nms tests revised

7/22/2019 NMS Tests Revised

1/12

NMS I Orthopedics

TESTS HOW TO PERFORM POSITIVE FI NDI NG INDI CATIONS

Rusts Pt spontaneously grabs headw/ both hands when lying

down or arising from

recumbent position

Pain , Very limited Cervical

ROM

Upper Cervical Instability

Severe sprain, RA, Fx, Severe

Cervical subluxation

(TAKE XRAYS ASAP nofurther testing w/o them)

LibmansPt seated, doc standing behind

pt. Doc applies pressure on

pts mastoid process withthumbs until pt reports

pain/discomfort. Compare side

to side.

Pain / Uncomfortable Tests the pts pain tolerance -useful for later procedures

Bakodys Pt abducts & externally rotatesthe ipsilateral shoulder to

place hand on top of head.

Position relieves pt pain

(reduces tension on the

cervical nerve root)

Nerve tension, cervical

radiculopathy

Reverse Bakodys Pt abducts & externally rotatesthe ipsilateral shoulder to

place hand on top of head.

Position increases radicular

pain.

Interscalene compression of

lower brachial plexus.

TOS

Bikeles Pt seated. Abduct shoulder to90 degrees then externally

rotates shoulder. Arm is fully

extended at elbow and pt triesto reach behind them. (As if

you are reaching into the backseat of the car)

Radiation of pain along

brachial plexus pattern.

Radiation along a nerve root.

Brachial Plexus Neuritis

Brachial Plexus lesion /

Radiating pain along T1

dermatome only KlumpkesPalsy

Stinger injury usually fromlateral flexion / traction injury.

(Injury may cause Neuropraxia

/ Axonotmesis / Wallerian

degeneration)

Brachial Plexus Tension

Test

Pt seated erect. Pt puts hands

behind head w/ shoulders

abducted to 90 degrees andshoulders externally rotated

right before onset of pain. Doc

stands behind pt with hip

touching pt spine for

stabilization. Doc uses ptelbows to slowly pull

backwards.

Radicular pain Nerve Root symptoms of C5

indicate Erb Palsy (C5 Nerve

Root Syndrome)Radiation following more than

1 dermatome indicates a

brachial plexus lesion.

Valsalvas Test Pt seated. Pt asked to takedeep breath in & hold it. While

holding breath pt bears down

Radicular pain SOL causing Nerve Rootcompression

DeJerines Triad(question not test)

Pt reports increase in radicularsymptoms when coughing,

sneezing, or straining during

defecation

Increase radicular symptoms SOL (Aggravation frommechanical attraction of spinal

fluid)

Swallowing Test Pt seated & asked to swallow. Pain or inability to swallow Esophageal irritation via directtrauma or retroesophageal

SOL, severe strain/sprain, Fx,

Disc protrusion/herniation,

Osteophyte.

Naffzigers Test Pt seated. Doc occludesjugular vein bilaterally for 30-

40 seconds. Pt then asked to

cough

Local or radicular pain in

spine

SOL

* do not do on pt w/ cardiac

problems

Barre-Lieou Pt seated. Doc tells pt toslowly rotate head side to side

(BP & pulse are taken beforetest)

Vertigo, Blurred vision,

Nausea, Syncope, Nystagmus

Vascular Compromise

Vertebrobasilar FunctionManeuver

Pt seated. Subclavian &carotid arteries auscultated for

buits. Then palpate. If bruitspresent do not perform. Pt

rotates head to left &

hyperextends. Repeat on right.

Vertigo, Blurred vision,Nausea, Syncope, Nystagmus

Vertebral, Basilar, or Carotidartery stenosis/compression

DeKleyns Pt supine. Pt head off table doctells pt to hyperextend & rotate

head hold for 15-45 sec

Vertigo, Blurred vision,

Nausea, Syncope, Nystagmus

Vascular Compromise


2/12

Distraction Test Pt seated. w/ hands on glabellaand EOP slightly traction pts

head upward.

1. Local pain increases

2. Peripheral pain decreases

3. Local pain decreases

1. Muscle, ligament, or joint

capsule damage

2. IVF encroachment, cervical

radiculopathy3. Facet impingement

Foraminal Compression Active C ROM performedfirst.

Pt seated doc places

downward pressure on pthead/neck. Head is rotated to

each side with similar

compression.

