Copyright Ted Nissen March 2003
1 Shoulder and Shoulder Girdle
1 Shoulder and Shoulder Girdle
Back
Table of Contents References
1.1
Kessler 189-194
1.1.1
History
1.1.1.1
Questions
1.1.1.1.1
Pain Spread below Elbow?
1.1.1.1.2
Patient able to lie on the
shoulder at night?
1.1.1.1.3
Able to use arm to comb
hair?
1.1.1.1.4
Reach hip pocket or fasten
bra behind?
1.1.1.1.5
Eat comfortably with arm?
1.1.1.1.6
Hurt to put on or remove
Shirt or jacket?
1.1.1.1.7
Difficulty reaching above
shoulder level?
1.1.1.2
Site of Pain
1.1.1.2.1
Pain refers over lateral
brachial region
1.1.1.2.2
Pain felt in C5
(Glenohumeral) segment or C4 (Acromioclavicular) sclerotome.
1.1.1.3
Nature of Pain
1.1.1.3.1
1.1.1.4
Onset of Pain
1.1.1.4.1
1.1.1.5
General Health
1.1.1.5.1
1.1.2
Physical
Examination
1.1.2.1
Observation
1.1.2.1.1
1.1.2.2
Inspection
1.1.2.2.1
1.1.2.3
Selective Tissue
Tension Tests
1.1.2.3.1
Active Movements (Sitting)
1.1.2.3.1.1
1.1.2.3.2
Passive Movements (Supine)
1.1.2.3.2.1
1.1.2.3.3
Resisted Isometric
Movements (Supine)
1.1.2.3.3.1
1.1.2.3.4
Joint-Play Movements
(Supine)
1.1.2.3.4.1
1.1.2.4
Neuromuscular
Tests
1.1.2.4.1
1.1.2.5
Palpation
1.1.2.5.1
Skin
1.1.2.5.1.1
1.1.2.5.2
Soft Tissues
1.1.2.5.2.1
1.1.2.5.3
Bones and Soft-Tissue
attachments
1.1.2.5.3.1
1.1.2.6
Special Tests
1.1.2.6.1
Locking Test
1.1.2.6.1.1
Locking
Test
1.1.2.6.2
Quadrant Test
1.1.2.6.2.1
Quadrant
Test
1.1.2.6.3
Anterior Stability Test
1.1.2.6.3.1
Anterior
Stability Test
1.1.2.6.4
Impingement Syndrome Test
1.1.2.6.4.1
Impingement
Syndrome Test
1.1.2.6.5
Bicipital Tendinitis Test
1.1.2.6.5.1
Bicipital
Tendinitis Test
1.1.2.7
Miscellaneous
1.1.2.7.1
1.1.2.8
Ancillary Tests
1.1.2.8.1
1.2
Cyriax 33-36
1.2.1
Referred Pain
1.2.1.1
1.2.2
History
1.2.2.1
1.2.3
Examination
1.2.3.1
1.2.3.2
Active and
Passive Movements
1.2.3.2.1
1.2.3.3
Mechanism of Arm
Elevation
1.2.3.3.1
1.2.3.4
Resisted
Movements
1.2.3.4.1
1.3
Hoppenfeld 1-34
1.3.1
1.3.2
Inspection
1.3.3
1.3.4
Bony Palpation
1.3.4.1.1
1.3.4.2
Suprasternal
Notch
1.3.4.2.1
1.3.4.3
Sternoclavicular
Joint
1.3.4.3.1
1.3.4.4
Clavicle
1.3.4.4.1
1.3.4.5
Coracoid Process
1.3.4.5.1
1.3.4.6
Acromioclavicular
Articulation
1.3.4.6.1
1.3.4.7
Acromion
1.3.4.7.1
1.3.4.8
Greater
Tuberosity of the Humerus
1.3.4.8.1
1.3.4.9
Bicipital Groove
1.3.4.9.1
1.3.4.10
Spine of the
Scapula
1.3.4.10.1
1.3.4.11
Vertebral Border
of the Scapula
1.3.4.11.1
1.3.5
Soft Tissue
Palpation by Clinical Zones
1.3.5.1
1.3.5.2
Zone 1 Rotator
Cuff
1.3.5.2.1
1.3.5.3
Zone 2 Subacromial
and Subdeltoid Bursa
1.3.5.3.1
1.3.5.4
Zone 3 Axilla
1.3.5.4.1
1.3.5.5
Zone 4 Prominent
Muscles of the Shoulder Girdle
1.3.5.5.1
1.3.5.5.2
Sternocleidomastoid
1.3.5.5.2.1
1.3.5.5.3
Pectoralis Major
1.3.5.5.3.1
1.3.5.5.4
Biceps
1.3.5.5.4.1
1.3.5.5.5
Deltoid
1.3.5.5.5.1
1.3.5.5.6
Trapezius
1.3.5.5.6.1
1.3.5.5.7
Rhomboid Minor and Major
1.3.5.5.7.1
1.3.6
Range of Motion
1.3.6.1
1.3.6.2
Active Range of
Motion Tests
