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Special tests

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  • 1. SPECIAL TESTS
  • 2. CERVICAL
  • 3. Foraminal Compression Test Px: Sitting (+) sign: pain radiates to arm toward which head is side flexed Significance: Cervical Nerve Root Compression Procedure: First Phase: compress with head in neutral position Second Phase: compress with head extended Third Phase: compression with head extended and rotated to unaffected side. Othes name: Spurling’s Test
  • 4. Shoulder Depression Test Px: sitting (+) sign: increase pain Significance: Nerve Root Compression Procedure: side flex patient’s head on unaffected side then apply a downward pressure on the opposite shoulder (affected side).
  • 5. Shoulder Abduction Test Px: sitting (+) sign: relief of symptoms Significance: Nerve Root Compression Procedure: abduct patients arm then rest hand or forearm on top of the head.
  • 6. Distraction Test Px: Sitting (+) sign: relief of Pain Significance: Pressure on the Nerve Roots Procedure: place one hand under the patient’s chin and the other around the occiput. Slowly lift the head, applying traction to the cervical spine.
  • 7. Lhermitte’s Sign Px: Long Sitting position (+) sign: pain radiating down the spine Significance: Dural or Meningeal Irritation Procedure: Flex the patient’s head and one hip simultaneously with the leg kept straight.
  • 8. Jackson’s Test Px: sitting (+) sign: Pain Radiates into the arm Significance: Cervical Nerve Root Compression Procedure: Rotates patient’s head to one side and apply a downward pressure on the head.
  • 9. Scalene Cramp Test Px: sitting (+) sign: increase pain Significance: Plexopathy / Thoracic Outlet Syndrome Procedure: Patient actively rotates the head to the affected side and pulls chin down into the hollow above the clavicle by flexing the cervical spine
  • 10. Valsalva Test Px: (+) sign: increase pain Significance: increase intrathecal pressure Procedure: Patient takes a deep breath and hold it while bearing down, as if moving bowels
  • 11. Tinel’s Sign Px: sitting with neck slightly flexed (+) sign: localized pain Significance: cervical plexus lesion Procedure: Tap the area of the Brachial Plexus with a finger along the nerve trunks.
  • 12. Brachial Plexus Compression Test Px: sitting (+) sign: pain radiates into the shoulder Significance: Mechanical cervical lesions having a mechanical component Procedure: Apply firm compression to the brachial plexus by squeezing the plexus under the thumb or fingers
  • 13. Upper Limb Tension Test 1 (ULTT1)
  • 14. Upper Limb Tension Test 2 (ULTT2) Shoulder: Depression and abduction (10⁰) Elbow: Extension Forearm: Supination Wrist: Extension Fingers and Thumb: Extension Shoulder: Lateral Rotation Cervical Spine: Contralateral side flexion Nerve Bias: Median Nerve, Axillary Nerve, Musculocutaneous Nerve
  • 15. Upper Limb Tension Test 3 (ULTT3) Shoulder: Depression and abduction (10⁰) Elbow: Extension Forearm: Pronation Wrist: Flexion and Ulnar deviation Fingers and Thumb: Flexion Shoulder: Medial Rotation Cervical Spine: Contralateral side flexion Nerve Bias: Radial Nerve
  • 16. Upper Limb Tension Test 4 (ULTT4) Shoulder: Depression and abduction (90⁰) Elbow: Flexion Forearm: Supination Wrist: Extension and Radial deviation Fingers and Thumb: Extension Shoulder: Lateral Rotation Cervical Spine: Contralateral side flexion Nerve Bias: Ulnar Nerve, Nerve Roots C8 and T1
  • 17. Romberg’s Test Px: Standing (+) sign: Swaying Significance: Upper Motor Neuron Lesion (UMNL) Procedure: Patient stands and is asked to close their eyes and hold the position for 20-30 seconds.
  • 18. Vertebral Artery Test Px: Supine (+) sign: Dizziness / Nystagmus Significance: Compression of Vertebral Arteries Procedure: 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.
  • 19. Naffziger’s Test Px: Sitting (+) sign: Pain Significance: Nerve Root problem or Space Occupying Lesion Procedure: Compress patient’s jugular veins for 30 seconds then ask the patient to cough.
  • 20. Caloric Test Px: (+) sign: Vertigo Significance: Inner ear problem Procedure: Alternately apply hot and cold test tubes several times just behind the patient’s ear on the side of the head.
  • 21. Sharp Purser Test Px: (+) sign: PT feels the head slide backwards during the movement Significance: Subluxation of the atlas on the axis Procedure: 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.
  • 22. SHOULDER
  • 23. Load and Shift Test Px: sitting relaxed on the chair (+) sign: a. b. c. d. Normal Laxity = 1-25% Grade 1 = head rides over the glenoid rim (25-50%) Grade 2 = head over rides the rim but reduces (>50%) Grade 3 = head over riding the rim and remains dislocated Significance: traumatic problems at the glenohumeral Joint Procedure: Grasp the humeral head and stabilize the shoulder. Seat the humerus on the glenoid fossa and puch anteriorly and posteriorly to check for instability.
  • 24. Apprehension Test Px: supine; shoulder abducted 90 and externally rotated (+) sign: pain and apprehension Significance: for traumatic instability problems Procedure: Slowly apply lateral rotation on shoulder. Other name: Crank Test
  • 25. Fulcrum Test Px: supine; shoulder abducted 90 and externally rotated (+) sign: pain and apprehension Significance: for traumatic instability problems Procedure: Place a hand under the Glenohumeral Joint then apply lateral rotation. * a modification of Crank Test
  • 26. Fowler Sign Px: supine; shoulder abducted 90 and externally rotated (+) sign: relief of pain and apprehension Significance: posterior internal impingement / traumatic instability problems Procedure: Apply a posterior directed force to the head of the humerus then further external rotation becomes possible Other name: Jobe Relocation Test
  • 27. Surprise Test Px: supine; shoulder abducted 90 and externally rotated (+) sign: pain and forward translation of the humeral head Significance: for traumatic instability problems Procedure: Perform “Fowler’s Sign”, after further external rotation, release the posterior force Other name: Anterior Release Test
  • 28. Rockwood Test Px: sitting (+) sign: 90⁰ - marked apprehension 45⁰ & 120⁰ - some uneasiness and pain Significance: Anterior Instability Procedure: shoulder is abducted to 45⁰, 90⁰, then 120⁰. Then apply external rotation to each angle.
  • 29. Rowe Test Px: Supine; hand behind the head (+) sign: apprehension (Pain) | clunk or grinding sound Significance: Anterior Instability | Torn anterior labrum Procedure: place clenched fist on the posterior humeral head then apply downward force while arm extends.
  • 30. Andrew’s Anterior Instability Test Px: supine; shoulder abducted 130⁰, external 90⁰ (+) sign: apprehension (Pain) | clunk or grinding sound Significance: anterior instability | anterior labral tear Procedure: stabilize elbow and humerus then grasp the humeral head and lift it forward.
