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A Comparative Study on Immediate Effects of Traction Straight Leg And
International Jour nal of Applie d Rese arc h 2019; 5(4): 274-278 ISSN Print: 2394-7500 ISSN Online: 2394-5869 A comparative study on immediate effects of traction Impact Factor: 5.2 IJAR 2019; 5(4): 274-278 straight leg and bent leg raise on hamstring muscle www.allresearchjournal.com Received: 07-02-2019 flexibility in normal individuals Accepted: 09-03-2019 Pooja D Kapadia Intern at Late Shree Fakirbhai Pooja D Kapadia and Dr. Virendra K Meshram Pansare Education Foundation’s College Of Abstract Physiotherapy, Nigdi, Pune, Background: Muscular flexibility is an important aspect of normal human function. Limited flexibility Maharashtra, India has been shown to predispose a person to several musculoskeletal overuse injuries and significantly affect a person’s level of function. The objective of our study was to find out the effect of mulligan Dr. Virendra K Meshram Traction Straight Leg Raise (TSLR) on hamstring flexibility, to find out the effect of Mulligan bent Leg Associate Professor, Raise (BLR) on hamstring flexibility & Comparison of Mulligan TSLR & Mulligan BLR on hamstring Department of Cardiovascular and Respiratory flexibility in normal individuals. Physiotherapy, Late Shree Method: For the present study, a total of 124 physiotherapy students were screened; of which 50 adults Fakirbhai Pansare education with hamstring muscle tightness were recruited and randomly divided into two groups: Group A- given Foundation’s College Of Mulligan Traction Straight Leg Raise and Group B- given Mulligan Bent Leg Raise. Hamstring Physiotherapy, Nigdi, Pune, flexibility was measured before and after the application of each stretching technique with the use of sit Maharashtra, India and reach test. -
SIMMONDS TEST: Patient Is Prone Doctor Flexes the Patients Knee to 90 Degrees Doctor Squeezes the Patient’S Calf
Clinical Orthopedic Testing Review SIMMONDS TEST: Patient is prone Doctor flexes the patients knee to 90 degrees Doctor squeezes the patient’s calf. Classical response: Failure of ankle plantarflexion Classical Importance= torn Achilles tendon Test is done bilaterally ACHILLES TAP: Patient is prone Doctor flexes the patient’s knee to 90 degree Doctor dorsiflexes the ankle and then strikes the Achilles tendon with a percussion hammer Classical response: Plantar response Classical Importance= Intact Achilles tendon Test is done bilaterally FOOT DRAWER TEST: Patient is supine with their ankles off the edge of the examination table Doctor grasps the heel of the ankle being tested with one hand and the tibia just above the ankle with the other. Doctor applies and anterior to posterior and then a posterior to anterior sheer force. Classical response: Anterior or posterior translation of the ankle Classical Importance= Anterior talofibular or posterior talofibular ligament laxity. Test is done bilaterally LATERAL STABILITY TEST: Patient is supine Doctor grasps the tibia with one hand and the foot with the other. Doctor rotates the foot into inversion Classical response: Excessive inversion Classical Importance= Anterior talofibular ligament sprain Test is done bilaterally MEDIAL STABILITY TEST: Patient is supine Doctor grasps the tibia with one hand and the foot with the other Doctor rotates the foot into eversion Classical response: Excessive eversion Classical Importance= Deltoid ligament sprain Test is done bilaterally 1 Clinical Orthopedic Testing Review KLEIGER’S TEST: Patient is seated with the legs and feet dangling off the edge of the examination table. Doctor grasps the patient’s foot while stabilizing the tibia with the other hand Doctor pulls the ankle laterally. -
Sacroiliac Joint Dysfunction a Case Study
