Physical Therapy Special Tests – Flashcards
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Apprehension Test for Anterior Shoulder Dislocation
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Purpose: increased likelihood of anterior shoulder dislocation Method: Pt in supine, shoulder in 90 degrees abduct. PT externally rotates shoulder. Positive Test: look of apprehension or facial grimace before reaching end point.
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Apprehension Test for Posterior Shoulder Dislocation
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Purpose: increased likelihood of posterior shoulder dislocation Method: Pt in supine, shoulder flexed to 90 degrees and internally rotated. PT applies posterior force. Positive Test: look of apprehension or facial grimace before reaching end point.
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Ludington's Test
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Purpose: Biceps tendon pathology Method: Pt is in sitting with hand behind head and fingers interlocked. Pt then alternately contracts and relaxes the biceps. Positive Test: Absence of movement in the biceps tendon.
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Yergason's Test
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Purpose: Biceps tendon pathology Method: Pt is sitting with 90 degrees elbow flexion & pronation. PT places one hand over the pt's forearm and one over the pt's bicipital groove. Pt is instructed supinate and laterally rotate against resistance. Positive Test: pain or tenderness in the bicipital groove.
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Allen Test
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Purpose: Thoracic Outlet Syndrome Method: Pt in sitting or standing, with should in 90 abduction & lateral rotation, elbow flexed. Pt is asked to rotate head away from test shoulder and PT monitors radial pulse. Positive Test: Absent or diminished pulse.
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Costoclavicular Syndrome Test
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Purpose: Thoracic Outlet Syndrome caused by compression of subclavian artery between first rib and clavicle. Method: Pt is in sitting, and PT monitors radial pulse as pt moves into military posture (retracted and depressed scapula. PT moves shoulder into extension). Positive Test: Absent or diminished pulse.
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Roos Test
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Purpose: Thoracic Outlet Syndrome Method: Pt is sitting or standing with shoulder abducted to 90 degrees, externally rotated, and elbow flexed. Pt opens and closes hands for 3 minutes. Positive Test: Inability to maintain test position, weakness of arms, sensory loss, or ischemic pain.
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Wright Test (Hyperabduction Test)
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Purpose: Thoracic Outlet Syndrome due to compression in the costoclavicular space. Method: Pt is sitting or supine. PT moves pt's UE overhead into abduction while monitoring pulse. Positive Test: Absent or diminished radial pulse.
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Glenoid Labrum Tear Test
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Purpose: Glenoid Labrum Tear Method: Pt in supine. PT places one hand over posterior humeral head and the other hand stabilizes the humerus proximal to the elbow. PT moves shoulder into abduction and ER above pt's head. PT then applies anterior directed force to humerus. Positive Test: A clunk or grinding sound.
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Varus Stress Test (At Elbow)
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Purpose: Lateral collateral ligament sprain Method: Pt is sitting with elbow flexed between 20-30 degrees. PT places one hand on elbow and the other proximal to pt's wrist. PT applies varus force while palpating joint line. Positive Test: Increased laxity, apprehension, or pain.
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Valgus Stress Test (At Elbow)
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Purpose: Medial Collateral Ligament Sprain Method: Pt is sitting with elbow flexed between 20-30 degrees. PT places one hand on elbow and the other proximal to pt's wrist. PT applies valgus force while palpating joint line. Positive Test: Increased laxity, apprehension, or pain.
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Brunnel-Littler Test
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Purpose: Intrinsic Muscle Tightness Method: Pt is sitting with metacarpophalangeal joint in slight extension. PT moves the PIP joint into flexion Positive Test: PIP joint does not flex with metocarpholageal joint in slight extension.
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Tight Retinacular Ligament Test
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Purpose: Retinacular tightness / Capsule Tightness Method: PIP joint is in neutral position. PT flexes DIP joint. Positive Test: Inability to flex DIP joint.
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Grind Test
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Purpose: Degenerative joint disease in carpometacarpal joint. Method: PT stabilizes pt's hand and grasps pt's thumb.PT applies a compressive and rotatory force to thumb. Positive Test: Pain.
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Murphy Sign
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Purpose: Dislocated Lunate Method: Pt makes a fist. Positive Test: Pt's third metacarpal remains level with second and forth metacarpals.
