SPECIAL TEST FOR UPPER EXTREMITY

SHOULDER REGION
Test for Anterior Stability
SPECIAL TEST POSITION HOW TO DO (+) RESPONSE INDICATION
Load and Shift Sitting(No back  Hand of test resting on the thigh. Normal translation is 25% of  Anterior shoulder
Test support) / Supine  Examiner behind stabilizes the shoulder humeral head diameter or less Instability
with one hand over the clavicle and anteriorly
scapula. Grade 1: Up to 50%, with head
 Other hand grasps the head humerus riding up to the glenoid rim and
with the thumb over posterior humeral spontaneous reduction
head and fingers over the anterior Grade 2: More than 50%, head
humeral head. feels as though it is riding over
 Humerus is then gently pushed into glenoid rim but spontaneously
glenoid to eat it properly in the glenoid reduces
fossa (“load” portion of test). Grade 3: humeral head rides
 Examiner then pushes humeral head over glenoid rim and does not
anteriorly (ant. instability or posteriorly spontaneously reduce
(post instability), noting the amount of Normal posterior translation is
translation (shift portion of test) 50%
If with multidirectional
instability, both ant. and post.
Translation may be excessive on
the affected side compared with
the normal side
Apprehension  Examiner abducts arm to 90°  Look or feeling of apprehension  Anterior shoulder
(Crank) Test  Then laterally rotates the patient’s or alarm with resistance to instability
shoulder slowly further motion  Labral lesion (Bankart
*For most patients, lateral rotation is  With relocation, further lateral lesion or SLAP lesion-
released before posterior stress is rotation is possible (Jobe superior labrum, ant.,
released relocation test/ Fowler sign post.)
 If the arm is released (release  Bicipital tendinitis
test), in the newly acquired, pain
and forward translation of head
are noted
Rockwood Test Sitting  Examiner behind the pt.  Marked apprehension with post.  Anterior shoulder
 Arm abducted 45° Pain at 90°, at 45° & 120° lesser instability
 Then passively rotate (same at 90°, 120°) pain
Rowe Test Supine  Patient places hand behind the head  Look of apprehension or pain  Anterior instability
 Examiner places one hand (clenched fist)
against the post. humeral head
 Then pushes up while extending the arm
slightly
Fulcrum Test Supine  Arm abducted to 90°  Look of apprehension or pain  Anterior instability
 Examiner place one hand under
glenohumeral joint to act as fulcrum
 Then extends and laterally rotates arm
gently over the fulcrum
Prone Anterior Prone  Examiner abducts patient’s arm to 90°  Reproduction of symptoms  Anterior instability
instability and laterally rotates it to 90°
 While holding this position with one
hand at the elbow, other hand is over
humeral head and pushes forward
Andrew’s Anterior Supine  Shoulder abducted 130° and laterally  Reproduction of symptoms  Anterior instability
Test rotated 90°  Clunk may be heard  Anterior labral tear
 Examiner stabilizes the elbow and distal
humerus with one hand and uses other
hand to grasp humeral head
 Then lift it forward
Anterior Drawer Supine  Examiner places pt.’s hand in examiner’s  Excessive movement compared  Anterior instability
Test axilla, relaxes to normal side accompanied by
 Shoulder is abducted (80°-120°), flexed click or patient’s apprehension
(0-20°), ER (0-30°) then with other hand
 Stabilizes scapular spine with middle and
index fingers with thumb on coracoid
process, draw the humerus forward
Prozman Test Sitting/ Supine with  Pt.’s arm abducted 90° is supported  Pain and abnormal ant-inferior  Anterior instability
elbows on pillow against examiner’s hip movement, may associated with
 Examiner palpates ant. aspect of click
 humeral head with one hand and  Normal, translation should be
another on post. aspect >25% humeral head
 Then apply ant. inf. push to humeral
head
Anterior Instability Sitting  Examiner’s inner hand palpates the  Movement/ displacement of  Anterior instability
Test humeral head (ant. index) coracoid index finger
process (middle), thumb (post. humeral
head)
 Then abd and ER shoulder carefully
Dugas Test Sitting  Used if an unreduced ant. shoulder  Pain in the shoulder  Anterior instability
dislocation is suspected  Pain over acromioclavicular joint  Problem in the AC
 Patient places hand on opposite joint
shoulder and then attempt to lower the
elbow to the chest
Test for Posterior Stability
Posterior Supine  Examiner forward flexes patient’s  Apprehension or alarm and  Posterior instability
Apprehension or shoulder in the plane of scapula to 90° patient’s resistance to further  Dislocation of the
Stress Test  Then applies a posterior force elbow motion or the reproduction of humerus
 While applying the axial load, examiner symptoms
horizontally abducts and medially  Test is negative with atraumatic
rotated the arm multidirectional (inferior)
 Test should also be performed with arm instability
in 90° of abduction  Head moves posteriorly more
 Examiner palpates head of humerus with than 50° of its diameter, and
one hand while other hand pushes may be accompanied by a clunk
humeral head posteriorly
Norwood Stress Supine  Shoulder abducted 60°-100° and ER 90°  Slipping of humeral head  Posterior instability
Test with elbow flexed 90° (arm horizontal) posteriorly / click (no
 Then flex shoulder forward go with one apprehension)
hand post. to head od humerus other  Care must be done/ subluxation
hand apply downward push to forearm is possible
 Forearm maybe internally rotated 20°
Push-Pull Test Supine  Examiner holds patient’s arm at the  Normally 50% post. translation  Posterior instability
wrist, abducts the arm 90° , and forward can be accomplished
 flexes it 30°  More than 50% or apprehension
 Other hand is over humerus close to and pain
humeral head
 Then pulls up on the arm at the wrist
while pushing down on the humerus
Posterior Drawer Supine  Examiner grasp proximal forearm with  Head of humerus felt posteriorly  Posterior instability
Test one hand by index finger (pain free) but it
 Then flexes elbow to 120° abduction and may exhibit apprehension
20°-30° forward flexion
 Other hand stabilizes scap, (index and
middle fingers on spine, thumb at
coracoid process)
 Then rotates forearm medially and flexes
60°-80° while withdrawing thumb and
pushing humeral head posteriorly
Jerk Test Sitting  Arm is medially rotated forward flexed to  Production of a sudden jerk or  Recurrent posterior
90° clunk as amount of movement instability
 Examiner grasps patient’s elbow and the humeral head slides off
axially loads humerus in a proximal (subluxes) the back of the
direction glenoid
 While maintain axial loading, examiner  When arm is returned to original
moves the arm horizontally(cross flexion) position, a second jerk may be
across the body felt

