Physical therapy assistant

Yergason test

Standing, elbow 90 degree in pronation at the side. Pt must supinate and ex. Rotate. Pain= transverse ligament instability/bicep tendonitis

Speed test

Standing. Arm ext. in and supinate. Pt must resist shoulder flex. Pain=bicepital tendonitis

Neer's impingement test

Siting. PT hand on scapular. Internal rotate arm and bring it into flex. Anterior pain= supraspinatus

Posterior = internal impingement

Supraspinatus test * empty can

Sit/ stand. Pt arm full ext with 90 degree abd. In supination. Have pt pronate arm (like emptying a can). Pain=Tear/impinge supraspinatus tendon or Supra-scapular nerve neuropathy

Clunk test

Pt in supine. PT place fist under scapular. Move arm in full ext. positive test = snapping or clunk soup # glenoid labrum tear

Ant. Apprehension test

Pt in supine, elbow flex and abd. PT does ext. rotation. Pain= ant. Shoulder dislocation

Posterior apprehension test

Pt in supine, elbow flex and abd. PT does horizontal add. Along with medial rotation. Pain= post shoulder dislocation

Adson test

Pt siting arm in ext. PT find radial pulse. Have pt ext. neck and turn head away. Then look back. Positive test= decreased pulse when pt looks back

Tinel sign

Pt in siting. Hand in ext on table. PT tabs along the transverse carpal ligament and distal wrist. Pt numb/ tingling in first 3 1/2 digits. Means positive for carpal tunnel

Pronator teres syndrome test

Pt elbow is flex. PT tries to supinate pt hand. Tell pt don't let me move it (keeping arm probated) while doing that ext. arm putting pronator teres on stretch. Pain in median area of hand= median nerve entrapment not carpal tunnel

Finkelstein test

Pt must put thumb in palm, wrap their 4 fingers around it, put elbow in flex. And wrist in neutral. PT have pt slowly go into ulnar deviation. Pain over abductor polis long us and extensor polis brevity tendon. Positive for deQuervains tenosynovitis

Cozen test "lateral epicondylitis"

Stabilize elbow palmate lateral epicondyle with thumb. Pt make fist pronate and radial deviate and ext wrist. PT gives resistance. Pain at last seal epicondyle = tennis elbow

Medial epicondylitis

Pt stand with elbow flex then supinate forearm ext pt wrist and move elbow into ext. pain along medial epicondyle .golf elbow

Phalen test

Pt does full wrist flex. Hold dorsal side together for 1 minute. Positive test = tingling in thumb index finger middle finger and lateral half ring finger indicate carpal tunnel

Allen test

Open and close hand quick as possible then squeeze hand tightly. Then compress the radial & ulnar artery with thumb. Then ask pt to open hand and release radial. See if blood streams back quick. Repeat with ulnar. Check for vascular compromise

Thomas test

Pt in supine at the edge of table. Have pt ext on leg over the edge of table and hold the opposite leg with both hands with knee in flex. Positive test is extended knee lifting off table = tight hip flexor ( illiopsoas. If pt abd then tight IT band

Ober test

Pt in sideline with knee slightly flex. PT brings leg into abd and ext while stablizing the hip. Lower leg back to table. If leg stays in the air = positive for tight tensor fascia latte/ IT band

Ely test

Pt in prone. Stabilize hip. Flex knee max. If pt hip flex then positive tightness of rectus femoris

Patrick faber

Pt supine. Place affected hip into foot just above knee allowing hip to rotate. Apply gentle pressure. Positive test pain laterally internal or SI

Piriformis test

Pt in supine. Pt hip is passively moved into 90 degree of flex and knee over towards the opposite shoulder. Pt will complain of pain

Craig test

Pt in prone with knee flex. Palpate greater trochanter. Int/ external rotate the hip. This checks for retro (a lot external rotation) and anteversion (a lot internal rotation)

Lachman test

Pt in supine bring test leg into 30 degree knee flex. Fixate femur then slight ext rotate of tibia. Then translate tibia anterior. Soft end feel = ACL rupture

Anterior draw test

Pt in supine. Pt affect leg in knee flex 90 and hip 45. Sit on pt leg. Feel for joint line on knee then move tibia anteriorly explosivly. Test positive if tibia move more 6 mm or soft end feel

Pivot test

Pt in supine leg ext. slight internal rotation of tibia. Move leg from ext to flex. If tibia reduce or jump back or a click sound= positive acl tear

Posterior sag test

Pt in supine hips flex 45 knee flex 90 test

Mcmurray test

Pt in supine hip flex 90 with knee flex then medial rotate/ lateral the tibia. Moving leg from ext to flex. Repeat. If click lock or pain = meniscus damage (lateral tibia rot= testing the medial meniscus vice versa)