  • 31. Anterior Drawer Test Px: supine; abducted 80⁰ - 120⁰, flexed 20⁰, externally rotated 30⁰, hand on PT’s axilla (+) sign: apprehension (Pain) | click sound Significance: anterior instability | anterior labral tear Procedure: stabilize scapula, pushing the spine forward using index and middle finger. Apply a counter pressure on the coracoid then draw the humerus forward
  • 32. Protzman Test Px: sitting; abducted 90⁰, supported on the PT’s hip (+) sign: pain Significance: Anterior Instability Procedure: Palpate anterior head with one hand, other hand on patient’s axilla. Push humerus anteriorly and inferiorly.
  • 33. Dugas Test Px: sitting (+) sign: Pain / inability to do the command of the PT Significance: Anterior Dislocation Procedure: Ask patient to place one hand on opposite shoulder and to lower the elbow to the chest.
  • 34. Posterior Apprehension Test Px: supine; elevate shoulder to 90⁰ (+) sign: Apprehension Significance: Posterior Shoulder Instability Procedure: Apply posterior force on the elbow then horizontally adduct and internally rotate the shoulder. Other name: Stress Test
  • 35. Push-Pull Test Px: supine; shoulder abducted 90⁰, flexed 30⁰ (+) sign: >50% translation, pain/apprehension Significance: Posterior Instability Procedure: 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.
  • 36. Jerk Test Px: sitting, shoulder flexed 90⁰ and internally rotated (+) sign: Sudden jerk or clunk Significance: Recurrent Posterior Instability Procedure: 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.
  • 37. Inferior Shoulder Instability Test Px: standing relaxed (+) sign: sulcus sign +1 = <1cm +2 = 1-2cm +3 = >2cm Significance: inferior instability / glenohumeral laxity Procedure: grasp the patient’s elbow then pull it distally. Other name: Sulcus Sign
  • 38. Feagin Test Px: standing; shoulder abducted 90⁰ on PT’s shoulder (+) sign: Presence of sulcus on coracoid process / apprehension Significance: Multidirectional Instability Procedure: close hands over the humerus and push down and forward.
  • 39. Rowe Test for Multidirectional Instability Px: stands forward flexed 45⁰ at the waist with arms pointing to the floor. (+) sign: sulcus sign Significance: Multidirectional Instability Procedure: hand on the px’s shoulder index and middle finger (anterior) thumb (posterior) Anterior: Shoulder extended 20⁰-30⁰, then push anteriorly Posterior: Shoulder flexed 20⁰-30⁰, then push posteriorly Inferior: Shoulder flexed 20⁰-30⁰, then push posteriorly and apply traction
  • 40. Clunk Test Px: supine (+) sign: clunk / grinding sound Significance: 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.
  • 41. Biceps Tension Test Px: standing; shoulder abducted 90⁰, elbow extended; forearm supinated (+) sign: reproduction of symptoms Significance: SLAP lesion Procedure: apply eccentric adduction force
  • 42. Biceps Load Test Px: supine; shoulder abducted 90⁰ and external rotate; elbow flexed 90⁰; forearm supinated (+) sign: Apprehension does not disappear Significance: integrity of superior labrum Procedure: Fully externally rotate shoulder until apprehension, stop external rotation and hold the position. Then patient resist elbow flexion at the wrist.
  • 43. SLAP Prehension Test Px: sitting (+) sign: first = painful second = relief of pain Significance: SLAP Lesion Procedure: Patient actively abducts shoulder 90⁰; Forearm pronated then horizontally adducts. Then abducts shoulder 90⁰; Forearm supinated, horizontally adducted
  • 44. Lateral Scapular Slide Test Px: sitting / standing with arms at the side (+) sign: >1-1.5cm difference from the original measure Significance: Scapular Instability Procedure: 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
  • 45. Wall Push Up Test Px: standing, arms length on the wall (+) sign: winging within 5-10reps of push-up Significance: weakness of scapular muscles Procedure: ask patient to do 15-20 wall push ups
  • 46. Closed Kinetic Chain Upper Extremity Stability Test Px: prone; on the floor at arms length with hands 36 inches apart. (+) sign: winging of the scapula Significance: weakness of scapular muscles Procedure: 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.
  • 47. Acromioclavicular Shear Test Px: Sitting (+) sign: abnormal movement of at the AC joint Significance: Acromioclavicular joint Pathology Procedure: Cup hands over the deltoid, one on the clavicle and one on the scapula. Squeeze both hands together.
  • 48. Ellman’s Compression Rotary Test Px: side lying on unaffected side (+) sign: pain reproduction Significance: Glenohumeral Arthritis Procedure: Compress humeral head while patient rotates the shoulder medially and laterally.
  • 49. Speed’s Test Px: Standing (+) sign: Pain on Bicipetal Groove | Pain | weakness Significance: Bicipital Tendonitis | SLAP II | rupture biceps Procedure: Resist shoulder extension by patient first in supination then in pronation with elbow extension. Other names: Biceps Test / Straight Arm Test
  • 50. Yergason’s Test Px: sitting/standing; elbow 90⁰, forearm pronated (+) sign: pain/tenderness | popping out of goove Significance: Bicipital Tendonitis | torn transverse humeral ligament Procedure: resist supination while px externally rotates shoulder.
  • 51. Ludington’s Test Px: sitting; clasp hands behind head (+) sign: no contraction evident/palpable Significance: torn Long Head of Biceps Procedure: ask px to contract the biceps.
  • 52. Gilchrest’s Test Px: Standing (+) sign: pain on Bicipital Groove Significance: Bicipital Paratendonitis Procedure: ask px to lift 2-3kg/5-7lbs of weight over head with the arm in external rotation.
  • 53. Lippman’s Test Px: sitting/standing (+) sign: sharp pain on the bicipital groove Significance: Bicipital Tendonitis Procedure: 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.
  • 54. Heuter’s Sign Px: sitting; Forearm pronated (+) sign: absence of elbow supination Significance: ruptured distal biceps tendon Procedure: Resist elbow flexion with the forearm pronated.
  • 55. Supraspinatus Test Px: standing; shoulder is abducted 90⁰ (+) sign: pain | weakness Significance: torn supraspinatus | neuropathy of suprascapular nerve Procedure: shoulder is internallyy rotated and angled forward 30⁰, thumb pointing to the floor, then resist. Other names: Empty Can Test / Jobe Test
  • 56. Drop Arm Test Px: standing; shoulder abducted 90⁰ (+) sign: inability to return arm to side slowly Significance: Rotator Cuff Tear Procedure: ask px to slowly lower arms to the side with some arc movements. Other Names: Codman’s Test
  • 57. 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 subscapularis Procedure: passively abducts shoulder to 90⁰, elbow flexed to 90⁰ and externally rotate. Px holds the position. Other Names: Infraspinatus “Spring Back” Test
  • 58. Hornblower’sTest Px: standing; shoulder flexed to 90⁰, elbow flexed to 90⁰ (+) sign: inability to external rotate the shoulder Significance: tear on the teres minor Procedure: px external rotates with resistance.
  • 59. Infraspinatus Test Px: standing, arm on the side with elbow 90⁰ (+) sign: pain / inability to resist internal rotation Significance: infraspinatus strain Procedure: Apply a internal rotation force that the px resist.
