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176 Cards in this Set

  • Front
  • Back
DUGAS
Instruct: Pt. seated- ask Pt. to place the hand of the affected side on the opposite shoulder & then bring the affected elbow to the chest

Postive: inability to touch the opposite shoulder and or inability of the elbow to touch the chest

Indicates: Acute dislocation of the shoulder @ glenohumeral joint
ANTERIOR APREHENSION
Instruct: Pt. seated, Dr. abducts the Pt’s shoulder, flexes the Pt’s elbow & then gradually externally rotates to the Pt’s shoulder

Positive: Pt. will have a noticeable look of apprehension or alarm on face with possible pain

Indicates: chronic anterior dislocation of the shoulder @ glenohumeral joint
POSTERIOR APPREHENSION TEST
Instruct: Pt. supine, Dr. flexes Pt’s shoulder, flexes Pt’s elbow & internally rotates the Pt’s shoulder. Dr. places his/her hand on the Pt’s elbow & gradually applies increasing posterior pressure

Positive: Pt. will have a noticeable look of apprehension or alarm on face with possible pain

Indicates: chronic posterior dislocation of the shoulder @ glenohumeral joint
CODMAN’S DROP ARM Test aka: DROP ARM Test
Instruct: Pt. seated, Dr. passively abducts Pt’s arm to slightly over 90 degrees & removes support, If Pt. can maintain arm, then instruct Pt. to slowly lower their arm.

Positive: Pt will not be able to lower the arm slowly or the arm drops suddenly

Indicates: rotator cuff tear, usually supraspinatus
DAWBARN’S
Instruct: Pt. seated, Dr. applies pressure below the affected acromial process with his/her fingertips. Note for pain or tenderness. Dr. continues to apply pressure while abducted the Pt’s arm past 90 degrees

Positive: decrease in pain and or tenderness

Indicates: subacromial bursitis
YERGASON’S Test (CIPRIANO)
Instruct: Pt. seated, Dr. flexes Pt’s elbow to 90 degrees Dr. stabalizes Pt’s elbow with one hand & exerts slight inferior traction. Dr. uses their other hand & grasps slightly above Pt’s wrist. Dr. offers resitance while pt is instructed to externally rotate his/her shoulder & slighly supinated

Positive: 1) localized pain or tenderness at bicipital groove

Indicates:1) tendonitis

Positive: 2) audible click or the biceps tendon subluxes or dislocates

Indicates: 2) instability of the biceps tendon possibly associated with a torn transverse humeral ligament
ABBOTT-SAUNDERS TEST
Instruct: Pt. seated, Dr. fully abducts & externally rotates Pt’s affected arm. Dr. places his/her fingers on the Pt’s bicipital groove & then slowly lowers Pt’s affected arm to their side


Positive: palpable and or audible click


Indicates: subluxation or dislocation of the biceps tendon (rupture of transverse ligament or tendon subluxation beneath subscapularis muscle belly)
SPEED’S
Instruct: Pt seated with forearm supinated, & elbow flexed to 45 degrees. Dr. places his/her fingers on Pt’s bicipital groove with their opposite hand on the Pt’s forearm. Instruct the Pt. to flex his/her shoulder, maintain supination & completely extend the elbow as the Dr. applies resistance

Positive: pain and or tenderness in bicipital groove

Indicates: bicipital tendonitis
APLEY’S TEST
Instruct: Pt. seated. Have Pt. place his/her affected hand behind the head and touch the opposite superior angle of the scapula= apley’s scratch superior
Have the Pt to place the hand behind the back to touch the inferior angle of scapula= apley’s scratch inferior

Positive: exacerbation of pain

Indicates: degenerative tendonitis of the rotator cuff tendons, usually supraspinatus
IMPINGEMENT Sign
Instruct: Pt. seated with arm at side, Dr. slightly abducts Pt’s arm (hand should be pronated) & moves it fully through flexion (this will jam the greater tuberosity & anterior/ inferior surface of the acromion

Positve: pain in shoulder

Indicates: overuse injury to the supraspinatus and possibly biceps tendon
MEDIAL COLLATERAL LIGAMENT TEST (ABDUCTION STRESS TEST)
Instruct: Pt. seated, Dr. stabalizes the lateral aspect of the arm & places an abduction (valgus) pressure on the medial forarm

Positive: excessive gapping and pain

Indicates: medial collateral ligament instability
LATERAL COLLATERAL LIGAMENT TEST (ADDUCTION STRESS TEST)
Instruct: Pt. seated, Dr. stabalizes the medial aspect of the arm & places an adduction (varus) pressure on the Pt’s lateral forarm

Positive: excessive gapping and pain

Indicates: lateral collateral ligament instability
TINEL’S ELBOW SIGN
Instruct: Pt. seated, with Taylor reflex hammer, Dr. taps over the groove b/t the medial epicondyle & the olecranon process

Positive: pain and or tenderness at the site being tapped and paresthesia in the ulnar nerve distributon are…fingers 4/5

Indicates: neuroma of the ulnar nerve
COZEN’S
Instruct: Pt. seated, Dr. instructs Pt. to make a fist & place wrist into extension. Dr. Instructs Pt. to resist as Dr. tries to push extended wrist into flexion

Positive: pain over the lateral epicondyle

Indicates: lateral epicondylitis (tennis elbow)
MILL’S TEST (Maneuver – Evans)
Instruct: Pt. seat with forearm supinated. In a smooth continuous motion the Dr. passively maximally flexes the Pt’s elbow, then wrist & fingers. While maintaining wrist & finger flexion, The Dr. passively extends the Pt’s elbow (the forearm is now pronated)

Positive: pain over the lateral epicondyle

Indicates: lateral epiconylitis (tennis elbow)
GOLFER’S ELBOW TEST
Instruct: Pt. seated, Dr. instructs Pt. to extend the elbow & supinate the hand

Positive: pain over the medial epicondyle

Indicates: medial epicondylis
TINEL’S WRIST SIGN
Instruct: Pt. seated with wrist supinated, Dr. taps over the palmar (volar) surface of the wrist (flexor retinaculum) with the Taylor hammer

Positive: reproduction of pain, tenderness and/or paresthisia in the median nerve distribution area…thumb, 2, 3, lateral half of 4

Indicates: carpal tunnel syndrome
PHALEN’S SIGN & REVERSE PHALEN’S SIGN (aka PRAYER SIGN)
Instruct: Pt. seated, Dr. instructs Pt. to flex both wrists to maximum degree & approximate until point of pain or 60 seconds
Prayer sign= maximally extend wrist (palms together) elbows @ same level as shoulder for 60 seconds or until point of pain

Positive: reproduction of pain and or paresthesia in the median nerve distribution area…thumb, 2,3, lateral half of 4.

