1. Straight-Leg-Raising Test (SLR) A. 0-35 degrees: extradural involvement (spastic piriformis S! "oint lesion) B.

35-#0 degrees: tension is applied to sciatic nerve roots (!$% pat&olog') C. ( #0 degrees: lum)osacral involvement (lum)ar "oint pain) *. Braggards Sign (SLR + %orsiflex foot) A. ,erformed -&en SLR is positive B. Leg is lo-ered )elo- t&e point of discomfort foot is dorsiflexed C. Sign is present if pain is increased D. ,ositive associated -it&: sciatic neuritis spinal cord tumors !$% lesions and spinal nerve irritation 3. Siccards Sign (SLR + %orsiflex .ig /oe) A. Leg is lo-ered )elo- t&e point of discomfort .ig /oe is dorsiflexed B. Sign is present if sciatic pain is produced C. ,ositive associated -it&: sciatic radiculopat&' 0. Turyns Sign (12 SLR %orsiflex .ig /oe) A. ,atient is supine legs extended dorsiflex )ig toe B. ,ositive is pain in t&e gluteal region C. ,ositive associated -it&: sciatic radiculopat&' 5. Coxs Sign (SLR + ,elvis Raises) A. Same test as SLR -it& t&e addition of &and placement over t&e 3nee of t&e raised leg B. ,ositive is -&en t&e patient lifts t&e pelvis of t&e raised leg off of t&e ta)le instead of t&e &ip flexing 4 pain C. ,ositive associated -it&: ,rolapse of t&e nucleus into t&e interverte)ral foramen 5. Demianoffs Sign (SLR 615 deg. !liocostalis lum)orum muscle) A. Same test as SLR B. ,ositive is -&en: 1. ,ain in lum)ar region *. ,ain prevents examiner from lifting t&e leg to 15 degrees C. ,ositive associated -it&: Strain of t&e !liocostalis lum)orum musculature

#. Buckling Sign (SLR + 7nee 8lexion) A. Same test as SLR B. ,ositive is -&en t&e patient flexes t&e leg at t&e 3nee to reduce t&e traction on t&e sciatic nerve C. ,ositive associated -it&: sciatic radiculopat&' 9. Lasegue Differential Sign (7nee 8lexion pain relieved) A. ,erform a SLR and note angle at which pain is produced B. :xaminer t&en flexes t&e t&ig& at t&e 3nee -&ic& relieves t&e stretc& on t&e sciatic nerve C. ,ositive is -&en t&e pain is relieved D. ,ositive -ould indicate a radiculopat&' versus &ip articular pain (differential) ;. Lasegue Test (7nee extension increases pain) A. Supine legs extended &ip and 3nee of one leg flexed to ;0 degrees B. 7nee is t&en extended C. ,ositive is -&en pain is elicited -&en t&e 3nee goes into extension D. ,ositive associated -it&: sciatica -it& nerve root inflammation or compression 10. Homans Sign (%$/ dorsiflex foot and s<uee=e calf) A. Supine legs extended elevate leg 05 degrees s<uee=e calf firml' B. >&ile calf pressure maintained dorsiflex foot C. ,ositive is -&en pain is produced upon dorsiflexion of foot D. ,ositive is associated -it&: t&rom)op&le)itis Clinical Pearl: Patient will complain of pain that occurs in one or both legs and in the calf muscles and comes on after walking a certain distance. The pain will disappear with rest. At time goes on the distance that the patient can walk without pain will continue to diminish. Intermittent claudication is a condition that denotes an insufficient blood supply to the muscles of the lower extremities when they are called into activity during locomotion. .oard <uestion A. B. C. D. !ernigs Sign ,atient is supine legs extended (li3e lasegue?s) :xaminers flexes t&e &ip and 3nee of eit&er leg to ;0 degrees :xaminer t&en attempts to completel' extend t&e leg ,ositive is -&en pain is present and prevents t&e extension of t&e leg

11

E. ,ositive is often accompanied )' involuntar' flexion of t&e opposite 3nee and &ip F. ,ositive is associated -it&: meningeal irritation or inflammation

1*.

