fall 2023 CP practical final Flashcards
apley scratch test
purpose: ROM (abduction, flexion, external rotation, pronation, adduction, extension, internal rotation and supination)
Pt. pos: standing
prac. pos.: behind pt.
procedure: pt. is asked to touch both hands together behind the back with one arm going over the shoulder and the other arm under the shoulder
positive: asymmetry
spring test (SC)
purpose: sterno-clavicular joint (anterior and posterior sc ligaments, costo-clavicular lig. and inter clavicle lig.)
Pt. pos: standing
prac. pos.: in front of pt. 2-3 fingers placed on proximal clavicle
procedure: prac. pushes clavicle posteriorly and inferiorly. done several repetitions and performed bilaterally
positive: excessive movement of proximal clavicle as it springs back into place
spring test (AC)
purpose: acromio-clavicular ligament (superior and inferior acromio-clavicular ligament, conoid and trapezoid portion of CC ligament)
Pt. pos: standing
prac. pos.: in front of pt. 2-3 fingers on distal clavicle
procedure: push distal clavicle inferiorly. done several repetition and performed bilaterally
positive: excessive movement of distal clavicle
AC/ SC compression test or crossover test
purpose: check sc or ac joints or clavicle fracture
Pt. pos: seated or standing, affected arm brought across the body and rests on the opposite shoulder
prac. pos.: in front of pt., hand on the pt.s affected elbow
procedure: push elbow to opposite shoulder
positive: pain in either the AC or SC joint or clavicle
AC shear test
purpose: check AC joint (superior and inferior ac lig., conoid and trapezoid portion of CC lig)
Pt. pos: standing or sitting
prac. pos.: in front of pt. interlaced fingers are placed over the spine of the scapula and mid-clavicle
procedure: prac. squeezes scapula and mid clavicle
positive: excessive movement of the distal clavicle; pain
traction
purpose: check AC joint (& associated ligaments), stability of the inferior glenohumeral joint
Pt. pos: standing with arms at the side
prac. pos.: standing in front of pt. grasping pt.’s wrists
procedure: prac. pulls uniformly down on each arm and looking for step up or sulcus sign
positive: step off of AC joint and pain AND/OR sulcus sign seen on superior, anterior shoulder and pain and instability
apprehension (crank) test
GOLD STANDARD FOR SHOULDER INSTABILITY
purpose: anterior/ inferior shoulder instability
Pt. pos: can be standing or lying supine
prac. pos.: standing: in front of Pt. with one hand on wrist and other on elbow, bring arm into external rotation. Supine: one hand can be placed on mid forearm with thumb up the forearm and one hand pushing gh joint back to push the humerus back into place
procedure: move the humerus into abduction and external rotation, look for facial expression
positive: facial expression that indicate pain, pt. feels instability or apprehension with ROM
relocation (fowler or Jobe or surprise) test
purpose: confirmation of a positive apprehension test
Pt. pos: supine, arm abducted and external rotated
prac. pos.: to the side of pt. one hand on wrist and the other on the anterior shoulder
procedure: once an uncomfortable or painful ROM in apprehension, prac. places the palm of hand over the anterior shoulder while maintaining the abducted and externally rotated position, the hand can be pushed down and releases to discern pain levels
positive: a relief of pain levels with pressure or release of pressure on anterior GH
adson
purpose: Thoracic outlet syndrome
Pt. pos: sitting
prac. pos.: standing behind pt.
procedure: prac. feels for radial pulse, externally rotate and extends the shoulders. pt. is instructed to look towards the effected Side and hold breath for 10-15 sec.
positive: reduced or diminished pulse
allen’s (wright’s) test
purpose: thoracic outlet syndrome
Pt. pos: sitting
prac. pos.: behind pt.