Indicates: carpal tunnel syndrome
FINKELSTEIN’S TEST
Instruct: Pt. seated, Dr. instructs Pt. to place his/her thumb across the palmer surface of the hand & make a fist. Have Pt. flex elbow & instruct Pt. to ulnar deviate their hand

Positive: pain distal to the radial styloid process

Indicates: stenosing tenosynovitis of the abductor pollicis longus (AbPL) and extensor pollicis brevis EPB tendons (DEQUERVAIN’S DISEASE)
BUNNEL-LITTLER TEST
Instruct: Pt. seated, Dr. places MCP joint in extension & tries to flex the PIP joint. If no flexion is possible that there is either a joint capsule contracture or tight intrinsic muscles. To differentiate, Dr. places the MCP joint in a few degrees of flexion & attemps to move the PIP joint into flexion

Positive: 1) flexion of the (PIP) proximal interphalangeal joint can’t be achieved

Indicates: 1) joint capsule contracture

Positive: 2) flexion of the (PIP) proximal interphalangeal joint is achieved

Indicates: 2) tight intrinsic muscles
RETINACULAR TEST
Instruct: Pt. seated, Dr. places PIP joint in neutral & tries to flex the DIP joint. If no flexion is possible then there is either a joint capsule contracture or tight retinacular ligaments. To differentiate, Dr. places the PIP joint in a few degrees of flexion & attemps to move the DIP joint into flexion

Positive: 1) flexion of the (DIP) distal interphalangeal joint cannot be achieved

Indicates: 1) joint capsule contracture

Positive: 2) flexion of the (DIP) distal interphalangeal joint is achieved

Indicates: 2) tight retinacular ligament
ALLEN’S TEST
Instruct: Pt. seated, Dr. instructs Pt. to raise his/her hand above the heart level of his/her head & to open/close his/her fist for 60 seconds. Dr. occludes both the radial & ulnar artery @ wrist & then lower’s the Pt’s arm with the fist closed & allows the fist to rest on Pt’s thigh. Dr. instructs Pt. to open closed fist & release digital pressure over one artery while keeping the other artery occuled. Record the filling time, while comparing color to the other hand. The repeat procedure for the other artery.

Positive: a delay of more than 10 seconds in returning a reddish color to the hand (Evans 5 seconds)

Indicates: radial or ulnar artery insufficiency.
*The artery held by the examiner is not the artery being tested.
FORAMINAL COMPRESSION
Instruct: Pt. seated, Dr. standing behind Pt. Dr. clasps his/her hands over Pt’s head & exerts gradual increasing downward pressure. Dr. repeats this with Pt’s head rotated Right then Left

Positive: 1) exacerbation of localized cervical pain

Indicates: 1) foraminal encroachment or facet pathology without nerve root compression

Positive: 2) exacerbation of cervical pain with a radicular component

Indicates: 2) foraminal encroachment with nerve root compression or facet pathology
CERVICAL DISTRACTION
Instruct: Pt. seated. Dr. grasps the Pt’s head with both hands & gradually exerts upward pressure keeping hands off TMJ & EARS

Positive: diminished or absence of pain

Indicates: foraminal encroachment (local pain diminishes), nerve root compression (radicular pain diminishes)

Positive: increase of cervical pain

Indicates: muscular strain, ligamentous sprain, myospasm, facet capsulitis
SPINAL PERCUSSION
Instruct: Pt. seated with head in slight flexion, percuss each cervical SP & the associated musculature with the pointed end of the Taylor reflex hammer

Positive: 1) local pain

Indicates: 1) possible fractured vertebrae, ligamentous involvement (spinous pain), muscular involvelment (muscular pain)

Positive: 2) radiating pain

Indicates: 2)possible disc pathology
SHOULDER DEPRESSION
Instruct: Pt. seated., Dr. stabilizes Pt’s laterally flexed head while pushing down on shoulder

Positive:
localized pain on the side being tested
Pain on either side

Indicates:
Localized Pain- dural sleeve adhesion, and muscular adhesion/ contracture or spasm or ligamentous injury
Radicular pain on
A) side being tested-neurovascular bundle compression, dural sleeve adhesions, or thoracic outlet syndrome
B) Opposite side- foraminal encroachment with nerve root compression
VALSALVA MANEUVER
Instruct: Pt. seated, Dr. instruct Pt. to take a deep breath & hold, while bearing down as if having a bowel movement

Positive: local or radiating pain from site of lesion

Indicates: space occupying lesion
SWALLOWING TEST
Instruct: Pt. seated, Dr. instructs the patient to swallow

Positive: difficulty in swallowing

Indicates: space occupying lesion at anterior portion of cervical spine. possibly esophageal or pharyngeal injury, anterior disc defect, muscle spasm or oseophytes
SOTO HALL SIGN
Instruct: Pt. supine, Dr. flexes Pt’s head toward his/her chest while exerting downward pressure on Pt’s sternum with hypothenar eminence of inferior hand

Positive: generalized pain in the cervical region, may extend down to the level of T2

Indicates: non specific test for structural integrity of cervical region
KERNIG’S SIGN
Instruct: Pt. supine, Dr. passively flexes Pt’s hip to 90 degrees & the Pt’s knee to 90 degrees. Dr. extends Pt’s leg completely

Positive: inability to fully extend the leg and or pain (usually in neck region)

Indicates: meningeal irritation/meningitis
O’DONOGHUE MANEUVER
Instruct:
Pt. is seated, Dr. grasps the Pt’s head with both hands & passively takes the cervical region thru a range of motion. The Dr. then takes the cervical region thru isometric contractions

Positive:
Pain during passive range of motion
Pain during resisted range of motion

Indicates:
Ligamentous sprain (passive ROM stresses ligaments)
Muscle/tendon strain (active ROM stresses muscles and tendons
HOOVER’S SIGN
Instruct: Pt. supine, Dr. instructs patient to lift the affected leg while the Dr. places one hand under the heel of the non-affected leg (healthy side)

Positive: Lack of counter pressure on the healthy side

Indicates: Lack of organic basis for paralysis. (Malingering/hysteria)

**with organic hemiplegia, the patient will still exert downward pressure when attempting to raise paralyzed leg**
STRAIGHT LEG RAISER
Instruct: Pt. supine, Dr. raises Patient’s leg slowly to 90 degrees or to the point of pain

Positive: Radiating pain &/or dull posterior thigh pain

Indicates: Sciatic radiculopathy or tight hamstrings.
Positive between 35-70 degrees= possible discogenic sciatic radiculopathy (Cipriano)
GOLDTHWAIT’S SIGN
Instruct: Pt. supine, Dr. places 3 fingers of the superior hand under the interspinous space of the Pt’s lower lumbar vertebrae. Dr. then raises one of the Pt’s extended legs.

Positive: localized pain, low back or radiation pain down the leg

Indicates: Lumbo-sacral or sacroiliac pathology.
-Pain occurring after the lumbars move=
possible lumbo sacral problem.
-Pain occurring before the lumbars move = possible sacroiliac problem.
Bragard’s Sign
Instruct: Pt. Supine, Dr. performs a SLR on the Pt. Dr. lowers the raised leg (5 degrees) from the point of pain and sharply dorsiflexes Pt’s foot

Positive: Radiating pain in posterior thigh

Indicates: Sciatic Radiculopathy
BUCKLING SIGN (CIPRIANO)
Instruct: Pt. supine, Dr. performs a SLR on Pt.

