NMS practical 1- Orthopedic tests Flashcards
What are the 3 categories of ROM you can assess?
Active, passive, Resisted
Normal Cervical flexion and extension?
Chin to chest (within 2 finger widths) or 50-60 degrees; 60-75 degrees of extension (able to look at ceiling)
Cervical lateral flexion?
45 degrees (halfway to shoulder)
Cervical rotation ROM?
80 degrees, chin to mid clavicular line
Cervical Flexion assessment guidelines?
Patient seated- sit tall, legs together, feet flat on floor
One inclinometer on SP of T1
One inclinometer on superior occiput
Adjust to zeros
Instruct patient to move chin to chest
Document difference between inclinometers
Cervical Extension assessment guidelines?
Patient seated- sit tall, legs together, feet flat on floor
One inclinometer on the spine of scapula
One inclinometer on superior occiput
Adjust to zeros
Instruct patient to lift chin to ceiling keeping trunk straight
Document difference between inclinometers
How would you assess for cervical rotation?
- Patient supine, make sure headrest is in neutral
- Place one inclinometer in the middle of the patient’s forehead
- Adjust inclinometer to read zero degrees
- Instruct the patient to turn their head slowly as far a possible
- Record and document the degrees at the end range position
How would you assess Thoracic spine ROM using 2 inclinometers?
Patient standing, ask them to stand tall, feet together
One inclinometer at C&-T1, 2nd at T12-L1
Ask the patient to move through chosen ROM
Flexion- 20-45
Extension- 25-35
Lat Flexion- 20-40
Rotation- 35-50
How would you assess thoracic flexion?
- Patient standing, ask them to stand tall and feet together
- Place one inclinometer over the spinous process of T1
- Adjust inclinometer to read zero degrees
- Place a second inclinometer over the spinous process of L1
- Adjust inclinometer to read zero degrees
- Instruct the patient to bow forward keeping their low back straight
- Record the degrees of both inclinometers at end range
- Document the difference between the two inclinometers
How would you assess thoracic extension?
- Patient standing, stand tall, feet together
- Place one inclinometer over the spinous process of T1
- Place a second inclinometer over the spinous process of L1
- Adjust inclinometers to read 0
- Instruct the patient to bend backwards keeping their low back straight
- Record the degrees of both inclinometers at end range
- Document difference between the two inclinometers
How do you assess Thoracic lateral flexion?
- Patient standing, stand tall, feet together
- Place one inclinometer over the spinous process of T1
- Place a second inclinometer over the spinous process of L1
- Adjust inclinometers to read 0
- Instruct the patient to bend to one side as far as possible
- Record the degrees of both inclinometers at end range
- Document difference between the two inclinometers
Explain how to assess thoracic rotation
- Patient is in a low quadruped position resting their hips on their heels and upper body on their forearms. Get them as closed packed as possible
- Place one inclinometer over the spinous process of T1
- Place a second inclinometer over the spinous process of L1
- Adjust the inclinometers to read zero degrees
- Instruct the patient to bend to one side as far as possible
- Record the degrees of both inclinometers at end range
- Document difference between the two inclinometers
How do you assess Lumbar flexion?
- Patient standing, instruct them to stand tall, feet together
- Place one inclinometer over the spinous process of L1
- Place a second inclinometer over the spinous process of S2
- Adjust inclinometers to read zero degrees
- Instruct the patient to bow forward keeping their legs straight
- Record the degrees of both inclinometers at end range
- Document the difference between the two inclinometers
How do you assess Lumbar extension?
- Patient standing, instruct them to stand tall, feet together
- Place one inclinometer over the spinous process of L1
- Place a second inclinometer over the spinous process of S2
- Adjust inclinometers to read zero degrees
- Instruct the patient to bend backwards
- Record the degrees of both inclinometers at end range
- Document the difference between the two inclinometers
How do you assess lumbar lateral flexion
- Patient standing, instruct to stand tall, feet together
- Place one inclinometer over the spinous process of L1
- Place a second inclinometer over the spinous process of S2
- Adjust inclinometers to read zero degrees
- Instruct the patient to bend to one side as far as possible
- Record the degrees of both inclinometers at end range
- Document difference between the two inclinometers
Name that test-
Procedure:
* Practitioner passively rotates the patient’s head as far as possible to patient’s comfort
* Instruct patient to bring their chin to their chest
* 20 degrees of occipital flexion is considered normal
Interpretation:
* If the patient can successfully nod their head 20 degrees, the lower cervical spine is most likely responsible for the restriction
* If the patient cannot nod their head 20 degrees, the upper cervical spine is most likely responsible for the restriction
This test is used when a cervical flexion restriction is identified and helps to differentiate between upper and lower cervical dysfunction.
