Special Tests

Front 1

Apprehension test for anterior shoulder dislocation

Back 1

- Supine, arm 90 degrees abduction

- PT rotates pt's shoulder

- + test= look of apprehension or facial grimace prior to reaching end point

Front 2

Apprehension test for posterior shoulder dislocation

Back 2

- Supine, arm 90 degrees flexion and medial rotation

- PT applies posterior force through long axis of humerus

- + test= look of apprehension or facial grimace prior to reaching end point

Front 3

Ludington's Test

Back 3

- Biceps tendon pathology

- Pt. in sitting, asked to clasp both hands behind head with fingers interlocked.

- Pt. asked to alternately contract and relax biceps

- + test= absence of movement in biceps tendon (may indicate rupture of long head of biceps)

Front 4

Speed's Test

Back 4

- Pt. in sitting or standing. Elbow extended and forearm supinated.

- PT places one hand over bicipital groove and the other over the volar surface of the forearm

- PT resists active shoulder flexion

- + test= pain/tenderness over bicipital groove. May indicate bicipital tendonitis.

Front 5

Yergason's Test

Back 5

- Sitting with 90 degrees of elbow flexion and forearm pronation

- Pt. humerus stabilized against thorax

- PT places one hand over pt. forearm, the other over their bicipital groove.

- Pt. directed to actively supinate and laterally rotate against resistance

- + test= pain/tenderness of bicipital groove. May indicate bicipital tendonitis

Front 6

Drop Arm Test

Back 6

- Sitting/standing, arm at 90 degrees abduction

- Pt. asked to slowly lower arm to the side

- + test= pt. failing to slowly lower arm, or the presence of severe pain. May indicate tearing of the rotator cuff.

Front 7

Hawkins-Kennedy Impingement Test

Back 7

- Sitting or standing

- PT flexes pt. shoulder to 90 degrees and then medially rotates arm. (PASSIVE)

- + test= pain. May be indicative of shoulder impingement involving supraspinatus tendon.

Front 8

Neer Impingement Test

Back 8

- Sitting/standing.

- PT puts one hand on posterior aspect of pt's scapula and the other stabilizing at elbow.

- PT elevates pt's arm through flexion (PASSIVE)

- + test= facial grimace/pain. May indicate shoulder impingement of supraspinatus tendon.

Front 9

Supraspinatus Test

Back 9

- Pt. arm in 90 degrees of abduction followed by 30 degrees of horizontal adduction. Thumb pointed down

- PT resists pt. attempt to abduct arm.

- + test= weakness/pain. May indicate a tear of supraspinatus tendon, impingement or suprascapular nerve involvement.

Front 10

Adson Maneuver

Back 10

- Sitting/standing

- PT monitors radial pulse.

- Pt. rotates head to face test shoulder.

- Pt. then asked to extend head while PT laterally rotates and extends pt's shoulder.

- + test= Absent or diminished radial pulse. May indicate Thoracic Outlet

Front 11

Allen Test (THO)

Back 11

- Sitting/standing with test arm in 90 degrees of abduction,lateral rotation and elbow flexion.

- Pt asked to rotate head away from test shoulder while therapist monitors radial pulse.

- + test= absent/diminished pulse when head is rotated away from test shoulder. May indicate Thoracic Outlet

Front 12

Costoclavicular Syndrome Test

Back 12

- Sitting

- PT monitors radial pulse. Assists pt to military posture.

- + test= absent/diminished radial pulse. May indicate Thoracic outlet caused by compression of subclavian artery between the first rib and the clavicle.

Front 13

Roos Test

Back 13

- Sitting/standing

- Pt. arms positioned in 90 degrees abduction, lateral rotation and elbow flexion.

- Pt. asked to open and open and close hands for 3 minutes.

- + test= inability to maintain test position, weakness of arms, sensory loss, ischemic pain. May indicate thoracic outlet.