procedure: prac. finds radial pulse and abducts and externally rotates (90 90). pt. is then instructed to look away from the affected side (for Wright’s test= take arm into hyperabduction and check for pulse)
positive: reduced or diminished radial pulse
speeds
purpose: tendinitis of long head of the biceps
Pt. pos: standing with arms at 90 degrees of forward flexion and supination
prac. pos.: facing pt. with one hand on the bicipital groove and the other hand on the distal wrist
procedure: pt instructed to hold at 90 degrees while the prac. provides resistance into flexion
positive: pain and/or inability to complete the maneuver, or crepitus at the biceps tendon
Yergason’s
purpose: bicipital tendonitis, or rupture of the transverse humeral ligament
Pt. pos: sitting, elbow straight, internally rotated and pronated
prac. pos.: next to pt. one hand on the bicipital groove and other hand on the distal wrist
procedure: pt. instructed to move from an internally rotated and pronated position to external rotation and supination against resistance. start in pronation and extension then resist against supination and elbow flexion
positive: pain in bicipital groove, long head of the biceps moving out of the bicipital groove, weakness
empty can
purpose: isolated contraction of the supraspinatus muscle
Pt. pos: standing with arms raised to 90 degrees, horizontal abducted to 45 degrees and pronated (thumb down)
prac. pos.: in front of pt. one hand stabilizing shoulder and the other on the distal wrist
procedure: pt is instructed to resist downward movement through the motion of the scaption. perform with both arms at the same time
positive: pain, inability to complete maneuver
impingement
A
purpose: impingement, pinching long head of biceps tendon, supraspinatus, and sub-acromial bursa under coracoaromial ligament
Pt. pos: standing
prac. pos.: in front of pt. one hand on distal wrist and one hand supporting arm at the elbow
procedure: arm is take into forced abduction and external rotation
positive: anterior shoulder pain
painful arc
purpose: shoulder impingement
Pt. pos: standing with arms held at sides
prac. pos.: in front of pt. slight resistance may be placed on pt. wrists as needed
procedure: the pt. is instructed to move through full ROM in abduction from the hands at the side to fully overhead
positive: only pain in ROM from 45-120 degrees.
clunk
purpose: tear of glenoid labrum
Pt. pos: supine with arm flexed fully overhead
prac. pos.: standing at head of pt. with both hands under and grasping the head of the humerus
procedure: push arm straight in towards the body and lift humerus straight up towards the ceiling.
positive: clunking, clicking, catching
drop arm
purpose: tear of the rotator cuff musculature
Pt. pos: standing with arms abducted to 90 degrees
prac. pos.: standing in font of pt., hands may be placed on pt.s wrist as necessary
procedure: pt. is instructed to slowly lower arms. prac. may add resistance pushing arms down
positive: pain, an inability to slowly lower arms, sudden dropping of one arm
hawkins- Kennedy impingement
GOLD STANDARD FOR SHOULDER IMPINGEMENT
purpose: shoulder impingement
Pt. pos: standing with shoulder flexed to 90 degrees and internally rotated
prac. pos.: standing in front of pt. one hand supporting the elbow and the other on the distal forearm
procedure: downward pressure is applied on the wrist, while other Hand remains stationary
positive: pain, facial expression, apprehension
neer impingement
A
purpose: shoulder impingement
Pt. pos: standing
prac. pos.: standing next to pt. one hand stabilizing the scapular region and the other hand placed on distal wrist
procedure: shoulder is taken into full flexion and the practitioner applies a slight overpressure. pressure to scapula forward
positive: pain
pectorals major contracture
purpose: tightness through pectorals major muscle