Active Supine Occipito-Atlantal Cervical Flexion test
Active Supine Occipito-Atlantal Cervical Flexion test- how is it performed?
Procedure:
* Practitioner passively rotates the patient’s head as far as possible to patient’s comfort
* Instruct patient to bring their chin to their chest
* 20 degrees of occipital flexion is considered normal
Interpretation:
* If the patient can successfully nod their head 20 degrees, the lower cervical spine is most likely responsible for the restriction
* If the patient cannot nod their head 20 degrees, the upper cervical spine is most likely responsible for the restriction
This test is used when a cervical flexion restriction is identified and helps to differentiate between upper and lower cervical dysfunction.
Cervical Flexion Rotation Test- how is it performed?
Procedure:
* Practitioner passively flexes the cervical spine maximally and supports the patient’s head in this position
* Instruct the patient to rotate head to one side
* Rotation should be 45 degrees
* Repeat test on other side Interpretation:
* Pain during the first 45 degrees is indicative of upper cervical involvement
* If the patient can successfully rotate their head 45 degrees, the lower cervical spine is
most likely responsible for the restriction
* If the patient cannot rotate their head 45 degrees, the upper cervical spine is most likely responsible for the restriction
Name this test-
Procedure:
* Practitioner passively flexes the cervical spine maximally and supports the patient’s head in this position
* Instruct the patient to rotate head to one side
* Rotation should be 45 degrees
* Repeat test on other side Interpretation:
* Pain during the first 45 degrees is indicative of upper cervical involvement
* If the patient can successfully rotate their head 45 degrees, the lower cervical spine is
most likely responsible for the restriction
* If the patient cannot rotate their head 45 degrees, the upper cervical spine is most likely responsible for the restriction
CERVICAL FLEXION ROTATION TEST
What are the two common testing protocols?
1.Test the unaffected side first to establish a comparison of results
- Any response of pain should be followed by a line of questioning.
* Where is the pain?
* What kind of pain?
* Rate (quantify) the pain?
* Does the pain radiate?
When pain is a finding, what is your follow up?
What
Where
Rate
Radiate
Name this test-
Procedure:
* Patient is sitting
* Patient performs active range of motion. Examiner makes note of any painful motions
* Examiner then moves the patient’s head passively through each range of motion
* Examiner make note of any painful motions
* The patient maintains head in a neutral position while examiner applies overpressure in all three planes of motion forcing isometric contractions
Interpretation of Findings:
* Pain during active or resisted range of motion signifies muscle strain
* Pain during passive range of motion signifies ligamentous sprain
O’Donoghue Maneuver
How do you perform O’Donoghue Maneuver?
Procedure:
* Patient is sitting
* Patient performs cervical active range of motion. Examiner makes note of any painful motions
* Examiner then moves the patient’s head passively through each range of motion
* Examiner make note of any painful motions
* The patient maintains head in a neutral position while examiner applies overpressure in all three planes of motion forcing isometric contractions
Interpretation of Findings:
* Pain during active or resisted range of motion signifies muscle strain
* Pain during passive range of motion signifies ligamentous sprain
What test is this?
Procedure:
* Patient is seated
* Patient is looking forward
* The clinician applies axial compression downward on the head with the head in neutral.
Interpretation of Findings:
* A positive test is radiating pain into the arm(s) or local pain in the spine
* Test is indicative of nerve root compression due to foraminal stenosis, osteophytes; a space occupying lesion (i.e. herniated disc, fracture, tumor), or facet encroachment.
Cervical/Axial Compression Test
How does one perform the Cervical/Axial Compression Test?
Procedure:
* Patient is seated
* Patient is looking forward
* The clinician applies axial compression downward on the head with the head in neutral.
Interpretation of Findings:
* A positive test is radiating pain into the arm(s) or local pain in the spine
* Test is indicative of nerve root compression due to foraminal stenosis, osteophytes; a space occupying lesion (i.e. herniated disc, fracture, tumor), or facet encroachment.
What is the Jackson Cervical Compression Test?
Procedure:
* Patient is seated
* Patient is looking forward
* The clinician laterally flexes the patient’s head towards the side of testing
* The clinician applies axial compression to the head
* The test is then repeated with the head laterally flexed toward the involved side
Interpretation of Findings:
* A positive test is radiating pain into the arm which the head is laterally flexed towards
* Test is indicative of nerve root compression due to foraminal stenosis, osteophytes, space occupying lesion, herniated disc, fracture
* Local neck pain on the side the head is flexed towards is indicative of facet joint encroachment.
