Arch Pathologies
- Test for supple pes planus / Rigid pes planus (122)
o Compare between non-weight-bearing & weight-bearing positions
o (+) Supple pes planus – Medial longitudinal arch disappear
o (-) Windlass effect – Arch returns with toe raise
- Feiss’ line for Navicular Drop (104)
o Line from apex of medial malleolus & plantar aspect of 1st MTP joint
o (+) Hyperpronated foot – Navicular drops 2/3 or greater distance to floor
- Navicular Drop test (123)
o Navicular tuberosity of height in non-weight-bearing & weight-bearing
o (+) Hyperpronated foot – Navicular drops 10mm or greater
Tarsal Tunnel Syndrome
- Tinel’s Sign
o Posterior tibial nerve – Pain into foot and toes
Metatarsal / Phalanx Fracture
- Long Bone Compression Test (129)
Intermetatarsal Neuroma
- Pencil Test (131)
o Pressure to intermetatarsal space, compressing nerve ending
Metatarsalgia or Morton’s neuroma
- Morton’s test (460 A)
o Supinate foot, transverse pressure to heads of metatarsals, causing sharp pain in forefoot
Ankle and Lower Leg
Anterior Talofibular Ligament Instability
- Anterior Drawer test (158)
Calcaneofibular Ligament Instability
- Inversion Stress test (Talar Tilt test) (159)
Ankle Syndesmosis Instability (Torsion test)
- Kleiger’s test (External rotation test) (161)
o (+) Deltoid ligament involvement – Medial joint pain
o (+) Syndesmosis involvement – Pain in Anterolateral ankle at the site of distal tibiofibular syndesmosis
- Squeeze Test (166)
o (+) Fibula fracture – Pain along fibular shaft
o (+) Syndesmosis sprain – Pain at distal tibiofibular jiont
Deltoid Ligament Instability
- Eversion stress test (Talar Tilt test) (160)
- Kleiger’s test (External rotation test) (161)
Lower Leg Fractures
- Squeeze test (166)
Stress Fracture
- Bump test (Percussion test) (170)
Neurovascular Pathology
- Homan’s sign (Test for Deep Vein Thrombophlebitis) (181)
o Ultrasonic imaging is used to make definitive diagnosis
Achilles Tendon Pathology
- Thompson test (177)
Knee
Determination of intracapsular versus extracapsular swelling
- Sweep test (205)
o (+) Intracapsular swelling (ACL, Osteochondral fracture, Synovitis, Meniscal lesion, or Patellar dislocation)
- Ballotable patella (204)
ACL Instability
- Anterior drawer test (209)
- Lachman’s test (21)
o Knee passively flexed 20 ~25º
- Alternate Lachman’s test (212)
o Prone, knee passively flexed 30º
o (+) PCL sprain – (+) Anterior drawer test and/or Lachman’s test with (-) Alternate Lachman’s test
PCL Instability
- Posterior Drawer test
- Godfrey’s test (Posterior Sag Sign)
o Prone, hip and knee flex 90
MCL Instability
- Valgus Stress tests (215)
LCL Instability
- Varus Stress tests (216)
Proximal tibiofibular syndesmosis
- Tibiofibular Translation test (217)
o (+) Anterior fibular Shift - Proximal posterior tibiofibular ligament
o (+) Posterior Shift - Anterior tibiofibular ligament of proximal tibiofibular syndesmosis
Rotary knee instability
- Slocum (Drawer) test (224)
o Anterolateral instability - Internal 25º & Anterior drawer
§ (+) ACL, Anterolateral capsule, LCL, IT band, Popliteus tendon, Posterolateral capsule
o Anteromedial instability - External 15º & Anterior drawer
§ (+) MCL, Anteromedial capsule, ACL, posteomedial capsule
- Crossover test (225)
o (+) ALRI – Lateral capsular restraints – Step across and in front with uninvolved leg
o (+) AMRI – Medial capsular restraints - Step across and behind with uninvolved leg
- Lateral Pivot Shift test (226)
o Anterolateral knee instability - Hip flexed 30º knee flexed and internal rotation 20º
- Slocum Anterolateral Rotatory Instability (ALRI) test (227)
o Sidelying, valgus & 30-50º knee flexion
- Flexion-Reduction Drawer test (228)
