Ortho Tests

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Ortho Tests
2012-04-09 07:57:55

This has the test on the front of the card and how to perform it on the back No pictures so that it is easier to load. Cards with photos to come
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  1. Anterior/posterior load and shift test (for shoulder)
    • Have pt lay on their back or sit upright
    • Axial load is placed on the humeral head (press the humerus into the joint)
    • Now keeping inward pressure shift the humoral head forward and backward
    • Implication:
    • Anterior Laxity- anterior labral tear and possible bankart lesion
    • Posterior Laxity- posterior labral tear and possible reverse bankart lesion
    • + test is more than 25% movement (Grade 1= 20-50%, Grade 2= 50-75% and Grade 3 = >75%)
  2. Sulcas Sign
    • Tests for inferior shoulder laxity
    • Pt is seated
    • Hold epicondyles with one hand (elbow) and lock out the shoulder from above and behind with the other hand (stand behind the pt curling your fingers around their distal clavicle)
    • Apply inline downward pressure with the hand that is on the elbow.
    • A positive sign will be the opening of the joint space creating a visible crease/dimple between the humeral head and lateral edge of the acromion
    • + sign = inferior shoulder laxity
  3. Neer Impingment Sign (Rotator cuff)
    • Pt is seated or standing
    • Stabilize the scapula from behind with one hand and passively internally rotate and flex the shoulder (with palm facing in and arm straight out raise their arm)
    • extend the shoulder fully or until the pt experiences pain
    • + pain with passive flexion at or before 90 degrees
    • Causes: Impingment syndrome or rotator cuff tear
  4. Neer impingment test
    • Follow up to Neer impingment sign
    • Inject 10cc of 1% lidocaine and Repeat neer impingement sign test
    • No pain with passive flexion indicates impingment
    • Unable to passively flex = rotator cuff tear
  5. Hawkins Impingment sign
    • Pt is seated or standing
    • Pt shoulder and elbow are flexed to 90 degrees so that the forearm is parallel to the floor
    • Examiner holds pts elbow with one hand an passively internally rotates the shoulder with arm in forward flexed possition
    • + is pain with internal rotation
    • Implication: Supraspinatus impingment
    • Rotator cuff tear or rotator cuff tendonitis
  6. Drop Arm Test
    • Pt is standing
    • Pt's arm is passively abducted to 90 degrees
    • Examiner releases grip on arm and asks the pt to slowly lower their arm smoothly
    • + inability to lower the arm slowly (jerky movement) or there is pain with slowly dropping the arm, or they cannot hold arm long enough to lower slowely and insted the arm just drops with gravity
  7. Jobe's Full/Empty Can test
    • Tests the spinatus
    • Pt standing
    • Examiner passively flexes both arms to 90 degrees
    • arms are brought forward from straght out to the sides to 30-40 degrees forward
    • Arms are rotated, thumbs up for full, thumbs down for empty
    • Examiner places downward force on the pts arms as the pt is asked to resist this force
    • + weakness (best indicator)
    • + also with pain only but weakness is better
    • Implication: supraspinatus tear
  8. O'Brien (yea he is a drinker too) Empty Can and Full can test
    • Pt is standing
    • Examiner passively flexes both arms to 90 degrees
    • Arms are brought an additional 15 degrees medially so that the hands are close to touching.
    • Arms are internally rotated (thumbs down)
    • Examiner places downward forceon the pts arms as the pt resists.
