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MS 25-end Flashcards

1
Q

What part of examination:

Gather information to develop a hypothetical diagnosis to dictate the flow of the examination, delineate any precautions and or contraindications when performing components of examination

10 things

A

Patient hx

  1. current condition/cc
  2. demographics: age, gender, diagnosis, referral, hand dominance
  3. Social and family hx
  4. general health status
  5. social health
  6. employment/work
  7. growth and development
  8. living environment
  9. functional status and activity level
  10. medical, surgical history, including previous treatment and review of systems
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2
Q

What is important about the systems review

Musculoskeletal
Neuromuscular
Cardiopulmonary
Integumentary

A
  1. determine whether conditions are comorbidities and or complicating factors
  2. determine whether referral to additional healthcare are provider is needed
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3
Q

What is important about tests and measures:

  1. Anthropometric
  2. Postural alignment and position (dynamic + static)
  3. ROM: (AROM, PROM, Flexibility testing)
  4. Muscle performance: resisted tests, MMT, muscle tension
  5. Motor function
  6. Cranial and peripheral nerve integrity
  7. Reflex integrity
  8. Sensory Integrity
  9. Joint integrity and mobility
  10. Pain
  11. Assistive/adaptive devices
  12. orthotic, protective, supportive devices
  13. ergonomics and body mechanics
  14. self care and home management
  15. Gait, Locomotion, Balance
  16. Work, community, and leisure integration or reintegration
  17. Special Tests
A

gather specific data, choose specific components as well as order of exam based on pt history

Possible components:

  1. Anthropometric
  2. Postural alignment and position (dynamic + static)
  3. ROM: (AROM, PROM, Flexibility testing)
  4. Muscle performance: resisted tests, MMT, muscle tension
  5. Motor function
  6. Cranial and peripheral nerve integrity
  7. Reflex integrity
  8. Sensory Integrity
  9. Joint integrity and mobility
  10. Pain
  11. Assistive/adaptive devices
  12. orthotic, protective, supportive devices
  13. ergonomics and body mechanics
  14. self care and home management
  15. Gait, Locomotion, Balance
  16. Work, community, and leisure integration or reintegration
  17. Special Tests
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4
Q

Common sx with: DJD and OA

(5)

  1. when is it painful
  2. what decreases pain
  3. what increases pain
  4. is it constant or intermittent
  5. what does pain feel like
A
  1. PAIN and STIFFNESS upon RISING
  2. Pain EASES through the morning 4-5 hours
  3. Pain increases with REPETITIVE BENDING activities
  4. CONSTANT awareness of discomfort with episodes of exacerbation
  5. Describes pain as more SORENESS and NAGGING
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5
Q

Common sx with: Facet Joint Dysfunction

(5)

  1. when is it painful
  2. ROM change?
  3. what does pain feel like
  4. what decreases pain
  5. what increases pain
A
  1. STIFF upon rising and pain EASES within an HOUR
  2. loss of motion accompanied by PAIN
  3. Pain described as SHARP with certain motions
  4. Sx usually reduced with movement in pain-free range
  5. Sx increase with STATIONARY POSITIONS
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6
Q

Common sx with: Discal Dysfunction with nerve root compromise

(4)

  1. any position decrease pain
  2. what increase pain
  3. what does pain feel like
  4. patient complaint about ADL and strength
A
  1. NO pain in RECLINED/SEMIRECLINED position
  2. Pain increases with increasing WB activities
  3. Describes pain as SHOOTING, BURNING, or STABBING
  4. pt may describe altered strength or ability to perform ADLs
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7
Q

Common sx with: Spinal Stenosis

(5)

  1. is pain related to position?
  2. What position increases/decreases pain?
  3. What does pain feel like?
  4. What brings on sx?
  5. Once assuming resting position, how long will pain persist?
A
  1. Pain is related to POSITION
  2. FLEXED positions decrease pain/ EXTENDED position increase pain
  3. Describes sx as NUMBNESS, TIGHTNESS, or CRAMPING
  4. WALKING for any distance brings on sx
  5. Pain may persist for HOURS after assuming resting position
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8
Q

Common sx with: Vascular Claudication

(5)

  1. Is pain related to position?
  2. What brings on pain?
  3. What relieves pain?
  4. What does pain feel like?
  5. Common sign?
A
  1. Pain is consistent in ALL SPINAL POSITIONS
  2. Pain is brought on by PHYSICAL EXERTION
  3. Pain is relieved promptly with REST (1-5) minutes
  4. Pain is described as NUMBNESS
  5. Pt usually has DECREASED/ABSENT PULSES
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9
Q

Common sx with: Neoplastic Disease

(3)

  1. What does pain feel like?
  2. What resolves the pain?
  3. Common sign?
A
  1. pt describes pain as GNAWING, INTENSE, or PENETRATING
  2. pain is NOT resolved by changes in position, time of day, or activity level
  3. Pain will wake the patient
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10
Q

Plain Film Radiographs = Xrays

  1. What is it used for?
  2. How it works: what makes it whiter?
  3. # of views needed
  4. Pros (3)
  5. Cons (2)
A
  1. BONY TISSUES: dysfunction +/or disease of bones
  2. Beams pass through tissues: varying gray depending on density of tissue: More dense(bone) => whiter
  3. 2 views (superimposed–cannot see pathology 1 view): ie: anterior-posterior, lateral
  4. Readily AVAILABLE, INEXPENSIVE shows BONY ANATOMY well
  5. RADIATION exposure, does not demonstrate soft tissues)
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11
Q

Computed Tomography (CT) Scan

  1. What is it used for?
  2. How it works?
  3. How many planes shown?
  4. Pros (3)
  5. Cons (2)
A
  1. BONY and SOFT TISSUE:
    Complex fx, facet dysfunction, disc disease, stenosis of spinal canal or IV foramen
  2. Plain film slices enhanced by computer to improve resolution.
  3. Multiplanar so can image in any plane; tissue viewed from multiple directions
  4. CT quality + visualization of BONY structures > xray, demonstrates SOFT TISSUE structures [
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12
Q

Discography

  1. What is it used for?
  2. How it works?
  3. Cons?
A
  1. Identify disc abnormalities: specific identify internal disc disruptions of nucleus and/or annulus
  2. Radiopaque dye is injected into the disc, needle is inserted into the disc with radiography (flouroscopy)
  3. Requires high skill and equipment, $, may be painful, risk infection (invasive)
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13
Q

Magnetic Resonance Imaging : MRI

  1. What is it used for?
  2. How it works?
  3. Pros (2)
  4. Cons (3)
A
  1. Demonstrates BONY (T1) and Soft Tissue (T2)
  2. Uses 2 types of images:
    T1 = assess bony anatomy: demonstrates fat within the tissues
    T2 = assess soft tissue: demonstrates tissue with high water content [suppresses fat]
  3. Excellent visualization of tissue anatomy, uses magnetic fields not radiation
  4. $, pt claustrophobia not tolerate well, cannot use if pt has metalic implant

**open MRI better quality than closed MRI

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14
Q

MRI

T1 vs T2

A

T1 = assess BONY anatomy: demonstrates FAT within the tissues

T2 = assess SOFT TISSUE: demonstrates tissue with high WATER content [suppresses fat]

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15
Q

Arthrography

A
  1. Identify abnormalities in joints [tendon rupture]
  2. demonstrates anatomy where fluid moves within a joint
    inject water soluble dye into area and observed with radiograph : dye is observed as it surrounds tissues
  3. $, risk because invasive
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16
Q

Bone Scans

  1. when is it used?
  2. how does it work?
A
  1. Demonstrate hot spot of increased metabolic activity:
    - RA
    - Stress fracture
    - Bone infection
    - Bone cancer
  2. Radioactive tracer chemicals injected: isotopes settle at high metabolic activity bone
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17
Q

Diagnostic ultrasound

  1. What it is used for?
  2. How it works?
  3. Pros (3)
  4. Cons (5)
A
  1. SOFT TISSUE dysfunction
  2. transmission high frequency sound waves
  3. Real-time dynamic images, can assess soft tissue dysfunction, NO KNOWN HARMFUL EFFECTS
4. Limited by contrast resolution, 
small viewing field, 
how deep it penetrates, 
POOR PENETRATION OF BONE
Data interpretation is subjective [results depend on skill of operator]
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18
Q

Myelography

  1. What is it used for?
  2. How it works?
  3. Cons?
A
  1. Dx assess discs and STENOSIS
  2. Water soluble dye visualized as pass through vertebral canal to observe anatomy
  3. $ requires overnight hospital stay, side effects [and not as good as MRI or CT and worse side effects]
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19
Q

Why would a patient with musculoskeletal condition be given:

  • blood tests
  • serum chemistries
  • immunological tests
  • pulmonary function tests
  • arterial blood gas
  • fluid analysis
A

since many patients with musculoskeletal dysfunction present with other medical pathology it is important to monitor clinical laboratory findings

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20
Q

Electrodiagnostic Testing

Why are they used?

