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THE BOARDS > Special Tests > Flashcards

Special Tests Flashcards

1
Q

Lumbar: Tests for lumbar instability

A

Prone segmental instability test

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2
Q

Sag Sign

A

Assesses PCL integrity

Supine, both legs 45º hip flexion and 90º knee flexion. Feet flat on table. Have a gander from the side.

Positive: tibial sags posteriorly in comparison to the unaffected side.

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3
Q

Posterior Drawer Test

A

Assesses for posterior stability of the knee

Supine. 45º hip flexion, 90º knee flexion. Foot on table. Stabilize ankle and foot by sitting on them. Grasp tibia with both hands and push.

Positive: excursion greater than 6mm. Pain may or may not be present. Snapping or jerking suggest meniscal damage

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4
Q

Kemp’s/Quadrant Test

A

Tests for: facet lock/irritation, and nerve root irritation

Standing. Examiner controls patient movement by holding shoulders (may support occiput on shoulder). Patient extends the spine, overpressure applied while patient flexes and rotates to side of pain. Continue movement until limit of range is reached, or symptoms.

Positive: Local pain (facet lock); neurological Sx (nerve root)

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5
Q

Segmental Instability Test

A

Tests for: segmental instability (spondylolisthesis)

Therapist / Action Examiner applies pressure to the posterior
aspect of lumbar spine OR an individual spinous process of the lumbar spine (with patient at rest). Patient then lifts legs off the floor and examiner again applies posterior compression to lumbar spine.

Positive: pain when feet on floor, which is relieved with legs lifted.

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6
Q

Squeeze Test –foot

A

Tests for stress fracture and/or Morton’s neuroma

Seated. Squeeze foot.

Positive: sharp pain. For Morton’s neuroma usually between 3rd and 4th MT.

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7
Q

Anterior Drawer Test (knee)

A

Assesses anterior stability of the knee

Supine. Hip at 45º flexion, knee at 90º flexion, foot on table. Stabilize ankle and foot by sitting on it. Grab tibia with both hands and pull forward.

Positive. Big yoink. Excursion greater than 6mm. Pain may or may not be present. Snapping or jerking motion suggests meniscal damage

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8
Q

Supine-Sit Test

A

Tests for pelvic malalignment

Compare positions of medial malleoli supine and then in long sit.

Supine Long, sitting short: Anterior rotation of that side

Supine short, sitting long: Posterior rotation of that side

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9
Q

Squeeze Test – Tib Fib

A

Tests for strain of distal tibfib joint

Supine. Squeeze tibfib together at mid-calf.

Positive: Pain in lower leg

DDx: stress fracture, compartment syndrome

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10
Q

Lumbar: Tests for neurological dysfunction

A 
SLR
Slump
Bowstring
Valsalva
Nachlas (PKB)
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11
Q

Lumbar: Tests for joint dysfunction

A

Quadrant test

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12
Q

Calcaneofibular Stress Test

A

AKA: talar tilt

Tests for: integrity of calcaneofibular ligament

PT seated, knee flexed and leg hanging off edge of table OR sidelying with foot off end of table; Ther stabilizes distal tibia & fibula, while taking the calcaneus (hindfoot) into inversion, applying over-pressure at end range. Ensure ankle is in neutral position (no plantar or dorsiflexion)

Positive: Acute: Pain local to the ligament & some excessive movement Sub-acute: May have muscle spasm end-feel

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13
Q

Aply’s Distraction Test

A

Assesses integrity of the collateral ligaments of the knee.

Prone, knee flexed to 90º. Stabilize back of the thigh; grasp ankle and pull upwards. Apply IR and ER to the tibia.

Positive: pain on medial side (MCL); pain on lateral side (LCL); excess movement, apprehension

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14
Q

McMurrays Test

A

Unreliable test for meniscal injury

  • Pt is supine with hip and knee flexion
  • The amount of knee flexion may be changed to test all aspects of the posterior aspect of the menisci
  • Examiner cups the palm of one hand over the patella while the fingers and thumb palpate over the joint line - Other hand grasps the heel of the affected side - The examiner brings the knee into slow extension as various stresses are applied:
  • IR + Varus stress = lateral meniscus
  • ER + Valgus stress = medial meniscus

Positive test = clicking or catching in knee extension however a negative test doesn’t rule out a meniscal injury

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15
Q

Anterior Drawer Test (Ankle)