1.3.6.2.1
1.3.6.3
Passive Range of
Motion Tests
1.3.6.3.1.1
1.3.6.3.2
Abduction=180 Adduction=45
1.3.6.3.2.1
1.3.6.3.3
Flexion=90 Extension=45
1.3.6.3.3.1
1.3.6.3.4
Internal Rotation=55
External Rotation=40-45
1.3.6.3.4.1
1.3.7
Neurologic
Examination
1.3.7.1
1.3.7.2
Muscle Testing
1.3.7.2.1
1.3.7.2.2
Flexion
1.3.7.2.2.1
1.3.7.2.3
Extension
1.3.7.2.3.1
1.3.7.2.4
Abduction
1.3.7.2.4.1
1.3.7.2.5
Adduction
1.3.7.2.5.1
1.3.7.2.6
External Rotation
1.3.7.2.6.1
1.3.7.2.7
Internal Rotation
1.3.7.2.7.1
1.3.7.2.8
Scapular Elevation
1.3.7.2.8.1
1.3.7.2.9
Scapular Retraction
1.3.7.2.9.1
1.3.7.2.10
Scapular Protraction
1.3.7.2.10.1
1.3.7.3
Reflex Testing
1.3.7.3.1
1.3.7.4
Sensation
Testing
1.3.7.4.1
1.3.8
Special Tests
1.3.8.1
1.3.8.2
Yergason’s Test
1.3.8.2.1
Yergason’s
Test
1.3.8.3
Drop Arm Test
1.3.8.3.1
Drop
Arm Test
1.3.8.4
Apprehension
Test for Shoulder Dislocation
1.3.8.4.1
Apprehension
Test
1.3.8.5
Examination of
related Areas
1.3.8.5.1
1.4 Wheeless' Textbook of Orthopaedics
1.4.1 http://www.ortho-u.net/o6/37.htm
2 Elbow
Back Table of Contents References
2.1
Kessler 215-216
2.1.1
History
2.1.1.1
Questions
2.1.1.1.1
2.1.2
Physical
Examination
2.1.2.1
Observation
2.1.2.1.1
2.1.2.2
Inspection
(Include Entire Extremity)
2.1.2.2.1 Structure
2.1.2.2.1.1
2.1.2.2.2 Soft Tissue
2.1.2.2.2.1
2.1.2.2.3 Skin
2.1.2.2.3.1
2.1.2.3
Selective Tissue
Tension Tests
2.1.2.3.1 Active Movements
(Sitting)
2.1.2.3.1.1
2.1.2.3.2 Passive Movements
(Supine for Optimal Stabilization)
2.1.2.3.2.1
2.1.2.3.3 Joint Play Movements
2.1.2.3.3.1
2.1.2.3.4 Resisted Isometric
Movements (Supine)
2.1.2.3.4.1
2.1.2.4
Palpation
2.1.2.4.1 Skin
2.1.2.4.1.1
2.1.2.4.2 Subcutaneous Soft
Tissues
2.1.2.4.2.1
2.1.2.4.3 Bones
2.1.2.4.3.1
2.1.2.5
Other
2.1.2.5.1
2.2
Cyriax 51-52
2.2.1
Referred Pain
2.2.1.1
2.2.2
Examination
2.2.2.1
2.2.2.2
Passive Movements
2.2.2.2.1
2.2.2.3
Resisted
Movements
2.2.2.3.1
2.3
Hoppenfeld 35-57
2.3.1
2.3.2
Inspection
2.3.2.1
Carrying Angle
2.3.2.1.1
2.3.2.1.2
Cubitus Valgus
2.3.2.1.2.1
2.3.2.1.3
Cubitus Varus
2.3.2.1.3.1
2.3.2.2
Swelling
2.3.2.2.1
2.3.2.3
Scars
2.3.2.3.1
2.3.3
Bony Palpation
2.3.3.1
2.3.3.2
Medial
Epicondyle
2.3.3.2.1
2.3.3.3
Medial
Supracondylar Line of the Humerus
2.3.3.3.1
2.3.3.4
Olecranon
2.3.3.4.1
2.3.3.5
Ulnar Border
2.3.3.5.1
2.3.3.6
Olecranon Fossa
2.3.3.6.1
2.3.3.7
Lateral Epicondyle
2.3.3.7.1
2.3.3.8
Lateral
Supracondylar Line of the Humerus
2.3.3.8.1
2.3.3.9
Radial Head
2.3.3.9.1
2.3.4
Soft Tissue
Palpation
2.3.4.1
2.3.4.2
Zone 1 Medial
Aspect
2.3.4.2.1
2.3.4.2.2
Ulnar Nerve
2.3.4.2.2.1
2.3.4.2.3
Wrist Flexor-Pronator
Muscle Group
2.3.4.2.3.1
2.3.4.2.3.2
Pronator Teres
2.3.4.2.3.2.1
2.3.4.2.3.3
Flexor Carpi Radialis
2.3.4.2.3.3.1
2.3.4.2.3.4
Palmaris Longus
2.3.4.2.3.4.1
2.3.4.2.3.5
Flexor Carpi Ulnaris
2.3.4.2.3.5.1
2.3.4.2.4
Medial Collateral Ligament
2.3.4.2.4.1
2.3.4.2.5
Supracondylar Lymph Nodes
2.3.4.2.5.1
2.3.4.3
Zone 2 Posterior
Aspect
