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NBCE Part 4 Ortho
| Test | Procedure | Positive | Indication | Q? |
|---|---|---|---|---|
| [3] Foraminal Compression | Seated. Doctor stands behind patient and puts downward pressure in neutral position. The head is then rotated to each side with pressure. | Radicular Pain | Nerve Root Compression | Progressive? Gotten worse? Pain down arm? |
| [3] Jackson's Compression | Seated. Doctor laterally flexes the patients head to each side with downward pressure. | Radicular Pain | Nerve Root Compression | Progressive? Gotten worse? Pain down arm? |
| [9] Distraction Test | Seated. Doctor exerts upward pressure on the patient's head. | 1) Decreased Pain 2) Increased Pain | 1) Nerve Root Compression 2) Sprain/Strain | How did you get this? (S/S) Localized & Does it hurt when you press on it? (S/S) vs Pain down arm? (NRC) |
| [3] O'Donohue's Test | Seated. Active ROM against resistance followed by passive ROM. | Pain | Active (Strain) vs Passive (Sprain) | Strain...Muscle spasms? Sprain...Painful to move joint? |
| [10] Valsalva Maneuver | Seated. The doctor asks the patient to take a deep breath and hold it while bearing down. | Radicular Pain | SOL (Disc) | Disc = Worse with coughing, sneezing or straining at the stool? |
| [9] Maximum Cervical Compression | Seated. Rotate and extend head. If no pain, have patient flex head while maintaining head in rotation. Do NOT apply compression. | Radicular Pain | Nerve Root Compression | Progressive? Gotten worse? Pain down arm? |
| [8] Shoulder Depression Test | Seated. The doctor depresses the patient's shoulder while laterally flexing the head away from that shoulder. Repeat on other side. | Pain | Nerve Root Adhesion | Progressive? Gotten worse? Pain down arm? |
| [6] Soto Hall Sign | Supine. The doctor places one hand on the sternum while passively flexing the patient's head toward the chest. | Localized Pain | Cervical Fracture OR Sprain-Strain | How did you get this? (With fx, patient will know EXACTLY how they got this) |
| [5] Bakody's Test AKA Shoulder Abduction Test | Seated. Patient actively places hand on head. | Relief of Pain | Nerve Root Compression | Progressive? Gotten worse? Pain down arm? |
| Swallowing | Seated. Instruct the patient to swallow. | Pain | Pre-vertebral Mass / Swelling | Are you having any difficulty swallowing? Any recent trauma to neck? DISH = Progressive stiffness? |
| [3] Allen's Test [VC] | Seated. Ask patient to pump hand while you occlude the radial and ulnar arteries until hand is blanched. Ask patient to slowly open hand. Then doctor opens one artery and records filling time. Repeat for other artery. | Delay of more than 10 seconds for blood to return | Occlusion of corresponding artery | Usually a VC since patient can't fake |
| [1] Costoclavicular Maneuver AKA Eden's Test | Standing. Doctor stands behind patient and bilaterally palpates for radial pulse. Have patient draw shoulders down and back (exaggerated military position) and then flex head forward. | Pain and/or alteration in amplitude of radial pulse | Costoclavicular Syndrome -> Compression of Subclavian Artery and Brachial Plexus by Clavicle and 1st Rib | General: Color or temperature changes in hand? Does your hand fall asleep? Specific: Worse when you carry a heavy bag? |
| [9] Adson's Test AKA Scalenus Anticus Test | Seated. Doctor stands behind patient and palpates for radial pulse. Doctor slightly abducts, extends and externally rotates the arm. Patient then rotates head toward tested side and extends head. Patient takes a deep breath and holds. | Pain and/or alteration in amplitude of radial pulse | Scalenus Anticus Syndrome -> Compression of Subclavian Artery and Brachial Plexus by Anterior and Medial Scalene Muscles | General: Color or temperature changes in hand? Does your hand fall asleep? Specific: Worse when you turn your head? |
