Special MSK Tests For Physiotherapists Easy & Fast-1st Edition (Ali Muslim Raza)

1st Edition
Special MSK Tests for

Physiotherapist
Easy
Fast
Dr. Ali Muslim Raza (PT)

Introduction
Welcome to "Special MSK Tests for Physiotherapists Made Easy &
Fast" This book is your ultimate guide to mastering the special tests commonly
used in physiotherapy. Whether you're an experienced professional or a student
starting your physiotherapy journey, this book will give you the knowledge and
skills you need to succeed.
As physiotherapists, our job is to assess and diagnose musculoskeletal and

neurological conditions. Special tests are an important part of this process. They
help us gather important information about a patient's condition, identify specific
problems, and create targeted treatment plans. But learning and applying these tests
can sometimes feel overwhelming and time-consuming.
That's where this book comes in. Our goal is to make learning special tests easy and
accessible. We have carefully selected the most commonly used tests, covering
different body areas and conditions. Each test is explained step-by-step, with clear
instructions on how to perform it, what to look for, and what it means for the
diagnosis.
What makes this book special is its focus on making learning efficient and effective.
We understand the demands of a physiotherapist's work and have designed the
content to help you quickly grasp the key concepts and apply them in real-life
situations. The book includes detailed illustrations and diagrams to help you
understand the tests .
Whether you're studying for an exam, looking to improve your clinical skills, or
just need a reliable reference, "Special MSK Tests for Physiotherapists Made Easy
& Fast" is the book for you. It's a comprehensive yet concise manual that will give
you the confidence to perform special tests, interpret the results, and make informed
treatment decisions.
I hope this book becomes your trusted companion throughout your professional
journey, helping you provide the best possible care to your patients. So let's get
started and explore the exciting world of special MSK tests for physiotherapists.
Get ready to expand your knowledge, sharpen your skills, and become a master of
special tests, all while saving time and effort!
(Dr Ali Muslim Raza (PT))
Disclaimer: This book is for educational purposes only. It does not replace
professional training or clinical judgment. Always consult with a qualified
healthcare professional before performing special tests or starting any treatment .
Table of Contents
SPINE _______________________________________________ 1
CERVICAL __________________________________________ 1
Foraminal Compression ____________________________________________________ 1
(Spurling’s) _____________________________________________________________ 1
(Spurling's Test)__________________________________________________________ 1
Distraction Test __________________________________________________________ 2
(Cervical Distraction Test) __________________________________________________ 2
Upper Limb Tension Test ___________________________________________________ 3
(Upper Limb Neurodynamic Test)_____________________________________________ 3
(Upper Limb Nerve Tension Test) _____________________________________________ 3
Allen Test ______________________________________________________________ 5
(Allen Maneuver) ________________________________________________________ 5
Halstead Maneuver _______________________________________________________ 6
(Halstead's Test) _________________________________________________________ 6
Shoulder Abduction Test ___________________________________________________ 7
Valsalva Test ____________________________________________________________ 8
(Valsalva Maneuver) ______________________________________________________ 8
Romberg’s Test __________________________________________________________ 9
(Romberg Balance Test)____________________________________________________ 9
(Romberg Sign) __________________________________________________________ 9
Vertebral Artery Test _____________________________________________________ 11
(Cervical Quadrant) ______________________________________________________ 11
LUMBAR ___________________________________________ 12
Straight Leg Raise _______________________________________________________ 12
(Lasègue Test) __________________________________________________________ 12
Prone Knee Bending _____________________________________________________ 13
(Prone Knee Flexion Test) _________________________________________________ 13
Slump Test ____________________________________________________________ 14
(Slump Maneuver)_______________________________________________________ 14
Brudzinski-Kernig Test ____________________________________________________ 16
(Kernig's Test) __________________________________________________________ 16
(Brudzinski's Sign) _______________________________________________________ 16
Bowstring Test _________________________________________________________ 18
(Bowstring Sign) ________________________________________________________ 18
Babinski Test ___________________________________________________________ 19
(Plantar Reflex Test) _____________________________________________________ 19
(Babinski Reflex) ________________________________________________________ 19
Beevor’s Sign___________________________________________________________ 20
(Beevor's Test) _________________________________________________________ 20
(Umbilical Sign) _________________________________________________________ 20
Hoover Test ___________________________________________________________ 21
(Hoover's Sign) _________________________________________________________ 21
SHOULDER _________________________________________ 23
ANTERIOR INSTABILITY ____________________________ 23

Load and Shift Test ______________________________________________________ 23
(Anterior Load and Shift Test) ______________________________________________ 23
Crank Test_____________________________________________________________ 24
(Crank Maneuver) _______________________________________________________ 24
Fulcrum Test ___________________________________________________________ 25
Anterior Drawer Test_____________________________________________________ 27
(Anterior Drawer Maneuver) _______________________________________________ 27
(Anterior Drawer Sign)____________________________________________________ 27
POSTERIOR INSTABILITY ___________________________ 28

Load and Shift Test ______________________________________________________ 28
(Posterior Load and Shift Test) ______________________________________________ 28
Posterior Apprehension Test _______________________________________________ 30
(Posterior Apprehension Maneuver) _________________________________________ 30
(Posterior Apprehension Sign) ______________________________________________ 30
Push-Pull Test __________________________________________________________ 31
INFERIOR INSTABILITY _____________________________ 33

Sulcus Sign ____________________________________________________________ 33
(Sulcus Test) ___________________________________________________________ 33
(Inferior Sulcus Sign) _____________________________________________________ 33
Feagin Test ____________________________________________________________ 34
(Inferior drawer test)_____________________________________________________ 34
LABRAL LESIONS (TEARS) __________________________ 36

Clunk Test _____________________________________________________________ 36
(Clunk Sign)____________________________________________________________ 36
Anterior Slide Test _______________________________________________________ 37
(Anterior Labral Slide Test)_________________________________________________ 37
Compression Rotation Test ________________________________________________ 38
(Compression Rotation Shift Test) ___________________________________________ 38
SCAPULAR STABILITY ______________________________ 39

Lateral Scapular Slide Test_________________________________________________ 39
(Lateral Scapular Slide Maneuver) ___________________________________________ 39
(Scapular Slide Test) _____________________________________________________ 39
ACROMIOCLAVICULAR SEPARATION/SPRAIN ________ 41

Acromioclavicular Shear Test _______________________________________________ 41
(Cross-Arm Adduction Test) ________________________________________________ 41
(the Shear Test)_________________________________________________________ 41
(Scarf Test) ____________________________________________________________ 41
Scratch and Pull Test _____________________________________________________ 42
MUSCLE TENDON PATHOLOGY _____________________ 43

Speed’s Test ___________________________________________________________ 43
(Biceps Tendinitis Test) ___________________________________________________ 43
Yeargason’s Test ________________________________________________________ 45
(Yeargason's Maneuver) __________________________________________________ 45
(Biceps Reflex Test) ______________________________________________________ 45
Empty Can Test _________________________________________________________ 46
(Supraspinatus Test) _____________________________________________________ 46
(Jobes Test)____________________________________________________________ 46
Drop Arm Test__________________________________________________________ 47
(Codman’s) ____________________________________________________________ 47
(Codman's Drop Arm Test)_________________________________________________ 47
(Codman's Maneuver) ____________________________________________________ 47
Lift-off Sign ____________________________________________________________ 48
(Gerber's Test) _________________________________________________________ 48
IMPINGEMENT _____________________________________ 50
Neer Test _____________________________________________________________ 50
(Neer Impingement Test)__________________________________________________ 50
Hawkins-Kennedy Test____________________________________________________ 51
Impingement Test _______________________________________________________ 52
(Painful Arc Test) ________________________________________________________ 52
NEUROLOGICAL TESTS _____________________________ 53

Brachial Plexus Tension Test _______________________________________________ 53
(Upper Limb Neural Tension Test) ___________________________________________ 53
(Brachial Plexus Provocation Test) ___________________________________________ 53
(Elvey Test) ____________________________________________________________ 53
Tinel’s Sign ____________________________________________________________ 55
(Tinel's Tap Test) ________________________________________________________ 55
(Nerve Percussion Test) ___________________________________________________ 55
THORACIC OUTLET SYNDROME ____________________ 57

Roos Test _____________________________________________________________ 57
(Elevated Arm Stress Test) _________________________________________________ 57
(Roos Maneuver)________________________________________________________ 57
Costoclavicular Syndrome Test______________________________________________ 58
(Costoclavicular Maneuver) ________________________________________________ 58
(Military Brace Test) _____________________________________________________ 58
Wright Test ____________________________________________________________ 60
(Hyperabduction Test) ____________________________________________________ 60
Adson Maneuver________________________________________________________ 61
(Adson's Test) __________________________________________________________ 61
ELBOW ____________________________________________ 63
Elbow flexion test _______________________________________________________ 63
Tennis elbow test (resisted) ________________________________________________ 64
(Tennis Elbow Resisted Test) _______________________________________________ 64
(Cozen's Test) __________________________________________________________ 64
Tennis elbow test (passive) ________________________________________________ 65
( Tennis Elbow Passive Test)________________________________________________ 65
(Mill's Test) ____________________________________________________________ 65
Tennis elbow test (resisted middle-finger extension) _____________________________ 66
(Maudsley’s Test) _______________________________________________________ 66
(Middle Finger Extension Resisted Test) _______________________________________ 66
Golfer’s elbow test (resisted) _______________________________________________ 67
(Golfer's Elbow Resisted Test) ______________________________________________ 67
(Medial Epicondylitis Test) _________________________________________________ 67
Golfer’s elbow test (passive) _______________________________________________ 69
(Golfer's Elbow Passive Test) _______________________________________________ 69
(Medial Epicondylitis Passive Test) ___________________________________________ 69
Pinch grip test __________________________________________________________ 70
(Pinch Strength Test) _____________________________________________________ 70
(Key Pinch Test)_________________________________________________________ 70
Posterolateral pivot shift test _______________________________________________ 71
(Pivot Shift Test) ________________________________________________________ 71
(Outer Pivot Test) _______________________________________________________ 71
Tinel’s sign (at elbow) ____________________________________________________ 73
(Tinel's Sign at the Elbow) _________________________________________________ 73
(Cubital Tunnel Tinel's Sign) ________________________________________________ 73
Varus stress test ________________________________________________________ 74
Valgus stress test________________________________________________________ 75
WRIST & HAND _____________________________________ 77
LIGAMENTS, CAPSULES, AND JOINT INSTABILITY ____ 77

Ligamentous Instability For The Fingers _______________________________________ 77
Thumb Ulnar Collateral Ligament Laxity or Instability Test__________________________ 78
(Ulnar Collateral Ligament Stress Test – Thumb) _________________________________ 78
(Skier's Thumb Test) _____________________________________________________ 78
(Valgus Stress Test for the Thumb) ___________________________________________ 78
Murphy’s test __________________________________________________________ 80
(Murphy's Sign) _________________________________________________________ 80
Watson Test ___________________________________________________________ 81
(Scaphoid Shift) _________________________________________________________ 81
(Scaphoid Shift Test) _____________________________________________________ 81
(Scaphoid Instability Test) _________________________________________________ 81
Piano Keys Test _________________________________________________________ 82
(Ulnar Styloid Test) ______________________________________________________ 82
(Dorsal Glide Test) _______________________________________________________ 82
Axial Load _____________________________________________________________ 83
TENDONS AND MUSCLES____________________________ 85
Finkelstein Test _________________________________________________________ 85
(Finkelstein's Maneuver) __________________________________________________ 85
(De Quervain's Test) _____________________________________________________ 85
Sweater Finger Sign ______________________________________________________ 86
(Jersey Finger Test) ______________________________________________________ 86
(Flexor Digitorum Profundus Avulsion Test) ____________________________________ 86
Extensor Hood Rupture ___________________________________________________ 87
(Extensor Hood Integrity Test) ______________________________________________ 87
(Extensor Mechanism Rupture Test)__________________________________________ 87
Bunnel-Littler Test_______________________________________________________ 88
(Bunnel-Littler Maneuver) _________________________________________________ 88
(Lumbrical-Plus Test _____________________________________________________ 88
NEUROLOGICAL DYSFUNCTION _____________________ 90

Tinel’s Sign ____________________________________________________________ 90
(Tinel's Tap Test) ________________________________________________________ 90
Phalan’s Test___________________________________________________________ 91
(Phalen Maneuver) ______________________________________________________ 91
Carpal Compression Test __________________________________________________ 93
(Carpal Compression Syndrome Test) _________________________________________ 93
Forment’s Sign _________________________________________________________ 94
(Forment's Test) ________________________________________________________ 94
(Forment Compression Test) _______________________________________________ 94
Weber’s Two-Point Discrimination Test _______________________________________ 95
(Moberg’s Test)_________________________________________________________ 95
CIRCULATION AND SWELLING ______________________ 97

Allen Test _____________________________________________________________ 97
(Allen's Maneuver) ______________________________________________________ 97
Digital Blood Flow _______________________________________________________ 98
(Digital Vascular Flow Test) ________________________________________________ 98
(Capillary Refill Test) _____________________________________________________ 98
HIP _______________________________________________ 101
MORE THAN ONE AREA ____________________________ 101

Straight Leg Raise ______________________________________________________ 101
(Lasègue Test) _________________________________________________________ 101
Patrick’s Test _________________________________________________________ 102
(FABER Test) __________________________________________________________ 102
(Patrick's FABER Test) ___________________________________________________ 102
Piriformis Syndrome Test _________________________________________________ 103
(FAIR test (Flexion Adduction and Internal Rotation) _____________________________ 103
Sign Of The Buttock_____________________________________________________ 104
(Pace's Sign) __________________________________________________________ 104
(FABERE)(Flexion, Abduction, External Rotation, Extension)) _______________________ 104
Trendelenburg Test _____________________________________________________ 106
(Trendelenburg Sign) ____________________________________________________ 106
(Pelvic Drop Test) ______________________________________________________ 106
Flamingo Test _________________________________________________________ 107
(Unilateral Stance Test) __________________________________________________ 107
(Single Leg Balance Test) _________________________________________________ 107
Gaenslen’s Test ________________________________________________________ 109
(Gaenslen Maneuver) ___________________________________________________ 109
(Sacroiliac Joint Stress Test _______________________________________________ 109
SI JOINT __________________________________________ 110

Ipsilateral Prone Kinetic Test ______________________________________________ 110
Piedallu’s Sign_________________________________________________________ 111
(Standing Flexion Test) __________________________________________________ 111
Gillet’s Test ___________________________________________________________ 113
(Sacroiliac Joint Motion Test) ______________________________________________ 113
(Gillet Stork Test)_______________________________________________________ 113
Trochanteric Bursitis Test ________________________________________________ 114
Iliopsoas Bursitis Test ___________________________________________________ 115
(Stinchfield Test) _______________________________________________________ 115
Thomas Test __________________________________________________________ 116
(Thomas Maneuver) ____________________________________________________ 116
Craig’s Test ___________________________________________________________ 117
(Craig's sign) __________________________________________________________ 117
(Trochanteric Prominence Angle Test (TPAT) ) _________________________________ 117
Torque Test __________________________________________________________ 119
OTHERS __________________________________________ 120

Leg Length Discrepancy Test ______________________________________________ 120
Torsion Test __________________________________________________________ 121
KNEE _____________________________________________ 123
LIGAMENT TESTS _________________________________ 123

Valgus Test ___________________________________________________________ 123
(Valgus Stress Test) _____________________________________________________ 123
(Medial Collateral Ligament Test)___________________________________________ 123
Varus Test ___________________________________________________________ 124
(Lateral Collateral Ligament Test)___________________________________________ 124
Posterior Drawer_______________________________________________________ 125
(Posterior drawer sign) __________________________________________________ 125
(Posterior drawer maneuver)______________________________________________ 125
Anterior Drawer _______________________________________________________ 127
(Drawer sign) _________________________________________________________ 127
(Anterior drawer maneuver) ______________________________________________ 127
Lachman Test _________________________________________________________ 128
(Lachman sign) ________________________________________________________ 128
(Lachman drawer test)___________________________________________________ 128
Slocum Test __________________________________________________________ 129
(Slocum drawer test) ____________________________________________________ 129
(Anterolateral rotary instability (ALRI) test) ___________________________________ 129
Hughston Test ________________________________________________________ 131
(Hughston Drawer Test)__________________________________________________ 131
MENISCUS TESTS __________________________________ 132

Apley Compression _____________________________________________________ 132
(Apley's Compression Test) _______________________________________________ 132
Apley Distraction ______________________________________________________ 133
Squat – medial (internal rotation) ; lateral (external rotation) ______________________ 135
(Screw-home mechanism) ________________________________________________ 135
McMurray____________________________________________________________ 137
(McMurray sign) _______________________________________________________ 137
OTHER TESTS _____________________________________ 139

“Q” Angle Test ________________________________________________________ 139
(Quadriceps angle) _____________________________________________________ 139
(Patellofemoral angle) ___________________________________________________ 139
Apprehension Test _____________________________________________________ 141
(Apprehension sign) ____________________________________________________ 141
(Apprehension test for patellar instability) ____________________________________ 141
(Patellar apprehension test.) ______________________________________________ 141
Femoral Grinding ___________________________________ 142

Waldron Test _________________________________________________________ 142
(Waldron's sign, squat test) _______________________________________________ 142
(patellofemoral stress test) _______________________________________________ 142
Noble Compression Test _________________________________________________ 144
Wilson Test___________________________________________________________ 145
(Wilson's sign) _________________________________________________________ 145
(Wilson's knee test.) ____________________________________________________ 145
Thigh Contusion _______________________________________________________ 146
(Quadriceps Contusion Test ) ______________________________________________ 146
(Quadriceps Compression Test) ____________________________________________ 146
ANKLE ____________________________________________ 148

Anterior Drawer _______________________________________________________ 148
(Anterior drawer maneuver) ______________________________________________ 148
( Anterior drawer sign)___________________________________________________ 148
Talar Tilt _____________________________________________________________ 149
(Inversion stress test) ___________________________________________________ 149
(Anterior talofibular ligament stress test) _____________________________________ 149
Kleiger Test ___________________________________________________________ 151
(External Rotation Stress Test) _____________________________________________ 151
Thompson’s Test_______________________________________________________ 152
(Calf Squeeze Test) _____________________________________________________ 152
(Simmonds-Thompson Test) ______________________________________________ 152
Swing Test____________________________________________________________ 153
(Posterior Drawer Test) __________________________________________________ 153
(Posterior Subluxation Test)_______________________________________________ 153
Tinel’s Sign ___________________________________________________________ 155
(Tinel's sign at the ankle) _________________________________________________ 155
(Tinel's sign for tarsal tunnel syndrome) ______________________________________ 155
Morton’s Test _________________________________________________________ 157
(Metatarsal squeeze test) ________________________________________________ 157
(Morton's neuroma test) _________________________________________________ 157
Homan’s Sign _________________________________________________________ 158
(Dorsiflexion sign or Homan's test)__________________________________________ 158
REFERENCES _____________________________________ 160
Books _____________________________________________ 160
Websites ___________________________________________ 160

SPINE
1
SPINE
CERVICAL
Foraminal Compression
(Spurling’s)
(Spurling's Test)
Foraminal compression, also known as Spurling's test or Spurling's
maneuver, is a physical examination technique used to assess the presence of
nerve root compression in the cervical spine (neck). It helps to identify
potential nerve impingement or irritation caused by conditions such as
cervical radiculopathy or herniate d discs.
Patient position:
The patient is usually seated or standing upright for this test.
Therapist position:
The therapist stands behind the patient and places their hands on the patient's
head and neck.
Procedure:
The following steps are involved in performing Spurling's test:
SPINE
2
1. The therapist gently extends the patient's neck (bending the head
backward) while applying slight downward pressure.
2. The therapist may then apply a lateral (sideways) force to the head,
tilting it towards the affected side.
3. The therapist maintains this position for a brief period, usually around
30 seconds.
Interpretation:
A positive Spurling's test is indicated by the reproduction or exacerbation of
the patient's symptoms. This can include pain, tingling, or numbness
radiating down the arm on the side being tested. The symptoms may be sharp,
shooting, or electric-like in nature. A positive test suggests nerve root
compression or irritation in the cervical spine.
Note:
It's important to note that Spurling's test is just one component of a
comprehensive physical examination and should be interpreted in
conjunction with other clinical findings, imaging studies, and the patient's
overall presentation.
Distraction Test
(Cervical Distraction Test)

The distraction test is another physical examination technique used to evaluate
the cervical spine (neck) for potential nerve root compression or irritation. It is
often performed in conjunction with Spurling's test and other diagnostic
maneuvers.
Patient position:
The patient is usually seated or lying down on a treatment table.
Therapist position:
The therapist stands behind the patient and positions their hands under the
patient's chin and occiput (back of the head).
Procedure:
The distraction test involves the following steps:
1. The therapist gently grasps the patient's chin and occiput with their
hands, creating a cradling effect.
2. The therapist applies a gentle upward traction or distraction force on the
cervical spine, pulling the head away from the neck.
3. The traction force is maintained for a brief period, usually around 30
seconds.
SPINE
3
During the distraction test, the therapist aims to temporarily alleviate any
compression or pressure on the nerve roots in the cervical spine.
Interpretation:
A positive distraction test is characterized by a reduction or relief of the
patient's symptoms, such as a decrease in pain, tingling, or numbness. This
suggests that nerve root compression or irritation may be present and that
distraction provides temporary relief by decompressing the affected nerve.
Upper Limb Tension Test
(Upper Limb Neurodynamic Test)
(Upper Limb Nerve Tension Test)

The Upper Limb Tension Test (ULTT), also known as the Brachial Plexus
Tension Test or Neurodynamic Test, is a physical examination technique
used to assess the mobility and sensitivity of the nerves that innervate the
upper limb. It helps to identify nerve compression or irritation along the path
of the brachial plexus or its peripheral branches.
Patient position:
Therapist position:
The therapist stands or sits beside the patient and manipulates their arm and
neck during the test.
Procedure:
The ULTT involves a series of movements that progressively tensi on the
nerves of the upper limb. The specific steps may vary depending on the
variant of the test being performed, but a common sequence is as follows:
SPINE
4
1. Median Nerve ULTT (Upper Limb Tension Test): The therapist

positions the patient's arm in various combi nations of shoulder
abduction, elbow extension, forearm supination, wrist and finger
extension, and contralateral cervical side bending.
2. Ulnar Nerve ULTT: The therapist positions the patient's arm in

shoulder abduction and elbow extension, while the wrist and fingers
are flexed.
3. Radial Nerve ULTT: The therapist positions the patient's arm in

various combinations of shoulder abduction, elbow extension,
forearm pronation, wrist and finger flexion, and ipsilateral cervical
side bending.
During each step, the therapist gradually applies tension to the nerve by
increasing the range of motion or adding slight overpressure, while observing
the patient's response.
SPINE
5
Interpretation:
The therapist evaluates the patient's symptoms and response to the ULTT. A
positive test is characterized by the reproduction or exacerbation of the
patient's typical symptoms, such as pain, tingling, or altered sensation along
the nerve's distribution in the upper limb. This indicates neural tension or
compression along the cour se of the brachial plexus or its peripheral
branches.
Allen Test
(Allen Maneuver)
The Allen test is a physical examination technique used to assess the patency and
integrity of the radial and ulnar arteries in the hand. It is commonly performed
before certain procedures, such as arterial blood gas sampling or radial artery
cannulation, to ensure adequate collateral circulation in the hand.
Patient position:
Therapist position:
The therapist stands beside the patient and performs the test on the patient's hand.
Procedure:
The Allen test involves the following steps:
1. The therapist asks the patient to extend their hand and relax it on a flat
surface, with the palm facing upward.
2. The therapist palpates the radial and ulnar arteries in the patient's wrist. The
radial artery is located on the thumb side, while the ulnar artery is on the
little finger side.
3. The therapist firmly compresses both arteries using their fingers or thumb
to occlude the blood flow.
4. While maintaining pressure on the arteries, the therapist instructs the patient
to make a fist several times to increase blood flow through the ulnar artery.
SPINE
6
5. Next, the therapist releases pressure on the ulnar artery while still occluding
the radial artery, allowing blood to flow solely through the ulnar artery.
6. The therapist observes the patient's hand for color changes.
Positive sign:
A positive Allen test is indicated by delayed or absent refill of the hand with blood
after releasing pressure on the ulnar artery. If the hand remains pale or shows
inadequate reperfusion within 5-15 seconds, it suggests insufficient collateral
circulation and may contraindicate procedures that rely on radial artery access.
Adequate reperfusion, on the other hand, is indicated by a flush of normal color
returning to the hand within the specified time frame.
Halstead Maneuver
(Halstead's Test)
The Halstead maneuver is a physical examination test used to assess for possible
thoracic outlet syndrome (TOS). TOS is a condition that occurs when there is
compression of the nerves or blood vessels in the thoracic outlet, an area between
the neck and shoulder.
Patient position:
The patient is seated or standing.
Therapist position:
The therapist palpates the radial pulse on the side being tested.
SPINE
7
Procedure:
1. The therapist abducts the arm to 45 degrees, extends the shoulder to 45

degrees, and externally rotates the upper extremity while applying a
downward distraction to the arm.
2. The patient is then asked to fully turn her head away from the side being
tested and extend the cervical spine.
Positive sign:
• A decrease or disappearance of the radial pulse

