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
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
3
Q
Bowstring’s Sign
A
Relief of radicular pain that occurs when the knee is flexed during a positive straight leg raise
4
Q
Cervical Distraction
A
- Place pt in supine position
* Apply gentle manual distraction
5
Q
Positive Cervical Distraction
A
- Reduced neck and limb symptoms
* Helpful to diagnose radiculopathy
6
Q
Compression Test (for thoracic outlet syndrome)
A
Exert pressure b/w clavicle and medial humeral head
7
Q
Positive Compression Test
A
- Causes radiation of pain +/- numbness
* Can indicate thoracic outlet syndrome
8
Q
Crossed (contralateral) SLR
A
Passive eleation of the unaffected leg by the examiner
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)
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
11
Q
Positive FABER Test
A
- Elicits hip or buttock pain
* If positive, raises suspicion for hip or SI disease. Nonspecific for radiculopathy
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)
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
14
Q
Forward Bend Test in length discrepancy
A
The prominence is on the concave side of the curve
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
16
Q
Lhermitte Sign
A
*Have pt flex their neck
17
Q
Positive Lhermitte Sign
A
- Electric (shock-like) sensations radiating down the spine (sometimes to the extremities)
- Helpful to diagnose radiculopathy
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
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
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
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)
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
23
Q
Positive EAST
A
- Symptoms are present
* Can suggest thoracic outlet syndrome
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
25
Positive Seated SLR
* 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
26
Slump Test of Matiland (Meningeal test)
* 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
27
Positive Slump Test
* 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)
28
Spurling's Test
* 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
29
Positive Spurling's Test
* 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
30
Straight Leg Raise (supine)
* 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
31
Positive SLR
*Worsening of radicular pain with the straight leg maneuver (usually occurs at 30-60 degrees of flexion)
32
Trendelenburg Test
* 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
33
Positive Trendelenburg Test
* Pelvis drops below the level on the opposite side
| * Useful to evaluate hip abductor strength (gluteus medius)
34
Waddell's Sign (nonorganic signs)
* 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
35
Nonorganic tenderness
*with the pt standing, lightly touch the tissues over the lumbar spine
*Procedure sould not cause pain
Positive test = marked pain behavior
36
Axial simulation
*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
37
Wright's Test
*From sitting position you hold your arm up and back (hyperabduction), rotating it outward, check for decreased pulse or reproduction of symptoms
38
Positive Wright's Test
* suggest thoracic outlet syndrome
39
Tests for Thoracic Outlet Syndrome
* Adson's sign
* Compression test
* Roos Stress Test (EAST)
* Wright's Test
40
Tests for Radicular pain
* Crossed SLR
* FABER
* Lhermitte Sign
* Reverse SLR
* Slump Test
* Spurling's
* SLR
41
Test that elicits pain in the Hip/Buttock
FABER (hip or SI disease, nonspecific for radiculopathy)
42
Test for scoliosis
Forward Bend test
43
Test for Myelopathy
Rhomberg's sign
44
Test for Cervical Radiculopathy
Spurlings
45
Test for Hip Abductor Strength
Trendelenburg test
46
Test for non-peripheral nocioception creating pain behavior
Waddell's sign
47
Compression pressure Test
*Applying sustained manual pressure over the ulnar nerve in the ulnar groove
48
Positive compression pressure test
*Positive for ulnar neuropathy when they result in paresthesia or pain in ulnar innervated regions of the hand
49
Elbow flexion test
*Sustained maximal elbow flexion for 1 minute with the wrist in a neutral position
50
Positive Elbow Flexion Test
Positive for ulnar neuropathy when they result in paresthesia or pain in ulnar innervated regions of the hand
51
Combined elbow flexion with pressure
*combine elbow flexion and compression test
52
External Rotation Strength Testing (shoulder)
* 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
53
Finkelstein Test
*Full flexion of the thumb into the palm followed by ulnar deviation of the wrist
54
Positive Finkelstein Test
*Positive test can indicate de Quervain's tenosynovitis
55
Hand elevation tests
* Raise the hands above the head for 1 minute
| * Positive test reproduces symptoms of carpal tunnel
56
Hawkins-Kennedy Test
* 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
Positive Hawkins-Kennedy Test
* Pain induced by the maneuver
| * Useful to help identify rotator cuff tear or rotator cuff tendinopathy
58
Jobe's test (Empty Can test)
* 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
Positive Empty Can test
* Assesses supraspinatus fxn
* Pain without weakness suggests tendinopathy
* Pain with weakness is c/w tendon tear
60
Ludington Test
* Pt puts his or her hands behind the head and flexes the biceps muscle
* Useful to assist in dx of biceps tendon rupture
61
Manual carpal compression
*performed by applying pressure over the transverse carpal ligament
62
Positive manual carpal compression
*Paresthesia occurs within 30 seconds of applying pressure
63
Neer Test
*Clinician passively flexes the glenohumeral joint while simultaneously preventing shoulder shrugging
64
Positive Neer Test
* 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
Phalen
*Pt fully flexes the palms at the wrist with the elbow in full extension to provide extra pressure on the median nerve
66
Alternative to Phalen's
*Backs of the hands are placed against each other to provide hyperflexion of the wrist and elbow remain flexed
67
Positive Phalen
*Pain and/or paresthesia in the median innervated fingers with one minute of wrist flexion
68
Posterior Impingement Test
*Place affected shoulder in 90 degrees of ABduction, 110 degrees of extension and maximal external rotation
69
Positive posterior impingement test
*pain is reproduced
70
Push Off Test (Gerber's Test)
* assesses strength of subscapularis muscles
| * Have pt place one hand behind his/her back and push posteriorly against resistance
71
Speed's Test
*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
Positive Speed's Test
