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c h a p te r
Normal Values
and Assessments
1
ASIA Classification of Spinal Cord Injury
•• The 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.
• Dermatomal sensation assessment for pinprick and light touch is
performed and scored numerically.
• The ASIA Impairment Scale, using letters A to E, represents the
overall classification of the spinal injury.
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Chapter 1 Normal Values and Assessments
STANDARD NEUROLOGICAL CLASSIFICATION OF
SPINAL CORD INJURY
C2
C3
C4
C5
C6
C7
C8
T1
T2
T3
T4
T5
T6
T7
T8
T9
T10
T11
T12
L1
L2
L3
L4
L5
S1
S2
S3
S4-5
R
Totals
(Maximum 50
L
MOTOR
Key muscles
Elbow flexors
Wrist extensors
Elbow extensors
Finger flexors (distal phalanx of middle finger)
Finger abductors (little finger)
0 = total paralysis
1 = palpable or visible contraction
2 = active movement,
gravity eliminated
3 = active movement,
against gravity
4 = active movement,
against some resistance
5 = active movement,
against full resistance
NT = not testable
Hip flexors
Knee extensors
Ankle dorsiflexors
Long toe extensors
Ankle plantar flexors
Voluntary anal contraction (Yes/No)
+
=
50
Motor score
function
(Maximum 56
100)
NEUROLOGICAL
LEVEL
R
The most
Sensory
caudal segment
Motor
with normal
C2
C3
C4
C5
C6
C7
C8
T1
T2
T3
T4
T5
T6
T7
T8
T9
T10
T11
T12
L1
L2
L3
L4
L5
S1
S2
S3
S4-5
Totals
LIGHT
TOUCH
R L
L
Complete or
incomplete?
Incomplete = Any sensory or
motor function in S4-S5
ASIA IMPAIRMENT
SCALE
+
56
P
R
=
5
ZONE OF PARTIAL
PRESERVATION
Caudal extent of partially
innervated segments
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 permis­
sion from the American Spinal Injury Association.
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ASSIFICATION OF
TOR
uscles
halanx of middle finger)
finger)
ble contraction
nt,
ed
nt,
nt,
esistance
nt,
tance
ction (Yes/No)
plete or
mplete?
plete = Any sensory or
unction in S4-S5
IMPAIRMENT
LE
3
ASIA Classification of Spinal Cord Injury
C2
C3
C4
C5
C6
C7
C8
T1
T2
T3
T4
T5
T6
T7
T8
T9
T10
T11
T12
L1
L2
L3
L4
L5
S1
S2
S3
S4-5
Totals
LIGHT
TOUCH
R L
(Maximum 56
SENSORY
Key sensory points
PIN
PRICK
R L
0 = absent
1 = impaired
2 = normal
NT = not testable
= Key
sensory
point
C2
C3
C4
T2
T2
T3
T4
T5
T6
T7
T8
T9
T10
C5
T1
C6
C5
T1
C6
T11
Palm
L1
L1
C8
C8
Dorsum
Palm
T12
L2
C6
L2
C6
C7
C7
Dorsum
L3
L3
S3
S3
S4-5
L4
L4
L5
L2
L5
L2
L3
L3
S2
S2
S1
S1
S1
C2
L4
S1
S1
L5
L5
C3
C4
Any anal sensation (Yes/No)
+
+
56
=
56
ZONE OF PARTIAL
PRESERVATION
Caudal extent of partially
innervated segments
=
56)
Pin prick score (Max 112)
Light touch score (Max 112)
R
L
Sensory
Motor
Figure 1.1 continued
tion of Spinal Cord Injury
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Chapter 1 Normal Values and Assessments
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
neurological level, and more than half of key muscles below
the neurological level have a muscle grade less than 3.
D = Incomplete: Motor function is preserved below the
neurological level, and at least half of key muscles below the
neurological level have a muscle grade of 3 or more.
E = Normal: Motor and sensory function are normal.
