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176 Cards in this Set
- Front
- Back
DUGAS
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Instruct: Pt. seated- ask Pt. to place the hand of the affected side on the opposite shoulder & then bring the affected elbow to the chest
Postive: inability to touch the opposite shoulder and or inability of the elbow to touch the chest Indicates: Acute dislocation of the shoulder @ glenohumeral joint |
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ANTERIOR APREHENSION
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Instruct: Pt. seated, Dr. abducts the Pt’s shoulder, flexes the Pt’s elbow & then gradually externally rotates to the Pt’s shoulder
Positive: Pt. will have a noticeable look of apprehension or alarm on face with possible pain Indicates: chronic anterior dislocation of the shoulder @ glenohumeral joint |
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POSTERIOR APPREHENSION TEST
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Instruct: Pt. supine, Dr. flexes Pt’s shoulder, flexes Pt’s elbow & internally rotates the Pt’s shoulder. Dr. places his/her hand on the Pt’s elbow & gradually applies increasing posterior pressure
Positive: Pt. will have a noticeable look of apprehension or alarm on face with possible pain Indicates: chronic posterior dislocation of the shoulder @ glenohumeral joint |
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CODMAN’S DROP ARM Testaka: DROP ARM Test
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Instruct: Pt. seated, Dr. passively abducts Pt’s arm to slightly over 90 degrees & removes support, If Pt. can maintain arm, then instruct Pt. to slowly lower their arm.
Positive: Pt will not be able to lower the arm slowly or the arm drops suddenly Indicates: rotator cuff tear, usually supraspinatus |
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DAWBARN’S
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Instruct: Pt. seated, Dr. applies pressure below the affected acromial process with his/her fingertips. Note for pain or tenderness. Dr. continues to apply pressure while abducted the Pt’s arm past 90 degrees
Positive: decrease in pain and or tenderness Indicates: subacromial bursitis |
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YERGASON’S Test (CIPRIANO)
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Instruct: Pt. seated, Dr. flexes Pt’s elbow to 90 degrees Dr. stabalizes Pt’s elbow with one hand & exerts slight inferior traction. Dr. uses their other hand & grasps slightly above Pt’s wrist. Dr. offers resitance while pt is instructed to externally rotate his/her shoulder & slighly supinated
Positive: 1) localized pain or tenderness at bicipital groove Indicates:1) tendonitis Positive: 2) audible click or the biceps tendon subluxes or dislocates Indicates: 2) instability of the biceps tendon possibly associated with a torn transverse humeral ligament |
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ABBOTT-SAUNDERS TEST
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Instruct: Pt. seated, Dr. fully abducts & externally rotates Pt’s affected arm. Dr. places his/her fingers on the Pt’s bicipital groove & then slowly lowers Pt’s affected arm to their side
Positive: palpable and or audible click Indicates: subluxation or dislocation of the biceps tendon (rupture of transverse ligament or tendon subluxation beneath subscapularis muscle belly) |
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SPEED’S
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Instruct: Pt seated with forearm supinated, & elbow flexed to 45 degrees. Dr. places his/her fingers on Pt’s bicipital groove with their opposite hand on the Pt’s forearm. Instruct the Pt. to flex his/her shoulder, maintain supination & completely extend the elbow as the Dr. applies resistance
Positive: pain and or tenderness in bicipital groove Indicates: bicipital tendonitis |
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APLEY’S TEST
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Instruct: Pt. seated. Have Pt. place his/her affected hand behind the head and touch the opposite superior angle of the scapula= apley’s scratch superior
Have the Pt to place the hand behind the back to touch the inferior angle of scapula= apley’s scratch inferior Positive: exacerbation of pain Indicates: degenerative tendonitis of the rotator cuff tendons, usually supraspinatus |
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IMPINGEMENT Sign
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Instruct: Pt. seated with arm at side, Dr. slightly abducts Pt’s arm (hand should be pronated) & moves it fully through flexion (this will jam the greater tuberosity & anterior/ inferior surface of the acromion
Positve: pain in shoulder Indicates: overuse injury to the supraspinatus and possibly biceps tendon |
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MEDIAL COLLATERAL LIGAMENT TEST(ABDUCTION STRESS TEST)
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Instruct: Pt. seated, Dr. stabalizes the lateral aspect of the arm & places an abduction (valgus) pressure on the medial forarm
Positive: excessive gapping and pain Indicates: medial collateral ligament instability |
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LATERAL COLLATERAL LIGAMENT TEST(ADDUCTION STRESS TEST)
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Instruct: Pt. seated, Dr. stabalizes the medial aspect of the arm & places an adduction (varus) pressure on the Pt’s lateral forarm
Positive: excessive gapping and pain Indicates: lateral collateral ligament instability |
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TINEL’S ELBOW SIGN
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Instruct: Pt. seated, with Taylor reflex hammer, Dr. taps over the groove b/t the medial epicondyle & the olecranon process
Positive: pain and or tenderness at the site being tapped and paresthesia in the ulnar nerve distributon are…fingers 4/5 Indicates: neuroma of the ulnar nerve |
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COZEN’S
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Instruct: Pt. seated, Dr. instructs Pt. to make a fist & place wrist into extension. Dr. Instructs Pt. to resist as Dr. tries to push extended wrist into flexion
Positive: pain over the lateral epicondyle Indicates: lateral epicondylitis (tennis elbow) |
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MILL’S TEST(Maneuver – Evans)
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Instruct: Pt. seat with forearm supinated. In a smooth continuous motion the Dr. passively maximally flexes the Pt’s elbow, then wrist & fingers. While maintaining wrist & finger flexion, The Dr. passively extends the Pt’s elbow (the forearm is now pronated)
Positive: pain over the lateral epicondyle Indicates: lateral epiconylitis (tennis elbow) |
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GOLFER’S ELBOW TEST
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Instruct: Pt. seated, Dr. instructs Pt. to extend the elbow & supinate the hand
Positive: pain over the medial epicondyle Indicates: medial epicondylis |
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TINEL’S WRIST SIGN
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Instruct: Pt. seated with wrist supinated, Dr. taps over the palmar (volar) surface of the wrist (flexor retinaculum) with the Taylor hammer
Positive: reproduction of pain, tenderness and/or paresthisia in the median nerve distribution area…thumb, 2, 3, lateral half of 4 Indicates: carpal tunnel syndrome |
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PHALEN’S SIGN & REVERSE PHALEN’S SIGN (aka PRAYER SIGN)
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Instruct: Pt. seated, Dr. instructs Pt. to flex both wrists to maximum degree & approximate until point of pain or 60 seconds
Prayer sign= maximally extend wrist (palms together) elbows @ same level as shoulder for 60 seconds or until point of pain Positive: reproduction of pain and or paresthesia in the median nerve distribution area…thumb, 2,3, lateral half of 4. Indicates: carpal tunnel syndrome |
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FINKELSTEIN’S TEST
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Instruct: Pt. seated, Dr. instructs Pt. to place his/her thumb across the palmer surface of the hand & make a fist. Have Pt. flex elbow & instruct Pt. to ulnar deviate their hand
Positive: pain distal to the radial styloid process Indicates: stenosing tenosynovitis of the abductor pollicis longus (AbPL) and extensor pollicis brevis EPB tendons (DEQUERVAIN’S DISEASE) |
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BUNNEL-LITTLER TEST
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Instruct: Pt. seated, Dr. places MCP joint in extension & tries to flex the PIP joint. If no flexion is possible that there is either a joint capsule contracture or tight intrinsic muscles. To differentiate, Dr. places the MCP joint in a few degrees of flexion & attemps to move the PIP joint into flexion
Positive: 1) flexion of the (PIP) proximal interphalangeal joint can’t be achieved Indicates: 1) joint capsule contracture Positive: 2) flexion of the (PIP) proximal interphalangeal joint is achieved Indicates: 2) tight intrinsic muscles |
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RETINACULAR TEST
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Instruct: Pt. seated, Dr. places PIP joint in neutral & tries to flex the DIP joint. If no flexion is possible then there is either a joint capsule contracture or tight retinacular ligaments. To differentiate, Dr. places the PIP joint in a few degrees of flexion & attemps to move the DIP joint into flexion
Positive: 1) flexion of the (DIP) distal interphalangeal joint cannot be achieved Indicates: 1) joint capsule contracture Positive: 2) flexion of the (DIP) distal interphalangeal joint is achieved Indicates: 2) tight retinacular ligament |
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ALLEN’S TEST
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Instruct: Pt. seated, Dr. instructs Pt. to raise his/her hand above the heart level of his/her head & to open/close his/her fist for 60 seconds. Dr. occludes both the radial & ulnar artery @ wrist & then lower’s the Pt’s arm with the fist closed & allows the fist to rest on Pt’s thigh. Dr. instructs Pt. to open closed fist & release digital pressure over one artery while keeping the other artery occuled. Record the filling time, while comparing color to the other hand. The repeat procedure for the other artery.
