Special Tests - Possibly Station B

Question 1

Straight Leg Raise

Answer 1

• Client supine
• Affected limb Adducted and Internally Rotated; passively raise affected leg by grasping the Calcaneous and flexing the Hip; the Knee must remain Extended; Flex the Hip until the client indicates pain is felt (70-80degrees); slowly lower leg until not pain is reported and Dorsiflex the client’s Ankle and/or have client Flex neck so their chin is on their chest;
• • Sign: Pain in Posterior thigh and knee with Hip Flexion only
• Indication: Hamstring tightness
• • Sign: Pain down leg with forced Dorsiflexion
• Indication: Sciatic nerve involvement
• • Sign: Pain in lower back after 70degrees Hip Flexion without Ankle Dorsiflexion
• Indication: Lumbar or SI Joint Dysfunction

Question 2

ULTT1

Answer 2

• Client Supine
• Affected arm close to edge of table; grasp client’s shoulder and apply a constant depressive force to it; with other hand, hold client’s wrist and Abduct Humerus to about 110degrees -> extend arm to 10degrees below coronal plane -> 60degrees of External Rotation -> slowly Extend client’s wrist the digit’s ->fully supinate the forearm -> Extend elbow
• • Sign: Reproduction of client’s shoulder/arm pain
• Indication: C5-C7 Nerve Root or Median nerve is source of pain

Question 3

ULTT2

Answer 3

• Client supine
• Affected arm close to edge of table; grasp client’s shoulder and apply a constant depressive force to it; with other hand, hold clients wrist and Abduct Humerus to about 110degrees -> Extend arm to 10degrees below coronal plane - > 60degrees of External Rotation; slowly Extend client’s wrist then digit’s; fully supinate the forearm then slowly Extend the elbow
• • Sign: Reproduction of client’s shoulder/arm pain
• Indication: Median, Musculocutaneous and Axillary Nerves can be source of pain

Question 4

ULTT3

Answer 4

• Client supine
• Affected arm close to edge of table; grasp client’s shoulder and apply a constant depressive force to it; with other hand, hold client’s wrist and Abduct Humerus to 10degrees -> Medially Rotate Humerus -> Slowly Flex wrist and Digits - > Ulnar Deviation -> Fully Pronate Forearm and Extend Elbow
• • Sign: Reproduction of client’s symptoms
• Indication: Radial nerve is source of pain

Question 5

Pace Abduction Test

Answer 5

• Client seated with knee’s together
• Place both hands on Lateral Knee’s and apply resistance; have client attempt to Abduct Hips
• • Sign: Pain
• Indication: Piriformis Trigger Points

Question 6

Swallowing Test

Answer 6

• Client seated
• Palpate SCM in Pincer Grasp; when most tender point in muscle is found, maintain firm pressure while the client swallows
• • Sign: Pain diminishes while the client swallows
• Indication: Trigger point in SCM

Question 7

Two-Point Discrimination Test

Answer 7

• Use a paper clip bent into a “U”’ set the 2 points 2-3mm apart; touch the points to the affected area of the clients skin; ask client how many points are felt; if necessary, set the points farther apart and repeat the test
• • Sign: Inability to determine 2 points at a distance greater than 2-5mm
• Indication: Local sensation impairment

Question 8

Proprioceptive Movement Test

Answer 8

• Client’s eyes closed; grasp clients affected finger or toe by the sides and passively move it into Flexion or Extension; ask client what position the digit is in
• • Sign: Incorrect answer or hesitation before answer
• Indication: Proprioception Loss

Question 9

Proprioceptive Space Test

Answer 9

• Client’s eyes closed
• Place one of client’s hands or feet into a selected position; have client imitate that position with the other limb or find the hand or foot with the other limb
• • Sign: Client unable to properly position or find unaffected limb
• Indication: Proprioception Loss

Question 10

Hautant’s Test

Answer 10

• Client seated
• Both arms Flexed to 90degrees; eyes closed; hold 10-30 seconds; Therapist watches for any loss of arm position
• • Sign: Arm movement
• Indication: Nonvascular cause
• Client Rotates or Extends and Rotates Neck with eyes closed; holds for 10-30 seconds
• • Sign: Wavering of arms
• Indication: Vascular impairment to brain

Question 11

Vertebral Artery Test

Answer 11

• Client supine
• Therapist passively moves clients Head and Neck into Extension and then Rotation (or Lateral Flexion); hold for 30 seconds
• • Sign: Client reports Vertigo and Nausea; eye shows signs of Nystagmus (involuntary eye movement)
• Indication: Circulation deficiency of Vertebral Artery

Question 12

Abductor Pollicis Brevis Strength Test

Answer 12

• Client seated
• Affected forearm Supinated and Thumb fully Abducted; have client hold position and attempt to Adduct Proximal Phalanx of Thumb
• • Sign: Inability to hold thumb in Abduction
• Indication: Weakness in APB

