Special Maneuvers (musculoskeletal) Flashcards
What are the special testing for the cervical spine
- Spurlings maneuver
- Distraction test
How to complete spurlings maneuver
- Examiner is behind the patient with their hand interlocked on the patients head
- The patients neck is at neutral
- The examiner will apply pressure to the top of the patients head
- The test is repeated with the head/neck in slight extension then in slight extension and lateral flexion
What is a positive finding of spurlings maneuver
Pain or radicular symptoms
*indicative of nerve root impingement
*making the neural foramina smaller
*trying to induce radicular symptoms
How to complete the distraction test
- Examiner will place one hand under the patients chin and the other around the occipital
- The examiner will then slowly lift the patients head
What is a positive distraction tests
- When pain is relieved or decreased when the head is lifted / distracted
What are the special tests for the shoulder
- Drop arm test (Codman’s Test)
- Empty can test (Supraspinatus test)
- Neer impingement test
- Speeds test (biceps test)
- Hawkins impingement test
How to complete the drop arm test
- Examiner will abduct the patients shoulder to 90 degrees
- Then the patient will (try to) slowly lower their arm back to neutral
What is a positive drop arm test (codmans test) and what does it indicate?
- Patient is unable to return arm slowly to side (or has serve pain with doing so)
*indicates RTC tear
How to complete the empty can test (Supraspinatus test)
- Patients arm will be abducted to 70-90 degrees with no rotation
- Shoulder will then be medially rotated and angled forwards 30 degrees (thumbs pointed towards the floor)
What is a positive empty can test (supraspinatus test) and what does it indicate
Resistance to abduction given, examiner looks for weakness or pain
*indicated supraspinatus injury
How to conduct Neer impingement test
- Patients arm is forcibly elevated through forward flexion by examiner
- Will creating a jamming of the greater tuberosity against the anteroinferior border of the acromion (ac joint)
+test (looking for grimace)
How to conduct speeds test (bicep test)
- Patients arm is placed in forward flexion at 90 degrees with forearm in supination
*palms up, examiner pushes down - Assessing for pain and or weakness
How to complete Hawkins impingement test
- Patients arm is forward flexed to 90
- Elbow is bent to 90
- Shoulder is then forcibly medially (internally rotated)
What does a positive Hawkins impingement test indicate
Pain will indicate a positive test for supraspinatus tendonitis or long head of biceps
*pushes supraspinatus tendon against Coracoid process
What are the special tests of the elbow
- Tinels sign
- Lateral epicondylitis test
- Medial epicondylitis test
How to conduct Tinel sign (elbow)
Tests for ulnar neuropathy (cubital tunnel syndrome)
1. Tap over the ulnar nerve in the ulnar groove
*between the olecranon process and medial epicondyle)
What does a positive tinel sign indicate
- Tingling sensation int eh ulnar nerve distribution of the forearm and hand
How to complete the lateral epicondylitis test
- Examiner stands lateral to affected elbow and stabilizes patients elbow
*thumb on lateral epicondyle, fingers medially - Patient makes a fist in pronation and resist
- The examiner will be applying downward pressure to the fist
Where is pain coming from if the lateral epicondylitis test is positive
Extensors from the lateral epicondyle
How to complete the medial epicondylitis test
- Examiner will stand lateral to affected side, the patients elbow is in supination and bent a 90 degrees with the hand in a fist
- Examiner palpates medical epicondyle with one hand and place the other hand over the patients supinated wrist
- Examiner will place downward pressure over patients wrist while the patient resists the pressure
What does a positive medical epicondylitis test indicate
- Pain over the medial epicondyle
*medical epicondylitis (golfers elbow)
What are the special tests of the wrist
- Phalens test
- Tinel sign
- Finkelstein test
How to complete phalens test (carpal tunnel syndrome)
- Hold patients hand/wrist in flexion for one minute
*tell patient to hold the back of their hands together
*will be putting stress on the median nerve
What does a positive phalens test indicate
- Development (or worsening) of numbness and or tingling in a median nerve distribution
How to conduct tinel sign (median nerve)
- Percuss over the median nerve at the base of the hand/palm
- Tingling or numbness in a median nerve distribution is a positive finding and suggests carpal tunnel syndrome
What is finkelstein test used for
- To determine the presence of de Quervains tenosynovitis of the thumb
How to conduct finkelstein test
- The patient will make a fist with the thumb INSIDE the fingers
- Examiner will stabilize the forearm and deviates the wrist toward the ulnar side
What does a positive finkelstein test indicate
- Pain over the abductor pollicis longus (APL) and extensor pollicis brevis tendon (EPB)
*compare bilaterally
What are the special tests for the lumbar spine
- Straight leg raise
- Waddellls sign
When is the straight leg raise conducted (lumbar spine)
- Performed when a patient complains of low back pain or pain weakness, burning numbness and or tingling in the lower extremities
*test both sides
How to conduct the SLR?
- Have the patient supine
- Raise the patients leg until pain occurs
*then Dorsi flex the foot - Record the degree of elevation at which pain occurs
*hamstring discomfort / tightness does not indicate low back pathology
What is a positive finding of the SLR?
