Practical Final Exam Flashcards
(109 cards)
1
Q
What are the C5 MRSs?
A
Muscle Test: Shoulder Abduction
DTR: Biceps
Dermatome: lateral half of arm
2
Q
What are the C6 MRSs?
A
Muscle Test: Wrist Extension
DTR: Brachioradialis
Dermatome: lateral forearm from the elbow to the tip of the first 2 digits
3
Q
What are the C7 MRSs?
A
Muscle Test: Wrist Flexion
DTR: Triceps
Dermatome: 3rd digit up to the wrist
4
Q
What are the T1 MRSs?
A
Muscle Test: Finger Abduction/Adduction
DTR: Pectoralis
Dermatome: medial half of the arm
5
Q
What are the L4 MRSs?
A
Muscle Test: Foot Inversion
DTR: Patellar tendon
Dermatome: Medial knee down anteriolateral leg to medial foot
6
Q
What are the L5 MRSs?
A
Muscle Test: Toe Dorsiflexion
DTR: Medial hamstring tendon
Dermatome: Anterolateral knee down anteriolateral lower leg to top of foot
7
Q
What are the S1 MRSs?
A
Muscle Test: Foot Eversion
DTR: Achilles Tendon
Dermatome: posterolateral knee down posterolateral lower leg to lateral foot
8
Q
NIFFZIGER’S TEST
A
Procedure: Pt is seated. Bilateral digital pressure is placed on JUGULAR VEINS to occlude their flow for up to 1 minute. Pt is asked to cough deeply.
Aggravation of cord symptoms indicates SOL within the dura mater, local or radiating spinal symptoms indicates an extra dural SOL
9
Q
VALSALVA’S MANEUVER
A
Procedure: Pt is seated. Examinar instructs pt to take a deep breath and bear down.
Cord symptoms indicate intra-dural SOL. Spinal pains that may radiate down the extremities indicate SOL in the spinal canal, such as an IVD protrusion, trauma, and vascular injury causing a hematoma.
10
Q
SWALLOWING TEST
A
Procedure: Ask pt if they have had any problems swallowing food, drink, etc or have pt drink a small amount of fluid
PAINFUL swallowing indicates SOL. NONPAINFUL, difficult swallowing indicates CN IX or CN X Pathology
11
Q
DEJERNINE’S SIGN
A
Procedure: Pt coughs, sneezes, and strains (bearing down), can be performed or ask about historically
Reproduction of cord symptoms indicates a SOL in the cord, symptoms locally and radiating into the extremity indicates spinal canal SOL.
12
Q
DEKLEYN’S TEST
A
Procedure: Pt is supine, so that the head is off the end of the table that is being used. Patient hyperextends their neck and rotates to one side, hold 15-45 seconds, while keeping eyes open and fixed on a point.
Lightheadedness, nausea, vertigo, hearing and visual disturbances, nystagmus (horizontal fluttering of eye), occurring with the head rotated will indicate occlusion of the internal carotids and the ipsilateral vertebral artery.
13
Q
MAIGNE’S TEST
A
Procedure: PT is seated. Pt hyperextends the head and rotates
Lightheadedness indicates cclusion of the ipsilateral vertebral or internal carotids
14
Q
BARRE-LIEOU SIGN
A
Procedure: PT is seated. Instruct PT to rotate head all the way in one direction, and then all the way in the other direction, then back to normal
Lightheadedness indicates occlusion of ipsilateral vertebral artery or internal carotids
15
Q
SOTO-HALL TEST
A
Pt is supine. Doctor stands alongside the pt and places knife edge of one hand over the sternum (for women pt, ask them to put their hands over their sternum first). The other hand goes underneath the back of the patient’s head. Doctor passively flexes the head, chin to chest.
Reproduction of symptoms of muscles, ligaments, or bony structure of the posterior spine would indicate strain, sprain, or fractures. Relieving symptoms suggest facet surfaces are causing the pain. Reproduction of symptoms along the anterolateral neck and radiating may compress nerve roots from things such as disc lesions, von luschka joint arthritis, or spondylosis.
16
Q
O’DONOHEU’S MANEUVER
A
Pt is seated. Passively do all cervical ROM, denoting any symptomatology with localizing and characterizing. In neutral, perform isometric resistive contractions of the cervical spine in all ROMs.
Ligament symptomatology will be deep and pinpoint upon passive ROM along the contralateral side, indicating a SPRAIN. Muscle symptomatology will be noted with isometric contraction, indicating a STRAIN.
17
Q
RUST SIGN
A
If the pt spontaneously grasps the head with both hands when lying down or when arising from a recumbent position, this action is a positive sign that indicates severe sprain, RA, fracture, or severe cervical subluxation.
18
Q
FORAMINAL COMPRESSION TEST
A
Pt is seated. Dr rotates Pt head to the side being tested. Dr will place both his hands on top of the head and exerts a strong compressive force. After rotations have been done, perform the test in neutral.
