Neuro Lab Final

• 1) Orientation
• 2) Level of alertness, attention, & cooperation
• 3) Memory
• 4) Language
• 5) Calculations
• 6) Apraxia
• 7) Sequencing tasks
• 8) Abstraction

Ask the patients name, location, date

• Ask the patient to spell a word forward & back (i.e. world)
• Ast the patient to repeat a string of integers forward & back
• Ask the patient to name the months forward & back

• Recent- recall 3 items after 5 minutes
• Remote- recall certain historical facts within patients memory (lifetime- where did you go to highschool)

• Object naming (index card)
• Repetition of single words & sentences (The early bird gets the worm).

Simple additions & subtractions, should never be more than 2 steps (2+3-4)

Following a complex motor command like pretend to comb your hair or pretend to brush your teeth

Ask the patient to tap the table with fist, open palm then side of hand (rock paper scissors) as rapidly as possible

Abstraction interpretation of a proverb or colloquialism The early bird gets the worm

• Inspection
• Testing muscle strength

• Check limbs & trunk for fasciculations (hands, shoulder, thigh), involuntary movements, or abnormal positions
• Look for atrophy & hypertrophy
• Observe posture

• Passively move limbs through range of motion noting resistance & rigidity
• Ask patient to hold arms straight out front palms up for 20-30 sec w/ eyes closed, look for drift to one side or pronator drift
• Test muscle strength at multiple joints & record

• Diadochokinesia
• Dysmetria
• Gait

Rapid rhythmic alternating movements. Have pt pat leg w/ each hand as fast as possible

Have pt pronate & supinate palms as rapidly as possible

• Have patient touch your index finger & then his/her nose alternately several times (note tremor/lack of coordination)
• Have patient run their heel from the knee to the foot

Observe the patient walking toward & away, note posture, stability, foot elevation, trajectory of leg swing, balance & arm motions

ask the patient to walk heel to toe

Ask the patient to walk on heels & toes

• Point Localization (Topognosis)
• Pain (Pinprick)
• Vibration (Pallesthesia)
• Light touch
• Joint position sense
• Romberg's test

The ability to recognize points being touched on the body (use dull side of neurotip)

Use sharp end of neurotip stimuli on the hands & feet (spinothalamic)

• Vibration
• Place the handle of a vibrating tuning fork on the bony prominances of the upper & lower extremities. Start distal, work proximal. Ask can you feel vibration & when does it stop

Gently stroke skin with a wisp of cotton or with a camel hair brush

Examiner movers patients fingers & toes, patient is asked to describe the digit position

Ask the patient to stand with eyes open, then closed, note any swaying

• Sharp v dull discrimination
• Stereognosis
• Graphesthesia
• Barognosis
• 2 point discrimination
• Double simultaneous stimulation- extinction, displacement, synesthesia

Alternate sharp & dull stimuli on the hands & feet (spinothalamic)

The ability to recognize familiar objects by the sense of touch

The ability to recognize numbers traced lightly on the skin

The ability to distinguish different weights

Determining the smallest area in which 2 points can be separately perceived (use paperclip)

• Extinction- only one side is felt
• Displacement- one side is felt normally & the other displaced toward the midline
• Synesthesia- one side is felt normally & the other is a vague burning

• Response: Elbow flexion
• Afferent/Efferent: Musculocutaneous nerve
• Integrating center: C5 SC

• Response: Slight forearm flexion
• Afferent/Efferent: Radial nerve
• Integrating center: C5 SC

• Response: Elbow extension
• Afferent/Efferent: Radial nerve
• Integrating center: C7 SC

• Response: Knee extension
• Afferent/Efferent: Femoral nerve
• Integrating center: L2,3,4 SC

• Response: Foot plantar flexion
• Afferent/Efferent: Tibial nerve
• Integrating center: S1,2 SC

Absence of any DTR (especially patellar, LMNL)

