nms tests revised
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7/22/2019 NMS Tests Revised
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NMS I Orthopedics
TESTS HOW TO PERFORM POSITIVE FI NDI NG INDI CATIONS
Rusts Pt spontaneously grabs headw/ both hands when lying
down or arising from
recumbent position
Pain , Very limited Cervical
ROM
Upper Cervical Instability
Severe sprain, RA, Fx, Severe
Cervical subluxation
(TAKE XRAYS ASAP nofurther testing w/o them)
LibmansPt seated, doc standing behind
pt. Doc applies pressure on
pts mastoid process withthumbs until pt reports
pain/discomfort. Compare side
to side.
Pain / Uncomfortable Tests the pts pain tolerance -useful for later procedures
Bakodys Pt abducts & externally rotatesthe ipsilateral shoulder to
place hand on top of head.
Position relieves pt pain
(reduces tension on the
cervical nerve root)
Nerve tension, cervical
radiculopathy
Reverse Bakodys Pt abducts & externally rotatesthe ipsilateral shoulder to
place hand on top of head.
Position increases radicular
pain.
Interscalene compression of
lower brachial plexus.
TOS
Bikeles Pt seated. Abduct shoulder to90 degrees then externally
rotates shoulder. Arm is fully
extended at elbow and pt triesto reach behind them. (As if
you are reaching into the backseat of the car)
Radiation of pain along
brachial plexus pattern.
Radiation along a nerve root.
Brachial Plexus Neuritis
Brachial Plexus lesion /
Radiating pain along T1
dermatome only KlumpkesPalsy
Stinger injury usually fromlateral flexion / traction injury.
(Injury may cause Neuropraxia
/ Axonotmesis / Wallerian
degeneration)
Brachial Plexus Tension
Test
Pt seated erect. Pt puts hands
behind head w/ shoulders
abducted to 90 degrees andshoulders externally rotated
right before onset of pain. Doc
stands behind pt with hip
touching pt spine for
stabilization. Doc uses ptelbows to slowly pull
backwards.
Radicular pain Nerve Root symptoms of C5
indicate Erb Palsy (C5 Nerve
Root Syndrome)Radiation following more than
1 dermatome indicates a
brachial plexus lesion.
Valsalvas Test Pt seated. Pt asked to takedeep breath in & hold it. While
holding breath pt bears down
Radicular pain SOL causing Nerve Rootcompression
DeJerines Triad(question not test)
Pt reports increase in radicularsymptoms when coughing,
sneezing, or straining during
defecation
Increase radicular symptoms SOL (Aggravation frommechanical attraction of spinal
fluid)
Swallowing Test Pt seated & asked to swallow. Pain or inability to swallow Esophageal irritation via directtrauma or retroesophageal
SOL, severe strain/sprain, Fx,
Disc protrusion/herniation,
Osteophyte.
Naffzigers Test Pt seated. Doc occludesjugular vein bilaterally for 30-
40 seconds. Pt then asked to
cough
Local or radicular pain in
spine
SOL
* do not do on pt w/ cardiac
problems
Barre-Lieou Pt seated. Doc tells pt toslowly rotate head side to side
(BP & pulse are taken beforetest)
Vertigo, Blurred vision,
Nausea, Syncope, Nystagmus
Vascular Compromise
Vertebrobasilar FunctionManeuver
Pt seated. Subclavian &carotid arteries auscultated for
buits. Then palpate. If bruitspresent do not perform. Pt
rotates head to left &
hyperextends. Repeat on right.
Vertigo, Blurred vision,Nausea, Syncope, Nystagmus
Vertebral, Basilar, or Carotidartery stenosis/compression
DeKleyns Pt supine. Pt head off table doctells pt to hyperextend & rotate
head hold for 15-45 sec
Vertigo, Blurred vision,
Nausea, Syncope, Nystagmus
Vascular Compromise
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Distraction Test Pt seated. w/ hands on glabellaand EOP slightly traction pts
head upward.
1. Local pain increases
2. Peripheral pain decreases
3. Local pain decreases
1. Muscle, ligament, or joint
capsule damage
2. IVF encroachment, cervical
radiculopathy3. Facet impingement
Foraminal Compression Active C ROM performedfirst.
Pt seated doc places
downward pressure on pthead/neck. Head is rotated to
each side with similar
compression.