    • Arms are externally rotated (thumbs up)
    • Examiner places downward force on teh pts arms as the pt resists
    • + increased deep pain, clicking, or weakness with downward force during internal rotation
    • Relief of pain or less pain with downward force during external rotation
    • Implication: SLAP lesion (Superior Labral tear from Anterior to Posterior) , or superficial pain or pain at AC joint may indicate AC joint pathology
  9. Passive Cross-Chest adduction
    • Tests AC joint
    • Pt is seated
    • Arm is flexed to 90 degrees. Examiner holds arm at elbow joint and forcefully adducts the arm across the chest
    • + Test: Pain in the AC joint
    • Implication: AC joint separation, Posterior pain may indicate posterior joint capsule lesion, SC joint injury or arthritis
  10. Subscapularis lift off test
    • Tests the rotator cuff/subscapularis
    • Seated or standing
    • Internally rotate the arm and place the dorsum of the hand on teh lower back int eh mid lumbar region. Pt is asked to lifet hand off the badk against resistance
    • + Test: Weakness or inability to life the hand of the back
    • Implication: subscapularis tear
  11. Apprehension Test
    • Tests for anterior stability of the shoulder
    • Pt is supine
    • Examiner passively abducts the arm to 90 degrees
    • Elbow is flexed to 90 degrees.
    • Arm is externally rotated
    • Gentle anterior force is placed on teh posterior humerus with one hand
    • + test: Apprehension (not pain) pt will move to try to avoid their shoulder dislocating
    • Implication: Anterior instability
  12. Relocation Test on the shoulder (frequently used with apprehension test)
    • Pt is supine
    • After completion of a positive apprhension test, pressure is place on the humeral head with palm of the examiners hand.
    • This should relieve the pts apprehension
    • + test: Decrease in apprehension
    • Implication: Supports likelihood of anterior instability
  13. Posterior Impingment sign
    • Pt is supine shoulder partially off the gurney
    • Shoulder is abducted to 90 degrees.
    • Shoulder is brought into 15 degrees of extension
    • Shoulder is maximally internally rotated (palm facing floor)
    • + Test: Pain in the posterior shoulder
    • Implication: Posterior labral or rotator cuff tear
  14. Speed's Test
    • Tests for Bicepts Tendonitis
    • Pt is standing
    • pt forward flexes arms to 90 degrees and supinate the forarms (palms up)
    • Pt holds this position
    • Examiner applies a downward force on pts arm as pt resists
    • + test: Pain in anteior shoulder
    • Implication: Biceps tendonitis
  15. Yergason's Test
    • Bicepts tendonitis
    • Pt is seated or standing
    • Pts elbow is flexed and forearm is pronated
    • Examiner holds teir arm and wrist
    • Pt actively tries to supinate against resistance
    • (Way to remember...pt: "give me a yeager! ;;supinates::: provider: "no your cut off!" :::pronates:::)
    • + test: Pain in the bicipital groove
    • Implication: Bicepts tendonitis
  16. Horn Blowers Test
    • Rotator cuff (teres minor lesion)
    • Pt is seated or standing
    • Examiner flexes pt arm to 90 degrees at 45 degrees plane and flexes elbow to 90 degrees
    • Pt is asked to resist internal rotation of the shoulder
    • OR
    • pt is asked to raise hand to their mouth as if they are feeding themselves
    • + test: pain or weakness on internal rotation or
    • elbow way up to get hand into correct mouth position
    • Implication: Teres minor lesion
  17. Belly Press Test
    • Rotator Cuff test for a Subscapularis lesion
    • Pt seated or standing
    • Pts hand is placed on abdomen.
    • Examiner places hand under pts hand
    • Pt pushes as hard as possible into abdomen as provider provides resistance
    • Pt attempts to bring elbow forward for more strenght against resistance (negative result)
    • + Test: Weakness or extension of the shoulder during exam
    • Implication: Subscapularis lesion
  18. Jerk Test
    • Posterior instability
    • Examiner stabilizes scapula with one hand
    • Examiner flexes the pts arm to 90 degrees
    • Elbow is flexed to 90 degrees.
