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1. Test Asymptomatic Side First, unless bilateral movement is required
2. Any movements which are painful are performed Last
3. Active movements are performed before Passive movements
4. At completion of an examination, the examiner must Warn the patient their symptoms may be worsened as a result of the examination
General Rules for Performing of Ortho / Neuro Tests
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This type of Neurologic Pain is the condition of the Nerve Roots.
- Radicular / Radiculitis / Radiculopathy
- i.e. L4 Radiculoapathy, C5 Radiculopathy
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This type of Neurologic Pain is the condition of Peripheral Nerves.
- Neuralogic / Neuritis / Neuropathy
- i.e. Femoral Neuropathy, Ulnar Neuropathy
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What is the term for alteration of feel / touch / sensation?
Dysesthesia
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What is the term for no feel / touch / sensation?
Anesthesia
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What is the term for increased feel / touch / sensation?
Hyperesthesia
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What is the term for decreased feel / touch / sensation?
Hypoesthesia
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What is the term for altered feel / touch / sensation (like ants crawling into skin)?
Paraesthesia
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What is the term for alteration in pain sensitivity?
Algesia
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What is the term for no pain sensitivity?
Analgesia
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What is the term for increased pain sensitivity?
Hyperalgesia
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What is the term for decreased pain sensitivity?
Hypoalgesia
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How is muscle strength graded?
- 5 - Normal (complete range of motion, against gravity with resistance)
- 4 - Good (complete range of motion, against gravity with some resistance)
- 3 - Fair (complete range of motion, against gravity only)
- 2 - Poor (complere range of motion, with gravity eliminated, but in the perpendicular plane there is contractility)
- 1 - Trace (evidence of slight contractility but no joint motion
- 0 - Zero (no evidence of contractility)
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A ligamentous injury, pain aggrevated upon passive movement.
Sprain
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Musculocutaneous Injury, pain upon resisted range of motion
Strain
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What is the test performed the determine whether to keep a patient or refer them out?
- Heel Walk / Toe Walk
- Support forward stretched arms while they walk on their heel (tests L5 nerve root)
- Support forward stretched arms while they walk on their tippy toes (test S1 nerve root)
- (+) unable to perform the test
- *If patient cannot doe both, they are considered a surgical case
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Using resisted movements to test motor function, what are the nerve(s) responsible when testing Iliopsoas?
L1-2 primarily
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Using resisted movements to test motor function, what are the nerve(s) responsible when testing Adductors of the Hip?
L3 primarily
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Using resisted movements to test motor function, what are the nerve(s) responsible when testing Tibialis Anterior?
L4 primarily
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Using resisted movements to test motor function, what are the nerve(s) responsible when testing Extensor Hallucis (big toe)?
L5 primarily
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Using resisted movements to test motor function, what are the nerve(s) responsible when testing Peroneus?
S1 primarily
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What is ROM for Lumbar?
- Flexion: 80°
- Extension: 20°-30°
- Lateral Flexion: 35°
- Rotation: 45°
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Which nerve roots are associated with the Lumbar Plexus?
- L1-L4 Nerve Roots
- *the lumbar plexus is situated in the posterior part of the psoas major. In front of the tranverse process of the lumbar vertebrae
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Which nerve roots are associated with the Sacral Plexus?
L4-S4 Nerve Roots
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Which nerve is affected at the site of Protrusion 1? Protrusion 2?
- Protrusion 1: L5 Nerve Compression
- Protrusion 2: S1 Nerve Compression
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What are the nerve(s) responsible when testing Patellar?
L4 Primary
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What are the nerve(s) responsible when testing Medial Hamstrings?
L5 primary
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What are the nerve(s) responsible when testing Achilles?
S1 Primary
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What is the image study for Disc Herniation?
- 1. MRI
- 2. CT Scan (patient cannot have MRI if metal is in their body)
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How does the practitioner determine whether a Disc Herniation is lateral or medial to a nerve root?
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What are the indications for Straight Leg Raise (SLR)?
- Lumbar Radiculopathy / Neuropathy
- Hip / Hamstring problems
- SI joint problems
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When performing SLR, if pain is found between 0°-35°, what possible problem(s) does the patient have?
- Ipsilateral SI (same side sacroiliac) or Hip Problems
- Severe Lumbar muscle spasms
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When performing SLR, if pain is found between 35°-70°, what possible problem(s) does the patient have?
Lumbar Radiculopathy
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When performing SLR, if pain is found over 70°, what possible problem(s) does the patient have?
- Ipsilateral Hamstring
- Contralateral SI joint
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What are the indicadtions of Braggard's test?
Lumbar Radiculopathy / Neuropathy
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What are the indications of Well Leg Raise (WLR)?
Lumbar Radiculopathy
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What are the indications of the Belt test?
- Decreased pain => SI / Hip problem
- No change / Increased pain => Lumbar / Lumbosacral problems
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The Femoral Triangle is bounded by which anatomical structures?
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What are the degress of Active Hip Normal ROM's?
- Flexion (knee flex): 120°
- Flexion (knee ext): 80°-90°
- Extension: 15°
- Abduction: 50°
- Adduction: 30°
- Internal Rotation: 40°
- External Rotation: 60°
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What are the indication(s) of the Thomas test?
- Contracture of Hip Flexors including:
- Iliopsoas
- TFL (tensor facia latae)
- ITB (iliotibial band)
- Rectus Femoris
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What is the indication of Trendelenburg's test?
- Weakness of Gluteus Medius
- *to perform this test, you stand on the affected sides leg
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What is the indication for Yeoman's test?
SI sprain
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What is the indication for Gaenslen's test?
SI sprain
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What is the indication of the Hibb's test?
Hip / SI joint problem
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What is the indication of Piriformis Stretch test?
Piriformis Syndrome
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What are the degress of Active Knee Normal ROM's?
- Flexion: 135°
- Extension: 0°
- Int. Rotate: 30°
- Ext. Rotate: 40°
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What are the indications of the Drawer test?
- Anterior Cruciate Ligament (ACL) damage; (+) excessive motion pushing Tibia forwards
- Posterior Cruciate Ligament (PCL) damage; (+) excessive motion pushing Tibia backwards
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What is the indication for Sag sign?
Loss of PCL integrity
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What is the indication for Valgus stess test?
Medial Collateral Ligament (MCL) damage
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What is the indication for Varus stress test?
Lateral Collateral Ligament (LCL) damage
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What is the indication for Appley's Distraction?
MCL / LCL damage
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What are the indications for Appley's Compression test?
- Damage to posterior horn of Medial Meniscus, found on exteranl rotation
- Damage to poseterior horn of Lateral Meniscus, found on internal rotation
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What are the indications of McMurray's test?
- Damage to posterior horn of Medial Meniscus, found on exteranl rotation
- Damage to poseterior horn of Lateral Meniscus, found on internal rotation
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