Orthopedic Tests
Cervical
Cervical ROM
Flexion - 45°
Extension – up to 55°
R & L lateral bending – 40°
R & L rotation – 70°
O’ Donoghue Maneuver
Patient seated
Cervical spine actively moved through resisted ROM
Pain – muscle strain
Cervical spine actively moved through passive ROM
Pain – ligamentous sprain
Spinal Percussion Test
Patient seated, head slightly flexed
Tap each spinous
Localized pain – possible fracture
Radicular pain – possible disc lesion
Pain can also indicate sprain or strain
Soto-Hall Sign
Patient supine
Inferior hand on sternum with slight pressure to stabilize thoracic and lumbar
Superior hand under patient occiput and flex head to chest
Pain in cervical – subluxation, disc, sprain or strain, vertebral fracture, meningeal
irritation
Valsalva Maneuver
Patient seated
Patient takes deep breath and holds it while bearing down
Pain – increased intrathecal pressure due to space-occupying lesion (disc, tumor,
osteophytes)
Rusts’ Sign
If patient spontaneously grasps the head when lying down or arising
Indicates severe sprain, rheumatoid arthritis, fracture, severe cervical subluxation
Confirm with diagnostic imaging
Foraminal Compression Test
Patient seated
Exert downward pressure while head rotated L & R and then neutral
Causes closure of IVF
Localized pain – foraminal encroachment
Radicular pain – pressure on nerve root
Jackson Cervical Compression Test
Patient seated
Rotate and extend neck while pressure down through the vertex
Positive if localized pain radiates down arm
Caused by space-occupying lesion, subluxation, inflammatory swelling, DJD, tumor, disc
Maximal Cervical Compression Test
Patient seated
Patient rotates neck and hyperextends neck
Pain concave – nerve root or facet
Pain convex – muscular strain
Spurling’s Test
Patient seated
Head flexed toward side of complaint
Downward pressure applied and steadily increased
Not bilateral
Shoulder Depression Test
Patient seated
Hold down patients shoulder and laterally flex cervical spine away from shoulder
Radicular pain – adhesions of dural sleeves, nerve root, adjacent structures of joint
capsule of shoulder
Distraction Test
Patient seated
Cup occiput and mandible and lift patient head for 30 – 60 seconds
Increased pain – muscle spasm
Relief of pain – nerve root compression, joint capsule pressure
Bakody Sign
Patient seated
Patient actively places palm of affected arm on head with elbow level with head
Relief of pain – nerve root compression, brachial plexus compression
VBA (HC Exam Form)
VBA Functional Maneuver
Patient seated
Auscultate carotid and subclavian arteries for pulsations & bruits
Presence of either - positive
If neither exist, patient rotates and hyperextends neck
Positive – vertigo, dizziness, visual blurring, nausea, faintness, nystagmus due to
vertebral, basilar or carotid artery stenosis or compression
Hautant’s Test
Patient seated
Extend arms out, palms up
Eyes closed, patient rotates and extends neck
Positive – drifting of arms, vertigo, blurred vision, nausea, syncope, nystagmus
Indicates vertebral, basilar or carotid artery stenosis or compression
Underberg’s Test
Patient standing
Extend arms out, palms up
Eyes closed, patient rotates and extends neck, patient marches in place
Positive – loss of balance, dropping arms, pronation of hands
Indicates vertebral, basilar or carotid artery stenosis or compression
De Kleyn’s Test
Patient supine
Head off table, patient rotates and extends neck and holds for 15 – 45 seconds
Positive – vertigo, blurred vision, syncope, nystagmus
Indicates vertebral, basilar artery stenosis or compression
Hallpike Maneuver
Patient supine
Head off table supported by doctor
Bring head into: extension, rotation, lateral flexion and hold them for 15 – 45 seconds
Allow patient head to hyperextend freely off table
Positive – vertigo, blurred vision, nausea, syncope, nystagmus
Indicates vertebral, basilar artery stenosis or compression
Barre-Lieou Sign
Patient seated
Patient rotates head from side to side repeatedly, increasing in speed
Positive – vertigo, dizziness, visual disturbances, nausea, syncope, nystagmus
Indicates buckling of ipsilateral vertebral artery
Thoracic Outlet Syndrome
Adson’s Test
Patient seated
Arm slightly abducted
Check radial pulse while patient rotates toward that side and hyperextends neck
Patient holds breath
Positive – loss of pulse
If negative repeat with head rotated to opposite side
Costoclavicular Maneuver
Patient seated
