SPECIAL TEST

• To determine the presence of a particular disease, condition CN 7-Facial N.

or injury -mixed
M-facial mm, facial expression
Synonymous terms: S-ant. 2/3 of tongue
• Clinical Accessories
• Provocative Test Bell’s palsy
• Structural Test -hereditary, viral, ischemia
• Palpation Test -unilateral (Mobius syndrome-bilateral)
-paralysis
Patient Evaluation: -infection
• Patient history -cold
• Observation -traveling
• Examination -Rubella, Herpes Zoster, Simpler
• Movement SS:
• Functional Assessment •Marin Amat Syndrome
-forceful or max opening of the mouth
=closure of the eyes
Special Test
• Done after assessment of the data mentioned above
•Marcus Gunn Phenomenon
• Used for each joint to determine presence of a disease,
-Jaw Winking
condition or injury
-active movement of the jaw to the opposite side
• These are only suggestive, if (+), there is a probability
=elevation of the upper eyelid
• Specific test for specific conditions
• Choose the test that yields the best results
•Bells Phenomenon
-ask pt to close eyes
Uses of Special test =eyes looks upward and outward
• To confirm a tentative diagnosis
• To make a different diagnosis •Chvostek Test
• To differentiate between structures -tap the parotid gland
• To understand unusual signs =increase salivation and twitching of the masseter
• To unravel difficult signs and symptoms
Basal ganglia
More accurately performed -Dopamine
• Right after injury •Parkinson’s Disease (Paralysis Agitans)
Period of shock -Resting tremors
5-10 mins after injury -bradykinisia
• Under anaesthesia -rigidity
• Chronic condition -postural instability
• Highly dependent on: SS-Bradum-frontal lobe
Examiners skill
Patient’s relaxation •Snout Reflex
-tap the lips
Special Test =pouting or protrusion of lips
• Never use in isolation
• Need not learn all •Palmomental Reflex
• Choose which gives the best result -rotate thumb or vigorously stimulation of thinar palm
• Reproduce the same movement as the mechanism of injury =twitching of mentalis mm and orbicularis oris
(MOI) which may provoke symptoms
• Care should be taken if there is severe pain and apprehension •Glabellar Tap/Myerson’s Sign
-tap the glabella
Contraindications and Precautions: =pt won’t stop blinking
• Severe pain and apprehension
• Acute and irritable condition of joints SCI
• Severe pain -spinal shock = flaccidity (flabby, no tone)
• Instability
• Osteoporosis •Bulbocavernous reflex
• Pathologic bone disease - pinch glans penis
• Active disease processes
• Unusual s/s •Clitocavernous reflex
• Major neurological signs -pinch the gland and clit
• Patient apprehension =anal winking/contraction (normal)
-S3-S4 Myotomes 1. STOOP TEST
- Pt is asked to walk briskly for about 50m
•Cremasteric reflex - Pain ensues in the buttock and lower limb
-stroke middle portion of thigh - Pt is ask to flex forward
=elevated ipsilateral testicle (normal) - (+) IF PAIN IS RELIEVE UPON FLEXION
-S1-S2
2. BICYCLE TEST OF VAN GELDEREN
•Beevor’s Reflex - Pt is seated on an exercise bicycle & asked to pedal against
-cough, flex head, and sit up resistance
=umbilicus doesn’t stay on the midline (normal) - Pt starts to pedal while leaning backward to accentuate the
Lumbar Lordosis
•Abdominal Reflex • 1st Part (+) – Pain on the buttock & posterior thigh
-T8-T12 distribution occurs, followed by tingling in the affected extremity
-stimulate area between costal margin to inguinal ligament • 2nd Part (+) – Pain subsides over a period of time when
=twitching of abs (normal) asked to lean forward while continue pedalling; Pain
returns when upright again
•Gluteal reflex
-L4-L5 IV. Test for Malingering:
-gluteus max stroke of reflex hammer 1. HOOVER TEST
=ipsilateral twitch/contraction of glut max - Pt in supine position
- Examiner places over one hand under each heel while pt’s
Cervical Area leg remain relaxed on the table
Test for neurological symptoms - Pt asks to perform USLR
- (+) UNABLE TO LIFT LEG WITH NEGATIVE
•Foraminal compression test aka Spurling’s test PRESSURE ON OPPOSITE LIMB
-pt actively bends and side flexes the head on the affected side
-examiner carefully presses straight down on the head
2. BURNS TEST
-if (+) pain radiates into the arm toward wc the head is
- Pt is asked to kneel on a chair & then bend forward to touch
flexed during compression
the floor with the fingers
-indicates pressure on a nerve root or cervical radiculitis.
- (+) IF UNABLE TO PERFORM or PATIENT
OVERBALANCES
•Jackson’s compression test
-pt rotates head on one side
-examiner presses carefully straight down on head V. Test for Paediatric Hip Pathology:
-repeat on the other side 1. ORTOLANI’S SIGN
- (+) pain radiates into arm - Infant in supine, the examiner flexes the hip and grasps the
-indicative of pressure on the nerve leg & the fingers are placed along the outside of the thighs to
-pain distribution buttocks
•Maximum cervical compression test - With gentle traction, the thighs are abducted & pressure is
-pt side flexes head and then rotates applied against Greater Trochanter
- (+) EXAMINER MAY FEEL THE CLICK or CLUNK,
ST HIP IS REDUCED
I. Test for Intrathecal Pressure:
1. VALSALVA MANEUVER 2. BARLOW’S TEST
- Pt is seated and is asked to take a breath, hold it and then - Infant lies supine with hip flexed to 90 & kneed fully flexed
bear down as if evacuating the bowel. - Examiner’s middle finger of each hand is placed over the
- If pain increases in the Lumbar area, it is an indication of greater trochanter & thumb is placed on med. thigh
increase intrathecal pressure, - Hip is taken into abduction while the examiner’s middle
- Increased intrathecal pressure leads to symptoms in the finger applies forward pressure behind the greater troch
Sciatic Nerve distribution. - If the femoral head slips out over the post. Lip of the
