Used to determine the presence of a sacroiliac and/or iliosacral dysfunction With the patient seated laying supine, physician will find the anterior superior iliac spines (ASIS), and physician will place their palm on top of the ASIS on both sides. The physician will then exert a posterior compressive force on each of […]
Category: Special Tests
57 posts
Used to assess for leg length discrepancy With the patient supine, the patient brings the knees so that they are equally flexed to 90 degrees with the hips at roughly 45 degrees of flexion If the heights vary, there may be a leg length discrepancy One leg more anterior on lateral view, […]
Used to determine is the state of the subclavian artery Steps: Patient is standing or seated Patient is instructed to abduct the shoulders to 90 degrees, externally rotate, and flex the elbows Instruct the patient to flex and extend their fingers for up to 3 minutes Physician watch for discoloration […]
Anatomy Function Quadricep muscles are hip flexors and knee extensors. Innervation The quadricep muscles are innervated by the femoral nerve (L2-L4). Prone Muscle Test Patient in prone with physician at side of table Monitor the pelvis at the PSIS so it does not rise Bring ankles toward the patient’s buttock, […]
Anatomy Function Hamstring muscles are hip extensors. Innervation The hamstring muscles are innervated by sciatic nerve (L5, S1-S2). Method One Patient supine with their hip flexed at a 90 degree angle and knee bent Attempt to straighten the knee out vertically with the hip still flexed at a 90 degrees […]
Overview Function Piriformis is a lateral/external rotator of the hip joint. Innervation Levels: L5, S1-S2 Sciatic nerve often runs through or behind the piriformis muscle Supine Muscle Testing Patient lies supine Grasp above the ankles bilaterally (important to grab above the ankle joint) Using the lower extremity, internally rotate each […]
A good mnemonic to remember: “Eating Fried Chicken makes ABs ADd Inches Definitely” Steps: Know the exact order! Shoulder extension with elbow flexed Doctors cephalad hand stabilizes the acromioclaviular + scapulothoracic joints to prevent their motion = isolates the glenohumeral joint Shoulder flexion with elbow extended Doctor continues to stabilize […]
“Costovertebral angle tenderness“ Used to assess for a pyelonephritis, kidney stone, or other kidney pathology With the patient seated and slightly flexed, a percussive force is applied to the back between T9-12 Positive with pain
Tests for gallbladder pathology Patient supine, examiner placed a hand beneath the right costal margin anterior at the midclavicular line and applies a force superiorly beneath the rib cage and into the gallblader. Patient is instructed to take a deep breath in, Positive sign is when the patient pauses during inspiration […]
Kernig’s Test With the patient supine, passively raise the leg with the knee extended Positive if patient is forced to flex head with leg raise Video Tutorial for Kernig’s Test: Brudzinski Test Patient supine, head is passively flexed Positive if patient flexes hips and knees with head flexion Video Tutorial […]
Clinical manifestation of hypocalcemia which creates a state of hyper-excitability (tetany) of the facial nerve With the patient seated, the examiner taps on the side of the face over the cheek Positive for involuntary wincing of the face with gentle tapping
•Use a firm object – scrape from calcaneal distal on the lateral side•Cross over at the ball of the foot Tests for Upper Motor Neuron Injury A positive test is when the toes flair cephalad and spread out. A negative test is when the toes curl towards plantar surface of the foot […]
•Tests for Upper Motor Neuron Patient’s hand is supported and relaxed with the wrist extended and the middle finger slightly flexed The middle finger is flicked from dorsal to volar Positive test = the thumb and index finger approximation as if the finger pads are going to touch
Test for adequate circulation of the arteries of the hand First the radial and ulnar arteries need to be palpated. Then, both arteries are blocked by the examiner applying sufficient pressure while the patient makes a fist. This forces all of the blood out of the hand. Next, the patient relaxes their […]
Tests for DeQuarvain Tenosynovitis Steps: Have the patient close their fingers around their thumb Doctors holds on patients hand to ulnar deviate the wrist to put a pull on the extensor pollicis brevis and abductor pollicis longus Test is considered to be positive if pain is reproduced indicating tenosynovitis
Used to test for impingement of the median nervein the carpal tunnel Phalen Test: Patient is instructed to place the dorsal surfaces of the hands together and fully flex the wrists. This position is to be held for 60 seconds or until numbness/tingling of the hand(s) is felt, whichever is shorter Reverse […]
Used to assess for neuropathy or median nerve compression In the hand, the wrist is passively extended, and a tapping force is applied directly over the flexor retinaculum Test is considered to be positive if pain or paresthesias are reproduced within the median nerve distribution May be used in other areas of […]
Used to assess for neuropathy or nerve compression Test is performed by forcefully tapping at the cubital tunnel between the medial epicondyle of the humerus and the olecranon. Positive if symptoms of pain or paresthesias are reproduced in the ulnar nerve distribution.
