Special Tests Flashcards
Yergason’s Test
Where?
What for?
Main purpose?
Where: shoulder
What for: muscle/tendon pathology.
Main purpose: check that the transverse humeral ligament is in tact (this ligament holds the biceps tendon down in the bicipital groove).
Technique: have Pt flex forearm to 90* + fully pronated. + stabilized against the body. Pt will then perform supination against resistance; at the same time Prac will palpate the biceps tendon in the bicipital groove.
Positive sign: “popping out” of the biceps tendon in the bicipital groove= transverse humeral lig tear. OR pain/tenderness w/o “popping” indicates biceps tendinosis or SLAP lesion.
Mill’s Test
Where: Elbow
What for: testing for elbow pathology (epicondylalgia) caused by tension in the ext carpi radialis brevis mm.
Main purpose: diagnosing tennis elbow (lateral epicondylitis). Provocative test.
Technique: Pt flexes arm to 90* + forearm pronated. Prac will palpate lateral epicondyle at the same time as passively flexing wrist and then slowly ext elbow.
Positive sign: reproduction of Pt’s lateral elbow pain
Cozen’s Test
Where: Elbow
What for: test for elbow patho (epicondylalgia)
Main purpose: Dx lateral epicondylitis (ext carpi radialis mm)
Technique: Pt’s arm rested on table + forearm pronated + hand in a fist. Prac will palpate lat epicondylitis while the Pt performs wrist ext and radial deviation against resistance.
Positive sign: reproduction of Pt’s lateral elbow pain.
VAT (vertebral artery test)
Where? What for? Main purpose? Technique \+ SIgn
Where: C-spine
What for: testing for any arteriole, basilar or vertebral stenosis or compression present.
Main purpose: evaluate the adequacy of blood supply to the brain by compressing the vertebral artery + examining the onset of S+S of VAT.
Technique: Pt lying supine with head supported by prac off the table. Passively ext pt’s head then slightly flex to the side then rotate. Hold for 30 sec. Watch for any nystagmus or abnormal head mvmnts.
Positive Sign: If pt reports any dizziness, lightheadedness, difficulty swallowing or speaking, vision changes or any numbness anywhere.
Compression Test
Axial
Where: C-spine
What for: orthopedic special test for cervical spine
Main purpose: examining for nerve root impingement. Provocative test.
Technique: Pt’s head in neutral position with prac applying downward pressure on top of head.
Positive sign: if pt feels a radiating pain down their arm, indicating compression on a nerve root. Pain distribution may indicate which nerve root is being impinged (dermatome).
Compression test
Spurling’s
Where: C-spine
What for: used if pt complains of nerve root pain like symptoms that have diminished or are absent at the time of examination.
Main purpose: provocative test for nerve root impingement
Technique: 3 stages–> Pt seated,
first stage is with Pt’s head in a neutral
position.
Second stage is with Pt’s head extended
Third stage is Pt’s head in ext + rotation
Positive sign: reproduction of pain down pt’s arm on the same side causing the vertebral compression. (vertebral radiculitis).
Yeoman’s test
Where: SIJ
What for: 2 part test for sacroiliitis (inflammation of 1 or both SIJ) causing pain.
Main purpose: tests for SIJ dysfunction
Technique: Pt prone, first part is passive hip ext with Pt’s knee fully ext. Second part is passive hip ext with Pt’s knee flexed to 90*
Positive sign: pain reproduced in SIJ or buttock pain.
Nachlas Test
Where: L-spine
What for: neurological dysfunction
Main purpose: to examine if there is L-spine nerve root lesion (typically in L2 L3)
Technique: Pt is prone–> Prac will passively flex knee (heel to buttock). If Pt is unable to flex knee past 90*, prac will flex knee as far is will go then passively ext the hip.
Positive sign: Pain in the anterior thigh= tight rec fem.
Pain in the LB region= L2/L3 nerve root
lesion
If ipisilateral ASIS rotates forward prior to
knee reaching 90* flexion + pain in SIJ=
hypermobile joint.
Jackson Compression Test
modification of Spurling’s compression test
What for: if Pt reports of nerve root symptoms like radicular pain into the arm.
Technique: Pt rotates head to one side and then the prac will compress down ontop of the head. BILAT.
Positive sign: reproduction of pain.
Gillet’s Test
aka Stork Test
Where: SIJ
What for: SIJ pathology
Main purpose: to exmine the movement of the SIJ to determine if the joint is hypomoble
Technique: Pt is asked to flex one hip to 90* while the prac palpates the PSIS with one thumb and the SP of the SIJ with the other.
Positive sign: IF the PSIS goes down= normal mvmnt. IF the PSIS goes up= hypomobility in the flexed side.
Speed’s Test
aka straight arm test
Where: shoulder
What for: tests for a pathology of the biceps tendon
Main purpose: to examine if there is labral tears or bicipital tendonitis.
Technique: Pt sitting or standing, their shoulder will be flexed to 90* + fully ext rot, elbow fully ext, and forearm supinated. Prac will apply a downward force that the Pt will resist.
