NMS practical 2 Orthopedic

Question 1

Patient stands with head in neutral position and arms at sides
* Demonstrate and/or instruct the patient to walk toward doctor while balancing on their
heels
* Observe for ability to balance all body weight on the patient’s heels, one foot at a time
Interpretation of findings:
* Inability to maintain dorsiflexion (balancing on heels) indicates foot drop
* L5 radiculopathy, L4-L5 disc problem, common peroneal nerve injury, weak anterior tibialis

Answer 1

Heel walking screening test

Question 2

Explain the Heel walking screening test

Answer 2

Patient stands with head in neutral position and arms at sides
* Demonstrate and/or instruct the patient to walk toward doctor while balancing on their
heels
* Observe for ability to balance all body weight on the patient’s heels, one foot at a time

Question 3

What are the interpretation of findings for the Heel walking screening test?

Answer 3

• Inability to maintain dorsiflexion (balancing on heels) indicates foot drop
• L5 radiculopathy, L4-L5 disc problem, common peroneal nerve injury, weak anterior tibialis

Question 4

Patient stands with head in neutral position and arms at sides
* Demonstrate and/or instruct the patient to walk away from doctor while balancing on
their toes
* Observe patient’s ability to balance all body weight on their toes, one foot at a time
Interpretation of findings:
* Inability to maintain plantar flexion (balancing on toes) indicates heel drop * S1 radiculopathy, L5-S1 disc problem, tibial nerve injury, weak calf muscles

Answer 4

Toe Walking Screening test

Question 5

How do you perform the Toe walking screening test?

Answer 5

atient stands with head in neutral position and arms at sides
* Demonstrate and/or instruct the patient to walk away from doctor while balancing on
their toes
* Observe patient’s ability to balance all body weight on their toes, one foot at a time

Question 6

What are the interpretation of findings for the Toe walking screening test?

Answer 6

Observe patient’s ability to balance all body weight on their toes, one foot at a time
Interpretation of findings:
* Inability to maintain plantar flexion (balancing on toes) indicates heel drop * S1 radiculopathy, L5-S1 disc problem, tibial nerve injury, weak calf muscles

Question 7

• Patient is supine with arms at sides
• Doctor stands to the side of the patient facing cephalad
  -Doctor tests the unaffected leg first
• Doctor contacts distal femur and calcaneus to maintain knee extension
• Doctor passively flexes the hip to 90 ̊ or to the point of pain
• Doctor asks patient if there is pain, verifying location, severity, radiation and quality if pain is present.
  Interpretation of findings:
• Local pain with radiculopathy at 0 ̊-30 ̊ suspect SI lesion or piriformis syndrome
• Local pain with radiculopathy at 30 ̊-70 ̊ suspect sciatic nerve root irritation by
  intervertebral disc pathology or intradural lesion
• Local pain at 70 ̊+ suspect lumbar joint involvement

Answer 7

Straight Leg Raise (SLR) test

Question 8

How do you perform the SLR test?

Answer 8

Patient is supine with arms at sides
* Doctor stands to the side of the patient facing cephalad
-Doctor tests the unaffected leg first
* Doctor contacts distal femur and calcaneus to maintain knee extension
* Doctor passively flexes the hip to 90 ̊ or to the point of pain
* Doctor asks patient if there is pain, verifying location, severity, radiation and quality if pain is present.

Question 9

What are the interpretation of findings for the SLR test?

Answer 9

• Local pain with radiculopathy at 0 ̊-30 ̊ suspect SI lesion or piriformis syndrome
• Local pain with radiculopathy at 30 ̊-70 ̊ suspect sciatic nerve root irritation by
  intervertebral disc pathology or intradural lesion
• Local pain at 70 ̊+ suspect lumbar joint involvement

Question 10

What is the follow up procedure if you get a Positive SLR test?

Answer 10

Bragard’s Test

Question 11

Name the test-
This is only performed following a positive SLR Test. It is a follow up procedure.
Procedure:
* Doctor lowers the leg 5 ̊ from the point of pain
* Doctor passively dorsiflexes the affected foot
* Doctor asks patient if there is pain, verifying location, severity, radiation and quality if pain is present.
Interpretation of findings:
* If dorsiflexion produces pain at 0 ̊-30 ̊suspect extradural sciatic nerve irritation
* If dorsiflexion produces pain at 30 ̊-70 ̊ suspect intradural problem such as an intervertebral disc pathology causing sciatic nerve root irritation
* Dull posterior lower leg or thigh pain indicates tight muscles

Answer 11

Bragard’s Test

Question 12

What is the follow up to SLR & Bragards?

Answer 12

Sicard’s Test

Question 13

Name the test-
Procedure:
* Lower 5° from the positive Bragards position and extend the great (1st) toe. Interpretation of findings:
* Pain indicates stretching of the dura mater of the spinal cord or a lesion within the spinal cord (e.g., disc herniation, tumor, meningitis).

Answer 13

Sicard’s Test

Question 14

How do you perform Sicard’s test and what are the findings?

Answer 14

Procedure:
* Lower 5° from the positive Bragards position and extend the great (1st) toe. Interpretation of findings:
* Pain indicates stretching of the dura mater of the spinal cord or a lesion within the spinal cord (e.g., disc herniation, tumor, meningitis).

Question 15

How do you perform The well leg raise (Crossover Test)? What are the interpretation of findings?