NOR200188.qxd 3/8/11 9:53 PM Page 126 Sacroiliac Joint Dysfunction A Case Study CPT William Murray Pain is a widespread issue in the United States. Nine of physical therapist. She was evaluated and her treatment 10 Americans regularly suffer from pain, and nearly every consisted of a transcutaneous electrical nerve stimula- person will experience low back pain at one point in their lives. tion unit while in the PT clinic, aqua therapy, and ice Undertreated or unrelieved pain costs more than and heat application. $60 billion a year from decreased productivity, lost income, After several weeks, Ms. T returned to the primary care and medical expenses. The ability to diagnose and provide ap- provider and informed her that the pain has not decreased and “feels like that it is getting worse.” She also informed propriate medical treatment is imperative. This case study ex- the provider that she was having difficulty sleeping and amines a 23-year-old Active Duty woman who is preparing to constantly feeling tired secondary to pain. Throughout the be involuntarily released from military duty for an easily cor- next several months, the primary care provider tried nu- rectable medical condition. She has complained of chronic low merous medication trials with no relief for the patient. Ms. back pain that radiates into her hip and down her leg since ex- T gives a history of being prescribed numerous medica- periencing a work-related injury. She has been seen by numer- tions within several drug classifications. She stated vari- ous providers for the previous 11 months before being referred ous side effects that are related to the medications and to the chronic pain clinic. -
The Lower Extremity Exam for the Family Practitioner
Melinda A. Scott, D.O. THE LOWER EXTREMITY Orthopedic Associates of EXAM FOR THE FAMILY Dayton Board Certified in Primary Care PRACTITIONER Sports Medicine GOALS Identify landmarks necessary for exam of the lower extremity Review techniques for a quick but thorough exam Be familiar with normal findings and range of motion Review some special maneuvers and abnormal findings Review common diagnoses PRE-TEST QUESTIONS 20% 20% 20% 20% 20% If a patient has hip arthritis, where will he or she typically complain of pain? A. Buttock B. Low back C. Lateral hip D. Groin E. Posterior thigh 10 A. B. C. D. E. Countdown PRE-TEST QUESTIONS A positive straight leg raise test indicates 20% 20% 20% 20% 20% that the patient’s hip pain is from a A. Radicular/sciatic etiology B. Hip joint pathology C. Bursitis D. Tight Hamstrings E. Weak hip flexors 10 Countdown A. B. C. D. E. PRE-TEST QUESTIONS A positive McMurray’s tests is indicative of 20% 20% 20% 20% 20% a possible A. ACL tear B. MCL tear C. Patellar dislocation D. Joint effusion E. Meniscus tear 10 Countdown A. B. C. D. E. PRE-TEST QUESTIONS Anterior drawer test on the knee is performed with the knee in 20% 20% 20% 20% 20% A. 30 degrees flexion B. 90 degrees flexion C. Full extension D. 45 degrees flexion E. 130 degrees flexion 10 Countdown A. B. C. D. E. PRE-TEST QUESTIONS A positive squeeze test during an ankle 20% 20% 20% 20% 20% exam is indicative of A. Syndesmotic injury B. -
Best Tests for Differential Diagnosis What Are the Metrics of Diagnosis?
9/6/2018 Best Tests for Differential Diagnosis What are the Metrics Chad Cook PhD, PT, MBA, FAAOMPT of Diagnosis? Professor and Program Director Duke University Duke Clinical Research Institute For Diagnosis, There are Analytic Diagnostic Test Metrics Metrics • Diagnostic accuracy • Reliability • Diagnostic accuracy relates to the ability of • Sensitivity a test to discriminate between the target condition and another competing condition. • Specificity • Positive and Negative Predictive Value • Positive and Negative Likelihood Ratios Does Reliability Matter? Sensitivity and Specificity No worries, The you will Sensitivity: Percentage of people who test positive for a condition • be fine is fatal specific disease among a group of people who have the disease • Specificity: Percentage of people who test negative for a specific disease among a group of people who do not have the disease Kappa Intraclass Correlation www.zillowblog.com Coefficient 5 1 9/6/2018 Sensitivity Example Specificity Example • 50 patients with arm pain associated • 50 patients with no arm pain with cervical radiculopathy associated with a cervical strain • Test was positive in 40 of the 50 • Test was positive in 5 of the 50 cases cases • Sensitivity = 40/50 or 80% • Specificity = 45/50 or 90% • Correct 80% of the time in cases • Correct 90% of the time in cases that were cervical radiculopathy that were NOT cervical radiculopathy http://www.triggerpointbook.com/infrasp2.gif http://www.triggerpointbook.com/infrasp2.gif Likelihood Ratios • A high LR+ influences post-test probability with a positive finding • A value of >1 rules in a diagnosis • A low LR- influences post-test probability with a negative finding • A value closer to 0 is best and rules out Bossuyt P, et al. -
