Orthopedic Exams

Question 1

Kernig’s sign

Answer 1

Supine, passively flex hip and Knee to 90-90, then extend leg
Pain with fever - meningitis

Question 2

Brudzinski’s sign

Answer 2

Supine, passively flex neck

Pain with fever - meningitis

Question 3

Soto-Hall test

Answer 3

Supine, knife edge against sternum (immobilize T&L), active then passively flex neck
Fracture suspected

Question 4

Lalsalva’s maneuver

Answer 4

Seated, ask PM to bear down “heavy squat”

SOL, tumor, IVD, lesion, hemangioma

Question 5

Dejerine’s sign

Answer 5

Gathered from history
Cough, sneeze, strain cause aggravation of symptoms
Herniated disc, tumor, spinal compression fracture

Question 6

Distraction test

Answer 6

Supine or seated, traction neck 30-60 seconds
Increase pain: muscle spasm
Decrease pain: IVF encroachment, facet capsulitis

Question 7

Foraminal compression test

Answer 7

Seated, check ROM, compress neck in neutral and rotated position
Local pain: foraminal encroachment
Radiating pain: pressure on nerve root

Question 8

Jackson compression test

Answer 8

Seated, check ROM, compress neck in neutral and lateral flexion position
Same side pain: facet or nerve root involvement
Opposite side pain: muscle strain

Question 9

Maximum cervical compression test

Answer 9

Seated, actively extend, rotate, and lateral bend neck to max
Same side pain: facet or nerve root involvement
Opposite side pain: muscle strain

Question 10

Spurring’s test

Answer 10

Seated, check ROM, compress in neutral and Lat. flex neck, then downward blow to top of head in neutral position
IVF encroachment and nerve root involvement

Question 11

Bakody’s test

Answer 11

Seated, place back of hand on top of head w/ elbow above ear
Decreased pain
Decreased traction on lower brachial plexus

Question 12

Reverse Bakody’s sign

Answer 12

Increases pain

TOS, inter-scalene compression

Question 13

Bikele’s sign

Answer 13

Seated, actively aBduct shoulder to 90, then go into full extension
Increase radicular pain
Traction brachial plexus and nerve roots

Question 14

Brachial plexus tension test

Answer 14

Seated, hands behind head, doc pulls elbows back
Traction brachial plexus and nerve roots
Increase radicular pain

Question 15

Allen’s test

Answer 15

Seated, palms up on lap, squeeze hands 5x, occlude arteries, open hand, release one artery, check hand color
Radial artery runs - brachioradialis and flexor Capri radialis
Ulnar artery runs - flexor carpi ulnaris

Question 16

Halstead test

Answer 16

Seated, palpate pulse, aBduct and externally rotate arm, actively extend neck as far as possible, doc tractions arm, rotate head to opposite side, hold breath 10 seconds
Neurovascular compression of: subclavian artery and brachial plexus
MIDDLE scalene hypertrophy or cervical rib

Question 17

Allen’s maneuver

Answer 17

Seated, find pulse, shoulder and elbow 90-90, turn head away

TOS

Question 18

Wright’s test

Answer 18

Seated, find pulse, passively bring arm to 180, compare sides
Axillary artery under pectoralis minor

Question 19

Roo’s test

Answer 19

Seated, “hands up”, 90-90 arms, hold for 1-3 minutes

TOS, increased tingling or parathesias

Question 20

Costoclavicular (Eden’s) test

Answer 20

Seated, find pulse, patient draws back and down shoulders and chin to chest, hold breath for 10 seconds
Narrow space b/w clavicle and 1st rib
Compress subclavian artery and brachial plexus

Question 21

Lhermitte’s

Answer 21

Seated, passively flex neck
Traction of spine
MS, myelopathy, stenosis, spondylosis, protruding disc, n. root compression