Ortho Tests

Question 1

A/C Shear

Answer 1

Assesses the integrity of the acromioclavicular joint.

• Client is seated
• Stand behind client
• Place cupped hands over client’s shoulder, the fingers interlaced, with one palm on the clavicle and the other on the spine of the scapula.
• Slowly squeeze heels of hand together.

A positive test – pain or abnormal movement > AC joint pathology, AC ligament sprain

Question 2

Adson’s Maneuver

Answer 2

Assesses for TOS caused by the anterior scalene muscle.

• Client is seated
• Stand behind client
• Locate radial pulse
• Client rotates head to face the test shoulder
• Client extends head while the examiner laterally rotates and extends the client’s shoulder.
• Client takes a deep breath and holds it for 10-15 seconds

A positive test – decrease/loss of pulse AND recreation of symptoms > TOS caused by compression of the anterior scalene

Question 3

Apley Scratch

Answer 3

Assesses combination movements at the shoulder.

• Stand behind the client
• Instruct client to reach behind the head to touch as far down the spine as possible. Assesses external rotation, flexion, and abduction of one GH joint.
• Instruct client to reach up, at the same time, behind the back with the other hand, touching as far up the spine as possible. Assesses internal rotation, extension, and adduction of other GH joint.
• Note location of fingers according to thoracic vertebra.
• Perform on other side.
• Compare ranges
  Note: there is often less flexibility on the dominant arm

A positive test – pain and inability to perform motion > limited range of motion, possibly indicating frozen shoulder

Question 4

Yergason’s Test

Answer 4

Assesses the integrity of the transverse humeral ligament in the bicipital groove or the presence of biceps tendinitis, or both.

• Client is seated
• Client flexes elbow of the affected arm to 90 degrees and pronates the forearm with elbow stabilized against client’s thorax
• Palpate the bicipital groove during test
• Apply resistance to supination, while the client actively supinates the forearm and laterally rotates the humerus

A positive test – biceps tendon popping out of bicipital groove > torn transverse humeral ligament

Tenderness in the bicipital groove alone > biceps tendinosis or paratenonitis

Question 4

Drop Arm

Answer 4

Assesses for a tear in the rotator cuff muscles.

• Passively abduct the client’s arm to 90 degrees.
• Ask the client to slowly lower the arm to the side in the same arc of movement.

A positive test – if the client can’t return the arm to their side slowly or has severe pain when attempting to do so > rotator cuff tear

Question 5

EAST test (Roos)

Answer 5

Assesses for TOS.

• Client is seated
• Client abducts arm to 90 degrees, laterally rotates shoulder, and flexes the elbow to 90 degrees so the elbows are slightly behind the frontal plane
• Client opens and closes hands slowly for 3 minutes

A positive test – unable to keep arms in starting position for 3 minutes or ischemic pain, heaviness or profound weakness of the arm, numbness and tingling of hand > TOS

NOTE: minor fatigue and distress are considered negative tests

Question 6

Speed’s (Bicep) Test

Answer 6

Assesses for bicep tendonitis.

• Client is seated
• Have client flex arm to 60-70 degrees with elbow fully extended and forearm supinated.
• Resist flexion of the GH joint

A positive test – pain at the bicipital groove on resistance > biceps tendinosis or paratenonitis

Question 7

Supraspinatus strength test “empty
& full” can

Answer 7

Assesses for supraspinatus tendinitis, strain or weakness.

Empty:
* Client is seated or standing
* Instruct client to abduct arm to 90 degrees with neutral rotation
* Examiner provides resistance to abduction – stop resistance
* Client medially rotates shoulder and angles forward 30 degrees, so thumbs point toward floor
* Examiner provides resistance to abduction again

Full: repeat test with thumb up instead of down

A positive test – pain or weakness > tear of supraspinatus tendon or muscles, supraspinatus tendinitis

Question 8

Finkelstein’s

Answer 8

Assesses for de Quervain’s or Hoffman’s tenosynovitis (abductor pollicis longus or extensor pollicis brevis).

