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Special test - Lecture notes 1

Physical therapy (Our Lady of Fatima University)

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hip • Purpose : To asses mobility limitation in the sacro

Gillet’s Test
(Sacral Fixation Test)
iliac region.
• Pt’s position: Standing
• Procedure:The examiner palpates the inferior aspect
of the PSIS of the tested side in the other hand
palpates the S2 spinous process.
• The pt flexes the hip past 90 degrees.
• The examiner should feel the PSIS move inferiorly
and laterally relative to the sacrum.
• An alternate for this test is to palpate both PSIS’s at
the same time and compare the end position.
• Positive sign: If the sacro iliac joint moves
minimally (hypomobile or blocked).

Lasegue’s Test • Purpose : To asses the sciatic nerve , lower lumbar

(Straight Leg Raising Test)
Squish Test
and upper sacral nerve roots.
• Pt’s position: Supine
• Procedure: The examiner lifts the pt’s leg from the
plinth by holding it at the calcaneum keeping the
knee straight.
• The hip is flexed up to 90, if tolerated.
• The leg should be rotated medially.
• If no symptoms are provoked then try the ankle to
dorsiflexed for further stretch on sciatic nerve.
• Positive sign: Back pain or radicular pain in the
lower extremity indicates sciatic nerve root
irritation, for example due to prolapsed lumbar disc.
•
• Purpose:
• To asses the mobility of the sarcoiliac joint.
• Pt’s position: Supine
• Procedure:
• The examiner places his/ her hands on each ASIS.
• Push inward at a 45 degree angle on both to engage
the tissue. (this is creating a shear force to analyze
how much motion is available at the SI joint)
• While maintaining the position on one side, on the
other opposite side continue to overpress in order to
determine the mobility of the joint. Repeat on the
opposite side.

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• Positive sign: less motion is noted on one side

compared to the other.
•
Flamingo Test • Purpose: To asses the stability of the sarcoiliac joint
(Maneuver) and symphysis pubis.
• Pt’s position: Standing
• Procedure: The pt standing on one leg to cause the
sacrum to shift forward & distally with forward
rotation. The ilium moves in opposite direction.
• On the non-weight bearing side the opposite occurs
but stressed less than the weight bearing side.
• Positive sign: Pain in the symphysis pubis or
sarcoiliac joint indicates a positive test for lesion of
the paiful structure.
•
Piedallu’s Sign • Purpose: Tests the movement of the sacrum on the
ilia
• Pt’s position: Sitting
• Procedure:The examiner palpates the PSIS to
compare their heights.
• Usually the painful one, is lower than the other
• The pt is asked to move forward flex while
remaining seated.
• If the lower PSIS becomes higher one on forward
flexion that side is affected.
• Postive sign: abnormality in the torsion movement
at sacroilliac joint(hypomobile)
•
Gaenslen’s Test • Purpose: To asses for pain originating from
sacroiliac joint.
• Pt’s position: Supine
• Procedure: The non-tested leg is kept in extension,
while the tested leg is placed in maximal flexion.
• The examiner places one hand on the anterior thigh
of the non-tested leg and the other hand on the knee
of the tested leg to apply a flexion overpressure.
• Positive sign: Produces low back pain
•

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Slump Test • Purpose: To asses a herniated disc, neural tension, or

altered neurodynamics are contributing to the pt’s
symptoms.
• Pt’s position: Sitting.
• Procedure: The pt in seated upright with hands held
together behind his/her back.
• The examiner instructs the pt to flex his/her spine
followed by neck flexion.
• The examiner places his/her hand on top of head
and the pt perform knee extension and dorsiflexion
of foot. The pt is told to return the neck to neutral.
• Positive sign: Symptoms are increases in the slump
position and decreased as the pt moves out of neck
flexion.
•
Prone Knee Bending Test • Purpose: to determine the contribution of neural
tension to the pt’s symptoms.
• Pt’s position: Prone
• Procedure: The examiner passively flexes the pt’s
knee to end range and hold it for 45 seconds.
• The hip should not be rotated.
• Positive sign:
• Pain in the anterior thigh that indicates tightness in
quadriceps muscle or neural tension of the femoral
nerve.
• Pain on the unilateral lumbar area, buttock or
posterior thigh that indicates lumbar radiculopathy
of L2-L3 nerve roots.
•
Brudzinski-Kernig Test • Purpose:
• Pt’s position: Supine
• Procedure: The pt is instructed to flex the head onto
the chest.
• The pt raises the extended leg actively by flexing
the hip until pain is felt and flexes the knee.
• Positive sign: If the pain disappears after the knee
flexion it indicates meningeal irritation, nerve root
involvement or dural irritation.
•

