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Ortho Tests > Specialized PE Tests > Flashcards

Specialized PE Tests Flashcards

1
Q

Adson’s Sign

A
  • Loss of radial pulse in arm by rotating head
  • Turn head toward symptomatic shoulder while arm, neck and shoulder extended and slightly away from body
  • Have pt inhale and check pulse in extended arm
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2
Q

Positive Adson’s Sign

A
  • If decreased HR or symptoms are reproduced, then test is positive
  • Positive test can suggest thoracic outlet syndrome
  • Lacks specificity and sensitivity
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3
Q

Bowstring’s Sign

A

Relief of radicular pain that occurs when the knee is flexed during a positive straight leg raise

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4
Q

Cervical Distraction

A
  • Place pt in supine position

* Apply gentle manual distraction

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5
Q

Positive Cervical Distraction

A
  • Reduced neck and limb symptoms

* Helpful to diagnose radiculopathy

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6
Q

Compression Test (for thoracic outlet syndrome)

A

Exert pressure b/w clavicle and medial humeral head

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7
Q

Positive Compression Test

A
  • Causes radiation of pain +/- numbness

* Can indicate thoracic outlet syndrome

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8
Q

Crossed (contralateral) SLR

A

Passive eleation of the unaffected leg by the examiner

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9
Q

Positive Crossed SLR

A
  • Lifting the unaffected leg reproduces radicular pain in the affected leg
  • Relatively specific test for radiculopathy d/t disc herniation (poor sensitivity)
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10
Q

FABER Test (Patrick’s Test, figure of 4 test, Jansen Test)

A
  • FABER:flexion-abduction-external rotation
  • Stress maneuver to detect hip and SI pathology
  • Patient is supine
  • Hip is externally rotated with the ipsilateral knee flexed at 90 degrees and placed on opposite knee
  • Clinician stabilizes the pelvis with a hand on the contralateral anterior superior iliac spine and presses down with the other hand on the thigh of the affected side
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11
Q

Positive FABER Test

A
  • Elicits hip or buttock pain

* If positive, raises suspicion for hip or SI disease. Nonspecific for radiculopathy

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12
Q

Forward Bend Test (Adams forward bend test)

A
  • Observe the pt from the back while he/she bends forward at the waist (until the spine becomes parallel to the horizontal plane, feet together, knees straight ahead and arms hanging free
  • Inability to bend forward at the waist with decreased ROM or side bending may be secondary to pain, lumbar muscle spasm and/or tighntness in hamstrings (Non-idiopathic etiology)
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13
Q

Forward Bend Test in a pt with scoliosis

A
  • Most sensitive of the clinical exam findings for scoliosis
  • A thoracic (rib) or lumbar prominence one side will be evident
  • The vertebral column rotates, making the chest wall on the convex side more prominent
  • In structural scoliosis, the rotational prominence is on the same side as the convexity of the curve
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14
Q

Forward Bend Test in length discrepancy

A

The prominence is on the concave side of the curve

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15
Q

Lasegue’s sign

A
  • Presence of worsening of radicular pain with the straight leg maneuver
  • Usually occurs when hip flexion is between 30 and 60 degrees
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16
Q

Lhermitte Sign

A

*Have pt flex their neck

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17
Q

Positive Lhermitte Sign

A
  • Electric (shock-like) sensations radiating down the spine (sometimes to the extremities)
  • Helpful to diagnose radiculopathy
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18
Q

Occiput to Wall Test

A
  • Can be used to quantify severity of hyperkyphosis
  • Pt stands agianst a wall and the distance between their occiput and the wall is measured
  • Normally pts should be able to touch their occiput to the wall
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19
Q

Rhomberg’s Sign

A
  • Swaying of the body when the feet are placed close together and the eyes are closed
  • Can be seen with myelopathy
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20
Q

Reverse Straight Leg Raise

A
  • Traditional way to place the L1-L2 nerve roots under tension
  • Place pt prone on table
  • Passively extend the hip and leg straight up off table
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21
Q

