Orthopedic Tests Nplex

Front 1

Anterior and Posterior Drawer's Foot Sign

Back 1

 Passive, supine 

Anterior: Stabilize the tibia, and pull calcaneus Posterior: Stabilize the foot dorsum, and pull the tibia anteriorly
 Anterior: (+) ↑gapping = a tear of the anterior talofibular ligament 

Posterior (+) ↑gapping = a tear of the posterior talofibular ligament

Front 2

Dorsiflexion Test

Back 2

 Passive, seated 

With the knee flexed, dorsiflex the foot
 Test for hypertonicity of gastrocnemius and soleus  ( + ) foot dorsiflexion when the knee is flexed: hypertonic gastroc  ( + ) foot dorsiflexion limited when the knee is flexed: hypertonic soleus  Soleus is a one-joint muscle, it is not affected by flexion of the knee. Gastroc is a two joint muscle, it slackens when the knee is flexed

Front 3

Forefoot Adduction Test (Pediatric)

Back 3

 Passive, seated 

Grasp the child’s ankle with thumb and index fingers, passively abduct the forefoot by pushing on the medial side of the 1st metatarsal head
 (+) the foot can be abducted manually beyond the neutral position: forefoot adduction  (+) the foot does not abduct beyond the neutral position: cast correction is necessary for this forefoot adduction

Front 4

Forefoot Squeeze Test (Morton's)

Back 4

 Passive, supine or seated 

Apply transverse pressure across the heads of the metatarsals
 (+) ↑ pain in the forefoot: neuroma between metatarsals or metatarsalgia

Front 5

Homan's Sign

Back 5

 Passive, supine  Knee flexed 

Dorsiflex the foot and squeeze the calf
 Test for deep vein thrombosis 

(+) ↑ pain at the posterior leg or calf: thrombophlebitis

Front 6

Talor Tilt Test

Back 6

Passive, seated 

Adduct (invert, supinate, varus) foot
 (+) ↑ gapping: a tear of the anterior talofibular and/or calcaneofibular ligament

Front 7

Test for Rigid or Supple Flat Feet

Back 7

 Passive and active  Seated and standing  Observe the patient’s feet while seated (non-weight bearing of feet) or standing (weight bearing)
 (+) medial longitudinal arch absent in all positions: rigid flat feet  (+) medial longitudinal arch absent only when standing: supple flat feet that can be corrected with longitudinal arch supports

Front 8

Thompson (squeeze) Test

Back 8

 Passive, prone  Squeeze the calf muscles observing for plantar-flexion of the foot
 (+) lack of plantar flexion: Achilles tendon rupture

Front 9

Tibial Torsion Test

Back 9

 Passive, seated  Draw a straight line between the two melleoli, and a line from the tibial tubercle and the ankle joint
 Test for internal torsion of the tibia  ( - ): the line drawn between the two malleoli is rotated externally 15° from a perpendicular line drawn from the tibial tubercle to the ankle  ( + ) the malleolar line faces directly anterior, close to the perpendicular line: internal tibial torsion

Front 10

Adam's Sign

Back 10

 Active, standing, shoes off  Stand behind pt, examine spine as patient flexes
 ↓ angle: functional scoliosis, usually < 25°  No change: structural deformity (hemivertebra, compression fracture)

Front 11

Adson's Test

Back 11

Active, seated  Monitor radial pulse while taking a deep breath and rotating the head towards involved side and extending the neck
 Test for TOS   compression of subclavian artery and/or brachial plexus  (+) ↓ pulse: Scalenus anterior, cervical rib problem or mass (Pancoast tumor)  Paresthesia or radiculopathy of upper extremity: compression of neural components of brachial plexus
Reverse

Front 12

Braggard Test

Back 12

• Passive, supine
• Perform SLR test to the point of pain, then lower 5°
and dorsiflex the foot

Test for lumbar radicular pain
• Traction of sciatic nerve
• (+) ↑ Pain at 0-­35°: priformis
syndrome, SI joint restriction
• (+) ↑ Radicular pain at 35- 70°:
disc pathology
• (+) ↑ Pain at 70-­90°: lumbar
joint problem
• (+) ↑ Dull posterior thigh
pain: tight hamstring

