ALL Flashcards
GH
Active Compression Test of O’Brien
Pt standing, straight arm at 90 deg with add to 10-15 deg, thumb down.
Op places downward force. Then Pt with thumb up position - Op rpts pressure.
+ve if pain or clicking inside the shoulder on thumb down, and if decreased or eliminated with thumb up.
+ve for labral abnormalities - designed to test for (SLAP) Type II or superior labrum lesions.
T spine
Adams’ sign
If the Pt has an S or a C scoliosis, note if the scoliosis straightens when the spine is flexed forward.
If it does, it is a negative sign and evidence of functional scoliosis.
A positive sign is noted when the scoliosis is not improved, thus evidence of a structural scoliosis.
TOS
Adson’s Test
With the Pt sitting or standing, the Op palpates the radial pulse and advises the patient to bend the head obliquely backward toward the side being examined, to take a deep breath, and to tighten the neck and chest muscles on the side tested.
The maneuver decreases the interscalene space (anterior and middle scalene muscles) and increases any existing compression of the subclavian artery and lower components (C8 and T1) of the brachial plexus against the 1st rib.
Marked weakening of the pulse or increased paresthesias indicate a positive sign of pressure on the neurovascular bundle, particularly of the subclavian artery as it passes between or through the scaleni musculature, thus indicating a probable cervical rib or scalenus anticus syndrome.
This test is sometimes called the scalene maneuver.
C spine
Alar Ligament Test
Place one hand on the occiput and use the other hand to palpate the spinous process of C2. Laterally flex or rotate the head to one side; you should feel the spinous process move to the opposite side. Repeat on the other side.
Absence of the spinous process moving to the opposite side may indicate alar ligament injury.
If you block the spinous process of C2 from moving, you may stress the ligament. You should encounter a firm end-feel in this case. Significant movement may indicate ligamentous injury.
TOS / Vascular
Allen’s Test
The sitting Pt elevates the arm and is instructed to make a tight fist to express blood from the palm. The Op occludes the radial and ulnar arteries by finger pressure. The Pt then lowers the hand and relaxes fist, and the examiner releases the arteries one at a time. Some examiners prefer to test the radial and ulnar arteries individually in two tests.
The sign is negative if the pale skin of the palm flushes immediately when the artery is released. The Pt should be instructed not to hyperextend the palm as this will constrict skin capillaries and render a false positive sign.
The sign is positive if the skin of the palm remains blanched for more than 3 seconds. This test, which should be performed before Wright’s test, is significant in vascular occlusion of the artery tested.
Ankle
Ankle Eversion Test
The Pt lies on the uninvolved side on a table with the involved foot relaxed and the knee flexed to 90 degrees. The Op places the foot in the anatomical neutral position, then tilts the talus into an abducted position.
Range of motion in the abducted position on the involved foot greater than that of the uninvolved foot reveals a positive test and suggests a tear of the deltoid ligament of the ankle.
Ankle
Ankle Inversion Test
The Pt lies on the uninvolved side on a table with the involved foot relaxed and the knee flexed to 90 degrees. The Op places the foot in the anatomical neutral position, then tilts the talus into an adducted position.
Range of motion in the adducted position on the involved foot greater than that of the uninvolved foot reveals a positive test and suggests a tear of the calcaneofibular ligament of the ankle.
GH
Anterior Apprehension Test
The Pt lies supine on the table with the involved shoulder in 90 degrees of abduction and the elbow in 90 degrees of flexion. The Op slowly externally rotates the shoulder.
A positive finding is a “look of apprehension” on the subject’s face toward further movement in the externally rotated direction and may suggest instability of the glenohumeral joint.
Knee
Anterior Lachman’s Test
The Pt lies supine with the test knee flexed 20-30 degrees. From a neutral position, the Op applies an anterior force to the tibia with the distal hand while stabilizing the femur with the proximal hand.
Excessive anterior translation of the tibia with a diminished or absent endpoint is indicative of a partial or complete tear of the ACL.
Ankle
Anterior Lachman’s Test
The Pt is seated on a table with the knee flexed to 90 degrees and the involved foot relaxed in slight plantar flexion. While assuring stabilization of the distal tibia and fibula, the Op applies an anterior force to the calcaneous and talus.
Anterior translation of the talus away from the ankle mortise that is greater on the involved side suggesta possible anterior talofibular ligament sprain.
