Musculoskeletal Medicine (MSM) Testing + Generalizations of Conditions
,Thoracic
Adam’s (Tx)
Px standing, ask to bend over & touch toes
• Asymmetry & raised hump on 1 side which stays on bending = structural/congenital scoliosis
• Asymmetry & raised hump on 1 side which goes on bending = functional scoliosis
Chest/Rib Expansion
Px seated, stand behind Px & cup the scapulae with web of hand, ask Px to breathe deeply while you follow movement
• Asymmetry or pain = rib / thorax pathology
,Cervical
Cervical Screen
1. Observe - forward head posture, swelling, redness, lumps, bumps, bruises, asymmetry
o Mention the Px is to be unclothed for this
2. Palpate - atlas, Cx & muscles
o Mention you also palpate for warmth, lumps, bumps, swelling, spasm, hypertonicity, tenderness
3. ROM - PROM, AROM, RROM
o AROM pain = muscle issue
o PROM pain = joint / ligament issue
o Mention PROM is always more than AROM
4. Compression - with positive & indication
5. Distraction - with positive & indication
6. Valsalva’s - with positive & indication
Compression
Press down on head with 2 hands in neutral (+ lateral flexion/rotation/extension for maximum compression)
• Local neck pain = facet
• Pain radiating to arms = disc
Distraction
Add traction to lift up head (hands not over ear!)
• Relief = disc
• Local pain = muscle/ligament/soft tissue
Valsalva’s (Cx)
Px upright, thumb in mouth & bear down as if going to toilet/blowing a balloon to raise pressure
• Pain & radiation = disc
, Other Cervical Tests
Lhermitte’s Sign
Px upright, flex chin to chest
• Electric shocks down the spine = cervical myelopathy / early MS
Cervical Arterial Dysfunction (CAD) Test
Px seated, ask if PT experiences any symptoms before doing the test. PT to AROM rotate head L/R & hold for 10 sec (tests vertebrobasilar arteries), then PT
to AROM rotate head L/R combined with extension & hold for 10 sec (tests internal carotid arteries). Return to neutral for 10 sec both times. Testing
ipsilateral artery (R rotation = compromising L BF = testing R artery & vice versa). Requires cervical rotation/extension PROM of PT
• 5 D's & 3N's + LoC = VBAI
,Thoracic
Adam’s (Tx)
Px standing, ask to bend over & touch toes
• Asymmetry & raised hump on 1 side which stays on bending = structural/congenital scoliosis
• Asymmetry & raised hump on 1 side which goes on bending = functional scoliosis
Chest/Rib Expansion
Px seated, stand behind Px & cup the scapulae with web of hand, ask Px to breathe deeply while you follow movement
• Asymmetry or pain = rib / thorax pathology
,Cervical
Cervical Screen
1. Observe - forward head posture, swelling, redness, lumps, bumps, bruises, asymmetry
o Mention the Px is to be unclothed for this
2. Palpate - atlas, Cx & muscles
o Mention you also palpate for warmth, lumps, bumps, swelling, spasm, hypertonicity, tenderness
3. ROM - PROM, AROM, RROM
o AROM pain = muscle issue
o PROM pain = joint / ligament issue
o Mention PROM is always more than AROM
4. Compression - with positive & indication
5. Distraction - with positive & indication
6. Valsalva’s - with positive & indication
Compression
Press down on head with 2 hands in neutral (+ lateral flexion/rotation/extension for maximum compression)
• Local neck pain = facet
• Pain radiating to arms = disc
Distraction
Add traction to lift up head (hands not over ear!)
• Relief = disc
• Local pain = muscle/ligament/soft tissue
Valsalva’s (Cx)
Px upright, thumb in mouth & bear down as if going to toilet/blowing a balloon to raise pressure
• Pain & radiation = disc
, Other Cervical Tests
Lhermitte’s Sign
Px upright, flex chin to chest
• Electric shocks down the spine = cervical myelopathy / early MS
Cervical Arterial Dysfunction (CAD) Test
Px seated, ask if PT experiences any symptoms before doing the test. PT to AROM rotate head L/R & hold for 10 sec (tests vertebrobasilar arteries), then PT
to AROM rotate head L/R combined with extension & hold for 10 sec (tests internal carotid arteries). Return to neutral for 10 sec both times. Testing
ipsilateral artery (R rotation = compromising L BF = testing R artery & vice versa). Requires cervical rotation/extension PROM of PT
• 5 D's & 3N's + LoC = VBAI
