Special tests

SPECIAL TESTS

CERVICAL

Foraminal Compression TestPx: Sitting(+) sign: pain radiates to arm toward which head is side flexedSignificance: Cervical Nerve Root CompressionProcedure:

First Phase: compress with head in neutral positionSecond Phase: compress with head extendedThird Phase: compression with head extended and rotated to unaffected side.

Othes name: Spurling’s Test

Shoulder Depression Test

Px: sitting(+) sign: increase painSignificance: Nerve Root CompressionProcedure:

side flex patient’s head on unaffected side then apply a downward pressure on the opposite shoulder (affected side).

Shoulder Abduction Test

Px: sitting(+) sign: relief of symptomsSignificance: Nerve Root CompressionProcedure:

abduct patients arm then rest hand or forearm on top of the head.

Distraction Test

Px: Sitting(+) sign: relief of PainSignificance: Pressure on the Nerve RootsProcedure:

place one hand under the patient’s chin and the other around the occiput. Slowly lift the head, applying traction to the cervical spine.

Lhermitte’s Sign

Px: Long Sitting position(+) sign: pain radiating down the spineSignificance: Dural or Meningeal IrritationProcedure:

Flex the patient’s head and one hip simultaneously with the leg kept straight.

Jackson’s Test

Px: sitting(+) sign: Pain Radiates into the armSignificance: Cervical Nerve Root CompressionProcedure:

Rotates patient’s head to one side and apply a downward pressure on the head.

Scalene Cramp Test

Px: sitting(+) sign: increase painSignificance: Plexopathy / Thoracic Outlet SyndromeProcedure:

Patient actively rotates the head to the affected side and pulls chin down into the hollow above the clavicle by flexing the cervical spine

Valsalva Test

Px: (+) sign: increase painSignificance: increase intrathecal pressureProcedure:

Patient takes a deep breath and hold it while bearing down, as if moving bowels

Tinel’s Sign

Px: sitting with neck slightly flexed(+) sign: localized painSignificance: cervical plexus lesionProcedure:

Tap the area of the Brachial Plexus with a finger along the nerve trunks.

Brachial Plexus Compression Test

Px: sitting(+) sign: pain radiates into the shoulderSignificance: Mechanical cervical lesions having a

mechanical componentProcedure:

Apply firm compression to the brachial plexus by squeezing the plexus under the thumb or fingers

Upper Limb Tension Test 1 (ULTT1)


Shoulder: Depression and abduction (10⁰)Elbow: ExtensionForearm: SupinationWrist: ExtensionFingers and Thumb: ExtensionShoulder: Lateral RotationCervical Spine: Contralateral side flexionNerve Bias: Median Nerve, Axillary Nerve,

Musculocutaneous Nerve


Shoulder: Depression and abduction (10⁰)Elbow: ExtensionForearm: PronationWrist: Flexion and Ulnar deviationFingers and Thumb: FlexionShoulder: Medial RotationCervical Spine: Contralateral side flexionNerve Bias: Radial Nerve


Shoulder: Depression and abduction (90⁰)Elbow: FlexionForearm: SupinationWrist: Extension and Radial deviationFingers and Thumb: ExtensionShoulder: Lateral RotationCervical Spine: Contralateral side flexionNerve Bias: Ulnar Nerve, Nerve Roots C8 and T1

Romberg’s Test

Px: Standing(+) sign: SwayingSignificance: Upper Motor Neuron Lesion (UMNL)Procedure:

Patient stands and is asked to close their eyes and hold the position for 20-30 seconds.

Vertebral Artery Test

Px: Supine(+) sign: Dizziness / NystagmusSignificance: Compression of Vertebral ArteriesProcedure:

Move patient’s head out and neck into extension and side flexion. Rotate patient’s head to the same side and hold for 30 seconds.

Naffziger’s Test

Px: Sitting(+) sign: PainSignificance: Nerve Root problem or Space Occupying

LesionProcedure:

Compress patient’s jugular veins for 30 seconds then ask the patient to cough.

Caloric Test

Px: (+) sign: Vertigo Significance: Inner ear problemProcedure:

Alternately apply hot and cold test tubes several times just behind the patient’s ear on the side of the head.

Sharp Purser Test

Px: (+) sign: PT feels the head slide backwards during the

movementSignificance: Subluxation of the atlas on the axisProcedure:

Place one hand over the patient’s forehead while the thumb of the other hand is placed over the spinous process of the axis to stabilize it. Patient slowly flexes the head while PT presses backward with the palm.

SHOULDER

Load and Shift Test

Px: sitting relaxed on the chair (+) sign:

a. Normal Laxity = 1-25%b. Grade 1 = head rides over the glenoid rim (25-50%)c. Grade 2 = head over rides the rim but reduces (>50%)d. Grade 3 = head over riding the rim and remains dislocated

Significance: traumatic problems at the glenohumeral JointProcedure:

Grasp the humeral head and stabilize the shoulder. Seat the humerus on the glenoid fossa and puch anteriorly and posteriorly to check for instability.

Apprehension Test

Px: supine; shoulder abducted 90 and externally rotated

(+) sign: pain and apprehensionSignificance: for traumatic instability problemsProcedure:

Slowly apply lateral rotation on shoulder.

Other name: Crank Test

Fulcrum Test

Px: supine; shoulder abducted 90 and externally rotated

(+) sign: pain and apprehensionSignificance: for traumatic instability problemsProcedure:

Place a hand under the Glenohumeral Joint then apply lateral rotation.

* a modification of Crank Test

Fowler Sign

Px: supine; shoulder abducted 90 and externally rotated(+) sign: relief of pain and apprehensionSignificance: posterior internal impingement / traumatic

instability problemsProcedure:

Apply a posterior directed force to the head of the humerus then further external rotation becomes possible

Other name: Jobe Relocation Test

Surprise Test

Px: supine; shoulder abducted 90 and externally rotated(+) sign: pain and forward translation of the humeral headSignificance: for traumatic instability problemsProcedure:

Perform “Fowler’s Sign”, after further external rotation, release the posterior force

Other name: Anterior Release Test

Rockwood Test

Px: sitting(+) sign:

90⁰ - marked apprehension 45⁰ & 120⁰ - some uneasiness and pain

Significance: Anterior InstabilityProcedure:

shoulder is abducted to 45⁰, 90⁰, then 120⁰. Then apply external rotation to each angle.

Rowe Test

Px: Supine; hand behind the head(+) sign: apprehension (Pain) | clunk or grinding soundSignificance: Anterior Instability | Torn anterior labrumProcedure:

place clenched fist on the posterior humeral head then apply downward force while arm extends.

Andrew’s Anterior Instability Test

Px: supine; shoulder abducted 130⁰, external 90⁰(+) sign: apprehension (Pain) | clunk or grinding soundSignificance: anterior instability | anterior labral tearProcedure:

stabilize elbow and humerus then grasp the humeral head and lift it forward.

Anterior Drawer Test

Px: supine; abducted 80⁰ - 120⁰, flexed 20⁰, externally rotated 30⁰, hand on PT’s axilla

(+) sign: apprehension (Pain) | click soundSignificance: anterior instability | anterior labral tearProcedure:

stabilize scapula, pushing the spine forward using index and middle finger. Apply a counter pressure on the coracoid then draw the humerus forward

Protzman Test

Px: sitting; abducted 90⁰, supported on the PT’s hip(+) sign: painSignificance: Anterior InstabilityProcedure:

Palpate anterior head with one hand, other hand on patient’s axilla. Push humerus anteriorly and inferiorly.

Dugas Test

Px: sitting(+) sign: Pain / inability to do the command of the PTSignificance: Anterior DislocationProcedure:

Ask patient to place one hand on opposite shoulder and to lower the elbow to the chest.

Posterior Apprehension Test

Px: supine; elevate shoulder to 90⁰(+) sign: ApprehensionSignificance: Posterior Shoulder InstabilityProcedure:

Apply posterior force on the elbow then horizontally adduct and internally rotate the shoulder.

Other name: Stress Test

Push-Pull Test

Px: supine; shoulder abducted 90⁰, flexed 30⁰(+) sign: >50% translation, pain/apprehensionSignificance: Posterior InstabilityProcedure:

Hold patient’s arm on the wrist and humerus. Pull on the arm at the wrist while pushing down on the humerus with the other hand.

