MSK FF Special test Flashcards
(112 cards)
1
Q
Yergarsons Test
A
PURPOSE- Integrity of transverse ligament
RESULT- Tendon of long head of biceps will pop out of the
groove. Tenderness in the bicipital groove alone without the
dislocation may indicate bicipital paratenonitis/tendinosis
2
Q
Speed Test
A
PURPOSE- Identify bicipital tendinosis/ tendinopathy
RESULT- Pain in long head of biceps tendon/ increased
tenderness in the bicipital groove
3
Q
NEERS Impingement test
A
PURPOSE- For impingement of supraspinatus and
biceps tendon
RESULT- Reproduces symptoms of pain in the shoulder
region
4
Q
Empty Can/ Jobe Test
A
PURPOSE- Identify tear/ impingement of supraspinatus
tendon or suprascapular nerve neuropathy
RESULT- Reproduces pain in supraspinatus tendon
or weakness in empty can position
5
Q
Drop Arm Test or Codmands test
A
PURPOSE- Also known as Codman’s test. Identify tear/
full rupture of rotator cuff
RESULT- A positive test is indicated if the patient
is unable to return the arm to the side slowly or
has severe pain when attempting to do so
6
Q
Posterior IR Impengement Test
A
PURPOSE- To identify impingement between rotator
cuff and greater tuberosity or posterior glenoid and labrum
RESULT- Reproduction of pain in posterior shoulder
during test
7
Q
Hawkins-Kennedy Impengement test/ Yocum
A
PURPOSE: Identify sub-acromial impingement
RESULT: Pain indicates a positive test for supraspinatus paratenonitis/tendinosis or
secondary impingement
8
Q
Horn Blowers Sign or Patte Test
A
PURPOSE: To detect Rotator cuff tears involving the teres minor
RESULT: . If the patient is unable to externally rotate the shoulder in this position, the
horn-blower’s sign is said to be present
9
Q
Active Compression Test of O’Brien
A
PURPOSE: To detect SLAP (Type II) or superior labral lesions
RESULT: If pain on the joint line or painful clicking is produced inside the shoulder
(not over the acromioclavicular joint) in the first part of the test and eliminated or
decreased in the second part, the test is
considered positive for labral abnormalities.
10
Q
Biceps Load Test
A
PURPOSE: To check the integrity of the superior labrum.
RESULT: If apprehension decreases or the patient
feels more comfortable, the test is negative for a
SLAP lesion. If the apprehension remains the same
or the shoulder becomes more painful, the test is
considered positive for SLAP lesions
11
Q
Lateral Rotation LAG Sign or Spring back test
A
PURPOSE: To test the teres minor and infraspinatus. Also known as Infraspinatus
“Spring Back” Test.
RESULT: For a positive test, the patient cannot hold the position and the hand
springs back anteriorly toward midline, indicating infraspinatus and teres minor
cannot hold the position due to weakness or
pain
12
Q
Abdominal Compression Test or Belly press or Napoleon Test
A
PURPOSE: Checks the subscapularis muscle.
RESULT: If the patient is unable to maintain the pressure on
the examiner’s hand while moving the elbow forward, or
posteriorly flexes the wrist or extends the shoulder, the test
is positive for a tear of the subscapularis muscle
13
Q
Lift Off Sign or Gerbers test
A
PURPOSE- To detect a lesion of the subscapularis muscle
RESULT- An inability to do so indicates a lesion of the subscapularis muscle.
14
Q
Jerk test
A
PURPOSE: To test recurrent posterior instability
RESULT: A positive test is the production of a sudden jerk or clunk as the humeral
head slides off (subluxes) the back of the glenoid. When
the arm is returned to the original 90° abduction position,
a second jerk may be felt as the head reduces.
15
Q
Sulcus Sign
A
PURPOSE: To test for inferior shoulder instability
RESULT: The presence of a sulcus sign may indicate inferior instability or
glenohumeral laxity but should only be considered positive for instability if the patient
is symptomatic
16
Q
Pectoralis Major Contrature Test
A
PURPOSE: To identify tightness of pectoralis major muscle
RESULT: A positive test occurs if the elbows do not reach the table and indicates a
tight pectoralis major muscle.
17
Q
Halstead Maneuver
A
PURPOSE: Identify pathology of structures that pass through thoracic inlet
RESULT: Absence or disappearance of a pulse indicates
a positive test for thoracic outlet syndrome.
(looking away)
18
Q
Clunk Test
A
PURPOSE- Identifies glenoid labrum tear
RESULT- Audible clunk is heard while performing test
19
Q
Anterior Apprehension/ Crank Test
A
PURPOSE- Identify past anterior dislocation of shoulder
RESULT- Patient does not allow or does not like to move shoulder into that direction
to simulate anterior dislocation
20
Q
Posterior Apprehension sign
A
PURPOSE- To identify past history of posterior
shoulder dislocation
RESULT- RESULT- Patient does not allow or does not
like to move shoulder into that direction to simulate
posterior dislocation
21
Q
Acromioclavicular Shear Test
A
PURPOSE- Identifies dysfunction of AC joint
such as arthritis, separation
RESULT- Reproduces pain in AC joint
22
Q
Adson’s Test
A
PURPOSE- Identify pathology of structures that
pass through thoracic inlet
RESULT- A disappearance of the pulse
indicates a positive test.