Knee
Apley’s Compression Test
The Pt is placed prone with the involved leg flexed at 90º. The Op stabilizes the patient’s thigh with a knee and grasps the patient’s foot. Downward pressure is applied to the foot to compress the medial and lateral menisci between the tibia and femur. The Op then rotates the tibia internally and externally on the femur, holding downward pressure.
Pain during this maneuver indicates probable meniscus or collateral ligament damage.
Medial knee pain suggests medial meniscus damage; lateral pain, lateral meniscus injury.
Knee
Apley’s Distraction Test
The Pt lies prone with the test knee flexed to 90 degrees. The Op uses the distal hand to medially and laterally rotate the tibia while applying a distraction force through the heel.
An increase in and/or change in location of pain is more indicative of ligamentous verses meniscal pathology.
Pain or clicking with a compression test that is followed by an absence of the same symptoms with a distraction test is more indicative of a meniscal pathology.
GH
Apley’s Scratch Test
While sitting or standing, the Pt is instructed to take one hand and touch the opposite shoulder. The test is repeated with the other hand to the opposite side. The Pt is then instructed to place the arm overhead and reach behind the neck as if scratching the upper back. To complete the test, the Pt is instructed to place the hand in the small of the back and reach upward as far as possible.
Asymmetrical results from side to side are positive for limitationsin the joint capsule.
LEX
Apparent Leg-Length Discrepancy Test
The Pt lies supine with the hips and knees fully extended and parallel. Using a tape measure, the Op measures from the umbilicus to the most distal point of the medial malleolus.
A difference of more than 1 cm is indicative of abnormalpelvis positioning.
Significant discrepancies should be verified via radiology.
GH
Apprehension and Relocation Test
To detect anterior instability of the glenohumeral joint.
Apprehension : The Pt lies supine on the table with the involved shoulder in 90 degrees of abduction and the elbow in 90 degrees of flexion. The Op holds the lower forearm and supports the elbow. Then slowly externally rotates the shoulder.
If a positive response is not given, the hand supporting the elbow is then moved to the posterior aspect of the humeral head and an anteriorly directed force can then be applied to further challenge the stability of the shoulder.
Relocation : The Pt’s shoulder position of 90° abduction and external rotation is maintained and the clinician re-positions the heel of their hand over the anterior aspect of the humeral head and applies a firm posteriorly directed force.
C spine
Baccody Sign
The Pt with cervical radicular pain actively places the palm of the affected extremity flat on the top of the head raising the elbow to a height approximately level with the head.
The sign is present when the radiating pain is lessened or absent by this maneuver and is indicative of nerve root irritation due to cervical foraminal compression.
C Spine / Brainstem
Barre’s Test
Pt standing, shoulders forward flexed to 90 degrees, forearms supinated, palms up and eyes closed. Hold 10-30 secs.
+ve for vascular impediment to brainstem if one arm starts to fall with simultaneous forearm pronation.
L spine
Bechterew’s Test
The Pt in the sitting position attempts to extend each leg one at a time followed by an attempt to extend both legs.
The sign is positive if backache or sciatic pain is increased or the maneuver is impossible.
In disc involvements, extending both legs will usually increase spinal and sciatic discomfort.
LEX
Beery’s Sign
This sign is positive if a patient with a history of lower trunk discomfort and fatigue is fairly comfortable when sitting with the knees flexed but experiences discomfort in the standing position.
It is typically seen in spasticity or contractures of the posterior thigh and/or calf muscles.
T spine / L spine
Beevor’s Sign
Pt supine: Flexes head against resistance, coughs or tries to sit up with hands behind head.
+ve if umbilicus doesn’t stay in straight line - heads towards the stronger side.
Indicates weakness of lower abdominal mm. Can indicate Amyotrophic Lateral Sclerosis (MND), lesion of spinal cord below T10.
Knee
Bounce Home Test
With the Pt lying supine, the Op passively flexes the Pt’s test knee and then allows the knee to passively fall into extension.
A rubbery endfeel or springy lock is indicative of a meniscal tear.
This test should be performed with caution.
L spine
Bowstring Sign
If pain occurs during Lasegue’s SLR test, the knee is slightly flexed and the patient’s foot is allowed to rest on the examiner’s shoulder.
When pain subsides, manual pressure is applied against the hamstrings. If this does not increase pain, manual pressure is then quickly applied to the popliteal fossa while holding the knee as straight as patient comfort will allow.
Although local pain in the popliteal fossa is of minor consequence, a reproduction of leg or low-back pain is highly significant of an IVD rupture producing nerve root compression.
L spine
Bragard’s Test
If Lasegue’s SLR test is positive at a given point, the examined leg is lowered below this point and dorsiflexion of the foot induced.
