CERVICAL SPINE SPECIAL TESTS

HOFFMANN’S SIGN

Purose/indication: corticospinal tract dysfunction localised to cervical segments of spinal cord.

Procedure

1) Position the subject’s relaxed hand ensuring dorsiflexion at the wrist and partial flexion of the
fingers.

2)Hold the subject's partially extended middle finger between your index and middle finger, ensuring
you stabilize the proximal IP joint.

3)Perform a sharp and forceful flick of your thumb, making contact with the nail of the subject’s
middle finger.

4)The subject's finger will flex immediately followed by relaxation.

positive sign

is characterized by flexion and adduction of the thumb and flexion of the index finger,seen in cervical
myelopathy,multiple sclerosis

ALAR LIGAMENT STRESSTEST

Purpose/Indication : Alar ligament sprain

Procedure

1) Patient supine

2) Cup occiput w/ 1 hand, pincher grasp on C2 w/ other hand

3) Passively side flex the Occiput on C1

Positive Sign

Soft end feel, excessive movement

DISTRACTION TEST

Purpose/indication :Alleviate symptoms;confirmation of nerveroot compression

procedure

1) Patient seated

2) Apply a distraction of the C-spine

Positive sign
Relief of symptoms

MAXIMAL CERVICAL COMPRESSION TEST

Purpose /indication Cervical nerve root compression

procedure

1) Patient seated

2) Passive cervical side flex. + rot. to affected side, then apply downward pressure on top of patient’s
head

3) If no symptoms, add cervical ext. then compress

Positive sign

Radiating pain into the arm

FORAMINAL COMPRESSION (SPURLING’S) TEST

Purpose / indication : Cervical nerve root compression

procedure

1) Patient seated

2) Apply downward pressure on top of patient’s head

3) If no symptoms, add cervical ext. then compress

4) If no symptoms, add cervical rot. to tested side then compress (Do not perform if V.A.T(vertebral
artery test) is positive)

Positive sign

Radiating pain into the arm

SHOULDER ABDUCTION(RELIEF) TEST( BACODY SIGN)

Purpose /indication: Radicular symptoms involving C4 or C5 nerve roots

procedure

1) Patient seated or supine

2) Passively or actively elevate arm above head (abduction ). so the forearm rests on top of the head

Positive sign

Relief of symptoms
 TRANSVERSE LIGAMENTSTRESS TEST

Purpose /indication: Tranverse ligament sprain; hypermobility of atalanto axial joint

procedure

1) Patient supine

2) Support occiput w/ fingers 3-5 interlocked

3) Place index fingers in the space between occiput & Spine of C2

4) Carefully lift head & C1, allowing no flex. or ext. & hold positionfor 10-20s

Positive sign

Soft end feel, spasm, dizziness, nausea, paresthesia of the lip, face or limb, nystagmus, lump
sensation in the throat

SHARP PURSOR TEST

Purpose/indication :assess integrity of atlanto axial joint

Procedure

1)patient is seated and examiner places palm of one hand on the patient’s forehead,and index finger
or thumbof other hand on the tip of spinous processof axis vertebra(c2).

2)ask patient to flex,at the same time the examiner presses posteriorly on the forehead.

Positive sign

A sliding motion of head in relation to axis vertebra indicates atlanto axial instability

VERTEBRAL ARTERY(CERVICAL QUADRANT)TEST

Purpose /indication: Circulation deficiency ofvertebral artery

procedure

1) Patient supine w/ head off the edge of the table

2) Passive cervical ext. + side flex. + rot. to untested side for approx.30s or until symptoms present

Positive sign

Dizziness, nystagmus, vertigo, nausea

 Prepared by Dr.KAVYA A.G | FINAL MD SCHOLAR

SHOULDER JOINT EXAMINATION

The shoulder joint examination involves several specific tests to assess the integrity of the shoulder
structures, including the muscles, tendons, ligaments, and the joint itself.

1. INSPECTION
Observation:
Examine the shoulder for any asymmetry, swelling, deformity, muscle bulk, and signs of scoliosis or
kyphosis, muscle atrophy, Scapular Position, skin changes.

2. PALPATION
Bony Landmarks:
Palpate the clavicle, acromion, scapula, and humeral head for tenderness or deformity.
Soft Tissues:
Palpate the rotator cuff muscles, biceps tendon, and subacromial space for tenderness.

3. RANGE OF MOTION (ROM)

Active ROM:
Ask the patient to move the shoulder through its full range actively.

• Flexion and Extension: Assess forward and backward motion.

• Abduction and Adduction: Assess sideward motion.
• Internal and External Rotation: Assess rotation with the arm at the side and at 90° abduction.

Passive ROM:

• The examiner moves the shoulder through its full range to assess for any restrictions, pain, or
crepitus.

