General Table of Contents

Transcription

1 General Table of Contents Detailed Table of Contents ii List of Classic Special Orthopaedic Tests ix p1 Introduct i1 Chapter I: Ankle & Foot 1 Chapter II: Knee 33 Chapter III: Hip & Innominate 79 Chapter IV: Comprehensive Examination of the Spine 137 Chapter V: Sacroiliac Joint & Pelvis 149 Chapter VI: Lumbar Spine 203 Chapter VII: Thoracic Spine & Ribs 267 Chapter VIII: Cervical Spine 309 Chapter IX: Thoracic Outlet 387 Chapter X: Shoulder p 403 Chapter XI: Elbow 447 Chapter XII: Wrist & Hand 477 References 519/ (r1) i

2 Detailed Table of Contents Introduction How to use this book p1 How this book is comprehensive p3 When Learning too much is not enough p4 Introductory Lectures The Spirit of Assessment i1 The Procedure for Assessment i7 Pain i13 Observations i24 Overview of Assessment Protocol i25 Intake: Forms, Interviewing & Case History Taking i28 Case History Form i29 Pain and Impairment i33 Active Listening i39 Rule Outs i42 Range of Motion Testing i42 Differential Tissue Testing i45 Assessment & Treatment Planning i46 Postural Assessment i48 Muscle Balance and Posture i48 Common Postures i52 Postural Examination i54 Palpating Landmarks i60 Rotations i69 Gait Analysis(Classic) i75 Gait Analysis: Alternative View i80 Charting & Recording i86 Spinal Motion: Structure & Function i99 Chapter I ANKLE & FOOT Page 1 Clinical Implications of Anatomy & Physiology 3 Case History (Specific Questions) 5 Observations 5 Rule Outs 7 Active Free Range Of Motion (AF-ROM) 9 Passive Relaxed Range Of Motion (PR-ROM) 11 Active Resisted Range of Motion (AR-ROM) 13 Special Tests 16 Differential Muscle Testing 16 Talar-Tilts 19 Anterior Draw Test 20 Wedge Test 21 Thompson s Test 22 Morton s Neuroma 22 Tinel s Sign 23 Pulse Testing 23 Homans Sign 24 Metatarsal-Phalangeal & Phalangeal Joints 25 AF-ROM 25 PR-ROM 26 AR-ROM 28 Ankle & Foot Conditions/Pathologies 29 Chapter II KNEE 33 Clinical Implications Of Anatomy & Physiology 35 Case History (Specific Questions) 40 Observations 41 Rule Outs 45 Fractures 47 Wipe Test for minor effusion 47 Fluctuation Test for moderate effusion 49 Patellar Tap Test for major effusion 50 Active Free Range Of Motion (AF-ROM) 51 Quadriceps Inhibition Test 53 Passive Relaxed Range Of Motion (PR-ROM) 55 Active Resisted Range Of Motion (AR-ROM) 59 Special Tests 60 Differential Muscle Testing 60 Modified Helfet Test 63 Valgus Stress Test 64 Varus Stress Test 65 Apley Distraction Test 65 Anterior Draw Test 66 Posterior Draw Test 68 Lachman s Test 68 Apley Compression Test 70 McMurray s Meniscus Test 71 Patellar Apprehension Test 75 Patellofemoral Compression Testing 75 Clark s Test 76 Noble s Compression Test 77 Bounce Home Test 77 Chapter III: HIP & INNOMINATE 79 Clinical Implications of Anatomy & Physiology 80 i Comprehensive Assessment for Massage Therapists

