The 3 Minute Musculoskeletal amp Peripheral Nerve Exam -Alan Miller

nnervation—Abdomen, Hip, and Pelvis omic Localization EMG/ Nerve Root Supply ion needle placement Obturator L2, L3, L4 Obturator L2, L3, L4 er breadths distal to pubic cle along a line to medial Anterior/Adductor L2, L3, L4, al condyle Flexor Head: L5, S1 Obturator T7–T12 hird distance between the Posterior/Extensor/ ctor tubercle and the medial Adductor Head: yle of the femur, just Tibial rior to the femur. Thoracoabdominal and subcostal (continued on next page)

258 I 9 MUSCLE TABLES Muscle Action, Localization, and Innervation— Muscle Action Anato injecti Gluteus Maximus Extends and externally Midwa Gluteus Medius rotates the hip upper trocha Gluteus Minimus Abducts and internally Iliacus rotates the hip, externally 1–2 fin Inferior Gemellus rotates the hip when hip midpo is extended in late (the on Abducts and internally maxim rotates the hip, externally gluteu rotates the hip when hip is extended Flexes the hip, assists with external rotation Externally rotates and extends the hip, stabilizes femoral head

—Abdomen, Hip, and Pelvis (continued) omic Localization EMG/ Nerve Root Supply ion needle placement ay in a line from Inferior Gluteal L5, S1, S2 edge of the greater Superior Gluteal L4, L5, S1 anter to S1 nger breadths below oint of iliac crest; patient eral decubitus position nly place the gluteus mus does not cover the us medius) Superior Gluteal L4, L5, S1 Femoral L2, L3, L4 L5, S1 Nerve to Quadratus Femoris

Internal Oblique Flexes and rotates the 1 finge Obturator Externus thoracolumbar spine, supports pubic Obturator Internus the abdominal organs Pectineus Externally rotates the hip and stabilizes femoral head in the acetabulum Externally rotates the hip and stabilizes femoral head in the acetabulum, weak hip abduction Adducts the hip, assists in hip flexion LOWER EXTREMITIES I 259 Piriformis Externally rotates the hip, Halfw may abduct the hip when poster flexed the gre MUSCLES

Ilioinguinal T7, T8, Hypogastric T9–12, L1 Obturator L2, L3, L4 Nerve to L5, S1, S2 Obturator Internus er breadth lateral to Femoral +/ L2, L3, L4 tubercle Obturator or L5, S1, S2 Accessory way along a line from Obturator rior inferior iliac spine to Ventral Rami eater trochanter Nerve to Piriformis (continued on next page)

260 I 9 MUSCLE TABLES Muscle Action, Localization, and Innervation— Muscle Action Anato Psoas injecti Flexes the hip, some Iliopso Pyramidalis contribution to external femora Quadratus Femoris rotation, abduction of the ligame hip and ipsilateral bending inguin Quadratus of the spine in ante Lumborum Rectus Abdominis Tenses the linea alba 1 inch Select Serratus Posterior Externally rotates the hip be stu Inferior and stabilizes the femoral superf head in the acetabulum Extends and laterally flexes the lumbar spine Flexes the thoracolumbar spine, supports the abdominal organs Opposes diaphragmatic pull on lower ribs, assists in trunk extension, rotation

—Abdomen, Hip, and Pelvis (continued) omic Localization EMG/ Nerve Root Supply ion needle placement Lumbosacral L2, L3, L4 oas: 1.5 inches lateral to plexus, ventral al pulse along inguinal roots T12 ent and 1 inch below L5, S1 nal ligament, insert needle Subcostal T12–L2, 3, 4 erior posterior plane Nerve to T7–T12 Quadratus h lateral to linea alba. Femoris T9–T11, T12 t the level that needs to Ventral rami, udied. Stay in the subcostal ficial part of the muscle. Thoracoabdominal and subcostal Ventral rami and/or intercostals

Superior Gemellus Externally rotates and extends 1 inch Tensor Fascia Lata the hip, stabilizes femoral head of the Abducts and internally spine Transversus rotates the hip lateral Abdominis 1 inch Supports abdominal organs positio anterio LOWER EXTREMITIES I 261 MUSCLES

h below the medial edge Nerve to L5, S1 anterior superior iliac Obturator Internus L4, L5, S1 on a line toward the Superior Gluteal l femoral condyle and h lateral, patient in supine on, insert needle in or posterior plane Thoracoabdominal T7–T12, L1 and subcostal

