Orthopedic Special Tests & Differential Diagnosis Flashcards

A positive Spurling's test—cervical compression with lateral flexion and slight extension toward the symptomatic side reproducing arm symptoms—most strongly indicates:

Answer: Cervical radiculopathy

Spurling's test narrows the intervertebral foramen ipsilaterally, compressing an irritated cervical nerve root and reproducing radicular symptoms into the arm, confirming cervical radiculopathy.

Vertebral artery screening tests (such as the Sharp-Purser or combined cervical extension-rotation test) are performed PRIMARILY to:

Answer: Screen for contraindications to cervical high-velocity manipulation

Vertebral artery screening rules out vertebrobasilar insufficiency before applying high-velocity cervical techniques, because manipulation could compromise blood flow and cause serious neurological events.

A positive straight leg raise (SLR) that reproduces radicular leg pain between 30° and 60° of hip flexion most strongly indicates:

Answer: Lumbar nerve root irritation

SLR at 30-60° creates dural tension on the sciatic nerve roots; reproduction of radicular pain at this early range indicates nerve root irritation, most commonly from a herniated lumbar disc.

The Slump test is most useful for differentiating lumbar nerve root compression from:

Answer: Sacroiliac joint dysfunction or local hip pathology

The Slump test applies neural tension through the entire spinal canal; reproduction of radicular symptoms with neural loading (and relief with cervical extension) confirms neurodynamic involvement rather than local sacroiliac or hip pathology.

Waddell's non-organic signs are best described as indicators of:

Answer: Non-organic or psychosocial contributors to low back pain

Waddell's signs identify non-organic pain behaviors and psychosocial yellow flags that may amplify the pain experience; they do not diagnose malingering but signal the need for a biopsychosocial management approach.

Kemp's test (lumbar extension combined with ipsilateral lateral flexion and rotation) most likely reproduces symptoms associated with:

Answer: Lumbar facet joint syndrome

Kemp's test closes the ipsilateral facet joints and narrows the intervertebral foramen, reproducing local or referred pain consistent with lumbar facet joint syndrome.

When a patient demonstrates a positive Kernig's sign—pain and resistance to knee extension when the hip is flexed to 90°—the most appropriate immediate clinical action is to:

Answer: Refer immediately for medical evaluation due to possible meningeal irritation

Kernig's sign indicates meningeal irritation, which may signal meningitis or subarachnoid hemorrhage—a medical emergency requiring immediate physician referral, not manual therapy intervention.