Podcast
Questions and Answers
During the Vertebral Artery Test (VBI), the examiner passively moves the patient's neck into extension, side bending, and rotation. Which of the following is the MOST likely mechanism by which this test may provoke symptoms?
During the Vertebral Artery Test (VBI), the examiner passively moves the patient's neck into extension, side bending, and rotation. Which of the following is the MOST likely mechanism by which this test may provoke symptoms?
- The positioning compresses the ipsilateral vertebral artery, reducing blood flow and potentially inducing ischemia in the vertebrobasilar system.
- The positioning stretches the dura mater, increasing pressure on the spinal cord and eliciting neurological symptoms. (correct)
- The positioning irritates the facet joints, causing referred pain that mimics vertebrobasilar insufficiency.
- The positioning increases blood flow through the contralateral vertebral artery, exacerbating underlying vascular abnormalities.
A patient presents with suspected meningitis. During the physical examination, you perform Brudzinski's sign. Which response would be considered a positive test?
A patient presents with suspected meningitis. During the physical examination, you perform Brudzinski's sign. Which response would be considered a positive test?
- Increased pain in the hip and groin when the hip is flexed and internally rotated.
- Involuntary flexion of the hips and knees when the patient's neck is passively flexed. (correct)
- Sharp, shooting pain down the leg when the straight leg is raised.
- Severe pain in the lower back upon palpation of the lumbar spine.
Which of the following BEST describes the underlying mechanism of neurological symptom relief during the cervical Distraction Test?
Which of the following BEST describes the underlying mechanism of neurological symptom relief during the cervical Distraction Test?
- Increasing the space within the intervertebral foramen, decreasing pressure on nerve roots.
- Stretching the paravertebral muscles, decreasing muscle spasm. (correct)
- Reducing inflammation within the vertebral artery, improving blood flow to the brain stem.
- Stimulating the release of endorphins, reducing the perception of pain.
A clinician performs the Foraminal Compression (Spurling's) Test on a patient. The patient reports reproduction of pain and paresthesia in their right arm. Which of the following is the MOST likely anatomical structure being affected?
A clinician performs the Foraminal Compression (Spurling's) Test on a patient. The patient reports reproduction of pain and paresthesia in their right arm. Which of the following is the MOST likely anatomical structure being affected?
During a Straight Leg Raise (SLR) test, a patient reports pain radiating down their leg at 40 degrees of hip flexion. Which of the following is the MOST likely underlying cause of this pain?
During a Straight Leg Raise (SLR) test, a patient reports pain radiating down their leg at 40 degrees of hip flexion. Which of the following is the MOST likely underlying cause of this pain?
The Well Leg Raise (Crossed SLR) test is performed on a patient with suspected disc herniation. Which of the following findings would provide the STRONGEST evidence supporting the diagnosis of disc herniation?
The Well Leg Raise (Crossed SLR) test is performed on a patient with suspected disc herniation. Which of the following findings would provide the STRONGEST evidence supporting the diagnosis of disc herniation?
Braggard's Test is a variation of the Straight Leg Raise. After eliciting pain with SLR, the leg is lowered slightly and dorsiflexed. What is the rationale for adding dorsiflexion of the foot?
Braggard's Test is a variation of the Straight Leg Raise. After eliciting pain with SLR, the leg is lowered slightly and dorsiflexed. What is the rationale for adding dorsiflexion of the foot?
During the Slump Test, the clinician instructs the patient to perform a sequence of movements. What is the PRIMARY purpose of adding each component (thoracic/lumbar flexion, cervical flexion, knee extension, and ankle dorsiflexion) incrementally?
During the Slump Test, the clinician instructs the patient to perform a sequence of movements. What is the PRIMARY purpose of adding each component (thoracic/lumbar flexion, cervical flexion, knee extension, and ankle dorsiflexion) incrementally?
In the Prone Instability Test, what key finding differentiates a positive test from a negative test?
In the Prone Instability Test, what key finding differentiates a positive test from a negative test?
During performance of the Quadrant Test, the patient experiences a reproduction of pain. What is the MOST likely structure implicated in this presentation?
During performance of the Quadrant Test, the patient experiences a reproduction of pain. What is the MOST likely structure implicated in this presentation?
A patient performs the Trendelenburg Test, and the therapist observes that the pelvis on the non-stance leg side drops significantly. What does this indicate?
