Special Tests Flashcards
Distraction test
Tests for: nerve root symptoms
Seated.
Hand under chin and at occiput, or by ears. Slowly lift head.
Positive: radicular symptoms relieved or diminished
Traction Test
Tests for: pressure on nerve roots
Supine. Place hand on chin and occiput. Gently traction
Positive: symptoms alleviated.
Upper limb tension tests.
Test for test neurological tissue of the upper limb.
Four steps:
- Shoulder depression
- Shoulder abduction 10-110°
- Forearm, wrist, fingers taken to end range.
- Finally move elbow.
ULTT 1
Tests median nerve, anterior interosseus
C5-7
Abduction 110°
Supination
Extension: elbow, wrist, digits
Flexion:
ULTT 2
Median nerve, musculocutaneous nerve, axilllary nerve
Abduction 10°
Supination
Extension: elbow, wrist, digits
Flexion: –
ULTT 3
Radial nerve
Abduction 110°
Pronation
Extension: elbow
Flexion: wrist (with ulnar dev), digits
ULTT 4
Ulnar nerve, C8-T1
Abduction 10-90° (hand to ear)
Supination or pronation
Extension: wrist (with radial Dev), digits
Flexion: elbow
Bakody’s sign
AKA Relief test, Shoulder Abduction Test
Tests for: C4-5 or C5-6 nerve root involvement. Extradural compression problem.
Abduct arm, flex elbow, rest arm on head. Passive or active.
Positive: decrease in symptoms
If shoulder abdication test increases pain?
Pressure increasing in inter scalene triangle (TOS)
Scalene cramp test
Tests for scalene TrP
TOS
Seated
Rotates head to affected side, tucking chin into space behind clavicle
Positive: increased pain (IL scalene TrP); radicular signs (TOS)
Valsalva test
Tests for increased intrathecal pressure (space-occupying lesion – herniation, tumor, osteophyte)
Sit. Lean forward. Take deep breath and bear down.
Positive: increases pain
Tinel’s sign for brachial plexus lesion
Tests for brachial
Plexus lesion
Seated. Neck slightly side flexed.
Tap along nerve trunk.
Positive if:
Local pain –> underlying cervical plexus lesion
Tinel’s signs –> lesion intact and recovery occurring
Pain along peripheral nerve: neuroma and disruption of nerve continuity.
Tinel’s sign
Tingling in distribution pattern of peripheral nerve
Vertebral artery test
Tests for: vertebral artery compression (CL)
Supine.
Passively position head and neck into extension, side flexion, IL rotation.
Positive: dizziness, nystagmus
Anterior shear test
AKA sagittal stress test
Tests for: integrity of supporting ligaments, capsular tissues, of C spine.
Supine.
Apply anterior force through posterior arch of C1 and SP of C2-T1, or bilaterally through the laminar of each vertebral body b
Positive: nystagmus, pupil changes, dizziness, soft end feel, facial or lip paresthesia, lump in throat.
Transverse ligament stress test
Tests for: instability of the transverse ligament of C1
Supine
Support occiput. Place fingers in space between occiput and C2.
Lift head and C1 together. Hold for 10-20 seconds.
Positive: soft end feel, muscle spasm, dizziness, nausea, paresthesia of lip, face or limb, nystagmus, lump in throat.
*some discomfort normal
Tests for cervical instability
Anterior shear
Transverse ligament stress test
Lateral shear test
Alar ligament test
Lateral shear test
Tests for: instability of atlanto-axial joint
Supine.
Use radial side of 2nd MCPs to push TVPs of C1 and C2 across each other
Positive: excessive movement
Alar ligament test
Tests for integrity of alar ligament
Supine
Stabilize axis around SPs or TVPs. Attempt to side flex head and axis
Positive: excessive side flexion (a little flexion with strong capsular end feel normal).
Swallowing test
Tests: if SCM TrPs at the cause of pain while swallowing
Seated.
Pincer grasp SCM. Locate and apply firm pressure to most tender point.
Swallow.
Positive: pain diminishes
Rib motion test
Rib depression/elevation.
Assess upper middle lower ribcage during inhalation and exhalation
Rib stops moving earlier/moves less during inhalation: depressed
Rib stops moving earlier/moves less during exhalation: elevated
Costovertebral expansion test
Tests for costovertebral joint movement; rib motion
Place tape around 4th intercostal space. Or axilla (apical), nipple line (xiphisternal) and tenth rib (lower thoracic)
Inhale and exhale.
Normal: 3-7.5 cm difference.
Testing mobility of rib relative to thoracic vertebra
One thumb on TVP, one thumb on ribs.
Forward flex head or thorax.
Normal: rib rotates anteriorly and tubercle stays at same level of TVP.
If rib elevates relative to TVP: hypermobile
If rib movement stops before Tspine: hypomobile.