• Numbness, tingling, or pain in the arm or hand
• Weakness in the arm or hand
Shoulder Abduction Test

The Shoulder Abduction Test, also known as the Bakody's Sign, is a physical
examination technique used to assess for nerve impingement or cervical
radiculopathy in the upper extremity. It specifically evaluates the involvement of
the C5 and C6 nerve roots.
Patient position:
The patient is usually standing or sitting upright for this test.
Therapist position:
The therapist stands beside the patient and assists in positioning the patient's arm.
SPINE
8
Procedure:
The Shoulder Abduction Test involves the following steps:
1. The therapist instructs the patient to raise their affected arm to the side
(abduct) and reach as high as they comfortably can.
2. The therapist may assist the patient by providing support under the patient's
wrist or forearm, if necessary, to help maintain the arm in an abducted
position.
Interpretation:
During the Shoulder Abduction Test, a positive finding is characterized by a
reduction or alleviation of the patient's symptoms, such as a decrease in pain,
tingling, or numbness, when the arm is abducted. This suggests that there may be
compression or irritation of the nerve roots in the cervical spine, specifically the C5
and C6 nerve roots. The abduction position helps to relieve tension on these nerve
roots, leading to symptom improvement.
Valsalva Test
(Valsalva Maneuver)
The Valsalva maneuver can be used as a diagnostic test to assess the presence of a
herniated disc or to reproduce symptoms associated with nerve compression in the
spine. The Valsalva maneuver involves a forced expiration against a closed airway,
which increases pressure within the chest and abdominal cavities. This increased
pressure can affect the spinal nerves and potentially aggravate symptoms related to
a herniated disc.
Patient position:
The patient is typically seated or lying down on a treatment table.
SPINE
9
Therapist position:
The therapist usually observes the patient and provides instructions for performing
the maneuver.
Procedure:
The Valsalva Test involves the following steps:
1. The therapist instructs the patient to take a deep breath and then exhale
forcefully against a closed airway. This can be done by closing the mouth
and pinching the nose shut while attempting to exhale.
2. The patient is asked to maintain this increased pressure in the chest and
abdomen for about 10-15 seconds.
Interpretation:
During the Valsalva maneuver, a positive finding is indicated by the reproduction
or exacerbation of the patient's typical symptoms, such as pain radiating down the
arm or leg, numbness, tingling, or increased back pain. These symptoms may be
suggestive of nerve compression due to a herniated disc or other spinal conditions.
Romberg’s Test
(Romberg Balance Test)
(Romberg Sign)
Romberg's test is a neurological examination technique used to assess a
person's balance and proprioception. It helps to evaluate the functioning of
the sensory and motor systems, particularly the proprioceptive pathways and
the vestibular system.
Patient position:
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The patient is usually asked to stand with their feet together, heels and toes
touching, and their arms placed by their sides.
Therapist position:
The therapist typically stands nearby to observe and assist if necessary to
prevent falls.
Procedure:
The Romberg's test involves the following steps:
1. The therapist instructs the patient to stand in the designated position
with their eyes open. The patient should focus on maintaining their
balance and remaining as still as possible.
2. Once the patient is stable, the therapist asks them to close their eyes
while maintaining the same position.
3. The therapist carefully observes the patient for any signs of swaying,
loss of balance, or inability to maintain an upright position.
Interpretation:
During the Romberg's test, a positive finding is characterized by increased
postural instability or loss of balance when the patient closes their eyes
compared to when their eyes are open. This suggests a sensory deficit or
impairment in proprioception, which relies on the integration of visual,
vestibular, and somatosensory input for maintaining balance and spatial
orientation.
Note:
It's important to note that a positive Romberg's test can indicate various
underlying conditions, including peripheral neuropathy, proprioceptive
dysfunction, vestibular dysfunction, or other neurological disorders. Further
evaluation and diagnostic tests may be needed to determine the exact cause
of the positive test result.
SPINE
11
Vertebral Artery Test
(Cervical Quadrant)
The Vertebral Artery Test, also known as the Cervical Quadrant Test, is a physical
examination technique used to assess the integrity and blood flow of the vertebral
arteries in the neck. It helps to identify potential vascular compromise or vertebral
artery insufficiency.
Patient position:
Therapist position:
The therapist stands beside the patient and performs the test on the patient's neck.
Procedure:
The Vertebral Artery Test (Cervical Quadrant Test) involves the following steps:
1. The therapist instructs the patient to extend their neck and rotate it to one
side, usually the same side being tested. For example, if the left vertebral
artery is being assessed, the patient rotates their head to the left.
2. The therapist then assists the patient in maintaining this rotated position.
3. Next, the therapist checks for any signs or symptoms, such as dizziness,
lightheadedness, visual changes, or nystagmus (involuntary eye
movements), that may suggest vertebral artery compromise.
4. The therapist repeats the procedure for the opposite side, assessing the
rotation of the neck in the other direction.
Interpretation:
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During the Vertebral Artery Test, a positive finding is indicated by the reproduction
or exacerbation of symptoms associated with vertebral artery insufficiency, such as
dizziness, lightheadedness, or visual changes, during neck rotation. This may
suggest compromised blood flow through the vertebral artery on the tested side.
LUMBAR
Straight Leg Raise
(Lasègue Test)
The Straight Leg Raise (SLR) test, also known as the Lasègue test, is a physical
examination technique used to assess for potential nerve root irritation or
compression, particularly in the lumbar spine (lower back). It helps to evaluate the
presence of sciatica or other conditions that may cause pain or neurological
symptoms in the leg.
Patient position:
The patient is usually lying down on a treatment table in a supine position (on their
back).
Therapist position:
The therapist stands beside the patient and performs the test by manipulating the
patient's leg.
Procedure:
The Straight Leg Raise test involves the following steps.
1. The therapist instructs the patient to lie flat on their back with both legs
extended.
2. Starting with the unaffected leg, the therapist raises the patient's leg slowly
and gently, keeping the knee straight. The therapist raises the leg until the
patient experiences pain or discomfort or until a predetermined angle is
reached (usually between 30 and 70 degrees).
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13
3. The therapist carefully observes the patient's response and notes any
symptoms, such as pain, tingling, or numbness that radiates down the leg.
4. The same procedure is repeated on the affected leg.
Interpretation:
During the Straight Leg Raise test, a positive finding is characterized by the
reproduction or exacerbation of the patient's typical symptoms, such as radiating
pain down the leg (sciatica) or neurological symptoms (tingling, numbness). This
suggests the possibility of nerve root irritation or compression, often caused by
conditions such as a herniated disc, spinal stenosis, or nerve impingement in the
lower back.
The angle at which the patient experiences symptoms can also be noted and may
provide additional information about the severity of nerve involvement.
Prone Knee Bending
(Prone Knee Flexion Test)

Prone Knee Bending, also known as Prone Knee Flexion Test, is a physical
examination technique used to assess the mobility and flexibility of the knee joint
and to evaluate for the presence of hamstring tightness or other knee-related
conditions.
Patient position:
The patient lies on their stomach (prone position) on a treatment table or another
flat surface.
Therapist position:
patient's leg.
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Procedure:
The Prone Knee Bending test involves the following steps:
1. The therapist instructs the patient to lie face down with both legs extended.
2. The therapist positions themselves near the patient's leg that is going to be
tested.
3. The therapist flexes the patient's knee by gently bending it, bringing the heel
towards the buttock.
4. The therapist moves the leg through its full range of motion, gradually
increasing the knee flexion until the point of discomfort or the maximum
achievable range is reached.
limitations in knee flexion, pain, or discomfort during the movement.
Interpretation:
During the Prone Knee Bending test, a positive finding may indicate hamstring
tightness or limited knee flexion. Signs that may suggest a positive result include
resistance to knee flexion, pain in the posterior thigh or knee, or inability to achieve
the expected range of motion.
Slump Test
(Slump Maneuver)
The Slump Test is a physical examination technique used to assess ner ve
root irritation or compression, particularly in the lumbar spine and lower
extremities. It helps to evaluate the presence of sciatica or other conditions
that may cause pain or neurological symptoms in the leg.
Patient position:
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The patient is usually seated on a treatment table with their legs hanging
freely over the edge.
Therapist position:
The therapist stands in front of the patient and performs the test by
manipulating the patient's legs and spine.
Procedure:
The Slump Test involves the followin g steps:
1. The therapist instructs the patient to sit upright with their back
straight and their legs hanging over the edge of the table.
2. The therapist then instructs the patient to slump forward by rounding
their back, dropping their chin to their chest, and bending their upper
body forward.
3. Once the patient is in the slumped position, the therapist provides
support by placing their hands on the patient's shoulders.
4. The therapist then asks the patient to extend one leg at the knee joint,
while keeping the other leg relaxed and hanging freely.
5. The therapist gently applies overpressure by flexing the patient's
neck, which further increases the stretch on the spinal nerves.
6. The therapist may also ask the patient to dorsiflex their ankle (pulling
the foot upward toward the shin) on the extended leg to increase the
tension on the nerves further.
symptoms, such as pain, tingling, or numbness, that radiate down the

leg.
8. The same procedure is repeated on the other leg.
Interpretation:
During the Slump Test, a positive finding is characterized by the
reproduction or exacerbation of the patient's typical symptoms, such as
radiating pain down the leg (sciatica) or neurological symptoms (tingling,
numbness), when tension is applied to the nerves. This suggests the
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possibility of nerve root irritation or compression, often caused by

conditions such as a herniated disc, spinal stenosis, or nerve impingement
in the lumbar spine.
Brudzinski-Kernig Test
(Kernig's Test)
(Brudzinski's Sign)
The Brudzinski-Kernig test is a set of two physical examination techniques used to
assess for signs of meningeal irritation, particularly in cases of suspected meningitis
or other conditions affecting the meninges (the protective covering of the brain and
spinal cord).
Brudzinski's Sign:
Patient position:
The patient is usually lying flat on their back (supine position) on a treatment table.
Therapist position:
patient's head and neck.
Procedure:
The Brudzinski's Sign test involves the following steps:
1. The therapist gently supports the patient's head and neck with their hands.
2. The therapist flexes the patient's neck by bringing the chin toward the chest.
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3. As the therapist flexes the neck, they observe the patient's response for any
involuntary flexion of the hips and knees (hip and knee flexion).
Interpretation:
A positive Brudzinski's Sign is indicated by the patient's involuntary flexion of the
hips and knees (hip and knee flexion) when their neck is flexed. This suggests
irritation of the meninges, such as in cases of meningitis.
Kernig's Sign:
Patient position:
Therapist position:
patient's legs.
Procedure:
The Kernig's Sign test involves the following steps:
1. The therapist flexes the patient's leg at the hip and knee joints, bringing the
thigh towards the chest.
2. The therapist then attempts to extend the patient's knee joint while keeping
the hip joint flexed.
3. The therapist observes the patient's response for any resistance, pain, or
inability to fully extend the knee while the hip is flexed.
Interpretation:
A positive Kernig's Sign is indicated by the patient's resistance or pain when
attempting to extend the knee with the hip flexed. This may suggest meningeal
irritation, such as in cases of meningitis.
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Bowstring Test
(Bowstring Sign)
The Bows t r i ng Te s t i s a phys i c a l e xa m i nati on t e c hni que us e d to
a s s e s s f or ne r ve r oot c om pr e ss ion or i r r i ta tion, pa r t i cula rly i n t he
l um ba r s pi ne . It i s c om m onl y e m pl oye d t o e va l ua te t he pr e s e nc e of
s c i a t ic a or ot he r c ondi t i ons t ha t m a y c a us e pa i n or ne ur ol ogical
s ym pt om s i n t he l e g.
Patient position:
The pa t i e nt i s us ua l l y l yi ng down on a t r e a tm ent t a bl e i n a s upine
pos i t i on ( on t he i r ba c k) .
Therapist position:
The t he r a pist s t a nds be s i de t he pa t i e nt a nd pe r f or ms t he t e s t by
m a ni pul a t i ng t he pa t i e nt ' s l e g.
Procedure:
The Bows t r i ng Te s t i nvol ve s t he f ol l owi ng s t e ps :
1. The t he r a pi st i ns t ruc ts t he pa t i e nt t o l i e f l a t on t he i r ba c k with
bot h l e gs e xt e nde d.
2. The t he r a pi st t he n f l e xe s t he pa t i e nt 's hi p a nd kne e j oint,
br i ngi ng t he t hi gh t owa r d t he c he s t .
3. Ne xt , t he t he r a pis t a ppl i e s pr e s s ur e wi t h t he i r ha nd on t he
pa t i e nt's popl i t ea l f os s a ( t he ba c k of t he kne e ) while
m a i nt a i ni ng t he hi p a nd kne e f l e xi on.
4. The t he r a pis t gr a dua l ly i nc r e as es t he pr e s s ur e i n a downward
di r e c t ion, pus hi ng t he popl i te al f os s a t owa r ds t he t r e a tment
t a bl e .
5. The t he r a pis t c a r e f ully obs e r ves t he pa t i e nt's r e s ponse a nd
not e s a ny s ym pt om s, s uc h a s r a di a ting pa i n down t he l eg
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19
( s c i a ti ca ) or ne ur ol ogica l s ym pt oms ( t i ngling, num bne s s) that

a r e r e pr oduc e d or e xa c e r ba t e d dur i ng t he t e s t .
6. The t he r a pis t m a y a l s o pe r f or m t he s a m e pr oc e dure on t he
oppos i t e l e g f or c om pa r i s on.
Interpretation:
Dur i ng t he Bows t r i ng Te s t , a pos i t i ve f i ndi ng i s i ndi c a te d by t he
r e pr oduct ion or e xa c e r ba tion of t he pa t i e nt' s t ypi c a l s ym pt om s, s uch
a s r a di a t ing pa i n down t he l e g or ne ur ol ogi ca l s ym pt oms , when
pr e s s ure i s a ppl i e d t o t he popl i t ea l f os s a . Thi s s ugge s ts t he
pos s i bil ity of ne r ve r oot c om pr e s sion or i r r i ta tion, of t e n c a us e d by
c ondi t ions s uc h a s a he r ni a te d di s c , s pi na l s t e nos is , or ne rve
i m pi nge m e nt i n t he l um ba r s pi ne .
Babinski Test
(Plantar Reflex Test)
(Babinski Reflex)
The Babinski Test, also known as the Babinski reflex or plantar reflex, is a
neurological examination technique used to assess the function of the corticospinal
tract and to identify abnormal responses in the foot. It helps to evaluate the integrity
of the upper motor neuron pathway.
Patient position:
The patient is usually lying down on a treatment table or seated with their legs
extended.
Therapist position:
The therapist stands or sits in front of the patient and performs the test by
stimulating the sole of the patient's foot.
Procedure:
The Babinski Test involves the following steps:
1. The therapist takes a blunt object, such as the handle of a reflex hammer or
the edge of a tongue depressor, and applies firm but gentle pressure along
the lateral aspect of the patient's sole, starting from the heel and moving
towards the ball of the foot.
2. The therapist then continues to stroke the object along the medial aspect of
the foot, curving toward the base of the toes.
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3. The therapist carefully observes the patient's response and notes the
movement of the toes.
Interpretation:
During the Babinski Test, a positive finding, known as a positive Babinski sign, is
characterized by the dorsiflexion (upward movement) of the big toe and fanning
out of the other toes in response to the stimulation of the sole of the foot. This
response is abnormal in adults and indicates dysfunction or damage to the upper
motor neurons.
In a normal response, called a negative Babinski sign, the toes will flex or curl
downward in response to the stimulus.
Beevor’s Sign
(Beevor's Test)
(Umbilical Sign)
Beevor's Sign is a physical examination technique used to assess for
weakness or abnormal movement of the abdominal muscles,
particularly the rectus abdominis muscle. It is performed to evaluate
the level of spinal cord dysfunction or nerve root involvement.
Patient position:
The patient is usually lying flat on their back (supine position) on a
treatment table.
Therapist position:
The therapist stands or sits at the head of the patient.
Procedure:
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The Beevor's Sign test involves the following steps:

1. The therapist instructs the patient to perform a partial sit -up
or raise their head and shoulders slightly off the treatment
table, similar to a mini crunch.
2. The therapist closely observes the movement of the patient's
umbilicus (belly button).
3. While the patient is attempting the sit -up, the therapist looks
for any deviation or movement of the umbilicus.
Interpretation:
During the Beevor's Sign test, a positive finding is indicated by the
abnormal movement or deviation of the umbilicus. If the umbilicus
moves in a direction other than straight up or down, it sug gests
weakness or dysfunction of the abdominal muscles, particularly the
rectus abdominis muscle.
The specific direction of the umbilicus movement can indicate the
level of spinal cord dysfunction or nerve root involvement. For
example, if the umbilicus deviates upwards towards the head, it
suggests weakness or involvement of the upper thoracic spinal cord
segments, while a deviation downwards towards the feet indicates
weakness or involvement of the lower thoracic or lumbar spinal cord
segments.
Hoover Test
(Hoover's Sign)
The Hoover Test, also known as the Hoover's sign or the Hoover maneuver, is a
physical examination technique used to assess for malingering or non-organic
weakness of the lower limbs. It helps differentiate between true weakness and
functional or psychogenic weakness.
Patient position:
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Therapist position:
The therapist stands at the foot of the patient.
Procedure:
The Hoover Test involves the following steps:
1. The therapist places their hands under the patient's heels, with the fingers
extending towards the patient's toes.
2. The therapist instructs the patient to lift one leg off the table while applying
downward pressure with the therapist's hands.
3. While the patient is attempting to lift one leg, the therapist feels for any
upward pressure or downward movement of the opposite heel.
4. The therapist repeats the procedure with the other leg.
Interpretation:
During the Hoover Test, a positive finding is indicated by the absence of upward
pressure or movement of the opposite heel while the patient is attempting to lift one
leg. In other words, when a patient genuinely tries to lift one leg, there should be
some downward movement of the opposite heel due to reciprocal action of the hip
extension.
However, in cases of non-organic or functional weakness, the patient may claim to
be unable to lift one leg while keeping the other leg completely relaxed. In such
cases, the therapist will observe that there is no downward movement or pressure
exerted by the opposite heel, suggesting that the patient may not be exerting
genuine effort and may be malingering or experiencing functional weakness.
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23
SHOULDER
ANTERIOR INSTABILITY
Load and Shift Test
(Anterior Load and Shift Test)

The Load and Shift Test is a physical examination technique used to assess the
stability of the glenohumeral joint, which is the shoulder joint. It evaluates the
amount of translation (movement) and laxity (looseness) in the joint, particularly
in cases of shoulder instability.
Patient position:
The patient is usually seated or lying down on a treatment table with their arm
relaxed at their side.
Therapist position:
The therapist stands or sits beside the patient and performs the test by manipulating
the patient's arm and shoulder.
Procedure:
The Load and Shift Test involves the following steps:
1. The therapist stabilizes the scapula (shoulder blade) with one hand while
cupping the patient's humeral head (upper arm bone) with the other hand.
2. The therapist applies a gentle axial load (pressure) on the humeral head to
seat it in the glenoid fossa (the socket of the shoulder joint).
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24
3. The therapist then performs a series of anterior (forward) and posterior

(backward) translation or shifting movements of the humeral head within
the glenoid fossa.
4. The therapist assesses the amount of movement, comparing it to the
opposite uninjured shoulder or a normal reference range.
Interpretation:
During the Load and Shift Test, the therapist evaluates the amount of translation
(movement) and laxity (looseness) of the humeral head within the glenoid fossa.
Excessive or abnormal movement beyond the normal reference range may indicate
shoulder instability.
Specifically, the therapist evaluates the anterior and posterior translation of the
humeral head to assess for anterior and posterior instability, respectively. They
compare the movement in the affected shoulder to the uninjured side or a normal
reference range.
Positive findings may include:
Increased anterior translation: If there is excessive anterior movement (anterior
instability), it may indicate anterior glenohumeral instability, such as anterior
shoulder dislocation or subluxation.
Increased posterior translation: If there is excessive posterior movement (posterior
instability), it may indicate posterior glenohumeral instability.
Crank Test
(Crank Maneuver)
It is used to assess the integrity of the glenoid labrum, specifically to evaluate for
labral tears or other abnormalities in the shoulder joint.
Patient position:
The patient is usually seated or standing.
Therapist position:
patient's arm and shoulder.
Procedure:
The Crank Test involves the following steps:
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25
1. The therapist holds the patient's affected arm at approximately 90 degrees

of abduction (out to the side) and flexion (bent at the elbow).
2. The therapist places one hand on the patient's elbow and the other hand on
the patient's wrist.
3. While maintaining the arm in the specified position, the therapist applies a
rotational force through the arm, simultaneously internally and externally
rotating the shoulder.
4. The therapist asks the patient to report any pain or discomfort during the
rotation.
Interpretation:
During the Crank Test, a positive finding is indicated by the reproduction of pain
or discomfort in the shoulder during the rotational movement. This suggests the
presence of a labral tear or other abnormality in the glenoid labrum.
The Crank Test specifically stresses the labrum and can help identify tears or
instability in the shoulder joint. However, it is important to note that the test should
be interpreted alongside other clinical findings, imaging studies (such as MRI or
arthroscopy), and the patient's overall presentation. A positive Crank Test may
indicate the need for further investigation or consultation with a specialist to
confirm the diagnosis and determine appropriate treatment options.
Fulcrum Test
The Fulcrum Test, also known as the Scapular Assistance Test, is a physical
examination technique used to assess scapular stability and its influence on
shoulder pain or dysfunction. It helps determine if scapular stabilization can
alleviate symptoms or improve shoulder function.
Patient position:
The patient is usually seated or standing with their arms relaxed at their sides.
Therapist position:
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26
The therapist stands behind the patient and performs the test by providing support
to the scapula.
Procedure:
The Fulcrum Test involves the following steps:
1. The therapist places their hand or a small cushion under the patient's medial
border of the scapula (the inner edge of the shoulder blade) on the affected
side.
2. The therapist applies a gentle upward pressure to support and stabilize the
scapula in a more optimal position.
3. The therapist instructs the patient to perform various shoulder movements,
such as shoulder flexion, abduction, or external rotation, while the scapula
is supported.
4. The patient is asked to report any changes in symptoms or improvements in
shoulder movement or function during the supported scapular movements.
Interpretation:
During the Fulcrum Test, a positive finding is indicated if supporting the scapula
with the therapist's hand or a cushion reduces or eliminates the patient's symptoms
or improves their shoulder range of motion. This suggests that scapular stabilization
plays a role in their symptoms or functional limitations.
A positive Fulcrum Test result may indicate scapular dyskinesis or weakness,
which can contribute to shoulder pain, impingement, or instability. The test helps
identify if providing external support to the scapula can help alleviate symptoms
and improve shoulder function.
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27
Anterior Drawer Test
(Anterior Drawer Maneuver)
(Anterior Drawer Sign)

