Orthopedic Tests Flashcards
Rust’s Sign
Patient spontaneously grasps the head with both hands when lying down or when rising from a recumbent position
+ Rust’s sign
Indicates:
- Severe sprain
- RA
- Fracture
- Severe cervical subluxation
When Rust’s sign is present, this indicates a severe ___________ instability
Upper cervical
Libman’s Sign
Examiner applies thumb pressure to the mastoid process and gradually increases the pressure until the patient states that it is becoming noticeably uncomfortable
+ Libman’s Sign
Patient is exhibiting an unusually low or high threshold for pain
Bakody Sign
Patient will be in a seated position and will place the hand of the affected extremity on top of their head, raising the elbow to the level of the ear
+ Bakody Sign
Patient has nerve root irritation (position tractions the brachial plexus which reduces irritation) that is diminished by this posture/sign
+ Reverse Bakody Sign. What does this indicate?
Pain is exacerbated
-Thoracic Outlet Syndrome from interscalene pressure
Negative Bakody Sign. What does this indicate?
No change in pain
-DDX nerve root encroachment from a thoracic outlet syndrome
Bikele’s Sign
Patient is asked to abduct their shoulder to 90 degrees and then the elbow is put into full extension
+ Bikele’s Sign
The patients pain will be radicular and extend into the arm (from tractioning of the brachial plexus)
Brachial Plexus Tension Test
Patient is asked to abduct both shoulder to 0- degree and place the hands behind the head. Doctor then pulls the elbows back
+ Brachial Plexus Tension Test
Pain radiates into the patients arm
Any functional disturbance and/or pathological change in the spinal cord; often used to denote nonspecific lesions
Myelopathy
Cervical orthopedic tests for dural irritation
- Brachial plexus tension
- Lhermitte sign
- Shoulder depression test
- Kernig-Brudzinski
- Soto-Hall
Characteristic fever, headache, stiff neck (nuchal rigidity), febrile sign
Meningitis
Febrile sign
During passive flexion on the neck, the knees will automatically bend
Cervical orthopedic tests for meningitis
- Kernig-Brudzinski
- Bikele
- Brachial plexus tension
- Soto-Hall
Best methods for identifying myelopathy
- Hoffman’s
- DTR in the UE
- Inverted supinator reflex
- Suprapatellar quadriceps reflex
- Hand withdrawl reflex
- Babinski sign
- Clonus of the ankle
Lhermitte’s Test
With the patient seated, the doctor instructs the him/her to drop their chin to their chest. The doctor then passively flexes the patient head
+Lhermitte’s Test
Patient experiences shock like sensations radiating down the neck and spine
+Lhermitte’s sign indicates what 2 possible pathologies?
- Posterior Column Disease
- MS
If a patient has MS, where on their body are they most likely to test + for Lhermittes?
Back of the neck, lower back, and other parts of the body.
What is thought to cause MS patients to test + for Lhermitte’s sign?
Hypersensitivity of demyelinated cervical sensory axons to stretching
T/F Lhermitte’s sign is said to have been present at some point of the course of MS in 80% of patients
FALSE.
40%
What signs/symptoms during a physical exam will rule out meningitis if present?
- Absence of fever
- No neck stiffness
- No altered mental status
Among patients with fever and a headache, ___________________ if headache is a useful adjunctive manuever
Jolt accentuation
Kernig-Brudzinski Sign
- With the patient laying supine, the doctor passively flexes the cervical spine (Brudzinski)
- With the patient lying supine, they are asked to flex their hip to 90 degrees with knee extension (Kernig)
+ Kernig-Brudzinski
Febrille sign
-opposite knee and hip flexion occurs and/or patient reports pain in the neck
Soto-Hall Test
Patient lies supine. Doctor places knife edge of hand on the sternum to brace thoracic region. Passive flexion of the cervical spine occurs
What is Soto-Hall used to evaluate?
Check for cervical sprain, fracture, facet, of SOL problems
Valsalva’s maneuver
Doctor stands in front of the patient and instructs the patient to take in a deep breath and bear down
+ Valsalva’s maneuver
Patient will experience pain at the location of the SOL
What physiologically causes a + Valsalva’s maneuver?
Increases abdominal and thoracic pressure which blocks blood flow in the intervertebral veins from the epidural space and causes a retrograde flow of blood. This causes distension of the epidural space which forces the dura toward the spinal cord which stretches the dura and pulls the nerve root tractioning it and causing pain
Dejerine’s Triad/Sign
Patient will report that coughing, sneezing, straining causes aggravation of symptoms
Sudden unexpected adscence of Dejerine sign with all other nerve root findings still present would point to what?