• AKA Reinforcement Test or Cortical Distraction Test
• A form of cortical distraction that brings out a reflex when hard to elicit
• Pt hooks hands together by flexed fingers & pulls on the clenched hands at the moment the reflex is performed

LMNL (can include peripheral nerve disease, posterior column involvement, cerebellar disease, hypothyroidism)

UMNL (can include motor cortex, pyramidal tract lesions, strychnine poisoning, hyperthyroidism)

• Response: Ipsilateral pupillary constriction when light is shined in the eye
• Afferent: Optic nerve-2
• Integrating center: midbrain
• Efferent: Oculomotor-3

• Response: Contralateral pupillary constriction when light is shined in the eye
• Afferent: Optic nerve-2
• Integrating center: Midbrain
• Efferent: Oculomotor-3

• Response: Convergence of the eyes, pupillary constriction, lens convexity when object is brought into near vision
• Afferent: Optic nerve-2
• Integrating center: Occipital cortex
• Efferent: Oculomotor nerve-3

• Response: Reduction in heart rate when examiner presses the carotid sinus
• Afferent: Glossopharyngeal nerve-9
• Integrating center: Medulla
• Efferent: Vagus nerve-10

• Response: Reduction in heart rate when examiner presses the eye
• Afferent: Trigeminal nerve-5
• Integrating center: Medulla
• Efferent: Vagus nerve-10

• Response: Pupillary dilation when examiner pinches the base of the neck @ the cervical sympathetic chain
• Afferent: Cervical sympathetic chain
• Integrating center: T1-T2 SC
• Efferent: Cervical sympathetic chain

• Response: Blinking & tearing of eye upon touching the cornea with a cotton wisp
• Afferent: Trigeminal
• Integrating center: Pons
• Efferent: Facial

• Response: Gagging upon touching the back of the throat with a tongue depressor
• Afferent: Glossopharyngeal
• Integrating center: Medulla
• Efferent: Vagus

• Response: Raising of the uvula upon phonation or touching the tongue with a tongue depressor
• Afferent: Glossopharyngeal
• Integrating center: Medulla
• Efferent: Vagus

• Response: Drawing inward of scapula when skin or interscapular space is irritated
• Afferent: T2-7 spinal nerves
• Integrating center:T2-7 SC
• Efferent: Dorsal scapular nerve

• Response: Umbilicus deviation to the stroked side. Absence is normal, only if bilaterally
• Afferent: Upper T7-10, Lower T11-12
• Integrating center: T7-12 SC
• Efferent: Upper T7-10, Lower T11-12

• Response: Plantar flexion (curling) of toes upon stroking sole of foot
• Afferent: Tibial
• Integrating center: S1-2 SC
• Efferent: Tibial

Contraction of orbicularis occuli muscle upon percussion of supraorbital ridge; clonus- stays then gradually relaxes

Clawing of the fingers & thumb (flexion & adduction of thumb with flexion of the fingers) upon flicking tip of index finger into exension

Flexion of fingers & thumb upon tapping palmar surface or tips of middle three fingers

Continued involuntary contraction (sustained plantar flexion) of foot upon quick forcible dorsiflexion of the foot

Dorsiflexion of the big tow & fanning or splaying of other toes upon stimulation of the plantar surface of the foot (lateral to medial)

• Oppenheim's: Application of pressure to anterior tibia stroking downward
• Chaddock's: Stroking down the lateral leg around lateral malleolus
• Gordon's: Squeezing the calf
• Schaefer's: Squeezing the achilles tendon

• Spasticity of muscles w/ possible contractures
• Decreased muscle strength, little or no atrophy
• Presence of pathological reflexes
• Altered superficial reflexes
• Hyperactive DTR's
• No fasciculations (twitches)

• Flaccidity of muscles
• Loss of muscle strength & tone, noticeable muscle atrophy
• Absence of pathological reflexes
• Decreased or absent DTR's
• Altered superficial reflexes
• Fasciculations (twitches