2.3.4.3.1
Olecranon Bursa
2.3.4.3.1.1
2.3.4.3.2
Triceps Muscle
2.3.4.3.2.1
2.3.4.4
Zone 3 Lateral
Aspect
2.3.4.4.1
Wrist Extensors
2.3.4.4.1.1
2.3.4.4.2
Brachioradialis
2.3.4.4.2.1
2.3.4.4.3
Extensor Carpi Radialis
Longus and Brevis
2.3.4.4.3.1
2.3.4.4.4
Lateral Collateral Ligament
2.3.4.4.4.1
2.3.4.4.5
Annular Ligament
2.3.4.4.5.1
2.3.4.5
Zone 4 Anterior
Aspect
2.3.4.5.1
Cubital Fossa
2.3.4.5.1.1
2.3.4.5.2
Biceps Tendon
2.3.4.5.2.1
2.3.4.5.3
Brachial Artery
2.3.4.5.3.1
2.3.4.5.4
Median Nerve
2.3.4.5.4.1
2.3.4.5.5
Musculocutaneous Nerve
2.3.4.5.5.1
2.3.5
Range of Motion
2.3.5.1
2.3.5.2
Active Range of
Motion Tests
2.3.5.2.1
2.3.5.2.2
Flexion=135 +
2.3.5.2.2.1
2.3.5.2.3
Extension=0/-5
2.3.5.2.3.1
2.3.5.2.4
Supination=90
2.3.5.2.4.1
2.3.5.2.5
Pronation=90
2.3.5.2.5.1
2.3.5.3
Passive Range of
Motion Tests
2.3.5.3.1
2.3.5.3.2
Flexion and Extension
2.3.5.3.2.1
2.3.5.3.3
Supination and Pronation
2.3.5.3.3.1
2.3.6
Neurologic
Examination
2.3.6.1
2.3.6.2
Muscle Testing
2.3.6.2.1
2.3.6.3
Reflex Testing
2.3.6.3.1
2.3.6.3.2
Biceps Reflex=C5
2.3.6.3.2.1
2.3.6.3.3
Brachio0radialis Reflex=C6
2.3.6.3.3.1
2.3.6.3.4
Triceps Reflex=C7
2.3.6.3.4.1
2.3.6.4
Sensation
Testing
2.3.6.4.1
2.3.7
Special Tests
2.3.7.1
Test for
Ligamentous Stability
2.3.7.1.1
Ligamentous
Stability
2.3.7.2
Tinel Sign
2.3.7.2.1
Tinel
Sign
2.3.7.3
Tennis Elbow
Test
2.3.7.3.1
Tennis
Elbow Test
2.3.8
Examination of
Related Areas
2.3.8.1
2.4 Wheeless' Textbook of Orthopaedics
2.4.1
http://www.ortho-u.net/oo3/142.htm
3 Wrist and Hand
Back
Table of Contents References
4 Knee
Back
Table of Contents References
5 Ankle and Hindfoot
Back
Table of Contents References
6 Temporomandibular Joint
Back
Table of Contents References
7 Lumbar Spine
Back Table of
Contents References
7.1 Evaluation (Kessler)
7.1.1 History
7.1.1.1 Signs and Symtoms
7.2 Physical Examination Merck THE MERCK MANUAL, Sec. 5, Musculoskeletal and Connective Tissue Disorders
7.2.1 Vertebral column
7.2.2 Diagnosis
7.2.2.1
Blood tests
7.2.2.2 X-rays
7.2.3 Pain THE MERCK MANUAL, Sec. 14, Ch. 167, Pain
7.2.3.1 Acute
7.2.3.2 Chronic
7.2.3.3
Neuropathic pain
7.2.4 Evaluation of Pain
7.2.5 Cancer Pain
7.2.6 Neuropathic Pain
7.3 Neurologic Approach to Patient Merck
7.3.1 General
7.3.1.1 History
7.3.1.2 Neurologic Examination
7.3.1.2.1 Mental status examination
Cranial nerve examination
7.3.1.2.2 Examination of the motor
system
7.3.1.2.2.1 Fasciculations
7.3.1.2.3 Assessment of muscle strength
7.3.1.2.4 Examination of coordination,
stance, and gait
7.3.1.2.5 Sensory testing
7.3.1.2.6 Reflex testing
7.3.1.2.7 Autonomic system testing
7.3.1.2.8 Cerebrovascular examination
7.3.1.3 Neurologic Diagnostic Procedures
7.3.1.3.1 Lumbar puncture (spinal tap):
7.3.1.3.2 Computed tomography
7.3.1.3.3 Magnetic resonance imaging
7.3.1.3.4 Magnetic resonance angiography (MRA)
7.3.1.3.5 Magnetic resonance venography
7.3.1.3.6 Echoencephalography