4. STRENGTH TESTING
- Manual Muscle Testing (MMT): Evaluate the strength of individual shoulder muscles.
- Specific Tests for Muscle Groups:
- Deltoid: Shoulder abduction.
- Supraspinatus: Empty Can Test.
 - Infraspinatus/Teres Minor: External rotation.
- Subscapularis: Internal rotation (Lift-off Test).

5. SPECIAL TESTS

I. FOR ROTATOR CUFF PATHOLOGIES:

➢ Neer’s Impingement Test:

Assesses for subacromial impingement.

Method:

a. Made the patient sit

b. Stands behind the patient and stabilizes their scapula with one hand
c. Flexes the patient's arm passively while internally rotating it
d. Asks the patient to flex their arm upward

Interpretation
Pain indicates impingement.

➢ Hawkins-Kennedy Impingement Test:

Also assesses for impingement.

Method

The examiner places the patient's arm

shoulder in 90 degrees of shoulder flexion
with the elbow flexed to 90 degrees and then
internally rotates the arm.

Interpretation

The test is considered to be positive if the patient experiences pain with internal rotation.

➢ Drop Arm Test:

Used to assess for full thickness rotator cuff tears, particularly of the supraspinatus
Method:
Ask the patient to hold their arm out to the side at a 90-
degree angle with the thumb pointing down. The arm will
then be needed to lowered down slowly towards the
ground.
Interpretation:
Positive if the arm drops uncontrollably.
 ➢ Empty Can Test:

Tests the supraspinatus muscle.

Method:
The patient holds their arms in 90 degrees of abduction,
30 degrees of forward flexion, and internal rotation
(thumbs pointing down). The examiner resists abduction.
Interpretation:
Weakness or pain suggests a supraspinatus tear.

II. TESTS FOR SHOULDER INSTABILITY.

➢ Apprehension Test:
Assesses for anterior or posterior shoulder instability.
Method:
The examiner externally rotates the patient’s shoulder with the arm in 90
degrees of abduction.
Interpretation:
A feeling of apprehension or fear of dislocation indicates instability.
 ➢ Load and Shift test

To assess the stability of Gleno

Humeral joint.
Method-
With the patient sits or lies supine
with arm at their side and elbow
flexed at 90 degree the examiner
stands behind the patient and
stabilise the patients scapula with one hand.
With the other hand the examiner grasps the humerus head and applies a force to move it in an
anteromedial or posterolateral direction to assess anterior and posterior instability respectively.
Interpretation-
Test positive if the tested side translates further than the other side

➢ Sulcus sign

Indicates inferior shoulder instability

Method-
With the patient sitting / standing the examiner grabs the patients
arm and pulls inferiorly.
Interpretation-

visible or palpable sulcus appears beneath the acromion as the

humeral head is translated inferiorly (test positive)

III. FOR LABRAL PATHOLOGIES

➢ O’Brien’s Test:
Assesses for labral tears.
Method
The patient flexes the shoulder to 90 degrees and adducts it slightly.
The arm is then internally rotated (thumb down) and the examiner
resists downward pressure.
Interpretation
Pain in the joint or clicking suggests a labral tear.

IV. FOR BICEPS TENDON PATHOLOGIES

➢ Speed's test
 Speed's Test is used to test for superior labral tears or bicipital
tendonitis.
Method:
Places the patient's arm in shoulder flexion, external rotation, full
elbow extension, and forearm supination; manual resistance is then
applied by the examiner in a downward direction
Interpretation
The test is considered to be positive if pain in the bicipital tendon or bicipital groove is
reproduced.

➢ YERGASON'S TEST

The Yergason's Test is used to test for biceps tendon pathology, such as bicipital tendonitis and an
unstable superior labral anterior posterior (SLAP) lesion.

Method:
The patient should be seated or standing in the anatomical
position, with the humerus in a neutral position and the elbow
in 90 degrees of flexion in a pronated position.

The patient is asked to externally rotate and supinate their arm

against the manual resistance of the examiner produced by
wrapping the hand around the distal forearm (just above the
wrist joint).

Interpretation

Yergason's Test is considered positive if the pain is reproduced in the bicipital groove and a biceps
or a SLAP lesion is suspected. If a "clicking" sensation familiar to the patient is produced during
the test, damage to the transverse humeral ligament (which overlies the intertubercular sulcus)
should be suspected too.
V. FOR ACROMIO CLAVICULAR JOINT PATHOLOGIES

➢ Cross body adduction test

Assessing for AC joint pathology by passively adducting the arm
across the body
Method-
The cross-over adduction test is performed by the motion of forward
flexion to 90° with horizontal adduction of the arm across the chest.
Interpretation-
Reproducible pain over the joint suggests AC joint involvement

Prepared By | Dr.Greeshma M | SECOND YEAR MD SCHOLAR

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ELBOW JOINT
SPECIAL TEST : TENNIS ELBOW

