CERVICAL SPINE

Special Test Purpose/Indication Procedure Positive Sign

Alar Ligament Stress Alar ligament sprain 1) Patient supine Soft end feel, excessive
Test 2) Cup occiput w/ 1 hand, pincher grasp on C2 w/ other hand movement
177 3) Passively side flex the Occiput on C1
Distraction Test Alleviate symptoms; 1) Patient seated Relief of symptoms
163 confirmation of nerve 2) Apply a distraction of the C-spine
root compression
Maximal Cervical Cervical nerve root 1) Patient seated Radiating pain into the arm
Compression Test compression 2) Passive cervical side flex. + rot. to affected side, then apply
163 downward pressure on top of patients head
3) If no symptoms, add cervical ext. then compress
Foraminal Cervical nerve root 1) Patient seated Radiating pain into the arm
Compression compression 2) Apply downward pressure on top of patients head
(Spurlings) test 3) If no symptoms, add cervical ext. then compress
163 4) If no symptoms, add cervical rot. to tested side then compress
(Do not perform if V.A.T is positive)
Shoulder Abduction Radicular symptoms 1) Patient seated or supine Relief of symptoms
(Relief) Test involving C4 or C5 nerve 2) Passively or actively elevate arm through abd. so the forearm
166 roots rests on top of the head
Transverse Ligament Tranverse ligament 1) Patient supine Soft end feel, mm spasm,
Stress Test sprain; hypermobility at 2) Support occiput w/ fingers 3-5 interlocked dizziness, nausea, paresthesia of
176 atlantoaxial joint 3) Place index fingers in the space between occiput & SP of C2 the lip, face or limb, nystagmus,
4) Carefully lift head & C1, allowing no flex. or ext. & hold position lump sensation in the throat
for 10-20s
Vertebral Artery Circulation deficiency of 1) Patient supine w/ head off the edge of the table Dizziness, nystagmus
(Cervical Quadrant) vertebral artery 2) Passive cervical ext. + side flex. + rot. to untested side for approx. (involuntary, repetitive, circular
Test 30s or until symptoms present motion of the eyes), vertigo,
171 nausea

Last updated: October 30, 2014

Page 1
FACE
Special Test Purpose/Indication Procedure Positive Sign
3 Knuckle Test TMJ hypomobility 1) Patient attempts to put 3 knuckles into mouth Can get only 1 knuckle or no
214 knuckles between incisors
(Rattray)
Chvostek Test C.N. VII (facial nerve) 1) Tap on parotid gland overlying masseter w/ index & middle finger Facial muscles twitch
217 lesion; Bells palsy
Jaw Reflex C.N. V (mandibular 1) Patient seated w/ mouth relaxed & open in resting position & w/ Closing of the mouth
219 branch of trigeminal eyes closed
nerve) lesion; trigeminal 2) Place thumb on patients chin
neuralgia 3) Tap on thumb nail w/ reflex hammer
OR
1) Hold tongue depressor firmly against bottom teeth while patient
relaxes jaw mms
2) Tap on tongue depressor w/ reflex hammer
Orbicularis Oris Confirmation of Bells 1) Patient seated or supine Patient unable to keep eye closed
Strength Test palsy 2) Therapist gently opens eyelids while patient tries to keep eye
(Rattray 1071) closed

THORACIC OUTLET SYNDROME

Special Test Purpose/Indication Procedure Positive Sign
Adsons Test TOS caused by anterior 1) Patient seated Diminished radial pulse
322 scalene syndrome 2) Monitor radial pulse
3) Active cervical ext. + rot. to tested side
4) Passive GH ext. + LR
5) Patient takes a deep breath & holds it
Allen Maneuver TOS caused by 1) Patient seated Diminished radial pulse or
322 costoclavicular 2) Monitor radial pulse recurrence of symptoms
syndrome 3) Passive GH abd. (90), ext. + elbow flex.
4) Patient rotates head away from tested side

Last updated: October 30, 2014

Page 2
Costoclavicular TOS caused by 1) Patient seated Diminished radial pulse or
Syndrome Test costoclavicular 2) Passively depress & retract GH of affected arm while monitoring recurrence of symptoms
322 syndrome radial pulse

Halstead Maneuver TOS 1) Patient seated Diminished radial pulse or

322 2) Monitor radial pulse recurrence of symptoms
3) Passive GH ext. then apply downward traction to arm
4) Active cervical ext. + rotation to untested side
Shoulder Girdle Provide relief of 1) Patient seated, crossing arms over chest Relief of arterial, venous or
Passive Elevation symptoms; confirm 2) Stand behind patient & place hands underneath their elbows neurological signs & symptoms
322 diagnosis 3) Lift the shoulder girdle up & forward for 30s or more
Provocative Vascular insufficiency 1) Patient raises arms above horizontal and rapidly opens & closes Fatigue, cramping, tingling
Elevation Test caused by TOS hands 15x
322
Roos Test or TOS caused by pectoralis 1) Patient seated or standing w/ arms raised so that the elbows Ischemic pain, arm weakness or
Elevated Arm Stress minor syndrome are slightly behind frontal plane heaviness, numbness or tingling of
Test (EAST) 2) Actively open & close hands slowly for 3mins or until positive the hand
320 test
Scalene Cramp Test Reproduce pain of active 1) Patient seated Pain in scalene referral pattern
167 scalene TrPs, TOS 2) Ask patient to bring chin towards armpit (cervical rot. + flex.)
Wright Test or TOS caused by 1) Patient seated Diminished radial pulse or
Maneuver costoclavicular 2) Passive GH abd. (180) + LR while monitoring radial pulse recurrence of symptoms
321 syndrome 3) Active cervical ext. + rot. away from test side