Front 13

Bhecterew Test

Back 13

• Active,
seated
• Extend one knee, then the

other knee, then both

• Test for lumbar radicular pain
• ↑ Traction of the sciatic nerve
• (+) not able to perform d/t
radicualr pain, or perform with
leaning back: ↑ compression
to the sciatic nerve or lumbar nerve
roots, disc protrusion

Front 14

Burns Bench Test

Back 14

• Kneeling on the exam table

• Stabilize pts legs at the ankle joint

• Instruct pt to bend at the waist to touch the floor

• Test for malingering LBP
• (+) unable to perform test b/c LBP complaints
• This test puts stress on the posterior thigh
mm not on back mm, thus the pt with LBP
should be able to perform this test (they
might need help to raise up from the bent
position though)

Front 15

Cervical Spine Compression Test

Back 15

 Passive  Seated  Compression at neutral and rotated position B/L
 Downward pressure causes: o Narrowing of Intervertebral foramina (IVF) o Compression of apophyseal joints in cervical spines o Compression of intervertebral disc in cervical spine  (+) Local pain: foraminal encroachment w/o nerve root pressure or apophyseal capsulitis  (+) Radicular pain: foraminal encroachment w/ nerve root compression  If suspect nerve root involvement, evaluate neurological level

Front 16

Cervical Spine Distraction Test

Back 16

 Passive  Seated  Grasp beneath mastoid process (avoid face and TMJ) & lift up pt’s head
 Stretch the cervical muscles, ligaments, and Z joint capsules.  (+)  local pain: muscle spasm, strain, sprain, facet capsulitis.  (+)  local or radicular pain: foraminal encroachment or disc defect

Front 17

East Test (Roo's Test)

Back 17

 Active, seated  Pt abducts arms to 90°and flexes elbows 90°; instruct pt to open and close fists slowly for 3 min.
 Test for TOS  (+) affected arm weakness and/or discoloration of hand

Front 18

Hoover Test

Back 18

• Active, supine
• Place palm under heel of unaffected leg;
ask pt to lift affected leg

• Test for malingering LBP
• (+) Pt will not raise the affected leg and
NO posterior pressure on the unaffected
heel side would be felt
• If pt is genuinely trying to raise the leg
but cannot do so, you should feel pressure
from the unaffected heel

Front 19

Kemp Test

Back 19

• Passive, seated

• Stabilize the PSIS w/ one hand
• Reach around to front of pt & grasp shoulder w/ other hand
• Rotate, laterally flex, and extend the trunk

• Test for lumbar radicular pain
• When pt bends obliquely backwards,
the dural sac on the side of bending moves
laterally
• (+) ↑ Local pain: facet capsulitis, lumbar
m. spasm
• (+) ↑ Radicular ipsilateral pain: Lateral
disc protrusion

• (+) ↑ Radicular contra pain: medial
disc protrusion

Front 20

Kernig Test

Back 20

• Passive, supine
• Flex the hip and the knee on the affected
side; then keeping the hip flexed extend the
knee
• Test for meningeal irritation and inflammation

• (+) pain while straightening the leg
or inability to straighten leg: traction
of sciatic nerve, and therefore dural
sac/meninges

• Sciatic radicular pn may also be present
but look for other meningeal irriation signs
such as severe HA, stiff neck, neck pn,

↑ temp, mental status changes

Front 21

SLR (Lasegue Test)

Back 21

• Passive, supine
• Raise affected leg to the point of pain or
90°.
• Place an inclinometer at the tibial tuberosity.
• Test for lumbar radicular pain

• ↑ Stretch of sciatic nerve and spinal nerve
roots at the L5-­‐S2.

• (+) ↑ Pain at 0-­35°: priformis syndrome,
SI joint restriction
• (+) ↑ Radicular pain at 35-70°: disc

pathology
• (+) ↑ Pain at 70-­90°: lumbar joint problem
• (+) ↑ Dull posterior thigh pain: tight
hamstring
• Confirm with Bragard’s and Lasegue’s
tests

Front 22

Lindner Test

Back 22

 Passive  Supine  Flex pt’s neck
 ↑ traction of dural sac and spinal cord causes pain  (+) pain or flex knees to ↓ traction of cord and meninges: meingeal irritation or nerve root involvement.  Head pain w/ sudden neck movements, neck stiffness, nuchal rigidity and ↑ temp: suspect bacterial meningitis  immediate referral to ER

Front 23

Milgram Test

Back 23

• Active, supine
• Raise and hold legs 3-­6 inches off the
table.