1. Radicular pain
2. Local Neck pain
1. Foraminal (cervical Nerve
Root) encroachment,
radiculopathy
2. Sprain/strain
Jacksons CompressionTest
Pt seated. Head is laterally
flexed toward shoulder. Doc
exerts downward compression.(Bilaterally tested)
Radicular pain IVF encroachment
(radiculopathy)
Facet irritation (local pain)
Maximum Cervical
Compression
Pt seated Pt actively rotates
head & hyperextends neck to
side of complaint. Repeats onopposite side
Radicular Pain IVF encroachment
*Tight stretching pain onconvex side muscle strain
Spurlings Test Pt seated. Pt head is laterallyflexed to side of complaint.Doc applies compression to
head/neck. Neck then
extended/rotated and
compressed. Doc then applies
a vertical blow to top of head
Radicular Pain Foraminal / Nerve Root
encroachment
Facet involvement local pain
Lhermittes Test Pt seated in neutral position.Head/neck passively flexed to
pt chest
Sharp radiating pain down
spine & upper/lower
extremities.
Bilateral arm/leg pain
Cervical
myelopathy.radiculopathyUnilateral arm/leg pain
following a dermatome
Nerve Root traction .
Pt. may have MS, Stenosis,
Tumor, Disc herniation
O'Donahues Passive and active resistedROM or any joint.
Pain Pain w/ active strain
Pain w/ passive sprain
*test can be used on any joint
in body*
Kernigs Sign Pt supine doc flexes pt hip &
knee 90 degrees doc then triesto extend leg
Pain in spine or involuntary
flexion of the oppositeknee/hip
Pain with fever meningitis
Brudzinskis Sign Supine pt flexes head/necktoward xiphoid process/chest
Involuntary hip and knee
flexion
Pain & fever meningitis
Shoulder Depressor Test Pt seated. Doc depresses ptshoulder on affected side &
laterally flexes neck awayfrom shoulder.
Radicular pain
produced/aggravated
Dural sleeve adhesion of
spinal Nerve Root, adjacent
joint capsule, brachial plexustraction.
* common hyperextension
injury especially in young.
Soto Hall Test Pt supine. Doc supports pthead w/ one hand & knife-
edge contact on sternum w/
opposite hand. Pt actively
flexes head/neck to chest . Docfollows w/ passive head/neck
flexion to chest
Pain Local pain w/ active musclesprain.
Local pain w/ passive
ligament strain.
FractureFacet Involvement
Allens Test Pt seated. Affected elbow isflexed & arm supinated. Dococcludes radial and ulnar
arteries. Pt pumps hand
open/close. Then opens hand
and doc will release 1 artery soblood flow can resume.
Repeated on other artery.
Performed bilaterally.
Circulation should return in 5
seconds or less.
Vascular Compromise
TOS
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Adsons Test Pt seated. Doc palpates theradial artery. Pt rotates head to
affected side. Pt extends neck
as far as possible. Pt holdsbreath for 10 sec.
Decrease of pulse amplitude
Paresthesia
Neurovascular compromise of
Subclavian A due to Scalenus
Anticus or Cervical Rib TOS
Modified Adsons Test Same as above but rotate headtoward unaffected side.
Decrease of pulse amplitude
Paresthesia
Scalene medius & Cervical
rib TOS
Halsteads Test Pt seated. Doc palpates radial
pulse of affected arm. Docapplies downward traction on
arm while pt hyperextendsneck. (If negative do test with
pt rotating head to opposite
side
Decrease of pulse amplitude
Paresthesia
Scalene medius & Cervical
Rib TOS
Allen's Maneuver Test Pt seated. Doc flexes ptselbow to 90, palpates the
radial pulse while shoulder is
abducted and externally
rotated. Pt. rotates head awayfrom side being tested.
Pulse disappears TOS
Roos TestHostage test
Pt seated. Abduct both arms to
90, flex elbows to 90 andexternally rotate. Pt
opens/closes fist for 3 min or
until symptoms occur.
Paresthesia/tingling, pain,
weakness
TOS
Wrights TestHyperabduction test
Pt seated. Doc palpates Radialpulse of affected arm. Doc
passively abducts arm to 180
degrees. Note angle of
abduction where pulsedisappears/decreases.
Compare to opposite side
Loss of pulse / Tingling
(look at amplitude of
symptoms)
Hyperabduction syndrome(compression of axillary artery
under the pec minor)
Costoclavicular ManeuverTest
Pt seated with arms on thighs
and palms up. Doc palpatesradial pulse. Pt told to draw
shoulders down and back,
lower chin to chest and take a
deep breath and hold for 10sec.
Cessation or dampening of
radial pulse, ischemic colorchange, paresthesia, radicular
pain in upper extremity.
