Physical Medicine – groupings according to pathology
THORACIC SPINE
Pathology
Thoracic Outlet Syndrome
Signs/Symptoms
Swelling of arm/hand
Bluish discoloration
Feeling of heaviness
Pulsating lump over clavicle
Deep, boring tooth-ache like pain in neck/shoulder that
increases at night
Paresthesia along C8, T1
Muscle weakness & atrophy of gripping muscles
Difficulty w/ fine motor tasks
Often develops through repetitive hyperabduction of arms
Women 20-50 yoa m/cly affected
CERVICAL SPINE
Pathology
Nerve Root Compression (disc
herniation, stenosis,
osteophytes, trauma,
spondylosis)
Vertebral Artery Compression
Facet Joint Pathology
-1Tests to Rule In
Elevated Arm Stress Test
Costoclavicular Test
Hyperabduction Test
Adson’s Test
Tests to Rule Out
Scapular Elevation
Scapular Retraction
Scapular Protraction
Signs/Symptoms
Sharp, burning pain in affected dermatomes
Paresthesia in affected dermatomes
Tenderness over affected area
Decreased ROM
Transient weakness/paralysis
Deep tendon reflex of affected nerve root m/b depressed
Tests to Rule In
Distraction Test
Maximal Foraminal
Compression Test (pain on
concave side)
Shoulder Depression Test
(pain on compressed side)
Shoulder Abduction Test
Valsalva Test
Tests to Rule Out
Vertebral Artery Test
Maximal Foraminal
Compression Test (pain on
convex side)
Dizziness/vertigo/light headedness
Headaches, weakness in extremities
Unsteadiness in walking, incoordination
Visual disturbances
Spine stiffness
Pain on hyperextension & rotation
Tenderness to palpation over facet joints & paraspinal
muscles
Absent neurological symptoms
May walk in hunched forward position/have to turn entire
body to see over shoulder
Vertebral Artery Test
Any of the other C/S tests
Foraminal Compression
Test
Maximal Foraminal
Compression Test
(concave side)
Vertebral Artery Test
Max. Foraminal
Compression (convex
side)
Physical Medicine – groupings according to pathology
-2-
DDX
Signs/Symptoms
Pain referral
Possible
Facet Syndrome
Cervical Nerve Root
Yes
TOS
Possible
Pain on hyperextension & rotation
Spine stiffness
Paresthesia
Reflexes
Yes (often without increased referral of symptoms)
Yes
No
Not affected
Yes w/ increased symptoms
Possible
Yes
m/b affected
No
Possible
Possible
m/b affected
SHOULDER
Pathology
Acromioclavicular Joint
Pathology
Signs/Symptoms
Pain especially at extreme of motion
Joint painful on palpation
Tests to Rule In
Cross Arm Test
Active Compression Test
(if pain felt in AC jt)
Painful Arc (after 100°)
Bicipital Tendon pathology
Anterior shoulder/humeral pain aggravated by lifting,
overhead reaching, or both
Patient will often point directly on bicipital groove when
describing pain
May have weakness with elbow flexion
Pain enhanced by resisted elbow flexion
Yergason’s Test
Speed’s test
Rotator Cuff Impingement
(supraspinatous tendon tear)
Pain, weakness, loss of motion m/cly reported
Pain exacerbated by overhead/above the shoulder
activities
May complain of night pain, particularly when they sleep on
affected shoulder
Full Can Test
Empty Can Test
Neer Impingement
Painful Arc (between 80° 100°)
Subscapularis Injury
May report trouble getting dressed or lying on side to sleep
Anterior shoulder pain, night pain, and weakness when the
arm is used below or above shoulder level
Difficulty reaching for a wallet in a back pocket or problems
with tucking in one's shirt
Napolean Sign
Gerber’s test
Tests to Rule Out
Speed’s Test
Yergason’s Test
Full/Empty Can Test
Neer Impingement
Napolean Sign
Gerber’s Test
Apprehension Sign
Sulcus Sign
Clunk Test
Cross Arm Test
Full/Empty Can
Napolean Sign
Gerber’s Test
Apprehension Sign
Sulcus Sign
Clunk Test
Cross Arm Test
Yergason’s test
Speed’s test
Napolean Sign
Gerber’s test
Apprehension Sign
Clunk test
Yergason’s
Speed’s
Cross Arm test
Apprehension sign
Sulcus sign
Clunk test
Physical Medicine – groupings according to pathology
-3-
Glenohumeral Instability
Shoulder continually slips out of joint, especially when Pt
throws something, or possibly bump into something
History of the shoulder “giving way” or the arm “going
dead” after an activity e.g. throwing a ball
Anterior Apprehension sign
Posterior Apprehension
sign
Sulcus sign
Labral Pathology
Popping/clicking
Often due to repetitive microtrauma
Clunk test
Active Compression test
(pain felt in shoulder)
ELBOW
Pathology
Lateral Epiconylitis
Ulnar Nerve Pathology
Signs/Symptoms
Pain in extensor muscle mass at lateral epicondyle
Pain on palpation, stretch, & resisted motion
Often due to repetitive use of wrist extensors
Common in racquet sports, typing & clerical work
May have sensory deficits and weakness of the flexor carpi
ulnaris muscle, flexor digitorum profundus muscle of the
fourth and fifth fingers, and intrinsic hand muscles
HAND AND WRIST
Pathology