    • Axial load is applied to the elbow
    • Arm is then Quickly adducted across the pts chest
    • + test: sudden onset of sharp pain with or without click as humerus subluxes posteriorly
    • Implication: Posterior or inferior labral tear
    • Posterior instability
  19. Drop arm test
    • Rotator cuff infraspinatus
    • Pt is seated
    • Pts elbow is at 90 degrees and forearm is at maximum external rotation. examiner externally rotates the pts arm and the pt resists
    • + Test: Weakness
    • Implication: Infraspinatus Tear
    • Alternate method:
    • Pts arm is abducted 90 degrees. Elbow is flexed to 90 degrees. Examiner passively externally rotates arm. Examiner lets go of arm
    • + Test: Drop of the forearm
  20. Lateral pivot shift test
    • LCL instability
    • Pt is supine
    • Arm is fully abducted, extended and externally rotated
    • Elbow is forcibly supinated
    • Elbow is flexed to > 40 degrees with a valgus and axial load applied
    • + Test: Apprehension of the radial head subluxation, Radial head reduces >40 degrees
    • Implication: Lateral collateral ligament instability
  21. Milking Maneuver
    • MCL Laxity
    • Pt is seated
    • "Hitchhiking" Pts arm is abducted 90 degrees, elbow is flexed to 90 degrees, arm is externally rtoated and forearm is supinated (so that the palm is towards the face)
    • Examiner supports arm with one hand and grasps pt thumb with other hand
    • Examiner pulls on thumb causing valgus stress
    • + Test: Opening of the elbow joint with stress or pain at the medial aspect of the elbow
    • Implication: Medial collateral ligament laxity
  22. PIN Compression Test
    • Posterior interosseus nerve compression
    • Pt is seated
    • "Arm wrestling"
    • Pt elbow is flexed, wrist is neutral position, (in between supination and pronation)
    • Examiner attempts to supinate the pts hand and the pt resists (no need to lock out the elbow it is testing pronator teres strenght)
    • + Test: paresthesia and or weakness
    • Implication: PIN Compression
    • Alternative: Examiner extends pts middle finger as pt resists by trying to flex it
    • + test: Pain or weakness of digit extension of MCP
  23. Resisted Wrist Extension
    • Lateral Epicondylitis
    • Pt is seated
    • Pt forms fist
    • Pt extends wrist and examiner provides resistance
    • + Test: Pain at lateral epicondyle
    • Implication: Lateral Epicondylitis
  24. Resisted Wrist Flexion
    • Medial Epicondylitis
    • Pt forms fist.
    • Pt flexes wrist and examiner resists pt
    • + Test: Pain at medial epicondyle
    • Implication: Medial epicondylitis (golfer's elbow)
  25. Valgus Stress Test on elbow
    • UCL Laxity
    • Pt is seated
    • Arm is externally rotated and forearm is supinated
    • Elbow is flexed 10-20 degrees
    • 3 points of resistance: ulnar ligament with one hand, forearm against provider's abdomen and other hand grips humerus.
    • Examiner applies valgus stress (Pts forarm is moved laterally)
    • + Test: Pain along the medial joint line
    • Implication: Ulnar collateral ligament laxity
  26. Valgus Stress Test in elbow
    • LCL Laxity
    • Pt is seated
    • Arm is externally roatated and forearm is supinated
    • Elbow is flexed 10-20 degrees
    • 3 points of resistance: radial head with one hand, forearm against abdomen and other hand grips humerus Examiner applies varus stress (pts forearm is moved medially)
    • + Test: Pain along the lateral joint line
    • Implication: Radial collateral ligament laxity
  27. Posterolateral Rotary Drawer Test of elbow
    • LCL instability
    • Pts seated or supine
    • Elbow is forcefully supinated
    • Examiner applies valgus tress to elbow and elbow is flexed
    • + Test: Apprehension and reproduction of symptoms
    • Implication: Lateral Collateral ligament Instability
  28. Moving Valgus stress test
    • MCL tear
    • Pt is seated
    • Elbow is fully flexed and examiner applies valgus force and elbow is rapidly extended
    • + Test: Medial elbow pain 120 -70 degrees
    • Implication: Medial collateral ligament tear
  29. Tinels Sign for median nerve
    • Pt is seated
    • pts elbow is flexed
    • examiner taps over ulnar notch (funny bone)
    • + Test: Tingling or numbness in the 4th and 5th digits
  30. Ulnar Nerve Compression Test
    • Pt is seated
