SPECIAL TEST (UPPER EXTREMITY & CERVICAL SPINE)

Cervical Region
Test Purpose Positioning Execution Positive Test Notes
Distraction & For px who have Px: Sitting Place one hand under the patient’s chin and the other * (+) If pain is relieved or decreased WADs – Whiplash Associated
Spurling Tests complained of Examiner: At the side around the occiput. Slowly lift the head, applying INTERPRETATION Disorders
radicular symptoms – of the patient traction to the cervical spine. > Spurling: This indicates a pressure on the nerve
used to alleviate root (cervical radiculitis)
symptoms > Reverse Spurling: Indicative of Muscle
Spasms in conditions, such as tension myalgia and
WADs.
Foraminal For provoking Px: Sitting The examiner carefully presses straight down the head. * Spurling:
Compression symptoms Examiner: At the back First Stage: Involves compression with the head in (+) If pain radiates into the arm toward which the head
(Spurling’s) Test of the patient Neutral Position. is side flexed during the compression
& Reverse Second Stage: Involves compression with the head * Reverse Spurling:
Spurling’s Test extended. (+) If pain is is felt in the opposite side to which
Third Stage: Involves compression with the head the head is taken, it is reverse spurling.
extended and rotated to the unaffected side. INTERPRETATION
> Spurling: This indicates a pressure on the nerve
root (cervical radiculitis)
> Reverse Spurling: Indicative of Muscle
Spasms in conditions, such as tension myalgia and
WADs.
Maximum For provoking Px: Sitting Patient side flexes the head and rotates it to the A. (+) If pain radiates to the arm. The second position may
Cervical symptoms Examiner: At the back same side & repeated to the other side. B. (+) Pain on the Concave Side also compress the vertebral
Compression of the patient C. (+) Pain on the Convex Side artery. If one is testing the
Test INTERPRETATION vertebral artery, the position
A. Intervertebral Foramina close maximally to the side should be held for 20 to 30
of movement and symptoms are accentuated. seconds to elicit symptoms that
B. Nerve Root or Facet Joint Pathology would indicate compression of
C. Muscle Strain the vertebral artery.
 Jackson’s To determine joint Px: Sitting * Rotates the head to one side * (+) If pain radiates into the arm
compression damage, Examiner: At the back * Carefully presses straight down on the head * The pain distribution (dermatome) can give some
meniscoid of the patient * Repeated with the head rotated to the other side indication of which nerve root is affected.
entrapment or INTERPRETATION
muscle strain. > Indicating pressure on a nerve root
It is a confirmatory test
for cervical spine
nerve root
compression
which causes neck
pain.

Modification of the
foraminal
compression test
Tinels for Assesses for Px: Sitting * The neck slightly side flexed * (+) Tinel sign (tingling sensation in the distribution of
Brachial plexus cervical nerve * Taps the area of the brachial plexus with a finger a nerve) means the lesion is anatomically intact and
root along the nerve trunks in such a way that the different some recovery is occurring.
compression, nerve roots are tested * (+) If pain is elicited in the distribution of a peripheral
neuroma, nerve
thoracic outlet INTERPRETATION
syndrome and > The sign is positive for a neuroma and indicates a
space-occupying disruption of the continuity of the nerve.
lesions in the area. > Pure local pain implies that there is an underlying
cervical plexus lesion.
This test involves
lightly tapping over the
nerve to identify nerve
irritation.
Upper limb Designed to put ULNT 1 * (+) If neurological symptoms were manifested before
tension test 1 & 2 stress on Shoulder: Depression and abduction (110) 60° of elbow extension when elbow extension was the
or Brachial Plexus neurological Elbow: Extension last movement performed.
Tension or Elvey Test Forearm: Supination
 structures of Wrist: Extension
upper limb Fingers & Thumb: Extension
Cervical Spine: Contralateral side flexion
These tension tests are Nerve bias: Median, Anterior interosseous nerve,
performed to check C5,C6,C7
the peripheral
nerve ULNT 2
compression or as Shoulder: Depression and abduction (10)
a part of neurodynamic Elbow: Extension
assessment. Forearm: Supination
Wrist: Extension
Shoulder: Lateral Rotation
Cervical Spine: Contralateral side flexion
Nerve bias: Median, Musculocutaneous nerve, axillary
nerve
Upper limb When positioning the * Elbow extension stresses the radial and median * If symptoms are minimal or no symptoms appear, the If the neurological signs
tension test 3 & shoulder, it is nerves head and cervical spine are taken into contralateral are worsening or in the
4 essential that a * Flexion stresses the ulnar nerve side flexion. acute phase, or if a
constant * Wrist and finger extension stresses the median and cauda equina or spinal
depression ulnar nerve cord lesion is present,
force be applied to * releasing stress on the radial nerve these stress tests are
the shoulder girdle so contraindicated.
that, even with ULNT3
abduction, the Shoulder: Depression and Abduction (110°) This final movement is
shoulder girdle Elbow: Extension sometimes referred to as a
remains depressed. Forearm: Pronation sensitizing test. This
While the shoulder Wrist: Flexion and Ulnar Deviation sensitizing test may be within or
girdle is depressed, Fingers and thumb: Flexion near the test limb (e.g., neck side
the glenohumeral Shoulder: Internal/ Medial Rotation flexion in ULNT), or it may be in
joint is taken to the Cervical spine: Contralateral Side Flexion another quadrant (e.g., right
appropriate Nerve bias: Radial Nerve ULNT and right SLR)
abduction position
and the forearm, ULNT4
wrist, and fingers are
 taken to their Shoulder: Depression and abduction (10° to 90°), hand
appropriate to ear
end-of-range Elbow: Flexion
position. Forearm: Supination or Pronation
Wrist: Extension and Radial Deviation
Fingers and thumb: Extension
Shoulder: External/ Lateral Rotation
Cervical spine: Contralateral Side Flexion
Nerve bias: Ulnar Nerve, C8 and T1 nerve roots
Brachial plexus This test is similar to Px: Sitting * The sitting patient abducts the arms with the * (+) Reproduction of radicular symptoms with
tension test ULNT4 and stresses elbows extended, stopping just short of the onset elbow flexion
primarily the of symptoms. The patient laterally rotates the
ulnar nerve and shoulder just short of symptoms, and
the C8 and T1 * The examiner then holds this position. Finally, the
nerve roots. patient
* Flexes the elbows so that the hands lie behind
the head
Bikele’s sign This test is a Px: Sitting * Abduct their shoulder to 90 degrees as well as fully * (+) Reproduction of Radicular symptoms:
modification of flex the elbow. a. Nerve root tension
the ULNT done * Examiner then instructs patient to extend shoulder b. Brachial plexus neuritis
actively. and then the elbow. c. possibly meningitis