Positive: a delay of more than 10 seconds in returning a reddish color to the hand (Evans 5 seconds) Indicates: radial or ulnar artery insufficiency. *The artery held by the examiner is not the artery being tested. |
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FORAMINAL COMPRESSION
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Instruct: Pt. seated, Dr. standing behind Pt. Dr. clasps his/her hands over Pt’s head & exerts gradual increasing downward pressure. Dr. repeats this with Pt’s head rotated Right then Left
Positive: 1) exacerbation of localized cervical pain Indicates: 1) foraminal encroachment or facet pathology without nerve root compression Positive: 2) exacerbation of cervical pain with a radicular component Indicates: 2) foraminal encroachment with nerve root compression or facet pathology |
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CERVICAL DISTRACTION
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Instruct: Pt. seated. Dr. grasps the Pt’s head with both hands & gradually exerts upward pressure keeping hands off TMJ & EARS
Positive: diminished or absence of pain Indicates: foraminal encroachment (local pain diminishes), nerve root compression (radicular pain diminishes) Positive: increase of cervical pain Indicates: muscular strain, ligamentous sprain, myospasm, facet capsulitis |
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SPINAL PERCUSSION
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Instruct: Pt. seated with head in slight flexion, percuss each cervical SP & the associated musculature with the pointed end of the Taylor reflex hammer
Positive: 1) local pain Indicates: 1) possible fractured vertebrae, ligamentous involvement (spinous pain), muscular involvelment (muscular pain) Positive: 2) radiating pain Indicates: 2)possible disc pathology |
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SHOULDER DEPRESSION
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Instruct: Pt. seated., Dr. stabilizes Pt’s laterally flexed head while pushing down on shoulder
Positive: localized pain on the side being tested Pain on either side Indicates: Localized Pain- dural sleeve adhesion, and muscular adhesion/ contracture or spasm or ligamentous injury Radicular pain on A) side being tested-neurovascular bundle compression, dural sleeve adhesions, or thoracic outlet syndrome B) Opposite side- foraminal encroachment with nerve root compression |
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VALSALVA MANEUVER
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Instruct: Pt. seated, Dr. instruct Pt. to take a deep breath & hold, while bearing down as if having a bowel movement
Positive: local or radiating pain from site of lesion Indicates: space occupying lesion |
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SWALLOWING TEST
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Instruct: Pt. seated, Dr. instructs the patient to swallow
Positive: difficulty in swallowing Indicates: space occupying lesion at anterior portion of cervical spine. possibly esophageal or pharyngeal injury, anterior disc defect, muscle spasm or oseophytes |
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SOTO HALL SIGN
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Instruct: Pt. supine, Dr. flexes Pt’s head toward his/her chest while exerting downward pressure on Pt’s sternum with hypothenar eminence of inferior hand
Positive: generalized pain in the cervical region, may extend down to the level of T2 Indicates: non specific test for structural integrity of cervical region |
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KERNIG’S SIGN
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Instruct: Pt. supine, Dr. passively flexes Pt’s hip to 90 degrees & the Pt’s knee to 90 degrees. Dr. extends Pt’s leg completely
Positive: inability to fully extend the leg and or pain (usually in neck region) Indicates: meningeal irritation/meningitis |
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O’DONOGHUE MANEUVER
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Instruct:
Pt. is seated, Dr. grasps the Pt’s head with both hands & passively takes the cervical region thru a range of motion. The Dr. then takes the cervical region thru isometric contractions Positive: Pain during passive range of motion Pain during resisted range of motion Indicates: Ligamentous sprain (passive ROM stresses ligaments) Muscle/tendon strain (active ROM stresses muscles and tendons |
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HOOVER’S SIGN
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Instruct: Pt. supine, Dr. instructs patient to lift the affected leg while the Dr. places one hand under the heel of the non-affected leg (healthy side)
Positive: Lack of counter pressure on the healthy side Indicates: Lack of organic basis for paralysis. (Malingering/hysteria) **with organic hemiplegia, the patient will still exert downward pressure when attempting to raise paralyzed leg** |
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STRAIGHT LEG RAISER
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Instruct: Pt. supine, Dr. raises Patient’s leg slowly to 90 degrees or to the point of pain
Positive: Radiating pain &/or dull posterior thigh pain Indicates: Sciatic radiculopathy or tight hamstrings. Positive between 35-70 degrees= possible discogenic sciatic radiculopathy (Cipriano) |
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GOLDTHWAIT’S SIGN
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Instruct: Pt. supine, Dr. places 3 fingers of the superior hand under the interspinous space of the Pt’s lower lumbar vertebrae. Dr. then raises one of the Pt’s extended legs.
Positive: localized pain, low back or radiation pain down the leg Indicates: Lumbo-sacral or sacroiliac pathology. -Pain occurring after the lumbars move= possible lumbo sacral problem. -Pain occurring before the lumbars move = possible sacroiliac problem. |
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Bragard’s Sign
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Instruct: Pt. Supine, Dr. performs a SLR on the Pt. Dr. lowers the raised leg (5 degrees) from the point of pain and sharply dorsiflexes Pt’s foot
Positive: Radiating pain in posterior thigh Indicates: Sciatic Radiculopathy |
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BUCKLING SIGN (CIPRIANO)
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Instruct: Pt. supine, Dr. performs a SLR on Pt.