• Do you have any change in your ability to smell?
• Using a penlight, make sure nostrils are not blocked
• Close eyes, occlude 1 nostril at a time, have patient sniff: Do you smell anything, can you identify the substance

• Inspect external structures of the eye
• Inspect optic fundi w/ opthalmascope
• Test visual acuity- read print, shapes &/or colors
• Test visual fields by confrontation- examine directly in front & level w/ patients face, have patient cover one eye, bring object in view from 8 different directions
• Direct light reflex- ipsilateral pupillary constriction
• Indirect light reflex- contralateral pupillary constriction
• Accommodation reflex- test ability of eyes to adapt for near vision, instruct pt to follow object inward from distance, convergence of eyes, constriction of pupil, convexity of lens

• Direct light reflex
• Indirect light reflex
• Accommodation reflex
• Check for ptosis (droopy eyes)

• Extraoccular movements w/ 6 cardinal fields of gaze. Observe pts eyes for normal conjugate or parallel movements of the eyes & nystagmus as you have him/her follow your finger or pencil while it makes a wide H in the air
• Trochlear- down & in
• Abducens- Lateral
• Oculomotor- all other fields

• Have patient clench teeth, palpate masseter & temporalis muscles
• Test pain discrimination on face (sharp/dull) bilateral (12x- 2x in each division on both sides)
• Test for light touch to the face with wisp of cotton or brush
• Test corneal reflex w/ wisp of cotton, should see blinking & tearing
• Light touch to anterior 2/3 of tongue, inside cheeks, & hard palate with toothpick (use a penlight to view the inside of the mouth)
• Oculocardiac reflex: Take pulse, apply pressure over the patients closed eye, pulse rate should decrease 2-3 beats per 15 sec

• Inspect face for asymmetry (at rest & during motion)
• Ask the patient to perform the following:
• Raise eyebrows
• Close eyes tightly
• Show teeth
• Puff out cheeks
• Smile
• Frown
• Ask the patient about changes in taste sensations, sweet, salty, & sour on the anterior 2/3 of tongue

• Sensory-Cochlear Portion:
• Screen tests: Finger rub test, Whisper test
• Distinguish b/w perceptive & conductive hearing: Weber's test, Rinne's test
• Vestibular portion:
• Labyrinthine test for positional nystagmus, Barany's whirling chair test, mittlemeyers test aka fukuda step test, vestibulo-ocular reflex

Assess hearing by rubbing fingers together near the EAM, find maximal distance sound can be heard

Have patient close his eyes (to prevent lip reading) & cover the ear on side not being tested. Place your head/ mouth 2 feet from the ear being tested and whisper words to the patient & ask patient to repeat the words. You can also ask questions to the patient and have the patient answer yes or no to each question. Repeat this procedure at varying (usually increasing) distances or with loud, medium, & soft tones

• Procedure: Place the handle of the vibrating tuning fork on the midline of the skull & ask the patient to compare the intensity of the sound in the 2 ears
• Indicates: (-) Normal: sound is equal in both ears, (+) Conductive deafness: sound lateralizes to bad ear, (+) Sensorineural deafness: sound lateralizes to good ear

• Procedure: Place the handle of the tuning fork against the mastoid process. Have the patient signal when the sound ceases, then hold the fork near the external ear w/o touching the patient, again have the patient indicate when the sound ceases
• Indicates: (+) Normal: air conduction persists twice as long as bone conduction; (-) Conduction deafness: air conduction is equal to or less than bone conduction; (-) Sensorineural deafness: air conduction & bone conduction are both radically decreased or absent