Used to determine is the state of the subclavian artery Steps: The test is considered to be positive if the radial pulse weakens or fades completely. Positive test indicates there is compression of subclavian artery (Arterial component of Thoracic Outlet Syndrome) Video Tutorial:
Used to assess for acromioclavicular joint pathology Steps Physician passively places the arm into 90 degrees of forward flexion and adducts the arm until fully adducted across the chest with monitoring the AC joint with the other hand. The examiner may then gently add additional medially direcected force to further stress the […]
Used to determine labral, acromioclavicular (AC), or other anterior shoulder pathology Steps: Part one: Patient forward flexes the arm with the elbow extended. The patient then internally rotates the arm so THE THUMB IS POINTING DOWN. The patient then adducts the arm 5-10 degrees and resists the downward force applied by the […]
Used to determine active range of motion of the shoulder Steps: Patient may be seated or standing Ask the patient to first reach behind their back to try and reach the opposite shoulder 2. Next, have the patient reach across their chest to grab the other shoulder from the front. 3. […]
Used to detect tears in the rotator cuff muscles, particularly the supraspinatus Steps: Option 1 Patient fully abducts the arm, then is instructed to slowly lower the arm Test is considered to be positive if: patient’s arm with drop suddenly during the lowering of the arm (adduction back to the midline). Option […]
Used to assess whether or not the biceps tendon is stable within the groove, as well as for the presence of biceps tendinopathies Steps: Patient flexes the elbow to 90 degrees Examiner holds the elbow of the arm being tested in one hand, and with the other the physician externally rotates the arm and […]
Used to test for biceps tendinopathy Steps: Test is considered to be positive with pain at the shoulder/biceps tendon Video Tutorial:
Used to determine the integrity of the supraspinatus tendon Steps: Patient seated, physician standing Physician flexes patient’s shoulder and elbow 90° Physician internally rotates shoulder making sure it remains straight Test is considered to be positive if: pain upon internal rotation – indicates shoulder impingement
Used to test for supraspinatus or biceps brachii impingement Steps: With the patient’s arm forward flexed to 90 degrees and internally rotated so that the thumb is pointing downward, the examiner instructs the patient to continue flexion up toward the ceiling against physician resistance. Test is considered to be positive if: […]
A good mnemonic to remember: Feeling Extra Cold Today In Erie, Better ADd layers!” (note: Better is to remind you to ABduct before you ADduct!) Steps: Done in the specific order. Flexion (120°) Extension (30°) + support hip on other side Circumduction with compression: small circles → big circles (Counter-clockwise […]
Used to test the sciatic nerve for inflammation vs radicular pain or hamstring hypertonicity Begin with the patient supine, the leg is passively raised with the knee in full extension until the pain is reproduced. Pain in lower back indicates lumbar radiculopathy Continue by lowering the leg by approx 10 degrees, and […]
Used to determine if a sacral diagnosis is flexed or extended With the patient prone, the examiner monitors the sacral sulci while instructing the patient to extend by “getting up on your elbows like you’re going to watch tv.” Test is considered to be positive if the sulci do not even out, or if […]
Used to evaluate hypertonicity of the iliopsoas Begin with the patient supine, the patient takes both legs and passively flexes the knees and hip to flatten the lumbar lordosis. Remember to watch for increased lumbar lordosis (should not have this because it’s compensatory) – monitor this with placing your hand below […]
Used to test for hypertonicity of the quadriceps muscle, specifically the rectus femoris Similar to the Thomas Test, however this test is performed at the edge of the table Patient supine with gluteal crease near the edge of the table Have patient bring both knees to chest then let one leg […]
Used to assess for hypertonicity of the iliotibial band Begin with patient in the lateral decubitus position, passively abducted the leg with the knee flexed to 90 degrees while keeping hip joint in neutral position The leg is then released from abduction, while still supporting the calf/ankle – hold onto the […]
Used to test for chronic anterior shoulder instability Steps: The examiner stands behind the patient and with one hand places the patient’s arm into abduction and external rotation. With the other hand the patient contacts the posterior shoulder and pushes anterior Test is considered to be positive if: the patient reports pain or a feeling of impending dislocation
