Special Tests & Gait Flashcards
What are Special Tests?
Special tests can be performed for the involved joints as they are mostly region specific
After the history, observation and movement evaluations have been completed, special tests can be performed
They are used to determine whether a particular type of disease, condition or injury is present
Although these tests can yield positive results, they do not necessarily rule out the disease or condition when they yield negative results
They should seldom be used in isolation or as “stand alone” tests
Therapists sometimes hope that special tests will give them a definitive answer as to what is wrong, but more commonly it does not and combined with other assessments, a clearer picture of the problem arises
No physical test is 100% reliable, valid, sensitive or specific
To be useful, a test must give reliable data, be valid and must be accurate to maximize patient outcomes
Reliability of Special Tests
Reliability of special tests may be affected by:
Cooperation of the patient, which may be influenced by the patient’s ability to relax, tolerate pain, describe apprehension and show sincerity
The skill of the therapist, which may be influenced by experience or their ability to relax and to the test confidently
Special Test Uses
To confirm a tentative diagnosis
To make a differential diagnosis
To differentiate between structures
To understand unusual signs
To unravel difficult signs and symptoms
Special Test Considerations
Any special test, regardless of the classification can be positively or negatively affected by:
Patient’s ability to relax
Presence of pain and the patient’s perception of the pain
Presence of patient apprehension
Skill of the therapist
Ability and confidence of the therapist
Supraspinatus (Empty Can) Test
Indication: To assess for a tear of the supraspinatus tendon or muscle, or neuropathy of the suprascapular nerve
Test: Patient’s arm is abducted to 90 degrees in neutral and resistance is applied by the therapist. The shoulder is then medially rotated and angled forward 30 degrees (empty can position) so the patient’s thumbs are pointing toward the floor. Resistance is applied again.
Positive: Weakness or pain
Phalen’s (Wrist flexion) Test
Indication: To test for carpal tunnel syndrome caused by pressure on the median nerve
Test: The therapist flexes the patient’s wrists maximally and holds this position for 1 minute by pushing the patient’s wrists together
Positive: Tingling in the thumb, index finger and middle and lateral half of the ring finger
Lachman Test
Indication: To assess for injury to anterior cruciate ligament
Test: The patient lies supine and the therapist holds the patient’s knee between full extension and 30 degrees of flexion. The therapist stabilizes the femur with one hand, while the proximal aspect of the tibia is moved forward with the other hand.
Positive: A “mushy” or soft end feel when the tibia is moved forward on the femur
Gait Cycle
- The time interval or sequence of motions occurring between two consecutive initial contacts of the same foot
- Also referred to as stride length
Consists of two phases for each foot:
\+ Stance phase: makes up 60-65% of walking cycle \+ Swing phase: makes up 35-40% of walking cycle
Stance Phase
Occurs when the foot is on the ground and weight bearing
Allows the lower leg to support the weight of the body and acts as a shock absorber
Stance Phase Stages:
- Initial contact (heel strike)
- Load response (foot flat)
- Midstance (single-leg stance)
- Terminal stance (heel off)
- Preswing (toe off)
Initial Contact Stage
Weight loading or weight acceptance period
Accounts for the first 10% of the gait cycle
One foot is coming off the floor, while the other foot is accepting body weight and absorbing shock
Because both feet are in contact with the floor, it is a period of double support or double leg stance
Load Response & Midstance Stages
Single support or single-leg stance
Accounts for next 40% of the gait cycle
One leg carries the body weight while the other leg goes through its swing phase
Stance leg must be able to hold the weight of the body and the body must be able to balance on the one leg
Lateral hip stability must be exhibited to maintain balance and the tibia of the stance leg must advance over the stationary foot
Terminal Stance & Pre-swing Stages
Make up the weight-unloading period
Accounts for the next 10% of the gait cycle
The stance leg is unloading the weight of the body to the contralateral limb and preparing the leg for the swing phase
Both feet are in contact, so double support occurs for the second time during the gait cycle
Swing Phase
Occurs when the foot is not bearing weight and is moving forward
Allows the toes of the swing leg to clear the floor and allows for leg length adjustments
Makes up approximately 40% of the gait cycle and consists of three subphases
Swing Phase Stages:
- Initial swing (acceleration)
- Midswing
- Terminal swing (deceleration)
Initial Swing (acceleration)
- Occurs when the foot is lifted off the floor
- With normal gait, there is rapid knee flexion and ankle dorsiflexion to allow the swing limb to accelerate forward
Midswing
The swing leg is adjacent to the weight-bearing leg, which is in midstance
Terminal Swing (deceleration)
The swinging leg slows down in preparation for initial contact with the floor
With normal gait, there is active quadriceps and hamstring muscle actions
Abnormal Gait
Gait deviations can occur for three reasons:
May occur because of pathology or injury in the specific joint
May occur as compensations for injury or pathology in other joints on the same side
May occur as compensations for injury or pathology on the opposite limb
Antalgic Gait
A self protective gait that is the result of injury to the pelvis, hip, knee, ankle or foot
The stance phase on the affected leg is shorter than that on the non affected leg because the patient attempts to remove weight from the affected leg as quickly as possible
The swing phase of the unaffected leg is decreased
The result is a shorter step length on the uninvolved side, decreased walking velocity vận tốc and decreased cadence/rate
Ataxic Gait
If a patient has poor sensation or lacks muscle coordination, there is a tendency toward poor balance and a broad base
The resulting gait is irregular, jerky and weaving
Equinus Gait (toe walking)
A childhood gait that is seen with talipes bàn chân vẹo equinovarus (club foot)
Weight bearing is primarily on the dorsolateral or lateral edge of the foot, depending on degree of deformity dị dạng
The weight bearing phase on the affected limb is decreased and a limp is present
Gluteus Maximus Gait
If the gluteus maximus muscle is weak, the patient will thrust their thorax posteriorly at initial contact to maintain hip extension of the stance leg as it’s a primary hip extensor
The resulting gait involves a characteristic backward lurch of the trunk
Gluteus Medius (trendelenburg) Gait
If the hip abductor muscles (gluteus medius and minimus) are weak, the stabilizing effect of these muscles during the stance phase is lost and the patient exhibits an excessive lateral list in which the thorax is thrust laterally to keep the centre of gravity over the stance leg
Hemiplegic Gait
The patient swings the paraplegic leg outward and ahead in a circle or pushes it ahead
The affected upper limb is carried across the trunk for balance
Sometimes referred to as a neurogenic or flaccid gait
Parkinsonian Gait
The neck, trunk and knees of a patient with parkinsonian gait are flexed
Gait is characterized by shuffling or short rapid steps at times
Arms are held stiffly and do not have their normal associative movement
Patient may lean forward and walk progressively faster as though they are unable to stop (festination)
Steppage or Drop Foot Gait
Patient’s will have a weak or paralyzed dorsiflexor muscles, resulting in a drop foot
To compensate and avoid dragging the toes against the ground, the patient lifts the knee higher than normal
At initial contact, the foot slaps on the ground because of loss of control of the dorsiflexor muscles