| [4] Wright's Test AKA Hyperabduction Maneuver | Seated. Doctor stands behind patient and palpates for radial pulse on affected side. Abduct arm to 180 degrees and note angle at which radial pulse diminishes or disappears. Repeat on other side and compare results. | Pain and/or alteration in amplitude of radial pulse on affected side by more than 10 degrees differential than nonaffected side | Pec Minor Syndrome -> Compression of Axillary Artery and Brachial Plexus by Pec Minor and Coracoid Process | General: Color or temperature changes in hand? Does your hand fall asleep? Specific: Worse with your arm above your head? |
| [4] Apley's Test AKA Apley's Scratch Test | Seated. Doctor stands behind patient. Ask patient to actively put hand behind head and touch opposite upper shoulder blade (doctor pointing). Then have patient put hand behind back and touch opposite lower shoulder blade (doctor pointing). | Pain or limited ROM | Degenerative Tendonitis of Rotator Cuff (Usually Supraspinatus) | Any particular motion make this better or worse? |
| [5] Codman's Drop Arm Test | Seated. The doctor passively abducts arm to above 90 degrees and then instructs patient to slowly lower the arm to the side after doctor removes support. | Inability to slowly lower the arm to the side or has severe pain | Supraspinatus Tear | How did you get this? What did you do? Do you experience pain or weakness when using your arms overhead? |
| [2] Apprehension Test | Seated. Doctor stands behind patient and abducts and slowly externally rotates the affected shoulder. | Patient shows signs of apprehension or alarm | Chronic Shoulder Dislocation | Have you ever dislocated your shoulder? Do you experience pain or weakness when using your arms overhead? |
| [0] Dugas Test | Seated. The patient places the hand of the affected shoulder on the opposite shoulder and attempts to touch the chest with the elbow. | Unable to perform | Acute Shoulder Dislocation | Have you ever dislocated your shoulder? Do you experience pain or weakness when using your arms overhead? |
| [4] Yergason's Test [VC] | Seated. The doctor palpates the biceps tendon with one hand and extends other hand to patient as if shaking hands with them. The doctor then resists the patient's attempt to actively supinate the hand and flex the elbow in two separate motions. | Audible click or snap in the bicipital groove | Bicipital Tendon Instability | How did you get this? What did you do? Do you ever hear a click or snap in your shoulder with certain movements? |
| [3] Dawbarn's Sign | Seated. The doctor stands behind the patient and palpates the subacromial bursa to elicit pain. With finger still on painful spot, the doctor then passively abducts the patient's arm with other hand. | Reduction of Pain | Subacromial Bursitis | How did you get this? What did you do? |
| [2] Supraspinatus Press Test AKA Empty Can Test | Seated. The doctor stands behind the patient. Patient abducts both arms to 90 degrees and doctor applies downward resistance. The patient then angles shoulders forward 30 degrees and points the thumbs down. Doctor again applies downward resistance. | Pain or Weakness | Supraspinatus Tear | How did you get this? What did you do? Do you experience pain or weakness when using your arms overhead? |
| [4] Passive Shoulder Approximation | Standing. The doctor stands behind the patient and approximates the scapulae by lifting the shoulders up and back. | Pain in the scapular area | T1 or T2 nerve root problem on the side of the pain | Where is the pain? |
| [0] Cozen's Test | Seated. Patient's elbow is flexed to 90 degrees with the forearm pronated and wrist dorsiflexed. Doctor stabilizes the elbow and resists the patient's wrist dorsiflexion. | Pain in the lateral elbow | Lateral Epicondylitis | How did you get this? |
| [0] Mill's Test | Seated. Doctor stands on side of patient that is being tested. The doctor passively flexes the elbow, wrist and fingers in supination and then brings the elbow into max extension and pronation while maintaining wrist and finger flexion. | Pain in the lateral elbow | Lateral Epicondylitis | How did you get this? |
