AHAD Module 11 MSK Upper Body Lower Body Systemic Cervical radiculopathy Scoliosis Shoulder pain: fractures, dislocations, acromioclavicular joint sprain/separation, shoulder strain, impingement, rotator cuff injury/dysfunction, adhesive capsulitis, bursitis, tendonitis Elbow pain: lateral/medial epicondylitis, nursemaid's elbow, bursitis, tendonitis Wrist and hand pain: carpal tunnel syndrome, ganglion cysts, scaphoid fracture, tendonitis Shin splints Ankle and foot: sprains/strains, fractures, plantar fasciitis Knee injury: strains/sprains, fracture, ligament injuries, meniscus injury, patellar subluxation /dislocation, chondromalacia patellae, bursitis, Patello-femoral syndrome Hip: bursitis Low back pain: acute and chronic lumbosacral strain, herniated disk, spondylolysis and spondylolisthesis, degenerative process, spinal stenosis Fibromyalgia Joint Pain associated with systemic process Rheumatoid arthritis Systemic lupus erythematosus Septic arthritis Gout Osteoarthritis Red Flags DDx Danger Urinary retention followed by insensible urinary overflow, loss of saddle/perineal sensation, decreased anal tone and reflex, unrecognized fecal incontinence, muscle testing in lower limbs showing bilateral weakness Cauda equina syndrome (emergency) Conus medullaris syndrome Herniated nucleus pulposus Spinal stenosis Guillain-Barre syndrome Vertebral fracture Permanent nerve damage, including urinary/faecal incontinence and paralysis Acute posterior knee pain with radiation and swelling into the calf DVT, ruptured Baker’s cyst Death if DVT Severe joint pain + fever Septic arthritis, osteomyelitis Diffuse sepsis Limb swelling with pain that is out of proportion with injury and increased pain with passive stretch Compartment syndrome Infection DVT Limb loss Special Test Manoeuvre Indication Shoulder Neer’s test Bring patients arm up in flexion and toward ear (Neer) Subacromial impingement Positive test → pain at extension near ear Empty can test Patient hold arm outstretched as if they’re pouring out a can, Apply downward resistance Supraspinatus tear Positive test → pain at tip of shoulder Apley scratch test Patient internally rotates shoulder (normally up to 120*), ask pt to touch tip of opposite scapula Rotator cuff tear Positive test → Limited ROM/pain Painful arc test Patient performs abduction: normal 180* Subacromial impingement syndrome /rotator cuff tendonitis Positive test → pain Apprehension test 1. In supine position, hold patient’s arm out to the side with elbow flexed, hold patient’s wrist with one hand and pull humerus forward anteriorly 2. Relocation test → apply opposite (posterior) pressure 3. Anterior release sign → remove posterior pressure Recurrent anterior subluxation / dislocation 1.Positive test: pain + apprehension 2. Patient will be relieved 3. Patient expresses pain + apprehension Cross-arm test (scarf test) Patient raises arm up and places hand above opposite shoulder Hold opposite shoulder while pushing against the raised elbow - raised arm slides over opposite shoulder AC joint compression Positive test → pain over AC joint Wrist/Hand Phalen’s test Maintain wrist flexion (pressed together) 60s Carpal tunnel Positive test → paraesthesia to fingers Tinel’s sign Percuss over bottom of palm Carpal tunnel Positive test → paresthesia to fingers ”snuff box” assessment Palpate Scaphoid fracture or carpal arthritis Positive test → tenderness Ankle Anterior drawer sign Push down on lower tibia with one hand while cupping heel in other hand and pulling up Lateral collateral ligaments Laxity indicates tear Talar tilt test Hold lower tibia with one hand and invert foot/ankle with other hand Anterior Talofibular ligament and the Calcaneofibular ligament Knee McMurray manoeuvre Meniscus Medial meniscus tear With knee maximally flexed, place hand over patella with fingers over medial joint line to feel for click/pop Externally rotate the lower leg with other hand Apply a varus force (pulling knee out, pushing lower leg inward) Then extend the knee, then flex the knee Lateral meniscus Lateral/Medial Meniscus tears Positive test → feeling pop/click, pain With knee maximally flexed, place hand over patella with fingers over medial joint line to feel for click/pop Internally rotate the lower leg with other hand Apply a valgus force (pushing knee in, pulling lower outward) Then extend the knee, then flex the knee Anterior/Posterior drawer test Ligament ACL PCL With knees flexed at 90* - first compare tibias, dropped/sagging tibia may indicate PCL tear Stabilize