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Special tests Flashcards

1
Q

Cervical spine ROM

A

flexion: 40
extension: 50
rotation: 50
lateral flexion: 22

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2
Q

Cervical clearing test

A

-AROM with overpressure in all directions

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3
Q

Alar ligament test

A
  • Purpose: assess integrity of alar ligament
  • Position: supine hooklying
  • How to perform: Place one hand on the occiput and use the other to palpate the spinous process of C2. Laterally flex or rotate the head to one side, you should feel the spinous process move to the opposite side. If you block C2 you can stress the ligament and should encounter a firm end feel if it is intact.
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4
Q

Bakody’s sign

A
  • Purpose: to assess for cervical radiculopathy at the C4-6 levels
  • Position: sitting
  • How to perform: Actively or passively place patients hand on top of their head. A decrease in pain is a positive test.
  • Unknown accuracy
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5
Q

Cervical distraction test

A
  • Purpose: to assess the contribution of cervical radiculopathy to pt’s symptoms
  • Position: Supine hooklying
  • Performing the test: Grasp head and gently flex the neck while pulling towards torso
  • Sensitivity: 44
  • Specificity: 90
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6
Q

Cervical rotation lateral flexion test

A
  • Purpose: To assess the contribution of 1st rib hypomobility to brachial plexus pain
  • Position: Sitting
  • Perming the test: Rotate the head away from the painful side to end range. While maintaining rotation attempt to laterally flex as far as possible on the tested side. If unable t laterally flex the head the test is considered positive.
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7
Q

Craniocervical flexion test

A
  • Purpose: to assess the ability of utilizing the deep neck flexors
  • Position: Supine hooklying
  • Performing the test: Place inflated blood pressure cuff under neck, while keeping back of head stable patient performs graded cervical flexion in a graded fashion in 5 increments. Each position is held for 10 seconds with 10 second rest. Patient should be able to achieve 26-30 mmhg.
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8
Q

Deep neck flexor endurance test

A
  • Purpose: to assess the endurance of the deep neck flexors
  • Position: supine, hooklying
  • Performing the test: Tuc patients chin and lift off table 1 inch hold until compensations seen.
  • Normative values: men 38.9 seconds, women 29.4 seconds
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9
Q

Posterior-anterior segmental mobility

A
  • Purpose: assess for segmental motion and the effect on symptoms
  • Position: prone
  • Performing the test: Apply PA pressure to spinous processes
  • Sensitivity: 82
  • Specificity: 79
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10
Q

Segmental mobility

A
  • Purpose: to assess the motion at each cervical segment
  • Position: supine
  • Performing the test: Occipitoatlantal joint: rotate the head to the side 30 degrees then flex and extend just the head. Atlantoaxial joint: maximally flex the head and rotate the head in each direction. C2-C7: Contact articular pillar, flex the spine maximally below the tested segment and side glide in each direction.
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11
Q

Sharp purser test

A
  • Purpose: to assess the integrity of the transverse ligament
  • Position: sitting
  • Performing test: Patient performs slight cervical nod, PT places one hand on forehead and the other on the spinous process of C2 (arms should be parallel to the ground). Apply force directed posteriorly while stabilizing C2. There should be a firm end feel.
  • Sensitivity: 69
  • Specificity: 96
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12
Q

Spurlings maneuver

A
  • Purpose: To assess the contributions of cervical radiculopathy to pt’s symptoms.
  • Position: sitting
  • Performing the test: Laterally flex the head to the unaffected side. Apply compression to head and repeat on affected side. Positive if symptoms are reproduced.
  • Sensitivity: 88
  • Specificity: 50
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13
Q

Transverse ligament test

A
  • Purpose: to assess the integrity of the transverse ligament and cervical stability.
  • Position: supine hooklying
  • Performing the test: Place one hand on the occiput with index finger between C2 spinous process and occipital protuberance. Place other hand on the forehead. Lift the head straight up in a vertical plane. Positive test is patient experience feelings of weakness, dizziness, numbness, nystagmus, or an odd feeling in the back of the throat.
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14
Q

Median nerve ULNTT

A
  • Purpose: to assess the contributions of median N to pt symptoms
  • Position: supine
  • Performing test: Depress shoulder, laterally rotate and ABD the shoulder to 90 degrees. Extend the elbow while forearm is supinated, wrist and fingers extended.
  • Sensitivity: 50
  • Specificity: 86
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15
Q

Radial nerve ULNTT

A
  • Purpose: to assess contributions of the radial N to pt symptoms
  • Position: supine
  • Performing test: Depress shoulder, grasp pt’s hand and place arm in 10 degrees of ABD and fully extended elbow. Medially rotate the shoulder, pronate the forearm, and flex the wrist and fingers.
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16
Q

Ulnar nerve ULNTT

A
  • Purpose: to assess contributions of the ulnar N
  • Position: supine
  • Performing the test: Depress shoulder, flex elbow to 115 degrees with the forearm pronated. Keep patient’s wrist and fingers extended. Laterally rotate the patient’s shoulder to end range and abduct the patient’s shoulder.
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17
Q

Vertebral artery test

A
  • Purpose: to assess contributions of vertebral artery occlusion to the vertebral artery
  • Position: sitting
  • Performing the test: patient rotates head opposite to tested side maximally and holds 10 seconds then returns to neutral for 10 seconds. Patient extends head for 10 seconds then neutral for 10 seconds. Patient extends and rotates head for 10 seconds. Positive test with 5 D’s.
  • Sensitivity: 0
  • Specificity: 67-90%
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18
Q

