-
Bony Palpation of the Shoulder
- 1) Sternoclavicular articulation
- 2) Clavicle
- 3) Coracoid process
- 4) Acromioclavicular articulation
- 5) Acromion 6) Greater tuberosity of the humerus
- 7) Bicipital groove
- 8) Less tuberosity of the humerus
- 9) Spine of the scapula
- 10) Body of scapula
- 11) Scapulothoracic articulation
-
Soft Tissue Palpation of the Shoulder
- 1) Rotator Cuff Muscles
- Supraspinatus
- Infraspinatus
- Teres minor
- Subscapularis
- 2) Subacromial bursa
- 3) Subdeltoid bursa
- 4) Axillary borders
- Pectoralis major
- Serratus anterior
- Axillary lymph nodes
- Latissimus dorsi
- Bicipital tendon
- 5) Prominent muscles of region
- Sternocleidomastoid
- Biceps
- Deltoid (palpate as a group and individually)
- Anterior portion
- Middle portion
- Posterior portion
- Trapezius
- Rhomboid muscles (palpate as a unit and individually)
- Minor
- Major
-
Dugas Test
- Instruct: Patient seated, examiner instructs patient to place the hand of the affected side on the opposite shoulder and then bring the affected elbow to the chest.
- Positive: Inability to touch the opposite shoulder and/or inability of the elbow to touch the chest.
- Indicates: Acute dislocation of the shoulder (glenohumeral joint).
-
Anterior Apprehension Test
- Instruct: Patient seated, examiner abducts the patients shoulder, flexes the patient’s elbow and
- then gradually externally rotates to the patient’s shoulder.
- Positive: Patient will have a noticeable look of apprehension or alarm on their face with possible pain.
- Indicates: Chronic anterior dislocation of the shoulder (glenohumeral joint).
-
Posterior Apprehension Test
- Instruct: Patient supine, examiner flexes patient’s shoulder, flexes patient’s elbow and internally rotates the patient’s shoulder. Examiner places his/her hand on the patient’s elbow and gradually applies increasing posterior pressure.
- Positive: Patient will have a noticeable look of apprehension or alarm on their face with possible pain.
- Indicates: Chronic posterior dislocation of the shoulder (glenohumeral joint).
-
Drop Arm Test aka Codman Drop Arm Test
- Instruct: Patient
- seated, examiner passively abducts patients arm to slightly over 90 degrees and
- removes support, if patient can maintain arm, then instructs patient to slowly
- lower their arm.
- Positive: Patient will not be able to lower the arm slowly or the arm drops suddenly.
- Indicates: Rotator cuff tear, usually supraspinatus.
-
Dawbarn Test
- deep palpation of shoulder elicits well-localized tender area, by subacromial bursa
- Instruct: Patient seated, examiner applies pressure below the affected acromial process with his/her fingertips. Note for pain or tenderness. Examiner continues to apply pressure while abducting the patient’s arm past 90 degrees.
- Positive: Decrease in pain and/or tenderness.
- Indicates: Subacromial bursitis.
-
Yergason Test
- Instruct: Patient seated, examiner flexes patient’s elbow to 90 degrees. Examiner stabilizes patient’s elbow with one hand and exerts slight inferior traction. Examiner uses their other hand and grasps slightly above patient’s wrist. Examiner offers resistance while patient is instructed to externally
- rotate his/her humerus and slightly supinate the forearm.
- Positive: 1) Localized pain and/or tenderness at the bicipital groove. 2)Audible click or the biceps tendon subluxes or dislocates
- Indicates: 1) Tendinitis 2) Instability of the biceps tendon possibly associated with a torn transverse
- humeral ligament
-
Abott-Saunders
- Instruct: Patient seated, examiner fully abducts and externally rotates the patient’s affected arm. Examiner places his/her fingers on the patient’s bicipital groove and then slowly lowers the patient’s affected arm to their side.
- Positive: Palpable and/or audible click.
- Indicates: Subluxation or dislocation of the biceps tendon. (Rupture of transverse ligament or tendon subluxation beneath subscapularis muscle belly)
-
Speed Test
- Instruct: Patient seated with forearm supinated, and elbow flexed to 45 degrees. Examiner places
- his/her fingers on patients bicipital groove with their opposite hand on the patients forearm. Instruct the patient to flex his/her shoulder, maintain supination and completely extend the elbow as the doctor applies resistance.
- Positive: Pain and/or tenderness in the bicipital groove.
- Indicates: Bicipital tendinitis.
-
Apley Test
- Instruct: Patient seated. Have him/her place the affected hand behind the head and touch the
- opposite superior angle of the scapula = Apley scratch superior. Then patient is instructed to place the hand behind the back to touch inferior angle
- of scapula = Apley scratch inferior
- Positive: Exacerbation of pain
- Indicates: Degenerative tendinitis of rotator cuff tendons (usually Supraspinatus.)