Glenohumeral capsular pattern limitations

Greater limitation of external Rotation then abd then internal rotation

Humeroulnar & humeroradial limits

Loss of flex greater than ext

Forearm pattern limits

Equally restricted in supination & pronation

Wrist pattern limits

Fexion = extension

Hip pattern limit

Flexion & internal rotation greater than loss of extension greater than flexion

Tibiofemoral knee

Flexion grossly limited; slight limitation of extension

Talocrural ankle

Hydrocolloid

Absorb exudate partial (epidermis & some dermis) and full thickness (when you see fat)

Hydrogel

Superficial & partial little drainage

Foam

Partial & full (level of exudate vary)

Transparent film

Superficial & partial little drainage

Alginate

Seaweed dressing partial to full. Use with excessive absorption

Superficial wound

only epidermis

minor wounds that affect the outermost layers of skin and include minor cuts and scrapes

heal very well, minimal blood loss,less infection

Partial wound

Involve epidermis and may involve dermis. Shallow moist wound bed. No tissue necrosis. No slough

Full thickness wound

Damage goes below epidermis and dermis into subcutaneous tissue. May see tendon muscle and bone

Colles fracture

Fracture at the distal end of the radius that displaces the smaller fragment posteriorly

Smith fracture

fracture of distal radius with anterior (palmar) displacement

Scaphoid fracture

Most common fracture occurs when person fall onto outstretched UE

Dupuytrens contracture

Shortening of atrophy of palmar aponeurosis, contracture of 4th and possibly 5th digit. Affect MCP & PIP

Boutonnière deformity

Observer deformity is ext. of MCP ext. of the DIP along with flex. Of PIP. Common with rheumatoid arthritis with degeneration of central extensor tendon.

Swan neck deformity

Result from contracture of intrinsic muscles with dorsal subluxation of lateral extensor tendon. Observe deformity is flex of MCP & DIP along with ext. of PIP. Occurs with rheumatoid arthritis following degeneration of lateral extensor tendon

Ape hand deformity

Observed as thenar muscle wasting with first digit moving dorsal until its in line with second digit. Result from median nerve dysfunction

Mallet finger

Injury to distal extensor tendon causing DIP flexion contracture.

Gamekeeper thumb

Sprain/ rupture of ulnar collateral ligament of MCP joint of first digit. Result in medial instability of thumb. Usually occurs with skiers . Immobilized for 6 wks

Boxer fracture

Fracture of neck of fifth metacarpal

Trigger finger

common in DM, stenosing tenosynovitis, nodule at MCP of ring or index finger

Avascular necrosis (AVN) of hip

Impaired blood supply to femoral head. Decrease in flex, IR & ABD. Pain in groin/thigh. Coxalgic gait avoid WB on affect side and lateral lurch to opposite side

Coxalgic gait

trunk lurch toward affected side (shortens MA of hip abductors so they have to work less, producing less torque on hip), also called compensated Trendelenburg.

Legg-Calve Perthe (osteochondrosis)

(LCPD) is a childhood hip disorder initiated by a disruption of blood flow to the ball of the femur called the femoral head. Due to the lack of blood flow, the bone dies (osteonecrosis or avascular necrosis) and stops growing.

Slipped capital femoral epiphysis

Disorder in which the capital femoral epiphysis slips over the neck of the femur

seen in children during the growth spurt years

Femoral anteversion

Angle btwn the femoral neck and the acetabulum is >15 (greater) degrees, toe in gait

'Pigeon toed'

Femoral retroversion

Angle less than 0 degrees femoral head rotated backwards in relation to femoral condyle

Coxa vara

Angle of femoral neck in relation to shaft is less than 120°. Will give pt genu Valgum

Coxa valgus

Angle between neck & shaft of femur > 135°

Trochanteric bursitis

Inflammation of trochanteric bursa from direct blow, irritation of ITB. Positive for noble test during knee ext & ober test

Piriformis syndrome

Caused by excessive pronation of foot causing femoral to internal rotate. Can lead to compression of sciatic nerve/sacroiliac dysfunction. Pt has restricted internal rotation and pain posterior thigh weak external rotation

Osgood schlatter

disease can cause a painful, bony bump on the shinbone just below the knee. It usually occurs in children and adolescents experiencing growth spurts during puberty.