Rowe Sign If lateral rotation of the shoulder is  Restricted lateral rotation of  Posterior dislocation
limited shoulder and limited supination at the glenohumeral
Examiner should check forearm in forward flexion joint
supination with arm forward flexed to 90°
Test for Other Shoulder Joint by: ROA & SVM
Acromioclavicular Sitting  Examiner clasps or cups pt. shoulder,  Pain / abnormal movement at  Acromioclavicular
Shear Test one hand on clavicle, and other on AC joint joint pathology
scapula
 Then squeezes heels of hand together
(inward)
Test for integrity Sidelying  Examiner stabilizes clavicle while pulling  Pain in the area of conoid  Conoid ligament
of the conoid the inferior angle of the scapula away location lesion
ligament from the chest wall
Test for integrity Sidelying  Examiner stabilizes clavicle while pulling  Pain in the area of trapezoid  Trapezoid ligament
of trapezoid the medial angle of the scapula away location lesion
ligament from the chest wall
Ellman’s Sidelying on  Examiner compress the humeral head  Reproduction of symptoms  Glenohumeral
Compression unaffected side into the glenoid while patient rotates the arthritis
shoulder medially and laterally
Apley’s “Scratch” Standing  (1st part) To test abduction and external  Inability to do the motion  Quickest way to
Test rotation, ask patient to reach behind his signifies limited ROM evaluate shoulder
head and touch the superior medial range of motion
angle of the opposite scapula
 (2nd part) To determine range of internal
rotation and adduction, have patient to
reach in front of his head and touch the
opposite acromion
 (3rd part) To further test internal rotation
and adduction, have patient reach
behind back to touch in inferior angle of
the opposite scapula
Test for Muscle Tendon Pathology by: ROA & SVM
Speed’s Test / Sitting Examiner resist forward flexion with pt.’s  Increase tenderness in bicipital  Bicipital tendonitis
Biceps or Straight forearm first supinated groove  Pain (+) in SLAP lesion
Arm Test Then pronated and elbow is completely  Profound weakness
- More effective extended on resisted
than Yergason’s supination, second or
third-degree rupture
or strain of the biceps
Yergason’s Test Sitting Patient’s elbow flexed 90° stabilized  Tenderness in bicipital groove  Bicipital tendinitis
against thorax  Tendon may pop out of the  Not as effective as
Examiner resist (forearm pronated) groove Speed’s due to
supination while pt. also ER arm against smaller movement or
resistance biceps in the groove
Ludington’s Test Sitting / Standing Pt. clasps both hands (interlocked fingers)  Absence of contracting biceps  Ruptured tendon of
on nape, arm abd. 90° then asked to tendon on involved side biceps long head
contract & relax biceps alternately
(thumbs down)
Gilchrest’s Sign Standing Patient lifts a 2-3 kg (5-7lbs) weight over  Pain or discomfort in the  Bicipital tendinitis
the head bicipital groove
Arm is ER and lowered to the side in the  In some cases, audible snap of
coronal plane pain may felt between 100° and
90° abduction
Lippman’s Test Sitting or Standing Examiner holds arm flexed to 90° with  Sharp pain  Bicipital tendinitis
one hand other hand palpates the biceps
tendon 7-8 cm(2.5-3 inches) below the
glenohumeral
Then moves the biceps tendon from side
to side in the bicipital grooves
Heuter’s Sign Standing / Sitting Elbow flexion resisted with arm pronated,  Absent supination  Disrupted biceps
(Supination some supination occurs (biceps attempts tendon
movement) to help brachialis
“Popeye” Muscle Sitting / Standing Do resisted isometric elbow flexion  Bunching of muscle  Third degree strain
(rupture on biceps
long head tendon
Supraspinatus Sitting  Pt.’s shoulder abducted to 90° with  Weakness and pain Tear of supraspinatus
(“Empty Can”) neutral rotation, examiner resist muscle/ tendon
Test  Shoulder is then IR (thumbs down) and Neuropathy of
angled forward 30° (empty can position) suprascapular nerve
as resistance is again given
Drop Arm Sitting / Standing Examiner abducts arm to 90°  Inability to return arm slowly or Rotator cuff tear
(Codman’s) Test Then patient drops the arm slowly has severe pain
Abrasion Sign Sitting Patient abducts arm to 90° with elbow is  Crepitus Rotator cuff tendons
flexed to 90° are frayed and are
Then medially and laterally rotated the abrading the acromion
arm at shoulder and the coracoacromial
ligament
Pectoralis Major Supine Pt. clasps hand behind head  Elbow cannot touch table Tight pectoralis major
Contracture Test Arms lowered until elbow touch the muscle
examining table
Lift-off Sign Standing Patient places dorsum of hand on back of  Inability to do the movement Lesion of subscapularis
pocket  Abnormal motion of scapula muscle
Then lifts the hand away from the back  To test the rhomboids, medial Scapular instability
border
Test for Impingement
Neer Sitting Pt. arm is forcibly elevated thru forward  Pain shows on patient’s face  Overuse injury to the
Impingement Test flexion by examiner causing a jamming of supraspinatus muscle
the greater tuberosity against the and sometimes to eh
anteroinferior border of the acromion biceps tendon
Hawkins-Kennedy Sitting Flex patient’s arm to 90°  Pain in the area of supraspinatus  Supraspinatus
Impingement Test Then forcibly IR shoulder pushing the tendon / coracoacromial tendinitis
supraspinatus tendon against ant. surface ligament
of coracoacromial ligament
Impingement Test Sitting Pt.’s arm forcibly abducted 90° and fully  Pain reflecting on face  If no hx of
ER, causing jamming of greater tuberosity subluxation or
to rotator cuff dislocation, due to
secondary
impingement of
rotator cuff (gr II or II
shoulder lesion –
Jobe classification)
Reverse Supine Used if patient has a positive painful arch  Pain decreases or disappear  Mechanical
Impingement Sign or pain on lateral rotation impingement under
Examiner pushes head of humerus the acromion
inferiorly as the arm is abducted or
laterally rotated
Thoracic Outlet Syndrome Test by: ROA & SVM
Roos Test (East- Standing Patients abducts shoulder to 90°  Unable to hold arms for 3 mins.  TOS
Elevated Arm Externally rotates it  Ischemic pain
Stress Test) or Flex elbow to 90°  Tingling/heaviness
Hand up Test or Then opens and closes hands slowly for 3  Numbness
Abduction mins.
External Rotation
(AER) Test
Wright Test / Sitting Arm is hyperabducted with hand and  See difference/alteration in pulse  TOS
Maneuver elbow over the head-taking breath, rate - Compression usually
rotating/extending head at costoclavicular
space
Costoclavicular Sitting Examiner palpates radial pulse and draws  Absence/ disappearance of radial  TOS
Syndrome / shoulder down and back pulse
Military Brace Test  Test effective if pt. complain of
symptoms while wearing
backpack/heavy coats
Provoactive Standing Pt. is asked to elevate arm above  Cramping  Vascular insufficiency
Elevation Test horizontal (180° flexion)  Tingling sensation  TOS
- modification of And open-close hands rapidly for 15 times  Fatigue
ROOS Test
Shoulder Girdle Sitting Used for patients who already present  Arterial relief- strong pulse, skin
Passive Elevation with symptoms colour more pink and increase
Examiner grasps pt.’s arm from behind hand temperature
and passively elevates shoulder girdle up  Venous relief- decreased
and forward into full elevation (a passive cyanosis and venous
bilateral shoulder shrug) engorgement
Position is held for 30 or more seconds  Neurological signs- numbness,
pins and needles or tingling, as
well as some pain as ischemia to
the nerve is released (Release
Phenomenon)
Adson Maneuver Sitting Examiner locate pulse  Pulse disappear  TOS
Head rotate to test shoulder
Pt. then extend head while examiner ER
and extends shoulder
Then hold breath (after taking deep
breath)
Allen Maneuver Sitting Examiner palpates for radial pulse  Absent pulse upon turning/  TOS
Then flexes pt.’s elbow to 90° while rotating head away
 shoulder is horizontally extended and
external rotated
Then rotate head away
Halstead Sitting Examiner applies a downward traction to  Absence or disappearance of  TOS
Maneuver pt.’s shoulder while pt hyperextends and radial pulse
rotates the neck to opposite side
Test for Inferior and Multidirectional Shoulder Instability
Sulcus Sign Standing Patient Shoulder muscle relax  Sulcus sign (deep furrow in  Inferior instability or
Examiner grasps pt. forearm below and suprahumeral joint) laxity of the inferior
push arm distally- best position at 20 ° to  Graded by measuring inferior glenohumeral
50° abduction with neutral rotation margin of acromion to humeral ligament
head  Glenohumeral
+1 is <1cm subluxation as seen
+2 is 1 to 2 cm in CVD, axillary &
+3 is >2cm suprascapular
denervations and/or
paralysis of deltoid
and supraspinatus
Feagin Test Standing Arm abducted 90° and elbow extended  Apprehension on face  Anterior instability
resting on top of examiner’s shoulder  Laxity or instability of
Examiner clasps upper 2/3 of humerus the inferior
and pushes anteroinferiorly glenohumeral
ligament
Test for Labral Tears
SLAP Lesion (superior labrum, anterior and posterior)
4 types according to Synder and colleagues:
Type 1: Superior labrum markedly frayed but attachments intact
Type 2: Superior labrum has small tear and there is instability of the labral biceps complex (most common)
Type 3: Bucket handle tear of labrum that may displace into joint; labral biceps attachment intact
Type 4: Bucket handle tear of labrum that extends to biceps tendon, allowing tendon to sublux into joint
Clunk Test Supine Examiner holds post. humeral head and  Clunk or grinding sound  Tear of labrum
other hand on the humerus (elbow part)  Apprehension if anterior  Instability relocate
fully abducts shoulder above pt.’s head instability is present the humerus
Push humeral head anteriorly, other hand  Walsh claims a clunk
 rotates humerus into laterally rotates or click indicates a
humerus labral tear
Walsh follows this maneuver with
horizontal abduction that relocated the
humerus
Anterior Slide Test Supine Patient’s hands on waist, thumbs  Humeral head slides over the  SLAP lesion
posterior labrum with a pop or crack and
Examiner behind patient stabilizes patient complains of
scapula and clavicle with one hand, other anterosuperior pain
hand applies
Compression Supine Examiner grasps arm and flexes elbow  Snapping or catching sensation is  Bankart or SLAP
Rotation Test with the arm abducted to about 20° felt lesion
Then pushes or compresses the humerus Note: Bankart lesion
in the glenoid by pushing up on the elbow refers to a tear in the
while other hand rotates humerus anteroinferior
medially and laterally labrum)
Posterior Inferior Sitting Examiner forward flexed the arm  Humerus protrudes or pain is felt  Lesion of posterior
Ligament Test between 80° and 90° in the area portion of inferior
Then horizontally adducts the arm 40° glenohumeral
with medial rotation while palpating the ligament
posteroinferior region of the glenoid
Test for Other Shoulder Joints by: ROA &SVM
Lateral Scapular Sitting Arm resting at the side  Normally, in each position  Excessive movement
Test Examiner measures distance from the distance measured should not is seen with
base of the spine of the scapula to the vary more than 1.5 cm (0.5 to instability
spinous process of T2-T4, from inferior 0.75 inch) from the original
angle of scapula to spinous process of T7- measure
T9 or from T2 to superior angle of scapula  Note any asymmetry of
The patient is then tested holding two or movement between right and
four other positions: left sides as well as
45° abduction (hand’s on waist,  Normally more movement
thumbs posteriorly) occurs at the glenohumeral joint
90° abduction with medial rotation compared to the scapulothoracic
120° abduction joint
 150° abduction *Note any winging
*Distance is measured in these positions