(look toward)
23
Q
Costoclavicular Syndrom or Military Brace Test
A
PURPOSE- Identify pathology of structures that
pass through thoracic inlet
RESULT- A positive test is indicated by an absence
of the pulse and implies possible thoracic outlet
syndrome (costoclavicular syndrome). This test is
particularly effective in patients who complain of
symptoms while wearing a backpack or heavy coat.
24
Q
Wright (Hyperabduction) Test
A
PURPOSE- Identify pathology of structures that
pass through thoracic inlet
RESULT- Neurological/ vascular symptoms
(disappearance of pulse) will be reproduced
25
Roos test or Elevated arm Stress test
PURPOSE- Identify pathology of structures that
pass through thoracic inlet
RESULT- If the patient is unable to keep the arms
in the starting position for 3 minutes or suffers
ischemic pain, heaviness or profound weakness of the
arm, or numbness and tingling of the hand during the
minutes, the test is considered positive for thoracic outlet
syndrome on the affected side.
26
Ligament Instability Test
## Footnote
Elbow
PURPOSE- To identify ligament laxity or restriction
RESULT-Primary finding is laxity but pain may be present.
Valgus test- Ulnar
Varus test- Radial
27
Lateral Epicondylitis Test/ Cozen Test
## Footnote
Elbow
PURPOSE- Identify lateral epicondylopathy
RESULT- Sudden severe pain in the area of the lateral epicondyle of the humerus is a positive sign
28
Mills Test
PURPOSE- Identify lateral epicondylopathy
PURPOSE- Evaluates for pain with compression of the retrodiscal tissues
DESCRIPTION- Patient siting or supine. Support/stabilize the head with one hand,
with other hand push mandible superior, causing a compressive load to TMJ
RESULT- Positive finding is pain in TMJ
RESULT- Pain over the lateral epicondyle of the humerus indicates a positive test.
29
Maudsleys Test
PURPOSE- Identify lateral epicondylopathy
RESULT- Positive test is indicated by pain over the lateral epicondyle of the humerus
30
Elbow Flexion Test
PURPOSE- Identify cubital tunnel syndrome
RESULT- Tingling or paresthesia in the ulnar nerve distribution of the forearm and
hand indicates a positive test. The test helps to determine whether a cubital tunnel
(ulnar nerve) syndrome is present.
31
Medial Epicondylitis Test or Golfers Elbow test
PURPOSE- Identify medial epicondylopathy (Golfer’s elbow test)
RESULT- A positive sign is indicated by pain over the medial epicondyle of the
humerus
32
Tinel's Sign
PURPOSE- Identifies dysfunction of ulnar nerve at olecranon
RESULT- A positive sign is indicated by a tingling sensation in the ulnar distribution of
the forearm and hand distal to the point of compression of the nerve. The test
indicates the point of regeneration of the sensory fibers of a nerve. The most distal
point at which the patient feels the abnormal
sensation represents the limit of nerve regeneration.
33
Finkelstient Test
PURPOSE- Determine the presence of de Quervain disease, a paratenonitis in the
thumb
RESULT- Pain over the abductor pollicis longus and extensor pollicis brevis tendons
at the wrist and is indicative of a paratenonitis of these two tendons.
33
Pronator Teres syndrome Test
PURPOSE- Identify median nerve entrapment within pronator teres
RESULT- Tingling or paresthesia in the median nerve distribution in the forearm
and hand indicates a positive test.
33
Tight Retinacular Test
PURPOSE- Identify tightness around PIP joint
DESCRIPTION- The proximal interphalangeal joint is held in a neutral position while
the distal interphalangeal joint is flexed by the examiner. If the distal interphalangeal
joint does not flex, the retinacular (collateral) ligaments or proximal interphalangeal
capsule are tight. If the proximal interphalangeal joint is flexed and the distal
interphalangeal joint flexes easily, the retinacular ligaments are tight and the capsule
is normal.
33
Bunnel-Litter Test or Intrinsic Plus test
PURPOSE- Identifies tightness in structures surrounding the MCP joint
RESULT- If the test is positive (which is indicated by inability to flex the proximal
interphalangeal joint), there is a tight intrinsic muscle or contracture of the joint
capsule. If the metacarpophalangeal joints are slightly flexed, the proximal
interphalangeal joint flexes fully if the intrinsic muscles are tight, but it does not flex
fully if the capsule is tight. The patient remains passive during the test. This test is
also called the intrinsic-plus test
33
Ligament Instability Test (finger)
PURPOSE- Identify ligament instability, medial or lateral
RESULT- The results are compared for laxity with those of the uninvolved hand,
which is tested first.
34
Froment's Sign
PURPOSE- Identify ulnar nerve dysfunction
RESULT- When the examiner attempts to pull away the paper, the terminal phalanx
of the thumb flexes because of paralysis of the adductor pollicis muscle, indicating a
positive test. If, at the same time, the metacarpophalangeal joint of the thumb
hyperextends, the hyperextension is noted as a positive Jeanne’s sign. Both tests, if
positive, are indicative of ulnar nerve paralysis
35
Wartenberg Sign
PURPOSE- Identify ulnar nerve neuropathy
RESULT- Inability to squeeze the little finger to the remainder of the hand indicates a
positive test for ulnar neuropathy
36
Hoffman Sign
PURPOSE- Indicates upper motor neuron dysfunction
RESULT- A positive sign is noted if the interphalangeal joint of the thumb of the same
hand flexes/adducts. The fingers may also flex.