Jerk Test

Px: sitting, shoulder flexed 90⁰ and internally rotated(+) sign: Sudden jerk or clunkSignificance: Recurrent Posterior InstabilityProcedure:

Grasp patient’s elbow and axially load the humerus proximally. Maintain axial load then move arm to horizontal arm to horizontal adduction with internal rotation.

Inferior Shoulder Instability Test

Px: standing relaxed(+) sign: sulcus sign

+1 = <1cm+2 = 1-2cm+3 = >2cm

Significance: inferior instability / glenohumeral laxityProcedure:

grasp the patient’s elbow then pull it distally.

Other name: Sulcus Sign

Feagin Test

Px: standing; shoulder abducted 90⁰ on PT’s shoulder(+) sign: Presence of sulcus on coracoid process /

apprehensionSignificance: Multidirectional InstabilityProcedure:

close hands over the humerus and push down and forward.

Rowe Test for Multidirectional Instability

Px: stands forward flexed 45⁰ at the waist with arms pointing to the floor.

(+) sign: sulcus signSignificance: Multidirectional InstabilityProcedure: hand on the px’s shoulder index and middle finger

(anterior) thumb (posterior)Anterior: Shoulder extended 20⁰-30⁰, then push anteriorlyPosterior: Shoulder flexed 20⁰-30⁰, then push posteriorlyInferior: Shoulder flexed 20⁰-30⁰, then push posteriorly and

apply traction

Clunk Test

Px: supine(+) sign: clunk / grinding soundSignificance: Tear of the Labrum (Bankart)Procedure:

One hand on posterior aspect of shoulder, one hand holds the humerus above elbow. Fully abduct arm over the px’s head. Push anteriorly with the hand over the humeral head (place a fist under the GH joint) . Other hand rotates the humerus into lateral rotation.

Biceps Tension Test

Px: standing; shoulder abducted 90⁰, elbow extended; forearm supinated

(+) sign: reproduction of symptomsSignificance: SLAP lesionProcedure:

apply eccentric adduction force

Biceps Load Test

Px: supine; shoulder abducted 90⁰ and external rotate; elbow flexed 90⁰; forearm supinated

(+) sign: Apprehension does not disappearSignificance: integrity of superior labrumProcedure:

Fully externally rotate shoulder until apprehension, stop external rotation and hold the position. Then patient resist elbow flexion at the wrist.

SLAP Prehension Test

Px: sitting(+) sign:

first = painfulsecond = relief of pain

Significance: SLAP LesionProcedure:

Patient actively abducts shoulder 90⁰; Forearm pronated then horizontally adducts.Then abducts shoulder 90⁰; Forearm supinated, horizontally adducted

Lateral Scapular Slide Test

Px: sitting / standing with arms at the side(+) sign: >1-1.5cm difference from the original measureSignificance: Scapular InstabilityProcedure:

Measure distance from spine to scapula to T2/T3, inferior angle to T7-T9 or superior angle to T2

* Test patient in shoulder abd: 45⁰, 90⁰, 120⁰ and 150⁰

Wall Push Up Test

Px: standing, arms length on the wall(+) sign: winging within 5-10reps of push-upSignificance: weakness of scapular musclesProcedure:

ask patient to do 15-20 wall push ups

Closed Kinetic Chain Upper Extremity Stability Test

Px: prone; on the floor at arms length with hands 36 inches apart.

(+) sign: winging of the scapulaSignificance: weakness of scapular musclesProcedure:

patient touches the other hand then returns to original position. This is done for 15 seconds while PT counts how many reps the patient is able to do.

Acromioclavicular Shear Test

Px: Sitting(+) sign: abnormal movement of at the AC jointSignificance: Acromioclavicular joint PathologyProcedure:

Cup hands over the deltoid, one on the clavicle and one on the scapula. Squeeze both hands together.

Ellman’s Compression Rotary Test

Px: side lying on unaffected side(+) sign: pain reproductionSignificance: Glenohumeral ArthritisProcedure:

Compress humeral head while patient rotates the shoulder medially and laterally.

Speed’s Test

Px: Standing(+) sign: Pain on Bicipetal Groove | Pain | weaknessSignificance: Bicipital Tendonitis | SLAP II | rupture

bicepsProcedure:

Resist shoulder extension by patient first in supination then in pronation with elbow extension.

Other names: Biceps Test / Straight Arm Test

Yergason’s Test

Px: sitting/standing; elbow 90⁰, forearm pronated(+) sign: pain/tenderness | popping out of gooveSignificance: Bicipital Tendonitis | torn transverse

humeral ligamentProcedure:

resist supination while px externally rotates shoulder.

Ludington’s Test

Px: sitting; clasp hands behind head(+) sign: no contraction evident/palpableSignificance: torn Long Head of BicepsProcedure:

ask px to contract the biceps.

Gilchrest’s Test

Px: Standing(+) sign: pain on Bicipital GrooveSignificance: Bicipital ParatendonitisProcedure:

ask px to lift 2-3kg/5-7lbs of weight over head with the arm in external rotation.

Lippman’s Test

Px: sitting/standing(+) sign: sharp pain on the bicipital grooveSignificance: Bicipital TendonitisProcedure:

Hold px arm and flex to 90⁰ with one hand, other hand palpates the biceps tendon 7-8cm below the glenohumeral joint. Then move the biceps tendon side to side.

Heuter’s Sign

Px: sitting; Forearm pronated(+) sign: absence of elbow supinationSignificance: ruptured distal biceps tendonProcedure:

Resist elbow flexion with the forearm pronated.

Supraspinatus Test

Px: standing; shoulder is abducted 90⁰(+) sign: pain | weaknessSignificance: torn supraspinatus | neuropathy of

suprascapular nerveProcedure:

shoulder is internallyy rotated and angled forward 30⁰, thumb pointing to the floor, then resist.

Other names: Empty Can Test / Jobe Test

Drop Arm Test

Px: standing; shoulder abducted 90⁰(+) sign: inability to return arm to side slowlySignificance: Rotator Cuff TearProcedure:

ask px to slowly lower arms to the side with some arc movements.

Other Names: Codman’s Test

Lateral Rotation Lag Sign

Px: seated/standing; arms at the side(+) sign: cannot hold the position | pain | increase

internal rotation on affected side.Significance: torn supraspinatus, infraspinatus and

subscapularisProcedure:

passively abducts shoulder to 90⁰, elbow flexed to 90⁰ and externally rotate. Px holds the position.

Other Names: Infraspinatus “Spring Back” Test

Hornblower’sTest

Px: standing; shoulder flexed to 90⁰, elbow flexed to 90⁰

(+) sign: inability to external rotate the shoulderSignificance: tear on the teres minorProcedure:

px external rotates with resistance.

Infraspinatus Test

Px: standing, arm on the side with elbow 90⁰(+) sign: pain / inability to resist internal rotationSignificance: infraspinatus strainProcedure:

Apply a internal rotation force that the px resist.

Teres Minor Test

Px: prone; with one hand on the iliac crest(+) sign: pain and weaknessSignificance: Teres Minor strainProcedure:

ask px to extend and adduct shoulder against resistance.

Pectoralis Major Contracture Test

Px: supine; hands clasps behind head(+) sign: elbows do not reach the tableSignificance: Tight Pectoralis MajorProcedure:

Lower arm until elbows tough the table

Lift Off Sign

Px: standing; dorsum of hand on back pocket(+) sign: inability to lift hand off backSignificance: Subscapularis LesionProcedure:

ask px to lift hand away from the back.

Neer-Impingement Test

Px: sitting (+) sign: PainSignificance: overuse injury to the supraspinatus

muscleProcedure:

Px arm is passively and forcibly fully elevated and shoulder is internally rotated.

Hawkin’s Kennedy Impingement Test

Px: standing / sitting(+) sign: painSignificance: supraspinatus tendonitisProcedure:

flex shoulder to 90⁰ then medially rotate the shoulder

Coracoid Impingement Test


flex shoulder to 90⁰, horizontally adduct to 10⁰-20⁰ then medially rotate the shoulder

*a modification of Hawkin’s Kennedy Test

Yocum Test


Px places hand on the opposite shoulder then PT elevates the elbow.

*a modification of Hawkin’s Kennedy Test

Tinel’s Sign at the Shoulder

Px: sitting(+) sign: tingling sensationSignificance: Peripheral Nerve InjuryProcedure:

tap on the scalene triangle on the area of the brachial plexus

Adson’s Maneuver

Px: sitting with head on the ipsilateral(+) sign: disappearance of pulseSignificance: Thoracic Outlet SyndromeProcedure:

Locate radial pulse, external rotate and extend the shoulder and instruct px to take a deep breath and hold it.