Front 14

Wright test (hyperabduction test)

Back 14

- Sitting/supine

- PT moves pt's arm overhead in frontal plane while monitoring radial pulse.

- + test= absent/diminished radial pulse. May indicate compression in the costoclavicular space.

Front 15

Glenoid Labrum Tear Test

Back 15

- Supine.

- PT places one hand on pt's posterior humeral head while other hand stabilizes the humerus just proximal to the elbow.

- PT PASSIVELY abducts and laterally rotates arm over the pt's head, then applies an anterior directed force to the humerus.

- + test= clunk or a grinding sound, may indicate glenoid labrum tear.

Front 16

Upper Limb Tension Test

Back 16

- Neural provocation maneuvers.

- Each test begins with uninvolved side being tested first.

- Recommended for pt's with symptoms in arm, head, neck and thoracic spine.

Front 17

Upper Limb Tension Test #1

Back 17

- Shoulder depression-> 110 degrees abduction-> elbow extension-> forearm supination-> wrist extension-> finger/thumb extension

- Sensitization test with contralateral cervical lateral flexion.

- Nerves tested= Median nerves, anterior interosseous nerve

Front 18

Upper Limb Tension Test #2

Back 18

- Shoulder depression-> 10 degrees abduction-> elbow extension-> forearm supination-> wrist extension-> finger/thumb extension-> shoulder lateral rotation

- Sensitization test with contralateral cervical lateral flexion.

- Nerves tested= median nerve, musculocutaneous nerve, axillary nerve

Front 19

Upper Limb Tension Test #3

Back 19

- (Waiter's Tip)

- Shoulder depression-> 10 degrees abduction-> elbow extension-> forearm pronation-> wrist flexion/ulnar deviation-> finger/thumb flexion-> shoulder medial rotation

- Sensitization test with contralateral cervical lateral flexion

- Nerves tested= radial nerve

Front 20

Upper Limb Tension Test #4

Back 20

- (Holding a tray)

- Shoulder depression-> 10-90 degrees abduction-> elbow flexion-> forearm supination-> wrist extension/radial deviation-> finger/thumb extension-> shoulder lateral rotation

- Sensitization test with contralateral cervical lateral flexion

- Nerves tested= ulnar nerve

Front 21

Varus Stress Test (Elbow)

Back 21

- Sitting, elbow in 20-30 degrees flexion.

- PT places one hand on pt's elbow, the other on proximal wrist

- PT applies varus force to test LCL while palpating lateral joint line.

- + test= increased laxity, apprehension or pain. May indicate LCL sprain.

Front 22

Valgus Stress Test (Elbow)

Back 22

- Sitting, elbow in 20-30 degrees flexion

- PT places on hand on pt's elbow, other at proximal wrist.

- PT applies valgus force to test MCL while palpating medial joint line.

- + test= increased laxity in MCL, apprehension or pain. May indicate MCL sprain.

Front 23

Cozen's Test

Back 23

- Sitting with elbow in slight flexion

- PT places thumb on pt's lateral epicondyle while stabilizing elbow joint.

- Pt asked to make a fist, pronate forearm and radially deviate and extend wrist against resistance.

- + test= Pain in lateral epicondyle region or muscle weakness. May indicate lateral epicondylitis.

Front 24

Lateral Epicondylitis Test

Back 24

- Sitting. PT stabilizes elbow with one hand and places other hand on the dorsal aspect of the pt's hand distal to PIP joints.

- Pt asked to extend 3rd digit against resistance.

- + test= pain in lateral epicondyle region or muscle weakness. May indicate lateral epicondylitis.

Front 25

Medial Epicondylitis Test

Back 25

- Sitting. PT palpates medial epicondyle.

- PT supinates the pt forearm, extends wrist and elbow.

- + test= pain in medial epicondyle region. May indicate medial epicondylitis.

Front 26

Mill's Test

Back 26

- Sitting. PT palpates lateral epicondyle, pronates pt. forearm, flexes wrist and extends elbow.

