Special Tests

Question 1

Hip quadrant test

Answer 1

Tests labral tear and look for clunking or pain reproduction
Patient lie supine with hip and knee flexed
SR takes hip in 90 degree flexion and then adduction
Maintain adduction and move into abduction- feel arc of movement
Can repeat test in abduction

Question 2

FADIR

Answer 2

Patient supine
SR passively fully flex the affected hip, or to 90 degrees if P ++
Then addict hip and internally rotate

Can test hip impingement

Question 3

Modified Thomas Test

Answer 3

Ask patient to perch at very end of couch with gluteal folds just in edge of couch
Patient should lay back to lie flat with both knees and hips flexed and clasped to chest - SR should guide and support
Ask patient to release one leg and let it hang off couch

+ = knee extends - shortness in rect fem, TFL and sartorius
Posterior thigh elevated - shortness in illiopsoas, pectineus and adductors
Abduction in thigh and lateral deviation of patella - shortness in TFL

Question 4

Trendelenburg test

Answer 4

Patient stand on one leg
Look for any drop on the contralateral side

Question 5

Modified obers test

Answer 5

Patient in side lying, lower leg flexed at hip and knee for stability
SR stand behind patient and passively extend and abduct their leg at the hip, and stabilise pelvis
Hip stays in ext, leg is allowed to lower to plinth
Test is modified to include ITB plus TFL

Question 6

Valgus stress test

Answer 6

30 degrees knee flexion, SR applies valgus force
Tibial ext rotation can also be applied to bias the deep oblique fibres of the MCL

Question 7

Varus stress test

Answer 7

SR apply Varus force in approx 25 degrees of flexion, take care of allowing any femoral rotation as stress is applied

Question 8

Anterior drawer knee

Answer 8

Knee is passively flexed to approx 80 degrees and patients foot kept stable by SR sitting on edge of it
Ensure hamstrings are relaxed with gentle palpation
SR wraps hands around the joint line with thumbs either side of the patella apex
Anterior force applied to proximal tibia assessing increased translation

Question 9

Lachmans test

Answer 9

Tests ACL rupture
Knee held between 15-30 degrees of flexion, one hand secured and stabilises the distal femur while other grasps proximal tibia - slightly internally rotate tibia
Gentle anterior translation force is applied to proximal tibia
Assess quality of end feel

Question 10

Posterior drawer knee

Answer 10

Knee is passively flexed to approx 80 degrees and patients foot kept stable by SR sitting on it
Ensure hamstrings are relaxed with palpation
SR wraps hands around joint line and applies posterior force to proximal tibia to assess increased translation

Question 11

Posterior sag sign

Answer 11

Patient lie supine with knees flexed to 90degrees
SR observed patient inured side - if posterior cruciate is torn, the tibia will appear to sag and tibial tubercle will be less prominent

Question 12

Mc murrays

Answer 12

Knee is passively flexed, at various stages of flexion the tibia is internally and externally rotated
Pain and clicking is consistent if menisci is injured

Question 13

Apleys grind

Answer 13

Patient prone and knee flexed 90 degrees
SR lightly secured the femur and adds compression and rotation to flexed tibia on the femur to try an elicit pain in the region of torn meniscus
Rotation is repeated with distraction

Question 14

Anterior drawer ankle

Answer 14

Ankle is placed passively into slight plantarflexion
SR places one hand at distal end of tibia and other at heel of foot in palm of hand
Apply a force in anterior direction
Pain and laxity noted

Question 15

Talar tilt

Answer 15

Ankle in plantarigrade the SR cups the heel and attempts to invert the ankle
Relative laxity is noted
Can be repeated with eversion

Question 16

The ‘squeeze’ test

Answer 16

Perform a proximal 3rd compression of the tibia and fibula
Pain at site of syndesmosis implies damage

Question 17

Thompson squeeze test

Answer 17

Patient prone with feet over edge of couch
SR squeezes calf muscle with one hand
Should cause a contraction and plantarflexion should occur

Question 18

A-P glide / drawer test shoulder.

Answer 18

Patient seated or lying
Stand behind patient and grasp humeral head with outside hand whilst stabilising the acromion with other hand
Then move humeral head in anterior direction
Assess quality of movement

Question 19

Load and shift

Answer 19

Patient seated or lying
SR stabilises the scapula and applied a PA force to humeral head, whilst palpating the joint line to assess degree of movement
Graded 1-3
Assess GHJ stability anterior and posteriorly

Question 20

Apprehension /relocation

Answer 20

Patient supine with shoulder passively abducted to 90 degrees
SR adds passive external rotation
If patient displays sign of apprehension- indicate anterior instability (not pain alone)
Further confirmation with relocation test - SR applies an anteroposterior force to head of humerus - is apprehension is lessened this acts as addictions confirmation
Assess anterior shoulder instability

Question 21

Sulcus sign

Answer 21

Patient sitting with arm resting and relaxed
Flex patients elbow and apply a downward force through the humerus
+ = gapping or sulcus sign distal to acromion
Assess inferior stability and dysfunction in GH ligaments

Question 22

O’briens

Answer 22

Patient standing
Flex arm to 90 degrees with elbow extended then adduct arm 10-15 degrees
Arm then maximally internally rotated (thumb down) and patient resists SR downward force
Repeated in supination (thumb up)
+ = pain resisted thumb down and eliminated thumb up
Assesses superior labrum

Question 23

Biceps load 2

Answer 23

Patient supine
SR abducts shoulder to 120 degrees with max ext rotation
Elbow flexed to 90 degrees and forearm supinated
If this position reproduces pain, perform active flexion against resistance - if pain increases = positive test
SLAP lesion tested

Question 24

Speeds test

Answer 24

Patient elbow is extended, forearm supinated and humerus is passively elevated and humerus is passively elevated to 60 degrees
SR resists GH flexion
Detects SLAP lesion
+ = pain in bicepital groove

Question 25

Hawkins Kennedy

Answer 25

Patient sitting or standing
Arm flexed 90 degrees and elbow flexed to 90 degrees supported by SR to ensure max relaxation
SR stabilises the shoulder girdle and elbow by standing in front of the subject and resting their outside hand over patients shoulder girdle with their proximal forearm levered over SRs supporting elbow
SR holds subjects forearm with inside hand and moves the arm into internal rotation
Assess shoulder impingement

Question 26

Painful arc

Answer 26

Patient sitting or standing
SR instructs patient to abduct their arm in scapular plane
If pain experienced SR instructs patient to continue as high as they can
Once at 120 degrees there should be pain reduction
Assess impingement

Question 27

Empty / full can test

Answer 27

Patient tested with 90 degrees glenohumeral flexion in scapular plane with full int rotation (thumb down)
SR applies a downward pressure at elbow or wrist and patient resists
Can be repeated in full ext
Assess rotator cuff pain - supraspinatus

Question 28

Gerbers lift off

Answer 28

Patient stood
Place hands behind back with dorsum of hand resting in mid-lumbar spine
Patient lifts hand away from body
Light resistance can be added by SR
+ = unable to lift hand away from body

Question 29

Scarf test

Answer 29

Patient sat or lying
Patient arm taken to full range of horizontal flexion
If no pain felt the SR can apply moderate over pressure into further horizontal flexion
+ = pain provoked

Question 30

What is a SLAP lesion

Answer 30

Superior Labral tear in anterior to posterior
Occurs in overhead throwing athlete
Usually occur with instability and Rotator cuff tear