Shoulder Depression Test Shoulder Abduction Test Distraction Test Lhermittes Sign Jacksons Test Scalene Cramp Test Valsalva Test Tinels Sign Brachial Plexus Compression Test Upper Limb Tension Test (ULTT) Rombergs Test Vertebral Artery Test Naffzigers Test Caloric Test Sharp Purser Test 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.
Othes name: Spurlings Test Shoulder Depression Test Px: sitting (+) sign: increase pain Significance: Nerve Root Compression Procedure: side flex patients head on unaffected side then apply a downward pressure on the opposite shoulder (affected side).
Shoulder Abduction Test Px: sitting (+) sign: relief of symptoms Significance: Nerve Root Compression Procedure: abduct patients arm then rest hand or forearm on top of the head. Distraction Test Px: Sitting (+) sign: relief of Pain Significance: Pressure on the Nerve Roots Procedure: place one hand under the patients chin and the other around the occiput. Slowly lift the head, applying traction to the cervical spine. Lhermittes Sign Px: Long Sitting position (+) sign: pain radiating down the spine Significance: Dural or Meningeal Irritation Procedure: Flex the patients head and one hip simultaneously with the leg kept straight. Jacksons Test Px: sitting (+) sign: Pain Radiates into the arm Significance: Cervical Nerve Root Compression Procedure: Rotates patients head to one side and apply a downward pressure on the head. Scalene Cramp Test Px: sitting (+) sign: increase pain Significance: Plexopathy / Thoracic Outlet Syndrome Procedure: Patient actively rotates the head to the affected side and pulls chin down into the hollow above the clavicle by flexing the cervical spine Valsalva Test Px: (+) sign: increase pain Significance: increase intrathecal pressure Procedure: Patient takes a deep breath and hold it while bearing down, as if moving bowels Tinels Sign Px: sitting with neck slightly flexed (+) sign: localized pain Significance: cervical plexus lesion Procedure: Tap the area of the Brachial Plexus with a finger along the nerve trunks. Brachial Plexus Compression Test Px: sitting (+) sign: pain radiates into the shoulder Significance: Mechanical cervical lesions having a mechanical component Procedure: Apply firm compression to the brachial plexus by squeezing the plexus under the thumb or fingers Upper Limb Tension Test 1 (ULTT1) Shoulder: depression and abduction (110:) Elbow: Extension Forearm: Supination Wrist: Extension Fingers and Thumb: Extension Shoulder: --- Cervical Spine: Contralateral side flexion Nerve Bias: Median Nerve, Anterior Interosseous Nerve, Nerve Roots C5, C6, C7 Upper Limb Tension Test 2 (ULTT2) Shoulder: Depression and abduction (10:) Elbow: Extension Forearm: Supination Wrist: Extension Fingers and Thumb: Extension Shoulder: Lateral Rotation Cervical Spine: Contralateral side flexion Nerve Bias: Median Nerve, Axillary Nerve, Musculocutaneous Nerve Upper Limb Tension Test 3 (ULTT3) Shoulder: Depression and abduction (10:) Elbow: Extension Forearm: Pronation Wrist: Flexion and Ulnar deviation Fingers and Thumb: Flexion Shoulder: Medial Rotation Cervical Spine: Contralateral side flexion Nerve Bias: Radial Nerve Upper Limb Tension Test 4 (ULTT4) Shoulder: Depression and abduction (90:) Elbow: Flexion Forearm: Supination Wrist: Extension and Radial deviation Fingers and Thumb: Extension Shoulder: Lateral Rotation Cervical Spine: Contralateral side flexion Nerve Bias: Ulnar Nerve, Nerve Roots C8 and T1 Rombergs Test Px: Standing (+) sign: Swaying Significance: Upper Motor Neuron Lesion (UMNL) Procedure: Patient stands and is asked to close their eyes and hold the position for 20-30 seconds. Vertebral Artery Test Px: Supine (+) sign: Dizziness / Nystagmus Significance: Compression of Vertebral Arteries Procedure: Move patients head out and neck into extension and side flexion. Rotate patients head to the same side and hold for 30 seconds. Naffzigers Test Px: Sitting (+) sign: Pain Significance: Nerve Root problem or Space Occupying Lesion Procedure: Compress patients jugular veins for 30 seconds then ask the patient to cough. Caloric Test Px: (+) sign: Vertigo Significance: Inner ear problem Procedure: Alternately apply hot and cold test tubes several times just behind the patients ear on the side of the head. Sharp Purser Test Px: (+) sign: PT feels the head slide backwards during the movement Significance: Subluxation of the atlas on the axis Procedure: Place one hand over the patients forehead while the thumb of the other hand is placed over the spinous process of the axis to stabilize it. Patient slowly flexes the head while PT presses backward with the palm. Load and Shift Test Apprehension Test Rockwood Test Rowe Test Andrews Anterior Instability Test Anterior Drawer Test Protzman Test Dugas Test Posterior Apprehension Test Push-Pull Test Jerk Test (ULTT) Inferior Shoulder Instability Test Feagin Test Rowe Test for Multidirectional Instability Test Clunk Test Biceps Tension Test Biceps Load Test SLAP Prehension Test Lateral Scapular Slide Test Wall Push-Up Test Close Kinetic Chain UE Stability Test Acromioclavicular Shear Teas Ellmans Compression Rotary Test Speeds Test Yergasons Test Ludingtons Test Gilchrests Sign Lippmans Test Heuters Sign Empty Can Test Drop Arm Test Lateral Rotation Test Hornblowers sign Infraspinatus Test Teres Minor Test Pectoralis Major Contracture Lift-off Sign Near-impingement Test Hawkins Kennedy Test Tinels Sign Adson Maneuver Allen Maneuver Halstead Maneuver Roos Test Wright Test Costoclavicular Test
Load and Shift Test Px: sitting relaxed on the chair (+) sign: a. Normal Laxity = 1-25% b. Grade 1 = head rides over the glenoid rim (25-50%) c. Grade 2 = head over rides the rim but reduces (>50%) d. Grade 3 = head over riding the rim and remains dislocated Significance: traumatic problems at the glenohumeral Joint Procedure: Grasp the humeral head and stabilize the shoulder. Seat the humerus on the glenoid fossa and puch anteriorly and posteriorly to check for instability.
Apprehension Test Px: supine; shoulder abducted 90 and externally rotated (+) sign: pain and apprehension Significance: for traumatic instability problems Procedure: Slowly apply lateral rotation on shoulder.
Other name: Crank Test Fulcrum Test Px: supine; shoulder abducted 90 and externally rotated (+) sign: pain and apprehension Significance: for traumatic instability problems Procedure: Place a hand under the Glenohumeral Joint then apply lateral rotation.
* a modification of Crank Test Fowler Sign Px: supine; shoulder abducted 90 and externally rotated (+) sign: relief of pain and apprehension Significance: posterior internal impingement / traumatic instability problems Procedure: Apply a posterior directed force to the head of the humerus then further external rotation becomes possible
Other name: Jobe Relocation Test Surprise Test Px: supine; shoulder abducted 90 and externally rotated (+) sign: pain and forward translation of the humeral head Significance: for traumatic instability problems Procedure: Perform Fowlers Sign, after further external rotation, release the posterior force
Other name: Anterior Release Test Rockwood Test Px: sitting (+) sign: 90: - marked apprehension 45: & 120: - some uneasiness and pain Significance: Anterior Instability Procedure: shoulder is abducted to 45:, 90:, then 120:. Then apply external rotation to each angle. Rowe Test Px: Supine; hand behind the head (+) sign: apprehension (Pain) | clunk or grinding sound Significance: Anterior Instability | Torn anterior labrum Procedure: place clenched fist on the posterior humeral head then apply downward force while arm extends.
Andrews Anterior Instability Test Px: supine; shoulder abducted 130:, external 90: (+) sign: apprehension (Pain) | clunk or grinding sound Significance: anterior instability | anterior labral tear Procedure: stabilize elbow and humerus then grasp the humeral head and lift it forward. Anterior Drawer Test Px: supine; abducted 80: - 120:, flexed 20:, externally rotated 30:, hand on PTs axilla (+) sign: apprehension (Pain) | click sound Significance: anterior instability | anterior labral tear Procedure: stabilize scapula, pushing the spine forward using index and middle finger. Apply a counter pressure on the coracoid then draw the humerus forward Protzman Test Px: sitting; abducted 90:, supported on the PTs hip (+) sign: pain Significance: Anterior Instability Procedure: Palpate anterior head with one hand, other hand on patients axilla. Push humerus anteriorly and inferiorly. Dugas Test Px: sitting (+) sign: Pain / inability to do the command of the PT Significance: Anterior Dislocation Procedure: Ask patient to place one hand on opposite shoulder and to lower the elbow to the chest. Posterior Apprehension Test Px: supine; elevate shoulder to 90: (+) sign: Apprehension Significance: Posterior Shoulder Instability Procedure: Apply posterior force on the elbow then horizontally adduct and internally rotate the shoulder.
