chapter normal values and assessments

Normal Values and Assessments

ASIA Classification of Spinal Cord InjuryThe American Spinal Injury Association (ASIA) has developed a spinal •injury classification system based on specific motor and sensory assessments as depicted in the figure on page 2.

Motor function is determined by manual muscle testing of 10 key •muscles. Results of manual muscle tests are expressed numerically.

• Dermatomalsensationassessmentforpinprickandlighttouchisperformed and scored numerically.

• TheASIAImpairmentScale,usinglettersAtoE,representstheoverall classification of the spinal injury.

1

1c h A p T E r

53415_CH01_FINAL.indd 1 4/23/12 12:28:49 PM

ASIA Standard Neurological Classification of Spinal Cord Injury ChartJones and Bartlett PublishersElizabeth Morales Illustration Services Figure 38115_CH01_0101.eps Date 05-31-06

C2

C3

C4

C2

C3

C4

T3T4T5T6T7T8T9T10

T11

T12

C5

C6 C6

C7 C7

C8 C8

C6 C6

C5

T2 T2

T1 T1

L1

L2 L2

L3

L4

L5 L5

L4

L3

L1

S1 S1

S1

S3

S2

L5 L5

S1 S1

S2

L2L2

L3 L3

S3

S4-5

L4

C2R L

C3C4C5C6C7C8T1

Elbow flexorsWrist extensorsElbow extensorsFinger flexors (distal phalanx of middle finger)Finger abductors (little finger)

T2T3T4T5T6T7T8T9 T10T11T12L1L2L3L4L5S1

Hip flexorsKnee extensorsAnkle dorsiflexorsLong toe extensorsAnkle plantar flexors

Voluntary anal contraction (Yes/No)

(Maximum 50 50 100)

The most caudal segmentwith normalfunction

S2S3S4-5

+ = =Totals Motor score

STANDARD NEUROLOGICAL CLASSIFICATION OFSPINAL CORD INJURY

NEUROLOGICALLEVEL

Complete or incomplete? ZONE OF PARTIAL

PRESERVATION

ASIA IMPAIRMENT SCALE

SensoryMotor

Light touch scorePin prick score (Max 112)

(Max 112)

Any anal sensation (Yes/No)

C2R L

C3C4C5C6C7C8T1T2T3T4T5T6T7T8T9 T10T11T12L1L2L3L4L5S1

(Maximum 56 56 56 56)

Incomplete = Any sensory or motor function in S4-S5 Caudal extent of partially

innervated segments

S2S3S4-5

+Totals =+

0 = total paralysis1 = palpable or visible contraction2 = active movement, gravity eliminated3 = active movement, against gravity4 = active movement, against some resistance5 = active movement, against full resistanceNT = not testable

LIGHTTOUCH

R L

PINPRICK

R LSensory

Motor

R L

0 = absent1 = impaired2 = normalNT = not testable

MOTORKey muscles

SENSORYKey sensory points

= Key sensory point

Palm Palm

Dorsum

Dorsum

Figure 1.1 Standard Neurological Classification of Spinal Cord Injury

Source: Reproduced with permission of the American Spinal Injury Association (2005). This form may be copied freely but should not be altered without permission from the American Spinal Injury Association.

2 Chapter 1 Normal Values and Assessments

53415_CH01_FINAL.indd 2 4/23/12 12:28:50 PM


C2

C3

C4

C2

C3

C4

T3T4T5T6T7T8T9T10

T11

T12

C5

C6 C6

C7 C7

C8 C8

C6 C6

C5

T2 T2

T1 T1

L1

L2 L2

L3

L4

L5 L5

L4

L3

L1

S1 S1

S1

S3

S2

L5 L5

S1 S1

S2

L2L2

L3 L3

S3

S4-5

L4

C2R L

C3C4C5C6C7C8T1

Elbow flexorsWrist extensorsElbow extensorsFinger flexors (distal phalanx of middle finger)Finger abductors (little finger)

T2T3T4T5T6T7T8T9 T10T11T12L1L2L3L4L5S1

Hip flexorsKnee extensorsAnkle dorsiflexorsLong toe extensorsAnkle plantar flexors

Voluntary anal contraction (Yes/No)

(Maximum 50 50 100)

The most caudal segmentwith normalfunction

S2S3S4-5

+ = =Totals Motor score

STANDARD NEUROLOGICAL CLASSIFICATION OFSPINAL CORD INJURY

NEUROLOGICALLEVEL

Complete or incomplete? ZONE OF PARTIAL

PRESERVATION

ASIA IMPAIRMENT SCALE

SensoryMotor

Light touch scorePin prick score (Max 112)

(Max 112)

Any anal sensation (Yes/No)

C2R L

C3C4C5C6C7C8T1T2T3T4T5T6T7T8T9 T10T11T12L1L2L3L4L5S1

(Maximum 56 56 56 56)

Incomplete = Any sensory or motor function in S4-S5 Caudal extent of partially

innervated segments

S2S3S4-5

+Totals =+

0 = total paralysis1 = palpable or visible contraction2 = active movement, gravity eliminated3 = active movement, against gravity4 = active movement, against some resistance5 = active movement, against full resistanceNT = not testable

LIGHTTOUCH

R L

PINPRICK

R LSensory

Motor

R L

0 = absent1 = impaired2 = normalNT = not testable

MOTORKey muscles


= Key sensory point

Palm Palm

Dorsum

Dorsum

Figure 1.1 continued

ASIA Classification of Spinal Cord Injury 3

53415_CH01_FINAL.indd 3 4/23/12 12:28:50 PM

A = Complete: No motor or sensory function is preserved in the sacral segments S4–S5.

