Special Tests

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lyncho87
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301165
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Special Tests
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2015-05-05 12:56:33
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Special Tests Physical Therapy
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  1. Yergason's Test
    • integrity of bicipital tendonosis/tendonopathy, integrity of humeral transverse ligament
    • Sitting, shoulder neutral, elbow 90*, forearm pronation
    • Resist supination and shoulder ER
    • + Bicep long head pops out of groove, pain in LH bicep
  2. Speeds Test
    • -bicipital tendonosis/tendonopathy
    • -sitting, arm in full extension, supinated
    • -Resist shoulder flexion
    • ( may also place shoulder at 90* and push upper limb into extension)
    • -+ reproduces pain
  3. Neer's
    • -Impingement of soft tissue (LH bicep/Supraspin)
    • -sitting, passively IR, fully abducted
    • - + Reproduction of pain in shoulder
  4. Empty Can Test
    • -Supraspinatus tear or impingement or suprascapular nerve neuropathy
    • -sitting, shoulder 90*, no rotation
    • -First resist shoulder Abduction, then place shoulder in IR and 30* horizontal adduction and resist abduction
    • - + Reproduces pain and weakness in empty can position
  5. Drop Arm Test
    • -Tear or full rupture of rotator cuff
    • -Sitting, passive abduction to 120*
    • -Patient asked to slowly bring arm to side, guard to prevent arm from falling
    • - + unable to lower arm to side slowly
  6. Posterior internal impingement Test
    • -Impingement between RC and greater tuberosity or posterior glenoid and labrum
    • -supine, shoulder 90* abduction, max ER and 15-20* horizontal adduction
    • -+ reproduction of pain
  7. Clunk Test
    • -Glenoid labrum tear
    • -supine, shoulder full abduction,
    • -push humeral head anterior while rotating humerus externally
    • - + audible clunk heard
  8. Anterior Apprehension sign
    • -history of anterior shoulder dislocation
    • -supine, shoulder 90* abduction, take shoulder slowly into ER
    • - + patient does not like or does not allow
  9. Posterior Apprehension Sign
    • -History of Posterior dislocation
    • -Supine, shoulder abduction to 90* (in plane of scapula) , spine of scap stabilized by table
    • -Place posterior force thru shoulder while moving shoulder into IR and horizontal adduction
    • - + does not allow or like movement
  10. Shear Test
    • - AC joint dysfunction (arthritis/seperation)
    • -Sitting with arm at side
    • -clasp hands, placing heel of one hand on scap spine and heel of other hand on clavicle- squeeze
    • - + pain at AC joint
  11. Adson's Test
    • - Thoracic Outlet
    • -Sitting, find radial pulse, rotate head toward extremity being tested
    • -Extend and ER shoulder while extending head
    • - + Disappearance of pulse
  12. Military Brace Test
    • -Costoclavicular test/Thoracic outlet
    • -Sitting, find radial pulse
    • - Move involved shoulder down and back
    • - + disappearance of pulse
  13. Wright (hyperabduction) test
    • -Thoracic Outlet
    • -Sitting, find radial pulse
    • - Move shoulder into maximal abduction and ER
    • -Deep breath and rotate head opposite of arm
    • - + decrease in pulse
  14. Roos Test
    • -Thoracic outlet
    • -Standing, shoulder fully ER, 90* abduction, slight horizontal abduction, elbow bent to 90*
    • -slowly open/close hands for 3 min
    • - + disappearance of pulse
  15. Elbow instability tests
    • - Ligament laxity of restriction
    • -supine/sitting, entire limb supported, place elbow in 20* flexion
    • -Valgus force for UCL, varus force for RCL
    • - + laxity, may also have pain
  16. Lateral Epicondylitis test
    • -identifies lateral epicondylopathy
    • -Sitting with elbow at 90 degrees of flexion and supported/stabilized.
    • -Resisted wrist extension, radial deviation and forearm pronation with fingers fully flexed (fist) simultaneously
  17. Medial Epicondylitis (golfers elbow)
    • -Identifies medial epicondylopathy
    • -Patient sitting with elbow in 90* flexion, and supported. passively supinate, extend elbow and extend wrist. 