lower leg/ankle, and place fingers posteriorly below patella with thumbs on tibia and pull calf anteriorly, then push backwards posteriorly Anterior & Posterior Cruciate ligaments Positive tests: Anterior drawer laxity indicates ACL tear Posterior drawer laxity indicates PCL tear Lachman’s test Ligament ACL With leg supported at 20* - Hold leg above patella with one hand, hold leg below patella with other hand and pull tibia forward Positive test: Laxity indicates ACL tear Varus/valgus stress tests Ligaments MCL LCL Valgus Stress Test - medial collateral ligament Hold leg below patella and at ankle - push knee in (medially) and pull ankle out (laterally) Varus Stress Test - lateral collateral ligament In same position, pull knee out (laterally) and push ankle inwards (medially) Medial & Lateral collateral Ligaments Positive valgus test: Laxity + pain → MCL tear Positive varus test: Laxity + pain → LCL tear Patellar tap Place one above patella with pressure, tap patella down with other hand Effusion Bulge sign Sweep hand up the medial aspect of knee, pushing fluid laterally and superiorly Then immediately sweep hand down the lateral aspect of the knee, pushing fluid back Effusion Apprehension test?? Patellar movement push patella medially and laterally Patellar compression test apply pressure and push patella distally, ask pt to tighten quadriceps Positive movement test: Pain or apprehension while pushing laterally may indicate former dislocation Positive compression test: rough or painful movement, suggests OA or patella-femoral syndrome Hip Trendelenburg Test Patient stands on one leg for 30s Hip abductor Positive test → may indicate congenital hip dislocation, rheumatic arthritis, osteoarthritis Back Neurological (sensory/motor) components Red Flags → Urinary retention/incontinence, fecal incontinence, fever/chills/night sweats, history of CA (NIFTI) Power assessments (resistance), DTRs, sensory test, DRE Straight leg raise (Lasegue sign) Sciatica Straight leg raise - with patient supine Cup the back of the ankle with one hand and lift the leg Lasegue’s Sign Lower the leg, dorsiflex the foot Positive test → pain returns Sciatica - irritation of the root of the sciatic nerve Positive test → pain radiating down leg to foot Crossed straight leg test Sciatica Perform straight leg raise on asymptomatic leg Sciatica Positive test → pain radiating down symptomatic leg Patrick’s test/FABER/figure 4 test Iliac joint stress FABER = flexion, abduction, external rotation In supine position, patient crosses ankle over opposite knee Stabilize opposite hip and press down on crossed knee Positive test → pain in lower back/buttock Focused History O: Onset slow or sudden, duration, frequency P: Palliative factors, Provocative factors (pain with rest, activity, certain postures, time of day), Progression Q: Nerve pain: sharp, burning, follows distribution of nerve ● Bone pain: deep, localised ● Vascular pain: diffuse, aching, poorly localised, may be referred to other areas ● Muscle pain: dull and aching, poorly localised, may be referred to other areas R: Radiation or referred pain S: Severity 1-10 ● Symptoms associated - joint locking, instability, changes in colour of limb, pins and needles, clicking T: Treatments: meds, heat/cold application Social Hx: smoking, alcohol, drug use, occupation, marital status/social supports, screening for violence Functional Hx: walking perimeter, use of mobility aids, ability to perform stairs, hand dominance Inflammatory/Immunological Symptoms: pain, erythema, warmth, swelling, morning stiffness >30 min ● Improves with activity, responds to NSAIDs ● Important to differentiate from mechanical/degenerative manifestations Mechanical/Degenerative Symptoms: pain is worse at end of day, better with rest, worse with activity ● Ligament or meniscal symptoms: joint collapsing, clicking, locking, instability, gives out Neoplastic and Infectious Symptoms: constant pain, fever, chills, weight loss, anorexia, fatigue, weakness ● Hx prostate, thyroid, breast, lung or kidney CA Neurological Symptoms: paresthesia, tingling, bowel incontinence, urinary retention, headaches, weakness, clumsiness ● Differentiation from vascular - neurogenic has postural changes, standing cause symptoms, stair climbing up is easier, pulses normal Vascular Symptoms: exercise-induced pain - usually in calf but can be in buttock, hip, thigh, or foot that makes the patient stop exertion, pain disappears within ~ 10 min ● No pain at rest ● Differentiation from neurogenic