In this episode we discuss what special tests are good for and how they fit in the diagnostic process. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6994315/ ACL test cluster (LR+ 15, LR - 27)
History of Trauma
Pivoting during injury felt/heard a pop immediate swelling experiencing giving way
Lachman (LR+ 10, LR- 0.2)
Hip Labrum and FAl test
Thomas test LR+ 11.1
Reproduction of patients pain with/without a click
Hip OA cluster
LR+ 3/5= 5.2, 4/5= 24.3
Pain with squatting
Scour
Pain with active hip flexion
Passive IR <25
Pain with active hip extension
Shoulder Subacromial pain syndrome cluster (LR+ 10)
Hawkins-Kennedy impingement sign
Painful arc sign
•Infraspinatus muscle test
Neer Impingement
Empty Can
Lumbar Radiculopathy
Dermatomal pattern
Subjective sensory loss
Paresis
Decreased ankle reflex unilateral
+ SLR and or cross SLR sign
Pain with coughing, sneezing
or straining
More pain with sitting
Myotomal weakness
(+/-). Patellofemoral pain syndrome
Cluster 1 (<40 years LR+ 8.7, LR- .39)
Medial patellar tenderness
Under 40 years of age
Isolated knee pain
Cluster 2 (40-58 years old LR+14.2, LR-45)
Age 40-58 and isolated anterior or diffuse knee pain difficulty descending stairs
medial patellar facet tenderness full passive knee extension
Rotator cuff teat diagnostic cluster (LR+ 9.8;, LR- 0.53)
Age 265
weakness in ER (infraspinatus test)
night pain
Shrug sign Stenosis LR+ 4/5=4.6, 5/5=infinite
Bilateral symptoms
Leg pain more than back
Age >48
Pain with walking and standing
Pain relief with sitting
(+/-)
Meniscus Cluster
History of pivoting injury with foot planted
Joint line tenderness
McMurray test
Thessaly test
Knee OA Clinical cluster
LR +13.6 LR - .38
Age 50-58
BMI >30
Varus/algus alignment
Limited passive knee extension
Palpable crepitus
Knee OA diagnostic cluster (LR+ 13.6; LR- 0.38)
Age 50-58
BMI ≥30
Varus/valgus alignment limited passive knee extension
PCL cluster (LR+ 16, LR- 0.2)
History of falling on a bent knee
Posterior Drawer (LR+ 50, LR -. 11) Cluster for Carpal Tunnel syndrome
LR+ 4/5= 4.6, 5/5=18.3, LR-4/5= .028, 5/5=.83
1. Shaking hands to relieve symptoms
2. Wrist ratio > 67
3. Symptom Severity Scale > 1.9
4. Diminished sensation in median sensory field 1 (thumb)
5. Age > 45 years old
Test cluster for
myelopathy (positive likelihood ratio 3/5 30, 4/5 infinite)
Hoffman sign
Brachioradials reflex
Age >45
Gait deviation
Babinski sign
Cervical Radiculopathy (likelihood ratios 3/5 +6.01
-0.65, 4/5 +30.3 - 0.77)
ULTT
<60 rotation bilaterally
Distraction
Spurlings
Cervical Traction Cluster (3/5 positive likelihood 4.81,
4/5 23.1)
Abduction relief
ULTTA
Age >55
Distraction
Periphrealization with mobility testing at C4-7
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