SPECIAL TESTS

SHOULDER TEST Yergason EXECUTION Sitting, shoulder in neutral against trunk, elbow at 90, FA pron. Resist sup of FA and ER of shoulder Sitting or standing, UE in ext and FA sup. Resist shoulder flex. Or: Shoulder in 90 flexion. Push UE to ext eccentric contraction biceps Sitting Shoulder passively IR then fully abd Sitting, shoulder at 90, no rot. Resist shoulder abd. Place shoulder in empty can pos (IR & 30 fwd or hor add), resist abd Sitting. Shoulder passively abd 120, pt instructed to bring arm to side Supine. Move shoulder 90 abd, max ER, 15-20 hor add Supine, shoulder in full abd. Push humeral head ant while ER humerus. Supine, shoulder in 90 abd. Slowly take shoulder to ER. Supine, shoulder abd 90, scapula stabilized by table. Place post force on elbow while moving shoulder to IR and hor add at the same time Sitting, arm resting at side. PT clasps hand, place heel of 1 hand on spine of scapula and heel of other hand on clavicle. Squeeze hands to compress AC joint. Sitting. Find radial pulse of extremity tested. Rotate head toward extremity being tested. Ext and ER shoulder while ext head. Sitting. Find radial pulse of extremity tested. Move shoulder down and back. Sitting. Find radial pulse of extremity tested. Move shoulder to max abd and ER. Take deep breath and rot head opposite side. Standing, shoulders fully ER, 90 abd, slight hor abd, elbows flex 90. Open/close hands 3 minutes slowly. POSITIVE FINDING LH biceps pops out. Pain in LH biceps. Pain LH biceps INDICATION Checks integrity of trans lig. Bicipital tendonitis. Bicipital tendonitis / tendonosis Impingement LH biceps and supraspinatus Tear / impingement supraspinatus or suprascapular N neuropathy Tear rot cuff Impingement rot cuff and >tub or post glenoid & labrum Glenoid labrum tear Previous ant shoulder dislocation Prev post shoulder dislocation AC jt dysfunction

Speeds (biceps straight arm)

Neers impingement Supraspinatus (empty can)

Pain in shoulder Pain in supraspinatus while in empty can position. Unable to lower arm back to side Pain in post shoulder Audible clunk heard Px wont allow movt in that direction Px wont allow movt in that direction Pain in AC joint.

Drop arm

Post internal impingement Clunk Ant apprehension Post apprehension

AC jt shear

Adson

Pulse disappear

Pathology of structures passing through thoracic inlet Same as above Same as above

Costoclavicular (Military brace) Wright (hyperabduction)

Pulse disappear Pulse disappear

Roos

Pulse disappear Reproduction of neurological sxs

Same as above Peripheral N compression

Upper limb tension

ELBOW TEST Ligament instability

Lat epicondylitis Med epicondylitis Tinels sign Pronator teres syndrome

EXECUTION Sitting or supine. UE supported and stabilized. Elbow in 20-0 flex. Valgus force placed thru elbow for ULNAR COLLATERAL, varus for RADIAL COLLATERAL Sitting elbow in 90 flex, supported and stabilized. Resist wrist ext, wrist rad dev, FA pron & fingers flex Sitting, elbow in 90 flex, supported and stabilized. Passive sup FA, ext elbow, ext wrist Tap region where ulnar N passes in cubital tunnel Sitting, elbow in 90 flexion, supported and stabilized. Resist FA pronation and elbow ext simultaneously.

POSITIVE FINDING Laxity and pain

INDICATION Identifies ligament laxity or restriction Tennis elbow Golfers elbow Ulnar N dysfunction at olecranon Median N entrapment in pronator teres

Pain in lat epic Pain med epic Tingling sensation in ulnar distribution Tingling or paresthesia in median N distribution

WRIST AND HAND TEST EXECUTION Finkelstein Make a fist, thumb within confines of fingers. Passively move wrist in ulnar dev. Bunnel_littler MCP jt stabilized in slight ext. PIP jt flex. MCP jt flex. PIP jt flex. PIP stabilized in neutral while DIP flex. PIP flex, DIP flex. Fingers supported and stabilized. Valgus and varus forces applied to PIPJ in all digits. Repeat at DIPJ. Grasp paper between 1st and 2nd digits hand. Pull paper out. Tap region where median N passes thru carpal tunnel. Maximally flexes B wrist for 1 min. Sitting, hand stabilized. Use calliper, apply to palmar aspect of fingers to assess ability to distinguish between 2 points. Record smallest difference that pt can sense 2 separate points. Pt close/open fingers quickly several times. Close fist. PT occlude ulnar artery, px open hand. Observer palm then release compression. Observe vascular filling.