A patient performs the Trendelenburg Test, and the therapist observes that the pelvis on the non-stance leg side drops significantly. What does this indicate?
During Gaenslen's Test, a patient is positioned sidelying at the edge of the table, with one leg flexed at the hip and the other leg extended. What is the PRIMARY stress placed on the patient's body during this test?
During Gaenslen's Test, a patient is positioned sidelying at the edge of the table, with one leg flexed at the hip and the other leg extended. What is the PRIMARY stress placed on the patient's body during this test?
The Patrick (FABER) test is performed with the patient supine, and the test leg is placed in a position of flexion, abduction, and external rotation. What is the MOST likely source of pain if the patient reports discomfort during this test?
The Patrick (FABER) test is performed with the patient supine, and the test leg is placed in a position of flexion, abduction, and external rotation. What is the MOST likely source of pain if the patient reports discomfort during this test?
During a Scoliosis Assessment (Adam's Forward Bend Test), the examiner observes a rib hump on the patient's right side when the patient bends forward. What does this finding suggest?
During a Scoliosis Assessment (Adam's Forward Bend Test), the examiner observes a rib hump on the patient's right side when the patient bends forward. What does this finding suggest?
Which of the following instructions to a patient undergoing spinal examination is MOST appropriate to promote safety and accuracy during joint assessment?
Which of the following instructions to a patient undergoing spinal examination is MOST appropriate to promote safety and accuracy during joint assessment?
What is the PRIMARY reason for documenting the specific location, type, and intensity of pain reported by a patient during spinal special tests?
What is the PRIMARY reason for documenting the specific location, type, and intensity of pain reported by a patient during spinal special tests?
Which of the following findings would be considered a RED FLAG during a spinal examination, potentially warranting immediate referral?
Which of the following findings would be considered a RED FLAG during a spinal examination, potentially warranting immediate referral?
What is the MOST important reason to consistently obtain informed consent from a patient before performing any special test on the spine?
What is the MOST important reason to consistently obtain informed consent from a patient before performing any special test on the spine?
A physical therapist is treating two patients with similar symptoms of lower back pain. Both patients have positive findings on the Straight Leg Raise test, but one patient also presents with progressive lower extremity weakness. How should the therapist modify the treatment approach for the patient with weakness compared to the other?
A physical therapist is treating two patients with similar symptoms of lower back pain. Both patients have positive findings on the Straight Leg Raise test, but one patient also presents with progressive lower extremity weakness. How should the therapist modify the treatment approach for the patient with weakness compared to the other?
A clinician is concerned about over-relying on special tests when diagnosing a patient. What strategy would BEST mitigate this concern?
A clinician is concerned about over-relying on special tests when diagnosing a patient. What strategy would BEST mitigate this concern?
A patient reports constant, severe back pain that is unrelieved by rest or medication. How should a clinician respond to this information?
A patient reports constant, severe back pain that is unrelieved by rest or medication. How should a clinician respond to this information?
Which modification of the Straight Leg Raise (SLR) test is MOST appropriate to increase its specificity for diagnosing lumbar nerve root compression due to disc herniation?
Which modification of the Straight Leg Raise (SLR) test is MOST appropriate to increase its specificity for diagnosing lumbar nerve root compression due to disc herniation?
You are examining a patient with suspected spinal instability. Which of the following examination findings would give you the MOST confidence in your suspicion?
You are examining a patient with suspected spinal instability. Which of the following examination findings would give you the MOST confidence in your suspicion?
A patient undergoing the slump test reports an increase in leg pain with cervical flexion. What is the MOST likely explanation for this finding?
A patient undergoing the slump test reports an increase in leg pain with cervical flexion. What is the MOST likely explanation for this finding?
Imagine a patient presents with right-sided low back pain. You suspect facet joint involvement and perform the quadrant test. Which combination of movements during the quadrant test is MOST likely to provoke pain and indicate a positive test?
Imagine a patient presents with right-sided low back pain. You suspect facet joint involvement and perform the quadrant test. Which combination of movements during the quadrant test is MOST likely to provoke pain and indicate a positive test?
You are performing a spinal examination on a patient with suspected nerve root compression. Which combination of tests would provide the MOST comprehensive assessment of nerve root involvement?
You are performing a spinal examination on a patient with suspected nerve root compression. Which combination of tests would provide the MOST comprehensive assessment of nerve root involvement?
A clinician is evaluating a patient with suspected SI joint dysfunction. They perform Gaenslen's test and the Patrick (FABER) test, but both are negative. What does this mean?
