Lab Final Ortho Tests Flashcards
L’Hermitte Sign
Procedure: Patient sitting or supine, examiner passively flexes patient’s head to the chest.
Positive: Electric shock-like sensations down the spine and/or through extremities.
Indicates: Dural irritation, severe spinal cord injury or degeneration.
Confirmation Tests:
Soto Hall Test, MRI
Kernig Sign
Instructs: Patient supine, examiner passively flexes patient’s hip to 90 degrees and the patient’s
knee to 90 degrees. Examiner extends patient’s leg completely.
Positive: Inability to fully extend the leg and/or pain (usually in the neck region)
Indicates: Meningeal irritation/ meningitis.
Confirmation Tests:
Brudzinski Sign, Lumbar Tap
Brudzinski Sign
Procedure: Patient supine, examiner flexes patient’s head to the chest.
Positive: Involuntary knee flexion.
Indicates: Meningeal irritation or nerve root lesion (classic test for meningitis)
Confirmation Tests:
Kernig Sign, Lumbar Tap
Soto-Hall Sign
Instruct: Patient supine, examiner flexes patient’s head toward his/her chest while exerting
downward pressure on patient’s sternum with hypothenar eminence of inferior hand.
Positive: Generalized pain in the cervical region, which may extend down to the level of T2.
Indicates: Non-specific test for structural integrity of cervical region.
Confirmation Tests:
O’Donoghue Test, Spinal Percussion Test, Swallowing Test, Valsalva Test, Sensory and Reflex
Testing, MRI
Foraminal Compression Test
Instruct: Patient seated with examiner standing behind. Examiner clasps his/her hands over
patient’s head and exerts gradual increasing downward pressure. Examiner repeats this
procedure with the patient’s head rotated right and then left.
Positive: 1) Exacerbation of localized cervical pain.
2) Exacerbation of cervical pain with a radicular component.
Indicates: 1) Foraminal encroachment or facet pathology without nerve root compression.
2) Foraminal encroachment or facet pathology with nerve root compression
Confirmation Tests:
Shoulder Depression Test, Cervical Distraction Test, Reflex and Sensory Testing,
Radiography, MRI,
Jackson Compression
Procedure: Patient seated with examiner standing behind. Patient laterally flexes his/her
head to one side and examiner clasps his/her hands over patient’s head and
exerts increasing downward pressure. Perform bilaterally.
Positive: 1) Exacerbation of localized cervical pain.
2) Exacerbation of cervical pain with a radicular component.
Indicates: 1) Foraminal encroachment without nerve root pressure or facet
pathology.
2) Foraminal encroachment with nerve root compression (one would then want
to evaluate the myotome, reflex and dermatome of the nerve root involved)
Maximal Cervical Compression
Procedure: Patient seated with examiner standing behind. The examiner instructs the
patient to rotate the head and hyperextend the neck over the shoulder on the
side of rotation. Perform bilaterally.
Positive: Pain on the concave side
Indicates: Foraminal encroachment with or without nerve root compression
(based on presence or absence of radicular component)
Confirmation Tests:
Foraminal Compression, Jackson Compression Test, Bakody Test, Shoulder Depression Test,
Cervical Distraction Test, Reflex and Sensory Testing, Radiography, MRI, Nerve Conduction
Testing
Valsalva Maneuver
Instruct: Patient seated, examiner instructs patient to take a deep breath and hold while bearing
down as if straining at a bowel movement.
Positive: Radiating pain from site of lesion (usually positive in cervical or lumbar area of the
spine).
Indicates: Space occupying lesion (e.g. disc pathology).
Confirmation Tests:
Swallowing Test, Shoulder Depression Test, Cervical Distraction, Foraminal Compression Test,
Sensory and Reflex Testing, MRI
Cervical Distraction Test
Instruct: Patient seated: the examiner grasps the patient’s head with both hands and gradually
exerts upward pressure keeping hands off TMJ and ears.
Positive: 1) Diminished or absence of local cervical pain.
2) Diminished or absence or radiating pain.
3) Increase of cervical pain.
Indicates: 1) Foraminal encroachment without nerve root compression
2) Foraminal encroachment with nerve root compression
3) Muscular strain, ligamentous sprain, myospasm or facet capsulitis.
Bakody Sign
(Shoulder abduction Test)
Procedure: Patient seated, examiner instructs patient to place the palm of the affected side
flat on top of their head.
Positive: Decrease or absence of radiating pain.
