Special Tests

Front 1

Shoulder

Apprehension Test, Anterior

Purpose and Method

Back 1

Positioned supine, arm 90 of abduction. Lateral rotation of shoulder.

+ test = facial grimacing when approaching end range

Front 2

Shoulder

Apprehension Test, Posterior

Purpose and Method

Back 2

Positioned supine, arm 90 of abduction. Medial rotation of shoulder

+ test = facial grimacing when approaching end range

Front 3

Bicep Tendon Pathology

Speed's Test

Purpose and Method

Back 3

Sitting or supine, elbow extended and forearm supinated. Place one hand over bicipital groove and other on the volar surface of forearm. Therapist to resist shoulder flexion.

+ = pain or tenderness in bicipital groove

Front 4

Biceps Tendon

Yergason's Test

Purpose and Method

Back 4

Pt. seated with 90 elbow flexion and forearm pronated. Humerus stabilized against thorax. Therapist places one hand on pt's forearm and other on bicipital groove. pt directed to supinate and lat. rot shoulder.

+ = pain or tenderness @ bicipital groove

Front 5

Rotator Cuff

Drop Arm Test

Purpose and Method

Back 5

pt seated or standing with arm @ 90 abduction. pt asked to slowly lower arm

+ = failing to slowly lower arm or by presence of severe pain

Front 6

Rotator Cuff

Hakin's Kenedy Impingement Test

Back 6

pt seated or standing. therapist flexes the pt's shoulder to 90 and then med. rot.

+ = pain (shoulder impingement involving supraspinatus tendon)

Front 7

Rotator Cuff

Neer Impingement Test

Purpose and Method

Back 7

pt standing or sitting. therapist positions one hand on posterior aspect of pt scapula and other stabilizing elbow. therapist elevates pt.'s arm through flexion

+ = facial grimace or pain (shoulder impingement involving supraspinatus tendon)

Front 8

Rotator Cuff

Supraspinatus Test

Purpose and Method

Back 8

pt positioned whith arm @ 90 of abduction, 30 of horizontal abduction, thumb pointing down. therapist to resist pt's attempt to abduct arm.

+ = weakness or pain (tear of supraspinatus tendon, impingement, or subscapular nerve involvement)

Front 9

Thoracic Outlet

Adson Maneuver

Purpose and Method

Back 9

pt sitting or standing. therapist monitors radial pulse while pt rotates head to test side. pt asked to extend head while therapist laterally rotates and extends shoulder.

+ = absent or diminished radial pulse

Front 10

Thoracic Outlet

Allen Test

Purpose and Method

Back 10

sitting or standing with test elbow at 90 abduction, lat. rotation, elbow flexion. pt asked to rotate head away from test side while pta monitors radial pulse.

+ = absent or diminished radial pulse

Front 11

Thoracic Outlet

Roos Test

Purpose and Method

Back 11

sitting or standing with arms at 90 or abduction, lateral rotation, elbow flexion. pt asked to open and close hands for 3:00

+ = inability to maintain test position, weakness in arms, sensory loss, ischemic pain (indicative of thoracic outlet syndrome)

Front 12

Elbow Lig. Instability

Varus Stress Test

purpose and method

Back 12

sitting with elbow in 20-30 degrees of flexion. pta places one hand on the elbow and the other proximal to pt's wrist. pta applies varus force to the lateral collateral ligament while palpating lateral joint line.

+ = increased laxity in lat. collateral ligament when compared bilateral, apprehension, or pain

Front 13

Elbow Lig. Instability

Valgus Stress Test

Purpose and Method

Back 13

sitting with elbow in 20-30 degrees of flexion. pta places one hand on the elbow and the other proximal to pt's wrist. pta applies valgus force to the medial collateral ligament while palpating medialjoint line.

+ = increased laxity in med. collateral ligament when compared bilateral, apprehension, or pain

Front 14

Epicondylitis

Cozen's Test

Purpose and method

Back 14

sitting with elbow in slight flexion. pta places thumb on lateral epicondyle while stabilizing elbow. pt is asked to make fist, pronate the forearm, radially deviate, and extend wrist against resistance.

+ = pain, weakness in lateral epicondyle region

Front 15

Epicondylitis

Lat. Epicondylitis Test

Purpose and Method

Back 15

pt sitting. pta stabilizes the elbow with one hand and places the other hand on the dorsal aspect of the pt's hand distal to the proximal interphalangeal joint. pt asked to extend the 3rd digit against resistance.

+ = pain in lat. epicondyle, mm weakness

Front 16

Epicondylitis

Medial Epicondylitis

Purpose and Method

Back 16

pt positioned in sitting. pta palpates the med. epicondyle and supinates pt's forearm , extends the wrist, and extends the elbow.

