CHIR13008 Week 6 Synopsis – April 20 – April 24, 2020

Test INTERPRETATION/WHAT TISSUE STRUCTURE DOES THIS TEST

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Squat test This action will quickly test the ankles, knees and hips or any
pathological condition. If the patient can fully squat and bounce
without signs and symptoms, these joints are in all probability free of
pathology related to the complaint.

Lumbar Kemps The aim of this test is to decrease the IVF and impact the facets by
test creating extension and rotation in the lumbar spine. If this procedure
reproduces pain in the leg, neurogenic claudication is indicated. If the
pain is local, the facets may be responsible .

Djerine’s triad If low back and or leg and thigh pain increases on valsalva (e.g.
(Valsalva, cough, intervertebral disc herniation), the symptoms may be accentuated by
sneeze) having the patient first flex the hips to a position just short of causing
pain.

Flip or For the sign to be positive, both tests must cause pain in the sciatic
Bechterew’s test nerve distribution. If only one test is positive, the examiner should be
suspicious of problems in the lower lumbar spine.

Straight leg A unilateral straight leg raise is full at 70° where the nerve roots
raising test (SLR) (sciatic nerve) are completely stretched (primarily the L5,S1 and S2
nerve roots). Thus, pain after 70° is probably joint pain from the
lumbar area or sacro-iliac joints.

Well straight leg If the well leg is lifted and the patient complains of pain on the
raising test opposite side, it is an indication of a space-occupying lesion (eg
(WSLR) herniated disc). It is usually indicative of a rather large intervertebral
disc protrusion, usually medial to the root 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 Pain that increases with ankle dorsiflexion, indicates stretching of the
dura mater of the spinal cord.

Bowstring’s test Thumb or finger pressure is then applied to the popliteal area to re-
establish the painful radicular symptoms. The test is an indication for
tension or pressure on the sciatic nerve.

Bonnet’s test Internal rotation stretches the piriformis muscle. Leg pain may result
 from sciatic nerve irritation or compression from a contracted
piriformis muscle. Similarly, SLR with external rotation may be
performed. This may also affect the sciatic nerve via contraction of
the piriformis muscle.

Kernigs test The mechanics of the Kernig/Brudzinski test are similar to those of the
straight leg raising test except that the movements are done actively
by the patient. Pain is a positive sign, and may indicate the
meningeal irritation, nerve root involvement or dural irritation.

Sign of the If hip flexion does not increase when the knee is flexed, it is a positive
buttock sign of the buttock test, and indicates disease in the buttock, such as
bursitis, tumour or abscess. In these cases, the patient should also
exhibit a non-capsular pattern of the hip.

Slump test If the patient is unable to fully extend the knee because of pain, the
examiner releases the pressure on the cervical spine and the patient
actively extends the neck. If the knee extends further and the
symptoms decrease with neck extension, then the test is considered
positive for increased tension in the neuro-meningeal tract.

Milgrams test This test increases intrathecal pressure, and if pain is reproduced,
may indicate a space-occupying lesion (e.g. intervertebral disc). This
procedure should always be performed with caution because of the
high stress load placed on the lumbar spine.

Sacral thrust The patient lies prone on a flat table, so that the symphysis pubis is
(Springing the on an unyielding surface. The operator applies the heel of his hand to
sacrum) the apex of the sacrum and springs firmly over it. While springing, the
other fingers palpate over the SI joint. It is primarily a subjective test,
relying on the patient’s sensation of pain.

Gaenslen Place the patient in a supine position, with both their legs drawn onto
their chest. Shift the patient to the side of the couch, so that one
buttock extends over the edge of the table while the other remains on
it. Allow the unsupported leg to drop over the edge, while the
opposite leg remains flexed.

Nachlas test Shooting pain in the front of the thigh and leg may indicate an L2 or
(prone knee L3 nerve root lesion. Pain may also occur by stretching the anterior
bending thigh musculature. If the rectus femoris is tight, the examiner should
remember that taking the heel to the buttocks might cause anterior
torsion to the ilium, which could lead to sacroiliac or lumbar pain. This
 test also stretches the femoral nerve.

Ely’s test On flexion of the knee a positive test indicates femoral nerve tension
(L2-4). It also indicates tension in the rectus femoris.

Yeoman’s test The examiner stabilises the pelvis and extends the patients hips in
with the knees extended. The examiner then extends each of the
patient’s legs in turn with the knee flexed. In both cases the patient
remains passive. A positive test is indicated by pain in the lumbar
spine and/or sacroiliac joints during both parts of the test.

Lumbar The patient lies prone in a slightly extended position. A gradual

springing test downward force is applied with the heel of the hand to each lumbar
vertebra, one by one. Pain felt on the brisk release of the contact is
recorded according to the level.