    • Pt extends hand palm up to provider provider holds thumb forcefully over the volar wrist for 60 sec
    • + Test: numbness or tingling in teh 4th and 5th digit
    • Indication: Ulnar nerve compression
  31. Axial Compression and Distraction
    • Cervical Disk disease/Nerve root compression
    • Pt is seated
    • Cross fingers and apply acial load on the crown of the head
    • Gently increase pressure
    • Chang pts head position either hyperextension or flexion and repeat. Repeat in several positions on both sides
    • +Test: Radicular pain (numbness or tingling)
    • Implication: Cervical disk disease, with nerve root compression
    • Alternative: if test is + see if you can relieve sx by distracting (pulling upward) by holding the sides of the head and gently pulling upward stretching out the neck
    • + Test: Pain is relieved with distraction and reinforces the diagnosis of cervical disk disease
    • CAUTION do not do with acute injury
  32. Thomson Test (Hip flexion contracture test)
    • Pt is supine
    • Pt brings both knees to chest and lifts the butt off the table
    • Back remains flat on teh table
    • Pt releases one leg and attempts to bring it back flat to the table
    • + Test: Raising the back off the table or inability to bring the test leg flat to the table
    • Implication: Hip flexion contracture
  33. Faber Test/ Patrick test
    (or Patrick Faber famous guy don'cha know)
    • Pt is supine
    • Pt places foot of tested leg onto the patella of the opposite leg (Flexion, Abduction, External Rotation FABER)
    • Provider presses down on ipsilateral knee while supporting opposite ASIS
    • + Test: Pain in the SI joint
    • Implication: SI joint as a cause of Lumbar Back pain
  34. Piriformis Test
    • Looks for Piriformis Syndrome
    • Pt is left lateral decubitus position
    • Hip of the top leg is flexed to 45 degrees and knee to 90 degrees the opposite leg remains straight on the table.
    • Pelvis is stabilized to prevent pelvic rotation
    • Knee is pushed towards floor
    • + Test: Localized pain --> piriformis syndrome
    • Diffuse pain --> Sciatica
  35. Ober Test
    • Tight illiotibial band
    • (tight illiOtibial band O for Ober)
    • Pt in left lateral decubitus position
    • Pts knee is flexed to 90 degrees, abducted to 40 degrees and maximally extended off the table
    • Hip is stabilized
    • Limb is adducted towards the table
    • + Test: pain at teh IT band
    • Implication: Tight iliotibial band
  36. Trendelenberg Test
    • Weak Hip abductors
    • Position standing
    • Pt raises one leg off the floor and balences on one foot
    • + Test: drop of teh opposite hip, if the drop is to the right the problem is on the left
    • Implication: Weak Hip Abductors
  37. Reverse Psoas Sign
    • Pt lying prone
    • Pt is asked to extend therir leg against resistance
    • + Test: Pain in the lumbar region
    • Implication: Lumbar Stress/Strain
  38. Anterior and Posterior Drawer test for the ankle
    • ATFL Injury (anterior talofibular ligament)
    • pt is seated with legs dangling off the exam table
    • Examiner stabilizes the pts leg
    • with free hand grasp the heel and pull forward while posteriorly displacing the leg
    • Repeat in the opposite direction
    • Compare to non-injured side
    • + Test: Laxity
    • Implication: ATFL injury
  39. Talar Tilt test
    • CFL or Deltoid Laxity
    • pt is seated with legs dangling
    • Ankle is dorsiflexed
    • Oposite hand graspts the heel and forcefully inverts the everted ankle
    • + Test: Laxity
    • Implication: Suggests CFL laxity during inversion
    • or suggests deltoid laxity with eversion
  40. Peroneal Tendon Stability Test
    • Peroneal tendon subluxation
    • Pt is seated with legs dangling
    • the examiner holds the foot with one hand and palpates the peroneal tendon with the other hand
    • (hand is wrapped around the ankle and palpated just posterior to the lateral malleolus)
    • The examiner fully inverts the pts foot Pt attempts to evert the foot against resistance
    • + Test: palpable or audible snap or translation of the tendon
    • Implication: Suggests peroneal tendon subluxation
  41. Morton Test
    • Tests for a Morton's neroma
    • pt is seated with feet dangling
    • Examiner grasps the forefoot at the head of the 1st and 5th metatarsals.
