Interventional pain

Hoffman’s signs

A clinical test used to assess for upper motor neuron lesions, characterized by involuntary flexion of the thumb and index finger upon flicking the nail of the middle finger.

Hawkins-kennedy test

Assesses for shoulder impingement by elevating the arm, bending it 90 degrees towards the body, and using internal rotation (downwards) to see if pain is elicited

Neers shoulder test

Used to diagnose subacromial impingement by raising the arm above the head while stabilizing the scapula to see if pain occurs.

Empty can test

Used to assess for rotator cuff tears, particularly of the supraspinatus muscle, by having the patient elevate their arms in a "thumbs down" position with palms facing outward and apply downward resistance.

Phalen’s test

A clinical test used to diagnose carpal tunnel syndrome by having the patient place the palms of their hands together like a prayer, flexing their wrists to see if numbness or tingling occurs in the fingers.

Carpal tunnel syndrome

A condition caused by compression of the median nerve as it travels under the carpal tunnel passageway through the wrist, leading to symptoms like numbness, tingling, and weakness in the hand.

Straight leg raises

Patient lies supine on their back and raise one leg while keeping the knee straight, observing for pain or discomfort. Positive if pain is reproduced while the leg is between 30 and 70 degrees in the air with the knee straight

Flexion, Abduction, and External Rotation

FABER test spelled out

FABER test

A physical examination test used to assess hip and sacroiliac joint dysfunction by evaluating the patient's ability to flex, abduct, and externally rotate the hip. Press down on the knee as it is folded over the other leg in a 4

Thigh thrust test

Reach under the buttocks while the knee is bent so that the heel is digging into the thigh, press a vertical force through the femur while the patient lies supine, evaluating for pain in the sacroiliac region.

Stork test

Physician stands behind the standing patient and places their hands at the left and right lateral sides of their hips. The patient stands on one leg while raising the other with a bent knee towards their chest. Positive is when lifting the opposite leg causes the pelvis to drop or pain is elicited in the sacroiliac region.

Sacral compression

Patient is laid on their side and downward pressure was applied to the hip - positive test is if the patient reports pain from the pressure in the sacroiliac joint area.

Log roll

Patient lies on their back and the physician places both hands on one shin and makes a rolling motion. Positive test if the patient reports pain during this action.

Flexion, adduction, and internal rotation

FADIR test spelled out

FADIR test

Patients are on their back, knee is bent inward to the body and pressure is placed on the shin so that the hip is turned inwardly. Positive is pain reproduced with or without clicking.

Lumbar facet loading

Patient stands upright and the doctor leans them back and twists them side to side. Positive if the patient reports pain in their back while twisting. This indicates lumbar facet origin to the low back pain.

Cervical facet loading

The patient is sitting and their neck is slightly leaned back while twisting gently from side to side. The test is positive if the patient reports any pain in their neck or upper extremities or shoulders

Spurlings

Positive if the patient reports radiation of pain into their upper extremities during the cervical facet loading

Sacroiliac joint injections

INJECTION: Must document sacral compression, thigh thrust, and FABERs to justify this procedure

Sacral compression, thigh thrusts, FABAR tests

Tests that have to be documented to perform a sacroiliac joint injection (3):

Transforaminal epidural steroid injections

INJECTION: Usually indicated if the pain isn’t SI joint or lumbar/cervical facet originating. Injection goes into the space between your spinal column and the spinal cord

Interlaminar epidural steroid injections

INJECTION: Usually indicated if the pain isn’t SI joint or lumbar/cervical facet originating. Injection goes into the space between the laminae of two adjacent vertebrae

Medial branch blocks

MBB spelled out

MBB

INJECTION: diagnoses to determine if facet joints are the cause of pain; patient must show improvement after 2 of these to proceed to RFA

Radiofrequency ablation

RFA spelled out

RFA

Patient may only proceed with this if they show improvement following two diagnostic MBBs or if this is a repeat of the procedure in less than 2 years since the last one

Botox

INJECTION: Used for migraines or cervical dystonia; make sure to include the number of headaches that a patient experiences in a month (must be over 15), quality of the headaches, and length for insurance purposes

Migraines, cervical dystonia

What are botox used to treat? (2)

Number in a month, quality, length

Features of headaches that must be documented for botox treatments for migraines (3):

Ultrasound guided injection

INJECTION: Diverse array of injections specific to the location of a patient’s pain.

Trigger point injections

INJECTION: rare procedure

Spinal cord stimulator

SCS spelled out

SCS

TREATMENT: a patient must show that they have exhausted all other options to treat their pain - failed to show significant improvement with medication, physical therapy, other injections. Also needs psych evaluation

Toradol injection

INJECTION: would go under the medications tab of the A&P and can be done in the office; anti-inflammatory steroid injection into the deltoid muscle or buttock