• Procedure: Pt seated, examiner inspects pts eyes for spontaneous nystagmus. Then inspect for nystagmus for 30 sec in each of following positions: Pt supine, turn head to one side, turn head to other side, pts head hanging off table, pt returns to seated position
• Indicates: Normal: the fast component of the eye movement will be in the direction the pt is being moved; Peripheral Lesion: the pt will exhibit nystagmus within 2-5 sec & it disappears within 30 sec; Medullary lesion: Nystagmus begins immediately upon movement & may change direction while the pt is stationary (also pt doesn't have vertigo)

• Procedure: Seated pt is spun in chair in one direction
• Indicates: Normal: fast component of nystagmus will be in the direction of the spin

• Procedure: Pt marches in place, eyes open then closed
• Positive: A turning to one side
• Indicates: Side of vestibular lesion

• Procedure: Dr holds pts head & instructs pt to fix vision on the dr's face. Dr then turns pts head into rotation, lateral flexion, & flexion/extension
• Indicates: Normal pt should maintain eye contact eyes moving at the same speed in opposite direction of head movement.

• Note any hoarsness of the voice
• Uvula reflex- pt says ah; watch for symmetrical rising of soft palate
• Bilateral lesion of vagus- palate does not rise
• Unilateral paralysis- one side of palate does not rise & uvula will deviate to normal side
• Gag reflex
• Have pt swallow while you palpate thyroid cartilage
• Carotid sinus reflex
• Ask the pt about change in bitter taste sensation on the posterior 1/3 of the tongue

• Trapezius: inspect, palpate, muscle test
• SCM: Inspect, palpate, muscle test

• Inspect tongue for: atrophy, fasciculations, deviation
• Have pt stick out tongue & test bilateral w/ tongue depressor, or use the tongue in cheek method
• Unilateral paralysis- protruded tongue deviates to involved side

• Disc Level: C4
• Muscle tests: Shoulder abduction: deltoid (axillary n), Forearm flexion: biceps (musculocutaneous n)
• Reflex: Biceps
• Sensation: Lateral arm & shoulder

• Disc Level: C5
• Muscle Test: Wrist extension: extensor carpi radialis longus & brevis, extensor carpi ulnaris (radial n)
• Reflex: Brachioradialis
• Sensation: Anterior lateral forearm, palm, thumb & index finger

• Disc Level: C6
• Muscle Tests: Elbow extension: triceps (radial n), wrist flexion: flexor carpi radialis (median n), flexor carpi ulnaris (ulnar n), finger extension (radial n)
• Reflex: Triceps
• Sensation: Middle finger, middle of palm

• Disc Level: C7
• Muscle Test: Finger flexion: flexor digitorum superficialis, flexor digitorum profundus, lumbricals (median & ulnar n)
• Reflex: None
• Sensation: 4th & 5th phalanges, antero-medial hand & forearm

• Disc Level: T1
• Muscle Tests: Finger abduction: dorsal interossei (ulnar n), finger adduction: palmar interossei (ulnar n)
• Reflex: None
• Sensation: Medial arm (distal aspect of arm to proximal forearm)

• Disc Level: L3
• Muscle Test: Foot inversion w/ slight dorsiflexion: tibialis anterior (deep peroneal/fibular n)
• Reflex: None Patellar tendon
• Sensation: Medial aspect of leg, medial foot, medial aspect of big toe

• Disc Level: L4
• Muscle Tests: Foot dorsiflexion, big toe dorsiflexion: extensor hallucis longus (deep peroneal/fibular n), Toes 2,3,4 dorsiflexion: extensor digitorum longus & brevis (deep peroneal/fibular n), hip/thigh abduction: gluteus medius & minimus (superior gluteal n)
• Reflex: None
• Sensation: Lateral leg, dorsum of foot, middle 3 toes

• Disc Level: L5
• Muscle Tests: Foot platnar flexion: gastrocnemius & soleus (tibial n), foot plantar flexion & eversion: peroneus longus & brevis (superficial peroneal/fibular n), hip extension: gluteus maximus (inferior gluteal n)
• Reflex: achilles
• Sensation: Posterior aspect of the leg, lateral aspect of foot, lateral aspect of little toe