ELBOW REGION
Ligamentous Test by: ROA & SVM
SPECIAL TEST POSITION HOW TO DO (+) RESPONSE INDICATION
Ligamentous Patient’s elbow is slightly flexed (20°-30°  Alteration in pain  Adduction- Last
Instability Test and stabilize with examiner hand  Laxity decreased mobility collate lig pathology
Apply adduction/varus force on humerus  Abduction- medial
in full IR; Valgus stress/abduction force collateral lig
on distal forearm with humerus in full ER
Test for Epicondylitis
Lateral Epicondylitis With hand fisted and elbow stabilized by  Severe pain in area of lateral  Lateral epicondylitis
( Tennis Elbow ) examiner’s thumb at lat epicondyle epicondyle of humerus
Method 1 / Cozen’s Pronate forearm and radially deviates
Test Extend the wrist while examiner resist
Method 2/ Mill’s While palpating lateral epicondyle,  Severe pain in the area lateral  Lateral epicondylitis
Test examiner pronates forearm epicondyle of humerus
Flexes wrist fully
Then extend the elbow
Method 3/ Maudley Examiner resist extension of 3rd digit of  Severe pain in area of lateral  Lateral epicondylitis
Test hand distal to PIP joint (stressing epicondyle of humerus
extensor digitorum muscle and tendon)
Medial Palpate medial epicondyle, pt.’s forearm  Pain on medial epicondyle  Medial epicondylitis
Epicondilitis(Golfer’s is supinated and elbow and wrist
Elbow extended by examiner
Test for Neurological Dysfunction
Wartenburg’s Sign Sitting (with hand Spread fingers in the table  Inability to adduct little  Ulnar neuritis or
resting on the table) Then ask patient to bring fingers together ulnar neuropathy
Elbow Flexion Test Sitting Pt. is asked to completely flex elbow for 5  Tingling sensation / paresthesia  Cubital tunnel
mins with wrist extended and shoulder on ulnar distribution syndrome
abducted and depressed
Test for pronator Sitting Elbow flexed to 90°  Paresthesia in median nerve  Pronator teres
teres Then examiner strongly resist pronation distribution syndrome
as elbow is extended
Okay Sign / Pinch Sitting Ask pt to pinch index and thumb  Pulp to pulp pinch  Anterior
Grip Test together (normally tip to tip pinch) interossesseous
nerve pathology/
syndrome

FOREARM, WIRST AND HAND REGIONS

Test for Ligament, Capsule and Joint Instability
SPECIAL TEST POSITION HOW TO DO (+) RESPONSE INDICATION
Ligamentous Sitting  Examiner stabilizes the finger with one  Laxity  Gamekeeper’s / skier
Instability Test for hand proxy to joint to be tested, other thumb
fingers hand grasps test finger distal to joint to
be tested
 Apply varus/valgus stress
  
  
Thumb Ulnar Sitting  Examiner stabilizes patient’s hand with  If valgus movement is greater  Tear of ulnar
Collateral laxity or one hand than 35° collateral and
Instability Test  And takes the thumb into extension with accessory collateral
other hand ligaments
 Then applies a valgus stress to MCP joint  Gamekeeper’s or
of thumb Skier’s thumb
Test for Sitting  PIP joints is held in neutral position while  DIP joint does not flex  Retinacular
Retinacular DIP joint is flexed by examiner (pt. is  If PIP joint is flexed and DIP joint (collateral) lig or
Ligament passive) flexes easily capsule are thight
 Retinacular lig are
tight and capsule is
normal
Lunatotriqueteral Sititing  Examiner grasps lunate with thumb & 2nd  Laxity  Lunatotriquetral
Ballottement / finger & triquetrum with other hand  Pain instability
Reagan’s Test  Then move lunate up and down/ant-  Crepitus
post
Murphy’s Sign Sitting Pt. asked to  Head of 3rd MCP is level with 2nd & 4th  Head of 3rd MCP is level with 2nd  Lunate dislocation
make a fist metacarpal &4th MCP
Watson (Scaphoid Sitting  Examiner stabilizes radius and ulna with  Abnormal laxity  Instability or
Shift) Test Sitting one hand subluxation of
 Other hand grasps the scaphoid using scaphoid
thumb and index finger, moving it ant
and post
Scaphoid Stress Sitting  Examiner holds patient’s wrist so that  Normally, patient is unable to  Scaphoid instability
Test- modification the thumb applies pressure over distal deviate the wrist
of waston test, pole of scaphoid  Excessive laxity, with resulting
done actively by  Patient then attempts to radially deviate “clunk” and pain
the patient the wrist
Paino Keys Test Sitting  Patient’s both arms in pronation  Difference in mobility of both  Instability of distal
 Examiner stabilizes patient’s arm with hands radioulnar joint
one hand so that his index finger can  Production of pain and/or
push down on the distal ulna tenderness
 Other hand act as support
 Distal ulna is then pushed down
Axial Load Test Sitting  Examiner stabilizes patient’s wrist with  Pain and/or crepitation  Fracture of
one hand while other hand carefully metacarpal or
grasps thumb and applies axial adjacent carpal bones
compression or joint arthrosis
Pivot Sift Test of Sitting  Elbow flexed to 90° and resting on a firm  Capitate shifts away from the  Injurt to anterior
the Midcarpal Joint surface and hand fully supinated lunate capsula and
 Examiner stabilizes forearm with one interosseuos
hand and with the other hand takes ligaments
patient’s hand into full radial deviation
with wrist in neutral
 Maintaining this position, patient’s hand
is taken into full ulnar deviation
Grind Test Sitting  Examiner hold patient’s hand with one  Pain is elicited  Degenerative joint
hand and grasps the thumb below MCP disease to MCP
joint with other hand
 Then applies axial compression and
 rotation to MCP
Test for Tendon and Muscles
Finkelstein Test Sitting  Patient makes a fist with thumb inside  Pain over abductor pollcis longus  De Quervains or
the fingers Hoffmans’ disease
 Examiner ulnary deviates the wrist (tenosynovitis of
thumbs)
Sweater finger Sitting  Pt. is asked to make a fist  Instability of 1 distal phalanx to  Ruptured FDP tendon
flex (usually ring finger)
Test for extensor Sitting  Finger is flexed to 90 °at the PIP joint  Examiner feels little pressure  Torn central extensor
hood rupture over edge of table held in position by from the middle phalanx while hood
the examiner DIP joint is extending
 Patient is asked to carefully extended
PIP joint while examiner palpates for the
middle phalanx
Boyes Test Sitting  Examiner holds finger in slight extension  Inability or difficulty flexing DIP  Central slip of the
at the PIP joint joint extensor affected
 Patient is then asked to flex the DIP joint
Bunnel-Little Sitting  (1st part) MCP joint held slightly,  Cannot flex PIP jt.  Tight intrinsic muscle
(Finochletto extended while examiner moves  PIP jt. Ca be flexed or contracture of
Bunnel Test/ proximal IP jt. In flexion if possible  PIP jt. Cannot be fixed capsule
Instrinsic plus sign  (2nd part) MCP joint is semi flexed & PIP  Intrinsic muscle
jt. Is flexed tightness
 (3rd part) MCP jt. Is semi flexed  Capsule contracture/
tightness
Linburg Sign Sitting  Patient flexes thumb maximally into the  Limited index finger extension  Tendinitis at the
hypothenar eminence and pain interconnection
 Actively extends the index finger as far between flexor pollicis
as possible longus and flexor
inidicis(anomalous
tendon) condition
seen in 10-15 of hands
Flexor Digitorum Sitting  Pt.’s finger is extended except the one to  Inability to flex joint  Flexor digitorum
Superficialis Test be tested( to isolate the tendon) superficialis tendon is
 Ask pt. to flex finger at PIP joint either cut or absent
Flexor Digitourm Sitting  These tendons only work in union  Inability to flex DIP joint  Flexor digitorum
Profundus Test  Examiner isolates the DIP joint by tendon may be cut or
stabilizing the MCP and IP joint is the muscle
extension denervated
 Then ask pt to flex finger at the DIP joint
Test for Neurological Dysfunction by ROA & MV
Froment’s Sign  Pt. attempt to hold or grasp a cardboard  Patient could hardly hold the  Weakness of the
between the thumb (with IP extension) cardboard in place and may adductor pollicis and
and index finger while examiner pulls cheat by flexing thumb first dorsal
out the cardboard/ paper IP(through FPL muscle to hold interosseuos muscle
on the paper (paralysis of due to ulnar
adductor pollicis neuropathy/paralysis

