Part 4 Boards - Ortho

The flashcards below were created by user dcmommy13 on FreezingBlue Flashcards.

  1. Range of motions...
    • Show the pt what to do.
    • *Cervical
    • *Shoulder: start from neutral for int & ext rot. (Flexion down, extension up... int rotation down, ext rotation up).  
    • *Elbow: neutral is thumb up... Keep elbows bent.  
    • *Wrist
    • *Thoracolumbar: lean forward for rotation... standing.  
    • *Hip: do standing unless told otherwise. 
    • *Knee
    • *Ankle: pt seated. 
  2. What should you say if the patient experiences pain during an ortho test?
    "Show me where it hurts."
  3. 1. What should you do before performing FCT?
    2. What does a positive radicular FCT indicate?
    • 1. Before doing FCT, check rotation
    • 2. (+) FCT w/ radiating SX = NRC... (+) FCT w/ local pain = foraminal encroachment. 
    • *Pt actively rotates head, then the dr applies pressure in neutral, then rotation.
    • *Make sure to ask: "Any pain with that?"  
  4. Describe Jackson's Compression Test...
    • Pt seated, dr laterally flexes the pt's head & then applies downward pressure. 
    • *Do bilaterally.
    • *Radicular pain = NRC. 
    • *Screen first by doing LF. 
  5. Verbal component for Cervical Distraction Test?
    • "Let me know what you experience.
    • *Decreased pain = NRC.
    • *Increased pain = sprain/strain. 
  6. 2 MC locations they ask us to do O'Donohue's?
    • 1. C-spine: F, E, LF, rot. 
    • 2. Ankle: dorsiflexion, plantar flexion, inversion, eversion. 
    • *Do AROM first, followed by PROM.
    • *AROM = tendon. 
    • *PROM = ligament. 
  7. A (+) Valsalva indicates a SOL; for NBCE MCly D/T ______.
    A (+) Valsalva indicates a SOL; for NBCE MCly D/T disc.
  8. Describe the 2 steps for Max CCT...
    • 1. Pt seated; actively rotate head & hyperextends the neck to one side.
    • 2. If no pain; maximally LF the neck. 
    • *Perform bilaterally.
  9. What does a (+) Max CCT indicate?
    Nerve root compression.
  10. A (+) Shoulder Depressor Test indicates...
    • Pain = Nerve Root Adhesion. 
    • *W/ the dr's arms criss crossing & the pt seated; depress the shoulder while LFing the C-spine away from the shoulder.
    • *Do bilaterally. 
  11. What are the 2 indications associated with Soto Hall Sign?
    • 1. Anterior localized pain = FX.
    • 2. Posterior localized pain = ligament. 
    • *Pt supine; Dr places one hand on the sternum while passively flexing the pt's head towards chest. 
  12. What is an A/K/A for the Shoulder ABduction Test?
    • Bakody's Test. 
    • *Pt seated; pt actively places affected arm on top of their head.
    • *Relief of pain = IVF encroachment. 
  13. ALLEN'S TEST NBCE style...
    • 1. Pt's hand on their thigh. 
    • 2. Occlude the A's.
    • 3. Have them pump their fist 3 x's, then clinch & open. 
    • *Delay of more than 10 seconds for the blood to return = occlusion of the corresponding A. 
  14. Which (+) TOS test indicates compression between the first rib & clavicle?
    • Costoclavicular Maneuver (Eden's Test). 
    • *Dr palpates the radial pulse while bringing the shoulder down & arm back... then the pt flexes their chin to chest. 
    • *Alteration in radial pulse amplitude = compression between the 1st rib & clavicle. 
  15. A (+) Adson's Test indicates compression by....
    • A/K/A Scalenus Anticus Test = the anterior scalene &/or cervical rib. 
    • *Pt seated, doctor slightly ABducts/extends/externally rotates the arm while taking the radial pulse... Pt rotates the head towards the tested side & extends the head... Pt takes a deep breath in & holds. 
  16. Which structures are involved with a positive Modified Adson's Test?
    • The subclavian A & medial scalene. 
    • *If Adson's is negative; have the pt rotate their head to the opposite side, extend their head & take a deep breath & hold while dr feels radial pulse. 
