Guide to Musculoskeletal

Assessment

Abnormalities of Gait from Hip Findings

Specific Testing/Maneuvers of Knee
Specific Testing/Maneuvers of Ankle & Foot
Specific Testing/Maneuvers of the Shoulder
Specific Testing/Maneuvers of the Elbow
Specific Testing/Maneuvers of the Wrist & Hand
Specific Testing/Maneuvers of the Spine
Specific Testing/Maneuvers of the Hip

Click subject to view clinical tests References

 Abnormalities of Gait
from Hip Findings

Trendelenburg Sign (March Test)

Abductor Lurch
Pelvic Obliquity
Specific Testing/Maneuvers
of the Knee

Varus Stress Test

Valgus Stress Test
Anterior Drawer Test
Posterior Drawer Test
Lachmans Test
McMurrays Test
Patellar Grind Test
Specific Testing/Maneuvers
of Ankle & Foot

Thompsons Test
Monofilament Sensory Testing
Specific Testing/Maneuvers
of the Shoulder
Hawkins- Kennedy Impingement Test
Neers Impingement Test
Painful Arc of Motion
Yergasons Test
Speeds Test
Apprehension Sign
Sulcus Sign
 Specific Testing/Maneuvers
of the Elbow

Tinels over Ulnar Nerve/ Cubital Tunnel

Resisted Wrist Extension
Resisted 3rd Finger Extension
Specific Testing/Maneuvers
of the Wrist & Hand

Tinels Sign
Phalens Test
Finkelsteins Test
Allens Test
Specific Testing/Maneuvers
of the Spine

Patricks (FABER) Test

Straight Leg Raise
Seated Slump Test
Trendelenburg Sign (March Test)
Specific Testing/Maneuvers
of the Hip

Thomas Test
Trendelenberg Sign (March Test)
True vs Apparent Leg Length
Ober Test
 Abnormalities of Gait
from Hip Findings
Trendelenburg Sign (March Test)
Structure/sign being tested: Pelvic core instability, insufficiency of the
gluteus medius to support the torso in an erect position, indicates
weakness in the muscle or decreased innervation

Position of Patient: Standing with weight evenly distributed between both

feet. Lower the shorts to the point at which the iliac crest or PSIS’ are
visible

Position of examiner: Sitting, Standing, or kneeling behind the patient

Procedure: Patient is instructed to lift the leg opposite the side being
tested, holding the hip joint between neutral and 30 degrees flexion

Positive Test Result: Pelvic asymmetry. The pelvis lowers on the non-
weight bearing side

Reference # 4,7
 Abnormalities of Gait
from Hip Findings
Abductor Lurch
Structure/sign being tested: Pelvic core instability.

Position of Patient: Patient is pacing around examination room

Position of examiner: Seated

Procedure: Examiner observes gait of the patient

Positive Test Result: A shoulder shift limp, minus the pelvic tilt
of the Trendelenburg gait. The trunk swings over the
affected leg on the ground (stance phase). If the condition is
bilateral, the trunk swings from side to side
 Abnormalities of Gait
from Hip Findings
Pelvic Obliquity
Structure/sign being tested: Anterior rotation of pelvis suggest shortening of
hip flexors, and/or lumbar spinal extensors. Posterior rotation suggest
tightness of hamstrings. Pelvic Obliquity secondary to functional
shortening of one leg is common

Position of Patient: Standing

Position of examiner: Standing

Procedure: The relative symmetry of bilateral ASIS, iliac crests and PSIS
should be noted

Positive Test Result: ASIS, iliac crest, or PSIS asymmetry

 Specific Testing/Maneuvers
of the Knee
Varus Stress Test
Structure/sign being tested: Integrity of the lateral collateral ligament (LCL)

Position of Patient: Lying supine with involved leg close to the side of the table

Position of examiner: Standing lateral to the patient. One hand supports to the
lateral portion of the distal tibia (acting as the fulcrum), while the other
hand grasps the knee along the medial joint line

Procedure: While holding the knee in slight flexion, an adduction force is

applied to the knee while the distal tibia is moved medially

Positive Test Result: Increased laxity when compared bilaterally with the other
knee. Ligament tests are graded as Negative (firm endpoint), 1+, 2+, 3+

Reference # 4,9
 Specific Testing/Maneuvers
of the Knee
Valgus Stress Test
Structure/sign being tested: Integrity of the medial collateral ligament (MCL)

Position of Patient: Lying supine with involved leg close to the side of the
table