1. Radicular pain

2. Local Neck pain

1. Foraminal (cervical Nerve

Root) encroachment,

radiculopathy

2. Sprain/strain

Jacksons CompressionTest

Pt seated. Head is laterally

flexed toward shoulder. Doc

exerts downward compression.(Bilaterally tested)

Radicular pain IVF encroachment

(radiculopathy)

Facet irritation (local pain)

Maximum Cervical

Compression

Pt seated Pt actively rotates

head & hyperextends neck to

side of complaint. Repeats onopposite side

Radicular Pain IVF encroachment

*Tight stretching pain onconvex side muscle strain

Spurlings Test Pt seated. Pt head is laterallyflexed to side of complaint.Doc applies compression to

head/neck. Neck then

extended/rotated and

compressed. Doc then applies

a vertical blow to top of head

Radicular Pain Foraminal / Nerve Root

encroachment

Facet involvement local pain

Lhermittes Test Pt seated in neutral position.Head/neck passively flexed to

pt chest

Sharp radiating pain down

spine & upper/lower

extremities.

Bilateral arm/leg pain

Cervical

myelopathy.radiculopathyUnilateral arm/leg pain

following a dermatome

Nerve Root traction .

Pt. may have MS, Stenosis,

Tumor, Disc herniation

O'Donahues Passive and active resistedROM or any joint.

Pain Pain w/ active strain

Pain w/ passive sprain

*test can be used on any joint

in body*

Kernigs Sign Pt supine doc flexes pt hip &

knee 90 degrees doc then triesto extend leg

Pain in spine or involuntary

flexion of the oppositeknee/hip

Pain with fever meningitis

Brudzinskis Sign Supine pt flexes head/necktoward xiphoid process/chest

Involuntary hip and knee

flexion

Pain & fever meningitis

Shoulder Depressor Test Pt seated. Doc depresses ptshoulder on affected side &

laterally flexes neck awayfrom shoulder.

Radicular pain

produced/aggravated

Dural sleeve adhesion of

spinal Nerve Root, adjacent

joint capsule, brachial plexustraction.

* common hyperextension

injury especially in young.

Soto Hall Test Pt supine. Doc supports pthead w/ one hand & knife-

edge contact on sternum w/

opposite hand. Pt actively

flexes head/neck to chest . Docfollows w/ passive head/neck

flexion to chest

Pain Local pain w/ active musclesprain.

Local pain w/ passive

ligament strain.

FractureFacet Involvement

Allens Test Pt seated. Affected elbow isflexed & arm supinated. Dococcludes radial and ulnar

arteries. Pt pumps hand

open/close. Then opens hand

and doc will release 1 artery soblood flow can resume.

Repeated on other artery.

Performed bilaterally.

Circulation should return in 5

seconds or less.

Vascular Compromise

TOS


3/12

Adsons Test Pt seated. Doc palpates theradial artery. Pt rotates head to

affected side. Pt extends neck

as far as possible. Pt holdsbreath for 10 sec.

Decrease of pulse amplitude

Paresthesia

Neurovascular compromise of

Subclavian A due to Scalenus

Anticus or Cervical Rib TOS

Modified Adsons Test Same as above but rotate headtoward unaffected side.


Paresthesia

Scalene medius & Cervical

rib TOS

Halsteads Test Pt seated. Doc palpates radial

pulse of affected arm. Docapplies downward traction on

arm while pt hyperextendsneck. (If negative do test with

pt rotating head to opposite

side


Paresthesia

Scalene medius & Cervical

Rib TOS

Allen's Maneuver Test Pt seated. Doc flexes ptselbow to 90, palpates the

radial pulse while shoulder is

abducted and externally

rotated. Pt. rotates head awayfrom side being tested.

Pulse disappears TOS

Roos TestHostage test

Pt seated. Abduct both arms to

90, flex elbows to 90 andexternally rotate. Pt

opens/closes fist for 3 min or

until symptoms occur.

Paresthesia/tingling, pain,

weakness

TOS

Wrights TestHyperabduction test

Pt seated. Doc palpates Radialpulse of affected arm. Doc

passively abducts arm to 180

degrees. Note angle of

abduction where pulsedisappears/decreases.

Compare to opposite side

Loss of pulse / Tingling

(look at amplitude of

symptoms)

Hyperabduction syndrome(compression of axillary artery

under the pec minor)

Costoclavicular ManeuverTest

Pt seated with arms on thighs

and palms up. Doc palpatesradial pulse. Pt told to draw

shoulders down and back,

lower chin to chest and take a

deep breath and hold for 10sec.

Cessation or dampening of

radial pulse, ischemic colorchange, paresthesia, radicular

pain in upper extremity.

Clavicle and first rib TOS (due

to poor posture, cervical rib,bone tumor, or poorly united

fx of clavicle)

Apley's Scratch Test Pt seated. Place affected handbehind head to touch opposite

superior angle of scapula.The place hand behind back

and touch inferior angle of

scapula Compare bilaterally.

