OT in house: Special tests
NAME OF TEST
Head compression
test
TESTING POSITION
sitting in neutral
PROCEDURE
POSITIVE TEST
apply vertical
downward force
INTEPRETATION
pain radiates to UE
Spurlings test
Sitting head laterally
flexed
Jackson test
sitting head rotated
Maximum cervical
sitting head flexed and
compression test
rotated to the same
side
Bradleys
Step 1= neutral
modification
step 2= extended
step 3= extended and
neutral
Distraction test
sitting examiners hand Lift head upward
on chin and occiput
Shoulder abduction
sitting, Active or
relief test (Bakodys) passive shoulder
abduction until forearm
and hand rests on head
I. CERVICAL RADICULOPATHY/CERVICAL NERVE ROOT COMPRESSION
cervical radiculopathy
due to nerve root
compression
SAME AS ABOVE
SAME AS ABOVE
SAME AS ABOVE
SAME AS ABOVE
Relief of radiating neck
cervical radiculopathy
decrease symptoms
cervical radiculopathy
II. Brachial Plexus Tests
1. UPPER LIMB TENSION TEST- Brachial Plexus Tension or Elvey test
ULTT
SHOULDER
1 (MEDIAN
NERVE,
ANTERIOR
INTEROSSEOUS
Depression
and abduction
(110 degree)
ELBOW
Extension
Prepared by: ma. roxanne fernandez, mspt ptrp
FOREARM
Supination
WRIST
Extension
FINGERS
AND
THUMB
Extension
SHOULD
ER
CERVICAL
Contralateral
side flexion
OT in house: Special tests
NERVE
2 (MEDIAN,
musculocutane
ous nerve,
axillary nerve
Depression
and abduction
(10 degree)
Extension
Supination
Extension
Extension
Lateral
rotation
Contralateral
side flexion
3 (RADIAL)
Depression
and abduction
(10 degree)
Extension
pronation
Flexion and
ulnar
deviation
Flexion
medial
rotation
Contralateral
side flexion
4 (ULNAR)
Depression
and abduction
(10-90 degree)
hand to ear
Flexion
Supination
Extension
and radial
deviation
Extension
Lateral
rotation
Contralateral
side flexion
2. Shoulder depression test for brachial plexus- Pt side flexed, PT gives pressure on shoulder, (+) pain on dermatome
III. LUMBAR SPECIAL TESTS
A. Nerve Root Impingement:
1. Valsalva Test:
Test Position:
Patient seated, examiner standing next to patient
Action:
Subject takes a deep breath and holds while bearing down as if having a bowel movement
Positive Finding:
Increased spinal or radicular pain due to intrathecal pressure
May be secondary to a space-occupying lesion (i.e. herniated disc, tumor, osteophyte in lumbar
canal)
Comments:
Increase in intrathecal pressure may result in pulse, venous return, venous pressure
(dizziness and/or fainting)
2. Milgram Test:
Test Position:
Prepared by: ma. roxanne fernandez, mspt ptrp
OT in house: Special tests
Patient supine, examiner at feet of the patient
Action:
Patient performs a bilateral straight leg raise to the height of 2 to 6 inches and is asked to hold the
position for 30 seconds
Positive Finding:
Patient unable to hold position, cannot lift the leg, or has pain with test
Implications:
Intrathecal or extrathecal pressure causing an intervertebral disc to place pressure on a lumbar
nerve root
3. Kernigs Test:
Test Position:
Patient supine, examiner at side of patient
Action:
Patient performs a unilateral active straight leg raise with the knee extended until pain occurs
After pain occurs, the patient flexes the knee
Positive Finding:
Pain in the spine and possibly radiating into lower extremity
Pain relieved when patient flexes the knee
Implications:
Nerve root impingement secondary to bulging of the intervertebral disc or bony entrapment;
irritation of dural sheath; irritation of meninges
4. Kernig/Brudzinski Test:
Patient actively flexes the cervical spine (lifts the head)
Hip unilaterally flexed (no more than 900)
Knee than flexed to no more than 900
(+) pain with neck and hip flexion; pain relieved when knee is flexed
5. Unilateral Straight Leg Raise Test (Lasegue Test):
Test Position:
Patient supine, examiner standing at tested side with the distal hand around the subjects heel and
proximal hand on subjects distal thigh (anterior) maintains knee extension
Action:
Examiner slowly raises the leg until pain/tightness noted or full ROM is obtained
Prepared by: ma. roxanne fernandez, mspt ptrp
OT in house: Special tests
Slowly lower the leg until the pain or tightness resolves, at which point dorsiflex the ankle and have
subject flex the neck
Positive Findings:
Leg and/or low back pain occurring with DF and or neck flexion is indicative of dural involvement