Clavicle and first rib TOS (due
to poor posture, cervical rib,bone tumor, or poorly united
fx of clavicle)
Apley's Scratch Test Pt seated. Place affected handbehind head to touch opposite
superior angle of scapula.The place hand behind back
and touch inferior angle of
scapula Compare bilaterally.
Reproduces shoulder pain Exacerbation of pain
degenerative tendonitis
(especially supraspinatus)
Apprehension Test Pt seated. Shoulder is abductedand externally rotated (Ant
Shoulder).
Pt supine. Shoulder flexed &internally rotated doc applies
posterior force (post shoulder)
Pain / pay attention to look on
pt face.
*instable shoulder candislocated w/ this test
Anterior or Posterior Shoulder
Dislocation trauma
Codmans Drop Arm Test Pt seated. Doc passivelyabducts affected arm. Docsuddenly removes support at
an angle about 90 degrees
Pt cannot stop arm from
dropping / Pain
Rotator cuff tear / injury
(specifically rupture ofsupraspinatus tendon)
Dawbarns Test Pt seated Doc palpatesaffected shoulder deeply for
localized tenderness at the
subacromial bursa. Hold
pressure as arm is passively
abducted.
Pain disappears. Pain disappears subacromialbursitis
Dugas Test Pt seated places affected sideshand on opposite shoulder &
tries to touch chest w/ elbow
Inability to move elbow or
pain
Propensity for shoulder to
dislocate anteriorly.
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Impingement Test Pt seated. Pts arm is slightly
abducted and moved fully
through flexion by the doctor.(Jams greater tuberosity into
ant inf acromial surface).
Pain in shoulder Overuse injury of
supraspinatus tendon
(sometimes biceps tendon)
Speeds Test Pt seated. Forearm is flexedand supinated. Pt flexes
shoulder against resistance.
Pain / tenderness in thebicipital groove.
Bicipital Tendonitis
Supraspinatus Press Test Pt seated shoulders areabducted to 90 degrees. Theshoulders are medially rotated
& angled 30 degrees forward
w/ thumbs pointing to floor.
Doc applies resistance toabduction while observing for
weakness/pain.
Pain / Weakness in shoulder Supraspinatus muscle/tendon
tear
Yergasons Test Pt seated w/ elbow flexed. Ptresists doc pronating and
extending the arm. Docs other
hand is palpating the inter-
tubercular groove
Clicking or pain over theintertubercular groove
Pain = Bicipital TenosynovitisClicking = tear of transverse
humeral ligament
Load & Shift Test While stabilizing the scapula,the doc performs the
following:Push I-S, P-A for Ant CapsulePush I-S, A-P for Post Capsule
Pull S-I for Inf Capsule
Sulcus Line / Pain / Laxity Shoulder Capsule Instability /
loosening
Propensity to dislocate
OBriens Pt arm flexed forward to 90degrees w/ elbow extended &arm adducted to 15 degrees.
Part 1: arm in internal rotation
(thumbs down). Part 2: arm in
external rotation (palm up).Doc applies downward
pressure while pt resists.
Pain on part 1 or part 2 Pain during part 1: anterior
labrum tear, SLAP lesionPain during part 2: biceps
tendonitis
* Positive Speeds & OBriensindicates Type II SLAP lesion
Lift Off Test Pt places dorsum of hand onlow back. Pt then lifts hand off
back as far as possible.
Compare side to side.
Inability to life the hand off
the back as far as the otherside.
Pain on Ant Shoulder
Subscapularis Tendonitis
Capsulitis
Elbow Flexion TestPt seated and actively flexeselbow for 5 minutes
Tingling or paresthesia inulnar distribution of
hand/forearm.
Ulnar paresthesia CubitalTunnel Syndrome
Tinels test at the Elbow Pt seated w/ elbow flexed to90 degrees doc taps groove
between olecranon and lateral
epicondyle. Repeat between
the olecranon and medial
epicondyle.
Hypersensitivity.Tingling radiating toward
forearm
Lateral: Superficial RadialNerve Palsy (degeneration)/
neuroma/neuritis
Medial: Ulnar N palsy /
neuroma / neuritis
Cozens Test Pt seated affected elbowflexed & pronated. Pt makes a
fist. Pt actively extends hand /wrist. Doc applies pressure
against dorsum of hand
Pain near Lateral Epicondyle Lateral Epicondylitis Tennis
Elbow
Radiohumeral bursitis
Golfers Elbow Test Pt seated w/ elbow flexed &hand/wrist supinated. Pt makesa fist and actively flexes the
wrist. Doc applies pressure toextend wrist and pt resists.
