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Study Guide Questions: 6.4

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Test INTERPRETATION/WHAT TISSUE STRUCTURE DOES THIS TEST

LOAD? For you to complete

Squat test Ankles, knees and hips testing the integrity of joints of lower limb
SI/lumbar
Orthopedic assessment (Vizniak p194)

Lumbar Kemps Reproduce pain in leg/neurogenic claudication/facets (decrease IVF)

test

Djerine’s triad Reproduce symptoms = leg pain /nerve root

(Valsalva, cough, tension/radiculopathy/disc herniation (intrathecal pressure)
sneeze) local lumbosacral pain = lumbosacral sprain/strain

Orthopedic assessment (Vizniak p203)

Flip or If +ve = sciatic nerve distribution

Bechterew’s test

Straight leg 0-40 degrees (hip joint)

raising test (SLR) 40-80 degrees (nerve/disc
>80 degrees SI Lumbar
Orthopedic assessment (Vizniak p205)

Well straight leg If well leg lifted if patient complains of pain on opposite side is an
raising test indication of a space-occupying lesion (e.g. herniated disc)
(WSLR) it is usually indicative of a rather LARGE intervertebral disc
protrusions usually MEDIAL to the nerve root .
The test causes stretching of the ipsilateral as well as the contralateral
nerve root, pulling laterally on the Dural sac.

Braggard’s test While performing SLR Dorsiflexion of the foot (if pain is not through
the sciatic nerve, nerve not muscle, nerve or hamstring)
rationale: ankle dorsiflection indicates stretching of the dura matter of
spinal cord

Bowstring’s test Examiner carries out SLR , knee slightly flexed,thumb or finger
pressure is applied to the popliteal area to reestablish the painful
radicular symptoms
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rationale: the test is indicative for tension on the sciatic nerve .

ie do the SLR till pain is reproduced , then lower leg and bend knee
and press popliteal fossa . reproduction pain indicates sciatic nerve
issue .

Bonnet’s test Patient supine and leg extended 45 Degrees and internally rotated .
(Bighting of rationale: internal rotation stretches the piriformis muscle .
Sciatic nerve) leg pain may result from sciatic nerve irritation or compression from a
contracted piriformis muscle .
similarly SLR with external rotation can be performed

Kernigs test Patient supine Flex head to chest .(active) patient then flexes at
hip/knees and pain will diaapear.
Brudzinski (the hip flexion part)
Kernings (Head flex part)
+ ve may indicate the meningeal irritation, nerve root involvement or
Dural irritation

Sign of the Passive SLR if restriction examiner flexes the knee to see if hip flexion
buttock increases = -ve sign.
+ve if flexion does not increase indicate disease of the buttock,
bursitis, tumour, absess

Slump test Dural slump test .

+ve reproduction of symptoms =leg pain=nerve root tension (shooting
/electrical) radiculopathy
+ve posterior leg pain with arched back = sciatica
+local lumbosacral pain= lumbosacral sprain/strain
Orthopedic assessment (Vizniak p204)

Milgrams test Instruct patient to lift heels 10 cm off table (patient is prone)
+ve = lumbar spine pathology ,intervertebral disc herniation, muscle
strain.
+ve inability to maintain position may indicate hip flexor & core
strength conditioning (lack of)

Sacral thrust Operator applies heel of hand on apex of sacrum and springs .
(Springing the Fingers palpate the SIJ , subjective test relying on patients sensation
sacrum) of pain .
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SIJ distraction Examinars hands bi-laterally over the patients ASIS apply force
laterally and downward.
+ve pain = anterior sacroiliac or pubic joint sprain, pelvic fracture
Spinal Manual (Vizniak p257)

SIJ compression Patient lying on side ,examiner places pressure on Ilium & applies
downward
+ve pain = sacroiliac sprain/strain, fracture, SIJ dysfunction
+ve Pain down = sacroiliac instability (also indicated if patient stands
feet wide apart)
Spinal Manual (Vizniak p257)

Thigh thrust Downward pressure on femur (knee flexed 90 degrees)

+ve SI pain =SIJ pathology
+ve Hip pain = hip pathology

Gaenslen Patient supine ,patients other leg over table ,knee flexed
+ve sacroiliac or anterior thigh pain = SIJ pathology (ligamentous
sprain/instability)
+ve elevation of extended hip = iliopsoas contracture
-ve No sacroiliac pain = possible lumbar or hip pain origin (if leg
hanging off table starts to straighten look for iliopsoas contracture)
Orthopedic assessment (Vizniak p229)

