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special tests Flashcards

1
Q

Yergason’s test

A

test for integrity of transverse ligament of the shoulder - possibly biceps tendinosis

pt seated, shoulder neutral, elbow 90 deg flexion, forearm pronated, resist supination and external rotation

positive if tendon of biceps pops out of groove, or pain reproduced

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2
Q

Speed’s test

A

test for biceps tendinosis

pt seated or standing, arm in full extension and supination, resist shoulder flexion. May also place shoulder in 90 deg flexion and eccentrically push into extension

pos if pain reproduced

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3
Q

Neer’s test

A

test for long head biceps and supraspinatus impingement

pt seated, shoulder passively internally rotated then fully abducted

pos if pain reproduced

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4
Q

Empty can test

A

ID tear or impingement of supraspinatus or suprascapular nerve neuropathy

pt sitting, shoulder 90 elevation, no rotation, resist abduction. then IR and 30 deg forward, resist elevation.

pos if pain only in empty can position

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5
Q

drop arm test

A

ID tear or full rupture of rotator cuff

sitting, shoulder passively abducted to 120 deg, pt asked to slowly lower

pos if pt cannot control lowering

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6
Q

posterior internal impingement test

A

ID impingement b/w rotator cuff and greater tuberosity or posterior glenoid and labrum

pt supine, passively move shoulder into 90 deg abduction, max IR, 15-20 deg horizontal adduction

pos if pain in posterior shoulder

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7
Q

Clunk test

A

ID GH labrum tear

pt supine, shoulder in full abduction, push humeral head anterior while rotating humerus externally

pos if audible clunk heard

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8
Q

anterior apprehension sign

A

ID past history of anterior shoulder dislocation

pt supine, shoulder 90 deg abduction, slowly passively externally rotate

pos if pt doesn’t want to to into that position

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9
Q

posterior apprehension sign

A

ID pas history of posterior shoulder dislocation

pt supine with shoulder abducted to 90 deg in plane of scapula. place a posterior force through shoulder via force on elbow while moving into medial rotation and horizontal adduction

pos if pt doesn’t want to to into that position

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10
Q

AC shear test

A

ID dysfunction of AC joint

pt seated, arm resting at side, examiner places heel of hands on spine of scapula and clavicle, squeeze hands together.

pos if pain in AC joint

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11
Q

Adson’s test

A

ID pathology of structures passing through thoracic inlet

pt sitting, find radial pulse. rotate head toward tested side, then extend and externally rotate shoulder while extending head

pos if pulse disappears, or if neuro/vascular symptoms are reproduced

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12
Q

costoclavicular maneuver (military brace) test

A

ID pathology of structures passing through thoracic inlet

pt sitting, find radial pulse, move shoulder down and back

pos if pulse disappears, or if neuro/vascular symptoms are reproduced

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13
Q

Wright (hyperabduction) test

A

ID pathology of structures passing through thoracic inlet

pt sitting, find radial pulse, move shoulders into max abduction and ER, have pt take deep breath. rotate head to opposite side to accentuate sxs

pos if neuro/vascular symptoms are reproduced

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14
Q

Roo’s elevated arm test

A

ID thoracic outlet

in standing, chicken dance - open/close hands for 3 min slowly

pos if neuro or vascular sxs

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15
Q

Noble compression test

A

ID distal ITB friction syndrome

pt supine, hip flexed to 45 deg, knee at 90 deg, apply pressure to lateral femoral epicondyle

pos if pain reproduced

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16
Q

Ely’s test

A

ID tightness of rectus femoris

pt prone, passively flex knee

pos if ipsilateral hip flexes

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17
Q

Thompson test

A

test for rupture of Achilles tendon

pt prone, squeeze calf

pos if no movement of foot

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18
Q

Ober test

A

ID stiffness of ITB/TFL

pt sidelying, knee flexed

pos if leg unable to come to rest on table

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19
Q

medial epicondylitis test (golfer’s elbow)

A

ID medial epicondylopathy

pt sitting with elbow at 90 deg, supported. passively supinate, extend forearm and wrist

pos if pain reproduced at medial epicondyle

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20
Q

lateral epicondylitis test (tennis elbow)

A

ID lateral epicondylopathy

pt sitting, elbow 90 deg, supported. resist wrist extension/radial deviation/forearm pronation with fingers flexed

pos if pain at lateral epicondyle.