A clinician is evaluating a patient with suspected SI joint dysfunction. They perform Gaenslen's test and the Patrick (FABER) test, but both are negative. What does this mean?
You are assessing a young athlete for scoliosis using the Adam's Forward Bend Test. While visualizing from the posterior, you detect a mild rib hump on the right side of the patient's thorax during forward flexion. All of the following statements are TRUE regarding this finding EXCEPT:
You are assessing a young athlete for scoliosis using the Adam's Forward Bend Test. While visualizing from the posterior, you detect a mild rib hump on the right side of the patient's thorax during forward flexion. All of the following statements are TRUE regarding this finding EXCEPT:
Upon observing a patient perform a single leg stance as part of the Trendelenburg test, you note that the pelvis on the non-stance leg side remains level, but the patient demonstrates significant trunk lurching towards the stance leg side to maintain balance. What is the MOST likely explanation for this observation?
Upon observing a patient perform a single leg stance as part of the Trendelenburg test, you note that the pelvis on the non-stance leg side remains level, but the patient demonstrates significant trunk lurching towards the stance leg side to maintain balance. What is the MOST likely explanation for this observation?
A patient complains of neck pain, headaches, and dizziness. You perform the Vertebral Artery Test (VBI). During the test, the patient reports dizziness and blurred vision. What IMMEDIATE action should the clinician take FIRST?
A patient complains of neck pain, headaches, and dizziness. You perform the Vertebral Artery Test (VBI). During the test, the patient reports dizziness and blurred vision. What IMMEDIATE action should the clinician take FIRST?
A clinician suspects meningitis in a patient presenting with severe headache and neck stiffness. After performing Kernig's test, the patient reports intense pain and exhibits significant resistance to knee extension. Which of the following is the MOST appropriate next step?
A clinician suspects meningitis in a patient presenting with severe headache and neck stiffness. After performing Kernig's test, the patient reports intense pain and exhibits significant resistance to knee extension. Which of the following is the MOST appropriate next step?
A patient reports pain with both cervical flexion AND extension. What is the MOST likely implication of this finding?
A patient reports pain with both cervical flexion AND extension. What is the MOST likely implication of this finding?
A therapist is treating a patient in an outpatient setting. The patient had cervical discectomy and fusion one week ago. Which special test would be CONTRAINDICATED?
A therapist is treating a patient in an outpatient setting. The patient had cervical discectomy and fusion one week ago. Which special test would be CONTRAINDICATED?
Following a motor vehicle accident, a patient reports low back pain that increases with prolonged sitting. Radiographs are negative for fracture and MRI is negative for disc herniation. Which special test would BEST help determine if the patient's pain stems from lumbar instability?
Following a motor vehicle accident, a patient reports low back pain that increases with prolonged sitting. Radiographs are negative for fracture and MRI is negative for disc herniation. Which special test would BEST help determine if the patient's pain stems from lumbar instability?
A patient with known lumbar spinal stenosis reports increased leg pain, numbness, and tingling with lumbar extension. Which of the following special tests would MOST likely reproduce the patient’s symptoms?
A patient with known lumbar spinal stenosis reports increased leg pain, numbness, and tingling with lumbar extension. Which of the following special tests would MOST likely reproduce the patient’s symptoms?
A patient is being tested for scoliosis with Adam's Forward Bend Test. Which finding MOST clearly indicates the need for referral for further medical evaluation?
A patient is being tested for scoliosis with Adam's Forward Bend Test. Which finding MOST clearly indicates the need for referral for further medical evaluation?
A patient is exhibiting weak hip abductors during the Trendelenburg test. All of the following exercises would be appropriate to address this weakness EXCEPT:
A patient is exhibiting weak hip abductors during the Trendelenburg test. All of the following exercises would be appropriate to address this weakness EXCEPT:
A patient performing the Patrick (FABER) test reports pain in the contralateral sacroiliac joint. What is the MOST likely explanation for this finding?
A patient performing the Patrick (FABER) test reports pain in the contralateral sacroiliac joint. What is the MOST likely explanation for this finding?
A patient undergoing the Slump Test reports increased pain and paresthesia in the right lower extremity during cervical flexion. After the cervical flexion is released, symptoms decrease. What is the MOST likely explanation for the change in symptoms?
A patient undergoing the Slump Test reports increased pain and paresthesia in the right lower extremity during cervical flexion. After the cervical flexion is released, symptoms decrease. What is the MOST likely explanation for the change in symptoms?
