-
How is Bakody's test performed?
- Seated
- Patient actively places palm of arm of complaint on top of head with elbow at level of head
-
What is a Positive sign for Bakody's? What does it indicate?
Decreased pain --> Foraminal Compression, Cervical Radiculopathy
-
How is the Distraction test performed?
- Seated
- Exert upward pressure on patient's head at base of skull/mastoids (avoid mandible)
-
What is a positive sign for the Distraction test? What does it indicate?
- Decreased pain --> foraminal encroachment or facet capsulitis
- Increased pain --> sprain/strain/spasm
-
How is Foraminal Compression performed?
- Seated
- Patient rotates head side to side actively
- With head in neutral extert downward pressure on head and neck
- Rotate head to side of complaint, exert pressure
- Repeat on opposite side
- After each step ask if there is pain
-
What is a positive Forminal encroachment? What does a positive indicate?
- Local pain --> foraminal encroachement or facet capulitis
- Radicular pain --> nerve root pressure (cervical radiculopathy)
-
How is Jackson's Compression test performed?
- Seated
- Laterally flex head to right and exert downward pressure
- Repeat on opposite side
- Ask if there is pain
-
What is a positve for Jackson's? What does it indicate?
Pain on side of lateral flexion --> Foraminal encroachment, cervical radiculopathy or facet capulitis
-
How is Lhermitte's Sign performed?
- Seated/Supine
- Patient actively flexes head toward chest
- Can also be performed passively
-
What is a positive Lhermitte's? What does it indicate?
- Sharp, electric shocks down spine into extremeties indicates
- Demyelinating cord disease (Multiple Sclerosis or myelopathy)
-
How is Maximum Cervical Compression test performed?
- Seated
- Patient actively, maximally flexes neck and rotates head to right
- to left
- Repeat with neck in extension
- Ask if pain occurs with any of these movements
-
What is a Positive Sign for Maximal Cervical compression? What does a positive indicate?
Increased pain --> Facet Capulitis, Foraminal encroachment, Cervical radiculopathy
-
How is Naffziger's test performed?
- Seated
- Compress jugular veins for one minute bilaterally
- If no pain have patient take a breath and cough
-
What is a positive Naffziger's? What does it indicate?
Radicular or Local pain indicates a SOL (space occupying lesion)
-
What are 3 examples of SOL?
- Osteophyte
- Tumor
- Disc rupture
-
What are 3 contraindicators for Naffziger's test?
Visible jugulars, migraines, vascular disorders
-
How is O'Donoghue's Maneuver performed?
- Seated
- Cervical spine is moved actively through resisted ROM then passively
-
What is a positive for O'Donoghue's? What does it indicate? Where can it be used?
- Pain during active --> muscle strain
- Pain during passive --> ligament sprain
- Can be used on any joint
-
How is the shoulder depression test performed?
- Seated
- Doctor depresses shoulder on side of complaint while laterally flexing head to opposite side
-
What is a positive for Shoulder depression? What does it indicate?
- Shooting arm pain
- Dural sleeve adhesion (burner/stinger) - adhesion of brachial plexus doesn't allow sleeve to slide
-
How is the Soto-Hall test performed?
- Supine
- One hand on sternum (knife edge contact) to stabilize, other hand passively flexes head to chest
-
What is a positive for Soto-Hall? What does it indicate?
- Local pain
- Fracture, cervical disc rupture, facet capulitis
- If ant. pain --> ant. compression fracture
- If post. pain --> post. ligament sprain or muscle strain
- If head pain --> possible meningitis
-
How is Spurling's test performed? What is an alternate method?
- Seated
- Patiently activately rotates head side to side
- Laterally flex head toward side of complaint, press down
- Ask if pain after each step
- Alternate method: percuss patient on top of head and ask if pain in neck
-
What is a positive for spurling's? What does it indicate?
- Pain to side of flexion or with percussion
- Radicular pain --> nerve root compression
- Local pain --> facet capulitis
-
Which of the cervical tests is most aggressive?
Spurling's
-
How is Valsalva's Maneuver performed?