Allen Maneuver

Px: sitting with head on the contralateral side(+) sign: disappearance of pulseSignificance: Thoracic Outlet SyndromeProcedure:

Elbow is flexed to 90⁰, shoulder is extended and externally rotated horizontally, palpate the radial side.

Halstead Maneuver

Px: neck is hyper extended rotated on contralateral side

(+) sign: disappearance of Radial PulseSignificance: Thoracic Outlet SyndromeProcedure:

Find the radial pulse, apply downward traction on the extremity.

Roos Test

Px: shoulder abducted 90⁰; elbow flexed 90⁰, externally rotate

(+) sign: ischemic pain, heaviness, weaknessSignificance: Thoracic Outlet SyndromeProcedure:

ask px to close and open hands for 3mins

Other names: Aer Test / Hands-up Test

Wright Test

Px: shoulder hyper abducted, elbow extended and externally rotated

(+) sign: Disappearance of pulseSignificance: Thoracic Outlet SyndromeProcedure:

Instruct px to take a deep breath while palpating for the radial pulse.

Costoclavicular Test

Px: (+) sign: disappearance of pulseSignificance: Thoracic Outlet SyndromeProcedure:

Locate radial pulse, draw shoulder down and back.

Other Name: Military Base

ELBOW

Ligamentous Valgus Instability Test

Px: sitting; elbow flexed 90⁰ (+) sign: decrease laxity / painSignificance: Valgus Instability (medial collateral

ligament)Procedure:

Stabilize elbow with 1 hand and above px’s wrist with the other. Apply an abd. Force to the distal forearm.

Milking Maneuver

Px: sitting; elbow flexed 90⁰, forearm supinated(+) sign: Reproduction of SymptomsSignificance: Partial tear to the medial collateral

ligamentProcedure:

Graps the px’s thumb and pull it importing a valgus stress to the elbow

Ligamentous Varus Instability Test

Px: elbow slightly flexed(+) sign: laxity, soft end feelSignificance: injury to the lateral collateral ligamentProcedure:

Stabilize arm and apply varus force to the distal forearm.

Posterolateral Rotary Drawer Test

Px: supine, arm over head; elbow flexed 40⁰ - 90⁰(+) sign: reproduction of symptomsSignificance: tear on the lateral collateral ligament /

posterolateral instability at the elbowProcedure:

Stabilize the humerus, radius and ulna is pushed posterolaterally.

Stand-Up Test

Px: seated on a chair w/ no arm rests; forearm supinated

(+) sign: reproduction of symptomsSignificance: injury to the posterior band of medial

collateral ligamentProcedure:

instruct px to lift bottom off of the seat using his/her arms.

Lateral Epicondylitis (Method 1) Test

Px: sitting; elbow flexed 90⁰; forearm supinated(+) sign: painSignificance: Tennis Elbow EpicondylitisProcedure:

Palpate the lateral epicondyle. Ask the px to make a fist , pronate forearm, radially deviate and extend the wrist while PT resist the motion.

Other names: Tennis Elbow or Cozen’s Test


Px: sitting; elbow flexed 90⁰; forearm supinated(+) sign: painSignificance: Tennis Elbow EpicondylitisProcedure:

Palpate the lateral epicondyle. Passively pronate the px’s forearm; flex the wrist fully and extend the elbow.

Other names: Tennis Elbow or Mill’s Test


Px: sitting; elbow flexed 90⁰; forearm pronated(+) sign: painSignificance: Tennis Elbow EpicondylitisProcedure:

Resist the extension of the 3rd digit of the hand. Distal to proximal interphalangeal joints.

Other names: Tennis Elbow Test

Medial Epicondylitis Test

Px: sitting; elbow flexed 90⁰; forearm pronated(+) sign: painSignificance: Golfer’s elbow medial epicondylitisProcedure:

Palpate the medial epicondyle. Px’s forearm is passively supinated and the PT extends the elbow and wrist.

Other names: Golfer’s Elbow

Tinel’s Sign at the Elbow

Px: sitting with the elbow flexed(+) sign: Tingling SensationSignificance: Regeneration of FibersProcedure:

tap the ulnar nerve.

Wartenberg’s Sign

Px: sitting with hands resting on the table (+) sign: Inability to squeeze little fingerSignificance: Ulnar Nerve NeuropathyProcedure:

Passively spread the fingers apart and ask the patient to them together

Elbow Flexion Test

Px: (+) sign: Tingling or paresthesia in the ulnar nerve

distribution of the forearm and Significance: Cubital Tunnel SyndromeProcedure:

Fully flex the elbow, wrist extended, shoulder is abducted and depressed. Hold this position for 3-5 minutes.

Test for Pronator Teres Syndrome

Px: sitting; elbow flexed 90⁰(+) sign: Tingling or paresthesia in the median nerve

distributionSignificance: Pronator Teres SyndromeProcedure:

Resist pronation and the patient extends.

Pinch Grip Test

Px: (+) sign:

Normal: tip-to-tipAbnormal: pulp-to-pulp

Significance: Entrapment of the Anterior Interosseous nerve

Procedure:ask the patient to pinch the tips of the index and thumb together.

FOREARM, WRIST & HAND

Test for Tight Retinacular Ligament

Px: PIP joint is in neutral | PIP joint is flexed(+) sign: (-) flexion | (+) flexionSignificance: Collateral ligaments or Capsule is tight |

Only the collateral ligament is tightProcedure:

Flex the distal interphalengeal joint.

Other Name: Haines-Zancolli Test

Lunotriquetral Ballottement Test

Px: (+) sign: Pain, Laxity, CrepitusSignificance: Lunotriquetral InstabilityProcedure:

Grasp the triquetrium and lunate. Move the lunate anteriorly and posteriorly.

Other Name: Reagan’s Test

Finger Extension Test

Px: Sitting; wrist in flexion(+) sign: PainSignificance: Radiocarpal or midcarpal instability,

scaphoid instability, inflammation, Kienböck’s DiseaseProcedure:

Hold the px’s wrist and ask the px to extend the fingers. Resist movement at he radiocarpal joints.

Other Name: Shuck Test

Murphy’s Sign

Px: (+) sign: 3rd MCP joint is in line with and 2nd and 4th

MCP joint.Significance: Lunate DislocationProcedure:

Ask the px to make a fist.

Watson Test

Px: Sitting; Forearm is pronated on the lap(+) sign: PainSignificance: Scaphoid SubluxationProcedure:

Ulnar deviate the wrist with slight extension. Stabilize the scaphoid. Radially deviate and slightly flex the hand.

Other Name: Scaphoid Shift Test

Piano Keys Test

Px: sitting; forearm pronated(+) sign: Difference in Mobility, pain and tendernessSignificance: Distal radioulnar joint instabilityProcedure:

Push down the distal ulna

Finkestein Test

Px: Make a fist with the thumb inside the fingers(+) sign: pain over the abductor pollicis longus and

extensor pollicis brevis tendonsSignificance: Hoffmann’s disease, de Quervain’s

disease, paratendonitis in the thumbProcedure:

Stabilize forearm and ulnar deviate the wrist.

Sweater Finger Sign

Px: (+) sign: (-) flexion of one of the distal phalanxSignificance: Ruptured flexor digitorum profundus

tendonProcedure:

Instruct px to make a fist

Test for Extensor Hood Rupture

Px: Flex PIP of finger 90⁰ at the edge of the table(+) sign: Little Pressure from the middle phalanxSignificance: Torn Central Extensor HoodProcedure:

Ask the px to extend the proximal interphalangeal joint while PT palpates for the middle phalanx

Boyes Test

Px: (+) sign: Unable to flex DIP jointsSignificance: torn central extensor hoodProcedure:

Hold finger in slight extension at the PIP joint. Ask px to flex the DIP joint.

Bunnel – Littler TestPx: a. extend MCP jt.

b. slight flexed MCP jt.

(+) sign: a. (-) flexion b. fully flexed c. not fully flexed PIP jt.

Significance: a. tight intrinsic muscles or contracture of joint capsule b. intrinsic muscles tightness c. Contracture of joint capsule

Procedure:Flex PIP joint.