Used to determine weakness of the Serratus Anterior Serratus Anterior Innervation: Long thoracic nerve, C5-7 Steps: Examiner instructs patient to place their hands at chest height against a wall and to push forward Test is considered to be Positive if scapula lifts off of the thoracic cage
Used to determine the laterality of somatic dysfunction of the hip joint With the patient prone, the knee is passively flexed to 90 degrees and the hip abducted to 30-45 degrees. With the other hand, an anterior and slightly superior force is directed from just posterior to the greater trochanter, compressing the femoral head into the acetabulum Positive for […]
Evaluates gluteus medius Begin with the patient standing in front of you in normal stance, observe PSIS dimples and pelvic height Ask patient to raise one leg and observe dimples/pelvis A drop in height on the side of the lifted leg indicates a positive test for a weak gluteus medius of the stance leg […]
Used to detect somatic dysfunction of either the hip or the sacroiliac joint With the patient supine, the hip is flexed, abducted, and externally rotated. A posterior force is then placed on the ipsilateral knee and contralateral ASIS Test is considered to be positive if there is pain at the hip or SI joint
Used to assess for leg length discrepancy With the patient supine, the patient brings the knees so that they are equally flexed to 90 degrees with the hips at roughly 45 degrees of flexion If the heights vary, there may be a leg length discrepancy One leg more anterior on lateral view, […]
Used to assess for presence of an effusion (excess fluid) in the knee joint With the patient supine, the examiner passively flexes the leg being tested and lifts the ankle up off of the table. The examiner than releases the upper portion of the leg, allowing the knee to extend. Test is considered to be […]
Used to test for issues with patellar tracking or chondromalacia Doctor applies a compressive force to the proximal patella moving it into the trochlear groove. The patient is then instructed to activate the quadriceps muscle by contracting their quadriceps Test is considered to be positive when pain, crepitus, or grinding occurs
Used to differentiate the cause of knee pain between ligamentous and meniscus causes Compression: With the patient prone, flex the knee to 90 degrees, apply a moderate force to the knee into the table and internally and externally rotate If positive (pain produced) then there is either a ligamentous OR a meniscal cause Distraction: Hold the thigh […]
The object of this testing is to assess motion and note which motion the sacrum moves more freely in Hands on sacrum with fingers pointing cephalad and the heel of your hand on the sacral apex. Apply alternating pressure with tips of fingers and heel of the hand Each Transverse […]
With one hand, place one finger on the posterior superior iliac spine (PSIS) and another in the ipsilateral sacral sulcus The heel of your other hand goes on the contralateral inferior lateral angle (ILA) Press down on the ILA while feeling for posterior motion using index and middle fingers The […]
Used to determine whether the sacrum has developed a flexion or extension dysfunction Have patient lie prone and find the lumbosacral junction. Find L4 at the level of the iliac crests. Move down to just past L5 but remain cephalad to sacral base – this is the lumbosacral junction (BETWEEN the lumbar and […]
Purpose Assess for ligamentous laxity in the medial and lateral collateral ligaments of the knee Varus: Lateral Collateral Ligaments With the knee slightly flexed, stabilize the distal lower limb and apply a varus force to the knee, causing a stress to the LCL Positive Test = excessive gapping of the joint space Valgus: Medial […]
Used to assess for tears in the meniscus Positive Test = clicking (pain) Medial Meniscus: Externally rotate tibia Apply valgus stress Bring knee into extension Lateral Meniscus: Internally rotate tibia Apply varus stress Bring knee into extension
Used to assess the integrity of the Anterior Cruciate Ligament (ACL) Similar to the anterior drawer test but more sensitive – removes the hamstrings as a factor Patient is supine, knee flexed to 30 degrees – the flexion at 30 degrees is what removes the hamstrings as a factor in the test Physician places one hand around […]
Purpose Assess the integrity of the Posterior Cruciate Ligament (PCL) Steps The patient is supine and the knee flexed to 90 degrees For extra stability, doctor may stabilize the foot by sitting on it Apply a posteriorly directed force with one or both hands to the tibial portion of the knee Test is considered to be positive with […]
