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DX 612 Orthopedics Midterm Review
James J. Lehman, DC, MBA, DABCO University of Bridgeport College of Chiropractic
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Cervical Distraction Test
Distraction test for nerve root, facet, or myospasm Positive test relieves pain Negative test increases pain James J. Lehman, DC, MBA, DABCO
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Shoulder Abduction Test
Relieves arm and neck pain Presence of Bakody sign
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Maximum cervical compression test (active)
Less provocative than the passive tests Perform prior to other cervical compression tests James J. Lehman, DC, MBA, DABCO
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O’Donoghue’s Maneuver
First cervical special test recorded following range of motion testing. James J. Lehman, DC, MBA, DABCO
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O’Donoghue’s Maneuver
Passive ROM pain = ligament tissue sprain injury Resistive ROM pain = muscle/tendon strain injury Passive and resistive pain = sprain and strain injury James J. Lehman, DC, MBA, DABCO
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Shoulder Abduction Test
Bakody’s sign for nerve root irritation James J. Lehman, DC, MBA, DABCO
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Scheplemann’s Test Intercostal Pain
Contralateral pain might indicate pleurisy or intercostal strain Ipsilateral pain might indicate intercostal neuropathy or costovertebral sprain
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Preferred Protocol for Orthopedic Evaluation
History taking Observation Palpation Range of motion Special tests
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Definition of an orthopedic test
A provocative maneuver that involves stretching, compressing and/or contracting in order to replicate the pain and identify the painful tissues.
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Accuracy of spinal orthopaedic tests: a systematic review
Accuracy of spinal orthopaedic tests: a systematic review. Simpson and Gemmell The ideal orthopaedic test would always give a positive result in those with the disorder tested for (true-positive), and a negative result in those without the condition being tested for (true-negative). It is, therefore, necessary to consider sensitivity and specificity of the tests.
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Accuracy of spinal orthopaedic tests: a systematic review
Accuracy of spinal orthopaedic tests: a systematic review. Simpson and Gemmell Sensitivity is the proportion of those with the target disorder in whom the test result is positive. Specificity is the proportion of those without the target disorder in whom the test result is negative
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Cervical Distraction Test
Distraction test for nerve root, facet, or myospasm Positive test relieves pain Negative test increases pain James J. Lehman, DC, MBA, DABCO
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Straight Leg Raise Test Nerve Root Tension Signs
Pain reaction 0-35 = extradural 35-70 = disc lesion 70-90 = lumbosacral lesion Dull pain in posterior thigh = hamstrings
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Femoral Nerve Traction Test
Side posture extension of lower extremity with knee flexed with affected side up Ipsilateral pain at upper lumbar spine and/or anterior thigh
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Toe Drop Steppage gait Grade 3 when gravity resistance only
Grade 4 with partial resistance
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Toe Drop Dorsi-flexion weakness L 5 is major motor innervation
Tibialis anterior = dorsiflexion and inversion of foot
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Five Symptoms of Nerve Pain Conwell
Burning and/or hot Sharp pain without motion Stabbing or lightening-like pain Tingling and/or numbness Constant pain
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Muscle Pain Dull ache Crampy, knot and/or spasm pain Myofascial
Pin point pain (trigger point) Crawling sensation (formication) Scleratogenous Radiating dull or deep ache
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Resistive Motion Muscle Pain
Eliminate joint motion Isometric muscle contraction
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Muscle Pain Dull achey or spasm pain with active motion
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Joint Pain with Motion Constant pain
Sharp pain upon active and passive motion
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Scleratogenous Pain Referred or radiating dull or deep ache
Ligament or muscle
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Primum Non Nocere Example:
Maximum cervical rotary compression (active) Maximum cervical rotary compression (passive)
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Valsalva and Dejerine
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Jackson and Maximal Foraminal Compression (passive)
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L’Hermitte Sign Space occupying lesion Myelopathy
Sharp shooting or lancinating pain down spinal cord and one or more extremities with cervical flexion
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Kemp’s Test May be performed in either a standing or sitting position
A positive test involves radicular pain
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Kemp’s Oblique bending toward symptomatic side increases pain with a lateral protrusion Oblique bending away from symptomatic side increases pain with a medial protrusion
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Kemp’s Test Assessment
Intervertebral nerve root encroachment Muscular strain Ligamentous sprain Pericapsular inflammation
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Kemp’s Test Once again, the opposite side is tested with increased pain with a medial disc protrusion Remember modus operandi or MO (medial opposite)
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Well-Leg-Raising Test Fajersztajn’s Test
Assessment for lumbar nerve root lesion caused by IVD syndrome or dural sleeve adhesion Contralateral LE SLR
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Antalgic Lean Sign Lateral disc protrusion produces a contralateral list Medial disc protrusion produces an ipsilateral list
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