NMSK 3. Orthopedic Examination

What are the signs for a positive Spurling's Test (Foraminal Compression Test)?

Pain in the neck that RADIATES into arm/shoulder on side of rotation

What does a positive Spurling's Test (Foraminal Compression Test) indicate?

1. Cervical Radiculopathy

2. Nerve root compression

3. Space occupying lesion

What are the signs for a positive Spurling's Test?

Pain in the neck that radiates into the arm/shoulder on the side of rotation

What does a positive Spurling's Test indicate?

1. Cervical radiculopathy 2. Nerve root compression 3. Space-occupying lesion

What are the signs for a positive Jackson's Compression Test?

Radicular pain on side of lateral flexion OR local pain

What does a positive Jackson's Compression Test indicate?

1. Nerve root compression 2. Facet syndrome

What are the signs for a positive Maximum Cervical Foraminal Compression Test?

Radicular pain on side of testing OR localized pain

What does a positive Maximum Cervical Foraminal Compression Test indicate?

1. Nerve root compression 2. Facet syndrome

What are the signs for a positive Cervical Distraction Test?

Relief of pain OR increase in pain if unstable

What does a positive Cervical Distraction Test indicate?

1. Relief: Nerve root compression 2. Pain: Ligamentous or muscular strain

What are the signs for a positive Shoulder Depression Test?

Pain on the side being stretched (often radiating)

What does a positive Shoulder Depression Test indicate?

1. Brachial plexus stretch injury 2. Nerve root adhesion or compression

What are the signs for a positive Bakody's Sign (Shoulder Abduction Relief Test)?

Decrease in symptoms (especially radicular pain)

What does a positive Bakody's Sign indicate?

1. Cervical radiculopathy (especially C5-C6) 2. IVF encroachment

What are the signs for a positive Lhermitte's Sign?

Sharp, electric shock-like sensation down spine and limbs

What does a positive Lhermitte's Sign indicate?

1. Cervical myelopathy 2. Multiple sclerosis 3. Spinal cord irritation

What are the signs for a positive Soto-Hall Test?

Local or radicular pain

What does a positive Soto-Hall Test indicate?

1. Local anterior pain: Fracture 2. Local posterior pain: Sprain/strain 3. Radicular pain: Disc herniation or cord lesion

What are the signs for a positive O'Donoghue's Maneuver?

Pain during active and/or passive ROM

What does a positive O'Donoghue's Maneuver indicate?

1. Active pain: Muscle strain 2. Passive pain: Ligament sprain

What are the signs for a positive Valsalva's Maneuver?

Radiating pain or increased spinal pressure

What does a positive Valsalva's Maneuver indicate?

1. Space-occupying lesion (disc herniation, tumor)

What are the signs for a positive Dejerine's Triad?

Reproduction of radicular pain

What does a positive Dejerine's Triad indicate?

1. Increased intrathecal pressure 2. Disc herniation 3. Tumor

What are the signs for a positive Naffziger Test?

Reproduction of radicular pain or neurological symptoms

What does a positive Naffziger Test indicate?

1. Space-occupying lesion (disc, tumor) 2. Increased intracranial/intrathecal pressure

What are the signs for a positive Rust's Sign?

Patient supports head/neck with hands and reports instability or pain

What does a positive Rust's Sign indicate?

1. Cervical instability 2. Fracture 3. Severe sprain

What are the signs for a positive Lateral Flexion Alar Ligament Test?

Excessive motion or soft end feel

What does a positive Lateral Flexion Alar Ligament Test indicate?

1. Alar ligament instability

What are the signs for a positive Sharp-Purser Test?

Clunk, excessive motion, or symptom relief

What does a positive Sharp-Purser Test indicate?

1. Transverse ligament instability 2. Atlantoaxial instability

What are the signs for a positive Adam's Position Test?

Scoliosis remains in forward flexion

What does a positive Adam's Position Test indicate?

1. Structural scoliosis (functional if disappears)

What are the signs for a positive Schepelmann's Sign?

Pain on concave side OR convex side

What does a positive Schepelmann's Sign indicate?

1. Concave pain: Intercostal neuralgia 2. Convex pain: Pleurisy or intercostal strain

What are the signs for a positive Beevor's Sign?

Umbilicus moves abnormally

What does a positive Beevor's Sign indicate?

1. Thoracic spinal cord lesion (T7-T10) 2. Myopathy

What are the signs for a positive Chest Expansion Test?

Expansion

What does a positive Chest Expansion Test indicate?

1. Ankylosing spondylitis 2. Costovertebral restriction

What are the signs for a positive Rib Motion Test?

Asymmetry or decreased rib motion

What does a positive Rib Motion Test indicate?

1. Rib hypomobility or fixation

What are the signs for a positive Sternal Compression Test?

Localized or radiating chest pain

What does a positive Sternal Compression Test indicate?

1. Rib fracture 2. Costosternal inflammation

What are the signs for a positive Spinal Percussion Test?

Localized or radiating pain

What does a positive Spinal Percussion Test indicate?

1. Vertebral fracture 2. Disc lesion 3. Inflammation

What are the signs for a positive Amoss's Sign?

Thoracic stiffness/pain when rising

What does a positive Amoss's Sign indicate?