Positive: Pain in the posterior thigh with sudden knew flexion (buckle)

Indicates: Sciatic radiculopathy
BOWSTRING SIGN
Instruct: Pt. supine, Dr. Places Pt’s leg on their shoulder & first applies pressure to the hamstring muscle if pain is not elicited then apply pressure to the popliteal fossa

Positive: Pain in the lumbar region or radiculopathy

Indicates: Sciatic nerve root compression, helps rule out tight hamstrings.
LASEGUE’S TEST
Instruct: Pt. Supine, Hip & leg bent to 90 degrees. Slowly extend the knee (keeping hip@/or close to 90 degrees

Positive: Reproduction of sciatic pain before 60 degrees

Indicates: Sciatica
MILGRAM’S TEST
Instruct: Pt. supine, Dr. raises both of Pt’s legs 2-3 inches off the table & instructs Pt. to hold legs off the table for 30 seconds.

Positive: Inability to perform test and or low back pain

Indicates: Weak abdominal muscles or (SOL) space occupying lesion
BECHTEREW’S TEST
Instruct: Pt. seated, Dr. instructs Pt. to extend one knee at a time alternately, then both together

Positive: Reproduction of radicular pain or inability to perform correctly due to tripod sign

Indicates: Sciatic radiculopathy
ANTERIOR INNOMINATE TEST/ MAZION’S PELVIC MANEUVER/ADVANCEMENT SIGN
Instruct: Pt. standing, Dr. instructs Pt. to advance one leg forward approximately 2-3 feet. Pt. is then instructed to bend forward at the waist and touch the advanced foot with both hands. (advanced knee should be straight)

Positive: The inability to bend at the waist more than 45 degrees because of either/or:

Positive: 1)Radiating pain along the sciatic nerve, either unilateral or bilateral

Indicates:1) sciatic radiculopathy or neuralgia possible due to lumbar disc pathology

Positive: 2) Low back pain in lumbar or pelvic region

Indicates: 2) Anterior (rotational) displacement of the ilium relative to the sacrum
Lewin Standing Test
Instruct: Dr. instructs Pt. to bend forward slightly @ the waist with knees slightly flexed. Dr. first brings one knee into complete extension. Next the Dr. brings the other knee into complete extension. Finally Dr. brings both knees into complete extension.

Positive: Radiating pain down the leg causing flexion of the Pt’s knee or knees

Indicates: lumbo-sacral, sacroiliac, or gluteal pathologies
NERI’S BOWING TEST AKA NERI’S SIGN
Instruct: Dr. instructs PT. to bend forward from the waist

Positive: Pain accompanied by flexion of the knee of the affected side and body rotation away from the affected side

Indicates: Positive with a variety of low back pathologies. Hamstring tension on the pelvis may trigger the response.
HEEL WALK
Instruct: Ask Pt. to walk on their heels (7-8 steps)

Positive: Inability to perform test

Indicates: L4/ L5 disc problem…L5 nerve root
TOE WALK
Instruct: Ask Pt. to walk on their toes (7-8 steps)

Positive: Inability to perform test

Indicates: L5/S1 disc problem…S1 nerve root
ELY’s HEEL TO BUTTOCK TEST AKA ELY’S SIGN
Instruct: Pt. prone, Dr. flexes the knee of the Pt’s affected leg to 90 degree. Dr. then approximates the heel of the affected leg to the contralateral buttock and hyperextends the thigh off the table

Positive:
Inability to raise the thigh
Pain in the anterior thigh
Pain in the lumbar region

Indicates:
Iliopsoas spasm
Lumbar nerve root inflammation
Lumbar nerve root adhesion
LEG LENGTH DISCREPANCY
Instruct: Pt. supine, (TRUE) Dr. takes a cloth measuring tape & measures from ASIS to medial malleoli of the same leg. Dr. measures from ASIS to medial malleoli of opposite leg. (Apparent) Dr. takes a cloth tape measure & measures from the umbilicus to the medial malleoli of one leg & then measures from umbilicus to medial malleoli of opposite leg

Positive: Different measurements

Indicates:
True=bony abnormality above or below level of trochanter difference.
Apparent=pelvic obliquely
ALLIS’ SIGN
Instruct: PT. is supine, Dr. instructs Pt. to place both flat feet on bench while flexing both knees to 90 degrees

Positive: Difference in height and anteriority of the knees

Indicates:
1) If one knee is lower=ipsilateral congenital hip dislocation or tibial discrepancy (anatomical short leg):
2)If one knee is anterior= ipsilateral congenital hip dislocation or femoral discrepancy (anatomical short leg)
THOMAS TEST
Instruct: Pt. supine, Dr. instructs Pt. to approximate each knee one at a time to his/her chest and hold

Positive: Lumbar spine maintains lordosis (should flatten) and opposite hip doesn’t straighten

Indicates: Contracture of the hip flexors (iliopsoas)
ANVIL TEST
Instruct: Pt. supine, Dr. elevates the affected leg while keeping the knee extended. The Dr. then makes a fist & strikes the affected leg’s inferior calcaneus

Positive: Localized pain in long bone or in hip joint

Indicates: Possible fracture of long bones, hip joint pathology
PATRICK’S TEST/FABERE SIGN
Instruct: Pt. Supine, Dr. flexes, abducts, & externally rotates the Patient’s hip so that the ankle rests above or below the contralateral knee. Dr. then extends the hip by pushing just superior to the knee while stabilizing the contralateral ASIS

Positive: Pain in the hip region

Indicates: Hip joint pathology
Laguerre’s Test
Instruct: Pt. supine, Dr. grasps the affected leg, flexes and externally rotates the hip and abducts the thigh (similar to Patrick’s except the ankle of the affected leg is not resting on the contra-lateral knee). Dr. applies pressure to the end range of motion while stabilizing the contra-lateral ASIS (rest ankle on forearm and with other hand reach under arm to stabilize)

Positive: 1) Pain in the hip joint

Indicates: 1) Hip joint pathology

Positive: 2) Pain in the sacroiliac joint

Indicates:2) Mechanical problem of the sacroiliac joint
Gaenslen’s Test
Instruct: Pt. is supine with affected side of the sacroiliac joint as close to the edge of the table as possible. The Pt. then grasps the unaffected leg just below the knee and approximates the knee to his chest. The Dr. Then places a downward pressure on the affected thigh until it is lower than the edge of the table.

