Ortho Spine Specialized Physical Exam Tests

Question 1

Adson’s Sign

Answer 1

Loss of radial pulse in arm by rotating head
Turn head toward symptomatic shoulder while arm, neck and shoulder is extended and slightly away from body

Have patient inhale and check pulse in extended arm (if decreased HR or symptoms are reproduced, then test is positive)

Positive test can suggest thoracic outlet syndrome

Lacks specificity and sensitivity

Question 2

Bowstring’s sign:

Answer 2

Relief of radicular pain that occurs when the knee is flexed during a positive straight leg raise

Question 3

Cervical Distraction

Answer 3

Place patient in supine position

Apply gentle manual distraction

Positive test: reduced neck and limb symptoms

Helpful to diagnose radiculopathy

Question 4

Compression Test (for thoracic outlet syndrome)

Answer 4

Exert pressure b/w clavicle and medial humeral head

Positive test: causes radiation of pain +/- numbness

Can indicate thoracic outlet syndrome

Question 5

Crossed (contralateral) SLR

Answer 5

Passive elevation of the unaffected leg by the examiner

Positive Test: lifting the unaffected leg reproduces radicular pain in the affected leg

Relatively specific test for radiculopathy d/t disc herniation (poor sensitivity)

Question 6

FABER Test (Patrick’s Test, figure of 4 test, Jansen test)

Answer 6

FABER: flexion-abduction-external rotation

Stress maneuver to detect hip and sacroiliac pathology

Question 7

Forward bend test (Adams forward bend test)

Answer 7

Observe the patient from the back while he/she bends forward at the waist (until the spine becomes parallel to the horizontal plane, feet together, knees straight ahead and arms hanging free)

In a patient with scoliosis, a thoracic (rib) or lumbar (loin) prominence one side will be evident

Question 8

Lasegue’s sign:

Answer 8

Presence of worsening of radicular pain w/ the straight leg maneuver

Usually occurs when hip flexion is between 30 and 60 degrees

Question 9

Lhermitte sign

Answer 9

Have patient flex their neck

Positive test: Electric (shock-like) sensations radiating down the spine (sometimes into the extremtities)

Helpful to diagnose radiculopathy

Question 10

Occiput to Wall Test

Answer 10

Can be used to quantify severity hyperkyphosis

Patient stands against a wall and the distance between their occiput and the wall is measured

Normally patients should be able to touch their occiput to the wall

Question 11

Rhomberg’s sign

Answer 11

Swaying of the body when the feet are placed close together and the eyes are closed

Can be seen with myelopathy

Question 12

Reverse Straight Leg Raise

Answer 12

Traditional way to place the L1-L2 nerve roots under tension

Place patient prone on table

Passively extend the hip and leg straight up off the plane of the table

Positive test: reproduces radicular pain over the anterior thigh

Useful to identify L2-L4 radiculopathy (limited sensitivity and specificity)

Also positive w/ conditions that involve inflammation of the iliopsoas (such as appendicitis)

Question 13

Roos Stress Test (Elevated Arm Stress Test/EAST)

Answer 13

Place patient in front sitting position

Have patient hold both elbows at shoulder height while pushing shoulder back

Repeatedly open and close hands for several minutes

If symptoms are present, then a positive test (can suggest thoracic outlet syndrome)

Question 14

Seated SLR

Answer 14

Useful to evaluate sciatic tension

Distract the patient’s attention away from the back by asking whether the patient has knee problems

Lift the foot and extend the knee

If straightening the knee to full extension on both sides does not cause the patient to lean back, no significant sciatic tension is present.

Question 15

Slump Test of Matiland (Meningeal test)

Answer 15

Progressive test that is performed bilaterally and the patient is questioned regarding symptoms at each step.

Ask the seated patient to slump in a lumbar and thoracic flexed position

Clinician asks the patient to actively flex the chin to the chest (can gently place a hand above the shoulders to maintain the position).

Clinician then asks the patient to actively extend the knee fully.

Clinician then asks the patient to dorsiflex fully (clinician may need to passively assist to maximally extend the knee and dorsiflex)

Any of these preceeding steps can cause impingement on the dura, spinal cord, or nerve roots which can result in radicular symptoms in the area supplied by the sciatic nerve.

If any of the preceeding steps results in sympoms, the clinician can ask the patient to straighten the neck but keep the knee fully extending and the foot fully dorsiflexed

Relief of radicular symptoms indicates a positive test. (If symptoms persist, they may be d/t pathology in the leg musculature rather than the dural region)

Question 16

Spurling’s Test

Answer 16

Best test for confirming the diagnosis of cervical radiculopathy (cervical disc herniations, cervical spondylosis)

Ask the seated patient to rotate and laterally flex the head to the unaffected side first then to the affected side

Clinician should use one hand to lightly compress downward on the head to axial load the cervical spine
o If tolerated well, test may be repeated in the rotated and laterally flexed position with cervical extension added.
o This maneuver narrows the neural foramen and will increase or reproduce radicular arm pain a/w cervical disc herniations or cervical spondylosis
o Positive test: pain radiates into the limb ipsilateral to the side in which the head is rotated

Question 17

Straight Leg Raise (supine)

Answer 17

Place patient in supine position

Examiner raises the patient’s extended leg on the symptomatic side with the foot dorsiflexed (patient may not actively “help”)

Results in increased dural tension in the lower lumbar and high scaral regions

Positive test: worsening of radicular pain w/ the straight leg maneuver (usually occrs w/ 30-60 degrees of flexion)

Question 18

Trendelenburg Test

Answer 18

Useful to evaluate hip abductor strength (primarily the gluteus medius)

Stand behind the patient to observe the level of the pelvis as you instruct the patient to stand on one leg

With normal hip abductor strength, the pelvis will remain level

Postivie test: Pelvis drops below the level on the opposite side (occurs d/t inadequate hip abductor strength)

Question 19

Waddell’s sign (nonorganic signs)

Answer 19

If results of ≥ 2 of these tests (including a subjective evaluation) are positive, the examiner should be concerned that issues other than periperal nocioception are creating pain behavior.

With the patient standing, lightly touch the tissues over the lumbar spine

With the pateint standing, apply light downward pressure on the patient’s head

Question 20

Wright’s Test

Answer 20

From sitting position you hold your arm up and back (hyperabduction), rotating it outward, check for decreased pulse or reproduction of symptoms

Positive test can suggest thoracic outlet syndrome