1. Cozen’s test:
• The patient’ s elbow is stabilized by the examiner’s thumb, which
rest on patient’s lateral epicondyle.
• The patient is then asked to make a fist, pronate the forearm, and
radially deviate and extend the wrist while the examiner apply
resistance
• Positive sign: sudden severe pain in lateral epicondyle.
2. Mill’s test:
• While palpating lateral epicondyle, the examiner passively
pronates the patient’ forearm, flexes the wrist fully and extends
the elbow.
• Positive sign: Pain over lateral epicondyle

3. Maudsley’ test:
• The examiner resists extension of third digit of the hand distal to
the proximal interphalangeal joint.
• Positive sign: Pain over lateral epicondyle.
4. The chair test:
• Ask the patient to attempt to lift a chair with elbow straight and
shoulders flexed to 60 degrees.
• Positive sign: Difficulty to perform and complain of pain over
lateral epicondyle

5. Thomson’s test:
 • Ask the patient to clench the fist, dorsiflex the wrist and extend
the elbow. A forceful palmar flexion against patient’s resistance.
• Positive sign: Pain over lateral epicondyle.

SPECIAL TET : GOLFER’S ELBOW

1. Golfer’s elbow test:
• Flex the elbow, supinate the hand and then extend the elbow.
• Positive sign: Pain over medial epicondyle.

Prepared by | Dr.Archana V | First Year MD Scholar

HAND AND WRIST – SPECIAL TESTS

1. Hand grip strength -

Procedure –

• Ask the patient to grasp your second and third fingers as tightly
as possible
• This test function of wrist joint , finger flexors , intrinsic muscles
and joints of hand.

Significance –
• Decreased grip strength is a positive test for weakness of the
flexors and /or intrinsic muscles of hand .
• It can also results from inflammatory or degenerative arthritis ,
carpel tunnel syndrome , epicondylitis , cervical radiculopathy
and other nerve disorders of hand and wrist .
• Grip weakness plus wrist pain are often present in Quervain
tenosynovitis.

2. Finkelstein test (test for tenosynovitis)

Procedure –
• Ask the patient to grasp the thumb against the palm and
then move the wrist towards midline in ulnar deviation

Significance - pain during this test identifies

deQuervain tenosynovitis from inflammation of the
 abductor pollicis longus and extensor pollicis brevis
tendon sheaths

3. Test for nerve entrapment neuropathy –

a. Thumb abduction test –

Procedure –
• Ask the patient to raise the thumb straight up away from
the palm straight away from the palm at 900 angle from
the hand as you apply downward resistance

Significance – Weakness on thumb abduction or

opposition is a positive test . The abductor pollicis longus
is innervated by the median nerve .
 b. Tinel sign
Procedure –

• Elicited by repeatedly tapping over the course of the

median nerve in the carpel tunnel .

Significance – shooting pain, aching or worsening numbness in

the median nerve distribution is a positive test .

c. Phalen sign
Procedure -
• Ask the patient to hold the wrist in full flexion and
juxtaposing the dorsum of each hand against each other
for 60 seconds with the elbows fully extended. This
maneuver compresses the median nerve.
 Significance – numbness and tingling in the median nerve
distribution within 60 seconds is positive test .

Prepared by | Dr.Lakshmi Gowda | First Year MD Scholar

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LUMBOSACRAL SPINE
Special tests of the lumbosacral spine

- Straight Leg Raise (SLR) Test

- How to Perform:
SLR is a passive test
- The patient lies supine on the examination table.
- The examiner lifts the patient’s leg with the knee fully extended. Support
one hand above the knee and other hand below the ankle joint.
- The leg is raised until the patient reports pain or discomfort, or until the
examiner feels resistance.
- Interpretation:
- Positive Test: Pain radiating down the leg at 350-70 0degrees of hip flexion
suggests lumbar disc herniation, especially if the pain extends below the
knee.
- Negative Test: No pain or discomfort may indicate a non-neurological cause
for lower back pain.
- SLR test is best for eliciting L4,L5,S1 radiculopathy.

- Crossed Straight Leg Raise Test (Contralateral SLR)

- How to Perform:
- Similar to the SLR test, but the examiner lifts the unaffected leg (the leg
without symptoms).
- Interpretation:
- Positive Test: If raising the unaffected leg produces pain in the affected leg,
this strongly suggests a lumbar disc herniation.

- Lassegue,s sign

- How to Perform
- Perform the SLR test
- When the patient feels pain , flex the knee to 90 0 reduce the tension on
sciatic nerve roots. Now further flex the hip to 900 . Then gently extend the
knee until the pain reproduces again
- Interpretation:
- Positive Test : Pain radiating along the path of the sciatic nerve suggests
lumbar disc herniation or other pathology compressing a nerve root
(commonly at L4-L5 or L5-S1).

- Bowstring Test
- How to Perform:
- The patient lies supine.
- The examiner performs a straight leg raise test until the patient reports
pain. The examiner then slightly flexes the knee to reduce the tension on
the sciatic nerve.
- After reducing the tension, the examiner applies pressure with their thumb
to the popliteal fossa (the area behind the knee).
- The pressure is applied to the tibial nerve as it passes through this area.
- The examiner observes if the pain in the leg is reproduced with the
pressure.
- Interpretation:
- Positive Test: Reproduction of the radicular pain when pressure is applied
to the popliteal fossa suggests lumbar radiculopathy due to nerve root
compression.

