CERVICAL SPINE

ROM: Flexion, Extension, Rotation, Lateral Flexion; Dermatomes: C3-T2; Myotomes: C3-T2
Name of Test
Distraction
Test

Description
Dr: - hand under pts chin; other under occiput
- slowly lifts pts head

Positive
Pain is relieved or decreased

Indication
Nerve root compression
(decreasing pressure on facet jt.)

Foraminal
Compression
Test
(Spurlings)

Pain radiating into arm toward

which the head is side flexed
during compression

Facet jt. Pathology

Maximal Foraminal
Compression Test

Dr: press straight down on head in 3 stages

unless sx elicited:
1. neutral
2. extension
3. lat. Flexion (to affected side)
Pt: side flex, rotate (same side) & extend head
Dr: compress head in this position

Pain radiating to arm

Concave Side: nerve root or facet

jt pathology
Convex Side: M. strain

Shoulder
Depression
Test

Dr:
- side flex pts head to one side
- apply downward pressure on opp. shoulder

Pain to either side

Same side: nerve root compress

Opp side: dural sleeve adhesion

Vertebral Artery Test

Generally not performed

Pt: supine
Dr: - put pts neck into extension & side flexion.
rotate neck to same side
hold for 30 sec
Pt: seated have them blow against the back of
their hand.

Dizziness or nystagmus

Vert. Art compression

Pain in Cspine or dermatome

related to Cspine injury 2dary to
increased pressure
Decrease or relief of symptoms

Space occupying lesion (e.g.

tumor, herniated disc) present in
cervical canal
Cervical extradural compression
problem

Facial muscles twitch as result of

tapping

CN 7 palsy or injury, low blood

calcium

Valsalva Test
Shoulder Abduction
(relief) Test (Bakodys
Sign)

TMJ (Jaw reflex, C5)

ROM: open/close mouth,
protrude jaw, lateral
deviation
Chvosteks Test

Pt: sitting or lying down, actively abducts arm

so hand rest on top of head
OR Dr: passively abducts arm
Pt: seated
Dr: taps on parotid gland and observes pts
reaction

Physical Medicine Special Orthopedic Tests

THORACIC SPINE
ROM: Flexion, Extension, Side Bending, Rotation; Dermatomes: C3-T2; Myotomes: C3-T2; DTRs: Biceps (C5), Brachioradialis (C6), Triceps
(C7)
Name of Test
Elevated Arm Stress Test
(EAST) (Roos/Hands Up)

Description
- ext rotate shoulders
- elbows slightly behind head
- open & close hands slowly for 3 min.

Positive
- Pain, heaviness, profound arm
weakness or numbness and
- tingling in hand

Indication
TOS

Hyperabduction
Test (Wrights)

Dr: monitors pts radial pulse

Dr: elevates pts arm up to 180 degrees

- pulse disappear / diminution

- sx elicited

TOS
(d/t subclavian a compression &
brachial plexus behind pecs minor
and under coracoid process)

Adsons Test

Dr: - abduct pts affected arm

- palpates radial pulse
Pt: - turn head towards affected side
- extend neck
- take deep breath

- pulse disappear / diminution

- sx elicited

TOS
(d/t tight scalenes)

Scapular protraction
(winging)

Pt: - pushes against a wall with both hands

with feet farther away from wall then shoulders

- scapular winging, pain and

weakness during maneuver

Costoclavicular Test

Pt: seated
Dr: - monitors pts radial pulse
- draws pts shoulder down and back as the
pt assumes a military posture
Pt: seated in neutral with arms crossed
Dr: stands behind pt, wraps arms around pt
and lifts upwards, distracting Tspine

Disappearance or diminution of
pulse or if symptoms are elicited

Serratus anterior weakness, long

thoracic N. dysfunction, lower
trapezius dysfunction
TOS, usually subclavian A. being
compressed b/t 1st rib and clavicle

Pt: - standing, feet together, straight knees

- flex forward at hips, allow arms to drop

- scoliosis improved w/ forward

flexion

Thoracic Distraction Test

**Adams Sign

Physical Medicine Special Orthopedic Tests

Diminished pain

Relief from pressure on a nerve

root by widening neural foramen;
decreasing pressure on the facet
joint; relaxing contracted muscles
Structural Scoliosis

Lumbar Spine
ROM: Flexion, Extension, Lateral Bending, Rotation; Dermatomes: L1-S2; Myotomes: L2-S2, DTR: Patellar (L4), Achilles (S1)
Name of Test
Tests to Stretch Spinal
Cord:
1. Straight Leg Raising
Test (SLR)

Description
Pt: supine, keeps knee straight
Dr: lifts involved leg up (support foot around
calc.)

