Special Tests Outline PDF

Special Tests Outline By: Rosa Padilla Shoulder Anterior Shoulder Apprehension Test PURPOSE- Identify past anterior dislocation of shoulder. DESCRIPTION- Patient supine, the examiner abducts the arm to 90° and laterally rotates the patient’s shoulder slowly. By placing a hand under the glen...

Special Tests Outline By: Rosa Padilla Shoulder Anterior Shoulder Apprehension Test PURPOSE- Identify past anterior dislocation of shoulder. DESCRIPTION- Patient supine, the examiner abducts the arm to 90° and laterally rotates the patient’s shoulder slowly. By placing a hand under the glenohumeral joint to act as a fulcrum, the apprehension test becomes the fulcrum test. POSITIVE RESULT- Patient does not allow or does not like to move shoulder into that direction to simulate anterior dislocation.  Posterior Shoulder Apprehension Test PURPOSE- To identify past history of posterior shoulder dislocation. DESCRIPTION- Patient supine/sitting. The examiner elevates the patient’s shoulder to 90°of flexion and medial rotation while stabilizing the scapula with the other hand, then applies a posterior force on the patient’s elbow. POSITIVE RESULT- Patient does not allow or does not like to move shoulder into that direction to simulate posterior dislocation.  Speed’s Test PURPOSE- Identify bicipital tendinosis/tendinopathy. DESCRIPTION- The patient is positioned in sitting or standing with the elbow extended, and forearm supinated. The therapist resists active shoulder flexion. POSITIVE RESULT- Pain in long head of biceps tendon/ increased tenderness in the bicipital groove.  Yergason’s Test PURPOSE- Integrity of transverse ligament. DESCRIPTION- Patient sitting with elbow flexed to 90° and stabilized against the thorax and with the forearm pronated. Resist the supination of forearm and external rotation of shoulder. POSITIVE RESULT- Tendon of long head of biceps will pop out of the groove. Tenderness in the bicipital groove alone without the dislocation may indicate bicipital tendonitis.  Drop Arm Test (Codman’s test.) PURPOSE- Identify tear/full rupture of rotator cuff. DESCRIPTION- The patient is positioned in sitting or standing, examiner abducts the patient’s shoulder to 90° and then asks the patient to slowly lower the arm to their side. POSITIVE RESULT- A positive test is indicated if the patient is unable to return the arm to the side slowly or has severe pain when attempting to do so. Hawkins-Kennedy Impingement Test PURPOSE: Identify shoulder impingement involving the supraspinatus tendon. DESCRIPTION: The patient is positioned in sitting or standing. The therapist flexes the patient's shoulder to 90° and then medially rotates the arm. POSITIVE RESULT: Pain indicates a positive test involving the supraspinatus tendon.  Infraspinatus Test PURPOSE: Identify infraspinatus tendon sprain/tear. DESCRIPTION: The patient stands with their elbow flexed to 90° and the shoulder in 45° of medial rotation. The patient then resists as the therapist applies a medially directed force to the forearm. POSITIVE RESULT: Pain or weakness indicates the presence of an infraspinatus tendon sprain/tear.  Neer Impingement Test PURPOSE- For impingement of supraspinatus tendon. DESCRIPTION- The patient is positioned in sitting or standing. The therapist positions one hand on the posterior aspect of the patient’s scapula and the other hand stabilizing the elbow. The therapist elevates the patient’s arm through flexion. POSITIVE RESULT- Facial grimace or reproduces symptoms of pain in the shoulder region.  Empty Can (Supraspinatus Test) PURPOSE- Identify tear/ impingement of supraspinatus tendon or suprascapular nerve neuropathy. DESCRIPTION- The patient is positioned with the arm abducted to 90° followed by 30° of horizontal adduction with the thumb pointing downward. The therapist resist the patient’s attempt to abduct the arm. POSITIVE RESULT- Reproduces pain in supraspinatus tendon or weakness in empty can position.  Adson Maneuver PURPOSE- Identify pathology of structures that pass through thoracic outlet. DESCRIPTION-The examiner locates the radial pulse. The patient’s head is rotated to face the test shoulder. The patient then extends the head while the examiner laterally rotates and extends the patient’s shoulder. POSITIVE RESULT- An absent or diminished radial pulse may indicate thoracic outlet syndrome.  