Special tests Flashcards
Dislocation special tests
- Apprehension test for anterior shoulder dislocation
* Apprehension test for posterior shoulder dislocation
Biceps tendon pathology special tests
- Speed’s test
* Yergason’s test
RC pathology/impingement special tests
- drop arm test
- Hawkins/Kennedy impingement test
- Infraspinatus test
- Neer impingement test
- Supraspinatus test
Thoracic outlet syndrome special tests
- Adson maneuver
- Allen test
- Roos test
Ligamentous instability special tests
- Valgus stress test
* Varus stress test
Epicondylitis special tests
- Cozen’s test
- Lateral epicondylitis test
- Medial epicondylitis test
Neurological dysfunction special tests
•Tinel’s sign
Ligamentous instability special tests
• Ulnar collateral ligament instability
Vascular insufficiency
• Allen test
Neurological dysfunction special tests
- Froment’s sign
- Phalen’s test
- Tinels sign
Miscellaneous neurological special tests
• Finkelsteins
Contracture/tightness special tests
- Ely’s test
- Ober’s test
- Piriformis test
- Thomas test
- Tripods sign
- 90-90 SLR test
Miscellaneous LE special tests
- Craig’s test
- Patrick’s test (FABER test)
- Trendelenburg test
Ligamentous stability LE special tests
- Anterior drawer test
- Lachman test
- Lateral pivot/shift test
- Posterior drawer test
- Posterior sag sign
- Valgus stress test
- Varus stress test
Meniscal pathology special tests
- Apley’s test
* McMurray test
Swelling special tests
- Brush test
* Patellar tap test
Ankle ligamentous instability special tests
- Anterior drawer test
* Talar tilt test
Miscellaneous ankle special tests
- Homan’s sign (cardiovascular and pulmonary)
- Thompson test
- true leg length discrepancy
Apprehension test for anterior shoulder dislocation
pt supine with arm in 90° of abduction and 90° elbow flexion. Therapist laterally rotates pt shoulder. A positive test is indicated by a grimace prior to end point.
Apprehension test for posterior shoulder dislocation
pt positioned supine with the arm in 90° of flexion and medial rotation. The therapist applies a posterior force through the long axis of the humerus. A positive test is indicated by a grimace.
Speed’s test
pt positioned in sitting or standing with the elbow extended and the forearm supinated. The therapist places one hand over the bicipital groove and the other hand on the volar surface of the forearm. The therapist resists active shoulder flexion. A positive test is indicated by pain or tenderness in the bicipital groove region and may be indicative of bicipital tendonitis
Yergason’s test
pt is positioned in sitting with 90° of elbow flexion and the forearm pronated. The humerus is stabilized against pt’s thorax. The therapist places one hand on the pt’s forearm and the other hand over the bicipital groove. The pt is directed to actively supinate and laterally rotate against resistance. A positive test is indicated by pain or tenderness the bicipital groove and may be indicative of bicipital tendonitis.
Drop arm test
pt is positioned in sitting or standing with the arm in 90° of abduction. The patient is asked to slowly lower the arm to their side. A positive test is indicated by the pt failing to slowly lower the arm or by the presence of severe pain, and may be indicative of an RC tear.
Hawkins/Kennedy impingement test
pt is positioned in sitting or standing. The therapist flexes the patient’s shoulder to 90° and then medially rotates the arm. A positive test is indicated by pain and may be indicative of shoulder impingement involving the supraspinatus tendon.
Infraspinatus test
pt stands with their elbow flexed to 90° and the shoulder in 45° of IR. The pt then resists as the therapist applies a medially directed force to the forearm. Pain or weakness indicates the presence of an infraspinatus strain/tear
Neers impingement test
pt positioned in sitting or standing. The therapist positions one hand on the posterior aspect of the patient’s scapula and the other hand stabilizing the elbow. The therapist elevates the pt’s arm through flexion. A positive test is indicated by a grimace or pain and may be indicative of shoulder impingement.
Supraspinatus test
pt positioned with the arm in 90° abduction followed by 30° of horizontal adduction with the thumb pointing downward. The therapis resists the patient’s attempt to abduct the arm. A positive test is indicated by weakness or pain and may be indicative of a tear of the supraspinatus tendon impingement or suprascapular nerve involvement.
Adson maneuver
pt is positioned in sitting or standing. the therapist monitors the radial pulse and asks the pt to rotate their head to face the test shoulder. The patient is then asked to extend their head while the therapist laterally rotates and extends the pt’s shoulder. A positive test is indicated by an absent or diminished radial pulse and may be indicative of thoracic outlet syndrome.
