LE Neural tests part 2 (standing, prone, SI)

Question 1

What are the other names for a belt test?

Answer 1

Supported Adam’s test
Supported forward bending test

Question 2

If a patient feels great in the tub and worse getting out of the tub what condition may be suspected?

Answer 2

SI joint lesion

Question 3

Which orthopedic test/sign is used to differentiate a lumbo-sacral issue vs an SI problem?

A. Lewin’s standing
B. Neri’s Bowing sign
C. Belt test
D. Advancement Test
E. Braggard’s test

Answer 3

C. Belt test

Question 4

How is an Adam’s test performed?

Answer 4

Observe patient with structural scoliosis standing
Then ask patient to file forward at the waist while the doctor observes the patients back for signs of structural change

Question 5

What is a doctor looking for when a patient bends forward for an Adam’s test?

Answer 5

Scapular winging, rib humping, iliac crest height

Question 6

What are the positive findings for an Adam’s test?

Answer 6

Resolution of structural findings

Question 7

What are the indications for the positive findings for an Adam’s test?

Answer 7

Resolution indicates functional scoliosis
No resolution indicates structural scoliosis

Question 8

A patient performs an Adam’s and their scapular winging and rib humping goes away. How is this recorded and what is indicated?

Answer 8

Positive Adam’s test indicating functional scoliosis

Question 9

A patient performs an Adam’s test and their rib humping and iliac crest height differential does not go away. How is this recorded and what is indicated?

Answer 9

Positive Adam’s test indicating structural scoliosis

Question 10

How is a Belt/Supported Forward Bend/Supported Adam’s test performed?

Answer 10

• Instruct pt to bend fully forward toward their toes and note when pain begins
• have pt contact both ASIS
• Repeat while dr stands behind pt and blocks SI joint motion by supporting sacrum with their thigh/hip and pulling backward on ASIS bilaterally over pt’s hands (prevents flexion below level of LS junction)

Question 11

What are the positive findings for a Belt/Supported Forward Bend/Supported Adam’s test?

Answer 11

Decrease in pain upon supported flexion
Increase in pain at an earlier angle

Question 12

What is indicated by a positive finding for a Belt/Supported Forward Bend/Supported Adam’s test?

Answer 12

Source of pain in the unsupported Adam’s test was of SI origin if pain decreases
(SOF: If pain increases at an earlier angle may indicate a LS problem)

Question 13

What test is performed standing to determine if the source of a patients low back pain is of SI origin?

Answer 13

Belt test/Supported Adam’s test/Supported Forward bending test

Question 14

A Belt test is performed and the patient has increased pain at an early angle before completing forward flexion, how is this recorded and what does it indicate?

Answer 14

Positive indicating LS involvement

Question 15

A Belt test is performed and the patient has a decrease in pain in forward flexion, how is this recorded and what does it indicate?

Answer 15

Positive indicating SI involvement

Question 16

What is Neri’s sign also called?

Answer 16

Bowing sign or Knee flexion test

Question 17

How is a Neri’s sign performed?

Answer 17

Patient stands and bends forward from the waist

Question 18

What is a present finding for Neri’s/Bowing sign?

Answer 18

Patient’s affected leg flexes at the knee and the patient reports reproduction of the LE complaint in this position

Question 19

What is indicated by a present Neri’s/Bowing sign?

Answer 19

Sciatic radiculopathy, hamstring spasm, SI lesion, or LS strain

Question 20

A present Neri’s/Bowing sign will be present with knee flexion on the (Asymptomatic/Symptomatic) side?

Answer 20

Symptomatic

Question 21

What test is performed after a Neri’s/Bowing sign if present?

Answer 21

Lewin’s Standing test

Question 22

How is a Lewin’s Standing test performed?

Answer 22

If the patient’s knee is flexed when standing normally, or with performance of Neri’s test, the examiner stabilizes the patient’s pelvis then attempts to pull the flexed knee back into extension

Question 23

What is a positive result for a Lewin’s Standing test?

Answer 23

Increase in posterior leg pain or inability to keep the leg straight

Question 24

What is indicated by a positive result for a Lewin’s Standing test?

Answer 24

Sciatic radiculopathy or hamstring spasm

Question 25

What standing LE orthopedic tests can indicate sciatic radiculopathy or a hamstring spasm?

