Extra ortho tests

Question 1

L’Hermitte sign

Answer 1

-pt supine, dr flexes head toward chest

positive- electric shock-like sensations down the spine and/or through extremities
indicates- dural irritation, severe spinal cord injury or degeneration

Question 2

Brudzinski sign

Answer 2

pt supine, dr flexes pts head to chest

positive: involuntary knee flexion
indicates: meningeal irritation or nerve root lesion

Question 3

Jackson Compression

Answer 3

pt seated with examiner standing behind. dr lat flexes head and with interlocking fingers and apply downward pressure

positive: exacerbation of local cervical pain
indicates: foraminal encroachment without or facet pathology nerve root compression

positive: exacerbation of cervical pain with radicular component
indicates: foraminal encroachment with nerve root compression

Question 4

Maximal Cervical Compression

Answer 4

pt seated with dr standing behind. pt rotates head and hyperextend neck

pain on concave side indicates foraminal encroachment with or without nerve root compression

Question 5

Bakody sign

Answer 5

pt seated, pt places palm of affected side flat on top of head

-decrease or absence of radiating pain indicates cervical foraminal compression, nerve root entrapment (usually C5C6 area bc this motion elevates suprascapular n and relieves traction on upper brachial plexus)

Question 6

Adam sign

Answer 6

pt standing with dr standing behind. examine for scoliosis , examiner instucts pt to bend forward (fingers together hands extended) examiner observes for evidence of change in scoliosis.

positive: a C or S shaped curve that is observed to straighten
indicates: a functional scoliosis, trauma, or subluxation

positive: C or S shaped curve does not straighten indicates a pathological or structural scoloisis

Question 7

Schepelmann sign

Answer 7

pt seated, arms fully abducted and raised over head, examiner instructs pt to lat flex thoracic spine to both sides

positive: pain on concave
indicates: intercostal neuritis

positive: pain on convex side
indicates: fibrous inflammation of pluera

Question 8

Beevor Sign

Answer 8

pt supine with arms crossed and perform partial situp

• superior mov’t of umbilicus indicates spinal cord lesion at the level of T10 or lower ab weakness
• inferior mov’t of umbilicus is indicative of nerve root involvement T7-T10

Question 9

Roos aka?

Answer 9

aka Roos
-elevated arm stress test
pt sitting and bring arms at 90/90 and opens/closes fists bilaterally at a moderate pace for up to 3 min

• ischemic pain, heaviness in arms, numbness/tingling in hands
• Thoracic outlet syndrome on side involved

Question 10

Adson Test aka?

Answer 10

aka scalene maneuver aka scalenus anticus test
-locate radial pulse, slightly abduct arm with elbow extended. pt takes deep breath and holds, rotates head and elevates head toward dr. then another breath rotate head to opposite side

• pain and/or parathesia, decreased or absent pulse, pallor
• compression of neurovascular bundle by scalenus anticus or cervical rib

Question 11

Halstead Maneuver

Answer 11

pt seated, locate radial pulse with one hand, and with other hand traction pts arm to floor above elbow. pt hyperextends neck. if negative, add head rotation to opposite side

• pain and/or parathesia, decreased or absent pulse, pallor
• compression of the neurovascular bundle by scalenus anticus or cervical rib

Question 12

Costoclavicular mauever aka?

Answer 12

aka Eden
pt seated, find radial pulse and have pt sit up tall, push shoulders back, chest out, touch chin to chest and hold breath

• pain and/or parathesia, decreased or absent pulse, pallor
• compression of the neurovascular bundle b/t clavicle and first rib

Question 13

Hyperabduction maneuver aka?

Answer 13

aka wright test
pt seated, find radial pulse, hyperabducts pt arm

-compression of axillary artery by pectoralis minor or coracoid process, or thoracic outlet syndrome

Question 14

Minor sign

Answer 14

dr asks pt to stand. observe for abnormal motion

• knee flexion of affected leg while supporting upper body weight
• sciatica, lumbosacral or sacroiliac pain

Question 15

Kemp test

Answer 15

pt seated with arms crossed. dr stands behind and stabilizes opposite PSIS, then use pts shoulder to laterally flex then and extend toward opposite PSIS

• pain usually radicular, recreating existing sciatic pain
• indicates disc protrusion. positive when leaning away from affected side indicates a medial disc protrusion and pain when leaning toward the affected side indicates lateral disc protrusion

-localized pain indicates lumbar spasm or facet capsulitis

Question 16

Lindner sign

Answer 16

pt supine, flex head to chest

• pain along sciatic distribution or sharp, diffuse pain
• sciatic radiculopathy

Question 17

Turyn sign

Answer 17

pt supine, dorsiflex big toe of affected extremity

• pain in gluteal region or radiating sciatic pain
• sciatic radiculopathy

Question 18

Bragard sign

Answer 18

perform SLR, lower 5 deg, dorsiflex foot

• radiating pain in posterior thigh
• sciatic radiculopathy

Question 19

Sicard sign

Answer 19

SLR, lower leg 5 deg and dorsiflex big toe

• posterior thigh and leg pain
• sciatic radiculopathy, usually from disc lesion

Question 20

Bonnet sign

Answer 20

pt supine, strongly internally rotate and adduct leg across midline and then SLR

• pain in posterior thigh or leg
• immediate pain is sciatic neuropathy from piriformis syndrome

Question 21

Fajersztajn aka

Answer 21

aka well-leg raise aka cross over

• SLR on unaffected leg to 75deg or until it produces pain down affected side. if no pain, then dorsiflex foot
• pain down affected leg (cross over sign, indicates medial disc protrusion
• decrease in pain down affected leg indicates lateral disc protrusion

Question 22

Femoral stretch test

Answer 22

-pt lies on unaffected side, hip and knee slightly flexed, chin tucked. affected leg is extended and then knee is flexed while stabilizing hip with other hand

• pain on anterior portion of the thigh
• traction of the femoral nerve indicating involvement of the 2nd,3rd,4th lumbar nerve roots