Musculoskeletal System: Special Tests

Question 1

In sitting, patient is asked to clasp both hands behind the head with the fingers interlocked. Patient is then asked to alternately contract and relax the biceps muscles.

Positive test is indicated by absence of movement in the biceps tendon and may be indicative of a rupture of the long head of the biceps

Answer 1

Lundington’s test

Question 2

Patient elbow extended and forearm supinated. the therapist places one hand over the bicipital groove and the other hand on the volar surface of the forearm. The therapist resists active shoulder flexion.

Positive test is indicated by pain or tenderness in the bicipital groove region and may be indicative of bicipital tendonitis

Answer 2

Speed’s test

Question 3

Patient with 90 degrees of elbow flexion and the forearm pronated. Humerus is stabilized against the patient’s thorax. Therapist places one hand on the patient’s forearm and the other hand over the bicipital groove. The patient actively supinates and laterally rotates against resistance.

Positive test is indicated by pain or tenderness in the bicipital groove and may be indicative of bicipital tendonitis

Answer 3

Yergason’s test

Question 4

Arm at 90 degrees of abduction. Patient is asked to slowly lower the the arm to their side.

Positive test is indicated by the patient failing to slowly lower their arm to the side or by the presence of severe pain and may be indicative of a tear in the rotator cuff

Answer 4

Drop arm test

Question 5

Therapist flexes the patient’s shoulder to 90 degrees and then medially rotates that arm.

Positive test is indicated by pain and may be indicative of shoulder impingement involving the supraspinatus tendon

Answer 5

Hawkins-Kennedy impingement test

Question 6

Therapist positions one hand on the posterior aspect of the patient’s scapula and the other hand stabilizing the elbow. The therapist elevates the patient’s arm through flexion.

Positive test is indicated by a facial grimace or pain and may be indicative of shoulder impingement involving the supraspinatus tendon

Answer 6

Neer impingement test

Question 7

Patient’s arm in 90 degrees of abduction followed by 30 degrees of horizontal adduction with the thumb pointing downward. The therapist resists the patient’s attempt to abduct the arm.

Positive test indicated by weakness or pain and may be indicative of a tear of the supraspinatus tendon, impingement or suprascapular nerve involvement

Answer 7

Supraspinatus test

Question 8

Therapist monitors the radial pulse and asks the patient to rotate his/her head to face the test shoulder. The patient is then asked to extend his/her head while the therapist laterally rotates and extends the patient’s shoulder.

Positive test is indicated by an absent or diminished radial pulse and may be indicative of thoracic outlet syndrome

Answer 8

Adson maneuver

Question 9

Test arm in 90 degrees of abduction, ER, and elbow flexion. Patient is asked to rotate the head away from the test shoulder while the therapist monitors the radial pulse.

Positive test is indicated by an absent or diminished pulse when the head is rotated away from the test shoulder. Positive test may be indicative of thoracic outlet syndrome.

Answer 9

Allen test

Question 10

Therapist monitors the patient’s radial pulse and assists the patient to assume a military posture.

Positive test is indicated by an absent or diminished radial pulse and may be indicative of thoracic outlet syndrome caused by compression of the subclavian artery between the first rib and the clavicle.

Answer 10

Costoclavicular syndrome test

Question 11

Arms positioned in 90 degrees of abduction, ER, and elbow flexion. Patient is asked to open and close their hands for 3 minutes.

A positive test is indicated by the inability to maintain the test position, weakness of the arms, sensory loss or ischemic pain. A positive test may be indicative of thoracic outlet syndrome.

Answer 11

Roos tet

Question 12

Therapist moves the patient’s arm overhead in the frontal plane while monitoring the patient’s radial pulse.

A positive test is indicated by an absent or diminished radial pulse and may be indicative of compression in the costoclavicular space

Answer 12

Wright test (hyperabduction test)

Question 13

Patient in supine. Therapist places one hand on the posterior aspect of the patient’s humeral head while the other hand stabilizes the humerus proximal to the elbow. The therapist passively abducts and laterally rotates the arm over the patient’s head and then proceeds to apply an anterior directed force to the humerus.

