NBCE Part 2 Boards - Part II NBCE Questions and Answers correct

NBCE Part 2 Boards - Part II NBCE Questions and Answers correct Foraminal Compression Test The patient is seated and actively rotates head from side to side. Then the doctor exerts downward pressure and the head is rotated to each side with pressure. Positive Radicular Pain - Nerve Root Compression Positive Local Pain - Foraminal Encroachment Jackson's Compression Test The patient is seated and the doctor laterally flexes the patient head to the left and the right and applies downward pressure. Postive Radicular Pain - Nerve Root Compression Distraction Test The patient is seated and the doctor holds under the mastoid and pulls the patient's head superior, removing the weight of the head. "What did you experience?" Decreased Pain - Nerve Root Compression Increased Pain - Sprain/Strain O'Donohue's Test is for.... Determining whether it is a SPRAIN or STRAIN O'Donohue's Test Performed 1) Patient actively moves part against resistance. 2) Then the doctor moves part passively through a full ROM. Pain Active: STRAIN (damage in mm tissue) Pain Passive: SPRAIN (damage I'm ligamentous tissue) Valsalva's Maneuver The doctor asks the patient to take a deep breath and hold while bearing down. Postive Radicular Pain - SOL Maximal Cervical Compression Test Patient is seated and actively rotated and extended head. If no pain the patient is asked to maximally laterally flex head in the same direction. Repeat on the other side. No compression applied. Postive Radicular pain - Nerve Root Compression Shoulder Depression Test Patient is seated, the doctor depressed the patient's shoulder while laterally flexing the cervical spine away from the shoulder. Repeat on other side. Postive Pain - Nerve Root Adhesion Soto Hall Sign Patient supine and the doctor places one hand on the patient's stream and passively flexes the patient's head towards his/her chest. Positive localized pain - ant: fracture/ post: ligament tear Bakody's Test AKA Shoulder Abduction Test Patient is seated and placed affected arm's palm on top of their head. The elbow should be at the level of the head. Postive Relief of Pain - IVF encroachment Thoracic Outlet Syndrome AKA Neurovascular Compression Syndrome Allen's Test Patient is seated with their elbow flexed and forearm supinated. Ask patient to pump their hand while doctor occludes the radial and ulnar arteries until hand whitens. The patient the opens hand and doctor releases on artery, recording fill time (until hand regains color). Repeat for other artery. Postive for delay more than 10 seconds - occlusion of the tested artery Costoclavicular Maneuver AKA Eden's Test Eden's Test Performed Patient is seated and doctor palpated for the radial pulse. Patient brings shoulder down and back and then flexes chin to their chest. Positive if alteration to amplitude of radial pulse - compression between first rib and clavicle Adson's Test AKA Scalenus Anticus Test Scalenus Anticus Test Performed (MUST KNOW) Patient is seated and doctor abducts, extends and externally rotates arm while taking the radial pulse. Patient rotates head TOWARDS the tested side and extends head. Patient takes a deep breath and holds it. Postive if alteration to amplitude of radial pulse - Scalenus Anticus Syndrome (Cervical "Halstead" rib) Modified Adson's Test AKA Scalenus Medius Test Scalenus Medius Test Performed (MUST KNOW) Patient is seated and doctor abducts, extends and externally rotates arm while taking the radial pulse. Patient rotates head AWAY from the tested side and extends head. Patient takes a deep breath and holds it. Positive if alteration to amplitude of radial pulse - Scalenus medium syndrome (Subclavian Artery) Wright's Test AKA Hyperabduction Maneuver Hyperabduction Maneuver Performed (MUST KNOW) Patient is seated and doctor palpated radial pulse. Both arms are abducted 180degrees. The doctor notes at what angle the radial pulse diminishes or disappears. Positive f pulses are lost greater than 10degrees difference - Pectorals Minor Syndrome (Axillary Artery) Reverse Bakody Maneuver Patient is seated and patient actively placed palm on top of their head. Positive is pain is increased - TOS Halstead's Test Patient is seated and extends their head backwards. The examiner exerts downward traction and slight abduction on arm while taking patient's pulse. Positive if alteration in the amplitude of the radial pulse - cervical rib Rotator Cuff Injury...is muscle or tendon more commonly injured? TENDONS Which Rotator cuff tendon is most likely injured? SUPRASPINATUS How do you diagnosis and treat a Rotator Cuff Tear? Diagnosis: MRI Treatment: Codman's Exercises Apley's Scratch Test Patient is seated and actively moves hand behind head in attempt to touch the superior angle of the scapula. The patient then moves hand behind back to touch the inferior angle of the same scapula. Positive decreased ROM - Degenerative tendonitis of the Rotator Cuff Cowman's Drop Arm Test The doctor passively abducts the patient's arm to above 90 degrees and suddenly removes support. This will cause a firing of the deltoid