Reproduces shoulder pain Exacerbation of pain

degenerative tendonitis

(especially supraspinatus)

Apprehension Test Pt seated. Shoulder is abductedand externally rotated (Ant

Shoulder).

Pt supine. Shoulder flexed &internally rotated doc applies

posterior force (post shoulder)

Pain / pay attention to look on

pt face.

*instable shoulder candislocated w/ this test

Anterior or Posterior Shoulder

Dislocation trauma

Codmans Drop Arm Test Pt seated. Doc passivelyabducts affected arm. Docsuddenly removes support at

an angle about 90 degrees

Pt cannot stop arm from

dropping / Pain

Rotator cuff tear / injury

(specifically rupture ofsupraspinatus tendon)

Dawbarns Test Pt seated Doc palpatesaffected shoulder deeply for

localized tenderness at the

subacromial bursa. Hold

pressure as arm is passively

abducted.

Pain disappears. Pain disappears subacromialbursitis

Dugas Test Pt seated places affected sideshand on opposite shoulder &

tries to touch chest w/ elbow

Inability to move elbow or

pain

Propensity for shoulder to

dislocate anteriorly.


4/12

Impingement Test Pt seated. Pts arm is slightly

abducted and moved fully

through flexion by the doctor.(Jams greater tuberosity into

ant inf acromial surface).

Pain in shoulder Overuse injury of

supraspinatus tendon

(sometimes biceps tendon)

Speeds Test Pt seated. Forearm is flexedand supinated. Pt flexes

shoulder against resistance.

Pain / tenderness in thebicipital groove.

Bicipital Tendonitis

Supraspinatus Press Test Pt seated shoulders areabducted to 90 degrees. Theshoulders are medially rotated

& angled 30 degrees forward

w/ thumbs pointing to floor.

Doc applies resistance toabduction while observing for

weakness/pain.

Pain / Weakness in shoulder Supraspinatus muscle/tendon

tear

Yergasons Test Pt seated w/ elbow flexed. Ptresists doc pronating and

extending the arm. Docs other

hand is palpating the inter-

tubercular groove

Clicking or pain over theintertubercular groove

Pain = Bicipital TenosynovitisClicking = tear of transverse

humeral ligament

Load & Shift Test While stabilizing the scapula,the doc performs the

following:Push I-S, P-A for Ant CapsulePush I-S, A-P for Post Capsule

Pull S-I for Inf Capsule

Sulcus Line / Pain / Laxity Shoulder Capsule Instability /

loosening

Propensity to dislocate

OBriens Pt arm flexed forward to 90degrees w/ elbow extended &arm adducted to 15 degrees.

Part 1: arm in internal rotation

(thumbs down). Part 2: arm in

external rotation (palm up).Doc applies downward

pressure while pt resists.

Pain on part 1 or part 2 Pain during part 1: anterior

labrum tear, SLAP lesionPain during part 2: biceps

tendonitis

* Positive Speeds & OBriensindicates Type II SLAP lesion

Lift Off Test Pt places dorsum of hand onlow back. Pt then lifts hand off

back as far as possible.

Compare side to side.

Inability to life the hand off

the back as far as the otherside.

Pain on Ant Shoulder

Subscapularis Tendonitis

Capsulitis

Elbow Flexion TestPt seated and actively flexeselbow for 5 minutes

Tingling or paresthesia inulnar distribution of

hand/forearm.

Ulnar paresthesia CubitalTunnel Syndrome

Tinels test at the Elbow Pt seated w/ elbow flexed to90 degrees doc taps groove

between olecranon and lateral

epicondyle. Repeat between

the olecranon and medial

epicondyle.

Hypersensitivity.Tingling radiating toward

forearm

Lateral: Superficial RadialNerve Palsy (degeneration)/

neuroma/neuritis

Medial: Ulnar N palsy /

neuroma / neuritis

Cozens Test Pt seated affected elbowflexed & pronated. Pt makes a

fist. Pt actively extends hand /wrist. Doc applies pressure

against dorsum of hand

Pain near Lateral Epicondyle Lateral Epicondylitis Tennis

Elbow

Radiohumeral bursitis

Golfers Elbow Test Pt seated w/ elbow flexed &hand/wrist supinated. Pt makesa fist and actively flexes the

wrist. Doc applies pressure toextend wrist and pt resists.

