Orthopedic tests

Adson
o Used to test thoracic outlet
o Radial pulse diminishment with abduction of arm and turning face
Allens test
o Used to test adequacy of hands blood supply via radial & ulnar aa
o Patient is instructed to pen and close hand several times and then make a tight
fist
Physician will occlude radial and ulnar arteries at the wrist
Patient is then instructed to open his/her hand and the palm should be
pale
Physician releases one of the arteries to assess flushing of the hand
Hawkins
o Used to test for shoulder impingement or rotator cuff tendinosis
o Shoulder is flexed forward and elevated to 90 then forcibly internally rotated
Brings the greater tuberosity of the humeral head toward the acromion
Drop Arm test
o Used to detect rotator cuff problems
o Patient is instructed to abduct shoulder to 90 and slowly lower arm
o Test is positive if patient cannot lower arm smoothly or if arm quickly drops to
patients side
Jobes/Empty can
o Used to assess rotator cuff tendinosis
o Patient activity abducts arm to 90, flexes forward 30, and internally rotates
pointing the thumb toward the floor
Patient then resists downward force applied by the physician
o Test isolates surpraspinatus muscle
Yergasons maneuver
o Used to assess for biceps tendinopathy
o Patient will try supinate arm with physician resisting
Wrights maneuver
o Used to assess thoracic outlet syndrome
o Physician passively and progressively hyperabducts and externally rotates
patients arm
If position reproduces symptoms or causes diminished radial pulse, it is
considered positive
Lasegue test / Unilateral SLR
o Used to evaluate dural involvement (e.g. herniated disc, stenosis)
o With the subject supine and both knees and hips extended, the examiner slowly
raises the symptomatic leg until reproduction of pain and then lowered
The ankle is dorsiflexed and patient is asked to flex neck
Thomas test
o Used to evaluate for iliopsoas muscle tightness
 o With the subject supine at the very end of the examination table and both knees
flexed against the chest, a subject lowers one leg until it is fully relaxes or until
there is an anterior pelvic tilt or increased lumbar lordosis
o Results
Iliopsoas if there is lack of hip extension with knee flexion >45
Rectus femoris if there is both lack of hip extension & knee flexion <45
Well SLR
o Used to evaluate for vertebral disc damage
o Patient supine and both knees and hips extended, the examiner passively flexes
subjects univolved LE
Positive test is when there is radicular down symptomatic leg
o Considered more specific for intervertebral disc pathology than Lasegue
Trendelenburg
o Assesses the gluteus medius muscle strength
o Physician stands behind the patient and the patient is instructed to pick one of
the legs off the floor
o A positive test occurs when pelvis drops to the side opposite stance leg
indicates muscle weakness on side of stance leg

Freibergs infarction
Involves osteochondrosis of 2nd MT head
Most commonly encountered in adolescent and young adult women

Kienbocks disease
Involves AVN and collapse of lunate
Frequently encountered in individuals who overuse wrist through repetitive
compressive loading

Kohlers disease
Involves osteonecrosis of tarsal navicular
Presents frequently in childhood

Panners disease
Involves osteochondrosis of capitellum
Commonly associated with overuse and seen in little league baseball players

Severs disease
Involves osteochondrosis at Achilles insertion
Frequently observed in skeletally immature patients growing pains
Treatment is with activity modification, NSAIDs, and PT

Gaucher disease
The MC lysosomal storage disease
 Caused by a hereditary glucocerebrosidase deficiency
There are three subtypes all autosomal recessive
Leads to glucosylceramide accumulation in the bone marrow, liver, spleen, and lung
o Leads to pancytopenia, HSM, diffuse infiltrative pulmonary disease

Tay-Sachs
Is an autosomal recessive disease caused by a hexosaminidase A deficiency
It is MC in infants
Will normally not begin to show S/S until 6 months
Children can become blind, deaf, and unable to swallow
o Patients will be hyperreflexic
Death will usually occur by the age of four

Niemann-Pick
Is an autosomal recessive disease characterized by SMPDA1 mutation (missesnse)
Caused by a sphinomyelinase defiency
S/S include HSM w/ abdominal distension, ataxia, dysarthria, dystonia, and possible
dementia and seizures

Pneumonia
**MCC = S. pneumonia
Those suffering from neurological impairment = anaerobes
Cystic fibrosis
o Age < 20 = S. aureus
o Age > 20 = Pseudomonas
HIV/AIDS = PCP

Postpartum endometritis
Is an infection of decidua that occurs in the PP period
Findings include fever, tachy, lower abd pain, uterine tenderness, and purulent lochia
Risk factors include:
o C-section, prolonged labor, prolonged rupture of membranes, GBS, maternal
removal of placenta, low socioeconomic status
It is typically a polymicrobial infection with two or three pathogens from the genital
tract
Treatment is IV broad-spectrum (e.g. clindamycin and gentamycin)

DeQuervains disease
Presents with pain near the anatomical snuffbox and a positive Finkelsteins test
Treatment is splint injection surgery (of abductor pollicious longus)