- Slump Test
- How to Perform:
- The patient sits on the edge of the examination table
with legs dangling and with hands behind back to achieve a
neutral spine.
- If this position does not cause pain, have the patient flex the neck by
placing the chin on the chest and then extending one knee as much as
possible.
- If extending the knee causes pain, have the patient extend the neck into
neutral. If the patient is still unable to extend the knee due to pain, the
test is considered positive.
- If extending the knee does not cause pain, ask the patient to actively
dorsiflex the ankle. If dorsiflexion causes pain, have the patient slightly flex
 the knee while still dorsiflexing. If the pain is reproduced, the test is
considered positive.
- Interpretation:
- Positive Test: Reproduction of symptoms or pain suggests nerve root
tension, possibly due to lumbar disc herniation or nerve impingement.

- Patrick's Test (FABER Test)

- Position of leg into 900 Flexion, Abduction and

External Rotation
- How to Perform:
- The patient lies supine.
- The examiner places the leg of the affected side in a figure-four position,
with the ankle resting above the opposite knee.
- The examiner then applies pressure on the knee of the bent leg.
- Interpretation:
- Positive Test: Pain in the sacroiliac joint indicates SI joint dysfunction or
pathology. Pain in the hip suggests hip joint pathology.

- Femoral Nerve Stretch Test

How to Perform:

- The patient lies prone.

- The examiner stabilize the pelvis with one hand and knee is passively
flexed to the thigh and hip is passively extended

- Interpretation:
- Positive Test: Pain radiating down the anterior thigh suggests femoral
nerve involvement, often due to upper lumbar nerve root impingement
(L2-L4).
 - Schober's Test
- How to Perform:
- Mark a point approximately at L5
- Now mark two horizontal lines, one 10
cm above and one 5 cm below L5
- Ask the patient to touch his/her toes
- . Normally the distance between two
lines increases by 5 cm (total >20 cm)
- Interpretation:

- If the increase is less than 5 cm, it

suggests restriction.

- Flip test

- How to Perform:
- To distinguish between sciatic nerve root irritation from malingering.
- Ask the patient to sit on the edge of the couch with the hips and knees
flexed to 90°
- Examine the knee reflexes.
- Now extend the knee, as if to examine the ankle jerk.
- Seated SLR or flip test
- This test is similar to a slump test. To perform the Flip test, the patient
sits on the edge of a table with the legs dangling. The
painful/symptomatic leg is extended and if the patient puts their hands
on the table and “flips” backward, the test is positive.
- Interpretation:
- A patient with a prolapsed disc will lie back (flip) to relieve the tension
on the nerve roots.
- If no nerve root irritation, the patient's attention distracted to the ankle
jerk and allow full extension of the knee (to 90 degree).

Prepared By | Dr.Dineesha M | Second Year MD Scholar

 HIP JOINT EXAMINATION
The Hip joint is one of the most important joints in the body because of the vital role it plays in
locomotion. It is the second largest weight-bearing joint in the body, after the knee joint. It is a ball-
and-socket synovial joint formed between the os coxa (hip bone) and the femur. The rounded head
of the femur forms the ball, which fits into the acetabulum (socket in the pelvic bone) and ligaments
connect the ball to the socket, thereby providing tremendous stability to the joint.

Techniques of examination

Inspection

Gait- observe 2 phases of gait:

1. Stance- when the foot is on the ground and bears weight (60% of walking cycle)

2. Swing- when the foot moves forward and doesn't bear weight ( 40% of cycle)

● Inspect the gate - for the width of base, tilt of pelvis, and the flexion of knee.
● Inspect the lumbar portion of spine- for the degree of lordosis, and with supine position
assess the length of legs for symmetry.
 ● Inspect the anterior and posterior surfaces of the hip for any areas of muscle atrophy or
bruising.

*A wide gate suggests cerebellar disease or foot problems. Pain during weight bearing or examiner
strike on the heel occurs in femoral neck stress fractures,

*Hip dislocation, arthritis, unequal lengths, or abductor weakness can cause the pelvis to drop on the
opposite side, producing a waddling gait

*Lack of knee flexion, which makes the leg functionally longer, interrupts the smooth pattern of gait,
causing circumduction (swinging the leg out to the side)

*The Loss of lordosis occurs with paravertebral spasm, excess lordosis suggests a flexion deformity of
the hip.

*Disparities in leg length occur in abduction or adduction deformities and scoliosis. Leg shortening
and external rotation are common in hip fracture

Palpation

Anterior landmark:

● Iliac crest at the level of L4

● Iliac tubercle
● Anterior superior iliac spine
● Greater trochanter
● Pubic tubercle

Posterior landmark:
 ● Posterior superior iliac spine
● Greater trochanter
● Ischial Tuberosity
● Sacroiliac joint

Anterior or inguinal pain, typically deep within the hip joint and radiating to the knee, points to intra-
articular pathology, pain radiating to the buttocks or posterior trochanteric region points to extra-
articular causes.