Pt. pos: lying on back with fingers laced behind head
prac. pos.: standing at head of pt. with hands on elbows if needed
procedure: pt. is instructed to allow the elbows to relax and try to touch the table; pressure by the prac. may be performed to check end feels
positive: inability to move elbows closer to the table
Military brace position (eden test)
purpose: costo-clavicular syndrome
pt. pos: standing with arms to the side and supinated
prac. pos: standing behind pt. with fingers on radial pulse and the other hand on the clavicle
procedure: redial pulse is palpated and the shoulder is drawn down and back with slight traction. hand over from scapula to clavicle squeezes while other hand is palpating radial pulse
positive: decreased or diminished pulse
anterior/ posterior drawer test
purpose: posterior shoulder instability
pt. pos: sitting relaxed with forearm RESTING on thigh
prac. pos: next to pt. one hand stabilizing hand on spine of scapula and clavicle and the other hand over the head of the humerus
procedure: head of humerus is moved anterior and posteriorly while other hand stabilizes
positive: excessive movement at GH joint and or pain
Load and Shift
purpose: Labral tears
pt. pos: sitting, relaxed, forearm relaxed on thigh
prac. pos: next to pt. one hand stabilizing of scapula and clavicle and other hand over the head of the humerus
procedure: same procedure as anterior/ posterior drawer + pressure applied on humerus towards the joint
positive: pain, clicking, and/or catching
Rowe test
purpose: GH instability (ligaments structures)
pt. pos: supine with hands behind the head
prac. pos: balled fist under posterior head of humerus and other hand on top of bent elbow
procedure: downward pressure is applied at the elbow towards the table
positive: pain, anterior instability
posterior apprehension (humeral shear or posterior glide)
purpose: posterior shoulder instability
pt. pos: supine, forward flexion to 90 degrees elbow bent to 90 degrees
prac. pos: standing next to pt., one hand on pt. elbow
procedure: humerus is pushed posteriorly straight back
positive: pain, excessive glide of humerus, apprehension
Liu Crank
purpose: Labral tear
pt. pos: supine arm abducted to 160 degrees with 30 degrees of horz. adduction
prac. pos: standing next to pt. hand on pt. elbow
procedure: humerus is pushed back posteriorly and the arm is taken into internal and external rotation
positive: pain, clicking, apprehension, especially with external rotation
bear hug
purpose: subscapularis weakness or neuro deficit
pt. pos: standing, arm resting of opposite shoulder with the shoulder flexed to 90 degrees
prac. pos: put hand under pt. hand that is one opposite shoulder. standing in front of pt.
procedure: pt is instructed to maintain the position and push down on the opposite shoulder
positive: pain and/or inability to push down
lift off sign (belly lift off)
A
purpose: subscapularis weakness or neruo deficit
pt. pos: standing arm internally rotated and resting on low back
prac. pos: behind pt. with one hand on the mid humerus and other hand on the distal wrist
procedure: slight resistance may be applied by the prac. as the pt. attempts to lift the hand off the low back
positive: pain and/or inability to raise hand
feagin (inferior drawer)
purpose: shoulder instability (inferior middle and superior gh ligaments)
pt. pos: standing with arm abducted to 90 degrees or flexion to 90 degrees
prac. pos: shoulder abduction: standing next to pt. with both hands on top of head of humerus OR shoulder flexion: standing in front of pt. with both hands on top of humerus
procedure: with both hands on top of humerus head, a downward force is applied
positive: instability of the GH joint and/or anterior sulcus and/or pain
Roos
purpose: thoracic outlet syndrome
pt. pos: abducted and externally rotated arms (90 90 field goal position) with hands open
prac. pos: next to pt.