The Anterior Drawer Test can indeed be performed to assess anterior shoulder
instability.
Patient position:
The patient sits or lies down in a comfortable position.
Therapist position:
The therapist stands or sits beside the patient’s affected shoulder.
Procedure:
1. The therapist stabilizes the scapula (shoulder blade) with one hand,
applying gentle pressure to prevent scapular movement.
2. With the other hand, the therapist grasps the patient’s humerus (upper
arm bone) just below the shoulder joint.
3. The therapist applies an anterior force or pull on the humerus,
attempting to translate the head of the humerus forward in the glenoid
fossa (shoulder socket).
4. The therapist assesses the amount of translation or movement of the
humeral head relative to the glenoid fossa.
5. The therapist observes the patient’s response and asks if they experience
any pain, discomfort, or a sense of instability during the test.
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28
Interpretation:
The Anterior Drawer Test for the shoulder is interpreted based on the degree of
anterior translation or movement observed and the patient’s symptoms. The
following interpretations are possible:
• Normal or negative finding: If there is minimal to no anterior
translation of the humeral head, and the patient does not
experience pain or discomfort, it suggests the absence of
significant anterior shoulder instability.
• Abnormal or positive finding: If there is excessive anterior
translation of the humeral head or if the patient experiences pain,
discomfort, or a sense of instability during the test, it may
suggest anterior shoulder instability.
POSTERIOR INSTABILITY
Load and Shift Test
(Posterior Load and Shift Test)

The Load and Shift Test is a physical examination technique used to assess the
stability of the glenohumeral joint, which is the shoulder joint. It evaluates the
amount of translation (movement) and laxity (looseness) in the joint, particularly
in cases of shoulder instability.
Patient position:
The patient is usually seated or lying down on a treatment table with their arm
relaxed at their side.
Therapist position:
the patient’s arm and shoulder.
Procedure:
The Load and Shift Test involves the following steps:
1. The therapist stabilizes the scapula (shoulder blade) with one hand while
cupping the patient’s humeral head (upper arm bone) with the other
hand.
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29
2. The therapist applies a gentle axial load (pressure) on the humeral head
to seat it in the glenoid fossa (the socket of the shoulder joint).
3. The therapist then performs a series of anterior (forward) and posterior
(backward) translation or shifting movements of the humeral head
within the glenoid fossa.
Interpretation:
During the Load and Shift Test, the therapist evaluates the amount of translation
(movement) and laxity (looseness) of the humeral head within the glenoid fossa.
Excessive or abnormal movement beyond the normal reference range may indicate
shoulder instability.
Specifically, the therapist evaluates the anterior and posterior translation of the
humeral head to assess for anterior and posterior instability, respectively. They
compare the movement in the affected shoulder to the uninjured side or a normal
reference range.

• Increased anterior translation: If there is excessive anterior
movement (anterior instability), it may indicate anterior
glenohumeral instability, such as anterior shoulder dislocation
or subluxation.
• Increased posterior translation: If there is excessive posterior
movement (posterior instability), it may indicate posterior
glenohumeral instability.
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30
Posterior Apprehension Test
(Posterior Apprehension Maneuver)
(Posterior Apprehension Sign)

The Posterior Apprehension Test is a physical examination maneuver used to assess
for posterior instability or dislocation of the shoulder joint. It is primarily performed
to evaluate the integrity of the posterior glenohumeral ligaments and the posterior
capsule.
Patient position:
Therapist position:
Procedure:
The Posterior Apprehension Test involves the following steps:
1. The patient's affected shoulder is positioned at approximately 90 degrees of
abduction (out to the side) and 90 degrees of flexion (bent at the elbow),
with the forearm resting against the therapist's body for stabilization.
2. The therapist holds the patient's arm at the wrist or forearm and applies a
posteriorly directed force or pressure on the humerus (upper arm bone)

while externally rotating the shoulder.
3. The therapist gradually increases the force and observes the patient's
reaction.
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31
4. The therapist asks the patient if they experience any sensations of pain,
discomfort, or apprehension in the posterior aspect of the shoulder.
Interpretation:
During the Posterior Apprehension Test, a positive finding is indicated by the
patient's apprehension, discomfort, or the sensation of their shoulder feeling like it
may posteriorly dislocate during the application of the posterior force and external
rotation.
The test is designed to provoke symptoms in patients with known or suspected
posterior instability. The presence of apprehension or a feeling of imminent
posterior dislocation suggests instability of the shoulder joint in the posterior
direction.
Push-Pull Test
The Push-Pull Test is a physical examination technique used to assess the stability
and integrity of the shoulder joint, specifically the anterior and posterior structures,
including the glenohumeral ligaments.
Patient position:
The patient is usually seated or standing.
Therapist position: The therapist stands facing the patient, typically on the same
side as the shoulder being tested.
Procedure:
The Push-Pull Test involves the following steps:
1. For the anterior stability assessment:

I. The therapist stabilizes the scapula (shoulder blade) with one hand
while placing the other hand on the patient's humeral head (upper
arm bone).
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32
II. The therapist applies an anteriorly directed force on the humeral

head, attempting to push it forward or in an anterior direction.
III. The patient resists this force by maintaining the position of their arm
and shoulder.
2. For the posterior stability assessment:
I. The therapist changes their hand position to cup the patient's
humeral head from behind.
II. The therapist applies a posteriorly directed force on the humeral
head, attempting to pull it backward or in a posterior direction.
III. The patient resists this force by maintaining the position of their arm
and shoulder.
Interpretation:
During the Push-Pull Test, a positive finding is indicated by excessive anterior or
posterior movement of the humeral head relative to the glenoid fossa (shoulder
socket) when compared to the uninjured side or a normal reference range. This may
suggest instability or laxity in the anterior or posterior structures of the shoulder
joint.
Positive signs for the Push-Pull Test can include:
• Increased anterior translation: If there is excessive forward

movement (anterior instability), it may indicate anterior
glenohumeral instability or anterior shoulder
dislocation/subluxation.
• Increased posterior translation: If there is excessive backward
movement (posterior instability), it may indicate posterior
glenohumeral instability.
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33
INFERIOR INSTABILITY
Sulcus Sign
(Sulcus Test)
(Inferior Sulcus Sign)

The Sulcus Sign is a physical examination maneuver used to assess the stability and
integrity of the glenohumeral joint, which is the shoulder joint. It specifically
evaluates for inferior instability or laxity of the joint.
Patient position:
The patient is usually seated or standing with their arm relaxed at their side.
Therapist position:
Procedure:
The Sulcus Sign involves the following steps:
1. The therapist grasps the patient's elbow with one hand and the patient's wrist
with the other hand.
2. The therapist applies a downward or inferior traction force on the patient's
arm, gently pulling it away from the shoulder.
SHOULDER
34
3. The therapist observes the shoulder joint area, particularly the space or
indentation that forms between the acromion (bony prominence of the
shoulder blade) and the humeral head (upper arm bone) during the traction.
4. The therapist notes the presence and depth of a visible or palpable sulcus
(indentation) that appears between the acromion and humeral head.
Interpretation:
During the Sulcus Sign, a positive finding is indicated by the presence of a visible
or palpable sulcus, indicating inferior instability or laxity of the glenohumeral joint.
The depth of the sulcus can be graded to assess the severity of instability:
Grade 1: Shallow or barely visible sulcus.
Grade 2: Moderate-depth sulcus.
Grade 3: Deep or easily visible sulcus.
A deeper sulcus suggests greater inferior instability and laxity of the glenohumeral
joint.
The Sulcus Sign is particularly useful in assessing for inferior shoulder instability,
such as multidirectional instability or cases where there is excessive joint laxity. It
can help differentiate between normal shoulder anatomy and pathological
conditions.
Feagin Test
(Inferior drawer test)

The Feagin test is a physical examination test used to assess inferior instability of
the shoulder. It is named after Robert D. Feagin, who first described it in 1975.
Patient position:
The patient stands with the involved arm abducted to 90 degrees with the elbow
extended and resting on the top of the examiner's shoulder so that the shoulder is
completely relaxed.
Therapist position:
The examiner stands facing the involved side of the patient with the involved arm
resting on his or her shoulder. The examiner's hands are clasped together and resting
on the upper 1/3 of the patient's humerus.
Procedure:
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35
1. The examiner makes sure that the shoulder musculature is relaxed.

2. The examiner uses his clasped hands to push the head of the humerus down
and forward.
3. The examiner then asks the patient to resist this movement.
Positive sign:
A positive Feagin test is indicated by pain or apprehension in the patient's shoulder.
The examiner may also be able to feel the humeral head subluxate (pop out) of the
glenoid fossa.
The Feagin test is a sensitive test for inferior instability of the shoulder. However,
it is not specific, meaning that it can also be positive in people who do not have
shoulder instability. If the Feagin test is positive, further imaging studies, such as
an MRI, may be necessary to confirm the diagnosis.
Here are some of the things to keep in mind when performing the Feagin test:
• The patient should be relaxed and comfortable.
• The examiner should apply a gentle but firm force when pushing the
humeral head down and forward.
• The examiner should ask the patient to resist this movement to assess for
pain or apprehension.
The Feagin test is a valuable tool for assessing inferior instability of the shoulder.
However, it is important to remember that it is not a definitive test and should be
used in conjunction with other tests to make a diagnosis.
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36
LABRAL LESIONS (TEARS)

Clunk Test
(Clunk Sign)
The Clunk Test for the shoulder is a physical examination maneuver used to assess
for the presence of a labral tear, particularly a superior labral anterior to posterior
(SLAP) lesion. It is specifically designed to evaluate the stability and integrity of
the superior portion of the glenoid labrum.
Patient position:
Therapist position:
Procedure:
The Clunk Test for the shoulder involves the following steps:
1. The therapist stabilizes the scapula (shoulder blade) with one hand, while
the other hand holds the patient's arm near the elbow.
2. The therapist then fully flexes the patient's shoulder to approximately 90
degrees.
3. While maintaining this flexed position, the therapist externally rotates the
patient's arm and applies an axial load or downward force on the humerus
(upper arm bone).
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4. The therapist then slowly extends the patient's shoulder while maintaining
the external rotation and axial load.
5. During this movement, the therapist may feel or hear a "clunk" or "click"
sensation or sound, which is indicative of a potential labral tear, specifically
a SLAP lesion.
Interpretation:
The presence of a clunk or click sensation during the Clunk Test suggests a superior
labral tear, specifically a SLAP lesion. This type of tear is commonly associated
with instability or a detachment of the superior portion of the labrum from the
glenoid rim.
Anterior Slide Test
(Anterior Labral Slide Test)

The anterior slide test is a physical examination test that is used to assess for
anterior instability of the shoulder. It is a sensitive test for labrum tears, particularly
SLAP tears (superior labrum anterior and posterior tears).
Patient position:
• The patient is seated or standing with their arm at their side.
• The shoulder to be examined should be in the neutral position, with the
elbow flexed to 90 degrees and the forearm supinated.
Therapist position:
• The therapist stands behind the patient and stabilizes the scapula with one
hand.
• The other hand is placed on the patient’s humerus, just proximal to the
elbow.
Procedure:
1. The therapist applies a gentle anterior force to the humerus, while
stabilizing the scapula.
2. The amount of anterior translation of the humerus is assessed.
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Positive sign:
• A positive anterior slide test is indicated by excessive anterior translation of
the humerus.
• This may be accompanied by pain, a clicking or popping sensation, or a
feeling of instability in the shoulder.
Compression Rotation Test
(Compression Rotation Shift Test)

The compression rotation test is a physical examination test used to assess superior
labrum anterior posterior (SLAP) tears. It is a sensitive test for SLAP tears, but it
is not specific, meaning that it can also be positive in people who do not have SLAP
tears.
Patient position:
The patient is positioned supine with the affected arm abducted to 90 degrees and
the elbow flexed to 90 degrees.
Therapist position:
The examiner stands facing the patient's affected side and places one hand on the
patient's shoulder to stabilize the scapula. The examiner's other hand grasps the
patient's humerus just proximal to the elbow.
Procedure:
1. The examiner applies a compression force to the humerus.
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2. The examiner then rotates the humerus internally and externally.
Positive sign:
A positive compression rotation test is indicated by pain or a clicking or popping
sensation in the patient's shoulder. The examiner may also be able to feel the labrum
catch or tear.
If the compression rotation test is positive, further imaging studies, such as an MRI,
may be necessary to confirm the diagnosis.
Here are some of the things to keep in mind when performing the compression
rotation test:
• The patient should be relaxed and comfortable.
• The examiner should apply a gentle but firm force when compressing the
humerus.
• The examiner should rotate the humerus through a full range of motion,
both internally and externally.
The compression rotation test is a valuable tool for assessing SLAP tears. However,
it is important to remember that it is not a definitive test and should be used in
conjunction with other tests to make a diagnosis.
SCAPULAR STABILITY
Lateral Scapular Slide Test
(Lateral Scapular Slide Maneuver)
(Scapular Slide Test)

The Lateral Scapular Slide Test, also known as the Scapular Slide Test or Scapular
Dyskinesis Test, is a physical examination maneuver used to assess scapular
stability and identify abnormalities or dysfunctions in scapular movement patterns.
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It helps evaluate the coordination and control of the scapula (shoulder blade) during
shoulder movements.
Patient position:
The patient is usually standing or sitting with their arms relaxed at their sides.
Therapist position:
The therapist stands or sits behind the patient to observe and perform the test.
Procedure:
The Lateral Scapular Slide Test involves the following steps:
1. The therapist visually inspects the patient's scapulae to assess for any
apparent asymmetry, winging (protrusion of the scapula), or abnormal
scapular positions.
2. The therapist then instructs the patient to perform shoulder flexion (lifting
the arms forward) to approximately 90 degrees or shoulder abduction
(lifting the arms to the side) to approximately 90 degrees.
3. While the patient maintains this position, the therapist observes the scapular
movement and assesses for any abnormal patterns, such as scapular
winging, excessive upward rotation, or abnormal tilting.
4. The therapist may also palpate the scapulae to assess for any abnormal
muscle activation or tension during the movement.
Interpretation:
The Lateral Scapular Slide Test allows the therapist to identify any abnormalities
or dyskinesis (impaired movement) of the scapula during shoulder movements.
• Scapular winging: Protrusion or abnormal movement of the scapula away
from the ribcage.
• Excessive upward rotation: Excessive or insufficient rotation of the scapula
during arm elevation.
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• Abnormal tilting: Tilting or tipping of the scapula in an abnormal direction

during shoulder movement.
These findings may indicate scapular muscle imbalances, weakness, or altered
movement patterns, which can contribute to shoulder dysfunction, pain, or
instability.
It's important to note that the Lateral Scapular Slide Test should be performed by a
trained healthcare professional, such as a physical therapist or sports medicine
specialist, who can interpret the findings in the context of the patient's overall
condition and other assessment findings. The test helps guide the development of
appropriate treatment strategies, including exercises and interventions to address
scapular dyskinesis.
Please keep in mind that the Lateral Scapular Slide Test is a specialized assessment
technique, and its interpretation and application should be done by qualified
professionals.
ACROMIOCLAVICULAR
SEPARATION/SPRAIN
Acromioclavicular Shear Test
(Cross-Arm Adduction Test)
(the Shear Test)
(Scarf Test)
The Acromioclavicular (AC) Shear Test, also known as the Cross-Arm Adduction
Test or the Shear Test, is a physical examination maneuver used to assess the
integrity and stability of the acromioclavicular joint in the shoulder. It is commonly
performed to evaluate for AC joint pathology, such as sprains, separations, or
instability.
Patient position:
The patient is usually seated or standing with their arms relaxed at their sides.
Therapist position:
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Procedure:
The Acromioclavicular Shear Test involves the following steps:
1. The therapist places one hand on the patient's shoulder, specifically on the
acromion process (the bony prominence on the top of the shoulder).
2. With the other hand, the therapist grasps the patient's elbow and horizontally
adducts the patient's arm across their body.
3. While maintaining this position, the therapist applies a downward and
shearing force through the patient's elbow, exerting pressure on the
acromioclavicular joint.
4. The therapist assesses for any pain, clicking, or abnormal movement in the
AC joint during the shearing force application.
Interpretation:
During the Acromioclavicular Shear Test, a positive finding is indicated by the
presence of pain, clicking, or abnormal movement in the AC joint. This may
suggest acromioclavicular joint pathology, such as ligament sprains, separations, or
instability.
Scratch and Pull Test

The “Scratch and Pull Test” is a maneuver commonly used to assess the
acromioclavicular (AC) joint. It helps evaluate the integrity and stability of the AC
joint and can be used to detect AC joint pathology such as AC joint separation or
injury. Here’s a description of the Scratch and Pull Test for the AC joint:
Patient position:
The patient stands or sits in an upright position with their arms relaxed by their
sides.
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Therapist position:
The therapist stands or sits in front of the patient, facing them.
Procedure:
1. The therapist starts by instructing the patient to bring their hand of the
affected side behind their back, attempting to reach the opposite shoulder
blade or as far down the back as possible.
2. The patient is asked to “scratch” or touch the upper back or scapular region
with their fingers.
3. Once the patient’s hand is in contact with the back, the therapist places one
hand on the patient’s affected shoulder and applies a gentle downward and
anterior (forward) pull.
4. The therapist observes the patient’s response and assesses for pain,
discomfort, or any abnormal movement or crepitus at the AC joint.
Interpretation:
A positive Scratch and Pull Test is indicated by the reproduction of pain or
discomfort specifically at the AC joint or the presence of abnormal movement or
crepitus during the maneuver. These findings may suggest AC joint pathology, such
as AC joint separation or injury.
MUSCLE TENDON
PATHOLOGY
Speed’s Test
(Biceps Tendinitis Test)

Speed's Test is a physical examination maneuver used to assess potential biceps
tendon pathology, particularly biceps tendinitis or biceps tendon impingement, in
the shoulder.
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Patient position:
The patient is typically seated or standing with their arm extended in front of them,
palm facing up (supinated position).
Therapist position:
The therapist stands in front of the patient and performs the test by manipulating
the patient's arm.
Procedure:
The Speed's Test involves the following steps:
1. The therapist stabilizes the patient's shoulder with one hand, holding the
upper arm in place.
2. With the other hand, the therapist applies a downward force on the patient's
forearm, resisting the patient's attempt to actively flex their shoulder against
the resistance.
3. The therapist maintains the downward resistance as the patient tries to flex
their shoulder against the resistance.

4. The patient is instructed to flex their shoulder while keeping their elbow
extended and palm facing up.
Interpretation:
During the Speed's Test, a positive finding is indicated by pain or tenderness in the
bicipital groove, which is the groove in the front of the shoulder where the biceps
tendon runs. The pain or tenderness suggests potential biceps tendon pathology,
such as biceps tendinitis or biceps tendon impingement.
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Yeargason’s Test
(Yeargason's Maneuver)
(Biceps Reflex Test)

Yeargason's Test is a physical examination maneuver used to assess potential
pathology or instability of the long head of the biceps tendon in the shoulder.
Patient position:
The patient is typically seated or standing with their arm flexed at the elbow and
their forearm resting on their thigh.
Therapist position:
the patient's arm.
Procedure:
The Yeargason's Test involves the following steps:
1. The therapist stabilizes the patient's shoulder with one hand, holding the
upper arm in place.
2. With the other hand, the therapist resists the patient's attempt to actively
supinate their forearm (rotate the palm upward) against the resistance.
3. The therapist maintains the resistance as the patient tries to supinate their
forearm against the resistance.
4. The patient is instructed to keep their elbow flexed at approximately 90
degrees throughout the test.
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Interpretation:
During the Yeargason's Test, a positive finding is indicated by pain or
tenderness in the area of the bicipital groove, which is the groove in the front of
the shoulder where the long head of the biceps tendon runs. The pain or
tenderness suggests potential pathology or instability of the long head of the
biceps tendon.
Empty Can Test
(Supraspinatus Test)
(Jobes Test)
The Empty Can Test, also known as the Supraspinatus Test, is a physical
examination maneuver used to assess the integrity and strength of the supraspinatus
muscle and tendon in the shoulder. It helps identify potential rotator cuff pathology,
particularly supraspinatus tendinitis or tears.
Patient position:
The patient is usually standing or sitting with their arms at their sides.
Therapist position:
manipulating the patient's arms.
Procedure:
The Empty Can Test involves the following steps:
1. The therapist instructs the patient to elevate both arms to shoulder level with
their elbows extended and their thumbs pointing downward (similar to
pouring liquid out of an empty can).
2. The therapist then applies downward pressure on the patient's forearms,
attempting to resist the patient's attempt to actively abduct their arms against
the resistance.
3. The patient is instructed to hold this position and resist the downward
pressure applied by the therapist.
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4. The therapist carefully observes for any pain, weakness, or abnormal

movement during the test.
Interpretation:
During the Empty Can Test, a positive finding is indicated by pain or weakness in
the supraspinatus region, which is the top and front part of the shoulder. This may
suggest supraspinatus tendinitis or tears. Some clinicians consider pain alone as a
positive sign, while others look for a combination of pain and weakness.
Drop Arm Test
(Codman’s)
(Codman's Drop Arm Test)
(Codman's Maneuver)
The Drop Arm Test, also known as Codman's Test or the Codman's Sign, is a
physical examination maneuver used to assess potential rotator cuff pathology,
particularly involving the supraspinatus muscle and tendon, in the shoulder.
Patient position:
The patient is typically standing or sitting with their arms relaxed at their sides.
Therapist position:
the patient's arm.
Procedure:
The Drop Arm Test involves the following steps:
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1. The therapist asks the patient to actively elevate their arm straight out to the
side (abduction) to approximately 90 degrees.
2. The patient is instructed to hold the elevated position for a few seconds.
3. The therapist then asks the patient to slowly and controlledly lower their
arm back down to their side.
Interpretation:
During the Drop Arm Test, a positive finding is indicated by the patient's inability
to maintain control and a smooth, controlled descent of the arm. If the patient is
unable to control the arm during descent and experiences sudden, uncontrolled
dropping of the arm, it suggests weakness or pain associated with the supraspinatus
muscle or tendon.
A positive Drop Arm Test is often indicative of a supraspinatus tear or other
significant rotator cuff pathology. However, it's important to note that other factors,
such as pain or weakness in other shoulder muscles, can also contribute to a positive
test result.
Lift-off Sign
(Gerber's Test)
The Lift-off Sign, also known as the Gerber's Lift-off Test or is a physical
examination maneuver used to assess the integrity and strength of the subscapularis
muscle in the shoulder. It helps identify potential subscapularis muscle pathology,
such as tears or weakness.
Patient position:
The patient is typically standing or sitting with their affected arm internally rotated
behind their back.
Therapist position:
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the patient's arm.
Procedure:
The Lift-off Sign involves the following steps:
1. The therapist instructs the patient to internally rotate their affected arm,
bringing their hand behind their back as if trying to touch the lower back or
sacrum.
2. The patient is then asked to actively lift their hand away from their back
while maintaining internal rotation.
3. The therapist carefully observes for the patient's ability to lift their hand
away from their back and maintain control during the movement.
Interpretation:
During the Lift-off Sign, a positive finding is indicated by the patient's inability to
lift their hand away from their back or difficulty maintaining control during the
movement. This suggests weakness or pathology involving the subscapularis
muscle.
A positive Lift-off Sign is often associated with subscapularis muscle tears,
subscapularis tendinitis, or subscapularis muscle dysfunction. However, it's
important to note that other factors, such as pain or limitations in range of motion,
can also contribute to a positive test result.
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IMPINGEMENT
Neer Test
(Neer Impingement Test)