Question 13

Motion Palpation of the Spine

Answer 13

• Client standing
• Place fingertips in Laminar Groove immediately Lateral to SP’s or place palm of hand over SP’s with fingertips oriented superiorly; have client move slowly through Flexion, Extension, Lateral Flexion and Rotation
• Perform this motion palpation on the entire spine, segment by segment
• • Sign: Segments that move as one unit with a leathery endfeel
• Indication: Local Hypomobility
• • Sign: Segments move more than segments above or below them
• Indication: Local Hypermobility

Question 14

Halstead Maneuver

Answer 14

• Client seated
• Palpate Radial pulse on affected upper limb, apply a downward traction on the upper limb while client’s neck is Hyperextended and Head is Rotated to opposite side
• • Sign: Diminishment of Pulse
• Indication: TOS

Question 15

Provocative Elevation Test

Answer 15

• Client elevates both arms above the Horizontal, rapidly closes/opens hands 15 times
• • Sign: Fatigue, cramping or tingling
• Indication: TOS; or vascular insufficiency

Question 16

Roo’s Test

Answer 16

• Client stands, Abducts arms to 90degrees; Laterally Rotates the shoulder and Flexion of the Elbow to 90degrees; so Elbows are slightly behind frontal plane, client opens and closes hand’s slowly for 3 minutes
• • Sign: Client unabated to keep arms in position or has ischemic pain, heaviness, profound weakness
• Indication: TOS on that side

Question 17

Sign of the Buttock

Answer 17

• Client supine, perform passive unilateral straight leg raise test, if restriction/pain on one side, keep thigh there and Flex knee
• • Sign: Hip Flexion does not increase. (If hip flexion increases, problem is in
    L/S of Hamstrings)
• Indication: Pathology in the Buttock (bursitis, Tumour or abscesses)

Question 18

Hip Quadrant Test

Answer 18

• Client supine
• Flex and Adduct affected Hip so Knee is positioned toward client’s opposite shoulder; when there is resistance to the movement, maintain minimal resistance and move the Flexed Hip through an arc into Abduction; palpate the quality of Hip Motion throughout the range
• • Sign: Early leathery endfeel, crepitus in the movement, pain/apprehension with the motion
• Indication: Hip Capsular tightness, Osteophytes formation or other Hip Pathology

Question 19

Quick Test

Answer 19

• Client squats as far as possible, and bounces 2-3 times, then returns to standing
• • Sign: Inability to perform the action
• Indication: Pathology of any lower limb joint (ankle, knee, hip, Sacrum)

Question 20

Forward Bending Test

Answer 20

• Client standing
• Have client bend forward, allowing arms to hang, then Laterally Flex torso to both sides
• • Sign: Correction/reversal of curve with Lateral Flexion Convexity
• Indication: Functional Scoliosis
• • Sign: Lateral Flexion does not correct curve and asymmetrical Lateral Flexion
• Indication: Structural Scoliosis
• • Sign: Correction/reversal of curve and rib humping with forward Flexion
• Indication: Functional Scoliosis
• • Sign: No correction of curve or rib humping with forward Flexion
• Indication: Structural Scoliosis

Question 21

SI Joint “Squish” Test

Answer 21

• Client supine
• Place one hand on Lateral aspect of each ASIS; apply pressure Medially and then Inferiorly toward SI Joints at a 45degree angle
• • Sign: Pain local to SI Joint
• Indication: Posterior SI Ligament Sprain

Question 22

Nachlas Test

Answer 22

• Client prone
• Passively Flex Knee so heel is brought to Buttocks, ensuring Hip is not Rotated; if 90degrees Knee Flexion cannot occur due to Hip Pathology passively Extend Hip while Flexing Knee as much as possible
• • Sign: Unilateral Neurological pain in Lumbar area, Buttock and/or Posterior thigh
• Indication: L2 or L3 Nerve Root Lesion
• • Sign: Pain in Anterior thigh before heel reaches buttock
• Indication: Tight quadriceps muscle or stretching of Femoral Nerve

Question 23

Thompson’s Test

Answer 23

• Client prone
• Feet over edge of table; squeeze client’s calf muscles
• • Sign: Absence of plantar Flexion
• Indication: Achilles Tendon Rupture (third degree strain)

Question 24

Trendelenberg’s Test

Answer 24

• Client standing
• Have client stand on affected leg and observe PSIS’s
• • Sign: Pelvis on unsupported side stays level or drops
• Indication: Gluteus Medius weakness - possible nerve root lesion on weight bearing side, or Unstable Hip due to dislocation

