Spine, Thoracic Outlet
Vertebral Artery Test
Purpose: assess vertebral artery sufficiency in compromised position
Position: supine, head supported in neutral
Motion: side-bend head left, rotate left, extend, hold for 10s
Results: + when dizzy/faint/nystagmus
Yergason Test
Purpose: determines bicep stability in bicipital groove
Position: sitting, shoulder neutral, elbow at 90
Motion: pull into elbow ER/extension
Results: + if biceps tendon pops out of groove
Tinel Sign
Purpose: assess integrity of ulnar nerve
Position: sitting or supine, elbow slightly flexed
Movement: PT taps under ulnar nerve
Result: + if tingling sensation w/ distribution into forearm and hand
Clarke's Sign / Patellofemoral Grind Test
Indication: patellofemoral dysfunction
Position: supine, PT holds patella superiorly
Movement: pt performs quad set
Result: + if pain w/ contraction/unable to hold contraction
Apley's Distraction Test
Indication: medial or lateral collateral injury
Position: prone w/ knee flexed at 90
Movement: knee distracted then placed in lateral and medial rotation.
Result: + if pain with any movement
–w/lateral rotation and medial pain = medial collateral
–w/medal rotation and lateral pain = lateral collateral
Drawer Test
Indication: ankle instability caused by sprain
Position: sitting or supine, ankle in 20 degrees PF
Movement: PT stabilizes distal leg, displaces calcaneus forward on talus
Result: + if excessive displacement forward or unilateral, indicates a sprain
Distraction Test
Purpose: tests disk protrusion/intervertebral foramen compromise/ligamentous lesions/irritation of facet joint capsules
Position: seated or supine, head neutral
Motion: gentle traction
Results: - if symptoms decrease (disk protrusion), + if symptoms increase (ligament lesions/facet joint capsule)
Drop Arm Test
Purpose: detects tears in rotator cuff
Position: sitting, shoulder neutral, elbow extended
Motion: pt slowly abducts, slowly lowers
Results: + if arm drops or cannot lower slowly w/out pain
Tennis Elbow (lateral epicondylitis) Test
Purpose: detects lateral epicondyle inflammation
Position: sitting or supine, elbow slightly flexed, pronated
Movement: PTA resists wrist/finger extension
Result: + if pain at epicondyle
McConnell's Test
Indication: patellofemoral dysfunction
Method: pt performs any exercise that increases patellofemoral pain, PT then holds patella medially and pt repeats
Result: + if pain diminishes
Valgus Stress
Indication: MCL dysfunction
Position: supine, 20 to 30 degrees knee flexion
Movement: PT places Valgus stress on knee
Result: + if pain or gapping
Varus Test
Indication: anterior/posterior talofibular and calcaneofibular sprain
Position: sitting or supine
Movement: PT stabilizes distal leg, rocks calcaneus into inversion
Result: + if excessive movement or gapping in inversion
Compression Test
Purpose: test disk protrusion/intervertebral foramen compromise/ligamentous lesions/irritation of facet joint capsules
Position: seated, head neutral
Motion: gentle downward force on head
Results: + if symptoms increase (disk protrusion)
Apprehension Test
Purpose: determines chronic tendency towards shoulder dislocation
Position: sitting/standing/supine, shoulder neutral, elbow to 90
Movement: pull arm into ABD/ER
Result: + if pt doesn't allow movement/looks scared/sublux
Golfer's Elbow (medial epicondylitis) Test
Purpose: detects wrist flexor inflammation
Position: sitting or supine, elbow slightly flexed, supinated
Movement: PT extends wrist though full range w/ elbow extension
Result: + if pain at epicondyle
Monkey Walk
Indication: patellofemoral dysfunction/patellar tendonitis/Osgood Slaughter disease
Method: pt crouched in full knee flexion and walks in crouches position
Result: + if pain at knee or tibial tuberosity
Varus Stress
Indication: LCL dysfunction
Position: supine, knee at 20 to 30 degrees flexion
Movement: PT places varus stress on knee
Result: + if pain or gapping
Valgus Test
Indication: deltoid ligament sprain
Position: sitting or supine
Movement: PT stabilizes distal leg, rocks calcaneus into eversion
Result: + if excessive movement or gapping in eversion
Laseque (SLR) Test
Purpose: assess irritability of lumbar spinal nerve roots
Position: supine w/ non-test leg on table
Motion: passively raise straightened test leg
Results: + if pain reproduced in back/sciatic nerve prior to 70 degrees flexion, document angle.