-
Impingement Sign
- Instruct: Patient seated with arms at side, examiner slightly abducts patient’s arm (hand should be
- pronated) and moves it fully through flexion (will jam greater tuberosity and anterior/inferior surface of the acromion)
- Positive: Pain in the shoulder
- Indicates: Overuse injury to the supraspinatus and possibly biceps tendon.
-
Bony Palpation of Elbow
- 1) Medial epicondyle
- 2) Medial supracondylar line of the humerus
- 3) Groove of the ulnar nerve
- 4) Trochlea
- 5) Olecranon
- 6) Olecranon fossa
- 7) Lateral epicondyle
- 8) Lateral supracondylar line of the humerus
- 9) Radial head
-
Soft Tissue Palpation of Elbow
- 1) Ulnar nerve
- 2) Wrist flexor muscles (palpate as a unit and individually)
- Pronator teres
- Flexor carpi radialis
- Palmaris longus
- Flexor carpi ulnaris
- 3) Medial collateral ligament
- 4) Supracondylar lymph nodes
- 5) Brachial Artery
- 6) Triceps muscle
- 7) Lateral collateral ligament
- 8) Biceps
- 9) Olecranon bursa
- 10) Elbow Flexors muscles “mobile wad of three” (palpate as a unit and individually)
- Brachioradialis
- Extensor carpi radialis longus
- Extensor carpi radialis brevis
-
Medial Collateral Ligament Test aka Abduction Stress Test
- Instruct: Patient seated, examiner stabilizes the lateral aspect of the arm and places an abduction
- (valgus) pressure on the medial forearm.
- Positive: Excessive gapping & pain.
- Indicates: Medial collateral ligament instability.
-
Lateral Collateral Ligament Test aka Adduction Stress Test
- Instruct: Patient seated, examiner stabilizes the medial aspect of the arm and places an adduction
- (varus) pressure on the patient’s lateral forearm.
- Positive: Excessive gapping & pain.
- Indicates: Lateral collateral ligament instability.
-
Tinel Elbow Sign
- Instruct: Patient seated, with a Taylor reflex hammer, examiner taps over the groove between the
- medial epicondyle and the olecranon process.
- Positive: Pain and/or tenderness at the site being tapped and paresthesia in the ulnar nerve distribution
- area (fingers 4,5).
- Indicates: Neuroma of the ulnar nerve.
-
Cozen Test
- Instruct: Patient seated, examiner instructs patient to make a fist and place wrist into extension. Examiner instructs patient to resist as examiner tries to push extended wrist into flexion.
- Positive: Pain over the lateral epicondyle.
- Indicates: Lateral epicondylitis (Tennis Elbow).
-
Mill's Test
- Instruct: Patient seated at rest with forearm supinated. In a smooth continuous motion the Dr.
- passively maximally flexes the patient’s elbow, then wrist and then fingers. While maintaining wrist
- and finger flexion, the Dr. passively extends the patient’s elbow (the forearm is now pronated)
- Positive: Pain over the lateral epicondyle.
- Indicates: Lateral epicondylitis (Tennis Elbow).
-
Golfer Elbow Test
- Instruct: Patient seated, examiner instructs patient to extend the elbow and supinate hand. Examiner instructs patient to flex the wrist against resistance.
- Positive: Pain over the medial epicondyle.
- Indicates: Medial Epicondylitis
-
Bony Palpation of Hand
- 1) Radial styloid process
- 2) Scaphoid (Navicular)
- 3) Lunate
- 4) Lister’s tubercle (Dorsal tubercle)
- 5) Triquetrium
- 6) Pisiform
- 7) Trapezium
- 8) Trapezoid
- 9) Capitate
- 10) Hook of hamate
- 11) Ulnar styloid process
- 12) Metacarpals
- 13) Phalanges
-
Soft Tissue Palpation of Hand
- 1) Ulnar artery
- 2) Radial artery
- 3) Palmaris longus tendon
- 4) Carpal tunnel region
- 5) Thenar eminence
- 6) Hypothenar eminence
- 7) Palmar aponeurosis
- 8) Tissues surrounding proximal interphalangeal joints
- 9) Tissues surrounding distal interphalangeal joints
- 10) Distal tufts of fingers
-
Tinel Wrist Sign
- Instruct: Patient seated with wrist supinated, examiner taps over the palmar (volar) surface of the wrist. (flexor retinaculum – over carpal tunnel region).
- Positive: Reproduction of pain, tenderness and/or paresthesia in the median nerve distribution area (thumb, 2nd, 3rd, and the lateral ½ of the 4th digit).
- Indicates: Carpal Tunnel Syndrome
-
Phalen Sign & Reverse Phalen Sign aka Prayer Sign
- Instruct: Patient seated, examiner instructs patient to flex both wrists to maximum degree and
- approximate until point of pain or 60 seconds.