3 Case History (Specific Questions) 89 Observations 90 Rule Outs 98 Active Free Range Of Motion (AF-ROM) 103 Passive Relaxed Range Of Motion (PR-ROM) 108 Testing Joint Play 112 Active Resisted Range Of Motion (AR-ROM) 114 Special Tests 118 Differential Muscle Testing 118 Thomas Test 123 Ober s Test 126 Piriformis Test 128 Trendelenburg s Test 130 Scouring Test 131 FABER Test 132 Ely s Test 133 Leg Length Discrepancy Test 133 Stork Test 135 Chapter IV Comprehensive Examination of Spine 137 Comprehensive Structural Examination of the Spine & Pelvis Standing Postural Views Checking Symmetry Of Landmarks Checking Symmetry During AF-ROM Assessing Postural Stability Checking Postural Symmetries & AF-ROM Sitting Checking Postural Symmetries While Supine Checking Rotation In The Body Checking Landmarks Prone 148 Chapter V: Sacroiliac Joint & Pelvis 149 Note to Reader 151 Chapter Organization 152 Part I: Clinical Implications of Anatomy & Physiology 153 Anatomical Structures & Landmarks 153 S.I. Joints and Impairments 154 Terminology & Types of Movements 155 Some Points to Consider 156 Definitions of Sacroiliac Movements 157 What Stabilizes the S.I. Joints? 158 Testing Within the General Examination of the Spine 162 Part II: Innominate Motions & Impairments 164 Movements of the Lumbopelvic Girdle 164 Unilateral and Bilateral Pelvic Tilts 167 Physiological Motions of the Innominates during Gait 168 Symptoms of Innominate Impairments 168 Part III: Testing For Innominate Impairments 169 Observation & Inspection 170 Testing for Leg Length Discrepancy 172 Assessing for Inflares & Outflares 173 Placing Innominate Orientation in Context Of the Trunk & Head 174 Stork Test 175 Standing Flexion Test 176 Standing Extension Test 177 Palpation & Inspection of Sacral Motion 178 Four-Point Test 178 Spring Test 179 Gapping Test 179 Pelvic Challenge for Pubic Symphysis Impairments 180 Interpreting Results of Motion Testing & Palpatory Findings 181 Part IV: Introduction to Sacral Dysfunctions 182 Gait: The Innominates & Sacroiliac Joints182 Physiological Motions Where the Sacrum Can Become Fixed 183 Non-Physiological Motions Where the Sacrum Can Become Fixed 184 Other Non-Physiological Impairments Of The S.I. Joints 185 Part V: Testing for Sacral Dysfunctions 186 Observations 186 Seated Flexion Test 186 Prone Palpation of Sacrum 187 iii

4 Prone Extension ( Sphinx ) Test 187 Chart of Findings for Extension Test 188 Summary of Findings for Sacral Torsions 188 Presentation of Pain Experienced By Client with Torsion Lesions 189 Sacral Shears, Summary of Findings 189 Bilaterally Nutated Or Counter-Nutated Sacrum, with Summary of Findings 190 Part IV: Orthopaedic Assessment of the Sacroiliac Joints 192 Rule Outs 192 Differential Muscle Testing 193 Special Tests 197 Compression Test of S.I. Joints 197 Posterior Displacement Test 198 Anterior Displacement Test 198 FABER Test 199 Ganslen s Test (Caution) 199 Appendix 200 Gait & Sacral Motion 200 Walking/Running 200 Rules of Movement for the Sacrum & L5 202 Chapter VI: Lumbar Spine 203 Clinical Implications of Anatomy & Physiology 205 Fryette s Rules of Spinal Motion 206 Lumbar Intervertebral Disc (IVD) 208 Note on Causes of Low Back Pain 208 The IVD & Low Back Pain 208 Levels of Degenerative Disc Disease 209 Suspected Sources of Intermittent & Chronic Low Back Pain 210 Are X-rays, CT Or MRIs Really Better Than Hands-On Testing? 211 Facet Joint Dysfunction & Pain 212 Group & Segmental Impairments 213 Comprehensive Examination 215 Case History (Specific Questions) 216 Observations 216 Common Postures & How iv They Affect the Lower Back 218 Lumbar Curves & L3: The Source of Most Impairments & Dysfunction within The Lumbar Spine 220 Rule Outs 222 Exceptions for Range of Motion (ROM) Testing & Use of Motion Palpation Testing 223 Active Free Range of Motion (AF-ROM) 224 Measuring Amount of Lumbar flexion 225 Pain on Flexion 226 AF Flexion with Over-Pressure 227 Extension 228 Pain on Extension 228 Sidebending 229 Pain on Sidebending 229 AF Sidebending with Over Pressure 230 Hip-Drop Test 231 Lumbar Rotation 232 Over Pressure to lumbar Rotation 233 Motion Testing for Facet Joint Dysfunctions in the Lumbar Spine 234 Palpation in Neutral 235 Basic Rules & Findings of Motion Testing in the Spine 236 Palpating in Flexion & Extension 236 Findings, Explanations & Examples 238 Palpatory Findings Chart 239 Alternative Motion Palpation Testing in Prone 240 A Common Clinical Finding: The Disappearing Scoliosis 241 Lumbar Curves & Segmental Dysfunctions 242 Passive Relaxed Range Of Motion Introductory Note 242 Passive Range of Motion 243 Insight Assessing Lumbopelvic Motion in Supine 245 Joint Mobilization 246 Resisted Isometric Testing & Strength Testing 249 Special Tests 251