A

Electroneuromyography (ENMG) and Nerve Conduction Velocity (NCV) tests are commonly used to assess or monitor musculoskeletal conditions

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21
Q

Yergason’s Test

  1. What does it test for?
  2. Patient Position
  3. Action
  4. Positive
A
  1. Integrity of Transverse Ligament
    Bicipital Tendonosis/Tendonopathy
  2. Patient Position: Seated, shoulder neutral stabilized against trunk, elbow 90 degrees, forearm pronated
  3. Action: patient attempts forearm supination and shoulder ER while PT resists it
  4. (+) Tendon of biceps long head will “pop out” of groove
    may reproduce pain in long head of bicep tendon
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22
Q

Speed’s Test

  1. What does it test for?
  2. Patient Position
  3. Action
  4. Positive
A
  1. Bicipital Tendonosis/Tendonopathy
  2. Patient Position: seated/stand with UE extended, forearms supinated
  3. Action: pt holds shoulder flexion against resistance

Can also put shoulder in 90 degrees of flexion and PT push UE into extension for eccentric biceps

  1. (+) reproduce sx (pain) in longhead of biceps tendon
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23
Q

Neer’s Test

  1. What does it test for?
  2. Patient Position
  3. Action
  4. Positive
A
  1. Impingement of soft tissue structures of shoulder complex (longhead of biceps and supraspinatus tendon)
  2. Patient position: seated
  3. Action: pt passive: PT brings shoulder into IR and Flexion

[book says abduction]

  1. (+) reproduction of pain in shoulder region
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24
Q

Supraspinatus Test

  1. What does it test for?
  2. Patient Position
  3. Action
  4. Positive
A

= empty can test

  1. Tear or impingement of supraspinatus tendon or possible subscapular nerve neuropathy
  2. Patient Position: seated, shoulder 90 degrees without rotation
  3. Action: pt hold shoulder abduction against resistance

