Special maneuvers Flashcards
Spurling’s test
Should not be performed on patients with history of trauma,bone metastasis, bone cancer or osteoporosis -> may cause microfractures
Indications: checks foraminal encroachment of anerve root is manifested as hypoesthesia
Position: Stand at the side or behind the patient Position of patient: Seated Head is extended, laterally flexed and down up to 1 miute
(+)Test: pain over the shoulder and arm
Pain is felt from shoulder to tip -> CERVICAL PROBLEM Pain is felt from shoulder to elbow -> SHOULDER PROBLEM
Yegason’s Test
ROM and MMT should be done first
identify bicipital tendinitis
- Biceps are responsible for supination, external rotation, and elbow flexion.
- it is at maximum advantage when elbow is at 90 degree angle
Fix elbow held by one hand and pronated forearm Externally rotate the arm as patient resists and pull down on the elbow
(+) test: pain felt over the bicipital groove area
Speed’s test
identifies bicipital tendinitis
(+)test: pan is felt at the bicipital groove area on resisted shoulder flexion at 80-90 degrees
Only apply resistance when shoulder flexion is already halfway through range of motion
Make sure forearm is supine while doing shoulder flexion
Empty can test
Tests for supraspinatus strength and impingement
Supraspinatus: shoulder abduction
Patient: sitting with arms straight out, elbows locked, thumbs down and arms 30 degrees in the scapular plane- where is is most natural to raise your arms
The patient should attempt to abduct his arms against examiner’s resistance
(+)test eliciting pain or weakness
Apprehension test
TEst for chronic shoulder dislocation/anterior shoulder instability
Examiner should first stabilize the shoulder before starting the examination
Patient has to position his arms in a 90 degrees position patients abducts and externally rotates the shoulder (like throwing a baseball)
Apply force on the forearm to further externally rotate the shoulder
(+)TEST: pain and resistance of the patient to further motion indicates possible anterior shoulder dislocation
- This test can be done while the patient is lying supine or in an erect position
Sulcus sign
Dimpling between humural head and acromion with downward pull on a neutrally positioned arm
Must be in upright position Measure the subluxation using patient’s finger breadth (usually separated by 1)
(+) appearance of dimpling/sulcus -> inferior glenohumeral instability and subluxation
Scapular winging
check when suspecting for brachial plexus injury or nerve entrapment
Make sure to inspect first before asking the patient to do anything
Make person push a wall with both hands to accentuate and appreciate scapular winging
- Weakness of serratus anterior (forward push) or trapezius (side push)
Tennis elbow Test
Reproduces pain of lateral epicondilitis
Stabilize forearm and fist the hand in prone position.
Ask the patient to do active wrist ROM. press on lateral epicondyle and ask if the is pain. If there is none, proceed
Patient actively extends the wrist as the examiner applies resistance
- Can also test middle finger only, instead of the whole hand
(+) test: pain of the lateral epicondyle
Golfer’s elbow test
Reproduces pain of medial epicondyltitis
same position as tennis elbow but wrist flexion
Finkelstein’s Test
For stenosing tensynovitis of the tendons (abductor pollicis longus and extensor pollicis brevis) ; De Quervain’s Tenosynovitis
Phalen’s test
for median nerve pathology and carpal tunnel syndrome
Examiner flexes the patient’s wrist maximally for one minute
(+) tingling in the thumb ,index, middle and lateral half of the ring finger
- Reverse phalen’s : PRAYER TEST
Allen’s Test
for radial and ulnar patency
Adam’s Test
Patient standing, feet together examiner has to observe patient from the psoterior of the patient
Bend forward, arms dangling Observe level of the back for any asymmetry
Can detect scoliosis
Straight Leg raising Test
Lasegue test
(+) if pain is left less than 60 degrees flexion
Differentiate from stretch PAtient in supine position, passively flex the leg.
Stabilize the knee with one hand on the knee cap to prevent knee flexion.
Keep the knee extended while the examiner flexes the hip until the patient complains of pain or tightness in the back or back of leg
Crossed leg/well leg raising
Indication: Low back pain, sign of disk herniation
SLR/elevation of asymptomatic leg
(+) Pain in affected leg
Schober’s test
Used to measure the amount of flexion occuring in the lumbar spine; in suspected ankylosing spodylitis
A 4 cm increase between the above marks normally seen on bending. if not, decreased lumbar spine ROM
FABER or Patrick’s test
ROM of hip flexion, abduction, and external rotation of hip
SI joint vs hip joint origin of pathology
Thomas test
Indication: flexion contractures of the hip, range of hip flexion and hip flexor tightness
PAtient supine, fully flex thigh of the unaffected leg, then fully extend the other leg the other leg against the table
(+)failure to fully extend the leg against the table - > flexion contracture of the hip
(+) lumbar arching or lowered leg not flat -> hip flexor tightness
Bulge sign
For minor or minimal effusions
Extend knee -> milk fluid downward from suprapatellar pouch -> apply medial pressure to force fluid into lateral area -> tap behind lateral margin to elicit wave
Vagus Stress test
Integrity of the MCL
Patient supine, knee at 20-30 degress flexion with thigh susported
Varus Stress test
Integrity of the the LCL
Patient supine knee at 20-30 degrees of flexion with thigh supported
Lachmann’s Test
Integrity of the ACL
Supine, knee at 20-30 degrees of the flexion with thigh supported.
Grip the femur in one hand and the tibia in the other Examine the anteroposterior motion of the knee by displacing the tibia on the femur
Also examine the endpoint of the ligament and grade it as firm, marginal, stiff
Anterior and Posterior Drawers Test
test the integrity of the ACL and PCL
Supine, knee at 90 degrees of flexion.
McMurray’s test
Integrity of the menisci
Supine, knee completely flexed. grab the plantar aspect of the foot of the patient and stabilize the knees
Medially rotate the tibia while palpating the lateral meniscus and extend the knee
- Snap accompanied by pain -> loose fragment of the lateral meniscus
Laterally rotate the tibia while palpating the medial meniscus and extend the knee
- Snap accompanied by pain -> Loose fragment of the medial meniscus
Grinding Test (Arley’s compression)
Patient is prone, flex knee at 90 degrees.
Lean at the heel and compress the menisci by internally and externally rotating the tibia;
(+) pain indicates meniscal damage