  • 60. Teres Minor Test Px: prone; with one hand on the iliac crest (+) sign: pain and weakness Significance: Teres Minor strain Procedure: ask px to extend and adduct shoulder against resistance.
  • 61. Pectoralis Major Contracture Test Px: supine; hands clasps behind head (+) sign: elbows do not reach the table Significance: Tight Pectoralis Major Procedure: Lower arm until elbows tough the table
  • 62. Lift Off Sign Px: standing; dorsum of hand on back pocket (+) sign: inability to lift hand off back Significance: Subscapularis Lesion Procedure: ask px to lift hand away from the back.
  • 63. Neer-Impingement Test Px: sitting (+) sign: Pain Significance: overuse injury to the supraspinatus muscle Procedure: Px arm is passively and forcibly fully elevated and shoulder is internally rotated.
  • 64. Hawkin’s Kennedy Impingement Test Px: standing / sitting (+) sign: pain Significance: supraspinatus tendonitis Procedure: flex shoulder to 90⁰ then medially rotate the shoulder
  • 65. Coracoid Impingement Test Px: standing / sitting (+) sign: pain Significance: supraspinatus tendonitis Procedure: flex shoulder to 90⁰, horizontally adduct to 10⁰-20⁰ then medially rotate the shoulder *a modification of Hawkin’s Kennedy Test
  • 66. Yocum Test Px: standing / sitting (+) sign: pain Significance: supraspinatus tendonitis Procedure: Px places hand on the opposite shoulder then PT elevates the elbow. *a modification of Hawkin’s Kennedy Test
  • 67. Tinel’s Sign at the Shoulder Px: sitting (+) sign: tingling sensation Significance: Peripheral Nerve Injury Procedure: tap on the scalene triangle on the area of the brachial plexus
  • 68. Adson’s Maneuver Px: sitting with head on the ipsilateral (+) sign: disappearance of pulse Significance: Thoracic Outlet Syndrome Procedure: Locate radial pulse, external rotate and extend the shoulder and instruct px to take a deep breath and hold it.
  • 69. Allen Maneuver Px: sitting with head on the contralateral side (+) sign: disappearance of pulse Significance: Thoracic Outlet Syndrome Procedure: Elbow is flexed to 90⁰, shoulder is extended and externally rotated horizontally, palpate the radial side.
  • 70. Halstead Maneuver Px: neck is hyper extended rotated on contralateral side (+) sign: disappearance of Radial Pulse Significance: Thoracic Outlet Syndrome Procedure: Find the radial pulse, apply downward traction on the extremity.
  • 71. Roos Test Px: shoulder abducted 90⁰; elbow flexed 90⁰, externally rotate (+) sign: ischemic pain, heaviness, weakness Significance: Thoracic Outlet Syndrome Procedure: ask px to close and open hands for 3mins Other names: Aer Test / Hands-up Test
  • 72. Wright Test Px: shoulder hyper abducted, elbow extended and externally rotated (+) sign: Disappearance of pulse Significance: Thoracic Outlet Syndrome Procedure: Instruct px to take a deep breath while palpating for the radial pulse.
  • 73. Costoclavicular Test Px: (+) sign: disappearance of pulse Significance: Thoracic Outlet Syndrome Procedure: Locate radial pulse, draw shoulder down and back. Other Name: Military Base
  • 74. ELBOW
  • 75. Ligamentous Valgus Instability Test Px: sitting; elbow flexed 90⁰ (+) sign: decrease laxity / pain Significance: 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.
  • 76. Milking Maneuver Px: sitting; elbow flexed 90⁰, forearm supinated (+) sign: Reproduction of Symptoms Significance: Partial tear to the medial collateral ligament Procedure: Graps the px’s thumb and pull it importing a valgus stress to the elbow
  • 77. Ligamentous Varus Instability Test Px: elbow slightly flexed (+) sign: laxity, soft end feel Significance: injury to the lateral collateral ligament Procedure: Stabilize arm and apply varus force to the distal forearm.
  • 78. Posterolateral Rotary Drawer Test Px: supine, arm over head; elbow flexed 40⁰ - 90⁰ (+) sign: reproduction of symptoms Significance: tear on the lateral collateral ligament / posterolateral instability at the elbow Procedure: Stabilize the humerus, radius and ulna is pushed posterolaterally.
  • 79. Stand-Up Test Px: seated on a chair w/ no arm rests; forearm supinated (+) sign: reproduction of symptoms Significance: injury to the posterior band of medial collateral ligament Procedure: instruct px to lift bottom off of the seat using his/her arms.
  • 80. Lateral Epicondylitis (Method 1) Test Px: sitting; elbow flexed 90⁰; forearm supinated (+) sign: pain Significance: Tennis Elbow Epicondylitis Procedure: 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
  • 81. Lateral Epicondylitis (Method 2) Test Px: sitting; elbow flexed 90⁰; forearm supinated (+) sign: pain Significance: Tennis Elbow Epicondylitis Procedure: 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
  • 82. Lateral Epicondylitis (Method 3) Test Px: sitting; elbow flexed 90⁰; forearm pronated (+) sign: pain Significance: Tennis Elbow Epicondylitis Procedure: Resist the extension of the 3rd digit of the hand. Distal to proximal interphalangeal joints. Other names: Tennis Elbow Test
  • 83. Medial Epicondylitis Test Px: sitting; elbow flexed 90⁰; forearm pronated (+) sign: pain Significance: Golfer’s elbow medial epicondylitis Procedure: Palpate the medial epicondyle. Px’s forearm is passively supinated and the PT extends the elbow and wrist. Other names: Golfer’s Elbow
  • 84. Tinel’s Sign at the Elbow Px: sitting with the elbow flexed (+) sign: Tingling Sensation Significance: Regeneration of Fibers Procedure: tap the ulnar nerve.
  • 85. Wartenberg’s Sign Px: sitting with hands resting on the table (+) sign: Inability to squeeze little finger Significance: Ulnar Nerve Neuropathy Procedure: Passively spread the fingers apart and ask the patient to them together
  • 86. Elbow Flexion Test Px: (+) sign: Tingling or paresthesia in the ulnar nerve distribution of the forearm and Significance: Cubital Tunnel Syndrome Procedure: Fully flex the elbow, wrist extended, shoulder is abducted and depressed. Hold this position for 3-5 minutes.
  • 87. Test for Pronator Teres Syndrome Px: sitting; elbow flexed 90⁰ (+) sign: Tingling or paresthesia in the median nerve distribution Significance: Pronator Teres Syndrome Procedure: Resist pronation and the patient extends.
  • 88. Pinch Grip Test Px: (+) sign: Normal: tip-to-tip Abnormal: pulp-to-pulp Significance: Entrapment of the Anterior Interosseous nerve Procedure: ask the patient to pinch the tips of the index and thumb together.
