Thursday, January 20, 2011



Size denotes the diameter of the material. Stated numerically, the more zeros (0's) in the number, the smaller the size of the strand. As the number of 0's decreases, the size of the strand increases. The 0's are designated as 5-0, for example, meaning 00000 which is smaller than a size 4-0. (NOTE: Physicians will often say what sounds like "oh vicryl sutures" for instance -- by this they mean 0 Vicryl (zero Vicryl) not the letter "O")



Tensile Strength

(surgeon's knot)
















Types of Suture Material:


Braided synthetic absorbable suture
Polyglactin 910
Retains 70% of initial strength at 10 days and 30% at 20 days
Complete absorption in 60 - 90 days

Coated Vicryl

As Above
Coated with a mixture of calcium stearate and polyglactin 370
Maintains 100% strength for ~ 45 days and then decreases to 70% by ~ 50 days
Needle sizes commonly used;
1 36mm taper
2/0 26mm cutting edge
3/0 22mm cutting edge


Mono-filament synthetic absorbable suture
Retains 70% of initial strength for ~ 21 days and is reduced to 50% at ~ 35 days
Absorption usually complete within 180 days
Results in minimal tissue reaction
Needle sizes commonly used;
1 40 or 26mm needle


Intestinal submucosa of sheep and intestinal serosa of cattle
Retains tensile strength for ~ 10 days

Chromic Catgut

(Chromatised) retains tensile strength for 20 - 40 days
Both forms of catgut result in a moderate tissue reaction


Non absorbable synthetic mono-filament suture
Polypropylene (extruded)
Low tissue reaction and easy tissue passage
Needle sizes commonly used;
2/0 & 3/0 26mm cutting edge
6/0 13mm (epitendon)
8/0 6.35mm (digital nerve)


Non absorbable synthetic mono-filament suture
Needle sizes commonly used;
5/0 18.7mm cutting edge


Braided non absorbable synthetic suture
Polyester coated with polybutilate (also a polyester) for lubrication to aid tissue passage with good tissue qualities and tensile strength
Needle sizes commonly used;
1 24mm cutting edge


Natural silk is made up 70% of protein fibre and 30% extraneous material such as gum
Processing involves degumming
Protein make up and extraneous material results in increased tissue reactivity


316L - SS Stainless steel
Inert with virtually no tissue reaction
Difficult to handle and knot


Incorrect: Peribronchial coughing

Correct: Peribronchial cuffing

Peribronchial cuffing, also referred to as peribronchial thickening or bronchial wall thickening is a radiographic sign which occurs when excess fluid or mucus buildup in the small airway passages of the lung causes localized patches of atelectasis (lung collapse). This causes the area around the bronchus to appear more prominent on an x-ray.

Peribronchial cuffing is seen in a number of conditions including:

  • asthma following exercise or during an acute episode
  • bronchopulmonary dysplasia
  • congestive heart failure
  • cystic fibrosis
  • diffuse parenchymal lung disease
  • Extreme exertion through physical exercise
  • Hantavirus pulmonary syndrome
  • human metapneumovirus
  • Kawasaki disease
  • Lung cancer
  • Pneumonia
  • pulmonary edema
  • Smoke inhalation

Treatment -- As peribronchial cuffing is a sign rather than a symptom or condition, there is no specific treatment except to treat the underlying cause.

Wednesday, January 19, 2011


Five-part short neurological examination

Part I neurological examination

  • General demeanor
  • Speech
  • Gait
  • Arm swinging

Part II neurological examination

  • Fundi
  • Pupils
  • Eye movements
  • Facial movements

Part III neurological examination

  • Posture of outstretched arms
  • Wasting, fasciculation
  • Power, tone
  • Coordination
  • Reflexes

Part IV neurological examination

  • Power (hip flexion, ankle dorsiflexion)
  • Tone
  • Reflexes
  • Plantar responses

Part V neurological examination

  • Ask the patient

1. Look at the patient

2. Examine the head

3. Examine the upper limbs

4. Examine the lower limbs

5. Assess sensation

The relevant findings are drawn together in a brief written diagnostic summary. This will form the basis for investigations, transfer of information, and management.

