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Orthopedic Tests -MT

TMJ / Cervical / Thoracolumbar

TestPurposeMethodPostive Sign
Jaw Reflex (TMJ) Integrity of Trigeminal (CN V) Elicit a reflex contraction of jaw. Client's jaw is relaxed and open. Therapist places thumb on client's chin, presses down slightly and hit thumb with hammer. Hyperreflexia or hyporeflexia
Chvostek Test (TMJ) Integrity of Facial (CN VII) Tap area of nerve. Therapist taps fingers over client's masseter muscle. Twitching in masseter
3-Finger Test (TMJ) Assessing for restrictions in active ROM in the jaw Instruct client to insert three stacked fingers in their mouth Inability to open mouth wide enough
Cervical Compression (Spurling's) Test (Cervical) Assess for cervical disc protrusion, narrowing of the IVFs and irritation of facet joints Client seated, push directly on the top of their head Disc: local pain, may be accompanied by shooting pain IVF: shooting pain NOTE: Always follow with cervical distraction
Cervical Distraction Test (Cervical) Assess for possibility of ligament injury as cause of pain Client supine, separate vertebrae (distract them) Local pain indicated ligament injury.
Kemp's Test (Cervical) Assess for cervical disc protrusion, narrowing of the IVFs and irritation of facet joints. Same as Compression test, but places more emphasis on facets. Client seated, head rotated to one side. Push directly on top of their head. Disc: local pain, may be accompanied by shooting pain IVF: shooting pain NOTE: Always follow with cervical distraction
Quadrant Test (Cervical) Testing for vertebrobasilar insufficiency Place cervical spine in a position that may apply pressure to vertebral arteries. Client supine, head extended off table, pillow underneath upper back. Bring head into sidebending with ipsilateral rotation. Observe for 8-12 seconds. Dizziness, nausea, nystagmus, faintness, tinnitus, slurred speech
Backward Bending Test (Cervical) Testing for vertebrobasilar insufficiency Place cervical spine in a position that may apply pressure to vertebral arteries. Client supine, head extended off table, pillow underneath upper back. Bring head into hyperextension. Observe for 8-12 seconds. Dizziness, nausea, nystagmus, faintness, tinnitus, slurred speech
Maigne's Test (Cervical) Testing for vertebrobasilar insufficiency Place cervical spine in a position that may apply pressure to vertebral arteries. Client supine, head extended off table. Head is brought into full extension with rotation to same side. Observe for 8-12 seconds. Dizziness, nausea, nystagmus, faintness, tinnitus, slurred speech
Lumbar Quadrant Test (Thoracolumbar) Assessing for lumbar disc protrusion, IVF narrowing or facet irritation Place lumbar spine in position that will partially close foramen. Client standing, shoulders supported by therapist. Instruct client to reach behind and attempt to touch their opposite ankle. Reproduction of symptoms of local or shooting pain. Facet=local, Disc=local/shooting, IVF=shooting
Straight Leg Raise (Thoracolumbar) Assessing for cause of low back and posterior leg pain Attempt to stretch structure of posterior leg, glutes and low back. Client supine, therapist grasps affected leg and raises it until client feels pain. Follow with Braggard's Test. Pain in posterior leg. May be caused by tight hamstrings or sciatic nerve irritation. Sciatic pain will be detected before leg in at 70 degrees... if pain is felt after that, likely muscular
Braggard's Test (Thoracolumbar) Confirmation of sciatic pain as cause of posterior leg pain From straight leg position, lower client's leg until pain disappears. Passively dorsiflex client's ankle. Reproduction of pain confirms that sciatic nerve is irritated.
Well's Leg Raise/Lermitte's Test/Crossed Extension Straight Leg Raise (Thoracolumbar) Assessing for possibility of space occupying lesion as cause of sciatic irritation Bring pelvis into posterior tilt which will cause disc to bulge posteriorly. Client supine, perform straight leg raise on unaffected side. Reproduction of pain in affected leg.
Slump Test (Thoracolumbar) Dural entrapment as case of the client's sciatic pain Stretch sciatic nerve and apply pressure to root. Client seated on edge of table. Instruct them to slump over, applying additional pressure with your forearm. Client's neck flexed forward; knee on affected side brought into extension; dorsiflex ankle Symptoms should increase with each added step. Once head and neck are released, should experience noticeable decrease in symptoms
Valsalva's Maneuver (Thoracolumbar) Testing for presence of space occupying lesion, ie. tumor Increase pressure inside and outside spinal nerves. Client holds breath and bears down as if to cause bowel movement Pain when pressure in area is increased.
Hoover's Test (Thoracolumbar) Help determine whether client is malingering or withholding effort Instruct client to perform movement where effort can be detected. Client supine, therapist places hands underneath both heels. Instruct client to raise one leg. No increased pressure felt under opposite heel could be indication that client is not trying to perform action.
Function vs Structural Scoliosis (Thoracolumbar) Assess to determine whether lateral curves in spine are structural or functional Bend spine to assess whether curves change. Client standing, instruct them to bend laterally to both sides, then flex forward. Observe for changes. Curves are considered functional if curve or rib hump change or correct during movement. If there is no change, they are considered structural.
Chest Expansion Test (Thoracolumbar) Test for presence of rib dislocation or fixation Measure the circumference of ribcage on expiration and inspiration. Wrap measuring tape around client's rib cage. Measure after a full breath, then after complete exhalation. Difference of less than one inch may indication rib fixture. Difference of greater than 3 inches may indicate dislocation.
Created by: beck.thomson on 2009-03-22



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