The test is negative if pain is not increased.
A positive sign is a finding in sciatic neuritis, spinal cord tumors, IVD lesions, and spinal nerve irritations.
A negative sign points to muscular involvement such as tight hamstrings. Bragard’s test does not stress the sacroiliac or lumbosacral articulations.
T spine
Breathing Test
The Pt may sit or stand and is asked to breath in and out normally, then take a deep breath followed by rapid expiration.
Normal breathing that is shallow and rapid is indicative of a rib fracture.
Pain with deep inspiration may suggest a rib fracture, costochondral separation, or external intercostal muscle strain.
LEX / Vascular
Buerger’s Test
The Pt is placed supine with the knees extended in a relaxed position, and the Op lifts a leg with the knee extended so that the lower limb is flexed on the hip to about a 45º angle. Pt moves the ankle up and down (dorsiflex and plantarflex the foot) for a minimum of 2 minutes. The limb is then lowered, the Pt is asked to sit up, the legs are allowed to hang down loosely over the edge of the table, and the color of the exercised foot is noted.
Positive signs of arterial insufficiency are found if
- the skin of the foot blanches and the superficial veins collapse when the leg is in the raised position and/or
- it takes more than a minute for the veins of the foot to fill and for the foot to turn a reddish cyanotic color when the limb is lowered.
Hand
Bunnel Littler Test
The Pt is seated with the metacarpophalangeal joint of the involved finger in slight extension. The Op passively flexes the proximal interphalangeal joint (PIP) of the same ray and assesses the amount of PIP joint flexion. The Op then passively flexes the metacarpophalangeal joint (MCP) slightly, and again assesses the amount of flexion at the PIP joint.
A positive finding is revealed if the PIP joint does not flex while the MCP joint is in an extended position.
If the PIP joint does not fully flex once the MCP joint is slightly flexed, intrinsic muscle tightness can be assumed.
By contrast, if flexion of the PIP joint remains limited once the MCP joint is slightly flexed, capsular tightness can be assumed.
L spine / Malingering
Burn’s Bench Test
The patient kneels upright on the examining table or a padded bench that is about 18-20” high. The Op firmly grasps the patient’s ankle from behind and instructs the Pt to bend over and touch the floor with the fingertips.
Pts who normally cannot be expected to carry out this action are those extremely weak from injury or disease or those significantly diseased at the hip or knee.
Those Pts who may not be able to perform the action are those with sciatic neuralgia, congenital anomalies, arthritis, a specific disease of the spine (such as tuberculosis), or a compression fracture of the spine.
Any Pt (other than those mentioned above who cannot be expected to carry out this action) either refuses to perform the action or claims they can only go part way, is presenting evidence of malingering or hysteria.
C spine
Cervical Active Rotary Compression Test
With the Pt sitting, observe while the pt voluntarily laterally flexes the head toward the side being examined. With the neck flexed, the pt is then instructed to rotate the chin toward the same side, which narrows the IVF diameters on the side of scoliotic concavity.
Pain or reduplication of other symptoms suggests a physiologic narrowing of one or more IVFs.
C spine
Cervical Compression Tests
AKA Jacksons Compression Test
Two tests are involved.
First, with the Ptt sitting, the Op stands behind the Pt and the Pt’s head is laterally flexed and rotated about 45º toward the side being examined. Interlocked fingers are placed on the Pt’s scalp and gently pressed caudally.
If an IVF is physiologically narrowed, this maneuver will further insult the foramen by compressing the disc and narrowing the channel, causing pain and reduplication of other symptoms.
Second, the Pt’s neck is extended by the examiner placing interlocked hands on the Pt’s scalp and gently pressing caudally.
If an IVF is physiologically narrowed, this maneuver mechanically compromises foraminal diameters bilaterally and causes pain and reduplication of related symptoms.
C spine
Cervical Distraction Test
With the Pt sitting, the Op stands to the side and places one hand under the Pt’s chin and the other hand under the base of the occiput. Slowly and gradually the Pt’s head is lifted to remove weight from the cervical spine.
This maneuver elongates the IVFs, decreases the pressure on the joint capsules around the facets, and stretches perivertebral soft tissues.
If the maneuver decreases pain and relieves other symptoms, it suggests narrowing of one or more IVFs, cervical facet syndrome, or spastic perivertebral muscles.
C spine
Cervical Percussion Test
The neck of a sitting Pt is flexed to about 45º while the Op percusses each of the cervical SPs and adjacent superficial soft tissues with a rubber-tipped reflex hammer.
