Special Tests Flashcards
Develop a special test to compress the intervertebral foramen. Describe the position the patient should be in and the position of the PT and their hands. Describe in biomechanical terms what the special test is trying to accomplish.
Test: With patient sitting and the therapist’s hands under the base of the skull put their neck in a position of slight extension, then slightly rotate to the side you are testing and then perform lateral flexion on the same side. Then add compressive downward force through the top of the head along a centered line.
What is a positive test for compression of the intervertebral foramen? What are typical symptoms of a compressed intervertebral foramen?
If symptoms are reproduced with downward force. Pain and or stiffness in the neck, numbness, and radiating pain.
Why would you test for a compression of the intervertebral foramen ?
This would be used to attempt to reproduce symptoms when patient has a suspected pinched nerve in the cervical spine.
Develop a special test to distract the intervertebral foramen. Describe the position the patient should be in and the position of the PT and their hands. Describe in biomechanical terms what the special test is trying to accomplish.
Test: With patient supine and therapists’ hands on the base of their skull, perform neck flexion, rotate and laterally flex to the opposite side of the effected foramen, and apply a distracting force upwards (essentially pull their neck superiorly)
What is a positive test for distracting the intervertebral foramen?
Positive test: Arm pain or other symptoms caused by suspected pinched nerve are relieved
What is one technique to provoke thoracic outlet syndrome?
Roos Test: Patient is sitting with shoulders abducted to 90 degrees and externally rotated. The patient is instructed to open and close their hands slowly for 3 minutes.
What is a positive test for the Roos Test (technique to provoke thoracic outlet syndrome)?
Reproduction of symptoms (tingling and numbness and a lack of bloodflow/slow return of bloodflow)
What is one technique to relieve a patients symptoms of thoracic outlet syndrome?
Diaghramatic breathing - diaphragmatic breathing will lessen the workload on already overused or tight scalenes and can possibly reduce symptoms
Develop one test to impinge (squeeze) the subacromial space.
Test as performed by therapist: Stabilize clavicle, then passively abduct the GH joint on the same side
What is a positive test for a test that impinges on the subacromial bursa?
Symptoms are increased are reproduced
What structures are being impinged in someone with subacromial impingement syndrome?
The subacromial bursa, supraspinatus tendon, superior portion of the glenohumeral joint capsule, & the tendon of the longhead of the biceps
Develop a test to assess the integrity of the anterior band of the inferior glenohumeral ligament complex.
Test: With patient in supine, shoulder abducted to 90º and the elbow flexed to 90º, externally rotate the humerus of the same side.
What is a positive test when assessing the integrity of the anterior band of the inferior glenohumeral ligament complex?
In a positive test therapist will observe an anterior translation of the humeral head or the patient guarding (stopping you from performing the movement) because they feel the humerus is about to pop out.
On a partner, palpate the inferior angle of the scapula. Through visual observation and palpation, describe how it moves as they elevate their arm in the scapular plane. Do they move symmetrically, if not is there anything you notice that may contribute to this asymmetry? What weak muscle(s) and what nerve could be damaged that can contribute to the asymmetry?
In most cases we observed symmetrical movement because shoulder stabilizers (in particular serratus anterior) are working as expected and producing normal scapulohumeral rhythm. A weak serratus anterior and/or a weak lower trapezius, and a damaged long thoracic nerve could lead to the asymmetry.
How do you perform the upper limb median nerve tension test?
Starting position: Patient lying supine, abduct shoulder 90deg, externally rotate shoulder 90deg, elbow in 90deg flexion, extend & supinate wrist, extend 1st three digits. Test is to passively extend elbow until symptoms reproduce; measure is the amount of elbow extension when symptoms are reproduced. This test is to be performed periodically to measure the change in elbow extension until symptoms indicating length tolerance of median nerve.
What are some symptoms of a median nerve injury?
Tingling or numbness in the forearm, weakness with gripping, and difficulty flexing the wrist
Develop a test to help diagnose lateral epicondylitis (tennis elbow).
Mills Test - Have my patient standing with elbow flexed to 90 degrees, stabilize their elbow, passively pronate their forearm, flex their wrist, and extend their elbow fully
What is a positive test for a test to help diagnose lateral epicondylitis (tennis elbow)?
Sudden pain at the lateral epicondyle
When performing the Mill’s Test (a test to help diagnose lateral epicondylitis (tennis elbow)), what are you testing for?
Tendinopathy (a condition in which the tissue connecting muscle to bone becomes inflamed) of the common extensor tendon and contractile tissue
Develop a test to help diagnose medial epicondylitis (golfer’s elbow).
Have my patient standing with elbow flexed to 90 degrees, stabilize their elbow, passively supinate their forearm, extend their wrist, and extend their elbow fully
What is a positive test for a test to help diagnose medial epicondylitis (golfers elbow)?
Sudden pain at the medial epicondyle
When you are performing a test to help diagnose medial epicondylitis (golfer’s elbow)), what are you testing for?
The contractile tissue
Develop a test to assess the integrity of the MCL (UCL).
Test:
o 1. Flex arm to 30º or so to ensure that elbow isn’t blocked and then test by-
o 2. Passively moving arm into valgus alignment
What is a positive test when assessing the integrity of the MCL (UCL)?
Pain and/or laxity
Develop a test to assess the integrity of the LCL.
Test: With arm flexed to around 30 degrees, slightly test the LCL by passively moving the patient’s arm into a varus alignment
What is a positive test when assessing the integrity of the LCL?
Pain and/or laxity
Develop a tensile test to help diagnose tendinopathy of the abductor pollicus longus and the extensor pollicis brevis.
Test: Put thumb into flexion and adduction, close the fingers, and ulnarly deviate the wrist
What is a positive test when assessing for tendinopathy of the abductor pollicus longus and the extensor pollicis brevis?
Pain or reproduction of symptoms with stretch
Develop a test to compress the median nerve at the wrist.
Press the hands together in front of their chest in a prayer position
What is the goal when testing to compress the median nerve at the wrist?
To compress the carpal tunnel
If a person is demonstrating decreased PROM at the wrist, how might you differentiate between extrinsic muscle stiffness and joint stiffness at the wrist?
For joint stiffness: changing the position of the elbow will NOT affect available PROM at the wrist
· For extrinsic stiffness: changing the position of the elbow will affect available PROM at the wrist
If a person is demonstrating decreased PROM at the PIP joint, how might you differentiate between intrinsic muscle stiffness and PIP joint tightness.
If MCP position changes available PROM at the PIP then the problem is muscle stiffness. If MCP position does not affect available ROM then its PIP joint tightness