procedure: pt is instructed to open and close hands for 3 minutes
positive: decrease in motor function of the hand, loss of sensation, inability to maintain test position
O’brien’s
purpose: SLAP lesion
pt. pos: sitting or standing, shoulder flexion to 90 degrees, full horz. adduction and full internal rotation
prac. pos: in front of pt. one hand on the elbow and other on the distal wrist
procedure: pt is instructed to resist against the downward force of the prac. The test is repeated wit external rotation. have pt go from opposite asis to opposite shoulder
positive: pain and/or popping that is alleviated with the external rotation component
shoulder scouring
purpose: instability of the GH joint, labral tears
pt. pos: sidling, arm abducted to 90 degrees
prac. pos: standing behind pt., pt arm is resting on prac. elbow/ forearm. one hand on lateral joint line on the proximal humerus, the other hand stabilizing the scapula posteriorly
procedure: anterior and inferior and posterior and superior forces are placed on the humerus, feeling for instability or clicking or popping
positive: clicking or popping (labrum); instability or apprehension (ligamentous instability)
SLAP series
purpose: slap lesion, particularly from the bicipital pull on the superior labrum
pt. pos: supine with arm hanging off the table. pt. abducts arm to 120 degrees, shoulder rotation neutral, pronated and elbow flexed to 65-70 degrees
prac. pos: standing next to pt. one hand is stabilizing the upper arm mid humerus while the other grasps the pt. wrist
procedure: the pt is instructed to spinate the hand against maximal resistance while the pt. moves the shoulder into full abduction and external rotation (1). the elbow is then flexed against maximal resistance (2)
positive: clicking or popping, pain deep in the GH joint with resisted actions of supination (1) or elbow flexion (2)
predictability/ percentage: 81-96%
valgus stress
purpose: test integrity of ulnar collateral ligament
pt. pos.: seated with arms in anatomical position
prac. pos.: standing in front of pt. supporting arm, one hand at lateral elbow and other is placed on medial distal arm near wrist
procedure: valus stress is applied to elbow at 0 and at 30 degrees of flexion
positive: increased valgus movement with a diminished or absent end point
varus stress
purpose: test integrity of radial collateral ligament
pt. pos.: seated with arms in anatomical position
prac. pos.: standing in front of pt. supporting arm, one hand at lateral elbow and other is placed on medial distal arm near wrist
procedure: varus stress is applied to elbow at 0 and at 30 degrees of flexion
positive: increased varus movement with a diminished or absent end point
cozen’s test
purpose: lateral epicondylitis
pt. pos.: seated next to table, wrist and hand hanging off the edge. hand in a fist, pronated and radial deviated
prac. pos.: seated opposite pt. one hand stabilizing arm, other on dorsal hand resisting movement
procedure: pt moves into extension, supination, and ulnar deviation against resistance
positive: pain along lateral epicondyle of humerus; general muscular weakness and discomfort in the lateral elbow
Mill’s test
purpose: lateral epicondylitis
pt. pos.: standing or sitting
prac. pos.: standing next to pt., one hand on the elbow and the other on the posterior hand
procedure: forearm is passively pronated, radially deviated and wrist flexed and the elbow is taken into extension
positive: pain over the lateral epicondyle
Maudley’s test
purpose: lateral epicondylitis
pt. pos.: seated with hand flat on table
prac. pos.: seated next to pt. wit one finger over the pt.’s middle finger
procedure: instruct pt to extend middle finger against resistance
positive: pain over lateral epicondyle
Kaplan’s sign
purpose: lateral epicondylitis
pt. pos.: standing or sitting, elbow slightly flexed, forearm neutral and wrist slightly extended
prac. pos.: standing in front of pt. two fingers in the pt. hand
procedure: have the pt. grasp your two fingers or a dynamometer, put a strap or have someone constrict the forearm 1-2 inches distal to the elbow and recheck grip
positive: a decreased in pain and/ or an increase in grip strength following the strap
milking sign
purpose: test the integrity of the ulnar collateral ligament
pt. pos.: shoulder and elbow flexion with thumb pointing down. (as if reaching behind the head)
prac. pos.: standing behind pt. holding pt. thumb
procedure: apply a downward force to pt.’s thumb
positive: pain on the medial joint line
Andrew’s UCL test
purpose: determine integrity and laxity of the ulnar collateral ligament
pt. pos.: seated, facing away from the prac. shoulder is abducted and externally rotated, elbow fully flexed
prac. pos.: standing behind pt. one hand on the elbow (thumb on UCL) and other on the wrist
procedure: PT. is instructed to extend the elbow while the prac. provides a valgus force at the elbow
positive: pain and/or laxity at any point in the ROM
Table top Test
purpose: determine integrity and laxity of the ulnar and radial collateral ligament
pt. pos.: standing facing away from the table. forearm is supinated and shoulder externally rotated. arm is placed flat against the table
prac. pos.: stading to the side of the table. both hands placed around the elbow
procedure: prac. takes elbow into both valgus and varus forces
positive:
golfer’s elbow (medial epicondylitis Test #1
A
purpose: medial epicondylitis
pt. pos.: forearm supinated with wrist and elbow in extension and hand hanging off the end of the table
prac. pos.: standing next to pt.