  • 89. FOREARM, WRIST & HAND
  • 90. Test for Tight Retinacular Ligament Px: PIP joint is in neutral | PIP joint is flexed (+) sign: (-) flexion | (+) flexion Significance: Collateral ligaments or Capsule is tight | Only the collateral ligament is tight Procedure: Flex the distal interphalengeal joint. Other Name: Haines-Zancolli Test
  • 91. Lunotriquetral Ballottement Test Px: (+) sign: Pain, Laxity, Crepitus Significance: Lunotriquetral Instability Procedure: Grasp the triquetrium and lunate. Move the lunate anteriorly and posteriorly. Other Name: Reagan’s Test
  • 92. Finger Extension Test Px: Sitting; wrist in flexion (+) sign: Pain Significance: Radiocarpal or midcarpal instability, scaphoid instability, inflammation, Kienböck’s Disease Procedure: Hold the px’s wrist and ask the px to extend the fingers. Resist movement at he radiocarpal joints. Other Name: Shuck Test
  • 93. Murphy’s Sign Px: (+) sign: 3rd MCP joint is in line with and 2nd and 4th MCP joint. Significance: Lunate Dislocation Procedure: Ask the px to make a fist.
  • 94. Watson Test Px: Sitting; Forearm is pronated on the lap (+) sign: Pain Significance: Scaphoid Subluxation Procedure: Ulnar deviate the wrist with slight extension. Stabilize the scaphoid. Radially deviate and slightly flex the hand. Other Name: Scaphoid Shift Test
  • 95. Piano Keys Test Px: sitting; forearm pronated (+) sign: Difference in Mobility, pain and tenderness Significance: Distal radioulnar joint instability Procedure: Push down the distal ulna
  • 96. Finkestein Test Px: Make a fist with the thumb inside the fingers (+) sign: pain over the abductor pollicis longus and extensor pollicis brevis tendons Significance: Hoffmann’s disease, de Quervain’s disease, paratendonitis in the thumb Procedure: Stabilize forearm and ulnar deviate the wrist.
  • 97. Sweater Finger Sign Px: (+) sign: (-) flexion of one of the distal phalanx Significance: Ruptured flexor digitorum profundus tendon Procedure: Instruct px to make a fist
  • 98. Test for Extensor Hood Rupture Px: Flex PIP of finger 90⁰ at the edge of the table (+) sign: Little Pressure from the middle phalanx Significance: Torn Central Extensor Hood Procedure: Ask the px to extend the proximal interphalangeal joint while PT palpates for the middle phalanx
  • 99. Boyes Test Px: (+) sign: Unable to flex DIP joints Significance: torn central extensor hood Procedure: Hold finger in slight extension at the PIP joint. Ask px to flex the DIP joint.
  • 100. Bunnel – Littler Test Px: 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
  • 101. Linburg’s Sign Px: (+) sign: Loss of Motion, Pain Significance: Tendinitis at the interconnection between flexor pollicis longus and flexor indices Procedure: Fully flex the thumb then extend the index finger
  • 102. Tinel’s Sign at the Wrist Px: (+) sign: Tingling or Paresthesia in the median nerve distribution Significance: Carpal Tunnel Syndrome Procedure: tap over the carpal tunnel at the wrist.
  • 103. Phalen’s Test Px: (+) sign: tingling or paresthesia in the median nerve distribution Significance: Carpal Tunnel Syndrome Procedure: Flex the wrist maximally and hold for 1 minute.
  • 104. Reverse’s Phalen’s Test Px: (+) sign: Tingling or Paresthesia in the median nerve distribution Significance: Carpal Tunnel Syndrome Procedure: Extend wrist maximally and press the carpal tunnel for 1 minute. Other Name: Prayer Test
  • 105. Carpal Compression Test Px: supinated (+) sign: tingling or paresthesia in the median nerve distribution Significance: Carpal Tunnel Syndrome Procedure: Grasp hand then apply direct pressure over the carpal tunnel for 30 seconds *a modification of Reverse Phalen’s Test
  • 106. 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
  • 107. Egawa’s Sign Px: Flex middle digit (+) sign: unable to do the motion Significance: Ulnar Nerve Palsy Procedure: Ask the patient to alternately ulnar deviate and radial deviate the finger
  • 108. Wrinkle Test Px: (+) sign: no wrinkling Significance: Denervated Procedure: Place patient’s fingers in warm water for 5-20 minutes
  • 109. Ninhydrin Sweat Test Px: wait for clean hand to sweat (+) sign: no color change (Normal: White – purple) Significance: Nerve Lesion Procedure: 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.
  • 110. 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
  • 111. Allen Test Px: open and close hand several times. (+) sign: flushing of the hand Significance: 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.
  • 112. Hand Volume Test Px: (+) sign: 30-50mL difference between right and left hands. (Normal = 10mL) Significance: Swelling, edema (Normal = dominant) Procedure: Use a volumeter.
  • 113. THORACIC & LUMBAR
  • 114. Slump Test 1 (ST1) Cervical Spine: Flexion Thoracic & Lumbar Spine: Flexion (slump) Hip: Flexion (90⁰+) Knee: Extension Ankle: Dorsiflexion Foot: --Toes: --Nerve Bias: Spinal Cord, Cervical and Lumbar Nerve Roots, Sciatic Nerve
  • 115. Slump Test 2 (ST2) Cervical Spine: Flexion Thoracic & Lumbar Spine: Flexion (slump) Hip: Flexion (90⁰+), Abduction Knee: Extension Ankle: Dorsiflexion Foot: --Toes: --Nerve Bias: Obturator Nerve
  • 116. Side Lying Slump Test (ST3) Cervical Spine: Flexion Thoracic & Lumbar Spine: Flexion (slump) Hip: Flexion (20⁰) Knee: Flexion Ankle: Plantar flexion Foot: --Toes: --Nerve Bias: Femoral Nerve
  • 117. Long Sitting Slump Test (ST4) Cervical Spine: Flexion, Rotation Thoracic & Lumbar Spine: Flexion (slump) Hip: Flexion (90⁰+) Knee: Extension Ankle: Dorsiflexion Foot: --Toes: --Nerve Bias: Spinal Cord, Cervical and Lumbar Nerve Roots, Sciatic Nerve
  • 118. Straight Leg Raising Test (SLR Basic) Hip: Flexion + Adduction Knee: Extension Ankle: Dorsiflexion Foot: --Toes: --Nerve Bias: Sciatic Nerve and Tibial Nerve Other Name: Lasegue’s Test
  • 119. Straight Leg Raising Test 2 (SLR2) Hip: Flexion Knee: Extension Ankle: Dorsiflexion Foot: Eversion Toes: Extension Nerve Bias: Tibial Nerve
  • 120. Straight Leg Raising Test 3 (SLR3) Hip: Flexion Knee: Extension Ankle: Dorsiflexion Foot: Inversion Toes: --Nerve Bias: Sural Nerve
  • 121. Straight Leg Raising Test 4 (SLR4) Hip: Flexion and Medial Rotation Knee: Extension Ankle: Plantar Flexion Foot: Inversion Toes: --Nerve Bias: Common Peroneal Nerve
  • 122. Cross Straight Leg Raising Test (SLR5) Hip: Flexion Knee: Extension Ankle: Dorsiflexion Foot: --Toes: --Nerve Bias: Nerve Root (disc prolapse)
  • 123. Basic Prone Knee Bending Test (PKB1) Cervical Spine: Ipsilateral Rotation Thoracic & Lumbar Spine: Neutral Hip: Neutral Knee: Flexion Ankle: --Foot: --Toes: --Nerve Bias: Femoral Nerve, L2-L4 nerve roots
  • 124. Prone Knee Bending Test (PKB2) Cervical Spine: Ipsilateral Rotation Thoracic & Lumbar Spine: Neutral Hip: Extension, Adduction Knee: Flexion Ankle: --Foot: --Toes: --Nerve Bias: Lateral Femoral Cutaneous Nerve Other Name: Nachlas Test
  • 125. Prone Knee Extension Test (PKE) Cervical Spine: --Thoracic & Lumbar Spine: Neutral Hip: Extension, Abduction, Lateral Rotation Knee: Extended Ankle: Dorsiflexion Foot: Eversion Toes: --Nerve Bias: Saphenous Nerve
  • 126. 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 pain Procedure: Passively extend the knee * a modification of Slump Test
  • 127. Bechterewis Test Px: Flex neck, extend knee (+) sign: Pain in the back or leg Significance: Sciatica Procedure: Ask the patient to extend the knee one at a time, and then both. * A modification of Sitting Root Test
  • 128. Bowstring Test Px: Supine or Sitting (+) sign: Radicular pain (sciatic tension test or Deyerle’s Sign) Significance: Sciatica Procedure: 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.