Answer 15

Patient is supine arms at sides
* Doctor stands on the UNAFFECTED side of the patient facing cephalad
* Doctor passively flexes the hip to 90 ̊ or to the point of pain, maintaining knee extension
* Doctor asks patient if there is pain, verifying location, severity, radiation and quality if pain is present.
Interpretation of findings:
* reproduction of pain with radiculopathy on the affected side indicates central or medial disc protrusion.

Question 16

What test is this?
Patient is supine arms at sides
* Doctor stands and tests on the UNAFFECTED side of the patient facing cephalad
* Doctor passively flexes the hip to 90 ̊ or to the point of pain, maintaining knee extension
* Doctor asks patient if there is pain, verifying location, severity, radiation and quality if pain is present.
Interpretation of findings:
* reproduction of pain with radiculopathy on the affected side is indicates a central or medial disc protrusion.

Answer 16

The Well Leg Raise (aka Crossover test)

Question 17

This test is performed on the unaffected side after receiving a positive well leg raise test…

Answer 17

Fajersztajn’s Sign

Question 18

How do you perform Fajersztajn’s sign?

Answer 18

it is performed on the unaffected side after receiving a positive Well Leg Raise test.
* Lower the unaffected leg 5 degrees and DF the ankle.
Interpretation of Findings:
* Positive test: procedure re-creates pain on the affected side.

Question 19

What test is this?
Patient is supine arms at sides
* Doctor stands to the side of the patient facing cephalad
* Doctor places one hand under the lumbar spine with each finger contacting an interspinous space
* Doctor passively flexes the leg with the other hand
* Doctor asks patient if there is pain, location, severity, radiation and quality
* Doctor notes if the pain occurs before or during lumbar spinous fanning occurs

Interpretation of findings:
* Pain that is produced before the spinouses fan (0 ̊-30 ̊) suspect SI lesion
* Radicular pain during lumbar fanning (30 ̊-70 ̊) indicates an intradural lesion – disc defect, osteophyte, mass)
* Local pain after lumbar fanning (70 ̊+) indicates a posterior lumbar joint disorder

Answer 19

Smith-Peterson Test or Goldthwaits Test

Question 20

Perform the Smith-Peterson Test or Goldthwaits test. What are the findings and positive indications?

Answer 20

Patient is supine arms at sides
* Doctor stands to the side of the patient facing cephalad
* Doctor places one hand under the lumbar spine with each finger contacting an interspinous space
* Doctor passively flexes the leg with the other hand
* Doctor asks patient if there is pain, location, severity, radiation and quality
* Doctor notes if the pain occurs before or during lumbar spinous fanning occurs Interpretation of findings:
* Pain that is produced before the spinouses fan (0 ̊-30 ̊) suspect SI lesion
* Radicular pain during lumbar fanning (30 ̊-70 ̊) indicates an intradural lesion – disc defect, osteophyte, mass)
* Local pain after lumbar fanning (70 ̊+) indicates a posterior lumbar joint disorder

Question 21

Name this test-
Patient is supine with arms at sides
* Doctor stands square to the patient, on the unaffected side first, then the affected side
* Doctor passively flexes the patient’s hip and keeps the knee flexed
* Doctor keeps the hip flexed and extends the knee
* Doctor asks patient if there is pain verifying
location, severity, quality and radiation
Interpretation of findings:
* If there is no pain with hip and knee flexion, but pain is elicited when the knee is extended the test is positive for sciatic radiculolopathy

Answer 21

Lasegue Test

Question 22

Talk through performing the Lasegue test and it’s findings

Answer 22

Patient is supine with arms at sides
* Doctor stands square to the patient, on the unaffected side first, then the affected side
* Doctor passively flexes the patient’s hip and keeps the knee flexed
* Doctor keeps the hip flexed and extends the knee
* Doctor asks patient if there is pain verifying
location, severity, quality and radiation
Interpretation of findings:
* If there is no pain with hip and knee flexion, but pain is elicited when the knee is extended the test is positive for sciatic radiculolopathy

Question 23

How do you perform Bechterew’s Test ?

Answer 23

Procedure:
* Patient is seated with legs hanging off table, head in neutral and arms at sides
* Doctor stands in front of the patient
* Instruct the patient to extend one knee (unaffected side)
* Ask if there is any discomfort and if so, verify location, radiation, severity and quality
* Instruct the patient to extend the other knee (affected side)
* Ask if there is any discomfort and if so, verify location, radiation,
severity and quality
* If no pain is produced with unilateral leg extension the doctor instructs the patient to extend both legs at the same time
* Doctor asks if there is any pain, verifying location, radiation, severity and quality if pain is present.

Question 24

What special test is this?
Patient is seated with legs hanging off table, head in neutral and arms at sides
* Doctor stands in front of the patient
* Instruct the patient to extend one knee (unaffected side)
* Ask if there is any discomfort and if so, verify location, radiation, severity and quality
* Instruct the patient to extend the other knee (affected side)
* Ask if there is any discomfort and if so, verify location, radiation,
severity and quality
* If no pain is produced with unilateral leg extension the doctor instructs the patient to extend both legs at the same time
* Doctor asks if there is any pain, verifying location, radiation, severity and quality if pain is present
Interpretation of findings:
* Extending the leg tractions the sciatic nerve
* Radicular pain or if the patient must lean back due to pain indicate compression of the sciatic nerve or lumbar nerve roots often due to lumbar disc protrusion

Answer 24

Bechterew’s Test

Question 25

What are the interpretation of findings for Bechterew’s Test?

