Special Tests (Objective Exam) Flashcards
Crossover Impingement Test
- Passive test
- Patient is standing; Flex the shoulder to 90deg, & passively bring the testing arm to the opposite shoulder –> while supporting on patients back, apply pressure into horizontal adduction
- Positive test for impingement =
- anterior pain: subscapularis, supraspinatus, long head of biceps
- posterior pain: infraspinatus, teres minor, posterior capsule
- superior pain: AC joint
Hawkins-Kennedy Test
- Passive test
- Flex the shoulder to 90deg w/ elbow at 90deg, slowly apply pressure into IR
- Positive test for impingement of supraspinatus = painful (reproduction of symptoms)
Neer’s Test
- Passive test
- Patient is sitting, clinician stands behind & while stabilizing the scapula passively elevate the arm w/ arm neutral or supinated; to make it impinged more elevate with thumb down
- Positive test for impingement of supraspinatus = painful
Speed’s Test
- Active test
- Palpate the biceps tendon, flex the arm to 90deg & supinate (ER) –> apply pressure down on distal forearm
- Positive test for biceps tendonitis = painful & weak
Supraspinatus tendonitis test
“empty can test”
- Active test
- Elevate arm to 90deg in scapular plane w/ thumb down, ask patient to hold arms and apply force down on distal forearm
- Positive test for tendonitis or partial tear = painful & weakness
Drop Arm Test
- Active test
- Passively elevate the patient’s arm into 90deg elevation w/ neutral rotation (palm down) –> ask patient to hold position & add minimal resistance
- Positive test for complete supraspinatus tear = arm drops or severely compensates by leaning or using traps (no pressure from supraspinatus to hold the arm up even though the delt is the primary muscle acting in that position)
O’Brien’s Test
- Active test
- Flex arm to 90deg, bring into 10deg of horizontal adduction & IR (thumb down) –> ask patient to hold position and apply pressure on distal forearm down
- IF this is painful then supinate the arm (IR) and perform the same test… if this alleviates the pain then the test is confirmed
- Positive test for SLAP tear or AC dysfunction = pain in ER position & alleviated in IR position
*reason is b/c when ER’d the biceps tendon & capsule are on stretch
GH Load & Shift
GH anterior & posterior instability tests
- Passive test
- Patient is sitting relaxed –> stabilize the scapula and push on ant/post of humeral head OR grip as proximal to head on shaft & move forward/backward
- Grade I = 1.5cm
* testing for ant/post laxity
GH Inferior Instability Tests
- Passive test
- Patient is sitting –> grip humerus more distally (can use elbow crease) & pull the humerus down
- Grade I = 1.0cm
Grade II = 1-2cm
Grade III - >2cm
Clunk Test
- Passive test
- Patient is supine –> arm overhead in full abduction –> clincian put one hand under posterior aspect of humeral head & simultaneously ER the arm & apply pressure/compression straight down
- Positive test for labrum tear = pain, clunk or grinding
Apprehension/Relocation Test
- Passive test
- Patient is supine –> Abduct the arm to 90deg, rest on your thigh & slowly ER; IF the patient feels apprehension or makes a face then apply a posterior glide pressure
- Positive test for anterior GH instability Or labral tear(usually bankarts lesion) = pain or apprehension
- Relocation test positive if pain or apprehension is relieved when posterior force is applied to GH & can tolerate maximal ER
Lateral Collateral Stress Test
–> for lateral (radial) collateral ligament laxity
- Patient is seated –> forearm supinated & 5-30deg of elbow flexion
- Apply a varus force to the elbow joint
- Positive test = abnormal gapping; pain
Medial Collateral Stress Test
–> for medial (ulnar) collateral ligament laxity
- Patient is seated –> forearm supinated & in 20-30deg elbow flexion
- Apply a valgus force to the elbow joint
- Positive test = abnormal gapping; pain
ECRB Test
–> muscle resisted test for lateral epicondylitis
- patient flex the elbow to 80deg and pronate forearm
- Apply pressure down on middle finger
- Positive test = pain at lateral epicondyle
Cozen’s Test
–> muscle resisted test for lateral epicondylitis
- Patient should make a fist, arm pronated, & elbow flexed
- Ask patient to extend their wrist & apply pressure into flexion
- Positive test = pain at lateral epicondyle or weakness
Mill’s test
–> passive stretch test for lateral epicondylitis
- palpate the lateral epicondyle
- passively pronate the forearm w/ the wrist flexed and bring into elbow extension
- Positive test = pain at lateral epicondyle
Medial Epicondylitis Test’s
–> passive stretch test AND muscle resisted test
- Palpate medial epicondyle
- Passively supinate the arm w/ the wrist extended & bring the elbow into extension
- ask patient to flex the wrist and resist
- Positive test = pain at medial epicondyle
