Clearance test

The upper limb clearance test

Test:-BACK SCRATCH
Purpose: - To know the ROM, muscle strength and coordination of IP, wrist, elbow and shoulder.
Procedure:-Ask the patient to sit or stand on erect position. Ask the patient to keep hand extended, abducted arm, flex on elbow & place the arm behind the neck and scratch at back. Observe from front and back. If patient can perform means test is negative.
Result: - Positive / Negative

Test: - COORDINATION
Purpose: - To know the mental status.
Procedure: - Ask the patient to sit or stand on erect position. Ask the patient to touch distal end of finger with another distal end of finger of same hand. Ask the patient to do fast with both hands. Observe from front. If patient can perform means test is negative.
Result: - Positive / Negative

The spine clearance test

Test: - FORWARD BENDING & LATERAL BENDING
Purpose: - To know expected ROM of spine.
Procedure: -Ask the patient to stand on erect position. Ask the patient to bend forward & reach to the toes. Slide their hand down each thigh and bend at lateral side. Observe from front and side.
Result: - Positive / Negative

The lower limb clearance test

Test: - LOW SQUAT
Purpose: -To know movements, balance and coordination of the hip, knee and ankle.
Procedure: - Ask the patient to stand on erect position. Ask the patient to keep both upper limb extended forward on shoulder level. Flex the knee and hip at 90 degree. (Just like sitting on chair). Then extend the knee and hip on same position. If the patient can perform means test is negative Observe from front and side.
Result: - Positive /Negative

Test: -STANDING ON TOE
Purpose: - To know ROM, muscle strength and balance of ankle and foot.
Procedure: - Ask the patient to stand on erect position. Ask the patient to raise the toes and stand on toes for while. Observe from front and side.
Result: - Positive / Negative

Note: Ensure that support like walking frame or chair is available during low squat & standing on toe.

The specific test
Test: - THOMAS
Purpose: - To know Hip flexion contracture.
Procedure: - Ask the patient to lie down on supine position on examination table with relax. Examiner stand just near about hip at affected side. Ask the patient to flex both knee and hip and try to touch at chest. Place the one hand just below the lumber region of patient. Examiner should feel lumber region by palm and examination table surface by dorsum of palm. Ask the patient to hold knee on same flexion position and ask to extend the affected limb.
If patient can fully extend the limb & there is no gap between lumber region and palm means that there is no hip flexion contracture. If patient can not fully extend the limb and is stopped in between, it may be due to muscle tightness. So try to give passive force on same limb to keep extend from where it stopped. In this time if there is some gap or curve on lumber spine and difficult to keep on extended position then it can say that pt has hip flexion contracture positive
Result: - Positive /Negative

Test: OBER
Purpose: - To know tightness of ilio tibial band
Procedure: - Ask the patient to lie on examination table by side lying position. (Affected side above).keep the pelvis (ASIS) in level & ask the patient not to move. The examiner stands just back of patient near about thigh.

The examiner hold the affected limb by supporting medial aspect of knee, flex the knee about 90 degree and abduct the hip to end of range (limit).Then release the limb. If limb sudden drop straight, the test is negative. If limb don’t drop sudden and remain abduct means ilio tibial band is tight and test is positive.
Result: - Positive / Negative

Test: - FABER
Purpose: - To know the Flexor, Abductor, External rotators of hip.
To know coordination, flexion & extension of toes.

Procedure: - Ask the patient to sit on the chair with hip and knee joint on 90 degree flex (Possible in lying position also).Ask the patient to raise the sole of foot of affected side and touch opposite knee and slight rub at medial aspect of knee. If patient feel pain and can not perform means test is positive. If patient can perform easily means test is negative
Result: - Positive / Negative

Test: - TRENDELENGBURG SIGN
Purpose: - To know the weak hip abductor
Procedure: - Ask the patient to stand on erect position. Check the ASIS level. Ask the patient to stand on one limb and check pelvic level that whether it is on level or not .If patient is standing on right limb (left limb unsupported) and pelvic drop on unsupported side means right side hip abductor are weak. If pelvic do not drop and on level means right side hip abductor is not weak and it is controlling unsupported side. To compensate unsupported side patient bend his trunk at supported limb. It can be observed from front and back.
Result: - Positive / Negative
Note: Ensure that support like walking frame or chair is available during test.

Test: - KNEE ANTERIOR & POSTERIOR DRAW TEST
Purpose: - To know the anterior and posterior knee stability.
Procedure: - Ask the patient to lie down on the couch (Or sitting on chair).Keep the affected limb on 90 degrees flexed position. The examiner sits just near about flexed knee. Place the both thumb at just side of the patella tendon & fore finger at popliteal area (hamstring tendon) Ask the patient to hold & stablished the leg.
Slowly pull toward examiner and push backward to patient. If forward slide of tibia means anterior cruciate ligament damage and if backward slide of tibia means posterior cruciate ligament damage. The sliding of tibia toward and backward show positive test. If there is no slide means test is negative.

Result: - Positive / Negative

Test: - COLLATERAL LIGAMENT (Medial & lateral)
Purpose: - To know the medial and lateral stability of knee.
Procedure: - Ask the patient to lie on examination table. Flex the knee on 10-20 degree.
For medial collateral ligament
Hold the patient leg at medial aspect of distal end just near about ankle joint. Hold at just above the lateral aspect of knee by another hand. Apply the valgus force on knee. If it is loose or more valgus means medial collateral ligament is weak or not functioning properly. It shows test is positive.

For lateral collateral ligament
Hold the patient’s leg at lateral aspect of distal end just near about ankle joint.
Hold at just above the medial aspect of knee by another hand. Apply the varus force on knee. If it is loose or more varus means lateral collateral ligaments is weak or not functioning. It shows test is positive.

Result: - Positive / Negative

Test: - ANKLE DRAW TEST
Purpose: - To know the ankle joint stability.

Procedure: - Ask the patient to sit on couch. Examiner just sit front of the patient. Ask the patient to keep the foot on slight planter flexion. Keep one hand on the anterior aspect of lower tibia (pushing backwards).By other hand hold just above calcaneus using index finger and thumb at either side of Achilles tendon. Hold calcaneus on palm & pull forward.

If foot draw forward relative to leg or if patient feels pain shows ruptured or weak ligament. It shows that test is positive.
Result: - Positive / Negative