**then do empty can in shoulder IR and 30 degrees horizontal adduction and hold scaption against resistance

  1. (+) reproduction of pain in supraspinatus tendon and/or weakness while in empty can position
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25
Drop Arm Test 1. What does it test for? 2. Patient Position 3. Action 4. Positive
1. Identifies tear and/or full rupture of RC 2. Patient Position: Seated, shoulder passively abducted to 120 degrees 3. Action: pt slowly lowers arm to side (pt guard pt arm from falling in case it gives way) 4. (+) pt unable to lower arm back down to side
26
Posterior Internal Impingement Test 1. What does it test for? 2. Patient Position 3. Action 4. Positive
1. Identified an Impingement between RC + greater tuberosity or posterior glenoid + labrum 2. Patient Position: Supine 3. Action: PT move shoulder into 90 degrees ABDUCTION, Max ER, 15-20 degrees HORIZONTAL ADDUCTION 4. (+): reproduction of pain in posterior shoulder during test
27
Clunk Test 1. What does it test for? 2. Patient Position 3. Action 4. Positive
1. Identifies a glenoid labrum tear 2. Patient Position: supine, shoulder in full abduction 3. Action: PT ER shoulder while push humeral head anteriorly 4. (+) Audible clunk
28
Anterior Apprehension Sign 1. What does it test for? 2. Patient Position 3. Action 4. Positive
1. Identify past history of anterior shoulder dislocation 2. Patient Position: supine, shoulder in 90 degrees abduction 3. Action: PT slowly take shoulder into ER 4. (+): patient does not allow or does not like shoulder to move in direction to stimulate anterior dislocation
29
Posterior Apprehension Sign 1. What does it test for? 2. Patient Position 3. Action 4. Positive
1. Identify past history of posterior shoulder dislocation 2. Patient Position: supine, shoulder abducted 90 degrees scaption with scapula stabilized by the table 3. Action: PT puts a posterior force through the shoulder through patient elbow with shoulder IR and HORIZONTAL ADDUCTION 4. (+): patient does not allow and/or does not like shoulder to move in direction to stimulate posterior dislocation
30
Acromioclavicular Shear Test 1. What does it test for? 2. Patient Position 3. Action 4. Positive
1. Identify dysfunction of AC joint (arthritis, separation) 2. Patient Position: seated, arm rest at side 3. Action: PT compress AC joint: clasps hand and place heel of #1 hand on spine of scapula and heel of #2 hand on clavicle and squeezes 4. (+): reproduce pain in AC joint
31
Adson's Test 1. What does it test for? 2. Patient Position 3. Action 4. Positive
1. Thoracic Outlet Syndrome 2. Patient Position: Seated 3. Action: *PT palpate radial pulse or UE being tested* passive: EXTEND and ER shoulder pt head is rotated to UE being tested and EXTEND the head 4. (+): neurological and/or vascular sx in UE [diminisehd/absent pulse]
32
Costoclavicular Syndrome Test 1. What does it test for? 2. Patient Position 3. Action 4. Positive
military brace test 1. Thoracic Outlet Syndrome 2. Patient Position: seated 3. Action: *PT palpate radial pulse or UE being tested* Passive: shoulder moved down and back 4. (+): neurological and/or vascular sx in UE [diminisehd/absent pulse]
33
Wright Test 1. What does it test for? 2. Patient Position 3. Action 4. Positive
hyperabduction test 1. Thoracic Outlet Syndrome 2. Patient Position: Seated 3. Action: *PT palpate radial pulse or UE being tested* shoulder in max ABDUCTION and ER accentuate sx: Pt take deep breath and rotate head to opposite side being tested 4. (+): neurological and/or vascular sx in UE [diminisehd/absent pulse]
34
Roos Test 1. What does it test for? 2. Patient Position 3. Action 4. Positive
Roos elevated arm test 1. Thoracic Outlet Syndrome 2. Patient Position: stand, shoulders ER, 90 degree abduction, slight horizontal abduction. Elbows flexed to 90 degrees. 3. Action: Patient opens and closes hands slowly for 3 minutes 4. (+): neurological and/or vascular sx in UE [diminished/absent pulse]
35
Upper Limb Tension Test 1. What does it test for? 2. What are they 3. Positive
1. Evaluates peripheral nerve compression 2. ULTT1: Median and anterior Interosseous nerve ULLT2: Median, axillary, and musculocutaneous nerve ULTT3: Radial nerve ULTT4: Ulnar nerve 3. (+) neurological sx reproduced in the UE
36
ULTT1 1. Shoulder 2. Elbow 3. Forearm 4. Wrist 5. Fingers and Thumb ***Cervical Spine
Median and anterior Interosseous nerve 1. Shoulder: DEPRESSION + ABDUCTION (110 degrees) 2. Elbow: EXTENSION 3. Forearm: SUPINATION 4. Wrist: EXTENSION 5. Fingers and Thumb: EXTENSION ***Cervical Spine: Contralateral side flexion
37
ULTT2 1. Shoulder 2. Elbow 3. Forearm 4. Wrist 5. Fingers and Thumb 6. Shoulder ***Cervical Spine
Median, axillary, and musculocutaneous nerve 1. Shoulder: DEPRESSION + ABDUCTION (10 degrees) 2. Elbow: EXTENSION 3. Forearm: SUPINATION 4. Wrist: EXTENSION 5. Fingers and Thumb: EXTENSION 6. Shoulder: ER ***Cervical Spine: Contralateral side flexion
38
ULTT3 1. Shoulder 2. Elbow 3. Forearm 4. Wrist 5. Fingers and Thumb 6. Shoulder ***Cervical Spine
Radial nerve 1. Shoulder: DEPRESSION + ABDUCTION (10 degrees) 2. Elbow: EXTENSION 3. Forearm: PRONATION 4. Wrist: FLEXION + ULNAR DEVIATION 5. Fingers and Thumb: FLEXION 6. Shoulder: IR ***Cervical Spine: Contralateral side flexion
39
ULTT4 1. Shoulder 2. Elbow 3. Forearm 4. Wrist 5. Fingers and Thumb 6. Shoulder ***Cervical Spine
Ulnar nerve 1. Shoulder: DEPRESSION + ABDUCTION (10-90 degrees) with hand to ear (waiter's position) 2. Elbow: FLEXION 3. Forearm: SUPINATION 4. Wrist: EXTENSION + RADIAL DEVIATION 5. Fingers and Thumb: EXTENSION 6. Shoulder: ER ***Cervical Spine: Contralateral side flexion
40
1. Integrity of Transverse Ligament Bicipital Tendonosis/Tendonopathy 2. Patient Position: Seated, shoulder neutral stabilized against trunk, elbow 90 degrees, forearm pronated 3. Action: patient attempts forearm supination and shoulder ER while PT resists it 4. (+) Tendon of biceps long head will "pop out" of groove may reproduce pain in long head of bicep tendon
Yergason's Test
41
1. Bicipital Tendonosis/Tendonopathy 2. Patient Position: seated/stand with UE extended, forearms supinated 3. Action: pt holds shoulder flexion against resistance Can also put shoulder in 90 degrees of flexion and PT push UE into extension for eccentric biceps 4. (+) reproduce sx (pain) in longhead of biceps tendon
Speed's Test
42
1. Impingement of soft tissue structures of shoulder complex (longhead of biceps and supraspinatus tendon) 2. Patient position: seated 3. Action: pt passive: PT brings shoulder into IR and Flexion [book says abduction] 4. (+) reproduction of pain in shoulder region
Neer's Test
43
= empty can test 1. Tear or impingement of supraspinatus tendon or possible subscapular nerve neuropathy 2. Patient Position: seated, shoulder 90 degrees without rotation 3. Action: pt hold shoulder abduction against resistance **then do empty can in shoulder IR and 30 degrees horizontal adduction and hold scaption against resistance 4. (+) reproduction of pain in supraspinatus tendon and/or weakness while in empty can position
Supraspinatus Test
44
1. Identifies tear and/or full rupture of RC 2. Patient Position: Seated, shoulder passively abducted to 120 degrees 3. Action: pt slowly lowers arm to side (pt guard pt arm from falling in case it gives way) 4. (+) pt unable to lower arm back down to side
Drop Arm Test
45
1. Identified an Impingement between RC + greater tuberosity or posterior glenoid + labrum 2. Patient Position: Supine 3. Action: PT move shoulder into 90 degrees ABDUCTION, Max ER, 15-20 degrees HORIZONTAL ADDUCTION 4. (+): reproduction of pain in posterior shoulder during test
Posterior Internal Impingement Test
46
1. Identifies a glenoid labrum tear 2. Patient Position: supine, shoulder in full abduction 3. Action: PT ER shoulder while push humeral head anteriorly 4. (+) Audible clunk
Clunk Test
47
1. Identify past history of anterior shoulder dislocation 2. Patient Position: supine, shoulder in 90 degrees abduction 3. Action: PT slowly take shoulder into ER 4. (+): patient does not allow or does not like shoulder to move in direction to stimulate anterior dislocation
Anterior Apprehension Sign
48
1. Identify past history of posterior shoulder dislocation 2. Patient Position: supine, shoulder abducted 90 degrees scaption with scapula stabilized by the table 3. Action: PT puts a posterior force through the shoulder through patient elbow with shoulder IR and HORIZONTAL ADDUCTION 4. (+): patient does not allow and/or does not like shoulder to move in direction to stimulate posterior dislocation
Posterior Apprehension Sign
49
1. Identify dysfunction of AC joint (arthritis, separation) 2. Patient Position: seated, arm rest at side 3. Action: PT compress AC joint: clasps hand and place heel of #1 hand on spine of scapula and heel of #2 hand on clavicle and squeezes 4. (+): reproduce pain in AC joint
Acromioclavicular Shear Test
50
1. Thoracic Outlet Syndrome 2. Patient Position: Seated 3. Action: *PT palpate radial pulse or UE being tested* passive: EXTEND and ER shoulder pt head is rotated to UE being tested and EXTEND the head 4. (+): neurological and/or vascular sx in UE [diminisehd/absent pulse]
Adson's Test
51
military brace test 1. Thoracic Outlet Syndrome 2. Patient Position: seated 3. Action: *PT palpate radial pulse or UE being tested* Passive: shoulder moved down and back 4. (+): neurological and/or vascular sx in UE [diminisehd/absent pulse]
Costoclavicular Syndrome Test
52
hyperabduction test 1. Thoracic Outlet Syndrome 2. Patient Position: Seated 3. Action: *PT palpate radial pulse or UE being tested* shoulder in max ABDUCTION and ER accentuate sx: Pt take deep breath and rotate head to opposite side being tested 4. (+): neurological and/or vascular sx in UE [diminisehd/absent pulse]
Wright Test
53
Roos elevated arm test 1. Thoracic Outlet Syndrome 2. Patient Position: stand, shoulders ER, 90 degree abduction, slight horizontal abduction. Elbows flexed to 90 degrees. 3. Action: Patient opens and closes hands slowly for 3 minutes 4. (+): neurological and/or vascular sx in UE [diminished/absent pulse]
Roos Test
54
1. Shoulder: DEPRESSION + ABDUCTION (110 degrees) 2. Elbow: EXTENSION 3. Forearm: SUPINATION 4. Wrist: EXTENSION 5. Fingers and Thumb: EXTENSION ***Cervical Spine: Contralateral side flexion