A

Tests for: Stability of the anterior talofibular ligament

1) PT supine, Ther stabilizes foot at 20°P FLX via fist under calcaneus. Mobilize low leg posteriorly.
2) Pt supine, with knee flexed & foot on the table; Ther stabilizes the foot and moves tibia & fibula posteriorly
3) PT prone with foot off the end of table; Ther stabilizes distal tibia & fibula, and pushes talus anteriorly with pressure over the calcaneus

Positive: Excessive anterior translation of the talus, sometimes an audible “thunk”, indicating ligament laxity or rupture

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16
Q

Thompson’s Test

A

Tests for: Achilles rupture (3rd degree)

PT prone with feet over edge of table …OR….PT kneeling on table with feet over the edge Ther squeezes the relaxed calf muscles

Positive: absence of plantarflexion

17
Q

Deltoid Ligament Stress Test

A

Tests for: Integrity of the deltoid ligament

PT seated, leg hanging over end of table; Ther stabilize anterior tibia & fibula proximal to ankle Test 3 Movements: 1) Anterior fibers: Grasp dorsal surface of foot, apply eversion & plantarflexion, apply POP at end range 2) Middle fibers: Grasp heel and take hindfoot into eversion, apply POP at end range 3) Posterior fibers: Grasp heel, apply eversion & dorsiflexion of foot, apply POP at end range

18
Q

Brush Stroke Test

A

Tests for: swelling in knee AFTER ACUTE INJURY

Patient is supine in as much knee extension as possible
- The therapist applies a light to moderate sweeping motion with fingers and hands on the knee – from the inf/medial aspect to sup/lat aspect, with ‘inside hand’ and sup/lat aspect to med/inf aspect with ‘outside hand’

Postitive: fluid moving or accumulating as a bulge in the inferior aspect of the patella: May indicate cruciate or meniscal attention – postive = immediate medical attention

19
Q

Lachman’s Test

A

The superior ACL test.

Supine, knee flexed to 30º. Stabilize femur with one hand and grasp the tibia with the other. Pul.

Positive: excessive anterior movement, disappearance of infrapatellar tendon slope, possible pain.

20
Q

Anterior Talofibular Stress Test

A

Tests for: integrity of the anterior talofibular ligament

PT seated, knee flexed and leg hanging off edge of table; Therapist stabilizes anterior tibia & fibula proximal to ankle joint; with other hand grasp plantar surface of heel and apply a combined movement of plantarflexion, inversion and adduction, applying over-pressure at end ROM; apply pressure gradually to prevent guarding

Positive: Sub-acute: Local pain at site of ligament, slight excessive movement with muscle spasm end-feel indicates mild to moderate ligament sprain. Total ligament rupture may present as hypermobility or false negative due to protective muscle spasm. Chronic: Total rupture is painlessly hypermobile

21
Q

Lumbar: Tests for muscle tightness

A

90/90 SLR
Obers
Thomas Test

22
Q

Why is Lachman’s the preferred ACL test?

A

Flexing the knee to 30º (rather than 90º) places the knee in a position where the ACL plays a more functional role.

Stabilizing effect of menisci and bony lip of tibial condyles less influential.

23
Q

Varus Stress Test (knee)

A

Assesses the integrity of the lateral stabilizing structures of the knee (20-30º flexion specific to LCL)

Supine, knee in slight flexion. Leg held by therapist, stabilizing lateral to lateral malleolus (or tucking leg under arm and using both hands to gap). Gaps knee laterally

Positive: recreation of pain, excessive movement, apprehension

24
Q

Apley’s Compression Test

A

Asseses: meniscal injury

Prone: knee flexed to 90º. Push foot and tibia into table and then performs IR and ER.

Positive: pain on lateral side – lateral meniscus
Pain on medial side – medial meniscus

25
Q

Tests after inversion sprain

A

Anterior Drawer (ankle)
Anterior Talofibular Stress Test
Calcaneofibular Stress Test

26
Q

Valsalva Test

A

Tests for: Intrathecal pressure, usually due to space occupying lesion (herniation, tumour, osteophyte)

Take a deep breath, hold it and bear down as if evacuating the bowels.

Positive: pain

27
Q

Valgus Stress Test (knee)

A

Assesses the integrity of the medial stabilizing structures of the knee. (20-30º flexion specific to MCL)

Supine. Knee in slight flexion. Therapist holds leg (balanced on hip?) Stabilize medial to medial malleolus.
Gaps medial knee joint.

Positive: recreation of pain, excessive movement, apprehension

THE BOARDS (5 decks)

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