claudication: vascular has no postural changes, standing stationary relieves symptoms, stair climbing down is easier, pulses abnormal, often have skin colour and hair changes on lower legs Focused Physical Examination Always examine the joint above and below the site of interest ● Lower extremity complaints: examine lower back and perform complete neuro exam of lower limbs ○ Have the patient walk, note antalgic gait (limp), examine alignment in standing and supine positions ● Upper extremity complaints: examine neck and perform neuro exam of upper limbs ○ Neur exam: test power, sensation Inspection: SEADS Swelling, Erythema, Atrophy of muscles, Deformity, Skin changes Palpation: skin, soft tissues, bones and joints, compare both sides ● Feel for warmth, effusion, tenderness, tremors, crepitus, and joint stability ● Note dryness or excessive moisture of skin and hair distribution/quality Range of Motion Active: performed by patient Passive: examiner moves the patient’s joints through a range of motion ● Detect limitation of movement (stiffness) or excessive range (hypermobility), any associated pain ● Hypermobility: result of ligament tears, collagen disorders, chronic pain, tendinitis, rheumatoid arthritis ● Stiff joints: result of muscle strains, pinched nerve syndromes, tendinitis, osteoarthritis Test reflexes End Feel Power Assessment (resistance) Upper Extremities SHOULDER Common conditions: fractures, dislocations, acromioclavicular joint sprain/separation, shoulder strain, impingement, rotator cuff injury/dysfunction, adhesive capsulitis, bursitis, tendonitis Adhesive capsulitis: global restriction in active and passive ROM, painful in early phase Subacromial bursitis: tenderness at anterior/inferior acromion, limited active ROM but full passive ROM, dull ache, worse on exertion better with rest Active ROM Abduction: normal 180* ● Look for painful arc → suggests subacromial impingement syndrome/rotator cuff tendonitis Adduction ● Drop arm test - arm suddenly drops to the side → indicates complete tear of the supraspinatus tendon While facing patient laterally Flexion: normal 180* Backward Extension: 60* With clients arms abducted at shoulder height and elbows flexed External rotation 90* Internal rotation 90* With clients arms at sides and elbows flexed External rotation 45-90* Internal rotation up to 120* ● Apley’s scratch test - ask pt to touch tip of opposite scapula While facing the patient’s back Observe abduction - Scapulothoracic Rhythm ● Reverse scapulothoracic rhythm → patients whole shoulder raises ○ Indicates adhesive capsulitis Passive ROM Holding patient’s elbow + shoulder → move patients arm through abduction, adduction, flexion, extension Holding patient’s elbow + wrist → move patients arm through external and internal rotation If active ROM is normal, may not need passive If active ROM is limited, perform passive ROM in affected planes Neuromuscular weakness → active ROM is limited, passive ROM should be normal Bony ligamentous or capsular problems → active + passive ROM limited Power Assessment Hold resistance against patient’s arms while performing Both arms at the same time → Abduction, adduction Flexion, extension, internal and external rotation Special Tests Tests for impingement ● Painful arc (done during active ROM) ● Neer’s test ○ Bring patients arm up in flexion and toward ear (Neer) ■ Positive test → pain at extension near ear ■ Subacromial impingement ● Hawkins Test ○ Patient’s arm flexed at shoulder level with elbow flexed ○ Hold forearm and internally rotate shoulder ■ Positive test → pain with internal rotation ■ Supraspinatus impingement ● Empty Can Test ○ Patient hold arm outstretched as if they’re pouring out a can ○ Apply downward resistance ■ Positive test → pain at tip of shoulder ■ Supraspinatus tear Test for torn or weak subscapularis ● Lift-Off test ○ Patient hold arm behind back with palm facing out ○ Apply resistance to hand ■ Positive test → patient unable to push against hand Test for Bicipital Tendonitis ● Roll fingers over anterior tendon just under acromion ● Yergason’s test ○ patient supinates arm against pronating resistance ■ Positive test → pain in bicep near tendon ● Speed’s test ○ Patient moves arm in flexion, apply resistance to elbow *both arms at the same time ■ Positive test → pain near biceps tendon Assessment for Acromioclavicular (AC) joint pathology ● Scarf Test (AC joint compression) ○ Patient raises arm up and places hand on opposite shoulder ○ Hold opposite shoulder while pushing against the raised