Special Tests Flashcards
Functional Opening “Knuckle” Test
TMD
Functional Opening “Knuckle Test”
- Patient is instructed to place 2 flexed PIP joints w/in thier mouth
(+): Inability to fit 2 PIP joints w/in their open mouth
Functional Opening = 2 PIP w/in mouth
Maximal Opening = 3 PIP w/in mouth
Spurling’s (Foraminal Compression) Test
Cervical Radiculopathy
Therapist applies a axial load by pressing straight down on patient’s head
If no symptoms occur whille head is in neutral progress to:
1. Extension + rotation to unaffected side, then extension + rotation to affected side
Closing the IVF down even more
2. Side flexion to affected side - contralateral (may alleviated S/S slightly)
(+) = reproduction of radicular symptoms (towrds the side of side flexion)
Cervical Distratction
Cervical Radiculopathy
Test is used when a patient is currently experiencing radicular symptoms
PT places one hand under the chin & the other hand around the occiput, lifts upward to apply a traction to the c-spine
(+): Radicular symptoms decreased or abolished
Vertebral Artery (Cervical Quadrant) Test
- Patient is positioned in supine
- Therapist passively takes patients head & neck into extension & side flexion & holds for 10-30 seconds
If no symptoms are produced, ipsilateral neck rotation is added & posiiton is held for 10-30 seconds
** EYES OPEN thoughout test
(+) = Dizziness or nystagmus. This indicates that the contralateral side artery is being compressed
- Tensioned & getting compressed as it passes through the canal
Anterior Shear or Saggital Shear Test
Cervical Instability
Tests the integrity of supporting anterior ligaments & capsular tissues
Procedure:
- Patient in supine, head in neutral
- Therapist stabilizes the vertebra by placing both thumbs over the anterior aspect of the TPs
- Therapist applies an anterior force on the adjacent vertebra above the stabilized vertebra
May apply force through SP or bilaterally through the posterior arch (lamina)
(+) = Excessive motion &/or S/S of cervical instability
Lateral Flexion Alar Ligament Stress Test
Cervical Instability
Tests the integrity of the contralateral alar ligament
Procedure:
- Patient in supine, head in neutral
- PT stabilizes C2 with wide pinch grip around SP & lamiina
- PT side flexes C1 & head
(+) = excessive side flexion
An intact alar ligament results in a strong capsular end-feel
Lateral (Transverse) Shear Test
Cervical Instability
Tests the integrity of lateral ligaments & capsular tissue
Procedure:
- Patient in supine, head in neutral
- Forwarn patient that test may cause pain and discomfort **
- PT places the radial aspect of the 2nd MTP joint of one hand aginst the TP of one vertebra & the radial aspect of the 2nd MTP joint of the other hand on the TP of an adjacent vertebrae on the other side of the neck
- PT hands are then pushed together carefully creating a shearing force of one vertebra over the other
(+) = Excessive motion or sumptoms of instability, spinal cord, or vascular pathology
- Minimal motion and no symptoms should be produced with intact ligaments & capsular tissue
NEED to refer patient - at risk for numerous adverse events (stroke)
Sharp-Purser Test
Cervical Instability
Should be performed with extreme caution
Test to determine subluxation of C1 (atlas) on C2 (axis)
- Transverse ligament helps maintain position of the odontoid process of C2 relative to C1. If the transverse ligament is torn, C1 will sub lux by translating forward relative to C2 in flexion
- Patient may be hesitant or reluctant to perform forward flexion
Procedure:
- PT places one hand over the patient’s forehead & the thumb of the other hand is placed over the C2 SP in order to stabilize C2.
