Orthopedic tests Flashcards
Bakody sign
Hand on head alleviates symptoms. Nerve root syndrome
Barre Lieou sing
Patient sits and moves head from side to side faster and faster. + blurred vision, nausea, nystagmus. Vertebral artery syndrome.
Bikele’s sign
Patient Seated, Shoulder at 90 degrees externally rotates and reaches back behind body. + produces radicular pain. Radiculopathy
Brachial Plexus Tension Test
Patient seated with hands behind head. doc supports elbows, Patient flexes head forward. + reproduction of radicular symptoms. Nerve root syndrome, probably c5
Distraction test
patient seated, Doctor lifts head. + relief of radicular symptoms. nerve root compression
Foraminal compression test
Patient seated, head neutral. Doc puts downward pressure on top of head. Turn head toward side of complaint and repeat. + localized pain. Foraminal encroachment
Hautant’s test
Patient Seated, arms extended out front and supinated for a few seconds. Then patient closes eyes and rotates head and hyperextends. + significant drifting of hands. Vertebral basial vascular compromise
Maximum cervical compression test
Patient seated and rotates head and then extends neck toward side of radicular complaint. + radicular symptoms reproduced. Foraminal Encroachment
O’Donaghue Maneuver
Patient seated, doctor holds patient’s head and asks patient to try and rotate head against isometric resistance. +pain. Muscle strain. (if there is no pain but there is with passive turning of patient’s head, then it’s ligament injury)
Rust sign
Patient presents supporting wt of head in hands because cannot tolerate wt of head. Gross instability of upper C spine due to fracture or severe sprain.
Shoulder depression test
Patient seated and doc presses head into lateral flexion while also pressing shoulder down. + increase in symptoms. Brachial plexus or dural sleeve adhesions.
Soto Hall
Patient supine, doctor supports head with one hand and chest with other. Head is passively flexed, chin to chest. + Pain in the cervical or thoracic spine. General instability of c and or t spine. (if knees reflexively bend could be meningitis.)
Spurling’s test
Patient seated, turns head side to side to localize pain. Doc supports neck and head is laterally flexed to side of pain. Doc applies downward pressure to head and neck. if reproduction of symptoms or collapse sign then stop. Otherwise extend head as far as patient can tolerate, and reapply downward pressure. + radicular pain, nerve root compression. + localized pain, facet involvement.
Swallow test
Doc has patient drink a glass of water. + Pain. Esophageal irritation due to direct retroesophageal space occupying mass. (Like D.I.S.H. )
Valsalva’s
Patient asked to take in deep breath, seal nose and mouth and blow out against that seal as hard as they can. + pain. Nerve root compression by space taking lesion.
ROM of shoulder
Flexion 180 (less than 160 impaired) Extension (less than 40 impaired) Abduction, 180 (less than 160 impaired) Adduction (less than 30 impaired) internal and external rotation, 90, (less than 60 impaired)
Nerve roots for Shoulder.
Flexion c5-c6 Nerve, Axillary nerve. Extension c6-c8, Abduction c5-c6. Adduction c5-c6. External rotation, c5-c6. Internal rotation c5-t1.
Abbott Sounders test
Patient seated. Doc places hand over Patient shoulder to be able to palpate bicep tendon. Then abducts patient’s arm, then externally rotates arm and lowers arm. + audible or palpable click . Bicep tendon subluxation or dislocation.
Adson’s test
Patient seated. Doc stands behind patient finds radial pulse on affected side. Doc slightly extends arm while feeling pulse. Patient is instructed to turn head to affected side and extend head take in a deep breath and hold it. + pulse disappears. Thoracic Outlet Syndrome.
Allen Maneuver (shoulder)
Patient seated. Doc abducts the affected shoulder to 90 degrees and flexes elbow 90 degrees and externally rotates elbow while taking radial pulse. Patient instructed to turn head away from affected side. + pulse disappears. Thoracic Outlet Syndrome.
Appley’s test
Patient seated, instructed to place hand of affected arm behind head and touch opposite scapula. Then to repeat with hand behind back. + pain reproduced. tendonitis of supraspinatus.
Apprehension test
Patient seated, Doc slowly abducts and externally rotates patients affected arm. + look or feeling of alarm. Anterior shoulder dislocation.
Bryant’s sign
Doc observes both axial folds. + one is lower than the other. Glenohumeral dislocation.
Codman’s sign
Patient seated. Doc abducts affected arm slightly above 90 degrees and drops arm. + pain and hunching of shoulder. Rotator cuff tear.
Costoclavicular maneuver
Patient seated. Doc palpates both radial pulses, extends patient shoulders and has patient flex head downward. + disappearing pulse. Thoracic outlet syndrome.
Dawburn’s sign
Patient seated. Doc palpates tender spot over subacromial bursa. Doc abducts arm. + pain goes away. Subacromial bursitis.