  17. How far do you ABduct the arms with Wright's Test?
    • Both arms @ once to 180 degrees. 
    • *Note the angle in which the pulse decreases... >10 degrees = asymmetrical pec minor syndrome (compression of the Ax A). 
  18. What is Reverse Bakody's testing for?
    • TOS.
    • *Pt seated; places palm on top of head = increased pain. 
  19. A (+) Halstead's indicates...
    • Cervical rib. 
    • *Pt extends head back & dr exerts downward traction & slight ABduction of the arm while taking the pulse.
    • *Test both arms at once. 
  20. What exercise should be prescribed for shoulder complaints?
    • Codman's Pendulum Exercises.
    • *DX via MRI. 
  21. Which ortho test is for degenerative tendonitis of the rotator cuff?
    • Apley's Test: pain or decreased motion = degenerative tendonitis. 
    • *Pt seated; touch sup & inf angles of both scapulas. 
    • *Show pt how to do it then go behind them to observe. 
  22. Which 2 shoulder tests are used to DX a supraspinatus tear?
    • 1. Codman's Drop Arm. 
    • 2. Empty the Can Test (Supraspinatus Press Test).
  23. A look of apprehension on the patients face when testing the shoulder indicates...
    • Apprehension Test = chronic shoulder dislocation. 
    • *Pt seated; dr ABducts the arm slowly then rotates the shoulder w/ stabilization. 
  24. A (+) Dugas Test indicates...
    Shoulder dislocation.
  25. You are palpating the shoulder for which 2 ortho tests?
    • Yergason's & Dawbarns. 
  26. Which ortho test for the shoulder DX's bicipital tendon instability?
    • Yergason's.
    • *Pt seated; dr places LIGHT pressure @ the biceps tendon against resistance. 
    • *Audible click in the bicipital groove = bicipital tendon instability. 
  27. Which shoulder ortho test is (+) when the pain is decreased?
    • Dawbarn's.
    • *Pt seated; deep palpation over the subacromial bursa elicits pain... dr ABducts arm & pain is decreased. 
  28. Which ortho test causes the greater tuberosity to jam against the acromial surface?
    • Impingement Sign.
    • *Pt seated; arm slightly ABducted, the doctor moves the shoulder through full flexion. 
    • *Pain =  overuse of tendons. 
  29. A/K/A for Empty Can Test?
    • Supraspinatus Press Test. 
    • *Pt seated; shoulders ABducted to 90, then apply resistance. Have pt flex their shoulders to 30 degrees & point thumbs downward & apply resistance again... (Test like deltoid, then pour it out). 
    • *Weakness = Supraspinatus Tear. 
  30. (+) finding for Speeds Test?
    Pain = bicipital tendonitis.
    • Dr applies quick deep pressure over the subacromial bursa.
    • *Pain = supraspinatus degeneration, subacromial bursitis. 
    • Pt is standing; dr approximates the scapulae by lifting the shoulders up & back. 
    • *Scapular pain = T1 or T2 NR problem on the side of pain
    • Dr observes the pt's posture & notes the heights of the ax folds. 
    • *Lower ax fold on involved side = shoulder dislocation. 
  34. A/K/A for Radiohumeral Bursitis?
    • Lateral Epicondylitis / Tennis Elbow. 
    • *ECRB.
    • *Pain w/ wrist extension & elbow pronation. 
  35. A/K/A for Little Leaguer's Elbow?
    • Medial epicondylitis / Golfer's Elbow. 
    • *FCU. 
    • *Pain w/ wrist flexion @ the medial portion of the elbow. 
    • *TX = TFM, US, counterforce, stretch, cross friction & strengthening. 
  36. What are the 2 tests for lateral epicondylitis?
    • 1. Cozen's Test.
    • 2. Mill's Test.
    • Test how I learned Mill's Test.
    • *Pain @ medial elbow = medial epicondylitis. 
    • Dr passive flexes the fingers, wrist & elbow, then brings the elbow around into max pronation & extension. 
    • *Pain @ lateral elbow = lateral epicondylitis. 
  39. What is the positive finding for tinel's sign @ the wrist? What does it indicate?
    • Tingling into the lateral 3 fingers = CTS.
    • Medial 2 fingers = Ulnar N impingement.