| [7] Tinel's Sign at the Wrist | Seated. Patient's elbow is flexed and forearm supinated with wrist in slight dorsiflexion. Percuss over the flexor retinaculum of wrist (median nerve) and the tunnel of guyon (ulnar nerve). | 1) Tingling into lateral 3 fingers (median nerve) 2) Tingling into medial 2 fingers (ulnar nerve) | 1) Carpal Tunnel Syndrome 2) Ulnar Nerve Impingement | CTS: Do you ever get pain, numbness or tingling in thumb, index and middle fingers? Does it wake you up at night? Ulnar Nerve Impingement: Do you ever get pain, numbness or tingling in the ring and little fingers? |
| [6] Phalen's Sign | Seated. The patient flexes the wrists maximally by pushing the dorsal surface of each hand together for up to 1 minute. | Tingling into lateral 3 fingers of hand | Carpal Tunnel Syndrome | Do you ever get pain, numbness or tingling in thumb, index and middle fingers? Does it wake you up at night? |
| [4] Reverse Phalen's AKA Prayer Sign | Seated. The patient extends the wrists maximally by pushing the palms together for up to 1 minute. | Tingling into lateral 3 fingers of hand | Carpal Tunnel Syndrome | Do you ever get pain, numbness or tingling in thumb, index and middle fingers? Does it wake you up at night? |
| [5] Finkelstein's Test | Seated. The patient is asked to make a fist with thumb tucked inside. The doctor then moves fist into ulnar deviation. | Pain over the anatomical snuffbox (extensor pollicis brevis & abductor pollicis longus tendons) | DeQuervain's Disease AKA Stenosing Tenosynovitis | Has this been progressively worse? Do repetitive hand or wrist movements tend to make it worse? Does it hurt to grip things or make a fist? |
| [5] Bracelet Test | Seated. The doctor applies moderate compression to the distal aspects of the radius and ulna. | Pain | RA (bilateral and correlated with additional findings) or sprain/strain injury (unilateral) | RA: Have you noticed any morning stiffness in your joints? How long has this been going on? (6 week minimum) S/S: Recent wrist injury? |
| [13] SLR Test | Supine. With patient's legs extended, the doctor places one hand under heel and the other over the knee and slowly raises the leg (affected side only). | Pain down affected side | Sciatica, Disc or Lumbar Lesion | See Lumbar Spine ddx document. |
| [1] Bragard's Sign | Supine. After pain is elicited with SLR, the leg is lowered below the point of discomfort and the foot is sharply dorsiflexed (affected side only). | Pain in affected leg | Primary Sciatica | See Lumbar Spine ddx document. |
| [0] Well-Leg-Raiser AKA Fajersztajn's | Supine. SLR with dorsiflexion of the foot is performed on the unaffected side of a sciatic patient(unaffected side only). | Pain down affected side | Medial Disc Lesion | Where is the pain, outline? (below knee w/ dermatomal pattern) Is your pain worse when you cough, sneeze or strain at the stool? Any position make it better or worse? (Medial Disc -> lean TOWARD painful leg to get relief) |
| [8] Millgram's Test | Supine. With the patient's limbs extended, ask patient to elevate legs until 6 inches off table and hold for as long as possible (30 sec minimum). | Pain | SOL | Is your pain worse when you cough, sneeze or strain at the stool? Unexplained weight loss? |
| [2] Goldthwait's Sign | Supine. Affected leg raised slowly while hand is under lumbar spine. Repeat on other side. | Pain | Pain brought on before the lumbar spine moves -> SI. Pain brought on after the lumbar spine moves -> Lumbosacral | See Lumbar and SI ddx documents. |
| [8] Lindner's Sign | Supine. Patient's head is passively flexed to the chest. | Lumbar pain radiating to sciatic nerve | Sciatica | See Lumbar Spine ddx docs |
| [3] Bowstring Sign | Supine. Perform SLR to point of pain. The knee is slightly flexed and placed on the doctor's shoulder. Digital pressure is placed over posterior thigh and then in the popliteal fossa. | Lumbar pain OR Radiculopathy | Sciatica due to Disc Lesion | See Lumbar Spine ddx document. |
| [3] Bonnet's Sign | Supine. Doctor stands on side being tested. Doctor internally rotates leg, adducts leg, and then performs SLR. | Radicular Pain | Piriformis Syndrome | How did you get it, what have you been doing? (non-traumatic onset) Any position make it better or worse? (worse sitting) Worse when you turn your foot in or out? |