- Seated
- Sit up straight, take a deep breath then bear down
- Do you feel any pain? Where?
-
What is a positive Valsalva's? What does it indicate?
- Local or shooting pain
- Increased intrathecal pressure (inside dura) due to an SOL
-
How is cervical collapse sign performed?
- Seated
- Doctor applies downward pressure in neutral position
-
What is a positive for Cervical collapse sign? What does it indicate?
- Neck collapses
- Grade 2 or 3 sprain
-
When should you try to ellicit a cervical collapse sign? What should you do if it is positive?
- If any trauma
- Do not adjust! Refer to MD.
-
How is Bikele's test performed?
- Seated
- Shoulder abducted to 90 with elbow flexed, patient actively extends elbow while attempting to reach behind them
-
What is a positive for Bikele's? What does it indicate?
- Radicular pain
- Radiculopathy, Brachial plexus neuritis (esp. C7 to T1)
- If bilateral positive --> possible meningitis
-
How is the Vertebral-Basilar artery function test performed?
- Seated
- Have the patient sit up straight
- Palpate and auscultate carotid and subclavian arteries
- Have patient hyperextend and rotate neck
- Hold for 30 seconds then repeat on opposite side
-
What is a positive for the vertebral-basilar artery function test? What does it indicate?
- Vertigo, diplopia, nystagmus, syncope, nausea
- Vertebral insufficiency
-
What are the signs for a stroke? (9) What should you do if a patient shows any of these?
- Dizziness, drop attacks, diplopia, dysarthria, dysphagia, ataxia, nausea, numbness, nystagmus
- Do not use rotary moves!
- Refer to a neurologist
-
How is Maigne's maneuver performed?
- Seated
- Ask patient to rotate and extend head for 30 seconds to each side
-
What is a positive for Maigne's maneuver? What does it indicate?
- Vertigo, diplopia, nystagmus, syncope, nausea
- Vertebral, basilar or carotid artery stenosis (vascular insufficiency)
-
How is Barre-Leiou sign performed?
- Seated
- Have the patient slowly rotate their head from side to side for 30 seconds
-
What is a positive for Barre-Leiou sign? What does it indicate?
- Vertigo, diplopia, nystagmus, syncope, nausea
- Vertebral artery compression/syndrome
-
How is Adson's test performed?
- Seated
- Doctor slightly abducts and extends arm back while taking radial pulse
- Ask patient to rotate head to affected shoulder and extend neck
- Patient takes a deep breath and holds
-
What is a positive for Adson's test? What does it indicate?
- Disappearance or alteration of pulse
- Scalenus Anticus syndrome (anterior scalenes)
-
What is Modified Adson's test? What does a positive indicate for it?
- If Adson's is negative have patient turn head to opposite side
- If pulse changes or disappears it indicates a spasm of the scalenus medius
-
How is Allen's test performed?
- Seated
- Patient's elbow is flexed, arm supinated
- Occlude radial and ulnar arteries distally
- Patient opens and closes fist repeatedly to express remaining blood --> hand blanches
- Doctor releases one artery and observes refill
- Repeat procedure for the other artery
-
What is a positive for Allen's test? What does it indicate?
- If skin of hand remains blanched longer than 5 seconds
- Arterial occlusion/compromise
-
What are the 5 types of Thoracic outlet syndrome?
- Cervical rib
- Anterior scalenes
- Medial scalenes
- Pec minor
- Costoclavicular
-
How is Costoclavicular Maneuver performed?
- Seated
- Palpate radial pulse bilaterally while pulling the patients shoulders down and into extension
- Ask patient to flex their chin to their chest
-
What is another name for Costoclavicular Maneuver? What is a positive for it? What does a positive indicate?
- Eden's
- Alteration of pulse and/or replication of complaints (paresthesia, pallor, blanching, radiculopathy)
- Costoclavicular syndrome (compression of neurovascular bundle between clavicle and first rib)
-
How is Halstead Maneuver performed?