The Neer Test is a physical examination maneuver used to assess potential
impingement or pathology of the rotator cuff tendons, particularly the supraspinatus
tendon, in the shoulder.
Patient position:
Therapist position:
manipulating the patient's arm.
Procedure:
The Neer Test involves the following steps:
1. The therapist stabilizes the patient's scapula (shoulder blade) with one hand,
holding it firmly against the rib cage.
2. With the other hand, the therapist grasps the patient's arm near the elbow
and passively elevates the arm fully in forward flexion, with the thumb
pointing downward.
3. The therapist continues to elevate the arm until the maximum range of
motion is reached or until the patient experiences pain.
4. The therapist carefully observes for any pain, discomfort, or reproduction
of symptoms during the test.
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Interpretation:
During the Neer Test, a positive finding is indicated by the patient experiencing
pain or discomfort in the shoulder during the passive forward flexion of the arm.
The pain is typically localized to the front of the shoulder and may suggest
impingement of the rotator cuff tendons, particularly the supraspinatus tendon,
against the acromion or coracoacromial arch.
A positive Neer Test is often associated with conditions such as rotator cuff
tendinitis, rotator cuff impingement, or rotator cuff tears. However, it's important
to note that other factors, such as arthritis or labral pathology, can also contribute
to a positive test result.
Hawkins-Kennedy Test
The Hawkins-Kennedy Test is a physical examination maneuver used to assess
potential impingement or pathology of the supraspinatus tendon and other
structures within the shoulder joint.
Patient position:
The patient is typically seated or standing with their arm relaxed at their side.
Therapist position:
the patient's arm.
Procedure:
The Hawkins-Kennedy Test involves the following steps:
1. The therapist flexes the patient's shoulder to 90 degrees.
2. With one hand, the therapist supports the patient's arm at the elbow and
wrist.
3. With the other hand, the therapist internally rotates the patient's shoulder by
passively rotating the arm inward.
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4. The therapist continues to internally rotate the shoulder until the patient
experiences pain or discomfort.
5. The therapist carefully observes the patient's response during the test.
Interpretation:
During the Hawkins-Kennedy Test, a positive finding is indicated by the patient
experiencing pain or discomfort in the shoulder during the passive internal rotation
of the arm. The pain is typically localized to the front or top of the shoulder and
may suggest impingement of the supraspinatus tendon or other structures within the
shoulder joint.
A positive Hawkins-Kennedy Test is often associated with conditions such as
rotator cuff tendinitis, rotator cuff impingement, or rotator cuff tears. However, it's
important to note that other factors, such as arthritis or labral pathology, can also
contribute to a positive test result.
Impingement Test
(Painful Arc Test)

The Impingement Test, also known as the Painful Arc Test is a physical
examination maneuver used to assess potential impingement of the rotator cuff
tendons within the shoulder joint.
Patient position:
Therapist position:
manipulating the patient's arm.
Procedure:
The Impingement Test involves the following steps:
1. The therapist instructs the patient to actively elevate their arms in forward
flexion, bringing them overhead to approximately 180 degrees.
2. The patient is asked to hold this elevated position for a few seconds.
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3. The therapist carefully observes the patient's movement and notes any pain
or discomfort experienced during the active elevation of the arms.
Interpretation:
During the Impingement Test, a positive finding is indicated by the patient
experiencing pain or discomfort during the active elevation of the arms, particularly
within a specific range of motion. The pain is typically felt in the front or top of the
shoulder and may suggest impingement of the rotator cuff tendons against the
acromion or coracoacromial arch.
A positive Impingement Test is often associated with conditions such as rotator
cuff tendinitis, subacromial bursitis, or rotator cuff tears. However, it's important
to note that other factors, such as arthritis or labral pathology, can also contribute
to a positive test result.
NEUROLOGICAL TESTS
Brachial Plexus Tension Test
(Upper Limb Neural Tension Test)
(Brachial Plexus Provocation Test)
(Elvey Test)
The Brachial Plexus Tension Test, also known as the Upper Limb Neural Tension
Test or Brachial Plexus Provocation Test, is a physical examination maneuver used
to assess the mobility and tension of the brachial plexus nerves.
Patient position:
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The patient is typically lying supine (face up) on an examination table.

Therapist position:
the patient's upper limbs.
Procedure:
The Brachial Plexus Tension Test involves the following steps:
1. The therapist positions the patient's shoulder in slight abduction (away from
the body) and external rotation.
2. The therapist then extends the patient's elbow and externally rotates the
forearm.
3. Next, the therapist extends the patient's wrist and fingers while keeping the
elbow in extension.
4. The therapist slowly applies tension or stretches the patient's upper limb in
this position, increasing the tension on the brachial plexus nerves.
5. The therapist carefully observes the patient's response to the tension, noting
any symptoms or discomfort experienced along the path of the brachial
plexus nerves.
Interpretation:
During the Brachial Plexus Tension Test, a positive finding is indicated by the
patient experiencing symptoms such as pain, tingling, or altered sensation along the
path of the brachial plexus nerves. These symptoms may radiate into the upper limb
and can indicate nerve compression or tension.
A positive Brachial Plexus Tension Test may suggest nerve root impingement,
nerve entrapment, or nerve tension due to various conditions, including cervical
radiculopathy, thoracic outlet syndrome, or brachial plexus injury.
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Tinel’s Sign
(Tinel's Tap Test)
(Nerve Percussion Test)

Tinel's Sign is a physical examination maneuver used to assess nerve irritation or
injury at a specific site along a nerve pathway. It is commonly used to evaluate
peripheral nerve entrapments or compressions.
Patient position:
The patient is typically seated or lying in a comfortable position, depending on the
area being examined.
Therapist position:
The therapist stands or sits beside the patient and performs the test by tapping or
lightly percussing along the path of the nerve being assessed.
Procedure:
The Tinel's Sign involves the following steps:
1. The therapist identifies the specific nerve pathway being assessed based on
the patient's symptoms and clinical presentation.
2. With a gentle tapping motion, the therapist applies light percussion or
pressure to the area along the nerve pathway, starting distally (away from
the spine) and moving proximally (toward the spine).
3. The therapist repeats the tapping or pressure along the nerve pathway,
observing the patient's response.
Interpretation:
During the Tinel's Sign, a positive finding is indicated by the patient experiencing
symptoms such as tingling, pins and needles sensation, or a "shooting" sensation
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along the nerve pathway being tested. These symptoms are often indicative of nerve
irritation or compression.
A positive Tinel's Sign may suggest the presence of conditions such as nerve
entrapment, peripheral neuropathy, or nerve injury. However, it's important to note
that a positive sign does not confirm a specific diagnosis and should be interpreted
alongside other clinical findings and diagnostic tests.
THORACIC OUTLET SYNDROME
57
THORACIC OUTLET
SYNDROME
Roos Test
(Elevated Arm Stress Test)
(Roos Maneuver)
The Roos Test, also known as the Elevated Arm Stress Test or East Test, is a
physical examination maneuver used to assess thoracic outlet syndrome (TOS) or
other conditions affecting the neurovascular structures in the upper extremities.
Patient position:
The patient is typically seated or standing.
Therapist position:
The therapist stands or sits in front of the patient and observes the patient's arm
movements during the test.
Procedure:
The Roos Test involves the following steps:
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1. The therapist instructs the patient to actively and rapidly elevate both arms
to 90 degrees in a "stick 'em up" position, with the elbows flexed and the
shoulders abducted.
2. The patient is then asked to open and close their hands rapidly for
approximately 3 minutes while maintaining the elevated arm position.
3. The therapist carefully observes the patient's ability to maintain the arm
position and any associated symptoms or difficulties experienced by the
patient during the test.
Interpretation:
During the Roos Test, a positive finding is indicated by the patient's inability to
maintain the elevated arm position or the development of symptoms such as
weakness, heaviness, fatigue, or sensory changes in the affected arm(s). These
symptoms may suggest compression or compromise of the neurovascular structures
in the thoracic outlet region.
A positive Roos Test is often associated with thoracic outlet syndrome, a condition
characterized by the compression or irritation of the brachial plexus nerves and/or
blood vessels as they pass through the thoracic outlet between the neck and
shoulder. However, it's important to note that other factors, such as muscle
weakness, cervical spine pathology, or other nerve-related conditions, can also
contribute to a positive test result.
Costoclavicular Syndrome Test
(Costoclavicular Maneuver)
(Military Brace Test)

The Costoclavicular Syndrome Test, also known as the Military Brace Test or
Costoclavicular Maneuver, is a physical examination maneuver used to assess for
thoracic outlet syndrome (TOS) or other conditions involving compression or
irritation of the neurovascular structures in the thoracic outlet region.
Patient position:
The patient is typically seated or standing.
Therapist position:
the patient's upper limbs.
59
Procedure:
The Costoclavicular Syndrome Test involves the following steps:
1. The therapist assists the patient in assuming a military-like posture by
instructing them to stand up straight, draw their shoulders back, and retract
their scapulae.
2. The therapist then instructs the patient to depress their shoulders by pulling
their shoulders downward and slightly backward, while simultaneously
extending their head and neck backward.
3. The therapist holds the patient's shoulders in the depressed and retracted
position and observes any changes or symptoms experienced by the patient
during this maneuver.
Interpretation:
During the Costoclavicular Syndrome Test, a positive finding is indicated by the
patient experiencing symptoms such as pain, numbness, tingling, or weakness in
the affected arm(s) during the maneuver. These symptoms may suggest
compression or compromise of the neurovascular structures, including the brachial
plexus nerves and/or blood vessels, in the thoracic outlet region.
A positive Costoclavicular Syndrome Test is often associated with thoracic outlet
syndrome, specifically the costoclavicular subtype. In this subtype, compression or
irritation occurs between the clavicle (collarbone) and the first rib. However, it's
important to note that other factors, such as muscle hypertonicity, anatomical
variations, or cervical spine pathology, can also contribute to a positive test result.
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Wright Test
(Hyperabduction Test)
Wright Test for thoracic outlet syndrome (TOS) with patient position, therapist
position, procedure, and positive sign:
Patient position:
The patient should be seated or standing in an upright position with their shoulders
relaxed and arms by their sides.
Therapist position:
The therapist stands behind the patient, allowing access to the patient’s affected
arm and thoracic outlet region.
Procedure:
1. The therapist palpates the radial pulse on the affected side, typically at the
wrist, to establish a baseline.
2. With the patient’s arm in a neutral position, the therapist performs the
following actions:
a. The therapist fully abducts the patient’s affected arm to 180 degrees,
meaning the arm is fully raised laterally away from the body.
b. The therapist externally rotates the patient’s arm, meaning the palm
of the hand is turned away from the body.
c. The therapist extends the patient’s arm, moving it backward or

posteriorly.
61
d. The therapist instructs the patient to take a deep breath and hold it
(Valsalva maneuver) while maintaining the arm position.
e. The therapist maintains the arm position and observes for any
changes in the radial pulse or reproduction of symptoms.
Positive sign:
A positive Wright Test is indicated by the reproduction of symptoms or a significant
decrease in the radial pulse during the test. These findings suggest the presence of
neurogenic thoracic outlet syndrome (TOS), indicating compression or irritation of
the brachial plexus nerves within the thoracic outlet.
Adson Maneuver
(Adson's Test)
The Adson Maneuver, also known as Adson's test or Adson's maneuver, is a
physical examination technique used to assess the presence of thoracic outlet
syndrome (TOS). TOS refers to a group of conditions characterized by the
compression or irritation of the nerves, blood vessels, or both, as they pass through
the thoracic outlet area between the neck and shoulder.
Patient position:
The patient is usually seated or standing upright for this test.
Therapist position:
The therapist stands behind the patient and assists in positioning and monitoring
the patient's radial pulse.
Procedure:
The Adson Maneuver involves the following steps:
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1. The therapist palpates and locates the patient's radial pulse on the affected
side, typically at the wrist.
2. The therapist instructs the patient to take a deep breath and hold it.
3. While the patient holds their breath, the therapist assists in positioning the
patient's shoulder in external rotation, meaning the patient's arm is rotated
outward and slightly back.
4. The therapist also extends the patient's neck and rotates it toward the
affected side.
5. The therapist then monitors the patient's radial pulse to assess any changes
or diminished blood flow.
Interpretation:
During the Adson Maneuver, a positive finding is indicated by the disappearance
or diminished intensity of the patient's radial pulse on the affected side. This
suggests that compression or impingement of the subclavian artery or the brachial
plexus (nerves) may be occurring within the thoracic outlet.
Elbow
63
Elbow
Elbow flexion test
The Elbow Flexion Test, also known as the Cubital Tunnel Test, is a clinical maneuver used
to assess for cubital tunnel syndrome or ulnar nerve compression at the elbow. Here’s a
description of the Elbow Flexion Test:
Patient position:
The patient should be seated or lying down in a relaxed position.
Therapist position:
The therapist stands or sits in front of the patient, facing them.
Procedure:
1. The therapist instructs the patient to fully flex their elbow joint, bringing their
forearm toward their shoulder.
2. The patient maintains the elbow flexed position while the therapist applies gentle
pressure over the ulnar nerve at the cubital tunnel region, located on the inside
of the elbow.
3. The therapist holds the pressure for a period of time (usually around 60 seconds).
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4. During the test, the therapist asks the patient about any symptoms they may
experience, such as tingling, numbness, or pain along the ulnar nerve distribution
in the hand and fingers.
Positive sign:
A positive Elbow Flexion Test is indicated by the reproduction of symptoms, such as
tingling, numbness, or pain, along the ulnar nerve distribution (typically affecting the little
finger and ring finger). These symptoms suggest the presence of cubital tunnel syndrome
or ulnar nerve compression at the elbow.
Tennis elbow test (resisted)
(Tennis Elbow Resisted Test)
(Cozen's Test)
The Tennis Elbow Test (Resisted) is a clinical maneuver used to assess for lateral
epicondylitis, commonly known as tennis elbow. It helps evaluate the integrity and
function of the muscles and tendons on the outside of the elbow. Here’s a description of
the Tennis Elbow Test (Resisted):
Patient position:
The patient should be seated or standing in a comfortable position with their forearm
supported on a surface, such as a table or the examiner’s hand.
Therapist position:
The therapist stands or sits facing the patient, positioned to have access to the patient’s
affected arm and elbow.
Procedure:
1. The therapist instructs the patient to extend their wrist and fingers fully, keeping
the elbow straight.
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2. The therapist applies resistance by placing their hand or fingers on the dorsal side
(back) of the patient’s hand.
3. The therapist asks the patient to resist the downward pressure applied by the
therapist while trying to keep their wrist and fingers extended.
4. The therapist gradually increases the resistance, but it should be done gradually
to avoid excessive pain or discomfort.
5. During the test, the therapist observes the patient for pain or discomfort in the
lateral aspect of the elbow, specifically over the lateral epicondyle.
Positive sign:
A positive Tennis Elbow Test (Resisted) is indicated by the reproduction of pain or
tenderness over the lateral epicondyle (bony prominence on the outside of the elbow)
during resisted wrist and finger extension. This finding suggests the presence of lateral
epicondylitis or tennis elbow.
Tennis elbow test (passive)
( Tennis Elbow Passive Test)
(Mill's Test)
The Tennis Elbow Test (Passive) is a clinical maneuver used to assess for lateral
epicondylitis, commonly known as tennis elbow. It helps evaluate the integrity and
function of the muscles and tendons on the outside of the elbow. Here’s a description of
the Tennis Elbow Test (Passive):
Patient position:
The patient should be seated or standing in a comfortable position with their arm relaxed
and elbow extended.
Therapist position:
Procedure:
1. The therapist supports the patient’s affected forearm with one hand, grasping it
just above the wrist.
2. With the other hand, the therapist applies passive wrist extension by bending the
patient’s wrist backward.
3. The therapist gradually extends the wrist to the end range of motion, while
maintaining control and ensuring patient comfort.
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lateral aspect of the elbow, specifically over the lateral epicondyle.
Positive sign:
A positive Tennis Elbow Test (Passive) is indicated by the reproduction of pain or
tenderness over the lateral epicondyle (bony prominence on the outside of the elbow)
during passive wrist extension. This finding suggests the presence of lateral epicondylitis
or tennis elbow.
Tennis elbow test (resisted middle-
finger extension)
(Maudsley’s Test)
(Middle Finger Extension Resisted Test)

Also know as Maudsley’s Test, which is a variation of the Tennis Elbow Test. It is used to
assess for lateral epicondylitis or tennis elbow. Here’s a description of Maudsley’s Test:
Patient position:
supported on a surface, such as a table.
Therapist position:
Procedure:
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1. The therapist instructs the patient to make a fist with their hand.
2. The therapist asks the patient to extend their middle finger against resistance by
pushing the middle finger upward while the therapist provides resistance.
3. The therapist may apply resistance by placing their fingers or hand on the dorsal
side (back) of the patient’s middle finger.
4. During the test, the therapist observes the patient for pain or discomfort over the
lateral epicondyle (bony prominence on the outside of the elbow) during resisted
middle-finger extension.
Positive sign:
A positive Maudsley’s Test is indicated by the reproduction of pain or tenderness over the
lateral epicondyle during resisted middle-finger extension. This suggests the presence of
lateral epicondylitis or tennis elbow.
Golfer’s elbow test (resisted)
(Golfer's Elbow Resisted Test)
(Medial Epicondylitis Test)

The Golfer’s Elbow Test (Resisted) is a clinical maneuver used to assess for medial
epicondylitis, commonly known as golfer’s elbow. It helps evaluate the integrity and
function of the muscles and tendons on the inside of the elbow. Here’s a description of
the Golfer’s Elbow Test (Resisted):
Patient position:
supported on a surface, such as a table or the examiner’s hand.
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Therapist position:
Procedure:
1. The therapist instructs the patient to flex their wrist and fingers fully, keeping the
elbow straight.
2. The therapist applies resistance by placing their hand or fingers on the palmar
side (inside) of the patient’s hand.
3. The therapist asks the patient to resist the inward pressure applied by the
therapist while trying to keep their wrist and fingers flexed.
4. The therapist gradually increases the resistance, but it should be done gradually
to avoid excessive pain or discomfort.
medial aspect of the elbow, specifically over the medial epicondyle.
Positive sign:
A positive Golfer’s Elbow Test (Resisted) is indicated by the reproduction of pain or
tenderness over the medial epicondyle (bony prominence on the inside of the elbow)
during resisted wrist and finger flexion. This finding suggests the presence of medial
epicondylitis or golfer’s elbow.
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Golfer’s elbow test (passive)
(Golfer's Elbow Passive Test)
(Medial Epicondylitis Passive Test)

The Golfer’s Elbow Test (Passive) is a clinical maneuver used to assess for medial
epicondylitis, commonly known as golfer’s elbow. It helps evaluate the integrity and
function of the muscles and tendons on the inside of the elbow. Here’s a description of
the Golfer’s Elbow Test (Passive):
Patient position:
The patient should be seated or standing in a comfortable position with their arm relaxed
and elbow extended.
Therapist position:
Procedure:
1. The therapist holds the patient’s affected forearm with one hand, gently
supporting it.
2. With the other hand, the therapist applies passive wrist flexion by bending the
patient’s wrist downward (palmar flexion).
3. The therapist gradually flexes the patient’s wrist to the end range of motion,
while maintaining control and ensuring patient comfort.
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medial aspect of the elbow, specifically over the medial epicondyle.
Positive sign:
A positive Golfer’s Elbow Test (Passive) is indicated by the reproduction of pain or
tenderness over the medial epicondyle (bony prominence on the inside of the elbow)
during passive wrist flexion. This finding suggests the presence of medial epicondylitis or
golfer’s elbow.
Pinch grip test
(Pinch Strength Test)
(Key Pinch Test)

The Pinch Grip Test for Elbow is a clinical maneuver used to assess for anterior
interosseous nerve (AIN) entrapment, which is a branch of the median nerve. It helps
evaluate the function of the muscles innervated by the AIN, specifically the flexor pollicis
longus and the flexor digitorum profundus to the index finger. Here’s a description of the
Pinch Grip Test for Elbow:
Patient position:
Therapist position:
Procedure:
1. The therapist instructs the patient to make a full grip or pinch with their thumb and
index finger, forming an “O” shape.
2. The therapist asks the patient to maintain the pinch grip while the therapist attempt s
to pull the thumb away from the index finger, providing gentle resistance.
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3. During the test, the therapist observes the patient’s ability to maintain the pinch grip
and assesses any weakness or loss of coordination in the flexor muscles of the thumb and
index finger.
Positive sign:
A positive Pinch Grip Test for Elbow is indicated by the inability to maintain a strong and
coordinated pinch grip between the thumb and index finger. Weakness or loss of
coordination specifically in the flexor pollicis longus and the flexor digitorum profundus
to the index finger may suggest AIN entrapment.
Posterolateral pivot shift test
(Pivot Shift Test)
(Outer Pivot Test)

Posterolateral Pivot Shift Test for assessing posterolateral rotatory instability of the
elbow and the integrity of the lateral collateral ligament (LCL). Here’s a description of the
Posterolateral Pivot Shift Test for the elbow:
Patient position:
The patient should be lying on their back (supine) on an examination table.
Therapist position:
The therapist stands or sits on the same side as the patient’s affected arm.
Procedure:
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1. The therapist flexes the patient’s elbow to approximately 90 degrees and

stabilizes the upper arm against their own body using their forearm.
2. The therapist holds the patient’s forearm just above the wrist with one hand,
while the other hand supports the patient’s forearm near the elbow joint.
3. The therapist externally rotates the patient’s forearm and applies a valgus stress
(outward pressure) to the elbow.
4. With the valgus stress maintained, the therapist slowly extends the patient’s
elbow joint while pronating the forearm.
5. During the test, the therapist assesses the elbow for any abnormal movement or
subluxation (partial dislocation) of the joint.
6. The test is performed while gradually increasing the degree of elbow extension
to evaluate the presence or absence of instability.
Positive sign:
A positive Posterolateral Pivot Shift Test is indicated by the presence of a palpable or
visible subluxation or instability of the elbow joint during the maneuver. This suggests
posterolateral rotatory instability and potential damage to the lateral collateral ligament
(LCL).
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Tinel’s sign (at elbow)
(Tinel's Sign at the Elbow)
(Cubital Tunnel Tinel's Sign)