Other name: Stress Test Push-Pull Test Px: supine; shoulder abducted 90:, flexed 30: (+) sign: >50% translation, pain/apprehension Significance: Posterior Instability Procedure: Hold patients arm on the wrist and humerus. Pull on the arm at the wrist while pushing down on the humerus with the other hand. Jerk Test Px: sitting, shoulder flexed 90: and internally rotated (+) sign: Sudden jerk or clunk Significance: Recurrent Posterior Instability Procedure: Grasp patients elbow and axially load the humerus proximally. Maintain axial load then move arm to horizontal arm to horizontal adduction with internal rotation. Inferior Shoulder Instability Test Px: standing relaxed (+) sign: sulcus sign +1 = <1cm +2 = 1-2cm +3 = >2cm Significance: inferior instability / glenohumeral laxity Procedure: grasp the patients elbow then pull it distally.
Other name: Sulcus Sign Feagin Test Px: standing; shoulder abducted 90: on PTs shoulder (+) sign: Presence of sulcus on coracoid process / apprehension Significance: Multidirectional Instability Procedure: close hands over the humerus and push down and forward. Rowe Test for Multidirectional Instability Px: stands forward flexed 45: at the waist with arms pointing to the floor. (+) sign: sulcus sign Significance: Multidirectional Instability Procedure: hand on the pxs shoulder index and middle finger (anterior) thumb (posterior) Anterior: Shoulder extended 20:-30:, then push anteriorly Posterior: Shoulder flexed 20:-30:, then push posteriorly Inferior: Shoulder flexed 20:-30:, then push posteriorly and apply traction
Clunk Test Px: supine (+) sign: clunk / grinding sound Significance: Tear of the Labrum (Bankart) Procedure: One hand on posterior aspect of shoulder, one hand holds the humerus above elbow. Fully abduct arm over the pxs head. Push anteriorly with the hand over the humeral head (place a fist under the GH joint) . Other hand rotates the humerus into lateral rotation. Biceps Tension Test Px: standing; shoulder abducted 90:, elbow extended; forearm supinated (+) sign: reproduction of symptoms Significance: SLAP lesion Procedure: apply eccentric adduction force Biceps Load Test Px: supine; shoulder abducted 90: and external rotate; elbow flexed 90:; forearm supinated (+) sign: Apprehension does not disappear Significance: integrity of superior labrum Procedure: Fully externally rotate shoulder until apprehension, stop external rotation and hold the position. Then patient resist elbow flexion at the wrist. SLAP Prehension Test Px: sitting (+) sign: first = painful second = relief of pain Significance: SLAP Lesion Procedure: Patient actively abducts shoulder 90:; Forearm pronated then horizontally adducts. Then abducts shoulder 90:; Forearm supinated, horizontally adducted Lateral Scapular Slide Test Px: sitting / standing with arms at the side (+) sign: >1-1.5cm difference from the original measure Significance: Scapular Instability Procedure: Measure distance from spine to scapula to T2/T3, inferior angle to T7-T9 or superior angle to T2
* Test patient in shoulder abd: 45:, 90:, 120: and 150: Wall Push Up Test Px: standing, arms length on the wall (+) sign: winging within 5-10reps of push-up Significance: weakness of scapular muscles Procedure: ask patient to do 15-20 wall push ups Closed Kinetic Chain Upper Extremity Stability Test Px: prone; on the floor at arms length with hands 36 inches apart. (+) sign: winging of the scapula Significance: weakness of scapular muscles Procedure: patient touches the other hand then returns to original position. This is done for 15 seconds while PT counts how many reps the patient is able to do. Acromioclavicular Shear Test Px: Sitting (+) sign: abnormal movement of at the AC joint Significance: Acromioclavicular joint Pathology Procedure: Cup hands over the deltoid, one on the clavicle and one on the scapula. Squeeze both hands together. Ellmans Compression Rotary Test Px: side lying on unaffected side (+) sign: pain reproduction Significance: Glenohumeral Arthritis Procedure: Compress humeral head while patient rotates the shoulder medially and laterally. Speeds Test Px: Standing (+) sign: Pain on Bicipetal Groove | Pain | weakness Significance: Bicipital Tendonitis | SLAP II | rupture biceps Procedure: Resist shoulder extension by patient first in supination then in pronation with elbow extension.
Other names: Biceps Test / Straight Arm Test Yergasons Test Px: sitting/standing; elbow 90:, forearm pronated (+) sign: pain/tenderness | popping out of goove Significance: Bicipital Tendonitis | torn transverse humeral ligament Procedure: resist supination while px externally rotates shoulder. Ludingtons Test Px: sitting; clasp hands behind head (+) sign: no contraction evident/palpable Significance: torn Long Head of Biceps Procedure: ask px to contract the biceps. Gilchrests Test Px: Standing (+) sign: pain on Bicipital Groove Significance: Bicipital Paratendonitis Procedure: ask px to lift 2-3kg/5-7lbs of weight over head with the arm in external rotation. Lippmans Test Px: sitting/standing (+) sign: sharp pain on the bicipital groove Significance: Bicipital Tendonitis Procedure: Hold px arm and flex to 90: with one hand, other hand palpates the biceps tendon 7-8cm below the glenohumeral joint. Then move the biceps tendon side to side. Heuters Sign Px: sitting; Forearm pronated (+) sign: absence of elbow supination Significance: ruptured distal biceps tendon Procedure: Resist elbow flexion with the forearm pronated. Supraspinatus Test Px: standing; shoulder is abducted 90: (+) sign: pain | weakness Significance: torn supraspinatus | neuropathy of suprascapular nerve Procedure: shoulder is internallyy rotated and angled forward 30:, thumb pointing to the floor, then resist.
Other names: Empty Can Test / Jobe Test Drop Arm Test Px: standing; shoulder abducted 90: (+) sign: inability to return arm to side slowly Significance: Rotator Cuff Tear Procedure: ask px to slowly lower arms to the side with some arc movements.
Other Names: Codmans Test Lateral Rotation Lag Sign Px: seated/standing; arms at the side (+) sign: cannot hold the position | pain | increase internal rotation on affected side. Significance: torn supraspinatus, infraspinatus and subscapularis Procedure: passively abducts shoulder to 90:, elbow flexed to 90: and externally rotate. Px holds the position.
Other Names: Infraspinatus Spring Back Test HornblowersTest Px: standing; shoulder flexed to 90:, elbow flexed to 90: (+) sign: inability to external rotate the shoulder Significance: tear on the teres minor Procedure: px external rotates with resistance. Infraspinatus Test Px: standing, arm on the side with elbow 90: (+) sign: pain / inability to resist internal rotation Significance: infraspinatus strain Procedure: Apply a internal rotation force that the px resist. Teres Minor Test Px: prone; with one hand on the iliac crest (+) sign: pain and weakness Significance: Teres Minor strain Procedure: ask px to extend and adduct shoulder against resistance. Pectoralis Major Contracture Test Px: supine; hands clasps behind head (+) sign: elbows do not reach the table Significance: Tight Pectoralis Major Procedure: Lower arm until elbows tough the table Lift Off Sign Px: standing; dorsum of hand on back pocket (+) sign: inability to lift hand off back Significance: Subscapularis Lesion Procedure: ask px to lift hand away from the back. Neer-Impingement Test Px: sitting (+) sign: Pain Significance: overuse injury to the supraspinatus muscle Procedure: Px arm is passively and forcibly fully elevated and shoulder is internally rotated. Hawkins Kennedy Impingement Test Px: standing / sitting (+) sign: pain Significance: supraspinatus tendonitis Procedure: flex shoulder to 90: then medially rotate the shoulder Coracoid Impingement Test Px: standing / sitting (+) sign: pain Significance: supraspinatus tendonitis Procedure: flex shoulder to 90:, horizontally adduct to 10:-20: then medially rotate the shoulder
*a modification of Hawkins Kennedy Test Yocum Test Px: standing / sitting (+) sign: pain Significance: supraspinatus tendonitis Procedure: Px places hand on the opposite shoulder then PT elevates the elbow.
