Movements and Orthopedic Tests: quick, easy, and reliable

By Walter Friberg

This quick reference guide designed for medical students, physical therapists, physical therapy assistants, residents, chiropractic physicians, physicians and physician assistants, and the independent medical examiners specialized in Family practice, Neurology, Internal Medicine, PM&R, Orthopedic Surgery, and other specialist in Musculoskeletal Medicine and Legal Medicine, as well as Attorneys.
traditionally muscle and orthopedic tests described ether in different chapters or (most common) in different textbooks. The book provides practitioners with is a quick, reliable, equipment-free way to test together natural (muscle testing) and special (orthopedic tests) movements.
Usually in the medical textbooks all tests listed in the alphabetic order.
In this book tests described in a logical order rather than in an alphabetical order.
For example, all tests for the cervical radiculopathy and cervical nerve root compression are grouped together. The optimal combination of the tests based on literature data provided.
Surprisingly different textbooks described even "classical" tests in completely different ways and sometimes under different names. Readers have the clear, non-confusing, and commonly used descriptions of the tests. . In some cases, if it seems appropriate the author's description of the tests used.
All tests described in a consistent, uniform way: 1. Indications. 2. Patient's position.3.Technique. 4. Interpretation. Description of some tests had been complimented by the Clinical Notes. The Notes reflect either literature data or my own 40+ years of the Musculoskeletal Medicine practice.

• Language: English
• Publisher: BookBaby
• Release date: Dec 1, 2020
• ISBN: 9781098338206

Book preview

©2020 All rights reserved. This book or any portion thereof may not be reproduced or used in any manner whatsoever without the express written permission of the publisher except for the use of brief quotations in a book review.

Chicago 2020

Print ISBN: 978-1-09833-297-6

eBook ISBN: 978-1-09833-297-6

Disclaimer

Neither the Publisher nor the Author assume any responsibility for any loss or injury and/or damage to persons or property arising out of or related to any use of the material contained in this book. It is responsibility of the treating practitioner, relying on independent expertise and knowledge of the patient, to determinate the best diagnostic tool for the patient and how to perform the tests in the safe way.

Remember the Dr. Osler words, To study the phenomena of disease without books is to sail an uncharted sea, while to study books without patients is not to go to sea at all. Sir William Osler. Aequanimitas ‘Books and Men.’ 1914:220.

Acknowledgements

To my respectful teachers Prof. Esfir Tykocinski, MD, PhD, D Sc. (St. Petersburg, Russia) and Prof. Lyn Weis, MD (NY, USA) who during my Russian Neurology and American RM&R residencies passed on most of this knowledge to me.

To my friends and teachers in the Legal Medicine Prof. Mohammed Ranavaya, MD, JD and Steven Babitsky, Esq.

To my students at the Trinity School of Medicine and American University of Integrative Sciences, School of Medicine.

Contents

Preface

CERVICAL and THORACIC SPINE TESTS

SHOULDER JOINT TESTS

ELBOW JOINT TESTS

WRIST and HAND TESTS

LUMBAR SPINE TESTS

PIRIFORMIS MUSCLE TESTS

HIP JOINT TESTS

SACRAL SPINE AND SACROILIAC

JOINT (SI) TESTS

LEG DISCREPANCY TESTS

KNEE JOINTTESTS

UNHAPPY TRIAD

ANKLE JOINT and FOOT TESTS

CIRCULATORY DISORDER TESTS

TESTS FOR SYMPTOMS FALSIFICATION

OR MAGNIFICATION

REFERENCES

Preface

This quick reference guide designed for medical students, physical therapists, physical therapy assistants, residents, chiropractic physicians, physicians and physician assistants, and the independent medical examiners specialized in Family practice, Neurology, Internal Medicine, PM&R, Orthopedic Surgery, and other specialist in Musculoskeletal Medicine and Legal Medicine, as well as Attorneys.

Practitioner always has a limited amount of time to exam patients. How to choose the most important and easy to perform test pertinent to the particular clinical situation? Muscle tests designed to evaluate the everyday’s natural movements, for example elbow flexion, knee extension. Significance of the muscle tests is difficult to overestimate. By simple observation and/or testing of particular movements we can estimate involvement of the particular muscles, nerves, and nerve roots. Orthopedic tests use to evaluate particular structures, for example muscles, tendons, ligaments, bones by using special, sometimes unusual for the subject movements. Both tests are the integral part of the musculoskeletal examination. However, traditionally muscle and orthopedic tests described ether in different chapters or (most common) in different textbooks.

This small book provides practitioners with is a quick, reliable, equipment-free way to test together natural (muscle testing) and special (orthopedic tests) movements.

Usually in the medical textbooks all tests listed in the alphabetic order.

In this book tests described in a logical order rather than in an alphabetical order.

For example, all tests for the cervical radiculopathy and cervical nerve root compression are grouped together.

Most importantly, I provide the optimal combination of the tests based on literature data.

Surprisingly different textbooks described even classical tests in completely different ways and sometimes under different names. I attempted to give my readers the clear, non-confusing, and commonly used descriptions. In some cases, when I believe it is appropriate my own description of the tests used.

All tests described in a consistent, uniform way: 1. Indications. 2. Patient’s position.3.Technique. 4. Interpretation. Description of some tests had been complimented by the Clinical Notes. The Notes reflect either literature data or my own 40+ years of the Musculoskeletal Medicine practice.

The possessive form is used with nouns referring to people, groups of people, countries, and animals. It shows a relationship of belonging between one thing and another. Most tests named after the clinicians who first described the test. Grammatically the possessive is necessary. Some textbooks use the possessive for one group of tests and don’t use the possessive form for another group. Here is a typical example from one of the textbook: Tinel’s sign, previously known as the Hoffman-Tinel sign. The sign takes its name from a German neurologist Johann Hoffman and a French neurologist Jules Tinel. In the same sentence the author uses two names of the same test with and without the possessive form. It creates a lot of confusion. I decided to do not discriminate authors of the tests and do not utilize the possessive form at all.

For some of the most important tests provided available sensitivity and specificity data.

Sensitivity measures how frequent a test correctly generates a positive result for patients with the suspected medical condition. The test sensitivity is also known as the true positive rate. True positive means correctly identified. Let’s take the rotator cuff tear as an example. A high sensitive test will be positive for the most patients with the rotator cuff tear and not generate many false-negative results. (Example: a test with 90% sensitivity will correctly show a positive result for 90% of patients who DO HAVE the rotator cuff tear but also will show a negative result (i.e. a false-negative ) for 10% of the patients who have the rotator cuff tear and should have positive test result.

Specificity measures a test’s ability to correctly generate a negative result for patients who do not have the suspected medical condition that’s being tested for (also known as the true negative rate). A high-specificity test will correctly rule out almost every patient who doesn’t have the disease and won’t generate many false-positive results. (Example: a test with 90% specificity for the rotator cuff tear will correctly