Final Ortho Tests

Tissue Stretch

70-90 Degrees

Tissue Stretch or Bone

30-50 Degrees

Tissue Stretch

30 Degrees

Tissue Stretch

35 Degrees

Test: Pt bends forward [bow]

+ Pt flexes knee on affected side- traction on nerve root = radicular pain

I:: Dural mobility compromise [disc herniation, lateral recess stenosis, tumor]

Test: Pt walk 10 feet towards Dr on heels

+ Toes drop

I:: L4-L5 lesion, common peroneal nerve, problem with Ant Tib or Extensors

Test: Pt walks on toes away from Dr about 10 feet

+ Heels drop

I:: S1 leson or tibial nerve, gastroc/soleus problem

Test: Pt actively extends each leg separately, then both legs together

+ radicular pain, inability to perform b/c pain, pt leans back on both hands w/extension of one or both legs

I:: L4-S3 radiculopathy [disc herniation, tumor, osteophytes, lateral canal stenosis]

Pt leans back with arms on the table creating a tripod like posture

a.k.a Lasegue Sitting

Test: Pt seated w/neck flexed to chest, Dr passively extends the leg

+ radicular pain in elevated leg

I:: L4-S3 radiculopathy [disc herniation, tumor, osteophytes, lateral canal stenosis]

Test: Dr. raise's pt leg to point of pain- then flex knee until pain in alleviated, Dr then places fingers in post. thigh & popliteal fossa & tries to recreate stretch on nerve ~ Bilateral

+ Radicular pain

I:: intra or extra dural irritation of sciatic nerve

Test: Pt stand up & Dr watch's how it is performed

+ Pt supports self on unaffected side while standing & keeps affected leg flexed

I:: L4-S3 radiculopathy

Test: Elevate leg to point of pain or 90 degrees~ Bilateral

+ Radicular Pain

I:: pain between 35-70 = L4-S3 nerve root irritation; Pain prior to 35 extra-dural sciatic involvement

Test: Perform SLR to point of pain & backs off the hip flex 5 degrees, or until pt is out of pain & dorsiflex the foot

+ Radicular Pain [Sicard's or Turyn's can confirm]

I:: irritation of L4-S3 nerve roots w/pain 35-70; pain prior to 35 extra-dural sciatic irritation

Dr. performs a SLR to just short of pain & then extends the big toe

Confirms Bragard's Test

W/both legs straight on the table Dr. Dorsiflexes the big toe

Confirm's Bragard's Test

Test: Dr. Raises unaffected leg until pain is produced or reaches 90 degrees

+ increase radicular pain on affected leg

I:: Probably medial disc protrusion involving L4-S3 Nerve Roots

Test: Dr. Raises unaffected leg & then dorsiflexes the foot

+ increase in pain or production of radicular pain on affected leg

I:: Probable medial disc protrusion involving L4-S3 nerve roots

a.k.a Cram Test or Popliteal Pressure Sign

Test: SLR to point of pain, Dr. Flexes knee w/o flexing hip further; Dr asks pt if sx are relieved & Dr exerts pressure on hamstrings working down the popliteal fossa

+ Radicular pain

I:: irritaton of sciatic nerve either intradurally or extradurally

Test: pt on side w/head flexed; extend hip 15 degrees while keeping knee straight, if no radicular pain is produced flex knee w/o further hip extension

+ radicular pain down anterior thigh {L2-L4}

I:: Possible L2, L3, L4 radiculopathy

Test: Pt on stomach, Dr passively flexes the Pt's heel to their opposite buttock, dr can then extend the hip

+ radicular {ant thigh} or non-radicular pain &/or inability to hyperextend hip

I:: tight rectus femoris, iliopoas irritation or L2, L3, L4 radiculopathy

Test: Dr stabilize PSIS w/one hand & other hand grasps pt shoulders & passively bends the spine obliquely backwards

+ radicular or achy pain

I:: radicular pain=irritation of spinal nerve roots, achy pain may indicate facetal problems, capsulitis, mm spasms

Test: Dr internally rotates affected leg & performs an SLR; if pain is produced dr externally rotates the leg and asks if there is a change in Sx

+ sx relieved by external rotation

I:: probably piriformis syndrome

Test: pt on side, flex hip to 90 & positioned near edge of table, dr puts 1 hand on pelvis while other puts downward pressure on the knee

+ buttock pain or radicular pain

I:: butt pain=piriformis spasm, radicular pain=piriformis syndrome

Test: pt on stomach, flex leg to buttock & internall rotates hip

+ pain in SI or hip joint

I:: abcess/sprain of SI, hip joint capsulitis, arthritis

Test: pt on stomach, grab knee, stabilize pt SI joint, passively extend hip & applies a P-A pressure on SI

+ SI joint pain

I:: SI joint inflammation, infection, sprain

a.k.a approximation test

Test: pt on side, contact iliac crests & press towards the floor

+ pain in the SI

I:: SI joint inflammation, infection, sprain

Ask if Sx are provoked by coughing, sneezing, &/or bearing down

+ localized or radiating pain

I:: increased intrathecal pressure from disc defect, mass, osteophyte

Test: percuss each SP starting away from area of pain

+ localized pain or radicular

I:: local pain= possible fx, radicular pain= possible disc defect