Special Tests Flashcards
Yergason’s Test
Integrity of transverse ligament
Bicipital tendonosis/tendonopathy
Sitting, shoulder in neutral stabilized against trunk, elbow at 90 deg, forearm pronation
Resist supination of forearm and ER shoulder
+: tendon of biceps long head will “pop out” of groove, may produce pain in long head of biceps tendon
Speed’s Test
Biceps straight arm test
Bicipital tendonosis/tendonopathy
Sitting or standing, upper limb in full extension and forearm supination
Resist shoulder flexion
+: pain in long head of biceps tendon
Neer’s impingement test
Impingement of soft tissue structures of shoulder complex (long head of biceps and supraspinatus tendon)
Sitting, shoulder passively IR then fully abducted
+: pain within shoulder region
Supraspinatus test
Empty can test
Tear and/or impingement of supraspinatus tendon or possible suprascapular nerve neuropathy
Sitting with shoulder at 90 deg and no rotation, resist shoulder abduction
THEN place shoulder in IR and 30 deg horizontal adduction and resist abduction
+: pain in supraspinatus tendon and/or weakness in the “empty can” position
Drop arm test
Tear and/or full rupture of RC
Sitting, shoulder passively abducted to 120 deg
Pt slowly brings arm down to side
NOTE: guard pt’s arm in case it gives way
+: unable to lower arm back to side
Posterior internal impingement test
Impingement between RC and greater tuberosity or posterior glenoid and labrum
Supine, move shoulder into 90 deg abduction, max ER and 15-20 deg horrid add
+: pain in posterior shoulder
Clunk test
Glenoid labrum tear
Supine, shoulder in full abduction
Push humeral head anterior while rotating humerus externally
+: audible “clunk” is heard while performing the test
Anterior apprehension sign
Past history of anterior shoulder dislocation
Supine, shoulder in 90 deg abduction
Slowly ER the shoulder
+: pt does not allow and/or does not like shoulder to move in direction
Posterior apprehension sign
Past history of posterior shoulder dislocation
Supine, shoulder in 90 deg abduction with scapula stabilized by table
Place a posterior force through shoulder through pt’s elbow while moving shoulder into IR/horiz add
+: pt does not allow and/or does not like shoulder to move in direction to simulate posterior dislocation
Acromioclavicular (AC) shear test
Dysfunction of AC joint (arthritis, separation)
Sitting with arm resting at side, PT clasps hands and places heel of one hand on spine of scapula and heel of other hand on clavicle
Squeeze hands together, causing compression of AC joint
+: pain in AC joint
Adson’s test
Pathology of structures that pass through thoracic inlet
Sitting, find radial pulse, rotate head toward UE being tested, extend and ER shoulder while extending head
+: neurological and/or vascular symptoms in UE
Costoclavicular syndrome test
Military brace test
Pathology of structures that pass through thoracic inlet
Sitting, find radial pulse, move shoulder down and back
+: neurological and/or vascular symptoms in UE
Wright test
Hyperabduction test
Pathology of structures that pass through thoracic inlet
Sitting, find radial pulse, move shoulder into max abduction and ER
Pt takes a deep breath and rotates head to opposite side being tested
+: neurological and/or vascular symptoms in UE
Roo’s elevated arm test
Pathology of structures that pass through thoracic inlet
Standing, shoulders fully ER, 90 deg abduction, slight horizontal abduction, elbows flexed to 90 deg
Pt opens/closes hands for 3 minutes slowly
+: neurological and/or vascular symptoms in UE
Elbow ligament instability tests
medial and lateral stability
Ligament laxity or restriction
Sitting or supine, upper limb supported and stabilized, elbow in 20-0 deg of flexion
- valgus force through elbow tests ulnar collateral ligament
- varus force through elbow tests radial collateral ligament
+: laxity, pain may also be present
Lateral epicondylitis test
Tennis elbow test
Lateral epicondylopathy
Sitting, elbow in 90 deg flexion supported and stabilized
Resist wrist extension, radial deviation and forearm pronation with fingers fully flexed simultaneously
+: pain at lateral epicondyle
Medial epicondylitis test
Golfer’s elbow test
Medial epicondylopathy
Sitting, elbow in 90 deg flexion and supported/stabilized
Passively supinate forearm, extend elbow and extend wrist
+: pain at medial epicondyle
Tinel’s sign (elbow)
Dysfunction of ulnar nerve at olecranon
Tap region where ulnar nerve passes through cubital tunnel
+: tingling sensation in ulnar distribution
Pronator teres syndrome
Median nerve entrapment within pronator teres
Sitting, elbow 90 deg flexion and supported/stabilized
Resist forearm pronation and elbow extension simultaneously
+: tingling or paresthesia within median nerve distribution
Finkelstein’s test
deQuervain’s tenosynovitis
(paratendoinitis of the abductor policies longs and/or extensor policies brevis)
Pt makes a fist with thumb inside fingers.