- Prayer sign = maximally extend wrist (palms together), elbows same level as shoulders for 60 seconds.
- Positive: Reproduction of pain and/or paresthesia in the median nerve distribution area (thumb, 2nd , 3rd and the lateral ½ of the 4th digit).
- Indicates: Carpal Tunnel Syndrome
-
Finkelstein Test
- Instruct: Patient seated, examiner instructs patient to place his/her thumb across the palmar surface of the hand and make a fist. Have patient flex elbow and instruct patient to ulnar deviate his/her hand.
- Positive: Pain distal to the radial styloid process.
- Indicates: Stenosing tenosynovitis of the abductor pollicis longus and extensor pollicis brevis tendons
- (DeQuervain’s Disease).
-
Bunnel- Littler Test
- Instruct: Patient seated, examiner places metacarpophalangeal joint in extension and tries to
- flex the proximal interphalangeal joint. If no flexion is possible then there is either a joint capsule contracture or tight intrinsic muscles. To differentiate, examiner places the metacarpophalangeal joint in a few degrees of flexion and attempts to move the proximal interphalangeal joint into flexion.
- Positive: (1) Flexion of the proximal interphalangeal joint cannot be achieved. (2) Flexion of the proximal interphalangeal joint is achieved.
- Indicates: (1) Joint capsule contracture. (2) Tight intrinsic muscles.
-
Retinacular Test
- Patient presents with difficulty flexing the DIP joint.
- Instruct: Patient seated, examiner places proximal interphalangeal joint in neutral and tries to flex the distal interphalangeal joint. If no flexion is possible then there is either a joint capsule contracture or tight retinacular ligaments. To differentiate, examiner places the proximal interphalangeal joint in a few degrees of flexion and attempts to
- move the distal interphalangeal joint into flexion.
- Positive: (1) Flexion of the distal interphalangeal joint cannot be achieved. (2) Flexion of the distal interphalangeal joint is achieved.
- Indicates: (1) Joint capsule contracture. (2) Tight retinacular ligament.
-
Allen Test
- Instruct: Patient seated, examiner instructs patient to raise his/her hand above the heart level of his/her head and to open and close his/her fist for 60 seconds. Examiner occludes both the radial and ulnar artery at the wrist and then lowers the patient's arm with the fist closed and allows the fist to rest on patient's thigh. Examiner instructs patient to open closed fist and releases digital pressure over one artery while keeping the other artery occluded. Record the filling time, while comparing color to the other hand. Then repeat procedure for other artery.
- Positive: A delay of more than 10 seconds (Evans 5 sec.) in returning a reddish color to the hand.
- Indicates: Radial or ulnar artery insufficiency. The artery held (occluded) by the examiner is not the artery being tested.
-
Bony Palpation of Cervical Spine
- Anterior Aspect
- 1) Hyoid Bone
- 2) Thyroid Cartilage
- 3) First Cricoid Ring
- 4) Mandible
- Posterior Aspect
- 1) Occiput
- 2) Inion (EOP)
- 3) Superior Nuchal Line
- 4) Mastoid Processes
- 5) Spinous Processes of Cervical Vertebrae
- 6) Facet Joints
-
Soft Tissue Palpation of Cervical Spine
- 1) Sternocleidomastoid muscle
- 2) Anterior lymph node chain
- 3) Posterior lymph node chain
- 4) Thyroid gland
- 5) Carotid pulse
- 6) Supraclavicular fossa
- 7) Trapezius muscle
- 8) Greater occipital nerves
- 9) Superior nuchal ligament
-
Foraminal Compression Test
- Instruct: Patient seated with examiner standing behind. Examiner clasps his/her hands over patient’s head and exerts gradual increasing downward pressure. Examiner repeats this procedure with the patient’s head rotated right and then left.
- Positive: 1) Exacerbation of localized cervical pain.
- 2) Exacerbation of cervical pain with a radicular component.
- Indicates: 1) Foraminal encroachment or facet pathology without nerve root compression.
- 2) Foraminal encroachment with nerve root compression or facet pathology (then evaluate the myotome, reflex & dermatome of the nerve root involved).
-
Cervical Distraction Test
- Instruct: Patient seated: the examiner grasps the patient’s head with both hands and gradually
- exerts upward pressure keeping hands off TMJ and ears.
- Positive: 1)Diminished or absence of pain. 2) Increase of cervical pain.
- Indicates: 1) Foraminal encroachment (local pain diminishes), nerve root compression (Radicular pain diminishes). 2) Muscular strain, ligamentous
- sprain, myospasm, facet capsulitis.
-
Spinal Percussion Test
- Instruct: Patient seated with head in slight flexion, percuss each cervical spinous process(es) and the associated musculature with the pointed end of a reflex hammer.
- Positive: 1)Local pain 2) Radiating pain
- Indicates: 1) Possible fractured vertebrae, ligamentous involvement (spinous pain), muscular
- involvement (muscular pain). 2) Possible disc
- pathology.