  18. Tinels Sign (U)
    • -identify dysfunction of ulnar nerve at olecranon
    • -Tap region where ulnar nerve passes thru the cubital tunnel
    • - +reproduction of pain and tingling sensation
  19. Pronator teres syndrome test
    • -ID median nerve entrapment within pronator teres
    • -Sitting elbow supported at 90*
    • -Resist forearm pronation and elbow extension simultaneously
    • -+ tingling or paresthesia in median nerve distribution
  20. Finkelstein Test
    • - ID de Quervain's tenosynovitis (paratendonitis of abductor pollicis longus or extensor pollicis brevis)
    • - Pt making fist with thumb within confines of fingers. Passivley move wrist into ulnar deviation.
    • - + reproduction of wrist pain, often painful with no pathology, compare with uninvolved side
  21. Bunnel-Littler Test
    • -ID tightness around MCP joints
    • -MCP joint stabilized in slight extension, while PIP is flexed
    • -MCP joint is flexed is flexed and PIP joint is flexed
    • -Differentiates between tight capsule and tight intrinsic muscles; if flexion is limited in both cases, capsule is tight. If more PIP flexion with MCP flexion then intrinsic muscles are tight
  22. Tight Retinacular Test
    • -Tightness around proximal interphalangeal joint
    • - Stabilize PIP while DIP is flexed. then flex PIP. 
    • -Tight capsule if flexion is limited in both. If more DIP flexion with PIP flexion then retinacular ligaments are tight
  23. Ligamentous Instability test
    • -Laxity or restriction in fingers
    • -Fingers are supported and stabilized, valgus and varus forces applied to PIP joints
    • - pain or laxity may be noted
  24. Froment's Sign
    • -Identifies ulnar nerve dysfunction
    • -Patient grasps paper between first and second digits of hand. Pull paper out and look for flexion of the thumb (compensation due to weakness of the adductor pollicis)
    • - + Patient unable to perform test without compensation
  25. Tinel's Sign (M)
    • -Carpal tunnel compression of medial nerve
    • -tap region where median nerve passes thru the carpal tunnel
    • - + tingling and parethesia in hand following median nerve distribution
  26. Phalen's test
    • -ID carpal tunnel compression of median nerve
    • -Patient maximally flexes both wrists olding them against eachother for 1 min
    • -Reproduces tingling or paresthesia following M nerve distribution
  27. Two-point discrimination test
    • -ID level of sensory inneravation within hand that correlates with functional ability to perform certain tasks involving grasp
    • -Patient in sitting with hand stabilized. Using a caliper, two point discriminator or paper clip, apply device to palmar aspect of fingers to assess patient's ability to distinguish between two poitns of testing device. record smallest difference that patient can sense two seperate points
    • -normal amount that can be discriminated is <6mm
  28. Allen's Test
    • -Vascular compromise in hands
    • -Identify radial and ulnar artieries at wrist. Have patient open and close several times and then make a closed fist. Use your thumb to occlude the ulnar artery and have patient open hand. Observe palm of hand and then release the compression on artery and observe for vascular filling. Perform the same procedure with the radial artery.
    • - + present with abnormal filling of blood in the hand. Normally change in color from white to normal appearance on palm
  29. Patrick's Test
    • -FABER- ID dysfunction of hip, such as mobility restriction
    • -Patient lies supine, passively flex, abduct and externally rotate test leg so that foot is resting just above knee on opposite leg. Slowly lower testing leg down to the table surface. 
    • -+ involved knee is unable to assume relaxed position and or reproduction of painful symptoms
  30. Grind Test
    • -Scour test
    • -ID degenerative joint disease (DJD) of hip
    • -patient supine with hip in 90* flexion and knee maximally flexed. Place compressive load into femur via knee joint
    • -+ reproduce pain within hip and refer pain down leg
  31. Trendelenburg Sign
    • -ID weakness in glute med or unstable hip
    • -Patient standing is asked to stand on one leg and flex opposite knee. Observe pelvis
    • -+ if ipsilateral hip drop when lower limb support is removed while standing
  32. Thomas Test
    • - Tight hip flexors
    • -Patient supine with one hip and knee maximally flexed to chest and held there. Opposite limb is kept straight on the table. Observe whether hip flexion occurs on straight leg as opposite limb is flexed. 