Passively ulnar deviate
+: pain in wrist
NOTE: often painful w/o pathology so compare to uninvolved side
Bunnel-Littler Test
Tightness in structures surrounding MCP joints
MCP joint stabilized in slight extension with PIP flexion
MCP joint is flexed and PIP is flexed
+: IF FLEXION is limited in BOTH cases = capsule tightness
+: IF MORE PIP flexion with MCP flexion = intrinsic mm tightness
Tight retinacular test
Tightness around proximal interphalangeal joint
PIP stabilized in neutral, DIP is flexed; THEN
PIP is flexed and DIP is flexed
+: IF FLEXION is limited in BOTH cases = capsule tightness
+: IF MORE DIP flexion with PIP flexion = reticular ligaments are tight
Finger ligamentous instability tests
medial and lateral stability
Ligament laxity or restriction
Fingers supported/stabilized. Valgus and varus forces applied to PIP joints at all digits. Repeated to DIP joints.
+: laxity, may also be pain
Froment’s sign
Ulnar nerve dysfunction
Pt grasps paper between first and second digits. Pull paper out and look for IP flexion of thumb (compensation for weak adductor pollicis)
+: unable to perform test without compensating
Tinel’s sign (wrist)
Carpal tunnel compression of median nerve
Tap region where median nerve passes through carpal tunnel
+: tingling and/or paresthesia into hand following median nerve distribution
Phalen’s test
Carpal tunnel compression of median nerve
Pt maximally flexes both wrists holding them against each other for 1 minute
+: tingling or paresthesia into hand following median nerve distribution
Two-point discrimination test
Level of sensory innervation within hand that correlates with functional ability to perform certain activities involving grasp
Sitting, hand stabilized
Using a paper clip, apply device to palmar aspect of fingers to assess ability to distinguish between two points of device. Record smallest difference the patient can sense 2 separate points.
+: normal amount can be discriminated is
Allen’s test
Vascular compromise
Pt opens/closes fingers quickly several times then closes fist.
Using thumb, occlude ulnar artery and have patient open hand. Observe palm and then release compression on artery and observe for vascular filling.
Repeat with radial artery.
+: abnormal filling of blood within hand
Patrick’s test
FABER
Dysfunction of hip such as mobility restriction
Supine, passively flex, abduct and ER hip. Slowly lower txt leg toward table surface
+: involved knee unable to assume relaxed position and/or reproduction of painful symptoms
Grind test
Scour test
Degenerative joint disease (DJD) of hip
Supine, hip in 90 deg flexion and max knee flexion.
Place compressive load into femur via knee joint
+: pain within hip joint and refer pain to knee and elsewhere
Trendelenburg sign
Weakness of gluteus medium or unstable hip
Standing, ask to stand on one leg.
Observe pelvis of stance leg
+: ipsilateral pelvis drops when lower limb support is removed while standing
Thomas test
Tightness of hip flexors
Supine, one hip and knee max flexion to chest and held there.
Opposite limb kept straight on table. Observe whether hip flexion occurs on straight leg as opposite limb is flexed.