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Femoral Traction Test • Purpose: To stretch the femoral nerve.

• Pt’s position: Side lying
• Procedure: The pt lies on the unaffected side with
the unaffected limb flexed slightly at the hip and
knee.
• The pt’s back should be straight, not hyperextended
and the head should be slightly flexed.
• The examiner grasps the affected side and extends
the knee and gently extending the hip for about 15
• Positive sign: Neurological pain radiates down the
anterior thigh.
•
One Leg Standing Test • Purpose: To assess joint dysfunction.
(Stork Test) • Pt’s position: Standing
• Procedure: The pt stands on one leg and extends the
spine while balancing on the leg.
• The test is repeated with the pt standing on the
opposite leg.
• Positive sign: Pain in the back and associate with a
pars interarticularis stress fracture
(spondylolisthesis).
•

Schober’s Test • Purpose: Used to measure the amount of flexion

occuring in the lumbar spine.
• Pt’s position: Standing
• Procedure: Marked a point between the two PSIS’s
(level of S2) then 5cm below and 10cm above the
level of the marked.
• The patient is asked to flex forward to measure the 3
marked points.
• Positive sign: The difference between the points
indicates the amount of flexion occuring in the spine
•
Yeoman’s Test • Purpose: To assess sacroiliac joint lesion
• Pt’s position: Prone
• Procedure: The examiner flexes the subject’s knee to
90 degrees and extends the same hip
• Positive sign: Pain over the back of the sacroiliac

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joint.
•
Milgram’s Test • Purpose:
• Pt’s position: Supine
• Procedure: The pt actively lifts both legs off the
plinth from 5 to 10 cm (2 to 4 inches), holding this
position for 30 seconds.
• Positive sign: If the limbs or affected limb cannot
held for 30 seconds.
•
Beevor’s Sign • Purpose: To assess pathology in abdominal muscles
• Pt’s position: Supine
• Procedure: The pt flexes the head against resistance,
coughs, or attempts to sit up with the hands resting
behind the head.
• Positive sign: If the umbilicus does not remain in a
straight line when the abdominals contract.

KENDALL TEST • Test Measure: Muscle Tightness or Restriction of

(Rectus Femoris Contracture Test) tight joint structures (ex.capsule)
• Patient Position: Supine with knees bent over the
end or edge of the examining table.
• Procedure: The patient flexes one knee onto the
chest and holds it. The angle of the test knee should
remain at 90’ when the opposite knee is flexed to the
chest.
• Positive Sign: Test knee extends.

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ELY’S TEST • Test Measure: Rectus Femoris Tightness

• Patient Position: Prone

• Procedure: Examiner passively flexes the patient’s
knee
• Positive Sign: Hip flexion on the same side

OBER’S TEST • Test Measure: Tensor Fasciae latae (IT band)

contracture
• Patient Position: Side Lying with lower leg flexed at
hip and knee for stability.
• Procedure: The examiner passively abducts and
extends the patient’s upper leg with knee straight or
flexed to 90’
• Positive Sign: Leg remains abducted while the
patient’s muscle is relaxed

NOBLE COMPRESSION TEST • Test Measure: Iliotibial band friction syndrome

• Patient Position: Supine with knees flexed at 90’
accompanied with hip flexion
• Procedure: Examiners applies pressure with the
thumb to lateral femoral epicondyle (1 or 2 cm)
proximal to it. While the pressure is maintained the
patient slowly extend the knee at approx. 30’
• Positive Sign: Pain over the lateral femoral condyle.

