Special Tests Flashcards

Question

Tinel's sign (wrist)

Answer 1

Carpal tunnel compression of median nerve Tap region where median nerve passes through carpal tunnel +: tingling and/or paresthesia into hand following median nerve distribution

Answer 2

Carpal tunnel compression of median nerve Pt maximally flexes both wrists holding them against each other for 1 minute +: tingling or paresthesia into hand following median nerve distribution

Answer 3

Level of sensory innervation within hand that correlates with functional ability to perform certain activities involving grasp Sitting, hand stabilized Using a paper clip, apply device to palmar aspect of fingers to assess ability to distinguish between two points of device. Record smallest difference the patient can sense 2 separate points. +: normal amount can be discriminated is

Answer 4

Vascular compromise Pt opens/closes fingers quickly several times then closes fist. Using thumb, occlude ulnar artery and have patient open hand. Observe palm and then release compression on artery and observe for vascular filling. Repeat with radial artery. +: abnormal filling of blood within hand

Answer 5

Dysfunction of hip such as mobility restriction Supine, passively flex, abduct and ER hip. Slowly lower txt leg toward table surface +: involved knee unable to assume relaxed position and/or reproduction of painful symptoms

Answer 6

Degenerative joint disease (DJD) of hip Supine, hip in 90 deg flexion and max knee flexion. Place compressive load into femur via knee joint +: pain within hip joint and refer pain to knee and elsewhere

Answer 7

Weakness of gluteus medium or unstable hip Standing, ask to stand on one leg. Observe pelvis of stance leg +: ipsilateral pelvis drops when lower limb support is removed while standing

Answer 8

Tightness of hip flexors Supine, one hip and knee max flexion to chest and held there. Opposite limb kept straight on table. Observe whether hip flexion occurs on straight leg as opposite limb is flexed. +: straight limb's hip flexes and/or pt is unable to remain flat on table

Answer 9

Tightness of TFL and/or IT band Sidelying, lower limb flexed at hip and knee. Passively extend and abduct testing hip with knee flexed to 90 deg. Slowly lower uppermost limb and observe if it reaches the table. NOTE: modified oner's = knee extended +: uppermost limb is unable to come to rest on table

Answer 10

Tightness of rectus femoris Prone, knee of testing limb flexed. Observe hip of testing limb. +: hip of testing limb flexes

Answer 11

Tightness of hamstrings Supine, hip and knee of test limb in 90 deg flexion. Passively extend knee of test limb until barrier is encountered. +: knee is unable to reach 10 deg from neutral (lacking 10 deg extension)

Answer 12

Piriformis syndrome Supine, foot of test leg passively placed lateral to opposite limb's knee. Testing hip adducted. Observe position of testing knee relative to opposite knee. +: test knee is unable to pass over resting knee and/or reproduction of pain in buttock and/or along sciatic nerve distribution

Answer 13

True leg length discrepancy Supine, pelvis balanced/aligned with lower limbs and trunk. Measure distance from ASIS to lateral or medial malleolus on each limb several times. *Unequal girth of thigh musculature (right vs left) can skew results if using medial malleolus landmark. +: TRUE discrepancy = anatomical difference in bone length +: FUNCTIONAL discrepancy = result of compensation due to abnormal position or posture (pronation of foot or pelvic obliquity)

Answer 14

Abnormal femoral antetorsion angle Prone, knee flexed to 90 deg. Palpate greater trochanter and slowly move hip through IR/ER. When greater trochanter feels most lateral, stop and measure angle of leg relative to a line perpendicular with table surface. NORMAL = 8-15 deg hip IR +: RETROVERTED HIP = 15 deg

Answer 15

Ligament laxity or restriction Supine, lower limb supported/stabilized, knee placed in 20-30 deg of flexion. Varus force = lateral collateral ligament Valgus force = medial collateral ligament +: laxity, may also be pain

Answer 16

Integrity of anterior cruciate ligament Supine, knee flexed 20-30 deg, stabilized femur and passively try to glide tibia anterior +: excessive anterior glide of tibia

Answer 17

Anterior cruciate ligament integrity Supine, test knee in extension, hip flexed and abducted 30 deg with slight IR. Hold knee with one hand and foot with other hand. Place valgus force through knee and flex knee. +: ligament laxity--tibia relocating during test. As knee is flexed, tibia clunks backward at approx 30-40 deg.