Clinical Syndromes
Central Cord
Brown-Séquard
Anterior Cord
Conus Medullaris
Cauda Equina
Figure 1.2 ASIA Impairment Scale
Source: Reproduced with permission of the American Spinal Injury Association
(2005).
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Table 1.1 Blood—Complete Blood Count (CBC)
continues
Infants: 30–60%
Children: 30–49%
Men: 37–49%
Women: 36–46%
Hematocrit (HCT)
Hematocrit is the percent of whole blood composed of
erythrocytes.
Exercise may be restricted at values of ≤25%.
The ESR is the rate at which erythrocytes settle out of blood
plasma in 1 hour.
A high rate is indicative of infection or inflammation
Children: 1–13 mm/h
Men: 0–17 mm/h
Women: 1–25 mm/h
Erythrocyte Sedimentation
Rate (ESR/Sed. Rate)
Description/Implications/Red Flag Values
Individuals with lower-than-normal values have anemia.
Anemia symptoms: fatigue, weakness, SOB, dizziness,
tachycardia
Individuals with higher-than-normal values have polycythemia.
Polycythemia symptoms: SOB, headache, dizziness, itchiness.
Values
Red Blood Cells (RBCs) (erythrocytes) Infants:
5.5–6.0 million/mm3
Children:
4.6–4.8 million/mm3
Men:
4.5–5.3 million/mm3
Women:
4.1–5.1 million/mm3
Assessment Component
Note: Normal values may vary from one laboratory to another. The values presented in these charts should not be considered absolute.
Table 1.1 Blood—Complete Blood Count (CBC) 5
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Table 1.1 Blood—Complete Blood Count (CBC), continued
Values
Infants: 17–19 g/dL
Children: 14–17 g/dL
Men: 13–18 g/dL
Women: 12–16 g/dL
Units: cells/mm3
Infants: 200,000–
475,000
Children: 150,000–
400,000
Adults: 150,000–400,000
Units: cells/mm3
Children: 4,500–14,500
Adults: 4,500–11,000
Assessment Component
Hemoglobin (HGB)
Platelets
White Blood Cells (WBCs)
White blood cells play a crucial role in the body’s immune
reaction.
Exercise may not be permitted at values of ≤5,000 cells/mm3.
Platelets play a key role in the initiation of the clotting process
within damaged blood vessels.
Exercise may be cautiously performed with values of 21,000–
50,000 cells/mm3.
Exercise may be contraindicated at values of ≤20,000 cells/mm3.
HGB measures the oxygen-carrying capacity of RBCs. Low
values between 8 and 10 g/dL are associated with poor exercise
tolerance, increased fatigue, and tachycardia.
Description/Implications/Red Flag Values
Note: Normal values may vary from one laboratory to another. The values presented in these charts should not be considered absolute.
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Chapter 1 Normal Values and Assessments
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Differential WBC Count
Neutrophils:
1,800–7,000 cells/mm3
Lymphocytes:
1,500–4,000 cells/mm3
Monocytes:
0–800 cells/mm3
Eosinophils:
0–450 cells/mm3
Basophils:
0–200 cells/mm3
The various white blood cells play different roles in the immune
process. They exist in stereotypical proportions.
Table 1.1 Blood—Complete Blood Count (CBC) 7
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Table 1.2 Blood—Electrolytes
Values
Children: 3.5–5.5 mEq/L
Adults: 3.5–5.3 mEq/L
135–145 mEq/L
Children: 98–105 mEq/L
Adults: 95–105 mEq/L
Children: 9–11.5 mg/dL
Adults: 9–11 mg/dL
Children: 1.6–2.6 mEq/L
Adults: 1.5–2.5 mEq/L
Assessment Component
Potassium
Sodium
Chloride
Calcium
Magnesium
Hypocalcemia: paresthesias, muscle spasms
Hypercalcemia: lethargy, muscle weakness, flaccidity, bone pain
Hypomagnesemia: muscle cramping, tetany, confusion
Hypermagnesemia: decreased reflexes, muscle weakness, lethargy
Hypokalemia: dizziness, muscle weakness, fatigue, leg cramps
Hyperkalemia: muscle weakness, flaccid paralysis, paresthesias
Hyponatremia: muscle twitching, weakness
Hypernatremia: fever, convulsions
Chloride shifts are most often associated with shifts in sodium.
