NWHSU Methods 3 Orthopedic and Neurological test
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| O’DONAGHUE’S MANEUVER (seated) | Cervical range of motion (ROM) testing is performed.
•Pain with passive ROM
○ Ligamentous sprain
•Pain with resisted ROM
○ Muscle strain
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| SOTO-HALL (supine) | Cervical spine of patient is passively flexed while the sternum is stabilized.
Non-specific test that can be used to diagnose a cervical spine fracture or possible muscular/ligamentous injury
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| SHOULDER DEPRESSION TEST (seated) | Shoulder is depressed while head is laterally flexed toward
opposite side
•Production or aggravation of radicular pain
○ Dural sleeve adhesions
•Local pain
○ Local tissue irritation
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| CERVICAL DISTRACTION (seated) | Examiner gently grasps both sides of the patient’s head and
exerts steady upward axial distraction
Generalized increased pain
Muscle spasm
Relief of pain or paresthesia
May indicate intervertebral foraminal
encroachment or facet capsulitis
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| CERVICAL COMPRESSION (seated) | With the head in a neutral position, direct downward compression is applied to the patient’s head
•Generalized increase in local neck discomfort
foraminal encroachment
•Radicular complaints
Foraminal encroachment is compromising
a nerve root
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| FORAMINAL COMPRESSION (seated) | The patient’s head is rotated and an axial compressive force
is applied
•Localized pain
○ Foraminal encroachment
•Radicular pain
○ Nerve root compromise
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| JACKSON COMPRESSION TEST (seated) | An axial compressive force is applied with the patient’s head
slightly rotated and laterally flexed
•Localized pain
○ Foraminal encroachment
•Radicular pain
○ Nerve root compromise
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| MAXIMUM CERVICAL COMPRESSION (seated) | The patient rotates and hyperexteds head
•Local pain on the concave side
Facet involvement
•Pain on the concave side
Nerve root involvement
•Local pain on the convex side
Tissue involvement
•Pain on the convex side
Indicates dural sleeve adhesions
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| MODIFIED SPURLING’S TEST (seated) | Slowly rotated and extended head while applying gradual axial compression
•Generalized increase in local neck discomfort
○Facet capsulitis or foraminal encroachment
•Radicular complaints
○Foraminal encroachment is compromising a nerve root
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| Bakody sign (seated) | The patient presenting with neck and arm discomfort has arm involved abducted and placed on the top of the head; they state that this relieves their arm pain
•Radicular pain decreased when the arm is placed
in this position
○Nerve root compromise
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| Dejerine’s sign (Triad of Dejerine) | The patient reports that coughing, sneezing, or straining at the stool causes an increase in nerve root or cord compression signs
○ Space occupying lesion (SOL)
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| Lhermitte’s sign (seated) | The neck is passively flexed
• (+) Sharp electric shock sensation down the spine and into
the upper or lower extremity
○ Cord myelopathy
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| Naffziger test (seated) | The examiner holds digital pressure over the jugular veins bilaterally for 30-40 seconds; the patient is then instructed to cough
• (+) Radicular pain
○ SOL
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| Allen’s test (seated) | BEFORE other TOS tests. Have patients rapidly open/close fist ending with the fist closed. Occlude radial & ulnar aa. releasing one at a time
•A delay in return to normal color
○If reduction in collateral circulation a TOS test may not be accurate
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| Adson’s test (seated) | Palpate radial pulse. Have patient rotate and extend head to the side of palpation and to take a deep breath in
•A decrease in strength of the pulse
○Compression of the neurovascular bundle
btw the middle & anterior scalenes
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| Costoclavicular maneuver (seated) | The examiner palpates the radial pulse. The patient flexes
their head while the examiner extends the shoulder.
• Reduction in strength of the pulse
○ Neurovascular compression between the
clavicle and first rib
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| Wright’s test or Hyperabduction maneuver (seated) | Radial pulse palpated palpated as the arm is abducted 180 degrees.
•Reduction in the pulse when arm is raised
○Neurovascular compression under the
pec minor m.
*A reduction in the pulse above 120
degrees may be physiologic rather than
pathologic
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| Roos test (seated) | Patient holds arms 90 degrees in abduction and external rotation. Ask them to open/close fists until symptoms occur
•Reproduction of arm/hand complaints indicates neurovascular compression but does not indicate the source of the compression
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| Halstead maneuver (seated) | The radial pulse is palpated and traction is applied to the arm while the patient extends their head
• A reduction in the pulse
○ Neurovascular compression by a cervical
rib or by the anterior scalenes
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| Bikele’s sign (seated) | The patient holds their arm in an abducted and extended position with the elbow flexed. They are instructed to extend the arm.
• An increase in radicular pain
○ Brachial plexus neuritis
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| Swallowing test (seated) | The patient is instructed to swallow
• Pain
○ Indicative of esophageal irritation due to
a mass in the anterior aspect of the cervical spine
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| Valsalva maneuver (seated) | The patient is instructed to place their thumb in their mouth and to blow as if they were trying to blow up a balloon.