  • 129. Compression Test Px: Supine; hip flex (100⁰); knee flex (+) sign: Radicular Pain on Posterior Leg Significance: Disc Herniation Procedure: Apply axial compression to the spine by applying direct pressure on the patient’s feet or buttocks.
  • 130. Flip Sign Px: sitting, then supine (+) sign: Pain (on both tests) Significance: Sciatice Procedure: Px in sitting: extend knee Px in supine: unilateral straight leg raising test
  • 131. Babinski Test Px: (+) sign: Extension of big toe and abduction of the other toes. Significance: Upper Motor Neuron Lesion Procedure: Run a pointed object along the plantar aspect of the px’s foot.
  • 132. Oppenheim Test Px: (+) sign: Extension of big toe and abduction of the other toes Significance: Upper Motor Neuron Lesion Procedure: Run a fingernail along the crest of the tibia
  • 133. Gluteal Skyline Test Px: Prone; head straight; arms at the side (+) sign: Flat gluteus muscle=atrophied | less contraction Significance: 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
  • 134. 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.
  • 135. 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.
  • 136. Farfan Torsion Test Px: Prone (+) sign: Reproduction of Symptoms Significance: 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
  • 137. Pheasant Test Px: Prone (+) sign: Pain Significance: Lumbar Spine Instability Procedure: Apply pressure on the lumbar spine, then passively flex the knee until the heel touches the buttocks.
  • 138. One Leg Standing Lumbar Extension Test Px: One leg stand (+) sign: Pain Significance: Spondylolisthesis Procedure: 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
  • 139. Quadrant Test Px: Standing (+) sign: Pain or Reproduction of Symptoms Significance: Facet Joint Pathology Procedure: Extend the px’s spine, apply overpressure. Px side flexes and rotates to the affected side.
  • 140. Shober’s Test Px: Standing (+) sign: difference between the two measurements Significance: Lumbar Spine Mobility Procedure: Mark the following points: a. S2 – Point of reference b. 5cm/2inches below c. 10cm/4inches above measure the distance between the 3 points. Ask px to forward flex (fingers touching his toes), then measure the distance.
  • 141. Yeoman’s Test Px: Prone (+) sign: Pain Significance: Sacroiliac Joint Dysfunction Procedure: Stabilize the pelvis then extend the hip, with knee flexed and extended
  • 142. Milgram’s Test Px: Supine (+) sign: Cannot hold the position or Reproduction of Symptoms Significance: Sacroiliac Joint Dysfunction Procedure: Instruct px to lift his legs from the table ~ 2-4in (510cm) and hold the position for 30 secs.
  • 143. Beevor’s Sign Px: Supine, hands behind the head (+) sign: The umbilicus does not remain in a straight line Significance: Abdominal Muscle Paralysis Procedure: Px flexes the head against resistance, coughs, or attempts to sit up.
  • 144. Stoop Test Px: Sitting or Standing (+) sign: Relief of Pain Significance: Neurogenic Intermittent Claudication Procedure: After brisk walking, px feels pain in the buttock and lower limb. Px flexes forward
  • 145. Treadmill Test Px: on the treadmill (+) sign: severe symptoms Significance: Intermitent Claudication Procedure: Two trials are conducted: a. 1.2mph b. 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
  • 146. Hoover’s Test Px: Supine (+) sign: If the opposite hand doesn’t feel any pressure Significance: Malingering Procedure: Place 1 hand under each calcaneus and ask the px to lift one leg off of the table
  • 147. Burn’s Test Px: Kneeling on the chair (+) sign: Unable to do / overbalances Significance: Malingering Procedure: Bend forward to touch the floor with the fingers
  • 148. Sign of the Buttock Px: Supine (+) sign: Hip flexion doesn’t increase Significance: Pathology in the buttock (tumor, bursitis, abcess) Procedure: Perform passive unilateral straight leg raising test until restriction. Then Flex the px’s knee
  • 149. PELVIS
  • 150. Straight Leg Raising Test Px: Supine (+) sign: Pain >70⁰ | > 120⁰ (hypermobile) Significance: Sacroiliac Joint Pathology Procedure: Flex the px’s hip with the knee extended Other Name: Lasѐgue’s Test
  • 151. Prone Knee Bending Test Px: Prone (+) sign: Pain in: a. Front of the Thigh b. Lumbar Spine c. < 90⁰ Significance: a. Rectus Femoris Tightness b. L3 nerve root lesion c. Sacroiliac Jt. Pathology Procedure: Flex the knee until the heel touches the buttocks Other Name: Nachlas Test
  • 152. Flamingo Test Px: One Leg Standing (+) sign: Pain on Pubic Symphysis or SI joint Significance: Lesion on the Structure Procedure: Ask the px to do a one leg stand. *px may hop, increasing the stress on pubic symphysis = Stress X-ray
  • 153. Gaenslen’s Test Px: Side-lying or Supine (+) sign: Pain Significance: Ipsilateral Sacroiliac joint lesion, Hip Pathology, L4 nerve root lesion Procedure: Px holds the lower leg flexed against the chest. Stabilize the hip while hyper extension on the upper leg.
  • 154. Gillet’s Test Px: Standing (+) sign: SI jt moves minimally or up Significance: Hypomobile Procedure: Palpate PSIS and ask px to stand on one leg while pulling the opposite knee towards the chest Other Name: Sacral Fixation Test
  • 155. Yeoman’s Test Px: Prone (+) sign: Pain on SI jt. | Lumbar Pain | Ant. Thigh Paresthesia Significance: Anterior SI lig. | Lumbar Pathology | Femoral Nerve Stretch (L2-L4) Procedure: Flex the knee to 90⁰, then extend the hip
  • 156. Leg Length Test Px: Supine (+) sign: >1-1.3cm (0.5-1in) Significance: Leg Length Discrepancy Procedure: True Leg Length = measure the ASIS to Lateral Malleolus ALL = measure umbilicus to Medial Malleolus
  • 157. Functional Limb Length Test Px: Standing (+) sign: assymetry is corrected by correct positioning Significance: Functional Leg Length Discrepancy Procedure: Palpate for the ASIS and PSIS and px is placed in “correct” stance (subtalar joints neutral, knees fully extended, and toes facing straight ahead)
  • 158. Sign of the Buttock Px: Supine (+) sign: Hip flexion does not increase Significance: Pathology in the Buttock (tumor, bursitis, abscess) Procedure: Passive unilateral SLR until restriction, then flex the knee
  • 159. Trendelenburg’s Test Px: One leg Stance (+) sign: pelvis falls on the non stance stand Significance: weakness of the gluteus medius muscle, superior gluteal nerve lesion, L4-S1 lesion Procedure: ask the px to do a one leg stance. Observe the px
  • 160. HIP
  • 161. Ortolani’s Sign Px: Supine (+) sign: feels clunk, clink or jerk Significance: 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.