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21
Q

elbow ligament instability test

A

ID ulnar collateral or radial collateral ligament instability

varus/valgus force with elbow in 20-0 deg flexion

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22
Q

pronator teres syndrome test

A

ID median nerve entrapment within pronator teres

pt sitting with elbow in 90 deg, supported. resist pronation and extension

pos if tingling/paresthesia in median nerve distribution

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23
Q

Finkelstein’s test

A

ID de Quervain’s tenosynovitis

pt makes fist with thumb within fingers, passively move wrist into ulnar deviation

pos if pain reproduced. will often be painful, compare to uninvolved side

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24
Q

Bunnel-Littler test

A

ID tightness in structures surrounding MCP joints

MCP stabilized in slight extension with PIP flexed, flex MCP joint maintaining PIP flexion.

tight capsule: flexion limited in both cases
tight intrinsics: more PIP flexion with MCP flexion

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25
tight retinacular test
ID tightness around PIP joint stabilize PIP in neutral while DIP flexed. flex PIP maintaining DIP flexion tight capsule: flexion limited in both cases tight retinacular ligament: more DIP flexion with PIP flexion
26
Froment's sign
ID ulnar nerve dysfunction grasp paper between first and second digits, pull paper out pos if IP flexion (compensation due to weakness of adductor pollicis)
27
Phalen's test
ID carpal tunnel compression of median nerve pt maximally flexes both wrists, holding dorsum of hands together for 1 min pos if tingling/paresthesia following median nerve distribution
28
normal 2 point discrimination on hand
6 mm
29
Allen's test
ID vascular compromise find radial and ulnar arteries at wrist, have pt open and close fingers several times, then make closed fist. Using thumb, occlude ulnar artery and have pt open hand, then release pressure. observe palm and watch for vascular refilling. repeat with radial artery pos if abnormal filling
30
Patrick's (FABER) test
ID mobility restriction in hip pt supine, passively flex, abduct, ER test leg to foot resting just above knee on opposite leg (fig 4), slowly lower knee to table pos if unable to assume relaxed position or reproduction of sxs
31
Grind (scouring) test
ID degenerative joint disease of hip pt supine with hip in 90 deg flexion and knee maximally flexed, place compressive load into femur via knee joint pos if pain in hip, may refer to knee and elsewhere
32
Trendelenburg sign
ID weakness of glute med pt stands on one leg pos if pelvis drops
33
Thomas test
ID tightness of hip flexors pt supine with one hip and knee maximally flexed to chest and held there, opposite leg kept straight on table, observe if hip flexion occurs on straight leg as opposite limb is flexed. pos if straight limb's hip flexes or pt unable to remain flat on table
34
piriformis test
ID piriformis syndrome pt supine, foot of test leg passively placed lateral to opposite limb's knee. testing hip is adducted, watch position of testing knee relative to opposite knee. pos if testing knee unable to pass over resting knee, reproduction of pain in buttock/sciatic nerve distribution
35
Craig's test
I know the test... Normal: 8-15 deg hip IR retroverted <8 deg anteverted >15
36
knee collateral ligament tests
varus/valgus forces applied at 20-30 deg knee flexion
37
Lachman's stress test
ID integrity of ACL Pt supine, knee flexed 20-30 deg, stabilize femur, glide tibia anterior pos if excessive glide comp to uninvolved side
38
Pivot shift (anterolateral rotary instability)
ID ACL integrity pt supine, knee extended, hip flexed and abducted 30 deg with slight IR. hold knee with one hand and foot with the other, place valgus force through knee and flex knee pos if tibia relocates during test, as knee is flexed, tibia clunks backward at 30-40 deg flexion. tibia was subluxed then reduced by pull of ITB as knee was flexed
39
Posterior sag test
ID integrity of PCL pt supine with testing hip flexed to 45, knee flexed to 90 pos if tibia "sags" compared to femur
40
posterior drawer test
ID integrity of PCL pt supine hip 45, knee 90, passively glide tibia posterior following joint plane pos if excessive glide
41
reverse Lachman
ID integrity of PCL pt prone, knee flexed to 30, stabilize femur, glide femur posterior pos if excessive laxity compared to uninvolved side
42
McMurray's test
ID meniscal tears pt supine, testing knee in max flexion, passively IR and extend knee (lateral meniscus?), medial meniscus tested by ER and extension pos if reproduction of click or pain in knee joint