    • *Tap pisiform & retinaculum. 
  40. (+) finding for Phalen's Sign?
    • Tingling into the lat 3 fingers = CTS.
    • *Have the pt mirror you.
    • *The patient flexes the wrists maximally & holds the position for 1 min by pushing both wrists together. 
    • "58,59,60 - ok relax."
  41. A/K/A for Reverse Phalen's?
    Prayer Sign.
  42. A (+) pinch grip test indicates a problem with...
    • Pt approximates pads of fingers together = Median N lesion. 
    • *Have pt approximate the tip of the index finters to the tip of the thumb.
    • "Put your fingers like this - tip to tip."
  43. A (+) Froment's Paper Sign indicates a problem with which nerve?
    • Ulnar N.
    • *Unable to keep paper between fingers = Ulnar N palsy. 
    • Dr applies moderate compression to the distal aspect of the radius & ulna (Squeeze hand).  
    • *Pain = RA if bilateral & fits HX, or sprain/strain injury if unilateral. 
  45. A (+) SLR indicates...
    • Sciatic, disc or lumbar lesion on the affected side.
    • *Place one hand under the heel & one over the knee. 
  46. What are the 4 SLR-like tests?
    • 1. Lasegue Rebound Test. 
    • 2. Bragard's Sign. 
    • 3. Sicard's Sign. 
    • 4. Well Leg Raiser.
    • Following a (+) SLR; the Dr gradually drops the pt's leg. 
    • *Increased pain = sciatica, disc or mm spasm. 
  48. What does a (+) Bragard's sign indicate?
    • Increased pain = primary sciatica.
    • *Following a (+) SLR; the leg is lowered 5 degrees & the foot is sharply dorsiflexed.
  49. Describe Sicard's Sign...
    • Perform the SLR, drop 5 degrees & dorsiflex the big toe. 
    • *Pain in affected leg = sciatica. 
  50. Which test for sciatica includes dorsiflexion of the big toe?
    • Turyn's Sign. 
    • *Pt supine; Dr dorsiflexes the big toe.
    • *Pain in affected leg = sciatica. 
    • SLR w/ dorsiflexion of the foot performed on the asymptomatic side. 
    • *Pain on symptomatic side = medial disc lesion. 
  52. A (+) Millgram's indicates...
    • SOL. 
    • *Pt supine; hold legs 6" off table for 30 seconds.
    • *Pain = SOL. 
    • Pt supine; Dr picks up the pt's legs to 90 degrees & asks the pt to lower legs slowly to the table.
    • *LBP = SOL. 
    • Pt supine; Dr does a SLR on each side noting the degree of pain... then does both legs & notes the degree of pain.
    • *Single, single, double.  
    • *Pain occurs earlier when both legs are raised = lumbosacral joint lesion. 
  55. What are the 3 (+)'s for Goldwaith's Sign?
    • 1. 0-30: SI-joints.
    • 2. 30-60: lumbosacral joint.
    • 3. 60-90: lumbar spine or contralateral SI joint. 
    • *Pt supine; raise affected leg slowly w/ hand under lumbar portion of the spine. 
  56. What 4 ortho tests are the same but with a different indication?
    • 1. Soto Hall: FX or ligament sprain. 
    • 2. Brudzinski's: meningitis. 
    • 3. L'Hermittes: MS.
    • 4. Lindler's: root sciatica.
  57. A (+) Lindner's Sign indicates...
    Pain in the lumbar spine radiating to the sciatic N = NR sciatica.
  58. With which ortho test is the patient's leg on your shoulder as you place pressure over the popliteal fossa?
    • Bowstring.
    • *Pain in the lumbar region/radiculopathy = sciatica on side being tested. 
    • *Dr performs a SLR to the point of pain; knee flexed slightly & placed on the dr's shoulder... digital pressure in the popliteal fossa. 
  59. What is the ortho test for piriformis syndrome?
    • Bonnet's Sign. 
    • *Pt supine; Dr stands on being tested & internally rotates & adducts the leg, then SLR's it. 
    • *Radicular pain into the limb = piriformis syndrome. 
    • *"Squeeze your boner.
  60. Name this test... Image Upload 1
    • Sitting Becterew's.
