Neurodynamic Tests Flashcards
Lhermitte Sign
Process :
- Client long seated, examiner passively flexes client’s head & one hip simultaneously
Positive Sign :
- Sharp, electric shock like pain down spine & into upper or lower limbs
+ve Indicates :
- Dural or meningeal irritation, upper motor neuron lesion, cervical myelopathy
Slump Test
Process :
- Client seated at the edge of the table, hands behind back; is then asked to “slump” & keep head neutral.
- Examiner :
*pushes down on shoulders; head neutral, then flexed
*applies overpressure to flexes cervical spine
*passible extends one knee, keeping spine flexed
*Adds passive ankle dorsiflexion; ask client to maintain knee extension
Positive Sign :
- Knee extends further or symptoms decrease with neck extension, or positioning of client increases symptoms
+ve Indicates :
- Increased tension in the neuromeningeal tract
Upper Limb Neurodynamic (Tension) Test 1
M2RU
Process : Client supine
Shoulder : Depress & abduct 110 degrees
Elbow & Forearm : Extension & supination
Wrist : Extension
Digits : Extension
Cervical Spine : Contralateral lateral flexion
Nerve(s) : Median, Anterior Interosseous
Upper Limb Neurodynamic (Tension) Test 2
M2RU
Process : Client supine
Shoulder : Depress & abduct 10 degrees
Elbow & Forearm : Extension & supination
Wrist : Extension
Digits : Extension
Cervical Spine : Contralateral lateral flexion
Nerve(s) : Median, Musculotaneous, Axillary
Upper Limb Neurodynamic (Tension) Test 3
M2RU
Shoulder : Depress, medially rotate, abduct 40 degrees & extend 25 degrees
Elbow & Forearm : Extension & pronation
Wrist : Flexion & radial deviation
Digits : Flexion
Cervical Spine : Contralateral lateral flexion
Nerve(s) : Radial
Upper Limb Neurodynamic (Tension) Test 4
M2RU
Shoulder : Depress & abduct (10-90 degrees)
Elbow & Forearm : Flexion
Wrist : Extension & ulnar deviation
Digits : Extension
Cervical Spine : Contralateral lateral flexion
Nerve(s) : Ulnar
Straight Leg Raising Test
Process :
- Client supine, examiner flexes & adducts hip, extends knee & dorsiflexes ankle
Positive Sign :
- Pain or tightness in back or back of leg, paresthesia between 35-70 degrees hip flexion
+ve Indicates :
- Disc lesion, pressure on nerve roots
SLR Additions : Once symptoms are elicited back off of SLR by carefully decreasing hip flexion until symptoms dissipate THEN?
- Brudzinski’s Sign : client actively flexes neck until chin touches chest
- Bragard’s Sign : Examiner dorsiflexes client’s ankle
+ve = symptoms elicited during SLR return
“Bowstring” Test (Cram test or Popliteal Pressure Sign)
Process :
- Examiner performs SLR & once symptoms are elicited backs off of SLR by flexing knee slightly (20 degrees) reducing symptoms, then thumb or finger pressure is applied to popliteal area
Positive Sign :
- Returns of symptoms, pain or tightness in back or back of leg, paresthesia
+ve Indicates :
- Pressure on sciatic nerve
ROOS Test (Elevated Arm Stress Test [EAST])
Process :
- Client stands & abducts shoulders to 90 degrees, laterally rotates shoulders & flexes elbows to 90 degrees (slightly behind frontal plane); opens & closes hands for 3 minutes
Positive Sign :
- Client unable to hold position, suffers ischemic pain, heaviness or profound weakness of the arm, or numbness & tingling of the hand
+ve Indicates : Thoracic outlet syndrome
Adson Maneuver
Process :
- Examiner palpates radial pulse, client extends & rotates head + neck towards test side,
- Examiner laterally rotates & extends client’s shoulder, client takes a deep breath & holds it (hold position for 1-2 min_
Positive Sign : reproduction of symptoms & disappearance of radial pulse
+ve Indicates : Thoracic outlet syndrome
Wright Test or Maneuver
Process :
- Examiner palpates radial pulse & hyperabducts & externally rotates the client’s arm in the coronal plane, hold position for 1-2 min
