Special diagnostic method of Tui Na in Chinese medicine
Brachial plexus nerve pulling test is positive when the patient is sitting with the neck flexed forward, the doctor stands on the affected side, holds the affected head with one hand, holds the wrist of the affected limb with the other hand, and pulls in the opposite direction, and the affected limb has pain or numbness.
Compression and percussion test (intervertebral foramen compression test)
With the patient in sitting position, the physician places both hands overlapping on the top of the patient’s head and controls the cervical vertebrae at different angles for compression, which is positive if it causes neck pain and radiating pain, indicating cervical nerve root compression. In the orthostatic position, the patient’s head is tapped with the palm of the fist, and if it causes neck pain and upper limb pain and numbness; or if it causes lumbar pain on the affected side, it is positive, suggesting cervical or lumbar nerve root compression.
Brachial plexus nerve pulling test
The patient is seated, the neck is flexed forward, the doctor stands on the affected side, holds the affected head with one hand, holds the wrist of the affected limb with the other hand, and pulls in the opposite direction.
Head and neck tilt test
The patient sits with the head slightly tilted back and the lower jaw turned to the affected side, inhales deeply and holds the breath. The doctor holds the patient’s jaw with one hand and gives resistance, while the other hand feels the radial artery of the patient. If the pulse is weakened or disappears, it is positive, mostly in anterior oblique muscle syndrome.
Neck extraction and extension test
The patient is sitting, relaxed, and the doctor stands behind him, holding his hands on the patient’s occipital area and slowly lifting the patient’s head upward. If the patient’s neck and shoulder pain and numbness are reduced, the test is positive. This test is often used as one of the indications for the need of traction for cervical conditions.
Vertebral artery torsion test
The patient sits with the neck relaxed, the doctor stands behind the patient, holds the patient’s head with both hands for fixation, and makes the patient tilt and turn the neck to the maximum.
Neck flexion test
The patient sits with both lower limbs straight, actively or passively flexes the neck, and the lower jaw is close to the chest wall for about 1 minute, causing lumbar and leg pain is positive, suggesting lumbar nerve root compression.
Supine jerk test
The patient lies on his back, using the heels of both feet at the occipital level as the fulcrum, and raises the abdomen with the waist and pelvis off the bed, while coughing.
Femoral nerve pulling test
The patient lies prone with the affected limb bent at 90°, the doctor lifts the affected calf up or continues to bend the knee joint, if there is radiating pain along the femoral nerve, it is positive.
Double knee and hip flexion test
The patient lies on his back, and the doctor presses the patient’s two lower limbs in flexion toward the abdomen at the same time, if the pain is restricted, it indicates lumbosacral or hip lesion. If the lower limb is pressed to the opposite side of the abdomen causing pain in the sacroiliac joint, it indicates sacroiliac ligament injury or arthrosis.
Pelvic separation or squeeze test
The patient lies on his back, and the doctor presses the iliac wings on both sides with two hands, and presses outward (separation) or squeezes inward with force, and it is positive if there is pain. It indicates sacroiliac joint lesion, separation of pubic symphysis or pelvic fracture, etc.
The patient lies supine, the lower limb on the healthy side is straight, the affected limb is flexed and externally rotated, so that the foot is placed above the knee on the healthy side. This suggests a hip lesion, i.e., a lesion in the sacroiliac joint.
Straight leg raise and foot dorsiflexion test
The patient lies supine with both lower extremities straight, and while keeping the knee joint straight, perform straight leg raise respectively. The pain-free range (the angle between the elevated limb and the bed surface) is measured during elevation. If there is nerve root compression, there can be significant restriction of straight leg raising, usually more than 60° or less, i.e., pain in the area of distribution of the compressed nerve root appears as a positive straight leg raising test. Then lower the lower extremity by 5-10° until the pain disappears, and suddenly dorsiflex the foot, and sciatica reappears as positive. The latter is more clinically valuable than the former for the diagnosis of lumbar disc herniation. The latter is more clinically valuable than the former for the diagnosis of lumbar disc herniation because the straight leg elevation test can also be positive with other lower extremity pathologies such as iliotibial tract tension, whereas a positive foot dorsiflexion test is an indication of simple tension on the sciatic nerve.
The patient lies supine with the affected hip close to the bedside and the healthy lower limb is flexed at the knee and hip to fix the pelvis. The doctor moves the affected limb outside the bed and extends it as far back as possible to stretch and move the sacroiliac joint.
Heel and hip test
The patient lies prone with both lower limbs straight and muscles relaxed, the doctor holds his foot so that the heel touches the buttocks, if there is a lesion in the lumbosacral joint, it causes pain in the lumbosacral area and the pelvis and even the waist are lifted.
Shoulder hitch test (Duggar’s test)
In a normal person, when the hand rests on the opposite shoulder, the elbow joint can be close to the chest wall, while in a positive Duggar’s test, it can be seen that when the hand rests on the opposite shoulder, the elbow joint cannot be close to the chest, suggesting the possibility of shoulder joint dislocation.
Bony triangle test
The triangle is formed by the three points of the acromion, rostral process and greater tuberosity. In the case of dislocation, the triangle is different from the contralateral side because the position of the greater tuberosity changes.
Shoulder joint abduction test
This test can be used to identify shoulder disorders in general.
A If there is a loss of shoulder function with severe pain, the shoulder joint may be dislocated or fractured.