+ =pain in med. epicondyle

Front 17

Neurological Dysfunction

Tinel's Sign

Purpose and Method

Back 17

pt positioned in sitting with the elbow in slight flexion. pta taps with middle finger between olecranon process and med. epicondyle

+ = tingling in ulnar nerve distribution in forearm, hand, fingers

Front 18

Wrist/Hand Lig Instability

Ulnar Collateral Lig Instability Test

Back 18

positioned in sitting. pta holds the pt's thumb in extension and applies a valgus force to the metacarpal phalangeal joint in the thumb.

+ = excessive valgus mvmt and may be indicative of a tear of the ulnar collateral ligament ("gamekeeper's thumb" or "skier's thumb")

Front 19

Vascular Insufficiency

Allen Test

Back 19

sitting or standing. pt asked to open and close hand several times then maintain hand in closed position. pta compresses radial and ulnar arteries. pt asked to relax hand while pta releases one of the arteries and observes color.

+ = delayed or absent color on released side.

Front 20

Neurological Dysfunction

Froment's Sign

Back 20

sitting or standing while holding a piece of paper b/w thumb and index finger. pta attempts to pull paper away.

+ = flexing distal phalanx of thumb due to adductor pollicis mm paralysis. if hyperextends thumb = "Jeanne's Sign" both indic. of ulnar nerve compromise

Front 21

Neurological Dysfunction

Phalen's Test

Back 21

sitting or standing, pta flexes pt's wrists maximally and asks pt to maintain position for :60

+ = tingling in thumb, index, middle, lateral half of ring finger and indicative of carpal tunnel syndrome due to median nerve compression

Front 22

Wrist/ Hand Neurological Dysfunction

Tinel's Sign

Back 22

standing or sitting. pt taps over the volar aspect of the pt's wrist.

+ = tingling in the thumb, index finger, middle finger, lateral half of ring finger distal to the contact site at the wrist. indicative of carpal tunnel syndrome due to median nerve compression

Front 23

Wris/Hand Misc.

Finkelstein Test

Back 23

standing or sitting, pt asked to make a fist with the thumb tucked inside the fingers. pta stabilizes the pt's forearm and ulnarly deviates the wrist

+ = pain over abductor pollicis longus and extensor pollicis brevis tendons at the wrist and may be indicative tenosynovitis in the thumb (de Quervian's Disease)

Front 24

Hip Contracture/Tightness

Ely's Test

Back 24

pt in prone while pta passively flexes knee.

+ = spontaneous hip flexion occurring with knee flexion. indicative of rectus femoris contracture

Front 25

Hip Contracture/Tightness

Ober's Test

Back 25

sidelying with the lower leg flexed at the hip and knee. pta moves the test leg into hip extension and abduction and the attempts to slowly lower the test leg

+ = inability of the test leg to adduct and touch the table and may be indicative of TFL contracture

Front 26

Hip Contracture/Tightness

Piriformis Test

Back 26

sidelying with the test leg positioned toward the ceiling and hip flexed to 60. pta placed one hand on pt's pelvis and other on pt's knee. while stabilizing pelvis, the pta applies downward (adduction) force on knee.

+ = pain or tightness. may be indicative of piriformis tightness or compression of sciatic nerve

Front 27

Hip Tightness/Contracture

Thomas Test

Back 27

supine with legs fully extended. pt asked to bring on knee to the chest in order to flatten lumbar spine. pta observes the position of the contralateral hip while the pt holds the flexed hip.

+ = straight leg rising from the table and may be indicative of a hip contracture

Front 28

Hip Tightness/Contracture

Tripod Sign

Back 28

pt sitting with knees flexed to 90 over the edge of a table. pta passively extends one knee.

+ = tightness in the hamstrings or extension of trunk in order to limit tight hamstrings

Front 29

Hip Contracture/Tightness

90-90 Straight Leg Raise Test

Back 29

supine, pt asked to stabilize the hips in 90 of flexion with the knees relaxed. pta instructs pt to alternately extend each knee as much as possible while maintaining the hips in 90 of flexion.

+ = knee remaining in 20 or more of flexion and is indicative of tight hamstrings

Front 30

Hip Misc.

Craig's Test

Back 30

pt positioned in prone with the test knee flexed to 90. pta palpates posterior aspect of the greater trochanter and medially and laterally rotates the hip until the greater trochanter is parallel with table. the degree of femoral anteversion corresponds to the angle formed by the lower leg with the perpendicular axis of table. norm = 8-15 deg

Front 31

Hip Misc.

Patrick's Test/ Faber Test

Back 31

pt supine with test leg flexed, abducted, and laterally rot at the hip onto the opposite leg. pta slowly lowers the test leg through abduction toward the table

+ = failure of test leg to abduct below the level of the opposite leg and may be indicative of iliopsoas, sacroiliac, or hip joint abnormalities

Front 32

Hip Misc.