• Procedure: Pt sitting or supine, pt flexes head toward chest or, per evans, dr actively flexes pts head toward chest.
• Positive: Electric shock-like sensations down the spine and/or through extremities
• Indicates: Dural irritation, severe spinal cord injury, or degenration (MS pts exhibit a positive 30% of time)

• Procedure: Pt supine, examiner passively flexes pts hip to 90 degrees, & pts knee to 90 degrees. Examiner extends pts leg completely
• Positive: Inability to fully extend the leg &/or pain (usually in the neck region)
• Indicates: Meningeal irritation/meningitis

• Procedure: Pt supine, examiner flexes pts head to chest
• Positive: Involuntary knee flexion
• Indicates: Meningeal irritation or nerve root lesion (classic test for meningitis)

• Procedure: Pt supine, examiner flexes pts head toward chest while stabilizing pts sternum w/ hypothenar of inferior hand
• Positive: Generalized pain in cervical region which may extend down to level of T2
• Indicates: Nonspecific test for structural integrity of cervical region

• Procedure: Pt seated w/ examiner standing behind. Examiner clasps his/her hands over pts head & exerts increasing downward pressure. Examiner repeats this procedure w/ pts head rotated right then left
• Positive: 1) Exacerbation of localized cervical pain, 2) Exacerbation of cervical pain w/ a radicular component
• Indicates: 1) Foraminal encroachment or facet pathology w/o nerve root compression, 2) Foraminal encroachment w/ n root compression (one would then want to evaluate the myotome, reflex, & dermatome of n root involved)

• Procedure: Pt seated w/ examiner standing behind. Examiner laterally flexes pts head to one side & clasps his/her hands over pts head & exerts increasing downward pressure. Perform bilaterally
• Positive: 1) Exacerbation of localized cervical pain, 2) Exacerbation of cervical pain w/ a radicular component
• Indicates: 1) Foraminal encroachment w/o nerve root pressure or facet pathology, 2) Foraminal encroachment w/ nerve root compression (one would then want to evaluate the myotome, reflex, & dermatome of nerve root involved)

• Procedure: Pt seated w/ examiner standing behind. The examiner instructs pt to rotate head & hyperextend neck. Perform bilaterally
• Positive: 1) Pain on concave side, 2) Pain on convex side
• Indicates: 1) Foraminal encroachment w/ or w/o nerve root compression (based on presence or absence of radicular component), 2) Muscular strain

• Procedure: Pt seated, examiner instructs pt to take a deep breath & hold while bearing down as if having a bowel movement
• Positive: Radiating pain from site of lesion
• Indicates: Space occupying lesion

• Procedure: Pt seated, examiner grasps pts head w/ both hands & gradually exerts upward pressure keeping hands off TMJ & ears
• Positive: 1) Diminished or absence of pain, 2) Increase of cervical pain
• Indicates: 1) Foraminal encroachment (local pain diminishes), nerve root compression (radicular pain diminishes), 2) Muscular strain, ligamentous sprain, myospasm, facet capsulitis

• Procedure: Pt seated, examiner instructs pt to place palm of affected side flat on top of head
• Positive: Decrease or absence of radiating pain
• Indicates: Cervical foraminal compression, nerve root entrapment (usually C5/6 level b/c this motion elevates the subscapular n & puts traction on the upper brachial plexus)

• Instruct: Pt standing, examiner standing behind pt, examiner looks for evidence of scoliosis. Examiner instructs pt to bend forward at waist w/ fingers extended & hands together. Examiner observes for evidence of change in scoliosis
• Positive: 1) C or S shaped scoliosis observed to straighten, 2) C or S shaped scoliosis does not straighten (look for rib humping, muscular imbalance, & asymmetry in hand length)
• Indicates: 1) Negative: evidence of functional scoliosis, 2) Positive: Evidence of pathologic or structural scoliosis as well as trauma or subluxation