ULTT1 Median and anterior Interosseous nerve
55
1. Shoulder: DEPRESSION + ABDUCTION (10 degrees) 2. Elbow: EXTENSION 3. Forearm: SUPINATION 4. Wrist: EXTENSION 5. Fingers and Thumb: EXTENSION 6. Shoulder: ER ***Cervical Spine: Contralateral side flexion
ULTT2 Median, axillary, and musculocutaneous nerve
56
1. Shoulder: DEPRESSION + ABDUCTION (10 degrees) 2. Elbow: EXTENSION 3. Forearm: PRONATION 4. Wrist: FLEXION + ULNAR DEVIATION 5. Fingers and Thumb: FLEXION 6. Shoulder: IR ***Cervical Spine: Contralateral side flexion
ULLT3 Radial nerve
57
1. Shoulder: DEPRESSION + ABDUCTION (10-90 degrees) with hand to ear (waiter's position) 2. Elbow: FLEXION 3. Forearm: SUPINATION 4. Wrist: EXTENSION + RADIAL DEVIATION 5. Fingers and Thumb: EXTENSION 6. Shoulder: ER ***Cervical Spine: Contralateral side flexion
ULTT4 Ulnar nerve
58
Ligament Instability Tests --- elbow 1. What does it test for? 2. Patient Position 3. Action 4. Positive
1. Medial and Lateral Stability identifies ligament laxity or restriction 2. pt sitting or supine, entire UE is supported and stabilized pt elbow placed in 20-0 degrees of flexion. 3. Valgus force through elbow = ulnar collateral ligament Varus force through elbow = radial collateral ligament 4. (+) laxity pain may also be noted
59
Lateral Epicondylitis Test --- elbow 1. What does it test for? 2. Patient Position 3. Action 4. Positive
Tennis Elbow Test 1. Identifies lateral epicondylopathy (epicondylosis) 2. Pt seated with elbow flexed 90 degrees and supported/stabilized 3. Action: resisted wrist EXTENSION, RADIAL deviation, forearm PRONATION with fingers fully flexed 4. (+): reproduce pain at medial epicondyle
60
Tennis Elbow Test --- elbow 1. What does it test for? 2. Patient Position 3. Action 4. Positive
1. Identifies LATERAL epicondylopathy (epicondylosis) 2. Pt seated with elbow flexed 90 degrees and supported/stabilized 3. Action: resisted wrist EXTENSION, RADIAL deviation, forearm PRONATION with fingers fully flexed 4. (+): reproduce pain at medial epicondyle
61
Medial Epicondylitis --- elbow 1. What does it test for? 2. Patient Position 3. Action 4. Positive
Golfer's Elbow 1. Identifies MEDIAL epicondylopathy 2. Pt seated with elbow in 90 degrees flexion and supported 3. Passively supinate forearm and extend elbow and wrist 4. (+) reproduce pain at medial epicondyle
62
Golfer's Elbow Test 1. What does it test for? 2. Patient Position 3. Action 4. Positive
1. Identifies MEDIAL epicondylopathy 2. Pt seated with elbow in 90 degrees flexion and supported 3. Passively supinate forearm and extend elbow and wrist 4. (+) reproduce pain at medial epicondyle
63
Tinel's Sign (ulnar) 1. What does it test for? 2. Patient Position 3. Action 4. Positive
1. Dysfunction of ulnar nerve at olecranon 2. Pt seated 3. Tap region where ulnar nerve passes through cubital tunnel 4. (+) Tingling sensation at ulnar distribution
64
Pronator Teres Syndrome Test 1. What does it test for? 2. Patient Position 3. Action 4. Positive
1. Identify median nerve entrapment within pronator teres 2. Pt seated, elbow in 90 degrees of flexion and supported/stabilized. 3. Pt hold forearm pronation and elbow extension against resistance 4. (+) Tingling or paresthesia within median nerve distribution
65
1. Medial and Lateral Stability identifies ligament laxity or restriction 2. pt sitting or supine, entire UE is supported and stabilized pt elbow placed in 20-0 degrees of flexion. 3. Valgus force through elbow = ulnar collateral ligament Varus force through elbow = radial collateral ligament 4. (+) laxity pain may also be noted
Ligament Instability Tests --- elbow
66
1. Identifies lateral epicondylopathy (epicondylosis) 2. Pt seated with elbow flexed 90 degrees and supported/stabilized 3. Action: resisted wrist EXTENSION, RADIAL deviation, forearm PRONATION with fingers fully flexed 4. (+): reproduce pain at medial epicondyle
Lateral Epicondylitis Test --- elbow Tennis Elbow Test
67
1. Identifies MEDIAL epicondylopathy 2. Pt seated with elbow in 90 degrees flexion and supported 3. Passively supinate forearm and extend elbow and wrist 4. (+) reproduce pain at medial epicondyle
Medial Epicondylitis --- elbow Golfer's Elbow
68
1. Dysfunction of ulnar nerve at olecranon 2. Pt seated 3. Tap region where ulnar nerve passes through cubital tunnel 4. (+) Tingling sensation at ulnar distribution
Tinel's Sign
69
1. Identify median nerve entrapment within pronator teres 2. Pt seated, elbow in 90 degrees of flexion and supported/stabilized. 3. Pt hold forearm pronation and elbow extension against resistance 4. (+) Tingling or paresthesia within median nerve distribution
Pronator Teres Syndrome Test
70
Finkelstein's Test 1. What does it test for? 2. Patient Position 3. Action 4. Positive
1. Identifies de Quervain's Tenosynovitis (paratendonitis of abductor pollicis longus and/or extensor pollicis brevis) 2. patient makes a fist with thumb within confines of fingers 3. Passively move wrist into ulnar deviation 4. (+) pain, this is often painful with no pathology so compare sides
71
de Quervain's Tenosynovitis
paratendonitis of the - -aBductor pollicis longus and/or - -extensor pollicis brevis
72
Bunnel-Littler Test 1. What does it test for? 2. Patient Position 3. Action 4. Positive
1. Identifies tightness in structures surrounding the MCP joints: differentiate btwn tight CAPSULE vs INTRINSICS 2. pt seated 3. MCP joint is stabilized in slight EXTENSION while PIP is FLEXED. then the MCP joint is FLEXED and PIP is FLEXED 4. (+) tight CAPSULE: Limited flexion in both cases tight INTRINSICS: when MCP is flexed there is more PIP flexion
73
Tight Retinacular Test
1. Identifies tightness around proximal interphalangeal joint 2. pt seated 3. PIP is stabilized in neutral while DIP is flexed then PIP is flexed and DIP is flexed. 4. (+) tight CAPSULE: flexion limited in both cases tight RETINACULAR LIGAMENTS: when PIP flexed there is greater DIP flexion
74
Ligamentous Instability Tests 1. What does it test for? 2. Patient Position 3. Action 4. Positive
Medial and Lateral Stability 1. Identifies ligament laxity or restriction 2. Fingers are supported and stabilized 3. varus/valgus forces applied to PIP and then DIP joints of all digits 4. (+) laxity pain may also be noted
75
Froment's Sign 1. What does it test for? 2. Patient Position 3. Action 4. Positive
1. identify ulnar nerve dysfunction 2. patient grasp paper between 1st and 2nd digits of hand. 3. Pull paper out and look for IP flexion of thumb = compensation for weak ADDUCTOR POLLICIS 4. (+) unable to perform test without compensation may indicate ulnar nerve dysfunction
76
Tinel's Sign (median) 1. What does it test for? 2. Patient Position 3. Action 4. Positive
1. identify carpal tunnel compression of median nerve 2. pt seated 3. tap region where median nerve passes through carpal tunnel 4. (+) reproduces tingling and/or paresthesia into hand following median nerve distribution
77
Phalen's Test 1. What does it test for? 2. Patient Position 3. Action 4. Positive
1. identify carpal tunnel compression of median nerve 2. pt seated 3. pt maximally flexes both wrists holding them against eachother for 1 minute 4. (+) reproduces tingling and/or parasthesia into hand following median nerve distribution
78
2 point discrimination test 1. What does it test for? 2. Patient Position 3. Action 4. Positive
1. identify level of sensory innervation within hand that correlates with functional ability to perform certain tasks involving grasp 2. pt seated, hand stabilized 3. use caliper/2 point discriminator/paper clip apply device to palmar aspect of fingers to assess patient ability to distinguish between 2 points of testing device 4. (+) recored smallest difference that a patient can sense two separate points, normal is less than 6mm
79
Allen's Test 1. What does it test for? 2. Patient Position 3. Action 4. Positive
1. identify vascular compromise 2. seated 3. Palpate radial and ulnar artery -Patient opens and closes fingers quickly several times and makes a closed fist -PT uses thumb to occlude the ulnar artery and the pt open hand -observe the palm of hand, release compression on artery to observe vascular filling (do for each artery) 4. (+) Abnormal filling of blood within hand during test **normally there should be a change in color from white to normal appearance on palm of hand
80
1. Identifies de Quervain's Tenosynovitis (paratendonitis of abductor pollicis longus and/or extensor pollicis brevis) 2. patient makes a fist with thumb within confines of fingers 3. Passively move wrist into ulnar deviation 4. (+) pain, this is often painful with no pathology so compare sides
Finkelstein's Test
81
1. Identifies tightness in structures surrounding the MCP joints: differentiate btwn tight CAPSULE vs INTRINSICS 2. pt seated 3. MCP joint is stabilized in slight EXTENSION while PIP is FLEXED. then the MCP joint is FLEXED and PIP is FLEXED 4. (+) tight CAPSULE: Limited flexion in both cases tight INTRINSICS: when MCP is flexed there is more PIP flexion
Bunnel-Littler Test
82
1. Identifies tightness around proximal interphalangeal joint 2. pt seated 3. PIP is stabilized in neutral while DIP is flexed then PIP is flexed and DIP is flexed. 4. (+) tight CAPSULE: flexion limited in both cases tight RETINACULAR LIGAMENTS: when PIP flexed there is greater DIP flexion
Tight Retinacular Test
83
Medial and Lateral Stability 1. Identifies ligament laxity or restriction 2. Fingers are supported and stabilized 3. varus/valgus forces applied to PIP and then DIP joints of all digits 4. (+) laxity pain may also be noted
Ligamentous Instability Tests
84
1. identify ulnar nerve dysfunction 2. patient grasp paper between 1st and 2nd digits of hand. 3. Pull paper out and look for IP flexion of thumb = compensation for weak ADDUCTOR POLLICIS 4. (+) unable to perform test without compensation may indicate ulnar nerve dysfunction
Froment's Sign
85
1. identify carpal tunnel compression of median nerve 2. pt seated 3. tap region where median nerve passes through carpal tunnel 4. (+) reproduces tingling and/or paresthesia into hand following median nerve distribution
Tinel's Sign
86
1. identify carpal tunnel compression of median nerve 2. pt seated 3. pt maximally flexes both wrists holding them against eachother for 1 minute 4. (+) reproduces tingling and/or parasthesia into hand following median nerve distribution
