CCEStudyGuide

CervicalExam

C5:ShoulderAbduction,ElbowFlexion
C6:ElbowFlexion,WristExtension
C7:ElbowExtension,WristFlexion,FingerExtension
C8:FingerFlexion
T1:FingerAb/Adduction

Orthos=
CervicalCompressionIVFencroachment,SOL,herniation,tumor
o TP:radicularpainintoarm
DistractionIVFencroachment
o TP:reliefofradicularpain
ShoulderDepressionNRtcompression,foraminalencroachment,plexusstretchinjury
o TP:radicularpainonstretchedside
ValsalvasSOL
o TP:radicularpain
TOS
AllensRadial/UlnarAocculusion;orBrachial/Axillary/Subclavianocculusionw/both
o TP:>3secondsforreturnofcolourtohand
AdsonsTOS,ScalenusAnticusSyndr
o TP:Diminishedpulse+reproductionofpn,tingling,numbness,paresthesias
HalsteadsTOS,ScalenusMediusSyndrome
o TP:Diminishedpulse+reproductionofpn,tingling,numbness,paresthesias
EdensTOS,CostoclavicularSyndrome
o TP:Diminishedpulse+reproductionofpn,tingling,numbness,paresthesias
Hyperabduction/WrightsTOS,PecMinorSyndrome
o TP:Diminishedpulse+reproductionofpn,tingling,numbness,paresthesias
RoosTOS
o TP:reproducedischemicpn,tingling,numbnessorparesthesias

DTRs
Biceps:C5
Brachioradialis:C6
Triceps:C7
BabinskiUMNlesions,latcorticalspinaltractormotorcortex
TP:extensionofbigtoe+flaringoflittletoes(BabinskiSign)

ShoulderExam

Orthos=
ApleysScratchgeneralscreenforshouldermobility
PainfulArcimpingementsyndromeorACJtdysfunction
o TP:paininabduction
EmptyCanTestsupraspinatustendonitis,ortear
o TP:paininsupraspinatusregionsworw/ofullresistance,inabilitytohold

LagSignweakortornsubscap
o TP:inabilitytoliftarmoffback,inabilitytoholdposition,and/orabnormmotion
ofscapuladuringLiftOfftest
LoadandShiftanteriororpostGHinstability
o TP:translation>25%ofhumeralheaddiameteranteriorlyorbeyond50%
posteriorly
NeersTestimpingementsyndromeofsupraspinatus,LHbiceps,infraspinatus,bursa
o TP:anteriorshoulderpain
KennedyHawkinsimpingementsyndromeofsupraspinatus,LHbiceps,infraspinatus,
bursa
o TP:anteriorshoulderpain
LiftOffTestweakortornsubscapularis
o TP:inabilitytoliftarmoffbackwithorwithoutresistance
Speedsbicepstendonitisorstrain
o TP:anteriorshoulderpain,locatedinbicepsmmortendon,espinintertubercle
groove,givingwaytopain
ApprehensionSignrecurrentantdislocationofGHjoint
o TP:patientguarding,discomfortoralookofapprehensiononface
RelocationSignconfirmationofrecurrentdislocationofGHjoint
o TP:lossofapprehensionorpain,greaterexternalrotationbeforereturnof
apprehensionandpain
CrankTestGHlabraltear
o TP:hearingorfeelingaclunkorclick

ElbowExam

Orthos=
Valgus/VarusInstabilityMed/LatCollateralligamentdamage
o TP:excessjointgapping
Valgus/ExtensionOverloadMedialcollateralligamentdamage
o TP:excessjointgapping
Cozens+MillsLateralEpicondylitis(Tennis)
o TP:tendernessonpalponextensortendons,unabletoholdwristinextension
(Cozens),painatlateralepicondyle
ReverseCozens+ReverseMillsMedialEpicondylitis(Golfers)
o TP:tendernessonpalponflexortendons,unabletoholdwristinflexion(Rev
Cozens),painatmedialepicondyle
TinelsCubitalTunnelSyndrome
o TP:tingling,paresthesiasradiatinginto4/5thfingers
PassiveElbowFlexionCubitalTunnelSyndrome
o TP:tingling,painorparesthesiasradiatingintoforearmand4/5thfingers

Wrist/HandExam

Orthos=
Watsonsligamentouslaxityofscaphoidligaments

o TP:shiftingofscaphoidoverposteriorrimofdistalradiusorpain
Ballotmentliglaxityorinstabilityoflunatotriquetralinterossousmembrane
o TP:excesslunatemotion,crepidusorpainwithlunateshear
UlnarDeviation/Pronation?
Finkelsteinsstenosingtendosynovitisofabductorpollicuslongusandextensor
pollicusbrevis
o TP:sharppaininanatsnuffbox
TinelsCarpelTunnelCarpelTunnelSyndrome
o TP:tingling,paresthesiasintothumb,2nd,3rd,latof4thfingers
TinelsTunnelofGuyonUlnarTunnelSyndrome
o TP:tingling,parestheiasintomedof4thand5thfinger
BunnelLittlerTest
o TP:inabilitytoflexPIPw/eitherflexorextofMCP
jointcapsulecontracture
o TP:inabilitytoflexPIPw/MCPinextension,butflexionofboth
intrinsichandmm
o Interwebz=(ifPIPflexionincreaseswithMCPflexion=lumbricaltightness,if
samewithMCPflexionorextension=jointcapsulecontracture)
RetinacularTest
o TP:inabilitytoflexDIPw/eitherflexorextofPIP
jointcapsulecontracture
o TP:inabilitytoflexDIPwithPIPinextension,butflexionofboth
tightretinacularligaments
Allens(repeat)