Ten-part neurological examination

Orientation in time and place, recall of recent and distant events (memory, level of intellect, language and speech/cerebral dominance, other disorders of skilled function, e.g. apraxia)

Upper limbs:

· Wasting and fasciculation

· Posture of arms: drift, rebound, tremor

· Tone: spasticity or extrapyramidal rigidity

· Power: 0-5 scale

· Tendon reflexes: + or ++ normal; +++ increased:

· 0 absent with reinforcement

Thorax and abdomen:

· Respiration

· Thoracic and abdominal muscles

· Abdominal reflexes

· Cremasteric reflexes

Lower limbs:

· Wasting and fasciculation

· Tone, power and tendon reflexes

· Plantar responses

First, ask whether feeling in the limbs, face and trunk is entirely normal

Posterior columns:

  • Vibration (using a 128 Hz tuning fork)
  • Joint position
  • Light touch
  • 2-point discrimination (normal: 0.5 cm fingertips, 2 cm soles)

Spinothalamic tracts:

  • Pain: use a split orange-stick or a sterile pin
  • Temperature: hot or cold tubes

If sensation is abnormal, chart areas involved

1. State of consciousness, arousal, appearance (e.g. coma)

2. Mental state, attitude, insight

3. Cognitive function

4. Gait and Romberg's test

5. Skull shape- circumference, bruits

6. Neck- stiffness, palpation and auscultation of carotid arteries

7. Cranial nerves

8. Motor system

9. Coordination and fine movements

10. Sensory system



1. Empty Can (Supraspinatus) Test

2. Yergason Test

3. Speed's Test

4. Ludington's Sign

5. Drop Arm Test

6. Apley's Scratch Test

7. Cross-Over Impingement Test

8. Neer Impingement Test

9. Hawkins-Kennedy Impingement Test

10. Sternoclavicular (SC) Joint Stress Test

11. Acromioclavicular (AC) Joint Distraction Test

12. Acromioclavicular (AC) Joint Compression Test (Shear)

13. Piano Key Sign

14. Apprehension Test (Anterior)

15. Apprehension Test (Posterior)

16. Sulcus Sign

17. Anterior Drawer Test

18. Posterior Drawer Test

19. Jobe Relocation Test

20. Feagin Test

21. Load and Shift Test

22. Grind Test

23. Clunk Test

24. O'Brien Test

25. Brachial Plexus Stretch Test

26. Shoulder Abduction Test

27. Adson's Maneuver

28. Allen's Test

29. Roos Test

30. Military Brace Position

31. Pectoralis Major Contracture Test


1. Chvostek's Sign

2. Loading Test

3. Palpation Test

Cervical Spine

1. Vertebral Artery Test

2. Foraminal Compression Test (Spurling)

3. Foraminal Distraction Test

4. Valsalva's Maneuver

5. Swallowing Test

6. Tinel's Sign


1. Resistive Tennis Elbow Test (Cozen's Test)

2. Resistive Tennis Elbow Test

3. Passive Tennis Elbow Test

4. Golfer's Elbow Test

5. Hyperextension Test

6. Elbow Flexion Test

7. Varus Stress Test

8. Valgus Stress Test

9. Tinel's Sign

10. Pinch Grip Test

Wrist and Hand

1. Tap or Percussion Test

2. Compression Test

3. Long Finger Flexion Test

4. Finkelstein Test

5. Phalen Test

6. Tinel's Sign

7. Froment's Sign

8. Wrinkle Test (Shrivel Test)

9. Digital Allen's Test

10. Bunnel Littler Test

11. Murphy's Sign

12. Watson Test

13. Valgus Stress Test

14. Varus Stress Test

15. Section VI: Thoracic Spine

16. Kernig/Brudzinski Signs

17. Lateral Rib Compression Test

18. Anterior/Posterior Rib Compression Test

19. Inspiration/Expiration Breathing Test

Thoracic Spine

1. Kernig/Brudzinski Signs

2. Lateral Rib Compression Test

3. Anterior/Posterior Rib Compression Test

4. Inspiration/Expiration Breathing Test

Lumbar Spine

1. Valsalva's Maneuver

2. Stoop Test

3. Hoover Test

4. Kernig/Brudzinski Signs

5. 90-90 Straight Leg Raise Test

6. Bowstring Test (Cram Test)