Positive: Pain on the affected SI joint stressed into extension

Indicates: General sacroiliac joint lesion, anterior sacroiliac ligament sprain, or inflammation of the SI joint.
Lewin-Gaenslen Test
Instruct: Pt lying on his unaffected side, instruct patient to flex his inferior leg. Dr. grasps the superior leg and brings into extension while stabilizing the lumbo-sacral joint (extension of the leg stresses the sacroiliac joint and anterior joint ligaments on the side of leg extension

Positive: Pain on the side of extension

Indicates: General sacroiliac joint lesion, anterior sacroiliac ligament sprain, or inflammation of the SI joint.
Hibb’s Test
Instruct: Pt. prone, Dr. stabilizes pelvis on near side while grasping the opposite ankle and flexing the knee to 90 degrees Dr. maximally flexes the knee and then slowly internally rotates the thigh (pushing lateral on the leg). Compare bilateral

Positive: 1) Pain in the hip region

Indicates: 1)Hip joint pathology

Positive: 2) Pain in the buttock/pelvic region

Indicates: 2) Sacroiliac joint lesion
Ober’s
Instruct: Pt. on his/her side, Dr. flexes the knee of the Pt’s affected leg 90 degrees, while abducting & extending the hip. Perform bilaterally

Positive: Affected thigh remains in Abduction. (normally biomechanics the thigh/hip will adduct)

Indicates: Contraction of the iliotibial band or tensor fascia lata, (usually secondary to synovitis of the hip, secondary to trauma of the gluteus medius and maximus.
PELVIC ROCK TEST/ILIAC COMPRESSION TEST
Instruct: Pt. lies on their side. Dr. places both hands on the lateral portion of the Pt’s ilium. Dr. pushes downward (lateral to medial) on the Pt’s ilium. Test bilaterally

Positive: Pain in either sacroiliac joint

Indicates: Sacroiliac joint lesion
NACHLAS TEST
Instruct: Pt. prone, Dr. takes the heel of the affected leg & approximates it to the ipsilateral buttock while stabilizing the pelvis to prevent hip flexion.

Positive: Pain in the buttock &/or pain in the lumbar region

Indicates: Sacroiliac joint lesion or lumbar pathology
Yeoman’s Test
Instruct: Pt. prone, Dr. flexes Pt’s leg to ipsilateral buttock and then extends the thigh

Positive: Pain deep in the SI joint

Indicates: (Strain)/Sprain of the anterior sacroiliac ligaments
ELY’S SIGN
Instruct: Pt. Prone, Dr. passively flexes the Pt’s knee toward the ipsilateral buttock (no stabilization)

Positive: Hip on side being tested will flex causing the buttock to raise off the table

Indicates: Rectus femoris or hip flexor contracture
Ely’s Heel to Buttock Test
Instruct: Pt. prone, Dr. flexes the knee of the Pt’s affected leg to 90 degrees. Dr. then approximates the heel of the affected leg to the contralateral buttock and hyperextends the thigh off the table

Positive:
Inability to raise the thigh
Pain in the anterior thigh
Pain in the lumbar region

Indicates:
Iliopsoas spasm
Lumbar nerve root inflammation
Lumbar nerve root adhesion
TRENDELENBURG’S TEST
Instruct: Pt. stands on foot of involved side of hip problem. Observe level of hips.


Positive: High iliac crest on supported side and low crest on side of elevated leg


Indicates: Weak gluteus medius muscle on the supported side
MCMURRAY SIGN
Instruct: Pt. supine, Dr. flexes Pt’s affected hip to 90 degrees & the affected knee to 90 degrees. Dr. grasps the heel of the affected leg & applies external rotation of the knee. Dr. places his/her hand on the lateral aspect of the affected knee & applies valgus (abduction) stress. Dr. maintains the external rotation & valgus stress on the knee & extends affected leg slowly to the top of the table while palpating the medial knee joint line

Positive: Clicking sound or pain by knee joint

Indicates: Tear of medial meniscus if positive on external rotation. Tear of lateral meniscus if positive on internal rotation. The higher leg is raised when positive is elicited, the more posterior the meniscal injury.
MEDIAL COLLATERAL LIGAMENT /ABDUCTION STRESS/VALGUS STRESS TEST
Instruct: Pt. supine, Dr. stabilizes the lateral thigh of the Pt’s affected leg. Dr. grasps just superior to the medial ankle of the affected leg & gradually pushes laterally ( to open medial side of joint)

Positive: Gapping and or elicited pain above/at/or below joint line


Indicates: Torn medial collateral ligament
LATERAL COLLATERAL LIGAMENT TEST/ADDUCTION STRESS TEST/VARUS STRESS TEST
Instruct: Pt. supine, Dr. stabilizes the medial thigh of the Pt’s affected leg. Dr. grasps just superior to the lateral ankle of the affected leg & gradually pushes medially (opening the lateral side of the joint)

Positive: Gapping &/or elicited pain above/at/or below joint line

Indicates: Torn lateral collateral ligament
BOUNCE HOME TEST
Instruct: Pt. supine, Dr. instructs Pt. to flex his leg, Dr. grasps the Pt’s heel & knee of the affected leg, Dr. pulls leg slowly into extension (passively)

Positive: Knee does not go into full extension (slight flexion remains)

Indicates: Diffuse swelling of the knee, accumulation of fluid, due to possible torn meniscus
DRAWER TEST
Instruct: Pt. supine, Dr. flexes the hip & the knee of the Pt’s affected leg until the foot is flat on the table. Dr. sits on the foot of the Pt’s affected leg. Dr. grasps behing the Pt’s flexed knee & exerts a pushing & pulling pressure into the affected knee.

Positive: 1) Gapping >6 mm (tibia moves posterior) when the leg is pushed

Indicates: 1) Torn posterior cruciate ligament

Positive: 2) Gapping >6 mm (tibia moves anterior) when the leg is pulled

Indicates: 2)Torn anterior cruciate ligament
LACHMAN’S TEST
Instruct: Pt. supine, Dr. puts the Pt’s knee @ 30 degrees angle of flexion & from this angle the Dr. grasps both the proximal end of the tibia with one hand & attempts to pull tibia forward in order to feel the joint play (variation of Drawer’s Test)

Positive: Gapping with the tibia moving away from the femur

Indicates: Anterior cruciate ligament or posterior oblique ligament instability
APPREHENSION TEST FOR PATELLA
Instruct: Pt. supine (or seated) with Quadriceps relaxed & resting over Dr’s leg @ a 30 degrees flexion, Dr. pushes the patella laterally

Positive: Apprehension, distress of facial expression, contraction of quadriceps to bring patella back in line

Indicates: Chronic patella dislocation or pre-disposition to dislocation
PATELLA FEMORAL GRINDING TEST aka CLARKE’S SIGN
Instruct: Pt. supine, affected knee extended Dr. uses the web of the hand to move the patella to an inferior position. Dr. instructs Pt. to tighten the quadriceps muscles as the Dr. continues to hold the patella in the inferior direction.

Positive: Retropatellar pain & the patient is unable to hold the quadriceps contraction

Indicates: Degenerative changes of the patellar facets and/or within the trochlear groove (chondromalacia patella)
PATELLA BALLOTTMENT TEST
Instruct: Pt. supine with knee extended. Anterior to posterior pressure is applied over the patella.

