5-13-98
Terrett p 42 and 19
Whiplash
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Rear end collision usually
Acceleration/deceleration
Hyperextension yields a reflex muscular contraction which throws head into hyperflexion
Headreast at level of EOP (should be)
 Too high ( catapult)]
 Too low (fulcrum)
Contra coup
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Head comes back suddenly
 Brain in fluid
 Frontal bones slam into brain
 Brain moves back while skull is moving and occiput hits brain
Post concussive syndrome
 Loss of consciousness not a prerequisite
5/15/98 Guest Speaker--no testable material
5/18/98
Orthopedic Tests
O' Donohughes (Differential Tension Testing) p53 E
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Compares resisted motion(isometric) with passive motion
If muscle damaged will hurt when doing work
If ligament problem pain should not be significantly different between
passive and resisted ROM
Spinal Percussion
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Not a good way to diagnose spinal fracture
Gives information about location of pain
Percuss spinouses and paravertebral mm
Distraction p34
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Bimanual contact and lift head
General pain across back of neck indicated ligaments
Localized pain indicates capsular problem
Foraminal Compression Test
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Ivf involved
Pt presents with myotomal and or dermatomal involvement with possible
parasthesia
Locate area of c/c
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With head in neutral position, press down on top of head and look for
increase in radicular pn
Then laterally bend pt and compress
Then laterally bend and rotate and then compress
If problem in compression, distraction provides relief
5/20/98
Muscle Strain Grading
1.
2.
3.
Mild
 May be only microscopic damage or can be macroscopic but damage is
small
 May heal completely
Moderate
 Capillary damage
 Longer to heal
 More scar tissue (stiffer ) decr ROM
severe (rupture: tearing of at least part of the tendon)
 surgical repair often necessary
Sprains (Ligaments)
1.
2.
3.
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mild
moderate
severe (separation/rupture or avulsion fracture)
see rubor, calor, dolar, tumor in sprain
damage to proprioceptors (can lose functional aspects of ligaments)
usually take longer to heal than muscle
 more movement allowed which can lead to secondary injury, but less pain
 poor vascular supply
5/22/98
Post Concussive Syndrome
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symptoms
 light headedness
 vertigo/dizziness
 headache
 neck pain
 photophobia (aversion to light)
 phonophobia (aversion to loud sounds)
 tinnitus
 impaired memory
 easily distracted
 impaired comprehension
 forgetfulness
 insomnia
 fatigues easily
 outbursts of anger
 mood swings
 depression
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 loss of sexual drive
 intolerance to alcohol
hard to document that the symptoms are from the accident
PET scan of brain (be sure insurance will pay)
Proprioceptive Neuromuscular Facilitation (Voss)
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Stroke rehab
Thyroid Damage
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Symptoms take a while to develop
 Fatigue
 Decr labido
 Weight gain
 Forgetfulness
Often attributed to malingering
5/27/98  Video on whiplash
Thoracic Outlet Syndrome
Scalenius Anticus Syndrome
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Compression of the neurovascular bundle as it exits between anterior and middle
scalenes
Usually secondary to cervical injury
Hypertonic scalenes
Post stenotic dilitation of the subclavian artery
 May hear bruit
Neurologic and vascular symptoms
Main test: Adson's
Cervical Rib Syndrome
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May be bone or cartilage
Forms a ridge that takes up space in scalene triangle
Costoclavicular syndrome
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Carrying backpack, suitcase, etc.
Shoulder injuries
Clavicular and 1st rib fixations
Eden's test
Hyperabduction Syndrome
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Abduction of the arm increases
Hypertonicity of the pec minor
Rib fixation
Shoulder injuries
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Can compress axial artery and brachial plexus
People who work overhead a lot can develop this
Aka Pec Minor coracoid syndrome or P. minor compression syndrome
5/29/98
TMJ
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Hinge jt with anterior translation
When opening jaw, rotation 1st then anterior translation
Often injured in whiplash
Review anatomy
When palpation check for differences in timing and degree of opening
Check whether teeth fit together well
6/1/98
Shoulder
Apley's Scratch Test
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Have pt reach above their shoulder with one hand and touch shoulder blade and other
hand under shoulder and try to approximate the hands
Look for lack of pain ???
