Term
| Upper Limb Tension Test 1 |
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Definition
Pt's neck is laterally flexed away from side tested
Arm is abducted to 110 deg
Pt's elbow is in full extension, forearm is supinated, wrist is extended, fingers are extended
Dr. depresses the shoulder on that side
Performed bilaterally
+ = reproduction of pt's sx's
Median neuropathy, C5-C7 radiculopathy |
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Term
| Upper Limb Tension Test 2 |
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Definition
Pt's neck is laterally flexed away from the side tested
Arm abducted to 10
Pt's elbow is extended fully, forearm is supinated, wrist extended, fingers and thumbs are extended, arm laterally rotated
Reproduction of pt's sx's
Neuropathy to Median, musculocutaneous or axillary nerves |
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Term
| Upper Limb Tension Test 3 |
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Definition
Pt's neck is laterally flexed away
Arm abd 10 deg
Elbow extended, forearm pronated, wrist flexed, ulnar deviated, fingers and thumb flexed, arm medially rotated
Dr. depresses shoulder on that side
performed Bilaterally
+ = preroduction of pt's sx's
Radial Neuropathy |
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Term
| Upper Limb Tension Test 4 |
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Definition
Pt's neck is laterally flexed away
Arm abducted between 10 & 90
Elbow is fully flexed, forearm supinated, wrist extended, and radial deviated, fingers and thumb extended, arm laterally rotated
Dr depresses shoulder on that side
Performed Bilaterally
+ = reproduction of symptoms, pain
Ulnar neuropathy or C8-T1 radiculopathy |
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Term
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Definition
Pt positioned on table so shoulders and head are clear of the end of table
Pt's head and eyes turned slightly towards Dr
Dr suppots head so it isn't extending
Dr rapidly lowers the pt so head is below the horizontal
Pt held for 8-10 secs looking for nystagmus
Raised and reassessed
Performed Bilaterally
+ = nystagmus/vertigo
Benign positional vertigo |
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Term
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Definition
Dr has pt move body and head in oposite directions until vertigo is produced
when vertigo subsides the Dr holds pts head stable and asks pt to rotate their torso on a swivel chair (head stationary)
+ = vertigo is reproduced when head is held stationary
Cervicogenic vertigo |
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Term
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Definition
Pt supine
Dr slowly flexs pts neck
+ = reflex flexion of both knees and hips
meningitis or nerve root involvement |
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Term
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Definition
Palm of one hand on the pts forehead
Pt's head in slight flexion
Dr's thumb on C2 spinous process
Dr gently and passively extends pts head slightly
+ = exccessive movement of atlas, palpable motion or "clunk"
Instability of atlas on the axis, RA, AS or other conditions |
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Term
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Definition
Ask pt to swallow
Dr observes how it is accomplished
Ask if they are experiencing pain or discomfort
Try to ascertain wheather they are having problems w/ solids or liquids or both
+ = dysphagia or aphagia
Anterior vertebral osteophytes, DISH, tumor, hematoma, edema &/or lesion to CN IX, X, or XII |
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Term
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Definition
Dr asses pt's radial pulse
Arm is externally rotated
Dr passively abducts the arm slowly
Performed Bilaterally
+ = reproduction of symptoms and decreased pulse strength
Pect minor syndrome or Deformed Coracoid process (Hyperabduction Syndrome) |
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Term
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Definition
Dr assesses the pt's radial pulse
Pt head is rotated to side tested and slightly extended
Pt's arm is extended slightly and laterally rotated
Pt is instructed to take a deep breath and hold it
Performed bilaterally
+ = Reproduction of symptoms and decreased pulse strength
Scalenus Anticus syndrome, Cervical Rib Compression |
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Term
| Eden's (Costoclavicular test or Military Brace test) |
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Definition
Pt retracts their shoulders
dr takes pulse
Dr pulls down and back on arm
Performed Bilaterally
+ = Reproduction of symptoms &/or decrease in pulse strength
Costoclavicular syndrome, Compression by elongated C7 TPs, Cervical Rib |
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Term
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Definition
