Reversed ALL Flashcards
(146 cards)
1
Q
Pt prone. Firm pressure is applied by Op over the suspected sacroiliac joint, fixing the Pt’s anterior pelvis to the table. With the other hand, the Pt’s leg is flexed on the affected side to the physiologic limit, and the thigh is hyperextended by Op lifting the knee from the examining table.
If pain is increased in the sacroiliac area, it is significant of a ventral sacroiliac or hip lesion because of the stress on the anterior sacroiliac ligaments.
Normally, no pain should be felt on this maneuver.
A
SI
Yeoman’s Test
1
Q
Op takes a chest measurement with the tape measure over the lowest part of the fourth intercostal space with the patient maximally exhaling. Pt then maximally inhales and another measurement is taken.
Normal expansion for an adult male is at least two inches, and one and one-half inches for an adult female.
Less than these amounts would be a positive test, indicating thoracic fixation. This is considered an important sign in any ankylosing condition such as Marie-Strumpell Disease.
A
T spine
Chest Expansion Test
2
Q
Pt supine, Op places on palm against the medial aspect of knee (opposite to the one being tested) at the joint line. With the other hand Op grips the ankle, pulling it medial, thus opening the lateral side of the joint.
If this action causes no pain, then Op repeats it with the knee in 20-30 degrees of flexion, which puts the knee joint maximally vulnerable to a torsion stress.
If either of these actions produces or exacerbates pain, below, above or at the joint line, then the test is considered positive, indicating a lateral collateral ligament injury.
A
Knee
Varus Stress Test
2
Q
To assess for an unstable superior labral anterior posterior (SLAP) lesion.
Op standing adjacent to the affected arm and observing the Pt’s response to the test. Op can place their hand over the shoulder to palpate for a click. Pt elevates the affected shoulder in the scapular plane to 90°, with the elbow extended and the forearm fully pronated, and horizontally adducts the arm across the chest.
The presence of pain is noted and the arm is returned to the abducted start position.
The same movement is then repeated with the forearm in supination and any pain noted.
Localized anterior shoulder pain, sometimes combined with an audible or palpable click that is more pronounced during the first test, is suggestive of an unstable SLAP lesion.
The functional nature of this test (turning a steering wheel) makes it an easy one for the clinician to remember!
A
GH
SLAPprehension test
3
Q
This is a variation of the shoulder abduction stress test and the arm drop test.
If the Pt’s arm can be passively abducted laterally to about 100º without pain, the Op removes support so the position is held actively by the Pt. This produces sudden deltoid contraction.
When a rupture of the supraspinatus tendon or strain of the rotator cuff exists, the pain produced causes the patient to hunch the shoulder and lower the arm.
A
GH
Codman’s Sign
3
Q
Pt prone, Op palpates the sacral sulcus and inferior angle of the sacrum on each side. Assess sacral sulci and inferior angles to see if they are symmetrical or asymmetrical.
Pt moves up onto their elbows.
If the landmarks become more symmetrical, it is a forward torsion.
If the landmarks become more asymmetrical, it is a backward torsion.
A
SI
Sphinx Test
4
Q
Pt supine, Op strikes a line from the ASIS to the midpoint of the patella, and from the tibial tubercle to the midpoint of the patella. A goniometer is placed on the knee such that the axis if over the midpoint of the patella, the proximal arm is over the line to the ASIS, and the distal arm is over the line to the tibial tubercle.
The result angle is the Q-angle. Q-angle norms for males are 13 degrees and 18 degrees for females. Angles greater or less than these norms may be indicative of patellofemoral pathology.
A
Hip / Knee
Q-Angle Test
4
Q
Pt supine, Op slowly extends, rotates and laterally flexes cervical spine to each side for 30 seconds.
Dizziness, blurred vision, nystagmus, slurred speech or loss of consciousness are indicative of partial or complete occlusion of the vertebral artery.
A
C spine / Vascular
Vertebral Artery Test
4
Q
Pt seated, Op rests both hands on the top of Pt’s head and applies a downward pressure while the subject laterally flexes the head. When Pt’s head is in maximum rotation and flexion, Op delivers a vertical blow to the top of the head.
The test is repeated with the subject laterally flexing to the opposite side.
A reporting of pain into the upper extremity toward the same side that the head is laterally flexed is a positive sign and indicates pressure on a nerve root which can be correlated by dermatomal distribution of pain.
A
C spine
Spurling’s Test
5
Q
Pt standing, shoulders forward flexed to 90 degrees, forearms supinated, palms up and eyes closed. Hold 10-30 secs.
+ve for vascular impediment to brainstem if one arm starts to fall with simultaneous forearm pronation.
A
C Spine / Brainstem
Barre’s Test
5
Q
The Pt in the sitting position attempts to extend each leg one at a time followed by an attempt to extend both legs.
The sign is positive if backache or sciatic pain is increased or the maneuver is impossible.
In disc involvements, extending both legs will usually increase spinal and sciatic discomfort.
A
L spine
Bechterew’s Test
6
Q
Two tests are involved.
First, with the Ptt sitting, the Op stands behind the Pt and the Pt’s head is laterally flexed and rotated about 45º toward the side being examined. Interlocked fingers are placed on the Pt’s scalp and gently pressed caudally.
If an IVF is physiologically narrowed, this maneuver will further insult the foramen by compressing the disc and narrowing the channel, causing pain and reduplication of other symptoms.
Second, the Pt’s neck is extended by the examiner placing interlocked hands on the Pt’s scalp and gently pressing caudally.
If an IVF is physiologically narrowed, this maneuver mechanically compromises foraminal diameters bilaterally and causes pain and reduplication of related symptoms.
A
C spine
Cervical Compression Tests
AKA Jacksons Compression Test
6
Q
The Pt is seated on a table with the knee flexed to 90 degrees and the involved foot relaxed in slight plantar flexion. While assuring stabilization of the distal tibia and fibula, the Op applies a posterior force to the calcaneous and talus.
Posterior translation of the talus away from the ankle mortise that is greater on the involved side suggesta possible posterior talofibular ligament sprain.
A
Ankle
Posterior Lachman’s Test
6
Q
During Lasegue’s SLR test, the limb is lowered slightly to a point just below the level of pain, the examiner then dorsiflexes the big toe to induce traction on the sciatic nerve.
Pain arising in the posterior thigh or calf indicates sciatic radiculopathy.
A
L spine
Sicard’s Sign
7
Q
To detect anterior instability of the glenohumeral joint.
Apprehension : The Pt lies supine on the table with the involved shoulder in 90 degrees of abduction and the elbow in 90 degrees of flexion. The Op holds the lower forearm and supports the elbow. Then slowly externally rotates the shoulder.
If a positive response is not given, the hand supporting the elbow is then moved to the posterior aspect of the humeral head and an anteriorly directed force can then be applied to further challenge the stability of the shoulder.
Relocation : The Pt’s shoulder position of 90° abduction and external rotation is maintained and the clinician re-positions the heel of their hand over the anterior aspect of the humeral head and applies a firm posteriorly directed force.
A
GH
Apprehension and Relocation Test
7
Q
Ulnar:
Pt seated and the elbow in slight flexion, Op stabilizes the wrist and taps the ulnar nerve in the ulnar notch with the index finger.
Tingling along the ulnar distribution of the forearm, hand, and fingers is indicative of ulnar nerve compromise.
Bilateral assessment is recommended for comparison of results.
Posterior Tibal (Tarsal tunnel):
Pt supine, Op uses his finger to tap over the medial aspect of the ankle where the posterior tibial nerve is the most superficial.
Pain or tingling that radiates along the pathway of the posterior tibial nerve is indicative of tarsal tunnel syndrome.
Compression of the posterior tibial nerve in the tarsal tunnel will result in referred symptoms to the medial and plantar regions of the foot.
A
Peripheral Nerve
Tinel’s Sign
8
Q
To test for a partial or complete tear of subscapularis.
Pt position - Standing or sitting on the edge of a treatment couch with the shoulder internally rotated so that the dorsum of the hand rests against the mid-lumbar spine.
