Physical Exam Jared Van Der Beek
1
Basics To Remember
Know the anatomy and how the muscles function.
Know what the special tests are looking for and understand why they are positive.
Don’t just memorize, rationalize!
2 Outline of Today
Review the upper extremity and the special tests
Review the lower extremity and the special tests
Review the spine and the special tests
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Joint Movements External Rotation Flexion Extension Abduction
Adduction Internal Rotation
4 Upper Extremity
Shoulder
Elbow
Wrist
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Flexion 180 Extension 60 Internal Rotation 90 Shoulder External Rotation 80 Abduction 180 Adduction 35 Horizontal Adduction 30 Rotator Cuff Horizontal Abduction 130 Consists of 4 main muscles Supraspinatus, Subscapularis, Infraspinatus, Teres Minor (SITS). Function: Stabilize the humerus in the Glenoid fossa
6 Supraspinatus
Supra = above
Located on top of the scapula
Most likely to get pinched in an impingement syndrome.
Function: Elevates the Humerus
Test: Empty Can Test
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Infraspinatus
Infraspinatus = Below
Located below the scapula spine on the posterior part of the scapula
Function: Externally rotates the Humerus
Test: Resist External Rotation
8 Te re s M i n o r
Teres Minor = Being round and long
Located below the scapula spine on the posterior part of the scapula
Function: Externally rotates the Humerus
Test: Resist External Rotation
Helps the Infraspinatus
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Subscapularis
Sub = Underneath
Located on the anterior part of the scapula
Function: Internally rotates the Humerus
Test: Resist internal rotation
10 Biceps Test Yergason's Test
Palpate the biceps tendon while internally/externally rotating the arm.
Positive if there is pain
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Elbow ROM
Flexion 150
Extension 0
Pronation 90
Supination 90
12 Elbow Special Test Cozen’s: Lateral Epicondylitis - Tennis Elbow
Reverse Cozen’s: Medial Epicondylitis - Golfer’s Elbow
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Wrist
Carpal Tunnel
Compression of the Median Nerve in the carpal tunnel
14 Wrist Special Tests
Phalen’s Test Reverse Phalen’s Test
Tinel’s Test
You get increased in symptoms: pain, tingling
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Lower Extremity
Hip Joint
Knee Joint
Ankle Joint
16 Hip Joint
Flexion 130 Extension 20 Internal Rotation 45 External Rotation 45 Abduction 60 Adduction 30
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Hip Special Tests FABER/Patrick’s Test Ober’s Test Irritation of the Hip Joint IT Band Tightness
18 Yeoman’s Test Tests for SI Joint Pain
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Straight Leg Raise
First 30-70 degrees is to test for the sciatic nerve. Past that point, you start to move the SI joint and L5/S1
20 Abdominal Pain
Murphy’s Test McBurney’s Point
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Appendicitis Tests Rovsing’s Sign Obturator Sign
Apply%hand%pressure%to%the%lower%le1%side%of% The%examiner%holds%the%pa;ent's%ankle%with%one% the%abdomen.%Pain%felt%on%the%lower%right% hand%and%knee%with%the%other%hand%and%rotates%the% side%of%the%abdomen%upon%the%release%of% hip%by%moving%the%pa;ent's%ankle%away%from%the% pressure%on%the%le1%side pa;ent's%body%while%allowing%the%knee%to%move% only%inward.%If%there%is%abdominal%pain%on%the%right% side,%this%is%posi;ve%for%an%inflamed%appendix
22 Knee Joint ROM
Flexion 150
Extension 0- (-5)
Internal Rotation 5
External Rotation 5
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24 25
Knee Special Tests cont.
Anterior/Posterior Drawer Test Pushing Posterior tests the PCL Pulling Anterior tests the ACL
Valgu s Stress Test Pushing from lateral to medial on the knee tests the MCL
Varu s Stress Test Pushing from medial to lateral on the knee tests the LCL
26 Knee Joint Special Tests Apley’s Test McMurray’s Test
Feel for clicking or popping
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Ankle Joint ROM
Dorsi Flexion 20
Plantar Flexion 50
28 Ankle Special Test
Anterior Drawer Test Tests the Anterior Talofibular ligaments
Posterior Drawer Test Tests the Posterior Talofibular ligaments
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Ankle Special Test cont.
Babinski UMN Lesion if Positive Video: Start at 3:40
Homan’s Test Looks for DVT
30 Cervical Spine
Anatomy
Looking for pinched nerves or disc problems
Looking for ligament injuries
Looking for meningitis.
Key signs: HA, stiff neck
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Flexion 60
Extension 60
Right and Left Lateral Flexion 45
Right and Left Rotation 80
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Thoracic Spine ROM
Flexion 60
Extension 25
Right and Left Lateral Flexion 35
Right and Left Rotation 50
34 Lumbar Spine
Flexion 60
Extension 30
Right and Left Lateral Flexion 30
Right and Left Rotation 30
35
Herniated Disc
36 Compression Test Force
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Ligament Distraction
38 Meningitis
Why? Inflamed tissue hurts to move! These two techniques put a stretch on the dura, arachnoid, and pia matter.
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Deep Tendon Reflex
0-4: 2 is average.
Hyper-reflexic: sensory and motor nerve are working fine, LMN is fine, there is no inhibitory factor (UMN).
Absent reflex, LMN lesion.
40 Grading of Reflexes
0 = no response; always abnormal
1+ = a slight but definitely present response; may or may not be normal
2+ = a brisk response; normal
3+ = a very brisk response; may or may not be normal
4+ = a tap elicits a repeating reflex (clonus); always abnormal
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Distribution of Reflexes Biceps reflex (C5, C6)
Brachioradialis reflex (C5, C6, C7)
Extensor digitorum reflex (C6, C7)
Triceps reflex (C6, C7, C8)
Patellar reflex or knee-jerk reflex L2, L3, L4)
Ankle jerk reflex (Achilles reflex) (S1, S2)
Plantar reflex or Babinski reflex (L5, S1, S2)
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