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PIRIFORMIS TEST • Test Measure: Piriformis Muscle Tightness

• Patient Position: Side lying Position with test leg
uppermost
• Procedure: The patient flexes the test hip at 60’ with
the knee flexed. The examiner stabilizes the hip with
one hand and applies a downward pressure to the
knee.
• Positive Sign: Pain is elicited in the muscle

90’-90’ SLR • Test Measure: Hamstring Contraction

(Hamstring Contracture Method 1)
• Patient Position: Supine with both hips flexed to
90’ while knees are bent.
• Procedure: Patient actively extends each knee in
turn as much as possible.
• Positive Sign: Popliteal Angle less than 125’

• Test Measure: Hamstring Muscle Tightness

TRIPOD SIGN
(Hamstring Method Contracture 3)
• Patient Position: Seated with both knees flexed to
90’
• Procedure: The examiner passively extends one
knee. If the hamstring muscle on that side are tight,
the patient extends the trunk to relieve the tension in
the hamstring muscle.
• Positive Sign: Extension of the spine

PHELP’S TEST • Test Measure: Gracilis Muscle Contracture

• Patient Position: Prone with knees extended
• Procedure: The examiner passively abducts both of
the patient’s leg as far as possible. The knees are
then flexed to 90’ and the examiner tries to abducts
the hips further.
• Positive Sign: Increases Abduction

knee •

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Valgus Stress Test • Steps: Patient is supine with the involved leg close
to the edge of the table and the knee is flexed ~ 25–
30 degrees
• Examiner supports the medial portion of the distal
tibia with one hand while the other hand grasps the
knee along the lateral joint line.
• Examiner applies a medial (valgus) force to the knee
& the distal tibia is moved laterally while the knee is
in 25–30 degrees of flexion
• Positive Test: Increased laxity, pain, guarding
Positive Test Implications: Injury to the MCL; No end point
indicates a Grade 3 injury; solid end point with no laxity but
pain indicates a Grade 1 injury

Varus Stress Test • Steps: Patient is supine with the involved leg close
to the edge of the table and the knee is flexed ~ 25–
30 degrees
• Examiner: supports the lateral portion of the distal
tibia with one hand while the other hand grasps the
knee along the medial joint line
• Examiner: applies a lateral (varus) force to the knee
& the distal tibia is moved medially while the knee
is in 25–30 degrees of flexion
• Positive Test: Increased laxity, pain, and guarding

• Positive Test Implications: Injury to the LCL; No

end point indicates a Grade 3 injury; solid end point
with no laxity but pain indicates a Grade 1 injury

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Lachman’s Test • Steps: Patient is supine with his/her knee passively

flexed to approximately 20 degrees & hands crossed
across his/her chest
• Examiner's thumb of the same–side hand as the knee
to be examined is placed at the anterior medial tibial
plateau/joint line, while digits 2–5 are positioned
posterior, slighty distal to the popliteal fossa
• Examiner's contralateral hand is placed laterally
around the distal femur, just proximal to the patella
with the thumb anterior & the digits 2–5 are
positioned posteriorly
• Examiner sets the tibia by pushing posterior (to
make sure the PCL is in tact)Examiner provides an
anterior force to the tibia while applying posterior
pressure to the femur; repeats the process 2–3 times
• Positive Test: Increased anterior tibial translation,
pain
• Positive Test Implications: ACL tear (primary
posterolateral bundle but also the anteromedial
bundle)

Anterior Drawer Test • Steps: Patient is lying supine with his/her hip flexed
45 degrees & knee flexed 90 degrees
• Examiner sits on the patient's foot & grasps the tibia
just below the joint line
• Examiner's thumbs are placed along the joint line on
either side of the patellar tendon & the index fingers
are used to palpate the hamstring tendons
• Examiner ensures that the patient is relaxed, esp. the
hamstring tendons
• Examiner draws the tibia straight forward (no
rotation)
• Positive Test: Increased anterior tibial translation,
pain
• Positive Test Implications: ACL tear (mainly the
anteromedial bundle because the posterolateral
bundle is basically laxed in this position)