• Hold for as long as possible

• Test for Space occupying lesion (SOL)
• ↑ Intrathecal pressure

• Normally, should be able to perform
test for > 30 seconds w/o LBP
• (+) Low back pain (LBP): SOL

Front 24

Minor Sign

Back 24

• Active, seated

• Tell pt to stand up

• (+) stand on painless side and
flex leg on the painful side to ↓ tension
of the sciatic nerve: sciatic radiculopathy
on the side of flexed leg (pushes off
uninvolved side leg or chair arm to
get up)

Front 25

Shoulder Depression Test

Back 25

 Passive  Seated  Push down the shoulder and laterally flex pt’s head to opposite side
 Muscles, ligaments, nerve roots, nerve root coverings, and brachial plexus are stretched & clavicle is depressed, approximating the 1st rib  ↑ local pain on tested side: muscle spasm, adhesions, ligament injury.  ↑ radicular pain: compression of the neurovascular bundle, adhesion of the dural sleeve, or thoracic outlet syndrome (TOS)  ↑ pain on opposite side: foraminal enchroachment, facet, disc problem
Brudzinski’s

Front 26

Soto Hall Test

Back 26

 Passive, supine  Passive neck flexion with sternum stabilization
 (+) ↑ Local pain: ligament, muscular, osseous, or cervical cord problem  (+)↑ Radicular pain: disc problem

Front 27

Valsalva Test

Back 27

 Active  Seated  Take a deep breath, hold, and bear down
 ↑ Intrathecal pressure of entire spine  (+) Pain at cervical region: Space occupying lesions (SOL) in the cervical canal or foramen

Front 28

Vertebral Artery Test

Back 28

Patient rotates head opposite to tested side maximally and holds position for 10 seconds. Patient returns to neutral for 10 seconds. Patient extends head for 10 seconds. Patient returns to neutral for 10 seconds. Patient extends and rotates head (again opposite tested side) maximally for 10 seconds. Positive symptoms include (The 5 D’s) dizziness, diplopia, dysarthria, dysphagia, drop attacks, nausea and vomiting, sensory changes, nystagmus, etc.

Front 29

Wright (Hyperabduction) Test

Back 29

 Passive, seated  Establish the character of the radial pulse  Monitor radial pulse while hyperabducting the arm
 Test for TOS  (+) ↓ Pulse: compression of axillary artery by pectoralis minor muscle (spastic or hypertrophied) or by a deformed coracoid process

Front 30

Apley Scratch Test

Back 30

 Active, seated  Touch contralateral scapula behind head from superior and inferior
 ↑ Stress on the rotator cuff tendons  (+)↑ Pain: rotator cuff tendinitis (usually supraspinatus)

Front 31

Drop Arm (Codman) Test

Back 31

 Active, seated  Abduct the arm to 90°, then ask pt to lower the arm slowly
 (+) not able to lower the arm slowly or drops suddenly: rotator cuff tear (usually supraspinatus)  The supraspinatus m. acts as an abductor of the arm and holds the head of the humerus in place

Front 32

Glenohumeral Apprehension Test

Back 32

 Passive, seated  Abduct the affected arm 90° and externally rotate slowly while stabilizing the shoulder
 Anterior glenohumeral instability test  External rotation of the arm → dislocates the humerus anteriorly  (+)  local pain: chronic anterior shoulder dislocation (lack of integrity of the inferior glenohumeral ligament, anterior capsule, rotator cuff tendons, and glenoid labrum)

Front 33

Impingement (Hawkins-Kennedy, Neer) Test

Back 33

 Passive, seated  Grasp the wrist and fully flex the arm
 Test for supraspinatus tendinitis  Movement jams the greater tubercle of the humerus against the acromion  (+)↑ Pain: supraspinatus, bicep tendinitis (overuse injury)

Front 34

Lippman Test

Back 34

 Passive, seated  , with the other hand palpate the biceps tendon and move arm from side to side
  stress of the bicipital tendon and transverse humeral ligament  (+) ↑ pain: bicipital tendinitis, ruptured transverse humeral ligamen