- + test= Pain in lateral epicondyle region. May indicate lateral epicondylitis.

Front 27

Tinel's Sign (Elbow)

Back 27

- Sitting with elbow in slight flexion

- PT taps index finger between olecranon process and medial epicondyle.

- + test= tingling sensation in the ulnar nerve distribution of the forearm, hand and fingers. May indicate ulnar nerve compression or compromise

Front 28

Ulnar Collateral Ligament Instability Test

Back 28

- Sitting

- PT holds pt's thumb in extension and applies a valgus force to MCP joint of thumb.

- + test= Excessive valgus movement. May indicate tear of ulnar collateral and accessory collateral ligaments.

- Gamekeepers or Skier's thumb

Front 29

Allen Test (At wrist)

Back 29

- Sitting/standing.

- Pt asked to open and close hand several times, then maintain closed hand position.

- PT compresses radial and ulnar arteries. Pt asked to relax hand.

- PT releases pressure on one of the arteries, observes color of hand and fingers.

- + test= delayed or absent flushing of hand. May indicate occlusion of radial or ulnar artery.

Front 30

Bunnel-Littler Test

Back 30

- Sitting with MCP joint in slight extension

- PT attempts to move proximal IP joint into flexion.

- If proximal IP joint doesn't flex when MCP joint is extended, there may be intrinsic muscle or capsular tightness.

- If proximal IP joint fully flexes with MCP joint in slight flexion, there might be intrinsic muscle tightness without capsular tightness.

Front 31

Tight Retinacular Ligament Test

Back 31

- Proximal IP joint help in a neutral position while there therapist attempts to flex the distal IP joint.

- If PT unable to flex DIP, the retinacular ligaments or capsule may be tight.

- It PT able to flex DIP when PIP is in flexion, the retinacular ligaments may be tight but the capsule is normal

Front 32

Froment's Sign

Back 32

- Sitting or standing, asked to hold a piece of paper between thumb and index finger.

- PT attempts to pull paper away from pt.

- + test= pt. flexing the distal phalanx of thumb due to adductor pollicis muscle paralysis.

- If pt hyperextends MCP joint of thumb at same time, it's termed Jeanne's sign.

- Both objective findings may indicate ulnar nerve compression.

Front 33

Phalen's Test

Back 33

- Sitting or standing. PT flexes pt. wrist maximally and asks them to hold the position for 60 sec.

- + test= tingling in the thumb, index finger, middle finger and lateral half of ring finger.
May indicate carpal tunnel due to median nerve compression.

Front 34

Tinel's Sign (Wrist)

Back 34

- Sitting or standing. PT taps volar aspect of pt's wrist.

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

Front 35

Finkelstein Test

Back 35

- Sitting or standing. Pt. asked to make a fist with the thumb tucked inside the fingers.

- PT stabilizes pt forearm and ulnarly deviates the wrist. (PASSIVE)

- + test= pain over abductor pollicis longus and extensor pollicis brevis tendons and the wrist. May indicate tenosynovitis in thumb. (deQuervain's disease)

Front 36

Grind Test

Back 36

- Sitting and standing.

- PT stabilizes the pt's hand and grasps the pt. thumb on the metacarpal.

- PT applies compression and rotation through the metacarpal.

- + test= pain. May indicate a degenerative joint disease in CMC joint.

Front 37

Murphy's Sign

Back 37

- Sitting/standing. Pt asked to make a fist

- + test= pt's 3rd metacarpal remaining level with the 2nd and 4th metacarpals (Should rise higher)

- May indicate dislocation of the lunate.

Front 38

Ely's Test

Back 38

- Prone. PT passively flexes pt's knee.

- + test= spontaneous hip flexion occurring simultaneously with knee flexion. May indicate rectus femoris contracture/tightness.

Front 39

Ober's Test

Back 39

- Sidelying, lower leg flexed at hip and knee.

