Examination – Special Tests

Audiological Tests

  1. Rinne Test
    • Purpose: Differentiate between conductive and sensorineural hearing losses.
    • Procedure: A tuning fork is struck and placed on the mastoid bone. Once the patient can no longer hear the sound (bone conduction), the fork is moved next to the ear canal (air conduction). Normally, air conduction is better than bone conduction. A reversal suggests conductive hearing loss.
  2. Weber Test
    • Purpose: Determine the type of hearing loss in unilateral hearing loss cases.
    • Procedure: A struck tuning fork is placed on the center of the forehead. The patient notes where the sound is heard best. In conductive hearing loss, the sound should lateralize to the affected side; however, in patients with sensorineural hearing loss, the sound lateralizes to the contralateral side. 

Neurological Tests

  1. Phalen’s Test
    • Purpose: Diagnose carpal tunnel syndrome.
    • Procedure: The patient flexes the wrists and presses the backs of the hands together. Tingling or numbness in the thumb, index, and middle fingers within 60 seconds suggests carpal tunnel syndrome.
  2. Tinel’s Sign
    • Purpose: Detect irritated nerves.
    • Procedure: The examiner taps over the suspected nerve path (commonly over the median nerve at the wrist). A tingling sensation along the nerve path suggests a positive Tinel’s sign, indicative of nerve compression or regeneration.
  3. Babinski Sign
    • Purpose: Assess the integrity of the corticospinal tract.
    • Procedure: The sole of the foot is stroked to provoke a response. A positive sign (upward flexion of the big toe and fanning of the other toes) indicates upper motor neuron disease.
  4. Romberg Test
    • Purpose: Assess balance and proprioception.
    • Procedure: The patient stands with feet together and eyes closed. Swaying or falling is considered a positive Romberg sign, indicating sensory ataxia or vestibular dysfunction.
  5. Hoffmann’s Test
    • Purpose: Identify upper motor neuron disease affecting the hands.
    • Procedure: A flicking motion is applied to the patient’s middle fingernail. A positive response is a reflex contraction of the thumb and index finger.

Orthopedic Tests

  1. Anterior Drawer Test
    • Purpose: Assess the integrity of the anterior cruciate ligament (ACL) in the knee.
    • Procedure: The patient lies on their back with knees bent at 90 degrees. The examiner stabilizes the foot and pulls the tibia forward. Excessive movement indicates a torn ACL.
  2. Lachman Test
    • Purpose: A more sensitive test than the anterior drawer for detecting ACL injury.
    • Procedure: The knee is flexed at 20-30 degrees, the tibia is pulled forward while the femur is stabilized. Increased laxity indicates ACL damage.
  3. McMurray Test
    • Purpose: Evaluate for meniscal tears in the knee.
    • Procedure: The patient lies down, the knee is fully flexed, then rotated and extended. A clicking sound or pain suggests a meniscal tear.
  4. Varus and Valgus Stress Tests
    • Purpose: Assess the integrity of the lateral and medial collateral ligaments of the knee.
    • Procedure: For the varus test, the knee is slightly bent and a medially directed force is applied to test the lateral collateral ligament. For the valgus test, a laterally directed force tests the medial collateral ligament. Pain or laxity indicates ligament injury.
  5. Ortolani Test
    • Purpose: Detect developmental dysplasia of the hip in infants.
    • Procedure: The examiner holds the infant’s legs in both hands and gently abducts the hips while applying upward pressure. A ‘clunk’ indicates the hip is being relocated into the acetabulum, suggesting hip dysplasia.
  6. Barlow’s Test
    • Purpose: Identify if an infant’s hips can be dislocated.
    • Procedure: With the infant’s hips flexed at 90 degrees, the examiner adducts the hips and applies pressure. A ‘clunk’ suggests that the hip can be dislocated.
  7. Finkelstein Test
    • Purpose: Diagnose de Quervain’s tenosynovitis.
    • Procedure: The patient makes a fist with the thumb inside, and the wrist is ulnarly deviated sharply. Pain over the radial styloid indicates de Quervain’s tenosynovitis.
  8. Apprehension Test for Shoulder Dislocation
    • Purpose: Assess the likelihood of recurrent shoulder dislocations.
    • Procedure: The arm is abducted and externally rotated. Apprehension or discomfort from the patient suggests potential instability or previous dislocation.

Cardiovascular Tests

  1. Ankle-Brachial Index (ABI)
    • Purpose: Diagnose peripheral arterial disease.
    • Procedure: Blood pressure measurements are taken at the arms and ankles. An ABI of less than 0.9 suggests peripheral arterial disease.
  2. Allen Test
    • Purpose: Assess the patency of the radial and ulnar arteries.
    • Procedure: The patient clenches their fist, which is then opened while the examiner releases pressure on one artery at a time to observe the flushing of the hand.

Respiratory Tests

  1. Spirometry
    • Purpose: Measure lung function to diagnose conditions like asthma and COPD.
    • Procedure: The patient exhales forcefully into a mouthpiece connected to a device that measures the volume and flow of air.
  2. Peak Expiratory Flow Rate (PEFR)
    • Purpose: Assess the maximum speed of expiration.
    • Procedure: The patient blows into a peak flow meter; lower than normal readings may indicate conditions like asthma.

Special Sensory Tests

  1. Schirmer Test
    • Purpose: Evaluate tear production to diagnose dry eye disease.
    • Procedure: A strip of filter paper is placed under the lower eyelid; insufficient wetting of the paper indicates dry eyes.
  2. Color Vision Testing
    • Purpose: Screen for colour vision deficiencies.
    • Procedure: The patient identifies coloured numbers or paths on a background of dots in varying colours (e.g., Ishihara plates).