Positive: Pain in the posterior thigh with sudden knew flexion (buckle) Indicates: Sciatic radiculopathy |
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BOWSTRING SIGN
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Instruct: Pt. supine, Dr. Places Pt’s leg on their shoulder & first applies pressure to the hamstring muscle if pain is not elicited then apply pressure to the popliteal fossa
Positive: Pain in the lumbar region or radiculopathy Indicates: Sciatic nerve root compression, helps rule out tight hamstrings. |
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LASEGUE’S TEST
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Instruct: Pt. Supine, Hip & leg bent to 90 degrees. Slowly extend the knee (keeping hip@/or close to 90 degrees
Positive: Reproduction of sciatic pain before 60 degrees Indicates: Sciatica |
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MILGRAM’S TEST
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Instruct: Pt. supine, Dr. raises both of Pt’s legs 2-3 inches off the table & instructs Pt. to hold legs off the table for 30 seconds.
Positive: Inability to perform test and or low back pain Indicates: Weak abdominal muscles or (SOL) space occupying lesion |
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BECHTEREW’S TEST
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Instruct: Pt. seated, Dr. instructs Pt. to extend one knee at a time alternately, then both together
Positive: Reproduction of radicular pain or inability to perform correctly due to tripod sign Indicates: Sciatic radiculopathy |
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ANTERIOR INNOMINATE TEST/ MAZION’S PELVIC MANEUVER/ADVANCEMENT SIGN
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Instruct: Pt. standing, Dr. instructs Pt. to advance one leg forward approximately 2-3 feet. Pt. is then instructed to bend forward at the waist and touch the advanced foot with both hands. (advanced knee should be straight)
Positive: The inability to bend at the waist more than 45 degrees because of either/or: Positive: 1)Radiating pain along the sciatic nerve, either unilateral or bilateral Indicates:1) sciatic radiculopathy or neuralgia possible due to lumbar disc pathology Positive: 2) Low back pain in lumbar or pelvic region Indicates: 2) Anterior (rotational) displacement of the ilium relative to the sacrum |
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Lewin Standing Test
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Instruct: Dr. instructs Pt. to bend forward slightly @ the waist with knees slightly flexed. Dr. first brings one knee into complete extension. Next the Dr. brings the other knee into complete extension. Finally Dr. brings both knees into complete extension.
Positive: Radiating pain down the leg causing flexion of the Pt’s knee or knees Indicates: lumbo-sacral, sacroiliac, or gluteal pathologies |
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NERI’S BOWING TEST AKA NERI’S SIGN
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Instruct: Dr. instructs PT. to bend forward from the waist
Positive: Pain accompanied by flexion of the knee of the affected side and body rotation away from the affected side Indicates: Positive with a variety of low back pathologies. Hamstring tension on the pelvis may trigger the response. |
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HEEL WALK
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Instruct: Ask Pt. to walk on their heels (7-8 steps)
Positive: Inability to perform test Indicates: L4/ L5 disc problem…L5 nerve root |
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TOE WALK
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Instruct: Ask Pt. to walk on their toes (7-8 steps)
Positive: Inability to perform test Indicates: L5/S1 disc problem…S1 nerve root |
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ELY’s HEEL TO BUTTOCK TEST AKA ELY’S SIGN
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Instruct: Pt. prone, Dr. flexes the knee of the Pt’s affected leg to 90 degree. Dr. then approximates the heel of the affected leg to the contralateral buttock and hyperextends the thigh off the table
Positive: Inability to raise the thigh Pain in the anterior thigh Pain in the lumbar region Indicates: Iliopsoas spasm Lumbar nerve root inflammation Lumbar nerve root adhesion |
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LEG LENGTH DISCREPANCY
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Instruct: Pt. supine, (TRUE) Dr. takes a cloth measuring tape & measures from ASIS to medial malleoli of the same leg. Dr. measures from ASIS to medial malleoli of opposite leg. (Apparent) Dr. takes a cloth tape measure & measures from the umbilicus to the medial malleoli of one leg & then measures from umbilicus to medial malleoli of opposite leg
Positive: Different measurements Indicates: True=bony abnormality above or below level of trochanter difference. Apparent=pelvic obliquely |
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ALLIS’ SIGN
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Instruct: PT. is supine, Dr. instructs Pt. to place both flat feet on bench while flexing both knees to 90 degrees
Positive: Difference in height and anteriority of the knees Indicates: 1) If one knee is lower=ipsilateral congenital hip dislocation or tibial discrepancy (anatomical short leg): 2)If one knee is anterior= ipsilateral congenital hip dislocation or femoral discrepancy (anatomical short leg) |
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THOMAS TEST
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Instruct: Pt. supine, Dr. instructs Pt. to approximate each knee one at a time to his/her chest and hold
Positive: Lumbar spine maintains lordosis (should flatten) and opposite hip doesn’t straighten Indicates: Contracture of the hip flexors (iliopsoas) |
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ANVIL TEST
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Instruct: Pt. supine, Dr. elevates the affected leg while keeping the knee extended. The Dr. then makes a fist & strikes the affected leg’s inferior calcaneus
Positive: Localized pain in long bone or in hip joint Indicates: Possible fracture of long bones, hip joint pathology |
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PATRICK’S TEST/FABERE SIGN
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Instruct: Pt. Supine, Dr. flexes, abducts, & externally rotates the Patient’s hip so that the ankle rests above or below the contralateral knee. Dr. then extends the hip by pushing just superior to the knee while stabilizing the contralateral ASIS
Positive: Pain in the hip region Indicates: Hip joint pathology |
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Laguerre’s Test
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Instruct: Pt. supine, Dr. grasps the affected leg, flexes and externally rotates the hip and abducts the thigh (similar to Patrick’s except the ankle of the affected leg is not resting on the contra-lateral knee). Dr. applies pressure to the end range of motion while stabilizing the contra-lateral ASIS (rest ankle on forearm and with other hand reach under arm to stabilize)
Positive: 1) Pain in the hip joint Indicates: 1) Hip joint pathology Positive: 2) Pain in the sacroiliac joint Indicates:2) Mechanical problem of the sacroiliac joint |
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Gaenslen’s Test
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Instruct: Pt. is supine with affected side of the sacroiliac joint as close to the edge of the table as possible. The Pt. then grasps the unaffected leg just below the knee and approximates the knee to his chest. The Dr. Then places a downward pressure on the affected thigh until it is lower than the edge of the table.
