Special Tests

Question 1

Neer test / subacromial pain syndrome (SAPS)

Answer 1

For the rotator cuff (coracoacromial ligament) shoulder impingement.

Patient sitting down, slightly invert the arm and raise arm forward and up high whilst supporting scapular with other hand.
positive = if patient feels familiar shoulder pain.

Question 2

Hawkins- kennedy test/ Subacromial pain syndrome (SAPS)

Answer 2

Shoulder impingement on coracoacromial ligament.

Patient sitting with his arm flexed at 90• infront of him.
Fixate scapular with one hand and hold elbow with other hand whilst internally rotating the shoulder (patients arm down)
Positive= patients experiences familiar shoulder pain.

Question 3

Painful arc / subacromial pain syndrome (SAPS)

Answer 3

Patient slowly abducts arms with thumbs facing up.
Positive = usually pain between 60-120•
if pain is felt at the top then it’s usally due to AC joint

Question 4

Speeds test

Answer 4

Used for several pathologies of the biceps.
2 methods
1. Patient extends elbow in supernation. Patient raise arm 0-60• whilst I give slight resistance.
2. Patient has his arm supernated at 90• infront of him and should resist downwards pressure.

Positive = patient reports pain in bicipital grove (where long bicep tendon enters shoulder capsule)

Question 5

Sulcus sign / Shoulder instability

Answer 5

For inferior shoulder instability.
Patients standing relaxed with arms down. Grab patient under elbow and pull down.
Positive = little dip under acromion or feeling of dislocation

Question 6

Load and shift test / shoulder instability

Answer 6

Patient sitting with relaxed posture hands on knees.
One hand on their clavicle/ scapular.
And other hand grabbing their numeral head.
Move the head anteriorly and then posteriorly (testing anterior and posterior capsule)
Positive= reproduction of patients symptom & if one side more mobile than other.

Question 7

Shoulder apprehension test / anterior instability

Answer 7

Patient is laying down on edge of the bench,
Shoulder 90• abduction. Carefully bring their shoulder into external rotation
Positive= patient is apprehended (scared) reports fear of dislocation.
(highly recommended test)

Question 8

Cozens test / lateral epicondylitis/ tennis elbow

Answer 8

Tendon of the extensor carpi radials brevis muscle.
Patient sits with arm straight& pronated on the table. Patients makes fist & slight radial deviation.

With one hand hold/palpate the brevis tendon and with the other place pressure down on the fist as patient tries to extend the fist.

Positive = pain around carpi radialus brevis muscle

Question 9

Medial epicondylitis/ golfers elbow

Answer 9

Patient standing, fixate/ palpate humorous/ palpate medial simultaneous. Fixate elbow next to him and bring forearm to 90• extend wrist and carefully bring arm back down

Positive = if felt sudden pain in medial epicondyle

Question 10

Times sign: wrist

Answer 10

For carpel tunnel syndrome.
Arm supernate and relaxed on a table/bed. Tap with 2 fingers on the median nerve from the index finger to the elbow.

Positive = if tingling feeling in the thumb, index, middle and lateral side of ring finger

Question 11

Phalan’s tea

Answer 11

Carpal tunnel syndrome (compression on medial nerve)
Flex wrist maximally and bring hands to chest making back of hands touch each-other and hold for 1min

Positive = tingling feeling in the thumb, index, nerve and medial side of ring finger.

Question 12

Finkelsyein test

Answer 12

(the quervain’s) Tendinitis of the thumb (Inflammation)
Arm on table with wrist hanging off and thumb pointing up and ulna deviate the wrist.
Positive= pain in styloid (acute thase)

If negative Do it passively

If negative again then just bend thumb down into his palm

Question 13

TFCC compression test (triangular fibrocartilage complex lesions)

Answer 13

Forearm rotation for stabilisation (pivot point)
fixate the wrist with one hand and ulnar deviate his wrist with other hand whilst thumb stays neutral.
Positive= clicking or grinding sounds.

Question 14

Transdelenburg sign

Answer 14

Hip abductor weakness
Patient stands on 1 leg (knee up infront)
Leg that’s lifted should have a raised hip
Positive = if lifted leg pelvis is dropped then abductor is week on the standing leg

Question 15

Weber Barstow manoeuvre

Answer 15

Functional leg length differences (spinal scoliosis or excessive foot pronation)
Lay flat on back, pull little on feet to make them equal length.
Palpate distal medial malleoli and ask patient brink heel to bum and lift bum up (glute bridge) passively extend knee and bring feet together.
Compare medial malleoli with thumbs.