B = Incomplete: Sensory but not motor function is preserved below the neurological level and includes the sacral segments S4–S5.

C = Incomplete: Motor function is preserved below the neurologicallevel,andmorethanhalfofkeymusclesbelowthe neurological level have a muscle grade less than 3.

D = Incomplete: Motor function is preserved below the neurologicallevel,andatleasthalfofkeymusclesbelowtheneurological level have a muscle grade of 3 or more.

E = Normal: Motor and sensory function are normal.

Clinical Syndromes Central Cord BrownSéquard Anterior Cord Conus Medullaris caudaEquina

Figure 1.2 ASIA Impairment Scale

Source: Reproduced with permission of the American Spinal Injury Association (2005).


53415_CH01_FINAL.indd 4 4/23/12 12:28:50 PM

cont

inues

Tabl

e 1.

1

Bloo

d—Co

mpl

ete

Bloo

d Co

unt (

CBC)

No

te: N

orm

al v

alue

s may

var

y fro

m o

ne la

bora

tory

to a

noth

er. T

he v

alue

s pre

sent

ed in

thes

e ch

arts

shou

ld n

ot b

e co

nsid

ered

abs

olut

e.

Asse

ssm

ent C

ompo

nent

Valu

esDescription/Implications/redFlagValues

Red

Bloo

d Ce

lls (R

BCs)

(ery

thro

cyte

s)In

fant

s:

5.5–6.0million/mm

3 Ch

ildre

n:

4.6–4.8million/mm

3 M

en:

4.5–5.3million/mm

3 W

omen

: 4.1–5.1million/mm

3

Indi

vidu

als w

ith lo

wer

tha

nno

rmal

val

ues h

ave

anem

ia.

Anemiasymptom

s:fatigue,weakness,SOB,dizziness,

tach

ycar

dia

Indi

vidu

als w

ith h

ighe

rth

ann

orm

al v

alue

s hav

e po

lycy

them

ia.

polycythemiasymptom

s:SOB,headache,dizziness,itchiness.

Eryt

hroc

yte

Sedi

men

tati

on

Rate

(ESR

/Sed

. Rat

e)children:1–13mm/h

Men:0–17mm/h

Wom

en:1–25mm/h

TheESristherateatwhicherythrocytessettleoutofblood

plas

ma

in 1

hou

r.A

high

rate

is in

dica

tive

of in

fect

ion

or in

flam

mat

ion

Hem

atoc

rit (

HCT

)In

fant

s: 3

0–60

%

Child

ren:

30–

49%

M

en: 3

7–49

%

Wom

en: 3

6–46

%

Hem

atoc

rit is

the

perc

ent o

f who

le b

lood

com

pose

d of

er

ythr

ocyt

es.

Exercisemayberestrictedatvaluesof≤25%.

Table 1.1 Blood—Complete Blood Count (CBC) 5

53415_CH01_FINAL.indd 5 4/23/12 12:28:50 PM

Hem

oglo

bin

(HGB

)Infants:17–19g/dL

children:14–17g/dL

Men:13–18g/dL

Wom

en:12–16g/dL

hGBmeasurestheoxygen-carryingcapacityofrBcs.Low

valuesbetween8and10g/dLareassociatedwithpoorexercise

tolerance,increasedfatigue,andtachycardia.

Plat

elet

sUnits:cells/mm

3 Infants:200,000–

475,000

children:150,000–

400,000

Adults:150,000–400,000

Plat

elet

s pla

y a

key

role

in th

e in

itiat

ion

of th

e cl

ottin

g pr

oces

s w

ithin

dam

aged

blo

od v

esse

ls.Exercisemaybecautiouslyperformedwithvaluesof21,000–

50,000cells/mm

3 .Exercisemaybecontraindicatedatvaluesof≤20,000cells/mm

3 .

Whi

te B

lood

Cel

ls (W

BCs)

Units:cells/mm

3 children:4,500–14,500

Adults:4,500–11,000

Whi

te b

lood

cells

pla

y a

cruc

ial r

ole

in th

e bo

dy’s

imm

une

reac

tion.

Exercisemaynotbepermittedatvaluesof≤5,000cells/mm

3 .

Tabl

e 1.1

Bl

ood—

Com

plet

e Blo

od Co

unt (

CBC)

, continued

Note:

Nor

mal

value

s may

vary

from

one l

abor

ator

y to a

noth

er. T

he va

lues p

rese

nted

in th

ese c

harts

shou

ld no

t be c

onsid

ered

abso

lute.

Asse

ssmen

t Com

pone

ntVa

lues

Description/Im

plications/redFlagValues


53415_CH01_FINAL.indd 6 4/23/12 12:28:50 PM

Dif

fere

ntia

l WBC

Cou

ntN

eutr

ophi

ls:

1,800–7,000cells/mm

3

Lym

phoc

ytes

:1,500–4,000cells/mm

3

Mon

ocyt

es:

0–800cells/mm

3

Eosi

noph

ils:

0–450cells/mm

3

Baso

phils

:0–200cells/mm

3

The

vario

us w

hite

blo

od ce

lls p

lay

diffe

rent

role

s in

the

imm

une

proc

ess.

