What are the sensitivities and specificities of Braddom's (physical examination special tests) in diagnosing musculoskeletal and neurological conditions?

Physical Examination Special Tests: Sensitivities and Specificities

I cannot provide a comprehensive list of Braddom's physical examination special tests with their sensitivities and specificities because the evidence provided does not contain information from Braddom's Physical Medicine and Rehabilitation textbook or similar musculoskeletal/neurological examination resources.

However, based on the available guideline evidence, I can provide specific test characteristics for several clinically important physical examination maneuvers:

Musculoskeletal Examination Tests

Ankle Examination

The anterior drawer test for lateral ankle ligament rupture has optimal diagnostic accuracy when performed 4-5 days post-injury, with sensitivity of 84% and specificity of 96%. 1

• Immediate testing has lower accuracy due to pain and swelling 1
• The test should be performed with the patient relaxed, applying anterior force to the heel while stabilizing the distal tibia 1
• A positive test indicates likely rupture of the anterior talofibular ligament 1

Cardiovascular Examination

Exercise ECG testing using 1mm ST-segment depression as the diagnostic threshold demonstrates sensitivity of 68% and specificity of 77% for coronary artery disease. 1

• Sensitivity increases with disease severity: higher in triple-vessel disease than single-vessel disease 1
• Specificity decreases in patients with baseline ECG abnormalities (bundle branch block, LV hypertrophy, resting ST-T changes) 1
• The test has higher positive predictive value in high-prevalence populations and higher negative predictive value in low-prevalence populations 1

Vascular Examination Tests

Ankle-Brachial Index (ABI)

Resting ABI has sensitivity of 68-84% and specificity of 84-99% for peripheral arterial disease diagnosis. 1

• ABI ≤0.90 confirms PAD 1
• Values >1.40 indicate non-compressible arteries 1
• Post-exercise ABI measurements improve diagnostic accuracy in patients with exertional symptoms but normal resting ABI 1

Toe-Brachial Index (TBI)

TBI demonstrates sensitivity ranging from 45-100% and specificity from 17-100% for PAD diagnosis. 1

• The usual pathological threshold is TBI ≤0.70 1
• TBI is particularly useful when ABI is unreliable due to arterial calcification 1

Neurological Examination Tests

Proprioception Assessment

Joint position sense testing of the great toe (moved up or down with eyes closed) is the recommended method for assessing proprioception. 2

• Begin distally and move proximally only if abnormalities are detected 2
• Avoid tactile cues that might help the patient guess position 2
• Proprioceptive deficits typically present in "glove and stocking" distribution in peripheral neuropathies 2

Rigidity Assessment in Parkinsonism

Rigidity assessment through passive limb movement is a cardinal diagnostic feature of Parkinson's disease, though specific sensitivity/specificity data are not provided in guidelines. 3

• Test by passively moving limbs while patient relaxes completely 3
• Use activation maneuvers (contralateral limb movement) to enhance detection of subtle rigidity 3
• Look for lead-pipe rigidity (constant resistance) or cogwheel phenomenon (ratchet-like resistance with tremor) 3
• Asymmetric rigidity with alien hand phenomenon suggests corticobasal syndrome rather than idiopathic Parkinson's disease 3

Important Caveats

Test accuracy varies significantly based on disease prevalence, patient population, and timing of examination. 1, 4, 5

• Sensitivity and specificity are not fixed properties but vary with population case mix and disease severity 4
• Predictive values change with disease prevalence and should not be applied across different populations 5
• Tests are rarely 100% accurate, and false-positive/false-negative results occur 6
• The likelihood ratio (combining sensitivity and specificity) is the most useful tool for clinical interpretation 6

For comprehensive musculoskeletal and neurological special test data from Braddom's textbook, you would need to consult the original Physical Medicine and Rehabilitation reference directly, as this information is not contained in the cardiovascular, thrombosis, and general diagnostic test methodology guidelines provided.