SHOULDER
Special Test Purpose/Indication Procedure Positive Sign
Drop-Arm Rotator cuff strain 1) Patient seated Patient unable to return the arm
(Codmans) Test 2) Passive GH abd. (90) smoothly & slowly to starting
311 3) Patient slowly lowers their arm to the side position
Empty Can Tear of supraspinatus 1) Patient seated Pain w/ resisted GH abd.
(Supraspinatus or tendon or mm, or 2) Active GH abd. (90) then resist further abd.
Jobe) Test

Last updated: October 30, 2014

Page 3
310 neuropathy of 3) Passive GH MR + flex. (30) so that thumb points downward &
suprascapular nerve arm is in scapular plane, then again resist further abd.
Feagin/ Inferior Inferior GH instability 1) Sit beside patient on the table Increased inferior movement,
Instability Test 2) Rest patients elbow on your shoulder apprehension, possible pain
292 3) Wrap both hands around patients shoulder & apply an ant/inf
mobilization
Hawkins-Kennedy Supraspinatus 1) Patient standing or seated Pain in supraspinatus
Impingement Test tendinopathy 2) Passive GH & elbow flex. (90) so the forearm is level w/ the
293 ground
3) Passive forceful GH MR

Neer Impingement Overuse injury to 1) Patient seated Pain in supraspinatus

Test supraspinatus 2) Passive GH MR, then fully elevate arm in the scapular plane
293 (sometimes biceps
tendon)
Push Pull (Posterior Posterior GH instability 1) Patient supine Over 50% posterior translation or
Instability) Test 2) Passive GH abd. (90) + flex. (30), holding the arm at the elbow & apprehension
287 squeezing their hand between your body
3) Lean back to distract GH & apply post. mob. to head of humerus
Rockwood Test for Anterior GH instability 1) Patient seated Marked apprehension w/
Anterior Instability 2) Stand behind patient posterior pain when arm is tested
281 3) Passive GH LR at 0, 45, 90, & 120 of GH abd. at 90; discomfort at 45 & 120
Speeds (Biceps or Biceps tendinitis 1) Patient seated w/ GH flex. (90) + LR Pain and/or tenderness in bicipital
Straight-Arm)Test 2) Push arm into ext. while patient resists, once w/ forearm groove
308 supinated, then again pronated
Upper Limb Tension Median nerve lesion 1) Patient seated Reproduction of neurological
Test 1 (median 2) Passive GH abd. (110), sl. LR + elbow, wrist, finger ext. + cervical symptoms
nerve) side flex. to opposite side
164
Upper Limb Tension Median nerve lesion 1) Patient seated Reproduction of neurological
Test 2 (median 2) Depress patients shoulder symptoms
nerve) 3) Passive GH abd. (10) + LR, elbow, wrist, finger ext. + cervical side
164 flex. to opposite side
Last updated: October 30, 2014
Page 4
Upper Limb Tension Radial nerve lesion 1) Patient standing or seated Reproduction of neurological
Test 3 (radial nerve) 2) Depress patients shoulder symptoms
164 3) Passive forearm pronation, wrist flex.
4) Active cervical side flexion to unaffected side
Upper Limb Tension Ulnar nerve lesion 1) Patient seated Reproduction of neurological
Test 4 (ulnar nerve) 2) Depress patients shoulder symptoms
164 3) Passive GH abd. (90), elbow flex., forearm supination, wrist +
fingers ext. + radial deviation

Yergasons Test Ability of transverse 1) Patient seated at the corner of the table w/ elbow flexed (90) & Biceps tendon displaces from
309 humeral ligament to forearm pronated bicipital groove, pain
hold biceps tendon in 2) Stabilize arm w/ the side of your body while palpating biceps
the bicipital groove tendon
3) Resist forearm into GH LR + forearm supination simultaneously

ELBOW
Special Test Purpose/Indication Procedure Positive Sign
Elbow Flexion Test Cubital tunnel (ulnar 1) Active elbow flexion, wrist extension, shoulder girdle abd. + Tingling and/or paresthesia in
380 nerve) syndrome depression ulnar nerve distribution
2) Hold position for 3-5mins
Medial Epicondylitis Medial epicondylitis 1)
Resisted wrist flex. + ulnar deviation Pain in common flexor tendon
(Golfers Elbow
Resisted) Test
Medial Epicondylitis Medial epicondylitis 1) Palpate medial epicondyle Pain in common flexor tendon
(Golfers Elbow Active
2) forearm sup. + elbow ext. + wrist ext. +
radial deviation
Stretch) Test 3)
Apply passive overpressure to add further stress
380
Lateral Epicondylitis Lateral epicondylitis clench fist
1) Actively , wrist flex. + ulnar deviation, forearm Pain in common extensor tendon
(Tennis Elbow or pronation, elbow ext.
Mills) Test 2)
Apply passive overpressure & pressure on common extensor
379 tendon to add further stress
(test can cause stretch to radial nerve)