procedure: pt. is instructed to pronate and flex wrist against resistance. opposite of Mill’s test
positive: pain in medial epicondyle region of humerus
Golfer’s elbow (medial epicondylitis) Test #2
purpose: medial epicondylitis
pt. pos.: forearm supinated with wrist in extension
prac. pos.: standing next to pt. hand on maintaining supination and wrist flexion
procedure: pt. is instructed to extend the elbow with arm in supination and wrist flexion
positive: pain in medial epicondyle region of humerus
bicep squeeze test
purpose: potential bicep rupture
pt. pos.: seated with arm resting in lap at approx. 60-80 degrees of flexion and arm in pronation
prac. pos.: standing or seated next to pt. with one hand over the musculotendinous juncture of the bicep and the other on the belly of the muscle
procedure: squeezing with both hands along the bicep
positive: if the arm does not supinate= indicative of a bicep rupture
tinel’s sign
purpose: determine abnormal pathology of a nerve, particularly the ulnar nerve
pt. pos.: seated or standing with elbow in slight flexion
prac. pos.: standing next to pt. supporting distal arm
procedure: while supporting distal arm, tap the ulnar nerve on the ulnar notch with index finger
positive: tinging along ulnar nerve distribution in forearm, hand, or fingers
wartenberg sign
A
purpose: test for ulnar nerve problem
pt. pos.: sitting with hands on table
prac. pos.: sitting across from pt.
procedure: instruct pt. to abduct fingers then bring them back together
positive: inability to adduct little finger is indicative of a ulnar nerve pathology
elbow flexion
purpose: cubital tunnel syndrome
pt. pos.: standin or sitting, with elbows in flexion and wrists extended
prac. pos.: sitting across from pt.
procedure: instruct pt. to hold position of full elbow flexion and wrist extension for 3-5 minutes
positive: numbness, tingling indicative of cubital tunnel syndrome (typically last finger and 1/2)
ulnar nerve compression
A
purpose: test for involvement of ulnar nerve or cubital tunnel syndrome
pt. pos.: standing with arm in supination
prac. pos.: standing next to pt. with one finger just proximal to the cubital tunnel on the medial elbow
procedure: apply a force for 30 seconds and note any changes in sensation through the ulnar nerve distribution
positive: numbness and tingling or shooting pain through the ulnar nerve distribution
pinch grip
purpose: nerve entrapment
pt. pos.: may be seated or standing
prac. pos.: standing or sitting next to pt.
procedure: instruct pt. to pinch the tips of fingers between thumb and fingers
positive: inability to touch tips of fingers and thumb together, touching pad to pad
capillary refill
purpose: determine vascularity of upper extremity
pt. pos.: standing or sitting, fingers extended
prac. pos.: standing next to pt.
procedure: apply pressure to fingernail (nail should turn white)
positive: should return to pink color. whiteness or a slow return to pink are abnormal
brachial pulse
purpose: determine vascularity of the upper extremity
pt. pos.: standing or sitting
prac. pos.: standing next to pt. fingers along medial humerus
procedure: pressure is applied to the brachial area, medially on the humerus, and a pulse is determined
positive: diminished or weak pulse as compared bilaterally
isosceles triangle
purpose: fracture of the medial or lateral epicondyle or the olecranon process
pt. pos.: seated or standing
prac. pos.:standing across from pt .
