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PCOM #101
PCOM Ortho Neuro Exam 2 - final
| TEST | TECHNIQUE | POSITIVE SIGN | DIAGNOSIS |
|---|---|---|---|
| Sitting Root Test (lumbar) | Patient seated: (1) with flexed neck and hips at 90° (i.e., pt is ""slumped""), pt is asked to extend knee [optionally, to catch pt off guard, examiner can passively extend the knee while pretending to examine the foot] | PAIN (+) patients who arch backward and complain of pain into the buttock, posterior thigh and/or calf when the leg is straightened present with sciatica | sciatica |
| Prone Knee Bending (Nachlas) Test (lumbar) | Patient prone: (1) examiner passively flexes pt's knee as far as possible so that the pt's heel rests against the buttock (examiner should ensure pt's hip is not rotated) [optionally, Prone Gapping Test can be done by medially rotating pt's hip while perf | PAIN (+) unilateral neurological pain in the lumbar, buttock and/or post thigh may indicate L2 or 3 nerve root lesion (-) anterior thigh pain indicates femoral nerve pathology or tight quadadriceps | sacroiliac (SI) joint dysfunction, L2 or L3 nerve root lesion; or tight rectus femoris |
| Femoral Nerve Traction Test (lumbar) | Patient side-lying, test side up: (1) pt lies w straight back & flexed head on unaffected side, hips & knees slightly flexed (2) examiner grasps pt's affected leg & extends knee, then gently extends hip 15° (3) examiner then flexes the affected knee | PAIN (+) neurological pain radiating down the anterior thigh indicates pathology of the femoral nerve (-) since this also tracts the nerve roots originating from L2-L4, this can also indicate a pathology in that area | femoral nerve neuropathy |
| Crossed Femoral Stretching Test (lumbar) | Patient side-lying, test side down: (1) pt lies w straight back & flexed head on affected side, hips & knees slightly flexed (2) examiner grasps pt's unaffected leg & extends knee, then gently extends hip 15° (3) examiner then flexes the unaffected knee | PAIN (+) pain in groin and hip that radiates along the anterior medial thigh indicates L3 nerve root lesion (+) pain extending to the mid-tibia indicates L4 nerve root lesion | L3 (anterior medial thigh) or L4 (mid-tibia) nerve root lesion |
| Straight Leg Raising (Lasègue's) Test (lumbar) | Patient supine: (1) pt is fully relaxed with hips adducted in medial rotation, and knees extended (2) testing the unaffected leg first, examiner flexes pt's hip until pt complains of pain or tightness (3) examiner carefully drops leg slightly until there | PAIN (+) pain that occurs < 70° is sciatica (-) pain that occurs > 70° is a pathology in the lumbar or SI joints (-) tightness in back or back of thigh, calf or foot would indicate tight hamstrings | < 70° is sciatica (sciatic nerve is completely stretched after 70°) > 70° is lumbar or sacroiliac (SI) joint pathology (once the sciatic nerve is completely stretched, if pain occurs after that point, the pathology will be in the spine: stretching/irritat |
| Bilateral Straight Leg Raising Test (lumbar) | Patient supine: (1) pt is fully relaxed w knees extended (2) examiner carefully lifts both legs by flexing pt's hips until pt complains of pain or tightness | LOW BACK PAIN (LBP) (+) gluteal pain, posterolateral thigh pain or lateral leg pain indicates sciatica | < 70° lesion in the SI joint > 70° lesion is in the lumbar spine" |
| Gaenslen's Test (pelvis / hip) | Patient supine: (1) pts flexes unaffected hip against the chest (2) while examiner stabilizes pt's pelvis, pt hyperextends other hip off side of table | PAIN (+) pain in the SI Joint, hip or LE dermatome of the affected leg | sacroiliac (SI) joint pathology, hip pathology or L4 nerve root lesion |
| Sacroiliac Rocking (Knee-to-Shoulder) Test (pelvis / hip) | Patient supine: (1) examiner fully flexes pt's hip and knee while adducting pt's hip (2) examiner ""rocks"" the SI joint by moving pt's knee toward and away from the opposite shoulder [optionally, hip is medially rotated to maximize stress on the sacroili | SI JOINT PAIN (+) pain in the SI joint indicates a positive test | sacroiliac (SI) joint pathology |