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Piriformis Test
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Purpose: Piriformis tightness of sciatic nerve compression caused by the piriformis. Method: Pt is in sideline and flexes top hip to 60 degrees. PT stabilizes pelvis and applies a downward force on the knee. Positive Test: Pain or tightness in the piriformis.
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Tripod Sign
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Purpose: Tight hamstrings Method: Pt sits with legs hanging off the mat. PT extends one knee. Positive Test: Tightness in hamstrings or trunk extension to limit hamstring tightness.
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Ortolani Sign
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Purpose: the ability for a hip dislocation to reduce. Method: Examiner flexes the infant's hips so that the examiners thumbs are on the inside of the infant's thighs and the rest of the examiners fingers on the outside of the infant's thighs. The examiner provides gentle traction with hip abduction while providing pressure on the greater trochanter of the femur. Positive Test: Presence of a click, clunk, or jerk, the hip is reduced.
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Barlow's Test
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Purpose: likelihood of hip dislocation Method: Examiner flexes the infant's hips and knees to 90 degrees. The examiner's middle finger should be over the infant's greater trochanter and the thumb should be on the inner thigh. The infant's hip is brought into abduction as the examiner applies forward pressure on the greater trochanter. If a click, clunk, or jerk is heard as the femoral head slips forward into the acetabulum, the test is positive. The examiner then applies a backward and outward pressure to the inner thigh. If the femoral head slips out of the acetabulum, the hip is unstable and is able to dislocate.
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Slocum Test
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Purpose: anterolateral or anteromedial instability Method: Pt is supine with one hip flexed 45 degrees and knee flexed to 90 degrees. PT IR or ER foot and then sits on forefoot. PT applies an anterior directed force to the tibia plateu. Positive Test: Movement of tibia on lateral side when foot is IR or movement on medial side of tibia when foot is ER.
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Bounce Home Test
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Purpose: Meniscal Lesion Method: Pt is in supine and PT grabs pt's heel and maximally flexes knee then passively extends knee. Positive Test: Incomplete extension or rubbery end-feel.
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Clarke's Sign
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Purpose: Patellofemoral dysfunction Method: Pt is supine with knees extended. PT applies pressure superorly to patella with PT's web space of his/her hand. Pt contracts quadriceps while PT maintains pressure superior of the patella. Positive Test: Failure to complete muscle contraction without pain.
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Hughston's Plica Test
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Purpose: Presence of plica Method: Pt in supine. PT flexes knee and IR the tibia with one hand while the other hand attempts to move the patella medially and palpate the medial condyle. Positive Test: Popping sound.
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Noble Compression Test
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Purpose: Iliotibial Band Friction Syndrome Method: Pt supine with hip and knee flexed. PT places thumb over the lateral epicondyle of the femur and other hand around the ankle. Pt slowly extends knee. Positive Test: Pain over lateral epicondyle of the femur at approximately 30 degrees of knee flexion.
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Patella Apprehension Test
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Purpose: Patella subluxation of dislocation Method: Pt is supine with knees extended. PT applies a lateral directed force on the medial side of the patella. Positive Test: A look of apprehension or an attempt of a quadriceps contraction.
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Tibial Torsion Test
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Purpose: Lateral rotation of the tibia Method: Pt is sitting with legs off of the edge of the mat. PT places his/her thumb and index finger over the lateral & medial malleoli. PT measures the angle formed by the axes of the knee and ankle. Positive Test: Normal lateral rotation of the tibia = 12-18 degrees in adults.
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Sacroiliac Joint Stress Test
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Purpose: Sacroiliac Joint Dysfunction Method: Pt is supine. PT crosses his/her arms, places the palms on the pt's anterior superior iliac spine. PT applies a downward & lateral force. Positive Test: Unilateral pain to the sacroiliac joint or gluteal area.
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Sitting Flexion Test
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Purpose: Sacroiliac articular restriction Method: Pt is sitting with feet on floor. PT palpates PSIS and monitors its movement as pt bends forward and touches the floor. Positive Test: One PSIS moves farther in the cranial direction than the other PSIS.