• Radicular pain
○ Indicative of a space occupying lesion
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| Rust’s sign (any position) | The patient holds their head while moving, particularly while changing position
• Indicates a severe sprain or instability of the neck
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| Brudzinski’s sign (supine) | The patient’s head is passively flexed
• The sign is positive if flexion of both knees occurs
○ Indicative of meningitis
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| Brachial plexus tension test (seated) | The examiner supports the arms while the patient fully abducts and gradually externally rotates the arms. The elbows are flexed and the neck is flexed.
• A reproduction of radicular symptoms
○ Suggests C5 nerve root syndrome
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| Libman’s sign (seated) | The examiner applies pressure to the mastoid processes.
• This will provide an indication of the patient’s
pain threshold
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| Mannkopf’s sign (any position) | The examiner establishes the resting pulse rate. The area of complaint is then stimulated
• Increase in the pulse rate
○ Normal response
• No change in pulse rate
○ May be suggestive of nonorganic pain
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| Magnuson’s test | Ask patient to point to the area of pain. Later in the exam the patient is again instructed to point to the area of complaint.
• The findings should be consistent
• A significant change in the location of pain may be suggestive of nonorganic pain
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| Thoracic spine range of motion using two inclinometers | Place one inclinometer at C7-T1 and the other at T12-L1.
Measure the difference and record as thoracic movement.
Normal:
• Flexion 20-45 degrees
• Extension 25-35 degrees
• Lateral flexion 20-40 degrees
• Rotation 35-50 degrees
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| Adam’s position | Patient w/ scoliosis (per visual or x-ray assessment) bends forward at the waist
The curve straightens and no significant rib hump is present
○(-) sign suggests a functional scoliosis
•Deformity is present
○(+) sign suggests a structural scolisois
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| Amos’s sign | The patient attempts to sit up from a supine or side lying position
• Localized thoracolumbar or thoracic pain
○ May suggest ankylosing spondylitis, severe sprain, or
intervertebral disc lesion
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| Beevor’s sign | The supine patient flexes their head. When the abdominal muscles contract, the umbilicus should remain in its location
• If the umbilicus migrates
○ Muscle weakness is present suggesting a
T10 cord compression
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| Schepelmann’s sign | The seated patient laterally flexes to each side
Pain on the concave side
○ Intercostal neuralgia
Pain on the convex side
○ Intercostal myofascitis
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| Spinal percussion | The spinous processed are percussed with a reflex hammer
• Pain is a nonspecific finding
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| Costovertebral stress (seated) | Have patient rotate torso and apply stress at rib angles
Pain may occur on costovertebral or costosternal junction
Loss of movement indicates fixation of costotransverse and/or costovertebral articulation in P-A translation(caliper movement)
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| Chest expansion test | Place thumbs around the posterior chest surface. Thumbs should separate equally on full breath
•Diminished chest expansion = Ankylosing spondylitis, intercostal neuralgia, Pulmonary or painful rib pathology
•Unequal chest expansion = Atelectasis
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| Rib compression test (seated) | Examiner compresses the rib cage while the patient takes a deep breath.
Symptomatic relief with restriction of rib expansion
○Intercostal neuralgia with hypomobile costotrans-verse articulation
Localized pain
○Lesion at the location of the pain
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| Oblique extension and compression | The patient is rotated and extended while an axial compressive force is applied
• Pain at the site of the thoracic facets
○ Facet inflammation or irritation
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| Lateral Chest (rib) compression | Apply side to side compression of the rib cage
•Tenderness on costosternal junction= An inflammatory reaction of the costosternal articulation
•Back Pain= costotransverse or costovertebral lesions
•Localized pain on lateral border of ribs= A fracture
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| Sternal (AP) compression test | A-P compression of rib cage (sternum and back)
•Tenderness on costosternal junction= inflammatory reaction of costosternal articulation
•Back Pain= costotransverse or costovertebral
lesions
•Localized pain on lateral border of ribs= fracture
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| Rib Springing Test (prone) | Thenar contacts over the rib cage. With full expiration apply pressure to spring ribs, separating & stressing costovertebral joints
•Lack of spring or pain on costotransverse articulation= Loss of caliper or bucket handle motion,intercostal muscle strain
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| Spinal percussion test (seated) | The neck is flexed and the spinous processes are percussed with a reflex hammer
• A positive pain finding
○ May indicate spinous process fracture or
underlying disease processes
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| Neuro-C5 | M= Deltoid
S= Lateral Deltoid
R= Biceps
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| Neuro-C6 | M= Biceps and Wrist Extensors
S= Lateral forearm and digits 1-2
R= Brachioradialis
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| Neuro-C7 | M= Triceps and Wrist Flexors
S= Middle finger
R= Triceps
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| Neuro-C8 | M= Finger Flexors
S= Medial forearm and digits 4-5
R= Finger Flexors
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| Nuro-T1 | M= Finger abd/add
S= Medial antebrachium and elbow
R= N/A
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