COMPS 2 ONE 2 Flashcards
Well Leg Raise (WLR) Test
aka Fajersztajn
test: lumbar
position: supine
Action:
1) examiner tests unaffected leg only
2) place pt’s hip in medial rotation and adduction, with knee in extension
3) examiner flexes hip until pt complains of tightness in back or back of leg
4) examiner slowly drops leg till pt feels no pain or tightness
Positive finding:
Diff Dx:
straight leg raise (SLR)
nerve traction test AKA Leseque
test: lumbar
position: supine
Action:
1) examiner tests the unaffected side first
2) place pt’s hip in medial rotation and adduction, with knee in extension
3) examiner flexes hip until pt complains of tightness in back or back of leg
4) examiner drops leg till pt feels no pain or tightness
5) pt is then asked to flex chin to chest (sotohall)
6) examiner dorsiflexes foot (braggards)
Positive findings:
low back pain
Diff dx:
sciatica of lumbar pathology = pain >70 degree of hip flexion
SI joint pathology = <70 degree of hip flexion
Kemp’s (Quadrant) Test
test: lumbar
position: standing
Action:
1) examiner is behind pt
2) ask pt to extend spine, lat flex and rotate to same side
3) examiner can control movt by supporting shoulders
4) continue until end of ROM
Positive finding:
pain or reproduction of symptoms
Diff Dx:
Lumbar facet dysfunction or IVFE
Braggard’s Test
test: lumbar
position: supine
action: same as Strait Leg Raise Test:
Examiner flexes the hip until Pt. complains of tightness in back or back of leg. Then Examiner slowly drops leg till Pt. feels no pain or tightness. Examiner dorsiflexes foot.
positive Sx:
LOW BACK PAIN (LBP) or tightness in back or back of thigh, calf or foot.
differential Dx:
PAIN @ 0-70° of hip flexion = Sciatica or Lumbar Pathology. PAIN @ 71°-90° of hip flexion = SI Joint Pathology. Stretching/irritation of dura, disc herniation, cord lesion: tumor or meningitis.
Hibb’s Test - prone gapping test
test: pelvis & hip
position: prone
Action:
1) examiner stabilizes pt’s pelvis
2) flex pt’s knee to 90 degree or greater
3) medially rotate hip as far as possible
4) palpate SI joint of ipsilateral side
5) perform bilaterally and compare to contralateral SI jt
Positive finding:
decreased range of movt of SI jt or SI jt becomes hypermobile
Diff Dx:
SI joint pathology
knee-to-shoulder test
aka SI rocking test or sacrotuberous lig stress test
test: pelvis & hip
position: supine
Action:
1) examiner flexes affected knee and hip fully then add hip
2) sacro-iliac (SI) jt is rocked by flexion and adduction of hip, moving knee toward opp shoulder
Positive finding:
SI jt pain
Diff Dx:
SI joint pathology
Patrick Fabere Test
Flx ABd Ext Rot Ext
test: pelvis & hip
position: supine
Action:
1) “figure 4”
2) examiner places pt’s foot on contralateral knee (proximal), then gently lowers knee toward table
Positive finding:
pain in hip jt
tested leg’s knee remains above opp leg
Diff Dx:
hip or SI jt pathology, ilopsoas spasm
Thomas Test
test: pelvis & hip
position: supine
Action:
1) 1st check for lumbar lordosis
2) flex one of pt’s hip
3) bring knee to chest and pt holds it
Positive finding:
straight leg rises off the table - hip & knee flex slightly
Diff Dx:
hip flexion contracture or hip jt contracture
Valgus & Varus Stress Test of Knee
test: knee
position: supine
Action:
1) examiner’s superior hand contracts pt’s lateral knee, inferior hand grabs the ankle
2) pt’s knee in full extension
3) apply valgus or medial stress at knee w ankle in slight external rotation
4) apply varus or lateral stress at knee w ankle stabilized
Positive finding:
- excessive medial deviation - valgus
- excessive lateral deviation - varus
Diff Dx:
medial instability of medial collateral ligament
lateral instability of lateral collateral ligament
Drawer sign - anterior and posterior
test: knee
position: supine
Action:
1) flex pt’s hip and knee until their foot flat on the table
2) examiner stabilizes the pt’s foot by sitting on it
3) anterior - interlock both hands behind the proximal tibia, then draw tibia forward on femur
4) posterior - place a web contact with both hands, over tibial tuberosity. push tibia posterior on the femur
Positive finding:
excessive anterior or posterior movt of tibia - anterior or posterior laxity
Diff Dx:
anterior cruciate ligament laxity
posterior cruciate ligament laxity
Slocum Test
test: knee
position: supine
Action:
1) pt’s knee is flexed to 90 and hip is flexed to 45
2) foot is placed in 30 medial rotation
3) examiner then sits on pt’s forefoot to hold foot and draws tibia forward
Positive finding:
excessive anterior movt of tibia on medial or lateral side
Diff Dx:
excessive motion of tibia away from femur primarily on lat side = anterolateral rotary instability
medial side = anteromedial rotary instability
Anterior drawer test of ankle
test: lower leg, foot & ankle
position: supine
Action:
1) examiner stabilizes distal tibia & fibula
2) holds Pt’s foot in 20 degree plantarflexion, draws talus forward in ankle mortice
Positive sign:
excess anterior movt of talus
Diff dx:
anterior talofibular ligament sprain
Talar Tilt
test: lower leg, foot & ankle
position: supine
Action:
1) foot in anatomic position
2) 90 degree talus is tilted from side to side into adduction and abduction
Positive sign:
excessive abduction or adduction
Diff dx:
excess abduction = deltoid ligament
excess adduction = calcaneofib and/or anterior talofibular ligament
Morton’s Test
test: lower leg, foot & ankle
position: supine
Action:
examiner grasps foot around metatarsal heads and squeezes metatarsal heads together
Positive sign:
metatarsal pain
Diff dx:
Morton’s neuroma (inflamed nerve)l
Hughston’s Test
Test: knee
position: supine
action:
Pt.’s knee is flexed to 90° and hip is flexed to 45°. The foot is placed in 30° medial rotation. Examiner then sits on Pt.’s forefoot to stabilize it. Examiner places thumbs on both sides of knee (at ST 35) and pushes tibia posteriorly. Repeat with lateral rotation.