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Posterior Drawer Test
Active Drawer Test/Quad Active test
Bounce Home’s Test
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• Steps: Patient is lying supine with his/her hip flexed
to 45 degrees & knee flexed to 90 degrees
• Examiner: sits on the patient's foot & grasps the
tibia just below the joint line
• Examiner's thumbs are placed along the joint line on
either side of the patellar tendon
• Examiner ensures that the patient is relaxed, esp. the
quadriceps
• Examiner pushes the tibia posteriorly
• Positive Test: Increased posterior tibial translation,
pain
• Positive Test Implications: PCL tear
Steps: Patient is lying supine with his/her hip flexed to 45
degrees & knee flexed to 90 degrees
Examiner: observes the tibial tubercles for presence of a
posterior sag
Examiner: holds the patient's feet down against the table
Examiner: instructs the patient to contract his/her quadriceps
as if trying to straighten his/her knees
Examiner: observes the tibial tubercle for anterior shifting
upon quadriceps contraction
Positive Test: Anterior shift of the tibia upon quadriceps
contraction
Positive Test Implications: ACL injury (if no posterior sag is
present); PCL injury (if posterior sag is present)
• The patient lies in supine position, and the heel of
the patient’s foot is cupped in examiner’s hand.
• The patient’s knee is completely flexed, and the
knee is passively allowed to extend.
• If extension is not completed or has a rubbery end
feel there is something blocking full extension. The
most likely cause of a block is a torn meniscus.
• The test is positive for a meniscus lesion if the
patient experiences a sharp pain on the joint line
after quickly extending the knee in one jerk.
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O’Donoghue’s Test • If a patient complains of pain along the joint line, lie
patient in supine position.
• Flex the patient’s knee to 90°, rotate it twice
medially and laterally. Fully flex knee and repeat
rotation.
• Test is positive if increased pain is felt on rotation.
indicative of capsular irritation or a meniscus tear.

Modified Helfet Test • Tibial tuberosity must be lined with patellar midline
when knee is flexed to 90°.
• Tibial tubercle is lined with the lateral border of
patella when knee is extended.
• Test is positive when changes does not occur during
movement, indicating possible cruciate injury.

Bohler’s Sign • While patient lies supine, apply varus and valgus
stresses to the knee.
• The test is positive for meniscus pathology when
pain in the opposite joint line on stress testing is felt.

Bragard’s sign • While patient lies supine, flex the knee.

• Laterally rotate the tibia and extend the knee.
• Indicative of meniscus pathology are pain and
tenderness, but when the tibia is medially rotated
and knee is flexed, these will decrease.
• Symptoms are indicative of medial meniscus
pathology.

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Step up test The patient stands beside a stool

which is 25 cm (10 inches) high. The examiner asks
the patient to step up sideways onto the stool using
the good leg. The test is repeated with the other leg.
Normally, the patient should have no difficulty doing
the test and have no pain. Inability to do the test may
indicate patellofemoral arthralgia, weak quadriceps, or
an inability to stabilize the pelvis.

Waldron test This test also assesses the presence

of patellofemoral syndrome.34 The examiner palpates
the patella while the patient performs several slow deep
knee bends. As the patient goes through the ROM, the
examiner should note the amount of crepitus (significant
only if accompanied by pain), where it occurs
in the ROM, the amount of pain, and whether there is
"catching" or poor tracking of the patella (see Fig.
12-25) throughout the movement. If pain and
crepitus(popping or crackling sound)
occur together during the movement, it is considered
a positive sign.

Zohler’s sign The patient lies supine with the

knees extended. The examiner pulls the patella distally
and holds it in this position. The patient is asked to
contract the quadriceps (Fig. 12-113). Pain is indicative
of a positive test for chondromalacia patellae
However, the test may be positive (false positive) in
large proportion of the normal population.

Wilson test This is a test for osteochondritis dissecans.

