Total (3 points for Superman + 3 points for SI joint test + 3 points for efficiency) / 9 points possible

Transcription

1 Scenario #1 The patient is seated and complains of general low-back and buttock pain. History reveals a gradual onset of pain with no prior history of injury or trauma. Observation reveals nothing of significance. From your palpation you find that the patient reports pain along the right erector spinae and around the right SI joint region. Based on this information, continue with your evaluation by performing one test for each of the areas of pain. Please name the test, the positive signs for the test, and the implications of these positive signs. You have 2 minutes to perform these skills. Muscle Test of erector spinae (Superman) 1. Position patient prone 2. Ask athlete to actively extend shoulders and legs off of table 3. Ask athlete if there is any pain with that motion SI Compression/Distraction or 1. Position athlete side-lying for SI Distraction or supine for SI Compression 2. Give downward force over lateral ilium (distraction) or posterior force over ASIS bilaterally (compression) 3. Asks athlete if there is any pain in SI joint region Patrick Test (FABERE) or 1. Position Athlete supine with right foot resting on left knee 2. Applies posterior force to left ASIS and right knee 3. Asks patient if there is any pain in SI region Gaenslen s Test 1. Patient lies supine at edge of table 2. Patient pulls the far knee from examiner to their chest 3. Near leg hangs off of table 4. Examiner applies pressure to the near leg forcing it into hyperextension 5. States positive signs are pain in SI region 6. States implication is SI joint pathology Overall efficiency in performing these skills Total (3 points for Superman + 3 points for SI joint test + 3 points for efficiency) _/ 9 points possible

2 You find a 4+/5 grade muscle test of the erector spinae, Negative result of SI joint tests, but the patient remembers that pain sometimes runs down back of the right leg and is worse when sitting. Based on this information perform 2 special tests to determine the cause of the numbness down the patient s right leg. Please name the test, the positive signs for the test, and the implications of these positive signs. You have 2 minutes to perform these skills. Piriformis Test 1. Position patient prone w/ right knee & hip flexed over edge of table 2. Stabilize hip with one hand and apply downward pressure to knee of right leg 3. Ask patient if this increases pain in buttock region or sciatica Kernig s Test 1. Position the patient supine 2. Ask patient to perform an active SLR until pain occurs 3. After pain occurs, asks patient to flex knee 4. States positive test is when pain is relieved when knee is bent 5. States implications are nerve root impingement, disk injury, or irritation of dural sheath Lasegue s Test or SLR Test 1. Position the patient supine 2. Raises leg with knee in extension until pain is felt 3. Once pain is felt, decreases hip flexion until pain goes away 4. Then dorsiflexes foot 5. States positive sign for test is pain upon dorsiflexion of foot 6. States implication for test is disk involvement or sciatica Brudzinski s Test 1. Position the patient supine 2. Asks patient to perform SLR until pain is felt 3. Once pain is felt, patient decreases amount of SLR 4. Student passively flexes the patient s neck 5. States positive sign for test is pain (possible radiating) 6. States implication of test is disc injury or irritation of dural sheath Slump Test 1. Position patient seated 2. Ask patient to slump (round shoulders) 3. Ask patient to flex neck 4. Student then holds neck in flexion 5. Asks patient to extend knee 6. Asks patient to dorsiflex ankle 7. States positive sign for test is pain (sciatic) Other Tests possible: Well SLR, Quadrant 1. Overall efficiency in performing these skills Total Possible (5 points for each test + 3 points for efficiency) = 13 points

3 You have found a positive test for nerve root impingement. You need to determine which nerve root is primarily involved before you refer to your physician. Perform a bilateral Lower Extremity Neurological Evaluation. Perform an assessment of appropriate sensory, motor, and reflex tests. You have 4 minutes to complete this skill. Based on your instructions and assessment, the patient will give you feedback for you to determine which nerve root or nerve roots are specifically involved. 1. Position patient in proper supine or sitting position 2. L1 3. L2 4. L3 5. L4 6. L5 7. S1 8. S2 a. Sensory (buttocks, gluteal region) b. Motor Testing (SLR) a. Sensory (Upper Lateral Quad) b. Motor Testing (SLR) a. Sensory (Lower Medial Quad) b. Motor Testing (Knee Extension) a. Sensory (Medial Lower Leg) b. Motor Testing (Dorsiflexion) a. Sensory (Anterior compartment lower leg) b. Motor Testing (Great Toe Extension) a. Sensory (Achilles Tendon or 5 th Metatarsal Area) b. Motor (Plantarflexion) c. Reflex (Achilles) a. Sensory (Gastrocnemius) b. Reflex (Achilles) 9. Perform bilaterally 10. Obtained correct answer (L5&S1) x 5 Overall efficiency in performing skill (1-poor; 2-average; 3-excellent) Total: / 23 possible