Anterolateral neck pain and/or radiating nerve pain on the side being tested = nerve roots; posterolateral pain is a facet joint surface. Contralateral side producing superficial pain is muscle stretching and posterolateral deep pinpoint pain is a facet joint capsule.
19
Q
SHOULDER DEPRESSION TEST
A
Pt is seated and lateral flexes the head away from the side being tested. The doctor stands behind the pt on the side being tested and places his medial hand on the head to stabilize it. Then places his lateral hand on top of the shoulder on the side being tested and depresses the shoulder.
Anterolateral neck pain and/or radiating neck pain into the brachial plexus and possible down through the arm, indicative of nerve root lesions. Superficial streching pain indicate the musculature.
20
Q
BRACHIAL PLEXUS TENSION TEST
A
Pt seated, Dr stands behind the pt and asks the pt to place their hands behind their head, then grasps the elbows and extends the elbows back.
Anterolateral neck pain and/or radiating pain into the brachial plexus indicates nerve root lesions.
21
Q
BRACHIAL PLEXUS STRETCH TEST
A
Pt is seated. Pt’s arm will be abducted as far as it can, externally rotated and extended as far as it can (~110 degrees). Pt will rotate the head away from the side being tested and laterally flex from the side being tested.
Anterolateral neck pain and/or radiating neck pain into the brachial plexus and down the arm indicates nerve root lesion.
22
Q
JACKSON’S COMPRESSION TEST
A
Pt is seated. Dr will laterally flex the pt to the side being tested and with both hands on top of the head, exert a strong downward compression
Ipsilateral neck pain and/or radiating pain, nerve root, and posterolateral (and pinpoint) =facets. Contralateral symptoms producing generalized pain and symptoms (muscles). Pinpoint posterolateral is facet joint surface.
23
Q
SPURLING’S TEST
A
Pt seated. Dr will rotate, laterally flex, and extend the pt head toward the side being tested with downward force. If you do not reproduce the pt symptoms, then take hand place on the pt’s head in neutral and bonk them on the head. If still no symptoms then rotate, laterally flex, extend and then bonk them on the head
Ipsilateral neck pain and/or radiating pain, nerve root, and posterolateral (and pinpoint) =facets. Contralateral symptoms producing generalized pain and symptoms (muscles). Pinpoint posterolateral is facet joint surface.
24
Q
DISTRACTION TEST
A
Pt seated. Place palm under the pt chin, the thumb web of the other hand back underneath the occiput. Lift head straight up, enough to sit the pt up.
Relief of anterolateral and radiating symptoms = nerve root. Relief of posterolateral symptoms - facet joint surface problem. Aggravation of local posterolateral = joint capsule.
25
ADSON'S TEST
Dr locates the radial pulse of the involved (TOS) extremity. Pt head is rotates to the involved extremity and extended as the dr externally rotates and extends the shoulder. Pt takes a deep breath and holds. Loss of pulse is a positive test indicating TOS. If the test is negative, it is repeated by having the pt rotate the head to the uninvolved extremity.
26
REVERSE BAKODY'S MANEUVER
For TOS. Pt seated, have pt put their hand on top of their head. Reproduction or aggravation of the pt's symptoms in the anterolateral neck, along the brachial plexus, and/or down the arm indicates brachial plexus compression (TOS)
27
WRIGHT'S TEST
For TOS. Pt seated with their arm at their side. Dr finds radial pulse on the affected extremity. Then the examiner abducts the arm with external rotation and extends the arm.
A loss of pulse indicates TOS. If the pulse stays strong but there are aggravating symptoms, it would indicate peripheral nerve entrapment.
28
COSTOCLAVICULAR MANEUVER
For TOS via clavicle and 1st rib. Pt seated. Both sides can be done at the same time. Arms are at pt side. Dr stands behind the pt, locate and palpate both radial pulses. Draw the pt's shoulders down by pulling on the arms and then extend the arms slightly. Have the pt flex their head, chin to chest. Have them take a deep breath and hold for a few seconds.
Loss of pulse is a positive test for TOS, aggravation of symptoms indicates brachial plexus compressive irritation.
29
ALLEN'S MANEUVER
For TOS via middle scalene. Pt seated. Dr will palpate the radial pulse and ask the pt to rotate their head away from the side being tested and extend the head. Dr will extend and externally rotate the pt's arm. Have pt take a deep breath and hold for a few seconds.
For a vascular problem there will be a decrease or ascend radial pulse amplitude. If aggravating symptoms occur there will be a compression of the brachial plexus.
30
APLEY'S SCRATCH TEST
For rotator cuff tendon pathology. Pt is seated. Part I: Dr instructs pt to place the hand of the affected shoulder behind the head and try to touch their fingers to the opposite upper scapula. Part II: Instruct the pt to put their hand behind their back and touch the inferior border of the opposite scapula.
