Clin Ortho tri 5 Practical 2

Thomas Test

Both knees brought to chest while pt sitting at end of table. Help pt back into supine postion then pt holds the unaffected lef and allows the test leg top drop into extension. Pt back should remain flat against table then allow knee to drop into flexion. test - if knee stays up could indicate tight hip flexor muscle aka IT band

Lasegue's Sign

Part of the SLR What is the test for? Assess for presence of irritative space occupying cord lesion (herniation, tumor, adhesions, etc.), Confirms a +SLR PP- Supine DP- SOT facing headward on side of involved leg. Procedure- Flex knee and hip to 90 degrees, extend knee slowly when hip is in flexion until symptoms appear. (+) Reproduction/Exacerbation of SSx with knee extension (radiculopathy, sciatica)

Iliac Distraction Test

What is the test for? Assessing for SI pain & dysfunction posteriorly - Anterior SI is gapped, Posterior SI is compressed Procedure 1. Pt. supine, Dr. stands to side 2. Calcaneal contact on both ASIS - Dr. gets centered over pts. body and presses A-P on each ASIS to induce innominate external rotation. (can rock here if one side is more suspected than other) (POSITIVE) = Pain in the SI joint on the ipsilateral side

Fajersztajn / Well leg / C-SLR (crossed straight leg raise)

Covered on passive SLR card What is the test for? Determine location &/or presence of irritative space occupying cord lesion (herniation, tumor, adhesions, etc.), tells you where not what Procedure- Just a normal passive SLR just looking for symptoms to appear in opposite side leg. (POSITIVE) Reproduction/Exacerbation of neurological/radicular SSx in opposite leg that is being tested. Lesion is most likely posteromedial on the side of the non-test leg If issue is just tight hamstrings then patient will usually present with bilateral symptoms and pain wont pass the knee - If exacerbated b/t 35-70 degrees- Sciatica - If pain past 70 degrees then its most likely biomechanical issue at joint.

Adam's Test Meyers Test

PP. Standing with Feet together and Arms hanging, palms together. Knees in extension. Sitting if leg length is uneven. 1. Pt. bends forward (as far as they can) a. Bend from top down up to the waist until back is in horizontal plane. b. Have patient roll up slightly and stop at bottom, middle, and top of thoracic spine to examine each section. Can use scoliometer/inclinometer placed at bottom, middle, and top thirds of the thoracic spine to measure irregularities. DP- Behind patient Doctor is looking for · Increased or decreased lordosis/kyphosis · Trunk asymmetry · Un-level shoulders and/or hips · Scapula asymmetry · Head not lining up with pelvis · Rib hump Positive test- curve DN straighten upon bending = structural Negative Test - curve straightens/changes upon bending = Functional Confirmatory tests- 1.Adduction Test of the hips (active vs. passive). 2. Elly-Dunkan/Staheli/Thom Test 3. Kneeling test 4. Side bending test 5. Standing at Ease Test 6. Rotation of the pelvis test Next step is to X ray to confirm COBB's Line

Sicard's Test

Part of Passive SLR Test What is this Test For? Stretching Sciatic Nerve (L4,5,S1, mostly L5/S1) to see if irritated by space occupying lesion such as herniation, tumor, or adhesion. Confirms a Positive SLR PP- Supine DP- Side of table of involved leg Procedure- Do passive SLR until symptoms exacerbated then back off 5 degrees. Dorsiflex just the big toe and see if symptoms are exacerbated. Positive- Sciatica symptoms (radicular signs), lesion most likely posterior lateral

Bragard's Test

Part of Passive SLR Test, confirmatory test Looking for? Stretching Sciatic Nerve (L4,5,S1, mostly L5/S1) to see if irritated by space occupying lesion such as herniation, tumor, or adhesion. PP- Supine DP- Side of table of involved leg Procedure- Do passive SLR until symptoms exacerbated then back off 5 degrees. Dorsiflex the foot and see if symptoms are reproduced. Positive- Sciatica symptoms (radicular signs), lesion most likely posterior lateral

Tripod vs Flip

Procedure- Do Bechterew's and then look for the tripod or flip signs. Tripod- will extend the leg or both legs at the trunk and put hands behind them for support (+) to relieve the tension. d/t hamstring tightness/cord lesion etc... Flip- is an exaggerated version of tripod. d/t hamstring tightness/cord lesion etc... pt. will extend at the trunk and abruptly put hands behind them for support (+) (+) Exacerbation/Reproduction of pain and/or neurological/radicular SSx of sciatic N. D/t increased pressure on the disc, a + finding here is most likely indicative of a disc lesion