-
Shoulder Depression Test
- Instruct: Patient seated, examiner stabilizes patient’s laterally flexed head while pushing down on shoulder.
- Positive: 1) Localized pain on the side being tested.
- 2) Radicular pain on either side.
- Indicates: 1) Localized Pain: Dural sleeve adhesion, and muscular adhesion/contracture, or spasm, or ligamentous injury. 2) Radicular Pain: On side being tested neurovascular bundle compression, dural sleeve adhesions, or Thoracic Outlet Syndrome On opposite side being tested foraminal encroachment
- with nerve root compression.
-
Swallowing Test
- Instruct: Patient seated: examiner instructs the patient to swallow.
- Positive: Difficulty in swallowing.
- Indicates: Space-occupying lesion at anterior portion of cervical spine. Possibly esophageal or pharyngeal Injury, anterior disc defect, muscle spasm or osteophytes etc.
-
Soto Hall Sign
- Instruct: Patient supine, examiner flexes patient’s head toward his/her chest while exerting downward pressure on patient’s sternum with hypothenar eminence of inferior hand.
- Positive: Generalized pain in the cervical region, which may extend down to the level of T2.
- Indicates: Non-specific test for structural integrity of cervical region.
-
Kernig Sign
- Instructs: Patient supine, examiner passively flexes patient’s hip to 90 degrees and the patient’s knee to 90 degrees. Examiner extends patient’s leg completely.
- Positive: Inability to fully extend the leg and/or pain (usually in the neck region.)
- Indicates: Meningeal irritation/ meningitis.
-
O'Donoghue Maneuver (One of the best tests
for Whiplash injury used by an examiner, can also be utilized on ANY joint in the body to determine
sprain/strain injury)
- Instruct: Patient is seated, examiner grasps the patient's head with both hands and passively and
- slowly takes the cervical region through a range of motion. The examiner then takes the cervical
- region through isometric contractions.
- Positive: 1)Pain during passive range of motion. 2)Pain during resisted range of motion.
- Indicates: 1) Ligamentous sprain. (Passive ROM stresses ligaments) 2) Muscle/tendon strain.
- (Active ROM stresses muscles and tendons)
-
Bony Palpation of Lumbar Spine
- 1) Lumbar spinous processes
- 2) Sacral tubercles
- 3) Iliac crest
- 4) PSIS
-
Soft Tissue Palpation of Lumbar Spine
- 1) Paraspinal muscles (palpate as a unit) superficial layer
- Spinalis
- Longissimus
- Iliocostalis
- 2) Sciatic nerve
- 3) Gluteus Maximus
- 4) Gluteus Medius
- 5) Hamstrings
- Biceps femoris
- Semitendinosus
- Semimembranosus
- 5) Anterior abdominal muscles
-
Hoover Sign
- (Used to differentiate organic versus hysterical leg paralysis)
- Instructs: Patient supine, examiner instructs patient to lift the affected leg while the examiner places one hand under the heel of the non-affected leg (healthy side).
- Positive: Lack of counter-pressure on the healthy side
- Indicates: Lack of organic basis for paralysis (Malingering/hysteria). With organic hemiplegia, the patient will still exert downward pressure when attempting to raise paralyzed leg
-
SLR
- Instruct: Patient supine, examiner raises patient’s leg slowly to 90° or to the point of pain.
- Positive: Radiating pain and/or dull posterior thigh pain.
- Indicates: Sciatic radiculopathy or tight hamstrings. Positive between 35 – 70 degrees = possible
- discogenic sciatic radiculopathy (Cipriano)
-
Goldthwait Sign
- Instruct: Patient supine examiner places the fingers of their superior hand under the interspinous spaces of the patient's lower lumbar vertebrae. Examiner then raises one of the patient's extended legs.
- Positive: Localized pain, low back or radiating pain down the leg.
- Indicates: Lumbo-sacral or sacroiliac pathology. Pain occurring after the lumbar spinouses move = possible lumbo-sacral problem. Pain occurring before the lumbars move = possible sacroiliac problem.
-
Bragard Sign
- Instruct: Patient supine, examiner performs a (SLR) on the patient. Examiner lowers the raised leg (5
- degrees) from the point of pain and sharply dorsiflexes patient’s foot.
- Positive: Radiating pain in posterior thigh.
- Indicates: Sciatic radiculopathy
-
Buckling Sign (Cipriano)
- Instruct: Patient is supine, examiner performs a SLR on the patient.
- Positive: Pain in the posterior thigh with sudden knee flexion (buckle).
- Indicates: Sciatic radiculopathy.
-
Bowstring Sign
- Instruct: Patient is supine, examiner places patient’s leg on their shoulder and first applies pressure to the
- hamstring muscle if pain is not elicited then apply
- pressure to the popliteal fossa.
- Positive: Pain in the lumbar region or radiculopathy.