  • 162. Barlow’s Test Px: Supine (+) sign: feels clunk, clink or jerk Significance: 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.
  • 163. Galeazzi Sign Px: Supine (+) sign: One knee is Higher Significance: 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.
  • 164. 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
  • 165. Abduction Test Px: Supine (+) sign: Asymmetry or Limitation of Movement Significance: Congenital Hip Dislocation Procedure: Hip and knee is flexed to 90⁰, then abducted Other Name: Hart’s Sign
  • 166. Patrick’s Test Px: Supine (+) sign: Test leg’s knee remains above the opposite straight leg Significance: Hip jt. Pathology, Iliopsoas spasm, SI jt. pathology Procedure: 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
  • 167. Anterior Labral Tear Test Px: supine (+) sign: Pain with or without click Significance: Hip Joint Pathology Procedure: Place hip into full FABER, then to EADIR Other Name: FADDIR Test
  • 168. Craig’s Test Px: Prone with knee flexed 90⁰ (+) sign: > 15⁰ Significance: Anteversion of Hip Procedure: 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
  • 169. Torque Test Px: Supine, with the test leg over the edge of the table (+) sign: Yield Significance: Hip Jt. Pathology Procedure: 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.
  • 170. Nelaton’s Line Px: Supine (+) sign: Greater trochanter is palpated above the line Significance: Hip Dislocation or Coxa Vara Procedure: draw an imaginary line from the ischial tuberosity of the pelvis to the ASIS of the pelvis on the same side.
  • 171. Bryant’s Triangle Px: Supine (+) sign: Difference in measurement Significance: Congenital Dislocation of Hip or Coxa Vara Procedure: Draw imaginary lines: 1st – perpendicular from the ASIS to the PSIS 2nd – tip of greater trochanter to ASIS
  • 172. Rotational Deformities Px: Supine (+) sign: Face in | face up, out, away Significance: Internal Rotation of femur or tibia | External Rotation of femur or tibia Procedure: Observe the patella
  • 173. 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 Band Procedure: Flex hip bringing the knee to the chest.
  • 174. Kendall’s Test Px: Supine with knee bent over the edge of the table (+) sign: slight extension of the other leg Significance: Rectus Femoris muscle contracture Procedure: Px flexes one knee (90⁰) onto the chest and holds it Other: Rectus Femoris Contracture Test (Method 1)
  • 175. Ely’s Test Px: Prone (+) sign: Spontaneous ipsilateral hip flexion Significance: Rectus Femoris Muscle Tightness Procedure: Passively flex the px’s knee Other Name: Tight Rectus Femoris Test (Method 2)
  • 176. Ober’s Test Px: 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 Contracture b. Femoral Nerve Involvement c. Trochanteric Bursitis Procedure: Abduct and extend the upper leg with the knee flexed (90⁰) or extended, then slowly lower the upper leg.
  • 177. Adduction Contracture Test Px: Supine (+) sign: ASIS forms an angle < 90⁰, and Pelvis shifts up on affected side Significance: Adductor Muscles contracture (adductor longus, brevis and magnus, pectineus, and gracilis) Procedure: Check for the assymetry of ASIS and balance the pelvis
  • 178. Abduction Contracture Test Px: Supine (+) sign: ASIS forms and angle > 90⁰, and Pelvis shifts down on the affected side Significance: Abductor Muscles Contracture (Gluteus Medius and Minimus Procedure: Check for the assymetry of ASIS and balance he pelvis
  • 179. Prone Lying Test for ITB Contracture Px: Prone (+) sign: Firm End-feel Significance: 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.
  • 180. Noble Compression Test Px: Supine; Knee flexed 90⁰; Hip flexed 90⁰ (+) sign: Localized pain at 30⁰ knee flexion Significance: Iliotibial Band Friction Syndrome Procedure: Apply pressure to the lateral femoral epicondyle or 1-2cm proximal to it while the px slowly extends the knee
  • 181. Piriformis Test Px: Side-lying; upper leg in 60⁰ hip flexion; flex knee (+) sign: Pain in groin | Pain in buttock Significance: Piriformis muscle tightness | piriformis syndrome Procedure: Stabilize pelvis with one hand and the other applies downward pressure to the knee
  • 182. 90-90 SLR Test Px: Supine; hip and knee 90⁰ flexion (+) sign: 20⁰- 0⁰ knee extend Significance: Hamstrings muscle contracture, or sciatica Procedure: Px Alternately extends the knee Other Name: Hamstring Contracture Test (Method 1)
  • 183. Hamstring Contracture Test (Method 2) Px: Long-sitting; 1 knee flexed against the chest (+) sign: Unable to reach the toes Significance: Tight Hamstrings muscle Procedure: Flex the trunk and touch the toes of the extended lower limb.
  • 184. Tripod Sign Px: Short-sitting (+) sign: Extension of the trunk Significance: Hamstring muscles are tight, Sciatica Procedure: Passively extend the knee Other Name: Hamstring Contracture Method 3
  • 185. Phelp’s Test Px: Prone (+) sign: Abduction increases with knee extension Significance: Gracilis muscle contracture Procedure: Passively abduct both leg as far as possible. Then flex knees 90⁰ and try to abduct further.
  • 186. Fulcrum Test Px: Short-sitting (+) sign: Sharp Pain and Apprehension Significance: Femoral Shaft Stress, Fracture Procedure: Place an arm under px’s thigh to act as a fulcrum, then apply pressure to distal femur.
  • 187. KNEE
  • 188. a. Abduction Test Px: 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
  • 189. b. Abduction Test Px: 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: Stress X-ray: Gr.1: 5mm opening Procedure: Gr.2: 10mm opening Fully extend the knee then place in 20⁰- 30⁰ flexion. Laterally rotate the knee (lock knee) and then apply valgus stress Gr.3: >10mm opening
  • 190. c. Abduction Test Px: 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: Stress X-ray: Procedure: Gr.1: 5mm opening Gr.2: 10mm opening Fully extend the knee then place in 20⁰- 30⁰ flexion. Grasp the big toe (lock knee) and then apply valgus stress Gr.3: >10mm opening
  • 191. a. Adduction Test Px: 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
  • 192. b. Adduction Test Px: 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: Stress X-ray: Gr.1: 5mm opening Procedure: Gr.2: 8mm opening Fully extend the knee then place in 20⁰- 30⁰ flexion. Apply varus stress on the knee Gr.3: >8mm opening
  • 193. Lachman Test Px: Supine (+) sign: Mushy or Soft End Feel Significance: Injury to these structures: a. Anterior Cruciate Ligament (posterolateral bundle) b. Posterior Oblique Ligament c. 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.