Lhermitte’s sign Test for the spinal Px: Long Sitting * Examiner flexes patient’s head and hip
cord and a possible simultaneously.
upper motor * Soto-Hall Test – Patient actively flexes the head
neuron lesion. to the chest while in the supine lying position.
Hautant’s Test Assesses for Px: Sitting The patient sits and forward flexes both arms to If the arms move It is also a neurological
(1st Part) vertebrobasilar Examiner: At the side 90°. The eyes are then closed. The examiner watches for INTERPRETATION procedure that checks for
ischaemia. of the patient any loss of arm position. > Non vascular insufficient blood flow through
the vertebral arteries
Hautant’s Test Px: Sitting * The patient sits and forward flexes both arms to Wavering of the arms occurs
(2nd Part) Examiner: At the side 90°. The eyes are then closed. The examiner watches for INTERPRETATION
of the patient > Vascular Impairment
 any loss of arm position. The patient is then asked to
rotate, or extend and rotate, the neck.
Naffziger Test For nerve root Px: Sitting * The examiner compresses the veins for 30 seconds Pain An increase or aggravation of
compression Examiner: Behind the and then asks the patient to cough INTERPRETATION pain or sensory disturbance
patient with his/her * Manual compression of the jugular veins > Nerve root problem or space occupying lesion over the distribution
fingers over the bilaterally of the involved nerve
patient’s jugular vein root confirms the presence
of an extruded intervertebral
disk or other mass.
Hallpike-dix Test To identify benign Px: Long-sit on a * Patient is the assisted into a supine position with the (+) signs of dizziness, and nystagmus are considered a
paroxysmal plinth with the head patient’s head slightly below the horizontal plane, the positive test
positional vertigo rotated position maintained for 30 to 60 seconds
(BPPV), a condition approximately 30 to * Performed with the head rotated to both sides
in which patients 45 degrees starting the unaffected side.
experience episodes of Examiner: Stands
dizziness, or vertigo, behind the patient
especially if the head is with one hand
moved to different supporting the
positions. head/neck and the
other hand
supporting the trunk

Chvostek Test To determine whether Examiner: Taps the

there is pathology parotid gland
involving the overlying the
seventh cranial masseter muscle. If
(facial) nerve the facial muscles
twitch, the test is
considered positive.

Adson Maneuver This test is probably Pt: Sitting The examiner locates the radial pulse. Patient’s head is * (+) A disappearance of the pulse.
one of the most rotated to face the test shoulder. Examiner laterally
common methods of
 testing for thoracic rotates and extends the patient’s shoulder. The
outlet syndrome patient is instructed to take a deep breath and hold it.
reported in the
literature.
Costoclavicular This test is particularly The examiner palpates the radial pulse and then * (+) Absence of the pulse and
Syndrome effective in patients draws the patient’s shoulder down and back. INTERPRETATION
(Military Brace) who complain of > Iimplies possible thoracic outlet syndrome
Test symptoms while (costoclavicular syndrome).
wearing a backpack or
heavy coat.

Halstead The examiner finds the radial pulse and applies a (+) Absence or disappearance of a pulse
Maneuver downward traction on the test extremity while the INTERPRETATION
patient’s neck is hyperextended and the head is > Implies possible thoracic outlet syndrome.
rotated to the opposite side.

Provocative This test is a Px: Sitting * Elevates both arms above the horizontal + (TOS & Vascular Insufficiency): fatigue,
Elevation Test modification of * Rapidly open and close the hands fifteen times cramping, or tingling occurs during the test
the Roos test. Used
on pt’s who already
present with sx.

Roos Test This test is a diagnostic Px: Standing * Both arms in 90°abduction-external rotation; + (TOS): Unable to keep the arms in the starting
AKA Positive Abduction tool used in the elbows in 90° flexion & slightly behind the frontal position for 3 minutes or suffer ischemic pain,
and External Rotation identification plane heaviness or profound weakness of the arm, or
Position Test (AER), of Thoracic Outlet * Opens and closes the hands slowly for 3 mins numbness and tingling of the hand during the 3 minutes
“Hands up” Test, Syndrome. - (TOS): Minor fatigue and distress
Elevated Arm Stress
Test (EAST).

Shoulder Region
 Andrew’s Modification of * Supine with the shoulder abducted 130° and * (+) A reproduction of patient’s symptoms
Anterior the load and laterally rotated 90° * (+) clunk = (+) anterior labral tear
Instability Test shift test * Stabilize elbow and distal humerus with one hand and INTERPRETATION
use the other hand to grasp the humeral head and lift it > Positive test for anterior instability
forward > Anterior labral tear

Anterior Drawer Modification of Px: Supine * Shoulder abducted 80°-120°, forward flexed * A positive test indicates anterior instability
Test of the load and shift Examiner: Places the up to 20°, and laterally rotated up to 30° depending on the amount of anterior translation
Shoulder test hand of the affected * Stabilize the patient’s scapula with the opposite hand, * Click= labral tear or slippage of the humeral head
shoulder in the pushing the spine of the scapula forward with the index over the glenoid rim
examiner’s axilla, and middle fingers INTERPRETATION
holding the patient’s * Examiner’s thumb exerts counter pressure on the > Positive test for anterior instability
hand with the arm so patient’s coracoid process > Labral tear or slippage of the humeral head over
that the patient * Using the arm that is holding the patient’s hand, the the glenoid rim
remains relaxed examiner places his or her hand around the patient’s
relaxed upper arm and draws the humerus forward
* The movement may be accompanied by a click, by
patient apprehension, or both
* The amount of movement available is compared with
that of the normal side

Leffert’s Test Px: Sitting * Place near hand over the shoulder so that the index * (+) When the arm is returned to the starting
Examiner: Stand behind finger is over the head of the humerus anteriorly and the position, the index finger returns to the starting
the shoulder being middle finger is over the coracoid process position as the humeral head glides backward
examined * The thumb is placed over the posterior humeral head
* Other hand grasps the patient’s wrist and carefully
abducts and laterally rotates the arm

Crank Primarily designed to * PT abducts the arm to 90° (+) If pain predominated when doing
(Apprehension) check for * Slowly laterally rotates the px. shoulder. A. Pt looks or feels apprehensive or alarmed the crank test and disappears with
for Anterior traumatic * To see if apprehension or pain increases B. Pt resists further motion the relocation test, the diagnosis is
Dislocation instability Apply a mild anteriorly-directed force to the posterior C. Pt may also state that the feeling resembles what pseudolaxity or anterior
problems causing humeral head when in the test position (Kvitne and Jobe) it felt like when the shoulder was dislocated instability either at the
gross or anatomical INTERPRETATION glenohumeral joint or
 instability of the If posterior pain increases, this indicates posterior > Indicates posterior internal impingement. scapulothoracic joint with
shoulder. internal impingement. secondary impingement or a
posterior SLAP lesion.
The crank test may be
modified to test
lateral rotation
at different degrees
of abduction,
depending on the
patient history and
mechanism of injury.

The Rockwood
test is simply a
modification of the
crank test.

Fulcrum By placing a hand under the glenohumeral joint to act as

a fulcrum, the apprehension test becomes the fulcrum
test.

Fowler sign/test Px: Supine Elbow flexed to 90° and abducted to 90° * (+) If pain decreases during the maneuver, even
or Jobe Test Examiner: Applies a with no apprehension
posterior translation * If symptoms decrease or are eliminated
stress to the head of when doing the relocation test the diagnosis is
the humerus or the glenohumeral instability, subluxation,
arm. dislocation or impingement
* If apprehension predominated when
doing the crank test and disappears with the
relocation test, the diagnosis is glenohumeral
instability, subluxation or dislocation.
* If pain predominated when doing the crank
test and disappears with the relocation test, the
diagnosis is pseudolaxity or anterior
 instability either at the glenohumeral
joint or scapulothoracic jt. with
secondary impingement or a posterior
SLAP lesion.
* If, when doing the relocation test for posteriorly,
posterior pain decreases, it is a positive test
for posterior internal impingement.