7. Sitting Root Test

8. Unilateral Straight Leg Raise Test (Lasegue Test)

9. Bilateral Straight Leg Raise Test

10. Well Straight Leg Raise Test

11. Slump Test

12. Thomas Test

13. Spring Test

14. Trendelenburg's Test

15. Stork Standing Test

Sacral Spine

1. Sacroiliac (SI) Joint Fixation Test

2. Gillet Test

3. Sacroiliac (SI) Joint Stress Test

4. Squish Test

5. Yeoman's Test

6. Gaenslen's Test

7. Patrick or FABER Test

8. Long-Sitting Test


1. Hip Scouring or Quadrant Test

2. NĂ©laton's Line

3. Craig's Test

4. 90-90 Straight Leg Raise Test

5. Patrick or FABER Test

6. Trendelenburg's Test

7. Ober's Test

8. Piriformis Test

9. Thomas Test

10. True Leg-Length Discrepancy Test

11. Apparent Leg-Length Discrepancy Test

12. Ely's Test

13. Tripod Test

14. Femoral Nerve Traction Test


1. Patella Tendon/Patella Ligament Length Test

2. Patellar Apprehension Test

3. Ballotable Patella or Patella Tap Test

4. Sweep Test

5. Quadriceps or Q-Angle Test

6. Medial-Lateral Grind Test

7. Bounce Home Test

8. Patellar Grind Test (Clarke's Sign)

9. Renne Test

10. Noble Test

11. Hughston's Plica Test

12. Godfrey 90/90 Test

13. Posterior Sag Test (Gravity Drawer Test)

14. Reverse Pivot Shift (Jakob Test)

15. Anterior Lachman's Test

16. Anterior Drawer Test

17. Slocum Test With Internal Tibial Rotation

18. Slocum Test With External Tibial Rotation

19. Pivot Shift Test

20. Jerk Test

21. Posterior Drawer Test

22. Hughston Posteromedial Drawer Test

23. Hughston Posterolateral Drawer Test

24. Posterior Lachman's Test 27

25. External Rotation Recurvatum Test

26. Valgus Stress Test

27. Varus Stress Test

28. McMurray Test

29. Apley Compression Test

30. Steinmann’s Tenderness Displacement Test

31. Rectus Femoris Contracture Test

Ankle and Foot

1. Homans' Sign

2. Anterior Drawer Test

3. Talar Tilt Test (Inversion)

4. Talar Tilt Test (Eversion)

5. Thompson Test

6. Tap or Percussion Test

7. Feiss Line 30

8. Interdigital Neuroma Test

9. Compression Test

10. Long Bone Compression Test

11. Swing Test

12. Kleiger's Test

13. Tinel's Sign

Thursday, September 25, 2008



Anterior Drawer – anterior talofibular ligament

Positive Sign – pain, laxity

Talar Tilt – calcaneofibular ligament; deltoid ligament

Positive Sign – pain, laxity

Kleiger – deltoid ligament

Positive Sign – medial and lateral pain, displaced talus

Thompson’s Test – Achilles tendon rupture

Positive Sign – no plantar flexion

Swing Test – posterior tibiotalar subluxation

Positive Sign – resistance to normal dorsiflexion

Tinel’s Sign – deep peroneal nerve; posterior tibial nerve

Positive Sign – no tingling and paraseizure

Morton’s Test – Morton’s neuroma

Positive Sign – pain between 3 rd and 4 th metatarsals

Homan’s Sign – deep vein thrombophlebitis (calf)

Positive Sign – pain in calf with passive dorsiflexion of ankle and knee

extended; pain with palpation of calf



Valgus – lateral collateral ligament

Positive Sign – pain, laxity

Varus – medial collateral ligament

Positive Sign – pain, laxity

Posterior Drawer – posterior cruciate ligament

Positive Sign – pain, laxity

Anterior Drawer – anterior cruciate ligament

Positive Sign – pain, laxity

Lachman – anterior cruciate ligament

Positive Sign – pain, laxity

Slocum – anterior cruciate ligament

Positive Sign – pain, laxity

Hughston – posterior cruciate ligament

Positive Sign – pain, laxity


Apley Compression – meniscus lesion

Positive Sign – pain,

Apley Distraction – ligament lesion

Positive Sign – pain,

Squat – medial (internal rotation); lateral (external rotation)

