (minor → milking and tap)

McMurray’s

External rotation → medial meniscus

Internal rotation → lateral meniscus

heel points to pathology

Apleys compression

meniscus

Apley’s distraction

ligaments

Thompson’s

achilles rupture

ankle stability test

Medial → deltoid ligament

lateral → anterior talofibular ligament

draw

anterior talofibular ligament

apparent leg length

functional (shared site - umbilicus)

Actual leg length

structural (independent sites - ASIS)

Allis’

femur vs tibia length

scanogram

xray evaluation of leg length

Brudzinski’s

meningitis (flex neck → knees buckle)

Kernig’s

meningitis (flex hip and extend knee, kicks)

Hoover’s (paralysis)

leg paralysis

Burns bench (LBP)

low back pain (18 inch table)