Positive: Pain on the affected SI joint stressed into extension Indicates: General sacroiliac joint lesion, anterior sacroiliac ligament sprain, or inflammation of the SI joint. |
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Lewin-Gaenslen Test
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Instruct: Pt lying on his unaffected side, instruct patient to flex his inferior leg. Dr. grasps the superior leg and brings into extension while stabilizing the lumbo-sacral joint (extension of the leg stresses the sacroiliac joint and anterior joint ligaments on the side of leg extension
Positive: Pain on the side of extension Indicates: General sacroiliac joint lesion, anterior sacroiliac ligament sprain, or inflammation of the SI joint. |
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Hibb’s Test
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Instruct: Pt. prone, Dr. stabilizes pelvis on near side while grasping the opposite ankle and flexing the knee to 90 degrees Dr. maximally flexes the knee and then slowly internally rotates the thigh (pushing lateral on the leg). Compare bilateral
Positive: 1) Pain in the hip region Indicates: 1)Hip joint pathology Positive: 2) Pain in the buttock/pelvic region Indicates: 2) Sacroiliac joint lesion |
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Ober’s
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Instruct: Pt. on his/her side, Dr. flexes the knee of the Pt’s affected leg 90 degrees, while abducting & extending the hip. Perform bilaterally
Positive: Affected thigh remains in Abduction. (normally biomechanics the thigh/hip will adduct) Indicates: Contraction of the iliotibial band or tensor fascia lata, (usually secondary to synovitis of the hip, secondary to trauma of the gluteus medius and maximus. |
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PELVIC ROCK TEST/ILIAC COMPRESSION TEST
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Instruct: Pt. lies on their side. Dr. places both hands on the lateral portion of the Pt’s ilium. Dr. pushes downward (lateral to medial) on the Pt’s ilium. Test bilaterally
Positive: Pain in either sacroiliac joint Indicates: Sacroiliac joint lesion |
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NACHLAS TEST
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Instruct: Pt. prone, Dr. takes the heel of the affected leg & approximates it to the ipsilateral buttock while stabilizing the pelvis to prevent hip flexion.
Positive: Pain in the buttock &/or pain in the lumbar region Indicates: Sacroiliac joint lesion or lumbar pathology |
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Yeoman’s Test
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Instruct: Pt. prone, Dr. flexes Pt’s leg to ipsilateral buttock and then extends the thigh
Positive: Pain deep in the SI joint Indicates: (Strain)/Sprain of the anterior sacroiliac ligaments |
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ELY’S SIGN
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Instruct: Pt. Prone, Dr. passively flexes the Pt’s knee toward the ipsilateral buttock (no stabilization)
Positive: Hip on side being tested will flex causing the buttock to raise off the table Indicates: Rectus femoris or hip flexor contracture |
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Ely’s Heel to Buttock Test
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Instruct: Pt. prone, Dr. flexes the knee of the Pt’s affected leg to 90 degrees. Dr. then approximates the heel of the affected leg to the contralateral buttock and hyperextends the thigh off the table
Positive: Inability to raise the thigh Pain in the anterior thigh Pain in the lumbar region Indicates: Iliopsoas spasm Lumbar nerve root inflammation Lumbar nerve root adhesion |
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TRENDELENBURG’S TEST
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Instruct: Pt. stands on foot of involved side of hip problem. Observe level of hips.
Positive: High iliac crest on supported side and low crest on side of elevated leg Indicates: Weak gluteus medius muscle on the supported side |
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MCMURRAY SIGN
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Instruct: Pt. supine, Dr. flexes Pt’s affected hip to 90 degrees & the affected knee to 90 degrees. Dr. grasps the heel of the affected leg & applies external rotation of the knee. Dr. places his/her hand on the lateral aspect of the affected knee & applies valgus (abduction) stress. Dr. maintains the external rotation & valgus stress on the knee & extends affected leg slowly to the top of the table while palpating the medial knee joint line
Positive: Clicking sound or pain by knee joint Indicates: Tear of medial meniscus if positive on external rotation. Tear of lateral meniscus if positive on internal rotation. The higher leg is raised when positive is elicited, the more posterior the meniscal injury. |
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MEDIAL COLLATERAL LIGAMENT /ABDUCTION STRESS/VALGUS STRESS TEST
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Instruct: Pt. supine, Dr. stabilizes the lateral thigh of the Pt’s affected leg. Dr. grasps just superior to the medial ankle of the affected leg & gradually pushes laterally ( to open medial side of joint)
Positive: Gapping and or elicited pain above/at/or below joint line Indicates: Torn medial collateral ligament |
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LATERAL COLLATERAL LIGAMENT TEST/ADDUCTION STRESS TEST/VARUS STRESS TEST
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Instruct: Pt. supine, Dr. stabilizes the medial thigh of the Pt’s affected leg. Dr. grasps just superior to the lateral ankle of the affected leg & gradually pushes medially (opening the lateral side of the joint)
Positive: Gapping &/or elicited pain above/at/or below joint line Indicates: Torn lateral collateral ligament |
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BOUNCE HOME TEST
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Instruct: Pt. supine, Dr. instructs Pt. to flex his leg, Dr. grasps the Pt’s heel & knee of the affected leg, Dr. pulls leg slowly into extension (passively)
Positive: Knee does not go into full extension (slight flexion remains) Indicates: Diffuse swelling of the knee, accumulation of fluid, due to possible torn meniscus |
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DRAWER TEST
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Instruct: Pt. supine, Dr. flexes the hip & the knee of the Pt’s affected leg until the foot is flat on the table. Dr. sits on the foot of the Pt’s affected leg. Dr. grasps behing the Pt’s flexed knee & exerts a pushing & pulling pressure into the affected knee.
Positive: 1) Gapping >6 mm (tibia moves posterior) when the leg is pushed Indicates: 1) Torn posterior cruciate ligament Positive: 2) Gapping >6 mm (tibia moves anterior) when the leg is pulled Indicates: 2)Torn anterior cruciate ligament |
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LACHMAN’S TEST
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Instruct: Pt. supine, Dr. puts the Pt’s knee @ 30 degrees angle of flexion & from this angle the Dr. grasps both the proximal end of the tibia with one hand & attempts to pull tibia forward in order to feel the joint play (variation of Drawer’s Test)
Positive: Gapping with the tibia moving away from the femur Indicates: Anterior cruciate ligament or posterior oblique ligament instability |
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APPREHENSION TEST FOR PATELLA
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Instruct: Pt. supine (or seated) with Quadriceps relaxed & resting over Dr’s leg @ a 30 degrees flexion, Dr. pushes the patella laterally
Positive: Apprehension, distress of facial expression, contraction of quadriceps to bring patella back in line Indicates: Chronic patella dislocation or pre-disposition to dislocation |
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PATELLA FEMORAL GRINDING TEST aka CLARKE’S SIGN
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Instruct: Pt. supine, affected knee extended Dr. uses the web of the hand to move the patella to an inferior position. Dr. instructs Pt. to tighten the quadriceps muscles as the Dr. continues to hold the patella in the inferior direction.
Positive: Retropatellar pain & the patient is unable to hold the quadriceps contraction Indicates: Degenerative changes of the patellar facets and/or within the trochlear groove (chondromalacia patella) |
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PATELLA BALLOTTMENT TEST
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Instruct: Pt. supine with knee extended. Anterior to posterior pressure is applied over the patella.
Positive: A floating sensation of the patella is a positive finding Indicates: A large amount of swelling in the knee |
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APLEY’S COMPRESSION TEST
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Instruct: Pt. prone, Dr. flexes Pt’s affected knee to 90 degrees. Stabilize Pt’s thigh with your knee place downward pressure on the Pt’s heel while internally & externally rotating the Pt’s foot.
