Physical Exam. Jared Van Der Beek. Basics To Remember. Know the anatomy and how the muscles function.
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1 Physical Exam Jared Van Der Beek 1 Basics To Remember Know the anatomy and how the muscles function. Know what the special tests are looking for and understand why they are positive. Don t just memorize, rationalize! 2
2 Outline of Today Review the upper extremity and the special tests Review the lower extremity and the special tests Review the spine and the special tests 3 Joint Movements Flexion Extension Abduction External Rotation Adduction Internal Rotation 4
3 Upper Extremity Shoulder Elbow Wrist 5 Shoulder Rotator Cuff Consists of 4 main muscles Supraspinatus, Subscapularis, Infraspinatus, Teres Minor (SITS). Function: Flexion 180 Extension 60 Internal Rotation 90 External Rotation 80 Abduction 180 Adduction 35 Horizontal Adduction 30 Horizontal Abduction 130 Stabilize the humerus in the Glenoid fossa 6
4 Supraspinatus Supra = above Located on top of the scapula Most likely to get pinched in an impingement syndrome. Function: Elevates the Humerus Test: Empty Can Test 7 Infraspinatus Infraspinatus = Below Located below the scapula spine on the posterior part of the scapula Function: Externally rotates the Humerus Test: Resist External Rotation 8
5 Teres Minor Teres Minor = Being round and long Located below the scapula spine on the posterior part of the scapula Function: Externally rotates the Humerus Test: Resist External Rotation Helps the Infraspinatus 9 Subscapularis Sub = Underneath Located on the anterior part of the scapula Function: Internally rotates the Humerus Test: Resist internal rotation 10
6 Yergason's Test Biceps Test Palpate the biceps tendon while internally/externally rotating the arm. Positive if there is pain 11 Elbow ROM Flexion 150 Extension 0 Pronation 90 Supination 90 12
7 Elbow Special Test Cozen s: Lateral Epicondylitis - Tennis Elbow Reverse Cozen s: Medial Epicondylitis - Golfer s Elbow 13 Wrist Carpal Tunnel Compression of the Median Nerve in the carpal tunnel 14
8 Wrist Special Tests Phalen s Test Reverse Phalen s Test Tinel s Test You get increased in symptoms: pain, tingling 15 Lower Extremity Hip Joint Knee Joint Ankle Joint 16
9 Hip Joint Flexion 130 Extension 20 Internal Rotation 45 External Rotation 45 Abduction 60 Adduction Hip Special Tests FABER/Patrick s Test Irritation of the Hip Joint Ober s Test IT Band Tightness 18
10 Yeoman s Test Tests for SI Joint Pain 19 Straight Leg Raise First degrees is to test for the sciatic nerve. Past that point, you start to move the SI joint and L5/S1 20
11 Abdominal Pain Murphy s Test McBurney s Point 21 Appendicitis Tests Rovsing s Sign Obturator Sign Apply%hand%pressure%to%the%lower%le1%side%of% the%abdomen.%pain%felt%on%the%lower%right% side%of%the%abdomen%upon%the%release%of% pressure%on%the%le1%side The%examiner%holds%the%pa;ent's%ankle%with%one% hand%and%knee%with%the%other%hand%and%rotates%the% hip%by%moving%the%pa;ent's%ankle%away%from%the% pa;ent's%body%while%allowing%the%knee%to%move% only%inward.%if%there%is%abdominal%pain%on%the%right% side,%this%is%posi;ve%for%an%inflamed%appendix 22
12 Knee Joint ROM Flexion 150 Extension 0- (-5) Internal Rotation 5 External Rotation
13 25 Knee Special Tests cont. Anterior/Posterior Drawer Test Pushing Posterior tests the PCL Pulling Anterior tests the ACL Valgus Stress Test Pushing from lateral to medial on the knee tests the MCL Varus Stress Test Pushing from medial to lateral on the knee tests the LCL 26
14 Knee Joint Special Tests Apley s Test McMurray s Test Feel for clicking or popping 27 Ankle Joint ROM Dorsi Flexion 20 Plantar Flexion 50 28
15 Ankle Special Test Anterior Drawer Test Tests the Anterior Talofibular ligaments Posterior Drawer Test Tests the Posterior Talofibular ligaments 29 Ankle Special Test cont. Babinski UMN Lesion if Positive Video: Start at 3:40 Homan s Test Looks for DVT 30
16 Cervical Spine Anatomy Looking for pinched nerves or disc problems Looking for ligament injuries Looking for meningitis. Key signs: HA, stiff neck 31 32
17 Range of Motion Flexion 60 Extension 60 Right and Left Lateral Flexion 45 Right and Left Rotation Thoracic Spine ROM Flexion 60 Extension 25 Right and Left Lateral Flexion 35 Right and Left Rotation 50 34
18 Lumbar Spine Flexion 60 Extension 30 Right and Left Lateral Flexion 30 Right and Left Rotation Herniated Disc 36
19 Compression Test Force 37 Ligament Distraction 38
20 Meningitis Why? Inflamed tissue hurts to move! These two techniques put a stretch on the dura, arachnoid, and pia matter. 39 Deep Tendon Reflex 0-4: 2 is average. Hyper-reflexic: sensory and motor nerve are working fine, LMN is fine, there is no inhibitory factor (UMN). Absent reflex, LMN lesion. 40
21 Grading of Reflexes 0 = no response; always abnormal 1+ = a slight but definitely present response; may or may not be normal 2+ = a brisk response; normal 3+ = a very brisk response; may or may not be normal 4+ = a tap elicits a repeating reflex (clonus); always abnormal 41 Distribution of Reflexes Biceps reflex (C5, C6) Brachioradialis reflex (C5, C6, C7) Extensor digitorum reflex (C6, C7) Triceps reflex (C6, C7, C8) Patellar reflex or knee-jerk reflex L2, L3, L4) Ankle jerk reflex (Achilles reflex) (S1, S2) Plantar reflex or Babinski reflex (L5, S1, S2) 42
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