NPLEX Ortho Tests with Indications (Dr. Rachel Klein)

1. Orthopedic tests: vertebral column

A. Adam’s sign. + when rib hump is noted indicating a structural scoliosis

B. Adson’s test. + when radial pulse is diminished indicating TOS

C. Braggard's test. + when leg pain is present indicating a nerve root lesion.

D. Bechterew’s test. + when leg pain is present indicating a nerve root lesion.

E. Burns’ bench test. + when there is an exaggerated pain response indicating malingering.

F. cervical spine compression test. + when there is arm pain indicating a nerve root lesion or

neck pain indicating a joint or ligamentous injury

G. cervical spine distraction test. + when arm pain is decreased indicating a nerve root

lesion or neck pain indicating ligamentous or joint injury.

H. East’s test (Roos’ test). + when patient cant maintain position due to increased

tingling/numbness of arms indicating TOS.

I. Hoover’s test. + when contraction is felt in “paralyzed” leg, indicating malingering.

J. Kemp’s test. + when there is back pain with leg pain indicating nerve root lesion or local

back pain indicating sprain/strain or facet issues.

K. Kernig's test. + when there leg indicating nerve root lesion or increased resistance due to

tight hamstring.

L. Lasegue’s test (straight-leg raise). + when there is leg pain indicating a nerve root lesion

or local back pain indicating si/lumbar sprain strain.

M. Lindner’s test. + when there is pain locally and radiates indicating nerve root lesion.

N. Milgram’s test. + when there is pain indicating a space occupying lesion usually a disc.

O. Minor’s sign. + when patient walks hands up in order to get up from a seated to standing

position indicating a lumbar/si pathology.

P. shoulder depression test. + when there is arm pain indicating radiculopathy, nerve root

lesion, or local neck pain indicating cervical sprain/strain.

Q. Soto Hall test. + when there is radiating pain indicating nerve root lesion or local neck

pain indicating cervical sprain/strain.

R. valsalva test. + when radicular pain is intensified indicating space occupying usually a

disc.

S. vertebral artery test. + when there is dizziness or nystagmus. Supposedly indiciates “impending VBA dissection” J

T. Wright's (hyperabduction) test. + when there is a reproduction of tingling, numbess, or

weakness indicating TOS.

2. Orthopedic tests: shoulder

A. Apley's scratch test. + when there is pain indicating shoulder pathology including ac joint

issues, rotator cuff issues etc. + when inability to perform maneuver indicating gh

contracture or rotator cuff m tightness.

B. drop-arm test (Codman’s). + when pain is noted due to rotator cuff injuries, + when

patient is unable to maintain abducted arm position against gravity most likely indicating

rotator cuff tear.

C. glenohumeral apprehension test. + when maneuver is performed and patient makes a

funny face indicating prior glenohumeral dislocation.

D. impingement test (Hawkins-Kennedy,

Neer’s ). + for pain indicating supraspinatus strain. Neers + pain when hand is supinated

indicates biceps tendintis, hand pronated indicates supraspinatus.

E. Lippman’s test. + for pain indicates bicipital tendinitis or + apprehension indicates prior

subluxating bicipital tendon.

F. Speed’s test. + pain indicates bicipital strain or possible SLAP lesion.

G. Yergason’s test. + pain indicates bicipital tendinitis, + when there is a pop indicating

subluxating long head of biceps.

3. Orthopedic tests: wrist, hand, and elbow

A. Cozen’s test. + pain indicates tennis elbow or lateral epicondylitis.

B. Finkelstein’s test . + pain indicates deQuervain's synovitis.

C. Mill’s test. + pain indicates tennis elbow or lateral epicondylitis.

D. Phalen's test. + pain of anterior wrist and increasing numbness over median nerve

distribution, carpal tunnel.

E. retinacular test + when patient cannot actively flex digits, but they can be passively flexed. Indicates tightened retinaculum.

F. Tinel's sign. + when tapping at the cubital fossa of the elbow causes tingling, numbness of

medial portion of arm and hand indicating ulnar neuropathy. (Tinel’s indicates nerve irritation and can be done over any nerve in question, classically the ulnar n.)

