Anterior Shoulder Instability
Tests:
- Apprehension
- Relocation
- Anterior Drawer
Ankylosing Spondylitis (Berlin Criteria)
Tests:
- Morning stiffness > 30 min
- Improvement in back pain with exercise but not with rest
- Awakening because of back pain during the second half of the night only
- Alternating buttock pain
Ankylosing Spondylitis (IBP Criteria
- Age at onset < 40 years old
- Insidious onset
- Improvement with exercise
- No improvement with rest
- Pain at night with improvement on getting up
Canadian Cervical Spine Rules
High Risk Factors Present?
- Age > 65
- Dangerous Mechanism of Injury (i.e. fall > 1m or 5 stairs, axial load to head, high-speed motor vehicle accident, motorized recreational vehicle, bicycle collision)
- Paresthesias in extremities
Low Risk Factors that allow safe assessment of range of motion?
- Simple rear-end motor accident
- Normal sitting posture in emergency department
- Ambulatory at any time since injury
- Delayed onset of neck pain and absence of midline tenderness
Is the patient able to actively rotate the neck > 45 degrees to the right and the left?
If there is (1) High Risk Factors or (2) Low Risk Factors and the inability to actively rotate the neck > 45 degrees to the right and the left, radiographs are indicated.
Carpal Tunnel Syndrome
- Shaking hands for symptom relief
- Wrist-ratio index greater than .67
- Symptom Severity Scale score greater than 1.9
- Reduced median sensory field of digit 1
- Age greater than 45 years
Cervical Myelopathy
- Gait deviation
- Positive Hoffmann’s test
- Positive inverted supinator sign
- Positive Babinski test
- Age > 45 years
Cervical Radiculopathy
- Positive Upper Limb Tension Test A
- Involved cervical rotation < 60 degrees
- Positive Distraction Test
- Positive Spurling’s A
Closed Cervical Fractures
- Age < 55 years old
- Single (Marital status)
- Condition involved trauma
- Acute condition
- Condition involved ER visit
Deep Vein Thrombosis
Clinical Characteristic Score
Active cancer (patient receiving treatment for cancer within the previous 6 mo or currently receiving palliative treatment) +1
Paralysis, paresis, or recent plaster immobilization of the lower extremities +1
Recently bedridden for 3 days or more, or major surgery within the previous 12 wk requiring general or regional anesthesia +1
Localized tenderness along the distribution of the deep venous system +1
Entire leg swollen +1
Calf swelling at least 3 cm larger than that on the asymptomatic side (measured 10 cm below tibial tuberosity) +1
Pitting edema confined to the symptomatic leg +1
Collateral superficial veins (nonvaricose) +1
Previously documented deep-vein thrombosis +1
Alternative diagnosis at least as likely as deep-vein thrombosis -2
> 3: High Probability
1-2: Moderate Probability
0: Low Probability
Hip Osteoarthritis
- Squatting as aggravating factor
- (+) Scour Test for groin or lateral hip pain
- Active hip flexion causing lateral hip pain
- Passive internal rotation < 25 degrees
- Active hip extension causing hip pain
Lumbar Spinal Stenosis
- Bilateral symptoms
- Leg pain > back pain
- Pain during walking/standing
- Pain relief upon sitting
- > 48 years old
Medial Collateral Ligament Pathology
- Trauma by external force to leg
- Rotational trauma
- Pain with valgus stress test at 30° (PVLS30)
- Laxity with valgus stress test at 30° (LVLS30)
Meniscal Pathology
- History of catching or locking reported by the patient
- Joint line tenderness
- Pain with forced hyperextension (modified bounce home test)
- Pain with maximal passive knee flexion
- Pain or audible click with McMurray maneuver
Ottawa Ankle Rules
Pain in malleolar or midfoot area and Either:
1. Inability to bear weight immediately after injury AND in the ED (taking 4 steps)
OR
- Bone tenderness at the posterior edge of tibia or fibula or tip of medial or lateral malleolus
- Bone tenderness at the navicular or proximal base of 5th metatarsal
Ottawa Knee Rules
- Age > 55
- Tenderness at the head of the fibula
- Isolated tenderness of the patella during palpation
- Inability to flex the knee to 90 degrees
- Inability to bear weight immediately and upon ER evaluation
Pittsburgh Knee Rules
Blunt trauma or a fall as mechanism of injury PLUS either of the following:
- Age older than 50 years or Younger than 12 years
- Inability to walk 4 weight-bearing steps in the emergency department
Rotator Cuff Pathology
- Painful Arc Sign
- Drop-arm Sign
- Infraspinatus Manual Muscle Tes
Sacroiliac Joint Pain
Laslett et al., 2003/05 van der Wurff et al., 2006 SI Distraction SI Distraction SI Compression SI Compression Thigh Thrust Test Thigh Thrust Test Gaenslen’s Test Gaenslen’s Test Sacral Thrust Patrick’s Sign (FABER)
Subacromial Impingement
- Positive Hawkins-Kennedy Test
- Painful Arc Sign
- Infraspinatus Manual Muscle Test
Vertebral Compression Fracture
- Age > 52 years
- No presence of leg pain
- Body mass index < 22
- Does not exercise regularly
- Female gender
