Orthopedic Testing, +ve signs, description, purpose
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| Valsalva's - Thoracolumbar | Checking for the presence of space occupying lesions | Hold breath and bear down as if to have a bowel movement. | Reproduction or exacerbation of spinal pain or radiation into the limb.
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| Chvostek's Test - TMJ | Integrity of facial nerve and blood calcium levels | (demonstrate first) - tap the parotid gland, which overlies masseter muscle | (state to client) - twitching of the facial nerve
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| 3 Finger/2 Knuckle Insert - TMJ | A quick way to determine nomral mandibular opening | (demonstrate first) - place two or three flexed proximal interphalangeal joints into open mouth | hypomobility mandible deviates in a C to the side of TMJ thats hypomobile, S movement when opening - suffering from muscle imbalance, inability to open initially indicates lack of rotation of TMJ
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| Wright's Test - Cervical | Suspected thoracic outlet sydrome due to entrapment of subclavian vessels and brachial plexus beneath tendon of pectoralis minor and coracoid process | (demonstrate first) - Upper limb placed and maintained in shoulder hyperabduction, palpate radial pulse | (state first) - diminishment of pulse, pain, numbing and pins and needles
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| Eden's Test (Costoclavicular) - Cervical | When compromise of the thoracic outlet might be attributed to entrapment of the subclavian and brachial plexus as they pass between clavicle and first rib | (demonstrate first) - palpate radial pulse and continues to do so while depressing and retracting shoulder | (state first) - diminishment of pulse, pain, numbing and pins and needles
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| Adson's Maneuver - Cervical | Rule out compression of neurovascular bundle, secondary to a cervical rib or abnormalities of scalene musculature | (demonstrate first) - head extended and rotated toward side being tested. Palpate pulse while extending and externally rotating the shoulder. Client holds breath. | (state first) - disappearance of pulse, pain, numbing and pins and needles
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| Hautant's Test - Cervical | Vertebrobasilar artery insufficiency | (demonstrate first) - seated with arms outstretched and forearms sypinated. Close eyes and bring head into full backward bending and rotation. | (state first) - if one hand sinks and pronates to side of compromise
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| Maigne's Test - Cervical | vertebrobasilar artery insufficiency | (demonstrate first) - supine, head into full backward bending and rotation, hold for 30 seconds | (state first) - faintness, dizziness, nystogmus and personality changes
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| Backward Bending Test - Cervical | Vertebrobasilar artery insufficiency | (demonstrate first) - lies supine with pillow beneath upper and middle thoracic spine, head supported in neutral. Head is brought into full backward bending, without sidebending or rotations. 8 - 12 seconds | (state first) - faintness, dizziness, nystagmus and personality changes
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| Vertebral Artery Quadrant Test - Cervical | Vertebrobasilar artery insufficiency | (demonstrate first) - lies supine, pillow beneath upper and middle thoracic spine, head supported in neutral. Head brought into side bending with rotation to same side. Observe 8 - 12 seconds. No Signs Go To Backward Bending Test. | (state first) - faintness, dizziness, nystagmus, and personality changes
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| Valsalva's Maneuver - Thoracolumbar | Checking for presence of space occupying lesions i.e herniated disc, tumor | (demonstrate first) - Hold breath and bear down as if to have a bowel movement | (state first) - reproduction of exacerbation of spinal pain or radiation into the limb.
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| Lermittie's Test - Thoracolumbar | Involvement or irritability of lumbar spinal nerve roots by assessing reproduction of symptoms when nerve roots are tensed | (demonstrate first) - lies supine, passively performs straight leg raise of uninvolved leg. Causes pressure on lumbar spine. | (state first) - pain reproduced in back or involved limb.
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| Milgram's Test - Thoracolumbar | Checking for presence of space-occupying lesion | (demonstrate first) - supine, life both lower limbs simultaneously 2-4" off of the table and hold for 30 seconds | (state first) - if unable to hold limbs for 30 seconds or reproduction of pain in spine or radiation into limb.
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| Hoover's Test - Thoracolumbar | Whether the subject may be malingering or holding effort | (demonstrate first) - supine, place one hand under each heel and ask to raise one limb | (state first) - no increase of pressure in hand from opposite limb.
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| Ely's/Femoral Nerve Stretch - Thoracolumbar | Wether there is any irritation of the femoral nerve. | (demonstrate first) - prone, flex subjects knee while supporting thigh just proximal to knee. Stabilize pelvis while extending hip to provide further stretch of femoral nerve. | (state first) - pain reproduced or exacerbated in back or throughout femoral nerve distribution
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| Slump Test - Thoracolumbar | Involvement or irritability of lumbar spinal nerve roots by assessing reproduction of symptoms when nerve roots are tensed | (demonstrate first) - seated with hands clasped behind the back, slump forward, with 1 arm apply pressure to shoulders and overpressure to forward bent neck. With overpressure extend knee and dorsiflex ankle then release. | (state first) - symptoms progressively increase once head and neck are released there should be a noticeable decrease in pain.