Answer 25

Neri's sign Lewin's standing test Advancement test

Question 26

How is an advancement test performed?

Answer 26

The patient bends forward to elicit pain into the leg The patient is then asked to advance the SYMPTOMATIC leg one step and bend forward again

Question 27

What is a positive result for an advancement test?

Answer 27

Reproduction of the radiating pain with less trunk flexion than before

Question 28

What is indicated by a positive result for an advancement test?

Answer 28

Sciatic radiculopathy, sciatic neuritis, hamstring spasm

Question 29

What two prone LE tests can be positive for facet syndrome?

Answer 29

Nachlas test Ely's Heel to Buttock Test

Question 30

If a Nachlas test is performed and a patient points to the anterior thigh as their site of pain. How is this recorded?

Answer 30

Positive femoral nerve traction test with a negative Nachlas test

Question 31

How is Nachlas test performed?

Answer 31

Approximate the patient's heel to the IPSILATERAL buttock and ask the patient to localize the site of pain

Question 32

For a Nachlas test the examiner approximates the patient's heel to the (Ipsilateral/Contralateral) buttock?

Answer 32

Ipsilateral

Question 33

What is a positive finding for a Nachlas test?

Answer 33

Pain localized by a patient

Question 34

What is indicated by a positive finding for a Nachlas test?

Answer 34

Non-specific LS, SI, or facet pain (if in lower back) Femoral nerve root irritation

Question 35

A Nachlas test is performed and the heel is approximated to the ipsilateral buttocks, how many findings are recorded and what are they?

Answer 35

Three: Nachlas, Ely's sign, femoral nerve traction test

Question 36

If a Nachlas test is performed and the patient reports pain in the lower back how is this recorded what does it indicate?

Answer 36

Positive indicating facet syndrome

Question 37

How is Ely's sign performed?

Answer 37

Upon performance of Nachlas test, observe for hunching of the pelvis

Question 38

What is a present Ely's sign?

Answer 38

Hunching of the pelvis during Nachlas test

Question 39

What prone orthopedic test can elicit an Ely's sign?

Answer 39

Nachlas test

Question 40

What is indicated by a present Ely's sign during Nachlas test?

Answer 40

Tightness of the 2 joint hip flexors (Rectus femoris and tensor fascia lata)

Question 41

What muscles are two joint hip flexors?

Answer 41

Rectus femoris and tensor fascia lata

Question 42

What muscles are likely tight in a patient with a present Ely's sign during Nachlas test?

Answer 42

Rectus femoris and tensor fascia lata

Question 43

What test confirms an Ely's sign?

Answer 43

Thomas' test

Question 44

How is an Ely's Heel to Buttock test performed?

Answer 44

The examiner approximates the patient's heel to the OPPOSITE buttock

Question 45

When an examiner performed an Ely's Heel to Buttock test they approximate the patient's heel to the (Ipsilateral/Opposite) buttock?

Answer 45

Opposite

Question 46

What is a positive result for an Ely's Heel to Buttock Test?

Answer 46

Inability to perform the movement or pain upon approximation

Question 47

What is indicated by a positive result for an Ely's Heel to Buttock Test?

Answer 47

Hip joint lesion, facet, SI, lumbar, iliopsoas (If Ely's present), femoral nerve root irritation

Question 48

A positive result for Ely's Heel to Buttock Test is the same as Nachlas test but may also include what joint?

Answer 48

Femoracetabular joint

Question 49

What are examples of SI orthopedic tests?

Answer 49

Fortin Finger test Gaenslen's test Lewin's-Gaenslen test Erichsen's sign Hibb's test Yeoman's test Mennel's test

Question 50

How is a Fortin Finger test perfomed?

Answer 50

Have patient point to the site of pain

Question 51

What are positive results for a Fortin Finger test?

Answer 51

Localization with one finger Localization inferomedial to the PSIS within one centimeter Localization is consistent as the patient points to the same area over at least TWO trials

Question 52

What is indicated by a positive Fortin Finger test?

Answer 52

SI joint lesion

Question 53

All ligaments of the hip restrict what motion?

Answer 53

Extension

Question 54

How is a Gaenslen's test performed?

Answer 54

With the patient's side close to the edge of the examining table, instruct the patient to grasp the opposite knee and approximate it to their chest Examiner then gently lowers the affected side OFF THE EDGE OF THE TABLE

Question 55

What is a positive finding for a Gaenslen's test?