Answer 25

Interpretation of findings:
* Extending the leg tractions the sciatic nerve
* Radicular pain or if the patient must lean back due to pain indicate compression of the sciatic nerve or lumbar nerve roots often due to lumbar disc protrusion

Question 26

How do you perform the Knee Flexion test aka Neri’s Sign?

Answer 26

Patient is standing
* Doctor stands to one side of the patient
* Doctor instructs patient to bend forward and touch their toes
* Doctor observes for knee flexion on either side
Interpretation of finding:
* Knee flexes on affected side
* Lumbar disc, lumbosacral or SI problems

Question 27

What test is this? Give both names
Patient is standing
* Doctor stands to one side of the patient
* Doctor instructs patient to bend forward and touch their toes
* Doctor observes for knee flexion on either side
Interpretation of finding:
* Knee flexes on affected side
* Lumbar disc, lumbosacral or SI problems

Answer 27

Knee Flexion Test
Neri’s Sign

Question 28

How do you perform Bowstring Sign test?

Answer 28

Procedure:
* Patient is supine with arms at sides
* Doctor is seated on the side being tested, facing cephalad
* Doctor places affected leg on their inside shoulder
* Doctor places firm pressure on the hamstring muscles using bilateral thumbs
* If pain is not elicited then apply pressure into the popliteal fossa

Interpretation of findings:
* Applying pressure to the hamstring or popliteal fossa increases sciatic nerve tension
* Pain in the lumbar region or radiculopathy is a positive sign of sciatic nerve compression

Question 29

What test is this?
Procedure:
* Patient is supine with arms at sides
* Doctor is seated on the side being tested, facing cephalad
* Doctor places affected leg on their inside shoulder
* Doctor places firm pressure on the hamstring muscles using bilateral thumbs
* If pain is not elicited then apply pressure into the popliteal fossa

Interpretation of findings:
* Applying pressure to the hamstring or popliteal fossa increases sciatic nerve tension
* Pain in the lumbar region or radiculopathy is a positive sign of sciatic nerve compression

Answer 29

Bowstring Sign

Question 30

What are the steps to the Slump test? What does it indicate?

Answer 30

Procedure: if there is no pain move on to the next step for all steps. * If symptoms are produced with any phase the test should be stopped to prevent further pain
* Patient is seated with hands behind their back
1: Doctor instructs patient to slump forward while the doctor holds the patient’s chin to prevent cervical flexion Doctor asks if there is any pain - location, quality, severity, radiation

2: Doctor releases chin and further flexes the torso by pressing on the shoulder and advises the patient to further flex their chin forward Intern asks if there is any pain - location, quality, severity, radiation

3: Doctor further flexes the cervical spine by pushing on the occiput Intern asks if there is any pain - location, quality, severity, radiation

4: Doctor maintains the cervical overpressure and instruct the patient to extend one knee Intern asks if there is any pain - location, quality, severity, radiation

5: Doctor maintains the cervical overpressure and dorsiflexes the foot while the patient remains in leg extension Intern asks if there is any pain - location, quality, severity, radiation

6: Doctor releases the cervical overpressure and advises the patient to extend their neck while maintaining leg extension and foot dorsiflexion
Interpretation of findings:

• Each phase of the test induces motion induced spinal traction that increases with each phase
• Pain during any portion of the phase indicates meningeal tract irritation usually caused by a disc defect
• Pain lessened with cervical extension is also confirmation of meningeal irritation.

Question 31

What is the Thomas test and what does it indicate?

Answer 31

• Patient supine legs extended. Doctor tests the unaffected side first.
• Doctor has patient pull hip into flexion by pulling on their flexed knee.
• Doctor observes if the contralateral femur flexes as the patient flexes the hip.
• Doctor performs the test bilaterally
• Doctor asks patient if there is pain, verifying location, quality, severity,
  radiation if pain is present.
  Interpretation of findings:
• If the patient’s contralateral leg is unable to lay flat on the table lumbar spine stays in a lordosis as they pull their knee to their chest. This indicates a flexion contracture of the iliopsoas muscle.

Question 32

What test is this?
* Patient supine legs extended. Doctor tests the unaffected side first.
* Doctor has patient pull hip into flexion by pulling on their flexed knee.
* Doctor observes if the contralateral femur flexes as the patient flexes the hip.
* Doctor performs the test bilaterally
* Doctor asks patient if there is pain, verifying location, quality, severity,
radiation if pain is present.
Interpretation of findings:
* If the patient’s contralateral leg is unable to lay flat on the table lumbar spine stays in a lordosis as they pull their knee to their chest. This indicates a flexion contracture of the iliopsoas muscle.

Answer 32

Thomas Test

Question 33

What exam is this?
Procedure:
* Patient is supine
* Doctor stands on either side of the patient near their feet
* Doctor stabilizes the patient’s lower legs on the table
* Doctor directs the patient to sit up
* Doctor asks patient if there is pain verifying location, severity, quality and radiation if pain is present
Interpretation of Findings:
* Inability to sit up is associated with lumbar arthritis, lumbar fibrosis/ankylosis, lumbar disc protrusion, or sciatica
* Patients with weak abdominals will experience difficulty with this test

Answer 33

Lewin Supine Test

Question 34

How do you perform the Lewin Supine Test?