Dr assesses pt's pulse
Pt's neck is extended and rotated away from arm being tested
Dr tractions down on the arm
Performed Bilaterally
+ = Reproduction of symptoms &/or decrease in pulse strength
Scalenus anticus syndrome, Cervical Rib syndrome &/or Subluxated rib |
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Term
| Roos' Test (Elevated Arm sTress Test; Hands-up Test) |
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Definition
Pts arms abducted to 90, laterally rotated, and elbows flexed to 90
Pt is to open and close fists for 3 min or until symptoms start
+ = ischemic pain, profound weakness, paresthesias
Thoracic outlet syndrome |
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Term
| Ptyergoid Fossa Palpation |
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Definition
Pt opens mouth
Dr stands on pt's right and palpates pts left fossa with gloved hand
Once finger is in mouth, Dr instructs pt to close down and movie jaw to side being palpated
With finger pad pointing medially, sticks index finger between cheek,teeth under zygoma and performs a "C" shaped sweep
Dr switches position and does the contralateral side
+ = pain and bogginess
Inflammation of fossa possibly associated with pterygoid tendinitis &/or joint |
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Term
| Temporalis Tendon Palpation |
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Definition
Dr has pt open mouth wide
Dr stands on pt's right and palpates pt's right tendon with gloved hand
Dr with finger pad pointing laterally, sticks index finger between check/teeth under zygoma
Dr repeats the procedure standing on pts left and palpating their left tendon
+ = Pain
Temporalis tendinitis |
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Term
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Definition
Dr marks on bottom tooth with pencil if there is overlap of top teeth
Measure maximum opening by asking pt to open mouth as wide as possible
Measure from bottom of top tooth to the top of the line
Pt closes mouth and reference point is marked horizontally
Pt deviates to right
Measure from center of top teeth to reference point on bottom tooth
Repeat by deviating and measuring to the left
Dr asks pt to protract the jaw and observes for symmetry
+ = ranges, pain, clicks, deviations |
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Term
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Definition
Dr asks pt to open mouth as far as possible
Measure maximal opening distance
Cold stimulus applied to each side of face simultandously
After a minute pt is instructed to put 2 fingers in mouth and pull down mandible
Dr keeps ice on until no longer notices the mouth opening father
Remeasure maximal opening distance
+ = Mouth opens 5mm or more, post application of cold
Extrinsic muscles problem |
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Term
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Definition
Pt opens mouth
Dr places gloved hand in mouth on molars, holding mouth like a trigger
Dr's other hand stabilizes head and palpates joint
Dr distracts joint S to I and slight PA
Performed Bilaterally by switching hands
+ = Pain under palpating finger
Capsulitis |
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Term
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Definition
Dr uses right had as primary contact
Left hand reinfoces when assessing right TMJ
Head is supported against torso and compression is applied
Performed bilaterally, switching hand contancts
+ = Pain in joint
Retrodiscitis or synovitis |
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Term
| Lateral Rotation Lag Sign (Infraspinatus "Spring Back" test) |
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Definition
Pts elbow is flexed to 90, arm is passively abducted 90 in scapular plain
Maximally externally rotated
Pt is asked to hold the position and dr lets go
Performed bilaterally
+ = inability to hold the position so arm springs forward
Infraspinatus &/or Teres minor strain |
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Term
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Definition
Pt is seated or supine
Pt's arm elevated 160 deg in scapular plain
Dr applies loading stress along axis of humerus with one hand
Other hand Dr rotates humerus
Performed Bilaterally
+ = Pain during maneurver with or without clicking
Glenoid labral tears (probably Inferior labrum) |
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Term
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Definition
Pt places hands on hips
Dr stabilizes shoulder with one hand
Other hand contacts proximal humerus and applies and anteriorsuperior force
Performed bilaterally
+ = Anterosuperior pain &/or click
Superior Labral Anterior Posterior Lesion (SLAP) |
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Term
| Active Compression of O'Brien |
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Definition