Look for assymmetry
If you see a problem it is probably rotator cuff mm
Same as deep knee bend (lower ext)
Dawbarn's
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P104
Subacromial bursa involved
Bring arm into extension and palpate the bursa
Pt presents with history of shoulder pain
Abduction of the arm relieves the pain
Ludington's Test sp???
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Pts hands behind head
Palpate biceps mm for symmetry
If long head of biceps tendon ruptures, initially looks bigger then atrophies
Codman's Sign
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Passive abduction of pt shoulder
Dr drops arm and pt tries to stop
Dr feels for contraction of the delts
Pain with rupture of the supraspinatus or joint capsule
Modified codman's: abduction against resistance
Impingement Sign
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Supraspinatus tendinitis
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Supraspinatus or biceps tendon
Palpate at site of supraspinatus insertion
Tendonitis
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Can get calcium deposits
 Body stablilizing area
Bursitis
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Usually secondary to something else (tendonitis)
With acute tendonitis and bursitis, area get real red
Shoulder Dislocation
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Usually anterior and inferior
Calloway's Test
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Measure from axilla to acromion process
The larger side is the dislocated side due to neck of humerus dropping down
Dugas Test ??? Hard to Read page 44 of Linda's Notes
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With affected side, have pt grab other shoulder then push elbow into chest
Pt will deck you if shoulder dislocated
Mazion Shoulder Maneuver
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Same as Dugas but try to raise elbow up
If dislocated pain in front of acromion
Apprehension Test
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Abduct shoulder to 90 deg. And flex elbow
Look for apprehension on pt face
6/3/98
Adhesive Capsulitis
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Frozen shoulder - aka
Usually secondary to tendonitis or bursitis
Pt uses less which allows for adhesions to form
Codman's Pendular Exercises
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6/5/98
Use pendular motion and go into painful ROM and to often each day
Rotator Cuff Tears
Luddington's
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Check for symmetry of the biceps (rupture of tendons)
Rheumatoid Arthritis
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Inflammatory condition
Hot swollen painful red joints
Synovial hypertrophy
Pannus formation
Erosion of menisci
Instability
Later on get complete loss of joint function due to ankylosis
Stages
1.
acute
2.
proliferation of pannus
3.
fibrotic ankylosis
4.
bony ankylosis
2-3 X more common in females
*** symmetrical in presentation ****
check for stability especially in C1/C2 area
 if too much space between ant. Arch of the atlas and dens can get cord
compression
autoimmune in nature
ulnar deviation of fingers
carpal bones become hard to identify
flexion deformity of thumb (boutonniere)
swan neck deformity of fingers
rheumatoid nodules appear in connective tissue near jt.
Baker's cysts: synovial outcroppings popliteal region
Supraspinatus Press Test 130
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Abduct shoulder to 90 degrees and resist abduction
Abbot-Saunders
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Abduct and extern rotate
Bring arm down
Listen for click or pop of bicipital tendon
Instability of transverse humeral ligament
Elbow
Valgus: lateral deviation
Vlagus stress test : tests medial collateral ligament
distal body part to the joint is in the more lateral position
Varus
Distal part to the joint is in the more medial position
Varus Stress Test is aducting the distal part and testing lateral collateral
Tinel sign of elbow
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Huge % of false positives
Tests ulnar and radial nerves
 Lateral side of olecranon  radial n
 Medial side  ulnar n
Tendonitis of the Elbow
Common Extensor Tendotinits
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Tennis Elbow
Lateral epiconylitis
Pain more commonly in forearm just distal to elbow
Flexor Tendinitis
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Golfer's elbow
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Medial epicondylitis
Ligamentous Instability Test 154
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Elbow slightly flexed to 20 deg
Hand in supination
Stabilize arm
Abduct forearm to test medial collateral (valgus)
Adduct forearm to test lateral collateral (varus)
If grade III sprain expect hypermobility
Elbow Flex Test 148
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Maintain forced flexion for > 5 min
Cozen's Test *** standard elbow test *****
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Flex elbow
Pronate forearm
Wrist extended
Pt resists wrist flexion from Dr.
Mill's *****standard elbow test ******
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Elbow in flexion
.flex wrist, then fingers
bring elbow into extension and pronation with wrist and fingers still flexed
Cabil Test ?????? check spelling
 have pt squeeze sphyg bulb
 place band around extensors and do again
 should be stronger with band if tennis elbow
Golfer's Elbow Test
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elbow flexed, supinated forearm and extended wrist
pt. Tries to flex