Positive
Pain at 35-70 degrees

2. Well Leg Raising Test

(WLR)

Pt: supine
Dr: lifts good leg

Back and sciatic pain on opposite

side

Lasegues Test

Pt: supine/sitting
Dr: does SLR, lowers leg to just below level of
pain and adds ankle dorsiflexion (stretch sciatic
n.)
Dr: cups hand under calc of opposite foot as pt
tries to raise leg; pressure will be felt in hand if
pt really tries to lift leg

Pain radiating below knee

Absence of downward pressure

on foot opposite to the one the pt
has been instructed to lift

Pt is malingering

Kernig Test

Pt: supine, places both hands behind head and

forcibly flexes head onto chest

Sharp shooting pain in C/S, low

back, or down legs

Slump Test

Pt: seated at end of table with back straight

looking straight ahead; then slumps allowing
T/S and L/S to collapse into flexion still looking
forward; then flex C/S and extend one knee,
dorsiflex ankle; repeat opposite side
Pt: stands in straddle position with one leg
extended behind other; then leans back as far
as possible; repeat on other side
Dr: prevents pt from falling over
Pt: supine, Lifts both legs straight 2 inches
above table, holds for 30 seconds
** C/I if Disc rupture is suspected**

Radicular pain at any stage

Meningeal irritation, nerve root

involvement, or irritation to dural
coverings of nerve root
Sciatic N. root tension, disc
pathology

Pt: supine
Dr: compresses jugular veins for 10 secs until
face flushes then ask pt to cough
Pt: seated, deep breath in and blows out into
back of hand
Pt: supine

Hoover Test

Single Leg
Hyperextension Test
Tests to Increase
Intrathecal Pressure:
1. Milgram Test

2. Naffziger Test
3. Valsalva Test
Tests to Rock SI Joint:

Physical Medicine Special Orthopedic Tests

Pain at >70 degrees

Indication
IVD pressure on sciatic n (us. Lat
herniation)
SI joint pain

Space Occupying Lesion i.e.

herniated disc (us.
Med herniation)
Disc herniation, neural
impingement, sciatica

Pain exacerbated with it more

severe when affected side is
extended posteriorly

Spondylolysis or spondylolisthesis

Affected limb cannot be held for

30 sec or sx are reproduced

Intrathecal pathology
i.e herniated disc

Pain increases with coughing

Increases in intrathecal pressure

(space occupying lesion, SOL)

Pain in back or down legs

SOL causing increase in

intrathecal pressure
SI joint pathology

Pain around SI joint

1. Pelvic Rock Test

Dr: places hands on iliac crests with thumbs on

PSIS and palms on iliac tubercles; forcibly
compresses pelvis to midline

2. Gaenslens Test

Pt: supine, knees to chest with one buttock

over side of table, allow unsupported leg to
drop to floor
Dr: applies over pressure to stretch leg

Pain in SI joint or hip

SI joint or hip pathology

3. Patrick Faber Test

Pt: supine
Dr: places foot of involved side on opposite
knee; applies over pressure down on flexed
knee and the opposite side ASIS

Increased pain SI joint or hip

SI joint or hip joint pathology

Hip and Pelvis

ROM: Flexion, Extension, Abduction, Adduction, Int/Ext Rotation; Dermatomes: L1-S2; Myotomes: L2-S2, DTR: Biceps (C5),
Brachioradialis (C6), Triceps (C7)
Name of Test
Trendelenburg Test

Description
Dr: stands behind pt and observes PSIS
dimples or place thumbs on PSIS
Pt: stands on one leg

Positive
Pelvis on unsupported side
remains in position or descends

Indication
Weak or nonfunctioning Glute
Medius on supported side

Obers Test

Pt: sidelying with involved leg on top; abduct

leg, flex knee to 90 degrees keeping hip jt in
neutral
If IT band is normal, thigh should drop to
adducted position
Pt: supine with pelvis level and square to trunk;
flexes both knees to chest then extends one leg
and lets it rest on table
Dr: places hand under lumbar spine feeling for
flattening of L/S

Thigh remains abducted when leg

is released

IT band contracture

Leg remains flexed, will not lie

flat on table

Tight hip flexors (Iliopsoas)

Elys Test

Pt: prone, knee flexed

Hip on ipsilateral side will

spontaneously flex

Rectus femoris contracture,

femoral n. irritation (if radicular
sxs present)

Fabers Test

See tests to rock SI jt

Thomas Test

Physical Medicine Special Orthopedic Tests

Tests for Congenital Hip

Dislocation:
1. Ortolani Click (new
born)