The

y ex

ist in

ster

eoty

pica

l pro

port

ions

.

Table 1.1 Blood—Complete Blood Count (CBC) 7

53415_CH01_FINAL.indd 7 4/23/12 12:28:50 PM

Tabl

e 1.2

Bl

ood—

Elec

trol

ytes

Note:

Nor

mal

value

s may

vary

from

one l

abor

ator

y to a

noth

er. T

he va

lues p

rese

nted

in th

ese c

harts

shou

ld no

t be c

onsid

ered

abso

lute.

Asse

ssmen

t Com

pone

ntVa

lues

Description/Im


Pota

ssiu

mchildren:3.5–5.5mEq/L

Adults:3.5–5.3mEq/L

hypokalem

ia:dizziness,muscleweakness,fatigue,legcramps

hyperkalemia:muscleweakness,flaccidparalysis,paresthesias

Sodi

um135–145m

Eq/L

hyponatremia:muscletwitching,weakness

hypernatremia:fever,convulsions

Chlo

ride

children:98–105mEq/L

Adults:95–105mEq/L

Chlor

ide sh

ifts a

re m

ost o

ften a

ssocia

ted w

ith sh

ifts i

n sod

ium.

Calci

umchildren:9–

11.5mg/dL

Adults:9–11mg/dL

hypocalcemia:paresthesias,musclespasms

hypercalcemia:lethargy,muscleweakness,flaccidity,bonepain

Mag

nesiu

mchildren:1.6–2.6mEq/L

Adults:1.5–2.5mEq/L

hypomagnesemia:musclecramping,tetany,confusion

hypermagnesemia:decreasedreflexes,muscleweakness,lethargy


53415_CH01_FINAL.indd 8 4/23/12 12:28:50 PM

Tabl

e 1.3

Bl

ood—

Prot

hrom

bin

Time

Note:

Nor

mal

value

s may

vary

from

one l

abor

ator

y to a

noth

er. T

he va

lues p

rese

nted

in th

ese c

harts

shou

ld no

t be c

onsid

ered

abso

lute.

Asse

ssmen

t Com

pone

ntVa

lues

Description/Im


Prot

hrom

bin Ti

me (

PT)

12–1

5 sec

This

asse

ssmen

t mea

sure

s the

clot

ting a

bility

of bl

ood.

Parti

al Pr

othr

ombin

Tim

e (PT

T)30

–40 s

ecM

easu

res o

f 1.5

to 2.

5 tim

es th

e refe

renc

e ran

ge ar

e con

sider

ed th

erap

eutic

.Ph

ysica

l the

rapy

may

be co

ntra

indica

ted a

t valu

es of

≥2.5

tim

es th

e refe

renc

e ra

nge i

n ind

ividu

als no

t tak

ing an

ticoa

gulan

ts an

d valu

es of

≥2.5

–3.0

times

the

refer

ence

rang

e for

thos

e tak

ing an

ticoa

gulan

t med

icatio

ns.

Table 1.3 Blood—Prothrombin Time 9

53415_CH01_FINAL.indd 9 4/23/12 12:28:50 PM


C2

C3

C4

C2

C3

C4

T3T4T5T6T7T8T9T10T11

T12

C5

C6 C6

C7 C7

C8 C8

C6 C6

C5T2 T2

T1 T1

L1

L2 L2

L3

L4

L5 L5

L4

L3

L1

S1 S1

S1

S3

S2

L5 L5S1 S1

S2

L2L2

L3 L3

S3

S4-5

L4


= Key sensory point

Palm Palm

Dorsum

Dorsum

Figure 1.3 Key Sensory Points

Source: Reproduced with permission of the American Spinal Injury Association (2005).


53415_CH01_FINAL.indd 10 4/23/12 12:28:51 PM

Range of Motion—Lower Extremity PercentagesInsomeinstances,itmaybepreferabletoreportmeasuredrangeofmotion as a percentage of normal values. This may be especially true when setting or interpreting long and shortterm goals and for reporting to thirdparty payers or nonphysical therapy personnel. The chart on page 16 provides percentage approximations in 5% intervals. An approximate percentage can be determined by choosing the number fromthechartthatisclosesttothemeasuredjointrange(e.g.,95°ofknee flexion represents an approximate 30% deficit).

Table 1.4 Range of Motion—Lower Extremity and SpineNote:ValuesareaccordingtotheAmericanAcademyofOrthopedicSurgeons.

Joint HipRange of Motion

(in degrees)Hip Flexion

ExtensionAdductionAbductionLateralrotationMedial rotation

0–120 0–30 0–300–45 0–45 0–45

Knee Flexion 0–150

Ankle DorsiflexionPlantar flexionInversionEversion

0–20 0–50 0–35 0–15

Cervical FlexionExtensionRotationLateralflexion

0–45 0–45 0–60 0–45

Thoracolumbar FlexionExtensionRotationLateralflexion

0–80 0–25 0–35 0–45

rangeofMotion—LowerExtremitypercentages 11

53415_CH01_FINAL.indd 11 4/23/12 12:28:51 PM

Tabl

e 1.5

Ra

nge o

f Mot

ion—

Lowe

r Ext

rem

ity P

erce

ntag

es%

of N

orm

al10

095

9085

8075

7065

6055

5045

4035

3025

2015

105

% o

f Def

icit

05

1015

2025

3035

4045

5055

6065

7075

8085

9095

Hip

flex.