| (7) Becterew's Sitting Test | Seated. The patient is instructed to a) extend the affected leg, then flex thigh of affected leg against resistance b) extend the unaffected leg, then flex thigh of unaffected leg against resistance, then c) extend both legs simultaneously. | Pain OR Leaning back | Disc Lesion (Medial disc if pain when good leg raised) | Where is the pain, outline? (below knee w/ dermatomal pattern) Is your pain worse when you cough, sneeze or strain at the stool? Any position make it better or worse? (Medial Disc -> lean TOWARD painful leg to get relief) |
| [3] Minor's Sign [VC] | Seated. Ask patient to rise from a seated position. | The patient will support and balance body with good side | Sciatica | See Lumbar ddx doc |
| [13] Kemp's Test | Standing. Instruct the patient to place one hand on the back of the thigh and slowly slide the hand down the back of the thigh as far as possible or until pain is felt. Repeat on other side. | Radicular Pain (Local pain does NOT constitute a positive test but indicates a sprain/strain to facet joints) | Disc or Facet | Where is the pain, outline? (disc below knee / facet above knee) Any pain when you cough, sneeze or strain at the stool? (disc) Any position make it better or worse? (med vs lat disc) |
| [20] Heel Walk | Standing. Patient is instructed to walk on their Heels for a minimum of 7 steps while doctor walks beside ready to catch the patient. | Unable to perform (foot will slap down) | L5 Lesion | Where is the pain, outline? (below knee w/ dermatomal pattern) Is your pain worse when you cough, sneeze or strain at the stool? |
| [20] Toe Walk | Standing. Patient is instructed to walk on their Toes for a minimum of 7 steps while doctor walks beside ready to catch the patient. | Unable to perform (heel will fall down) | S1 Lesion | Where is the pain, outline? (below knee w/ dermatomal pattern) Is your pain worse when you cough, sneeze or strain at the stool? |
| [1] Belt Test AKA Supported Adam's Test | Standing. The doctor stands behind the patient. The patient bends forward and doctor notes when pain occurs. Then the doctor grasps each ASIS and braces their hip into the patient's sacrum. The patient then bends forward again. | Pain | 1) Pain with pelvic stabilization = Lumbar Lesion 2) No pain with pelvic stabilization = SI Lesion | See Lumbar and SI ddx docs |
| [4] Gaenslen's Test | Supine. Patient is moved near edge of table and flexes the opposite knee against the abdomen. The involved leg is gradually lowered off the table into extension by the doctor. Doctor applies downward pressure against clasped knee and knee of extended leg. | SI Pain | SI Lesion | General SI: worse w/ prolonged sitting or standing? Sprain/Strain/Fx: how did you get this? any falls, or trauma? AS: progressive stiffness? Reiter's: UTI's, heel pain or conjunctivitis? Cancer: unexplained weight loss? OCI: any children? |
| [2] Lewin-Gaenslen's Test | Side Lying. Patient lies on unaffected side and pulls lower knee to chest. Doctor stands behind patient and stabilizes pelvis and hyperextends the top thigh. | SI Pain | SI Lesion | General SI: worse w/ prolonged sitting or standing? Sprain/Strain/Fx: how did you get this? any falls, or trauma? AS: progressive stiffness? Reiter's: UTI's, heel pain or conjunctivitis? Cancer: unexplained weight loss? OCI: any children? |
| [4] Iliac Compression | Side Lying. Patient lies on unaffected side. Doctor places both hands over iliac crest and applies a downward pressure. | SI Pain | SI Lesion | General SI: worse w/ prolonged sitting or standing? Sprain/Strain/Fx: how did you get this? any falls, or trauma? AS: progressive stiffness? Reiter's: UTI's, heel pain or conjunctivitis? Cancer: unexplained weight loss? OCI: any children? |
| [8] Femoral Nerve Traction Test | Side Lying. Patient lies on unaffected side with spine straight and head slightly flexed. The affected leg is extended at the hip 15 degrees. The affected knee is flexed, stretching the femoral nerve. | Pain on the anterior thigh | L2, L3, L4 Nerve Root Lesion | |