Last updated: October 30, 2014

Page 5
Lateral Epicondylitis Lateral epicondylitis 1) Stabilize around patients elbow w/ thumb on their lateral Pain in common extensor tendon
(Tennis Elbow or epicondyle
Cozens) Test 2) Patient makes a fist
379 3) Resisted wrist ext. + radial dev.
Ligamentous Valgus Ulnar collateral ligament 1) Perform a medial gap of the elbow complex in 15 (anterior Excessive laxity or soft end feel
Instability Test sprain fibers) & 90 (posterior fibers) of elbow flexion
373
Ligamentous Varus Radial collateral 1) Perform a lateral gap of the elbow complex in 20-30 of elbow Excessive laxity or soft end feel
Instability Test ligament sprain flexion
377
Pronator Teres Median nerve lesion 1) Patient seated w/ elbow flexed (90) & forearm supinated Tingling or paresthesia in median
Syndrome Test 2) Resist into pronation via hand shake grip while passively nerve distribution
380 extending patients elbow
Tinels Sign Hypersensitive ulnar 1) With patient elbow extended & relaxed, firmly tap (with Tingling in ulnar distribution of
380 nerve fingertips) 3xon ulnar nerve in the cubital tunnel (groove between forearm & hand
medial epicondyle & olecranon)

WRIST/HAND
Special Test Purpose/Indication Procedure Positive Sign
Allen Test Arterial insufficiency to 1) Patient open & closes hand quickly several times, then squeezes Bilateral comparison for equal
445 the hand tightly flush ratios
2) Compress each thumb over radial & ulnar arteries at the wrist
3) As patient opens hand, release pressure over 1 of the arteries to
test it, checking for flushing of the hand
4) Repeat for the other artery
Axial Load Test Fracture of MCP or 1) Patient seated Pain and/or crepitus
439 adjacent carpal bones or 2) Stabilize wrist w/ 1 hand
joint arthrosis 3) With the other hand, grasp patients thumb & apply axial
compression
Carpal Compression Carpal tunnel syndrome 1) Hold patients supinated wrists & apply direct pressure over Reproduction of neurological
Test median nerve in the carpal tunnel for up to 30s symptoms
442

Last updated: October 30, 2014

Page 6
Finkelstein Test De Quervains 1) Patient makes fist w/ thumb held inside the flexed fingers Pain along abductor pollicis
439 tenosynovitis 2) Passive ulnar deviation longus & extensor pollicis brevis
tendons at the wrist
Froments Sign Ulnar nerve paralysis 1) Patient squeezes small piece of paper between thumb & index Distal phalanx of thumb flexes or
442 (loss of adductor pollicis finger while examiner pulls the paper away MCP of thumb hyperextends
function)
Grind Test Degenerative joint 1) Patient seated Pain
and/or crepitus
439 disease of MCP & IP 2) Stabilize MCP joint w/ 1 hand & apply axial compression +
rotation to MCP joint w/ the other hand

Phalens (Wrist Carpal tunnel syndrome 1) Patient pushes the back of their wrists together w/ fingers Tingling in median nerve
Flexion) Test pointing downward for 1min distribution
442
Pinch Grip Test Anterior interosseous 1) Patient pinches tips of thumb & index finger together Inability to perform a tip to tip
nerve (branch of median pinch
nerve) lesion
Reverse Phalens Median nerve lesion 1) Patient standing Tingling in median nerve
(Prayer) Test 2) Patient pushes palm of hands together (fingers pointing upward) distribution
442 & brings hands down towards the waist for 1min
OR
1) Passive wrist extension while patient grips therapists hand
2) Apply pressure over carpal tunnel for 1min
Scaphoid Stress Test Scaphoid instability 1) Patient seated Excessive laxity (scaphoid is
438 2) Stabilize patients wrist w/ 1 hand & apply pressure to distal forced dorsally out of the
scaphoid w/ thumb scaphoid fossa of the radius w/ a
3) Active radial deviation (normally, patient is unable to) resulting clunk & pain)
Supination Lift Test Triangular fibrocartilage 1) Patient seated w/ elbows flexed to 90 & forearms supinated Localized pain on ulnar side of
438 complex (TFCC) lesion 2) Patient attempts to flex elbows against the underside of a table wrist; difficulty applying the force
or against manual resistance
Sweater Finger Sign Flexor digitorum 1) Patient makes a fist Lack of DIP flexion in any of
440 profundus tendon fingers 2-5 (most common in ring
rupture finger)