Op position - Standing behind Pt, the distal end of the Pt’s forearm is lifted away from the lumbar spine, so that the shoulder is fully internally rotated. With the arm passively ‘lifted off’, Pt is asked to maintain the position without extending the elbow as the support of the Op’s hand is removed.
An inability to maintain the lifted-off position signifies a complete tear of the subscapularis tendon.
A partial tear is denoted by a limited ability to maintain the liftedoff position, such that the arm drops back less than 5°.
A
GH
Lift-off Sign
AKA Gerber’s test
Gerber’s lift-off test
Internal rotation lag sign
Medial rotation ‘spring back’ test
9
Q
The Pt sits or stands and makes a fist on the involved side. The Op passively supinates the forearm and extends the elbow and wrist.
Complaints of discomfort along the medial aspect of the elbow may be indicative of medial epicondylitis (Golfer’s Elbow).
A
Elbow
Golfer’s Elbow Test
10
Q
Pt side-lying with the hips and knees extended test leg superior. Op stabilizes the Pt’s pelvis to prevent rolling while abducting and extending the test hip and allowing the leg to lower slowly.
The inability of the leg to adduct and touch the table is indicative of ITB tightness.
A
ITB
Ober’s Test
11
Q
This test is used to rule out hip disease.
Pt with sciatic symptoms is placed supine. If pain is elicited on flexing the thigh on the trunk with the knee extended but not produced when the thigh is flexed on the trunk with the knee relaxed (flexed), hip pathology can usually be ruled out.
A
L spine / Hip
Lasegue’s Differential Sign
11
Q
Pt supine, Op grasps elbow with one hand and stabilizes the ipsilateral and involved shoulder with the other hand. Op places the Pt’s involved shoulder in a position of 90 degrees of flexion and internal rotation while applying a posterior force through the long axis of the humerus.
A positive finding is a “look of apprehension” on the subject’s face toward further movement in the posterior direction.
A
GH
Posterior Apprehension Test
11
Q
Pt seated with both arms hanging at the sides, Op behind the patient palpates the radial pulse during 180 degrees of active and then passive abduction of both arms, while noting at how many degrees of abduction the radial pulse on the affected side diminishes or disappears when compared to the opposite side.
If this action diminishes or eliminates the radial pulse, the test is considered positive, indicating a neurovascular compression of the axillary artery as seen in thoracic outlet syndrome (TOS).
A
TOS
Wright’s Test
12
Q
The neck of a sitting Pt is flexed to about 45º while the Op percusses each of the cervical SPs and adjacent superficial soft tissues with a rubber-tipped reflex hammer.
Evidence of point tenderness suggests a fractured or acutely subluxated vertebral motion unit or a localized sprain or strain, while symptoms of radicular pain suggest radiculitis or an IVD lesion.
A
C spine
Cervical Percussion Test
12
Q
Pt side-lying with the tested hip on top. Passively move the Pt’s LEX into flexion (90 degrees), adduction, and internal rotation.
A positive test for irritation of the sciatic nerve by the piriformis occurs when pain is produced in the sciatic/gluteal area.
Due to the position of the test, pain may produced in the anterior thigh as well as a result of femoral acetabular impingement.
A
Hip
Flexion, Adduction, Internal Rotation (FAIR) Test
13
This test is primarily employed when fracture of a vertebra is suspected.
Pt supine without pillows. One hand of Op is placed on the sternum, and mild pressure is exerted to prevent flexion at either the lumbar or thoracic regions of the spine. The other hand of Op is placed under the occiput, and the head is slowly flexed toward the chest.
Flexion of the head and neck on the chest progressively produces a pull on the posterior spinous ligaments from above, and when the spinous process of the injured vertebra is reached, an acute local pain is experienced by Pt.
C spine
**Soto-Hall Test**
14
The Pt lies supine on the table with the involved shoulder in 90 degrees of abduction and the elbow in 90 degrees of flexion. The Op slowly externally rotates the shoulder.
A positive finding is a “look of apprehension” on the subject’s face toward further movement in the externally rotated direction and may suggest instability of the glenohumeral joint.
GH
**Anterior Apprehension Test**
14
With the Pt sitting, the Op stands to the side and places one hand under the Pt's chin and the other hand under the base of the occiput. Slowly and gradually the Pt's head is lifted to remove weight from the cervical spine.
This maneuver elongates the IVFs, decreases the pressure on the joint capsules around the facets, and stretches perivertebral soft tissues.
If the maneuver decreases pain and relieves other symptoms, it suggests narrowing of one or more IVFs, cervical facet syndrome, or spastic perivertebral muscles.
C spine
**Cervical Distraction Test**
15
Op compresses the suprapatellar pouch with the proximal hand, then compresses the patella into the femur. Downward movement of the patella followed by a rebound will give the appearance of a floating or ballotable patella and is indicative of moderate to severe joint effusion.
Knee
**Patella Tap Test**
16
Pt prone and Op standing on the side of involvement, the Op reaches over and stabilizes the uninvolved sacroiliac joint while the thigh on the involved side is extended at the hip.
Pain initiated by this maneuver in the sacroiliac area of the involved side is a positive sign of acute sacroiliac sprain/subluxation or sacroiliac disease.
SI
**Gillis' test**
17
Pt standing, Op behind with thumbs on the posterior superior iliac spines. Op then notes whether the posterior superior iliac spines are level.
Unleveling is indicative of sacroiliac joint fixation or one side or the other. The examiner may also perform the test while the subject actively flexes each hip one at a time.
SI
**SI Joint Fixation Test**
18
1st - pt seated flexes both arms to 90 degrees and closes eyes.
If arms move cause is nonvascular.
2nd - pt rotates or extns and rots head, closes eyes.
If arms move then is it +ve for vascular
Vascular
**Hautant’s Test**
18
The affected limb's hip and knee are passively flexed to 90 degrees. The examiner applies pressure with the thumb over the IT Band proximal to the lateral femoral condyle. Pt then actively extends the hip and knee.
Pain produced over the distal IT band, where the pressure is being applied, before 30 degrees short of knee extension is a positive test indicating ITB contribution to Pt symptoms.
Pain produced at less than 30 degrees of knee flexion is not a positive test.
ITB
**Noble Compression Test**
19
Pt actively elevates the arm in the scapular plane, then slowly reverse the motion.
The test is considered positive for subacromial impingement if the patient has pain between 60- 120 degrees of scaption during elevation.
GH
**Painful Arc Sign**
20
With the Pt sitting, the Op stands behind and to the side to monitor the radial pulse. OP brings the P's shoulder and arm posterior and then depresses the shoulder on the side being examined.
This maneuver narrows the ipsilateral costoclavicular space by approximating the clavicle to the first rib, tending to compress the neurovascular structures between.
When the shoulder is retracted, the clavicle moves backward on the sternoclavicular joint and rotates counterclockwise.
An alteration or obliteration of the radial pulse or a reduplication of other symptoms suggests compression of the neurovascular bundle passing between the clavicle and the 1st rib (costoclavicular syndrome).
TOS
**Costoclavicular Manoeuver**
20
Pt supine with the hips and knees fully extended and parallel. Using a tape measure, the examiner measures from the most distal point of the ASIS to the most distal point of the medial malleolus.
A difference of more than 1 cm is indicative of discrepancies in either the length of the femur or tibia, or in the angle of the femoral neck inclination.
LEX
**True Leg-Length Discrepancy Test**
21
Active tests of LEX to assess for intermittant claudication:
1. Neurogenic claudication - stenosis/extn of spine. Relieved by flexion
2. Vascular claudication - relieved by rest only.
**Bicycle Test of van Geldren**
AKA Treadmill Test & Stoop Test
22
The Pt lies supine with the test knee flexed 20-30 degrees. From a neutral position, the Op applies an anterior force to the tibia with the distal hand while stabilizing the femur with the proximal hand.
Excessive anterior translation of the tibia with a diminished or absent endpoint is indicative of a partial or complete tear of the ACL.
