Special Test
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Indications of (+) result
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Test position/description
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Anterior apprehension test
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Look of apprehension = pt. prone to anterior dislocation of shoulder
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pt. supine with arm in 90 deg abd. therapist ER pt's shoulder.
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Posterior apprehension test
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Look of apprehension = pt. prone to posterior dislocation of shoulder
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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
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Absence of movement in the biceps tendon = rupture of long head of
biceps brachii
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pt sitting. clasps hands behind head with fingers interlocked,
alternately contracts/relax biceps muscle.
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Speed's test
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Pain or tenderness in bicipital groove region = bicipital tendonitis
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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
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Pain or tenderness in bicipital groove = bicipital tendonitis
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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.
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Drop arm test
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In ability to slowly lower arm or severe pain = tear in rotator cuff
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pt sitting/standing arm in 90 deg abd. pt is asked to slowly lower arm
to side.
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Hawkins-Kennedy test
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pain = impingement involving supraspinatus tendon
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pt sitting or standing. therapist flexes pt's shoulder to 90 and IR
arm.
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Neer test
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pain = impingement involving supraspinatus tendon
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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.
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Supraspinatus test (empty can)
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weakness or pain = tear of supraspinatus, impingement, or
suprascapular nerve involvement
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pt arm in 90 deg abd followed by 30 of horiz add, thumb down.
therapist resists attempt to abd arm.
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Adson maneuver
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absent or diminished radial pulse = TOS
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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.
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Allen test
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absent or diminished radial pulse = TOS
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pt sitting/standing test arm in 90 abd, ER, and elbow flex. pt rotates
head away from test shoulder while therapist monitors radial pulse.
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Costoclavicular syndrome test
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absent or diminished radial pulse = TOS caused by compression of
subclavian artery between the first rib and the clavicle
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pt sitting. therapist monitors radial pulse and assists the pt to
assume a military posture.
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Roos test
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Inability to maintain test position, weakness of the arms, sensory
loss or ischemic pain = TOS
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pt sitting arm in 90 abd, ER, and elbow flexion. pt asked to open/close
hands for 3 minutes.
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Glenoid labrum tear test
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Clunk or grinding sound = glenoid labrum tear.
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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)
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Increased laxity in the lateral collateral ligament when compared to
the contralateral side, apprehension or pain = lateral collateral ligament
sprain
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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.
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Valgus stress test (elbow)
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Increased laxity in the medial collateral ligament when compared to
the contralateral side, apprehension or pain = medial collateral ligament
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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
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Pain in the lateral epicondyle region or muscle weakness = lateral
epicondylitis
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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.
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Lateral epicondylitis test
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Pain in the lateral epicondyle region or muscle weakness = lateral
epicondylitis
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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
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Pain in the medial epicondyle region = medial epicondylitis
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pt sitting. therapist palpates medial epicondyle and supinates the
forearm, extends wrist, and extends elbow.
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Mill's test
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Pain in the lateral epicondyle region = lateral epicondylitis
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pt sitting. therapist palpates lateral epicondyle and pronates
forearm, flexes writes and extends elbow.
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Tinel's sign (ulnar)
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Paresthesia in ulnar nerve distribution of forearm, hand, and fingers
= ulnar nerve compression or compromise
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pt sitting with elbow in slight flex. therapist taps with index finger
between olecranon and medial epicondyle.
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Ulnar collateral ligament test
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excessive valgus movement in thumb = tear of ulnar collateral and
accessory collateral ligaments (gamekeeper's/skier's thumb)
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pt sitting . therapist holds thumb in ext. and applies a valgus force
to MCP jt of thumb.
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Allen test
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delayed or absent flushing of the radial or ulnar half of the hand =
occlusion of radial or ulnar artery
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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
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delayed or muted response of color returning to nails (greater than 2
sec) = arterial insufficiency
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pt sitting/standing. therapist compresses pt's nailbed and after
releasing pressure notes amount of time for color to return.
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Bunnel-Littler test
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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
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pt sitting with MCP jt in slight ext. therapist attempts to move PIP
into flex
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Tight retinacular test
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1. unable to flex DIP = retinacular lig or capsule tight 2. able to
flex DIP with PIP in flexion = retinacular lig tight, capsule normal
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pt sitting with PIP in neutral and DIP flexed. therapist attempts to
flex DIP
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Froment's sign
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pt. flexing distal phalanx of thumb = adductor pollicis
paralysis/ulnar n. compromise or paralysis.
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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
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tingling in thumb, index finger, middle finger and lateral half of
ring finger = carpal tunnel syndrome
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pt sitting/standing. therapist flexes pt's wrist maximally and asks pt
to hold position for 60 sec.
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Tinel's sign (median)
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tingling in median n. distribution = carpal tunnel syndrome
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pt sitting/standing. therapist taps over volar aspect of pt's wrist.