Pain near Medial Epicondyle Medial Epicondylitis Golfers
Elbow
Lift Test Cozens & Golfers Testperformed with weights
instead of pressure
Pain near Medial / Lateral
Epicondyle
Medial / Lateral Epicondylitis
Ligament Instability Test Pts elbow slightly flexed. Docstabilizes elbow while
applying an adduction (varus)
force to the distal forearm to
test the LCL. Then anabduction (valgus) force is
applied to test the MCL.
Laxity, decreased mobility,altered pain.
Adduction force: medialcollateral ligament instability
(sprain)
Abduction force: lateralcollateral ligament instability
(sprain)
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Mills Test Pt seated w/ forearm, fingers,and wrist passively flexed. The
doc pronates and extends the
forearm.
Elbow pain increases Lateral Epicondylitis / Tennis
Elbow
Tinels Test at the Wrist Doc taps over the carpel tunnel Tingling into thumb, indexand middle finger and lateral
half of ring finger.
Carpal Tunnel Syndrome
Phalens Test Doc flexes pts wrists and
pushes them together for 1minute.
Tingling into thumb, index and
middle fingers and lateral halfof ring finger.
Carpal Tunnel Syndrome
Froments Test Pt. Grasps a piece of paperbetween thumb and index
finger. Doc pulls paper away.
Distal phalanx of thumb goes
into flexion when paper is
pulled away.
Ulnar nerve injury
Pinch Grip Test Pt asked to pinch tips of indexfinger and thumb together.
Unable to pinch the tips of the
index finger and thumb
together
Pathology of the anterior
interosseous nerve
Bunnell-Littler Test MCP joint held slightlyextended while doc moves the
PIP joint into flexion.
PIP joint cannot be flexed Osteoarthritis (capsular
contraction)
Finkelsteins Test Doc stabilizes the forearm andulnar deviates the wrist.
Pain over the abductor pollicis
longus and the extensor
pollicis brevis tendons at the
wrist
DeQuervainss or Hoffmans
disease tenosynovitis of the
thumb
Mankopfs Test Take pts resting HR. Apply
firm pressure over area ofpain.
Pulse increase of 10 or more
bpm
Pain is real they are not
faking/malingering.
THORACIC TESTS
Adams Position Pt has high shoulder &/orvisible scoliosis while standing
/ Doc watches for change inscoliosis while Pt flexes at
waist
High shoulder / High hip uponflexion
Usually the Rt. side
Scoliosis Remains duringflexion Structural or
Pathological ScoliosisScoliosis disappears during
flexion Functional Scoliosis
(90% F / functional best
treated w/ chiro care)
Amoss Sign Pt in side lying position isasked to move to a seated
position. Doc observes for
pain/discomfort or the use ofupper body strength
(hands/arm/abs) to assist in
rising from a supine/side lying
position
Rising elicits localized pain in
Thoracics or Thoraco-Lumbararea or Pt uses upper body to
help themselves up
AS, IVD syndrome,
sprain/stain(AS will also have decreased
ROM, decreased chestexpansion, tender sternum & T
spine)
Beevors Sign Pt supine, does partial crunch(enough to lift shoulders off
table) doc observes umbilicusfor deviation
Deviation of umbilicus (will
deviate in the opposite
direction of weakness)(Rectus Ab. Innerv T7 T12)
Ex Umbilicus moves to R
shoulder weakness in LLQ
showing a left T10 12 lesion(lower Thoracic myelopathy)
Chest Expansion Test Measure chest during maximalinspiration & maximal
expiration at the 4thintercostalspace (nipple line).
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LUM BAR TESTS
Adams Position Pt has high shoulder &/orvisible scoliosis while standing
/ Doc watches for change in
scoliosis while Pt flexes at
waist
High shoulder / High hip uponflexion
Usually the Rt. side
Scoliosis Remains duringflexion Structural or
Pathological Scoliosis
Scoliosis disappears during
flexion Functional Scoliosis
(90% F / functional besttreated w/ chiro care)
Amoss Sign Pt in side lying position isasked to move to a seated
position. Doc observes for
pain/discomfort or the use ofupper body strength
(hands/arm/abs) to assist inrising from a supine/side lying
position
Rising elicits localized pain inThoracics or Thoraco-Lumbararea or Pt uses upper body to
help themselves up
AS, IVD syndrome,sprain/stain(AS will also have decreased
ROM, decreased chestexpansion, tender sternum & T
spine)
Antalgia Sign Doc observes an antalgicposture / lean to one side torelieve pts pain
Pain Relief
Away from side of pain PLLToward side of pain PLM
Forward w/ little relief
central Rhizel
Disc herniation / bulge
(pt is not locked into position -
that would indicated
tortipelvis)
Straight Leg Raiser (1) Pt supine. Raise leg straight upon side of pain.