1. Ankylosing spondylitis 2. Severe sprain/strain 3. Discitis

What are the signs for a positive Thoracic Compression Test?

Local or radicular pain

What does a positive Thoracic Compression Test indicate?

1. Thoracic facet involvement 2. Disc involvement 3. Compression fracture

What are the signs for a positive Rib Compression Test?

Reproduction of pain

What does a positive Rib Compression Test indicate?

1. Rib fracture

What are the signs for a positive Adson's Test?

Diminished/absent radial pulse or symptom reproduction

What does a positive Adson's Test indicate?

1. TOS due to scalene compression 2. Cervical rib 3. Scalenus anticus syndrome

What are the signs for a positive Modified Adson's Test?

Diminished/absent pulse or symptoms

What does a positive Modified Adson's Test indicate?

1. TOS due to middle scalene compression 2. Scalenus medius syndrome

What are the signs for a positive Allen's Test?

Pulse becomes diminished or disappears

What does a positive Allen's Test indicate?

1. TOS due to pectoralis minor compression 2. Vascular compromise

What are the signs for a positive Costoclavicular Maneuver (Eden's Test)?

Decrease/loss of pulse or symptom reproduction

What does a positive Costoclavicular Maneuver indicate?

1. TOS due to compression between clavicle and first rib

What are the signs for a positive Wright's Test (Hyperabduction Maneuver)?

Diminished pulse (>10° difference) OR reproduction of symptoms

What does a positive Wright's Test indicate?

1. TOS from pectoralis minor compression 2. Axillary sheath compression

What are the signs for a positive Halstead's Maneuver (Reverse Adson's)?

Loss of pulse or paresthesia

What does a positive Halstead's Maneuver indicate?

1. TOS due to scalene compression 2. Cervical rib

What are the signs for a positive Reverse Bakody's Sign?

Increased pain or paresthesia

What does a positive Reverse Bakody's Sign indicate?

1. Brachial plexus traction 2. TOS 3. C8-T1 nerve root compression

What are the signs for a positive Bikele's Test?

Radicular pain or paresthesia in upper limb

What does a positive Bikele's Test indicate?

1. TOS 2. Brachial plexus tension 3. Meningitis (if bilateral)

What are the signs for a positive Roos Test?

Reproduction of symptoms or unusual discomfort

What does a positive Roos Test indicate?

1. TOS

What are the signs for a positive Straight Leg Raise (SLR)?

Radicular pain at 30-70° elevation down affected side

What does a positive Straight Leg Raise indicate?

1. Lumbar disc herniation 2. Sciatica 3. Nerve root irritation

What are the signs for a positive Bragard's Test?

Reproduction of radicular pain

What does a positive Bragard's Test indicate?

1. Sciatic nerve irritation (primary sciatica)

What are the signs for a positive Sicard's Sign?

Pain in affected leg

What does a positive Sicard's Sign indicate?

1. Primary sciatica

What are the signs for a positive Turyn's Sign?

Sciatic pain in affected leg/buttocks

What does a positive Turyn's Sign indicate?

1. Sciatic nerve irritation 2. Lumbar disc herniation

What are the signs for a positive Lindner's Sign (Brudzinski's)?

Lumbar pain radiating to sciatic nerve OR knee flexion/neck pain

What does a positive Lindner's Sign indicate?

1. Root sciatica 2. Meningitis

What are the signs for a positive Foresiter's Bowstring Sign?

Lumbar pain or radiculopathy

What does a positive Foresiter's Bowstring Sign indicate?

1. Sciatica

What are the signs for a positive Minor's Sign?

Patient supports body with uninvolved side when rising

What does a positive Minor's Sign indicate?

1. Sciatica

What are the signs for a positive Well Leg Raise (Crossed SLR)?

Pain radiates down symptomatic leg

What does a positive Well Leg Raise indicate?

1. Medial disc herniation 2. Large central disc lesion

What are the signs for a positive Kemp's Test?

Local pain OR radiating pain

What does a positive Kemp's Test indicate?

1. Local pain: Facet syndrome 2. Radiating pain: Radiculopathy

What are the signs for a positive Milgram's Test?

Recreation of pain

What does a positive Milgram's Test indicate?

1. Space-occupying lesion (disc)

What are the signs for a positive Lasegue's Test?

Pain in sciatic distribution

What does a positive Lasegue's Test indicate?

1. Sciatic nerve irritation

What are the signs for a positive Slump Test?

Reproduction of radicular symptoms

What does a positive Slump Test indicate?

1. Dural tension 2. Disc lesion 3. Sciatica

What are the signs for a positive Goldthwait's Test?

Pain before or after lumbar movement

What does a positive Goldthwait's Test indicate?

1. SI joint (early pain) 2. Lumbar origin (later pain)

What are the signs for a positive Nachlas Test?

Pain in low back or thigh

What does a positive Nachlas Test indicate?

1. Lumbosacral/SI lesion 2. Femoral nerve irritation 3. Tight quadriceps

What are the signs for a positive Yeoman's Test?

Pain in SI or anterior thigh

What does a positive Yeoman's Test indicate?

1. SI joint dysfunction 2. Hip flexor tightness