4 Scenario #2 Your patient has entered your facility on crutches and their chief complaint is left ankle pain. The patient remembers falling and injuring the ankle but does not know which way the ankle moved. The injury occurred 6 days ago and there is still quite a bit of swelling and ecchymosis around the ankle joint. Palpation is difficult because the patient is point tender almost everywhere on their ankle. Please perform a thorough bilateral ligamentous evalauation of the patient s ankle. During your evaluation, please state the test, the positive signs for the test, and the implications of these positive signs. You have 2 minutes to complete this skill. Anterior Drawer 1. Positions patient in sitting position with knee flexed 90 degrees 3. Puts foot in relaxed position (slight plantarflexion) 4. Applies anterior force with hand grasping calcaneus 5. Explains what structure is being tested (ATF) 6. Explains what a positive result is (laxity) Talar Tilt Test 1. Positions patient in sitting position with knee flexed 90 degrees 3. Puts foot in neutral position 4. Applies inversion force with hand grasping calcaneus 5. Explains what structure is being tested (CF) 6. Explains what a positive result is (laxity) Kleiger s Test 1. Positions patient in either sitting or supine position 3. Puts foot in dorsiflexed position 4. Applies external rotation force with hand grasping forefoot 5. Explains what structure is being tested (Ant. Tib-Fib) 6. Explains what a positive result is (laxity/pain) Eversion Stress Test 1. Positions patient in either sitting or supine position 3. Puts foot in neutral position 4. Applies eversion force with hand grasping forefoot 5. Explains what structure is being tested (Deltoid) 6. Explains what a positive result is (laxity) 7. Performs all tests bilaterally Overall efficiency in performing skill Total: / 25 possible

5 Scenario #3 You witnessed a soccer athlete being hit on the lateral side of the right knee. The referee has waved you onto the field and the athlete is in a great amount of pain. After you approach and calm the athlete, the athlete states that they heard a pop and has pain everywhere around the knee. You have ruled out fracture with your palpation and you are now concerned about an unhappy triad of the knee. Please perform the on-the-field special tests to determine if the patient does have an unhappy triad. Please state the test you are performing, the positive signs for the tests, and the implications of these tests. You have 1 minute to perform this skill. (Please note: for the sake of time on this test, you do not need to perform these skills bilaterally). 1. Lachman Test _ a. Positions hands correctly _ b. Asks patient to relax _ c. Passively flex knee about 20 degrees _ d. Applies anterior translation to tibia _ e. States positive sign is lack of end-point or laxity (end-point _ is ideal) f. States implications is ACL tear _ 2. Valgus Stress Test _ a. Positions hands correctly _ b. Asks patient to relax _ c. Performs valgus stress test at 0 degrees _ d. Implication at 0 degrees is MCL & PCL _ e. Performs valgus stress test at 30 degrees _ f. Implication at 30 is MCL sprain _ g. Positive sign is laxity compared to other side _ 3. McMurray Test a. Have the athlete lay down supine b. Have correct hand placement with one hand over knee joint line c. Perform three passes one in neutral position, one in ext. rotation, one in int. rotation d. Perform valgus and varus during flexion of the knee e. State the positive signs for each test f. State the implication of this test Overall efficiency in performing skill Total / 25

6 All tests special tests performed for an unhappy triad were negative. You have removed the athlete from the field to a table behind the bench. You have ruled out ligamentous and meniscal injury to the patient. The patient has pain on the tibia just anterior to the attachment of the MCL. Perform a concentric manual muscle test to each muscle in this muscular group that acts as a dynamic support against a valgus stress at the knee. Please state the muscle you are testing during your evaluation. You have 2 minutes to perform this skill. Sartorius 1. Position the patient seated at edge of table 2. Instructs patient to bring one foot up to opposite knee 3. Applies force on superior aspect of knee and medial side of foot 4. Resists concentrically Semitendinosus 1. Position patient prone 2. Flex knee to 90 degrees 3. Externally rotate the tibia 4. Stabilize thigh with one hand 5. Resists concentrically Gracilis 1. Position the patient side-lying 2. Stabilize pelvis with one hand 3. Resists concentrically Overall efficiency in performing skill Total / 18