Neuro Diagnosis Clinical Tests

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100225
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Neuro Diagnosis Clinical Tests
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2011-11-22 19:41:56
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Life University Neuro Diagnosis Clinical Tests CodexSearch
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Preparation for Life University Neurological Diagnosis Practical Exam
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  1. L'Hermitte's Sign
    Patient sitting or supine, patient flexes the head toward the chest or, per Evans, Dr. actively flexes patient's head toward chest.

    • Positive:
    • Electric shock-like sensations down the spine and/or through extremities.

    • Indicates:
    • Dural irritation, severe spinal cord injury or degeneration.

    (MS patients exhibit a positive 30% f the time)
  2. Kernig's Sign
    Patient supine, examiner passively flexes patient's hip to 90 degrees and the patient's knee to 90 degrees. Examiner then extends patient's leg completely.

    • Positive:
    • Pain, usually in the neck region.

    • Indicates:
    • Meningeal irritation / Meningitis
  3. Brudzinski's Sign
    Patient supine, examiner flexes patient's head to chest.

    • Positive:
    • Involuntary knee flexion

    • Indicates:
    • Meningeal irritation or Nerve Root Lesion

    (classic test for meningitis)
  4. Soto Hall Sign
    • Patient supine, examiner flexes patient's head tward his/her chest while stabilizing the patient's sternum with hypothenar (knife edge) of inferior hand.
    • (patient covers breast tissue)

    • Positive:
    • Generalized pain in the cervical region which may extend down to the level of T2.

    • Indicates:
    • Non-specific test for structural integrity of cervical region.
  5. Foraminal Compression Test
    Patient seated with examiner standing behind. Examiner clasps his/her hands over patient's head and exerts increasing downward pressure with the patient's head rotated right, and then left.

    • Positive I: Exacerbation of localized cervical pain.
    • Indicates: Framinal encroachment or facet pathology without nerve root compression.

    • Positive II: Exacerbation of cervical pain with a radicular component.
    • Indicates: Foraminal encroachment with nerve root compression.*

    * One would then want to evaluate the myotome, reflex and dermatome of the nerve root involved.
  6. Jackson Compression Test
    Patient seated with examiner standing behind. Examiner laterally flexes the patient's head to one side and clasps his/her hands over patient's head and exerts increasing downward pressure (down spine at an angle, NOT straight down.

    Perform bilaterally.

    • Positive I: Exacerbation of localized cervical pain.
    • Indicates: Framinal encroachment or facet pathology without nerve root compression.

    • Positive II: Exacerbation of cervical pain with a radicular component.
    • Indicates: Foraminal encroachment with nerve root compression.

    ** One would then want to evaluate the myotome, reflex and dermatome of the nerve root involved.
  7. Maximal Cervical Compression Test
    Patient seated with examiner standing behind. The examiner instructs the patient to (first) rotate the head and then hyperextend the neck.

    Perform bilaterally.

    • Positive I: Pain on the compression side.
    • Indicates: Foraminal encroachment with or without nerve root compression.

    • Positive II: Pain on the stretched side.
    • Indicates: Muscular strain.
  8. Valsalva Maneuver
    Patient seated, examiner instructs patient to take a deep breath and hold while bearing down as if having a bowel movement.

    Positive: Radiating pain from site of lesion.

    Indicates: Space occupying lesion*

    * Tumor, osteophyte, disc protrusion, etc.
  9. Cervical Distraction Test
    Patient seated, the examiner grasps the patients head with both hands and gradually exerts upward pressure, keeping hands off TMJ and ears.

    • Positive I: Diminished or absence of pain.
    • Indicates: Foraminal Encroachment (local pain diminishes), or Nerve Root Compression (radicular pain diminishes).

    • Positive II: Increase of cervical pain
    • Indicates: Muscular strain, ligamentous sprain, or facet capsulitis ( some form of soft tissue injury )
  10. Bakody Sign
    Patient seated, examiner instructs patient to place the palm of the hand on the affected side flat on top of their head.

    Positive: Decrease or absence of radiating pain.

    Indicates: Cervical foraminal compression, nerve root entrapment*

    * Usually C5-C6 level because this motion elevates the subscapular nerve and relieves traction on the brachial plexus.
  11. Adam's Sign (positions)
    • Patient standing with examiner standing behind patient. Examiner looks for signs of scoliosis.
    • Examinier instructs patient to bend forward at the waist with fingers extended and hands together.
    • Examiner observes for evidence of scoliosis.

    • Positive I: A "C" or "S" shaped scoliosis is observed to straighten.
    • Indicates: Negative: This is evidence of a Functional Scoliosis.