Dr: Flex, abduct, ext rotate hips

Involved hip clicks and is unable

to be abducted as far as other
hip

Congenital hip dislocation

2. Telescoping Test

Dr: applies traction to femur at knee level;

other hand stabilizes pelvis placing thumb on
greater trochanter (should be able to feel gt
move distally as traction applied)
Dr: flex pts hips to 90 and abduct them

Abnormal to and fro motion of GT

telescoping

Congenital hip dislocation

Lmtd abduction (20 degrees or

less)

Congenital hip dislocation

3. Adduction Contracture

Shoulder
ROM: Flexion, Extension, Abduction, Adduction, Ext Rotation, Int Rotation, Scapular Elevation; DTR: Biceps (C5), Brachioradialis (C6),
Triceps (C7)
Name of Test
RC Impingement
1. Neer
Impingement
Sign

Description
Dr: - stabilize pts shoulder on top with hand
- forward flex humerus to 180o then
internally rotate arm

Positive
Pain in shoulder

Indication
RC impingement (usually
supraspinatous or biceps tendon)

2. Full Can Test

Pt: - abducts both arms to 90o & forward flexes

45o with thumbs pointing to ceiling
Dr: - applies downward pressure to arms

Weakness, pain, or dropping of

arm, which occurs in significant
tears of supraspinatus muscle
with even a gentle tap to forearm

Supraspinatus tendon tear

3. Empty Can Test

Same as full can but with thumbs down

4. Painful Arc

Pt: abducts arms overhead as far as they can

go, bringing them out laterally

Pain with shoulder abduction b/t

80-100o

Glenohumeral Instability
1. Ant Apprehension Sign

Pt: supine
- abducts arm 90o, elbow flexed 90o
Dr: force forearm into ext rotation past 90o

Pain in shoulder, apprehension on

pts face

Rotator cuff impingement (if pain

after 100o=AC jt pathology; if
pain immediately=adhesive
capsulitis or shoulder trauma)
Anterior GH dislocation

Physical Medicine Special Orthopedic Tests

2. Post Apprehension
Sign

Pt: place hand of affected arm on opp shoulder

Dr: push posteriorly on elbow (down)

Pain in shoulder, apprehension on

pts face

Posterior GH dislocation, anterior

dislocation

3. Sulcus sign

Dr: grasping pts elbow apply inf traction

AC Joint
1. Cross Arm Test

Dr: - passively adduct pts arm across chest

wall with humerus parallel to floor (pts hand
will rest on opposite shoulder)
- apply downward resistance to elbow
Pt: flex arm to 90o and adduct to 10-15o with
thumb down
Dr: apply downward resistance to arm
Repeat with thumbs up
Dr: observe rhytym as pt abducts arm over
head
Pt: push-up performed at wall

Indentation appears in area

beneath acromium
Pain with end-range adduction or
with pushing against resistance

Inf instability, multidirectional

instability
Acromioclavicular joint pathology

Pain in ac joint or shoulder during

1st maneuver that improves or
resolves with 2nd maneuver

If pain is in AC joint=AC joint

pathology; if pain is more
internal in shoulder=labral
pathology
Scapulothoracic pathology

2. Active Compression
Test
Scapulothoracic
1. ROM
2. Scapular Winging

Movement in 1st 30 =abnormal

Scapular wings

Weakness of serratus ant or long

thoracic N.
Unstable bicipital tendon and
subluxation

Bicipital Tendon
1. Yergasons
Test

Pt: sit with elbow at side, forearm flex to 90o.

Dr: - palpate long head of bicep with one hand
and wrist with other hand.
- supinate and flex arm against resistance

Tendon pops out of groove and

causes lots of pain

2. Speeds Test

Pt: - shoulder in 90o forward flexion, elbow

extended, hand supinated
Dr: - apply resistance downward

Pain in bicipital groove

Bicipital tendon pathology

(usually tendonitis)

Subscapularis Injury
1. Napoleon Sign
2. Gerbers (Liftoff) Test

Pt: places arm on ST and pushes against it

Elbow will drop backward

Subscapularis weakness or injury

Pt: put hand behind lumbar spine and attempt

to lift hand away from back
Pt: supine
Dr: apply ant force to humeral head, other
hand holds distal humerus & rotates it.
Passively abduct pts arm over head???
See AC joint pathology

