1
VERTEBRAL COLUMN
(NPLEX)
ROM:
Cervical
ThoracoLumbar
Flex
Extension
45
55
75-90
30
(L)(R) Rotation (L)(R)Lateral Flex
70
40-45
30
35
1) Kernig's Sign
Procedure: Patient is supine; the examiner passively flexes the thigh upon the pelvis to a right
angle, then an attempt is made to completely extend the leg.
Significance: If pain prevents complete extension = Meningeal irritation, radiculopathies.
2) Straight Leg Raise
Procedure: Patient is supine and examiner lifts patient's leg by supporting the heel of the foot,
knee should remain straight, (examiner places other hand on anterior aspect of the knee).
Normal leg should raise 80 without pain.
If there is pain, the examiner must DDX both the hamstring tightness and sciatica. There may be
pain in the opposite leg (positive cross leg straight leg raising test). At the point where the leg is
raised and the patient experiences pain, lower the leg slightly and dorsiflex the foot to stretch the
sciatic nerve. If pain is reproduced = sciatica, if not, most likely the cause is tight hamstrings. 3)
Hyperabduction Test/Wright's Test:
Procedure: Patient is seated with both arms hanging at sides. The examiner palpates the radial
pulse of one arm while it is abducted to 180 and the examiner watches for diminishing or loss of
pulse. Then the other arm is checked.
Significance: Neurovascular compression of the Axillary Artery = Hyperabduction Thoracic outlet
syndrome.
Note: Some patients have cessation of the pulse without having the syndrome. If the non-affected
side shows pulse dampening also, at the same degree of abduction as the affected side = the test
isn't positive.
4) Hoover Test
Procedure: This test is done in conjunction with straight leg raise. As the patient tries to raise his
leg, cup 1 hand under the heel of the opposite foot. If the patient is trying to raise his leg, he will
put pressure on the opposite leg to gain leverage.
Significance: Malingering if examiner doesn't feel pressure.
5) Milgram Test
Procedure: Patient is supine, does a straight leg raise (with both legs) and holds them 2" from the
table for as long as possible. The test is negative if the patient can hold this position for 30
seconds without pain.
Significance: Increased intrathecal pressure due to extrathecal or intrathecal pathology, or
pathological pressure on the theca itself - (the patient won't be able to hold the position, can't lift
the legs or experiences pain).
6) Nafziger Test
Procedure: Gently compress jugular veins for 10 seconds until the patient's face flushes and then
have patient cough.
Significance: If coughing causes pain = increased intrathecal pressure due to pathology.
7) Distraction Test - (cervical spine)
Ortho Test-spine
2
Procedure: Place open palm of 1 hand under the patient's chin and the other under his occiput
and lift the head, removing its weight from the neck.
Significance: Relief of pain may be due to narrowing of neural foramen, or spasm muscles.
Increased pain may be result of torn fibers in trauma.
8) Compression Test
Procedure: Press down on the top of the patient's head.
Significance: Positive test with increased pain may be due to narrowed neural foramen, pressure
on the facet joints, muscle spasm. It may reproduce referred pain so that the nerve and
dermatome can be traced.
9) Valsalva's Maneuver
Procedure: Patient holds breath and bears down as though trying to move bowels.
Significance: Test is positive if there is pain = increased intrathecal pressure. Note coughing,
sneezing, laughing, BM's all increase intrathecal pressure.
10) Adson Test
Procedure: Examiner takes radial pulse of patient and abducts, extends and externally rotates the
arm. The patient then takes a deep breath and turns his head to the arm being tested.
Significance: If there is a reduction of the radial pulse = compression of the subclavian artery due
to a cervical rib, tight scalenus anticus and scalenus medius muscles.
11) Malingering Test
A) Hoover's - See #4
B) Burns Bench Test/Kneeling Bench Test
Procedure: Patient kneels upright on padded bench or table about 18" high, kneels and leans as
far forward as possible. The examiner grasps the patient's ankles and asks the patient to bend
over and touch the floor with his finger tips.
Patients who should not perform the test: weakened patients, patients with diseased hips or
knees.
Patients who can perform the test include: sciatic neuralgia, congenital anomalies, arthritis,
compression fractures of the spine.
The test is positive when anyone other than those listed refuse to make an effort or performs part
of it and then rises to the perpendicular stating that they can't do it.
12) Lasaques Test
Procedure: Patient is supine and examiner raise's patient's leg.
Sciatic pain at 0-30 = Sacroilical lesion
Sciatic pain at 30-60 = Lumbosacral lesion
Sciatic pain at 60-90 = L1-L4 lesion
Lesions may include: subluxation, primary radiculitis, disc lesion.
Braggard's: If Lasaque test is positive lower the leg 5 and dorsiflex the foot. Test is positive if
pain is reproduced.
Significance: 1 radiculitis, possible Disc lesion.
Ortho Test-spine
3
13) Kemps Test
Procedure: Patient can be sitting or standing. The examiner stands behind the patient with 1
hand anchoring the pelvis and with the other hand the examiner grasps the opposite shoulder and
forces the patient obliquely backward, downward, and medialward.
Significance: The test is positive when pain into the lower extremity fits that of a pattern of
dermatogenous radiation, relative to the involved nerve root being compressed by discal
protrusion or prolapse.
Local pain in the low back does not constitute a positive test.
14) Wright's Test
Procedure: Patient is seated upright with both arms hanging at the sides. The examiner palpates
the radial pulse from behind the patient, and the arm is abducted 180 . The examiner feels for
diminished or disappearing pulses. Allen's test should be done before this test.
Significance: Neurovascular compression of the axillary artery as seen in the Hyperabduction
Thoracic Outlet Syndrome.
Note: Many patients have cessation of the radial pulse upon abduction in absence of the
Hyperabduction Syndrome, that is why it is compared to the other arm.
15) Doorbell Test
Procedure: The patient is standing with the examiner directly behind the patient. The examiner
then compresses the base of the neck bilaterally and watches for radicular pain into either arm.
Significance: Compression/impingement of the Brachial Plexus.
Ortho Test-spine