Orthopedic Tests Upper Extremity

Question 0

Libman’s Sign

Answer 0

Procedure: Apply increasing thumb pressure to the mastoid until patient says it is noticeably uncomfortable.
Determines patients pain tolerance.

Question 1

Rust’s Sign

Answer 1

Procedure: Patient grabs head with both hands when lying down or sitting up from recumbent position. Indicates Severe Sprain, RA, Fracture, Cervical Sx.
Clinical Indication: Upper Cervical Instability

Question 2

Bakody Sign

Answer 2

Procedure: Patient places affected hand on head.
Positive Sign: pain diminishes- traction of lower part of brachial plexus
Reverse Sign: pain increases-Thoracic outlet syndrome
Negative: no change in pain

Question 3

Bikele’s Sign

Answer 3

Procedure: Patient reaches behind them.

Stresses the brachial plexus

Question 4

Brachial Plexus Tension Test

Answer 4

Procedure: Patient places hands behind head and doctor pulls on elbows back.
Stresses on the brachial and tests for traction

Question 5

Dejerine’s Sign

Answer 5

Procedure: Coughing, Sneezing, or Straining during defecation aggravates symptomes.
Suggests herniated disc, spinal cord tumor, or spinal compression fracture

Question 6

Valsalva’s Maneuver

Answer 6

Procedure: Patient Bears down

A sharp pain at a certain level indicates a space occupying lesion at that level.

Question 7

Swallowing Test

Answer 7

Patient swallows while seated.
Pain or difficulty indicates space occupying lesion, ligament sprain, muscle strain, fracture, disc protrusion, Tumor, osteophyte at A. cervical spine.

Question 8

Naffziger’s Test

Answer 8

Occludes Jugular vein for 10-15 seconds, then patient coughs.
Sharp increase of pain at the level of lesion

Question 9

Barr’e-Lie’ou Test

Answer 9

Patient is seated and rotates head as fast as they can.
Rules out vascular insufficiency, cervicogenic vertigo, and vestibular apparatus abnormality.
Positive with vertigo, nausea, syncope, and nystagmus

Question 10

Vertebrobasilar Artery Functional Maneuver

Answer 10

First auscultate subclavian and carotid arteries for bruit, then rotate and hyperextend the head and count back from 20.
Tests for vascular insufficiency.
Positive if bruit or vertigo, nausea, syncope, and nystagmus. Compresses vertebral arteries.

Question 11

DeKleyn’s Test

Answer 11

Supine, patient rotates and hyperextends and counts back from 20.
Testing for vertebral artery insufficiency.
Positive if vertigo, nausea, syncope, and nystagmus

Question 12

Distraction Test

Answer 12

Patient seated, Doctor exerts upward pressure on the head. hold for 30-60 seconds.
Pain relief if IVF encroachment or facet capsulitis, pain increase if muscle spasm.

Question 13

Foraminal Compression Test

Answer 13

First patient rotates head from side to side if no pain, exert downward pressure in neutral then rotated.
Localized pain-foraminal encroachment
Radicular Pain-nerve root

Question 14

Jackson Compression Test

Answer 14

First patient actively rotates head from side to side and laterally. Then doctor applies neutral downward pressure then pressure when laterally flexed. Pressure should be kept for 30-60 seconds.
Pain on opposite side-muscular strain
Pain on same side- facet or nerve root

Question 15

Maximum Cervical Compression Test

Answer 15

First Patient rotates the chin the the shoulder then extends the neck then Doctor exerts downward pressure.
Pain on concave side: nerve root or facet problem
Pain on convex side: muscular strain

Question 16

Spurling’s Test

Answer 16

First patient actively rotates-no pain- continue to active laterally flexion-no pain- continue to downward pressure in neutral for 30-60 seconds. Finally a vertical bop on the head.
Finds IVF encroachment at point of pain.

Question 17

Lhermitte’s Test

Answer 17

Patient, seated, drops chin to chest. Doctor then passively flexes head. Tractions posterior column of spinal cord.
Electric shock-like sensation down neck and spine is posterior column disease and is also a classic sign of MS

Question 18

O’Donoghue Maneuver

Answer 18

Neck is put through active and passive ROMS.
Stresses muscles of neck.
Pain during active motion: muscle strain.
Pain during passive Motion: ligament sprain

Question 19

Kernig’s Sign

Answer 19

Patient supine.
Doctor flexes patients hip and knee to 90*. Doctor then tries to extend leg.
Positive-pain in head or spine or involuntary flexion of opposite knee or hip.
Finding- Pain with fever-menengitis

Question 20

Brudzinski Sign

Answer 20

Patient supine.
Doctor flexes head toward the xiphoid process.
positive-pain in head or spine or involuntary flexion at hip and knee.
Finding-pain with fever-meningitis

Question 21

Shoulder Depression Test

Answer 21

Doctor pushes head away when pushing the shoulder down.
Tractions the brachial plexus and associated nerve roots.
Radicular symptoms may be-Fibrosis in IVF, adhesions to dural sleeve, traction across osteophytes, edema or compression of nerve root at IVF.

Question 22

Soto-Hall Test

Answer 22

Patient Supine.
Doctor has one hand on sternum so only cervical flexion is possible. then passively flexes the head of patient.
Testing the spinous tissues and vertebral bodies.
findings include- Sp/train, avulsion fracture, facet involvement, possible SOL

Question 23

Allen’s Test

Answer 23

First, open and close hand five time and hold fifth time. Doctor occludes arteries, patient opens hand, doctor releases one side and looks for refill. shouldn’t take longer than 5 seconds.
Slow refill-partial occlusion
absent refill- complete blockage

Question 24

Adson’s/Modified Adson’s Test

Answer 24

First palpate radial pulse and determine normal, then rotate head (adson’s towards doctor/modified away) extend neck as far as possible, take a deep breath and hold for 10 seconds.
tests for neurovascular compression of subclavian Art. or brachial plexus. Adson’s-Finds hypertrophy of A. scalene. Modified-M. Scalene

Question 25

Halstead’s test

Answer 25

Palpate radial pulse and determine normal then pull down on arm and patient looks away and extends. drop in amplitude is positive.
Finds compression of subclavian Art. or brachial plexus.
Tests for M. Scalene and cervical rib.

Question 26

Allen’s Maneuver

Answer 26

Abduct arm to 90, flex elbow to 90. palpate radial pulse then patient looks away. if pulse disappears when rotated positive for TOS.
Pulse can diminish in normal patient.

Question 27

Roos’ Test/Hands Up Test (Hostage Test)

Answer 27

Arm is 90* and 90*. Reach for the stars. Then opens and close fist for 3 minutes. Tingling or paresthesia indicates TOS.

Question 28

Wright’s Test (Hyperabduction Test)

Answer 28

Doctor passively abducts the patients arm 180*. Radial pulse diminishes or disappears.
Tests for compression of axillary artery under the pectoralis minor muscle

Question 29

Costoclavicular (Eden’s) Test

Answer 29

Doctor palpates Radial pulse and finds normal. Patient then brings shoulder back and down and puts chin to chest and take a deep breath and hold for 10 seconds. Narrows space between the clavicle and first rib.
Positive- cessation or dampening if the radial pulse, ischemic color changes, paresthesia, radicular pain in UL.