Pt arm in 90 flexion, 10 deg adduction and thumb down
Dr stabilizes shoulder and applies downward pressure on the arm
Arm is brought back to starting position with palm up
Resistance is repeated if pain occurred during 1st position
Performed Bilaterally
+ = Deep shoulder pain in thumb down position is relieved with palm up position
SLAP lesion or superior labral lesion |
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Term
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Definition
Pt is standing arms length from wall
Asked to perform 15-20 wall pushups
+ = Weakness or scapular winging
WEakness of scapular stabilizers, Neuropathy (long thoracic nerve) |
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Term
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Definition
Pt supine
One hand under joint pushing anterior
Other hand abduts pts arm to 90 and externally rotates it (with elbow at 90)
Performed bilaterally
+ = Anterior glenohumeral laxity/instability or dislocation |
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Term
| Relocation test (fowler sign or test) |
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Definition
Pt is positioned supine
Arm abducted to 90, elbow at 90, externall rotated (just like fulcrum)
Posterior translations applied to humeral head
Usually done on side of + fulcrum test
+ = Greater external rotation &/or reduction in pain or apprehension
Occult or subtle anterior instability |
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Term
| Generalized ligament laxity tests |
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Definition
Dr passively opposes the thumb to the volar aspect of forearm + = less then .5 cm
Passive hyperextension of 2nd to 5th fingers + = >90 deg or parallel to forearm
Hyperextension of elbow + = greater than 10 deg
Hyperextension of knee + = greater than 10 deg
Dorsiflexion of ankle + = 45 deg
+ = at least 4 out of 5 criteria are met
Generalized Ligamentous laxity |
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Term
| Posterior Internal Impingement Test |
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Definition
Pt supine
Dr holds wrist with one hand and elbow with other
Pts arm is abducted to 90 in scapular plane and maximal external rotation is applied
Performed Bilaterally
+ = localized pain in posterior shoulder
Impingement of cuff against posterior glenoid and labrum |
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Term
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Definition
Pts arm is in 90 deg of flexion and forced horizontal adduction is applied
Performed Bilaterally
Pain in area of AC joint
+ = Inflammation or DJD or the AC joint |
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Term
| Test for Pronator Teres Syndrome |
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Definition
Pts elbow is flexed to 90
Dr resists pronation as they passively extend the elbow
Performed Bilaterally
+ = Paresthesias into forearm and hand following Median nerve distribution
Pronator Syndrome |
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Term
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Definition
Dr instructs pt to touch tip of thumb to tip of the index and middle fingers
Pt performs the maneuver as Dr. observes
Performed Bilaterally
+ = Patent touches pad to pad instead of tip to tip
Anterior interosseous Nerve Syndrome |
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Term
| Weber's Two Point Discrimination (Moberg's) |
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Definition
Dr uses a paper clip or calipers and applies simultaneous pressure with one or two points to distal phalanx perpendicular to the long axis of finger
Pts hand should be resting on firm surface
Points start wider then Dr continues to narrow points until pt no longer distingushes
At that point measure
Test repeated on several different fingers on each hand
+ = Inability to discern two points between 2 and 6 mm
Peripheral Neuropathy, Radiculopathy or Posterior colum disease |
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Term
| Triangular Fibrocartilage Compression Test |
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Definition
Dr stabilizes forearm with one hand while the other passively ulnar deviates the wrist and applies long axis compression
Performed Bilaterally
+ = Pain in the region of the ulnar styloid process
Tear of the Triangular Fibrocartilage |
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Term
| Thumb Ulnar Collateral Ligament Laxity Test |
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Definition
Dr stabilizes the thumb in extension with one hand (palm down)
With other hand the Dr applies a valgus stress to the MCP
Performed bilaterally
+ = Valgus movement is greater than 30 deg or between 15-30 deg
>30 = complete tear of Ulnar collateral and Accessory collateral ligaments
15-30 deg = Partial tear of ulnar collateral ligament |
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Term