Allen Test PURPOSE- Identify pathology of structures that pass through thoracic outlet. DESCRIPTION-The patient is positioned in sitting or standing with the test arm in 90° abduction, lateral rotation, and elbow flexion. The patient is asked to rotate the head away from the test shoulder while the therapist monitors the radial pulse. POSITIVE RESULT- An absent or diminished radial pulse may indicate thoracic outlet syndrome.  Roos Test PURPOSE- Identify pathology of structures that pass through thoracic outlet. DESCRIPTION- The patient is positioned in sitting or standing with the arms positioned in 90° of abduction, lateral rotation, and elbow flexion. The patient is asked to open and close their hands slowly for 3 minutes. POSITIVE RESULT- Inability to maintain the test position, ischemic pain, weakness of the arm, or sensory loss is considered positive for thoracic outlet syndrome on the affected side. Elbow, Wrist/Hand  Valgus Stress Test PURPOSE- To identify ligament laxity or restriction of the medial collateral ligament. DESCRIPTION- Patient sitting with the elbow placed in 20° to 30° of flexion. The therapist places one hand on the elbow and the other hand proximal to the patient’s wrist. The therapist applies a valgus force to test the medial collateral ligament while palpating the medial joint line. POSITIVE RESULT- Indicative by increased laxity, apprehension or pain in the MCL when compared to the contralateral limb.  Varus Stress Test PURPOSE- To identify ligament laxity or restriction of the lateral collateral ligament. DESCRIPTION- Patient sitting with the elbow placed in 20° to 30° of flexion. The therapist places one hand on the elbow and the other hand proximal to the patient’s wrist. The therapist applies a varus force to test the lateral collateral ligament while palpating the lateral joint line. POSITIVE RESULT- Indicative by increased laxity, apprehension or pain in the LCL when compared to the contralateral limb.  Cozen’s Test ( A.K.A Tennis Elbow Test) PURPOSE- Identify lateral epicondylitis. DESCRIPTION- The patient is sitting with elbow in slight flexion then asked to actively make a fist, pronate the forearm, and radially deviate and extend the wrist while the therapist resists the motion. POSITIVE RESULT- Sudden severe pain in the area of the lateral epicondyle of the humerus.  Lateral Epicondylitis Test PURPOSE- Identify lateral epicondylitis. DESCRIPTION- The patient is sitting. The therapist stabilizes the elbow with one hand and places the other hand on the dorsal aspect of the patient’s hand distal to the proximal interphalangeal joint. The patient is asked to extend the third digit against resistance. POSITIVE RESULT- Indicative by pain in the lateral epicondyle region or muscle weakness.  Medial Epicondylitis Test PURPOSE- Identify medial epicondylitis (Golfer’s elbow test). DESCRIPTION- While the therapist palpates the patient’s medial epicondyle, the patient’s forearm is passively supinated and the examiner extends the elbow and wrist. POSITIVE RESULT- A positive sign is indicated by pain over the medial epicondyle of the humerus.  Tinel’s Sign PURPOSE- Identifies median nerve compression. DESCRIPTION- The patient is positioned in sitting or standing. The therapist taps over the volar aspect of the patient’s wrist. POSITIVE RESULT- Indicated by a tingling sensation in the thumb, index finger, middle finger, and the lateral half of the ring finger distal to the contact site at the wrist. May be indicative of carpal tunnel syndrome due to median nerve compression. Ulnar Collateral Ligament Instability Test PURPOSE- Identifies tear in ulnar collateral ligament. Also refereed to as a gamekeeper’s or skier’s thumb. DESCRIPTION- The patient is positioned in sitting. The therapist holds the patient’s thumb in extension and applies the valgus force to the metacarpophalangeal joint of the thumb. POSITIVE RESULT- Indicated by an excessive valgus movement and mya be indicative of a tear of the ulnar collateral and accessory collateral ligaments.  