    • Positive II: A "C" or "S" shaped scoliosis does not straighten. (Look for rib humping, muscular imbalance, and assymetry in hand length.
    • Indicates: Positive evidence of a Pathologic or Structural Scoliosis as well as trauma or subluxation.
  12. Schepelmann's Sign

    (always on Part IV of Boards)
    Patient seated, arms fully abducted and raised over head. Examiner instructs patient to laterally flex thoracic spine to the left and then to the right side.

    Positive: Pain on the concave or convex side.

    • Indicates:
    • a) Pain on the concave side indicates intercostal neuritis.

    b) Pain on the convex side indicates fibrous inflammation of the pleura (or possible intercostal myofascitis)
  13. Beever's Sign
    Patient supine, examiner instructs patient to cross his/her arms across the chest and perform a partial sit-up.

    Positive: Superior or inferior movement of the umbilicus.

    • Indicates:
    • a) Superior movement of the umbilicus indicates spinal cord lesion at the level of T10 or lower. (Lower abdominal muscles not working)

    b) Inferior movement of the umbilicus indicates spinal cord lesion at the level of T7-T10. (Upper abdominal muscles not working)
  14. Roo's Test aka E.A.S.T. (elevated arm stress test)
    • Patient sitting or standing, instruct patient to bring both arms out in front of their body and bend the elbows to 90o.
    • The patient then externally rotates the arms and opens & closes their fists bilaterally at a moderate pace for up to 3 minutes.

    Positive: Ischemic pain, heaviness of the arms, or numbness and tingling of the hand.

    Indicates: Thoracic Outlet Syndrome on the involved side. (Evans considers this the most accurate test for TOS)
  15. Adson's Test
    aka Anterior Scalene Maneuver
    • Patient seated with arms at sides and elbows fully extended. Examiner finds radial pulse then slightly abducts affected arm and has patient take a deep breath and hold.
    • Then instruct patient to rotate head and elevate chin toward examiner while holding breath. If test is negative, repeat on opposite side.

    Positive: Pain and/or paresthesia, decreased or abscent pulse, or pallor.

    Indicates: Compression of the neurovascular bundle by the anterior scalene muscle or cervical rib (usually on opposite side.
  16. Costoclavicular Maneuver
    aka Eden's Test
    Patient seated, examiner finds radial pulse and instructs patient to sit erect, force shoulders back, chest out, and touch chin to chest.

    Positive: Pain and/or paresthesia, decreased or abscent pulse, pallor.

    Indicates: Compression of the neurovascular bundle between the clavicle and first rib.
  17. Hyperabduction Maneuver
    aka Wright's Test
    Patient seated, examiner finds radial pulse and slowly hyperabducts the patient's arm.

    Positive: Pain and/or paresthesia, decreased or abscent pulse, pallor.

    Indicates: Compression of the axillary artery by pectoralis minor or coracoid process. Thoracic Outlet Syndrome.
  18. Tinel's Elbow Sign
    Patient seated, examiner taps with the Taylor reflex hammer over the groove between the medial epicondyle and the olecranon process.

    Positive: Pain and/or tenderness at the site being tapped and parasthesia in the unlnar nerve distribution area.

    Indicates: Neuroma of the ulnar nerve (and neuritis).
  19. Fromet's Sign
    The patient is asked to hold a peice of paper between any two adducted fingers. Doctor attempts to remove the paper (pull out, not up as this will cause a paper cut.)

    Positive: The patient is unable to maintain grip on the paper.

    Indicates: Ulnar nerve paralysis.
  20. Phalen's Sign & Reverse Phalen's Sign
    aka Prayer Sign
    Patient seated, examiner instructs patient to flex both wrists to maximum degree and approximate to the point of pain or 60 seconds.

    Positive: Reproduction of pain and/or parasthesia in the median nerve distribution center.

    Indicates: Carpal Tunnel Syndrome.
  21. Tinel's Wrist Sign
    Patient seated with wrist supinated. Examinar taps with a Taylor reflex hammer over the palmar (volar) surface of the wrist. (flexor retinaculum)

    Positive: Reproduction of pain, tenderness, or parasthesia in the median nerve distribution area.

    Indicates: Carpal Tunnel Syndrome
  22. Minor's Sign
    Examiner instructs patient to stand. Observe for abnormal motion.

    Positive: Knee flexion of affected leg while supporting upper body weight (hand on back or thigh.).

    Indicates: Sciatica, lumbosacral or sacroiliac.
  23. Belt Test
    aka Supported Adam Test
    aka Supported Forward Bending Test
    Positive: Low back pain.