Positive Reverse Straight Leg Raise

A
  • Reproduces radicular pain over the anterior thigh
  • Useful to identify L2-L4 radiculopathy
  • Also positive with conditions with inflammation of the iliopsoas (appendicitis)
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22
Q

Roos Stress Test (Elevated Arm Stress Test/EAST)

A
  • Place pt in front sitting position
  • Have pt hold both elbows at shoulder ht while pushing shoulder back
  • Repeatedly open and close hands for several min
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23
Q

Positive EAST

A
  • Symptoms are present

* Can suggest thoracic outlet syndrome

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24
Q

Seated SLR

A
  • Distract the pt’s attention away from the back by asking if the pt has knee problems
  • Lift the foot and extend the knee
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25
Q

Positive Seated SLR

A
  • Useful to evaluate sciatic tension
  • If straightening the knee to full extension on both sides does not cause the pt to lean back, no significant sciatic tension is present
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26
Q

Slump Test of Matiland (Meningeal test)

A
  • Progressive test that is performed bilaterally and the pt is questioned regarding symptoms at each step
  • As the seated pt to slump in a lumbar and thoracic flexed position
  • Ask pt to actively flex the chin to the chest
  • Then ask pt to actively extend the knee fully
  • Then as the pt to dorsiflex fully
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27
Q

Positive Slump Test

A
  • Can cause impingement on the dura, spinal cord, or nerve roots which can result in radicular symptoms
  • If symptoms occur, ask the pt to straighten the neck but keep the knee fully extended and the foot fully dorsiflexed
  • Relief of radicular symptoms indicates a positive test (if pain persists=muscle problem not dural)
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28
Q

Spurling’s Test

A
  • Ask the seated pt to rotate and laterally flex the head to the unaffected side first, then to the affected side
  • Use one hand to lightly compress downward on the head to axial load the cervical spine
  • If tolerated, test is repeated in the rotated and laterally flexed position with cervical extension
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29
Q

Positive Spurling’s Test

A
  • Best test for confirming the diagnosis of cervical radiculopathy
  • Pain will radiate into the limb ipsilateral to the side in which the head is rotated
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30
Q

Straight Leg Raise (supine)

A
  • Place pt in supine position
  • Raise the pt’s extended leg on the symptomatic side with foot dorsiflexed
  • Results in increased dural tension in the lower lumbar and high sacral regions
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31
Q

Positive SLR

A

*Worsening of radicular pain with the straight leg maneuver (usually occurs at 30-60 degrees of flexion)

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32
Q

Trendelenburg Test

A
  • Stand behind the pt to observe the level of the pelvis as you instruct the pt to stand on one leg
  • With normal hip abductor strength, the pelvis will remain level
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33
Q

Positive Trendelenburg Test

A
  • Pelvis drops below the level on the opposite side

* Useful to evaluate hip abductor strength (gluteus medius)

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34
Q

Waddell’s Sign (nonorganic signs)

A
  • If results of >/= 2 of these tests are +, issue other than peripheral nocioception are creating pain behavior
  • -Nonorganic tenderness
  • -Axial simulation
  • -Seated SLR
  • -Nondermatomal sensory loss
  • -sudden “giving way” or jerky movements with motor examination
  • -Observation of pt overreaction or inconsistencies
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35
Q

Nonorganic tenderness

A

*with the pt standing, lightly touch the tissues over the lumbar spine
*Procedure sould not cause pain
Positive test = marked pain behavior

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36
Q

Axial simulation

A

*With the pt standing, apply light downward pressure on the pt’s head
*This maneuver should not cause pain
Positive Test = pt grimaces and moves, reporting pain

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37
Q

Wright’s Test

A

*From sitting position you hold your arm up and back (hyperabduction), rotating it outward, check for decreased pulse or reproduction of symptoms

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38
Q

Positive Wright’s Test

A
  • suggest thoracic outlet syndrome
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39
Q

Tests for Thoracic Outlet Syndrome

A
  • Adson’s sign
  • Compression test
  • Roos Stress Test (EAST)
  • Wright’s Test
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40
Q

