Pt mgmt 4 final OP

joint play

decreased PFROM TMJ close

joint play anterior

decreased PFROM TMJ open

joint play posterior

decreased PFROM TMJ deviation

joint play medial / latearl

decreased PFROM TMJ protrusion

joint play anterior

decreased PFROM TMJ retrusion

joint play posterior

anterior GH instability with a labral tear

anterior drawer test

GH instability with a dislocation or trauma

apprehension / crank test

posterior GH instability

posterior drawer test

inferior GH instability

sulcus sign or push-pull test

how to perform sulcus sign / test

observe for gap, if none, stabilize & pull humerus inferior (+ve hypermobility)

supraspinatus tendinosis / impingement

hawkins-kennedy

how to perform hawkins-kennedy test

flex arm 90 in front of body; apply internal rotation overpressure (+ve pain)

supraspinatus overuse or subacromial bursitis

neer impingement

how to perform neer impingement

abduct arm fully in scaption with internal rotation (greater tub on acromion) (+ve pain / apprehension)

subacromial impingement / AC trauma

painful arc test

how to perform painful arc test

actively abduct shoulders fully (+ve mid arc pain = subacromial; end range pain = AC trauma)

restrictions with combined movements of the scapulae

apley’s scratch test

how to perform apley’s scratch test

client actively touches fingertips behind back - IR + ADD lower; ER + ABD upper (+ve difference in movement)

biceps tendon pathology or coracohumeral/transverse ligament instability

yergason’s

how to perform Yergason’s test

arms against side, elbow flexed 90 + pronated; therapist resists supination + ext rot of shoulder (+ve tendon pops out of groove = ligament; pain = pathology)

rotator cuff tear

drop arm / codman’s test

how to perform drop arm / codman’s test

passively abduct arms to 90 then release (+ve difficult controlling movement / severe pain)

supraspinatus tear or suprascapular nerve pathology

supraspinatus / empty can / jobe’/s test

how to perform supraspinatus / empty can test

with arm abd 90 in neutral rotation, resist abduction; repeat with arms in scaption + int rot (+ve weakness / pain)

AC joint pathology

AC shear test

how to perform AC shear test

therapist squeezes over clavicle and spine of scapula (+ve abnormal movement / pain)

facial nerve (CN VII) hypersensitivity

chvostek’s test

how to perform Chvostek’s test

tap 3-5x over parotid gland / masseter where facial nerve passes (+ve muscle twitch)

TMJ hypomobility

knuckle test

how to perform knuckle test

client attempts to place three knuckles into mouth (+ve unable to fit)

instability of ulnar (medial) collateral ligament (elbow)

valgus stress test

instability of radial (lateral) collateral ligament (elbow)

varus stress test

how to perform valgus / varus stress test

therapist applies a medial or lateral force at the elbow (+ve hypermobility)

tennis elbow

lateral epicondylitis test

tennis elbow related to extensor carpi radialis brevis

cozen’s lateral epicondylitis test

how to perform Cozen’s (method 1) lateral epicondylitis test

palpate common extensor tendon; hand in a fist + pronated + extended; therapist resists wrist extension

tennis elbow related to extensor carpi ulnaris and extensor carpi radialis brevis

Mill’s (method 2) lateral epicondylitis test

how to perform Mill’s (method 2) lateral epicondylitis test

palpate common extensor tendon; w wrist mid pronation, passively flex + radial dev then extend elbow

tennis elbow related to extensor digitorum

maudsley’s / method 3 lateral epicondylitis test

how to perform Maudsley’s (method 3) lateral epicondylitis test

palpate common extensor tendon; therapist resists extension of 3rd digit distal to PIP

golfer’s elbow

medial epicondylitis test

how to perform medal epicondylitis test

palpate common flexor tendon; supinate + extend elbow and wrist

interosseous nerve entrapment in pronator teres

pinch grip test

how to perform pinch grip test

client attempts to make an “OK” with index & thumb (+ve abnormal grip)

pronator teres compressing median nerve

pronator teres syndrome test

how to perform pronator teres syndrome test

elbow 90 + mid pro/supination; therapist resists pronation while extending elbow (+ve neuro s/s)

ulnar nerve compression

tinel’s sign at elbow

how to perform tinel’s at elbow

repeatedly tap ulnar groove (+ve neuro s/s)

dislocated lunate

murphy’s sign

how to perform murphy’s sign test

with hand in a fist, observe alignment of MCPs (+ve head of 3rd level with 2nd & 4th)

ulnar (medial) collateral ligament instability at the wrist

radial ligamentous stress test

how to perform radial ligamentous stress test

with hand supinated, bring into radial dev and apply overpressure (+ve hypermobility)

radial (lateral) collateral ligament instability at the wrist

ulnar ligamentous stress test

how to perform ulnar ligamentous stress test

with hand supinated, apply ulnar deviation overpressure (+ve hypermobility / pain)