Cluster exam

Tests for the SI cluster include: Gaenslen's Iliac Compression & Distraction Sacral Thrust Thigh Thrust If 3/5 tests are (POSITIVE) = SI dysfunction is highly probable

Straight Leg Raise (SLR)

What is test Looking for? Stretching Sciatic Nerve (L4,5,S1, mostly L5/S1) to see if irritated by space occupying lesion such as herniation, tumor, or adhesion. Very sensitive test so can rule out herniation if negative. PP- Supine DP- Side of table of involved leg Procedure- Start with asymptomatic leg first and explain to patient you will be lifting their leg and to let you know if any symptoms are produced. Flex leg until symptoms reproduced in low back or in back of leg. Positive- 1- Radiculopathy symptoms down leg past knee indicates posterolateral lesion/herniation 2- Pain in just low back indicates central disc herniation. 3- If LBP and leg pain then, discopathy is at L4-4- (posterolateral issue) 5- Mostly leg pain suggests lateral disc herniation 6- If symptoms produced on opposite side leg then its called a Well Leg Raising test/Crossed SLR test/Fajersztajn test, indicates a posterior medial herniation on other side. - If exacerbated b/t 35-70 degrees- Sciatica - If pain past 70 degrees then its most likely biomechanical issue at joint. Confirmatory tests- Lasegue, Bragard's, Sicard's, Turyn's

Amoss' Sign

What is test for? (Observational) Looking for presence of: ·1.Ankylosing spondylitis* (and/or associated AS stiffness) ·2. Intervertebral disc syndrome (IVDS) ·3 Sprain, strain or fracture PP: 1. Pt. lies on side, with feet/legs together, table side arm under head for support, other hand resting on table 2. Dr. tells pt. to rise to a seated position from position 1 DP: 1. Dr. observes pt. during movement to seated position, Looking for position of greatest comfort and/or discomfort/pain Positive Test = - Pt. complains of localized thoracic or thoracolumbar pain (with or without difficulty) If Severe AS or IVDS - IF you Suspect IVDS - assess pt. AROM/PROM & general mobility Chest Circumference Test could help confirm Ankylosing spondylitis

Yeoman's Test

What is test looking for? Pain in the SI joint on the ipsilateral side, especially deep in the abdomen & groin - Be sure to ask where the pain is if (+) PP- Prone DP- Side of patient on involved side Procedure- Bend knee of patient to 90 degrees and with inferior arm cradle the knee in palm of hand. With superior hand, place heel on same side PSIS with fingers facing away from sacrum. Pull up to hyper extend femur with inferior hand while pushing down on PSIS with superior hand. Forces innominant into a nutated position. Positive: Pain in SI Joint Indicates: SI lesion Stresses Anterior Portion of SI/ligament, segmental pain provocations signs present in anterior or posterior SI

Goldthwaits

What is the test for? Differentiate between lumbar/lumbosacral and sacroiliac issues Procedure: 1. Dr. performs a SLR on affected side while palpating lumbar spine by placing fingers under patients body and into interspinous spaces. (L5/S1, L4/L5, L3/L4 etc....) 2.Assess for joint motion and ask patient to let you know when they feel symptoms. Positive (+) - If patient has pain before Dr. feels lumbar motion = sacroiliac problem / lesion - If patient has pain while Dr. feels lumbar motion = lumbar spine problem/lesion

Bechterew's/Sitting SLR/sitting Lasegue

What is the test for? Assess for presence of irritative space occupying cord lesion of sciatic nerve (herniation, tumor, adhesions, etc.) = Nerve tension test. procedure- Can be active or passive if patient needs assistance. Patient sitting on SOT with feet dangling. Ask patient to extend out involved leg until symptoms exacerbated. Then do other leg, and then both legs at the same time. (Positive) = Exacerbation/Reproduction of pain and/or neurological/radicular SSx of sciatic N. D/t increased pressure on the disc, a + finding here is most likely indicative of a disc lesion Tripod/Flip is a compensatory sign - d/t hamstring tightness, or too much nerve tension of sciatic nerve. pt. will extend at the trunk and put hands behind them for support (+) Flip is just a more pronounced version of tripod.