Positive: Patient points to side of pain Indicates: Pain or medial side is medial meniscus tear. Pain on the lateral side indicates lateral meniscus tear |
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APLEY’S DISTRACTION TEST
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Instruct: Pt. prone, Dr. flexes Pt. affected knee to 90 degrees. Dr. places his/her knee on Pt’s affected thigh for stabilization. Dr. grasps the Pt’s foot & pulls the leg while internally & externally rotating the tibia
Positive: Patient will point to side of pain Instruct: Pain on the medial side indicates medial collateral ligament tear. Pain on the lateral side indicates lateral collateral ligament tear. |
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DRAWER SIGN (Anterior Drawer sign of the ankle)
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Instruct: Pt. seated, Dr. grasps just superior to the ankle with one hand & around the calcaneus of the affected foot with the other hand. Dr. pulls (draws) the calcaneus anteriorly & pushes the tibia posteriorly, the reverse procedure by pulling the ankle anterior & calcaneus posterior
Positive: Translation with the talus moving away from or toward the tibia Indicates: 1) With tibia pushed/foot pulled; a tear/instability of the anterior talofibular ligament. 2) With tibia pulled/foot pushed; a tear/ instability of posterior talofibular ligament. |
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ANKLE DORSIFLEXION TEST
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Instruct: Pt. seated, Dr. tries to dorsiflex foot of affected leg, 1st with the knee extended, then again with the knee flexed
Positive: 1) The foot cannot dorsiflex with knee extended, but is able to with knee flexed Indicates: 1) contracture of gastrocnemius muscle Positive: 2) The foot cannot dorsiflex in either knee position Indicates: 2) contracture of the soleus muscle |
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RIGID OR SUPPLE FLAT FEET TEST
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Instruct: Pt. is seated & then stands, Dr. observes Pt’s feet while seated & while standing
Positive: 1) Absence of medial longitudinal arch in both positions Indicates: 1) Rigid flat feet Positive: 2) Presence of medial longitudinal arch while seated with a loss of medial longitudinal arch while standing Indicates: 2) Supple flat feet |
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HOMANS’ SIGN
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Instruct: Pt. supine, Dr. raises the extended affected leg about 12” off table or 45 degrees & then forcibly dorsiflexes the foot of the affected leg. (Squeezing the calf is recommended by some sources, yet other sources feel it is contra-indicated)
Positive: Deep pain in the calf Indicates: Deep vein thrombophlebits |
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THOMPSON’S TEST
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Instruct: Pt. prone with leg flexed to 90 degrees by Dr. squeezes the belly of the calf muscle of the affected leg
Positive: Absence of foot plantarflexion motion Indicated: Achilles tendon rupture |
|
MORTON’S TEST
|
Instruct: Pt. supine, Dr. grasps the affected forefoot with one hand & applies transverse pressure across the metatarsal heads
Positive: Sharp pain in the forefoot Indicates: Metatarsalgia or neuroma (usually @ 3rd or 4th metatarsal interspace) |
|
L' Hermitte's sign
|
Instruct: Pt sitting or supine, Pt flexes their head toward their chest, or per Evan’s Dr. Actively flexes Pt’s head toward chest
Positive: Electric shock-like sensations down the spine and/or spinal cord. Indicates: Meningeal irritation/meningitis |
|
Brudzinski
|
Instruct: Pt. supine, Dr. Flexes Pt's head to the chest
Positive: Involuntary knee flexion Indicates: Meningeal irritation or nerve root lesion |
|
Jackson Compression
|
Procedure: Patient seated with examiner standing behind. Examiner laterally flexes
the patient's head to one side and clasps his/her hands over patient's head and exerts increasing downward pressure. Perform bilaterally. Positive: 1) Exacerbation of localized cervical pain. Indicates: 1) Foraminal encroachment without nerve root pressure or facet pathology. Positive: 2) Exacerbation of cervical pain with a radicular component. Indicates: 2) Foraminal encroachment with nerve root compression |
|
Maximal Cervical Compression
|
Procedure: Patient seated with examiner standing behind. The examiner instructs
the patient to rotate the head and hyperextend the neck. Perform bilaterally. Positive: 1) Pain on the concave side Indicates: 1) Foraminal encroachment with or without nerve root compression (based on presence or absence of radicular component) Positive: 2) Pain on the convex side Indicates: 2) Muscular strain |
|
Bakody Sign (Shoulder Abduction Test)
|
Procedure: Patient seated, examiner instructs patient to place the palm of the
affected side flat on top of their head. Positive: Decrease or absence of radiating pain. Indicates: Cervical foraminal compression, nerve root entrapment (usually C5/C6 level because this motion elevates the subscapular nerve and puts traction on the lower brachial plexus). |
|
Adam's Sign (positions)
|
Instruct: Patient standing, with examiner standing behind patient, Dr. looks for evidence of scoliosis. Dr. instructs patient to bend forward at the waist with fingers extended and hands together. Examiner observes for evidence of change in the scoliosis.
Positive: 1) Pt. Has a C or S shaped scoliosis in observed to straighten Indicates: 1) Negative: evidence of a functional scoliosis Positive: 2) Pt. Has a C or S shaped scoliosis that does not straighten Indicates: 2) evidence of a pathologic or structural scoliosis as well as trauma or subluxation. |
|
Schepelmann's Sign
|
Procedure: Patient seated arms fully abducted and raised over head, Dr.instructs Pt. to laterally flex thoracic spine to the left side and then to the right side.
Positive: Pain on the concave or convex side. Indicates: Pain on the concave side indicates intercostal neuritis while pain on the convex side indicates fibrous inflammation of the pleura (or possible intercostal myofascitis). |
|
Beevor's Sign
|
Procedure: Pt. supine, Dr. instructs Pt. to cross his/her arms across the chest and perform a partial sit up.