262 I 9 MUSCLE TABLES Muscle Action, Localization, and Muscle Action Anato Biceps Femoris injecti Flexes the knee, extends and externally rotates the hip Short h above Extensor Extends the 2nd – 5th the ten Digitorum Longus MTP > PIP and DIP joints; patien dorsiflexes and everts needle Extensor Hallucis the ankle Long h Longus from Extends the 1st toe and head dorsiflexes the ankle One th Flexor Digitorum Flexes the 2nd – 5th toes from t Longus and plantarflexes the ankle betwe 4 finge bimall crest a lateral needle 4 finge media breadt

d Innervation—Thigh and Leg omic Localization EMG/ Nerve Root Supply ion needle placement Long head: Tibial L5, S1, S2 Short head: L5, S1, S2 head: 4 finger breadths Common Peroneal e fibular head just lateral to ndon of biceps femoris; nt in prone position. Insert e in anterior posterior plane. head: Midpoint of the line ischial tuberosity to fibular hird distance of the leg Deep Peroneal L4, L5, S1 the knee a the mid point een fibula and tibial crest. er breadths proximal to Deep Peroneal L4, L5, S1 leolar line along the tibial Tibial L5, S1, S2, S3 and 1 finger breadth l to the crest. Aim the e proximally erbreadths above the al malleolus and one finger th posterior to the tibia.

Flexor Hallucis Flexes the 1st toe and Media Longus plantarflexes the ankle muscl Gastrocnemius poster Plantarflexes ankle and of the Gracilis flexes the knee Peroneus Brevis Proxim Peroneus Longus Adducts hip and flexes knee of the anterio Peroneus Tertius Plantarflexes and everts LOWER EXTREMITIES I 263 Plantaris the ankle Popliteus Plantarflexes and everts the ankle Dorsiflexes, everts and abducts ankle Assists in knee flexion and ankle plantarflexion Unlocks, weakly flexes and medially rotates the knee MUSCLES

al head: The bulk of the Tibial L5, S1, S2, S3 le; 3 finger breadths rior to the posterior edge Tibial L5, S1, S2 Medial head L5, S1, S2 tibia Lateral head L2, L3, L4 L4, L5, S1, S2 mal and mid third junction Obturator L4, L5, S1, S2 leg and 1 finger breadth Superficial or to fibula Peroneal L4, 5, S1 Superficial L4, L5, S1, S2 Peroneal L4, L5, S1 Deep Peroneal Tibial Tibial (continued on next page)

264 I 9 MUSCLE TABLES Muscle Action, Localization, and Innervation— Muscle Action Anato injecti Quadriceps Extends knee; rectus femoris (vastus lateralis, also flexes hip Vastus vastus intermedius, above vastus medialis, patella rectus femoris) patella spine Sartorius Flexes, abducts and breadt externally rotates the hip, of the assists knee flexion media superi femori upper and an 2.5 inc superi conne superi media 1 inch media iliac sp

—Thigh and Leg (continued) omic Localization EMG/ Nerve Root Supply ion needle placement Femoral L2, L3, L4 s lateralis: 4 fingerbreadths Femoral L2, L3, L4 e the upper pole of the a in a line joining lateral a to anterior superior iliac Vastus medialis: 4 finger ths above the upper pole patella in a line joining al patella to anterior ior iliac spine Rectus is: Halfway between the middle of the patella nterior superior iliac spine ches distal to anterior ior iliac spine on a line ecting the anterior ior iliac spine and al femoral condyle or h below and 1 inch al to the anterior superior pine

Semimembranosus Flexes the knee, extends Subjec Semitendinosus and internally rotates the hip fingerb Flexes the knee, extends middle Soleus and internally rotates the hip Halfw Plantarflexes ankle finger poster Tibialis Anterior Dorsiflexes and inverts Tibialis Posterior the ankle 4 finge tubero LOWER EXTREMITIES I 265 Plantarflexes and inverts lateral the ankle Midpo fibula, middle perpen the int MUSCLES

ct in prone position, one Tibial L5, S1, S2 breadth lateral to the Tibial L5, S1, S2 e of the mid thigh Tibial S1, S2 Deep Peroneal L4, L5, S1 way down the leg and one Tibial L4, L5, S1, S2 breadth posterior to the rior edge of the tibia er breadths distal to tibial osity and 1 finger breadth l to tibial crest oint between tibia and , junction of upper and e third of the leg, insert ndicular to skin; penetrate terosseous membrane

266 I 9 MUSCLE TABLES Muscle Action, Localization, and Muscle Action Anato injecti Abductor Abducts the fifth toe and Digiti Minimi flexes the fifth MTP joint Halfw metac Abductor Hallucis Abducts the first toe edge o Adductor Hallucis Adducts first toe 1 finge Dorsal Interossei navicu Abduct the second to Extensor Digitorum fourth toes, flex the MTP First D Brevis joints of the second to above fourth toes and be second Extends the second to fifth toes 2 finge anterio malleo fourth Extensor Hallucis Extends the first toe Brevis

d Innervation—Foot omic Localization EMG/ Nerve Root Supply ion needle placement Lateral Plantar L5, S1, S2, S3 way point over the fith Medial Plantar L5, S1, S2, S3 carpal bone in the lateral Lateral Plantar S1, S2, S3 of the foot Lateral Plantar L5, S1, S2, S3 er breadth inferior to Deep Peroneal L4, L5, S1, S2 ular tuberosity Deep Peroneal L4, L5, S1, S2 Dorsal: 2 finger breadths e the base of the big toe etween the first and d metatarsal bones. er breadths distal to the or edge of the lateral olus on a line to the h web space

