Cervical Tests

Baccody Sign

The subject with cervical radicular pain actively places the palm of the affected extremity flat on the top of the head raising the elbow to a height approximately level with the head. The sign is present when the radiating pain is lessened or absent by this maneuver and is indicative of nerve root irritation due to cervical foraminal compression.

Distraction Test

With the subject seated, the examiner places one hand under the subject’s chin and the other hand around the occiput then slowly distracts the subject’s head from the trunk. The finding is positive when existing complaints of pain decrease or disappear during the distraction. This indicates that a nerve root compression may exist or muscular and/or ligamentous damage is present.

Jackson Compression Test

With the subject seated upright and the examiner standing behind, the subject is directed to laterally flex the neck and head in an attempt and without undue discomfort to approximate the ear on the effected side to the shoulder. The examiner then clasps his hands over the subject’s head and exerts downward pressure. An exacerbation of cervical and/or radicular pain indicates a positive test and is suggestive of nerve root compression.

Max Compression Test

With the subject seated in an upright position, the examiner rests both hands on the top of the subjects head and applies a downward pressure while the subject laterally flexes and rotates the head. The test is repeated with the subject laterally flexing to the opposite side. A reporting of pain into the upper extremity toward the same side that the head is laterally flexed is a positive sign and indicates pressure on a nerve root which can be correlated by dermatomal distribution of pain.

Shoulder Depression Test

With the subject seated in an upright position, the examiner laterally flexes the subject’s head away from the side being tested while applying traction to the shoulder. Pain is indicative of muscular or ligamentous injury, or dural sleeve adhesions.

Soto-Hall Test

The subject is placed in a supine position and asked to flex his or her neck and touch chin to chest. The test is positive if lightening-like pain is elicited and may indicate a spinal cord pathology, tumor, tuberculosis, or fracture. A positive finding may also be suggestive of a variety of ominous spinal conditions.

Spurling's Test

With the subject seated in an upright position, the examiner rests both hands on the top of the subjects head and applies a downward pressure while the subject laterally flexes the head. When the subject’s head is in maximum rotation and flexion, the examiner delivers a vertical blow to the top of the head. The test is repeated with the subject laterally flexing to the opposite side. A reporting of pain into the upper extremity toward the same side that the head is laterally flexed is a positive sign and indicates pressure on a nerve root which can be correlated by dermatomal distribution ofpain.

Swallowing Test

The examiner asks the subject to swallow. Increased pain or difficulty swallowing is a positive finding and may indicate anterior or cervical spine obstructions, such as vertebral subluxations, osteophyte protrusion, soft tissue swelling or tumors in the anterior cervical spine.

Valsava's Maneuver

The examiner asks the subject to take a deep breath and hold while bearing down, as if having a bowel movement. Increased pain due to intrathecal pressure is a positive finding and may reflective of a space- occupying lesion, herniated disc, tumor, or osteophyte in the cervical spine.

Thoracic Tests

Breathing Test

The subject may sit or stand and is asked to breath in and out normally, then take a deep breath followed by rapid expiration. Normal breathing that is shallow and rapid is indicative of a rib fracture. Pain with deep inspiration may suggest a rib fracture, costochondral separation, or external intercostal muscle strain.

Kernig/Brudzinski Signs

The subject lies supine with his or her hands cupped behind the head and is instructed to flex the cervical spine by lifting the head. Each hip is unilaterally flexed to no more than 90 degrees by the subject. The subject then flexes the knee to no more than 90 degrees. The opposite leg remains on the examining table. A positive finding is increased pain (that is localized or radiates into the lower extremity) with neck and hip flexion and is indicative of meningeal irritation, nerve root impingement, or dural irritation.

Rib Compression Test

With the subject in a supine position, the examiner applies lateral compression to the rib cage. The test is repeated using anterior to posterior compression. Pain with compression or release of pressure indicates the possibility of a rib fracture, rib contusion, or costochondral separation.

Adam's Sign

A patient with scoliosis when bending over will have no straightening of the curve and give a “positive” result. A straightening of the curve would indicate a “negative” result.