*a modification of Hawkins Kennedy Test Tinels Sign at the Shoulder Px: sitting (+) sign: tingling sensation Significance: Peripheral Nerve Injury Procedure: tap on the scalene triangle on the area of the brachial plexus Adsons Maneuver Px: sitting with head on the ipsilateral (+) sign: disappearance of pulse Significance: Thoracic Outlet Syndrome Procedure: Locate radial pulse, external rotate and extend the shoulder and instruct px to take a deep breath and hold it. Allen Maneuver Px: sitting with head on the contralateral side (+) sign: disappearance of pulse Significance: Thoracic Outlet Syndrome Procedure: Elbow is flexed to 90:, shoulder is extended and externally rotated horizontally, palpate the radial side. Halstead Maneuver Px: neck is hyper extended rotated on contralateral side (+) sign: disappearance of Radial Pulse Significance: Thoracic Outlet Syndrome Procedure: Find the radial pulse, apply downward traction on the extremity. Roos Test Px: shoulder abducted 90:; elbow flexed 90:, externally rotate (+) sign: ischemic pain, heaviness, weakness Significance: Thoracic Outlet Syndrome Procedure: ask px to close and open hands for 3mins
Other names: Aer Test / Hands-up Test Wright Test Px: shoulder hyper abducted, elbow extended and externally rotated (+) sign: Disappearance of pulse Significance: Thoracic Outlet Syndrome Procedure: Instruct px to take a deep breath while palpating for the radial pulse. Costoclavicular Test Px: (+) sign: disappearance of pulse Significance: Thoracic Outlet Syndrome Procedure: Locate radial pulse, draw shoulder down and back.
Other Name: Military Base Ligamentous Valgus Instability Test Milking Maneuver Ligamentous Varus Instability Test Posterolateral Rotary Drawer Test Stand Up Test Lateral Epicondylitis Method 1 Lateral Epicondylitis Method 2 Lateral Epicondylitis Method 3 Medial Epicondylitits Tinels Sign at the Elbow Wartenbergs Sign Elbow Flexion Test Pronator Teres Syndrome Pinch Grip Test Ligamentous Valgus Instability Test Px: sitting; elbow flexed 90: (+) sign: decrease laxity / pain Significance: Valgus Instability (medial collateral ligament) Procedure: Stabilize elbow with 1 hand and above pxs wrist with the other. Apply an abd. Force to the distal forearm. Milking Maneuver Px: sitting; elbow flexed 90:, forearm supinated (+) sign: Reproduction of Symptoms Significance: Partial tear to the medial collateral ligament Procedure: Graps the pxs thumb and pull it importing a valgus stress to the elbow Ligamentous Varus Instability Test Px: elbow slightly flexed (+) sign: laxity, soft end feel Significance: injury to the lateral collateral ligament Procedure: Stabilize arm and apply varus force to the distal forearm. Posterolateral Rotary Drawer Test Px: supine, arm over head; elbow flexed 40: - 90: (+) sign: reproduction of symptoms Significance: tear on the lateral collateral ligament / posterolateral instability at the elbow Procedure: Stabilize the humerus, radius and ulna is pushed posterolaterally. Stand-Up Test Px: seated on a chair w/ no arm rests; forearm supinated (+) sign: reproduction of symptoms Significance: injury to the posterior band of medial collateral ligament Procedure: instruct px to lift bottom off of the seat using his/her arms. Lateral Epicondylitis (Method 1) Test Px: sitting; elbow flexed 90:; forearm supinated (+) sign: pain Significance: Tennis Elbow Epicondylitis Procedure: Palpate the lateral epicondyle. Ask the px to make a fist , pronate forearm, radially deviate and extend the wrist while PT resist the motion.
Other names: Tennis Elbow or Cozens Test Lateral Epicondylitis (Method 2) Test Px: sitting; elbow flexed 90:; forearm supinated (+) sign: pain Significance: Tennis Elbow Epicondylitis Procedure: Palpate the lateral epicondyle. Passively pronate the pxs forearm; flex the wrist fully and extend the elbow.
Other names: Tennis Elbow or Mills Test Lateral Epicondylitis (Method 3) Test Px: sitting; elbow flexed 90:; forearm pronated (+) sign: pain Significance: Tennis Elbow Epicondylitis Procedure: Resist the extension of the 3 rd digit of the hand. Distal to proximal interphalangeal joints.
Other names: Tennis Elbow Test Medial Epicondylitis Test Px: sitting; elbow flexed 90:; forearm pronated (+) sign: pain Significance: Golfers elbow medial epicondylitis Procedure: Palpate the medial epicondyle. Pxs forearm is passively supinated and the PT extends the elbow and wrist.
Other names: Golfers Elbow Tinels Sign at the Elbow Px: sitting with the elbow flexed (+) sign: Tingling Sensation Significance: Regeneration of Fibers Procedure: tap the ulnar nerve. Wartenbergs Sign Px: sitting with hands resting on the table (+) sign: Inability to squeeze little finger Significance: Ulnar Nerve Neuropathy Procedure: Passively spread the fingers apart and ask the patient to them together Elbow Flexion Test Px: (+) sign: Tingling or paresthesia in the ulnar nerve distribution of the forearm and Significance: Cubital Tunnel Syndrome Procedure: Fully flex the elbow, wrist extended, shoulder is abducted and depressed. Hold this position for 3-5 minutes. Test for Pronator Teres Syndrome Px: sitting; elbow flexed 90: (+) sign: Tingling or paresthesia in the median nerve distribution Significance: Pronator Teres Syndrome Procedure: Resist pronation and the patient extends. Pinch Grip Test Px: (+) sign: Normal: tip-to-tip Abnormal: pulp-to-pulp Significance: Entrapment of the Anterior Interosseous nerve Procedure: ask the patient to pinch the tips of the index and thumb together. Test For Tight Retinacular Ligament Lunotriquetral Ballottement Test Finger Extension Test Murphys Sign Watsons Test Piano Keys Test Finkelstein Test Sweater Finger Sign Test For Extensor Hood Rupture Boyes Test Bunnel-littler Test Linburgs Sign Tinels Sign At The Wrist Phalens Test Reverse Phalens Test Carpal Compression Test Froments Sign Egawas Sign Wrinkle Test Ninhydrin Test Dellons Moving 2-point Discrimination Test Allen Test Hand Volume Test Test for Tight Retinacular Ligament Px: PIP joint is in neutral | PIP joint is flexed (+) sign: (-) flexion | (+) flexion Significance: Collateral ligaments or Capsule is tight | Only the collateral ligament is tight Procedure: Flex the distal interphalengeal joint.
Other Name: Haines-Zancolli Test Lunotriquetral Ballottement Test Px: (+) sign: Pain, Laxity, Crepitus Significance: Lunotriquetral Instability Procedure: Grasp the triquetrium and lunate. Move the lunate anteriorly and posteriorly.
Other Name: Reagans Test Finger Extension Test Px: Sitting; wrist in flexion (+) sign: Pain Significance: Radiocarpal or midcarpal instability, scaphoid instability, inflammation, Kienbcks Disease Procedure: Hold the pxs wrist and ask the px to extend the fingers. Resist movement at he radiocarpal joints.
Other Name: Shuck Test Murphys Sign Px: (+) sign: 3 rd MCP joint is in line with and 2 nd and 4 th
MCP joint. Significance: Lunate Dislocation Procedure: Ask the px to make a fist. Watson Test Px: Sitting; Forearm is pronated on the lap (+) sign: Pain Significance: Scaphoid Subluxation Procedure: Ulnar deviate the wrist with slight extension. Stabilize the scaphoid. Radially deviate and slightly flex the hand.
Other Name: Scaphoid Shift Test Piano Keys Test Px: sitting; forearm pronated (+) sign: Difference in Mobility, pain and tenderness Significance: Distal radioulnar joint instability Procedure: Push down the distal ulna Finkestein Test Px: Make a fist with the thumb inside the fingers (+) sign: pain over the abductor pollicis longus and extensor pollicis brevis tendons Significance: Hoffmanns disease, de Quervains disease, paratendonitis in the thumb Procedure: Stabilize forearm and ulnar deviate the wrist. Sweater Finger Sign Px: (+) sign: (-) flexion of one of the distal phalanx Significance: Ruptured flexor digitorum profundus tendon Procedure: Instruct px to make a fist Test for Extensor Hood Rupture Px: Flex PIP of finger 90: at the edge of the table (+) sign: Little Pressure from the middle phalanx Significance: Torn Central Extensor Hood Procedure: Ask the px to extend the proximal interphalangeal joint while PT palpates for the middle phalanx Boyes Test Px: (+) sign: Unable to flex DIP joints Significance: torn central extensor hood Procedure: Hold finger in slight extension at the PIP joint. Ask px to flex the DIP joint. Bunnel Littler Test Px: a. extend MCP jt. b. slight flexed MCP jt. (+) sign: a. (-) flexion b. fully flexed c. not fully flexed PIP jt. Significance: a. tight intrinsic muscles or contracture of joint capsule b. intrinsic muscles tightness c. Contracture of joint capsule Procedure: Flex PIP joint.