Last updated: October 30, 2014

Page 7
Thumb Ulnar Thumb ulnar collateral 1) Passive thumb ext. Valgus movement of 30-35
Collateral Ligament ligament sprain 2) Apply valgus stress to MCP of thumb to stress ulnar collateral & = complete tear
Laxity Test accessory collateral ligaments (normal laxity: approx. 15)
435 3) Place thumb in 30 degrees flex. to stress only ulnar collateral
ligament
Tinels Sign Carpal tunnel syndrome 1) Light percussion w/ the fingertips is applied along the course of Tingling or paresthesia in median
441 the nerve starting at the index finger nerve distribution distally
(the most distal point at which the abnormal sensation is felt
represents the limit of nerve regeneration)
TFCC Load Test TFCC instability 1) Patient seated w/ arm on table Local pain, clicking or crepitus
438 2) Stabilize distal forearm & hold patients hand w/ hand shake
3) Axially load, ulnarly deviate wrist, then rotate in both directions
THORACIC SPINE
Special Test Purpose/Indication Procedure Positive Sign
Costovertebral Breathing assessment 1) Patient standing or seated Chest expansion measurements
Expansion Test 2) Make sure to stand behind patient less than 3cm or greater than
3) Measure difference in chest circumference at the level of axilla, 7.5cm
nipple line & xiphoid process while patient takes deep breath in &
out
(Normal: 3.0 - 7.5cm)
Dural Slump (Sitting Impingement of dura & 1) Patient seated Symptoms of sciatic pain or
Dural Stretch) Test spinal cord or nerve 2) Actively flex trunk & sag shoulders forward while therapist holds reproduction of patients
497 roots chin & head erect symptoms
3) If no symptoms, passively flex neck
4) If no symptoms, passively extend 1 knee
5) If no symptoms, passively dorsiflex same foot
First Thoracic Nerve T1 nerve root lesion 1) Active GH abd. (90), forearm pronation (90) Pain into scapular area or arm
Root Stretch Test 2) Fully flex elbow, putting hand behind neck
497
Passive Scapular T1 or T2 nerve root 1) Patient prone Pain in scapular area
Approximation Test lesion 2) Place hands underneath patients ant. shoulders & lift up and
497 back

Last updated: October 30, 2014

Page 8
Quadrant Test Narrows IVF, apply
574 stress to facet joints,
localized capsular
restriction
1) Patient standing Reproduction of neurological
2) Stand behind patient holding the top of their shoulders symptoms
3) Active trunk ext.
4) Apply overpressure in ext. while patient side flexes & rotates to
painful side

LUMBAR SPINE
Special Test Purpose/Indication Procedure Positive Sign
Bowstring Test Sciatic nerve lesion 1) Perform SLR test Painful radicular symptoms
568 (tested after positive 2) Hip flexed & knee flexed (20) w/ Achilles resting on your
SLR) shoulder
3) Apply thumb or finger pressure on popliteal area

Femoral Nerve Femoral nerve lesion 1) Patient side-lying on unaffected side w/ hip & knee slightly flexed Neurological pain down anterior
Traction Test (back straight, head slightly flexed) thigh
567 2) Passively extend affected knee & hip (15)
3) Passively flex affected knee
Hoover Test Malingering (faking) 1) Patient supine Lack of downward pressure of
577 2) Place 1 hand under each calcaneus resting heel
3) Actively lift 1 leg, keeping knees straight
McKenzies Side Scoliosis or joint 1) Patient standing Neurological symptoms on
Glide Test dysfunction 2) Side of scoliosis should be tested first affected side
576 3) Stand to the side of patient & grasp pelvis on the far side w/ both
hands
4) Place shoulder against patients side beneath their axilla
5) Pull pelvis towards you & hold for 10-15s
Prone Knee Bending L2 or L3 nerve root 1) Patient prone Pain in gluts, L-spine or post. thigh
(Nachlas) Test lesion 2) Passively flex 1 knee as far as possible for 45-60s may indicate L2 or L3 nerve root
566, 637 3) Passively extend hip if unable to flex knee to 90 lesion; pain in ant. thigh indicates
(may cause traction to femoral nerve) femoral nerve lesion

Last updated: October 30, 2014

Page 9
Segmental Instability Spondylolisthesis 1) Patient prone w/ hips off edge of table & toes touching the Pain elicited only in resting
Test ground position
573 2) Apply pressure to L-spine
3) Actively lift both feet off the floor & again apply pressure
Schober Test Measure amount of 1) Patient standing 1st dot (4-6cm gain)
- 2nd
nd rd
574 L-spine flexion 2) 3 points along spine are marked (S2, 5cm below S2, 5cm above 2- 3dot (2-4cm gain)
S2) - 4th
3rd dot (1-2cm gain)
2) 4 points along the spine are marked (S2, measure 10cm & repeat
until you have 4 dots) (Mike Dixon)
3) Measure distance between each point
4) Patient flexes forward & re-measure
Sign of Buttock Test Determine if lesion is in 1) Perform SLR No improved hip flexion indicates
578, 642, 692 buttock/hip or 2) If there is limitation, flex knee to see if further hip flexion can be pathology in buttock (bursitis,
hamstrings obtained tumor, abscess)
Skyline Test Determine whether 1) Observe lateral curvature of spine w/ patient standing, then w/ Lateral curvature becomes less
scoliosis is functional or patient bent forward, keeping knees straight apparent w/ bent forward
structural position indicates a functional
scoliosis