acetabulum & then reduces again when pressure is
II. Test for Muscle Dysfunction: removed, the hip is classified as UNSTABLE.
1. BEEVOR’S SIGN
- Pt lies supine and ask to do the ff: 3. GALEAZZI’S SIGN (Alli’s Test)
• Flexes the head against resistance - For assessing the unilateral congenital dislocation of the hip
• Coughs - Used in children from 3 to 18 months
• Attempts to sit up & with hands behind - Child lies supine with the knees flexed and hip flexed to 90
- (+) IF UMBILICUS DOES NOT REMAIN IN degrees
STRAIGHT LINE - (+) IF ONE KNEE IS HIGHER THAN THE OTHER
- Indicates pathology in abdominal mm
4. TELESCOPING SIGN (Piston/Dupuytren’s Test)
III. Test for Intermittent Claudication: - Child lies in supine position
- Examiner flexes the knee and hip to 90 degrees - (+) TENDS TO EXTEND TRUNK TO RELIEVE
- Femur pushed down on the table then lifted up & away from TENSION IN HAMSTRING MUSCLE
the table
- With dislocated hip, there is a lot of relative movement or 8. HAMSTRING CONTRACTURE TEST
excessive movement called “Telescoping or Pistoning” - Pt sits with one knee flexed against the cheat to stabilize the
pelvis
VI. Test for Muscle Tightness or Pathology: - Other knee is extended
1. THOMAS TEST - Pt attempts to flex trunk & touch the toes of extended LE
- Used to assess a hip flexion contracture with the fingers
- Pt lies supine while examiner checks for excessive Lordosis - Repeat on the other side
- Examiner bring the knee to the chest, Pt holds the flexed hip - (+) IF UNABLE TO REACH TOES
against chest - Hamstring tightness
- (+) PATIENT LEG RAISES OFF THE TABLE
VII. Test for One Plane Instability:
2. RECTUS FEMORIS CONTRACTURE TEST (Kendall 1. ABDUCTION TEST – MEDIAL (Valgus Stress Test)
test) - For medial instability
- Pt lies supine with knee bent over the edge of table - Examiner pushes the knee medially on full extension and
- Pt flexes one knee on to chest & holds it slightly flexed (20’-30’)
- The angle of the test, knee should remain at 90 degrees - (+) TIBIA MOVES AWAY FROM FEMUR
- (+) TEST KNEE SLIGHTLY EXTENDS EXCESSIVELY
- A (+) finding on full extension is classified as a major
3. ELY’S TEST disruption of knee
- Pt lies prone & the examiner passively flexes the knee
- (+) FLEXION OF THE HIP ON THE SAME SIDE • If positive in extension • If positive with knee in 20’-30’
- Indicates tight Rectus Femoris mm Flexion
- 2 sides should be tested/compared - MCL - MCL
- Posterior Oblique Ligament - PCL
4. OBER’S TEST - Posteromedial capsule -Posterior Oblique
- Assess the TFL (Iliotibial Band) for contracture Ligament
- Pt in side lying with lower leg flexed at hip and knee for - ACL -Posteromedial capsule
stability - PCL
- Examiner then passively abducts and extends the patient’s - Medial quadriceps expansion
upper leg with knee straight or 90’ flexed - Semimembranosus muscle
- (+) WHEN EXAMINER SLOWLY LOWERS THE
UPPER LEG, IF IT REMAINS ABDUCTED & DOES 2. ADDUCTION TEST – LATERAL (Varus Stress Test)
NOT FALL - For Lateral Instability
- Examiner pushes knee laterally
5. NOBLE COMPRESSION TEST - In stress radiograph:
- For Iliotibial Band Friction Syndrome a. 5mm Opening- Grade 1 injury
- Pt lies supine with 90’ flexed and hip in flexed position b. Up to 10 mm – Grade 2 injury
- Examiner applies pressure with the thumb to the lat.femoral c. > 10mm – Grade 3 injury
epicondyle or 1-2 cm proximally - Examiner pushes the knee laterally on full extension and
- Pressure is maintained while Pt slowly extend the knee slightly flexed (20’ – 30’)
- (+) PATIENT IN SEVERE PAIN OVER THE - (+) TIBIA MOVES AWAY FROM FEMUR
LAT.FEMORAL CONDYLE AT 30 DEGREES OF EXCESSIVELY
FLEXION
• In extension • In 20’-30’ Flexion
6. PIRIFORMIS TEST - LCL -LCL
- Pt side lying position with the test leg uppermost - Posterolateral capsule - Posterolateral capsule
- Pt flexes the test hip to 60’ with knee flexed - Arcuate-popliteal Complex - Arcuate-popliteal
- Then examiner applies a downward pressure to the knee Complex
while stabilizing the hip - Biceps femoris tendon -ITB
- If piriformis is tight, pain is elicited in the muscle - PCL -Biceps femoris Tendon
- If piriformis is pinching the sciatic nerve, pain in - ACL
buttocks & sciatic may be present. - Lateral gastrocnemius
- ITB
7. TRIPOD SIGN
- For Hamstring Contracture 3. LACHMAN’S TEST – ANTERIOR (Ritchie, Trillat or
- Pt is seated with both knees flexed to 90’ over the edge of Lachman-Trillat Test)
the table - Best indicator of injury to ACL, esp. the posterolateral band
- Examiner passively extends 1 knee - Test for 1 plane anterior instability
- Check for PCL tear before doing the test
• Pt is in supine with involved leg beside examiner
• Examiner holds pt’s knee between full extension and 30’
Flexion
• Pt femur is stabilized by with one hand while the proximal
tibia is moved forward by the other hand
• To achieve the best result:
- (+) “MUSHY” OR SOFT END FEEL &
DISAPPEARANCE OF INFRAPATTELAR TENDON
SLOPE
4. DRAWER’S SIGN – ANTERIOR
-Pt supine
* Knee flexed to 90’; Hip flexed 45’ (ACL is almost
parallel with tibial plateau)
* PT sits on pt’s forefoot (neutral rotation)
- Hands of PT around tibia (relaxed hamstring)
- PT draws tibia forward on the femur
- (N) = 6mm
• If positive:
-
• Modifies Drawer’s
- 90-90 Drawer
5. POSTERIOR SUG SIGN (Gravity Drawer Test)
- For one plane posterior instability
- Supine with hips at 45’ flexion and knees 90’
- Posterior displacement is more noticeable when the knee is
flexed at 90’-100’
- (+) Sulcus on affected knee compared to the normal one
- Tibia drops back or sags back if PCL is torn
- PCL, ACL, arcuate-popliteus complex, posterior oblique
ligament
• If positive:
- - Reverse Pivot Shift maneuver
6. GODFRY TEST (Gravity Test)
- Pt is supine
- Examiner holds both legs while flexing pt’s hips and knees
to 90’
- (+) THERE IS POSTERIOR SAG OF THE TIBIA
- An increase in posterior displacement with manual post.
Pressure
7. SLOCUM TEST (Anterolateral)
- Flex pt’s knee to 80’ or 90’ and hip to 45’
- Foot is placed in 30’ medial rotation
- PT sits in pt’s forefoot
- PT draws tibia forward
- (+) MOVEMENT OCCURS PRIMARILY ON THE
LATERAL SIDE OF THE KNEE
- Anterolateral rotatory instability
8. SLOCUM TEST (Anteromedial)
- Flex pt’s knee to 80’ or 90’ and hip to 45’
- Foot is placed in 15’ lateral rotation
- PT sits in pt’s forefoot
- PT draws tibia forward
- (+) MOVEMENT OCCURS PRIMARILY ON THE
MEDIAL SIDE OF THE KNEE
- Anterolateral rotatory instability
- “Lemaire’s T Drawers Test”
9. ACTIVE PIVOT SHIFT TEST
- Sitting with foot on the floor in neural rotation and knee
flexed 80’ or 90’
- Pt isometrically contracts quads while PT stabilizes foot
- (+) ANTEROLATERAL SUBLUXATION OF
LATERAL TIBIAL PLATEAU
- Anterolateral instability
10. DEJOUR TEST
- Supine
- PT holds pt’s leg with one arm against the body
- One hand under the calf to lift tibia while applying a valgus
stress
- Other hand pushes femur down
- IN EXTENSION: (+) ANTEROMEDIAL SUBLUXATION
- IN FLEXION: (+) SUDDEN REDUCE TIBIAL
PRESSURE
- (+) PAIN IN JOLT – MEDIAL MENISCUS
- (-) PAIN – POSTEROMEDIAL CORNER INJURY
11. HUGHSTON’S POSTEROMEDIAL BRAWER SIGN
- Pt is supine position with knee flexed to 80’-90’ and hip
flexed to 45’
- PT medially rotates pt’s foot slightly and sits on the foot to
stabilize
- Pt pushes tibia posteriorly
- (+) EXCESSIVE MOVEMENT or ROTATION ON THE
MEDIAL ASPECT
- Posteromedial rotatory instability
12. JACOB TEST
- Pt stands and leans against a wall with the uninjured side
adjacent to the wall
- Body weight distributed equally between the 2 feet
- PT’s hand placed above and below the involved knee
- Valgus stress is given while knee flexion is inhibited
- (+) JERK OR TIBIA SHIFTS POSTERIORLY or
“GIVING WAY” PHENOMENON OCCURS
VIII.