Palpate radial pulse bilaterally
Doctor extends patients shoulders, patient flexes cervical spine
Positive – pulse lost in affected arm
Indicates – TOS
Wright’s Test
Patient seated
Arm abducted 180° white palpating radial pulse
Note at what angel loss or diminished pulse occurs, compare to other side
Positive – affected side diminishes earlier
Indicates neurovascular compromise of axillary artery seen in TOS
Traction Test
Patient seated
Stand behind patient and palpate radial pulse
Using other hand, traction arm down by grasping the elbow
Positive – loss of radial pulse
Indicates TOS
Halstead Maneuver
Patient seated
Patient hyperextends neck while doctor applies downward pressure on arm
Positive – loss of radial pulse
If pulse is not lost, repeat with head rotated to opposite side
Indicates TOS
Roos’ Test
Patient seated
Arms raised, elbow at 90° angle, palms forward
Patient opens and closes fists for up to 3 minutes
Positive – unusual discomfort
Indicates TOS
Allen Maneuver
Patient seated
Arm raised, elbow 90°, palm forward
Doctor abducts and externally rotates shoulder
Head rotated away from involved side
Positive – radial pulse disappears
Indicates TOS
Shoulder Compression Test
Patient seated
Palpate and mark distal apex of coracoid process
Using hypothenar contact, apply downward pressure on mark area
Positive – symptoms of neurovascular compression of subclavian artery and brachial
plexus
Indicates coracoid pressure syndrome and TOS
Shoulder
Apley’s (Scratch) Test
Patient seated
Affected hand behind head and touch opposite superior angle of scapula
Affected hand behind the back and touch the opposite inferior scapula
Positive – exacerbation of pain
Indicates degenerative tendonitis of one tendon of rotator cuff, usually supraspinatus
Dawbarn’s Sign
Patient seated
Deeply palpate shoulder to find well-localized tender area
Maintain pressure on tender spot, passively abduct that arm
Positive – pain disappears as arm is abducted
Indicates significant subacromial bursitis
Ludington’s Test
Patient seated
Claps both hand behind head
Alternately contact biceps, palpate biceps tendon
Positive – tendon contraction is absent on affected side
Indicates rupture of long head of biceps tendon
Codman’s Sign (Drop Arm)
Patient seated
Passively abduct arm to more than 100°
Drop arm to make deltoid contract
Positive - if patient cannot maintain arm at 90°
Indicates tear of rotator cuff complex
Tendonitis
Impingement Sign
Patient seated
Slightly abduct and forward flex arm fully
Positive – pain in shoulder
Indicates overuse injury of supraspinatus and possibly biceps tendon
Supraspinatus Press Test
Patient seated
Patient abducts shoulder to 90°
Doctor resists abduction
Patient rotates forearm so thumbs point to floor
Doctor resists abduction
Positive – patient experiences weakness or pain
Indicates tear of supraspinatus tendon or muscle
Speed’s Test
Patient seated
Doctor palpates biceps tendon while resisting patients shoulder flexion
Positive – increased tenderness in bicipital groove
Indicates bicipital tendonitis
Yergason’s test
Patient seated
Patient flexes elbow, then supinate hand against resistance
Patient then resists extension of elbow
Positive – pain over intertubercular groove
Indicates – tenosynovitis of transverse humeral ligament
Abbott-Saunders Test
Patient seated
Doctor fully abducts and externally rotates patients arm, then lowers arm to side
Positive – audible click
Indicates subluxation or dislocation of biceps tendon
Transverse Humeral Ligament Test
Patient seated
Palpate bicipital tendon
Passively abduct and internally rotate shoulder
Patients arm is passively externally rotated
Positive – tendon snaps in and out of groove
Indicates torn transverse humeral ligament
Dislocation
Bryant’s Sign
Patient seated, arms at side
Positive – lowering of the axillary fold (armpit)
Indicates dislocation of the glenohumeral articulation
Calloway’s Test
Patient seated
Measure thru the axilla to measure the girth of the affected shoulder at acromial tip
Positive – affected joint girth is increased compared to unaffected side
Indicates dislocation of the humerus
Dugas Test
Patient seated
Patient places hand of affected shoulder on the opposite shoulder
Attempt to touch chest with elbow
Positive – increased pain or inability to touch chest with elbow
Indicates shoulder subluxation or dislocation
Apprehension Test
Patient seated
Shoulder is slowly abducted and externally rotated
