-
Apply inferior traction with arm at side. Positive for AC joint instability if there is a gap between humeral head and acromion
Sulcus sign
-
Arm at 90 deg forward flexion, passive IR Pain is positive for impingement/RC tendonitis
Hawkins
-
start with arm at 90 deg forward flex and pronation, hold scap and passively forward flex to overhead. Pain is pos. for supraspinatus impingement.
Neer's
-
Have patient horizontally ADD arm. Pain is positive for AC injury
Cross over test
-
IR with hand on back. If pt cannot lift hand off back pos for weakness/tear of subscapularis
Lift-off test
-
With pt supine and arm at side with elbow flexed to 90, place your finger on biceps tendon. Externally Rotate. Pos for biceps tendonitis if pain or feel tendon slip out of groove
Yergason's test
-
Pt arm starts in forward flexion and supination, resist this motion, pain is pos for biceps tendonitis
Speed's
-
Shoulder AB to 90, elbow flexed to 90. Apply pressure behind humeral head and ER shoulder. Pos for anterior instability if pain.
Apprehension test
-
Tapping on volar aspect of wrist over carpal tunnel will reproduce pain/paresthesias in median nerve distribution. Pos for carpal tunnel syndrome.
Tinnel's
-
Place dorsum of hands together for 1 min. Pos for carpal tunnel syndrome if pain/paresthesias in median nerve distribution.
Phalen's
-
radial head fx in adults, supracondylar fx in kids
Posterior fat pad sign
-
usually normal, sail sign
Anterior fat pad sign
-
Test for disc herniation. Pt lies supine and leg is elevated. Pos is radicular pain below the knee.
Straight leg raise test
-
Essentially place foot of affected leg on pt's unaffected knee (Flexion, Abduction, ext. rotation). Hold opposite ASIS and apply downward pressure to affected knee. Pain is pos for problem with SI joint.
FABER test
-
Test for lumbar nerve root irritation. Pt sitting, passively extend affected leg. Pain is pos test (patient will put hands on table and arch backward)
Flip test
-
Gold standard for ACL tear. Knee flexed 15 deg. stabilize femur with one hand and tibia with other. Move tibia forward. Pos for ACL tear if movement and soft end point
Lachman
-
Knee flexed 90 deg. stabilize foot on table, pull tibia forward. Laxity can indicate ACL injury
Anterior drawer
-
Test for ACL dysfunction-Apply valgus stress, IR force and extend the knee. Maintain valgus stress and IR, and flex knee to 30 deg. ACL deficient knee will anterolaterally sublux on distal femur.
Pivot shift
-
For chronic PCL tear. Flex knee to 90 deg, stabilize heel on table. Tibia will droop at knee joint.
Sag sign
-
Knee flexed to 90 deg, stabilize foot on table. Move tibia posterior. Laxity can indicate PCL injury
Posterior drawer
-
Test for LCL injury, apply stress to medial knee while stabilizing lower leg.
Varus stress
-
Test for MCL injury, apply stress to lateral knee while stabilizing lower leg
Valgus stress
-
Test for meniscus injury. One hand on joint line and the other on the sole of the foot. Flex knee to 90 deg. IR/ER and extend the knee. Palpable or audible click
McMurray
-
Test for meniscal tears. Pt in prone position, flex knee to 90 deg, apply load through foot and IR/ER rotate. Pain is pos test.
Apley grind test
-
Cup hand around superior patella. Have pt contract quads while applying pressure. Pain is pos sign for patellar injury.
Patella grind
-
Draw line from ASIS to tibial tubercle. Draw straight line from tibial tubercle up. Measure angle. Females less than 17, males less than 14 is normal.
Q angle
-
Pt lying on side. Hold hips in neutral and cradle affected leg. Bring pt into hip flexion then adduction and extension. Let leg drop, if leg stays elevated positive for IT band tightness.
Ober test
-
put foot into 10 deg plantar flexion, stabilized tibia, other hand on heel and move ankle mortis forward on tibia. Pain and laxity pos for lateral ankle sprain. Tests ATF.
Anterior drawer (ankle)
-
Dorsiflex foot to 10 deg. Hold heel and invert talus/calcaneous on tibia while supporting tibia with other hand. Pain and laxity pos for lateral ankle sprain (CF).
Talar tilt
-
evert talus/calcaneus on tibia while supporting tibia with other hand. Pain and laxity pos for medial ankle sprain (deltoid lig.)