1. McMURRAY’S TEST
- Pt lies supine with knee completely flexed up to the buttocks
- Examiner then medially rotates the tibia in different amount
of flexion to test the lateral meniscus
- If laterally rotated, medial meniscus is being tested
- (+) A SNAP or CLICK WITH PAIN
2. APLEY’S TEST
- Pt lies supine with knee flexed to 90’
- Examiner medially & laterally rotated the tibia combined
first with distraction to test the ligaments
- If combined with compression – for meniscus injury
- Determine which maneuver is painful
3. “BOUNCE HOME” TEST
- Pt in supine position - PT places the palm of one hand over the suprapatellar pouch
- PT cups pt’s heel and the palm of the other hand anterior to the jt with the thumb
- Pt’s knees completely flexed & passively allowed to extend and index finger just beyond the margins of the patella
- (+) EXTENSION IS NOT COMPLETED, HAVING A - Press down with one hand and then the other
RUBBERY END FEEL (“Springy Block”) - (+) FLUCTUATION OF FLUID
- A torn meniscus most likely blocked the motion
XI. Patellofemoral Dysfunction (CHRONDOMALACIA
4. PAYR’S SIGN PATELLA):
- Pt in supine position with test leg in figure-four position 1. FRUND’S SIGN
- (+) PAIN IS ON MEDIAL JOINT LINE - Pt sitting
*Meniscal Lesion - PT percusses patella in various positions of knee flexion
*Middle or Posterior - (+) PAIN
- Chrondomalacia Patella
5. CHILDRESS’ SIGN
- Pt squats & performs a “Duck waddle” 2. ZOHLER’S SIGN
- (+) PAIN, SNAPPING or a CLICK - Pt supine with leg extended
*Posterior horn lesion of the meniscus - PT pulls patella distally and holds in position
- Pt contracts quadriceps
IX. Plica Tests: - (+) PAIN
1. PLICA STUTTER TEST - Chrondomalacia Patella
- Pt is seated on edge of table with both knees flexed to 90’ - May be (+) in large proportion of normal population
- Examiner places finger over the patella
- Pt is then instructed to slowly extend the knee UE
- (+) PATELLA STUTTERS or JUMPS BETWEEN 60-45 *SHOULDER
DEGREES OF FLEXION
- Effective if no swelling I. Anterior Instability:
• LOAD & SHIFT TEST
2. HUGHSTON’S PLICA TEST P: sitting
- Pt supine HP: hand of the test arm resting on the thigh
- PT flexes knee & IR tibia with one arm & hand Stabilize shoulder with one hand over the clavicle and
- Heel of the other hand presses patella medially & palpating scapula and grasp humerus
the medial femoral condyle with fingers of the same hand P: Gently push humerus into the glenoid fossa (load) then
- Passively flex & extend the knee while palpating for the push humeral head anteriorly and note the amount of
“popping” of the Plical band under the fingers translation (shift)
- (+) POPPING (+) sign: anterior translation
NORMAL: 0-25% shift anteriorly
3. BRUSH, STROKE, WIPE or BULGE TEST GRADE 1: 25-50% translation
- Minimal effusion GRADE 3: more than 50% but
- PT start stroking just below the medial jt line GRADE 4: more than 50% but remains dislocated
- Using palm & fingers, stroke proximally towards the hip as
far as the suprapatellar pouch (2-3x) • ANTERIOR APPREHENSION TEST FOR
- Opposite hand strokes down downward on the lateral aspect SHOULDER DISLOCATION
of the knee -aka CRANK test
- (+) FLUID PRESSES TO MEDIAL SIDE OF THE P: supine
JOINT & BULGES JUST BELOW THE MEDIAL HP: one hand holding the shoulder firmly
DISTAL PORTION OR BORDER OF PATELLA : Another hand on the wrist
- May take 2 SECONDS to appear P: 90° and ER shoulder slowly
- (N) 1-7 mL of synovial fluid -> extra 4-8mL (+) sign: look of apprehension

X. Swelling: • FULCRUM TEST

1. INDENTATION TEST P: supine with arm abd 90°
- Pt supine HP: PT’s clenched fist placed posteriorly, the other hand on
- PT passively flex good leg -> acute indentation elbow
- Fully flexed good leg -> indentation restrains P: examiner extends & ER the arm gently
- Injured knee is slowly flexed -> observe (+) sign: (+) look of apprehension
Disappearance of Indentation:
- Caused by swelling • FOWLER’S SIGN/TEST or JOBE’S RELOCATION
- The greater the swelling the sooner the indentation TEST
disappears P: supine
HP: one hand holding the shoulder firmly
2. FLUCTUATION TEST : Another hand on the wrist
P: move shoulder to 90° abd and ER slowly : PT stabilizes the upper limb by holding at the elbow, then
: Apply posterior stress to arm bring in forward flexion
(+) sign: pain is reduced : Arm IR approx 20° after forward flexion, pushing elbow
posteriorly
• ROCKWOOD TEST (+) sign: (+) humeral head slips posteriorly
P: sitting arm at side
HP: elbow and wrist • JERK TEST
P: move shoulder into abd and ER at 45°, 90° & 120° P: sitting
(+) sign: 45 & 120°- mild symptom HP: one hand to stabilize the posterior trunk
90°-marked apprehension : cradle & grasp the elbow
P: move the arm in IR & forward flexion to 90°
: Examiner grasps elbow & axially loads humerus in
proximal direction
: maintain axial load with arm moving horizontally (cross-
• ROWE TEST flexion)
P: supine with hand behind head (+) sign: (+) sudden jerk or clunk as the humeral head
HP: PT’s clenched fist placed posteriorly, the other hand on subluxes the back of glenoid
elbow
P: pushes humeral head upward while arm is extended • PUSH & PULL TEST
backward P: supine
: Hand on elbow pushes downwards HP: wrist and over the humerus close to the humeral head
(+) sign: apprehensive look P: abd arm to 90° and forward flex to 30°
: Pull arm up at the wrist while pushing down on the
• ANTERIOR DRAWER’S TEST humerus with the other hand
P: supine (+) sign:
HP: one hand cupping the shoulder are with middle & index
finger or the thumb on the posterior humeral head. • POSTERIOR DRAWER’S TEST
: The other hand stabilizes the scapula with the middle finger P: supine
and the thumb on the coracoid process HP: forearm & upper arm around the humeral head
P: abd arm at 80-120° & forward flex at 30° P: flex elbow at 120°
: Push the spine forward using the index and middle finger : shoulder abd at 80-120° and forward flex at 20-30° with the
and provide a counter pressure on the coracoids process using other hand
the thumb : stabilize the scapula
: Draw the humerus forward : Index & middle finger is placed posteriorly and the thumb
(+) sign: click & apprehension anteriorly
: rotate the upper arm medially and forward flex to 60-800
II. Posterior Instability: : using the thumb push the humeral head posteriorly
• LOAD & SHIFT (+) sign: >50% posterior translation
P: same as anterior
HP: same as anterior III. MULTI-DIRECTIONAL SHOULDER
P: push humeral head posteriorly INSTABILITY:
(+) sign: (+) posterior translation >50% humeral head • SULCUS SIGN
diameter P: stand with arm by side & shoulder mm relaxed
HP: grasp forearm below elbow
• POSTERIOR APPREHENSION/STRESS TEST P: pull arm distally
P: supine : Measure from inferior margin of acromion to the humeral
HP: elbow and wrist head
P: forward flex pt’s shoulder in scapular plane to 90° while : 20-500 abd
applying axial load (+) sign: presence of sulcus
: Horizontally add and IR arm GRADE 1-2: 1-sulcus implies distance of 1-2cm
(+) sign: apprehension GRADE 2-3: 2-sulcus 1-2cm
GRADE 3: greater than 3->1cm
• NORWOOD TEST
P: supine • FEAGIN TEST
HP: wrist & stabilize scapula while palpating the posterior P: standing
humeral head HP: both hands distal to the humeral head
P: abd the shoulder at 60-100°; ER at 90° and elbow flexed at P: shoulder abd at 900 with distal forearm resting over PT’s