+: straight limb’s hip flexes and/or pt is unable to remain flat on table
Ober’s test
Tightness of TFL and/or IT band
Sidelying, lower limb flexed at hip and knee.
Passively extend and abduct testing hip with knee flexed to 90 deg. Slowly lower uppermost limb and observe if it reaches the table.
NOTE: modified oner’s = knee extended
+: uppermost limb is unable to come to rest on table
Ely’s test
Tightness of rectus femoris
Prone, knee of testing limb flexed. Observe hip of testing limb.
+: hip of testing limb flexes
90-90 hamstring test
Tightness of hamstrings
Supine, hip and knee of test limb in 90 deg flexion.
Passively extend knee of test limb until barrier is encountered.
+: knee is unable to reach 10 deg from neutral (lacking 10 deg extension)
Piriformis test
Piriformis syndrome
Supine, foot of test leg passively placed lateral to opposite limb’s knee. Testing hip adducted. Observe position of testing knee relative to opposite knee.
+: test knee is unable to pass over resting knee and/or reproduction of pain in buttock and/or along sciatic nerve distribution
Leg length test
True leg length discrepancy
Supine, pelvis balanced/aligned with lower limbs and trunk. Measure distance from ASIS to lateral or medial malleolus on each limb several times.
*Unequal girth of thigh musculature (right vs left) can skew results if using medial malleolus landmark.
+: TRUE discrepancy = anatomical difference in bone length
+: FUNCTIONAL discrepancy = result of compensation due to abnormal position or posture (pronation of foot or pelvic obliquity)
Craig’s test
Abnormal femoral antetorsion angle
Prone, knee flexed to 90 deg. Palpate greater trochanter and slowly move hip through IR/ER.
When greater trochanter feels most lateral, stop and measure angle of leg relative to a line perpendicular with table surface.
NORMAL = 8-15 deg hip IR
+: RETROVERTED HIP = 15 deg
Knee collateral ligament instability tests
medial and lateral stability
Ligament laxity or restriction
Supine, lower limb supported/stabilized, knee placed in 20-30 deg of flexion.
Varus force = lateral collateral ligament
Valgus force = medial collateral ligament
+: laxity, may also be pain
Lachman’s stress test
Integrity of anterior cruciate ligament
Supine, knee flexed 20-30 deg, stabilized femur and passively try to glide tibia anterior
+: excessive anterior glide of tibia
Pivot shift test
anterolateral rotary instability
Anterior cruciate ligament integrity
Supine, test knee in extension, hip flexed and abducted 30 deg with slight IR.
Hold knee with one hand and foot with other hand. Place valgus force through knee and flex knee.
+: ligament laxity–tibia relocating during test. As knee is flexed, tibia clunks backward at approx 30-40 deg.
Posterior sag test
Slocum test
Integrity of posterior cruciate ligament
Supine, testing hip flexed 45 deg and knee flexed 90 deg
Observe to see whether tibia “sags” posteriorly
+: sag of tibia relative to femur
Posterior drawer test
Integrity of posterior cruciate ligament
Supine, test hip flexed 45 deg and knee flexed 90 deg.
Passively glide tibia posteriorly following joint line
+: excessive posterior glide
Reverse Lachman
Integrity of posterior cruciate ligament
Prone with knees flexed to 30 deg.
Stabilize femur and passively try to glide tibia posterior
+: ligament laxity
McMurray’s test
Meniscal tears
Supine, test knee in max flexion.
LATERAL = passively IR and extend knee
MEDIAL = passively ER and extend knee
+: click and/or pain in knee joint
Apley test
Meniscal tear vs ligamentous tear
Prone, test knee flexed 90 deg
Passively distract knee and IR/ER tibia
Compressive load to knee and IR/ER tibia
MENISCAL: pain or decreased motion during compression
LIGAMENT: pain or increased motion during distraction
Hughston’s plica test
Dysfunction of place
Supine, test knee flexed and tibia IR
Passive glide patella medially while palpating medial femoral condyle.
Feel for popping as passively flex and extend knee.