Trendelenburg Test

Back 32

pt is standing and is asked to stand on one leg for ~:10

+ = drop of pelvis on unsupported side and may be indicative of weakness of the glute. med on the supported side

Front 33

Knee Lig Instability

Anterior Drawer Test

Back 33

supine with knee flexed 90 and hip flexed 45. pta stabilizes lower leg by sitting on forefoot. pta grasps pt's proximal tibia and administers anterior directed force to the tibia on the femur

+ = excessive anterior translation, with diminished or absent end feel. indicative of ACL injury

Front 34

Knee Lig Instability

Lachman Test

Back 34

supine with knee flexed to 20-30. pta stabilized distal femur with one hand and places the other hand on the proximal tibia. pta applies anterior directed force to the tibia on the femur

+ = excessive ant. translation, diminished or absent end feel. indicative of ACL injury

Front 35

Knee Lig Instability

Lateral Pivot Shift Test

Back 35

supine, hip flexed and abducted 30 with slight medial rotation. pta grasps the leg with one hand and places the other hand over the lateral surface of proximal tibia. pta medially rotates the tibia and applies a valgus force tot he knee while the knee is slowly flexed.

+ = palpable shift or clunk occurring b/w 20-40 deg of flexion. indicative of anterolateral rotation instability

Front 36

Knee Lig Instability

Posterior Drawer Test

Back 36

supine with knee flexed to 90 and hip flexed to 45. pta stabilizes lower leg by sitting on forefoot. pta grasps the pt's proximal tibia with two hands, places thumbs on tib. plateau, and administers posterior directed force.

+ = excessive posterior translation of the tibia on the femur, diminished or absent end feel. indicative of PCL injury

Front 37

Knee Lig Injury

Posterior Sag Sign

Back 37

supine with knee flexed to 90 and hip flexed to 45.

+ = tibia sagging back on the femur and may be indicative of PCL injury

Front 38

Knee Lig Instability

valgus stress test

Back 38

supine, knee flexed 20-30. pta positions one hand on the medial surface of the pt's ankle and other on lateral surface of the knee. apply valgus stress

+ = excessive valgus mvmt, possible MCL injury (laxity in extension indicative if damage to MCL, PCL, posterior oblique lig., posteromedial capsule)

Front 39

Knee Lig Instability

Varus Stress Test

Back 39

supine, knee flexed 20-30. pta positions one hand on the lateral surface of the pt's ankle and other on medial surface of the knee. apply varus stress

+ = excessive varus mvmt, possible damage to LCL. if knee in extension and +, damage could be to LCL, PCL, arcuate complex, posterolateral capsule

Front 40

Meniscal Pathology

Apley's Compression Test

Back 40

prone with knee flexed to 90. pta stabilizes femur and places other hand on pt's heel. pta medially and laterally rotatates the tibia while applying compressive force through tibia

+ = pain or clicking, may be be indicative of meniscal lesion

Front 41

Meniscal Pathology

McMurray Test

Back 41

supine. pta grasps the distal leg with one hand and palpates the knee joint line with the other. with knee fully flexed, the therapist medially rotates the tibia and extends the knee then laterally rotate.

+ = click or pronounced crepitation felt over joint line. indicative of posterior meniscal lesion

Front 42

Knee Swelling

Brush Test

Back 42

supine. pta places one hand below joint line on the medial surface of the patella and strokes proximally with the palm and fingers as far as the suprapatellar pouch. the other hand then strokes down the lateral surface of the patella

+ = wave of fluid just below medial distal border of the patella, indicative of effusion in the knee.

Front 43

Knee Swelling

Patellar Tap Test

Back 43

supine with the knee flexes or extended to a point of discomfort. pta applies a slight tap over the patella

+ = if patella appears to be floating and may be indicative of joint effusion

Front 44

Ankle Lig Instability

Anterior Drawer Test

Back 44

supine. pta stabilizes the distal fibula with one hand while the other hand holds the foot in 20 deg of plantar flexion and draws the talus forward.

+ = excessive anterior translation, indicative of anterior talofibular ligament sprain

Front 45

Ankle Lig Instability

Talar Tilt

Back 45

sidelying with the knee flexed to 90. pta stabilizes the distal tibia with one hand while grasping the talus with the other. the foot remains neutral. pta tilts the talus into abduction and adduction

+ = excessive adduction and may be indicative of calcaneofibular ligament sprain

Front 46

Ankle Misc.

Thompson Test

Back 46

prone with feet extended over edge of table. pta asks pt to relax and proceeds to squeeze the muscle belly of the gastroc and soleus muscles.

+ = absence of platar flexion and may be indicative of ruptured Achilles tendon

Front 47

Ankle Misc

True Leg Length Discrepancy

Back 47

supine with hips, knees extended, legs 15-20 cm apart, and pelvis in balance with legs. using a tape measure, the pta measures from the distal point of the ASIS to the distal point of the medial malleoli.

+ = bilateral variation greater than 1cm