REHABILITATION MEDICINE AY 20-21

Dr. Jan-Tyrone Cabrera, MD, DPBRM, FPARM

FROM THE EDITOR AND TRANS TEAM:

This supplemental trans on UE/LE special tests is based on the given special tests in Dr. Cabrera’s lecture and is supplemented with notes from Orthopaedic Physical Assessment (6th ed) by David Magee.
All images (except Prayer Sign) are taken from the book. Other special tests not mentioned in the specific lectures are described in Appendix 3 of the Intro to Rehab Med trans by Batch 2020.

I. UPPER EXTREMITY SPECIAL TESTS

Pathology Special Test Procedures (+) Figure

SHOULDER

Examiner internally (medially) rotates the arm, then

forcibly flexes it forward.
Neer Impingement
Test This causes the greater tuberosity to jam →
anteroinferior border of the acromion.

Shoulder pain

Shoulder Impingement (due to overuse injury

to the supraspinatus
tendon

Examiner forward flexes patient’s arm to 90 degrees,

Hawkins-Kennedy
then medially rotates it at the shoulder joint.
Test
- Alternative test to
This causes supraspinatus tendon to hit → the
Neer’s
anterior surface of the coracoid process

Examiner abducts arm to 90 deg, arms in neutral

Shoulder pain when
rotation.
on resisted abduction
Supraspinatus With their arms abducted, patient resists the
Rotator Cuff in empty can position.
(“Empty Can” or downward force applied by the examiner.
Tendinopathy
“Jobe”) Test Same method is done, but now the shoulder is
(supraspinatus mm or
medially rotated (thumbs down – “empty can
tendon tear)
position”) and angled forward 30 deg.

DE GUZMAN AO, ESTRADA PD, ESTRELLA AV | DE MESA, LADEZA, LAGRISOLA (PTRP NOTES) Page 1 of 8
[REHAB] Supplemental – UE, LE, and Spine Special Tests Page 2 of 8

Sudden dropping of
the arm or severe
Examiner passively abducts the arm to 90 deg.
Drop-Arm shoulder pain
Patient tries to lower (adduct) the arm slowly.
(Codman’s) Test
(due to rotator cuff
tear or rupture)

Method 1:
Patient extends elbows, with the forearm supinated
first.
Speed’s (Biceps or
Examiner applies resistance on the proximal wrist Anterior shoulder pain
Straight-Arm) Test
while patient actively flexes their shoulder. (tenderness in bicipital
Do the same method with the forearm pronated. groove) and/or
- More effective than
Bicipital Tenosynovitis weakness
Yergason’s test
Method 2:
because the biceps
Patient forward flexes their arm to 90 degrees. (due to biceps tendon
tendon moves
With forearm supinated, patient resists an eccentric rupture or tendinosis)
here.
movement into shoulder extension (applied by the
examiner)
Do the same method with the forearm pronated.

Examiner palpates for the biceps tendon in the Tendon “pops out” of
bicipital groove. the bicipital groove
With the arm adducted, examiner flexes the patient’s
Yergason’s Test
elbow to 90 deg and pronates the forearm. (due to a torn
Patient then supinates forearm and laterally rotates transverse humeral
their arm against resistance. ligament)

Patient makes a fist with the forearm pronated.

Patient then radially deviates and extends the wrist Sudden, severe pain
Lateral epicondylitis Cozen’s Test against resistance by the examiner. in the lateral
The epicondyle may be palpated to indicate the epicondyle
origin of pain.
[REHAB] Supplemental – UE, LE, and Spine Special Tests
Phalen’s Test
Carpal Tunnel Syndrome
(Median n. compression)
Cubital Tunnel Syndrome Froment’s “Paper”
(Ulnar n. compression)
Entrapment Neuropathy
Page 3 of 8
Examiner flexes the patient’s wrists (dorsum of
hands opposed)
Hold position for 1 minute by pushing the wrists
together.
Pain and/or
paresthesia over the
lateral 3 ½ fingers
Examiner extends the patient’s wrists (palms
Prayer’s Test opposed)
Hold position for 1 minute.
Distal Interphalangeal
(DIP) flexion to
maintain paper
position between
thumb and palm
Patient grasps a piece of paper between their
*Suggests paralysis of
adducted thumb and index finger.
Sign adductor pollicis
Examiner attempts to pull the paper.
(+) Jeanne’s sign: if
thumb MCP also
hyperextends = ulnar
nerve paralysis
Shooting pain or
Examiner taps over the site of entrapment (e.g.
Tinel’s Sign paresthesia along
carpal tunnel)
nerve distribution
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II. LOWER EXTREMITY SPECIAL TESTS