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Standing Flexion Test
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Purpose: Sacroiliac articular restriction Method: Pt is standing. PT palpates PSIS and monitors its movement as pt bends forward and touches the floor with extended knees. Positive Test: One PSIS moves farther in the cranial direction than the other PSIS.
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Leg Length Discrepancy
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Purpose: Determine functional, structural, or compensatory difference in leg length. Method: Pt supine & PT measure from the ASIS to medial malleolus. Positive Test: A distance in leg length of greater than ---
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Hip Abduction Contracture Test
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Purpose: Determine contracture of the TFL, ITB, and Glut Med, or determine Capsule tightness or muscle shortening. Method: PT passively adducts hip when pt is in supine. Positive Test: ↓ in ROM, contralateral pelvis elevates
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Hip Adduction Contracture Test
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Purpose: Determine adductor longus, brevis, magnus, pectineus contractures/muscle shortening or determine capsule tightness. Method: PT passively abducts hip when pt is in supine. Positive Test: ↓in ROM, contralateral pelvis drops
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Thomas Test
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Purpose: Determine hip flexion contracture. Method: PT lowers pt's testing leg down to table and into knee flexion and PT measures hip extension. Positive Test: Illipopsoas Tightness = Leg rises off the table Rectus Femoris Tightness = Lower leg doesn't go into flexion IT Band Tightness = J sign
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Ober's Test
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Purpose: Determine hip abductor tightness Method: With pt is sidelyne, PT passively flexes, abducts, & extends the lower leg while stabilizing pelvis. Positive Test: The leg does not lower to surface of table Knee extended = ITB/TFL. Knee flexed = Hip Abductors
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Trendelenburg Sign
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Purpose: Hip abductor weakness Method: Have pt stand on one leg. Positive Test: Contralateral pelvis drops.
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FABER
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Purpose: Functional ROM screen Method: In supine, have pt abduct, flex, and ER hip. Positive Test: LE does not drop parallel to table.
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FADDIR Test
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Purpose: Anterior Labral Tear (opposite motion = posterior labral tear) Method: In supine and the FABER position, the PT passively moves the involved leg into flexion, IR, & Addution. Positive Test: Reproduction of symptoms, pain, or clicking noise.
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Craig's Test
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Purpose: Measures anteversion. Method: With pt in prone, PT measures the angle between the mat and the middle of the leg, with the trochanter parallel with table. Positive Test: Normal = 8-15 degrees Retroversion = 15 degrees
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Strait Leg Raise
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Purpose: Measures proximal hamstring length Method: Pt is supine. PT moves hip into flexion with straight knee. PT measures hip flexion. Positive Test: Normal ROM = 70-80 degrees.
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90-90 Politeal Angle
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Purpose: Measures distal hamstring length Method. Pt is supine with hip flexed. Pt straightens knee. Positive Test: Normal= within 20 degrees of full extension
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Knee Valgus Stress Test
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Purpose: Assess MCL structure Method: Pt is in supine. PT applies a medially force at the at joint line with the knee in full extension and 25 degrees of flexion. Positive Test: Full Extension = major disruption of MCL or posteromedial capsule Slight Flexion = MCL, PCL, Posteromedial capsule, & posterior oblique ligament.
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Knee Varus Stress Test
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Purpose: Assess LCL structure Method: Pt is in supine. PT applies a lateral force at the at joint line with the knee in full extension and 25 degrees of flexion. Positive Test: LCL & posterolateral capsule laxity.
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Posterior Sag Sign
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Purpose: Knee PCL Integrity Method: Pt is upine with knee flexed at 90°. PT observes tibial tubercle for sulcus. Positive Test: Tibia "drops" or "sags" back on femur.
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Lachman Test
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Purpose: Knee ACL Integrity Method: Pt is supine with knee in slight flexion. PT stabilizes femur distally and PT applies a force anteriorly. Positive Test: Jt laxity, mushy soft end feel.