Brud"inskis Sign (supine flex &ead) A. ,atient is supine examiner passivel' flexes t&e patient?s &ead B. ,ositive: flexion of )ot& 3nees occurs C. /&e sign is often accompanied )' flexion of )ot& &ips D. ,ositive is associated -it&: meningeal irritation or inflammation

13. Bo#string Sign (,ressure to &amstring and popliteal fossa) A. Supine examiner moves t&e patient?s leg until it is a)ove t&e examiner?s s&oulder (,artner assisted &amstring stretc&) B. :xaminer applies firm pressure near t&e insertion of t&e &amstring muscles C. !f no pain t&en t&e examiner -ill appl' pressure to t&e popliteal fossa ()e&ind t&e 3nee) D. ,ositive is -&en pain is elicited at eit&er location E. ,ositive is associated -it&: lum)osacral nerve root compression 10. Sign of the Buttocks (@ip pat& vs. sciatic tension flx t&ig&+3nee continue) A. ,erform a SLR test on t&e affected leg B. >it& restriction of leg movement (pain or m'ospasm) t&e :xaminer -ill passivel' flex t&e 3nee C. If hip flexion increases with knee flexion: lum)ar spine disorder D. If hip flexion does not increase with knee flexion: $ositi%e sign of the &uttock E. ,ositive sign of t&e )uttoc3 indicates &ip or )uttoc3 )ursitis tumor or a)scess 15. 'a(ers"ta(ns Test (>ell leg dorsiflex foot) A. SLR + dorsiflexion of foot performed on -ell leg (.raggard?s on good leg)

B. A positive is -&en pain is produced on t&e affected ()ad) leg indicating t&is sign is present C. ,ositive is associated -it&: sciatic nerve root involvement (disc s'ndrome or dural root sleeve ad&esions) D. /&is test causes stretc&ing of t&e ipsilateral and contralateral nerve root -&ic& in turns pulls laterall' on t&e dural sac.

15. A. B. C. D.

Lindners Sign (8lx cerv LS nerve root) Ban )e performed seated or supine :xaminer passivel' flexes t&e patient?s &ead onto t&e c&est A positive is pain in t&e lum)ar spine and sciatic nerve distri)ution ,ositive associated -it&: 1erve root irritation or inflammation including root sciatica (pain associated -it& pain radiating do-n t&e course of t&e sciatic nerve)

1#.

)ilgrams Test (@old legs 5C off ta)le) A. /&e patient is supine instruct t&e patient to lift )ot& legs 5 inc&es off t&e examination ta)le and t&en to &old as long as possi)le B. A positive is -&en t&e patient experiences lo- )ac3 pain and t&erefore is not a)le to &old t&e legs off t&e ta)le or reac& approximatel' 5 inc&es of elevation C. ,ositive is associated -it&: &erniated !$%

19. Bilateral Leg Lo#ering Test (SLR + drop slo- drop is normal) A. Supine examiner lifts )ot& legs -&ile full' extended to ;0 degrees B. :xaminer instructs patient to lo-er t&e legs from ;0 to 05 degrees C. A positive is -&en t&e legs drop or lo- )ac3 pain is produced D. A positive is associated -it&: mec&anical lum)osacral involvement or disc lesions 19. Le#ins Su$ine Test (Sit up pain) A. Supine legs extended examiner applies do-n-ard pressure to t&e legs t&en patient performs a sit up -it&out t&e use of t&eir &ands B. A positive is -&en t&e patient is una)le to do t&is

C. A positive is associated -it&: lum)ar-lum)osacral-sacroiliac art&ritis a degenerative disc -it& protrusion or sciatica *0. Bechtere#s Test (As'pDs'mpD)ot& 1RLDdisc) A. Seated position patient extends eac& leg one at a time examiner resists extension (do-n-ard pressure on t&e t&ig&) at end range one leg at a time B. 8ollo-ed )' t&e patient extending )ot& legs simultaneousl' C. A positive is -&en is )ac3ac&e or sciatic pain is increased or t&e maneuver is impossi)le D. !n disc involvement extending )ot& legs -it& increase painDdiscomfort E. A positive is associated -it&: sciatica su)luxation spasm

*1. A. B. C. D. E. **. A. B. C.