37
Thumb Grind Test
PURPOSE- Identify degenerative joint disease in the metacarpophalangeal or
metacarpotrapezial joint
RESULT- If pain is elicited, the test is positive and
indicative of degenerative joint disease in the
metacarpophalangeal or metacarpotrapezial joint
38
Murphy's Sign
PURPOSE- Identify lunate dislocation
DESCRIPTION- The patient is asked to make a fist. If the head of the third
metacarpal is level with the second and fourth metacarpals, the sign is positive and
indicative of a lunate dislocation. Normally, the third metacarpal would project beyond
(or further distally) the second and fourth metacarpals.
39
Tinel's Sign (wrist)
PURPOSE-Identify carpal tunnel compression of median nerve
RESULT- A positive test causes tingling or paresthesia into the thumb, index finger,
and middle and lateral half of the ring finger. Tinel sign at the wrist is indicative of a
carpal tunnel syndrome.
40
Phalen's Test
PURPOSE- Identify carpal tunnel compression of median nerve
RESULT- Production of the patient’s symptoms is considered to be a positive test for
carpal tunnel syndrome. The test may also involve flexing the wrist 60° before
applying the pressure and whether symptoms are relieved when the examiner lets
go. The wrist flexion is felt to make the test more sensitive
41
Two point discrimination Test
PURPOSE-To identify level of sensory innervation in hand
DESCRIPTION- The examiner uses a paper clip, two-point discriminator, or calipers
to simultaneously apply pressure on two adjacent points in a longitudinal direction or
perpendicular to the long axis of the finger; the examiner moves proximal to distal in
an attempt to find the minimal distance at which the patient can distinguish between
the two stimuli. Only the fingertips need to be tested. Normal discrimination distance
recognition is less than 6 mm
42
Allen's Test
PURPOSE- To identify vascular compromise
DESCRIPTION- The patient is asked to open and close the hand several times as
quickly as possible and then squeeze the hand tightly. The examiner’s thumb and
index finger are placed over the radial and ulnar arteries, compressing them. The
patient then opens the hand while pressure is maintained over the arteries. One
artery is tested by releasing the pressure over that artery to see if the hand flushes.
The other artery is then tested in a similar fashion.
43
Patricks (FABER) Test
PURPOSE- Identify hip dysfunction, such as mobility restriction
DESCRIPTION- Patient lies supine. Passively flex, abduct and externally rotate hip
test leg so that the foot of the test leg is on top of the knee of the opposite leg. Slowly
lowers the knee of the test leg toward the examining table.
RESULT- A negative test is indicated by the test leg’s
knee falling to the table or at least being parallel with the
opposite leg.
A positive test is indicated by the test leg’s knee
remaining above the opposite straight leg. Positive
the test indicates that the hip joint may be affected,
that there may be iliopsoas spasm, or that the sacroiliac
joint may be affected.
44
Grind (scouring) Test
PURPOSE- Identify DJD of hip joint
DESCRIPTION- The patient lies supine. The examiner flexes and adducts the
patient’s hip so that the hip faces the patient’s opposite shoulder and resistance to
the movement is felt
RESULT- May reproduce pain in hip joint and refer pain to knee or elsewhere
45
Trendelenburg Sign
PURPOSE- To identify weakness of gluteus medius or unstable hip joint.
DESCRIPTION- The patient is asked to stand on one lower limb. Normally, the pelvis
on the opposite side should rise; this finding indicates a negative test
RESULT- If the pelvis on the opposite side (non-stance side) drops when the patient
stands on the affected leg, a positive test is indicated.
46
Thomas Test
PURPOSE- Identifies tightness of hip flexors
DESCRIPTION- The patient lies supine while the examiner checks for excessive
lordosis, which is usually present with tight hip flexors. The examiner flexes one of
the patient’s hips, bringing the knee to the chest to flatten out the lumbar spine and to
stabilize the pelvis. The patient holds the flexed hip against the chest.
RESULT- If there is no flexion contracture, the
hip being tested (the straight leg) remains on the
examining table. If a contracture is present, the
patient’s straight leg rises off the table and a
muscle stretch end feel will be felt
47
Obers Test
PURPOSE- To identify tightness of TFL/IT band
DESCRIPTION- The patient is in the side lying position with the lower leg flexed at
the hip and knee for stability. The examiner then passively abducts and extends the
patient’s upper leg with the knee straight or flexed to 90°. The examiner
slowly lowers the upper limb
RESULT- If a contracture is present, the leg remains abducted and
does not fall to the table.
48
Elys Test
PURPOSE- To identify tightness of rectus femoris.
DESCRIPTION- The patient lies prone, and the examiner passively flexes the
patient’s knee
RESULT- On flexion of the knee, the patient’s hip on the same side spontaneously
flexes, indicating that the rectus femoris muscle is tight on that side and that the test
is positive.
49
90-90 HS Test
PURPOSE- Identify hamstring tightness
DESCRIPTION- The supine patient flexes both hips to 90° while the knees are bent.
The patient may grasp behind the knees with both hands to stabilize the hips at 90°
of flexion. The patient actively extends each knee in turn as much as possible.
RESULT- Positive if knee is unable to reach 10 degree from neutral position (lacking
10 degree of extension)
50
Tripod Sign
PURPOSE- Identifies tightness of hamstring muscle.
DESCRIPTION- The patient is seated with both knees flexed to 90° over the edge of
the examining table. The examiner then passively extends one knee. If the hamstring
muscles on that side are tight, the patient extends the trunk to relieve the tension in
the hamstring muscles. The leg is returned to its starting position, and the other leg is
tested and compared with the first side. Extension of the spine is indicative of a
positive test.