- Patient is asked to slowly flex head forward, while the PT applied pressure against the patient’s forehead. May hear a clunk - could possible reduce the subluxation
(+) = PT feels the head slide backwards during the movement
- Indicates relocation of subluxed atlas. May be accompanied by a clunk
Cervical Flexion-Rotation Test
Cervical Instability
Indicates C1-C2 dysfunction
Validated as a diagnostic test for C1-2 related CERVICOGENIC headache
Procedure:
- Patient in supine
- PT fully flexes the patient’s c-spine (chin-chest) & proceeds to rotate the patient’s head to the RT & LT (while maintaining full c-spine flexion) to assess ROM
FULL FLEX: locks C3-7) to evaluate how much rotation is at C1-2
(+) =
- Increased or decreased ROM 45 degrees upper c-spine rotation ROM indicating a C1-2 dysfunction
- Reproduction of headache indicating C1-2 cervicogenic headache
False (+) if you do not lock the pt C/S well
Craniocervical Flexion Test (Pressure Feedback Test)
(+) = 4
Segmental Instability - Clinical Instability
Procedure:
- Test deep neck flexor mm function
- Patient positioned in supine in crook-lying with c-spine in neutral (place towels under head to achieve neutral c-spine if necessary)
- Place inflatable pressure sense (BP cuff) under the upper c-spine
- Inflate pressure device to a base level of 20 mmHg
- Instruct the patient to perform upper c-spine flexion by nodding the head slowly & gently in order to reach a pressure grade of 22 mmHg & hold for 10 seconds
If activation of SCM occurs = pt is doing it wrong
- This is repeated at increasing pressure grades (22, 24, 26, 28, and 30)
- Most young & middle-aged patients can successfully perform test at 26 & hold for 10 seconds
(+) =
- Patient is unable to increase pressure to at least 26 mm Hg
- Unable to hold contraction at given pressure for 10 secs (or it teeters)
- Inability to raise pressure in small increments (2 mm Hg)
- Uses compensatory patterns:
Uses superficial neck mm (SCM)
Extends the head
*Overactivity of global mm & underactivity of deep mm
Adams Test
(Adams Forward Bend Test)
Scoliosis
Procedure:
- The patient takes off his/her t-shirt so that the spine is visible.
- The patient needs to bend forward, starting at the waist until the back comes in the horizontal plane, with the feet together, arms hanging and the knees in extension. The palms are held together.
- The examiner stands at the back of the patient and looks along the horizontal plane of the spine, searching for abnormalities of the spinal curve, like increased or decreased lordosis/ kyphosis, and an asymmetry of the trunk
(+) = indicated if asymmetry is observed (one side of the spine is higher than the other)
SLUMP
Lumbar Radiculopathy
Patient in sitting w/ legs unsupported
Procedure:
- PT instructs the patient to place hands behind back, go into slump posture (rounded shoulders) bringing thier chin to their chest
- PT passively extends the uninvolved knee then repeats the test on the involved side
- If symptoms have not been reproduced ankle DF is added
- If symptoms of low back pain/ radiating pain in posterior leg are recreated, ask patient to extend their neck while maintaining a rounded back
(+) =
- relief of symptoms when patient extends neck indicates neural tension/restriction of lumbosacral roots
- It can also be interpreted as a restriction of the dura/neural tissues
- If symptoms are reproduced at any stage futher sequential movements are not attempted
Straight Leg Raise (SLR)
Lumbar Radiculopathy
Patient lying in supine
Test unaffected side first
Procedure:
- PT slightly adducts & medially rotates patient’s hip, keeping the knee in full extension
- PT flexes patient’s hip (w/ knee in full extension) until the patient indicates pain or rightness in posterior thigh
- Therapist slowly lowers leg slightly until pain or tightness disappears
- PT dorsiflexes the foot or alternately asks the patient to flex their neck to verify if are symptoms reproduced
ROM explained:
- Before 35 degree nerve slack bring taken up
- At 35 root is under tension
- At 60-70 sciatic roots tense over disc
- > 70 degree pain is likely MSK (hamstring stretch)
Sign of the Buttock
Procedure:
- the PT performs a SLR until the point of restriction
- The PT proceeds to flex the knee to see whether an increase in hip flexion may be achieved
(+) =
- Hip flexion does NOT increase when the knee is flexed
- Indicates pathology behind the hip joint in the buttocks
Ex. bursitis, tumor, or abscess
REFERRAL - could be something sinister
Bow-String Test
Lumbar Radiculopathy
