Musculoskeletal PT

the convex surface moves in a direction opposite to the direction of the shaft of the bony lever.

the concave surface moves in the same direction as the bony lever

convex rule applies at the atlanto-occipital joint

below 2nd vertebra, concave rule applies

elevation/depression:
convex: clavicle
concave: sternum
opposite direction

protraction/retraction
convex: sternum
concave: clavicle
same direction

convex: clavicle
concave: acromion

opposite direction

resting position: 55 degrees abd, 30 degrees horizontal add

convex: humerus
concave: glenoid

opposite direction

55-77 degrees abd
30 degrees horizontal adduction
neutral rotation

max abd + ER

70 deg flex
10 deg sup

full ext +sup

full ext and sup

90 deg flex + 5 deg sup

70 deg flex, 35 deg sup

5 deg sup + full ext

10 deg sup

5 deg sup

neutral with slight ulnar deviation

30 deg flex
30 deg abd
slight lateral rotation

ligamentous: full ext, abd, IR
bony: 90 deg flexion, slight abd, slight ER

25 deg flex

full ext + ER

mid inversion/eversion
10 deg PF

full DF

midway between extremes of ROM with 10 deg PF

full inversion

2nd - 7th

on lateral angle of scapula
30 deg anterior to frontal plane
(so true abduction is 30 deg ant to frontal plane)

limitation of mouth opening

forward bening more limited than backward bending

restriction with rotation

limitation of all motions except flexion

sidebending = rotations> backward bending

full elevation limited; pain at extreme ROM

full elevation limited; pain at extreme ROM

greater limitation of ER, followed by abdcution and IR

loss of flexion > extension

loss of flexion> extension

equally restricted in pronation and supination in presence of elbow restriction

limitation pronation = supination

limitation: pronation = supination

limitation: flexion = extension

limitation of sidebending and rotation>loss of extension>flexion

marked and equal limitation of sidebending and rotation; loss of extension > flexion

pain when joints are stressed

limited flexion/IR; some limiation of abduction; no or little limitation of adduction and ER.

flexion grossly limited; slight limitation of extension

Pain when joint is stressed

loss of PF>DF

increasing limitations of varus; joint fixed in valgus (inversion>eversion)

supination.pronation (limited DF, PF, add, medial rotation

marked limitation of extension; slight limitation of flexion

Variable; tend toward flexon restrictions

tend toward extension restrictions

convex - superior/inferior

concave - anterior/posterior

C5 - biceps brachii
C6 - brachioradialis
C7 - triceps

external rotation occurs which prevents compression of greater tubercle against the acromion.

2:1 glenohumeral with scapulothoracic

Pt position: supine
Limb position: arm 90 d abduction
PT action: ER arm
Positive test indicated by: look of apprehension
Positive test suggests: shoulder laxity/risk for dislocation

Pt position: supine
Limb position: arm 90 d flexion and IR
PT action: apply posterior force through long axix of humerus
Positive test indicated by: look of apprehension
Positive test suggests: posterior capsule laxity/risk for dislocation

teiceps Tendon Pathology
Pt position: sitting;
Limb position: clasp both hands behind head w/ fingers interlocked. Actively contracts and relaxes biceps.
PT action: ask pt to actively contract and relax biceps.
Positive test indicated by: absence of movement in biceps tendon
Positive test suggests: rupture of long head of biceps

Biceps Tendon Pathology
Pt position: sitting or standing
Limb position: arm extended and forearm supinated
PT action: put one hand over bicipital groove and other hand on volar surface of forearm. Resist active shoulder flexion.
Positive test indicated by: pain or tenderness in biciptial groove region.
Positive test suggests: bicipital tendonitis.

Bicipital Tendon Pathology
Pt position: sitting
Limb position: 90 d elbow flexion, forearm pronated. Humerus stabilized against pt's thorax
PT action: 1 hand on pt's forearm, other hand over biciptal groove. Ask pt to actively supinate and ER against resistance
Positive test indicated by: pain or tenderness in bicipital groove
Positive test suggests: bicipital tendonitis

Rotator Cuff Pathology / Impingement
Pt position: sitting or standing
Limb position: arms 90 d of abduction
PT action: ask pt to slowly lower arms to side
Positive test indicated by: unable to lower arm slowly or severe pain
Positive test suggests: tear in rotator cuff

Pt position: sitting or standing
Limb position: shoulder at 90 d flexion + IR
PT action: positions arm in flexion and IR
Positive test indicated by: pain
Positive test suggests: impingement involving supraspinatus tendon

Pt position: sitting or standing
Limb position & PT action: 1 hand on posterior aspect of pt's scapula and other hand stabilizing elbow. elevate pt's arm through flexion.
Positive test indicated by: facial grimace, pain
Positive test suggests: impingement invovling supraspinatus tendon

Pt position:
Limb position & PT action: limb positioned in 90 d abduction + 30 d horizontal adduction with thumb pointing downward. PT resists pt's attempt to abduct arm
Positive test indicated by: weakness or pain
Positive test suggests: tear of supraspinatus tendon, impingement, suprascapular nerve involvement.