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Anterior Drawer Test
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Purpose: Knee ACL Integrity Method: Pt is supine with knee flexed to 90 degrees. PT stabilizes foot, thrusts tibia anteriorly while palpating the joint line. Positive Test: Joint Laxity
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Lateral Pivot Shift
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Purpose: Assess anterolateral rotary instability of the knee. Method: Pt is supine with hip and knee flexed to 90 degrees. PT supports at the ankle and apples a valgus force on the fibular head while passively extending the knee. Positive Test: Pain or clunking noise at approximately 30 degrees of knee extension.
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McMurray's Test
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Purpose: Meniscus Integrity Method: Pt is supine with knee flexed. PT supports the ankle and knee joint line. The PT moves the knee passively into extension while medially or laterally rotating the tibia. Positive Test: Pain. Medial Meniscus = pain with lateral rotation Lateral Meniscus = pain with medial rotation Posterior Horn = pain with flexion Anterior Horn = pain with extension
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Appley's Test
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Purpose: Meniscus and ligament integrity Method: Pt is prone with knee flexed. PT applies medial and lateral rotation with compression and distraction forces. Positive Test: pain Pain with compression = meniscus involvement Pain with distraction = ligament involvement
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Thessaly Test
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Purpose: Meniscus Integrity and articular surface integrity Method: Pt stands on one leg with 5° knee flexion. Pt rotates his body left and right 3x each direction. Repeat in 20° knee flexion. Positive Test: joint line pain, discomfort, or locking/ catching.
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Patella Tap Test
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Purpose: Joint Capsule Swelling Method: Pt supine with knee extended. PT taps over the patella. Positive Test: Floating or "dancing" patella.
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Sweep Test
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Purpose: Joint Capsule Swelling Method: Pt is supine with knee extended. PT starts on the medial side of patella and "milks" proximally and laterally. Positive Test: Reformation of edema on with pressure applied to lateral aspect of knee.
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Ballotable Patella
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Purpose: Joint Capsule Swelling Method: Pt is supine with knee extended. PT palpates the medial and lateral patella borders while stroking down suprapatellarly. Positive Test: Separation of thumb and finger due to swelling.
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Heel Height Test
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Purpose: Knee flexion contracture due to swelling, joint arthrofibrosis, or spasms. Method: Pt is prone with legs hanging off the table. PT measures the differences of heal height in cm. Positive Test: A difference in heights. 1 cm= 1° of contracture
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Q-Angle
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Purpose: Assess Genu Varum or Genu Valgum Method: Measure angle from ASIS to patella and tibial tubercle to patella. Postive Test: Normal: Male=13° Female=18°
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Ankle Anterior Draw Test
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Purpose: Anterior Talofibular Ligament Integrity Method: Pt is supine. PT stabilizes superior to ankle while drawing the talus forward. Positive Test: Excessive Joint Laxity
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Talar Tilt Test
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Purpose: Assess ankle ligament integrity Method. Pt is sidelyne with ankle at 90°. PT rolls the calcaneus into ADD & ABD. Positive Test: Excessive Joint Laxity Laxity in ABD= deltoid ligament Laxity in ADD= Calcaneofibular ligament Laxity in PF = ATFL
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Thompson Test
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Purpose: Achilles Tendon sprain or rupture Method: Pt in prone. PT squeezes calf musculature while observing PF. Positive Test: A lack of PF.
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Feiss Line
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Purpose: Assesses the amount of pronation Method: Mark medial malleolus, navicular tuberosity, * 1st MTP joint. Assess marks in weightbearing. Positive Test: Navicular drop during WB 1st deg. = falls 1/3 of distance to floor 2nd deg. = Falls 2/3 of distance to floor 3rd deg. = Navicular rests on floor
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Morton's Test
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Purpose: Detect neuroma, stress fractures, or metatarsalgia. Method: Pt is supine. PT provides medial & lateral compression of the forefoot. Positive Test: Pain in between the MTP joints.
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Ankle Tinel's Sign
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Purpose: Assess tibial nerve integrity Method: Percussion of the posterior tibial nerve behind medial malleolus. Positive Test: Tingling/parasthesia distally in foot.
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Empty Can Test
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Purpose: Assess supraspinatus involvement with shoulder injury. Method: Pt. raises arms in scaption to shoulder height with thumps up. Pt rotates thumbs down ( "empty can" ). PT applies resistance. Positive Test: Pain or weakness
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Speed's Test
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Purpose: Bicep Tendon Involvement Method: Arm in 90 flexion with forearm supinated. PT palpates biceps tendon and applies resistance. Positive Test: Pain in biceps tendon area.