Dugas test
Patient seated. Instructed to place hand on opposite shoulder and then lift elbow. + pain. Shoulder subluxation/dislocation.
Impingement sign
Patient seated. Doc slightly abducts arm and moves it through flexion. + pain. Overuse injury to supraspinatus/bicep tendon.
Ludington’s test
Patient seated, clasps hands behind head. Doc palpates both biceps tendons and asks patient to flex and relax biceps. + cannot feel tendon. Rupture of long head of the bicep tendon.
Reverse Bakody maneuver
If placing affect arm on head increases pain,. Interscalene compression of the lower branches of the brachial plexus.
Roo’s test
Patient seated, holds hands up arms and elbows flexed to 90 degrees. Asked to open and close hands for 3 minutes. + significant increase in symptoms. Thoracic outlet syndrome.
Shoulder compression test
Patient seated. Doc exerts downward pressure on coracoid process. + neurovascular compression symptoms. Hyper abduction thoracic outlet syndrome.
Speed’s test
Patient seated and flexes arm while doc provides resistance. Patient then supinates arm and completely extends elbow. + pain. Biceps tendonitis.
Subacromial push button sign
Patient seated. Doc presses down with finger or thumb into supraspinatus. +pain. Supraspinatus tear.
Supraspinatus press test
Patient seated, arms and elbow flexed 90 degrees, palms down. presses up against doc resistance. then patient rotates thumbs down and internally rotates shoulder and repeats pressing up against resistance. + pain. Supraspinatus tear.
Transverse humeral ligament test
Patient seated. Doc palpates the the bicipital groove then abducts arm to 90 degrees and internally and externally rotates shoulder. + palpable snap of the tendon. Transverse humeral ligament tear.
Wright’s test
Patient seated. Doc palpates radial pulse and slowly abducts arm. +pulse disappears. Hyperabduction thoracic outlet syndrome.
Yerganson’s test
Patient seated (or standing really) Doc palpates the biceps tendon and patient fights against flexion and external rotation. + pain. Tenosynovitis or involvement of the transverse ligament.
Cozen’s test
Patient seated, elbow slightly flexed, hand pronated. then makes fist and dorsiflexes the wrist. Doc trys to flex the hand. +pain at the lateral epicondyle. Lateral epicondylitis.
Elbow flexion test
Patient seated with elbow fully flexed for as long as possible. ( 5 minutes) + ulnar nerve paresthesia. Cubital tunnel syndrome.
Golfers elbow test
Patient seated, arm slightly flexed, hand supinated and flexed as doc tries to force hand into extension. + Pain over medial epicondyle. Medial epicondylitis.
Ligamentous Instability test
Patient seated, arm slightly flexed hand supinated. Doc supports elbow while putting valgus/varus pressure on distal forearm. + pain. Elbow sprain of collateral ligaments.
Mills test
Patient seated. Doc passively flexes elbow then flexes patient wrist. Patient flexes fingers. Maintaining wrist and finger flexion, the doc then extends the elbow and at full extension pronates the forearm. +pain over lateral epicondyle. Lateral epicondylitis.
Tinel’s sign at elbow
Patient is seated arm flexed at elbow. Doc percusses over nerve at lateral epicondylar groove and medial epicondylar groove. + tingling (nerve palsy) + pain (nerve degeneration)
Allen’s test (wrist)
Patient is asked to open and close hand until all the blood is pumped out of it then hold a closed fist and the doc puts pressure on both arteries, then releases one of them. + takes longer than 5 seconds for blood to return. vascular compromise.
Bracelet test
Patient is seated doc wraps fingers around wrist applying lateral compression to distal radius and ulna. + acute pain. Rheumatoid arthritis.
Carpal lift sign
Patient seated hand, palm down on table. Doc fixes other digits down and has patient try to lift affected digit against resistance. + pain on dorsum of wrist. Carpal fracture or sprain.
Cascade sign
Patient closes hand so fingers rest on thenar eminence. should be a nice flowing line across finger tips. + not a nice line of fingers. internal derangement of metacarpals or carpals or both.
Finkelstein’s test
patient wraps fingers around thumb of affected hand. then ulnar deviates the wrist. + pain in anatomical snuff box. Stenosing tenosynovitis.
Finstern’s sign.
Doc percusses just proximal of the proximal head of the 3rd metacarpal. + pian distal to center wrist. Kienbocks disease (aseptic necrosis of the lunate)
Froment’s paper sign
Patient abducts fingers, doc places paper between them. patient adducts fingers and is asked to try and hold paper while doc tries to pull it out. + can’t hold paper. Ulnar nerve paralysis.
Interphalangeal neuroma test
Doc probes metacarpophalangeal interdigital tissues with blunt end of reflex hammer. +severe pain. Neuroma.