Indicates: Cervical foraminal compression, nerve root entrapment (usually C5/C6 level
because this motion elevates the suprascapular nerve and relieves traction on
the upper brachial plexus).
Confirmation Tests:
Foraminal Compression, Maximal Compression, Jackson Compression Test, Spurling Test,
Shoulder Depression Test, Cervical Distraction Test, Reflex and Sensory Testing,
Radiography, MRI, Nerve Conduction Testing
Adam Sign
(positions)
Instruct: Patient standing, with examiner standing behind patient, examiner looks for
evidence of scoliosis. Examiner instructs patient to bend forward at the waist
with fingers extended and hands together. Examiner observes for evidence of
change in the scoliosis.
Positive: 1) A “c” or “s” shaped scoliosis is observed to straighten.
2) A “c” or “s” shaped scoliosis does not straighten (look for rib humping,
muscular imbalance, and asymmetry in hand length).
Indicates: 1) Negative: evidence of a functional scoliosis, trauma or subluxation
2) Positive: evidence of a pathologic or structural scoliosis
Confirmation Tests:
Postural Analysis, Radiography
Beevor Sign
Procedure: Patient supine, examiner instructs patient cross his/her arms across the chest
and perform a partial sit up.
Positive: Superior or inferior movement of the umbilicus.
Indicates: Superior movement of the umbilicus is indicative of a spinal cord lesion at the
level of T11-12 or lower abdominal weakness. Inferior movement of the
umbilicus is indicative of nerve root involvement T7 – T10.
Confirmation Tests:
Sensory testing of thoracic nerve roots, MRI
Roos Test a.k.a
a.k.a. E.A.S.T (elevated arm stress test)
Instruct: Patient sitting or standing, instruct patient to bring arms out in front of their body,
bend the elbows to 90°. The patient then externally rotates the arms and opens
and closes their fists bilaterally at a moderate pace for up to 3 minutes.
Positive: Ischemic pain, heaviness of the arms, or numbness and tingling of the hand.
Indicates: Thoracic outlet syndrome on side involved (Evan’s considers this test to be most
accurate for TOS evaluation)
Confirmation Tests:
Halstead Test, Adson Test, Wright Test, Shoulder Depression Test, Eden Test
Adson Test
Scalene Maneuver and Scalenus Anticus Test)
Procedure: Patient seated with arms at side and elbows fully extended. Examiner finds
radial pulse in neutral position, slightly abducts affected arm and has patient take
a deep breath and hold, then instruct patient to rotate head and elevate chin
toward examiner while holding the breath. Note positive or negative findings, if
negative then rotate head to the opposite side and repeat the procedure.
Positive: Pain and/or paresthesia, decreased or absent pulse amplitude, pallor.
Indicates: Compression of the neurovascular bundle by scalenus anticus or cervical rib.
Confirmation Tests:
Halstead Maneuver, Shoulder Depression Test, Wright Test, Eden Test
Halstead Maneuver
Instruct: Patient seated, examiner finds and monitors radial pulse in neutral position with
one hand and with the other hand traction the patient’s arm toward the floor.
Examiner instructs patient to elevate chin and hyperextend their neck. If the test
is negative (the pulse does not disappear), then rotate the head to the
opposite side and repeat.
Positive: Pain and/or paresthesia, decreased or absent pulse amplitude, pallor.
Indicates: Compression of the neurovascular bundle by scalenus anticus or cervical rib.
Confirmation Tests:
Roos Test, Adson Test, Shoulder Depression Test
Costoclavicular Maneuver
a.k.a. Eden Test
Procedure: Patient seated, examiner finds radial pulse in a neutral position and instructs
patient to sit erect, force shoulders back, chest out and touch chin to chest
and hold breath.
Positive: Pain and/or paresthesia, decreased or absent pulse amplitude, pallor.
Indicates: Compression of the neurovascular bundle between the clavicle and 1st rib.
Confirmation Tests:
Shoulder Depression Test, Adson Test, Halstead Test, Wright Test
Hyperabduction Maneuver
a.k.a. Wright Test
Procedure: Patient seated, examiner finds radial pulse in a neutral position and
hyperabducts the patient’s arm slowly to full abduction while monitoring the
pulse.
Positive: Pain and/or paresthesia, decreased or absent pulse amplitude, pallor.
Indicates: Compression of the axillary artery by pectoralis minor or coracoid process.
Thoracic outlet syndrome.
