-
Bakody Sign
- Pt seated
- Dr grabs pt wrist and raises arm slowly and places on top of pt head
- Dr asks pt to repeat the maneuver actively
- Classical response: Relief of pain in the arm
- Classical Importance: Reduction of nerve root tractioning
- Bilateral
-
Distraction test
- Pt seated
- Dr places thumbs on occiput and hands in front of pt ears and axially distracts upwards
- Classical response: Relief of radicular pain
- Classical Importance: Removal of discal pressure
- Midline
-
Jackson's compression test
- Pt seated
- Dr behind laterally flexes pt head and compresses along plane of cervical articular pillar
- Classical response: Increase in radicular pain on side of lateral flexion
- Classical Importance: IVF encroachment
- Bilateral
-
Maximum Foraminal Compression Test
- Pt seated
- Dr tells pt to laterally flex head, rotate towards side of lateral flexion, and then extend
- Classical response: Increase in radicular pain on side of lateral flexion
- Classical Importance: IVF encroachment
- Bilateral
-
Shoulder Depression Test
- Pt seated
- From behind Dr laterally flexes pt head to one side and depresses the opposite shoulder
- Classical response: Increase in radicular pain
- Classical Importance: Adhesions of the dural sleeve are aggravated
- Bilateral
-
Valsalva maneuver
- Pt seated
- Dr instructs pt to put thumb in mouth, take & hold deep breath, puff out cheeks and try to blow the thumb out
- Classical response: Increase in radicular pain
- Classical Importance: Discal disease due to increased intrathecal pressure
- Midline
-
Adson's Test
- Pt seated
- Dr notes radial pulse while abducting and extending pt arm. Dr tells pt to rotate head towards arm, take a deep breath and hold it for 10 seconds and extend their head
- Classical response: Dampening of the radial pulse
- Classical Importance: Anterior scalene TOS
-
Eden's Test
- Pt standing
- Dr notes amplitude of radial pulse and tells pt to bring their shoulder backwards and down
- Classical response: Dampening in radial pulse
- Classical Importance: Costoclavicular TOS
- Bilateral
-
Wright's Hyperabduction Test
- Pt seated
- Dr notes amplitude of radial pulse, extends and abducts arm 120 degrees
- Classical response: Dampening of radial pulse
- Classical Importance: Pectoralis minor compression TOS
- Simultaneous
-
Mills Test
- Pt seated
- Dr palpates lateral epicondyle and tells pt to do the following in one smooth motion: Flex the elbow, flex the wrist, pronate the wrist, point index finger, then extend elbow
- Classical response: Pain in the lateral epicondyle
- Classical Importance: lateral epicondylitis
- Bilateral
-
Adam's position
- Pt standing
- Dr observes back of pt for evidence of scoliosis (rib humping, high shoulder, winged scap)
- Dr tells pt to bend forward at waist & reexamines for any changes
- Classical response: Reduction of scoliosis
- Classical Importance: Functional scoliosis
- Midline
-
Murphy's punch test
- Pt seated
- Dr stands opp to side tested and delivers 3 short choppy blows to Dr's hand on pt flank
- Classical response: Increase in lancinating pain from flank into groin
- Classical Importance: kidney inflammation
- Bilateral
-
Lasegue's Straight Leg Raise
- Pt supine
- Dr places hand under pt ankle and other hand on pt knee (affected leg). Dr raises leg to 90 degrees or to point of symptoms
- Classical Response: Dr notes type of pain and degree of angulation
- Classical Importance: Increase in sciatic radiculopathy from 0-30 degrees means Sacroiliac lesion, 30-60 degrees means lumbosacral lesion and above 60 degrees means lumbar lesion
- Unilateral
-
Braggard's Test
- *only performed if significant SLR
- Pt supine
- Dr performs SLR to pt's classical signs, lowers it 5 degrees and then dorsiflexes ankle
- Classical response: Increase in sciatic radiculopathy
- Classical Importance: stretching of the sciatic nerve is aggrevative
- Unilateral
-
Fajersztajn's Test
- Pt supine