elbow - raised arm slides over opposite shoulder ■ Positive test → pain over AC joint ● AC joint distraction test ○ Patient places arm behind them, pull their arm from above elbow away from joint ■ Positive test → pain over AC joint Stability testing ● Anterior/Posterior stability ○ Hold top of patient’s shoulder, try to move head of humerus backward and forward ● Inferior stability ○ Pull patient’s arm down ■ Instability → sulcus sign - humeral head slides inferiorly or a gap is produced between the head of the humerus and the acromion Test for recurrent anterior subluxation / dislocation ● Anterior apprehension test (3 steps) ○ In supine position, hold patient’s arm out to the side with elbow flexed, hold patient’s wrist with one hand and pull humerus forward anteriorly ■ Positive test: pain + apprehension ○ Relocation test → apply opposite (posterior) pressure ■ Patient will be relieved ○ Anterior release sign → remove posterior pressure ■ Patient expresses pain + apprehension ELBOW Common conditions Key symptoms Physical exam findings Lateral epicondylitis (tennis elbow) Pain and decreased strength with resistant gripping and with wrist supination and extension - usually occurs under chronic conditions Pain over lateral epicondyle Medial epicondylitis Resisted wrist flexion and pronation produces pain (turning a door knob, holding a glass) While palpating the medial epicondyle, patient’s forearm is supinated and the elbow and wrist are extended - pain over medial epicondyle is diagnostic Bursitis Aseptic: Gradual irritation, absence of redness, warmth or signs of infections Septic: Sudden onset pain, swelling, warmth, erythema over olecranon Pain is often exacerbated by pressure but chronic bursitis is often painless Usual cause is overuse Acute bursitis will produce pain with flexion of the joint, no pain on extension Tendonitis Repetitive trauma activities, pain with movement Nursemaid’s elbow Inspect Observe medial and lateral epicondyles & olecranon ● Loss or fullness of para-olecranon grooves → indicates joint effusion /synovitis ● Enlarged olecranon bursa → rheumatoid arthritis, gout ○ Hot + red → septic bursitis ● Check for rheumatoid nodules and psoriasis ● Check for flexion contractures & extension deformities Palpate Palpate from shoulder down to wrist feeling for warmth, deformities, tenderness ● Joint effusion - palpate para-olecranon grooves, particularly laterally ○ Hold olecranon process between thumb and forefinger while flexing/extending elbow Passive Active ROM Flexion 150* Extension 0* +/- 5* With arms tucked in at sides and elbows flexed, with thumbs up Pronation 75-90* palms down Supination 85-90* palms up Power Assessment Flexion, extension, pronation and supination with resistance Special tests Stability tests ● Medial collateral ligament ○ Hold elbow flexed at 20* and apply a valgus force (pushing inwards), then apply a varus force (outwards) ● Antero-posterior stability ○ Hold forearm and bicep, push and pull on humerus ■ If movement occurs → bony destruction Tests for epicondylitis ● Resisted wrist extension tests for Lateral epicondylitis (tennis elbow) ○ Elbow extended out in front of client with wrist extended & fingers flexed - apply resistance (try to push wrist down) ■ Positive test: pain at lateral epicondyle ○ Passive stretch of common extensors ■ Elbow extended out in front of client with wrist flexed - apply resistance ● Test for medial epicondylitis (golfer’s elbow) ○ Same position but with wrist flexed and fingers extended - try to pull fingers up, then extend wrist and apply resistance pushing patient’s hand back ■ Positive test: pain at medial epicondyle Test for Cubital Tunnel syndrome ● Tinel’s test ○ Tap the ulnar nerve between the olecranon process and medial epicondyle ■ Positive test: paresthesia/numbness/tingling ● Elbow flexion test ○ Patient maximally flexes elbow and extends wrist for 60s ■ Positive test: paresthesia/numbness/tingling HAND AND WRIST Common condition Key symptoms Carpal tunnel syndrome Exam findings Atrophy of thenar eminence Tinel’s test , Phalen’s test Ganglion cysts Dorsal (most common) or volar hand mass, may be painful with wrist motion. Majority are asymptomatic Palpable, firm, and regular mass Scaphoid fracture “Snuffbox” pain/tenderness, palpation of scaphoid tubercles for displacement Palpate the anatomic snuffbox by bringing the patient’s wrist into ulnar deviation and slight flexion Tendonitis - De Quervain tendinitis Difficulty moving the thumb and wrist with grasping or