Other name: Intrinsic Plus , Finochietto – Bunnel

Linburg’s Sign

Px: (+) sign: Loss of Motion, PainSignificance: Tendinitis at the interconnection

between flexor pollicis longus and flexor indicesProcedure:

Fully flex the thumb then extend the index finger

Tinel’s Sign at the Wrist

Px: (+) sign: Tingling or Paresthesia in the median nerve

distributionSignificance: Carpal Tunnel SyndromeProcedure:

tap over the carpal tunnel at the wrist.

Phalen’s Test

Px: (+) sign: tingling or paresthesia in the median nerve


Flex the wrist maximally and hold for 1 minute.

Reverse’s Phalen’s Test

Px: (+) sign: Tingling or Paresthesia in the median nerve


Extend wrist maximally and press the carpal tunnel for 1 minute.

Other Name: Prayer Test

Carpal Compression Test

Px: supinated(+) sign: tingling or paresthesia in the median nerve


Grasp hand then apply direct pressure over the carpal tunnel for 30 seconds

*a modification of Reverse Phalen’s Test

Froment’s Sign

Px: Grasp a piece of paper between thumb and index (+) sign: thumb flexion | thumb hyperextension Significance: paralysis of adductor pollicis | Jeanne’s

Sign (Ulnar Nerve Paralysis)Procedure:

Pull paper away from patient

Egawa’s Sign

Px: Flex middle digit(+) sign: unable to do the motionSignificance: Ulnar Nerve PalsyProcedure:

Ask the patient to alternately ulnar deviate and radial deviate the finger

Wrinkle Test

Px: (+) sign: no wrinklingSignificance: DenervatedProcedure:

Place patient’s fingers in warm water for 5-20 minutes

Ninhydrin Sweat Test

Px: wait for clean hand to sweat(+) sign: no color change (Normal: White – purple)Significance: Nerve LesionProcedure:

Moderately press against good quality bond paper for 15 seconds. Trace with pencil and spray the paper with triketohydrindene (Ninhydrin) spray. Leave for 24 hrs to dry.

Dellon’s Moving 2-point Discrimination Test

Px: Eyes are closed and the hand is cradled in the examiners hand

(+) sign: 10 mm difference between the right and left hand

Significance: measures the quickly adapting mechanoreceptor system

Procedure:move 2 blunt points from proximal to distal along the long axis of the limb or digit, starting with a distance of 8mm b/n the points

Allen Test

Px: open and close hand several times. (+) sign: flushing of the handSignificance: Patency of the radial and ulnar arteries

(which artery provides the major blood supply to the hand)

Procedure:Compress radial and ulnar arteries. Px opens their hand while pressure is maintained. Release one artery at a time.

Hand Volume Test

Px: (+) sign: 30-50mL difference between right and left

hands. (Normal = 10mL)Significance: Swelling, edema (Normal = dominant)Procedure:

Use a volumeter.

THORACIC & LUMBAR

Slump Test 1 (ST1)

Cervical Spine: FlexionThoracic & Lumbar Spine: Flexion (slump)Hip: Flexion (90⁰+)Knee: ExtensionAnkle: DorsiflexionFoot: ---Toes: ---Nerve Bias: Spinal Cord, Cervical and Lumbar Nerve

Roots, Sciatic Nerve

Slump Test 2 (ST2)

Cervical Spine: FlexionThoracic & Lumbar Spine: Flexion (slump)Hip: Flexion (90⁰+), AbductionKnee: ExtensionAnkle: DorsiflexionFoot: ---Toes: ---Nerve Bias: Obturator Nerve

Side Lying Slump Test (ST3)

Cervical Spine: FlexionThoracic & Lumbar Spine: Flexion (slump)Hip: Flexion (20⁰)Knee: FlexionAnkle: Plantar flexionFoot: ---Toes: ---Nerve Bias: Femoral Nerve

Long Sitting Slump Test (ST4)

Cervical Spine: Flexion, RotationThoracic & Lumbar Spine: Flexion (slump)Hip: Flexion (90⁰+)Knee: ExtensionAnkle: DorsiflexionFoot: ---Toes: ---Nerve Bias: Spinal Cord, Cervical and Lumbar Nerve

Roots, Sciatic Nerve

Straight Leg Raising Test (SLR Basic)

Hip: Flexion + AdductionKnee: ExtensionAnkle: DorsiflexionFoot: ---Toes: ---Nerve Bias: Sciatic Nerve and Tibial Nerve

Other Name: Lasegue’s Test

Straight Leg Raising Test 2 (SLR2)

Hip: FlexionKnee: ExtensionAnkle: DorsiflexionFoot: EversionToes: ExtensionNerve Bias: Tibial Nerve


Hip: FlexionKnee: ExtensionAnkle: DorsiflexionFoot: InversionToes: ---Nerve Bias: Sural Nerve


Hip: Flexion and Medial RotationKnee: ExtensionAnkle: Plantar FlexionFoot: InversionToes: ---Nerve Bias: Common Peroneal Nerve

Cross Straight Leg Raising Test (SLR5)

Hip: FlexionKnee: ExtensionAnkle: DorsiflexionFoot: ---Toes: ---Nerve Bias: Nerve Root (disc prolapse)

Basic Prone Knee Bending Test (PKB1)

Cervical Spine: Ipsilateral RotationThoracic & Lumbar Spine: NeutralHip: NeutralKnee: FlexionAnkle: ---Foot: ---Toes: ---Nerve Bias: Femoral Nerve, L2-L4 nerve roots

Prone Knee Bending Test (PKB2)

Cervical Spine: Ipsilateral Rotation Thoracic & Lumbar Spine: NeutralHip: Extension, AdductionKnee: FlexionAnkle: ---Foot: ---Toes: ---Nerve Bias: Lateral Femoral Cutaneous NerveOther Name: Nachlas Test

Prone Knee Extension Test (PKE)

Cervical Spine: ---Thoracic & Lumbar Spine: NeutralHip: Extension, Abduction, Lateral RotationKnee: ExtendedAnkle: DorsiflexionFoot: EversionToes: ---Nerve Bias: Saphenous Nerve

Sitting Root Test

Px: Short sitting, neck flexed(+) sign: Arch back, pain on the buttock, posterior

thigh, and calf.Significance: Tension on Sciatic Nerve, True Sciatic painProcedure:

Passively extend the knee

* a modification of Slump Test

Bechterewis Test

Px: Flex neck, extend knee(+) sign: Pain in the back or legSignificance: SciaticaProcedure:

Ask the patient to extend the knee one at a time, and then both.

* A modification of Sitting Root Test

Bowstring Test

Px: Supine or Sitting(+) sign: Radicular pain (sciatic tension test or

Deyerle’s Sign)Significance: SciaticaProcedure:

Flex the hip at pain range, then flex the knee at 20⁰, apply presure on the popliteal area.

Other Name: Cram Test, Popliteal Pressure Sign.

Compression Test

Px: Supine; hip flex (100⁰); knee flex(+) sign: Radicular Pain on Posterior LegSignificance: Disc HerniationProcedure:

Apply axial compression to the spine by applying direct pressure on the patient’s feet or buttocks.

Flip Sign

Px: sitting, then supine(+) sign: Pain (on both tests)Significance: SciaticeProcedure:

Px in sitting: extend kneePx in supine: unilateral straight leg raising test

Babinski Test

Px: (+) sign: Extension of big toe and abduction of the

other toes.Significance: Upper Motor Neuron LesionProcedure:

Run a pointed object along the plantar aspect of the px’s foot.

Oppenheim Test

Px: (+) sign: Extension of big toe and abduction of the

other toesSignificance: Upper Motor Neuron LesionProcedure:

Run a fingernail along the crest of the tibia

Gluteal Skyline Test

Px: Prone; head straight; arms at the side(+) sign: Flat gluteus muscle=atrophied | less contractionSignificance: damage to the Inferior Gluteal nerve,

pressure on L5, S1 or S2 nerve roots.Procedure:

Stand on the px’s feet and observe the buttock. Then ask the px to contract the buttocks

H & I Stability Test

Px: Standing

(+) sign: pain on at least 2 segments on the same quadrant | Pain on 1 segment only and 1 quadrant

Significance: Hypomobile | Instability

Procedure:Stabilize the pelvis and other hand in shoulder.

“H”: side-flex, forward flex then extend, neutral, repeat with other side.

“I”: Forward flex, side bending, neutral, repeat with extension.