Positive: A floating sensation of the patella is a positive finding

Indicates: A large amount of swelling in the knee
APLEY’S COMPRESSION TEST
Instruct: Pt. prone, Dr. flexes Pt’s affected knee to 90 degrees. Stabilize Pt’s thigh with your knee place downward pressure on the Pt’s heel while internally & externally rotating the Pt’s foot.

Positive: Patient points to side of pain


Indicates: Pain or medial side is medial meniscus tear. Pain on the lateral side indicates lateral meniscus tear
APLEY’S DISTRACTION TEST
Instruct: Pt. prone, Dr. flexes Pt. affected knee to 90 degrees. Dr. places his/her knee on Pt’s affected thigh for stabilization. Dr. grasps the Pt’s foot & pulls the leg while internally & externally rotating the tibia

Positive: Patient will point to side of pain


Instruct: Pain on the medial side indicates medial collateral ligament tear. Pain on the lateral side indicates lateral collateral ligament tear.
DRAWER SIGN (Anterior Drawer sign of the ankle)
Instruct: Pt. seated, Dr. grasps just superior to the ankle with one hand & around the calcaneus of the affected foot with the other hand. Dr. pulls (draws) the calcaneus anteriorly & pushes the tibia posteriorly, the reverse procedure by pulling the ankle anterior & calcaneus posterior

Positive: Translation with the talus moving away from or toward the tibia

Indicates:
1) With tibia pushed/foot pulled; a tear/instability of the anterior talofibular ligament.
2) With tibia pulled/foot pushed; a tear/ instability of posterior talofibular ligament.
ANKLE DORSIFLEXION TEST
Instruct: Pt. seated, Dr. tries to dorsiflex foot of affected leg, 1st with the knee extended, then again with the knee flexed

Positive: 1) The foot cannot dorsiflex with knee extended, but is able to with knee flexed

Indicates: 1) contracture of gastrocnemius muscle

Positive: 2) The foot cannot dorsiflex in either knee position

Indicates: 2) contracture of the soleus muscle
RIGID OR SUPPLE FLAT FEET TEST
Instruct: Pt. is seated & then stands, Dr. observes Pt’s feet while seated & while standing


Positive: 1) Absence of medial longitudinal arch in both positions

Indicates: 1) Rigid flat feet


Positive: 2) Presence of medial longitudinal arch while seated with a loss of medial longitudinal arch while standing

Indicates: 2) Supple flat feet
HOMANS’ SIGN
Instruct: Pt. supine, Dr. raises the extended affected leg about 12” off table or 45 degrees & then forcibly dorsiflexes the foot of the affected leg. (Squeezing the calf is recommended by some sources, yet other sources feel it is contra-indicated)

Positive: Deep pain in the calf

Indicates: Deep vein thrombophlebits
THOMPSON’S TEST
Instruct: Pt. prone with leg flexed to 90 degrees by Dr. squeezes the belly of the calf muscle of the affected leg

Positive: Absence of foot plantarflexion motion

Indicated: Achilles tendon rupture
MORTON’S TEST
Instruct: Pt. supine, Dr. grasps the affected forefoot with one hand & applies transverse pressure across the metatarsal heads

Positive: Sharp pain in the forefoot

Indicates: Metatarsalgia or neuroma (usually @ 3rd or 4th metatarsal interspace)
L' Hermitte's sign
Instruct: Pt sitting or supine, Pt flexes their head toward their chest, or per Evan’s Dr. Actively flexes Pt’s head toward chest

Positive: Electric shock-like sensations down the spine and/or spinal cord.

Indicates: Meningeal irritation/meningitis 
Brudzinski
Instruct: Pt. supine, Dr. Flexes Pt's head to the chest

Positive: Involuntary knee flexion

Indicates: Meningeal irritation or nerve root lesion
Jackson Compression
Procedure: Patient seated with examiner standing behind. Examiner laterally flexes
the patient's head to one side and clasps his/her hands over patient's
head and exerts increasing downward pressure. Perform bilaterally.

Positive: 1) Exacerbation of localized cervical pain.

Indicates: 1) Foraminal encroachment without nerve root pressure or facet
pathology.

Positive: 2) Exacerbation of cervical pain with a radicular component.

Indicates: 2) Foraminal encroachment with nerve root compression
Maximal Cervical Compression
Procedure: Patient seated with examiner standing behind. The examiner instructs
the patient to rotate the head and hyperextend the neck. Perform
bilaterally.

Positive: 1) Pain on the concave side

Indicates: 1) Foraminal encroachment with or without nerve root compression
(based on presence or absence of radicular component)

Positive: 2) Pain on the convex side

Indicates: 2) Muscular strain
Bakody Sign (Shoulder Abduction Test)
Procedure: Patient seated, examiner instructs patient to place the palm of the
affected side flat on top of their head.

Positive: Decrease or absence of radiating pain.

Indicates: Cervical foraminal compression, nerve root entrapment (usually C5/C6
level because this motion elevates the subscapular nerve and puts
traction on the lower brachial plexus).
Adam's Sign (positions)
Instruct: Patient standing, with examiner standing behind patient, Dr. looks for evidence of scoliosis. Dr. instructs patient to bend forward at the waist with fingers extended and hands together. Examiner observes for evidence of change in the scoliosis.

Positive: 1) Pt. Has a C or S shaped scoliosis in observed to straighten

Indicates: 1) Negative: evidence of a functional scoliosis

Positive: 2) Pt. Has a C or S shaped scoliosis that does not straighten

Indicates: 2) evidence of a pathologic or structural scoliosis as well as trauma or subluxation.
Schepelmann's Sign
Procedure: Patient seated arms fully abducted and raised over head, Dr.instructs Pt. to laterally flex thoracic spine to the left side and then to the right side.

Positive: Pain on the concave or convex side.

Indicates: Pain on the concave side indicates intercostal neuritis while pain on the
convex side indicates fibrous inflammation of the pleura (or possible
intercostal myofascitis).
Beevor's Sign
Procedure: Pt. supine, Dr. instructs Pt. to cross his/her arms across the chest and perform a partial sit up.

Positive: Superior movement of the umbilicus.

Indicates: Superior movement of the umbilicus is indicative of a spinal cord lesion
at the level of T10 or lower abdominal weakness. Inferior movement
Roos' Test a.k.a. E.A.S.T (elevated arm stress test)
Instruct: Pt. standing, Dr. instructs Pt. to bring arms out in front of their body,
bend the elbows to 90°. The patient then externally rotates the arms and opens and closes their fists bilaterally at a moderate pace for up to 3 minutes.

Positive: Ischemic pain, heaviness of the arms, or numbness and tingling of the
hand.

Indicates: Thoracic outlet syndrome on side
Adson's Test (Scalene Maneuver and Scalenus Anticus Test)
Procedure: Pt. seated with arms at side and elbows fully extended. Dr. finds radial
pulse, slightly abducts affected arm and has Pt. take a deep breath and hold, then
instruct patient to rotate head and elevate chin toward examiner while holding the
breath. Note positive or negative findings, if negative then rotate head to the opposite
side and repeat the procedure.