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Finkelstein test
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pain over abductor pollicis longus and extensor pollicis brevis =
tenosynovitis in thumb (deQuervain's)
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pt sitting/standing and asked to make fist with thumb tucked inside
fingers. Therapist stabilizes forearm and ulnarly deviates wrist.
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Grind test (hand)
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pain in thumb over CMC = DJD of CMC
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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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Murphy sign
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pts. third metacarpal remains level with the second and fourth =
dislocated lunate
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pt sitting/standing and asked to make fist.
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Ely's test
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spontaneous hip flexion occuring simultaneously with knee flexion =
rectus femoris contracture
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pt prone while therapist passively flexes pt. knee.
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Ober's test
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inability of test leg to adduct and touch table = TFL contracture
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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
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pain or tightness = piriformis tightness or compression on the sciatic
n. caused by piriformis
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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
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the straight leg rises from the table = hip flexion contracture
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pt supine with legs fully ext. pt asked to bring one knee to chest.
Observe position of contralateral hip.
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Tripod sign
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tightness of hamstring or extension of the trunk in order to limit the
effect of the tight hamstring = tight hamstring
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pt sitting with knees flexed 90 over edge of table. therapist
passively ext one knee.
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90-90 Straight leg raise
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knee remaining in 20 deg or more of flexion = tight hamstring
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pt supine. Hip 90 flex with knee relaxed. Therapist passively ext.
knee.
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Barlow's test
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click or clunk = hip dislocation being reduced (pediatric)
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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.
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Ortolani's test
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click or clunk = hip dislocation being reduced (pediatric)
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pt supine hips flex 90 and knee flex. therapist abducts infants hips
and gentle pressure applied to greater trochanter until resistance is felt.
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Craig's test
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tests for deg of anteversion @ hip. normal for adult= 8-15
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pt prone with knee flex 90. therapist palpates posterior aspect of
greater trochanter and IR/ER hip until greater trochanter is parallel with
table.
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Patrick's test (FABER)
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failure of test leg to abduct below the level of the opposite leg =
iliopsoas, sacroiliac, or hip jt. abnormalities
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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
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grinding-caching or crepitation in the hip = arthritis, avascular
necrosis, or an osteochondral defect in hip
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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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Trendelenburg test
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a drop of the pelvis on the unsupported side = weakness of gluteus
medius on supported side
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pt standing and asked to stand on one leg for approx. 10 seconds.
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Anterior drawer test (knee)
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excessive anterior translation of tibia = ACL injury. less reliable
than Lachman
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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.
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Lachman test
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excessive anterior translation of tibia = ACL injury. More reliable
than Anterior drawer test.
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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.
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Lateral pivot shift test
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a palpable shift or clunk occuring between 20-40 degrees of flexion =
anterolateral rotary instability Clunk is reduction of tibia on femur
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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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Posterior drawer test
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excessive posterior translation of the tibia = PCL injury
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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
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tibia sags back on femur = PCL injury
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pt supine with knee flexed 90 and hip flexed 45.
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Slocum test
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movement of tibia occurring primarily on lateral side = anterolateral
instability
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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)
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excessive valgus movement = MCL sprain
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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.
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Varus stress test (knee)
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excessive varus movement = LCL sprain
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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
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pain or clicking = meniscal lesion
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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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Bounce home test
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incomplete extension or rubbery end-feel = meniscal lesion
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pt supine. Therapist grasps pt's heel and maximally flexes the knee.
Pt's knee is extended passively.
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McMurray test
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click or pronounced crepitation over joint line = posterior meniscal
lesion
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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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Brush test
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a wave of fluid just below the medial distal border of the patella =
effusion in the knee
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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
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patella appears to be floating = joint effusion
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pt supine with knee flexed or extended to a point of discomfort.
Therapist applies slight tap over patella.
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Clarke's sign
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failure to complete the contraction without pain = patellofemoral
dysfunction
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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.
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Hughston's plica test
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popping sound over the medial plica while knee is passively flexed and
extended = plica dysfunction
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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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Noble compression test
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pain overt the lateral femoral epicondyle at approximately 30 deg of
knee flexion = ITB friction syndrome
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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
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a look of apprehension or an attempt to contract the quadriceps =
patella subluxation/dislocation
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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)
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excessive anterior translation of talus = anterior talofibular
ligament sprain
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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
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excessive adduction = calcaneofibular ligament sprain
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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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Homan's sign
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pain in the calf = DVT
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pt supine. Therapist maintains leg in extension and passively
dorsiflexes pt's foot.
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Thompson test
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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
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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
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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
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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.
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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
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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
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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
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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)
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Sitting flexion test.
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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.
|
Hai fellow physiotherapists....this blog basically contains Amal's compilation of exam preparation materials for NPTE, PCE, HAAD, DHA,MOH, PROMETRIC, ACOPRA.
Saturday, May 23, 2015
Special tests..hope i didn't miss anything important.
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