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Special Tests

NPTE: Special Tests and (+) result indications (scorebuilder 2008)

Special TestIndications of (+) resultTest position/description
Anterior apprehension test Look of apprehension = pt. prone to anterior dislocation of shoulder pt. supine with arm in 90 deg abd. therapist ER pt's shoulder.
Posterior apprehension test Look of apprehension = pt. prone to posterior dislocation of shoulder pt supine with arm in 90 deg flexion and IR. Therapist applies a posterior force through the long axis of the humerus.
Ludington's test Absence of movement in the biceps tendon = rupture of long head of biceps brachii pt sitting. clasps hands behind head with fingers interlocked, alternately contracts/relax biceps muscle.
Speed's test Pain or tenderness in bicipital groove region = bicipital tendonitis pt sitting elbow extended forearm supinated. Therapist places hand over bicipital groove and other on forearm. Therapist resists active shoulder flexion.
Yeargason's test Pain or tenderness in bicipital groove = bicipital tendonitis pt in sitting 90 deg elbow flex and forearm pronated. therapist places one hand on pt's forearm and other on bicipital groove. pt directed to activitely supinate and ER against resistance.
Drop arm test In ability to slowly lower arm or severe pain = tear in rotator cuff pt sitting/standing arm in 90 deg abd. pt is asked to slowly lower arm to side.
Hawkins-Kennedy test pain = impingement involving supraspinatus tendon pt sitting or standing. therapist flexes pt's shoulder to 90 and IR arm.
Neer test pain = impingement involving supraspinatus tendon pt sitting/standing. Therapist positions one hand on the posterior aspect of the pt's scapula and other on stabilizing the elbow. therapist elevates pt arm through flexion.
Supraspinatus test (empty can) weakness or pain = tear of supraspinatus, impingement, or suprascapular nerve involvement pt arm in 90 deg abd followed by 30 of horiz add, thumb down. therapist resists attempt to abd arm.
Adson maneuver absent or diminished radial pulse = TOS pt sitting/standing. therapist monitors radial pulse and asks pt to rotate head to face test shoulder. pt asked to extend head while therapist ER and ext pt shoulder.
Allen test absent or diminished radial pulse = TOS pt sitting/standing test arm in 90 abd, ER, and elbow flex. pt rotates head away from test shoulder while therapist monitors radial pulse.
Costoclavicular syndrome test absent or diminished radial pulse = TOS caused by compression of subclavian artery between the first rib and the clavicle pt sitting. therapist monitors radial pulse and assists the pt to assume a military posture.
Roos test Inability to maintain test position, weakness of the arms, sensory loss or ischemic pain = TOS pt sitting arm in 90 abd, ER, and elbow flexion. pt asked to open/close hands for 3 minutes.
Glenoid labrum tear test Clunk or grinding sound = glenoid labrum tear. pt supine. therapist places one hand on posterior aspect of humeral head while other stabilizes humerus prox to elbow. therapist passively abducts and ER arm over the pt's head. applies anterior directed force to humerus.
Varus stress test (elbow) Increased laxity in the lateral collateral ligament when compared to the contralateral side, apprehension or pain = lateral collateral ligament sprain pt sitting with elbow in 20-30 flex. therapist places one hand on elbow and other prox to pt's wrist. therapist applies varus force while palpating lateral jt. line.
Valgus stress test (elbow) Increased laxity in the medial collateral ligament when compared to the contralateral side, apprehension or pain = medial collateral ligament pt sitting with elbow flexed 20-30. Therpist places one hand on elbow and other prox to wrist. Therapist applies valgus force while palpating medial jt. line.
Cozen's test Pain in the lateral epicondyle region or muscle weakness = lateral epicondylitis pt sitting with elbow in slight flex. therapist places thumb on pt's lat. epicondyle while stabilizing elbow jt. pt asked to make fist, pronate forearm, radial deviate and extend wrist against resistance.
Lateral epicondylitis test Pain in the lateral epicondyle region or muscle weakness = lateral epicondylitis pt sitting. therapist stabilizes elbow and places other hand on dorsal aspect of pt's hand distal to PIP jt. pt extends third digit against resistance.
Medial epicondylitis test Pain in the medial epicondyle region = medial epicondylitis pt sitting. therapist palpates medial epicondyle and supinates the forearm, extends wrist, and extends elbow.