7.3.1.3.7 Positron emission tomography
(PET)
7.3.1.3.8 Cerebral angiography
7.3.1.3.9 Duplex Doppler
ultrasonography
7.3.1.3.10
Myelography
7.3.1.3.11 Electroencephalography: EEG
7.3.1.3.12
Measurement of evoked responses
7.3.1.3.13 Electromyography and nerve conduction velocity studies
7.4 Inspection
7.4.1 Movement Abnormalities
7.4.1.1 Fluidity of Movement
7.4.1.1.1 Splinting
7.4.1.1.2 Movement Avoidance (Antalgic)
7.4.2 Skin Abnormalities
7.4.2.1 Redness & Unusual Skin Markings
7.4.2.2 Fatty Masses
7.4.2.3 Hair Patches
7.4.2.4 Skin Tags
7.4.2.5 Birth Marks
7.4.2.6
7.4.3 Postural Abnormalities
7.4.3.1 Body Type
7.4.3.1.1 Ectomorphic
7.4.3.1.2 Mesomorphic
7.4.3.1.3 Endomorphic
7.4.3.1.4 Mixed
7.4.3.2 Angular Kyphosis (Gibbus Deformity)
7.4.3.3 Spondylolisthesis
7.4.3.4 Displacement of Disc Material
7.4.3.5 Postural Lumbago
7.4.3.6 Horizontal Pelvis Leg Length Inequity
7.5 Assessment of Structural Alignment Kessler
7.5.1 Frontal Alignment (Posterior Viewing)
7.5.1.1 Horizontal Asymmetry
7.5.1.1.1 Using the Plumb Bob
7.5.1.1.2 Lateral Shift
7.5.1.1.2.1 Leg Length Inequity (On the side of the Shift)
7.5.1.1.2.2 Tight Hip Abductors (Iliotibial Band?)
7.5.1.1.2.3 Loss of Hip Abduction (On side of Shift)
7.5.1.1.3 Valgus/Varus Deviations or Asymmetries
7.5.1.1.3.1 Bilateral Genu Valgum (Knock Knees)
7.5.1.1.3.2 Unilateral Genu Varum
7.5.1.1.3.3 Tibial Varum
7.5.1.1.3.4 Calcaneal Valgum
7.5.1.1.3.5 Calcaneal Varum
7.5.1.1.4 Muscle Mass Asymmetries
7.5.1.1.5 Lateral Spinal Curvatures
7.5.1.1.5.1 Lateral Pelvic Inclination
7.5.1.1.5.2 Lateral Pelvic Shift
7.5.1.1.5.3 Acute Spinal Derangement (Disk prolapse or facet-joint dysfunction)
7.5.1.1.5.4 Asymmetrical Lumbar Degenerative Changes
7.5.1.1.5.5 Structural Thoracolumbar Scoliosis
7.5.1.1.6 Leg Length Inequities (Segmental Vertical asymmetries)
7.5.1.1.6.1 Medial Malleoli
7.5.1.1.6.2 Fibular heads and Popliteal Folds
7.5.1.1.6.3 Greater Trochanters
7.5.1.1.6.4 Posterior-Superior Iliac Spines
7.5.1.1.6.4.1 Posterior iliac Torsion
fff
7.5.1.1.6.4.2 ASIS & PSIS higher on femoral valgus side
7.5.1.1.6.4.3 Advanced Hip Degeneration
7.5.1.1.6.5 Iliac Crests
7.5.2 Sagittal Alignment (Side View)
7.5.2.1 Abnormal Extension (Hyperextension)
7.5.2.2 Abnormal Flexion
7.5.2.2.1 Restricted Ankle Plantar Flexion
7.5.2.2.2 Restricted extension of the knee from
7.5.2.2.2.1 Capsular Restriction
7.5.2.2.2.2 Internal Derangement
7.5.2.2.3 Restricted Hip Extension
7.5.2.2.4 Restricted Low-Back Extension
7.5.2.2.4.1 Acute Spinal Derangement
7.5.2.2.4.2 Multisegmental Capsular Restriction
7.5.3 Transverse Rotary Alignment (Front View)
7.5.3.1 Navicular Tubercles
7.5.3.2 Intermalleolar Line
7.5.3.2.1 Excessive External Tibial Torsion or Femoral Anteversion
7.5.3.2.2 Excessive Femoral retroversion or Internal Tibial torsion
7.5.3.3 Patellae
7.5.3.3.1 Medial Facing
7.5.3.3.2 Lateral Facing
7.5.3.4 ASIS
7.5.3.4.1 Fixed (Structural) Spinal Scoliosis