5 Note on Differential Muscle Testing 251 Testing of the Lumbar Spine Note on Orthopaedic Testing 251 Group 1 General Neurological Testing 252 Straight Leg Raise Test for Neurological Signs 252 Well Leg Raise 254 Slump Test 254 Bowstring Sign 255 Valsalva s Test 256 Hoover s Test 256 Group 2 Specific Neurological Tests 257 Myotome Testing 257 Dermatome Testing 260 Deep Tendon Reflexes 263 Excluded Classic Tests 265 Femoral Nerve Stretch (Nachlas Test) Quadrant Test (Kemps test) Milgram s Test Motion Testing of the Lower T- Spine 286 Motion Testing of Sidebending 287 Joint Mobilization Testing 289 Active Resisted Range of Motion 292 Palpation of Ligaments of the Thoracic Spine 295 Thoracic Spine Neurological Symptoms 296 Introduction to the Ribs Musculature & Joints 297 Palpation of First Rib 299 Palpation of Second Rib 300 The Sternomanubrial Joint & Its Palpation 301 The Sternoclavicular Joint & Its Palpation 302 General Motion of the Ribs & a Quick Scanning of Rib Motions 303 Possible Findings during Testing 304 Palpation of Rib Motion 305 Chapter VIII: Cervical Spine 309 Chapter VII: Thoracic Spine & Ribs 267 Clinical Implications of Anatomy & Physiology 269 Fryette s Rules of Spinal Motion 269 Motion impairments 270 Thoracic Intervertebral Disc 270 Rules of Three for Land-marking T-Spine 271 Comprehensive Examination 272 Observations 274 Note on Testing Range of Motion 276 Insight - Isolating Thoracic Spine from Rest of Spine: What To Do? 276 Active Free Range Of Motion (AF-ROM) 277 Notes on Scoliosis 278 Passive Relaxed Range of Motion 280 Testing End-of-Range Motion of Ribs 281 Motion Palpation of the Upper T-Spine 282 Basic Rules & Findings of Motion Testing in the Spine 282 Rule Outs Review of Findings & What They Mean 284 v Clinical Implications of Anatomy & Physiology 311 Sub-occipital Recti Muscles & Eye Movements 311 Definitions & Rules of Motion for the Cervical Spine 312 Clinical Considerations & More on the OA & AA Joints More on Anatomy of the Upper Quadrant 314 The Lower Quadrant 315 Presentation of Pain & Segmental or Group Dysfunctions 316 Insight Migraines can be a Pain in the Neck 318 Comprehensive Examination 319 Case History (Specific Questions) 321 Observations 321 Upper Cross Syndrome 323 Light Inspection Palpation 324 Shoulder 324 Temporal Mandibular Joint 325

6 Vertebral Artery Tests 326 Active Free Range of Motion (AF-ROM) p.328 Insight - Contribution to Flexion by the Upper Cervical & Lower Cervical Spine 328 Insight Observing OA Joint Impairment 329 Motion Palpation Testing of the Cervical Spine 331 Motion Palpation Testing of the Occipito-Atlantal (OA) Joints 332 First Method 333 Second Method 334 Third Method 335 Diagonal Glides 336 Motion Palpation Testing of the Atlanto-Axial (AA) Joints 337 Calculating ROM Loss in the AA Joint, v.s. from Lower Cervical Joints 339 Insight Rotated C1 Impairment 339 Alternate Hand Positioning for Testing of AA Joint 340 Motion Palpation of Lower Cervical Spine 341 Joint Mobilizations 341 What Type of Lesions are We Finding with Lateral Translations 344 Insight Further Comments On Translation Movements 344 Discovering Which Side is Impaired 345 Insight Don t Make Assumptions 346 Insight What We may have Seen in AF-ROM 349 Summary of Testing the Cervical Spine by Translations 350 Other Impairments and Red Flags 351 Passive Relaxed Range of Motion 352 Active Resisted Range of Motion.356 Insight Shortfalls of Some Orthopaedic Testing of the Cervical Spine 357 Special Tests 358 Compression Test 358 Decompression Test 359 Quadrant Testing 360 Lower Quadrant Test 361 Spurling s Test 362 vi Insight - Impact of Extended, Rotated, & Sidebent on Arteries, Veins & Nerves 363 Valsalva s Test 364 Swallowing Test 364 Tinel s Sign At The Neck 365 Bakody s Sign 365 Introduction to Specific Neurological Testing 366 Dermatome Testing 368 Sensory Testing Of the Face 369 Peripheral Nerve Testing 370 Myotome Testing 371 Motor Testing of Peripheral Nerves 373 Upper Limb Tension Testing (ULTT) 376 (See Thoracic Spine chapter, TOS Testing) Deep Tendon Reflex (DTR) Testing 376 Pathological Nerve Impairment Testing 378 Spastic Paralysis Versus Flaccid Paralysis 378 Temporal Mandibular Joint Testing: Introduction 379 Insight - Chewing: More Than Just Opening & Closing the Jaw 380 Active-Free Range of Motion Testing 381 Passive Relaxed Range of Motion & Joint Mobilization for TMJ 384 Chapter Nine: Thoracic Outlet 387 Clinical Implications of Anatomy & Physiology 389 Observations Prior To Specific TOS Testing 392 Rule Outs 393 Thoracic Outlet Tests 394 Adson s Test & Variations 394 Insight - Travell s Variation, and the Halstead Manoeuvre 395 Costoclavicular Syndrome Test 395 Pectoralis Minor Syndrome Test 396 Cervical Rib 397 Introduction to Upper Limb Tension Tests (ULTT) 397 Cautions & Considerations 398 General ULTT 399 Median Nerve Bias ULTT 400