Valgus stress (ankle)
-
With both hands press tibia and fibula together. Pain indicates injury to syndesmosis.
Squeeze test
-
Pt in prone position, squeeze calf. Lack of plantar flexion indicative of Achilles tendon rupture.
Thompson's test
-
Fusiform swelling of fingers, significant tenderness along the course of the tendon, marked pain on passive extension, flexed finger at rest. Positive for septic tenosynovitis.
Kanavel sign
-
Cervical disc degeneration
Spondylosis
-
-
-
C2 fx/dislocation from hyperextension and distraction
hangman's fx
-
C7 spinous process fx
Clay shoveler's fx
-
An injury to the glenoid labrum that can be described as Superior Labrum Anterior to Posterior.
SLAP lesion
-
95% of all shoulder dislocations
Anterior shoulder dislocation
-
cortical depression in the head of the humerus bone.from forceful impaction of the humeral head against the anteroinferior glenoid rim when the shoulder is dislocated anteriorly.
Hill Sachs
-
An avulsion of the anteroinferior glenoid labrum at its attachment to IGHL complex.
Bankhart lesion
-
Dislocation caused by an anterior force, seizure, or electric shock, and is fairly uncommon
Posterior shoulder dislocation
-
This injury can damage the radial nerve.
Humeral shaft fracture
-
Medial epicondylitis
golfer's elbow
-
Lateral epicondylitis
Tennis elbow
-
dislocation of the elbow joint caused by a sudden pull on the extended pronated arm. The head of the radius slips out of the annular ligament
Nurse maid's elbow
-
90% of elbow dislocations are in this direction
Posterior
-
Most common elbow fracture in kids
Supracondylar
-
Ulnar shaft fracture with proximal radius dislocation.
Monteggia fracture
-
Radial fracture with distal ulna dislocation
Galeazzi fracture
-
Isolated ulna fracture caused by direct blow to the forearm
Night stick fracture
-
90% of distal radial fractures. Usually from a FOOSH. Dorsal angulation of distal fragment
Colles fracture
-
Distal radial fracture from a fall on the back of the hand. Causes a volar angulation of the distal fragment.
Smith fracture
-
Most common carpal fracture, at an increased risk for avascular necrosis
scaphoid fracture
-
fracture of the distal 5th metacarpal
Boxer's or Brawler's fracture
-
Forced flexion of the finger from an axial load, causing rupture of extensor digitorum to DIP.
Mallet finger
-
Thickened palmar fascia forms nodules over the flexor tendons causing a flexion contracture. Most common at ring and pinky finger.
Dupuytren's contracture
-
occurs when the motion of the tendon that opens and closes the finger is limited, causing the finger to lock or catch
trigger finger
-
Caused by abduction stress at the thumb. UCL injury
Skier's thumb (gamekeeper's thumb)
-
bony growths on the terminal (DIP). interphalangeal joints of the fingers
Heberden's nodes
-
hard, bony outgrowths or gelatinous cysts on the proximal interphalangeal joints
Bouchard's nodes
-
flexion of DIP and hyperextension of PIP
swan neck deformity
-
Loss of central slip insertion on proximal dorsal middle phalanx. Flexion fo PIP and hyperextension of DIP.
boutonnieres deformity
-
Seen on oblique view, a defect in the pars interarticularis puts a collar on the scotty dog.
Spondylolysis
-
MVA injury where the lap belt immobilizes pelvis and the thorax is forcefully flexed forward. seen on AP as a crack through the owl's eyes (pedicles), or an open beak (cracked spinous process)
Chance fracture
-
Collapse of anterior vertebral body with intact posterior wall from hyperflexion or osteoporosis
wedge fracture
-
vertebral slipping
Spondylolisthesis
-
lateral curvature of the spine
Scoliosis
-
classification system used for grading hip fractures
Garden type
-
90% of hip fractures are in this direction
Posterior
-
Occurs at the origin og the sartorius, and is caused by knee flexion and hip hyper-extension.
ASIS avulsion fracture
-
Occurs at the origin of the hamstring, and is caused by vigorous hip flexion with knee extension.
Ischial tuberosity avulsion fracture
-
Occurs in obese adolescent boys. Will cause a limp and hip, thigh or knee pain, loss of IR, flexion and abduction
Slipped capital femoral epiphysis
-
avulsion fragment of the lateral tibial plateau associated with ACL or meniscus tear
Segond fracture
-
Gastrocnemius tendon sesamoid
Fabella
-
Proximal 1/3 fibula fracture associated with medial ankle fracture.