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Definition
Pt's wrist flexed
Pt extends fingers against Drs resistance
Performed Bilaterally
+ = pain in wrist
Radiocarpal, Midcarpal, or Scaphoid instability; Inflammation or Kienbock's disease |
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Term
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Definition
Pts elbow rests on table and forearm pronated
Dr takes wrist into full ulnar deviation and light extension while holding metacarpals with one hand
Dr holds scapoid with other hand while radially deviating and flexing the wrist
Performed bilaterally
+ = Dorsal Pole of Scaphoid Subluxes over the dorsal rim of the radius and pt experiences pain
Unstable scaphoid |
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Term
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Definition
Pt opens and close the hand several times then holds it closed
Dr occuldes both the radial and ulnar arteries
Pt opens hand
Pressure is relseased from one artery
Then the procedure is repeated and opposite artery is released
Performed Bilaterally
+ = Skin remains blanched or turns rubor/cyanotic longer than 10 sec
Ulnar or Radial artery insufficiency |
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Term
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Definition
Pt squeezes two of the doctor's fingers in each hand
Bilaterally simultaneously so Dr can compares the strength
Precision grip - have patient pick up an object like a pencil or key with thumb and each finger
+ = unequal pressure on the Dr's finger or inability to pick up a small object with precision
Lesion to Nerve Root, Peripheral nerve, Muscular lesion, Bony lesion, ect. |
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Term
| Passive Scapular Approximation |
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Definition
Pt is seated or prone
Dr approximates scapulae by lifting the shoulders up and back
+ = pain in scapular region
T1 or T2 nerve root problem on side of pain |
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Term
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Definition
Pt head is rotated to side being tested
Pts arm is adducted across the chest
Examiner pulls the pt's hand beyond the contralateral shoulder
Performed Bilaterally
OR
Performed with both arms simultaneously and no head rotation
+ = pain in the chest
Non-specific chest wall syndrome |
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Term
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Definition
Pt is instructed to lie on their side and inform about sx's
Dr contacts underneath the ribcage with both hands
Pulls the ribs anteriorly and superiorly
Bilaterally performed
+ = pain in the ribcage
Costochondritis, Rib Injury, Tear of the Rectus Abdominis muscle |
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Term
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Definition
Pt sits at the end of the table and performs maneuver sequentially
Pts arms are behind their back
Dr slumps the back, if no symptoms continue
Hold slump and flex pt's neck, if no sx's continue
Hold this position, and extend one leg, if no sx's continue
Dorsiflex the ankle if no sx's continue
Both legs then extend simultaneously and if no sx's dorsiflexed
+ = radicular pain during any of the maneuvers or pt unable to extend legs due to pain
Tension on the meninges and dura or nerve roots |
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Term
| Double Leg Raise (Bilateral SLR) |
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Definition
Dr performs SLR on both legs noting the angle at which the pain is produced
Dr performs a bilateral simultaneous SLR noting the angle at which the pain is produced
+ = lumbar pain is produced at an early angle when raising both legs together
Possible Disc Disease w/ Instability &/or lumbosacral joint movement |
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Term
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Definition
Pt supine
Dr flexes pt's hip with knee flexed (bring heel to butt)
Slowly extend the leg
Bilaterally Performed
+ = radicular pain
L4 to S3 radiculopathy |
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Term
| Sacroiliac Stretch Test (Gapping Test) |
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Definition
Pt supine
Dr applies crossed arm pressure to ASISs simultaneously
+ = Pain in one or both SI joints
Sprain of SI joints or an inflammatory process |
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Term
| Belt Test (Supported Adam's Test) |
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Definition
Pt is standing and asked to bend forward
Dr notes when pain is aggrevated
Dr holds the pt's iliac crests and braces a hip against their sacrum
Pt flexes forward again
+ = decrease in pain
Pain originates in Pelvis
No change = originates in spine |
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Term