+: pain and/or popping during test
Patellar apprehension test
Past history of patellar dislocation
Supine with patella passively glided laterally
+: pt does not allow and/or does not like patella to be moved laterally
Clarke’s sign
Patellofemoral dysfunction
Supine, knee extended resting on table.
Push posterior on superior pole of patella and ask patient to contract quads.
+: pain
Ballotable patella
patellar tap test
Infrapatellar effusion
Supine, knee extended resting on table.
Apply soft tap over central patella.
+: perception of the patella floating (“dancing patella” sign)
Fluctuation test
Knee joint effusion
Supine, knee extended resting on table.
Place one hand over supra patellar pouch and other over anterior aspect of knee joint.
Alternate pushing down with one hand at a time.
+: fluctuation (movement) of fluid noted during test
Q-angle measurement
Measurement of angle between quadriceps muscle and patellar tendon
NORMAL = 13 deg (men) and 18 deg (women)
Angles less or greater than normal may be indicative of knee dysfunction and/or biomechanics dysfunction within the lower limb
Noble compression test
Distal iliotibial (IT) band friction syndrome
Supine, hip flexed to 45 deg and knee flexed to 90 deg.
Apply pressure to lateral femoral epicondyle and extend knee.
+: reproduces same pain over lateral femoral condyle; pain over lateral femoral epicondyle at approx 30 deg flexion
Tinel’s sign (knee)
Dysfunction of common fibular nerve posterior to fibular head
Tap region where common fibular nerve passes through posterior to fibular head
+: tingling and/or paresthesia into leg
Neutral subtalar positioning
Abnormal rearfoot to forefoot positioning
Prone, foot over edge of table.
Palpate dorsal aspect of talus on both sides with one hand and grasp lateral forefoot with other hand.
Gently dorsiflex foot until resistance is felt then move foot through supination/pronation.
+: Neutral position is when foot falls off easier to one side or other. At this point, compare rearfoot to forefoot and rearfoot to leg.
Anterior drawer test (ankle)
Ligamentous instability (anterior talofibular ligament)
Supine, heel just off edge of table in 20 deg PF.
Stabilize lower leg and grasp foot. Pull talus anterior.
+: talus has excessive anterior glide and/or pain
Talar tilt
Ligamentous instability (calcaneofibular ligament)
Sidelying, knee slightly flexed and ankle neutral.
Move foot into adduction (calcaneofibular lig)
Move foo into abduction (deltoid lig)
+: excessive abd/add and/or pain
Thompson test
Integrity of Achille’s tendon
Prone with foot off edge of table.
Squeeze calf muscle.
+: no movement of foot while squeezing calf
Tinel’s sign (ankle)
Dysfunction of posterior tibial nerve posterior to medial malleolus OR deep fibular nerve anterior to talocrural joint
Supine, foot supported on table.
Tap region of posterior tibial nerve as it passes posterior to medial malleolus.
Tap region of deep fibular nerve as its passes under dorsal retinaculum (anterior to ankle jt).
+: tingling and/or paresthesia into the respective nerve distributions
Morton’s test
Stress fracture or neuroma in forefoot
Supine, foot supported on table. Grasp around metatarsal heads and squeeze.
+: pain in forefoot
Vertebral artery test
Integrity of vertebrobasilar vascular system
Supine, head supported on table.
(1) Extend head/neck for 30 sec. If no change in sx perform step 2.
(2) Extend head/neck with rotation left, then right, for 30 seconds. If no change in sx, perform step 3.
(3) With head cradled off table, extend had/neck for 30 seconds. If no change in sx, perform step 4.
(4) With head cradled off table, extend head/neck with rotation left for 30 sec. Repeat with rotation right for 30 sec.
- *Pt should be continuously monitored for change in sx during entire test. CAUTION should be used during test.
- *Performing mob/manip within cervical region without performing this test = breach of standard of care
+: dizziness, visual disturbances, disorientation, blurred speech, N/V
Hautant’s test
Vascular versus vestibular causes of dizziness/vertigo
(1) Pt sitting, shoulders at 90 deg, palms up. Pt close eyes and maintain position for 30 sec. IF arms lose position, may be VESTIBULAR.
