BASELINE NEUROLOGICAL EXAM:
Joint position sense:
Vibration sense:
Pathological reflexes
Oppenheim’s (stroke blunted end of reflex hammer down the anterolateral leg from below the patella to the lateral malleolus):
Gordon’s (squeeze the calf muscles):
Schaefer’s (apply deep pressure to the Achilles tendon):
Chaddock’s (briskly stroke the blunted end of the reflex hammer on the lateral side of the foot, starting at the level of the lateral malleolus area of the heel to the little toe):
Babinski:
Hoffman’s/Tromner’s:
Cortical combined testing
Stereognosis (identify an object):
Topesthesia (state where they are being touched):
Graphesthesia (trace 8 or 4):
Double simultaneous stimulation (state whether they feel one or two arms being touched):
Signs of hypocalcemia
Chvostek’s sign (tapping over the facial nerve just anterior to the ear causes contraction of the facial muscles):
Frontal release reflexes
Sucking reflex (touching the lips or corner of the mouth causes a sucking movement):
Grasp reflex (stroking the palm of the hand causes the hand to reflexively grasp):
Rooting reflex (stroking the corner of the mouth or cheek elicits reflexive turning of the head toward the stimulus):
Palmomental reflex (tapping or scraping the thenar eminence of the hand causes the hand muscles to contract):
Glabellar reflex (tapping on the forehead causes repeated uncontrollable blinking):
Snout reflex (tapping or touching the upper lip causes marked contraction of the lips):
Ulnar neuropathy (should be documented by EMG and nerve conduction studies)
Point tenderness:
Guyon’s tunnel
Flexor carpi ulnaris
Cubital tunnel
Medial brachium (arcade of Struthers)
Subscapularis
MMT:
Adductor pollicis
Opponens digiti minimi
Flexor carpi ulnaris
Flexor digitorum profundus (4th and 5th digits)
Radial neuropathy (should be documented by EMG and nerve conduction studies)
Point tenderness:
Superficial radial nerve
Supinator
Spiral groove
Triceps brachii
Subscapularis
MMT:
Abductor pollicis longus
Supinator
3rd digit extension
Median neuropathy (should be documented by EMG and nerve conduction studies)
Point tenderness:
Transverse carpal ligament (and 2-3 cm below TCL)
Pronator teres (and flexor digitorum superficialis)
Common flexor origin (lacertus fibrosus, ligament of Struthers)
Subscapularis
Pectoralis minor
MMT:
Abductor pollicis brevis
Opponens pollicis
Pronator teres
Flexor digitorum profundus (2nd and 3rd digits)
Equilibrium
Observation (gait, station, repose): Ambulation fluid; patient able to change positions during exam without distress. No decomposition of movement during gait, station, or repose. No nystagmus or difficulty with expressive language noted. Girth of extremities grossly appears bilaterally symmetrical.
Swaying of body
Balance problems
Increase base width stance
Loud cadence
Hypotonia
Dysmetria
Dyssynergia (irregular movement)
Dysarthria
Nystagmus
Pendular, normoreflexia, hyporeflexia
Hyperkinesia or hypokinesia
Romberg test:
Rapid alternating movements:
Finger-nose-finger:
Heel-shin:
Check reflex:
Position holding:
Fukuda’s marching-in-place test (Have the patient march in place, raising the ipsilateral arm as each leg is elevated. After a few cycles, have the patient close his eyes and continue for 30 seconds. Rotation of the body to one side indicates a lesion on that side.):
Tremor assessment (arms extended then flexed and brought into body)
Rigidity or hypokinesia assessment (passively move patient’s arms/legs)
Peripheral nerve injury
Femoral neuropathy
Lateral femoral cutaneous neuropathy
Meralgia paresthetica: numbness or tingling in the anterolateral thigh; corresponding history of prolonged sitting, diabetes or other condition involving dysglycemia, overweight/obesity, keys/other objects in front pockets, tight-fitting pants
Anterior pelvic tilt
Point tenderness
One inch inferior to ASIS (where the lateral femoral cutaneous nerve is most superficial)
At/around the inguinal ligament
Hip flexor myofascial triggering/hypertonicity
Other myofascial triggering/hypertonicty may be present in the lower quarter
Pelvic obliquity; joint restriction at the low back/pelvis, pubes, T/L junction, hip and/or feet
ROM
Passive hip extension or forced hip flexion may increase symptoms
L/S ROM typically normal
MMT
Iliopsoas
Quadriceps
Reflexes
Adductor reflex
Cremasteric reflex
Sciatic neuropathy
Tibial neuropathy
Point tenderness
Medial calcaneal tubercle (behind medial malleolus, inferior to navicular and/or medial arch)
Soleus
MMT
Dorsiflexion and eversion combined painful
Abduction of toes painful
Common peroneal neuropathy
Superficial peroneal neuropathy
Sural neuropathy
Medial plantar neuropathy
Lateral plantar neuropathy
MENTAL STATUS EVALUATION:
Affect and mood
Orientation
Memory
Language/speech
Consciousness/alertness
Calculation
Judgment
Comprehension/abstraction
The patient presented alert and oriented X3. Depressed affect, tearful, disheveled. Patient had difficulty in expressive language but was able to comprehend instructions during the history and physical exam. Abnormal articulation, including slow utterances and imperfect pronunciation of words. Normal voice quality and pitch. Speech had no unnatural separation of syllables.