7 Radial Nerve Bias ULTT 401 Ulnar Nerve Bias ULTT 402 Chapter X: Shoulder 403 Clinical Implications Of Anatomy & Physiology 405 Case History (Specific Questions) 407 Observations 408 Rule Outs 411 Insight Why we need to Test both Sides Bilaterally 412 Active Free Range Of Motion 413 Scapulothoracic Articulation 416 Apley s Scratch Test 417 Passive Relaxed Range of Motion 418 Assessing the Acromioclavicular & Sternoclavicular Joints 420 Joint Play Inspection of the - Glenohumeral Joint 421 Sternoclavicular Joint 423 Acromioclavicular Joint 424 Scapula 425 Three Interrelated Motion Tests for the Scapula & Glenohumeral Joint 426 Active Resisted Range of Motion 429 Special Tests 432 Differential Muscle Testing 432 Yergason s Test 438 Speed s Test 439 Supraspinatus Tendonitis Tests 440 Empty Can Test 440 Hawkens-Kennedy/Impingement Test 441 Apprehension Sign/Crank Test 441 Winging Scapula Test 442 Acromioclavicular Shear Tests 442 Shoulder Muscle Length Testing 443 Shoulder Pathologies 445 Chapter XI: ELBOW 447 Elbow Chapter Overview 448 Clinical Implications Of Anatomy & Physiology 449 Case History (Specific Questions) 451 Observations 451 Rule Outs 452 Active Free Range Of Motion 453 Passive Relaxed Range Of Motion 454 Joint Play Inspection for the Elbow 456 Active Resisted Range Of Motion 458 Special Tests 460 Differential Muscle Testing 460 Ligamentous Stability Tests 466 Valgus Stress Tests 466 Varus Stress Tests 467 Tests For Epicondylitis 468 Tendonitis vs. Tendonosis 468 Lateral Epicondylitis/Tennis Elbow 469 Medial Epicondylitis/Golfer s or Pitcher s Elbow 470 Tests for Nerve Compression Syndromes 471 Ulnar Nerve Tinel s Sign at Elbow 471 Ulnar Nerve Stretch Test at Elbow 471 Pronator Teres Syndrome Test or Anterior Interosseous Syndrome 472 Compression of the Median Nerve at the Ligament of Struthers Test 472 Supinator Radial Nerve Syndrome Test 473 Tinel s Sign for Radial Nerve At Elbow 473 Source Of Neurological Symptoms Not Found? 474 Pathologies and Conditions of the Elbow 475 Chapter XII: Wrist & Hand 477 Wrist & Hand Chapter Overview 478 Clinical Implications of Anatomy & Physiology 479 Case History (Specific Questions) 480 Observations 481 Observing, Inspecting and Palpating 482 Rule Outs 485 Neurological Issues 486 Active Free Range of Motion 487 Capsular Patterns of Restriction & Position of Rest 487 Passive Relaxed Range Of Motion 488 Joint Play Inspection of the Wrist 489 Active Resisted Range Of Motion 490 vii