| [5] Hibb's Test | Prone. Doctor stabilizes pelvis on side they are standing on. Doctor grasps the ankle of opposite leg and flexes knee to 90 degrees and then pushes leg laterally away causing internal rotation of hip. | SI/Hip Pain | SI/Hip Lesion | See SI/Hip ddx doc |
| [9] Yeoman's Test | Prone. Doctor stabilizes suspect SI joint with one hand and with the other hand, flexes the leg and hyperextends the thigh on affected side by lifting the knee off the table. | SI Pain | SI Lesion | General SI: worse w/ prolonged sitting or standing? Sprain/Strain/Fx: how did you get this? any falls, or trauma? AS: progressive stiffness? Reiter's: UTI's, heel pain or conjunctivitis? Cancer: unexplained weight loss? OCI: any children? |
| [8] Patrick's Test AKA FABERE sign | Supine. Doctor flexes, abducts and externally rotates the thigh by crossing the ankle over the contralateral knee. The doctor then extends the hip by applying downward pressure on the knee while stabilizing opposite ASIS to the table. | Hip Pain | Hip Lesion | How did you get this? (Fx) Unable to bear weight without pain? (Fx) Progressive? (OA in older patient) Unexplained weight loss? (If yes, Mets/MM) Pain relieved by rest? (If not, Mets/MM) Worse at night? (If yes, Mets/MM) Pain bilateral? (RA in women) |
| [2] Laguerre's Test (Patrick Fabere in the air) | Supine. The doctor flexes, abducts, and laterally rotates hip. Doctor then stabilizes the opposite ASIS with one hand and with the other hand presses down on the knee. The patient's foot rests on the doctor's forearm that is stabilizing the ASIS. | SI/Hip Pain | SI/Hip Lesion | See SI/Hip ddx doc |
| [5] Thomas Test [VC] | Supine. The patient's unaffected thigh is actively flexed toward the abdomen. The patient holds the leg in this position with both hands. | Opposite thigh/knee rises off table | Hip Flexor Contracture (shortened iliopsoas muscle) | |
| [10] Anvil Test | Supine. The doctor elevates the affected leg while keeping the knee extended. The doctor strikes the heel with their fist. | Localized pain in the thigh, leg or heel | Hip joint pathology or Femur, Tibia, Fibula or Calcaneal Fx | How did you get this? Any recent falls, or trauma? |
| [1] Ely's Sign | Prone. Flex the knee fully by approximating heel to the SAME buttock. | Pelvic rises from the table | Hip Flexor Contracture | |
| [2] Trendelenburg Test [VC] | Standing. The patient raises one hip into flexion toward the chest. | Buttock on foot that is elevated drops | Gluteus Medius weakness on stance leg side | |
| [5] Apley's Distraction Test | Prone. Flex patient's knee to 90 degrees and anchor their thigh with your knee (use a cushion for patient comfort). Doctor grasps foot & applies upward traction & rotates leg internally and externally. Heel points towards side being tested. | Pain in knee | Collateral Ligament Tear | Where is the pain, outline with hand? (MCL: Pain at medial knee) How did this happen? (MCL: Knee hit from outside -> Valgus stress) |
| [5] Apley's Compression Test | Prone. Flex patient's knee to 90 degrees. Doctor grasps foot & applies downward pressure & rotates leg internally and externally. Heel points towards side being tested. | Pain in knee | Meniscal Tear | Where is the pain, outline with hand? Did you twist your knee? Does your knee lock? Delayed swelling after injury? (swelling occurs 12-24 hrs post injury) |
| [6] Drawer Test | Supine. Knee flexed to 90 degrees and hip to 45 degrees. Doctor stabilizes foot on table. Tibia is then drawn anterior/posterior. | Pain or Joint Laxity | Anterior (Pulling P-A): ACL Instability. Posterior (Pushing A-P): PCL Instability. | ACL: Did you hear a POP at time of injury? Immediate swelling after injury? |
| [3] Lachman's Test | Supine. With knee flexed to 30 degrees, the doctor stabilizes the femur with one hand and pulls the tibia anterior with other hand. | Soft End Feel | ACL Instability | ACL: Did you hear a POP at time of injury? Immediate swelling after injury? |