Flexor Digiti Flexes MTP of the Midwa Minimi Brevis fifth toe and th Flexor Digitorum Flexes the second to Just pr Brevis fifth toes metata flexor Flexor Hallucis Flexes MTP joint of the Brevis first toe Lumbricals Flex the MTP and extend the PIP and DIP joints of the second to fifth toes Plantar Interossei Adduct the second to fourth toes, flex the MTP joints of LOWER EXTREMITIES I 267 the second to fourth toes Quadratus Plantae Assists flexion of the second One th to fifth toes calcan metata Anatomic localization copyright CR Sridhara, MD, Director, Moss Rehab Ele Medical Center; Clinical Professor of Rehabilitation Medicine, Jefferson Med Medicine. Printed with permission. MUSCLES

ay between calcaneus Lateral Plantar S1, S2, S3 he third metatarsal head Medial Plantar L5, S1, S2, S3 Medial Plantar L5, S1, S2, S3 roximal to the first arsal head and medial to hallucis longus tendon Digit II: Medial L4, L5, S1, S2 Plantar L5, S1, S2, S3 Digits III, IV and V: Lateral Plantar L5, S1, S2, S3 Lateral Plantar hird the distance from Lateral Plantar L5, S1, S2, S3 neus to the second arsal head ectrodiagnostic Center; Associate Chairman, Department of P M and R, Albert Einstein dical College; Adjunct Professor, Department of PMR, Temple University School of

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I I I INDEX *Boldface pages indicate illustrations; page numbers with t indicate tables. Abdomen, muscle action, localiza- Apley’s scarf test in shoulder tion, and innervation, exam, 18 257–261t Apprehension test in shoulder Abductor digiti minimi, 112, 226, exam, 20 254t, 266t Arm, muscle action, localization, Abductor hallucis, 266t and innervation, 242–247t Abductor pollicis brevis, 109, 254t Abductor pollicis longus, 226, 248t Ashworth Scale, modified, for Achilles tendon palpation in foot grading spasticity, 200t and ankle exam, 82 Ataxic gait, 175 Acromioclavicular joint, palpation Athetosis, 208t Axillary nerves, 151 of, 9 Active compression test in shoulder Babinski’s sign, 136 Ballismus, 208t exam, 20 Biceps, 130 Adductor brevis, 257t Adductor hallucis, 266t palpation of, 9 Adductor longus, 257t Biceps brachii, 100, 226, 242t Adductor magnus, 257t Biceps femoris, 119, 262t Adductor pollicis, 110, 226, 254t Bony pain, 207t Adductor reflex, 133 Brachialis, 226, 248t Adson’s maneuver in shoulder Brachial plexus, 148 Brachioradialis, 130, 227, 248t exam, 22 Braggard’s Test, 55 Allen’s test in shoulder exam, 22 Brainstem syndromes, 210–211t American College of Rheumatology Brown-Sequard syndrome, 186 Bunnel-Littler’s Test in wrist/hand/ 1990 Criteria for the Classification of Fibromyalgia, digit exam, 43 213–214t Anatomic planes and descriptor, 198 Carpal compression test in wrist/ Anconeus, 226, 248t hand/digit exam, 41 Ankle anterior drawer in foot and ankle exam, 83 Cauda equina syndrome, 186 Ankle exam. See Foot and ankle exam Central cord syndrome, 186 Ankle jerk reflex, 134 Cervical spinous process exam in Antalgic gait, 174 Anterior cord syndrome, 186 shoulder exam, 12 Anterior drawer test for knee Chaddock’s sign, 137 exam, 71 Chorea, 208t Apley’s distraction tests for knee Circumduction gait, 179 exam, 76 Clamshell Apley’s grinding test for knee exam, 75 in wrist/hand/digit exam, 42 reverse, 42 Classic radiculopathies INDEX I 269