| Gillet's (Sacral Fixation) Test (pelvis / hip) | Patient standing: (1) examiner palpates pt's posterior superior iliac spine (PSIS) w one thumb while the other is parallel to the first, on the sacrum (~SF2) (2) examiner asks patient to stand on one leg while pt lifts opposite knee to the chest; repeat b | PSIS MOVING UP (+) reduced or reversed motion (PSIS moving up) of SI joint on side of raised leg indicates hypomobility of the SI joint | sacroiliac (SI) joint is hypomobile or "blocked" |
| Trendelenburgs Test or Sign (pelvis / hip) | Patient standing: (1) examiner palpates—skin-on-skin—pt's PSIS and notes positioning; (2) examiner has pt stand & balance on one leg, while the examiner observes any movement of the pt's pelvis; repeat bilaterally | PELVIS DROPS (+) if the pelvis drops on the side of the non-stance (non weight-bearing) leg, this is a sign of instability of the hip abductor muscles | weak or unstable m. gluteus medius on the weight bearing side |
| Patrick's (Faber) Test (pelvis / hip) | Patient supine: (1) examiner places foot of pt's test leg on top (just proximal) of the contralateral knee (2) examiner applies posterior pressure, and gently lowers test knee toward table | TEST KNEE ABOVE OPPOSITE LEG (+) if the test knee does not lower to at least parallel with the opposite straight leg, this indicates the hip joint is affected | hip or sacroiliac (SI) joint pathology, iliopsoas spasm |
| Stinchfield Resisted Hip Flexion Test (pelvis / hip) | Patient supine: (1) w pt's knee extended, pt is instructed to flex hip to 30° against the examiner's resistance | PAIN (+) pain in the hip & groin indicates intra-articular pathology of the hip joint, including labral tear, synovitis, arthritis, occult femoral neck fracture, iliopsoas tendinitis / bursitis, and prosthetic failure or loosening (+) pain in the low back | hip joint pathology (pain in anterior hip & groin) or lumbar/SI joint pathology (pain in posterior hip & low back) |
| Ely's Test (Tight Rectus Femoris, Method 2) (pelvis / hip) | Patient prone: (1) examiner passively flexes pt's knee; repeat bilaterally and compare sides | IPSILATERAL HIP FLEXION (+) if patient's ipsilateral hip spontaneously flexes while knee is being flexed, it indicates that the m. rectus femoris is tight on that side | tight m. rectus femoris |
| Thomas Test (pelvis / hip) | Patient supine: (1) examiner checks first for excessive lordosis (normally present w tight hip flexors) (2) examiner flexes pt's one hip, bringing knee to chest to flatten out the lumbar spine and stabilize the pelvis; pt holds leg (3) examiner observes t | THIGH COMES OFF TABLE (+) if the thigh of the straight leg rises off the table, this indicates a hip flexion contracture of the straight leg (-) if straight leg abducts as the other legs is flexed, this is the ""J"" sign and indicates a tight iliotibial b | hip flexion contracture or hip joint contracture |
| Rectus Femoris Contracture (Kendall, Method 1) Test (pelvis / hip) | Patient supine: (1) pt hangs flexed knees over end of table; (2) examiner asks pt to flex one hip, bringing knee toward chest, and to hold it; (3) if contralateral knee, the test knee, begins to extend, examiner can passively hold knee in flexion, and pal | CONTRALATERAL KNEE EXTENDS (+) the angle of the contralateral leg should remain flexed to 90°, if it does not, it indicates muscle or joint tightness (-) if upon palpation, the muscles do not feel tight, then restriction is due to tight joint structures, | m. rectus femoris contacture or tightness in the joint structures |
| Piriformis Test (pelvis / hip) | Patient side-lying, test-side up: (1) pt flexes test hip to 60° w knee flexed (top ankle supported by bottom thigh) (2) examiner stablizes hip w one hand while applying downward pressure to knee | PAIN (+) sharp pain radiating to the buttocks, or duplication of sciatica symptoms would indicate piriformis syndrome, i.e., piriformis causing a pinch in the sciatic nerve (-) pain specific to m. piriformis indicates a tight piriformis muscle | piriformis syndrome (sciatica pain) or tight m. piriformis (muscle pain) |
| Ober's Test (pelvis / hip) | Patient side-lying, test-side up: (1) pt's bottom hip & knee flexed for stability; (2) from behind, examiner stablizes pt's hip w superior hand, while passively abducting and slightly extending pt's test hip (to position the TFL over the greater trochante | LEG REMAINS ABDUCTED (+) if leg does not drop with examiner's lower hand this indicates a TFL contracture (-) pain or paresthesia at any point during the test can indicate involvement of the femoral nerve (-) tenderness over the greater trochanter can ind | contracture of the tensor fasciae latae (TFL), femoral nerve pathology or trochanteric bursitis |