Mill's test Pain in the lateral epicondyle region = lateral epicondylitis pt sitting. therapist palpates lateral epicondyle and pronates forearm, flexes writes and extends elbow.
Tinel's sign (ulnar) Paresthesia in ulnar nerve distribution of forearm, hand, and fingers = ulnar nerve compression or compromise pt sitting with elbow in slight flex. therapist taps with index finger between olecranon and medial epicondyle.
Ulnar collateral ligament test excessive valgus movement in thumb = tear of ulnar collateral and accessory collateral ligaments (gamekeeper's/skier's thumb) pt sitting . therapist holds thumb in ext. and applies a valgus force to MCP jt of thumb.
Allen test delayed or absent flushing of the radial or ulnar half of the hand = occlusion of radial or ulnar artery pt sitting/standing. pt asked to open/close hand several times and then maintain hand closed. therapist compresses radial and ulnar arteries. pt then asked to relax hand and therapist releases pressure.
Capillary refill test delayed or muted response of color returning to nails (greater than 2 sec) = arterial insufficiency pt sitting/standing. therapist compresses pt's nailbed and after releasing pressure notes amount of time for color to return.
Bunnel-Littler test 1. PIP does not flex with MCP jt ext = tight intrinsic m. or capsular tightness. 2. PIP fully flexes with MCP in slight flex = tight intrinsic m. without capsular tightness pt sitting with MCP jt in slight ext. therapist attempts to move PIP into flex
Tight retinacular test 1. unable to flex DIP = retinacular lig or capsule tight 2. able to flex DIP with PIP in flexion = retinacular lig tight, capsule normal pt sitting with PIP in neutral and DIP flexed. therapist attempts to flex DIP
Froment's sign pt. flexing distal phalanx of thumb = adductor pollicis paralysis/ulnar n. compromise or paralysis. pt sitting or standing. asked to hold paper between thumb and index. therapist attempts to pull paper away.
Phalen's test tingling in thumb, index finger, middle finger and lateral half of ring finger = carpal tunnel syndrome pt sitting/standing. therapist flexes pt's wrist maximally and asks pt to hold position for 60 sec.
Tinel's sign (median) tingling in median n. distribution = carpal tunnel syndrome pt sitting/standing. therapist taps over volar aspect of pt's wrist.
Finkelstein test pain over abductor pollicis longus and extensor pollicis brevis = tenosynovitis in thumb (deQuervain's) pt sitting/standing and asked to make fist with thumb tucked inside fingers. Therapist stabilizes forearm and ulnarly deviates wrist.
Grind test (hand) pain in thumb over CMC = DJD of CMC pt sitting/standing. therapist stabilizes pt's hand and grasps pt's thumb @ MCP. Therapist applies compression and rotation through metacarpal.
Murphy sign pts. third metacarpal remains level with the second and fourth = dislocated lunate pt sitting/standing and asked to make fist.
Ely's test spontaneous hip flexion occuring simultaneously with knee flexion = rectus femoris contracture pt prone while therapist passively flexes pt. knee.
Ober's test inability of test leg to adduct and touch table = TFL contracture pt sidelying with lower leg flexed at hip and knee. Therapist moves test leg into hip ext and abd and then attempts to lower the leg.
Piriformis test pain or tightness = piriformis tightness or compression on the sciatic n. caused by piriformis pt sidelying. leg positioned toward ceiling and hip flexed to 60. Therapist places hand on pelvis and other on knee. Stabilize pelvis and apply downward force on knee.
Thomas test the straight leg rises from the table = hip flexion contracture pt supine with legs fully ext. pt asked to bring one knee to chest. Observe position of contralateral hip.
Tripod sign tightness of hamstring or extension of the trunk in order to limit the effect of the tight hamstring = tight hamstring pt sitting with knees flexed 90 over edge of table. therapist passively ext one knee.
90-90 Straight leg raise knee remaining in 20 deg or more of flexion = tight hamstring pt supine. Hip 90 flex with knee relaxed. Therapist passively ext. knee.
Barlow's test click or clunk = hip dislocation being reduced (pediatric) pt supine with hips flex 90 and knees flex. Therapist tests hip individually - stabilizing femur and pelvis while moving test leg into abd. while applying forward pressure post. to greater trochanter.