120

114

108

102

9690

8478

7266

6054

4842

3630

2418

126

Ab

d.45

3241

3836

3432

2927

2523

2018

1614

119

75

2

Ad

d.30

2927

2624

2321

2018

1715

1412

119

86

53

2

Ex

t. ro

t.45

4241

3836

3432

2927

2523

2018

1614

119

75

2

Int

. rot

.45

4241

3836

3432

2927

2523

2018

1614

119

75

2

Ex

t.30

2927

2624

2321

2018

1715

1412

119

86

53

2

Knee

flex.

150

143

135

128

120

113

105

9890

8375

6860

5345

3830

2315

8

Ankle d

orsi.

2019

1817

1615

1413

1211

109

87

65

43

21

Pla

ntar

5048

4543

4038

3533

3028

2523

2018

1513

108

53

Inv

ers.

3533

3230

2826

2523

2119

1816

1412

119

75

42

Ev

ers.

1514

1413

1211

1110

98

87

65

54

32

21


53415_CH01_FINAL.indd 12 4/23/12 12:28:51 PM

Table 1.6 Range of Motion—Upper ExtremityNote:ValuesareaccordingtotheAmericanAcademyofOrthopedicSurgeons.

Joint MotionRange of Motion

(in degrees)Shoulder Flexion

ExtensionAbductionLateralrotationMedial rotation

0–180 0–60

0–180 0–900–70

Elbow Complex FlexionPronationSupination

0–150 0–80 0–80

Wrist FlexionExtensionRadial deviationUlnar deviation

0–80 0–70 0–20 0–30

Thumb CMC flexionCMC extensionCMC abductionMCP flexionIP flexion

0–15 0–20 0–70 0–50 0–80

2nd through 5th digits

MCP flexionMCP hyperextensionMCP abductionPIP flexionDIpflexionDIphyperextension

0–90 0–45 0–45

0–1000–90 0–10

cMc=carpometacarpal;DIp=interphalangealdistal;Ip=interphalangeal;MCP=metacarpophalangeal; PIP=posterior interphalangeal.

Table1.6 rangeofMotion—UpperExtremity 13

53415_CH01_FINAL.indd 13 4/23/12 12:28:51 PM

Tabl

e 1.7

Ra

nge o

f Mot

ion—

Uppe

r Ext

rem

ity P

erce

ntag

es

(See

ratio

nale

and u

se in

struc

tions

on pa

ge 15

.)

% o

f Nor

mal

100

9590

8580

7570

6560

5550

4540

3530

2520

1510

5

% o

f Def

icit

05

1015

2025

3035

4045

5055

6065

7075

8085

9095

Shou

lder

abd

.18

017

116

215

314

413

512

611

710

899

9081

7263

5445

3627

189

Fl

exio

n18

017

116

215

314

413

512

611

710

899

9081

7263

5445

3627

189

Ex

t. ro

t.90

8681

7772

6863

5954

5045

4136

3227

2318

149

5

In

t. ro

t.70

6763

6056

5349

4642

3935

3228

2521

1814

117

4

Ex

tens

ion

6057

5451

4845

4239

3633

3027

2421

1815

129

63

Elbo

w fl

ex.

150

143

135

128

120

113

105

9890

8375

6860

5345

3830

2315

8

pron./Supin.

8076

7268

6460

5652

4844

4036

3228

2420

1712

84

Wris

t fle

xion

8076

7268

6460

5652

4844

4036

3228

2420

1712

84

Ex

t. 70

6763

6056

5349

4642

3935

3228

2521

1814

117

4

Ra

d. d

ev.

2019

1817

1615

1413

1211

109

87

65

43

21

U

ln. d

ev.

3029

2726

2423

2129

1817

1514

1211

98

65

32


53415_CH01_FINAL.indd 14 4/23/12 12:28:51 PM

Thum

b

CMC

flex.

1514

1413

1211

1110

98

87

65

54

32

21

CM

C ex

t.20

1918

1716

1514

1312

1110

98

76

54

32

1

CM

C ab

d.70

6763

6056

5349

4642

3935

3228

2521

1814

117

4

M

CP fl

ex.

5048

4543

4038

3533

3028

2523

2018

1513

108

53

IP

flex

.80

7672

6864

6056

5248

4440

3632

2824

2017

128

4

Digi

ts 2-

5

MCP

flex

.90

8681

7772

6863

5954

5045

4136

3227

2318

149

5

M

CP h

ypex

.45

4341

3836

3432

2927

2523

2018

1614

119

75

2

MC

P abd

.45

4341

3836

3432

2927

2523

2018

1614

119

75

2

PI

P fle

x.10

095

9085

8075

7065

6055

5045

4035

3025

2015

105

D

IP fl

ex.

9086

8177

7268

6359

5450

4541

3632

2723

1814

95

D

IP h

ypet

xt.

109

99

88

77

66

55

44

33

22

11

Table1.7 rangeofMotion—UpperExtremitypercentages 15

53415_CH01_FINAL.indd 15 4/23/12 12:28:52 PM

Table 1.8 Manual Muscle Testing—Hip and Knee

Joint Motion Muscle(s)Gravity+ Fair

Gravity− Poor

Hip Flexion IliopsoasRectus femorisPectineusTensor fas. latae Sartorius

Sitting Side lying

Extension Gluteus maximusHamstrings

ProneProne

Side lying

Abduction Gluteus mediusGluteus minimus

Side lying Supine

Adduction Adductor longusAdductor brevisAdductor magnus GracilisPectineus

Side lying Supine

Lateralrot. PiriformisGemellussup./inf.Obturatorext./int.Quadratus fem.Gluteus maximus

Sitting Supine

Medial rot. Gluteus minimusGluteus mediusTensor fas. lat.