Asthma
Intermittent
 o Defined as symptoms that occur 2/week
o There will be <2x/month nighttime
o Tx is usually with -agonist
Mild persistent
o Symptoms that occur >2x/week, but NOT daily
o Will be 3-4x/month nighttime
o Tx is with -agonists
Moderate persistent
o Will have daily symptoms and use of -agonist daily
o Will have >1x/week nighttime but NOT nightly
o Spirometry will have diminished values such as FEV1 60-80% and FEV1/FVC
reduced 5%
Severe persistent
o Will have daily symptoms and use of -agonist multiple times daily
o Has daily nighttime symptoms
o Activity is severely limited
o Spirometry will show FEV1 <60% and an FEV1/FVC ratio >5% reduced

Benign salivary tumors

MC = pleomorphic adenoma
o Accounts for 80% of all benign parotid tumors
o Present with a painless slow-growing mass in the preauricular or manidibular
angle region
o FNA is typically done to r/o malignancy
2nd MC = Warthin tumor
o occur later in life
The presence of pain or Facial N. involvement suggests MALIGNANCY!
o MC = mucoepidermoid carcinoma

Premature ovarian failure

Defined as primary hypogonadism
Can be caused by chemotherapy, radiation, an AI disorder, Turners syndrome, or Fragile
X syndrome
Lack of estrogen results in a loss of normal feedback mechanism
Will have FSH increase, LH increase (FSH > LH)

CRPS
Disorder of the extremities that is characterized by pain, swelling, limited ROM,
vasomotor instability, skin changes, and patchy bone demineralization
Has three stages
o Stage 1
Burning or throbbing pain along with sensitivity to touch
 X-ray is typically normal but may show some patchy bone
demineralization
o Stage 2
Characterized by progression of edema, thickening, and mm wasting
Can last for 3-6 months
o Stage 3
Most severe
Characterized by decreased ROM, contractures, skin changes, brittle
nails
Bone radiography reveals severe demineralization

Succinylcholine
A depolarizing NM blocker that has 2 phases
o Phase 1 is the primary paralytic effect
Involves keeping the membrane potential above threshold so that it is
constantly depolarized
o Phase 2 involves a non-depolarizing blockage where ACh is comp antagonized
Onset is rapid, biphasic, and has NO refractory period
**Risk of hyperkalemia due to increased cellular potassium reflex
o Contraindicated in burns, crush injuries, and those with known hyperkalemia
Associated with malignant hyperthermia, treated with dantrolene
Passive motion will engage the anatomical barrier
Active motion will engage the physiologic barrier

Soft tissue is a direct and passive technique

Articulatory is a direct and passive technique
Muscle energy is an indirect/direct and active/passive technique
HVLA is a direct and passive technique
Counterstrain is an indirect and passive technique
FPR is an indirect and passive technique

Fryettes principles
I when spine is neutral, group of vertebra will rotate & sidebend in opposite directions
II when spine is flexed/extended, vertebral will rotate & sidebend in same direction
III movement of a segment in one plane will modify/reduce movement in other planes
NOTES
o I & II refer to thoracic and lumbar vertebra and NOT occiput, atlas, sacrum, and
cervical
o III refers to everything

Inominate outflares
Will have a positive standing flexion on the affected side
There is an ipsilateral increased distance from umbilicus ASIS
Ipsilateral ischial tuberosity is closer to midline
PS and SI joint are TTP

Common cause of talotibial joint restriction is tightness of gastroc + soleus

Remember that the calf muscles will plantar flex ankle
o If the calf muscles are tight, talotibial = plantar flexed which means dorsiflexion
restriction
o Treating the dysfunction results in dorsiflexion improvement

Psoas syndrome
Patient has a hypertonic psoas that reflexively affects C/L piriformis
Can present as back or leg pain
o You typically find lumbar sd that are flexed, side-bent, and rotated toward side
of hypertonic psoas / dysfunction
You should focus tx on lumbar & psoas findings and then address the other somatic
dysfunctions
o The upper lumbar segments should be treated first

Scheurmann kyphosis
Defined as a presence of 5 anterior wedging in at least 3 adjacent vertebrae
Characterized by rigid thoracic kyphosis and can commonly cause small disc herniation
 Treatment will generally involve bracing before skeletal maturity and then f/u with
OMT & PT

Chapman points
Appendix
o Anterior tip of 12th rib on right
o Posterior tip of the transverse process of T11
Kidneys
o Anterior one-inch lateral and one inch superior to the umbilicus
o Posterior between the spinous and transverse process at T11-T12
Adrenal glands
o Anterior one inch lateral and two inches superior to the umbilicus
o Posterior between the spinous and transverse process at T12-L1

Ribs
Rib 1 anterior and middle scalenes
Rib 2 posterior scalene
Ribs 3-5 pectoralis minor
Ribs 6-8 serratus anterior
Ribs 9-10 latissimus dorsi
Rib 12 quadratus lumborum