Positive: Pain and/or paresthesia, decreased or absent pulse, pallor.

Indicates:
1)Scalenus anticus syndrome or cervical rib syndrome. (usually same side)
2) Decrease or absence of radial pulse indicates compression of
subclavian artery.
3) Paresthesia/radiculopathy indicates compression of the brachial plexus at the neurovascular bundle by scalenius anticus or cervical rib (usually opposite side)
Halstead's Maneuver
Instruct: Pt. seated,Dr. finds and monitors radial pulse in neutral position with one
hand and with the other hand tractions the Pt's arm toward the floor. Dr. instructs Pt. to elevate chin and hyperextend their neck. If the test is negative (the pulse does not disappear), then rotate the head to the opposite side and repeat.

Positive: Pain and/or paresthesia, decreased or absent pulse, pallor.

Indicates: Compression of the neurovascular bundle by scalenus anticus or cervical
rib.
Costoclavicular Maneuver a.k.a. Eden's Test
Procedure: Patient seated, examiner finds radial pulse and instructs patient to sit
erects, force shoulders back, chest out and touch chin to chest.

Positive: Pain and/or paresthesia, decreased or absent pulse, pallor.

Indicates: Compression of the neurovascular bundle between the clavicle and 1st
rib.
Hyperabduction Maneuver a.k.a. Wright's Test
Procedure: Patient seated, examiner finds radial pulse and hyperabducts the
patient's arm.

Positive: Pain and/or paresthesia, decreased or absent pulse, pallor.

Indicates: Compression of the axillary artery by pectoralis minor or coracoid
process. Thoracic outlet syndrome
Fromet's Paper Sign
Instruct: Pt seated and is instructed to hold a piece of paper b/t any two adducted fingers. The Dr tries to remove the paper

Positive: The Pt. is unable to maintain grip on the paper

Indicates: Ulnar nerve paralysis
Minor's Sign
Instruct: Examiner instructs patient to stand. Observe for abnormal motion.

Positive: Knee flexion of affected leg while supporting upper body weight (hand on
back or thigh) on unaffected side.

Indicates: Sciatica, lumbosacral or sacroiliac joint lesion
Belt Test (Supported Adam's Test, Supported Forward Bending Test)
Procedure: Patient standing. Have patient bend forward and note for presence of low
Back pain. With the Pt. standing, stabilize Pt's iliac crest and brace hip against Pt's sacrum. have Pt. bend forward as you immobilize the pelvis.

Positive: Low back pain

Indicates: 1) Pain in during unsupported and supported bending = Lumbar
involvement

Indicates: 2) Pain in during unsupported, no pain during supported bending =
pelvic involvement
Kemp's Test
Procedure: Pt. either seated or standing with arms crossed in front of the chest. Dr. stands behind Pt. and stabilizes at the PSIS. With other hand Dr. reaches around Pt. and grasps Pt's shoulder. Dr. Passively brings Shoulder back and obliquely pushes shoulder toward opposite PSIS.

Positive: 1) Pain usually radicular, recreating existing sciatic pain


Indicates: 1) Disc protrusion:
*In Medial disc protrusion Kemps will be positive as the patient is leaning AWAY from the side of pain.

*In Lateral disc protrusion Kemps will be positive as the Pt is leaning into side of pain.

Positive: 2) local pain

Indicates: 2) Localized pain may indicate lumbar spasm or facet capsulitis.
Lindner's Sign
Instruct: Patient supine, examiner flexes patient's head toward the chest.

Positive: Pain along sciatic distribution or sharp, diffuse pain (leg)

Indicates: Sciatic radiculopathy
Sicard's Sign
Instruct: Examiner lowers raised leg (see SLR) 5 degrees from point of pain and dorsiflexes
patient's big toe.

Positive: Posterior thigh and leg pain.

Indicates: Sciatic radiculopathy, usually from disc lesion
Turyn's Sign
Instruct: Patient supine, examiner dorsiflexes the big toe of the affected extremity.

Positive: Pain in the gluteal region or radiating sciatic pain.

Indicates: Sciatic radiculopathy
Bonnet's Sign
Procedure: Patient supine, examiner strongly internally rotates and adducts the
affected leg across the midline and then performs a straight leg raiser
test.

Positive: Pain in posterior thigh or leg.

Indicates: Sciatica (possibly piriformis syndrome)
Fajersztajn's Test a.k.a. Well-Leg-Raising Test of Fajersztajn a.k.a. Cross-over Sign
Procedure: Patient is supine. Examiner performs a SLR on the patient's unaffected
leg to 75º or until it produces pain down the affected leg. If no pain is
produced, examiner dorsiflexes the foot.

Positive: 1) Pain down affected leg.(Cross-Over Sign)

Indicates: 1) Medial disc protrusion

Positive: 2) Decrease in pain down affected leg.

Indicates: 2) Lateral disc protrusion
Femoral Stretch Test (Femoral Nerve Traction Test)
Procedure: Patient lies on the unaffected leg side, hip and knee slightly flexed,
patient straightens back and flexes neck. The affected leg is extended by
the examiner at the hip approx. 15º. The affected knee is flexed
(stretching femoral nerve).

Positive: Pain on the anterior portion of the thigh.

Indicates: Traction on the femoral nerve indicating involvement of the 2nd, 3rd and 4th lumbar nerve roots
Tinel's Foot Sign
Procedure: Doctor taps the region of the medial plantar nerve, posterior to the
medial malleolus

Positive: Paresthesia radiating into the foot.

Indication: Tarsal tunnel syndrome
Point Localization (Topognosis)
The ability to recognize points being touched on the body (use dull side of neurotip on skin) ask Pt. to point to the spot being touched with their finger
Orientation
Ask Pt. Their name, location, and date
Level of alertness, attention, and cooperation
Ask the patient to spell a word forward and backward

Ask the patient to repeat a string of integers forward and backward

Ask the patient to name the months forward and backward
Memory
Recent- recall three items after 5 minute delay
Remote- recall certain historical facts within the Pt's lifetime
"where did you go to highschool?"
Language
Object naming
Repetition of single words and sentences
Calculations
Simple additions and subtractions, should be two or more steps
Apraxia
Following a complex motor command like "pretend to comb your hair" or "pretend to brush your teeth"
Sequencing Tasks
Ask Pt to tap on the table with: fist, open palm, then side of open hand (rock, paper, scissor)
Abstraction
Interpretation of a proverb or colloquiallism "early bird catches the worm"
Diadochokinesia
Patting Test: Rapid rhythmic alternating movements.
Have patient pat leg with each hand as fast as possible
Diadochokinesia
Supination M Pronation Test: Have patient pronate and
supinate palms as rapidly as possible
Dysmetria
Have patient touch your index finger and then his/her nose
alternately several times. (Note tremors or lack of coordination)
Dysmetria
Heel-Shin: Have patient run their heel from his/her knee to his/her foot.
Forced Gait
Forced gait testing- ask the patient to walk on heels one way and on toes back toward you

observe patient walking toward and away, note posture, stability, foot
elevation, trajectory of leg swing, balance, and arm motions
Tandem Gait
Tandem gait- ask the patient to walk heel toe.