Position of examiner: Standing lateral to the patient. One hand supports to

the medial portion of the distal tibia (acting as the fulcrum), while the
other hand grasps the knee along the lateral joint line

Procedure: While holding the knee in slight flexion, an abduction force is

applied to the knee while the distal tibia is moved laterally

Positive Test Result: Increased laxity when compared bilaterally with the
other knee. Ligament tests are graded as Negative (firm endpoint), 1+,
2+, 3+

Reference # 4,9
 Specific Testing/Maneuvers
of the Knee
Anterior Drawer Test
Structure/sign being tested: Integrity of the anterior collateral ligament (ACL)

Position of Patient: Lying supine, the hip is passively flexed to 45°, and the
knee is passively flexed to 90°

Position of examiner: The examiner sits on the examination table placing the
patients foot under the buttocks, providing a base of stability to fixate the
tibia. The examiner grasps the proximal tibia, with the fingers overlying
the joint space to access excursion, and the thumbs placed along the
joint line on either side

Procedure: Palpating to make sure the hamstrings are relaxed, an anteriorly

directed force is applied

Positive Test Result: Increased laxity when compared bilaterally with the
other knee. Ligament tests are graded as Negative (firm endpoint), 1+,
2+, 3+. NOTE: Lachmans test should be preferred maneuver for the
ACL

Reference # 3,4,9
 Specific Testing/Maneuvers
of the Knee
Posterior Drawer Test
Structure/sign being tested: Integrity of the posterior collateral ligament (PCL)

Position of Patient: Lying supine, the hip is passively flexed to 45°, and the
knee is passively flexed to 90°

Position of examiner: The examiner sits on the examination table placing the
patients foot under the buttocks, providing a base of stability to fixate the
tibia. The examiner grasps the proximal tibia, with the fingers overlying
the joint space to access excursion, and the thumbs placed along the
joint line on either side

Procedure: Palpating to make sure the hamstrings are relaxed, a posteriorly

directed force is applied

Positive Test Result: Increased laxity when compared bilaterally with the
other knee. Ligament tests are graded as Negative (firm endpoint), 1+,
2+, 3+

Reference # 2,3,4,9
 Specific Testing/Maneuvers
of the Knee
Lachmans Test
Structure/sign being tested: Integrity of the anterior collateral ligament ACL)

Position of Patient: Lying supine, the knee is passively flexed to 20°

Position of examiner: Standing lateral to the patient, the dominant hand

grasps the proximal tibia around the level of the tibial tuberosity. The
non-dominant hand grasps the distal femur just above the level of the
condyles

Procedure: While the examiner supports the weight of the leg and the knee
is flexed at 20°, with the hamstrings relaxed a firm anteriorly directed
force is applied drawing the tibia anteriorly while a posterior force is
applied to the femur

Positive Test Result: Increased laxity when compared bilaterally with the
other knee. Ligament tests are graded as Negative (firm endpoint), 1+,
2+, 3+

Reference # 3,4
 Specific Testing/Maneuvers
of the Knee
McMurrays Test
Structure/sign being tested: Integrity of the meniscus

Position of Patient: Lying supine

Position of examiner: Standing lateral and distal to the involved knee. One hand supports
the lower leg while the fingers and thumb of the opposite hand are placed along the
medial and lateral joint line

Procedure: Pass one- While the tibia is maintained in a neutral position, an axial load is
applied to the knee passively flexing and extending through the available ROM

Pass two- A valgus force is applied while the knee is flexing and extending. Then a
varus force is applied while the knee is flexing and extending

Pass three- The examiner internally rotates the tibia, while the knee is being flexed
and extended, and a varus force is applied. This procedure is repeated again with
external rotation of the tibia and a valgus force

Positive Test Result: A palpable click along the joint line, a reproduction of pain from the
menisci, or locking of the knee

Reference # 3,4,9
 Specific Testing/Maneuvers
of the Knee
Patellar Grind Test
Structure/sign being tested: Provocative test for patellofemoral etiology of pain

Position of Patient: Lying supine with the knees extended

Position of examiner: Standing lateral to the limb being evaluated. One hand is
placed proximal to the superior patellar pole

Procedure: The examiner applies a downward force to the patella in the femoral
groove. The patient is then asked to contract the quadriceps muscle slowly
while pressure is maintained on patella

Positive Test Result: The patient experiences pain

Reference # 4,9
 Specific Testing/Maneuvers
of the Ankle and Foot
Thompsons Test
Structure/sign being tested: Test for rupture of the Achilles Tendon