Question 16

Faber test/ figure 4 test

Answer 16

Limitation of hip ROM.
Patient lay on back and cross test leg over other knee. Make sure ankle is free and neutral.
1 hand fixes there hip and other slowly pushes bent knee down.
Positive = test leg remains higher then opposite leg (affected hip joint or iliopsoas spasm)

Question 17

Gillet/ stalk test

Answer 17

For sacroiliac (Si joint) dysfunction
Palpate psis with one hand and s2 with the other. Ask patient to flex hip 90• on same side. Psis should drop under s2.
Positive = psi’s does not drop or move minimally (hyper-mobile or blockage).

Question 18

Anterior labral tear test

Answer 18

For Anterior superior impingement, Anterior labral tear or iliopsoas tendinitis.
Patient lays on back, flex hip 90•, bring leg up and internally and externally rotate knee/ hip joint (play around w hip joint clockwise direction).
Positive= symptoms reproduced with clicking or pain.

Question 19

Posterior labral tear

Answer 19

For posterior hip impingement, posterior labral tear and anterior hip instability.
Patient lays on back, bring hip to flexion, internal rotation and adduct. (Play around w hip joint anti clock wise) then abduct and extend.

Positive = same symptoms, groin pain.

Question 20

McCarthy test

Answer 20

Femoro-acetabular impingement (FAI)
Patient lies on back and legs are maximally passively flexed. Patient holds non test knee and kept flexed.
Put test leg in external rotation and extend. & do the same with internal rotation.

Positive= same hip pain

Question 21

McMurry test (figure of 8)

Answer 21

Meniscus tear
Patient lays on back, test knee fully flexed and do figure of 8s whilst going into extension. Repeat couple of times with different angles going into extension.

Later rotation of tibia = medial meniscus
Medial rotation of tibia = lateral meniscus

Positive = clicking, locking or pain in meniscus

Question 22

Apply’s test

Answer 22

Meniscal damage
Patient laying down on front, fixate tested leg by putting you knee on their hamstring, bring knee 90• of flexion. Hold ankle whilst pulling up (distraction) whilst laterally & medically rotating tibia. Same again whilst pushing down (traction/compression).

Positive = decreased rotation or discomfort
Distraction = ligamentous
Compression = meniscus damage

Question 23

Thessaly test

Answer 23

Meniscus lesion
Check un-injured leg first.
stand on injured leg with slight bent. And rotate hips 3-4 times holding patient in-front of u

Positive= pain in joint like during rotation.

Question 24

Anterior draw test

Answer 24

Anterior Cruciate ligament (ACL)
(Posterior draw test should be done first)
Patient lays down with knee bent 45•. Sit on foot to fixate and but your thumbs on joint line. Move tibia anteriorly in explosive movement.
Positive= tibia moves more than 6mm or experience soft Enfield

Question 25

The windlass test

Answer 25

Plantar fasciitis
Patient stands on bed / table with the head of meta tarsals rest on edge whilst patient puts weight on leg. Passively flex the big toe.

Positive = pain

Question 26

Homan’s sign

Answer 26

Deep vain thrombosis in calf (blood clot)

Patients lays on back and actively dorsiflex the ankle

Positive = pain deep in calf

Question 27

Thompson’a test

Answer 27

Achilles tendon rupture

Patient lay on front and let there foot free off the bed. Squeeze calf
Positive= no movement or pain

Question 28

Metatarsal squeeze test /Morton’s neuroma test

Answer 28

Place hand around metatarsals and squeeze to create concave on bottom of foot (tenderness usually between 3-4th metatarsals)

Positive= pain

Question 29

Anterior draw test on ankle

Answer 29

Anterior talofibular ligament ATL and ankle laxity

Fixate above ankle with one hand and calcaneus with the other and pull PA.
Positive = excessive movement compared to other foot

Question 30

Talar tilt test

Answer 30

Lateral ankle sprain. Patient sitting with leg hanging off.
aTFL= Bring foot to plantar flexion, grab calcaneus and invert.
CFL = foot neutral, invert and evert the foot.
TFL = dorsiflexion, then invert the foot
Positive = pain or excessive gapping

Question 31

Obers test

Answer 31

Iliotibia (iT) band tightness
Patient lays on side. Stand behind and passively abduct and then extension on the hip whilst other hand fixated pelvis.
Then slowly lower the leg to the table without griping the leg.
Positive = leg stays up