    • *Pt seated; pt extends one leg at a time. Dr applies resistance to one leg at a time & then  both. 
    • *Pain or leaning back = postmed disc protrusion if pain when good leg raised. 
  61. A (+) Minor's Sign indicates...
    • Sciatica. 
    • *Ask pt to rise from a seated position... (+) when they crawl up their leg when standing up. 
  62. NBCE instructions for Kemp's...
    • Cross arms, lean forward, then bring them back into extension.
    • *Radiating sciatic pain = disc.
    • *Local symptoms = facet. 
  63. How many steps should the pt take for heel walk & toe walk?
    • 7. 
    • Heel walk = L5.
    • Toe walk = S1. 
  64. What are the (+) findings for the Supported Adam's Test?
    • No pain w/ stabilization = SI lesion.
    • Pain w/ stabilization = lumbar. 
    • *Belt test. 
  65. Name this test
    Image Upload 2
    • Gaenslen's.
    • *SI-joint pain = SI-joint lesion. 
  66. Name this test
    Image Upload 3
    • Lewin Gaenslen's. 
    • *SI-joint pain = SI-joint lesion. 
  67. What does a (+) Iliac Compression Test indicate?
    SI-joint pain = SI-joint lesion.
  68. Hip ABduction Stress Test: pt is side-lying w/ involved side up. ________ ABducts the leg & the Dr _________________.
    • Hip ABduction Stress Test: pt is side-lying w/ involved side up. Pt actively ABducts the leg & the Dr exerts downward pressure prox. to the knee
    • *Pain @ the PSIS = SI-joint problems.
    • *Weakness = Glute med weakness. 
  70. Which side do you stabilize for Hibb's Test?
    • Stand on the side you stabilize, test the other side. 
    • *SI pain = SI lesion.
    • *Or pt points to hip pain. 
  71. Which side do you stabilize with Nachlas Test?
    • Stand, stabilize & test same side. 
    • *Heel approximated to same side butt. 
    • *SI pain = SI lesion. 
  72. Is there stabilization with Yeoman's Test?
    • Stabilize same side of leg you are raising. 
    • *Dr stabilizes SI-joint testing & lifts the knee off the table bring it towards the pt's butt. 
    • *Deep SI pain = SI joint lesion. 
    • Pt prone & Dr stabilizes the lumbosacral area. Dr lifts involved leg into hyperextension while the knee remains extended.
    • *Lift leg prox. to the knee.
    • *Localized lumbar pain w/ ant thigh pain = L3/4 NR lesion. 
  74. Which test makes a 4 with the pt's leg?
    • Patrick's / Fabere
    • *Pain in the hip = hip lesion. 
  75. A (+) Laguerre's Test indicates...
    Pain in the hip = hip joint lesion.
    • Pt supine; thigh flexed w/ knee bent to abdomen. 
    • *Opposite thigh/knee rises off the tale = hip flexion contracture. 
  77. (+) Anvil Test indicates...
    • Pain in the hip = hip joint pathology. 
    • *Can be heel, tibia, fibula or femur FX. 
    • *Elevate the leg before striking. 
  78. What is a lazy Nachlas?
    • Ely's Sign. 
    • *Pt prone; heel approximated to the butt after flexion of the knee.
    • *Hip elevates = hip flexor contracture. 
  79. ________: heel approximated to the opposite butt.
    • Ely's Test: heel approximated to the opposite buttock. 
    • *Pain = hip lesion. 
  80. Which side is tested w/ Trendelenberg's?
    • Supported leg.
    • *Buttock on foot that is elevated drops = glute med weakness on leg they are standing on. 
  81. A (+) Neri's Sign indicates...
    Knee buckles = tight hamstrings.
  82. What is the MCly injured mm of the knee?
    Vastus medialis.
  83. 3 mm's that make up the Terrible Triad?
    • 1. MCL.
    • 2. ACL.
    • 3. Medial meniscus.
  84. What is the MCly injured knee ligament?
  85. Which mm is responsible for chondromalacia patella?
    Vastus lateralis.
  86. When you tear your meniscus, when does swelling show up?
    12-24 hours post injury.
  87. When does swelling show up after a ligament tear?
  88. A (+) Apley's Distraction Test of the knee indicates...
    • Pain in the knee = collateral ligament tear. 
