Special Tests Flashcards
Lump special tests
Transillumination
Ascultate
Ulcer special tests
Peripheral pulses
light touch and pressure sensation
Upper limb neurological special tests
Pronator drift
How do you test pronator drift
Patients arms outstretched and supinated
Examiner gently taps on one of the outstretched arms
This should be corrected
What is a positive for pronator drift
Patient’s arms start to pronate and drift downwards
What does a positive pronator drift test suggest
Collateral upper motor neurone lesion
Lower limb neurological special tests
Rombergs test
How do you perform Rombergs test
Patient stands with feet together, arms outstretched in front of the them, hands suppinated
What is are abnormal Romberg test results
Patient cannot perform test with their eyes open. Or when eyes closed the patient rocks and sways
What does inability to perform Romberg test with eyes open suggest
Cerebellar lesion
What does rocking and swaying when the eyes are closed suggest in Romberg test
Loss of proprioception
Hip special tests
Thomas’ test
Assess gait
Trendelenburgs test
How do you perform Thomas’s test
Place hand between lumbar spine and bed. Flex the ipsilateral hip and look for correction of lumbar lordosis
What is an abnormal Thomas’s test
The contralateral leg (hip you are testing (not touching)) will raise off the bed
What does an abnormal Thomas’s test suggest
Fixed flexion deformity
How do you assess gait
Watch the patient walking
What is an abnormal gait in a hip examination
Waddling gait
Antalgic gait
What does an abnormal gait in a hip examination suggest
Waddling= hip pain or proximal muscle weakness Antalgic= pain on weight bearing
How do you perform trendelenburgs test
Ask the patient to stand on one leg
What is an abnormal trendelenburgs test result
The pelvis will dip on the contralateral side (sound side sags)
What does an abnormal trendelenburgs test result suggest
Reduced abductor muscle strength
What are the abductors of the hip
Gluteus medius, gluteus minimus, tensor fascia latae and sartorius
Cranial nerve examination special tests
Rinnes Test
Webers Test
How do you perform Rinnes test
Hold 512Hz tuning fork on the mastoid and then immediately move it to the external acoustic meatus.
What is an abnormal Rinnes test result
The tuning fork will sound louder when on the mastoid
What does an abnormal Rinnes test result suggest
Conductive hearing loss
sensorineural=quitter at both
How do you perform Webers test
Hold 512Hx tuning fork on the forehead in the midline
What is an abnormal Webers test
Sound is louder in one of the ears
What does an abnormal Webers test suggest
Conductive= louder in affected ear Sensorineural= louder in normal ear
Knee examination special tests
Lachmans test
McMurrays test
What is an abnormal gait, knee examination
Abnormal toeing angle or antalgic gait
How do you perform Lachmans test
Flex knee to 20 degrees. One hand behind tibia and thumb on tuberosity. Pull thigh anteriorly with other hand.
What is an abnormal lachmans test
A soft end point of the tibia on the femur
What does an abnormal Lachmans test suggest
ACL damage
How do you perform McMurrays test
Flex hip to 90 degrees and maximally flex the knee. Externally rotate the knee whilst grandually extending. Repeat during internal rotation.
What is an abnormal McMurrays test
Palpable, audible or painful click over the medial joint line
What does an abnormal McMurrays test suggest
Meniscal tear
Spine examination special tests
Straight leg raise
Bowstring test
Femoral stretch test
How do you perform a straight leg raise
Patient lies flat
Passively flex their thigh with their leg extended
Lower the leg gradually and then dorsiflex foot (that makes it worse= Lasegue’s sign)
What is an abnormal straight leg raise
Back or leg pain
Paraesthesia or pain in a nerve root distribution
What does an abnormal straight leg raise suggest
Back pain= central disc prolapse
Leg pain= lateral protrusion
Paraesthesia or pain in a nerve root distribution= nerve root irritation
How do you perform a Bowstring test
Perform straight leg raise
If pain, flex knee slightly
Apply pressure with thumb in the popliteal fossa to stretch tibial nerve
What is an abnormal Bowstring test
Radiating pain and paraesthesia
What does an abnormal Bowstring test suggest
Nerve root irritation
How do you perform a femoral stretch test
With patient prone and anterior thigh fixed to couch
Flex each knee in turn
What is an abnormal femoral stretch test
Pain in the skin of the anterior compartment of the thigh
What does an abnormal femoral stretch test suggest
Protrusion of a vertebral disc at L2-4
Shoulder examination special tests
Rotator cuff -resisted active abduction -resisted active external rotation -resisted active interal roatation Acromioclavicular joint pathology
How do you test resisted active abduction
Abduct the arm.
What is an abnormal resisted active abduction
Painful between 60 and 120 degrees
What does an abnormal resisted active abduction suggest
Supaspinatus injury
How do you test resisted active external rotation
Resist external rotation, with the elbow flexed at 90 degrees
What does an abnormal active external rotation suggest
Infraspinatus and teres minor injury
Which muscle initiates abduction
Supraspinatus
Which muscle abducts up to 90 degrees
Deltoid
Which muscle causes abduction beyond 90 degrees
Trapezius and serratus anterior
How do you test active internal rotation
Lift off test. Place hand in small of back push dorsum of hand off the back
What is an abnormal test of active internal rotation
Inability to move the dorsum of the hand off the back
What does an abnormal test of active internal rotation suggest
Subscapularis rupture or dysfunction
How do you test acromioclavicular joint pathology
Scarf test. Place arm in forced adduction across body at 90 degrees of flexion at the shoulder.
What is an abnormal test of acromioclavicular joint pathology
Pain or tenderness across the ACJ
What does abnormal test of acromioclavicular joint pathology suggest
Acromioclavicular joint pathology
Elbow examination special tests
Medial epicondylitis
Lateral epicondylitis
How do you test for medial epicondylitis
In supinated position ask patient to make a fist and flex their wrist against resistance
What is an abnormal test for medial epicondylitis
Pain at the medial epicondyle
How do you test for lateral epicondylitis
In pronated position, ask patient to extend their wrist against resistance.
What is an abnormal test for lateral epicondylitis
Pain at the lateral epicondyle (extensor muscle origin)
Hand examination special tests
Tinels test Phalens test Median nerve function Ulnar nerve function Radial nerve function
How do you perform tinels test
Tapping strongly but not too fast over the median nerve as it crosses under the flexor retinaculum via the carpal tunnel
What is an abnormal tinels test
Pain, numbness or tingling in the cutaneous distribution of the median nerve
What does an abnormal tinels test suggest
Carpal tunnel syndrome
How do you perform phalens test
Hold both wrists of the patient;s in palmar flexion for one minute. Compress carpal tunnel with thumbs.
What is an abnormal phalens test
Pain, numbness or tingling in the cutaneous distribution of the median nerve
What does an abnormal phalens test suggest
Carpal tunnel syndrome
How do you test median nerve function
Test palmar abduction of the thumb against resistance
Median nerve distribution sensation
What is an abnormal median nerve function test
Reduced power and sensation
How do you test the ulnar nerve function
Ask the patient to cross their index and middle fingers
Test sensation in ulnar nerve distribution
What is an abnormal ulnar nerve function
Reduced power and sensation
How do you test radial nerve function
Test wrist dorsiflexion against resistance
Test sensation in the anatomical snuffbox
