NBCE PART 4 BOARDS - ORTHOPEDICS, EXAM LATEST 2024
ACTUAL EXAM
Foraminal Compression Test - ANSWER: The patient is seated and actively rotates
head from side to side. Then the doctor exerts downward pressure and the head is
rotated to each side with pressure.
Positive Radicular Pain -> Nerve Root Compression
Positive Local Pain -> Foraminal Encroachment
Jackson's Compression Test - ANSWER: The patient is seated and the doctor laterally
flexes the patient head to the left and the right and applies downward pressure.
Postive Radicular Pain -> Nerve Root Compression
Distraction Test - ANSWER: The patient is seated and the doctor holds under the
mastoid and pulls the patient's head superior, removing the weight of the head.
"What did you experience?"
Decreased Pain -> Nerve Root Compression
Increased Pain -> Sprain/Strain
O'Donohue's Test is for.... - ANSWER: Determining whether it is a SPRAIN or STRAIN
O'Donohue's Test Performed - ANSWER: 1) Patient actively moves part against
resistance.
2) Then the doctor moves part passively through a full ROM.
Pain Active: STRAIN (damage in mm tissue)
Pain Passive: SPRAIN (damage I'm ligamentous tissue)
Valsalva's Maneuver - ANSWER: The doctor asks the patient to take a deep breath
and hold while bearing down.
Postive Radicular Pain -> SOL
Maximal Cervical Compression Test - ANSWER: Patient is seated and actively rotated
and extended head. If no pain the patient is asked to maximally laterally flex head in
the same direction. Repeat on the other side. No compression applied.
Postive Radicular pain -> Nerve Root Compression
,Shoulder Depression Test - ANSWER: Patient is seated, the doctor depressed the
patient's shoulder while laterally flexing the cervical spine away from the shoulder.
Repeat on other side.
Postive Pain -> Nerve Root Adhesion
Soto Hall Sign - ANSWER: Patient supine and the doctor places one hand on the
patient's stream and passively flexes the patient's head towards his/her chest.
Positive localized pain -> ant: fracture/ post: ligament tear
Bakody's Test AKA Shoulder Abduction Test - ANSWER: Patient is seated and placed
affected arm's palm on top of their head. The elbow should be at the level of the
head.
Postive Relief of Pain -> IVF encroachment
Thoracic Outlet Syndrome AKA - ANSWER: Neurovascular Compression Syndrome
Allen's Test - ANSWER: Patient is seated with their elbow flexed and forearm
supinated. Ask patient to pump their hand while doctor occludes the radial and ulnar
arteries until hand whitens. The patient the opens hand and doctor releases on
artery, recording fill time (until hand regains color). Repeat for other artery.
Postive for delay more than 10 seconds -> occlusion of the tested artery
Costoclavicular Maneuver AKA - ANSWER: Eden's Test
Eden's Test Performed - ANSWER: Patient is seated and doctor palpated for the
radial pulse. Patient brings shoulder down and back and then flexes chin to their
chest.
Positive if alteration to amplitude of radial pulse -> compression between first rib
and clavicle
Adson's Test AKA - ANSWER: Scalenus Anticus Test
Scalenus Anticus Test Performed (MUST KNOW) - ANSWER: Patient is seated and
doctor abducts, extends and externally rotates arm while taking the radial pulse.
Patient rotates head TOWARDS the tested side and extends head. Patient takes a
deep breath and holds it.
Postive if alteration to amplitude of radial pulse -> Scalenus Anticus Syndrome
(Cervical "Halstead" rib)
Modified Adson's Test AKA - ANSWER: Scalenus Medius Test
, Scalenus Medius Test Performed (MUST KNOW) - ANSWER: Patient is seated and
doctor abducts, extends and externally rotates arm while taking the radial pulse.
Patient rotates head AWAY from the tested side and extends head. Patient takes a
deep breath and holds it.
Positive if alteration to amplitude of radial pulse -> Scalenus medium syndrome
(Subclavian Artery)
Wright's Test AKA - ANSWER: Hyperabduction Maneuver
Hyperabduction Maneuver Performed (MUST KNOW) - ANSWER: Patient is seated
and doctor palpated radial pulse. Both arms are abducted 180degrees. The doctor
notes at what angle the radial pulse diminishes or disappears.
Positive f pulses are lost greater than 10degrees difference -> Pectorals Minor
Syndrome (Axillary Artery)
Reverse Bakody Maneuver - ANSWER: Patient is seated and patient actively placed
palm on top of their head.
Positive is pain is increased -> TOS
Halstead's Test - ANSWER: Patient is seated and extends their head backwards. The
examiner exerts downward traction and slight abduction on arm while taking
patient's pulse.
Positive if alteration in the amplitude of the radial pulse -> cervical rib
Rotator Cuff Injury...is muscle or tendon more commonly injured? - ANSWER:
TENDONS
Which Rotator cuff tendon is most likely injured? - ANSWER: SUPRASPINATUS
How do you diagnosis and treat a Rotator Cuff Tear? - ANSWER: Diagnosis: MRI
Treatment: Codman's Exercises
Apley's Scratch Test - ANSWER: Patient is seated and actively moves hand behind
head in attempt to touch the superior angle of the scapula. The patient then moves
hand behind back to touch the inferior angle of the same scapula.
Positive decreased ROM -> Degenerative tendonitis of the Rotator Cuff
Cowman's Drop Arm Test - ANSWER: The doctor passively abducts the patient's arm
to above 90 degrees and suddenly removes support. This will cause a firing of the
deltoid muscle.
