Reversed ALL Flashcards
Pt prone. Firm pressure is applied by Op over the suspected sacroiliac joint, fixing the Pt’s anterior pelvis to the table. With the other hand, the Pt’s leg is flexed on the affected side to the physiologic limit, and the thigh is hyperextended by Op lifting the knee from the examining table.
If pain is increased in the sacroiliac area, it is significant of a ventral sacroiliac or hip lesion because of the stress on the anterior sacroiliac ligaments.
Normally, no pain should be felt on this maneuver.
SI
Yeoman’s Test
Op takes a chest measurement with the tape measure over the lowest part of the fourth intercostal space with the patient maximally exhaling. Pt then maximally inhales and another measurement is taken.
Normal expansion for an adult male is at least two inches, and one and one-half inches for an adult female.
Less than these amounts would be a positive test, indicating thoracic fixation. This is considered an important sign in any ankylosing condition such as Marie-Strumpell Disease.
T spine
Chest Expansion Test
Pt supine, Op places on palm against the medial aspect of knee (opposite to the one being tested) at the joint line. With the other hand Op grips the ankle, pulling it medial, thus opening the lateral side of the joint.
If this action causes no pain, then Op repeats it with the knee in 20-30 degrees of flexion, which puts the knee joint maximally vulnerable to a torsion stress.
If either of these actions produces or exacerbates pain, below, above or at the joint line, then the test is considered positive, indicating a lateral collateral ligament injury.
Knee
Varus Stress Test
To assess for an unstable superior labral anterior posterior (SLAP) lesion.
Op standing adjacent to the affected arm and observing the Pt’s response to the test. Op can place their hand over the shoulder to palpate for a click. Pt elevates the affected shoulder in the scapular plane to 90°, with the elbow extended and the forearm fully pronated, and horizontally adducts the arm across the chest.
The presence of pain is noted and the arm is returned to the abducted start position.
The same movement is then repeated with the forearm in supination and any pain noted.
Localized anterior shoulder pain, sometimes combined with an audible or palpable click that is more pronounced during the first test, is suggestive of an unstable SLAP lesion.
The functional nature of this test (turning a steering wheel) makes it an easy one for the clinician to remember!
GH
SLAPprehension test
This is a variation of the shoulder abduction stress test and the arm drop test.
If the Pt’s arm can be passively abducted laterally to about 100º without pain, the Op removes support so the position is held actively by the Pt. This produces sudden deltoid contraction.
When a rupture of the supraspinatus tendon or strain of the rotator cuff exists, the pain produced causes the patient to hunch the shoulder and lower the arm.
GH
Codman’s Sign
Pt prone, Op palpates the sacral sulcus and inferior angle of the sacrum on each side. Assess sacral sulci and inferior angles to see if they are symmetrical or asymmetrical.
Pt moves up onto their elbows.
If the landmarks become more symmetrical, it is a forward torsion.
If the landmarks become more asymmetrical, it is a backward torsion.
SI
Sphinx Test
Pt supine, Op strikes a line from the ASIS to the midpoint of the patella, and from the tibial tubercle to the midpoint of the patella. A goniometer is placed on the knee such that the axis if over the midpoint of the patella, the proximal arm is over the line to the ASIS, and the distal arm is over the line to the tibial tubercle.
The result angle is the Q-angle. Q-angle norms for males are 13 degrees and 18 degrees for females. Angles greater or less than these norms may be indicative of patellofemoral pathology.
Hip / Knee
Q-Angle Test
Pt supine, Op slowly extends, rotates and laterally flexes cervical spine to each side for 30 seconds.
Dizziness, blurred vision, nystagmus, slurred speech or loss of consciousness are indicative of partial or complete occlusion of the vertebral artery.
C spine / Vascular
Vertebral Artery Test
Pt seated, Op rests both hands on the top of Pt’s head and applies a downward pressure while the subject laterally flexes the head. When Pt’s head is in maximum rotation and flexion, Op delivers a vertical blow to the top of the head.
The test is repeated with the subject laterally flexing to the opposite side.