Positive Sign :
- Reproduction of symptoms & disappearance of radial pulse
+ve Indicates :
- Thoracic outlet syndrome
Costoclavicular Syndrome (Military Brace) Test
Process :
- Examiner palpates radial pulse & then draws client’s shoulder down & back
Positive Sign :
- Reproduction of symptoms & disappearance of radial pulse
+ve Indicates :
- Thoracic outlet syndrome
Valsalva Test
Process :
- Client takes a deep breath & holds it while bearing down
Positive Sign :
- Increased pain & radicular symptoms
+ve Indicates :
- Increased pressure on spinal cored due to space occupying lesion
Tinnel Sign
Process : Examiner taps along nerve
Positive Sign : Tingling in distribution of nerve
+ve Indicates : Nerve lesion
Distraction Test
Process : Client seated or supine, examiner slowly lifts/tractions head
Positive Sign : Relief from pain & radicular symptoms
+ve Indicates : nerve root compression
Foraminal Compression (Spurling) Test
Process :
- Client seated & laterally flexes head to side being tested, examiner carefully presses straight down on head
Positive Sign :
- Pain & neurological symptoms radiate into side being test
+ve Indicates :
- Nerve root compression
Jackson Compression Test
Process :
- Client seated & rotates head to one side, examiner carefully presses straight down on head
Positive Sign :
- Pain & neurological symptoms radiate into side being tested
+ve Indicates : Nerve root compression
Serratus Anterior Weakness (Punch Out Test)
Process :
- Client standing, flexes shoulder to 90 degrees, examiner applies backward force to the arm
Positive Sign :
- Medial border of the scapula wings
+ve Indicates :
- Weak or paralyzed serratus anterior
Elbow Flexion Test (Wadsworth Elbow Flexion Test)
Process :
- Client fully flexes elbows, extends wrists, depresses and adducts shoulder girdles
Positive Sign :
- Tingling/parasthesia in medial forearm & 1.5 digits of the hand (ulnar nerve distribution0
+ve Indicates :
- Cubital tunnel syndrome
Wartenberg’s Sign
Process :
- Client sits with hands resting on table, examiner passively spreads fingers apart & asks client to bring them together again
Positive Sign :
- Inability to squeeze the 5th digit to the rest of the hand
+ve Indicates :
- Ulnar neuropathy or cervical myelopathy
Phalen’s (Wrist Flexion) Test
Process :
- Examiner maximally flexes client’s wrist & pushes them together, hold position for 1 minute
Positive Sign :
- Tingling/Parasthesia in median nerve distribution
+ve Indicates :
- Carpal tunnel syndrome
Reverse Phalen’s (Prayer) Test
Process :
- Examiner maximally extends client’s wrist & pushes them together
Positive Sign :
- Tingling/parashesia in median nerve distribution
+ve Indicates : Carpal tunnel syndrome
Pronator Teres Test
Process :
- Client sits with elbow flexed to 90 degrees, examiner strongly resist pronation & passively extends elbow while palpating medial epicondyle
Positive Sign :
- Tingling/parashesia in lateral 3.5 digits
+ve Indicates :
Pronator teres syndrome
Pinch Grip Test
Process :
- Client is asked to pinch tips of index finger & thumb together
Positive Sign :
- Pulp to pulp pinch/inability pinch tip to tip
+ve Indicates :
- Anterior interosseous nerve syndrome
Piriformis (Flexion, Adduction & Internal [Medial] Rotation; [FAIR]; Fishman) Test
Process :
- Client side lying with top hip flexed to 60 degrees with knee flexed
Positive Sign :
- Pain in piriformis and/or radicular symptoms
+ve Indicates : Piriformis hypertonicity and/or sciatic nerve compression
Morton’s (Squeeze) Test
Process :
- Client supine, examiner uses thumb and index finger to squeeze dorsal and plantar aspect of each intermetatarsal space, then grasps foot around metatarsal heads & squeezes
Positive Sign :
- Pain tingling/paresthesia
+ve Indicates :
- Fracture, neuroma