Description/Implications/Red Flag Values
Note: Normal values may vary from one laboratory to another. The values presented in these charts should not be considered absolute.
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Chapter 1 Normal Values and Assessments
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Table 1.3 Blood—Prothrombin Time
Values
12–15 sec
30–40 sec
Assessment Component
Prothrombin Time (PT)
Partial Prothrombin Time (PTT)
This assessment measures the clotting ability of blood.
Measures of 1.5 to 2.5 times the reference range are considered therapeutic.
Physical therapy may be contraindicated at values of ≥2.5 times the reference
range in individuals not taking anticoagulants and values of ≥2.5–3.0 times the
reference range for those taking anticoagulant medications.
Description/Implications/Red Flag Values
Note: Normal values may vary from one laboratory to another. The values presented in these charts should not be considered absolute.
Table 1.3 Blood—Prothrombin Time
9
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Chapter 1 Normal Values and Assessments
SENSORY
Key sensory points
= Key
sensory
point
C2
C3
C4
T2
T1
C6
L1
Palm
Dorsum
C8
C6
T2
T3
T4
T5
T6
T7
T8
T9
T10
T11
C5
C5
T1
C6
T12
L1
L2
L2
L3
L3
Palm
C6
C8
C7
C7
Dorsum
S3 S3
S4-5
L4
L4
L5
L5
L2 L2
L3
L3
S2
S2
S1
S1
S1
C2
L4
S1
L5
S1
L5
C3
C4
Figure 1.3 Key Sensory Points
Source: Reproduced with permission of the American Spinal Injury Association
(2005).
ASIA Standard Neurological Classification of Spinal Cord Injury Chart
Jones and Bartlett Publishers
Elizabeth Morales Illustration Services
Figure 38115_CH01_0103.eps Date 04-13-06
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Range of Motion—Lower Extremity Percentages
11
Table 1.4 Range of Motion—Lower Extremity and Spine
Note: Values are according to the American Academy of Orthopedic Surgeons.
Joint
Hip
Hip
Flexion
Extension
Adduction
Abduction
Lateral rotation
Medial rotation
Flexion
Dorsiflexion
Plantar flexion
Inversion
Eversion
Flexion
Extension
Rotation
Lateral flexion
Flexion
Extension
Rotation
Lateral flexion
Knee
Ankle
Cervical
Thoracolumbar
Range of Motion
(in degrees)
0–120
0–30
0–30
0–45
0–45
0–45
0–150
0–20
0–50
0–35
0–15
0–45
0–45
0–60
0–45
0–80
0–25
0–35
0–45
Range of Motion—Lower Extremity Percentages
In some instances, it may be preferable to report measured range of
motion as a percentage of normal values. This may be especially true
when setting or interpreting long- and short-term goals and for report­
ing to third-party 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
from the chart that is closest to the measured joint range (e.g., 95° of
knee flexion represents an approximate 30% deficit).
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Hip flex.
Abd.
Add.
Ext. rot.
Int. rot.
Ext.
Knee flex.
Ankle dorsi.
Plantar
Invers.
Evers.