ACTUAL EXAM
Foraminal Compression Test - ANSWER: The patient is seated and actively rotates
head from side to side. Then the doctor exerts downward pressure and the head is
rotated to each side with pressure.
Positive Radicular Pain -> Nerve Root Compression
Positive Local Pain -> Foraminal Encroachment
Jackson's Compression Test - ANSWER: The patient is seated and the doctor laterally
flexes the patient head to the left and the right and applies downward pressure.
Postive Radicular Pain -> Nerve Root Compression
Distraction Test - ANSWER: The patient is seated and the doctor holds under the
mastoid and pulls the patient's head superior, removing the weight of the head.
"What did you experience?"
Decreased Pain -> Nerve Root Compression
Increased Pain -> Sprain/Strain
O'Donohue's Test is for.... - ANSWER: Determining whether it is a SPRAIN or STRAIN
O'Donohue's Test Performed - ANSWER: 1) Patient actively moves part against
resistance.
2) Then the doctor moves part passively through a full ROM.
Pain Active: STRAIN (damage in mm tissue)
Pain Passive: SPRAIN (damage I'm ligamentous tissue)
Valsalva's Maneuver - ANSWER: The doctor asks the patient to take a deep breath
and hold while bearing down.
Postive Radicular Pain -> SOL
Maximal Cervical Compression Test - ANSWER: Patient is seated and actively rotated
and extended head. If no pain the patient is asked to maximally laterally flex head in
the same direction. Repeat on the other side. No compression applied.
Postive Radicular pain -> Nerve Root Compression
,Shoulder Depression Test - ANSWER: Patient is seated, the doctor depressed the
patient's shoulder while laterally flexing the cervical spine away from the shoulder.
Repeat on other side.
Postive Pain -> Nerve Root Adhesion
Soto Hall Sign - ANSWER: Patient supine and the doctor places one hand on the
patient's stream and passively flexes the patient's head towards his/her chest.
Positive localized pain -> ant: fracture/ post: ligament tear
Bakody's Test AKA Shoulder Abduction Test - ANSWER: Patient is seated and placed
affected arm's palm on top of their head. The elbow should be at the level of the
head.
Postive Relief of Pain -> IVF encroachment
Thoracic Outlet Syndrome AKA - ANSWER: Neurovascular Compression Syndrome
Allen's Test - ANSWER: Patient is seated with their elbow flexed and forearm
supinated. Ask patient to pump their hand while doctor occludes the radial and ulnar
arteries until hand whitens. The patient the opens hand and doctor releases on
artery, recording fill time (until hand regains color). Repeat for other artery.
Postive for delay more than 10 seconds -> occlusion of the tested artery
Costoclavicular Maneuver AKA - ANSWER: Eden's Test
Eden's Test Performed - ANSWER: Patient is seated and doctor palpated for the
radial pulse. Patient brings shoulder down and back and then flexes chin to their
chest.
Positive if alteration to amplitude of radial pulse -> compression between first rib
and clavicle
Adson's Test AKA - ANSWER: Scalenus Anticus Test
Scalenus Anticus Test Performed (MUST KNOW) - ANSWER: Patient is seated and
doctor abducts, extends and externally rotates arm while taking the radial pulse.
Patient rotates head TOWARDS the tested side and extends head. Patient takes a
deep breath and holds it.
Postive if alteration to amplitude of radial pulse -> Scalenus Anticus Syndrome
(Cervical "Halstead" rib)
Modified Adson's Test AKA - ANSWER: Scalenus Medius Test
, Scalenus Medius Test Performed (MUST KNOW) - ANSWER: Patient is seated and
doctor abducts, extends and externally rotates arm while taking the radial pulse.
Patient rotates head AWAY from the tested side and extends head. Patient takes a
deep breath and holds it.
Positive if alteration to amplitude of radial pulse -> Scalenus medium syndrome
(Subclavian Artery)
Wright's Test AKA - ANSWER: Hyperabduction Maneuver
Hyperabduction Maneuver Performed (MUST KNOW) - ANSWER: Patient is seated
and doctor palpated radial pulse. Both arms are abducted 180degrees. The doctor
notes at what angle the radial pulse diminishes or disappears.
Positive f pulses are lost greater than 10degrees difference -> Pectorals Minor
Syndrome (Axillary Artery)
Reverse Bakody Maneuver - ANSWER: Patient is seated and patient actively placed
palm on top of their head.
Positive is pain is increased -> TOS
Halstead's Test - ANSWER: Patient is seated and extends their head backwards. The
examiner exerts downward traction and slight abduction on arm while taking
patient's pulse.
Positive if alteration in the amplitude of the radial pulse -> cervical rib
Rotator Cuff Injury...is muscle or tendon more commonly injured? - ANSWER:
TENDONS
Which Rotator cuff tendon is most likely injured? - ANSWER: SUPRASPINATUS
How do you diagnosis and treat a Rotator Cuff Tear? - ANSWER: Diagnosis: MRI
Treatment: Codman's Exercises
Apley's Scratch Test - ANSWER: Patient is seated and actively moves hand behind
head in attempt to touch the superior angle of the scapula. The patient then moves
hand behind back to touch the inferior angle of the same scapula.
Positive decreased ROM -> Degenerative tendonitis of the Rotator Cuff
Cowman's Drop Arm Test - ANSWER: The doctor passively abducts the patient's arm
to above 90 degrees and suddenly removes support. This will cause a firing of the
deltoid muscle.