Phalen's Test
87
1. identify level of sensory innervation within hand that correlates with functional ability to perform certain tasks involving grasp 2. pt seated, hand stabilized 3. use caliper/2 point discriminator/paper clip apply device to palmar aspect of fingers to assess patient ability to distinguish between 2 points of testing device 4. (+) recored smallest difference that a patient can sense two separate points, normal is less than 6mm
2 point discrimination test
88
1. identify vascular compromise 2. seated 3. Palpate radial and ulnar artery -Patient opens and closes fingers quickly several times and makes a closed fist -PT uses thumb to occlude the ulnar artery and the pt open hand -observe the palm of hand, release compression on artery to observe vascular filling (do for each artery) 4. (+) Abnormal filling of blood within hand during test **normally there should be a change in color from white to normal appearance on palm of hand
Allen's Test
89
Patricks Test 1. What does it test for? 2. Patient Position 3. Action 4. Positive
1. identify hip dysfunction 2. pt supine 3. Passively flex, abduct, ER (foot rests on opposite leg above knee) Slowly push test leg to table surface 4. (+) Involved side unable to assume relaxed position +/or reproduction of pain sx
90
FABER Test 1. What does it test for? 2. Patient Position 3. Action 4. Positive
1. identify hip dysfunction 2. pt supine 3. Passively flex, abduct, ER (foot rests on opposite leg above knee) Slowly push test leg to table surface 4. (+) Involved side unable to assume relaxed position +/or reproduction of pain sx
91
Grind Test 1. What does it test for? 2. Patient Position 3. Action 4. Positive
also called scour test 1. identify DJD of hip 2. pt supine with hip in 90 degrees flexion and knee max flexion 3. place compressive load into femur via knee to load the hip 4. (+) reproduce pain within hip joint and may refer pain to the knee and elsewhere
92
Scour Test 1. What does it test for? 2. Patient Position 3. Action 4. Positive
also called grind test 1. identify DJD of hip 2. pt supine with hip in 90 degrees flexion and knee max flexion 3. place compressive load into femur via knee to load the hip 4. (+) reproduce pain within hip joint and may refer pain to the knee and elsewhere
93
Trendelenburg Sign 1. What does it test for? 2. Patient Position 3. Action 4. Positive
1. Identify weakness of gluteus medius or unstable hip 2. Pt stand on one leg and flex opposite knee 3. **observe pelvis of stance leg 4. (+) ipsilateral pelvis drops when lower limb support is removed while standing
94
Thomas test 1. What does it test for? 2. Patient Position 3. Action 4. Positive
1. Identify tight hip flexors 2. Patient supine with one hip and knee maximally flexed to chest and held there Opposite LE straight on table 3. observe whether hip flexion occurs on straight leg as opposite limb is flexed 4. (+) straight limb hip flexes and/or pt unable to remain flat on table when opposite limb is flexed **test doesnt differentiate between iliacus and psoas major
95
Ober's Test 1. What does it test for? 2. Patient Position 3. Action 4. Positive
1. identify tightness of TFL and/or ITB 2. pt sidelie with lower LE flexed at hip and knee 3. Passively extend and abduct testing hip with knee flexed to 90 degrees. Slowly lower upper LE and observe whether it reaches table. (modified Ober's test starts with knee extended) 4. (+) upper LE cannot rest on table
96
Ely's Test 1. What does it test for? 2. Patient Position 3. Action 4. Positive
1. tightness rectus femoris 2. pt prone with knee of testing limb flexed 3. observe hip of testing limb 4. (+) hip of testing limb flexes
97
90-90 Hamstring Test 1. What does it test for? 2. Patient Position 3. Action 4. Positive
1. tightness of hamstring 2. pt supine, hip and knee of testing limb supported in 90 degrees flexion 3. Passively extend knee of testing limb until barrier 4. (+) knee unable to reach 10 degrees from neutral position (lacking 10 degrees of extension)
98
Piriformis Test 1. What does it test for? 2. Patient Position 3. Action 4. Positive
1. identifies piriformis syndrome 2. pt supine, test LE foot lateral to opposite LE knee 3. Hip tested is aDDucted 4. (+) testing knee unable to pass over opposite knee and/or reproduction of pain in buttock and/or reproduction of pain along sciatic nerve distribution
99
Leg Length Test 1. What does it test for? 2. Patient Position 3. Action 4. Positive
1. identifies true LLD 2. pt supine with pelvis aligned with lower limbs and trunk 3. Measure distance from ASIS to lateral malleolus or medial malleolus on each limb (compare multiple times) 4. (+) diff in leg length is true LLD TRUE discrepancy: anatomical bone length (tibia or femur) FUNCTIONAL discrepancy: compensation due to abnormal position or posture (pronation of foot or pelvic obliquity) **unequal girth of thigh muscles an skew results if use medial malleolus
100
Craig's Test 1. What does it test for? 2. Patient Position 3. Action 4. Positive
1. identify abnormal femoral antetorsion angle 2. pt prone with knee flexed to 90 degrees 3. palpate greater trochanter, slowly move hip IR/ER until greater trochanter feels most lateral. Measure angle of leg relative to a line perpendicular with table surface 4. Normal: 8-15 degrees hip IR Anteverted Hip: >15 degrees Retroverted Hip:
101
degrees of angle for retroverted/anterverted hip
Retroverted
102
1. identify hip dysfunction 2. pt supine 3. Passively flex, abduct, ER (foot rests on opposite leg above knee) Slowly push test leg to table surface 4. (+) Involved side unable to assume relaxed position +/or reproduction of pain sx
Patricks Test | FABERs Test
103
1. identify DJD of hip 2. pt supine with hip in 90 degrees flexion and knee max flexion 3. place compressive load into femur via knee to load the hip 4. (+) reproduce pain within hip joint and may refer pain to the knee and elsewhere
Grind Test | Scouring Test
104
1. Identify weakness of gluteus medius or unstable hip 2. Pt stand on one leg and flex opposite knee 3. **observe pelvis of stance leg 4. (+) ipsilateral pelvis drops when lower limb support is removed while standing
Trendelenburg Sign
105
1. Identify tight hip flexors 2. Patient supine with one hip and knee maximally flexed to chest and held there Opposite LE straight on table 3. observe whether hip flexion occurs on straight leg as opposite limb is flexed 4. (+) straight limb hip flexes and/or pt unable to remain flat on table when opposite limb is flexed **test doesnt differentiate between iliacus and psoas major
Thomas Test
106
1. identify tightness of TFL and/or ITB 2. pt sidelie with lower LE flexed at hip and knee 3. Passively extend and abduct testing hip with knee flexed to 90 degrees. Slowly lower upper LE and observe whether it reaches table. (modified Ober's test starts with knee extended) 4. (+) upper LE cannot rest on table
Ober's Test
107
1. tightness rectus femoris 2. pt prone with knee of testing limb flexed 3. observe hip of testing limb 4. (+) hip of testing limb flexes
Ely's Test
108
1. tightness of hamstring 2. pt supine, hip and knee of testing limb supported in 90 degrees flexion 3. Passively extend knee of testing limb until barrier 4. (+) knee unable to reach 10 degrees from neutral position (lacking 10 degrees of extension)
90-90 hamstring test
109
1. identifies piriformis syndrome 2. pt supine, test LE foot lateral to opposite LE knee 3. Hip tested is aDDucted 4. (+) testing knee unable to pass over opposite knee and/or reproduction of pain in buttock and/or reproduction of pain along sciatic nerve distribution
Piriformis Test
110
1. identifies true LLD 2. pt supine with pelvis aligned with lower limbs and trunk 3. Measure distance from ASIS to lateral malleolus or medial malleolus on each limb (compare multiple times) 4. (+) diff in leg length is true LLD TRUE discrepancy: anatomical bone length (tibia or femur) FUNCTIONAL discrepancy: compensation due to abnormal position or posture (pronation of foot or pelvic obliquity) **unequal girth of thigh muscles an skew results if use medial malleolus
LLD Test
111
1. identify abnormal femoral antetorsion angle 2. pt prone with knee flexed to 90 degrees 3. palpate greater trochanter, slowly move hip IR/ER until greater trochanter feels most lateral. Measure angle of leg relative to a line perpendicular with table surface 4. Normal: 8-15 degrees hip IR Anteverted Hip: >15 degrees Retroverted Hip:
Craig's Test
112
8-15 Degrees
normal angle of hip IR
113
Collateral Ligament Instability test (medial and lateral stability) 1. What it is for? 2. Patient Position? 3. Action 4. (+) 3. Action?
1. Identifies Ligament laxity or restriction 2. Pt supine, LE is supported and stabilized, knee in 20-30 degrees of flexion 3. Test MCL: Valgus force through knee Test LCL: Varus force through knee 4. (+) laxity, can also note pain
114
Lachman Stress Test 1. What it is for? 2. Patient Position? 3. Action 4. (+)
1. Integrity of ACL 2. Pt supine, testing knee flexed 20-30 degrees 3. Femur is stabilized, tibia glided anteriorly 4. (+): excessive anterior glide of tibia
115
Pivot Shift 1. What it is for? 2. Patient Position? 3. Action 4. (+)
1. ACL integrity (anterolateral rotary instability) 2. Pt supine, hip flexed, slight IR, and abducted 30 degrees, knee extended 3. PT holds knee with one hand and foot with other hand: place VALGUS through knee and flex knee 4. (+) ligament laxity = tibia relocates during test = as knee is flexed the tibia clunks backwards at approximately 30-40 degrees **this is because Tibia is subluxed and then reduced by the pull of the ITB as the knee was flexed
116
Posterior Sag Sign 1. What it is for? 2. Patient Position? 3. Action 4. (+)
1. Indicates integrity of PCL 2. Supine, hip flexed to 45 degrees, knee flexed to 90 degree 3. Observe whether the tibia sags posteriorly in this position 4. (+) sag of tibia relative to femur
117
Posterior Drawer Test 1. What it is for? 2. Patient Position? 3. Action 4. (+)
1. Indicates PCL integrity 2. Pt supine, hip flexed to 45 degrees and knee flexed to 90 degrees 3. PT glides tibia posteriorly following the joint plane 4. (+) excess posterior glide
118
Reverse Lachman 1. What it is for? 2. Patient Position? 3. Action 4. (+)
