Chapter 1: Special Tests of Spine, Pelvis, and TMJ

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dmshaw9
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296542
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Chapter 1: Special Tests of Spine, Pelvis, and TMJ
Updated:
2015-02-22 17:43:19
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Spine Pelvis Special Tests
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NPTE Review
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NPTE: Chapter 1
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  1. Vertebral Artery Test
    • Assesses integrity of vertebrobasilar vascular system
    • Pt supine with head supported on table 
    • Extend head and neck for 30 seconds. If no change, progress to next step
    • Extend head and neck with rotation L then R for 30 seconds. If no change, progress 
    • Repeat with head cradled off table
    • Pt should be monitored for any change in symptoms during test
    • PERFORM THIS BEFORE PERFORMING MOBILIZATION/MANIPULATION WITHIN CERVICAL REGION
    • (+) = Dizziness, visual disturbances, disorientation, blurred speech, nausea/vomiting
  2. Hautant's Test
    • Differentiates vascular versus vestibular causes of dizziness/vertigo
    • Pt sitting with shoulders at 90 deg and palms up, have pt close eyes and remain in position for 30 seconds. If arms lose their position there may be a vestibular condition 
    • Pt sitting with shoulders at 90 deg and palms up, have pt close eyes and cue pt into head and neck ext with rotation R, then L, remaining in each position for 30 seconds. If arms lose their position, the condition may be vascular in nature
  3. Transverse Ligament Stress Test
    • Tests integrity of transverse ligament
    • Pt supine, with head supported on table
    • Glide C1 anterior (should have firm end-feel)
    • (+) = Soft end-feel, dizziness, nystagmus, lump in throat sensation, nausea
  4. Anterior Shear Test
    • Assesses integrity of upper c-spine ligaments and capsules
    • Pt supine with head supported on table
    • Glide C2-7 anterior, should have firm end-feel
    • (+) = Laxity of ligaments, dizziness, nystagmus, lump in throat, nausea
  5. Foraminal Compression (Spurling's Test)
    • Identifies dysfunction (typically compression) of cervical nerve root
    • Pt sitting with head side bent toward uninvolved side
    • Apply pressure through head straight down
    • Repeat with head side bent toward involved side
    • (+) = Pain and/or paresthesia in dermatomal pattern for involved nerve root
  6. Maximum Cervical Compression Test
    • Identifies compression of neural structures at intervertebral foramen and/or facet dysfunction
    • Pt sitting, passively move head into SB and rotation toward non-painful side followed by ext
    • Repeat toward painful side
    • (Be careful since test is similar to vertebral artery test)
    • (+) = Pain and/or paresthesia in dermatomal pattern for involved nerve root, or localized pain in neck if facet dysfunction
  7. Distraction Test
    • Indicates compression of neural structures at intervertebral foramen or facet joint dysfunction 
    • Pt sitting with head passively distracted
    • (+) = Decrease in symptoms in neck (facet condition) or decrease in upper limb pain (neurological condition)
  8. Shoulder Abduction Test
    • Indicates compression of neural structures within intervertebral foramen
    • Pt sitting and asked to place one hand on top of their head, repeat with opposite hand
    • (+) = Decrease in symptoms into upper limb
  9. Lhermitte's Sign
    • Identifies dysfunction of spinal cord and/or an upper motor neuron lesion
    • Pt in long sitting on table
    • Passively flex pts head and one hip while keeping knee in ext (repeat with other hip)
    • (+) = Pain down the spine and into upper or lower limbs
  10. Romberg Test
    • Identifies UMN lesion
    • Pt standing and closes eyes for 30 seconds
    • (+) = Excessive swaying during test
  11. Rib Springing
    • Evaluates rib mobility
    • Pt prone, begin at upper ribs applying P-A force through each rib
    • Then pt side lying and repeat (careful springing 11th and 12th ribs since they have no ant attachment (less stable))
    • (+) = Pain, excessive motion of rib, or restriction of rib
  12. Thoracic Springing
    • Evaluates intervertebral joint mobility in thoracic spine
    • Pt prone, apply P-A glides to TPs of thoracic vertebra (remember SP and TP of same vertebra may not be at the same level in the thoracic spine) 
    • (+) = Pain, excessive movement, and/or restricted movement
  13. Slump Test
    • Identifies dysfunction of neurological structures supplying lower limb
    • (You know this test, Danielle)
    • (+) = Reproduction of pathological neurological symptoms
  14. Laseque's Test (SLR)