Ortolani's test click or clunk = hip dislocation being reduced (pediatric) pt supine hips flex 90 and knee flex. therapist abducts infants hips and gentle pressure applied to greater trochanter until resistance is felt.
Craig's test tests for deg of anteversion @ hip. normal for adult= 8-15 pt prone with knee flex 90. therapist palpates posterior aspect of greater trochanter and IR/ER hip until greater trochanter is parallel with table.
Patrick's test (FABER) failure of test leg to abduct below the level of the opposite leg = iliopsoas, sacroiliac, or hip jt. abnormalities pt supine with hip flexed, abducted, and ER on opposite leg. Therapist slowly lowers the leg in abduction toward the table.
Quadrant scouring test grinding-caching or crepitation in the hip = arthritis, avascular necrosis, or an osteochondral defect in hip pt supine. Therapist flexes and adducts the hip with knee in max flexion. Therapist provides compressive force through shaft of femur while passively moving hip.
Trendelenburg test a drop of the pelvis on the unsupported side = weakness of gluteus medius on supported side pt standing and asked to stand on one leg for approx. 10 seconds.
Anterior drawer test (knee) excessive anterior translation of tibia = ACL injury. less reliable than Lachman pt supine with knee flexed to 90 and hip flexed to 45. therapist stabilizes lower leg by sitting on it. therapist grasps proximal tibia, places thumbs on tibial plateau, and administers and ant. directed force to tibia on the femur.
Lachman test excessive anterior translation of tibia = ACL injury. More reliable than Anterior drawer test. pt supine with knee flexed to 20-30. Therapist stabilizes distal femur with one hand and places other hand on proximal tibia. Therapist applies anterior directed force to tibia on the femur.
Lateral pivot shift test a palpable shift or clunk occuring between 20-40 degrees of flexion = anterolateral rotary instability Clunk is reduction of tibia on femur pt supine wit hip flexed and abducted to 30 with slight IR. Therapist grasps leg with one hand and places other hand over lateral surface of proximal tibia. Therapist IR tibia and applies valgus force to knee while knee is slowly flexed.
Posterior drawer test excessive posterior translation of the tibia = PCL injury pt supine with knees flexed 90 and hip flexed 45. Therapist stabilizes lower leg by sitting on foot. Therapist grasps pt's proximal tibia with two hands, places thumbs on tibial plateau, and administers a posterior directed force to tibia on femur.
Posterior sag sign tibia sags back on femur = PCL injury pt supine with knee flexed 90 and hip flexed 45.
Slocum test movement of tibia occurring primarily on lateral side = anterolateral instability pt supine knee flexed 90 hip flexed 45. Therapist rotates pt's foot 30 deg medially to test anteriolateteral instability, 15 deg laterally to test anteriomedial instability. Therapist stabilizes lower leg by sitting on forefoot. Follow ant drawer test.
Valgus stress test (knee) excessive valgus movement = MCL sprain pt supine with knee flexed 20-30. Therapist puts one hand on medial ankle and other on lateral surface of knee on jt line. Therapist applies valgus force to knee with distal hand.
Varus stress test (knee) excessive varus movement = LCL sprain pt supine with knee flexed 20-30. Therapist puts one hand on lateral ankle and other on medial surface of knee on jt line. Therapist applies varus force to knee with distal hand.
Apley's compression test pain or clicking = meniscal lesion pt prone with knee flexed to 90. Therapist stabilizes pt's femur using one hand and places other hand on pt's heel. Therapist medially and laterally rotates tibia while applying a compressive force through tibia.
Bounce home test incomplete extension or rubbery end-feel = meniscal lesion pt supine. Therapist grasps pt's heel and maximally flexes the knee. Pt's knee is extended passively.
McMurray test click or pronounced crepitation over joint line = posterior meniscal lesion pt supine. Therapist grasps distal leg with one hand and palpates the knee joint with other. With knee fully flexed, therapist medially rotates tibia and extends knee. Therapist repeats same procedure while lat rotating tibia.
Brush test a wave of fluid just below the medial distal border of the patella = effusion in the knee pt supine. Therapist places one hand below jt line on medial surface of patella and strokes proximally with palm and finger as far as the suprapatellar pouch. The other hand then strokes down the lateral surface of the patella.
