Special Test for Cervical Spine Px: Sitting
(+) sign: Relief of Pain
Craniocervical Flexion Test Significance: Pressure on the
Px: Supine Nerve Roots
(+) sign: If patient cannot increase pressure to at least Procedure: Place one hand under
26mmHg, unable to hold contraction for 10 seconds, uses the patient's chin and the other
superficial neck around the occiput. Slowly lift the
muscles and extends head, applying traction to the
the head cervical spine.
Significance: Deep Jackson’s Compression Test
cervical flexor muscle Px: Sitting
function (+) Sign: Pain radiates into the
Procedure: Pressure arm
device is inflated to fill in Significance: Cervical Nerve
the lordotic curve of Root Compression
cervical spine. Pt. flexes spine by nodding the head in 5 Procedure: Rotates patient’s
segments of increasing pressure. head to one side and apply a
downward pressure on the
Brachial Plexus Tension Test head.
Px pos: Sitting
(+) sign: Radicular symptoms ULNT (1-4)
with elbow flexion
Significance: Mechanical
cervical lesions having a
mechanical component
Procedure: Patient abducts the
arms with the elbows extended,
stopping just short of the onset of
symptoms. The patient laterally
rotates the shoulder just short of
symptoms, and the examiner then
holds this position. Finally, the
patient flexes the elbows so that
the hands lie behind the head.
Foraminal Compression Test
Px: Sitting
(+) sign: Pain radiates to arm toward which head is side
flexed
Significance: Cervical
Nerve Root Compression
Procedure:
First Phase: Compress
with head in neutral
position
Second Phase:
Compress with head
extended
Third Phase: Compression with head extended and rotated
to unaffected side. Romberg Test
Px: Standing, both feet together, arms by the sides
Distraction Test (+) sign: Excessive swaying, patient losses
balance
Significance: Upper motor neuron lesion
Procedure: Patient is asked to close the eyes. The
position is held for 20 to 30 seconds.
Lateral Shear Test
Px: Supine Procedure:
(+) sign: Increased translation between C1 and C2 1. Sustained full neck and
Significance: Assess segmental instability head extension
Procedure: PT places 2nd MCP of one hand against the 2. Sustained full neck and
transverse process of the atlas and the MCP joint of the head rotation, right and
other hand against the opposite transverse process of the left (Barre-Lieou sign)
axis. Push hands together carefully, causing a shear of one 3. Sustained full neck and
bone on the other. head rotation with
VASCULAR SIGNS TEST extension right and left
(DeKleyn’s test)
BARRE’S TEST (PRONATOR DRIFT) 4. Provocative movement position*
Pt’s Position: Standing, shoulders forward flexed to 90 5. Quick head movement into provocative position*
degrees, elbow straight and 6. Quick repeated head movement into provocative position*
forearms supinated, palms up and 7. Head still, sustained trunk movement left and right (10 to
eyes closed. 30 seconds)
Procedure: 1. Pt must hold the 8. Head still, repeated trunk movement left and right
position for 10-20 seconds. (+) Sign: (+) Sign: Nystagmus and complaints by the pt of dizziness,
One arm slowly falls with lightheadedness, or visual disturbances
simultaneous forearm pronation Significance: Vertebral Artery Pathology
Significance: Diminished blood flow Note: if symptoms occur with the first test, there is no need
to the brainstem to progress to the next test
HAUTANT’S TEST Pt’s Position: Supine
Pt’s Position: Seated Procedure:
Procedure: 1. Pt actively forward flexes both arms to 90 1. Sustained full neck and head extension
degrees and closes the eyes. Hold for 10-30 seconds. PT will 2. Sustained full neck and
watch for any loss of arm position. 2. Pt is then asked to rotate, head rotation left and right
or extend and rotate the neck with both arms still flexed to 90 3. Sustained full neck and
degrees. Pt closes the eyes and holds for 10-30 seconds. PT head rotation with extension
will watch for any loss of arm position. left and right (if combined
(+) Sign: 1. Arms move — nonvascular cause 2. Wavering of with side flexion, it is called
arms — vascular impairment to the brain the Hallpike maneuver).