Stoop test The stoop test is done to assess neurogenic intermittent claudication,
to determine whether a relationship exists among neurogenic
symptoms, posture and walking. When the patient with neurogenic
intermittent claudication walks briskly for 1 minute, pain will ensue in
the buttock and lower limb within a distance of 50 m. To relieve the
pain, the patient flexes forward. These symptoms may also be
relieved when the patient is sitting and forward flexing. If flexion does
not relieve the symptoms, the test is negative. Extension may also be
used to bring the symptoms back

Hoover test If the patient does not lift the leg, or the examiner does not feel
pressure under the opposite calcaneus, the patient is probably not
really trying, or may be malingering. However, if the lifted limb is
weaker, pressure under the normal heel will increase because of the
increased effort to lift the weak leg. The two sides are compared for
differences

Trendelenberg’s If the pelvis on the opposite side drops, a positive test is indicated.
test This test assesses the stability of the hip and the ability of the hip
abductors to stabilise the pelvis on the femur. The test should always
be performed on the normal side first, so that the patient understands
what to do. If the pelvis drops on the opposite side it indicates a weak
gluteus medius or an unstable hip joint on the affected side (for
example as a result of hip dislocation).

Patrick Fabere A negative test is indicated by the test leg falling to the table, or at
test least being parallel to the opposite straight leg. If positive, the test
indicates that either the hip joint may be affected, there may be
iliopsoas spasm, or there may be a lesion in the sacro-iliac joint.

Thomas test The Thomas test is used to assess a hip flexion contracture, the most
common contracture of the hip. If there is no flexion contracture, the
hip being tested (the straight leg) will remain on the examining table.
If a contracture is present, the patient’s straight leg will ride off the
table. The angle of the contracture can be measured. If the lower limb
is pushed down onto the table, the patient may exhibit an increase in
lordosis, again this result indicates a positive test.

Test for true leg The examiner uses a tape and measures the distance between the
length ASIS and the lateral malleolus or the ASIS and the umbilicus. If one
leg is shorter than the other, the examiner can determine if a true
short leg is present by measuring from the greater trochanter to the
lateral malleolus.

Ober’s test Ober’s test assesses the tensor fasciae latae (iliotibial band) for
contracture. If a contracture is present, the examiner stabilises the
pelvis at the same time to stop the pelvis from falling backward. Ober
originally described this test with the knee flexed. However, the
iliotibial band has a greater stretch placed on it when the knee is
extended.

Pelvic Rock test With the patient supine, place your hands on the iliac crests with the
thumbs on his ASIS’s and your palms on the iliac tubercles. Then,
forcibly compress the pelvis toward the midline of the body.

Homer pheasant The aim of this procedure is to decrease the size of the IVF. If the
test pain is produced in the leg by this hyperextension of the spine, the
test is considered positive and indicates an unstable spinal segment
and neurogenic claudication. The Achilles reflex may be checked
before and after the test to determine any change in nerve function.

Schober test With flexion, the difference between the two measurements is an
indication of the amount of flexion occurring in the lumbar spine. After
completing the flexion movement, the patient extends the spine, and
the distance between the marks is noted.

Also measure movement of the Sacro-iliac joints during forward

flexion. Separation of these contacts usually indicates movement
 occurring in the sacro-iliac joints during forward flexion.

Bicycle test of If pain in the buttock and posterior thigh occurs, followed by tingling in
Van Felderen the affected lower extremity, the first part of the test is positive. The
patient is then asked to lean forward while continuing to pedal. If the
pain subsides after a short period of time, the second part of the test
is positive. If the patient sits upright again, the pain returns. The test
is used to determine if the patient has neurogenic claudication.

The Gait Cycle Review

1. Describe the gait cycle.

The gait cycle is the time interval between the exact same repetitive events of
walking. The defined cycle can start at any moment, but it is generally begun when
one-foot contacts the ground

2. The stance phase is 40% of the gait cycle and the swing phase is 60%.
True or false.

False, the stance phase is 62% of the cycle, beginning with initial foot strike and
ending with toe-off. Stance phase is the part of the cycle when the foot is in contact
with the ground. Swing phase occurs when the foot is in the air and comprises 38%
of the cycle, beginning with toe-off and ending with second (ipsilateral) foot strike.

3. What are the definitions of the following terms?

a. Stride Length
The distance between successive ground contacts of the same foot

b. Step Length
The distance measured from the heel print of one foot to the heel print of the other
foot.

c. Step width
The distance between the centres of the feet during the double limb support portion
of the gait cycle when both feet are in contact with the ground.
 d. Foot angle
The angle made by the long axis of the foot from the heel to 2 nd metatarsal and the
line of progression of gait. 

e. Cadence
The rate at which a person walks, expressed in steps per minute

4. When examining the motion in the sagittal plan, which joint undergoes
the most angular motion?
The knee joints

5. Describe the typical gait for a post-stroke patient.

Bilateral lower extremity spasticity, adductor spasm, toe walker-shearing, waddling
gait. The gait is described as clumsy, staggering movements with a wide-based gait.

6. At what phase of the gait cycle do the quadriceps activate?

Mid-stance phase

7. At what phase of the gait cycle do the hamstring muscles activate?

Initial contact in stance phase

8. List 2 causes for excessive inversion (supination)

Upper motor neuron lesion (CVA, cerebral palsy), congenital structural deformity

9. List 3 causes for excessive eversion.

Upper motor neuron lesion, congenital structural deformity, acquired structural

deformity

10. List 4 causes for limited knee flexion.

Upper motor neuron lesion, immobilization (cast brace) or surgical fusion, femoral
nerve palsy, arthritis

11. List 2 causes for excessive hip flexion.

Hip osteoarthritis or arthritis

12. List 2 causes for contralateral pelvic drop

Guillain-Barre syndrome or poliomyelitis