Please bare with me.
It take a quite some time to post post all of them. I'll do my best to post everything in shortest time possible.

Saturday, March 14, 2009

Neer Impingement Test

Position:
Seated

Performance:
Patient's arm is passively and forcibly fully elevated in the scapular plane, the arm is also medially rotated by the examiner.

Positive:
Pain indicated a positive result.
Positive test is indicative of an overuse injury to the supraspinatus and at times biceps tendon.

Note: Positive test with lateral rotation, examiner should check arcomioclavicular joint.

Inferior Shoulder Instability (Sulcus Sign) Test

Position:
Standing

Performance:
Patients arm is by the side and shoulder relaxed. Examiner grasps the patient's forearm below the elbow and pulles arm distally.

Positive:
Presence of Sulcus sign indicates inferior shoulder instability or glenohumeral laxity.

Sulcus Sign grading. (Measuring from inferior margin of the acromion to the humeral head)
+1 Sulcus implies a distance of less then 1 cm
+2 Sulcus implies a distance of 1-2 cm
+3 Sulcus implies a distance of more then 2 cm


Note: For best result test should be performed in the position in which sensation of instability was reported.

Posterior Drawer Test Shoulder

Position:
Supine

Performance:
Step 1
While standing at the patients shoulder level, examiner grasps patients proximal forearm with one hand, flexing elbow to 120 degrees, shoulder abduction to 80-120 degrees and forward flexion (shoulder) 20-30 degrees. With other hand examiner stabilizes patients scapula with index and middle fingers on the spine of the scapula and thumb on corocoid process.

Step 2
Examiner rotates the upper arm medially and forward flexes the shoulder to 60-80 degrees. At the same time places the thumb from corocoid process to head of the humerus and applies posterior pressure. Head of he humerus can be felt by the index and middle fingers.

Positive:
Significant posterior translation ( >50% humeral head diameter) indicates a positive test.
Note: Although test is usually pain free the signs of apprehension may be shown.

Posterior Apprehension or Stress Test

Position:
Supine or Sitting

Performance:
Examiner elevates patients shoulder to 90 degrees in the plane of the scapula. Then examiner applies posterior pressure on the patients elbow. While the pressure (axial load) is applied, examiner horizontally adducts and medially rotates patients arm.

Positive:
Test is considered positive if the sign of apprehension, alarm on the face, patient's resistance to further motion or reproduction of symptoms are noted.
Note: Presence of pain is more likely with a positive test.

Friday, March 13, 2009

Anterior Drawer Test Shoulder

Position:
Supine

Performance:
Examiner hold the patients arm of the affected shoulder in a manner that patient is relaxed. Shoulder in testing is abducted to 80-120 degrees, forward flex up to 20 degrees, and laterally rotated up to 30 degrees. With opposite hand examiner stabilizes patients scapula, pushing spine of the scapula forward with middle and index fingers while the thumb applies pressure to the coracoid process. With the hand that holds patients arm, examiner draws humerus forward.
Performed bilaterally.

Positive:
Depending on the amount anterior translation the test is considered positive.
Clicking sound may indicate slippage of the humeral head over glenoid rim or a labral tear.

Prone Anterior Instability Test

Position:
Prone

Performance:
Patients arm is abducted to 90 degrees and laterally rotated to 90 degrees. With one hand examiner hold patients arm in that position while the other hand pushes the humeral head forward.

Positive:
Test is positive if patients symptoms are reproduced.

Apprehension (Crank) Test

Primarily designed to test for traumatic instability problems causing gross or anatomical instability of the shoulder.

Position:
Supine

Performance:
Examiner abducts patients hand to 90 degrees and slowly laterally rotates the shoulder.
Note: By placing a hand under Glenohumeral joint to act as a fulcrum the test becomes the Fulcrums Test.

Positive:
The test in considered positive if signs of apprehension or alarm on the patients face and resistance to further motion is noted.

Scalene Cramp Test

Position:
Seated

Performance:
Patient rotates the head to affected side and pulls chin down into the hollow above the clavicle by flexing cervical spine.

Positive:
Pain is usually in the trigger points of the scalenes toward which the head is rotated.
Radicular pain may indicate a plexopathy or TOS (Thoracic Outlet Syndrome)

Jackson's Compresion Test

This test is a modification of Foraminal Compression (Spurling's) Test

Position:
Seated

Performance:
Patient rotates head to one side. Examiner then carefully presses down on the head.
Performed bilaterally.

Positive:
Pain radiating down the arm indicated nerve root compression.

Shoulder Depression Test

Used to evaluate brachial plexus for lesions, plexopathies and radiculopathies.

Position:
Seated

Performance:
Examiner side flexes the head to one side and applies a downward pressure on the opposite shoulder.
Performed bilaterally.

Positive:
Pain on the side of the compression indicates irritation or compression nerve root or foraminal irritation.
Pain on the side of the stretch indicates hypomobile joint capsule or a nerve sleeve irritation.

Thursday, March 12, 2009

Distraction Test

Used for complaint with reticular symptoms in the history and radicular signs during examination. It is used to alleviate symptoms.

Position:
Seated

Performance:
Examiner places one hand under the patients chin the other at the occiput, then slowly lifts the patients head, in effect, applying traction to cervical spine.

Positive:
If the pain is relieved or decreased when the head is lifted the test is considered positive, indicating pressure on the nerve roots that has been relieved.

Maximum Cervical Compression Test

Variation of Spurling's Test. With the second position (head side flexion, rotation and extension) tests for vertebral artery compression.

Position:
Seated

Performance:
Patient side flexes the head and then rotates it to the same side (look at shoulder).Examiner carefully presses down on the head. Performed bilaterally

For maximum compression the head can also be taken in extension (as well as side flexion and rotation) and compression is applied. This position may also compress vertebral artery. Compression should be held for 20-30 seconds.

Positive:
+ Pain on the concave side (side of flexion) indicates nerve root or facet joint pathology.
+ Pain on the convex side (side of extension) indicates muscle strain.
+ Vertebral artery compression indicated positive if symptoms like dizziness, nausea, feeling of fainting are elicit.

Foraminal Compression (Spurling’s) Test

Used if patient has history or complaints of nerve root symptoms, which at the time of examination are diminished or absent. Test provokes symptoms.

Position:
Seated

Performance:
Patient side flexes the head to the unaffected side first. Examiner carefully presses down on the head.
Performed bilaterally

Positive:
The test is positive if pain radiates into the arm towards which the side flexed during compression, indicates compression of the nerve root. The pain on the opposite side of the flex side during compression indicated muscle spasm in a condition such as Whiplash syndrome, also referred to as Reverse Spurling’s sign.