Sitting Supine

Knee Extension Quadriceps Sitting Side lying

Flexion HamstringsGastrocnemius

Prone Side lying


53415_CH01_FINAL.indd 16 4/23/12 12:28:52 PM

Tabl

e 1.9

M

anua

l Mus

cle Te

sting

—An

kleJo

intM

otion

Mus

cle(s)

Gravity+Fair

Grav

ity−

Poor

Ankl

eDorsiflexion

Tibial

is an

terio

rPe

rone

us te

rtius

Ext.digitlong.

Ext.hal.long.

Sittin

gSit

ting

Plant

ar fle

xion

Gastr

ocne

mius

Soleu

s St

andin

gPr

one

Plant

ar fle

xion

Soleu

sSt

andin

g (wi

th kn

ee fle

xion)

prone(with90°kneeflexion)

Inve

rsion

Tibial

is po

sterio

rTib

ialis

ante

rior

Flex.digit.long.

Flex.hal.long.

Ext.hal.long.

Sittin

gSit

ting

Eversion

Pero

neus

long

usPe

rone

us br

evis

Sittin

gSit

ting

Table 1.9 Manual Muscle Testing—Ankle 17

53415_CH01_FINAL.indd 17 4/23/12 12:28:52 PM

Table 1.10 Manual Muscle Testing—Shoulder

Joint Motion Muscle(s)Gravity+ Fair

Gravity− Poor

Shoulder Abduction DeltoidSupraspinatus

Sitting Supine

Extension DeltoidLatissimusdorsiTeres major

Prone Side lying

Flexion DeltoidCoracobrachialisPectoralis major

Sitting Side lying

horizon.abd.

DeltoidTeres minorInfraspinatus

Prone Sitting

horizon.add.

DeltoidPectoralis major

Supine Sitting

Lateralrot.

Teres minorInfraspinatusDeltoid

Prone Prone (with elbow ext.)

Medial rot.

DeltoidLatissimusdorsiTeres majorPectoralis majorSubscapularis

Prone Prone (with elbow ext.)


53415_CH01_FINAL.indd 18 4/23/12 12:28:52 PM

Tabl

e 1.1

1 M

anua

l Mus

cle Te

sting

—Elb

ow an

d Wris

tJo

intM

otion

Mus

cle(s)

Gravity+Fair

Grav

ity−

Poor

Elbo

w

Com

plex

Flexion

Bice

psBr

achia

lisBr

achio

radia

lis

Sittin

gSitting(with90°ofshoulderabd.)

Extension

Trice

psAn

cone

usprone(with90°of

shou

lder a

bd.)

Sitting(with90°ofshoulderabd.)

Supin

ation

Bice

psSu

pinat

orSitting(with90°of

elbow

flex.)

Sitting(with45°–90°ofshoulderflex.and90°ofelbow

flex.)

Pron

ation

Pron

ator

tere

sPr

onat

or qu

ad.

Sitting(with90°of

elbow

flex.)

Sitting(with45°–90°ofshoulderflex.and90°ofelbow

flex.)

Wris

tExtension

Ext.c.rad.long.

Ext.c.rad.brev.

Ext.c.ulnaris

Sittin

g (wi

th fo

rear

m

pron

ation

and e

lbow

flex.)

Sittin

g (wi

th ne

utra

l fore

arm

and e

lbow

flex.)

Flexion

Flex.carpiuln.

Flex.carpirad.

Palm

aris

longu

s

Sittin

g (wi

th fo

rear

m

supin

ation

and e

lbow

flex.)

Sittin

g (wi

th ne

utra

l fore

arm

and e

lbow

flex.)

Table1.11 ManualMuscleTesting—ElbowandWrist 19

53415_CH01_FINAL.indd 19 4/23/12 12:28:52 PM

Tabl

e 1.1

2 S

pecia

l Tes

ts Lis

ting

Joint

Test

Asse

ssmen

tSh

ould

erAp

preh

ensio

n Tes

tClu

nk Si

gnDropArmTest

Hawk

insK

enne

dy Im

pinge

men

t Tes

tIm

pinge

men

t Sign

LockTest

Neer

Impin

gem

ent S

ignO’BrienTest

Spee

d’s M

aneu

ver

Yerg

ason

’s Te

st

Ante

rior g

lenoh

umer

al ins

tabil

ityLabraldisorder

Rota

tor c

uff t

ear

Supr

aspin

atus

tend

on im

pinge

men

tImpingementofthesupraspinatusand/orlongheadofbiceps

Supr

aspin

atus

tend

on im

pinge

men

tSu

bacro

mial

impin

gem

ent

Supe

rior l

abra

l tea

rBi

ceps

tend

on in

stabil

ity or

tend

oniti

sBi

ceps

tend

on in

stabil

ity or

tend

oniti

s

Elbo

wcozen’sTest

ElbowFlexionTest

Golfer’sElbowTest

Mill’