G. valgus/varus stress test. Valgus + when there is pain or laxity of ulnar collateral ligament

indicating ulnar collateral ligament sprain. Varus + when there is pain or laxity of radial

collateral ligament indicating radial collateral ligament sprain.

4. Orthopedic tests: hip and pelvis

A. Ely’s test. + for pain in SI joint dysfunction or when ROM is limited due to rectus femoris

tightness or hip pathology.

B. Gaenslen’s test. + for pain when there is a SI sprain/dysfunction.

C. Hibb's test. + for pain for SI Joint, hip, or pain down the leg indicating piriformis

entrapment of sciatic n.

D. Nachlas test. + pain indicating SI joint issue or pain in the anterior thigh indicating femoral

nerve entrapment.

E. Ober’s test. + pain for hip or greater trochanter indicating trochanteric bursitis.

F. Ortolani click. + when there is an audible click indicating femoral head dislocation seen in

congenital dislocations of hip in infants.

G. Patrick’s test (Patrick-Fabere). + for pain in hip or SI indicates dysfunction where pn is felt. Classically hip problem.

H. pelvic rock test. + when there is pain indicating SI lesion.

I. telescoping test. + when there is excess movement of hip indicating dislocation of the hip.

J. Thomas’ test. + when straight leg is elevated indicating a tight ilipsoas.

K. Trendelenburg test. + when there is a lateral pelvic shift to the side opposite of the weak

gluteus medius.

L. Yeoman’s test. + when there is pain in the sacroiliac region  indicating SI jt problem or pain in the anterior thigh indicating a femoral nerve tension.

5. Orthopedic tests: knee

A. anterior/posterior drawer sign. Anterior drawer sign is + when there is pain indicating an

ACL sprain. Posterior drawer sign is + when there is pain indicating a PCL sprain. Greater

than a 6 mm movement during joint play indicates tear of ligament.

B. Apley's compression test. + when compression causes pain and is alleviated by

distraction indicating a mensical lesion.

C. Apley's distraction test. + when distraction alleviates the pain following compression

indicating a meniscal lesion. Also + when there is pain indicating joint or ligamentous lesion.

D. apprehension test (for patellar dislocation). + when patient is apprehensive upon doc

moving patella indicating patellar instability. Usually dislocates laterally.

E. bounce home test. + when there is pain in the joint line indicating meniscal lesion.

F. Lachman’s test. Gold standard of ACL lesion. + when pain is noted indicating ACL

sprain. Pain with increased anterior translation indicates ACL tear.

G. McMurray’s test. When toes are pointed laterally, pain or clicking indicates lateral

meniscus while toes pointed medially indicates medial meniscus. (Medial meniscus classic use of test.)

H. patella femoral grinding test (including Clark’s test). + when there is pain behind the

patella indicating chondromalacia patella.

I. reduction click. An extension of McMurray's Test performed at 100 deg to full extension of

the knee. + findings similar to those found in McMurrays. Meniscus injury

J. valgus and varus stress test. valgus test is + when there is pain or laxity indicating MCL

lesion. Varus test is + when there is pain or laxity indicating LCL lesion.

K. knee joint effusion tests (ballotable patella test [major effusion]; bulge test [minor effusion] + when patella “floats” back to place after compression, indicating swelling posterior to the patella

6. Orthopedic tests: ankle and foot

A. anterior/posterior drawer test. + when there is increased motion of the ankle indicating

damage to the ligaments of the ankle specifically the anterior and posterior talofibular

ligament.

B. dorsiflexion test. + when there is pain indicating nerve irritation in the tarsal tunnel/tarsal tunnel syndrome.

C. forefoot adduction test. Testing for the integrity of the talofibular ligaments.

D. forefoot squeeze test (Morton’s test). + when there is pain indicating Morton's Neuroma or

fracture of metatarsal head.

E. Homan's sign. + pain in the calf indicating thrombophlebitis/DVT.

F. talor tilt test. Eversion tests the integrity of the deltoid ligaments while inversion tests the

integrity talofibular ligaments.

G. test for rigid or supple flat feet. – I have no idea what this means. Uuuhhh. Palpation?

H. Thompson's (squeeze) test. + When there is no visible plantar flexion indicating Achilles

tendon tear.

I. tibial torsion test. + when there is pain in the knee indicating a meniscal lesion. OR + when an angle is noted, indicating tibial torsion.