Pathology Special Test Procedure (+)

HIP

Patient lies supine. Knee remains above

Examiner passively flexes, abducts, and externally the opposite straight
rotates (FABER) the hip of the test leg so that the leg or inguinal pain
Patrick’s Test/ foot on top of the knee of the opposite leg (figure-
Hip Pathology FABER four position). Examiner lowers the knee of the test (due to hip joint
leg toward the examining table. affectation i.e.,
Normally, the knee should be able to fall on the table iliopsoas spasm, or
or at least be parallel with the opposite leg. sacroiliac joint
pathology).

Patient lies supine while examiner checks for

Hip Flexor Tightness
excessive lumbar lordosis (seen with tight hip
Patient’s straight leg
flexors).
rises off the table and
The examiner flexes one of the patient’s hips and
a muscle stretch end-
brings the ipsilateral knee towards the patient’s chest
feel will be felt.
to flatten out the lumbar spine and to stabilize the
Thomas Test pelvis.
(In Doc’s PPT: lack of
The patient holds the position.
hip extension)
Normally, the hip being tested (the straight leg)
remains on the examining table.
(indicates hip flexor
contractures)
(In Doc’s PPT: both hips flexed → affected leg
lowered)

The patient is in the side lying position with the lower

leg flexed at the hip and knee for stability.
The leg remains
The examiner then passively abducts and extends
abducted and does
the patient’s test thigh (to ensure that the tensor
not fall to the table
Iliotibial Band (ITB) fascia latae runs over the greater trochanter). The
Ober’s Test (lack of hip adduction)
Tightness knee may either be extended or flexed to 90°.
The limb is then slowly lowered.
(indicates ITB
contracture)
Note that greater stretch is placed on the ITB with
the knee extended.
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KNEE
Patient lies supine.
The examiner places the patient’s knee in 30° Increased anterior
Lachman’s
flexion. translation with medial
(Ritchie/Trillat/
The patient’s femur is stabilized with the examiner’s rotation of the tibia,
Lachman-Trillat)
“outside” hand, while the proximal aspect of the tibia and disappearance of
Test
is moved forward with the other (“inside”) hand. the infrapatellar
tendon slope
- Best indicator of
Note: The tibia should be slightly literally rotated, and With or without pain
injury to the ACL
the force applied by the examiner should come from Soft “mushy” end-feel
the posteromedial aspect.
ACL Tear

Excess anterior glide

Patient lies supine with testing hip flexed to 45
Anterior Drawer of the tibia, with or
degrees, and the knee flexed to 90 degrees.
Test without pain
Examiner passively glides tibia anteriorly.
Soft end-feel

Patient lies supine with testing hip flexed to 45 Excess posterior glide
Posterior Drawer degrees and knee flexed to 90 degrees. of the tibia. with or
PCL Tear
Test Examiner passively glides the tibia posteriorly without pain
following the joint plane. Soft end-feel

Patient lies supine.

Examiner palpates the medial and lateral areas of
the knee joint.
“Gapping” on the
Valgus (for MCL) For the MCL: examiner places a valgus force
medial (for MCL) or
MCL or LCL Tear and Varus (for (pushes the knee medially) at the knee joint
lateral (for LCL)
LCL) Stress Test For the LCL: examiner places a varus force (pushes
aspect of the knee
the knee laterally).
The test is done with the knee in full extension first,
then in 20-30 degrees flexion.
[REHAB] Supplemental – UE, LE, and Spine Special Tests Page 6 of 8

Patellofemoral joint
disorder Patient lies supine, knees extended. Retropatellar pain and
Clarke’s Sign Examiner presses down proximal to the upper pole inability to hold the
(patellofemoral pain (Patellar Grind or the base of the patella with the web of the hand. muscle contraction,
syndrome, Test) Patient is asked to contract their quadriceps while crepitus, and
chondromalacia the downward pressure is maintained. apprehension
patellae)

Patient lies in supine, knee completely flexed (heel

touches the buttock).
To test the lateral meniscus: examiner
McMurray Test
medially/Internally rotates the tibia and extends the Audible snap or click
Meniscal Pathology - Grandfather of
knee while applying a varus force. accompanied by pain
meniscus tests
To test the medial meniscus: same procedure, but
tibia is laterally/externally rotated, and a valgus force
is applied.

