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ORTHOPEDIC TESTS Site NECK

Adsons Maneuver With the patient seated, the examiner takes the patients radial pulse, noting the force of the pulse. As the pulse is taken, the examiner abducts (draws away from the patients body), extends and rotates the arm of the patient outward so that it is extended behind with the palm facing outward. The patient is then instructed to turn the head toward the arm being tested, take a deep breath and raise the chin. Closed fist-striking blow on top of the head Compression on the head with extension of the neck Pulse should remain strong. A marked decrease or absence of radial pulse could indicate presence of extra cervical rib, tightened neck muscle, or thoracic outlet syndrome.

Technique

Comments

Anvil test Spurling test

Elicits pain in the vertebra(e). For cervical spine and foraminal nerve encroachment. Causes radicular pain into the upper extremities Pain or discomfort may indicate pressure on spinal cord from herniated disc.

Naffziger

With patient lying supine, examiner compresses jugular veins about 10 seconds (face will flush) and asks patient to cough.

BACK
Bechterews Test Patient sits on the edge of the exam table with feet hanging over the side. Examiner asks patient to raise one leg until it is parallel with the floor, then to repeat the motion with the opposite leg. Test is positive (abnormal) if patient feels pain in response to the maneuver, or is unable to perform the maneuver at all. The test is a substitute for some of the straight leg raising tests because it stretches the sciatic nerve. A positive test result is indicative of lumbar intervertebral disc protrusion and sciatic nerve root pathology. For nerve root irritability in sciatica. With sciatica he cannot sit up on the table this way; he can only stretch out each leg in turn. Test does not stress any musculoskeletal structures. All

Bekhterev test

While sitting up in bed, patient is asked to stretch out both legs

Bench test (Burns test)

Patient knees on a short bench close to one end. Examiner holds the patients

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ankles so he will not fall forward or lose his balance and asks the patient to bend forward and reach for the floor.

Comments
patients except very weak and inform should be able to do it without difficulty. Not being able to implies a nonorganic (or psychologic) back pain. Increased pain is sign of nerve irritability.

Bowstring sign

With leg raised and knee bent in same position, pain is felt in the back of limb pressing on the popliteal fossa (back of the knee). Patient lies face up on exam table with both legs extended. Examiner raises patients straight leg and then dorsiflexes the foot (flexes the foot toward the kneecap). A Valsalva maneuver is used (holding breath and bearing down like coughing, sneezing, and straining at stool) The letters stand for flexion adduction internal rotation in extension. Also called Patrick test, fadire sign. Examiner flexes patients leg at the knee and places her foot on top of her opposite knee. Examiner holds patients hip on the opposite side from the patients flexed knee to stabilize the pelvis, and with his free hand, pushes down on the patients flexed knee. With the patient supine, a leg is raised with one hand, while the examiners other hand is placed under the patients lower back. Leverage is placed under the patients lower back; leverage is then applied to the side of the pelvis.

Braggard sign

For nerve or muscular involvement. Test is positive is patient feels pain in response to the maneuver. Positive finding is characteristic of sciatic nerve injury. For symtpoms of a herniated nucleus pulposus (HNP) Produces aggravation of symptoms of radiculitis For testing lower back or sacroiliac joint disorder. Pain in the hip joint during the maneuver is abnormal. Is characteristic of hip joint pathology and is frequently seen in tuberculosis involving this joint.

Djrine sign

Fabere sign

Goldthwaite sign

For distinguishing lumbosacral from sacroiliac pain. f pain is felt by the patient before the lumbar spine is moved, the lesion is a sprain of the S1 joint. If pain is not felt until after the lumbar spine is moved, the lesion is in the S1 or lumbosacral articulation. Any active effort to do this will result in pressure of the opposite heel against the examiners hand. The lack of such effort implies malingering.

Hoover test

While lying supine, the patient is asked to raise one leg with the knee straight and with the examiner holding the opposite heel.

ORTHOPEDIC TESTS Site Technique Comments

Excessive pressure of the heel against the examiners hand implies abdominal muscle weakness. Lasgues sign Flexion of thigh upon hips is painless, and when the knee is bent, such flexion is easily made. If painless, there is no hip joint disease. Patient lies face up on the exam table. Examiner places his hands in back of the patients head and lifts the head off the exam table, flexing the patients cervical and thoracic spine and trying to touch her chin to the chest. Examiner asks seated patient to stand up and observes how the patient rises from the chair. For sciatica. If test produces pain when the leg is held straight, nerve root irritation or lower back disorder may be present. See straight leg raising test. For sciatica. Will cause pain in the leg or lumbar region if patient has spinal nerve root compression in the lumbar spine.