Circumduction Px: Standing position * The PT stands behind the patient grasping the px’s If the examiner palpates the posterior aspect of the
Test forearm with the hand. px’s shoulder as the arm moves downward in
* The PT begins circumduction by extending the px’s forward flexion and adduction, the humeral head will
arm while maintaining slight abduction be felt to sublux posteriorly in a positive test, and the
* As the circumduction cont. into elevation, the arm is px. will say, “That’s what it feels like when it bothers
brought over the top & into the flexed & adducted me”.
pos.
* As the arm moves into forward flexion and
adduction from above, it is vulnerable to post.
subluxation if the px is unstable posteriorly.
Faegin Test It is a Px: Standing or Sitting Standing A look of apprehension on the patient’s face
modification of Examiner: At the side * Px stands with the arm abducted to 90° and the indicates a positive test and the presence of inferior
the sulcus sign elbow extended and resting on the top of the capsular laxity. If both the sulcus sign and Faegin
test with the arm examiner’s shoulder. test are positive, it is a greater indication of
abducted to 90° * The examiner’s hands are clasped together over multidirectional instability rather than just laxity, but
instead of being at the px’s humerus, between the upper and middle thirds. it should only be considered positive if the patient is
the side. Some * The examiner pushes the humerus down and forward. symptomatic.
authors consider it to
be the second part of Sitting
the sulcus test. * Examiner holds the px’s arm at the elbow (elbow
straight) abducted to 90° with one hand and arm
holding the arm against the examiner’s body.
* The other hand is placed just lateral to the acromion
over the humeral head.
 * Ensuring the shoulder musculature is relaxed, the
examiner pushes the head of the humerus down and
forward.

Hawkins One of the most Pt: Standing Px stands while the examiner forward flexes the * (+) Pain
Kennedy common special tests arm to 90° and then forcibly medially rotates the INERPRETATION
Impingement used in orthopedic shoulder. > supraspinatus paratenonitis/tendinosis or
Test physical assessment secondary impingement.
and examination
of the shoulder.
Neer Commonly used in The patient’s arm is passively and forcibly fully elevated The patient’s face shows pain, reflecting a positive The test indicates an overuse injury
Impingement orthopedic in the scapular plane with the arm medially rotated by test result. to the supraspinatus muscle and
Test examinations to test the examiner. sometimes to the biceps tendon. If
for subacromial the test is positive when done with
Impingement. the arm laterally rotated, the
examiner should check the
acromioclavicular joint
(acromioclavicular differentiation
test)
Active This test is designed The test also “locks and loads” the acromioclavicular * (+) If pain on the joint line or painful clicking is
Compression for to detect SLAP joint in medial rotation so that the examiner must take produced inside the shoulder (not over the
labral tear or (Type II) or care to differentiate between labral and acromioclavicular joint) in the first part of the test
Active superior labral acromioclavicular (pain over acromioclavicular joint) and eliminated or decreased in the second part.
Compression lesions. pathology.
Test of O’Brien
Biceps Load Test This test is designed * (- SLAP lesions) If apprehension appears, the
(Kim Test II) to check the examiner stops lateral rotation and holds the
integrity of the position. If apprehension decreases or the patient
superior labrum. feels more comfortable.
* (+ SLAP lesions) If the apprehension remains the
same or the shoulder becomes more painful, the test
 is considered positive for in the presence of
recurrent dislocations.
* Wilk, et al. also advocate doing the test with the
forearm pronated (pronated biceps load test).
(+) If the pain is located deep in the superior
glenohumeral joint.

Biceps Tension This test determines * The patient, in standing, abducts and laterally * (+) A reproduction of the patient’s symptoms The examiner should also do a
Test whether a SLAP rotates the arm to 90° with the elbow extended Speed’s test (discussed later) to
lesion is present. and forearm supinated. The examiner then applies an rule out biceps pathology.
eccentric adduction force to the arm.
Abdominal This test checks the Px: Standing position * Examiner place a hand on the abdomen below xiphoid * (+) If the patient is unable to maintain the pressure
Compression subscapularis process. on the examiner’s hand while moving the elbow
Test (Belly-Press muscle. * The patient place his or her hand on the shoulder being forward, or posteriorly flexes the wrist or extend the
or Napoleon tested on the examiner’s hand and pushes the hand as shoulder
Test) hard as he or she can into the stomach (medial shoulder INTERPRETATION
rotation) > Positive for a tear of subscapularis muscle.
* The patient attempts to bring the elbow forward to the
scapular plane, causing greater medial rotation.

Drop Arm * The examiner abducts the patient’s shoulder to 90° * (+) If the patient is unable to return the arm to the
(Codman’s) Test and the asks the patient to slowly lower the arm to the side slowly or has a severe pain when attempting to
side arc of movement do so.
INTERPRETATION
> Positive results indicate a tear in the rotator cuff
complex.
Dropping Sign Px: Standing * Passively places the elbow in 90 ° flexion with the * (+) If the patient is not able to maintain the
Examiner: Stands by arm in 45 ° lateral rotation. laterally rotated position
the test side * The patient is then asked to isometrically INTERPRETATION
laterally rotate the arm against resistance and then > Positive for an infraspinatus tear.
relax.
Hornblower’s To test the strength of * (+) when the patient is unable to laterally rotate
(Signe de teres minor the arm
 Clairon) Sign or INTERPRETATION
Patte Sign > Positive indicates a tear of teres minor

Lift-Off Sign * The patient stands and places the dorsum of the hand
on the back pocket or against the midlumbar spine. Great
subscapularis activity is shown with the second position
* (+) If inability to do so
* Abnormal motion in the scapula during the test
may indicate scapular instability.
INTERPRETATION
> Indicates a lesion of the subscapularis muscle.
Modified lift-off test
If the patient’s hand is passively
medially rotated as far as possible
and the patient is asked to hold the
position, it will be found that the
hand moves toward the back
(subscapularis or medial rotation,
“spring back,” or lag test ) because
subscapularis cannot hold the
position due to weakness or pain

Ludington’s Test While the patient does the contractions and relaxations, A positive result indicates that the long head of
the examiner palpates the biceps tendon, which will be biceps tendon has ruptured
felt on the uninvolved side but not on the affected side if
the test result is positive.
Speed’s Test This test looks for * The PT places the px’s arm in shoulder flexion 90 * To see if apprehension or pain increases: Note: Test may cause pain and,
(Biceps or biceps muscle deg., external rotation, full elbow extension, A positive test elicits increased tenderness in the therefore, is positive if a SLAP
Straight-Arm Test) or tendon and forearm supination bicipital groove especially with the arm supinated (type II) lesion is present.
pathology * Manual resistance is then applied by the PT in a INTERPRETATION If profound weakness is found on
downward direction. > Indicative of bicipital paratenonitis or tendinosis. resisted supination, a severe
second- or thirddegree (rupture)
strain of the distal biceps
should be suspected.
Supraspinatus The Empty Can Test is Px: Sitting or Standing * The px's arm should be elevated to 90 degrees with * To see if apprehension or pain increases:
(“Empty Can” or Jobe) used to assess the the elbow extended, full internal rotation, The PT should stabilize the shoulder while applying a
Test supraspinatus and pronation of the forearm. downwardly directed force to the arm, the patient
muscle and This results in a thumbs-down position, as if the tries to resist this motion. This test is considered
tendon. patient were pouring liquid out of a can positive if the patient experiences pain or weakness
with resistance.
INTERPRETATION
 > A positive test result indicates a tear of the
supraspinatus tendon or muscle, or neuropathy of
the suprascapular nerve.