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Lift Off / Belly Press Test
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Purpose: Identify a lesion of the subscabularis muscle. Method: Pt places Arm behind back (moving into IR), dorsum of hand against mid-lumbar spine. Other hand goes on in front of stomach with the palm on the belly. Pt is instructed to lift arm away from back against a resistance. observe scapular motion Positive Test: Pain or pt. cannot perform test motions or cannot hold against resistance.
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Neer Impingement Sign
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Purpose: Detect Impingement (supraspinatus, biceps tendon, subacromial bursa) Method: Forceful passive shoulder elevation with shoulder IR. PT applies over pressure throughout motion. Positive Test: Pain in the sub-arcomial arch.
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Hawkins-Kennedy
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Purpose: Supraspinatus Impingment Method: PT raises pt's arm to 90 degrees flexion and moves shoulder passively into IR. (This places the greater tubercle in a position to compromise subacromial space.) Postive Test: Pain under sub-acromial arch.
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Sulcus Sign
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Purpose: Assess Shoulder Instability Method: Pt's arm is relaxed at the side. PT appiles caudal traction to the humerus to displace inferiorly. Positive Test: A significant feeling of inferior subluxation
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O'Brien Test
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Purpose: Detect a SLAP Lesion Method: Pt's arm is in 90 degrees of shouler flexion, 20-30 degees of Horizontal adduction with forearm pronation. PT applies resistance. Repeat with forearm in supination. Positive Test: Pain and relief of symptoms with arm supinated.
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Biceps Tension Test
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Purpose: Detect a SLAP Lesion Method: Shoulder in abduction at 90 degrees and ER. Pt eccentrically resists PT applied force as pt moves into shoulder adduction. Positive Test: Pain
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Compression Rotation Test
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Purpose: Detect Labral tears (SLAP or Bankart) Method: Pt's shoulder is abducted. PT provide compression to GH joint and passively moves shoulder into ER & IR. Positive Test: Snapping, catching, or pain.
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Scapular Retraction Test
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Purpose: Detect weak scapular stabilizers and instability (SICK scapula) Method: Pt. is standing and PT stabilizes the pt's clavicle & scapula while providing a tactile cue to inferior angle of scapula Pt. then performs shoulder flexion. Positive Test: Decreases pain, improved ROM, and improves RTC strength with PT support.
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Scapular Assistance Test
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Purpose: Detects weak scapular control causing impingement symptoms. Method: Pt. is standing and PT is behind pt. The pt. flexes shoulder in scapular plane while the PT pushes inward, laterally, and upward on the medial border of scapula. Positive Test: Decreased pain during shoulder elevation with scapular assistance.
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AC Shear
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Purpose: AC joint pathology Method: PT cup his hands over pt's shoulder (clavicle and spine of scapula) and squeeze his hands together. Positive Test: Pain or excessive movement of AC joint.
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AC Crossover
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Purpose: Degenerative / arthritis changes of the AC joint. Method: Pt flexes shoulder to 90 degrees, and adducts shoulder across the body. PT applies over pressure forcing the acromion into the distal clavicle. Positive Test: Pain in AC joint.
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Adson Maneuver
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Purpose: Thoracic Outlet Syndrome Method: Pt. in seated position. PT finds radial pulse and passively brings shoulder into abd. and extension. Pt. then rotates head and looks over ipsilateral shoulder. Pt takes deep breath and hold the position. Positive Test: Diminished pulse, and symptoms of pain, numbness, tingling, weakness, & coldness in the upper extremity.
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Moving Valgus Test
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Purpose: Elbow MCL ligament integrity Method: Pt. is supine of standing with shoulder abducted & elbow flexed. PT provides a valgus stress while quickly extending pt's elbow. Positive Test: Pain between 120 and 70 degrees of elbow flexion.
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Milking Maneuver
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Purpose: Elbow MCL ligament integrity Method: Pt's ellbow is flexed to 90 degrees with forearm supinated. PT grasps pt's thumb and pulls, creating a valgus stress to the elbow. Positive Test: Pain in MCL area.