The 5 D’s

A
  1. dizziness
  2. diplopia
  3. dysarthria
  4. dysphagia
  5. drop attacks
    6 nausea and vomiting
  6. sensory changes
  7. nystagmus
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19
Q

Canadian C-spine rules

A
  1. 65+ or dangerous mechanism or paresthesias in extremities
  2. any low risk factor that allows safe assessment of AROM
  3. active 45 degrees of rotation bilaterally in neck
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20
Q

Cervical manipulation for neck pain

A
  • symptoms duration <38 days
  • positive expectation that manipulation will help
  • side to side difference in cervical rotation ROM of 10 degrees or greater
  • pain with PA spring testing of the middle cervical spine
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21
Q

Cervical myelopathy symptoms

A
  • Ataxic gait
  • (+) hoffman’s
  • (+) babinski
  • (+) inverted supinator sign
  • age >45 years
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22
Q

Cluster for cervical radiculopathy

A
  • cervical rotation <60 degrees affected side
  • (+) distraction test
  • (+) spurlings test
  • (+) ULNT- median
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23
Q

Cluster for patients with neck pain that will benefit from T-spine manipulation

A

-symptoms <30 days
-no symptoms distal to the shoulder
-looking up does not aggravate symptoms
-FABQ physical activity score <12
-diminished upper thoracic spine kyphosis
cervical extension ROM <30 degrees

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24
Q

Mechanical traction for neck pain

A
  • patient reported peripheralization with lower cervical spine (C4-7) mobility testing
  • (+) bakody’s sign
  • age 55+
    • ULNT A
    • cervical distraction test
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25
Q

Adam’s forward bend test

A
  • Purpose: to identify individuals with scoliosis
  • Position: standing
  • Performing the test: Pt bends forward as far as possible. Look for one side of the rib cage to be higher than the other next tot eh vertebral column. Rib hump forms on side of the convexity.
  • Sensitivity: 92
  • Specificity: 60
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26
Q

Passive neck flexion test

A
  • Purpose: to assess the contribution of neural tension to the patient’s symptoms
  • Position: supine
  • Performing the test: patient actively performs upper cervical nod. Examiner passively flexes the lower cervical spine.
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27
Q

Thoracic compression test

A
  • Purpose: to identify the effect of vertebral compression to symptoms
  • Position: sitting
  • Performing the test: apply an inferiorly directed pressure through the shoulders. Positive response is an indication of pain.
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28
Q

Thoracic distraction test

A
  • Purpose: to identify the impact decompression has on the patient
  • Position: long sitting
  • Performing the test: Patient’s arms are crossed. While kneeling or standing grab under axillary areas to grasp the patient’s forearms. Lean back and dig hip into the patient’s low back.
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29
Q

Thoracic foraminal closure test

A
  • Purpose: assess impact of decreased intervertebral foramin
  • Position: sitting
  • Performing the test: laterally flex the spine to the unaffected side. Apply an axial compression through both shoulders.
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30
Q

Active sit up test

A
  • Purpose: to assess the strength of the trunk and hip flexors
  • Position: hooklying
  • Performing the test: stabilize the feet of the patient and with arms forward pt performs a sit up and holds position for 5 seconds.
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31
Q

Alternate Gillet Test

A
  • Purpose: To assess SI motion restrictions
  • Position: standing
  • Performing the test: palpate the PSIS on one side and S2 with the other hand, the patient then flexes the opposite hip past 90 degrees. Should movement of the PSIS occur in the superior direction the test is positive, no movement is negative.
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32
Q

Crossed Straight Leg Raise Test

A
  • Purpose: to test for the presence of a disc herniation
  • Position: supine
  • Performing the test: passively flex patient’s uninvolved hip while maintaining the knee in full extension. Positive when there is sympton reproduction in the involved limb at 40 degrees of hip flexion.
  • Sensitivity:29
  • Specificity: 88
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33
Q

Extensor Endurance Test

A
  • Purpose: to assess the strength and endurance of the lumbar extensors
  • Position: prone with the upper body and abdomen off the edge of the table
  • Performing the test: arms crossed across the chest, stabilize legs and extend back to maintain a level torso as long as possible, no more than 5 minutes.
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34
Q

FABER

A
  • Purpose: To assess the SI joint or hip joint for being source of pain.
  • Position: supine
  • Flexion, ABD, ER
  • Sensitivity: 71
  • Specificity: 1.0
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35
Q

Fortin’s Sign

A
  • Purpose: to assess for SI dysfunction
  • Position: sitting or standing
  • Performing the test: Have patient use one finger to localize their pain. Positive test is when the patient twice identifies the painful region as within 1 cm of inferomedial to the PSIS.
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36
Q

Gaenslen

A
  • Purpose: assess for SI pain
  • Position: supine
  • Performing test: Non tested leg is in extension, tested leg is in full flexion, apply an extension force on tested limb, may drop leg off EOB for greater force.
  • Sensitivity: 71
  • Specificity: 26
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37
Q

Gower’s Sign

A
  • Purpose: to assess the contribution of proximal LE muscle weakness to pt’s symptoms
  • Position: squatting
  • Performing the test: Have pt attempt to stand up right, positive test a patient has to walk hands up the thighs to achieve erect position
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38
Q