• Client is seated
• Have client make fist with hand, with thumb inside fingers
• Examiner stabilizes forearm and passively ulnar deviates the wrist

A positive test – pain reproduced over the abductor pollicis longus or extensor pollicis brevis tendons > de Quervain’s or Hoffman’s tenosynovitis (abductor pollicis longus or extensor pollicis brevis)

Question 9

Phalen’s (Wrist Flexion)
Test and Reverse Phalen’s

Answer 9

Assesses for carpal tunnel syndrome/compression of the median nerve.

Phalen’s:
* Client is seated
* Instruct client to put the backs of the hands together. The client’s wrists are flexed, the elbows are held horizontally, and the shoulders are not elevated.
* Instruct client to strongly compress backs of hands together for one minute.

Reverse Phalen’s: perform with hands in prayer position

A positive test – tingling, numbness or pain in the thumb, index finger, middle finger and lateral half of the ring finger > carpel tunnel syndrome/median nerve compression

Question 10

Apley’s Test

Answer 10

Assesses for meniscus injury or ligament sprain.

• Patient lies prone with knee flexed 90 degrees
• Compression test – examiner presses down through tib/fib and then medially and laterally rotates tibia while maintaining compression
• Distraction test – examiner anchors patient’s thigh to table with knee. Examiner lifts tib/fib and then medially and laterally rotates maintain distraction

A positive test:
* if rotation + distraction is more painful or shows increased rotation > ligament sprain
* if rotation + compression is more painful or shows decreased rotation > meniscus injury

Question 10

Tinel’s (wrist)

Answer 10

Assesses for CTS.

• Tap over carpal tunnel with finger or hammer

A positive test – tingling or paresthesia into thumb, index, and middle finger of palmer surface or tips of fingers of dorsal surface > carpel tunnel syndrome

Question 11

Drawer Sign (knee)

Answer 11

Assesses for cruciate ligament sprain or tear.

Anterior drawer – anterior cruciate ligament
* Client supine with hips at 45 degrees, knees flexed to 90 degrees and feet on table
* Examiner medially rotates tibia slightly and sits on patient’s foots.
* Examiner draws tibia forward

Positive test – pain and/or laxity > anterior cruciate ligament sprain or tear

Posterior drawer – posterior cruciate ligament
* Client supine with hips at 45 degrees, knees flexed to 90 degrees and feet on table
* Examiner medially rotates tibia slightly and sits on patient’s foots.
* Examiner pushes tibia backward

Positive test – pain and/or laxity > posterior cruciate ligament sprain or tear

Question 12

Lachman Test

Answer 12

Assesses for sprain/instability to anterior cruciate ligament.

• Patient lies supine with involved leg beside examiner
• Examiner holds patient’s knee between full extension and 30 degrees of flexion
• Stabilize femur with one hand, draw tibia anteriorly with other

Positive test – mushy/soft end feel when tibia is moved forward on the femur, increased movement > sprain/instability to anterior cruciate ligament

Question 13

McMurray

Answer 13

Assesses for torn meniscus.

• Client is supine with knee completely flexed (heel to butt)
• Examiner medially rotates tibia then extends knee (keeping medial rotation throughout) – tests lateral meniscus
• Examiner laterally rotates tibia then extends knee (keeping lateral rotation throughout) – tests medial meniscus

A positive test – pain and/or snap or click > medial rotation and extension – torn lateral meniscus; lateral rotation and extension – torn medial meniscus

Question 14

Noble Compression
Test

Answer 14

Assesses for IT band friction syndrome.

• Client is supine
• Examiner flexes patient’s knee to 90 degrees with hip flexion
• Pressure is applied to lateral femoral epicondyle – hold with thumb
• Maintain pressure and passively extend knee

A positive test – pain at approx. 30 degrees recreating pain occurring during activity > IT band friction syndrome

Question 15

Valgus & Varus stress tests

Answer 15

Assesses for MCL/LCL ligament sprain/tear.