Linder sign

Minor sign)

For sciatica. If patient has pain on either side, will generally support himself on healthy side by placing a hand on the lower back, flexing the leg on the affected side and balancing on the leg of the healthy side when getting up from a seated position. Positive sign characteristic of sciatic nerve disease, since the test causes traction and aggravation of the inflamed nerve tissue. Negative test in patient who complains of symptoms suggesting sciatic nerve pain may suggest malingering because patient will not support his weight or flex his knee as would be expected if symptoms were present. For sciatica or herniated nucleus pulposus. Nerve root irritation is produced

Naffziger sign

External jugular venous compression by examiner

Patrick test Pelvic rock test Soto-Hall sign

See Fabere sign and Fadire test Forcible compression of the iliac crest toward the midline With the patient supine, examiner places his hand on patients sternum to apply counterpressure and asks patient

For pain in lumbosacral area or hip Will produce pain in sacroiliac joint. Flexion of the spine beginning at the neck and going downward will elicit pain in the area of the lesion.

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to raise the head and touch the chin to the chest. Straight leg raising (SLR) test Patient lies face up on exam table. Examiner lifts the patients extended, straight leg off the exam table. Also called Lasgue sign.

Comments
Is an all purpose bone-ligamentmuscle-nerve test of the cervical and upper thoracic spine. If patient experiences pain and/or resistance upon having his straight leg raised, the test is positive. Positive findings are recorded by noting how high the leg can be raised before the patient complains of pain. Pain may indicate pathology of the lumbar spine, degenerative disk disease, lumbosacral nerve root compression and sciatic nerve disease. For determining nerve root irritability within the spinal canal. Will note pain when bearing down.

Valsalva maneuver

This maneuver is also used for many other unrelated reasons. The patient takes a deep breath and then bears down. The arm is held abducted and extended while in external rotation. Patients expression is checked for signs of apprehension. Examiner notes lowering of the axillary folds Examiner stands behind the patient and raises the patients arm straight out to the side above shoulder height. After the patients arm has been lifted past horizontal, the examiner lets go of the arm and evaluates whether or not the patient can support his arm above horizontal without support.

SHOULDER
Apprehension test For anterior subluxing or dislocating shoulder. The patient is apprehensive in a positive exam. For dislocation of the shoulder The arm can be passively abducted without pain, but when support of the arm is removed and the deltoid muscle contracts suddenly, pain occurs again. Test is positive is positive if the patients arm falls down against his side. Results are positive when the rotator cuff or (SIT muscle group) in the shoulder ahs been torn. For rotator cuff tear. See Codmans

Bryant sign Codman sign

Drop arm test

The patient is unable to actively control bringing the arm down from a full abducted position past 90 degrees. The arm drops at 90 degrees. Examiner asks patient to open and close the fist several times and then to clench the fist tightly. Examiner then places his hand around the patients hand from the rear and squeezes the patients wrist while applying pressure to the patients radial and ulnar arteries

HANDS Allen test

For early rheumatoid arthritis involving the distal radioulnar joint. If patients hand remains pale or if the color returns to the palm very slowly, the test is positive. This test evaluates the blood flow to the hand. Each of the two arteries can be

ORTHOPEDIC TESTS Site Technique

with his thumb and middle fingers. Pressure applied to the arteries must be strong enough to shut off the blood flow. Patient is then asked to open her clenched fist. After a few seconds, the examiner releases his hold on the patients wrist and allows blood to flow rapidly into her hand. Phalen test Patient is asked to place the backs of his hands together and push.

Comments
tested separately by releasing pressure on one at a time.

Test is positive if patient feels pain on the inside of one (or rarely, both) of the wrists in response to the maneuver. Pain is indicative of carpal tunnel syndrome. Numbness or tingling of thumb or fingers may indicate carpal tunnel syndrome also. For ulnar tunnel or carpal tunnel syndrome. Tingling along ulnar nerve pathway may indicate neuroma or ulnar tunnel syndrome. Tingling of fingers along median nerve pathway indicates carpal tunnel syndrome.

Tinel test

Examiner taps area between olecranon and medial condyle (for ulnar nerve) or taps volar surface at center of wrist (for median nerve).

HIPS
Anvil test A closed fist striking a blow to the sole of the foot with leg extended For early hip joint disease or diseased vertebrae. Will produce pain in the nerve or vertebrae. If patient has pain during the maneuver, or is unable to havae the leg raised off the exam table, the test is positive. If the patient experiences pain unilaterally (on one side only), it is usually indicative of sacroiliac joint pathology. If the pain is bilateral, pathology of the lumbar spine and/or the iliopsoas muscle or fascia is indicated. Pain that radiates from the lumbar spine during the maneuver is characteristic of lumbar spinal nerve root compression, inflammation or other neuropathology.