Nachlas test Femoral nerve /nachlas test

(prone knee examiner flexes patients knee and attempts to hold patient heel to
bending ipsilateral buttock.
+ve Local pain = SI/lumbar /knee ligament sprain, quad strain
+ve Unilateral radiating pain in anterior thigh = Femoral nerve
pathology or nerve root compression (L2-3)
Orthopedic assessment (Vizniak p208)

Ely’s test As above except the heel is approximating to the contralateral buttock
examiner then extends the Hip by elevating the knee
+ve pain with knee flexion =femoral nerve or root compression ,quad
contracture
+ve pain with hip extension = femeral nerve or root compression
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,iliopsoas muscle strain or inflammation

Orthopedic assessment (Vizniak p200)

Yeoman’s test Patient prone knee flexed 90 degrees , attempt to extend the hip .
+ve sacroiliac or anterior thigh pain = SIJ pathology (ligamentous
sprain,instability,arthritis)
+ve muscle tightness of the extended hip = iliopsoas or rectus femoris
contracture
Orthopedic assessment (Vizniak p237)

Lumbar Patient prone , gradual force down on SP’s , then brisk release .
springing test +ve if pain felt on release note the segment .

Stoop test Stoop test done to assess neurogenic intermittent claudication , to

determine a relationship exists among neurogenic symptoms, posture
and walking,

+ve is patient walke briskly for 1 min = pain will ensue in buttock and
lower limb within a distance of 50 mtrs.(to relive pain patient plexes
forward) (or sitting flexed foreard)
-ve if flexion does not relieve symptoms
(extension may be used to bring the symptoms back)

Hoover test Examiner (patient supine) places hands under both heels (calcaneus)
then patient is asked to leg one leg up, keeping the knees straight.
+ve if examiner should feel pressure under the other heel .(if not
patient not trying or malingering)
If lifted limb is weaker increased pressure will be felt under the other
heel

Trendelenberg’s Patient lifts one leg examiner observes hips level of patient.
test +ve pelvic lateral tilt = weak abductors (especially glut medius)
,neurological or muscle conditioning deficit .
+ve Pain in SIJ on support leg = SIJ pathology
Orthopedic assessment (Vizniak p232)

Patrick Fabere Figure 4 test

FABRE acronym for : Flexion, abduction, external rotation Extension
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test Patient placed in “figure 4 position”

+pain or inability to perform motion = Hip joint pathology ,severe
arthritis, spain/strain, fracture, tight hip adductors (low back pain may
indicate SIJ issue)
Orthopedic assessment (Vizniak p231)

Thomas test Patient supine flexes one knee to chest

+ve elevation of straight leg = hip contracture , tight iliopsoas or rectus
femoris
Orthopedic assessment (Vizniak p342)

Test for true leg Patient prone ,examiner then bends/extends patient legs at knee and
length compares leg height/length (referencing medial malleolus, or superior
portion of soles of shoes (shoe wear patterns can be extremely usefull
for diagnosis of gait pathology & prescription of corrective orthotics)

Ober’s test Parient side –lying with effected extremity up , examiner then
stabalises hip and adducts effected limb over table behind other leg.
+ve hip pain = hip joint pathology
+ve trochanteric pain = trochanteric bursitis
+ decreased ROM = ITB contracture
Orthopedic assessment (Vizniak p331)

Pelvic Rock test Patient supping place thumbs on iliac crests with thumbs and ASAI
and your palms in iliac tubercles .
THEN forcibly compress pelvis towards the midline of body
(detecting SIJ movement)

Homer pheasant Patient prone flex both knees and heels to buttocks .
test Aim is to decrease the size of IVF >
Rationale:
+ve if the pain is produced by the hyperextension of the spine =
unstable spinal segment and neurgenic claudication
Achilles reflex may be checked before and after test to determine any
change in nerve function (S1)

Schober test Patient standing mark at s2 + 10 com above S2

patient instructed to flex forward
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+ve less the 5 cm increase in length (measured with cloth tape) =

decreased lumbar spine ROM , ankylosing spondylitis
Orthopedic assessment (Vizniak p195)