Valgus Stress Test:
* Client is supine or sitting with knee slightly flexed/almost straight
* Examiner stabilizes lateral femur
* Apply valgus stress to medial tibia (push laterally)

Varus Stress Test:
* Client is supine or sitting with knee slightly flexed/almost straight
* Examiner stabilizes medial femur
* Apply varus stress to lateral tibia (push medially)

A positive – pain and/or laxity > valgus stress test – medial collateral ligament sprain/tear; varus stress test – lateral collateral ligament sprain/tear

Question 16

Ely

Answer 16

Assesses for shortened rectus femoris.

• Client is prone
• Examiner passively flexes knee
• Repeat on other side

A positive test – during flexion of the knee the hip on the same side spontaneously flexes > shortened rectus femoris

Question 17

90-90 Straight Leg
Raise

Answer 17

Assesses for shortened hamstring length.

• Client is supine
• Client bends knees to 90 degrees and hips to 90 degrees (dead bug)
• Client straightens each leg in turn

A positive test – angle of knee is less than 160 degrees > shortened hamstrings

Question 18

FABER (Patrick, Fig. 4)

Answer 18

Assesses for hip joint pathology (lateral pain), iliopsoas spasm (groin pain) or sacroiliac joint pathology (posterior pain).

• Client is supine
• Examiner places heel of test leg (bent) above knee of non-test leg (straight), then slowly lowers test leg to table
• Stabilize opposite ASIS.

A positive test – leg remains above non-test leg (normal if parallel to non-test leg or drops to table) > hip joint pathology (lateral pain), iliopsoas spasm (groin pain) or sacroiliac joint pathology (posterior pain)

Question 19

Gaenslan’s Test

Answer 19

Assesses for ipsilateral SI joint lesion, hip pathology, or L4 nerve root lesion

• Client lines on side (upper leg is test leg)
• Upper leg is hyperextended at hip
• Client holds lower leg flexed against chest
• Examiner stabilizes pelvis (holds hip) while extending hip of upper leg

A positive test – pain > may be caused by ipsilateral SI joint lesion, hip pathology, or L4 nerve root lesion

Question 20

Ober’s and modified

Answer 20

Assesses for contracture of TFL and IT band

Ober’s – TFL – knee bent

• Client is side lying (test leg on top)
• Client bends hip/knee and holds and hugs to chest for stability
• Examiner passively abducts and bends test leg at knee, stabilizing pelvis
• Examiner slowly lowers the leg to the table preventing crest of hip from dropping towards thigh

A positive test – top leg remains abducted and does not fall to table > contracture of TFL

Ober’s modified – TFL and IT band – knee extended

• Client is side lying (test leg on top)
• Client bends hip/knee and holds and hugs to chest for stability
• Examiner passively abducts and extends leg, stabilizing pelvis
• Examiner slowly lowers the leg to the table preventing crest of hip from dropping towards thigh

A positive test – top leg remains abducted and does not fall to table > contracture of TFL and IT band

Question 21

Pace Maneuver

Answer 21

Assesses piriformis strength.

• Client is seated
• Examiner resists abduction and lateral rotation of hip

A positive – pain and weakness > weakness of piriformis

Question 22

Piriformis Length Test

Answer 22

Assesses for piriformis length.

• Client is prone
• Client brings knees together and bends knees to 90 degrees
• Allow feet to separate from midline

A positive test – less than 45 degrees of internal rotation > short piriformis muscle

Question 22

Thomas

Answer 22

Assesses for hip flexor contracture. * Client is supine * Examiner checks for excessive lumbar curve * Client hugs non-test knee to chest * Test leg should be relatively flat on table A positive test – straight leg raises off table and/or excessive lumbar curve > hip flexor contracture. NOTE: if hip abducts on straight leg, this is due to tight IT band.