    • Examiner compresses the metatarsals and then distracts them by bringing the first and 5th in opposite directions
    • + Test: pain and a palpable click
    • Implication: Morton's neuroma
  42. Tompson Test
    • Test for Rupture of an Achilles Tendon
    • Pt is laying prone
    • With feet dangling over the edge of the table
    • Grab calf and squeeze gently
    • (can also have pt lay on stomach and ask them to plantarflex feet and look for symmetry in the movement)
    • + Test: Failure of the foot to plantar flex or Achilles to tighten
    • Implication: Suggests rupture of the achilles tendon
  43. Patellar Apprehension test
    • Patellar subluxation/dislocation
    • Pt is supine
    • Pts leg is abducted off the side of the table with lower leg supported
    • Displace the pts patella laterally
    • Slowly flex the knee
    • + Test: apprehension that the patella will dislocate laterally upon flexion
    • Implication: suggests a likelihood of further patellar subluxation/dislocation
  44. Passive Patellar Grind
    • Arthritis of the patella
    • pt is supine
    • Cup patella betwen thumb and index finger
    • Press the patella against the femur.
    • Provider passively flexes knee
    • + Test: pain or crepitus
    • Implication: Suggests arthritis of the patella
  45. Active Patellar Grind test
    • Arthritis of the patella
    • Pt is supine
    • Cup the patella between thumb and index finger.
    • Press patella against the femur.
    • Have pt perform a quad flex
    • + Test: is pain or crepitus
    • Implication: suggests arthritis of the patella
  46. Bounce Home Test
    • Meniscal tear or posterior capsular sprain
    • Pt lying supine
    • Pt extends knee as far as possible and provider lifts leg off table
    • Provider holds heel and proximal tibia.
    • Let is gently extended up further (bounce)
    • + Test : deep pain at the medial knee joint
    • Implication: Possible meniscus tear (pain and springy block)
    • possible posterior capsular sprain (pain and guarding but no springy block)
  47. Lachman Test
    • Laxity in the ACL
    • Pt Supine
    • Pt's knee is flexed to 20-30 degrees
    • Provider's thumb is placed on the tibial tubercle with the rest of the hand wrapped around the calf
    • The other hand grasps the femur above teh patella and the thumb is pressed into the quadricepts tendon
    • The pt fully relaxes the leg
    • The tibia is pulled forward while the femur is simultaneously pushed backwards
    • + Test laxity: compare to opposite side
    • Implication: Suggests laxity of the ACL
  48. Anterior/Posterior Drawer Test
    • Tear in the ACL or PCL
    • Pt is supine
    • Knee is flexed to 90 degrees
    • Provider sits on the table with thigh blocking pts feet
    • Tibia is grasped just below the joint line with both hands
    • Tibia is brought forward and backward in relation to the femur
    • + Test: Laxity
    • Implication: Tear in the ACL or PCL
  49. Quad Active Drawer Test
    • Posterior subluxation
    • Pt is laying supine
    • Knee is flexed to 90 degrees
    • Provider sits on table with thigh blocking pts feet
    • tibia is grasped with both hands and held stable.