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Cozen's Test
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Purpose: Lateral Epicondylitis (Tennis Elbow) Method: Pt is siting with elbow slightly flex. Pt is asked to make a fist, pronate forearm, radially deviate and extend the wrist against resistance. Positive Test: Pain in lateral epicondyle region or muscle weakness.
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Mill's Test
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Purpose: Lateral Epicondylitis (Tennis Elbow) Method: PT moves the pt into passive pronation, wrist flexion, & elbow extension to provide a static stretch to the wrist extensors. Positive Test: Pain over lateral epicondyle
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Tennis Elbow Tests (3 Tests)
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Purpose: Lateral Epicondylitis (Tennis Elbow) Method: Perform Cozen's Test & Mill's Test. In addition, PT places pt's forearm intopronation with fingers extende. PT applies resisance to middle finger. Positive Test: Pain over lateral epicondyle
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Golfer's Elbow Test
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Purpose: Medial Epicondylitis (Golfer's Elbow) Method: PT palpates medial epicondyle while resisting wrist flexion & ulnar deviation with extended elbow. Positive Test: Pain over the medial epicondyle
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Golfer's Elbow Stretch
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Purpose: Medial Epicondylitis (Golfer's Elbow) Method: PT palpates medial epicondyle. PT passively extends the elbow, supinates forearm, and extends the wrist to staticly stretch the wrist flexors. Positive Test: Pain over the medial epicondyle
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Elbow Tinel's Test
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Purpose: Ulnar nerve involvement Method: Palpate ulnar groove and tap ulnar nerve. Positive Test: Tingling sensation in the ulnar distribution.
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Elbow Flexion Test
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Purpose: Cubital Tunnel (Ulnar Nerve Syndrome) Method: Pt flexes elbows, extend wrists, abducts shoulder and depresses scapulae. Pt holds position for 3-5 mins. Positive Test: Tingling, paresthesia in ulnar nerve distribution.
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Pronator Teres Test
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Purpose: Median Nerve Pathology Method: Pt is sitting with elbow flexed to 90 degrees. PT applies resistance and pt resists pronation as elbow is extended. Positive Test: Tingling or paresthesia in the median nerve distribution of the forearm.
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Phalen Test
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Purpose: Carpal Tunnel Syndrome (Median Nerve Pathology) Method: Pt places wrists at maximal flexion (dorsum of hands pressed together) and holds this position for 1 minute. Positive Test: Paresthesia/ tingling in median nerve distribution. (This compresses the carpal tunnel.)
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Reverse Phalen Test
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Purpose: Carpal Tunnel Syndrome (Median Nerve Pathology) Method: Pt places wrists at maximal extension (pray position) and holds this position for 1 minute. Positive Test: Paresthesia/ tingling in median nerve distribution. (This tighten/ stretches flexor retinaculum to put strain on carpal tunnel.)
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Wrist Tinel's Sign
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Purpose: Median Nerve Pathology Method: Wrist is in a neutral position. PT taps over the carpal tunnel or slightly above. Positive Test: Paresthesia/ tingling in median nerve distribution.
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Frinkelstein Test
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Purpose: de Quervain's Tenosynovitis and/or paratenonitis in thumb Method: Pt. makes a fist with thumb inside fingers. PT stabilizes pt's forearm and ulnar deviates the wrist Positive Test: Pain over abductor pollicus longus and extensor pollicus brevis.
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Froment's Sign
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Purpose: Ulnar Nerve Pathology Method: Pt grasps a paper between his thumb and lateral index finger. PT pulls paper out of pt's hand. Positive Test: Distal phalanx flexes with potential MCP hyperextension. (Due to paralysis of ADD pollicus.)
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Nail Compression Test
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Purpose: Arterial Insufficiency Method: PT compress pt's nail bed and notes the time taken for color to return to nail bed. Positive Test: Longer than 3 seconds.
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Hoffman's Reflex
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Purpose: Upper motor neuron lesion Method: PT flicks the distal phalanx of the index, middle, or ring finger. Positive Test: Reflex flexion of the distal phalanx of the thumb or finger that was not flicked.