Significance: Dizziness and vertigo caused by vascular 4. Unilateral posteroanterior oscillation (Maitland’s grade IV)
problems of C1 to C2 facet joints (prone lying) with head rotated left
and right
5. Simulated mobilization and manipulation position
6. Each position should be held for at least 10 to 30 seconds
unless symptoms are evoked.
(+) Sign: Nystagmus and complaints by the pt of dizziness,
lightheadedness, or visual disturbances
Significance: Vertebral Artery Pathology
NAFFZIGER TEST CERVICAL QUADRANT (VERTEBRAL ARTERY) TEST
Pt’s Position: Seated Pt’s Position: Supine
Procedure: 1. While standing behind the pt, the examiner Procedure: 1. While standing at
places his or her fingers over the pt’s the head of the pt, the examiner
jugular veins. 2. Examiner passively moves patient’s head
compresses the veins for 30 seconds. and neck into extension and side
3. Ask the pt to cough. flexion 2. Then rotation to the
(+) Sign: Pain same side 3. Hold for 30 seconds
Significance: Nerve root problem or (+) Sign: Dizziness or nystagmus
space-occupying lesion (e.g tumor) Significance: Vertebral artery compression
Precaution: If lightheadedness or
similar symptoms occur with HALLPIKE-DIX TEST
compression of the jugular veins, the test should be Pt’s Position: Long-sit, head rotated 30° to 45°
terminated. Procedure: 1. Examiner stands behind the pt. with one hand
supporting the head/neck and the other hand supporting the
STATIC VERTEBRAL ARTERY TEST (2 Positions) trunk. 2. The patient assisted into supine position with the
Pt’s Position: Seated
patient’s head slightly below the horizontal plane, and the Pt’s Position: Supine lying
position is maintained for 30 to 60 seconds Procedure:
(+) Sign: Dizziness and nystagmus 1. While standing/sitting at the
Significance: BPPV pt’s head, the examiner sits or
stands at the head of the
patient
2. Examiner flexes the
cervical spine fully
3. While holding the flexed
position, the examiner then
rotates the head left and right.
(+) Sign: The rotation is less
(hypomobility) or more
(hypermobility) than normal
SHARP PURSER TEST rotation in the flexed position
Pt’s Position: Short sitting (about 45° each way)
Procedure: Significance: C1-C2
1. Place one hand over the pt’s dysfunction
forehead while the thumb of the
other hand is placed over the axial
spinous process to stabilize it.
2. Pt slowly flexes the head while the SPECIAL TESTS: SHOULDER
PT presses backward c the palm.
(+) Sign: PT feels the head slide Anterior Release Test (Surprise Test)
backwards during the mvt & may be Pt. position: pt. in supine; abducts arm to 90 deg and laterally
accompanied by a “clunk”. rotates pt's shoulder
Significance: Subluxation of the atlas on the axis Procedure/s: Abduction and lateral rotation combined with
Note: This test should be performed with extreme caution. posterior translation of the humerus (relocation test)
- then release the pressure from the shoulder
DEEP NECK FLEXOR ENDURANCE TEST Positive response: pain and forward translation of the head
Pt’s Position: Hook lying supine position, chin maximally of the humerus
retracted and maintained Significance: anterior shoulder instability, labral lesion
Procedure: (SLAP lesion — superior labrum, anterior posterior lesion)
1. Ask the patient to perform a maximum chin tuck while lifting
their head approximately 2 to 5 cm (1inch) above the table.
2. The physical therapist places their hand under the patients
head (occiput).
3. Watch for skin folds on the chin area, when the skin folds
disappear or the patient’s head touches the PT’s hand, the
test is terminated.