Specific Lumbar Spine Torsion Test

(example: left L5-S1)

Px: Right Side-Lying with slight extension of lumbar spine

(+) sign: minimal movement is felt, right capsular tissue stretch

Significance: Stress on the Specific Levels

Procedure:Grasp the left arm then pull upward/forward (45⁰) then stabilize L5 spinous process by holding the left shoulder back with the PT’s elbow while rotating the pelvis and sacrum forward until S1 starts to move with the opposite hand.

Farfan Torsion Test

Px: Prone(+) sign: Reproduction of SymptomsSignificance: Stress the facet jt.. Jt. Capsule,

Interspine/supraspine ligament, neural arch, longitudinal lig. and disc.

Procedure:Stabilize the ribs and spine (T12), then the other hand is placed on the anterior aspect of ilium

Pheasant Test

Px: Prone (+) sign: PainSignificance: Lumbar Spine InstabilityProcedure:

Apply pressure on the lumbar spine, then passively flex the knee until the heel touches the buttocks.

One Leg Standing Lumbar Extension Test

Px: One leg stand(+) sign: PainSignificance: SpondylolisthesisProcedure:

Instruct px to extend the spine while balancing on one leg.

*If rotation is combined with extension = Facet Joint pathology on which the rotation occurs.

Other Name: Stork Standing Test

Quadrant Test

Px: Standing(+) sign: Pain or Reproduction of SymptomsSignificance: Facet Joint PathologyProcedure:

Extend the px’s spine, apply overpressure. Px side flexes and rotates to the affected side.

Shober’s Test

Px: Standing

(+) sign: difference between the two measurements

Significance: Lumbar Spine Mobility

Procedure:Mark the following points:

a. S2 – Point of referenceb. 5cm/2inches belowc. 10cm/4inches above

measure the distance between the 3 points. Ask px to forward flex (fingers touching his toes), then measure the distance.

Yeoman’s Test

Px: Prone(+) sign: PainSignificance: Sacroiliac Joint DysfunctionProcedure:

Stabilize the pelvis then extend the hip, with knee flexed and extended

Milgram’s Test

Px: Supine (+) sign: Cannot hold the position or Reproduction of

SymptomsSignificance: Sacroiliac Joint DysfunctionProcedure:

Instruct px to lift his legs from the table ~ 2-4in (5-10cm) and hold the position for 30 secs.

Beevor’s Sign

Px: Supine, hands behind the head(+) sign: The umbilicus does not remain in a straight

lineSignificance: Abdominal Muscle Paralysis Procedure:

Px flexes the head against resistance, coughs, or attempts to sit up.

Stoop Test

Px: Sitting or Standing(+) sign: Relief of PainSignificance: Neurogenic Intermittent ClaudicationProcedure:

After brisk walking, px feels pain in the buttock and lower limb. Px flexes forward

Treadmill TestPx: on the treadmill

(+) sign: severe symptoms

Significance: Intermitent Claudication

Procedure:Two trials are conducted:

a. 1.2mphb. Preferred walking speed

Px walks upright on the treadmill for 15mins/onset of symptoms.Time to 1st symptoms, total ambulatory time, and precipitating symptoms are recorded

Hoover’s Test

Px: Supine (+) sign: If the opposite hand doesn’t feel any pressureSignificance: MalingeringProcedure:

Place 1 hand under each calcaneus and ask the px to lift one leg off of the table

Burn’s Test

Px: Kneeling on the chair(+) sign: Unable to do / overbalancesSignificance: MalingeringProcedure:

Bend forward to touch the floor with the fingers

Sign of the Buttock

Px: Supine(+) sign: Hip flexion doesn’t increaseSignificance: Pathology in the buttock (tumor, bursitis,

abcess)Procedure:

Perform passive unilateral straight leg raising test until restriction. Then Flex the px’s knee

PELVIS

Straight Leg Raising TestPx: Supine (+) sign: Pain >70⁰ | > 120⁰ (hypermobile)Significance: Sacroiliac Joint PathologyProcedure:

Flex the px’s hip with the knee extended

Other Name: Lasѐgue’s Test

Prone Knee Bending TestPx: Prone(+) sign: Pain in:

a. Front of the Thighb. Lumbar Spinec. < 90⁰

Significance: a. Rectus Femoris Tightnessb. L3 nerve root lesionc. Sacroiliac Jt. Pathology

Procedure:Flex the knee until the heel touches the buttocks

Other Name: Nachlas Test

Flamingo Test

Px: One Leg Standing(+) sign: Pain on Pubic Symphysis or SI jointSignificance: Lesion on the StructureProcedure:

Ask the px to do a one leg stand. *px may hop, increasing the stress on pubic symphysis = Stress X-ray

Gaenslen’s Test

Px: Side-lying or Supine (+) sign: PainSignificance: Ipsilateral Sacroiliac joint lesion, Hip Pathology,

L4 nerve root lesionProcedure:

Px holds the lower leg flexed against the chest. Stabilize the hip while hyper extension on the upper leg.

Gillet’s TestPx: Standing(+) sign: SI jt moves minimally or upSignificance: HypomobileProcedure:

Palpate PSIS and ask px to stand on one leg while pulling the opposite knee towards the chest

Other Name: Sacral Fixation Test

Yeoman’s Test

Px: Prone(+) sign: Pain on SI jt. | Lumbar Pain | Ant. Thigh

ParesthesiaSignificance: Anterior SI lig. | Lumbar Pathology |

Femoral Nerve Stretch (L2-L4)Procedure:

Flex the knee to 90⁰, then extend the hip

Leg Length Test

Px: Supine (+) sign: >1-1.3cm (0.5-1in) Significance: Leg Length DiscrepancyProcedure:

True Leg Length = measure the ASIS to Lateral MalleolusALL = measure umbilicus to Medial Malleolus

Functional Limb Length Test

Px: Standing (+) sign: assymetry is corrected by correct positioningSignificance: Functional Leg Length DiscrepancyProcedure:

Palpate for the ASIS and PSIS and px is placed in “correct” stance (subtalar joints neutral, knees fully extended, and toes facing straight ahead)

Sign of the Buttock

Px: Supine (+) sign: Hip flexion does not increaseSignificance: Pathology in the Buttock (tumor, bursitis,

abscess)Procedure:

Passive unilateral SLR until restriction, then flex the knee

Trendelenburg’s Test

Px: One leg Stance(+) sign: pelvis falls on the non stance standSignificance: weakness of the gluteus medius muscle,

superior gluteal nerve lesion, L4-S1 lesionProcedure:

ask the px to do a one leg stance. Observe the px

HIP

Ortolani’s SignPx: Supine (+) sign: feels clunk, clink or jerkSignificance: Congenital Hip Dislocation Procedure:

Grasp the thigh and leg with the thumb on the medial knee and the fingers alongside the thigh and hip. Flex the hip to 90⁰, then abduct while lifting it forward

*up to 12wks–6mos.

Barlow’s Test Px: Supine (+) sign: feels clunk, clink or jerkSignificance: Congenital Hip Dislocation Procedure:

Grasp the thigh and leg with the thumb on the medial knee and the fingers alongside the thigh and hip. Flex the hip to 90⁰, then abduct then adduct while pushing downward

*up to 12wks–6mos.

Galeazzi SignPx: Supine (+) sign: One knee is HigherSignificance: Unilateral Congenital Hip Dislocation Procedure:

Hip and knee is flexed to 90⁰ with feet flat on the table

Other Name: Allis Test*up to 3–18mos.

Telescoping Sign Px: Supine; Hip and knee flexed to 90⁰ (+) sign: Excessive mov’t upon lifting up

(pistoning/telescoping)Significance: Congenital Hip Dislocation Procedure:

Femur is pushed down onto the table. Femur and leg is then lifted up and away the from the table

Other Name: Piston Test, Dupuytren’s Test

Abduction Test Px: Supine (+) sign: Asymmetry or Limitation of MovementSignificance: Congenital Hip Dislocation Procedure:

Hip and knee is flexed to 90⁰, then abducted

Other Name: Hart’s Sign

Patrick’s TestPx: Supine(+) sign: Test leg’s knee remains above the opposite straight legSignificance: Hip jt. Pathology, Iliopsoas spasm, SI jt. pathologyProcedure:

Place the test leg on top of the other leg (FABER). Slowly lower the knee of the test leg.

Other Name: Faber Test, Figure-Four Test, Jansen’s Test

Anterior Labral Tear TestPx: supine(+) sign: Pain with or without clickSignificance: Hip Joint PathologyProcedure:

Place hip into full FABER, then to EADIR

Other Name: FADDIR Test

Craig’s Test

Px: Prone with knee flexed 90⁰(+) sign: > 15⁰Significance: Anteversion of HipProcedure:

Palpate greater trochanter then medially and laterally rotate the hip until the greater trochanter is parallel to the examining table or it reaches it’s most lateral position.

