Orthopedic Tests

1. Orthopedic Tests

2. Cervical Range of Motion • Flexion • 45 degrees • Extension • 50 degrees • Lateral Flexion • 40 degrees • Rotation • 70 degrees

3. Bakody Sign • Patient abducts and externally rotates ipsilateral shoulder by moving hand towards head • The hand is placed on top of the head, if position relieves radicular pain, positive sign that suggests a nerve root syndrome

4. O’Donoghue Maneuver • Patient sits while doctor grasps head with both hands. • Patient attempts to rotate head while doctor provides isometric resistance • If pain, positive sign for muscle strain of activated muscles • If no pain, doctor passively rotates head through joint play • If pain is produced, suggests ligamentous injury

5. Spinal Percussion Test • Patient flexes to reveal spinous processes • Doctor percusses spinous processes of each vertebrae. • Localized pain is evidence of fracture or severe sprain • Radiating pain suggests intervertebral disc syndrome

6. Valsalva Maneuver • Patient is seated, instructed to hold breath and bear down • Reproduction of radicular pain is indicative of nerve root compression by space-occupying mass in the spine

7. Rusts’ Sign • Patient exhibits splinting of head, removal of support can not be tolerated • Implies gross instability of upper cervical spine, usually from fracture or severe sprain

8. Foraminal Compression Test • Patient is seated with doctor standing behind them • Doctor puts both hands on top of head and crosses fingers, patient rotates head to one side • Doctor presses down on patients head, followed by rotating head to other side and repeating • Reproduction of complaint is positive sign suggesting foraminal encroachment

9. Jackson Cervical Compression Test • While seated, patient rotates head from side to side. • Pain on the side opposite of rotation suggests muscular strain, whereas pain on the side of rotation suggests facet or nerve root involvement • Head is laterally flexed in an attempt to approximate the ear to shoulders, position is held and examiner exerts downward pressure on the patient’s head, exacerbation of lecal or radicular pain indicates a positive test

10. Maximal Foraminal Compression Test • Patient is seated comfortably with head and neck in neutral position. • Patient activly rotates the head and hyperextends the nexk toward the side of radicular complaint, reproduction of symptoms suggests foraminal encroachment, Repeated bilaterally

11. Spurling’s Test • While seated comfortably and with an erect posture , the patient actively rotates the head from side to side • Patients head is laterally flexed toward the side of complaint, examiner applies gradually progressive downward pressure to the head and neck, reproduction of symptoms or collapse sign at this point constitutes a positive test and rest of test should not be competed • From laterally flexed position, the neck is extended as far as patient can tolerate, examiner applies progressive downward pressure, reproduction of radicular symptoms suggests nerve root compression, localized spinal pain suggests facet involvement • Vertical blow is delivered to teh uppermost portion of the cranium, the examiner may wish to interpose a hand between the concussing hand and the patient’s skull. Start with patients head in neutral position, then lateral flexion and extension with percussion repeated, Stimulates any nerve root irritation or other pain-sensative structures related to disc disease and cervical spondylosis.

12. Distraction Test • Examiners hands cup the patient’s jaw line, examiner lifts paient’s head slightly just enough to relieve the weight of the head. • Positive finding is a relief of patient’s localized or radicular pain, sign is confirmed is symptoms return when weight of head is returned to neck.

13. Adson’s Test • Patient is seated with arms at sids, examiner slightly abducts the affected arm and palpates the radical pulse • Patient rotates head toward affected shoulder, Patient then extends head, and examiner externally rotates and extends the shoulder slightly • Patient takes a deep breath and holds it, loss of pulse is a positive test, if test is negative it is repeated with patient turning the head to the uninvolved side.

14. Costoclavicular Maneuver • Patient si seated with arms at side, examiner bilaterally palpates the radial pulse • Examiner extends patient’s shoulders as patient flexes the cervical spine, the test is positive if the radial pulse of the affected arm disappears, positive test indicates TOS • Alternative is for patient to actively abduct the shoulders and flex elbows at 90 degrees, examiner palpates radial pulse of affected arm adn externally rotates arm, test is positive if pulse disappears, positive test indicates TOS,

15. Wright’s Test • Patient is seated with both arms hanging at the sides, examiner palpates radial pulse of affected arm • Examiner abducts the affected arm to 180 degrees • Examiner notes angle of abduction at which radial pulse on affected side diminishes ot disappears, compare to angle of unaffected side, test is significant for neurovascular compromise of axillary artery like hypersbduction TOS, if nonaffected arm demonstrates radial pulse dampening or cessation at same approximate angle, test is not positive for hyperabduction syndrome

16. Traction Test

17. Halstead Maneuver

18. Roo’s Test • Patient is in a seated position, and places both arms in a 90 degree abducted and externally rotated position • Patient repeatedly opens and closes hands slowly for 3 minutes • Test is positive when symptoms are reproduced and affected arm weakens, indicating TOS

19. Allen Maneuver

20. Shoulder Compression Test • Patient is seated and head and neck are in neutral positioning, on the side of complaint, the examiner uses the contact points of lateral skull and superior shoulder • In a slow, controlled fashion, the examiner depresses the shoulder while flexing the head toward the opposite shoulder, reproduction of symptoms suggests a brachial plexitis or dural sleeve adhesion.

21. Dermatomes

22. Myotomes • C5- Deltoid Muscle • C6- Biceps Muscle, Wrist Extension • C7- Triceps Muscle, Wrist Flexion • T1- Finger adduction, abduction

23. DTR • C5- Biceps Tendon • C6- Brachioradialis • C7- Triceps extension