Tests for Radicular pain

A
  • Crossed SLR
  • FABER
  • Lhermitte Sign
  • Reverse SLR
  • Slump Test
  • Spurling’s
  • SLR
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41
Q

Test that elicits pain in the Hip/Buttock

A

FABER (hip or SI disease, nonspecific for radiculopathy)

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42
Q

Test for scoliosis

A

Forward Bend test

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43
Q

Test for Myelopathy

A

Rhomberg’s sign

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44
Q

Test for Cervical Radiculopathy

A

Spurlings

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45
Q

Test for Hip Abductor Strength

A

Trendelenburg test

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46
Q

Test for non-peripheral nocioception creating pain behavior

A

Waddell’s sign

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47
Q

Compression pressure Test

A

*Applying sustained manual pressure over the ulnar nerve in the ulnar groove

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48
Q

Positive compression pressure test

A

*Positive for ulnar neuropathy when they result in paresthesia or pain in ulnar innervated regions of the hand

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49
Q

Elbow flexion test

A

*Sustained maximal elbow flexion for 1 minute with the wrist in a neutral position

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50
Q

Positive Elbow Flexion Test

A

Positive for ulnar neuropathy when they result in paresthesia or pain in ulnar innervated regions of the hand

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51
Q

Combined elbow flexion with pressure

A

*combine elbow flexion and compression test

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52
Q

External Rotation Strength Testing (shoulder)

A
  • External rotation of the shoulder is performed primarily by the infraspinatus
  • The pt’s elbow is flexed to 90 degrees and held against the pt’s body by the examiner
  • Pt actively rotates the arm externally against the resistance of the examiner’s other hand placed at the wrist
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53
Q

Finkelstein Test

A

*Full flexion of the thumb into the palm followed by ulnar deviation of the wrist

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54
Q

Positive Finkelstein Test

A

*Positive test can indicate de Quervain’s tenosynovitis

55
Q

Hand elevation tests

A
  • Raise the hands above the head for 1 minute

* Positive test reproduces symptoms of carpal tunnel

56
Q

Hawkins-Kennedy Test

A
  • Pt’s shoulder and elbow are flexed at 90 degrees

* Stabilize the shoulder with one hand and internally rotate the shoulder using the other hand

57
Q

Positive Hawkins-Kennedy Test

A
  • Pain induced by the maneuver

* Useful to help identify rotator cuff tear or rotator cuff tendinopathy

58
Q

Jobe’s test (Empty Can test)

A
  • Pt places a straight arm in about 90 degrees of abduction and 30 degrees of forward flexion
  • Pt asked to internally rotate the shoulder completely
  • Clinician adducts the arm while the pt resists
59
Q

Positive Empty Can test

A
  • Assesses supraspinatus fxn
  • Pain without weakness suggests tendinopathy
  • Pain with weakness is c/w tendon tear
60
Q

Ludington Test

A
  • Pt puts his or her hands behind the head and flexes the biceps muscle
  • Useful to assist in dx of biceps tendon rupture
61
Q

Manual carpal compression

A

*performed by applying pressure over the transverse carpal ligament

62
Q

Positive manual carpal compression

A

*Paresthesia occurs within 30 seconds of applying pressure

63
Q

Neer Test

A

*Clinician passively flexes the glenohumeral joint while simultaneously preventing shoulder shrugging

64
Q

Positive Neer Test

A
  • compresses the greater tuberosity against the ant acromion and elicits discomfort in pts with rotator problems
  • useful to assess degree of shoulder impingement
  • -mild= pain at 90 degrees
  • -moderate= pain at 60-95
  • -severe= pain at 45 degrees
65
Q

Phalen

A

*Pt fully flexes the palms at the wrist with the elbow in full extension to provide extra pressure on the median nerve

66
Q

Alternative to Phalen’s

A

*Backs of the hands are placed against each other to provide hyperflexion of the wrist and elbow remain flexed

67
Q

Positive Phalen

A

*Pain and/or paresthesia in the median innervated fingers with one minute of wrist flexion

68
Q

Posterior Impingement Test

A

*Place affected shoulder in 90 degrees of ABduction, 110 degrees of extension and maximal external rotation