Fragmentation of the disc
Swallowing Test
Patient is giving a glass of water and instructed to drink
+ Swallowing Test
Presence of pain/difficulty swallowing
What could a + Swallowing test indicate?
- SOL
- Sprain/strain
- Fracture
- Disc problem
- Tumor
- Osteophyte
- Esophageal irritation from trauma or retroesophageal SOL
Cervical orthopedic tests for IVE encroachment
- Distraction Test
- Foraminal Compression Test
- Jackson’s Compression Test
- Maximum Cervical Compression Test
- Spurling’s Test
Naffzinger’s Test
Doctor stands behind the patient and occludes the external jugular vein at the clavicle for 10-15 seconds. Doctor then acts the patient to cough
+ Naffzinger’s Test
Back of venous flow accentuates intra-thecal pressure much like mechanism of Vasalvas. Creates a localized pain area for the lesion
Distraction Test
Doctor exerts upward pressure on the patient’s head
+ Distraction Test
- Increased pain = Muscle spasm
- Decreased pain = confirms IVF encroachment
Foraminal Compression Test
Doctor exerts downward pressure on the head in a neutral position and rotated position bilaterally
+ Foraminal Compression Test
Rotation and compression cause closure of the IVF
- Local pain = foraminal encroachment
- Radicular pain = pressure on the nerve root
Jackson Compression Test
Patient rotates and laterally flexes the head. Downward pressure is placed on the spine on the spine in the neutral and lateral flexion positions
+ Jackson Compression Test
Used to confirm IVF encroachment and nerve root involvement
- Pain ipsilateral flexion = facet or nerve root involvement
- Pain contralateral flexion = muscle strain
Maximum Cervical Compression Test
Patient actively extend, rotate, and laterally flexes the neck to its maximum position
+ Maximum Cervical Compression Test
Ipsilateral pain = nerve root or facet involvement
Contralateral pain = muscle strain
Spurling’s Test
Have patient exhibit their normal cervical ROM. After that, downward pressure in performed in the neutral, lateral flexion, and finally a vertical blow is delivered to the top of the head in a neutral position
+ Spurling’s Test
Confirms IVF encroachment and nerve root involvement
Upper Limb Tension Test
Patient is supine. Depress scapula, supinate forearm and wrist, finger extension, elbow extension. Follow with contralateral and ipsilateral spine bending
+ Upper Limb Tension Test
- Reproduction of pain/symptoms
- Side to side difference is more than 10 degrees
- Contralateral neck bend increases symptoms while ipsilateral decreases
Cervical Radiculopathy Test Cluster
- Upper Limb Tension Test A
- Reduced Cervical Rotation
Orthopedic test for Brachial plexus injuries
- Bakody’s Test
- Bikele’s Test
- Brachial plexus tension test
- Brachial plexus compression test
Signs/symptoms of a brachial plexus injury
Lack of muscle control in the arm, hand, or wrist, and a lack of feeling or sensation in the arm or hand, tingling through the arm and hand. Often occur secondary to trauma, tumors, or inflammation
Bakody’s Test
Patient will place the back of the hand on the top of the head
+ Bakody’s Test
Decreases traction of the lower brachial plexus and diminishes pain
+ Reverse Bakody’s Sign
Same procedure as Bakody’s test except this will increase the pain
Cause of a + Reverse Bakody’s Sign
Thoracic Outlet Syndrome from scalene compression
Bikele’s sign
Abduct the shoulder to 90 degrees and reach back stretching the nervous tissue. Similar to upper limb tension test
+ Bikele’s sign
Traction of the brachial plexus increases radicular pain symptoms
Brachial Plexus Tension Test
Patient placed both hands on the back of the head. Dr. Pulls elbows back stressing the brachial plexus
+ Brachial Plexus Tension Test
Stressing increases radicular pain
Brachial Plexus Compression
Dr. Squeezes the brachial plexus between the thumb and index finger
+ Brachial Plexus Compression
Pain radiates to the shoulder and UE
Orthopedic Tests for Thoracic Outlet Syndrome
- Allens Test
- Adsons
- Modified Adsons
- Halstead
- Allens Maneuver
- Roos test
- Wrights test
- Costoclavicular maneuver
Allens Test
With hand on thigh patient opens and closes the palm 5 times keeping a closed hand tightly after the 5th. Dr. occludes both radial and ulnar artery just proximal to the wrist. Patient will then open hand and Dr. releases one of the vessels from compression. Compare refill bilaterally with both vessels bilaterally
+ Allens Test
Delayed color return during compression reveals blockage
-Also can be a sign of compartment syndromes in the arm
The _______ artery runs between the brachioradialis and the flexor carpi radialis, while the ____ artery lies under the flexor carpi ulnaris
Radial
Ulnar
(Both are branches off the brachial, axillary, subclavian, etc.)