Sacroiliac Joint Dysfunction and Piriformis Syndrome
Classic vs. Functional Movement Approach in Physical Therapy Setting Crista Jacobe-Mann, PT Nevada Physical Therapy UNR Sports Medicine Center Reno, NV 775-784-1999 [email protected] Lumbar Spine Intervertebral joints Facet joints Sacroiliac joint Anterior ligaments Posterior ligaments Pelvis Pubic symphysis Obturator foramen Greater sciatic foramen Sacrospinous ligament Lesser sciatic foramen Sacrotuberous ligament Hip Capsule Labrum Lumbar spine: flexion and extension ~30 total degrees of rotation L1-L5 Facet joints aligned in vertical/saggital plane SI joints 2-5 mm in all directions, passive movement, not caused by muscle activation Shock absorption/accepting load with initial contact during walking Hip Joints Extension 0-15 degrees 15% SI joint pain noted in chronic LBP patients Innervation: L2-S3 Classic signs and symptoms Lower back pain generally not above L5 transverse process Pain can radiate down posterior thigh to posterior knee joint, glutes, sacrum, iliac crest sciatic distribution Pain with static standing, bending forward, donning shoes/socks, crossing leg, rising from chair, rolling in bed Relief with continuous change in position Trochanteric Bursitis Piriformis Syndrome Myofascial Pain Lumbosacral Disc Herniation and Bulge Lumbosacral Facet Syndrome J. Travell suspects Si joint pain may causes piriformis guarding and lead to Piriformis syndrome… Tenderness to palpation of PSIS, lower erector spinae, quadratus lumborum and gluteal muscles Sometimes positive SLR Limited hip mobility -
Special Tests
SPECIAL TESTS ANKLE Anterior Drawer – anterior talofibular ligament Positive Sign – pain, laxity Talar Tilt – calcaneofibular ligament; deltoid ligament Positive Sign – pain, laxity Kleiger – deltoid ligament Positive Sign – medial and lateral pain, displaced talus Thompson’s Test – Achilles tendon rupture Positive Sign – no plantar flexion Swing Test – posterior tibiotalar subluxation Positive Sign – resistance to normal dorsiflexion Tinel’s Sign – deep peroneal nerve; posterior tibial nerve Positive Sign – no tingling and paraseizure Morton’s Test – Morton’s neuroma Positive Sign – pain between 3 rd and 4 th metatarsals Homan’s Sign – deep vein thrombophlebitis (calf) Positive Sign – pain in calf with passive dorsiflexion of ankle and knee extended; pain with palpation of calf KNEE LIGAMENT TESTS Valgus – lateral collateral ligament Positive Sign – pain, laxity Varus – medial collateral ligament Positive Sign – pain, laxity Posterior Drawer – posterior cruciate ligament Positive Sign – pain, laxity Anterior Drawer – anterior cruciate ligament Positive Sign – pain, laxity Lachman – anterior cruciate ligament Positive Sign – pain, laxity Slocum – anterior cruciate ligament Positive Sign – pain, laxity Hughston – posterior cruciate ligament Positive Sign – pain, laxity MENISCUS TESTS Apley Compression – meniscus lesion Positive Sign – pain, Apley Distraction – ligament lesion Positive Sign – pain, Squat – medial (internal rotation); lateral (external rotation) Positive Sign – pain, McMurray – medial (varus/internal rotation); lateral -
Orthopaedic Examination Spinal Cord / Nerves
