joint tenderness
subjective; must be correleated with an objective abnormality for a daignossi of arthritsi to be made
brain neurological level
weakness from stroke contralateral side
brainstem neurological level
tremor and clusiness from cerebellar disease, not as much weakness
spinal cord neurological level
weakness from myelopathy
peripheral nerve neurological level
assymmetry- i.e. carpal tunnel syndrome
muscle neurological level
proximal weakness
anterior horn cell
sensory
motor
reflexes
other
intact
patchy
often brisk
fasiculations
root
sensory
motor
reflexes
dermatome
myotome
absent single root level
plexus
sensory
motor
reflexes
specific multiple nerve levels
specific multiple nerves
specific
individual nerve
sensory
motor
reflexes
specific single nerve
specific single nerve
specific
periph nerve
sensory
motor
reflexes
stocking glove
distal
diminished distally
neuromuscular junction
sensory
motor
reflexes
other
intact
proximal
stable
fatigue
muscles
sensory
motor
reflexes
intact
proximal
stable
onset and duration specifics
acute- less than 4 weeks
subacute: 4 weeks to 6 months
chronic : greater than 6 months
correlation of symptoms with conditions
acute
early AM stiffness
with activity
during night
assoicated with fever
focal weakness
vascular/trauma
rheumatologic
MSK
cancer
infectious
neurologic
Spinal screen
C spine flexion: 50 degrees
C spine Extension 60 deg
spine roation, right and left- 80 deg
LS spine flexion- 60 deg
LS spine extension 25 deg
lumbar lateral flexion, r, l- 25 eg
special spine screeing
spurling (test rediuclopathy)- extenion with downward pressure into somehwere- pinch nerve
schober (anklyosing spondylitis)
lumber: finger to to floor
lumber facet: extention and rotation
trigger v tender points
myofascial: trigger- touch one place and hit somewhere else
fibromalgia- diffuse tender points in multiple areas ;
Schober's test
test for anklosing spondylitis- mark 10 cm up from anklyosing sponylitits - 5 cm distraction
L4
pain
numbness
motor weakness
screening exam
reflex
over thigh
antero medial lower thigh
extension of quads
squat and rise
knee jerk diminished
L5
pain
numbness
motor weakness
screening exam
reflex
from butt to along IT band
along lateral calf
dorsiflexion of great toe and foot
heel walking
none reliable
S1
butt along posterior thigh
posterior leg
plantar flexion of great toe and foot
walking on toes
ankle jerk diminished
Hip Flexion
root
plexus
nerve
L2-L3
posterior division lumbar
femoral
hip adduction
root
plexus
nerve
L2-L4
anterior division lumbar
obturator
hip abduction
root
plexus
nerve
L45S1
posterior division sacral
superior gluteal
knee extenstion
root
plexus
nerve
L2-4
posterior division lumbar
femoral
knee flexion
root
plexus
nerve
L5-S1
anterior division sacral
sciatic
ankle dorsiflexsion
root
plexus
nerve
L4-5
Posterior Division Lumbar
deep fibular
ankle plantarflexion
root
plexus
nerve
S1-S2
Anterior Division Sacral
Tibial
Ankle inversion
root
plexus
nerve
L5-S1
Anterior Division Sacral
Tibial
Ankle Eversion
root
plexus
nerve
L5-S1
posterior division sacral
super fibular
great toe
root
plexus
nerve
L5-S1
Posterior Division Sacral
deep fibular
lower extremity screen
hip flexion - 120
hip external roation- 35
hip interal roation - 45
adduction-30
knee flexion-135
knee extension-0
ankle dorsiflexion- 20
ankle plantar flexion-50
lower extremity special test
leg length - measure asis to medial malleolus
faber- flexion, abduction external roation - specific in hip pain rather than back
trochanteric bursa
knee special test
check alighnment
inspect prepatellar bursa
palpate joint line
check for fluid
ACL- lachman, anterior drawer
PCL- posterior drawer
MCL- valgus
LCL- varus
mcmurrary- knee flxed, valgus stres on knee while extening and externally rotating foot (varus- medial, valgus- lateral)
prone: apley- compression with meniscus and distraction for MCL/LCL with IR/ER
Motron's neuroma
b/t metatarsal head 4th and 5th digit - do a medial lateral squeeze, look at cap refill