The patient sits with the knee flexed over the
examining table. The knee is then actively extended
with the tibia medially rotated. At approximately 30°
of flexion (0° being straight leg), the pain in the knee
increases, and the patient is asked to stop the flexion
movement. The patient is then asked to rotate the
tibia laterally, and the pain disappears. This finding
indicates a positive test, which is indicative of
osteochondritis

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Fairbanks apprehension test
Noble compression test
ankle
Too Many Toes" Sign.
Anterior Drawer Test of the Ankle.
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dissecans of the femoral condyle. The test is
positive only if the lesion is at the classic site for
osteochondritis dissecans of the knee, namely, the medial
femoral condyle near the intercondylar notch (Fig,
12-121).
This is a test for
dislocation of the patella. I II , 175 The patient lies in the
supine position with the quadriceps muscles relaxed
and the knee flexed to 30° while the examiner carefully
and slowly pushes the patella laterally (Fig. 12-122).
If the patient feels the patella is going to dislocate, the
patient will contract the quadriceps muscles to bring
the patella back "into line." This action indicates a
positive test. The patient will also have an apprehensive
look. (kicks)
This is a test for iliotibial
band friction syndrome.176 The patient lies in the
supine position, and the examiner flexes the patient's knee to
90°, accompanied by hip flexion (Fig. 12123).
Pressure is then applied to the lateral femora.
epicondyle, or 1 to 2 cm (0.4 to 0.8 inch) proximal t
it, with the thumb. While the pressure is maintained
the patient's knee is passively extended. At approximately
30° of flexion (0° being straight leg), the patient
complains of severe pain over the lateral femora.
condyle. Pain indicates a positive test. The patien states
that it is the same pain that occurs with activity.
The patient stands in a normal relaxed position while the
examiner views the patient from behind. If the heel is in valgus,
the forefoot abducted, or the tibia laterally rotated more than
normal (tibial torsion), more toes can be seen on the affected
side than on the normal side
This test is designed primarily to test for injuries to the anterior
talofibular ligament, the most frequendy injured ligament in the
ankle. 58 - 60 The patient lies supine with the foot rel<n::ed. The
examiner stabilizes the tibia and fibula, holds the patient's foot
in 20° of plantar flexion, and draws the talus forward in the
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ankle mortise Sometimes, a dimple appears over the area of the

anterior talofibular ligament on anterior translation (dimple or
suction sign) if pain and muscle spasm are minima1.63- 65 In the
plantar-flexed position, the anterior talofibular ligament is
perpendicular to the long axis of the tibia. instability (Fig. 13-
61C), which is increasingly evident with increasing plantar
flexion of the foot. 18,20,67-69 Ideally, the knee should be
placed in 90° of flexion to alleviate tension on the Achilles
tendon. The test should be performed in plantar flexion and
in dorsiflexion to test for straight and rotational instabilities.
The test may also be performed by stabilizing the foot and
talus and pushing the tibia and fibula posteriorly on the talus
In this case, excessive posterior movement of the tibia and
fibula on the talus indicates a positive test.
Talar Tilt. The patient lies in the supine or side
lying position with the foot relaxed (Fig. 13-63).18,-1
The patient's gastrocnemius muscle may be relaxed by
flexion of the knee. This test is used to determine
whether the calcaneofibular ligament is torn. 59,66 The
normal side is tested first for comparison. The foot i
held in the anatomic (90°) position, which brings the
calcaneofibular ligament perpendicular to the long axis
of the talus. If the foot is plantar flexed, the anterior
talofibular ligament is more likely to be tested (inversion
stress test).65 The talus is then tilted from side to
side into adduction and abduction. Adduction tests the
calcaneofibular ligament and, to some degree, the anterior
talofibular ligament by increasing the stress on
the ligament. 10 Abduction stresses the deltoid ligament,
primarily the tibionavicular, tibiocalcaneal, and
posterior tibiotalar ligaments. On a radiograph, the
talar tilt may be measured by obtaining the angle between
the distal aspect of the tibia and the proximal
surface of the talus
Squeeze Test of the Leg The patient lies supine. The examiner grasps the
lower leg at midcalf and squeezes the tibia and
fibula together Pain in the lower leg may indicate a
syndesmosis injury, provided that fracture,c
ontusion, and compartment syndrome have been
ruled out.8,6o,n-75 Brosky and associates76 call this