Answer 18

Integrity of posterior cruciate ligament Supine, testing hip flexed 45 deg and knee flexed 90 deg Observe to see whether tibia "sags" posteriorly +: sag of tibia relative to femur

Answer 19

Integrity of posterior cruciate ligament Supine, test hip flexed 45 deg and knee flexed 90 deg. Passively glide tibia posteriorly following joint line +: excessive posterior glide

Answer 20

Integrity of posterior cruciate ligament Prone with knees flexed to 30 deg. Stabilize femur and passively try to glide tibia posterior +: ligament laxity

Answer 21

Meniscal tears Supine, test knee in max flexion. LATERAL = passively IR and extend knee MEDIAL = passively ER and extend knee +: click and/or pain in knee joint

Answer 22

Meniscal tear vs ligamentous tear Prone, test knee flexed 90 deg Passively distract knee and IR/ER tibia Compressive load to knee and IR/ER tibia MENISCAL: pain or decreased motion during compression LIGAMENT: pain or increased motion during distraction

Answer 23

Dysfunction of place Supine, test knee flexed and tibia IR Passive glide patella medially while palpating medial femoral condyle. Feel for popping as passively flex and extend knee. +: pain and/or popping during test

Answer 24

Past history of patellar dislocation Supine with patella passively glided laterally +: pt does not allow and/or does not like patella to be moved laterally

Answer 25

Patellofemoral dysfunction Supine, knee extended resting on table. Push posterior on superior pole of patella and ask patient to contract quads. +: pain

Answer 26

Infrapatellar effusion Supine, knee extended resting on table. Apply soft tap over central patella. +: perception of the patella floating ("dancing patella" sign)

Answer 27

Knee joint effusion Supine, knee extended resting on table. Place one hand over supra patellar pouch and other over anterior aspect of knee joint. Alternate pushing down with one hand at a time. +: fluctuation (movement) of fluid noted during test

Answer 28

Measurement of angle between quadriceps muscle and patellar tendon NORMAL = 13 deg (men) and 18 deg (women) Angles less or greater than normal may be indicative of knee dysfunction and/or biomechanics dysfunction within the lower limb

Answer 29

Distal iliotibial (IT) band friction syndrome Supine, hip flexed to 45 deg and knee flexed to 90 deg. Apply pressure to lateral femoral epicondyle and extend knee. +: reproduces same pain over lateral femoral condyle; pain over lateral femoral epicondyle at approx 30 deg flexion

Answer 30

Dysfunction of common fibular nerve posterior to fibular head Tap region where common fibular nerve passes through posterior to fibular head +: tingling and/or paresthesia into leg

Answer 31

Abnormal rearfoot to forefoot positioning Prone, foot over edge of table. Palpate dorsal aspect of talus on both sides with one hand and grasp lateral forefoot with other hand. Gently dorsiflex foot until resistance is felt then move foot through supination/pronation. +: Neutral position is when foot falls off easier to one side or other. At this point, compare rearfoot to forefoot and rearfoot to leg.

Answer 32

Ligamentous instability (anterior talofibular ligament) Supine, heel just off edge of table in 20 deg PF. Stabilize lower leg and grasp foot. Pull talus anterior. +: talus has excessive anterior glide and/or pain

Answer 33

Ligamentous instability (calcaneofibular ligament) Sidelying, knee slightly flexed and ankle neutral. Move foot into adduction (calcaneofibular lig) Move foo into abduction (deltoid lig) +: excessive abd/add and/or pain

Answer 34

Integrity of Achille's tendon Prone with foot off edge of table. Squeeze calf muscle. +: no movement of foot while squeezing calf

Answer 35

Dysfunction of posterior tibial nerve posterior to medial malleolus OR deep fibular nerve anterior to talocrural joint Supine, foot supported on table. Tap region of posterior tibial nerve as it passes posterior to medial malleolus. Tap region of deep fibular nerve as its passes under dorsal retinaculum (anterior to ankle jt). +: tingling and/or paresthesia into the respective nerve distributions