Evidence of point tenderness suggests a fractured or acutely subluxated vertebral motion unit or a localized sprain or strain, while symptoms of radicular pain suggest radiculitis or an IVD lesion.
GH
Codman’s Sign
This is a variation of the shoulder abduction stress test and the arm drop test.
If the Pt’s arm can be passively abducted laterally to about 100º without pain, the Op removes support so the position is held actively by the Pt. This produces sudden deltoid contraction.
When a rupture of the supraspinatus tendon or strain of the rotator cuff exists, the pain produced causes the patient to hunch the shoulder and lower the arm.
TOS
Costoclavicular Manoeuver
With the Pt sitting, the Op stands behind and to the side to monitor the radial pulse. OP brings the P’s shoulder and arm posterior and then depresses the shoulder on the side being examined.
This maneuver narrows the ipsilateral costoclavicular space by approximating the clavicle to the first rib, tending to compress the neurovascular structures between.
When the shoulder is retracted, the clavicle moves backward on the sternoclavicular joint and rotates counterclockwise.
An alteration or obliteration of the radial pulse or a reduplication of other symptoms suggests compression of the neurovascular bundle passing between the clavicle and the 1st rib (costoclavicular syndrome).
Elbow
Cozen’s Test
With the Pt’s forearm stabilized, makes a fist and extends the wrist. The Op grips the Pt’s elbow with the stabilizing hand and the top of the Pt’s fist with the active hand and attempts to force the wrist into flexion against patient resistance.
A sign of tennis elbow is a severe sudden pain at the lateral epicondyle area.
GH
Cross-Over Impingement Test
With the Pt seated, the Op passively and maximally horizontally adducts the test shoulder.
Superior shoulder pain is indicative of acromioclavicular joint pathology.
Anterior shoulder pain is indicative of subscapularis, supraspinatus, and/or biceps long head pathology.
Posterior shoulder pain is indicative of infraspinatus, teresminor, and/or posterior capsule pathology.
GH
Dawbarn’s Sign
This test has the Pt standing with the arms hanging loosely at the side. The Op deeply palpates the Pt’s shoulder eliciting a localized tender area. The Op, while leaving the finger on the painful spot, passively abducts the Pt’s arm.
This sign is present when the painful spot disappears on abduction, indicating subacromial bursitis.
L spine
Demianoff’s Test
This variant of Lasegue’s SLR test is used in lumbago and IVF funiculitis with the intent of differentiating between lumbago and sciatica.
When the affected limb is first extended and then flexed at the hip, the corresponding half of the body becomes lowered and with it the muscle fibers fixed to the lumbosacral segment. This act, which stretches the involved muscles, can induce sharp lumbar pain.
Lasegue’s sign is thus negative as the pain is caused by stretching the affected muscles at the posterior portion of the pelvis rather than stretching the sciatic nerve.
To accomplish this test with the Pt supine, the pelvis is fixed by the Op’s hand firmly placed on the ASIS while the other hand elevates the ipsilateral leg. No pain results when the leg is raised to an 80 angle. When lumbago and sciatica coexist, Demianoff’s sign is negative on the affected side but positive on the opposite side unless the pelvis is stabilized.
This sign is also negative in bilateral sciatica with lumbago. The stabilization of the pelvis prevents stretching the sciatic nerve, and any undue pain experienced is usually associated with ischiotrochanteric groove adhesions or soft-tissue shortening.
Hip
Dial Test
Passively roll the leg into full medial and lateral rotation.
The test is considered positive for laxity of the anterior hip capsule and iliofemoral ligament if range of motion is greater than 45 degrees and there is no rebound back to neutral.
C spine / vascular
Dix Hallpike’s Manoeuver
Pt seated holding head into full extn and 45 degree rot - bring head lower than body
+ve if dizziness or nystagmus occurs.
NB Also assesses nerve root compression of lower cervical spine.
Vascular
Dizziness Test
Vertebral Artery Occlusion vs Inner Ear
Pt seated, Op rotates head to EOR R and L holding at each extreme for 30secs - shoulders should remain stationary. Then Pt’s shoulders only are rotated keeping head facing forward.
+ve for vertebral artery occlusion if symptoms in both directions as it is kinked in both directions. If dizziness is only experienced when head is rotated the problem lies within the semicircular canals of inner ear.
L spine
Double Leg Raise Test
This is a two-phase test:
- The Pt is placed supine, and a straight-leg-raising (SLR) test is performed on each limb: first on one side, and then on the other.