LumbarExam

L4:AnkleDorsiflexion
L5:GreatToeExtension
S1:AnklePlantarflexionandEversion

Orthos=
StandingKempsDuralmobilitycompromise,muscularrestriction?
o TP:radicularpain
SupportedAdams
o reductionofpelvicpainwithpelvicimmobilization=SIjtsprain/strain,inflamm
o painregardlessoftheimmobilization=lumbarlesion
HeelRaises/WalkL4/L5nerverootlesion
o TP:onetoe/forefootdoesntriseasmuch
ToeRaises/WalkL5/S1nerverootlesion
o TP:oneheeldoesntriseasmuch
SeatedKempsDuralmobilitycompromise
o TP:radicularpain
BecterewsDuralmobilitycompromise,postlatdischerniationsuspectedifradicular
painisinthesameleg
o TP:radicularpainorUTP,Tripodsign=archingofbackwithhandsbehind
Combo:Becterew,Braggard,Valsalva

o *U/Landadditive
MurphysKidneyPunch
SLRDuralmobilitycompromise,orperipherialentrapmentneuropathy
o TP:radicularpndownbackoflegbefore70degrees
WLRDuralmobilitycompromise,posspostmedialdiscprotrusion
o TP:radicularpndownbackoflegNOTbeingraised
BraggardsDuralmobilitycompromise
o TP:radicularpndownbackoflegbefore70degrees
Thomastightanteriorhipmuscles
o TP:straightlegcomesoffthetable
GaenslensSIjointinfection,inflammorsprain
o TP:paininSIjoint
PatricksHippathology
o TP:paininthehip(NOTthighnotbeingparallelwiththetable)
YeomansSIjointinfection,inflammorsprain
o TP:paininSIjoint
PronePressupaggravationofdischerniationsandfacetsyndrome
o TP:reproductionofpain

DTRs
Patella:L4
Achilles:S1

HipExam

Orthos=
Trendelenbergweakglutmedonstanceleg
o TP:crestwilldrop
LegueresSIjointinfection,inflammorsprain
o TP:paininSPjoint
OberstightITB/TFL
o TP:thighunabletodropdowntoleveloftable,orpain
Craigsfemoralanteroversion(>15),orretroversion(>8)
HibbsLaxityofposteriorSIligaments
o TP:excessivegappingorpaininSIjoint
Yeomans(repeat)
FemoralNerveStretchDuralmobilitycompromiseofL24orfemoralNcompromise
o TP:radicularpaindownfrontoftheinvolvedleg

LLI:
ApparentUmbillicustoMed.Malleolus
TrueASIStoMed.Malleolus

KneeExam

Orthos=
Squat

Weightbearing@30
Valgus/VarusTestMed/LatCollateralligamentdamage
o TP:excessgappinginjointline
PatellarStability(30thenExt)
PatellarInhibitionChondromalaciapatella
o TP:retropatellarpain,possiblegrinding
LachmansACLdamage
o TP:excesskneemotionfromPAorlaxity
AntDrawerACLtear,orpostkneecapsuletear
o TP:excessANTmotionoftibia
PostDrawerPCLtearorarcuatepopliteuscomplextear
o TP:excessPOSTmotionoftibia
Slocums
o ExcessAntLatmotionACL,LCL,PostLatCapsule
o ExcessAntMedmotionACL,MCL,PostMedCapsule
PivotShiftAntLatrotaryinstabilitypotentialdamagetoACLand/orLCL
o TP:clunkorjerkoftibiashiftingposterior
McMurraysMeniscaltear
o TP:clicking
DynamicTestLatmeniscustear
o TP:painatlatmeniscusand/orsharppaininendposition
NoblesCompressionITBfrictionsyndrome
o TP:pnoverlateralfemoralcondyle
Obers(repeat)
ApleysCompression/Distractionmeniscaltearorloosecartilage
o TP:painorclicking,orreductionofclicking

AnkleExam

Orthos=
Draweranklesprainorligamenttear(ifantlatsidethenATFL)
o TP:gapping,laxity,excessmotion
InversionStressTestanklesprainorligtear(ATFL,calcaneofib,posttalofib)
o TP:gapping,laxity,excessmotion
EversionStressTest
NavicularDropTestflatfoot
o TP:naviculardrops1/3disttofloor=1stdeg,2/3=2nddeg,fullonfloor=3rddeg
Syndesmosissyndesmosisinjury,highanklesprain?
o TP:paindistaltositeofsqueeze
ForefootCompressionMortonsNeuroma
o TP:sharportinglingpainbtwmetatarsals
HeelCompressionHeelspur
o TP:sharp,localpain
TinelsTarselTunnelSyndrome
o TP:tinglingorparesthesiasintofoot
ThompsonAchillestendonrupture
o TP:absenceofplantarflexionwithtricepssuraesqueeze