    • -Weakness of test is that it does not differentiate between iliacus vs psoas major
    • -+ if straight limb hip flexes or patient is unable to remain flat on table when opposite limb is flexed
  33. Ober test
    • -TFL tightness or IT band
    • -sidelying, passively extend and abduct teting hip with knee flexed to 90. Modified has knee extended. Slowly lower uppermost limb and observe if it reaches table
    • - + if uppermost limb is unable to come to rest on table
  34. Ely's Test
    • -Tight rectus femoris
    • -Prone with knee of testing hip flexed. Observe hip
    • -+ if hip of testing limb flexed
  35. 90-90 hamstring
    • - Tightness in hamstring
    • -supine, hip and knee in 90* flexion. Passively extend knee of testing limb until a barrier is encountered
    • -Positive if knee if unable to reach 10* from neutral (lacking 10* from neutral)
  36. Piriformis test
    • -Piriformis Syndrome
    • -Supine, with foot of leg passively placed lateral to oppoiste limb's knee. Testing hip is adducted . Observe position of testing knee relative to opposite knee.
    • - + test if knee is unable to pass over resting knee and or reproduction of pain in buttock and along sciatic nerve distribution
  37. Leg length test
    • -ID true leg length
    • -Patient is supine with pelvis aligned with lower limbs and trunk. Measure ditance from ASIS to lateral malleolus or medial malleolus on each limb several times for consistency and compare the result. Unequal girth of the thigh musculature can skew results if using medial malleolus
    • -A difference in lengths between two limbs identify a true discrepancy. True is caused by anatomical difference in bone length where functional is non-anatomical and result of compensation due to abnormal position or posture such as pronation or pelvic obliquity
  38. Craig's Test
    • ID abnormal femur antetorsion angle
    • -patient prone with knee flexed to 90* palpate greater trochanter and slowly move hip thru IR and ER. When greater trochanter feels most lateral, stop and measure angle of leg.
    • -nomral between 8-15*, <8 is retroverted, >15 is anteverted
  39. Collateral ligament instability test
    • -laxity
    • -Varus and valgus force placed at knee
  40. Lachman's stress test
    • - ACL
    • - patient supine with testing knee flexed to 20-30*. Stabilize femur and passively tru to glide tibia anterior
    • -+ excessive anterior glide
  41. Pivot shift
    • -Anterolateral rotary instability test
    • -Patient supine with testing knee in extension, hip flexed and abducted 30* with slight IR. Hold knee with one hand and foot with other. Place valgus stress thru knee and flex knee. 
    • - + finding is ligament laxity as indicated by tibia relocating during test. As knee is flexed the tibia clunks backward at approximately 30-40*. The tibia at beginning of the test was subluxed and then was reduced by pull of the IT band as the knee was flexed
  42. Posterior sag test
    • -Integrity of PCL
    • -Pateint supine with testing hip flexed to 45* and knee flexed to 90*. Observe to see whether tibia sags posteriorly in this position
    • - + if tibia sags relative to femur
  43. Posterior Drawer
    • -PCL
    • -Patient supine with knee flexed 90* Passively glide tibia posteriorly
    • -+ excessive joint glide
  44. Reverse Lachman
    • - PCL
    • -patient prone with knee flexed to 30*. Stabilize femus and passively glide tibia posterior
    • - + ligament laxity 
  45. McMurrays Test
    • -Meniscal Tear
    • -Patient supine with testing knee in maximal flexion. Passively internally rotate and extend knee. Tests lateral meniscus. Test medial meniscus with same procedure, except rotate tibia into lateral rotation
  46. Apley's Test
    • -Meniscal tear vs ligamentous lesion
    • -prone, testing knee to 90*, passively disrtact knee and IR/ER. Then Compress knee and IR/ER. 