7.5.3.4.2 Torsional Asymmetry of SI Joints
7.6 Muscles Testing and Function Kendall
7.6.1 Length Testing
7.6.1.1 HIP FLEXORS
7.6.1.2 HAMSTRING
7.6.1.2.1 STRAIGHT-LEG-RAISING
7.6.1.2.2 FORWARD BENDING
7.6.1.2.3 1 JOINT HAMSTRING
7.6.1.3 SPINE
7.6.1.3.1 PRONE TRUNK RAISE
7.6.1.3.2 Extension
7.6.1.3.2.1 BACK EXTENSION MUSCLE TEST
7.6.1.3.2.2 STANDING BACK EXTENSION
7.6.1.3.2.3 LATERAL FLEXION
7.6.1.3.3 Flexion
7.6.1.3.3.1 Supine Flexion
7.6.1.3.3.2 STANDING FLEXION
7.6.1.3.4 1 JOINT PLANTAR FLEXION
7.6.1.3.5 2 JOINT PLANTAR FLEXION
7.6.1.3.6 OBER Tensor Facia Lata
7.6.1.3.7 MODIFIED OBER
7.6.2 Postural Analysis
7.6.2.1 Principles
7.6.2.2 The Standard Posture
7.6.2.3 Pelvis and Low Back
7.6.2.4 Hip and Knee Joints
7.6.2.5 Ankle
7.6.2.6 Feet
7.6.2.7 Head and Neck
7.6.2.8 Thoracic Spine
7.6.2.9 Shoulder Joint and Shoulder Girdle
7.6.2.10 Ideal Plumb Alignment Side View
7.6.2.11 Four Type of Postural Alignment
7.6.2.11.1 Ideal Alignment
7.6.2.11.2 Kyphosis Lordosis
7.6.2.11.3 Flat Back
7.6.2.11.4 Sway Back
7.6.2.12 Faulty Plumb Alignment Side View
7.6.2.13 Lordosis
7.6.2.14 Handedness Patterns
7.6.2.15 Faulty Posture Side and Back Views
7.6.2.16 Ideal Segmental Alignment Side View
7.6.2.17 Kyphosis Lordosis Posture
7.6.2.18 Sway Back Posture
7.6.2.19 Military Type Posture
7.6.2.20 Flat Back Posture
7.6.2.21 Ideal Alignment Posture Posterior View
7.6.2.22 Faulty Alignment Posterior View
7.6.2.23 Faulty Alignment Posterior View
7.6.2.24
7.6.3 Muscle Testing
7.7 Thoracolumbar Range of Motion
7.7.1 Flexion
7.7.1.1 PP 89
7.7.1.2 K 8"-10"
7.7.1.3 HHC 60
7.7.1.4 O 90
7.7.1.5 Range 60-90
7.7.1.6 Mean 80
7.7.1.7 Total
7.7.2 Extension
7.7.2.1 PP 30
7.7.2.2 K 2"-4"
7.7.2.3 HHC 25
7.7.2.4 O 30
7.7.2.5 Range 25-30
7.7.2.6 Mean 28
7.7.2.7 Total 108
7.7.3 Lateral Flexion
7.7.3.1 PP 30
7.7.3.2 K F=4"H=K
7.7.3.3 HHC 25
7.7.3.4 O 20
7.7.3.5 Range 20-30
7.7.3.6 Mean 25
7.7.3.7 Total 50
7.7.4 Rotation
7.7.4.1 PP 30
7.7.4.2 K
7.7.4.3 HHC 30
7.7.4.4 O 30
7.7.4.5 Range
7.7.4.6 Mean 30
7.7.4.7 Total 60
7.8 Quick Lesion Analysis (Cyriax)
7.8.1 Joint Signs
7.8.1.1 Passive Extension
7.8.1.2 Passive Lateral Flexion
7.8.1.3 Passive Anterior Flexion
7.8.1.4 Movement to the Table
7.8.2 Dural Signs Dural Mobility
7.8.2.1 Straight –Leg Raising L4-5, S1-2
7.8.3 Root Signs
7.8.3.1 SIJ Stretch
7.8.3.2 Resisted Hip Flexion L2-3
7.8.3.3 Resisted Dorsiflexion L4
7.8.3.4 Resisted Toe Extension L4-5
7.8.3.5 Resisted Eversion L5, S1
7.8.3.6 Knee Jerk Reflex L3
7.8.3.7 Ankle Jerk Reflex S1-2
7.8.3.8 Passive Knee Flexion L3
7.8.3.9 Resisted Knee Extension L3
7.8.3.10 Resisted Knee Flexion S1-2
7.8.3.11 Buttocks Squeeze S1-2
7.8.3.12 Calf Raise S1-2
7.8.3.13 Sensation Testing Plantar Region
7.8.3.14 Plantar Reflex L4-5 S1-2, S4
7.8.3.15 Extension Pressure Sacrum and L1-5
7.8.4 Analysis
7.8.4.1 Capsular Lesions
7.8.4.2 Radiographic Evidence
7.8.4.3 Displacements
7.8.4.4 Disc Lesions: Anomalies
