Ortho Tests

Question 1

(Spinal Cord & Meningeal Testing)
Kernig Sign:
Pt supine, examiner passively flexes pt’s hip to 90 degrees & the pt’s knee to 90 degrees. examiner extends pt’s leg completely.
+/ind?

Answer 1

\+ = inability to fully extend the leg and/or pain (usually in the neck region)
ind. = meningeal irritation/meningitis

Question 2

(Spinal Cord & Meningeal Testing)
Brudzinski Sign:
Pt supine, examiner flexes pt’s head to the chest.
+/ind?

Answer 2

\+ = involuntary knee flexion
ind. = meningeal irritation or nerve root lesion (classic test for meningitis)

Question 3

(Cervical Spine & Nerve Root Testing)
Soto-Hall Sign:
Pt. supine, examiner flexes pt’s head toward hi/her chest while exerting downward pressure on pt’s sternum w/hypothenar eminence of inf hand.
+/ind?

Answer 3

\+ = generalized pain in the cervical region, which may extend down to the level of T2.
ind = non-specific test for the structural integrity of the cervical region.

Question 4

(Cervical Spine & Nerve Root Testing)
Foraminal Compression Test:
Pt seated with examiner standing behind. examiner clasps hi/her hands over pt’s head & exerts gradual increasing downward pressure. Examiner repeats this procedure w/ the pt’s head rotated right and then left.
+/ind?

Answer 4

\+ = exacerbation of localized cervical pain
ind = foraminal encroachment or facet pathology w/o nerve root compression
\+ = exacerbation of cervical pain w/ a radicular component
ind = foraminal encroachment or facet pathology with a nerve root compression

Question 5

(Cervical Spine & Nerve Root Testing)
Jackson Compression:
Pt seated w/ examiner standing behind. Examiner laterally flexes the pt’s head to one side & clasps his/her hands over pt’s head & exerts increasing downward pressure. perform bilaterally.
+/ind?

Answer 5

\+ = exacerbation of localized cervical pain
ind = foraminal encroachment w/o nerve root pressure or facet pathology 
\+ = exacerbation of cervical pain with a radicular component
ind = foraminal encroachment w/nerve root compression (one would then want to evaluate the myotome, reflex & dermatome of the nerve root involved)

Question 6

(Cervical Spine & Nerve Root Testing)
Maximal Cervical Compression:
Pt seated w/examiner standing behind. The examiner instructs the pt to rotate the head and hyperextend the neck. Perform bilaterally.
+/ind?

Answer 6

\+ = pain on the concave side
ind = foraminal encroachment w/ or w/o nerve root compression (based on presence or absence of radicular component)

Question 7

(Cervical Spine & Nerve Root Testing)
Valsalva Maneuver:
+/ind?

Answer 7

\+ = radiating pain from site of lesion (usually positive in cervical or lumbar area of the spine)
ind = space occupying lesion (e.g. disc pathology)

Question 8

(Cervical Spine & Nerve Root Testing)
Cervical Distraction Test:
+/ind?

Answer 8

\+ = decrease or absence of radiating pain
ind = foraminal encroachment (local pain diminishes), nerve root compression (radicular pain diminishes)
\+ = increase in cervical pain
ind = muscular strain, ligamentous sprain, myospasm, facet capsulitis

Question 9

(Cervical Spine & Nerve Root Testing)
Bakody Sign (shoulder abduction test):
Pt seated, examiner instructs pt to place the palm of the affected side flat on top of their head.
+/ind?

Answer 9

\+ = decrease or absence of radiating pain 
ind = cervical foraminal compression, nerve root entrapment (usually C5/C6 level b/c this motion elevates the suprascapular nerve & relieves traction on the upper brachial plexus)

Question 10

(Spinal Cord & Meningeal Testing)
L’Hermitte Sign:
Pt sitting or supine, pt flexes the head toward the chest or Dr. actively flexes pt’s head toward chest.
+/ind=

Answer 10

\+ = electric shock-like sensations down the spine and/or thru extremities.
ind. = dural irritation, severe spinal cord injury or degeneration