Answer 36

Stress fracture or neuroma in forefoot Supine, foot supported on table. Grasp around metatarsal heads and squeeze. +: pain in forefoot

Answer 37

Integrity of vertebrobasilar vascular system Supine, head supported on table. (1) Extend head/neck for 30 sec. If no change in sx perform step 2. (2) Extend head/neck with rotation left, then right, for 30 seconds. If no change in sx, perform step 3. (3) With head cradled off table, extend had/neck for 30 seconds. If no change in sx, perform step 4. (4) With head cradled off table, extend head/neck with rotation left for 30 sec. Repeat with rotation right for 30 sec. * *Pt should be continuously monitored for change in sx during entire test. CAUTION should be used during test. * *Performing mob/manip within cervical region without performing this test = breach of standard of care +: dizziness, visual disturbances, disorientation, blurred speech, N/V

Answer 38

Vascular versus vestibular causes of dizziness/vertigo (1) Pt sitting, shoulders at 90 deg, palms up. Pt close eyes and maintain position for 30 sec. IF arms lose position, may be VESTIBULAR. (2) Pt sitting, shoulders at 90 deg, palms up. Pt closes eyes, cue pt into head/neck extension with rotation right, then left, remaining in each position x 30 sec. IF arms lose position, may be VASCULAR. +: position/movement of arms

Answer 39

Integrity of transverse ligament Supine, head supported on table. Glide C1 anterior. Should be firm end feel. +: soft end feel, dizziness, nystagmus, lump sensation in throat, nausea

Answer 40

Integrity of upper cervical spine ligaments and capsules Supine, head supported on table. Glide C2-7 anterior. Should be firm end feel. +: laxity of ligaments, dizziness, nystagmus, lump sensation in throat, nausea

Answer 41

Dysfunction (typically compression) of cervical nerve root Sitting with head side bent toward uninvolved side. Apply pressure through head straight down. Repeat with head toward involved side. +: pain and/or paresthesia in a dermatomal pattern for involved nerve root

Answer 42

Compression of neural structures at intervertebral foramen and/or facet dysfunction Sitting. Passively move head into SB and rotation toward non painful side followed by extension. Repeat toward painful side. **Be careful since similar to vertebral artery test. NERVE ROOT = pain and/or paresthesia in dermatomal pattern FACET = localized pain

Answer 43

Compression of neural structures at the intervertebral foramen or facet dysfunction Sitting with head passively distracted ``` FACET = decrease in symptoms in neck NEUROLOGICAL = decrease in upper limb pain ```

Answer 44

Compression of neural structures within intervertebral foramen Sitting with one hand on top of head. Repeat with opposite hand. +: decrease in symptoms into upper limb

Answer 45

Dysfunction of spinal cord and/or UMN lesion Long sitting at table. Passively flex pt's head and one hip while keeping knee in extension. Repeat with other hip. +: pain down spine and into upper or lower limbs

Answer 46

UMN lesion Standing and close eyes 30 seconds. +: excessive swaying

Answer 47

Rib mobility Prone. Begin at upper ribs with P/A force through each rib through entire rib cage. Sidelying. Repeat test. *Be careful when springing 11th and 12th ribs since they are less stable. +: pain, excessive motion or restriction of ribs

Answer 48

Intervertebral joint mobility in thoracic spine Prone. Apply P/A glides/springs to transverse processes of thoracic vertebrae. +: pain, excessive and/or restricted movement

Answer 49

Dysfunction of neurological structures supplying lower limbs Sitting edge of table with knees flexed. Pt slump sits while maintaining neutral position of head and neck. (1) Passively flex pt's head and neck. If no reproduction of sx, perform step 2. (2) Passively extend one of pt's knees. If no reproduction of sx, performs step 3. (3) Passively DF ankle of limb with extended knee. Repeat with opposite leg. +: reproduction of pathological neurological symptoms

Answer 50

Dysfunction of neurological structures that supply the lower limb. Supine, legs resting on table. Passively flex hip of one leg with knee extended until pt complains of shooting pn in lower limb. Slowly lower limb until pn subsides, then passively DF foot. +: reproduction of pathological neurological sx when foot is DF