Positive: Superior movement of the umbilicus. Indicates: Superior movement of the umbilicus is indicative of a spinal cord lesion at the level of T10 or lower abdominal weakness. Inferior movement |
|
Roos' Test a.k.a. E.A.S.T (elevated arm stress test)
|
Instruct: Pt. standing, Dr. instructs Pt. to bring arms out in front of their body,
bend the elbows to 90°. The patient then externally rotates the arms and opens and closes their fists bilaterally at a moderate pace for up to 3 minutes. Positive: Ischemic pain, heaviness of the arms, or numbness and tingling of the hand. Indicates: Thoracic outlet syndrome on side |
|
Adson's Test (Scalene Maneuver and Scalenus Anticus Test)
|
Procedure: Pt. seated with arms at side and elbows fully extended. Dr. finds radial
pulse, slightly abducts affected arm and has Pt. take a deep breath and hold, then instruct patient to rotate head and elevate chin toward examiner while holding the breath. Note positive or negative findings, if negative then rotate head to the opposite side and repeat the procedure. Positive: Pain and/or paresthesia, decreased or absent pulse, pallor. Indicates: 1)Scalenus anticus syndrome or cervical rib syndrome. (usually same side) 2) Decrease or absence of radial pulse indicates compression of subclavian artery. 3) Paresthesia/radiculopathy indicates compression of the brachial plexus at the neurovascular bundle by scalenius anticus or cervical rib (usually opposite side) |
|
Halstead's Maneuver
|
Instruct: Pt. seated,Dr. finds and monitors radial pulse in neutral position with one
hand and with the other hand tractions the Pt's arm toward the floor. Dr. instructs Pt. to elevate chin and hyperextend their neck. If the test is negative (the pulse does not disappear), then rotate the head to the opposite side and repeat. Positive: Pain and/or paresthesia, decreased or absent pulse, pallor. Indicates: Compression of the neurovascular bundle by scalenus anticus or cervical rib. |
|
Costoclavicular Maneuver a.k.a. Eden's Test
|
Procedure: Patient seated, examiner finds radial pulse and instructs patient to sit
erects, force shoulders back, chest out and touch chin to chest. Positive: Pain and/or paresthesia, decreased or absent pulse, pallor. Indicates: Compression of the neurovascular bundle between the clavicle and 1st rib. |
|
Hyperabduction Maneuver a.k.a. Wright's Test
|
Procedure: Patient seated, examiner finds radial pulse and hyperabducts the
patient's arm. Positive: Pain and/or paresthesia, decreased or absent pulse, pallor. Indicates: Compression of the axillary artery by pectoralis minor or coracoid process. Thoracic outlet syndrome |
|
Fromet's Paper Sign
|
Instruct: Pt seated and is instructed to hold a piece of paper b/t any two adducted fingers. The Dr tries to remove the paper
Positive: The Pt. is unable to maintain grip on the paper Indicates: Ulnar nerve paralysis |
|
Minor's Sign
|
Instruct: Examiner instructs patient to stand. Observe for abnormal motion.
Positive: Knee flexion of affected leg while supporting upper body weight (hand on back or thigh) on unaffected side. Indicates: Sciatica, lumbosacral or sacroiliac joint lesion |
|
Belt Test (Supported Adam's Test, Supported Forward Bending Test)
|
Procedure: Patient standing. Have patient bend forward and note for presence of low
Back pain. With the Pt. standing, stabilize Pt's iliac crest and brace hip against Pt's sacrum. have Pt. bend forward as you immobilize the pelvis. Positive: Low back pain Indicates: 1) Pain in during unsupported and supported bending = Lumbar involvement Indicates: 2) Pain in during unsupported, no pain during supported bending = pelvic involvement |
|
Kemp's Test
|
Procedure: Pt. either seated or standing with arms crossed in front of the chest. Dr. stands behind Pt. and stabilizes at the PSIS. With other hand Dr. reaches around Pt. and grasps Pt's shoulder. Dr. Passively brings Shoulder back and obliquely pushes shoulder toward opposite PSIS.
Positive: 1) Pain usually radicular, recreating existing sciatic pain Indicates: 1) Disc protrusion: *In Medial disc protrusion Kemps will be positive as the patient is leaning AWAY from the side of pain. *In Lateral disc protrusion Kemps will be positive as the Pt is leaning into side of pain. Positive: 2) local pain Indicates: 2) Localized pain may indicate lumbar spasm or facet capsulitis. |
|
Lindner's Sign
|
Instruct: Patient supine, examiner flexes patient's head toward the chest.
Positive: Pain along sciatic distribution or sharp, diffuse pain (leg) Indicates: Sciatic radiculopathy |
|
Sicard's Sign
|
Instruct: Examiner lowers raised leg (see SLR) 5 degrees from point of pain and dorsiflexes
patient's big toe. Positive: Posterior thigh and leg pain. Indicates: Sciatic radiculopathy, usually from disc lesion |
|
Turyn's Sign
|
Instruct: Patient supine, examiner dorsiflexes the big toe of the affected extremity.
Positive: Pain in the gluteal region or radiating sciatic pain. Indicates: Sciatic radiculopathy |
|
Bonnet's Sign
|
Procedure: Patient supine, examiner strongly internally rotates and adducts the
affected leg across the midline and then performs a straight leg raiser test. Positive: Pain in posterior thigh or leg. Indicates: Sciatica (possibly piriformis syndrome) |
|
Fajersztajn's Test a.k.a. Well-Leg-Raising Test of Fajersztajn a.k.a. Cross-over Sign
|
Procedure: Patient is supine. Examiner performs a SLR on the patient's unaffected
leg to 75º or until it produces pain down the affected leg. If no pain is produced, examiner dorsiflexes the foot. Positive: 1) Pain down affected leg.(Cross-Over Sign) Indicates: 1) Medial disc protrusion Positive: 2) Decrease in pain down affected leg. Indicates: 2) Lateral disc protrusion |
|
Femoral Stretch Test (Femoral Nerve Traction Test)
|
Procedure: Patient lies on the unaffected leg side, hip and knee slightly flexed,
patient straightens back and flexes neck. The affected leg is extended by the examiner at the hip approx. 15º. The affected knee is flexed (stretching femoral nerve). Positive: Pain on the anterior portion of the thigh. Indicates: Traction on the femoral nerve indicating involvement of the 2nd, 3rd and 4th lumbar nerve roots |
|
Tinel's Foot Sign
|
Procedure: Doctor taps the region of the medial plantar nerve, posterior to the
medial malleolus Positive: Paresthesia radiating into the foot. Indication: Tarsal tunnel syndrome |
|
Point Localization (Topognosis)
|
The ability to recognize points being touched on the body (use dull side of neurotip on skin) ask Pt. to point to the spot being touched with their finger
|
|
Orientation
|
Ask Pt. Their name, location, and date
|
|
Level of alertness, attention, and cooperation
|
Ask the patient to spell a word forward and backward
Ask the patient to repeat a string of integers forward and backward Ask the patient to name the months forward and backward |
|
Memory
|
Recent- recall three items after 5 minute delay
Remote- recall certain historical facts within the Pt's lifetime "where did you go to highschool?" |
|
Language
|
Object naming
Repetition of single words and sentences |
|
Calculations
|
Simple additions and subtractions, should be two or more steps
|
|
Apraxia
|
Following a complex motor command like "pretend to comb your hair" or "pretend to brush your teeth"
|
|
Sequencing Tasks
|
Ask Pt to tap on the table with: fist, open palm, then side of open hand (rock, paper, scissor)
|
|
Abstraction
|
Interpretation of a proverb or colloquiallism "early bird catches the worm"
|
|
Diadochokinesia
|
Patting Test: Rapid rhythmic alternating movements.