Other name: Intrinsic Plus , Finochietto Bunnel Linburgs Sign Px: (+) sign: Loss of Motion, Pain Significance: Tendinitis at the interconnection between flexor pollicis longus and flexor indices Procedure: Fully flex the thumb then extend the index finger Tinels Sign at the Wrist Px: (+) sign: Tingling or Paresthesia in the median nerve distribution Significance: Carpal Tunnel Syndrome Procedure: tap over the carpal tunnel at the wrist. Phalens Test Px: (+) sign: tingling or paresthesia in the median nerve distribution Significance: Carpal Tunnel Syndrome Procedure: Flex the wrist maximally and hold for 1 minute. Reverses Phalens Test Px: (+) sign: Tingling or Paresthesia in the median nerve distribution Significance: Carpal Tunnel Syndrome Procedure: Extend wrist maximally and press the carpal tunnel for 1 minute.
Other Name: Prayer Test Carpal Compression Test Px: supinated (+) sign: tingling or paresthesia in the median nerve distribution Significance: Carpal Tunnel Syndrome Procedure: Grasp hand then apply direct pressure over the carpal tunnel for 30 seconds
*a modification of Reverse Phalens Test Froments Sign Px: Grasp a piece of paper between thumb and index (+) sign: thumb flexion | thumb hyperextension Significance: paralysis of adductor pollicis | Jeannes Sign (Ulnar Nerve Paralysis) Procedure: Pull paper away from patient Egawas Sign Px: Flex middle digit (+) sign: unable to do the motion Significance: Ulnar Nerve Palsy Procedure: Ask the patient to alternately ulnar deviate and radial deviate the finger Wrinkle Test Px: (+) sign: no wrinkling Significance: Denervated Procedure: Place patients fingers in warm water for 5-20 minutes Ninhydrin Sweat Test Px: wait for clean hand to sweat (+) sign: no color change (Normal: White purple) Significance: Nerve Lesion Procedure: Moderately press against good quality bond paper for 15 seconds. Trace with pencil and spray the paper with triketohydrindene (Ninhydrin) spray. Leave for 24 hrs to dry. Dellons Moving 2-point Discrimination Test Px: Eyes are closed and the hand is cradled in the examiners hand (+) sign: 10 mm difference between the right and left hand Significance: measures the quickly adapting mechanoreceptor system Procedure: move 2 blunt points from proximal to distal along the long axis of the limb or digit, starting with a distance of 8mm b/n the points Allen Test Px: open and close hand several times. (+) sign: flushing of the hand Significance: Patency of the radial and ulnar arteries (which artery provides the major blood supply to the hand) Procedure: Compress radial and ulnar arteries. Px opens their hand while pressure is maintained. Release one artery at a time. Hand Volume Test Px: (+) sign: 30-50mL difference between right and left hands. (Normal = 10mL) Significance: Swelling, edema (Normal = dominant) Procedure: Use a volumeter. Slump Test Straight Leg Raising Test Prone Knee Bending Test Sitting Root Test Brudzinski Kernig Sign Bowstring Test Compression Test Flip Sign Babinski Test Oppenheim Test Gluteal Skyline Test H & I Stability Test Specific Lumbar Spine Torsion Test Farfan Torsion Test Pheasant Test One Leg Standing Lumbar Extension Test Quadrant Testt Schober Test Yeomans Test Milgrams Test Beevors Sign Stoop Test Treadmill Test Hoovers Test Burns Test Sign Of The Buttock Slump Test 1 (ST1) Cervical Spine: Flexion Thoracic & Lumbar Spine: Flexion (slump) Hip: Flexion (90:+) Knee: Extension Ankle: Dorsiflexion Foot: --- Toes: --- Nerve Bias: Spinal Cord, Cervical and Lumbar Nerve Roots, Sciatic Nerve Slump Test 2 (ST2) Cervical Spine: Flexion Thoracic & Lumbar Spine: Flexion (slump) Hip: Flexion (90:+), Abduction Knee: Extension Ankle: Dorsiflexion Foot: --- Toes: --- Nerve Bias: Obturator Nerve Side Lying Slump Test (ST3) Cervical Spine: Flexion Thoracic & Lumbar Spine: Flexion (slump) Hip: Flexion (20:) Knee: Flexion Ankle: Plantar flexion Foot: --- Toes: --- Nerve Bias: Femoral Nerve Long Sitting Slump Test (ST4) Cervical Spine: Flexion, Rotation Thoracic & Lumbar Spine: Flexion (slump) Hip: Flexion (90:+) Knee: Extension Ankle: Dorsiflexion Foot: --- Toes: --- Nerve Bias: Spinal Cord, Cervical and Lumbar Nerve Roots, Sciatic Nerve Straight Leg Raising Test (SLR Basic) Hip: Flexion + Adduction Knee: Extension Ankle: Dorsiflexion Foot: --- Toes: --- Nerve Bias: Sciatic Nerve and Tibial Nerve
Other Name: Lasegues Test Straight Leg Raising Test 2 (SLR2) Hip: Flexion Knee: Extension Ankle: Dorsiflexion Foot: Eversion Toes: Extension Nerve Bias: Tibial Nerve Straight Leg Raising Test 3 (SLR3) Hip: Flexion Knee: Extension Ankle: Dorsiflexion Foot: Inversion Toes: --- Nerve Bias: Sural Nerve Straight Leg Raising Test 4 (SLR4) Hip: Flexion and Medial Rotation Knee: Extension Ankle: Plantar Flexion Foot: Inversion Toes: --- Nerve Bias: Common Peroneal Nerve Cross Straight Leg Raising Test (SLR5) Hip: Flexion Knee: Extension Ankle: Dorsiflexion Foot: --- Toes: --- Nerve Bias: Nerve Root (disc prolapse) Basic Prone Knee Bending Test (PKB1) Cervical Spine: Ipsilateral Rotation Thoracic & Lumbar Spine: Neutral Hip: Neutral Knee: Flexion Ankle: --- Foot: --- Toes: --- Nerve Bias: Femoral Nerve, L2-L4 nerve roots Prone Knee Bending Test (PKB2) Cervical Spine: Ipsilateral Rotation Thoracic & Lumbar Spine: Neutral Hip: Extension, Adduction Knee: Flexion Ankle: --- Foot: --- Toes: --- Nerve Bias: Lateral Femoral Cutaneous Nerve Other Name: Nachlas Test Prone Knee Extension Test (PKE) Cervical Spine: --- Thoracic & Lumbar Spine: Neutral Hip: Extension, Abduction, Lateral Rotation Knee: Extended Ankle: Dorsiflexion Foot: Eversion Toes: --- Nerve Bias: Saphenous Nerve Sitting Root Test Px: Short sitting, neck flexed (+) sign: Arch back, pain on the buttock, posterior thigh, and calf. Significance: Tension on Sciatic Nerve, True Sciatic pain Procedure: Passively extend the knee
* a modification of Slump Test Bechterewis Test Px: Flex neck, extend knee (+) sign: Pain in the back or leg Significance: Sciatica Procedure: Ask the patient to extend the knee one at a time, and then both.
* A modification of Sitting Root Test Bowstring Test Px: Supine or Sitting (+) sign: Radicular pain (sciatic tension test or Deyerles Sign) Significance: Sciatica Procedure: Flex the hip at pain range, then flex the knee at 20:, apply presure on the popliteal area.
Other Name: Cram Test, Popliteal Pressure Sign. Compression Test Px: Supine; hip flex (100:); knee flex (+) sign: Radicular Pain on Posterior Leg Significance: Disc Herniation Procedure: Apply axial compression to the spine by applying direct pressure on the patients feet or buttocks. Flip Sign Px: sitting, then supine (+) sign: Pain (on both tests) Significance: Sciatice Procedure: Px in sitting: extend knee Px in supine: unilateral straight leg raising test Babinski Test Px: (+) sign: Extension of big toe and abduction of the other toes. Significance: Upper Motor Neuron Lesion Procedure: Run a pointed object along the plantar aspect of the pxs foot. Oppenheim Test Px: (+) sign: Extension of big toe and abduction of the other toes Significance: Upper Motor Neuron Lesion Procedure: Run a fingernail along the crest of the tibia Gluteal Skyline Test Px: Prone; head straight; arms at the side (+) sign: Flat gluteus muscle=atrophied | less contraction Significance: damage to the Inferior Gluteal nerve, pressure on L5, S1 or S2 nerve roots. Procedure: Stand on the pxs feet and observe the buttock. Then ask the px to contract the buttocks H & I Stability Test Px: Standing (+) sign: pain on at least 2 segments on the same quadrant | Pain on 1 segment only and 1 quadrant Significance: Hypomobile | Instability Procedure: Stabilize the pelvis and other hand in shoulder. H: side-flex, forward flex then extend, neutral, repeat with other side. I: Forward flex, side bending, neutral, repeat with extension. Specific Lumbar Spine Torsion Test (example: left L5-S1) Px: Right Side-Lying with slight extension of lumbar spine (+) sign: minimal movement is felt, right capsular tissue stretch Significance: Stress on the Specific Levels Procedure: Grasp the left arm then pull upward/forward (45:) then stabilize L5 spinous process by holding the left shoulder back with the PTs elbow while rotating the pelvis and sacrum forward until S1 starts to move with the opposite hand. Farfan Torsion Test Px: Prone (+) sign: Reproduction of Symptoms Significance: Stress the facet jt.. Jt. Capsule, Interspine/supraspine ligament, neural arch, longitudinal lig. and disc. Procedure: Stabilize the ribs and spine (T12), then the other hand is placed on the anterior aspect of ilium Pheasant Test Px: Prone (+) sign: Pain Significance: Lumbar Spine Instability Procedure: Apply pressure on the lumbar spine, then passively flex the knee until the heel touches the buttocks. One Leg Standing Lumbar Extension Test Px: One leg stand (+) sign: Pain Significance: Spondylolisthesis Procedure: Instruct px to extend the spine while balancing on one leg. *If rotation is combined with extension = Facet Joint pathology on which the rotation occurs.
