Special Tests

Question 1

Cervical Distraction Test

Answer 1

Test for nn Compression in Cervical Region
Position: sitting or supine
PT lifts bilaterally from the mastoid processes
Slowly lift pt head maintaining slight neck flex
Positive: cervical/UE pain decreased during distraction
+ could indicate: Pressure on nerve root temporarily relieved; Pain from cervical OA relieved
** Suggests traction may be a viable treatment

Question 2

Cervical Compression Test

Answer 2

Test for nn Compression in Cervical Region
Position: pt. is sitting; PT applies pressure downward on top of head
Positive: if pain/radiculopathy is evoked

**Usually try decrease symptoms with distraction rather than evoke with compression

Question 3

Foraminal Compression Test (Spurlings A)

Answer 3

Test for nn Compression in Cervical Region
Position: Pt. is sitting
Pt. laterally flexes to one side and PT applies ~ 10lbs of pressure straight down on head
Positive: if pain radiates into UE toward which head is laterally flexed

Question 4

Neer’s Sign

Answer 4

Test for Subacromial Impingement
Position:seated or lying; Passive forward flexion with IR with overpressure
Positive: “pt. pain” in subacromion anterior shoulder

Question 5

Hawkins & Kennedy Test

Answer 5

Test for Subacromial Impingement
Position:seated
passive flexion of arm to 90o, then IR shoulder
Positive: “pt.”pain in subacromion anterior shoulder

Question 6

GH Apprehension

Answer 6

Test for Anterior GH Instability
Position:pt. supine; passive ABD arm to 90, then ER SLOWLY
Positive: pt. shows sign of apprehension, resistance to further movement

Question 7

Cozen’s Test

Answer 7

Test for Lateral Epicondylitis
Position: Patient asked to make a fist, pronate forearm, extend and RD wrist
PT resists wrist ext and/or RD
Positive: pain at lateral epicondyle

Question 8

Mill’s Test

Answer 8

Test for Lateral Epicondylitis
Position: Patient asked to make a fist, pronate forearm flex and UD wrist and extend elbow; Test can be done passively
Positive: pain at lateral epicondyle

Question 9

3rd Finger Resistance Test

Answer 9

Test for Lateral Epicondylitis
Position: Resist extension of the third digit of the hand distal to the PIP joint
Positive: pain @ lateral epicondyle

Question 10

Tinel’s Sign at Carpal Canal

Answer 10

Test for Ulnar nn Dysfunction
Position:Tap ulnar nerve as it lies in groove between olecranon process and medial epicondyle 4-6X
Positive: tingling distally in ulnar n distribution

Question 11

Froment’s Sign

Answer 11

Test for ulnar nerve dysfunction/paralysis
Position: Patient holds a piece of paper between thumb and index finger; PT tries to pull paper away
Positive: terminal phalanx of thumb flexes to compensate for inability of adductor pollicis muscle to work

Question 12

Tinel’s Sign at the Wrist

Answer 12

Test for Carpal Tunnel Syndrome
Position: pt. sitting, wrist supported on plinth; PT taps over carpal tunnel at the wrist
Positive: tingling or paresthesia into thumb, index, middle and radial side of ring finger

Question 13

Phalen’s Test

Answer 13

Test for Carpal Tunnel Syndrome
Position: pt. sitting or standing; pt. flexes both wrists maximally, brings dorsal aspect of both hands together, bring elbow down slightly; Hold position for 1 minute
Positive: tingling in thumb, index, middle and radial ½ of ring finger
Can also do the reverse: Reverse Phalen’s (Prayer)

Question 14

Finklestein Test

Answer 14

Test for Wrist Tendonitis (APL/EPB):DeQuervain’s
Extensor compartment #1
Position: pt. makes fist with thumb inside fingers; Passive or active UD
Positive: pain over APL or EPB tendons at wrist
Look for reproduction of their pain at the wrist
Compare to opposite side ( may be normally uncomfortable!)

Question 15

Trendelenburg Test

Answer 15

Position: Standing
Method: PT stands behind patient. Observe symmetry of PSIS, pelvis in stance. PT can place hands on iliac crests. Have patient stand on 1 leg
+: during unilateral stance, pelvis drops on the OPPOSITE side; indicates weakness of glut medius on the STANCE side

Question 16

True Leg Length Test

Answer 16

Position: Supine
Method: Measure from ASIS to medial malleolus
+: greater than 1.5 cm difference between legs

Question 17

Thomas Test

Answer 17

Position: Supine, Check for excessive lordosis, Bring one knee to chest, Stabilize lumbar spine and pelvis, Relax contralateral hip
NORMAL: hip remains on the table
CONTRACTURE: hip rises from table; Contracture angle can be measured
J SIGN: hip ABDucts indicating tight iliotibial band