Other Name: Ryder Method

Torque TestPx: Supine, with the test leg over the edge of the table(+) sign: YieldSignificance: Hip Jt. PathologyProcedure:

Extend the leg until the pelvis moves. Medially rotate up to end range while applying a slow posterolateral pressure along the line of the neck of the femur for 20secs.

Nelaton’s Line

Px: Supine(+) sign: Greater trochanter is palpated above the lineSignificance: Hip Dislocation or Coxa VaraProcedure:

draw an imaginary line from the ischial tuberosity of the pelvis to the ASIS of the pelvis on the same side.

Bryant’s Triangle

Px: Supine(+) sign: Difference in measurementSignificance: Congenital Dislocation of Hip or Coxa VaraProcedure:

Draw imaginary lines:1st – perpendicular from the ASIS to the PSIS2nd – tip of greater trochanter to ASIS

Rotational Deformities

Px: Supine(+) sign: Face in | face up, out, away Significance: Internal Rotation of femur or tibia |

External Rotation of femur or tibiaProcedure:

Observe the patella

Thomas Test

Px: supine(+) sign: knee of the other leg rises of the table | abduction

of the other leg (“J” sign or Stroke)Significance: Illiopsoas muscle contracture | Tight Iliotibial

BandProcedure:

Flex hip bringing the knee to the chest.

Kendall’s TestPx: Supine with knee bent over the edge of the table(+) sign: slight extension of the other legSignificance: Rectus Femoris muscle contractureProcedure:

Px flexes one knee (90⁰) onto the chest and holds it

Other: Rectus Femoris Contracture Test (Method 1)

Ely’s TestPx: Prone(+) sign: Spontaneous ipsilateral hip flexionSignificance: Rectus Femoris Muscle Tightness Procedure:

Passively flex the px’s knee

Other Name: Tight Rectus Femoris Test (Method 2)

Ober’s TestPx: Side-lying with lower leg flexed(+) sign:

a. Leg remain abducted (with knee extended)b. Pain radiated (with knee flexed)c. Localized pain

Significance:a. Tenson Fascia Latae / Iliotibial Band Contractureb. Femoral Nerve Involvementc. Trochanteric Bursitis

Procedure:Abduct and extend the upper leg with the knee flexed (90⁰) or extended, then slowly lower the upper leg.

Adduction Contracture TestPx: Supine(+) sign: ASIS forms an angle < 90⁰, and Pelvis shifts up on

affected sideSignificance: Adductor Muscles contracture (adductor

longus, brevis and magnus, pectineus, and gracilis)Procedure:

Check for the assymetry of ASIS and balance the pelvis

Abduction Contracture Test

Px: Supine(+) sign: ASIS forms and angle > 90⁰, and Pelvis shifts down

on the affected sideSignificance: Abductor Muscles Contracture (Gluteus

Medius and MinimusProcedure:

Check for the assymetry of ASIS and balance he pelvis

Prone Lying Test for ITB Contracture

Px: Prone(+) sign: Firm End-feelSignificance: Iliotibial and Contracture Procedure:

Stand on the opposite side. With one hand, hold the ankle and maximally abduct while applying pressure to the buttock with the other hand. Knee is flexed 90⁰, adduct the hip.

Noble Compression Test

Px: Supine; Knee flexed 90⁰; Hip flexed 90⁰(+) sign: Localized pain at 30⁰ knee flexionSignificance: Iliotibial Band Friction SyndromeProcedure:

Apply pressure to the lateral femoral epicondyle or 1-2cm proximal to it while the px slowly extends the knee

Piriformis Test

Px: Side-lying; upper leg in 60⁰ hip flexion; flex knee(+) sign: Pain in groin | Pain in buttockSignificance: Piriformis muscle tightness | piriformis

syndromeProcedure:

Stabilize pelvis with one hand and the other applies downward pressure to the knee

90-90 SLR TestPx: Supine; hip and knee 90⁰ flexion(+) sign: 20⁰- 0⁰ knee extendSignificance: Hamstrings muscle contracture, or sciaticaProcedure:

Px Alternately extends the knee

Other Name: Hamstring Contracture Test (Method 1)

Hamstring Contracture Test (Method 2)

Px: Long-sitting; 1 knee flexed against the chest (+) sign: Unable to reach the toesSignificance: Tight Hamstrings muscleProcedure:

Flex the trunk and touch the toes of the extended lower limb.

Tripod Sign Px: Short-sitting(+) sign: Extension of the trunkSignificance: Hamstring muscles are tight, SciaticaProcedure:

Passively extend the knee

Other Name: Hamstring Contracture Method 3

Phelp’s Test

Px: Prone(+) sign: Abduction increases with knee extensionSignificance: Gracilis muscle contractureProcedure:

Passively abduct both leg as far as possible. Then flex knees 90⁰ and try to abduct further.

Fulcrum Test

Px: Short-sitting(+) sign: Sharp Pain and ApprehensionSignificance: Femoral Shaft Stress, FractureProcedure:

Place an arm under px’s thigh to act as a fulcrum, then apply pressure to distal femur.

KNEE

a. Abduction TestPx: Short sitting

(+) sign: excessive gapping of the tibia and femur (medial condyle)

Significance: with knee extension, injury to these structures:

Procedure:Fully extend the knee then apply valgus stress

b. Abduction TestPx: Supine or Long sitting with the test leg over the edge of the table(+) sign: excessive gapping of the tibia and femur (medial condyle)Significance: knee flexed to 20⁰- 30⁰, injury to these structures:

Procedure:Fully extend the knee then place in 20⁰- 30⁰ flexion. Laterally rotate the knee (lock knee) and then apply valgus stress

Stress X-ray:

Gr.1: 5mm opening

Gr.2: 10mm opening

Gr.3: >10mm opening

c. Abduction TestPx: Supine/Long sitting with the test leg over the edge of the table(+) sign: excessive gapping of the tibia and femur (medial condyle)Significance: knee flexed to 20⁰- 30⁰, injury to these structures:

Procedure:Fully extend the knee then place in 20⁰- 30⁰ flexion. Grasp the big toe (lock knee) and then apply valgus stress

Stress X-ray:

Gr.1: 5mm opening

Gr.2: 10mm opening

Gr.3: >10mm opening

a. Adduction TestPx: short sitting(+) sign: excessive gapping of the tibia and femur (Lateral condyle)Significance: Knee extension, injury to these structures:

Procedure:Fully extend the knee then apply a varus stress

b. Adduction TestPx: Supine or long sitting with the test leg over the edge of the table(+) sign: excessive gapping of the tibia and femur (Lateral condyle)Significance: Knee in 20⁰- 30⁰ flexion, injury to these structures:

Procedure:Fully extend the knee then place in 20⁰- 30⁰ flexion. Apply varus stress on the knee

Stress X-ray:

Gr.1: 5mm opening

Gr.2: 8mm opening

Gr.3: >8mm opening

Lachman TestPx: Supine(+) sign: Mushy or Soft End FeelSignificance: Injury to these structures:

a. Anterior Cruciate Ligament (posterolateral bundle)b. Posterior Oblique Ligamentc. Arcuate-Popliteus Complex

Procedure:Stabilize the anterior distal thigh and the posteromedial aspect of the proximal leg. Fully extend the knee, then flex to 20⁰- 30⁰, laterally rotate the leg and apply anterior tibial translation.

Lachman TestModification 1: Short-sittingModification 2: Supine with the test knee rests on PT’s knee (for small

hands)Modification 3: Supine with the test leg between the arm and thorax

(not sufficient)Modification 4: Supine, eye is level with the kneeModification 5: Prone (difficult to determine the quality of the end feelModification 6 (active/no touch): Supine with PT’s arm under px’s knee

the ask to extend the knee.Other Name: Ritchie Test, Trillat Test, Lachman Trillat Test

Drawer SignPx: Supine; hip flexed to 45⁰; knee flexed to 90⁰(+) sign: Tibia Moves forward (>6mm on the femur)Significance: Injury to these structures:

a. ACLb. Posterolateral Capsulec. Medial Collateral Ligamentd. Iliotibial Bande. Posterior Oblique Ligamentf. Arcuate-Popliteus comlex injury

Procedure:Sit on px’s foot with both hands clasp around the tibia, then translate it anteriorly.