Trapezius Testing trapezius, Upper- elevating the soulder with the arm slightly * (+) If scapular protraction occurs, the middle and
weakness upper, middle and abducted or to resisted shoulder abduction & head side lower fibers are weak.
lower portions flexion If the scapular are elevated more than normal, it may
Middle- px in prone position wth the arm abducted 90º INTERPRETATION
& laterally rotated > Indicated a tight trapezius or presence of the
Lower- px in prone lying with arm abducted to 120º & cervical torticolis
shoulder laterally rotated

The patient sits down and places hands over the head
Rhomboids Px: Prone lying or * PT places the index finger along and under the medial * (+) If the rhomboids are normal, the thumb is
weakness Sitting position, with border of the scapula while asking the px against pushed away from under the scapula
the arm behind the resistace to relax the trapezius
body so the hand is on
opposite hand
Serratus Anterior * The px is in standing position and forward flexes the * (+) If the serratus anterior is weak or paralyzed,
Weakness arm to 90º. the medial border of the scapula will wing.
* The PT applies a backward force to the arm
* The px will also have difficulty abducting or forward
flexing the arm above 90º with a weak serratus anterior,
but may be possible with lower trapezius compensation

Elbow and Wrist

Lateral Pivot Designed to test for Px: Supine The examiner grasps the px’s wrist and forearm with the +causes the radius and ulna to sublux off the
Shift Test for valgus and varus elbow and extended and forearm fully supinated. Px humerus leading to a prominent radial head and
Elbow instability in the elbow is flexed while a valgus stress and axial capitulum. 40-70 degrees there is a sudden
elbow compression is applied to the elbow while maintaining reduction (clunk) of the joint.
supination. If the px is unconscious, subluxation and clunk
reduction happens when the elbow is extended,
seldom present in the conscious patient.
 Ligamentous Designed to test Px: Sitting: elbow Stabilize elbow with 1 hand and above px’s wrist with the + decrease laxity and pain
Valgus valgus instability in flexed to 90° other. Apply and abd force to the distal forearm
instability test the elbow

Ligamentous Designed to test Px: Sitting: elbow Execution: stabilize with the examiners hand, and + increase pain and excessive laxity
Varus instability varus instability in flexed to 20 or 30° adduction or varus force is applied by the examiner to
test elbow the the distal forearm to test the lat. collateral ligament
while the ligament is palpated

Biceps Squeeze Test to determine the Px: Sitting Sitting, elbow is flexed approximately 60-80 degrees
presence of a biceps with the forearm slightly pronated.
brachii tendon The clinician stands on the side of the extremity being
rupture tested and squeezes the biceps brachii firmly with both
hands, one hand at myotendinous junction, and the other
around the muscle belly. As the biceps is squeezed, the
muscle belly is drawn away from the humerus, causing
an anterior bow of the muscle. A positive test is lack of
forearm supination indicating biceps brachii rupture.

Hook Test Test for distal biceps Px: Sitting Sitting, elbow flexed 90 deg. with forearm supinated. Extremely sensitive and specific for a complete
rupture Permits the examiner to hook his or her index finger distal biceps rupture.
under the intact biceps tendon from the lateral side.

Mill’s Test Diagnosing Lateral Px: Seated The clinician palpates the patient’s lateral epicondyle A reproduction of pain in the area of the insertion at
Epicondylitis in the with one hand, while pronating the patient’s forearm, the lateral epicondyle indicates a positive test.
elbow, also known as fully flexing the wrist, the elbow extended.
“Tennis Elbow”
Cozen’s Test The purpose of Px: Sitting Elbow flexed to 90°, radial deviation and forearm The test is considered positive if it produces pain or
Cozen's test (also pronation reproduction of other symptoms in the area of the
known as the Resisted wrist extension in this position against manual lateral epicondyle.
"resisted wrist resistance of the therapist
extension test" or
 "resistive tennis
elbow test") is to
check for lateral
epicondylalgia or
"tennis elbow".

Maudsley's test A study showed that Px: Sitting Elbow flexed to 90°, radial deviation and forearm A positive test is indicated by pain over the lateral
a common finding in pronation epicondyle of the humerus
tennis elbow is pain The examiner resists extension of the 3rd digit of the
in the region of the hand, stressing the extensor digitorum muscle and
lateral epicondyle tendon, while palpating the patient’s lateral epicondyle.
during resisted
extension of the
middle finger
Golfer’s test To test if there is Px: Sitting/Standing Patient’s forearm is passively supinated and the Positive sign is indicated by pain over the medial
medial epicondylitis examiner extends the elbow and wrist epicondyle of the humerus
Plica To test for plica injury Px: Sitting/Standing The examiner applies a valgus load to the elbow while Pain or snapping between 90° and 110° of flexion
impingement passively flexing the elbow with the forearm held in indicates a positive test for the anterior
test pronation. radiocapitellar plica
To test the posterior radiocapitellar plica:
Examiner applies a valgus load to the elbow while
passively extending the elbow with the forearm held in
supination

Elbow flexion A test for ulnar Px: Sitting/Standing The patient is asked to fully flex the elbow with Tingling or paresthesia in the ulnar nerve distribution
test nerve pathology extension of the wrist and shoulder girdle abduction of the forearm and hand indicates a positive test.
(90°) and depression and to hold this position for 3 to 5
minutes.

MacKinnon’s A test for peripheral Px: Sitting/Standing The patient stands with the elbow flexed to 90° and by If the patient cannot momentarily laterally rotate
Scratch Collapse nerve compression the side. The patient is asked to laterally rotate and against the examiner, it is considered a positive test.
Test abduct the forearms against resistance and then relaxes.
The examiner then scratches along the course of the

Allen test Circulation and
swelling. Determines
the patency of the
radial and ulnar
arteries and
determines which
artery provides the
major blood supply to
the hand
Tinel test May indicate carpal
tunnel syndrome
Finkelstein test Used to determine the Px: Sitting/Standing
presence of de
Quervain or Hoffmann
disease
( a paratenosis in the
thumb)
Froment’s A test for Ulnar Nerve Px: Sitting/Standing
“paper” sign palsy, specifically
testing the action of
Adductor Pollicis
ulnar nerve at the elbow and then asks the patient to
repeat the movement against resistance.
Px: Sitting Px is asked to open and closes the hand.
Px: Sitting PT taps over the carpal tunnel at the wrist
Px makes a fist with the thumb inside the fingers
The px attempts to grasp a piece of paper between the
thumb and index finger
+(An uncommon complication of radial arterial
blood sampling/cannulation is disruption of the
artery (obstruction by clot), placing the hand at risk
of ischemia.)
+(Tingling or paresthesia of the thumb, index finge
r(forefinger), and middle and lateral half of the ring
finger (median distribution).)
+ test is indicated by pain over the abductor pollicis
longus and extensor pollicis brevis tendon at the
wrist and is indicative of a paratenonitis of these
two tendons.
The test can cause some discomfort in normal
individuals , the examiner should compare the pain
caused on the affected side with that normal side. If
px symptoms is produced the test is considered
positive.
When the examiner attempts to pull away the paper,
the terminal phalanx of the thumb flexes because of
paralysis of the adductor pollicis muscle, indicationg
a positive test.
If at the same time the metacarpophalangeal joint of
the thumb hyperextend , the hyperextension is noted
as a Jeanne’s sign. Both test, if positive are
indicative of ulnar paralysis
 Supination Lift This test is used to Px: Sitting w/ elbow Px is asked to place palms flat on the underside of a
Test determine pathology flexed to 90 degrees & heavy table (or flat against the examiner’s hand). Then
in the TFCC (a.k.a forearms supinated asked the px to lift the table (or push up against the
triangular resisting examiner’s hand)
cartilaginous disc) Localized pain on the ulnar side of the wrist and difficulty
applying force are positive indications for a dorsal TFCC
tear.
Pain on forced ulnar deviation causing ulnar impactation
is a symptom of TFCC tears.

