Exam Maneuvers

Snellen

Indication: Visual acuity assessment

Technique:

• Position pt 20ft from chart

• Cover 1 eye and read smallest line of text visible (start at 20/40)

• Repeat w/ other eye

Notes: If wearing corrective lenses an example score would be “20/20 corrected”

Note number of errors w/ a minus 1 ex. 20/40 -2 (2 errors)

Peripheral vision by confrontation

Indication: Assessing visual fields (CN II) / peripheral vision assessment

Technique:

• Position self 1 arms length from patient

• Cover 1 of the patient’s eyes

• Either hold up a random number of fingers and ask to identify or wiggle fingers and ask to state when they see movement (do in all visual fields)

Notes: Need to keep looking straight ahead / at your nose

cover uncover

Indication: Strabismus (lazy eye), esotropia, exotropia

Technique:

• Have pt stare straight ahead at an object

• Cover 1 eye w/ opaque card/paddle

• Look at position of uncovered eye - note any deviation

• Uncover eye and look at position - note any deviation

• Repeat on other side

Notes: Uncovered: __tropia

Covered: __phoria

• Good eye covered, weak eye will move toward target

covered

Movement of the __ eye during the cover/uncover test is termed prefix-tropia

up

what direction does the uncovered eye move in hypertropia

down

what direction does the uncovered eye move in hypotropia

exotropia

Uncovered eye moves outward during cover/uncover test

esotropia

Uncovered eye moves inward during cover/uncover test

rosenbaum jaeger vision card

Indication: Near vision assessment

Technique:

• Position card 14 inches from pt

• Cover 1 eye and prompt to read smallest line possible

Notes: normal score = J1 (20/20) or J2 (20/25), if using corrective lenses, keep on

>2 errors on line → fail, move to bigger line

amsler grid

Indication: Testing central visual acuity

Technique:

• Hold grid 12-15 inches in front of patient

• Cover one eye and prompt to look at center black dot

• Ask them if the surrounding lines are straight and uniform

Notes: If wearing corrective lenses, keep them on for test

weber rinne

Indication: lateralization of hearing loss; differentiating conductive vs sensorineural hearing loss

Technique:

• Hit tuning fork on palm

• Place tuning fork on patient’s head (should hear equally in both sides)

• Hit tuning fork on palm again, then place on mastoid process

• Ask patient when they stop hearing it - note the duration

• Move tuning fork in front of their ear and ask them to say when they stop hearing it - note duration

Notes: Sound should be heard equally on both sides and the duration of hearing the sound should be equal

pneumatic otoscopy

Indication: Ear pain, suspicion for effusion of middle ear

Technique:

• Pull pinna up and back (adult), down and back (children) and place otoscope in ear canal

• Visualize TM and press gently on insufflator and watch for movement of TM

Notes: no movement → potential effusion

sinus tranillumination

Indication: Concern for sinus infection, severe facial pressure, congestion, HA

Technique:

• Place light source to maxillary (on cheek) and frontal (under brow) sinuses

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tactile fremitus

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whispered pectoriliquy

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egophony

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bronchophony

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diaphragmatic excursion

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murphys sign

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mcburneys point (rebound tenderness)

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rovsings sign

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psoas sign

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obturators sign

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shifting dullness

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fluid wave

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succesion splash

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cullens sign

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grey turners sign

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kehrs sign

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dances sign

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howship romberg sign

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blumbergs sign

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markles sign (heel jar)

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balance sign

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aaron sign

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modified allens test

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homans sign

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elevational pallor dependent rubor

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ABI (ankle brachial index)

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adson maneuver (provocation test)

Indication: assesses cervical spine

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straight leg raise (SLR)

Indication: lumbar spine

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cross leg test

Indication: lumbar spine

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sitting root test

Indication: lumber spine

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femoral stretch test

Indication: lumbar spine

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drop arm test

Indication: rotator cuff

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empty can test

Indication: rotator cuff

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neers sign

Indication: shoulder

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hawkins sign

Indication: shoulder

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Notes: confirms + Neer’s sign

tennis elbow (lateral epicondylitits)

Indication: elbow

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golfers elbow (medial epicondylitits)

Indication: elbow

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tinel test

Indication: carpal tunnel

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phalen test

Indication: carpal tunnel

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finklestein test

Indication: hand and wrist

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thomas test

Indication: hip

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trendelenberg test

Indication: hip, abductor weakness

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posterior pelvic pain provocation

Indication: pelvic girdle pain vs low back pain often in pregnant women

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gaenslens test

Indication: hip

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bulge sign

Indication: fluid in knee joint (small amount)

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Notes: patella will move if there is fluid

ballottment test

Indication: fluid in knee joint (a lot)

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Notes: patella will move if there is fluid

anterior posterior drawer test

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valgus varus stress maneuvers

Indication: knee, LCL and MCL stability

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apley compression maneuver

Indication: knee

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mcmurray maneuver

Indication: knee, meniscal tear

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ober test

Indication: knee, IT band tightness (inflammation)

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thompson simmonds test

Indication: achilles tendon rupture

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anterior drawer (ankle)

Indication: ankle, ligamentous injury (sprain)

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talar tilt test

Indication: ankle, ligamentous injury (sprain)

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