Sternal compression test

What is the test for? 1. Rib, sternum or costo-cartilage fractures (Positive) = Indicated by localized pain in the rib cage 2. · Impaired costal or vertebral mobility (Positive) = Indicated by pain and/or crepitus (popping/cracking) 3. NEGATIVE (-) = Contusion or muscle strain PP: 1. Patient lying supine, arms to their side DP: 1. Doctor stands to the side of the patient facing towards the head. 2. Doctor takes his hand that is closest to the table and makes a calcaneal contact over the patients' sternum with their fingers pointing superiorly. 3. With the doctors' other hand supporting the contact hand. 4. Doctor applies a steady but forceful pressure through both hands. 5. Doctor awaits a response from the patient. 6. After a response, the doctor attempts to localize.

Schepelmann Sign

What is the test for? Tests for intercostal neuritis or intercostal strain Procedure 1. The patient is sitting or standing looking straight ahead with their feet together. 2. Doctor standing in front or behind the patient. 3. The doctor instructs the patient to raise both arms over their head and lean to one side. 4. The doctor observes which side recreates or exacerbates the patient symptoms. 5. The doctor then determines if it was on the side spinal convexity or concavity. 6. Repeat on the other side. Positive Patient complains of rib pain Pain when bending on concave side (ribs being compressed = intercostal neuritis (SSx: pins/needles/burning/numbness) · Pain when bending on convex side (ribs being separated): = intercostal strain or myofascitis

Rib Compression Test

What is the test for? To determine which joint of the rib cage is irritated/restricted POSITIVE TEST Localized pain in at least 1 of 4 joints of the rib cage · Costosternal, costochondral, costotransverse, costovertebral · Example: costochondritis (3rd/4th/5th CS joints) or Tietze syndrome (2nd or 3rd CS joints) IT IS difficult to treat, usually resolves w/in 1 year POSITIVE TEST Pain along the body of the rib OR between 2 ribs (with or without dyspnea) This suggests: · Rib fracture (m/c at rib angle) · Intercostal neuralgia PP: 1. Pt. can be supine, prone, side-lying, sitting or standing (they want standing for practical) DP Dr. applies P->A and A -> P or lateral compression of the ribs (Head looking back) NOTE: Costochondritis is responsible for 30% of ER visits related to chest pain True ribs - 1-7 False - 8-10 Floating - 11 & 12 Typical - 3-9 Atypical - 1,2, 10-12 Procedure: 1. Have the patient standing looking straight ahead with their feet together. 2. Doctor stands to the side of the patient. 3. The doctor instructs the patient to raise their arms. 4. The doctor then braces one side of the patient against his chest with his head towards the back. 5. The doctor reaches around the patient with both hands to the opposite side of the thorax. Superior arm lower than the posterior arm. 6. The doctor then applies lateral to medial pressure moving from the axilla downward. 7. Doctor awaits a response from the patient. 8.Doctor repeats the procedure on the other side

Thigh Thrust

What is the test for? Assessing for SI pain & dysfunction (not actually thrusting just a consistent pressure applied for this test) Procedure: 1. PP- Supine DP- SOT on side of involved innominate. 2. Pt. flexes hip to 90° and knee fully flexed 3. Dr. palpates the SI joint with superior hand and has other hand on pts. knee 4. Applies axial load down femur to force femoral head into the acetabulum to innominate and engage counternutation Positive: Pain in the SI joint on the IPSILATERAL side Anterior posterior shear stress on SI joint; this will also look for femoral acetabular issues of the posterior capsule (posterior dislocation, Labral tears etc.). dislocation, labral tears, etc.)

Turyn's Sign

What is the test for? Assess for presence of a large irritative space occupying cord lesion (herniation, tumor, adhesions, etc.) 1. Perform test on asymptomatic leg 1st PP- Supine DP- Foot of table Procedure- Have patient remove shoes for this one. While patient is in the supine position the doctor dorsiflexes the big toe quickly and releases it. No SLR! Positive sign is pain in the affected leg indicating sciatica. For this test to be positive the lesion will have to be vary large

Modified Ely's

What is the test for? Assess for presence of higher root level (L2,3,4) lesion, lumbar radiculopathy or meningeal irritation Like an SLR, but for the anterior lateral thigh, Increases tension in the femoral nerve attachments to the quads, pulling on nerve roots L2, 3. Procedure- Same test as Ely's but once you get to final position of Ely's, stabilize the sacrum with superior forearm while simultaneously anchoring the patients involved ankle with the same hand to the opposite glute. - With your inferior hand, scoop up patients involved side knee to hyperextend the leg at the hip and stretch out the femoral nerve (L2-L4). (POSITIVE) = Exacerbation/Reproduction of pain and/or neurological/radicular SSx - Could indicate Meralgia paresthetica- lateral femoral cutaneous N involved (radicular signs in anterior outer thigh)