Triangular The examiner holds the px’s hand w/ the other hand. A positive test is indicated by pain, clicking or
Fibrocartilage Then axially loads and ulnarly deviates the wrist while crepitus in the area of the TFCC.
Complex Load moving it dorsally and palmarly or by rotating the
Test (Sharpey’s forearm.
Test)
Pinch Grip Test May indicate an Px: Sitting/Standing Px is asked to pinch the tips of the index finger and +(pathology to the anterior interosseous nerve,
entrapment of the thumb together. which is a branch of the median nerve b/w 2 heads
anterior interosseous (Normal = Tip-to-tip pinch) of the pronator teres muscle)
nerve b/w the 2
heads of the pronator
teres muscle.
Test for Pronator Determines if there is Sitting: Elbow flexed to Elbow is extended while examiner resists pronation +(compression to the median nerve b/w 2 heads of
Teres Syndrome compression of the 90° the pronator teres muscle): Tingling or paresthesia
median nerve b/w 2 in the median nerve distribution in the forearm and
heads of pronator hand
teres muscle
Tinel Sign at The test indicates the The area of the ulnar nerve in the groove is tapped A positive sign is indicated by a tingling sensation in
Elbow point of regeneration the ulnar distribution of the forearm and hand distal
of the sensory fibers to the point of compression of the nerve
of a nerve
Wartenberg Sign Determines if there is Px: Sitting with hands The examiner passively spreads the fingers apart Inability to squeeze the little finger to the remainder
ulnar nerve paralysis resting on the table. and asks the patient to bring them together again of the hand indicates a positive test for ulnar
neuropathy
Flick Maneuver Used to diagnose Px: Sitting or standing The px is asked to vigorously shake the hands or flick the A resolution of the symptoms after flicking or
carpal tunnel wrists shaking the hands is considered a positive test
syndrome

Phalen’s (Wrist used to diagnose The examiner flexes the patient’s wrist maximally and A positive test is indicated by tingling in the thumb,
Flexion) Test carpal tunnel holds this position for 1 min. by pushing the patient’s index finger, and middle and lateral half of the ring
syndrome wrists together finger and is indicative of carpal tunnel syndrome
caused by pressure on the median nerve

Reverse Phalen used to diagnose The examiner extends the patient’s wrist while asking A positive test produces the same symptoms as
(Prayer) Test carpal tunnel the patient to grip the examiner’s hand. those seen in Phalen’s test and is indicative of
syndrome The examiner then applied direct pressure over the pathology of the median nerve
carpal tunnel for 1 minute
Patient may also perform this actively but doing so will
not put as much pressure on the carpal tunnel

TRUNK AND LOWER EXTREMITY

Test Purpose Positioning Execution Positive Test Notes
Squish Test This movement tests Px: Supine Examiner places both hands on the patient’s A positive test is indicated by pain.
the posterior ASIS and iliac crests and pushes down and in at a
Sacroiliac ligaments. 45° angle
Slump Test The most common Px: Sitting (edge of the The hips in neutral position and the hands behind the ● (+) If the knee extends further, the symptoms
neurological test for examining table) back decrease with neck extension
the lower limb. The examination is performed in ● (+) If the positioning of the patient increases the
sequential steps
patient’s symptoms,
- Asked to “slump” the back into thoracic and lumbar
flexion INTERPRETATION
- maintains the patient’s chin in the neutral position
to prevent neck and head flexion
 - apply overpressure across the shoulders to ▪ Positive for increased tension in the
maintain flexion of the thoracic and lumbar spines neuromeningeal tract.
- asked to actively flex the cervical spine and head
as far as possible
- applies overpressure to maintain flexion of all
three parts of the spine (cervical, thoracic, and
lumbar)
- with the other hand, the examiner then holds the
patient’s foot in maximum dorsiflexion
- asked to actively straighten the knee as much
as possible
- the test is repeated with the other leg and then with
both legs at the same time

Yeoman’s Test Px: Prone Examiner stabilizes the pelvis and extends each of ● (+) Indicated by pain in the lumbar spine during
the patient’s hips in turn with the knees extended. The both parts of the test.
examiner then extends each of the patient’s legs in
turn with the knee flexed. In both cases, the patient
remains passive.

Straight Leg .Neurodynamic tests Px: Supine Each leg is tested individually with the normal leg being ● (+) Passive bilateral straight leg Primarily considered a test of the
Raising check the tested first. raising (SLR) - test pain occurring before 70° neurological
(Lasègue’s) Test mechanical The hip medially rotated and adducted, and the INTERPRETATION tissue around the lumbar spine, this
movement of the knee extended. test also places
▪ indicative of sacroiliac joint problems
neurological tissues The PT lifts the px's leg by the posterior ankle while a stress on the sacroiliac joints
● (+) SLR - the pain in the sacroiliac joint is
as well as their keeping the knee in a fully extended position
sensitivity to unaltered or decrease
mechanical stress or INTERPRETATION
compression. ▪ Anterior torsion
● If the pain increases in the sacroiliac
Most important
joint,
physical signs of disc
 herniation, INTERPRETATION
regardless of the ▪ Posterior torsion
degree of disc injury ● If pain increases on the opposite side,
an anterior torsion on the opposite side should be
It is one of the most
suspected.
common neurological
tests of the lower INTERPRETATION
limb ▪ Anterior torsion on the opposite side

Phelp’s Test To detect the Px: Prone with knees Examiner passively abducts both thighs as far as ● The test is positive if abduction increases further.
contracture of extended possible, then flexes knees to 900 & tries to abduct INTERPRETATION
gracilis muscle. Examiner: At the feet of hips further. ▪ Gracilis contracture
the prone patient

Braggards Test If the Lasegue Px: Supine Straight leg raise; then lower the leg below the ● The test is positive if pain increases during
Test elicits pain Examiner: At the side to point of pain and passively dorsiflex the ankle dorsiflexion (nervous), whereas with no pain
when the patient's be tested (muscular)
leg is passively
INTERPRETATION
elevated,
▪ Meniscus injury
then Bragard's
Test is included as
an extra maneuver.
To test for
Meniscal
Tearing

Piriformis Test In about 15% of the Px: Side lying position The patient flexes the test hip to 60° with the knee ● If the piriformis muscle is tight, pain is elicited in Sciatica
population, the with the test leg flexed. The examiner stabilizes the hip with one hand the muscle. Fat wallet Syndrome
sciatic nerve, all or in uppermost and applies a downward pressure to the knee.
part, passes through
 the Piriformis muscle ● If the piriformis muscle is pinching the
rather than below it. sciatic nerve, pain results in the buttock
and sciatica may be experienced by the
These people are
patient.
more likely to suffer
● Resisted lateral rotation with the muscle
from this relatively
rare condition, on stretch (hip medially rotated) can cause the
piriformis syndrome same sciatica

Sicard’s test Straight leg raising and then extension of the

big toe instead of foot dorsiflexion.
Godfrey (Gravity) A Ligamentous Px: Supine The examiner holds both legs while flexing the ● The recognition of one tibia resting more inferiorly
Stability Test wherein patient’s hips and knees to 90° than the contralateral side.
the Posterior Cruciate The examiner should note if the patient has any This may be related to the posterior cruciate
Ligament (PCL) is the difference in the position the tibia is sitting bilaterally.
ligament.
one being tested.
INTERPRETATION
▪ Indicate a posterior sag or instability
● (+) Tear in the posterior cruciate ligament

INTERPRETATION
▪ Causing posterior knee instability.

