Test your clinical knowledge

 

Cyriax Modern Orthopaedic Medicine, a must ?

Test your clinical knowledge...

Discover why Cyriax Modern Orthopaedic Medicine is an added value for therapists involved with soft tissue lesions of the locomotor system :

Films on peripheral and spinal manipulation...

Films on clinical reasoning...

A patient is coming in our practice complaining of a shoulder problem...

  •  What is the diagnosis ??

 We perform a specific history, a clinical examination and hope to reach a conclusion, before starting a treatment plan.

 At this point we could ask ourselves an honest "to the point" question : can we make the clinical distinction between :

  • a shoulder stage III arthritis
  • a supraspinatus tenoperiostal tendinitis
  • a chronic subdeltoid bursitis
  • an acromioclavicular lesion ?

 These are all typical lesions which can be distinguished on clinical grounds and which have different treatment strategies.

 

Yes, can you make the clinical distinction ?  Great !
or, 
rather not at this point....? 

... then the updated Cyriax model will be a useful tool in order to increase the diagnostic efficiency, by using a standardized assessment protocol.

 

Do the Cyriax test...

A quick clinical reasoning test in orthopaedic medicine :

Try to answer following multiple choice questions : Minimum one answer up to all answers could be correct…

The correct answers can be found at the end of this page

  1. Shoulder : in which cases can a painful arc during active elevation be a « localizing sign » ?
    (a localizing sign helps us to determine the exact localisation of the lesion)

a) supra-, infraspinatus and teres minor tendinitis
b) supra-, infraspinatus and subscapularis tendinitis
c) infraspinatus, biceps and subscapularis tendinitis
d) Acromioclavicular joint sprain, deep part
e) 
supraspinatus, biceps and teres minor tendinitis


 2. Shoulder : the passive horizontal adduction is clearly positive as a complementary test in case of 

a) chronic subdeltoid bursitis
b) acromioclavicular joint lesion
c) supraspinatus tendinitis
d) subcoracoid bursitis
e) subscapularis tendinitis
f) traumatic arthritis 


3. Spine : where can the pain be felt in case of a unilateral sacroiliac arthritis or a unilateral facet joint lesion 

a) Unilateral segmental referred pain
b) Unilateral multisegmental (more than 3 dermatomes) referred pain
c) Spinal pain on the midline
d) Local pain over the joint
e) Bilateral low lumbar or gluteal pain

 

4. The clinical image in which  passive movement in a joint is limited and painful in only one direction and is not limited, but possibly painful, in other directions makes us think of…

a) internal derangement
b) acute ligamentous lesion
c) acute tendinous lesion
d) acute muscle belly lesion
e) chronic muscle belly lesion

 

5. Shoulder : if one or more  isometric resisted test(s) is/are painful AND weak, the underlying lesion can be

a) arthritis stage III
b) mononeuritis
c) arthritis stage I
d) complete tendinous rupture
e) fracture
f) partial tendinous rupture


6. The clinical image of a « dysfunction syndrome » is defined by

a) End range pain on repeated testing, no limitation of movement, after testing symptoms are not worse-not better
b) End range pain on repeated testing, possibly small limitation of movement, after testing symptoms are better
c) Mid range pain on repeated testing, no limitation of movement, after testing symptoms are not worse-not better
d) End range pain on repeated testing, possibly small limitation of movement, after repeated testing symptoms are not worse-not better

 

7. Soft tissue lesions can refer pain : the pattern of referred pain is

a) always unilateral
b) always bilateral
c) unilateral or bilateral, depending on the lesioned structure
d) always multisegmental
e) segmental reference form the dura mater
f) possibly multisegmental pain
g) possibly segmental pain

  

8. Wrist : which clinical elements can we find in case of a scaphoid fracture ?

a) gross limitation of passive extension only + muscle spasm
b) capsular pattern + muscle spasm
c) pain on passive radial deviation
d) pain on passive ulnar deviation

 

9. Lumbar spine : an « adherent nerve root », also known as a dysfunction syndrome, presents itself clinically as

a) Passive Straight Leg Raise and flexion in standing are very painful end range
b) Only SLR is slightly limited and painful end range
c) A painful arc on SLR
d) P
assive SLR and active flexion in standing are slightly limited and painful end range
e) On repeating the SLR test, during the functional examination, the symptoms get better

 

10. Lumbar spine : in case of a smaller, reducible, internal derangement (disc protrusion) with pressure against the dura mater or the nerve root, we might find following signs :

a) SLR test is negative
b) SLR is painful, limited and motor deficit
c) A painful arc on SLR
d) SLR is painful end range
e) SLR is negative, although there is excessive motor deficit

  

11. Lumbar spine : clinically , a clear lumbar lateral deviation, without rotational component, points in the direction of

a) A small internal derangement
b) A bigger internal derangement
c) A sacroiliac dysfunction
d) Severe scoliosis

 

 

Solutions :

  1. B, c, d
  2. B, d, e
  3. A, d
  4. A, d
  5. E, f
  6. D
  7. C, f, g
  8. B, c
  9. D
  10. A, c, d
  11. B

 

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