    • Identifies dysfunction of neurological structures that supply lower limb
    • Pt supine with legs resting on table
    • Passively flex hip of one leg with knee extended until pt complains of shooting pain, slowly lower limb until pain subsides then passively DF foot
    • (+) = Reproduction of pathological neurological symptoms when foot is DF
  15. Femoral Nerve Traction Test
    • Identifies compression of femoral nerve anywhere along its course
    • Pt lies on non painful side with trunk in neutral, head slightly flexed, and lower limb's hip and knee flexed
    • Passively extend hip while knee of painful limb is in extension
    • If no reproduction of symptoms, flex knee of painful leg
    • (+) = Neurological pain in ant thigh
  16. Valsalva's Maneuver
    • Identifies a space-occupying lesion
    • Pt sitting, instruct pt to take a deep breath and hold while they "bear down" as if having a bower movement
    • (+) = Increased LBP or neurological symptoms into LE
  17. Babinski Test
    • Identifies UMN lesion
    • Pt supine or sitting
    • Glide bottom end of standard reflex hammer along plantar surface of pt's foot
    • (+) = Extension of big toe and splaying (abd) of other toes
  18. Quadrant Test
    • Identifies compression of neural structures at the intervertebral foramen and facet dysfunction
    • Pt standing
    • Intervertebral foramen: cue pt into SB L, rotation L, and extension to maximally close foramen on L (repeat on other side)
    • Facet dysfunction: cue pt into SB L, rotation R, and ext to maximally compress facet jt on L (repeat on other side)
    • (+) = Pain and/or paresthesia in dermatomal pattern for involved nerve root or localized pain if facet dysfunction
  19. Stork Standing Test
    • Identifies spondylolisthesis
    • Pt standing on one leg, cue pt into trunk ext
    • Repeat with pop leg on ground
    • (+) = Pain in low back with ipsilateral leg on ground
  20. McKenzie's Side Glide Test
    • Differentiates between scoliotic curvature vs neurological dysfunction causing abnormal curvature (lateral shift) of trunk
    • Test performed if "lateral shift" of trunk is noted
    • Pt standing, stand on side of pt so upper trunk is shifted toward you, place your shoulders into pt's upper trunk and wrap arms around pt's pelvis
    • Stabilize upper trunk and pull pelvis to bring pelvis and trunk into proper alignment
    • (+) = Reproduction of neurological symptoms as alignment of trunk is corrected
  21. Bicycle (Van Gelderen's Test)
    • Differentiates between intermittent claudication and spinal stenosis
    • Pt seated on stationary bike, rides while sitting errect
    • Time how long pt can ride at set pace/speed
    • After sufficient rest, have pt ride bike at she speed while in slumped position 
    • If pain is related to spinal stenosis, pt should be able to ride bike longer while slumped
  22. Gillet's Test
    • Assessing posterior movement of ilium relative to sacrum
    • Pt standing, place thumb under PSIS of limb to be tested and other thumb on center of sacrum at same level
    • Ask pt to flex hip and knee of limb being tested
    • PSIS should move in an inf direction
    • (+) = No identified movement of PSIS as compared to sacrum
  23. Ipsilateral Anterior Rotation Test
    • Assessing anterior movement of ilium relative to sacrum
    • Place thumb under PSIS of limb to be tested and other thumb on center of sacrum at same level
    • Ask pt to extend hip of limb being tested
    • Assess movement of PSIS - should move in a superior direction
    • (+) = No identified movement of PSIS compared to sacrum
  24. Gaenslen's Test
    • Identifies SIJ dysfunciton
    • Pt side-lying at endue of table holding bottom leg in max hip and knee flex (knee to chest)
    • Stand behind pt and passively ext hip of uppermost limb (places stress on SIJ)
    • (+) = Pain in SIJ
  25. Long Sitting (Supine to Sit) Test
    • Identifies dysfunction of SIJ that may be cause of functional leg length discrepancy
    • Pt supine with correct alignment of trunk, pelvis and lower limbs
    • Assess symmetry of medial malleoli
    • Have pt come to long sit and re-assess leg length
    • (+) = Reversal in limb lengths between supine and long-sitting
  26. Goldthwait's Test
    • Differentiates between dysfunction in lumbar spine vs SIJ
    • Pt supine with fingers between SP of lumbar spine
    • Passively perform SLR
    • (+) = Pain presents prior to palpation of movement in lumbar segments, dysfunction is related to SIJ
  27. TMJ Compression
    • Evaluates for pain with compression of retrodiscal tissues 
    • Pt sitting or supine, support/stabilize head with on hand
    • With other hand, push mandible superior causing compression to load TMJ
    • (+) = Pain in the TMJ

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