Special Tests

Active Compression Test (O'Brien's)

Pt. is standing with arm forward flexed to 90° and elbow fully extended. The arm is then slightly adducted and internally rotated (Thumb down). Examiner applies a downward force on forearm. The arm is then returned to the start position, now in external rotation (palm up). Positive Test: Pain or clicking in 1st part (thumb down) and eliminated or decreased in the 2nd part (palm up) Tests For: SLAP or superior labral lesion

Apprehension Test

Tests For: Anterior instability (Dislocation) or impingement Pt. is supine. Examiner abducts arm to 90° then gradually externally rotates pt. shoulder Positive Test: Pt. feels like this shoulder is going to dislocate; apprehension dominates over the pt. complaints of pain

Medial Epicondylitis test (golfer's test)

elbow support/ in 90 deg of flexion passively supinate arm, extend elbow, extend wrist

Upper Limb Tension Test 1

shoulder depression and abduction (110 deg), arm extended, wrist supinated and extended, head side bending to contralateral side for median and anterior interossesous nerve

Supraspinatus Test - Full Can

Pt. is in the scapular plane at 90° of flexion. Pt. has thumb up as if holding a full can. Examiner applies downward pressure as pt. resists Positive Test: Weakness and/or pain Tests For: Rotator cuff tear or SAIS

Phalen's test

carpal tunnel compression of median nerve max flexion of both wrists holding for 1 min sx of tingling/paresthesia into hand

Tests for circulation

Allen's test digit blood flow (nail bed compression)

Thigh thrust

In supine, hip flexed to 90, apply posteriorly directed force through femur Positive if sx

Anterior & Posterior Drawers (for shoulder)

Tests For: Instability *Click may indicate a labral tear or slippage of the humeral head over the glenoid rim Pt. is supine with arm abducted between 80 and 120° Examiner places thumb on coracoid and fingers on the spine of the scapula to stabilize. Then glide the humeral head anterior and posterior Positive Test: Pain, apprehension, excess movement, and/or click

Posterior Apprehension Test

Tests For: Posterior instability Pt. supine at edge of table with shoulder in the plane of the scapula Examiner adducts and medially rotates the pt. arm then applies a posterior force on the pt. elbow Positive Test: Look of apprehension or reproduction of symptoms

Wright (hyperabduction test)

TOS find radial pulse, move shoulder into max abduction and external rotation take deep breath and rotate head opposite to side being tested disappearance of pulse or reproduction of sx.

Meniscus test

McMurrary's, Apley, Thessaly, bounce home, joint line tenderness

Sacral thrust

Prone, force applied vertically downward toward center of sacrum

Adson's Test

TOS find radial pulse while patient is sitting rotate head toward extremity and extend and externally rotate shoulder while extending the head + if pulse disappears, sx reproduced in UE

Long sitting test

Determine anteriorly or posteriorly rotated innominate Anteriorly rotated: long leg in supine, short in sitting Posteriorly rotated: short in supine, long in sitting

Gillet

Determine sacroiliac joint dysfunction Palpable PSISs and stand on one leg, bring opposite knee to chest. Blocked joint won't move, normal moves inferiority

Tests for cubital tunnel syndrome

Pressure provocation test Flexion test Tinnel's sign

Compression

Sidelying, affected side up. Hips flexed to 45deg, knees flexed to 90, force applied vertically downward through ASIS

Roos Test

TOS shoulders fully externally rotated ,90 deg abduction, slightly horizontally abducted. Elwbos flexed to 90. Pt open/closes hands for 3 minutes slowly + if neuro/vascular sx reproduced in UE

Drop Arm Test

Pt. is sitting Arm is passively abducted to 90°. The pt. is then asked to slowly lower arm to side Positive Test: Unable to hold arm at 90° or slowly lower Tests For: Large rotator cuff tear

Lift-Off Test

Pt. standing facing away from examiner Pt. places arm behind back and is then asked to lift hand off their back Positive Test: Unable to lift hand off back Tests For: Large subscapularis tear

Supraspinatus Test - Empty Can

Same test as "Full Can" however now the pt. has their thumb down as in holding an empty can Positive Test: Weakness and/or pain Tests For: Rotator cuff tear or SAIS

Shear Test (Paxinos Sign)

Pt. sitting Stabilize the either the acromion or the clavicle. Apply a shear force (ant/ post glide) to the structure not being stabilized Positive Test: Pain or abnormal movement Tests For: AC Joint Pathology

Sacroiliac region screen

Cluster of 5 tests: Distraction Thigh Thrust Gaenslen's test Sacral thrust Compression 3/5 to be positive

Hip pathology tests

Patrick's (FABER), FADIR impingement test, scour test, Trendelenburg sign

MCL of elbow tear

Valgus stress at 30, 60, 70, 90, Moving Valgus stress test

Test for AC joint

Horizontal adduction test Resisted horizontal extension test O'briens sign Paxinos sign Palpation of AC joint