o Anterolateral Rotatory instability - Knee flexed 25º & valgus
- External Rotation test (230)
o Posterolateral knee instability - Prone/Supine, Knee flexed 30º, external rotation, then knee flexed 90º
Meniscal tears
- McMurray’s test (231)
o Valgus & Internal rotation & Flexed
o Varus & External rotation & Extended
- Apley’s compression/Distraction tests (232)
Osteochondral Defects of knee
- Wilson’s test (234)
o Sitting, 90º Knee flexed, internal rotation, then extend knee
ITB friction syndrome
- Ober’s test (237)
o (+) Iliotibial band tightness - Sidelying, knee flex 90º
- Noble’s test (236)
o (+) Inflammation of IT band - Supine, knee flex 30º - Pain under the thumb
Patellofemoral Articulation
Patella Pathology
- Clarke’s Sign (253)
o (+) Chondromalacia Patella - Supine, full knee extend / Quad-set
- Patellar tile test (256)
o (+) Tightness of lateral restraints < 0º tilt
- Petellofemoral Grind test
- Petellofemoral Apprehension tests (261)
o (+) Subluxation/Dislocation patella - Move patella laterally
- Tinel’s Sign – Neuropathy of Infrapatella brach of sapherous nerve (Medial aspect of knee)
Synovial plica
- Test for Medial Synovial Plica (265)
o Knee flex 90º & Tibia internal rotation, Move patella medially, then knee full extend
- Stutter test for Medial Synovial Plica (266)
o Sitting, knee flex, cupping one hand over patella, extend knee
Pelvis and Thigh
Neurological Tests
- Sciatic nerve compression
- Femoral Nerve Stretch test – Nerve root impingement (L2~4) (stretch quads w/ knee flex 90)
- Lower quarter screen
Muscle weakness or tightness
- Thomas test for tightness of hip flexor (289)
- Trendelenburg’s test for Gluteus medius weakness (293)
o One leg stand with involved side
Degenerative hip changes
- Hip Scouring test (297)
o Articular cartilage of femur or acetabulum - Supine, full knee flex, rotate)
Piriformis syndrome
- Piriformis test (297)
o Resisted hip abduction with the patient seated to duplicate pain by Piriformis syndrome
Elbow
Ligamentous Tests
- Valgus Stress test – Sprain ulnar collateral ligament (Elbow flex 25, valgus force)
- Varus Stress test – Sprain radial collateral ligament (Elbow flex 25, varus force)
Elbow Sprains
- Posterolateral Rotatory Instability test
o GH and elbow flex 90, forearm full supinated
Epicondylitis
- Lateral Epicondylitis test – (Elbow flex 90, forearm pronated, fingers flex)
- Medial Epicondylitis test -
Nerve trauma
- Tinel’s Sign – Neuropathy (Ulnar or radial nerve)
Other
- Pronator Teres Syndrome
- Pinch Grip test
Forearm, Wrist, Hand
Ligamentous Tests
- Valgus Stress test – UCL (Elbow flex 90, forearm pronated)
- Varus Stress test - RCL (Elbow flex, forearm pronated)
- Glide test – Tear collateral or intercarpal ligaments or triangular fibrocartilage
Carpal Tunnel Syndrome
- Phalen’s test
o Wrist flex 90, together, hold 1 min
DeQuervain’s Syndrome
- Finkelstein’s test
o Tuck thumb, make fist
Shoulder
Thoracic outlet syndrome
- Adson’s Maneuver – (Check pulse, Elbow extend, turn neck)
- Allen test – (Check pulse, Elbow flex 90, turn neck opposite side)
- Military Brace Position – check pulse, elbow full extend, GH extend)
- Roo’s test
AC Instability
- Shear test
- Compression test – AC ligament & Coracoclavicular ligement
- AC Traction test – AC sprain or costoclavicular ligaments (Pull down humerus)
GH Instability
- Anterior Drawer test
- Posterior Drawer test
- Relocation test – (GH flex 90, elbow flex 90, push humeral head)
- Apprehension test -
- Clunk test -
- Sulcus Sign – (Pull down humerus)
- O’Brien test (Active Compression test)
– Superior labrum, anterior to posterior tear (GH 90 flex, internal & external rotation)
- GH translation (load and shift test)
- GH Glide test