- PT moves test leg into abduction and extension, then attempts to lower the test leg.

- + test= inability of test leg to adduct and touch table. May indicate TFL contracture.

Front 40

Piriformis Test

Back 40

- Sidelying with test leg positioned toward the ceiling and the hip flexed to 60 degrees.

- PT places one hand on pt pelvis and the other on pt's knee.

- While stabilizing pelvis, apply a downward force on knee.

- + test= pain or tightness. May indicate piriformis tightness or compression on the sciatic nerve caused by the piriformis.

Front 41

Thomas Test

Back 41

- Supine with legs fully extended

- Pt asked to bring one knee to chest, to flatten lumbar spine.

- PT observes position of the contralateral hip

- + test= the straight leg rising from the table. May indicate hip flexion contracture.

Front 42

Tripod Sign

Back 42

- Pt sitting, with knees flexed to 90 over table edge.

- PT passively extends one knee.

- + test= Tightness in hamstrings or and extension of the trunk to limit the effect of the tight hamstrings. Obviously this test is a test for tight hamstrings.

Front 43

90-90 Straight Leg Raise

Back 43

- Supine, pt asked to stabilize the hips in 90 degrees of flexion with knees relaxed.

- PT instructs pt to alternately extend each knee as much as possible while still maintaining 90 degrees hip flexion.

- + test= Knee remaining in 20 degrees or more of flexion. Indicates hamstring tightness.

Front 44

Barlow's Test (Pediatric)

Back 44

- Supine, hips flexed to 90 degrees and knees flexed.

- PT tests each hip individually by stabilizing femur/pelvis with one hand, and with the other moving the test leg into adduction while applying forward pressure posterior to the greater trochanter.

- + test= click/clunk. May indicate hip dislocation being reduced. Variation of Ortolani's Test. Used to identify hip dysplasia.

Front 45

Ortolani's Test (Pediatric)

Back 45

- Pt supine with hips flexed to 90 and knees flexed.

- PT grasps legs so that thumbs are along pt's medial thighs and fingers on lateral thighs.

- PT abducts hips and applies a gentle pressure to the greater trochanter until resistance is felt at about 30 degrees.

- + test= click/clunk. May indicate dislocation being reduced.

Front 46

Craig's Test

Back 46

- Prone. Test knee flexed to 90 degrees.

- PT palpates greater trochanter, medially and laterally rotates the hip until greater trochanter is parallel with the table (or when the GT is most prominent)

- The degree of femoral anteversion corresponds to the angle formed by the lower leg with the perpendicular axis of the table. (Anteversion seen as medial rotation)

- Normal anteversion for adult is 8-15 degrees

Front 47

Patrick's Test (FABER)

Back 47

- Supine with test leg flexed, abducted and laterally rotated at hip onto opposite leg.

- PT slowly lowers test leg toward table

- + test= failure of the leg to abduct below level of the opposite leg. May indicate iliopsoas, sacroiliac or hip joint abnormalities.

Front 48

Quadrant Scouring Test

Back 48

- Supine. PT passively flexes and adducts the hip with the knee in maximal flexion.

- PT applies force through shaft of femur while continuing to passively move hip.

- + test= grinding, catching, crepitation in the hip. May indicate pathologies such as arthritis, avascular necrosis or an osteochondral defect. (ICCOAL?)

Front 49

Trendelenburg Test

Back 49

- Standing. Asked to stand on one leg for 10 sec

- + test= drop in the pelvis on the unsupported side. May indicate gluteus medius weakness on the supporting side

Front 50

Anterior Drawer Test (Knee)

Back 50

- Supine. Knee at 90 degrees, hip at 45. PT stabilizes leg by sitting on forefoot.

- PT grasps proximal tibia, places thumbs on tibial plateau, and gives and ant. directed force.

- + test= excessive anterior translation of tibia on femur with diminished/absent end-point. May indicate ACL injury.

Front 51

Lachman Test

Back 51

- Supine with knee flexed to 20-30 degrees.