Knee
**Anterior Lachman's Test**
23
Pt stands on the test leg with the knee bent to 20 degrees of flexion (the opposite leg is flexed behind the patient). Pt may place his/her hands on the hands of Op for balance during the test. Pt then rotates the knee medially and laterally 3 times each direction.
A positive test occurs when there is joint line discomfort or if locking/catching occurs indicating a meniscus lesion.
Knee
**Thessaly Test**
24
If pain occurs during Lasegue's SLR test, the knee is slightly flexed and the patient's foot is allowed to rest on the examiner's shoulder.
When pain subsides, manual pressure is applied against the hamstrings. If this does not increase pain, manual pressure is then quickly applied to the popliteal fossa while holding the knee as straight as patient comfort will allow.
Although local pain in the popliteal fossa is of minor consequence, a reproduction of leg or low-back pain is highly significant of an IVD rupture producing nerve root compression.
L spine
**Bowstring Sign**
25
This test has the Pt standing with the arms hanging loosely at the side. The Op deeply palpates the Pt's shoulder eliciting a localized tender area. The Op, while leaving the finger on the painful spot, passively abducts the Pt's arm.
This sign is present when the painful spot disappears on abduction, indicating subacromial bursitis.
GH
**Dawbarn's Sign**
26
Pt seated , Op laterally flexes head away from the side being tested while applying traction to the shoulder.
Pain is indicative of muscular or ligamentous injury, or dural sleeve adhesions.
C spine
**Shoulder Depression Test**
27
This test is used for indicating low back radiculopathy or lumbar disc herniation.
Pt seated upright on the edge of a table or bench without a backrest. Op extends the Pt LEX's below the knee one at a time, so each limb is parallel with the floor.
If there is no radiculoneuropathy, the patient should experience no discomfort from this action.
It has advantages when checking for malingering, because the test can be performed without the patient knowing what is being tested. This version can be used on those patients where simulation, falsifying or magnification of symptoms is suspected.
L spine / Malingering
**Lasegue's Sitting Test**
28
This test is used to determine excessive iliopsoas tension.
Pt supine holds one flexed knee against his abdomen with his hands while the other limb is allowed to fully extend. Pt's lumbar spine should normally flatten.
If the extended limb does not extend fully (ie, the knee flexes from the table) or if the Pt rocks his chest forward or arches his back, a fixed flexion contracture of the hip is indicated, as from a shortened iliopsoas muscle.
This should always be tested bilaterally. Some examiners use the degree of pain elicited on forced extension of the flexed knee as their criterion of iliopsoas tension.
Hip / Psoas
**Thomas' Test**
29
Pt standing and asked to closeeyes for 20 secs.
If body sways excessively or pt loses balance = +ve for upper motor neurone lesion.
UMNL
**Rhomberg’s Test**
30
Pt prone. Firm pressure is applied by Op over the suspected sacroiliac joint, fixing the Pt's anterior pelvis to the table. With the other hand, the Pt's leg is flexed on the affected side to the physiologic limit, and the thigh is hyperextended by Op lifting the knee from the examining table.
If pain is increased in the sacroiliac area, it is significant of a ventral sacroiliac or hip lesion because of the stress on the anterior sacroiliac ligaments.
Normally, no pain should be felt on this maneuver.
SI
**Yeoman's Test**
31
This variant of Lasegue's SLR test is used in lumbago and IVF funiculitis with the intent of differentiating between lumbago and sciatica.
When the affected limb is first extended and then flexed at the hip, the corresponding half of the body becomes lowered and with it the muscle fibers fixed to the lumbosacral segment. This act, which stretches the involved muscles, can induce sharp lumbar pain.
Lasegue's sign is thus negative as the pain is caused by stretching the affected muscles at the posterior portion of the pelvis rather than stretching the sciatic nerve.
To accomplish this test with the Pt supine, the pelvis is fixed by the Op's hand firmly placed on the ASIS while the other hand elevates the ipsilateral leg. No pain results when the leg is raised to an 80 angle. When lumbago and sciatica coexist, Demianoff's sign is negative on the affected side but positive on the opposite side unless the pelvis is stabilized.
This sign is also negative in bilateral sciatica with lumbago. The stabilization of the pelvis prevents stretching the sciatic nerve, and any undue pain experienced is usually associated with ischiotrochanteric groove adhesions or soft-tissue shortening.
L spine
**Demianoff's Test**
31
Supine Pt extends the head and neck over the edge of the table. With eyes open the Pt actively rotates the head and neck while maintaining the extended position.
One or more of the following indicates a positive test: either blanching or cyanosis of the face, nystagmus, sweating, dizziness, nausea, headache or an increase of temperature.
Until vascular disorders are ruled out by further examination, a positive test would indicate that cervical manipulation involving rotation and/or extension is contra-indicated.
VBI
**George's Test**
33
Pt seated but with leg straight out on table (hip flexed only). Op flexes head and flexes leg simultaneously (leg is kept straight)
+ve for spinal cord lesion and/or upper motor neurone lesion if there is sharp, electric shock-like pain down the spine and into the UEx and/or LEx.
Coughing or sneezing may produce similar results.
UMNL / Spinal cord
**Lhermitte’s Sign**
34
Pt supine with test shoulder placed in 90–110 degrees of abduction and 10-15 degrees of extension. The test elbow is flexed to 90 degrees. Op slowly rotates Pt's shoulder into maximal external rotation.
Reproduction of the subject’s pain in the posterior aspect of the shoulder is indicative of rotator cuff and/or posterior labral pathology.
GH
**Posterior Impingement Sign**
35
Pt should normally be able to walk several steps on the heels with the forefoot dorsiflexed. Except for a localized heel disorder (eg, a calcaneal spur) or contracted calf muscles.
Inability to do this because of low-back pain or weakness can suggest an L5 lesion.
L spine / Brainstem
**Heel Walk Test**
36
With the Pt sitting or standing, the Op applies a firm tap to the end of the finger being tested.
Pain at the site of injury suggests a possible fracture. The Op may also use a percussion hammer for this test.
Hand
**Finger Tap Test**
38
Pt performs “spectacle” ulnar nerve stretch
Pain in scapular or arm is +ve for ulnar nerve or T1 nerve root irritation.
Peripheral Nerve
**Ulnar Nerve Traction Test**
AKA T1 Nerve Root Stretch
39
Pt seated, Op stands behind compressing jugular veins for 30 secs & asks Pt to cough. Soon as any light-headedness etc occurs abort.
+ve may indicate nerve root problem or space occupying lesion.
Vascular / Spinal cord
**Naffziger’s Test**
40
Aim to identify subacromial or internal impingement.
Pt with the arm relaxed in the anatomical position. Op standing adjacent to the patient on the affected side, one hand is placed under the elbow, the other holds just above the wrist. The elbow is flexed to 90° and the shoulder taken passively into 90° of forward flexion. The shoulder is passively taken into internal rotation thereby rotating the greater tuberosity under the coracoacromial arch.
Pain is reproduced increasingly towards the end of the rotation movement and indicates rotator cuff pathology involving the cuff itself, the adjacent bursa or the long head of biceps. The glenoid labrum is also vulnerable in this test.
A positive result is highly likely in the presence of a capsulitis which should therefore be excluded to avoid a false positive result.
GH
**Hawkin's-Kennedy**
40
Op stands opposite the involved side and places both thumbs on the medial border of the patella being tested. Pt should remain relaxed with no quadriceps contraction while Op pushes the patella laterally.
If Pt is apprehensive to this movement or contracts the quadriceps muscle to protect again subluxation, the test is indicative of patellar subluxationor dislocation.
This test can also be performed with the knee flexed 30 degrees.
Knee
**Patellar Apprehension Test**
41
Pt seated holding head into full extn and 45 degree rot - bring head lower than body
+ve if dizziness or nystagmus occurs.
NB Also assesses nerve root compression of lower cervical spine.
C spine / vascular
**Dix Hallpike’s Manoeuver**
42
Pt sidelying and underneath LEX flexed acutely at the hip and knee. With the upper LEX held straight and extended at the knee, Pt attempts to abduct the upper limb while the Op applies resistance.