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Definition
Pt supine
Dr flexes pt knee and hip to 90 degrees and slowly extends the pt's knee
Performed Bilaterally if negative on first side
+ = Inability to straighten leg due to pain and possible involuntary flexion of opposite knee and hip
Meningitis or Radiculopathy |
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Term
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Definition
Dr instructs pt to walk briskly for about 50 m (165 ft) until symptoms start
When symptoms start instruct pt to flex forward at waist and continue walking
+ = Symptoms are relieved in flexion
Neurogenic claudication (Canal stenosis) (vs arterial insufficiency) |
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Term
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Definition
Pt prone
Dr starts at approximately 11th rib, picks up the skin and rolls it between his/her fingers
Down to iliac crest
+ = Hypersensitivity response
Maigne's syndrome ( facet syndrome at T/L junction) |
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Term
| Prone Instability Test (Segmental Instability) |
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Definition
Pt prone with legs off the end of the table, feet on the floor
Dr applies pressure to the posterior lumbar spine
If pain proceed to ask pt to actively lift legs off the ground (active lumbar and hip extension)
Apply pressure to posterior spin again while the legs are off the ground
+ = no longer has pain when there is contribution of the muscles providing stability
Lumbar instability |
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Term
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Definition
Pt is seated
Dr extends pts knee and looks for symptoms
Pt is placed supine and does SLR
+ = radicular pain is provoked in only one position
Possible malingerer |
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Term
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Definition
Dr asks pt to point to area of pain
Dr marks the area and then performs some other exams
Dr asks pt to point to site of pain again
+ = change in location of pain greater than 1-2 cm
Malingering, Simulated Pain, Hysteria |
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Term
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Definition
Dr establishes resting pulse rate
Without changing pt position dr applies mechanical pressure to the site of pain while assessing pulse rate
+ = no increase in pulse rate (normal would be an increase by 10+ beats/min)
Malingering or Simulated pain |
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Term
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Definition
Pt supine with hip and knee flexed to 90
Dr externally rotates thigh and presses down on the knee while pulling up on the ankle
+ = pain in the hip joint &/or SI joint
Capsulitis, Osteoarthritis, Inflammation, Fracture |
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Term
| Recuts Femoris Contracture Test (Modified Thomas Test) |
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Definition
Pt supine at the edge of the table
Flex one knee to their chest and pt holds
Other knee should remain at 90 (off table)
If not the dr tries to passively bring the knee to 90 and palpates muscle
Performed Bilaterally
+ = Knee does not remain at 90 &/or Hip flexes
Tight Rectus Femoris &/or Iliopsoas |
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Term
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Definition
Pt supine with hips and knees flexed and malleoli approximated
Dr observes from lateral aspect and from the foot of table
+ = Femur protrudes farther caudally &/or tibia protrudes higher
Femoral Length Discrepancy &/or Tibial Length Discrepancy |
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Term
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Definition
Pt standing
Keep weight on both feet equally
Dr measures from ASIS to floor length
Performed Bilaterally
+ = unequal lower extremity lengths
Anatomic short lower Extremity |
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Term
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Definition
Pt supine
Dr flexes hip to 90 and forcefully internally rotates and adducts
Performed bilaterally
+ = Pain deep in the hip joint
Femoroacetabular Impingement &/or Capsulitis |
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Term
|
Definition
Pt suine and positioned at end of table
Dr extends pts hip fully and forces it into external rotation
Performed Bilaterally
+ = Deep hip joint pain
Femoroacetabular impingement |
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Term
| Lateral Pivot Shift Maneuver (Test of MacIntosh) |
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Definition
Pt supine
Dr flexes pt's hip and knee approx to 20 deg with 20 deg of internal rotation
Dr contacts the fibular head/gastrocs posteriorly
Dr flexes knees with a valgus stress
Performed Bilaterally