Positive test is indicated by a clunk or grinding sound and may be indicative of a glenoid labrum tear.

Answer 13

Glenoid labrum tear test

Question 14

Elbow in 20-30 degrees of flexion. Therapist places on hand on the elbow and the other hand proximal to the patient’s wrist. Therapist applies a varus force to test the lateral collateral ligament while palpating the lateral joint line.

Positive test is indicated by increased laxity in the lateral collateral ligament when compared to the contralateral limb, apprehension or pain. Indicative of a lateral collateral ligament sprain

Answer 14

Varus Stress test

Question 15

Elbow in 20-30 degrees of flexion. Therapist places on hand on the elbow and the other hand proximal to the patient’s wrist. Therapist applies a valgus force to test the medial collateral ligament while palpating the medial joint line.

Positive test is indicated by increased laxity in the medial collateral ligament when compared to the contralateral limb, apprehension or pain. Indicative of a medial collateral ligament sprain.

Answer 15

Valgus stress test

Question 16

Elbow in slight flexion. Therapist places his/her thumb on the patient’s lateral epicondyle while stabilizing the elbow joint. Patient is asked to make a fist, pronate the forearm, radially deviate, and extend the wrist against resistance.

Positive test is indicated by pain in the lateral epicondyle region or muscle weakness and may be indicative of lateral epicondylitis

Answer 16

Cozen’s test

Question 17

Therapist stabilizes the elbow with one hand and places the other hand on the dorsal aspect of the patient’s hand distal to the proximal interphalangeal joint. Patient is asked to extend the third digit against resistance.

Positive test is indicated by pain in the lateral epicondyle region or muscle weakness and may be indicative of lateral epicondylitis.

Answer 17

Lateral epicondylitis test

Question 18

Therapist palpates the medial epicondyle and supinates the patient’s forearm, extends the wrist, and extends the elbow.

Positive test is indicated by pain in the medial epicondyle region and may be indicative of medial epicondylitis.

Answer 18

Medial epicondylitis test

Question 19

Therapist palpates the lateral epicondyle, pronates the patient’s forearm, flexes the wrist, and extends the elbow.

Positive test is indicated by pain in the lateral epicondyle region and may be indicative of lateral epicondylitis.

Answer 19

Mill’s test

Question 20

Elbow in slight flexion. Therapist taps with the index finger between the olecranon process and the medial epicondyle.

Positive test is indicated by a tingling sensation in the ulnar nerve distribution of the forearm, hand, and fingers. A positive test may be indicative of ulnar nerve compression or compromise.

Answer 20

Tinel’s sign

Question 21

Therapist holds the patient’s thumb in extension and applies a valgus force to the metacarpophalangeal joint of the thumb.

Positive test is indicated by excessive valgus movement and may be indicative of a tear of the ulnar collateral and accessory collateral ligaments. Injury is referred to as gamekeeper’s or skier’s thumb.

Answer 21

Ulnar collateral ligament instability test

Question 22

Patient is asked to open and close the hand several times in succession and then maintain the hand in a closed position. Therapist compresses the radial and ulnar arteries. Patient is then asked to relax the hand and the therapist releases the pressure on one of the arteries while observing the color of the hand and fingers.

Positive test is indicated by delayed and absent flushing of the radial or ulnar half of the hand and may be indicative of an occlusion in the radial or ulnar artery.

Answer 22

Allen’s test

Question 23

Metacarpophalangeal joint held in slight extension. Therapist attempts to move the proximal interphalangeal joint into flexion. If the proximal interphalangeal joint does not flex with the metacarpophalangeal joint extended, there may be a tight intrinsic muscle or capsular tightness. If the proximal interphalangeal joint fully flexes with the metacarpophalangeal joint in slight flexion, there may be intrinsic muscle tightness without capsular tightness

Answer 23

Bunnel-Littler test

Question 24

Proximal interphalangeal joint is held in a neutral position while the therapist attempts to flex the distal interphalangeal joint. If the therapist is unable to flex the distal interphalangeal joint, the retinacular ligaments or capsule may be tight. If the therapist is able to flex the distal interphalangeal joint with the proximal interphalangeal joint in flexion, the retinacular ligaments may be tight and the capsule may be normal.