Pain near Medial Epicondyle Medial Epicondylitis Golfers

Elbow

Lift Test Cozens & Golfers Testperformed with weights

instead of pressure

Pain near Medial / Lateral

Epicondyle

Medial / Lateral Epicondylitis

Ligament Instability Test Pts elbow slightly flexed. Docstabilizes elbow while

applying an adduction (varus)

force to the distal forearm to

test the LCL. Then anabduction (valgus) force is

applied to test the MCL.

Laxity, decreased mobility,altered pain.

Adduction force: medialcollateral ligament instability

(sprain)

Abduction force: lateralcollateral ligament instability

(sprain)


5/12

Mills Test Pt seated w/ forearm, fingers,and wrist passively flexed. The

doc pronates and extends the

forearm.

Elbow pain increases Lateral Epicondylitis / Tennis

Elbow

Tinels Test at the Wrist Doc taps over the carpel tunnel Tingling into thumb, indexand middle finger and lateral

half of ring finger.

Carpal Tunnel Syndrome

Phalens Test Doc flexes pts wrists and

pushes them together for 1minute.

Tingling into thumb, index and

middle fingers and lateral halfof ring finger.

Carpal Tunnel Syndrome

Froments Test Pt. Grasps a piece of paperbetween thumb and index

finger. Doc pulls paper away.

Distal phalanx of thumb goes

into flexion when paper is

pulled away.

Ulnar nerve injury

Pinch Grip Test Pt asked to pinch tips of indexfinger and thumb together.

Unable to pinch the tips of the

index finger and thumb

together

Pathology of the anterior

interosseous nerve

Bunnell-Littler Test MCP joint held slightlyextended while doc moves the

PIP joint into flexion.

PIP joint cannot be flexed Osteoarthritis (capsular

contraction)

Finkelsteins Test Doc stabilizes the forearm andulnar deviates the wrist.

Pain over the abductor pollicis

longus and the extensor

pollicis brevis tendons at the

wrist

DeQuervainss or Hoffmans

disease tenosynovitis of the

thumb

Mankopfs Test Take pts resting HR. Apply

firm pressure over area ofpain.

Pulse increase of 10 or more

bpm

Pain is real they are not

faking/malingering.

THORACIC TESTS

Adams Position Pt has high shoulder &/orvisible scoliosis while standing

/ Doc watches for change inscoliosis while Pt flexes at

waist

High shoulder / High hip uponflexion

Usually the Rt. side

Scoliosis Remains duringflexion Structural or

Pathological ScoliosisScoliosis disappears during

flexion Functional Scoliosis

(90% F / functional best

treated w/ chiro care)

Amoss Sign Pt in side lying position isasked to move to a seated

position. Doc observes for

pain/discomfort or the use ofupper body strength

(hands/arm/abs) to assist in

rising from a supine/side lying

position

Rising elicits localized pain in

Thoracics or Thoraco-Lumbararea or Pt uses upper body to

help themselves up

AS, IVD syndrome,

sprain/stain(AS will also have decreased

ROM, decreased chestexpansion, tender sternum & T

spine)

Beevors Sign Pt supine, does partial crunch(enough to lift shoulders off

table) doc observes umbilicusfor deviation

Deviation of umbilicus (will

deviate in the opposite

direction of weakness)(Rectus Ab. Innerv T7 T12)

Ex Umbilicus moves to R

shoulder weakness in LLQ

showing a left T10 12 lesion(lower Thoracic myelopathy)

Chest Expansion Test Measure chest during maximalinspiration & maximal

expiration at the 4thintercostalspace (nipple line).


6/12

LUM BAR TESTS

Adams Position Pt has high shoulder &/orvisible scoliosis while standing

/ Doc watches for change in

scoliosis while Pt flexes at

waist

High shoulder / High hip uponflexion

Usually the Rt. side

Scoliosis Remains duringflexion Structural or

Pathological Scoliosis

Scoliosis disappears during

flexion Functional Scoliosis

(90% F / functional besttreated w/ chiro care)

Amoss Sign Pt in side lying position isasked to move to a seated

position. Doc observes for

pain/discomfort or the use ofupper body strength

(hands/arm/abs) to assist inrising from a supine/side lying

position

Rising elicits localized pain inThoracics or Thoraco-Lumbararea or Pt uses upper body to

help themselves up

AS, IVD syndrome,sprain/stain(AS will also have decreased

ROM, decreased chestexpansion, tender sternum & T

spine)

Antalgia Sign Doc observes an antalgicposture / lean to one side torelieve pts pain

Pain Relief

Away from side of pain PLLToward side of pain PLM

Forward w/ little relief

central Rhizel

Disc herniation / bulge

(pt is not locked into position -

that would indicated

tortipelvis)

Straight Leg Raiser (1) Pt supine. Raise leg straight upon side of pain.