Maisonneuve fracture
-
Tibial tubercle apophysitis common in adolescents
Osgood Schlatter's
-
Holds tibia and fibula together
Syndesmosis
-
indications for getting imaging after ankle injury
Ottawa rules
-
85% of all ankle sprains are in this direction, and are from a plantar flexion inversion injury.
Lateral
-
Fracture of proximal 5th metatarsal, from an inversion injury
Jones fracture
-
most common fracture of the ankle
distal fibula fracture
-
Usually seen in deconditioned athletes, and is caused by quick plantar flexion
Achilles injury
-
AKA shin splints
medial tibial stress syndrome
-
Calcaneal apophysis, very common in 7-15 year olds
Sever’s disease
-
pain on plantar aspect of calcaneus, will result in but are not caused by heel spurs
Plantar fasciitis
-
disruption of tarsometatarsal joint
Lisfranc fracture
-
Perineural fibrosis of digital nerve between 3rd and 4th web space, caused by walking on hard surfaces or wearing tight shoes.
Morton's neuroma
-
Urate crystals in 1st MTP joint
Gout
-
-
first mtp joint sprain from excessive force of dorsiflexion or plantarflexion
turf toe
-
Childhood fracture in which the physis is widened. Growth disturbances are uncommon.
Salter Harris I
-
Childhood fracture that involves the metaphysis as well as the physis. Rarely results in functional deficits. The most common type.
Salter Harris II
-
Childhood fracture that involves both the epiphysis as well as the physis. There is damage to the growth plate but prognosis is relatively favorable.
Salter Harris III
-
Child hood fracture that involves the epiphysis, physis, and metaphysis. Can result in chronic disability.
Salter Harris IV
-
Childhood fracture that is a compression of the physis caused by an axial load. Poor functional prognosis.
Salter Harris V
-
As seen on a lateral radiograph of the cervical spine a widened predental space (greater than 2.5 mm)idicates what type of injury.
Transverse ligament injury or laxity.
-
Can occur from a blow to the top of the head and affects C1.
Jefferson fx
-
Tip of the dens, usually stable
Type I odontoid fracture
-
Base of the dens, most common
Type II odontoid fracture
-
Through C2 body, unstable
Type III odontoid fracture
-
Commonly occur at proximal 2/3 and distal 1/3 of the involved bone.
Clavicle fx
-
When the humeral head slightly overlaps the glenoid in a normal AP radiograph.
Crescent sign
-
AP view of the shoulder shows the humeral head to lie medial to the glenoid and inferior to the coracoid
Anterior shoulder dislocation
-
On an AP radiograph the humeral head is lateral to the glenoid so that there is no overlap.
Posterior shoulder dislocation
-
These are the three cardinal signs for what; joint space narrowing, bony overgrowth at edge of joint, sclerosis along articular surface
Osteoarthritis
-
A focal area of avascular necrosis
Osteochondritis desiccans
-
Most common site of osteochondritis desiccans
Knee
-
Loose body in a joint
Joint mouse
-
Avascular necrosis of the lunate
Kienböck’s disease
-
Oblique fracture through the base of the radial styloid
Chauffeur's fracture
-
Buckle fracture with intact periosteum, common in children
Torus fracture
-
Fracture of the thumb metacarpal base from an axial blow or adduction stress to thumb
Bennet's fracture
-
Comminuted Bennet's fracture
Rolando fracture
-
This part of a carpal bone can get fractured from a direct impact of a racquet, baseball, golf club.
Hook of the Hamate
-
Forceful extension of the DIP, patient now unable to flex DIP due to FDP avulsion.
Jersey finger
-
Acetaminophen (Tylenol)
Efficacy comparable to aspirin, first line therapy for osteoarthritis. No good antiinflammatory action
-
Aspirin
First NSAID, Irreversible platelet effects
-
Ibuprofen (Motrin, rufen, Nuprin, Advil)
NSAID-200 mg superior to 650 mg aspirin. Better antiinflammatory than acetaminophen.
