HNBS Special Tests

Test for Expanding Intracranial Lesions

Neurological Control Test - UE

Neurological Control Test - LE

Positive Sign of Neurological Control Test - UE

Arm moves/drifts (outward and downward)

Positive Sign of Neurological Control Test - LE

Leg moves/drifts

Hold for Neurological Control Test - UE and LE

30 Seconds

Examinations for Ear

Rinnes and Weber Test

Location of tuning fork on Rinnes Test

Mastoid Process and 1 to 2 cm away from auditory canal

(+) Sensorineural Hearing Loss

Decrease Air Conduction and Bone Conduction

(+) Conductive Hearing Loss

Increase Bone Conduction than Air Conduction

Location of tuning fork in Weber’s Test

Vertex/Midline of Skull

(+) Louder on GOOD ear

Contralateral Sensorineural Deafness

(+) Louder on BAD ear

Ipsilateral Conductive Deafness

Indication for Brachial Plexus Compression Test

Mechanical Cervical Lesion

Procedure for Brachial Plexus Compression Test

Squeeze brachial Plexus

Positive sign of Brachial Plexus Compression Test

Pain RADIATES to the arm

Procedure for Foraminal Compression Test/ Spurling Test (3 Positions)

Neutral

Extended

Extension and Rotation (unaffected first)

In Foraminal Compression Test/ Spurling Test, if pain radiates to IPSILATERAL to side bending

Cervical Radiculopathy

In Foraminal Compression Test/ Spurling Test, if pain radiates to CONTRALATERAL to side bending

Muscle Spasm

Sign when pain radiates to CONTRALATERAL to side bending in Foraminal Compression Test/ Spurling Test

Reverse Spurling Sign

AKA as Modified Foraminal Compression Test

Jackson Compression Test

Procedure of Jackson Compression Test

ROTATE to one side then compress

Indication of Jackson Compression Test

Cervical Radiculopathy

Sign when there is RELIEF in Shoulder Abduction (Relief) Test

Bakody’s Sign

Indications of Shoulder Abduction (Relief) Test (HEN)

Herniated Disc

Epidural Vein Compression

Nerve Root Compression

Procedure for Valsalva Test

Take a deep breath, hold, try to bear down as if evacuating bowel

Indications of Valsalva Test (HOST)

Herniated Disc

Osteophyte

Stenosis

Tumor

Other names of ULNT/ULTT (Upper Limb Neurodynamic/Tension Test)

Brachial Plexus Tension Test / Elvey’s Test

Nerve tested in ULNT 1

Median Nerve / Anterior Interosseous Nerve

Nerve tested in ULNT 2

Median Nerve, Axillary Nerve, Musculocutaneous Nerve

Nerve tested in ULNT 3

Radial Nerve

Nerve tested in ULNT 4

Ulnar Nerve

Movement in ULNT 1

Shoulder - Depression & 110 Abduction

FA - Supinated

Wrist - Extended

Fingers - Extended

Elbow - Extended

Movement in ULNT 2

Shoulder - Depression & 10 Abduction

FA - Supinated

Wrist - Extended

Fingers - Extended

Elbow - Extended

Movement in ULNT 3

Shoulder - Depression & 110 Abduction

FA - Pronated

Wrist - Ulnar Deviated & Flexed

Fingers - Flexed

Elbow - Extended

Movement in ULNT 4

Shoulder - Depression & 10-90 Abduction

FA - Pronated/Supinated

Wrist - Radial Deviated & Extended

Fingers - Extended

Elbow - Flexed

Procedure of Lhermitte Sign

PASSIVE head and neck flexion & hip flexion with knee in extension

Positive sign of Lhermitte Sign

Sharp, electric shock-like pain

Indication of Lhermitte Sign

Meningeal Irritation, Myelopathy in Cervical Region

Indication of Romberg Test

Proprioceptive Problem

Spinal Cord Disease affecting Posterior Column

UMNL

Expanding Intracranial Lesion

Special test for Diminished blood flow to BRAINSTEM

Barre’s Test

Procedure for Barre’s Test

Active shoulder forward flexion to 90 degrees with FA in supination hold for 10 to 20 seconds

Positive sign for Barre’s Test

Arm slowly falls and pronates

Procedure for Naffziger Test

Compression of jugular vein for 20 to 30 seconds then ask the patient to ACTIVELY cough

Positive sign for Naffziger Test

Pain

Indication for Naffziger Test

Nerve Root Problem

Space-Occupying Lesion (Tumor)

Other name for Vertebral Artery Test

Cervical Quadrant Test

Procedure for Vertebral Artery Test

Supine. Passive head and neck SIDE FLEXION, EXTENSION, and ROTATION on SAME side then hold for 30 seconds

Positive Sign of Vertebral Artery Test

Nystagmus and Dizziness

Indication for Vertebral Artery Test

Compressed vertebral arteries

Other name for Slump Test

Sitting Dural Test

Procedure of Slump Test

Sitting. Assumes in slump position (Spine flexion and slouched shoulder) if no symptoms, progress to:

Head or neck flexion

Knee extension

Ankle/foot dorsiflexion

Indication for Slump Test

Spinal Cord Impingement

Procedure for Scapular Approximation Test

Prone, Approximate scapula by lifting shoulder BACK and UP

Indication of Scapular Approximation Test

T1 or T2 Impingement

Special Tests for Thoracic Outlet Syndrome

Roos Test

Halstead Maneuver

Addison Test

Wright Test

Allen Maneuver

Procedure for Roos Test

Standing. Shoulder abduction to 90 degrees, ER with elbow flexion to 90 degrees and ACTIVELY repeat close/open of both hands for 3 mins

Positive sign for Roos Test

Weakness, Heaviness, Tingling sensation, Ischemic pain, Numbness

Procedure for Addison Test

Locate radial pulse. Rotate head to SAME side, passively ER and Extend shoulder then ask the patient to take a deep breath and hold it.

Procedure for Halstead Maneuver

Locate radial pulse. Hyperextend neck and rotate AWAY from test site then apply downward traction on shoulder

Procedure to Wrigth Test

Sitting/supine. Hyperabduction and ER the shoulder and ask the patient to take a deep breath and hold it

Procedure to Allen Maneuver/ Modified Wrigth Test

Sitting. Shoulder horizontal extension and ER, elbow flexion, and head rotation AWAY from test site

Procedure of Babinski Test

Run pointed object along plantar aspect of foot

Positive Sign of Babinski Test

Big toe extension and abduction/fanning of lateral four toes

Indication of Babinski Test if tested (+) on UNILATERAL LE

Lower Motor Neuron Lesion

Indication of Babinski Test if tested (+) on BILATERAL LE

Upper Motor Neuron Lesion

Procedure for Oppenheim Test

Run fingernails along the tibial crest

Indication for Prone Knee Bending/ Nachlas Test

L2 L3 nerve root problem

Procedure for Prone Knee Bending

Passive knee flexion (heel to buttock)

Positive sign of Prone Knee Bending

Neurological pain on lumbar region, anterior & posterior thigh and buttock

Indication of Brudzinski-Kernig Test

Meningeal Irritation

Procedure for Brudzinski-Kernig Test

Supine. Head flexion, hip flexion with knee extension until (+) pain, then actively flex the knee on same leg

Positive sign of Brudzinski-Kernig Test

Diminished pain upon knee flexion

Brudzinski part of Brudzinski-Kernig Test

Head Flexion

Kernig part of Brudzinski-Kernig Test

Hip Flexion

Procedure of Straight Leg Raise/ Lasegue Test

Supine. Passive SLR until presence of pain

Indication of SLR if pain presents on back

Disc Herniation (Pressure over Anterior Theca of Spinal Cord)

Indication of SLR if pain presents on back

Disc Herniation (Lateral protrusion)

Nerve tested in SLR 1

Sciatic and Tibial Nerve

Positions in SLR 1

Hip Flexion and Adduction

Knee Extension

Ankle Dorsiflexion

Nerve tested in SLR 2

Tibial Nerve

Positions in SLR 2

Hip Flexion

Knee Extension

Ankle Dorsiflexion

Foot Eversion

Toe Extension

Nerve tested in SLR 3

Sural Nerve

Positions in SLR 3

Hip Flexion

Knee Extension

Ankle Dorsiflexion

Foot Inversion

Nerve tested in SLR 4

Common Peroneal Nerve

Positions in SLR 4

Hip Flexion and IR

Knee Extension

Ankle Plantarflexion

Foot Eversion

Nerve tested in SLR 5

Nerve root involvement (disc prolapse)

Positions in SLR 5

Hip Flexion

Knee Extension

Ankle Dorsiflexion

Sign for adding DORSIFLEXION

Braggard’s Sign

Signs for adding HEAD FLEXION

Brudzinski Sign

Hyndman’s Sign

Linder Sign

Soto Hall Sign

Sign for adding BIG TOE FLEXION

Sicard’s Sign

In SLR, degree with NO dural stretch

0-30 degrees

In SLR, Degree with tension to sciatic roots

30 degrees

In SLR, Degree with joint involvement

>70 degrees

Special test for malingering

Burn’s Test

Hoover’s Test

Procedure of Burns Test

Kneel on a chair with standard height and bend forward to touch the floor with fingers

Positive sign for Burn’s Test

Unable to perform or outbalance

Procedure for Hoovers Test

Supine. Hold (B) heel and ask the patient to ACTIVELY lift one leg

Positive Sign for Hoovers Test

NO pressure on opposite heel

Special Test for Muscle Dysfunction

Beevor’s Sign

Procedure of Beevor’s Sign

Supine. Sit upright or cough

Positive sign for Beevor’s Sign

Umbilicus does not remain in straight line (moves lateral or oblique)