Straight Leg Raise Disc herniation 1) Patient supine w/ affected leg in add. + MR Centralized back pain likely
(Lasegues) Test 2) Raise affected leg by grasping around calcaneus & flexing the hip indicates disc herniation; leg pain
559, 635 (35-70) while keeping knee extended suggests pressure on neurological
3) Flex hip until patient indicates pain or tightness in L-spine or tissues is more lateral
posterior thigh
Bragards Test Disc herniation; 1) Perform SLR test w/ passive ankle dorsiflexion See above
564 increases stretch on
dura
Soto-Hall Test Disc herniation; 1) Perform SLR test w/ passive cervical flex. See above
564 increases stretch on
dura
Valsalva Maneuver Herniated disc, tumor, 1) Instruct patient to take a breath, hold it, then bear down as if Increased pain
167, 567 stenosis, osteophytes evacuating the bowels

Last updated: October 30, 2014

Page 10
Yeomans Test Facet irritation 1) Patient prone Pain in SI joint indicates anterior
575, 640 2) Passively flex 1 knee to 90 & extend the hip SI ligament pathology; anterior
(creates shear to femoral nerve) thigh paresthesia may indicate
femoral nerve stretch

PELVIS
Special Test Purpose/Indication Procedure Positive Sign
Femoral Shear Test SI joint lesion 1) Patient supine SI joint pain
634 2) Passive hip flex (45) + abd + LR
3) Palpate PSIS & apply axial load into hip @ the knee
Flamingo Test or Pubic symphysis or SI 1) Patient stands on 1 leg Pubic symphysis or SI joint pain
Maneuver joint lesion 2) To increase the stress, instruct patient to hop on 1 leg
638
Functional Hamstring Hamstring tightness 1) Patient seated on table Pelvis rotates posteriorly and/or
Length 2) Palpate PSIS & S2 spinal flexion
643 3) Active knee ext.
Gapping (Transverse Anterior SI ligament 1) Patient supine Unilateral gluteal or posterior leg
Anterior Stress) Test sprain 2) Apply crossed-arm pressure to ASIS, push down & out pain
631

Gillets (Sacral SI joint hypomobility 1) Patient standing PSIS

(doesnt move at all or)
Fixation) (Standing (inferior aspect of)
2) Palpate PSIS & S2 w/ each thumb moves superiorly during hip flex.
Wall) Test 3) Actively flex hip on tested side (standing on untested leg)
637
Ipsilateral Anterior SI joint ROM assessment 1) Patient standing PSIS does not move superiorly &
Rotation Test 2) Palpate PSIS & S2 laterally
638 3) Active hip ext. on tested side
Leg Length Test Determine leg length 1) Patient supine making sure ASISs are level Measurement difference of over
640 discrepancy 2) Use tape measure to find distance from ASIS to (inferior aspect 1.3cm
of)medial malleolus (difference of 1-1.3cm is normal)

Last updated: October 30, 2014

Page 11
Piriformis Stress Test Piriformis syndrome, 1) Patient sidelying w/ tested side on top Pain in the buttock or sciatic pain
696 sciatica 2) Active hip flex. (60), knee flex.
3) Stabilize hip & apply downward pressure to knee into horizontal
add. OR resist hip LR
Prone Gapping Posterior SI ligament 1) Patient prone w/ knee flexed to 90 SI joint pain
(Hibbs) Test sprain 2) Passively bring hip into IR as far as possible while palpating SI
633 joint on the same side
Sacral Apex Pressure SI joint pathology 1) Patient prone SI joint pain
(Prone Springing) 2) Place base of hand on apex of sacrum & apply pressure, causing a
Test shear of the sacrum on the ilium
633
Sacrotuberous Sacrotuberous ligament 1) Patient supine SI joint pain
Ligament Stress (SI sprain 2) Passively bring knee to opposite shoulder
Rocking)
(Knee-to-Shoulder)
Test
632
Seated Flexion Test SI joint hypomobility 1) Patient seated w/ legs off the edge of the table PSIS moves superiorly on 1 side
2) Palpate PSISs & have patient touch their toes
Squish Test Posterior SI ligament 1) Patient supine Pain
633 sprain 2) Place both hands on ASIS & iliac crests
3) Push down & in at a 45 angle
Standing Flexion Test SI joint hypomobility 1) Patient standing PSIS moves superiorly on 1 side
2) Palpate both PSIS w/ thumbs
3) Have patient attempt to touch their toes

Stork Standing Test Tests proprioception & 1) Patient stands w/ bottom of 1 foot against medial knee Patient stance is unstable
665 stability of SI joints,
knee, ankle & foot
Supine-to-Sit (Long Determine if leg length 1) Patient supine Affected limb longer in supine
Sitting) Test discrepancy is functional 2) Compare lvl of both medial malleoli than when sitting up (anterior
640 or structural 3) Actively sit up innominate rotation); vice versa
4) Observe whether 1 leg moves up farther than the other (posterior innominate rotation);
Last updated: October 30, 2014
Page 12
 long leg becomes longer indicates
structural