43
Apley test
differentiate b/w meniscal tear vs ligament lesion pt prone, testing knee flexed to 90, stabilize thigh with your knee, passively distract knee joint, then IR and ER. next compress knee and IR and ER pos meniscus: pain during compression pos ligament: pain or increased motion during distraction
44
Hughston's test
ID dysfunction of knee plica pt supine, tested knee flexed with tibia internally rotated, glide patella medially while palpating medial femoral condyle. Flex and extend knee pos if pain/popping as knee flexes/extends
45
patellar apprehension test
ID past history of patellar dislocation pt supine, patella glided laterally pos if pt doesn't like/allow that motion
46
Clarke's sign
ID patellofemoral dysfunction pt supine, knee in extension resting on table. push posterior on superior pole of patella, ask pt to perform active contraction or quads pos if pain produced in knee
47
Ballotable patella (patellar tap test)
ID infrapatellar effusion pt supine with knee in extension resting on table, apply soft tap over central patella pos if perception of patella "floating", "dancing patella" sign
48
fluctuation test
ID knee joint effusion pt supine, knee in extension resting on table. place one hand over suprapatellar pouch and other over anterior aspect of knee. alternate pushing down with one hand at a time pos if movement of fluid noted during test
49
Q angle measurement
measurement of angle between quad muscle and patellar tendon normal: 13 deg men 18 deg for women
50
anterior drawer test (ankle)
ID ligament instability (particularly anterior talofibular) pt supine, heel just off edge of table in 20 deg plantarflexion, stabilize lower leg and grasp foot, pull talus anterior pos if excessive glide compared to uninvolved side, or pain.
51
talar tilt
ID ligament instability (particularly calcaneofibular) pt side-lying, with knee slightly flexed and ankle in neutral. move foot into adduction (calcaneofibular) and abduction (deltoid ligament) pos if excessive glide or pain
52
vertebral artery test
assess integrity of vertebrobasilar artery - should be done prior to any cervical mobs pt supine with head supported on table, follow progression: a. extend head for 30 sec b. extend with rotation left, hold 30 sec. repeat right c. head cradled off table, extend, hold 30 sec d. head cradled with rotation, hold 30 sec pos if dizziness, visual disturbance, disorientation, blurred speech, nausea/vomiting, affected side opposite direction of rotation
53
Hautant's test
differentiates b/w vascular and vestibular causes of vertigo 1. pt sitting, shoulders at 90deg palms up, close eyes and remain in position for 30 sec, if arms lose their position, may be vestibular 2. pt in same position, eyes closed, cue into head and neck extension with rotation right, then left, remaining in each position for 30 sec. if arms lose their position, may be vascular.
54
transverse ligament stress test
ID integrity of transverse ligament Pt supine, head supported on table. glide C1 anterior pos if soft end feel, dizziness, nystagmus, lump sensation in throat, nausea
55
anterior shear test
assess integrity of upper cervical spine ligaments and capsules pt supine, head supported on table, glide C2-7 anterior, should be firm end feels pos if laxity, dizziness, nausea, lump in throat feeling, nystagmus
56
foraminal compressing (Spurlings)
ID dysfunction of cervical nerve root pt sitting, head side-bent to uninvolved side. apply pressure through head, straight down. repeat head side bent to involved side pos if pain/paresthesia in dermatomal pattern for involved nerve root.
57
maximum cervical compression test
ID compression of neural structures at intervertebral foramen and/or facet dysfunction pt sitting, passively sidebend and rotate to same side, then extend. perform on non-painful side first pos for nerve compression if pain in dermatomal pattern pos for facet dysfunction if localized pain
58
distraction test
ID compression of neural structures at the intervertebral foramen or facet joint dysfunction pt sitting with head passively distracted pos if dec in neck sxs (facet) or arm sxs (neurological)
59
shoulder abduction test
ID compression of neural structures within intervertebral foramen pt sitting and asked to place hand on top of their head pos if decrease in symptoms in UE
60
Lhermitte's sign
ID dysfunction of spinal cord and/or UMN lesion pt long sitting, passively flex head and one hip, keeping knee straight, repeat on other leg pos if pain down spine into UE or LE
61
Romberg test
ID UMN lesion pt standing, close eyes for 30 sec pos if excessive swaying