Tinel’s sign at the elbow is a clinical test used to assess for nerve compression or irritation,
particularly the ulnar nerve, as it passes through the cubital tunnel. Here’s a description
of Tinel’s sign at the elbow:
Patient position:
The patient should be seated or lying down in a comfortable position.
Therapist position:
Procedure:
1. The therapist locates the cubital tunnel, which is located on the inside of the
elbow (medial aspect) where the ulnar nerve passes beneath the medial
epicondyle of the humerus.
2. Using their fingertips or a gentle tapping motion, the therapist lightly taps or
applies pressure to the area around the cubital tunnel.
3. The therapist asks the patient to report any sensations they experience during
the tapping or pressure, such as tingling, electrical sensations, or discomfort
traveling along the ulnar nerve distribution (down the forearm and into the fourth
and fifth fingers).
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Positive sign:
A positive Tinel’s sign at the elbow is indicated by the reproduction of symptoms, such as
tingling, electrical sensations, or discomfort traveling along the ulnar nerve distribution,
when tapping or applying pressure to the area around the cubital tunnel. This suggests
the presence of ulnar nerve compression or irritation, which can occur in conditions like
cubital tunnel syndrome.
Varus stress test

The Varus Stress Test is a clinical maneuver used to assess the stability of the lateral
collateral ligament (LCL) of the elbow. It helps evaluate the integrity of the ligament and
identify any potential laxity or instability. Here’s a description of the Varus Stress Test for
the elbow:
Patient position:
The patient should be seated or lying down in a comfortable position with their forearm
Therapist position:
Procedure:
1. The therapist supports the patient’s forearm with one hand, grasping it just above
the wrist.
2. With the other hand, the therapist places their thumb on the lateral aspect
(outside) of the patient’s elbow joint, near the lateral epicondyle.
3. The therapist applies a valgus stress (inward pressure) to the elbow by pushing
the forearm inward while maintaining the upper arm stabilized.
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4. During the test, the therapist observes the elbow joint for any abnormal
movement or excessive opening (gapping) on the lateral side, indicating laxity or
instability of the lateral collateral ligament (LCL).
Positive sign:
A positive Varus Stress Test is indicated by the presence of increased lateral gapping or a
visible opening of the joint space on the lateral side of the elbow when the valgus stress
is applied. This suggests a potential injury or instability of the lateral collateral ligament
(LCL).
Valgus stress test

The Valgus Stress Test is a clinical maneuver used to assess the stability of the medial
collateral ligament (MCL) of the elbow. It helps evaluate the integrity of the ligament and
identify any potential laxity or instability. Here’s a description of the Valgus Stress Test for
the elbow:
Patient position:
The patient should be seated or lying down in a comfortable position with their forearm
Therapist position:
Procedure:
1. The therapist supports the patient’s forearm with one hand, grasping it just above
the wrist.
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2. With the other hand, the therapist places their thumb on the medial aspect
(inside) of the patient’s elbow joint, near the medial epicondyle.
3. The therapist applies a valgus stress (outward pressure) to the elbow by pushing
the forearm outward while maintaining the upper arm stabilized.
4. During the test, the therapist observes the elbow joint for any abnormal
movement or excessive opening (gapping) on the medial side, indicating laxity or
instability of the medial collateral ligament (MCL).
Positive sign:
A positive Valgus Stress Test is indicated by the presence of increased medial gapping or
a visible opening of the joint space on the medial side of the elbow when the valgus stress
is applied. This suggests a potential injury or instability of the medial collateral ligament
(MCL).
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WRIST & HAND

LIGAMENTS, CAPSULES, AND
JOINT INSTABILITY
Ligamentous Instability For The
Fingers
The Ligamentous Instability Test for the Fingers is a physical examination
maneuver used to assess the stability and integrity of the finger ligaments.
Patient position:
The patient is typically seated or lying down with the hand resting
comfortably.
Therapist position:
manipulating the patient's fingers.
Procedure:
The Ligamentous Instability Test for the Fingers involves the following
steps:
1. The therapist stabilizes the patient's hand with one hand while
grasping the finger being tested with the other hand.
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2. The therapist applies controlled stress or force to the finger joint

being examined, usually in a specific direction.
3. The stress is applied in various directions depending on the
specific finger joint being assessed. For example, for the
metacarpophalangeal (MCP) joint, the therapist may apply stress
in the dorsal (backward), volar (forward), and lateral (sideways)
directions.
4. The therapist carefully observes the joint for excessive laxity,
abnormal movement, or pain during the application of stress.
Interpretation:
The Ligamentous Instability Test for the Fingers aims to identify abnormal
joint laxity or instability, which may suggest ligamentous injury or
instability.
A positive finding in the test is indicated by excessive joint laxity,
abnormal movement, or pain during the application of stress to the finger
joint. These signs may suggest ligamentous sprain or tear, joint
hypermobility, or ligamentous instability.
The specific positive signs may vary depending on the joint being tested
and the direction of stress applied. It is important for the therapist to
compare the findings with the unaffected hand or the normal range of
motion and stability for accurate interpretation.
Thumb Ulnar Collateral Ligament
Laxity or Instability Test
(Ulnar Collateral Ligament Stress Test –
Thumb)
(Skier's Thumb Test)
(Valgus Stress Test for the Thumb)

The Thumb Ulnar Collateral Ligament (UCL) Laxity or Instability Test, also
known as the Valgus Stress Test for the Thumb, is a physical examination
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maneuver used to assess the integrity and stability of the ulnar collateral ligament
in the thumb.
Patient position:
The patient is typically seated or lying down with the hand resting comfortably.
Therapist position:
manipulating the patient's thumb.
Procedure:
The Thumb UCL Laxity or Instability Test involves the following steps:
1. The therapist stabilizes the patient's hand or forearm with one hand, while
grasping the patient's thumb with the other hand.
2. The therapist applies a valgus stress to the thumb by angulating it away from
the hand, towards the index finger.
3. The therapist carefully observes the joint for excessive laxity, abnormal
movement, or pain during the application of the valgus stress.
4. To further assess the UCL, the therapist may also perform additional
maneuvers, such as the 'Stener test' or the 'Grind test', to determine the
severity and specific location of the ligamentous injury if instability is
suspected.
Interpretation:
The Thumb UCL Laxity or Instability Test aims to identify abnormal laxity or
instability of the ulnar collateral ligament in the thumb, which can be indicative of
a ligamentous injury or instability.
A positive finding in the test is indicated by excessive joint laxity, abnormal
movement, or pain during the application of the valgus stress. These signs may
suggest UCL sprain, partial or complete tear, or ligamentous instability.
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It is important for the therapist to compare the findings with the unaffected thumb
or the normal range of motion and stability for accurate interpretation.
Murphy’s test
(Murphy's Sign)
Murphy's test is a clinical test used to diagnose lunate dislocation. The test is
performed by having the patient make a fist with the injured wrist. If the knuckle
of the middle finger is level with the knuckles of the ring and index fingers, then it
is a positive Murphy's sign and suggests that the lunate bone is dislocated.
Patient position:
The patient should sit in a chair with the injured arm resting on a table. The wrist
should be in a neutral position, not flexed or extended.
Therapist position:
The therapist should stand facing the patient. The therapist should place their hands
on the patient's wrist and hand, with the thumb on the back of the hand and the
fingers on the palm.
Procedure:
1. Have the patient make a fist with the injured wrist.
2. The therapist should examine the hand and look for the knuckle formed by
the third metacarpal.
3. Compare the level of the knuckle to the knuckles of the ring and index
fingers.
4. If the knuckle of the middle finger is level with the knuckles of the ring and
index fingers, then the test is positive.
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Positive sign:
A positive Murphy's sign indicates that the lunate bone is dislocated. This is
because the lunate dislocation causes the third metacarpal to be displaced volarly,
which in turn raises the knuckle of the middle finger.
Watson Test
(Scaphoid Shift)
(Scaphoid Shift Test)
(Scaphoid Instability Test)

The Watson Test, also known as the Scaphoid Shift Test, is a physical examination
maneuver used to assess the stability and integrity of the scaphoid bone in the wrist.
It is primarily used to evaluate for scapholunate ligament pathology, such as
scapholunate instability or tear.
Patient position:
The patient is typically seated or lying down with the forearm resting on a flat
surface.
Therapist position:
manipulating the patient's wrist.
Procedure:
1. The therapist stabilizes the patient's forearm with one hand, holding it
securely against the examination table or their own body.
2. With the other hand, the therapist grasps the patient's thumb and applies a
dorsal (backward) force on the thumb, pushing it away from the palm.
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3. While maintaining the dorsal force on the thumb, the therapist moves the
patient's wrist into ulnar deviation (towards the little finger) and then radial
deviation (towards the thumb).
4. The therapist carefully observes and palpates the wrist joint during these
movements for any abnormal shifting or subluxation of the scaphoid bone.
Interpretation:
During the Watson Test, a positive finding is indicated by the patient experiencing
pain, a palpable clunk, or a significant "shift" or subluxation of the scaphoid bone
during the ulnar and radial deviation movements.
A positive Watson Test suggests scapholunate instability, which is often associated
with scapholunate ligament tears or other ligamentous injuries in the wrist.
However, it's important to note that other factors, such as arthritis or other
ligamentous instability patterns, can also contribute to a positive test result.
Piano Keys Test
(Ulnar Styloid Test)
(Dorsal Glide Test)

The Piano Keys Test, also known as the Ulnar Styloid Test or Dorsal Glide Test, is
a physical examination maneuver used to assess instability or subluxation of the
distal radioulnar joint (DRUJ) in the wrist.
Patient position:
The patient is typically seated or lying down with the forearm resting on a flat
surface.
Therapist position:
the patient's wrist.
Procedure:
The Piano Keys Test involves the following steps:
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1. The therapist stabilizes the patient's forearm with one hand, holding it
securely against the examination table or their own body.
2. With the other hand, the therapist places their thumb on the ulnar styloid
process (bump on the side of the wrist) and their index or middle finger on
the dorsal aspect of the patient's distal ulna (end of the forearm bone).
3. The therapist applies a dorsal (backward) force on the ulnar styloid process
while simultaneously attempting to glide or push the distal ulna in a volar
(forward) direction.
4. The therapist carefully observes and palpates for any abnormal movement,
clicking, or pain during the gliding motion of the distal ulna.
Interpretation:
During the Piano Keys Test, a positive finding is indicated by the patient
experiencing pain, a palpable "clunk," or excessive dorsal gliding movement of the
ulna relative to the radius during the test.
A positive Piano Keys Test suggests instability or subluxation of the distal
radioulnar joint (DRUJ), which can be associated with ligamentous injuries, tears,
or other conditions affecting the stability of the joint.
Axial Load
The Axial Load Test, also known as the Compression Test, is a physical
examination maneuver used to assess for potential fractures or joint arthrosis in the
metacarpal or carpal bones of the hand.
Patient position:
The patient is typically seated or lying down with the hand resting comfortably.
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Therapist position:
manipulating the patient's hand.
Procedure:
The Axial Load Test involves the following steps:
1. The therapist stabilizes the patient's forearm or wrist with one hand to
provide support and stability.
2. With the other hand, the therapist applies an axial load or compressive force
to the metacarpal or carpal bones by pressing down on the hand in a vertical
direction, typically using their palm or fingers.
3. The therapist carefully observes the patient's response during the
application of the axial load, noting any pain, discomfort, or abnormal
movement in the area being tested.
Interpretation:
During the Axial Load Test, a positive finding is indicated by the patient
experiencing pain, tenderness, or discomfort in the metacarpal or carpal bones
during the application of the axial load. This may suggest a fracture, joint arthrosis
(degenerative joint disease), or other conditions affecting the bones or joints of the
hand.
A positive Axial Load Test should prompt further evaluation, such as imaging
studies (X-rays, MRI, or CT scan), to confirm the diagnosis and assess the extent
of the injury or degenerative changes.
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85
TENDONS AND MUSCLES

Finkelstein Test
(Finkelstein's Maneuver)
(De Quervain's Test)

The Finkelstein Test is a physical examination maneuver used to assess for de
Quervain's tenosynovitis, a condition characterized by inflammation of the tendons
in the thumb.
Patient position:
The patient is typically seated or standing with their forearm and hand in a relaxed
position.
Therapist position:
the patient's hand and thumb.
Procedure:
The Finkelstein Test involves the following steps:
1. The therapist instructs the patient to make a fist with their thumb inside the
closed fingers.
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2. The therapist then asks the patient to bend their wrist toward the little finger,
while keeping the thumb tucked inside the closed fist.
3. The therapist applies a gentle downward force or passive ulnar deviation of
the wrist.
4. The therapist carefully observes the patient's response during the maneuver,
noting any pain or discomfort along the thumb side of the wrist.
Interpretation:
During the Finkelstein Test, a positive finding is indicated by the patient
experiencing pain or tenderness along the thumb side of the wrist during the ulnar
deviation of the wrist with the thumb tucked inside the fist.
A positive Finkelstein Test is highly suggestive of de Quervain's tenosynovitis,
which involves inflammation of the tendons of the abductor pollicis longus and
extensor pollicis brevis as they pass through the tunnel (extensor retinaculum) at
the thumb side of the wrist. The condition is commonly caused by repetitive thumb
movements or overuse.
Sweater Finger Sign
(Jersey Finger Test)
(Flexor Digitorum Profundus Avulsion
Test)
The Sweater Finger Sign is a clinical observation used to assess for a possible
rupture of the flexor digitorum profundus (FDP) tendon in the finger.
Patient position:
The patient can be seated or standing, with their hand in a relaxed position.
Therapist position:
The therapist stands or sits in front of the patient and observes the fingers.
Procedure:
The Sweater Finger Sign involves the following steps:
1. The therapist instructs the patient to make a full fist by flexing all the
fingers, including the thumb, into the palm.
2. The therapist observes the patient's hand and fingers for any abnormal
movement or posture.
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Interpretation:
During the Sweater Finger Sign, a positive finding is indicated if one or more
fingers fail to flex fully into the fist position. Instead, the affected finger(s) may
remain partially extended or straight, resembling a finger stuck in a sweater sleeve.
A positive Sweater Finger Sign suggests a potential rupture of the flexor digitorum
profundus (FDP) tendon in the affected finger(s). This condition may be caused by
trauma, such as a sports injury or an accident involving the hand or finger. The
rupture typically occurs at the distal attachment of the FDP tendon.
Extensor Hood Rupture
(Extensor Hood Integrity Test)
(Extensor Mechanism Rupture Test)

The Extensor Hood Rupture Test is a physical examination maneuver used to assess
for a potential rupture or dysfunction of the extensor hood mechanism in the
fingers.
Patient position:
The patient can be seated or standing, with their hand in a relaxed position.
Therapist position:
Procedure:
The Extensor Hood Rupture Test involves the following steps:
1. The therapist instructs the patient to fully extend all their fingers.
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2. The therapist applies resistance or downward pressure to the patient's distal

phalanges (finger tips) while the patient tries to maintain finger extension.
3. The therapist observes the patient's fingers for any abnormal movement or
inability to maintain finger extension.
Interpretation:
During the Extensor Hood Rupture Test, a positive finding is indicated if one or
more fingers demonstrate a swan-neck deformity. The swan-neck deformity is
characterized by hyperextension of the proximal interphalangeal (PIP) joint and
flexion of the distal interphalangeal (DIP) joint, resembling the shape of a swan's
neck.
A positive Extensor Hood Rupture Test suggests a potential rupture or dysfunction
of the extensor hood mechanism, which is responsible for coordinating finger
extension and maintaining stability of the PIP and DIP joints. This condition may
be caused by trauma, chronic repetitive stress, or underlying connective tissue
disorders.
Bunnel-Littler Test
(Bunnel-Littler Maneuver)
(Lumbrical-Plus Test
The Bunnel-Littler Test is a physical examination maneuver used to assess the
tightness or contracture of the intrinsic muscles and structures in the fingers,
particularly the proximal interphalangeal (PIP) joint.
Patient position:
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The patient can be seated or lying down with their hand in a relaxed position.
Therapist position:
Procedure:
The Bunnel-Littler Test involves the following steps:
1. The therapist stabilizes the patient's hand or forearm with one hand to
provide support and stability.
2. With the other hand, the therapist holds the patient's affected finger by
grasping the middle phalanx (the middle bone of the finger).
3. The therapist then attempts to passively flex the PIP joint while keeping the
metacarpophalangeal (MCP) joint (closest joint to the palm) in extension.
4. After attempting to flex the PIP joint, the therapist gently tries to passively
flex the patient's MCP joint while maintaining PIP joint flexion.
5. The therapist carefully observes the patient's response during the maneuver,
noting any limitations in PIP joint flexion or changes in MCP joint flexion.
Interpretation:
During the Bunnel-Littler Test, the degree of PIP joint flexion achieved while
keeping the MCP joint in extension is assessed. The test evaluates the tightness or
contracture of the intrinsic muscles and structures that limit PIP joint flexion.
A positive finding in the Bunnel-Littler Test is indicated if there is limited PIP joint
flexion (less than 70-90 degrees) while the MCP joint is held in extension. This
suggests intrinsic tightness or contracture of the finger, which can be caused by
various conditions such as intrinsic muscle contracture, joint capsule contracture,
or scar tissue formation.
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90
NEUROLOGICAL
DYSFUNCTION
Tinel’s Sign
(Tinel's Tap Test)

Tinel's Sign, also known as Tinel's Test, is a physical examination maneuver used
to assess for the presence of median nerve compression or irritation in the carpal
tunnel, which is indicative of carpal tunnel syndrome.
Patient position:
The patient is typically seated or lying down with their forearm and hand in a
relaxed position.
Therapist position:
The therapist stands or sits in front of the patient and performs the test by tapping
or percussing the area over the carpal tunnel.
Procedure:
The Tinel's Sign or Test for Carpal Tunnel Syndrome involves the following steps:
1. The therapist identifies the location of the carpal tunnel, which is a narrow
passageway on the palm side of the wrist formed by the carpal bones and
the transverse carpal ligament.
2. Using their fingers or a reflex hammer, the therapist taps or lightly strikes
the skin directly over the carpal tunnel.
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3. The therapist carefully observes the patient's response during the tapping,
noting any abnormal sensations, tingling, or pain radiating into the thumb,
index finger, middle finger, and half of the ring finger.
Interpretation:
During the Tinel's Sign or Test, a positive finding is indicated if the patient
experiences tingling, pins and needles sensation (paresthesia), or an electric shock-
like sensation along the distribution of the median nerve (thumb, index finger,
middle finger, and half of the ring finger) upon tapping the carpal tunnel area.
A positive Tinel's Sign is highly suggestive of carpal tunnel syndrome, a condition
characterized by compression or irritation of the median nerve as it passes through
the carpal tunnel. However, it's important to note that other factors, such as nerve
entrapment or neuropathy, can also contribute to a positive test result.
Phalan’s Test
(Phalen Maneuver)
Phalen's Test for carpal tunnel syndrome, as it is a well-known examination
maneuver used in clinical practice.
Patient position:
The patient is typically seated or standing, with their forearms resting on a table or
their lap.
Therapist position:
manipulating the patient's wrists.
Procedure:
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The Phalen's Test involves the following steps:

1. The therapist instructs the patient to flex both wrists fully and gently press
the back of the hands together, creating a downward angle.
2. The patient maintains this position for approximately 1 minute.
3. The therapist carefully observes the patient's response, noting any abnormal
sensations, tingling, or pain radiating into the thumb, index finger, middle
finger, and half of the ring finger.
Interpretation:
During the Phalen's Test, a positive finding is indicated if the patient experiences
tingling, numbness, or paresthesia (pins and needles sensation) in the thumb, index
finger, middle finger, and half of the ring finger within approximately one minute
of assuming the flexed wrist position.
A positive Phalen's Test is suggestive of carpal tunnel syndrome, indicating
potential median nerve compression within the carpal tunnel. However, it's
important to note that other factors, such as nerve entrapment or neuropathy, can
also contribute to a positive test result.
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Carpal Compression Test
(Carpal Compression Syndrome Test)

The Carpal Compression Test, also known as the Carpal Compression Provocative
Test, is a physical examination maneuver used to assess for potential carpal tunnel
syndrome by evaluating for median nerve compression within the carpal tunnel.
Patient position:
relaxed position.
Therapist position:
manipulating the patient's wrist.
Procedure:
The Carpal Compression Test involves the following steps:
1. The therapist locates the carpal tunnel, which is a narrow passageway on
the palm side of the wrist formed by the carpal bones and the transverse
carpal ligament.
2. The therapist applies firm pressure or compression directly over the carpal
tunnel area with both thumbs or the heel of their hands. The pressure should
be exerted for approximately 30 seconds to 1 minute.
3. The therapist carefully observes the patient's response, noting any abnormal
sensations, tingling, numbness, or pain radiating into the thumb, index
finger, middle finger, and half of the ring finger.
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Interpretation:
During the Carpal Compression Test, a positive finding is indicated if the patient
experiences tingling, numbness, or paresthesia (pins and needles sensation) in the
thumb, index finger, middle finger, and half of the ring finger during the application
of pressure over the carpal tunnel area.
A positive Carpal Compression Test suggests potential median nerve compression
within the carpal tunnel, which is characteristic of carpal tunnel syndrome.
However, it's important to note that other factors, such as nerve entrapment or
neuropathy, can also contribute to a positive test result.
Forment’s Sign
(Forment's Test)
(Forment Compression Test)

Froment's Sign, which is used to assess for ulnar nerve palsy or weakness
specifically affecting the adductor pollicis muscle in the thumb. The Froment's Sign
is also referred to as the "Paper Sign" or "Book Sign" due to the method used in
performing the test.
Patient position:
relaxed position.
Therapist position:
manipulating the patient's thumb.
Procedure:
The Froment's Sign involves the following steps:
1. The therapist instructs the patient to hold a piece of paper or a thin object,
such as a pen or pencil, between their thumb and index finger.
2. The therapist attempts to pull the paper or object away from the patient's
grip while the patient tries to maintain their hold.
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3. The therapist carefully observes the patient's response and thumb movement
during the test.
Interpretation:
During the Froment's Sign test, a positive finding is indicated if the patient
compensates for the weakened or paralyzed adductor pollicis muscle (innervated
by the ulnar nerve) by flexing the thumb interphalangeal joint and relying on the
flexor pollicis longus muscle (innervated by the median nerve) to maintain the grip
on the paper or object. This results in a visible flexion of the thumb's distal joint (IP
joint), creating a pinching or "hook-like" appearance.
A positive Froment's Sign suggests ulnar nerve palsy or weakness affecting the
adductor pollicis muscle. Ulnar nerve palsy can be caused by various factors, such
as nerve compression, trauma, or underlying medical conditions.
Weber’s Two-Point Discrimination
Test
(Moberg’s Test)
Weber's Two-Point Discrimination Test, also known as Moberg's Test, is a sensory
examination maneuver used to assess the tactile discrimination ability of the skin.
It measures the smallest distance at which an individual can perceive two distinct
points of touch.
Patient position:
The patient is typically seated or lying down with their hand or finger in a relaxed
position.
Therapist position:
The therapist stands or sits in front of the patient and performs the test by applying
two points of contact to the patient's skin.
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Procedure:
The Weber's Two-Point Discrimination Test involves the following steps:
1. The therapist uses a specialized device with two small, blunt points (such
as a caliper or a set of aesthesiometer points) to apply pressure on the
patient's skin.
2. Starting with a wider distance between the points, the therapist applies light
pressure and gently touches the patient's skin at the designated site, such as
the fingertip.
3. The therapist gradually brings the two points closer together until they are
at a minimum distance.
4. The therapist asks the patient to indicate whether they feel one point or two
distinct points. The patient should respond each time they perceive two
points.
5. The therapist repeats the process at various locations on the patient's skin,
such as different areas of the finger pads, to obtain a comprehensive
assessment.
Interpretation:
During the Weber's Two-Point Discrimination Test, the therapist measures the
smallest distance at which the patient can accurately discriminate between two
distinct points of touch.
The results are typically recorded in millimeters and vary depending on the area of
the body being tested. For example, the fingertips generally have a smaller two-
point discrimination threshold compared to other body regions.
A lower two-point discrimination threshold (smaller distance) indicates a higher
level of tactile discrimination ability and sensitivity in the tested area. A higher two-
point discrimination threshold (larger distance) suggests decreased tactile
discrimination ability, which may be indicative of nerve damage, sensory deficits,
or other conditions affecting sensory perception.
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The Weber's Two-Point Discrimination Test is commonly used in assessing nerve

function, evaluating sensory deficits, monitoring recovery following nerve injuries
or surgeries, and determining the success of sensory re-education programs.
CIRCULATION AND
SWELLING
Allen Test
(Allen's Maneuver)
The Allen Test is a physical examination maneuver used to assess the patency and
adequacy of the ulnar and radial arteries in the hand. It evaluates the collateral
circulation between these two arteries.
Patient position:
relaxed position.
Therapist position:
manipulating the patient's hand.
Procedure:
The Allen Test involves the following steps:
1. The therapist instructs the patient to make a fist, ensuring the hand is not
clenched too tightly.
2. The therapist compresses both the ulnar and radial arteries simultaneously
by applying pressure over the patient's wrist, specifically over the ulnar and
radial arteries.
3. While maintaining pressure, the therapist asks the patient to open their hand
and relax it, resulting in a pale appearance of the hand due to arterial
compression.
4. The therapist then releases pressure on the ulnar artery while continuing to
compress the radial artery.
5. The therapist observes the color of the patient's hand as it reperfuses with
blood.
6. The therapist repeats the process by releasing pressure on the radial artery
while continuing to compress the ulnar artery.
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7. The therapist observes the color of the patient's hand again as it reperfuses
with blood.
Interpretation:
During the Allen Test, the therapist assesses the time it takes for the hand to
reperfuse with blood after releasing the pressure on each artery. The color change
from pale to normal indicates the return of blood flow.
A positive finding in the Allen Test is indicated by a delay or absence of hand
reperfusion with blood in either the ulnar or radial artery territory. This suggests
insufficient collateral circulation between the two arteries, potentially indicating an
obstruction or impairment of one of the arteries.
The Allen Test is commonly performed before procedures involving radial artery
cannulation, such as arterial blood gas sampling or during certain surgical
interventions. It helps determine the safety of using the radial artery for such
procedures, ensuring adequate blood supply to the hand.
Digital Blood Flow
(Digital Vascular Flow Test)
(Capillary Refill Test)

