Physical Assessment Techniques in Musculoskeletal Care

A break in the main part of a vertebra, most often in the thoracic spine, frequently due to osteoporosis.

Progressive inflammatory disease causing gradual fusion of vertebral joints and bony structures.

A fracture caused by minimal force, often related to osteoporosis.

A force applied directly down through the spine.

Clinical guidelines used to determine if a neck injury requires imaging.

A small herniation of the nucleus pulposus (NP) into the vertebral endplate.

The nucleus pulposus pushes outwards against the annulus fibrosus, but the outer layers remain intact.

The nucleus pulposus bulges through the annulus fibrosus, partially breaking through the outer layers.

The nucleus pulposus completely ruptures through the annulus fibrosus and escapes into the spinal canal.

A portion of the nucleus pulposus breaks off and becomes free within the spinal canal.

Pain spreading further away from its initial location during assessment.

Pain becoming more localized or concentrated during assessment.

Activities or postures that worsen pain, often suggesting a mechanical issue.

Activities or postures that reduce or eliminate pain.

A series of specific spinal movements used to assess pain patterns and identify nerve root irritation.

Symptoms indicating potential spinal cord compression, requiring urgent medical attention.

Involuntary muscle contractions, often a protective response to pain.

Visual inspection of a patient's posture, gait, muscle condition and movement patterns.

A defect in the pars interarticularis of the vertebrae, typically in the lumbar spine. It's usually unilateral or bilateral, and involves no displacement of the vertebral body.

A condition where a vertebra slips forward over the vertebra below, often due to a bilateral pars defect. Most common at L5.

Narrowing of a canal, typically the spinal canal, often due to arthritic changes or spondylolisthesis.

Narrowing of the spinal canal, leading to bilateral symptoms.

Narrowing of intervertebral foramina, leading primarily to unilateral symptoms.

A condition characterized by decreased bone density and increased risk of fragility fractures.

Ligament injury.

Muscle or tendon injury.

Problems with the facet joints (joints between vertebrae), often caused by repetitive stress.

Issues with the intervertebral discs, often involving herniation or bulging.

Forward slippage of a vertebra.

Posterior slippage of a vertebra.

A sprain or strain in the neck caused by sudden, forceful movement.

PPIVMs are Postural Painful Impairment Variants that are hypomobile and painful. PAIVMs are Postural Activity Impairment Variants that are also hypomobile and painful. They both indicate limitations with movement and pain.

These tests assess the function and integrity of the nerves in the neck. They help determine if a nerve root is compressed or irritated, which is common in cervical radiculopathy.

Adverse neurodynamics occur when nerves are stretched, compressed, or otherwise irritated, affecting their normal function. This can lead to pain or other neurological symptoms.

These are areas in the body where nerves frequently converge and are more prone to tension or irritation. These include C6, T6, L4, Elbow, Shoulder and Knee

These are movements that increase or worsen pain in cases of nerve issues. They are used to identify nerve tension or irritation.

Various factors like trauma, disc problems, poor posture , inflammation, injections, and even surgery can lead to nerve damage.

People with nerve problems might show signs like poor posture and muscle wasting in the affected area. However, sometimes there are no visible abnormalities.

In addition to common nerve tests, some less frequently used tests include Tinel's sign, brachial plexus traction test, and the prone knee bend.

A condition where nerves, blood vessels, or both are compressed in the space between your collarbone and your first rib. This can cause pain, numbness, tingling, and weakness in your arm and hand.

1. Neurogenic TOS: Compression affects the nerves, causing pain, numbness, and tingling.
2. Vascular TOS: Compression affects the blood vessels, causing pain, swelling, and discoloration.
3. Non-specific TOS: A combination of nerve and blood vessel compression, showing symptoms of both types.

Pain, numbness, tingling, weakness in the arm, hand, or fingers. Swelling, discoloration, heaviness in the arm. Fatigue, loss of strength in the arm and hand. Cramping, pallor, cyanosis, decreased skin temperature, edema, distended veins.

Women are more likely than men to develop TOS. People with jobs involving repetitive overhead movements or sustained positions, like desk workers, are also more susceptible.

Smoking reduces vascular health, which can worsen TOS symptoms by limiting blood flow to the arm.

Whiplash injuries from car accidents can cause damage to nerves or blood vessels in the neck, leading to compression and TOS.

Poor posture, repetitive overhead activities, using heavy backpacks or bags, and adaptive muscle shortening can all contribute to chronic TOS.

A condition present at birth, often caused by a cervical rib or decreased space between the first rib and clavicle. This can compress nerves and vessels.

Special tests help assess nerve and blood vessel function and identify potential compression points. These tests include: neurodynamic testing, vascular tests, and evaluation of first rib mobility.

PAIVMs help assess joint mobility and restriction in the thoracic spine, which can be affected by TOS and may contribute to the condition.