Follows a positive SLR
- While maintaining the SLR position which reproduced symptoms, the PT slightly flexes (20 degrees) the patient’s knee to reduce symptoms
Procedure:
- The PT then puts pressure into the popliteal area using his/her thumbs or fingers
(+) = Reproduction of radicular symptoms
Indicates pressure or tension on sciatic nerve
Quadrant (Extension Quadrant) Test
(Kemp’s Test)
L/S Facet Syndrome
Patient standing upright with PT standing behind patient
Procedure:
- Patient extends the L/S, and side flexes & rotates to the side of pain
- Overpressure is applied into extension by the OT
(+) = reproduction of symptoms (low back pain) may indicate facet joint involvement
Special Test: H & I Stability Test
L/S Clinical Instability - Set of movements which tests for mm spasms or possible spinal instability
Procedure:
“H” movement:
- The patient begins in neutral standing position
- the patient is asked to perform side flexion as far as possible (both are tested, start w/ pain-free direction first)
- The patient is then asked to perform flexion or extension as far as possible (both are tested, start with pain-free direction first)
- Repeat with side flexion to other side
“I” movement
- The patient begins in neutral standing position
- The patient is asked to perform lumbar flexion OR extension as far as possible (both are tested, start with pain-free direction first)
- The patient is then asked to perform side flexion to one side as far as possible (both are tested, start with pain-free direction first)
- Repeated with side flexion to other side
(+) =
Hypomobility
- At least 2 movements limited or painful in the SAME quadrant
Instability
- Only 1 movement into the quadrant is affected (may present with pain or instability “jog” > one moment when you feel instability & get pain in that moment BUT after you go past that you are good
- The direction of instability is the movement that is performed in the first phase of movement
- If the movement is performed in the second phase of movement it can be stabilized by the first movement & an instability would not be apparent
** IF “H” or “I” is painful & there other is not = INSTABILITY
Prone Segmental Instability Test
Position:
Patient lies with their upper body prone on the examination table while their legs are over the edge of the table resting on the floor
Procedure:
- PT applied PA pressure on the L/S
- The patient is instructed to lift their legs off the floor
(+) = pain is produced while the legs are resting on the floor, but not present when the legs are lifted off the floor
- Test indicates patient would benefit from core strengthening/stability exercises
Adson Manuever
Costoclavicular Syndrome (Military Brace) Test
Halstead Manuever
Wright Test
Allen Test
TOS
All tests palpate RADIAL pulse in different postures
(+) = if radial pulse disappears
Arterial type TOS
Adson’s test OR Manuever
Compression of the subclavian artery by a cervical rib or tightened anterior and middle scalene muscles
The test can be performed with the patient in either sitting or standing with their elbow in full extension
Procedure
- The arm of the standing (or seated) patient is abducted 30 degrees at the shoulder and maximally extended.
- The radial pulse is palpated and the examiner grasps the patient’s wrist.
- The patient then extends the neck and turns the head toward the symptomatic shoulder and is asked to take a deep breath and hold it.
- The quality of the radial pulse is evaluated in comparison to the pulse taken while the arm is resting at the patient’s side.
- Some clinicians have patients turn their head away from the side tested in a modified test.
(+) = marked decrease, or disappearance, of the radial pulse. It is important to check the patient’s radial pulse on the other arm to recognize the patient’s normal pulse.
Costoclavicular Syndrome ( OR Military Brace OR Eden’s) Test
TOS
Procedure:
- Patient is standing.
- The examiner palpates the radial pulse and then draws the patient’s shoulders down and back as the patient lifts their chest in an exaggerated “at attention” posture
(+) =
1. An absence or decrease in vigor of the pulse and implies possible costoclavicular syndrome
2. Also positive if the client experiences an increase of neurologic symptoms into the upper extremity on that side
This test is particularly effective in patients who complain of symptoms while wearing a backpack or heavycoat
Halstead Manuever
TOS
Procedure:
- The patient is sitting or standing. - The therapist continuously palpates the radial pulse on the side being tested.