90° shoulder
: PT stabilizes the scapula, palpating the posterior humeral : PT clasps hands over upper 3rd of upper arm and
head with fingers applies downward pressure
(+) sign: (+) sulcus sign

• ROWE TEST FOR MULTI-DIRECTIONAL
INSTABILITY
P: standing
HP: one hand over the shoulder with index & middle finger
over anterior aspect of humeral head & thumb on posterior
aspect
P: pt flexes trunk to 450 with arms relaxed
: PT pulls arm downwards slightly
: Anterior: 20-300 extended
: Posterior: 20-30 flexed
: Inferior: traction applied
(+) sign: (+) sulcus sign
IV. TEST FOR SHOULDER LABRAL TEARS:
• CLUNK TEST
P: supine
HP: place one hand on posterior humeral head
: Other holds humerus above elbow
P: abd arm over pt’s head then push anteriorly with hand over
humeral head while the other ER humerus
(+) sign: (+) clunk or grinding sound
: Apprehension if there is anterior instability
SLAP LESIONS –cause by FOOSH (fall on out-stretched
hand)
TYPE I- superior labrum marked frayed but attachments intact
TYPE II- superior labrum has small tear& there is instability
of the labral biceps complex (most common)
TYPE III- bucket handle tear of labrum that may displace into
joint, labral biceps attachments intact
TYPE IV- bucket handle tear of labrum that extends to biceps;
tendon, allowing tendon to sublux into joint
• ANTERIOR GLIDE TEST
P: sitting with hands on the waist and thumb placed
posteriorly
HP: one hand on the distal humerus/ elbow
: Other hand stabilizes the scapula and clavicle
P: hand on the distal humerus applies anterior superior force
(+) sign- humeral head slides over the labrum with pop or
crack and pain
• BICEPS TENSION TEST
P: standing
: Arm abd and ER at 900 with elbow extended & forearm
supinated
HP: wrist
: stabilize shoulder area with the other hand
P: PT applies eccentric adduction to the arm
(+) sign: reproduction of symptoms
• BICEPS LOAD TEST
P: supine with shoulder abd to 900 and ER, elbow flexed to
900 and forearm supinated
HP: wrist & elbow
P: PT takes arm into full ER (apprehension test)
: Pt actively flexes elbow against resistance
(+) sign: apprehension increases
• LABRAL CRANK TEST
P: sitting
HP: wrist and elbow
P: PT elevates arm to 1600 scaption
: Axial load is given to the humerus, other hand on the wrist
ER and IR the shoulder
(+) sign: pain on rotation with or without a click
V. TEST FOR MUSCLE AND TENDON PATHOLOGY:
• SPEED’S TEST/ BICEPS/ STRIAGHT-ARM TEST
-more effective than Yergason’s test since the bone moves
against the tendon
P: sitting
P: resist shoulder forward flexion with elbow completely
extended while pt’s forearm is supinated & then pronated
: may also be performed by forward flexion of pt’s arm to 900
then ask the pt to resist eccentric movement into extension
(+) sign: (+) increase tenderness in bicipital groove;
indicates bicipital tendinitis
• YERGASON’S TEST
P: sitting
HP: elbow flexed 900 stabilized against thorax with forearm
pronated
P: PT resist supination with pt ER arm against resistance
(+) sign: (+) tenderness on bicipital groove or tendon may
pop out of the groove; indicates bicipital tendinitis
Bicipital tendinitis:
• GILCHREST SIGN
P: standing
P: pt lifts 2-3 kg weight over the head, arm is laterally rotated
fully and lowered to the side in the coronal plane (active)
(+) sign: (+) pain/ discomfort in the bicipital groove; an
audible snap/ pain may be felt between 100-900 of abd;
indicates bicipital tendinitis
Biceps Tendon Rupture:
1. HEUTER’s SIGN
*resist elbow flexion with forearm pronated
*(N) reaction is slight supination to assist flexion
-Brachialis mm
-Heuter’s sign
*(+) sign: absence of sign
*indicates a disrupted biceps tendon
2. LUDINGTON’S TEST
P: sitting with hands clasped behind head
P: Pt alternately contracts & relaxes biceps while being
palpated by the examiner
(+) sign: (+) unpalpable biceps tendon/ no active
contraction on one side; indicates rupture of the long head
of the biceps tendon
Rotator Cuff Pathology:
1. SUPRASPINATUS TEST/ EMPTY CAN TEST
P: sitting/ standing
HP: pt abd arm 900 with neutral rot
P: examiner resist abd; shoulder is then IR & angled forward
300 (empty can position) with thumb pointing towards the
floor while examiner resists abd
(+) sign: weakness/pain; indicates supraspinatus tendon
tear/ neuropathy of scapular nerve
2. DROP-ARM’S TEST/ CODMAN’S TEST Elbow extension
P: sitting/ standing Forearm supination
P: PT abd pt’s shoulder to 900 Wrist extension
: Pt slowly lowers the arm to side Fingers & thumb extension
(+) sign: inability to return to the side or severe pain; Shoulder no rotation
indicates tear of rotator cuff complex Cervical spine contralateral side flexion
Nerve Bias at median, anterior interosseous C5, C6, and C7
3. LIFT-OFF SIGN
*Pt: standing ULTT2
*Place dorsum of the hand on the back pocket / midlumbar Shoulder depression & abd I0o
spine Elbow extension
*Pt lifts hand away from the neck Forearm supination
(+) inability to perform Wrist extension
*lesion on subscapularis mm Fingers & thumb extension
*if able apply load by pushing hand toward back Shoulder lateral rotation
Cervical spine contralateral side flexion
4. ABDOMINAL COMPRESSION TEST Nerve Bias median, musculocutaneous, axillary
*If unable to take hand behind the back
*Standing position ULTT3
*PT places hand on the abdomen (that the examiner can feel Shoulder depression & abd I0o
how much pressure the pt is applying to the abdomen) Elbow extension
*Pt places hand of UE to be tested on the PT’s hand and Forearm pronation
pushes hand as hard as possible, and then the pt attempts to Wrist flexion & ulnar deviation
bring the elbow forward. Fingers & thumb flexion
*(+) inability to perform Shoulder medial rotation
*tear of subscapular mm Cervical spine contralateral side flexion
Nerve Bias radial nerve
VI. TEST FOR SHOULDER IMPINGEMENT:
1. NEER IMPINGEMENT TEST
P: sitting
P: pt’s arm forcibly elevated through forward flexion by
examiner causing a “jamming” of the greater tuberosity ULTT4
against the anterior-inferior acromial surface Shoulder depression & abd I0o -90o hand to ear
(+) sign: (+) face show signs of pain; indicates overuse Elbow flexion
injury to supraspinatus mm & sometimes biceps tendon Forearm supination
Wrist extension & radial deviation
2. HAWKINS-KENNEDY TEST Fingers & thumb extension
P: standing Shoulder lateral rotation
P: pt forward flex arms to 900 then forcibly IR shoulder Cervical spine contralateral side flexion
(pushes supraspinatus tendon against acromial surface of Nerve Bias Ulnar nerve, C8, T1
coracoacromial ligament & coracoids process)
(+) sign: (+) pain; indicates supraspinatus tendinitis *TEST FOR THORACIC OUTLET SYNDROME:
–usually due to decrease in blood supply
3. POST. INTERNAL IMPINGEMENT TEST
*P: supine 1. ROOS TEST/EAST aka POSITIVE AB & ER
*PT abducts shoulder into 90° abd, with 15-20° forward POSITION TEST, “HANDS-UP” test or ELEVATED
flexion and maximum lat. rotation ARM STRESS TEST
*(+) localized pain in the post. Shoulder P: standing
*impingement lf the rotator cuff against posterosuperior edge P: arms abd 90o shoulder in ER & elbows flexed 90o while pt
of glenoid fossa opens & closes hands slowly for 3mins
(+) sign: unable to keep arms in starting position for 3mins