Allen test
pt is positioned in sitting or standing with the test arm in 90° abduction, lateral rotation, and elbow flexion. The patient is asked to rotate the head away from the test shoulder while the therapist monitors the radial pulse A positive test is indicated by an absent or diminished pulse when the head is rotated away from the test shoulder. A positive test may be indicative of thoracic outlet syndrome
Roos test
pt is positioned in sitting or standing with the arms positioned in 90° abduction, lateral rotation, and elbow flexion. The patient is asked to open and close their hands for three minutes. A positive test is indicated by the inability to maintain the test position, weakness of the arms, sensory loss or ischemic pain. A positive test may be indicative of thoracic outlet syndrome.
Valgus stress test (elbow)
pt positioned in sitting with the elbow in 20-30° of flexion. The therapist places one hand on the elbow and the other hand proximal to the pt’s wrist. The therapist applies a valgus force to test the medial collateral ligament while palpating the medial joint line. A positive test is indicated by increased laxity in the medial collateral ligament when compared to the contralateral limb, apprehension or pain. A positive test may be indicative of a medial collateral ligament sprain.
Varus stress test
pt is positioned in sitting with the elbow in 20-30° of flexion. The therapist places one hand on the wlbow and the other hand proximal to the patient’s wrist. The therapist applies a varus force to test the lateral collateral ligament while palpating the lateral joint line. A positive test is indicated by increased laxity in the lateral collateral ligament when compared to the contralateral limb, apprehension, or pain. A positive test may be indicative of a lateral collateral ligament sprain.
Cozen’s test
pt is positioned in sitting with the elbow in slight flexion. The therapist places their thumb on the patient’s lateral epicondyle while stabilizing the elbow joint. The patient is asked to make a fist, pronate the forearm, radially deviate, and extend the wrist against resistance. A positive test is indicated by pain in the lateral epicondyle region or muscle weakness and may be indicative of lateral epidondylitis.
Lateral epicondylitis test
pt is positioned is sitting, The therapist stabilizes the elbow with one hand and places the other hand on the dorsal aspect of the patient’s hand distal to the proximal IP joint, The patient is asked to extend the 3rd digit against resistance. A positive test is indicated by pain in the lateral epicondyle region or muscle weakness and may be indicative of lateral epicondylitis
Medial epicondylitis test
pt is positioned in sitting. The therapist palpates the medial epicondyle and supinates the pt’s forearm, extends the wrist, and extends the elbow. A positive test is indicated by pain in the medial epicondyle region and may indicate medial epicondylitis.
Tinel’s sign
pt is positioned in sitting with the elbow in slight flexion. The therapist taps with the index finger between the olecranon process and the medial epicondyle. A positive test is indicated by a tingling sensation in the ulnar nerve distribution of the forearm, hand, and fingers. A positive test may be indicative of ulnar nerve compression or compromise.
Ulnar collateral ligament instability test
pt is positioned in sitting. The therapist holds the pt’s thumb in extension and applies a valgus force to the MCP joint of the thumb. A positive test is indicated by excessive valgus movement and may be indicative of a tear of the ulnar collateral ligament and accessory collateral ligaments. This type of injury is referred to as gamekeeper’s or skier’s thumb.
Allen test (wrist/hand)
pt positioned sitting or standing. The patient is asked to open and close the hand several times in succession and then maintain the hand in a closed position. The therapist compresses the radial and ulnar arteries. The pt is then asked to relax the hand and the therapist releases the pressure on one of the arteries while observing the color of the hand and fingers. A positive test is indicated by delayed of absent flushing of the radial or ulnar half of the hand and may be indicative of an occlusion in the radial or ulnar artery.
Froment’s sign
pt positioned in sitting or standing and is asked to hold a piece of paper between the thumb and index finger. The therapist attempts to pull the paper away from the pt. A positive test is indicated by the pt flexing the distal phalanx of the thumb due to adductor pollicis muscle paralysis. If at the same time , the pt hyperextends the MCP joint of the thumb and it is termed Jeanne’s sign. Both objective findings may be indicative of ulnar nerve compromise or paralysis.
Phalen’s test
pt is positioned in sitting or standing. The therapist flexes the pt’s wrists maximally and asks the pt to hold the position for 60 seconds. A positive test is indicated by tingling in the thumb, index finger, and lateral half of the ring finger and may be indicative of carpal tunnel syndrome due to median nerve compression.