Jeanne’s Sign `  Pt. attempts to hold or grasps a  Hypertension of MCP joint of  Ulnar nerve paralysis/
cardboard between the thumb (with IP thumb neuropathy
extension) and index finger while
examiner pulls out cardboard/paper
Egawa’s sign  Pt. flexes middle finger and alternately  Inability to deviate finger  Interosseuos (2nd &
and alternately deviate ulnarly and 3rd) muscle weakness
radially due to nerve
neuropathy
Wrinkle(Shrivel Sitting  Hand/fingers are placed in warm water  No wrinkles  Denervation
Test for 5-20 mins  Normal fingers sow wrinkling
 Then observe skin over the pulp for
wrinkles
 Valid only within the first few months
after injuiry
Ninhydrin Sweet  Pt.’s hand is cleaned thoroughly and  Change in color of paper(from  Nerve lesion
Test wiped with alcohol. white to purple does not occur
 Wait 5-30 mins with fingertips not in
contract with any surface to allow time
for sweating process to ensue
 After waiting period, press fingertip
(with moderate pressure) against good
 quality untouched bond paper (15 sec)
and trace it with pencil
 Spray paper with trikehydrindene
(nihydrin) spray reagent and allow to dry
(24hrs)
Weber’s(Moberg’s)  Examiner uses a paper clip, two point  Normal discrimination distance
Two Point discrinminator, or callipers to recognition is less than 6mm
Discrinmination simultaneously napply pressure on two
Test adjacent points in a longitudinal
direction or perpendicular to long axis of
fingers, moving from proximal to distal,
attempting to find the minimal distance
at which the patient can distinguish
between the two stimuli
 Distance is called threshold for
discrimination
Delton’s Moving  Used to predict functional recovery, it  Normal discriminition distance is
Two Point measures the quickly adapting 2-5mm
Discrimination Test mechanoreceptor system
 Similar to Weber’s expect than two
points aremoving during the test
 Examiner moves two blunt from
proximal to distal along the long axis of
limb or digit, starting with a distance of
6mm
 Beat fir hand sensation related to
activity and movement
Test for Carpal Tunnel Syndrome by: ROA &SVM
Phalen’s(Wirst Sitting  Oppose both wrist (in flexed position for  Tingling or numbness sensation  In 75% of CTS and
Flexion) Tests 1 minute along median distribution median neuropathy
(thumb, index, middle fingers +/- withing 1-2 mins
lateral half ring  In >25% of normal at
10 min.
Tetheres Median Sitting  Hyperexetnd the index finger at DIP  Median parenthesis or forearm  CTS
Nerve Stress joint with wrist extended and supinated pain
to pull or stretch the nerve
Carpal Sitting  Apply 150 mmHg pressure over wrist at  Production of symptoms  Median Paresthesis or
Compression Test- the median nerve for 30 second dysesthesias CTS
modification of
Reverse Phalen’s
Test
Reverse Phalen’s Sitting  Extend wrists to full extension and  Paresthesia along the median  CTS
Test or Prayer Sign oppose each other like in prayer’s nerve distribution
position