- While still palpating the radial pulse, the therapist abducts the arm to 45 degrees, extends the shoulder to 45 degrees, and externally rotates the upper extremity while applying a downward distraction to the arm. - The patient is then asked to fully turn her head away from the side being tested and extend the cervical spine.
(+) = Disappearance or decreasing of the radial pulse
Wright Test (Hyper-Abduction test)
TOS - thought to implicate the axillary interval (space posterior to pectoralis minor)
The test is performed in the sitting and then in a the supine positions
Procedure:
the test is performed in 2steps
First step:
- Head forward, while the arm is passively brought into abduction and external rotation to 90 without tilting the head.
The elbow is flexed no more than 45. The arm is then held for 1 min
- The tester measure radial pulse and monitor patient symptoms onset
- Seconed step:
- The tester monitors the patient’s symptom onset and the quality of the radial pulse.
- The test is repeated with extremity in hyperabduction (end range of abduction)
(+) = decrease in the radial pulse and/or reproduction of the patient’s symptoms
Roos Test (Elevated Arm Stress Test)
TOS
Procedure:
PT open & closes fists with shoulder (horizontal abduction) & elbow at 90 degrees for 3 minutes
(+) = inability to hold position for 3 mins
- Ischemic pain - arterial
- Heaviness/weakness = arterial
- S/S of neurological weakness - ex. numbness & tingling
Shoulder Girdle Passive Elevation (Cyriax Release Test)
Procedure:
- Pt crosses arms & PT lifts elbows up - elevation
(+) = relieves neurological S/S
- Skin colour changes / temp - arterial
- Pulse becomes stronger
- Less cyanotic - venous
Cyriax = switch arm positions: pt has elbows @ 90 & pronated & PT lifts the arms this way
Special Test: Cross Body (Horizontal) Adduction Test
Shoulder Separation
- The test is performed by passively bringing the patient’s arm into 90 degrees of forward flexion, with their elbow also flexed to 90 degrees.
- The examiner then horizontally adducts the flexed arm across the patient’s body, bringing their elbow towards the contralateral shoulder
(+) = if the maneuver successfully reproduces the patient’s symptoms of pain localized over the AC joint
Crank (apprehension) & relocation test
Apprehension release (suprise) test
Load & shift test
Anterior Instability
Crank (apprehension) & relocation test
Jobe Relocation Test (also referred to as the Fowler Sign) is to test for anterior instability of the glenohumeral joint.
- often administered after the Apprehension Test
Position:
- The patient is positioned supine, with the elbow flexed to 90 degrees and abducted to 90 degrees
Procedure:
- The therapist then applies an external rotation force to the shoulder,
- If the patient reports apprehension in any way, the Apprehension Test is considered to be positive.
- At this point, the therapist may apply a posteriorly directed force to the shoulder
- If the patient’s apprehension or pain is reduced in this position, the Jobe Relocation Test is considered to be positive
Apprehension release (Surprise) test
Before you can use the release or surprise test the patient has to have had apprehension during the apprehension test that was reduced during at AP glide of the relocation test. The “surprise” comes from spontaneously releasing the Anterior-posterior directed pressure on the glenohumeral joint. This should result in re-elicitation of the patient’s fear of luxation and indicates a positive test. Be careful to not bring the arm into further external rotation or horizontal abduction while releasing as you may risk anterior luxation!
Load & shift test
Anterior &/or Posterior Instability
Procedure:
- To perform the test have your patient in sitting position with his arm resting on the thigh, a straight posture, and relaxed muscles.
- Stabilize the clavicle and scapula with one hand and grab the head of the humerus with your other hand and bring it into the normal position relative to the glenoid.
- With many patients, the head of the humerus will rather be positioned a bit anteriorly.