Tinel’s sign
pt is positioned in sitting or standing. The therapist taps over the volar aspect of the pt’s wrist. A positive test is indicated by tingling in the thumb, index finger, middle finger, and lateral half of the ring finger distal to the contact site at the wrist. A positive test may be indicative of carpal tunnel syndrome due to median nerve compression.
Finkelstein test
pt is positioned sitting or standing and is asked to make a fist with the thumb tucked inside the fingers. the therapist stabilizes the patient’s forearm and ulnarly deviates the wrist. A positive test is indicated by pain over the abductor pollicis longus and extensor pollicis brevis tendons at the wrist and may be indicative of tenosynovitis (de Quervain’s disease)
Ely’s test
pt positioned prone while the therapist passively flexes the patient’s knee. A positive test is indicated by spontaneous hip flexion occurring simultaneously with knee flexion and may be indicative of a rec fem contracture.
Ober’s test
pt positioned sidelying with the lower leg flexed at the hip and knee. The therapist moves the test leg into hip extension and abduction and then attempts to slowly lower the test leg. A positive test is indicated by an inability of the test leg to adduct and touch the table and may be indicative of an iliotibial band or TFL contracture.
Piriformis test
pt positioned in sidelying with the test leg positioned toward the ceiling and the hip flexed to 60°. The therapist places one hand on the pt’s pelvis and the other hand on the pt’s knee. While stabilizing the pelvis, the therapist applies an adduction force to the knee. A positive test is indicated by pain or tightness, and may be indicatice of piriformis tightness or compression on the sciatic nerve caused by the piriformis.
Thomas test
pt positioned in supine with the legs fully extended the pt is asked to bring one of their knees to the chest in order to flatten the lumbar spine. The therapist observes the position of the contralateral hip while the pt holds the flexed hip. A positive test is indicated by the straight leg rising from the table and may be indicative of a hip flexion contracture.
Tripod sign
pt is positioned in sitting with the knees flexed to 90° over the edge of the table. The therapist passively extends one knee. A positive test is indicated by tightness in the HS, or extension of the trunk in order to limit the effect of the tight HS.
90-90 SLR test
pt positioned supine and is asked to stabilize the hips in 90° flexion with the knees relaxed. The therapist instructs the pt to alternately extend each knee as much as possible while maintaining the hips in 90° of flexion. A positive test is indicated by the knee remaining in 20°or more of flexion and is indicative of HS tightness.
Craig’s test
pt is positioned prone with the test knee flexed to 90° . The therapist palpates the posterior aspect of the greater trochanter and medially and laterally rotates the hip until the greater trochanter is parallel with the table. The degree of femoral anteversion corresponds to the angle formed by the lower leg with the perpendicular axis of the table. Normal anteversion for an adult is 8-15°
Patrick’s test (FABER test)
pt is positioned in supine with the test leg flexed, abducted, and laterally rotated at the hip onto the opposite leg. The therapist slowly lowers the test leg through abduction toward the table. A positive test is indicated by failure of the test leg to abduct below the level of the opposite leg and may be indicative of iliopsoas, sacroiliac or hip joint abnormalities.
Trendelenburg test
pt is positioned in standing and is asked to stand on one leg for approx. ten seconds. A positive test is indicated by a drop of the pelvis on the unsupported side and may be indicative of weakness of the glute med muscle on the supported side.
Anterior drawer test (knee)
pt is positioned in supine with the knee flexed to 90° and the hip flexed to 45°. The therapist stabilizes the lower leg by sitting on the forefoot. The therapist grasps the pt’s proximal tibia with two hands, places their thumbs on the tibial plateau, and administers an anterior directed force to the tibia on the femur. A positive test is indicated by excessive anterior translation of the tibia on the femur with a diminished or absent end-point and may be indicative of an anterior cruciate ligament injury.
Lachman test
pt is positioned in supine with the knee flexed to 20-30°. The therapist stabilizes the distal femur with one hand and places the other hand on the proximal tibia. The therapist applies an anterior directed force to the tibia on the femur. A positive test is indicated by excessive anterior translation of the tibia on the femur with a diminished or absent end-point and may be indicative of an anterior cruciate ligament injury.