- Indicates: Sciatic nerve root compression, helps rule out tight hamstrings.
-
-
Milgram Test
- Instruct: Patient supine, examiner raises both of patient’s legs 2-3 inches off the table and instructs
- patient to hold legs off the table for 30 seconds.
- Positive: Inability to perform test and/or low back pain.
- Indicates: Weak abdominal muscles or space occupying lesion.
-
Bechterew Test
- Instruct: Patient seated, examiner instructs patient to extend one knee at a time alternately, then both together.
- Positive: Reproduction of radicular pain or inability to perform correctly due to tripod sign.
- Indicates: Sciatic radiculopathy.
-
Neri Bowing Test (Neri Sign)
- Instruct: Examiner instructs patient to bend forward from the waist.
- Positive: Pain accompanied by flexion of the knee on the affected side and bodyrotation away from the
- affected side.
- Indicates: Positive with a variety of low back pathologies. Hamstring tension on the pelvis may trigger the response.
-
Anterior Innominate Test aka Mazion Pelvic Maneuver (Advancement Sign)
- Instruct: The patient is standing. Examiner instructs patient to advance one leg forward approximately
- 2-3 feet. Patient is then instructed to bend forward from the waist and touch the advanced foot with both hands (advanced knee should be straight).
- Positive: The inability to bend at the waist more than 45 degrees, because of either/or (1) radiating pain along the sciatic nerve, either unilateral or bilateral (2) low back pain (lumbar or pelvic regions)
- Indicates: (1) sciatic neuralgia or radiculopathy, etc., possibly due to lumbar disc pathology (2) anterior (rotational) displacement of the ilium relative to the sacrum.
-
Lewin Standing Test
- Instruct: Examiner instructs patient to bend forward slightly at the waist with knees slightly flexed. Examiner first brings one knee into complete extension. Next the examiner brings the other knee into complete extension. Finally the examiner brings both knees into complete extension.
- Positive: Radiating pain down the leg causing flexion of the patient's knee or knees.
- Indicates: Gluteal, lumbosacral or sacroiliac pathologies.
-
Heel Walk
- Instruct: Patient walks on heels.
- Positive: Inability to perform test.
- Indicates: L4-L5 disc problem (L5 nerve root).
-
Toe Walk
- Instruct: Patient walks on toes.
- Positive: Inability to perform test.
- Indicates: L5-S1 disc problem (S1 nerve root).
-
Ely Heel to Buttock Test (Evans calls this Ely sign as an aka)
- Instruct: Patient prone, examiner flexes the knee of the patient's affected leg to 90 degrees. Examiner then approximates the heel of the affected leg to the contralateral buttock and hyperextends the thigh off the table.
- Positive: (1) Inability to raise the thigh. (2) Pain in the anterior thigh. (3) Pain in the lumbar region.
- Indicates: (1) Iliopsoas spasm. (2) Inflammation of
- lumbar nerve roots. (3) Lumbar nerve root adhesions.
-
Bony Palpation of Hip & Pelvis
- Anterior
- 1) ASIS
- 2) Iliac crest
- 3) Iliac tubercle
- 4) Greater trochanter
- Posterior
- 1) PSIS
- 2) Ischial tuberosity
- 3) Coccyx
-
Soft Tissue Palpation of Hip & Pelvis
- 1) Femoral triangle borders
- Sartorius
- Adductor longus
- Inguinal ligament
- 2) Quadriceps muscles (palpate as a unit and individually)
- Vastus Lateralis
- Vastus Medialis
- Vastus Intermedius
- Rectus Femoris
- 3) Greater trochanteric bursa
- 4) Gluteus medius
- 5) Gluteus maximus
- 6) Sciatic nerve
- 7) Cluneal nerves
- 8) Hamstrings
- Biceps femoris
- Semitendinosus
- Semimembranosus
-
Leg Length Discrepancy
- Instruct: Patient supine, (True) examiner takes a cloth measuring tape and measures from ASIS to
- the medial malleoli of the same leg. Examiner then measures from ASIS to the medial malleoli of the opposite leg. (Apparent) Examiner takes a cloth
- tape measure and measures from the umbilicus to the medial malleoli of one leg and then measures from the umbilicus to the medial malleoli of the opposite leg.
- Positive: Different measurements.
- Indicates: True = bony abnormality above or below level of trochanter difference (anatomical short leg).
- Apparent = pelvic obliquity (Tilted pelvis).
-
Allis Sign (Galeazzi Sign) = (Pediatric Test used for 1 month to 2 yo, can also be used in adults)
- Instruct: Patient is supine, examiner instructs patient to place both feet flat (approximate great toes
- and medial malleoli bilateral) on the bench while flexing both knees to 90 degrees.
- Positive: Difference in height and anteriority of the knees.