observe patient walking toward and away, note posture, stability, foot
elevation, trajectory of leg swing, balance, and arm motions
Pain (pinprick)
use sharp end of neurotip) stimuli on the hands and feet
(spinothalamic).
Vibration (Pallesthesia)
Place the handle of a vibrating 128 Hz tuning fork
on the bony prominances of the upper and lower extremities. Start distal work proximal. Ask Pt "can you feel vibration? and when does it stop?" (Dr. stops it)
Light Touch
Gently stroke skin with a wisp of cotton or with a camel hair
brush
Joint Position Sense
Examiner moves patient's fingers and toes, he/she is
asked to describe the digit position. (open or closed position)
Romberg's Test
ask the patient with eyes open, then closed, note any swaying

stand next to patient
Sharp vs Dull discrimination
Alternate sharp and dull (use a neurotip)
stimuli on the hands and feet (spinothalamic).
Stereognosis
The ability to recognize familiar objects by the sense of touch
Graphesthesia
The ability to recognize numbers traced lightly on the skin
Barognosis
The ability to distinguish between different weights
Two Point discrimination
Determining the smallest area in which two points
can be separately perceived. (use paperclip)
Double Simultaneous Stimulation
Extinction- only one side is felt

Displacement- one side is felt normally and the other displaced toward midline

Synesthesia- one side is felt normally and the other is a vague burning
Deep Tendon Reflex C5
Biceps

Response : elbow flexion

Afferent/Efferent: Musculocutaneous
Nerve

Integrating Center: C5 spinal cord
Deep Tendon Reflex C6
Brachioradialis

Response: slight forearm flexion

Afferent/efferent: Radial Nerve

intergrating center: C6 spinal cord
Deep Tendon Reflex C7
Triceps

Response: Elbow flexion

afferent/efferent: Radial Nerve

Integrating Center: C7 spinal cord
Deep Tendon Reflex L4
Patella

response: Knee extension

Afferent/efferent: femoral nerve

Intergrating Center: L2, L3, L4 spinal cord
Deep Tendon Reflex S2
Achilles

Response: Foot plantar flexion

Afferent/efferent: Tibial Nerve

Intergrating Center: S1, S2 spinal cord
Jendrassik's Maneuver
AKA Reinforcement Test or Cortical Distraction Test
A form of cortical distraction that brings out a reflex when hard to elicit Pt. hooks hands together by flexed fingers and pulls on the clenched hands at the moment the reflex is performed
Direct Light Reflex
Response: Ipsilateral
pupillary
constriction when light is shined in the eye

afferent: Optic Nerve CN II

Intergrating Center: Midbrain

Effernet: Oculomotor Nerve CN III
Indirect Light Reflex
Reponse:Contralateral
pupillary
constriction when light is shined in the eye

Afferent: Optic Nerve CN II

Intergrating Center: Midbrain

Efferent: Oculomotor Nerve CN III
Accommodation
Response: Convergence of
the eyes,
pupillary
constriction, Lens convexity when object is brought into near vision

afferent: Optic Nerve CN II

Intergrating Center: Occipital Cortex

Efferent: Oculomotor Nerve CN III
Carotid Sinus
Pairing of Radial and Carotid Pulse

Response: Reduction in heart rate when Dr. presses the carotid sinus

afferent: Glossopharyngeal
Nerve IX

intergrating: Medulla

Efferent: Vagus Nerve CN X
Oculocardiac
Response: Reduction in
heart rate When Dr. presses
the eye

Afferent: Trigeminal Nerve CN V

Intergrating: Medulla

Efferent: Vagus Nerve CN X
Ciliospinal
Response: Pupillary dilation
when examiner
pinches the base of the neck at the cervical sympathetic chain

Afferent:Cervical Sympathetic Chain

intergrating: T1-T2 Spinal
Cord

Efferent: Cervical Sympathetic
Chain
Corneal
Response: Blinking and tearing of the eye upon touching the cornea with a cotton wisp

afferent: trigeminal Nerve CN V

intergrating: Pons

efferent: Facial nerve CN VII
Gag/Pharyngeal
Reponse: Gagging upon touching the back of the
throat with a tongue depressor

afferent: Glossopharyngeal
Nerve IX

Intergrating Center: Medulla

Efferent: Vagus Nerve CN X
Uvular/Palateal
Patient says "ah."
Watch for symmetrical rising of soft palate.
Bilateral lesion of Vagus = Palate does not rise.
Unilateral paralysis = One side of palate does not rise and uvula will deviates to the normal side.

Response: Raising of the uvula upon phonation, or touching with a tongue depressor

afferent: Glossopharyngeal
Nerve IX

Intergrating: Medulla

Efferent: Vagus Nerve CN X
X
Interscapular
Response: Drawing inward of
scapular when skin or interscapular space is irritated.

Afferent: T2-T7 Spinal Nerves

Intergrating: T2-T7 Spinal Cord

Efferent: Dorsal scapular nerve
Abdominal
Response: Umbilicus deviation to the stroked side. Absence is
normal only if bilateral

afferent: Upper T7-10 & Lower T11-12

Intergrating:Spinal Cord T7-T12

Efferent: Upper T7-10 & Lower T11-12
Plantar
Respone: Plantar flexion
(curling) of toes upon stroking sole of foot

Afferent: Tibial Nerve

intergrating: Spinal Cord S1-S2

Efferent: Tibial Nerve
Glabella aka
McCarthy's
Contraction of orbicularis occuli muscle upon percussion of supraorbital ridge (glabella)

Abnormal Response (Upper Motor Neuron Lesion)
Hoffman's
Clawing of the fingers and thumb (flexion and adduction of thumb with flexion of
the fingers) upon flicking tip of index finger into extension

Abnormal Response (Upper Motor Neuron Lesion)
Trommer's
Flexion of the fingers and thumb upon tapping palmar surface or tips of middle
three fingers

Abnormal Response (Upper Motor Neuron Lesion)
Ankle Clonus
Continued involuntary contraction (flexion and extension) of foot upon quick
forcible dorsiflexion of the foot

Abnormal Response (Upper Motor Neuron Lesion)
Babinski
Dorsiflexion of the big toe and fanning or splaying of other toes upon
stimulation of the plantar surface of the foot (lateral to medial)

Abnormal Response (Upper Motor Neuron Lesion)
Olfactory Nerve CN I
Ask about disorders of sense of smell and of taste (will diminish with loss of smell)
a) Using a penlight, make sure nostrils are not blocked.
b) Occlude one nostril at a time (eyes should be closed)
Have patient sniff familiar and non-irritating odors, use the milder scent first.
Ask the patient:
1) Do you smell anything?
2) Can you identify the substance?
Test visual acuity
Screen by reading print
Screen with shapes and/or colors