Looks at hip flexor LENGTH

Question 18

Modified Thomas Test

Answer 18

Position: Pt supine, Knee bent over edge of table, Bring one knee to the chest, Stabilize lumbar spine and pelvis, Relax contralateral limb
NORMAL: knee angle 90°
CONTRACTURE: knee angle < 90

Looks at RECTUS FEMORIS LENGTH

Question 19

90/90 Test

Answer 19

Position:Pt Supine
Method: PASSIVE flexes the hip to 90°with knee bent, Pt extend one knee as much as possible
+: Lacking more than 20 degrees of extension

Looks at length on hamstrings

Question 20

Ober’s Test

Answer 20

Position: Pt side lying; Lower limb flexed; Stabilize pelvis
Method: Passively abducts and extend upper limb with knee flexed 90° Slowly lower upper limb
+: thigh doesn’t reach midline indicating a contracture of TFL and ITB

Question 21

Modified Ober’s Test

Answer 21

Position: Pt side lying; Lower limb flexed; Stabilize pelvis
Knee is fully extended
Greater stretch on IT band
Less tension on patella
Less tension on rectus

+: if thigh doesn’t reach midline
+: with pain at the greater trochanter even if full ROM is present (trochanteric bursitis)

Question 22

Patellar Apprehension Test

Answer 22

(+) = pt will look anxious and contract quad with passive lateral displacement of patella

Question 23

Lachman’s Test

Answer 23

Tests ACL integrity; primarily posterolateral bundle
Checks anterior translation of tibia on femur
Done in 20-30o knee flex; grasp tibia and move anterior on femur
(-)= solid end stop
(+) = mushy or soft end feel

Question 24

Posterior Drawer

Answer 24

Test for PCL tear
Supine, knee flexed to 90o; hip flexed to 45o
Palpate tibial plateaus as tibia is pushed posteriorly
(-): solid end stop
(+): mushy excessive posterior translation

False negative: tibia sags back on the femur at the starting point of the test (Sag Sign)

Sit on foot to stabilze
Pull slightly forward and then push posterior

Question 25

Valgus Stress Test (Knee)

Answer 25

Assess MCL
PT applies valgus stress at the knee
Test at 0 and 30o of flex; MCL = primary constraint at 30o
Positive test = tibia moves away from femur increased amount when compare side to side
End feel: mushy/not firm
Look for increased opening at joint line
Hip to stabilize thigh against table

Palpate MCL and pull in a straight plane against their knee, be careful not to rotate

Question 26

Varus Stress Test (Knee)

Answer 26

Assess LCL
PT applies varus stress to knee
Test at 0 and 30o flexion
(+): increased excursion; no abrupt stop; note gapping at lateral joint line

Question 27

Feiss Line

Answer 27

Apex of medial malleolus, medial plantar aspect of 1stMTP joint marked with the patient sitting

Palpate navicular tuberosity; should be above line between

Patient then stands with feet 3-6 inches apart; points marked rechecked for accuracy; palpate navicular tuberosity

Normal longitudinal arch: navicular tuberosity lies on or very close to the line between medial malleolus and MTP joint

1stdegree flatfoot: NT falls 1/3 distance to floor
2nddegree flatfoot: NT falls 2/3 distance to floor
3rddegree flatfoot: NT rests on floor

Question 28

Anterior Drawer

Answer 28

Supine, knee extended
PT stabilizes lower leg, holds pt’s foot in 10-20oPF and draws talus forward in mortise through calcaneous
(+): > anterior excursion compared to other side, no firm end point,

Question 29

Thompson Test

Answer 29

Test for Achilles rupture
Patient lies prone and relaxed.
Squeeze calf muscles
(+) test: absence of PF when muscle is squeezed

Question 30

Straight Leg Raise

Answer 30

Position: Done passively in supine
Method: Start with both legs extended, PT flexes hip while keeping knee straight , Looking for reproduction of LE symptoms

If SLR recreates LE symptoms = (+) nerve root involvement
Typically this is between 35-70 degrees
(most stretch on sciatic nerve)
*Can measure with inclinometer (distal to tib tuberosity)

Question 31

Lumbopelvic Screen

Answer 31

Sitting PSIS height: Unequal heights = positive test (+)
Standing Flexion Test: Change in relationship of PSIS from start to finish = (+)
Supine to Sit Test: Supine; palp inferior to medial malleoli; come to sitting; change in relative LE length = (+)
Prone Knee Flexion Test: Prone; palpate inferior to lat malleoli; flex knee to 90 deg; observe change in position start to finish; if change = (+)

• Lumbopelvic Screen should be done prior to lumbar ROM testing *