Lumbar Quadrant Test

A
  • Purpose: to determine if the lumbar spine is the source of pt’s pain
  • Position: sitting
  • Performing the test: pt’s arms are folded across his/her chest and examiner places the lumbar spine in hyperextension along with combined ipsilateral lateral flexion and rotation to end range.
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39
Q

Posterior Shear Test (POSH)

A
  • Purpose: to assess for pain originating in the SI joint
  • Position: supine
  • Performing the test: Examiner stands on tested side, stabilize sacrum and push through femur.
  • Sensitivity: 80
  • Specificity: 100
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40
Q

Posteroanterior Mobility

A
  • Purpose: to test for segmental mobility
  • Position: prone
  • Performing the test: apply PA pressure to the spine
  • Two variables: lumbar flexion >53 and lack of hypomobility. One variable: sensitivity: 82, specificity: 22. Two variables: sensitivity: 29, specificity: 98.
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41
Q

Prone Knee Bend

A
  • Purpose: to determine if neural tension is contributing to symptoms
  • Position: Prone
  • Performing test: passively flex pt’s knee to end range and hold for 45 seconds. Positive if there is pain in unilateral lumbar area, buttock, or posterior thigh.
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42
Q

Prone instability test

A
  • Purpose: test for the likelihood of a pt responding well to stabilization program
  • Position: prone with legs fully off the plinth resting on floor
  • Performing the test: Find painful spot in spine with pt’s feet on the ground, pt lifts legs off the ground and re-assess pain with a PA pressure. Positive if pain lessens when feet are off the ground.
  • Sensitivity: 72
  • Specificity: 58
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43
Q

Resisted ABD test

A
  • Purpose: assess SI or hip joint for source of pain
  • Position: Supine
  • Performing test: patient’s tested leg is extended and abducted to about 30 degrees and examiner resisted abduction. Production of LBP is a positive test and is indicative of pain stemming from SI joint.
  • Sensitivity: 87
  • Specificity: 100
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44
Q

Sacral thrust

A
  • Purpose: to determine if SI is source of pain
  • Position: prone
  • Performing test: apply PA force to sacrum (base, apex, and each side of the sacrum medial to PSIS), then apply cephalad pressure to same.
  • Sensitivity: 63
  • Specificity: 75
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45
Q

Seated Forward Flexion Test

A
  • Purpose: to assess for decreased motion at one of the SI joints
  • Position: sitting
  • Performing the test: examiner has a hand on each PSIS and patient bends forward while examiner compares the movement of each PSIS.
  • Sensitivity: 9
  • Specificity: 93
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46
Q

SIJ Compression/Distraction test

A
  • Purpose: to assess SI contributions to pt’s pain
  • Position: supine
  • Performing the test: examiner pushes outwards on ASIS’s then presses inwards
  • Compression: Sensitivity: 69, Specificity: 69
  • Distraction: Sensitivity: 60, Specificity: 81
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47
Q

Slump Test

A
  • Purpose: to assess whether a herniated disc, neural tension, or altered neurodynamics are contributing to the patient’s symptoms
  • Position: sitting
  • Performing the test: pt is seated upright with hands held together behind pt’s back, pt slumps and flexes head, leg is extended and foot dorsiflexed.
  • Sensitivity: 84
  • Specificity: 83
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48
Q

Sphinx test

A
  • Purpose: to assess for sacral torsion
  • Position: prone
  • Performing test: palpate sacral sulcus and inferior angle of the sacrum on each side when pt is in prone. Assess sacral sulci and inferior angles for symmetry, have pt perform PPOE and if landmarks become more symmetrical they have forward torsion, if more asymmetrical they have backward torsion.
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49
Q

Spine Rotators and Multifidus Test

A
  • Purpose: to determine the ability to recruit and utilize the muscles while under going movements of the extremities
  • Position: q-ped
  • Performing the test: pelvis is placed in a neutral position and is maintained through various positions. 5/5 if can perform contralateral UE/LE lift, 4/5 unilateral leg lift, 3/5 unilateral UE lift, 2/5 able to lift arm or leg off table, 1/5 unable to lift arm off table.
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50
Q

Squish test

A
  • Purpose: to assess the mobility of the SI joint
  • Position: Supine
  • Performing the test: Push inward on bilateral ASIS’s at a 45 degree angle
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51
Q

Straight leg raise

A
  • Purpose: to asses for the presence of a disc herniation
  • Position: supine
  • Performing the test: examiner will passively flex the patient’s hip while maintaining the knee in full extension. Positive if pain is reproduced at 40 degrees of hip flexion.
  • Sensitivity: 91
  • Specificity: 26
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52
Q

Supine to Long Sit test

A
  • Purpose: to assess the contribution of the SI joint to an apparent leg length discrepancy
  • Position: supine
  • Performing the test: palpate inferior to medial malleoli in supine then have patient sit upright. If there is a posterior innominate the leg that appeared shorter will lengthen with sit up. If there is an anterior innominate the leg that appeared longer will shorten with the sit up.
  • Sensitivity: 44
  • Specificity: 64
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53
Q

Lumbar AROM

A
  • flexion: 60
  • extension: 35
  • lateral flexion: 25-30
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54
Q