Answer 24

Tight retinacular ligament test

Question 25

Patient asked to hold a piece of paper between the thumb and index finger. The therapist attempts to pull the paper away from the patient.

A positive test is indicated by the patient flexion the distal phalanx of the thumb due to adductor pollicis muscle paralysis. If at the same time, the patient hyperextends the metacarpophalangeal joint of the thumb, it is termed Jeanne’s sign. Both objective findings may be indicative of ulnar nerve compromise or paralysis

Answer 25

Froment’s sign

Question 26

Therapist flexes the patient’s wrists maximally and asks the patient to hold the position for 60 seconds.

Positive test is indicated by tingling in the thumb, index finger, middle finger, and lateral half of the ring finger and may be indicative of carpal tunnel syndrome due to median nerve compression

Answer 26

Phalen’s test

Question 27

Therapist taps over the volar aspect of the patient’s wrist.

Positive test is indicated by tingling in the thumb, index finger, middle finger, and lateral half of the ring finger distal to the contact site at the wrist. A positive test may be indicative of carpal tunnel syndrome due to medial nerve compression.

Answer 27

Tingel’s sign

Question 28

Patient makes a fist with the thumb tucked inside the fingers. The therapist stabilizes the patient’s forearm and ulnarly deviates the wrist.

Positive test is indicated by pain over the abductor pollicis longus and extensor pollicis brevis tendons at the wrist and may be indicative of tenosynovitis in the thumb (de Quervain’s disease)

Answer 28

Finkelstein test

Question 29

Therapist stabilizes the patient’s hand and grasps the patient’s thumb on the metacarpal. Therapist applies compression and rotation through the metacarpal.

A positive test is indicated by pain and may be indicative of degenerative joint disease in the carpometacarpal joint.

Answer 29

Grind test

Question 30

Patient makes a fist.

Positive test is indicated by the patient’s third metacarpal remaining level with the second and fourth metacarpals. A positive test may be indicative of a dislocated lunate.

Answer 30

Murphy sign

Question 31

In prone, therapist passively flexes the patient’s knee.

Positive test is indicated by spontaneous hip flexion occurring simultaneously with knee flexion and may be indicative of a rectus femoris contracture

Answer 31

Ely’s test

Question 32

Patient positioned in sidelying with the lower leg flexed at the hip and the knee. Therapist moves the test leg into hip extension and abduction and then attempts to slowly lower the test leg.

Positive test is indicated by an inability of the test leg to adduct and touch the table and may be indicative of a tensor fasciae latae contracture.

Answer 32

Ober’s test

Question 33

Patient in sidelying with the test leg positioned towards the ceiling and the hip flexed to 60 degrees. Therapist places one hand on the patient’s pelvis and the other hand of the patient’s knee. While stabilizing the pelvis, the therapist applies a downward (adduction) force on the knee.

Positive test is indicated by pain or tightness, and may be indicative of piriformis tightness or compression on the sciatic nerve caused by the piriformis

Answer 33

Piriformis test

Question 34

Patient in supine with the legs fully extended. Patient is asked to bring one of his/her knees to the chest in order to flatten the lumbar spine. Therapist observes the position of the contralateral hip while the patient holds the flexed hip.

Positive test is indicated by the straight leg rising from the table and may be indicative of a hip flexion contracture.

Answer 34

Thomas test

Question 35

Patient positioned in sitting with knees flexed to 90 degrees over the edge of a table. Therapist passively extends one knee.

Positive test is indicated by tightness in the hamstrings or extension of the trunk in order to limit the effect of the tight hamstrings.

Answer 35

Tripod sign

Question 36

Patient is positioned in supine and is asked to stabilize the hips in 90 degrees of flexion with the knees relaxed. The therapist instructs the patient to alternately extend each knee as much as possible while maintaining the hips in 90 degrees of flexion.

Positive test is indicated by the knee remaining in 20 degrees of more of flexion and is indicative of hamstrings tightness.

