Passive Scapular Adduction Test

Introduction

• Passive Scapular Adduction test is a thoracic spine examination procedure that tests for T1 – T2
nerve root compression.

Procedure

• Patient may be seated or standing during the procedure.

• The examiner passively approximates the scapulae by lifting the shoulders up and back thereby
adducting the scapulae bilaterally.
• The examiner takes note of any pain or discomfort along the area.

Positive Passive Scapular Adduction Test

• There is positive Passive Scapular Adduction Test when the patient exhibits signs of discomfort or
pain while the scapulae are being manipulated.
• This sign indicates possible T1-T2 nerve root compression on the side where the pain is being
experienced.

Clinical Notes

• The pain that patients feel during this procedure is secondary to the stretching of a damaged serratus
anterior muscle or scapulocostal syndrome.
Percussion Testing

Introduction

• Percussion / over pressure / Tinel’s Test - of spinous processes and ribs for pain, which may suggest
fracture or bone disease, is important.

Procedure
• If a rib fracture is suspected, percuss the affected rib away from the site of pain and see if the pain is
reproduced.
Adam’s Forward Bend

Introduction

• Adam’s sign is a thoracic spine examination procedure that identifies structural or functional
scoliosis.
• Also known as the Adam’s forward bend test, it is the most common technique used in school
screening for scoliosis.

Procedure

• Patient stands as the test is done.

• The patient bends forward from the waist until their back becomes a horizontal plane.
• The patient’s feet must be together with arms hanging along the sides and knees extended.
• The examiner may otherwise tell the patient to touch her toes and remain in the position.
• The examiner checks the patient’s back in the posterior, lateral and anterior views
• The examiner checks the patient’s back, along the horizontal plane of the column vertebrae
• He looks for spinal and scapular asymmetry (‘winging’), non-level shoulders and hips or a rib hump.
• After examining the patient, the examiner assists the patient to return to a standing position.

Positive Adam’s Sign

• A rib hump when a patient bends forward to touch his toes is a positive Adam’s Sign. This indicates
scoliosis.
• If the scoliosis and any associated rib hump disappear on flexion, the scoliosis is functional; if they
remain the scoliosis is structural.
Ott’s Sign Test

Introduction

This test is used to measure the ROM of the thoracic spine in the sagittal plane.

Procedure

• The patient is standing,

• The examiner marks the C7 spinous process and a point 30 cm inferior to it.
• This distance should increase by 2-4 cm in flexion and decrease by 1-2 cm in extension.
Positive Ott’s sign
• Degenerative inflammatory processes of the spine restrict spinal mobility and range of motion.
• An alternative method is to measure the smallest finger-to-floor distance with the knees extended.
Chest Expansion Test

Introduction

• Chest Expansion test is a thoracic spine examination procedure that checks for reduction of
costovertebral joint motion, ankylosing spondylitis and also for the assessment of respiratory
conditions.
• In the normal adult male the difference between maximum inspiration and at maximum
expiration.will be at least 5cm, and for females at least 3.5cm.

Procedure

• Patient may sit or stand while the procedure is done.

• The patient takes a deep breath in and out.
• The examiner places a tape measure around the patient’s chest at the T4 level
• He measures chest expansion at the maximum inspiration and at maximum expiration.
• The difference between the two measurements is noted.
• The examiner checks for any abnormal joint motion.

Positive Chest Expansion Test

• There is positive Chest Expansion Test when there is measurement difference of less than 2.5 cm or
(1 inch).
• A decreased measurement may indicate an ankylosing condition such as ankylosing spondylitis.
Slump Test GORP OMNICS

Introduction
• The slump test places tension on the entire spinal cord and peripheral nerves of the upper and lower
extremities.
• It can therefore assess a space-occupying condition/lesion of the cervical and lumbar spinal regions
as well as thoracic outlet syndrome (TOS).
• Slump Test is often used to produce symptoms of radiculopathy/disc herniation in patients with
lower back pain.

Procedure
• The patient is seated on the edge of the examining table with the legs supported, the hip is in the
neutral position and the hands behind the back
• The patient is asked to slump so that the lumbar and thoracic spine go into full flexion.
• The examiner maintains the patient’s chin in neutral position to prevent head and neck flexion.
• The examiner then uses one arm to apply over-pressure and maintain flexion of the lumbar and
thoracic spine.
• While this position is held the patient is then asked to flex the cervical spine and head as far as
possible.
• The examiner then applies over-pressure to maintain flexion in all three parts of the spine using the
same arm to maintain over-pressure in the cervical spine.
• With the other hand, the examiner then holds the patient’s foot in maximum dorsiflexion. While the
examiner holds these positions, the patient is asked to actively straighten the knee as much as
possible.
• The test is repeated with the other leg, and then with both legs together.