Pain initiated in the area of the upper aspect of the sacroiliac joint or the hip joint suggests an inflammatory process of the respective joint.
Hip / SI
**Hip Abduction Stress Test**
43
Walking for several steps on the base of the toes with the heels raised will normally produce no discomfort to the patient.
Except for a localized forefoot disorder (eg, plantar wart, neuroma) or an anterior leg syndrome (eg, shin splints).
Inability to do this because of low-back pain or weakness can suggest an S1–S2 lesion.
L spine / Brainstem
**Toe Walk Test**
44
With the Pt lying supine, the Op passively flexes the Pt’s test knee and then allows the knee to passively fall into extension.
A rubbery endfeel or springy lock is indicative of a meniscal tear.
This test should be performed with caution.
Knee
**Bounce Home Test**
44
Pt standing. Op grasps pelvis with both hands clasped and blocks one side of the Pt’s lower thorax with the Op’s shoulder. Op pulls pelvis towards Op and holds for 15 secs. Rpt on opp side.
Increased neuro signs = +ve sign, and indicates if scoliosis is causing symptoms.
T spine
**McKenzie’s Side Glide Test**
46
Op should lift the tested leg off the table with the knee fully extended. Place the heel of one hand behind the fibular head of the patient. Use the other hand to grasp the tibia, while palpating the medial joint line. While maintaining a valgus force and internal rotation of the tibia throughout the test, slowly flex the Pt's knee (note: the test starts by putting the tibia in the abnormal position!).
A positive test occurs when the lateral tibial plateau begins anteriorly subluxed and returns to neutral as you flex the knee to around 30 degrees. This indicates loss of integrity of the MCL and ACL (rotary instability).
Knee
**Pivot-Shift Test**
47
Pt seated - hands behind back
Ask Pt to:
Slump - add pressure
Drop head - add pressure
Ext leg - ask pt to straighten and apply dorsi flexion
Rpt on other leg Rpt on both legs at same time Keep pressure applied thru-out.
If knee cannot be extnd bc of pain = +ve for increased tension in neuromeningeal tract
Release neck to neutral - ask pt to extnd/straighten knee = +ve for above.
In hypermobile patients more than 90 degrees of hip flex is needed and also add int rot and add. Stop as soon as a positive test results.
L spine / Spinal cord
**Slump Test**
48
The Pt lies supine with the hips and knees fully extended and parallel. Using a tape measure, the Op measures from the umbilicus to the most distal point of the medial malleolus.
A difference of more than 1 cm is indicative of abnormalpelvis positioning.
Significant discrepancies should be verified via radiology.
LEX
**Apparent Leg-Length Discrepancy Test**
49
If the Pt has an S or a C scoliosis, note if the scoliosis straightens when the spine is flexed forward.
If it does, it is a negative sign and evidence of functional scoliosis.
A positive sign is noted when the scoliosis is not improved, thus evidence of a structural scoliosis.
T spine
**Adams' sign**
50
Pt supine while Op flexes the thigh and knee to right angles. The thigh is then abducted and rotated outward.
This forces the head of the femur against the anterior portion of the hip joint capsule.
The sign is present when this action produces pain, tending to rule out a lumbosacral lesion, but indicating a hip joint lesion, iliopsoas muscle spasm or a sacroiliac lesion.
L spine / Hip / SI
**Laguerre's Sign**
52
Pt seated, Op rotates head to EOR R and L holding at each extreme for 30secs - shoulders should remain stationary. Then Pt’s shoulders only are rotated keeping head facing forward.
+ve for vertebral artery occlusion if symptoms in both directions as it is kinked in both directions. If dizziness is only experienced when head is rotated the problem lies within the semicircular canals of inner ear.
Vascular
**Dizziness Test**
**Vertebral Artery Occlusion vs Inner Ear**
53
Pt sidelying with the underneath lower limb flexed acutely at the hip and knee. Op stabilizes the uppermost hip with one hand. With the other hand, the uppermost leg is grasped near the knee and the thigh is extended on the hip.
Initiated or aggravated pain suggests a sacroiliac lesion.
SI
**Lewin-Gaenslen Test**
54
This sign is positive if a patient with a history of lower trunk discomfort and fatigue is fairly comfortable when sitting with the knees flexed but experiences discomfort in the standing position.
It is typically seen in spasticity or contractures of the posterior thigh and/or calf muscles.
LEX
**Beery's Sign**
54
Pt sits with the elbow flexed to 90 degrees and stabilized against the thorax. The forearm is in a pronated position. Op places one hand along the subject’s forearm and the other hand on the proximal portion of the humerus, near the bicipital groove. Op resists Pt's attempt to actively supinate the forearm and externally rotate the humerus.
Pain in the bicipital groove is a positive finding that may indicate bicipital tendonitis.
GH
**Yergason Test**
56
If Lasegue's SLR test is positive at a given point, the examined leg is lowered below this point and dorsiflexion of the foot induced.
The test is negative if pain is not increased.
A positive sign is a finding in sciatic neuritis, spinal cord tumors, IVD lesions, and spinal nerve irritations.
A negative sign points to muscular involvement such as tight hamstrings. Bragard's test does not stress the sacroiliac or lumbosacral articulations.
L spine
**Bragard's Test**
56
The McMurray test is used to evaluate individuals for tears in the medial meniscus of the knee.
Pt's knee is flexed to ninety degrees. Op places one hand on the lateral side of the knee to stabilize the joint and provide a valgus stress. The other hand rotates the foot externally while extending the knee.
If pain or a "click" is felt, this constitutes a "positive McMurray test." The sensitivity of the McMurray test for medial meniscus tears is 53% and the specificity is 59%.
Knee
**McMurray Test**
57
The primary purpose of the sign is to identify symptomatic subacromial impingement involving the rotator cuff, subacromial bursa and long head of biceps.
Pt with arm in the anatomical position, Op stands on the affected side and stabilizes the scapula with one hand and grasps the arm below the elbow with the other hand. The arm is then passively elevated into full flexion with the scapula stabilized.
Pain is reproduced at the end of the passive elevation movement.
GH
**Neers' Sign**
AKA Forward Flexion Impingement Test
59
Pt supine with knees and hips acutely flexed,clasps the knees with both hands and pulls them toward the abdomen.
This brings the lumbar spine firmly in contact with the table and fixes both the pelvis and lumbar spine.
Op standing at right angles to the Pt, the Pt is brought well to the side of the table and the Op slowly hyperextends the opposite thigh by gradually increasing force by pressure of one hand on top of the Pt's knee while the Op's other hand is on the Pt's flexed knee for support in fixing the lumbar spine and pelvis. Some Ops allow the hyperextended limb to fall from the table edge.
The hyperextension of the hip exerts a rotating force on the corresponding half of the pelvis. The pull is made on the ilium through the Y ligament and the muscles attached to the AIISs.
The test is positive if the thigh is hyperextended and pain is felt in the sacroiliac area or referred down the thigh, providing that the opposite sacroiliac joint is normal and the sacrum moves as a unit with the side of the pelvis opposite to that being tested.
The test should be conducted bilaterally.
A positive sign may be elicited in a sacroiliac, hip, or lower lumbar nerve root lesion.
If the L4 nerve is involved, pain is usually referred anteriorly to the groin or upper thigh.
If the sign is negative, a lumbosacral lesion should be the first suspicion.
This test is usually contraindicated in the elderly.
L spine / Hip / SI
**Gaenslen's test**
60
Pt supine, Op places on palm against the medial aspect of knee (opposite to the one being tested) at the joint line. With the other hand Op grips the ankle, pulling it medial, thus opening the lateral side of the joint.
If this action causes no pain, then Op repeats it with the knee in 20-30 degrees of flexion, which puts the knee joint maximally vulnerable to a torsion stress.
If either of these actions produces or exacerbates pain, below, above or at the joint line, then the test is considered positive, indicating a lateral collateral ligament injury.
