Orthopedics, Tests, Knee Injuries, Spinal Disorders & Neurological Signs

Definition of strain

Injury to muscle or tendinous attachment

Definiton of sprain

Injury to ligament

Striated:

Smooth:

Cardiac:

Striated: voluntary/skeletal muscle

Smooth: move internal organs

Cardiac: look striated, but are like smooth muscle in function

Adson's test

-positive = thoracic outlet syndrome at scalene triangle

-palpate radial pulse while abducting, extending, externally rotating arm

-patient rotates head towards involved side, takes a deep breath and holds it

-positive = diminished or absent pulse

Brudzinski's Test:

Positive if:

Tests for meningitis

Passive flexion of the head induces flexion of lower limbs

Kernig's test:

Positive if:

Tests for meningitis

Pain & resistance while sitting & trying to extend knee

Yergason Test

-biceps injury

-determines stability of biceps tendon in the bicipital groove

-flex elbow to 90 degrees while patient resists while externally rotating the arm

-positive = produces pain in biceps tendon

Finkelstein's test

-positive = stenosing tenosynovitis // dequervain's disease

-make a fist with thumb inside fingers, turn wrist toward upwards ulnar

Phalen's test

postive = carpal tunnel syndrome

-patient wrist is in acute flexion at 60 degrees, or ask patient to press hands into reverse prayer

-this compresses median nerve

-numbness and tingling over palmar surface of thumb, index and part of ring finger = positive

Tinel's test

-positive = carpal tunnel syndrome

-tap median nerve in wrist

-positive = exacerbates tingling in fingers

Straight Leg test

-positive = back pain, osteoarthritis, sciatica

-raise one leg until pain in thigh, buttock and calf

Braggard's test:

Positive if:

Tests for nerve root lesion, disc herniation, or sciatica

Straight leg test + ankle dorsiflexion produces pain in spine

Apley Compression test:

Positive if:

Tests meniscus tear. Patient prone with knee 90 degrees, compression medial or lateral ligament

Pain on side of compression

Apley Distraction test:

Positive if :

Distinguishes between meniscus or ligament injury

Pain upon distraction indicates ligament injury

McMurray test:

Positive if:

Tests for meniscus tear. Patient supine

Medically and laterally rotating the tibia produces an audible click. Medial rotation with a click indicates lateral meniscus tear

Anterior Drawer Test

-ACL tear

-grasp tibia and pull forward

-positive = excessive forward translation

Posterior Drawer Test

-PCL tear

-pull tibia backward

-excessive = positive

Romberg's test:

Positive if:

Tests cerebellum

Stand with feet close together, eyes closed, check for swaying

Patella Injury

could come when you fall directly on the knee, or sudden flexion

ACL Injury

could come from running fast then stopping quickly, or stopping when going forward

PCL Injury

Stopping when going backward (dashboard injury)

- could be motor vehicle accident or falling on a bent knee

LCL

varus = bow legged

MCL

valgus = knock kneed

Meniscus Injury

Jumping & twisting at the same time

Cervical Spine Compression

Push down on patient's head which compresses the whole neck and spine putting pressure on nerve root. If there is inflammation on the nerve root it will be irritated and patient will have pain traveling down the arm or around shoulder.

Cervical Distraction

Place palms under the occiput of the patient and lift head up and look for relief of pain. This decompresses the nerves. The test is positive if the radicular symptoms lesson or centralize toward the midline of the body.

Rotator Cuff Muscles

SITS

Supraspinatus

Infraspinatus

Teres Minor

Subscapularis

Supraspinatus Action & Test

One of the muscles that abducts arm. Empty can test: Hold affected arm (abducted) with elbow extended and wrist pronated. As if they are pouring a can of pop. Push down on the extended arm patient must resist. Positive sign is pain or weakness.

Infraspinatus / Teres Minor Test

Patient holds arms nest to the body and the elbow flexed at 90 degrees. Attempt to internally rotate the arms while patients resists Pain and weakness is a positive sign.

Subscapularis Test

The patient places the dorsum of their hand on their lower back. Push on the hand while the patient tries to lift the hand from the lower back. Pain and weakness is a positive sign.

Knee ROM

0 degrees for extension- 90 degrees with foot flat on the floor, flexion 130 degrees

Elbow ROM

0 degrees for extension, flexion 135 degrees- supination 90 degrees, pronation 90 degrees.

Shoulder ROM

Abduction 150 degree, Forward flexion 180 degrees, Extension 45-60 degrees, Rotation external rotation 90 degrees, Internal rotation 70-90 degrees.

Patrick/ Faber Test

To evaluate pathology of the hip joint or sacroiliac joint. Patient lies face up and you take their knee into flexion of hip and knee. First perform a compression force from knee into hip & ask if there is any pain. Second put ankle across opposite knee, keeping the ankle off of knee. Usually above knee but if patient is unable put it below the knee. Place compressive force from anterior part of the body straight down. if there is pain on ipsilateral side anteriorly could be hip joint disorder on the same side. If the pain is on the contrlateral side posteriorky around sacroiliac joint, may be dysfunction in that joint.

Faber acronym

Flexion ABduction & External Rotation of hip

Athlete's Triad

Three common injuries: medial collateral ligament (MCL), medial meniscus, anterior cruciate ligament (ACL)

Cauda Equina Syndrome

Caused by a compression of the nerves in the lumbar spine and narrowing of the spinal canal. Weakness and numbness in the lower extremities, sharp stabbing pain in the leg or the lower back pain, urinary or bowel incontinence or dysfunction that causes retention of urine.

Must go to the emergency room. Surgical correction is necessary within 24 hours. Life threatening

lordosis

-inward curvature of cervical and lumbar vertebrae

kyphosis

-rounded thoracic, or sacrum

-common in aging women

scoliosis

-lateral curvature

-best seen when flexing forward

Bicep reflex:

C5 (though innervated by C5 & C6)

Wrist or brachioradialis reflex:

C6 (though innervated by C5 & C6)

Sensory to thumb & 2nd finger:

C6

Tricep reflex:

C6 & C7

Sensory to third finger:

C7

Sensory to 4th & 5th finger:

C 8

Upper abdominal reflex:

T8 - T10

Lower abdominal reflex:

T10 - T12

Patella reflex:

L2 - L4

Sensory to lateral thigh & ankle:

L4

Sensory to lateral calf, big toe, 2nd & 3rd toe

L5

Plantar reflexes:

L5, S1

Achilles reflex, sensory to 4th & 5th toe:

S1

C5 neurological sign

biceps reflex

C6 neurological sign

wrist or brachioradialis

sensory = thumb and 2nd finger

C6, C7

triceps reflex

C7 neurological signs

sensory = third finger

C8 neurological signs

sensory = 4th and 5th fingers

T8-12 neurological signs

abdominal reflex 8, 9 10 = upper. 10, 11, 12 = lower

L2-L4 neurological signs

patella reflex

(bulging disc)

L4 neurological signs

sensory = lateral thigh and ankle

L5

sensory = lateral calf and big toe, 2nd and 3rd toes

babinski

L5-S1 neurological signs

plantar responses

S1 neurological signs

achilles reflex

sensory = 4th and 5th toes and heel