- Indicates: (1) If one knee is lower = ipsilateral congenital hip dislocation or tibial discrepancy (anatomical short leg) (2) If one knee is anterior = ipsilateral congenital hip dislocation or femoral discrepancy (contralateral anatomical short leg)
-
Thomas Test
- Instruct: Patient supine, examiner instructs patient to approximate each knee one at a time to his/her chest and hold.
- Positive: Lumbar spine maintains lordosis (should flatten) and opposite hip does not straighten.
- Indicates: Contracture of the hip flexors (iliopsoas).
-
Anvil Test
- Instruct: Patient supine, examiner elevates the affected leg while keeping the knee extended. The
- examiner then makes a fist and strikes the affected leg’s inferior calcaneus.
- Positive: Localized pain in long bone or in hip joint
- Indicates: Possible fracture of long bones, or hip joint pathology.
-
Patrick Test aka FABERE sign
- Instruct: Patient supine, examiner flexes, abducts and externally rotates the patients’ hip so that the
- ankle rests above or below the contralateral knee. Examiner then extends the hip by pushing just superior to the knee while stabilizing the contralateral ASIS.
- Positive: Pain in the hip region.
- Indicates: Hip joint pathology.
-
Laguerre Test
- Instruct: Patient is supine, examiner grasps the affected leg, flexes and externally rotates the hip and abducts the thigh (this test is similar to Patrick except the ankle of the affected leg is not resting on the contralateral knee). Examiner applies pressure to the end range of motion while stabilizing the contralateral ASIS (rest ankle on forearm and with other hand reach under arm to stabilize).
- Alternate Procedure (Cipriano): examiner exerts downward pressure on knee with superior hand, and exerts upward pressure on the ankle with the inferior hand.
- Positive: (1)Pain in the hip joint (2) Pain in the
- sacroiliac joint.
- Indicates: (1) Hip joint pathology (2) Mechanical problem of the sacroiliac joint
-
Gaenslen Test
- Instruct: Patient in the supine position with the affected side of the sacroiliac joint as close to the edge of the table as is possible. The patient then grasps the unaffected leg just below the knee and approximates the knee to his chest. The examiner then places adownward pressure on the affected thigh until it is lower than the edge of the
- table.
- Positive: Pain on the affected SI joint stressed into extension.
- Indicates: General sacroiliac joint lesion, anterior sacroiliac ligament sprain, or inflammation of the SI joint.
-
Lewin-Gaenslen Test
- Instruct: Patient lying on his unaffected side,
- instruct patient to flex his inferior leg. Examiner grasps the superior leg and brings into extension while stabilizing the lumbosacral joint (extension of the leg stresses the sacroiliac joint and anterior joint ligaments on the side of leg extension).
- Positive: Pain on the side of extension.
- Indicates: General sacroiliac joint lesion, anterior sacroiliac ligament sprain, or inflammation
- of the SI joint.
-
Hibb Test
- Instruct: Patient prone, examiner stabilizes pelvis on near side while grasping the opposite ankle and flexing the knee to 90 degrees. The examiner maximally flexes the knee and then slowly internally rotates the thigh (pushing lateral on the leg). Compare bilateral.
- Positive: (1) Pain in the hip region. (2) Pain in the buttock/pelvic region.
- Indicates: (1) Hip joint pathology. (2) Sacroiliac joint lesion.
-
Ober Test
- Instruct: Patient on his/her side, examiner flexes the affected knee while abducting and extending the hip. Perform bilaterally.
- Positive: Affected thigh remains in abduction.
- (Normal biomechanics, the thigh/hip will adduct.)
- Indicates: Contraction of the iliotibial band or tensor fascia lata, (usually secondary to synovitis of the hip, secondary to trauma of the gluteus medius and maximus)
-
Pelvic Rock Test aka Iliac Compression Test
- Instruct: Patient lies on their side. Examiner places both hands on the lateral portion of the patient’s ilium. Examiner pushes downward (lateral to medial) on the patient’s ilium. Test bilaterally.
- Positive: Pain in either sacroiliac joint.
- Indicates: Sacroiliac joint lesion.
-
Nachlas Test
- Instruct: Patient prone, examiner takes the heel of the affected leg and approximates it to the ipsilateral buttock while stabilizing the pelvis to prevent hip flexion.
- Positive: Pain in the buttock and/or pain in the lumbar region.
- Indicates: Sacroiliac joint lesion, or Lumbar pathology.
-
Yeoman Test
- Instruct: Patient prone, examiner flexes patient's leg to ipsilateral buttock and then extends thigh.
- Positive: Pain deep in the SI joint.
- Indicates: Strain/sprain of the anterior sacroiliac ligaments.
-
Ely Sign (Test)
- Instruct: Patient prone, examiner passively flexes the patient's knee toward the ipsilateral buttock.
- Positive: Hip on side being tested will flex causing the buttock to raise off the table.
- Indicates: Rectus femoris or hip flexor contracture.