Reproduction or aggravation of symptoms indicates rotator cuff tendon pathology. Part I: Supraspinatus, Infraspinatus, and teres minor Part II: Subscapularis
31
CODMAN'S (DROPARM) TEST
For supraspinatus tear. Pt is seated or standing. Dr passively abducts pt arm above 90 degrees and lets the arm drop.
Reproduction of symptoms in the deep superior shoulder indicates rotator cuff injury in the supraspinatus.
32
SUPRASPINOUS PRESS TEST
For supraspinatus tendonitis. Can be performed bilaterally. Instruct pt to abduct the shoulder to 90 degrees, flex the elbow 90 degree, and slightly internally rotate the shoulder (20 degrees). Doctor contacts elbows and tells the patient to resist and then pushed down on the elbow.
Painful symptoms or weakness at the attachment point of the supraspinatous or up in the muscle belly indicates supraspinatous tendonitis or muscle belly pathology.
33
APPREHENSION TEST ANTERIOR
For shoulder dislocation. Pt seated. For Ant dislocation. Doctor is behind the shoulder being tested. With medial hand, stabilize the shoulder and with the other hand, grasp the forearm just below the elbow. Abduct the shoulder and flex the elbow. Cautiously externally rotate the humerus.
Apprehension with test indicates anterior dislocation
34
APPREHENSION TEST POSTERIOR
For posterior dislocation. Pt is supine. Place shoulder with humerus off the edge of the table and the scapula still on the table. Reach behind the pt, stabilize the scapula, and flex the humerus to 90 degrees. Then push the humerus posteriorly .
Apprehension with test indicates posterior shoulder dislocation.
35
DUGAS TEST
For Anterior dislocation. Pt will flex their shoulder to 90 degrees and flex their elbow and place their fingers on the opposite shoulder. Then they will try touching their elbow to their chest.
If the patient can't do this it indicates an anterior dislocation.
36
ABBOT-SAUNDER'S TEST
Assesses for dislocation of the long head of the biceps out of the bicipital groove. Pt is seated. Dr stands behind the pt and locates the bicipital groove with the medial hand and palpates the tendon. With the lateral hand the doctor flexes, abducts and externally rotates the humerus, and then lower the arm to the patient's side.
Palpable or audible click indicates tendon dislocation; pain in the bicipital groove indicate tendonitis or tendonosis.
37
SPEED'S TEST
assesses for biceps tendonitis. Pt is seated. Flex the shoulder to 45 degrees with the elbow extended, the arm supinated and externally rotated while palpating the bicipital groove. Tell the pt to continue to try to flex the shoulder while the doctor resists.
Increase or reproduction of symptoms over the biceps tendon will indicate biceps tendonitis/osis.
38
YERGUSON'S TEST
Assesses for biceps tendonitis or transverse ligament pathology. Pt is seated. Pt will flex the elbow to 90 degrees and supinate the forearm, stabilize the elbow and contact the wrist. Dr will resist the pt from supinating the forearm and externally rotating the shoulder.
Aggravation/reproduction of symptoms in the bicipital groove is indicative of tendonitis/osis; click or snap in the bicipital groove indicates tendon dislocation due to transverse ligament pathology.
39
COZEN'S TEST
For lateral epicondylitis and radial head bursitis. Pt is seated. Pt makes a fist and put their wrist in extension and hold it there while the examiner tries to flex the fist.
For acute lancinating pain at the lateral epicondyle indicates lateral epicondylitis. If the pain is more inferior over the radial head, it could be a bursitis.
40
MILL'S TEST
Assesses for lateral epicondylitis (passive test). Pt is seated. With the pt's fingers flexed, wrist flexed, elbow flexed and the forearm supinated; the examiner will passively extend the elbow while pronating the forearm.
Reproduction of the pt's symptoms at the lateral epicondyle indicates lateral epicondylitis.
41
TINEL'S SIGN SUPERFICIAL RADIAL NERVE
Pt is seated. With a reflex hammer, over the muscle bellies of the wrist extensor muscles.
Reproduction of symptoms from the lateral upper forearm, and also radiating down the lateral arm
42
ELBOW VARUS STRESS TEST
Tests lateral collateral ligament. Pt is seated. With one arm contact the distal lateral forearm and the other hand contact the medial distal humerus. Stabilize the humerus and try to adduct (varus stress) the forearm. Flex the elbow to about 20 degrees and test varus stress again.
Reproduction of pinpoint pain to the lateral collateral ligament, can indicate a sprain to the ligament, excessive play indicates ligament laxity.
43
TINEL'S SIGN ELBOW ULNAR NERVE
Pt is seated. Place the elbow in a position so you can locate the cubital tunnel. Strike the tunnel with a reflex hammer.
Reproduction of paresthesia upon percussion and down the arm indicates ulnar nerve inflammation.