B In shoulder arthritis, there is pain from abduction to supination.
C If the shoulder is painless at the beginning, but becomes more painful when the angle of abduction increases, it may be due to shoulder joint adhesions.
E Pain during abduction but not during supination may be due to subdeltoid bursitis.
F Pain within the range of 60° to 120° from abduction to supination, but no pain beyond this range, may be supraspinatus tendonitis.
G Careful abduction with pain may be a clavicle fracture.
Long biceps tendon test
A Shoulder internal rotation test: Let the patient initiate extreme internal rotation of the shoulder, i.e. in the flexed elbow position with the forearm placed behind the back, causing shoulder pain is positive, indicating biceps longus tendinitis.
B Resistance test: The patient’s elbow joint is flexed with force; the physician holds the patient’s wrist in his or her hand against the force to straighten the patient’s elbow joint. If the patient’s pain increases, the resistance test is positive, indicating biceps longus tenosynovitis.
Tennis elbow test (Mill’s test)
The forearm is slightly bent, the hand is half-clenched, the wrist is flexed as much as possible, and then the forearm is rotated completely forward and then the elbow is straightened. If pain occurs on the lateral side of the brachioradialis joint when the elbow is straightened, it is positive.
Forearm flexion and extension muscle tension (resistance) test
A The patient makes a fist and flexes the wrist with the palm down, the examiner presses the back of the patient’s hand and the patient extends the wrist against resistance.
B The patient’s palm is up, the fingers are extended and the wrist is dorsally extended. The examiner presses the patient’s palm with the hand and the patient flexes the wrist against resistance.
The relationship between the medial and lateral epicondyles of the humerus and the ulnar hawk is a straight line in the extended elbow position and forms an isosceles triangle in the 90° flexion position, called the elbow triangle. When the elbow is dislocated, the elbow triangle loses its normal relationship.
Clenched fist ulnar deviation test
Clenching the fist of the affected hand (thumb in, four fingers out), ulnar deviation of the wrist joint: pain at the radial tuberosity is positive, suggesting radial tuberosity stenosing tenosynovitis.
Wrist flexion test
The patient’s wrist joint is extremely flexed and causes numbness and pain in the fingers after a short period of time, which is a sign of carpal tunnel syndrome.
Floating patella test
The patient is lying down with the affected limb straight and relaxed. With one hand, the physician squeezes the fluid in the suprapatellar bursa above the patella into the joint cavity; the other finger presses the patella, one press and one release, repeatedly several times. If there is a fluctuating sensation, it means that there is fluid in the joint cavity.
Lateral squeeze test
The patient lies on his back, the affected knee is straight, the quadriceps is relaxed, the doctor fixes the knee joint with one hand, holds the ankle joint with the other hand, the two hands exert relative force, and makes passive inward or outward turning activities of the knee joint. If the ligament is completely torn, abnormal lateral movement occurs; if the ligament is twisted or partially torn, it causes pain.
The patient lies supine with the knee flexed to 90° and the muscles relaxed, and the physician holds the upper end of the calf with both hands and pushes and pulls it forward and backward repeatedly. There is no activity when normal, but if it slides forward, it indicates a cruciate ligament injury; if it slides backward, it indicates a posterior cruciate ligament injury.
Knee joint rotation test
The patient lies on his back, the doctor holds the knee with one hand, the other hand holds the ankle, the knee joint will be passively flexed and extended at the same time, inward internal rotation or abduction external rotation, causing popping sound or pain is positive, for meniscal injury.
The patient is lying prone with the hip joint straight and the affected knee flexed to 90°. The doctor kneels with one leg on the patient’s thigh flexion surface, fixes it, holds the affected foot with both hands, squeezes the knee joint and rotates the lower leg, causing pain is positive, suggesting meniscal injury; on the contrary, lifting the lower leg to widen the knee joint gap and rotating the lower leg, if it causes pain, it is a lateral collateral ligament injury.
In the sitting position, the patient sits on the edge of the bed with both lower legs hanging naturally. In the prone position, the patient lies on his back, and the examiner holds up his knee with his left hand, making it slightly flexed, about 20°-30°, and then taps the quadriceps tendon of the lower knee, responding to the knee extension action, with the reflex center at L2,4.
Achilles tendon deviation syndrome
In normal standing position, the long axis of the Achilles tendon should be parallel to the long axis of the lower limb. In flat feet, the long axis of the Achilles tendon is deviated outward.
Internal and external foot rotation test
The examiner fixes the calf with one hand and holds the foot with the other hand, turning the ankle extremely inward or outward.
Ankle reflex (Achilles tendon reflex)
The patient is in supine position with hip externally rotated and knee flexed. The doctor pushes the sole of the foot with one hand to make the ankle joint slightly dorsally extended, and taps the Achilles tendon with the other hand with a percussion hammer. If it is not easily induced, the patient can kneel at the bedside and the doctor pushes the sole of the foot with one hand to make it dorsiflex, while the other taps the Achilles tendon with a percussion hammer. The reflex center is in S1,2.
It often coexists with hyperreflexia of the Achilles tendon. The patient lies supine with the hip and knee slightly flexed, the doctor holds the patient’s popliteal fossa with one hand, holds the foot with the other hand, abruptly dorsiflexes the ankle joint, and continuously presses the sole of the foot.