Knee
**Varus Stress Test**
61
Pt supine, Op passively abducts the shoulder to 90 degrees and horizontally flexes the shoulder 20 to 30 degrees. While stabilizing Pt's scapula, Op applies downward pressure, pushing the humeral head posteriorly.
Increased posterior instability of the humeral head relative to the scapula/glenoid fossa may be indicative of posterior instability.
A bilateral comparison should be done for a more accurate assessment.
GH
**Posterior Drawer Test**
63
Perform standard SLR. If the SLR is positive, the end-feel is usually spasm or capsular, but definitely painful.
Return Pt to neutral. Passively flex the hip, but this time with the ipsilateral knee flexed to end-range. Assess for if further hip flexion was achieved.
If no change in range of motion, the pathology is within the hip or buttock, and not the hamstrings or sciatic nerve.
The second part of the test usually has an empty end-feel and is more painful than the first part.
To be positive indication of non-musculoskeletal causes for the patient's symptoms, the Sign of the Buttock must have all present: restriction of SLR concurrently with limited hip flexion and a non-capsular pattern of restriction of hip joint ROM.
L spine / Hip / Gluteal
**Sign of the Buttock**
64
Pt seated and the test elbow flexed 20-30 degrees, Op applies a valgus stress to the elbow with the proximal hand.
Medial elbow pain and/or increased valgus movement with a diminished or absent endpoint is indicative of damage to the medial (ulnar) collateral ligament.
Elbow
**Valgus Stress Test**
65
Pt shoulder is flexed to 90 degrees, the elbow is fully extended, and the forearm is supinated. Op resists attempt to actively flex the humerus forward.
Tenderness and/or pain in the bicipital groove is a positive finding indicative of bicipital tendonitis.
GH
**Speed's Test**
66
Pt supine: Flexes head against resistance, coughs or tries to sit up with hands behind head.
+ve if umbilicus doesn’t stay in straight line - heads towards the stronger side.
Indicates weakness of lower abdominal mm. Can indicate Amyotrophic Lateral Sclerosis (MND), lesion of spinal cord below T10.
T spine / L spine
**Beevor’s Sign**
67
Pt supine, extended knees and raises both legs approximately two inches off the table for as long as possible.
If Pt is able to hold this position for thirty seconds without pain, intrathecal pathology is ruled out.
The test is positive if the subject cannot hold the position, experiences pain, or cannot lift his or her legs.
A positive test may suggest a herniated disc or pathological pressure on the theca itself.
L spine / Spinal cord
**Milgram's Test**
68
Pt supineand Op places one hand under the lumbar spine with each fingerpad pressed firmly against the interspinous spaces. The other hand of the examiner is used to slowly conduct an SLR test.
If pain occurs or is aggravated before the lumbar processes open (1º--30º, a sacroiliac lesion should be suspected.
In general, Goldthwait believed if pain occurred while the processes were opening at :
* 30º--60º, a lumbosacral lesion was suggested;
* at 60º--90º, an L1–L4 disc lesion.
* When pain is brought on before the lumbar spine begins to move, a lesion, either arthritic or a sprain involving the sacroiliac joint, is probably present.
* If pain does not arise until after the lumbar spine begins to move, the disorder is likely to be in the lumbosacral area or less commonly in the sacroiliac area(s).
The test should be repeated with the unaffected limb.
A positive sign of a lumbosacral lesion is elicited if pain occurs at about the same height as it did with the first limb.
When the unaffected limb can be raised higher than the affected limb, it is thought to be significant of sacroiliac involvement of the affected side.
L spine / SI
**Goldthwait's test**
69
Pt standing, straight arm at 90 deg with add to 10-15 deg, thumb down.
Op places downward force. Then Pt with thumb up position - Op rpts pressure.
+ve if pain or clicking inside the shoulder on thumb down, and if decreased or eliminated with thumb up.
+ve for labral abnormalities - designed to test for (SLAP) Type II or superior labrum lesions.
GH
**Active Compression Test of O’Brien**
71
**Anterior labral tears**: the affected limb is placed in full flexion, lateral rotation, and abduction. The Op then extends the hip passively, while moving it through medial rotation, and adduction as well.
**P****osterior labral tears**: begin with the affected hip in full flexion, adduction, and medial rotation. The Op then extends the hip passively, while moving it through lateral rotation, and abduction.
A sharp pain in the anterior hip is a positive test for a labral tear. Clicking may or may not be audible.
Hip
**Fitzgerald's Test**
73
Pt supine asked to contract the quadriceps muscle whileOp applies a downward and inferior pressure on the patella.
Pain with movement of the patella or an inability to complete the test is indicative of chondromalacia patella.
Knee
**Patellar Grind Test**
74
Pt prone, heels placed over the edge of the table. With the calf muscles relaxed, the examiner squeezes the belly of these muscles.
When squeezing the calf muscles, a normal response is to have the foot plantar flex. An absence of plantar flexion upon squeezing is a positive finding and suggests a possible rupture of the Achilles’ tendon.
Foot
**Thompson Test**
75
This is a two-phase test:
1. The Pt is placed supine, and a straight-leg-raising (SLR) test is performed on each limb: first on one side, and then on the other.
2. The SLR test is then performed on both limbs simultaneously; ie, a bilateral SLR test.
If pain occurs at a lower angle when both legs are raised together than when performing the monolateral SLR maneuver, the test is considered positive for a lumbosacral area lesion.
L spine
**Double Leg Raise Test**
76
Pt prone, Op flexes knee to a right angle; then, with pressure against the anterior surface of the ankle, the heel is slowly directed straight toward the ipsilateral buttock. The contralateral ilium should be stabilized by Op's other hand.
If a sharp pain is elicited in the ipsilateral buttock or sacral area, a sacroiliac disorder should be suspected.
If pain occurs in the hip then a hip lesion should be considered.
If pain occurs in the lower back area or is sciatic-like, a lower lumbar disorder (especially L3 or L4) is indicated.
If pain occurs in the upper lumbar area, groin, or anterior thigh, quadriceps spasticity/contracture or a femoral nerve lesion should be suspected.
L spine / Hip / SI
**Nachlas' Test**
AKA Hibb's Test
78
Pt's dorsal aspect of both hands in full contact so that both wrists are maximally flexed. A steady compressive force is applied through Pt's forearms so wrists are maximally flexed for 1 minute.
Numbness and tingling in the median nerve distribution of the fingers are indicative of carpal tunnel syndrome secondary to median nerve compression.
Wrist / Vascular / Peripheral Nerve
**Phalen's Test**
78
Op applies continuously places hot then cold test tubes behind pt’s ear on side of head.
+ve if induces vertigo which can indicate inner ear problems.
Vascular / Inner ear
**Temperature (Caloric) Test**
79
The Pt with cervical radicular pain actively places the palm of the affected extremity flat on the top of the head raising the elbow to a height approximately level with the head.
The sign is present when the radiating pain is lessened or absent by this maneuver and is indicative of nerve root irritation due to cervical foraminal compression.
C spine
**Baccody Sign**
80
This is a test for malingering associated with an active straight-leg-raising test.
Pt supine attempts to raise LEX, while Op cups one hand under the heel of the opposite foot.
When the typical Pt tries to raise his affected limb, he normally applies pressure on the heel of the opposite limb for leverage and a downward pressure can be felt.
If this pressure is not felt, the patient is probably not really trying.
L spine / malingering
**Hoover's Test**
82
Pt side-lying with the affected side upward. Op places his forearm over the iliac crest and leans pressure downward for about 30º seconds. This tends to compress the sacroiliac and pubic joints.
A positive sign of joint inflammation or sprain is seen with an increase in pain; however, absence of pain does not necessarily rule out sacroiliac involvement.
This test is usually contraindicated in geriatrics and pediatrics or with any sign of a hip lesion or osseous pelvic pathology.
SI
**Iliac Compression Test**
83
The Pt is placed prone with the involved leg flexed at 90º. The Op stabilizes the patient's thigh with a knee and grasps the patient's foot. Downward pressure is applied to the foot to compress the medial and lateral menisci between the tibia and femur. The Op then rotates the tibia internally and externally on the femur, holding downward pressure.