Position of Patient: Lying prone, with the feet off the edge of the table, or with
knee in flexion

Position of examiner: At the side of the patient, with one hand over the muscle
belly of the calf musculature

Procedure: The examiner compresses the calf muscle while observing for
plantar flexion of the foot

Positive Test Result: An absence of this plantar flexion implies a rupture of the
Achilles Tendon

Reference # 4,12
 Specific Testing/Maneuvers
of the Ankle and Foot
Monofilament Sensory Testing
Structure/sign being tested: Intact sensation in the plantar aspect of the foot
(Done yearly in Diabetics)

Position of Patient: Lying prone with feet off the edge of the table, or with
knee in flexion. The patients eyes should be closed

Position of examiner: At the side of the patient

Procedure: Monofilament is applied to plantar aspect of metatarsal heads of

foot over intact skin with enough pressure to begin bending the filament.
The patient should be able to detect sensation of the filament

Positive Test Result: Absence of sensation is an abnormal finding

 Specific Testing/Maneuvers
of Shoulder-Impingement Tests
Hawkins-Kennedy
Structure/sign being tested: Impingement of the supraspinatus tendon under
the coracoacromial arch

Position of Patient: Sitting or standing

Position of examiner: Standing lateral to involved limb, the patients shoulder

is stabilized on the posterior aspect with one hand, the other hand
grasps the patients arm at the elbow

Procedure: The shoulder and elbow are first passively flexed to 90°, then the
shoulder is passively internally rotated (with some force)

Positive Test Result: Pain is a positive sign, especially near end range

Reference # 4,5,8
 Specific Testing/Maneuvers
of Shoulder-Impingement Tests
Painful Arc of Motion

Structure/sign being tested: Possible impingement syndrome

Position of Patient: Standing, arms at sides

Position of examiner: Standing in front of patient

Procedure: With palms facing forward, patient abducts both arms from 0°
to 180°

Positive Test Result: Reproduction of pain on abduction between 60° and

120° of motion

Reference # 4,5
 Specific Testing/ Maneuvers
of Shoulder-Impingement Tests
Neers Test
Structure/sign being tested: Impingement syndrome, compression of the
greater tuberosity against the inferior acromion

Position of Patient: Sitting or Standing

Position of examiner: Standing lateral to involved limb. The patients

shoulder is stabilized on the posterior aspect with one hand, the other
hand grasps the patients arm at the elbow

Procedure: With elbow extended, the shoulder is passively flexed to its end
range

Positive Test Result: Terminal forward flexion causing pain

Reference # 4,5,13
 Specific Testing/Maneuvers of
Shoulder-Biceps Tendonitis
Yergasons Test
Structure/sign being tested: Checking for subluxation/pain of the long head
of the biceps tendon in bicipital groove, indicating laxity of the
transverse humeral ligament

Position of Patient: Sitting with arm at 0° abduction, elbow flexed to 90°,

and forearm pronated

Position of examiner: One hand is used to stabilize the elbow against the
body, the other hand is placed on the forearm proximal to the wrist

Procedure: The examiner resists the patients attempt to supinate the

forearm and externally rotate the shoulder

Positive Test Result: Subluxation, snapping or popping in the bicipital

groove

Reference # 4,5,9,15
 Specific Testing/Maneuvers
of Shoulder-Biceps Tendonitis
Speeds Test

Structure/sign being tested: Biceps tendonitis, possibly ruptured biceps tendon

Position of Patient: Sitting with elbow extended, and forearm supinated

Position of examiner: The fingers of one hand are placed over the bicipital
groove, the other hand is place on the forearm proximal to the wrist

Procedure: The examiner resists forward flexion to 90° while palpating the
bicipital groove

Positive Test Result: Pain over bicipital groove

Reference # 4,5
 Specific Testing/Maneuvers of
Shoulder-Instability Tests
Anterior Apprehension Test
Structure/sign being tested: The anterior capsule of the glenohumeral joint

Position of Patient: Lying supine, or sitting.

