Special Testing Flashcards
- Client is supine, with their side being tested at the edge of the table
- Apply a depressive force to the client’s affected shoulder
- With your hand. Hold the client’s wrist and abduct their affected humerus to 10 degrees
- Slowly extend their wrist and fingers
- Fully supinate their forearm then slowly extend their elbow
ULTT 2
What is ULTT2 for?
Median Nerve
Musculocutaneous Nerve
Axillary Nerve
Client is supine, with their side being tested at the edge of the table
- Apply a depressive force to the client’s wrist and abduct their affected shoulder
- With your other hand, hold the client’s wrist and abduct their affected humerus to 10 degrees
- Slowly flex their wrist and fingers, and then deviate the wrist to the ulnar side
- Fully pronate their forearm then slowly extend their elbow
Positive Sign:
Recurrence of their shoulder and arm pain
ULTT3
What is the ULTT3 for?
Radial Nerve
Client is supine, with their side being tested at the edge of the table
- Apply a depressive force to the client’s affected shoulder
- With your other hand, hold the client’s wrist and abduct their affected humerus to 90 degrees
- Slowly flex their elbow, and then supinate their forearm
- Slowly extend their wrist and fingers and deviate the wrist to the radial side
ULTT 4
What is ULTT4 testing for?
Ulnar Nerve
C8 and T1 Nerve Roots
Client supine, with their side being tested at the edge of the table
- Apply a depressive force to the client’s affected shoulder
- With your other hand, hold the client’s wrist and abduct their affected humerus to 110 degrees
- Extend their arm to 10 degrees below the coronal plane and, to 60 degrees of external rotation
- Slowly extend their wrist and fingers
- Fully supinate their forearm then slowly extend their elbow
ULTT 1
What is ULTT1 for?
Medial Nerve
C5,6,7 Nerve Roots
Client rotates head to one side
examiner carefully presses down on the head
Jacksons
what does Jacksons test indicate?
NN Root Compression
Client supine
Examiner passively takes the head and neck into extension and side flexion
hold for 30 seconds
Vertebral Artery
what does vertebral artery test indicate?
compression of vertebral arteries
Client stands with shoulders forward flexed to 90
elbows extended palms up
client closes eyes and holds for 20-30 secs
Barres
what does Barres indicate?
decrease blood flow to brain stem
Examiner abdducts clients arm to 90
examiner laterally rotates shoulder slowly
Crank
What does crank indicate?
GH joint dysfunction
previous dislocation
Client is seated with arms med rot and forward flexed to 90
examiner graps clients elbow and axially loads the humerus proximal direction
while maintaining load, examiner moves the arm through horizontal add
Jerk test
what does jerk test indicate?
Posterior instability
posterior inferior labral tear
client strands with arm by side and shoulder relaxed
examiner grasps clients forearm and pulls distally
sulcus sign
what does sulcus sign indicate?
Inferior instability
GH joint laxity
Client stands
examiner forward flexes the arm to 90 and then forcibly med rots the shoudler
hawkins kennedyw
what does Hawkins Kennedy indicate?
Supraspinatus tendinosis
Clients arm is forcible fully elevated with arm med rot by examiner
Neers
at does Neers test indicate?
overuse injury to supraspinatus and sometimes biceps
Client is supine
* Examiner holds the client’s
wrist and elevates client’s
arm to end range
* Examiner then laterally
rotates the arm and
adducts it into further
elevation with supinated
arm
* Examiner then medially
rotates client’s arm
Supine impingment
what does supine impingement test for?
Rotator cuff pathology
GH impingement
Client is standing
* Client abducts and laterally
rotates arm to 90’ with
elbow extended and
forearm supinated
* Examiner applies
downward force to arm
Bicep Tension test
what does biceps tension test for?
SLAP lesion
Client lies supine
* Examiner places one hand
on the back side of the
shoulder
* The other hand holds the
humerus
* Examiner fully abducts arm
* Examiner pushes head of
humerus anteriorly while
other hand rotates
humerus in lateral rotation
Clunk test
what does clunk test test for?
Labrum tear
anterior instability
Client is asked to perform
abduction of the shoulder
to full ROM
Pain arc
what does painful arc test for?
0-15 - Supraspinatus pathology
60-130 - GH joint pathology
170+ - AC joint pathology
- Client is standing with test
arm to side - Examiner passively flexes
elbow to 90’ - With arm in 45’ lateral
rotation, client is asked to
isometrically laterally
rotate arm against
resistance then relax
Dropping sign
what does dropping sign test for?