  • 194. Lachman Test Modification 1: Short-sitting Modification 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 knee Modification 5: Prone (difficult to determine the quality of the end feel Modification 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
  • 195. Drawer Sign Px: Supine; hip flexed to 45⁰; knee flexed to 90⁰ (+) sign: Tibia Moves forward (>6mm on the femur) Significance: Injury to these structures: a. b. c. d. e. f. ACL Posterolateral Capsule Medial Collateral Ligament Iliotibial Band Posterior Oblique Ligament Arcuate-Popliteus comlex injury Procedure: Sit on px’s foot with both hands clasp around the tibia, then translate it anteriorly.
  • 196. Posterior Sag Sign Px: Supine (+) sign: Step-off sign, thumb sign Significance: Injury to these structures: a. b. c. d. Posterior Cruciate Ligament Arcuate-Popliteus Complex Posterior Oblique Ligament Anterior Cruciate Ligament Procedure: Place the px in supine with the hips flexed to 45⁰ and knee flexed to 90⁰
  • 197. Reverse Lachman Test Px: Prone (+) sign: Mushy or Soft End feel Significance: Posterior Cruciate Ligament Injury Procedure: Stabilize the anterior distal thigh and the anterior proximal leg. Place the knee in full extension the 20⁰- 30⁰ flexion
  • 198. Godfrey Test Px: Supine (+) sign: Poterior Sag of the tibia Significance: Posterior Cruciate Ligament Procedure: Flex the hip and knee to 90⁰
  • 199. a. Slocum Test Px: 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
  • 200. b. Slocum Test Px: Supine (+) sign: Tibia moves forward (Anteromedial translation) Significance: Injury to these structures: a. b. c. d. Medial Collateral Ligament Posterior Oblique Ligament Posteromedial Capsule 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
  • 201. Jerk Test of Hughston Px: Supine (+) sign: Clunk or jerk at 20⁰- 30⁰ of knee flexion Significance: Injury to these structures: a. b. c. d. e. f. ACL Posterolateral capsule Arcuate popliteus complx Lat. Collateral ligament PCL Iliotibial Band Procedure: Flex the hip to 45⁰ and knee to 90⁰ then extend while maintaining medial rotation and a valgus stress
  • 202. Cross Over Test of Arnold Px: Standing (+) sign: “Giving Way” Significance: Injury to these structures: a. b. c. d. e. f. ACL Posterolateral capsule Arcuate popliteus complx Lat. Collateral ligament PCL 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.
  • 203. 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 aspect Significance: Injury to these structures: a. PCL b. POL c. MCL d. Semimembranosus mm e. Posteromedial capsule Procedure: f. ACL a. b. c. d. e. f. PCL Arcuate-popliteus complex LCL Biceps fem tendon Posterolat. Capsule ACL Sit on the px’s foot with both hands clasps around the tibia (slight medial rotation | slight lateral rotation) then translate postriorly.
  • 204. Loomer’s Test Px: Supine (+) sign: excess lateral rotation and posterior sag Significance: Injury to these sturctures: a. b. c. d. e. f. PCL Arcuate-popliteus complex LCL Biceps Fem tendon Posterolateral capsule ACL Procedure: Flex the hip and knee to 90⁰, then maximally lateraly rotate both tibias.
  • 205. Mcmurray Test Px: Supine; knee fully flexed (+) sign: snap/click with pain Significance: Meniscus Injury Procedure: Medially Rotate the tibia – for lateral meniscus Laterally Rotate the tibia – for medial meniscus *modification: same procedure but with knee extension.
  • 206. Apley’s Test Px: Prone; knee 90⁰ flexed (+) sign: pain Significance: a. Ligamentous injury b. Meniscus Injury Procedure: Stabilize thigh with PT’s knee. a. Medially/laterally rotate the tibia with distraction b. Medially/laterally rotate the tibia with compression
  • 207. Bounce Home Test Px: Supine; knee 90⁰ flexed (+) sign: Rubbery end-feel, pain upon extension on jt. line Significance: Torn Meniscus Procedure: Cup the heel and allow it to extend passively
  • 208. O’Donohue’s Test Px: Supine (+) sign: increase pain on rotation in either or both positions Significance: Capsular irritation | Meniscus Tear Procedure: Flex hip and knee to 90⁰, medially/laterally rotate the tibia twice, and then fully flex and rotate it both ways again.
  • 209. Modified Helfet Test Px: Short Sitting (+) sign: (-) patella goes laterally when standing Significance: Cruciate injury | Quadriceps weakness Procedure: Examine the patella in sitting and standing positions.
  • 210. Test For Retreating or Retracting Meniscus Px: Supine (+) sign: (-) appear/disappearing meniscus Significance: Torn meniscus Procedure: Flex hip and knee to 90⁰ then medially and laterally rotate the tibia. Medial Rotation: Appearing Lateral Rotation: Disappearing
  • 211. Payr’s Test Px: Supine (+) sign: pain on the medial jt. line Significance: Medial/posterior aspect of meniscus lesion Procedure: Position test leg in figure-4 position
  • 212. Bohler’s Sign Px: Supine (+) sign: pain Significance: Meniscus Pathology Procedure: Apply valgus/varus stress on the knee
  • 213. Bragard’s Sign Px: Supine (+) sign: increase/decrease pain upon doing the procedure Significance: Meniscus Pathology Procedure: 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.
  • 214. Childress Sign Px: Standing (+) sign: Pain, clicking, snapping Significance: Posterior lesion of meniscus Procedure: Instruct px to squat and do the “duck waddle”
  • 215. Cabot’s Popliteal Sign Px: Supine; Figure-4 position (+) sign: Pain Significance: Meniscus Pathology Procedure: Ask the px to isometrically straighten the knee while applying resistance.
  • 216. Mediopatellar Plica Test Px: Supine (+) sign: Pain Significance: Pinching of the edge of the plica b/n the medial femoral condyle and the patella Procedure: Flex the knee 30⁰ then push the patella medially with the thumb Other Name: Mital-Hayden Test
  • 217. Plica “Stutter” Test Px: Short-sitting (+) sign: patella stutters or jumps b/n 60⁰ and 45⁰ of flexion Significance: Plica Syndrome Procedure: Plcae one finger over one patella and then ask the px to slowly extend the knee
  • 218. Hughston Test Px: Supine (+) sign: Popping of the plica band Significance: Plica Syndrome Procedure: 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
  • 219. Brush, Stroke or Bulge Test Px: Supine (+) sign: Fluid wave bulge on the medial side of the patella Significance: 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
  • 220. 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.
  • 221. Patellar Tap Test Px: Supine (+) sign: Dancing patella Significance: Swelling Procedure: tap on the patella Other Name: Ballotable Patella
  • 222. Clarke’s Sign Px: Supine (+) sign: retropatellar pain / cannot hold the contraction Significance: Patellofemoral Dysfunction Procedure: 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.