Answer 34

Procedure:
* Patient is supine
* Doctor stands on either side of the patient near their feet
* Doctor stabilizes the patient’s lower legs on the table
* Doctor directs the patient to sit up
* Doctor asks patient if there is pain verifying location, severity, quality and radiation if pain is present
Interpretation of Findings:
* Inability to sit up is associated with lumbar arthritis, lumbar fibrosis/ankylosis, lumbar disc protrusion, or sciatica
* Patients with weak abdominals will experience difficulty with this test

Question 35

What test is this?
Procedure:
* Patient is supine with arms at sides
* Doctor instructs the patient to raise both legs 2-3 inches off the table
* Doctor instructs the patient to maintain this position for 30 seconds
* Doctor asks if there is any pain, verifying location, severity, quality, radiation if pain is present
Interpretation of findings:
* This test increases intrathecal pressure
* If pain is present suspect a space occupying lesion inside or outside of
the spinal canal – disc protrusions usually produce positive test
* Patients with weak abdominal muscles may have difficulty performing this test

Answer 35

Milgram’s Test

Question 36

How do you perform Milgram’s Test and what does it indicate?

Answer 36

Procedure:
* Patient is supine with arms at sides
* Doctor instructs the patient to raise both legs 2-3 inches off the table
* Doctor instructs the patient to maintain this position for 30 seconds
* Doctor asks if there is any pain, verifying location, severity, quality, radiation if pain is present
Interpretation of findings:
* This test increases intrathecal pressure
* If pain is present suspect a space occupying lesion inside or outside of
the spinal canal – disc protrusions usually produce positive test
* Patients with weak abdominal muscles may have difficulty performing this test

Question 37

What is Beevor Sign? patient needs to have their shirt rolled up…

Answer 37

rocedure:
* The patient lies supine.
* The patient flexes the head against resistance and attempts to sit up
with the hands resting behind the head or across the chest.
Interpretation of findings:
* When a patient sits up or raises the head from a recumbent position, the umbilicus is displaced toward the head. This is the result of paralysis of the inferior portion of the rectus abdominal muscle, so that the upper fibers predominate pulling upwards the umbilicus
* The sign is positive if the umbilicus does not remain in a straight line when the abdominals contract, indicating neurological pathologic condition.

Question 38

What test is this?
Procedure:
* The patient lies supine.
* The patient flexes the head against resistance and attempts to sit up
with the hands resting behind the head or across the chest.
Interpretation of findings:
* When a patient sits up or raises the head from a recumbent position, the umbilicus is displaced toward the head. This is the result of paralysis of the inferior portion of the rectus abdominal muscle, so that the upper fibers predominate pulling upwards the umbilicus
* The sign is positive if the umbilicus does not remain in a straight line when the abdominals contract, indicating neurological pathologic condition.

Answer 38

Beevor Sign

Question 39

Prone Knee Bending Test (aka – Nachlas Test). What is it?

Answer 39

Procedure:
* Patient is prone
* Doctor stands on either side of the table facing cephalad or square
* Doctor passively approximates the patient’s heel to the ipsilateral buttock
* Doctor asks patient if there is pain, verifying location, severity, quality and radiation
Interpretation of findings
* Flexing the leg to the buttock stretches the quadriceps muscles and femoral nerve
* Radicular anterior thigh pain may indicate L2-L4 compression or irritation by an intradural lesion (disc defect, spur, mass), a lumbar plexus or femoral nerve compression from iliopsoas hypertrophy
* Pain in the buttock may indicate an SI lesion
* Pain in the lumbosacral joint may indicate a lumbosacral lesion

Question 40

Name this test-
Procedure:
* Patient is prone
* Doctor stands on either side of the table facing cephalad or square
* Doctor passively approximates the patient’s heel to the ipsilateral buttock
* Doctor asks patient if there is pain, verifying location, severity, quality and radiation
Interpretation of findings
* Flexing the leg to the buttock stretches the quadriceps muscles and femoral nerve
* Radicular anterior thigh pain may indicate L2-L4 compression or irritation by an intradural lesion (disc defect, spur, mass), a lumbar plexus or femoral nerve compression from iliopsoas hypertrophy
* Pain in the buttock may indicate an SI lesion
* Pain in the lumbosacral joint may indicate a lumbosacral lesion

Answer 40

Prone Knee Bending Test aka – Nachlas Test

Question 41

What is Kemps test? What does it indicate?

Answer 41

Procedure:
* Patient is seated or standing with head in neutral position and arms crossing chest
* Seated increases intradiscal pressure
* Standing maximizes stress on facets
* Doctor stands behind the patient
* Doctor reaches across the chest to grab the contralateral shoulder or arm
* Doctor stabilizes the posterior superior iliac spine with other hand (palm or fist)
* Doctor passively extends the patient obliquely over contact
* Start by turning away then circumducting towards side being tested
* Repeat procedure on the other side
* Doctor asks patient if there is any pain, verifying location, severity, quality and radiating if
pain is present.
Interpretation of findings:
* Local lumbar pain with radiation indicates disc herniation
* Local lumbar pain with no radicular pain indicates lumbar muscle spasm or facet capsulitis

Question 42

Name this exam-
Procedure:
* Patient is seated or standing with head in neutral position and arms crossing chest
* Seated increases intradiscal pressure
* Standing maximizes stress on facets
* Doctor stands behind the patient
* Doctor reaches across the chest to grab the contralateral shoulder or arm
* Doctor stabilizes the posterior superior iliac spine with other hand (palm or fist)
* Doctor passively extends the patient obliquely over contact
* Start by turning away then circumducting towards side being tested
* Repeat procedure on the other side
* Doctor asks patient if there is any pain, verifying location, severity, quality and radiating if
pain is present.
Interpretation of findings:
* Local lumbar pain with radiation indicates disc herniation
* Local lumbar pain with no radicular pain indicates lumbar muscle spasm or facet capsulitis

Answer 42

Kemps test

Question 43

What is Pheasant’s Test?