    • *Exaggerate elbow movements! 
    • *Heel points towards the side being tested. 
  89. A (+) Apley's Compression Test indicates...
    • Pain in the knee = meniscal tear. 
    • *Grasp proximal to the foot.
    • *Rotate leg internally & externally while applying downward pressure. 
    • *Heel points towards side being test. 
  90. Pulling P-A (anteriorly) with the Drawer Test of the knee is testing which ligament?
    • ACL.
    • *Pulling A-P (posteriorly) = PCL. 
    • Pt supine; knee flexed to 30 degrees... Dr stabilizes the femur & twists the leg. 
    • *Soft end-feel = ACL instability. 
  92. Applying L-M pressure at the knee is known as __________ stress test A/K/A ______ stress test.
    • Applying L-M pressure at the knee is known as VALGUS stress test A/K/A ABDUCTION stress test. 
    • *Testing the MCL. 
    • *Pushing in = valgus stress = testing medial. 
    • Painful click or snap heard...
    • *Int rotation = lat meniscus.
    • *Ext rotation = medial meniscus. 
  94. (+) for the Apprehension Test (Patella)...
    • Look of apprehension = chronic patellar dislocation. 
    • *Push patella M-L. 
  95. Where are you looking for Clarke's Sign?
    At the pt's face = chondromalacia patella.
    Image Upload 4
    • Dr places the leg in the 90/90 position & applies pressure to the distal lat femur, then the Dr extends the knee. 
    • *Put pressure on the IT-band. 
    • *Increased pain = TFL contracture.
  97. OBER'S TEST 
    • Pt side-lying, ISU; Dr places one hand on the pelvis. Thigh is ABducted & extended. Dr allows the leg to drop into addiction. 
    • *Knee stays elevated = TFL contracture.
    • *They love this test. 
  98. Where is the MC location for a Morton's Neuroma?
    Between the 3rd & 4th metaT heads.
  99. Where does a March FX occur?
    2nd metaT.
  100. A heel spur is worse ________.
    • A heel spur is worse when waking in the morning... Improves as the day progresses. 
    • *Plantar fasciitis. 
  101. Pain & burning on the sole of the foot indicates a problem with...
    • Tarsal Tunnel Syndrome = medial plantar N. 
    • *Tap behind medial malleolus. 
  102. Hand placement for the Anterior Drawer Test of the ankle?
    • Pt supine; hand around the ant. aspect of the lower tibia, grasp calcaneus & pull the calcaneus forward. 
    • *Talus slides forward = ant. talofibular lig. instability. 
  103. Hand placement for the Posterior Drawer Test of the ankle?
    • Pt supine; hand around the post. aspect of the lower tibia while pushing the talus post. 
    • *Talus slides back = post. talofibuar lig. instability. 
  104. A (+) Ankle Stability Test indicates...
    • Excessive gapping w/ inversion = ant talofib lig tear.
    • Excessive gapping w/ eversion = deltoid lig tear. 
    • *Pt seated or supine; grasp pt's foot & passively inverts or everts it. 
  105. A (+) Tinel's Test of the ankle indicates...
    • Pain & tingling on the sole of the foot = TTS. 
    • *Pt supine; percuss post to the med. malleolus. 
  106. Thompson's VS Thomas test...
    • Thompson: pt prone; flex knee to 90 & pump the calf... no plantar flexion = achilles rupture.
    • Thomas: pt supine; thigh flexed w/ knee bent to abdomen... opposite thigh/knee rises off the tale = hip flexion contracture.
  107. A/K/A for Thompson's Test?
    Simmond's Test.
  108. What are the 4 malingering tests?
    • 1. Burn's Bench Test
    • 2. Hoover's Sign
    • 3. Magnusson's: have pt point to pain, then do it again later. 
    • 4. Mannkopf's Sign: take pulse & apply pressure.
  109. What are the 4 tests for AS?
    • 1. Chest expansion test
    • 2. Amos' Sign
    • 3. Lewin Supine
    • 4. Forrestier's Bowstring Test
  110. What is the WNL range for the Chest Expansion Test?
    • Women: <1.5"
    • Men: <2" 
    • *Tape measure placed at T4. 
