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NPTE > special tests > Flashcards

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
Q

tight retinacular test

A

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

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26
Q

Froment’s sign

A

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)

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27
Q

Phalen’s test

A

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

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28
Q

normal 2 point discrimination on hand

A

6 mm

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29
Q

Allen’s test

A

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

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30
Q

Patrick’s (FABER) test

A

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

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31
Q

Grind (scouring) test

A

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

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32
Q

Trendelenburg sign

A

ID weakness of glute med

pt stands on one leg

pos if pelvis drops

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33
Q

Thomas test

A

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
Q

piriformis test

A

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
Q

Craig’s test

A

I know the test…

Normal: 8-15 deg hip IR
retroverted <8 deg
anteverted >15

36
Q

knee collateral ligament tests

A

varus/valgus forces applied at 20-30 deg knee flexion

37
Q

Lachman’s stress test

A

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
Q

Pivot shift (anterolateral rotary instability)

A

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
Q

Posterior sag test

A

ID integrity of PCL

pt supine with testing hip flexed to 45, knee flexed to 90

pos if tibia “sags” compared to femur

40
Q

posterior drawer test

A

ID integrity of PCL

pt supine hip 45, knee 90, passively glide tibia posterior following joint plane

pos if excessive glide

41
Q

reverse Lachman

A

ID integrity of PCL

pt prone, knee flexed to 30, stabilize femur, glide femur posterior

pos if excessive laxity compared to uninvolved side

42
Q

McMurray’s test

A

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
Q

Apley test

A

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
Q

Hughston’s test

A

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
Q

patellar apprehension test

A

ID past history of patellar dislocation

pt supine, patella glided laterally

pos if pt doesn’t like/allow that motion

46
Q

Clarke’s sign

A

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
Q

Ballotable patella (patellar tap test)

A

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
Q

fluctuation test

A

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

Q angle measurement

A

measurement of angle between quad muscle and patellar tendon

normal:
13 deg men
18 deg for women

50
Q

anterior drawer test (ankle)

A

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
Q

talar tilt

A

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
Q

vertebral artery test

A

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
Q

Hautant’s test

A

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
Q

transverse ligament stress test

A

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
Q

anterior shear test

A

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
Q

foraminal compressing (Spurlings)

A

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
Q

maximum cervical compression test

A

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
Q

distraction test

A

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
Q

shoulder abduction test

A

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
Q

Lhermitte’s sign

A

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
Q

Romberg test

A

ID UMN lesion

pt standing, close eyes for 30 sec

pos if excessive swaying

62
Q

slump test

A

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
Q

Lasegue’s test

A

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
Q

femoral nerve traction test

A

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
Q

Valsalva maneuver (special test)

A

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
Q

babinski test

A

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
Q

Quadrant test

A

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
Q

Stork standing test

A

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
Q

van Gelderen’s test

A

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
Q

Gillet’s test

A

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
Q

Ipsilateral anterior rotation test

A

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
Q

Gaenslen’s test

A

ID SI dysfunction

two joint hip flexor position, with overpressure. can also be performed in sidelying apparently

pos if pain in SI

73
Q

long sitting (supine to sit) test

A

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
Q

Goldthwait’s test

A

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
Q

TMJ compression

A

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
Q

Rinne’s test

A

bone conduction vs air conduction of sound.

if bone conduction > air conduction, conductive deafness

if air>bone conduction, sensorineural deafness

77
Q

Weber’s test

A

hold vibrating tuning fork to top of head, pt is asked which ear is louder to differentiate between unimpaired vs deaf ear

78
Q

Kerning’s sign

A

ID meningeal irritation

pt supine, LE flexed at hip and knee, then knee straightened

pos if resistance to knee straightening

79
Q

Stemmer’s sign

A

ID lymphedema

pull up skin on base of 2nd toe or finger

in unable to pull up, usually primary lymphedema, sometimes advanced secondary

80
Q

adams forward bend test

A

screen for adolescent scoliosis

pt standing, feet together, knees straight, arms hanging free

81
Q

head jolt test

A

ID meningeal irritation

pt turns head 2-3 times/second

pos if worsening of baseline headache

82
Q

prone instability test

A

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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