3.3 Thoracolumbar Special Tests Flashcards
Pt sits on the exam table and is asked to “slump” so the spine flexes and shoulders sag forward while PT holds the chin and head erect
Slump Test or Sitting Dural Stretch Test
Procedure of Slump Test (4 parts)
Part 1: Pt slumps then PT holds chin & head erect
Part 2: PT flexes Pt’s neck & holds head down & shoulder slumped
Part 3: Extend Pt’s knees
Part 4: Dorsiflex the foot of the same leg
ULNT 1 nerve bias
Median, Anterior Interosseous, C5, C6,
C7
ULNT 2 nerve bias
Median, Axillary, Musculocutaneous
ULNT 3 nerve bias
Radial Nerve
ULNT 4 nerve bias
Ulnar, C8, T1
PT palpates for the radial pulse > pt’s head rotates to the side that is tested > pt then extends the head & PT puts the shoulder into extension and ER > pt is asked to take a deep breath
Adson’s Test
Pt’s arm is hyperabducted so that the hand is brought over the head c elbow and arm in the coronal plane c shoulder in ER
Wright’s Test
Modification of Wright’s test with shoulder 90 degrees abducted and ER > head rotated away from the test side
Allen’s Test
PT palpates the radial pulse then draws the pt’s shoulder down and back
Military brace test / Costoclavicular Syndrome
Pt is in supine c hands cupped behind the head > instructed to flex the head onto the chest > Pt actively raises the extended leg by flexing the hip until pain is felt > Pt then flexes the knee
Brudzinski-Kernig Test
(+) Brudzinski-Kernig Test
If pain disappears upon knee flexion
T OR F: Brudzinski-Kernig Test are similar to SLR test except it is passively done
FALSE
ACTIVELY done
(+) Brudzinski-Kernig Test may mean? (3)
indicate meningeal irritation,
nerve root involvement,
or dural irritation
Pt lies in prone while PT passively flexes the knee as far as possible so that pt’s heel rests at the buttocks
Nachlas Test (PKB1-2, PKE)
If the examiner is unable to flex the patient’s knee past 90° because of a pathological condition in the knee, the test may be performed by ____ of the hip while the ____ is flexed as much as possible.
passive extension of hip while knee is flexed
How many seconds does Nachlas Test (PKB1-2, PKE) need to be held for?
45-60 seconds
Unilateral neurological pain in the lumbar area, buttock, posterior thigh, or sometimes the anterior thigh in the Nachlas Test (PKB1-2, PKE) means?
L2 or L3 nerve root lesion
Pain in the anterior thigh in the Nachlas Test (PKB1-2, PKE) means?
tight quads or stretching of the femoral nerve
(+) Slump test
Sx decrease in neck extension
positive for increased tension in the neuromeningeal tract
Nerve bias for Slump test 1
spinal cord,
cervical and lumbar nerve roots,
sciatic nerve
Nerve bias for Slump test 2
obturator nerve
Nerve bias for Slump test 3
femoral nerve
Nerve bias for Slump test 4
spinal cord,
cervical and lumbar nerve roots,
sciatic nerve
What should be the hip and knee position in SLR test
hip IR & ADDUCTED
knee extended
If pain is primarily back pain in SLR testing?
disc herniation
or
pressure is more CENTRAL
If pain is primarily leg pain in SLR testing?
pressure is more LATERAL
T OR F: In SLR test, disc herniations or pathology causing the pressure between the two extremes are more likely to cause pain in both areas
TRUE
neck flexion movement in Lasegue’s
Test
Brudzinski Sign,
Linder Sign,
Soto-Hall test
Hyndman’s Sign,
ankle dorsiflexion movement in Lasegue’s Test
Bragard’s Test
SLR c neck flexion and extension of the big toe instead of dorsiflexion
Sicard’s Test
involves only extension of the big toe
Turyn’s Test
In SLR test, tension in the ____ is normal
cervicothoracic junction
In SLR test, pain increasing c neck flexion, ankle dorsiflexion, or both indicate?
stretching of the dura mater of the SC
OR
lesion of the spinal cord
In SLR test, pain that does not increase with neck flexion indicate?
hamstring area lesion
OR
lesion in the lumbrosacral/SI joints
Pt is relaxed in prone c head straight and arms by the sides > PT stands at pt’s feet and observes the buttocks from the level of the buttocks > Pt is asked to contract the gluteal muscles
Gluteal Skyline Test
(+) Gluteal Skyline Test
Affected gluteus maximus may show less contraction or may be atonic and remain flat
(+) Gluteal Skyline Test may indicate?