Infraspinatus tear
- Client is standing with arm
at the side and elbow
flexed to 90’ and the
humerus medially rotated
to 45’ - Examiner applies a medial
rotation force and client is
asked to resist
Infraspinatus test
What does infraspinatus test test for?
infraspinatus tear
- Client stands and places
dorsum of the hand
against the midlumbar
spine - Client then lifts hand away
from back - If client able to lift hand,
examiner pushes hand
towards back and asks
client to resist
Lift off sign
what tests indicate infraspinatus tears?
Infraspinatus test
Dropping sign
what does lift of sign indicate?
lesions in subscap
- Client is prone or sitting
with the test arm behind
the body so that the hand
is on the opposite side of
the body - Examiner places index
finger along and under the
medial border of scapula - Client pushes shoulder
forward then tries to lift
hand away from the back
rhomboid weakness
what is a positive result of rhomboid weakness test?
therapists finger is not pushed away from the scapula
- Client is standing and
forward flexes arm to 90’ - Examiner applies a
backward force to the arm
Punch out
what does punch out test for?
Serratus anterior weakness
what is a positive result of punch out test?
shoulder winging
- Client stands
- Examiner resists client
forward flexion of the
shoulder with elbow
extended - First done with arm
supinated then pronated
Speeds
what is speeds test indicating?
bicipital tendinitis
tendinosis
what is a positive sign of speeds test?
increase tenderness in bicipital groove
what is a positive sign of infraspinatus test?
cannot resist
pain
- Client’s arm is abducted to
90’ with neutral rotation - Examiner adds resistance
to abduction (pushes down
on arm) - Client then moves
shoulder to 30’ horizontal
adduction with medial
rotation so thumb points
to the floor - Examiner adds resistance
to abduction
empty can
what does empty can indicate?
tear of supraspinatus muscle/tendon
neuropathy of subscap nerve
Client lies prone and places
hand on the opposite
posterior iliac crest
* Client then asked to
extend and adduct the arm
with resistance
Teres minor test
what does teres minor test indicate?
teres minor tear
Client’s elbow flexed to
90’, stabilized against body
and pronated
* Examiner palpates bicipital
tendon
* Examiner resists
supination while client also
laterally rotates the arm
against resistance
yergasons
what does yeragsons indicate?
bicipital tendinits
- Examiner locates radial
pulse of the client - Client’s head is rotated
towards tested side with
head extended - Examiner laterally rotates
and extends client arm - Client takes a deep breath
and holds
Adsonswh
what does adsons indicate
TOS ant scalene
Examiner palpates client
radial pulse
* Examiner Draws the
client’s shoulder down and
back (extension)
Costoclavicular (military brace)
what does Costoclavicular (military brace) indicate?
TOS
Same as Adson’s but client
looks in the direction of
untested shoulder
Travelles (halsteads)
what does travelles/halstead indicate?
TOS - middle scalene
Examiner palpates client’s
radial pulse
* Examiner passively
abducts arm fully
wrights (hyperabduction)
what does wrights/hyperabduction test indicate?
TOS - Pec minor
- Patient’s arm is
stabilized at elbow with
one hand while other
hand placed at wrist - Extend elbow
- Apply pressure laterally
at the wrist
Valgus
what does valgus indicate?
MCL issues
Patient’s arm is
stabilized at elbow with
one hand and the other
is placed at the wrist
* Extend elbow
* Apply pressure medially
at the wrist
Varus
- Patient’s elbow is flexed
between 60-80 degrees - Examiner squeezes the
biceps muscle
Bicep squeeze
what does varus indicate?
LCL issues
what does bicep squeeze indicate?
bicep tendon rupture
what is a positive indication of bicep squeeze
forearm doesn’t supinate
what special tests are used to Lateral Epicondylitis?
Cozens
Mills
Lateral Epicondylitis test
- Patient’s elbow is
stabilized by examiner’s
thumb - Patient is asked to make
a fist and extend wrist
while examiner resists
action
Cozens
- Examiner palpates
lateral epicondyle - Examiner passively
pronates forearm, flexes
wrist and extends elbow
Mills
- Examiner palpates the
medial epicondyle - Examiner passively
supinates and extends
elbow and wrist
Golfers elbow
what does golfers elbow test indicate?
medial epicondylitis
what is tennis elbow the layman term for?
