Special tests Flashcards
Straight leg raise (SLR)
contact patient’s ankle, lift leg a little, internally rotate hip a little, adduct leg a little. Move leg up until symptoms are reproduced. POSS: radiculopathy, dural irritation, peripheral neuropathy. NB. if knee is then flexed and reduction in symptoms - positive
Crossed SLR
Same as SLR but using asymptomatic leg
Reported as having a 90% + sensitivity for radiculopathy combined with normal SLR
Braggard’s Test
(used to further tension nerve if SLR is - ve)
Perform SLR test, then lower leg just below symptomatic range and then dorsiflex foot. Reproduction of neurological symptoms may indicate a positive SLR.
Brudzinski’s Test
Patient supine with hands behind neck. Patient actively and maximally flexes neck. Reproduction of pain and / or neurological symptoms in the LEX is a positive for this test.
Kernig’s Test
Patient supine with hands behind neck.
Patient actively flexes hip with knee fully extended until pain or neurological symptoms are elicited. Patient then flexes knee.
Reduction of symptoms during knee flexion is considered a positive test as flexing the knee reduces neural tension.
Slump Test
assistswith diagnosis of radiculopathy, dural irritation, or peripheral neuropathy by increasing neural tension.
Patient seated with posterior thighs fully supported.
Patients slumps. Patient - relaxed Tsp and LSp, then chin to chest. Practitioner introduces caudal axial compression.
Practitioner gently extends one knee, dorsiflexes foot and asks patient to bear down (Valsalva test)
Bowstring Test
assists with diagnosis of radiculopathy, dural irritation, and peripheral neuropathy.
Do SLR to symptomatic range.
Whilst maintaining hip flexion, practitioner flexes the knee until symptoms are reduced.
Examiner applies pressure within the popliteal fossa and slowly extends LEX to traction sciatic nerve. Reproduction of LEX neurological symptoms is a positive test.
Median nerve test
Patient is supine, hold hand + thumb with palm open. Use leg to support arm, and hold should to prevent elevation. Abduct arm to 90-110 degrees, then externally rotate arm. Supernate forearm, extend wrist, extend elbow. Move head sidewards away from practitioner.
LSP Quadrant test
assists with diagnosis of Lsp facet joint pathology, and internal disc disruption (eg. annular tear)
Patient seated with arms folded.
Practitioner stabilizes contralateral iliac crest, and with guiding hand on patients opposite shoulder, sidebends and extends l-sp.
Apply axial compression. Repeat for other side.
Test is repeated in a flexed and sideband position on both sides.
extension - loads facet joints. flexes - loads discs
Femoral nerve traction test
same as psoas stretch ( I think)
+ve = reproduction of anterior thigh pain and / or neurological symptoms in a femoral distribution
Pelvis tests - order (3)
- Standing Flexion
- Test Stork Test
- Seated Flexion Test
Standing Flexion Test
Patient standing.
Pads of thumbs should be on the inferior slope of the posterior superior iliac spine.
Patient bends forwards smoothly.
test is +ve is one posterior superior iliac spine moves further than the other.
Median nerve test
Patient supine, practitioner depresses shoulder and abducts arm to 110 degrees. Externally rotate arm at shoulder joint. Extend arm at hummer-ulnar joint, supinate forearm, extend wrist & fingers. Contralateral then ipsilateral cervical side bending can further tension. Contralateral c-sp lateral flexion or rotation may increase symptoms, ipsilateral may decrease.
Radial nerve test
Patient supine, practitioner passively depresses patients shoulder complex, and abducts arm to 10 degrees. Pronate forearm, internally rotate shoulder, extend arm at humero-ulnar joint. Flex wrist with ulnar deviation, flex fingers. Contralateral then ipslateral cervial side bending to further tension nerve. NB. deep held inhalation may also further increase nerve compression.
Ulnar nerve test
Patient supine, practitioner passively depresses patients shoulder, and abducts arm to 90 degrees. Internally rotate shoulder, fully flex elbow joint. Extend radially deviated wrist to approximate hypothenar eminence to approximate ipsilateral external occipital protuberance with digit minim pointing inferiorly. (i.e. patient to place palm of hand over same side ear with fingers facing their feet). Contralateral c-sp lateral flexion or rotation may increase symptoms, ipsilateral may decrease symptoms. Deep held inhalation may also sensitize test.