SPECIAL TEST FOR LOWER EXTREMITY

 HIP
Test for hip pathology
SPECIAL TEST POSITION HOW TO DO (+) RESPONSE INDICATION
Patrick’s test Supine  Examiner places the foot of test leg on the knee of the opposite leg, then  Possible: illiopsoas
(FABERE or Figure of lowers the knee of the test leg toward the examining table spasm, SI jt
4)  Test leg remains above the opposite straight leg pathology
Trendelenburg’s test Standing  Pt is asked to stand on one leg  Pelvis on non-stance leg drops  Gluteus medius
weakness
Craig test (ryder Prone  Measures femoral anteversion. Pt’s  Normal:  Increase anteversion
method) knee flexed 90 degrees. Examiner  At birth: ~30 degree  Squinting patella
palpates greater trochanter (parallel to  Adult: ~8-15 degrees  Toeing in
table) then passively IR and ER the hip
until leg reaches its most lateral
position (measure angle of anteversion
in relation to vertical line)
Torque’s test Supine (edge of  Test leg is extended until the pelvis  This stresses capsular  Hip instability
table) begins to move ligament and stability of hip jt.
 Examiner uses 1 hand to IR femur and
other hand to apply posterolateral
pressure along the femoral neck for 20
secs.
Nelaton’s line Supine  Imaginary line is drawn from ischial  Greater trochanter of femur is  Hip dislocation
tuberosity to ASIS of of pelvis on same palpated well above the line
side
Bryant’s triangle Supine  Examiner drops an imaginary  Difference of measurement on  May indicate coxa
perpendicular line from ASIS to both hips vara, hip dislocation,
examining table. Second, imaginary line etc.
is from tip of greater trochanter to
meet the first line at right angle. This
line is measured through radiographs
Rotational Supine  LE are straight while examiner looks at  Patellae faces in (“squinting  IR of femur or ER of
deformities the patellae patellae”) tibia
 Patellae faces up, out, away  ER of femur or IT
from each other (“frog’s eye tibia
 or grasshopper’s eyes”)  IR of femur and tibia
 Feet facing in (“pigeon toes”)  *(N) feet angle out 5-
10 degrees (fick
angle)
Pediatric test for hip pathology
Ortolani’s sign Supine  Examiner grasp the leg with thumb  Click, clunk or jerk may be  Valid only during 1st
*valid within 1st inside the legs (flexed hips). Fingers are heard or felt week after birth and
weeks after birth placed under the buttocks (outside the only for dislocated or
and only for thigh). Gently, with gentle traction lax hips
dislocated or lax thighs are abducted and pressure over
hips greater trochanters, resistance is felt
30-40 degrees abduction and ER
Barlow’s test Supine  Examiner flexes pt’s hip into 90 degrees  Click, clunk or jerk. But if upon  (dislocation)
(modification of and knees flexed fully (each hip is (thumb) pushing, femoral
ortolani) evaluated individually) head slips into the posterior
*infants up to 6  One hand middle finger palpates for lip of acetabulum, it is
months greater trochanter, thumb is adjacent considered UNSTABLE
to inner side of knee and thigh opposite
lesser trochanter. Hip is abducted while
middle finger applies forward pressure,
behind greater trochanter. Hearing a
click, thumbs then apply backward and
outward pressure
Galleazi’s sign Supine  Pt’s hips and knees flexed, while  One knee higher than the  Unilateral congenital
(Alli’s) examiner looks for asymmetry other hip dislocation
3 months to 18
months
Telescoping sign Supine  Examiner flexes knee and hip to 90  Excessive movement  Hip dislocation
degrees, then apply distraction and (telescoping/pistoning)
compression on femur
Test For Muscle Tightness/ Pathology
Sign of buttock Supine  SLR is done, if limited, knees of test leg  No increase in hip flexion  Lesions in the
is flexed buttocks not in
sciatic nerve
 hamstring/hip (may
be d/t bursitis,
neoplasms, abscess
in buttock)
Thomas test Supine  Examiner checks lordosis (excessive),  Straight leg will rise off the  Hip flexion
asks pt. to bring the one knee to the table contracture (most
chest  If straight leg is pushed down common)
onto table, lumbar lordosis
increases
Rectus femoris Supine  Pt’s knees bent over the end of the  Extension of knee from the  Rectus femoris
contracture test table (test leg), then ask pt. to bring table contracture
(method 1) one knee to the chest
Ely’s test (method Prone  Examiner passively flexes the pt’s knee  Flexing of hip on test leg  Rectus femoris
2) contracture
Ober’s test Sidelying  Examiner passively abducts and  Leg will remain abducted and  Iliotibial band / TFL
extends the upper leg with knee will not fall into table contracture
straight /90 degrees flexed, then slowly
lower the upper limb
Adduction Supine (with ASIS  Examiner observe s the angle formed  Decrease in the angle  Adductor contracture
contracture test level) by 2 legs in relation to an imaginary line  <90 degrees
passing b/n 2 ASIS  Pelvis shifts up on affected
 If examiner attempts to balance LE on side  Functional limb
pelvis  Down – unaffected shortening
 In individuals, esp. children with  There is a grab or kicking in or
adductor spasticity, abduction is stretch reflex at < 30 degrees  Adductor spasticity
performed quickly by examiner (repeat
with knee flexed- to rule out medial
hamstring tightness)
Abduction Supine  Formation of angle greater than 90  Increase in angle >90 degrees  Abductor contracture
contracture degrees in relation to ASIS (imaginary  Pelvis shifts down on affected
line) side
 If examiner attempts to balance LE with  Up – unaffected  Contracture can lead
pelvis to functional leg
lengthening
Noble compression Supine  Examiner flexes the knees 90 degrees  Pain at lateral femoral condyle  ITB friction syndrome
test accompanied by hip flexion at 30 degrees knee flexion
 Examiner applies pressure with the
thumb on the lateral femoral condyle
(1-2 cm proximal) while maintaining
pressure, slowly extend the knee
Piriformis test Sidelying (test leg  Pt flexes the test hip 60 degrees with  Pain in piriformis  Tightness of
uppermost) knee flexed piriformis
 Examiner stabilizes hip with one hand  Pain in buttock sciatica
and apply pressure to knee with  Sciatic nerve
another impinged
Hamstring Sitting  Pt sits with one knee flexed towards  Inability to touch (slightly at  Hamstring tightness
contracture test the chest and leg is extended; pt’s least)
(method 1) attempts to touch his toe on test leg
Tripod sign (method Sitting  Pt’s both knees flexed at 90 degrees  Leaning backward or  Hamstring tightness
2) over edge if table, then passively extension of trunk or contracture
extend one knee  Sciatic nerve can also
be stretched
90-90 SLR test Supine  Pt flexes hip 90 degrees while his knees  Knee extension should be  Hamstring
(method 3) are bent within 20 degrees of full contracture
 Pt then grasps behind the knee with extension (decreased value)
both hands (stabilize hip)
 Ask pt to actively extend his knee in
turn
Test for swelling
Brush or stroke test Sitting / supine  Examiner commences just below the jt.  Wave of fluid passes to medial  Swelling (minor)4-8
(wipe test) Line in medial side of patella, stroking side of distal border and bulge ml of extra fluid
proximally towards the pt’s hip (as far just below medial distal  Normal ` 5-7 ml
as suprapatellar) with palms and portion of patella (wave takes
fingers (3x), opposite hand strokes 2 secs to appear)
down lateral side of the patella
Fluctuation test Supine  Examiner places palm 1 hand on  Shifting/fluctuating fluid b/n  Significant effusion
suprapatellar pouch and other hand hands
anterior to jt. With thumb and index
 just below the margin of the patella;
press down one hand, then the other
Patellar tap test Sitting/supine  Pts knee extended or flexed to  Dancing patella sign, floating  Large amount of
(“ballotable patella) discomfort patella swelling
 Examiner applies slight tap or pressure  Separation of 2 fingers  Large amount of
over patella swelling
 Place thumb and index finger beside
patella and stroke suprapatellar pouch
Clarke’s sign Supine  Examiner presses down proximal to the  Presence of retropatellar pain  Chondromalacia
(patellofemoral upper pole/base of the patella with the and cannot hold contraction patella
grind test) web of the hand  Test patella in knee flexion of
 Ask pt to contract quadriceps muscle 30 degree. 60 degree, 90
while examiner pushes down degreee and full extension
Waldron’s test Standing  Perform several deep knee bends while  Pain and crepitus  Chondromalacia
examiner palpates patella; note pain patella
and crepitus
Mc Connel test Sitting  Femur is ER. Ask pt to isometrically  Pain during contractions  Chondromalacia
contract quadriceps muscle [120, 90, patella
60, 30 degrees] held for 10 secs each
Passive patellar tilt Supine  Extended knee, quads relaxed;  Decreased angle  Prone to
test examiner lifts the lateral edge of patella  Normal =15 degrees Chondromalacia
away from femoral condyle, patella  Males = 5 degrees less than patella
should remain on femoral trochlea females
Lateral pull test Supine  Pt contracts the quadriceps muscle  Excessive lateral movement of  Lateral ovrpull of
while examiner observes the the patella quadriceps, resulting
movement of patella  Normal- patella moves sup. to patellofemoral
And lat. arthralgia
Zohler’s sign Supine  With pt’s knees extended, examiner  Pain in patella  Chondromalacia
pulls patella distally and hold in this patella
position, then also asks the pt to
contract quads muscle
Frund’s sign Sitting  Examiner percusses the patella in  Pain  Chondromalacia
various positions of knee flexion patella
Test For 1-Plane Posterior Instability
Posterior sag sign Supine  Pt’s hip flexed 45 degrees, knee flexed  Posterior tibial displacement  Structures possibly
(gravity drawer test) to 90 degrees more noticeable when knee injured:
 Note the dropping back of tibia in is flexed 90-110 degrees  PCL, ACL
relation to femur  Arcuate- popliteus
 Voluntary ant. Drawer sign: if it appears complex
that pt has positive post. Sag sign, pt  Post. Oblique
should carefully extend knee while ligament
examiner holds thigh in 90-100 degrees
flexion -> results same with active ant.
Drawer test
Godfrey test Supine  Examiner flexes both LE 90 degrees in  Posterior sag/increased  Posterior cruciate
knee and hips displacement after manual ligament tar
pressure
Test For Anteromedial Rotary Instabiliy
Slocum test Supine  Pt’s knee flexed to 80 or 90 degrees,  Excessive movement occurs  Anterolateral rotary
hip flexed to 45 degree, foot placed in primarily on the lateral side of instability
30 degrees IR. Examiner sits on pt’s the knee  Structures possibly
forefoot to hold it in position, then  Excessive movement occurs injured
draws tibia forward primarily on medial side of  ACL, PCL
 In stress radiographs, minimal or no knee  posterolat. Capsule
movement is negative test, 1 mm or  arcuate popliteus
less – grade 1 injury complex
 1 to 2 mm – grade 2  lat. Collateral lig
 >2 mm – grade 3  ITB
 Structures possibly
injured:
 MCL, ACL
 Posteromedial
capsule
 Posterior oblique lig
Losee test Supine  with pt relaxed, examiner holds pt’s  just before full extension,  structure possibly
ankle and foot, leg ER and brace against there will be a “clunk” injured:
examiner’s abdomen; knee is then forward)  ACL
flexed to 30 degrees and hamstrings  Posterolat. Capsule
 relaxed.with examiners finger over the  Arcuate popliteus
patella and thumb hooked behind complex
fibular head, valgus force is applied to  Lateral collateral lig
knee while extending it, applying  ITB
forward pressur behind fibular head. At
the same time
Slocum’s “ALRI” test Sidelying (30  Foot of involved leg (uppermost) rest  Subluxation of knee will  Same structures
degrees from on table and is in IR, knee in extension reduce during this test b/n 25- injured as above
supine)uninvolved and valgus. Examiner applies valgus 45 degreed flexion
leg is beneath stress to knee jt.