Front 35

Speed Test

Back 35

 Resisted, seated  Arm extended, supinated, and shoulder flexed to 45°.  Place fingers on the bicipital groove and with the other hand resist pt’s flexion of the shoulder
 This test stresses the biceps tendon in the bicipital groove  (+) ↑ pain at the bicipital groove: Bicipital tendinitis

Front 36

Yergason Test

Back 36

 Resisted, seated  Flex pt’s elbow to 90°, stabilize the elbow with one hand, then instruct pt to externally rotate the shoulder and supinate the forearm against resistance
  stress of the bicipital tendon and transverse humeral ligament  (+) ↑ Local pain: bicipital tendinitis  (+) displacement of bicipital tendon: rupture transverse humeral ligament

Front 37

Cozen Test

Back 37

 Resisted, seated  Pt’s forearm is pronated  Stabilize pt’s forearm and resist pt’s wrist extension
 Test for lateral epicondylitis  The tendons that extend the wrist attach to the lateral epicondyle. These include: extensor carpi radialis brevis, extensor digitorum, extensor digiti minimi, and extensor carpi ulnaris  The test can reproduce irritation to the already inflamed lateral epicondyle or common extensor tendon  (+) ↑pain: Lateral epicondylitis (Tennis’ elbow)

Front 38

Finkelstein Test

Back 38

 Active and Passive  Seated  Ask pt to bring the thumb into the palm, make a fist, and ulnar deviate the fist
 Test to determine presence of de Quervain’s disease  (+) ↑ pain: tenosynovitis of the abductor pollicis longus and extensor pollicis brevis tendons (de Quervatin’s dz)

Front 39

Mill Test

Back 39

 Passive, seated  Pronate pt’s forearm and flex the wrist fully, then passively extend the elbow
 Test for lateral epicondylitis  Test stretches the muscle attachment and puts stress on the radial nerve  (+) ↑ pain: Lateral epicondylitis

Front 40

Phalen Test

Back 40

 Active, seated  Flex the wrists and place dorsal surface of hands together for 60 seconds
 Test for paresthesia of the median nerve  Flexor retinaculum ↑ compression of the median nerve  (+) tingling in the hand (1st, 2nd, 3rd, and lateral half of the 4th digits): Carpal tunnel syndrome, anterior dislocation of lunate, arthritic changes, inflammation of the flexor retinuculum, tenosynovitis of the flexor digitorum tendons

Front 41

Retinacular Test

Back 41

 Passive, seated  Test each digit individually  Step 1: Hold MCP and PIP joints in neutral position while passively flexing DIP joint  Step 2: Flex the PIP joint slightly, then passively flex the DIP joint
 Test for joint capsule contraction or tight retinacular (collateral) ligaments  (+) DIPs don’t flex when MCPs and PIPs are neutral: retinacular tightness or PIP capsule contraction  (+) DIPs flex easily when the PIPs are flexed: flexing the PIPs relaxes the retinaculum, the capsule is normal but the retinaculum is tight

Front 42

Tinel Sign

Back 42

 Passive, seated  Tap the palmar surface of the wrist over the carpal tunnel
 Test for paresthesia of the median nerve  (+) tingling of the hand (1st, 2nd, 3rd, and lateral half of the 4th digits): Carpal tunnel syndrome

Front 43

Varus Stress Test

Back 43

 Passive, seated  Pt’s forearm is supinated  Stabilize pt’s elbow while adducting the forearm (Varus of the elbow)
 Test for lateral (radial) collateral ligament  (+) ↑pain and gapping: lateral (radial) collateral ligament instability

Front 44

Valgus Stress Test

Back 44

 Passive, seated  Pt’s forearm is supinated  Stabilize pt’s elbow while abducting the forearm (Valgus of the elbow)
 Test for medial (ulnar) collateral ligament  (+) ↑pain and gapping: medial (ulnar) collateral ligament instability

Front 45

Ely Test

Back 45


 Passive, prone  Flex the knee bringing the heel to the ipsilateral/ contralateral buttock 

Observe for hip flexion or pelvis rising on the side being tested
 (+)  pain: tight rectus femoris or hip flexion contracture

Front 46

Gaenslen Test

Back 46

 Active, supine  Instruct the pt to bring the knee to the chest on the unaffected side  Then place downward pressure on the affected thigh until it is lower than the edge of the table
 Extension of the leg stresses the SI joint and anterior SI joint ligament  (+) pain at SI on affected side: SI lesion (anterior SI joint ligament sprain) or SI joint inflammation