RESULT- Extension of the spine is indicative of a
positive test.
51
Piriformis Test
PURPOSE- Identifies piriformis syndrome
DESCRIPTION- The patient is in the side lying position with the test leg uppermost.
The patient flexes the test hip to 60° with the knee flexed. The examiner stabilizes
the hip with one hand and applies a downward pressure to the knee
RESULT- If the piriformis muscle is tight, pain is elicited in the muscle. If the piriformis
muscle is pinching the sciatic nerve, pain results in the buttock and sciatica may be
experienced by the patient
52
Leg Length Test
PURPOSE- Identifies true leg length discrepancy
DESCRIPTION- True leg length is measured by placing the patient in a supine
position with the ASISs level and the patient’s lower limbs perpendicular to the line
joining the ASISs. Using a flexible tape measure, the examiner obtains the distance
from the ASIS to the medial or lateral malleolus on the same side. The measurement
is repeated on the other side, and the results are compared.
RESULT - A difference of 1 to 1.3 cm (0.5 to 1 inch) is considered normal.
53
Craig Test
PURPOSE- It is used to identify abnormal femoral anteversion
DESCRIPTION- The patient lies prone with the knee flexed to 90°. The examiner
palpates the posterior aspect of the greater trochanter of the femur. The hip is then
passively rotated medially and laterally until the greater trochanter is parallel with the
examining table or reaches its most lateral position.
RESULT- The degree of anteversion can then be estimated, based on the angle of
the lower leg with the vertical.
54
Collateral Ligament Instability test LCL and MCL
PURPOSE- To identify ligament laxity or restriction
DESCRIPTION- Entire lower limb is supported and stabilized, knee placed in 20-30
degree of flexion. Valgus force placed through knee test MCL and varus force checks
LCL
RESULT- Primary finding is laxity but pain may be reproduced
55
Lachmans Stress test
PURPOSE- Indicates integrity of ACL
DESCRIPTION- The patient lies supine with the involved leg beside the examiner.
The examiner holds the patient’s knee between full extension and 30° of flexion. The
patient’s femur is stabilized with one of the examiner’s hands (the “outside” hand)
while the proximal aspect of the tibia is moved forward with the other (“inside”) hand
RESULT- A positive sign is indicated by a “mushy” or soft end feel when the tibia is
moved forward on the femur (increased anterior translation with medial rotation of the
tibia) and disappearance of the infrapatellar tendon slope
56
Pivot Shift Test
PURPOSE- Indicates ACL integrity
DESCRIPTION- The patient lies in the supine position with the clinician standing to
the side of the patient's involved knee. There are two main types of clinical tests to
determine the presence of the pivot shift: the reduction test and the subluxation test.
Reduction test. The clinician stabilizes the patient's lower leg and flexes the knee to
90 degrees with one hand while using the palm of the other hand to medially rotate
the tibia, effectively subluxing the lateral tibial plateau. A sudden reduction anteriorly subluxed lateral tibial plateau is seen as the pivot shift
Subluxation test. This test is effectively the reverse of the reduction test. The test
begins with patient’s knees flexed. The clinician internally rotates the patient’s tibias
with one hand and applies a valgus stress to the knee joint with the other hand. The
clinician slowly extends the knee, maintaining rotation of the tibia. As the patient’s
knee reaches full extension, the tibial plateau will be felt to relocate.
57
Posterior SAG Test
PURPOSE- Indicates PCL integrity
DESCRIPTION- The patient lies supine with the hip flexed to 45° and the knee flexed
to 90°.
RESULT- In this position, the tibia “drops back,” or sags back, on the femur because
of gravity if the posterior cruciate ligament is torn
58
Slocum Test
PURPOSE- To assess both anteromedial and anterolateral rotary instabilities
DESCRIPTION- The patient’s knee is flexed to 80° or 90°, and the hip is flexed to
45°. The foot is first placed in 30° medial rotation. The examiner then sits on the
patient’s forefoot to hold the foot in position and draws the tibia forward; if the test is
positive, movement occurs primarily on the lateral side of the knee. This movement is
excessive relative to the unaffected side and indicates ALRI.
In the second part of the test, the foot is placed in 15° of lateral
rotation, and the tibia is drawn forward by the examiner. If the
test is positive, the movement occurs primarily on the medial
side of the knee. This movement is excessive relative to the
unaffected side and indicates anteromedial rotary instability
59
Posterior Drawer Test
PURPOSE- Indicates integrity of PCL
DESCRIPTION- Patient supine with testing hip flexed to 45 degree and knee flexed
to 90 degree. Passively glide tibia posteriorly following the joint plane
RESULT- Excess posterior glide is positive finding
60
Reverse Lachman Test
PURPOSE- Test for the posterior cruciate ligament integrity
DESCRIPTION- The patient lies prone with the knee flexed to 30°, and the examiner
grasps the tibia with one hand while fixing the femur with the other hand. The
examiner then pulls the tibia up (posteriorly), noting the amount of movement and the
quality of the end feel.
61
McMurrays Test
PURPOSE- Identifies meniscal tears
DESCRIPTION- The patient lies in the supine position with
the knee completely flexed (the heel to the buttock). The
examiner then medially rotates the tibia and extends the knee
RESULT- If there is a loose fragment of the lateral meniscus,
this action causes a snap or click that is often
accompanied by pain.