Adapted from my QME template.
ORTHOPEDIC TESTS
Cervical spine
O’Donaghue’s maneuver
Soto-Hall
Shoulder depression
Cervical distraction
Cervical compression
Foraminal compression
Jackson compression
Maximum cervical compression
Modified Spurling’s
Bakody sign
Dejerine’s sign
Lhermitte’s sign
TOS
Allen’s
Adson’sCostclavicular maneuver
Wright’s test
Roos test
Halstead manuever
Miscellaneous
Bikele’s sign
Swallowing test
Valsalva
Rust’s sign
Brudzinski’s sign
Brachial plexus tension sign
Spinal percussion
Malingering tests
Libman’s sign
Mankopf’s sign
Magnuson’s test
Thoracic spine and ribs
Adam’s position
Amos’s sign
Beevor’s sign
Schepelmann’s sign
Costovertebral stress
Chest expansion test
Rib compression test
Oblique extension and compression
Lateral chest compression
Sternal compression test
Rib springing test
Lumbar spine
SLR
Braggard sign
Well leg rais
Fajersztajn’s sign
Smith-Peterson test
Sicard’s test
Bechterew’s test
Double let raise
Milgram’s test
Bowstring
Femoral traction
Neri’s
Kemp test
Upper extremity tests
Apprehension test (anterior apprehension test)
Posterior dislocation apprehension test
Relocation test
Sulcus sign
Load and shift test (drawer test)
Dugas test
Apley’s scratch test
Subacromial push-button sign
Subacromial bursa test (Dawbarn’s sign)
Drop arm test (Codman’s drop arm test)
Empty can test (supraspinatus test)
Lift-off test (Gerber’s test)
Yergason’s
Clunk test
Crank test
O’Brien’s sign
Impingement syndrome test
Hawkins-Kennedy test
Neer’s test
Impingement relief test (reverse impingement)
Cozen’s test
Mill’s test
Kaplan’s sign
Stress tests for elbow: valgus stress, varus stress, supination stress, pronation stress
Pinch grip test
Medial epicondylitis test
Tinel’s
Phalen’s
Revere Phalen’s
Finkelstein’s
Stress tests for wrist: ulnar stress (ulnar deviation), radial stress (radial deviation), flexion stress, extension stress
Bracelet test
Carpal lift test
Bunnel-Littler
Froment’s sign
Finsterer’s sign
Lower extremity tests
Anvil test
Allis’s sign
Patrick’s test (FABERE)
Laguerre’s test
Thomas test
Gaenslen’s test
Ober’s test
Lewin-Gaenslen’s test
Nachlas test
Ely’s test/sign
Yeoman’s
Hibb test
Trendelenburg test
Patella ballotement
Fouchet’s sign
Patella grinding test
Clarke’s sign
Patella apprehension test
Dreyer’s sign
Bounce home
McMurray
Steinmann’s
Apley’s compression test
Drawer
Lachman’s
Slocum’s
Adduction stress test
Abduction stress test
Apley’s distraction test
Lateral pivot shift
Wilson’s
Squeeze test
Ankle anterior drawer
Morton’s test
Strunsky’s sign
Homan’s sign
Metatarsal tap
Inversion stress (lateral stability test)
Eversion stress (medial stability test)
Tinel’s foot sign
Thompson’s test
Achilles tap test
Hoffa test/sign