A. Medial meniscus
B. Lateral meniscus
ANKLE JOINT

Absence of ankle
Patient lies prone or kneels on a chair, feet dangling
Thompson’s plantarflexion
Achilles Tendon Rupture on the edge of the plinth or chair.
(Simmond’s) Test (3rd degree Achilles
Examiner squeezes the patient’s calf muscles.
tendon rupture)

Patient lies supine, foot relaxed.

Anterior Talofibular
Ligament (ATFL) Injury
- Most frequenly injured
ligament in the ankle
Anterior translation of
Examiner stabilizes the distal leg and holds the foot
Anterior Drawer the foot with or without
in 20 degrees plantarflexion (neutral in doc’s ppt)
Test of the Ankle pain
The foot (by the talus) is then drawn forward against
Soft end-feel
the leg.
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III. LOWER EXTREMITY SPECIAL TESTS

Pathology Special Test Procedure (+)

CERVICAL
Provocation test (i.e., performed when symptoms are
diminished or absent at the time of testing)
Patient laterally flexes the head towards the
unaffected side then to the affected side, head in
neutral rotation (first stage)
Examiner carefully presses straight down on
patient’s head.
Pain radiates → arm
If the symptoms are not reproduced, do the same
to which the head is
Foraminal method for the next stages (see below)
side flexed during
Compression compression
(Spurling’s) Test Three stages:
1. Head in neutral
(indicates pressure on
2. Head extended.
a nerve root aka
3. Head extended and rotated to the
cervical radiculitis)
unaffected side.
Nerve Root Test positions narrow the intervertebral foramen to
Compression reproduce the symptoms.
May be positive in the ff: stenosis, cervical
spondylosis, osteophytes, joint pathologies, disk
herniation, or vertebral fracture.

Jackson’s Patient rotates head to one side.

Pain radiates → arm
Compression Test Examiner presses down on patient’s head.
(along dermatomal
- Modification of Same methods are repeated with the head rotated to
distribution)
Spurling’s the opposite side.

LUMBOSACRAL PLEXUS

Back pain only ➔

disc herniation or
Patient supine and completely relaxed.
prolapse that is
Examiner places the patient’s hip in medial rotation,
smaller and more
adduction, and the knee in extension.
central
Straight Leg The entire lower extremity is then raised (hip is
(pressure on anterior
Nerve Root Irritation Raising flexed) passively up to patient’s tolerance.
theca of the spinal
(Lasegue) Test Patient is then asked to flex the neck towards their
cord)
chest or the examiner dorsiflexes the foot –
considered as the most provocative or sensitizing
Pain in the leg ➔
tests.
disc herniation that is
more lateral
[REHAB] Supplemental – UE, LE, and Spine Special Tests Page 8 of 8

Modifications of the SLR Test to target specific nerve/nerve roots:

Sharp, electric, shock-

like pain down the
spine and into the
Patient in long sitting position on the plinth. upper or lower limbs
Modified SLR
Examiner flexes patient’s head and one hip
(Lhermitte Sign)
simultaneously. Maintain knee extension. (indicates dural or
meningeal irritation, or
possible cervical
myelopathy)

Patient lies prone.

Unilateral pain the
Examiner flexes patient’s knee → buttock (or as far
lumbar, buttock, or
as possible). Make sure that the hip is in neutral (i.e.,
posterior (sometimes
Prone Knee not rotated).
anterior) thigh
Bending
(Nachlas) Test If the knee cannot be flexed beyond 90 degrees
(indicates L2 or L3,
because of a knee condition, the examiner may opt
but in the caption L2-
to extend the hip while keeping the knee flexed up to
L4, nerve root lesion)
patient’s tolerance only.

Patient is seated on the edge of the examining table,

hips in neutral position, hands behind the back.
Sequence:
1. Patient is asked to “slump” the back into
thoracic and lumbar flexion.
2. Examiner maintains patient’s chin in neutral
(prevents neck and head flexion)
3. Overpressure is applied by one hand across
Ability to extend knee
patient’s shoulders to maintain flexion on
Slump Test or decreased pain with
cervical, thoracic, and lumbar spine.
neck extension
4. The other hand hold dorsiflexes patient’s foot.
5. Patient actively extends the knee as much as
they can.
6. Test is done on the other side.

If he patient can’t extend the knee due to pain,

release overpressure and let patient extend their
neck.