    • Pts performs a quad flex
    • + Test: anterior shift of tibia (reduction or posterior subluxation)
    • Implication: posterior subluxation
  50. Varus and Valgus stress on the knee
    • MCL or LCL injury
    • Pt is laying supine
    • The pt relaxes the knee
    • the examiner lifts the knee off the table and grips the ankle and the femur just above the knee joint
    • A valgus (inward) force is applied at the knee joint whiel the medial joint line is palpated
    • Repeat the same maneuver with the knee flexed to 20 degrees
    • Repeat the whole proceedure in both full extension and 20 degrees of flexion while applying Varus (outward) force to the knee
    • + Test: Laxity
    • Implication: MCL or LCL injury
  51. Pivot Shift test on the knee
    • ACL Tear
    • Pt is supine
    • Leg is lifted off the table and internally rotated
    • Palm of teh other hand is placed on the lateral joint line
    • Knee is flexed to 20 degrees
    • Valgus stress is applied to the knee
    • Knee is then flexed further
    • + Test: Reduction of the tibia at or greater than 30 degrees of flexion
    • Implications: ACL tear (usually significant)
  52. McMurray Test
    • Meniscal Tear
    • pt is supine
    • knee is flexed as far as possible
    • lower leg is externally rotated
    • Varus stress is applied to the knee
    • Medial joint line is palpated as the knee is extended
    • Knee is flexed
    • Lower leg is internally rotated
    • Valgus stress is applied to the knee
    • Lateral joint line is palpated while the knee is extended
    • + Test: Click or a pop
    • Implication: Meniscal tear
  53. Apply's Compression and Distraction Test
    • Meniscal Tears
    • Pt laying Prone
    • Knee is flexed to 90 degrees
    • The pts foot is grasped and an axial load is applied
    • Internal and external rotation are then applied to the foot
    • WIth the examiners knee applied to the pts hamstrings, the foot is distracted and internal and externally rotated again
    • + Test: pain with compression and no pain with distraction
    • Implication: suggests medial mensiscus tear with external roatation and lateral mensiscus tear with internal rotation
  54. Thessaly Test
    • Medial meniscal tear
    • dance like your in thessaly!
    • Pt is standing
    • Pt stands on one leg while holding onto examiner
    • pt flexes one knee to 20 degrees
    • pt internally and externally rotates leg at knee
    • repeat on opposite side
    • + Test: pain locking or giving way
    • Implication: medial meniscus tear
  55. Spurling Test
    • Cervical disc disease
    • Pt is seated
    • cervical spine is flexed, rotated laterally and bent in small degree increments and then an axial load is applied.
    • Cervical spine is then extended rotated and laterally bent in small degree incrementes and then an axial load is applied
    • Test the side with the complaint
    • + Test: pain or radicular numbness or tingling sx, stop once symptoms are elicited
    • Implications: Cervical Disk disease with nerve root compression
  56. Adson's Test
    • Thoracic Outlet syndrome
    • Pt is seated
    • Arm is abducted to 30 degrees and then the hsoulder is maximally extended
    • the provider palpates the radial pulse as the pt turns head to ipsilateral side and takes a deep breath and holds it
    • + Test: decrease in radial pulse (becomes thready) or the arm may fall asleep
    • Implication: Thoracic outlet syndrome (leads to neurologic or vascular deficits, caused by tumors, muscular disorders, injuries,a cervical rib or a fractured clavicle
  57. Wright maneuver
    • Thoracic outlet syndrome
    • Pt is seated or standing
    • Shoulder is abducted to 90 degrees and fully externally rotated (90/90)
    • Provider palpates radial pulse and feels for changes in the pulse
    • + Test: reproduction of symptoms or decreased radial pulse
    • Implication: Thoracic outlet syndrome
  58. Roos Test
    • Thoracic outlet syndrome
    • Pt is seated
    • Shoulder abducted to 90 degrees and fully externally rotated 90/90
    • Pt is asked to rapidly open and close hands at least 15 times
    • + Test: numbness, tingling or crampting or weakness in the hands or inability to complete the test
    • Implication: Thoracic outlet syndrome
