Special Tests Flashcards
Spurling’s/Reverse Spurling’s Test
To diagnose cervical disc herniations or spondylosis
Rotate and laterally flex head to the unaffected side. Lightly compress the head down to axial load the spine
Spurlings is ipsilateral
Reverse Spurlings is contralateral
L’Hermitte’s Sign
Passive or Active neck flexion
pain/electrical sensation shooting down back or into legs - indicates myelopathy or multiple sclerosis
Adson Test
To test for thoracic outlet syndrome
Palpate radial pulse on affected side w/ fully extended elbow. Have pt rotate head to side of testing and extend the neck. Then abduct, extend, and laterally rotate the shoulder. Have the patient take and hold a deep breath, then assess for decrease in pulse response
Hoffmann’s Test
Used to determine upper motor neuron lesion above T1
Have patient relax hand, flick the nail of the middle finger
Positive sign occurs if the muscles of the hand and thumb flex. This indicates a lesion originating in the CNS that is not a radiculopathy or peripheral nerve lesion
Shoulder Impingement and Tendonitis Test
Neer’s Test: fully extended arm resistance against thumb up and thumb down
Hawkin’s Test: Arm and shoulder flexed 90 degrees with thumb down - pain suggests subacromial impingement
Shoulder Internal Rotation Tests
Test subscapularis
Bear Hug: Have pt put palm on opposite shoulder and resist provider trying to push arm upwards
Belly Press: Have pt push against resistance towards their belly
Lift Off: Have patient place hand behind the back, palm facing away from body, and lift it away from back against resistance
Supraspinatus Shoulder Test
Drop Sign: Have the pt slowly raise arm in scapular plane and then slowly lower - positive if arm suddenly drops
Empty Can: Pt extends arm out with thumb down, and resists applied pressure downward
Shoulder Instability/Dislocation Tests
Apprehension: pt supine, abduct and elbow flexed 90 degrees with gentle external rotation - pt gets apprehensive
Sulcus: Pts arm relaxed at side - gentle traction in inferior direction to try to cause subluxation w/ visible dimple
Jobe’s Relocation: Apprehension with pressure on humeral head to relieve apprehension
Load and Shift: One hand holds scapular spine and coracoid process while other slides humeral head back and forth
Shoulder Labral Lesion Tests (SLAP)
Speed’s: Extended and supinated arm flexed superiorly against resistance - also for long head tendonitis
Yergason’s: elbow flexed with arm at side - resist supination and external rotation @ same time
Obrien Test: arm extended and internally rotated 15 D across chest- resist downward movement with both thumb down and palm up
AC Joint Separation Tests
Cross Arm Test: arm extended with elbow 90 degrees across the chest - have patient cross arm over to sweep by opposite shoulder
Infraspinatus and Teres Minor Tests
External rotation: arm adducted with elbow flexed 90 degrees, resist internal rotation
Hornblower’s Test: abduct arm to 90 degrees with elbow flexed in front, have pt rotate arm externally against resistance
Elbow Tests
Varus (inward deformity)
Valgus (outward deformity)
Hook test (distal biceps tear)
Ulnar nerve compression with bent elbow
Wrist Tests - Ulnar Palsy
Wartenbergs sign: 5th finger abduction at rest
Froments sign: flexion of thumb with decreased grip - cant hold paper between thumb and curled fingers
Wrist Tests - Median nerve palsy
Tinel’s sign: carpal tunnel or ulnar palsy
Phalen’s/Modified Phalen’s: bent wrist causing tingling in the thumb, index, and pointer finger
De Quervain’s Tenosynovitis
Swelling/stenosis around sheath surrounding abductor pollicis longus and extensor pollicis brevis
Pain, swelling, and triggering phenomena with thumb pinching
Finkelstein’s Test: pt makes a fist w/ thumb inside the fingers - push fist into ulnar deviation = pain @ dorsoradial aspect indicates de Quervain’s
Mallet Finger Test
Isolate extensor tendon by holding involved finger at the middle phalanx - instruct patient to actively extend distal interphalangeal joint
Inability to actively extend distal joint suggests extensor tendon avulsion at the base of the distal phalanx
Back Tests
Psoas sign: appendicitis or irritation to iliopsoas hip flexors
Straight leg raise: Underlying herniated disk (L5)
Hip Tests
Trendelenberg: used to determine hip abductor strength - one-legged pelvis tilt
FABER (figure-of-4): flexion-abduction-external rotation test to detect sacroiliac and hip pathology; place
Piriformis: hip and knee flexed to 90 D; stabilize pelvis and use hand to apply flexion, adduction, and internal rotation at the knee
Knee ACL Tests
Anterior drawer: sit on foot and slide the tibia anteriorly
Lachman’s: thigh supported and leg relaxed - flex knee 30 D and lift/pull on tibia while stabilizing the femur
Pivot Shift: fully extend knee and slowly flex while applying valgus stress and internal rotation
Lelli’s: Fist under calf while applying pressure to the top of the femur
Knee PCL Tests
Sag sign: tibia sags compared to femur position with hip and knee flexion
Posterior drawer: sit on pts foot and push the tibia posteriorly
Knee Meniscus Tests
McMurray’s: flex knee to max pain-free position then gradually extend while maintaining tibia internal/external rotation - wait for click
Pain with full flexion
Apley’s Test: McMurray’s test but pt is lying prone - using gravity
LCL/MCL Knee tests
Varus: assesses lateral collateral - push to lateral side
Valgus: assesses medial collateral - push to medial side
Patella
Grind for chondromalacia
Apprehension for dislocation
Foot/Ankle Tests
Thompson
Homan’s
Interdigital Neuroma
Ankle clonus
Thompson: squeezing calf for plantar flexion
Homan’s: Check for DVT
Interdigital Neuroma: Upward pressure between metatarsal heads - commonly 3rd and 4th heads
Ankle clonus: upper motor neuron lesions - rhythmic contractions; lower motor lesions - fasciculations