    • *Have pt exhale completely & take a measurement, then inhale deeply & measure again.
    • *Do 3 breaths. 
    • *(+) = AS. 
  111. Describe Amos' Sign.
    • Pt asked to go from side-lying to standing. 
    • *Localized pain &/or lack of ROM = AS, severe IVD, or sprain/strain. 
    • Pt supine; Dr holds the ankles on the table & does a partial sit up (to make an L) w/o using their hands. 
    • *Unable to perform = AS. 
    • Pt standing; side bending to both sides.
    • *Tight mm's on the concave side = AS. 
  114. What are the 3 tests for Meningeal Irritation?
    • 1. Brudzinski Sign
    • 2. Bikele's Sign
    • 3. Kernig's Sign
  115. Describe Brudzinski's Sign.
    • Pt supine; Dr passively flexes the pt's head to the chest.
    • *Buckling of the pt's knees = meningitis. 
  116. Name this test... 
    Image Upload 5
    • Kernig's. 
    • *Pt supine; resists extension which causes a kicking motion = meningitis.  
  117. BIKELE'S SIGN ???
    • Pt actively ABducts shoulder to 90 degrees w/ elbow flexed to 90 degree, then extends the shoulder, then extends the elbow.
    • *Up, back, extend ???
    • *Resistance = increased radicular pain = meningeal irritation, TOS, brachial plexus neuritis. 
  118. What is the ortho test associated with MS?
    • Lhermitte's Sign
    • *Pt seated or supine; pt passively flexes head towards chest. 
    • *Sharp electric shock like sensation down the spine into the extremities = MS, myelopathy. 
  119. What ortho test is used to DX a rib FX?
    • Sternal compression test.
    • *Pt supine; Dr applies downward pressure on the sternum.
    • *Pain localized at the lateral rib border = rib FX. 
  120. A pt just got back from Vietnam & presents w/ a red hot swollen calf... what ortho test should you do (for boards)?
    • Homan's Sign.
    • *Pt supine; dr puts leg in 90/90 position & squeezes the calf while dorsiflexing the foot. 
    • *Deep pain = DVT. 
    • *Send to ER for anticoagulant therapy. 
  121. Pain on the concave side w/ Schepelmann's Sign indicates...
    • Intercostal neuralgia. 
    • *Pain on convexity = pleurisy. 
    • *Pt raises both arms over their head while seated & lat bends to both sides.
    • *Incidental finding: shingles. 
    • "Where does it hurt?"
  122. Pain _______ indicates intermittent claudication.
    Claudication test: pt marches in place, taking 2 steps/second... pain in the calves = intermittent claudication.
  123. Describe the 3 steps for Adam's Test...
    • 1. Dr observes the pt's posture from back.
    • 2. Observe posture while bending over from back. 
    • 3. Observe posture while bending over from front.
  124. If the asymmetry does not change with Adam's Positions, that indicates...
    • Structural scoliosis (MCly D/T hemi vertebra). 
    • *Asymmetry changes = functional scoliosis. 
  125. Describe the Rib Compression Test.
    • Stand behind the pt & wrap your arms around the pt's chest, then extend your elbows thus applying pressure to the lateral aspect of the rib cage. 
    • *Localized pain = costochondritis. 
  126. How do you preform the Spinal Percussion Test?
    • Percuss over each SP, then repeat again on the musculature. 
    • *Call out segments you are on as you are doing it.
    • *Time consuming! If you do not have time, skip the mm's. 
    • *Pain = FX, lig sprain, disc herniation or mm strain. 
  127. Which tuining fork do you use for the Spinal Vibration Test?
    • The earmuffed one. 
    • *Pain = VB FX. 
    • Dr applies finger pressure over the MP. Increase pressure until the pt has discomfort. 
    • *Used to determine pain threshold. 
  129. Verbal compnent for Rust Sign?
    • "I noticed you have your hands on your neck. Can you tell me more about this?"
    • *Rust sign = cervical instability. 
    • Dr observes the pt's umbilicus while they do a partial sit-up.
    • *Umbilicus moves laterally = T10 NR lesion. 
    • *Goes up = T11/12 lesion.
    • *Goes down = T7-9 lesion. 
Card Set
Part 4 Boards - Ortho
Show Answers