Answer 36

90-90 straight leg raise test

Question 37

Patient in supine with hips flexed to 90 degrees and the knees flexed. Therapist tests each hip individually by stabilizing the femur and pelvis with one hand while the other hand moves the test leg into adduction while applying forward pressure posterior to the greater trochanter.

Positive test is indicated by a click or a clunk and may be indicative of a hip dislocation being reduced.

Answer 37

Barlow’s test

Question 38

Patient in supine with hips flexed to 90 degrees with knees flexed. Therapist grasps the legs so that their thumbs are placed along the patient’s medial thighs and the fingers are placed on the lateral thighs towards the buttocks. Therapist abducts the patient’s hips and gentle pressure is applied to the greater trochanters until resistance is felt as approximately 30 degrees.

Positive test is indicted by a click or clunk and may be indicative of a dislocation being reduced.

Answer 38

Ortolani’s test

Question 39

Patient in prone with test knee flexed to 90 degrees. Therapist palpates the posterior aspect of the greater trochanter and medially and laterally rotates the hip until the greater trochanter is parallel with the table. The degree of femoral anterversion corresponds to the angle formed by the lower leg with the perpendicular axis of the table.

Normal anterversion is 8-15 degrees.

Answer 39

Craig’s test

Question 40

Patient in supine with test leg flexed, abducted, and ER at the hip onto the opposite leg. Therapist slowly lowers the test leg through abduction towards the table.

Positive test is indicated by failure of the test leg to abduct below the level of the opposite leg and may be indicative of iliopsoas, sacroiliac or hip joint abnormalities.

Answer 40

Patrick’s test (Faber test)

Question 41

Patient in supine. Therapist passively flexes and adducts the hip with the knee in maximal flexion. The therapist applies a compressive force through the shaft of the femur while continuing to passively move the patient’s hip.

Positive test is indicated by grinding, catching or crepitation in the hip and may be indicative of pathologies such as arthritis, avascular necrosis or an osteochondral defect.

Answer 41

Quadrant scouring test

Question 42

Patient is asked to stand on one leg for approximately ten seconds.

Positive test is indicated by a drop of the pelvis on the unsupported side and may be indicative of weakness of the gluteus medius muscle on the supported side.

Answer 42

Trendelenburg test

Question 43

Patient in supine with the knee flexed to 90 degrees and the hip flexed to 45 degrees. The therapist stabilizes the lower leg by sitting on the forefoot. The therapist grasps the patient’s proximal tibia with two hands, places their thumbs on the tibial plateau, and administers an anterior directed force to the tibia on the femur.

Positive test is indicated by excessive anterior translation of the tibia on the femur with a diminished or absent end-point and may be indicative of an anterior cruciate ligament injury.

Answer 43

Anterior drawer test

Question 44

Patient in supine with the knee flexed to 20-30 degrees. Therapist stabilizes the distal femur with one hand and places the other hand on the proximal tibia. The therapist applies an anterior directed force to the tibia on the femur.

Positive test is indicated by excessive anterior translation of the tibia on the femur with a diminished or absent end-point and may be indicative of an anterior cruciate ligament injury

Answer 44

Lachman test

Question 45

Patient in supine with the hip flexed and abducted to 30 degrees with slight medial rotation. Therapist grasps the leg with one hand and places the other hand over the lateral surface of the proximal tibia. Therapist medially rotates the tibia and applies a valgus force to the knee while the knee is slowly flexed.

Positive test is indicated by a palpable slight of clunk occurring between 20-40 degrees of flexion and is indicative of anterolateral rotatory instability. The shift or clunk results from the reduction of the tibia on the femur.

Answer 45

Lateral pivot shift test

Question 46

Patient in supine with the knee flexed to 90 degrees and the hip flexed to 45 degrees. The therapist stabilizes the lower leg by sitting on the forefoot. Therapist grasps the patient’s proximal tibia with two hands, places their thumbs on the tibial plateau, and administers a posterior directed force to the tibia on the femur.

Positive test is indicated by excessive posterior translation of the tibia on the femur with a diminished or absent end-point and may be indicative of a posterior cruciate ligament injury.

Answer 46

Posterior drawer test

Question 47

Patient is positioned in supine with the knee flexed to 90 degrees and the hip flexed to 45 degrees.

