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ROM for tmj depression
- open mouth as wide as possible
- measure from bottom of top teeth to top of bottom teeth
normal 35-50mm
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ROM tmj lateral deviation
- deviate mouth as far as possible
- measure middle of top teeth to middle of bottom teeth
normal 8-12mm
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ROM tmj protrusion
- push bottom jaw out as much as possible
- measure bottom of top teeth to top of bottom teeth
normal 3-10mm
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MMT tmj depression
- open mouth as far as possible
- push up to try to close pts mouth
- lateral pterygoid
- suprahyoid
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MMT tmj elevation
- keep mouth closed
- try to open pts mouth
- temporalis
- massester
- medial pterygoid
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MMT tmj lateral deviation
- deviate jaw
- try to push pt out of deviation
- lateral pterygoid
- medial pterygoid
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MMT tmj protrusion
- protrude jaw out
- try to push jaw back in
- lateral pterygoid
- medial pterygoid
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MMT cervical extension
- pt lays prone and extends head up
- gravity min= pt lays prone, head fully supported by table, and pt can flex head partial range
- erector spinae/paraspinales (ILS)
- *hold hand under pts head...SAFETY
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MMT cervical flexion
- lay supine, flex head
- gravity min= rotate head, pt can perform partial range
SCM
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MMT cervical rotation
- pt lays supine (if testing left m, rotate to right), rotate head to neutral and cant let you push it back down
- gravity min= sitting, pt completes partial ROM
SCM, scalenes
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MMT cervical flexion to isolate single SCM
- pt lays supine, (rotate head to left if testing right side), rotates and lifts head, you try to push back down
- gravity min= pt still lays, and can complete partial ROM
SCM
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MMT trunk extension
- pt lays prone, arms behind head for 5,4 (4 wavers a little bit), arms at sides for 3,2,1
- grade 2 is partial ROM
erector spinae/paraspinale
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MMT trunk flexion (dance)
- pt lays supine, and has to clear inferior angle
- 5-arms behind head, 4-arms crossed, 3-arms straight, 2,1-knees bent, arms at side (flex up)
- grade 2 if scapula does not clear inferior angle
rectus abdominis
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MMT trunk rotation (same motions as dance)
- pt lays supine, lifts up and rotates.. 5-arms behind head, 4- arms crossed, 3- arms straight, 2,1- knees bent, arms at side
- grade 2= pt cant clear inferior angle (lifts arm with rotation), can observe depression of ribs
obliques (internal oblique on the inside curve)
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ROM cervical flexion
- 0-45
- axis- external auditory meatus
- SA- straight to ceiling
- MA- bottom of nares
- up to 90 is ok
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ROM cervical ext/hyperext
- 45
- axis- external auditory meatus
- SA- straight to ceiling
- MA- bottom of nares
- 90 is ok
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ROM cervical lateral flexion (L&R)
- 0-22
- axis- C7
- SA- through vertebrae
- MA- center of occipital protuberences
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ROM rotation
- 0-75
- axis- middle of top of head
- SA- AC joint
- MA- center of bridge of nose
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ROM thoracic and lumbar flexion
- 4" or 10 cm
- measure from C7 to S2 (pt bends down to touch hands to floor)
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ROM lumbar flexion
- 6-7 cm
- find S2, measure up back 15cm, measure flexion from there (pt bends to touch floor)
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ROM thoracic and lumbar ext/hyperext
- no normal
- measure C7 to S2 (bend backwards)
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ROM lumbar ext/hyperext
- 2 cm
- S2, measure up 15cm, and measure from there (bend backwards)
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ROM thoracic and lumbar lateral flexion (SB)
- no normal
- have pt SB and touch middle finger to floor, measure from tip of finger to the floor
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What special test checks for a disc bulge, or hernitated disc?
- valsalva
- pt holds breath and bears down
- (+) if symptoms reproduce in neck/arms
valsalva lumbar, symptoms reproduce in low back/legs
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What special test checks for subclavian artery occulsion?