Answer 43

Procedure:
* Patient is prone
* Doctor stands on either side of the table facing cephalad or
square
* Doctor passively approximates the patient’s heels to the buttocks
* Doctor applies posterior to anterior pressure over individual lumbar vertebrae
* Doctor asks patient if there is pain, verifying location, severity, quality and radiation if pain is present
Interpretation of findings:
* spinal instability, i.e.-spondylisthesis

Question 44

What test is this?
Procedure:
* Patient is prone
* Doctor stands on either side of the table facing cephalad or
square
* Doctor passively approximates the patient’s heels to the buttocks
* Doctor applies posterior to anterior pressure over individual lumbar vertebrae
* Doctor asks patient if there is pain, verifying location, severity, quality and radiation if pain is present
Interpretation of findings:
* spinal instability, i.e.-spondylisthesis

Answer 44

Pheasant’s Test

Question 45

Name this exam-
Procedure:
* Patient lies prone with the body on the examining table and the legs over the edge resting on the floor
* Doctor applies specific pressure to the posterior aspect of the lumbar spine or SIJ while the patient rests in this position.
* The patient then lifts the legs off the floor
* Doctor again applies posterior compression to the lumbar spine or
SIJ.
Interpretation of findings:
* If pain is elicited in the resting position only, the test is positive, because the muscle contraction masks the instability by stabilizing the segment.

Answer 45

Prone Segmental Instability Test

Question 46

how do you perform the Prone Segmental Instability Test?

Answer 46

Procedure:
* Patient lies prone with the body on the examining table and the legs over the edge resting on the floor
* Doctor applies specific pressure to the posterior aspect of the lumbar spine or SIJ while the patient rests in this position.
* The patient then lifts the legs off the floor
* Doctor again applies posterior compression to the lumbar spine or
SIJ.
Interpretation of findings:
* If pain is elicited in the resting position only, the test is positive, because the muscle contraction masks the instability by stabilizing the segment.

Question 47

When you ask a patient if, within the past week, they had experienced any sensation of lower back collapse or giving-way due to sudden onset of LBP during transitional movements like standing up or sitting down. What test is that?

Answer 47

Apprehension Sign

Question 48

how do you perform Apprehension Sign?

Answer 48

The patient is asked if, within the past week, they had experienced any sensation of lower back collapse or giving-way due to sudden onset of LBP during transitional movements like standing up or sitting down.
* This test shows high specificity (92.60%), but low sensitivity (17.4%) for spinal instability.

Question 49

What is Catch Sign?

Answer 49

The patient performs standing forward flexion and return to upright, while the clinician evaluates for an aberrant movement pattern.
* Specifically, the clinician should assess for: pain, catching, sudden acceleration or deceleration, or any disruption of normal rhythm, including the use of arms to return to an upright position.
* The patient is then asked to perform an abdominal brace and repeat the forward flexion maneuver.
* Dissipation or elimination of pain when performing flexion in the braced position is a positive test suggesting spinal instability.

Question 50

Name this procedure-
The patient performs standing forward flexion and return to upright, while the clinician evaluates for an aberrant movement pattern.
* Specifically, the clinician should assess for: pain, catching, sudden acceleration or deceleration, or any disruption of normal rhythm, including the use of arms to return to an upright position.
* The patient is then asked to perform an abdominal brace and repeat the forward flexion maneuver.
* Dissipation or elimination of pain when performing flexion in the braced position is a positive test suggesting spinal instability.

Answer 50

Catch Sign

Question 51

Name the 3 tests of the Instability Cluster

Answer 51

Apprehension Sign
Painful Catch Sign
Prone Instability Test

Question 52

How do you perform the SIJ Gapping/SIJ Distraction/Anterior Iliac stretch test?

Answer 52

Procedure:
* Instruct the patient to lie supine
* Examiner stands on either side of the table facing cephalad
* Examiner contacts both ASIS and stresses A-P (and M-L)
* Examiner asks patient if there is pain, verifying location, severity, quality and radiation if pain is present
Interpretation of findings:
* local pain over the ASIS is attributed to compression of soft tissue structures and is NOT considered a positive test
* unilateral sacroiliac or gluteal pain signifies a positive test for anterior SIJ ligament sprain

Question 53

What orthopedic test is this?
Procedure:
* Instruct the patient to lie supine
* Examiner stands on either side of the table facing cephalad
* Examiner contacts both ASIS and stresses A-P (and M-L)
* Examiner asks patient if there is pain, verifying location, severity, quality and radiation if pain is present
Interpretation of findings:
* local pain over the ASIS is attributed to compression of soft tissue structures and is NOT considered a positive test
* unilateral sacroiliac or gluteal pain signifies a positive test for anterior SIJ ligament sprain

Answer 53

SIJ Gapping/SIJ Distraction/Anterior Iliac stretch test

Question 54

How do you perform the iliac compression/approximation test?

Answer 54

Procedure:
* Patient is in side-lying position with hips and knees stacked and slightly flexed
* Examiner stands behind patient
* Examiner contacts superior ilium and applies downward compression
* Examiner asks patient if there is pain, verifying location, severity, quality and radiation if pain is present
Interpretation of findings:
* pain within either sacroiliac joint indicates sprain of posterior sacroiliac ligaments
* pain on lateral surface of either ilia could indicate contusion or compression of soft tissue

Question 55

What is the test that is described below?
Procedure:
* Patient is in side-lying position with hips and knees stacked and slightly flexed
* Examiner stands behind patient
* Examiner contacts superior ilium and applies downward compression
* Examiner asks patient if there is pain, verifying location, severity, quality and radiation if pain is present
Interpretation of findings:
* pain within either sacroiliac joint indicates sprain of posterior sacroiliac ligaments
* pain on lateral surface of either ilia could indicate contusion or compression of soft tissue

Answer 55

iliac compression/approximation test

Question 56

How do you perform Gaenslen’s test?