Maisonneuve’s sign
patient seated arm pronated extends wrist. + marked hyperextension. Collies fracture.
Phalen’s sign
Patient seated and presses backs of hands together for 60 seconds. + median nerve paresthesia. Carpal tunnel syndrome.
Pinch grip test
Patient makes an “OK” sign. finger and thumb should be tip to tip. + pulp to tip. anterior interosseous never involvement.
Tinel’s sign
Doc percusses over carpal tunnel. + tingling/pain. Carpal tunnel syndrome.
Wartenberg’s sign
Patient asked to grip dynamometer. + 5th digit remains abducted and doesn’t contribute to grip. Ulnar nerve palsy
Wringing test
Patient asked to wring towel with maximum effect. + pain in wrist (carpal arthropathy) +pain in elbow (epicondylitis) + tingling in hand ( carpal tunnel syndrome)
Thoracic spine ROM
Flexion, 20 to 45 degrees. (less than 30 impaired) Extension 25 to 30 degrees (less than 20 impaired) Lateral flexion 20 to 40 degrees, Rotation 35 to 50 degrees. (less than 20 impaired.)
Adam’s positions
Have patient bend forward and observe T spine for humps/deformity. (scoliosis screening)
Amos’s sign
Patient lies on side on table and attempts to move to a seated position. + localized T spine and T-L spine pain. Ankylosing Spondylitis, severe sprain or disc issues.
Anghelescu’s sign
Patient is supine. Doc has patient arch up to lift T spine off table and rest weight on shoulders. + inability to do this. Tuberculosis spondylitis.
Beevor’s sign
Patient supine, doc obsever umbilicus and holds legs down. Has patient do a partial sit up. + drifts up, lower T spine involvement, drifts down, upper T spine involvement, but not above T7.
Chest expansion test
Have Patient exhale, and take measurement around ribs, then have patient take deep inhale and measure agian. Normal is 5.75 to 7.62cm (1.5 to 3 inches)
First Thoracic never root test
have patient place hand behind head. +pain in scapular area. T1 nerve root involvement.
Forestier’s bow string sign
as patient tries to laterally flex t spine, + tightening or contracture of musculature on the same side as flexion. Ankylosing spondylitis
Passive scapular approximation test
doc approximates the scapulae by pulling the shoulder tips backwards. + pain in the scapular area. t1 or t2 nerve root involvement.
Schepelmann’s sign
Patient puts both arms in the air palms facing each other and laterally flexes torso. + pain on flexed side (intercostal neuritis) +pain on convex side (intercostal myofascitis.
Lumbar ROM
Flexion 80 degrees (less than 60 impaired) Extension 35 degrees (less than 20 impaired) lateral flexion 25 degrees (less than 20 impaired)
Antalgia sign
If disc is protruding lateral to nerve, patient leans toward affected side. If disc is protruding medial to nerve, patient leans away from affected side. and if central patient flexes forward.
Bechterew’s sitting test
Patient sits and extends one leg. Doc presses on thigh. + increase in back pain or sciatic pain. + pain if extending both legs at once. Sciatica, disc lesion, exostosis, adhesions, spasms or subluxations.
Bilateral leg lowering test
Patient is supine, doc flexes both legs to 90 degrees and asks patient to lower them to 45 and hold them. + inability to do so. Lumbosacral involvement.
Bowstring sign (L spine)
Patient supine, doc places affected leg ankle on shoulder and buts firm pressure near insertion of hamstring muscles. if painful then puts pressure in popliteal fossa. + pain in lumbar region or radicular pain. Nerve root compression.
Braggard’s sign
After pain reached with SLR, lower leg until pain is gone and then dorsiflex foot. + Pain returns. Disc bulge, sciatica, cord tumors.
Cox sign
When performing a SLR, +pelvis rises off table rather than flexing at hip. Nucleus prolapse into IVF
Double leg raiser
after pain from SLR doc makes note of angle. Then raises both legs at once. + pain at lower angle than SLR. Lumbosacral joint involvement.
Ely’s sign
Patient prone and doc flexes knee of affected leg 90 degrees and then takes heal to opposite buttock. after flexion the thigh can be hyper extended. + anterior thigh pain. Inflammation of lumbar nerve roots.
Fajersztajn’s test
Braggards on unaffected leg +pain in affected leg sciatica with disc involvement.
Femoral nerve traction test
Patient lying on unaffected side. Doc supports pelvis with one hand and takes affected leg and wraps it around his hips stretching then anterior thigh. + anterior thigh pain. Radiculopathy L2,3,4.
Heel/Toe walk test
+ If cannot walk on toes, tibial nerve, L5 S1 disc, S1 dermatome. + if cannot walk on heels, Common peroneal nerve, L4 L5 disc, L5 dermatome
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