Positive test is indicated by the tibia sagging back on the femur and may be indicative of a posterior cruciate ligament injury.

Answer 47

Posterior sag sign

Question 48

Patient is supine with knee flexed to 90 degrees and hip flexed to 45 degrees. Therapist rotates the patient’s foot 30 degrees medially to test anterolateral instability. Therapist stabilizes the lower leg by sitting on the forefoot. Therapist grasps the patient’s proximal tibia with two hands, places their thumbs on the tibial plateau, and administers an anterior directed force to the tibia on the femur.

Positive test is indicated by movement of the tibia occurring primarily on the lateral side and may be indicative of anterolateral instability. Test can also be performed to assess anteromedial instability by rotating the patient’s foot 15 degrees laterally.

Answer 48

Slocum test

Question 49

Patient in supine with knee flexed to 20-30 degrees. Therapist positions one hand on the medial surface of the patient’s ankle and the other hand on the lateral surface of the knee. Therapist applies a valgus force to the knee with the distal hand.

Positive test is indicated by excessive valgus movement and may be indicated of a medial collateral ligament sprain. Positive test with the knee in full extension may be indicative of damage to the medial collateral ligament, posterior cruciate ligament, posterior oblique ligament, and posteromedial capsule.

Answer 49

Valgus stress test

Question 50

Patient in supine with knee flexed to 20-30 degrees. Therapist positions one hand on the lateral surface of the patient’s ankle and the other hand on the medial surface of the knee. Therapist applies a varus force to the knee with the distal hand.

Positive test is indicated by excessive varus movement and may be indicative of a lateral collateral ligament sprain. Positive test with the knee in full extension may be indicative of damage to the lateral collateral ligament, posterior cruciate ligament, arcuate complex, and posterolateral capsule.

Answer 50

Varus stress test

Question 51

Patient in prone with knee flexed to 90 degrees. Therapist stabilizes the patient’s femur using one hand and places the other hand on the patient’s heel. Therapist medially and laterally rotates the tibia while applying a compressive force through the tibia.

Positive test is indicated by pain or clicking and may be indicative of a meniscal lesion.

Answer 51

Apley’s compression test

Question 52

Patient in supine. Therapist grasps the patient’s heel and maximally flexes the knee. Patient’s knee is extended passively.

Positive test is indicated by incomplete extension or a rubbery end-feel and may be indicative of a meniscal lesion.

Answer 52

Bounce home test

Question 53

Patient is positioned in supine. Therapist grasps the distal leg with one hand and palpates the knee joint line with the other. With the knee fully flexed, the therapist medially rotates the tibia and extends the knee. Therapist repeats the same procedure while laterally rotating the tibia.

Positive test is indicated by a click or pronounced crepitation felt over the joint line and may be indicative of a posterior meniscal lesion

Answer 53

McMurrary test

Question 54

Patient positioned in supine. Therapist places one hand below the 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.

Positive test is indicated by a wave of fluid just below the medial distal border of the patella and is indicative of effusion in the knee.

Answer 54

Brush test

Question 55

Patient in supine with the knee flexed or extended to a point of discomfort. therapist applies a slight tap over the patella.

Positive test is indicated if the patella appears to be floating and may be indicative of joint effusion.

Answer 55

Patellar tap test

Question 56

Patient positioned in supine with knees extended. Therapist applies slight pressure distally with the web space of their hand over the superior pole of the patella. Therapist then asks the patient to contract the quadriceps muscle while maintaining pressure on the patella.

Positive test is indicated by failure to complete the contraction without pain and may be indicative of patellofemoral dysfunction

Answer 56

Clarke’s sign

Question 57

Patient in supine. Therapist flexes the knee and medially rotate the tibia with one hand while the other hand attempts to move the patella medially and palpate the medial femoral condyle.

Positive test is indicated by a popping sound over the medial plica while the knee is passively flexed and extended.

Answer 57

Hughston’s plica test

Question 58

Patient in supine with hip slightly flexed and the knee in 90 degrees of flexion. Therapist places the thumb of one hand over the lateral epicondyle of the femur and the other hand around the patient’s ankle. The therapist maintains pressure over the lateral epicondyle while the patient is asked to slowly extend the knee.