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Inverted Supinator Sign
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Purpose: Cervical myelopathy Method: PT support pt's forearm and taps the dista brachioradialis with a reflex hammer. Positive Test: Finger flexion or slight elbow extension
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Watson Test
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Purpose: Scaphoid Instability Positive Test: Pain or "thunk" noise.
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Skier's Thumb
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Purpose: Thumb UCL laxity or instability.
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Deep Neck Flexor Endurance Test
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Purpose: Deep Cervical flexor weakness Method: Pt supine with knees flexed and feet flat on table. Pt tucks chin in, and lifts head off of examiners finger tips. PT measure the time to fatigue in seconds. Positive Test: The use of substitution patterns. Males <45 seconds Females <35 seconds
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Craniocervical Flexion Test
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Purpose: Deep Cervical Flexor Weakness Method: Pt supine with BP cuff behind neck. PT inflates cuff to 20mmHg. Pt. nod's "Yes" and hold for 10 sec. PT inncreases pressure b 2mmHg until 30mmHg. Positive Test: Inability to perform test or inable to increase pressure in cuff.
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Spurling's Test
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Purpose: Cervical nerve root involvement Method: Stage 1: head compression in neutral Stage 2: head extension with compression Stage 3: head in extension & rotation or side bending (ipsilateral) Positive: Pain or distraction reducing symptoms.
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Vertebral Artery Test (No longer recommended)
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Purpose: Vertebral artery pathology or compression Method: Pt is supine with eyes open. PT extends pt's neck for 30 sec, then extends and side-bends neck for 30 sec, ext, and lastly sidebends and rotates neck for 30 sec. Positive Test: Dizziness or Nystagmus
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Minimal DE Klyn Test (use instead of vertebral artery test)
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Purpose: Vertebral artery pathology or compression Method: Pt is seated and actively rotates neck to end range with eyes open. Pt. count out-load from 15-1. Repeat with neck extended. In addition, pt should tongue protrusion & eye tracking should be assessed in each position. Positive Test: Loss of count, confusion, dizziness, nystagmus, fluttering voice changes, nausea.
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Cervical Flexion Rotation Test
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Purpose: Assesses AA Mobility and reasons for cervicogenic headaches. Method: Pt is supine and PT passively flex c-spine, and then maintains flexion with passive rotation. Positive Test: A difference in AA rotation by 10 degrees or greater.
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Bakody's Sign
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Purpose: Cervical pain differential Method: Pt. abducts shoulder while placing hand on head. Positive Test: Decrease pain: C4-C5 radiculopathy, Potential elevated 2nd rib Increase pain: increased pressure in interscalene triangle
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Sharp Purser
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Purpose: AA instability / hypomobility due to disruption of the transverse ligament. Method: PT places his palm on pt's. forehead and the web of other hand on AA spinous process. PT apply posterior pressure through pt's forehead. Positive Test: subluxation of atlas on axis, reduction of symptoms
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Alar Ligament Stress Test
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Purpose: Alar ligament Disruption Method: PT grasps C2 spinous process and perfoms cervical side flexion and rotation. Positive Test: Reproduction of symptoms, an abnormal feeling.
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Transverse Ligament Stress Test
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Purpose: AA hypermobility Method: PT supports pt's head with palm under occiput and grips the C1 transverse processes. , A posterior force is applied to pt's forehead. Positive Test: Reproduction of symptoms, excessive translation, Soft end feel, mm. spasm, dizziness, lump sensation in throat.
