Orthopedic Tests Health Article

Definition

Orthopedic tests are designed to evaluate individuals for musculoskeletal impairment. Orthopedic tests enable the clinician, such as a physician or physical therapist, to identify a specific area of injury and aid in the diagnosis and treatment plan of the injured individual. There is a general plan for physical assessment that includes taking a patient's history; examining how the patient moves and how individual joints move; evaluating sensation and reflexes; and, if necessary, administering diagnostic tests to aid in the diagnosis. These are specific orthopedic tests for the upper and lower extremities as well as the spine. The orthopedic tests, or "special tests," help the clinician in the differential diagnosis of the patient.

Purpose

A medical or health history taken by the clinician is extremely important in evaluating and diagnosing the patient. A patient's description of the pain, weakness, or both will guide the clinician as to what structures to evaluate and which orthopedic tests, if necessary, to complete. After the history has been taken, the clinician may focus on sensory and reflex testing to evaluate the integrity of the nervous system. Depending on where the injury or impairment is on the body, the clinician may opt to evaluate range of motion of the joint(s) of the area of injury or near the injury. For example, if a patient has knee pain, the clinician will more than likely assess how far the patient can bend the knee and straighten the knee. The clinician will compare this movement to the uninvolved side or "good leg." Thus, the clinician has a baseline for the individual and the "good leg" serves as a reference point or goal. It is usually advisable that the "good side" always be evaluated first, so that a true comparison can be made to the affected side. Obviously, if there is bilateral involvement the clinician must use his/her experience with other patients to evaluate and set a plan of care. Also included in an assessment is the evaluation of muscle strength.

Precautions

Most orthopedic tests stress areas to be evaluated in an effort to evaluate pain, joint play, and muscle extensibility. Because of the stress involved during some orthopedic tests, care must be taken to avoid further injury. Before doing any orthopedic tests, an area must be free from fracture or neoplasm (an abnormal growth). Furthermore, any patient with characteristics such as severe spasm, pain with unknown etiology, or pain that awakens the patient at night, should not be evaluated with orthopedic tests until a full medical evaluation can be completed to address these unexplained symptoms.

Description

There are numerous orthopedic tests that help the clinician diagnose impairment. It should be pointed out that these tests alone do not confirm a diagnosis. As stated previously, the medical history and other evaluative tools need to be completed so as to get a total representation of the patient's health and the nature of injury or problem. Furthermore, a positive test does not necessarily indicate a specific problem, and a negative test does not necessarily rule out the problem. Some tests that are frequently used by clinicians to evaluate the spine and extremities will be described below.

Cervical spine

One possible problem associated with the cervical spine could be narrowing of the space occupied by the nerve root. This could be due to many causes, two of which could be injury or osteoarthritis. It is possible that as the space occupied by the nerve root closes, there may be impingement on the nerve root. If this occurs there could be pain, changes in sensation, and weakness in the neck, shoulder, and possibly down the arm. Two tests that may help diagnose an individual with this pathology are the distraction and compression tests. The distraction test for the cervical spine is performed by the clinician to assess if there is pressure on the nerve roots. In a positive test, symptoms will decrease or disappear. The compression test is also performed by the clinician to evaluate if there is pressure on the nerve root. If symptoms are provoked down either arm during the test, it would indicate pressure on the nerve root and thus, a positive test.