DX 612 Orthopedics Midterm Review James J. Lehman, DC, MBA, DABCO University of Bridgeport College of Chiropractic

Cervical Distraction Test Distraction test for nerve root, facet, or myospasm Positive test relieves pain Negative test increases pain James J. Lehman, DC, MBA, DABCO

Shoulder Abduction Test Relieves arm and neck pain Presence of Bakody sign

Maximum cervical compression test (active) Less provocative than the passive tests Perform prior to other cervical compression tests James J. Lehman, DC, MBA, DABCO

O’Donoghue’s Maneuver First cervical special test recorded following range of motion testing. James J. Lehman, DC, MBA, DABCO

O’Donoghue’s Maneuver Passive ROM pain = ligament tissue sprain injury Resistive ROM pain = muscle/tendon strain injury Passive and resistive pain = sprain and strain injury James J. Lehman, DC, MBA, DABCO

Shoulder Abduction Test Bakody’s sign for nerve root irritation James J. Lehman, DC, MBA, DABCO

Scheplemann’s Test Intercostal Pain Contralateral pain might indicate pleurisy or intercostal strain Ipsilateral pain might indicate intercostal neuropathy or costovertebral sprain

Preferred Protocol for Orthopedic Evaluation History taking Observation Palpation Range of motion Special tests

Definition of an orthopedic test A provocative maneuver that involves stretching, compressing and/or contracting in order to replicate the pain and identify the painful tissues.

Accuracy of spinal orthopaedic tests: a systematic review Accuracy of spinal orthopaedic tests: a systematic review. Simpson and Gemmell The ideal orthopaedic test would always give a positive result in those with the disorder tested for (true-positive), and a negative result in those without the condition being tested for (true-negative). It is, therefore, necessary to consider sensitivity and specificity of the tests.

Accuracy of spinal orthopaedic tests: a systematic review Accuracy of spinal orthopaedic tests: a systematic review. Simpson and Gemmell Sensitivity is the proportion of those with the target disorder in whom the test result is positive. Specificity is the proportion of those without the target disorder in whom the test result is negative

Cervical Distraction Test Distraction test for nerve root, facet, or myospasm Positive test relieves pain Negative test increases pain James J. Lehman, DC, MBA, DABCO

Straight Leg Raise Test Nerve Root Tension Signs Pain reaction 0-35 = extradural 35-70 = disc lesion 70-90 = lumbosacral lesion Dull pain in posterior thigh = hamstrings

Femoral Nerve Traction Test Side posture extension of lower extremity with knee flexed with affected side up Ipsilateral pain at upper lumbar spine and/or anterior thigh

Toe Drop Steppage gait Grade 3 when gravity resistance only Grade 4 with partial resistance

Toe Drop Dorsi-flexion weakness L 5 is major motor innervation Tibialis anterior = dorsiflexion and inversion of foot

Five Symptoms of Nerve Pain Conwell Burning and/or hot Sharp pain without motion Stabbing or lightening-like pain Tingling and/or numbness Constant pain

Muscle Pain Dull ache Crampy, knot and/or spasm pain Myofascial Pin point pain (trigger point) Crawling sensation (formication) Scleratogenous Radiating dull or deep ache

Resistive Motion Muscle Pain Eliminate joint motion Isometric muscle contraction

Muscle Pain Dull achey or spasm pain with active motion

Joint Pain with Motion Constant pain Sharp pain upon active and passive motion

Scleratogenous Pain Referred or radiating dull or deep ache Ligament or muscle

Primum Non Nocere Example: Maximum cervical rotary compression (active) Maximum cervical rotary compression (passive)

Valsalva and Dejerine

Jackson and Maximal Foraminal Compression (passive)

L’Hermitte Sign Space occupying lesion Myelopathy Sharp shooting or lancinating pain down spinal cord and one or more extremities with cervical flexion

Kemp’s Test May be performed in either a standing or sitting position A positive test involves radicular pain

Kemp’s Oblique bending toward symptomatic side increases pain with a lateral protrusion Oblique bending away from symptomatic side increases pain with a medial protrusion

Kemp’s Test Assessment Intervertebral nerve root encroachment Muscular strain Ligamentous sprain Pericapsular inflammation

Kemp’s Test Once again, the opposite side is tested with increased pain with a medial disc protrusion Remember modus operandi or MO (medial opposite)

Well-Leg-Raising Test Fajersztajn’s Test Assessment for lumbar nerve root lesion caused by IVD syndrome or dural sleeve adhesion Contralateral LE SLR

Antalgic Lean Sign Lateral disc protrusion produces a contralateral list Medial disc protrusion produces an ipsilateral list