A reporting of pain into the upper extremity toward the same side that the head is laterally flexed is a positive sign and indicates pressure on a nerve root which can be correlated by dermatomal distribution of pain.
C spine
Spurling’s Test
Pt standing, shoulders forward flexed to 90 degrees, forearms supinated, palms up and eyes closed. Hold 10-30 secs.
+ve for vascular impediment to brainstem if one arm starts to fall with simultaneous forearm pronation.
C Spine / Brainstem
Barre’s Test
The Pt in the sitting position attempts to extend each leg one at a time followed by an attempt to extend both legs.
The sign is positive if backache or sciatic pain is increased or the maneuver is impossible.
In disc involvements, extending both legs will usually increase spinal and sciatic discomfort.
L spine
Bechterew’s Test
Two tests are involved.
First, with the Ptt sitting, the Op stands behind the Pt and the Pt’s head is laterally flexed and rotated about 45º toward the side being examined. Interlocked fingers are placed on the Pt’s scalp and gently pressed caudally.
If an IVF is physiologically narrowed, this maneuver will further insult the foramen by compressing the disc and narrowing the channel, causing pain and reduplication of other symptoms.
Second, the Pt’s neck is extended by the examiner placing interlocked hands on the Pt’s scalp and gently pressing caudally.
If an IVF is physiologically narrowed, this maneuver mechanically compromises foraminal diameters bilaterally and causes pain and reduplication of related symptoms.
C spine
Cervical Compression Tests
AKA Jacksons Compression Test
The Pt is seated on a table with the knee flexed to 90 degrees and the involved foot relaxed in slight plantar flexion. While assuring stabilization of the distal tibia and fibula, the Op applies a posterior force to the calcaneous and talus.
Posterior translation of the talus away from the ankle mortise that is greater on the involved side suggesta possible posterior talofibular ligament sprain.
Ankle
Posterior Lachman’s Test
During Lasegue’s SLR test, the limb is lowered slightly to a point just below the level of pain, the examiner then dorsiflexes the big toe to induce traction on the sciatic nerve.
Pain arising in the posterior thigh or calf indicates sciatic radiculopathy.
L spine
Sicard’s Sign
To detect anterior instability of the glenohumeral joint.
Apprehension : The Pt lies supine on the table with the involved shoulder in 90 degrees of abduction and the elbow in 90 degrees of flexion. The Op holds the lower forearm and supports the elbow. Then slowly externally rotates the shoulder.
If a positive response is not given, the hand supporting the elbow is then moved to the posterior aspect of the humeral head and an anteriorly directed force can then be applied to further challenge the stability of the shoulder.
Relocation : The Pt’s shoulder position of 90° abduction and external rotation is maintained and the clinician re-positions the heel of their hand over the anterior aspect of the humeral head and applies a firm posteriorly directed force.
GH
Apprehension and Relocation Test
Ulnar:
Pt seated and the elbow in slight flexion, Op stabilizes the wrist and taps the ulnar nerve in the ulnar notch with the index finger.
Tingling along the ulnar distribution of the forearm, hand, and fingers is indicative of ulnar nerve compromise.
Bilateral assessment is recommended for comparison of results.
Posterior Tibal (Tarsal tunnel):
Pt supine, Op uses his finger to tap over the medial aspect of the ankle where the posterior tibial nerve is the most superficial.
Pain or tingling that radiates along the pathway of the posterior tibial nerve is indicative of tarsal tunnel syndrome.
Compression of the posterior tibial nerve in the tarsal tunnel will result in referred symptoms to the medial and plantar regions of the foot.
Peripheral Nerve
Tinel’s Sign
To test for a partial or complete tear of subscapularis.
Pt position - Standing or sitting on the edge of a treatment couch with the shoulder internally rotated so that the dorsum of the hand rests against the mid-lumbar spine.
Op position - Standing behind Pt, the distal end of the Pt’s forearm is lifted away from the lumbar spine, so that the shoulder is fully internally rotated. With the arm passively ‘lifted off’, Pt is asked to maintain the position without extending the elbow as the support of the Op’s hand is removed.