Have patient pat leg with each hand as fast as possible |
|
Diadochokinesia
|
Supination M Pronation Test: Have patient pronate and
supinate palms as rapidly as possible |
|
Dysmetria
|
Have patient touch your index finger and then his/her nose
alternately several times. (Note tremors or lack of coordination) |
|
Dysmetria
|
Heel-Shin: Have patient run their heel from his/her knee to his/her foot.
|
|
Forced Gait
|
Forced gait testing- ask the patient to walk on heels one way and on toes back toward you
observe patient walking toward and away, note posture, stability, foot elevation, trajectory of leg swing, balance, and arm motions |
|
Tandem Gait
|
Tandem gait- ask the patient to walk heel toe.
observe patient walking toward and away, note posture, stability, foot elevation, trajectory of leg swing, balance, and arm motions |
|
Pain (pinprick)
|
use sharp end of neurotip) stimuli on the hands and feet
(spinothalamic). |
|
Vibration (Pallesthesia)
|
Place the handle of a vibrating 128 Hz tuning fork
on the bony prominances of the upper and lower extremities. Start distal work proximal. Ask Pt "can you feel vibration? and when does it stop?" (Dr. stops it) |
|
Light Touch
|
Gently stroke skin with a wisp of cotton or with a camel hair
brush |
|
Joint Position Sense
|
Examiner moves patient's fingers and toes, he/she is
asked to describe the digit position. (open or closed position) |
|
Romberg's Test
|
ask the patient with eyes open, then closed, note any swaying
stand next to patient |
|
Sharp vs Dull discrimination
|
Alternate sharp and dull (use a neurotip)
stimuli on the hands and feet (spinothalamic). |
|
Stereognosis
|
The ability to recognize familiar objects by the sense of touch
|
|
Graphesthesia
|
The ability to recognize numbers traced lightly on the skin
|
|
Barognosis
|
The ability to distinguish between different weights
|
|
Two Point discrimination
|
Determining the smallest area in which two points
can be separately perceived. (use paperclip) |
|
Double Simultaneous Stimulation
|
Extinction- only one side is felt
Displacement- one side is felt normally and the other displaced toward midline Synesthesia- one side is felt normally and the other is a vague burning |
|
Deep Tendon Reflex C5
|
Biceps
Response : elbow flexion Afferent/Efferent: Musculocutaneous Nerve Integrating Center: C5 spinal cord |
|
Deep Tendon Reflex C6
|
Brachioradialis
Response: slight forearm flexion Afferent/efferent: Radial Nerve intergrating center: C6 spinal cord |
|
Deep Tendon Reflex C7
|
Triceps
Response: Elbow flexion afferent/efferent: Radial Nerve Integrating Center: C7 spinal cord |
|
Deep Tendon Reflex L4
|
Patella
response: Knee extension Afferent/efferent: femoral nerve Intergrating Center: L2, L3, L4 spinal cord |
|
Deep Tendon Reflex S2
|
Achilles
Response: Foot plantar flexion Afferent/efferent: Tibial Nerve Intergrating Center: S1, S2 spinal cord |
|
Jendrassik's Maneuver
AKA Reinforcement Test or Cortical Distraction Test |
A form of cortical distraction that brings out a reflex when hard to elicit Pt. hooks hands together by flexed fingers and pulls on the clenched hands at the moment the reflex is performed
|
|
Direct Light Reflex
|
Response: Ipsilateral
pupillary constriction when light is shined in the eye afferent: Optic Nerve CN II Intergrating Center: Midbrain Effernet: Oculomotor Nerve CN III |
|
Indirect Light Reflex
|
Reponse:Contralateral
pupillary constriction when light is shined in the eye Afferent: Optic Nerve CN II Intergrating Center: Midbrain Efferent: Oculomotor Nerve CN III |
|
Accommodation
|
Response: Convergence of
the eyes, pupillary constriction, Lens convexity when object is brought into near vision afferent: Optic Nerve CN II Intergrating Center: Occipital Cortex Efferent: Oculomotor Nerve CN III |
|
Carotid Sinus
|
Pairing of Radial and Carotid Pulse
Response: Reduction in heart rate when Dr. presses the carotid sinus afferent: Glossopharyngeal Nerve IX intergrating: Medulla Efferent: Vagus Nerve CN X |
|
Oculocardiac
|
Response: Reduction in
heart rate When Dr. presses the eye Afferent: Trigeminal Nerve CN V Intergrating: Medulla Efferent: Vagus Nerve CN X |
|
Ciliospinal
|
Response: Pupillary dilation
when examiner pinches the base of the neck at the cervical sympathetic chain Afferent:Cervical Sympathetic Chain intergrating: T1-T2 Spinal Cord Efferent: Cervical Sympathetic Chain |
|
Corneal
|
Response: Blinking and tearing of the eye upon touching the cornea with a cotton wisp
afferent: trigeminal Nerve CN V intergrating: Pons efferent: Facial nerve CN VII |
|
Gag/Pharyngeal
|
Reponse: Gagging upon touching the back of the
throat with a tongue depressor afferent: Glossopharyngeal Nerve IX Intergrating Center: Medulla Efferent: Vagus Nerve CN X |
|
Uvular/Palateal
|
Patient says "ah."
Watch for symmetrical rising of soft palate. Bilateral lesion of Vagus = Palate does not rise. Unilateral paralysis = One side of palate does not rise and uvula will deviates to the normal side. Response: Raising of the uvula upon phonation, or touching with a tongue depressor afferent: Glossopharyngeal Nerve IX Intergrating: Medulla Efferent: Vagus Nerve CN X X |
|
Interscapular
|
Response: Drawing inward of
scapular when skin or interscapular space is irritated. Afferent: T2-T7 Spinal Nerves Intergrating: T2-T7 Spinal Cord Efferent: Dorsal scapular nerve |
|
Abdominal
|
Response: Umbilicus deviation to the stroked side. Absence is
normal only if bilateral afferent: Upper T7-10 & Lower T11-12 Intergrating:Spinal Cord T7-T12 Efferent: Upper T7-10 & Lower T11-12 |
|
Plantar
|
Respone: Plantar flexion
(curling) of toes upon stroking sole of foot Afferent: Tibial Nerve intergrating: Spinal Cord S1-S2 Efferent: Tibial Nerve |
|
Glabella aka
McCarthy's |
Contraction of orbicularis occuli muscle upon percussion of supraorbital ridge (glabella)
Abnormal Response (Upper Motor Neuron Lesion) |
|
Hoffman's
|
Clawing of the fingers and thumb (flexion and adduction of thumb with flexion of
the fingers) upon flicking tip of index finger into extension Abnormal Response (Upper Motor Neuron Lesion) |
|
Trommer's
|
Flexion of the fingers and thumb upon tapping palmar surface or tips of middle
three fingers Abnormal Response (Upper Motor Neuron Lesion) |
|
Ankle Clonus
|
Continued involuntary contraction (flexion and extension) of foot upon quick
forcible dorsiflexion of the foot Abnormal Response (Upper Motor Neuron Lesion) |
|
Babinski
|
Dorsiflexion of the big toe and fanning or splaying of other toes upon
stimulation of the plantar surface of the foot (lateral to medial) Abnormal Response (Upper Motor Neuron Lesion) |
|
Olfactory Nerve CN I
|
Ask about disorders of sense of smell and of taste (will diminish with loss of smell)
a) Using a penlight, make sure nostrils are not blocked. b) Occlude one nostril at a time (eyes should be closed) Have patient sniff familiar and non-irritating odors, use the milder scent first. Ask the patient: 1) Do you smell anything? 2) Can you identify the substance? |
|
Test visual acuity
|
Screen by reading print
Screen with shapes and/or colors Optic Nerve CN II |
|
Test visual fields by confrontation (peripheral vision) a.k.a. Wiggling test
|
Examine directly in front and level with patient's face
Have patient cover one eye Bring object into view from eight different directions per eye |
|
Extraocular movements
Motor CN III, IV, VI |
test CN III, IV, and VI combined
with six cardinal gazes observe Pt's eyes for normal conjugate, or parallel movements of the eyes and nystagmus as you have him/her follow your finger or pencil while it makes a wide "H" in the air: Trochlear = down and in Abducens = lateral Oculomotor all other fields |
|
Light touch to anterior 2/3 of tongue
|
inside cheeks, and hard palate with toothpick. (Use a penlight to view the inside of the mouth)
(V) Trigeminal Nerve (Ophthalmic, Maxillary, and Mandibular) |
|
Motor for (VII) Facial Nerve
|
Inspect face for asymmetry (at rest and during motion)
Ask the patient to perform the following: Raise eyebrows Close eyes tightly Show teeth Puff out cheeks Smile Frown |
|
Finger Rub Test
|
Assess hearing by rubbing fingers together near the EAM, find maximal distance sound can be heard.