(+) Sign: unable to hold the neck for >26 sec
Significance: Neck pain (24 sec)
Crank & Relocation Test
Pt. position: Supine
Procedure/s:
Abduct arm to 90 deg and laterally rotates pt's shoulder
slowly. Abduction and lateral rotation combined with posterior
translation of the humerus (relocation test)
Positive response: Posterior pain increase
Significance: Posterior internal impingement
CERVICAL FLEXION ROTATION TEST
Load & Shift Test: Anterior Instability
Pt. position: Sitting relaxed on the chair with his arm resting
on the thigh
Procedure/s: The examiner grasp the humeral head and Procedure/s: The examiner
stabilize the shoulder. Seat the humerus on the glenoid fossa forward flexes the arm to 90
and punch anteriorly to check for instability degrees, horizontally adducts the
Positive response: arm across the body 10-20
degrees and internally rotated
then forcibly medial rotates the
shoulder
Positive response: Pain in the
area of the coracoid
Significance: Impingement of
the subscapularis between the
coracoid process and the lesser
tuberosity
Significance: A traumatic problems at the glenohumeral joint
Yocum Test
Load & Shift Test: Posterior Instability Pt. position: Patient stands
Pt. position: Sitting relaxed on the chair with his arm resting Procedure/s: Patient’s hand is placed
on the thigh on the opposite shoulder and the
Procedure/s: The examiner grasp the humeral head and examiner elevates the elbow
stabilize the shoulder. Seat the humerus on the glenoid fossa Positive response: Pain
and punch posteriorly to check for instability Significance: Examine the possibility
Positive response: same above of a shoulder rotator cuff impingement
Significance: A traumatic problems at the glenohumeral joint (subacromial impingement syndrome).
Sulcus Sign
Pt. position: Stands with the arm by the side and shoulder Zaslav Test
muscles relaxed. Pt. position: The patient stands
Procedure/s: The examiner grasps the patient’s forearm with the arm abducted to 90° and
below the elbow and pulls the arm. laterally rotated 80° to 85°.
Positive response: Pain/ ache on activity Shoulder does not Procedure/s: The examiner then
“feel right” with activity applies an isometric resistance into
Significance: Inferior Shoulder Instability lateral rotation followed by
isometric resistance into medial
rotation
Positive response: patient has
good strength in lateral rotation but not medial rotation.
Significance: Internal Impingement
Active Compression Test of O'Brien
Pt. position:
Position 1: Standing with arm forward flexed to 90* with the
elbow fully extended and adducted 10-15* medial to the
midline of the body and with the thumb pointed down
Position 2: The Pt. Is in the same position, but the patient fully
*Humeral head displacement of more than 2 cm from the supinates the arm with the palm facing the ceiling
acromion has been reported to be indicative of a high degree Procedure/s: The examiner applies a downward force to the
of glenohumeral laxity arm and the patient will resist the force.
Positive response: Pain is elicited in Position 1 when force
Coracoid Impingement Sign is applied and reduced or eliminated when applying force in
Pt. position:Patient is standing or sitting on a high table Position 2
Significance: Superior Labral Tear/Injury (SLAP Type II)
HORIZONTAL ADDUCTION TEST
The patient stands and reaches the hand across to the (+)WEAKNESS OR PAIN FOR
opposite shoulder. The examiner may also passively perform RESISTANCE TO
the test. With the patient in a sitting position, the examiner ABDUCTION
passively forward flexes the arm to 90 and then horizontally Significance:TEAR OF
adducts the arm as far as possible. If the patient feels THE SUPRASPINATUS
localized pain over the acromioclavicular joint, the test is TENDON OR MUSCLE,
positive. Localized pain in the sternoclavicular joint indicates OR NEUROPATHY OF
that joint is at fault. SUPRASCAPULAR
NERVE.
PAXINOS SIGN Procedure:provides
The patient is seated with the test arm relaxed at the side. The resistance to abduction.
examiner stands beside the test arm and places one hand
over the shoulder so that the thumb is under the posterolateral GERBER’S TEST/LIFT OFF
aspect of the acromion and the index and long fingers of the SIGN
same hand over the middle part of the clavicle on the same Px: Stands and places the
side. The examiner then applies pressure to the acromion with dorsum of the hand on the
the thumb anterosuperiorly while applying an inferior directed pocket or against the
counterforce to the clavicle with the fingers. The test is midlumbar spine. The
considered positive if pain in the area of acromioclavicular patient then lifts the hand
joint is increased away from the back.
(+)INABILITY TO DO
SPEED’S TEST
Significance: Lesion to
Biceps or Straight-Arm Test
subscapularis muscle
The examiner resists shoulder forward flexion by the patient
while the patient's forearm is first supinated, then printed, and (+) ABNORMAL MOTION IN THE
the elbow is completely extended. The test may also be SCAPULA
performed by forward flexing the patient's arm to 90 and then Significance: Scapular instability
asking the patient to resist an eccentric movement into
extension first with the arm supinated, then pronated.