- Seated
- 1. Doctor pulls patients arm inferiorly while taking radial pulse, patient is asked to extend neck
- 2. If negative, patient extends neck and looks away from affected side
-
What is a positive for Halstead Maneuver? What does it indicate?
- Change in amplitude/disappearance of pulse
- Thoracic outlet syndrome (1st is costoclavicular, 2nd is medial scalenes)
-
How is Reverse Bakody Maneuver performed?
- Seated
- Patient places palm on top of head with elbow at head level
-
What is a positive for reverse Bakody? What does it indicate?
- Increased or appearance of pain
- Thoracic outlet syndrome (Pec minor, cervical rib or costoclavicular)
-
How is Roos test performed?
- Seated
- Patient bends elbows to 90 degrees and abducts and externally rotates shoulders then opens and closes hands for 3 minutes
-
What is a positive for Roos? What does it indicate?
- Reproduction of symptoms
- Thoracic outlet syndrome (general)
-
How is Wright's test performed?
- Seated
- Doctor monitors radial pulse of affected arm while passively abducting arm 180 degrees
- Note at what angle the radial pulse diminishes or disappears on each side
-
What is another name for Wright's test? What is a positive for Wright's test? What does a positive indicate?
- Hyperabduction maneuver
- Decreased or disappearance of pulse at a smaller angle than the other side
- Pectoralis minor syndrome
-
What if when doing Wright's test in both arms the pulse decreases at the same angle?
- Test is negative
- Could be normal or could be bilateral TOS, use other tests to confirm
-
What tests would you do for foraminal compression/encroachment, cervial radiculopathy or facet capsulitis?
- Bakody sign
- Distraction test
- Foraminal compression
- Jackson's compression test
- Maximum cervical compression test
- Spurlings test
-
What test would you do for demyelinating cord disease (multiple sclerosis, myelopathy)?
Lhermitte's sign
-
What tests would you do for an SOL of cervicals?
- Naffziger's test
- Valsalva's maneuver
-
What test would you do for a muscle strain or ligament sprain of cervicals?
- Distraction test (negative)
- O'Donoghue's maneuver
- Cervical collapse sign (grade 2-3 sprain)
-
What test would you do for brachial plexus neuritis?
- Shoulder Depression test (burner/stinger)
- Bikele's test
-
What test would you do for a cervical fracture?
Soto-hall
-
What tests would you do for vascular insufficiency in the cervicals?
- Vertebral-basilar artery function test
- Maigne's maneuver
- Barre-Leiou sign
-
What tests would be positive for scalenus anticus syndrome?
-
What tests would be positive for a spasm in scalenus medius?
- Modified adson's test
- 2nd part of Halstead maneuver
- Roos test
-
What test would you do for an arterial occlusion/compromise of the arteries of the arm?
Allen's test
-
What tests would you do to confirm Thoracic outlet syndrome?
- Adson's test
- Costoclavicular maneuver (eden's)
- Halstead maneuver
- Reverse Bakody maneuver
- Roos test
- Wright's test (hyperabduction maneuver)
-
What test would be positive for costoclavicular syndrome?
- Costoclavicular maneuver (Eden's)
- 1st part of Halstead maneuver
- Reverse Bakody maneuver
- Roos test
-
What tests would be positive for Pec minor syndrome?
- Reverse Bakody maneuver
- Roos test
- Wright's test (hyperabduction maneuver)
-
What is the difference between a radiculopathy and a neuropathy?
- Radiculopathy - issue is at nerve root
- Neuropathy - peripheral nerve issue
-
How is Apley's test performed?
- Seated
- Patient reaches behind head to touch superior angle of opposite scapula
- Patient reaches behind to touch inferior angle of scapula
- Patient reaches with same arm to touch opposite shoulder
-
What is a positive for Apley's (scratch) test? What does it indicate?
- Increased pain or reduced ROM (can't reach)
- General shoulder problem (not specific)
-
How is the apprehension test performed?
- Seated or supine
- Patient's elbow is bent to 90 degrees, passively abducted and externally rotated
- Doctor watches patient's face for indication of apprehesion
-
What is a positive for the apprehension test? What does a positive indicate?