-
Naproxen(Naprosyn)naproxen Na (Anaprox, Aleve)
NSAID-275 mg Na salt comparable to 650 mg aspirin with slower onset and longer duration
-
Ketorolac (Toradol)
NSAID 30-60 mg is comparable to 6-12 mg morphine
-
Celecoxib (Celebrex)
Selective COX-2 inhibitor-use sparingly if at all, short term reduction of GI toxicity
-
Diclofenac patch (Flector)
Topical NSAID strains, sprains, contusions
-
Diclofenac gel (Voltaren)
Topical NSAID approved for osteoarthritis
-
Tramadol
Opioid-adjust for renal function, not a controlled substance
-
Meperidine (Demerol/demonal)
Opioid-not recommended. Metabolite causes CNS toxicity, accumulates due to long half-life.
-
Nalbuphine
Kappa-opioid not recommended
-
Butorphanol
Kappa-opioid not recommended
-
Dexacine
Kappa-opioid not recommended
-
Buprenorphine
Kappa-opioid not recommended
-
Pentazocine
Kappa-opioid not recommended
-
Propoxyphene (Darvocet/darvocrap)
Opioid-not recommended, efficacy in trials no more than that of 650 mg ASA or APAP. Metabolite accumulation may cause seizures.
-
Used for neuromuscular conditions. Little evidence for use in musculoskeletal conditions
Antispastic
-
Used for musculoskeletal spasms related to injury. Evidence supports SHORT TERM use
Antispasmodic
-
Cyclobenzaprine (Flexeril)
tricyclic antidepressant used clinically as a muscle relaxant/antispasmodic
-
Methocarbamol (Robaxin)
muscle relaxant/antispasmodic
-
Tizanidine (Zanaflex)
muscle relaxant/antispasmodic
-
Carisoprodol (soma)
Muscle relaxant
-
Chlorzoxazone (Parafon forte)
muscle relaxant/antispasmodic
-
Tizanidine (Zanaflex)
muscle relaxant/antispasmodic
-
Pregabalin (Lyrica)
indicated for fibromyalgia
-
Gabapentin (Neurontin)
indicated for fibromyalgia
-
Seldom warranted for back pain
Opioids in general
-
Amitriptyline
Tricyclic antidepressant-low doses indicated for treatment of back pain.
-
duloxetine (Cymbalta)
SNRI-Used for treatment of subacute and chronic musculoskeletal pain
-
venlafaxine (Effexor)
SNRI-Used for treatment of subacute and chronic musculoskeletal pain
-
-
-
-
Shoulder abduction/elbow flexion
C5-6
-
-
-
-
-
-
-
Sensory-tip of shoulder
C4
-
-
-
-
-
-
-
-
Brachial plexus
C5, C6, C7, C8, T1
-
-
-
-
-
Hallices longus extension
L5
-
Hallices longus flexion
S1
-
Sensory-upper outer thigh
L1
-
Sensory-mid anterior thigh
L2
-
-
-
Sensory-first web space foot
L5
-
-
-
-
-
Sensory-first dorsal web space hand
Radial nerve
-
Sensory-palmar middle pad
Median nerve
-
Sensory-palmar small pad
Ulnar nerve
-
-
-
Sensory-outer thigh at knee
L3
-
-
-
-
-
-
-
-
-
Strength testing 0/5
Absent
-
Strength testing 1/5
trace movement/fasciculation
-
Strength testing 2/5
Full range of motion without gravity
-
Strength testing 3/5
Full range of motion against gravity but not resistance
-
Strengths testing 4/5
Full range of motion against gravity and mild resistance
-
Strength testing 5/5
Full range of motion against full resistance
-
-
-
-
-
-
-
Elbow pronation/supination
0-80
-
-
Wrist-palmar flexion
0-70
-
Wrist-ulnar deviation
0-30
-
Wrist-radial deviation
0-20
-
-
-
-
-
Shoulder external rotation
0-90
-
Shoulder internal rotation
0-40
-
-
-
-
-
Hip internal rotation
0-40
-
Hip external rotation
0-50
-
-
-
Ankle plantarflexion
0-40
-
-
-
Cervical spine flexion
0-45
-
Cervical spine extension
0-45
-
Cervical spine lateral flexion
0-45
-
Cervical spine rotation
0-80
-
Thoracolumbar spine flexion
0-90
-
Thoracolumbar spine extension
0-30
-
Thoracolumbar spine lateral flexion
0-30
-
Thoracolumbar spine rotation
0-30
-
-
-
-
-
-
-
-
Naproxen Sodium
Anaprox, Aleve
-
-
-
-
-
Chlorzoxazone
Parafon Forte
-
-
-
-
-
-
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