pinching movements Pain and swelling at the base of the thumb, hand or wrist Finkelstein test Inspect - SEADS Palpate General firm palpation of hand, ulnar head, wrist, snuffbox, metacarpals, thenar eminence Wrist effusion ● Slide thumb down middle of dorsal wrist to metacarpals and push down to produce effusion ● Ballottement: hold pressure with one thumb and push up and down with other thumb to displace fluid over the radiocarpal joint space MCP effusion ● Four finger technique - apply pressure with both thumbs distal to MCP joint ● Ballottement: hold pressure with one thumb and push up and down with other thumb to displace fluid ● Repeat to distal finger joints Flexor Tenosynovitis ● Palpate for tenderness, nodules, thickening along each flexor tendon in the palm of the hand ● Hold tendon with one hand and passively flex each finger Range of motion Make fist, then extend fingers, then flex (tuck) fingers in Thumb - with palm up, flex thumb across palm, then extend, adduct, abduct, circumduction Fingers - adduct, abduct Wrist - flexion, extension, radial deviation, ulnar deviation, pronation, supination, circumduction Special Tests Stability tests ● Wrist subluxation ○ Stabilise forearm with one hand, pull/push patient’s hand up and down with other hand ● Piano Key Sign ○ Press down on ulnar head with thumb ■ If very mobile, it will move up and down like a piano key - indicates disruption of the radioulnar ligament → rheumatoid arthritis ● MCP joints for dorsal/volar instability ○ Similar to a drawer test ● Collateral ligaments ○ Fingers extended - lateral movement ○ Fingers flexed - limited movement ■ Excessive movement indicates torn or lax collateral ligament Carpal Tunnel Syndrome ● Tinel’s test ○ Percuss over bottom of palm ■ Positive test: paresthesia to distal fingers ● Phalen’s test ○ Maintain wrist flexion (pressed together) ■ Positive test: paraesthesia to fingers De Quervain tendinitis ● Finkelstein test ○ Patient makes fist with thumb tucked in, passively put wrist into ulnar deviation ■ Positive test: pain at wrist near radius bone Functional Assessment ● Grip strength - patient squeezes hand ● Pincer grasp - patient picks up coin or holds sheet of paper or hold and turn a key ● Dexterity - do up a set of buttons or write a few words Neuro exam ● Grip strength ● Resistance against extended fingers, adducted fingers, abducted fingers ● thumb/finger opposition (tests median nerve) - with resistance ● Wrist flexion and extension with resistance (median nerve) ● Sensory: cotton test - patient indicates when they feel cotton KNEE Common Conditions: strains/sprains, fracture, ligament injuries, meniscus injury, patellar subluxation /dislocation, chondromalacia patellae, bursitis, Patello-femoral syndrome Inspect: gait → stance phase (heel - toe), note presence of antalgic gait While standing Observe for swelling, hyperextension, varus/valgus, swelling behind knee (Baker’s cyst) While supine Observe for skin changes, swelling, muscle atrophy, symmetry Palpate: Check for warmth, palpate border of patella, quadriceps tendon and muscle and patella ligament, and bony prominences Check popliteal pulse, palpate joint lines, medial and lateral collateral ligaments (with patients legs crossed), check for crepitus with passive motion, Assess for Knee Effusion ● Milking test/fluid wave/Bulge sign ○ Sweep hand up the medial aspect of knee, pushing fluid laterally and superiorly ○ Then immediately sweep hand down the lateral aspect of the knee, pushing fluid back ● Ballotment test ○ Hold patella between thumb and index finger, with other hand squeeze and press down on quadricep ○ Move hands up/down, back/forth to displace fluid ● Patellar tap ○ Place one above patella with pressure, tap patella down with other hand Range of motion While supine or sitting with feet hanging Flexion/extension, check for hyperextension by pulling ankle up & pushing down on femur (>10* is abnormal) Internal rotation → with knee flexed at 90*, pt points toe inward 30*, external rotation → point toe outward 20* ● Patellar movement ○ push patella medially and laterally ■ Pain or apprehension while pushing laterally may indicate former dislocation ● Patellar compression test ○ apply pressure and push patella distally, ask pt to tighten quadriceps ■ Positive test → rough or painful movement, suggests OA or patella-femoral syndrome Power Assessment While supine Flexion/extension with knee flexed at 90* Special Tests ● Anterior/Posterior Drawer tests ○ With knees flexed at 90* - first compare