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Isometric Abdominal Endurance Test
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Purpose: Assess abdominal endurance Method: Pt is in hookline and pt tucks chin and lifts both scapula off of the table.Pt's hands may be behind head, across chest, or straight. Pt holds this position. Positive Test: Holding breath, altered mechanics, fatigue G5: arms behind head, 20-30sec G4: arms crossed, 15-20 sec G3: arms straight, 10-15 sec G2: arms straight, 1-10sec G1: unable to raise head off table, slight mm. contraction
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Isometric Extensor Endurance Test
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Purpose: Erector Spinae & Multifidi Weakness Method: Pt is in prone and he extend his trunk. Head/chest/ribs must be off table, and pt holds this position. Arms may be behind head or at side. Positive Test: Fatigue, pelvic/spinal movement, holding breath. G5: arms behind head, 20-30sec G4: arms crossed, 15-20 sec G3: arms straight, 10-15 sec G2: arms straight, 1-10sec G1: unable to raise head off table, slight mm. contraction
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Double Leg Straight Lowering
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Purpose: Abdominal Activation Method: Only perform if pt scores a 5/5 abdominal test. Pt is in supine and flexes hips to 90 degrees with straight knees, and neutral pelvis. Pt eccentrically lowers legs until ASIS 's start to rotate forward. Examiner my place hand behind pt. to assess pelvic motion. Positive Test: ASIS forward rotation, measure angle from plinth to thigh. G5: 0-15 degrees from table before tilt G4: 16-45 degrees G3: 46-75 degrees G2: 75-90 degrees G1: unable to hold pelvic
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Dynamic Isometric Horizontal Side Support Test (Side-Bridge)
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Purpose: Quadratus lumborum weakness & endurance Method: Pt is in sidelying with knees flexed or straight. Pt. lifts pelvis up and holds spine straight. Positive Test: Pt rolls pelvis forward /backward. G5: hold pelvis/ straight spine 10-20 sec G4: 5-10 sec G3: cannot hold spine straight, <5 sec G2: unable to lift pelvis off
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Back Rotators (Multifidus Test)
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Purpose: Assess the ability of the lumbar rotators & multifidi to stabilize trunk during dynamic extremity movements. Method: Pt in quadruped and holds neutral pelvis. 1) single straight arm lift/hold 2) single straight leg lift/hold 3) contralateral arm/leg lift and hold Positive Test: G5: 3 positions, 20-30sec G4: 20 sec, unable to do arm/leg together G3: maintain pelvis w/ arm lift 20 sec G2: unable to neutral pelvis w/ arm lift
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Slump Test
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Purpose: Neurological Dysfunction or sensitivity Method: Pt. sitting straight, cervical flexion, slump thoracic/lumbar spine, extend knee, passive DF. Positive Test: Symptoms decrease with release of neck flexion.
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Neuro Straight Leg Raise
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Purpose: Disc herination, neural sensitivity Method: Hip internal rotation and adduction, knee extended, neutral DF, passively flex hip until symptoms, lower leg to no symptoms, DF foot Positive Test: Back or leg pain are reproduced with dorsiflexion movement.
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Well's SLR
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Purpose: Space Occupying Lesion (medial to nerve root) Method: Hip internal rotation and adduction, knee extended, neutral DF, passively flex hip until symptoms, lower leg to no symptoms, DF foot Positive Test: Pain on contralateral leg.
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Prone Knee Bend
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Purpose: Nerve involvement Method: Pt is in prone and PT passivly flexes knee while watching the pelvis/hip position. Positive Test: Pain L2-3 = lumbar, buttock, or posterior thigh pain. Femoral Nerve = anterior thigh pain
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Lumbar Instability Test
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Purpose: Lumbar instability Method: Pt prone with legs hanging off of the table and feet resting on the floor. PT applies a PA pressure to lumbar spine. Pt. lifts legs off floor and PT applies a PA pressure again. Positive Test: Pain in resting position only (mm. activation masks the instability)
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H & I Stability Tests
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Purpose: Determine lumbar stability Method: I - flex/extend, side bend H- side bend, flex/extend Positive Test: Reproduction of symptoms. Hypomobile: at least 2 movements into same quad. Are limited Instability: 1 movement into quad is affected Possible DJD or foraminal narrowing
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Gillet's / Stork Test
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Purpose: Sacrum Alignment Method: PT places his thumbs at PSIS's and the web of his hand across the iliac crests. Pt. flexes hip to stand on one leg. PT assesses each motion at least 2 times. Positive Test: Abnormal pelvic mechanics NORMAL: Contralateral = anterior tilt Ipsilateral= posterior tilt
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McKenzie Side Glide
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Purpose: Immobility, symptoms causing presence of scoliosis. Method: Examiner blocks pt's shoulder against thorax, grasp pelvis and pulls. Positive Test: Reproduction of symptoms on affected side.