The Chest Expansion Test

With the subject standing or sitting erect, the examiner takes a chest measurement with the tape measure over the lowest part of the fourth intercostal space with the patient maximally exhaling. The subject then maximally inhales and another measurement is taken. Normal expansion for an adult male is at least two inches, and one and one-half inches for an adult female. Less than these amounts would be a positive test, indicating thoracic fixation. This is considered an important sign in any ankylosing condition such as Marie-Strumpell Disease.

Sternal Compression Test

The subject is supine and the examiner exerts downward pressure on the sternum. A positive finding of lateral rib pain suggest possible rib fracture.

Spinal Percussion

The subject is seated while the doctor percusses the spinous process’ and paraspinal tissues. Pain during percussion of the spinous process suggests fracture or severe sprain. Pain during percussion of the paravertebral soft tissues suggests muscular strain or sensitive myofascial trigger points.

Schepplemann's Sign

The subject is asked to side bend with their arms over their head. Pain elicited on the concave side suggests intercostal neuritis. Pin on the convex side suggests generalized musculoligamentous strain/sprain

Lumbar Tests

Valsalva's Maneuver

The examiner asks the subject to take a deep breath and hold while bearing down, as if having a bowel movement. Increased pain due to intrathecal pressure is a positive finding and may reflective of a space- occupying lesion, herniateddisc, tumor, or osteophyte in the cervical spine.

Kernig/Brudzinski Signs

The subject lies supine with his or her hands cupped behind the head and is instructed to flex the cervical spine by lifting the head. Each hip is unilaterally flexed to no more than 90 degrees by the subject. The subject then flexes the knee to no more than 90 degrees. The opposite leg remains on the examining table. A positive finding is increased pain (that is localized or radiates into the lower extremity) with neck and hip flexion and is indicative of meningeal irritation, nerve root impingement, or dural irritation.

Sitting Root Test

The subject sits with the hip flexed to 90 degrees and the cervical spine in flexion, then actively extends the knee. The subject who arches backward and/or complains of pain in the regions of the buttocks, posterior thigh, and calf during knee extension demonstrates a positive finding for possible sciatic nerve pain. This test can also be reproduced with the examiner passively extending the subject’s knee.

Straight Leg Raise Test

The subject is supine with both hips and knees extended. The examiner slowly raises the test leg until pain or tightness is noted. Pain in the leg produced from 0 to 30 degrees indicates nerve root compression. Sciatica produced between 30 and 60 degrees indicates sacroiliac disease. Sciatic pain produced with leg motion beyond 60 degrees points to lumbosacral conditions.

Bragard's Sign

If the straight leg raise test is positive, the leg on the affected side is lowered to just below the point of pain and the foot is placed into dorsiflexion. If the pain is duplicated or increased, this suggests sciatic neuritis.

Well Straight Leg Raise Test

With the subject lying supine on a table, the examiner passively flexes the subject’s uninvolved hip while maintaining the knee in an extended position. Complaints of pain on the involved side indicate a positive test and suggest possible vertebral disc injury.

Thomas Test

The subject lies supine with both knees fully flexed against the chest and the buttocks near the table edge, then slowly lowers the test leg until the leg is fully relaxed or until either anterior pelvic tilting or an increase in lumbar Lordosis occurs. A lack of hip extension with knee flexion greater than 45 degrees is indicative of iliopsoas muscle tightness. Full hip extension with knee flexion less than 45 degrees is indicative of rectus femoris muscle tightness. A lack of hip extension with knee flexion less than 45 degrees is indicative of iliopsoas and rectus femoris muscle tightness.

Kemp's Test

With the patient seated in an upright position, the examiner stands behind the patient and puts him or her into a combined position of rotation, lateral bending and extension while stabilizing the sacrum. Low back pain radiating into the lower extremity indicates a positive test and may be suggestive of a disc pathology. If this is the case, the nuclear material of the disc may lie in a medial, lateral or inferior position relative to the nerve root. In disk material medial to the nerve root, the patient will lean into the side of the disk compression and the test will be primarily positive when leaning away from the side of the lower extremity dermatogenous pain and mildly positive when leaning into the side of pain. In disk material lateral to the nerve root, the relief position of the patient will be away from the side of the pain and negative when leaning away. In an inferiorly placed disk, the patient resists bending to either side and prefers to stay in a strict flexed attitude of the lumbar spine. Local pain in the low back does not constitute a positive test, but rather is indicative of a strain or sprain of the posterior articular facets and their pericapsular tissue.