69
Q

Positive posterior impingement test

A

*pain is reproduced

70
Q

Push Off Test (Gerber’s Test)

A
  • assesses strength of subscapularis muscles

* Have pt place one hand behind his/her back and push posteriorly against resistance

71
Q

Speed’s Test

A

*Pt forward flexes the shoulder about 30 degrees against the clinician’s resistance while keeping the elbow fully extended and the arm fully supinated

72
Q

Positive Speed’s Test

A
  • useful to assess the biceps tendon

* pain is elicited in the bicipital groove

73
Q

Tinel’s Test (Elbow)

A
  • Firm percussion over the ulnar nerve in the ulnar groove and a bit further distally over the cubital tunnel
  • Positive= ulnar neuropathy when results in paresthesia or pain in ulnar innervated areas of hand
74
Q

Tinel’s Test (Wrist)

A
  • Percussion over Guyon’s canal can be performed

* Positive= ulnar neuropathy when results in paresthesia or pain in ulnar innervated areas of hand

75
Q

Tinel’s Test (Wrist 2)

A
  • Firm percussion performed over the course of the median nerve just proximal to or on top of the carpal tunnel
  • Positive for median neuropathy
76
Q

Yergason’s Test

A
  • Pt holds arm ADducted with the elbow flexed to 90 degrees and the arm fully pronated
  • clinician holds hands with the pt and attempts to supinate the pt’s arm while the examiner resists
77
Q

Positive Yergason’s Test

A
  • Useful to assess the biceps tendon

* Pain is elicited in the bicipital groove

78
Q

Positive Impingement Sign (femoral acetabular impingement)

A
  • provocative maneuver which involves placing the hip in maximal flexion, ADduction, and internal rotation
  • Pain with this maneuver is a positive sign
79
Q

Anterior Drawer Test

A
  • Pt lies supine and knee is flexed at 90 degrees

* Proximal tibia is gripped with both hands and pulled anteriorly (may need to sit on pt’s foot)

80
Q

Positive Anterior Drawer Test

A
  • assesses ACL

* Anterior translation compared to the unaffected knee

81
Q

Apley’s compression test

A
  • Pt is prone and Knee is flexed to 90 degrees
  • Clinician can stabilize the pt’s thigh with a knee or hand
  • Press the pt’s heel directly toward the floor while internally and externally rotating the foot
82
Q

Positive Apley’s compression test

A
  • useful to assess meniscal injury

* focal pain elicited by compression

83
Q

Ballottement Sign

A
  • Use both hands and milk the synovial fluid into the center of the knee from all 4 quadrants
  • With the index finger, the patella is forcibly snapped down against the femur
  • Moderate effusion a/w clicking or tapping sensation
84
Q

Dynamic malalignment evaluation

A
  • observe gait for excessive varus or valgus knee movement

* increased risk for patellofemoral pain syndrome

85
Q

Knee Extension Test

A

*with pt supine, starting with the knee at 90 degrees of flexion, the patella is forced medially while the examiner internally rotates the lower leg and then slowly extends the knee

86
Q

Positive Knee Extension Test

A

*Pt’s pain and popping are reproduced b/w 45-60 degrees of flexion

87
Q

Lachman Test

A

*Place the knee in 30 degrees of flexion and then stabilize the distal femur with one hand while pulling the proximal tibia anteriorly with the other hand

88
Q

Positive Lachman Test

A
  • Useful to assess ACL

* Increased translation compared with the uninjured knee and a vague endpoint suggests ACL injury

89
Q

McMurray Test

A
  • Pt likes supine and the knee if flexed to max pain free position
  • Clinican holds the leg in the position while externally rotating the foot and then gradually extending the knee (medial menisicus)
  • holding foot in internal rotation (lateral meniscus)
90
Q

Positive McMurray Test

A
  • Used to assess knee menisci

* localized medial/lateral compartment click and/or pain

91
Q

Medial Patellar Plica Test

A
  • Pt lies in supine position
  • apply pressure with the thumb over the inferior and medial aspect of the patellofemoral joint with the aim of interposing the medial plica b/w the medial patellar facet and the medial condyle
  • While maintaining this pressure, the knee is passively flexed from 0-90 degrees
92
Q