*TEST FOR NEUROLOGICAL INVOLVEMENT: of suffers ischemic pain, heaviness/ profound weakness of
• UPPER LIMB TENSION TEST (ULTT/ brachial plexus arm of numbness & tingling of the hand
tendon/ ELVEY)
-equivalent to SLR test to lumbar spine 2. COSTOCLAVICULAR SYNDROME TEST
-tension tests to put stress on neurological structures of the -MILITARY BRACE TEST
upper limb P: examiner palpates the radial pulse then draws the pt’s
-test good side 1st shoulder down & back
(+) sign: absence of radial pulse
ULTT1
Shoulder depression & abd II0o 3. ADSON’S MANEUVER
P: examiner palpates radial pulse, pt head is rotated to face the
test shoulder, then extends the head while the examiner
laterally rotates & extends the pt’s shoulder, pt is instructed to
take deep breath and hold it
(+) sign: absence/ disappearance of pulse
4. ALLEN’S TEST
P: examiner flexes the pt’s elbow to 900 while the shoulder is
extended horizontally & rotated laterally, pt head is then
rotated away from the test side, and examiner palpates the
radial pulse
(+) sign: absence/ disappearance of pulse
5. HALSTEAD MANEUVER
P: examiner finds the radial pulse and applies a downward
traction on the test extremity while the pt’s neck is
hyperextended and rotated on the opposite side
(+) sign: absence/ disappearance of pulse
SCAPULA*
1. WALL PUSH UP TEST
*Pt stands arm’s length from a wall
*Ask pt to do a “wall push ups” 15-20 times
*for stronger pts, do push ups on the floor
*(+) winging –after 5-10 push up
2. SCAPULAR ISOMETRIC PINCH/ SQUEEZE TEST
*standing
*ask pt to actively inch or retract the scapulae together as
hard as possible and hold it as long as possible
*Normal at 15-20 secs
*(+) burning pain occurs in < than 15 secs
*Weak scapular retractors
ELBOW*
TEST FOR EPICONDYLITIS:
• LATERAL EPICONDYLITIS/ TENNIS ELBOW TEST
-common to badminton players
Method 1/COZEN’S TEST
- Resist wrist extension & radial deviation with forearm
pronated
Method 2/MILL’S TEST
-examiner passively pronates forearms & flexes wrist fully &
extends elbow
Method 3/MUADSLEY’S TEST
-resist extension of middle finger distal to PIP with wrist
&fingers extended
(+) sign: sudden severe pain in area of lateral epicondyle
MEDIAL EPICONDYLITIS/ GOLFER’S ELBOW
*PT palpates the medial epicondyle
*PT passively supinates forearm, elbow extended, and wrist
extended
*(+) if pain over the medial epicondyle
*TEST FOR NEUROLOGICAL DYSFUNCTION:
• TINEL’S SIGN at the ELBOW
P: the area of the ulnar nerve in the groove between the
olecranon process & medial epicondyle is tapped
(+) sign: tingling sensation in the ulnar distribution of the
forearm and hand; indicates the point of regeneration of a
nerve
• WARTENBERG’S TEST
P: sitting with hands on table
P: examiner passively abd/ spread the fingers apart, pt then
add fingers
(+) sign: inability to add little finger; indicates ulnar
neuropathy
• PRONATOR TERES SYNDROME TEST
P: sitting
HP: elbow flexed to 90o
P: examiner strongly resists pronation as elbow is extended
(+) sign: tingling/paresthesia in the median nerve
distribution
• PINCH GRIP TEST
*Pt is asked to pinch the tips of the index finger and thumb
together
*(+) pulp to pulp pinch
*Anterior Interosseous Nerve Pathology
-entrapment
TEST FOR LIGAMENTOUS, CAPSULAR or JOINT
INSTABILITY:
• MURPHY’S SIGN
P: pt is asked to make a fist
(+) sign: if the head of the 3rd metacarpal is level with the
2nd & 4th metacarpals; indicates lunate dislocation
• FINGER EXTENSION / SHUCK TEST
*Pt sitting
*PT holds pt’s wrist flexed
*Ask pt to actively extend the fingers against resistance-
loading the radiocarpal joints
*(+) Pain
*radiocarpal or midcarpal instability, scaphoid instability,
inflammation or Kienbock’s disease
• TEST FOR TIGHT RETINACULAR LIGAMENTS
P: hold PIP in neutral position while DIP is flexed if no
flexion, retinacular collateral ligaments or capsule are tight
(+) sign: if DIP flexes easily when PIP is flexed- retinacular
ligaments are tight, capsule is normal
• WATSON’S (SCAPHOID SHIFT TEST)
P: sitting; elbow resting on lap with forearm pronated
P: examiner takes the pt’s wrist into ulnar deviation & slight
extension. Examiner presses thumb of the other hand against
the distal pole of the scaphoid to prevent it from moving
toward the palm. With the first hand, the examiner radially
deviates & slightly flexes the pt’s hand
(+) sign: pain, if the scaphoid is unstable, the dorsal pole of
the scaphoid subluxes over the dorsal rim of the radius
• LIGAMENTOUS INSTABILITY TEST FOR FINGERS
P: Examiner stabilizes the finger proximal to the joint to be
tested & grasp finger distal to the tested joint, apply
varus/valgus stress& note for laxity
-laxity tests integrity of the collateral ligaments of the IP joints
*TEST FOR TENDONS & MUSCLES:
• FINKELSTEIN’S TEST
P: pt makes a fist with thumb inside the fingers, the examiner
stabilizes the forearm & deviates the wrist towards the ulnar
side
(+) sign: pain over the abd pollicis longus & EPB; indicates
a tenosynovitis of these 2 tendons/ De Quervain’s disease,
Hoffman’s disease, Washerwoman’s Hand
• SWEATER FINGER TEST
P: pt is asked to make a fist
(+) if one of the distal phalanx of one of the fingers does
not flex; indicates a ruptured FDP tendon- occurs most
frequently to the ring finger
• BUNNEL-LITTER TEST/ FINOCHIETTO-BUNNEL
TEST
P: MCP jt is held slightly extended while the examiner moves
the PIP jt into flexion
(+) sign: inability to flex the PIP joint; indicates a tight
intrinsic muscle or contracture of the joint capsule
-if the MCP joints are slightly flexed, the PIP jts flexes fully,
if the intrinsic are tight but does not flex fully if the capsule is
tight
• LINDBURG SIGN
P: pt flexes the thumb maximally onto the hypothenar
eminence & actively extends the index finger as far as
possible
(+) sign: limited finger extension & pain; indicates
tendinitis at the interconnection between flexor pollicis
longus & flexor indices
*TEST FOR NEUROLOGICAL DYSFUNCTION:
• TINEL’S SIGN at the WRIST
P: examiner taps over the carpal tunnel at the wrist
(+)sign: tingling/ paresthesia into the thumb, index, middle
& lateral half of the ring finger; indicates carpal tunnel
syndrome/ most distal point of median nerve regeneration
• PHALEN’S TEST
P: examiner flexes the pt’s wrist maximally & holds this
position for 1min by pushing the pt’s wrist together
(+) sign: tingling in the thumb, index, middle and lateral
half of the ring finger; indicates carpal tunnel syndrome
• REVERSE PHALEN’S TEST/ PRAYERS TEST
P: examiner extends the pt’s wrist while asking the pt to grip
the examiner’s hand. The examiner then applies direct
pressure over the carpal tunnel for 1min
(+) sign: tingling in the thumb, index, middle and lateral
half of the ring finger; indicates pathology of the median
nerve (CTS)
FROMENT’S SIGN
P: pt grasps a piece of paper between the thumb & index
finger, examiner then attempts to pull away the paper
(+) sign: terminal phalanx of the thumb flexes
JEANNE’S SIGN
- If the MCP jt of the thumb hyperextends indicates paralysis
of the adductor pollicis due to ulnar nerve paralysis
EGAWA’S SIGN
P: pt flexes middle digit & alternately deviates finger radially
& ulnary
(+) sign: unable to perform; indicates ulnar nerve palsy
affecting interossei
• ALLEN TEST
P: pt is asked to open & close the hand several times as
quickly as possible and then squeeze the hand tightly.