Bursae

● Psoas bursa
● Trochanteric bursae
● Ischiogluteal bursa.

Look for tenderness in ischiogluteal bursitis or Weaver's bottom , because of the adjacent sciatic
nerve, this may mimic sciatica.

ROM

Flexion-

The patient lies in supine position.

Place your hand under the patient's lumbar spine.

Ask the patient to bend each knee in turn up to the chest and pull it firmly against the abdomen.

When the back touches your hand, indicating normal flattening of the lumbar lordosis

Extension-
Patient lies in a prone position.

Extend the thigh towards you in a posterior direction.

Abduction-

Stabilize the pelvis by pressing down on the opposite anterior superior iliac spine with one hand

With the other hand, grasp the ankle and abduct the extended leg until you feel the iliac spine move.

Adduction-

Patient lies in supine position.

Stabilise the pelvis

Hold one ankle

Move leg medially across the body and over the opposite extremity.

External and internal rotation-

Flex the leg to 90° at hip and knee

Stabilise the thigh with one hand

Grasp the ankle with the other and swing the lower leg medially for external rotation at the hip, and
laterally for internal rotation.

*In flexion deformity of hip, as the opposite hip is flexed, (with the thigh against chest wall) ,

The affected hip does not allow full hip extension and affected thigh appears flexed
*Restricted abduction and internal and external rotation are common in hip OA.

*Pain with maximal flexion and adduction and internal rotation or with abduction and external
rotation with full extension signals acetabular labral tear.

*A wide base suggests, cerebellar disease or foot problem.

Hip movement Main muscle Accessory muscle

Flexion Iliopsoas (femoral nerve) Sartorius, Rectus femoris,

pectineus (supplied by femoral
nerve)

Extension Gluteus maximus (Inferior Gluteal Hamstring muscles (sciatic nerve)

nerve) Maintain extension in normal
Helps in raising the trunk from standing and sitting.
sitting position or in climbing
stairs.

Abduction Gluteus medius and Gluteus Tensor fascia latae

minimus. (Superior gluteal nerve)

Adduction Adductor- brevis, longus, magnus Gracilis, pectineus (obturator

(obturator nerve) nerve)

Medial rotation Anterior fibres of gluteus medius Tensor fascia latae

and minimus (superior gluteal
nerve)

Lateral rotation Obturator internus (Nerve to Piriformis (s1 and s2 nerve)

quadrates femoris) Gluteus maximus
Obturator externus Sartorius
Superior gemellus (nerve to
obturator internus)
Inferior gemelli (nerve to
obturator internus)
 Quadratus femoris (nerve to
quadrates femoris)

Circumduction All muscles

Pain with maximal flexion and adduction and internal rotation or with abduction and external
rotation with full extension signals acetabular labral tear.

A wide base suggests, cerebellar disease or foot problem.

SPECIAL TESTS

1. STRAIGHT LEG RAISING TEST

The patient is positioned in supine without a pillow under their head, the clinician stands at the
tested side with their distal hand around the patient's heel and proximal hand on the patient's distal
thigh(anterior) to maintain knee extension.

The clinician lifts the patient's leg by the posterior ankle while keeping the knee in a fully extended
position.

The clinician continues to lift the patient's leg slowly through flexing at the hip, until the patient's
symptoms are replicated, or they experience tightness in the back or posterior thigh.

Interpretation: Pain occurs when the hip is flexed at 30 and 60 or 70 degrees from horizontal.
Neurological pain which is reproduced in the leg and lower back between 30-70 degrees of hip
flexion is suggestive of lumbar disc herniation at the L4-S1 nerve roots.

Pain at greater than 70 degrees of hip flexion might indicate tightness of the hamstrings, gluteus
maximus, or hip capsule, or pathology of the hip or sacroiliac joints.

Figure: Straight leg raising test

2. THOMAS TEST

To perform the test, the patient lies on his or her back. The patient is asked to pull the non-
testing leg toward the chest until the bulge in the lumbar spine smoothes out.
Interpretation: The test is positive when the extended leg lifts off the treatment table and
the patient feels a stretch in the groin. If adduction of the extended leg is observed, the so-
called J-sign, this could indicate a shortening of the iliotibial tract.

Figure: Thomas Test

3. TRENDELENBURG TEST

The patient is asked to stand on one leg for 30 seconds without leaning to one side the patient can
hold onto something if balance is an issue. The therapist observes the patient to see if the pelvis
stays level during the single-leg stance.