Prone Knee Bend

What is the test for? Assess for presence of higher root level (L2,3,4) lesion, lumbar radiculopathy or meningeal irritation Like an SLR, but for the anterior lateral thigh, Increases tension in the femoral nerve attachments to the quads, pulling on nerve roots L2, 3. PP- Prone DP- SOT facing headward on involved leg side. Procedure- Take patients involved leg and flex towards same side glute until radicular symptoms appear. (POSITIVE)= Exacerbation/Reproduction of pain and/or neurological/radicular SSx down anterior lateral thigh. - Could indicate Meralgia paresthetica- lateral femoral cutaneous N involved (radicular signs in anterior outer thigh)

Ely's

What is the test for? Assess for presence of lumbosacral structural pathologies. facets / disc / SI PP- Prone DP- On side of involved leg Procedure- Grab patients ankle with inferior hand and bring heel of involved leg to opposite side glute. Increases tension in the femoral nerve attachments to the quads, pulling on nerve roots L2, 3, 4 (+) - Pain in the lower back (LS) or hips (SI) Back pain disc or facet origin. May also relieve symptoms. -Hip pain SI joint problem

Gaenslen's Test

What is the test for? Assessing for SI pain & dysfunction (Applies torsional stress on the SI joints) Procedure: TEST UNINVOLED SIDE FIRST 1. Pt. supine & close to edge of the table, Dr. stands on same side 2. Pt. holds non-test leg in full flexion (hugs to chest) 3. Dr. instructs and turns patient pt. to hang involved side thigh and leg off the edge of the table (make sure table is not blocking thigh from falling off ) Dr. applies a downward force on distal thigh while stabilizing the non-test leg by holding the knee (hip hyperextension (POSTIVE) = Pain in the SI joint on the ipsilateral side, especially in the groin, posterior thigh or down the leg pain - Be sure to ask where the pain is if (+) (Characteristics of a positive test are ipsilateral groin, posterior thigh or down the leg pain) Trying to induce nutation into the innominate Which test would be cross referenced? Thomas Test

Sacral Thrust Test

What is the test for? Assessing for SI pain & dysfunction Procedure: 1. Pt. prone, Dr. stands to SOT facing headward 2. Inferior hand- Calcaneal contact ½cm below S2 midline fingers pointed up the spine and reinforcing with superior hand. 3. Superior forearm angled perpendicular to nutated sacrum (~90° to nutated sacrum not the patient, superior forearm will actually look 70 degrees compared to patients body) 4. Push P-A on sacrum to induce more nutation Positive: Pain in the SI joint on IPSILATERAL side

Lewin Gaenslen's test

What is the test for? Assessing for SI pain & dysfunction Procedure: TEST UNINVOLED SIDE FIRST 1. Pt. side-lying and holding flexed knee on the side they are laying on (hugging downward knee into chest), test leg up 2. Dr. stands behind and holds test leg with inferior hand and pushes P-A on the ipsilateral PSIS with the superior hand 3.Remove all hip extension until at end range, then apply P-A pressure on PSIS and add more hyperextension if needed (POSTIVE) = Pain in the SI joint on the ipsilateral side, especially in the groin, posterior thigh or down the leg pain - Be sure to ask where the pain is if (+) (Characteristics of a positive test are ipsilateral groin, posterior thigh or down the leg pain) Trying to induce nutation into the innominate Which test would be cross referenced? Thomas Test

Iliac Compression Test

What is the test for? Assessing for SI pain & dysfunction anteriorly - Anterior SI is compressed, Posterior SI is gapped DP- Dr. stands behind patient PP- Side lying on table hips at 60 and knees at 90 Procedure: 1. Pt. side-lying w/ test leg up and hips stacked (uninvolved side down, involved side up). Hips @ 60 degrees, Knees at 90 degrees 2. Inferior hand- Calcaneal contact on lateral aspect of ASIS with fingers down toward floor (stay off the trochanter) Superior hand- Reinforce other hand and apply pressure downward towards table to gap the joint (b/t greater trochanter and iliac crest) (POSITIVE) = Pain in the SI joint on the upward side