1. Indicates integrity of PCL 2. Pt prone, knee flexed to 30 degrees 3. Action: PT stabilizes femur and passively glides tibia posteriorly 4. (+) ligament laxity
119
McMurray's Test 1. What it is for? 2. Patient Position? 3. Action 4. (+)
1. Identify meniscal tears 2. Pt supine, knee in maximal flexion 3. Lateral Meniscus: passively IR and extend knee Medial Meniscus: passively ER and extend knee 4. (+): reproduction of click and/or pain in knee joint
120
Apley's Test 1. What it is for? 2. Patient Position? 3. Action 4. (+)
1. Differentiate between meniscal tears and ligamentous lesions 2. prone, knee flexed to 90 degrees 3. PT stabilize thigh to table with PT knee. Passively distract knee and then slowly IR/ER tibia. Then apply compression load to knee and slowly IR/ER tibia. 4. (+) Meniscal dysfunction: Pain or decreased motion during compression Ligamentous dysfunction: pain or increased motion during distraction
121
Hughston's Plica Test 1. What it is for? 2. Patient Position? 3. Action 4. (+)
1. Identify dysfunction of Plica 2. Pt supine and testing knee is flexed with tibia IR 3. PT palpates medial femoral condyle and passively glides the patella medially, feel for popping as passively flex and extend the knee 4. (+) pain and/or "popping" during test
122
Patellar apprehension test 1. What is it used for? 2. Patient position? 3. Action? 4. (+)
1. Indicates history of patella dislocation 2. Pt supine 3. PT passively glides patella laterally 4. (+) pt does not allow and/or does not like the patella to move lateral direction to stimulate subluxation/dislocation
123
Clarke's Sign 1. What is it for? 2. Pt position? 3. Action? 4. (+)
1. Indicates patellofemoral dysfunction 2. Pt supine, knee in extension resting on table. 3. PT pushes posteriorly on the superior pole of patella. Patient performs active quadriceps contraction 4. (+) pain in knee
124
Ballotable Patella (Patellar tap test) 1. What is it for? 2. Pt position? 3. Action? 4. (+)
1. Indicates infrapatellar effusion 2. Pt supine, knee in extension resting on table. 3. Apply soft tap over the central patella 4. (+) perception of patella floating ("dancing patella" sign)
125
"Dancing Patella" Sign What test?
Positive Ballorable Patella (Patella tap test) Indicates infrapatellar effusion
126
Fluctuation Test 1. What is it for? 2. Pt position? 3. Action? 4. (+)
1. Indicates knee joint effusion 2. Pt supine, knee in extension resting on table 3. PT places one hand over suprapatellar and other over anterior aspect of knee joint. Alternate pushing down with one hand at a time. 4. (+) fluctuation (movement) of fluid noted during the test
127
Q-angle Measurement What is it? What is normal? What does it indicate?
1. Measurement of angle between QUADRICEPS muscle and PATELLAR TENDON 2. Normal: Men (13 degrees) and Women (18 degrees) 3. Angles less than or greater than normal may be indicative of knee dysfunction and/or biomechanical dysfunctions within the LE
128
Q angle norms
Men (13 degrees) | Women (18 degrees)
129
Noble Compression Test 1. What does it indicate? 2. Patient position? 3. Action? 4. (+)
1. Identifies whether distal ITB friction syndrome is present 2. Pt supine with hip flexed to 45 degrees and knee flexed to 90 degrees . 3. PT apply pressure to the lateral femoral epicondyle and then extend the knee. 4. (+) reproduce same pain over lateral femoral condyle. Patient complain of pain over lateral femoral epicondylitis at approximately 30 degrees of flexion.
130
Tinel's Sign (fibular) 1. What is it for? 2. Patient position? 3. Action? 4. (+)
1. Identifies dysfunction of common fibular nerve posterior to fibular head following common fibular nerve distribution 2. 3. Tap region where common fibular nerve passes through posterior to fibula head 4. (+) reproduces tingling and/or paresthesia into leg
131
1. Identifies Ligament laxity or restriction 2. Pt supine, LE is supported and stabilized, knee in 20-30 degrees of flexion 3. Test MCL: Valgus force through knee Test LCL: Varus force through knee 4. (+) laxity, can also note pain
Collateral Ligament Instability test (medial and lateral stability)
132
1. Integrity of ACL 2. Pt supine, testing knee flexed 20-30 degrees 3. Femur is stabilized, tibia glided anteriorly 4. (+): excessive anterior glide of tibia
Lachman Stress Test
133
1. ACL integrity (anterolateral rotary instability) 2. Pt supine, hip flexed, slight IR, and abducted 30 degrees, knee extended 3. PT holds knee with one hand and foot with other hand: place VALGUS through knee and flex knee 4. (+) ligament laxity = tibia relocates during test = as knee is flexed the tibia clunks backwards at approximately 30-40 degrees **this is because Tibia is subluxed and then reduced by the pull of the ITB as the knee was flexed
Pivot Shift
134
1. Indicates integrity of PCL 2. Supine, hip flexed to 45 degrees, knee flexed to 90 degree 3. Observe whether the tibia sags posteriorly in this position 4. (+) sag of tibia relative to femur
Posterior Sag Sign
135
1. Indicates PCL integrity 2. Pt supine, hip flexed to 45 degrees and knee flexed to 90 degrees 3. PT glides tibia posteriorly following the joint plane 4. (+) excess posterior glide
Posterior Drawer Test
136
1. Indicates integrity of PCL 2. Pt prone, knee flexed to 30 degrees 3. Action: PT stabilizes femur and passively glides tibia posteriorly 4. (+) ligament laxity
Reverse Lachman
137
1. Identify meniscal tears 2. Pt supine, knee in maximal flexion 3. Lateral Meniscus: passively IR and extend knee Medial Meniscus: passively ER and extend knee 4. (+): reproduction of click and/or pain in knee joint
McMurray's Test
138
1. Differentiate between meniscal tears and ligamentous lesions 2. prone, knee flexed to 90 degrees 3. PT stabilize thigh to table with PT knee. Passively distract knee and then slowly IR/ER tibia. Then apply compression load to knee and slowly IR/ER tibia. 4. (+) Meniscal dysfunction: Pain or decreased motion during compression Ligamentous dysfunction: pain or increased motion during distraction
Apley's Test
139
1. Identify dysfunction of Plica 2. Pt supine and testing knee is flexed with tibia IR 3. PT palpates medial femoral condyle and passively glides the patella medially, feel for popping as passively flex and extend the knee 4. (+) pain and/or "popping" during test
Hughston's Plica Test
140
1. Indicates history of patella dislocation 2. Pt supine 3. PT passively glides patella laterally 4. (+) pt does not allow and/or does not like the patella to move lateral direction to stimulate subluxation/dislocation
Patellar apprehension test
141
1. Indicates patellofemoral dysfunction 2. Pt supine, knee in extension resting on table. 3. PT pushes posteriorly on the superior pole of patella. Patient performs active quadriceps contraction 4. (+) pain in knee
Clarke's Sign
142
1. Indicates infrapatellar effusion 2. Pt supine, knee in extension resting on table. 3. Apply soft tap over the central patella 4. (+) perception of patella floating ("dancing patella" sign)
Ballotable Patella (Patellar tap test)
143
1. Indicates knee joint effusion 2. Pt supine, knee in extension resting on table 3. PT places one hand over suprapatellar and other over anterior aspect of knee joint. Alternate pushing down with one hand at a time. 4. (+) fluctuation (movement) of fluid noted during the test
Fluctuation Test
144
Men (13 degrees) | Women (18 degrees)
Q-angle 1. Measurement of angle between QUADRICEPS muscle and PATELLAR TENDON 2. Normal: Men (13 degrees) and Women (18 degrees) 3. Angles less than or greater than normal may be indicative of knee dysfunction and/or biomechanical dysfunctions within the LE
145
How to measure Q angle: what is the angle
1. Measurement of angle between QUADRICEPS muscle and PATELLAR TENDON 2. Normal: Men (13 degrees) and Women (18 degrees) 3. Angles less than or greater than normal may be indicative of knee dysfunction and/or biomechanical dysfunctions within the LE
146
1. Identifies whether distal ITB friction syndrome is present 2. Pt supine with hip flexed to 45 degrees and knee flexed to 90 degrees . 3. PT apply pressure to the lateral femoral epicondyle and then extend the knee. 4. (+) reproduce same pain over lateral femoral condyle. Patient complain of pain over lateral femoral epicondylitis at approximately 30 degrees of flexion.
Noble Compression Test
147
1. Identifies dysfunction of common fibular nerve posterior to fibular head following common fibular nerve distribution 2. 3. Tap region where common fibular nerve passes through posterior to fibula head 4. (+) reproduces tingling and/or paresthesia into leg
Tinel's Sign
148
Neutral Subtalar Positioning 1. What does it indicate? 2. Patient position? 3. Action? 4. (+)
1. Identifies abnormal rearfoot to forefoot positioning 2. Pt prone with foot over edge of table 3. PT: 1 hand palpate dorsal talus on both sides, 1 hand grasp lateral forefoot PT gently DF until resistance felt then gently move foot through arc of supination-pronation 4. Neutral when feel foot fall off easier to one side or other: compare rearfoot to forefoot and rearfoot to leg
149
Anterior drawer test (foot/ankle) 1. What does it indicate? 2. Patient position? 3. Action? 4. (+)
1. Identify ligamentous instability (particularly anterior talofibular ligament) 2. pt supine, heel off edge of table in 20 degrees PF. 3. Stabilize LE and grasp foot. Pull talus anteriorly. 3. (+) talus has anterior glide and/or pain is noted
150
Talar Tilt 1. What does it indicate? 2. Patient position? 3. Action? 4. (+)
1. Identifies ligamentous instability (particularly calcaneofibular ligament) 2. Pt side-lying with knee slightly flexed and ankle in neutral 3. PT test: calcaneofibular ligament move foot into adduction/ and deltoid ligament move foot into abduction 4. (+) excessive adduction or abduction and/or pain
151
Thompson's Test 1. What does it indicate? 2. Patient position? 3. Action? 4. (+)
1. Evaluates integrity of achilles tendon 2. Pt prone, foot off edge of table 3. Squeeze calf muscles 4. (+) No movement of foot while squeezing calf
152
Tinel's Sign (posterior tibial nerve) 1. What does it indicate? 2. Patient position? 3. Action? 4. (+)