Interpretation: A positive Trendelenburg Test is indicated if during unilateral weight bearing the
pelvis drops toward the unsupported side

Figure: Trendelenburg Test

 4. FABER (Flexion ABduction External Rotation) TEST / PATRICK TEST

The patient is positioned in supine. The leg is placed in a figure-4 position (hip flexed and abducted
with the lateral ankle resting on the contralateral thigh proximal to the knee. While stabilizing the
opposite side of the pelvis at the anterior superior iliac spine, an external rotation, abduction and
posterior force is then lightly applied to the ipsilateral knee until the end range of motion is achieved.

Interpretation: A positive FABER test is when any pain is reproduced (this may involve pain in or
around the hip, groin, buttock, SIJ, and lumbar spine). A negative FABER test is when pain is not
reproduced.

Figure: FABER / PATRICK Test

5. FADDIR (Flexion, Adduction, Internal Rotation) Test

Patient is in supine position. Affected hip fully flexed or 90 degree flexion. Adduct the hip with
combined Internally rotation of the hip. A positive test is indicated by the production of pain in the
groin, the reproduction of the patient’s symptoms with or without a click, or apprehension.

Interpretation: Pain in the groin area is considered indicative of labral pathology, including
degeneration, fraying, or tearing. This is also known as a positive impingement sign.
 Figure: FADDIR Test

6. OBERS TEST

To test for tightness in Tensor Facia Lata (TFL) or Contractures in Iliotibial Band (ITB), that limit hip
adduction. Use to diagnose Iliotibial Band Syndrome.

With the patient lying in the lateral position, support the knee and flex it to 90 degrees. Then abduct
and extend the hip. Then release the knee support. Failure of the knee to adduct is a positive test.

The examiner places a stabilizing hand on the patient's upper iliac crest and then lifts the upper leg,
is flexed at the knee, extends it at the hip, and slowly lowers it toward the bottom leg, allowing the
thigh to lower towards the table. The examiner must continue to stabilize at the hip to ensure there
is no movement.

Interpretation: The test result is positive if the patient is unable to adduct the leg parallel to the table
in a neutral position.
 Figure: OBERS Test

7. ELY’s TEST / DUNCAN-ELY TEST

This test is used to assess rectus femoris spasticity or tightness.

The patient lies prone in a relaxed state. The therapist is standing next to the patient, at the side of
the leg that will be tested. One hand should be on the lower back, the other holding the leg at the
heel. Passively flex the knee in a rapid fashion. The heel should touch the buttocks. Test both sides
for comparison.

Interpretation: The test is positive when the heel cannot touch the buttocks, the hip of the tested
side rises up from the table, the patient feels pain or tingling in the back or legs.

Figure: ELY’s / DUNCAN-ELY Test

Prepared By | Dr.Sreevidya PR |Final MD Scholar

 SPECIAL TESTS OF KNEE

PATTELLAR GLIDE TEST

A patellar glide test, also known as a patellar mobility test, assesses the
patella's ability to move smoothly and symmetrically in the femoral groove
during knee flexion and extension. The test can help evaluate instability,
tightness of the structures around the joint, and patellar tracking:
USE TO ASSESS

• Instability: The test can help evaluate patellofemoral instability.

• Tightness: The test can help assess the tightness of the structures around the
joint, especially if the patella has recently been dislocated. Minimal movement
may indicate tight structures, while too much movement may indicate torn or
damaged structures.
• Tracking: The test can help assess the patella's ability to track smoothly along
the femur during knee flexion and extension. The examiner looks for
abnormalities or restrictions in patellar movement, such as grinding or clicking
sounds.

TEST METHOD

To perform the test, a healthcare provider stands beside the patient and places
their fingers on both edges of the patella. They then gently glide the patella up
and down and to both sides. The provider may also ask the patient to contract
their quadriceps as if they are trying to extend the knee. The test should not be
painful, and the provider should stop immediately if there is pain.
PATELLAR TILT TEST

USE TO ASSESS

The patellar tilt test is a clinical exam that can help diagnose
patellofemoral pain syndrome (PFP).

TEST METHOD

During the test, the patient's knee is extended with their quadriceps
relaxed. The examiner then grasps the medial and lateral borders of
the patella and attempts to lift the lateral border without gliding it. If
the examiner is unable to lift the lateral border above the horizontal
plane, it may indicate a tight lateral retinaculum.
ANTERIOR DRAWER TEST

USE TO ASSESS

The anterior drawer test is a physical exam that helps healthcare

providers diagnose injuries to the anterior cruciate ligament (ACL) in
the knee.

METHOD OF TEST

1. The patient lies on their back with their knee bent to 90 degrees and their foot
in a neutral position.
2. The provider may sit on the patient's foot or have the patient stabilize their
foot with their hand or an assistant's hand.
3. The provider wraps their hands around the back of the patient's knee, places
their thumbs on the front of the kneecap, and gently pulls the knee forward.
4. The provider may also rotate the patient's foot in a different direction and pull
forward again.
If the patient's lower leg moves further away from their upper leg than
normal, the test indicates a positive result and a possible ACL injury.
However, the test may not be as accurate as other diagnostic options.
POSTERIOR DRAWER TEST

USE TO ASSESS

The posterior drawer test is a common exam that assesses the integrity
of the posterior cruciate ligament (PCL) in the knee. It's considered the
most accurate test for this purpose.