- PT stabilizes distal femur with one hand, places other hand on proximal tibia.

- PT applies ant. directed force to tibia.

- + test= excessive anterior translation of the tibia on the femur with diminished/absent endpoint. May indicate ACL injury

Front 52

Lateral Pivot Shift Test

Back 52

- Supine with hip flexed and abducted to 30 degrees with slight medial rotation.

- PT grasps leg with one hand and places the other over the lateral surface of the prox. tibia

- PT medially rotates tibia and applies a valgus force to the knee while the knee is slowly flexed.

- + test= palpable clunk/shift occurring between 20-40 degrees of flexion and is indicative of anterolateral rotatory instability.

- The shift/clunk results from the reduction of the tibia on the femur.

Front 53

Posterior Drawer Test

Back 53

- Supine. Knee at 90 degrees, hip at 45. PT stabilizes leg by sitting on forefoot.

- PT grasps proximal tibia, places thumbs on tibial plateau, and gives and posterior directed force.

- + test= Excessive posterior translation of tibia on femur with diminished/absent end-point. May indicate PCL injury.

Front 54

Posterior Sag Sign

Back 54

- Pt supine with knee flexed to 90 and hip to 45

- + test= tibia sagging back on the femur. May indicate PCL injury

Front 55

Valgus Stress Test

Back 55

- Supine. Knee flexed 20-30 degrees.

- PT places one hand on medial surface of ankle and the other on the lateral surface of knee.

- PT applies valgus force at knee.

- + test= Excessive valgus movement. May indicate MCL sprain.

- + test with knee in full extension may indicate damage to MCL, PCL, posterior oblique ligament and posteromedial capsule.

Front 56

Solcum Test

Back 56

- Supine, knee flexed to 90, hip to 45.

- PT rotates pt's foot 30 degrees medially to test anterolateral instability.

- PT stabilizes leg by sitting on forefoot.

- PT grasps pt. prox tibia and administers an anterior directed force of tibia on femur.

- + test= movement of tibia occurring primarily on the lateral side. May indicate anterolateral instability.

- Can test anteromedial instability by rotating pt's foot 15 degrees laterally.

Front 57

Varus Stress Test

Back 57

- Supine. Knee flexed 20-30 degrees.

- PT places one hand on later surface of ankle and the other on the medial surface of knee.

- PT applies varus force at knee.

- + test= Excessive varus movement. May indicate LCL sprain.

- + test with knee in full extension may indicate damage to LCL, PCL, arcurate comples and posterolateral compartment

Front 58

Apley's Compression Test

Back 58

- Prone with knee flexed to 90 degrees.

- PT stabilizes femur with one hand, other hand on pt's heel.

- Applies compressive force through tibia while medially and laterally rotating tibia.

- + test= Pain or clicking. May indicate a meniscal lesion.

Front 59

Bounce Home Test

Back 59

- Supine. PT grasps pt's heel and maximally flexes knee.

- Pt's knee extended passively.

- + test= incomplete extension or a rubbery end-feel. May indicate a meniscal lesion.

Front 60

McMurray Test

Back 60

- Supine. PT grasps distal leg with one hand, palpates knee joint line with the other.

- With knee fully flexed, PT medially rotates tibia and extends the knee.

- + test= click/pronounced crepitation felt over the joint line. May indicate posterior meniscal lesion.

Front 61

Brush Test

Back 61

- Supine. PT places one hand just below the joint line on the medial surface of the patella. Strokes surface.

- Other hand strokes lateral surface of patella.

- + test= wave of fluid just below the medial distal border of the patella and is indicative of effusion of the knee.

Front 62

Patellar Tap Test

Back 62

- Supine with knee flexed/extended to a point of discomfort.

- PT applies slight tap over the patella.

- + test= Indicated if the patella appears to be floating and may be indicative of joint effusion.