What test is this?
Procedure:
* Patient is seated
* Patient is looking forward
* The clinician laterally flexes the patient’s head towards the side of testing
* The clinician applies axial compression to the head
* The test is then repeated with the head laterally flexed toward the involved side
Interpretation of Findings:
* A positive test is radiating pain into the arm which the head is laterally flexed towards
* Test is indicative of nerve root compression due to foraminal stenosis, osteophytes, space occupying lesion, herniated disc, fracture
* Local neck pain on the side the head is flexed towards is indicative of facet joint encroachment.
Jackson Cervical Compression Test
Name this test-
Procedure:
* Patient is seated
* Patient is instructed to extend their head
* Laterally flex toward the affected side
* Compress axially (S-I)
* Repeat the procedure to the side of complaint
Interpretation of Findings:
* The patient notes any pain or paresthesia and the distribution thereof.
* This maneuver closes the intervertebral foramina on the side of the lateral flexion and reproduces the patient’s pain or radiculopathy indicating nerve root compression
Modified Spurling’s
how do you perform Modified spurling’s? what does it indicate?
Procedure:
* Patient is seated
* Patient is instructed to extend their head
* Laterally flex toward the affected side
* Compress axially (S-I)
* Repeat the procedure to the side of complaint
Interpretation of Findings:
* The patient notes any pain or paresthesia and the distribution thereof.
* This maneuver closes the intervertebral foramina on the side of the lateral flexion and reproduces the patient’s pain or radiculopathy indicating nerve root compression
How is the Maximum Cervical Compression Test performed?
Procedure:
* Patient is seated
* Patient is instructed extend, laterally flex, and
rotate towards the side of testing
* The test is performed bilaterally
Interpretation of Findings:
* Pain on the concave side indicates nerve root (radiating symptoms) or facet involvement (local pain).
* Pain on the convex (muscle stretch) side indicates muscular strain
What test is this?
Procedure:
* Patient is seated
* Patient is instructed extend, laterally flex, and
rotate towards the side of testing
* The test is performed bilaterally
Interpretation of Findings:
* Pain on the concave side indicates nerve root (radiating symptoms) or facet involvement (local pain).
* Pain on the convex (muscle stretch) side indicates muscular strain
Maximum Cervical Compression Test
What test is this?
Patient is laying supine and is passive through this test.
Procedure-
1. examiner depresses the patient’s scapula/shoulder. Pins in place with medial hand
Using their lateral hand the examiner grips the patient’s palm/fingers.
2. Shoulder abduction
3. Forearm supination, wrist and finger extension
4. Shoulder ER
5. Elbow Extension
6. Contralateral side bend
7. Ipsilateral side bend
Interpretation of findings-
Positive test is a reproduction of the patient’s symptoms. Indicates median nerve entrapment (C5-C7)
Upper Limb Tension Test (ULTT)
How do you perform the Upper Limb Tension Test (ULTT)? What does it indicate?
Patient is laying supine and is passive through this test.
Procedure-
1. examiner depresses the patient’s scapula/shoulder. Pins in place with medial hand
Using their lateral hand the examiner grips the patient’s palm/fingers.
2. Shoulder abduction
3. Forearm supination, wrist and finger extension
4. Shoulder ER
5. Elbow Extension
6. Contralateral side bend
7. Ipsilateral side bend
Interpretation of findings-
Positive test is a reproduction of the patient’s symptoms. Indicates median nerve entrapment (C5-C7)
What test is this?
Procedure:
* Patient is seated
* Examiner stands behind patient
* Examiner grasps beneath the mastoid processes and lifts vertically.
Interpretation of Findings:
* This pressure removes the weight of the patient’s head from the neck.
* Generalized, increased pain indicates muscle spasm or sprain/strain.
* Relief of pain indicates intervertebral foraminal encroachment or facet capsulitis. Secondary indications are nerve root compression or pressure on apophyseal joints.
Cervical Distraction Test
How do you perform the Cervical Distraction Test? What does it indicate?
Procedure:
* Patient is seated
* Examiner stands behind patient
* Examiner grasps beneath the mastoid processes and lifts vertically.
Interpretation of Findings:
* This pressure removes the weight of the patient’s head from the neck.
* Generalized, increased pain indicates muscle spasm or sprain/strain.
* Relief of pain indicates intervertebral foraminal encroachment or facet capsulitis. Secondary indications are nerve root compression or pressure on apophyseal joints.
What test is this?
Procedure:
* Patient is seated
* The patient rotates the head to the uninvolved side.
* The examiner then carefully presses straight down on the head
* The test is repeated with the head rotated to the involved side.