* useful to assess the biceps tendon
| * pain is elicited in the bicipital groove
73
Tinel's Test (Elbow)
* 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
Tinel's Test (Wrist)
* Percussion over Guyon's canal can be performed
| * Positive= ulnar neuropathy when results in paresthesia or pain in ulnar innervated areas of hand
75
Tinel's Test (Wrist 2)
* 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
Yergason's Test
* 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
Positive Yergason's Test
* Useful to assess the biceps tendon
| * Pain is elicited in the bicipital groove
78
Positive Impingement Sign (femoral acetabular impingement)
* provocative maneuver which involves placing the hip in maximal flexion, ADduction, and internal rotation
* Pain with this maneuver is a positive sign
79
Anterior Drawer Test
* 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
Positive Anterior Drawer Test
* assesses ACL
| * Anterior translation compared to the unaffected knee
81
Apley's compression test
* 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
Positive Apley's compression test
* useful to assess meniscal injury
| * focal pain elicited by compression
83
Ballottement Sign
* 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
Dynamic malalignment evaluation
* observe gait for excessive varus or valgus knee movement
| * increased risk for patellofemoral pain syndrome
85
Knee Extension Test
*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
Positive Knee Extension Test
*Pt's pain and popping are reproduced b/w 45-60 degrees of flexion
87
Lachman Test
*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
Positive Lachman Test
* Useful to assess ACL
| * Increased translation compared with the uninjured knee and a vague endpoint suggests ACL injury
89
McMurray Test
* 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
Positive McMurray Test
* Used to assess knee menisci
| * localized medial/lateral compartment click and/or pain
91
Medial Patellar Plica Test
* 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
Positive Plica Test
* useful to assess plica syndrome
| * Medial pain is reproduced b/w 30-45 degrees (a/w clicking or popping sensation)
93
Noble's Test
* Pt lies supine
* clinician thumb is placed over the lateral femoral epicondyle
* Pt repeatedly flexes and extends knee
94
Positive Noble's Test
* Useful to assess IT band syndrome
| * Pain when knee flexed (often worse at 30 degrees)
95
Ober's Test
* Pt lies on side (unaffected side down)
* Flex unaffected hip and knee to 90 degrees
* ADduct affected knee into ADduction
96
Positive Ober's Test
* 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
Patellar apprehension test
* Pt lies supine on table with knee in 20-30 degrees of flexion and quads relaxed
* Examiner glides patella laterally
98
Positive patellar apprehension test
* 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
Patellar compression test
* directly compress the patella into the trochlear groove while the leg is extended
* positive = pain (c/w patellofemoral pain syndrome)
100
Patellar Facet
* 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
Positive Patellar facet
*pain/tenderness (c/w patellofemoral pain syndrome)
102
Patellar Glide
*with knee extended and quadriceps relaxed, manually displace the patella laterally and medially
103
Positive patellar glide
* Translation s width signifies a tight retinaculum while translation 3/4 of patellar width is hypermobile
* Useful to assess patellofemoral instability
104
Patellar Grind Test (Clarke Sign)
* Pt is supine with knee in extended position
| * examiner pushes the patella distally and asks the pt to contract the quadriceps
105
Positive Patellar Grind Test
* assesses for cartilage degeneration under patella
* Patella should glide smoothly cephalad
* Positive = pain and crepitation on patellar movement
106
Patellar Tracking
* 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
Normal Arc
*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
J sign
*patella moves laterally >1cm as the knee nears full extension
109
Posterior Drawer Test
*similar to anterior drawer test except examiner pushes tibia away from themselves
110
Positive Posterior Drawer Test
* useful to assess posterior cruciate ligament
| * Tibia slides backward on the femur
111
Thessaly test
* 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
Positive Thessaly Test
* useful to asses meniscal injury
| * Pain or locking or catching sensation
113
Valgus Stress Test
* 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
Positive Valgus
* 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
Varus Stress Test
*useful to determine integrity of lateral collateral ligament
116
Wilson Test
* 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
Positive Wilson Test
* Useful to assess osteochondritis dissicans
| * If pt experiences pain when leg reaches 30 degrees of flexion
118
Anterior Drawer (Ankle)
* 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
Positive Anterior Drawer (ankle)
*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
External Rotation Stress Test (ankle)
*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
Positive External Rotation Stress Test (ankle)
* 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
Matles Test
* 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
Metatarsal Compression Test
* 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
Mulder's Sign
* clicking sensation when palpating the interspace and simultaneously squeezing the metatarsal joints
* can indicate presence of interdigital neuroma
125
Piano Key Test
* 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
Single Limb Heel Rise
* Stand on one foot and come up on "tip toes
* This places significant stress across midfoot
* Results in pain if Lisfranc injury present
127
Squeeze Test (ankle)
*Compression of the fibula against the tibia at the mid-calf level
128
Positive Squeeze Test
*Pain is elicited in region of the anterior tibiofibular ligament when a syndesmotic sprain has occured
129
Stress Examination of the Midfoot
* 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
Talar Tilt Test
* 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
Positive Talar Tilt Test
* 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
Thompson Test
* 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
Positive Thompson test
*Absence of plantar flexion when squeezing the gastrocnemius muscle marks positive test for rupture
134
Tinel's sign (tarsal tunnel)
* symptoms are elicited by tapping over the path of the tibial nerve
* useful for assessing presence of tarsal tunnel syndrome