PFPS

McConnell test, passive patellar tilt test, Clarke's sign (patellar compression test)

Apley

Pt prone with testing knee flexed to 90 deg. Stabilize thigh, distract knee joint then slowly rotate tibia IR/ER. Then apply compressive load to knee and rotate tibia IR/ER. + if pain or decreased motion during compression= meniscus, pain or decreased motion during distraction= ligamentous

Belly Press Test

Pt. standing Pt. hand is on stomach and with elbow out so that the arm is in internal rotation. The pt. is told to maintain the position. Positive Test: Unable to maintain position Tests For: Subscapularis tear

tests for neurolgical dysfunction

Tinnel's sign Phalen's test reverse halen's test carpal compression test Froment's sign

Ligamentous instability of ankle

anterior drawer test of ankle, talar tilt, squeeze test of leg for syndesmosis injury

Bunnel-Littler test

tightness in MCP joint MCP in extension, PIP flexed then MCP is flexed, PIP is flexed tight capsule: flexion limited in both cases tight intrinsic muscles: >PIP flexion with MCP flexion

Standing flexion test

Palate PSIS and bend forward. PSIS that moves first and farthest is considered blocked or positive side

Neers Impingement Test

Pt. arm is passively elevated in the plane of the scapula with the arm medially rotated (Causes the greater tuberosity to jam against the anteroinferior border of the acromion) Positive Test: Pain Tests For: Overuse injury of supraspinatus and sometimes biceps tendon

Speed's Test

Pt. standing or sitting The examiner resists shoulder forward flexion while the pt. arm is supinated. The elbow remains fully extended Positive Test: Tenderness in the bicipital groove, especially when the arm is supinated Tests For: Bicipital paratenonitis or tendinosis General pain may be indicative of a SLAP lesion Weakness may be indicative of a 2nd or 3rd degree strain of the distal biceps

Patellar instability tests

paterllar apprehension test

Tennis elbow test (lateral epicondylitis test)

elbow in 90 deg flexion and supported. Resist wrist extension with radial deviation and forearm pronated + if pain at lateral epicondlye

Upper Limb Tension Test 4

Depression and abduction (10 to 90 deg) with hand to ear, elbow flexed, arm supinated, wrist extended and radial deviated, head contralateral side bending for ulnar nerve

Quadrant/Spurling's Test

Cervical extension, rotation, side bending with over pressure If positive then need to look into cervical spine causing UE symptoms Cervical radiculopathy, cervical disc prolapse, neck pain

IT band syndrome

Noble's compression test

McMurrays

pt supine with testing knee in max flexion. Passively IR and extend knee to determine to test lateral meniscus. ER to test medical meniscus. + if click or pain

Costoclavicular Test

TOS find radial pulse, move shoulder down and back disappearance of pulse

IR Resistance Strength Test Zaslay

Pt. sitting Shoulder is flexed to 90° with elbow bent to 90°. The pt. then externally rotates against resistance, followed by internally rotating against resistance. Positive Test: Pain with resistance into internal rotation Tests For: Labral Tear

Tests for labrum of shoulder

Crank test Biceps load test Pain provocation test Compression rotation test Resisted supine and external rotation test O'briens active compression test

Finkelstein's test

Identifies de Quervain's tenosynovitis (abductor pollicis longus and/or extensor pollicis brevis paratendonitis) pt makes a fist with thumb inside, wrist passively moved into ulnar deviation

Tests for impingement

Neer's Hawkin-Kennedy Painful arc

Muscle length tests for hip (tight muscles)

Ober's, Thomas, SLR, Ely's piriformis test

Distraction test

Pt in supine. Perform cross armed pressure to both ASISs Positive if sx reproduced

External Rotation Lag Test

Pt. is in the plane of the scapula (30° of scaption) with full external rotation. Next bring out of full ER a few degrees and ask the pt. to hold the position. Positive Test: Unable to maintain position Tests For: Supraspinatus 7° lag; Supraspinatus and infraspinatus 11° of lag; Supraspinatus, infraspinatus, and teres minor 18° of lag.

Sulcus Sign

Pt. stands with arm by side and muscles relaxed Examiner grasps pt. forearm (just below elbow) and pulls distally with the shoulder in 20-50° of abduction Positive Test: Sulcus greater than 1cm Bilateral sulcus sign is not of clinical significance and just indicates potential generalized laxity. Tests For: Inferior Instability

Clunk Test

Pt. supine. Examiner places one hand on post shoulder and other on humerus just above the elbow. The examiner fully abducts the pt. arm, then applies an anterior force over the humeral head while rotating the humerus into external rotation. Positive Test: Clunk or grinding sound Tests For: Labral Tear *Note: you can perform the test in different amounts of abduction to stress different areas of the labrum

Vertebral Artery

Should be performed prior to manual treatment of cervical spine and repeated as ROM increases. Supine or sitting. Extend and rot neck to one side, hold for 10 sec. Positive: dizziness, tinnitus, nausea, pupillary construction/dilation