Interpretation of Findings:
* The test is positive if pain radiates into the arm
* A positive test indicates nerve root compression.
Foraminal Compression test
How do you perform the Foraminal Compression test? what does it indicate?
Procedure:
* Patient is seated
* The patient rotates the head to the uninvolved side.
* The examiner then carefully presses straight down on the head
* The test is repeated with the head rotated to the involved side.
Interpretation of Findings:
* The test is positive if pain radiates into the arm
* A positive test indicates nerve root compression.
How do you perform the shoulder abduction relief test? What is another name for it?
Procedure:
* While in the seated position, the patient actively places the palm of the affected extremity on top of the head, raising the elbow to a height approximately level with the head
Interpretation of Findings:
* By elevating the suprascapular nerve, traction of the upper trunk of the brachial plexus is relieved
* Overall, this maneuver decreases stretching of the compressed nerve root.
* The sign is present when the radiating pain is lessened or disappears with this maneuver.
* The test is as reliable as Spurling test and is less painful for the patient to endure.
* A cervical nerve root compression is suggested by a positive Bakody sign
What test is this?
Procedure:
* While in the seated position, the patient actively places the palm of the affected extremity on top of the head, raising the elbow to a height approximately level with the head
Interpretation of Findings:
* By elevating the suprascapular nerve, traction of the upper trunk of the brachial plexus is relieved
* Overall, this maneuver decreases stretching of the compressed nerve root.
* The sign is present when the radiating pain is lessened or disappears with this maneuver.
* The test is as reliable as Spurling test and is less painful for the patient to endure.
* A cervical nerve root compression is suggested by a positive sign
shoulder abduction relief test aka Bakody’s sign
What test is described below?
Procedure:
* With the patient seated, the examiner laterally flexes the cervical spine away from that shoulder then depresses the patient’s shoulder on the affected side
Interpretation of Findings:
* This sign is positive if radicular pain is produced or aggravated. This indicates adhesions of the dural sleeves, spinal nerve roots, or adjacent structures of the joint capsule of the shoulder.
Shoulder Depression Test
How do you perform the shoulder depression test? It indicates what?
Procedure:
* With the patient seated, the examiner laterally flexes the cervical spine away from that shoulder then depresses the patient’s shoulder on the affected side
Interpretation of Findings:
* This sign is positive if radicular pain is produced or aggravated. This indicates adhesions of the dural sleeves, spinal nerve roots, or adjacent structures of the joint capsule of the shoulder.
What test is this?
Procedure:
* With the patient seated and the head slightly flexed, the examiner percusses the spinous processes and associated musculature of each of the cervical vertebra with a neurologic reflex hammer
Interpretation of Findings:
* Evidence of localized pain indicates a possible fractured vertebra.
* Evidence of radicular pain indicates a possible disc lesion.
* Because of the nonspecific nature of this test other conditions will also elicit a positive pain response.
* A ligamentous sprain will cause pain when the spinous processes are percussed.
Spinal Percussion Test
How do you perform the Spinal Percussion Test? What does this indicate?
Procedure:
* With the patient seated and the head slightly flexed, the examiner percusses the spinous processes and associated musculature of each of the cervical vertebra with a neurologic reflex hammer
Interpretation of Findings:
* Evidence of localized pain indicates a possible fractured vertebra.
* Evidence of radicular pain indicates a possible disc lesion.
* Because of the nonspecific nature of this test other conditions will also elicit a positive pain response.
* A ligamentous sprain will cause pain when the spinous processes are percussed.
What is Rust Sign?
If the patient spontaneously grasps the head with both hands when lying down or when arising from a recumbent position, this is a positive sign that indicates instability due to possible sprain, rheumatoid arthritis, fracture, or severe cervical subluxation
How do you perform a Valsalva Maneuver? What does a positive sign indicate?
Procedure:
* The patient inhales deeply and holds their breath, while bearing down abdominally
Interpretation of Findings:
* A positive test is indicated by increased pain caused by increased intrathecal pressure.
* Increased intrathecal pressure is usually caused by a space- occupying lesion (herniated disc, tumor, osteophytes).
* The test should be performed with care and caution. Procedure can block the blood supply to the brain.
What test is this?
Procedure:
* The patient inhales deeply and holds their breath, while bearing down abdominally
Interpretation of Findings:
* A positive test is indicated by increased pain caused by increased intrathecal pressure.
* Increased intrathecal pressure is usually caused by a space- occupying lesion (herniated disc, tumor, osteophytes).
* The test should be performed with care and caution. Procedure can block the blood supply to the brain.
Valsalva maneuver
What is Dejerine sign?