Pain during this maneuver indicates probable meniscus or collateral ligament damage.
Medial knee pain suggests medial meniscus damage; lateral pain, lateral meniscus injury.
Knee
**Apley's Compression Test**
85
Op flicks patients DIPJ of middle finger.
+ve if the IPJ of the thumb flexes (same side) Pt can also actively flex and extd head and then test is performed.
Hand / UMNL
**Hoffman’s Sign**
86
With the Pt either sitting or standing, the Op passively abducts the Pt’s involved arm to 90 degrees and then instructs the subject to slowly lower the arm to the side.
A positive finding is indicated if the subject is unable to slowly return the arm to the side and/or has significant pain when attempting to perform the task. This is indicative of a rotator cuff pathology.
GH
**Drop Arm Test**
87
Biomechanically, this test is the cephalad representation of Lasegue's SLR test.
Supine Pt place both hands behind his head and forcibly flex his head toward his chest.
Pain in either the neck, lower back, or down the lower extremities indicates meningeal irritation, nerve root involvement, or irritation of the dural coverings of the nerve root.
That is, some hypersensitive tissue is being aggravated by tensile forces.
When the examiner passively flexes the patient's neck and trunk, it is called the Soto-Hall test or Lindner's test, depending on the examiner's position.
C spine / T spine / L spine
**Kernig's Test**
88
To detect the presence of inferior instability and the possibility of multidirectional instability (MDI) of the glenohumeral joint.
Pt seated, Op has a clear view of the lateral aspect of the shoulder with the arm dependent over the side of the couch. Op standing on the affected side, the middle finger and thumb of one hand are placed on the anterior and posterior angles of the acromion,leaving the index finger free to palpate the gap between the middle of the acromion and the humeral head. The other hand comfortably grasps the arm just above the elbow in readiness to apply distraction. Pt is instructed to relax the shoulder. A firm downward distraction is exerted gradually.
A sulcus (a deep groove) develops between the lateral edge of the acromion and upper humerus with tautening of the overlying skin suggesting physiological glenohumeral laxity which can be assessed further with directional instability tests.
GH
**Sulcus Sign**
89
The Pt lies prone with the test knee flexed to 90 degrees. The Op uses the distal hand to medially and laterally rotate the tibia while applying a distraction force through the heel.
An increase in and/or change in location of pain is more indicative of ligamentous verses meniscal pathology.
Pain or clicking with a compression test that is followed by an absence of the same symptoms with a distraction test is more indicative of a meniscal pathology.
Knee
**Apley's Distraction Test**
91
Pt supine, Op applies lateral compression to the rib cage. The test is repeated using anterior to posterior compression.
Pain with compression or release of pressure indicates the possibility of a rib fracture, rib contusion, or costochondral separation.
T spine
**Rib Compression Test**
93
Pt sitting is asked to bear down firmly (abdominal push), as if straining at the stool. This act increases intrathecal pressure, which tends to elicit localized pain in the presence of a space-occupying lesion (eg, IVD protrusion, cord tumor, bony encroachment) or of an acute inflammatory disorder of the cord (eg, arachnoiditis).
Deep coughing or sneezing produces the same effect under like circumstances.
Spinal cord
**Valsalva's maneuver**
AKA Dejerine's Sign / triad
94
With the Pt seated, the Op passively and maximally horizontally adducts the test shoulder.
Superior shoulder pain is indicative of acromioclavicular joint pathology.
Anterior shoulder pain is indicative of subscapularis, supraspinatus, and/or biceps long head pathology.
Posterior shoulder pain is indicative of infraspinatus, teresminor, and/or posterior capsule pathology.
GH
**Cross-Over Impingement Test**
94
This test is performed when malingering or hysteria is suspected in the Pt with low back complaints.
Pt points to the site of the pain which in turn is marked by Op. Op then performs other actions away from the marked site of pain.
The test is positive if there is any significant change of the pain site once Op resumes the examination of the low back. A positive test would indicate evidence of simulated pain,hysteria or malingering.
L spine / Malingering
**Magnuson's Test**
95
At the conclusion of a positive sign during Lasegue's supine SLR test, the Op allows the limb to drop to a pillow without warning.
If this rebound test causes a marked increase in pain and muscle spasm, then a disc involvement is said to be suspect.
However, it would appear that any site of irritation in the lower back or pelvis would be aggravated by such a maneuver.
L spine
**Lasegue's Rebound Test**
96
Pt supine, Op places one palm against the lateral aspect of the knee at the joint line of the side being tested and with the other hand grips the ankle pulling it laterally, thus opening the medial side of the joint.
If this action causes no pain, then the examiner repeats it with the knee in 20-30 degrees of flexion, which puts the knee joint maximally vulnerable to a torsion stress.
If either of these actions produces or exacerbates pain, below, above or at the joint line, then the test is considered positive, indicating a medial collateral ligament injury.
Knee
**Valgus Stress Test**
97
Pt sits with the hip flexed to 90 degrees and the cervical spine in flexion, then actively extends the knee.
Pt who arches backward and/or complains of pain in the regions of the buttocks, posterior thigh, and calf during knee extension demonstrates a positive finding for possible sciatic nerve pain.
This test can also be reproduced with the examiner passively extending the Pt’s knee.
L spine
**Sitting Root Test**
98
The Pt is seated with the metacarpophalangeal joint of the involved finger in slight extension. The Op passively flexes the proximal interphalangeal joint (PIP) of the same ray and assesses the amount of PIP joint flexion. The Op then passively flexes the metacarpophalangeal joint (MCP) slightly, and again assesses the amount of flexion at the PIP joint.
A positive finding is revealed if the PIP joint does not flex while the MCP joint is in an extended position.
If the PIP joint does not fully flex once the MCP joint is slightly flexed, intrinsic muscle tightness can be assumed.
By contrast, if flexion of the PIP joint remains limited once the MCP joint is slightly flexed, capsular tightness can be assumed.
Hand
**Bunnel Littler Test**
100
Pt places the thumb in a closed fist and tilts the closed hand towards the little finger.
If pain occurs at the wrist below the thumb, DeQuervain's tenosynovitis is likely.
Wrist
**Finkelstein's Test**
102
Perform with extreme caution!!
Pt seated: Op hand on pt forehead other hand on C2 to stabilise it. Pt slowly flexes head while op pushes posteriorly on forehead.
Determines subluxation of atlas on the axis. If transv lig which maintains dens/odontoid process is torn, C1 will translate forward (sublux) on C2 on flexion.
Pt may not want to flex/be reticent to flex head. +ve if head slides backward during the movement indicating subluxation has been reduced and may be followed with a clunk
C spine
**Sharp-Purser Test**
103
The patient kneels upright on the examining table or a padded bench that is about 18-20" high. The Op firmly grasps the patient's ankle from behind and instructs the Pt to bend over and touch the floor with the fingertips.
Pts who normally cannot be expected to carry out this action are those extremely weak from injury or disease or those significantly diseased at the hip or knee.
Those Pts who may not be able to perform the action are those with sciatic neuralgia, congenital anomalies, arthritis, a specific disease of the spine (such as tuberculosis), or a compression fracture of the spine.
Any Pt (other than those mentioned above who cannot be expected to carry out this action) either refuses to perform the action or claims they can only go part way, is presenting evidence of malingering or hysteria.
L spine / Malingering
**Burn's Bench Test**
105
Pt sidelying - sore side superior Back is straight Op lifts & extns hip with knee extnd (straight) Knee is then flexed.
+ve pain radiating down anterior thigh.
Peripheral nerve
**Femoral Nerve Traction Test**
107
The Pt in the upright position is asked to bend laterally, first to one side and then to the other.
Normally, the contralateral perivertebral muscles will bulge because of the normal coupling rotation of the lumbar spine (exhibited by the spinous processes pointing to the ipsilateral side of lateral flexion).