- Dr raises UNAFFECTED leg to point of pain on contralateral side, lowers leg 5 degrees and then dorsiflexes the ankle
- Classical Response: Increase in sciatic radiculopathy down affected leg
- Classical Importance: Irritation of sciatic nerve d/t an inflamed disc by tractioning the nerve due to pelvic rotation
- Unilateral
-
Double leg raise
- Pt supine
- Dr performs SLR on each side noting the degree when symptoms appear. Dr then lifts both legs to the point of symptoms and again notes the degree
- Classical Response: Pain at a lower level when both legs are raised compared to SLR
- Classical Importance: Easier tractioning on the sciatic nerve d/t combined movement of the pelvis
- Bilateral AND Simultaneous
-
Goldthwait's Test
- Pt supine
- Dr places 2 fingers under pt at lumbosacral jxn then Dr grabs heel and raises one leg
- Classical Response: Dr observes if symptoms appear before or after the L/S area moves
- Classical Importance: Pain occuring before L/S moves means SacroIliac involvement, pain during L/S movement means L/S involvement, and pain after L/S motion means Lumbar involvement
- Bilateral
-
Lewin's Gaenslen's Test
- Pt side lying with unaffected side down
- Dr tells pt to grab unaffected knee & pull it towards their chest. Dr extends the affected hip while stabilizing the unaffected leg at the knee
- Classical Response: Pain in the S/I joint on side being pulled off the table
- Classical Importance: Sacroiliac joint lesion
- Bilateral
-
Iliac compression Test
- Pt side lying
- Dr places both hands on the innominates and pushes down
- Classical Response: Pain in the S/I joint
- Classical Importance: Sacroiliac joint lesion
- Simultaneous
-
Nachlas Test
- Pt prone
- Dr passively flexes pt's knee bringing their heel to ipsilateral buttock while pressing downward on the ipsilateral sacroiliac joint
- Classical Response: Increase in local lumber, lumbosacral, or sacroiliac joint
- Classical Importance: Strain or sprain of the above structures
- Bilateral
-
Ely's Heel to Buttock Test
- Pt prone
- Dr flexes pt's knee and brings toward contralateral buttock. Dr notes if it can be done and if so, lifts bent knee in order to extend the hip
- Classical Response: Increased nerve root pain
- Classical Importance: torsional stress in the hip, lumber nerve root lesion, or psoas irritation
- Bilateral
-
Hibb's Test
- Pt prone
- Dr flexes one of pt's knees to 90 degrees, then externally rotates leg while stabilizing contralateral pelvis
- Classical Response: Increased pain in the S/I joint
- Classical Importance: Sacroiliac joint lesion
- Bilateral
-
-
Yeoman's Test
- Pt prone
- Dr stands on opposite side of tested S/I joint. Dr flexes tested side knee, brings toward ipsilateral buttock and extends the hip while pressing downward on tested S/I joint
- Classical Response: Pain felt deep in the anterior Sacroiliac joint
- Classical Importance: Deep anterior Sacroiliac sprain/strain
- Bilateral
-
Kemp's Test
- Pt seated with arms crossed
- Dr laterally flexes pt to one side, rotates toward that side and then extends pt backwards
- Classical response: Increased radicular pain upon bending
- Classical Importance: Increased pain while bending away from pain means medial disc lesion. Increased pain while bending towards the pain means lateral disc lesion
- Bilateral
-
Belt Test
- Pt standing
- Dr behind pt tells them to bend from the waist & try to touch their toes. Dr asks pt to repeat but now grabs pt's ASIS's and puts their hip into pt's sacrum
- Classical Response: Dr observes pt's response, ease of motion, and compares the responses from supported and non-supported positions
- Classical Importance: Pain on both supported and non-supported means lumbar involvement, No pain while supported mean sacroiliac lesion
- Midline
-
Apprehension test
- Pt seated
- Dr in front on side being tested. Dr flexes elbow 90 degrees, abducts and externally rotates shoulder while noting pt's facial expression
- Classical Response: Reactive guarding during maneuver
- Classical Importance: Shoulder instability d/t previous dislocation