7.9 Bony Palpation-Lumbar Spine
7.9.1 Posterior Aspect
7.9.1.1 Position of the transverse and spinous processes (Kessler)
7.9.1.2 Spinous Processes
7.9.1.3 Sacrum, Sulcus, Sacral hiatus, and coccyx (Kessler)
7.9.1.4 Iliac crest, ischial tuberosity, and hip joint (Kessler)
7.9.1.5 Posterior Aspect of the Coccyx
7.9.2 Anterior Aspect
7.9.2.1 Sacral Promontory
7.10 Soft Tissue Palpation
7.10.1 Muscles of the Gluteal region and sciatic Nerve (Kessler)
7.10.2 Skin and subcutaneous tissue (Kessler)
7.10.3 Area 1-Midline Raphe
7.10.3.1 Supraspinous and Interspinous Ligaments
7.10.3.2 Paraspinal Muscles
7.10.4 Area 2-Iliac Crest
7.10.5 Area 3-Posterior Superior Iliac Spines
7.10.6 Area 4 Sciatic
7.10.6.1 Sciatic Nerve
7.10.7 Anterior Abdominal Wall and Inguinal Area
7.10.7.1 Abdominal Wall, iliac crest and symphysis pubis (Kessler)
7.10.7.2 Inguinal area and femoral triangle (Kessler)
7.10.7.3 Arterial pulses (Kessler)
7.10.7.4 Anterior Abdominal Muscles
7.10.7.5 Inguinal Area
7.11 Spinal Movement
7.11.1 Range of Motion (Hoppenfeld)
7.11.1.1 Flexion
7.11.1.2 Extension
7.11.1.3 Lateral Bending
7.11.1.4 Rotation
7.11.2 Selective Tissue Tension Tests- Active Movements (Kessler)
7.11.1 Active physiological movements of the spine
7.11.1.1.1 Extension
7.11.1.1.1.1 Acute Spinal Derangement
7.11.1.1.1.2 Multisegmental capsular restriction
7.11.1.1.1.3 Localized unilateral capsular restriction
7.11.1.1.2 Lateral Flexion (side bending)
7.11.1.1.2.1 Acute Spinal Derangement
7.11.1.1.2.2 Multisegmental capsular restriction
7.11.1.1.2.3 Localized unilateral capsular restriction
7.11.1.1.3 Flexion (forward bending)
7.11.1.1.3.1 Posterior Disk Prolapse
7.11.1.1.3.2 Facet Joint Dysfunction or Moderate to Mild Disk Prolapse
7.11.1.1.3.3 Fixed Scoliosis (View from back and side)
7.11.1.1.4 Lateral Shift (Side Gliding)
7.11.1.1.5 Rotation
7.11.1.1.6 Chest Expansion and active peripheral joint tests
7.11.1.1.6.1 Measurement
7.11.1.1.6.2 Squatting
7.11.1.1.7 Auxiliary Tests
7.11.1.1.7.1 Passive Overpressure
7.11.1.1.7.2 Repeated Motions
7.11.1.1.7.3 Sustained pressure
7.11.1.1.7.4 Combined Motions
7.11.1.1.7.4.1 Active Motions without overpressure
7.11.1.1.7.4.1.1 Lateral Flexion with extension to the left and right
7.11.1.1.7.4.1.2 Lateral flexion combined with flexion to the right and left
7.11.1.1.7.4.2 Combined movements with passive overpressure
7.11.1.1.7.4.2.1 Combined movements in flexion
7.11.1.1.7.4.2.1.1 Combined movements of forward flexion and right lateral flexion
7.11.1.1.7.4.2.1.2 Combined forward flexion with rotation
7.11.1.1.7.4.2.2 Combined movements in extension
7.11.1.1.7.4.2.2.1 Extension with lateral flexion
7.11.1.1.7.4.2.2.2 Extension and rotation to the right
7.11.1.1.7.5 Positive heel-drop test
7.11.1.1.8 Active segmental mobility
7.11.1.1.8.1 Upper Lumbar spine lateral flexion
7.11.1.1.8.2 L5-S1 lateral flexion
7.11.1.1.8.3 L5-S1 region