Cluster for patients likely to benefit from spinal manipulation

A
  • duration of current LBP for less than or equal to 16 days
  • No symptoms below the knee
  • FABQ work subscale score 18 points or less
  • Segmental mobility testing results in finding 1 or more hypomobile segments
  • hip IR with at least one hip having at least 35 degrees
55
Q

Cluster for patients likely to benefit from lumbar stabilization

A
  • Age <40
  • Avg straight leg raise >91
  • Positive prone instability test
  • Aberrant movement present
56
Q

Cluster for patients likely to benefit from lumbar traction

A
  • FABQ-W score <21
  • No neurological deficit involvement
  • Age >30
  • Non-manual work job status
57
Q

Cluster for pain originating from SI joint

A
  • Sacral clearing test
  • SIJ compression
  • Distraction test
  • POSH test
  • Gaenslen’s test
58
Q

Cluster for signs and symptoms indicative of spinal stenosis

A
  • bilateral symptoms
  • leg pain > back pain
  • pain during walking/standing
  • pain relief upon sitting
  • > 48 years old
59
Q

Craig’s test

A
  • Purpose: to determine anteversion of the femur
  • Position: prone
  • Performing test: prone with knee flexed to 90. Find greater trochanter and move hip medial and laterally until the outward most point is found in the lateral aspect of the hip. Measure the angle of the hip. Normal anteversion is 8-15 degrees.
60
Q

Dial test

A
  • Purpose: to assess for laxity of the anterior hip capsule and iliofemoral ligament
  • Position: supine
  • Performing the test: passively roll the leg into full medial and lateral rotation. Considered positive if ROM is greater than 45 degrees and there is no rebound back to neutral
61
Q

FADIR test

A
  • Purpose: detect femoroacetabular impingement
  • Position: supine
  • Performing test: move hip into flexion, ADD, and IR.
  • Sensitivity: 41
  • Specificity: 47
62
Q

Fitzgerald’s test

A
  • Purpose: to assess for a labral tear
  • Position: supine
  • Performing the test: to test for anterior labral tear: move affected limb is placed in full flexion, lateral rotation, and ABD. The examiner then extends the hip passively while moving it through medial rotation and ADD. To test for posterior labral tear: start with affected hip in full flexion, adduction, and medial rotation. The examiner then passively extends the hip while moving it through lateral rotation and ABD. Sharp pain is a positive test.
63
Q

Hip Quadrant Test

A
  • Purpose: to determine if the hip is the source of the pt’s symptoms
  • Position: Supine
  • Performing the test: Affected limb is placed in ADD and a compression force is applied and maintained through the femur through a range of 70-140 degrees of hip flexion. The test is repeated in ABD. Positive test is a reproduction of the patient’s pain.
  • Sensitivity: 75
  • Specificity: 43
64
Q

Hop test

A
  • Purpose: to assess for a fracture in the LE
  • Position: standing
  • Performing the test: have pt hop up and down on the affected limb barefoot. A large amount of pain in a localized area of the LE may signify a fx.
65
Q

Labral Anterior Impingement Test

A
  • Purpose: to assess for impingement to the anterior labrum
  • Position: supine
  • Performing the test: flex the patient’s hip to 90 degrees and then place the hip in about 25 degrees of ADD. The examiner then medially rotates the hip to end range. Positive if anterior hip pain is produced.
66
Q

Labral Posterior Impingement Test

A
  • Purpose: to assess for labral impingement posteriorly
  • Position: supine
  • Performing the test: in thomas test position place the affected limb in extension, lateral rotation, slight ABD and apply overpressure into extension. Anterior hip pain is considered a positive test for posterior impingement.
67
Q

Long axis femoral distraction test

A
  • Purpose: to assess the mobility and laxity of the hip joint
  • Position: supine
  • Performing the test: hip is passively moved into 30 degrees of hip flexion, 30 degrees of ABD, and 15 degrees of lateral rotation then examiner applies a distraction force.
68
Q

Noble compression test

A
  • Purpose: to assess for contributions of the IT band to the patient’s symptoms
  • Position: supine
  • Performing the test: affected limb’s hip and knee are passively flexed to 90 degrees. The examiner applies pressure with the thumb over the ITB proximal to the femoral condyle then actively extend the hip and knee. Pain produced where the pressure is being applied before 30 degrees short of knee extension is a positive test.
69
Q

Percussion test

A
  • Purpose: to assess for a fracture in the LE
  • Position: supine
  • Performing the test: strike the heel of affected limb, positive test is reproduction of the patient’s worst pain.
70
Q

Sign of the Buttock

A
  • Purpose: to determine the possibility of non musculoskeletal causes for the pt’s pain
  • Position: supine
  • Performing the test: Restriction of SLR concurrently with limited hip flexion and a non capsular pattern of restriction of hip joint ROM.
71
Q

Trendelenburg test

A
  • Purpose: detect gluteus medius tendon tears or weakness in hip ABD’s
  • Position: standing
  • Pt stands on one leg…compensated trendelenburg pt’s trunk leans ipsilaterally to the side of stance leg. Uncompensated trendelenburg observe contralateral pelvic drop.
  • Sensitivity: 72
  • Specificity: 76
72
Q

Anterior Drawer Test

A
  • Purpose: to assess the integrity of the ACL
  • Position: supine
  • Performing the test: apply a posterior to anterior tibial glide
  • Sensitivity: 49
  • Specificity: 58
73
Q