+ = feeling of giving way of tibia then comes back at 30-40
ACL, posterolateral capsule, LCL sprains |
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Term
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Definition
Pt supine with knee and hip flexed, feet on table
Leg is medially rotated and dr pulls the proximal tibia P to A (laterally)
Leg is externally rotated and Dr pulls the proximal tibia P to A (medially)
Performed Bilaterally
+ = Excessive movement of tibia while medially rotated is anterolateral rotatry instability
Excessive movment of tibia while externally rotated is anteromedial rotary instability
Anterolateral = ACL, LCL, posterolateral capsule
Anteromedial = MCL, ACL, posteromedial capsule |
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Term
| Hughston's Posterolateral and Posteromedial Drawer Test |
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Definition
Pt supine with knee and hip flexed with feet on table
Leg is interally rotated and push the proximal tibia A to P
Do same with external rotation
Perform bilaterally
+ = External rotation - excexive posterolateral displacement of lateral tibial eminence
Internal rotation - excessive posteromedial displacement of tibia
Posterolateral instability = PCL, LCL
Posteromedial instability = PCL, MCL |
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Term
| Steinmann's Tenderness Displacement |
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Definition
Dr palpates medial or lateral tibiofemoral joint line for tenderness and notes the location
Dr flexes or extends pt's knee
Note the position of the tenderness moves
+ = tenderness moves anterior in join line with extension and posterior joint line on flexion
Tear of either Medial or Lateral meniscus |
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Term
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Definition
Pt stands facing dr
Dr holds pt's hands to stabilize the pt
Pt balances on one leg and bends weight bearing knee 5 deg
Pt then rotates knee 3 times
If negative at 5 deg, proceed to 20 deg
+ = Pain or sense of locking or catching
Lateral pain = lateral meniscus
Medial pain = Medial Meniscus |
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Term
| Patellar Apprehension test |
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Definition
Pt flexes knee slightly and slowly tries to pull patella laterally
Performed Bilaterally
+ = Apprehension, Grab hand, Pain, contraction of quads
Recent dislocation of patella |
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Term
|
Definition
Dr flexes knee slightly and slowly tries to pull patella laterally
Performed bilaterally
+ = Patella Displaces laterally over half its width
Recurring subluxation/dislocation of the patella |
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Term
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Definition
Pt knee flexed to 90
Dr uses thumb to apply pressure to ITB with in 2 cm of lateral condyle
Dr passively extends the knee
Performed Bilaterally
+ = severe pain over lateral condyle at about 30 degrees of flexion
ITB friction syndrome |
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Term
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Definition
Pt is asked to squat down on one leg (30 deg)
Performed bilaterally
+ = lateral knee pain
ITB friction sydrome |
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Term
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Definition
Dr passively flexes knee 30 degrees
Displace the patella medially with heel of hand
Dr palpates under the mdial aspect of the patella for tenderness
Performed bilaterally
+ = palpable tenderness
Inflammation of the Mediopatellar Plica |
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Term
|
Definition
Pt is seated w/ knee flexed to 90 deg and medially rotated
Pt is asked to exted their leg
If at 30 deg the pt is unable to continue due to pain they are instructed to externally rotate the leg and continue
Performed bilaterally
+ = Pt is able to continue extension with the tibia in external rotation
Osteochondritis Dissecans |
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Term
| Squeeze Test (Distal Tibiofibular Compression Test) |
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Definition
Dr squeezes the mid to distal tibia and fibula
Performed Bilaterally
+ = pain in the lower leg
Syndesmosis Injury, High Ankle Sprain |
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Term
| External Rotation Stress Test |
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Definition
Pt seated with leg hanging over the table
Dr stabilizes proximal to mid leg with one hand
Dr uses other hand to place the angle in 90 degrees of and passively externally rotate the leg
Performed Bilaterally
+ = Pain in the region of deltoid ligament with talar displcement or pain in the syndesmosis
Deltoid ligament sprain
High ankle sprain |
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