7.11.1.2 Selective Tissue Tension- Passive Movements
7.11.1.2.1 Posture Correction
7.11.1.2.2 Quadrant testing
7.11.1.2.3 Passive physiological movements of the spine
7.11.1.2.3.1 Flexion (forward bending)
7.11.1.2.3.2 Extension (backward bending)
7.11.1.2.3.3 Lateral flexion (side bending)
7.11.1.2.3.4 Rotation
7.11.1.2.4 Passive physiological movements with segmental palpation
7.11.1.2.4.1 Flexion-extension (forward and backward bending)
7.11.1.2.4.2 Lateral flexion (side bending)
7.11.1.2.4.3 Rotation
7.11.1.2.5 Segmental mobility
7.11.1.2.5.1 Posteroanterior pressure
7.11.1.2.5.2 Transverse pressure
7.11.1.2.5.3 Posteroanterior unilateral pressure
7.11.1.2.6 Passive sacroiliac and peripheral joint tests
7.11.1.2.6.1 Sacroiliac provocation/mobility tests
7.11.1.2.6.1.1 Posterior rotation
7.11.1.2.6.1.2 Anterior rotation
7.11.1.2.6.1.3 Sacroiliac fixation
7.11.1.2.6.2 Hip joint
7.11.1.2.6.3 Knee joint
7.11.1.3
7.12 Neuromuscular Evaluation
7.12.1 Kessler
7.12.1.1 Sensory (dermatomal) tests
7.12.1.2 Resisted isometric tests (motor, myotomal tests)
7.12.1.2.1 Tests with patient supine
7.12.1.2.1.1 L2 Hip flexion (Iliopsoas)
7.12.1.2.1.2 L3 Knee extension (Quadriceps)
7.12.1.2.1.3 L4 Ankle Dorsiflexion and inversion (Tibialis Anterior)
7.12.1.2.1.4 L5 Great toe extension (Extensor Hallucis longus)
7.12.1.2.1.5 L5-S1 Extension of the toes (Extensor Digitorum longus)
7.12.1.2.1.6 S1 Ankle eversion (Peroneus longus and brevis)
7.12.1.2.2 Tests with patient prone
7.12.1.2.2.1 S2 Knee flexion (hamstrings)
7.12.1.2.2.2 S1 Hip extension (gluteus maximus)
7.12.1.2.3 Tests with patient standing
7.12.1.2.3.1 S1 Plantar flexion (gastrocnemius)
7.12.1.2.3.2 L3 Knee flexion (quadriceps)
7.12.1.3 Dural mobility tests
7.12.1.3.1 Sciatic Nerve
7.12.1.3.1.1 Sitting Tests
7.12.1.3.1.2 Supine tests
7.12.1.3.1.3 Slump Test
7.12.1.3.1.4 Femoral –nerve traction test
7.12.1.4 Reflex Tests
7.12.1.4.1 Plantar reflex test
7.12.1.4.2 Deep-tendon reflexes
7.12.1.5 Test for ankle clonus
7.12.1.6 Balance testing
7.12.1.7
7.12.2 Hoppenfeld
7.12.2.1 Neurologic Levels T12, L1, L2, L3
7.12.2.1.1 Muscle Testing
7.12.2.1.2 Sensation Testing
7.12.2.2 Neurologic Levels L2, L3, L4
7.12.2.2.1 Muscle Testing
7.12.2.2.1.1 Quadriceps L2, L3, L4, Femoral Nerve
7.12.2.2.1.2 Hip Adductor Group L2, L3, L4, Obturator Nerve
7.12.2.3 Neurologic Levels L4
7.12.2.3.1 Muscle Testing
7.12.2.3.1.1 Tibialis Anterior L4, Deep Peroneal Nerve
7.12.2.3.2 Reflex Testing
7.12.2.3.2.1 Patellar Reflex
7.12.2.3.3 Sensation Testing
7.12.2.4 Neurologic Level L5
7.12.2.4.1 Muscle Testing
7.12.2.4.1.1 Extensor Hallucis Longus L5, Deep Peroneal Nerve
7.12.2.4.1.2 Extensor Digitorum Longus and Brevis L5, Deep Peroneal Nerve
7.12.2.4.2 Reflex Testing
7.12.2.4.3 Sensation
7.12.2.5 Neurologic Level S1
7.12.2.5.1 Muscle Testing
7.12.2.5.1.1 Peroneus Longus and Brevis S1, Superficial Peroneal Nerve
7.12.2.5.1.2 Gastrocnemius-Soleus Muscles S1, S2, Tibial Nerve