120 114 108 102 96 90 84
45 32 41 38 36 34 32
30 29 27 26 24 23 21
45 42 41 38 36 34 32
45 42 41 38 36 34 32
30 29 27 26 24 23 21
150 143 135 128 120 113 105
20 19 18 17 16 15 14
50 48 45 43 40 38 35
35 33 32 30 28 26 25
15 14 14 13 12 11 11
78
29
20
29
29
20
98
13
33
23
10
72
27
18
27
27
18
90
12
30
21
9
66
25
17
25
25
17
83
11
28
19
8
60
23
15
23
23
15
75
10
25
18
8
54
20
14
20
20
14
68
9
23
16
7
48
18
12
18
18
12
60
8
20
14
6
42
16
11
16
16
11
53
7
18
12
5
36
14
9
14
14
9
45
6
15
11
5
30
11
8
11
11
8
38
5
13
9
4
24
9
6
9
9
6
30
4
10
7
3
18
7
5
7
7
5
23
3
8
5
2
12
5
3
5
5
3
15
2
5
4
2
6
2
2
2
2
2
8
1
3
2
1
Table 1.5 Range of Motion—Lower Extremity Percentages
95 90 85 80 75 70 65 60 55 50 45 40 35 30 25 20 15 10 5
5 10 15 20 25 30 35 40 45 50 55 60 65 70 75 80 85 90 95
% of Normal 100
% of Deficit
0
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Chapter 1 Normal Values and Assessments
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Table 1.6 Range of Motion—Upper Extremity
13
Table 1.6 Range of Motion—Upper Extremity
Note: Values are according to the American Academy of Orthopedic Surgeons.
Joint
Motion
Shoulder
Flexion
Extension
Abduction
Lateral rotation
Medial rotation
Flexion
Pronation
Supination
Flexion
Extension
Radial deviation
Ulnar deviation
CMC flexion
CMC extension
CMC abduction
MCP flexion
IP flexion
MCP flexion
MCP hyperextension
MCP abduction
PIP flexion
DIP flexion
DIP hyperextension
Elbow Complex
Wrist
Thumb
2nd through
5th digits
Range of Motion
(in degrees)
0–180
0–60
0–180
0–90
0–70
0–150
0–80
0–80
0–80
0–70
0–20
0–30
0–15
0–20
0–70
0–50
0–80
0–90
0–45
0–45
0–100
0–90
0–10
CMC=carpometacarpal; DIP=interphalangeal distal; IP=interphalangeal;
MCP=metacarpophalangeal; PIP=posterior interphalangeal.
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% of Normal
% of Deficit
Shoulder abd.
Flexion
Ext. rot.
Int. rot.
Extension
Elbow flex.
Pron./Supin.
Wrist flexion
Ext.
Rad. dev.
Uln. dev.
100
0
180
180
90
70
60
150
80
80
70
20
30
95
5
171
171
86
67
57
143
76
76
67
19
29
90
10
162
162
81
63
54
135
72
72
63
18
27
85
15
153
153
77
60
51
128
68
68
60
17
26
80
20
144
144
72
56
48
120
64
64
56
16
24
75
25
135
135
68
53
45
113
60
60
53
15
23
70
30
126
126
63
49
42
105
56
56
49
14
21
65
35
117
117
59
46
39
98
52
52
46
13
29
60
40
108
108
54
42
36
90
48
48
42
12
18
Table 1.7 Range of Motion—Upper Extremity Percentages
(See rationale and use instructions on page 15.)
55
45
99
99
50
39
33
83
44
44
39
11
17
50
50
90
90
45
35
30
75
40
40
35
10
15
45
55
81
81
41
32
27
68
36
36
32
9
14
40
60
72
72
36
28
24
60
32
32
28
8
12
35
65
63
63
32
25
21
53
28
28
25
7
11
30
70
54
54
27
21
18
45
24
24
21
6
9
25
75
45
45
23
18
15
38
20
20
18
5
8
20
80
36
36
18
14
12
30
17
17
14
4
6
15 10
85 90
27 18
27 18
14 9
11 7
9 6
23 15
12 8
12 8
11 7
3 2
5 3
5
95
9
9
5
4
3
8
4
4
4
1
2
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Chapter 1 Normal Values and Assessments
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Thumb
CMC flex.
15
CMC ext.
20
CMC abd.
70
MCP flex.
50
IP flex.
80
Digits 2-5
MCP flex.
90
MCP hypex. 45
MCP abd.
45
PIP flex.
100
DIP flex.