Dial Test (Tibial Rotation Test)

A
  • Purpose: to assess for rotary instability in the knee
  • Position: Prone
  • Performing the test: Place tested knee into 30 degrees of flexion and passively rotate tibia medially and laterally on the femur, compare to other side.
74
Q

Joint Line Tenderness

A
  • Purpose: to assess for meniscal injury
  • Position: sitting
  • Performing the test: palpate along joint line
  • Sensitivity: 63
  • Specificity: 77
75
Q

Lachman Test

A
  • Purpose: assess the integrity of the ACL
  • Position: supine
  • Performing the test: Place tested leg in about 20 degrees of flexion by placing examiner’s knee under pt’s knee. Stabilize femur with one hand and with the other apply a quick PA through the tibia, there should be a firm end feel.
  • Sensitivity: acute: 94, chronic: 95
  • Specificity: acute 97, chronic: 90
76
Q

McMurray Test

A
  • Purpose: to assess for a lesion in the meniscus
  • Position: supine
  • Performing the test: Maximally flex knee and hip, apply valgus force to the knee, externally rotate and extend the knee. Repeat with a varus pressure with internal rotation.
  • Sensitivity: 70
  • Specificity: 71
77
Q

Pivot-Shift Test

A
  • Purpose: to assess the integrity of the MCL and ACL
  • Position: Supine
  • Performing the test: lift tested leg off the table with knee extended apply valgus force and internal rotation of the tibia and slowly flex the knee. Positive test occurs when the lateral tibial plateau begins anteriorly subluxed and returns to neutral as you flex the knee to around 30 degrees.
  • Sensitivity: 32
  • Specificity: 100
78
Q

Posterior Drawer Test

A
  • Purpose: assess the integrity of the PCL
  • Position: supine
  • Performing the test: with hip and knee flexed apply AP force to the tibia. Positive test is absence of end feel.
  • Sensitivity: 90
  • Specificity: 99
79
Q

Posterior sag test

A
  • Purpose: to assess for integrity of PCL
  • Position: supine
  • Performing the test: have patient’s involved limb in a position of 45 degrees of hip flexion and 90 degrees of knee flexion. Look for tibial “sag”.
  • Sensitivity: 79
  • Specificity: 100
80
Q

Quad active test

A
  • Purpose: to assess integrity of PCL
  • Position: supine
  • Performing test: perform sag test then have pt contract quad, positive test occurs if the patient’s tibia shifts forward.
  • Sensitivity: 54
  • Specificity: 97
81
Q

Thessaly test

A
  • Purpose: to assess for lesions in the meniscus
  • Position: standing
  • Performing the test: have pt stand on leg with nee bent to 20 degrees of flexion then rotate the knee medially and laterally 3 times each direction.
  • Sensitivity: 89
  • Specificity: 92
82
Q

Valgus Stress Test

A
  • Purpose: assess integrity of the MCL
  • Position: supine
  • Performing the test: nflex knee to about 30 degrees and apply valgus force
83
Q

Anterior Drawer Test

A
  • Purpose: assess for ligamentous laxity or instability in the ankle
  • Position: supine or sitting
  • Performing the test: Stabilize the distal leg, grasp calcaneus and place foot into 10-15 degrees of PF and translate anteriorly.
  • Sensitivity: 71
  • Specificity: 33
84
Q

Calf squeeze test

A
  • Purpose: assess for achilles tendon rupture
  • Position: Prone
  • Performing the test: gently squeeze calf, positive test if the foot stays still
  • Sensitivity: 96
  • Specificity: 93
85
Q

External rotation test

A
  • Purpose: assess for tib-fib syndesmotic injury
  • Position: supine or sitting
  • Performing the test: maintain ankle dorsiflexion and externally rotate the foot. Positive test when pain is recreated.
  • Sensitivity: 20
  • Specificity: 84
86
Q

Metatarsal loading test

A
  • Purpose: to rule out metatarsal fx
  • Position: supine or sitting
  • Performing the test: apply axial force of metatarsal on calcaneus
87
Q

Impingement Sign

A
  • Purpose: to assess for impingement of the talocrural joint
  • Position: sitting
  • Performing the test: grasp pat’s calcaneus with one hand and the forefoot of the patient with a second hand to bring patient’s foot into PF then bring foot into DF and eversion. Positive test results when pt reports pain with pressure ove the anterolateral ankle.
  • Sensitivity: 95
  • Specificity: 88
88
Q

Navicular drop test

A
  • Purpose: to assess the height of the navicular
  • Position: standing
  • Performing the test: mark navicular tuberosity and measure the height of the navicular bone in subtalar neutral with pt sitting. Have patient stand and re-assess height of the navicular. A difference >10mm is considered excessive foot pronation
89
Q

Squeeze test

A
  • Purpose: assess for tib-fib syndesmotic injuries
  • Position: Supine
  • Performing the test: grasp the pt’s leg midway up calf and compress and release motion, if there is pain test is positive.
90
Q

Talar tilt

A
  • Purpose: to test for injury to lateral ligaments of the ankle
  • Position: supine or sitting
  • Performing the test: stabilize the distal leg in a neutral position and invert the ankle.
91
Q