HIP
Special Test Purpose/Indication Procedure Positive Sign
Anterior Labral Tear Anterior-superior 1) Patient supine w/ hip in full flex. + LR + abd. Pain or reproduction of symptoms
Test impingement syndrome, 2) Passive full hip ext. + MR + add w/ or without a click
681 anterior labral tear,
iliopsoas tendinitis
Flexion-Adduction Hip pathology in children 1) Patient supine Adduction will be limited &
Test & young adults 2) Passive hip flex. (90) w/ knee fully flexed accompanied by pain or
680 3) Passively adduct the flexed leg discomfort
Obers Test ITB & TFL contracture 1) Patient side-lying w/ tested leg on top & bottom leg flexed at the Leg remains strongly abducted
693 hip & knee to 90
2) Stand behind patient & have them close to edge of table
3) Stabilize pelvis, then passively move hip into abd. + ext. w/ knee
straight or flexed (90)
4) Slowly lower the upper leg
Patricks (Faber or Hip pathology, 1) Patient supine Test legs knee remains above the
Figure-Four) Test shortened/spasmed 2) Position foot of tested leg on top of opposite knee opposite straight leg
680 iliopsoas, SI joint 3) Passively lower knee towards table
dysfunction
Posterior Labral Tear Labral tear, anterior hip 1) Patient supine w/ hip into full flex. + MR + full add. To begin Groin pain, patient apprehension,
Test instability, 2) Passive hip ext. + abd. + LR simultaneously reproduction of symptoms w/ or
681 posterior-inferior 3) Apply axial load to add further stress without click
impingement
Quadrant (Scouring) Hip pathology (OA, 1) Patient supine Pain, patient apprehension,
Test bursitis, labral tear) 2) Passive hip flex. + add. bumpiness, or any irregularity in
706 3) Passively move flexed hip through an arc into abd. & assess movement
quality of movement

Last updated: October 30, 2014

Page 13
 (Precaution: causes impingement of femoral neck against acetabular
rim & pinches adductor longus, pectineus, iliopsoas, sartorius
and/or TFL)
Rectus Femoris Rectus femoris 1) Patient supine w/ knees bent over the end of the table Knee of extended leg does not
Contracture (Kendall) contracture 2) Patient brings knee to chest & holds it remain at 90
Test 3) Palpate for mm tightness
693
Thomas Test Hip flexor mm shortness 1) Patient supine Opposite (straight) leg raises off
692 or contracture 2) Passively bring 1 knee to chest & have patient hold this position the table & mm stretch end feel
will be felt
Tight Hip Rectus Fem 1) Patient lying supine on the table, with knees bent over the edge The dangling knee remains less 90
Rectus Femoris mm of the table. degrees of flexion.
Contracture Test 2) Pt pulls opposite knee to chest
(Kendall Test):
693
Trendelenburgs Test Hip instability or weak 1) Patient asked to stand on tested leg Pelvis of non-stance side drops
or Sign hip abductors (primarily 2) Observe non-stance side
642, 680 glut. med)
Weber-Barstow Measure leg length 1) Patient supine w/ hips flexed (45) & knees flexed (90) Medial malleoli are not level
Maneuver asymmetry 2) Palpate & compare inferior aspect of medial malleoli w/ thumbs
689 3) Patient lifts pelvis momentarily
4) Passively extend legs & again compare malleoli

KNEE
Special Test Purpose/Indication Procedure Positive Sign
Anterior Drawer Test ACL injury, 1) Patient supine w/ hip flexed (45) & knee flexed (90) Tibia moves anteriorly more than
770 posterolateral & (Ensure posterior sag sign is not present) 6mm (hemarthrosis, torn medial
posteromedial capsule, 2) Sit on patients forefoot to stabilize (check about ankle injuries meniscus wedged against medial
MCL, ITB, post. oblique first) femoral condyle or hamstring
ligament and/or 3) Apply ant. glide of tibia on the femur spasm may result in
arcuate-popliteus false-negative)
complex

Last updated: October 30, 2014

Page 14
Apleys Test Differentiate between 1) Patient prone w/ knee flexed to 90 Distraction/rotation more painful
791 ligamentous or meniscal 2) Place your knee on patients post. distal thigh to stabilize indicates ligamentous injury.
injury 3) Medially & laterally rotate tibia w/ distraction, then again w/ Compression/rotation more
compression painful indicates meniscal injury
Brush, Stroke, or Joint effusion 1) Patient supine Wave of fluid passes to the medial
Bulge (Wipe) Test 2) Starting on the medial aspect of the knee just below the joint line, side of the joint & bulges just
796 stroke proximally as far as the suprapatellar pouch 2 or 3 times w/ below the medial distal border of
the palm & fingers the patella
3) Stroke down lateral side of patella
Clarkes Sign Patellofemoral 1) Patient supine Retropatellar pain & patient
(Patellar Grind Test) dysfunction 2) With web space of hand, apply post. pressure to sup. border of cannot hold contraction
798 patella
3) Patient contracts quads while patellar pressure is maintained
4) Repeat test at 0, 30, 60, 90 of knee flex. to test different parts of
patella
Fairbanks Patellar dislocation 1) Patient supine w/ knee flexed (30) Patient will contract quads &
Apprehension Test 2) Carefully & slowly push the patella laterally & distally w/ thumbs show signs of apprehension
802 & index fingers
Hughstons Plica Test Plica syndrome 1) Patient supine Popping of the plica band
795 2) Passively flex the knee & medially rotate the tibia w/ 1 hand while
pressing the patella medially w/ the heel of the other hand &
palpating medial femoral condyle
3) Passively flex & extend the knee while feeling for popping
Hughstons Posteromedial or 1) Patient supine w/ hip flexed (45) & knee flexed (80-90) Excessive posterior rotation on
Posteromedial & posterolateral rotary 2) Medially rotate tibia (to check posteriolateral instability) or in the side to which the tibia is
Posterolateral instability Lateral rotation (to check for posteriomedial instability) & sit on rotated
Drawer Sign patients foot to stabilize
781 3) Push tibia posteriorly
Lachman Test (many ACL injury (especially 1) Patient supine w/ knee @ 30 flex. Mushy or soft end feel and
modifications) posterolateral bundle), 2) Stabilize distal femur w/ outside hand disappearance of the infrapatellar
767 post. oblique ligament, 3) Place tibia in slight LR tendon slope
arcuate-popliteus 4) Apply an ant. glide of the tibia on the femur w/ inside hand
complex
Last updated: October 30, 2014
Page 15
McMurray Test Meniscal injury (loose 1) Patient supine w/ knee fully flexed (heel to buttock) Snap or click that is accompanied
791 fragments) 2) To test lateral menisci, medially rotate tibia then extend knee by pain
3) To test medial menisci, laterally rotate tibia then extend knee