An inability to maintain the lifted-off position signifies a complete tear of the subscapularis tendon.
A partial tear is denoted by a limited ability to maintain the liftedoff position, such that the arm drops back less than 5°.
GH
Lift-off Sign
AKA Gerber’s test
Gerber’s lift-off test
Internal rotation lag sign
Medial rotation ‘spring back’ test
The Pt sits or stands and makes a fist on the involved side. The Op passively supinates the forearm and extends the elbow and wrist.
Complaints of discomfort along the medial aspect of the elbow may be indicative of medial epicondylitis (Golfer’s Elbow).
Elbow
Golfer’s Elbow Test
Pt side-lying with the hips and knees extended test leg superior. Op stabilizes the Pt’s pelvis to prevent rolling while abducting and extending the test hip and allowing the leg to lower slowly.
The inability of the leg to adduct and touch the table is indicative of ITB tightness.
ITB
Ober’s Test
This test is used to rule out hip disease.
Pt with sciatic symptoms is placed supine. If pain is elicited on flexing the thigh on the trunk with the knee extended but not produced when the thigh is flexed on the trunk with the knee relaxed (flexed), hip pathology can usually be ruled out.
L spine / Hip
Lasegue’s Differential Sign
Pt supine, Op grasps elbow with one hand and stabilizes the ipsilateral and involved shoulder with the other hand. Op places the Pt’s involved shoulder in a position of 90 degrees of flexion and internal rotation while applying a posterior force through the long axis of the humerus.
A positive finding is a “look of apprehension” on the subject’s face toward further movement in the posterior direction.
GH
Posterior Apprehension Test
Pt seated with both arms hanging at the sides, Op behind the patient palpates the radial pulse during 180 degrees of active and then passive abduction of both arms, while noting at how many degrees of abduction the radial pulse on the affected side diminishes or disappears when compared to the opposite side.
If this action diminishes or eliminates the radial pulse, the test is considered positive, indicating a neurovascular compression of the axillary artery as seen in thoracic outlet syndrome (TOS).
TOS
Wright’s Test
The neck of a sitting Pt is flexed to about 45º while the Op percusses each of the cervical SPs and adjacent superficial soft tissues with a rubber-tipped reflex hammer.
Evidence of point tenderness suggests a fractured or acutely subluxated vertebral motion unit or a localized sprain or strain, while symptoms of radicular pain suggest radiculitis or an IVD lesion.
C spine
Cervical Percussion Test
Pt side-lying with the tested hip on top. Passively move the Pt’s LEX into flexion (90 degrees), adduction, and internal rotation.
A positive test for irritation of the sciatic nerve by the piriformis occurs when pain is produced in the sciatic/gluteal area.
Due to the position of the test, pain may produced in the anterior thigh as well as a result of femoral acetabular impingement.
Hip
Flexion, Adduction, Internal Rotation (FAIR) Test
This test is primarily employed when fracture of a vertebra is suspected.
Pt supine without pillows. One hand of Op is placed on the sternum, and mild pressure is exerted to prevent flexion at either the lumbar or thoracic regions of the spine. The other hand of Op is placed under the occiput, and the head is slowly flexed toward the chest.
Flexion of the head and neck on the chest progressively produces a pull on the posterior spinous ligaments from above, and when the spinous process of the injured vertebra is reached, an acute local pain is experienced by Pt.
C spine
Soto-Hall Test
The Pt lies supine on the table with the involved shoulder in 90 degrees of abduction and the elbow in 90 degrees of flexion. The Op slowly externally rotates the shoulder.
A positive finding is a “look of apprehension” on the subject’s face toward further movement in the externally rotated direction and may suggest instability of the glenohumeral joint.
GH
Anterior Apprehension Test
With the Pt sitting, the Op stands to the side and places one hand under the Pt’s chin and the other hand under the base of the occiput. Slowly and gradually the Pt’s head is lifted to remove weight from the cervical spine.
This maneuver elongates the IVFs, decreases the pressure on the joint capsules around the facets, and stretches perivertebral soft tissues.