Position of examiner: Standing behind or beside the patient. One hand is

placed just distal to the shoulder, while the other hand supports the
forearm proximal to the wrist

Procedure: The shoulder is abducted to 90°, and the elbow is flexed to 90°.
The examiner passively externally rotates as far as patient will allow

Positive Test Result: Sensation of instability, not pain, reflected by facial or

verbal visualization

Reference # 4,9,11
 Specific Testing/Maneuvers of
Shoulder-Instability Tests
Sulcus Sign
Structure/sign being tested: Integrity of the inferior capsule of glenohumeral
joint

Position of Patient: Sitting with arms relaxed and hanging at their side

Position of examiner: Standing behind or beside the patient. One hand

palpates the shoulder by placing the thumb and fingers on the anterior
and posterior aspects of the humeral head. The other hand grasps the
arm just proximal to the elbow

Procedure: While palpating and observing the humeral head, inferior

traction is applied

Positive Test Result: An observable and/or palpable space or sulcus

between humeral head and acromion when compared bilaterally

Reference # 4,11
 Specific Testing/Maneuvers
of Elbow
Tinels Sign over Ulnar
Nerve/Cubital Tunnel
Structure/sign being tested: The integrity of the Ulnar nerve

Position of Patient: Standing or sitting with the elbow slightly flexed

Position of examiner: Standing lateral to the patient

Procedure: The examiner taps the Ulnar nerve where it passes through the
Ulnar groove (Tinels) between the medial epicondyle and olecranon
process, then tapping the Ulnar nerve in the Cubital tunnel

Positive Test Result: Reproduction of pain/paresthesias in the lateral

forearm, hand, and 4-5th fingers

Reference # 4,9
 Specific Testing/Maneuvers
of Elbow
Resisted Wrist Extension Test
Structure/sign being tested: The common extensor tendon as it passes over the
lateral epicondyle

Position of Patient: Standing with elbow in extension, forearm pronated, and fingers
flexed

Position of examiner: Standing lateral to the patient. One hand is placed over the
dorsal aspect of the wrist and hand

Procedure: The examiner resists wrist extension while palpating the lateral
epicondyle

Positive Test Result: Pain over the lateral epicondyle

Reference # 4,9
 Specific Testing/Maneuvers
of the Elbow
Resisted 3rd Finger Extension Test
Structure/sign being tested: The common extensor tendon as it passes over the
lateral epicondyle

Position of Patient: Standing with elbow in extension, forearm pronated, and fingers
flexed

Position of examiner: Standing lateral to the patient. One hand is placed over the
dorsal aspect of the fingers

Procedure: The examiner resists finger extension while palpating the lateral
epicondyle

Positive Test Result: Pain over the lateral epicondyle

 Specific Testing/Maneuvers
of the Wrist & Hand
Tinels Sign
Structure/sign being tested: Pathology of the median nerve

Position of Patient: Seated or standing

Position of examiner: Standing or sitting in front of patient

Procedure: Tap the surface in the region of the distal palmar crease over the carpal
tunnel

Positive Test Result: Pain/ numbness/ tingling elicited with the tap

Reference # 4
 Specific Testing/Maneuvers
of Wrist & Hand
Phalens Test
Structure/sign being tested: Pathology of the median nerve

Position of Patient: Seated

Position of examiner: Seated or standing in front of patient

Procedure: The examiner instructs the patient to place both hands together with
wrists in full flexion. The patient then drops their elbows below their wrists and
holds the position for 30 seconds

Positive Test Result: Pain/ paresthesias in median nerve distribution

Reference # 4,9
 Specific Testing/Maneuvers
of Wrist & Hand
Finkelsteins Test

Structure/sign being tested: De Quervains Tenosynovitis

Position of Patient: Seated

Position of examiner: Standing or seated

Procedure: The examiner instructs the patient to grasp a flexed thumb under the
fingers by making a fist. The patient then ulnarly deviates the wrist

Positive Test Result: Increased pain over radial styloid in the first dorsal
compartment of the wrist differentiates De Quervains from arthritis in the first
metacarpal

Reference # 4,6
 Specific Testing/Maneuvers
of Wrist & Hand
Allens Test
Structure/sign being tested: Partial or complete occlusion of radial or ulnar artery

Position of Patient: Seated

Position of examiner: Seated

Procedure: The examiner instructs patient to open and close fists several times,
and then squeeze fists tightly. Place the thumb over the radial artery, and the
index and middle fingers over the ulnar artery and apply pressure.
While maintaining pressure, instruct patient to relax the hand. Release
pressure on one artery and observe refilling response. Repeat this with the
other artery and compare with both hands

Positive Test Result: Lack of resumption of circulation upon release of pressure of

artery

Reference # 4,9
 Specific Testing/Maneuvers
of the Spine
Patricks/ FABER Test
Structure/sign being tested: SI joint pathology and intraarticular hip
pathology

