Special Test (LE) Flashcards
Position: supine
Drop a line from ASIS to tibial tuberosity
Palpate for the GT
Sign: GT is above nelaton’s line
Indication: hip d/l or coxa vara
Nelaton’s line
(Hip pathology)
Position: supine
Drop a perpendicular line from ASIS to table
Measure distance from GT to the perpendicular line
Compare both sides
Sign: (+) difference between two
Indication: hip d/l or coxa vara
Bryant’s triangle
(Hip pathology)
Position: supine with hip and knee flexed
Action: passively adduct hip
(+) sign: LOM, discomfort and pain
Ind: hip pathology
Flexion- adduction test / FAD test
(Hip pathology ST)
Position: supine with both hips in flexion
Action: passive extension then Hip ER and hip IR
Sign: reproduction of symptoms
Ind: labral pathology
McCarthy hip extension sign
(Hip pathology ST)
Position: supine, with foot of affected leg on opposite knee
Action: slowly lower knee on the table
(+) sign: knee remains high
Indication: SI joint problem/ iliopsoas spasm
Patrick test/ figure of 4 test/ Faber test/ Jansen’s test
(Hip pathology ST)
Position: standing
Action: one leg stance on affected leg
(+) sign: opposite pelvis drop
Indication: G med weakness or unstable hip
Trendelenburg sign
(Hip pathology)
Position: supine with hip and knee flexed
Action: slight traction, abduction and press GT bilaterally inward
(+) sign: click, clunk, jerk
Indication: CDH
Done only for first few weeks after birth and only for d/l hip or lax hip
Ortolani’s sign
(Pediatric ST)
Position: same with ortolani sign
Action: push thigh outward and forward
(+) sign: femoral head slips forward with click and clunk or jerk
Indication: DDH/ dislocatable hip
Barlow’s test
(Pediatric ST)
Position: supine with hips and knees flexed
Action: observe
(+) sign: uneven height of the knee (3-18 months)
Indication: u/l hip d/l, DDH or CDH
Galleazi’s test/ Alli’s test
(Pediatric ST)
Position: supine, hip and knee flexed to 90
Action: passively push thigh down and lift it up
(+) sign: inc motion
Indication: hip d/l (non specific)
Telescoping sign/ piston/ dupuytren’s test
(Pediatric ST)
Position: supine with hips and knees flexed
Action: passively abduct hips
(+) sign: LOM or asymmetrical gluteal folds
Indication: hip d/l, CDH, DDH
Abduction test/ Hart sign
(Pediatric ST)
Position: Passive SLR
Action: if there is LOM, passively flex the knee and continue doing SLR
(+) sign: no increase of hip flexion
Indication: Hip pathology
Abscess
Neoplasm
Ischial bursitis
Sign of the buttock
(Muscle Pathology)
Position: supine
Action: unaffected leg perform knee to chest
(+) sign: opposite knee flex or increase in lumbar lordosis
Indication: hip flexion contracture (iliopsoas)
Thomas test
(Muscle Pathology)
Position: pt supine with knee dangling on the edge of the bed
Action: unaffected LE, knee to chest
(+) sign: extension of the affected leg
Indication: tight rectus femoris muscle
3.1 Kendall’s test
(Muscle Pathology)
Position: prone
Action: passively flex ipsilateral knee
(+) sign: ipsilateral hip flexion
Indication: rectus femoris tightness
3.2. Ely’s test
(Muscle Pathology)
Position: supine with knees and hips flex to 90
Action: active knee extension
(+) sign: popliteal angle is less than 125 deg
Indication: hamstring tightness
4.1 method 1: 90-90 SLR
(Muscle Pathology)
Position: long sitting
Action: actively reach toes
(+) sign: inability to reach toes
Indication: hamstring tightness
4.2 method 2: Hamstring contracture tightness
(Muscle Pathology)
Position: short sitting
Action: passive knee extension
(+) sign: trunk leans back
Indication: hamstring tightness
4.3 method 3: tripod sign
Muscle Pathology
Position: sidelying, lower leg flex, upper leg extend
Action: passively abduct the higher leg and ask pt to slowly lower it
(+) sign: LE remains abducted
Indication: contracture of ITB/ TFL
5.1 Ober test
(Muscle Pathology)
Position: supine, hip and knee flex
Action: apply pressure on lateral femoral condyle and ask pt to slowly extend the knee
(+) sign: severe pain especially on the last 30 deg of knee extension
Indication: ITB friction syndrome
5.2 Noble compression test
(Muscle Pathology)
Position: sidelying, upper leg flex at 60 deg
Action: push knee towards the bed
(+) sign: pain
Indication: piriformis syndrome
- Piriformis test
(Muscle Pathology)
Position: prone, abduct hips as far with knees extended