Tarsal Tunnel Test

A
  • Purpose: test for presence of tarsal tunnel syndrome or compression of posterior tibial N
  • Position: sitting
  • Performing the test: maximally DF the ankle, evert the foot, and extend all the toes, hold for 5-10 seconds while tapping over the tarsal tunnel. Positive test is a positive Tinel’s.
92
Q

Test for interdigital neuroma

A
  • Purpose: test for presence of a neuroma
  • Position: supine
  • Performing then test: Grasp two metatarsals and move back and forth while compressing them. Positive test is recreation of symptoms.
93
Q

Windlass

A
  • Purpose: assess for plantar fascial involvement
  • Position: sitting, then standing
  • Performing the test: Sitting: stabilize ankle in neutral and extend the 1st metatarsal, a positive test is considered is passive extension is continued to end range or pain is recreated. Standing: The patient stands and 1st MTP is extended, positive test if pain is reproduced.
94
Q

Active compression

A
  • Purpose: to test for the presence of a labral tear or AC lesion
  • Position: sitting or standing
  • Performing the test: empty can and then full can. Positive for AC lesion if pt has localized pain in the AC joint with the thumb pointing down and a decrease in pain with thumb pointing up. Is positive for a labral tear if the patient reports a painful clicking in the joint with the thumb pointed down, which is reduced or eliminated when the thumb is up.
  • Sensitivity for AC lesion: 41-100
  • Specificity for AC lesion: 97
  • Sensitivity for labrum: 63-100
  • Specificity for labrum: 73-98
95
Q

Anterior Apprehension

A
  • Purpose: to assess for anterior instability of the GH joint capsule
  • Position: supine
  • Performing the test: flex the pt’s elbow to 90 degrees and ABD shoulder to 90 degrees. Slowly externally rotate the patient’s shoulder. Positive if the patient demonstrates apprehension during shoulder ER
  • Sensitivity: 52
  • Specificity: 99
96
Q

Bicep Load Test II

A
  • Purpose: to test for the presence of GH labral tears (SLAP lesion)
  • Position: supine
  • Performing the test: examiner brings the pt’s shoulder into 120 degrees ABD, maximal ER, 90 degrees of elbow flexion and forearm supination. The examiner holds onto the pt’s wrist and stabilizes elbow while patient flexes elbow against examiner’s resistance. Positive if symptoms are increased with bicep contraction
  • Sensitivity: 89
  • Specificity: 96
97
Q

Drop arm sign

A
  • Purpose: test for the presence of a full thickness RTC tear
  • Position: sitting or standing
  • Performing the test: Pt is told to actively elevate the arm in the scapular plane, followed by slowly reversing the motion. Positive test if the arm drops suddenly or the pt experiences pain.
  • Sensitivity: 7
  • Specificity: 97
98
Q

Cluster for full thickness RTC tear

A
  1. drop arm sign
  2. painful arc sign
  3. infraspinatus manual muscle test
99
Q

External Rotation Lag Sign (ERLS)

A
  • Purpose: to test for the presence of isolated full thickness RTC tears
  • Position: seated
  • Performing the test: passively flex the pt’s elbow to 90 degrees and bring the shoulder into a position of 20 degrees of scaption. Then passively take pt’s shoulder into a position of maximal lateral rotation. The patient is then instructed to hold that position, a positive test is if the pt cannot maintain the position.
  • Sensitivity: 56
  • Specificity: 98
100
Q

Hawkins Kennedy Impingement

A
  • Purpose: to test for subacromial impingement
  • Position: sitting or standing
  • Performing the test: place pt’s shoulder into 90 degrees of shoulder flexion with the elbow flexed to 90 degrees. Passively internally rotate the pt’s arm, test is positive if the pt has pain with IR.
  • Sensitivity: 92
  • Specificity: 25
101
Q

Cluster for identifying subacromial impingement

A
  1. positive hawkins kennedy
  2. painful arc sign
  3. weak or painful infraspinatus manual muscle test
102
Q

Jobe Sign

A
  • Purpose: aid in diagnosising RTC tears or subacromial impingement
  • Position: sitting or standing
  • Performing the test: examiner passively elevates the pt’s shoulder to 90 degrees of ABD with IR. The examiner then applies a downward pressure against the arm, positive test is the provocation of pain or abnormal weakness
103
Q

Painful Arc Sign

A
  • Purpose: to test for the presence of subacromial impingement
  • Position: sitting or standing
  • Performing the test: the pt is instructed to actively elevate the arm in the scapular plane, then slowly reverse the motion. Positive if the patient has pain between 60-120 degrees of scaption.
104
Q

Neer Test

A
  • Purpose: to test for the presence of subacromial impingement
  • Position: sitting or standing
  • Performing the test: While scapular rotation is prevented with one hand the arm of the patient is forced to elevate in a scapular ROM
  • Sensitivity: 88
  • Specificity: 30
105
Q

Horizontal ADDuction Testq

A
  • Purpose: to test for the presence of AC joint dysfunction or subacromial impingement
  • Position: sitting or standing
  • Performing the test: The examiner stands behind pt on the side being tested. Grasp the pt’s arm just distal to the elbow and passively flex the pt’s shoulder to 90 degrees. Then maximally ADDuct the pt’s shoulder across their body. A positive test is considered if the pt reports pain during ADDuction motion or localized pain in the AC joint
  • Sensitivity: 82
  • Specificity: 27
106
Q