Pain reproduced (note angle &
location of pain)
0-30 = SOL (N or N Root
irritation)
30-60 = SIJ inflammation /
sciatica60+ = Lumbosacral problem
Bechterews Test Pt sits w/ hips & knee at 90degrees. Pt actively extends
leg at knee
Pain from lumbars radiating
down the leg (reproduced)
SOL, IVF encroachment,
Radiculopathy, nerve root
tension, sciatica
Braggards Sign (2) Straight Leg Raiser whenpain is elicited, lower the leg 5
degrees and dorsiflex foot
Radiating Pain (reproduced) SOL, IVF encroachment,
Radiculopathy, nerve root
tension, sciatica
Crossed Straight LegRaiser (5)
Pt. Supine. Raise leg straight
up on asymptomatic side.
Pain reproduced on the
affected leg (opposite the side
being tested)
Medial bulge on symptomatic
/ painful side
SOL, IVF encroachment,
Radiculopathy, nerve roottension, sciatica
Fajersztajns Test (6) Well Leg Braggards straight leg raiser on well side.when pain is elicited lower the
leg 5 degrees and dorsiflex the
foot
Radiating Pain on
symptomatic side (reproduced)
Pain at same angle as
Braggards PLM bulgePain at greater angle PLL
bulge.
Coxs Sign (4) During the Straight leg raisertest the pt raises ipsilateral hip
to relieve pain
Pain / Roll to opposite side SOL, IVF encroachment,Radiculopathy, nerve root
tension, sciatica
Elys Heel to Buttocks Pt prone. Doc touches foot tocontralateral buttocks
Pain in anterior thigh / groinarea (ipsilateral leg testing)
Radiating: Femoral N, or Nroot compression
Localized: Quadriceps muscle
contracture.
Anterior thigh pain from L2-4
NR, Hip lesion (rule out AVN,OA, TB, subluxation)
Femoral Nerve Traction
Test
Pt side lying, bottom leg is
straight, top leg bent at knee,extend thigh back on affected
side to traction the femoral n
Pain on Ant Thigh
To groin L3To mid tibia L4
Femoral N or N root
compression.If bilateral in elderly prostate
hypertrophy/cancer
Heel/Toe Walk Test Walk on heels
Walk on toes
Cant walk on heels
Cant walk on toes
Cant walk on heels: L5 N -
L4 IVDCant walk on toes S1 N - L5
IVD
Kemps Test Pt seated. Doc stabilizes Lspine with one hand and
supports contralateral shoulder
w/ other hand. Pt laterally
flexed away from doc, thenflexed forward , laterally bent
toward doc and brought into
extension in one smooth
motion (circumduction)
Radiating leg pain or local lowback pain.
NR irritation / disc herniationRadiculopathy
Local pains
Pain w/ slight rotation or on
convexity capsulitisPain on extension or concavity
facet .
Pain at waist LS sprain/strain
Pain w/ flexion IVD lesion
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Kernigs Sign Pt supine doc flexes pt hip &knee 90 degrees doc then tries
to extend leg
Pain in spine or involuntary
flexion of the opposite
knee/hip
Pain with fever - meningitis
Brudzinski Sign Supine pt flexes head towardthe xiphoid process
Involuntary hip and knee
flexion
Pain & fever - meningitis
Lasegue Test Pt supine doc flexes pt hip &knee 90 degrees doc then triesto extend leg
Pain low back, hip or thigh Hip: hip pathology
Thigh: RadiculopathyBilateral: tight hamstrings
Lindners Sign Pt seated/supine. Passivelyflex head/neck toward xiphoid
process
Pain in L spine or radicular legpain
Compression of Lumbar NR
Milgrams Test Pt Supine and lifts feet 6 offtable (knees in extension) and
told to hold for 30 sec
Unable to hold Due to low back pain:herniation or L strain/sprain
No pain may have weak core
muscles
Minors Sign Pt uses upper body strength tostand from seated position.
(walk up legs)
Recruitment of upper body
strength to stand up
SIJ lesion, L5 strain/sprain, LP
fx, IVD syndrome, Muscular
Dystrophy, Sciatica, myotonia
Nachlas Test (lumbars)Elys Test (buttocks)
Pt prone. Knee is flexed totouch foot to ipsilateral
buttocks
Pain in SI/ lumbosacral area.Radiation of pain down
thigh/leg.
SI or Lumbosacral Problems(sprain/strain)
Ant thigh pain may be from
inflammation of L2-4 NRs.