Tri$od Test (:xt. 3nees + drop )ac3 to &ands) Assessment for imulated Lum)ar pain ,atient is seated 3nees flexed to ;0 degrees /ell t&e patient to rapidl' and repeatedl' 3ic3 t&e legs -&ile t&e legs are extended (flutter 3ic3) *ositi%e + True lum)ar disc involvement patient -ill need to lean )ac3 to perform t&is (tripod posture) 'alse (simulated) lum)ar disc involvement patient -ill not lean )ac3 -&ile performing t&is ,uick Test (Stand s<uat stand) ,atient is standing and is instructed to s<uat do-n and t&en stand up again /&is is a screening test for lum)ar and lo-er extremit' complaints !n a fe- s&ort and active movements t&ree ma"or contri)utors to lo-er extremit' complaints (an3les 3nees and &ips) can )e ruled in or out of t&e differential diagnosis process ,atients t&at are pregnant or -it& 3no-n art&ritis in t&e lo-er extremit' s&ould never perform t&is test

D. *3.

!em$s Test (:xt+Rot discDfacet) A. ,atient is in a seated position B. :xaminer supports patient )' reac&ing around t&e patients s&oulders and upper c&est (-it& one arm) from )e&ind and to t&e side of t&e patient

C. ,atient is t&en directed to lean o)li<uel' for-ard and a-a' from t&e affected side D. /&e examiner t&en activel' rotates t&e patient?s trun3 from t&e original position and circumducts t&e trun3 to-ard t&e affected side E. 7emp?s test performed seated increases disc pressure and t&erefore maximi=es stress on t&e disc F. 7emp?s test performed standing increases -eig&t )earing and maximi=es stress to t&e facets G. Standing test: Same doctor position and sta)ili=ation -it& one arm across s&oulder and c&est in addition one &and is used to anc&or t&e pelvis on t&e affected side (iliac crest) t&e doctor t&en firml' moves t&e patient?s opposite s&oulder o)li<uel' )ac3-ard to-ard t&e affected side

*0. *rone !nee 'lexion (8lx 3nees ;0 degrees t&en maximall') A. ,atient is prone -it& )ot& legs full' extended B. :xaminer flexes )ot& 3nees to ;0 degrees C. :xaminer t&en flexes )ot& 3nee maximall' approximating t&e &eels to t&e )uttoc3s D. ,ositive: :xaminer una)le to flex t&e 3nees past ;0 degrees E. ,ositive: Enilateral lum)ar pain (indicating an L* or L3 nerve root lesion) andDor pain in t&e anterior t&ig& (stretc&es femoral nerve) *5. A. B. C. D. *5. -achlas Test (8lx &eel to )utt ipsi LSDS!D8em n.) ,atient is prone -it& legs full' extended :xaminer flexes t&e 3nee of t&e affected leg to ;0 degrees and t&e &eel is approximated to t&e )uttoc3 on t&e same side ,ositive: ,ain in t&e S!DLum)osacral area or if t&e pain radiates do-n t&e t&ig& or leg !ndicates a S! or LS disorder

.lys Test (8lx &eel to )utt contra LSDS!D8em n.) A. ,atient is prone -it& legs full' extended B. :xaminer flexes t&e 3nee of t&e affected leg to ;0 degrees and t&e &eel is approximated to t&e )uttoc3 on t&e opposite side

C. After flexion of t&e 3nee t&e t&ig& is &'perextended D. ,ositive: pain in t&e anterior t&ig& indicating femoral nerve or inflammation of t&e lum)ar nerve roots *#. 'emoral -er%e Traction Test (Side posture extend leg 15 flex 3nee) A. ,atient is in a side-l'ing posture affected leg is up and t&e patient slig&tl' flexes t&e &ip and 3nee B. ,atient straig&tens t&e )ac3 and flexes t&e nec3 C. /&e affected leg (top leg) is extended 15 degrees and t&en t&e 3nee is flexed (-&ic& stretc&es t&e femoral nerve) D. ,ositive: ,ain radiates do-n t&e anterior t&ig& and indicates a nerve root radiculopat&' involving L*-L3-L0 *9. /oemans Test (8em 1. Stretc& -D&ip ext) A. ,atient is prone :xaminer on same side of unaffected leg B. :xaminer sta)ili=es affected S! "oint and t&en flexes t&e 3nee of t&e affected leg to ;0 degrees and t&en &'perextends t&e t&ig& off of t&e ta)le C. ,ositive: ,ain in t&e S! area indicating in"ur' of t&e anterior S! ligaments

*;. A. B. C. D.