If patient cannot accomplish liftoff

Subscapularis weakness or injury

Clunk or grinding in shoulder

Labral pathology

Labral Pathology
1. Clunk Test
2. Active Compression
Test

Physical Medicine Special Orthopedic Tests

Elbow
ROM: Flexion, Extension, Supination, Pronation; Dermatomes: C3-T2; Myotomes: C3-T2; DTRs: Biceps (C5), Brachioradialis (C6), Triceps
(C7)
Name of Test
Valgus Stress Test

Description
Dr: - cup post elbow & hold wrist in other hand
- hand at wrist forces forearm laterally
- Assess at 0, 30 and 90o

Positive
Pain, increased medial joint
gapping

Indication
Sprain/pathology of MCL

Varus Stress Test

Same as above except forcing forearm medially

Pain, increased lateral joint

gapping

Sprain/pathology of LCL

Mills Test

Dr: extend pts elbow, pronate & flex wrist

Pain at lat epicondyle

Lat epicondylitis, Ext m. strain

Tinel sign

Dr: Tap ulnar n b/t olecranon and med

epicondyle

Tingling down forearm in ulnar n

distribution

Ulnar n neuroma

Tennis elbow test

(Cozens Test)

Pt: makes fist, pronates, radially deviates and

extends wrist.
Dr: attempts to force wrist into flexion against
pts resistance

Sudden severe pain at lat

epicondyle (common ext origin)

Lat epicondylitis (Tennis elbow)

Ulnar N. Instability

Dr: - place pts arm in abduction and ext

rotation
- palpate ulnar n. at ulnar groove while
flexing & extending pts arm repeatedly

Will feel nerve as it subluxes out

of ulnar groove

Ulnar n. instability

Hand and Wrist

ROM: Flexion, Extension, Ulnar Deviation, Radial Deviation, Supination, Pronation; Neuro: Radial, Median, Ulnar
Name of Test
Allens Test

Description
Pt: opens/closes hand multiple times then
makes fist
Dr: - holds down radial & ulnar as with thumb
& index finger
- let go of tested a. = pts hand should go
pink on same side
Repeat other side

Physical Medicine Special Orthopedic Tests

Positive
Skin stays white on tested side,
no apparent return of BL flow
after decompression of a.

Indication
Vascular compromise to radial or
ulnar a.

Bunnel-Littler Test

Dr: stabilize pts hand around MCPs, move

PIPs into flexion
If no flexion move MCPs into slight flexion
and attempt to flex PIPs
Pt: make fist with thumb tucked in
Dr: deviate wrist in ulnar direction

Inability to flex PIPs

Phalens Test

- places dorsal aspect of hand against dorsal

aspect of other hand (flexion at wrists)
- hold for >30 sec
- report changes in sensation/pain

Reproduction of neurological sx

Carpal Tunnel Syndrome (CTS)

Tinels Sign

Pt: seated with both wrists facing up on lap

Dr: tap transverse carpal lig with reflex
hammer or reinforced finger

Paresthesia in median n.
distribution with percussion

CTS

Finkelsteins Test

Pain in the area of the first dorsal

compartment

Tight intrinsic m. or contracture

of jt. Capsule
2nd step: if PIPs still cannot flex
fully=contracture of jt. capsule
First dorsal compartment
stenosing tenosynovitis (AbPL
and EPB) DeQuervains
tenosynovitis

Knee
ROM: Flexion (A: squat in deep knee bend), Extension, Medial Rotation, Lateral Rotation; Dermatomes: L1-S2; Myotomes: L2-S2; DTR:
Patellar (L4), Achilles (S1)
Name of Test
Collateral Ligament
Stability Test

Description
Dr: supports pts ankle and applies valgus
stress to knee to test MCL; then varus stress to
knee to test LCL
Perform first in full extension (to test
ligament), then in 30 degrees of flexion (to
test joint capsule)
Pt: supine, flex knees and hips
Dr: sits on pts foot, places hand around knee
with thumbs in eyes of knee; applies ant force,
then post force to tibia on femur

Positive
Excess movement/pain to medial
or lateral knee

Indication
MCL/LCL damage

Excess movement of tibia on

femur

Ant drawer: ACL instability

Post drawer: PCL instability

Lachman Test

Pt: supine with involved leg beside Dr

Dr: holds pt knee b/t full extension and 30
degrees flexion; one hand stabilizes femur,
other hand moves prox tibia forward

Mushy/soft end feel when tibia is

moved forward and infrapatellar
tendon slope disappears

ACL (esp the posterolateral band)

Slocum Test

Pt: same position as drawer tests

Dr: medially rotate foot 30 degrees, sit on pts
foot and draw knee forward, then same with
foot laterally rotated
Pt: supine; knee completely flexed
Dr: supports pts knee with one hand while
applying valgus force; other hand externally
rotates tibia while taking knee out of flexion;
repeated with varus force and int rotation