90
DIP hypetxt. 10
14
18
63
45
72
81
41
41
90
81
9
14
19
67
48
76
86
43
43
95
86
9
77
38
38
85
77
9
13
17
60
43
68
72
36
36
80
72
8
12
16
56
40
64
68
34
34
75
68
8
11
15
53
38
60
63
32
32
70
63
7
11
14
49
35
56
59
29
29
65
59
7
10
13
46
33
52
54
27
27
60
54
6
9
12
42
30
48
50
25
25
55
50
6
8
11
39
28
44
45
23
23
50
45
5
8
10
35
25
40
41
20
20
45
41
5
7
9
32
23
36
36
18
18
40
36
4
6
8
28
20
32
32
16
16
35
32
4
5
7
25
18
28
27
14
14
30
27
3
5
6
21
15
24
23
11
11
25
23
3
4
5
18
13
20
18
9
9
20
18
2
3
4
14
10
17
14
7
7
15
14
2
2
3
11
8
12
9
5
5
10
9
1
2
2
7
5
8
5
2
2
5
5
1
1
1
4
3
4
Table 1.7 Range of Motion—Upper Extremity Percentages 15
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Chapter 1 Normal Values and Assessments
Table 1.8 Manual Muscle Testing—Hip and Knee
Gravity+ Gravity−
Joint Motion
Muscle(s)
Fair
Poor
Hip
Iliopsoas
Rectus femoris
Pectineus
Tensor fas. latae
Sartorius
Gluteus maximus
Hamstrings
Sitting
Side lying
Prone
Prone
Side lying
Abduction
Gluteus medius
Gluteus minimus
Side lying Supine
Adduction
Adductor longus
Adductor brevis
Adductor magnus
Gracilis
Pectineus
Piriformis
Gemellus sup./inf.
Obturator ext./int.
Quadratus fem.
Gluteus maximus
Gluteus minimus
Gluteus medius
Tensor fas. lat.
Quadriceps
Hamstrings
Gastrocnemius
Side lying Supine
Flexion
Extension
Lateral rot.
Medial rot.
Knee Extension
Flexion
Sitting
Supine
Sitting
Supine
Sitting
Prone
Side lying
Side lying
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Sitting
Eversion
Plantar flexion
Inversion
Plantar flexion
Soleus
Tibialis posterior
Tibialis anterior
Flex. digit. long.
Flex. hal. long.
Ext. hal. long.
Peroneus longus
Peroneus brevis
Sitting
Standing (with knee flexion)
Sitting
Standing
Gravity+ Fair
Tibialis anterior
Peroneus tertius
Ext. digit long.
Ext. hal. long.
Gastrocnemius
Soleus
Ankle
Dorsiflexion
Table 1.9 Manual Muscle Testing—Ankle
Joint
Motion
Muscle(s)
Sitting
Prone (with 90° knee flexion)
Sitting
Prone
Sitting
Gravity− Poor
Table 1.9 Manual Muscle Testing—Ankle
17
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Chapter 1 Normal Values and Assessments
Table 1.10 Manual Muscle Testing—Shoulder
Gravity+ Gravity−
Joint
Motion Muscle(s)
Fair
Poor
Shoulder Abduction Deltoid
Supraspinatus
Extension Deltoid
Latissimus dorsi
Teres major
Flexion
Deltoid
Coracobrachialis
Pectoralis major
Horizon. Deltoid
abd.
Teres minor
Infraspinatus
Horizon. Deltoid
add.
Pectoralis major
Lateral
rot.
Medial
rot.
Sitting
Supine
Prone
Side lying
Sitting
Side lying
Prone
Sitting
Supine
Sitting
Prone
Teres minor
Infraspinatus
Deltoid
Prone
Deltoid
Latissimus dorsi
Teres major
Pectoralis major
Subscapularis
Prone
(with
elbow ext.)
Prone
(with
elbow ext.)
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Wrist
Elbow
Complex
Flexion
Extension
Pronation
Supination
Extension
Flexion
Biceps
Supinator
Pronator teres
Pronator quad.
Ext. c. rad. long.
Ext. c. rad. brev.