Prone Instability Test

What is the test for? Assessing for hypermobility resulting in clinical instability, laxity, and/or pathological increase in the neutral zone Procedure- First raise table up to patients ASIS's and Instruct patient to *lie prone on the table and to grab the edges of the table with legs off* the end and feet on the floor 1. Apply pressure to the lumbar spine using spring test (P-A shear with hypothenar/knife edge reinforcing with other hand) & ask if it provokes symptoms 2.*If pain is found* proceed to the next step, if pain is not found then the test is over 3. Ask patient to slightly lift legs off the ground (active lumbar & hip extension) 4. Apply pressure to the spine again while the legs are elevated (POSITIVE) = Pain is alleviated when lifting legs off floor b/c lumbar spine is contracting and stabilizing the involved segment. Indication of Lumbar instability (NEGATIVE) =No alleviation when legs are lifted indicates muscular strain Line Draws - A line drawn at the highest point of the iliac crests will usually cross the body of L4. Using PSIS is more accurate than Tuffiers. (Helps to find L4/L5. have to take into account; Variables are Weight/height/age)

Kemp's Test Lumbar Quadrant Test (if also done in flexion)

What is the test for? Compression of the lumbar IVF's to exacerbate/reproduce radicular, SSx · Helps differentiate b/t neurological vs. structural problems. PP: Standing DP: Behind patient Procedure 1. Dr. Places thumb on affected side paraspinal area Dr. Passively induces ipsilateral lateral flexion, extension and contralateral rotation 2. Dr. Presses P to A with thumb while adding over pressure on pt. shoulders Ipsilateral rotation = decrease foraminal size (not significant due to lumbar rotation) Contralateral rotation = Causes Facet Impaction Further decrease the size of the IVF we try to compress the spine downward through the shoulders if possible. (POSITIVE) =Exacerbation/Reproduction of pain and/or neurological/radicular SSx especially down the leg & below the knee · (+) Finding DDx: disc herniation, central canal or IVF stenosis causing neural Claudia toon (-) - Localized pain, mostly likely indicative of a facet structural problem Differentials- stenosis, DJD, DDD, IVF stenosis, Lumbar Quadrant Test- Do all four quadrants of the test, flexing forward and also extending back to the laft and right side. If pain when flexing forward, it is more indicative of a sprain/strain injury than IVF stenosis.

Stork standing test One-leg standing test one legged extension test Michelis' Test unilateral extension test

What is the test for? Confirms a diagnosis of spondylosis, spondylolysis or facet syndrome · Not specific or sensitive for detection of active spondylolysis -SPECT preferred > MRI -SPECT: Healing = osteoblastic, Developing = osteoclastic Procedure: 1. Pt. instructed to stand on one leg with opposite leg dorsum of foot in popliteal fossa 2. Pt. is instructed to lean backward to induce hyperextension of the lumbar spine (POSITIVE) = Reproduction/exacerbation of low back pain · Unilateral lesions produce pain when standing on ipsilateral leg · Follow up tests: percussion, spring test, hook/rocking

Nachlas Test

What is the test for? Differentiate between lumbar/lumbosacral and SI issues. Tests for more of a structural issue than Femoral nerve tension. Patient will point to where pain is located. PP- Prone DP- SOT facing headword on involved leg side. Procedure- Flex leg to same side glute until heel touches the butt. (POSITIVE) = Pain in the lower back (LS) or hips (SI) Back pain = disc or facet origin Hip pain = SI joint problem Same as prone knee bend, but this is a structural facet test NOT a nerve tension test

Belt Test, Supported Adams, Supported Lumbo-Pelvic Flexion Test

What is the test for? Differentiate between lumbar/lumbosacral and sacroiliac issues Procedure 1. Pt. standing, Dr. stands behind 2. Dr. asks patient to bend forward at the hips - Ask how pain was. 3. Dr. braces patients sacrum with one of their thighs and uses hands to pull back on both ASIS Dr. instructs pt. to bend at the hips again - asks how the pain was Positive (+) If pain was alleviated with sacrum support = sacroiliac issue If pain was not alleviated with sacrum support = lumbosacral or lumbar spine issue