Ely test

Patient lies face down on exam table. Examiner flexes patients leg at the knee until her heel touches her buttocks. Examiner holds patients heel against the buttocks and lifts the patients knee off the exam table, hyperextending the patients upper leg.

ORTHOPEDIC TESTS Site KNEES

Abduction stress test Patient lies supine (face up) on the exam table. The examiner places one hand on the lateral side (outside) of the patients knee and grasps the patients ankle with the other. The examiner then pulls laterally (toward the outside) on the patients ankle while holding the knee in a fixed position. This maneuver attempts to open the joint space on the medial side (inside) of the knee joint and stresses the medial collateral ligaments. Patient lies prone (face down) on the exam table and flexes the leg 90 degrees. Examiner holds the foot with one hand on the heel and the other on the ball of the foot. Examiner pushes down on patients foot with both hands and rotates the foot and lower leg both internally and externally (to the inside and outside. The test is positive (abnormal) if the patient feels pain in response to the maneuver, and if the joint space on the medial side of the knee opens up, allowing the leg to be displaced laterally. A positive finding indicates that the patient probably has torn the medial collateral ligaments of the knee. Most ligamentous injuries of the knee occur on the medial side of the knee. For differentiating ligamentous from meniscal injury. Test is positive (abnormal) if the patient feels pain response to the maneuver on either the medial side (inside) or the lateral side (outside) of the knee. Pain on either the medial or lateral side of the knee is characteristic of torn meniscus cartilage on the side where pain is felt. Test is positive (abnormal) if patient feels pain in response to the maneuver. Pain in the knee area indicates damage to the ligamentous structures of the knee. If only the meniscus is torn, this lifting maneuver will relieve pressure on the meniscus and the patient will not complain of pain during the test. This is performed in combination with the Apley Compression test to diagnose knee pathology. For ligamentous instability or ruptured cruciate ligaments. Also called an anterior drawer sign, meaning the anterior cruciate is lax or ruptured. In elderly patients, slight movement can be normal and should be compared with the patients other knee. For knee pain or crepitus. Patient will grimace with pain or if crepitus is present.

Technique

Comments

Apley Compression test

Apley Distraction test

Patient lies prone (face down( on the exam table and flexes the leg 90 degrees. Examiner holds the foot with one hand on the heel and the other hand under the dorsal (top) side of the foot. Examiner lifts up on the foot with both hands and rotates the foot and lower leg both internally (toward the inside) and externally (toward the outside).

Drawer sign

Grimace test

Patient lies face up on the exam table and flexes the knee to 90 decrees, placing her foot firmly on the table. The examiner sits on the table, blocking forward movement of the patients foot and grasps the patients leg just below the knee. Examiner pulls forward on the patients knee, drawing it toward him. Examiner compresses the patella.

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Lachman test

Technique
Same as anterior drawer test only the patients leg is flexed (bent) 10 to 20 degrees during the maneuver.

Comments
Should be no excursion of the knee in a normal (negative) test. A give reaction or mushy end point indicates a torn anterior cruciate ligament An audible or palpable click in the patients knee is a positive (abnormal) finding. The test may indicate a torn meniscus cartilage of the knee. Results are interpreted as in the anterior drawer test.

McMurray circumduction maneuver

Patient lies face up on the exam table. Examiner then flexes the patients knee as he draws the knee to the patients chest. Similar to the Anterior Drawer test, except that the examiner pushes the joint inward instead of pulling it out, as if pushing in a drawer to close it.

Posterior drawer test

GAITS

A persons walking pattern (gait) is very important in the evaluation of disorders, particularly those affecting the lower limbs. A limp is more apparent in the stance phase of walking. Of the various gait patterns, some have very specific characteristics. Due to pain in the stance phase (while walking through on the foot), the time spent on the affected side is shortened compared to the normal side. Due to weak or nonfunctioning hip extensor muscles, the patient thrusts the thorax posteriorly to maintain hip extension Due to weak or nonfunctioning hip abductor muscles, the patient lurches toward the weak side to place the center of gravity over the hip Said of a patient who leans to one side or another when standing or walking. Most commonly seen in lumbar disk disease. Due to weak or nonfunctioning ankle dorsiflexor muscles, the foot slaps down after heel strike

Antalgic gait Gluteus maximus gait Gluteus medius gait (abductor lurch) List Slap foot (drop foot) gait

MISCELLANEOUS
Cogwheel phenomenon Jerky motions produced on testing a muscles strength. The jerks are neither rhythmic nor equal and represent malingering or protection from pain. Also called cogwheel sign.