(+) elicits increased tenderness in the bicipital groove
especially with the arm supinated and is indicative of bicipital
paratenonitis or tendinosis
Significance: bicipital paratenonitis or tendinosis
YERGASON’S TEST
Px: Elbow flexed to 90°and stabilized against the thorax and
with the forearm pronated
Procedure: Resists supinated while the pt. Also laterally
rotates the arm against resistance.
(+) Tenderness in the bicipital groove alone without the
dislocation
Significance:Bicipital paratenonitis/tendinosis
INFRASPINATUS TEST
Px: stands with the arm at the
side with the elbow at 90°and
the humerus medially rotated to
45°
DROP ARM TEST Examiner:Applies a medial
Procedure: Pt. abducts the arm to 90°. rotation force that the patient
and ask the pt to slowly lower the arm. resists
(+):the pt is unable to return the arm to (+)Pain or the inability to resist medial rotation
the side slowly or has severe pain when Significance:Infraspinatus strain
attempting to do. WHIPPLE TEST
Significance:Tear in rotator cuff complex Px: stands with the arm forward flexed to 90 and adducted
until the hand is opposite the shoulder
SUPRASPINATUS (“EMPTY CAN” OR JOBE) TEST
Px: arm is abducted to 90°with neutral rotation
Examiner: pushes downward at the wrist while the patients PROVOCATIVE ELEVATION
resists TEST
(+): partial rotator cuff tears and/or superior labrum tears. This test is a modification of the
Significance: for rotator cuff and superior labral tears Roos test
(+) fatigue, cramping, or tingling
HORNBLOWER'S SIGN (SIGNE DE CLAIRON)/PATTE occurs during the test
TEST Significance vascular insufficiency and thoracic outlet
Position:Standing syndrome
Procedure: The examiner elevates the patient's arm to 90 Procedure The patient elevate both arms above the
degrees in scapular plane (scaption). The examiner then horizontal and is asked to rapidly open and close the hands
flexes the elbow to 90 degrees, and the patient is asked to fifteen times
laterally rotate the shoulder against resistance.
(+): Unable to laterally rotate the arm SH GIRDLE PASSIVE ELEVATION
Significance:Teres minor tear TEST
This test is conducted when Pt has
McClusky Modification symptoms
Position:Standing The patient sits, and the examiner
Procedure:Patient's arm by the side and then is asked to grasps the patient’s arms from behind
bring the hands to the mouth and passively elevates the shoulder
(+):The patient is unable to to this without abducting the arm girdle up and forward into full
first elevation (a passive bilateral shoulder
Significance:Posterior rotator cuff tear shrug) the position is held for 30 or more seconds
(+) the release phenomenon in which symptoms are relief
Special Test: Arms and Elbows
Test for Thoracic Outlet Syndrome
ADSON MANEUVER
Procedure The examiner locates the radial. The patient’s
head is rotated to face the test shoulder The patient then
extends the head while the examiner laterally rotates and
extends the patient’s shoulder The patient is instructed to take
a deep breath and hold it
(+) Absence of pulse WRIGHT TEST
Procedure: PT palpates the radial pulse
COSTOCLAVICULAR and the hand is brought over the head with
Procedure PT palpates radial pulse and draws pt’ shoulder the elbow and arm in the coronal plane with
down and back the shoulder laterally rotated flexes the
(+) Absence of pulse patient's elbow to 90 while the shoulder is
extended horizontally and rotated laterally
HALSTEAD MANEUVER The patient then rotates the head away
(+) Absence Disappearance of pulse from the test side
Procedure The examiner finds the radial pulse and applies a (+) Disapperance/Absence of pulse when
downward traction on the test extremity while the patient’s head is rotated away from the test side
neck is hyperextended and the head is rotated to the opposite
side
ROOS TEST
Procedure patient stands and Abduction arm to 90 degrees,
laterally rotates the shoulder flexes elbow to 90 degrees, so
that elbows are slightly behind the frontal plane the patient