Noble Compression ITB friction syndrome 1) Patient supine w/ hip flexed (45) & knee flexed (90) Pain over lateral femoral condyle
Test 2) Apply thumb pressure, just proximal to lateral femoral condyle, at approx 30 of knee flex.
803 1-2 cm
3) Slow, active hip & knee ext. while pressure is maintained
Patellar Tap Test Detect swelling in the 1) Patient supine Floating of the patella is felt
(Ballotable Patella) knee 2) With knee extended or flexed to discomfort, apply a slight tap or (dancing patella sign)
798 pressure over the patella
Posterior Drawer PCL sprain 1) Patient supine w/ hip flexed (45) & knee flexed (90) Tibia moves posteriorly more than
Test 2) Sit on patients forefoot to stabilize it in neutral rotation (check 6mm
770 about ankle injuries first)
3) Wrap hands around tibia & apply post. glide
Posterior Sag Sign Injury to PCL, 1) Patient supine w/ hip flexed (45) & knee flexed (90) Affected tibia sags posteriorly,
(Gravity Drawer Test) arcuate-popliteus 2) Observe knee from lateral side step is lost,
sulcus is observed
773 compelx, posterior (Normally, the medial tibial plateau extends 1cm anteriorly beyond
oblique ligament and/or the femoral condyle when knee is flexed to 90)
ACL
Q-Angle or Determine Q-Angle 1) Patient standing w/ lower limbs at a right angle to the line Normal
Patellofemoral Angle connecting the ASISs & w/ shoes off Males - 13
799 2) Landmark line from ASIS to midpoint of patella on the same side Females - 18
3) Landmark line from midpoint of patella to tibial tuberosity
4) Measure angle formed by the crossing of the 2 lines
Slocum Test Anteromedial or 1) Patient supine w/ hip flexed (45) & knee flexed (90) Movement occurs primarily on
774 anterolateral rotary 2) Apply ant. glide of tibia w/ foot in 30 of MR (stressing the opposite side to which the
instability anteriolateral instability), then again in 15 of LR (checking tibia is rotated
anteriomedial instability), while sitting on forefoot to stabilize
Valgus Stress Medial knee instability 1) Patient supine Excessive movement
(Abduction) Test or injury to medial 2) Stabilize ankle in slight LR (Not necessary, but may make it easier Grades of instability (p501 H&K):
763 structures to apply force appropriately) Gr 1: Up to 5 mm
Last updated: October 30, 2014
Page 16
 3) Perform a medial gap w/ knee in full ext., then again w/ knee in Gr 2: 6-10
20-30 of flex. Gr 3: 11-15
Gr 4: 15+
Varus Stress Lateral knee instability 1) Patient supine Excessive movement
(Adduction) Test or injury to lateral 2) Stabilize ankle in slight IR (Not necessary, but may make it easier Gr 1: Up to 5 mm
767 structures to apply force appropriately) Gr 2: 6-10
3) Perform a lateral gap w/ knee in full ext., then again w/ knee in Gr 3: 11-15
20-30 of flex. Gr 4: 15+

ANKLE/FOOT
Special Test Purpose/Indication Procedure Positive Sign
Anterior Drawer Test Anterior talofibular 1) Patient supine w/ feet off edge of table Excessive movement or dimple
888 and/or calcaneofibular 2) Stabilize distal leg over ant. talofibular ligament
ligament sprain 3) Position ankle in plantarflexion (20) (suction sign)
4) Cup hand around heel & mobilize anteriorly
5) Add inversion & dorsiflex. to stress calcaneofibular ligament as
well
Dorsiflexion 1) Patient seated on edge of table Pain on forced dorsiflexion
Maneuver 2) Stabilize distal leg
890 3) Cup hand underneath heel & use forearm to dorsiflex the foot

Feiss Line Determine degree of pes 1) Patient seated on edge of table 1stdegree
: tubercle falls 1/3 of
896 planus 2) Landmark apex (most inferior point) of medial malleolus, plantar the distance to the floor

aspect of 1stMTP joint & navicular tuberosity degree
2nd : tubercle falls 2/3 of
3) Patient then stands 8-15cm apart the distance to the floor
4) Re-palpate landmarks degree
3rd : tubercle rests on the
floor