Ext. c. ulnaris
Flex. carpi uln.
Flex. carpi rad.
Palmaris longus
Biceps
Brachialis
Brachioradialis
Triceps
Anconeus
Sitting (with 90° of
elbow flex.)
Sitting (with 90° of
elbow flex.)
Sitting (with forearm
pronation and elbow
flex.)
Sitting (with forearm
supination and elbow
flex.)
Prone (with 90° of
shoulder abd.)
Sitting
Table 1.11 Manual Muscle Testing—Elbow and Wrist
Joint
Motion
Muscle(s)
Gravity+ Fair
Gravity− Poor
Sitting (with neutral forearm and elbow flex.)
Sitting (with 45°–90° of shoulder flex. and 90° of elbow
flex.)
Sitting (with 45°–90° of shoulder flex. and 90° of elbow
flex.)
Sitting (with neutral forearm and elbow flex.)
Sitting (with 90° of shoulder abd.)
Sitting (with 90° of shoulder abd.)
Table 1.11 Manual Muscle Testing—Elbow and Wrist
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Apprehension Test
Clunk Sign
Drop Arm Test
Hawkins-Kennedy Impingement Test
Impingement Sign
Lock Test
Neer Impingement Sign
O’Brien Test
Speed’s Maneuver
Yergason’s Test
Cozen’s Test
Elbow Flexion Test
Golfer’s Elbow Test
Mill’s Test
Tinel’s Sign at elbow
Shoulder
Elbow
Table 1.12 Special Tests Listing
Joint
Test
Lateral epicondylitis
Cubital tunnel syndrome
Medial epicondylitis
Lateral epicondylitis
Ulnar nerve entrapment
Anterior glenohumeral instability
Labral disorder
Rotator cuff tear
Supraspinatus tendon impingement
Impingement of the supraspinatus and/or long head of biceps
Supraspinatus tendon impingement
Subacromial impingement
Superior labral tear
Biceps tendon instability or tendonitis
Biceps tendon instability or tendonitis
Assessment
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Wrist and Hand
Froment’s Sign
Murphy’s Sign
Phalen’s Test
Tinel’s Test
Allen Test
Bunnel-Littler Test
Carpal Shake Test
Finkelstein’s Test
Radial and ulnar artery circulation
Tightness of intrinsic muscles
Intercarpal synovitis
Stenosing tenosynovitis of abductor pollicis longus and extensor
pollicis brevis
Ulnar nerve entrapment of elbow and wrist
Lunate dislocation
Carpal tunnel syndrome
Carpal tunnel syndrome
continues
Table 1.12 Special Tests Listing
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Hip
Thomas Test
Trendelenburg Sign
90–90 Straight Leg Raise
Craig Test
Ely’s Test
FABER or Patrick’s Test
Fulcrum Test
Ober Test
Hip Piriformis Test
Pelvic Drop Test
Quadrant (Scour) Test
Table 1.12 Special Tests Listing, continued
Joint
Test
Hamstring tightness
Assess femoral anteversion or retroversion
Flexibility of rectus femoris
Hip, lumbar, sacroiliac joint dysfunction or iliopsoas spasm
Stress fracture of the femoral shaft
Tightness of iliotibial band and tensor fascia lata
Tightness of the piriformis muscle
Unstable hip or weak external rotators
Capsular tightness, an adhesion, myofascial restriction or loss of joint
congruity
Decreased flexibility of rectus femoris or iliopsoas
Weakness of gluteus medius
Assessment
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Ankle
Knee
Anterior Draw Test
Apley’s Test
Apley’s Distraction Test
Gravity (Godfrey) Sign
Hughston’s Posterolateral Drawer Test
Lachman’s Test
McMurray’s Test
Posterior Draw
Buerger’s Test
Fleiss Line
Gungor Test
Homans’ Sign
Kleiger Test
Matles Test
Morton’s Test
Thompson Test
ACL and medial and posteromedial capsuloligamentous instability
Lesion of meniscus
Medial or lateral collateral ligament injury
PCL injury
Posterolateral instability
ACL injury
Lesion of medial meniscus
PCL injury
Poor anterior circulation
Height of the medial arch
Anterior displacement of the talus
Deep-vein thrombosis
Integrity of medial (deltoid) ligament
Chronic Achilles tendon rupture
Presence of neuroma or a stress fracture
Acute Achilles tendon rupture
continues
Table 1.12 Special Tests Listing
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Barré’s Test
Dix-Hallpike Test
Modified Sharp-Purser Test
Compression Test
Hyperabduction Maneuver (Wright Test)
Spurling’s Test
Stress Test
Gaenslen’s Test
Yeoman’s Test
ACL=anterior cruciate ligament; PCL=posterior cruciate ligament.