    • - pain or decreased motion with compression is meniscal. Pain or decreased motion with distraction is ligamentous.
  47. Hughston's Test
    • -dysfunction in the plica
    • -supine, testing knee flexed with tibia IR. Passively glide the patella medially, while palpating the medial femoral condyle. Feel for popping as you passively flex and extend the knee
    • -(+) pain or popping
  48. Patellar Apprehension Test
    • -hx of patellar dislocation
    • -supine, passively glide patella to the left
    • - patient does not allow or does not like patella to move in the lateral direction to simulate subluxation
  49. Clarke's sign
    • -patellofemoral dysfunction
    • -supine, knee in extension. Push posterior on superior pole of patella and ask patient to perform quad set. 
    • -(+) pain produced in knee
  50. Ballotable patella
    • -Patellar tap test
    • -infrapatellar effusion
    • -patient supine, knee extension. Apply soft tap over central patella
    • -(+) sense that patella is floating 'dancing patella sign'
  51. Fluctuation Test
    • -knee joint effusion
    • -supine, knee in extension, place one hand over suprapatellar pouch and other hand over anterior aspect of knee. Alternate pushing down with one hand at a time.
    • - (+) fluctuation (movement) of fluid noted during the test
  52. Q-angle
    • -measure between quadriceps mm and patellar tendon
    • -normal - 13* for men, 18* for women
    • -greater or less angles is indicative of knee dysfunction or biomech dysfunction
  53. Noble Compression test
    • -Identifies whether distal IT band friction syndrome is present
    • -Supine, hip flexed to 45*, knee to 90*. Apply pressure to lateral femoral epicondyle and extend knee
    • -(+) reproduces same pain over lateral femoral condyle; pt complain of pain over femoral epicondyle at 30* knee flexion
  54. Tinel's (knee)
    • -dysfunction at the common fibular nerve posterior to fibula head following common fibular nerve distribution
    • -tap region where CFN passes behind fibular head
    • -Reproduces tingling or paresthesia
  55. Neutral subtalar Positioning
    • -Exam ID abnormal rearfoot or forefoot positioning
    • -Prone, foot over edge of table. Palpate dorsal aspect of talus on both sides with one hand, grasp lateral forefoot with other hand. Gentle DF foot until resistance is felt, then gently move foot thru arc of supination and pronation
    • -neutral position is point at which you feel foot fall off easier to one side or the other. At this point compare rearfoot and forefoot to leg
  56. Anterior Drawer (ankle)
    • -Ligamentous instability (mostly ant talofib)
    • -supine with heel just off edge of table, 20* PF, stabilize lower leg and grasp foot. Pull talus anterior
    • -(+)excessive anterior glide
  57. Talar tilt
    • -Ligamentous instability
    • -Sidelying, knee slightly flexed and ankle in neutral, move foot into adduction to test calcaneofibular ligament, and into abduction testing deltoid ligament
    • -+ if excessive adduction or abduction occur
  58. Thompson's Test
    • -Eval integrity of achilles tendon
    • -patient prone, foot off table, squeeze calf
    • -no movement during squeeze
  59. Tinel's sign (foot)
    • -dysfunction of the posterior tibial nerve posterior to the medial malleolus or deep fibular nerve anteriro to talocrural joint
    • -supine, foot supported on table. Tap over region of psterior tibial nerve as it passes posterior to medial malleolus. Tap over region of deep fibular nerve under dorsal retinaculum (anterior to ankle joint)
    • -(+) tingling or paresthesia
  60. Morton's test
    • -ID stress fx
    • -spuine, foot supported on table, grasp around metatarsal heads and squeeze
    • -(+) pain in forefoot
  61. Vertebral artery test
    • -Assesses the integrity of the vertebrobasilar vascular system
    • -supine, head supported on table
    • -extend head and neck for 30 sec, progress if no symptom change
    • -extend head and neck with rotation left, then right for 30 seconds. No change progress to next step
    • -Head cradled off table, extend head and neck for 30 sec, progress if no symptom change
    • -head cradled off tbale, extend head and neck and R and L rotation for 30 seconds. 