Positive Sign – pain,

McMurray – medial (varus/internal rotation); lateral (valgus/ external


Positive Sign – pain,


“Q” Angle – patella tracking; dislocation

Apprehension – patellar dislocation

Positive Sign – contraction of quadriceps muscles

Femoral Grinding

Waldron – condralmalaysia

Positive Sign – grinding of patella while extending leg

Noble Compression Test – IT band

Positive Sign – decreased pain

Wilson Test – osteochondritis dissecans

Positive Sign – decreased pain

Thigh Contusion



Straight Leg Raise – hip joint pathology (single); SI joint pathology

(bilateral); tight hamstrings

Positive Sign

Patrick’s Test Positive


Periformis Syndrome Test – periformis tightness (periformis); sciatica


Positive Sign – pain in periformis or buttock

Sign Of The Buttock – lumbar, sciatic, or hamstring (negative); bursitis,

tumor, or abscess in buttock (positive)

Positive Sign – no increased flexion

Trendelenburg – gluteus medius

Positive Sign – pain in Symphysis pubis or SI joint

Flamingo – Symphysis pubis or SI

Positive Sign – pain in Symphysis pubis or SI joint

Gaenslen’s Test – ipsilateral SI joint lesion; hip; L4

Positive Sign – pain


Ipsilateral Prone Kinetic Test – ilium flexion and rotation

Positive Sign – no movement

Piedallu’s Sign – hypomobile SI

Positive Sign – lower side becomes higher side

Gillet’s – hypomobile SI

Positive Sign – affected side moves little or up


Ober – IT band tightness

Positive Sign – leg doesn’t drop to the table, pain on trochanter

Trochanteric Bursitis

Positive Sign – pain on palpation, hip flexion and adduction while

weight bearing

Iliopsoas Bursitis – anterior groin pain

Positive Sign – pain on hip flexion

Thomas – rectus femoris

Positive Sign – extended leg flexes at knee;

Craig’s Test – internal/external rotation of hip

Positive Sign

Torque Test – hip capsular ligament integrity

Positive Sign


Leg Length Discrepancy

Torsion tibial

or femoral (cause of discrepancy)



Foraminal Compression (Spurling’s) – cervical radiculitis/nerve root


Positive Sign – pain on side head towards; pain on opposite side is

muscle spasm

Distraction Test – nerve root pressure

Positive Sign – decreased pain

Upper Limb Tension Test – brachial plexus

Positive Sign – minimal or no symptoms

Adson Maneuver – thoracic outlet syndrome

Positive Sign – disappearance of pulse

Allen Test

Positive Sign – disappearance of pulse

Halstead Maneuver

Positive Sign – disappearance of pulse

Shoulder Abduction Test – herniated disc, epidural vein, and nerve root


Positive Sign – decrease or relief of symptoms

Valsalva Test – herniated disc or tumor

Positive Sign – increased pain

Romberg’s Test – upper motor neuron lesion

Positive Sign – excessive sway or loss of balance

Vertebral Artery Test (Cervical Quadrant) – vertebral artery


Positive Sign – dizziness and nystagmus


Straight Leg Raise – spaceoccupying


Positive Sign – radiating pain; pain on opposite side (unilateral


Prone Knee Bending – L2 or L3 nerve root lesion (posterior & lumbar);

tight quad or stretched femoral nerve (anterior thigh)