Bicycle test of Patient seated on exercise bike pedal against resistance

Van Felderen *patient pedals leaning backward to emphasis lumbar lordosis IF
PAIN OCCURS in buttocks and posterior thigh –followed by tingling
First part is +ve.
then patient asked to lean forward and pegal if pain subsides then
second part of test is +ve
If patient sits upright –the pain returns .
The test is used to determine if the patient has neurogenic
claudication.
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The Gait Cycle Review

1. Describe the gait cycle.

Ans:
the gait cycle is normal walking movement there are two plases of the gait
cycle :
1)Stance phase(60%)
heel strike(27%) ,Mid stance (40%) ,Take off/Toe off (33%)
2)Swing phase (38-40%)
Intial swing,mid swing, terminal swing
Muscle manual (Vizniak p10)

2. The stance phase is 40% of the gait cycle and the swing phase is 60%. True
or false.
Ans:
False: other way around Stance 60% Swing 40%
3. What are the definitions of the following terms?
a. Stride Length
Ans: advancement of both feet (one step by each side of your body)
b. Step Length
Ans: advancement of a single foot (half a stride)
c. Step width
Ans: mediolateral space between two feet l
d. Foot angle
Ans: angle made by long axis of foot from heel to 2nd metatarsal
e. Cadence
Ans:steps per minute
4. When examining the motion in the sagittal plan, which joint undergoes the
most angular motion?
Ans: Ankle
5. Describe the typical gait for a post-stroke patient.
Ans: Hemiplegic, Cerebellar or Ataxic
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6. At what phase of the gait cycle do the quadriceps activate?

Ans: Midstance (stance phase)
7. At what phase of the gait cycle do the hamstring muscles activate?
Ans:Heel strike (stance phase)

8. List the 7 principles of gait assessment.

? not in lecture notes ?

https://images.app.goo.gl/UCHr6uh2gYVkH6HA6
Gait abnormality rating scale (link above)

9. List 2 causes for excessive inversion (supination)

Ans : compensated forefoot valgus deformity,pes carvus ,short limb,uncompensated lateral
rotation of tibia or femur
Table 14-7 Megee pg 869-70
Bergmann pg 368-9

10. List 3 causes for excessive eversion.(pronation)

Ans: compensated forefoot or rearfoot varus deformatity (bow legs) uncompensated forefoot
valgus (knock knees) pes planus(flat feet) ,decreased ankle dorsiflexion ,increased tibial
varum,long limb, uncompensated medial rotation of tibia or femur ,weak tibialis posterior
Table 14-7 Megee pg 869-70
Bergmann pg 368-9
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11. List 4 causes for limited knee flexion. (opposite of excessive knee flexion)
Ans: tight hamstrings/Gasto /
Table 14-7 Megee pg 869-70
Bergmann pg 368-9

12. List 2 causes for excessive hip flexion.

ANS: (Trendelenburg’s gait) = Glude medius weakness
Table 14-7 Megee pg 869-70
Bergmann pg 368-9

13. List 2 causes for contralateral pelvic drop

ANS: contralateral weak glute medius/minimus
Table 14-7 Megee pg 869-70
Bergmann pg 368-9

This would be a good time to reinforce with you the evaluation of the
peripheral nerves, too, which would involve the SMR and NTT (nerve
tension tests)
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Complete the following table:

Peripheral Nerve Motor Sensory Reflex

Spinal accessory Shoulder

elevation/scapular Nil Nil
adduction

Suprascapular Supraspinatus (C4,C5) Anterior & Bicep

and axillary nerve Infraspinatus (C5,C6) posterior
Axillary nerve Deltoid area
Deltoid (C5,C6)
Teres minor (C5 C6)
triceps Long head
(C5,C6)

Lateral pectoral Lateral and pectoral Nil Nil

nerve muscles

Musculocutaneous Biceps brachii Lateral Biceps C6

nerve Brachialis antebrachium
Coracobrachialis

Radial nerve Elbow/wrist thumb and Posterior Triceps C7

finger extension antebrachial

Median nerve Forearm 1/3 of the C6-T1

Flexors digitorum anterior palmer Triceps DTR
carpi radialis, digitorium surface of hand
profoundus and posterior of
Hand thum and first 2
abductors opponens, fingers
lumbricals posteriorly

Ulnar nerve Forarm Medial 1 ½ C7,C8

Flexor carpi ulnaris fingers Triceps C7
(C7,C8)
Flexor digitorum
profoundus (medial ½)