Positive Slump Test

• The client should either experience a reproduction of the upper or lower extremity symptoms that
they have been experiencing or a high level of pain during the procedure.
• If the patient is unable to fully extend the knee because of pain, the examiner releases the pressure
on the cervical spine and the patient actively extends the neck.
• If the knee extends further and the symptoms decrease with neck extension, then the test is
considered positive for increased tension in the neuromeningeal tract
Beevor’s Sign

Introduction

• Beevor’s Sign is a thoracic spine examination procedure and is described as the abnormal upward
movement of the umbilicus when attempting to sit up from a supine lying position.
• The Beevor’s Sign is a pathologic reflex test indicative of a upper motor neuron lesion (UMNL)

Procedure
• Patient lies supine
• The examiner asks the patient to lift their head and shoulders slightly from the bench
• The patient’s hands may be placed on their sides to help prop the body.
• The examiner checks the patient’s umbilicus for any deviation.
• The umbilicus should normally stay relatively still.
• Normally, the umbilicus will not move laterally, superiorly or inferiorly when moving from a supine
lying to a sitting position.

Positive Beevor’s Sign

• A positive Beevor’s Sign is when there is noticeable deviation of the umbilicus.
• This is a sign of functional paralysis consisting of inability of the patient to inhibit the antagonistic
muscles.
• This could indicate the presence of lower thoracic myelopathy which results to regional abdominalis
muscle paralysis
• Upward deviation of the umbilicus on attempting this test (caused by contraction of the upper but not
the lower abdominal muscles), may be indicative of a spinal cord lesion in the region of the lower
thoracic vertebrae.
Schepelmann’s Test

Introduction
• Schepelmann’s Sign is an efficient way to screen the thoracic spine. It can also help localize the
injured area.
• Schepelmann’s sign is a thoracic spine examination procedure that tests for intercostal neuritis or
intercostal strain.
• The pain or discomfort increases when the patient bends on the unaffected side while in intercostal
neuralgia, the pain increases when the patient bends on the affected side.

Procedure
• Patient may stand or sit during the procedure.
• The patient abducts her shoulders at 180 degrees and flexes her spine from side to side.
• The examiner assists the patient in assuming the position and observes for uniform motion and any
signs of discomfort or pain.

Positive Schepelmann’s Sign

• There is positive Schepelmann’s Sign when the patient complains of rib pain.
• Concave side pain could indicate intercostal neuritis while convex side pain could
indicate myofascitis or intercostals strain.
Abdominal Reflexes

Introduction

• An abdominal reflex is a superficial neurological reflex stimulated by stroking of

the abdomen around the umbilicus.
• It can be helpful in determining the level of a thoracic spinal cord compression lesion.

Procedure

• The patient is positioned comfortably in a supine position with the abdomen exposed.
• The skin of each quadrant is stimulated by quickly dragging the sharp end of the reflex hammer
across it.

Positive reflex test

• Normally stimulation should cause the abdominal muscles to involuntarily contract, resulting in
movement of the umbilicus in the direction of the quadrant being stimulated.
• The reflex can be absent due to obesity, previous surgery, in the multiparous female and with
increasing age.
• Pathological absence of the normal response suggests thoracic spinal cord compression on the side
of the diminished reflex.
• Remembering that the upper abdominal muscles are innervated by T7 through T10 nerve roots and
the lower abdominal musculature is innervated by T10 through L1 nerve roots helps the examiner
identify the approximate level of involvement.
Adson’s Test (TOS)

Introduction
• Adson's test is a provocative test used to examine for Thoracic Outlet Syndrome accompanied by
compression of the Subclavian artery by a cervical rib or tightened anterior and middle scalene
muscles.
Procedure
• Patient seated, examiner palpates radial pulse bilaterally.
• The examiner extends, abducts and externally rotate the patient’s arm.
• Then the patient is asked to extend their neck and rotate their head towards the side being tested.
• Patient may be instructed to take a deep breath and hold it after the head is rotated to help apply
further pressure to the brachial plexus nerve roots and subclavian artery.

Positive Adson’s Test

• If this test causes a reproduction in the patient’s symptoms with a disappearance of the radial pulse,
the test is positive for thoracic outlet syndrome. The scalene triangle muscles, (in particular, the
anterior scalene) is likely to be responsible.
• Adson’s Test is considered positive if the examiner detects a significant decrease in strength, or
complete disappearance, of the radial pulse.
Halstead’s Tests (TOS)

Introduction
• Halstead’s Maneuver test is a shoulder examination used to test for Thoracic Outlet Syndrome.
• Indicates thoracic outlet syndrome. The presence of a cervical rib compressing the neurovascular
bundle may be responsible.