Q angle

ASIS, midpoint of patella and tibial tuberosity

13 men 18 women

Can result in patella femoral syndrome

Pes anserine bursitis

Knee

Tibial plateau

Mostly injured combination of valgum & compression force to knee while flex

Femoral condyle

Most injured due to location

Epiphyseal plate

Injured during WB torsion stress

Fractures at knee joint

Early flexibility to prevent capsular adhesion

Anterior compartment syndrome ACS

Increased compartment pressure resulting in ischemic condition. Symptoms produce by exercise or exertion deep cramping feeling swelling parasthesia severe pain . MEDICAL EMERGENCY STOP TX

Anterior tibial periostitis *shin splits

Muscles included anterior tibialis and extensor hallucis longus. Pain when palpate lateral tibia and anterior compartment. Flexibility ex for anterior compartment and tricep surae

Tricep surae

- Soleus

- 2 head of Gastrocnemius

Medial tibial stress syndrome

Overuse of tibial posterior and medial soleus . Excessive pronation. Pain when palpate dorsal posteromedial border of tibia. Extremely tricep surae (flexion)

Lateral ligament sprain

Injury occur when foot is PF and inverted. Ligament usually injured is the anterior talofibular ligament. Use anterior draw test and talar tilt test.

Lateral ligament grade two

Some loss of function with complete tear of anterior talofibular ligament and calcaneofibular ligament

Lateral ligament grade 3

Complete loss of function with complete tear of anterior talofibular ligament and calcaneofibular ligament with partial tear of posterior talofibular ligament

Unimalleolar fracture

Involve medial or lateral malleolus

Bimalleolar fracture

Involve medial and lateral malleolus

Trimalleolar fracture

Involve medial and lateral malleolus and posterior tubercle of distal tibia. Early PROM to prevent capsular adhesion

Tarsal tunnel syndrome

Entrapment do the tibial nerve. Excessive pronation & overuse result in tendinitis of long flexor & posterior tibialis tendon and trauma may cause compromise to tunnel

Tarsal tunnel syndrome

Symptoms include pain numbness paresthesias along the medial ankle to the plantar surface of foot. Use orthoses to maintain neutral alignment of foot

Flexor hallucinating tendonopathy

Identified as tendinitis in acute phase common with ballerina

Pes cavus (hollow foot)

Deformity observe. Is an increase in longitudinal arches, dropping of anterior arch, metatarsal head lower than hind foot plantar flexion and splaying of forefoot and claw toes

Pes planus flat foot

Can be caused by excessive pronation. Deformation is reduce height of medial longitudinal arch. Difficult push o f during gait

Talipes equinovarus club foot

Talipe is an abnormal development of the head& neck of the talus

Club foot

Postural= PF ADD & inverted foot

Talipes = PF at talocrural joint, inversion at subtalar, talocalcaneal, talonavicular, & calcaneocuboid joint. Supination at midtarsal

Equinus

Contracture of gastro and/or soleus. Limited DF. Foot is plantar flex. Pt walks on toes

Hallux valgus

Can be caused by excessive pronation. Deformities = medial deviation of head of first metatarsal from midline of bone. Distal phalanx move laterally.

Metatarsalgia

Tight tricep surae group or Achilles, collapse of transverse arch, short first ray, pronation of forefoot. Structural changes in transverse arch possibly leading vascular and neural compromise in tissue of forefoot. Pt usually complain first and second metatarsal heal

Metatarsus adductus

Cause by muscle imbalance or neuromuscular disease

Charcot-Marie tooth disease

Peroneal muscular atrophy that affects motor& sensory nerve. IntiL affect us le in leg and foot but progress to muscle in hand & forearm

Plantar fasciitis

Irritation of plantar fascia from excessive pronation. Tight tricep surae rigid cavus foot. Limit ROM of MTP AND talocrural joint.work on flex of tricep surae and strength of invertor

Rear foot varus

Inversion of calcaneus when subtalor joint is in neutral.

Rearfoot valgus

Result from genu valgum. Eversion of calcaneus. Owing increases mobility of hind foot

Forefoot varus

Inversion of the forefoot caused by abnormal development of head and neck of talus

Forefoot valgus

Eversion of forefoot

Spondylolysis

Stress fracture to the pars interarticularis

fracture of transverse process of vertebrae "Scotty dog sign"

Spondylolisthesis

forward sliding of lumbar vertebra over vertebra below it

Spondylolisthesis & spondylolysis

Ex focus on dynamic stabilization of trunk with emphasis on abdominal & trunk extension working from a flex position into a neutral. Avoid extension side bending or rotation. Reeducation on posture. Use Boston brace or TLSO

Spinal stenosis

a condition, mostly in adults 50 and older, in which your spinal canal starts to narrow. ... The open spaces between the vertebrae may start to get smaller. The tightness can pinch the spinal cord or the nerves around it, causing pain, tingling, or numbness in your legs, arms, or torso. Pain decrease in spinal flexion and increase in extension. Pain increase with walking and relieved with prolonged rest. Avoid lateral bending and rotation ex. Focus on truck and pelvis dynamic stability