The Digital Blood Flow Test, also known as the Digital Allen's Test or Modified
Allen's Test, is a physical examination maneuver used to assess the adequacy of
blood flow to the fingers or digits. It evaluates the patency of the radial and ulnar
arteries in the hand.
Patient position:
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relaxed position.
Therapist position:
manipulating the patient's hand and fingers.
Procedure:
The Digital Blood Flow Test involves the following steps:
1. The therapist instructs the patient to relax their hand and fingers.
2. The therapist applies pressure to both the radial and ulnar arteries in the
patient's wrist simultaneously, completely occluding blood flow to the hand.
This is done by compressing the arteries against the underlying bone.
3. While maintaining pressure, the therapist asks the patient to open and close
their hand several times or make a fist for about 30 seconds.
4. After the specified time, the therapist releases pressure on one of the arteries
(typically the ulnar artery) while maintaining pressure on the other artery
(typically the radial artery).
5. The therapist observes the patient's fingers for color changes and the time it
takes for the fingers to regain their normal color.
6. The therapist repeats the process by releasing pressure on the other artery
(radial artery) while maintaining pressure on the previously released artery
(ulnar artery).
7. The therapist again observes the patient's fingers for color changes and the
time it takes for the fingers to regain their normal color.
Interpretation:
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During the Digital Blood Flow Test, the therapist assesses the time it takes for the
fingers to regain their normal color after releasing pressure on each artery. The
return of normal color indicates the restoration of blood flow to the fingers.
A positive finding in the Digital Blood Flow Test is indicated by a delay or absence
of color return in the fingers after releasing pressure on either the ulnar or radial
artery. This suggests insufficient blood flow or collateral circulation to the affected
artery territory.
The Digital Blood Flow Test is commonly performed before procedures involving
radial or ulnar artery cannulation, such as arterial blood gas sampling or during
certain surgical interventions. It helps assess the suitability of using these arteries
for the procedure and ensures adequate blood supply to the fingers.
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HIP
MORE THAN ONE AREA
Straight Leg Raise
(Lasègue Test)
The Straight Leg Raise (SLR) test, also known as the Lasègue's test, is a physical
examination maneuver used to assess for possible nerve root impingement or
irritation in the lower back (lumbar spine) or the sciatic nerve. It is commonly used
to evaluate conditions such as sciatica or herniated discs.
Patient position:
The patient is typically lying flat on their back on an examination table.
Therapist position:
The therapist stands beside the patient's leg being tested.
Procedure:
The Straight Leg Raise (SLR) test involves the following steps:
1. The therapist starts with the patient lying flat on their back and instructs
them to keep both legs relaxed and extended.
2. The therapist lifts the patient's affected leg (usually one at a time) while
keeping the knee straight. The leg is raised gradually and actively until the
patient experiences pain or discomfort or until a predetermined angle is
reached (usually between 30 to 70 degrees of elevation).
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3. The therapist carefully observes the patient's response and notes any pain,
tingling, or other sensations radiating down the leg, typically below the knee
and into the foot.
4. The test can be repeated on the opposite leg for comparison.
Interpretation:
During the Straight Leg Raise (SLR) test, a positive finding is indicated by the
reproduction of pain or radiating symptoms (such as sciatic pain) along the path of
the sciatic nerve. This suggests possible nerve root compression or irritation, often
caused by conditions such as a herniated disc or lumbar spinal stenosis.
The angle at which pain or symptoms are reproduced can also be noted, as it may
provide information about the severity or location of nerve compression.
Patrick’s Test
(FABER Test)
(Patrick's FABER Test)

Patrick's Test, also known as the FABER (Flexion, ABduction, External Rotation)
Test or Figure-4 Test, is a physical examination maneuver used to assess the hip
joint and surrounding structures for possible pathology or dysfunction.
Patient position:
The patient lies flat on their back on an examination table.
Therapist position:
Procedure:
Patrick's Test involves the following steps:
1. The therapist positions the patient's hip and knee in the following way:
a. The tested leg is flexed at the hip joint, with the knee bent and resting
on the opposite leg, forming a "figure-4" shape.
b. The ankle of the tested leg is placed on the knee of the opposite leg,
creating an "Abduction" and external rotation position.
4. The therapist gently presses down on the raised knee while stabilizing the
opposite hip to prevent any movement.
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5. The therapist carefully observes the patient's response and notes any pain,
discomfort, or limited range of motion in the hip joint.
Interpretation:
During Patrick's Test, a positive finding is indicated by the reproduction of pain or
discomfort in the hip joint, groin, or sacroiliac (SI) joint region. This can suggest
possible pathology or dysfunction involving the hip joint, such as hip arthritis,
labral tear, hip impingement, or SI joint dysfunction.
Piriformis Syndrome Test
(FAIR test (Flexion Adduction and
Internal Rotation)
The Piriformis Syndrome Test is a physical examination maneuver used to assess
for piriformis syndrome, a condition in which the piriformis muscle, located in the
buttock region, compresses or irritates the sciatic nerve. This can result in pain,
numbness, and tingling along the sciatic nerve distribution in the buttock and leg.
Patient position:
The patient is typically lying flat on their back on an examination table.
Therapist position:
Procedure:
The Piriformis Syndrome Test involves the following steps:
1. The therapist flexes the patient's affected leg at the hip and knee joints,
bringing the knee toward the opposite shoulder.
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2. The therapist places one hand on the patient's knee and the other hand on
the patient's ankle, stabilizing the leg in this position.
3. The therapist applies a gentle downward force on the knee, attempting to
internally rotate the hip joint.
4. While maintaining the downward force and hip internal rotation, the
therapist observes the patient's response and notes any reproduction of pain,
tingling, or other symptoms along the sciatic nerve distribution in the
buttock and leg.
Interpretation:
During the Piriformis Syndrome Test, a positive finding is indicated by the
reproduction of pain or symptoms along the sciatic nerve distribution during the
maneuver. This suggests possible compression or irritation of the sciatic nerve by
the piriformis muscle.
Sign Of The Buttock
(Pace's Sign)
(FABERE)(Flexion, Abduction, External
Rotation, Extension))
The Sign of the Buttock, also known as Pace's Sign or FABERE (Flexion,
Abduction, External Rotation, Extension), is a physical examination maneuver used
to assess various conditions that can cause pain or discomfort in the hip and buttock
area. It is not a specific test for a particular condition but rather a way to evaluate
the presence of pain or symptoms in that region.
Patient position:
The patient lies flat on their back (supine) on an examination table.
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Therapist position:
The therapist stands beside the patient's affected hip.
Procedure:
1. The therapist flexes the patient's hip and knee on the affected side, bringing
the knee towards the chest.
2. The therapist then abducts the patient's hip, moving the knee outward away
from the body.
3. The therapist externally rotates the patient's hip, turning the knee and foot
outward.
4. While maintaining this position, the therapist applies gentle downward
pressure on the patient's knee, trying to bring it closer to the examination

table.
5. The therapist asks the patient if they experience any pain or discomfort
during this maneuver.
Interpretation:
The interpretation of the Sign of the Buttock depends on the presence or absence of
pain or symptoms experienced by the patient during the maneuver. The following
interpretations are possible:
• Positive finding: If the patient reports pain or discomfort in the hip or
buttock area during the Sign of the Buttock maneuver, it may suggest
various conditions such as hip joint pathology, hip impingement, sacroiliac
joint dysfunction, or other structures in that region.
• Negative finding: If the patient does not experience pain or discomfort
during the maneuver, it may indicate the absence of significant pathology
in the hip and buttock area.
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Trendelenburg Test
(Trendelenburg Sign)
(Pelvic Drop Test)

The Trendelenburg Test is a physical examination maneuver used to assess the
strength and function of the gluteus Medius muscle, particularly its role in
stabilizing the pelvis during single-leg weight-bearing activities.
Patient position:
The patient is typically standing upright on a flat surface.
Therapist position:
The therapist stands or sits in front of the patient, observing their pelvic alignment
and movement.
Procedure:
The Trendelenburg Test for the gluteus medius involves the following steps:
1. The patient is instructed to stand on one leg while the other leg is lifted off
the ground, either by flexing the knee or holding it in a non-weight-bearing
position.
2. The therapist closely observes the patient's pelvis, particularly the height
and alignment of the iliac crests (the bony prominences at the top of the
pelvic bones).
3. The patient is asked to maintain the single-leg stance for a few seconds
while the therapist assesses the pelvic stability and levelness.
4. The patient repeats the test on the opposite leg for comparison.
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Interpretation:
During the Trendelenburg Test, a positive finding is indicated by a drop or tilt of
the pelvis on the side of the lifted leg. This suggests a weakness or dysfunction of
the gluteus medius muscle on the weight-bearing side.
Normally, when the gluteus medius muscle is functioning properly, it helps
stabilize the pelvis and prevent it from tilting downward on the opposite side during
single-leg weight-bearing activities. However, if there is gluteus medius weakness
or dysfunction, the pelvis on the lifted leg side will drop or tilt downward, creating
an abnormal pelvic alignment.
A positive Trendelenburg Test may suggest gluteus medius weakness, which can
be associated with various conditions such as gluteal tendinopathy, hip
osteoarthritis, or nerve injuries. Further evaluation by a healthcare professional,
such as a physical therapist or orthopedic specialist, may be warranted to determine
the underlying cause and develop an appropriate treatment plan.
Flamingo Test
(Unilateral Stance Test)
(Single Leg Balance Test)

The Flamingo test is a physical examination test that is used to assess for instability
of the pubic symphysis or sacroiliac (SI) joint. The test is performed by having the
patient stand on one leg with the other leg extended behind them. The examiner
then observes the patient for any signs of pain or instability in the pelvis.
Patient position:
The patient stands on one leg with the other leg extended behind them.
Therapist position:
The therapist stands behind the patient and observes the patient's pelvis for any
signs of pain or instability.
Procedure:
The therapist observes the patient's pelvis for any signs of pain or instability. The
patient is then asked to slowly bend forward and backward. The therapist observes
the patient's pelvis for any changes in alignment or movement.
Here are the steps of the Flamingo test in more detail:
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1. The patient stands on one leg with the other leg extended behind them.
2. The therapist stands behind the patient and observes the patient's pelvis for
any signs of pain or instability.
3. The patient is asked to slowly bend forward and backward.

4. The therapist observes the patient's pelvis for any changes in alignment or
movement.
Positive test:
A positive test is indicated by pain in the pubic symphysis or SI joint. The patient
may also show signs of instability, such as the pelvis tilting or rotating.
Interpretation:
A positive test is indicated by pain in the pubic symphysis or SI joint. The patient
may also show signs of instability, such as the pelvis tilting or rotating.
Other findings:
Other findings that may be present in a positive Flamingo test include:
1. Tenderness to palpation of the pubic symphysis or SI joint
2. Decreased range of motion of the hip
3. Swelling of the pubic symphysis or SI joint
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Gaenslen’s Test
(Gaenslen Maneuver)
(Sacroiliac Joint Stress Test

Gaenslen's Test is a physical examination maneuver used to assess for potential
pathology or dysfunction in the sacroiliac (SI) joint, hip joint, or the L4 (fourth
lumbar) nerve root. It helps evaluate for pain or symptoms associated with these
structures.
Patient position:
The patient is typically lying on their back on an examination table.
Therapist position:
The therapist stands beside the patient's legs, preparing to perform the test.
Procedure: Gaenslen's Test involves the following steps:
1. The therapist instructs the patient to lie flat on their back and brings one leg
to the chest, holding onto the shin or knee.
2. The therapist asks the patient to grasp the opposite knee and pull it toward
the opposite shoulder, creating a stretch across the lower back and SI joint.
3. The therapist applies gentle downward pressure on the leg that is being
brought to the chest while the patient maintains the opposite knee-to-
shoulder position.
4. The therapist carefully observes the patient's response and notes any pain or
discomfort in the SI joint, hip, or along the distribution of the L4 nerve root
(typically the inner aspect of the thigh and knee).
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Interpretation:
During Gaenslen's Test, a positive finding is indicated by the reproduction of pain
or symptoms in the SI joint, hip, or along the distribution of the L4 nerve root during
the maneuver. This suggests possible pathology or dysfunction involving these
structures.
SI JOINT
Ipsilateral Prone Kinetic Test
The Ipsilateral Prone Kinetic Test is a physical examination maneuver used to
assess ilium flexion and rotation in the context of sacroiliac joint dysfunction or
asymmetry. It helps evaluate the movement and function of the ilium bone in
relation to the sacrum.
Patient position:
The patient lies face down (prone) on an examination table.
Therapist position:
The therapist stands beside the patient's pelvis or lower back, preparing to perform
the test.
Procedure:
The Ipsilateral Prone Kinetic Test for ilium flexion and rotation involves the
following steps:
1. The therapist palpates the patient's iliac crest (the bony ridge on the side of
the pelvis) to identify the position and orientation of the ilium.
2. The therapist places one hand on the patient's iliac crest and applies gentle
pressure or traction, encouraging movement of the ilium.
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3. The therapist asks the patient to perform a movement of hip flexion and
rotation on the same side as the hand placed on the iliac crest. This involves
lifting the leg off the table and rotating it inward or outward.
4. While the patient performs the movement, the therapist closely observes
and feels for any asymmetry, restriction, or abnormal motion of the ilium in
response to the hip movement.
5. The test can be repeated on the opposite side for comparison.
Interpretation:
During the Ipsilateral Prone Kinetic Test, the therapist evaluates the movement and
response of the ilium to hip flexion and rotation. A positive finding may include
the following:
Asymmetry: If one side of the ilium shows restricted or abnormal movement
compared to the other side, it may suggest an imbalance or dysfunction in the
sacroiliac joint or surrounding structures.
Pain or discomfort: The patient may experience pain or discomfort in the region of
the sacroiliac joint or iliac crest during the movement.
These findings can indicate potential sacroiliac joint dysfunction, such as restricted
ilium movement, asymmetry, or irritation of the joint.
Piedallu’s Sign
(Standing Flexion Test)

Piedallu's Sign, also known as the Standing Flexion Test, is a physical examination
maneuver used to assess for potential hypomobility or restriction in the sacroiliac
(SI) joint. It helps evaluate the movement and function of the SI joint during
forward flexion of the trunk.
Patient position:
The patient stands upright with the feet together.
Therapist position:
The therapist stands behind the patient, observing their posture and preparing to
perform the test.
Procedure:
Piedallu's Sign for hypomobile SI involves the following steps:
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1. The therapist visually assesses the patient's posture, looking for any
asymmetry or misalignment in the pelvis or lower back.
2. The therapist instructs the patient to bend forward at the waist, allowing the
arms and trunk to hang loosely towards the floor.
3. The therapist carefully observes the movement of the patient's pelvis,
specifically looking for any asymmetry or restriction in the SI joint motion
during forward flexion.
4. The therapist may use their hands to palpate or feel for any differences in
movement or position of the ilium bones (the hip bones) or the sacrum
during the test.
Interpretation:
Piedallu's Sign is interpreted based on the observation of movement and symmetry
in the SI joint during forward flexion. A positive finding may include the following:
Asymmetry: If there is an asymmetrical movement of the ilium bones or sacrum
during forward flexion, it may suggest hypomobility or restriction in the SI joint.
Lack of movement: If the SI joint on one side shows limited or decreased movement
compared to the other side during forward flexion, it may indicate hypomobility or
stiffness in that joint.
These findings can indicate potential SI joint dysfunction, such as restricted motion
or hypomobility in the joint.
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Gillet’s Test
(Sacroiliac Joint Motion Test)
(Gillet Stork Test)

Gillet's Test, also known as the Sacroiliac Joint Motion Test or Gillet Stork Test, is
a physical examination maneuver used to assess the mobility and movement of the
sacroiliac (SI) joint. It helps evaluate the function and alignment of the pelvis and
lower back.
Patient position:
The patient stands upright, barefoot, with their feet slightly apart.
Therapist position:
The therapist stands behind the patient, observing their pelvic and lumbar region.
Procedure:
Gillet's Test involves the following steps:
1. The therapist visually assesses the patient's pelvic alignment and landmarks,
including the posterior superior iliac spines (PSIS) and sacrum.
2. The therapist instructs the patient to lift one leg, bending the knee and
bringing the thigh towards the chest.
3. As the patient lifts their leg, the therapist palpates the PSIS on the same side
with their fingers or thumbs to feel for movement.
4. The therapist observes the movement of the PSIS while the patient performs
the leg lift and notes any asymmetry or lack of movement in the joint.
5. The test is then repeated on the opposite leg for comparison.
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Interpretation:
During Gillet's Test, the therapist assesses the movement of the PSIS during the leg
lift. The interpretation of the test includes the following:
Positive finding: If the PSIS on the lifted leg side does not move or exhibits limited
movement compared to the opposite side, it may indicate dysfunction or
hypomobility in the corresponding SI joint. This can suggest SI joint pathology or
imbalance in the pelvic region.
Negative finding: If the PSIS on the lifted leg side moves freely and symmetrically
with the opposite side, it suggests normal movement and function of the SI joint.
Gillet's Test is one component of a comprehensive assessment of the SI joint and
should be interpreted in conjunction with other clinical findings and assessments.
Trochanteric Bursitis Test

Trochanteric bursitis, or inflammation of the trochanteric bursa located on the
outside of the hip, can be assessed using various physical examination maneuvers.
One common test used to evaluate for trochanteric bursitis is the following:
Patient position:
The patient lies on their unaffected side with the affected hip facing upwards.
Therapist position:
Procedure:
1. The therapist locates the greater trochanter, which is the bony prominence
on the outer side of the hip.
2. The therapist applies gentle pressure to the area overlying the greater
trochanter using their hand or fingers.
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3. While maintaining pressure, the therapist asks the patient to perform various
movements involving the hip joint, such as hip flexion, extension,
abduction, and rotation.
4. During these movements, the therapist observes for any localized pain,
tenderness, or discomfort over the trochanteric bursa.
Interpretation:
A positive test for trochanteric bursitis is indicated by the reproduction of pain or
tenderness over the greater trochanter during the movements. This suggests
inflammation or irritation of the trochanteric bursa.
Iliopsoas Bursitis Test
(Stinchfield Test)
Iliopsoas bursitis, or inflammation of the bursa located near the iliopsoas muscle in
the hip region, can be assessed using various physical examination maneuvers. One
common test used to evaluate for iliopsoas bursitis is the following:
Patient position:
The patient lies on their back on an examination table.
Therapist position:
Procedure:
1. The therapist identifies the location of the iliopsoas muscle by palpating the
inguinal region (groin area) where the muscle attaches.
2. The therapist places one hand on the patient's lower abdomen just above the
inguinal ligament, and the other hand on the patient's lower leg near the
ankle.
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3. The therapist instructs the patient to actively flex their hip, lifting their leg
off the table while maintaining the knee in a straight position.
4. During this hip flexion movement, the therapist applies resistance against
the patient's leg, attempting to prevent or limit the hip flexion.
5. The therapist observes for any pain or discomfort reported by the patient in
the inguinal region, which may suggest irritation of the iliopsoas bursa.
Interpretation:
A positive test for iliopsoas bursitis is indicated by the reproduction of pain or
discomfort in the inguinal region during the resisted hip flexion. This suggests
inflammation or irritation of the iliopsoas bursa.
Thomas Test
(Thomas Maneuver)
The Thomas Test is a physical examination maneuver used to assess hip flexor
muscle tightness and potential hip joint contractures. It is commonly performed to
evaluate conditions such as hip flexor tightness, iliopsoas muscle tightness, or hip
joint limitations.
Patient position:
The patient lies flat on their back on an examination table or firm surface.
Therapist position:
The therapist stands beside the patient, assisting and observing the test.
Procedure:
1. The therapist instructs the patient to bring one knee towards their chest,
holding it with both hands.
2. The opposite leg remains extended and flat on the table.
3. The therapist observes the position of the extended leg's hip and lower back.
4. The therapist assesses for any tilting or lifting of the pelvis on the extended
leg side, which could indicate tightness in the hip flexors or hip joint
contracture.
5. The therapist may also palpate the patient's lower back and hip area for any
signs of muscle tension or discomfort.
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Interpretation:
During the Thomas Test, the therapist evaluates the hip flexor muscle length and
assesses for any hip joint contractures. The test is considered positive if any of the
following signs are observed:
• The patient's extended leg hip lifts off the table, indicating hip flexor muscle
tightness or contracture.
• The patient's lower back arches or loses contact with the table, suggesting
lumbar spine extension due to tight hip flexors.
• The patient experiences pain or discomfort during the test, which could
indicate muscle or joint limitations.
These findings may suggest the presence of hip flexor tightness, iliopsoas muscle
tightness, or hip joint restrictions that could contribute to altered hip mechanics or
movement patterns.
Craig’s Test
(Craig's sign)
(Trochanteric Prominence Angle Test
(TPAT) )
Craig's Test is a physical examination maneuver used to assess the presence of
femoral anteversion or retroversion. It helps evaluate the rotational alignment of
the femur (thigh bone) in relation to the hip joint.
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Patient position:
The patient lies flat on their stomach (prone) on an examination table.
Therapist position:
The therapist stands beside the patient's hip, preparing to perform the test.
Procedure:
1. The therapist flexes the patient's knee to a 90-degree angle, allowing the
lower leg to hang off the edge of the examination table.
2. The therapist rotates the patient's hip externally (outward rotation) while
palpating the greater trochanter (the bony prominence on the side of the
hip).
3. The therapist gradually rotates the hip until they feel the greater trochanter
move posteriorly (backward) and the femur becomes parallel to the
examination table.
4. The therapist carefully observes the degree of hip external rotation at which
the greater trochanter aligns parallel to the table. This angle indicates the
amount of femoral anteversion or retroversion.
Interpretation:
The angle at which the greater trochanter aligns parallel to the table during external
rotation indicates the rotational alignment of the femur. The interpretation is as
follows:
• If the greater trochanter aligns parallel to the table with a greater degree of
hip external rotation (greater than 15 degrees), it suggests femoral
anteversion. This means the femur is rotated forward relative to the hip
joint.
• If the greater trochanter aligns parallel to the table with a lesser degree of
hip external rotation (less than 15 degrees), it suggests femoral retroversion.
This means the femur is rotated backward relative to the hip joint.
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These findings provide information about the rotational alignment of the femur and
can help in understanding certain hip conditions or limitations in hip movement.
Torque Test
The Torque Test for hip capsular ligament integrity, also known as the Hip Joint
Stability Test or Hip Ligament Integrity Test, is a physical examination maneuver
used to assess the strength and stability of the hip joint's capsular ligaments. It helps
evaluate the integrity and potential laxity or instability of the ligaments that
contribute to hip joint stability.
Patient position:
The patient lies on their back (supine) on an examination table.
Therapist position:
Procedure:
1. The therapist stabilizes the patient's pelvis by placing one hand on the
opposite hip or lower abdomen and the other hand on the thigh just above
the knee.
2. The therapist positions the patient's hip in approximately 45 degrees of
flexion, with the knee also flexed to a comfortable position.
3. The therapist applies rotational force or torque to the hip joint, either
internally (medial rotation) or externally (lateral rotation), while
maintaining stabilization of the pelvis.
4. The therapist observes for any excessive movement or abnormal laxity in
the hip joint during the rotational force application.
Interpretation:
The Torque Test for hip capsular ligament integrity is interpreted based on the
amount of excessive movement or abnormal laxity observed during the test. A
positive finding may include the following:
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• Excessive movement or laxity: If the hip joint demonstrates excessive

rotational movement or abnormal laxity during the application of rotational
force, it suggests potential instability or ligamentous laxity in the hip joint's
capsular ligaments.
• Lack of stability: If the hip joint feels unstable or exhibits a sense of "giving
way" during the test, it may indicate compromised hip joint stability.
These findings may suggest the presence of ligamentous laxity, hip joint instability,
or potential pathology in the hip joint.
OTHERS
Leg Length Discrepancy Test
(Leg Length Discrepancy Measurement)