Skyline test
Tests for structural scoliosis
Forward flexion. Observe from behind.
Look for hump on convex side and hollow on concave side.
If hump decreases with flexion: functional
Increased angulation: structural kyphosis
Prone extension
If kyphosis remains –> structural.
Spurlings test
AKA foraminal compression test
Tests for: cervicular radiculitis
Client laterally flexes head to unaffected side Compress in neutral Compress in extension Compress in extension and rotation Repeat on affected side Stop if there's pain
Positive: radiating pain down IL arm (along dermatome)
Scapula approximation test
Tests for: IL T1/T2 nerve root problems
Prone. Passive approximation of scapula
Positive: pain in scapular area
Tingles: TOS
First thoracic nerve root stretch
Tests for: T1 nerve root issues
Seated. Passive abdication, external rotation, elbow flexion. Apply over pressure.
Positive: ulnar nerve pain
Rib springing
Tests: quality of movement
Prone. Hands at costotransverse junction. Anterior pressure on outbreath
Uni or bilateral.
Quadrant test
AKA: kemp’s test
Tests for: facet lock/nerve irritation in the lumbar spine. Narrows intervertebral foramen
Standing. Examiner behind, holding shoulders. Applies overpressure.
Guide into spinal extension, lateral flexion, rotation to side of pain.
Positive: local pain (facet lock); reproduction of neurological symptoms
Segmental instability test
Tests for lumbo-pelvic instability (spondylolisthesis)
Prone, torso on table, feet on floor.
Pressure to posterior lumbar spine or to a specific SP. lifts legs.
Positive: pain with pressure that is relieved when legs lift.
Dural slump test
Tests for: mechanical movement of neurological tissue
Seated. Hands behind back. Slumps with chin in neutral Overpressure on shoulders. Cervical flexion Knee extension; passive dorsiflexion Overpressure to c-spine. Cervical extension.
Stop when symptoms reproduced.
Positive: reproduction of symptoms.
Straight leg raising test
AKA Lasegue’s test
Tests for: SI joint integrity; disc herniation and/or peripheral nerve involvement;
Dura mater or spinal cord lesion
Supine. Move leg into hip flexion, medially rotation, adduction; keep knee extended.
If pain reproduced, decrease hip flexion until better. Active cervical flexion Passive dorsiflexion.
Positive: pain at 70°; neurological symptoms in back (disc herniation), posterior thigh (peripheral nerve) or both. Increased pain (dura mater/spinal cord lesion).
Lasegue’s sign
Finding of pain when unaffected leg is tested.
Indicates large disc protrusion medial to nerve root.
SLRT: degrees of flexion
0-35°. Slack in sciatic arborization. No dural movement.
35° sciatic nerve tensioned
35-70°. Sciatic roots tense over IVD. Rate of deformation decreases as angle increases.
70° no further deformation of roots. Pain is probably joint pain.
Bowstring sign
Test for: pressure on sciatic nerve after positive SLR
Supine. Knee slightly flexed (20°)
Thumb/finger pressure to popliteal area.
Positive: reproduction of radicular symptoms.
Well leg raising test
Tests for: space occupying lesion medial to nerve root.
SLR test in which unaffected leg is lifted
Positive: radicular signs in affected leg (which is still on table)
Malingering test
AKA Hoover test
Tests for: malingering
Supine. Hands each under calcaneus. Ask client to lift one leg, keeping knees extended.
Positive: no pressure is felt under opposite heel even though they say they’re attempting to lift leg.
Babinski test
Tests for: UMN or LMN lesion
Run pointed object along sole of foot
Positive: extension of big toe and splaying of other toes.
BL: UMN. Unilateral: LMN
Brudzinski-Kernig test
Tests for: meningeal irritation, dural irritation, nerve root involvement.
Supine: flex neck (chin to chest) – Brudzinski
Flex hip with knee extended – Kernig
Positive: neck/LB discomfort, relieved by knee and or hip extension
LB/neck/head pain relieved by knee flexion
Nachlas test
Tests for L2-3 nerve root
lesion (femoral)
Prone. Flex knee for 45-60 seconds
Avoid hip rotation
Positive: unilateral neurological pain in lumbar area, buttock, or posterior thigh.
Mckenzie’s slide/glide test
Tests for: ?
Use shoulder to block lower thorax while pulling pelvis.
Positive increased neurological symptoms. If evident scoliosis, test convex side first. Also tests if Sx causing the scoliosis.
Trendelenberg test
Tests for weakness of hip abductors (esp glute med)
Stand on one leg.
Positive: hip drops or lifts too much. Test is for stance leg not lifted leg.
Stork standing test
Tests for: integrity of pelvic joints; stability and proprioception
Stand in tree pose.
Positive: pain or inability to obtain test position (joints); difficult balancing
Flamingo test
Tests for: lesions in pubic symphysis or SI joint.