Procedure:
* Coughing, sneezing, and straining during defecation may aggravate radiculitis symptoms
Interpretation of Findings:
* This aggravation results from the mechanical obstruction of spinal fluid flow.
* Is present when one of the following space occupying lesions exists: herniated or protruding intervertebral disc, spinal cord tumor, or spinal compression fracture.
* The course of the radiculitis helps identify the location of the lesion
What test is this?
Procedure:
* Coughing, sneezing, and straining during defecation may aggravate radiculitis symptoms
Interpretation of Findings:
* This aggravation results from the mechanical obstruction of spinal fluid flow.
* Dejerine sign is present when one of the following space occupying lesions exists: herniated or protruding intervertebral disc, spinal cord tumor, or spinal compression fracture.
* The course of the radiculitis helps identify the location of the lesion
Dejerine sign
Lhermitte Sign is what?
Procedure:
* The patient is seated on the examining table
* The patient’s head is passively flexed
Interpretation of Findings:
* Electric shock sensation down the neck indicates multiple sclerosis
* A sharp pain radiating down the spine and into the upper or lower limbs is a positive finding for cord pathology
* Dural irritation, tumor, or dens fracture all possible implications.
Name this test-
Procedure:
* The patient is seated on the examining table
* The patient’s head is passively flexed
Interpretation of Findings:
* Electric shock sensation down the neck indicates multiple sclerosis
* A sharp pain radiating down the spine and into the upper or lower limbs is a positive finding for cord pathology
* Dural irritation, tumor, or dens fracture all possible implications.
Lhermitte Sign
What is Brudzinski Sign? What does it indicate?
Procedure:
* The patient is supine
* examiner passively flexes the patient’s head
Interpretation of Findings:
* The sign is present if flexion of both knees occurs
* The sign is often accompanied by flexion of both hips and is present with meningitis.
What test is this describing?
Procedure:
* The patient is supine
* examiner passively flexes the patient’s head
Interpretation of Findings:
* The sign is present if flexion of both knees occurs
* The sign is often accompanied by flexion of both hips and is present with meningitis.
Brudzinski Sign
What is Soto-Hall Sign?
Procedure:
* The patient is placed supine
* The examiner places one hand on the sternum of the patient and exerts slight pressure so that no flexion can take place at either the lumbar or thoracic regions of the spine
* The examiner places the other hand under the patient’s occiput and flexes the head toward the chest
Interpretation of Findings:
* The test is used primarily when fracture of a vertebra is suspected.
* A positive result (noticeable local pain)indicates subluxation, exostoses, disc lesion, sprain or strain, vertebral fracture, or meningeal irritation (an elevated temperature must exist for corroboration).
Name this test-
Procedure:
* The patient lies supine
* Chin is maximally retracted by the patient
* Maintaining chin tucked instruct the patient to lift their head and neck approximately 2 to 5 cm (1 inch) above the examining table.
* The examiner places a hand on the table under the patient’s head (occiput).
* The examiner watches the skin folds resulting from the chin tuck and neck flexion. As soon as the skin folds separate (due to loss of chin tuck) or the patient’s head touches the examiner’s hand, the test is terminated.
Interpretation:
* Establish a strength/endurance baseline. Inability to maintain position for at least 39 seconds for males, 29 seconds for females indicates weak deep neck flexor group.
DEEP NECK FLEXOR ENDURANCE TEST
How do you perform the deep neck flexor endurance test?
Procedure:
* The patient lies supine
* Chin is maximally retracted by the patient
* Maintaining chin tucked instruct the patient to lift their head and neck approximately 2 to 5 cm (1 inch) above the examining table.
* The examiner places a hand on the table under the patient’s head (occiput).
* The examiner watches the skin folds resulting from the chin tuck and neck flexion. As soon as the skin folds separate (due to loss of chin tuck) or the patient’s head touches the examiner’s hand, the test is terminated.
Interpretation:
* Establish a strength/endurance baseline. Inability to maintain position for at least 39 seconds for males, 29 seconds for females indicates weak deep neck flexor group.
What is proper positioning and technique is mmt testing the Deep Neck Flexors?
Patient Position:
* Supine
* Shoulders in 90 degrees of abduction and external rotation and elbows at 90 degrees of flexion
* Patient lifts head with the chin tucked (occipital flexion) towards sternum
Pressure:
* Contact patient’s forehead * Apply A-P pressure
++ Chin needs to stay tucked
How do you perform a MMT for the SCM and Scalenes?