Beevor's sign

What is the test for? Paralysis of abdominal muscles (contraction is normal, characteristic of a cord lesion at T9-10 level Procedure: 1. Patient lying supine with their arms to their side. 2. Doctor standing to the side of the patient looking towards the head of the table. 3. The doctor instructs the patient to begin a partial sit-up. (patient raises head and shoulders off table) 4. The doctor observes for any shift in the umbilicus. Positive: Doctor is looking for Deviation of the umbilicus Upwards which indicates paralysis of lower abdominal muscles from a cord lesion at T9/T10 Example: Paralysis of inferior portion of rectus abdominis mm. the umbilicus will be pulled upwards Also can be seen with inter alia, ALS and facio-scapulo-humoral muscular dystrophy Compare Beevor's Sign to Abdominal Reflex · Contraction of superficial abdominal muscles when stroking abdomen lightly = significant if asymmetric; This indicates a UMN lesion on ABSENT SIDE

Dejerine's Triad

What is the test for? To assess for presence of a space-occupying lesion (POSITIVE) - Exacerbated symptoms with increased intra-thecal pressure Procedure: Ask patient if SSx worsen when coughing, sneezing or while passing a bowel movement (pre-indication to do Milgram's Test)

Valsalva maneuver

What is the test for? To assess for presence of a space-occupying lesion (POSITIVE) - Exacerbated symptoms with increased intra-thecal pressure Procedure: Blow into thumb or asking pt. to "bear down" (pre-indication to do Milgram's Test)

Chest Circumference Test

What is the test for? To assess for: · Reduction of costovertebral joint motion · Ankylosing spondylitis · Respiratory conditions that reduce chest expansion Procedure 1. Have the patient standing looking straight ahead with their feet together. 2. Doctor standing behind the patient places a tape measure around (skin on skin) the chest at the nipple line in males and the level of T10 for females. 3. The doctor holds both ends of the tape to visualize the numbers. 4. The doctor instructs the patient to exhale fully and hold. 5. The doctor observes the measurement. 6. The doctor instructs the patient to inhale fully and hold. 7. The doctor observes the measurement. 8. The 2 numbers are subtracted from each other. Positive: · Abnormal for men: <2.5 cm or 1 inch · Abnormal for women: <1.9 cm or 0.75 inches Normal: Normal range: 5.8-7.6 cm or 1.5-3 inches Extra info: Pump-handle - upper ribs, increase A-P , 1-6 Bucket handle - lower ribs, increase lateral, 7-10

Milgram's Test

What is the test for? to assess for presence of a space-occupying lesion Procedure 1. Pt. supine with legs flat on table 2. Dr. stands at FOT and asks patient to lift both legs 6 inches off the table and hold for 30 sec. Can assist with leg lift if needed but make sure patient holds legs up on own. This causes patient to hold breath and increase intrathecal pressure. Keep hands under feet for safety. 3. Ensure patient can hold without pain after releasing air and decreasing intrathecal pressure. (POSITIVE) = Exacerbated back and/or leg symptoms with increased intra-thecal pressure Could mean Herniated disc or Space-ocupying lesion, spur Confirmatory tests- Valsalva + Dejerine's Triad

Nerri's bowing test/sign

What is the test for? Assess for presence of irritative space occupying cord lesion (herniation, tumor, adhesions, etc.) PP- standing Procedure- Active test, ask patient to bend over at the hip and try and touch their toes. As patient is going down one of the knees will buckle by flexing leg to stop symptoms. This is + neris test. - Next, try and push the buckled leg back into extension by pshing A-P on the knee. - If patient cant handle that, take thumb and goad just medial to the lateral hamstring tendon at the popliteal fossa area while the leg is still buckled to produce Nerri's Sign. - If issue is just tight hamstrings then patient will usually present with bilateral symptoms and pain wont pass the knees. (+) Neri's Test -Knee buckling alleviates SSx Lesion is most likely posterolateral (+) Neri's Sign - palpation over sciatic nerve (popliteal area) is provocative

Bowstring test and Bowstring Sign

What is the test for? Assess for presence of irritative space occupying cord lesion (herniation, tumor, adhesions, etc.) pp- supine, with leg flexed 90 degrees (+) Bowstring Test-Alleviation of radicular SSx with decrease in knee extension (+) Bowstring sign - Goading of hamstring tendon just medial to the lateral hamstring tendon in the popliteal area after decreased extension at the knee reproduces +SLR SSx Bowstring test- is simply the act of coming out of knee ext. Bowstring sign- includes goading B-T-A B-S-G