s Tes

tTin

el’s S

ign at

elbo

w

Lateralepicondylitis

Cubit

al tu

nnel

synd

rom

eM

edial

epico

ndyli

tisLateralepicondylitis

Ulna

r ner

ve en

trapm

ent


53415_CH01_FINAL.indd 20 4/23/12 12:28:52 PM

cont

inues

Wris

t and

Han

dAl

len Te

stBunnel-LittlerTest

Carp

al Sh

ake T

est

Finkelstein’sTest

From

ent’sSign

Mur

phy’s

Sign

Phale

n’s Te

stTin

el’s T

est

Radia

l and

ulna

r arte

ry ci

rculat

ionTig

htne

ss of

intri

nsic

mus

cles

Inte

rcarp

al sy

novit

isSt

enos

ing te

nosy

novit

is of

abdu

ctor p

ollici

s lon

gus a

nd ex

tens

or

pollic

is br

evis

Ulna

r ner

ve en

trapm

ent o

f elbo

w an

d wris

tLunatedislocation

Carp

al tu

nnel

synd

rom

eCa

rpal

tunn

el sy

ndro

me

Table1.12 SpecialTestsListing 21

53415_CH01_FINAL.indd 21 4/23/12 12:28:52 PM

Hip

90–90StraightLegraise

Craig

Test

Ely’sTest

FABErorpatrick’sTest

Fulcrum

Test

OberTest

Hip P

irifo

rmis

Test

pelvicDropTest

Quad

rant

(Sco

ur) T

est

Thom

as Te

stTr

ende

lenbu

rg Si

gn

Ham

string

tigh

tnes

sAs

sess

femor

al an

teve

rsion

or re

trove

rsion

Flexibilityofrectusfemoris

hip,lumbar,sacroiliacjointdysfunctionoriliopsoasspasm

Stre

ss fra

cture

of th

e fem

oral

shaft

Tight

ness

of ili

otibi

al ba

nd an

d ten

sor f

ascia

lata

Tight

ness

of th

e piri

form

is m

uscle

Unsta

ble hi

p or w

eak e

xter

nal r

otat

ors

capsulartightness,anadhesion,myofascialrestrictionorlossofjoint

cong

ruity

Decreasedflexibilityofrectusfemorisoriliopsoas

Wea

knes

s of g

luteu

s med

ius

Tabl

e 1.1

2 S

pecia

l Tes

ts Lis

ting,

continued

Joint

Test

Asse

ssmen

t


53415_CH01_FINAL.indd 22 4/23/12 12:28:52 PM

cont

inues

Knee

AnteriorDrawTest

Apley

’s Te

stApley’sDistractionTest

Grav

ity (G

odfre

y) Si

gnhughston’sposterolateralDrawerTest

Lachman’sTest

McM

urra

y’s Te

stposteriorDraw

AcLandmedialandposteromedialcapsuloligamentousinstability

Lesionofm

eniscus

Med

ial or

late

ral c

ollat

eral

ligam

ent i

njur

ypcLinjury

Poste

rolat

eral

insta

bility

AcLinjury

Lesionofm

edialmeniscus

pcLinjury

Ankl

eBu

erge

r’s Te

stFleissLine

Gung

or Te

stHo

man

s’ Sig

nKl

eiger

Test

Mat

les Te

stM

orto

n’s Te

stTh

omps

on Te

st

Poor

ante

rior c

ircula

tion

Heigh

t of t

he m

edial

arch

Ante

rior d

isplac

emen

t of t

he ta

lusDeep-veinthrombosis

Inte

grity

of m

edial

(delt

oid) l

igam

ent

Chro

nic A

chille

s ten

don r

uptu

rePr

esen

ce of

neur

oma o

r a st

ress

fractu

reAc

ute A

chille

s ten

don r

uptu

re

Table1.12 SpecialTestsListing 23

53415_CH01_FINAL.indd 23 4/23/12 12:28:52 PM

Cran

iove

rteb

ral

Barré

’s Te

stDix-hallpikeTest

Mod

ified

Shar

pPu

rser T

est

Verte

bral

arte

ry in

suffi

cienc

yVe

stibu

lar im

pairm

ent—

accu

mula

tion o

f utri

cle de

bris

Excessivetranslationofatlas

Cerv

ical S

pine

Com

pres

sion T

est

Hype

rabd

uctio

n Man

euve

r (W

right

Test)

Spur

ling’s

Test

Stre

ss Te

st

Brac

hial p

lexus

injur

yTh

orac

ic ou

tlet c

ompr

essio

n Ne

rve r

oot i

rrita

bility

Brac

hial p

lexus

injur

y

Sacr

oilia

c Joi

ntGa

ensle

n’s Te

stYe

oman

’s Te

stSacroiliaclesion,hippathology,orL4nerverootlesion

Prob

lem at

the s

acro

iliac j

oint

AcL=anteriorcruciateligament;pcL=posteriorcruciateligament.

Tabl

e 1.1

2 S

pecia

l Tes

ts Lis

ting,

continued

Joint

Test

Asse

ssmen

t


53415_CH01_FINAL.indd 24 4/23/12 12:28:52 PM

cont

inues

Tabl

e 1.1

3 S

elec

ted S

pecia

l Tes

t Des

cript

ions

Na

me

Asse

ssmen

tPo

sitive

Test

SHOU

LDER

D

rop

Arm

Test

Posit

ive te

st m

ay in

dicat

e rot

ator

cuff

tear

.Ab

duct

the s

hould

er ag

ainst

grav

ity. In

struc

t pat

ient t

o slow

ly low

er

arm

to si

de.