- Sharp shooting pain radiating from the back down the leg
*indicated pressure on the nerve roots
What will increase the pain in a positive test of SLR
- Dorsiflexion of the foot
What is a very strong indication of low back / nerve impingement
- Increased pain in affected leg when opposite leg is being tested
What are waddles sign
- What to make sure patient is not malingering to get out of work
*not 100% diagnostic
What are the special tests of the hip
- Leg length measurement
- True hip pathology evaluation
What is a true leg length discrepancy
- Actual lengths of the lower extremities themselves are different
*ASIS to medial malleolus
What is a functional leg length discrepancy
- Actual lengths of the lower extremities are equal but appear to be different due to another condition
*such as pelvic obliquity
*measure from umbilicus to medial malleolus
How to complete a true hip pathology evaluation
Completed for arthritis, tendon / muscle strain
1. FABER (Patrick’s test)
What does FABER (Patrick’s test) stand for
- Flexion abduction External rotation
*positive test is groin pain (hip) or sacroiliac pain
What are the special tests for the knee
- Valgus stress test (abduction stress test) MCL
- Varus stress test (adduction stress test) LCL
- Anterior drawer sign (ACL)
- Lachman test (ACL)
- Posterior drawer sign (PCL)
- McMurray test (meniscal tear)
- Patella ballottement (effusion)
- Knee ballon sign (effusion)
- Knee bulge sign
How to conduct the valgus stress test (abduction stress test)
- Patient supine with legs extended
- Apply pressure to the lateral distal femur while pulling the ankle towards you
- Perform in full extension (severe)
- Perform with knee in 20-30 degrees of flexion (mild)
*pain indicates a positive test
*>5mm of opening
How to conduct the varus stress test (adduction stress test)
- Patient is supine with legs extended
- Apply pressure to the medial a distal femur while pulling the ankle towards you
- Perform first in full extension (severe)
- Repeat with knee in 20 to 30 degrees of flexion
*pain or laxity at lateral knee is a + test
*injury to LCL if >5mm opening
How to conduct the anterior drawer sign
- Have patient supine, with hips and knees flexed and feet flat on the table
- Place hands around the knee with thumbs on the medial and lateral joint line
- Pull tibia forward and compare bilaterally
What indicates a positive anterior drawer sign
- Anterior movement of the tibia
*>6mm of anterior movement
How to conduct Lachman test
- Have patient supine with knee in 15 degrees of flexion and ER
- Grasp distal femur with one hand and proximal tibia with other (thumb on joint line)
- Move tibia forward and femur backward at the same time
*mushy end feeling indicate injury
How is the Lachman test graded
Grade I injury = 3-6mm
Grade II injury = 6-9mm
Grade III injury = 10-16mm
grade IV injury = 16-20mm
How to conduct the posterior drawer sign
- Have patient supine
- Place hands around knee with thumbs on the medial and lateral joint lines
- Push tibia posteriorly, observe degree of posterior movement of the tibia
How to conduct McMurray test
- Have patient supine
- Grasp heel and flex knee
- Cup other hand over the knee joint
*fingers along the medial and lateral joint line - Rotate the lower leg internally and externally
*will be pinching between the tibia and the femur
How to perform the patella ballottement
- Firmly grasp the thigh above the knee with one hand
*forces fluid out of the pouch into the joint behind the patella - With fingers of the other hand, sharply force patella back against the femur
What indicates a presence of effusion during patella ballottement
- A palpable tap of fluid against hand on thigh
How to conduct the knee balllon sign
- Place right hand thumb and index finger on each side of patella
- Using left hand compress the suprapatellar pouch against the femur
*feel for fluid “ballooning” into the spaces by the patella
How to conduct the knee bulge sign
- Extend the knee
- Milk any fluid out of the suprapatellar pouch
- Continue to milk the fluid Inferiorly and then into the lateral aspect of the knee
- Tap the knee posterior to the lateral margin of the patella with the right hand
What will indicate effusion during the knee bulge sign
- Any fluid wave at medial aspect of knee
What are the special tests of the ankle
- Anterior drawer test
- Talar tilt test
- Thompson test
What is the anterior drawer test used for>
- Evaluation of the ATaF ligament
- Anterior translation indicates injury to the ATaF ligament (possibly CF ligament)
- Dimple / suction sign may be visible
*at the ATaF
How to conduct the anterior drawer test
- Have the patient supine with foot relaxed
- Examiner stabilizes the tibia and fibula ad holds the ankle in 20 degrees of plantar flexion
- Examiner draws the foot forward while stabilizing (pushing down on) the tibia and fibula
What is the Tatar tilt test used for
- To asses the CF ligament and deltoid ligament
*more medial
How to conduct the talar tilt test
- Patient is sitting with leg over table (knee flexed at 90 degrees) or lying on side with knee flexed
- Talus is tilted side to side into adduction and abduction
How to conduct the Thompson test
- Patient is prone with legs in extension and feet/ankles hanging off of the end of the bed
- Calf is squeezed by the examiner
What does a positive Thompson test indicate
- The foot should plantar flex
*positive means rupture of the Achilles if no plantar flexion is observed