Other Name: Stork Standing Test Quadrant Test Px: Standing (+) sign: Pain or Reproduction of Symptoms Significance: Facet Joint Pathology Procedure: Extend the pxs spine, apply overpressure. Px side flexes and rotates to the affected side. Shobers Test Px: Standing (+) sign: difference between the two measurements Significance: Lumbar Spine Mobility Procedure: Mark the following points: a. S2 Point of reference b. 5cm/2inches below c. 10cm/4inches above measure the distance between the 3 points. Ask px to forward flex (fingers touching his toes), then measure the distance. Yeomans Test Px: Prone (+) sign: Pain Significance: Sacroiliac Joint Dysfunction Procedure: Stabilize the pelvis then extend the hip, with knee flexed and extended Milgrams Test Px: Supine (+) sign: Cannot hold the position or Reproduction of Symptoms Significance: Sacroiliac Joint Dysfunction Procedure: Instruct px to lift his legs from the table ~ 2-4in (5- 10cm) and hold the position for 30 secs. Beevors Sign Px: Supine, hands behind the head (+) sign: The umbilicus does not remain in a straight line Significance: Abdominal Muscle Paralysis Procedure: Px flexes the head against resistance, coughs, or attempts to sit up. Stoop Test Px: Sitting or Standing (+) sign: Relief of Pain Significance: Neurogenic Intermittent Claudication Procedure: After brisk walking, px feels pain in the buttock and lower limb. Px flexes forward Treadmill Test Px: on the treadmill (+) sign: severe symptoms Significance: Intermitent Claudication Procedure: Two trials are conducted: a. 1.2mph b. Preferred walking speed Px walks upright on the treadmill for 15mins/onset of symptoms. Time to 1 st symptoms, total ambulatory time, and precipitating symptoms are recorded Hoovers Test Px: Supine (+) sign: If the opposite hand doesnt feel any pressure Significance: Malingering Procedure: Place 1 hand under each calcaneus and ask the px to lift one leg off of the table Burns Test Px: Kneeling on the chair (+) sign: Unable to do / overbalances Significance: Malingering Procedure: Bend forward to touch the floor with the fingers Sign of the Buttock Px: Supine (+) sign: Hip flexion doesnt increase Significance: Pathology in the buttock (tumor, bursitis, abcess) Procedure: Perform passive unilateral straight leg raising test until restriction. Then Flex the pxs knee Straight Leg Raising Test Prone Knee Bending Test Flamingo Test Gaenslens Test Gillets Test Yeomans Test Leg Length Test Functional Limb Length Test Sign Of The Buttock Trendelenburgs Test Straight Leg Raising Test Px: Supine (+) sign: Pain >70: | > 120: (hypermobile) Significance: Sacroiliac Joint Pathology Procedure: Flex the pxs hip with the knee extended
Other Name: Lasgues Test Prone Knee Bending Test Px: Prone (+) sign: Pain in: a. Front of the Thigh b. Lumbar Spine c. < 90: Significance: a. Rectus Femoris Tightness b. L3 nerve root lesion c. Sacroiliac Jt. Pathology Procedure: Flex the knee until the heel touches the buttocks Other Name: Nachlas Test Flamingo Test Px: One Leg Standing (+) sign: Pain on Pubic Symphysis or SI joint Significance: Lesion on the Structure Procedure: Ask the px to do a one leg stand. *px may hop, increasing the stress on pubic symphysis = Stress X-ray Gaenslens Test Px: Side-lying or Supine (+) sign: Pain Significance: Ipsilateral Sacroiliac joint lesion, Hip Pathology, L4 nerve root lesion Procedure: Px holds the lower leg flexed against the chest. Stabilize the hip while hyper extension on the upper leg. Gillets Test Px: Standing (+) sign: SI jt moves minimally or up Significance: Hypomobile Procedure: Palpate PSIS and ask px to stand on one leg while pulling the opposite knee towards the chest
Other Name: Sacral Fixation Test Yeomans Test Px: Prone (+) sign: Pain on SI jt. | Lumbar Pain | Ant. Thigh Paresthesia Significance: Anterior SI lig. | Lumbar Pathology | Femoral Nerve Stretch (L2-L4) Procedure: Flex the knee to 90:, then extend the hip Leg Length Test Px: Supine (+) sign: >1-1.3cm (0.5-1in) Significance: Leg Length Discrepancy Procedure: True Leg Length = measure the ASIS to Lateral Malleolus ALL = measure umbilicus to Medial Malleolus
Functional Limb Length Test Px: Standing (+) sign: assymetry is corrected by correct positioning Significance: Functional Leg Length Discrepancy Procedure: Palpate for the ASIS and PSIS and px is placed in correct stance (subtalar joints neutral, knees fully extended, and toes facing straight ahead) Sign of the Buttock Px: Supine (+) sign: Hip flexion does not increase Significance: Pathology in the Buttock (tumor, bursitis, abscess) Procedure: Passive unilateral SLR until restriction, then flex the knee Trendelenburgs Test Px: One leg Stance (+) sign: pelvis falls on the non stance stand Significance: weakness of the gluteus medius muscle, superior gluteal nerve lesion, L4-S1 lesion Procedure: ask the px to do a one leg stance. Observe the px Ortalanis Sign Barlows Test Galeazzi Sign Telescoping Sign Abduction Test Patricks Test Anterior Labral Tear Test Craigs Test Torque Test Nelatons Line Bryants Triangle Rotational Deformities Thomas Test Rectus Femoris Contracture Test (Method 1) Elys Test (Method 2) Obers test Adduction Contracture Test Abducion Test Contracture Test Prone Lying Test for Iliotibial band contracture Noble compression test Piriformis test Hamstring contracture test (method 1) Tripod sign (method 2) 90-90 SLR test (method 3) Phelps Test Fulcrum Test Ortolanis Sign Px: Supine (+) sign: feels clunk, clink or jerk Significance: Congenital Hip Dislocation Procedure: Grasp the thigh and leg with the thumb on the medial knee and the fingers alongside the thigh and hip. Flex the hip to 90:, then abduct while lifting it forward
*up to 12wks6mos. Barlows Test Px: Supine (+) sign: feels clunk, clink or jerk Significance: Congenital Hip Dislocation Procedure: Grasp the thigh and leg with the thumb on the medial knee and the fingers alongside the thigh and hip. Flex the hip to 90:, then abduct then adduct while pushing downward
*up to 12wks6mos. Galeazzi Sign Px: Supine (+) sign: One knee is Higher Significance: Unilateral Congenital Hip Dislocation Procedure: Hip and knee is flexed to 90: with feet flat on the table
Other Name: Allis Test *up to 318mos. Telescoping Sign Px: Supine; Hip and knee flexed to 90: (+) sign: Excessive movt upon lifting up (pistoning/telescoping) Significance: Congenital Hip Dislocation Procedure: Femur is pushed down onto the table. Femur and leg is then lifted up and away the from the table
Other Name: Piston Test, Dupuytrens Test Abduction Test Px: Supine (+) sign: Asymmetry or Limitation of Movement Significance: Congenital Hip Dislocation Procedure: Hip and knee is flexed to 90:, then abducted
Other Name: Harts Sign Patricks Test Px: Supine (+) sign: Test legs knee remains above the opposite straight leg Significance: Hip jt. Pathology, Iliopsoas spasm, SI jt. pathology Procedure: Place the test leg on top of the other leg (FABER). Slowly lower the knee of the test leg. Other Name: Faber Test, Figure-Four Test, Jansens Test Anterior Labral Tear Test Px: supine (+) sign: Pain with or without click Significance: Hip Joint Pathology Procedure: Place hip into full FABER, then to EADIR
Other Name: FADDIR Test Craigs Test Px: Prone with knee flexed 90: (+) sign: > 15: Significance: Anteversion of Hip Procedure: Palpate greater trochanter then medially and laterally rotate the hip until the greater trochanter is parallel to the examining table or it reaches its most lateral position.