Front 63

Clarke's Sign

Back 63

- Supine with knees extended. PT applies slight pressure to superior pole of patella.

- PT asks pt to contract quads while maintaining pressure on patella.

- + test= failure to complete contraction without pain. May indicate patellofemoral dysfunction.

Front 64

Hughston's Plica Test

Back 64

- Supine. PT flexes knee and medially rotates tibia with one hand. Other hand attempts to move patella medially and palpate medial femoral condyle.

- + test= Popping sound over media plica while knee is passively flexed and extended.

Front 65

Noble Compression Test

Back 65

- Supine, hips flexed slightly and knees in 90 degrees flexion.

- PT places thumb of one hand over lateral epicondyle of femur and other hand around pt's ankle.

- PT maintains pressure over lateral epicondyle while pt. asked to slowly extend knee.

- + test= pain over lateral femoral epicondyle at 30 degrees of knee flexion. May indicate ITB friction syndrome.

Front 66

Patellar Apprehension Test

Back 66

- Supine with knees extended.

- PT places both thumbs on medial border of patella, applies laterally directed force.

- + test= look of apprehension or attempt to contract quads in effort to avoid subluxation. May be indicative of patella subluxation or dislocation.

Front 67

Anterior Drawer Test (Ankle)

Back 67

- Supine. PT stabilizes distal tibia and fibula with one hand. Other hand holds foot in 20 degrees plantarflexion.

- Draw talus forward in ankle mortise.

- + test= excessive anterior translation of talus away from ankle mortise. May indicate ATFL sprain.

Front 68

Talar Tilt

Back 68

- Sidelying. Knee flexed to 90.

- PT stabilizes distal tibia with one hand, while grasping talus with the other.

- Foot in neutral position. PT tilts talus in ab and adduction.

- + test= excessive adduction. May indicate calcaneofibular ligament sprain.

Front 69

Thompson Test

Back 69

- Prone with feet extended over table.

- PT squeezes muscle belly of gastroc.

- + test= absence of plantarflexion. May indicate Achilles tendon rupture.

Front 70

Tibial Torsion Test

Back 70

- Sitting with knees over edge of table

- PT places thumb and index finger of one hand over medial and lateral malleolus.

- PT measures acute angle formed by the axes of the knee and the ankle.

- Normal lateral rotation of tibia is 12-18 degrees.

Front 71

True Leg Length Discrepancy Test

Back 71

- Supine, hips and knees extended, legs 15-20 cm apart. Pelvis in balance with legs.

- Measure from ASIS to distal point of medial malleoli of ankle.

- + test= Bilateral variation of greater than 1 cm. May indicate true leg length discrepancy

Front 72

Foraminal Compression Test (Spurlings)

Back 72

- Sitting, head laterally flexed.

- PT places hands on top of pt head and exerts a downward force.

- + test= pain radiating into arm toward the flexed side. May indicate nerve root compression.

Front 73

Vertebral Artery Test (VAT)

Back 73

- Supine. PT places pt head into extension, lateral flexion and rotation to ipsilateral side.

- + test= dizziness, nystagmus, slurred speech or LOC. May indicate compression of vertebral artery.

Front 74

Sacroiliac Joint Stress Test

Back 74

- Supine. PT crosses arms and place hands on pt's ASIS's.

- PT applies downward and lateral force to pelvis

- + test= Unilateral pain in the SI joint or gluteal area. May indicate SI joint dysfunction.

Front 75

Sitting Flexion Test

Back 75

- Sitting, knees flexed to 90 degrees, feet on floor

- PT places thumbs on PSIS's. Monitors movement of bony structures as pt bends forward and reaches towards floor.

- + test= one PSIS moving further in cranial direction. May indicate articular restriction.

Front 76

Standing Flexion Test

Back 76

- Standing, feet 12" apart.

- PT places thumbs on PSIS's. Monitors movement of bony structures as pt bends forward

- + test= one PSIS moving further in cranial direction. May indicate articular restriction.