Optic Nerve CN II
Test visual fields by confrontation (peripheral vision) a.k.a. Wiggling test
Examine directly in front and level with patient's face
Have patient cover one eye
Bring object into view from eight different directions per eye
Extraocular movements

Motor CN III, IV, VI
test CN III, IV, and VI combined
with six cardinal gazes
observe Pt's eyes for normal conjugate, or parallel movements of the eyes and nystagmus as you have him/her follow your finger or pencil while it makes a wide "H" in the air:
Trochlear = down and in
Abducens = lateral
Oculomotor all other fields
Light touch to anterior 2/3 of tongue
inside cheeks, and hard palate with toothpick. (Use a penlight to view the inside of the mouth)

(V) Trigeminal Nerve (Ophthalmic, Maxillary, and Mandibular)
Motor for (VII) Facial Nerve
Inspect face for asymmetry (at rest and during motion)
Ask the patient to perform the following:
Raise eyebrows
Close eyes tightly
Show teeth
Puff out cheeks
Smile
Frown
Finger Rub Test
Assess hearing by rubbing fingers together near the EAM, find maximal distance sound can be heard.

CN VIII
Whisper Test
Have patient close his eyes (to prevent lip-reading) and cover the ear on the
side not being tested. Place your head/mouth 2 feet from the ear being tested
and whisper words to the patient and ask patient to repeat the words. You can
also ask questions to the patient and have him/her answer yes or no to each
question. Repeat this procedure at varying (usually increasing) distances or
with loud, medium and soft tones.
Weber Test
Procedure: Place the handle of the vibrating tuning fork on the midline of the skull
and ask the patient to compare the intensity of the sound in the two ears.
Indicates: (-) Normal: sound is equal in both ears.
(+) Conductive deafness: sound lateralizes to the bad ear.
(+) Sensorineural deafness: sound lateralizes to the good ear.
RinneTest
Procedure: Place the handle of the tuning fork against the mastoid process. Have
the patient signal when the sound ceases, then hold the fork near the
external ear without touching the patient, again have the patient indicate
when the sound ceases.
Indicates: (+) Normal: air conduction persists twice as long as bone conduction
(-) Conduction deafness: air conduction is equal to bone conduction or
air conduction is less than bone conduction.
(-) Sensorineural deafness: air conduction and bone conduction are both radically decreased or absent
Labyrinthine Test for Positional Nystagmus
Procedure: Pt Seated, Dr inspects Pt's eyes for spontaneous Nystagmyus. Than inspect for Nystagmus for 30 seconds in each of the following positions:
Pt. supine head off table
turn head to one side, then to the other side
Pt's head hanging off table (extension/flexion)
Pt returns to seated position.

Indicates: Normal: the fast component of the eye movement will be in the direction the patient is being moved. (Nystagmus is named for the fast component).

Peripheral Lesion: the patient will exhibit nystagmus within 2-5 seconds, does not change direction if the patient is stationary, and disappears
within 30 seconds.

Medullary Lesion: Nystagmus begins immediately upon movement and may change direction while the patient is stationary (also patient does not have vertigo).
Vestibulo-ocular Reflex
Procedure: Pt. seated, Dr holds Pt's head and instructs Pt to fix vision on Dr's face. Dr then turns Pt's head into rotation, lateral flexion, and flexion and extension.

Indicates: Normal patient should maintain eye contact eyes moving at the same
speed in the opposite direction of head movement. Abnormal findings are detailed in labyrinthine test above

Peripheral Lesion: the patient will exhibit nystagmus within 2-5 seconds, does not change direction if the patient is stationary, and disappears
within 30 seconds.

Medullary Lesion: Nystagmus begins immediately upon movement and may change direction while the patient is stationary (also patient does not have vertigo).
(XI) Spinal Accessory Nerve
a) Trapezius Muscle
Inspect
Palpate
Muscle test

b) Sternomastoid Muscle
Inspect
Palpate
Muscle test
(XII) Hypoglossal Nerve
Have patient stick out tongue and test bilateral with tongue depressor, or use the
tongue in cheek method

Unilateral paralysis = Protruded tongue deviates to involved side
Neurological Level: C5
Motor exam
Disc Level C4
Muscle tests (2)
Shoulder abduction: deltoid (Axillary nerve)
Forearm flexion: biceps (Musculocutaneous Nerve)
Neurological Level: C6
Motor exam
Disc Level C5
Muscle test (1)
Wrist extension extensor carpi radialis longus & brevis, extensor carpi ulnaris (Radial Nerve)
Neurological Level: C7
motor exam
Disc Level C6
Muscle tests (3)
Elbow extension: triceps (Radial Nerve)
Wrist flexion: flexor carpi radialis (Median Nerve), flexor
carpi ulnaris (Ulnar Nerve) Finger extension: (Radial Nerve)
Neurological Level: C8
Motor exam
Disc Level C7
Muscle test (1) Finger flexion: Flexor digitorum superficialis, flexor digitorum profundus and lubricals Ulnar & Median Nerve
Neurological Level: T1
motor exam
Disc Level C8
Muscle tests (2)
Finger abduction: dorsal interossei (Ulnar Nerve)
Finger adduction: palmer interossei (Ulnar Nerve)
Neurological Level: L4
Motor exam
Disc Level L3
Muscle test (1) Foot inversion with slight dorsiflexion: tibialis anterior
(Deep Peroneal/fibular Nerve)
Neurological Level: L5
Motor exam
Disc Level L4
Muscle tests (4)
Foot dorsiflexion
Big toe dorsiflexion: extensor hallucis longus (Deep
Peroneal/fibular Nerve)
Toes 2,3,4 dorsiflexion: extensor digitorum longus and
brevis (Deep Peroneal/fibular Nerve)
Hip/Thigh abduction: gluteus medius & minimus (Superior
Gluteal nerve)
Neurological Level: S1
Motor Exam
Disc Level L5
Muscle tests (3)
Foot Plantar flexion: Gastrocnemius and Soleus (Tibial Nerve)
Foot plantar flexion and eversion: peroneus longus and
brevis (Superficial Peroneal/fibular Nerve).
Hip extension: gluteus maximus (Inferior Gluteal Nerve).
Vital signs
1. Pulse
Rate
Rhythm
Amplitude
Contour
2. Respiratory Rate
3. Temperature
4. Blood Pressure
Head and Neck Examination
Inspection
1. Hair
Color
Distribution
2. Head
Position
Tilt
Rotation
3. Scalp Surface
4. Skull
Size
Shape
Symmetry
Condition
5. Face
Shape
Symmetry
Structural abnormalities
6. Battle Sign
7. DeMusettes Sign
8. Neck
Symmetry of muscles
Webbing
Masses
9. Tracheal Position
10. Patient Swallowing
11. Distended Veins or Arteries
12. Skin Color Variations
13. Ranges of Motion