Special tests Flashcards
Lasegue’s Test
(SLR) supine, keep knee in extension and raise leg (by flexing hip) until discomfort is experienced or full ROM is reached.
+ pain (radiating) before end of normal ROM (70)
i: sciatic nerve irritation/compression
mod: after pain, lower leg to no pain point, dorsiflex ankle and/or have patient cervical flex. if no pain, previous positive was tight hamstrings.
Well Cross SLR test
side not experiencing symptoms, same as Lasegue’s.
+ pain on opposite side being raised,
i: large space-occupying lesion such as a herniated intervertebral disk
Slump test
sitting, sequence- 1. patient slumps along thoracolumbar spine, pressure app. 2. patient flexes cervical spine, pressure, 3. knee actively extended, 4. ankle dorsiflexed.
+sciatic pain or reproduction of other neurologic symptoms.
i: impingement of dural lining, spinal cord, or nerve roots
Kernig/Brudzinski test
uni active SLR, until pain occurs, then patient flexes the knee
+ pain is experienced in the spine and possibly radiating into lower ext; pain relieved when pt flexes the knee
i: nerve root impingement secondary to a bulging of the intervertebral disk or bony entrapment; irritation of dural sheath; or irritation of the meninges
mod (Brudzinski): in absense of pain during SLR, examiner may flex cerv. spine, increasing tension on dural sheath
Milgram’s test
bilateral 6 in. hold for 30 sec.
+ patient unable to hold, cannot lift leg, or experiences pain with the test
i: intra/extrathecal pressure causing an intervertebral disk to place pressure on lumbar nerve root
Valsalva test
bear down as if bowel mvmt.
+increased spinal/radicular pain
i: increase in intrathecal pressure causes pain secondary to a space occupying lesion
Hoover test
examiner hold patients heels, pt attemptsSLR on involved side,
+patient does not attempt to lift leg and examiner does not sense pressure from the uninvolved leg pressing down on the hand as should happen instinctively
i: malingering
Gapping test
SI compression test (Part of PROM!)
push ASIS apart
+pain arising from the SI jt
i: sacroiliac pathology
Approximation test
SI distraction test (part of PROM)
side lying, push ASIS’s together
+pain arising from SI jt
i: SI path
ipsilateral prone kinetic test
(part of PROM)
thumb on PSIS and other thumb parallel to sacrum, pt extends leg at hip jt,
+PSIS does not move (should move superiorly)
i: hypomobility with a posterior rotated ilium (outflare)
Sacroiliac rocking test AKA hip scouring test
supine, fully flexing pts hip and knee, apply a downward pressure along shaft to compress jt surfaces. internally and externally rotate femur at multiple angles of flexion
+ pain described or symptoms in hip reproduced
i: possible defect in articular cartilage of femur or acetabulum. or labral tear
Nachlas test
Prone knee bending test.
passively flex let at knee jt, test bilaterally
+ pain or the ASIS rotates forward before 90 deg of flexion or ipsilateral pelvic rim rotates forward
i: pain after 90 in front can indicate rect femoris tightness, pain in lumbar indicates lumbar pathology (usuallyL3 nerve root), if ASIS rotates forward (butt comes off table) indicates hypomobile SI jt
abdominal reflex (Beevor’s sign)
have pt do abdominal curl (partial sit up),
+ umbilicus moves up/down/to one side
i: segmental involvement of nerves innervating the rectus abdominis,
Naffziger’s test
compress jugular veins for 10 sec and cough,
+test pain in low back (intrathecal pressure)
Tension sign/Bowstring test
do during SLR test.
TS: supine, grasp heel and thigh, flex their hip and knee to 90, then extend the leg at knee jt while palpating the tibial portion of the sciatic nerve
+tenderness with possible duplication of sciatic symptoms
i: sciatic nerve irritation
Bows:
extends pt knee until radiating symptoms experienced, then flex knee to ~20 or until relief, then push on tibial portion of sciatic nerve
+reproduce symptoms w/palp i: sciatic nerve irritation
Babinski/Oppenheim test
Babinski:blunt device to run up plantar aspect of foor making an arc to ball of big toe, normal innerv makes toes curl
+ great toe extends,others splay
i: UMNL, esp in pyramidal tract, caused by brain/spinal cord trauma/pathology
Oppen: blunt object along crest of anteromedial tibia
+great tow extends &others splay or pt reports hypersensitivity.
i: UMNL caused by brain/spinal cord trauma/pathology
Stork standing
standing, lift one leg and hyperextend trunk
+ pain in lumbar spine or SI area
i: pars interarticularis pathology
quadrant test
grasp pt shoulders, have them extend as far as poss, then sidebends and rotates to affected side. prov overpressure through shoulders, supporting pt as needed
+reproduction of pts symptoms.
i: radicular pain =compression of intervertebral foramina (impinging on lumb nerve roots)… local pain indicates facet jt path… symptoms isolated to PSIS area may ind SI jt dysf
Gillet’s test
examiner thumbs on PSIS, pt lifts 1 knee to chest.
+ PSIS on side flexed does not move or moves inferiorly, or PSIS on opp side moves down or inferiorly
i: hypomobile SI or fixated jt
Gaenslen’s test
pt supine at edge of table, pt pulls far knee up to chest, near leg hangs over table. Stabilize pt and apply pressure near leg, forcing hip into extension
+ pain in the SI region
i: SI jt dysfunction
Long sit test
supine pt, heels off edge of table, hold medial malleoli. provide slight traction on legs while pt arches and lifts butt off table. pt then stops, then (actively if possible) moves from supine into a long sit position,
+ movement of medial malleoli: involved leg goes from longer to short position- anterior rotation of the ilium on that side. involved leg goes from short to long pos- posterior rotation of ilium on sacrum is indicated
Leg length test
If SI jt lesion is suspected
-can be measured from ASIS to med. malleoli of each leg
difference of .5-1 in normal
Trendelenburg test
tests for weak glute medius
lifted side drops=weak glut med on stance leg side
Weber-Barstow maneuver
same as long sit except without sit.
+ different levels of malleoli
i: asymmetry of legs
Laguere
supine, examier hand on ASIS and places pt lower leg/ankle on shoulder while gripping knee. flex, abduct and laterally rotate pts hip, then provide over pressure at end of ROM
+ pain on same side
i: SI pathology
Faber
foot of involved side crossed over opposite thigh. examiner hand on opp ASIS and other on medial aspect of flexed knee. apply over pressure on knee and ASIS.
+pain in SI jt or hip
i: pain in inguinal area anterior to hip may i hip path.
pain during application of overpressure in SI area may i SI jt path
Yeomen’s
prone, grasp heel and above knee, passively flex knee to 90 while extending leg at hip jt.
+pain in lumbar/SI/anterior thigh parasthesia
i: Lumbar pain i lumbar path, SI pain i anterior SI lig path, anter thigh parasthesia i femoral nerve stretch
Thomas
supine w knee off edge of table, passively bring non affected leg to pt chest, bilat test
+ lower leg moves into full extension and/or thigh comes off table
i: tightness of rectus femoris and/or iliopsoas group
Ober’s
side lying w/ bottom leg bent at knee. stabilize hip and grasp upper leg, passively abduct and extend leg, release leg knee but keep hold of ankle and hip stab.
+ thigh does not move toward table but stays abducted.
i: IT band tightness/contracture
tripod.
sitting w/ knees over edge, passively extend at knee jt, test bilat
+ pt extends trunk
i: tight hamstrings