Posterior Sag SignPx: Supine(+) sign: Step-off sign, thumb signSignificance: Injury to these structures:

a. Posterior Cruciate Ligamentb. Arcuate-Popliteus Complexc. Posterior Oblique Ligamentd. Anterior Cruciate Ligament

Procedure:Place the px in supine with the hips flexed to 45⁰ and knee flexed to 90⁰

Reverse Lachman Test

Px: Prone(+) sign: Mushy or Soft End feelSignificance: Posterior Cruciate Ligament InjuryProcedure:

Stabilize the anterior distal thigh and the anterior proximal leg. Place the knee in full extension the 20⁰- 30⁰ flexion

Godfrey Test

Px: Supine(+) sign: Poterior Sag of the tibiaSignificance: Posterior Cruciate LigamentProcedure:

Flex the hip and knee to 90⁰

a. Slocum TestPx: Supine (+) sign: Tibia moves forward (Anterolat. Translation)Significance: Injury to these structures:

Procedure:Flex the knee to 80⁰- 90⁰ with 45⁰ knee flexion, 30⁰ Medial rotation. Sit on the px’s foot then draw the tibia forward

b. Slocum TestPx: Supine(+) sign: Tibia moves forward (Anteromedial translation)Significance: Injury to these structures:

a. Medial Collateral Ligamentb. Posterior Oblique Ligamentc. Posteromedial Capsuled. Anterior Cruciate Ligament

Procedure:Flex the knee to 80⁰- 90⁰ with 45⁰ knee flexion, 15⁰ Lateral rotation. Sit on the px’s foot then draw the tibia forward

Jerk Test of HughstonPx: Supine(+) sign: Clunk or jerk at 20⁰- 30⁰ of knee flexionSignificance: Injury to these structures:

a. ACLb. Posterolateral capsulec. Arcuate popliteus complxd. Lat. Collateral ligamente. PCLf. Iliotibial Band

Procedure:Flex the hip to 45⁰ and knee to 90⁰ then extend while maintaining medial rotation and a valgus stress

Cross Over Test of ArnoldPx: Standing(+) sign: “Giving Way”Significance: Injury to these structures:

a. ACLb. Posterolateral capsulec. Arcuate popliteus complxd. Lat. Collateral ligamente. PCLf. Iliotibial Band

Procedure: Instruct px to cross the uninvolved leg in front of the test leg. Step on the involved led. Asked the px to rotate the upper torso away from the uninvolved leg then is asked to contract the quadriceps muscle.

Hughston’s Posteromedial and Posterolateral Drawer Sign

Px: Supine; hip flexed to 45⁰; knee flexed to 80⁰- 90⁰ (+) sign: moves/rotates posteriorly on the medial aspect | moves/rotates

posteriorly on the lateral aspectSignificance: Injury to these structures:

Procedure:Sit on the px’s foot with both hands clasps around the tibia (slight medial rotation | slight lateral rotation) then translate postriorly.

a. PCLb. POLc. MCLd. Semimembranosus mme. Posteromedial capsulef. ACL

a. PCLb. Arcuate-popliteus complexc. LCLd. Biceps fem tendone. Posterolat. Capsulef. ACL

Loomer’s TestPx: Supine (+) sign: excess lateral rotation and posterior sagSignificance: Injury to these sturctures:

a. PCLb. Arcuate-popliteus complexc. LCLd. Biceps Fem tendone. Posterolateral capsulef. ACL

Procedure:Flex the hip and knee to 90⁰, then maximally lateraly rotate both tibias.

Mcmurray TestPx: Supine; knee fully flexed(+) sign: snap/click with painSignificance: Meniscus InjuryProcedure:

Medially Rotate the tibia – for lateral meniscusLaterally Rotate the tibia – for medial meniscus

*modification:same procedure but with knee extension.

Apley’s TestPx: Prone; knee 90⁰ flexed(+) sign: painSignificance:

a. Ligamentous injury b. Meniscus Injury

Procedure:Stabilize thigh with PT’s knee. a. Medially/laterally rotate the tibia with distractionb. Medially/laterally rotate the tibia with compression

Bounce Home Test

Px: Supine; knee 90⁰ flexed(+) sign: Rubbery end-feel, pain upon extension on jt.

lineSignificance: Torn MeniscusProcedure:

Cup the heel and allow it to extend passively

O’Donohue’s Test

Px: Supine(+) sign: increase pain on rotation in either or both positionsSignificance: Capsular irritation | Meniscus TearProcedure:

Flex hip and knee to 90⁰, medially/laterally rotate the tibia twice, and then fully flex and rotate it both ways again.

Modified Helfet Test

Px: Short Sitting(+) sign: (-) patella goes laterally when standingSignificance: Cruciate injury | Quadriceps weaknessProcedure:

Examine the patella in sitting and standing positions.

Test For Retreating or Retracting Meniscus

Px: Supine(+) sign: (-) appear/disappearing meniscusSignificance: Torn meniscusProcedure:

Flex hip and knee to 90⁰ then medially and laterally rotate the tibia.Medial Rotation: AppearingLateral Rotation: Disappearing

Payr’s Test

Px: Supine(+) sign: pain on the medial jt. lineSignificance: Medial/posterior aspect of meniscus

lesionProcedure:

Position test leg in figure-4 position

Bohler’s Sign

Px: Supine(+) sign: painSignificance: Meniscus PathologyProcedure:

Apply valgus/varus stress on the knee

Bragard’s SignPx: Supine (+) sign: increase/decrease pain upon doing the procedureSignificance: Meniscus PathologyProcedure:

Place the px’s knee in flexion. Then laterally rotate the tibia and extend the knee = pain and tenderness. Medially rotate the tibia and flex the knee = decrease pain.

Childress Sign

Px: Standing(+) sign: Pain, clicking, snappingSignificance: Posterior lesion of meniscusProcedure:

Instruct px to squat and do the “duck waddle”

Cabot’s Popliteal Sign

Px: Supine; Figure-4 position(+) sign: PainSignificance: Meniscus PathologyProcedure:

Ask the px to isometrically straighten the knee while applying resistance.

Mediopatellar Plica TestPx: Supine(+) sign: PainSignificance: Pinching of the edge of the plica b/n the

medial femoral condyle and the patellaProcedure:

Flex the knee 30⁰ then push the patella medially with the thumb

Other Name: Mital-Hayden Test

Plica “Stutter” Test

Px: Short-sitting(+) sign: patella stutters or jumps b/n 60⁰ and 45⁰ of

flexionSignificance: Plica SyndromeProcedure:

Plcae one finger over one patella and then ask the px to slowly extend the knee

Hughston Test

Px: Supine(+) sign: Popping of the plica bandSignificance: Plica SyndromeProcedure:

Flex the knee and medially rotate the tibia while pressing the patella medially with the heel of the same hand on the medial condyle. Passively flex and extend the knee

Brush, Stroke or Bulge TestPx: Supine(+) sign: Fluid wave bulge on the medial side of the patellaSignificance: Swelling (4-8ml extra synovial fluid)Procedure:

stroke medial side (upwards) of the patella with 1 hand and the other hand on the lateral side (downward)

Other Name: Wipe Test

Fluctuation Test

Px: Supine (+) sign: Synovial Fluids Fluctuate Significance: Significant Effusion Procedure:

place 1 hand above the patella (suprapatellar pouch) and the other hand below the patella. Press down with one hand and then the other hand.

Patellar Tap Test

Px: Supine(+) sign: Dancing patellaSignificance: SwellingProcedure:

tap on the patella

Other Name: Ballotable Patella

Clarke’s Sign

Px: Supine(+) sign: retropatellar pain / cannot hold the

contractionSignificance: Patellofemoral DysfunctionProcedure:

Press down slightly proximal to the upper pole or the base of the patella. Ask the px to contract the quadriceps muscle while pressing down.

Waldron Test

Px: Standing(+) sign: count the crepitus with pain (note the

amount, location and the ROM)Significance: Patellofemoral DysfunctionProcedure:

Palpate the patella and then instruct the patiene to perform slow, deep knee bends.

Zohler’s Sign

Px: Supine(+) sign: PainSignificance: Chondromalacia PatellaeProcedure:

pulls the patella distally and ask the pt to contract quadriceps muscle.