- Patient shows apprehesion/alarm or resists further ROM for fear of dislocation
- Chronic anterior and inferior (95%) instability (previous dislocation)
-
How would you test for a posterior previous dislocation?
Internally rotate arm
-
If the apprehesion test is positive, what would you do next?
- Relocation test
- Push humerus back into place
- Watch if alarm goes away
- Confirmatory test for Ant. and inf. should instability
-
How is codman's sign performed?
- Seated
- Variation 1: Patient's arm is passively abducted to 90 degrees then dropped (tell them to let their arm fall to their side)
- Varitation 2; Patient's arm is slowly abducted to 90 degrees then ask them to slowly lower it down to their side
-
What is another name for Codman's sign? What is a positive for Codman's? What does a positive indicate?
- Drop arm test
- Pain in shoulder when tries to catch arm
- Rotator cuff tear (rupture of supraspinatus tendon)
-
What muscle initiates arm abduction?
Supraspinatus
-
What muscle finishes abduction of arm?
Deltoid
-
What are the rotator cuff muscles? Where do they originate and insert?
- SITS: Supraspinatus, Infraspinatus, Teres minor, Subscapularis
- Scapula --> humerus (pull humerus down and in when contract)
-
What is painful arc syndrome? What is it associated with?
- Pain in part of abduction
- Associated with rotator cuff issue
-
How is dawburn's sign performed?
- Seated
- Doctor applies pressure to subacromial bursa producing local pain
- Patient's arm is then passively abducted
-
What is a positive for Dawburn's?
- Arm is abducted --> pain disappears
- Sub acromial bursitis
- Note: bursitis is not generally a primary condition, search for other issues
-
How is Impingement sign performed?
- Seated
- Patient's arm is slightly abducted and moved through shoulder flexion passively to straight up
-
What is a positive for the impingement sign? What does it indicate?
- Pain in shoulder
- Impingement of supraspinatus/biceps tendon (long head) - jamming of greater tuberosity against acromion process
-
How is Mazion's Shoulder Rock Test?
- Seated
- Patient places the palm of affected arm on opposite shoulder with elbow facing anterior
- Patiently actively moves arm up and down (chest to forehead) while leaving hand on other shoulder
-
What is a positive for Mazion's Shoulder Rock test?
- Pain in ipsilateral shoulder or arm
- General significant shoulder pathology
-
How is the supraspinatus press test performed?
- Seated
- Patient's arm is actively abducted to 90 degrees then resistance is given
- The shoulder is then medially rotated and angled forward 30 degrees with thumb to floor and given resistance
-
What is scaption?
Flexed shoulder, arm 30 degrees forward
-
What is another name for the supraspinatus press test? What is a positive for it? What would a positive indicate?
- Empty can test
- Weakness or pain in affected shoulder
- Partial or full tear of supraspinatus tendon
-
How is Yerguson's test performed?
- Seated
- patient's elbow is flexed to 90 degrees while being stabilized
- Doctor resists active flexion of elbow
- Doctor resists active supination of forearm
-
What is a positive for Yerguson's test? What does it indicate?
- Audible click or snap of biceps tendon (may be heard at elbow or shoulder, usually elbow)
- Instability of biceps tendon
- Pain is NOT a positive
-
How is Speed's test performed?
- Seated
- Pull down quickly on hand with elbow and shoulder flexed (they resist)
-
What is a positive for speed's test? What does it indicate?
- Pain in shoulder over biceps tendon
- Bicepital tendonitis
-
How is the sub acromial push button test performed?
- Seated
- Stand behind the patient and apply pressure directly over the sub acromial bursa (1st part of Dawburn's test)
-
What is a positive for the sub acromial push button test? What does it indicate?
- Pain in shoulder with pressure
- Sub acromial bursitis
-
How is Bryant's test performed?
- Seated
- Patient's shirt is removed, doctor compares the axillary fold bilatrally
-
What is a positive test for Bryant's test? What does it indicate?
- One axillary fold will be lower than the other
- Shoulder dislocation
-
How is Calloway's test performed?