Thoracic Outlet Syndrome
Pt position: sitting or standing
Limb position:
PT action: monitor radial pulse, ask pt to rotate head to face test shoulder, then extend head while PT ERs and extens pt's shoulder
Positive test indicated by: absent or diminished radial pulse
Positive test suggests: possible TOS

Thoracic Outlet Syndrome
Pt position: sitting or standing
Limb position: test arm 90 d abduction, ER, elbow flexion
PT action: ask pt to rotate head away from test should, PT monitors radial pulse
Positive test indicated by: absent/diminished pulse when head is rot'd away from test shoulder
Positive test suggests: TOS

Pt position: sitting
Limb position:
PT action: monitors radial pules, assists pt to assume military posture
Positive test indicated by: absent or diminished pulse when head is rot'd away from the test shoulder.
Positive test suggests: TOS

Pt position: sitting or standing
Limb position: arm 90 d abduction, ER, elbow flex.
PT action: Ask pt to open and close their hands for 3 minutes
Positive test indicated by: inability to maintain test position, weakness of arms, sensory loss or ischemic pain.
Positive test suggests: TOS

Pt position: sitting or supine
Limb position:
PT action: moves pt's arm overhead in frontal plane while monitoring radial pusle
Positive test indicated by: absent or diminished radial pulse
Positive test suggests: compression of costoclavicular space

Pt position: supine
Limb position:
PT action: one hand on posterior aspect of pt's humeral head, other hand stabilizes huerus proximal to elbow. Passively abduct and ER arm over pt's head, then apply anterior directed forse to humerus.
Positive test indicated by: clunk of grinding sounds
Positive test suggests: glenoid labrum tear

Pt position: sitting
Limb position: elbow 20 d of flexion
PT action: places 1 hand on elbow and other hand proximal to pt's wrist. Applies varus force. Palpate lateral joint line.
Positive test indicated by: increased laxity in lateral collateral ligament, apprehension, pain.
Positive test suggests: lateral collateral ligament sprain

Pt position: sitting
Limb position:elbow 20-30 d flexion
PT action: place 1 hand on elbow, other hand proximal to pt's wrist. Applies valgus force, palpate medial joint line.
Positive test indicated by: increased laxity in medial collateral ligament, apprehension, pain.
Positive test suggests: medial collateral ligament sprain,

Epicondylitis
Pt position: sitting
Limb position: elbow in slight flexion
PT action: place thumb on pt's lateral epicondyle while stabilizing the elbow joint. Ask pt to make a fist, pronate forearm, radially deviate and extend wrist against resistance.
Positive test indicated by: pain in lateral epicondyle region or muscle weakness.
Positive test suggests: lateral epicondylitis

Pt position: sitting
Limb position:
PT action: stabilizes elbow w/ 1 hand, place other hand on dorsal aspect of pt's hand distal to proximal interphalangeal joint. Ask pt to extend 3rd digit against resistance.
Positive test indicated by: pain, weakness
Positive test suggests: lateral epicondylitis

Pt position: sitting
Limb position:
PT action: palpates medial epicondyle, supinates pt's forearm, extends, wrist, extends elbow.
Positive test indicated by: pain in medial epicondyle region
Positive test suggests: medfial epicondylitis

Pt position: sitting
Limb position:
PT action: palpates lateral epicondyle and pronates pt's forearm, flexes wrist, extends elbow.
Positive test indicated by: pain in lateral epicondyle regions
Positive test suggests: lateral epicondylitis

Pt position: sitting
Limb position:
PT action: holds pt's thumb in ext, applies valgus force to MCP joint of thumb.
Positive test indicated by: excessive valgus movements
Positive test suggests: tear of ulnar collateral and accessory collateral ligments
"gamekeeper's" or "skier's thumb"

Pt position: sitting or standing
Limb position:
PT action: ask pt to open/close hand several times in succession, then keep hand in closed position; compressradial and ulnar arteries; ask pt to relax hand, release pressure on 1 of arteris, observe color of hand/fingers
Positive test indicated by: delayed or absent flushing of radial or ulnar half of hand.
Positive test suggests: occusion in radial or ulnar artery.

Pt position: sitting
Limb position: MCP joint held in slight extension
PT action: moves proximal IP jt into flexion.
Positive test indicated by & Suggests: Proximal IP jt does not flex with MCP jt extended: may be tight intrinsic muscle or capsular tightness. If proximal IP joint fully flexes w/ MCP joint in slight flexion, there may be intrinsic muscle tightness without capsular tightness
Positive test suggests:

Pt position: sitting
Limb position: PIP joint in neutral, DIP flexed
PT action:
Positive test indicated by & Suggests: if unable to flex DIP the retinacular ligaments or capsule may be tight. If able to flex the DIP w/ PIP in flexion, retinacular ligaments may be tight and capsule may be normal.
Positive test suggests:

Pt position: sitting or standing
Limb position:
PT action: ask pt to hold piece of paper between thumb and index finger; pt attempts tto pull paper away from the pt
Positive test indicated by: pt flexing distal phlanb of thumb d/t adductor pollicis muscle paralysis. If at the same time pt hyper extends the MCP joint of thumb --> "Jeanne's Sign"
Positive test suggests: ulnar nerve compromise or paralysis

Pt position: sitting or standing
Limb position:
PT action: stabilize pt's thumb on metacarpal. Apply compression and rotation through the metacarpal.
Positive test indicated by pain:
Positive test suggests: DJD of carpometalcarpal joint

Pt position: sitting or standing
Limb position:
PT action: ask pt to make a fist
Positive test indicated by: pt's 3rd metcarpal remaining level w/ the 2nd and 4th metacarpals.
Positive test suggests: dislocated lunate

Pt position: sitting, knees flexed to 90 d over edg of table
PT action: passively extend 1 knee
Positive test indicated by: tightness in H.S. or extension of trunk in order to limit effect of tight h.s.0
Positive test suggests: tight h.s.

Pt position: supine
Limb position: pt stabilizes hips in 90 d flexion with knees relaxed.
PT action: ask pt to alternately extend each knee as much as possible while maintaining the hips in 90 d flexion.
Positive test indicated by: kne stays in 20 d+ flexion
Positive test suggests: H.S. tightness