Special Tests Descriptions LE

Question 1

Ely’s Test

Answer 1

Contracture/Tightness

• Patient in prone
• Therapist passively flexes patient’s knee
• Positive test indicated by spontaneous hip flexion occurring simultaneously with knee flexion
• May indicate rectus femoris contracture

Question 2

Ober’s Test

Answer 2

Contracture/Tightness

• Patient in sidelying with lower leg flexed at hip and knee
• Therapist moves test leg into hip extension and abduction, attempts to slowly lower the test leg
• Positive test indicated by inability of test leg to adduct and touch the table
• May indicate iliotibial band or TFL contracture

Question 3

Piriformis Test

Answer 3

Contracture/Tightness

• Patient in sidelying
• Test leg positioned toward the ceiling, hip flexed to 60
• Therapist stabilizes pelvis and places other hand on patient’s knee to apply adduction force
• Positive test indicated by pain or tightness
• May indicate tight piriformis or compression on sciatic nerve caused by the piriformis

Question 4

Thomas Test

Answer 4

Contracture/Tightness

• Patient in supine, legs fully extended
• Brings one knee to chest, to flatten lumbar spine
• Therapist observes the position of the contralateral hip while patient holds position
• Positive test indicated by the straight leg rising from the table

Question 5

Tripod Sign

Answer 5

Contracture/Tightness

• Patient in sitting
• Knees flexed to 90 over edge of table
• Therapist passively extends one knee
• Positive test indicated by tightness in hamstring or extension of trunk in order to limit effect of tight hamstrings

Question 6

Craig’s Test

Answer 6

Miscellaneous

• Patient in prone
• Test knee flexed to 90
• Therapist palpates posterior greater trochanter and medially and laterally rotates hip until greater trochanter is parallel with table
• 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 degrees

Question 7

90-90 Straight Leg Raise Test

Answer 7

Contracture/Tightness

• Patient in supine
• Asked to stabilize hips with hips in 90 of flexion, knees relaxed
• Patient alternately extends each knee as much as possible while maintaining the hips in 90 of flexion
• Positive test indicated by knee remaining in 20 or more of flexion
• Indicates hamstring tightness

Question 8

Patrick’s Test (FABER Test)

Answer 8

Miscellaneous

• Patient in supine
• Test leg flexed, abducted, laterally rotated at the hip onto the opposite leg
• Therapist slowly loser the test leg through abduction toward the table
• Positive test indicated by failure of the test leg to abduct below the level of the opposite leg
• May indicate iliopsoas, sacroiliac, or hip joint abnormalities

Question 9

Trendelenburg Test

Answer 9

Miscellaneous

• Patient in standing
• Stands on one leg for ~10 seconds
• Positive test indicated by drop of the pelvis on unsupported side
• May indicate weakness of gluteus medius muscle on supported side

Question 10

Anterior Drawer Test

Answer 10

Ligamentous Instability

• Patient in supine
• Knee flexed to 90, hip flexed to 45
• Therapist sits on foot
• Therapist grasps proximal tibia with 2 hands, places thumb on tibial plateau, administers anterior direction force to the tibia
• Positive test indicated by excessive anterior translation of the tibia on the femur with a diminished or absent end-point
• May indicate ACL injury

Question 11

Posterior Drawer Test

Answer 11

Ligamentous Instability

• Same as Anterior Drawer Test but force applied in posterior direction
• May indicate PCL injury

Question 12

Lachman Test

Answer 12

Ligamentous Instability
-Patient in supine
-Knee flexed 20-30.
-Therapist stabilizes distal femur, places other hand on proximal tibia
-Therapist applies anterior directed force to the tibia
-Positive test indicated by excessive anterior translation of the tibia on the femur with diminished end-point
-May indicate ACL injury
(Basically Anterior Drawer Test)

Question 13

Lateral Pivot Shift Test

Answer 13

Ligamentous Instability

• Patient supine
• Hip flexed and abducted to 30 with slight medial rotation
• Therapist grasps leg with 1 hand and places 1 hand over lateral surface of proximal tibia
• Therapist medially rotates tibia and applies valgus force to knee while knee is slowly flexed
• Positive test indicated by palpable shift or clunk occurring between 20-40 degrees of flexion
• Indicative of anterolateral rotary instability
• The shift or clunk results from the reduction of the tibia on the femur

Question 14

Posterior Sag Sign

Answer 14

Ligamentous Instability

• Patient in supine
• Knee flexed to 90 and hip flexed to 45
• Positive test indicated by tibia sagging back on the femur
• May indicate PCL injury

Question 15

Valgus Stress Test

Answer 15

Ligamentous Instability

• Putting in supine
• Knee flexed 20-30
• Therapist puts 1 hand on medial surface of patient ankle, other on lateral surface of knee
• Applies valgus force to knee with the distal hand
• Positive test indicated by excessive valgus movement
• May indicate MCL sprain
• Positive test with knee in full extension may indicate damage to MCL, PCL, Posterior Oblique Ligament, and Posteromedial Capsule

Question 16

Varus Stress Test

Answer 16

Ligamentous Instability

• Same as Valgus Stress Test, therapist hands switch
• May indicate LCL sprain
• Positive test with knee in full extension may indicate damage to LCL, PCL, Arcuate Complex, Posterolateral Capsule

Question 17

Apley’s Compression Test

Answer 17

Meniscal Pathology

• Patient prone
• Knee flexed to 90
• Therapist stabilizes femur and puts other hand on heel
• Medially and laterally rotates tibia while applying compression through tibia
• Positive test indicated by pain or clicking
• May indicate meniscal lesion

Question 18

McMurray Test

Answer 18

Meniscal Pathology

• Patient in supine
• Therapist grasps distal leg with one hand and palpates knee joint line with the other
• With knee fully extended, therapist medially rotates tibia and extends knee
• Repeats procedure while laterally rotates tibia
• Positive test indicated by click or pronounced crepitation felt over the joint line
• May indicate posterior meniscal lesion

Question 19

Brush Test

Answer 19

Knee Swelling

• Patient supine
• Therapist places one hand below joint line on medial surface of patella
• Strokes proximally with palm and fingers to suprapatellar pouch
• Then uses other hand to stroke down lateral surface of patella
• Positive test indicated by wave of fluid below medial distal border of patella
• Indicates effusion in the knee

Question 20

Patellar Tap Test

Answer 20

Knee Swelling

• Patient supine
• Knee flexed or extended to a point of discomfort
• Therapist applies slight tap over patella
• Positive test indicated if patella appears to be floating
• May indicate joint effusion

Question 21

Anterior Drawer Test (ankle)

Answer 21

Ligamentous Instability

• Patient in supine
• Therapist stabilizes distal tibia and fibula with one hand
• Therapist holds foot in 20 of plantar flexion and draws talus forward in the ankle mortise
• Positive test indicated by excessive anterior translation of the talus away from ankle mortise
• May indicate anterior talofibular ligament sprain

Question 22

Talar Tilt Test

Answer 22

Ligamentous Instability

• Patient in sidelying
• Knee flexed to 90
• Therapist stabilizes distal tibia and grasps talus with the other hand
• Foot maintained in neutral position
• Therapist tilts talus into abduction and adduction
• Positive test indicated by excessive adduction
• May indicate calcaneofibular ligament sprain

Question 23

Thompson Test

Answer 23

Miscellaneous Ankle

• Patient prone
• Feet extended over edge of table
• While patient relaxed, therapist squeezes muscle belly of gastroc and soleus
• Positive test indicated by absence of plantar flexion
• May indicate ruptured achilles tendon