Frund’s Test

Px: Short SItting(+) sign: PainSignificance: Chondromalacia PatellaeProcedure:

taps the patella in various knee flexion

Q-angle Test

Px: Supine

(+) sign: a. < 13⁰ | b. > 18⁰

Significance: a. Chondromalacia patellae / patella alta | b. Chondromalacia / subluxing patella, increase femoral anterversion, genu valgum, lateral displacement of tibial tubercle, or increase lateral tibial torsion

Procedure:Imaginary lines are drawn:

1st line – from ASIS to midpoint of patella2nd line – from tibial tubercle to midpoint of patella

Other Name: Patellofemoral angle

Wilson Test

Px: Short Sitting(+) sign: pain lessened/diminishedSignificance: Osteochondritis Dissecans of the medial

femoral condyleProcedure:

Px extends the knee with internal rotation of the leg. At 30⁰ of flexion, pain increases and the px is asked to stop the movement and rotate the leg laterally.

Fairbank’s Apprehension Test

Px: Supine; knee flexed to 30⁰(+) sign: quadriceps muscle contract to bring patella

“into line”Significance: Patellar dislocationProcedure:

Carefully and slowly push the patella laterally and distally

Noble Compression Test

Px: Supine(+) sign: pain at 30⁰ of knee flexion Significance: Iliotibial Band Syndrome Procedure:

Flex the knee up to 90⁰ then press the lateral femoral epicondyle with the thumb then extend the knee.

ANKLE AND FOOT

Neutral Position Of Talus (Weight Bearing Position)

Px: Standing(+) sign: BulgingSignificance: Affectation of the TalusProcedure:

Palpate for the talus (dorsal aspect) then ask the px to rotate the trunk to the right and left

Tibia rotates medially and laterallyTalus pronates and supinates

Neutral Position of Talus (Prone)

Px: Prone with foot dangled over the edge of the table(+) sign: Talar head bulges Laterally (Supination) /

Medially (Pronation)Significance: Affectation of the Talus Procedure:

Grasp over the 4th and 5th metatarsal heads. Palpate for the talus (dorsal aspect) the passively Dorsiflex the foot. Alternately move the foot to supination then pronation.

Leg Heel Alignment

Px: Prone with foot dangled over the edge of the table (+) sign: > 8⁰ of inversion of heel | Eversion of heelSignificance: Hindfoot varus | Hindfoot valgusProcedure:

1st line - mark the midline of calcaneus2nd line – 1cm distal to the 1st mark3rd line – lower third midline of the leg

Coleman Block Test

Px: Standing(+) sign: Heel is in neutral position | heel is still not in

neutral positionSignificance: mobile hindfoot | fixed hindfoot

inversionProcedure:

Place 2cm wooden block on the floor and ask the px to stand with their heel and the lateral side of their forefoot on the block

Too Many Toes Sign

Px: Standing(+) sign:More toes can be seen on the affected sideSignificance: Valgus deformity, Forefoot abducted,

increase lateral rotation of tibiaProcedure:

View the px from behind

Tibial Torsion (Sitting)

Px: Short-sitting(+) sign: Lateral tibial torsion: > 18⁰ | < 13⁰Significance: toe-out position | toe-in positionProcedure:

Draw imaginary Lines:1st line – 2 epicondyles2nd line – 2 malleoli

Tibial Torsion (Supine)

Px: Supine(+) sign: Lateral tibial torsion: > 18⁰ | < 13⁰Significance: toe-out position | toe-in positionProcedure:

Draw imaginary Lines:1st line – 2 apices of malleoli2nd line – heel parallel to the floor

Tibial Torsion (Prone)

Px: Prone; Knee flexed to 90⁰(+) sign: Lateral tibial torsion: > 18⁰ | < 13⁰Significance: toe-out position | toe-in positionProcedure:

Draw imaginary Lines:1st line – heel parallel to the floor2nd line – heel parallel to the thigh

a. Anterior Drawer Test Of the Ankle

Px: Supine; 20⁰ plantar flexion(+) sign: suction sign (over the anterior talofibular

ligament) with minimal painSignificance: Stress on anterior talofibular ligament

injuryProcedure:

Stabilize just above the ankle and draw the talus forward

b. Anterior Drawer Test Of the Ankle

Px: Supine; 20⁰ plantar flexion(+) sign: greater anterior translation (on lateral die

only) = medial rotation of the talusSignificance: Stress on anterior talofibular ligament

injury and calcaneofibular ligamentProcedure:

Stabilize just above the ankle and draw the talus forward + inversion

c. Anterior Drawer Test Of the Ankle

Px: Supine; 20⁰ plantar flexion(+) sign: Greater Anterior TranslationSignificance: Torn anterior talofibular ligament and

Calcaneofibular ligamentProcedure:

Stabilize just above the ankle and draw the talus forward + dorsiflexion

Prone Anterior Drawer Test

Px: Prone with foot dangled over the edge of the table(+) sign: Excessive anterior movement and “Sucking in”

at the Achilles TendonSignificance: Ligamentous Instability (Anterior

Talofibular Ligament)Procedure:

Push the heel steadily forward.

Talar Tilt

Px: Side-lying; knee flexed

(+) sign: Excessive Movement

Significance: Adduction: stress on torn Calcaneofibular Ligament and/or Anterior Talofibular LigamentAbduction: stress on Deltoid Ligament (tibionavicular, tibiocalcaneal, posterior tibiotalar ligament)

Procedure:Tilt the talus from side to side (abduction and adduction)

Squeeze Test of The Leg

Px: Supine (+) sign: Pain Significance: Syndesmosis Injury/high ankle sprainProcedure:

Grasp the lower leg at midcalf and squeeze the tibia and fibula together

Kleiger Test

Px: Short-sitting(+) sign: Pain with talus displacement (medial) | pain

over the anterior or posterior tibiofibular ligamentsSignificance: Deltoid Ligament Tear | SyndesmosisProcedure:

Apply passive lateral rotation to the foot.

Other Name: External Rotation Stress Test

Thompson’s Test

Px: Prone / kneels with feet over the edge of the table(+) sign: absence of plantar flexionSignificance: Ruptured Achilles TendonProcedure:

Squeeze the calf muscle

Other Name: Simmond’s Test, Sign for Achilles Tendon Rupture)

Test or Peroneal Tendon Dislocation

Px: Prone; knee flexed to 90⁰(+) sign: Tendon subluxes from behind the lateral

malleolus Significance: Peroneal Tendon DislocationProcedure:

Ask px to actively dorsiflex and plantar flex the ankle along with eversion against resistance.

Feiss Line

Px: Standing but with non-weight bearing(+) sign: a. Falls 1/3rd

b. Falls 2/3rd

c. Rests on the floor Significance: a. 1st degree Flat Foot

b. 2nd degree Flat Foot c. 3rd degree Flat Foot

Procedure:Mark the apex of Medial Malleolus to plantar aspect of 1st metatarsophalangeal jt. Then palpate the navicular tuberosity. (Normally lies on/close to the line b/n the 2 points)

Hoffa’s Test

Px: Prone with feet over the edge of the table(+) sign: feels less tautSignificance: Calcaneal FractureProcedure:

Palpate both the achilles tendon. Instruct px to plantar flex and dorsiflex

Tinel’s Sign At The Ankle

Px: (+) sign: Tingling SensationSignificance: Peripheral Nerve InjuryProcedure:

Percuss at the anterior tibial branch of the Deep Peroneal Nerve in front of the ankle or the Posterior Tibial Nerve behind the medial malleolus.

Other Name: Percussion Sign

Duchenne Test

Px: Supine with legs straight(+) sign: Only the Lateral Border plantar flexesSignificance: Lesion of the Superficial Peroneal Nerve,

L4-S1 nerve rootProcedure:

Push up on the head of the 1st metatarsal through the sole (dorsiflex). Px tries to plantarflex

Morton’s Test

Px: Supine(+) sign: PainSignificance: Stress fracture or neuromaProcedure:

Grasp the metatarsal heads and squeeze together

Homan’s Sign

Px: Supine(+) sign: Pain in the calf, PALLOR, swelling in the leg,

loss of the dorsalis pedis pulseSignificance: Deep Vein ThrombosisProcedure:

Passively dorsiflex with the knee extended

Buerger’s Test

Px: Supine and sitting(+) sign: 1-2mins before the color comes backSignificance: Poor arterial blood supplyProcedure:

Elevate the leg at 45⁰ for at least 3 minutes, foot blanches.Px is then placed in short-sitting.

Health & Medicine

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