: The examiner’s thumb & index finger are placed over the
radial & ulnar arteries compressing them. Pt then opens the
hand while the pressure maintained over the arteries
(+) sign: if the hand flushes when pressure over the
arteries are released, check one after the other.
-determines the patency of the radial & ulnar arteries
-determines which artery provides the major blood supply to
the hand
• WATSON’S (SCAPHOID SHIFT TEST)
P: sitting; elbow resting on lap with forearm pronated
P: examiner takes the pt’s wrist into ulnar deviation & slight
extension. Examiner presses thumb of the other hand against
the distal pole of the scaphoid to prevent it from moving
toward the palm. With the first hand, the examiner radially
deviates & slightly flexes the pt’s hand
(+) sign: pain, if the scaphoid is unstable, the dorsal pole of
the scaphoid subluxes over the dorsal rim of the radius
• LIGAMENTOUS INSTABILITY TEST FOR FINGERS
P: Examiner stabilizes the finger proximal to the joint to be
tested & grasp finger distal to the tested joint, apply
varus/valgus stress& note for laxity
-laxity tests integrity of the collateral ligaments of the IP joints
*TEST FOR TRENDONS & MUSCLES:
• FINKELSTEIN’S TEST
P: pt makes a fist with thumb inside the fingers, the examiner
stabilizes the forearm & deviates the wrist towards the ulnar
side
(+) sign: pain over the abd pollicis longus & EPB; indicates
a tenosynovitis of these 2 tendons/ De Quervain’s disease,
Hoffman’s disease, Washerwoman’s Hand
• SWEATER FINGER TEST
P: pt is asked to make a fist
(+) if one of the distal phalanx of one of the fingers does
not flex; indicates a ruptured FDP tendon- occurs most
frequently to the ring finger
• BUNNEL-LITTER TEST/ FINOCHIETTO-BUNNEL
TEST
P: MCP jt is held slightly extended while the examiner moves
the PIP jt into flexion
(+) sign: inability to flex the PIP joint; indicates a tight
intrinsic muscle or contracture of the joint capsule
-if the MCP joints are slightly flexed, the PIP jts flexes fully,
if the intrinsic are tight but does not flex fully if the capsule is
tight

• LINDBURG SIGN
P: pt flexes the thumb maximally onto the hypothenar
eminence & actively extends the index finger as far as
possible
(+) sign: limited finger extension & pain; indicates
tendinitis at the interconnection between flexor pollicis
longus & flexor indices
LE
Test for intrathecal pressure:
Valsalva maneuver
• Patient is seated and asked to take a breath, hold it and then
bear down as if evacuating the bowel.
• If pain increases in the lumbar area, it is an indication of
increase intrathecal pressure.
• Increased intrathecal pressure leads to symptoms in the
sciatic nerve distribution.
Test for Muscle Dysfunction:
Beevor’s Sign
• Patient lies supine and ask to do the ff:
o Flexes the head against resistance.
o Coughs
o Attempts to sit up with hands behind
• (+) sign if umbilicus does not remain in straight line.
• Indicates pathology in the abdominal muscles.
Test for Intermittent Claudication:
1.) Stoop Test
• Pt. is asked to walk briskly for about 50m.
• Pain ensues in the buttock and lower limb.
• Pt. is asked to flex forward.
• (+) test, if pain is relieve upon flexion.
2.) Bicycle test of van Gelderen
• Pt. is seated on an exercise bicycle and is asked to pedal
against resistance.
• Patient starts to pedal while leaning backward to accentuate
the lumbar lordosis.
1st part (+) – pain on buttock and posterior thigh occurs,
followed by tingling in the affected extremity
2nd part (+) – pain subsides over a period of time when
asked to lean forward while continue pedalling; pain
returns when upright again.
Test for Malingering:
1) Hoover Test
• Patient in supine position
• Examiner places one hand under each heel while pt. legs
remain relaxed on the table.
• Patient asks to perform USLR.
• (+) if Pt. is unable to lift leg with negative pressure on the
opposite leg.
2) Burns Test
• Patient is asked to kneel on a chair and then bend forward to
touch the floor with the fingers
• (+) if unable to perform or patient overbalances.
Hip Joint
Test for paediatric Hip pathology:
1. Ortolani’ sign
• Infant in supine, the examiner flexes the hip and grasps the
leg and the fingers are placed along the outside of the thighs to
the buttocks.
• With gentle traction, the thighs are abducted and pressure is
applied against greater trochanter.
• Examiner may feel click or clunk indicating a (+) test and
hip is reduced.
2. Barlow’s test
• Infant lies supine with hips flexed to 90 and knees fully
flexed
• Examiner’s middle finger of each hand is placed over the
greater troch and thumb is placed on medial thigh.
• Hip is taken into abduction while the examiner’s middle
finger applies forward pressure behind the greater troch.
• If the femoral head slips out over the posterior lip of the
acetabulum and then reduces again when pressure is
removed, the hip is classified as unstable.
3. Galleazzi Sign
• For assessing unilateral congenital dislocation of the hip
• Used in children from 3-18 mos. Of age.
• Child lies supine with the knees flexed and hips flexed to 90
degrees
• A (+) test would indicate if one knee is higher than the
other.
4. Telescoping sign (Piston or Dupuytren’s test)
• Child lies in supine position
• Examiner flexes the knee and hip to 90 degrees.
• Femur pushed down onto the examining table then lifted up
and away from the table.
• With dislocated hip, there’s a lot of relative movement or
excessive movement called telescoping or pistoning.
Test for muscle tightness or pathology
1. Thomas test
• Used to asses a hip flexion contracture.
• Pt. lies supine while the examiner checks for excessive
lordosis.
• The examiner brings the knee to the chest and pt. holds the
flexed hip against the chest.
• If (+) of contracture, pt. straight leg raises off the table.
2. Rectus femoris Contracture test (Kendell Test)
• Pt. lies supine with knees bent over the edge of the table.
• Pt. flexes one knee onto the chest and holds it.
• The angle of the test knee should remain @ 90 degrees when
the opposite knee is flexed to the chest.
• If the test knee slightly extends, a contracture probably
present.
3. Ely’s test
• Pt. lies prone and the examiner passively flexes the pt. knee
• If (+), there’s flexion of the hip on the same side.
• Indicates tight rectus femoris muscle.
• Two sides should be tested and compared.
4. Ober’s test
• Assess the TFL (iliotibial band) for contracture.
• Pt. in side lying with lower leg flexed at hip and knee for - Medial quadriceps expansion
stability. - Semimembranosus muscle
• Examiner then passively abducts and extends the pt. upper
leg with knee straight or 90 flexed. 2. Adduction test - lateral
• Examiner slowly lowers the upper leg, and if it remains • For lateral instability
abducted and does not fall, it indicates contracture. • A.K.A.