44
ELBOW VALGUS STRESS TEST
Assesses the medial collateral ligament for injury or instability. Pt is seated. The examiner contacts the medial distal forearm and the lateral humerus. Stabilize the humerus and try to abduct the forearm, and then flex the elbow 20 degrees and retest.
Reproduction of pain the medial collateral ligament indicates sprain or injury. Excessive play indicates ligament damage.
45
FINKELSTEIN'S TEST
Assesses for Tenosynovitis of the thumb. Pt adducts their thumb, wraps fingers around the thumb and then adducts the wrist.
Inflammation of adductor polices longs and extensor pollicus brevus tendons (tenosynovitis of thumb) . Reproduction of symptoms at lateral wrist along the tendons.
46
BRACELET TEST
Tests for arthritis. Pt is seated. Dr grasps distal forearm (radius and ulna) with their thumb and index finger. Then doctor compresses wrist with mild to moderate pressure.
Reproduction of wrist/distal forearm or proximal hand indicates arthritis.
47
FINSTERER'S TEST
Assesses lunate for avascular necrosis. Pt is seated. Ask the pt to grasp a small object (hand ball) with hard pressure, then take a reflex hammer and tap the proximal end of the 3rd metacarpal bone.
Reproduction of symptoms over the luncate indicates Kienbock's Disease (lunate necrosis).
48
PHALEN'S SIGN
Prayer Sign. Assesses for carpal tunnel syndrome AKA median nerve palsy. Pt is seated. Pt is asked to place the place the back of their hands together to flex the wrist and then lower the elbows to further flex the wrist.
Reproduction of median nerve symptoms indicates Carpal Tunnel Syndrome from compression of median nerve.
49
TINEL'S SIGN MEDIAN NERVE
Pt is seated. Doctor positions anterior wrist so that the doctor can percuss over the median nerve with a relax hammer.
Wrist symptoms that radiate into the hand indicate carpal tunnel syndrome.
50
WRINGING TEST
Pt wrings out a towel or washcloth. Test is done in both directions with the wrist in flexion and extension.
If on flexion the patient has anterior wrist symptoms with radiation to the middle of the hand = carpal tunnel syndrome. Also there is a possibility of medial epicondyle pain = medial epicondylitis. When in extension, there is compression to the posterior wrist and contracts the extensor muscles that attach to the lateral epicondyle.
51
FROMENT PAPER SIGN
For ulnar nerve pathology. Pt is seated. Pt will grasp a sheet of paper between the 4th and 5th digits. Tell the pt to hold the paper while the dr drags the paper through the fingers.
Failure to maintain the grip on the paper, as it is drug between the 4th and 5th digits indicates ulnar nerve pathology.
52
BUNNELL-LITTLER TEST
For intercapsular adhesion/scar tissue, or tendon problems. Examinar extends the proximal phalange at the MCP joint and then tries to flex the DIP joint.
The inability to flex the DIP joint suggests you have contractors (adhesions) at the PIP or DIP joint.
53
TIGHT RETINACULAR LIGAMENT TEST
Checks the transverse ligaments that the extensor tendons run through in order to extend the digital phalange. Place the PIP joint in neutral and then try and flex the DIP joint passively.
The inability to flex the DIP joint indicates adhesions b/t tendons and transverse ligaments of the DIP or PIP ligaments and tendons.
54
BRUDZINSKY'S SIGN
Assesses for meningeal irritation. This sign is seen when the pt is lying supine and passive cervical flexion is performed.
The sign is the patient flexing their knees bilaterally to relieve the tension in the hamstring muscles and therefore sciatic nerve and the stretch on the dura.
55
KERNIG'S SIGN
Assesses for meningeal irritation. The pt is supine and the dr will flex one leg at a time, flexing the hip and knee to 90 degrees, then attempting to extend the lower leg.
56
NACHLAS TEST
Pt is prone and relaxed. Dr passively flexes the pt's knee, approximating the heel to the same buttock.
Production or aggravation of pain in the SI joint on the side being tested indicates SI joint pathology. Pain in the lumbopelvic spine is facet joint. This would be an arthralgia diagnosis.
57
MENNELL'S SIGN
For pathologic involvement of the sacroiliac joint structures. Dr places thumb over PSIS, exerts pressure, slides thumb outward, and then slides thumb inward.
Reproduction of symptoms lateral to PSIS will be a gluteus medius involvement, and medial will by superior sacral iliac ligament involvement.
58
LINDNER'S SIGN
For lumbar nerve root irritation/inflammation. Passively flex pt head to chest (supine, seated, or standing). If pain occurs in the lumbar spine and along the sciatic nerve distribution, the test is positive and indicates root sciatica.