– Ant. Coracohumeral ligament, superior and middle GH ligaments, anterior joint capulse, labral tear
- Post. Posterior joint capsule, labral tear
- Inf.-ant. Inferior joint capsule, superior GH ligament, cotachohumeral ligament
Shoulder Impingement
- Neer’s Impingement test – Rotator cuff/Long head of biceps brachii (flex & internal rotation)
- Hawkins Kennedy test – Rotator cuff/Long head of biceps brachii (90 flex & internal rotation)
Supinatus Muscle Weakness
- Drop Arm test
- Empty Can test – (30~45 in scapular plane)
Biceps Tendon
- Speed’s Test – Biceps brachii (Elbow extended)
- Yergason’s test – Subluxation of biceps tendon (Elbow flexed 90 & external rotation)
- Ludington’s test
o Hands on top of head w/ fingers interlocked, then compression shoulder)
Others
- Pec Major Contracture test
- Apley’s Scratch tests
- Gerber Lift-off test – Subscapularis weakness
Thoracic and Lumbar
Ligamentous tests
- Spring test for Facet joint mobility
o Prone, press spinous process
Neurological Tests
- Beever’s Sign – Thoracic nerve inhibition
o Hook-lying, partial sit-up
- Lower motor neuron lesions
o Upper quarter screen
o Lower quarter screen
- Sciatic nerve compression
Herniated disc
- Valsalva’s Maneuver
o (+) Herniated disc, tumor, or osteophyte
- Milgram test
o (+) Intervertebral disc to place pressure on lumbar nerve root
o Supine, full knee extend, 2-6 inches leg raise and hold 30 seconds
- Kernig’s Sign
o (+) Nerve root impingement - Supine, leg raise, then flex knee @ pain spot)
- Brudzin Sign test
o Menigeal irritation (Supine, hand cupped behind head, flex head to chest, leg raise, then flex knee)
- Well Straight Leg Raising test
- Quadrant test
o (+) Compression of intervertebral foramina - Standing, sidebend and rotates
Nerve Root Impingement
- Quadrant test
- Femoral Nerve (Stretch) Traction test
Sciatic Nerve Involvement
- Straight Leg Raise test – Sciatic nerve irritation (stretch hamstrings and calf 70)
- Slump test – Impingement of dural lining, spinal cord, or nerve roots (sitting, flex neck, extend knee)
- Tension Sign
o Supine, hip flex 90, knee flex 90, palpate tibial portion of sciatic nerve through Popliteal space
- Bowstring test “Cram test/Popliteal pressure test”
o Straight leg raising test + pressure on Popliteal fossa
Dural sheath irritation
- Kernig’s Sign
o (+) Nerve root impingement
- Brudzin Sign test
o Menigeal irritation (Supine, hand cupped behind head, flex head to chest, leg raise, then flex knee)
Spondylosis/Spondylolisthesis
- Single Leg Stance test – Spondylolysis or spondylolisthesis (One leg stand, hyperextend trunk)
Sacroiliac Joint Dysfunction
- Sacroiliac compression / Distraction test
- Patrick’s/FABER test – Sacroilic pathology (Supine, foot crossed over opposite side thigh)
- Gaenslen’s test – SI joint dysfunction (hip flexor stretch)
- Long Sit test – Rotated ilium (Supine, then sit – check the position of medial malleoli)
- Hoover Sign test – Malingering (Supine, release hand from involved side - leg raise naturally)
Cervical Spine
Upper motor neuron lesions
- Babinski’s Reflex test
o Plantar aspect of foot
- Oppenheim’s Gait test
o Crest of Anteromedial tibia
Lower motor neuron lesions
- Upper quarter screen
- Lower quarter screen
Brachial plexus pathology
- Brachial Tension test
o Stretch upper trapezius
Cervical nerve root impingement
- Shoulder Abduction test
o Hand on top of head – decrease symptoms
- Shoulder Depression test
- Distraction/Compression test
- Spurling’s test
o Extend and laterally bend, then compression cervical spine
- Vertebral artery test
o Occlusion of cervical vertebral arteries
o Extend and laterally flexes cervical spine for 30s – dizziness, confusion, nystagmus, unilateral pupil changes, nausea