Answer 51

Compression of femoral nerve Sidelying on non painful side with trunk neutral, head flexed slightly and hip/knee flexed. Passively extend hip while knee of non painful limb is in extension. If no reproduction of symptoms, flex knee of painful leg. +: neurological pain in anterior thigh

Answer 52

Space-occupying lesion Sitting. Pt should take a deep breath and hold while they "bear down" as if having a bowel movement. +: increased low back pain or neurological symptoms into LE

Answer 53

UMN lesion Supine or sitting. Glide bottom end of standard reflex hammer along plantar surface of foot. +: extension of big toe and splaying (abd) of other toes

Answer 54

Compression of neural structures at the intervertebral foramen and facet dysfunction Standing. IV FORAMEN: L SB, L rotation and extension to maximally close IV foramen on L. Repeat on R side. FACET: L SB, R rot and extension to maximally compress facet on L. Repeat on R side. +: pain and/or paresthesia in dermatomal pattern for the involved nerve root or localized pain if facet.

Answer 55

Spondylolisthesis Standing on one leg. Pt extends trunk. Repeat with opposite leg on ground. +: pain in low back with IPSI leg on ground

Answer 56

Scoliotic curvature versus neurological dysfunction causing abnormal curvature (lateral shift) of trunk Patient standing. Stand on one side of pt so that upper trunk is shifted toward you. Place shoulders on pt's upper trunk and wrap arms around pelvis. Stabilize upper trunk and pull pelvis, to bring pelvis and trunk into proper alignment. +: reproduction of neurological symptoms as alignment of trunk is corrected

Answer 57

Intermittent claudication versus spinal stenosis Seated on stationary bicycle. Pt rides bicycle while sitting erect. Time how long the patient can ride at a set speed/pace. After sufficient rest, have patient ride bike at same speed while in slumped position. +: length of time patient can ride bike in sitting vs slumped positions. IF stenosis: ride longer while slumped

Answer 58

Posterior movement of ilium relative to sacrum Patient standing. Place thumb on PSIS of limb to be tested and other thumb on center of sacrum at level of PSIS. Ask pt to flex hip and knee of limb being tested. Assess movement of PSIS with your eyes at the level of your thumbs. PSIS should move inferior. +: no identified movement of PSIS compared to sacrum

Answer 59

Anterior movement of ilium relative to sacrum Place thumb on PSIS of limb to be tested and other thumb on center of sacrum at level of PSIS. Ask pt to extend hip of limb being tested. Assess movement of PSIS with your eyes at the level of your thumbs. PSIS should move superior. +: no identified movement of PSIS compared to sacrum

Answer 60

SIJ dysfunction Sidelying at edge of table while holding bottom leg in max hip/knee flexion. Standing behind patient, passively extend hip of uppermost limb. +: pain

Answer 61

Dysfunction of SIJ that may be cause of functional leg length discrepancy Supine with correct alignment. Stand at edge of table and palpate medial malleoli to assess symmetry. Have pt come to long sitting and assess leg length. +: reversal in limb lengths between supine and long sitting

Answer 62

Lumbar spine VS SIJ dysfunction Supine with fingers between spinous processes of lumbar spine. With other hand, passively perform SLR. +: pain prior to palpation of movement in lumbar segments: SIJ dysfunction

Answer 63

Pain with compression of retrodiscal segments Sitting or supine. Support/stabilize head with one hand. Push mandible superior, causing compressive load to TMJ. +: pain in TMJ

Answer 64

Long head of biceps tendon rupture Sitting. Clasp both hands behind head with fingers interlocked. Alternately contract and relax biceps. +: absence of movement in the biceps tendon

Answer 65

Impingement of supraspinatus tendon Sitting or standing. Flex shoulder to 90 deg and IR arm. +: pain

Answer 66

Median nerve, anterior interosseous nerve ``` Shoulder depression with 110 deg and Elbow extension Forearm supination Wrist extension Finger and thumb extension ``` Sensitize: contralateral cervical SB