However, in ankylosing spondylitis (Marie-Strumpell's disease) or a state of extensive spinal fixation, the muscles will appear to bulge greater on the side of the curve's concavity.
T spine / L spine
**Forestier's sign**
107
Stand at the side of the tested limb, facing towards the patient’s head. Use hand closer to patient to depress shoulder and punch into table to keep shoulder in depressed position. Use your second hand on patient’s hand to laterally rotate and abduct the shoulder (about 90 degrees or more). Extend the elbow while the forearm is supinated, wrist and fingers extended.
Stop when Pt reports neural symptoms. Have Pt laterally flex or rotate their head away (worsens pain/symptoms) and toward the arm (relieves pain/symptoms) - a positive test.
Peripheral Nerve
**Median Nerve Test**
108
The Pt lies on the uninvolved side on a table with the involved foot relaxed and the knee flexed to 90 degrees. The Op places the foot in the anatomical neutral position, then tilts the talus into an adducted position.
Range of motion in the adducted position on the involved foot greater than that of the uninvolved foot reveals a positive test and suggests a tear of the calcaneofibular ligament of the ankle.
Ankle
**Ankle Inversion Test**
110
Pt attempts to touch the floor with the fingers while the knees are held in extension during the standing position.
Under these conditions, the knee of the affected side will flex, the heel will slightly elevate, and the body will elevate more or less to the painful side.
It should be noted that this would also be true with shortened posterior thigh and calf muscles.
L spine
**Lasegue's Standing Test**
111
Pt lies on the nontest side with the test leg in 60 degrees of hip flexion and relaxed knee flexion. Op stands with the proximal hand on pelvis and the distal hand on knee and applies downward force.
Tightness or pain in the hip and buttock areas is indicative of piriformis tightness.
Gluteal
**Piriformis Test**
112
With the Pt sitting or standing, the Op palpates the radial pulse and advises the patient to bend the head obliquely backward toward the side being examined, to take a deep breath, and to tighten the neck and chest muscles on the side tested.
The maneuver decreases the interscalene space (anterior and middle scalene muscles) and increases any existing compression of the subclavian artery and lower components (C8 and T1) of the brachial plexus against the 1st rib.
Marked weakening of the pulse or increased paresthesias indicate a positive sign of pressure on the neurovascular bundle, particularly of the subclavian artery as it passes between or through the scaleni musculature, thus indicating a probable cervical rib or scalenus anticus syndrome.
This test is sometimes called the scalene maneuver.
TOS
**Adson's Test**
113
Pt shoulder is passively elevated to 90° in the scapular plane and taken into full internal rotation with the forearm in pronation so that the thumb is pointing to the floor (empty can test). Op stabilizes the scapula with one hand and places the other on the upper surface of forearm. Downward pressure is then applied to the arm while Pt maintains this position.
The test is then repeated with the arm externally rotated so that the thumb points upwards (full can test).
Reproduction of the Pt’s pain without weakness is suggestive of supraspinatus impingement or tendinopathy. Painful weakness may indicate a partial or complete tear.
Weakness in the absence of any pain may result from a C5 palsy, suprascapular neuropathy or Parsonage–Turner syndrome, a viral neuritis affecting the brachial plexus.
GH
**Supraspinatus Test**
AKA Empty / full can tests
Jobe's test
Scaption test
114
With the Pt's forearm stabilized, makes a fist and extends the wrist. The Op grips the Pt's elbow with the stabilizing hand and the top of the Pt's fist with the active hand and attempts to force the wrist into flexion against patient resistance.
A sign of tennis elbow is a severe sudden pain at the lateral epicondyle area.
Elbow
**Cozen's Test**
116
Pt stands on one leg and remains in this position for approximately 10 seconds, then switches legs and performs the test again.
A positive finding is when the pelvis on the unsupported side drops noticeably lower than the pelvis on the supported side. This indicates a weakness of the gluteus medius muscle on the supported side.
A positive finding may also indicate an unstable hip on the supported side.
Hip / Gluteal
**Trendelenburg's Test**
117
Seated Pt is supported by Op who reaches around the Pt's shoulders and upper chest from behind. Pt leans forward to one side and then around to eventually bend obliquely backward by placing the palm on the buttock and sliding it down the back of the thigh and leg as far as possible.
The maneuver is similar to that used in oblique cervical compression tests.
If this compression causes or aggravates a pattern of radicular pain in the thigh and leg, the sign is positive and suggests nerve root compression.
It may also indicate a strain or sprain and thus be present when the patient leans obliquely forward or at any point in motion.
Not to be dismissed lightly would be the possibility of shortened contralateral perispinal ligaments and tendons forcing erratic motion on the side of lateral flexion.
L spine
**Kemp's Test**
AKA Quadrant Test
118
Supine PT with straight LEX. Op places one hand under the heel of the affected side and the other hand is placed on the knee to prevent the knee from bending. Op most cautiously flexes the thigh on the pelvis to the point of pain, keeping the knee straight. Pt will normally be able to have the limb extended to almost 90º without pain.
If this maneuver is markedly limited by pain, the test is positive and suggests sciatica from a disc lesion, lumbosacral or sacroiliac lesion, subluxation syndrome, tight hamstring, spondylolisthetic adhesion, IVF occlusion, or a similar disorder.
L spine
**Lasegue's Straight-leg-raising (SLR) Test**
119
To support iliopsoas spasm suspicions, the Pt is placed prone with the toes hanging over the edge of the table, legs relaxed. Either heel is approximated to the opposite buttock.
After flexion of the knee, hip pain makes it impossible to carry out the test if there is any irritation of the psoas muscle or its sheath. The buttock will tend to rise on the involved side.
However, a positive Ely's test also can be an indication of rectus femoris contraction, a lumbar lesion, a contracture of the tensor fascia lata, or an osseous hip lesion.
L spine / Hip
**Ely's Test**
121
Part 1: Pt seated, Op stabilizes the ankle in neutral with 1 hand just proximal to the 1st metatarsal head. Next, Op extends the first phalange while allowing the IP joint to flex.
A positive test is considered if passive extension is continued to end range or until the Pt's pain is reproduced.
Part 2: Pt stands on a stool with the metatarsal heads just off the edge of the stool. Pt places equal weight on both feet. Again,Op passively extends the first phalange while allowing the IP to flex.
A positive test is considered if passive extension is continued to end range or until the patient's pain is reproduced.
The windlass effect is the primary mechanism that lifts the medial longitudinal arch during toe off. As the toes extend, the plantar fascia lengths and increases tension on the medial longitudinal arch. This increased tension pull the arch together, raises, and stabilizes the foot during toe-off. Decreased tension would limit the effectiveness of the windlass mechanism and less toe-off would be noted.
Pts that have pain or excessive toe extension motion should be examined more thoroughly. Additionally it would be important to check foot type, intrinsic muscle strength, and resting foot position.
Foot
**Windlass Mechanism Test**
122
The sitting Pt elevates the arm and is instructed to make a tight fist to express blood from the palm. The Op occludes the radial and ulnar arteries by finger pressure. The Pt then lowers the hand and relaxes fist, and the examiner releases the arteries one at a time. Some examiners prefer to test the radial and ulnar arteries individually in two tests.
The sign is negative if the pale skin of the palm flushes immediately when the artery is released. The Pt should be instructed not to hyperextend the palm as this will constrict skin capillaries and render a false positive sign.
The sign is positive if the skin of the palm remains blanched for more than 3 seconds. This test, which should be performed before Wright's test, is significant in vascular occlusion of the artery tested.
TOS / Vascular
**Allen's Test**
123
Pt lying in diagonal position on the table with shoulder off edge of table. Op facing towards the Pt's feet. Op uses thigh closer to Pt to depress shoulder. Use other hand to grasp Pt’s hand and place arm in 10 degrees of abduction and fully extended elbow. Medially rotate the shoulder, pronate the forearm, and flex the wrist and fingers. Abduct the shoulder until neural symptoms are reproduced.
Pt laterally flexes or rotates their head away (worsens pain/symptoms) and toward the arm (relieves pain/symptoms) - a positive test.
