NMS II - Practical I - Exam Process

Peripheral Vision/Confrontation

1. Patient focus on object far away with symptomatic eye closed.

2. Have pt say ‘now’ when they see the object  (S-50, M-60, I-70, L-90).

3. Repeat on other eye.

4. Any pain?

Pupillary Light Reflex

1. Dim the light.

2. Pt look at distant object and divide eyes with hand/notecard.

3. Shine light 2-4x in asymptomatic eye.

4. Repeat on symptomatic side.

5. Any pain?

Accommodation

1. Find distant object for pt to look at.

2. Have patient follow object with eyes only.

3. Instruct patient to look at distant object when you say ‘now’.

4. Any pain?

Corneal Light Reflex

1. Stand at patient’s midline.

2. Have patient look at your glabella.

3. Shine light at nasal bridge.

4. Examine reflection in both eyes - should be mirrored.

5. Any pain?

Cardinal Planes of Gaze

1. Have patient follow point of pen with their eyes only – not moving their head.

2. Perform H or star pattern.

3. Look for nystagmus/abnormal movement.

4. Perform on other side, ask if pain.

SCM & Trap Test

1. Test traps – have patient shrug/elevate their shoulders, then do the same against resistance.

2. Test SCM: if symptoms on R side, have patient turn head to R (test L SCM).

3. Repeat on other side.

4. Any pain?

Muscle Stretch Reflex - DTR

1. Patient seated with eyes closed.

2. Tap on muscle/tendon.

3. Grade reflex.

4. Test other side.

5. Any pain?

Adam’s Position

1. Pt standing, doctor behind.

2. Pt flexes forward to try and touch floor - bend at waist.

3. Any pain?

Beevor’s Sign

1. Pt supine

2. Pt does partial sit-up while dr looks at umbilicus.

3. Pt lifts legs off table, check umbilicus.

4. Any pain?

Chest Expansion

1. Pt seated.

2. Measure chest diameter and 4th ICS.

3. Pt fully exhale - measure.

4. Pt fully inhale - measure.

5. Any pain?

Rib Motion Test

1. Pt supine

2. Females - lift tissue UP

3. Dr place hands on lower rib cage.

4. Pt inhale, then exhale

5. Females - pull tissue DOWN

6. Dr place hands on upper ribcage.

7. Pt inhale then exhale.

8. Any pain?

Forestier’s Bowstring

1. Pt standing, doctor stands behind

2. Pt actively flexes to each side.

3. Dr observe for normal lateral flexion & contraction of paraspinals.

4. Any pain?

Schepelmann’s Sign

1. Pt seated or standing

2. Dr stand behind pt, observe pt’s back.

3. Pt active raise arms over head.

4. Pt laterally flex to each side.

5. Any pain?

Straight Leg Raiser

1. Pt lie supine.

2. Dr raise leg on side of pain until pain is produced/increased.

3. Note angle pain is produced.

4. Any other pain?

Well Leg Raiser

1. Pt lie supine.

2. Dr raise leg on OPPOSITE side of pain until pain is produced/increased.

3. Note angle pain is produced.

4. Any other pain?

Bragard’s Sign

1. Pt lie supine.

2. Dr raise leg on side of pain to point pain is produced, then slightly lower.

3. Pt tell dr when pain decreases.

4. Apply sharp dorsiflexion.

5. Any pain?

Fajersztajn’s Test

1. Pt lie supine.

2. Dr raise leg on OPPOSITE side of pain to point pain is produced, then slightly lower.

3. Pt tell dr when pain decreases.

4. Apply sharp dorsiflexion.

5. Any pain?

Slumps Test

1. Pt seated, shoes off.

2. Pt slumps forward with head and thorax.

3. Dr place slight pressure down on head.

4. Dr extend leg on side tested

5. Dr passively dorsiflexes foot.

6. Repeat on other side.

7. Any pain?

Bechterew’s Test

1. Pt seated with one knee extended.

2. Dr push down prox to knee while pt is extending leg at hip.

3. Repeat on other side.

4. Any pain?

Lindner’s Sign - Lhermitte’s

1. Pt supine.

2. Dr passively flex pt’s head to end range.

   1. Any pain?

Ely’s Sign

1. Pt lying prone.

2. Dr passively flexes affected side knee.

3. Dr approximate heel to opposite butt.

4. Repeat on other side.

5. Any pain?

Nachla’s Test

1. Pt lying prone.

2. Dr passively flexes affected side knee.

3. Dr approximate heel to ipsilateral butt.

4. Repeat on other side.

5. Any pain?

Femoral Nerve Traction Test

1. Pt lie on unaffected side with hip/knee flexed on unaffected side.

2. Dr hyperextend affected side hip.

3. Dr flex affected side knee.

4. Repeat on other side.

5. Any pain?

Milgram’s test

1. Pt supine, both legs straight.

2. Pt raise both legs 6” off table

3. Pt hold position for 5-10 seconds

   1. Any pain?

Bilateral Leg Lowering Test

1. Pt supine.

2. Dr passively raise legs to 90 degrees.

3. Pt actively lower legs to 45 and hold.

   1. Any pain?

Lasegue’s Test - Kernig’s

1. Pt supine

2. Dr place 1 hand on ankle and 1 on knee.

3. Dr passively flex hip to 90 and knee to 90.

4. Dr slowly extend pt’s knee to straight up.

5. Repeat on other side.

6. Any pain?

Kernig’s Test

1. Pt supine.

2. Dr flex asymptomatic hip/knee to 90.

3. Try to completely extend leg.

4. Any pain? Where?

Brudzinski Sign

1. Pt supine, knees straight.

1. Dr passively flex pt’s head.

2. Any pain? Where?

Heel-Toe Walk

1. Pt standing and barefoot.

2. Pt walk on toes

3. Pt walk on heels.

4. Any pain?

Kemp’s Test

1. Pt seated, dr supporting from behind.

2. Pt lean forward & to side opposite side being tested.

3. Dr circumducts pt’s trunk toward affected side.

4. Dr rotates, laterally flexes, & extends pt’s trunk to side being tested – stick stomach out.

5. Any pain?

Quick Test

1. Pt standing.

2. Pt squat and bounce twice.

3. Pt stand.

4. Have pt perform 5x.

5. Any pain?