What is the procedure for performing the supine roll test?

From the Guidelines

The supine roll test should be performed by having the patient lie flat on their back, turning their head 90 degrees to one side, observing for nystagmus, then returning to the center position, and repeating on the opposite side, as described by Bhattacharyya et al 1. To perform this test, have the patient lie flat on their back on an examination table.

• Turn the patient's head 90 degrees to one side,
• Observe their eyes for nystagmus (involuntary eye movements) for about 30 seconds,
• Then return the head to the center position,
• Before turning it 90 degrees to the opposite side and again observing for nystagmus. A positive test is indicated by horizontal nystagmus that changes direction when the head position changes.
• The intensity and duration of nystagmus should be noted,
• As should any symptoms of vertigo reported by the patient. This test works by moving otoconia (calcium carbonate crystals) within the affected semicircular canal, which creates an abnormal fluid movement that stimulates the vestibular nerve and produces the characteristic nystagmus, as shown in Figure 2 of the study by Bhattacharyya et al 1. The direction of the nystagmus helps determine which ear is affected and whether the condition is canalithiasis (free-floating debris) or cupulolithiasis (debris attached to the cupula), which guides appropriate treatment approaches.

From the Research

Supine Roll Test

• The supine roll test is not explicitly mentioned in the provided studies 2, 3, 4, 5, 6
• However, the studies discuss various tests for assessing hip instability, such as the abduction-hyperextension-external rotation (AB-HEER) test, the prone instability test, and the hyperextension-external rotation (HEER) test 3
• These tests are used to evaluate hip microinstability, which is a diagnosis gaining increasing interest 3
• The studies also mention the importance of physical examination, imaging studies, and patient history in diagnosing hip instability 2, 4
• It is possible that the supine roll test is a physical examination test used to assess hip instability, but further research is needed to confirm this

Related Tests

• The AB-HEER test is the most accurate test for predicting hip instability, with a sensitivity of 80.6% and a specificity of 89.4% 3
• The prone instability test has a low sensitivity but a high specificity, making it useful for "ruling in" abnormalities 3
• The HEER test performs second in both sensitivity and specificity 3
• The combination of multiple tests with positive findings does not yield significantly greater accuracy 3

Imaging Studies

• Imaging studies such as plain radiography, MRI, and MRI arthrography can be used to confirm the presence of hip instability 4
• Ultrasound evaluation of the hip is also emerging as a useful tool for detecting pathology and evaluating joint biomechanics 6