- Bilateral
-
Codman's drop arm test
- Pt standing
- Dr abducts pt's arm to 150 degrees and tells pt to slowly lower arm to their side. Dr notes ease and fluidity of motion. Dr then repeats procedure while applying slight resistance and again notes ease and fluidity of motion
- Classical Response: Inability to lower arm to their side smoothly
- Classical Importance: Supraspinatous injury from 120-90 and then 20-0 degrees and Deltoid injury from 90-120
- Bilateral
-
Dawbarn's Test
- Pt seated
- Dr behind palpates subacromial bursa & notes pt response to pressure. Dr flexes pt elbow 90 degrees then abducts 90 degrees
- Classical Response: Pain in subacromial bursa that decreases with abduction of shoulder
- Classical Importance: Subacromial bursitis
- Bilateral
-
Dugas Test
- Pt seated
- Dr tells pt to flex shoulder 90 degrees, grab opposite shoulder and lower elbow onto chest
- Classical Response: Inability to perform
- Classical Importance: Shoulder dislocation
- Bilateral
-
Yergason's Test
- Pt seated
- Dr tells pt to flex elbow 90 degrees & keep wrist pronated. Dr palpates bicipital groove with one hand and assumes the handshake position with the other hand. Dr tells pt to flex elbow completely and supinate their forearm while Dr applies resistance & palpates. Dr then applies external rotation at the end of the maneuver while still palpating groove.
- Classical Response: Pain in the bicipital groove or a palpable click in the same area
- Classical Importance: Tenosynovitis or subluxation of the biceps tendon
- Bilateral
-
Cozen's Test
- Pt seated w/ elbow flexed 90 degrees
- Dr tells to pronate forearm and extend wrist. Dr palpates lateral epicondyle then tells pt to maintain extension of wrist against resistance
- Classical Response: Pain in the lateral epicondyle
- Classical Importance: Lateral epicondylitis
- Bilateral
-
Mill's Test
- Pt seated
- Dr palpates lateral epicondyle. Dr then tells pt in one fluid motion to flex elbow, flex wrist, pronate forearm, point index finger then extend elbow
- Classical Response: Pain in the lateral epicondyle
- Classical Importance: Lateral epicondylitis
- Bilateral
-
Tinel's Test (wrist)
- Pt seated with hand supinated
- Dr supports hand with one hand and palpates carpal tunnel. Dr strikes carpal tunnel w/ percussion hammer
- Classical Response: Tingling distal to tapping
- Classical Importance: Median nerve lesion
- Bilateral
-
Phalens Test
- Pt seated
- Dr tells pt to put hands back to back while elevated above sternum & hold for about 1 min
- Classical Response: Tingling into digits 1-3 on volar surface
- Classical Importance: Median nerve entrapment (carpal tunnel syndrome)
- Simultaneous
-
Bunnell-Littler Test
- Pt seated
- Dr takes pronated wrist, extends MCPJ & flexes PIPJ. Dr then flexes MCPJ & flexes PIPJ
- Classical Response: A difference in tension in the PIPJ from the two tested positions
- Classical Importance: If PIPJ is tight only w/MCPJ extended = tight finger intrinsics, if PIPJ is tight w/MCPJ extended and flexed = think capsular involvement
- Bilateral
-
Retinacular Test
- Pt seated
- Dr takes pt pronated wrist and w/ neutral PIPJ flexes DIPJ. Dr then flexes PIPJ and flexes DIPJ
- Classical Response: A difference in tension in the DIPJ from the two tested positions
- Classical Importance: If DIPJ tight only when PIPJ is neutral = tight finger intrinsics, if DIPJ tight with neutral and flexed PIPJ think capsular involvement
- Bilateral
-
Anvil Test
- Pt supine
- Dr slightly raises one leg and strikes a blow to the heel w/ ulnar side of fist
- Classical Response: Increase in pain within hip joint
- Classical Importance: Hip joint lesion
- Bilateral
-
Ober's Test
- Pt side lying with unaffected side downDr tells pt to flex lower leg at knee for stability. Dr raises upper leg then releases it & lets it drop onto other leg
- Classical Response: Failure of limb to fall back to the table or it falls posteriorly
- Classical Importance: TFL contracture