Pronated Load Test

A
  • Purpose: To identify a SLAP lesion
  • Position: supine
  • Performing the test: place the tested extremity in 90 degrees of shoulder ABD and maximal shoulder ER. With the forearm pronated the examiner resists contraction of the biceps. A positive test is discomfort in the shoulder
107
Q

Resisted Supination External Rotation Test

A
  • Purpose: to identify individuals with SLAP lesion
  • Position: supine
  • Performing the test: tested extremity is placed in 90 degrees of shoulder ABDuction with neutral rotation. With the elbow in 60-70 degrees of flexion and neutral forearm rotation, the examiner resists supination, while passively externally rotating the shoulder. A positive test is discomfort within the shoulder.
  • Sensitivity: 82
  • Specificity: 81
108
Q

Speed’s Test

A
  • Purpose: to assess the integrity of biceps tendon or labrum
  • Position: sitting or standing
  • Performing the test: start with the pt’s arm in 90 degrees of shoulder flexion. Have the pt resist a movement into extension, a first time supinated and a second time with the arm pronated. A positive test is considered if there is significantly greater pain in the bicipital groove with the arm supinated.
  • Sensitivity: 90
  • Specificity: 14
109
Q

Adson’s Test

A
  • Purpose: test for the presence of thoracic outlet syndrome, specifically compression between the anterior and middle scalene muscles
  • Position: standing
  • Performing the test: palpate the radial pulse on the affected side with elbow fully extended. Have the pt rotate their head toward the side being tested and extend the neck. Next, ABDuct, extend, and laterally rotate the shoulder. From this position have the pt take a deep breath and hold while assessing the pulse. A positive test is a decrease in pulse vigor.
110
Q

Costoclavicular Brace Test

A
  • Purpose: to test for presence of TOS, specifically compression between the clavicle and first rib
  • Position: standing
  • Performing the test: palpate the pt’s radial pulse, either unilateral or bilateral. Ask the pt to perform and exaggerated military position. Positive test if there is a decrease in pulse vigor.
111
Q

Hyperabduction Test

A
  • Purpose: to test for symptom reproduction of TOS, specifically under the pec minor
  • Position: standing
  • Performing the test: palpate pt’s radial pulse, have them ABDuct their shoulder to >90 degrees with extension. Ask the pt to take a deep breath and hold. A positive test is a decrease in radial pulse vigor
112
Q

Roos Test

A
  • Purpose: to test for the presence of neural or vascular compromise in the thoracic outlet
  • Position: standing
  • Performing the test: Have the pt ABDuct each shoulder to 90 degrees with elbows flexed slightly behind the frontal plane. Instruct the patient to open and close their hands slowly for 3 minutes. A positive test is if the pt is unable to keep their arms in the starting position for 3 minutes or if ischemic pain, heaviness, or weakness is present in the arm or if the pt reports numbness or tingling in the hand during the test.
113
Q

Yergason’s Test

A
  • Purpose: to assess for long head of the bicep tendon pathology and SLAP lesion
  • Position: sitting
  • Performing the test: examiner stands next to the patient on the testing side with pt’s elbow flexed to 90 degrees and resting in pronated position. Pt is instructed to supinate the forearm and externally rotate the shoulder while examiner applies a pronation force. The test is positive if the pt has localized pain at the bicipital groove or a snapping of the biceps tendon out of the bicipital groove.
  • Sensitvity: 74
  • Specificity: 58
114
Q

Bicep Squeeze Test

A
  • Purpose: to determine the presence of biceps brachii tendon rupture
  • Position: sitting
  • Performing the test: pt is seated with forearm resting in their lap. Elbow is flexed approximately 60-80 degrees with the forearm slightly pronated. Squeeze the bicep firmly with both hands, one at musculotendinous junction the other around the muscle belly. As the biceps is squeeze the muscle belly is drawn away from the humerus causing and anterior bow of the muscle. A positive test is lack of forearm supination
  • Sensitivity: 96
  • Specificity: 100
115
Q

Chair Sign

A
  • Purpose: to assess for radial collateral ligament insufficiency of the elbow
  • Position: sitting
  • Performing the test: Patient is instructed to sit with the forearms pronated and arms abducted greater than shoulder width. Then fully extend their elbows. A positive test is if apprehension occurs with terminal extension of the involved elbow or reluctance to push through arms.
116
Q

Cozen’s Test

A
  • Purpose: to determine the presence of lateral epicondylalgia
  • Position: standing or sitting
  • Performing the test: stabilize the pt’s forearm and instruct the pt to make a fist, pronate the forearm. radially deviate, and extend the wrist. Next clinician palpates the lateral epicondyle with the stabilizing hand and applies a flexion force against pt’s resistance. Positive test is reproduction of lateral elbow pain.
117
Q

Elbow Extension Test

A
  • Purpose: to determine the presence of a bony fx or elbow joint effusion
  • Position: standing
  • Performing the test: The clinician instructs the pt to extend their elbow as far as possible. A positive test is if the pt is unable to fully extend the elbow.
  • Sensitivity: 91
  • Specificity: 70
118
Q

Medial Epicondylalgia Test

A
  • Purpose: to determine the presence of medial epicondylagia
  • Position: standing
  • Performing the test: the clinician palpates the medial epicondyle and passively supinates the pt’s involved forearm, radially deviates the wrist and passively extends the elbow/wrist.
119
Q