Quick Test Pt supports self w/ hand ontable/wall and performs ~5
deep squats
Pain / locking / crepitus in low
back, hips, knees, or ankles
(Helps locate problem alongthe kinetic chain)
Subluxation of any involved
joints (Problems with joints)
Do not perform on elderly /pregnant women
Sicards Sign (3) Straight leg raise, lower theleg 5 degrees, dorsiflex big toe
Radiating Pain (reproduced) Irritation to L5 NR (L4 or S1
possible too)
Bilateral Leg LoweringTest
Pt supine, Doc flexes hips to90 degrees with legs extended.
Pt lowers legs to 45 degrees.
Pain in buttocks, SI, lowerextremity, leg drops due to
pain
Lumbosacral sprain/strain,facet syndrome, IVD lesion
PELVI S TESTS
Anterior Innominate Test
(1)
Place unaffected foot 2-3 feet
forward. Flex forward at waist
to touch toes
Local pain over SI joint. Unilateral forward
displacement of ilium, sacrum,
SIJ sprain
Belt Test (2) 1) Patient stands, bendsforward to touch toes note
any pain.
2) Dr. braces hips with handsand places hip tightly against
pt sacrum then pt. bends
forward again note pain.
Pain in lumbar or sacral
regions
If pt had pain in part 1 but no
pain in part 2 or is able to bend
further in part 2 before painful
= SI jointIf pt had pain in part 1 and
pain in part 2 at the same or
lesser degree of flexion =
Lumbar involvement.
Erichsens Test Pt. prone and dr. compressesSI joint by applying pressure
to area of PSIS with thumbs orthenars Creates double IN
ilium
Pain around SI joint Usually caused by Ant
stabilization ligaments
weakness
Gaenslens Test Pt supine, doc stands onunaffected side and bringsaffected knee up toward
patients chest. Then dr.
slowly hyperextends
unaffected leg (may need todrop unaffected leg off table to
achieve hyperextension)
SI joint pain on side being
extended. Radiating pain togroin or thigh.
SI joint sprain, instability.
DDx SI pain fromLumbosacral pain
If neg L5 lesion possible
Goldthwaits Sign Pt. prone while dr. palpates L5
and S1. Dr uses other hand toelevated affected leg.
Pain Pain before separation SI
jointPain after L5/S1 separation
Lumbar
Hibbs Test Prone ThighRoll
Pt prone, flex knee to 90degrees & internally rot femur
(push foot laterally)
Pain Hip (Femoral head oracetabular problems)
Iliac Compression Test Pt laying on side, doccompresses iliac crest toward
table (affected side down)
Creates double EX ilium
Pain / increase pressure in SIJ Sprain Posterior SI ligament /SI inflammation/subluxation
(can also have ilium fx or
pubic symphysis pain)
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Lewin Gaenslen Test Lay on unaffected side. Ptbrings unaffected knee toward
chest. Then dr. slowly
hyperextends affected thigh.
SI joint pain on side being
extended
Muscle tightness
SI joint sprain, arthritis.
Iliopsoas muscle contracture
DDx SI pain from
Lumbosacral pain
Lewin Standing Teststanding straight leg raiser
Slightly flex knees & waist
slightly, cross arms, bend pt
forward to point before pain,
put 1 leg into extension when
stabilizing sacrum
Knee flexes or pt tries to stand
up b/c of pain / tightness
Herniation , SOL, Bulge
Yeomans Test Pt prone. Dr. applies pressureto PSIS with one hand and
places other hand under
ipsilateral knee and lifts flexed
knee off table (extending the
thigh)
Pain in SI joints
Muscle tightness
SI lesion esp Anterior SI ligs
Pain into ant thigh/groin Femoral N irritation (L2-4), or
prostate problems
Iliopsoas or rectus femoris
muscle contracture
HI P TESTS
Actual Leg Length Test Pt supine w/ feet together,knees & hips straight. Doc
measures apex of ASIS to
center of medial malleolus
Difference of more than 6mmfrom side to side
Hip joint of long bonedeficiency (accurate to 1 cm
need x-rays for higher
accuracy)
Apparent Leg Length Test Same as above measuremade from umbilicus to
medial maleolus
Difference of more than 6mm
from side to side
(adds in L3-5 discs w/ sublux
the leg lengths could change)
Pelvic Subluxation
Allis Sign / SaleazzisSign
Pt supine, Knees/Hips flexed,feet flat on table and medial
malleoli & big toes are aligned
side by side doc stands atfoot of table and observes
knees for any height
discrepancy. Dr. then stands
at side of table and looks for
one knee to be more anteriorthan the other.