procedure: fingers are placed on medial epicondyle, lateral epicondyle and olecranon process in full extension and then the elbow is flexed
positive: the three landmarks should form a straight line in extension and for an isosceles triangle in full flexion
Finkelstein
A
purpose: DeQuervain’s syndrome (inflammation of the extensor polices brevis and abductor pollicus)
pt. pos: sitting or standing
prac. pos.: standing next to pt.
procedure: have the pt. make a fist holding the thumb and passively move into ulnar deviation
positive: pain over the dorsal surface of the thumb
tinel’s
purpose: median nerve pathology (carpal tunnel syndrome)
pt. pos: standing or sitting
prac. pos.: facing pt.
procedure: nerve is tapped with the tip of one finger, in this instance, on the medial nerve distribution on the anterior wrist at the retinaculum
positive: shooting pain along the distribution of the median nerve
phalan’s
purpose: carpal tunnel syndrome presence
pt. pos: sitting or standing
prac. pos.: standing next to pt.
procedure: pt is instructed to push the dorsal aspects of both hands together, with the fingers pointing downward and hold the position for 1 minute
positive: numbness or tingling along the median nerve distribution; the solar aspect of the thumb and 2 1/2 fingers
carpal compression
purpose: carpal tunnel syndrome presence
pt. pos: sitting or standing
prac. pos.: standing in front of pt.
procedure: entire length of a finger or the thumb is placed on the volar aspect of the wrist, at the retinaculum and compressed
positive: tingling, pain or numbness along the median nerve distribution
allen’s test for the wrist
purpose: to determine vascularity of the hand
pt. pos: sitting or standing, palm supinated
prac. pos: standing in front of pt. one thumb on the radial artery and one on the ulnar artery on the volar aspect of the wrist
procedure: thumbs are compressed over both arteries and the pt. is instructed to compress and relax the hand several times until the hand turns white. one finger (done twice) is released and the hand should return to it’s normal pink color
positive: slow return of blood flow or the hand staying white
varus/ valgus
purpose: ligamentous instability, particularly collateral ligaments
pt. pos: standing or sitting
prac. pos: standing in front of pt.
procedure: distal finger is stabilized and the valgus or varus force is applied through the joint line and an anterior r and posterior glide is applied
positive: instability with any movements
gamekeeper’s test
purpose: ulnar collateral ligament of the thumb
pt. pos: standing or sitting
prac. pos: standing in front of pt.. one hand stabilizing the metacarpal of the thumb, the other hand grasping the distal thumb
procedure: valgus force is applied
positive: excessive moment of the joint or pain
tap
purpose: determine presence of a fracture of a phalanx or metacarpal
pt. pos: standing or sitting
prac. pos: standing in front of pt.
procedure: light tap with the pad of one finger is applied through the long axis of the phalanx or metacarpal. the finger can be flexed at the PIP or MP joints and tapped there for proximal segments
positive: pain long the shaft of the bone
Murphy’s sign
purpose: dislocation of the lunate carpal bone
pt. pos: standin or sitting with hand in fist.
prac. pos: standing in front of pt.
procedure: pt is instructed to make a fist. observe 3rd MCP joint (knuckle)
positive: 3rd MCP joint will be lower or equal level to all the other joints (knuckles)
march test
purpose: si joint dysfunction
pt. pos: standing
Prac. pos: standing or sitting behind pt. with both thumbs over the SI joint
procedure: pt is instructed to alternately raise one knee to the chest and prac. will note the movement of SI joint
positive: no movement or unilateral asymmetry in movement
Trendelenburg test
purpose: weakness in glute medius or involvement of superior gluteal nerve
pt. pos: standing
Prac. pos: sitting behind pt.
procedure: pt is instructed to alternately lift one knee to their test while prac. observes hip jolting out
positive: hip jutting laterally or pt is leaning to involved side
heel and toe walking
purpose: neurological involvement/ motor function of lower extremity
pt. pos: standing
Prac. pos: standing next to pt.