Allen Test PURPOSE- To identify vascular compromise. DESCRIPTION- The patient is asked to open and close the hand several times as quickly as possible and then squeeze the hand tightly. The examiner’s thumb and index finger are placed over the radial and ulnar arteries, compressing them. The patient then opens the hand while pressure is maintained over the arteries. One artery is tested by releasing the pressure over that artery to see if the hand flushes. The other artery is then tested in a similar fashion. POSITIVE RESULT- Indicated by delayed or absent flushing of the radial or ulnar half of the hand and mya be indicative of an occlusion in the radial or ulnar artery.  Capillary Refill Test PURPOSE- To identify impaired perfusion to the extremities. DESCRIPTION- Apply pressure over the nail bed or bony prominence until the nail or skin blanches. Release the pressure, observe the time for the nail or skin to regain its full color. Normal- full color returns in 2 seconds; indicates capillary blood flow compromised (i.e. arterial occlusion, hypovolemic shock, hypothermia).  Froment’s Sign PURPOSE- Identify ulnar nerve dysfunction. DESCRIPTION- The patient attempts to grasp a piece of paper between the thumb and index finger. The therapist attempts to pull the paper away from the patient. POSITIVE RESULT- Indicated by the patient flexing the distal phalanx of the thumb due to adductor pollicis muscle paralysis. If, at the same time, the patient hyperextends the metacarpophalangeal joint of thumb, it is termed as a positive Jeanne’s sign. Both tests, if positive, are indicative of ulnar nerve compromise or paralysis.  Phalen’s Test PURPOSE- Identify carpal tunnel syndrome due to compression of median nerve. DESCRIPTION- The patient is sitting or standing. The therapist flexes the patient’s wrists maximally and asks the patient to hold this position for 60 seconds. POSITIVE RESULT- Indicative by tingling in the thumb, index, middle, and the lateral half of the ring finger.  Finkelstein Test PURPOSE- Determine the presence of de Quervain’s disease, a tenosynovitis in the thumb. DESCRIPTION- The patient makes a fist with the thumb inside the fingers. The therapist stabilizes the patient’s forearm and ulnarly deviates the wrist. POSITIVE RESULT- Pain over the abductor pollicis longus and extensor pollicis brevis tendons at the wrist and is indicative of a tenosynovitis in the thumb (de Quervain’s disease). Hip  Ely’s Test PURPOSE- To identify tightness of rectus femoris. DESCRIPTION- The patient lies prone, and the examiner passively flexes the patient’s knee. POSITIVE RESULT- On flexion of the knee, the patient’s hip on the same side spontaneously flexes, indicating that the rectus femoris muscle is tight on that side and that the test is positive.  Ober’s Test PURPOSE- To identify tightness of TFL/IT band. DESCRIPTION- The patient is in the side lying position with the lower leg flexed at the hip and knee for stability. The therapist moves the test leg into hip extension and abduction and then attempts to slowly lower the test leg. POSITIVE RESULT- If a contracture is present, the leg remains abducted and does not fall to the table.  Piriformis Test PURPOSE- Identifies piriformis syndrome. DESCRIPTION- The patient is in the side lying position with the test leg positioned toward the ceiling and the hip flexed to 60°. The therapist stabilizes the hip with one hand and applies a downward pressure to the knee. POSITIVE RESULT- If the piriformis muscle is tight, pain is elicited in the muscle. If the piriformis muscle is pinching the sciatic nerve, pain results in the buttock and sciatica may be experienced by the patient.  Thomas Test PURPOSE- Identifies tightness of hip flexors. DESCRIPTION- The patient lies supine with the legs fully extended. The patient is asked to bring one of their knees to the chest in order to flatten the lumbar spine. The therapist observes the position of the contralateral hip while the patients holds the flexed hip. POSITIVE RESULT- If a contracture is present, the patient’s straight leg rises off the table and a muscle stretch end feel will be felt.  