CN VIII |
|
Whisper Test
|
Have patient close his eyes (to prevent lip-reading) and cover the ear on the
side not being tested. Place your head/mouth 2 feet from the ear being tested and whisper words to the patient and ask patient to repeat the words. You can also ask questions to the patient and have him/her answer yes or no to each question. Repeat this procedure at varying (usually increasing) distances or with loud, medium and soft tones. |
|
Weber Test
|
Procedure: Place the handle of the vibrating tuning fork on the midline of the skull
and ask the patient to compare the intensity of the sound in the two ears. Indicates: (-) Normal: sound is equal in both ears. (+) Conductive deafness: sound lateralizes to the bad ear. (+) Sensorineural deafness: sound lateralizes to the good ear. |
|
RinneTest
|
Procedure: Place the handle of the tuning fork against the mastoid process. Have
the patient signal when the sound ceases, then hold the fork near the external ear without touching the patient, again have the patient indicate when the sound ceases. Indicates: (+) Normal: air conduction persists twice as long as bone conduction (-) Conduction deafness: air conduction is equal to bone conduction or air conduction is less than bone conduction. (-) Sensorineural deafness: air conduction and bone conduction are both radically decreased or absent |
|
Labyrinthine Test for Positional Nystagmus
|
Procedure: Pt Seated, Dr inspects Pt's eyes for spontaneous Nystagmyus. Than inspect for Nystagmus for 30 seconds in each of the following positions:
Pt. supine head off table turn head to one side, then to the other side Pt's head hanging off table (extension/flexion) Pt returns to seated position. Indicates: Normal: the fast component of the eye movement will be in the direction the patient is being moved. (Nystagmus is named for the fast component). Peripheral Lesion: the patient will exhibit nystagmus within 2-5 seconds, does not change direction if the patient is stationary, and disappears within 30 seconds. Medullary Lesion: Nystagmus begins immediately upon movement and may change direction while the patient is stationary (also patient does not have vertigo). |
|
Vestibulo-ocular Reflex
|
Procedure: Pt. seated, Dr holds Pt's head and instructs Pt to fix vision on Dr's face. Dr then turns Pt's head into rotation, lateral flexion, and flexion and extension.
Indicates: Normal patient should maintain eye contact eyes moving at the same speed in the opposite direction of head movement. Abnormal findings are detailed in labyrinthine test above Peripheral Lesion: the patient will exhibit nystagmus within 2-5 seconds, does not change direction if the patient is stationary, and disappears within 30 seconds. Medullary Lesion: Nystagmus begins immediately upon movement and may change direction while the patient is stationary (also patient does not have vertigo). |
|
(XI) Spinal Accessory Nerve
|
a) Trapezius Muscle
Inspect Palpate Muscle test b) Sternomastoid Muscle Inspect Palpate Muscle test |
|
(XII) Hypoglossal Nerve
|
Have patient stick out tongue and test bilateral with tongue depressor, or use the
tongue in cheek method Unilateral paralysis = Protruded tongue deviates to involved side |
|
Neurological Level: C5
Motor exam |
Disc Level C4
Muscle tests (2) Shoulder abduction: deltoid (Axillary nerve) Forearm flexion: biceps (Musculocutaneous Nerve) |
|
Neurological Level: C6
Motor exam |
Disc Level C5
Muscle test (1) Wrist extension extensor carpi radialis longus & brevis, extensor carpi ulnaris (Radial Nerve) |
|
Neurological Level: C7
motor exam |
Disc Level C6
Muscle tests (3) Elbow extension: triceps (Radial Nerve) Wrist flexion: flexor carpi radialis (Median Nerve), flexor carpi ulnaris (Ulnar Nerve) Finger extension: (Radial Nerve) |
|
Neurological Level: C8
Motor exam |
Disc Level C7
Muscle test (1) Finger flexion: Flexor digitorum superficialis, flexor digitorum profundus and lubricals Ulnar & Median Nerve |
|
Neurological Level: T1
motor exam |
Disc Level C8
Muscle tests (2) Finger abduction: dorsal interossei (Ulnar Nerve) Finger adduction: palmer interossei (Ulnar Nerve) |
|
Neurological Level: L4
Motor exam |
Disc Level L3
Muscle test (1) Foot inversion with slight dorsiflexion: tibialis anterior (Deep Peroneal/fibular Nerve) |
|
Neurological Level: L5
Motor exam |
Disc Level L4
Muscle tests (4) Foot dorsiflexion Big toe dorsiflexion: extensor hallucis longus (Deep Peroneal/fibular Nerve) Toes 2,3,4 dorsiflexion: extensor digitorum longus and brevis (Deep Peroneal/fibular Nerve) Hip/Thigh abduction: gluteus medius & minimus (Superior Gluteal nerve) |
|
Neurological Level: S1
Motor Exam |
Disc Level L5
Muscle tests (3) Foot Plantar flexion: Gastrocnemius and Soleus (Tibial Nerve) Foot plantar flexion and eversion: peroneus longus and brevis (Superficial Peroneal/fibular Nerve). Hip extension: gluteus maximus (Inferior Gluteal Nerve). |
|
Vital signs
|
1. Pulse
Rate Rhythm Amplitude Contour 2. Respiratory Rate 3. Temperature 4. Blood Pressure |
|
Head and Neck Examination
Inspection |
1. Hair
Color Distribution 2. Head Position Tilt Rotation 3. Scalp Surface 4. Skull Size Shape Symmetry Condition 5. Face Shape Symmetry Structural abnormalities 6. Battle Sign 7. DeMusettes Sign 8. Neck Symmetry of muscles Webbing Masses 9. Tracheal Position 10. Patient Swallowing 11. Distended Veins or Arteries 12. Skin Color Variations 13. Ranges of Motion |