How is the blood supply of the hand ensured even if one of the arteries to the hand is occluded?
Ulnar and radial arteries form anastomoses in the hand (deep and superficial palmar arch)
Adson’s Test
Dr. palpates the radial pulse for rate, rhythm, and amplitude. Palpation is maintained while abducting and externally rotating the patients arm. Then have the patient rotate the head to the side being tested. Extend the neck as far as possible and inhale deeply and hold for 10 seconds
+ Adson’s Test
Parathesia or a decrease in pulse is noted
Function of the Adson’s Test. What structure is most indicative of a problem given a positive sign?
Test neurovascular compression of the subclavian artery and the brachial plexus
-Anterior scalene hypertrophy and or cervical rib are the most common causes of compression with this test
Modified Adson’s Test
Dr. palpates the radial pulse for rate, rhythm, and amplitude.
Maintain palpation wile abducting and externally rotating the patients arm. Then have patient rotate the head opposite the side being tested, extend the neck as far as possible, and inhale deeply and hold for 10 seconds
Function of the Modified Adson’s Test. What sctructure is most indicative of a problem given a positive sign?
Tests neurovascular compression of the subclavian artery and brachial plexus.
-Middle scalene hypertrophy and/or cervical rib is the most common causes of compression with this test
+ Modified Adson’s Test
Parasthesia or decrease in pulse is noted
Halstead Test
Dr. palpates the radial pulse for rate, rhythm, and amplitude. Maintain palpation wile abducting and externally rotating the arm. While the patient extends the neck as far as possible the Dr. tractions the arm by pulling down, if no change in pulse, then have patient rotate the head opposite the side being treated, and inhale deeply and hold for 10 seconds.
(Halstead is Modified Adson’s + Traction of the arm)
Function of the Halstead Test. What structure is most indicative of a problem given a positive sign?
Tests neurovascular compression of the subclavian artery and brachial plexus.
-Middle scalene hypertrophy and or cervical rib are the most common causes of compression with this test
+ Halstead Test
Parasthesia or decrease in pulse noted
Allen’s Maneuver
Dr. flexes patients elbow to 90 degrees while the shoulder is abducted and externally rotated. Patient then rotates the head away from the test side.
+ Allen’s Maneuver
Disappearance of radial pulse
Wrights Test
Palpating the radial pulse, the arm is abducted to 180 degrees. Compare side to side.
+ Wrights Test
Disappearance of the radial pulse
Which is the most common cause of a + Wrights Test?
Axillary artery compression under the Pec minor.
Roos Test
Patient has shoulder and elbow in a 90-90 position and hold for one minute, may also open and close fingers.
+ Roos Test
Increased tingling or parasthesias from stressing the thoracic outlet
Costoclavicular/Eden’s Test
Patients arms resting on thighs, Dr. will evaluate pulse rate, rhythm, and amplitude. Patient then draws shoulder downward, backward, and lowers the chin to chest while taking a deep breath then holding for 10 seconds
Fucntion of the Costoclavicular/Eden’s Test
Checks for compression of the subclavian artery and brachial plexus
Apley’s Test
Patient is seated and is instructed to place the affected hand behind the head and touch the opposite superior angle of the scapula. The patient is then instructed to place the hand behind the back and attempt to touch the opposite inferior angle of the scapula.
+ Apley’s Test
Exacerbation of the patients pain indicates degenerative tendinitis of one of the tendons of the rotator cuff, usually supraspinatus
Apprehension Test
The examiner abducts and externally rotates the patients shoulder.The examiner than lays the patient down and provides a posterior force on the joint
+ Apprehension Test
Patient turns toward examiner and the pain gets worse in the shoulder. Indicates a anterior or posterior shoulder dislocation depending on the position of the patient. Indicates laxity of the shoulder joint
Codman’s Sign
Patients arm is passively abducted. The examiner suddenly removes support at some point above 90 degrees, which makes the deltoid contract suddenly
+ Codman’s sign
Severe shoulder pain occurs or hunching of the shoulder due to the absence of rotator cuff function primarily from tearing of the supraspinatus tendon.