Lateral epicondylitis
- Client sits with elbow at
90’ - Examiner strongly resists
pronation as elbow is
extended
Pronator teres syndrome
what is a positive indication of pronator teres test?
Pain over pronator muscle
tingling in forearm
- Client is seated
- Examiner holds client’s
wrist flexed and asks client
to actively extend the
fingers against resistance
Shuck
what does shuck test indicate?
Radiocarpal instability
inflammation
Client’s forearm is
pronated with hand held in
support by examiner
* Examiner applies an
anterior directed force to
the capitate with axial
compression while
passively moving the wrist
from radial to ulnar
deviation.
lichtmans
what does lichtmans indicate
mid carpal instability
- Client is asked to make a
fist - Examiner observes level of
middle knuckle
Murphys sign
what does Murphys sigh indicate?
lunate dislocation
what is a positive indication of Murphys sign?
If third knuckle is
in line with
second and fourth
knuckle
- Client makes a fist with
the thumb inside the
fingers - Examiner stabilizes
forearm and deviates the
wrist towards the ulnar
side
Finkelstein
what dies Finkelstein indicate?
Dequervain tensosynivitis
- Examiner holds the client’s
supinated wrist in both
hands and applies a
pressure over the carpal
tunnel for up to 30
seconds
Carpal compression
- Client attempts to grasp a
piece of paper between
thumb and index finger - Examiner attempts to pull
paper away
Froments
What does froments indicate?
ulnar nerve paralysis
Client is asked to open and
close the hand several
times then to hold it
closed tightly
* Examiner applies pressure
with both thumbs, one
over the radial and other
over ulnar arteries
* Client opens hand
Allen testw
what does Allen test indicate?
determines which artery is the major blood supply to the hand
Examiner taps the parotid
gland overlying the
masseter muscle
Chvostek
what does chvostek indicate?
Facial nerve pathology
Patient lies supine
with head in neutral
* Examiner applies an
anterior directed
force through the
spinus processes of
c1-t1
Sagittal Stress
What does Saggital stress test indicate?
Hypermobility of C1-T1
what are the positive signs of sagittal stress test
Nystagmus
pupil change
nausea
Patient lies supine
* Examiner supports
occiput with palm
and fingers
* Index finger placed
between occiput and
C2
* Head and c1 lifted
anterior (held 20 sec)
Transverse ligament
what does transverse ligament test indicate
Hypermobile atlantoaxial joint
Examiner grips
lamina groove of C2
* Patients head is
passively rotated left
and right
Alar ligament test
What does the alar ligament test indicate
Dmg to the alar ligament
what is a positive sign for alar ligament?
If 20-30 degrees
of rotation
without
movement of C2
what test is performed before crank?
Apprehension
- Examiner abducts arm to
90, flex elbow to 90 - Laterally rotate shoulder
slowly
Crank
What does crank test indicate
Previous
dislocation
* Labrum dmg
Same as Crank*
* Posterior pressure
applied on tested GH jnt
Fowler sign
- Client side lying on
unaffected side - Hand of affected side
resting against lower
back - Examiner stabilizes
clavicle while pulling
inferior angle of scapula
away from chest wall
Coracoclavicular Ligament test
positive sign of corcoclavicular ligament test
Pain anteriorly under clavicle
what does Coracoclavicular
Ligament test indicate
Coracoclavicular
Ligament pathology
Patient elbow flexed to
90 and stabilized against
body
* Forearm pronated
* Examiner resists
supination and lateral
rotation or the arm
yergasons
what does yergasons indicate?
Bicipital tendinitis
what tests indicate Tennis elbow?
Cozens
Mills
Lateral epicondylitis
Examiner palpates the
medial epicondyle
* Examiner passively
supinates and extends
elbow and wrist
Golfers elbow
Examiner stabilizes
client’s tibia and fibula
* Holds client’s foot at 20’
plantar flexion
* Draws the talus forward
Anterior drawer
what does the anterior drawer test on the ankle indicate
- Dmg to the
ATFL and
deltoid ligament - ATFL dmg
- Dmg Deltoid
ligament
Examiner stabilizes the
client’s leg at the distal
tibia and fibula
* Examiner applies a
medial force to the
foot with other hand
Medial subtalar glide
what does medial subtler glide indicate?
ankle joint dysfunction
Examiner stabilizes the
client’s leg at the
distal tibia and fibula
* Examiner applies a
lateral force with the
other hand on the foot
Cotton test
what does cotton test indicate
ankle joint dysfunction
what is a positive sign of cotton test?
more that 3-5mm of lateral movement
- Client sits on the edge
of the table - Examiner stabilizes leg
with one hand - Passively and
forcefully dorsiflexes
the foot
Dorsiflexion manevuer
what does dorsiflexion maneuver indicate
ankle joint dysfunction
Client lies supine
* Examiner grasps foot
around the
metatarsals
* Squeeze the foot
Mortons
what does Mortons indicate?