59
KEMP'S TEST
Part I is standing. Part II is seated. If the pt has low back pain, standing should be done first. Part I: if the pt has unilateral problem, you will support the ipsilateral posterior ilium on the side of pain with one hand. With your other arm, grasp across the back of the pt shoulders. Then you will flex the pt forward and to the side away from testing, then extend, lateral flex and rotate toward the symptomatic side. Switch and check the other side. Part II: Seated, same procedure.
Standing: aggravation of pain being localized will be facets. Radiating pain will be a nerve root being compressed. In seated, reproduction or aggravation of low back and radiating pain indicates a disc encroaching on a nerve root.
60
ANTALGIA SIGN
When the disc protrudes lateral to the nerve root, the pt assumes an antalgic lean away from the side of the disc lesion or pain. When the disc protrudes medial to the nerve root, the pt will assume an antalgic lean into the side of the disc lesion or pain. With a central disc lesion, the pt assumes a flexed posture. With protrusion under the nerve root, the pt might not lean at all.
61
MINOR'S SIGN
Antalgia sign when going from seated to standing. The dr observes if the pt is antalgic and has difficulty rising.
Lean away from side of pain = lateral disc. Lean toward side of pain = medial disc. Lean forward unilateral pain = subrhizal . Lean forward bilateral pain = central disc.
62
BECHTEREW'S TEST
Active straight leg raise test seated. Pt is seated. Examiner asks pt to extend the symtomatic leg is there is a unilateral problem, then the good leg. Then have pt raise both legs. Doctor will hold down on the thigh when pt straightens lower leg.
Reproduction of low back/leg pain along the sciatic nerve indicates nerve root pathology, which could be due to a disc lesion, exostosises (bone spurs), and adhesions. Generalized superficial LBP represents muscle spasms and pathology. Tripod sign: Pt raises the symptomatic leg or bilateral legs and places arms behind them. Pain would indicate nerve root with a disc problem.
63
GOLDTHWAIT’S TEST
Pt is supine. Dr. places one hand under the lumbosacral spine; so that the pinky is on the PSIS and the other 3 fingers are b/t the SP of the lower lumbar spine. The dr slowly raises the affected leg with the other hand until the symptoms are reproduced.
Aggravation of symptoms during SI joint movement (felt with pinky) indicates an SI joint lesion. If during lumbar spine movement, then it is in the lumbar spine.
64
MILGRAM'S TEST
Pt is supine. Pt is instructed to raise both of their legs until both of their heels are 6'' off the table. Pt is to hold that position as long as possible (to 30sec).
Reproduction of low back pain and or leg pain along sciatic nerve indicates nerve root entrapment by the IVD.
65
ELY'S SIGN
The pt is prone w/the toes hanging over the edge of the table and the legs relaxed. One or the other heel is approximated to the opposite button. After flexion of the knee, the thigh is hyperextended.
Aggravation of symptoms in the low back and/or radiating to the anterior thigh, along the course of the femoral nerve indicates a nerve root lesion from stretch. If pt complains of ipsilateral joint pain could indicate SI joint lesion.
66
FEMORAL NERVE TRACTION TEST
Pt is lying on their side. Affected side up and stabilize the pt on the table with down leg slightly flexed. Dr will take the affected leg and with the knee flexed to 90 degrees extend the hip.
Aggravation of low back nerve root symptoms and/or radiating symptoms into the anterior thigh indicates nerve root pathology. General anterior thigh symptoms are probably the quads. Linear anterior thigh symptoms along the course of the femoral nerve would be femoral nerve.
67
STRAIGHT LEG RAISE TEST
Pt is supine w/legs extended and relaxed. Place one hand under the pt heel, the other hand on the anterior part of the knee. The hand on the knee helps to keep the knee extended. Dr passively flexes the hip by raising the leg to 90 degrees if possible.
Aggravation of local nerve root symptoms and/or radiating symptoms from the low back along the sciatic nerve indicates nerve root lesion from a lateral disc entrapment (if it relieves the N.R. symptoms may indicate a medial disc entrapment). Usually occur b/t 35-70 degrees of leg raise. Reproduction of low back symptoms will be more low back problems above 70-90 degrees (ligament). 0-30 degrees reproduction will be muscle pathology, hip or SI lesion.
68
LASEGUES TEST
Rules out knee and hip as a problem in a SLR test. W/pt supine and following the SLR test, take the relax symptomatic leg and flex the hip and knee to 90 degrees simultaneously, if there are no symptoms extend the leg by extending the knee.
If pt symptoms are produced with knee extension nerve root or sciatic nerve involvement is noted. Lateral disc entrapment will be aggravated medial disc may be relieved.
69
BRAGGARD'S TEST
Following the SLR test, @ the degree of leg raise where symptoms are reproduced. Lower the leg until symptoms are relieved or go away, and sharply dorsiflex the foot.
Reproduction of symptoms confirms nerve root, sciatic nerve root lesion from stretch seen in SLR test, also hamstring
70
FAJERSZTAJN’S TEST
Straight leg raise of unaffected leg.