Positive Plica Test

A
  • useful to assess plica syndrome

* Medial pain is reproduced b/w 30-45 degrees (a/w clicking or popping sensation)

93
Q

Noble’s Test

A
  • Pt lies supine
  • clinician thumb is placed over the lateral femoral epicondyle
  • Pt repeatedly flexes and extends knee
94
Q

Positive Noble’s Test

A
  • Useful to assess IT band syndrome

* Pain when knee flexed (often worse at 30 degrees)

95
Q

Ober’s Test

A
  • Pt lies on side (unaffected side down)
  • Flex unaffected hip and knee to 90 degrees
  • ADduct affected knee into ADduction
96
Q

Positive Ober’s Test

A
  • Useful to assess IT band syndrome

* suggestive of IT band syndrome if difficult ADduction of affected knee or lateral knee pain on attempted ADduction

97
Q

Patellar apprehension test

A
  • Pt lies supine on table with knee in 20-30 degrees of flexion and quads relaxed
  • Examiner glides patella laterally
98
Q

Positive patellar apprehension test

A
  • Useful to detect patellar instability
  • absence of a firm endpoint with lateral patellar movement and pt becomes apprehensive or contracts the quads to avoid further displacement
99
Q

Patellar compression test

A
  • directly compress the patella into the trochlear groove while the leg is extended
  • positive = pain (c/w patellofemoral pain syndrome)
100
Q

Patellar Facet

A
  • With pt’s knee in full extension and the quadriceps relaxed, displace the patella laterally and palpate the lateral facet through the retinaculum and synovium
  • repeat on medial side
101
Q

Positive Patellar facet

A

*pain/tenderness (c/w patellofemoral pain syndrome)

102
Q

Patellar Glide

A

*with knee extended and quadriceps relaxed, manually displace the patella laterally and medially

103
Q

Positive patellar glide

A
  • Translation s width signifies a tight retinaculum while translation 3/4 of patellar width is hypermobile
  • Useful to assess patellofemoral instability
104
Q

Patellar Grind Test (Clarke Sign)

A
  • Pt is supine with knee in extended position

* examiner pushes the patella distally and asks the pt to contract the quadriceps

105
Q

Positive Patellar Grind Test

A
  • assesses for cartilage degeneration under patella
  • Patella should glide smoothly cephalad
  • Positive = pain and crepitation on patellar movement
106
Q

Patellar Tracking

A
  • Palpate the patella as pt flexes and extends the knee

* If patellar instability is present, normal arc of movement is increased and may make an inverted J-shaped motion

107
Q

Normal Arc

A

*patella normally moves in a gentle arc from a relatively lateral position when the knee is extended to a more medial position during early flexion and then back to a lateral position

108
Q

J sign

A

*patella moves laterally >1cm as the knee nears full extension

109
Q

Posterior Drawer Test

A

*similar to anterior drawer test except examiner pushes tibia away from themselves

110
Q

Positive Posterior Drawer Test

A
  • useful to assess posterior cruciate ligament

* Tibia slides backward on the femur

111
Q

Thessaly test

A
  • attempts to simulate loading forces placed upon the knee
  • have pt hold examiner’s hand and then stand on one leg with the knee flexed to 20 degrees
  • have pt internally and externally rotate their knee
112
Q

Positive Thessaly Test

A
  • useful to asses meniscal injury

* Pain or locking or catching sensation

113
Q

Valgus Stress Test

A
  • Pt lies supine with hip in slight flexion and ABduction and knee slightly flexed (30 degrees)
  • secure leg by pinning the pt’s ankle/foot
  • place both hands on pt’s proximal lower leg with your fingers over the medial and lateral joints
  • exert gentle valgus stress across the knee by pushing on the foot with your elbow while holding the proximal leg in place with your hands
114
Q

