Spine, pelvic, and TMJ special tests Flashcards
How do you complete the vertebral artery test?
pt supine, head extended: monitor for symptoms after 30s
- if no symptoms, increase to rotation/sidebend away from testing side
You’re completing spurlings test, and your patient is seated with her head bent towards the R when you compress down and she reports reproduction of symptoms. Why is this reproducing symptoms?
looks at foraminal compression - compressing cervical nerve root dysfunction
- can make this more intense with extension, sidebend, and rotation toward tested side
What does the shoulder abduction test look at?
indicates compression of neutral structures within intervertebral foramen
- put hand on top of head, see if that reduces symptoms
What does a positive lhermitte’s sign indicate?
dysfunction of spinal cord and/or an UMN lesion
- pt in long sit: passively flex pt’s head and one hip, while other knee is in extension
- repeat with other limb
positive = sharp, “electrical” pain down the spine and into the upper/lower limbs
How do you test the integrity of the alar ligament?
have pt seated
- passively slightly flex the upper c-spine and grip C2’s SP
- palpate C2 during side bend and/or rotation
positive = inability to feel C2 move with C1 during motions
How do you test the integrity of the transverse ligament?
sharp purser
- pt seated, passively slightly flex the upper c-spine and grip C2 SP
- apply posterior translation and extension force through the forehead while assessing for excessive linear translation or reproduction of myelopathic symptoms
What are the thoracic spine special tests you can do?
rib spring thoracic spring (on TPs)
both involve P-A springing to look for excessive motion, pain
What’s Lasegue’s test?
SLR test with DF
What test can you use to look at instability of the lumbar spine?
prone instability test
- springing with legs down, painful -> then do with legs up
What’s the quadrant test?
looks at compression of neural structures in intervertebral foramen
- have pt sidebend left, rotate left, and extend to maximally close IVFs on left
- repeat on other side
If your patient maximally side bends to the left, rotates to the R, and extends and reports pain on L, what is the cause?
facet joint
- since for facets, you cue patient into sidebend left, rotate right, and extension to maximally compress facet joint on left
If your patient maximally side bends to the left, rotates to the left, and extends and reports pain on L, what is the cause?
IVF compression (based on quadrant test)
How does the Stork test identify spondylolisthesis?
patient stands on one leg, extends trunk back
- positive is low back pain with ipsilateral leg on ground
What test is used to identify a lateral shift vs scoliosis?
McKenzie’s side glide test
- pt standing; therapist stands on side of patient so upper trunk is shifted toward you
- place your shoulders into patient’s upper trunk and wrap your arms around patient’s pelvis
- stabilize upper trunk and pull pelvis to bring pelvis/trunk into proper alignment
positive = reproduction of neurological symptoms as alignment of trunk is corrected
How would you identify if your patient is experiencing claudication pain with exercise or is feeling effects of spinal stenosis?
bicycle test
- time patient riding bike while sitting erect; see how long they can bike at a certain pace
- then time them with riding in a slumped position
if they can ride longer when slumped, pain is related to spinal stenosis
