A bit O' Phys Med

Thoracic Spine
Pathology	Signs/Symptoms	Tests to Rule In	Tests to Rule Out
Thoracic Outlet Syndrome	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	Elevated Arm Stress Test Costoclavicular Test Hyperabduction Test Adson’s Test	Scapular Elevation Scapular Retraction Scapular Protraction

Cervical Spine
Pathology	Signs/Symptoms	Tests to Rule In	Tests to Rule Out
Nerve Root Compression (disc herniation, stenosis, osteophytes, trauma, spondylosis)	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	Distraction Test Maximal Foraminal Compression Test (pain on concave side) Shoulder Depression Test (pain on compressed side) Shoulder Abduction Test Valsalva Test	Vertebral Artery Test Maximal Foraminal Compression Test (pain on convex side)
Vertebral Artery Compression	Dizziness/vertigo/light headedness Headaches, weakness in extremities Unsteadiness in walking, incoordination Visual disturbances	Vertebral Artery Test	Any of the other C/S tests
Facet Joint Pathology	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	Foraminal Compression Test Maximal Foraminal Compression Test (concave side)	Vertebral Artery Test Max. Foraminal Compression (convex side)

DDx
Signs/Symptoms	Facet Syndrome	Cervical Nerve Root	TOS
Pain referral	Possible	Yes	Possible
Pain on hyperextension & rotation	Yes (often without increased referral of symptoms)	Yes w/ increased symptoms	No
Spine stiffness	Yes	Possible	Possible
Paresthesia	No	Yes	Possible
Reflexes	Not affected	m/b affected	m/b affected

Shoulder
Pathology	Signs/Symptoms	Tests to Rule In	Tests to Rule Out
Acromioclavicular Joint Pathology	Pain especially at extreme of motion Joint painful on palpation	Cross Arm Test Active Compression Test (if pain felt in AC jt) Painful Arc (after 100°)	Speed’s Test Yergason’s Test Full/Empty Can Test Neer Impingement Napolean Sign Gerber’s Test Apprehension Sign Sulcus Sign Clunk Test
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	Cross Arm Test Full/Empty Can Napolean Sign Gerber’s Test Apprehension Sign Sulcus Sign Clunk 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°)	Cross Arm Test Yergason’s test Speed’s test Napolean Sign Gerber’s test Apprehension Sign Clunk test
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	Yergason’s Speed’s Cross Arm test Apprehension sign Sulcus sign Clunk test
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	Yergason’s Speed’s Full/Empty Can Neer Impingement Cross Arm test Napolean Sign Gerber’s test Clunk test
Labral Pathology	Popping/clicking Often due to repetitive microtrauma	Clunk test Active Compression test (pain felt in shoulder)	Yergason’s Speed’s Full/Empty Can Neer Impingement Cross Arm test Napolean Sign Gerber’s test Apprehension sign Sulcus sign

Elbow
Pathology	Signs/Symptoms	Tests to Rule In	Tests to Rule Out
Lateral Epiconylitis	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	Mill’s test Cozen’s test	Valgus Stress test Tinel sign Ulnar nerve instability
Ulnar Nerve Pathology	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	Tinel Sign Ulnar Nerve Instability	Mill’s test Cozen’s test Varus Stress test

Hand and Wrist
Pathology	Signs/Symptoms	Tests to Rule In	Tests to Rule Out
Carpal Tunnel Syndrome	Pain, numbness, paresthesia, weakness/clumsiness, nocturnal awakening	Phalen’s test Tinel Sign	Finkelstein’s test Allen’s test
DeQuervain’s Tenosynovitis	Pain & tenderness at side of wrist beneath base of thumb Redness, slight swelling	Finkelstein’s test	Phalen’s test Tinel sign Allen’s test

Lumbar Spine
Pathology	Signs/Symptoms	Tests to Rule In	Tests to Rule Out
Disc Herniation/Sciatica	Pain, numbness, tingling down the leg Lumbar muscle spasm List away from lateral herniation, list towards medial herniation	Straight Leg Raising (pain at 35°-70°, usually lateral herniation) Well Leg Raising (medial herniation) Lasegue’s test Slump test	SLR (pain at >70°) Hoover test Pelvic Rock test Gaenslen’s test Faber test
SI Joint Pathology	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 à 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	Signs/Symptoms	Tests to Rule In	Tests to Rule Out
Groin Strain	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	Faber test	Ely’s test Thomas test
IT band contracture	Flexion, abduction, and external rotation of the hip	Ober’s test	Thomas Test Ely’s Test
Rectus femoris contracture	Pain may be felt from the area anterior to the acetabulum 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	Ely’s test	Thomas Test Ober’s test
Hip flexion contracture	Pain commonly occurs in weight lifting, uphill running, and sit-ups	Thomas test	Ely’s test Ober’s test

Knee
Pathology	Signs/Symptoms	Tests to Rule In	Tests to Rule Out
Anterior Cruciate Ligament Injury	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	Anterior Drawer Test Lachman Test Slocum test	Posterior Drawer test Collateral Ligament Stability test McMurray’s test Bounce Home test Apley’s test
Posterior Cruciate Lig. Injury	Similar to ACL injury “Dashboard injury”	Posterior Drawer test Slocum test	Anterior Drawer test McMurray’s Bounce Home test Apley’s test
Meniscus Injury	Pain, swelling, tenderness on palpation Popping/clicking within the knee Limited motion Joint locking, inability to straighten knee	McMurray’s test Bounce Home test Apley’s Compression	Ant/Post Drawer test Lachman test Collateral Lig. Stability Apley’s Distraction
Medial Collateral Ligament tear	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”	Collateral Lig. Stability Slocum test	Ant/Post Drawer test Lachman test
Patellofemoral Syndrome	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	Apprehension test Any of the previously mentioned tests

Ankle and Foot
Pathology	Signs/Symptoms	Tests to Rule In	Tests to Rule Out
Achilles Tendon Rupture	“Pop” or “snap” often heard Immediate sharp pain in ankle & lower leg Swelling, ecchymosis over achilles tendon Weak & painful plantar flexion	Thompson’s “Squeeze” test	Anterior Drawer test Homan’s sign
Ankle Sprain	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