Positive sign: reproduction of pain the bicipital groove.
Painful Arc
Where: shoulder
What for: to test for subacromial impingement syndrome.
Technique: Pt will ABD arm in the scapular plane
Positive sign: During ABD, Pt will feel pain ONLY b/w 60-120 of GH ABD. NO PAIN BEFORE 60, NO PAAIN AFTER 120.
ULTT
How many are there?: 4
Median 1 and Median 2
Ulnar
Radial
Main purpose: to stretch the upper limbs’ neurological structures.
ULTT Median 1
Structures tested: Median nerve, anterior interosseous nerves and nerve roots C5-C7.
Technique: Pt supine, depress their shoulder + ABD 110* + Lat rotate 90. Flex elbow to 90. From this position, extend elbow while also ext wrist and fingers.
ULTT Medain 2
Structures tested: Median nerve, musculocutaneous nerve, and axillary nerve.
Technique: SAME mvmnt as ULTT Medain1 except only ABD shoulder to 10* ABD.
ULTT Radial
Structures tested: Radial nerve
Technique: Depress Pt shoulder, ABD shoulder to 10, flex elbow to 90, flex wrist and fingers, hand pronated, then passively ext elbow until symptoms are provoked.
ULTT Ulnar
Structures tested: Ulnar nerve
Technique: Pt shoulder depressed, ABD shoulder 10* and passively bring pronated/flexed wrist to ear (waiter’s pose).
Straight Leg Test
aka Lasegues Test
Where: LB
What for: Test used when Pt reports low back pain
Main purpose: Tests for lumbrosacral nerve root irritation that is most commonly caused by disc herniation.
Technique: Pt supine, passively flex their hip while maintaining knee ext.
Positive sign: Reproduction of symptoms (numbness or tinglingness down the leg, radiating pain down the leg, loss of mm strength). Most symptoms occur within the range between 35-70*).
Neri’s sign
Part of SLR additional Ax; lifting the head into flexion
Positive sign= reproduction of symptoms
Bragard’s Sign
Part of the SLP additional Ax; dorsiflex the foot
Positive sign= reproduction of symptoms
Bragard’s Sign
Part of the SLP additional Ax; dorsiflex the foot
Positive sign= reproduction of symptoms
Dermatomes
What for: examines sensations to corresponding nerve roots
Myotomes
What for: examines mm weaknesses
LLTT
SLR
There are 3 in total
SLR –> tests for neural tension or irritation in L spine nerve roots L4+5, S1+2, Sciatic nerve, SID, PIP, TED
SID= testing the Sural nerve by IR + DF ankle
PIP= testing Peroneal nerve by IR + PF ankle
TED= testing Tibial nerve by ER + DF ankle
all in the SLR test position
LLTT
Slump test
Slump test–> test for neural tension or irritation in the L spine nerve roots and the sciatic nerve.
LLTT
Prone knee bend test
Prone Knee bend test–> tests for neural tension or irritation in L spine nerve roots L2 L3 L4 and the Femoral Nerve
“Sign of the buttock”
Where: Hip/buttock
What for: hip or buttock pathology
Main purpose: To examine hip flexion movement to confirm if it is a LB/hamstring problem or if the problem lies within the buttock region behind the hip.
Technique: First, perform SLR test with knee extended. Then flex the knee to see if the hip will further flex. If further hip flexion is achieved the test is negative and the problem lies in the L-spine or the hamstrings.
Positive sign: If further hip flexion can not occur, then the pathology lies in the buttock region that may to caused by bursitis, abscess or tumor.
Roo’s test
aka EAST (elevated arm stress test)
“hands up” test
AER (positive ABD Ext Rot position test)
Where: Thoracic spine or shoulder
What for:
Main purpose: Asses for TOS
Technique: Have Pt ABD shoulder 90, flex elbow 90 and Ext Rot forearm. Ask Pt to open and close hands for 3 min.
Positive Sign: If Pt is unable to continue mvmnt for 3 min or has ischemic pain, profound weakness or heaviness of the arm, or NTW into the hand. Or if their pulse diminishes= compression of the artery.
Tinel’s sign
Can be performed along any nerve pathway.
Purpose: To test for nerve damage or nerve compression (neuroma) Provocative test.
Technique: Tap along the course of the nerve being tested (distal to proximal).
Positive Sign: Tingling or “pins and needles” over the nerve the Prac is tapping on.
Finklestein’s test
Where: Wrist
What for: Ax tendons and mm in the wrist and hand
Main purpose: Provocative test for dx De Quervains syndrome or Hoffman disease.
Technique: Pt makes a fist with the thumb inside the fingers then ulnar deviates.
Positive sign: pain in the “snuff box” region. Indicating paratenonitis of the ABD pollicis longus and ext pollicis brevis tendons.
Kernig’s sign
Part of the Brudzinki-Kernig test.
Brudzinki portion= Pt actively flexes head while supine.