Answer 67

Median nerve, musculocutaneous nerve, axillary nerve ``` Shoulder depression with 10 deg ab Elbow extension Forearm supination Wrist extension Figer and thumb extension Shoulder ER ``` Sensitize: contralateral cervical SB

Answer 68

Radial nerve ``` Shoulder depression with 10 deg abd Elbow extension Forearm pronation Wrist flexion and ulnar deviation Finger and thumb flexion Shoulder IR ``` Sensitize: Contralateral cervical SB

Answer 69

Ulnar nerve ``` Shoulder depression with 10-90 deg abd Elbow flexion Forearm supination Wrist extension and radial deviation Finger and thumb extension Shoulder ER ``` Sensitize: contralateral cervical SB

Answer 70

Lateral epicondylitis Sitting. Stabilize elbow and place other hand on dorsal aspect of patient's hand distal to PIP joint. Ask pt to extend the 3rd digit against resistance. +: pain in lateral epicondyle region or muscle weakness

Answer 71

Lateral epicondylitis Sitting with elbow in slight flexion. Place thumb on lateral epicondyle. Ask patient to make a fist, pronate forearm, radially deviate and extend wrist against resistance. +: pain in lateral epicondyle region or muscle weakness

Answer 72

Lateral epicondylitis Sitting. Palpate lateral epicondyle, pronate forearm, flex wrist and extend elbow. +: pain in lateral epicondyle region

Answer 73

Tear of ulnar collateral and accessory collateral ligaments (gamekeeper's or skier's thumb) Sitting. Hold pt's thumb in extension and apply values force to MCP of thumb. +: excessive valgus movement

Answer 74

Degenerative joint disease in the CMC joint Sitting or standing. Stabilize pt's hand and grasp the thumb on the metacarpal. Apply compression and rotation through metacarpal. +: pain

Answer 75

Dislocated lunate Sitting or standing and makes a fist. +: pt's 3rd metacarpal remains level with the 2nd and 4th metacarpals

Answer 76

Tightness of hamstrings Sitting with knees flexed to 90 deg over edge of table. Passively extend one knee. +: tightness of hamstrings or extension of trunk

Answer 77

Congenital hip dislocation/DDH Supine with hips flexed to 90 deg and knees flexed. Stabilize femur and pelvis with one hand. Move test leg into adduction while applying forward pressure posterior to greater trochanter. +: click or clunk and may be indicative of hip dislocation being reduced

Answer 78

Congenital dislocation of hip/DDH Supine with hips flexed to 90 deg and knees flexed. Grasp legs so thumbs along medial thighs and fingers are on lateral thighs. Abduct pt's hips and gentle pressure applied to greater trochanters until resistance is felt at approx 30 deg. +: click or clunk and may be indicative of hip dislocation being reduced

Answer 79

ACL injury Supine with knee flexed to 90 deg and hip flexed to 45 deg. Sit on forefoot, grasp proximal tibia with thumbs on tibial plateau. Apply an anterior force to tibia. +: excessive anterior translation of tibia on femur

Answer 80

Meniscal lesion Supine. Grasp pt's heel and max flex knee then passively extend knee. +: incomplete extension or rubbery end-feel

Answer 81

Effusion in knee Supine. One hand below joint line on medial patella and stroke proximally with palm and fingers to supra patellar pouch. Other hand strokes down to lateral surface of patella. +: wave of fluid just below medial distal border of patella

Answer 82

Tibial torsion Sitting with knees over end of table. Place thumb and index finger of one hand over med and lat malleolus. Measure acute angle formed by axes of knee and ankle. NORMAL = 12-18 deg

Answer 83

SIJ dysfunction Supine. Cross arms and place palms on ASIS. Apply downward and lateral force to pelvis. +: unilateral pain in SIJ or gluteal area

Answer 84

Articular restriction of SIJ Sitting with knees flexed 90 deg and feet on floor. Place hands on PSIS and monitor movement as pt bends forward. +: one PSIS moving farther cranially

Answer 85

Articular restriction of SIJ Standing with feet 12" apart. Place hands on PSIS and monitor movement as pt bends forward. +: one PSIS moving farther cranially