If the maneuver decreases pain and relieves other symptoms, it suggests narrowing of one or more IVFs, cervical facet syndrome, or spastic perivertebral muscles.
C spine
Cervical Distraction Test
Op compresses the suprapatellar pouch with the proximal hand, then compresses the patella into the femur. Downward movement of the patella followed by a rebound will give the appearance of a floating or ballotable patella and is indicative of moderate to severe joint effusion.
Knee
Patella Tap Test
Pt prone and Op standing on the side of involvement, the Op reaches over and stabilizes the uninvolved sacroiliac joint while the thigh on the involved side is extended at the hip.
Pain initiated by this maneuver in the sacroiliac area of the involved side is a positive sign of acute sacroiliac sprain/subluxation or sacroiliac disease.
SI
Gillis’ test
Pt standing, Op behind with thumbs on the posterior superior iliac spines. Op then notes whether the posterior superior iliac spines are level.
Unleveling is indicative of sacroiliac joint fixation or one side or the other. The examiner may also perform the test while the subject actively flexes each hip one at a time.
SI
SI Joint Fixation Test
1st - pt seated flexes both arms to 90 degrees and closes eyes.
If arms move cause is nonvascular.
2nd - pt rotates or extns and rots head, closes eyes.
If arms move then is it +ve for vascular
Vascular
Hautant’s Test
The affected limb’s hip and knee are passively flexed to 90 degrees. The examiner applies pressure with the thumb over the IT Band proximal to the lateral femoral condyle. Pt then actively extends the hip and knee.
Pain produced over the distal IT band, where the pressure is being applied, before 30 degrees short of knee extension is a positive test indicating ITB contribution to Pt symptoms.
Pain produced at less than 30 degrees of knee flexion is not a positive test.
ITB
Noble Compression Test
Pt actively elevates the arm in the scapular plane, then slowly reverse the motion.
The test is considered positive for subacromial impingement if the patient has pain between 60- 120 degrees of scaption during elevation.
GH
Painful Arc Sign
With the Pt sitting, the Op stands behind and to the side to monitor the radial pulse. OP brings the P’s shoulder and arm posterior and then depresses the shoulder on the side being examined.
This maneuver narrows the ipsilateral costoclavicular space by approximating the clavicle to the first rib, tending to compress the neurovascular structures between.
When the shoulder is retracted, the clavicle moves backward on the sternoclavicular joint and rotates counterclockwise.
An alteration or obliteration of the radial pulse or a reduplication of other symptoms suggests compression of the neurovascular bundle passing between the clavicle and the 1st rib (costoclavicular syndrome).
TOS
Costoclavicular Manoeuver
Pt supine with the hips and knees fully extended and parallel. Using a tape measure, the examiner measures from the most distal point of the ASIS to the most distal point of the medial malleolus.
A difference of more than 1 cm is indicative of discrepancies in either the length of the femur or tibia, or in the angle of the femoral neck inclination.
LEX
True Leg-Length Discrepancy Test
Active tests of LEX to assess for intermittant claudication:
- Neurogenic claudication - stenosis/extn of spine. Relieved by flexion
- Vascular claudication - relieved by rest only.
Bicycle Test of van Geldren
AKA Treadmill Test & Stoop Test
The Pt lies supine with the test knee flexed 20-30 degrees. From a neutral position, the Op applies an anterior force to the tibia with the distal hand while stabilizing the femur with the proximal hand.
Excessive anterior translation of the tibia with a diminished or absent endpoint is indicative of a partial or complete tear of the ACL.
Knee
Anterior Lachman’s Test
Pt stands on the test leg with the knee bent to 20 degrees of flexion (the opposite leg is flexed behind the patient). Pt may place his/her hands on the hands of Op for balance during the test. Pt then rotates the knee medially and laterally 3 times each direction.
A positive test occurs when there is joint line discomfort or if locking/catching occurs indicating a meniscus lesion.
Knee
Thessaly Test
If pain occurs during Lasegue’s SLR test, the knee is slightly flexed and the patient’s foot is allowed to rest on the examiner’s shoulder.