DeQuervain’s tenosynovitis or paratenonitis of abductor pollicis longus / extensor pollicis brevis

Finkelstein / Eichoff test

how to perform Finkelstein / Eichoff test

wrist mid pro/supination, make a fist and ulnar deviate

paralysis of adductor pollicis from ulnar nerve pathology

Froment’s sign / test

how to perform Froment’s sign

client grasps piece of paper between thumb & index; attempt to pull away (resisted thumb adduction) (+ve distal phalanx of thumb flexes)

carpal tunnel syndrome related to bones of the carpus

phalen’s wrist flexion test

how to perform Phalen’s wrist flexion test

press dorsal aspects of hands together ~1 min (+ve tingling in digits 1-3 and ½ of 4)

carpal tunnel related to median nerve compression

reverse Phalen’s test

how to perform reverse phalen’s test

hold palms of hands together ~1 min (+ve tingling in digits 1-3 and ½ of 4)

ulnar / radial artery insufficiency

allen test

how to perform allen test

pump fist open & close quickly; make a fist and therapist compresses ulnar / radial arteries; open hand and release one; repeat process but release the other side and observe flushing (+ve difference in or slow flushing)

what test tensions median nerve

ULNT1

how to perform ULNT1

depress + abd 110 shoulder, exend + supinate ebow & wrist, extend digits, side bend head opposite

which test tensions the radial nerve

ULNT3

how to perform ULNT3

depress + int rot + abd 30 + extend 25 shoulder; extend + pronate elbow; flex + ulnar dev wrist; flex digits; side bend head opposite

which test tensions ulnar nerve

ULNT4

how to perform ULNT4

depress + abd 10-90 shoulder (hand to ear) + ext rot, flex + supinate/pronate elbow; extend + radial dec wrist; extend digits; side bend head opposite

CN 5 trigeminal nerve test

jaw jerk reflex test

how to perform jaw jerk test

tap 3-5x on middle of chin (+ve abnormal reflex)

TOS related to anterior / middle scalene

adson’s test

how to perform adson’s test

rot head ipsilateral + extend; extend + int rot shoulder; therapist palpates radial pulse then client takes a deep breath and holds (+ve neuro s/s / decreased pulse)

TOS related to scalenes

halstead’s test

how to perform halstead’s test

contralaterally rot head + extend; therapist palpates radial pulse and applies inferior glide to arm (+ve neuro s/s or dec pulse )

TOS related to pec minor

wright’s hyperabduction test

how to perform Wright’s hyperabduction test

head contralaterally rotated; therapist palpates pulse then fully abduct + external rot shoulder (+ve neuro s/s / decreased pulse)

TOS related to clavicle + 1st rib compressing neurovascular structures

eden’s test

how to perform Eden’s / costoclavicular syndrome / military brace test

head neutral; therapist palpates pulse then draws shoulder back + down (+ve neuro s/s / decreased pulse)

myotomes protocol

resist action 3 times, holding contraction 5-7s each with a slow build and release

C1-C2 myotome action

neck flexion

C3 myotome action

c-spine lateral flexion

C4 myotome action

shoulder elevation

C5 myotome action

shoulder abduction

C6 myotome action

elbow flexion + wrist extensino

C7 myotome action

elbow extension, wrist flexion

C8 myotome action

thumb extension, ulnar deviation

T1 myotome action

abduction / adduction of hand intrinsics (jazz hands)

triceps DTR (site of stimulus, normal response, nerve root)

distal triceps tendon; elbow extension / contraction; C7-C8

brachioradialis DTR (site of stimulus, normal response, nerve root)

brachioradialis tendon; elbow flexion + pronation; C5-C6

biceps DTR (site of stimulus, normal response, nerve root)

biceps brachii tendon; contraction / elbow flexion; C5-C6

Decreased passive forced shoulder flexion

length test latissimus dorsi

Decreased passive forced shoulder extension

length test anterior deltoid

Decreased passive forced shoulder abduction

length test coracobrachialis

Decreased passive forced shoulder adduction

length test middle deltoid

Decreased passive forced shoulder medial rotation

length test teres minor

Decreased passive forced shoulder lateral rotation

length test subscapularis

Decreased passive forced elbow flexion

length test triceps brachii

Decreased passive forced elbow extension

length test biceps brachii