Stand on one leg. Lifted leg barely above ground.
Positive: pain in pubic symphysis or SI joint.
Gillet’s test
AKA sacral fixation test
AKA ipsilateral posterior rotation test
Tests for: hypomobile SI joint
Standing
One thumb on PSIS of test leg, the other parallel on sacrum.
Flex test leg.
Positive: PSIS moves minimally or upwards
Ipsilateral anterior rotation test
Tests for; SI joint hypomobility.
Standing
Thumb on PSIS of test side. Other thumb parallel on sacrum.
Extend leg.
Positive: PSIS doesn’t move, or moves inferiorly
Ipsilateral prone kinetic test
Tests for: SI joint hypomobility; possible posterior rotation or outflare
Prone.
Thumb on PSIS, other parallel on sacrum. Extend same side hip.
Positive: PSIS doesn’t move or moves inferiorly.
Squish test
Tests for: Posterior sacroiliac ligament integrity
Prone. Place hands on ASISs/iliac crests. Pressure down and medially 45°
Positive: pain
Gapping test
AKA Transverse anterior stress test
Tests for: integrity of anterior stress test
Supine. Hands crossed, places on ASISs. Pressure down and out.
Positive: pain – unilateral glute or posterior leg.
Thomas test
Tests for: contraction of hip flexors.
Supine, one leg flexed to chest.
Positive:
Hip flexor: thigh off table
Rectus femoris: knee extended past 90°
ITB:J sign. Leg abducts.
Obers test
Tests: TFL and ITB contracture
Side lying. Pelvis stabilized.
Passively extend and abduct hip (so ITB passes over greater trochanter)
Slowly lower.
Positive: leg remains abducted
Tenderness over greater trochanter: trochanteric bursitis
Neurological signs when knee flexed: femoral nerve path.
Piriformis test
Tests for short and tighten piriformis. Piriformis syndrome.
Side lying. Stabilize pelvis. Flex test hip TO 60° (not 45, not 90) with knee flexed and apply downward pressure.
Positive: pain in piriformis. Pain in buttock wth sciatic paresthesia.
Faber Test
AKA Figure 4, Patrick’s, Jensen’s
Tests for: hip joint pathology, iliopsoas spasm, SI joint involvement
Supine. Place in figure 4 position.
Positive: knee remains above opposite leg.
Sacroiliac Rocking Test
AKA knee to shoulder test
AKA sacrotuberous ligament stress test
Tests for: SI joint and sacrotuberous ligament integrity
Supine. Flex knee and hip fully. Addict hip.
Rock SI joint by flexion/abduction of hip towards opposite shoulder.
May also Palpate sacrotuberous ligament.
Positive: pain in SI joint. Ligament tender to palpation.
Scouring test
AKA quadrant test
Supine
Passively flex knee and hip. Adduct hip to resistance. Maintain resistance and take hip into abduction.
Positive: irregular/bumpy movement
What are the two quadrant tests?
Scouring (for SI joint integrity)
Kemp’s (for lumbar facet lock, nerve root)
Femoral shear test
Tests for: SI joint
Supine.
Passive hip flexion (slight), abduction, lateral rotation 45° from midline.
Apply compressive force through long axis of femur.
Palpate PSIS for movements
Positive: SI jt pain or discomfort.
Ely’s test
Tests for: short and tight rectus femoris
Prone. Passive knee flexion.
Positive: hip flexion
Hibb’s test
AKA Prone gapping test
Tests for: integrity of posterior SI ligaments. Also symmetry and movement.
Prone.
Stabilize pelvis. Flex knee to 90°. Medially rotate to end range. Palpate SI joint for degree of opening, quality of movement.
Positive: SI pain. Asymmetrical movement.
Yeoman’s test
Test for: SI jt
Prone.
Passively flex knee to 90°. Extend hip.
Positive: localized SI joint pain.
Lumbar pain. Anterior thigh paresthesia.
Superoinferior symphysis pubic stress test
Tests for pathology of public symphysis, integrity of joint
Supine. Place heel of one hand over superior pubic ramus of one pubic home and inferior ramus of the other. Shear
Positive: pain
Gaenslen’s test
Tests for: SI joint integrity
Side lying. Lower leg flexed to chest. Test leg extended.
Positive: Pain in SI joint
Alternative: client can test self in a diagonal Thomas position
Supine to Sit
Tests for functional leg length discrete. Rotation/torsion
Supine. Sit.
Short to long: post rotation (SLOP)
Long to short: anterior rotation.
Chvostek
Tests for: pathology of CN VII (facial)
Tap parotid gland overlying masseter muscle.
Positive: facial twitch
Jaw Reflex test
Tests for: pathology of CN V
Place fingers or thumb on chin. Use reflex hammer to tap.
Positive: mouth/jaw closes.
In transverse ligament stress test, anterior force is applied to the TVP of:
C1