• Examiner pushes knee laterally.
5. Noble compression test • In stress radiograph:
• For iliotibial band friction syndrome. o A. 5mm opening – grade 1 injury
• Pt. lies supine with knee 90 flexed and hip in flexed position. o B. Up to 10mm – grade 2 injury.
• Examiner applies pressure with the thumb to the lateral o C. 10mm – grade 3 injury.
femoral epicondyle or 1-2cm proximally. • Examiner pushes the knee laterally on full extension and
• Pressure is maintained while pt. slowly extend the knee. slightly flexed (20 – 30 degrees)
• (+) if pt. would c/o severe pain over the lateral femoral • (+) if tibia moves away from femur excessively.
condyle at - 30 degrees flexion.
In extension In20 – 30 degree flexion
6. Piriformis test LCL -LCL
• Pt. side lying position with the test leg uppermost. Posterolateral capsule -Posterolateral capsule
• Pt. flexes the test hip to 60 degrees with knee flexed. Arcuate-popliteal complex -Arcuate-popliteal complex
• Then examiner applies a downward pressure to the knee Biceps femoris tendon -ITB
while stabilizing the hip. Biceps femoris -tendon
• If piriformis is tight, pain is elicited in the muscle. ACL -PCL
• If piriformis is pinching the sciatic nerve, pain in Lateral gastrocnemius -ITB
buttocks and sciatica may be present.

7. Tripod sign
• For hamstring contracture.
• Pt. is seated with both knees flexed to 90 degrees over the 3. Lachman’s test – anterior AKA Ritchie, trillat or
edge of table. Lachman-Trillat test
• Examiner passively extends one knee. o Best indicator of injury to ACL, especially the posterolateral
• (+) if pt. tends to extend trunk to relieve tension in the band
hamstring muscle. o Test for one plane anterior instability
o Check for PCL tear before doing the test.
8. Hamstring contracture test • Pt. is supine w/ involved leg beside examiner
• Pt. sits with one knee flexed against the chest to stabilize the • Examiner holds pt’s knee between full extension and 30
pelvis degrees of flexion.
• Other knee is extended • Pt.‘s femur is stabilized by w/ one hand while the proximal
• Pt. attempts to flex trunk and touch the toes of the extended tibia is moved forward by the other hand
LE with fingers.
• Repeat on other side • To achieve the best result:
• (+) if unable to reach toes o Lateral rotate tibia
• Hamstring tightness o Anterior tibial translation force application at posteromedial
aspect
Knee joint • (+) “mushy” or soft end feel and disappearance of
Test for one plane instability: infrapatellar tendon slope
1. Abduction test – medial AKA – Valgus stress test • Indication if (+)
• For medial instability
• Examiner pushes the knee medially on full extension and Test for one plane instability:
slightly flexed (20 – 30) 1.) Drawers sign – anterior
• (+) if tibia moves away from femur excessively • Pt in supine
• A (+) finding on full extension is classified as a major o Knees flexed to 90 degrees; hip flexed 45 degrees (ACL is
disruption of the knee. almost parallel w/ tibial plateau)
o PT sits on pt’s forefoot (neutral rotation)
• If positive in extension • If positive with knee in 20’-30’ • Hands of PT around tibia (relaxed hamstring)
Flexion • PT draws tibia forward on the femur
- MCL - MCL • (N) = 6mm
- Posterior Oblique Ligament - PCL
- Posteromedial capsule -Posterior Oblique 2.) Posterior Sag Sign AKA Gravity drawer test
Ligament • For one plane posterior instability.
- ACL -Posteromedial capsule • Supine w/ hips at 45 degrees flexionand knees 90 degrees
- PCL
• Posterior displacement is more noticeable when the knee is
flexed at 90 – 110 degrees.
• (+) Sulcus on affected knee compared to the normal one.
• Tibia drops back or sags back if PCL is torn
• PCL, ACL, arcuate-popliteus complex, posterior oblique
ligament.
o If positive
3.) Godfrey Test AKA Gravity Test
• Pt. is supine
• Examiner holds on the legs while flexing pt’s hips and knee
at 90 degrees
• (+) if there is posterior sag of the tibia
• An increase in posterior displacement with manual posterior
pressure
4.) Anterolateral - Slocum Test
• Flex pt’s knee 80 or 90 and hip 45
• Foot is placed in 30 medial rotation
• PT sits in pt’s forefoot
• PT draws tibia forward
• (+) movement occurs primarily on the medical side of the
knee
• Anterolateral rotator instability
5.) Active pivot shift test
• Sitting with foot on the floor in neutral rotation and knee
flexed 80 or 90 degrees
• Pt. isometrically contracts quads while PT stabilizes foot
• (+) anterolateral subluxation of the lateraltibial plateau
• Anterolateral instability
6.) Anteromedial - Slocum test
• Flex pt’s knee to 80 or 90 and hip to 45
• Foot is placed in 15 lateral rotation
• PT sits in pt’s forefoot
• PT draws tibia forward
• (+) movement occurs primarily on the medial side of the
knee
• Anteromedial rotator instability
Lemaire’s T Drawer Test
7.) Dejour Test
• Supine
• PT holds pt’s leg with one arm against the body
• One hand under the calf to lift tibia while applying a valgus
stress
• Other hand pushes femur down
• In extension – (+) anteromedial subluxation
• When flexed – sudden reduce tibial plateau
• (+) pain in jolt – medial meniscus
• (-) pain - posteromedial corner injury
8.) Posteromedial - Hughston’s posteromedial drawer sign
• Pt. Is in supine position with knee flexed to 80 – 90 and hip
flexed to 45 degrees
• PT medially rotates pt’s foot slightly and sits on the foot to
stabilize
• PT pushes tibia posteriorly
• (+) excessive movement or rotation on the medial aspect
• Posteromedial rotator instability
9.) Posteromedial Pivot Shift Test
• Pt relaxed in supine
• PT passively flexes the knee more than 45 while applying
varus stress, compression, and medial rotation of the tibia
• (+) subluxation of medial tibial plateau posteriorly
• PT extends knee, at about 20 to 40 flexion the tibia shifts
into reduced position
10.) Posterolateral - Hughston’s posteromedial drawer sign
• Pt is in supine with knee flexed to 80 to 90 and hip flexed 45
• PT laterally rotates pt’s foot slightly and sits on the foot to
stabilize
• PT pushes tibia posteriorly
• (+) excessive movement or rotation on the lateral aspect
• Posterolateral rotator instability.
11.) Jakob test (Reverse pivot shift maneuver)
• Pt stands and leans against a wall with the uninjured side
adjacent to the wall
• Body weight distributed equally between the two feet
• PT‘s hand placed above and below the involved knee
• Valgus stress is given while knee flexion is initiated
• (+) jerk or tibia shifts posteriorly or “giving way”
phenomenon occurs
Test for meniscus injury:
1.) McMurray’s Test
• Pt lies supine with knee completely flexed up
• Examiner then medially rotates the tibia in different amount
of flexion to test the lateral meniscus
• If laterally rotated, medial meniscus is being tested.
• A snap or click with pain would indicate (+) test.
2.) Appley’s test
• Pt lies supine with knee flexed to 90
• Examiner medially and laterally rotates the tibia combined
first with distraction to test the ligaments.