Tripod Sign PURPOSE- Identifies tightness of hamstring muscle. DESCRIPTION- The patient is seated with both knees flexed to 90° over the edge of the examining table. The examiner then passively extends one knee. If the hamstring muscles on that side are tight, the patient extends the trunk to relieve the tension in the hamstring muscles. The leg is returned to its starting position, and the other leg is tested and compared with the first side. POSITIVE RESULT- Extension of the spine is indicative of a positive test.  90-90 Straight Leg Raise Test PURPOSE- Identify hamstring tightness. DESCRIPTION- The patient is in supine with both hips flexed to 90° while the knees are bent. The patient actively extends each knee in turn as much as possible while maintaining the hips in 90° of flexion. POSITIVE RESULT- Indicative by the knee remaining in 20° or more of flexion.  Craig’s Test PURPOSE- It is used to identify abnormal femoral anteversion. DESCRIPTION- The patient lies prone with the knee flexed to 90°. The examiner palpates the posterior aspect of the greater trochanter of the femur. The hip is then passively rotated medially and laterally until the greater trochanter is parallel with the examining table or reaches its most lateral position. POSITIVE RESULT- The degree of anteversion can then be estimated by the angle formed by the lower leg with the perpendicular axis of the table. Normal anteversion for an adult is 8-15°.  Patrick’s Test (FABER Test) PURPOSE- Identify hip dysfunction, such as mobility restriction. DESCRIPTION- Patient lies supine. Passively flex, abduct and externally rotate hip test leg so that the foot of the test leg is on top of the knee of the opposite leg. Slowly lowers the knee of the test leg toward the examining table. POSITIVE RESULT- Indicative by failure of the test leg to abduct below the level of the opposite leg and may be indicative of iliopsoas, sacroiliac or hip joint abnormalities.  Trendelenburg Test PURPOSE- To identify weakness of gluteus medius or unstable hip joint. DESCRIPTION- The patient is asked to stand on one leg for approximately 10 seconds. POSITIVE RESULT- If the pelvis on the opposite side (non- stance side) drops when the patient stands on the affected leg, a positive test is indicated. Knee  Anterior Drawer Test PURPOSE- Indicates integrity of ACL. DESCRIPTION- The patient lies supine with the knee flexed to 90° and the hip flexed to 45°. The therapist stabilizes the lower leg by sitting on the forefoot. The therapist grasp the patient's proximal tibia with two hands, places their thumbs on the tibial plateau, and administers an anterior directed force to the tibia on the femur. POSITIVE RESULT- Indicative by excessive anterior translation of the tibia on the femur with a diminished or absent end-point.  Lachman Test PURPOSE- Indicates integrity of ACL. DESCRIPTION- The patient lies supine with the knee flexed to 20- 30°. The therapist stabilizes the distal femur with one hand and places the other hand on the proximal tibia. The therapist applies an anterior directed force to the tibia on the femur. POSITIVE RESULT- Indicative by excessive anterior translation of the tibia on the femur with a diminished or absent end-point.  Lateral Pivot Shift Test PURPOSE- Indicates ACL integrity. DESCRIPTION- The patient lies in the supine with the hip flexed and abducted to 30° with slight medial rotation. The therapist grasp the leg with one hand and places the other hand over the lateral surface of the proximal tibia. The therapist medially rotates the tibia and applies a valgus force to the knee while the knee is slowly flexed. Positive Test- Indicative by palpable shift or clunk of occurring between 20- 40° of flexion.  Posterior Drawer Test PURPOSE- Indicates integrity of PCL. DESCRIPTION- Patient laying in supine with testing hip flexed to 45° and knee flexed to 90°. The therapist stabilizes the lower leg by sitting on the forefoot. The therapist grasps the patient’s proximal tibia with two hands, places their thumbs on the tibial plateau, and administers a posterior directed force to the tibia on the femur. POSITIVE RESULT- Excess posterior translation of the tibia on the femur with diminished or absent end-point.  Posterior Sag Sign PURPOSE- Indicates PCL integrity. DESCRIPTION- The patient lies supine with the hip flexed to 45° and the knee flexed to 90°. POSITIVE RESULT- Indicative by the tibia sagging back on the femur.  