NPTE: Special Tests and (+) result indications (scorebuilder 2008)
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| Anterior apprehension test | show | pt. supine with arm in 90 deg abd. therapist ER pt's shoulder.
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| Posterior apprehension test | show | pt supine with arm in 90 deg flexion and IR. Therapist applies a posterior force through the long axis of the humerus.
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| Ludington's test | show | pt sitting. clasps hands behind head with fingers interlocked, alternately contracts/relax biceps muscle.
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| Speed's test | show | pt sitting elbow extended forearm supinated. Therapist places hand over bicipital groove and other on forearm. Therapist resists active shoulder flexion.
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| Yeargason's test | Pain or tenderness in bicipital groove = bicipital tendonitis | show 🗑
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| Drop arm test | show | pt sitting/standing arm in 90 deg abd. pt is asked to slowly lower arm to side.
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| Hawkins-Kennedy test | show | pt sitting or standing. therapist flexes pt's shoulder to 90 and IR arm.
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| Neer test | pain = impingement involving supraspinatus tendon | show 🗑
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| Supraspinatus test (empty can) | weakness or pain = tear of supraspinatus, impingement, or suprascapular nerve involvement | show 🗑
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| Adson maneuver | absent or diminished radial pulse = TOS | show 🗑
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| Allen test | absent or diminished radial pulse = TOS | show 🗑
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| Costoclavicular syndrome test | show | pt sitting. therapist monitors radial pulse and assists the pt to assume a military posture.
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| show | 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.
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| show | 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.
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| Varus stress test (elbow) | Increased laxity in the lateral collateral ligament when compared to the contralateral side, apprehension or pain = lateral collateral ligament sprain | show 🗑
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| show | 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.
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| Cozen's test | Pain in the lateral epicondyle region or muscle weakness = lateral epicondylitis | show 🗑
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| show | 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.
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| Medial epicondylitis test | show | pt sitting. therapist palpates medial epicondyle and supinates the forearm, extends wrist, and extends elbow.
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| Mill's test | Pain in the lateral epicondyle region = lateral epicondylitis | show 🗑
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| Tinel's sign (ulnar) | show | pt sitting with elbow in slight flex. therapist taps with index finger between olecranon and medial epicondyle.
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| show | 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.
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| show | 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.
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| Capillary refill test | delayed or muted response of color returning to nails (greater than 2 sec) = arterial insufficiency | show 🗑
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| Bunnel-Littler test | show | pt sitting with MCP jt in slight ext. therapist attempts to move PIP into flex
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| show | 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
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| Froment's sign | show | pt sitting or standing. asked to hold paper between thumb and index. therapist attempts to pull paper away.
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| Phalen's test | tingling in thumb, index finger, middle finger and lateral half of ring finger = carpal tunnel syndrome | show 🗑
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| Tinel's sign (median) | tingling in median n. distribution = carpal tunnel syndrome | show 🗑
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| show | 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.
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| show | 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.
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| show | pts. third metacarpal remains level with the second and fourth = dislocated lunate | pt sitting/standing and asked to make fist.
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| Ely's test | spontaneous hip flexion occuring simultaneously with knee flexion = rectus femoris contracture | show 🗑
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| show | 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.
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| Piriformis test | show | 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.
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| Thomas test | the straight leg rises from the table = hip flexion contracture | show 🗑
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| Tripod sign | show | pt sitting with knees flexed 90 over edge of table. therapist passively ext one knee.
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| show | knee remaining in 20 deg or more of flexion = tight hamstring | pt supine. Hip 90 flex with knee relaxed. Therapist passively ext. knee.
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| Barlow's test | click or clunk = hip dislocation being reduced (pediatric) | show 🗑
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| Ortolani's test | click or clunk = hip dislocation being reduced (pediatric) | show 🗑
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| Craig's test | tests for deg of anteversion @ hip. normal for adult= 8-15 | show 🗑
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| Patrick's test (FABER) | show | pt supine with hip flexed, abducted, and ER on opposite leg. Therapist slowly lowers the leg in abduction toward the table.
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| Quadrant scouring test | show | 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.
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| show | 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.
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| Anterior drawer test (knee) | excessive anterior translation of tibia = ACL injury. less reliable than Lachman | show 🗑
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| Lachman test | excessive anterior translation of tibia = ACL injury. More reliable than Anterior drawer test. | show 🗑
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| show | 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.
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| show | 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.
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| Posterior sag sign | tibia sags back on femur = PCL injury | show 🗑
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| show | 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.
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| Valgus stress test (knee) | excessive valgus movement = MCL sprain | show 🗑
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| Varus stress test (knee) | show | 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.
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| Apley's compression test | show | 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.
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| show | 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.
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| McMurray test | show | 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.
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| show | 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.
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| Patellar tap test | patella appears to be floating = joint effusion | show 🗑
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| Clarke's sign | failure to complete the contraction without pain = patellofemoral dysfunction | show 🗑
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| Hughston's plica test | show | 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.
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| show | 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.
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| Patellar apprehension test | show | pt supine with knee extended. Therapist places thumbs on medial border of patella and applies a laterally directed force.
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| Anterior drawer test (ankle) | excessive anterior translation of talus = anterior talofibular ligament sprain | show 🗑
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| show | 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.
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| show | pain in the calf = DVT | pt supine. Therapist maintains leg in extension and passively dorsiflexes pt's foot.
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| show | 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.
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| Tibial torsion test | tests for degree of tibial torsion. Normal lateral rotation of the tibia is 12-18 degrees in adult. | show 🗑
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| show | 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.
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| Foraminal compression test | show | pt sitting with head laterally flexed. Therapist places both hands on top of pt's head and exerts a downward force.
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| Vertebral artery test | show | pt supine. Therapist places pt's head in extension, lateral flexion, and rotation to the ipsilateral side.
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| Sacroiliac joint stress test | show | 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.
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| show | 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.
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| Wright test | show | pt sitting or supine. therapist moves pt's arm overhead in the frontal plane while monitoring radial pulse.
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| 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. | show 🗑
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| Sitting flexion test. | One PSIS moving further in a crainal direction = articular restriction of SI jt. | show 🗑
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