inferior gluteal nerve damage
OR
pressure on L5, S1, S2 nerve roots
Tests for joint dysfunction in lumbar spine (3)
Stork standing test
Quadrant test
Schober test
Pt stands on one leg and extends the spine while balancing on the leg
Stork Standing Test/ One-leg standing Lumbar extension test
(+) stork standing test
pain the back
what fx is associated with stork standing test?
pars interarticularis stress fx
If stress fx is unilateral – standing on the ____ leg causes more pain
unilateral: IPSILATERAL leg more pain
What is the indication if rotation is combined with extension in stork standing test and pain results with it?
joint facet pathology
Causes maximum narrowing of the intervertebral foramen & stress on the facet joint to the side on which rotation occurs
Quadrant Test/ Extension Quadrant Test
How many cm/inches above S2 in schober test
10 cm / 4 inches
In quadrant test, overpressure is applied in _____ while pt ____ and ____ to the side of pain
overpressure on EXTENSION
SIDE FLEXED & ROTATES to the side of pain
How many cm/inches below S2 in schober test
5 cm / 2 inches
Special tests for muscle tightness in lumbar spine (4)
- 90-90 Straight Leg Raising Test
- Ober’s Test
- Ely’s Test
- Thomas Test
Other name for 90-90 Straight Leg Raising Test
Hamstrings Contracture, Method 1
What test is this?
Pt in supine > flexes both hips to 90 degrees with knees bent
Pt may grasp behind the knees c both hands to stabilize hips at 90 degrees of flexion
Pt actively extends each knee in turn as much as possible
90-90 Straight Leg Raising Test
For normal hamstring flexibility in 90-90 Straight Leg Raising Test, knee extension should be within _____ degrees of full extension
20 degrees
In 90-90 Straight Leg Raising Test, if the hamstrings are tight, what is the end feel?
muscle stretch
Tests TFL for contracture
Ober’s Test
What test is this?
Pt is in side-lying c lower leg flexed at the hip and knee for stability > PT passively abducts and extends pt’s upper leg c knees straight or flexed to 90 degrees > PT slowly lowers the upper limb
Ober’s Test
(+) Ober’s Test
If (+) contracture, leg remains abducted and does not fall to the table
Other name for Ely’s Test
Tight rectus femoris, method 2
In Ely’s Test, if pt’s hip on the same side of the flexing knee spontaneously flexes, what does this indicate?
tight rectus femoris
Used to assess a hip flexion contracture (most common hip contracture)
Thomas Test
If the leg does not lift off the table but abducts as the other leg is flexed to the chest
J sign/stroke
J sign/stroke is indicative of what?
Indicative of a tight ITB on the extended side
(+) Thomas test
- Pt’s straight leg raises off the table
- Muscle stretch end feel will be felt
- If lower limb is pushed down onto the table, Pt may exhibit an increased lordosis (another positive sign)
Tests for lumbar instability (2)
- H and I Stability Test
- Passive Lumbar Extension Test
Tests for muscle spasm
H and I Stability Test
(+) hypomobile segment present in H and I Stability Test
at least 2 of the movements (into the same quadrant) would be limited
In Passive Lumbar Extension Test, how many cm/ft the PT lifts the legs of the Pt off from the bed?
30 cm / 1 ft
(+) instability present in H and I Stability Test
one quadrant will be affected but only by ONE of the moves
T OR F: Numbness/Pricking sensation are positive signs for Passive Lumbar Extension Test
FALSE
NOT positive signs
POSITIVE SIGNS:
If in the extended position, pt complains of:
- Very strong pain in the lumbar region
- Very heavy feeling in the low back
- Feels like low back is “coming off” and pain disappears when the legs are lowered to the start position
Lumbar special tests for malingering (2)
- Burns Test
- Hoover Test
Pt is asked to kneel on a chair then bend forward to touch the floor with the fingers
Burns Test
(+) Burns Test
pt is unable to perform the test or the pt overbalances
What test is this?
Pt lies in supine > PT places one hand under each calcaneus while pt’s legs remain relaxed on the exam table > PT is then asked to actively lift one leg off the table, keeping knees straight (straight leg testing)
Hoover Test
(+) Hoover Test
pt does not lift the leg or PT does not feel pressure under the opposite heel