Slump Test

What is the test for? Assess for presence of neurological irritative lesion or something causing increased nerve tension (helps to localize where). Lesion can be anywhere from head to foot to warrant test. PP- Sitting on SOT DP- Start on uninvolved side first standing to side of patient. Have arm over patients shoulders to guide into motion and apply overpressure if needed. Procedure: 1. Pt. Sitting, Dr. stands off to side 2. Dr. Instructs pt. To slouch keeping cervical spine extended (SLUMP component tests thoracic and lumbar spine), then add cervical flexion actively 3. Dr. May then add overpressure to increase cervical flexion & tension 4. Dr. Then extends 1 leg at the knee, dorsiflexes foot and then lastly the big toe Can add other leg if SSx are not reproduced by step 5 (POSITIVE) = Exacerbation/Reproduction of pain and/or neurological/radicular SSx · Possible causes of abnormal neuro dynamic test: o Osteophytes o Pancoast tumor and malignancies o Disc bulges o Swollen joints/tendon sheaths o Myotendinous & nervous system abnormalities Neuritis or nerve compression

Schober's test

What is the test for? Assess lumbar flexion range of motion for stiffness indicative of Ankylosing Spondylitis (AS) PP- Standing in front of Doc DP- Behind patient Procedure- Mark between PSIS's with wax pencil as a reference point. Next measure down 5cm from PSIS point and mark it. Then measure 10cm up from PSIS point and mark it. This should be 15cm between the 2 lowest and highest points. - Have patient bend over as far as they can and touch toes and measure between these two points again. - Subtract 15 from your measurement. (+) < 4cm measured flexion and stiffness is a positive test. Normal > 4cm Moderate 2-4cm Severe <2cm Confirmatory test- Amoss sign

Hibb's Test

What is the test for? Assessing for SI pain & dysfunction PP- Prone DP- contralateral of involved side of patient reaching across. Procedure- inferior hand grabs contralateral leg and flexes it at knee to use as a lever to rotate the femur internally (push out). With superior hand place fingers in SI joint in the "dimple" checking for gapping in the back dimple (level of S1). When opposite hip starts to raise, push down on it with palm and continue to internally rotate femur. (+) Pain in the SI joint on the ipsilateral side NOTE: Be sure to remove all internal hip rotation before gapping the joint Confirmatory tests- Active SLR, yeoman's

Active SLR Test

What is the test for? Assessing for SI pain & dysfunction · During the leg lift, the load transfers to the opposite leg's SI joint · Pt. may complain about pain during the stride phase of gait PP- supine on table. DP- on side of leg being raised Procedure- Have patient raise leg one at a time 6 to 12 in off table. If negative, add resistance and see if pain/ opposite trunk rotation to compensate. positive- should reproduce symptoms (pain/significant trunk rotation) in contralateral SI joint. Indications- SI joint dysfunction, abdominal or hip flexor inhibition, poor stability during ADLs, postpartum SI pain. Confirmatory tests- iliac compression test, belt test. To confirm a positive finding- stabilize the pelvis and have the patient repeat the test --> this will alleviate the pain in the affected SI joint Can grade pt. ability to do this test 0-5 (Likert Scale) - 0 = no difficulty - 5= unable to perform the test Test before and after treatment and between visits to use as an outcome marker.

Spring Test/P-A Shear

What is the test for? Assessing for general mobility, can also assess tissue tone changes, asymmetry, and misalignment. (POSITIVE) = decreased or increased motion at one vertebra compared to another with or without pain KEY sign/test --> supraspinous &/or interspinous ligament pressure induces pain = local sign of joint dysfunction Procedure: 1. Pt. is prone, Dr. stands off to side 2. Dr. places hypothenar over spinous process, fingers perpendicular to spine 3. Reinforce with other hand and apply a P-A springing force Repeat with thumbs over paraspinal area to assess facet joints

Bonnet's test

What is the test for? Determine location &/or presence of irritation on the sciatic nerve Procedure- SLR w/ internal rotation of leg and also cross leg over other leg in order to get maximum stretch of piriformis muscle. 1. Perform test on asymptomatic leg 1st 2. Pt. is supine, Dr. stands to side 3. Dr. passively flexes the leg at the hip while keeping the knee in extension Dr. Passively internally rotates and ADducts leg (Positive) - Reproduction/Exacerbation of neurological/radicular SSx only below the level of the Piriformis muscle Indicates Piriformis muscle is irritating/compressing sciatic nerve Dx: Piriformis Syndrome