Test medial meniscus with same procedure
except rotate tibia into lateral rotation
62
Apley Test
PURPOSE- Help differentiate between meniscal tears and ligamentous lesion
DESCRIPTION- The patient lies in the prone position with the knee flexed to 90°. The
patient’s thigh is then anchored to the examining table with the examiner’s knee. The
examiner medially and laterally rotates the tibia, combined first with distraction, while
noting any restriction, excessive movement, or discomfort. Then the process is
repeated using compression instead of distraction
RESULT- If rotation plus distraction is more painful
or shows increased rotation relative to the normal
side, the lesion is probably ligamentous. If the
rotation plus compression is more painful or
shows decreased rotation relative to the normal
side, the lesion is probably a meniscus injury.
63
Bounce Home Test
PURPOSE- Indicates meniscal lesion
DESCRIPTION- The patient lies in the supine position, and the heel of the patient’s
foot is cupped in the examiner’s hand. The patient’s knee is completely flexed, and
the knee is passively allowed to extend. If extension is not complete or has a rubbery
end feel (“springy block”), there is something blocking full extension.
RESULT- The most likely cause of a block is a torn meniscus.
64
Thessaly Test
PURPOSE- Indicates meniscal lesion
DESCRIPTION- The patient stands flat footed on one leg while the examiner
provides his or her hands for balance. The patient then flexes the knee to 5° and
rotates the femur on the tibia medially and laterally three times while maintaining the
5° flexion. The good leg is tested first, and then the injured leg. The test is then
repeated at 20° flexion.
RESULT- The test is considered positive for a meniscus tear if the patient
experiences medial or lateral joint line discomfort. The
patient may also have a sense of locking or catching in
the knee.
65
Hughston's Plica Test
PURPOSE- Identify dysfunction of plica
DESCRIPTION- The patient lies in the supine position, and the examiner flexes the
knee and medially rotates the tibia with one arm and hand while pressing the patella
medially with the heel of the other hand and palpating the medial femoral condyle
with the fingers of the same hand
RESULT- The patient’s knee is passively flexed and extended while the examiner
feels for “popping” of the plica band under the fingers.
The popping indicates a positive test.
66
Patellar Apprehension Test
PURPOSE- Indicate past history of patella dysfunction
DESCRIPTION- Patient supine, with patella passively glided laterally
RESULT- – Patient does not allow the patella to move in lateral direction
67
Clarke's Sign
PURPOSE- Identify patellofemoral dysfunction
DESCRIPTION- The examiner presses down slightly proximal to the base of the
patella with the web of the hand as the patient lies relaxed with the knee extended.
The patient is then asked to contract the quadriceps muscles while the examiner
pushes down.
RESULT- If the patient can complete and maintain the contraction without pain, the
test is considered negative. If the test causes retropatellar pain and the patient
cannot hold a contraction, the test is considered positive.
68
Ballotable Patella/ Patella Tap Test
PURPOSE- Indicates infrapatellar effusion
DESCRIPTION- With the patient’s knee extended or flexed to discomfort, the
examiner applies a slight tap or pressure over the patella
RESULT- When this is done, a floating of the patella should be felt. This is sometimes
called the “dancing patella” sign
69
Fluctuation TEst
PURPOSE- Indicates knee joint effusion
DESCRIPTION- The examiner places the palm of one hand over the suprapatellar
pouch and the palm of the other hand anterior to the joint with the thumb and index
finger just beyond the margins of the patella
RESULT- By pressing down with one hand and then the other, the examiner may feel
the synovial fluid fluctuate under the hands and move from one hand to the other,
indicating significant effusion
70
Q angle measurment
The angle is obtained by first ensuring that the lower limbs are at a right angle to the
line joining the two ASISs. A line is then drawn from the ASIS to the midpoint of the
patella on the same side and from the tibial tubercle to the midpoint of the patella.
The angle formed by the crossing of these two lines is called the Q-angle.
Normally, the Q-angle is 13° for males and 18° for
females when the knee is straight
71
Noble Compression Test
PURPOSE- Identifies distal IT band friction syndrome
DESCRIPTION- The patient lies in the supine position, and the examiner flexes the
patient’s knee to 90°, accompanied by hip flexion. Pressure is then applied to the
lateral femoral epicondyle, or 1 to 2 cm (0.4 to 0.8 inch) proximal to it, with the thumb.
While the pressure is maintained, the patient’s knee is passively extended
RESULT-. At approximately 30° of flexion (0° being straight leg), the patient
experiences severe pain over the lateral femoral condyle
72
Tinels Sign (LE)
PURPOSE- To identify dysfunction of common fibular nerve posterior to fibular head
DESCRIPTION- Tap the region where common fibular nerve passes posterior to
fibular head
RESULT- Reproduces tingling sensation or paresthesia in leg
73
Neutral Subtalar Positioning
PURPOSE- Identifies abnormal rearfoot to forefoot positioning
DESCRIPTION- Patient prone with foot over edge of the table. Palpate dorsal aspect
of talus on both sides with one hand, and grasp lateral forefoot with other hand.
Gently dorsiflex foot until resistance then gently move foot through arc of supination
and pronation
RESULT- Neutral position is where you feel foot fall off easier to one side or other. At
this point compare rearfoot to forefoot and rearfoot to leg.
74
Anterior Drawe test
PURPOSE- Identify ligamentous instability (particularly anterior talofibular ligament)
DESCRIPTION- The patient lies supine with the foot relaxed. The examiner stabilizes
the tibia and fibula, holds the patient’s foot in 20° of plantar flexion, and draws the
talus forward in the ankle mortise
RESULT- Positive test if talus has excessive anterior
glide/ pain is noted
75
Talar Tilt Test
PURPOSE- To identify instability of calcaneofibular ligament.