Confirmation Tests:
Adson Test, Halstead Test, Shoulder Depression Test, Eden Test
Tinel Elbow Sign
Procedure: Patient seated, with a Taylor reflex hammer, examiner taps with the reflex
hammer over the groove between the medial epicondyle and the olecranon
process.
Positive: Pain and/or tenderness at the site being tapped and paresthesia in the ulnar
nerve distribution area (fingers 4,5).
Indicates: Neuroma of the ulnar nerve.
Fromet Paper Sign
Procedure: The examiner asks a patient to hold a piece of paper in their hand between the thumb
and index finger with the thumb adducted. The examiner then attempts to pull the
paper from the patient’s grasp while they attempt to resist.
Positive: The patient is seen to flex the thumb thereby recruiting the median nerve to
compensate for apparent weakness
Indication: Ulnar nerve paralysis (weakness or palsy of the adductor pollicus muscle).
Phalen Sign AND Reverse Phalen Sign a.k.a. Prayer sign
Instruct: Patient seated, examiner instructs patient to flex both wrists to maximum degree and
approximate until point of pain or 60 seconds.
Prayer sign = maximally extend wrist (palms together), elbows same level as shoulders
for 60 seconds.
Positive: Reproduction of pain and/or paresthesia in the median nerve distribution area (1st, 2nd
,
3
rd and the lateral ½ of the 4th digit).
Indicates: Median neuritis, possibly Carpal Tunnel Syndrome
Confirmation Tests:
Tinel Sign, Nerve Conduction Testing
Tinel Wrist Sign
Instruct: Patient seated with wrist supinated, examiner taps over the palmar (volar) surface of the
wrist. (flexor retinaculum – over carpal tunnel region).
Positive: Reproduction of pain, tenderness and/or paresthesia in the median nerve distribution area
(thumb, 2nd, 3rd, and the lateral ½ of the 4th digit).
Indicates: Median neuritis, possibly Carpal Tunnel Syndrome
Minor Sign
Instruct: Examiner instructs patient to stand. Observe for abnormal motion.
Positive: Knee flexion of affected leg while supporting upper body weight (hand on back or
thigh) on unaffected side.
Indicates: Sciatica, lumbosacral or sacroiliac joint lesion
Confirmation Tests:
Nachlas Test, Spinal Percussion Test, Sciatica Tests
Belt Test
(Supported Adam Test, Supported Forward Bending Test)
Procedure: Patient standing. Have patient bend forward and note for presence of low back
pain. With patient standing, stabilize patient’s iliac crests and brace hip against
patient’s sacrum. Have patient bend forward as you immobilize the pelvis.
Positive: Low back pain
Indicates: 1) pain while bending with the sacrum stabilized and unstabilized = Lumbar
involvement
2) Pain during sacrum non-stabilized bending, and no pain during sacrum
stabilized bending = pelvic involvement
Confirmation Tests:
Gaenslen Test, Goldthwait Test
Milgram Test
Instruct: Patient supine, examiner raises both of patient’s legs 2-3 inches off the table and
instructs patient to hold legs off the table for 30 seconds.
Positive: Inability to perform test and/or low back pain.
Indicates: Weak abdominal muscles or space occupying lesion.
Confirmation Tests:
Valsalva, Bowstring Test, Heel Walk Test, Toe Walk Test, Kemp Test, Neri Bowing Test
Heel Walk
Instruct: Patient walks on heels.
Positive: Inability to perform test.
Indicates: L4-L5 disc lesion (L5 nerve root).
Confirmation Tests:
Bowstring Test, Kemp Test, Milgram Test, Neri Bowing Test
Toe Walk
Instruct: Patient walks on toes.
Positive: Inability to perform test.
Indicates: L5-S1 disc lesion (S1 nerve root).
Confirmation Tests:
Bowstring Test, Kemp Test, Milgram Test, Neri Bowing Test
Kemp Test
Procedure: Patient either seated or standing with arms crossed in front of the chest.
Examiner stands behind patient and stabilizes at the (opposite) PSIS. With
other hand examiner reaches around patient and grasps patient’s shoulder.
Examiner passively brings shoulder back and obliquely pushes shoulder
towards opposite PSIS.
Positive: 1) Pain usually radicular, recreating existing sciatic pain
2) Pain - local
Indicates: 1) Disc protrusion:
• In medial disc protrusion Kemps will be positive as the patient is leaning
AWAY from the side of pain.
• In lateral disc protrusion Kemps will be positive as the patient is leaning
INTO the side of pain.
2) Localized pain may indicate lumbar spasm or facet capsulitis.