- adson
- take pts pulse, bring the arm back and around (pt keeps looking at you)
- (+) if theirs a change in pulse
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What special test checks for a pinched nerve or disc (possible bulge or herniation)?
- compression test (cervical spine)
- apply pressure to top of head 30-60 seconds
- (+) if symptoms reproduce
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What special test checks for a pinched lumbar nerve?
- straight leg raise
- lift leg in air, DF pts foot
- (+) if theres pain up the leg with DF
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What special test checks for the biceps tendon popping out of the groove?
- yergason
- ER and supinate pts arm together and apply resistance to both
- feel for mvmt at longhead biceps origin
- (+) if you feel mvmt
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What special test checks for rotator cuff tears?
- drop arm
- arm straight out (horiz. abd) and pt slowly lowers (controlled)...can give a little push
- (+) if pt cant slowly lower arm, it just drops, or pt cant hold resistance
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What special test checks for shoulder dislocation?
- apprehension test
- ER and abduct the arm
- (+) if pt gets a look of apprehension
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How do you perform a caudal glide (shoulder), and what motion does it help with?
- abduction
- 55 abduction, 30 horizontal adduction
push out with armpit hand, then push head of humerus down towards their feet
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How do you perform a posterior glide (shoulder) and what motion does it help with?
- shld flex, IR, horizontal adduction
- 55 abduction, 30 horizontal adduction
- use ASIS for distraction, rotate body and bend down, push down on head of humerus (twist and dip)
- be on inside of pts arm, pt close to edge
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How do you perform an anterior glide (shoulder), and what does it help with?
- shld ext, ER, horizontal abduction
- 55 abduction, 30 horizontal adduction
- use knee for distraction, twist and dip, push ant. on head of humerus
- pt lays prone, stay on inside of pts arm (arm is towards the floor)
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ROM shoulder flexion (complex) (if goni lined with scapula your measuring GH motion)
- 0-180, pt supine
- axis- lateral aspect of greater tubercle
- SA- parallel to mix axillary line of thorax
- MA- midline of humerus, lateral epicondyle, olecranon process
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ROM shoulder ext/hyperext
- 0-60, pt prone, bend elbow
- axis- lateral epicondyle of greater tubercle
- SA- parallel to mid axillary line of thorax
- MA- midline of humerus, lateral epicondyle, olecranon process
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ROM shoulder abduction
- 0-180, pt supine
- axis- anterior aspect of acromion process
- SA- parallel to sternum
- MA- medial epicondyle
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ROM shoulder IR (2 measurements)
- GH= 0-60, complex= 0-90, pt supine, towel
- axis- olecranon process
- SA- straight toward ground
- MA- ulna (use styloid and olecranon process)
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ROM shoulder ER
- 0-90, pt supine, towel
- axis- olecranon process
- SA- straight to ground
- MA- ulna (use styloid and olecranon process)
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MMT shoulder flexion
- flex arm to 90 with pt sitting on an unsupported chair, support scapula, push proximal to elbow
- grade 2 completes partial range
- palpate ant. deltoid
ant. deltoid
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MMT shoulder ext
- pt prone, ext arm up, support at scapula, push proximal to elbow
- grade 2 is partial range
- palpate around shoulder
latissimus dorsi, post. deltoid, teres major
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MMT shoulder abduction
- abduct to 90 with sitting on unsupported chair, support at shoulder, push proximal to elbow
- gravity min is supine (pt completes partial ROM in sitting, or full ROM in supine) support wrist as pt is going thru ROM; palpate deltoid
deltoid, supraspinatus
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MMT shoulder horizontal abduction
- pt prone, pull elbow up, stabilize at scapula, push above elbow
- gravity min pt sits up, support arm as pt moves thru full ROM (stand behind); palpate post. shoulder above axilla
posterior deltoid
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MMT shoulder horizontal adduction
- supine, bringing elbow across body, stabilize shoulder, pull above the elbow towards you
- gravity min is sitting, support arm as pt completes full ROM; palpate chest
pectoralis major
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MMT shoulder ER