Tinel’s Test
–> ulnar nerve integrity test
- Patient relaxed w/ neutral rotation & slight elbow flexion
- Tap ulnar nerve in the ulnar groove between the olcranon & medial epicondyle
- Positive test = tingling, reproduction of symptoms
Pronator Teres Syndrome Test
–> median nerve integrity test –>pronator teres syndrome
- Stabilize elbow on table, grab ahold of patients hand like you are shaking hands
- Ask patient to turn forearm into pronation & resist
- Positive test = tingling, burning sensation
Allen Test
–> for Reynauds Sydrome; poor circulation of ulnar & radial arteries
- Stabilize elbow on table and put hand straight up
- PT compresses both radial & ulna arteries –> pt makes fist 3-5 times –> release one side and observe pattern of vessels on palmer side
(normal filling time <5sec) - Repeat for other side
- Positive test = blenching remains after pressure is released from the artery
Finkelstein’s Test
–> for tenosynovitis of the thumb (de Quervain’s)
- Stabilize elbow on table & ask patient to make a fist w/ thumb inside the fingers
- Passively move the patient into ulnar deviation
- Positive test = pain over the APL & EPB
Froment’s Sign
–> for ulnar nerve injury & weakened adductor pollicis
- Place a piece of paper between patients index finger and thumb
- Try to remove the paper
- Positive test = patient cannot hold onto the the paper or they flex IP joint (sub)
Phalen’s/Reverse Phalen’s Test
–> for carpal tunnel syndrome
- Patient puts dorsum of both hands together w/ fingers down for 60 seconds (phalens); OR opposite position for reverse phalens
- Positive test = pain or parasthesia in median nerve distribution
Tinel’s Sign (median nerve)
–> for median nerve compression/carpal tunnel
- Supinate the forearm and tap on the patients carpal ligament with you fingertip for 20 seconds
- Positive test = pain or parasthesia in median nerve distribution
Watson’s Sign
–> for scaphoid-lunate dissociation
- Patient is seated w/ elbow flexed to 90deg & forearm neutral
- Stabilize scaphoid to prevent natural volar glide and move patient from UD to RD
- Positive test = dorsal displacement of the scaphoid
Trendelenburg Sign
–> for weak hip abductors (specifically glute med)
- patient is standing on one leg
- Positive test if contralateral hip drops
Hamstring Length Test
aka Straight leg raise for length of hamstring muscles
- Patient is supine
- Positive test = less than 80deg hip flexion or compensations of raising opposite leg or hip/pelvis rotation
Thomas test
–> for iliopsoas length
- patient is supine, have them bring one knee to chest & look for contralateral leg to raise from the table
- slowly lower leg w/ knee in extension, IF the leg reaches the table & didnt w/ normal test then rectus femoris is tight
- slowly lower leg in abduction, IF leg reaches the table & didnt w/ normal test then tight TFL
IF the leg didnt reach the table in any of the 3 testing positions then it is a positive test for tight iliopsoas
Ober Test
–> for tight IT band
- Patient is sidelying w/ slight hip & knee flexion
- Stabilize pelvis & bring top leg into neutral or slight extension & lower into adduction
- watch for IR compensations
Positive test = no adduction or less than 10deg from horizontal
Scour’s Test
aka hip quadrant test–> for labral tear, osteoarthritis, bursitis
- Patient is supine
- Bring leg into knee & hip flexion then apply pressure through line of femur starting with ADDuction –> flexion –> ABDuction
Positive test = gritty, snapping or painful sensation
Femoral-acetabular impingement test
–> for anteriosuperior labral tear & piriformis syndrome
- Patient is supine w/ hip & knee flexion, then adduction & IR
Positive test = painful clicking in groin area (labral tear) OR pain in posterior area (piriformis)
FABER test
–> for loss of ROM
- Supine w/ leg placed so foot is resting on top of opposite knee (flexion, abduction & IR)
- stabilize opposite ASIS & slowly press knee down to table
Positive test = pain or knee does not reach same level as the ankle
Piriformis Test
–> for piriformis syndrome
- Sidelying w/ 60deg hip flexion, flexed knee
- Stabilize the pelvis and apply a downward force on the knee
Positive test = sciatic pain or tightness of the piriformis
Craig’s test
–> for anteversion
- Patient is prone w/ knee flexed
- Palpate greater trochanter tuberance & rotate th eleg until it is parallel to the table
- In this position measure IR/ER
Normal anteversion = 8-15deg IR
Excessive anteversion = excessive IR >15
Retroversion = decreased IR or excessive ER
Ely’s Test
–> for quadriceps length test
- Patient is prone
- Try to passively bring heel to buttocks while stabilizing the pelvis
Positive test = anterior pelvic tilt or limited knee flexion (cannot reach buttocks)
Q-angle
–> for patella position, hip & knee alignment