Answer 56

Procedure:
* Patient is supine towards one edge of the table
* Examiner stands on side of the table closest to patient, facing cephalad or
square
*Examiner tests the unaffected leg first
* Examiner flexes the knee and hip of the patient’s contralateral leg to their abdomen
* Examiner hyperextends the affected leg off the table
* Examiner asks patient if there is pain, verifying location, severity, quality and
radiation if pain is present
Interpretation of findings:
* positive test reproduces pain in the sacroiliac area
* dull anterior thigh pain could indicate tight hip flexors
* radiating symptoms down the thigh could indicate lumbar disc involvement
* if test is negative, a lumbosacral lesion is suspected

Question 57

What is the name of the following test?
Procedure:
* Patient is supine towards one edge of the table
* Examiner stands on side of the table closest to patient, facing cephalad or
square
* Examiner flexes the knee and hip of the patient’s contralateral leg to their abdomen
* Examiner hyperextends the affected leg off the table
* Examiner asks patient if there is pain, verifying location, severity, quality and
radiation if pain is present
Interpretation of findings:
* positive test reproduces pain in the sacroiliac area
* dull anterior thigh pain could indicate tight hip flexors
* radiating symptoms down the thigh could indicate lumbar disc involvement
* if test is negative, a lumbosacral lesion is suspected

Answer 57

Gaenslen’s test

Question 58

What is the Thigh Thrust Test?

Answer 58

Procedure:
* Instruct the patient to lie supine
* Clinician contacts the leg opposite from where they stand
* Clinician flexes the patient’s hip to 90° with the knee flexed
* The clinician’s caudal hand is placed beneath the sacrum to provide an supportive and opposing force and MAINTAINS THEIR ELBOW ON THE TABLE.
* Using the cephalad hand, contact the distal femur and apply A-P pressure along the length of the femur, the femur is used as a lever to push the ilium posteriorly.
Interpretation:
* A positive test reproduces the patient’s complaint of pain in the sacroiliac joint.

Question 59

What is the name of following test?
Procedure:
* Instruct the patient to lie supine
* Clinician contacts the leg opposite from where they stand
* Clinician flexes the patient’s hip to 90° with the knee flexed
* The clinician’s caudal hand is placed beneath the sacrum to provide an supportive and opposing force and maintains their elbow on the table.
* Using the cephalad hand, contact the distal femur and apply A-P pressure along the length of the femur, the femur is used as a lever to push the ilium posteriorly.
Interpretation:
* A positive test reproduces the patient’s complaint of pain in the sacroiliac joint.

Answer 59

Thigh Thrust Test

Question 60

Name the following test-
Procedure:
* Instruct the patient to lie prone.
* Clinician takes a reinforced contact over the midline of the sacrum and pushes P-A, producing a shearing force at both SIJs as the table provides an opposing force.
Interpretation:
* A positive test will produce pain in the affected SIJ, reproducing the patient’s symptoms.

Answer 60

Sacral Thrust Test

Question 61

How do you perform the sacral thrust test?

Answer 61

Procedure:
* Instruct the patient to lie prone.
* Clinician takes a reinforced contact over the midline of the sacrum and pushes P-A, producing a shearing force at both SIJs as the table provides an opposing force.
Interpretation:
* A positive test will produce pain in the affected SIJ, reproducing the patient’s symptoms.

Question 62

Describe the procedures and indications for the Drop Test

Answer 62

Procedure:
* Instruct the patient to stand facing a wall or table for support. The patient raises the heels from the floor. Keeping the knee in extension, the patient uses their bodyweight and drops the test side heel to the floor with force (should land causing a bump sound), producing a cranially directed shear force at the left SIJ
Interpretation:
* A positive test produces pain in the sacroiliac joint.

Question 63

what is the name of this procedure-
Procedure:
* Instruct the patient to stand facing a wall or table for support. The patient raises the heels from the floor. Keeping the knee in extension, the patient uses their bodyweight and drops the test side heel to the floor with force (should land causing a bump sound), producing a cranially directed shear force at the left SIJ
Interpretation:
* A positive test produces pain in the sacroiliac joint.

Answer 63

Drop Test

Question 64

What are the 6 tests in the Cluster of Laslette?

Answer 64

1. SI Joint Distraction
2. Thigh Thrust
3. Sacral Thrust
4. The Drop Test
5. Gaenslen’s
6. Iliac Compression

Question 65

How do you perform Erichsen sign?

Answer 65

Procedure:
* Patient is prone
* Examiner stands on either side of the table facing cephalad
* Examiner contacts bilateral ilia and thrusts towards the midline
* Examiner asks patient if there is pain, verifying location, severity, quality and radiation if pain is present
Interpretation of findings:
* test should reproduce pain if sacroiliac is the source of pain
* test will not reproduce pain if iliofemoral joint is the source of pain

Question 66

What test is described below?
Procedure:
* Patient is prone
* Examiner stands on either side of the table facing cephalad
* Examiner contacts bilateral ilia and thrusts towards the midline
* Examiner asks patient if there is pain, verifying location, severity, quality and radiation if pain is present
Interpretation of findings:
* test should reproduce pain if sacroiliac is the source of pain
* test will not reproduce pain if iliofemoral joint is the source of pain

Answer 66

Erichsen Sign

Question 67

What is the modified version of Gaenseln’s test?