Positive – look or feeling of apprehension in patients face
Indicates shoulder dislocation trauma
Hamilton’s Test
Patient seated
Positive – a straight edge can rest simultaneously on acromial tip and lateral epicondyle
of elbow
Indicates significant dislocation of the shoulder
Elbow
Cozen’s Test
Patient seated
Patient clenches a fist tightly, dorsiflexes it and maintains a pronated position
Grasp patients lower forearm, apply flexing force to dorsiflexion posture of patients wrist
Positive – reproduction of acute pain in lateral epicondyle
Indicates significant epicondylitis or radiohumeral bursitis
Mill’s Test
Patient seated
Patient’s forearm, fingers and wrist are passively flexed
Forearm is pronated and extended
Positive – elbow pain increases
Indicates lateral epicondylitis
Golfer’s Elbow Test
Patient seated
Elbow flexed slightly and hand is supinated
Patient flexes wrist against resistance
Positive – pain in medial epicondyle
Indicates epicondylitis
Ligamentous Instability Test
Patient seated
Doctor stabilizes patients arm, one hand on elbow, other at wrist
Elbow flexed 30° and adduction force is applied to test lateral collateral ligament
Then abduction force is applied to test medial collateral ligament
Positive – pain
Indicates sprain
Tinel’s Sign at Elbow
Patient seated
Tap groove between olecranon process and lateral epicondyle with reflex hammer
Repeat between olecranon and medial epicondyle
Positive – hypersensitivity
Indicates neuritis or neuroma of respective nerve
Elbow Flexion Test
Patient seated
Flexes elbow completely, hold for five minutes
Positive – tingling or paresthesia occurs in ulnar distribution of forearm and hand
Indicates presence of cubital tunnel syndrome
Wrist
Allen’s Test
Patient seated
Patient makes a fist to express blood from palm
Doctor uses finger pressure to occlude radial & ulnar arteries
Patient opens and closes fist to express any remaining blood
Doctor releases arteries one at a time
Positive – skin remains blanched for more than five seconds
Indicates vascular occlusion of the artery tested
Tinel’s Sign
Patient seated
Percuss the carpal tunnel at the wrist
Positive – tingling in the thumb, index, middle and lateral half of ring finger
Indicates peripheral neuropathy, distal point of nerve regeneration
Phalen’s Sign
Patient seated
Patients wrists are flexed maximally, held for one minute as dorsums are pushed together
Positive – tingling sensation that radiates into thumb, index, middle and lateral half of
ring finger
Indicates – carpal tunnel syndrome caused by median nerve compression
Note – may be performed by patients wrists extended maximmaly, held for one minute
Finkelstein’s Test
Patient seated
Patient makes a fist with thumb inside fingers
Doctor deviates the wrist in ulnar direction
Positive – pain over abductor pollicis longus and extensor pollicis brevis at the wrist
Indicates tenosynovitis
Hip
Allis Test
Patient lying supine with knees flexed, feet flat on table
Doctor examines the height of the knees bilaterally
Positive – one knee is lower than the other
Indicates ipsilateral hip dislocation or severe coax disorder
Hip Telescoping Test
Patient lying supine
Hip and knee flexed 90°
Femur is pushed toward the table while leg is lifted from the table
Positive – considerable movement
Indicates hip dislocation
Ortolani’s Click Test
Performed on babies
Hip is flexed and abducted
Doctor pushes from behind femur - hear a "Clunk"
Decreases dislocation
Actual Leg Length
Patient supine, feet together
Affected leg is measured from ASIS to medial malleolus
Compared to same measurement on other leg
Positive – difference in length
Indicates abnormality above or below trochanter level
Apparent Leg Length
Patient supine
Measure bilaterally from umbilicus to apex of medial malleolus
Measurement is an index of functional length of the lower extremities
Anvil Test
Patient supine
Leg is lifted off table and inferior calcaneus is struck using fist
Localized pain in thigh indicates femoral fracture
Localized pain to calcaneus indicates calcaneal fracture
Ober’s Test
Patient lying on affected side
Doctor stabilizes pelvis with one hand, grasps ankle with other holding knee in flexion
Thigh is abducted and extended in coronal plane of body
Positive – leg remains in abducted position
Indicates iliotibial band contracture
Thomas test
Patient supine, unaffected leg actively flexed toward abdomen, held by patient with hands