    • -Need to perform this test prior to mobilization/manip in cervical region
    • (+) dizziness, visual disturbances, disorientation, blurred speech, nausea/vomiting
  62. Hautant's test
    • -Differentiates vascular vs vestibular causes of dizziness/vertigo
    • -sitting, shouders at 90* and palms up. Have patient close eyes and remain here for 30 seconds. IF arms lose their position, vestibular condition
    • -patient sitting with shoulder at 90* and palms up. Eyes closed and head and neck into extension with rotation right and left for 30 seconds. If arms lose their positon, its vascular
  63. Transverse ligament stress test
    • -Tests integrity of transverse ligament
    • -Supine, head supported off of the table
    • -glide C1 anterior, should be firm end feel
    • -(+) soft end feel, dizziness, nystagmus, lumb sensation in throat, nausea
  64. Anterior Shear test
    • -assesses integrity of upper cervical spine ligaments and capsule
    • -supine with head supported on table. Glide C2-7 anterior. Firm end feel.
    • -laxity of ligaments is a postivie fidning as well as dizziness, nystagmus, lump in throat
  65. Foraminal compression
    • -Spurlings test
    • -ID dysfucntion in cervical nerve root
    • -sitting, head SB toward uninvolved side. Apply pressure thru the head straight down. Repeat with head toward involved side
    • -(+) pain or paresthesia in dermatomal pattern
  66. Maximum cervical compression test
    • -ID compression of neural structures at intervertebral foramen and facet dysfunction
    • -Sittingpassively move head into side bend and rotation toward nonpainful side followed by extension
    • + pain or paresthesia from dermatomal pattern
  67. Distraction test
    • -Indicates compression of neural structures at the intervertebral foramen or facet joint dysfunction
    • -Sitting with head passively distracted
    • -(+) decrease in symptoms
  68. Shoulder abduction test
    • -Compression of neural structures
    • -Sitting, place one hand on top of their head, repeat with other hand
    • -+ decrease in symptoms in upper limb
  69. Lhermitte's sign
    • -ID dysfunction in spinal cord and upper motor neuron lesion
    • -Long sitting, passively flex patients head and one hip while keeping knee in extension
    • -+ pain down spine and into upper and lower limbs
  70. Rhomberg
    • -UMN lesion
    • -standing, closes eyes for 30 seconds
    • - excessive swaying during test
  71. Rib springing
    • -eval rib mobility
    • -prone, begin at upper ribs and apply P-A force thru each rib. Repeat in side lying 
    • -+ pain, excessive rib motion, restricted rib motion
  72. Slump Test
    • -dysfunction in neural LE structures
    • -sitting, knees flexed. Patient slump sits, while maintaining neutral head and neck
    • -passively flex pt head and neck, if no reproduction continue
    • -passively extend one knee, no reproduction continue to next step
    • -passively DF ankle
    • -repeat with opposite leg
  73. Valsalva
    • Sitting, deep breath and hold while they bear down as if having bowel movement
    • + increase in LBP
  74. Quadrant Test
    • -Compression of neural structures at foramen and facet
    • -Foramen: in standing cue patient into SB left, rotation left, and extension to maximally close intervertebral foramen on the left. Repeat other side
    • -facet dysfxn: SB left, rotate R, and extension to compress L facet joint 
    • -+ pain and paresthesia in dermatomal pattern
  75. Stork standing test
    • -Spondylolisthesis
    • -standing on one leg, cue into trunk extension. Repeat with other leg on ground. 
    • +pain with ipsilateral leg on ground
  76. Gelderen's test
    • -differentiates between intermittent claudication and spinal stenosis
    • -seated on bike, rides while sitting erect. Tome how long they can ride at set pace/speed. After sufficient rest period have patient ride while slumped. 
    • -If they can ride bike longer while slumped then it is spinal stenosis
  77. Gillet's test
    • -In standing, place thumb of hand under PSIS of limb to be tested and other thumb on sacrum at the same level. Ask pt to flex hip andknee of limb being tested, bringing knee to chest. Assess PSIS, they should move inferior.
    • + no movement of PSIS compared with sacrum

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