Pain reproduced (note angle &

location of pain)

0-30 = SOL (N or N Root

irritation)

30-60 = SIJ inflammation /

sciatica60+ = Lumbosacral problem

Bechterews Test Pt sits w/ hips & knee at 90degrees. Pt actively extends

leg at knee

Pain from lumbars radiating

down the leg (reproduced)

SOL, IVF encroachment,

Radiculopathy, nerve root

tension, sciatica

Braggards Sign (2) Straight Leg Raiser whenpain is elicited, lower the leg 5

degrees and dorsiflex foot

Radiating Pain (reproduced) SOL, IVF encroachment,

Radiculopathy, nerve root

tension, sciatica

Crossed Straight LegRaiser (5)

Pt. Supine. Raise leg straight

up on asymptomatic side.

Pain reproduced on the

affected leg (opposite the side

being tested)

Medial bulge on symptomatic

/ painful side

SOL, IVF encroachment,

Radiculopathy, nerve roottension, sciatica

Fajersztajns Test (6) Well Leg Braggards straight leg raiser on well side.when pain is elicited lower the

leg 5 degrees and dorsiflex the

foot

Radiating Pain on

symptomatic side (reproduced)

Pain at same angle as

Braggards PLM bulgePain at greater angle PLL

bulge.

Coxs Sign (4) During the Straight leg raisertest the pt raises ipsilateral hip

to relieve pain

Pain / Roll to opposite side SOL, IVF encroachment,Radiculopathy, nerve root

tension, sciatica

Elys Heel to Buttocks Pt prone. Doc touches foot tocontralateral buttocks

Pain in anterior thigh / groinarea (ipsilateral leg testing)

Radiating: Femoral N, or Nroot compression

Localized: Quadriceps muscle

contracture.

Anterior thigh pain from L2-4

NR, Hip lesion (rule out AVN,OA, TB, subluxation)

Femoral Nerve Traction

Test

Pt side lying, bottom leg is

straight, top leg bent at knee,extend thigh back on affected

side to traction the femoral n

Pain on Ant Thigh

To groin L3To mid tibia L4

Femoral N or N root

compression.If bilateral in elderly prostate

hypertrophy/cancer

Heel/Toe Walk Test Walk on heels

Walk on toes

Cant walk on heels

Cant walk on toes

Cant walk on heels: L5 N -

L4 IVDCant walk on toes S1 N - L5

IVD

Kemps Test Pt seated. Doc stabilizes Lspine with one hand and

supports contralateral shoulder

w/ other hand. Pt laterally

flexed away from doc, thenflexed forward , laterally bent

toward doc and brought into

extension in one smooth

motion (circumduction)

Radiating leg pain or local lowback pain.

NR irritation / disc herniationRadiculopathy

Local pains

Pain w/ slight rotation or on

convexity capsulitisPain on extension or concavity

facet .

Pain at waist LS sprain/strain

Pain w/ flexion IVD lesion


7/12

Kernigs Sign Pt supine doc flexes pt hip &knee 90 degrees doc then tries

to extend leg

Pain in spine or involuntary

flexion of the opposite

knee/hip

Pain with fever - meningitis

Brudzinski Sign Supine pt flexes head towardthe xiphoid process

Involuntary hip and knee

flexion

Pain & fever - meningitis

Lasegue Test Pt supine doc flexes pt hip &knee 90 degrees doc then triesto extend leg

Pain low back, hip or thigh Hip: hip pathology

Thigh: RadiculopathyBilateral: tight hamstrings

Lindners Sign Pt seated/supine. Passivelyflex head/neck toward xiphoid

process

Pain in L spine or radicular legpain

Compression of Lumbar NR

Milgrams Test Pt Supine and lifts feet 6 offtable (knees in extension) and

told to hold for 30 sec

Unable to hold Due to low back pain:herniation or L strain/sprain

No pain may have weak core

muscles

Minors Sign Pt uses upper body strength tostand from seated position.

(walk up legs)

Recruitment of upper body

strength to stand up

SIJ lesion, L5 strain/sprain, LP

fx, IVD syndrome, Muscular

Dystrophy, Sciatica, myotonia

Nachlas Test (lumbars)Elys Test (buttocks)

Pt prone. Knee is flexed totouch foot to ipsilateral

buttocks

Pain in SI/ lumbosacral area.Radiation of pain down

thigh/leg.

SI or Lumbosacral Problems(sprain/strain)

Ant thigh pain may be from

inflammation of L2-4 NRs.