E. 30.

Hi&&s Test (!nternal Rot femur @ipDS!) ,atient is prone :xaminer is on t&e unaffected side :xaminer sta)ili=es t&e unaffected pelvis -it& one &and (dorsum of !lium )one) :xaminer uses ot&er &and to grasp t&e an3le of t&e affected leg flexes t&e 3nee to ;0 degrees t&en to maximum flexion (do not elevate t&ig& off ta)le) t&en pus& t&e leg laterall' ,ositive: ,elvic ,ain suggesting S! disease

0ntalgia Sign (,t antalgic lat deviation) A. ,atient -ill presentDdemonstrate an antalgic posture )ased on t&e t'pe of disc painDlesion B. >&en t&e disc protrudes lateral to t&e nerve root t&e patient assumes an antalgic lean away from t&e side of t&e disc lesion or pain C. >&en t&e disc protrudes medial to t&e nerve root t&e patient assumes an antalgic lean into from t&e side of t&e disc lesion or pain

D. >it& a central disc lesion t&e patient -ill assume a flexed posture of t&e lum)ar spine -it& or -it&out leaning to eit&er side E. >it& protrusion under t&e nerve root t&e patient ma' not lean at all F. Clinical Pearl: If the Antalgia is not readily apparent in a static posture! it will appear with forward flexion of the trunk 31. )inors Sign (,t uses arms to stand) A. ,atient is seated and is as3ed to stand B. :xaminer o)serves &o- patient rises from a seated position C. Sign is present -&en patient supports -eig&t on t&e uninvolved sideF )' )alancing t&e &ealt&' leg placing one &and on t&e )ac3 and flexing t&e 3nee and &ip on t&e affected side D. Sign present in: S! lesions LS strainsDsprains fractures disc s'ndromesG -eris 1Bo#ing2 Sign (.o-+7nee 8lx) A. ,atient is standing t&en instructed to )o- for-ard B. Sign is present -&en patient flexes t&e 3nee on t&e affected side C. ,ositive: lo-er lum)ar !$% pro)lems as -ell as LS and S! strain su)luxations

3*.

33. A. B. C. D. E. F. G. 30.

3aenslens Test (S! Supine leg off :xt &ip) ,atient is supine -it& t&e affected pelvis to t&e side of t&e ta)le :xaminer -ill )e on t&e side of t&e affected leg :xaminer flexes unaffected t&ig& and 3nee to-ard t&e a)domen :xaminer turns patient so t&at t&e affected leg is off t&e ta)le :xaminer simultaneousl' flexes 3neeDt&ig& of unaffected leg to-ard a)domen -&ile also &'perextending t&e affected leg (leg -ill )e off t&e ta)le) ,ositive: ,ain in t&e S! area or referred do-n t&e t&ig& !ndicates S! "oint disease Le#in 3aenslens Test (S! Side l'ing sta) LS)

A. ,atient in side-l'ing posture on t&e unaffected side -it& 3nee and &ip flexed :xaminer is positioned &ehind t&e patient B. :xaminer a)ducts affected leg slig&tl' -it& one &and ot&er &and sta)ili=es pelvis -it& do-n-ard pressure t&en t&e affected leg is placed furt&er into extension C. ,ositive: ,ain in t&e S! "oint indicating a S! "oint lesionDpat&olog' 35. S4 Stretch Test (S! Supine H &ands on AS!S) A. ,atient is supine :xaminer places )ot& &ands on t&e AS!S of eac& !lium and presses laterall' and do-n (:xaminer facing feet and arms are crossed) B. ,ositive: Enilateral gluteal or posterior crural (relating to t&e leg or t&ig&) pain C. Significant test for anterior S! ligament sprain S4 Resisted 0&duction Test (S! A)d side l'ing) A. ,atient in side-l'ing posture on t&e unaffected side :xaminer is positioned &ehind t&e patient B. ,atient activel' a)ducts t&e affected leg at t&e end R2I t&e examiner applies do-n-ard pressure on t&e affected leg -&ile t&e patient tries to resist C. ,ositive: ,ain near t&e ,S!S and is specific for S! sprain or su)luxation

35.

