Orthopaedic examination

This orthopaedic examination page is not intended to be an exhaustive list of hundreds of tests, but rather to consider a few that interest me. In particular those that may provoke tingling in arms and hands and legs.

The goal of the physical exam in general is to detect abnormalities in the human body and, like the entire examination, orthopedic tests are a challenge to the clinician.

In the acute patient often a whole batch of orthopedic tests are positive leading to confusion in the mind of the inexperienced doctor. It is the recognition of a pattern of positive tests and signs that enables him to make the critical diagnosis.

No one sign or test, in isolation, is of absolute significance and must be read into the context of the whole patient. One swallow doesn't make a summer! A difficult to find Posterior Tibial pulse doesn't make for a claudication but, in the presence of leg pain, a negative Lasegue and Braggard, and pain on walking or cycling it may be hugely significant. Whether the patient is a smoker, or has high cholesterol, also comes into the equation ...

Many tests have a huge subjective bias and may be difficult to reproduce and interpret. A positive Yeoman test in the presence of a Kemp Test may well be negative in regard the Sacroiliac joint. An Adson test may appear to be positive, but a slight change in the position of the arm may change the picture completely. And so on ... critical thinking and experience are the most vital tools in the orthopaedic examination.



Orthopedic tests

Congenital, or developmental hip dysplasia


Severe cases of Hip Dysplasia where the hip dislocates or subluxates readily are usually detected at birth, using the tests and signs of Ortholani, Galeazzi en Barlow.



Mild cases are however often only detected once the patient begins to complain of pain in the groin and upper thigh.

The grossly hypermobile (possibly clicking) hip in the child and adult should always be assessed for DDH. Otherwise it almost always progresses to severe hip arthritis.

It takes the chiropractor no more than 30 seconds to screen the hip joint for abnormalities. Detecting DDH and FAIS long before they present with pain will certainly make an enormous contribution to preventing future disability and total hip replacement.


Tingling in arms and hands

Shoulder Abduction Relief (SAR) sign

This is not really an orthopedic test of course, rather a sign, but an important one. This week a patient walked into our clinic with his hand on his head. One look, and I made the diagnosis ... SHOULDER ABDUCTION RELIEF sign ...

Coupled with a positive Upper Limb Tension Test every chiropractor knows he has a challenge on his hands, especially if there is also tingling in arms and hands ...



Orthopaedic examination of the hip

Faber test.

Missed, Femoro Acetabular Impingement Syndrome leads inexorably onto a degenerative arthritic hip. Caught early, Chiropractors are saving thousands, perhaps hundreds of thousands of people with silent, progressive FAIS from a future total hip replacement.

But you won't find this subluxation of the hip if you don't look for it. Read more about Femoro Acetabular Impingement Syndrome FAIS.

The Faber test (Flexion-Abduction-External-Rotation) is also an important orthopedic test for the Sacro-iliac Joint. Sacroiliac joint anatomy.



Cervical compression Test

Not to be missed. This is GREAT FUN! A few lighter moments are not unimportant, eh!


Slump test

The Slump 7 test is probably the ORTHOPAEDIC EXAMINATION test I use most often in my practice. On virtually every patient with low back and leg pain, still the majority of patients in chiropractic clinics, I use the Slump test. But the interpretation of a positive Slump Test is ... Read more about Slump Test …


JULLS test

It's been shown conclusively that CAD injuries cause weakened Neck Flexors. Perhaps this is related to the change in the cervical lordosis associated with whiplash. In any event Julls test has now become an important part of my orthopaedic examination. Read more about Julls test for neck flexor strength …


Adson's Test

This for me is one of the most important and frequently used tests in my clinic. And difficult tests. Done in the traditional manner, I have too many false positives.

Frequently used? In the patient with tingling in arms and hands I'm always want to know whether this is a cervical lesion, or a first rib dysfunction. Cervical ribs too will often disturb the tissues in the inter scalene triangle ...

Personally I find a first rib dysfunction very frequently is the underlying cause of Carpal Tunnel syndrome and core to successful Frozen shoulder treatments ...



LINKS


Physical Therapists providing a Chiropractic adjustment?

Many insurance companies now only pay for physical therapists to provide a chiropractic adjustment; that's in the face of powerful research proving that inclusion of DCs to perform their own technique would save them a good deal of money. One has to conclude that political medicine has gone off on another tack to contain our profession.



It's being successful with some doctors of chiropractic quitting. Others become involved in some dodgy practices, like demanding that patients sign up for a whole year of treatment in advance, in order to stay in business.

In recessionary times, the going is tough when the insurance won't pay.

Is the day approaching for a new Wilk versus the AMA and the insurance companies?

The chiropractic profession has tried hard to stay on the moral high ground; those who stoop to unscrupulous practices need to be exposed and disciplined if we are not to stoop to the low blows that medicine has often resorted to contain and eliminate us.


MORE LINKS



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