Question 23

Anterior Drawer Test (ankle)

Answer 23

Primarily assesses for injury to anterior talofibular ligament * Client is supine with heels off table * Examiner stabilizes tib + fib, and holds client’s foot in 20 degrees of plantarflexion * Examiner distracts and draws foot forward A positive test – excessive forward motion and/or pain > sprain to anterior talofibular ligament

Question 24

Tinel’s (ankle)

Answer 24

Assesses for nerve entrapment * Tap on either: * Anterior tibial branch of the deep peroneal nerve in front of ankle * Posterior tibial nerve behind the medial malleolus A positive test – tingling or paresthesia felt distally > nerve entrapment

Question 25

Cervical Distraction Test

Answer 25

Relieves pressure on the cervical nerve roots * Client is seated * Grasp client’s head at the occiput and temporal areas * Return head to anatomically neutral position * Apply a slow traction, maintaining for at least 30 seconds A positive test – relieves or decreases pain or other symptoms > compression of cervical nerve roots

Question 26

Foraminal Compression Test (Spurling’s)

Answer 26

Assesses for compression of a cervical nerve root or cervical facet joint irritation PERFORM VERTEBRAL ARTERY TEST FIRST – DO NOT CONTINUE IF POSITIVE * Client is seated * Stand behind client * Compress the client’s neck in a neutral position * Client extends head * Examiner compresses * Client extends and rotate the head to the affected side, consecutively. * Examiner compresses. A positive test – radiating pain or other neurological signs in the arm and shoulder on the side head is rotated, following dermatomes of affected nerve root > cervical nerve root compression Pain remaining local to the neck > cervical facet joint irritation on the side being tested.

Question 27

Provocative positional testing (vertebral artery)

Answer 27

Assesses for circulation deficiency of the vertebral artery at the transverse foramen * Client is supine and keeps eyes open for entire test * Examiner passively takes head and neck into extension and side flexion * Examiner rotates head to the same side and holds for 30 seconds * Pause in neutral position for 10 seconds and then repeat on the other side. A positive test – client complains of feeling dizzy or of nystagmus (involuntary, repetitive, circular motion of the eyes) or both > ischemia or circulation deficiency of the vertebral artery

Question 28

Tinel’s (Brachial Plexus)

Answer 28

Assesses for nerve lesion in brachial plexus * Client sits with neck slightly side flexed * Examiner taps area of brachial plexus – all along TVPs from C5 to T1 A positive test – tingling sensation in distribution of nerve > lesion of brachial plexus where nerve is anatomically intact Purely local pain > underlying cervical plexus lesion Pain along distribution of nerve > a neuroma is present

Question 29

Valsalva

Answer 29

Assesses for increased pressure within spinal cord. * Client is seated * Ask patient to take a deep breath and hold it as if moving bowels A positive test – increased pain > increased pressure usually due to a space occupying lesion such as a herniated disc

Question 30

Quadrant (Kemp’s) Test

Answer 30

Assesses for lumbar nerve root compression and lumbar facet joint irritation. * Client stands with examiner behind them * Client extends spine while examiner controls movement by holding client’s shoulders * Overpressure is applied in extension while client side flexes and rotates to test side * Movement is continued until limit of range is reached or symptoms are produces A positive test – radiating pain or other neurological signs into leg on test side > lumbar nerve root compression Pain remaining local to back > lumbar facet joint irritation

Question 31

Slump test

Answer 31

Assesses for dural or nerve root impingement * Client sits on table with hands behind back and chin up * Ask client to slump while examiner holds client’s chin and head erect * Examiner flexes client’s neck * Examiner applies overpressure through neck and thoracic spine * Examiner passively extends one of the client’s knees * Examiner passively dorsiflexes client’s ankle * If pain/symptoms are reproduced, add neck extension at end to see if symptoms decrease (confirms test) * Repeat with other leg A positive test – symptoms of sciatic pain or reproduction of client’s symptoms > impingement of dura and spinal cord, or nerve roots

Question 32

Straight Leg Raise

Answer 32

Assesses for nerve root impingement or peripheral nerve root lesions. * Client is supine * Examiner medially rotates and adducts hip, then passively flexes the hip, maintaining medial rotation and adduction with knee straight until client complains of pain or tightness in back or leg * Examiner extends hip until pain and tightness is gone. * Examiner passively dorsiflexes the ankle and instructs client to flex neck. A positive test – pain is primarily in low back > disc herniation Pain is primarily in the non-raised leg > a space-occupying lesion Pain in the raised leg before 70 degrees > sciatic nerve involvement Pain in the raised leg after 70 degrees > joint pain from lumber region or SI joint