Question 25

Leg Length Tests

Answer 25

• Client supine
• Therapist ensures client’s pelvis is square (ASIS’s are level); legs are parallel, about 15-20cm apart; measure from ASIS to Lateral Malleolus
• • Sign: Difference or more than 1.5cm
• Indication: True leg length discrepancy due to congenital maldevelopment or trauma

Question 26

Rebound Tenderness Test

Answer 26

• Client supine
• Knee’s and Hips Flexed; slowly apply pressure to McBurney’s point (2/3 way inferiorly between umbilicus and Right ASIS); quickly release pressure
• • Sign: Severe pain with the release of the pressure; often a low-grade fever and nausea
• Indication: Possible appendicitis

Question 27

Homan’s Sign

Answer 27

• Client supine
• Passively Dorsiflex client’s foot with the Knee Extended
• • Sign: Pain in calf
• Indication: Possible deep vein thrombophlebitis

Question 28

Buerger’s Test

Answer 28

• Client supine
• Elevate client’s leg to 45degrees for at least 3 minutes; have client sit with legs dangling over table
• • Sign: Foot blanches or prominent veins collapse shortly after elevating or it takes 1 to 2 minutes for the limb colour to be restored and veins to fill and become prominent
• Indication: Poor arterial blood circulation in lower limb

Question 29

Helfet’s Test

Answer 29

• Client seated
• Legs hanging over edge of table and Knee Flexed to 90degrees; slowly Extend client’s Knee; observe alignment of Tibial Tuberosity to midline of patella
• Normally when the knee is Flexed to 90degrees the tibial Tuberosity lies in line with the midline of the patella. In knee Extension the tibial Tuberosity moves in line with the Lateral border of the patella
• • Sign: Tibial Tuberosity does not line up with Lateral Border of Patella because there is no Lateral Tibial movement
• Indication: Torn Meniscus or injured cruciate ligament

Question 30

First Rib Mobility Test

Answer 30

• Client seated
• Have client Rotate head fully away from affected side, then forward Flex head as far as possible
• • Sign: Limited Flexion
• Indication: First Rib Hypomobility, likely due to Scalene Hypertonicity or fascial restrictions

Question 31

Finger Flexion Test

Answer 31

• Client seated
• Have client hold MCP joints of affected side in full Extension throughout the test; have client Flex IP joints, attempting to touch the fingertips to the palmar surfaces over the MCP joints; make sure client does not make a fist (MCPs remain extended)
• • Sign: Not all 4 fingertips can touch MCP joints
• Indication: Active Scalene trigger points

Question 32

Scoliosis Short Leg Test

Answer 32

• Client standing
• Observe Iliac Crest and AC Joint levels Bilaterally, noting any Lateral tilt and Scoliotic curve; place a foot lift under the apparently short leg, correcting the pelvic tilt
• • Sign: Curve neutralizes
• Indication: Functional Scoliosis due to short limb

Question 33

Infraspinatus Test

Answer 33

• Client standing
• Client has arm at side with elbow Flexed to 90degrees and Humerus Medially Rotated to 45degrees; apply Medial Rotation to Humerus and have client resist
• • Sign: Pain or inability to resist Medial Rotation
• Indication: Infraspinatus Tendinosis, Strain or Weakness

Question 34

Finklestein Test

Answer 34

• Client seated
• Have client make a fist with affected hand with the thumb Flexed inside the flexed finger’s; stabilize the arm proximal to the client’s wrist with one hand and Ulnarly deviate the wrist with the other hand
• • Sign: Pain along Abductor Pollicis Longus and Extensor Pollicis Brevis Tendons
• Indication: DeQuervain’s Tenosynovitis

Question 35

Q-Angle

Answer 35

• Client standing
• Feet neutral, Femur neutral; place goniometer pivot over centre of Patella; proximal arm over the quadriceps tendon aligned with ASIS; distal arm over patellar tendon aligned with middle axis of tendon
• Males: 18 degrees
• Females: 13 degrees
• Less than 13 degrees allows Patella to track Medially between Femoral Condyles, placing extra stress on Medial articulating facets of patella and contributing to chondromalacia Patellae
• Greater than 18 degrees allows patella to track Laterally, stressing Lateral Facets and contributing to Patellar tracking dysfunction, chondromalacia patellae and patellar subluxation

Question 36

Ankle Ligament Stress Test - Anterior Talofibular Ligament

Answer 36

• Have client seated with Knee’s Flexed and legs hanging over the end of the table
• Stabilize anterior surface of Tibia and Fibula Proximal to Ankle; grasp dorsal surface of foot and apply combined overpressure movement of Plantarflexion, Inversion and Adduction; gradually increase pressure
• • Sign: Local pain, some excessive movement with muscle spasm endfeel; chronic total ligament rupture is painlessly Hypermobile
• Indication: Anterior Talofibular Ligament Sprain