Aggravation of symptoms on the contralateral side indicates a neural lesion, usually a nerve entrapment from a medial disc. If you relieve the symptoms it may be because of a lateral disc.
71
BOWSTRING TEST
Pt is supine. Leg is relaxed. Dr will flex the leg just as in the SLR until symptoms are reproduced and then lower the leg to relieve the symptoms, and then place the patient's heel on the doctor's shoulder. Dr. will then place their thumbs on the medial and lateral hamstring and exert inward pressure.
Aggravation of low back symptoms and/or radiating symptoms along the sciatic nerve indicates nerve root irritation from stretch.
72
BELT TEST
Differentiates SI joint problem from a lumbar problem. Pt flexes the dorso-lumbar spine actively. Examiner notes the point at which the symptoms are produced. Part II: have the dr support the pt by grasping both ASIS's with his/her hands and then bracing the sacrum with their hip or thigh, and locking the SI joint. Ask the pt to foe again, but only allowing them to flex the lumbar spine.
In lumbar symptoms, you will produce or aggravate symptoms in both supported and unsupported test. Pelvic symptoms are not aggravated or reproduced in supported flexion.
73
GAENSLEN’S TEST
Pt is supine on the table; doctor will stand, on the symptomatic side. Move the pt leg over to the edge of the table on the affected side. Have the pt flex the hip and the knee on the unaffected side. Have the pt grasp the knee to keep it in flexion. Drop the symptomatic leg off the table so that the ilium is extended. Dr will then put pressure on the knee in flexion and the thigh in extension.
Aggravation of symptoms on the leg extension side (symptomatic side) indicates SI joint lesion.
74
YEOMAN’S TEST
Pt is prone. Dr will stand on the tested side and flex the leg at the knee to 90 degrees. Dr. will grasp the anterior knee with the inferior hand, and with the hell on the superior hand, stabilize the affected posterior SI joint (ipsilateral). Dr lifts the knee, which will extend the thigh.
Aggravation of posterior SI joint problems indicates SI joint surface pathology. Deep pelvic pain on the anterior side of the SI joint would indicate SI joint anterior sacro-iliac ligament.
75
ILIAC COMPRESSION TEST
Pt is lying on their side with the affected side up. Dr will grasp the superior ilium and rock it posterior and medial.
Aggravation of SI joint pain on the side being compressed indicates SI joint lesion.
76
HIBB'S TEST
Pt is prone. Dr flexes the knee approximating the heel to the buttock. Add internal rotation of the thigh by pushing the ankle laterally.
Aggravation of posterior SI joint symptoms indicates posterior SI joint ligament pathology.
77
ANVIL'S TEST
Pt is supine. Examiner will strike the inferior calcaneus of the affected hip with their fist after the leg is slightly flexed.
Aggravation of hip symptomatology would be hip joint pathology or may indicate a fracture. In the thigh, lower leg, or heel would suspect joint pathology or fracture.
78
PATRICK'S TEST
Pt is supine. Dr will grasp the ankle and the knee. Flex the knee and the hip. Abduct the hip. Externally rotate the hip and then lay the ankle on the opposite knee (making a figure 4). Stabalize the contralateral ASIS and push down on the ipsilateral knee. As the pt relaxes, they extend the hip.
Aggravation of hip symptoms especially in the groin area is the joint capsule. In the posterior part of the hip is the joint surface. It can also be pain int he SI joint.
79
OBER'S TEST
Pt lies on their side with the affected side up. Dr places one hand on the up side ilium to stabilize the pt. Grasp the pt lower leg and flex the knee to 90 degree. Then abduct and extend the hip. While in extension, relax and allow the hip to adduct.
If the maneuver is performed and the hip remains in abduction, or lowers in a rachet (jerky) motion it indicates hip joint pathology (IT band)
80
THOMAS TEST
Pt is supine. Dr stands on the same side as unaffected leg. Dr will flex the knee and the hip, approximating the knee to the abdomen.
Maintenance of a lordotic curve and flexion of the contralateral hip with this test indicates a contracture of the iliopsoas muscle.
81
NOBEL'S COMPRESSION TEST
With the pt supine the dr stands on the side being tested flexing the hip and knee to 90 degrees and then contact the lateral femoral condyle with his superior thumb compressing the distal tendon of the IT band. Then the examiner will extend the hip lowering the leg.
Severe pain under the thumb as the leg reaches about 30 degrees of extension indicates IT band contracture and friction rub against the lateral condyle of the femur.
82
KNEE VARUS STRESS TEST
Pt is supine or seated. Stand on the side being tested. Dr will grasp the lateral ankle with one hand and the medial distal femur with the other hand. Stabilize the femur and push the ankle medially, can be done in extension and in slight flexion.
Aggravation of lateral knee symptoms at the location of the lateral collateral ligament would indicate ligament pathology (a sprain). IF there is excessive varus angle. you may have damage to the collateral ligament that has left it lax or avulsed.
