Special Tests Flashcards
(27 cards)
Lumbar: Tests for lumbar instability
Prone segmental instability test
Sag Sign
Assesses PCL integrity
Supine, both legs 45º hip flexion and 90º knee flexion. Feet flat on table. Have a gander from the side.
Positive: tibial sags posteriorly in comparison to the unaffected side.
Posterior Drawer Test
Assesses for posterior stability of the knee
Supine. 45º hip flexion, 90º knee flexion. Foot on table. Stabilize ankle and foot by sitting on them. Grasp tibia with both hands and push.
Positive: excursion greater than 6mm. Pain may or may not be present. Snapping or jerking suggest meniscal damage
Kemp’s/Quadrant Test
Tests for: facet lock/irritation, and nerve root irritation
Standing. Examiner controls patient movement by holding shoulders (may support occiput on shoulder). Patient extends the spine, overpressure applied while patient flexes and rotates to side of pain. Continue movement until limit of range is reached, or symptoms.
Positive: Local pain (facet lock); neurological Sx (nerve root)
Segmental Instability Test
Tests for: segmental instability (spondylolisthesis)
Therapist / Action Examiner applies pressure to the posterior
aspect of lumbar spine OR an individual spinous process of the lumbar spine (with patient at rest). Patient then lifts legs off the floor and examiner again applies posterior compression to lumbar spine.
Positive: pain when feet on floor, which is relieved with legs lifted.
Squeeze Test –foot
Tests for stress fracture and/or Morton’s neuroma
Seated. Squeeze foot.
Positive: sharp pain. For Morton’s neuroma usually between 3rd and 4th MT.
Anterior Drawer Test (knee)
Assesses anterior stability of the knee
Supine. Hip at 45º flexion, knee at 90º flexion, foot on table. Stabilize ankle and foot by sitting on it. Grab tibia with both hands and pull forward.
Positive. Big yoink. Excursion greater than 6mm. Pain may or may not be present. Snapping or jerking motion suggests meniscal damage
Supine-Sit Test
Tests for pelvic malalignment
Compare positions of medial malleoli supine and then in long sit.
Supine Long, sitting short: Anterior rotation of that side
Supine short, sitting long: Posterior rotation of that side
Squeeze Test – Tib Fib
Tests for strain of distal tibfib joint
Supine. Squeeze tibfib together at mid-calf.
Positive: Pain in lower leg
DDx: stress fracture, compartment syndrome
Lumbar: Tests for neurological dysfunction
SLR Slump Bowstring Valsalva Nachlas (PKB)
Lumbar: Tests for joint dysfunction
Quadrant test
Calcaneofibular Stress Test
AKA: talar tilt
Tests for: integrity of calcaneofibular ligament
PT seated, knee flexed and leg hanging off edge of table OR sidelying with foot off end of table; Ther stabilizes distal tibia & fibula, while taking the calcaneus (hindfoot) into inversion, applying over-pressure at end range. Ensure ankle is in neutral position (no plantar or dorsiflexion)
Positive: Acute: Pain local to the ligament & some excessive movement Sub-acute: May have muscle spasm end-feel
Aply’s Distraction Test
Assesses integrity of the collateral ligaments of the knee.
Prone, knee flexed to 90º. Stabilize back of the thigh; grasp ankle and pull upwards. Apply IR and ER to the tibia.
Positive: pain on medial side (MCL); pain on lateral side (LCL); excess movement, apprehension
McMurrays Test
Unreliable test for meniscal injury
- Pt is supine with hip and knee flexion
- The amount of knee flexion may be changed to test all aspects of the posterior aspect of the menisci
- Examiner cups the palm of one hand over the patella while the fingers and thumb palpate over the joint line - Other hand grasps the heel of the affected side - The examiner brings the knee into slow extension as various stresses are applied:
- IR + Varus stress = lateral meniscus
- ER + Valgus stress = medial meniscus
Positive test = clicking or catching in knee extension however a negative test doesn’t rule out a meniscal injury
Anterior Drawer Test (Ankle)
Tests for: Stability of the anterior talofibular ligament
1) PT supine, Ther stabilizes foot at 20°P FLX via fist under calcaneus. Mobilize low leg posteriorly.
2) Pt supine, with knee flexed & foot on the table; Ther stabilizes the foot and moves tibia & fibula posteriorly
3) PT prone with foot off the end of table; Ther stabilizes distal tibia & fibula, and pushes talus anteriorly with pressure over the calcaneus
Positive: Excessive anterior translation of the talus, sometimes an audible “thunk”, indicating ligament laxity or rupture
Thompson’s Test
Tests for: Achilles rupture (3rd degree)
PT prone with feet over edge of table …OR….PT kneeling on table with feet over the edge Ther squeezes the relaxed calf muscles
Positive: absence of plantarflexion
Deltoid Ligament Stress Test
Tests for: Integrity of the deltoid ligament
PT seated, leg hanging over end of table; Ther stabilize anterior tibia & fibula proximal to ankle Test 3 Movements: 1) Anterior fibers: Grasp dorsal surface of foot, apply eversion & plantarflexion, apply POP at end range 2) Middle fibers: Grasp heel and take hindfoot into eversion, apply POP at end range 3) Posterior fibers: Grasp heel, apply eversion & dorsiflexion of foot, apply POP at end range
Brush Stroke Test
Tests for: swelling in knee AFTER ACUTE INJURY
Patient is supine in as much knee extension as possible
- The therapist applies a light to moderate sweeping motion with fingers and hands on the knee – from the inf/medial aspect to sup/lat aspect, with ‘inside hand’ and sup/lat aspect to med/inf aspect with ‘outside hand’
Postitive: fluid moving or accumulating as a bulge in the inferior aspect of the patella: May indicate cruciate or meniscal attention – postive = immediate medical attention
Lachman’s Test
The superior ACL test.
Supine, knee flexed to 30º. Stabilize femur with one hand and grasp the tibia with the other. Pul.
Positive: excessive anterior movement, disappearance of infrapatellar tendon slope, possible pain.
Anterior Talofibular Stress Test
Tests for: integrity of the anterior talofibular ligament
PT seated, knee flexed and leg hanging off edge of table; Therapist stabilizes anterior tibia & fibula proximal to ankle joint; with other hand grasp plantar surface of heel and apply a combined movement of plantarflexion, inversion and adduction, applying over-pressure at end ROM; apply pressure gradually to prevent guarding
Positive: Sub-acute: Local pain at site of ligament, slight excessive movement with muscle spasm end-feel indicates mild to moderate ligament sprain. Total ligament rupture may present as hypermobility or false negative due to protective muscle spasm. Chronic: Total rupture is painlessly hypermobile
Lumbar: Tests for muscle tightness
90/90 SLR
Obers
Thomas Test
Why is Lachman’s the preferred ACL test?
Flexing the knee to 30º (rather than 90º) places the knee in a position where the ACL plays a more functional role.
Stabilizing effect of menisci and bony lip of tibial condyles less influential.
Varus Stress Test (knee)
Assesses the integrity of the lateral stabilizing structures of the knee (20-30º flexion specific to LCL)
Supine, knee in slight flexion. Leg held by therapist, stabilizing lateral to lateral malleolus (or tucking leg under arm and using both hands to gap). Gaps knee laterally
Positive: recreation of pain, excessive movement, apprehension
Apley’s Compression Test
Asseses: meniscal injury
Prone: knee flexed to 90º. Push foot and tibia into table and then performs IR and ER.
Positive: pain on lateral side – lateral meniscus
Pain on medial side – medial meniscus