9/6/18 OBJECTIVES: • Identify the gross anatomy of the upper extremities, spine, and lower extremities. • Perform a thorough and accurate orthopaedic ORTHOPAEDIC EXAMINATION examination of the upper extremities, spine, and lower extremities. • Review the presentation of common spine and Angela Pearce, MS, APRN, FNP-C, ONP-C extremity diagnoses. Robert Metzger, DNP, APRN, FNP - BC • Determine appropriate diagnostic tests for common upper extremity, spine, and lower extremity problems REMEMBER THE BASIC PRINCIPLES OF MUSCULOSKELETAL EXAMINATION Comprehensive History Comprehensive Physical Exam THE PRESENTERS • Chief Complaint • Inspection • HPI OLDCART • Palpation HAVE NO CONFLICTS OF INTEREST • PMH • Range of Motion TO REPORT • PSH • Basic principles use a goniometer to assess joint ROM until you can • PFSH safely eyeball it • ROS • Muscle grading • Physical exam one finger point • Sensation to maximum pain • Unusual findings winging and atrophy SPINAL COLUMN SPINAL CORD / NERVES • Spinal cord • Begins at Foramen Magnum and • Consists of the Cervical, Thoracic, continues w/ terminus at Conus Medullaris near L1 and Lumbar regions. • Cauda Equina • Collection of nerves which run from • Specific curves to the spinal column terminus to end of Filum Terminale • Lordosis: Cervical and Lumbar • Nerve Roots • Kyphosis: Thoracic and Sacral • Canal is broader in cervical/ lumbar regions due to large number of nerve roots • Vertebrae are the same throughout, • Branch off the spinal cord higher except for C1 & C2, therefore same than actual exit through -
Straight Leg Raising Test – a Snapshot Summary of Evidence (May 2013)
Straight Leg Raising Test – a snapshot summary of evidence (May 2013) • Key messages • The passive straight leg raising test (PSLR) is commonly used as an aid to the diagnosis of Lower Back Pain and is considered to be of high importance in the clinical assessment of adults with low back pain with leg pain. • Diagnostic performance of most physical tests for lumbar radiculopathy from lumbar disc herniation appear to be poor, when used in isolation. However, this is mostly based on the findings from surgical populations and may not apply to primary care or non-selected populations. Better performance may be obtained when tests are combined. • Straight leg raising test has been found to be the most sensitive test, compared with others, for radiculopathy, however it is limited by poor specificity. • There remains no standard PSLR procedure, with no consensus on interpretation A negative PSLR may have more diagnostic value than a positive one. • More research is needed in the clinical use of PSLR; its intra- and inter-observer reliability, the influences of age, gender, diurnal variation, and psychosocial factors; and its predictive value in lumbar intervertebral disc surgery. 1 © National Council for Osteopathic Research 2013 Definitions The passive straight leg raising test (PSLR), also known as the test of Lasègue1, is commonly used as an aid to the diagnosis of Lower Back Pain (LBP)2,3. Forst4 was the first to describe the PSLR in his Paris medical thesis of 1881. Rang4, quoting from Forst4, described how the supine patient’s heel is supported with one hand while the other is placed over the same limb’s patella: “. -
The Rules of Four: a Systematic Approach to Diagnosing Common Musculoskeletal Conditions of the Knee
Lerew S, Stoker S, Nallamothu S. The Rules of Four: A Systematic Approach to Diagnosing Common Musculoskeletal Conditions of the Knee. SMRJ. 2020;4(2). doi:10.51894/001c.11765 Clinical Practice The Rules of Four: A Systematic Approach to Diagnosing Common Musculoskeletal Conditions of the Knee a Shawn Lerew, DO 1 , Steven Stoker, DO 1, Shivajee Nallamothu, DO 1 1 Orthopedic Surgery, McLaren Oakland Hospital Keywords: knee, physical exam, musculoskeletal https://doi.org/10.51894/001c.11765 Spartan Medical Research Journal Vol. 4, Issue 2, 2020 Musculoskeletal symptoms are consistently one of the most commonly cited reasons for visits to ambulatory care centers every year, with knee pain accounting for approximately one-third of the reported complaints. Previous studies have demonstrated that many non-orthopedic physicians report a lack of confidence in performing clinical musculoskeletal knee examinations. “The Rules of Four” approach presented in this paper is designed to present a systematic and concise method to musculoskeletal examination of the knee within a memorable format. The approach allows for the timely diagnosis of common musculoskeletal injuries while aiding in directing further treatment and diagnostic testing. This method will ideally allow medical students and non-orthopedic physicians alike to confidently and effectively evaluate patients with complaints of knee pain in ambulatory care settings. INTRODUCTION With this approach, the knee is divided into three columns each with four corresponding examination points th Musculoskeletal symptoms are consistently one of the most and a 4 “column” comprised of the four main ligaments commonly cited reasons for visits to primary care providers of the knee. -