lower extremity, 205t Extensor hallucis brevis, 266t upper extremity, 204t Extensor hallucis longus, 123, 262t Clinical landmarks for root-level Extensor indicis, 107, 228, 250t Extensor pollicis brevis, 108, dermatomal examination lower extremities, 160–161 228, 250t upper extremities, 153–154 Extensor pollicis longus, 108, Conus medullaris syndrome, 186 Coracobrachialis, 227, 242t 228, 250t Costoclavicular test in shoulder External oblique, 257t External rotation test in foot and exam, 23 Cozen’s test in elbow exam, 31 ankle exam, 84 Crossed arm/adduction/Apley’s scarf FABERE/Patrick’s test in Herbison test in shoulder exam, 18 3-minute back exam, 64 Deltoid muscle, 93, 227, 242t Femoral anteversion in lumbosacral Digits. See Wrist/hand/digit exam spine and hip exam, 58 Dorsal interossei, 227, 254t, 266t Drop arm test in shoulder exam, 13 Femoral nerve stretch test, 156 Dystonia, 208t in lumbosacral spine and hip Dystrophic gait, 178 exam, 57 modified, 61 Elbow exam, 25–33 in Herbison 3-minute back Cozen’s test in, 31 exam, 61 inspection in, 25 lateral ligamentous laxity in, 33 Fibromyalgia, American College of medial ligamentous laxity in, 32 Rheumatology 1990 Criteria palpation in, 25, 27–30 for the Classification of, range of motion in, 25, 26 213–214t Tinel’s sign of ulnar nerve at elbow in, 32 Finger flexors, 132 wrist flexion for medial Finkelstein’s test, modified, in wrist/ epicondylitis in, 31 hand/digit exam, 43 Ely’s test First dorsal interosseous, 111 in lumbosacral spine and hip Flexor carpi radialis, 102, 228, 250t exam, 56 Flexor carpi ulnaris, 103, 228, 251t modified, in Herbison 3-minute Flexor digiti minimi brevis, back exam, 61 255t, 267t Empty can test in shoulder exam, 15 Flexor digitorum brevis, 267t Extensor carpi radialis, 131 Flexor digitorum longus, 262t Extensor carpi radialis brevis, 104, Flexor digitorum profundus, 106, 227, 249t 229, 251t Extensor carpi radialis longus, 104, Flexor digitorum superficialis, 105, 227, 249t 229, 251t Extensor carpi ulnaris, 228, 249t Flexor hallucis brevis, 267t Extensor digiti minimi, 228, 249t Flexor hallucis longus, 122, 263t Extensor digitorum, 228 Flexor pollicis brevis, 252t, 255t Extensor digitorum brevis, 266t Flexor pollicis longus, 108, 229, 252t Extensor digitorum communis, 249t Foot, muscle action, localization, Extensor digitorum longus, 262t and innervation, 266–267t Foot and ankle exam, 77–86 Achilles tendon palpation in, 82 ankle anterior drawer in, 83 external rotation test in, 84 270 I Index

inspection in, 77 Hand. See also Wrist/hand/digit palpation in, 77, 79–81 exam plantar fasciitis test in, 85 range of motion in, 77, 78 muscle action, localization, and squeeze test (Thompson’s test) innervation, 254–256t in, 82 Hawkins’ test in shoulder Talar tilt test in, 85 exam, 16 Foot slap, 176 Forearm, muscle action, localization, Herbison 3-minute back exam, 59–64 and innervation, 248–253t Froment’s sign in wrist/hand/digit FABERE/Patrick’s test in, 64 hip range of motion test in, 62 exam, 44 modified Ely’s test in, 61 modified femoral nerve stretch Gaenslen’s test in lumbosacral spine and hip test in, 61 exam, 53 modified Gaenslen’s test in, 60 modified, in Herbison 3-minute modified Ober’s test in, 62 back exam, 60 straight leg raise test in, 63 Thomas’ test in, 60 Gait, 167–181 thoracic rotation in, 59 common abnormalities of Hip antalgic (painful), 174 extension in lumbosacral spine ataxic, 175 circumduction, 179 and hip exam, 50 dystrophic, 178 external rotation in lumbosacral foot slap, 176 gluteus maximus lurch, 177 spine and hip exam, 49 knee recurvatum, 176 flexion in lumbosacral spine and leg length discrepancy, 174 neuropathic, 175 hip exam, 49 Parkinson’s, 179 internal rotation in lumbosacral spastic diplegic, 178 spastic hemiplegic, 177 spine and hip exam, 48 steppage, 176 muscle action, localization, and Trendelenburg, 174 cycle innervation, 257–261t double support of, 173 range of motion test in Herbison stance phase of, 173 swing phase of, 173 3-minute back exam, 62 cycle diagram, 180 Hoffman’s sign, 138 evaluation, 170–171 Hoover’s sign in lumbosacral spine major muscle activity during, 181t normal and abnormal, 172 and hip exam, 58 Gastrocnemius, 124, 263t Iliacus, 258t Glabellar reflex, 140 Iliofemoral ligament, 170 Gluteus maximus, 258t Inferior gemellus, 258t Gluteus maximus lurch, 177 Infraspinatus, 229, 243t Gluteus medius, 258t Intermedius, 118 Gluteus minimus, 258t Internal oblique, 259t Gracilis, 263t Internal rotation in shoulder exam resisted external, 14 resisted internal, 14 Jaw jerk, 139 Jendrassik’s maneuver, 141 Joint line tenderness test for knee exam, 74 INDEX I 271