- pt prone, arm at 90 angle and rotate towards head, stabilize shoulder, use 2 fingers to push at wrist
- gravity min= arm dangles, and pt completes full ER motion; palpate at top of arm, scapula
infraspinatus, teres minor
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MMT shoulder IR
- pt prone, arm at 90 angle, rotate towards back, support shoulder, use 2 fingers to push at wrist
- gravity min= arm dangles, pt completes full IR; palpate in armpit
subscapularis, pectoralis major, latissimus dorsi, teres major
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ROM elbow flexion
- 0-145, supine, towel under elbow
- axis- lateral epicondyle
- SA- along humerus, acromion process
- MA- midline of radius (head a styoid)
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ROM elbow extension
- 0, supine, towel under
- axis- lateral epicondyle
- SA- along humerus, acromion process
- MA- midline of radius (head and styloid)
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ROM forearm supination
- 0-80, use small goni, arm tucked at side
- axis- medial and proximally to ulnar styloid process
- SA- parallel to anterior midline of humerus
- MA- across ventral aspect, proximal to styloids
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ROM forearm pronation
- 0-80, use small goni, arm tucked at side
- axis- lateral and proximal to ulnar styloid process
- SA- parallel to anterior midline of humerus
- MA- across dorsal aspect, proximal to styloids
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MMT elbow flexion
- pt sitting, stabilize shoulder, push at wrist
- flex pts arm, then release it a little
- gravity min= bring arm to side and support while pt completes full ROM
biceps, brachialis, brachioradialis
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MMT elbow extension
- pt prone, extend arm out, stabilize elbow, push at wrist
- gravity min= sitting, support arm out to the side while pt completes full ROM
triceps
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MMT forearm supination
- pt sitting, arm flexed to 90, start in pronation, then supinate, stabilize ulna, try to pull radius (take out of supination)
- gravity min= parade wave, support elbow and have pt supinate thru full ROM
supinator, biceps
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MMT forearm pronation
- pt sitting, arm flexed at 90, start supinated then go into pronation, stabilize ulna, pull radius, try to take out of pronation
- gravity min= parade wave, support elbow and have pt pronate thru full ROM
pronator teres, pronator quadratus
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What is the test to check for a tear or stretch in the medial/lateral collateral ligaments?
ligamentous stability
- push on sides of elbow
- (+) if theres too much play in the ligament, too much motion
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What is the test to check for neuromas in the arm, or extra sensitivity?
tinel sign
- tap on pts elbow
- (+) if area is extra sensitive or tingly
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What is the test to check for tennis elbow?
tennis elbow test
- straighten arm, extend wrist, and push down on the wrist
- (+) if theres pain with pressure on the wrist at the lateral epicondyle
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How do you do a HU distal glide, and what does it help with?
- flexion, 70 flex, 10 supination
- rest pts arm on your shoulder
- hands at ulna, push down then scoop up
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How do you do a HU radial glide, and what does it help with?
- flexion, 70 flexed, 10 supination, rest on shoulder...no distraction
- stabilize humerus, push towards radius (varus)
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How do you do a HU ulnar glide, and what does it help with?
- extension, 70 flexed, 10 supinated, rest on shoulder...no distraction
- stabilize radius, push humerus laterally (valgus)
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How do you do a HR dorsal glide, and what does it help with?
- extension, fully extended and supinated
- hold 2 fingers around the head of the radius, support humerus, push down, no distraction
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How do you do a HR volar glide, and what does it help with?
- flexion, fully extended and supinated
- 2 fingers around head of radius, support humerus, push up, no distraction
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How do you do a proximal RU dorsal glide, and what does it help with?
- pronation, 70 flexed, 35 supinated
- pt holds you arm or rest on shoulder, stabilize ulna, pull down and in on radius
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How do you do a proximal RU volar glide and what does it help with?
- supination, 70 flexed, 35 supinated
- pt holds onto your arm, or rest on your shoulder, stabilize ulna, push up and out on radius
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