Patient Position:
* Supine
* Shoulders in 90 degrees of abduction and external rotation and elbows at 90 degrees of flexion
* Head turned to side opposite of testing
* Patient lifts head off table keeping shoulders flat
Pressure:
* Contact temporal region
* Apply A-P and L-M pressure
How do you perform a MMT for the Posterolateral Neck Extensors?
Patient Position:
* Prone
* Shoulders in 90 degrees of abduction and external rotation and elbows at 90 degrees of flexion
* Patient looks toward the side of testing
Pressure:
* Contact the posterolateral occiput * Apply L-M and P-A pressure
Muscles tested-
Ipsilateral- splenius capitis and cervicis, semispinalis
capitis and cervicis, cervical spinal erectors
Contralateral- Upper Trapezius
How do you perform an isolated MMT for the upper Trapezius?
Patient Position:
* Seated or prone
* Head turned to side opposite of testing
* Patient elevates same side shoulder, approximating occiput and acromion process
Pressure:
* Contact #1
* posterior occiput
* Apply P-A and L-M pressure
* Contact #2
* Acromion process
* Apply S-I pressure(depressing shoulder)
What test is this describing?
The patient is seated and instructed to make a tight fist to express blood from the palm. The examiner uses finger pressure to occlude the radial and ulnar arteries
* The patient opens and closes the fist to express any remaining blood The examiner releases the arteries one at a time
* The sign is negative if the pale skin of the palm flushes immediately after an artery is released.
* The sign is positive if the skin of the palm remains blanched for more than 5 seconds.
Allen’s Test for patency of radial and ulnar arteries
What are the 4 Thoracic Outlet Syndrome Tests?
Roos Test
Adson’s test
Wright’s Test (hyperabduction test)
Costoclavicular Maneuver
what is the Scalenus Anticus/Adson’s test?
Procedure:
* The examiner locates the radial pulse of the involved extremity
* The patient’s head is extended and rotated to the involved
extremity
* The examiner externally rotates and extends the patient’s shoulder.
* The patient is instructed to inhale deeply and hold their breath
Interpretation of Findings:
* Loss of the pulse and/or reproduction of patient’s arm symptoms is considered a positive test indicative of compression of the neurovascular bundle between the middle and anterior scalenes
what test is described below?
Procedure:
* The examiner locates the radial pulse of the involved extremity
* The patient’s head is extended and rotated to the involved
extremity
* The examiner externally rotates and extends the patient’s shoulder.
* The patient is instructed to inhale deeply and hold their breath
Interpretation of Findings:
* Loss of the pulse and/or reproduction of patient’s arm symptoms is considered a positive test indicative of compression of the neurovascular bundle between the middle and anterior scalenes
Scalenus Anticus/Adson’s test
HYPERABDUCTION MANEUVER (WRIGHT’S TEST). please perform
Procedure:
* The patient is seated, with both arms hanging at the sides.
* The examiner palpates the patient’s radial pulse
* Both arms, one at a time, are passively abducted to 180 degrees
* The examiner notes the angle of abduction at which the radial pulse diminishes or disappears on the affected side
* The examiner compares the results with those on the unaffected side.
Interpretation of Findings:
* A true positive is reproduction of the patient’s arm complaints
* The test is significant for neurovascular compromise of the axillary artery, as seen in hyperabduction TOSs.
* The mechanics of the test stretches on the Pectorilis Minor
* Many patients have cessation of the radial pulse on abduction without hyperabduction syndrome being present. (false positive)
Name this test-
Procedure:
* The patient is seated, with both arms hanging at the sides.
* The examiner palpates the patient’s radial pulse
* Both arms, in turn, are passively abducted to 180 degrees
* The examiner notes the angle of abduction at which the radial pulse diminishes or disappears on the affected side
* The examiner compares the results with those on the unaffected side.
Interpretation of Findings:
* A true positive is reproduction of the patient’s arm complaints (Souza)
* The test is significant for neurovascular compromise of the axillary artery, as seen in hyperabduction TOSs.
* The mechanics of the test stretches on the Pectorilis Minor
* Many patients have cessation of the radial pulse on abduction without hyperabduction syndrome being present. (false positive)
Wright’s Test/Hyperabduction Maneuver
How do you perform the costoclavicular maneuver?
Procedure:
* The radial pulse is palpated while the patient’s shoulders are drawn down and in extension
* The cervical spine is flexed maximally
Interpretation of Findings:
* If the pulse is lost, the test is positive.
* A true positive is reproduction of the patient’s arm complaints
* Compression between the 1st rib and the clavicle is suggested by a positive test
What is the name of this test?
Procedure:
* The radial pulse is palpated while the patient’s shoulders are drawn down and in extension
* The cervical spine is flexed maximally
Interpretation of Findings:
* If the pulse is lost, the test is positive.