  59. Plantar reflex/Babinski's sign
    • Upper Motor neuron lesions
    • pt is seated
    • Bottom of the foot is troked from the lateral heel towards the toes and then across the midfoot
    • + Test: dorsiflexion and abduction of the toes
  60. Hoffman Sign
    • Spinal cord compression
    • Pt is seated
    • Examiner flicks the dorsal or plantar aspect of the middle finger only
    • + Test: forced contraction of the thumb and index finger into a claw-like pincer
    • Implication: spinal cord compression
  61. Inverted Radial Reflex Sign
    • Spinal cord compression
    • pt is seated
    • Examiner repeatedly tests for brachioradialis reflex
    • + Test: Wrist and finger flexion during reflex into a claw-liek form
    • Implication: Spinal cord compression or an upper motor neuron lesion
  62. Finger Escape sign
    • Cervical Myelopathy
    • Pt is seated
    • The provider stabilizes the forearm of the pt while the pta is asked to hold their fingers in extension
    • + Test: gradual flexion and abduction of the ring and small finger
    • Implication: Cervical Myelopathy
  63. 10 second test
    • Cervical Myelopalthy
    • Pt is seated
    • Pt is asked to grip and release 3rd 4th and 5th digits for 10 seconds
    • + Test: Inability to complete 20 in 10 seconds
    • Implication: Cervical myelopathy
  64. Lhermitte's Sign
    • Cervical Myelopathy
    • (way to remember it? Lhermittes "look down" test)
    • Seated or standing
    • Provider forces the pts neck into flexion
    • + Test: sudden electrical sensations in the craciocaudal distribution especially in lower extremities
    • Implication: spinal cord compression/myelopathy
  65. Scapulohumeral Reflex
    • Cervical Lesion above C3
    • Pt is seated
    • Scapular tip is percussed with a reflex hammer
    • + Test: hyperactive response (hyperreflexia) of the scapular elevation and humeral abduction
    • Implication: Lesion at or above C3
  66. Arm Abduction Test
    • Cervical myelopathy
    • Pt is seated
    • Arm is passively abducted to maximum abduction and pts grabs top of head/ opposite ear
    • + Test: Relief of Pain of Radicular sx
    • Implication: Cervical myelopathy
  67. Vertebral artery patency Test
    • Vertebral Artery Patency
    • Pt is supine at the head of table
    • The neck is passively rotated gently to one side and then extended. This is held for thirty seconds
    • + Test: Nystagmus, Vertigo, Dizziness
    • Implication: compromise of the vertebral artery
  68. Straight leg raise
    • Sciatic Nerve compression
    • Pt is supine
    • Examiner slowly lifts the pts extended leg off the table
    • (stop if the pt assists and remeing them to let you do the work)
    • Elevated to maximum flexion or the pt complains of pain
    • Augment the test by dorsiflexing the foot
    • + Test: Radicular symptoms or pain past the knee and down the leg
    • Implication: Sciatic Nerve compression
  69. Contralateral Straight leg raise
    • L4/L5 Lesion
    • The examiner slowly lifts teh pts nonaffected leg keeping it extended
    • Elevate to maximum flexion or the pt complains of pain
    • Can be augmented by dorsiflexion of the foot
    • + Test: Pain in the contralateral leg (the leg with the original SLR+test) or radicular pains in the contralateral leg
    • Implication: L4/L5 lesion if there is pain in the ipsilateral leg then think disk disease
  70. Seated Straight leg raise
    • Malingering
    • Pt is seated
    • Provider stimulates pain by "raising leg to check plantar reflex" Affected leg is raised beyond 90 degrees and should cause pain in a true sciatica
    • + Test: failure to have similar pain to supine SLR
    • Implication: Malingering
  71. Leg Length test
    • Leg Length Discrepancy
    • Pt is supine
    • Provider raises both legs off the table to at least 70 degrees
    • the Pts butt has to be lifted from the table
    • Both legs are lowered equally and together until they rest on the table
    • Leg is measured in cm from the ASIS to the medial malleolus
    • + Test: >1cm discrepancy
    • Implication: Leg lenght discrepancy
  72. Valsalva test
    • Pt is supine or sitting
    • Pt performes valsalva maneuver
    • + Test: Pain the the lower back with radicular sx