Excess mvmt on lat knee with

med rotation of foot and excess
mvmt on med knee with lat
rotation of foot
Snap/Click/Pain to med or lat
knee

Anterolateral rotary instability

(potential damage to ACL, LCL)
OR Anteromedial rotary instability
(potential damage to ACL, MCL)
Med/lat meniscus damage/tear

Valgus / Varus Tests

Ant/Post Drawer Test

McMurrays Test
Medial
Lateral

Physical Medicine Special Orthopedic Tests

Bounce Home Test

Pt: supine, knee flexed with heel of foot cupped

in Drs hand
Dr: Allows pts knee to passively extend

Incomplete extension or rubbery

end feel (something blocking full
extension)

Torn meniscus

Apleys Compression Test

Pt: prone knees flexed 90 degrees

Dr: laterally rotates tibia and pushes down;
repeat with medial rotation

Pain on med side with lat rotation

or pain on lat side with med
rotation

Medial or lateral meniscus

pathology

Apleys Distraction Test

Same as above but pulling up.

Dr: stabilizes pts thigh by placing knee on it;
rotate tibia internally, then externally

Pain in collateral ligs, excess

motion

Collateral ligament sprain

** If pain with As Compression
but not with As Distraction
helps confirm meniscus injury

Apprehension Test

Pt: supine, quads relaxed, knee flexed to 30

degrees
Dr: presses patella laterally

Pain, apprehension

Chronic patellar dislocation

Patella Femoral
Grinding Test (Clarks)

Pt: supine, slowly contracts quads

Dr: presses down on patella

Grinding under patella, pain

Patellar chondromalacia

Knee Jt Effusion Tests:

1. Bulge Test
(Brush/Stroke Test)
(MINOR Effusion)

Pt: seated
Dr: milks medial side of patella, pushing
superiorly; then strokes inferiorly on lat side of
patella

Fluid wave on distal medial side

of patella (may take 2 seconds to
appear)

Minor effusion

2. Ballotment Test
(Patellar Tap Test)
(MAJOR Effusion)

Pt: supine, leg extended or flexed to discomfort

Dr: applies pressure over patella

Patella feels like its floating or

theres a click or stopping when
patella strikes patellar femoral
groove

Major effusion

Physical Medicine Special Orthopedic Tests

Ankle and Foot

ROM: Ankle (Dorsiflexion: heel walk; Plantar Flexion: toe walk), Subtalar (Inversion: walk on lat foot; Eversion: walk on med foot), Midtarsal
(Adduction/Abduction: assessed during inv/ever), 1st MTP jt (flex/ext); Dermatomes: L1-S2; Myotomes: L2-S2; DTR: Patellar (L4), Achilles
(S1)
Name of Test
Rigid or Supple/Flat Feet
Tests

Description
Dr: Observe pt as they: stand normally, stand
on toes, seated

Positive
Absent arch in all 3 positions
Absent arch while standing

Indication
Rigid flat feet
Supple flat feet

Tibial Torsion Test

Pt: supine, rotate leg so patella points

anteriorly, palpate apices of malleoli; form
angle of line b/t malleolar apices and parallel to
floor through heel. Normal is 15o ext rotation.

>18 degrees
<13 degrees

Toe out torsion

Toe in torsion

Forefoot Adduction
Correction Test

Pt: sitting with parent

Dr: hold calcaneous with one hand and attempt
to abduct forefoot beyond neutral position

Unable to move foot into neutral

position or less

Structural foot defect on infants

with significant forefoot
adduction; will likely need cast
correction

Dorsiflexion
(DF) Test

Pt: seated
Dr: flexes pts knee and attempts to DF ankle

DF of ankle in seated position

Inability to DF in any position

Homans Sign

Pt: supine, knee extended

Dr: forcibly DFs pts ankle (and palpate calf)

Pain in calf region

Gastrocs hypertonicity
Soleus hypertonicity
* performed to DDX b/t gastrocs
and soleus (if pt cannot DF)
DVT

Thompsons
Squeeze Test

Pt: prone
Dr: squeezes pts gastrocs toward midline on
either side

Lack of plantar flexion of ankle

Achilles tendon rupture

Anterior drawer Test

Pt: supine, feet off table

Dr: stabilizes tib and fib, holds foot in 20
degrees of plantar flex and draws talus
anteriorly (up) in the ankle mortise, repeats
with DF

Excessive ant motion, or feel a

clunk

Ant Talofibular ligament damage

Physical Medicine Special Orthopedic Tests

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