  • 223. Waldron Test Px: Standing (+) sign: count the crepitus with pain (note the amount, location and the ROM) Significance: Patellofemoral Dysfunction Procedure: Palpate the patella and then instruct the patiene to perform slow, deep knee bends.
  • 224. Zohler’s Sign Px: Supine (+) sign: Pain Significance: Chondromalacia Patellae Procedure: pulls the patella distally and ask the pt to contract quadriceps muscle.
  • 225. Frund’s Test Px: Short SItting (+) sign: Pain Significance: Chondromalacia Patellae Procedure: taps the patella in various knee flexion
  • 226. 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 patella 2nd line – from tibial tubercle to midpoint of patella Other Name: Patellofemoral angle
  • 227. Wilson Test Px: Short Sitting (+) sign: pain lessened/diminished Significance: Osteochondritis Dissecans of the medial femoral condyle Procedure: 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.
  • 228. Fairbank’s Apprehension Test Px: Supine; knee flexed to 30⁰ (+) sign: quadriceps muscle contract to bring patella “into line” Significance: Patellar dislocation Procedure: Carefully and slowly push the patella laterally and distally
  • 229. 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.
  • 230. ANKLE AND FOOT
  • 231. Neutral Position Of Talus (Weight Bearing Position) Px: Standing (+) sign: Bulging Significance: Affectation of the Talus Procedure: Palpate for the talus (dorsal aspect) then ask the px to rotate the trunk to the right and left Tibia rotates medially and laterally Talus pronates and supinates
  • 232. 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.
  • 233. Leg Heel Alignment Px: Prone with foot dangled over the edge of the table (+) sign: > 8⁰ of inversion of heel | Eversion of heel Significance: Hindfoot varus | Hindfoot valgus Procedure: 1st line - mark the midline of calcaneus 2nd line – 1cm distal to the 1st mark 3rd line – lower third midline of the leg
  • 234. Coleman Block Test Px: Standing (+) sign: Heel is in neutral position | heel is still not in neutral position Significance: mobile hindfoot | fixed hindfoot inversion Procedure: 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
  • 235. Too Many Toes Sign Px: Standing (+) sign:More toes can be seen on the affected side Significance: Valgus deformity, Forefoot abducted, increase lateral rotation of tibia Procedure: View the px from behind
  • 236. Tibial Torsion (Sitting) Px: Short-sitting (+) sign: Lateral tibial torsion: > 18⁰ | < 13⁰ Significance: toe-out position | toe-in position Procedure: Draw imaginary Lines: 1st line – 2 epicondyles 2nd line – 2 malleoli
  • 237. Tibial Torsion (Supine) Px: Supine (+) sign: Lateral tibial torsion: > 18⁰ | < 13⁰ Significance: toe-out position | toe-in position Procedure: Draw imaginary Lines: 1st line – 2 apices of malleoli 2nd line – heel parallel to the floor
  • 238. Tibial Torsion (Prone) Px: Prone; Knee flexed to 90⁰ (+) sign: Lateral tibial torsion: > 18⁰ | < 13⁰ Significance: toe-out position | toe-in position Procedure: Draw imaginary Lines: 1st line – heel parallel to the floor 2nd line – heel parallel to the thigh
  • 239. a. Anterior Drawer Test Of the Ankle Px: Supine; 20⁰ plantar flexion (+) sign: suction sign (over the anterior talofibular ligament) with minimal pain Significance: Stress on anterior talofibular ligament injury Procedure: Stabilize just above the ankle and draw the talus forward
  • 240. b. Anterior Drawer Test Of the Ankle Px: Supine; 20⁰ plantar flexion (+) sign: greater anterior translation (on lateral die only) = medial rotation of the talus Significance: Stress on anterior talofibular ligament injury and calcaneofibular ligament Procedure: Stabilize just above the ankle and draw the talus forward + inversion
  • 241. c. Anterior Drawer Test Of the Ankle Px: Supine; 20⁰ plantar flexion (+) sign: Greater Anterior Translation Significance: Torn anterior talofibular ligament and Calcaneofibular ligament Procedure: Stabilize just above the ankle and draw the talus forward + dorsiflexion
  • 242. 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 Tendon Significance: Ligamentous Instability (Anterior Talofibular Ligament) Procedure: Push the heel steadily forward.
  • 243. Talar Tilt Px: Side-lying; knee flexed (+) sign: Excessive Movement Significance: Adduction: stress on torn Calcaneofibular Ligament and/or Anterior Talofibular Ligament Abduction: stress on Deltoid Ligament (tibionavicular, tibiocalcaneal, posterior tibiotalar ligament) Procedure: Tilt the talus from side to side (abduction and adduction)
  • 244. Squeeze Test of The Leg Px: Supine (+) sign: Pain Significance: Syndesmosis Injury/high ankle sprain Procedure: Grasp the lower leg at midcalf and squeeze the tibia and fibula together
  • 245. Kleiger Test Px: Short-sitting (+) sign: Pain with talus displacement (medial) | pain over the anterior or posterior tibiofibular ligaments Significance: Deltoid Ligament Tear | Syndesmosis Procedure: Apply passive lateral rotation to the foot. Other Name: External Rotation Stress Test
  • 246. Thompson’s Test Px: Prone / kneels with feet over the edge of the table (+) sign: absence of plantar flexion Significance: Ruptured Achilles Tendon Procedure: Squeeze the calf muscle Other Name: Simmond’s Test, Sign for Achilles Tendon Rupture)
  • 247. Test or Peroneal Tendon Dislocation Px: Prone; knee flexed to 90⁰ (+) sign: Tendon subluxes from behind the lateral malleolus Significance: Peroneal Tendon Dislocation Procedure: Ask px to actively dorsiflex and plantar flex the ankle along with eversion against resistance.
  • 248. 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)
  • 249. Hoffa’s Test Px: Prone with feet over the edge of the table (+) sign: feels less taut Significance: Calcaneal Fracture Procedure: Palpate both the achilles tendon. Instruct px to plantar flex and dorsiflex
  • 250. Tinel’s Sign At The Ankle Px: (+) sign: Tingling Sensation Significance: Peripheral Nerve Injury Procedure: 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
  • 251. Duchenne Test Px: Supine with legs straight (+) sign: Only the Lateral Border plantar flexes Significance: Lesion of the Superficial Peroneal Nerve, L4-S1 nerve root Procedure: Push up on the head of the 1st metatarsal through the sole (dorsiflex). Px tries to plantarflex
  • 252. Morton’s Test Px: Supine (+) sign: Pain Significance: Stress fracture or neuroma Procedure: Grasp the metatarsal heads and squeeze together
  • 253. Homan’s Sign Px: Supine (+) sign: Pain in the calf, PALLOR, swelling in the leg, loss of the dorsalis pedis pulse Significance: Deep Vein Thrombosis Procedure: Passively dorsiflex with the knee extended
  • 254. Buerger’s Test Px: Supine and sitting (+) sign: 1-2mins before the color comes back Significance: Poor arterial blood supply Procedure: Elevate the leg at 45⁰ for at least 3 minutes, foot blanches. Px is then placed in short-sitting.