Answer 67

Lewin-Gaenslen’s Test

Question 68

How do you perform Lewin-Gaenslen’s Test?

Answer 68

Procedure:
* Patient is in side-lying position
* The side being tested will be the superior side (top leg)
*Test the unaffected side first
* Examiner stands behind patient
* Examiner instructs patient to hug the bottom knee towards their chest
* Examiner stabilizes the patient’s pelvis and grasps the involved side knee
* Examiner hyperextends the top leg
* Examiner asks patient if there is pain, verifying location, severity,
quality and radiation if pain is present
Interpretation of findings:
* a positive test produces pain within the sacroiliac joint
* dull ache along the anterior thigh of the extended leg indicates tight hip flexors

Question 69

What test is this?
Procedure:
* Patient is in side-lying position
* The side being tested will be the superior side (top leg)
*Test the unaffected side first
* Examiner stands behind patient
* Examiner instructs patient to hug the bottom knee towards their chest
* Examiner stabilizes the patient’s pelvis and grasps the involved side knee
* Examiner hyperextends the top leg
* Examiner asks patient if there is pain, verifying location, severity,
quality and radiation if pain is present
Interpretation of findings:
* a positive test produces pain within the sacroiliac joint
* dull ache along the anterior thigh of the extended leg indicates tight hip flexors

Answer 69

Lewin-Gaenslen’s test

Question 70

What is the following test?
Procedure:
* Patient is prone.
*Examiner tests the unaffected side first
* Examiner takes a thenar contact over the ipsilateral PSIS
* Examiner applies firm downward pressure over the affected sacroiliac joint, fixing the pelvis to the table
* Examiner grasps anterior aspect of the knee and lifts the thigh, extending the patient’s hip
* Examiner asks patient if there is pain, verifying location, severity, quality and radiation if pain is present
Interpretation of findings:
* Pain within the sacroiliac joint indicates SI dysfunction
* Dull achy pain along the anterior thigh indicates tight hip flexors

Answer 70

Yeoman’s Test

Question 71

How do you perform Yeoman’s Test?

Answer 71

Procedure:
* Patient is prone.
*Examiner tests the unaffected side first
* Examiner takes a thenar contact over the ipsilateral PSIS
* Examiner applies firm downward pressure over the affected sacroiliac joint, fixing the pelvis to the table
* Examiner grasps anterior aspect of the knee and lifts the thigh, extending the patient’s hip
* Examiner asks patient if there is pain, verifying location, severity, quality and radiation if pain is present
Interpretation of findings:
* Pain within the sacroiliac joint indicates SI dysfunction
* Dull achy pain along the anterior thigh indicates tight hip flexors

Question 72

What are the two names for the following test?
Procedure:
* Patient is prone
* Examiner stands on the ipsilateral side of the table facing cephalad or
square
* Examiner palpates the medial side of the PSIS
* Examiner flexes ipsilateral knee 90 degrees without extending the hip
* Examiner internally rotates the hip (foot will move away from the midline)
* Examiner asks patient if there is pain, verifying location, severity, quality and radiation if pain is present
Interpretation of findings:
* pain experienced within the sacroiliac joint indicates a positive test
* pain within the iliofemoral joint indicates hip pathology

Answer 72

Hibb’s Test OR the Prone Gapping Test

Question 73

How do you perform the Prone Gapping Test aka Hibb’s Test?

Answer 73

Procedure:
* Patient is prone
* Examiner stands on the ipsilateral side of the table facing cephalad or
square
* Examiner palpates the medial side of the PSIS
* Examiner flexes ipsilateral knee 90 degrees without extending the hip
* Examiner internally rotates the hip (foot will move away from the midline)
* Examiner asks patient if there is pain, verifying location, severity, quality and radiation if pain is present
Interpretation of findings:
* pain experienced within the sacroiliac joint indicates a positive test
* pain within the iliofemoral joint indicates hip pathology

Question 74

How do you perform Ely’s Test?

Answer 74

Procedure:
* Patient is prone
* Examiner stands on either side of the table facing cephalad or square
*Examiner tests the unaffected side first
* Examiner passively approximates the patient’s heel to the contralateral buttock
* Thigh can also be hyperextended
* Examiner asks patient if there is pain, verifying location, severity, quality and radiation if pain is present
Interpretation of findings
* Femoral radicular pain indicates lumbar nerve root inflammation
* Upper lumbar discomfort indicates lumbar nerve root irritation
* Significant hip lesions will make performing the test difficult
* Iliopsoas muscle irritation will make performing the leg extension portion difficult

Question 75

What test is this?
Procedure:
* Patient is prone
* Examiner stands on either side of the table facing cephalad or square
*Examiner tests the unaffected side first
* Examiner passively approximates the patient’s heel to the contralateral buttock
* Thigh can also be hyperextended
* Examiner asks patient if there is pain, verifying location, severity, quality and radiation if pain is present
Interpretation of findings
* Femoral radicular pain indicates lumbar nerve root inflammation
* Upper lumbar discomfort indicates lumbar nerve root irritation
* Significant hip lesions will make performing the test difficult
* Iliopsoas muscle irritation will make performing the leg extension portion difficult

Answer 75

Ely’s Test

Question 76

What is the Patrick test also known as?