Mortons neuroma
stress fracture
Patient lies prone with
foot over edge of table
* Client actively flexes
knee to 90’
Matles
what does Matles indicate?
3rd degree achilles strain
what is a positive sign of matles
If foot is in neutral or doriflexed
- Client sits with feet off
table - Examiner palpates the
anterior portion of the
talus with thumbs - Examiner passively
plantar flexes then
dorsiflexes foot
Swing test
what does swing test indicate?
Posterior tibiotalar subluxation
- Client lies prone with
feet over edge of table - While patient relaxed,
examiner squeeze’s calf
muscle
Thompsons
what tests are used for achilles tendon?
Thompsons
matles
what does Thompsons indicate?
Ruptured achilles
what is a positive sign of Thompsons?
Absence of plantar flexion on squeeze
Client stands on stool or
chair with toes of edge
* Examiner passively
dorsiflexes big toe
Windlass
what does windlass indicate?
plantar fascitis
Client lies supine with
knees extended
* Examiner pulls patella
distally and holds
* Client is asked to
contract the quads
Zohlers sign
what does zohlers sign indicate?
Chondromalacia patella
Client lies supine
* Examiner elevates the
patient’s leg to 45’
* Hold for 3 minutes
Buergers
What does buergers indicate
poor arterial blood circulation
- Client is supine
- Client’s foot is passively
dorsiflexed with the
knee extended
Homans
what does homans indicate
DVT
Client lies supine, knee
flexed to 90’ with hip
flexion
* Examine applies pressure
with thumb over lateral
femoral epicondyle
* With pressure applied
knee is slowly extended
to 30’ flexion
Nobles
what does nobles indicate?
IT band friction syndrome
Client is in side lying
position
* Lower leg flexed at the
hip and knee for stability
* Examiner passively
abducts and extends
upper leg
* Examiner slowly lowers
leg while stabilizing hip
Obers
what does obers indicate?
IT band contracture
Client lies prone
* Examiner passively fully
flexes knee
Elys
what does Elys indicate?
Rec fem contracture
Patient lies supine
* Examiner places
patient’s leg so that
foot is on top of knee
of opposite leg
* Examine then slowly
lowers the knee of test
leg towards table
Patrick Faber Fig4
what does Patrick faber fig4 indicate?
Hip jnt
pathology
* Hip flexor
contractures
what is a positive sign of Patrick Fig4 Faber?
Test leg’s knee
remains above the
opposite straight
leg
Patient lies supine
* Examiner flexes and
adducts the patient’s
hip towards the
opposite side
Hip Scour
what does hip scour indicate?
Hip pathology
Client in supine position
* Examiner takes the hip
into full flexion, medial
rotation and full
adduction
* Examiner then fully
extends the hip
combined with lateral
rotation and abduction
posterior labral tear
Client in supine position
* Examiner takes the hip into
full flexion, lateral rotation
and full abduction
* Examiner then fully
extends the hip combined
with medial rotation and
adduction
anterior labral tear
- Client lies supine with hip
and knee flexed to 90
degrees - Client is asked to actively
rotate the hip medially - Client is asked to actively
rotate the hip laterally
Hip Rot tightness
Client is asked to stand
* Client is asked to stand on
1 leg
Trendelenburg
What does trendelenburg indicate
Weak Glute med
what is a positive indication of Trendelenburg
If the pelvis on the lifted leg drops
Client lies prone
* Knee bent to 90’
* (Distraction) examiner
stabilizes leg on table
with knee then distracts
while medially and
laterally rotating the
tibia
* (compression) repeat
process with
compression on the
knee
alleys compression/distraction
what does Apley’s
Distraction/
Compression indicate
Ligamentous
lesion
* Meniscal injury
Client lies supine
* Knee completely flexed
* Examiner medially
rotates tibia as knee is
extended (repeat with
increased rotation)
* Examiner laterally
rotates tibia as knee is
extended
Mcmurrary
what does mcmurray indicate
- Dmg to lateral
meniscus - Dmg to medial
meniscus
Client lies supine
* Examiner cups heel of
client
* Knee fully flexed
* Knee passively allowed
to extend
Bounce
What does bounce test indicate
torn meniscus
what is a positive sign of bounce
If extension not
complete
* Rubbery end feel
Examiner presses down
just above the patella with
the web of the hand
* Client is asked to flex
quads to pull patella past
web of hand
* Begin with light pressure
and slowly increase with
every application
* Compare with unaffected
side
Patella grind
what does patella grind indicate?