(2) Pt sitting, shoulders at 90 deg, palms up. Pt closes eyes, cue pt into head/neck extension with rotation right, then left, remaining in each position x 30 sec. IF arms lose position, may be VASCULAR.
+: position/movement of arms
Transverse ligament stress test
Integrity of transverse ligament
Supine, head supported on table. Glide C1 anterior. Should be firm end feel.
+: soft end feel, dizziness, nystagmus, lump sensation in throat, nausea
Anterior shear test
Integrity of upper cervical spine ligaments and capsules
Supine, head supported on table. Glide C2-7 anterior. Should be firm end feel.
+: laxity of ligaments, dizziness, nystagmus, lump sensation in throat, nausea
Foraminal compression
Spurling’s test
Dysfunction (typically compression) of cervical nerve root
Sitting with head side bent toward uninvolved side. Apply pressure through head straight down. Repeat with head toward involved side.
+: pain and/or paresthesia in a dermatomal pattern for involved nerve root
Maximum cervical compression test
Compression of neural structures at intervertebral foramen and/or facet dysfunction
Sitting. Passively move head into SB and rotation toward non painful side followed by extension. Repeat toward painful side.
**Be careful since similar to vertebral artery test.
NERVE ROOT = pain and/or paresthesia in dermatomal pattern
FACET = localized pain
Distraction test
Compression of neural structures at the intervertebral foramen or facet dysfunction
Sitting with head passively distracted
FACET = decrease in symptoms in neck NEUROLOGICAL = decrease in upper limb pain
Shoulder abduction test
Compression of neural structures within intervertebral foramen
Sitting with one hand on top of head. Repeat with opposite hand.
+: decrease in symptoms into upper limb
Lhermitte’s sign
Dysfunction of spinal cord and/or UMN lesion
Long sitting at table.
Passively flex pt’s head and one hip while keeping knee in extension. Repeat with other hip.
+: pain down spine and into upper or lower limbs
Romberg test
UMN lesion
Standing and close eyes 30 seconds.
+: excessive swaying
Rib springing
Rib mobility
Prone. Begin at upper ribs with P/A force through each rib through entire rib cage.
Sidelying. Repeat test.
*Be careful when springing 11th and 12th ribs since they are less stable.
+: pain, excessive motion or restriction of ribs
Thoracic springing
Intervertebral joint mobility in thoracic spine
Prone. Apply P/A glides/springs to transverse processes of thoracic vertebrae.
+: pain, excessive and/or restricted movement
Slump test
Dysfunction of neurological structures supplying lower limbs
Sitting edge of table with knees flexed. Pt slump sits while maintaining neutral position of head and neck.
(1) Passively flex pt’s head and neck. If no reproduction of sx, perform step 2.
(2) Passively extend one of pt’s knees. If no reproduction of sx, performs step 3.
(3) Passively DF ankle of limb with extended knee.
Repeat with opposite leg.
+: reproduction of pathological neurological symptoms
Lasegue’s test
Straight leg raising
Dysfunction of neurological structures that supply the lower limb.
Supine, legs resting on table.
Passively flex hip of one leg with knee extended until pt complains of shooting pn in lower limb. Slowly lower limb until pn subsides, then passively DF foot.
+: reproduction of pathological neurological sx when foot is DF
Femoral nerve traction test
Compression of femoral nerve
Sidelying on non painful side with trunk neutral, head flexed slightly and hip/knee flexed.
Passively extend hip while knee of non painful limb is in extension. If no reproduction of symptoms, flex knee of painful leg.
+: neurological pain in anterior thigh
Valsalva’s maneuver
Space-occupying lesion
Sitting. Pt should take a deep breath and hold while they “bear down” as if having a bowel movement.
+: increased low back pain or neurological symptoms into LE
Babinski test
UMN lesion
Supine or sitting. Glide bottom end of standard reflex hammer along plantar surface of foot.