| [3] Abduction Stress Test AKA Valgus Stress Test | Supine. Doctor applies valgus stress to knee while abducting the foot in full extension. If patient is indifferent this action, repeat while knee is flexed to 30 degrees. | Pain or Joint Laxity | MCL Instability | Where is the pain, outline with hand? (MCL: Pain at medial knee) How did this happen? (MCL: Knee hit from outside -> Valgus stress) |
| [3] Adduction Stress Test AKA Varus Stress Test | Supine. Doctor applies varus stress to knee while adducting the foot in full extension. If patient is indifferent this action, repeat while knee is flexed to 30 degrees. | Pain or Joint Laxity | LCL Instability | Where is the pain, outline with hand? (LCL: Pain at lateral knee) |
| [6] McMurray Sign | Supine. The doctor flexes the thigh and leg to 90. With one hand on knee and the other on the heel, the doctor ext rotates the leg w/ valgus force, and then extends knee. The doctor then int rotates the leg w/ varus force, and then extends knee. | Painful click or snap heard | Internal rotation checks lateral meniscus; external rotation checks medial meniscus | Where is the pain, outline with hand? (med meniscus -> medial knee & lat meniscus -> lateral knee) Did you twist your knee? Does your knee lock? Delayed swelling after injury? (swelling occurs 12-24 hrs post injury) |
| [2] Apprehension Test (Patella) | Supine. The doctor displaces the patella medial to lateral. | Look of apprehension | Chronic Patellar Dislocation | Have you ever dislocated your knee cap? |
| [2] Patellar Grinding Test AKA Clarke's Sign | Supine. Patient's knees extended. Doctor applies S-I pressure with the thumb web at the superior pole of the patella and then asks the patient to contract the quads. | Retro patellar pain OR Cannot hold the contraction | Chondromalacia Patella | Progressive? Worse when walking downstairs or after prolonged sitting in a cramped position? |
| [3] Noble Compression Test | Supine. Doctor places the leg in the 90/90 position and applies thumb pressure to the distal lateral femur (condyle). The doctor then extends the knee. | Increased Pain (pain at 30 degrees of flexion) | TFL Contracture | |
| [5] Ober's Test | Side Lying. Involved side up. Doctor stands behind patient and abducts thigh and flexes knee while supporting patient's ankle and knee. The doctor then allows knee to drop into adduction by removing support of knee while shifting hand to stabilize pelvis. | Knee stays elevated | TFL Contracture | |
| [3] Anterior Drawer of Foot | Supine. Doctor places hand around anterior aspect of lower tibia while grasping calcaneus in the palm of the other hand & then pulls calcaneus anterior. | Talus slides forward | Anterior Talofibular Ligament Instability (Inversion Sprain) | How did you get this? Where is the pain, outline with hand? Did you sprain your ankle? (yes with lateral ankle pain -> Inversion sprain) |
| [3] Posterior Drawer of Foot | Supine. Doctor places hand around posterior aspect of lower tibia while pushing the talus posterior. | Talus slides backward | Posterior Talofibular Ligament Instability (Surgical Consultation) | How did you get this? Where is the pain, outline with hand? Did you sprain your ankle? (yes with lateral ankle pain -> Inversion sprain) |
| [1] Medial/Lateral Stability Test | Supine. Doctor grasps the patient's foot and passively inverts and everts it. | Pain or Joint Laxity | Inversion Sprain: Anterior Talofibular Ligament Tear. Eversion Sprain: Deltoid Ligament Tear | How did you get this? Where is the pain, outline with hand? Did you sprain your ankle? (yes with lateral ankle pain -> Inversion sprain) |
| [4] Morton's Squeeze Test | Supine. Doctor clasps hands around the metatarsal heads and squeezes together. | Pain between 3rd and 4th metatarsal heads | Morton's Neuroma | Where is the pain, outline with hand? (ball of foot) Worse with tight shoes? If woman: Do you wear high heels? Less pain when barefoot? Sudden onset? (rule out fracture) |
| [6] Tinel's Test | Supine. Doctor percusses posterior to the medial malleolus (medial plantar nerve). | Pain and tingling on the sole of the foot | Tarsal Tunnel Syndrome (posterior tibial nerve) | Where is the pain, outline with hand? (medial foot pain) |