When pain subsides, manual pressure is applied against the hamstrings. If this does not increase pain, manual pressure is then quickly applied to the popliteal fossa while holding the knee as straight as patient comfort will allow.
Although local pain in the popliteal fossa is of minor consequence, a reproduction of leg or low-back pain is highly significant of an IVD rupture producing nerve root compression.
L spine
Bowstring Sign
This test has the Pt standing with the arms hanging loosely at the side. The Op deeply palpates the Pt’s shoulder eliciting a localized tender area. The Op, while leaving the finger on the painful spot, passively abducts the Pt’s arm.
This sign is present when the painful spot disappears on abduction, indicating subacromial bursitis.
GH
Dawbarn’s Sign
Pt seated , Op laterally flexes head away from the side being tested while applying traction to the shoulder.
Pain is indicative of muscular or ligamentous injury, or dural sleeve adhesions.
C spine
Shoulder Depression Test
This test is used for indicating low back radiculopathy or lumbar disc herniation.
Pt seated upright on the edge of a table or bench without a backrest. Op extends the Pt LEX’s below the knee one at a time, so each limb is parallel with the floor.
If there is no radiculoneuropathy, the patient should experience no discomfort from this action.
It has advantages when checking for malingering, because the test can be performed without the patient knowing what is being tested. This version can be used on those patients where simulation, falsifying or magnification of symptoms is suspected.
L spine / Malingering
Lasegue’s Sitting Test
This test is used to determine excessive iliopsoas tension.
Pt supine holds one flexed knee against his abdomen with his hands while the other limb is allowed to fully extend. Pt’s lumbar spine should normally flatten.
If the extended limb does not extend fully (ie, the knee flexes from the table) or if the Pt rocks his chest forward or arches his back, a fixed flexion contracture of the hip is indicated, as from a shortened iliopsoas muscle.
This should always be tested bilaterally. Some examiners use the degree of pain elicited on forced extension of the flexed knee as their criterion of iliopsoas tension.
Hip / Psoas
Thomas’ Test
Pt standing and asked to closeeyes for 20 secs.
If body sways excessively or pt loses balance = +ve for upper motor neurone lesion.
UMNL
Rhomberg’s Test
Pt prone. Firm pressure is applied by Op over the suspected sacroiliac joint, fixing the Pt’s anterior pelvis to the table. With the other hand, the Pt’s leg is flexed on the affected side to the physiologic limit, and the thigh is hyperextended by Op lifting the knee from the examining table.
If pain is increased in the sacroiliac area, it is significant of a ventral sacroiliac or hip lesion because of the stress on the anterior sacroiliac ligaments.
Normally, no pain should be felt on this maneuver.
SI
Yeoman’s Test
This variant of Lasegue’s SLR test is used in lumbago and IVF funiculitis with the intent of differentiating between lumbago and sciatica.
When the affected limb is first extended and then flexed at the hip, the corresponding half of the body becomes lowered and with it the muscle fibers fixed to the lumbosacral segment. This act, which stretches the involved muscles, can induce sharp lumbar pain.
Lasegue’s sign is thus negative as the pain is caused by stretching the affected muscles at the posterior portion of the pelvis rather than stretching the sciatic nerve.
To accomplish this test with the Pt supine, the pelvis is fixed by the Op’s hand firmly placed on the ASIS while the other hand elevates the ipsilateral leg. No pain results when the leg is raised to an 80 angle. When lumbago and sciatica coexist, Demianoff’s sign is negative on the affected side but positive on the opposite side unless the pelvis is stabilized.
This sign is also negative in bilateral sciatica with lumbago. The stabilization of the pelvis prevents stretching the sciatic nerve, and any undue pain experienced is usually associated with ischiotrochanteric groove adhesions or soft-tissue shortening.
L spine
Demianoff’s Test
Supine Pt extends the head and neck over the edge of the table. With eyes open the Pt actively rotates the head and neck while maintaining the extended position.
One or more of the following indicates a positive test: either blanching or cyanosis of the face, nystagmus, sweating, dizziness, nausea, headache or an increase of temperature.