| Abduction (Valgus Stress) Test (knee) | Patient seated or supine: (1) pt fully extends test knee and slightly laterally rotates lower leg; (2) standing to pt's side, examiner's superior hand contacts pt's lateral knee while the inferior hand stabilizes pt's ankle (3) examiner applies a medial s | EXCESSIVE MEDIAL DEVIATION (+) the tibia moving away from the femur when a valgus stress is applied to a bent knee suggests major instability of the knee joint due to injury to MCL, POL, PCL, or posteromedial capsule (+) instability w extended knee furthe | medial instability of the knee, often due to medial collateral ligament (MCL) injury |
| Adduction (Varus Stress) Test (knee) | Patient seated or supine: (1) pt fully extends test knee; (2) standing to pt's side, examiner's superior hand contacts pt's medial knee while the inferior hand stabilizes pt's ankle (3) examiner applies a lateral stress to the knee; test is repeated w kne | EXCESSIVE LATERAL DEVIATION (+) the tibia moving away from the femur when a varus stress is applied to a bent knee suggests major instablity of the knee joint due to injury to LCL, posterolateral capsule, or arcuate-popliteus complex (+) instability w ext | lateral instability of the knee often due to lateral collateral ligament (LCL) injury |
| Drawer Sign (Anterior) (knee) | Patient supine: (1) pt flexes knee to 90° & hip to 45°; examiner stabilizes pt's foot by sitting on it (2) examiner interlocks both hands behind the proximal tibia; examiner draws the tibia forward on the femur | TIBIA MOVES FORWARD (+) the tibia moving anteriorly in relation to the femur more than 6mm indicates possible injury to ACL, postero-lateral or -medial capsules, MCL (deep fibers), TFL, POL, or arcuate-popliteus complex (-) anterior movement can also occu | instability to the knee joint due most often to anterior cruciate ligament (ACL) laxity |
| Drawer Sign (Posterior) (knee) | Patient supine: (1) pt flexes knee to 90° & hip to 45°; examiner stabilizes pt's foot by sitting on it (2) examiner places the web of both hands over the tibial tuberosity and pushes the tibia back on the femur | TIBIA MOVES BACKWARD (+) the tibia moving posteriorly in relation to the femur suggests possible injury to PCL, arcuate-popliteus complex, POL, or ACL | instability to the knee joint due most often to posterior cruciate ligament (PCL) laxity |
| Slocum Test (knee) | Patient supine: (1) pt flexes knee to 90° & hip to 45°; examiner medially rotates pt's foot 30° and sits on pt's forefoot to stabilize (2) examiner interlocks both hands behind the proximal tibia and draws the tibia forward. Perform bilaterally to compare | EXCESSIVE ANTERIOR MOVEMENT / ROTATION (+) excessive movement of the tibia away from the femur on the lateral side of the knee indicates anterolateral rotary instability (+) excessive movement on the medial side indicates anteromedial rotary instability | anterolateral rotary instability (movement on lateral side) or anteromedial rotary instability (movement on medial side) |
| Hughston's Posteromedial and Posterolateral Drawer Sign (knee) | Patient supine: (1) pt flexes knee to 90° & hip to 45°; examiner medially rotates pt's foot 30° and sits on pt's forefoot to stabilize (2) examiner places web of both hands over the tibial tuberosity and pushes the tibia posteriorly on the femur. Perform | EXCESSIVE POSTERIOR MOVEMENT / ROTATION (+) foot in medial rotation: excessive posterior movement or rotation on the medial aspect indicates posteromedial rotary instability (+) foot in lateral rotation: excessive posterior movement or rotation on the lat | posteromedial rotary instability (movement on medial side) or posterolateral rotary instability (movement on lateral side) |
| A positive test indicates there may also be injury to the PCL, ACL, MCL, posterior oblique ligament, semimembranosus tendon, posteromedial capsule and/or the medial meniscus" | |||