Peripheral Nerve
**Radial Nerve Test**
124
Place one hand on the occiput with the index finger on the space between C2 spinous process and occipital protuberance (where the posterior arch of C1 lies). Place the other hand on the forehead. Lift the head straight up in a vertical plane (not flexion, more of a protraction motion).
The test is positive if Pt experiences some feelings of weakness, dizziness, numbness, nystagmus, or an odd feeling in the back of the throat. There is normally a firm end-feel.
C spine
**Transverse Ligament Test**
125
Passively roll the leg into full medial and lateral rotation.
The test is considered positive for laxity of the anterior hip capsule and iliofemoral ligament if range of motion is greater than 45 degrees and there is no rebound back to neutral.
Hip
**Dial Test**
126
Pt pinches the tips of the thumb and index finger together.
The inability to touch the tips of the thumb and index finger together demonstrates a positive finding and suggests an anterior interosseous nerve pathology.
The anterior interosseous nerve is a branch of the median nerve (C7, C8, T1) that innervates the pronator quadratus, flexor pollicis longus and the first and second components of the flexor digitorum profundus.
Hand
**Pinch Grip Test**
AKA Froment's Sign
127
Pt supine and Op exerts downward pressure on the sternum.
A positive finding of lateral rib pain suggest possible rib fracture.
T spine
**Sternal Compression Test**
129
Pt stands with shoulders flexed to 90 degrees with arms straight and supinated. Pt extds and rots head to one side and closes eyes and marches on spot.
+ve for vascular impediment to brainstem if one arm starts to fall, loss of balance, pronation of the hands.
Vascular / Brainstem
**Underburg’s Test**
130
Pt abducts each shoulder to 90 degrees with the shoulders laterally rotated and the elbows flexed slightly behind the frontal plane. Pt opens and closes their hands slowly for 3 minutes.
+ve for TOS if Pt is unable to keep their arms in the starting position for 3 minutes or if ischemic pain, heaviness, or weakness is present in the arm or if the patient reports numbness or tingling in the hand during the test.
TOS
**Roos Test**
131
With the Pt sitting, observe while the pt voluntarily laterally flexes the head toward the side being examined. With the neck flexed, the pt is then instructed to rotate the chin toward the same side, which narrows the IVF diameters on the side of scoliotic concavity.
Pain or reduplication of other symptoms suggests a physiologic narrowing of one or more IVFs.
C spine
**Cervical Active Rotary Compression Test**
132
While sitting or standing, the Pt is instructed to take one hand and touch the opposite shoulder. The test is repeated with the other hand to the opposite side. The Pt is then instructed to place the arm overhead and reach behind the neck as if scratching the upper back. To complete the test, the Pt is instructed to place the hand in the small of the back and reach upward as far as possible.
Asymmetrical results from side to side are positive for limitationsin the joint capsule.
GH
**Apley's Scratch Test**
133
The Pt is placed supine with the knees extended in a relaxed position, and the Op lifts a leg with the knee extended so that the lower limb is flexed on the hip to about a 45º angle. Pt moves the ankle up and down (dorsiflex and plantarflex the foot) for a minimum of 2 minutes. The limb is then lowered, the Pt is asked to sit up, the legs are allowed to hang down loosely over the edge of the table, and the color of the exercised foot is noted.
Positive signs of arterial insufficiency are found if
1. the skin of the foot blanches and the superficial veins collapse when the leg is in the raised position and/or
2. it takes more than a minute for the veins of the foot to fill and for the foot to turn a reddish cyanotic color when the limb is lowered.
LEX / Vascular
**Buerger's Test**
134
Increased pain or difficulty swallowing is a positive finding and may indicate anterior or cervical spine obstructions, such as vertebral subluxations, osteophyte protrusion, soft tissue swelling or tumors in the anterior cervical spine.
C spine
**Swallowing Test**
135
Place one hand on the occiput and use the other hand to palpate the spinous process of C2. Laterally flex or rotate the head to one side; you should feel the spinous process move to the opposite side. Repeat on the other side.
Absence of the spinous process moving to the opposite side may indicate alar ligament injury.
If you block the spinous process of C2 from moving, you may stress the ligament. You should encounter a firm end-feel in this case. Significant movement may indicate ligamentous injury.
C spine
**Alar Ligament Test**
136
This test helps to confirm a suspicion of hip joint pathology.
Pt supine, and Op grasps the ankle and flexed knee. The thigh is flexed (F), abducted (AB), externally rotated (ER), and extended (E).
Pain in the hip during the maneuvers, particularly on abduction and external rotation, is a positive sign of coxa pathology.
Hip
**Patrick's F-AB-ER-E test**
138
Op percusses the spinous process’ and paraspinal tissues.
Pain during percussion of the spinous process suggests fracture or severe sprain.
Pain during percussion of the paravertebral soft tissues suggests muscular strain or sensitive myofascial trigger points.
C spine / T spine / L spine
**Spinal Percussion**
139
Sciatic radiculitis is suggested by the manner in which the Pt with this condition rises from a sitting position. Body weight is supported on the uninvolved side by holding on to the chair for firm support in arising or Pt places the hands on the knees or thighs while working into the upright position, balances on the healthy leg, places one hand on the back, and flexes the leg and extends the thigh of the affected limb.
The sign is often positive in sacroiliac lesions, lumbosacral strains and sprains, fractures, disc syndromes, and dystrophies and myotonias.
L spine / SI
**Minor's Sign**
140
Op squeezes the subject’s metatarsal heads together and holds for 1 to 2 minutes.
Pain, tingling or numbness in the foot, toes, or ankle is indicative of an interdigital neuroma.
If positive, the pain is usually relieved when pressure is released. Pain between the metatarsal heads is indicative of Morton’s neuroma. The most common location is between the third and forth metatarsal heads.
Foot
**Interdigital Neuroma Test**
141
Pt stands on one leg and extnds the spine. Rpt other leg.
+ve test = pain in the back and is assoc with pars interarticularis stress fracture (spondylolisthesis).
\*If extn and rot are then combined could indicate facet joint pathology on side rotated towards.
L spine
**One-Leg Standing (Stork) Test**
142
Pt seated: 3 Stages Op presses down on Pt’s head Pt Extnd’s head, Op presses down Pt Extnds and rots head, Op presses down
Performed if there are neuro symptoms / or suspected facet irritation
+ve for nerve root irritation if symptoms are produced in the arm head is bending towards.
This may indicate: stenosis, spondylosis, osteophytes, inflammed facet joints, herniated disc or vertebral fracture.
If symptoms are produced at any stage the Op discontinues.
If symptoms are produced on opp side REVERSE SPURLINGS = mm spasm in conditions such as tension myalgia and Whiplash Associated Disorders (WADS).
C spine
**Spurling’s Test / Reverse Spurling's**
143
Pt active side bend with their arms over their head.
Pain elicited on the concave side suggests intercostal neuritis.
Pain on the convex side suggests generalized musculoligamentous strain/sprain
T spine
**Schepplemann's Sign**
144
The Pt may sit or stand and is asked to breath in and out normally, then take a deep breath followed by rapid expiration.
Normal breathing that is shallow and rapid is indicative of a rib fracture.
Pain with deep inspiration may suggest a rib fracture, costochondral separation, or external intercostal muscle strain.
T spine
**Breathing Test**
145
Pt supine with the knee extended.
Op dorsiflexes ankle.
+ve if localized deep pain either in back of the calf or behind the knee and indicative of DVT.
Vascular
**Homan's Sign**
146
When straight-leg raising and dorsiflexion of the foot are performed on the asymptomatic side of a sciatic patient and this causes pain on the symptomatic side, there is a positive Fajersztajn's sign, which is said to be particularly indicative of a sciatic nerve root involvement such as a disc syndrome, dural root sleeve adhesions, or some other space-occupying lesion.
This is sometimes called the well-leg or cross-leg straight-leg-raising test. From a biomechanical viewpoint, this test would be suggestive but not indicative.
L spine
**Fajersztajn's Test**