83
KNEE VALGUS STRESS TEST
Procedure is the same as varus, only the hands are switched. Contact the medial ankle with one hand, and lateral distal femur with the other. Stabilize the thigh and push the leg into abduction.
Aggravation of medial knee symptoms at the location of the medial collateral ligament would indicate ligament pathology (a sprain). If there is excessive valgus angle, you may have damage to the collateral ligament that has left it lax or avulsed.
84
CLARKE'S SIGN
Pt is supine, with the knee extended. Dr will compress quadriceps muscle at the superior poll of the patella with the thumb web of the hand. Ask the pt to contract the quadriceps muscle as the examiner resists the superior movement of the patella.
Aggravation of retro-patellar symptoms or a failure of the pt to contract the quadriceps due to symptoms indicates a chondromalacia development (softening of the cartilage on the backside of the patella).
85
FOUCHET'S SIGN
For patellar tracking disorder. Pt is supine, with the knee extended. Dr will use the palm of their hand and place it over the patella with slight compression. IF it does not produce symptoms, the dr will move the patella medial and lateral in a rocking motion.
Point tenderness with retro-patellar symptoms upon compression indicates a tracking disorder. Crepitus upon movement would also indicate a tracking disorder.
86
KNEE APPREHENSION TEST
For laterall recurring patellar dislocation. W/the pt supine and the symptomatic knee relaxed and flexed to 30 degrees the examiner will contact the medial patella with their thumbs and push the patella laterally.
Production of pain on lateral movement of the patella or an apprehensive appearance on the pt face indicates a dislocation problem with the patella.
87
PATELLAR BALLOTMENT TEST FOR EFFUSION
Assesses for swelling of the knee. W/the pt supine and the symptomatic leg extended the dr will press down or tap the patella.
Seeing fluid bulge around the patella during the procedure indicates effusion.
88
ANTERIOR POSTERIOR DRAWER SIGN KNEE
Pt is supine w/the knee and the hip flexed, so the pt can put their foot flat on the table. Dr will stabilize the pt foot by either sitting on it or placing their knee on it. Grasp the proximal tibia w/both hands. Pull to do the anterior drawer sign, and push to do the posterior drawer sign of the knee.
Test indicates cruciate tears when there is excessive tibial translation taking place, either anterior or posterior.
89
McMURRAY'S SIGN
For medial and lateral meniscal tears. Pt is supine. Dr. will be on the affected side being tested. Dr inferior hand will grasp the ankle or heel. W/the superior hand take the thumb and chiro index finger and grasp the knee. Then flex the knee and hip to 90 degrees. Then take the thumb and chiro index finger and palpate for the joint space. You will either externally or internally rotate the tibia. The heel will point to the meniscus being tested. Then extend the knee.
Palpable or audible click while extending the knee is indication of McMurray's sign, and indicates meniscal tear. In the absence of clicks, it may be just internal knee symptoms or locking.
90
APLEY'S COMPRESSION TEST
Pt is prone. Dr stands on side being tested. Dr flexes the knee to 90 degrees. Place one hand on the bottom of the foot and the other hand can grasp the ankle. Compress the knee as you rotate internally. Then compress the knee as you rotate externally.
Aggravation of internal knee symptoms w/internal rotation and compression would be lateral meniscus. Lateral knee symptoms would be the lateral collateral ligament. Symptoms with external rotation and compression would be medial meniscus. Medial knee symptoms would be the medial collateral ligament, clicking while performing the test indicates meniscal tears.
91
APLEY'S DISTRACTION TEST
Setup is the same as compression. Instead you will grasp the ankle with both hands. Place one of your knees on the back of the pt thigh to stabilize it on the table. Distract the leg and externally rotate then go back to neutral and distract the leg and internally rotate it. Distract and rotate at the same time. Heel will point to the side being tested.
If you relieve internal knee pain with distraction then there is an internal knee problem (meniscus). If you aggravate symptoms on the medial knee w/distraction and external rotation, then it is the medial collateral ligament. If you aggravate or reproduce symptoms on the lateral knee w/distraction and internal rotation, then it is the lateral collateral ligament.
92
BOUNCE HOME TEST
The pt is supine and relaxed, the dr will completely flex the knee and then allow it to passively extend.
The incompletely extension of the knee due to internal knee symptoms indicates meniscal injury.
93
ANKLE DRAWER SIGN (A/P)
Pt is supine. !st, dr will grasp the anterior tibia/fibula at the distal end with one hand and grasp the posterior calcaneus with the other hand. Pull the calcaneus anteriorly. Next the dr will grasp the posterior distal tibia/fibula with one hand and the dorsum of the foot with the other hand, stabilize the tibia/fibula and push the foot posterior.