Confirmation Tests:
Kemp Test, Milgram Test, Heel Walk Test, Toe Walk Test, Fajersztajn Test
Straight Leg Raiser (SLR)
Procedure: Patient supine, examiner raises patient’s leg slowly to 90º or to the point of pain.
Positive: Radiating pain and/or dull posterior thigh pain.
Indicates: Sciatic radiculopathy or tight hamstrings. Positive between 35 – 70 degrees =
possible discogenic sciatic radiculopathy
> 70 degrees = tight hamstrings
Confirmation Tests:
Bragard Test, Fajersztajn Test, Lasegue Test, Lindner Test
Lindner Sign
Instruct: Patient supine, examiner flexes patient’s head toward the chest.
Positive: Pain along sciatic distribution or sharp, diffuse pain (leg)
Indicates: Sciatic radiculopathy
Confirmation Tests:
Bragard Sign, Fajersztajn Test, Lasegue Test, Straight Leg Raising Test
Turyn Sign
Instruct: Patient supine, examiner dorsiflexes the big toe of the affected extremity with
the leg on the table (no hip flexion).
Positive: Pain in the gluteal region or radiating sciatic pain.
Indicates: Sciatic radiculopathy
Confirmation Tests:
Bechterew Test, Bragard Test, Fajersztajn Test, Lasegue Test, Lindner Test, Straight Leg
Raising Test, Lewin Standing Test, Sicard Test
Bragard Sign
Instruct: Patient supine, examiner performs an SLR on the patient. Examiner lowers the raised
leg (5 degrees) from the point of pain and sharply dorsiflexes patient’s foot.
Positive: Posterior thigh and leg pain.
Indicates: Sciatic radiculopathy (usually from disc lesion)
Confirmation Tests:
Bechterew Test, Lasegue Test, SLR Test
Sicard Sign
Instruct: Patient supine, examiner performs an SLR on the patient. Examiner lowers the raised
leg (5 degrees) from the point of pain and sharply dorsiflexes patient’s big toe.
Positive: Posterior thigh and leg pain.
Indicates: Sciatic radiculopathy (usually from disc lesion)
Confirmation Tests:
Bechterew Test, Bragard Test, Fajersztajn Test, Lasegue Test, Lindner Test, Straight Leg
Raising Test, Turyn Test, Lewin Standing Test
Bonnet Sign
Procedure: Patient supine, examiner strongly internally rotates and adducts the affected
leg across the midline and then performs a straight leg raiser test.
Positive: Pain in posterior thigh or leg.
Indicates: Immediate pain is sciatic neuropathy from piriformis syndrome.
Confirmation Tests:
Bragard Test, Fajersztajn Test, Lasegue Test, Lindner Test, Straight Leg Raising Test
Fajersztajn Test
a.k.a. Well-Leg-Raising Test of Fajersztajn a.k.a. Cross-over Sign
Procedure: Patient is supine. Examiner performs a SLR on the patient’s unaffected leg to
75º or until it produces pain down the affected leg. If no pain is produced,
examiner dorsiflexes the foot.
Positive: 1) Pain down affected leg.(Cross-Over Sign)
2) Decrease in pain down affected leg.
Indicates: 1) Medial disc protrusion
2) Lateral disc protrusion.
Confirmation Tests:
Bragard Test, Lasegue Test, Lindner Test, Straight Leg Raising Test, Kemp Test
Femoral Stretch Test
Procedure: Patient lies on the unaffected leg side, hip and knee slightly flexed, patient
straightens back and flexes neck. The affected leg is extended by the
examiner at the hip approx. 15º. The affected knee is flexed (stretching femoral
nerve).
Positive: Pain on the anterior portion of the thigh.
Indicates: Traction on the femoral nerve indicating involvement of the 2nd, 3rd and 4th
lumbar nerve roots.
Confirmation Tests: Ely Sign
Tinel Foot Sign
Procedure: Doctor taps the region of the medial plantar nerve, posterior to the medial
malleolus
Positive: Paresthesia radiating into the foot.
Indication: Tarsal tunnel syndrome
Confirmation Tests:
Duchene sign, nerve conduction study
Morton Test
Instruct: Patient supine, examiner grasps the affected forefoot with one hand and applies
transverse pressure across the metatarsal heads.
Positive: Sharp pain in the forefoot.
Indicates: Metatarsalgia or neuroma (usually at the 3rd and 4th metatarsal interspace).
Confirmation Tests:
Strunsky Sign, nerve conduction test