(Ankle-to-ASIS Test)
There are various tests used to assess leg length discrepancy (LLD), which refers
to a difference in leg length between the two lower limbs. One common test used
to evaluate LLD is the following:
Patient position:
The patient lies flat on their back (supine) on an examination table.
Therapist position:
The therapist stands beside the patient's lower limbs.
Procedure:
• The therapist begins by visually assessing the patient's lower limbs for any
apparent length discrepancy, such as a difference in the position of the feet
or knees.
• The therapist measures the length of each lower limb using a tape measure
or a specialized instrument called a leg length measuring device.
Measurements are taken from specific landmarks, such as the anterior
superior iliac spine (ASIS) to the medial malleolus (ankle bone).
• If a leg length difference is identified, the therapist may perform additional
tests to determine the cause of the discrepancy.
These tests may include:
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• Pelvic tilt assessment: The therapist assesses for any pelvic tilting or
rotation that may contribute to the leg length difference.
• Prone leg length test: The patient lies prone, and the therapist measures the
distance between the heels and compares them for any discrepancy.
• Standing leg length test: The patient stands, and the therapist measures the
distance between specific landmarks, such as the ASIS and the medial
malleolus, to assess leg length while weight-bearing.
Interpretation:
The interpretation of leg length discrepancy test results depends on the
measurements obtained and the clinical significance of the difference. A leg length
difference of up to 1 centimeter is considered within the normal range and may not
require intervention. However, if the leg length difference exceeds 1 centimeter or
if it is associated with functional limitations, gait abnormalities, or other symptoms,
further evaluation and treatment may be necessary.
Torsion Test
(Internal/External Tibial Torsion Test)

(Foot Progression Angle Test)
(Thigh-Foot Angle)
The Torsion Test for the hip, also known as the Thigh-Foot Angle Test, is a physical
examination maneuver used to assess the femoral version or torsion of the femur
bone. It helps evaluate the rotational alignment of the femoral neck in relation to
the hip joint.
Patient position:
The patient lies flat on their stomach (prone) on an examination table.
Therapist position:
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Procedure:
1. The therapist flexes the patient's knee to a 90-degree angle, allowing the
lower leg to hang off the edge of the examination table.
2. The therapist palpates the greater trochanter, which is the bony prominence
on the side of the hip.
3. The therapist internally rotates the patient's hip, aligning the knee with the
midline of the body.
4. While maintaining the internal rotation, the therapist visually observes the
angle between the long axis of the lower leg (tibia) and the horizontal plane.
This angle is referred to as the thigh-foot angle.
Interpretation:
The Thigh-Foot Angle Test is interpreted based on the angle observed during
internal rotation of the hip. The interpretation is as follows:
• If the thigh-foot angle is approximately 8-15 degrees, it suggests normal
femoral version.
• If the thigh-foot angle is greater than 15 degrees, it indicates increased
femoral anteversion (internal rotation).
• If the thigh-foot angle is less than 8 degrees, it suggests femoral retroversion
(external rotation).
These findings provide information about the rotational alignment of the femur and
can help in understanding certain hip conditions or limitations in hip movement.
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LIGAMENT TESTS
Valgus Test
(Valgus Stress Test)
(Medial Collateral Ligament Test)

The Valgus Test is a physical examination maneuver used to assess the integrity
and stability of the lateral collateral ligament (LCL) of the knee. It helps evaluate
for potential injuries or laxity in the LCL, which provides lateral stability to the
knee joint.
Patient position:
The patient is typically seated or lying down with the knee slightly flexed (around
20-30 degrees) and the lower leg supported.
Therapist position:
patient's leg and knee.
Procedure:
The Valgus Test for the LCL involves the following steps:
1. The therapist stabilizes the patient's thigh with one hand to provide support
and stability.
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2. With the other hand, the therapist grasps the patient's lower leg just above
the ankle, near the fibular head, and applies a valgus force.
3. The therapist then applies a gentle, outward force or pressure to the lower
leg, directing it away from the midline of the body, while keeping the knee
in a slightly flexed position.
4. The therapist carefully observes the patient's knee for any excessive medial
opening (gapping) or laxity compared to the unaffected side. They also note
any pain or discomfort reported by the patient.
Interpretation:
During the Valgus Test, a positive finding is indicated by excessive medial opening
or gapping of the knee joint, indicating potential instability or laxity in the lateral
collateral ligament (LCL). This may suggest an LCL sprain or tear.
A positive Valgus Test suggests a potential injury to the LCL and should prompt
further evaluation, such as imaging studies (e.g., MRI) and consultation with an
orthopedic specialist, to confirm the diagnosis and assess the severity of the
ligament injury.
Varus Test
(Lateral Collateral Ligament Test)

The Varus Test is a physical examination maneuver used to assess the integrity and
stability of the medial collateral ligament (MCL) of the knee. It helps evaluate for
potential injuries or laxity in the MCL, which provides medial stability to the knee
joint.
Patient position:
The patient is typically seated or lying down with the knee slightly flexed (around
20-30 degrees) and the lower leg supported.
Therapist position:
patient's leg and knee.
Procedure:
The Varus Test for the MCL involves the following steps:
and stability.
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the ankle, near the medial malleolus, and applies a varus force.
3. The therapist then applies a gentle, inward force or pressure to the lower
leg, directing it towards the midline of the body, while keeping the knee in
a slightly flexed position.
4. The therapist carefully observes the patient's knee for any excessive lateral
opening (gapping) or laxity compared to the unaffected side. They also note
any pain or discomfort reported by the patient.
Interpretation:
During the Varus Test, a positive finding is indicated by excessive lateral opening
or gapping of the knee joint, indicating potential instability or laxity in the medial
collateral ligament (MCL). This may suggest an MCL sprain or tear.
A positive Varus Test suggests a potential injury to the MCL and should prompt
ligament injury.
Posterior Drawer
(Posterior drawer sign)
(Posterior drawer maneuver)

The Posterior Drawer Test is a physical examination maneuver used to assess the
integrity and stability of the posterior cruciate ligament (PCL) in the knee. It helps
evaluate for potential injuries or laxity in the PCL, which is responsible for
providing stability to the knee joint.
Patient position:
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The patient is typically lying down on their back with the knee flexed at around 90
degrees.
Therapist position:
The therapist stands or sits at the foot of the examination table and performs the
test by manipulating the patient's lower leg and foot.
Procedure:
The Posterior Drawer Test for the PCL involves the following steps:
1. The therapist positions their hands on the patient's lower leg just below the
calf muscle, with their thumbs resting on the tibial plateau (the upper surface
of the shinbone).
2. The therapist applies a posterior-directed force or pressure on the lower leg
while simultaneously stabilizing the thigh with their other hand.
3. The therapist attempts to translate the lower leg posteriorly, mimicking a
backward movement of the tibia relative to the femur.
4. The therapist carefully observes the movement and endpoint of translation,
noting any excessive posterior displacement or laxity compared to the
unaffected side. They also note any pain or discomfort reported by the
patient.
Interpretation:
During the Posterior Drawer Test, a positive finding is indicated by excessive
posterior translation or backward movement of the tibia relative to the femur,
suggesting potential instability or laxity in the posterior cruciate ligament (PCL).
This may suggest a PCL sprain or tear.
A positive Posterior Drawer Test suggests a potential injury to the PCL and should
prompt further evaluation, such as imaging studies (e.g., MRI) and consultation
with an orthopedic specialist, to confirm the diagnosis and assess the severity of the
ligament injury.
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Anterior Drawer
(Drawer sign)
(Anterior drawer maneuver)

The Anterior Drawer Test is a physical examination maneuver used to assess the
integrity and stability of the anterior cruciate ligament (ACL) in the knee. It helps
evaluate for potential injuries or laxity in the ACL, which is responsible for
providing stability to the knee joint.
Patient position:
degrees.
Therapist position:
The therapist stands or sits at the foot of the examination table and performs the
test by manipulating the patient's lower leg and foot.
Procedure:
The Anterior Drawer Test for the ACL involves the following steps:
1. The therapist positions their hands on the patient's lower leg just below the
calf muscle, with their thumbs resting on the tibial plateau (the upper surface
of the shinbone).
2. The therapist applies an anterior-directed force or pressure on the lower leg
while simultaneously stabilizing the thigh with their other hand.
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3. The therapist attempts to translate the lower leg anteriorly, mimicking a

forward movement of the tibia relative to the femur.
4. The therapist carefully observes the movement and endpoint of translation,
noting any excessive anterior displacement or laxity compared to the
unaffected side. They also note any pain or discomfort reported by the
patient.
Interpretation:
During the Anterior Drawer Test, a positive finding is indicated by excessive
anterior translation or forward movement of the tibia relative to the femur,
suggesting potential instability or laxity in the anterior cruciate ligament (ACL).
This may suggest an ACL sprain or tear.
A positive Anterior Drawer Test suggests a potential injury to the ACL and should
prompt further evaluation, such as imaging studies (e.g., MRI) and consultation
with an orthopedic specialist, to confirm the diagnosis and assess the severity of the
ligament injury.
Lachman Test
(Lachman sign)
(Lachman drawer test)

The Lachman Test is a physical examination maneuver used to assess the integrity
and stability of the anterior cruciate ligament (ACL) in the knee. It is considered
one of the most sensitive and reliable tests for detecting ACL injuries.
Patient position:
The patient is typically lying down on their back with the knee flexed at around 20-
30 degrees.
Therapist position:
the patient's lower leg and thigh.
Procedure:
The Lachman Test for the ACL involves the following steps:
and stability.
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2. With the other hand, the therapist grasps the patient's lower leg just below
the knee joint and tibia.
3. The therapist gently pulls the tibia forward or anteriorly, while
simultaneously stabilizing the femur.
4. The therapist carefully assesses the amount of anterior displacement or
movement of the tibia relative to the femur, noting any excessive laxity or
endpoint feel compared to the unaffected side. They also note any pain or
discomfort reported by the patient.
Interpretation:
During the Lachman Test, a positive finding is indicated by excessive anterior
displacement or movement of the tibia relative to the femur, suggesting potential
instability or laxity in the anterior cruciate ligament (ACL). This may suggest an
ACL sprain or tear.
A positive Lachman Test is typically characterized by a soft or mushy endpoint feel
when compared to the unaffected side, indicating potential ACL laxity.
The Lachman Test is considered more accurate in the acute phase of ACL injuries
when compared to the Anterior Drawer Test. It can also provide information about
the severity of the ACL injury, as it allows for graded assessment of laxity.
Slocum Test
(Slocum drawer test)
(Anterolateral rotary instability (ALRI)
test)
The Slocum Test is a physical examination maneuver used to assess the integrity
and stability of the anterior cruciate ligament (ACL) in the knee. It is a specialized
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variation of the Anterior Drawer Test that evaluates for rotational instability in
addition to anterior translation of the tibia.
Patient position:
degrees.
Therapist position:
the patient's lower leg and foot.
Procedure:
The Slocum Test for the ACL involves the following steps:
1. The therapist positions the patient's knee in slight external rotation, typically
achieved by rotating the patient's foot outward.
and stability.
the ankle and applies an anterior-directed force on the lower leg, simulating
an anterior drawer motion.
4. While maintaining the anterior force, the therapist assesses the amount of
anterior displacement or movement of the tibia relative to the femur. They
also observe for any rotational instability of the tibia, specifically an
abnormal pivot shift or an increased external rotation compared to the
unaffected side.
5. The therapist carefully observes for any pain or discomfort reported by the
patient during the test.
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Interpretation:
The Slocum Test is primarily used to assess rotational instability of the tibia in
addition to anterior translation. A positive finding is indicated by excessive anterior
displacement or movement of the tibia relative to the femur and/or increased
external rotation of the tibia compared to the unaffected side. This suggests
potential instability or laxity in the anterior cruciate ligament (ACL).
A positive Slocum Test may indicate an ACL sprain or tear, particularly if
rotational instability is observed. It can provide valuable information about the
severity and nature of the ACL injury.
Hughston Test
(Hughston Drawer Test)

The Hughston Test is a physical examination maneuver used to assess the integrity
and stability of the posterior cruciate ligament (PCL) in the knee. It evaluates for
potential injuries or laxity in the PCL.
Patient position:
degrees.
Therapist position:
Procedure:
The Hughston Test for the PCL involves the following steps:
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and stability.
2. With the other hand, the therapist grasps the patient's lower leg just below
the knee joint and tibia.
3. The therapist applies a posterior-directed force or pressure on the lower leg
while simultaneously stabilizing the femur.
4. The therapist carefully assesses the amount of posterior displacement or
movement of the tibia relative to the femur, noting any excessive laxity or
endpoint feel compared to the unaffected side. They also note any pain or
discomfort reported by the patient.
Interpretation:
During the Hughston Test, a positive finding is indicated by excessive posterior
displacement or movement of the tibia relative to the femur, suggesting potential
instability or laxity in the posterior cruciate ligament (PCL). This may suggest a
PCL sprain or tear.
A positive Hughston Test suggests a potential injury to the PCL and should prompt
ligament injury.
MENISCUS TESTS
Apley Compression
(Apley's Compression Test)

The Apley Compression Test is a physical examination maneuver used to assess
the integrity and identify potential injuries or pathology in the menisci of the knee
joint. It helps evaluate for meniscal tears or abnormalities.
Patient position:
The patient is typically lying face down on an examination table or prone position.
Therapist position:
The therapist stands or sits beside the patient and performs the test by applying
compression and rotation to the patient's lower leg.
Procedure:
The Apley Compression Test involves the following steps:
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1. The therapist flexes the patient's knee to a 90-degree angle.

2. The therapist applies downward or compressive pressure onto the patient's
heel, using their body weight or hands, to load the joint.
3. While maintaining the compressive force, the therapist internally and
externally rotates the patient's lower leg or foot.
4. The therapist can also add axial or distraction force to the leg during rotation
to increase the sensitivity of the test.
5. The therapist carefully observes and notes any pain, clicking, or other
symptoms reported by the patient during the test.
6. The therapist may repeat the test with the patient's knee in a different degree
of flexion to further evaluate for meniscal pathology.
Interpretation:
During the Apley Compression Test, pain or discomfort localized to the joint line
or reproduction of specific symptoms suggests a potential meniscal injury or
pathology. The test helps assess the integrity of the menisci and identifies areas of
tenderness or irritation.
However, it's important to note that the Apley Compression Test is just one
component of a comprehensive knee examination. It should be interpreted in
conjunction with the patient's history, clinical presentation, and other diagnostic
tests such as imaging studies (e.g., MRI) for a definitive diagnosis.
Apley Distraction
The Apley distraction test is a medical test used to assess for ligamentous injury of
the knee. It is often performed in conjunction with the Apley grind test, which
assesses for meniscus injury.
Patient position:
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The patient lies supine on the examination table with the affected knee flexed to
90 degrees.
Therapist position:
The therapist stands facing the patient and places one hand on the patient's thigh to
stabilize the leg. The therapist's other hand grasps the patient's foot and applies a
valgus (medial) stress to the knee.
Procedure:
The therapist then distracts the knee by pulling the foot away from the body. This
is repeated with the knee in a varus (lateral) position. The therapist then repeats the
test with the knee in both positions, but this time applying a compressive force to
the knee instead of a distracting force.
Here are the steps of the Apley distraction test in more detail:
1. The patient lies supine on the examination table with the affected knee
flexed to 90 degrees.
2. The therapist stands facing the patient and places one hand on the patient's
thigh to stabilize the leg.
3. The therapist's other hand grasps the patient's foot and applies a valgus
(medial) stress to the knee.
4. The therapist then distracts the knee by pulling the foot away from the body.
5. The therapist repeats step 4 with the knee in a varus (lateral) position.
6. The therapist then repeats steps 4 and 5, but this time applying a
compressive force to the knee instead of a distracting force.
Positive test:
A positive test is indicated by pain in the knee that is worse with compression than
with distraction. This suggests that the ligamentous structures of the knee are
injured.
Interpretation:
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A positive test is indicated by pain in the knee that is worse with compression than
with distraction. This suggests that the ligamentous structures of the knee are
injured.
Other findings:
Other findings that may be present in a positive Apley distraction test include:
• Crepitus (a grating sensation)
• Decreased range of motion
• Increased laxity (looseness) of the knee
Squat – medial (internal rotation) ;
lateral (external rotation)
(Screw-home mechanism)
The Squat Test with medial (internal rotation) and lateral (external rotation)
movements is a physical examination maneuver used to assess knee stability and
potential ligamentous or meniscal injuries.
Patient position:
The patient stands upright with their feet shoulder-width apart.
Therapist position:
The therapist stands or sits in front of the patient to observe and perform the test.
Procedure:
The Squat Test with medial and lateral movements involves the following steps:
1. Medial (Internal Rotation) Squat:

• The therapist instructs the patient to perform a squat while
emphasizing inward or medial rotation of both knees.
• The patient lowers their body by bending their knees while
keeping their feet flat on the ground.
• The therapist carefully observes the patient's knees for any
abnormal movements or symptoms, such as pain, clicking, or
instability.
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• The test is repeated for a few repetitions or as needed to evaluate

2. Lateral (External Rotation) Squat:

• The therapist instructs the patient to perform a squat while
emphasizing outward or lateral rotation of both knees.
• The patient lowers their body by bending their knees while
keeping their feet flat on the ground.
• The therapist carefully observes the patient's knees for any
abnormal movements or symptoms, such as pain, clicking, or
instability.
• The test is repeated for a few repetitions or as needed to evaluate
Positive signs:
Positive findings during the Squat Test with medial or lateral movements may
include:
• Pain: The patient experiences localized pain around the knee

joint during the squatting motion, indicating potential knee
pathology or injury.
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• Instability: The patient feels a sense of giving way or instability

in the knee joint during the squatting motion, suggesting
ligamentous laxity or instability.
• Clicking or popping: The patient reports or the therapist
observes audible or palpable clicking or popping sensations
during the squat, which may indicate meniscal involvement.
These positive signs may suggest potential ligamentous or meniscal injuries, and
further evaluation by a healthcare professional, such as an orthopedic surgeon,
sports medicine physician, or physical therapist, may be necessary. Diagnostic
tests, such as imaging studies or additional clinical assessments, can be performed
to confirm the findings and guide the appropriate treatment plan.
McMurray
(McMurray sign)
The McMurray Test is a physical examination maneuver used to assess the presence
of meniscal tears in the knee joint. It helps identify potential damage to the menisci,
which are cartilaginous structures that provide cushioning and stability to the knee.
Patient position:
The patient is typically lying on their back (supine position) on an examination
table.
Therapist position:
Procedure:
The McMurray Test involves the following steps:
1. The therapist flexes the patient's knee fully and holds the heel with one
hand, while placing the other hand on the patient's lower leg near the joint
line.
2. The therapist externally rotates the lower leg while applying a valgus
(inward) stress to the knee joint.
3. While maintaining the rotation and stress, the therapist extends the knee
from the fully flexed position.
4. Next, the therapist internally rotates the lower leg while applying a varus
(outward) stress to the knee joint.
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5. While maintaining the rotation and stress, the therapist extends the knee
from the fully flexed position.
6. The therapist repeats the procedure, focusing on different meniscal areas,
such as the medial and lateral menisci, to thoroughly evaluate the knee.
Interpretation:
During the McMurray Test, the therapist carefully listens and feels for any audible
or palpable clicks, pops, or pain originating from the knee joint during the different
movements and rotations. These findings suggest potential meniscal tears or
damage.
Positive signs:
Positive findings during the McMurray Test may include:
• Clicking or popping sensations: Audible or palpable clicking or

popping felt or heard during the test, which can indicate
meniscal involvement.
• Pain: The patient experiences localized pain around the knee
joint during specific movements and rotations, potentially
indicating meniscal pathology.
A positive McMurray Test suggests a potential meniscal tear or injury. However,
it's important to note that the test's accuracy may vary, and additional diagnostic
imaging, such as magnetic resonance imaging (MRI), may be required to confirm
the diagnosis.
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OTHER TESTS
“Q” Angle Test
(Quadriceps angle)
(Patellofemoral angle)
The "Q" Angle Test is a physical examination maneuver used to assess the
alignment and tracking of the patella (kneecap) and to evaluate for potential patellar
dislocation or maltracking issues. It measures the angle between the quadriceps
muscle pull and the patellar tendon.
Patient position:
The patient is typically lying on their back (supine position) on an examination
table with their legs extended.
Therapist position:
The therapist stands or sits beside the patient and performs the test by measuring
specific anatomical landmarks on the patient's legs.
Procedure:
The "Q" Angle Test involves the following steps:
1. The therapist identifies and marks specific bony landmarks on the patient's leg:
• ASIS (anterior superior iliac spine): Located on the front of the
hip bone.
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• Patella: The kneecap itself.