POSITIVE FINDING Pain in wrist Flex limited (B)- tight capsule More PIP flex then MCP flex intrinsic ms tight Flex limited (B) tight capsule. More DIP flex with PIP flex tight retinacular ligaments Laxity and pain. IP flex thumb Tingling or paresthesia median N distribution Same as above Normal is <6mm

INDICATION de Quervain tenosynovitis (APL, EPB) Tightness structures in MCP jt Tightness around IPJ

Tight retinacular

Ligamentous instability Froments sign

Ligament laxity or restriction Ulnar N dysfunction Weak adductor pollicis Carpal tunnel compression of median N Same as above Identify level of sensory innervations within the hand Vascular compromise

Tinels

Phalen 2-pt discrimination

Allen

Normal change in color from white to normal appearance of palm.

HIPS TEST Patricks FABER EXECUTION Supine. Passively flex, abd and ER test leg, foot above knee on opposite leg. Lower testing leg down on table surface. Supine, hip in 90 flex and knee max flex. Place compressive load to femur via knee jt. Standing. Stand on one leg, flex opposite knee. Supine, one hip and knee max flex to chest and held there. Opposite limb kept straight on table. Observe if hip flex on straight leg as opp limb is flex. Sidelying, lower limb flex at hip and knee. Passive ext and abd testing hip with knee flex to 90. Slowly lower uppermost limb. Observe if reaches table. Prone. Knee of test limb is flex. Observe hip of test limb. Supine, hip and knee test limb in 90 flex. Passive ext knee of test limb until barrier is encountered Supine. Foot of test leg passively placed lat to opp limbs knee. Testing hip abd. Supine. Pelvis aligned with lower limbs and trunk. Measure distance from ASIS to lat mal on each limb several times. Prone, knee flex to 90. Palpate >troch, slowly move hip IR/ER. >troch lat, stop, measure angle leg perpendicular to table POSITIVE FINDING Involved knee unable to assume relaxed position. Reproduction of painful sxs. Pain in hip jt. Ipsilateral pelvis drops when lower limb support is removed while standing. Straight limbs hip flex and/or unable to remain flat on table when opp limn is flex. Uppermost limb unable to rest on table. Hip test limb flex. Knee unable to reach 10 from neutral (lack 10 ext) Test knee unable to pass over resting knee. Reproduction of pain in buttock or sciatic N dist. INDICATION Identify hip dysfunction (mobility restriction) Hip DJD Gluteus medius weakness Unstable hip Tight hip flexors

Grind (Scouring) Trendelenburg

Thomas

Ober

Tight TFL or ITB

Elys 90-90 hamstring Piriformis

Tight rectus femoris Tight hamstrings Piriformis syndrome

Leg length

True LLD N angle 8-15 hip IR. <8- retroverted hip >15-anteverted hip AbN femoral antetorsion angle

Craig

KNEE TEST Collateral ligament instability Lachman stress Pivot shift

EXECUTION Supine. Lower limb supported, stabilized. Knee 20-30 flex. Valgus force test MCL Varus force - LCL Supine. Testing knee flex 20-30. Stabilize femur and passively glide tibia ant. Supine. Test knee ext, hip flex and abd 30, slight IR. Hold knee with one hand and foot with other hand. Place valgus force through knee and flex knee.

POSITIVE FINDING Laxity and pain

INDICATION Ligament laxity or restriction ACL integrity ACL integrity

Excessive ant glide tibia. Tibia relocating during test. As knee is flexed, tibia clunks bwd 30-40. Tibia at beginning of test was subluxed then reduced by pull of ITB as knee was flexed Tibial sag relative to femur. Excessive posterior glide Ligament laxity. Click/pain knee joint Pain/decreased motion during compression

Posterior sag Posterior drawer Reverse lachman McMurray

Apley

Supine. Test hip flex 45 and knee flex 90. Supine. Test hip flex 45 and knee flex 90. Passively glide tibia post following the jt line. Prone. Knees flex 30. Stabilize femur. Passively glide tibia posteriorly. Supine. Test knee in max flex. Passively IR and ext knee (for lat meniscus). ER (for med meniscus) Prone. Testing knee flex to 90. Stabilzie thigh to table with PTs knee.