- patient is supine
- measure line from ASIS to mid patella & mid patella to tibial tuberosity
NORMAL = males 13deg and females 18deg
Positive test for chondromalacia patella or patella alta = 18
Patellar tap test
–> for joint effusion
- Patient is supine w/ knees slightly flexed & towel under knee
- Place one hand just superior to patella while lightly tapping the patella with the other hand
Positive test = patella that feels like its floating/bouncing
Posterior Sag
–> for PCL or posterior instability
- Patient is supine w/ knee and hips flexed to 90 degrees
- Observe from side view for presence of posterior lag of tibia
Positive test = knee posteriorly subluxed or tibia sags back >1cm
Posterior Drawer test
–> for PCL or posterior instability
- Patient is supine w/ knee flexed to 90deg and foot flat on table
- Sit on foot and grasp prox tibia and push back (post)
Positive test = excessive posterior translation of tibia on femur compared to opposite side
Anterior Drawer Test
–> for ACL or anterior instability
- Patient is supine w/ knee flexed to 90deg and foot flat on table
- Sit on foot & pull proximal tibia anterior
Positive test = excessive anterior translation of tibia on femur compared to opposite side
Lachman’s Test
–> for ACL or anterior instability
- Patient is supine w/ knee flexed to 15-30deg
- Grasp lateral femur to stabilize & medial tibia & exert anterior force on tibia
Positive test = excessive anterior translation of tibia on femur
Varus/Valgus Stress test
–> for medial/MCL (valgus) & lateralLCL (varus) stability
- Patient is supine w/ thigh fully supported & lower leg dangling off table
- FIRST test at 30deg to isolate MCL/LCL; NEXT test at 5deg to also test ACL;
- Stabilize medial/lateral knee and grasp lateral/medial ankle and apply force
If laxity only at 30deg then just collaterals are damaged, but if laxity at 5 deg then ACL also injured and more severe injury
Positive test = excessive gapping w/ or w/o pain
McMurray’s Test
–> for meniscus instability
- Patient is supine 2/ knee in full flexion & hip flexion to gain access to palpate joint line
- Support the heel and apply medial rotation of tibia w/ varus force (lateral meniscus) & lateral rotation of tibia w/ valgus force (medial) while pulling leg into extension
Positive test = pain
Apprehension test
–> for PF dysfunction/dislocation
- Patient is supine w/ quad relaxed and towel roll under knee for 30deg flexion
- glide patella laterally slowly looking for any signs of apprehension
Positive test = apprehensive reaction or quad contracts isometrically to control patella
Apley’s Compression Test
–> for meniscus injury
- Patient is prone w/ knee flexed
- Grasp ankle/heel and apply pressure down through tibia w/ IR & ER
Positive test = pain (IR for medial & ER for lateral)
Apley’s Distraction Test
–> for collateral ligament injury
- Patient is prone w/ knee flexed
- Grasp ankle & distract tibia then move into IR and ER
Positive test = pain (IR - MCL, ER - LCL)
Critical Test
–> for patellofemoral tracking dysfunction/pain
- Patient is sitting w/ leg off edge of table
- Patient performs quad contractions at different angles (starting at 120deg flex and going to 5deg)
If patient feels pain —> medially glide patella & have patient perform test again
IF that relieves pain then POSITIVE test
Navicular Drop Test
–> for excessive/over-pronation
- Mark the navicular tubercle
- Find subtalar neutral and measure distance from ground
- Have patient march 5x & then remeasure distance
Positive test = >10mm difference
Anterior Drawer Test (for ankle)
–> for integrity of anterior talofibular & anterior tibiofibular ligaments
- Patient is sitting w/ leg off table & foot relaxed
- Stabilize tib/fib w/ one hand while grasping calcaneus with the other & apply and anterior force (pull)
Positive test = excessive anterior movement or laxity of talus compared to contralateral side
Talar Tilt
–> for integrity of calcaneofibular ligament
- Patient is sitting w/ foot relaxed off table
- Stabilize tib/fib & grasp the lateral talus & calcaneus w/ other hand
- Apply an inversion force at TC & ST joint
Positive test = lateral gapping between fibula and calcaneus and/or pain
Homan’s Sign
–> for DVT/posterior compartment syndrome
- Patient is supine w/ foot relaxed
- Stabilize & hold knee in extension & grasp heel with the other hand & support the foot w/ the forearm
- Passively dorsiflex the foot
Positive test = pain in calf
Squeeze Test (Morton’s test)
–> for Morton’s Neuroma
- Patient is supine
- Grasp the foot around the metatarsal heads & squeeze the heads together
Positive test = increased pain or burning/stabbing sensation
Thompson’s Test
–> for achilles rupture
- Patient is prone in full knee extension & foot unsupported
- Squeeze the two gastroc heads together
Positive test = no plantar flexion