7.12.2.5.1.3
Gluteus
Maximus S1, Inferior Gluteal Nerve
7.12.2.5.2 Reflex Testing
7.12.2.5.2.1
Achilles
Tendon Reflex
7.12.2.5.3 Sensation Testing
7.12.2.6 Neurologic Level S2, S3, S4
7.12.2.6.1 Sensation Testing
7.12.2.7 Superficial Reflexes
7.12.2.7.1 Superficial Abdominal Reflex
7.12.2.7.2 Superficial Cremasteric Reflex
7.12.2.7.3 Superficial Anal Reflex
7.12.2.8 Pathologic Reflexes
7.12.2.8.1 Babinski Test
7.12.2.8.2 Oppenheim Test
7.12.2.9 Special Tests
7.12.2.9.1 Tests to Stretch the Spinal Cord or Sciatic Nerve
7.12.2.9.1.1 Straight Leg Raising Test
7.12.2.9.1.2 Well Leg Straight Leg Raising Test
7.12.2.9.1.3 Hoover Test
7.12.2.9.1.4 Kernig Test
7.12.2.9.2 Tests to Increase Intrathecal Pressure
7.12.2.9.2.1 Milgram Test
7.12.2.9.2.2 Naffziger Test
7.12.2.9.2.3 Valsalva Maneuver
7.12.2.9.3 Tests to Rock the Sacroiliac Joint
7.12.2.9.3.1 Pelvic Rock Test
7.12.2.9.3.2 Gaenslen’s Sign
7.12.2.9.3.3 Patrick or Fabere Test
7.12.2.9.4 Neurologic Segmental Innervation Test
7.12.2.9.4.1 Beevor’s Sign
7.12.2.10 Examination of Related Area’s
7.13 General Physical Examination (Kessler)
7.14 Other Studies (Kessler)
7.14.1 Roentgenograms and other imaging studies
7.14.1.1 Myelograms
7.14.1.2 Diskography
7.14.1.3 Computed axial tomography (CAT scan)
7.14.1.4 Bone Scanning
7.14.1.5 Other Techniques
7.14.2 Electromyography
7.14.3 Laboratory Tests
7.15 Tests for Nonorganic Back Pain
7.15.1 Distraction Test (leg test or flip test)
7.15.2 Stimulation tests
7.15.2.1 Axial loading
7.15.2.2 Hip and shoulder rotation
7.15.2.3 Kneeling on a stool (Burns test)
7.15.3 Other methods
7.16 Activities of Daily Living
7.17 Computerized Tests
7.18
8 Hip and Pelvis
Back Table of
Contents References
8.1 Bony Palpation
8.1.1 Anterior Aspect
8.1.1.1 Anterior Superior Iliac Spines
8.1.1.2 Iliac Crest
8.1.1.3 Iliac Tubercle
8.1.1.4 Greater Trochanter
8.1.1.5 Pubic Tubercles
8.1.2 Posterior Aspect
8.1.2.1 Posterior Superior Iliac Spines
8.1.2.2 Greater Trochanter
8.1.2.3 Ischial Tuberosity
8.1.2.4 Sacroiliac Joint
8.2 Soft Tissue Palpation
8.2.1 Area 1 Femoral Triangle
8.2.1.1 Inguinal Ligament
8.2.1.2 Femoral Artery
8.2.1.3 Femoral Nerve
8.2.1.4 Femoral Vein
8.2.1.5 Sartorius Muscle
8.2.1.6 Adductor Longus Muscle
8.2.2 Area 2 Greater Trochanter
8.2.2.1 Trochanteric Bursa
8.2.2.2 Gluteus Medius Muscle
8.2.3 Area 3 Sciatic Nerve
8.2.3.1 Sciatic Nerve
8.2.4 Area 4 Iliac Crest
8.2.4.1 Cluneal Nerves
8.2.5 Area 5 Hip and Pelvic Muscles
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8.2.5.1 Flexor Grouping
8.2.5.1.1 Iliopsoas Muscle
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8.2.5.1.2 Sartorius Muscle
8.2.5.1.3 Rectus Femoris Muscle
8.2.5.2 Adductor Grouping
8.2.5.3 Abductor Grouping
8.2.5.3.1 Gluteus Medius Muscle
8.2.5.4 Extensor Grouping
8.2.5.4.1 Gluteus Maximus
8.2.5.4.2 Hamstring Muscles
9 Cervical Spine
Back Table of
Contents References