METHOD OF TEST

To perform the test, the patient lies supine with their hip flexed 45° and
knee flexed 90°. The examiner then:

1. Sits on the patient's foot to stabilize it

2. Places each hand on the proximal anterior tibia, with a thumb on
each joint line
3. Applies a gentle, firm posterior force to the proximal tibia.
4. Estimates the amount of posterior translation of the plateau .
A normal knee shouldn't show any noticeable increase in translation.
If there is, it could indicate a PCL injury. The test is considered positive if
the tibia translates more than six millimeters posteriorly, or if there's a lack
of end feel or excessive posterior translation.

VARUS STRESS TEST

USE TO ASSESS

The varus stress test is a method used to assess injuries to the lateral
collateral ligament (LCL) of the knee and the radial collateral ligament
(RCL) of the elbow. The test involves applying a varus force to the ankle
or elbow while lying on your back and lifting your limb slightly above your
body:

METHOD OF TEST

With the knee flexed at 20–30°, place one hand above the ankle to
stabilize it and the other hand on the medial side of the femur. Apply
lateral rotation and passive adduction to the knee joint to put stress on
the LCL. While holding the foot and ankle, apply a varus force to the
knee by pressing out, away from your body. Use your fingers to assess
for any gapping in the lateral joint line. If the LCL is intact, there
shouldn't be any increase in gapping at this angle.
A positive varus stress test can indicate a damaged collateral ligament.
The test is used to assess injuries to the lateral collateral ligament (LCL)
of the knee or the elbow.

A positive varus stress test at 0° of knee flexion is usually indicative of a

severe combined posterolateral corner and cruciate ligament injury.

VALGUS STRESS TEST

Purpose

The valgus stress test, also known as the medial stress test, is
used to assess the integrity of the medial collateral ligament (MCL) of
the knee. MCL injuries are common in the athletic population and can
occur as either isolated injuries, or combined with other structural
injuries .
Patient Position

• Begin with the patient in a supine position. Their leg should be

relaxed as this test is performed.

Performing the Test

• The examiner places one hand at the outside of the knee, acting as a
pivot point, while the other hand is placed at the foot. The medial
joint line is palpated while the examiner simultaneously applies an
abducting force at the the foot, and a valgus force through the knee
joint.
• This test is typically performed at both 30 and 0 degrees of knee
flexion. When performed at 30 degrees, the MCL is more isolated
from other medial joint structures, with a sensitivity of .86-.96 for
 MCL tears[2]. This can be followed by performing the second version
of the test, at 0 degrees of knee flexion, which allows for assessment
of other medial joint structures.

• The two versions are summarized below:

o Knee valgus @ 0° - Along with the MCL, the Medial Joint
Capsule of The Knee, anterior cruciate ligament (ACL), and the
posterior cruciate ligament (PCL) are stressed..
o Knee valgus @ 30° - The MCL is the prime stabilizer in this
position and is therefore the primary structure assessed. The
medial joint capsule is also stressed in this position .

Interpretation

• Positive findings may include excessive gapping at the medial

joint and/or pain, indicating MCL damage. This may also
indicate capsular or cruciate ligament laxity, depending on what
degree of knee flexion the test is performed at.
• It should be noted that some joint gapping is considered
normal at 30 degrees. No gapping should be present at 0
degrees.

LACHMAN TEST

The Lachman test is a physical exam that assesses the integrity of the
anterior cruciate ligament (ACL) in the knee.
It's considered a variation of the anterior drawer test and is often used to
diagnose ACL injuries.
The test is considered reliable and sensitive, and some studies say it's
more accurate than the anterior drawer test and pivot shift test.
METHOD OF TEST
To perform the test, the examiner:

1. Flexes the knee 20–30° .

2. Stabilizes the distal femur with one hand
3. Stabilizes the proximal tibia with the other hand
4. Gently translates the proximal tibia forward.

The Lachman test has a diagnostic accuracy of:

• Acute ACL ruptures

77.7% sensitivity and >95% specificity if the exam is within two
weeks of the injury
• Subacute/chronic ACL ruptures
84.6% sensitivity and >95% specificity if the exam is more than two
weeks after the injury

APPLYS GRINDING TEST

The Apley grind test, also known as the Apley compression test or the
Apley test, is a maneuver performed to evaluate meniscus injury.
Clinicians usually perform it in conjunction with the Apley distraction test,
which assesses for ligamentous injury
A positive patellar grind test, also known as Clarke's Test, indicates
patellofemoral joint disorders.

The test involves a healthcare provider pushing the kneecap inward or

downward while asking the patient to contract their quadriceps muscle.

A positive test result occurs when the patient experiences: Pain in the
patellofemoral joint, A grinding noise, Inability to contract the quadriceps
muscle while pressure is applied to the knee, and Retropatellar pain.