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External Rotation Stress Test.
Cotton Test/
Thompson's (Simmonds') Test (Sign for Achilles
Tendon Rupture).
Figure-8 Ankle Measurement for Swelling.
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test the distal tibiofibular compression test and apply
the compression over the malleoli rather than the shaft
of the tibia and fibula. ussbaum et al77 reported that
the "length of tenderness" above the lateral malleolus
gave an indication of severity.
The patient is seated with the leg hanging over the
examining table with the knee at 90°. The examiner
faces the leg, holds the foot in plantigrade (90°) and
applies a passive lateral rotation stress to the foot and
ankle. The test is poslUve for a syndesmosis injury if
pain if produced over the anterior or posterior
tibiofibular ligaments and the interosseous membrane
This test is also used to assess for syndesmosis
instability with diastasis. The examiner stabilizes the
distal tibia with one hand and applies a lateral
translation force with the other hand to the foot. Any
lateral translation would indicate syndemotic
instability.
The patient lies prone or kneels on a chair with the
feet over the edge of the table or chair While the
patient is relaxed, the examiner squeezes the calf
muscles. A positive test is indicated by the absence
of plantar flexion when the muscle is squeezed and
is indicative of a ruptured Achillestendon ( third-
degree strain).80-83 One should be careful not to
assume that the Achilles tendon is not ruptured if
the patient is able to plantar flex the foot while not
bearing weight. The long flexor muscles can
perform this function in the non-weight-bearing stance
even with a rupture of the Achilles tendon.
The patient is positioned in long sitting with the ankle
and lower leg beyond the end of the examining table
with the ankle in plantigrade (90°). Using a 6 mm (1/4
inch) wide plastic tape measure, the examiner places
the end of the tape measure midway between the
tibialis anterior tendon and the lateral malleolus,
drawing the tape medially across the instep just distal
to the navicular tuberosity. The tape is then pulled
across the arch of the foot just proximal to the base of
the end feel by pushing dorsally on the navicular and
metatarsal heads. The end feel is compared with the
normal side. A positive test is indicated by
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reproduction of the patient's symptoms.

Homans' Sign. The patient's foot is passively dorsiflexed with the
knee extended. Pain in the calf indicates a positive
Romans' sign for deep vein thrombophlebitis (Fig. 13
-76). Tenderness is also elicited on palpation of the
calf. In addition to these findings, the examiner may
find pallor and swelling in the leg and a loss of the
dorsalis pedis pulse.
Buerger's Test. This test is designed to test the arterial blood supply to
the lower limb.21 The patient lies supine while the
examiner elevates the patient's leg to 45° for at least 3
minutes. If the foot blanches or the prominent veins
collap-se shortly after elevation, the test is positive for
poor arterial blood circulation. The patient is then
asked to sit with the legs dangling over the edge of the
bed. If it takes 1 to 2 minutes for the limb color to be
restored and the veins to fill and become prominent,
the test is confirmed positive.
Hoffa's Test. The patient lies prone with the feet extended over the
edge of the examining table. The examiner palpates
the Achilles tendon while the patient plantar flexes
and dorsiflexes the foot. If one Achilles tendon (the
injured one) feels less taut than the other one, the test
is considered positive for a calcaneal fracture. Passive
dorsiflexion on the affected side is also greater.
Tinel's Sign at the Ankle (Percussion Sign). Tinel's sign may be elicited in two places around the
ankle. The anterior tibial branch of the deep peroneal
nerve may be percussed in front of the ankle (Fig.
1375A). The posterior tibial nerve may be percussed
as it passes behind the medial malleolus (Fig. 13-
75B). In both cases, tingling or paresthesia felt distally
is a positive sign.
Duchenne Test. The patient lies supine with the legs straight. The
examiner pushes up on the head of the first metatarsal
through the sole, pushing the foot into dorsiflexion.
The test is positive for a lesion of the superficial
peroneal nerve or a lesion of LA, L5, or Sl nerve root
if, when the patient is asked to plantar flex the foot,
the medial border dorsiflexes and offers no resistance
while the lateral border plantar flexes.
Morton's Test The patient lies supine. The examiner grasps the foot
around the metatarsal heads and squeezes the heads

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together. Pain is a positive sign for stress fracture or

neuroma.

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