One knee is lower compared tothe other.
One knee is more anterior
compared to the other
Ipsilateral femoral lengthdiscrepancy (protrusion
acetabuli, hip dislocation PS,
dysplasia, fx)
Anvil Test Pt supine, doc elevates straightleg & hits bottom ofcalcaneous w/ clenched fist
Pain in kinetic chain heel to
acetabulum
Hip pain arthritis, femoral
neck fx, infectionHeel pain calcaneus fx, tibia
fx, fibula fx (depending onpoint of pain)
Gauvains Sign Pt lays on side w/ affected sideup doc grasps above ankle and
abducts leg & then internallyand externally rotates thigh
Ipsilateral contraction of
abdominal muscles / pain in
hip / referred pain to groin, antthigh,
AVN, Infection, Fx, gout,
Hernia, hip tuberculosis (rare)
Hip Telescoping Test Pt supine doc passively flexesknee & hip of affected side to
90 degrees , grasp calf with
one hand and place other handon thigh just proximal to knee
push femur into table anddistract femur away from
table.
Excess joint play and or
palpable click in joint
Hip dislocation / hip dysplasia
MC women (Mediterranean
& Scandinavian)
Patricks Test (mnemonicFABERE)
Pt supine, doc on unaffected
side and patient instructed to
cross legs into a figure 4.
Dr. then stabilizescontralateral ASIS on table
and puts downward pressure
on knee of affected side
Pain in hip or inability to
perform
Hip Pathology (DJD, OA, RA,
SCFE, AVN, Fx, sprain/strain,
tight hip adductors)
Obers Test Pt lies w/ affected side up, docstands behind pt & stabilizes
pelvis doc uses other hand to
abduct & extend thigh at hip
(holding at knee) with knee
bent to 90 degrees doc thenslides hand from knee to ankle
keeping knee bent
Affected thigh remains
abducted may be painful ormay drop w/ spastic jerks
(clonus)
ITB contracture
Common in runners
Thomas Test Pt supine & actively pullsunaffected knee to chest whilekeeping the other leg straight.
L spine maintains lordosis or
pt is unable to keep affectedthigh flat on the table
Flexion contracture or
shortening of iliopsoas onaffected side
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Trendelenburgs Test Pt stands on affected foot andraises unaffected foot off the
ground. (pt can brace
themselves against doc/table)Dr. observes for any pelvic
unleveling.
Iliac crest high on supported
leg and low on lifted leg.
Paralysis / weakness of hip
abductors on affected side
(gluteus medius)
Hip dysplasia
Ortolanis Test Infant supine. Dr. grasps boththighs at level of lesser and
greater trochanters betweenthumbs and fingers. Dr then
flexes and abducts the thighs
bilaterally.
Palpable click/clunk Congenital femoral
dislocation, instability
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NMS II Orthopedics
KNEE TESTS
Abduction (Valgus) StressTest
Pt. supine with legsstraight, Dr. stabilizes the
medial ankle and pusheslateral to medial at theknee. Procedure is thenrepeated w/ knee slightly
flexed (25!).
Pain or increasedmotion/gapping
Medial CollateralLigament strain or rupture.
Adduction (Varus) StressTest
Pt. supine with legsstraight, Dr. stabilizes thelateral ankle and pushesmedial to lateral at the
knee. Procedure is thenrepeated w/ knee slightly
flexed (25!).
Pain or increasedmotion/gapping
Lateral CollateralLigament strain or rupture.
Apleys Compression Test Pt. prone with knee flexed
to 90!. Dr. pushes down on
the foot with leg neutral,then medially rotated and
laterally rotated.
Pain or crepitus withcompression (usually
relieved by distraction)
Internal rotation = lateralmeniscus
External Rotation = MedialMeniscus
Patellar Ballottement Test Pt supine w/ leg straight,Dr. pushes down on the
patella and moves it lateraland medial, palpating formotion
Patella is slow to return toresting position. Increased
motion or spongy jointfeel.
Retropatellareffusion/Intraarticular knee
swelling.
Bounce Home Test Pt. supine and relaxed. Dr.lifts leg and bends knee to
20!. Dr. then allows theknee to drop into fullextension.
Joint line painInability to fully extend
knee:1. Spongy end feel2. Rubbery end feel3. Hard end feel
Meniscal tear
1. swelling/edema2. meniscal tear3. intra-articular
fragment
Clarks Sign (PatellarScrape Test)
Push down on the patellaand ask the patient to
contract the quadriceps.