Patellar tap test patella appears to be floating = joint effusion pt supine with knee flexed or extended to a point of discomfort. Therapist applies slight tap over patella.
Clarke's sign failure to complete the contraction without pain = patellofemoral dysfunction pt supine with knee ext. therapist applies slight pressure with web space of hand over the superior pole of patella. Therapist asks pt to contract quadriceps while therapist maintains pressure on patella.
Hughston's plica test popping sound over the medial plica while knee is passively flexed and extended = plica dysfunction pt positioned in supine. Therapist flexes the knee and medially rotates the tibia with one hand while other hand attempts to move patella medially and palpate the medial femoral condyle while extending the knee.
Noble compression test pain overt the lateral femoral epicondyle at approximately 30 deg of knee flexion = ITB friction syndrome pt supine with hip slightly flexed and knee in 90 flexion. Therapist places thumb over lateral epicondyle of femur and other hand around pt's ankle. Therapist maintains pressure on femur while the pt is asked to slowly extend knee.
Patellar apprehension test a look of apprehension or an attempt to contract the quadriceps = patella subluxation/dislocation pt supine with knee extended. Therapist places thumbs on medial border of patella and applies a laterally directed force.
Anterior drawer test (ankle) excessive anterior translation of talus = anterior talofibular ligament sprain pt supine. Therapist stabilizes distal tibia/fibula with one hand while other hand holds foot in 20 deg plantar flexion and draws talus forward in the ankle mortise.
Talar tilt test excessive adduction = calcaneofibular ligament sprain pt sidelying with knee flexed to 90. Therapist stabilizes distal tibia with one hand while grasping talus with other. The foot is maintained in neutral. Therapist tilts talus into abduction and adduction.
Homan's sign pain in the calf = DVT pt supine. Therapist maintains leg in extension and passively dorsiflexes pt's foot.
Thompson test absence of plantar flexion = ruptured Achilles tendon pt prone with foot extended over the edge of table. Therapist asks the patient to relax and proceeds to squeeze the muscle belly of the gastroc/soleus.
Tibial torsion test tests for degree of tibial torsion. Normal lateral rotation of the tibia is 12-18 degrees in adult. pt sitting with knees over the edge of the table. Therapist places thumb and index finger of one hand over the medial and lateral malleolus. Therapist measures the acute angle formed by the axes of the knee and ankle.
True leg length discrepancy test a bilateral variation of greater than 1 cm = true leg length discrepancy pt supine with hips and knees extended and legs 15-20 cm apart. Have pt do a bridge first to balance pelvis with legs. Measure from distal point of ASIS to distal point of medial malleoli.
Foraminal compression test pain radiating into arm toward flexed side = nerve root compression pt sitting with head laterally flexed. Therapist places both hands on top of pt's head and exerts a downward force.
Vertebral artery test dizziness, nystagmus, slurred speech, loss of consciousness = compression of vertebral artery pt supine. Therapist places pt's head in extension, lateral flexion, and rotation to the ipsilateral side.
Sacroiliac joint stress test unilateral pain in the sacroiliac joint or gluteal area = sacroiliac joint dysfunction pt supine. Therapist crosses their arms placeing the palms of the hands on the pt's ASIS. Therapist applies a downward and lateral force to pelvis.
Standing flexion test one PSIS moving further in a cranial direction = articular restriction of SI jt pt standing with feet 12" apart. Therapist places thumbs on PSIS and monitors movement of bony structures as pt bends forward with knees extended.
Wright test absent or diminished radial pulse. May be indicative of compression in the costoclavicular space. pt sitting or supine. therapist moves pt's arm overhead in the frontal plane while monitoring radial pulse.
Sulcus sign Inferior laxity is evident if there is a visible widening of the subacromial space with a sulcus appearing in the adjacent area just distal to the lateral acromion. patient stand/sit with the arm relaxed at the side. therapist applies a downward directed, distractive force on arm. compare (B)
Sitting flexion test. One PSIS moving further in a crainal direction = articular restriction of SI jt. pt sitting with knees flexed to 90 and feet on floor. pt's hips should be abducted to allow pt to bend forward. Therapist places thumbs on PSIS and monitors movement of bony structures as pt bends forward and reaches toward floor.
Created by: liz124714 on 2008-12-29



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