Answer 76

FABER test

Question 77

How do you perform the Patrick/Faber test?

Answer 77

Procedure:
* Patient supine with leg in extension.
* Examiner stands on either side of the table
*Examiner tests the unaffected side first
* Examiner grasps the patient’s leg and flexes the knee and abducts and externally rotates the hip, placing the ankle over the contralateral knee.
* Examiner stabilizes contralateral pelvis and extends hip with downward pressure on ipsilateral knee.
* Examiner performs the test bilaterally
* Examiner asks patient if there is pain, verifying location, severity, quality and
radiation if pain is present
Interpretation of findings:
* Pain in the hip indicates iliofemoral pathology
* Pain in the sacroiliac joint indicates SIJ pathology

Question 78

What are the names of the following test-
Procedure:
* Patient supine with leg in extension.
* Examiner stands on either side of the table
* Examiner grasps the patient’s leg and flexes the knee and abducts and externally rotates the hip, placing the ankle over the contralateral knee.
* Examiner stabilizes contralateral pelvis and extends hip with downward pressure on ipsilateral knee.
* Examiner performs the test bilaterally
* Examiner asks patient if there is pain, verifying location, severity, quality and
radiation if pain is present
Interpretation of findings:
* Pain in the hip indicates iliofemoral pathology
* Pain in the sacroiliac joint indicates SIJ pathology

Answer 78

Patrick Test or FABER test

Question 79

What is Patrick’s in the air?

Answer 79

Laguere’s Sign

Question 80

How do you perform Laguere’s Sign?

Answer 80

Procedure:
* Patient is supine
* Examiner stands on testing side of the table facing cephalad
*Examiner tests the unaffected side first, does not change sides to test either leg
* Examiner flexes, abducts, and externally rotates involved leg
* Examiner stabilizes opposite ASIS
* Examiner overpressures involved leg
* Examiner asks patient if there is pain, verifying location, severity, quality and radiation if pain is present
Interpretation of findings:
* positive test produces pain within sacroiliac joint
* pain felt within the iliofemoral joint indicates possible hip pathology

Question 81

What test is this?

Procedure:
* Patient is supine
* Examiner stands on testing side of the table facing cephalad
*Examiner tests the unaffected side first, does not change sides to test either leg
* Examiner flexes, abducts, and externally rotates involved leg
* Examiner stabilizes opposite ASIS
* Examiner overpressures involved leg
* Examiner asks patient if there is pain, verifying location, severity, quality and radiation if pain is present

Interpretation of findings:
* positive test produces pain within sacroiliac joint
* pain felt within the iliofemoral joint indicates possible hip pathology

Answer 81

Laguere’s Sign

Question 82

What is Bonnet’s Test? What is it also called?

Answer 82

FAIR test

Procedure:
* Patient is supine arms at sides
* Examiner stands near the foot of the table facing cephalad
*tests unaffected side first
* Examiner passively flexes the hip while keeping the knee extended while also internally rotating and adducting the leg
* Examiner asks patient if there is pain, verifying location, severity, quality and radiation if pain is present

Interpretation of findings:
* Radicular pain is indicative of sciatic nerve entrapment due to piriformis involvement

Question 83

What test is described below?
Procedure:
* Patient is supine arms at sides
* Examiner stands near the foot of the table facing cephalad
*tests unaffected side first
* Examiner passively flexes the hip while keeping the knee extended while also internally rotating and adducting the leg
* Examiner asks patient if there is pain, verifying location, severity, quality and radiation if pain is present

Interpretation of findings:
* Radicular pain is indicative of sciatic nerve entrapment due to piriformis involvement

Answer 83

Bonnet’s Test/Fair test

Question 84

What is the another name for Supported Adam’s?

Answer 84

Belt Test

Question 85

Describe the Belt test

Answer 85

Procedure:
* Patient with low back pain is standing
* Examiner stands in front of the patient and instructs the patient to flex forward at the
waist
* Examiner asks patient if there is pain, verifying location, severity, quality and radiation if pain is present
* Patient returns to standing
* Examiner then explains the next steps of the procedure to the patient and gains consent.
* Examiner then stands behind the patient and uses the lateral surface of their hip/thigh to brace the patient’s sacrum
* Examiner supports the patient’s bilateral ASIS and instructs the patient to flex forward
* Examiner asks patient if there is pain, verifying location, severity, quality and radiation if
pain is present

Interpretation of findings:
* If lesion is lumbar in origin, pain will be produced with or without pelvic bracing
* If lesion is pelvic in origin, pain will be produced without pelvic bracing but lessened or eliminated with pelvic bracing

Question 86

What is this test called?
Procedure:
* Patient with low back pain is standing
* Examiner stands in front of the patient and instructs the patient to flex forward at the
waist
* Examiner asks patient if there is pain, verifying location, severity, quality and radiation if pain is present
* Patient returns to standing
* Examiner then explains the next steps of the procedure to the patient and gains consent.
* Examiner then stands behind the patient and uses the lateral surface of their hip/thigh to brace the patient’s sacrum
* Examiner supports the patient’s bilateral ASIS and instructs the patient to flex forward
* Examiner asks patient if there is pain, verifying location, severity, quality and radiation if
pain is present
Interpretation of findings:
* If lesion is lumbar in origin, pain will be produced with or without pelvic bracing
* If lesion is pelvic in origin, pain will be produced without pelvic bracing but lessened or eliminated with pelvic bracing

Answer 86

Belt Test aka Supported Adam’s