PCL integrity PCL integrity PCL integrity Meniscal tear Differentiate between mensical tears and

Hughston plica

Patellar apprehension Clarkes sign

Passively distract joint then rotate tibia int and ext. Apply compressive load to knee and rotate tibia int and ext. Supine. Resting knee flex with tibia IR. Passively glide patella medialy, palpate MFC. Feel for popping as knee is passively flex and ext. Supine. Patella passively glided laterally. Supine. Knee in ext resting on table. Push posterior on sup pole of patella. Px to perform active contraction quads. Supine. Knee in ext and resting on table. Soft tap over central patella. Supine. Knee in ext resting on table. Place 1 hand over suprapatellar pouch and ant knee jt. Alternate pushing down with one hand at a time.

MECHANICAL If during distraction LIGAMENTOUS Pain or popping Px does not allow patella to move in lat direction Pain. Perception of patella floating (dancing patella) Fluctutation (movement) of fluid N men 13 Female 18 Pain over LFC at approximately 30 flex. Tingling or paresthesia into leg following common fibular nerve distribution

ligamentous lesions. Plica dysfunction Hx of patellar dislocation Patellofemoral dysfunction Infrapatellar effusion Knee joint effusion

Ballotable patella Fluctuation test

Q-angle Noble compression Tinels sign Supine. Hip flex 45 and knee flex 90. Apply pressure to LFC then ext knee. Tap region where common fibular nerve passess through posterior to fibula head

ITB friction syndrome Common fibular nerve poste to fibular head dysfunction

ANKLE AND FOOT TEST EXECUTION Neutral subtalar Prone. Foot over edge of table. positioning Palpate dorsal aspect of talus on both sides with 1 hand. Grasp lat forefoot with other hand. DF foot until resistance felt. Move foot to supination and pronation. Ant drawer test Supine. Heel off edge of table in 20 PF. Stabilize lower leg and grasp foot. Pull talus ant. Talar tilt Sidelying. Knee flex and ankle in neutral. Move foot to adduction testing calcaneofibular and abduction testing deltoid. Thopmson Prone. Foot off edge of table. Squeeze calf muscles. Tinels sign Supine. Foot supported on the table. Tap over region of posterior tibial N as it passes posterior to medial malleolus. Tap over region of deep fibular N as it passes under dorsal retinaculum (ant to ankle jt) Supine. Foot supported on table. Grasp metatarsal head. Squeeze.

POSITIVE FINDING Neutral position is point at which you feel foot fall off easier to 1 side or other. Talus has excessive ant glide and / or pain. Excessive adduction or abduction and/or pain. No movement of foot while squeezing calf. Tingling and/or paresthesia

INDICATION Determine abN rearfoot or forefoot positioning Ligamentous instability Ligamentous instability (calcaneofibular) Achilles tendon Dysfunction of posterior tibial N posterior to med mal or deep fibular N ant to talocrural jt Stress fx or neuroma

Morton

Pain in forefoot.

SPINE, PELVIS, TMJ TEST EXECUTION Vertebral artery Supine. Head supported on table. - Ext head and neck for 30sec. If no change in sxs... - Ext head and neck with rotation L and R for 30sec. If no change in sxs... - Head cradled off table. Ext head and neck for 30sec. If no change in sxs.. - Head cradled off table. Ext head and neck with rotation to L for 30sec. Repeat with rot to R. Hautant - Sitting. Shoulders 90 and palms up. Px closes eyes and remain in position for 30sec. - Sitting. Shoulders 90 and palms up. Px close eyes and cue into head and neck ext with rotation R then L remaining in each position for 30sec. Transverse Supine. Head supported on table. ligament Glide C1 ant. Should have firm endfeel Ant shear Supine. Head supported on table. Glide C2 to C7 anteriorly. Should have firm endfeel. Sitting. Head side bent toward uninvolved side. Apply pressure through head straight down. Repeat with head side bent on involved side. Sitting. Passively move head to side bending and rotation towards painful side followed by ext. Repeat on other side. Sitting. Head passively distracted. Sitting. Place 1 hand on top of head. Repeat with opposite hand. Long sitting on table. Passively flex head and 1 hip, keeping knee in ext. Repeat on opposite side. Standing and close eyes for 30 secs Prone. Begin at upper ribs applying a posterior/anterior force through each rib progressively working through entire rib cage. Follow by side lying and repeat. Prone. Apply posterior/ant glides/springs to trans process of thoracic vertebra. Sitting on edge of table knees flex. Px slump sits while maintaining neutral position of head and neck. - Passively flex head and neck. - Extend one of knees. - Passively DF ankle of limb of ext knee Supine. Legs resting on table. Passively flex hip of 1 leg with knee ext until px complains of pain into lower limb. Slowly lower limb until pain subsides, passively DF foot

POSITIVE FINDING Dizziness. Visual disturbance. Disorientation. Blurred speech. Nausea and vomiting.