Positive Valgus

A
  • If valgus stress test reveals laxity at 30 degrees of flexion, the superficial portion of MCL may be injured
  • Laxity at 0 degrees of flexion suggests deeper MCL and possible ACL disruption
115
Q

Varus Stress Test

A

*useful to determine integrity of lateral collateral ligament

116
Q

Wilson Test

A
  • Pt sits on edge of table
  • grasp foot and turn it inward so the anterior tibia rotates toward the opposite leg
  • instruct pt to extend the affected leg until painful
117
Q

Positive Wilson Test

A
  • Useful to assess osteochondritis dissicans

* If pt experiences pain when leg reaches 30 degrees of flexion

118
Q

Anterior Drawer (Ankle)

A
  • Pt’s foot in the neutral position
  • lower leg is stabilized by the examiner with one hand with the opposite hand on the heel
  • anterior force is gently but steadily applied to the heel while holding the distal anterior leg fixed
  • compare movement to uninvolved side
119
Q

Positive Anterior Drawer (ankle)

A

*detects excessive anterior displacement of the talus on the tibia
If ant talofibular lateral ligament is torn by inversion stress, the talus will sublux anteriorly and laterally out of the mortise
*Helpful in evaluation of chronic ankle instability

120
Q

External Rotation Stress Test (ankle)

A

*stabilize the leg proximal to the ankle joint while grasping the plantar aspect of the foot and rotating the foot externally relative to the tibia

121
Q

Positive External Rotation Stress Test (ankle)

A
  • Pain is elicited in the region of the anterior tibiofibular ligament (ant tot he lateral malleolus and proximal to the ankle joint)
  • helps to identify a syndesmotic ankle sprain
122
Q

Matles Test

A
  • Pt lies prone with knees flexed to 90 degrees
  • Observe whether the affected foot is dorsiflexed or neutral (both abnl)
  • Compare to uninjured side (foot should be plantar flexed)
123
Q

Metatarsal Compression Test

A
  • Squeeze the metatarsals together with one hand and using the thumb and index finger of the other hand to compress the affected area to reproduce the pain/symptoms
  • can indicate metatarsalgia
124
Q

Mulder’s Sign

A
  • clicking sensation when palpating the interspace and simultaneously squeezing the metatarsal joints
  • can indicate presence of interdigital neuroma
125
Q

Piano Key Test

A
  • Grasp toes and move them up and down to determine if pain results
  • useful to assess for Lisfranc injury
  • puts stress on midfoot and will cause pain if injured
126
Q

Single Limb Heel Rise

A
  • Stand on one foot and come up on “tip toes
  • This places significant stress across midfoot
  • Results in pain if Lisfranc injury present
127
Q

Squeeze Test (ankle)

A

*Compression of the fibula against the tibia at the mid-calf level

128
Q

Positive Squeeze Test

A

*Pain is elicited in region of the anterior tibiofibular ligament when a syndesmotic sprain has occured

129
Q

Stress Examination of the Midfoot

A
  • Grasp heel and twist the front of your foot to determine whether there is pain at the midfoot
  • Causes pain with Lisfranc injury but not with ankle injury
130
Q

Talar Tilt Test

A
  • With ankle in neutral position, gentle inversion force is applied to the affected ankle
  • degree of inversion is observed and compared with the uninjured side
131
Q

Positive Talar Tilt Test

A
  • detects excessive ankle inversion
  • if ligamentous tear extends posteriorly into the calcaneofibular poriton of the lateral ligament, the lateral ankle is unstable and talar tilt occurs
  • evaluates chronic ankle instability
132
Q

Thompson Test

A
  • Pt either lie prone with feet hanging off the end of table or kneels on a chair
  • clinician squeezed the gastrocnemius muscle belly while watching for plantar flexion
133
Q

Positive Thompson test

A

*Absence of plantar flexion when squeezing the gastrocnemius muscle marks positive test for rupture

134
Q

Tinel’s sign (tarsal tunnel)

A
  • symptoms are elicited by tapping over the path of the tibial nerve
  • useful for assessing presence of tarsal tunnel syndrome

Ortho Tests (1 decks)

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