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| Soto-Hall Test - Thoracolumbar | involvement or irritability of spinal (lumbar) nerve roots by assessing reproduction of symptoms when nerve roots are tensed. | (demonstrate first) - lies supine, passively raise involved lower limb, keep it straight just before pain, head and neck passively flexed. | (state first) - symptoms reproduced
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| Brudzinki's Test - Thoracolumbar | Involvement or irritability of lumbar spinal nerve roots by assessing reproduction of symptoms when nerve roots are tensed. | (demonstrate first) - lies supine with both hands behind neck. Assist in flexing head, neck and upper back. | (state first) - pain in low back, pelvic girdle or lower limb
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| Braggard's Test - Thoracolumbar | Involvement or irritability of lumbar spinal nerve roots by assessing reproduction of symptoms when nerve roots are tensed. | (demonstrate first) - lies supine, examiner raises involved lower limb to the point just short of where symptoms begin. Dorsiflex ankle. | (state first) - symptoms reproduced in lower back
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| Quadrant (Kemp) Test - Thoracolumbar | Evaluation of intervertebral foramina narrowing | (demonstrate first) - stand behind subject, standing, move into backward bending, place hand on shoulder to guide movement. Simultaneously move into rotation and sidebending toward painful side. Complete ROM or Pain | (state first) - limited ROM by provocation of symptoms.
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| Compression Test - Thoracolumbar | Assess the presence of a space-occupying lesion in the lumbar spine that may be compressing the spinal nerve root | (demonstrate first) - seated, moderate and even downward force (no forward, backward or sidebending) | (state first) - increased compression tends to exacerbate symptoms of distraction tends to alleviate a space-occupying lesion.
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| Distraction Test - Thoracolumbar | Assess the presence of a space-occupying lesion in the lumbar spine that may be compressing the nerve root. | (demonstrate first) - Sits with upper limbs crossed, reach around thorax and grasp forearms. Straigten or lean back to distract. | (state) - Distraction tends to alleviate a space-occupying lesion.
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| Skin Rolling - Thoracolumbar | To assess soft tissue mobility and locate trigger points, area of congestion, and temperature discrepancies | (demonstrate first) - Life an area of skin between thumb and forefinger of each hand. Skin is "rolled" forward along the length and in direction desired | (state) - Areas that are tethered, congested, hot, cold or tender
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| Straight Leg Raise (Lasegue's) Test - Thoracolumbar | Involvement or irritability of lumbar spinal nerve roots by assessing reproduction of symptoms when nerve roots are tensed. | (demonstrate first) - Lies supine, nontest limb in extension on table, passively raise other limb keeping hip slightly adducted and internally rotated and knee fully extended. Angle of hip and table measured. | (state) - reproduction of symptoms in back along sciatic nerve.
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| Anterior Gapping Test (Transverse Anterior Stress Test) - Sacroiliac | Implicates SI articulation as a source of symptoms. Specifically SI ligaments | (demonstrate first) - Lies supine, pillow under knees, cross upper limbs to contact right ASIS with right hand and Left ASIS with Left hand. Force directly lateral and posterior to separate them. | (state) - If motion reproduces localized unilateral SI pain
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| Posterior Gapping Test (Transverse Posterior Stress Test) - Sacroiliac | Implicates the posterior SI ligaments as a source of symptoms. Compliments anterior | (demonstrate first) - supine, contact lateral aspect of ASIS bilaterally. Force is directly medially and anterior | (state) - reproduced SI joint/localized pain
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| Posterior - Anterior Spring Test (Sacral Apex Pressure Test) - Sacroiliac | Implicates SI joint as a source of pain | (demonstrate first) - prone, hypothenar eminence of caudal hand contacts PSIS on side to be tested. Cranial hand contacts the apex of sacrum and produce short post/ant. stress to spring sacroiliac joint | (state) - reproduced pain in localized SI joint.
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| Sacroiliac Rocking Test (Sacrotuberous Ligament Stress Test) - Sacroiliac | Indentify irritation of sacrotuberous ligament | (demonstrate first) - supine, passively and maximally flex test hip and knee. Maintained flexed position and adduct hip in direction of opposite shoulder | (state) - pain in area of SI joint
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| Gillet's Test (Sacral Fixation Test) - Sacroiliac | Evaluates SI joint for restricted mobility | (demonstrate first) - stands, stand behind and locate and compare the position of one PSIS relative to S2 tubercle. Subject raises knee, again compare. Ischial Tuberosity and S2 tubercle should also be compared. | (state) - PSIS and or tuberosity is restricted in cephalad direction
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| Gaenslin's Test (Passive Hip Extension) - Sacroiliac | Implicates SI joint as a source of symptoms | (demonstrate first) - supine, holding knees to chest. Move lower trunk to edge of table so hip bone clears table. Lower limb lowers over side of table | (state) - pain reproduced in SI joint, if leg can fall, negative sign, if leg can't fall, positive test, and psoas is tight.
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| Yeoman's Test - Sacroiliac | Assess pathology of the anterior SI ligaments | (demonstrate first) - prone, passively flex knee to 90 degrees and then extend hip | (state) - Pain in SI joint area. Tissues may also cause pain in this area.
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| Caudal Shear Test - Sacroiliac | Implicate SI Joint as a source of symptoms | (demonstrate first) - prone, contact base of sacrum with cephalad hand and stabilizes hip joint at ischial tuberosity. Forearms parallel to table, a shear force is applied to move the sacrum on the hip bone in the caudal direction. | (state) - positive if reproduced symptoms and local to SI joint
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| Cephalad Shear Test - Sacroiliac | Implicate the SI joint as a source of symptoms. | (demonstrate first) - caudal hand contacts apex of sacrum and cephalad hand stabilizes hip bone along iliac crest. A shear force is given to move sacrum on the hip bone in the head direction. | (state) - positive if symptoms reproduce and local SI joint pain.
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| Patrick's Test (Faber Test) - Sacroiliac | Alert of possibility of hip pathology or involvement of SI Joint | (demonstrate first) - supine, positions limb to be tested in flexion, abduction, and external rotation so foot rests on opposite knee. Slowly and passively press knee to table and press on counter limb. | (state) - positive pain in back or hip or remains in plane and does not lower to table.
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