Use of Neurodynamic Or Orthopedic Tension Tests for the Diagnosis of Lumbar and Lumbosacral Radiculopathies: Study of the Diagnostic Validity
International Journal of Environmental Research and Public Health Article Use of Neurodynamic or Orthopedic Tension Tests for the Diagnosis of Lumbar and Lumbosacral Radiculopathies: Study of the Diagnostic Validity Francisco Javier González Espinosa de los Monteros 1, Gloria Gonzalez-Medina 2,* , Elisa Maria Garrido Ardila 3, Juan Rodríguez Mansilla 3, José Paz Expósito 1 and Petronila Oliva Ruiz 2 1 Andalusian Health Service, Hospital “Puerta Universitario del Mar”, Av. Ana de Viya, 21, 11009 Cádiz, Spain; [email protected] (F.J.G.E.d.l.M.); [email protected] (J.P.E.) 2 Nursing and Physiotherapy Department, Cadiz University, Av. Ana de Viya, 52, 11009 Cadiz, Spain; [email protected] 3 Department of Medical-Surgical Therapy, Medicine Faculty, Extremadura University, 06006 Badajoz, Spain; [email protected] (E.M.G.A.); [email protected] (J.R.M.) * Correspondence: [email protected]; Tel.: +34-670-609-656 Received: 31 July 2020; Accepted: 22 September 2020; Published: 26 September 2020 Abstract: Background: Lumbar radiculopathy is a nerve root disorder whose correct diagnosis is essential. The objective of the present study was to analyze the reliability diagnostic validity of eight neurodynamic and/or orthopedic tension tests using magnetic resonance imaging as the Gold Standard. Methods: An epidemiological study of randomized consecutive cases which was observational, descriptive, transversal, double blinded and was conducted following the Standards for Reporting Diagnostic accuracy studies (STARD) declaration. The sample size was 864 participants. Internal and external validity (CI = 95%) and reliability, were calculated for all tests performed independently. The diagnostic validity of the combined and multiple tests in parallel was also calculated. -
Minimally Invasive Sacroiliac Joint Fusion Surgery for Chronic Sacroiliac Pain
NICE interventional procedure consultation document, December 2016 NATIONAL INSTITUTE FOR HEALTH AND CARE EXCELLENCE Interventional procedure consultation document Minimally invasive sacroiliac joint fusion surgery for chronic sacroiliac pain Problems with the sacroiliac joints can cause lower back pain. These joints are at the bottom of the back where part of the spine called the sacrum joins part of the pelvis called the ilium. Minimally invasive sacroiliac joint fusion surgery is done through a small cut in the skin. It aims to stabilise the joint by fixing the sacrum to the ilium. It involves drilling small channels through the 2 bones, then fixing them together using 2 or 3 metal implants. The National Institute for Health and Care Excellence (NICE) is examining minimally invasive sacroiliac joint fusion surgery for chronic sacroiliac pain and will publish guidance on its safety and efficacy to the NHS. NICE’s interventional procedures advisory committee has considered the available evidence and the views of specialist advisers, who are consultants with knowledge of the procedure. The advisory committee has made draft recommendations about minimally invasive sacroiliac joint fusion surgery for chronic sacroiliac pain. This document summarises the procedure and sets out the draft recommendations made by the advisory committee. It has been prepared for public consultation. The advisory committee particularly welcomes: comments on the draft recommendations the identification of factual inaccuracies additional relevant evidence, with bibliographic references where possible. Note that this document is not NICE’s formal guidance on this procedure. The recommendations are provisional and may change after consultation. The process that NICE will follow after the consultation period ends is as follows.