| McMurray Test (knee) | Patient supine: (1) pt flexes knee to 90° & hip to 45°; (2) examiner cups the calcaneus with inferior hand while supporting pt's lateral knee w superior hand, fingers 2-4 aligned along the medial joint line (3) examiner medially rotates pt's tibia and ext | CLICKING & PAIN (+) tibia medially rotated: clicking sound in knee often accompanied by pain indicates a loose fragment of the lateral meniscus (+) tibia laterally rotated: clicking sound in knee often accompanied by pain indicates a loose fragment of the | joint mice" (loose fragment in the joint) or a meniscal tear |
| Bounce Home Test (knee) | Patient supine: (1) examiner cradles pt's achilles tendon w inferior hand while superior hand supports & guides knee (2) examiner releases pt's knee and allows leg to passively drop into extension while controlling resistance to gravity with the inferior | KNEE DOESN'T FULLY EXTEND (+) if knee is not fully extended, or it has has a rubbery end feel (""springy block""), this indicates meniscal tear (+) if knee extends quickly in one jerk, and pt feels sharp radiating pain at the joint line, this also indicat | torn meniscus |
| Clarke's Sign (Patellar Grind Test) (knee) | Patient supine: (1) pt is relaxed w knee extended (2) examiner uses web of hand to press down slightly proximal to upper pole of pt's patella; (3) examiner asks pt to contract m. quadriceps while examiner pushes down w controlled amount of pressure. Perfo | RETROPATELLAR PAIN (+) pain or inability to hold contraction indicates a positive sign for patellofemoral dysfunction | patello-femoral dysfunction |
| Mediopatellar Plica (Mital-Hayden) Test (knee) | Patient supine: (1) pt flexes test knee to 30° (examiner can support the knee by placing inferior forearm under it while clasping hand over pt's other leg); (2) examiner pushes pt's patella medially with thumb | KNEE PAIN (+) if patient complains of pain or a click, it indicates pinching of the edge of the plica between the medial femoral condyle and the patella | medial patellar plica inflammation |
| Fairbank's Apprehension Test (knee) | Patient supine: (1) pt flexes test knee to 30° and relaxes m. quadriceps (examiner can support the knee by placing inferior forearm under it while clasping hand over pt's other leg); (2) examiner carefully & slowly pushes pt's patella laterally | APPREHENSION, CONTRACTION (+) pt will contract m. quadriceps and have an apprehensive look as they feel the patella dislocate | patellar dislocation |
| Noble Compression Test (knee) | Patient supine: (1) examiner flexes pt's test knee to 90° & hip to 45°; examiner grasps pt's ankle with inferior hand; (2) examiner cups superior hand over the distal femur, and applies pressure with the thumb to lateral femoral condyle (or 1-2cm proximal | FEMORAL CONDYLAR PAIN (+) severe pain over the lateral femoral condyle (similar to what pt experiences w activity), at approx 30° of extension, indicates the iliotibial band is being compressed as it slides over the femoral condyle | iliotibial band compression (iliotibial band friction syndrome) or bursitis |
| Wilson Test (knee) | Patient seated: (1) pt hangs knees over side of table; examiner asks pt to medially rotate test foot thereby rotating the tibia (2) pt slowly extends knee to 30° at which point symptoms are recreated (knee pain) (3) examiner has pt stop and laterally rota | RELIEF OF PAIN (+) if pain disappears w lateral rotation of tibia, osteochondritis dissecans is indicated; pain must be at the medial femoral condyle near intercondylar emminence | osteocondritis dissecans (OCD) of femoral condyle |
| Quick Test (lumbar) | Patient standing: (1) pt squats down as far as possible, bounces 2-3x, & returns to standing (2) pt is asked to balance on the balls of one foot, raising up and down on toes 4-5x; repeat bilaterally | PAIN (+) pain in any of the joints of the lower extremity—ankles, knees, hips & sacrum | LE joint pathology |
| Seated Quadrant (Kemp's) Test (lumbar) | Patient seated: (1) examiner stands behind pt w hands on pt's shoulders for support (2) examiner extends, laterally flexes and rotates pt's spine to same side, stopping at end ROM, or until symptoms are reproduced | PAIN (+) pain or reproduction of symptoms indicates lumbar joint pathology | lumbar facet dysfunction or intervertebral foramen encroachment (IVFE) |
Created by:
kellyjelly
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