Sacroiliac Joint
Cervical Spine
Craniovertebral
Table 1.12 Special Tests Listing, continued
Joint
Test
Assessment
Vertebral artery insufficiency
Vestibular impairment—accumulation of utricle debris
Excessive translation of atlas
Brachial plexus injury
Thoracic outlet compression
Nerve root irritability
Brachial plexus injury
Sacroiliac lesion, hip pathology, or L4 nerve root lesion
Problem at the sacroiliac joint
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Positive test may indicate rotator cuff
tear.
Positive Test
Abduct the shoulder against gravity. Instruct patient to slowly lower
arm to side.
The patient will not be able to lower arm smoothly and slowly; the
arm will drop.
Hawkins-Kennedy Positive test may indicate impingement Flex the shoulder and elbow to 90° then internally rotate the
Test
syndrome involving the supraspinatus. shoulder.
The patient will complain of pain.
I mpingement
Positive test may indicate impingement When sitting, passively horizontally adduct the shoulder with arm in
Sign
of the supraspinatus and/or long head 90° of shoulder flexion.
of the biceps.
Patient will have pain at the end range.
Passively and forcibly flex the shoulder.
Neer Test
Positive test may indicate shoulder
impingement involving the biceps
Patient will complain of pain.
tendon.
continues
SHOULDER
Drop Arm Test
Table 1.13 Selected Special Test Descriptions
Name
Assessment
Table 1.13 Selected Special Test Descriptions 25
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Mill’s Test
Positive test may indicate lateral
epicondylitis.
Positive test may indicate medial
epicondylitis.
Positive test may indicate bicipital
tendonitis.
Yergason’s Test
ELBOW
Golfer’s Elbow
Test
Positive test may indicate bicipital
tendonitis.
Speed’s Test
Stabilize the elbow. Supinate the patient’s forearm while extending
the elbow and wrist.
Patient will complain of pain at the medial epicondyle.
Stabilize the elbow. Ask the patient to pronate the forearm and
extend and radially deviate the wrist against manual resistance.
Patient will complain of pain at the lateral epicondyle.
Flex the shoulder against gravity about 60° with the elbow extended
and forearm supinated.
Isometrically resist shoulder flexion at the forearm.
Patient will complain of pain at the bicipital groove.
Position the shoulder at the side and flex the elbow to 90° and
pronate the forearm.
Resist supination and external rotation.
Patient will complain of pain at the bicipital groove.
Table 1.13 Selected Special Test Descriptions, continued
Name
Assessment
Positive Test
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Tinel’s Sign
Phalen’s Test
WRIST
Bunnel-Littler
Test
Tinel’s Test
Positive test may indicate lateral
epicondylitis.
Positive test may indicate tightness of
the intrinsic muscles of the hand or a
capsular problem of the joints.
Positive test may indicate carpal tunnel
syndrome.
Positive test may indicate a problem
with the ulnar nerve.
Table 1.13 Selected Special Test Descriptions continues
The patient flexes both wrists and presses the dorsal surfaces against
each other to maintain flexion for 1 minute.
The patient will experience paresthesias along the median nerve
sensory distribution.
Supinate the forearm. Tap over the median nerve.
The patient will experience paresthesias along the median nerve
sensory distribution.