Answer 55

SI joint pain

Question 56

What is indicated by a positive finding for a Gaenslen's test?

Answer 56

SI joint lesion

Question 57

How is a Lewin-Gaenslen test performed?

Answer 57

Identical to Gaenslen's test except the patient is side-lying while the doctor stabilizes the pelvis

Question 58

What is the patient position for a Gaenslen's test?

Answer 58

Supine

Question 59

What is the patient position for a Lewin-Gaenslen test?

Answer 59

Side-lying (lateral recumbent)

Question 60

What is the patient position for Erichsen's sign, Hibb's test, Yeoman's test, and Mennell's test?

Answer 60

Prone

Question 61

Why may a Lewin-Gaenslen test be used over a Gaenslen test?

Answer 61

A Lewin-Gaenslen test has the additional advantage of allowing the examiner to palpate the SI joints

Question 62

What is a positive finding for a Lewin-Gaenslen test?

Answer 62

SI joint pain

Question 63

What is indicated by a positive finding for a Lewin-Gaenslen test?

Answer 63

SI joint lesion

Question 64

For a Lewin-Gaenslen test you must be skin on skin at the SI joint (TRUE/FALSE)?

Answer 64

t

Question 65

How is Erichsen's Sign performed?

Answer 65

Patient prone, firm pressure is applied toward the midline using a soft contact lateral to the PSIS

Question 66

What is a present finding for Erichsen's Sign?

Answer 66

SI joint pain

Question 67

What is indicated by a present finding for Erichsen's sign?

Answer 67

SI joint lesion

Question 68

How is Hibb's test performed?

Answer 68

Patient prone, flex the knee and use the lower leg as a lever to internally rotate the hip with NO STABILIZATION

Question 69

What is a positive finding for a Hibb's test?

Answer 69

SI joint pain or hip pain

Question 70

What is indicated by a positive finding for a Hibb's test?

Answer 70

SI joint or hip lesion

Question 71

How is a Hibb's test different from a piriformis stretch test in its procedure?

Answer 71

A Hibb's test has NO STABILIZATION of the hip while the piriformis stretch test does

Question 72

What SI test can be used to differentiate between femoracetabular and SI problems?

Answer 72

Hibb's test

Question 73

How is Yeoman's test performed?

Answer 73

Patient prone, flex the knee and lift the distal femur to create hip extension Add downward pressure on the IPSILATERAL SI

Question 74

What is a positive finding for Yeoman's test?

Answer 74

SI joint pain

Question 75

What is indicated by a positive finding for Yeoman's test?

Answer 75

SI sprain

Question 76

What SI orthopedic test can be used as an SI extension adjustment?

Answer 76

Yeoman's test

Question 77

What SI test is the most sensitive or SI lesions?

Answer 77

Yeoman's test

Question 78

A femoral nerve traction test can be positive when what two tests are performed?

Answer 78

Nachlas Test and Yeoman's test

Question 79

What position is the patient in for a Mennel's test?

Answer 79

Prone

Question 80

What orthopedic sign is indicative of an SI issue?

Answer 80

Erichsen's sign

Question 81

How is a Mennell's test performed?

Answer 81

Patient prone, examiner applies pressure with thumbs from the PSIS's outward into the soft tissue noting and pain at the SI Doctor then slides the thumbs toward the midline (Erichsen's sign) and notes any pain at the SI If the second maneuver elicits pain, rock the ilium forward with the superior hand on the SI joint, inferior hand on the femur, and then pull posteriorly noting any exacerbation of pain

Question 82

What is a positive finding for a Mennell's test?

Answer 82

Exacerbation of SI pain

Question 83

What is indicated by a positive finding for a Mennell's test?

Answer 83

Myofascial involvement of gluteal muscles if pain in step 1 SI subluxation or sprain if pain in steps 2-4

Question 84

If a patient has pain in step one of Mennell's test when the examiner pushes with their thumbs from the PSIS laterally what is indicated?

Answer 84

Myofascial involvement of gluteal muscles

Question 85

If a patient has pain in step two, three, or four of Mennell's test what is indicated?

Answer 85

SI subluxation or sprain

Question 86

What is the only SI orthopedic test than brings the hip into flexion?

Answer 86

Mennell's test

Question 87

What sign is performed in the second step of Mennell's test?

Answer 87

Erichsen's sign