• If combined with compression – for meniscus injury
• Determine which maneuver is painful
3.) “Bounce home” test
• Pt in supine
• PT cups pt’s heel
• Pt’s knees completely flexed, and then passively allowed to
extend
• (+) if extension is not completed, having a rubbery end
feel (“springy block”)
• A torn meniscus most likely blocked the motion
4.) Payr’s sign
• Pt in supine with test leg in figure-four position
• (+) pain is on medial joint line
o Meniscal lesion
o Middle or posterior
5.) Childress’ sign
• Pt squats and performs a “duck waddle”
• (+) pain, snapping, or a click
o Posterior horn lesion of the meniscus

Plica tests:
1.) Plica Stutter test
• Pt is seated on edge of table with both knees flexed 90
• Examiner places finger over the patella
• Pt is then instructed to slowly extend the knee
• (+) if patella stutters or jumps between 60-45 degrees of
flexion
• Effective if no swelling
2.) Hughston’s Plica Test
• Pt is in supine
• PT flexes knee and IR tibia with one arm and hand
• Heel of the other hand presses patella medially and palpating
the medial femoral condyle with fingers of the same hand
• Passively flex and extend the knee while palpating for the
“popping” of the plical hand under the fingers
• (+) popping
Swelling:
1.) Brush, Stroke, Wipe, or Bulge test
• Minimal effusion
• PT start stroking just below the medial joint line
• Using palm and fingers, stroke proximally towards the hip as
far as the suprapatellar pouch (2-3x)
• Opposite hand strokes downward on the lateral aspect of the
knee
• (+) fluid passes to medial side of the joint and bulges just
below the medial distal portion or border of the patella
o May take 2 sec to appear
• (N) 1.7ml of synovial fluid – extra of 4-8 ml
2.) Indentation test
• Pt. Supine
• PT passively flex good leg – note indentation
• Fully flex good leg – indentation remains
• Injured knee is slowly flexed – observe
o Disappearance of indentation
• Caused by swelling
• The greater the swelling the sooner the indentation
disappears
3.) Fluctuation test
• Pt places the palm of one hand over the suprapatellar pouch
and the palm of the other hand anterior to the joint with the
thumb and index finger just beyond the margins of the patella
• Press down with one hand and then the other
• (+) fluctuation of fluid
Patellofemoral dysfunction:
1.) Chondromalacia Patella – Frund’s sign
• Pt sitting
• PT percusses patella in various position of knee flexion
• (+) pain
• Chondromalacia patella
2.) Chondromalacia patella - Zohler’s sign
• Pt supine with leg extended
• PT pulls patella distally and holds in position
• Pt contracts quadriceps
• (+) pain
• Chondromalacia patella
• May be (+) in large proportion of normal population
3.) Chondromalacia Patella - McConnell test
• Pt is sitting with femur laterally rotated
• Pt performs isometrics quadriceps contractions at 120, 90,
60, 30 and 0 (10 sec hold)
• If (+) pain in any of the contractions the leg is then fully
supported on the PT’s knee, and the PT pushes the patella
medially.
• Medial glide is maintained, the knee is returned to the
painful angle
• Pt performs isometrics again with the patella held medially
• (+) decrease pain – patellofemoral origin
4.) Waldron’s test
• PT palpates patella while pt performs several slow deep knee
bends
• PT notes amount of crepitus
• (+) crepitus + pain
• Patellofemoral syndrome
5.) Clarke’s sign (Patellar Grind test)
• Pt relaxed with knee extended
• Using web of the hand, PT presses down slightly proximal to
the upper base of the patella
• Pt contracts quadriceps with the PT pushing down on the
patella
• (+) inability to maintain contraction with pain
• Controlled:
o Repeat
o 30,60,90, full extension
• Patellofemoral dysfunction
6.) Step up Test
• Pt stands beside a stool (25cm/10inches)
• Pt steps up sideways onto stool using good leg.
• Repeat with other leg
• (+) inability to perform with pain
• Patellofemoral arthralgia, weak quads, inability to stabilize
pelvis
Osteochondritis Dessicans:
1.) Wilson’s test
• Pt sits with knee flexed over examining table
• Actively extend knee with tibia medially rotated
• Increase in pain at = 30 flexion, ask pt to stop movement
• Pt rotates tibia laterally – pain disappears
• Only (+) if lesion is at the classic site
o Medial femoral condyle near the intercondylar notch
Patellar dislocation:
1.) Fairbank’s Apprehension test
• Pt in supine with quads relaxed and knee flexed at 30
degrees
• PT carefully and slowly pushes patella laterally (and distally)
• (+) pt will contract quads to bring patella back “into • Heel is in valgus, forefoot abducted, or the tibia laterally
limb” rotated more than normal (torsion)
• Apprehensive look • (+) more toes can be seen on the affected side

Ligamentous Instability: 2.) Tibial Torsion (Prone)

1.) Anterior drawer test • Pt in prone
• Supine and relaxed • Knees flexed 90 degrees
• PT stabilizes tibia and fibula. Holds foot in 20 degrees • View from above the angle formed by the foot and thigh
plantar flexion after the subtalar joint has been placed in the neutral position,
• Draw talus forward noting the angle the foot makes with the tibia.
• A dimple appears over the anterior talofibular ligament on • Easier in children
anterior translation with minimal pain and muscle spasm
(dimple or suction sign) Achilles Tendon Rupture:
• (+) anterior translation 1.) Thompson’s /Simmond’s test
• Anterior Talofibular Ligament • Pt in prone and relaxed
• Add inversion – anterolateral stress • Feet over the table or chair
• Anterior talofibular ligament • PT squeezes calf mm
• Calcaneofibular ligament • (+) is (-) plantar flexion
• (+) anterior translation than with ankle in plantar flexion
only Other Tests:
1.) Hoffa’s test
2.) Prone Anterior drawer Test • Pt in prone with feet over the edge of table
• Pt in prone with feet extending over the end of the examining • PT palpates Achilles tendon as pt plantar flexes and dorsi
table flexes
• With one hand the PT pushes heel steadily forward • (+) less taut than the other
• (+) excessive anterior movement and a sucking in of the o Calcaneal fx
skin on both sides of the Achilles tendon • Passive dorsiflexion is also greater
• Anterior talofibular ligament
2.) Tinel’s sign (Ankle) / Percussion sign
3.) Talar Tilt • Anterior Tibial Branch
• Pt is supine or side lying with foot relaxed o Front of ankle
• Gastrocs may be relaxed by flexion of the knee • Posterior Tibial Branch
• Normal side is tested first for comparison o Behind medial malleolus
• Foot is held in anatomical position (90 degrees) • (+) tingling sensation
• Talus is then tilted from side to side
• Adduction 3.) Morton’s test
o Calcaneofibular ligament • Pt supine
• Abduction • PT grasps foot around the metatarsal heads and squeezes
o Deltoid ligament head together
• (+) excessive translation • (+) pain
• Stress Fx
4.) Kleiger Test • Neuroma
• Pt sits with knees flexed to 90 degrees and foot relaxed and
non-weight bearing
4.) Homan’s Sign
• PT gently grasps foot and rotates laterally
• Pt’s foot is passively dorsi flexed with knees extended.
• (+) pain medially and laterally
• Palpation of calf
• PT may feel displacement from medial malleolus
• (+) pain on calf
o Deltoid
• DVT
Tibial Torsion
o Pallor
• 13-18 degrees in adults
o Swelling
• >18 degrees = toe-out position
o Loss of dorsalis pedis pulse
• <13 degrees = toe – in position
• Pigeon toes
• Medial tibial torsion 5.) Bueger’s Test
• Medial femoral torsion • Arterial Blood supply
• Excessive femoral anteversion • Pt supine
• PT elevates leg to 45 degrees for at least 3 minutes
• (+) blanching of foot or collapse of prominent veins after
1.) “Too many toes” Sign
elevation
• Pt standing relaxed
• Pt then sit with legs dangling
• PT views from behind
• Confirmed (+) if 1-2 minutes to restore redness