• Procedure: Pt seated, arms fully abducted & raised over head, examiner instructs pt to laterally flex thoracic spine to left side and then to right side.
• Positive: Pain on concave or convex side
• Indicates: Pain on concave side indicates intercostal neuritis while pain on convex side indicates fibrous inflammation of pleura (or possible intercostal myofascitis)

• Procedure: Pt supine, examiner instructs pt cross his/her arms across chest & perform partial sit up
• Positive: Superior movement of umbilicus
• Indicates: Superior movement of umbilicus is indicative of a spinal cord lesion at level of T10 or lower abdominal weakness. Inferior movement of the umbilicus is indicative of nerve root involvement T7-T10

• Instruct: Pt sitting or standing, instruct pt to bring arms out in front of their body, bend elbows to 90 degrees. The pt then externally rotates the arms & opens & closes their fists bilaterally at a moderate pace for up to 3 minutes.
• Positive: Ischemic pain, heaviness of arms, or numbness & tingling of hand
• Indicates: Thoracic outlet syndrome on side involved (Evan's considers this test to be most accurate for TOS evaluation)

• Procedure: Pt seated w/ arms at side & elbows fully extended. Examiner finds radial pulse, slightly abducts affected arm, & has pt take a deep breath & hold, then instruct pt to rotate head & elevate chin toward examiner while holding the breath. Note positive or negative findings, if negative then rotate head to opposite side & repeat procedure
• Positive: Pain &/or paresthesia, decreased or absent pulse, pallor
• Indicates: Scalenus anticus syndrome or cervical rib syndrome (usually same side), Decrease or absence of radial pulse indicates compression of subclavian artery, Paresthesia/radiculopathy indicates compression of brachial plexus @ neurovascular bundle by scalenius anticus or cervical rib (usually opposite side).

• Instruct: Pt seated, examiner finds & monitors radial pulse in neutral position w/ one hand & w/ other hand traction pts arm toward floor. Examiner instructs pt to elevate chin & hyperextend their neck. If the test is negative (the pulse does not disappear), then rotate head to opposite side & repeat
• Positive: Pain &/or paresthesia, decreased or absent pulse, pallor
• Indicates: Compression of neurovascular bundle by scalenus anticus or cervical rib

• Procedure: Pt seated, examiner finds radial pulse & instructs pt to sit erect, force shoulders back, chest out, & touch chin to chest
• Positive: Pain &/or paresthesia, decreased or absent pulse, pallor
• Indicates: Compression of neurovascular bundle b/w clavicle & 1st rib

• Procedure: Pt seated, examiner finds radial pulse & hyperabducts the pts arm
• Positive: Pain &/or paresthesia, decreased or absent pulse, pallor
• Indicates: Compression of the axillary artery by pec minor or coracoid process, TOS

• Procedure: Pt seated, examiner taps w/ Taylor reflex hammer over the groove b/w medial epicondyle & olecranon process
• Positive: Pain &/or tenderness at site being tapped & paresthesia in ulnar nerve distribution area (fingers 4,5)
• Indicates: Neuroma of ulnar nerve

• Procedure: Pt is instructed to hold a piece of paper b/w any 2 adducted fingers. Dr tries to remove paper
• Positive: Pt unable to maintain grip on paper
• Indicates: Ulnar nerve paralysis

• Procedure: Pt seated, examiner instructs pt to flex both wrists to maximum degree & approximate until point of pain or 60 seconds. Prayer sign= maximally extend wrist (palms together), elbows same level as shoulder for 60 sec
• Positive: Reproduction of pain &/or paresthesia in median n distribution (thumb, index finger, middle finger, & thumb side of ring finger)
• Indicates: Carpal Tunnel Syndrome

• Pt seated w/ wrist supinated, dr taps w/ taylor reflex hammer over palmar surface of wrist
• (+) Reproduction of pain, tenderness, &/or paresthesia in median nerve distribution thumb index finger, middle finger, & lateral aspect of ring finger
• (I) Carpal tunnel syndrome

