Special Tests

Question 1

Spurling Test

Answer 1

extend, side bend C spine to side tested, push down

positive - pain radiates to ipsilateral arm

help localize affected nerve root

Question 2

Wallenberg’s Test

Answer 2

tests vertebral artery insufficiency

flex neck and hold for 10 seconds, extend neck and hold for 10 sec

Positive test = dizziness, visual changes, lightheadedness, eye nystagmus

Question 3

Underberg test

Answer 3

neck bent backward and head fully rotated to either side

vascular or neuro sx = HVLA contraindicated

Question 4

Adson Test

Answer 4

Thoracic outlet sn d/t tight scalene muscles

monitor pulse

extend elbow, shoulder is extended, externally rotated, slightly abducted

Deep breath and turn head toward ipsilateral arm

Positive if severely decreased or absent radial pulse

Question 5

Wright’s test

Answer 5

Thoracic outlet sn d/t pec minor and coracoid process compression

hyperabduct arm above head w/t some extension, positive if severely decreased or absent radial pulse

Question 6

Costaclavicular syndrome test (Military posture test)

Answer 6

thoracic outlet sn d/t clavicle and first rib compression

radial pulse monitored while depressing and extending shoulder

positive if severely decreased or absent radial pulse

Question 7

Apley’s scratch test

Answer 7

ROM of shoulder

Look for asymmetry or any limitations

Question 8

Drop arm test

Answer 8

abduct shoulder 90 then slowly lower arm

positive if can’t lower smoothly or drops at 90 degrees

Question 9

Speed’s test

Answer 9

bicep tendon in bicipital groove

extend elbow, flex shoulder and supinate forearm

Resist flexion of shoulder

positive if tenderness in bicipital groove

Question 10

Yergason’s test

Answer 10

biceps tendon in bicipital groove

flex elbow 90

pull down on elbow, externally rotate forearm while patient resists motion

Pain as biceps tendon pops out of bicipital groove

Question 11

Allen’s test

Answer 11

tests adequacy of blood supply to hand by radial and ulnar a.

occlude both arteries, pt makes fist

release one artery watch for flushing of the hand, and repeat with other artery

Positive if not adequately supplying hand

Question 12

Finkelstein Test

Answer 12

tests tenosynovitis in abductor pollicis longus and extensor pollicis brevis tendons at wrist

De Quervain’s disease

First with thumb tucked inside finger

physician deviates wrist ulnarly while stabilizing forearm

Positive - pain over tendons at wrist

Question 13

Phalen’s test

Answer 13

flex wrist, old for 1 minute

Tingling sensation in thumb, index, middle, lateral ring indicates carpal tunnel syndrome

Question 14

Reverse Phalen’s Test (Prayer’s test)

Answer 14

pt extends wrist, gripping the physician’s hand

Tingling sensation in thumb, index, middle, lateral ring indicates carpal tunnel syndrome

Question 15

Tinel’s test

Answer 15

tap volar aspect of patients transverse carpal ligament

Tingling sensation in thumb, index, middle, lateral ring indicates carpal tunnel syndrome

Also can use to check ulnar nerve entrapment at elbow, peroneal compression at fibular head, posterior tibial nerve entrapment at ankle

Question 16

Hip drop test

Answer 16

sidebending ability of lumbar spine and thoracolumbar junction

Question 17

Straight leg Raising test (Lasegue’s test)

Answer 17

Tests sciatic nerve compression

Knee extended and stabilized, lift upward, flexing hip until pt feels discomfort.

back off then dorsiflex foot (Braggard’s test) - stretches sciatic

If no pain: tight hamstrings
If pain: sciatic origin -> positive straight leg

Question 18

Pelvic side shift test

Answer 18

Determines if sacrum is in midline

stabilize shoulder and push opposite hip, and switch

positive on site of freer translation

Seen in flexion contracture of iliopsoas (psoas syndrome)

Flexion contracture of right iliopsoase -> positive pelvic shift test to the left

Question 19

Trendelenberg test

Answer 19

tests gluteus medius strength (hip abductor)

Question 20

Lumbosacral spring test

Answer 20

tests if sacral base is tilted posterior

Question 21

backward bending test (Sphinx test)

Answer 21

positive if sacral base moves posterior

If thumbs become more symmetric w/ lumbar extension, part of sacral base moved anterior

If more asymmetric, part of the base has moved posterior

Question 22

Ober’s test

Answer 22

tight tensor fascia lata and IT band

flex knee to 90, abduct hip, slightly extend (IT over greater trochanter)

slowly allow thigh to fall to table

Positive if thigh remains abducted

Question 23

Patrick’s test

Answer 23

SI and hip joint

FABER - figure 4

Question 24

Thomas test

Answer 24

psoas test

flex one hip up causes contralateral knee to raise off table

Question 25

Anterior drawer - knee

Answer 25

ACL - tibia slides out under femur = positive for ACL tear

Question 26

Posterior drawer - knee

Answer 26

PCL - tibia moves backward under femur = positive PCL tear

Question 27

Apley’s compression and distraction tests

Answer 27

Compression: meniscal tear

• prone, knee 90, compress down through heel, add internal and external rotation of tibia
• positive if pain

Distraction: MCL or LCL

• distract and internal and external rotation added
• pain

Question 28

McMurray’s Test

Answer 28

Posterior aspect of medial meniscus

• fully extend knee, esternally rotate, add valgus stress
• positive if palpable or audible click

Posterior aspect of Lateral meniscus
-internal rotation of tibia, Varus stress on knee

Question 29

Patellar grind test

Answer 29

assess posterior articular surface of patella - chondromalacia patellae seen in patello-femoral syndrome

Supine, extended knee. Push patella distally, have patient contract quads

roughness of articular surface will grind
palable and painful when quads contract and move patella

Positive if pain with contraction

Question 30

Valgus and varus stress test of knee

Answer 30

Valgus stress test - lateral force, assess medial
-gapping = MCL tear

Varus stress test - medial force, assess lateral
-gapping = LCL tear

Question 31

Anterior draw test of ankle

Answer 31

assess ATF, some deltoid

hold 20 degrees of dorsiflexion as pulling foot forward

excessive motion positive

if b/l injury - excessive motion of talus

Deviation to one side - ligament to opposite side of foot are damaged