8 Special Tests 493 Differential Muscle Testing the Wrist 493 De Quervain s Syndrome (Finkelstein s Test) 497 Flexors Digitorum Tendinopathy (Mouse Hand) 497 Intersection Syndrome 498 Conditions of the Phalanges (The Fingers) 498 Fracture Of The Scaphoid 498 Extensor Expansion Test (Bunnel-Littler Test) 499 Ligamentous Tests of MCP, PIP & DIP Joints 499 Skier s Thumb 499 Trigger Finger 500 Nerve Compression Syndromes at the Wrist 500 Tests for Median Nerve Impingement - Tinel s Sign & Phalen s Tests 501 Motor Testing for the Median Nerve - Pinch Test 502 Tests for Ulnar Nerve Impingement - Ulnar Nerve Tinel s Sign 502 Frommet s Sign/Test 503 Vascular Compression Tests at the Wrist Allen s Test at the Wrist for Ulnar and Radial Arteries 504 Appendix A: General Testing of the Hand & Fingers 505 Appendix B: Testing Of Fingers & Thumb 510 Active Free Range of Motion 510 Passive Relaxed Range Of Motion 513 General Joint Mobilization Testing 512 Active Resisted Range Of Motion of the Thumbs and Fingers 514 References r1 (519) viii

9 Classic Orthopaedic Tests Acromioclavicular Shear Tests 442 Adson s Test 394 Adson s Test Variation Halstead Manoeuvre 395 Adson s Test Variation Travell s Variation 395 Allen s Test at the Wrist 504 Ankle Ligament Tests see Talar Tilts 19 Anterior Displacement Test of the Hip 198 Anterior Draw Test for the Ankle 20 Anterior Draw Test for the Knee 66 Apley Compression Test 70 Apley Distraction Test 65 Apley s Scratch Test 417 Apprehension Sign/Crank Test 441 Bakody s Sign 365 Bounce Home Test 77 Bowstring Sign 255 Bunnel-Littler Test 499 Cervical Rib 397 Clark s Patellar Test Excluded* 76 Compression Test for the Cervical Spine 358 Compression Test of S.I. Joints 197 Costoclavicular Syndrome Test 395 De Quervain s Syndrome (Finkelstein s Test) 497 Decompression Test for the Cervical Spine 359 Ely s Test 133 Empty Can Test 440 Excluded Classic Tests - Lumbar 265 Extensor Expansion Test (Bunnel-Littler Test) 499 FABER Test 132, 199 Femoral Nerve Stretch/Nachlas Test Excluded * 265 Finkelstein s Test 497 Fracture of the Scaphoid 498 Ganslen s Test (Caution) 199 Golfer s Elbow 470 Hawkens-Kennedy/Impingement Test 441 Hoover s Test 256 Intersection Syndrome 498 Kemps test for the Lumbar Spine Excluded * 265 Lachman s Test 68 Lateral Epicondylitis/Tennis Elbow 469 Leg Length Discrepancy Test 133 Lower Quadrant Test Cervical Spine 361 McMurray s Meniscus Test 71 Medial Epicondylitis/Golfer s/ Pitcher s Elbow 470 ix Milgram s Test Excluded * 265 Modified Helfet Test 63 Morton s Neuroma 22 Nachlas Test Excluded * 265 Noble s Compression Test 77 Ober s Test 126 Patellar Apprehension Test 75 Patellofemoral Compression Testing 75 Pectoralis Minor Syndrome Test 396 Phalen s Tests 501 Piriformis Test 128 Pitcher s Elbow 470 Posterior Displacement Test of the Hip 198 Posterior Draw Test for the Knee 68 Quadrant Testing 360 Scouring Test 131 Shoulder Impingement Test 441 Skier s Thumb 499 Slump Test 254 Speed s Test 439 Spurling s Test 362 Stork Test 135 Straight Leg Raise Test Supraspinatus Tendonitis Tests 440 Swallowing Test 364 Talar-Tilts (Ankle Ligament Tests) 19 Thomas Test 123 Thompson s Test 22 Tinel s Sign at the Ankle 23 Tinel s Sign at the Elbow 471 Tinel s Sign at the Neck 365 Tinel s Sign at the Wrist 501 Trendelenburg s Test 130 Trigger Finger 500 Valgus Stress Test Elbow 466 Valgus Stress Test Knee 64 Valsalva s Test: lumbar 256; cervical 364 Varus Stress Test Elbow 467 Varus Stress Test Knee 65 Wedge Test 21 Well Leg Raise 254 Winging Scapula Test 442 Yergason s Test 438 *Excluded tests are still described, but are not recommended for use with clients. However, they are still taught to students as their clients may have had them done with other health care practitioners. Reasons for exclusion are given for each in the text.