The p

atien

t will

not b

e able

to lo

wer a

rm sm

ooth

ly an

d slow

ly; th

e ar

m w

ill dr

op.

H

awki

ns-K

enne

dy

Test

Posit

ive te

st m

ay in

dicat

e im

pinge

men

t sy

ndro

me i

nvolv

ing th

e sup

rasp

inatu

s.Flextheshoulderandelbowto90°theninternallyrotatethe

shou

lder.

The p

atien

t will

com

plain

of pa

in.

Im

ping

emen

t Si

gnPo

sitive

test

may

indic

ate i

mpin

gem

ent

ofthesupraspinatusand/orlonghead

of th

e bice

ps.

Whensitting,passivelyhorizontallyadducttheshoulderwitharmin

90°ofshoulderflexion.

Patie

nt w

ill ha

ve pa

in at

the e

nd ra

nge.

N

eer T

est

Posit

ive te

st m

ay in

dicat

e sho

ulder

im

pinge

men

t inv

olving

the b

iceps

te

ndon

.

Passi

vely

and f

orcib

ly fle

x the

shou

lder.

Patie

nt w

ill co

mpla

in of

pain.

Table1.13 SelectedSpecialTestDescriptions 25

53415_CH01_FINAL.indd 25 4/23/12 12:28:52 PM

Sp

eed’s

Test

Posit

ive te

st m

ay in

dicat

e bici

pital

tend

oniti

s.Flextheshoulderagainstgravityabout60°w

iththeelbowextended

and f

orea

rm su

pinat

ed.

Isom

etric

ally r

esist

shou

lder f

lexion

at th

e for

earm

.Pa

tient

will

com

plain

of pa

in at

the b

icipit

al gr

oove

.

Ye

rgas

on’s T

est

Posit

ive te

st m

ay in

dicat

e bici

pital

tend

oniti

s.positiontheshoulderatthesideandflextheelbowto90°and

pron

ate t

he fo

rear

m.

Resis

t sup

inatio

n and

exte

rnal

rota

tion.

Patie

nt w

ill co

mpla

in of

pain

at th

e bici

pital

groo

ve.

ELBO

W

Gol

fer’s

Elbo

w

Test

Posit

ive te

st m

ay in

dicat

e med

ial

epico

ndyli

tis.

Stabilizetheelbow.Supinatethepatient’sforearmwhileextending

the e

lbow

and w

rist.

Patie

nt w

ill co

mpla

in of

pain

at th

e med

ial ep

icond

yle.

M

ill’s T

est

Posit

ive te

st m

ay in

dicat

e lat

eral

epico

ndyli

tis.

Stabilizetheelbow.Askthepatienttopronatetheforearmand

exte

nd an

d rad

ially

devia

te th

e wris

t aga

inst m

anua

l res

istan

ce.

Patie

nt w

ill co

mpla

in of

pain

at th

e lat

eral

epico

ndyle

.

Tabl

e 1.1

3 S

elec

ted S

pecia

l Tes

t Des

cript

ions

, continued

Nam

eAs

sessm

ent

Posit

ive Te

st


53415_CH01_FINAL.indd 26 4/23/12 12:28:53 PM

cont

inues

Ti

nel’s

Test

Posit

ive te

st m

ay in

dicat

e a pr

oblem

wi

th th

e uln

ar ne

rve.

Flextheelbowto90°.Tapovertheulnarnerve.

Patie

nt w

ill co

mpla

in of

pare

sthes

ias al

ong t

he ul

nar n

erve

sens

ory

distri

butio

n.

WRI

ST

Bun

nel-L

ittle

r Te

stPo

sitive

test

may

indic

ate t

ightn

ess o

f th

e int

rinsic

mus

cles o

f the

hand

or a

caps

ular p

roble

m of

the j

oints.

Hold

the M

CP in

exte

nsion

and m

ove t

he PI

P int

o flex

ion.

The P

IP w

ill no

t be a

ble to

be fle

xed.

P

hale

n’s Te

stPo

sitive

test

may

indic

ate c

arpa

l tun

nel

synd

rom

e.Th

e pat

ient f

lexes

both

wris

ts an

d pre

sses t

he do

rsal s

urfac

es ag

ainst

each

othe

r to m

ainta

in fle

xion f

or 1

minu

te.

The p

atien

t will

expe

rienc

e par

esth

esias

alon

g the

med

ian ne

rve

sens

ory d

istrib

ution

.

Ti

nel’s

Sign

Posit

ive te

st m

ay in

dicat

e lat

eral

epico

ndyli

tis.

Supin

ate t

he fo

rear

m. T

ap ov

er th

e med

ian ne

rve.

The p

atien

t will

expe

rienc

e par

esth

esias

alon

g the

med

ian ne

rve

sens

ory d

istrib

ution

.


53415_CH01_FINAL.indd 27 4/23/12 12:28:53 PM

HIP

O

ber T

est

Posit

ive te

st m

ay in

dicat

e tigh

tnes

s of

the i

liotib

ial ba

nd or

tens

or fa

scia l

atae

.Po

sition

the p

atien

t in s

ide ly

ing on

the u

ninvo

lved l

imb.

Abd

uct a

nd

extendtheuphillhip,andthenreleasethelimb.

The l

imb w

ill no

t low

er to

the u

ninvo

lved l

imb.

