Advanced Physical therapy
Procedures
Ahmed alhowimel
History taking ,observation
Active Functional ROM
Passive ROM
Resisted Muscle Testing
Special Tests
Special Tests
• It enables the clinician to both assemble
information and to interpret the findings in
order to assist in identifying the nature and
stage of the patient’s disease or injury,
determine the need for further investigations,
provide a prognosis, guide treatment and
measure outcome
Which test to choose!
• When you want to confirm your primary
hypothesis of e.g. Torn ACL ligament, there are
many tests available to use, good tests are
those with high Specificity and Sensitivity.
Interpreting the evidence
• Essentially, we want to know whether a
diagnostic test is accurate i.e. that it is positive
when a particular pathology is present (true
positive) and negative when it is not (true
negative). Unless the test is perfect (which
none are), it will sometimes prove positive
when pathology is not present (false positive)
or fail to reveal pathology when it is present
(false negative).
Result test
Target condition
present
Target condition
absent
Positive
A
B
Negative
C
D
•
•
•
•
A=True Positive
B=True Negative
C=False Positive
D=False Negative
Sensitivity
• Sensitivity is the proportion of people with the
condition of interest (target condition) who
have a positive test. If 100 people have the
condition, then a test that is 98% sensitive will
detect 98 of those cases and miss two.
Sensitivity is calculated using the figures from
the table
• Sensitivity= A⁄A+C
Specificity
• Specificity measures the proportion of people
without the condition of interest (target
condition) who have a negative test. If 100
people are free from the condition, then a test
that is 98% specific will correctly exclude 98 of
those cases but will incorrectly identify two
people as having the condition. Specificity is
calculated using figures from the table
• Specificity= B/B+D
Likelihood ratios
• Likelihood ratios (LR) are the best statistics to
assess the clinical usefulness of a diagnostic test
as they combine the sensitivity and specificity
into a ratio that quantifies a shift in the
probability of a condition being present or absent
in the event of a negative or positive test. As
most musculoskeletal tests have two outcomes
positive or negative we can talk about two ratios;
one for a positive test outcome (LR+) and one for
a negative outcome (LR-).
• LR+
indicates the increase in odds favoring the
target condition being present when the test
result is positive. A large LR+ indicates that the
condition is more likely to be present. This can
be calculated from the sensitivity and
specificity values:
LR+= Sen⁄1-Sp
• LRthe probability of the target condition being
present given a negative test result. A small
LR- indicates that the condition is less likely to
be present:
LR-= 1-Sen⁄Sp
LR+
LR-
Meaning
Usefulness
>10
<0.1
Generates large and Excellent
often conclusive
shift in probability
5-10
0.1_0.2
Generates
Moderate shift in
probability
Good
2-5
0.2—0.5
Generate small but
sometimes
important shift in
probability
Fair
1-2
0.5-1
Alters probability to Poor
small and rarely
important degree
Shoulder Joint
1.
2.
3.
4.
5.
Tendon Tests
Impingement Tests
LABRAL tests
Instability Tests
AC joint Tests
Tendon tests
1-Speed Test
2- Yergason’s Test
3-Empty/Full Can Test
Impingement tests
1-Neer Test
2-Hawkins–Kennedy
Labral Tests
Crank Test
Instability Tests
Apprehension and Relocation Test
ACJ Tests
Active Compression Test
Elbow Joint Tests
1- Tennis Elbow Test
2-Glofer’s Elbow Test
Wrist Tests
Finkelstein’s Tests
Phalen’s Test