Excessive anterior movement of the foot would indicate tearing of the anterior talo-fibular ligament. Excessive posterior movement of the foot indicates tearing of the posterior talo-fibular ligament.
94
TINEL'S SIGN POSTERIOR TIBIAL NERVE
Pt is supine. Dr stands on the side being tested. Put the pt leg in a figure 4 and strike the posterior tibial nerve at the tarsal tunnel inferior to the medial malleolus with a reflex hammer.
Reproduction of numbness and tingling indicates posterior tibial nerve pathology.
95
ANKLE VARUS
This is a passive inversion of the ankle.
Production of symptoms at the lateral ankle indicates ligament damage or pathology of the fibular-calcaneal ligament, if there is ligament laxity you must check the contralateral ankle.
96
ANKLE VALGUS
This is passive eversion of the ankle.
Production of symptoms at the medial ankle during this procedure indicates ligament damage or pathology of the tibial-calcaneal ligament, if there is ligament laxity you must check the contralateral ankle.
97
HOMAN'S SIGN
Pt is supine. Dr is on the side being evaluated. Dr grasps the bottom of the foot with his inferior hand, and grasps the calf muscles with the superior hand. As you dorsiflex the foot, you squeeze the calf.
Reproduction of calf symptoms indicates phlebitis or thrombophlebitis.
98
MORTON'S TEST
Pt is supine. Dr will grasp the affected foot from the bottom at the level of the metatarsal heads. Then squeeze the foot.
Reproduction of symptoms in the area of the metatarsal heads would be a metatarsalgia, if it b/t the metatarsals, then possibly a Morton's neuroma (usually b/t 3rd and 4th metatarsals)
99
STRUNSKY'S SIGN
Can be done at individual toe or all of the toes at once. Procedure is a sudden passive flexion of the toes.
Aggravation of symptoms at the metatarsal-phalangeal joint indicates metatarsalgia.
100
SUGACHROMIAL PUSH-BUTTON TEST
For bursa inflammation. Pt is seated. With upper extremities relaxed at their sides. Dr stands behind the pt and toward the side being tested. Dr exerts a strong finger or thumb pressure inferior, medial to the acromial process and lateral to the coracoid process.
Increase in/or reproduction of symptoms indicates an inflamed bursa.
101
DAWBURN'S TEST
For subacromial bursitis. Pt seated, arms relaxed at their side. Palpate medial, inferior to the acromial process and lateral to the coracoid process. Raise the shoulder in passive abduction.
A decrease in the pt symptoms as you abduct the shoulder will be indicative of a bursitis.
102
ADAM'S SIGN
Pt flexes the lumbar spine. A scoliotic curvature that does straighten is a negative sign, indicating evidence of functional scoliosis. A positive sign occurs when the scoliosis does not improve after flexing forward.
103
BEEVOR'S SIGN
Pt is supine. The pt lifts the head off of the examining table. Normally, the upper and lower abdominal muscles contract equally and the umbilicus does not move or drift. When the lower abdominal muscles alone are weakened, the umbilicus will be drawn upwards by the contraction of the intact upper musculature.
104
SCHEPELMANN'S SIGN
Identifies rib integrity. Pt raises the arms while in the seated position and then bends laterally. Pain created on the concave side is caused by intercostal neuritis. Pain created on the convex side is intercostal myofascitis. Intercostal myofascitis must be differentiated from the fibrous inflammation of pleurisy.
105
STERNAL COMPRESSION TEST
Pt is supine. Dr exerts a downward pressure on the pt sternum.
Localized pain at the lateral border of the ribs indicates a rib fracture.
106
FORESTIER'S BOWSTRING SIGN
Pt standing. Pt laterally bends and reveals ipsilateral tightening and contracture of the paraspinal musculature. Normally, the contralateral musculature demonstrates tightening. This test is significant for ankylosing spondylitis.
107
CHEST EXPANSION TEST
The chest diameter is measured at the level of the fourth intercostal space. Measurement is taken as the patient exhales maximally. A second measurement is made as the pt inhales deeply. The normal difference b/t inspiration and expiration is 5.75-7.62cm.
108
Allen's Test
Assesses for radial and ulnar artery patency. With the pt seated and their hand in the air as if they are being sworn in, have them make a fist a few times then the dr occludes both the ulnar and radial arteries with their thumbs by compression. Now lower the pt's arm and have them open their hand, the parlm of the hand will be whitish. Release the pressure on one of the arteries and notice the length of time it takes for the blood to fill the palm. Repeat the procedure for the other artery and compare bilaterally.
Slow filling in a pt with hand complaints (numbness/pain) indicates vascular occlusion
109
Elbow Flexion Test
Assesses the cubital tunnel (where the ulnar nerve passes through for irritation of ulnar nerve due to stretching). Pt actively flexes the elbow as far as they can and hold it there up to 5 minutes.
Numbness and tingling from the elbow along the ulnar nerve distribution indicates irritation.