A patient exhibits a positive Trendelenburg sign on the left, but also demonstrates excessive trunk lean towards the left during single-leg stance. Assuming isolated muscle weakness, which of the following scenarios BEST explains these findings?
A patient exhibits a positive Trendelenburg sign on the left, but also demonstrates excessive trunk lean towards the left during single-leg stance. Assuming isolated muscle weakness, which of the following scenarios BEST explains these findings?
During the Vertebral Artery Test (VBI), the patient reports diplopia and dysarthria, followed by sudden onset of nausea. Given the symptomatology, what is the MOST likely vascular territory affected?
During the Vertebral Artery Test (VBI), the patient reports diplopia and dysarthria, followed by sudden onset of nausea. Given the symptomatology, what is the MOST likely vascular territory affected?
A patient presents with suspected meningitis but exhibits a negative Brudzinski's sign. However, during Kernig's test, the patient experiences severe pain and resistance to knee extension bilaterally. Which of the following BEST explains these findings?
A patient presents with suspected meningitis but exhibits a negative Brudzinski's sign. However, during Kernig's test, the patient experiences severe pain and resistance to knee extension bilaterally. Which of the following BEST explains these findings?
A clinician is performing the Prone Instability Test on a patient with chronic low back pain. During the initial PA pressure, the patient reports significant pain at L4-L5. When the test is repeated with the patient actively contracting their core muscles and lifting their legs slightly off the table, the pain remains unchanged. What is the MOST likely explanation for this finding?
A clinician is performing the Prone Instability Test on a patient with chronic low back pain. During the initial PA pressure, the patient reports significant pain at L4-L5. When the test is repeated with the patient actively contracting their core muscles and lifting their legs slightly off the table, the pain remains unchanged. What is the MOST likely explanation for this finding?
Flashcards
Vertebral Artery Test (VBI)
Vertebral Artery Test (VBI)
Assesses the patency of the vertebral artery by extending, side bending, and rotating the patient's neck, holding the position for 30 seconds on each side.
Brudzinski's Sign
Brudzinski's Sign
Patient supine. Passively flex the patient's neck towards their chest.
Kernig's Sign
Kernig's Sign
Patient supine. Flex the patient's hip and knee to 90 degrees. Then, attempt to straighten the knee.
Distraction Test (Cervical)
Distraction Test (Cervical)
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Foraminal Compression (Spurling's) Test
Foraminal Compression (Spurling's) Test
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Straight Leg Raise (SLR) Test
Straight Leg Raise (SLR) Test
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Braggard's Test
Braggard's Test
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Slump Test
Slump Test
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Prone Instability Test
Prone Instability Test
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Quadrant Test
Quadrant Test
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Trendelenburg Test
Trendelenburg Test
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Gaenslen's Test
Gaenslen's Test
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Patrick (FABER) Test
Patrick (FABER) Test
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Scoliosis Assessment (Adam's Forward Bend Test)
Scoliosis Assessment (Adam's Forward Bend Test)
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Study Notes
Head, Neck, Back & Spine Special Tests
Head and Neck
- Vertebral Artery Test (VBI)
- Assesses the patency of the vertebral artery.
- The patient is supine for the procedure.
- Passively extend, side bend, and rotate the patient's neck to one side, holding the position for 30 seconds, and repeat on the other side.
- Dizziness, visual disturbances, disorientation, or other neurological symptoms indicate possible vertebral artery compression or insufficiency.
- The test reduces blood flow in the contralateral vertebral artery.
- Positive signs indicate occlusion in the ipsilateral artery.
- Spinal Meningitis Test
- Detects irritation or inflammation of the meninges (membranes surrounding the brain and spinal cord).
- Brudzinski's Sign:
- The patient is supine.
- Passively flex the patient's neck towards their chest.
- Involuntary flexion of the hips and knees indicates meningeal irritation.
- Kernig's Sign:
- The patient is supine.
- Flex the patient's hip and knee to 90 degrees, then attempt to straighten the knee.
- Resistance to knee extension and/or pain in the neck or back indicates meningeal irritation.
- Distraction Test (Cervical)
- Relieves pressure on cervical nerve roots.
- Apply manual traction to the head in an upward direction.
- Decreased symptoms indicate that the foramina are narrowed and compressing neural structures.
- Foraminal Compression (Spurling's) Test
- Identifies cervical nerve root compression.