Quick Test Pt supports self w/ hand ontable/wall and performs ~5

deep squats

Pain / locking / crepitus in low

back, hips, knees, or ankles

(Helps locate problem alongthe kinetic chain)

Subluxation of any involved

joints (Problems with joints)

Do not perform on elderly /pregnant women

Sicards Sign (3) Straight leg raise, lower theleg 5 degrees, dorsiflex big toe

Radiating Pain (reproduced) Irritation to L5 NR (L4 or S1

possible too)

Bilateral Leg LoweringTest

Pt supine, Doc flexes hips to90 degrees with legs extended.

Pt lowers legs to 45 degrees.

Pain in buttocks, SI, lowerextremity, leg drops due to

pain

Lumbosacral sprain/strain,facet syndrome, IVD lesion

PELVI S TESTS

Anterior Innominate Test

(1)

Place unaffected foot 2-3 feet

forward. Flex forward at waist

to touch toes

Local pain over SI joint. Unilateral forward

displacement of ilium, sacrum,

SIJ sprain

Belt Test (2) 1) Patient stands, bendsforward to touch toes note

any pain.

2) Dr. braces hips with handsand places hip tightly against

pt sacrum then pt. bends

forward again note pain.

Pain in lumbar or sacral

regions

If pt had pain in part 1 but no

pain in part 2 or is able to bend

further in part 2 before painful

= SI jointIf pt had pain in part 1 and

pain in part 2 at the same or

lesser degree of flexion =

Lumbar involvement.

Erichsens Test Pt. prone and dr. compressesSI joint by applying pressure

to area of PSIS with thumbs orthenars Creates double IN

ilium

Pain around SI joint Usually caused by Ant

stabilization ligaments

weakness

Gaenslens Test Pt supine, doc stands onunaffected side and bringsaffected knee up toward

patients chest. Then dr.

slowly hyperextends

unaffected leg (may need todrop unaffected leg off table to

achieve hyperextension)

SI joint pain on side being

extended. Radiating pain togroin or thigh.

SI joint sprain, instability.

DDx SI pain fromLumbosacral pain

If neg L5 lesion possible

Goldthwaits Sign Pt. prone while dr. palpates L5

and S1. Dr uses other hand toelevated affected leg.

Pain Pain before separation SI

jointPain after L5/S1 separation

Lumbar

Hibbs Test Prone ThighRoll

Pt prone, flex knee to 90degrees & internally rot femur

(push foot laterally)

Pain Hip (Femoral head oracetabular problems)

Iliac Compression Test Pt laying on side, doccompresses iliac crest toward

table (affected side down)

Creates double EX ilium

Pain / increase pressure in SIJ Sprain Posterior SI ligament /SI inflammation/subluxation

(can also have ilium fx or

pubic symphysis pain)


8/12

Lewin Gaenslen Test Lay on unaffected side. Ptbrings unaffected knee toward

chest. Then dr. slowly

hyperextends affected thigh.

SI joint pain on side being

extended

Muscle tightness

SI joint sprain, arthritis.

Iliopsoas muscle contracture

DDx SI pain from

Lumbosacral pain

Lewin Standing Teststanding straight leg raiser

Slightly flex knees & waist

slightly, cross arms, bend pt

forward to point before pain,

put 1 leg into extension when

stabilizing sacrum

Knee flexes or pt tries to stand

up b/c of pain / tightness

Herniation , SOL, Bulge

Yeomans Test Pt prone. Dr. applies pressureto PSIS with one hand and

places other hand under

ipsilateral knee and lifts flexed

knee off table (extending the

thigh)

Pain in SI joints

Muscle tightness

SI lesion esp Anterior SI ligs

Pain into ant thigh/groin Femoral N irritation (L2-4), or

prostate problems

Iliopsoas or rectus femoris

muscle contracture

HI P TESTS

Actual Leg Length Test Pt supine w/ feet together,knees & hips straight. Doc

measures apex of ASIS to

center of medial malleolus

Difference of more than 6mmfrom side to side

Hip joint of long bonedeficiency (accurate to 1 cm

need x-rays for higher

accuracy)

Apparent Leg Length Test Same as above measuremade from umbilicus to

medial maleolus

Difference of more than 6mm

from side to side

(adds in L3-5 discs w/ sublux

the leg lengths could change)

Pelvic Subluxation

Allis Sign / SaleazzisSign

Pt supine, Knees/Hips flexed,feet flat on table and medial

malleoli & big toes are aligned

side by side doc stands atfoot of table and observes

knees for any height

discrepancy. Dr. then stands

at side of table and looks for

one knee to be more anteriorthan the other.