Gaenslen

Thomas test but apply pressure to hanging leg and flexed leg

Pivot Shift test

for ACL integrity pt supine, knee extended, hip flexed/abducted 30 deg, with slight IR. Place valgus force through knee and flex at knee. + if tibia relocates/clunks by pull of IT band

Clarke's sign

push posterior on superior pole of patella, ask patient to contract quad. +if pain

Upper Limb Tension Test 2

shoulder depression and abduction (10 deg), laterally rotated, arm extended, wrist supinated and extended, head side bending to contralateral side for median, axillary and musculocutaneous nerve

Upper Limb Tension Test 3

shoulder depression and abduction (10 deg), medially rotated, arm extended, wrist pronated and flexed with ulnar deviation, fingers flexed, head side bending to contralateral side for radial nerve

Tinel's sign

tap region where ulnar nerve passes through cubital tunnel + reproduces a tingling sensation in ulnar distribution identifies dysfunction of ulnar nerve at olecranon OR tap over carpal tunnel

Thompson's Test

tests for Achilles rupture prone with foot off edge, squeeze calf muscle + if no movement of foot

Craig's test

to determine if hip is anteverted or retroverted. Normal ange is between 8-15 deg internal rotation less than 8 deg= retroverted greater than 15 deg= anteverted

Tests for ligamentous instability of wrist/hand

Thumb ulnar collateral ligament test test for tight retinacular ligaments lunatetriquetral ballottement test

Bear Hug Test

Pt. is sitting or standing Pt. places palm (flat hand) on opposite shoulder. Examiner then tries to pull the arm out of adduction as the pt. resists. Positive Test: Unable to maintain position against examiners resistance Tests For: Large subscapularis tear

Crank Test

Pt. is supine. Examiner elevates the arm to 160° in the scapular plane. From here an axial load in applied to the humerus with one hand while the other hand rotates the humerus medially and laterally. Positive Test: Pain on rotation (especially lateral rotation) Tests For: Labral Tear

Yergason's Test

Pt. standing or sitting Elbow flexed to 90°, pronated, and stabilized against the thorax. The examiner resists supination with the patient externally rotates the arm against resistance. Positive Test: Pain, tenderness in the bicipital groove and palpating the tendon "pop out" during supination and external rotation Tests For: Bicipital paratenonitis tendinosis (pain without tendon dislocation) or torn transverse humeral head ligament (tendon dislocation)

Hawkins-Kennedy Impingement Test

Pt. stands or sits Examiner forward flexes the arm to 90° then forcibly internally rotates the shoulder (Pushes supraspinatus tendon against coracoacromial ligament & coracoid process) Positive Test: Pain Tests For: Supraspinatus paratenonitis/ tendonosis or secondary impingement

Biceps Load Test II

Pt. supine Shoulder is abducted to 120° with the elbow flexed to 90°. The shoulder is then brought into max external rotation. *If apprehension appears, the examiner stops externally rotating and the test is performed from that position. The pt. then flexes the elbow against the examiners resistance Positive Test: Apprehension remains or the shoulder becomes painful If the apprehension decreases the test is negative for a SLAP lesion Tests For: Superior labral tear (SLAP)

Mill's Test

Stretching the forearm: The examiner palpates the patient's lateral epicondyle with his/her thumb while passively pronating the forearm, flexing the wrist and extending the elbow. A positive test would be the reproduction of pain near the lateral epicondyle. OR radial nerve involvement

Tests for shoulder Instability

Sulcus sign anterior apprehension test Relocation test Anterior draw test Jerk test for posterior instability

Distraction test

Supine, flex cervical spine and apply distraction force for 14 sec Positive if sx reduce

Lateral epicondylitis

Tennis elbow test Mill's test

Load & Shift Test

Tests For: Instability Pt. sitting and hand of testing arm resting on thigh while maintaining correct posture. Examiner stabilizes clavicle and scapula with one hand then glides the humeral head anterior and posterior Positive Test: Excess movement Normal Values: - Ant: 2-13mm - Post: 3-20mm

Tests for rotator cuff

Supraspinatus muscle test, infraspinatus muscle test, drop arm test, external rotation lag sign, internal Rotation lag sign Lift off test Belly press test

Allen's test

vascular compromise have pt open and close fingers several times then using thumb occlude the ulnar artery. Observe palm of hand and then release the compression and observe for vascular filling. Do the same with radial artery + if abnormal filling of blood (normal: change in color from white to normal on palm of hand)

Ligamentous test for knee

Lachman's, anterior drawer, pivot-shift test, valgus stress test, varus stress test, posterior drawer

ER Resistance

same test as external rotation MMT Perform test on R and L at the same time by telling the pt, "Don't let me press your hands in" Positive Test: Pain or Weakness Tests For: Rotator cuff tear or SAIS

Painful Arc

Positive Test: Pain Tests For: Pain between 45-120° indicates Glenohumeral painful arc; pain at the end of the range (170-180° indicates AC Joint painful arc