Lateral pivot shift test
pt positioned supine with the hip flexed and abducted to 30° with slight IR. The therapist grasps the leg with one hand and places the other hand over the lateral surface of the proximal tibia. The therapist medially rotates the tibia and applies a valgus force to the knee while the knee is slowly flexed. A positive test is indicated by a palpable shift or clunk occurring between 20-40° degrees of flexion and is indicative of anterolateral rotatory instability. The shift or clunk results from the reduction of the tibia on the femur.
Posterior drawer test (knee)
pt is positioned supine with the knee flexed to 90° and the hip flexed to 45 °. The therapist stabilizes the lower leg by sitting on the forefoot. The therapist grasps the pt’s proximal tibia with two hands, places their thumbs on the tibial plateau, and administers a posterior directed force to the tibia on the femur. A positive test is indicated by excessive posterior translation of the tibia on the femur with a diminished or absent end-point and may be indicative of an posterior cruciate ligament injury.
Posterior sag sign
pt is positioned in supine with the knee flexed to 90° and the hip flexed to 45°. A positive test is indicated by the tibia sagging back on the femur and may be indicative of a posterior cruciate ligament injury.
Valgus stress test (knee)
pt is positioned in supine with the knee flexed to 20-30°. The therapist positions one hand on the medial surface of the patient’s ankle and the other hand on the lateral surface of the knee. The therapist applies a valgus force to the knee with the distal hand. A positive test is indicated by excessive valgus movement and may be indicative of medial collateral ligament sprain. A positive test with the knee in full extension may be indicative of damage to the medial collateral ligament, posterior cruciate ligament, posterior oblique ligament, and posteromedial capsule.
Varus stress test
pt is positioned in supine with the knee flexed to 20-30°. The therapist positions one hand on the lateral surface of the patient’s ankle and the other hand on the medial surface of the knee. The therapist applies a varus force to the knee with the distal hand. A positive test is indicated by excessive varus movement and may be indicative of lateral collateral ligament sprain. A positive test with the knee in full extension may be indicative of damage to the lateral collateral ligament, posterior cruciate ligament, arcuate complex, and posterolateral capsule.
Apley’s compression test
pt is positioned in prone with the knee flexed to 90°. The therapist stabilizes the pt’s femur using one hand and places the other hand on the pt’s heel. The therapist medially and laterally rotates the tibia while applying a compressive force through the tibia. A positive test is indicated by pain or clicking and may be indicative of a meniscal lesion.
McMurray test
pt is positioned in supine. The therapist grasps the distal leg with one hand and palpates the knee joint line with the other. With the knee fully flexed, the therapist medially rotates the tibia and extends the knee, The therapist repeats the same procedure while laterally rotating the tibia. A positive test is indicated by a click or pronounces crepitation felt over the joint line and may be indicative of a posterior meniscal lesion.
Brush test
pt is positioned in supine. The therapist places one hand below the joint line on the medial surface of the patella and strokes proximally with the palm and fingers as far as the suprapatellar pouch, The other hand then strokes down the lateral surface of the patella. A positive test is indicated by a wave of fluid just below the medial distal border of the patella and is indicative of effusion in the knee.
Patellar tap test
pt is positioned in supine with the knee flexed or extended to a point of discomfort. The therapist applies a slight tap over the patella. A positive test is indicated if the patella appears to be floating and may be indicative of joint effusion.
Anterior drawer test (ankle)
pt is positioned in supine. The therapist stabilizes the distal tibia and fibula with one hand, while the other hand holds the foot in 20° of PF and draws the talus forward in the ankle mortise. A positive test is indicated by excessive anterior translation of the talus away from the ankle mortise and may be indicative of anterior talofibular ligament sprain.
Talar tilt test
pt positioned in supine with the knee flexed to 90°. The therapist stabilizes the distal tibia with one hand while grasping the talus with the other hand. The foot is maintained in a neutral position. The therapist tilts the talus into abduction and adduction. A positive test is indicated by excessive adduction and may be indicative of cacaneofibular ligament sprain.
Thompson test
pt is positioned in prone with the feet extended over the edge of a table. The therapist asks the pt to relac and proceeds to squeeze the muscle belly of the gastrocnemius and soleus muscles. A positive test is indicated by the absence of PF and may be indicative of a ruptured Achilles tendon.
True leg length discrepancy
pt is positioned supine with the hips and knees extended, the legs 15-20 cm apart, and the pelvis in balance with the legs. Using a tape measure, the therapist measures from the distal point of the anterior superior iliac spines to the distal point of the medial malleoli. A positive test is indicated by a bilateral variation of greater than one cm and may be indicative of a true leg length discrepancy.