- Bilateral
-
Fabere-Patrick's Test
- Pt supine
- Dr Flexes pt knee, abducts, externally rotates and then extends pt's hip. Dr stresses further by pressing down on pt's knee
- Classical Response: Pain within hip joint
- Classical Importance: Hip joint lesion
- Bilateral
-
Trendelenburg Test
- Pt standing
- Dr behind has pt grab one knee and bring it to their chest while balancing on other leg
- Classical Response: Gluteal fold will drop below level of contralateral side
- Classical Importance: Gluteus medius weakness on side that patient is standing
- Bilateral
-
Apley's Compression Test
- Pt prone
- Dr flexes knee to 90 degrees and places their own knee on pt's thigh to stabilize. Dr grabs pt's calf near the ankle and compresses the tibis into the femur. Dr then repeats with lateral and medial rotation
- Classical Response: Pain in the knee upon compression
- Classical Importance: Meniscal injury (Medial rotation tests lateral meniscus and lateral rotation tests medial meniscus)
- Bilateral
-
Apley's Distraction Test
- Pt prone
- Dr flexes pt's knee to 90 degrees and puts own knee onto pt's thigh to stabilize. Dr grabs near pt's ankle and distracts upward. Dr repeats with medial and lateral rotation
- Classical Response: Pain in the knee upon distraction
- Classical Importance: Ligamentous injury ( Medial rotation evaluates lateral collateral lig and Lateral rotation test medial collateral ligament)
- Bilateral
-
Grinding Patella Test
- Pt supine w/knees fully extending
- Dr forces patella into patellar groove and grinds it medially then laterally then repeats with knees flexed to 30 degrees
- Classical Response: Increase in retro-patellar pain
- Classical Importance: Chondromalacia patella
- Bilateral
-
McMurray's Click
- Pt supine
- Dr puts one hand under pt's heel and flexes knee to 90 degrees w/some abduction. Dr applies a valgus (L-M) force to knee while extending and adducting it
- Classical Response: A palpable or audible click as knee is brought into extension
- Classical Importance: Medial meniscus damage
- Bilateral
-
Patella Apprehension Test
- Pt supine with legs fully extended
- Dr grabs patella and manually displaces it laterally while observing pt's face
- Classical Response: visible facial sign of apprehension
- Classical Importance: Patella dislocation
- Bilateral
-
Anterior Drawer Test (Knee)
- Pt supine with legs flexed and feet flat on table
- Dr stabilizes pt's feet, grabs tibia with both hands and pulls anterior on Tibia
- Classical Response: Anterior translation of Tibia
- Classical Importance: ACL damage
- Bilateral
-
Posterior Drawer Test (Knee)
- Pt supine with legs bent and feet flat on table
- Dr stabilizes pt's feet,grabs tibia with both hands and pushes posteriorly
- Classical Response: Posterior translation of Tibia
- Classical Importance: PCL damage
- Bilateral
-
Anterior Drawer Test (Ankle)
- Pt supine with ankles off edge of table
- Dr grabs heel of ankle with one hand and tibia just above ankle with the other. Dr applies anterior force to heel
- Classical Response: Anterior translation of ankle
- Classical Importance: Anterior Talofibular ligament laxity
- Bilateral
-
Posterior Drawer Test (Ankle)
- Pt supine with ankles off table
- Dr grabs heel with one hand and Tibia just above ankle with the other and applies a posterior force
- Classical Response: Posterior translation of the Tibia
- Classical Importance: Posterior Talofibular ligament laxity
- Bilateral
-
Medial Stability Test (Ankle)
- Pt supine
- Dr grabs tibia with one hand and the foot with the other and rotates foot into eversion
- Classical Response: Excessive Eversion
- Classical Importance: Deltoid ligament sprain
- Bilateral
-
Lateral Stability Test (ankle)
- Pt supine
- Dr grabs tibia with one hand and the foot with the other and rotates foot into inversion
- Classical Response: Excessive inversion
- Classical Importance: Anterior talofibular lig sprain
- Bilateral
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