Other Name: Ryder Method Torque Test Px: Supine, with the test leg over the edge of the table (+) sign: Yield Significance: Hip Jt. Pathology Procedure: Extend the leg until the pelvis moves. Medially rotate up to end range while applying a slow posterolateral pressure along the line of the neck of the femur for 20secs. Nelatons Line Px: Supine (+) sign: Greater trochanter is palpated above the line Significance: Hip Dislocation or Coxa Vara Procedure: draw an imaginary line from the ischial tuberosity of the pelvis to the ASIS of the pelvis on the same side. Bryants Triangle Px: Supine (+) sign: Difference in measurement Significance: Congenital Dislocation of Hip or Coxa Vara Procedure: Draw imaginary lines: 1 st perpendicular from the ASIS to the PSIS 2 nd tip of greater trochanter to ASIS Rotational Deformities Px: Supine (+) sign: Face in | face up, out, away Significance: Internal Rotation of femur or tibia | External Rotation of femur or tibia Procedure: Observe the patella Thomas Test Px: supine (+) sign: knee of the other leg rises of the table | abduction of the other leg (J sign or Stroke) Significance: Illiopsoas muscle contracture | Tight Iliotibial Band Procedure: Flex hip bringing the knee to the chest. Kendalls Test Px: Supine with knee bent over the edge of the table (+) sign: slight extension of the other leg Significance: Rectus Femoris muscle contracture Procedure: Px flexes one knee (90:) onto the chest and holds it
Other: Rectus Femoris Contracture Test (Method 1) Elys Test Px: Prone (+) sign: Spontaneous ipsilateral hip flexion Significance: Rectus Femoris Muscle Tightness Procedure: Passively flex the pxs knee
Other Name: Tight Rectus Femoris Test (Method 2) Obers Test Px: Side-lying with lower leg flexed (+) sign: a. Leg remain abducted (with knee extended) b. Pain radiated (with knee flexed) c. Localized pain Significance: a. Tenson Fascia Latae / Iliotibial Band Contracture b. Femoral Nerve Involvement c. Trochanteric Bursitis Procedure: Abduct and extend the upper leg with the knee flexed (90:) or extended, then slowly lower the upper leg. Adduction Contracture Test Px: Supine (+) sign: ASIS forms an angle < 90:, and Pelvis shifts up on affected side Significance: Adductor Muscles contracture (adductor longus, brevis and magnus, pectineus, and gracilis) Procedure: Check for the assymetry of ASIS and balance the pelvis Abduction Contracture Test Px: Supine (+) sign: ASIS forms and angle > 90:, and Pelvis shifts down on the affected side Significance: Abductor Muscles Contracture (Gluteus Medius and Minimus Procedure: Check for the assymetry of ASIS and balance he pelvis Prone Lying Test for ITB Contracture Px: Prone (+) sign: Firm End-feel Significance: Iliotibial and Contracture Procedure: Stand on the opposite side. With one hand, hold the ankle and maximally abduct while applying pressure to the buttock with the other hand. Knee is flexed 90:, adduct the hip. Noble Compression Test Px: Supine; Knee flexed 90:; Hip flexed 90: (+) sign: Localized pain at 30: knee flexion Significance: Iliotibial Band Friction Syndrome Procedure: Apply pressure to the lateral femoral epicondyle or 1-2cm proximal to it while the px slowly extends the knee Piriformis Test Px: Side-lying; upper leg in 60: hip flexion; flex knee (+) sign: Pain in groin | Pain in buttock Significance: Piriformis muscle tightness | piriformis syndrome Procedure: Stabilize pelvis with one hand and the other applies downward pressure to the knee 90-90 SLR Test Px: Supine; hip and knee 90: flexion (+) sign: 20:- 0: knee extend Significance: Hamstrings muscle contracture, or sciatica Procedure: Px Alternately extends the knee
Other Name: Hamstring Contracture Test (Method 1) Hamstring Contracture Test (Method 2) Px: Long-sitting; 1 knee flexed against the chest (+) sign: Unable to reach the toes Significance: Tight Hamstrings muscle Procedure: Flex the trunk and touch the toes of the extended lower limb. Tripod Sign Px: Short-sitting (+) sign: Extension of the trunk Significance: Hamstring muscles are tight, Sciatica Procedure: Passively extend the knee
Other Name: Hamstring Contracture Method 3 Phelps Test Px: Prone (+) sign: Abduction increases with knee extension Significance: Gracilis muscle contracture Procedure: Passively abduct both leg as far as possible. Then flex knees 90: and try to abduct further. Fulcrum Test Px: Short-sitting (+) sign: Sharp Pain and Apprehension Significance: Femoral Shaft Stress, Fracture Procedure: Place an arm under pxs thigh to act as a fulcrum, then apply pressure to distal femur. Abduction Test Adduction Test Lachman Test Drawer Sign Posterior Sag Sign Reverse Lachman Test Godfrey Test Slocum Test Jerk Test Of Hughston Cross Over Test Of Arnold Hughstons Posteromedial And Posterolateral Drawer Sign Loomers Test Mcmurray Tests Apleys Test Bounce Home Test Odonohues Test Modified Helfet Test Test Retreating Or Retracting Meniscus Payrs Test Bohlers Sign Bragards Sign Childress Sign Cabots Popliteal Sign Mediopatellar Plica Test Plica Stutter Test Hughstons Plica Test Brush, Stroke, Or Bulge Test Fluctuation Test Patellar Tap Test Clarkes Sign Waldron Test Zohlers Sign Furnds Sign Q-angle Willson Test Fairbanks Apprehension Test Noble Compression Test a. Abduction Test Px: Short sitting (+) sign: excessive gapping of the tibia and femur (medial condyle) Significance: with knee extension, injury to these structures:
Procedure: Fully extend the knee then apply valgus stress a. Medial collateral ligament b. Posterior oblique ligament c. Posteromedial capsule d. Anterior cruciate ligament e. Posterior cruciate ligament f. Medial quadriceps expansion g. Semimembranosus muscle b. Abduction Test Px: Supine or Long sitting with the test leg over the edge of the table (+) sign: excessive gapping of the tibia and femur (medial condyle) Significance: knee flexed to 20:- 30:, injury to these structures:
Procedure: Fully extend the knee then place in 20:- 30: flexion. Laterally rotate the knee (lock knee) and then apply valgus stress a. Medial collateral ligament b. Posterior oblique ligament c. Posteromedial capsule d. Posterior cruciate ligament Stress X-ray: Gr.1: 5mm opening Gr.2: 10mm opening Gr.3: >10mm opening c. Abduction Test Px: Supine/Long sitting with the test leg over the edge of the table (+) sign: excessive gapping of the tibia and femur (medial condyle) Significance: knee flexed to 20:- 30:, injury to these structures:
Procedure: Fully extend the knee then place in 20:- 30: flexion. Grasp the big toe (lock knee) and then apply valgus stress a. Medial collateral ligament b. Posterior oblique ligament c. Posteromedial capsule d. Posterior cruciate ligament Stress X-ray: Gr.1: 5mm opening Gr.2: 10mm opening Gr.3: >10mm opening a. Adduction Test Px: short sitting (+) sign: excessive gapping of the tibia and femur (Lateral condyle) Significance: Knee extension, injury to these structures:
Procedure: Fully extend the knee then apply a varus stress a. Fibular/Lateral collateral ligament b. Posterolateral capsule c. Arcuate-popliteus complex d. Biceps femoris tendon e. Posterior cruciate ligament f. Anterior cruciate ligament g. Lateral gastrocnemius muscle h. Iliotibial band
b. Adduction Test Px: Supine or long sitting with the test leg over the edge of the table (+) sign: excessive gapping of the tibia and femur (Lateral condyle) Significance: Knee in 20:- 30: flexion, injury to these structures:
Procedure: Fully extend the knee then place in 20:- 30: flexion. Apply varus stress on the knee
a. Fibular/Lateral collateral ligament b. Posterolateral capsule c. Arcuate-popliteus complex d. Biceps femoris tendon e. Iliotibial band