- Seated
- Doctor measures circumference of shoulder from armpit to point of shoulder
-
What is a positive for Calloway's? What does it indicate?
- One shoulder is larger by more than 1 inch
- Shoulder dislocation
-
How is Duga's test performed?
- Seated
- Patient rests hand of affect arm on opposite shoulder then attempts to rest elbow on chest
- Doctor lightly pushes if won't touch
-
What is a positive for Duga's test? What does it indicate?
- Unable to rest elbow on chest
- Shoulder dislocation
-
How is Hamilton's test performed?
- Seated
- Doctor places straight edge/ruler against the acromial tip and lateral epicondyle elbow
-
What is a positive for Hamilton's test? What does it indicate?
- Ruler touches acromion and lateral epicondyle at the same time
- Shoulder dislocation (shoulder has displaced, exposing the acromial tip)
-
What is the step defect?
- Occurs if shoulder is dislocated
- Step from acromial tip to humeral head
-
What tests would indicate a shoulder instability from a previous dislocation?
- Apprehesion test
- Relocation test
-
What test would indicate a shoulder pathology (non-specific)?
- Apley's scratch test
- Mazion's Shoulder Rock test
-
What tests would indicate a partial or full tear of the supraspinatus tendon (rotator cuff tear)?
- Codman's sign (drop arm)
- Supraspinatus press test (empty can test)
-
What test would indicate sub acromial bursitis?
- Dawburn's sign
- Sub acromial push button test
-
What test would indiacte a problem with the biceps tendon?
- Impingement sign
- Yerguson's test (instability)
- Speed's test (bicipital tendonitis)
-
What tests would indicate a shoulder dislocation?
- Bryant's test
- Calloway's test
- Duga's test
- Hamilton's test
-
How is Cozen's test performed?
- Seated/Standing
- Patient is asked to clench a fist in pronation
- Doctor resists wrist extension
-
What nerve root does Cozen's test? What is a positive for Cozen's test? What does a positive indicate?
- C6
- Sharp, local pain in lateral epicondyle
- Lateral epicondylitis or radiohumeral bursitis
-
What is another name for lateral epicondylitis? What tendon is the most commonly affected?
- Tennis elbow
- Extensor carpi radialis brevis tendon
-
How is mill's test performed?
- Seated/standing
- Patient flexes forearm, fingers and wrist then the forearm is passively pronated with the wrist flexed
-
What is a positive for Mill's test? What does it indicate?
- Increased elbow pain
- Lateral epicondylitis
-
How is Golfer's elbow test performed?
- Seated
- Patient's forearm is stabilized with elbow flexed and arm supinated
- Patient flexes wrist against resistance
- Variation: Patient's wrist is fully extended and given resistance in flexion
-
What nerve root does Golfer's elbow test test? What is another name for Golfer's elbow test?
-
What is a positive for Golfer's elbow? What does it indicate?
- Pain over the medial epicondyle
- Medial epicondylitis (Golfer's elbow) (flexor pronator aponeurosis tendonitis)
-
How is the elbow flexion test performed?
- Seated
- Patient completely flexes elbow for 5 minutes (holding it with opposite arm)
-
What is a positive for the elbow flexion test? What does a positive indicate?
- Tingling or parasthesia in the ulnar distribution of the forearm and hand and medial 2 fingers
- Cubital tunnel syndrome (compression of the ulnar nerve in cubital tunnel)
-
How is the varus stress test performed in the elbow?
- Seated
- Patient's arm is flexed 20 degrees
- Doctor pushes medial to lateral at elbow while applying pressure lateral to medial at the wrist
-
What is another name for the varus stress test in the elbow? What is a positive for it? What does it indicate?
- Adduction stress test (note: adduction of wrist occurs)
- Pain in lateral elbow
- Damage of lateral collateral ligament
-
How is the valgus stress test performed in the elbow?
- Seated
- Patient's arm is flexed 20 degrees
- Doctor pushes lateral to medial at elbow while applying pressure lateral to medial at the wrist
-
What is another name for the valgus stress test in the elbow? What is a positive for it? What does a positive indicate?