| [4] Thompson's Test AKA Simmond's Test | Prone. Patient's feet is hanging off table. Doctor flexes patient's knee to 90 degrees and squeezes calf. | No plantar flexion of foot | Achilles Tendon Rupture | Where is the pain, outline with hand? How did you get this? |
| [0] Burn's Bench Test | Patient instructed to kneel on a table 18 inches from floor while doctor holds ankles, bend forward at the trunk, and touch the floor. | Patient refuses to perform | Malingering | Patient will manifest inconsistent or contradictory findings OR inappropriate attitude or behavior |
| [2] Hoover's Sign | Supine. The patient presents with hemiplegia. Doctor places one hand under each heel and asks patient to lift affected limb. | Absence of a downward counterpressure on the unaffected side | Malingering | Patient will manifest inconsistent or contradictory findings OR inappropriate attitude or behavior |
| [2] Magnusson's | The patient is asked to localize the point of pain at two different times. | Inability to accurately locate the same point | Malingering | Where is the pain should be asked several times, looking for discrepancy |
| [0] Mannkopf's Sign | Doctor takes resting pulse rate. Doctor then applies pressure on the area of complaint and takes pulse rate again. | Increase of 10 beats per minute | NOT a Malingerer | |
| [6] Chest Expansion Test | Standing. Patient elevates arms to 90 degrees. Tape measure placed around the 4th intercostal space (nipple level). Patient inhales completely and measurement taken. Then patient exhales deeply and measurement taken again. | < 1.5" in women; < 2" in men | AS | Progressive stiffness? Worse in the morning? |
| [1] Forrestier's Bowstring Sign [VC] | Standing. Instruct patient to bend to each side. | Muscle tightening on SAME SIDE as lateral flexion | AS | Progressive stiffness? Worse in the morning? |
| [3] Lewin Supine Test | Supine. While doctor holds ankles on the table, the patient is then asked to sit up without using hands. | Unable to perform | AS | Progressive stiffness? Worse in the morning? |
| [6] Amoss Sign [VC] | Side Lying. Ask patient to go from a side lying position to a seated position. | Thoracolumbar Pain OR Unable to perform | AS, Severe Sprain, IVD Syndrome | |
| [4] Brudzinski Sign | Supine. The doctor passively flexes the patient's head approximating the chin to chest. | Buckling of the patient's knees | Meningitis | Any fever or stiff neck? |
| [4] Kernig's Sign | Supine. The doctor flexes the hip and knee to 90/90 position and then attempts to extend knee. | Pain OR resistance to knee extension | Meningitis | Any fever or stiff neck? |
| [7] Lhermitte's Sign | Seated. The doctor passively flexes head toward chest. | Sharp electric shock like sensation down the spine into extremities | MS, Myelopathy | MS = Worse with hot weather? Pain come and go? |
| [4] Sternal Compression Test | Supine. The doctor places the ulnar aspect (knife edge) of one hand on the vertical axis of the sternum. The other hand is placed on top of it. The doctor then exerts a downward pressure on the sternum. | Pain localized at the lateral rib border | Rib Fracture | How did you get this? What did you do? |
| [2] Homan's Sign | Supine. The doctor puts the leg in the 90/90 position, squeezes the calf, and dorsiflexes the foot. | Deep Pain | Deep Vein Thrombosis | Smoking, birth control pills, anti-coagulants? Immobilized for a long time? Color or temperature changes in legs? |
| [4] Schepelmann's Sign [VC] | Seated. Patient raises both arms over head and laterally bends to both sides. | 1) Pain on concave side 2) Pain on convex side | 1) Intercostal Neuralgia 2) Pleurisy OR Intercostal Myofascitis | Merck: In dry pleurisy, the pain is increased when the patient bends his body toward the normal side (stretch pleura causing pain), whereas in intercostal neuralgia it is increased by bending toward the affected side (compress nerve causing pain) |
| [3] Claudication Test | Standing. The doctor asks the patient to march in place for (2 steps/sec) for 1 minute. | Pain in the calves | Intermittent Claudication | Is your pain worse with walking and relieved by either rest or holding a position? |