Action: if limitation, flex the knee and continue to abduct
(+) sign: inc abduction after knees are flexed
Indication: gracilis tightness
Phelp’s test
(Muscle Pathology)
Position: heel of test leg placed on the medial arch
Action: take off the shoe
(+) sign: pain
Indication: biceps femoris strain
Taking off the shoe test
(Muscle Pathology)
Position: supine
Action: 0-30 deg push knee medially, and pull ankle laterally
(+) sign: excessive motion
Indication: knee ext: all medial structure + medial quads
Knee flex: PCL, MCL, POL, PMC
Abduction test/ valgus stress test
(ONE PLANE INSTABILITY TEST)
Position: supine
Action: 0-30 deg push knee laterally, and pull ankle medially
(+) sign: excessive motion
Indication: knee ext: all lateral structure + lateral head of gastrocnemius
Knee flex: APOL, LCL, PLC, ITB, BF
Adduction test/ varus stress test
(ONE PLANE INSTABILITY TEST)
Position: supine, 0-30 deg knee flexion
Action: passively anterior translate tibia
(+) sign: mushy or soft end feel
Indication: ACL, APOL, POL
Lachman test/ Ritchie/ trillat/ lachman-trillat
(ANTERIOR INSTABILITY TEST)
Position: supine, hip: 45 deg; knee: 90 deg
Action: passively anterior translate tibia
(+) sign: > 6 mm anterior translation
Indication: ACL, APOL, POL, MCL, PMC, PLC, ITB
Anterior drawer sign
(ANTERIOR INSTABILITY TEST)
Position: same as anterior drawer
Action: observe
(+) sign: tibial sags back, thumb sign, step off sign
Indication: APOL, POL, ACL, PCL
Posterior sag sign/ Gravity drawer test
(POSTERIOR INSTABILITY TEST)
Position: supine, 90-90 hips and knees
Action: passively hold pt leg
(+) sign: tibia sags back
Indication: posterior instability
Godfrey test/ Gravity test
(POSTERIOR INSTABILITY TEST)
Position: supine, hip: 45 deg; knees: 90 deg
(+) sign: excess ant translation in 30 MR
Ind: ALRI
(+) sign: excess ant translation in 15 LR
Ind: AMRI
Slocum test
(ROTATORY INSTABILITY TEST)
Position: supine, hip: 45 deg; knees: 90 deg
(+) sign: excess post translation in MR
Ind: PMRI
(+) sign: excess post translation in LR
Ind: PLRI
Hughston test
(ROTATORY INSTABILITY TEST)
Position: supine with heel towards the buttock
Action: ER or IR then passively extend the knee
(+) sign: click or clunk
Indication: MR: loose fragment on lateral meniscus
LR: Loose fragment on medial meniscus
McMurray test
(Meniscus pathology)
Position: prone, knees 90 deg
Action: distract or compress and then passively rotate tibia into IR or ER
Indication:
Distraction: (+) pain and inc motion
Ligament lesion
Compression: (+) pain and dec motion
Meniscus pathology
Apley’s test
(Meniscus pathology)
Position: supine, heel to buttocks
Action: PT holds the ankle and quickly extend the knee
(+) sign: inc knee extension with rubbery end feel/ springy block
Indication: loose or torn meniscus
Bounce home test
(Meniscus pathology)
Position: supine
Action: medial: brush proximally
Lateral: stroke distally
(+) sign: bulging on medial and distal of patella
Indication: mild swelling ~4-8 mL
Wipe test/ brush or stroke test
(Test for knee swelling)
Position: supine cup the patella
Action: tap the patella
(+) sign: floating patella
Indication: 40-50 mL fluid in the knee
Patellar tap/ Ballotable patella
(Test for knee swelling)
Position: sitting, 20 PF of ankle
Action: anterior translate
(+) sign: dimple or suction in area of ATFL
Indication: ATFL tear
Anterior drawer test
(Test for ligament injuries)
Position: sitting, foot in neutral
Action: passively tilt the foot into eversion/ inversion
(+) sign: pain and inc motion
Indication: inversion: calcaneofibular ligament
Eversion: deltoid ligament
Inversion + PF: ATFL
Talar tilt test
(Test for ligament injuries)
Position: passively ER foot in short sitting
(+) sign: pain on medial ankle
Indication: Deltoid ligament tear
(+) sign: anterior-posterior tibiofibular
Indication: syndesmosis injury or high ankle sprain
Kleiger (ER stress test)
(Test for ligament injuries)
Position: standing
Action: observe (view posteriorly)
(+) sign: > 2 ½ toes is seen
Indication: valgus heel, abducted forefoot, LR tibia, pronated foot
Too many toes sign
Position: prone
Action: squeeze calf
(+) sign: no PF
Indication: ruptured achilles tendon
Thompson test/ simmond’s test
Position: supine
Action: passive DF
(+) sign: pain in calf muscle
Indication: DVT
Homan’s sign