    • Implication: Central disk disease
    • Alternate: Provider forcefully pushes on the abdomen (forced valsalva)
  73. Hoover Test
    • Malingering or Neuromuscular Weakness
    • Pt is supine or seated
    • Provider wholds both heels in hands
    • Pt is asked to raise affected leg
    • + Test: Failure to raise affected leg without applying downward pressure to the opposite leg
    • Implication: Malingeringn or neuromuscular weakness
  74. Heel and Toe Walk
    • Pt is standing
    • Pt is aksed to walk on toes and pt is asked to walk on heels
    • + test: failure to walk at least 3 steps
    • Implications:
    • Toes suggest L5/S2 (S1 nerve root)
    • Heels suggest L4 L5 (L5 Nerve root)
  75. Allen's Test
    • Ulnar Artery insufficency
    • Pt is seated
    • Examiner compresses the radial and ulnar arteries
    • Pt makes a fist several time suntil the hand blanchest
    • Examiner releases pressure over the ulnar artery
    • Color should return to the hand in less than 10 seconds
    • + Test: continued blanching
    • Implication: Ulnar artery insufficency
  76. Carpal Tunnel compression Test
    • (Carpal Tunnel Syndrome)
    • Pt is seated
    • Examiner provides pressure over the carpal tunnel for 30-60 seconds
    • + Test: Tingling in the 1st 3 digits
    • Implication: Carpal Tunnel Syndrome
  77. Crossed Finger Test
    • Ulnar nerve Damage
    • Pt is seated
    • Middle finger is actively crossed over second finger
    • + Test: inability to cross fingers
    • Implication: Damage to the ulnar nerve
  78. Elson Test
    • Central Slip injury
    • Pt is seated
    • Fingers are bent over the edge of the table and flexed at the PIP
    • Pt extends each digit or non supple DIP
    • +Test: Inability to extend digit or non supple DIP
    • Implication: Central Slip Injury
  79. Finkelsteins Test
    • DeQuervains Tenosynovitis
    • Pt is seated
    • Thumb is grasped in palm leaving the IP joint free
    • Wrist is ulnar flexed
    • + Test: pain in the first dorsal compartment
    • Implication: DeQuervains tenosynovitis
  80. Flexor Digitorum Profundus/Flexor Pollicis Longus Exam
    • FDP/FPL damage
    • Pt is seated
    • hyperextend the finger at the MCP
    • Lock out the PIP
    • Have pt flex the DIP
    • + Test: inability to flex the DIP
    • Implication: non continuity of the FDP
  81. Flexor Digitorum Superficialis exam
    • Pt is seated
    • Finger is isolated, while all other fingers are held in extension.
    • MCP joint is stabilized and the finger is flexed
    • + Test: Inability to flex isolated digit
    • Implication: noncontinuity of the FDS
  82. Froments Test
    • Ulnar neuropathy
    • Pt is seated
    • Have pt grasp a piece of paper with the thumb and forefinger
    • + Test: Weakness or IP flexion of the Thumb
    • Implication: Ulnar neuropathy
  83. Passive Test of Flexor Continuity
    • Ulnar Artery insufficency
    • Pt is seated
    • Wrist is flexed, grasp forearm just proximal to wrist flexion crease and compress
    • + Test: Fingers should flex with intact flexor tendons
    • Implication: Ulnar artery insufficency
  84. Phalen's Test
    • Carpal Tunnel Syndrome
    • Pt is seated
    • Forcefully volar flex wrists (place the dorsal hands together forcefully
    • + Test: Numbness or tingling in the first 3 digits suggests compression of the medial nerve
    • Implication: Carpal Tunnel syndrome
  85. Regan Test
    • Lunotriquetral interosseus ligament injury
    • pt is seated
    • Thumb and forefingers stabilize the triquetrium
    • Thumb and forefinger of the other hand stabilize the lunate
    • Pisiform and triquetrium are pushed dorsally
    • + Test: pain during movement
    • Implication: Lunotriquetrial interosseus ligament injury
  86. Tinels Test (wrist)
    • Carpal Tunnel Syndrome
    • Examiner taps directly over the carpal tunnel
    • + Test: tingling in the first 3 digits
    • Implication: Carpal tunnel syndrome
  87. Ulnar collateral ligament of the thumb Test
    • UCL Tear
    • Pt is standing (or seated)
    • Thumb is passively flexed to 20-30 degrees
    • Valgus stress should be placed on the joint
    • Ulnar ligament should be evaluated for laxity
    • + Test: Laxity
    • Implication: Ulnar collateral ligament tear