tibias, dropped/sagging tibia may indicate PCL tear ○ Stabilize lower leg/ankle, and place fingers posteriorly below patella with thumbs on tibia and pull calf anteriorly, then push backwards posteriorly ■ Anterior drawer laxity indicates ACL tear ■ Posterior drawer laxity indicates PCL tear ● Lachman Test - ACL tear ○ With leg supported at 20* - Hold leg above patella with one hand, hold leg below patella with other hand and pull tibia forward ■ Laxity indicates ACL tear Stability Tests of MCL and LCL ● Valgus Stress Test - medial collateral ligament ○ Hold leg below patella and at ankle - push knee in (medially) and pull ankle out (laterally) ■ Laxity + pain → MCL tear ● Varus Stress Test - lateral collateral ligament ○ In same position, pull knee out (laterally) and push ankle inwards (medially) ■ Laxity + pain → LCL tear Tests for meniscus tears ● McMurrary’s Test ● Medial meniscus tear ○ With knee maximally flexed, place hand over patella with fingers over medial joint line to feel for click/pop ○ Externally rotate the lower leg with other hand ○ Apply a varus force (pulling knee out, pushing lower leg inward) ○ Then extend the knee, then flex the knee ■ Positive test → feeling pop/click, pain ● Lateral meniscus ○ With knee maximally flexed, place hand over patella with fingers over medial joint line to feel for click/pop ○ Internally rotate the lower leg with other hand ○ Apply a valgus force (pushing knee in, pulling lower outward) ○ Then extend the knee, then flex the knee ■ Positive test → feeling pop/click, pain ● Apley’s compression test ○ Patient lays prone, knee flexed at 90*, apply downward pressure on the femur with one hand ○ Hold foot with other hand and externally & internally rotate the lower leg ○ Apply slight varus force to test medial meniscus ○ Apply slight valgus force to test lateral meniscus ■ Positive test → pain, popping/clicking BACK Common conditions: acute and chronic lumbosacral strain, herniated disk, spondylolysis and spondylolisthesis, degenerative process, spinal stenosis Inspect Gait, transition from sitting to standing, posture and alignment (from front, side and back), record height check for scoliosis Adam’s forward bend test → one scapula higher than the other Palpation While patient is sitting/laying prone Palpate spinal processes down to sacral spine, palpate muscles for bulk/atrophy/tenderness Range of motion Cervical Spine → flexion, extension, lateral flexion (ear to shoulder), rotation Thoracolumbar Flexion → bend forward (touch toes), rhythm of movement - lumbar lordosis shifts to lumbar kyphosis when bending forward *impaired with arthritis Thoracolumbar Extension → patient leans against a firm support and bends backwards Thoracolumbar Lateral Flexion → patient stands against a wall and bends sideways, sliding hand down leg Thoracolumbar Rotation → patients sits with crossed arms and turns to one side as much as possible, then other side Special tests Occiput-to-wall distance ● Patient stands against wall with head against wall (if possible) ○ Measure distance Chest Expansion ● Place hands around thoracic, patient takes deep breath in ○ Normal - movement of 4cm, <2cm = problem Test for sciatica - irritation of the root of the sciatic nerve ● Straight leg raise - with patient supine ○ Cup the back of the ankle with one hand and lift the leg ■ Positive test → pain radiating down leg to foot ● Lasegue’s Sign ○ Lower the leg, dorsilfex the foot ■ Positive test → pain returns ● Crossed Straight leg raise ○ Perform straight leg raise on asymptomatic leg ■ Positive test → pain radiating down symptomatic leg Tests to stress the iliac joints ● FABER / figure of four test ○ In supine position, patient crosses ankle over opposite knee ○ FABER = flexion, abduction, external rotation ○ Stabilize opposite hip and press down on crossed knee ■ Positive test → pain in lower back/buttock ● Gaenslen’s Test ○ Patient lays on edge of bed with one leg hanging to floor, patient brings other leg into chest ■ Positive test → pain in lower back/buttock ● Femoral Nerve Stretch ○ In prone position, patient flexes the knee ○ Place one hand on patient’s lower back, pull flexed leg up off the bed ■ Positive test → reproduction of anterior thigh pain Neuro Exam Tone assessment Power assessment → hip flexion/extension, knee flexion/extension, ankle dorsiflexion/plantar flexion, great toe dorsiflexion Deep Tendon Reflexes → patellar tendon, achilles tendon, plantar response Sensory Assessment → patient closes eyes, says “yes” when they feel touch