- The SLR test is then performed on both limbs simultaneously; ie, a bilateral SLR test.
If pain occurs at a lower angle when both legs are raised together than when performing the monolateral SLR maneuver, the test is considered positive for a lumbosacral area lesion.
GH
Drop Arm Test
With the Pt either sitting or standing, the Op passively abducts the Pt’s involved arm to 90 degrees and then instructs the subject to slowly lower the arm to the side.
A positive finding is indicated if the subject is unable to slowly return the arm to the side and/or has significant pain when attempting to perform the task. This is indicative of a rotator cuff pathology.
L spine / Hip
Ely’s Test
To support iliopsoas spasm suspicions, the Pt is placed prone with the toes hanging over the edge of the table, legs relaxed. Either heel is approximated to the opposite buttock.
After flexion of the knee, hip pain makes it impossible to carry out the test if there is any irritation of the psoas muscle or its sheath. The buttock will tend to rise on the involved side.
However, a positive Ely’s test also can be an indication of rectus femoris contraction, a lumbar lesion, a contracture of the tensor fascia lata, or an osseous hip lesion.
L spine
Fajersztajn’s Test
When straight-leg raising and dorsiflexion of the foot are performed on the asymptomatic side of a sciatic patient and this causes pain on the symptomatic side, there is a positive Fajersztajn’s sign, which is said to be particularly indicative of a sciatic nerve root involvement such as a disc syndrome, dural root sleeve adhesions, or some other space-occupying lesion.
This is sometimes called the well-leg or cross-leg straight-leg-raising test. From a biomechanical viewpoint, this test would be suggestive but not indicative.
Peripheral nerve
Femoral Nerve Traction Test
Pt sidelying - sore side superior Back is straight Op lifts & extns hip with knee extnd (straight) Knee is then flexed.
+ve pain radiating down anterior thigh.
Hand
Finger Tap Test
With the Pt sitting or standing, the Op applies a firm tap to the end of the finger being tested.
Pain at the site of injury suggests a possible fracture. The Op may also use a percussion hammer for this test.
Wrist
Finkelstein’s Test
Pt places the thumb in a closed fist and tilts the closed hand towards the little finger.
If pain occurs at the wrist below the thumb, DeQuervain’s tenosynovitis is likely.
Hip
Fitzgerald’s Test
Anterior labral tears: the affected limb is placed in full flexion, lateral rotation, and abduction. The Op then extends the hip passively, while moving it through medial rotation, and adduction as well.
Posterior labral tears: begin with the affected hip in full flexion, adduction, and medial rotation. The Op then extends the hip passively, while moving it through lateral rotation, and abduction.
A sharp pain in the anterior hip is a positive test for a labral tear. Clicking may or may not be audible.
Hip
Flexion, Adduction, Internal Rotation (FAIR) Test
Pt side-lying with the tested hip on top. Passively move the Pt’s LEX into flexion (90 degrees), adduction, and internal rotation.
A positive test for irritation of the sciatic nerve by the piriformis occurs when pain is produced in the sciatic/gluteal area.
Due to the position of the test, pain may produced in the anterior thigh as well as a result of femoral acetabular impingement.
C spine
Spurling’s Test / Reverse Spurling’s
Pt seated: 3 Stages Op presses down on Pt’s head Pt Extnd’s head, Op presses down Pt Extnds and rots head, Op presses down
Performed if there are neuro symptoms / or suspected facet irritation
+ve for nerve root irritation if symptoms are produced in the arm head is bending towards.
This may indicate: stenosis, spondylosis, osteophytes, inflammed facet joints, herniated disc or vertebral fracture.
If symptoms are produced at any stage the Op discontinues.
If symptoms are produced on opp side REVERSE SPURLINGS = mm spasm in conditions such as tension myalgia and Whiplash Associated Disorders (WADS).
T spine / L spine
Forestier’s sign
The Pt in the upright position is asked to bend laterally, first to one side and then to the other.
Normally, the contralateral perivertebral muscles will bulge because of the normal coupling rotation of the lumbar spine (exhibited by the spinous processes pointing to the ipsilateral side of lateral flexion).
However, in ankylosing spondylitis (Marie-Strumpell’s disease) or a state of extensive spinal fixation, the muscles will appear to bulge greater on the side of the curve’s concavity.
L spine / Hip / SI
Gaenslen’s test
Pt supine with knees and hips acutely flexed,clasps the knees with both hands and pulls them toward the abdomen.