-
Ely Heel To Buttock Test (Evans calls this Ely Sign as an aka)
- Instruct: Patient prone, examiner flexes the knee of the patient's affected leg to 90 degrees. Examiner then approximates the heel of the affected leg to the contralateral buttock and hyperextends the thigh off the table.
- Positive: (1) Inability to raise the thigh. (2) Pain in the anterior thigh. (3) Pain in the lumbar region.
- Indicates: (1) Iliopsoas spasm. (2) Inflammation of
- lumbar nerve roots. (3) Lumbar nerve root adhesions.
-
Trendelenburg Test
- Instruct: Patient stands on foot of involved side of hip problem. Observe level of hips.
- Positive: High iliac crest on supported side and low crest on side of elevated leg.
- Indicates: Weak gluteus medius muscle on the supported side.
-
Bony Palpation of Knee
- 1) Patella
- 2) Medial tibial plateau
- 3) Tibial tubercle
- 4) Medial femoral condyle
- 5) Lateral tibial plateau
- 6) Lateral femoral condyle
- 7) Fibula head
-
Soft Tissue Palpation of Knee
- 1) Quadriceps muscles Quadriceps muscles (palpate as a unit and individually)
- Vastus Lateralis
- Vastus Medialis
- Vastus Intermedius
- Rectus Femoris
- 2) Infrapatellar tendon
- 3) Bursae
- Prepatellar
- Superficial infrapatellar
- 4) Medial meniscus
- 5) Lateral meniscus
- 6) Pes anserine area
- Sartorius
- Gracilis
- Semitendinosus
- 7) Popliteal fossa
- 8) Lateral collateral ligament
- 9) Medial collateral ligament
- 10) Gastrocnemius muscle
-
McMurray Sign
- Instruct: Patient supine, examiner flexes patient’s affected hip to 90 degrees and the affected knee to 90 degrees. Examiner grasps the heel of the affected leg and applies external rotation to the knee. Examiner places his/her hand on the lateral aspect of the affected knee and applies a valgus stress. Examiner maintains the external rotation and valgus stress on the knee and extends the affected leg slowly to the top of the table while palpating the medial knee joint line. (Occasional variance = repeat with internal rotation and varus stress)
- Positive: Clicking sound or pain by knee joint.
- Indicates: Tear of medial meniscus if positive on external rotation Tear of lateral meniscus if positive on internal rotation The higher the leg is raised when positive is elicited, the more posterior the meniscal injury.
-
Medial Collateral Ligament Test aka Abduction Stress Test aka Valgus Stress Test
- Instruct: Patient supine, examiner stabilizes the lateral thigh of the patient’s affected leg. Examiner grasps just superior to the medial ankle of the affected leg and gradually pushes laterally (to open medial side of joint).
- Positive: Gapping and/or elicited pain above/at/or below joint line
- Indicates: Torn medial collateral ligament.
-
Lateral Collateral Ligament Test aka Adduction Stress Test aka Varus Stress Test
- Instruct: Patient supine, examiner stabilizes the medial thigh of the patient’s affected leg. Examiner grasps just superior to the lateral ankle of the affected leg and gradually pushes medially
- (opening the lateral side of the joint).
- Positive: Gapping and/or elicited pain above/at/or below joint line
- Indicates: Torn lateral collateral ligament.
-
Bounce Home Test
- Instruct: Patient supine, examiner instructs patient to flex his leg, examiner grasps the patient’s heel and knee of the affected leg. Examiner pulls affected leg slowly into extension (passively).
- Positive: Knee does not go into full extension (slight flexion remains).
- Indicates: Diffuse swelling of the knee, accumulation of fluid, due to possible torn meniscus.
-
Drawer Test
- Instruct: Patient supine, examiner flexes the hip and the knee of the patient’s affected leg until the foot is flat on the table. Examiner sits on the foot of the patient’s affected leg. Examiner grasps behind the patient’s flexed knee and exerts a pushing and pulling pressure into the affected knee.
- Positive: (1) Gapping > 6mm (tibia moves posterior) when the leg is pushed. (2) Gapping > 6mm (tibia moves anterior) when the leg is pulled.
- Indicates: (1) Torn posterior cruciate ligament. (2) Torn anterior cruciate ligament.
-
Lachman Test
- Instruct: Patient supine, examiner puts the patient’s knee at a 30° angle of flexion and from this angle the examiner grasps both the proximal end of the tibia with one hand and the distal end of the femur with the other, and attempts to pull the tibia forward in order to feel the joint play. (variation of Drawers’ test)
- Positive: Gapping with the tibia moving away from the femur.
- Indicates: Anterior cruciate ligament or posterior oblique ligament instability.
-
Apprehension Test for the Patella
- Instruct: Patient supine (or seated with quadriceps relaxed and resting over examiners leg at a 30 degree flexion), examiner pushes the patella laterally.
- Positive: Apprehension, distress of facial expression, contraction of quadriceps to bring patella back in line.