* A true positive is reproduction of the patient’s arm complaints
* Compression between the 1st rib and the clavicle is suggested by a positive test
Costoclavicular maneuver
How do you perform the Roos Test (elevated arm Stress test)
Procedure:
* The patient stands and abducts the arms to 90°, laterally rotates the shoulder, and flexes the elbows to 90° so that the elbows are slightly behind the frontal plane.
* The patient then opens and closes the hands slowly for 3 minutes.
Interpretation of Findings:
* If the patient is unable to keep the arms in the starting position for 3 minutes or suffers ischemic pain, heaviness or profound weakness of the arm, or numbness and tingling of the hand during the 3 minutes, the test is considered positive for thoracic outlet syndrome on the affected side.
* Minor fatigue and distress are considered negative tests.
What is the name of this test?
Procedure:
* The patient stands and abducts the arms to 90°, laterally rotates the shoulder, and flexes the elbows to 90° so that the elbows are slightly behind the frontal plane.
* The patient then opens and closes the hands slowly for 3 minutes.
Interpretation of Findings:
* If the patient is unable to keep the arms in the starting position for 3 minutes or suffers ischemic pain, heaviness or profound weakness of the arm, or numbness and tingling of the hand during the 3 minutes, the test is considered positive for thoracic outlet syndrome on the affected side.
* Minor fatigue and distress are considered negative tests.
Roos Test
How do you perform Adam’s Test?
Procedure:
* Assessment for pathologic or Structural Scoliosis
* Forward bending is an attempt to gain a skyline view of different areas of the back
Interpretation of Findings:
* A functional scoliosis will resolve upon forward flexion
*A structural scoliosis will remain.
* Measurement of the degree of trunk inclination may be performed with an inclinometer such as a scoliometer
* A trunk angle greater than 7° is an indication of a structural curve of at least 20°
What is the name of the following test?-
Procedure:
* Assessment for Pathologic or Structural Scoliosis
* Forward bending is an attempt to gain a skyline view of different areas of the back
Interpretation of Findings:
* A functional scoliosis will resolve upon forward flexion whereas…
* …A structural scoliosis will remain.
* Measurement of the degree of trunk inclination may be
performed with an inclinometer such as a scoliometer
* A trunk angle greater than 7° is an indication of a structural curve of at least 20°
Adam’s Test
What is Forrestier’s test?
Procedure:
* The back musculature must be visible (patient gowned).
* Ask the patient to laterally flex both directions.
Interpretation of Findings:
* As the patient bends sideways, the spine should curve sideways in a smooth, even, sequential manner.
* The examiner should look for any tightness or abnormal angulation, which may indicate hypomobility or hypermobility at a specific segment.
* If the ipsilateral paraspinal muscles tighten or their contracture is evident, ankylosing spondylitis or pathology causing muscle spasm should be considered.
What is Schepelmann sign?
Procedure:
* The patient raises the arms while standing
* Ask the patient to bend to each side (laterally).
Interpretation of Findings:
* Pain created on the concave side is indicative by intercostal neuritis
* Pain created on the convex side is indicative of intercostal myofascitis
* Intercostal myofascitis must be differentiated from the fibrous inflammation of pleurisy.
Name the following test-
Procedure:
* The patient raises the arms while standing
* Ask the patient to bend to each side (laterally).
Interpretation of Findings:
* Pain created on the concave side is indicative by intercostal neuritis
* Pain created on the convex side is indicative of intercostal myofascitis
* Intercostal myofascitis must be differentiated from the fibrous inflammation of pleurisy.
Schepelmann sign
What is the costovertebral stress test?
Procedure:
* The patient is asked to rotate their torso and stress is applied at the angle of the ribs
Interpretation of Findings:
* Pain may be induced on the same side of a costovertebral or costosternal irritation
* Loss of movement indicates fixation of the costotransverse and/or costovertebral articulation in posterior to anterior translation (caliper movement).
What is this test called?
Procedure:
* The patient is asked to rotate their torso and stress is applied at the angle of the ribs
Interpretation of Findings:
* Pain may be induced on the same side of a costovertebral or costosternal irritation
* Loss of movement indicates fixation of the costotransverse and/or costovertebral articulation in posterior to anterior translation (caliper movement).
Costovertebral Stress Test
How do you perform the chest expansion test?
Procedure:
* The chest diameter is measured at the level of the fourth intercostal space (roughly at the xyphoid process).
* The first measurement is taken as the patient exhales maximally.
* A second measurement is made as the patient inhales deeply.