- During the load portion of the test, push the head of the humerus anteriorly in order to test for anterior laxity and posteriorly for posterior laxity.
(+) = reproduce the patient’s symptoms and if the tested side clearly translates further than the other side.
Jerk Test
Load & shift test
Posterior Apprehension
Posterior Instability
Jerk test
Postero-inferior instability of the Glenohumeral joint.
Procedure:
- While stabilizing the patient’s scapula with one hand and holding the affected arm at 90° abduction and internal rotation
- Examiner grasps the elbow and axially loads the humerus in a proximal direction.
- The arm is moved horizontally across the body.
(+) = indicated by a sudden clunk as the humeral head slides off the back of the glenoid.
- When the arm is returned to the original position, a second jerk may be observed, that of the humeral head returning to the glenoid.
Posterior Apprehension
Posterior instability - To test for posterior glenohumeral capsular laxity and/ or posterior labrum.
Procedure:
- The examiner places the tested arm in 90 degrees shoulder flexion, neutral rotation, and 100-105 degrees of horizontal adduction.
- Next, the examiner places their other hand underneath the patient’s scapula for support & applies a force through the long axis of the humerus.
- Assess the patient’s response
(+) = long axis force reproduces a sense of apprehension and increased muscle guarding to prevent posterior shoulder dislocation
Suclus sign
Feagin Test
Inferior & multidirectional instability
Feagin Test (Inferior Drawer Test)
Check the inferior shoulder stability.It assesses humeral head inferior subluxation
Patient position: The patient is tested best when relaxed in the sitting position beside the clinician. Patient will be in either sitting or standing position.
Examiner position: The clinician holds the patient’s upper extremity at 90 degrees of abduction, with the patient’s forearm over the clinician’s shoulder and elbow extended.
Technique: The clinician uses one hand to apply an inferiorly and slightly anteriorly directed force while the other hand palpates the edge of the acromion and the humeral head to feel for displacement anteriorly and inferiorly.
(+) = a sense of apprehension, pain, or an increased amount of translation in the inferior direction (anteroinferior instability)
Clunk Test
Active Compression Test of O’Brien (specifc to..)
Biceps Load Test (Kim Test II)
Glenohumeral Labral Tear
Active Compression Test of O’Brien - specific to SLAP tear
Hawkins Kennedy Impingement Test
Neer’s Impingment
Scapular Assist Test
Subacromial Impingment Syndrome
Hawkins Kennedy Impingement Test
- IR arm in front of pt > placing the greater tubercle into the narrow aspect of the subacromial arch where it compresses the other structures
(+) = pain
Neer’s Impingement Test:
- PT places arm into IR (0 degree elbow ext) & passively flexes arm in scapular plane
- Bring the greater tubercle towards the narrow aspect of the subacromial arch SO compression happens earlier & more
(+) = pain
Scapular Assist
- ABD & PT helps facilitate the mvmt
(+) = decrease of pain
Speed’s Test
Yergason’s test
Biceps (LHB)
Yergason’s - not specific for tendinitis - rather assess the ligament holding the LHB tendon
Drop Arm Test
“Empty” Can Test
Supraspinatus
Drop Arm Test (TEAR): lifting pt arm passively & tell them to hold this position & let go && they can NOT hold the position
“Empty can” Test - pathology
Belly Press Test
Lift-off sign
Internal Rotation Lag Sign
Subscapularis
Infraspinatus Test
Lateral Rotation Lag sign
Infraspinatus
Hornblower’s Sign
Teres Minor
Wall or Floor Push Up Test
Scapular Load Test
Punch Out Test
Scapular Dyskinesia - Scapular Winging
Wall or Floor Push Up Test (wall = greater load)
Scapular Load Test - wt or manual resisting @ 45 of ABD ** Looking at scapula when doing the test.
Punch Out Test - making a fist w/ straight elbow & resisting protraction
Valgus Stress Test
Elbow
UCL Tear
0, 20-30 degrees
20-30 - limits stretch of joint capsule - really biasing the ligament