Positive sign: If pain or discomfort occurs in neck or LB region, Pt will attempt to alleviate discomfort by flexing the knee.
Kernig portion= Pt supine with hip and knee flexed to 90*. Pt will actively ext knee to straighten leg.
Positive sign: If pain or discomfort occurs on the neck, low back or head.
Valsalva
Where: with in the spinal chord
Purpose: To examine the effect of increased pressure on the spinal cord.
Technique: Pt seated ask them to bear down and hold their breath.
Positive sign: Provocation of pain
Clarke’s Sign (patellar grind test)
Where: performed on the knee depending on the pathology
Purpose: For patellar femoral syndrome
Technique: Knee fully extended quadriceps relaxed, the examiner press down onto the base of the patella with the web of their hand. The patient is then asked to contract their quadriceps while examiner pushes down.
Positive sign: reproduction of pain during muscle contraction.
O’Donoghue’s Test
Where: performed on the knee depending on the pathology
Purpose: Testing for capsular irritation or meniscus tear
Technique: with the patient prone, examiner flexes the knee to 90*, then externally and internally rotates the tibia. Followed by knee extension with ext and int rotation. Examiner will repeat these movements.
Positive sign: Pain during either rotation movement in either knee position.
Allen’s Test
Where: performed on the hands
Purpose: testing for circulation of the radial and ulnar arteries
Technique: Patient opens and closes hand multiple times. then makes a fist. The practitioner will press down on the radial and ulnar artery and then ask the patient to release the fist. After their hand is open practitioner will slowly release the arteries one at a time.
Result: determines which artery is the major supplier to the corresponding hand.
Halstead’s test
Where: performed on the radial pulse
Purpose: to assess for possible TOS
Technique: Find the radial pulse of one arm and apply light traction to the test extremity while the patient ext and rotates head away from test extremity.
Result: Absence or disappearance of the pulse indicates positive for TOS.
Eden’s
Where: performed on the radial pulse.
Purpose: tests for the presence of TOS
Technique: Patient is seated or standing. Examiner palpates radial pulse of test arm while bring shoulder back and down. Patient will also push their shoulders back and chest out.
Result: Positive if pulse disappears or of patient experience NTW. Common in ppl who wear back packs.
Wright’s test
aka hyperabduction test
Where: compression of the brachial plexus caused by pec minor tendon or costoclavicular tendon.
Purpose: Tests for TOS
Technique: 1st step: bring GH to 90 ABD, 90 elbow flex, and ext rot. this stretch the pec minor tendon which may compress the brachial plexus. 2nd step: hyperABD shoulder. This compresses the costoclavicular space.
Positive Result: Radial pulse absence or reproduction of NTW symptoms.
Adson’s test
Where: Compression of the subclavian artery by a cervical rib or tightened ant or mid scalene.
Purpose: To asses for TOS due to arterial compression.
Technique: Patient seated or standing; bring patients arm into 30* ABD and slight shoulder ext. Palpate radial pulse of outstretched arm. Pt will then ext head amd rotate head towards the test arm. Pt is then asked to take a deep breath in and hold. Compare quality of pulse to normal resting pulse.
Positive Result: Diminishing of radial pulse indicates TOS.
Murphy’s Sign
Where: RUQ or Epigastric region of the abdomen
Purpose: the positive sign for acute cholecystitis (swollen gallbladder).
Technique: Patient lying supine, the examiner will place hands just under the right costal margin and then apply some pressure. Pt will inhale to the best of their ability.
Positive sign: Patient stops breathing and winces in pain with a catch in breath. This is due to the practitioners finger coming in contact with the gallbladder as it descends upon inhalation.
Crank test
aka Compression rotation test
Or Labral Crank test
Where: Shoulder
Purpose: To test for glenoid labral tears and assess unstable superior labral anterior posterior (SLAP) lesions.
Technique: Can be done seated and supine: practitioner will bring patients should to 90* ABD . Joint load (compression) is applied onto the humerus at the elbow with one hand while the other (@ the shoulder) passively rotates shoulder in the scapular plane.
Positive Sign: Pain reproduction with or without a click during maneuver.
Apprehension
aka Relocation Test
Where: performed no the shoulder depending on pathology
Purpose: to asses the integrity of the GH joint capsule or GH instability in an anterior direction.
Technique: Patient lying supine, bring affected GH to 90* ABD and flex elbow to 90*. Passivley Ext Rot the shoulder and monitor the patients symptoms.
Positive Sign: Apprehension from the patient going into the maneuver NO PAIN.
If there is pain, but NO apprehension, could mean other pathology (post impingement of the rotator cuff).
Ober’s
Where: performed on the lumbar spine
Purpose: test for muscle tightness (contracture) along the IT band specifically due to a tight TFL.
Positive sign: if a contracture is present, the leg will remain ABD and does not fall onto the table.
Apley’s Test
Scratch test
Purpose: assess AROM of the shoulder to gain information about your patients functional capacity.