Mill’s Test

A
  • Purpose: to determine the presence of a lateral epicondylalgia
  • Position: standin
  • Performing the Test: Palpate the lateral epicondyle while passively pronating the forearm, flexing the wrist and extending the elbow. A positive test is reproduction of lateral elbow pain.
120
Q

Moving Valgus Stress Test

A
  • Purpose: to determine the presence of MCL insufficiency of the elbow
  • Position: standing
  • Performing the test: the patient is standing and asked to ABD shoulder to 90 degrees. The therapist grasps the distal forearm with one hand and stabilizes the elbow with the other. Therapist maximally flexes the elbow and places a valgus force to the elbow while simultaneously externally rotating the shoulder. When end range ER is reached the therapist quickly extends the elbow to about 30 degrees. A positive test must include 1. the pt experiences pain at the medial elbow and 2. the maximal amount of pain must be experienced between 120 and 70 degrees of elbow flexion.
  • Sensitivity: 100
  • Specificity: 75
121
Q

Push up Sign/Active Apprehension

A
  • Purpose: to determine the presence of LCL insufficiency of the elbow
  • Position: prone
  • Performing the test: pt begins in push up position with the arms ABDucted to greater than shoulder width. Have the pt extend their elbows. A positive test is if there is apprehension with terminal extension of the involved elbow.
122
Q

Ulnar Nerve Compression

A
  • Purpose: to determine the presence of cubital tunnel syndrome
  • Position: standing
  • Performing the test: the pt is standing and the examiner passively flexes the involved elbow to approximately 20 degrees. Next, the examiner places a firm pressure on the ulnar nerve just proximal to the cubital tunnel and maintains the pressure for 60 seconds. A positive test is if the pt reports numbness and/or tingling in an ulnar nerve distribution
  • Sensitivity: 89
  • Specificity: 98
123
Q

Valgus Stress Test

A
  • Purpose: to determine the presence of a MCL tear of the elbow
  • Position: seated
  • Performing the test: the affected elbow is placed in 20 degrees of flexion with the humerus in full lateral rotation and a neutral forearm while palpating the medial joint line. The therapist then applies a valgus force to the elbow. If pt experiences pain or excessive gapping compared to the contralateral side the test is positive.
124
Q

Varus Stress Test

A
  • Purpose: to assess LCL of the elbow
  • Position: seated
  • Performing the test: the affected elbow is placed approximately 20 degrees of flexion with the humerus in full medial rotation while palpating the lateral joint line. The therapist then applies a varus force to the elbow. If pt reports pain or excessive gapping compared to contralateral side the test is positive.
125
Q

Allen’s Test

A
  • Purpose: to assess the arterial blood flow to the hand
  • Position: sitting
  • Performing the test: examiner palpates and applies pressure to radial and ulnar arteries at the wrist to occlude blood flow to the hand. Have patient make a tight fist 10 times ending with hand open but relaxed. Remove pressure from one artery. A positive test occurs when it takes >5 seconds for color to return
  • Sensitivity: 75
  • Specificity: 81
126
Q

Carpal Compression Test

A
  • Purpose: to assess for carpal tunnel syndrome
  • Position: sitting
  • Performing the test: apply pressure to median nerve just distal to wrist crease with forearm in supination. A positive test occurs when pt complains of numbness and tingling in the median N distribution within 30 seconds.
  • Sensitivity: 87
  • Specificity: 90
127
Q

Finkelstein test

A
  • Purpose: to assess for the presence of DeQuervain’s disease
  • Position: sitting or standing
  • Performing the test: Pt tucks thumb into fist then ulnarly deviates the wrist. Test is positive if pt complains of pain over the 1st extensor compartment of the wrist
128
Q

Phalen’s Test

A
  • Purpose: to assess for carpal tunnel syndrome
  • Position: sitting or standing
  • Performing the test: passively flex the pt’s wrist maximally while maintaining the shoulder in neutral and elbow extension. This position is held for 60 seconds or until symptoms are reproduced. A positive test occurs with numbness and tingling on the palmar aspect of the 1st, 2nd, 3rd, and radial half of the 4th digit within 60 seconds.
  • Sensitivity: 100
  • Specificity: 86
129
Q

Reverse Phalen’s Test

A
  • Purpose: to assess for carpal tunnel syndrome
  • Position: sitting or standing
  • Performing the test: place the wrist in maximal extension while maintaining the shoulder in neutral and elbow in extension and finger extension. The position is held for 60 seconds or until numbness and tingling is felt in the median nerve distribution.
130
Q

Clinical Prediction Rule for the Diagnosis of Carpal Tunnel Syndrome

A
  • Age >45
  • Patient reports shaking hands relieves symptoms
  • Wrist ratio index >0.67
  • Reduced median N sensation in digit 1 compared to eminence
  • Symptom severity scale score >1.9
131
Q

Cluster for patients with shoulder pain likely to benefit from cervicothoracic manip.

A
  • pain free shoulder flexion <127 degrees
  • shoulder IR <53 degrees at 90/90
  • (-) neer test
  • not taking medications for shoulder pain
  • symptoms <90 days
132
Q

Cluster for RTC pathology

A
  • (+) painful arc sign
  • (+) drop arm sign
  • (+) infraspinatus MMT
133
Q

Cluster for Subacromial Impingement

A
  • (+) hawkins-kennedy test
  • (+) painful arc sign
  • (+) infraspinatus MMT

OCS (11 decks)

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