Retropatellar pain Chondromalacia patella,degeneration of
patellofemoral joint
McMurrays Sign Pt supine, hip and knee
flexed to 90!. Dr. stabilizesknee and grips heel withthe other hand. Dr. rotates
the tibia internally whileapplying a varus forcewhile extending the leg.Repeated with tibia rotatedexternally and Dr. applying
a valgus force whileextending the leg.
Pain or crepitus Int. rot. w/ valgus stress &
extend = lateral meniscusExt. rot. w/ varus stress &extend = medial meniscus
Lateral Pivot ShiftManeuver
Pt. supine, w/ hip and kneeflexed. Adduction, internal
rotation, valgus stress andflex knee.
Knee gives out Anterior Cruciate Lig.
Lachmans Test Drawer test with knee
flexed to 25!.
Pain w/ or w/o increasedanterior (ACL) and
posterior (PCL) translation.
Pain w/ normal translation:sprain. Pain w/ increasedtranslation: rupture.
Drawer Test Pt. supine with knee flexed
to 90!. Dr. pulls the tibia
anterior and then pushes itposterior feeling forexcessive motion.
Pain w/ or w/o increasedanterior (ACL) and
posterior (PCL) translation.
Pain w/ normal translation:sprain. Pain w/ increased
translation: rupture.
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Q-Angle Test Pt. standing. Draw a linefor ASIS through midpointof patella and another linefrom tibial tuberosity
through the midpoint of thepatella. The angle ismeasured between these 2
lines.
Angle is less than 13!. Genu varum
LOWER EXTREMI TY VASCULAR & ANKLE EXAMS
Anterior Drawer Sign Pt. supine or seated. Dr.places one hand on anteriortibia and the other on
posterior calcaneus andpulls the foot anteriorly.
Excessive anteriormovement/translation
Anterior talofibularligament instability
Calf Circumference Test Measure the calf at thewidest point.
Increased or decreaseddiameter comparing side toside
"= acute compartmentsyndrome
#= muscle atrophy
Claudication Test Pt. walks at 2 steps/sec
(120/min) for one minutewhile Dr. observes
Muscle weakness,
cramping, pain, discomfortor color change (palor)
Peripheral vascular disease,
intermittent vascularclaudication, popliteal a.entrapment syndrome,atherosclerosis
Homans Sign Pt. supine raise leg up to
10!, squeeze calf andquickly dorsiflex the foot
Short duration, deep calf
painPersistent achy calf pain
Thrombophlebitis
Gastrosoleus strain
Moses Test Pt. prone, flex knee to 90!and squeeze calf.
Short duration, deep calfpain
Persistent achy calf pain
LE vascular insufficiency,thrombophlebitis,arteriosclerosis obliterans
Gastrosoleus strain
Thompsons Test Pt. prone, flex knee to 90!
and squeeze the calf
No plantar flexion
Localized painShort, deep pain
Ruptured Achilles tendon
Gastroc/soleus sprainthrombophlebitis
FOOT TESTS
Duchennes Sign Apply upward force to
head of 1stmetatarsal
Supination of foot with
attempted plantar flexion
Superficial peroneal n.
lesion or L4-S1 lesion
Helbings Sign Pt stands Dr. observes
the Achilles tendon
Medial curving of Achilles Overpronation syndrome
Common with CerebralPalsy
Mortons Test Squeeze foot around the
metatarsal heads
Pain Mortons neuroma (usually
between 3rd
and 4th
digits),arthritis, stress fx ofmetatarsal heads,Metatarsalgia (less
localized/generalized pain)
Strunskys Sign Rapidly flex patients toes Forefoot pain Metatarsalgia, OA
Tinels Foot Tap posterior aspect of
medial malleolus (post.Tibial n./medial plantar n.)and dorsum of foot (deep
peroneal n)
Pain in the toe, arch, or
heel
Nerve compression
syndrome, Tarsal TunnelSyndrome (Post. Tibialnerve)
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MISC
Burns Bench Test Stand, bend, and note angleof painKneel on bench and bendforward
Should be able to bendfarther when kneeling
because the tension is offof the sciatic n.
Indicates malingering objective findings to notmatch the subjectivecomplaint
MannKopfs Test Take pts resting HR.
Apply firm pressure overarea of pain.
Pulse increase of 10 or
more bpm.
Pain is real They are not
faking/malingering.
Libmans Test Pt. seated, Dr. standingbehind pt. Dr. applies
pressure on the ptsmastoid process withthumbs until pt reports
pain/discomfort. Compare
side to side.
Pain/Uncomfortable Tests the pts paintolerance useful for later
procedures and todetermine malingering.
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