1. Identify dysfunction of: posterior tibial nerve posterior to MEDIAL malleolus or deep fibular nerve ANTERIOR to talocrural joint 2. Patient supine with foot supported on table 3. Tap over region of: POSTERIOR TIBIAL N. posterior to the medial malleolus. DEEP FIBULAR N. under dorsal retinaculum (anterior to ankle joint) 4. (+) reproduces tingling and/or paresthesia into the respective nerve distributions
153
Morton's Test 1. What does it indicate? 2. Patient position? 3. Action? 4. (+)
1. Identifies STRESS FRACTURE or NEUROMA in forefoot 2. Pt supine with foot supported on table 3. PT grasp around metatarsal heads and squeeze 4. (+) pain in forefoot
154
1. Identifies abnormal rearfoot to forefoot positioning 2. Pt prone with foot over edge of table 3. PT: 1 hand palpate dorsal talus on both sides, 1 hand grasp lateral forefoot PT gently DF until resistance felt then gently move foot through arc of supination-pronation 4. Neutral when feel foot fall off easier to one side or other: compare rearfoot to forefoot and rearfoot to leg
Neutral Subtalar Positioning
155
1. Identify ligamentous instability (particularly anterior talofibular ligament) 2. pt supine, heel off edge of table in 20 degrees PF. 3. Stabilize LE and grasp foot. Pull talus anteriorly. 3. (+) talus has anterior glide and/or pain is noted
Anterior drawer test (foot/ankle)
156
1. Identifies ligamentous instability (particularly calcaneofibular ligament) 2. Pt side-lying with knee slightly flexed and ankle in neutral 3. PT test: calcaneofibular ligament move foot into adduction/ and deltoid ligament move foot into abduction 4. (+) excessive addiction or abduction and/or pain
Talar Tilt
157
1. Evaluates integrity of achilles tendon 2. Pt prone, foot off edge of table 3. Squeeze calf muscles 4. (+) No movement of foot while squeezing calf
Thompson's Test
158
1. Identify dysfunction of: posterior tibial nerve posterior to MEDIAL malleolus or deep fibular nerve ANTERIOR to talocrural joint 2. Patient supine with foot supported on table 3. Tap over region of: POSTERIOR TIBIAL N. posterior to the medial malleolus. DEEP FIBULAR N. under dorsal retinaculum (anterior to ankle joint) 4. (+) reproduces tingling and/or paresthesia into the respective nerve distributions
Tinel's Sign (posterior tibial nerve)
159
1. Identifies STRESS FRACTURE or NEUROMA in forefoot 2. Pt supine with foot supported on table 3. PT grasp around metatarsal heads and squeeze 4. (+) pain in forefoot
Morton's Test
160
Vertebral Artery Test 1. What does it indicate? 2. Patient position? 3. Action? 4. (+)
**performing mobilization/manipulation within the cervical region without this test first wis a breach in standard of care 1. Assess integrity of the vertebrobasilar vascular system 2. pt supine , head supported on table 3. **pt continuously monitored for change in sx during full test **caution: danger in test so need to follow progressive flow : A) EXTEND head and neck for 30 seconds: if no change sx: B) EXTEND head and neck with ROTATION LEFT then RIGHT for 30 seconds: if no change in sx: C) head and neck cradled OFF TABLE: EXTEND head and neck for 30 seconds: : if no change in sx: D) head and neck cradled OFF TABLE: EXTEND head and neck with ROTATION LEFT then RIGHT for 30 seconds 4. (+) dizziness, visual disturbances, disorientation, blurred speech, nausea/vomiting (when turn head left, testing right vertebral artery)
161
performing mobilization/manipulation within the cervical region without this test first wis a breach in standard of care
Vertebral Artery Test
162
Hautant's Test 1. What does it indicate? 2. Patient position? 3. Action? 4. (+)
1. differentiate vascular vs vestibular dizziness/vertigo VESTIBULAR Part 1: Patient seated, shoulders 90 degrees, palms up. Patient closes eyes for 30 seconds. Vestibular= arms lose position VASCULAR Part 2: Pt seated shoulders 90 degrees, palms up. Patient closes eyes. Pt extends head/neck with RIGHT rotation then LEFT rotation. Remain in each position 30 seconds. Vascular = arms lose position 4. (+) based on position/movement of arms
163
Transverse Ligament Stress Test 1. What does it indicate? 2. Patient position? 3. Action? 4. (+)
1. Tests integrity of transverse ligament 2. pt supine with head supported on table 3. glide C1 anteriorly (should be firm end feel) 4. (+) soft end feel, dizziness, nystagmus, lump sensation in throat, nausea
164
Anterior Shear Test 1. What does it indicate? 2. Patient position? 3. Action? 4. (+)
1. Assess integrity of upper cervical spine ligaments and capsules 2. Pt supine with head supported on table 3. Glide C2-C7 anteriorly (should be firm end feel) 4. (+) laxity of ligaments, as well as dizziness, nystagmus, lump sensation in throat, nausea
165
Foraminal Compression 1. What does it indicate? 2. Patient position? 3. Action? 4. (+)
Spurling's Test 1. Identify dysfunction of CERVICAL NERVE ROOT (usually compression) 2. pt seated, head side bent to good side. 3. Apply pressure through head straight down. Repeat with head side bent to bad side. 4. (+) pain and/or paresthesia in dermatomal pattern for involved nerve root
166
Spurling's Test 1. What does it indicate? 2. Patient position? 3. Action? 4. (+)
Foraminal Compression 1. Identify dysfunction of CERVICAL NERVE ROOT (usually compression) 2. pt seated, head side bent to good side. 3. Apply pressure through head straight down. Repeat with head side bent to bad side. 4. (+) pain and/or paresthesia in dermatomal pattern for involved nerve root
167
Maximum Cervical Compression Test 1. What does it indicate? 2. Patient position? 3. Action? 4. (+)
* be careful since this is similar to vertebral artery test* 1. identify compression of NEURAL STRUCTURES at intervertebral foramen and/or FACET DYSFUNCTION 2. pt seated 3. Passively move head into SB and rotation to good side, followed by extension. Repeat to SB and rotation to bad side followed by extension. 4. (+) INVOLVED NERVE ROOT = pain +/or paresthesia in dermatomal pattern FACET DYSFUNCTION = localized pain in neck
168
Distraction Test 1. What does it indicate? 2. Patient position? 3. Action? 4. (+)
1. indicates compression of NEURAL STRUCTURES at the intervertebral foramen or FACET JOINT DYSFUNCTION 2. pt seated 3. PT perform distraction 4. (+) FACET CONDITION: decrease in sx in neck NEUROLOGICAL CONDITION: decrease in upper limb pain
169
Shoulder Abduction Test 1. What does it indicate? 2. Patient position? 3. Action? 4. (+)
1. Indicates compression of NEURAL STRUCTURES within the INTERVERTEBRAL FORAMEN 2. Patient seated 3. Patient places one hand on top of head, then repeats with other hand 4. (+) decreased symptoms into upper limb
170
Lhermitte's Sign 1. What does it indicate? 2. Patient position? 3. Action? 4. (+)
1. Identifies dysfunction of SPINAL CORD and/or an UMN lesion 2. pt in long sitting on table 3. Passively flex pt head and one hip while keeping knee extended. Repeat with other hip. 4. (+) pain down the spine and into the UE or LE
171
Romberg Test 1. What does it indicate? 2. Patient position? 3. Action? 4. (+)
1. identifies UMN lesion 2. pt standing 3. Pt closes eyes for 30 seconds 4. (+) excess swaying during test
172
Assess integrity of the vertebrobasilar vascular system
Vertebral Artery Test (+) dizziness, visual disturbances, disorientation, blurred speech, nausea/vomiting (when turn head left, testing right vertebral artery)
173
differentiate vascular vs vestibular dizziness/vertigo
Hautant's Test VESTIBULAR Part 1: Patient seated, shoulders 90 degrees, palms up. Patient closes eyes for 30 seconds. Vestibular= arms lose position VASCULAR Part 2: Pt seated shoulders 90 degrees, palms up. Patient closes eyes. Pt extends head/neck with RIGHT rotation then LEFT rotation. Remain in each position 30 seconds. Vascular = arms lose position
174
pt supine with head supported on table glide C1 anteriorly (should be firm end feel) (+) soft end feel, dizziness, nystagmus, lump sensation in throat, nausea
Transverse Ligament Stress Test
175
1. Assess integrity of upper cervical spine ligaments and capsules 2. Pt supine with head supported on table 3. Glide C2-C7 anteriorly (should be firm end feel) 4. (+) laxity of ligaments, as well as dizziness, nystagmus, lump sensation in throat, nausea
Anterior Shear Test
176
1. Identify dysfunction of CERVICAL NERVE ROOT (usually compression) 2. pt seated, head side bent to good side. 3. Apply pressure through head straight down. Repeat with head side bent to bad side. 4. (+) pain and/or paresthesia in dermatomal pattern for involved nerve root
Foraminal Compression | Spurling's Test
177
INVOLVED NERVE ROOT = pain +/or paresthesia in dermatomal pattern FACET DYSFUNCTION = localized pain in neck
Maximum Cervical Compression Test
178
FACET CONDITION: decrease in sx in neck | NEUROLOGICAL CONDITION: decrease in upper limb pain
Distraction Test
179
Patient places one hand on top of head, then repeats with other hand what test? what is it for?
Shoulder Abduction Test Indicates compression of NEURAL STRUCTURES within the INTERVERTEBRAL FORAMEN (+) decreased symptoms into upper limb
180
pt in long sitting on table Passively flex pt head and one hip while keeping knee extended. Repeat with other hip. (+) pain down the spine and into the UE or LE
Lhermitte's Sign
181
pt standing Pt closes eyes for 30 seconds (+) excess swaying during test
Romberg Test identifies UMN lesion
182
Rib Springing 1. What does it indicate? 2. Patient position? 3. Action? 4. (+)
**be careful springing rib 11 and 12 since no anterior attachments and therefore less stable 1. Evaluates Rib Mobility patient prone : begin at upper ribs and apply a P-A force through each rib sidelying: begin at upper ribs and apply a P-A force through each rib 4. (+) pain, excessive motion of rib or restriction of rib
183
Thoracic Springing 1. What does it indicate? 2. Patient position? 3. Action? 4. (+)
* remember that SP and TP of the same vertebra may not be at the same level in the thoracic region 1. Evaluates intervertebral joint mobility in the thoracic spine 2. patient prone 3. apply posterior/anterior glides/springs to transverse process of thoracic vertebra 4. (+) Pain, excess motion, and/or restricted motion
184
Slump Test 1. What does it indicate? 2. Patient position? 3. Action? 4. (+)
1. Identifies dysfunction of NEUROLOGICAL STRUCTURES supplying the LEs 2. Patient sitting on edge of table with knees flexed 3. Patient slump sits while maintain neutral head and neck A) Passive flex pt head and neck (cont. if no sx) B) Passive extend 1 knee (cont. if no sx) C) Passive DF ankle of same LE THEN: repeat with other LE 4. (+) reproduction of pathological neurological sx