DESCRIPTION- The patient lies in the supine or side lying position with the foot
relaxed . The patient’s gastrocnemius muscle may be relaxed by flexion of the knee.
The foot is held in the anatomical (90°) position, talus is then tilted from side to side
into inversion and eversion.
RESULT- Inversion tests the calcaneofibular ligament. Eversion stresses the deltoid
ligament
76
External Rotation Stress Test/ Kleiger Test
PURPOSE- Evaluates syndesmosis injury and a tear of the deltoid ligament. Also
known as Kleiger test.
DESCRIPTION- The patient is seated with the leg hanging over the examining table
with the knee at 90°. The examiner stabilizes the leg with one hand. With the other
hand, the examiner holds the foot in plantigrade (90°) and applies a passive lateral
rotation stress to the foot and ankle.
RESULT- The test is positive for a syndesmosis (“high ankle”)
injury if pain is produced over the anterior or posterior tibiofibular
ligaments and the interosseous membrane. If pain is present
medially and the examiner feels the talus displace from the medial
malleolus, it may indicate a tear of the deltoid ligament
77
Squeeze Test of the Leg
PURPOSE- To assess the syndesmosis integrity.
DESCRIPTION- The patient lies supine. The examiner grasps the lower leg at
midcalf and squeezes the tibia and fibula together. The examiner then applies the
same load at more distal locations moving toward the ankle.
RESULT- Pain in the lower leg may indicate a syndesmosis injury, provided that
fracture, contusion, and compartment syndrome have been ruled out.
78
Thompsons Test
PURPOSE- Evaluates integrity of Achilles tendon
DESCRIPTION- The patient lies prone or kneels on a chair with the feet over the
edge of the table or chair. While the patient is relaxed, the examiner squeezes the
calf muscles.
RESULT- The absence of plantar flexion when the muscle is squeezed indicates a
positive test and a ruptured Achilles tendon (third-degree strain)
79
Tinels Sign (Lower LE)
PURPOSE- Identifies dysfunction of posterior tibial nerve
DESCRIPTION- The anterior tibial branch of the
deep peroneal nerve may be percussed in front
of the ankle. The posterior tibial nerve may be
percussed as it passes behind the medial
malleolus
RESULT- In both cases, tingling or
paresthesia felt distally is a positive sign.
80
Mortons Test
PURPOSE- Identifies stress fracture or neuroma in forefoot
DESCRIPTION- The patient lies supine. The examiner grasps the foot around the
metatarsal heads and squeezes the heads together.
RESULT- Pain is a positive sign for stress fracture or
neuroma.
81
Vertebral Artery Test
PURPOSE- Assesses the integrity of vertebro-basilar vascular system
DESCRIPTION- With the patient supine, the examiner passively takes the patient’s
head and neck into extension and side flexion. After this movement is achieved, the
examiner rotates the patient’s neck to the same side and holds it for approximately
30 seconds.
RESULT- A positive test provokes referring
symptoms if the opposite artery is affected
82
Hautants Test
PURPOSE- Differentiate dizziness or vertigo caused by articular problems from that
caused by vascular problems
DESCRIPTION- The patient sits and forward flexes both arms to 90°.The eyes are
then closed. The examiner watches for any loss of arm position. If the arms move,
the cause is nonvascular.
The patient is then asked to rotate, or extend and rotate, the neck; this position is
held while the eyes are again closed. If wavering of the arms occurs, the dysfunction
is caused by vascular impairment to the brain. Each position should be held for 10 to
30 seconds
83
Transverse ligament stress test
PURPOSE- To test integrity of transverse ligament
DESCRIPTION- The patient lies supine with head supported on the table. Glide C1
anterior. Should be firm end feel. The position is held for 10 to 20 seconds to see
whether symptoms occur, indicating a positive test
RESULT- Positive symptoms include soft end feel; muscle spasm; dizziness; nausea;
paresthesia of the lip, face, or limb; nystagmus; or a lump sensation in the throat.
84
Sharp Purser Test
PURPOSE- To determine subluxation of the atlas on the axis.
DESCRIPTION- The examiner places one hand over the patient’s forehead while the
thumb of the other hand is placed over the spinous process of the axis to stabilize it.
The patient is asked to slowly flex the head; while this is occurring, the examiner
presses backward with the palm.
RESULT- A positive test is indicated if the examiner feels the head slide backward
during the movement. The slide backward indicates that the
subluxation of the atlas has been reduced, and the slide
may be accompanied by a “clunk.”
85
Anterior Shear Test
PURPOSE- Test the integrity of the supporting ligamentous and capsular tissues of
the cervical spine
DESCRIPTION- The patient lies supine with the head in neutral, resting on the bed.
The examiner applies an anteriorly directed force through the posterior arch of C1 or
the spinous processes of C2 to T1 or bilaterally through the lamina of each vertebral
body. In each case, the normal end feel is tissue stretch with an abrupt stop
RESULT- Positive signs, especially when the upper cervical spine is tested, include
nystagmus, pupil changes, dizziness, soft end feel, nausea, facial or lip paresthesia,
and a lump sensation in the throat
86
Foraminal Compression/ Spurlings test
PURPOSE- Identifies dysfunction (compression) of cervical nerve root
DESCRIPTION- The patient bends or side flexes the head to the unaffected side first,
followed by the affected side. The examiner carefully presses straight down on the
head.