| [6] Adam's Positions/Test | Standing. The doctor observes the patient's posture from behind and then asks the patient to bend forward at the waist with their arms out in front. The doctor observes from behind as well as from the front. | 1) Asymmetry changes (Scoliosis disappears) 2) Asymmetry does NOT change (Scoliosis stays) | 1) Physiological/Functional Scoliosis 2) Structural Scoliosis | |
| [1] Rib Compression Test | The doctor stands behind the patient and applies pressure with hands bilaterally on the lateral aspects of the rib cage. | Localized Pain | Costochondritis or Tietze Syndrome | Where is the pain, outline with hand? (Costochondritis -> bilateral with multiple articulations. Tietze -> unilateral with one articulation - usually 2nd or 3rd) |
| [8] Spinal Percussion Test | Seated (Cerv) OR Standing (Thor/Lumb). Have patient slightly flex the area to be percussed. The doctor percusses each spinous process with a reflex hammer, then repeats this process in the musculature. | 1) Localized Pain 2) Radicular Pain | 1) Vertebral Fracture OR Sprain/Strain 2) Disc Herniation | Where is the pain, outline with hand? How did you get this? What did you do? |
| [8] Spinal Vibration Test | The doctor performs vibration with a 128Hz tuning fork over each spinous process. | Pain | Vertebral Fracture | How did you get this? What did you do? |
| [1] Libman's | The doctor applies finger pressure over mastoid process. Increase pressure until patient expresses discomfort. | Used to determine pain threshold of the patient | How would you rate this pain on a scale of 1-10 (10 being the worst)? | |
| [2] Rust Sign (Case Hx) | The patient spontaneously grasps the head with both hands when rising from the recumbent position. | General Cervical Instability (RA,Fracture,Sprain/Strain) | How did you get this? What did you do? | |
| [0] Dejerine's Triad | The patient reports that pain is brought on by coughing, sneezing, or straining at the stool. | SOL | Worse with coughing, sneezing or straining at the stool? | |
| [2] Beevor's Sign | The doctor observes the patient's umbilicus while they do a partial sit up. | Umbilicus moves laterally | T10 (T7-T12) Nerve Root Lesion | Where is the pain, outline with hand? |
| Naffziger Test | Seated. Doctor holds digital pressure over the jugular veins for 30-40 seconds. Instruct patient to then cough deeply. | Radicular Pain | SOL | Worse with coughing, sneezing or straining at the stool? |
| Berry's Sign | Relief of LBP when going from standing to sitting | Tight Hamstrings | Is this better when you sit down? | |
| Allis' | Supine. Flex knees to 90 degrees with feet placed flat on table and aligned. Compare level and alignment of knees. | Discrepancy in the alignment of knees | 1) Knees displaced proximally suggests a short femer or hip pathology 2) Unequal knee height suggests short tibia | |
| Ortolani's | Supine. The patient's hips are flexed and slowly taken into abduction | Palpable or audible click | Congenital hip dislocation | |
| Major Effusion AKA Ballotment | Supine. Press down on patella and release | Patella "rebounds" | Large amount of joint effusion | |
| Minor Effusion | Supine. Medial aspect of knee milked upward to displace fluid. The lateral margin of knee is pressed | Bulge of fluid in medial knee | Small amount of joint effusion | |
| Bounce Home | Supine. Flex knee to 90 degrees. While holding heel, allow knee to drop in full extension. | Knee "rebounds" | Joint Effusion or Torn Meniscus | |
| McBride's (Toe to Mouth Test) | Standing. Instruct patient to stand on well leg and grasp the ankle of the affected leg. | Inability or refusal to attempt the maneuver because of pain | Malingering | |
| Nachlas Test | Prone. Heel approximated to same buttock while doctor stabilizes ipsilateral pelvis | Pain in SI or lumbosacral region or if pain radiates down thigh or leg | SI or Lumbosacral lesion | |
| Ely's Test | Prone. Approximate heel to opposite buttock and then use the other hand to lift knee off table inducing hyperextension | Pain | Hip lesion or Lumbar nerve root irrritation |
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