and/or sciatic nerve irritation
Lack of pain reproduction with DF and/or neck flexion is indicative of hamstring tightness or SI
pathology
6. Well Straight Leg Raising Test:
Can be used to differentiate between sciatic nerve irritation or a herniated intervertebral disc that is
irritating the nerve root
Test Position:
Patient supine, examiner standing at unaffected side; one hand grasps under the heel while other is
placed on anterior thigh to stabilize the leg in extension
Action:
Examiner raises the leg by flexing the hip until discomfort is reported (knee kept in full extension)
Positive Finding:
Pain is experienced on the side opposite that being raised
7. Slump Test:
Test Position:
Patient sits over edge of table; examiner is at side of patient
Action:
(1) Patient slumps forward along thoracolumbar spine, rounding the shoulders while keeping
cervical spine neutral
(2) Patient flexes cervical spine; Clinician holds patient in this position
(3) Knee is actively extended
(4) Ankle is actively dorsiflexed
(5) Repeat on opposite side
Positive Findings:
Sciatic pain or reproduction of other neurological symptoms
Implications:
Impingement of the dural lining, spinal cord, or nerve roots
B. Test for Patient Malingering
1. Hoover Test:
Prepared by: ma. roxanne fernandez, mspt ptrp
OT in house: Special tests
Test Position:
Patient supine
Examiner at feet of patient with hands cupping the calcaneous of each leg
Action:
Patient attempts to actively straight leg raise on the involved side
Positive Findings:
Patient does not attempt to lift the leg and examiner does NOT sense pressure from the uninvolved
leg pressing down on the hand
Patient is not attempting to perform the test
Bells Palsy Tests
1.
2.
3.
4.
Chvosteks test
Bells phenomenon
Marcus Gunn
Marin Amat
tap parotid gland
active eye closing
active C/L jaw deviation
active mouth opening
facial muscle twitching
upward rolling of eyeball
eye opening
Eye closing
Slump Test (Sitting Dorsal Stretch Test)
- Done in sitting, head flexed, extended , dorsiflexe ankle
- (+) sciatic pain
Scoliosis Tests
1. Cobbs angle
2. Forward bending test (adams test)
3. Lateral bending test
4. Plumb line test
Lumbar Region
1. SLR (Lasgues test)
HIP
1.
2.
3.
4.
Sciatic (tibial)
tibial
sural
common peroneal
flex
flex, add
flex
flex , IR
Prepared by: ma. roxanne fernandez, mspt ptrp
KNEE
extend
extend
extend
extend
ANKLE AND FOOT
dorsi flex
dorsi flex, eversion
dorsi flex, inversion
plantar flex, inversion
OT in house: Special tests
5. nerve root (disc prolapse)
flex
extend
DF
SLR 5 aka Well leg raising test, Cross over sign
SLR + ankle DF= Braggards
SLR + toe extension= Sicards
Toe extension only= Turyns
SLR + cervical flexion = aka Hindmans, Linders, Brudzinskis, Soto-Hall
SLR pain before 70 deg= Sacro iliac joint dysfunction
SLR pain after 70 deg= lumbar region
SLR pain on 80-90 deg = hamstrings tightness
2. Prone knee bending (Nachlas test)
HIP
1. Femoral nerve
neutral
2. lateral femoral cutaneous
extension
nerve
3. Saphenous nerve
extesbion, abduction and ER
* PKB 3 aka Prone knee bending test
KNEE
flex
flex
ANKLE AND FOOT
neutral
neutral
extend
dorsi flex and eversion
Lumbar Facet Dysfunction
Maneuver
unilateral standing, active trunk
extesnion
standing, head rest on PTs
shoulder, active trunk extend, side
bend, rotate
supine, lift (B) feet 5-10 cm off mat,
2-4 inches apart
maintain LE raised for 30 seconds
tape measure, landmark= S2
mark 10 cm above and 5 cm below
1. Stork Standing test
2. Quadrant test
3. Milgrams
4. Schobers
(+) sign
(+) pain=spondylolisthesis
(+) facet joint dysfunction
(+) DJD on lumbar spine
additional 5-10 cm flexion/extension
is normal
Special tests for SJID
Position
Prepared by: ma. roxanne fernandez, mspt ptrp
Maneuver
Finding
OT in house: Special tests
1. Gillets
standing
2. Flamingo
3. Gaenslens
unilateral standing
sidelying, bottom leg
flexed, test
(B) thumbs on PSIS, pt
flexes hip
passively extend hip
(+) if no movement or
moves up
(+) sharp pain
(+) pain
unilateral knee to chest
(+) pain
or
4. Yeomans (aka femoral
nerve stretc)
supine with test leg
dangling
prone, knees flexe 90 deg,
hip extended
Prepared by: ma. roxanne fernandez, mspt ptrp
(+) sharp pain= SIJD
(+) radiculating pain=
femoral nerve stretch