Carpal Tunnel Syndrome
DeQuervain’s Tenosynovitis
Yergason’s
Speed’s
Full/Empty Can
Neer Impingement
Cross Arm test
Napolean Sign
Gerber’s test
Clunk test
Yergason’s
Speed’s
Full/Empty Can
Neer Impingement
Cross Arm test
Napolean Sign
Gerber’s test
Apprehension sign
Sulcus sign
Tests to Rule In
Mill’s test
Cozen’s test
Tests to Rule Out
Valgus Stress test
Tinel sign
Ulnar nerve instability
Tinel Sign
Ulnar Nerve Instability
Mill’s test
Cozen’s test
Varus Stress test
Signs/Symptoms
Pain, numbness, paresthesia, weakness/clumsiness,
nocturnal awakening
Tests to Rule In
Phalen’s test
Tinel Sign
Tests to Rule Out
Finkelstein’s test
Allen’s test
Pain & tenderness at side of wrist beneath base of thumb
Redness, slight swelling
Finkelstein’s test
Phalen’s test
Tinel sign
Allen’s test
Physical Medicine – groupings according to pathology
LUMBAR SPINE
Pathology
Disc Herniation/Sciatica
SI Joint Pathology


-4-
Signs/Symptoms
Pain, numbness, tingling down the leg
Lumbar muscle spasm
List away from lateral herniation, list towards medial
herniation
Tests to Rule In
Straight Leg Raising (pain
at 35°-70°, usually lateral
herniation)
Well Leg Raising (medial
herniation)
Lasegue’s test
Slump test
Tests to Rule Out
SLR (pain at >70°)
Hoover test
Pelvic Rock test
Gaenslen’s test
Faber test
Deep & achy pain arising from the jt
Aggravated by sitting, stair climbing, driving, walking
Pain often associated w/ back muscle spasms
Pelvic Rock test
Gaenslen’s test
Faber test
Hoover test
Lasegue’s test
Slump test
SLR (35° – 70°)
WLR
If there is a positive SLR test externally rotate the leg to see if this lessons the pain  piriformis syndrome
If on SLR the pain is felt more in the back this could indicate a central/medial herniation; if pain is felt more in the leg this could indicate a lateral
herniation
HIP AND PELVIS
Pathology
Groin Strain
Tests to Rule In
Faber test
Tests to Rule Out
Ely’s test
Thomas test
IT band contracture
Signs/Symptoms
Tearing/popping sensation
Pain in medial upper thigh into the groin < w/ activity
Pain w/ passive abduction & active adduction over the
medial thigh into the groin
Flexion, abduction, and external rotation of the hip
Ober’s test
Rectus femoris contracture
Pain may be felt from the area anterior to the acetabulum
Ely’s test
Thomas Test
Ely’s Test
Thomas Test
Ober’s test
Hip flexion contracture
and may radiate to the thigh and inguinal area
Pain can be reproduced by resisted hip flexion or resisted
knee extension
Commonly overused during running, jumping, bicycling,
and skating
Pain commonly occurs in weight lifting, uphill running, and
sit-ups
Thomas test
Ely’s test
Ober’s test
Physical Medicine – groupings according to pathology
-5-
KNEE
Pathology
Anterior Cruciate Ligament
Injury
Signs/Symptoms
Sensation that the knee is going to “give out”
Heard a “pop” at time of injury
Sudden swelling of knee jt
Pain in the knee when walking
Tears are primarily sports related – sudden pivots
Tests to Rule In
Anterior Drawer Test
Lachman Test
Slocum test
Posterior Cruciate Lig. Injury
Similar to ACL injury
“Dashboard injury”
Posterior Drawer test
Slocum test
Meniscus Injury
Pain, swelling, tenderness on palpation
Popping/clicking within the knee
Limited motion
Joint locking, inability to straighten knee
Pain & swelling directly over the ligament
If only MCL is injured walking is not a problem
Usually injured when outside of knee is struck – “clipping”
McMurray’s test
Bounce Home test
Apley’s Compression
Abnormal tracking of patella towards lateral side of femur
Vague discomfort of inner knee area aggravated by activity
Pain from standing after prolonged sitting
Loss of quadriceps muscle strength & atrophy in chronic
cases
Patellar Femoral
Grinding/Clark’s test
Medial Collateral Ligament tear
Patellofemoral Syndrome
ANKLE AND FOOT
Pathology
Achilles Tendon Rupture
Ankle Sprain
Collateral Lig. Stability
Slocum test
Tests to Rule Out
Posterior Drawer test
Collateral Ligament
Stability test
McMurray’s test
Bounce Home test
Apley’s test
Anterior Drawer test
McMurray’s
Bounce Home test
Apley’s test
Ant/Post Drawer test
Lachman test
Collateral Lig. Stability
Apley’s Distraction
Ant/Post Drawer test
Lachman test
Apprehension test
Any of the previously
mentioned tests
Signs/Symptoms
“Pop” or “snap” often heard
Immediate sharp pain in ankle & lower leg
Swelling, ecchymosis over achilles tendon
Weak & painful plantar flexion
Tests to Rule In
Thompson’s “Squeeze”
test
Tests to Rule Out
Anterior Drawer test
Homan’s sign
Swelling, ecchymosis over lateral ankle ligaments
Tenderness over anterior talofibular ligament
Tenderness over calcaneofibular ligament
Occurs when foot twists/turns/rolls beyond normal motion
Anterior Drawer test
Thompson’s test
Homan’s sign
Ankle Dorsiflexion test