Last updated: October 30, 2014

Page 17
Functional or Determine whether pes 1) Observe patients medial longitudinal arch in standing position, Functional : arch restored when
Structural Pes Planus planus is functional or standing on heels & toes, standing on toes only, then seated on the standing on toes or seated
Test structural table Structural: arch remains flat when
(Rattray 1113) standing on toes or seated
Rigid vs Supple Pes Determine whether pes 1) Observe & compare patients arches while seated at edge of Supple: arches present in seated &
Planus planus is rigid or supple table, then standing, then standing on toes standing on toes but disappears in
(Regional Ortho) standing
Rigid
: no arches present in all
positions w/ inability to stand up
on toes
Homans Sign Presence of DVT 1) Passive dorsiflexion w/ knee extended Pain in calf, tenderness on
897 2) Deep palpation of calf palpation; may find pallor,
swelling & loss of dorsalis pedis
pulse
Mortons Test Stress fracture or 1) Patient supine Pain
897 neuroma 2) Grasp foot around the metatarsal heads & squeeze them
together

Neutral Position of Talus misalignment 1) Patient standing in their natural position Excessive medial or lateral bulging
Talus 2) Palpate head of talus w/ 2 fingers of the talus
(Weight-Bearing 3) Patient slowly rotates the trunk to the right & left (causing tibia to
Position) rotate so that talus supinates & pronates)
883
Talar Tilt Test Calcaneofibular ligament 1) Patient supine or side lying Excessive tilting of the talus
890 tear 2) With foot in slight plantarflexion, palpate talus
3) Move foot into add. + inversion& try to tilt talus laterally
4) Move foot into abd. + eversion& try to tilt talus medially
Thompsons Achilles tendon rupture 1) Patient prone w/ feet over edge of table Absence of plantar flexion
(Simmonds) Test degree strain
or 3rd 2) Squeeze calf muscles
894

Last updated: October 30, 2014

Page 18
Tinels Sign Deep peroneal or post. 1)
Patient supine Tingling or paresthesia felt distally
896 tibial nerve lesion 2) To test anterior tibial branch of deep peroneal nerve, percuss ant.
ankle
3x
3) To test post. tibial nerve, percuss behind medial malleolus
3x

SYSTEMIC TESTS
Special Test Purpose/Indication Procedure Positive Sign
Buergers (Rubor) Arterial insufficiency of 1) Patient supine Foot blanches & prominent veins
Test lower limbs 2) Passively elevate leg to 45 for at least 3mins collapse shortly after elevation;
897 3) Patient then sits w/ legs dangling over edge of table takes 1-2mins for limb color to be
restored & veins to fill =
confirmed positive
Capillary Refill Test Arterial insufficiency 1) Pinch patients finger & observe return of blood flow Abnormal return of blood flow
Crunch Test Determine whether 1) Patient supine Mass is palpable during crunch
palpable mass is of 2) Palpate for a mass while patient performs a crunch indicates it is of muscular origin
muscular origin or within
deeper structures
Diastasis Rectus Test Separation of rectus 1) Patient supine & performs a crunch Palpated holes above or below
abdominus at the linea umbilicus
alba

Greater Saphenous Competency of greater 1) Palpate varicose vein at a proximal & distal location (at least Palpable backflow at distal
Vein Competency saphenous vein 20cm apart) location
Test 2) Percuss vein at proximal location & feel for backflow in distal
location
Mediate Percussion
Test
(Rattray 1085)
Pitted Edema Test Presence of chronic 1) Apply firm finger pressure to edematous area for 10-20s, then Indentation remains where
(Rattray 1118) pitted edema release pressure pressure was applied

Last updated: October 30, 2014

Page 19
Pinch An Inch Test Peritonitis 1) Patient supine Pain on release
2) Pinch McBurneys point & quickly release
Rebound Tenderness Appendicitis 1) Patient supine w/ hips & knee flexed Severe pain when pressure is
Test 2) Slowly apply pressure over McBurneys point then quickly release released (medical emergency)
(Rattray 1095) pressure
Retrograde Filling Incompetent venous 1) Patient supine Rapid filling (normal takes about
(Trendelenburg) Test valves 2) Raise leg to 90 to drain venous blood 35s)
3) Occlude great saphenous vein in the upper thigh
4) While maintaining occlusion, patient is asked to stand
5) Remove occlusion after 20s
Vocal Fremitus Test Bronchial congestion 1) Patient prone Vibrations decreased over the
(Rattray 1085) due to emphysema or 2) Place both hands symmetrically on thorax & move them over lungs & bronchi
chronic bronchitis various aspects
3) Patient repeats ninety nine & feel for vibrations

OTHER TESTS
Special Test Purpose/Indication Procedure Positive Sign
Bradykinesia Test Bradykinesia 1) Patient seated Movement becoming slower &
(Rattray 1124) 2) Patient touches thigh w/ palm of hand & back of hand repeatedly increasingly difficult
(alternating pronation/supinaton)

First Rib Mobility Hypomobility of 1strib 1) Patient seated Limited flexion
Test 2) Active cervical rot. to unaffected side, followed by cervical flex.
(Rattray 1069)

Last updated: October 30, 2014

Page 20