3.3 Thoracolumbar Special Tests Flashcards by ashley c

Pt sits on the exam table and is asked to “slump” so the spine flexes and shoulders sag forward while PT holds the chin and head erect

Slump Test or Sitting Dural Stretch Test

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Procedure of Slump Test (4 parts)

Part 1: Pt slumps then PT holds chin & head erect

Part 2: PT flexes Pt’s neck & holds head down & shoulder slumped

Part 3: Extend Pt’s knees

Part 4: Dorsiflex the foot of the same leg

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ULNT 1 nerve bias

Median, Anterior Interosseous, C5, C6,
C7

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ULNT 2 nerve bias

Median, Axillary, Musculocutaneous

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ULNT 3 nerve bias

Radial Nerve

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ULNT 4 nerve bias

Ulnar, C8, T1

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PT palpates for the radial pulse > pt’s head rotates to the side that is tested > pt then extends the head & PT puts the shoulder into extension and ER > pt is asked to take a deep breath

Adson’s Test

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Pt’s arm is hyperabducted so that the hand is brought over the head c elbow and arm in the coronal plane c shoulder in ER

Wright’s Test

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Modification of Wright’s test with shoulder 90 degrees abducted and ER > head rotated away from the test side

Allen’s Test

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PT palpates the radial pulse then draws the pt’s shoulder down and back

Military brace test / Costoclavicular Syndrome

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Pt is in supine c hands cupped behind the head > instructed to flex the head onto the chest > Pt actively raises the extended leg by flexing the hip until pain is felt > Pt then flexes the knee

Brudzinski-Kernig Test

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(+) Brudzinski-Kernig Test

If pain disappears upon knee flexion

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T OR F: Brudzinski-Kernig Test are similar to SLR test except it is passively done

FALSE

ACTIVELY done

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(+) Brudzinski-Kernig Test may mean? (3)

indicate meningeal irritation,
nerve root involvement,
or dural irritation

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Pt lies in prone while PT passively flexes the knee as far as possible so that pt’s heel rests at the buttocks

Nachlas Test (PKB1-2, PKE)

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If the examiner is unable to flex the patient’s knee past 90° because of a pathological condition in the knee, the test may be performed by ____ of the hip while the ____ is flexed as much as possible.

passive extension of hip while knee is flexed

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How many seconds does Nachlas Test (PKB1-2, PKE) need to be held for?

45-60 seconds

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Unilateral neurological pain in the lumbar area, buttock, posterior thigh, or sometimes the anterior thigh in the Nachlas Test (PKB1-2, PKE) means?

L2 or L3 nerve root lesion

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Pain in the anterior thigh in the Nachlas Test (PKB1-2, PKE) means?

tight quads or stretching of the femoral nerve

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(+) Slump test

Sx decrease in neck extension

positive for increased tension in the neuromeningeal tract

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Nerve bias for Slump test 1

spinal cord,
cervical and lumbar nerve roots,
sciatic nerve

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Nerve bias for Slump test 2

obturator nerve

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Nerve bias for Slump test 3

femoral nerve

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Nerve bias for Slump test 4

spinal cord,
cervical and lumbar nerve roots,
sciatic nerve

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What should be the hip and knee position in SLR test

hip IR & ADDUCTED knee extended

If pain is primarily back pain in SLR testing?

disc herniation or pressure is more CENTRAL

If pain is primarily leg pain in SLR testing?

pressure is more LATERAL

T OR F: In SLR test, disc herniations or pathology causing the pressure between the two extremes are more likely to cause pain in both areas

TRUE

neck flexion movement in Lasegue’s Test

Brudzinski Sign, Linder Sign, Soto-Hall test Hyndman’s Sign,

ankle dorsiflexion movement in Lasegue’s Test

Bragard’s Test

SLR c neck flexion and extension of the big toe instead of dorsiflexion

Sicard’s Test

involves only extension of the big toe

Turyn’s Test

In SLR test, tension in the ____ is normal

cervicothoracic junction

In SLR test, pain increasing c neck flexion, ankle dorsiflexion, or both indicate?

stretching of the dura mater of the SC OR lesion of the spinal cord

In SLR test, pain that does not increase with neck flexion indicate?

hamstring area lesion OR lesion in the lumbrosacral/SI joints

Pt is relaxed in prone c head straight and arms by the sides > PT stands at pt’s feet and observes the buttocks from the level of the buttocks > Pt is asked to contract the gluteal muscles