RESULT- The dermatome distribution of the pain and altered sensation can give
some indication as to which nerve root is involved
87
Maximum Cervical Compression Test
PURPOSE- Identify compression of neural structures at intervertebral foramen or
facet joint dysfunction
DESCRIPTION- The patient side flexes the head and then rotates it to the same
side. The test is repeated to the other side. A positive test is indicated if pain radiates
into the arm.
If the head is taken into extension (as well as side flexion and rotation) and
compression is applied, the intervertebral foramina close maximally to the side of
movement and symptoms are accentuated. Pain on the
concave side indicates nerve root or facet joint
pathology, whereas pain on the convex side indicates
muscle strain
88
Distraction Test
PURPOSE- Identify compression of neural structures at intervertebral foramen or
facet joint dysfunction
DESCRIPTION- Patient sitting and distract the head passively
RESULT- Positive finding is decrease in symptom in neck (facet condition) or
decrease in upper limb pain (neurological condition)
89
Shoulder Abduction test
PURPOSE- To test for radicular symptoms, especially those involving the C4 or C5
nerve roots.
DESCRIPTION- The patient is sitting or lying down, and the examiner passively or
the patient actively elevates the arm through abduction so that the hand or forearm
rests on top of the head
RESULT- A decrease in or relief of symptoms indicates a
cervical extradural compression problem, such as a
herniated disc, epidural vein compression, or nerve
root compression, usually in the C4–C5 or C5–C6 area.
90
Lhermitte Sign
PURPOSE- Identifies dysfunction of spinal cord and upper motor neuron lesion.
DESCRIPTION- The patient is in the long leg sitting position. The examiner passively
flexes the patient’s head and one hip simultaneously with the leg kept straight
RESULT- A positive test occurs if there is a sharp, electric shock-like pain down the
spine and into the upper or lower limbs; it indicates dural or meningeal irritation in the
spine or possible cervical myelopathy.
91
Rib springing
PURPOSE- Evaluates rib mobility
DESCRIPTION- The patient lies prone or on the side while the examiner’s hands are
placed around the posterolateral aspect of the rib cage. The examiner’s hands are
approximately 45° to the vertical axis of the patient’s body. The examination begins at
the top of the rib cage and extends inferiorly, springing the ribs by pushing in with the
hands on each side in turn and then quickly releasing.
RESULT- Positive finding is pain, excessive
motion of rib or restriction
92
Thoracic Spinging
PURPOSE- Evaluates Intervertebral joint mobility in thoracic spine
DESCRIPTION- Patient prone. Apply posterior/anterior/springs to transverse
processes of thoracic vertebra.
RESULT- Positive finding is pain, excessive motion of rib or restriction
93
Slump Test
PURPOSE- Identifies dysfunction of neurological structures supplying lower limb
DESCRIPTION- The patient sits on the examining table and is asked to “slump” so
that the spine flexes and the shoulders sag forward while the examiner holds the chin
and head erect.
If no symptoms, are produced, the examiner flexes the patient’s neck and holds the
head down and shoulders slumped to see if symptoms are produced.
If no symptoms are produced, the examiner passively extends one of the patient’s
knees to see if symptoms are produced.
If no symptoms are produced, the examiner then passively dorsiflexes the foot of the
same leg to see if symptoms are produced.
RESULT- Reproduction of the patient’s
symptoms, implicating impingement of
the dura and spinal cord or nerve roots
94
Lasegues Test SLR
PURPOSE- Identifies dysfunction of neurological structures supplying lower limb
DESCRIPTION- With the patient in the supine position, the hip medially rotated and
adducted and the knee extended, the examiner flexes the hip until the patient
complains of pain or tightness in the back or back of the leg. The examiner then
slowly and carefully drops the leg back (extends it) slightly until the patient feels no
pain or tightness. The patient is then asked to flex the neck, or the examiner may
dorsiflex the patient’s foot.
RESULT- Reproduction of pathological neurological symptoms when foot is
dorsiflexed
95
Femoral Nerve traction test
PURPOSE- Identify compression of femoral nerve
DESCRIPTION- The patient lies on the unaffected side with the unaffected limb
flexed slightly at the hip and knee. The examiner grasps the patient’s affected or
painful limb and extends the knee while gently extending the hip approximately 15°.
The patient’s knee is then flexed on the affected side; this movement further
stretches the femoral nerve
RESULT- Neurological pain radiates down the anterior thigh if the test is positive.
96
Valsalva Maneuver
PURPOSE- Identify a space occupying lesion
DESCRIPTION- The seated patient is asked to take a breath, hold it, and then bear
down as if evacuating the bowels.
RESULT- If pain increases, it indicates increased intrathecal pressure.
97
Babinski Test
PURPOSE- Identifies UMN lesion
DESCRIPTION- The examiner runs a pointed object along the plantar aspect of the
patient’s foot.
RESULT- A positive Babinski test or reflex suggests an upper motor neuron lesion.
The reflex is demonstrated by extension of the big toe and abduction (splaying) of the
other toes.
98
Quadrant test
PURPOSE- Identify compression of neural structures at the intervertebral foramen
and facet dysfunction
DESCRIPTION- The patient stands with the examiner standing behind. The patient
extends the spine while the examiner controls the movement by holding the patient’s
shoulders. Overpressure is applied in extension while the patient side flexes and
rotates to the side of pain. The movement is continued until
the limit of range is reached or until symptoms are produced
RESULT- The position causes maximum narrowing of the
intervertebral foramen and stress on the facet joint to the
side on which rotation occurs. The test is positive if
symptoms are produced
99
Stork Standing Test
PURPOSE-Identifies spondylolisthesis
DESCRIPTION- The patient stands on one leg and extends the spine while balancing
on the leg. The test is repeated with the patient standing on the opposite leg.
