Ortho Spine Specialized Physical Exam Tests Flashcards
Adson’s Sign
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
Bowstring’s sign:
Relief of radicular pain that occurs when the knee is flexed during a positive straight leg raise
Cervical Distraction
Place patient in supine position
Apply gentle manual distraction
Positive test: reduced neck and limb symptoms
Helpful to diagnose radiculopathy
Compression Test (for thoracic outlet syndrome)
Exert pressure b/w clavicle and medial humeral head
Positive test: causes radiation of pain +/- numbness
Can indicate thoracic outlet syndrome
Crossed (contralateral) SLR
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)
FABER Test (Patrick’s Test, figure of 4 test, Jansen test)
FABER: flexion-abduction-external rotation
Stress maneuver to detect hip and sacroiliac pathology
Forward bend test (Adams forward bend test)
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
Lasegue’s sign:
Presence of worsening of radicular pain w/ the straight leg maneuver
Usually occurs when hip flexion is between 30 and 60 degrees
Lhermitte sign
Have patient flex their neck
Positive test: Electric (shock-like) sensations radiating down the spine (sometimes into the extremtities)
Helpful to diagnose radiculopathy
Occiput to Wall Test
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
Rhomberg’s sign
Swaying of the body when the feet are placed close together and the eyes are closed
Can be seen with myelopathy
Reverse Straight Leg Raise
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)
Roos Stress Test (Elevated Arm Stress Test/EAST)
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)
Seated SLR
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.
Slump Test of Matiland (Meningeal test)
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)
Spurling’s Test
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
Straight Leg Raise (supine)
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)
Trendelenburg Test
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)
Waddell’s sign (nonorganic signs)
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
Wright’s Test
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