procedure: have pt. walk on their toes and then walk on their heels
positive: inability to perform the procedure
stork standing
purpose: check for proprioception
pt. pos: standing
Prac. pos: standing next to pt.
procedure: have the pt. lift one leg and check for balance
positive: inability to perform the test, unable to balance
hip distraction test
purpose: apprehension due to an unstable hip or osteoarthritis or ligamentous issue
pt. pos: supine with test hip flexed to 30 degrees, slightly abducted and slightly externally rotated
Prac. pos: at foot of pt.; holding ankle with both hands
procedure: a distraction force is applied just to the point of the pt. beginning to move
positive: apprehension with distraction= unstable hip or ligamentous
relief of pain= osteoarthritis or leg calf perthes or OCD
hoover test
purpose: malingering or lying pt.
pt. pos: lying on table
Prac. pos: at foot of pt. both heels of pt. cupped in prac. hands
procedure: pt is instructed to raise one leg
positive: failure of the opposite leg to push down on the prac. hand indicated a sub maximal effort
SLR test
purpose: neurological involvement in lower extremity
pt. pos: supine with hip flexed
Prac. pos: standing next to pt. one hand maintaining knee extension and the other on the distal leg
procedure: hip is passively extended to the end of the range of motion. combination movements may be added such as the chin to the chest and/or dorsiflexion
positive: shooting pain, numbness, tingling. pain in the lumbar spine = then it would be indicative of bulging disc
well SLR test
purpose: neurological involvement in the lower extremity
pt. pos: supine with hip flex
Prac. pos: standing next to pt. one hand maintaining knee extension and the other on the distal leg
procedure: the hip passively extended to the end of the range of motion. combination movement may be added such as the chin to the chest and/or dorsiflexion
positive: shooting pain, numbness, tingling down the non-test leg
bowstring test
purpose: neurological involvement of tibial nerve or common perineal nerve
pt. pos: supine
Prac. pos: at foot of pt.
procedure: perform a SLR to the point of pain, flex the knee until pain is relieved then apply pressure to the popliteal fossa with the practitioner’s thumb
positive: reduced to eliminated pain with knee flexion that returns with popliteal pressure
pelvic compression
purpose: SI joint dysfunction
pt. pos: supine
Prac. pos: standing next to pt. arms are crossed and placed on ASIS of pt.
procedure: downward and outward pressure is applied uniformly on ASIS
positive: posterior pain along the SI joint
pelvic distraction
purpose: si joint dysfunction
pt. pos: supine
Prac. pos: next to pt. hands placed on superior portion of gluteus Maximus
procedure: prac. raises both hands, spreading the SI joint
positive: pain in the SI region
FABER/ Figure 4/ Patrick’s test
purpose: SI joint dysfunction or tight hip flexors
pt. pos: supine with ankle crossed above opposite knee, flexion, abduction, and external rotation (FABER)
Prac. pos: standing next to pt. one hand on crossed knee, one hand on opposite asis
procedure: pressure is applied at the knee and asis simultaneously
positive: posterior pain= SI joint dysfunction, anterior pain= tight hip flexors
Thomas test
purpose: tight hip flexors
pt. pos: supine with legs hanging off the table, knees flexed to 90 degrees
Prac. pos: standing next to pt.
procedure: pt is instructed to bring knee to chest and lean back onto table
positive: opposite leg lifts from table flexing at the hip
Pubic symphysis
purpose: ascertain problems in the pubic symphysis or SI joint
pt. pos: supine
Prac. pos: standing next to pt.; heel of hand is moved from the umbilicus to the pubic symphysis
procedure: downward pressure is applied to the pubic symphysis
positive: pain in the pubic symphysis or SI joint, indicating pelvis involvement
piriformis test
purpose: tight piriformis or tibial/ common peroneal nerve (sciatic nerve)
pt. pos: supine
Prac. pos: standing next to pt.