Interpretation of Findings:
* The normal difference between inspiration and expiration is 1.5 inches for females to 3 inches for males
* Decreases, in the absence of trauma, suggest ankylosing spondylitis
What is the name of this test?
Procedure:
* The chest diameter is measured at the level of the fourth intercostal space (roughly at the xyphoid process).
* The first measurement is taken as the patient exhales maximally.
* A second measurement is made as the patient inhales deeply.
Interpretation of Findings:
* The normal difference between inspiration and expiration is 1.5 inches for females to 3 inches for males
* Decreases, in the absence of trauma, suggest ankylosing spondylitis
Chest Expansion test
Perform the Posterior Respiratory Excursion test
Procedure:
* Chest expansion symmetry can be evaluated by placing the thumbs and index fingers around the posterior thorax surface
* Thumbs should start touching over the midline while the patient exhales
* The thumbs should then separate equally on full inspiration. Interpretation of Findings:
* Asymmetry may be seen in painful rib problems, collapsed lung (atelectasis) or pneumonia
What is the name of the following test-
Procedure:
* Chest expansion symmetry can be evaluated by placing the thumbs and index fingers around the posterior thorax surface
* Thumbs should start touching over the midline while the patient exhales
* The thumbs should then separate equally on full inspiration. Interpretation of Findings:
* Asymmetry may be seen in painful rib problems, collapsed lung (atelectasis) or pneumonia
Posterior Respiratory Excursion test
Perform the anterior rib motion test
Procedure:
* Assessment for Hypomobile Costal Structures
* As the supine patient inhales and exhales, the AP movement of the ribs is palpated
Interpretation of Findings:
* Restriction in motion is noted.
* Rib failing to move inferior during exhalation suggest a fixed elevated rib
* Rib failing to move superior during inhalation suggest a fixed depressed rib
What is the name of the test for the following procedures-
Procedure:
* Assessment for Hypomobile Costal Structures
* As the supine patient inhales and exhales, the AP
movement of the ribs is palpated
Interpretation of Findings:
* Restriction in motion is noted.
* Rib failing to move inferior during exhalation suggest a
fixed elevated rib
* Rib failing to move superior during inhalation suggest a fixed depressed rib
Anterior Rib Motion Test
What is the sternal compression test?
Procedure:
* While the patient is in the supine position, the examiner exerts downward pressure on the patient’s sternum
* Female patients should place their hands over breast tissue providing a barrier between the examiners hands and the patient’s sternum
Interpretation of Findings:
* Localized pain at the lateral border of the ribs indicates a rib fracture
* Pain reproduced along any part of the rib is indicative of rib fracture
What is the name for the following test-
Procedure:
* While the patient is in the supine position, the examiner exerts downward pressure on the patient’s sternum
* Female patients should place their hands over breast tissue providing a barrier between the examiners hands and the patient’s sternum
Interpretation of Findings:
* Localized pain at the lateral border of the ribs indicates a rib fracture
* Pain reproduced along any part of the rib is indicative of rib fracture
Sternal Compression Test
Lateral Chest (rib) compression test. How is it performed?
Procedure:
* Examiner contacts both lateral aspects of the rib cage and applies bilateral lateral to medial compression.
Interpretation of Findings:
* Pain at the costosternal junction- May indicate local inflammation
- Pain in the back- May indicate costotransverse or costovertebral lesions
- Localized pain at the lateral rib angle * May indicate a fracture
What test is this?
Procedure:
* Examiner contacts both lateral aspects of the rib cage and applies bilateral lateral to medial compression.
Interpretation of Findings:
* Pain at the costosternal junction- May indicate local inflammation
- Pain in the back- May indicate costotransverse or costovertebral lesions
- Localized pain at the lateral rib angle * May indicate a fracture
Lateral Chest (rib) compression test
PRONE (THORACIC) EXTENSION- What is it?
Assessment for structural hyperkyphosis
* To differentiate between the functional (postural) kyphosis and the structural kyphosis.
Procedure:
* The patient is instructred to lie prone with their arms behind their back
* Patient is instructed to extend their trunk, lifting their chest off the table
Interpretation of Findings:
* If the kyphosis persists it is a “structural” kyphosis
Which test is the following describing? -
Assessment for structural hyperkyphosis
* A hyperkyphosis is common in adolescents for two major reasons:
* poor posture
* Scheuermann’s disease.
* To differentiate between the functional (postural) kyphosis and the structural kyphosis.
Procedure:
* The patient is instructred to lie prone with their arms behind their back
* Patient is instructed to extend their trunk, lifting their chest off the table
Interpretation of Findings:
* If the kyphosis persists it is a “structural” kyphosis
Prone (thoracic) Extension test