Hold the MCP in extension and move the PIP into flexion.
The PIP will not be able to be flexed.
Flex the elbow to 90°. Tap over the ulnar nerve.
Patient will complain of paresthesias along the ulnar nerve sensory
distribution.
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T rendelenburg
Sign
Thomas Test
Piriformis Test
HIP
Ober Test
Positive test may indicate tightness of Position the patient in side lying on the uninvolved limb. Abduct and
the iliotibial band or tensor fascia latae. extend the uphill hip, and then release the limb.
The limb will not lower to the uninvolved limb.
Positive test may indicate tightness of Position the patient in side lying on the uninvolved limb. Flex the
the piriformis muscle.
hip to 60°–90° and the knee to 90°. Stabilize the pelvis and adduct
the hip to the table.
The patient will complain of pain in the buttocks.
Positive test may indicate hip flexion
Place patient in supine. Have patient flex both hips and knees to the
contracture.
chest. Instruct patient to extend one limb to the table.
The patient will be unable to fully extend the limb.
Positive test may indicate weakness of Have patient stand on one leg.
the gluteus medius.
The pelvis will drop to the noninvolved side.
Table 1.13 Selected Special Test Descriptions, continued
Name
Assessment
Positive Test
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Positive test may indicate meniscus
damage.
Positive test may indicate collateral
ligament damage.
A pley’s
Distraction Test
Positive test may indicate tightness of
the hamstrings.
A pley’s
(Compression)
Test
KNEE
90–90 Straight
Leg Raise Test
Have the patient assume the prone position and flex the knee to 90°.
With the clinician’s hands on the plantar surface of the foot,
internally and externally rotate the leg while pressing down.
Patient will complain of pain at the knee.
Have the patient assume the prone position and flex the knee to 90°.
Use one hand to grasp the leg just proximal to the malleoli and
distract the leg while the other hand stabilizes at the posterior thigh.
Patient will complain of pain at the knee.
In supine, have the patient flex the hip and knee to 90°. Using the
patient’s or clinician’s hands to maintain hip flexion, extend
knee as much as possible.
Patient is unable to extend knee beyond –20° extension.
Table 1.13 Selected Special Test Descriptions 29
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Table 1.14 Vital Signs
36 mo–adult
2–36 mo
Newborns
1y
2–6 y
8–12 y
13–16 y
Adults
Birth–1 mo
Heart Rate (Pulse)
Blood Pressure
Age Group
Vital Sign
70–190 beats/min
80–160 beats/min
70–125 beats/min
70–110 beats/min
60–100 beats/min
55–100 beats/min
Systolic: 60–90 mm Hg
Diastolic: 30–60 mm Hg
Systolic: 75–130 mm Hg
Diastolic: 45–90 mm Hg
Systolic: 90–140 mm Hg
Diastolic: 50–80 mm Hg
Normal Range
Note: Normal values may vary from one laboratory to another. The values presented in these charts should not be considered absolute.
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Oxygen Saturation (as measured
with a pulse oximeter)
Respiratory Rate
Birth–1 mo
3 mo–6 y
6–10 y
10–16 y
Adults
35–55 breaths/min
20–30 breaths/min
15–25 breaths/min
12–30 breaths/min
12–20 breaths/min
Normal oxygen saturation at rest or during exercise
is 98%.
Exercise may be contraindicated in values of ≤90%.
Table 1.14 Vital Signs
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Chapter 1 Normal Values and Assessments
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. Second Edition. Philadelphia: McGraw Hill.
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. Eighth
edition. Philadelphia: W.B. Saunders Company.
Hoppenfeld, S. (1976). Physical examination of the spine and
extremities. Norwalk, CT: Prentice Hall.
Norkin, C., & White, J. (2009). Measurement of joint motion: A guide
to goniometry. Fourth edition. Philadelphia: F.A. Davis.
Palmer, L., & Epler, M. (1998). Fundamentals of musculoskeletal
assessment techniques. Philadelphia: Lippincott.
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