Thoracic outlet syndrome tests (TOS) - Adson’s test
Patient seated. Locate pulse and monitor. Practitioner externally rotates and extends patients 90 degree abducted arm. Patient actively ipsilaterally rotates and head with c-sp flexion whilst deeply inhaling. +ve = < pulse, , or > neurological symptoms
Brachial plexus compression test
Practitioner stands behind seated patient, and applies compression through the trapezius and mid-clavicle to compress the brachial plexus towards the 1st rib. Pain in shoulder or UEX is a + test.
Spurlings A test - diagnosis of cervical radiculopathy Specifiy but poor sensitivity
Patient seated, practitioner stands behind patient, stabilises one shoulder and places other hand on the top of the patient’s head. Practitioner then introduces passive side-bending of C-sp towards the side being tested, and applies caudal compression directed towards the facets joints on this side. + ve = neurological symptoms/ pain in the arm, not just the neck. Can be performed segmentally to increase dermatomal accuracy (supine position).
Spurlings B test Often used in conjunction with C-Sp distraction test and Valsalva test Bi-lateral symptoms - possibly cord compression
Practitioner stands behind patient, stabilises, introduces passive side bending then rotates C-sp contralaterally. Examiner applies caudal compression. + ve = Reproduction of dermatomal symptoms.
C-sp Distraction test. Often used with Spurlings tests, Quadrant Csp Compression test, and Valsalva test to indicate Csp radiculopathy. Non-provocative . +ve is indicated by relief of symptoms
Supine or seated. Supine test ; Practitioner applies a superior traction force using a firm handhold on the occiput and chin. Seated test ; practitioner stabilises patient, assumes a firm handhold cradling the occiput with the thumbs approximately midway between the mastoid process and the inion. Apply upward traction.
Shoulder abduction test - used to assist diagnosis of c-sp radiculopathy. Good specificity when used in conjunction with C-sp compression/ distraction tests
Patient seated or standing. Practitioner instructs patient to abduct symptomatic arm, flex elbow and place hand on top of head. In this position the tension may be taken off the cervical nerve roots and parts of the brachial plexus. + ve = < symptoms
C-Sp Quadrant Compression test - test used to assist diagnosis of various C-sp conditions including; facet irritation and dysfunction, spondylosis. Bi-lateral symptoms is a red flag
Patient seated, practitioner passively flexes and sidebends the c-sp to each side, then extends, sidebends and contralaterally rotates Csp to each side. Practitioner applies gradual caudal compression at the end of each of these 4 movements.
+ve = reproduction of local C-sp symptoms
Valsalva test - general test to assist diagnosis of radicular symptoms in Csp, Tsp, and Lsp. Many causes.
practitioner instructs patient to take a deep breath, and hold it whilst bearing down as if the moving the bowels.
+ve = reproduction of dermatomal symptoms or localised symptoms
Lhermitte’s sign - test for cervical myelopathy and radiculopathy
Patient seated or supine.
Examiner passively flexes C-sp to end of range.
+ ve = Sharp spinal or dermatomal pain
VBI test
Patient supine or seated.
Examiner supports head and passively extends, sidebends, and rotates patient’s head to one side.
Examiner holds position for 15 seconds. Repeat on opposite side.
Stork Test - specific for sacroiliac joint restriction
Position left thumb over the most posterior portion of the left posterior superior iliac spine, and the right thumb overlying the midline of the sacrum at the same level.
Patient flexes left hip and knee to minimim 90% flexion.
Reverse thumbs.
+ve = thumb on posterior superior iliac spine moves superiorly to thumb on sacrum
Seated Flexion Test
Patient sitting. Two thumbs contact the inferior slope of each posterior superior iliac spine.
Patient bends forwards with arms between the knees as far as possible.
The thumb that moves most either superiorly or anteriorly is +ve
POSH (posterior shear test for SI joint)
Patient supine.
Flex thigh and secure with arm and axilla.
Exert a gradual even posterior compression force into the SIJ, noting any signs of hip joint pain.
+ ve = reproduction of SIJ symptoms
Sacroiliac compression tests
(version one)
Patient side-lying with knees supported by pillow.
Practitioner places forearm on patient’s supero-lateral ilium and applies a downward/ medial compression force into SIJ.
Sacroiliac compression test
(version two)
Patient supine, using both hands, practitioner applies bilateral and medial compression to the ilium to compress the SIJs.
Sacroiliac distraction test
patient supine, practitioner places both thenar and hypothenar eminences on medial aspect of ilium at the ASIS with arms crossed.
Apply a lateral and a slightly posterior compression force.
FABER (Patrick test)
flexion, abduction, external rotation of the hip joint passively with patient supine.
Location of pain helps with diagnosis.