Front 47

Hibb Test

Back 47

 Passive, prone  Flex the knee and medially rotate the hip (move the leg outward)  Palpate the SI joint for quality of movement and degree of opening
 (+) ↑Pain at the SI joint: inflammation of the SI joint  (+) ↑Pain at the hip: inflammation of ischiofemoral ligament  (+) lack of motion: = SI joint restriction

Front 48

Nachlas Test

Back 48

 Passive, prone  Knee flex bringing heel closer to the buttocks (ipsilateral)
 (+) radicular pain: compression/irritation at L2-L4 by intradural lesion (disc defect, spur, SOL)  (+) pain in SI/buttocks: consider SI joint lesion

Front 49

Ober Test

Back 49

 Passive, side lying (involved side up)  Abduct and slightly extend pt’s upper leg with the knee straight  Slowly lower the upper leg
 (+) leg fails to fall into adducted position below the horizontal: contracture of TFL and/or IT band  (+)  pain over greater trochanter: trochanteric bursitis

Front 50

Ortolani Click (Pediatric)

Back 50

 Passive, supine  Grasp both thighs with thumbs and index fingers at the lesser and greater trochanters respectively  Then, flex and abduct the thighs bilaterally
 (+) Palpable/audible click: displacement of femoral head from acetabular cavity

Front 51

Patrick (FABER) Test

Back 51

 Passive, supine  First flex the knee placing the foot flat on the table and press the thigh into the acetabular cavity.  Then rest the heel on the opposite knee. Stabilize the opposite side ASIS and press down on the knee of the hip that is being tested (kind of making a figure 4)
 Test for SI and acetabular dysfunction  FABER: Flexion, ABduction, and External Rotation  Test forces femoral head into acetabular cavity giving maximal congruence to the articular surfaces  (+) hip pain: inflammation of the hip  (+) pain due to trauma: fracture in acetabular cavity or femoral neck, avascular necrosis of femoral head

Front 52

Pelvic Rock Test

Back 52

 Passive, side lying (involved side up)  Apply downward pressure on the ilium
 Test for iliac compression  (+) pain at SI: inflammation of SI joint, or ilium fracture

Front 53

Telescoping Test (Pediatric)

Back 53

 Passive, supine  Flex hip and knee to 90°, push the femur down towards the table; then lift femur up away from the table
 (+) excessive movement or a click: dislocated hip or potential to dislocate

Front 54

Thomas Test

Back 54

 Passive, supine  Bring unaffected side of the knee to the chest  Observe for hip flexion and palpate quads on the affected side  Make sure lumbar spine is relatively flat on the table
 Test for hip contracture (soft tissue stiffness that restricts joint motion)  (+) ↑hip flexion or tightness of quads: hip flexors contracture, rectus femoris contracture, or restriction of hip joint

Front 55

Trendelenburg Test

Back 55

 Active, standing  Support pt at the waist placing your thumbs at the PSIS’s  Instruct pt to flex one leg
 (+) patient can’t stand due to pain or opposite hip falls or fails to raise (flexed hip side): weak gluteus medius on the standing side

Front 56

Yeoman Test

Back 56

 Passive, prone  Place the hand over the SI joint of the involved side to stabilize the pelvis  Grasp pt’s lower leg and passively flex the knee and extend the hip
 (+) ↑ Pain: an inflammation of SI joint, or sprain of anterior sacroiliac, iliofemoral, or ischiofemoral ligament, an abscess in SI joint

Front 57

Anterior Drawer Sign

Back 57

 Passive, supine  Flex the knee, grasp behind the knee and pull anterior (P  A)
 Test for ACL stability  (+) > 5 mm of tibial movement on the femur: injury or tear of anterior cruciate ligament o Also consider: posterolateral capsule, posteromedial capsule, MCL (>1 cm movement), IT band, posterior oblique lig, arcuate-popliteus complex

Front 58

Posterior Drawer Sign

Back 58

 Passive, supine  Flex the knee, grasp behind the knee and p posteriorly (A  P )
 Test for PCL stability  (+) > 5 mm of tibial movement on the femur: injury or tear of posterior cruciate ligament o Also consider: posterior oblique lig, arcuate-popliteus complex, ACL