Valgus Stress Test PURPOSE- To identify ligament laxity or restriction of the MCL. DESCRIPTION- Patient in supine with the knee flexed to 20-30°. The therapist positions one hand on the medial surface of the patient’s ankle and the other hand on the lateral surface of the knee. The therapist applies a valgus force to the knee with the distal hand. POSITIVE RESULT- Indicative by excessive valgus movement and may be indicative of a medial collateral ligament sprain.  Varus Stress Test PURPOSE- To identify ligament laxity or restriction of the LCL. DESCRIPTION- Patient in supine with the knee flexed to 20-30°. The therapist positions one hand on the lateral surface of the patient’s ankle and the other hand on the medial surface of the knee. The therapist applies a varus force to the knee with the distal hand. POSITIVE RESULT- Indicative by excessive varus movement and may be indicative of a lateral collateral ligament sprain.  Apley’s Compression Test PURPOSE- Help differentiate between meniscal tears and ligamentous lesion. DESCRIPTION- The patient lies in the prone position with the knee flexed to 90°. The therapist stabilizes the patient’s femur with one hand and places the other hand on the patient’s heel. The therapist medially and laterally rotates the tibia while applying a compressive force through the tibia. POSITIVE RESULT- Indicative by pain or clicking and may be indicative of a meniscal lesion.  McMurray Test PURPOSE- Identify posterior meniscal tears. DESCRIPTION- The patient lies in the supine with the knee completely flexed (the heel to the buttock). The examiner then medially rotates the tibia and extends the knee. The therapist repeats the same procedure while laterally rotating the tibia. POSITIVE RESULT- Indicative by a click or pronounced crepitation felt over the joint line and may be indicative of a posterior meniscal tear.  Brush Test PURPOSE- Identify effusion in the knee. DISCRIPTION- Patient is in supine. The therapist places on hand below the joint line on the medial surface of the patella and strokes proximally with the palm and the fingers as far as the suprapatellar pouch. The other hand then strokes down the lateral surface of the patella. POSITIVE RESULT- Indicated by a wave of fluid just below the medial distal border of the patella.  Patellar Tap Test PURPOSE- Indicates infrapatellar effusion. DESCRIPTION- With the patient’s knee extended or flexed to discomfort, the examiner applies a slight tap or pressure over the patella. POSITIVE RESULT- Indicated if the patella appears to be floating. Ankle  Anterior Drawer Test PURPOSE- Identify ligamentous instability (particularly anterior talofibular ligament). DESCRIPTION- The patient lies supine while the therapist stabilizes the distal tibia and fibula with one hand, while the other hand holds the foot in 20° of plantar flexion and draws the talus forward in the ankle mortise. POSITIVE RESULT- If talus has excessive anterior glide/pain is noted.  Talar Tilt Test PURPOSE- To identify instability of calcaneofibular ligament. DESCRIPTION- The patient lies in side lying with the knee flexed to 90°. The therapist stabilizes the distal tibia with one hand while grasping the talus with the other hand. The foot is maintained in neutral position. The therapist tilts the talus into inversion and eversion. POSITIVE RESULT- Inversion tests the calcaneofibular ligament. Eversion stresses the deltoid ligament.  Homan’s Sign PURPOSE- To identify DVT in LE. DESCRIPTION- Passively dorsiflex the foot at the ankle with the knee straight. POSITIVE RESULT- Indicative for deep vein thrombosis if the maneuver produces pain in the calf or popliteal space.  Thompson Test PURPOSE- Evaluates integrity of Achilles tendon. DESCRIPTION- The patient lies prone with the feet over the edge of the table. While the patient is relaxed, the therapist squeezes the belly of the gastrocnemius and soleus muscles. POSITIVE RESULT- The absence of plantar flexion when the muscle is squeezed indicates a positive test and a ruptured Achilles tendon.  True Leg Length Discrepancy Test PURPOSE- Evaluates leg length. DESCRIPTION- The patient is supine with the hips and knees extended, the legs 15 to 20 cm apart, and the pelvis in balance with the legs. Using a tape measure, the therapist measures from the distal point of the anterior superior iliac spines to the distal point of the medial malleoli. POSITIVE RESULT- Indicated by a bilateral variation of greater than one centimeter and may be indicative of a true leg length discrepancy.