muscle. Positive: Patient unable to maintain arm position - supraspinatous tear Apprehension Test The doctor abducts and slowly externally rotates the affected shoulder. Positive: Patient shows signs of apprehension that the arm will re-injure - Chronic Shoulder Dislocation Dugas' Test The patient places the hand of the affected shoulder on the opposite shoulder and attempts to touch the elbow to the chest. Positive: unable to perform - Shoulder Dislocation (Active & Acute) Yergason's Test The patient flexes their elbow to 90 degrees while seated. The doctor palpates the biceps tendon and actively resists the patient's attempt to actively supinate the hand and flex the elbow. Positive: Audible click or snap in bicipital groove - Bicipital Tendon Instability Dawbarn's Sign The doctor palpates the subacromial bursa and elicits pain. The doctor passively abducts patient's shoulder without moving his/her fingers off of the subacromial bursa. Positive: Reduction of pain in second maneuver - Subacromial Bursitis Impingement Sign The patient slightly abducts their arm and the doctor passively moves their arm through a full flexion. This causes a jam of the greater tuberosity against the lacrimal surface. Positive: Pain - Tendonitis (overuse of tendons) Supraspinatus Press Test AKA Empty Can Test Empty Can Test Performed Patient abducts shoulders to 90degrees and the doctor apple resistance. The patient flexes shoulders to 30 degrees and points thumbs downward and resistance is applied again. (Hold & push the proximal elbow). Positive: Weakness - Supraspinatus Tear Speed's Test Patient is seated with elbow slightly flexed and palm up. The doctor resists the patient's attempt to flex shoulder while extending and supinating the forearm. Positive: Pain - Bicipital Tendonitis Subacromial Push Button Test Doctor applies a deep pressure over the subacromial bursa. Postive: Pain - Supraspinatus degeneration OR Subacromial bursitis Passive Shoulder Approximation Patient is standing and the doctor asks patient to lift shoulders up and back (squeeze the shoulder blades together). Positive: Pain in scapular region - T1 or T2 Nerve Root problem on side of pain Bryant's Test Doctor observed patient standing and notes the heights of axillary folds. Positive: lower axillary fold on involved side - Shoulder Dislocation Brachial Plexus Tension Test Patient is seated. Patient places both hands behind his/her head and pulls elbows posteriorly. Positive: Pain - C5 Nerve Root Lesion and/or TOS Lateral Epicondylitis AKA Radiohumeral Bursitis Radiohumeral Bursitis AKA Tennis Elbow Lateral Epicondylitis Affects Extensor Carpi Radialis Brevis Pain in extension of wrist and pronation of elbow (overhand swing) Medial Epicondylitis AKA Little Leaguer's Elbow or Golfer's Elbow Medial Epicondylitis Affects Flexor Carpi Ulnaris Pain at elbow with flexion of the wrist Cozen's Test (C6 Biker Chicks) Patient's elbow is flexed to 90degrees with forearm pronated and fist dorsiflexed. Doctor stabilizes patient's elbow and resists patient's dorsiflexed wrist. Postive: Pain in the lateral elbow- Lateral Epicondylitis Reverse Cozen Same except arm is supinated and doctor pulled on flexed wrist. Positive: Pain in medial elbow-Medial Epicondylitis Mill's Test Doctor passively flexes patient's fingers, wrist, elbow and the brings elbow around and into max pronation and extension. Positive: Pain in Lateral Elbow - Lateral Epicondylitis Reverse Mill's Patients hand is flat, patient flexes and doctor resists. Postive: Pain in Medial Elbow - Medial Epicondylitis Tinel's Sign (wrist) Percuss over the flexor retinaculum (anterior portion of the wrist where a watch would sit) and the Tunnel of Guyon (most medial portion of above) Postive: Tingling in the lateral 3 fingers (Carpal Tunnel Syndrome) of medial two fingers (Ulnar Impingement) Phalen's Sign The patient flexes writs maximally and holds position for one minute, pushing hands together. Positive: tingling into lateral 3 fingers of hand - Carpal Tunnel Syndrome Pinch Grip Test Ask the patient to put the tip of their thumb to the tip of their index finger. Positive: if they put the pads of their thumb and forefinger together - Ant. Interosseous N. Syndrome - Median N. Lesion Froment's Paper Sign Doctor places a piece of paper between the patient's thumb and index finger (all other fingers too) and attempts to pull it out. Positive: Cannot hold paper- Ulnar N. Palsy Finkelstein's Test Patient makes a fist with thumb inside fist; then fist is passively ulnar deviated. Positive: Pain over the anatomical snuff box - DeQuervain's Disease AKA Stenosing Tenosynovitis. Stenosing Tenosynovitis Bracelet Test Doctor applies compression around patient's wrist like a bracelet. Positive: Pain - RA (if bilateral) or Strain/Sprain (if unilateral) Straight Leg Test Patient is supine. Doctor places one hand under heel and the other over the knee and slowly, passively raises patient's leg. Positive: Pain down affected side - Sciatica, Disc, lumbar lesion Lasegue Rebound Test Positive SLR + Drop Positive: increased pain - Sciatica, disc, and muscle spasm Bragard's Sign SLR + lower 5degrees + Foot flexed Postitive: Pain in affected leg - Sciatica Sicard's Sign SLR + lower 5degrees + Flex Big Toe Positive: Pain in affected leg - Sciatica Turyn's Sign Patient supine, Doctor flexes the big toe. Positive: Pain in affected leg - Sciatica WLR AKA Fajerstazn's WLR/ Fajerstazn's Doctor performs a SLR on asymptomatic side with dorsiflexion of the foot. Positive: pain in symptomatic side -medial disc lesion Millgram's Test Patient supine. Asked toe actively elevate legs off the table 6 inches. Hold for 30seconds. Positive: Pain - SOL Leg Lowering Test Patient supine. Doctor moves patient's legs passively to 90degrees and ask's patient to bring legs back down to the table. Positive: LBP - SOL Bilateral SLR SLR on L, SLR on R, SLR bilaterally Positive: Pain occurs earlier on bilateral than unilateral - Lumbosacral Joint Lesion Goldthwait's Sign SLR with hand under lumbar section of the spine. Positive: Pain 0-30degrees: SI joint 30-60degrees: Lumbosacral joint 60-90degrees: Lumbar spine or contralateral SI joint Linder's Sign Passively flex patient's head to chest. Positive: Pain the lumbar spine - Root Sciatica Bowstring Sign SLR to point of pain + flex knee to Doctor's shoulder + pressure in popliteal fossa Positive: Pain in lumbar region or radiculopathy - Sciatica (BEST TEST) Bonnet's Sign Patient supine. Doctor internally rotates, abducts leg and the performs SLR . Positive: Radicular pain - Piriformis Syndrome Becterew's Test Patient seated. Doctor stabilizes thighs and patient attempts to extend both legs. Positive: pain or leaning back - Disc (posteromedial disc IF pain when good leg is raised) Minor's Sign Ask patient to rise from a seated position. Positive: support body with good side - sciatica Kemp's Test Patient seated. Doctor rotates patient's trunk and laterally bends towards and then away from affected side. Positive: Sciatica pain in involved side - Disc Local pain - Facet Heel Walk minimum of 7 steps Patient walks on heels DOCTOR WALKS WITH PATIENT (in case they fall). Positive: unable to perform - L5 lesion Toe Walk minimum of 7 steps Patient walks on toes DOCTOR WALKS WITH PATIENT (in case they fall). Positive: unable to perform - S1 lesion Belt Test AKA Supported Adam's Test Belt Test 1) Patient bend forward (note when pain occurs) 2) Doctor applies L-M pressure on SI joints and patient bends forward again Positive: Pain in 1 & 2 - Lumbar lesion Pain in only 1 - SI joint lesion Stork Test Patient stands making a yoga tree pose. Extends. Positive: Pain - Spondy or SI lesion Gaenslen's Test Patient supine with involved side near exam table edge. The opposite knee and thigh are fully flexed against abdomen of patient. Involved leg is slowly lowered off table by Doctor. The Doctor then applies downward pressure against clasped knee and extended hip. Positive: SI pain - SI lesion Lewin-Gaenslen's Test Patient lie on unaffected side and pulls (table contacting) lower knee to chest. Doctor stabilizes pelvis and hyper extends top thigh. Positive: SI pain - SI lesion Iliac Compression Patient lies on unaffected side. Doctor contacts upper iliac crest and exerts downward pressure. Positive: SI pain - SI lesion Hip Abduction Stress Test (KNOW) Patient lies on unaffected side. Patient actively abducts top leg and the doctor exert downward pressure on proximal to knee. Positive: Pain at PSIS - SI lesion Weakness -Glut Med weakness Femoral Nerve Traction Test (KNOW) Patient lies on unaffected side. Patient extends knee and Doctor brings hip to 15degrees of extension...if no pain, increase extension and flex knee. Positive: Pain in anterior thigh - L2, L3, L4 N. root lesion Hibbs Test Patient is prone. Doctor stabilizes hip on side she is standing. Doctor take opposite ankle and flexes knee to 90degrees. Doctor slowly pushes leg laterally away producing internal rotation of the hip. Positive: SI pain - SI joint lesion Nachlas Test Pain prone. Heel is approximated to same buttock. Doctor stabilizes hip. Positive: SI Pain- SI lesion Yeoman's Test Doctor stabilizes SI joint. Flexes affected knee and hyperextends the thigh by lifting leg off the table. Positive SI pain - SI lesion Prone Hyperextension Test (KNOW) Patient is prone. Doctor stabilizes the lumbosacral area. Doctor lifts legs while the knee remains extended. Positive: Localized lumbar pain with anterior thigh pain - L3, L4 N root lesion Patrick's Test AKA Fabere's Test Patrick Fabere Patient is supine. Thigh is flexed, abducted and externally rotated and extended with downward pressure is placed on the opposite ASIS and same knee. Positive: pain in hip - hip lesion Laguerre's Test Patient is supine. Doctor flexes, abducts, and laterally rotates hip. Doctor than applies pressure over the opposite ASIS with one hand and other hand on knee. Positive: pain in hip - hip lesion Thomas Test Patient is supine. Thigh is flexed with the knee bent upon the abdomen. Positive: Opposite thigh/knee rises off the table - Hip flexure contracture Anvil Test Patient is supine. Doctor raises leg and strikes the heel with their fist. Positive: pain in the hip - hip pathology or fracture