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.