RESULT- A positive test is indicated by pain in the back and
is associated with a pars interarticularis stress fracture
(spondylolisthesis). If the stress fracture is unilateral,
standing on the ipsilateral leg causes more pain.
100
Mckenzies Side Glide Test
PURPOSE- Differentiates between scoliotic curvature versus neurological
dysfunction causing abnormal curvature of trunk
DESCRIPTION- The patient stands with the examiner standing to one side. The
examiner grasps the patient’s pelvis with both hands and places a shoulder against
the patient’s lower thorax. Using the shoulder as a block, the
examiner pulls the pelvis toward the examiner’s body. The
position is held for 10 to 15 seconds, and then the test is
repeated on the opposite side.
RESULT- A positive test is indicated by increased neurological
symptoms on the affected side. It
101
Biclycle (Van Gerlderens Test)
PURPOSE- Differentiates between intermittent claudication and spinal stenosis
DESCRIPTION- The patient is seated on an exercise bicycle and is asked to pedal
against resistance. The patient starts pedaling while leaning backward to accentuate
the lumbar lordosis. If pain into the buttock and posterior thigh occurs, followed by
tingling in the affected lower extremity, the first part of the test is positive. The patient
is then asked to lean forward while continuing to pedal. If the pain subsides over a
short period of time, the second part of the test is positive; if the patient sits upright
again, the pain returns.
A patient with intermittent claudication of the lower extremities typically experiences
an increase in symptoms with continued exercise, regardless of the position of the
spine.
102
Prone Instability Test
PURPOSE- Test for the likelihood of a patient with low back pain responding to a
stabilization exercise program.
DESCRIPTION- The patient is positioned prone so that the trunk rests on the bed,
and the feet rest on the floor, with the hips flexed and the trunk muscles relaxed. The
clinician applies a P-A pressure over the most symptomatic spinous process, and any
reproduction of symptoms is noted. The clinician then releases the P-A pressure, and
the patient is asked to hold onto the sides of the table and to slightly lift his or her feet
off the floor. This maneuver produces a co-contraction of the global abdominal,
gluteal, and erector spinae muscles. While the patient maintains their feet off the
floor, the clinician reapplies the P-A pressure over the same spinous process level. If
a dramatic reduction or the complete elimination of the symptoms compared to the
first application of P-A pressure is noted, it is considered a
positive prone instability test.
RESULT- The patients with LBP, who present with negative
prone instability test, are unlikely to respond to a
stabilization exercise program.
103
Gillets Test
PURPOSE- Assess posterior movement of the ilium relative to sacrum
DESCRIPTION- While the patient stands, the sitting examiner palpates the PSISs
with one thumb and the other thumb parallel with the first thumb on the sacrum. The
patient is then asked to stand on one leg while pulling the opposite knee up toward
the chest. This causes the innominate bone on the same side to rotate posteriorly.
The test is repeated with the other leg palpating the other PSIS. If the sacroiliac joint
on the side on which the knee is flexed (i.e., the ipsilateral side) moves minimally or
up, the joint is said to be hypomobile, or “blocked,”
indicating a positive test.
104
Ipsolateral Anterior Rotation Test
PURPOSE- Assess anterior movement of ilium relative to sacrum
DESCRIPTION- The patient stands. The examiner sits behind the patient and
palpates one PSIS with one thumb and the sacrum on a parallel line with the other
thumb. The patient is asked to extend the ipsilateral leg. Normally, the PSIS should
move superiorly and laterally. The other side is tested for comparison.
RESULT- This test determines the ability of the innominate on the test side to rotate
anteriorly while the sacrum rotates to the opposite side
105
Gaenslens Test
PURPOSE- Identifies SIJ dysfunction
DESCRIPTION- The patient lies on the side with the upper leg (test leg)
hyperextended at the hip. The patient holds the lower leg flexed against the chest.
The examiner stabilizes the pelvis while extending the hip of the uppermost leg.
RESULT- Pain indicates a positive test.
106
Long Sitting (supone to sit) Test
PURPOSE- Identifies SI joint dysfunction that may be the cause of leg length
discrepancy
DESCRIPTION- The patient lies supine with the legs straight. The examiner ensures
that the medial malleoli are level. The patient is asked to sit up, and the examiner
observes whether one leg moves up (proximally) farther than the other. If so, it is
believed that there is a functional leg length difference resulting from a pelvic
dysfunction caused by pelvic torsion or rotation
107
Goldthwaits TEst
PURPOSE-Differentiate between lumbar spine and SIJ dysfunction
DESCRIPTION- The patient lies supine. The examiner places one hand under the
lumbar spine so that each finger is in an interspinous space (i.e., L5–S1, L4–L5, L3–
L4, and L2–L3 interspaces). The examiner uses the other hand to perform SLR.
RESULT- If pain is elicited before movement occurs at the interspaces, the problem
is in the sacroiliac joint. Pain during interspace movement indicates a lumbar spine
dysfunction
108
# T
TMJ Compression
PURPOSE- Evaluates for pain with compression of the retrodiscal tissues
DESCRIPTION- Patient siting or supine. Support/stabilize the head with one hand,
with other hand push mandible superior, causing a compressive load to TMJ
RESULT- Positive finding is pain in TMJ