    Indicates I: Pain during unsupported or supported bending = Lumbar Involvement

    Indicates II: Pain during unsupported, but NO pian during supported bending = pelvic involvement.
  24. Milgram's Test
    Patient supine, examiner raises both of patient's legs 2-3 inches off table and instructs patient to hold legs up for 30 seconds.

    Positive: Inability to perform test, or low back pain.

    Indicates: Weak abdominal muscles or Space occupying lesion.
  25. Heel Walk
    Patient walks on heels.

    Positive: Inability to perform test.

    Indicates: L4-L5 disc problem (L5 nerve root)
  26. Kemp's Test
    • Patient either seated or standing with arms crossed in front of chest. Examiner stands behind patient and stabilizes at the (opposite) PSIS.
    • With other hand, examiner reaches around patient's shoulder. Examiner slowly brings patient's shoulder back and obliquely pushes shoulder towards opposite PSIS. Note: The patient is PASSIVE.

    • Positive I: Pain, usually radicular, recreating existing sciatic pain.
    • Indicates: Disc Protrusion
    • * In medial disc protrusion, Kemp's will be positive as the patient is leaning AWAY from the side of pain.
    • * In lateral disc protrusion, Kemp's will be positive as the patient is leaning INTO the side of pain.

    • Positive II: Local Pain
    • Indicates: Localized pain may indicate lumbar spasm or facet.
    • Indicates:
  27. Toe Walk
    Patient walks on toes

    Positive: Inability to perform the test.

    Indicates: L5-S1disc problem (S1 nerve root)
  28. Straight Leg Raiser (SLR)
    Patient supine, examiner raises patient's leg slowly to 90o or to the point of pain.

    Positive: Radiating pain and/or posterior thigh pain.

    Indicates: Sciatic radiculopathy or tight hamstrings. Positive elicited between 35o-70o = possible discogenic sciatic radiculopathy.

    Or, if positive occurs at > 70o = Tight hamstrings.
  29. Lindner's Sign
    Patient supine, examiner flexes patient's head toward the chest.

    Positive: Pain along sciatic distribution, or sharp, diffuse pain in leg.

    Indicates: Sciatic radiculopathy
  30. Turyn's Sign
    Patient supine, examiner dorsiflexes the big toe of the affected side.

    Positive: Pain in the gluteal region or radiating sciatic pain.

    Indicates: Sciatic radiculopathy.
  31. Bragard's Sign
    Patient supine, examiner performs a SLR on the patient. Examiner lowers the leg 5o from the point of eliciting pain then sharply dorsiflexes the patient's foot.

    Positive: Radiating pain in posterior thigh.

    Indicates: Sciatica
  32. Sicard's Sign
    Examiner lowers raised leg (see SLR) 5o from point of pain and then dorsiflexes patient's big toe.

    Positive: Posterior thigh and leg pain.

    Indicates: Sciatic radiculopathy, usually from a disc lesion.
  33. Bonnet Sign
    Patient supine, examiner strongly internally rotates and adducts the affected leg across the midline and then performs a straight leg raise (SLR) test.

    Positive: Pain in posterior thigh

    Indicates: Sciatic neuropathy or Piriformis syndrome
  34. Fajersztajn's Test
    aka Cross-over Sign
    Patient supine, examiner performs a SLR on the patient's unaffected leg to 75o or until it produces pain down the affected leg.

    If no pain is produced, examiner dorsiflexes the foot. (Same principle as Kemp's except pulling lesion toward SLR)

    • Positive I: Pain down affected leg. (Cross-over sign)
    • Indicates: Medial disc protrusion

    • Positive II: Decrease in pain down affected leg.
    • Indicates: Lateral disc protrusion.
  35. Femoral Stretch Test
    aka Femoral Nerve Traction Test
    Patient lies on the unaffected leg side, hip & knee slightly flexed. Patient straightens back and flexes neck. The examiner then extends the affected leg at the hip by approximately 15o. The affected knee is flexed (stretching femoral nerve)

    Positive: Pain on the anterior portion of the thigh. (Femoral nerve)

    Indicates: Traction on the femoral nerve indicating involvement of the 2nd, 3rd, and 4th lumbar nerve roots.
  36. Tinel's Foot Sign
    Doctor taps the region of the medial plantar nerve, posterior to the medial malleolus with pointed side of Taylor reflex hammer.

    Positive: Paresthesia radiating into foot.

    Indicates: Tarsal Tunnel Syndrome.
  37. Morton's Test
    Doctor squeezes the metatarsal heads.

    Positive: Sharp pain in forefoot.

    Indicates: Metatarsalgia or neuroma (3rd or 4th toe = Morton's Neuroma)

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