3#. Sacrotu&erous Ligament Stress Test (8lx 3neeD&ip AdD!nt Rot &ip) A. ,atient is in a side-l'ing position -it& t&e top leg )ent at ;0 degrees .. :xaminer -ill pus& do-n on t&e 3nee (of top leg) and also pus& in on t&e sacrotu)erous ligament (sacral notc& to isc&ial tu)erosit') :xaminer is positioned in front of t&e pt. B. ,ositive: /enderness at t&e S/ ligament %. !ndicates: S/ ligament sprain or tig&tness 39. 4liac Com$ression Test (Side l'ing pressure on iliac crest) A. /&e patient is in t&e side-l'ing position .. :xaminer places )ot& &ands over t&e upper part of t&e superior iliac crest and exerts a careful do-n-ard pressure. :xaminer is &ehind t&e pt. B. ,ositive: ,ain or increased pressure at t&e S! "oint %. !ndicates: S! sprain inflammation su)luxation or fracture

3;. 'lamingo Test (S! @op one leg) A. !nstruct t&e patient to &op on one leg (affected leg) .. ,ositive: ,ain locali=ed to t&e &ip B. !ndicates: @ip pat&olog' or femoral &ead fracture 3;. 0llis Sign (Supine lengt&+&eig&t 3nee) A. ,atient is supine 3nees flexed and soles of feet flat on t&e ta)le. B. :xaminer o)serves t&e &eig&t of t&e 3nees from a vie-point at t&e foot of t&e ta)le C. ,ositive sign (or sign is present) if one 3nee is lo-er t&an t&e ot&er D. !ndicates: ipsilateral &ip dislocation or severe coxa disorder A. .. B. 5rtolanis Click Test (!nfant displaced femur) ,erformed on !nfants :xaminer a)ducts (or moves) t&e infant?s legs apart. !f t&e &ip is dislocated during t&is motion t&e &ead of t&e femur slides over t&e rim of cartilage t&at is around t&e &ip soc3et. /&ere is a clic3 or clun3ing sensation as t&e &ead of t&e femur slips )ac3 into t&e soc3et. /&is is called a positive 2rtolaniJs Ianeuver. Recent researc& on t&is test indicates t&at KGt&e clun3 is al-a's a sign of a dislocated &ip (positive 2rtolaniJs test). @o-ever a positive 2rtolaniJs does not necessaril' mean t&e &ip &as relocated )ac3 into t&e soc3et. !maging studies must )e done to 3no- for sure. /&is second step is important to prevent treating a &ip t&at canJt )e fixed -it&out surger'.C Side note: Iore t&an li3el' 'ou -ill not &ear a clic3 )ut -ill most definitel' KfeelC somet&ing if t&e test is positive

00.

%.

:. 01.

0n%il Test (Stri3e calcaneous 8x) S&oes 288 A. ,atient is supine t&e inferior calcaneus (&eel) is struc3 -it& t&e examiner?s fist .. ,ositive: ,ain B. !ndicates: (depending on -&ere pain is reported) 1. ,ain in t&ig& L femoral "oint fracture or server pat&ologic condition of t&at "oint *. ,ain in leg L ti)ial or fi)ular fracture 3. ,ain at calcaneus L calcaneal fracture Thomas Test (Supine 7nee to B&est @ip 8lx Bontracture)

0*.