KNEE
Test Position Procedure Positive Indication
Test For Meniscal Injury
Mc Murray Supine  Knee is completely flexed (heel to the  Snap/ click with pain  Lateral meniscal
buttocks) tear

 Examiner IR tibia (change amount of

flexion to test other parts) to test for
lateral meniscus

 For medial meniscus- laterally rotate

the knee
Bounce Home Supine  Examiner cup the heel of the pt.’s foot  Incomplete extension/  Possible meniscal
( knee is completely flexed) tear
 Rubber end feeling or Springy
 Knee is passively allowed to extend block

O’ Donoghue Supine  Examiner flexes the knee to 90°  Pain upon rotation in either  Capsular Irritation
or both position meniscal tear
 Rotate it medially & laterally (2x)

 Fully flexes & rotates it both ways

 again
Apley Prone  Pt.’s knee 90°  Distraction with rotation:  Ligamentous Injury
more pain
 Pt.’s thigh is then anchored into  Meniscal Injury
 examining table with examiner’s knee.  Compression with rotation:
more painful
 Medially and laterally rotate tibia

 Combined first with distraction

 Then with Copression

Test For Anterolateral Rotary Instability
Lateral Pivot Shift / Supine  Primary test used for anterolateral  As the leg flexed, tibia will  Excellent for
Test of Macintosh / rotatory instability reduced or “jog” backward anterior cruciate
Lemaire Test (feeling of “giving way” ligament rupture
 Hip flexed 30° and relaxed in slight IR
(20°)  Iliotibial band and menisci
must be intact, pt. relaxed
 Examiner holds pt.’s foot with one
hand

 The other placed at the knee with heel

of hand behind fibula over lateral head
of gastrocnemius (Tibia IR),

 Knee is then taken into extension

 Apply valgus stress to knee while

maintaining medial rotation torque on
tibia at ankle

 Flexed leg
TEST FOR 1-PLANE MEDIAL INSTABILTY
Abduction (Valgus) Supine  Examiner applies a valgus stress  Excessive gaping in medial side  Injury to any of the
Test (lateral aspect of the leg/knees) with with full knee extension ff:
full extension a. MCL, ACL, PCL
b. Posterior oblique
 Then in slight flexion 20-30° to ligament
“unlock” (lateral rotation to ankle c. Posteromedial
slight) capsule
d. Medial quadriceps
 If a stress radiograph is taken with expansion
knee in full extension, opening of: e. Semimembranosus
5mm- gr.1 injury to medial ligaments,  If ER of foot is applied and muscle
Upto 10 mm- gr. 2, >10mm- gr.3 there is excessive ER on
affected side  Anteromedial
rotatory instability
 Gaping with knee flexed (true
test)
 Involved structures
may be:
a.MCL, PCL
b.Posteromedial
capsule
c. Posterior oblique
ligament
TEST FOR 1-PLANE LATERAL INSTABILITY
Varus Test Supine  Examiner applies a varus stress to test  Excessive gap on lateral aspect  Structures possibly
leg of knee during full extension injured:
a.LCL
 First done in full extension b.Posterolateral
capsule
 Then in slight 20-30° flexion (ER of c. Arcuate-popliteus
tibia will place more stress to lateral complex
collateral ligament) d.Bicep femoris
tendon
 With a stress radiograph is taken with e.PCL, ACL
 knee in full extension, opening of: f. Lateral
5mm- gr.1 injury to lateral ligaments, gastrocnemius
Upto 8 mm- gr. 2, >8 mm- gr.3 muscle
 Gaping with knee flexed 20 - g.Iliotibial band
30° (true test)
 Structure possibly
injured:
a.LCL
b.Posterolateral
capsule
c. Arcuate-poplitues
complex
d.Iliotibial band
e.Bicep femoris
tendon
TEST FOR 1-PLANE ANTERIOR INSTABILITY
Lachman 1 Siting  Pt. sitting with knees flexed over edge  “Mushy” or soft endfeel when  ACL Injury (esp.
of table tibia is moved forward & posterolateral
infrapatellar tendon slope bundle)
 Examiner stabilizes leg with his thigh disappears
(flexion knee 30)  Posterior Oblique
ligament
 Then pulls tibia anteriorly while
stabilizing the femur  Arcuate-popliteus
ligament
Stable Lachman 2 Supine  Pt.’s knee resting on examiner’s thigh  Recommended for examiner  ACL Injury (esp.
 Examiner stabilized femur; with small hands posterolateral
 Other hand applies anterior stress to bundle)
tibia  Posterior Oblique
ligament
 Arcuate-popliteus
ligament
Prone Lachman 5 Prone  Examiner stabilizes foot b/n thorax &  Instability/ difficulty in  ACL Injury (esp.
arm determining quality of end feel posterolateral
 bundle)
 One hand is placed on the tibia,
 Posterior Oblique
 The other stabilizes femur ligament

 Arcuate-popliteus
ligament

Anterior Drawer Supine  Examiner flexes hip 45° and knees 90°,  Excessive anterior movement  Structures possibly
of tibia injured:
 Stabilizes the foot,  ACL (AMB), MCL
 Normal = 6mm  Posteromedial
 Then pulls tibia forward bundle
 Examiner must ensure that PCL  Iliotibial band
is not torn or injured  Posterior Oblique
 FINOCHETTO’S Jumping Sign- Audible  Test is (-) if only ACL is torn ligament
snap/ palpable jerk occurring when  Acuate- popliteus
anterior drawer sign is done; torn ACL  Ensure that PCL is no torn, in ligament
may accompanied by a meniscal lesion order to prevent tibia to drop
back on femur giving a false (+)  Positive only if there
sign is (-) posterior sag
sign
TEST FOR 1-PLANE POSTERIOR INSTABILITY
Posterior Sag / Supine  Pt.’s hip flexed 40°, knee flexed to 90°  Posterior tibial  Structures possibly
Gravity Drawer Test displacement more injured:
 Note the “dropping back of tibia in noticeable when knee a.PCL, ACL
relation to femur is flexed 90- 110° b.Arcuate- poplitues
complex
 Voluntary anterior drawer sign: If it c. Posterior Oblique
appears that pt. has (+) posterior sag ligament
sign, Pt. should carefully extend knee
while examiner hold thigh in 90- 100°
flexion -> result same with active
 anterior drawer test