Gluteal Skyline Test

(+) Gluteal Skyline Test

Affected gluteus maximus may show less contraction or may be atonic and remain flat

(+) Gluteal Skyline Test may indicate?

inferior gluteal nerve damage OR pressure on L5, S1, S2 nerve roots

Tests for joint dysfunction in lumbar spine (3)

Stork standing test Quadrant test Schober test

Pt stands on one leg and extends the spine while balancing on the leg

Stork Standing Test/ One-leg standing Lumbar extension test

(+) stork standing test

pain the back

what fx is associated with stork standing test?

pars interarticularis stress fx

If stress fx is unilateral – standing on the ____ leg causes more pain

unilateral: IPSILATERAL leg more pain

What is the indication if rotation is combined with extension in stork standing test and pain results with it?

joint facet pathology

Causes maximum narrowing of the intervertebral foramen & stress on the facet joint to the side on which rotation occurs

Quadrant Test/ Extension Quadrant Test

How many cm/inches above S2 in schober test

10 cm / 4 inches

In quadrant test, overpressure is applied in _____ while pt ____ and ____ to the side of pain

overpressure on EXTENSION SIDE FLEXED & ROTATES to the side of pain

How many cm/inches below S2 in schober test

5 cm / 2 inches

Special tests for muscle tightness in lumbar spine (4)

- 90-90 Straight Leg Raising Test - Ober's Test - Ely's Test - Thomas Test

Other name for 90-90 Straight Leg Raising Test

Hamstrings Contracture, Method 1

What test is this? Pt in supine > flexes both hips to 90 degrees with knees bent Pt may grasp behind the knees c both hands to stabilize hips at 90 degrees of flexion Pt actively extends each knee in turn as much as possible

90-90 Straight Leg Raising Test

For normal hamstring flexibility in 90-90 Straight Leg Raising Test, knee extension should be within _____ degrees of full extension

20 degrees

In 90-90 Straight Leg Raising Test, if the hamstrings are tight, what is the end feel?

muscle stretch

Tests TFL for contracture

Ober’s Test

What test is this? Pt is in side-lying c lower leg flexed at the hip and knee for stability > PT passively abducts and extends pt’s upper leg c knees straight or flexed to 90 degrees > PT slowly lowers the upper limb

Ober's Test

(+) Ober's Test

If (+) contracture, leg remains abducted and does not fall to the table

Other name for Ely's Test

Tight rectus femoris, method 2

In Ely's Test, if pt’s hip on the same side of the flexing knee spontaneously flexes, what does this indicate?

tight rectus femoris

Used to assess a hip flexion contracture (most common hip contracture)

Thomas Test

If the leg does not lift off the table but abducts as the other leg is flexed to the chest

J sign/stroke

J sign/stroke is indicative of what?

Indicative of a tight ITB on the extended side

(+) Thomas test

- Pt’s straight leg raises off the table - Muscle stretch end feel will be felt - If lower limb is pushed down onto the table, Pt may exhibit an increased lordosis (another positive sign)

Tests for lumbar instability (2)

- H and I Stability Test - Passive Lumbar Extension Test

Tests for muscle spasm

H and I Stability Test

(+) hypomobile segment present in H and I Stability Test

at least 2 of the movements (into the same quadrant) would be limited

In Passive Lumbar Extension Test, how many cm/ft the PT lifts the legs of the Pt off from the bed?

30 cm / 1 ft

(+) instability present in H and I Stability Test

one quadrant will be affected but only by ONE of the moves

T OR F: Numbness/Pricking sensation are positive signs for Passive Lumbar Extension Test

FALSE NOT positive signs POSITIVE SIGNS: If in the extended position, pt complains of: - Very strong pain in the lumbar region - Very heavy feeling in the low back - Feels like low back is “coming off” and pain disappears when the legs are lowered to the start position

Lumbar special tests for malingering (2)

- Burns Test - Hoover Test

Pt is asked to kneel on a chair then bend forward to touch the floor with the fingers

Burns Test

(+) Burns Test

pt is unable to perform the test or the pt overbalances

What test is this? Pt lies in supine > PT places one hand under each calcaneus while pt’s legs remain relaxed on the exam table > PT is then asked to actively lift one leg off the table, keeping knees straight (straight leg testing)

Hoover Test

(+) Hoover Test

pt does not lift the leg or PT does not feel pressure under the opposite heel

3.3 Thoracolumbar Special Tests Flashcards

(73 cards)