185
Lasegue's Test (SLR) 1. What does it indicate? 2. Patient position? 3. Action? 4. (+)
1. Identifies dysfunction of neurological structures that supply the LE 2. pt supine with legs resting on table 3. Passive flex hip of one LE with knee extended UNTIL patient complains of shooting pain into LE Then slowly lower the LE until pain goes away Then passive DF 4. (+) reproduction of neurological sx when foot is DF
186
Femoral Nerve Traction Test 1. What does it indicate? 2. Patient position? 3. Action? 4. (+)
1. identifies compression of femoral nerve anywhere along is course 2. Pt sidelie neutral on good side with head/neck slight flexion, hip and knee flexed 3. Passive extend hip with knee extended, if no sx passive flex knee 4. (+) neurological pain in anterior thigh
187
Valsalva Maneuver 1. What does it indicate? 2. Patient position? 3. Action? 4. (+)
1. identify a space occupying lesion 2. pt seated 3. pt instructed to take a deep breath and hold while they bear down as if having a bowel movement 4. (+) increased LBP or neurological symptoms into LE
188
Babinski Test 1. What does it indicate? 2. Patient position? 3. Action? 4. (+)
1. identify UMN lesion 2. pt seated/supine 3. glide bottom of reflex hammer along plantar foot 4. (+) extension of big toe and splaying (abduction) of other toes
189
Quadrant Test (LUMBAR) 1. What does it indicate? 2. Patient position? 3. Action? 4. (+)
1. identify compression of NEURAL STRUCTURES at the intervertebral foramen and FACET DYSFUNCTION 2. pt standing 3. INTERVERTEBRAL FORAMEN: maximally close IV foramen on LEFT by patient SB left, rotate left and extend/ then repeat for right. FACET DYSFUNCTION: to maximally compress facet joint on LEFT patient SB left, rotate right and extend. 4. (+) pain and/or paresthesia in the dermatomal pattern for the involved nerve root or localized pain if facet dysfunction
190
Stork Standing Test 1. What does it indicate? 2. Patient position? 3. Action? 4. (+)
1. Identifies spondylolisthesis 2. pt stand on one leg 3. Pt extends trunk * *repeat with opposite SLS 4. (+) pain in low back with ipsilateral leg on ground
191
McKenzie's Side Glide Test 1. What does it indicate? 2. Patient position? 3. Action? 4. (+)
* *performed when lateral shift of trunk is noted 1. differentiates between SCOLIOTIC curvature vs NEUROLOGICAL DYSFUNCTION causing abnormal curvature (lateral shift of trunk) 2. pt standing 3. Stabilize upper trunk into proper alignment: PT stands on side of patient so that the upper trunk is shifted towards PT PTs shoulders placed into pt upper trunk and arms wrapped around pt pelvis to push trunk into alignment 4. (+) reproduction of neurological sx as alignment of trunk is corrected
192
Bicycle (van Gelderen's Test) 1. What does it indicate? 2. Patient position? 3. Action? 4. (+)
1. differentiate between intermittent claudication and spinal stenosis 2. pt seated on stationary bicycle 3. pt rides bike while sitting erect. Time how long patient can ride bike at set pace/speed. After a sufficient rest period have the patient ride bike at the same speed in a slumped position. 4. (+) if pain is related to spinal stenosis patient should be able to ride bike longer when SLUMPED
193
van Gelderen's Test 1. What does it indicate? 2. Patient position? 3. Action? 4. (+)
Bicycle (van Gelderen's Test) 1. differentiate between intermittent claudication and spinal stenosis 2. pt seated on stationary bicycle 3. pt rides bike while sitting erect. Time how long patient can ride bike at set pace/speed. After a sufficient rest period have the patient ride bike at the same speed in a slumped position. 4. (+) if pain is related to spinal stenosis patient should be able to ride bike longer when SLUMPED
194
Gillet's Test 1. What does it indicate? 2. Patient position? 3. Action? 4. (+)
1. asses posterior movement of the ILIUM relative to the sacrum 2. pt standing. PT places one thumb under PSIS and other thumb on center of sacrum 3. patient flexes hip and knee of LE tested, Assess movement of PSIS via comparison of both thumbs with eyes level to thumbs (PSIS should move in an inferior direction) 4. (+) PSIS does not move compared to sacrum
195
Ipsilateral Anterior Rotation Test 1. What it is for? 2. Patient Position? 3. Action 4. (+)
1. Asses anterior movement of ILIUM relative to sacrum 2. PT place 1 thumb under PSIS of tested side and other thumb on center of sacrum. 3. Patient extends hip of LE being tested. PT assess movement of PSIS by thumbs at eye level. PSIS should move SUPERIORLY. 4. (+) no identified movement of PSIS compared to sacrum
196
Gaenslen's Test 1. What it is for? 2. Patient Position? 3. Action 4. (+)
1. Identify SI Joint dysfunction 2. Pt sidelie at edge of table while holding bottom leg in maximal hip and knee flexion (knee to chest) PT stands behind pt and passively extends the hip of the upper LE to place stress on the SI joint of the upper LE 4. (+) pain in SI joint
197
Goldthwait's Test 1. What it is for? 2. Patient Position? 3. Action 4. (+)
1. differentiate dysfunction in LUMBAR spine vs SI JOINT 2. Pt supine 3. PT fingers between SP of lumbar spine, other hand used for a passive SLR 4. (+) SI joint dysfunction if pain prior to palpation of movement in lumbar segments
198
TMJ Compression 1. What it is for? 2. Pt position? 3. Action? 4. (+)
1. Evaluate pain with compression of the retrodiscal tissues 2. Pt seated/supine 3. Support/stabilize pt head with 1 hand, other hand to push mandible superior and compress TMJ 4. (+) pain in TMJ
199
1. Identifies dysfunction of NEUROLOGICAL STRUCTURES supplying the LEs 2. Patient sitting on edge of table with knees flexed 3. Patient slump sits while maintain neutral head and neck A) Passive flex pt head and neck (cont. if no sx) B) Passive extend 1 knee (cont. if no sx) C) Passive DF ankle of same LE THEN: repeat with other LE 4. (+) reproduction of pathological neurological sx
Slump Test
200
1. Identifies dysfunction of neurological structures that supply the LE 2. pt supine with legs resting on table 3. Passive flex hip of one LE with knee extended UNTIL patient complains of shooting pain into LE Then slowly lower the LE until pain goes away Then passive DF 4. (+) reproduction of neurological sx when foot is DF
Lasegue's Test
201
1. identifies compression of femoral nerve anywhere along is course 2. Pt sidelie neutral on good side with head/neck slight flexion, hip and knee flexed 3. Passive extend hip with knee extended, if no sx passive flex knee 4. (+) neurological pain in anterior thigh
Femoral Nerve Traction Test
202
1. identify a space occupying lesion 2. pt seated 3. pt instructed to take a deep breath and hold while they bear down as if having a bowel movement 4. (+) increased LBP or neurological symptoms into LE
Valsalva Maneuver
203
1. identify UMN lesion 2. pt seated/supine 3. glide bottom of reflex hammer along plantar foot 4. (+) extension of big toe and splaying (abduction) of other toes
Babinski Test
204
1. identify compression of NEURAL STRUCTURES at the intervertebral foramen and FACET DYSFUNCTION 2. pt standing 3. INTERVERTEBRAL FORAMEN: maximally close IV foramen on LEFT by patient SB left, rotate left and extend/ then repeat for right. FACET DYSFUNCTION: to maximally compress facet joint on LEFT patient SB left, rotate right and extend. 4. (+) pain and/or paresthesia in the dermatomal pattern for the involved nerve root or localized pain if facet dysfunction
Quadrant Test (LUMBAR)
205
1. Identifies spondylolisthesis 2. pt stand on one leg 3. Pt extends trunk * *repeat with opposite SLS 4. (+) pain in low back with ipsilateral leg on ground
Stork Standing Test
206
* *performed when lateral shift of trunk is noted 1. differentiates between SCOLIOTIC curvature vs NEUROLOGICAL DYSFUNCTION causing abnormal curvature (lateral shift of trunk) 2. pt standing 3. Stabilize upper trunk into proper alignment: PT stands on side of patient so that the upper trunk is shifted towards PT PTs shoulders placed into pt upper trunk and arms wrapped around pt pelvis to push trunk into alignment 4. (+) reproduction of neurological sx as alignment of trunk is corrected
McKenzie's Side Glide Test
207
1. differentiate between intermittent claudication and spinal stenosis 2. pt seated on stationary bicycle 3. pt rides bike while sitting erect. Time how long patient can ride bike at set pace/speed. After a sufficient rest period have the patient ride bike at the same speed in a slumped position. 4. (+) if pain is related to spinal stenosis patient should be able to ride bike longer when SLUMPED
Bicycle (van Gelderen's Test)
208
1. asses posterior movement of the ILIUM relative to the sacrum 2. pt standing. PT places one thumb under PSIS and other thumb on center of sacrum 3. patient flexes hip and knee of LE tested, Assess movement of PSIS via comparison of both thumbs with eyes level to thumbs (PSIS should move in an inferior direction) 4. (+) PSIS does not move compared to sacrum
Gillet's Test
209
1. Asses anterior movement of ILIUM relative to sacrum 2. PT place 1 thumb under PSIS of tested side and other thumb on center of sacrum. 3. Patient extends hip of LE being tested. PT assess movement of PSIS by thumbs at eye level. PSIS should move SUPERIORLY. 4. (+) no identified movement of PSIS compared to sacrum
Ipsilateral Anterior Rotation Test
210
1. Identify SI Joint dysfunction 2. Pt sidelie at edge of table while holding bottom leg in maximal hip and knee flexion (knee to chest) PT stands behind pt and passively extends the hip of the upper LE to place stress on the SI joint of the upper LE 4. (+) pain in SI joint
Gaenslen's Test
211
1. differentiate dysfunction in LUMBAR spine vs SI JOINT 2. Pt supine 3. PT fingers between SP of lumbar spine, other hand used for a passive SLR 4. (+) SI joint dysfunction if pain prior to palpation of movement in lumbar segments
Goldthwait's Test
212
1. Evaluate pain with compression of the retrodiscal tissues 2. Pt seated/supine 3. Support/stabilize pt head with 1 hand, other hand to push mandible superior and compress TMJ 4. (+) pain in TMJ
TMJ Compression

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