P

irifo

rmis

Test

Posit

ive te

st m

ay in

dicat

e tigh

tnes

s of

the p

irifo

rmis

mus

cle.

positionthepatientinsidelyingontheuninvolvedlimb.Flexthe

hipto60°–90°andthekneeto90°.Stabilizethepelvisandadduct

the h

ip to

the t

able.

The p

atien

t will

com

plain

of pa

in in

the b

utto

cks.

Th

omas

Test

Posit

ive te

st m

ay in

dicat

e hip

flexio

n co

ntra

cture

.Pla

ce pa

tient

in su

pine.

Have

patie

nt fle

x bot

h hips

and k

nees

to th

e ch

est.

Instr

uct p

atien

t to e

xten

d one

limb t

o the

table

.Th

e pat

ient w

ill be

unab

le to

fully

exte

nd th

e lim

b.

Tr

ende

lenb

urg

Sign

Posit

ive te

st m

ay in

dicat

e wea

knes

s of

the g

luteu

s med

ius.

Have

patie

nt st

and o

n one

leg.

The p

elvis

will d

rop t

o the

nonin

volve

d side

.

Tabl

e 1.1

3 S

elec

ted S

pecia

l Tes

t Des

cript

ions

, continued

Nam

eAs

sessm

ent

Posit

ive Te

st


53415_CH01_FINAL.indd 28 4/23/12 12:28:53 PM

KNEE

90

–90 S

trai

ght

Leg

Raise

Test

Posit

ive te

st m

ay in

dicat

e tigh

tnes

s of

the h

amstr

ings.

Insupine,havethepatientflexthehipandkneeto90°.Usingthe

patient’sorclinician’shandstom

aintainhipflexion,extend

knee

as m

uch a

s pos

sible.

patientisunabletoextendkneebeyond–20°extension.

A

pley

’s (C

ompr

essio

n)

Test

Posit

ive te

st m

ay in

dicat

e men

iscus

da

mag

e.havethepatientassumethepronepositionandflexthekneeto90°.

Withtheclinician’shandsontheplantarsurfaceofthefoot,

inter

nally

and e

xter

nally

rota

te th

e leg

whil

e pre

ssing

down

.Pa

tient

will

com

plain

of pa

in at

the k

nee.

A

pley

’s Di

stra

ctio

n Te

stPo

sitive

test

may

indic

ate c

ollat

eral

ligam

ent d

amag

e.havethepatientassumethepronepositionandflexthekneeto90°.

Use o

ne ha

nd to

gras

p the

leg j

ust p

roxim

al to

the m

alleo

li and

distractthelegwhiletheotherhandstabilizesattheposteriorthigh.

Patie

nt w

ill co

mpla

in of

pain

at th

e kne

e.


53415_CH01_FINAL.indd 29 4/23/12 12:28:53 PM

Tabl

e 1.1

4 V

ital S

igns

Note:

Nor

mal

value

s may

vary

from

one l

abor

ator

y to a

noth

er. T

he va

lues p

rese

nted

in th

ese c

harts

shou

ld no

t be c

onsid

ered

abso

lute.

Vita

l Sign

Age G

roup

Norm

al Ra

nge

Hear

t Rat

e (Pu

lse)

Newb

orns

1 y 2–6 y

8–12

y13

–16 y

Adult

s

70–190beats/m

in80–160beats/m

in70–125beats/m

in70–110beats/m

in60–100beats/m

in55–100beats/m

in

Bloo

d Pr

essu

reBi

rth–1

mo

2–36

mo

36 m

o–ad

ult

Systo

lic: 6

0–90

mm

Hg

Diastolic:30–60mmhg

Systo

lic: 7

5–13

0 mm

Hg


Systo

lic: 9

0–14

0 mm

Hg



53415_CH01_FINAL.indd 30 4/23/12 12:28:53 PM

Resp

irato

ry R

ate

Birth

–1 m

o3 m

o–6 y

6–10

y10

–16 y

Adult

s

35–55breaths/min

20–30breaths/min

15–25breaths/min

12–30breaths/min

12–20breaths/min

Oxyg

en Sa

tura

tion

(as m

easu

red

w

ith a

pulse

oxim

eter

)No

rmal

oxyg

en sa

tura

tion a

t res

t or d

uring

exer

cise

is 98

%.

Exercisem

aybecontraindicatedinvaluesof≤90%.

Table 1.14 Vital Signs 31

53415_CH01_FINAL.indd 31 4/23/12 12:28:53 PM

References American Spinal Injury Association. (2005). International

standard for neurological classification of spinal cord injury. Chicago: ASIA.

Dutton,M.(2008).Orthopedic examination, evaluation and intervention.SecondEdition.philadelphia:McGrawhill.

Goodman,c.,Boissonault,W.,&Fuller,K.(2009).Pathology: Implications for the physical therapist. Third edition. Philadelphia: Saunders.

hislop,h.,&Montgomery,J.(2007).Daniels and Worthingham’s muscle testing: Techniques of manual examination.Eighthedition. Philadelphia: W.B. Saunders Company.

hoppenfeld,S.(1976).Physical examination of the spine and extremities.Norwalk,cT:prenticehall.

Norkin,c.,&White,J.(2009).Measurement of joint motion: A guide to goniometry.Fourthedition.philadelphia:F.A.Davis.

palmer,L.,&Epler,M.(1998).Fundamentals of musculoskeletal assessment techniques.philadelphia:Lippincott.


53415_CH01_FINAL.indd 32 4/23/12 12:28:53 PM

chapter normal values and assessments

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