ANKLE & FOOT REGION

 Neutral position Standing  Pt stands with feet in relaxed standing  Foot is positioned so talar  Subtalar it will be in
of talus position so that base width and Fick head does not appear to bulge its neutral position in
(weight bearing) angle are normal for pt. examiner to either side weight bearing
palpates head of talus on dorsal aspect
of the foot with thumb and forefinger.
Pt. slowly rotates trunk to right then
left, causing tibia to IR/ER so talus
supinates/pronates
Ligament stress tests
 Anterior Long sitting  One hand cups the calcaneum (right  Pain on lateral aspect of the  To stress the ATFL, in
talofibular ankle/ right hand and vice versa), the ankle and/or limited range order to detect a
ligament stress other hand is wrapped around the grade I/II sprain
test dorsum of the foot, ensuring that the
medial border of the hand is positioned
over the talus in order to localize stress
on the ligament effectively
 The calcaneum is tilted into a PF
position. The upper hand then
gradually adds further PF and inversion
 Calcaneofibular Long sitting  The calcaneum is cupped by one hand  Pain over the lateral aspect of  To stress the CFL in
ligament stress (right foot/left hand and vice versa) the ankle and/or limited range order to detect grade
test while the other hand wraps over the with no laxity is suggestive of I/II sprain
dorsum of the foot, the fingers grade I/II sprain.
positioned over the lateral talar dome
and the thumb supporting the sole of
the foot.
 The foot is taken into plantargrade –
the talus should not be in the CPP. The
hand cupping the calcaneum provides a
firm varus stress and the range of talar
 motion can be assessed by palpation
 Calcaneocuboid Long sitting  One hand cups the calcaneum (right  Pain over the lower, lateral  To stress the CCL in
ligament stress ankle/right hand and vice versa), the aspect of the ankle and/or order to detect grade
test other hand is wrapped around the limited range, the extent of I/II sprain
dorsum of the foot, ensuring that the which depends on the
medial border of the hand is positioned acuteness of the injury and its
just below the calcaneocuboid joint line severity
 The calcaneum is fixed in a neutral
position while the other hand applies a
combined movement of adduction and
inversion of the forefoot.
 Medial collateral Long sitting  One hand cups the calcaneum (right  Pain over the medial aspect of  To stress the medial
ligament stress ankle/right hand and vice versa). The the ankle and/or laxity is collateral (deltoid) in
test other hand is wrapped around the eleicited as the stress is added order to detect grade
dorsum of the foot from medial side, I/II sprain and /or
ensuring that the hand is positioned laxity
quite proximally (the medial edge of
the hand resting over the navicular) in
order to avoid stress falling primarily on
the forefoot
 The calcaneum is tilted into a valgus
position while the upper hand gradually
adds eversion in a degree of DF
Other test
 Thompson’s Prone with their  The palm of the PT hand is positioned  Lack of PF  Complete fracture of
test/simmond’s feet hanging over over the pt’s calf at the point where the the Achilles tendon
test/squeeze the edge of table girth is widest, with the thumb on one
test side and fingers on the other
 The PT then opposes thumb and fingers
to squeeze the calf
 Peroneal Long sitting  The PT palpates over the peroneal  The PT will feel the tendon  Subluxation/
subluxation tendons as they pass behind the lateral sublux or snap out of position dislocation of the
malleolus and/or the manoeuver will peroneus brevis and
 The pt. is asked to actively dorsiflex and elicit pain longus tendons
 evert the affected foot
 Morton’s test Long sitting  The medial and lateral aspects of the  Provocation of the pain  Morton’s neuroma
forefoot are grasped using one hand on intermetatarsal
 The medial and lateral aspects are plantar digital nerve
squeezed together with one hand and
the area of tenderness palpated with
the other

SPECIAL TEST FOR HEAD, NECK & TRUNK

CERVICAL REGION
Test for cervical instability
Test Position How to do Positive response Indication
Spurling test Sitting, bends or  Carefully apply downward  Pain radiating into arm on same side  For Foraminal
side flexes head pressure on the head as side flexion compression
to one side
Distraction test Sitting or supine  Place one hand under the  Pain is relieved or decreased  Nerve root pressure in
patients chin and the other cervical spine
hand around the occiput,
slowly lift the pts head
Shoulder Sitting or supine  Active or passive abduction of  Relief or reduction of ipsilateral  Cervical IV disc pathology
abduction test the ipsilateral shoulder so that cervical symptoms
the hand rests on top of the
head
Hoffman’s sign Sitting  Passive snapping flexion of  Flexion-adduction of ipsilateral  Pyramidal tract
middle finger distal phalanx thumb and index finger involvement
Test For Cervical Instability
Sharp purser test Sitting  Examiner places one hand on  When the examiner feels that the  Subluxation of atlas on the
pt’s forehead and thumb of head of the patient slides backward axis
other hand at axis (spinous during movement (may have chunk)
process) to stabilize then ask
pt. to slowly flex the head
while applying backward
pressure to the forehead
Aspinall Supine  Examiner stabilizes the (atlas)  Pt. feels a lump in the throat (atlas  Hypermobility at atlanto-
transverse occiput on the atlas in /& hold move toward esophagus) axial articulation
ligament test occiput in flexed position, then
examiner applies anterior
force to the atlas
Test for 7th cranial   
nerve
Chvostek’s test Sitting  Examiner taps the parotid  Facial muscle twitch  Pathology of CN 7 (facial
gland overlying the masseter nerve)
Lhermitte’s sign Long sitting  Passive neck flexion  Electric like sensation down the spine  Cervical spinal cord
 or in the extremities pathology including MS,
tumor, spondylosis,
myelitis
Slump test Sitting at the edge  Pt slumps forward so spine  Reproduction of symptoms  Neural tension
of the table flexes and shoulders are
rounded. Pts neck is flexed
then one knee is passively
extended (usually unaffected
leg first) then ankle is passively
DF. Test is repeated on the
other leg
Static vertebral Supine/sitting  Mobilize, passively move the  Extension: test play of intervertebral  Nerve root compression
artery test head of the patient and look foramina  Vertebral artery
for nystagmus, dizziness, light  Rotation and flexion: test vertebral compression
headedness, hold position for artery (side)
atleast 10-30 sec., and 10 sec
should elapse between each
test
Jackson Sitting  Compression is applied with  Pain radiates into the arm  Nerve root compression
compression head rotated on one side
Valsalva test Sitting  Ask patient to take a deep  Increased pain  Space, occupying lesion
breath
 Then hold it
Naffziger’s test Sitting  Examiner behind the patient  Pain  Nerve root problem
with his fingers over the  If lightheadedness or similar
patient’s jugular veins symptoms occur with compression of
 Compresses the veins for 30 the jugular veins. The test should
secs beterminated
 And then ask patient to cough
Kernig test Supine Flexing the thigh to a right angle  Radiation of sharp pain to UE of LE  Dural / menigneal
and then straighten the knee /  Accompanied by pain and resistance irritation
leg due to spasm
Soto hall test Supine  45° flexion of hips, greater  Radiation of sharp pain UE or LE  Dural meningeal irritation
traction in spinal cord
  Patient actively flexes head
towards the chest
Brudzinski test Supine Head is elevated (passively,  Flexion of both thighs and legs  Dural Meningeal irritation
actively) from the table or head is
paasively flexed in the chest
Temperature Sitting  Alternate application of hot and  Inducement of vertigo  Inner ear problem
caloric test cold test tube at the mastoid
process (back of the ear)
Dizziness test Sitting  Patient actively rotates head as  Dizziness upon head and shoulder  Vertebral artery problem
far as possible (R and L) then rotation  Semi-circular canal (inner
keeping eyes straight ahead,  Dizziness only upon head rotation ear) problem
rotate the shoulder as far as
possible
THORACIC REGION
SPECIAL TEST POSITION HOW TO DO (+) RESPONSE INDICATION
Slump Test / High sitting  Pt. is asked to sit & slump (trunk  Reproduction of pain & other  Impingment of the dura of
Sitting Dural flexed & shoulder sagging symptoms (sciatic pain) spinal cord or nerv root
Stretch Test forward) flex the neck,  Pain is usually at site of lesion
straighten the knees (uninvolved
1st)
 Passive dorsiflexion may be used
to enhance the effect
Passive Scapular Prone  Examiner passively  Pain is scapular area (ipsilateral to  T1 & T2 nerve root problem
Approximation approximates the scapula by location) (ipsilateral side)
lifting shoulders up & back
1st Thoracic Nerve  Pt. abducts the arm to 90°  Pain in scapular area on arm  Ulnar nerve pathology or 1st
Root Stretch  Flexes the pronate arm to thoracic nerve root
90°(no sx should appear) involvement
 Then fully flex the elbow until
hand is behind the neck
Forestier’s Standing  Ask the patient to bend  Ipsilateral paraspinal muscle tighter or  Probable ankylosing
Bwostring Sign sideways evident contract spondylosis
 Look for any tightness
LUMBAR REGION
 SPECIAL TEST POSITION HOW TO DO (+) RESPONSE INDICATION
Straight Leg Raising / Supine  Hip medially rotated, adducted &  Pain increases with neck  Menigneal irritation due
Lasegue’s Test knee extended flexion and or ankle to dural stretch
 Examiner flexes the hip until pt. dorsiflexion  Hamstring tightness;
complains of tightness/ pain Ls/SI jt
 Then decrease flexion (up to
shortness of pain)
 Ask the pt to flex neck / dorsiflex
foot or both
Sicard Test Supine  SLR involving big toe extension  Pain increases with neck  Menigneal irritation due
instead of DF flexion and or ankle to dural stretch
dorsiflexion  Hamstring tightness;
Ls/SI jt
Turyn’s Test Supine  Involves only extension of big toe  Pain increases with neck  Menigneal irritation due
flexion and or ankle to dural stretch
dorsiflexion  Hamstring tightness;
 Ls/SI jt
Unilateral SLR (80°-90°  70°- sciatic nerve is fully stretched; after 70°- joint pathology (sacroiliac or lumbar pain
flexion is normal  L5,S1,S2 nerve root