+: extension of big toe and splaying (abd) of other toes
Quadrant test
Compression of neural structures at the intervertebral foramen and facet dysfunction
Standing.
IV FORAMEN: L SB, L rotation and extension to maximally close IV foramen on L. Repeat on R side.
FACET: L SB, R rot and extension to maximally compress facet on L. Repeat on R side.
+: pain and/or paresthesia in dermatomal pattern for the involved nerve root or localized pain if facet.
Stork standing test
Spondylolisthesis
Standing on one leg. Pt extends trunk. Repeat with opposite leg on ground.
+: pain in low back with IPSI leg on ground
McKenzie’s side glide test
Scoliotic curvature versus neurological dysfunction causing abnormal curvature (lateral shift) of trunk
Patient standing.
Stand on one side of pt so that upper trunk is shifted toward you.
Place shoulders on pt’s upper trunk and wrap arms around pelvis.
Stabilize upper trunk and pull pelvis, to bring pelvis and trunk into proper alignment.
+: reproduction of neurological symptoms as alignment of trunk is corrected
Bicycle test
van Gelderen’s test
Intermittent claudication versus spinal stenosis
Seated on stationary bicycle. Pt rides bicycle while sitting erect. Time how long the patient can ride at a set speed/pace. After sufficient rest, have patient ride bike at same speed while in slumped position.
+: length of time patient can ride bike in sitting vs slumped positions. IF stenosis: ride longer while slumped
Gillet’s test
Posterior movement of ilium relative to sacrum
Patient standing.
Place thumb on PSIS of limb to be tested and other thumb on center of sacrum at level of PSIS.
Ask pt to flex hip and knee of limb being tested.
Assess movement of PSIS with your eyes at the level of your thumbs.
PSIS should move inferior.
+: no identified movement of PSIS compared to sacrum
Ipsilateral anterior rotation test
Anterior movement of ilium relative to sacrum
Place thumb on PSIS of limb to be tested and other thumb on center of sacrum at level of PSIS.
Ask pt to extend hip of limb being tested.
Assess movement of PSIS with your eyes at the level of your thumbs.
PSIS should move superior.
+: no identified movement of PSIS compared to sacrum
Gaenslen’s test
SIJ dysfunction
Sidelying at edge of table while holding bottom leg in max hip/knee flexion.
Standing behind patient, passively extend hip of uppermost limb.
+: pain
Long sitting test
supine to sit test
Dysfunction of SIJ that may be cause of functional leg length discrepancy
Supine with correct alignment.
Stand at edge of table and palpate medial malleoli to assess symmetry.
Have pt come to long sitting and assess leg length.
+: reversal in limb lengths between supine and long sitting
Goldthwait’s test
Lumbar spine VS SIJ dysfunction
Supine with fingers between spinous processes of lumbar spine.
With other hand, passively perform SLR.
+: pain prior to palpation of movement in lumbar segments: SIJ dysfunction
TMJ compression
Pain with compression of retrodiscal segments
Sitting or supine. Support/stabilize head with one hand. Push mandible superior, causing compressive load to TMJ.
+: pain in TMJ
Ludington’s test
Long head of biceps tendon rupture
Sitting. Clasp both hands behind head with fingers interlocked. Alternately contract and relax biceps.
+: absence of movement in the biceps tendon
Hawkins-Kennedy Impingement Test
Impingement of supraspinatus tendon
Sitting or standing.
Flex shoulder to 90 deg and IR arm.
+: pain
ULNT1
Median nerve, anterior interosseous nerve
Shoulder depression with 110 deg and Elbow extension Forearm supination Wrist extension Finger and thumb extension
Sensitize: contralateral cervical SB
ULNT2
Median nerve, musculocutaneous nerve, axillary nerve
Shoulder depression with 10 deg ab Elbow extension Forearm supination Wrist extension Figer and thumb extension Shoulder ER
Sensitize: contralateral cervical SB
ULNT3
Radial nerve
Shoulder depression with 10 deg abd Elbow extension Forearm pronation Wrist flexion and ulnar deviation Finger and thumb flexion Shoulder IR
Sensitize: Contralateral cervical SB
ULNT4
Ulnar nerve
Shoulder depression with 10-90 deg abd Elbow flexion Forearm supination Wrist extension and radial deviation Finger and thumb extension Shoulder ER
Sensitize: contralateral cervical SB
Lateral epicondylitis test (#2)
Lateral epicondylitis
Sitting.