• Dr instructs pt to stand. Observe for abnormal motion.
• (+) Knee flexion of affected leg while supporting upper body weight (hand on back or thigh) on unaffected side.
• (I) Sciatica, lumnbosacral, or SI jt lesion

• Pt standing. Have pt bend forward & note for presence of low back pain. W/ pt standing, stabilize pts iliac crests & brace hip against pts sacrum. Have pt bend forward as you immobilize the pelvis
• (+) Low back pain
• (I) 1. Pain during unsupported & supported bending = lumbar involvement, 2. Pain during unsupported & not during supported = pelvic involvement

• Pt supine, dr raises both of pts legs 2-3 inches off table & instructs pt to hold legs off table for 30 secs
• (+) Inability to perform test &/or low back pain
• (I) Weak ab muscles or space occupying lesion

• Pt walks on heels
• (+) Inability to perform test
• (I) L4-L5 disc problem (L5 nerve root)

• Pt walks on tows
• (+) Inability to perform test
• (I) L5-S1 disc problem (S1 nerve root)

• Pt either seated or standing w/ arms crossed in front of the chest. Examiner stands behind pt & stabilizes PSIS. W/ other hand, examiner reaches around pt & grasps pts shoulder. Examiner passively brings shoulder back & obliquely pushes shoulder toward opposite PSIS
• (+) 1. Pain usually radicular, recreating existing sciatic pain, 2. Pain- local
• (I) 1. Disc protrusion- medial disc protrusion pt will be positive as pt is leaning away from side of pain & in lat disc protrusion pt will be positive as pt leans into side of pain. 2. Localized pain may indicate lumbar spasm or facet capsulitis

• Pt supine, examiner flexes pts head toward the chest
• (+) Pain along sciatic distribution or sharp diffuse leg pain
• (I) Sciatic radiculopathy

• Pt supine, examiner raises pts leg slowly to 90 deg. or to point of pain
• (+) Radiating pain &/or dull P thigh pain
• (I) Sciatic radiculopathy or tight hamstrings

• Pt supine, examiner performs SLR on pt. Dr lowers raised leg 5 deg from point of pain & sharply dorsiflexes pts foot
• (+) Radiating pain in P thigh
• (I) Sciatica

• Dr lowers raised leg (from SLR) 5 deg from point of pain & dorsiflexes pts big toe
• (+) P thigh & leg pain
• (I) Sciatic radiculopathy, usually from disc lesion

• Pt supine, examiner dorsiflexes the big toe of the unaffected extremity
• (+) Pain in the gluteal region or radiating sciatic pain
• (I) Sciatic radiculopathy

• Pt supine, examiner strongly internally rotates & adducts the affectd leg across the midline & then performs a SLR
• (+) Pain in P thigh or leg
• (I) Sciatica (possibly piriformis syndrome)

• Pt supine. Dr performs SLR on pts unaffected leg to 75 deg or until it produces pain down the affected leg. If no pain is produced, examiner dorsiflexes foot
• (+) 1. pain down affected leg (crossover sign), 2. decrease in pain down affected leg
• (I) 1. Medial disc protrusion, 2. Lateral disc protrusion

• Pt lies on the unaffected leg side, hip & knee slightly flexed, pt straightens back & flexes neck. Affected leg is extended by examiner @ hip approx 15 degrees. Affected knee is flexed
• (+) Pain on A portion of thigh
• (I) Traction on femoral n indicating involvement of 2nd, 3rd, & 4th lumbar n roots

• Dr taps region of the medial plantar n P to medial malleolus
• (+) Paresthesia radiating into the foot
• (I) Tarsal tunnel syndrome

• Dr squeezes metatarsal heads
• (+) Sharp pain in forefoot
• (I) Metatarsalgia or neuroma