Positive Sign – pain in posterior and lumbar area; pain in anterior


Slump Test – neuromenengeal tract tension

Positive Sign – knee extends further with release of cervical,

symptoms decrease; or increase in symptoms


Test – menengeal irritation

Positive Sign – neck and back discomfort

Valsalva – see cervical

Positive Sign –increased pain

Bowstring Test – sciatic nerve pressure or tension

Positive Sign – symptoms reestablished

Babinski Test – upper motor neuron lesion

Positive Sign – extension of big toe and abduction of the others

Beevor’s Sign – abdominal muscle dysfunction

Positive Sign – umbilicus not in straight line

Hoover Test

Positive Sign – patient can’t lift leg or examiner feels no pressure

from opposite leg



Load and Shift Test

Positive Sign – pain, laxity, reproduction of symptoms


Positive Sign – apprehension, resistance to further motion, feeling

experienced when previously dislocated


Positive Sign – apprehension

Anterior Drawer

Positive Sign – clicking, apprehension


Load and Shift Test

Positive Sign – pain, laxity, reproduction of symptoms

Posterior Apprehension Test

Positive Sign – apprehension, resistance to further motion,

reproduction of symptoms



Positive Sign – apprehension, greater than 50% posterior



Sulcus Sign

Positive Sign – measurement acromion to humeral head greater

than 1 cm

Feagin Test

Positive Sign – apprehension


Clunk Test

Positive Sign – clunk, grinding sound

Anterior Slide

Positive Sign – popping or cracking, anterosuperior pain

Compression Rotation Test – bankhart or SLAP lesion

Positive Sign – snapping or catching


Lateral Scapular Slide Test

Positive Sign


Acromioclavicular Shear Test

Positive Sign – pain or abnormal movement of AC joint

Scratch and Pull Test

Positive Sign – pain, apprehension


Speed’s Test – biceps tendon

Positive Sign – increased tenderness in the bicipital groove

(tendonitis); profound weakness (2 nd or 3 rd degree strain)

Yeargason’s Test – biceps tendon

Positive Sign – tenderness in the bicipital groove (may pop out)

Empty Can Test – supraspinatus

Positive Sign – pain, weakness

Drop Arm Test (Codman’s) – rotator cuff complex tear

Positive Sign – unable to return arms to side smoothly or slowly,

severe pain


Sign – subscapularis

Positive Sign – inability to lift hand away from back


Neer Test – supraspinatus and/or biceps tendon overuse

Positive Sign – pain



Positive Sign – pain

Impingement Test

Positive Sign – pain in anterior or posterior shoulder or both and

indicates a grade II or III shoulder lesion


Brachial Plexus Tension Test – stretch of brachial plexus

Positive Sign – minimal or no symptoms

Tinel’s Sign

Positive Sign – no tingling or paraseizure


Roos Test

Positive Sign

Costoclavicular Syndrome Test

Positive Sign



Ligamentous Instability For The Fingers – collateral ligaments

Positive Sign

Thumb Ulnar Collateral Ligament Laxity or Instability Test

Positive Sign – valgus > 35°

Murphy’s Sign – lunate dislocation; level of 3 rd metacarpal head

Positive Sign

Watson Test (Scaphoid Shift) – instability of scaphoid and lunate bones

Positive Sign – pain on radial deviation

Piano Keys Test – instability of distal radioulnar joint

Positive Sign – mobility and pain on ulnar depression

Axial Load – metacarpal or carpal fracture or joint arthrosis

Positive Sign


Finkelstein Test – tenosynovitis of abductor pollicis longus and extensor

pollicis brevis tendons

Positive Sign – pain over the tendons

Sweater Finger Sign – digitorum profundus tendon rupture

Positive Sign – distal phalanx of finger won’t flex

Extensor Hood Rupture

Positive Sign – inability to extend interphalangeal joint while DIP

is extending


Test – tight intrinsic muscle or contracture of joint capsule

Positive Sign


Tinel’s Sign – carpal tunnel syndrome

Positive Sign – tingling in median nerve

Phalan’s Test – carpal tunnel syndrome (median nerve)

Positive Sign – tingling in median nerve

Carpal Compression Test – carpal tunnel syndrome

Positive Sign

Forment’s Sign – ulnar nerve paralysis

Positive Sign – flexion of IP joint of thumb and/or hyperextension

of MCP joint

Weber’s TwoPoint

Discrimination Test (Moberg’s)

Positive Sign


Allen Test

Positive Sign

Digital Blood Flow

Positive Sign – nail bed doesn’t return to normal color within 3