Opposite leg should remain flat on table, lumbar spine should flatten
Positive – opposite leg flexes, lumbar lordosis remains
Indicates shortened illiopsoas muscle
Trendelenburg test
Patient standing on one leg, on side of involvement, other leg flexed at thigh and knee
Positive – liliac crest high on standing side
Indicates coax pathologic condition
Patrick Fabere test
Patient supine
Doctor flexes hip, abducts thigh, crosses ankle over contralateral knee and externally
rotates hip (affected leg ankle on unaffected knee)
Doctor exerts downward pressure on flexed knee and opposite ASIS
Positive – pain
Indicates coax pathologic condition
Hibbs Test
Patient prone
Affected knee bent
Superior hand – palpate PSIS (feel for opening)
Inferior hand – on ankle, rotate leg lateral
Positive – pelvic pain
Indicates SI lesion
Knee
Q-Angle
To determine: line from ASIS to midpoint of patella, line from tibial tubercle to midpoint
of patella
Angle of intersection of these lines= Q Angle
Normal: males: 13°, females: 18°
Less than 13° - patellofemoral dysfunction
Greater than 18° - patellofemoral dysfunction, subluxated patella, or increased lateral
tibial torsion
Meniscus
Apley’s Compression Test (aka Distraction)
Patient prone, ankles hanging over end of table
Doctor grasps the involved leg at the ankle, internally rotates and flexes knee past 90°
Repeat with strong external rotation
Positive – pain at any point
Indicates meniscus tear
McMurray’s Test
Patient supine
Doctor flexes thigh and knee 90°, one hand on knee other on heel
Doctor internally rotates lower leg and extend knee
Then externally rotates and extends knee
Positive – painful click or snap heard
Indicates meniscus tear
Bounce Home Test
Patient supine
Knee is completely flexed then allowed to drop into extension
Positive – extension is not complete
Indicates torn meniscus
Steinman’s test
Patient supine, knee extended
One hand grasps ankle, other hand palpates tenderness of knee joint
If pain is found then knee is extended
Positive – pain moves posteriorly when knee is flexed
Indicates meniscus tear
Sprain
Knee Drawer Test
Anterior - doctor palpates along anterior tibia, pull tibia under femur (anterior cruciate
ligament) - should NOT feel tibia sliding forward on tibia
Looking at cruciate ligament stability
Posterior - push tibia on femur (posterior cruciate ligament) - push tibia underneath femur
- should feel stable
Positive - hypermobility
Indicates sprain of anterior or posterior cruciate ligament
Apley’s Distraction Test (aka Compression)
Patient prone, ankles hanging over end of table
Doctor grasps the involved leg at the ankle, internally rotates and flexes knee past 90°
Repeat with strong external rotation
Positive – pain at any point
Indicates meniscus tear
Abduction Stress Test
Patient supine, knee extended
Doctor places one hand on knee, other hand grasps ankle
The leg is drawn lateral to open medial aspect of knee
Positive – pain around knee
Indicates MCL injury
Adduction Stress Test
Patient supine, knee extended
Doctor places one hand on knee, other hand grasps ankle
The leg is drawn medial to open lateral aspect of knee
Positive – pain around knee
Indicates LCL injury
Lachman’s Test
Patient supine
Knee held at 30° of flexion
Femur is stabilized with one hand at the knee
Other hand pushed tibia posterior
Positive – soft end-feel
Indicates damage to ACL, posterior oblique ligament and arcuate-popliteus complex
Patella
Fouchet’s Test (Grinding Test)
Patient supine
Posterior (compression) pressure on patella
If no pain, rub patella transversly on femur (back & forth)
Positive – pain
Indicates patella tracking disorder
Patella Apprehension Test
Patient supine
Doctor will shift patella laterally
If patella is about to dislocate, then the there will be apprehension
Patella Ballottement Test
Patient supine, knee extended
Tap or put pressure on patella
Positive – large amount of swelling in knee detected
Indicates joint effusion
Clarke’s Sign
Patient supine
Doctor compresses quads superior to patella
Patient contracts quads as Doctor resists movement of patella
Positive – failure to hold contraction or pain
Indicates chondromalacia patella
Dreyer’s Test
Patient supine
Patient is unable to raise legs off table
Doctor applies forceful circumferential pressure to thigh at knee to anchor quads, patient
attempts to raise legs
Positive – patient is able to lift legs
Indicates fracture to patella