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

2. 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

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

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

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

6. 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

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

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

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

10. 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.

11. 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.

12. 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

13. 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

14. 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

15. 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

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

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

18. 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

19. 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

20. Resistive Motion Muscle Pain
Eliminate joint motion
Isometric muscle contraction

21. Muscle Pain
Dull achey or spasm pain with active motion

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

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

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

25. Valsalva and Dejerine

26. Jackson and Maximal Foraminal Compression (passive)

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

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

29. 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

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

31. 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)

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

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