Turyn’s test A nerve root traction You will dorsiflex the great toe while the leg is at rest. ● (+) Sharp shooting pain down back of leg or
test exacerbation of lower extremity complaint

INTERPRETATION
▪ sciatic nerve/ root traction/ irritation

Bounce Home Px: Supine The heel of the patient’s foot is cupped in the ● If extension is not complete or has a rubbery end
Test position examiner’s hand. feel (“springy block”), there is something
The patient’s knee is completely flexed, and the blocking full extension.
knee is passively allowed to extend.
INTERPRETATION
 ▪ The most likely cause of a block is a torn
meniscus.
● Knee is allowed to quickly extend in one
movement or jerk and the patient experiences a
sharp pain on the joint line

INTERPRETATION
▪ Meniscus Lesion

Bilateral SLR Test Px: Supine position and Examiner lifts both of the legs by flexing the ● If the test causes pain before 70° of hip flexion
knees extended patient’s hips until the patient complains of pain or
Examiner: Beside the tightness. INTERPRETATION
patient’s leg ▪ Sacroiliac joints
● After 70

INTERPRETATION
▪ Lumbar spine area.

Childress Sign A procedure that Patient squats and performs a “duck waddle” ● (+) Pain, snapping, or a click
provides functional Patient standing with feet approximately 1 meter apart
weight bearing and legs maximally internally rotated INTERPRETATION
assessment of the Patient then attempts a full squat ▪ posterior horn lesion of the meniscus
medial and lateral Maneuver is repeated with patient’s legs externally ▪ With internal rotation: lateral meniscus tear
meniscus of the knee. rotated. With external rotation: medial meniscus tear

Well Leg Raising With the unilateral straight leg raising test, If one leg is lifted and the patient complains of pain
Test 80°-90° of hip flexion is normal on the opposite side, it is an indication of a
space-occupying lesion
 This finding of pain when testing the opposite (good)
leg may be called the well leg raising test of
Fajersztajn, a prostate leg raising test, a sciatic
phenomenon, Lhermitt’s test, or the crossover sign

Indicates a large intervertebral disc protrusion,

usually medial to the nerve root, and a poor
prognosis for conservative treatment

Causes stretching of the ipsilateral as well as the

contralateral nerve root, pulling laterally on the dural
sac

A positive Lasegue’s and crossover sign can also

indicate the degree of disc injury

For example, both are limited to a greater degree if

sequestration of the disc occurs

If the examiner finds this test positive, careful

questioning about bowel and bladder symptoms is a
necessity.

Many, but not all, patients with a central protrusion

are candidates for surgery, especially if there are
bowel and bladder symptoms
Patellar Tap Test To detect swelling in Px: Supine with knee Examiner applies the thumb and forefinger of one hand ● A positive test is indicated by separation of the
(Ballotable the knee. extended lightly on both side of the patella. The examiner then thumb and forefinger
Patella) strokes down on the suprapatellar pouch with the
other hand
Brudzinski Test To determine Patient is supine, and elevates the head from the ● (+) If patient flexes hip and knee to alleviate the
meningeal table. pain, it indicates a positive test.
inflammation.
 Fairbank’s Test for dislocation of Px: Supine position Px lies in the supine position with quadriceps muscles ● (+) If the patient feels the patella is going to
Apprehension patella relaxed and the knee flexed to 30° dislocate the patient contracts the quadriceps
Test PT carefully and slowly pushes the patella muscles to bring the patella back “into line”
laterally
Kernig’s Test A test indicating the The patient raises the extended leg actively by ● (+) If the pain disappears, it is considered a
presence of flexing the hip until pain is felt. The patient then positive test.
meningitis flexes the knee

Compression Px: Supine The hips and knees flexed ● (+) If radicular pain into the posterior leg is
Test The hips are flexed until the PSIS start to move produced
backward (usually about 100° hip flexion)
INTERPRETATION
▪ Possible disc herniation.

Femoral Nerve px lies on the unaffected side with the unaffected limb ● (+) Neurological pain radiates down the anterior ● Traction test for the nerve roots
Traction Test flexed slightly at the hip and knee thigh at the mid lumbar area (L2–L4).
px’s back should be straight, not As with the straight leg raising
hyperextended.
test, there is also a
px's head should be slightly flexed.
contralateral positive test. That
px’s knee is then flexed on the affected side;
this movement further stretches the femoral nerve. is, when the test is performed,
the symptoms occur in the
opposite limb. This is called the
crossed femoral
stretching test.
● pain in the groin and hip that
radiates along the anterior
medial thigh indicates an L3
nerve root problem; pain
extending to the midtibia
 indicates an L4 nerve root
problem
● This test is similar to Ober’s
test for a tight iliotibial band,
so the examiner must be able to
differentiate between the two
conditions.
● If the iliotibial band is tight, the
test leg does not adduct but
remains elevated away from
the table as the tight tendon
riding over the greater
trochanter keeps the leg
abducted.
● Femoral nerve injury presents
with a different history, and the
referred pain (anteriorly) tends
to be stronger.

Oppenheim Test Upper motor lesions Px: Supine Examiner runs a finger nail along the crest of the ● The test is positive by a babinski sign
Examiner: At the px’s tibia
patient’s side

Gluteal Skyline To determine if there Px: Prone with the head Examiner asks the px to contract the gluteal ● (+) If flat muscle = atrophied or less contraction.
Test is damage in the straight and arms by muscles.
inferior gluteal nerve the sides Damage to the inferior gluteal nerve or pressure on
Examiner: At the px’s the L5, S1, or S2 nerve roots.
feet and observes the
buttocks from the level
of the buttocks
Pheasant Test Px: Prone With one hand, the examiner gently applies pressure to
the posterior aspect of the lumbar spine.
With the other hand, the examiner passively flexes
the patient’s knees until the heels touch
the buttocks.
H & I Stability Px: Standing (H) and 1ST PART: “H” movement.
Test Standing (I) Standing in the normal resting position, which would be
considered the center of the “H ”
**NOTE: The pain-free side is tested first.
STABILIZE: PELVIS and guide the movement with the
other hand on the shoulder.
ACTION: The patient is asked, with guidance from
the clinician, to side flex as far as possible.
While in this position, the patient is then asked to
flex and then move into extension. The
patient then returns to neutral and repeats the
movements
to the other side.
**NOTE: If flexion was more painful than
extension, then extension would be done
before flexion.
nd
2 PART: “I” movement.
STANDING in the normal resting position, which would be
considered the center of the “I ”.
**NOTE: Pain-free movement (flexion or
extension) is tested first.
● (+) If this hyperextension of the spine causes the
patient to feel pain in the leg test is considered
positive
(+) Unstable spinal segment
● (+) muscle spasm and instability
● For example, if the patient had
● If a hypomobile segment is
present, at least two of the
movements (the movements into
the same quadrant would be
limited. If instability is present,
one quadrant will again be
affected, but only by one of the
moves.
spondylolisthesis instability in
anterior shear (a component of
forward flexion) and the “I” is
attempted, the shear or slip
occurs on forward flexion, and
there is little movement during
the attempted side bending or
flexion. If the “H” is attempted,
the side bending is normal, and
the following forward flexion is
full because the shear occurs in
the second phase. So, in this
case, the “I” movement is limited
but not the “H” movement.
● This test is primarily for
structural instability, but
an instability jog may be evident
during one of the movements if
 ACTION: With guidance from the clinician, the patient is loss of control occurs. In this
asked to forward flex (or extend) the lumbar case, the end range is commonly
spine until the hips start to move. Once in flexion, the normal, but loss of control
patient is guided into side bending followed by occurs somewhere in the
return to neutral and then side bending to available ROM
the opposite side. The patient then returns to
neutral standing and does the opposite
movement (extension in this case)
followed by side bending.