Stress X-ray: Gr.1: 5mm opening Gr.2: 8mm opening Gr.3: >8mm opening Lachman Test Px: Supine (+) sign: Mushy or Soft End Feel Significance: Injury to these structures: a. Anterior Cruciate Ligament (posterolateral bundle) b. Posterior Oblique Ligament c. Arcuate-Popliteus Complex Procedure: Stabilize the anterior distal thigh and the posteromedial aspect of the proximal leg. Fully extend the knee, then flex to 20:- 30:, laterally rotate the leg and apply anterior tibial translation. Lachman Test Modification 1: Short-sitting Modification 2: Supine with the test knee rests on PTs knee (for small hands) Modification 3: Supine with the test leg between the arm and thorax (not sufficient) Modification 4: Supine, eye is level with the knee Modification 5: Prone (difficult to determine the quality of the end feel Modification 6 (active/no touch): Supine with PTs arm under pxs knee the ask to extend the knee. Other Name: Ritchie Test, Trillat Test, Lachman Trillat Test Drawer Sign Px: Supine; hip flexed to 45:; knee flexed to 90: (+) sign: Tibia Moves forward (>6mm on the femur) Significance: Injury to these structures: a. ACL b. Posterolateral Capsule c. Medial Collateral Ligament d. Iliotibial Band e. Posterior Oblique Ligament f. Arcuate-Popliteus comlex injury Procedure: Sit on pxs foot with both hands clasp around the tibia, then translate it anteriorly. Posterior Sag Sign Px: Supine (+) sign: Step-off sign, thumb sign Significance: Injury to these structures: a. Posterior Cruciate Ligament b. Arcuate-Popliteus Complex c. Posterior Oblique Ligament d. Anterior Cruciate Ligament Procedure: Place the px in supine with the hips flexed to 45: and knee flexed to 90: Reverse Lachman Test Px: Prone (+) sign: Mushy or Soft End feel Significance: Posterior Cruciate Ligament Injury Procedure: Stabilize the anterior distal thigh and the anterior proximal leg. Place the knee in full extension the 20:- 30: flexion Godfrey Test Px: Supine (+) sign: Poterior Sag of the tibia Significance: Posterior Cruciate Ligament Procedure: Flex the hip and knee to 90: a. Slocum Test Px: Supine (+) sign: Tibia moves forward (Anterolat. Translation) Significance: Injury to these structures:
Procedure: Flex the knee to 80:- 90: with 45: knee flexion, 30: Medial rotation. Sit on the pxs foot then draw the tibia forward a. Anterior Cruciate Ligament b. Posterolat. Capsule c. Arcuate popliteus complex d. Lateral collateral ligament e. Posterior cruciate ligament f. Iliotibial band injury b. Slocum Test Px: Supine (+) sign: Tibia moves forward (Anteromedial translation) Significance: Injury to these structures: a. Medial Collateral Ligament b. Posterior Oblique Ligament c. Posteromedial Capsule d. Anterior Cruciate Ligament Procedure: Flex the knee to 80:- 90: with 45: knee flexion, 15: Lateral rotation. Sit on the pxs foot then draw the tibia forward
Jerk Test of Hughston Px: Supine (+) sign: Clunk or jerk at 20:- 30: of knee flexion Significance: Injury to these structures: a. ACL b. Posterolateral capsule c. Arcuate popliteus complx d. Lat. Collateral ligament e. PCL f. Iliotibial Band Procedure: Flex the hip to 45: and knee to 90: then extend while maintaining medial rotation and a valgus stress Cross Over Test of Arnold Px: Standing (+) sign: Giving Way Significance: Injury to these structures: a. ACL b. Posterolateral capsule c. Arcuate popliteus complx d. Lat. Collateral ligament e. PCL f. Iliotibial Band Procedure: Instruct px to cross the uninvolved leg in front of the test leg. Step on the involved led. Asked the px to rotate the upper torso away from the uninvolved leg then is asked to contract the quadriceps muscle. Hughstons Posteromedial and Posterolateral Drawer Sign Px: Supine; hip flexed to 45:; knee flexed to 80:- 90: (+) sign: moves/rotates posteriorly on the medial aspect | moves/rotates posteriorly on the lateral aspect Significance: Injury to these structures:
Procedure: Sit on the pxs foot with both hands clasps around the tibia (slight medial rotation | slight lateral rotation) then translate postriorly. a. PCL b. POL c. MCL d. Semimembranosus mm e. Posteromedial capsule f. ACL a. PCL b. Arcuate-popliteus complex c. LCL d. Biceps fem tendon e. Posterolat. Capsule f. ACL Loomers Test Px: Supine (+) sign: excess lateral rotation and posterior sag Significance: Injury to these sturctures: a. PCL b. Arcuate-popliteus complex c. LCL d. Biceps Fem tendon e. Posterolateral capsule f. ACL Procedure: Flex the hip and knee to 90:, then maximally lateraly rotate both tibias. Mcmurray Test Px: Supine; knee fully flexed (+) sign: snap/click with pain Significance: Meniscus Injury Procedure: Medially Rotate the tibia for lateral meniscus Laterally Rotate the tibia for medial meniscus *modification: same procedure but with knee extension. Apleys Test Px: Prone; knee 90: flexed (+) sign: pain Significance: a. Ligamentous injury b. Meniscus Injury Procedure: Stabilize thigh with PTs knee. a. Medially/laterally rotate the tibia with distraction b. Medially/laterally rotate the tibia with compression Bounce Home Test Px: Supine; knee 90: flexed (+) sign: Rubbery end-feel, pain upon extension on jt. line Significance: Torn Meniscus Procedure: Cup the heel and allow it to extend passively ODonohues Test Px: Supine (+) sign: increase pain on rotation in either or both positions Significance: Capsular irritation | Meniscus Tear Procedure: Flex hip and knee to 90:, medially/laterally rotate the tibia twice, and then fully flex and rotate it both ways again. Modified Helfet Test Px: Short Sitting (+) sign: (-) patella goes laterally when standing Significance: Cruciate injury | Quadriceps weakness Procedure: Examine the patella in sitting and standing positions. Test For Retreating or Retracting Meniscus Px: Supine (+) sign: (-) appear/disappearing meniscus Significance: Torn meniscus Procedure: Flex hip and knee to 90: then medially and laterally rotate the tibia. Medial Rotation: Appearing Lateral Rotation: Disappearing Payrs Test Px: Supine (+) sign: pain on the medial jt. line Significance: Medial/posterior aspect of meniscus lesion Procedure: Position test leg in figure-4 position Bohlers Sign Px: Supine (+) sign: pain Significance: Meniscus Pathology Procedure: Apply valgus/varus stress on the knee Bragards Sign Px: Supine (+) sign: increase/decrease pain upon doing the procedure Significance: Meniscus Pathology Procedure: Place the pxs knee in flexion. Then laterally rotate the tibia and extend the knee = pain and tenderness. Medially rotate the tibia and flex the knee = decrease pain. Childress Sign Px: Standing (+) sign: Pain, clicking, snapping Significance: Posterior lesion of meniscus Procedure: Instruct px to squat and do the duck waddle Cabots Popliteal Sign Px: Supine; Figure-4 position (+) sign: Pain Significance: Meniscus Pathology Procedure: Ask the px to isometrically straighten the knee while applying resistance. Mediopatellar Plica Test Px: Supine (+) sign: Pain Significance: Pinching of the edge of the plica b/n the medial femoral condyle and the patella Procedure: Flex the knee 30: then push the patella medially with the thumb
Other Name: Mital-Hayden Test Plica Stutter Test Px: Short-sitting (+) sign: patella stutters or jumps b/n 60: and 45: of flexion Significance: Plica Syndrome Procedure: Plcae one finger over one patella and then ask the px to slowly extend the knee Hughston Test Px: Supine (+) sign: Popping of the plica band Significance: Plica Syndrome Procedure: Flex the knee and medially rotate the tibia while pressing the patella medially with the heel of the same hand on the medial condyle. Passively flex and extend the knee Brush, Stroke or Bulge Test Px: Supine (+) sign: Fluid wave bulge on the medial side of the patella Significance: Swelling (4-8ml extra synovial fluid) Procedure: stroke medial side (upwards) of the patella with 1 hand and the other hand on the lateral side (downward)
Other Name: Wipe Test Fluctuation Test Px: Supine (+) sign: Synovial Fluids Fluctuate Significance: Significant Effusion Procedure: place 1 hand above the patella (suprapatellar pouch) and the other hand below the patella. Press down with one hand and then the other hand. Patellar Tap Test Px: Supine (+) sign: Dancing patella Significance: Swelling Procedure: tap on the patella
Other Name: Ballotable Patella Clarkes Sign Px: Supine (+) sign: retropatellar pain / cannot hold the contraction Significance: Patellofemoral Dysfunction Procedure: Press down slightly proximal to the upper pole or the base of the patella. Ask the px to contract the quadriceps muscle while pressing down. Waldron Test Px: Standing (+) sign: count the crepitus with pain (note the amount, location and the ROM) Significance: Patellofemoral Dysfunction Procedure: Palpate the patella and then instruct the patiene to perform slow, deep knee bends. Zohlers Sign Px: Supine (+) sign: Pain Significance: Chondromalacia Patellae Procedure: pulls the patella distally and ask the pt to contract quadriceps muscle. Frunds Test Px: Short SItting (+) sign: Pain Significance: Chondromalacia Patellae Procedure: taps the patella in various knee flexion Q-angle Test Px: Supine (+) sign: a. < 13: | b. > 18: Significance: a. Chondromalacia patellae / patella alta | b. Chondromalacia / subluxing patella, increase femoral anterversion, genu valgum, lateral displacement of tibial tubercle, or increase lateral tibial torsion Procedure: Imaginary lines are drawn: 1 st line from ASIS to midpoint of patella 2 nd line from tibial tubercle to midpoint of patella