Procedure
• The patient should be seated and relaxed
• The examiner stands behind the athlete and palpates the radial pulse on the involved side throughout
the test
• The examiner continuously palpates the radial pulse on the side being tested while abducting the arm
to 45 degrees, extending the shoulder to 45 degrees, externally rotating the humerus, and applying a
downward traction to the arm.
• The patient is then asked to fully turn his/her head away from the side being tested and extend the
cervical spine.
• The patient is instructed to take a deep breath and hold it.

Positive Halstead Maneuver Test

• If this test causes a reproduction in the patient’s symptoms with a disappearance of the radial pulse
the test is positive for thoracic outlet.
• The scalene triangle muscles, (in particular the posterior scalenes) is likely to be responsible.
• The presence of a cervical rib compressing the neurovascular bundle may also be responsible.
Wright’s Hyperabduction Test (TOS)

Introduction
• Wright’s test is designed to assess pectoralis minor syndrome, another one of the four forms of
thoracic outlet syndrome.
• Given that pectoralis minor syndrome is a neurovascular entrapment syndrome caused by a tight
pectoralis minor, the idea is to stretch and pull this muscle taut, causing it to further compress the
brachial plexus and the subclavian/axillary artery and vein that run between it and the ribcage.

Procedure
• Patient Position: Sitting
• The examiner palpates the radial pulse then hyper abducts and extends the patients arm so that the
hand is brought over the head with the elbow and arm in the coronal plane.
• To further elicit a positive finding, the client may be asked to take in a deep breath and hold it.
• Inspiration lifts the ribcage up and against the pectoralis minor.
• Because the pectoralis minor is a muscle of inspiration, this causes it to contract as it is being
stretched, further increasing its tension and the possibility that it will compress the neurovascular
structures located between it and the ribcage.

Positive Wright’s Test

• A positive finding is a weakening in the strength of the radial pulse (not a change in the speed of the
pulse), which indicates compression of the subclavian/axillary artery between the pectoralis minor
and the ribcage.
• If the client experiences the referral of sensory symptoms such as pain, tingling, or numbness into
the upper extremity during this test, it is also considered a positive finding and indicates direct
compression of the brachial plexus between the pectoralis minor and ribcage.
Edens (Costoclavicular Test) (TOS)

Introduction
• Eden’s test is designed to assess for costoclavicular syndrome, another one of the four forms of
thoracic outlet syndrome.
• This test is particularly effective in patients who complain of symptoms while wearing a backpack or
heavy coat.

Procedure
• Patient seated
• The client is asked to push the chest out and pull the shoulders back
• The examiner palpates the radial pulse and then draws the patient’s shoulder down and back.
• This test can be done bilaterally (“exaggerated military posture”)
• To further elicit a positive finding, the client may be asked to take in a deep breath and hold it.
• This causes the first rib to lift and move toward the clavicle, this further decreases the
costoclavicular space,

Positive Eden’s Test

• A positive finding is a weakening of the strength of the radial pulse (not a change in the speed of the
pulse), indicating compression of the subclavian artery in the costoclavicular space.
• If the client experiences the referral of sensory symptoms such as pain, tingling, or numbness into
the upper extremity during this test, it is also considered a positive finding and indicates direct
compression of the brachial plexus in the costoclavicular space.
Roo’s Test (TOS)

Introduction
• Roo’s test is a shoulder examination used to diagnose Thoracic Outlet Syndrome.
Procedure
• The patient is sitting
• Examiner instructs the patient to abduct the shoulders to 90°, to externally rotate then flex the
shoulders to 90°
• Shoulders and elbows should be slightly behind the frontal plane of the chest
• The patient is then instructed to rapidly open and close the hands 15 times.
• Or, open and close the hands slowly over a 3-minute period

Positive Roo’s test

• If fatigue, cramping, or tingling occurs during the test, the test is positive for vascular insufficiency
and thoracic outlet syndrome.
Allen’s Test

Introduction
• Allen’s test is used to determine the efficiency of the arterial
collateral circulation (blood flow) to the hand.

Procedure
• The patient is sitting
• Place the patients hand in a position wherein the palm is facing forward.
• To perform the test, instruct the patient to open and close his fist quickly several times, and then to
squeeze his fist tightly so that the venous blood is forced out of the palm.
• With your fingers and thumb, compress the radial and the ulnar pulses firmly to occlude them
• With the vessels still occluded instruct the patient to open his hand.
• Then release one of the arteries at the wrist, while maintaining the pressure on the other one, count
how many seconds it takes for the palm and the thumb to return to their normal pink colour.
• The other artery should be tested similarly, and the opposite hand checked for comparison.
• Normally the hand flushes immediately.

Positive Allen’s Test

• Within 3 to 5 seconds, the palm returns to its normal pink colour; this means that the artery is patent.
• If colour does not return or returns very slowly, suspect artery insufficiency (eg. occlusion)