Knee exam, 65–75 thigh and leg, 262–265t anterior drawer test for, 71 muscular examination Apley’s distraction tests for, 76 Apley’s grinding test for, 75 extensor hallucis longus, 123 inspection in, 65 flexor hallucis longus, 122 joint line tenderness test for, 74 gastrocnemius and soleus, 124 Lachman’s test for, 73 hamstrings, 119 lateral stability test for, 74 hip abductors, tensor fascia McMurray’s test for, 73 medial stability test for, 75 lata, gluteus medius, and palpation of, 65, 67–69 minimus, 116 patellar ballotment in, 70 hip adductors, adductor mag- pivot shift test for, 72 nus, longus, and brevis, 115 posterior drawer sign for, 72 hip internal rotators, tensor range of motion in, 65, 66 fascia lata, obturator internus, suprapatellar compression and gluteus medius and test in, 70 minimus, 117 Tinel’s sign of peroneal nerve iliopsoas, psoas and iliacus, 114 at fibular head for, 76 peroneus longus and brevis, 122 quadriceps, rectus femoris, Knee recurvatum, 176 vastus lateralis, intermedius, and lateralis, 118 Lachman’s test for knee exam, 73 tibialis anterior, 120 Lacunar syndromes, 211–212t tibialis posterior, 121 Large vessel syndromes, 209–210t musculoskeletal atlas Lateral hamstring reflex, 135 adductor brevis, gracilis and Lateralis, 118 pectineus, 233 Lateral ligamentous laxity in elbow adductor longus, 233 adductor magnus, 233 exam, 33 biceps femoris long head, 233 Lateral stability test for knee exam, 74 biceps femoris short head, 233 Latissimus dorsi, 229, 243t extensor digitorum longus, 233 Leg extensor hallucis longus, 234 flexor digitorum longus, 234 length discrepancy, 174 flexor hallucis longus, 234 in lumbosacral spine and hip gastrocnemius, 234 exam, 57 gluteus maximus, 234 gluteus medius, 234 muscle action, localization, and gluteus minimus, 235 innervation, 262–265t iliopsoas, 235 inferior gemellus and Levator scapulae, 229, 243t superior gemellus, 235 Lift-off test in shoulder exam, 16 obturator externus, 235 Light touch sensation, 162 obturator internus, 235 Lower extremities peroneus brevis, 235 peroneus longus, 235 classic radiculopathies, 205t peroneus tertius, 236 clinical landmarks for root-level piriformis, 235 plantaris, 236 dermatomal examination, popliteus, 236 160–161 quadratus femoris, 235 muscle action, localization, and innervation abdomen, hips, and pelvis, 257–261t foot, 266–267t 272 I Index

rectus femoris, 236 T-L-S spine lateral bending in, 48 sartorius and tensor fascia Yeoman’s test in, 53 Lumbricals, 255t, 267t lata, 236 semimembranosus, 236 McMurray’s test for knee exam, 73 semitendinosus, 237 Medial epicondylitis, wrist flexion soleus, 237 tibialis anterior, 237 for, 31 tibialis posterior, 237 Medial hamstring reflex, 134 vastus intermedius, lateralis, and Medial ligamentous laxity in elbow medialis, 237 exam, 32 peripheral nerve examination Medial stability test for knee exam, 75 Median nerve, 150 femoral nerve, 156 lumbosacral plexus, 155 Tinel’s sign of, at wrist, 40 obturator nerve, 157 Modified Ashworth Scale for peroneal (fibular) nerve, 158 tibial nerve, 159 grading spasticity, 200t Lumbar facet grind test in Modified Ely’s test in Herbison lumbosacral spine and hip 3-minute back exam, 61 exam, 52 Modified femoral nerve stretch test Lumbar spinous process exam in lumbosacral spine and hip in Herbison 3-minute back exam, 52 exam, 61 Lumbosacral plexus, 155 Modified Finkelstein’s test in wrist/ Lumbosacral spine and hip exam, hand/digit exam, 43 45–58 Modified Gaenslen’s test in Ely’s test in, 56 Herbison 3-minute back femoral anteversion in, 58 exam, 60 femoral nerve stretch test in, 57 Modified Ober’s test in Herbison Gaenslen’s test in, 53 3-minute back exam, 62 hip extension in, 50 Modified Phalen’s test in wrist/ hip external rotation in, 49 hand/digit exam, 40 hip flexion in, 49 Modified Yergason’s test in shoulder hip internal rotation in, 48 exam, 19 Hoover’s sign in, 58 Motor movements, involuntary, 208t inspection in, 45 Motor pain, 206t leg length discrepancy in, 57 Muscles lumbar facet grind test in, 52 diagnosis of symmetric lumbar spinous process exam weaknesses, 216–217 in, 52 grading strength of, 199t Noble’s compression test in, 54 major activity, during gait Ober’s test in, 54 cycle, 181t palpation in, 46, 51 Muscular examination, 87–124 range of motion of hip and low grading muscle strength in, 91t back in, 47 lower extremities slump in, 56 extensor hallucis longus, 123 straight leg raise test in, 55 flexor hallucis longus, 122 T-L-S spine extension and gastrocnemius and soleus, 124 rotation in, 47 hamstrings, 119 T-L-S spine flexion in, 47 hip abductors, tensor fascia lata, gluteus medius, and minimus, 116 INDEX I 273

