Transcript Physical Examination

Physical Examination
Clinical Signs
Low Back
Straight Leg raise
•
•
•
•
•
•
•
•
•
•
•
•
•
•
One of the Simplest and most effective
tests of nerve root irritation
Compare with bent knee
Elevate and measure angle in degrees
Purpose
To provoke a dural or root sign
Positive Response
Extra-segmental reference of pain
(dural)
Segmental reference of pain (root)
Technique
Patient supine
Flex hip while maintaining knee
extension
Amplify response by dorsiflexing
ankle and/or flexing neck
Comments
This test is biased toward the lower
part of the lumbo-sacral plexus (L4 S1)
A crossed leg (opposite leg) response
may indicate disk bulge medial to the
opposite side root
•
.
Lasegue Sign
• Variation of
Straight leg raise
• Flex hip first with
bent knee and
then straighten
knee or…
• Dorsiflex ankle
with straight leg
elevation to elicit
increased pain
Patrick’s Test
• Sacroiliac Testing
Cervical Examination
• The foraminal compression test or Spurling test is
performed by extending the neck and rotating the
head and then applying downward pressure on the
head. The test is considered positive if pain
radiates into the limb ipsilateral to the side that
the head is rotated to. The Spurling test has been
found to very specific, but not sensitive, in
diagnosing acute radiculopathy.
• Manual cervical distraction can be used as a
physical examination test. With the patient in a
supine position, gentle manual distraction often
greatly reduces the neck and limb symptoms in
patients with radiculopathy.
• Lhermitte sign is performed by flexing the neck
and asking the patient about symptoms of an
electric shock–like sensation radiating down the
spine, and in some patients, into the extremities.
This has been found in patients with cervical cord
involvement, cervical spondylosis, and also in
patients with tumor and multiple sclerosis (MS).
Shoulder Examination
• Apley Scratch Test
• A test for rotator
cuff stability
• Looking for
assymmetry
between shoulders
Neer Impingement Sign
•
is tested by having the patient place
his hand on the unaffected
shoulder and gradually forward
flexing the shoulder;
- impingement sign is elicited w/
pt seated and the examiner
standing;
- scapular rotation is prevented
w/ one hand while other hand
raises arm in forced foward
elevation
causing greater tuberosity to
impinge against the acromion;
- raise the arm somewhere
between flexion and abduction;
- this maneuver produces pain in
pts w/ impingement lesions of all
stages (as well as partial frozen
shoulder, instability, arthritis ect.)
- if this motion is painful at 90
degrees of forward flexion it is a
positive sign for impingement
(primary impingement sign);
- pain during abduction of
the arm to 80 deg and internal
rotation is a secondary
impingement sign;
Hawkins and Kennedy
• Hawkins and
Kennedy described a
second impingement
sign in which the arm
is flexed forward 90
degrees and then
forcibly internally
rotated, jamming the
supraspinatus tendon
against the anterior
edge of the
coracoacromial
ligament to produce
pain.
Apprehension Test/Relocation Test
Supraspinatus Test
•
Hold arms to side as if
holding cans bilaterally
–
Empty Cans test (original test)
•
–
Full Cans Test
•
•
•
Wrists pronated as if
emptying cans
Wrists supinated as if holding
cans upright
May be more specific for
Supraspinatus impingement
Hold arm abducted at 50
degrees against resistance
Supraspinatus
examination ("empty
can" test). The patient
attempts to elevate the
arms against resistance
while the elbows are
extended, the arms are
abducted and the thumbs
are pointing downward.
Infraspinatus/Teres Minor Test
• Infraspinatus/ter
es minor
examination. The
patient attempts
to externally
rotate the arms
against resistance
while the arms
are at the sides
and the elbows
are flexed to 90
degrees
Cross Arm Test
• Cross-arm test for
acromioclavicular
joint disorder. The
patient elevates the
affected arm to 90
degrees, then
actively adducts it
Yergason test
• Yergason test for
biceps tendon
instability or
tendonitis. The
patient's elbow is
flexed to 90 degrees,
and the examiner
resists the patient's
active attempts to
supinate the arm and
flex the elbow.
Speed’s Maneuver
• Forward flex the
shoulder against
resistance while
maintaining the
elbow in extension
and the forearm in
supination. Pain or
tenderness in the
bicipital groove in
dicates bicipital
tendinitis.
Sulcus Test
• With the patient's arm in a
neutral position, the
examiner pulls downward
on the elbow or wrist while
observing the shoulder area
for a sulcus or depression
lateral or inferior to the
acromion. The presence of a
depression indicates inferior
translation of the humerus
and suggests inferior
glenohumeral instability
Scarfs Test
• For AC Joint
Pathology
The Knee
Lachman Sign
•
•
•
•
•
•
ACL - Lachman Test
The patient is in the supine position,
with the knee flexed at 20 to 30
degrees.
Grasp the femur in one hand and the
tibia in the other, and examine the
anteroposterior motion of the knee
by displacing the tibia on the femur.
Grade the motion from 0 to 4+(1+,
5mm; 2+, 10mm; 3+, 15mm; 4+,
20mm).
In addition, examine the endpoint of
the ligament and grade it as firm,
marginal, or stiff. A soft endpoint is
usually indicative of a positive ACL
tear.
PCL - Posterior Drawer Test
(Posterior Sag Sign)
• Have the patient lie supine with
knee at 90 degrees of flexion.
Determine the neutral position by
comparing its resting position
with the normal knee.
• If the PCL is disrupted, the tibia
will sag posteriorly.
• The patient's foot is placed
between examiner's legs while the
palms of the hands are used to
push the tibia posteriorly.
• The stability can be seen from the
lateral view of the knee and the
posterior displacement may be
evaluated by palpating with the
thumb at the joint line.
MCL - Valgus Stress Test
•
•
•
•
•
With the patient in the supine
position, place the knee at 20 to 30
degrees of flexion with the thigh
supported.
Stabilize the femur and palpate the
medial joint line with one hand.
Place the other hand on the distal
tibia - Place the joint surface in the
starting position and abduct the
tibia on the femur, restricting axial
rotation.
Estimate the medial joint space and
evaluate the stiffness of motion.
Laxity is graded on a 1 to 4 scale:
1+, 5mm of medial joint space
opening with a firm but abnormal
endpoint; 2+, 10mm medial opening
with a soft endpoint; 3+ (15mm) and
4+ (20mm) may be indicative of an
assosiated cruciate ligament injury
and must be carefully examined
LCL - Varus Stress Test
•
•
•
•
•
Place the patient in the supine
position, with the knee at 20 to 30
degrees of flexion with the thigh
supported.
Stabilize the femur and palpate
the lateral joint line with one
hand.
Place the other hand on the distal
tibia - begin with the joint in the
starting position and adduct the
tibia on the fumur, restricting
axial rotation.
Estimate the joint space and
evaluate the stiffness of motion.
Grading is similar to that
described above for the valgus
stress test.
McMurray Test
• Have the patient lie
supine with the knee
completely flexed.
• Medially rotate the
tibia: if there is a loose
fragment of the lateral
meniscus, this action
will cause a snap
accompanied by pain.
• Laterally rotate the
tibia: if there is a loose
fragment of the medial
meniscus, this action
will cause a snap
accompanied by pain