One knee is lower compared tothe other.

One knee is more anterior

compared to the other

Ipsilateral femoral lengthdiscrepancy (protrusion

acetabuli, hip dislocation PS,

dysplasia, fx)

Anvil Test Pt supine, doc elevates straightleg & hits bottom ofcalcaneous w/ clenched fist

Pain in kinetic chain heel to

acetabulum

Hip pain arthritis, femoral

neck fx, infectionHeel pain calcaneus fx, tibia

fx, fibula fx (depending onpoint of pain)

Gauvains Sign Pt lays on side w/ affected sideup doc grasps above ankle and

abducts leg & then internallyand externally rotates thigh

Ipsilateral contraction of

abdominal muscles / pain in

hip / referred pain to groin, antthigh,

AVN, Infection, Fx, gout,

Hernia, hip tuberculosis (rare)

Hip Telescoping Test Pt supine doc passively flexesknee & hip of affected side to

90 degrees , grasp calf with

one hand and place other handon thigh just proximal to knee

push femur into table anddistract femur away from

table.

Excess joint play and or

palpable click in joint

Hip dislocation / hip dysplasia

MC women (Mediterranean

& Scandinavian)

Patricks Test (mnemonicFABERE)

Pt supine, doc on unaffected

side and patient instructed to

cross legs into a figure 4.

Dr. then stabilizescontralateral ASIS on table

and puts downward pressure

on knee of affected side

Pain in hip or inability to

perform

Hip Pathology (DJD, OA, RA,

SCFE, AVN, Fx, sprain/strain,

tight hip adductors)

Obers Test Pt lies w/ affected side up, docstands behind pt & stabilizes

pelvis doc uses other hand to

abduct & extend thigh at hip

(holding at knee) with knee

bent to 90 degrees doc thenslides hand from knee to ankle

keeping knee bent

Affected thigh remains

abducted may be painful ormay drop w/ spastic jerks

(clonus)

ITB contracture

Common in runners

Thomas Test Pt supine & actively pullsunaffected knee to chest whilekeeping the other leg straight.

L spine maintains lordosis or

pt is unable to keep affectedthigh flat on the table

Flexion contracture or

shortening of iliopsoas onaffected side


9/12

Trendelenburgs Test Pt stands on affected foot andraises unaffected foot off the

ground. (pt can brace

themselves against doc/table)Dr. observes for any pelvic

unleveling.

Iliac crest high on supported

leg and low on lifted leg.

Paralysis / weakness of hip

abductors on affected side

(gluteus medius)

Hip dysplasia

Ortolanis Test Infant supine. Dr. grasps boththighs at level of lesser and

greater trochanters betweenthumbs and fingers. Dr then

flexes and abducts the thighs

bilaterally.

Palpable click/clunk Congenital femoral

dislocation, instability


10/12

NMS II Orthopedics

KNEE TESTS

Abduction (Valgus) StressTest

Pt. supine with legsstraight, Dr. stabilizes the

medial ankle and pusheslateral to medial at theknee. Procedure is thenrepeated w/ knee slightly

flexed (25!).

Pain or increasedmotion/gapping

Medial CollateralLigament strain or rupture.

Adduction (Varus) StressTest

Pt. supine with legsstraight, Dr. stabilizes thelateral ankle and pushesmedial to lateral at the

knee. Procedure is thenrepeated w/ knee slightly

flexed (25!).

Pain or increasedmotion/gapping

Lateral CollateralLigament strain or rupture.

Apleys Compression Test Pt. prone with knee flexed

to 90!. Dr. pushes down on

the foot with leg neutral,then medially rotated and

laterally rotated.

Pain or crepitus withcompression (usually

relieved by distraction)

Internal rotation = lateralmeniscus

External Rotation = MedialMeniscus

Patellar Ballottement Test Pt supine w/ leg straight,Dr. pushes down on the

patella and moves it lateraland medial, palpating formotion

Patella is slow to return toresting position. Increased

motion or spongy jointfeel.

Retropatellareffusion/Intraarticular knee

swelling.

Bounce Home Test Pt. supine and relaxed. Dr.lifts leg and bends knee to

20!. Dr. then allows theknee to drop into fullextension.

Joint line painInability to fully extend

knee:1. Spongy end feel2. Rubbery end feel3. Hard end feel

Meniscal tear

1. swelling/edema2. meniscal tear3. intra-articular

fragment

Clarks Sign (PatellarScrape Test)

Push down on the patellaand ask the patient to

contract the quadriceps.