- Abduction stress test
- Pain in medial elbow
- Damage of medial collateral ligament
-
How is Tinel's sign performed in the elbow?
- Seated
- Doctor taps on the groove between the olecranon process and the lateral epicondyle with a reflex hammer
- Repeat between groove and medial epicondyle
-
What is a positve for Tinel's sign in the elbow? What does it indicate?
- Hypersensitvity, parasthesia
- Medial --> ulnar nerve neuropathy
- Lateral --> radial nerve neuropathy
-
What test would be positve for lateral epicondylitis?
-
What tests would be positive for radiohumeral bursitis?
Cozen's test
-
What test would be positive for Medial epicondylitis?
Golfer's elbow test (reverse cozen's)
-
What test would be positive for cubital tunnel syndrome?
Elbow flexion test
-
What test would be positive for lateral collateral ligament damage to the elbow?
Varus stress test
-
What test would be positive for medial collateral ligament damage to the elbow?
Valgus stress test
-
What test would be positive for ulnar or radial neuropathy?
Tinel's sign
-
How is the bracelet test performed?
- Any position
- Doctor gives moderate lateral compressive pressure to distal ulna and radius (squeeze wrist)
-
What is a positive for the Bracelet test? What does it indicate?
- Acute forearm, wrist and hand pain, bilateral
- RA when correlated with labs, x-ray and 6 weeks of waking with swelling/dexterity issues
-
How is Finklestein's test performed?
- Seated or standing
- Patient makes a fist around their thumb
- Doctor stabilizes the forearm and passively flexes the wrist into ulnar deviation
-
What is a positive for Finklestein's test? What does it indicate?
- Pain over abductor pollicis longus and extensor pollicis brevis tendons at wrist
- deQuervain's tenosynovitis (stenosing tenosynovitis) - narrowing of the sheath around the tendons
-
How is Froment's paper sign performed?
- Seated
- Doctor places a piece of paper between abducted fingers and tells the patient to adduct the finger and not allow the paper to be pulled out
- Fingers must remain straight
- Test between all fingers
-
What is a positive for Froment's paper sign? What does it indicate?
- Doctor is able to pull paper away from between at least one
- Ulnar nerve palsy (affects interosseous muscles)
-
How is Phalen's sign performed?
- Seated
- Patient actively flexes both wrists and places the dorsum of both hands together for one minute
-
What is a positive for Phalen's sign? What does it indicate?
- Tingling sensation that radiates into thumb, index, middle and lateral half of ring finger
- Carpal tunnel syndrome
-
How is Tinel's sign performed in the elbow?
- Seated
- Doctor percusses over the flexor retinaculum (at bottom of crease of hand)
- Doctor also percusses over the Tunnel of Guyon (just medial to pisiform)
-
What is a postive for Tinel's sign in the wrist? What does it indicate?
- Replication of tingling in thumb, index, middle and lateral half of ring finger distal to point of pressure
- Flexor retinaculum --> Carpal tunnel syndrome
- Tunnel of Guyon --> Peripheral neuropathy, ulnar nerve compression
-
How is prayer sign performed? What is another name for it?
- Seated
- Palm's are pressed together for one minute
- Reverse Phalen's
-
What is a positive for Prayer sign? What does it indicate?
- Tingling sensation that radiates into thumb, index, middle and lateral half of ring finger
- Carpal tunnel syndrome
-
How is the carpal lift test performed?
- Seated
- Patient's hand is flat on table
- Doctor stabilizes metacarpals of hand
- Patient lifts each finger off of the table against resistance
-
What is a positive for Carpal lift test? What does it indicate?
- Pain in wrist
- Carpal fracture/sprain
-
How is the Pinch grip test performed?
- Seated
- Patient is asked to approximate the tips of the index finger and thumb (ok sign)
-
What is a positive for the Pinch grip test? What does it indicate?
- If pads touch only (patient can't make tips touch)
- Median nerve compression
- Anterior interosseous syndrome
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