Well Leg raising test of  One leg is raised, pain occurs in opposite side (space occupying lesion
Fajersztajn / Prostrate leg a. Central profusion of ID-back pain primarily
raising test / Scaitic b. Intermediate area protrusion- pain in post aspect of lower limb & lower back
Phenomenon / Lhermitte’s c. Lateral protrusion= posterior leg pain primarily
test cross over sign
Prone Knee Bendind/ Prone  Examiner passively the knee until  Inability to flex pt.’s knee past  Femoral nerve stretch. L2
Nachlas Test heal touches the buttock or hip 90°-unilateral pain in lumbar to L3 nerve root lesion
extended with knee flexed area  Tight quadriceps muscle
 Positionmust be maintained for  Pain in ant thigh
45-60 seconds  *If rectus is tight this type of
movement may cause ant
torsion to the ilium which
could lead to SI or lumbar pain
Naffziger’s Test Supine  Examiner gently compresses  Pain in lower back area  Increased intrathecal
 jugular vein ~10 second presure
 Pt,’ sface will flush, ask him to
cough
Femoral nerve traction test Sidelying on  Examiner grasps the pt’s  Radiation of pain on ant. Thigh  L2-L4 nerve root lesion
unaffected side affected/painful limb and
extends knee while gently
extending hip ~15 degrees, then
flex knee
 L3 nerve root – hip and groin
radiating in ant., medial thigh
 L4 nerve root – pain extending to
mid tibia
Bowstring/cram Supine  Do SLR, then flex knee just in  Reestablishment of painful  Tension/ pressure in the
test/popliteal pressure sign short of pain (20degrees) then radicular sx sciatic nerve
apply pressure with examiners
thumb in the popliteal fossa area
Flip test Sitting  Examiner extends pt’s knee and  Both tests cause pain in sciatic  Sciatic nerve involvement
looks for symptoms. Pt is then nerve distribution
placed in supine, do unilateral  If only one test is positive,
SLR problem might be in th lower
lumbar spine
Sciatic tension test Sitting  Examiner passively extends knee  Reestablishment of painful  Tension/pressure in the
(upto pain production) slightly radicular sx sciatic nerve
flex and apply pressure in
popliteal area
Oppenheim test  Crest of tibia is stimulated  Splaying/abduction of fingers  UMNL
and extension of big toe
Gluteal skyline test Prone  Examiner observes symmetry of  Atonic, atrophied muscle,  Inferior gluteal nerve
gluteus muscle and asks pt to asymmetric/flat pathology
contract  L5, S1, S2
Babinski test  Stimulate lateral plantar  Splaying/abduction of fingers  UMNL
and extension of
Test For Joint Dysfunction
Schober test  A point is marked midway b/n  Difference b/n 2
 PSIS/level of S2; points 5 cm measurements indicate
below and 10 cm above it are amount of lumbar flexion
marked. The distance 3 points is
measured. Ask pt to flex
forward, and distance is
remeasured
Yeomans test Prone  Examiner extends each hip knees  Pain in lumbar spine  Lumbar spine dysfunction
extended then extends hip with
knees flexed
Milgrams test Supine  Pt actively lifts both legs 5-10 cm  Reproduction of sx and  Lumbar spine dyfunction
from the table and holds it for 30 inability to hold position
secs
Pheasant’s test Prone  Examiner gently applies pressure  By this hyperextension of  Unstable spinal segment
to posterior lumbar area, with spine, pain is produced in the
other hand flexing knee towards leg
the buttocks
Test For Muscle Dysfunction
Beevor’s sign Supine  Pt flexes the head/trunk against  Umbilicus doesn’t remain on  Abdominal muscle
resistance, cough or attempt to straight line upon contraction paralysis
sit up with hand behind the head of abdominal muscle
Test For Intermittent Claudication
Stoop test Standing  Pt asked to walk briskly for 1  Pain in buttocks/LE within a  Neurogenic intermittent
min. distance of 50 m. claudication
Test For Malingering
Hoover’s test Supine  Examiner places one hand on  No pressure is exerted on  Malingering
each calcaneus of pt, then asks opposite heel
pt to lift one leg (knees straight)
actively
Burn’s test Kneeling  Pt is asked to kneel on a chair  pt unable to  Malingering
and bend forward to touch the performoverbalance
floor with the fingers
PELVIC JOINT
Test Sacroiliac Involvement
Test Position How to do Positive response Indication
Piedallu’s sign Sitting (on hard,  Examiner palpates for PSIS  Affected PSIS becomes  Abnormally in torsion
flat surface) (affected is lower) then compare higher (hypomobile) movement of the SI jt.
height as he asks pt. to forward
flex the trunk
Gaenslen’s test Sidelying with  Pt. holds lower leg flexed against  Pain  Ipsilateral SI jt. Lesion,
upper leg chest. Examiner stabilizes pelvis hip pathology, or L4
hyperextended while exerting the hip of the nerve root lesion
at hip uppermost leg (test leg)
Supine
Laguere’s sign Supine  Examiner flexes, abducts, ER the  Pain in SI jt.  SI jt. Pathology
hip, then applies overpressure at
the end of ROM
 Examiner stabilizes the opposite
pelvis by holding the ASIS down
Gilett’s or sacral fixation test Standing  Examiner palpates PSIS, then asks  Minimal movement on  Hypomobile SI jt.
pt to stand on 1 leg while pulling flexed side
knees against/towards the chest  Normal – downward
movement
Yedmen’s test Prone  Examiner flexes the pt’s knees to  Pain in SI jt  Anterior SI jt ligament
90 degrees and extends the hip  Pain in lumbar area  Lumbar involvement
Goldwalt’s test Supine  Examiner places his fingers in  Pain in symphysis pubis or  Lesion in painful
lumbo-sacral interspace, and sacroiliac jt. structure
other hand performs SLR
Flamingo test or maneuver Standing  Pt is asked to stand on 1 leg  Pain in symphysis pubis or  Lesion in painful
 Increased pain when pt is asked sacroiliac jt structure
to hop on standing leg
Test For Limb Length
True leg length test Supine  Measure the distance between  Distance of 1-1.5 is  Leg length discrepancy
ASIS and medial malleolus (lateral considered normal (still
malleolus may be used in obese causes symptom)
individuals
Weberbarston maneuver Supine  With pt’s knees and hips flexed,  Different level of malleoli  LLD
examiner palpates the distal upon passive leg extension
aspect of medial ,malleoli with
thumbs and asks pt to pelvic
bridge, and return ti
startingposition.
Apparent leg length Supine  Examiner obtains distance from
the tip of the
xiphisternum/umbilicus to the
medial malleolus
Functional/standing leg Standing  Pt. is in relaxed stance; examiner  Difference is still noted  Check for structural leg