then opens and closes hands slowly for 3 min
(+) PAIN / TINGLING SENSATION
Significance THORACIC OUTLET SYNDROME BICEPS SQUEEZE TEST
Procedure The patient’s elbow
is flexed to between 60 and 80
The examiner then squeezes
the biceps muscle belly If the
biceps tendon is ruptured, the
patient’s forearm will not
supinate
(+) Forearm will not supinate • The examiner grasps
Significance Biceps Tendon Rupture the triquetrum
HOOK TEST between the thumb
(+): If no cord like structure can be hooked and second finger of
Procedure The patient abducts the shoulder to 90 with the one hand and the
elbow flexed to 90 and the arm supinated so that the thumb lunate with the
faces up The patient is then asked to actively supinate the thumb and second
forearm against resistance of the examiner With the index finger of the other
finger of the other hand, the examiner attempts to “hook” hand
underneath the biceps tendon, “hooking” from lateral to • The examiner then
medial at the same time moves the lunate
up and down (
SPECIAL TESTS Forearm, Wrist, and Hand anteriorly and
LIGAMENT, CAPSULE, AND JOINT INSTABILITY posteriorly)
Significance:
Axial Load Test • Lunotriquetral Instability
Px position: Sitting
Positive Sign: Pain or crepitation Murphy’s Sign
Procedure: Px position: Sitting
• The pt. sits while the examiner stabilizes the px’s Positive Sign: 3rd MCP joint is
wrist with one hand in line with and 2nd and 4th
• With the other hand the examiner carefully grasps MCP joint
the px’s thumb and apply axial compression Procedure:
Significance: • Ask the px to make a
• Fracture to metacarpal or adjacent carpal bones fist
• Jt. Arthrosis Significance:
• Lunate dislocation
Shuck Test | Finger Extension Test
Px position: Sitting NEUROLOGICAL
Positive Sign: Pain DYSFUNCTION
Procedure: Froment’s “Paper” Sign
• Hold pt’s wrist flexed Positive Sign: Terminal phalanx
• Ask pt to actively extend the fingers against of the thumb flexes because of
resistance paralysis of the adductor pollicis muscle
Significance: Procedure:
• Radiocarpal / Midcarpal instability • The patient attempts to grasp a piece of paper
• Scaphoid instability between the thumb and index finger
• Inflammation • The examiner then attempts to pull the paper away
• Kienbock’s disease Significance:
• Ulnar nerve paralysis
Lichtman (Midcarpal Shift) Test
Px position: Sitting with arm pronated and wrist in neutral
position
Positive Sign: Distal carpal row jumps or snaps dorsally
from its subluxed position palmary and reduces the pt’s
symptoms
Procedure:
• Apply anteriorly direct force to the capitate with
axial compression while passively moving the wrist
from radial deviation to ulnar deviation
Significance:
Midcarpal instability
Lunotriquetral Ballottement Test | Reagan’s Test
Px position: Sitting
Positive Sign: Laxity, Crepitus, Pain
Procedure:
Flick Maneuver
Px position: The patient is seated or standing. Pt.
complains of paresthesia in the hand in the median nerve
distribution.
Positive Sign: A resolution of the symptoms after flicking or
shaking the hands is considered a positive test
Procedure:
• The patient is asked to vigorously shake the hands
or flick the wrists
Significance:
• Carpal Tunnel Syndrome
Carpal Compression Test
Position: Seated
Positive Sign: Production of patient’s symptoms
Procedure:
• Examiner holds the supinated wrist in both hands
and applies direct, even pressure over the median
nerve in the carpal tunnel for up to 30 seconds
Significance:
• Carpal Tunnel Syndrome
Weber’s (Moberg’s) 2-Point Discrimination Test
Px position: Pt. seated and must not see the area to be
tested. Pt’s hand is immobile and on hard surface
Positive Sign: Beyond normal discrimination distance
(6mm)
Procedure:
• PT uses clip, two-point discriminator or calipers to
simultaneously apply pressure on two adjacent
points perpendicular to long axis of finger
• PT moves proximal to distal in finding “threshold for
discrimination”
Significance:
• Damage to peripheral nerve or posterior column-
medial lemniscus pathway