Retropatellar pain Chondromalacia patella,degeneration of

patellofemoral joint

McMurrays Sign Pt supine, hip and knee

flexed to 90!. Dr. stabilizesknee and grips heel withthe other hand. Dr. rotates

the tibia internally whileapplying a varus forcewhile extending the leg.Repeated with tibia rotatedexternally and Dr. applying

a valgus force whileextending the leg.

Pain or crepitus Int. rot. w/ valgus stress &

extend = lateral meniscusExt. rot. w/ varus stress &extend = medial meniscus

Lateral Pivot ShiftManeuver

Pt. supine, w/ hip and kneeflexed. Adduction, internal

rotation, valgus stress andflex knee.

Knee gives out Anterior Cruciate Lig.

Lachmans Test Drawer test with knee

flexed to 25!.

Pain w/ or w/o increasedanterior (ACL) and

posterior (PCL) translation.

Pain w/ normal translation:sprain. Pain w/ increasedtranslation: rupture.

Drawer Test Pt. supine with knee flexed

to 90!. Dr. pulls the tibia

anterior and then pushes itposterior feeling forexcessive motion.

Pain w/ or w/o increasedanterior (ACL) and

posterior (PCL) translation.

Pain w/ normal translation:sprain. Pain w/ increased

translation: rupture.


11/12

Q-Angle Test Pt. standing. Draw a linefor ASIS through midpointof patella and another linefrom tibial tuberosity

through the midpoint of thepatella. The angle ismeasured between these 2

lines.

Angle is less than 13!. Genu varum

LOWER EXTREMI TY VASCULAR & ANKLE EXAMS

Anterior Drawer Sign Pt. supine or seated. Dr.places one hand on anteriortibia and the other on

posterior calcaneus andpulls the foot anteriorly.

Excessive anteriormovement/translation

Anterior talofibularligament instability

Calf Circumference Test Measure the calf at thewidest point.

Increased or decreaseddiameter comparing side toside

"= acute compartmentsyndrome

#= muscle atrophy

Claudication Test Pt. walks at 2 steps/sec

(120/min) for one minutewhile Dr. observes

Muscle weakness,

cramping, pain, discomfortor color change (palor)

Peripheral vascular disease,

intermittent vascularclaudication, popliteal a.entrapment syndrome,atherosclerosis

Homans Sign Pt. supine raise leg up to

10!, squeeze calf andquickly dorsiflex the foot

Short duration, deep calf

painPersistent achy calf pain

Thrombophlebitis

Gastrosoleus strain

Moses Test Pt. prone, flex knee to 90!and squeeze calf.

Short duration, deep calfpain

Persistent achy calf pain

LE vascular insufficiency,thrombophlebitis,arteriosclerosis obliterans

Gastrosoleus strain

Thompsons Test Pt. prone, flex knee to 90!

and squeeze the calf

No plantar flexion

Localized painShort, deep pain

Ruptured Achilles tendon

Gastroc/soleus sprainthrombophlebitis

FOOT TESTS

Duchennes Sign Apply upward force to

head of 1stmetatarsal

Supination of foot with

attempted plantar flexion

Superficial peroneal n.

lesion or L4-S1 lesion

Helbings Sign Pt stands Dr. observes

the Achilles tendon

Medial curving of Achilles Overpronation syndrome

Common with CerebralPalsy

Mortons Test Squeeze foot around the

metatarsal heads

Pain Mortons neuroma (usually

between 3rd

and 4th

digits),arthritis, stress fx ofmetatarsal heads,Metatarsalgia (less

localized/generalized pain)

Strunskys Sign Rapidly flex patients toes Forefoot pain Metatarsalgia, OA

Tinels Foot Tap posterior aspect of

medial malleolus (post.Tibial n./medial plantar n.)and dorsum of foot (deep

peroneal n)

Pain in the toe, arch, or

heel

Nerve compression

syndrome, Tarsal TunnelSyndrome (Post. Tibialnerve)


12/12

MISC

Burns Bench Test Stand, bend, and note angleof painKneel on bench and bendforward

Should be able to bendfarther when kneeling

because the tension is offof the sciatic n.

Indicates malingering objective findings to notmatch the subjectivecomplaint

MannKopfs Test Take pts resting HR.

Apply firm pressure overarea of pain.

Pulse increase of 10 or

more bpm.

Pain is real They are not

faking/malingering.

Libmans Test Pt. seated, Dr. standingbehind pt. Dr. applies

pressure on the ptsmastoid process withthumbs until pt reports

pain/discomfort. Compare

side to side.

Pain/Uncomfortable Tests the pts paintolerance useful for later

procedures and todetermine malingering.

nms tests revised

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