• Tibial tubercle: The bony prominence located on the front of the
tibia, just below the kneecap.
2. Using a goniometer or a ruler, the therapist measures the "Q" angle:
• The first line is drawn between the ASIS and the center of the
patella.
• The second line is drawn between the center of the patella and
the tibial tubercle.
• The angle formed at the intersection of these two lines is
measured.
Interpretation:
The "Q" Angle Test provides an indication of the alignment and tracking of the
patella. In general, a larger "Q" angle may suggest a greater lateral pull on the
patella, potentially increasing the risk of patellar maltracking or dislocation.
Conversely, a smaller "Q" angle may indicate better patellar alignment.
It's important to note that the "Q" Angle Test is just one component of a
comprehensive assessment for patellar tracking and potential dislocation. Other
factors, such as muscle imbalances, ligament laxity, and anatomical variations, can
also contribute to patellar instability.
A higher "Q" angle alone does not necessarily mean there is a problem, as
individuals can have variations in their "Q" angle without experiencing patellar
instability. The test should be interpreted in conjunction with the patient's history,
symptoms, and other clinical findings to guide treatment decisions.
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Apprehension Test
(Apprehension sign)
(Apprehension test for patellar
instability)
(Patellar apprehension test.)

The Apprehension Test for patellar dislocation is a physical examination maneuver
used to assess the stability and potential for patellar dislocation in the knee joint. It
aims to elicit the sensation of apprehension or discomfort in individuals with a
history of patellar instability or those prone to patellar dislocation.
Patient position:
The patient is typically lying down on their back with their knee extended.
Therapist position:
the patient's leg and patella.
Procedure:
The Apprehension Test for patellar dislocation involves the following steps:
1. The therapist positions the patient's knee in full extension.
2. With one hand, the therapist places their thumb or fingers on the medial
(inner) aspect of the patient's patella (kneecap) to provide stabilization.
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3. The therapist applies a lateral (outward) force or pressure on the patella,

attempting to push it towards a dislocating position.
4. While maintaining the lateral pressure, the therapist observes the patient's
reaction and response, paying attention to any signs of apprehension,
discomfort, or an attempt to contract or guard the quadriceps muscle.
Interpretation:
During the Apprehension Test, a positive finding is indicated by the patient's
apprehension or discomfort in response to the lateral pressure applied on the patella.
The patient may exhibit signs of guarding or muscle contraction in an attempt to
prevent the patella from dislocating.
A positive Apprehension Test suggests a potential patellar instability or a history
of patellar dislocation. It indicates that the patient experiences a feeling of
instability or apprehension when the patella is subjected to lateral force, increasing
the risk of dislocation.
Femoral Grinding
Waldron Test
(Waldron's sign, squat test)
(patellofemoral stress test)

The Waldron test is a clinical test used to assess for chondromalacia patella, a
condition that causes pain and inflammation of the kneecap. The test is named after
Dr. Frederick Waldron, who first described it in 1977.
Patient position:
The patient sits on the edge of the examination table with the affected knee flexed
to 90 degrees.
Therapist position:
stabilize the leg. The therapist's other hand palpates the patella while the patient
actively goes through the full range of motion (ROM).
Procedure:
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While the patient actively goes through full ROM the examiner palpates the patella
and listens and feels for crepitus. Crepitus is a grating or popping sensation that can
be felt or heard as the patella moves.
Here are the steps of the Waldron test in more detail:
1. The patient sits on the edge of the examination table with the affected knee
flexed to 90 degrees.
3. The therapist's other hand palpates the patella while the patient actively
extends the knee.
4. The therapist repeats step 3 while the patient flexes the knee.
5. The therapist listens and feels for crepitus during both active extension and
flexion of the knee.
Positive test:
A positive test is indicated by the presence of crepitus during active knee extension.
This suggests that there is inflammation or damage to the cartilage under the
kneecap.
Interpretation:
A positive test is indicated by the presence of crepitus during active knee extension.
This suggests that there is inflammation or damage to the cartilage under the
kneecap.
Other findings:
Other findings that may be present in a positive Waldron test include:
• Pain in the front of the knee
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144
• Decreased range of motion

• Swelling of the knee
Noble Compression Test

The Noble Compression Test is a physical examination maneuver used to assess
the iliotibial (IT) band for potential inflammation or tightness. It can help in the
diagnosis of IT band syndrome, a common condition characterized by pain on the
outer side of the knee or hip.
Patient position:
The patient is typically lying down on their back or sitting with their legs extended.
Therapist position:
The therapist stands or sits beside the patient and performs the test by applying
pressure and manipulating the patient's knee.
Procedure:
1. The Noble Compression Test for the IT band involves the following steps:
1. The therapist identifies the lateral epicondyle of the femur, which is a bony
prominence on the outer side of the knee.
2. The therapist flexes the patient's knee to approximately 90 degrees.
3. With one hand, the therapist applies pressure just above the lateral
epicondyle, on the outer side of the thigh, using their thumb or palm.
4. While maintaining the pressure, the therapist passively extends the patient's
knee, slowly straightening the leg.
5. The therapist carefully observes the patient's reaction, noting any pain,
discomfort, or a snapping sensation along the outer side of the knee or thigh.
Interpretation:
During the Noble Compression Test, a positive finding is indicated by the
reproduction of pain or discomfort along the IT band as the knee is extended. This
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suggests potential inflammation or tightness of the IT band, commonly seen in IT

band syndrome.
It's important to note that the Noble Compression Test is not a definitive diagnostic
test but serves as a screening tool to assess for IT band involvement. It should be
interpreted in conjunction with the patient's history, symptoms, and other clinical
findings.
Wilson Test
(Wilson's sign)
(Wilson's knee test.)

The Wilson Test, also known as the Wilson Sign, is a physical examination
maneuver used to assess for osteochondritis dissecans (OCD) in the knee joint.
OCD is a condition characterized by the separation of a piece of cartilage and
underlying bone from the joint surface.
Patient position:
The patient is typically standing or sitting with their knee flexed.
Therapist position:
manipulating the patient's lower leg and foot.
Procedure:
The Wilson Test for OCD involves the following steps:
1. The therapist asks the patient to actively and fully extend their knee.
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146
2. While the patient holds the knee in extension, the therapist observes the
patient's foot position.
3. The therapist instructs the patient to slowly flex their knee while
maintaining the foot in external rotation (outward rotation).
4. The therapist carefully observes the patient's foot position during knee
flexion, noting any changes in foot rotation.
Interpretation:
During the Wilson Test, a positive finding is indicated by the rotation of the
patient's foot from external rotation (outward rotation) to internal rotation (inward
rotation) during knee flexion. This suggests a potential lesion or loose fragment
within the knee joint, which can be associated with osteochondritis dissecans.
A positive Wilson Test may warrant further evaluation, such as imaging studies
like X-rays or magnetic resonance imaging (MRI), to confirm the diagnosis of
osteochondritis dissecans.
Thigh Contusion
(Quadriceps Contusion Test )
(Quadriceps Compression Test)

The thigh contusion test is a clinical test used to assess for a thigh contusion, which
is a bruise to the thigh muscle. The test is performed by applying pressure to the
affected area of the thigh.
Patient position:
The patient lies supine on the examination table with the affected thigh exposed.
Therapist position:
stabilize the leg. The therapist's other hand palpates the affected area of the thigh.
Procedure:
The therapist applies pressure to the affected area of the thigh. The patient is asked
to rate the pain on a scale of 0 to 10, with 0 being no pain and 10 being the worst
pain imaginable.
Here are the steps of the thigh contusion test in more detail:
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147
1. The patient lies supine on the examination table with the affected thigh
exposed.
3. The therapist's other hand palpates the affected area of the thigh.
4. The therapist applies pressure to the affected area of the thigh.
5. The patient is asked to rate the pain on a scale of 0 to 10.
Positive test:
A positive test is indicated by pain that is greater than 5 on the pain scale. This
suggests that there is a thigh contusion.
Interpretation:
A positive test is indicated by pain that is greater than 5 on the pain scale. This
suggests that there is a thigh contusion.
Other findings:
Other findings that may be present in a positive thigh contusion test include:
• Swelling of the thigh
• Ecchymosis (bruising) of the thigh
• Tenderness to palpation of the thigh
ANKLE
148
ANKLE
Anterior Drawer
(Anterior drawer maneuver)
( Anterior drawer sign)

The Anterior Drawer Test for the anterior talofibular ligament (ATFL) is a physical
examination maneuver used to assess the stability of the ankle joint and specifically
evaluate the integrity of the ATFL. The ATFL is one of the main ligaments on the
lateral (outer) aspect of the ankle that helps provide stability to the joint.
Patient position:
The patient is typically seated or lying down with the leg relaxed and the foot
positioned off the edge of the examination table.
Therapist position:
The therapist stands or sits in front of the patient's foot and ankle, preparing to
manipulate the ankle.
Procedure:
The Anterior Drawer Test for the ATFL involves the following steps:
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1. The therapist stabilizes the lower leg with one hand, providing support and
preventing unwanted movement.
2. With the other hand, the therapist grasps the heel or lower part of the
patient's foot, ensuring a firm grip.
3. The therapist applies a gentle, anterior (forward) force on the heel or foot,
directing it in a forward movement relative to the leg.
4. While maintaining the anterior force, the therapist assesses the amount of
anterior displacement or movement of the talus bone (the bone between the
foot and leg) relative to the tibia (shin bone).
5. The therapist carefully observes the joint's response and notes any excessive
laxity or abnormal movement compared to the unaffected side. The patient
may also be asked to report any pain or discomfort experienced during the
test.
Interpretation:
During the Anterior Drawer Test for the ATFL, a positive finding is indicated by
excessive anterior displacement or movement of the talus bone relative to the tibia.
This suggests potential laxity or instability of the ATFL, which can occur with an
ATFL sprain or tear.
A positive Anterior Drawer Test indicates possible damage to the ATFL and may
warrant further evaluation, such as imaging studies (e.g., X-rays, MRI), to confirm
the diagnosis and assess the severity of the ligament injury.
Talar Tilt
(Inversion stress test)
(Anterior talofibular ligament stress
test)
The Talar Tilt Test is a physical examination maneuver used to assess the stability
and integrity of the calcaneofibular ligament (CFL) and the deltoid ligament in the
ankle joint. It helps identify potential ligamentous injuries or laxity in these
structures.
Patient position:
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Therapist position:
Procedure:
The Talar Tilt Test for the CFL and deltoid ligament involves the following steps:
2. With the other hand, the therapist grasps the heel or lower part of the
patient's foot, ensuring a firm grip.
3. The therapist applies an inversion force on the foot, which means they tilt
the foot inward or toward the midline of the body.
4. While maintaining the inversion force, the therapist assesses the amount of
movement or tilting of the talus bone (the bone between the foot and leg)
within the ankle joint.
laxity, abnormal movement, or pain compared to the unaffected side.
6. The same procedure can be repeated with the foot in a slightly dorsiflexed
(upward) position to further isolate the specific ligaments being tested.
Interpretation:
During the Talar Tilt Test, a positive finding is indicated by excessive inversion
movement or tilting of the talus bone relative to the tibia. This suggests potential
ligamentous laxity or instability, particularly in the CFL or deltoid ligament.
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151
A positive Talar Tilt Test may suggest ligamentous injury or instability and may
the diagnosis and assess the severity of the ligament damage.
Kleiger Test
(External Rotation Stress Test)

The Kleiger Test, also known as the External Rotation Stress Test, is a physical
examination maneuver used to assess the integrity and stability of the deltoid
ligament in the ankle joint. It helps identify potential injuries or laxity in the deltoid
ligament, which is a strong ligament on the medial (inner) aspect of the ankle.
Patient position:
Therapist position:
Procedure:
The Kleiger Test for the deltoid ligament involves the following steps:
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152
2. With the other hand, the therapist grasps the patient's foot, ensuring a firm
grip around the forefoot and heel.
3. The therapist applies a combination of external rotation and eversion forces
on the foot, which means they rotate the foot outward (externally) and tilt it
away from the midline of the body.
4. While maintaining the external rotation and eversion forces, the therapist
assesses the amount of movement or tilting of the talus bone (the bone
between the foot and leg) within the ankle joint.
Interpretation:
During the Kleiger Test, a positive finding is indicated by excessive movement or
tilting of the talus bone relative to the tibia in response to the external rotation and
eversion forces. This suggests potential deltoid ligament injury or instability.
A positive Kleiger Test may warrant further evaluation, such as imaging studies
(e.g., X-rays, MRI), to confirm the diagnosis and assess the severity of the ligament
damage.
Thompson’s Test
(Calf Squeeze Test)
(Simmonds-Thompson Test)
Thompson's Test, also known as the Calf Squeeze Test or Simmonds-Thompson
Test, is a physical examination maneuver used to assess the integrity of the Achilles
tendon. It helps identify potential ruptures or tears in the Achilles tendon, which
connects the calf muscles to the heel bone.
Patient position:
The patient is typically lying prone (face down) or sitting with their legs hanging
off the edge of an examination table.
Therapist position:
The therapist stands or sits beside the patient's lower leg and foot, preparing to
perform the test.
Procedure:
The Thompson's Test for the Achilles tendon involves the following steps:
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153
1. The therapist instructs the patient to relax their calf muscles.

2. With the patient's leg hanging loose or resting on the table, the therapist
firmly squeezes the calf muscle belly or gently squeezes the calf just above
the Achilles tendon insertion.
3. The therapist observes the patient's foot for any movement or lack of
movement in response to the squeeze.
Interpretation:
During the Thompson's Test, a positive finding is indicated by the absence of
plantar flexion (no movement or no change in position) of the foot when the calf
muscle is squeezed. This suggests a potential Achilles tendon rupture or tear.
Normally, when the Achilles tendon is intact, squeezing the calf muscle will cause
the foot to move into plantar flexion (pointing downward). However, if the Achilles
tendon is ruptured or significantly damaged, the foot will not move or show a
decreased range of motion.
Swing Test
(Posterior Drawer Test)
(Posterior Subluxation Test)

The Swing Test, also known as the Posterior Drawer Test or Posterior Subluxation
Test, is a physical examination maneuver used to assess for posterior tibiotalar
subluxation or instability in the ankle joint. It specifically evaluates the stability of
the talus bone in relation to the tibia.
Patient position:
The patient is typically seated or lying down with the knee flexed at approximately
90 degrees and the foot hanging off the edge of the examination table.
ANKLE
154
Therapist position:
Procedure:
The Swing Test for posterior tibiotalar subluxation involves the following steps:
2. With the other hand, the therapist grasps the patient's foot, ensuring a firm
grip around the heel and forefoot.
3. The therapist maintains a neutral or slightly dorsiflexed (upward) position

of the foot.
4. The therapist applies a posterior (backward) force or traction on the foot,
attempting to move the talus bone posteriorly in relation to the tibia.
5. While maintaining the posterior force, the therapist assesses the amount of
posterior displacement or movement of the talus bone relative to the tibia.
Interpretation:
During the Swing Test for posterior tibiotalar subluxation, a positive finding is
indicated by excessive posterior displacement or movement of the talus bone
relative to the tibia. This suggests potential instability or subluxation of the ankle
joint in a posterior direction.
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A positive Swing Test may suggest ligamentous injury or instability and may
the diagnosis and assess the severity of the condition.
Tinel’s Sign
(Tinel's sign at the ankle)
(Tinel's sign for tarsal tunnel syndrome)

Tinel's Sign is a physical examination maneuver used to assess nerve irritation or
entrapment in specific regions. It is commonly performed to evaluate the deep
peroneal nerve and posterior tibial nerve in the lower leg and foot.
Tinel's Sign for the Deep Peroneal Nerve:

Patient position:
The patient is typically seated or lying down with the leg relaxed.
Therapist position:
The therapist stands or sits in front of the patient's lower leg and foot.
Procedure:
Tinel's Sign for the deep peroneal nerve involves the following steps:
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1. The therapist identifies the area where the deep peroneal nerve is expected
to run. This is typically along the front of the ankle, just lateral to the
anterior tibial tendon.
2. Using their fingers or a reflex hammer, the therapist applies gentle taps or
pressure over the identified area, specifically targeting the course of the
deep peroneal nerve.
3. The therapist carefully observes the patient's response and asks if any
tingling, numbness, or other abnormal sensations are felt in the distribution
of the deep peroneal nerve, which typically includes the top of the foot and
the web space between the first and second toes.
Tinel's Sign for the Posterior Tibial

Nerve:
Patient position:
The patient is typically seated or lying down with the leg relaxed.
Therapist position:
The therapist stands or sits behind the patient's lower leg and foot.
Procedure:
Tinel's Sign for the posterior tibial nerve involves the following steps:
1. The therapist identifies the area where the posterior tibial nerve is expected
to run. This is typically along the inside of the ankle, just behind the medial
malleolus (the bony prominence on the inner side of the ankle).
2. Using their fingers or a reflex hammer, the therapist applies gentle taps or
pressure over the identified area, specifically targeting the course of the
posterior tibial nerve.
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3. The therapist carefully observes the patient's response and asks if any
tingling, numbness, or other abnormal sensations are felt in the distribution
of the posterior tibial nerve, which typically includes the bottom of the foot,
the heel, and the medial arch.
Interpretation:
A positive Tinel's Sign is indicated by the reproduction of tingling, numbness, or
abnormal sensations along the distribution of the deep peroneal nerve or posterior
tibial nerve during the respective tests. This suggests potential nerve irritation or
compression in the examined areas.
Morton’s Test
(Metatarsal squeeze test)
(Morton's neuroma test)

Morton's Test, also known as the Mulder's Sign, is a physical examination
maneuver used to assess for Morton's neuroma, a condition characterized by the
thickening and irritation of the nerves between the metatarsal bones in the foot.
Patient position:
The patient is typically seated or lying down with the foot and toes relaxed.
Therapist position:
The therapist stands or sits in front of the patient's foot.
Procedure:
Morton's Test for Morton's neuroma involves the following steps:
1. The therapist stabilizes the patient's foot with one hand, providing support
and preventing unwanted movement.
2. With the other hand, the therapist applies pressure or compression to the
transverse arch of the foot using their thumb or fingers.
3. The therapist applies firm and steady pressure while squeezing the
metatarsal heads together.
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4. While maintaining the compression, the therapist asks the patient if they
experience any pain or a distinct "click" or "pop" sensation, often localized
between the metatarsal heads.
Interpretation:
During Morton's Test, a positive finding is indicated by the reproduction of pain or
the presence of a distinct "click" or "pop" sensation between the metatarsal heads.
This suggests the potential presence of a Morton's neuroma.
A positive Morton's Test may warrant further evaluation, such as imaging studies
(e.g., ultrasound, MRI) or referral to a specialist for confirmation and management
of Morton's neuroma.
Homan’s Sign
(Dorsiflexion sign or Homan's test)

Homan's Sign is a physical examination maneuver that has historically been
used to assess for deep vein thrombosis (DVT) in the calf. However, it is
important to note that the reliability and diagnostic accuracy of Homan's Sign
in detecting DVT are widely debated, and it is not considered a definitive or
reliable test for diagnosing DVT.
Patient position:
The patient is typically lying flat on their back with the leg extended.
Therapist position:
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The therapist stands or sits beside the patient's leg, preparing to perform the test.
Procedure:
Homan's Sign for DVT involves the following steps:
1. The therapist supports the patient's leg and ankle, ensuring the foot is
relaxed.
2. With the other hand, the therapist firmly dorsiflexes the patient's foot,
pulling it towards the shin.
3. PThe therapist carefully observes the patient's response and notes any
pain or discomfort in the calf region.
Interpretation:
In the past, a positive Homan's Sign was thought to be indicated by pain in the
calf with passive dorsiflexion of the foot. It was believed to be suggestive of
DVT. However, it is important to note that Homan's Sign lacks specificity and
may not reliably indicate the presence or absence of DVT.
It is essential to understand that relying solely on Homan's Sign for the
diagnosis of DVT is not recommended. The diagnosis of DVT requires a
combination of clinical assessment, patient history, and appropriate diagnostic
tests such as ultrasound imaging, D-dimer blood tests, or venography.
References
160
References
Books
1. "Physical Examination of the Spine and Extremities" by Stanley
Hoppenfeld
2. "Orthopedic Physical Assessment" by David J. Magee
3. "Special Tests for Orthopedic Examination" by Jeff G. Konin
4. "Musculoskeletal Physical Examination: An Evidence-Based Approach" by
Gerard A. Malanga and Kenneth Mautner
5. "Clinical Orthopaedic Rehabilitation: A Team Approach" by Charles E.
Giangarra and Robert C. Manske
Websites
1. Physiopedia (www.physio-pedia.com)
2. MedBridge (www.medbridgeeducation.com)
3. OrthoBullets (www.orthobullets.com)
4. American Academy of Orthopaedic Surgeons (www.aaos.org)
5. American Physical Therapy Association (www.apta.org)
6. ORTHOFIXAR (www.orthofixar.com)

Special MSK Tests For Physiotherapists Easy & Fast-1st Edition (Ali Muslim Raza)

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Special MSK Tests For Physiotherapists Easy & Fast-1st Edition (Ali Muslim Raza)

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1st Edition

Special MSK Tests for

Dr. Ali Muslim Raza (PT)

As physiotherapists, our job is to assess and diagnose musculoskeletal and

(Dr Ali Muslim Raza (PT))

ANTERIOR INSTABILITY ____________________________ 23

POSTERIOR INSTABILITY ___________________________ 28

INFERIOR INSTABILITY _____________________________ 33

LABRAL LESIONS (TEARS) __________________________ 36

SCAPULAR STABILITY ______________________________ 39

ACROMIOCLAVICULAR SEPARATION/SPRAIN ________ 41

MUSCLE TENDON PATHOLOGY _____________________ 43

NEUROLOGICAL TESTS _____________________________ 53

THORACIC OUTLET SYNDROME ____________________ 57

WRIST & HAND _____________________________________ 77

LIGAMENTS, CAPSULES, AND JOINT INSTABILITY ____ 77

NEUROLOGICAL DYSFUNCTION _____________________ 90

CIRCULATION AND SWELLING ______________________ 97

HIP _______________________________________________ 101

MORE THAN ONE AREA ____________________________ 101

SI JOINT __________________________________________ 110

OTHERS __________________________________________ 120

KNEE _____________________________________________ 123

LIGAMENT TESTS _________________________________ 123

MENISCUS TESTS __________________________________ 132

OTHER TESTS _____________________________________ 139

Femoral Grinding ___________________________________ 142

ANKLE ____________________________________________ 148

REFERENCES _____________________________________ 160

Books _____________________________________________ 160

Websites ___________________________________________ 160

(Cervical Distraction Test)

Upper Limb Tension Test

(Upper Limb Neurodynamic Test)

(Upper Limb Nerve Tension Test)

1. Median Nerve ULTT (Upper Limb Tension Test): The therapist

2. Ulnar Nerve ULTT: The therapist positions the patient's arm in

3. Radial Nerve ULTT: The therapist positions the patient's arm in

The patient is seated or standing.

1. The therapist abducts the arm to 45 degrees, extends the shoulder to 45

• A decrease or disappearance of the radial pulse

Shoulder Abduction Test

(Romberg Balance Test)

Vertebral Artery Test

4. The same procedure is repeated on the affected leg.

Prone Knee Bending

(Prone Knee Flexion Test)

symptoms, such as pain, tingling, or numbness, that radiate down the

possibility of nerve root irritation or compression, often caused by

( s c i a ti ca ) or ne ur ol ogica l s ym pt oms ( t i ngling, num bne s s) that

(Plantar Reflex Test)

The Beevor's Sign test involves the following steps:

(Anterior Load and Shift Test)

3. The therapist then performs a series of anterior (forward) and posterior

1. The therapist holds the patient's affected arm at approximately 90 degrees

Anterior Drawer Test

(Anterior Drawer Maneuver)

(Anterior Drawer Sign)

(Posterior Load and Shift Test)

Positive findings may include:

Posterior Apprehension Test

(Posterior Apprehension Maneuver)

(Posterior Apprehension Sign)