- Indicates: Chronic patella dislocation or pre-disposition to dislocation.
-
Patella Femoral Grinding Test (aka Clarke Sign)
- Instruct: Patient supine, affected knee extended examiner uses the web of the hand to move the patella to an inferior position. Examiner instructs patient to tighten the quadriceps muscles as the
- examiner continues to hold the patella in the inferior direction.
- Positive: Retropatellar pain and the patient is unable to hold the quadriceps contraction.
- Indicates: Degenerative changes of the patellar facets and /or within the trochlear groove (chondromalacia patella).
-
Patella Ballottment Test
- Instruct: Patient supine with knee extended. Anterior to posterior pressure is applied over the patella.
- Positive: A floating sensation of the patella is a positive finding.
- Indicates: A large amount of swelling in the knee.
-
Apley Compression Test
- Instruct: Patient prone, examiner flexes patient’s affected knee to 90 degrees. Stabilize patient’s thigh with your knee, Place downward pressure on the patient’s heel while internally and externally rotating the patient’s foot.
- Positive: Patient points to side of pain.
- Indicates: Pain on medial side is medial meniscus tear. Pain on the lateral side indicates lateral meniscus tear.
-
Apley Distraction Test
- Instruct: Patient prone, examiner flexes patient affected knee to 90 degrees. Examiner places his/her knee on patient’s affected thigh for stabilization. Examiner grasps the patient’s foot and pulls the leg while internally and externally rotating the
- tibia.
- Positive: Patient will point to side of pain.
- Indicates: Pain on the medial side indicates medial collateral ligament tear. Pain on the lateral side indicates lateral collateral ligament tear.
-
Bony Palpation of Foot & Ankle
- 1) Calcaneus
- 2) Sustentaculum tali
- 3) Medial malleolus
- 4) Lateral malleolus
- 5) Talus
- 6) Navicular
- 7) Cuboid
- 8) 3 Cuneiforms
- 9) 5 Metatarsals
- 10) Metatarsophalangeal joints
-
Soft Tissue Palpation of Foot & Ankle
- 1) Tibialis posterior tendon
- 2) Spring ligament
- 3) Tibialis anterior tendon
- 4) Deltoid ligament
- 5) Peroneus brevis
- 6) Achilles tendon
- 7) Plantar aponeurosis
- 8) Anterior talofibular ligament
- 9) Posterior tibial artery
- 10) Dorsal pedal artery
-
Drawer Sign (Anterior Drawer Sign of the Ankle)
- Instruct: Patient seated, examiner grasps just superior to the ankle with one hand and around the calcaneus of the affected foot with the other hand. Examiner pulls (draws) the calcaneus anteriorly and pushes the tibia posteriorly, the reverse procedure by pulling the ankle anterior and
- calcaneus posterior.
- Positive: Translation with the talus moving away from or toward the tibia.
- Indicates: 1)With tibia pushed/ foot pulled; a tear/instability of the anterior talofibular ligament. 2) With tibia pulled/foot pushed; a tear/instability of posterior talofibular ligament.
-
Ankle Dorsiflexion Test
- Patient experiences difficulty dorsiflexing the
- foot
- Instruct: With the patient seated, the examiner tries to dorsiflex foot of affected leg; first with the knee extended, then again with the knee flexed.
- Positive: (1) the foot cannot dorsiflex with knee extended, but is able to with knee flexed. (2) the foot cannot dorsiflex in either knee position
- Indicates: (1) contracture of the gastrocnemius muscle (2) contracture of the soleus muscle
-
Rigid or Supple Flat Feet Test
- Instruct: Patient is seated and then stands, examiner observes patient’s feet while seated and while standing.
- Positive: (1)Absence of medial longitudinal arch in both positions. (2) Presence of medial longitudinal arch while seated with a loss of medial longitudinal arch while standing.
- Indicates: (1)Rigid flat feet (2)Supple flat feet
-
Homans Sign
- Instruct: Patient supine, examiner raises the extended affected leg about 12" off the table or 45° and then forcibly dorsiflexes the foot of the affected leg. (Squeezing the calf is recommended by some sources, yet other sources feel it is contra-indicated, please note that this is a verbal component to be explained in examination.)
- Positive: Deep pain in the calf.
- Indicates: Deep vein thrombophlebitis
-
Thompson Test
- Instruct: Patient prone with leg flexed to 90 degrees by examiner. Examiner squeezes the belly of the calf muscle of the affected leg.
- Positive: Absence of foot plantarflexion motion.
- Indicates: Achilles tendon rupture.
-
Morton Test
- Instruct: Patient supine, examiner grasps the affected forefoot with one hand and applies transverse pressure across the metatarsal heads.
- Positive: Sharp pain in the forefoot.
- Indicates: Metatarsalgia or neuroma (usually at the 3rd and 4th metatarsal interspace).
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