Muscular examination (continued) adductor longus, 233 hip adductors, adductor mag- adductor magnus, 233 nus, longus, and brevis, 115 biceps femoris long head, 233 hip internal rotators, tensor biceps femoris short head, 233 fascia lata, obturator internus, extensor digitorum longus, 233 and gluteus medius and extensor hallucis longus, 234 minimus, 117 flexor digitorum longus, 234 iliopsoas, psoas and iliacus, 114 flexor hallucis longus, 234 peroneus longus and brevis, 122 gastrocnemius, 234 quadriceps, rectus femoris, gluteus maximus, 234 vastus lateralis, intermedius, gluteus medius, 234 and lateralis, 118 gluteus minimus, 235 tibialis anterior, 120 iliopsoas, 235 tibialis posterior, 121 inferior gemellus and upper extremities in, 92 superior gemellus, 235 abductor digiti minimi, 112 obturator externus, 235 abductor pollicis brevis, 109 obturator internus, 235 adductor pollicis, 110 peroneus brevis, 235 biceps brachii, 100 peroneus longus, 235 extensor carpi radialis longus peroneus tertius, 236 and brevis, 104 piriformis, 235 extensor indicis, 107 plantaris, 236 extensor pollicis longus and popliteus, 236 brevis, 108 quadratus femoris, 235 first dorsal interosseous, 111 rectus femoris, 236 flexor carpi radialis, 102 sartorius and tensor fascia flexor carpi ulnaris, 103 flexor digitorum profundus, 106 lata, 236 flexor digitorum superficialis, 105 semimembranosus, 236 flexor pollicis longus, 108 semitendinosus, 237 lower trapezius, 93 soleus, 237 middle deltoid, 93 tibialis anterior, 237 middle trapezius, 92 tibialis posterior, 237 palmar interossei, 112 vastus intermedius, lateralis, and palmaris longus, 113 pectoralis major, 94 medialis, 237 pronator teres, 102 upper extremities, 226 rhomboids, 95 serratus anterior, 96 abductor digiti minimi, 226 shoulder external rotators, 98–99 abductor pollicis longus, 226 subscapularis, 97 adductor pollicis, 226 trapezius, 92 anconeus, 226 triceps, 101 biceps brachii, 226 brachialis, 226 Muscular pain, 207t brachioradialis, 227 Musculocutaneous nerve, 149 coracobrachialis, 227 Musculoskeletal atlas, 221–237 deltoid, 227 dorsal interossei, 227 lower extremities extensor carpi radialis brevis, 227 adductor brevis, gracilis and extensor carpi radialis longus, 227 pectineus, 233 extensor carpi ulnaris, 228 extensor digiti minimi, 228 274 I Index

extensor digitorum, 228 Neuropathic gait, 175 extensor indicis, 228 Neuropathic pain, 206t extensor pollicis brevis and Noble’s compression test in longus, 228 lumbosacral spine and hip flexor carpi radialis and exam, 54 ulnaris, 228 Ober’s test flexor digitorum profundus, 229 in lumbosacral spine and hip flexor digitorum superficialis, 229 exam, 54 flexor pollicis longus, 229 modified, in Herbison 3-minute infraspinatus, 229 back exam, 62 latissimus dorsi and O’Brien’s test in shoulder exam, 20 trapezius, 229 Obturator externus, 259t levator scapulae, 229 Obturator internus, 259t opponens digiti minimi and Obturator nerve, 157 Oppenheim’s sign, 137 pollicis, 230 Opponens digiti minimi, 230, 255t palmar interossei, 230 Opponens pollicis, 230, 255t palmaris longus, 230 pectoralis major, 230 Pain pectoralis minor, 230 types of, 206–207t pronator quadratus, 230 visual analog scale of, 218 pronator teres, 231 Waddell’s signs of nonorganic low rhomboids, 231 back pain, 215 subscapularis, 231 Wong-Baker’s FACES Pediatric supinator, 231 Pain Rating Scale, 219 supraspinatus, 231 teres major, 231 Palmar interossei, 112, 230, 256t teres minor, 232 Palmaris brevis, 256t triceps, 232 Palmaris longus, 113, 230, 252t Myofascial pain, 206t Palmomental reflex, 139 Myopathic pain, 206t Parkinsonian gait, 179 Patellar ballotment in knee exam, 70 Neer’s test in shoulder exam, 17 Patellar reflex, 133 Neurologic and musculoskeletal Patrick’s test in Herbison 3-minute resources back exam, 64 anatomic planes and Patte’s test in shoulder exam, 15 Pectineus, 259t descriptors, 198 Pectoralis major, 94, 230, 244t classic lower extremity Pectoralis minor, 230, 244t Pelvis, muscle action, localization, radiculopathies, 205t classic upper extremity and innervation, 257–261t Peripheral nerve examination, radiculopathies, 204t conventional method of 143–165 clinical landmarks for root-level documenting reflexes, 202 grading deep tendon/muscle dermatomal for lower extremity, 160–161 stretch reflexes, 201 for upper extremity, 153–154 grading muscle strength, 199t light touch sensation, 162 pinprick, 163 modified Ashworth Scale for grading spasticity, 200t upper motor neuron versus lower motor neuron findings, 203t INDEX I 275