Hawkins-Kennedy Test
Purpose: assess shoulder impingement
Position: seated, shoulder/elbow flexed to 90
Movement: PT internally rotates shoulder
Result: + if pain increases
Allen's Test
Purpose: tests integrity of radial and ulnar arteries
Position: sitting or supine, elbow slightly flexed, wrist fully flexed
Movement: pt flexes/extends wrist several times, stopping with fist clenched, PT palpates arteries, pt opens fist
Result: + if no flushing of blood to digits apparent
McMurray's Test
Indication: meniscal tear
Position: supine, knee fully flexed
Movement: PT holds heel, applies IR or ER to tibia, knee extended
Result: + if pain/snapping/clicking
Lachman's Test
Indication: ACL dysfunction
Position: supine, hip slight ER, knee in 20-30 degrees flexion
Movement: PT distracts joint, performs an anterior shift
Result: + if lack of firm end feel
Homan Sign
Indication: DVT
Position: supine, prone or sitting
Movement: PT passively extends knee and DFs ankle
Result: + if pain in calf during dorsiflexion
Adson Maneuver
Purpose: rule out thoracic outlet compression by scalenes or first rib
Position: seated w/ head extended/rotated to test side, palpate radial pulse
Movement: extend/ER shoulder, hold deep breath, palpate radial pulse
Results: + if radial pulse diminishes
Faber's Test AKA Patrick's Test
Indication: SI dysfunction/impairment
Position: supine, test limb on shin of opposite leg
Movement: test limb foot slides up opposite shin into flexion, ABD, ER
Result: + if pain in hip or back
Finkelstein's Test
Purpose: detects inflammation of thumb extensors/de Quervain's disease/trigger thumb
Position: sitting or supine, fist with thumb curled into grip
Movement: PT moves wrist into ulnar deviation
Result: + if pain at lateral wrist
Apley's Grind Test
Indication: meniscal Tear
Position: prone, knee flexed to 90
Movement: compressive force placed through heel to knee into lateral rotation or medial rotation
Result: + if pain, in lateral rotation means lateral meniscus, in medial rotation = medial meniscus
Anterior Drawer Test
Indication: ACL dysfunction
Position: supine, knee flexed at 90
Movement: PT pulls knee into anterior position at tibia
Result: + if greater than 6 mm translation of tibia on femur
Wells Criteria
Purpose: predict clinical probability of a DVT
Criteria:
–Do they have clinical symptoms
–Do these symptoms have no other logical cause
–Tachycardia
–History of DVT
–Immobilization or surgery in past 4 weeks
–Coughing blood (hemoptysis)
–Malignancy within last 6 months
Costcoclavicular Test
Purpose: assess compromise of subclavian artery and brachial plexus
Position: seated, palpate radial pulse
Movement: PT depresses/retracts shoulder complex
Result: + if radial pulse diminishes
Piriformis Test
Indication: tight piriformis causing sciating nerve compression/back pain
Position: sidelying, test limb on top in hip/knee flexion
Movement: PT pushes knee into ADD
Result: + if pain during ADD
Bounce Home Test
Indication: meniscal dysfunction
Position: supine, knee fully flexed
Movement: passively extends knee
Result: + if extension not complete, might have springy end feel
Posterior Drawer Test
Indication: PCL dysfunction
Position: supine, knee flexed at 90 degrees
Movement: PT places posterior shift on tibia
Result: + if posterior translation is not equal to uninvolved side/is excessive
Wright (hyperabduction) Test
Purpose: assess thoracic outlet compression under pec minor and coracoid process
Position: seated
Movement: PT raises arm into end range ABD and hold, palpate radial pulse
Result: + if radial pulse diminishes
Trendelenburg Sign
Indication: weakness of glute med during unilateral WB
Method: stand on one leg
Result: + if pelvis not level