INDICATION Vertebrobasilar system

Arms lose position.

Vestibular versus vascular causes of vertigo

Foraminal compression (Spurling) Maximum cervical compression

Soft end feel. Dizziness, nystagmus, lump sensation in throat, nausea. Laxity of ligaments. Diziness, nystagmus, lump sensation in the throat, nausea. Pain/paresthesia Pain/paresthesia

Transverse ligament Upper cervical spine ligaments and capsules Compression of cervical nerve roots Compression of neural structures at IV foramen or facet jt dysfunction Compression of neural structures at IV foramen or facet jt dysfunction Compression of neural structures within IV foramen. Spinal cord dysfunction or UMNL UMNL Rib mobility

Distraction

Decrease in sxs in neck (facet) or in upper limb pain (neurological) Decrease in sxs in upper limb. Pain down the spine and upper or lower limbs Excessive swaying during test Pain, excessive motion of rib or restriction of rib.

Shoulder abduction Lhermittes

Rombergs Rib springing

Thoracic springing Slump test

Pain, excessive movement, and or restricted movement Reproduction of pathological neurological sxs

IV jt mobility in thoracic spine Dysfunction of neurological structures supplying LEs

Lasegue(SLR)

Reproduction of pathological neurological sxs when foot is DF

Dysfunction of neurological structures supplying LEs

Femoral nerve traction

Valsalva maneuver Babinski

Quadrant test

Stork standing McKenzie side glide

Bicycle (van Gelderen)

Gillets

Ipsilateral ant rotation

Gaenslen

Long sitting

Goldthwait

TMJ Compression

Lies on nonpainful side. Trunk in neutral, head flex slightly, and lower limbs hip and knee flex. Passively extend hip while knee of painful limb is in ext. If no reproduction of sxs, flex knee of painful leg. Sitting. Take deep breath. Hold while bare down. Supine or sitting. Glide bottom of reflex hammer on plantar surface of foot Standing. IVF: Side bending to L, rotation L, ext to max close IVF on L Facet dysfunction: Side bending L, rotation R, ext to max compress facet on L. Standing on one leg. Trunk extension. Repeat. Standing. Stand on side of patient that upper trunk is shifted toward. Place ur shoulder to pxs upper trunk and wrap ur arms around pxs pelvis. Stabilize upper trunk and pull pelvis to bring pelvis and trunk to proper alignment. Seated on stationary bike. Ride bike while sitting erect and time how long they can ride at a set pace/speed. Rest. Bike in slumped position. Standing. Place thumb of hand under PSIS of limb to be tested and place other thumb on center of sacrum at same level as thumb under PSIS. Px flex hip and knee of limb tested. Assess movement of PSIS comparing positions of thumb. PSIS should move in inf direction Place thumb under PSIS of test limb and place other thumb in center of sacrum at same level as thumb under PSIS. Px extend hip of test limb Assess movement of PSIS via comparison of positions of ur thumbs. PSIS should move in sup direction Sidelying at edge of table while holding bottom leg in max hip and knee flex. Stand behind px, passively ext hip of upper most limb. Supine with correct alignment of trunk, pelvis and lower limbs. PT stand at edge of table by pxs feet palpating the medial malleoli to assess symmetry. Px comes to long sitting then assess leg lengths. Compare supine and sitting. Supine. Fingers in between spinous processes of lumbar spine. Other hand passively perform SLR. Sitting or supine. Support pxs head with 1 hand and with other hand push mandible sup causing compressive load to TMJ

Neurological pain in ant thigh Dysfunction of neurological structures supplying Les Extension of big toe and splaying of other toes Pain / paresthesia in dermatomal pattern for involved nerve root or localized pain if facet dysfunction. Pain in low back with ipsilateral leg on ground. Reproduction of neurological symptoms as alignment of trunk is corrected. If related to spinal stenosis, should be able to ride longer while slumped. No identified movement of PSIS compared to sacrum

Compression of femoral N Space-occupying lx UMNL Compression of neural structures at IVF and facet dysfunction

Spondylolisthesis Differentiate between scoliotic curve versus neurological dysfunction causing lateral shift of trunk Differentiate between intermittent claudication and spinal stenosis Assess posterior movement of ilium relative to sacrum

No identified movement of PSIS compared to sacrum

Assess ant movement of ilium relative to sacrum

Pain in SIJ Reversal in limb lengths between supine as compared to long sit.

SIJ dysfunction Dysfunction of SIJ causing functional LLD

Pain prior to palpation of movement in lumbar segment = SIJ Pain in TMJ

Differentiates between dysfunction in lumbar spine versus SIJ Compression of retrodiscal tissues.