Front 59

Apley Compression Test

Back 59

 Passive, prone  Flexed the knee and ankle to 90°, stabilize pt’s thigh w/ your knee; grasp pt’s ankle & place downward pressure while internally and externally rotating the flexed leg
 Test for meniscus instability  (+) ↑ Pain or crepitus on either side of knee: injury of the meniscus on that side

Front 60

Apley Distraction Test

Back 60

 Passive, prone  Flex the knee to 90°, stabilize the thigh, pull on the ankle while internally and and externally rotating the leg
 Test for ligamentous instability  Distraction of knee takes pressure off the meniscus & puts strain on the medial and lateral collateral ligaments  (+) ↑ Pain: non-specific ligament injury or instability

Front 61

Apprehension Test (for patellar dislocation)

Back 61

 Passive, supine  Observe the patient’s face while extend the knee, and manually displace patella laterally
 Test for patellofemoral dysfunction  (+) ↑ Pain or look of apprehension in the patient’s face: lateral patella dislocation

Front 62

Bounce Home Test

Back 62

 Passive, supine  Support pt’s leg at the knee and ankle, elevate leg off the table, and flex pt’s knee  Passively extend pt’s leg
 Test for meniscus lesion  (+) inability to fully extend or “rubbery” feel on full extension: torn meniscus blocking full extension  (+)  pn at joint radiating up or down the leg: meniscus lesion

Front 63

Lachman Test

Back 63

 Passive, supine  Flex the knee slightly (~30°), stabilize the femur, with other hand pull the leg anteriorly (P to A)
 Test for ACL stability  (+) Softened feel and anterior translation of the tibia: tear of ACL (more reliable than Anterior Drawer Test)

Front 64

McMurray Test

Back 64

 Passive, supine  Flex the hip and knee  Step 1. Externally rotate the leg (valgus stress) as you extend the leg  Step 2. Internally rotate leg (varus stress) as you extend
 Test for meniscus instability  (+) A palpable or audible click: injury of the meniscus

Front 65

Patello Femoral Grind Test (Including Clarke Test)

Back 65

 Active, resisted, supine  Step 1. Tract the patella inferior and ask the patient to contract quadriceps  Step 2. Move the patella medially and laterally while pressing down
 Test for patellofemoral dysfunction  Step 1 (+) ↑ Pain: chondromalacia patella  Step 2 (+) ↑ Pain under the patella: chondromalacia patellae, retropatellar arthritis, or a chondral fracture  Step 2 (+) ↑ Pain over the patella: may indicate prepatellar bursitis

Front 66

Reduction Click

Back 66

 Same as McMurray’s test  Passive, supine  Flex the knee with internal or external rotation while extending the leg
 Test for meniscus instability  (+) An audible clicking sound: injured meniscus has slipped back into place

Front 67

Valgus Stress Test

Back 67

 Passive, supine  Stabilize the knee from lateral side and abduct the leg (Valgus of the knee) by pushing leg laterally  Repeat test in 20°-30° knee flexion
 Test for MCL instability  (+) ↑Pain medial aspect of the knee Ligament Stability Rating Scale Grade O No joint opening Grade 1+ < 0.5 cm joint opening Grade 2+ 0.5-1 cm joint opening Grade 3+ > 1 cm joint opening

Front 68

Varus Stress Test

Back 68

 Passive, supine  Stabilizing the knee and adduct the leg (Varus of the knee) by pushing leg medially
 Test for LCL instability  (+) ↑Pain lateral aspect of the knee
 O No joint opening Grade 1+ < 0.5 cm joint opening Grade 2+ 0.5-1 cm joint opening Grade 3+ > 1 cm joint opening

Front 69

Ballotable Patella Test

Back 69

 Passive, supine  With knee extended or slightly bent, apply light pressure or tap over patella
 Test for major effusion  (+) floating patella over knee joint

Front 70

Bulge Test

Back 70

 Passive, supine  With knee extended, apply brushing strokes towards the hip along the medial aspect of the patella. Then press on the lateral side of the patella looking for a wave of fluid to move medially
 Test for minor effusion  (+) a wave of synovial fluid bulges just below the medial side of the inferior patellar border  Note: this wave of fluid may take a few seconds to appear