positive sign: excessive posterior movement of the tibia on the medial or lateral side
differential Dx: posterio-medial or posterio-lateral rotary instability
Phalen’s Test
test: wrist/hand
position: seated
action: Pt. places the dorsum of both hands together with forearms paralell to the floor, hold for 1 minute or until the point of pain.
positive Sx: Tingling or paresthesia into thumb, index, and middle and lat half of ring finger. PAIN, NUMBNESS, TINGLING.
differential Dx: CTS (Carpal Tunnel Syndrome) AKA median nerve neuropathy.
Reverse Phalen’s Test
test: wrist/hand
position: seated
action: Pt places the palms of both hands together with forearms paralell to the floor, hold for 1 minute or until the point of pain.
positive finding: Tingling or paresthesia into thumb, index, and middle and lat half of ring finger. PAIN, NUMBNESS, TINGLING.
differential Dx: CTS (Carpal Tunnel Syndrome) AKA median nerve neuropathy.
Finklestein Test
test: wrist/hand
position: seated
action: Pt makes a fist around their thumb. Examiner stabilizes forearm and ulnar deviates wrist.
positive Sx: PAIN over abd pollicus longus and extensor pollucis brevis at wrist.
differential Dx: Paratendonitis of thumb: De Quervain’s Syndrome or Stenosing Tenosynovitis.
Seated elbow flexion test
test: elbow
position: seated
action: Pt. fully flex elbow with wrist extension, shoulder abduction and depression, hold for 3-5 minutes
positive Sx: Tingling sensation or paresthesia in the ulnar nerve distribution of forearm and hand. PAIN, NUMBNESS, TINGLING.
differential Dx: Cubital Tunnel Syndrome (CTS) or ulnar neuropathy
Grind Test
test: wrist/hand
position: seated
action: Stabilize Pt’s hand with one hand and grasp thumb below the Metacarpophalangeal (MCP) jt. with other hand. Apply axial compression and rotation to MCP jt.
positive Sx: pain and/or grinding in the joint
differential Dx: DJD (Degenerative Joint Disease) of MCP or MC trapezial jts.
Golfer’s Elbow Test
aka Medial Epicondylitis Test
test: elbow
position: seated
action: Instruct pt. to extend their elbow and flex their wrist. The examiner grabs the pt.’s fist and stabilizes the pt.’s elbow or shoulder. Instruct the pt. to resist as you try to extend pt.’s wrist. Or, Examiner palpates Pt’s medial epicondyle and passively supinates forearm and extends the elbow and wrist.
positive Sx: pain for the medial epicondyle
differential Dx: medial epicondylitis
Lateral Epicondylitis Test
aka Mills and Cozens
test: elbow
position: seated
Cozens Action: Stabilize shoulder with one hand. Pt. makes a fist, flexes elbow and extends wrist. Examiner places other hand on top of Pt.’s fist, then examiner pulls anterior on pt.’s fist, while pt. resists the motion.
Mills Action: Have Pt. pronate forearm, extend wrist and extend elbow. Examiner then grabs Pt.s fist stabilizes their shoulder and tries to flex wrist against Pt. resistance.
positive Sx: Sudden severe PAIN in the lateral epicondyle- indicating lateral epicondylitis.
differential Dx: Lateral Epicondylitis
Speed’s Test:
test: shoulder
position: seated
action:Shoulder is flexed to approx 45°. Examiner resists shoulder forward flexion by patient with elbow extended and first in supination then pronation.
positive Sx: PAIN in bicipital groove.
differential Dx: bicipital tendonitis/osis
Hawkin’s Kennedy Impingement Test
test: shoulder
position: seated
action: The patient stands while examiner forward flexes the arm to 90°. Then forcibly medially rotates the shoulder.
positive Sx: pain
differential Dx: Supraspinatus tendonitis or secondary impingement.