MCMURRAY’S TEST

Purpose

McMurray's test is used to determine the presence of a meniscal tear

within the knee.

Technique

• Patient Position: Supine lying with knee completely flexed.

• Examiners Position: on the side to be tested.
• Proximal Hand: holds the knee and palpates the joint line,
thumb on one side and fingers on the other
• Distal Hand: holds the sole of the foot and acts to support the
limb and provide the required movement through range.
• Procedure: From a position of maximal flexion, extend the knee
with internal rotation (IR) of the tibia and a VARUS stress, then
return to maximal flexion and extend the knee with external
rotation (ER) of the tibia and a VALGUS stress.

The IR of the tibia followed by extension, the examiner can test the
entire posterior horn to the middle segment of the meniscus. The
anterior portion of the meniscus is not easily tested because the
pressure to that part of the meniscus is not as great.
IR of the tibia + Varus stress = lateral meniscus

ER of the tibia + Valgus stress = medial meniscus

Positive findings

• Pain
• snapping
• audible clicking
• locking

any of these symptoms can indicate a compromised medial or lateral

meniscus.
PIVOT SHIFT TEST

The pivot shift is a dynamic test of knee stability, passively carried out
by the examiner.
The movement is a combination of axial load and valgus force, applied by
the examiner, during knee flexion from an extended position. When the test
is positive, it indicates an injury of the anterior cruciate ligament.

Purpose

The purpose of this test is to detect anterolateral rotary instability of

the knee. This test is used in chronic conditons and is positive when
the ACL is torn. The ALC can also be torn.

Technique

The following steps explain how the test is carried out:

1. The patient lies supine with legs relaxed.

2. The therapist presses against the head of the fibula with one
hand, and grasps the ankle with the other hand.
3. The lower leg is passively internally rotated, while the knee is
kept in full extension.
4. The hip is flexed to 30 degrees, while the knee is flexed.
5. A valgus force and axial load are applied to the knee at the
same time.
6. Upon damage to the ACL, there will be subluxation of the lateral
tibial plateau in the fully extended position.
7. When the knee is flexed between 20 o and 40o, the lateral tibial
plateau will reduce itself, and a palpable shift or clunk will be
noticed.
REVERSE PIVOT SHIFT TEST

• Elicited by bringing the knee from a position of 90° flexion, where it is

subluxed, to the
fully extended position under a valgus load and foot externally rotated,
where it reduces
• Jakob test is grossly positive in 3% and weakly positive in 8% of
normal knees
• This has been found to correlate with ligamentous laxity
• When the test is asymmetrical comparing to other side or reproduces
symptoms, indicates
posterolateral instability.
The reverse pivot shift test is an orthopedic test that assesses for
posterolateral rotation of the knee. It's also used to indicate a shift in the
lateral tibial plateau in the opposite direction of the true joint shift. The test
is performed as follows:

1. The patient lies supine

2. The knee is flexed to about 80–90°
3. A valgus and external rotation force is applied to the knee
4. The foot is placed in ER
5. The knee is extended from 90° flexion to full extension
6. The examiner feels for a palpable shift of the lateral tibial plateau .

A positive test result may indicate:

• Subluxation of the tibia posterolaterally

• Visible reduction of the tibia on the femur
• Reduction of the tibia by the iliotibial band
• Acute or chronic posterolateral instability of the knee
• The knee begins in flexion while an external rotation and valgus stress are
applied

Prepared By | Dr Anurag S R | Final PGD Scholar

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ANKLE JOINT
1. Stress test: For medial and lateral collateral ligament.
• Place the Ankle in neutral position
• Hold the lower leg firmly from by one hand.
• Hold the foot at about level of talus by opposite hand.
• For testing the lateral collateral ligament, invert the foot
and for testing of medial collateral ligament stress has to
be given in opposite direction.

2. Anterior Drawer test:

• Patient seated legs over table
• Stabilize distal tibia and fibula
• Apply anterior force to calcaneus.
• Positive sign: Pain and/ or laxity
• Indicating Anterior Talofibular ligament sprain.

3.Talar Tilt test :

 • With the ankle in the neutral position, gentle inversion
force is applied to the affected ankle, and the degree
of inversion is observed and compared with the
uninjured side
• It detects excessive ankle inversion.
• If the ligamentous tear extends posteriorly into the
calcaneofibular portion of the lateral ligament, the
lateral ankle is unstable and talar tilt occurs.

4. Thompson test : test for rupture of Achilles tendon.

• Prone position with feet projecting beyond examining
table
• Calf muscle squeezed .
• Normal or partial tear- Plantar flexion.
• Complete rupture – No movement of foot.

5.Homan’s sign: Test for Deep vein thrombophlebitis.

• Forcibly dorsiflex ankle with leg in extension.

 • Positive sign : Pain in calf region

Prepared By | Dr Archana V | First Year MD Scholar

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