Question 37

Ankle Ligament Stress Test - Deltoid Ligament

Answer 37

• Have client seated with Knees Flexed and Legs hanging over the end of the table
• Stabilize Anterior surface of Tibia and Fibula proximal to Ankle; grasp dorsal surface of foot, combining Eversion and Plantarflexion with overpressure
• To assess middle fibres, grasp calcaneous so hindfoot can be taken into Eversion with overpressure
• To assess Posterior fibres, hold along plantar surface of the foot and combine Eversion and Dorsiflexion of the foot with overpressure
• For a general assessment of Deltoid Ligament, evert hindfoot only
• • Sign: Local pain and Hypermobility; muscle spasm endfeel
• Indication: Deltoid Ligament Sprain

Question 38

Ankle Ligament Stress Test - Calcaneofibular Ligament

Answer 38

• Have client seated with Knee’s Flexed and legs hanging over the end of the table
• Stabilize Anterior surface of Tibia and Fibula proximal to Ankle; grasp Calcaneous and Invert hindfoot with overpressure; keep ankle neutral
• • Sign: Local pain; excessive movement; muscle spasm endfeel

Question 39

Varus Stress Test - Elbow

Answer 39

• Client seated
• Stabilize forearm; Flex elbow slightly (20-30degrees) apply varus force to distal forearm
• • Sign: Pain; excessive movement on Lateral elbow
• Indication: Lateral Collateral Ligament Injury

Question 40

Valgus Stress Test - Elbow

Answer 40

• Client seated
• Stabilize forearm; Flex elbow slightly (20-30degrees); apply Valgus force to distal forearm
• • Sign: Pain; excessive movement on Medial Elbow
• Indication: Medial Collateral Ligament Injury

Question 41

Valgus Stress Test - Knee

Answer 41

• Client supine
• Stabilize affected lower limb in slight External Rotation with one hand on Medial Malleolus and other hand on Lateral aspect of Knee; Knee in 20-30degrees Flexion; apply Valgus stress on Lateral Knee; repeat with knee in Neutral
• • Sign: Pain; excessive movement/gapping at Medial aspect of knee
• Indication: Signs at 20-30degrees of Flexion indicate Medial Collateral Lig; other ranges could be due to Joint Capsule or Cruciate Ligaments

Question 42

Varus Stress Test - Knee

Answer 42

• Client supine
• Stabilize affected lower limb in slight external rotation with one hand on medial malleolus and other hand on Lateral aspect of Knee; Knee in 30degrees Flexion; apply varus stress on Medial Knee; repeat with Knee in Neutral
• • Sign: Pain; excessive movement/gapping at Lateral aspect of Knee
• Indication: Signs at 20-30degrees of Flexion indicate Lateral collateral ligament; at other ranges it could be due to Joint Capsule and Cruciate Ligaments

Question 43

Rib Motion Test

Answer 43

• Client in Prone or Supine
• Place hands symmetrically over different areas of the thorax, moving systemicatically from superior to inferior ribs; palpate for rib motion on left and right sides as the client inhales and exhales; note imbalances and asymmetries
• On inhalation, a rib that stops moving relative to the other ribs is a depressed rib
• On exhalation, a rib that does not move relative to the others is an elevated rib
• If a group of ribs is restricted, assess for the key rib that is primarily responsible for the restriction;
  With an inhalation rib-group dysfunction, the key rib is at the superior end of the group
• With an exhalation rib-group dysfunction, the key rib is at the inferior end of the group

Question 44

Rib Palpation Test

Answer 44

• Client Prone
• Palpate rib angles bilaterally with flat hands
• • Sign: More prominent rib angle contour than other ribs
• Indication: Rib is subluxed or fixed in a Posterior direction
• • Sign: Rib contour is less prominent than other ribs
• Indication: Rib is subluxed or fixed in an Anterior direction

Question 45

Scoliosis Small Hemipelvis Test

Answer 45

• Client seated
• Observe the Iliac Crest and AC joints bilaterally, noting any Lateral tilt and Scoliotic tilt; place ischial lift (book) under the lower side, correcting the lateral pelvic tilt
• • Sign: Curve neutralizes
• Indication: Functional Scoliosis due to small Hemipelvis

Question 46

Scapulohumeral Rhythm

Answer 46

• Client standing
• Observe Scapulohumeral Rhythm of shoulder complex (anterior and posterior view): have client Abduct GH joint 180 degrees; there should be an approximate 2:1 ratio of movement of Humerus to the Scapula - 120 movement at the GH joint and 60 of movement at Scapulothoracic joint; observe both the ascending and descending phases of abduction
• Indication: Long Thoracic Nerve Injury, Adhesive Capsulitis, Rotator Cuff Injuries