Peripheral nerve examination Quadratus femoris, 260t (continued) Quadratus lumborum, 260t Quadratus plantae, 267t proprioception, 165 Quadriceps, 264t vibratory, 164 lower extremities Radial nerves, 151 femoral nerve, 156 Radicular pain, 206t lumbosacral plexus, 155 Rectus abdominis, 260t obturator nerve, 157 Rectus femoris, 118, 264t peroneal (fibular) nerve, 158 Referred pain, 206t tibial nerve, 159 Reflexes median nerve, 150 musculocutaneous nerve, 149 conventional method of radial and axillary nerves, 151 documenting, 202 spinal roots (anterior examination of, 125–141 distribution) and, 146 Babinski’s sign, 136 spinal roots (posterior Chaddock’s sign, 137 conventional method of distribution) and, 147 documenting reflexes, 129 ulnar nerve, 152 glabellar reflex, 140 upper extremities, brachial grading deep tendon/muscle stretch reflexes, 128 plexus, 148 Hoffman’s sign, 138 Peroneal (fibular) nerve, 158 jaw jerk, 139 Jendrassik’s maneuver, 141 Tinel’s sign of, at fibular Oppenheim’s sign, 137 head, 76 palmomental reflex, 139 snout reflex, 140 Peroneus brevis, 122, 263t Wartenberg’s sign, 138 Peroneus longus, 122 Peroneus tertius, 263t Relocation test in shoulder exam, 21 Phalen’s test Resisted external rotation in modified, in wrist/hand/digit shoulder exam, 14 exam, 40 Resisted internal rotation in shoulder reverse, in wrist/hand/digit exam, 14 exam, 41 Reverse clamshell (wrist flexors), in Phantom pain, 207t wrist/hand/digit exam, 42 Pinprick sensation, 163 Reverse Phalen’s test in wrist/hand/ Piriformis, 259t Pivot shift test for knee exam, 72 digit exam, 41 Plantar fasciitis test Rhomboids, 95, 231, 244t Roos’ test in shoulder exam, 23 in foot and ankle exam, 85 Root-level dermatomal examination, tarsal tunnel test in, 86 Plantar interossei, 267t clinical landmarks for Plantaris, 263t for lower extremities, 160–161 Popliteus, 263t for upper extremities, 153–154 Posterior drawer sign for knee Sartorius, 264t exam, 72 Scalenes, 244–245t Posture evaluation, 170–171 Scapula, palpation of, 9 Pronator quadratus, 230, 252t Scouring maneuver in shoulder Pronator teres, 102, 131, 231, 253t Proprioception, 165 exam, 17 Psoas, 260t Pyramidalis, 260t 276 I Index

Semimembranosus, 119, 265t Spastic diplegic gait, 178 Semitendinosus, 119, 265t Spastic hemiplegic gait, 177 Sensory examination, 187, 188–189 Spasticity, 208t Sensory pain, 206t Speed’s test in shoulder exam, 19 Serratis anterior, 245t Spinal cord injury examination, Serratus posterior inferior, 260t Shoulder 183–194 impairment scale, 191 exam of, 8–24 motor, 190 active compression (O’Brien’s) sensory, 187, 188–189 test in, 20 standard classification form, 194 Adson’s maneuver in, 22 steps in classification, 192–193 Allen’s test in, 22 syndromes apprehension test in, 20 cervical spinous process exam anterior, 186 in, 12 Brown-Sequard, 186 costoclavicular test in, 23 cauda equina, 186 crossed arm/adduction/Apley’s central cord, 186 scarf test in, 18 conus medullaris, 186 drop arm test in, 13 Spurling’s test in shoulder exam, 13 empty can test in, 15 Squeeze test in foot and ankle Hawkins’ test in, 16 inspection of, 8 exam, 82 lift-off test in, 16 Steppage gait, 176 modified Yergason’s test in, 19 Sternoclavicular joint, palpation Neer’s test in, 17 palpation in, 9, 11–12 of, 9 Patte’s test in, 15 Sternocleidomastoid, 245t range of motion of, 8, 10 Straight leg raise test relocation test in, 21 resisted external rotation in, 14 in Herbison 3-minute back resisted internal rotation in, 14 exam, 63 Roos’ test in, 23 scouring maneuver in, 17 in lumbosacral spine and hip Speed’s test in, 19 exam, 55 Spurling’s test in, 13 surprise (anterior release) test Stroke syndromes, 209–212t in, 21 Subclavius, 245t Wright’s hyperabduction Subscapularis, 97, 231, 246tt test in, 24 Superior gemellus, 261t Yergason’s test in, 18 Supinator, 231, 253t Suprapatellar compression test in external rotators, 98–99 supraspinatus, infraspinatus, teres knee exam, 70 minor (“SIT” muscles), 98–99 Supraspinatus, 231, 246t Surprise (anterior release) test in muscle action, localization, and innervation, 242–247t shoulder exam, 21 Slump in lumbosacral spine and hip Talar tilt test in foot and ankle exam, 56 exam, 85 Snout reflex, 140 Tarsal tunnel test in foot and ankle Soleus, 124, 265t exam, 86 Tensor fascia lata, 261t Teres major, 231, 246t Teres minor, 232, 247t Thigh, muscle action, localization, and innervation, 262–265t INDEX I 277

