Spine
The nerve roots involved with the quadriceps deep tendon reflex.
*Assess both lower extremity DTRs*
What is L2-4?
Shoulder flexion ROM average
What is 165-180 degrees?
Patient positioned in supine. Fulcrum is aligned with lateral aspect of the greater tubercle. Proximal arm is bisecting the lateral trunk (midaxillary line), moving arm is bisecting the lateral humerus.
Typical Elbow Extension end feel
*Perform PROM assessment*
What is Hard/Bony?
Normal ROM- 0 deg/slight hyperextension
Open pack position for the radiocarpal joint
*Perform Joint Mobility Assessment*
What is Neutral with Slight Ulnar Deviation?
What is your favorite joint to assess in the body?
Bonus! Everyone gets 100 points. :)
The most commonly affected cervical nerve root which provides sensation to the distal middle finger.
*Assess entire nerve root*
What is C7?
These tests (if positive) would make you suspicious of the MOST COMMON direction of shoulder instability.
What are apprehension and relocation tests?
Manual Muscle Test Set-Up for Triceps Brachii
What is gravity-resisted Patient supine with shoulder flexed to 90 deg, near full elbow extension
Gravity Minimized- sidelying
Entrapment site of ulnar nerve at the wrist
*Palpate and discuss potential findings*
What is Guyon's Canal?
These muscles adduct the MCP joints of the hand.
*Perform a manual muscle test*
What are palmar interossei?
Seated with forearm supported wrist in neutral, fingers fully abducted and allowed to
extend beyond supporting surface. Stabilize over dorsal surface of 2nd through 5th
metacarpals. Patient adducts through full
ROM while examiner maintains stabilization of
MC’s. Use one finger to apply resistance along proximal phalanx of each finger individually as follows:
- on the ulnar side of the 2nd digit in direction of abduction
- on radial side of the 4th digit in direction of
abduction
2nd - radial side of base of proximal phalanx and the EH of the fourth digit.
3rd- radial side of the base of the proximal phalanx and the EH of the 5th digit.
A concern for myelopathy is indicated by this group of tests and would necessitate a referral OUT
What are Upper Motor Neuron Signs?
(Hyperreflexive DTRs, Babinski, Clonus, Hoffman)
Loss of range of motion in this coupled with hypomobility will help you to rule in a frozen shoulder diagnosis.
*Perform a Joint Mobility assessment of the affected joint*
What is Capsular Pattern- loss of ROM in at least 2 directions with ER being the most limited (>25% deficit)?
The muscle(s) that Cozen's Test is primarily assessing.
This finding would indicate an immediate referral OUT due to suspicion of a fracture at the proximal row of carpal bones.
What is Snuffbox tenderness or scaphoid compression?
What is Bunnell-Littler Test?
Lower back pain that radiates into the lower extremity would cause a clinician to assess this to evaluate centralization and peripheralization.
What is repeated movement testing?
This manual muscle test will help you to evaluate the strength of the infraspinatus and teres minor muscles.
*Demonstrate proper set-up for gravity resisted AND gravity minimized positions!*
What is external rotation MMT?
The steps of an ULNT for the median nerve.
This structure acts to stabilize the wrist and sits just distal to the ulnar head.
*Perform 3 special tests to assess for integrity*
What is TFCC (triangular fibrocartilage complex)?
Piano key test, Press test, ulnar fovea sign, supination lift test
Deformity characterized by MCP ext, PIP flex, DIP ext
*Demonstrate ROM assessment for the above*
What is Boutonniere’s deformity?
The following would make you suspicious of an ICF classification of neck pain with mobility deficits.
What is hypomobility of the cervical spine segments with CPA/UPA testing?
This cluster of tests, if positive, would significantly help you to rule in subacromial pain syndrome.
What are Hawkins Kennedy, Painful Arc, Infraspinatus RT?
Daily Double!!
Joint arthrokinematics of proximal AND distal radioulnar joints
*perform joint mobility assessment of both joints*
What is Proximal Radioulnar Joint: Convex radial head on concave radial notch of ulna
-pronation: posterior glide
-supination- anterior glide
Distal Radioulnar Joint: Concave ulnar notch of radius on convex ulnar head
-pronation: anterior glide
-supination: posterior glide
A muscle that, if impaired, would cause suspicion of carpal tunnel syndrome?
*Perform MMTs for these muscles*
What are:
L: Lumbricals 1,2
O: Opponens pollicis
A: Abductor pollicis brevis
F: Flexor pollicis brevis
Joint type and arthrokinematics of the first CMC joint.
*Assess Joint Mobility of 1st CMC Joint*
What is Saddle Joint?
Frontal Plane- Flexion/Extension- Concave on Convex
Flexion- ulnar roll/glide, Extension- Radial roll/glide
Sagittal Plane- Abduction/Adduction- Convex on Concave
Abduction: Palmar Roll/Dorsal Glide, Adduction: Dorsal Roll/Palmar Glide