Bicycle Test of Determines whether Px: Seated on an px is asked to pedal against resistance ● (+) neurogenic intermittent claudication Claudication *collection of
Van Gelderen the patient has exercise bicycle Part 1: The patient starts pedaling while leaning Part 1: (+) pain into the buttock and posterior symptoms usually caused by
neurogenic backward to accentuate the lumbar lordosis. thigh occurs, followed by tingling in the lumbar spinal stenosis — or
intermittent Part 2: The patient is then asked to lean forward narrowing of the lower spine.
affected lower extremity
claudication. while continuing to pedal. symptoms consist of:
Part 2: (+) pain subsides over a short period
• Pain
of time • Cramping
• Muscle Weakness –
limping in one or both
legs when walking

Milgram’s Test Test for joint Px: Supine Px actively lifts both legs simultaneously off the ● (+) Intrathecal/Extrathecal Pressure causing IV
dysfunction; should examining table 5 to 10 cm (2 to 4 inches), holding disk to place pressure on lumbar nerve root limbs
always be performed this position for 30 seconds. or affected limb cannot be held for 30 seconds –
with caution because
pain is present
of the high stress
load placed on the
lumbar spine.

Burn’s Test Determines if patient Px: Kneel on chair The px is asked to kneel on a ● If the px is unable to perform the test or the px
is positive for chair to touch the floor with the overbalances
malingering fingers
 Thomas Test The test is used to Px: Supine The examiner flexes one of the patient’s ● If a there is no flexion contracture, the hip being
assess a hip flexion hips, bringing the knee to the chest tested (straight leg) remains on the table
contracture to flatten out the lumbar spine and to ● If a contracture is present, the patient’s straight
stabilize the pelvis
leg rises off the table and a muscle stretch end
The patient holds the flexed hip against the
feel will be felt

Piedallu’s Sign Indicates restriction
of ther SI joint
mobility.
Px: Sitting Px is asked to bend forward, flexing the hip and ● If, with a finding of an uneven PSIS, the
trunk. relationship of PSIS to S2 reverses with forward
bending. This result occurs due to hypomobile SI
joint moving prematurely during the forward
bending of the subject.

Ober’s Test The Ober's test Px: Side lying, Flexed Extend and Abduct the hip joint ● If the ITB is tight, the leg would remain in the
evaluates a tight, hip and knee near 90 Slowly lower the leg toward the table -adduct hip- until abducted position and the patient would
contracted or deg. motion is restricted experience lateral knee pain.
inflamed tensor Ensure that the hip does not internally rotate during
fasciae latae (TFL) the test and the pelvis must be stabilized to maintain
and iliotibial band position
(ITB).
Thompson’s Used in lower limb Px: Patient lays prone Examiner squeeze the calf muscles. ● If plantarflexion is absent
(Simmond’s) examination to test or kneels on the chair INTERPRETATION
Test for the rupture of the with the feet over the ▪ Rupture of the Achilles tendon
Achilles tendon. edge of the table or
chair
Examiner: At the feet of
the prone patient

Ely’s Test Ely's test or Px: Prone Examiner passively flexes the px’s knee ● If the px’s hip on the same side spontaneously
Duncan-Ely test is Examiner: At the side to flexes
used to assess rectus be tested INTERPRETATION
femoris spasticity or
▪ Rectus femoris muscle is tight
tightness.
Windlass Test Patient stands on a stool or chair with the foot ● Pain or increased pain at the insertion of the “WINDLASS” – tightening of a rope
positioned so that the metatarsal heads rest on the edge plantar fascia or cable
of the stool while the patient maintains weight through INTERPRETATION Windlass Test – important in the
the leg. decision-making process involved
▪ Rectus femoris muscle is tight
Examiner passively dorsiflexes the big toe. in the evaluation and treatment of
▪ plantar fasciitis.
plantar fasciitis
● Lack of extension may indicate hallux rigidus. Plantar fascia – stimulates a cable
attached to the calcaneus and the
metatarsophalangeal joint
Winding of Plantar Fascia –
shortens the distance between the
calcaneus and metatarsals to
elevate the medial longitudinal arc
Can perform:
✔ Weight bearing position
✔ Non-weight bearing
position

Hoover Test To identify Px: Supine Examiner places one hand under each calcaneus while ● If patient does not lift the leg or the examiner
neuromuscular the patient’s legs remain relaxed on the examining table. does not feel pressure under the opposite heel:
weakness or lack of Patient is asked to lift one leg off the table, keeping the ● Patient is probably not really trying
effort by the patient knees straight, as for active straight leg raising.
● Patient is a malingerer
● If lifted limb is weaker, however, pressure under
the normal heel increases, because of the
increased effort to lift the weak leg.
● Two sides are compared for differences.

Morton’s Test Px: Supine The examiner grasps the foot around the metatarsal ● Pain is a positive sign for stress fracture or
heads and squeezes the heads together. neuroma.
Flamingo Test Px: asked to stand on When the patient is standing on one leg, the weight of
one leg the trunk causes the sacrum to shift forward and distally
(caudally) with forward rotation.
The ilium moves in the opposite direction. On the
non–weight-bearing side, the opposite occurs, but the
stress is greatest on the stance side.
Homan’s Sign The patient’s foot is passively dorsiflexed with
the knee extended. Pain in the calf indicates a positive
Homans sign for deep vein thrombophlebitis.
Gaenslen Test Px: Lies on the side Side-lying
with the upper leg (test The patient holds the lower leg flexed against the chest.
leg) hyperextended at The examiner stabilizes the pelvis while extending the
the hip. hip of the uppermost leg.
Supine
Gaenslen’s test is sometimes done with the patient
Supine, but this position may limit the amount of
hyperextension available. The patient is positioned so
that the test hip extends beyond the edge of the table.
The patient draws both legs up onto the chest and then
slowly lowers the test leg into extension. The other leg is
tested in a similar fashion for comparison.
Thessaly Test Px: Standing The patient stands flat footed on one leg while the
examiner provides his or her hands for balance. The
patient then flexes the knee to 5° and rotates the
● (+) If pain in the symphysis pubis or sacroiliac The stress may be increased by
joint is present -- indicates a positive test for having the patient hop on one leg.
lesion in whichever structure is painful. The stress This position is also used to take a
stress x-ray of the symphysis
may be increased by having the px hop on one leg.
pubis.
● A. Homans sign for thrombophlebitis.
● B. Palpation for tenderness in thrombophlebitis.
● Pain in the calf indicates a positive Homans sign
for deep vein thrombophlebitis.
● Tenderness is also elicited on palpation of the
calf. In addition to these findings, the examiner
may find pallor and swelling in the leg and a loss
of the dorsalis pedis pulse.
● (+) Pain - The pain may be caused by an
ipsilateral sacroiliac joint lesion, hip pathology, or
an L4 nerve root lesion.
● (+) Pain in the sacroiliac joints
● (+) If the patient experiences medial or lateral
joint line discomfort.
 femur on the tibia medially and laterally three
times while maintaining the 5° flexion. The good
leg is tested first, and then the injured leg. The test is
then repeated at 20° flexion. The patient may also
have a sense of locking or catching in the knee.
True Leg Length Examiner: Must set the The legs should be 15 to 20 cm (4 to 8 inches)
Test pelvis square, level, or apart and parallel to each other.
in balance with the
lower limbs The lower limbs must be placed in comparable positions
relative to the pelvis, because abduction of the hip brings
the medial malleolus closer to the ASIS on the same side
and adduction of the hip takes the medial malleolus
farther from the ASIS on the same side.
INTERPRETATION
▪ The test is considered positive for a meniscus tear
● If one hip is fixed in abduction or
adduction as a result of contracture or some
other cause, the normal hip should be adducted or
abducted an equal amount to ensure accurate leg
length measurement.
In North America, leg length
measurement is usually taken from
the ASIS to the medial malleolus;
however, these values may be
altered by muscle wasting or
obesity.