Thomas’ test in Herbison 3-minute forearm, 248–253t back exam, 60 hand, 254–256t shoulder and arm, 242–247t Thompson’s test in foot and ankle muscular examination, 92 exam, 82 abductor digiti minimi, 112 abductor pollicis brevis, 109 Thoracic rotation in Herbison adductor pollicis, 110 3-minute back exam, 59 biceps brachii, 100 extensor carpi radialis longus Thumb axial grind test in wrist/ hand/digit exam, 44 and brevis, 104 extensor indicis, 107 Tibialis anterior, 120, 265t extensor pollicis longus and Tibialis posterior, 121, 265t Tibial nerve, 159 brevis, 108 first dorsal interosseous, 111 Tinel’s sign of, at ankle, 86 flexor carpi radialis, 102 Tight hand intrinsics test (Bunnel- flexor carpi ulnaris, 103 flexor digitorum profundus, 106 Littler’s Test), in wrist/hand/ flexor digitorum superficialis, 105 digit exam, 43 flexor pollicis longus, 108 Tinel’s sign lower trapezius, 93 of median nerve at wrist in middle deltoid, 93 wrist/hand/digit exam, 40 middle trapezius, 92 of peroneal nerve at fibular head palmar interossei, 112 for knee exam, 76 palmaris longus, 113 of tibial nerve at ankle in foot and pectoralis major, 94 ankle exam, 86 pronator teres, 102 of ulnar nerve at elbow in elbow rhomboids, 95 exam, 32 serratus anterior, 96 T-L-S spine extension and rotation shoulder external rotators, 98–99 in lumbosacral spine and hip subscapularis, 97 exam, 47 trapezius, 92 T-L-S spine flexion in lumbosacral triceps, 101 spine and hip exam, 47 musculoskeletal atlas, 226 T-L-S spine lateral bending in abductor digiti minimi, 226 lumbosacral spine and hip abductor pollicis longus, 226 exam, 48 adductor pollicis, 226 Trapezius, 229, 247t anconeus, 226 lower, 93 biceps brachii, 226 middle, 92 brachialis, 226 upper, 92 brachioradialis, 227 Tremors, 208t coracobrachialis, 227 Trendelenburg gait, 174 deltoid, 227 Triceps, 101, 132, 232, 247t dorsal interossei, 227 extensor carpi radialis Ulnar nerve, 152 Tinel’s sign of, 32 brevis, 227 extensor carpi radialis longus, 227 Upper extremities extensor carpi ulnaris, 228 classic radiculopathies, 204t extensor digiti minimi, 228 clinical landmarks for root-level extensor digitorum, 228 dermatomal examination, 153–154 muscle action, localization, and innervation 278 I Index

extensor indicis, 228 Vastus medialis, 264t extensor pollicis brevis and Vibratory sensation, 164 longus, 228 Wartenberg’s sign, 138 flexor carpi radialis and Wright’s hyperabduction test in ulnaris, 228 shoulder exam, 24 flexor digitorum profundus, 229 Wrist extensors in wrist/hand/digit flexor digitorum superficialis, 229 flexor pollicis longus, 229 exam, 42 infraspinatus, 229 Wrist flexion for medial epicondylitis latissimus dorsi and trapezius, 229 levator scapulae, 229 in elbow exam, 31 opponens digiti minimi and Wrist flexors in wrist/hand/digit pollicis, 230 exam, 42 palmar interossei, 230 Wrist/hand/digit exam palmaris longus, 230 pectoralis major, 230 carpal compression test in, 41 pectoralis minor, 230 clamshell, 42 pronator quadratus, 230 pronator teres, 231 reverse, 42 rhomboids, 231 Finkelstein’s test, modified, in, 43 subscapularis, 231 Froment’s sign in, 44 supinator, 231 inspection in, 34 supraspinatus, 231 palpation in, 34, 37–39 teres major, 231 Phalen’s test teres minor, 232 triceps, 232 modified, 40 peripheral nerve examination reverse in, 41 brachial plexus, 148 range of motion in, 34, 35–36 reflexes thumb axial grind test in, 44 biceps, 130 tight hand intrinsics test (Bunnel- brachioradialis, 130 extensor carpi radialis, 131 Littler’s Test) in, 43 finger flexors, 132 Tinel’s sign of median nerve at pronator teres, 131 triceps, 132 wrist in, 40 Vastus intermedius, 264t Yeoman’s test in lumbosacral spine Vastus lateralis, 118, 264t and hip exam, 53 Yergason’s test. See also Modified Yergason’s test modified, in shoulder exam, 19 in shoulder exam, 18 Y ligament of Bigelow, 170 INDEX I 279

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