Position of Patient: Lying supine

Position of examiner: Standing in front of the patient

Procedure: The patient is instructed to place one leg in the ‘figure 4’

position (FABER: flexion, abduction, external rotation). The examiner
applies a downward pressure on the leg (above the knee) of the leg
that is crossed over

Positive Test Result: Pain in ipsilateral groin is intraarticular hip pathology,

pain in SI joint is suggestive of SI joint pathalogy

Reference # 4,9
 Specific Testing/Maneuvers
of the Spine
Straight Leg Raise
Structure/sign being tested: Nerve root tension test

Position of Patient: Lying supine

Position of examiner: At the side of the patient. One hand grasps the heel and the
other hand on the anterior knee to maintain knee extension throughout the test.
The test is performed on the involved side

Procedure: While dorsiflexing the foot, the examiner passively flexes the hip until
discomfort is experienced or the full ROM is obtained

Positive Test Result: Peripheral pain prior to the end of normal ROM

Reference # 4,9,10
 Specific Testing/Maneuvers
of the Spine
Seated Slump Test
Structure/sign being tested: Nerve root tension test

Position of Patient: Seated in a chair

Position of examiner: Standing or sitting at side of patient

Procedure: With hip at 90°, the patient performs an active unilateral straight leg
raise, extending the knee and dorsiflexing the foot. Finally the cervical spine is
flexed

Positive Test Result: Peripheral pain prior to the end of normal ROM, which can be
relieved by neck extension

Reference # 4
 Specific Testing/Maneuvers
of the Spine
Trendelenburg Sign (March Test)
Structure/sign being tested: Pelvic core instability, insufficiency of the gluteus
medius to support the torso in an erect position, indicates weakness in the
muscle or decreased innervation

Position of Patient: Standing with weight evenly distributed between both feet. Lower
the shorts to the point at which the iliac crest or PSIS’ are visible

Position of examiner: Sitting, Standing, or kneeling behind the patient

Procedure: Patient is instructed to lift the leg opposite the side being tested, holding
the hip joint between neutral and 30 degrees flexion

Positive Test Result: Pelvic asymmetry. The pelvis lowers on the non-weight bearing
side

Reference # 4,7
 Specific Testing/Maneuvers
of the Hip
Thomas Test
Structure/sign being tested: Tightness of iliopsoas muscle group, hip
flexor flexibility

Position of Patient: Lying supine

Position of examiner: At the side of the patient

Procedure: The patient puts contralateral hip and knee into terminal
flexion against the chest, the other leg is relaxed and allowed to
extend

Positive Test Result: If the femur/leg is above neutral in the sagittal plane,
it is considered to be abnormal flexibility of the hip flexors

Reference # 4
 Specific Testing/Maneuvers
of the Hip
Trendelenburg Sign (March Test)
Structure/sign being tested: Pelvic core instability, insufficiency of the gluteus
medius to support the torso in an erect position, indicates weakness in the
muscle or decreased innervation

Position of Patient: Standing with weight evenly distributed between both feet.
Lower the shorts to the point at which the iliac crest or PSIS’ are visible

Position of examiner: Sitting, Standing, or kneeling behind the patient

Procedure: Patient is instructed to lift the leg opposite the side being tested,
holding the hip joint between neutral and 30 degrees flexion

Positive Test Result: Pelvic asymmetry. The pelvis lowers on the non-weight
bearing side

Reference # 4,7
 Specific Testing/Maneuvers
of the Hip
True vs. Apparent Leg
Length Test
Structure/sign being tested: Structure leg length difference vs. anterior
rotation on the side of the shorter distance, or posterior rotation of the
side of the longer distance

Position of Patient: Lying supine

Position of examiner: Standing at side of patient

Procedure: First the examiner measures the distance from the umbilicus to
the medial malleolus of each leg. Then the examiner measures the
distance from the ASIS to the medial malleolus of each leg

Positive Test Result: A difference greater than ¼ inch between the two legs

Reference # 4,9
 Specific Testing/Maneuvers
of the Hip
Obers Test
Structure/sign being tested: Tightness of the IlioTibial Band

Position of Patient: The patient lays on contralateral side of the affected or

painful side, the bottom hip and knee are flexed for stability

Position of examiner: At the side of the patient

Procedure: The examiner passively flexes the knee to 90°, then passively
extends the top hip and abducts the hip. The muscles should be relaxed
and allowed to drop to the table

Positive Test Result: If the leg stays above the table, or feels tight when
overpressure is applied

Reference # 4,9,14
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