A. ,atient is supine unaffected leg?s t&ig& is flexed -it& 3nee )ent upon t&e a)domen patient will use both hands to keep the leg in this position .. :xaminer o)serves t&e posture of t&e lo-er )ac3 and affected leg (t&e leg flat on t&e ta)le) )e lateral to pt around &ips B. 1ormal: ,atient?s spine -ill flatten and affected leg -ill remain on t&e ta)le %. ,ostive: !f lum)ar spine maintains a lordosis if affect leg flexes (off of t&e ta)le) and if t&e patient is una)le to la' t&e leg flat on t&e ta)le :. !ndicates: S&ortened (flexion contracture) !liopsoas muscle 03. )odified Thomas Test (Leg off ta)le) A. ,atient is supine and t&e )uttoc3s are positioned at t&e edge of t&e ta)le so t&at )ot& legs are &anging off .. /&e patient t&en &olds &oth 3nees to t&e c&est as t&e examiner slo#ly lo#ers the affected leg &ack to#ards the floor B. !f t&e patient cannot ac&ieve ;0 degrees of flexion to t&e c&est a neutral angle of &ip flexion less 15 degrees of &ip a)duction relative to t&e pelvis and t&e affected leg does not drop -ell )elo- t&e &eig&t of t&e ta)le t&e patient is considered to &ave tig&tness %. Ian' slig&t variations on t&is test: Anot&er -a' to perform t&is test is to "ust &ave t&at patient let )ot& legs &ang off t&e ta)le a positive -ould )e if one or )ot& of t&e legs extends at t&e 3nee slig&tl' :. ,ositive: Affected leg does not drop )elo- t&e level of t&e ta)le cannot ac&ieve ;0 degrees of flexion 8. !ndicates: /ig&tness of t&e rectus femoris iliopsoas tensor fascia latae muscles as -ell as t&e !/. (!lio ti)ial )and) testing for flexor contraction A. .. B. %. :. 5&ers Test (!/. contracture) ,atient is in a side-l'ing position on t&e unaffected side :xaminer places one &and on t&e pelvis and grasps t&e patient?s an3le and t&en flexes t&e patient?s 3nee to ;0 degrees. :xaminer is &ehind pt. /&e examiner t&en a)ducts and extends t&e t&ig& ,ositive: /&e leg remains a)ducted (sign is present in )ot& conscious and unconscious individuals) !ndicates: !lioti)ial .and contracture

00.

45. *iriformis Test (Side l'ing 8lx &ip+7nee pressure 3nee) A. ,atient is in a side-l'ing posture on t&e unaffected side .. /&e patient flexes t&e &ip of t&e affected &ip (top leg) to a ;0 degree angle -it& t&e 3nee flexed B. /&e examiner sta)ili=es t&e &ip -it& one &and and applies a do-n-ard pressure to t&e 3nee. :xaminer is facing pt. %. ,ositive: ,ain in t&e piriformis :. !ndicates: /ig&t piriformis muscle (and possi)le sciatic li3e s'mptoms) ". Clinical Pearl: If the piriformis muscle is pinching the sciatic nerve! pain results in the buttock! and sciatica may be experienced by the patient. In about #$% of the population! the sciatic nerve! all or in part! passes through the piriformis muscle rather than below it. It is these people who are more likely to suffer from piriformis syndrome 05. *atricks Test '0B.R(8lexion-A)duction-:xternal Rotation-:xtension) (8lxDA)dD:xt Rot @ip ,at&) A. is supine :xaminer graps an3le and flexed 3nee of t&e affected leg .. /&e examiner t&en flexes t&e &ip a)ducts t&e t&ig& crosses t&e an3le over t&e contralateral 3nee and externall' rotates t&e &ip ()ring up t-ist t&en place do-n so leg forms a 0) B. /&e examiner t&en extends t&e &ip )' appl'ing do-n-ard pressure on t&e 3nee -&ile sta)ili=ing t&e contralateral pelvis (around AS!S is fine) %. ,ostive: ,ain during t&e maneuver (exp. during a)duction and external rotation) :. !ndicates: coxa pat&ologic condition (coxa L t&e &ip or &ip "oint) 0#. Trendelen&ergs Test (>ea3 m. opp &ip 8lx @ip ,at&) A. ,atient is standing. ,atient stands on t&e affected side of involvement -&ile raising t&e ot&er foot and leg into t&ig& flexion and 3nee flexion .. 1ormal: !liac Brest is lo- on t&e standing side and &ig& on t&e elevated side B. @ip-Moint !nvolvementDIuscle >ea3ness: !liac crest is &ig& on t&e standing side and lo- on t&e elevated side %. /&is test is positive as a result of: 1. gluteal paral'sis or -ea3ness (polio) *. gluteal in&i)ition (from pain arising

in t&e &ip "oint) 3. gluteal insufficienc' from coax vera or 0. congenital dislocation of t&e &ip. :. 8alse positives occur in a)out 10N of t&e patients tested statisticall' spea3ing 09. Laguerres Test (8A.:R in t&e air) A. ,atient is supine .. /&e patient?s involved &ip is flexed a)ducted and laterall' rotated B. :xaminer applies an over pressure at t&e end R2I %. /&e opposite AS!S is sta)ili=ed :. ,ositive: S! "oint pain