Positive test is indicated by pain over the lateral femoral epicondyle at approximately 30 degrees of knee flexion and may be indicative of illiotibial band friction syndrome

Answer 58

Noble compression test

Question 59

Patient in supine with knees extended. Therapist places both thumbs on the medial border of the patella and applies a laterally directed force.

Positive test is indicated by a look of apprehension or an attempt to contract the quadriceps, in an effort to avoid subluxation and may be indicative of patella subluxation or dislocation.

Answer 59

Patellar apprehension test

Question 60

Patient in supine, therapist stabilizes the distal tibia and fibula with one hand, while the other hand holds the foot in 20 degrees of plantar flexion and draws the talus forward in the ankle mortise.

Positive test is indicated by excessive anterior translation of the talus away from the ankle mortise and may be indicative of an anterior talofibular ligament sprain.

Answer 60

Anterior drawer test

Question 61

Patient in sidelying with knee flexed to 90 degrees. Therapist stabilizes the distal tibia with one hand while grasping the talus with the other hand. Foot is maintained in a neutral position. Therapist tilts the talus into abduction and adduction.

positive test is indicated by excessive adduction and may be indicative of a calcaneofibular ligament sprain.

Answer 61

Talar tilt

Question 62

Patient in prone with feet extended over the edge of a table. Therapist asks the patient to relax and proceeds to squeeze the muscle belly of the gastrocnemius and soleus muscles.

Positive test is indicated by the absence of plantar flexion and my be indicative of a ruptured Achilles tendon.

Answer 62

Thompson test

Question 63

Patient in sitting with knees over the edge of a table. Therapist places the thumb and index finger of one hand over he medial and lateral malleolus. Therapist then measures the acute angle formed by the axes of the knee and ankle.

Normal lateral rotation of the tibia is considered to be 12-18 degrees in an adult.

Answer 63

Tibial torsion test

Question 64

Patient in supine with hips and knees extended, the legs 15-20 cm apart, and the pelvis in balance with the legs. Using a tap measure, the therapist measures from the distal point of the anterior superior iliac spines to the distal point of the medial malleoli.

Positive test is indicated by a bilateral variation of greater than one centimeter and may be indicative of a true leg length discrepancy

Answer 64

True leg length discrepancy test

Question 65

Patient in sitting with the head laterally flexed. Therapist places both hands on the top of the subject’s head and exerts a downward force.

Positive test is indicated by pain radiating into the arm toward the flexed side and may be indicative of nerve root compression.

Answer 65

Foraminal compression test

Question 66

Patient in supine. Therapist places patient’s head into extension, lateral flexion, and rotation to the ipsilateral side.

Positive test is indicated by dizziness, nystagmus, slurred speech or loss of consciousness and may be indicative of compression of the vertebral artery.

Answer 66

Vertebral artery test

Question 67

Patient in supine. Therapist crosses their arms, placing the palms of the hands on the patient’s anterior superior iliac spines. Therapist applies a downward an lateral force to the pelvis.

Positive test is indicated by unilateral pain in the sacroiliac joint or gluteal area and may be indicative of sacroiliac joint dysfunction

Answer 67

Sacroiliac joints stress test

Question 68

Patient in sitting with the knees flexed to 90 degrees and the feet on the floor. Patient’s hips should be abducted to allow the patient to bend forward. Therapist places his/her thumbs on the inferior margin of the posterior superior iliac spines and monitors the movement of the bony structures as the patient bends forward and reaches toward the floor.

Positive test is indicated by one posterior superior iliac spine moving farther in a cranial direction and may be indicative of an articular restriction.

Answer 68

Sitting flexion test

Question 69

Patient is standing with feet 12 inches apart. Therapist places his/her thumbs on the inferior margin of the posterior superior iliac spines and monitors the movement of the bony structures as the patient bends forward with the knees extended.

Positive test in indicated by one posterior superior iliac spine moving farther in a cranial direction and may be indicative of an articular restriction

Answer 69

Standing flexion test