Other Name: Patellofemoral angle Wilson Test Px: Short Sitting (+) sign: pain lessened/diminished Significance: Osteochondritis Dissecans of the medial femoral condyle Procedure: Px extends the knee with internal rotation of the leg. At 30: of flexion, pain increases and the px is asked to stop the movement and rotate the leg laterally. Fairbanks Apprehension Test Px: Supine; knee flexed to 30: (+) sign: quadriceps muscle contract to bring patella into line Significance: Patellar dislocation Procedure: Carefully and slowly push the patella laterally and distally Noble Compression Test Px: Supine (+) sign: pain at 30: of knee flexion Significance: Iliotibial Band Syndrome Procedure: Flex the knee up to 90: then press the lateral femoral epicondyle with the thumb then extend the knee. Neutral Position Of Talus (Weight Bearing Position) Neutral Position Of Talus (Prone) Leg Heel Alignment Coleman Block Test Too Many Toes Sign Tibial Torsion (Sitting) Tibial Torsion (Supine) Tibial Torsion (Prone) Anterior Drawer Test Of The Ankle Prone Anterior Drawer Test Talar Tilt Squeeze Test Of The Leg Kleiger Test Thompsons Test Test For Peroneal Tendon Dislocation Feiss Line Hoffas Test Tinels Sign At The Ankle Duchenne Test Mortons Test Homans Sign Buergers Test Neutral Position Of Talus (Weight Bearing Position) Px: Standing (+) sign: Bulging Significance: Affectation of the Talus Procedure: Palpate for the talus (dorsal aspect) then ask the px to rotate the trunk to the right and left Tibia rotates medially and laterally Talus pronates and supinates Neutral Position of Talus (Prone) Px: Prone with foot dangled over the edge of the table (+) sign: Talar head bulges Laterally (Supination) / Medially (Pronation) Significance: Affectation of the Talus Procedure: Grasp over the 4 th and 5 th metatarsal heads. Palpate for the talus (dorsal aspect) the passively Dorsiflex the foot. Alternately move the foot to supination then pronation. Leg Heel Alignment Px: Prone with foot dangled over the edge of the table (+) sign: > 8: of inversion of heel | Eversion of heel Significance: Hindfoot varus | Hindfoot valgus Procedure: 1 st line - mark the midline of calcaneus 2 nd line 1cm distal to the 1 st mark 3 rd line lower third midline of the leg Coleman Block Test Px: Standing (+) sign: Heel is in neutral position | heel is still not in neutral position Significance: mobile hindfoot | fixed hindfoot inversion Procedure: Place 2cm wooden block on the floor and ask the px to stand with their heel and the lateral side of their forefoot on the block Too Many Toes Sign Px: Standing (+) sign:More toes can be seen on the affected side Significance: Valgus deformity, Forefoot abducted, increase lateral rotation of tibia Procedure: View the px from behind Tibial Torsion (Sitting) Px: Short-sitting (+) sign: Lateral tibial torsion: > 18: | < 13: Significance: toe-out position | toe-in position Procedure: Draw imaginary Lines: 1 st line 2 epicondyles 2 nd line 2 malleoli Tibial Torsion (Supine) Px: Supine (+) sign: Lateral tibial torsion: > 18: | < 13: Significance: toe-out position | toe-in position Procedure: Draw imaginary Lines: 1 st line 2 apices of malleoli 2 nd line heel parallel to the floor Tibial Torsion (Prone) Px: Prone; Knee flexed to 90: (+) sign: Lateral tibial torsion: > 18: | < 13: Significance: toe-out position | toe-in position Procedure: Draw imaginary Lines: 1 st line heel parallel to the floor 2 nd line heel parallel to the thigh a. Anterior Drawer Test Of the Ankle Px: Supine; 20: plantar flexion (+) sign: suction sign (over the anterior talofibular ligament) with minimal pain Significance: Stress on anterior talofibular ligament injury Procedure: Stabilize just above the ankle and draw the talus forward b. Anterior Drawer Test Of the Ankle Px: Supine; 20: plantar flexion (+) sign: greater anterior translation (on lateral die only) = medial rotation of the talus Significance: Stress on anterior talofibular ligament injury and calcaneofibular ligament Procedure: Stabilize just above the ankle and draw the talus forward + inversion c. Anterior Drawer Test Of the Ankle Px: Supine; 20: plantar flexion (+) sign: Greater Anterior Translation Significance: Torn anterior talofibular ligament and Calcaneofibular ligament Procedure: Stabilize just above the ankle and draw the talus forward + dorsiflexion Prone Anterior Drawer Test Px: Prone with foot dangled over the edge of the table (+) sign: Excessive anterior movement and Sucking in at the Achilles Tendon Significance: Ligamentous Instability (Anterior Talofibular Ligament) Procedure: Push the heel steadily forward. Talar Tilt Px: Side-lying; knee flexed (+) sign: Excessive Movement Significance: Adduction: stress on torn Calcaneofibular Ligament and/or Anterior Talofibular Ligament Abduction: stress on Deltoid Ligament (tibionavicular, tibiocalcaneal, posterior tibiotalar ligament) Procedure: Tilt the talus from side to side (abduction and adduction) Squeeze Test of The Leg Px: Supine (+) sign: Pain Significance: Syndesmosis Injury/high ankle sprain Procedure: Grasp the lower leg at midcalf and squeeze the tibia and fibula together Kleiger Test Px: Short-sitting (+) sign: Pain with talus displacement (medial) | pain over the anterior or posterior tibiofibular ligaments Significance: Deltoid Ligament Tear | Syndesmosis Procedure: Apply passive lateral rotation to the foot.
Other Name: External Rotation Stress Test Thompsons Test Px: Prone / kneels with feet over the edge of the table (+) sign: absence of plantar flexion Significance: Ruptured Achilles Tendon Procedure: Squeeze the calf muscle
Other Name: Simmonds Test, Sign for Achilles Tendon Rupture) Test or Peroneal Tendon Dislocation Px: Prone; knee flexed to 90: (+) sign: Tendon subluxes from behind the lateral malleolus Significance: Peroneal Tendon Dislocation Procedure: Ask px to actively dorsiflex and plantar flex the ankle along with eversion against resistance. Feiss Line Px: Standing but with non-weight bearing (+) sign: a. Falls 1/3 rd
b. Falls 2/3 rd
c. Rests on the floor Significance: a. 1 st degree Flat Foot b. 2 nd degree Flat Foot c. 3 rd degree Flat Foot Procedure: Mark the apex of Medial Malleolus to plantar aspect of 1 st
metatarsophalangeal jt. Then palpate the navicular tuberosity. (Normally lies on/close to the line b/n the 2 points) Hoffas Test Px: Prone with feet over the edge of the table (+) sign: feels less taut Significance: Calcaneal Fracture Procedure: Palpate both the achilles tendon. Instruct px to plantar flex and dorsiflex Tinels Sign At The Ankle Px: (+) sign: Tingling Sensation Significance: Peripheral Nerve Injury Procedure: Percuss at the anterior tibial branch of the Deep Peroneal Nerve in front of the ankle or the Posterior Tibial Nerve behind the medial malleolus.
Other Name: Percussion Sign Duchenne Test Px: Supine with legs straight (+) sign: Only the Lateral Border plantar flexes Significance: Lesion of the Superficial Peroneal Nerve, L4-S1 nerve root Procedure: Push up on the head of the 1 st metatarsal through the sole (dorsiflex). Px tries to plantarflex Mortons Test Px: Supine (+) sign: Pain Significance: Stress fracture or neuroma Procedure: Grasp the metatarsal heads and squeeze together Homans Sign Px: Supine (+) sign: Pain in the calf, PALLOR, swelling in the leg, loss of the dorsalis pedis pulse Significance: Deep Vein Thrombosis Procedure: Passively dorsiflex with the knee extended Buergers Test Px: Supine and sitting (+) sign: 1-2mins before the color comes back Significance: Poor arterial blood supply Procedure: Elevate the leg at 45: for at least 3 minutes, foot blanches. Px is then placed in short-sitting.