Stabilize elbow and place other hand on dorsal aspect of patient’s hand distal to PIP joint.
Ask pt to extend the 3rd digit against resistance.
+: pain in lateral epicondyle region or muscle weakness
Cozen’s test
Lateral epicondylitis
Sitting with elbow in slight flexion.
Place thumb on lateral epicondyle.
Ask patient to make a fist, pronate forearm, radially deviate and extend wrist against resistance.
+: pain in lateral epicondyle region or muscle weakness
Mill’s test
Lateral epicondylitis
Sitting.
Palpate lateral epicondyle, pronate forearm, flex wrist and extend elbow.
+: pain in lateral epicondyle region
Ulnar collateral ligament instability test (thumb)
Tear of ulnar collateral and accessory collateral ligaments (gamekeeper’s or skier’s thumb)
Sitting.
Hold pt’s thumb in extension and apply values force to MCP of thumb.
+: excessive valgus movement
Grind test
Degenerative joint disease in the CMC joint
Sitting or standing.
Stabilize pt’s hand and grasp the thumb on the metacarpal. Apply compression and rotation through metacarpal.
+: pain
Murphy sign
Dislocated lunate
Sitting or standing and makes a fist.
+: pt’s 3rd metacarpal remains level with the 2nd and 4th metacarpals
Tripod sign
Tightness of hamstrings
Sitting with knees flexed to 90 deg over edge of table.
Passively extend one knee.
+: tightness of hamstrings or extension of trunk
Barlow’s test
Congenital hip dislocation/DDH
Supine with hips flexed to 90 deg and knees flexed.
Stabilize femur and pelvis with one hand. Move test leg into adduction while applying forward pressure posterior to greater trochanter.
+: click or clunk and may be indicative of hip dislocation being reduced
Ortolani’s test
Congenital dislocation of hip/DDH
Supine with hips flexed to 90 deg and knees flexed.
Grasp legs so thumbs along medial thighs and fingers are on lateral thighs. Abduct pt’s hips and gentle pressure applied to greater trochanters until resistance is felt at approx 30 deg.
+: click or clunk and may be indicative of hip dislocation being reduced
Anterior drawer test
ACL injury
Supine with knee flexed to 90 deg and hip flexed to 45 deg.
Sit on forefoot, grasp proximal tibia with thumbs on tibial plateau. Apply an anterior force to tibia.
+: excessive anterior translation of tibia on femur
Bounce home test
Meniscal lesion
Supine.
Grasp pt’s heel and max flex knee then passively extend knee.
+: incomplete extension or rubbery end-feel
Brush test
Effusion in knee
Supine.
One hand below joint line on medial patella and stroke proximally with palm and fingers to supra patellar pouch. Other hand strokes down to lateral surface of patella.
+: wave of fluid just below medial distal border of patella
Tibial torsion test
Tibial torsion
Sitting with knees over end of table.
Place thumb and index finger of one hand over med and lat malleolus.
Measure acute angle formed by axes of knee and ankle.
NORMAL = 12-18 deg
SIJ stress test
SIJ dysfunction
Supine.
Cross arms and place palms on ASIS. Apply downward and lateral force to pelvis.
+: unilateral pain in SIJ or gluteal area
Sitting flexion test
Articular restriction of SIJ
Sitting with knees flexed 90 deg and feet on floor.
Place hands on PSIS and monitor movement as pt bends forward.
+: one PSIS moving farther cranially
Standing flexion test
Articular restriction of SIJ
Standing with feet 12” apart.
Place hands on PSIS and monitor movement as pt bends forward.
+: one PSIS moving farther cranially