Patellofemoral syndrome
what is a positive sign of Patella grind
If client cannot
maintain
contraction of
quads
* If test causes pain
what are the tests for patellofemoral syndrome
Patella grind
Waldrons
Examiner palpates the
patella while the client
performs several deep
knee bends
waldrons
what does Waldrons indicate
patellofemoral syndrome
Client supine, knee
placed in 80-90’
flexion
* Hip flexed to 45’
* Foot placed in 30’
medial rotation
* Examiner sits on
forefoot to stabilize
and then pulls the
tibia forward
slocum
what does slocum indicate?
Anteriolateral rotart instability
what is a positive sign of slocum?
Movement occurs primarily on the lateral aspect of the knee
Client lies supine,
knee flexed to 30’
* With one hand
examiner stabilizes
the femur at the
distal end
* With other hand,
examiner moves
proximal tibia
forward
Lachmans
what does lachmans indicate?
Injury to ACL
* Injury to
posterior
oblique
ligament
What is a positive sign of Lachlan’s?
Abnormal forward motion
Client lies supine
* Examiner firmly strikes the
heel of client
Heel strike
What does heel strike indicate?
Femoral neck stress fracture
- Client lies prone
- Examiner flexes client’s
knee to 90’ - While stabilizing pelvis,
examiner extends
client’s hip
Yeomans
what does yeomans indicate?
Lumbar spine dysfunction
SI joint pathology
Client stands
* Examiner palpates both
PSIS with thumbs
* Client is asked to stand
on 1 leg while pulling
knee towards chest
Gillets
what does Gillets indicate?
Hypomobile SI joint
what is a positive sign of Gillets
If the PSIS of lifted
leg moves upward
or moves minimally
- Client lies supine
- Examiner applies cross-
armed pressure to the
ASIS
Gapping
what does gapping indicate
Sprain of anterior
Sacroiliac ligament
What is a positive sign of Gapping
Pain in glutes or posterior leg
Client side-lying
* Client pulls lower knee
towards chest and holds
* Examiner stabilizes pelvis
while extending hip of
uppermost leg
Gaenslens
what does Gaenslens indicate
SI joint
pathology
* Hip flexor
contracture
what is a positive sign of Gaenslens
- Pain at SI joint
- Pain anterior
leg/hip
Client lies supine
* Examiner places both
hands on ASIS
* Examiner pushes down
and in at 45’ on ASIS
Squish
what does squish indicate
Sprain of posterior sacroiliac joint
- Client lies prone
- Examiner stabilizes
pelvis - Client knee flexed to 90’
- Hip is medially rotated
as far as possible while
palpating SI joint
Hibbs
what does hibbs indicate
Hyper/Hypomobile SI joint
SI joint pathology
Client is supine
* Examiner places one
hand under each heel
* Client is asked to lift one
leg off the table
Hoover
what does hoover indicate
Feigned weakness
limb weakness
what is a positive sign on Hoovers
If examiner doesn’t
feel any pressure on
opposite heel
* If examiner feels
increased pressure
under opposite heel
Client is supine
* Client hips flexed to 90
with knee in extension
* Client is asked to lower
leg in a slow movement
* Examiner observes
degree at which ASIS
starts to move
Double straight leg lowering
what does double straight leg lowering indicate
weak abdominals
what are the positive signs for double straight leg lowering
- Normal: 0 to 15
- Good: 16 to 45
- Fair: 46 to 75
- Poor: 75 to 90
- Trace: unable to
hold pelvis in neutra
Client lies prone
* Examiner flexes
knee as far as
possible
nachlas
what does nachlas indicate
Nerve root lesions/compression
- Client in supine
position - Examiner flexes
hip while
maintaining knee
extended - If painful, leg
lowered till pain is
relieved - Dorsiflex foot
- Client flexes neck
Straight leg rise
what does Straight leg raise indicate
disk herniation
neurological pathology