procedure: pt. knee is taken to the opposite shoulder and the foot is then internally rotated
positive: increased pain in the area of the piriformis or any neurological symptoms= nerve involvement
FADIR
purpose: femoral acetabular joint impingement
pt. pos: supine
Prac. pos: standing next to pt. one hand on flexed knee and the other no the ankle of the same leg in a motorcycle grip
procedure: knee is taken into full flexion and moved by the prac. to opposite shoulder. leg is then taken into internal rotation
positive: deep pain, clicking or limited range of motion indicated the necessity of x-ray to confirm diagnosis
babinski test
purpose: neurological deficit or impairment
pt. pos: supine or siting with legs extended
Prac. pos: at foot of pt.
procedure: a finger or hard object is run along the bottom of the foot from first toe to lateral foot towards heel
positive: toes should curl or do nothing. splaying or extension of the toes indicate a positive result
Oppenheim test
purpose: neurological deficit or impairment
pt. pos: supine or sitting
Prac. pos: at foot of pt.
procedure: a finger or hard object is run along the rest of the tibia
positive: same as for babinski. toes should curl or do nothing. splaying or extension of the toes indicate a positive result
milgram’s test
purpose: to determine muscular strain of the low back
pt. pos: supine
Prac. pos: at foot of pt.
procedure: pt is instructed to hold both legs in the air for 30 seconds
positive: inability to perform the procedure due to back pain
Beevor’s sign
A
purpose: determine the presence of a neurological or muscular disorder of the abdomen/ lumbar spine
pt. pos: supine with hands behind head
Prac. pos: at foot or next to pt.
procedure: have pt perform a sit up
positive: the umbilicus should stay in a straight line. side to side movement is a positive
springing test of back
purpose: check for hyper or hypo-mobility of an individual vertebrae
pt. pos: prone
Prac. pos: standing next to pt. the pisiform of the hand is placed on the spinous process of each vertebrae sequentially in the lumbar spine
procedure: anterior/ posterior movement in very small increments is initiated with differences noted in movements of each individual segment
positive: a level with extreme motion or lack of motion as compared to other levels
active spinal extension
purpose: to determine muscular involvement of the low back
pt. pos: prone with hands behind the back
Prac. pos: next to pt.
procedure: have the pt. move into active spinal extension
positive: pain with movement or inability to complete maneuver
sphinx position (done after active spinal extension)
purpose: to determine the possibility of a spondy (spondylosis, spondylolisis, spondylolisthesis)
pt. pos: prone with elbows on table
Prac. pos: next to pt.
procedure: have the pt. extend the spine using their arms on the able
positive: pain directly over the spine
spondyloysthesis’s test
A
purpose: check for spondylolisthesis or slippage of the vertebrae
pt. pos: side lying with both knees flexed
Prac. pos: standing in front of pt. one hand under both knees the other hand on the lumbar spine
procedure: knees are taken into flexion and extension and the lumbar spine is palpated at each vertebral level
positive: vertebrae that does not line up with the others with flexion and extension
Ober’s test
purpose: IT band syndrome
pt. pos: side lying on the table
Prac. pos: standing behind pt. one hand may be placed on the distal leg and the other could stabilize the pelvis
procedure: pt is instructed to let top leg hang over the back of the table
positive: inability to adduct; pain; asymmetry
noble
purpose: IT band syndrome
pt. pos: side lying on table
Prac. pos: standing behind pt. one hand on the distal leg, one thumb on the IT band, 2-4 cm proximal to the knee
procedure: the knee is alternatively flexed and extended while the force is applied with the thumb proximal to the knee
positive: pain, particularly at 30 degrees of flexion
femoral nerve traction test
purpose: determine involvement of the L2-L4 nerve roots or femoral nerve irritation
pt. pos: side lying
Prac. pos: standing behind pt., with top of pt’s foot on hip, one hand on the knee and the other on the PSIS for stabilization
procedure: the knee is passively flexed and the hip extended simultaneously
positive: pain, shooting pain, numbness, tingling