- Laterally flex cervical spine and apply axial compression.
- Reproduction of pain and/or paresthesia in dermatomal pattern is a positive test
Back and Spine
- Straight Leg Raise (SLR) Test
- Assesses lumbar nerve root irritation or compression, often due to disc herniation.
- The patient is supine.
- Passively raise the patient's leg, keeping the knee extended, until the patient reports pain or tightness, and note the angle at which pain occurs.
- Pain radiating down the leg (sciatica) between 30-70 degrees of hip flexion indicates possible disc herniation or nerve root impingement.
- Variations:
- Well Leg Raise (Crossed SLR): Raising the unaffected leg reproduces pain in the affected leg, more specific for disc herniation.
- Braggard's Test: After eliciting pain with SLR, lower the leg slightly and dorsiflex the foot; increased pain suggests nerve root involvement.
- Slump Test
- Assesses neural tension and identify compression of the spinal cord or nerve roots.
- Patient seated with knees flexed, then slump the thoracic and lumbar spine, flex the neck, extend one knee and dorsiflex the ankle.
- Add cervical flexion, knee extension and ankle dorsiflexion after each other respectively, to asses contribution to radicular pain
- Reproduction of pain and/or paresthesia in dermatomal pattern is a positive test.
- Prone Instability Test
- Assesses lumbar spine instability.
- The patient is prone with legs dangling off the table.
- Apply PA pressure to lumbar spine one vertebrae at a time, engage core / lift legs off the ground, and repeat pressure on the same vertebral levels.
- Pain decreases or disappears with muscle activation, possibly indicating spine instability.
- Quadrant Test
- Identifies facet joint pathology.
- The patient stands and the provider stabilizes the pelvis.
- The subject extends spine, SB and rotates to affected side.
- Reproduction of pain in lumbar spine is a positive test.
- Trendelenburg Test
- Assesses the strength of the hip abductor muscles, particularly the gluteus medius.
- The patient stands and balances on one leg, and observe the pelvis on the non-stance leg side.
- The pelvis on the non-stance leg side drops, indicating weakness of the hip abductor muscles on the stance leg side.
- SI Joint Tests
- Stresses the SI joint and reproduce pain.
- Gaenslen's Test:
- Patient sidelying at edge of table, with the top leg in hip flexion and the bottom leg in hip extension.
- Pain in SI joint is a positive test.
- Patrick (FABER) Test:
- Patient supine.
- The test leg is flexed, abducted, and externally rotated with the ankle resting on the opposite knee.
- The examiner stabilizes the opposite hip and applies overpressure to the test leg at the knee.
- Hip or Sacroiliac joint pain indicates a positive test.
- Scoliosis Assessment (Adam's Forward Bend Test)
- Screens for scoliosis (curvature of the spine).
- The patient stands with feet together and bends forward at the waist, allowing the arms to hang freely.
- Rib hump or asymmetry in the paraspinal muscles indicates a structural scoliosis.
Important Considerations
- Pay close attention to any neurological symptoms such as radiating pain, numbness, tingling, or weakness, as these can indicate nerve root compression or other neurological involvement.
- Document the specific location, type, and intensity of pain reported by the patient during testing to help differentiate between musculoskeletal and neurological sources of pain.
- Be aware of contraindications for specific tests, such as suspected fractures, dislocations, or unstable spinal conditions.
- Understand the sensitivity and specificity of each special test.
- A highly sensitive test will accurately identify individuals with the condition, while a highly specific test will accurately rule out individuals without the condition.
- Always interpret special test results in conjunction with a thorough patient history, physical examination findings, and other diagnostic tests.
- Explain the purpose and procedure of each test to the patient and obtain informed consent before proceeding.
- Use proper body mechanics and maintain a safe environment to prevent injury to both the patient and the clinician.
- Accurately document the procedures performed, findings, and the patient's response to each special test.
- Use a combination of special tests and other assessment tools to arrive at an accurate diagnosis, and do not rely on any single test in isolation.
- Be alert for red flags, such as bowel or bladder dysfunction, progressive neurological deficits, or severe pain that is unrelieved by rest or medication, as these findings may warrant further investigation or referral.
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Description
Tests to assess the head, neck, back, and spine. Includes Vertebral Artery Test (VBI) and Spinal Meningitis Test such as Brudzinski's and Kernig's signs. These tests help detect vertebral artery issues and meningeal irritation.