62
slump test
ID dysfunction of neurological structures supplying LE pt sitting on edge of table with knees flexed. pt slump-sits while maintaining neutral position of head and neck, then following progression: 1) passively flex pt's head and neck 2) passively extend knee 3) passively dorsiflex ankle with extended knee repeat opposite leg pos if neuro sxs reproduced
63
Lasegue's test
ID dysfunction of neurological structures that supply LE pt supine, passively flex hip with knee extended until neuro sxs, back off, then dorsiflex ankle pos if sxs reproduced when ankle dorsiflexed
64
femoral nerve traction test
ID compression of femoral nerve anywhere along its course pt lies on non-painful side, trunk in neutral, head flexed slightly, lower limb's hip and knee flexed. passively extend hip while knee of painful limb in extension, if no reproduction, flex knee of painful leg pos if neuro pain in anterior thigh
65
Valsalva maneuver (special test)
ID space occupying lesion pt sitting, instruct pt to hold breath while "bearing down", as if having a bowel movement pos if increased low back pain or peripheralization
66
babinski test
ID upper motor neuron lesion pt supine or sitting, glide bottom end of a reflex hammer along plantar surface of pt's foot pos if big toe extension and splaying of other toes
67
Quadrant test
ID compression of neural structures or facet dysfunction Pt standing. intervertebral foramen: pt sidebend and rotate left, extend to maximally close foramen on L repeat right facet: sidebend left, rotate right, extend maximally closes left facet pos if pain
68
Stork standing test
ID spondylolisthesis pt standing on one leg, cue pt into trunk extension, repeat opposite leg. pos if pain in low back with ipsilateral leg on ground
69
van Gelderen's test
differentiate b/w intermittent claudication and spinal stenosis ride bike upright until pain, ride bike slumped until pain. if spinal stenosis should be able to ride longer in slumped posture
70
Gillet's test
assess posterior movement of ilium relative to sacrum pt standing. place thumb under PSIS of tested limb and other thumb on center of sacrum at same level as thumb. ask pt to flex tested hip and knee. PSIS should move in inferior direction pos if no movement
71
Ipsilateral anterior rotation test
assessing movement of ilium relative to sacrum pt standing. place thumb under PSIS of tested limb and other thumb on center of sacrum at same level as thumb. ask pt to extend tested leg, PSIS should move superior pos if no movement
72
Gaenslen's test
ID SI dysfunction two joint hip flexor position, with overpressure. can also be performed in sidelying apparently pos if pain in SI
73
long sitting (supine to sit) test
ID SI dysfunction that may be cause of functional leg length discrepancy pt supine with correct alignment of trunk, pelvis and LE, stand at edge of table near pt's feet, palpating medial malleoli to assess symmetry. have pt come to long sitting, assess malleoli again. compare to supine abnormal finding is reversal in limb lengths b/w supine and long sitting
74
Goldthwait's test
differentiate b/w SI and lumbar pt supine with tester's fingers on lumbar spinous processes, with other hand passively raise straight leg. pos for SI dysfunction if pain before lumbar motion felt
75
TMJ compression
evaluates pain with compression of retrodiscal tissues pt sitting or supine. support or stabilize pt's head with one hand, with other push mandible superior, causing compressive load to TMJ pos if pain in TMJ.
76
Rinne's test
bone conduction vs air conduction of sound. if bone conduction > air conduction, conductive deafness if air>bone conduction, sensorineural deafness
77
Weber's test
hold vibrating tuning fork to top of head, pt is asked which ear is louder to differentiate between unimpaired vs deaf ear
78
Kerning's sign
ID meningeal irritation pt supine, LE flexed at hip and knee, then knee straightened pos if resistance to knee straightening
79
Stemmer's sign
ID lymphedema pull up skin on base of 2nd toe or finger in unable to pull up, usually primary lymphedema, sometimes advanced secondary
80
adams forward bend test
screen for adolescent scoliosis pt standing, feet together, knees straight, arms hanging free
81
head jolt test
ID meningeal irritation pt turns head 2-3 times/second pos if worsening of baseline headache
82
prone instability test
test for usefulness of lumbar stabilization pt prone with hips off table, hanging on, lift legs up off floor pos if decreased pain to palpation - if pos pt will likely respond to lumbar stabilization treatment

NPTE (8 decks)

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