Until vascular disorders are ruled out by further examination, a positive test would indicate that cervical manipulation involving rotation and/or extension is contra-indicated.
VBI
George’s Test
Pt seated but with leg straight out on table (hip flexed only). Op flexes head and flexes leg simultaneously (leg is kept straight)
+ve for spinal cord lesion and/or upper motor neurone lesion if there is sharp, electric shock-like pain down the spine and into the UEx and/or LEx.
Coughing or sneezing may produce similar results.
UMNL / Spinal cord
Lhermitte’s Sign
Pt supine with test shoulder placed in 90–110 degrees of abduction and 10-15 degrees of extension. The test elbow is flexed to 90 degrees. Op slowly rotates Pt’s shoulder into maximal external rotation.
Reproduction of the subject’s pain in the posterior aspect of the shoulder is indicative of rotator cuff and/or posterior labral pathology.
GH
Posterior Impingement Sign
Pt should normally be able to walk several steps on the heels with the forefoot dorsiflexed. Except for a localized heel disorder (eg, a calcaneal spur) or contracted calf muscles.
Inability to do this because of low-back pain or weakness can suggest an L5 lesion.
L spine / Brainstem
Heel Walk Test
With the Pt sitting or standing, the Op applies a firm tap to the end of the finger being tested.
Pain at the site of injury suggests a possible fracture. The Op may also use a percussion hammer for this test.
Hand
Finger Tap Test
Pt performs “spectacle” ulnar nerve stretch
Pain in scapular or arm is +ve for ulnar nerve or T1 nerve root irritation.
Peripheral Nerve
Ulnar Nerve Traction Test
AKA T1 Nerve Root Stretch
Pt seated, Op stands behind compressing jugular veins for 30 secs & asks Pt to cough. Soon as any light-headedness etc occurs abort.
+ve may indicate nerve root problem or space occupying lesion.
Vascular / Spinal cord
Naffziger’s Test
Aim to identify subacromial or internal impingement.
Pt with the arm relaxed in the anatomical position. Op standing adjacent to the patient on the affected side, one hand is placed under the elbow, the other holds just above the wrist. The elbow is flexed to 90° and the shoulder taken passively into 90° of forward flexion. The shoulder is passively taken into internal rotation thereby rotating the greater tuberosity under the coracoacromial arch.
Pain is reproduced increasingly towards the end of the rotation movement and indicates rotator cuff pathology involving the cuff itself, the adjacent bursa or the long head of biceps. The glenoid labrum is also vulnerable in this test.
A positive result is highly likely in the presence of a capsulitis which should therefore be excluded to avoid a false positive result.
GH
Hawkin’s-Kennedy
Op stands opposite the involved side and places both thumbs on the medial border of the patella being tested. Pt should remain relaxed with no quadriceps contraction while Op pushes the patella laterally.
If Pt is apprehensive to this movement or contracts the quadriceps muscle to protect again subluxation, the test is indicative of patellar subluxationor dislocation.
This test can also be performed with the knee flexed 30 degrees.
Knee
Patellar Apprehension Test
Pt seated holding head into full extn and 45 degree rot - bring head lower than body
+ve if dizziness or nystagmus occurs.
NB Also assesses nerve root compression of lower cervical spine.
C spine / vascular
Dix Hallpike’s Manoeuver
Pt sidelying and underneath LEX flexed acutely at the hip and knee. With the upper LEX held straight and extended at the knee, Pt attempts to abduct the upper limb while the Op applies resistance.
Pain initiated in the area of the upper aspect of the sacroiliac joint or the hip joint suggests an inflammatory process of the respective joint.
Hip / SI
Hip Abduction Stress Test
Walking for several steps on the base of the toes with the heels raised will normally produce no discomfort to the patient.
Except for a localized forefoot disorder (eg, plantar wart, neuroma) or an anterior leg syndrome (eg, shin splints).
Inability to do this because of low-back pain or weakness can suggest an S1–S2 lesion.
L spine / Brainstem
Toe Walk Test