To obtain the leg length, the examiner measures from the

ASIS to the lateral or medial malleolus. The flat metal end
of the tape measure is placed immediately distal to the
ASIS and pushed up against it.

The index finger of the other hand is placed immediately

distal to the lateral or medial malleolus and pushed
against it. The thumbnail is brought down against the tip
of the index finger so that the tape measure is pinched
between them.

A slight difference (as much as 1 to 1.5 cm) in leg length

is considered normal; however, this difference can still
cause symptoms.
Apparent Leg The examiner obtains the distance from the tip of the
Length Test xiphisternum or umbilicus to the medial malleolus.
● If true leg length is normal but the
umbilicus-to-malleolus measurements are
different, a functional leg length discrepancy is
present
 Trendelenburg To detect the Px: Standing Px: Standing or balance first on one leg and then on the ● If the pelvis on the opposite side (nonstance side)
Test/sign weakness of the other drops when the px stands on the affected leg
Gluteus medius. Examiner watches the movement of the pelvis INTERPRETATION
The pelvis on the side of the nonstance leg rises, that is
▪ Gluteus medius weakness or unstable hip.
considered negative.

Patrick Test To detect Iliopsoas Px: Supine The examiner the slowly lowers the knee of the test leg ● Indicate that the test leg's knee remains above
spasm or know if the Examiner: At the side to toward the examining table the opposite straight leg.
the sacroiliac joint is be tested ● It also indicates that the hip joint joint may be
affected.
affected
INTERPRETATION
▪ Iliopsoas spasm or the sacroiliac joint is affected.

Galeazzi Sign The Galeazzi test is Px: Supine The child lies supine with the knees flexed and the hip ● A positive test is indicated if one knee is higher
good only for flexed to 90 degrees than the other.
assessing unilateral
CDH or unilateral DDH
and may be used in
children from 3 to 18
months of age.
Rectus Femoris Px: Supine with knees The patient flexes one knee onto the chest and holds it. ● (+)If does not, a contracture is probably present.
Contracture Test bent over the end or The angle of the knee should remain 90 degrees
edge of the examining when the opposite knee is flexed to the chest.
table.
Lachman Test The Lachman Px: Supine The examiner holds the patient’s knee between full ● A positive sign is indicated by a “mushy” or
test, which may extension and 30° of flexion. soft end feel when the tibia is moved forward
also The patient’s femur is stabilized with one of the on the femur (increased anterior translation with
be referred to as the examiner’s hands (the “outside” hand) while the
medial rotation of the tibia) and
Ritchie, Trillat, proximal aspect of the tibia is moved forward with the
disappearance of the infrapatellar
or other (“inside”) hand.
Lachman-Trillat Frank1 reported that to achieve the best results, the tibia tendon slope.
test, is the best should be slightly laterally rotated and the anterior tibial
 indicator of injury to translation force should be applied from the
the anterior posteromedial aspect. Therefore the hand on the tibia ● A false negative test may occur if the femur is not
cruciate should apply the translation force properly stabilized, if a meniscus lesion blocks
ligament, translation, or if the tibia is medially rotated.
especially the
posterolateral band,
although this has A positive sign indicates
been questioned. It is 1. Anterior cruciate ligament (especially the
a test for one-plane
posterolateral bundle)
anterior
2. Posterior oblique ligament
instability.
3. Arcuate-popliteus complex

Reverse It is a test for the Px: Prone with knee The examiner grasps the tibia with one hand while fixing ● The examiner should be wary of a false-positive
Lachman posterior cruciate flexed to 30 the femur with the other hand. The examiner ensures test if the anterior cruciate ligament has been
ligament. that the hamstring muscles are relaxed. The examiner torn, because gravity may cause an anterior shift.
then pulls the tibia up (posteriorly), noting the amount of
This test is not as accurate for the posterior
movement and the quality of the end feel.
cruciate ligament as the posterior drawer test,
because when the posterior cruciate ligament is
torn, the greatest posterior displacement is at
90°.

(Knee) Drawer ACL and PCL The patient’s knee is flexed to 90°, and the hip is flexed If the test is (+), the following structures may have
Sign instability to 45°. The patient’s foot is held on the table by the been injured to some degree:
The drawer sign is a examiner’s body with the examiner sitting on the 1. Anterior cruciate ligament (especially the
test for one-plane patient’s forefoot and the foot in neutral rotation. The anteromedial
anterior and examiner’s hands are placed around he tibia to ensure bundle)
one-plane posterior that the hamstring muscles are relaxed. 2. Posterolateral capsule
instabilities. 🞆 Anterior drawer test - the tibia is then 3. Posteromedial capsule
drawn forward on the femur. The normal 4. Medial collateral ligament (deep fibers)
amount of movement that should be present 5. Iliotibial band
is approximately 5 mm. This part of the test 6. Posterior oblique ligament
assesses one-plane anterior instability. 7. Arcuate-popliteus complex
 🞆 Posterior drawer test - in this part of
the test, the tibia is pushed back on the
femur. This phase is a test for one-plane
posterior instability.
If the test is (+) or a posterior sag is evident, the
following structures may have been injured to some
degree:
1. Posterior cruciate ligament
2. Arcuate-popliteus complex
3. Posterior oblique ligament
4. Anterior cruciate ligament

Valgus Stress Is an assessment for The examiner applies a valgus stress (pushes the knee If the test is (+) when the knee is in extension:
Test one-plane (straight) medially) at the knee while the ankle is stabilized in 1. Medial collateral ligament (superficial and deep
medial instability, slight lateral rotation either with the hand or with the leg fibers)
which means that the held between the examiner’s arm and trunk. 2. Posterior oblique ligament
tibia moves away The knee is first in full extension, and then it is slightly 3. Posteromedial capsule
from the femur (i.e., flexed (20° to 30°) so that it is “unlocked.” 4. Anterior cruciate ligament
gaps) on the medial 5. Posterior cruciate ligament
side. 6. Medial quadriceps expansion
7. Semimembranosus muscle
If the test is (+) when the knee is flexed to 20° to
30° :
1. Medial collateral ligament
2. Posterior oblique ligament
3. Posterior cruciate ligament
4. Posteromedial capsule

Varus Stress Test For One-plane lateral Px: Supine or long Examiner applies a varus stress (pushes the knee ● (+) If tibia moves away from the femur when
instability sitting with test leg laterally) at the knee while ankle is stabilized. varus stress is applied.
over the edge of the INTERPRETATION
table;with Knee
▪ Indicates major instability of the knee.
Extended and
afterwards, Knee
Flexed 20 to 30
degrees.
 Examiner: At the
patient’s side of test
leg.

Apley’s For Meniscus Injury Px: Prone; Knees flexed For Distraction: ● (+) If Rotation + Distraction = Pain / shows
Distraction Test to 90 degrees 1. Stabilize thigh with PT’s Knee increased rotation relative to normal side
Examiner’s knee is 2. Medially / Laterally rotate tibia with ● (+) If Rotation + Compression = Pain / shows
used to stabilize thigh.
Distraction decreased rotation relative to the normal side
For Compression:
1. Stabilize thigh with PT’s Knee
Distraction = Lesion is Ligamentous
2. Medially / Laterally rotate tibia with Compression = Lesion is probably a meniscus injury
Compression