This brings the lumbar spine firmly in contact with the table and fixes both the pelvis and lumbar spine.
Op standing at right angles to the Pt, the Pt is brought well to the side of the table and the Op slowly hyperextends the opposite thigh by gradually increasing force by pressure of one hand on top of the Pt’s knee while the Op’s other hand is on the Pt’s flexed knee for support in fixing the lumbar spine and pelvis. Some Ops allow the hyperextended limb to fall from the table edge.
The hyperextension of the hip exerts a rotating force on the corresponding half of the pelvis. The pull is made on the ilium through the Y ligament and the muscles attached to the AIISs.
The test is positive if the thigh is hyperextended and pain is felt in the sacroiliac area or referred down the thigh, providing that the opposite sacroiliac joint is normal and the sacrum moves as a unit with the side of the pelvis opposite to that being tested.
The test should be conducted bilaterally.
A positive sign may be elicited in a sacroiliac, hip, or lower lumbar nerve root lesion.
If the L4 nerve is involved, pain is usually referred anteriorly to the groin or upper thigh.
If the sign is negative, a lumbosacral lesion should be the first suspicion.
This test is usually contraindicated in the elderly.
VBI
George’s Test
Supine Pt extends the head and neck over the edge of the table. With eyes open the Pt actively rotates the head and neck while maintaining the extended position.
One or more of the following indicates a positive test: either blanching or cyanosis of the face, nystagmus, sweating, dizziness, nausea, headache or an increase of temperature.
Until vascular disorders are ruled out by further examination, a positive test would indicate that cervical manipulation involving rotation and/or extension is contra-indicated.
SI
Gillis’ test
Pt prone and Op standing on the side of involvement, the Op reaches over and stabilizes the uninvolved sacroiliac joint while the thigh on the involved side is extended at the hip.
Pain initiated by this maneuver in the sacroiliac area of the involved side is a positive sign of acute sacroiliac sprain/subluxation or sacroiliac disease.
L spine / SI
Goldthwait’s test
Pt supineand Op places one hand under the lumbar spine with each fingerpad pressed firmly against the interspinous spaces. The other hand of the examiner is used to slowly conduct an SLR test.
If pain occurs or is aggravated before the lumbar processes open (1º–30º, a sacroiliac lesion should be suspected.
In general, Goldthwait believed if pain occurred while the processes were opening at :
- 30º–60º, a lumbosacral lesion was suggested;
- at 60º–90º, an L1–L4 disc lesion.
- When pain is brought on before the lumbar spine begins to move, a lesion, either arthritic or a sprain involving the sacroiliac joint, is probably present.
- If pain does not arise until after the lumbar spine begins to move, the disorder is likely to be in the lumbosacral area or less commonly in the sacroiliac area(s).
The test should be repeated with the unaffected limb.
A positive sign of a lumbosacral lesion is elicited if pain occurs at about the same height as it did with the first limb.
When the unaffected limb can be raised higher than the affected limb, it is thought to be significant of sacroiliac involvement of the affected side.
Elbow
Golfer’s Elbow Test
The Pt sits or stands and makes a fist on the involved side. The Op passively supinates the forearm and extends the elbow and wrist.
Complaints of discomfort along the medial aspect of the elbow may be indicative of medial epicondylitis (Golfer’s Elbow).
Vascular
Hautant’s Test
1st - pt seated flexes both arms to 90 degrees and closes eyes.
If arms move cause is nonvascular.
2nd - pt rotates or extns and rots head, closes eyes.
If arms move then is it +ve for vascular
GH
Hawkin’s-Kennedy
Aim to identify subacromial or internal impingement.
Pt with the arm relaxed in the anatomical position. Op standing adjacent to the patient on the affected side, one hand is placed under the elbow, the other holds just above the wrist. The elbow is flexed to 90° and the shoulder taken passively into 90° of forward flexion. The shoulder is passively taken into internal rotation thereby rotating the greater tuberosity under the coracoacromial arch.
Pain is reproduced increasingly towards the end of the rotation movement and indicates rotator cuff pathology involving the cuff itself, the adjacent bursa or the long head of biceps. The glenoid labrum is also vulnerable in this test.
A positive result is highly likely in the presence of a capsulitis which should therefore be excluded to avoid a false positive result.
L spine / Brainstem
Heel Walk Test
Pt should normally be able to walk several steps on the heels with the forefoot dorsiflexed. Except for a localized heel disorder (eg, a calcaneal spur) or contracted calf muscles.
Inability to do this because of low-back pain or weakness can suggest an L5 lesion.