Indicates tear in the rotator cuff complex tendons
Dawbarn’s Sign
With the patients arm comfortably at their side, deep palpation of the shoulder by the examiner elicits a well-localized, tender area. With the examiner’s finger still on the painful spot, the patient’s arm is passively abducted by the doctor.
+ Dawbarn’s sign
Pain over the point being palpated by the doctor is decreased as the arm becomes more abducted.
Indicates subacromial bursitis
Dugas’ Test
The patient places the hand of the affected shoulder on the opposite shoulder and attempts to touch the chest with the elbow.
+ Dugas’ Test
Shoulder dislocates
Indicates laxity of the shoulder joint for propensity of dislocation
Impingement Sign (Neer Sign)
The patients arm is slightly abducted and moved fully through flexion by the doctor, causing jamming of the greater tuberosity against the anteroinferior acromial surface.
+ Impingement Sign (Neer Sign)
Pain in the shoulder arises
Indicates possible supraspinatus and/or biceptial irritation aw well as DJD (over use injury)
Speed’s Test
Doctor provides resistance to flexion of the shoulder by the patient
+ Speed’s Test
Pain in the bicipital groove
Indicates biceps tendonitis
Supraspinatus Press Test
Patients shoulder is abducted to 90 degrees and the doctor provides resistance to this abduction. The shoulder is then medially rotated and angled 30 degrees forward so the patients thumb points to the floor. The doctor provides resistance to abduction
+ Supraspinatus Press Test
Weakness in abduction or pain is present
Indicates supraspinatus muscle or tendon tear
Yergason’s Test
Patient flexes the elbow while seated. The doctor resists the patient’s attempt to suppinate the hand. Then the patient resists the examiners efforts to extend the affected upper extremity.
+ Yergason’s Test
Pain over the intertubercular groove arises are becomes aggravated or a “pop” over the transverse humeral ligament (tenosynovitis)
Indicates possible transverse humeral ligament rupture (pop) and/or biceps tendonitis (pain)
Load and Shift Test
With the doctor stabilizing the scapula with one hand and grasping the humeral head with the other, the doctor loads the shoulder by pushing in towards the glenoid, then pushes forward to test anterior stability and finally pulls backwards to test posterior stability. The examiner then pulls down on the arm to test inferior stability
+ Load and Shift Test
Laxity of the joint may be noted during loading and translation. Visible sulcus may appear under the acromion with a multi-directional loose shoulder
Indicates shoulder instability
Lift Off Test
Patient places the dorsum of the hand on their lumbarsacral region and attempts to push backward with his hand, lifting the hand off of the lumbosacral region
+ Lift Off Test
Decreased range of motion would be noted by the inability to lift the hand of the lumbosacral region as far as the opposite side.
Tests the strength/tendon of Subscapulris
O’Brien’s Test
The patient flexes the arm to 90 degrees with the elbow in full extension. Patient adducts the arm 10-30 degrees with thumb up (full supination). Doctor applies downward pressure to the arm while the patient resists. Then the patients keeps the same position, but rotates the thumb down. Doctor applies downward pressure to the arm while the patient resists.
+ O’Brien’s Test
Pain happens when the thumb is pointed down indicates a labral tear
Indicates a SLAP tear
Elbow Flexion Test
Patient is asked to hold the elbow in flexion for 5 minutes to test for cubital tunnel syndrome
+ Elbow Flexion Test
Tingling or paresthesia in the ulnar distribution of the forearm and hand suggests the presence of cubital tunnel syndrome
Cozen’s Test
The patient is directed to clench the fist tightly, dorsiflex it, and maintain a pronated position. While grasping the patients lower forearm, the doctor applies a flexing force to the dorsiflexion posture of the patient’s wrist.
+ Cozen’s Test
Resistance reproduces acute lancinating pain to the region of the lateral epicondyle.
Indicates Lateral Epicondylitis (Tennis-Elbow) or radio-humeral bursitis
Golfer’s Elbow Test
While the patient is sated, the doctor flexes the patients elbow slightly against resistance.
+ Golfer’s Elbow Test
Pain is present over the medial epicondyle indicates medial epicondylitis
Ligamentous Instability Test
Patients arm is stabilized with one of the doctor’s hands at the elbow. The doctors other hand is placed at the patient’s wrist. With the patients elbow slightly flexed and stabilized with the doctors hand, an adduction (varus) force is applied to the distal forearm by the examiner to the test the lateral collateral ligament. This is redone several times with increases pressure to check the joint play and observe any pain. The procedure above is repeated only with a abduction (valgus) force to test the medial collateral ligament.
+ Ligamentous Instability Test
Doctor notes laxity, decreased mobility, or altered pain.