Trendelenburg's Test

The subject stands on one leg and remains in this position for approximately 10 seconds, then switches legs and performs the test again. A positive finding is when the pelvis on the unsupported side drops noticeably lower than the pelvis on the supported side. This indicates a weakness of the gluteus medius muscle on the supported side. A positive finding may also indicate an unstable hip on the supported side.

Milgram's Test

The subject lies supine on a table and asked to extend his or her knees and raise both legs approximately two inches off the table for as long as possible. If the subject is able to hold this position for thirty seconds without pain, intrathecal pathology is ruled out. The test is positive if the subject cannot hold the position, experiences pain, or cannot lift his or her legs. A positive test may suggest a herniated disc or pathological pressure on the theca itself.

Nachlas Test

This test is performed with the patient in a prone position. Each foot is passively raised from the table, maximally flexing the knee. The examiner also exerts downward pressure over the pelvis to prevent buckling at the hips. The test is considered positive when the patient experiences pain in the sacroiliac region or the lumbosacral region, and at times, along the nerves that run in front of these joints, indicating a lesion of those joints.

Dejerine's Sign

A positive finding is when the subject reports aggravation of radicular symptoms produced by coughing, sneezing or straining as if to have a bowel movement. A positive finding is suggestive of a disc herniation, tumor or bony closure. The course of the referred pain helps to localize the suspected lesion.

Bechterew's Test

The patient is seated in an upright position on a table with both legs hanging off. The examiner passively extends each leg to full extension. The examiner may also extend both legs simultaneously. Inability to fully extend a leg or pain in the posterior thigh, calf or foot is a positive sign and is indicative of an intervertebral disc protrusion.

Goldthwait's Sign

This test is designed to differentiate between sacroiliac and lumbosacral involvement. With the subject supine, the examiner palpates the lumbosacral joint while slowly straight leg raising the limb on the affected side. The test is then repeated on the unaffected side. When pain is brought on before the lumbosacral joint is opened and it's possible to raise the leg on the unaffected side to a greater level than the limb on the affected side without pain, then a lesion of the sacroiliac joint or ligaments is presumed. When no pain is experienced until the lumbosacral movement occurs and pain is felt when either leg is raised to approximately the same height then a lumbosacral lesion is more likely.

The Heel-Walk Test

The patient walks on the heels several steps forward, then back the same way. If the patient has low back complaints and is unable to perform this action because of either pain or weakness, then a lesion of the fibers of the L5 Nerve Root should be suspected.

The Toe-Walk Test

In this test the patient walks on the toes about seven steps forward, turns still on the toes, then walks back the seven steps. The patient's inability to do this easily could indicate a loss of integrity of fibers from the S1-2 nerve roots.

Sacral Spine Tests

Si Joint Fixation Test

With the subject standing, the examiner stands behind him or her with the thumbs on the posterior superior iliac spines. The examiner then notes whether the posterior superior iliac spines are level. Unleveling is indicative of sacroiliac joint fixation or one side or the other. The examiner may also perform the test while the subject actively flexes each hip one ata time.

Yeoman's Test

With the subject lying prone on a table, the examiner passively flexes the subject’s knee to 90 degrees while simultaneously extending the ipsilateral hip. A reporting of pain during the test is a positive finding. Pain in the sacroiliac joint may be related to anterior sacroiliac ligament pathology. Pain in the anterior thigh region may be related to hip flexor musculartightness or femoral nerve tension.

Gaenslen's Test

The subject lies on the side of the uninvolved leg the involved leg (upper leg) in slight hyperextension. The subject then flexes the knee of the uninvolved side toward the chest. The examiner stabilizes the subject’s pelvis and further extends the involved leg. Pain in the sacroiliac region is considered a positive finding and may suggest sacroiliac joint dysfunction.

Lewin-Gaenslen's Test

In this test, the subject lies on one side and pulls the knee of that same side up to the chest, while extending the other thigh. The examiner applies additional pressure from behind, forcing extension of the other thigh. Exacerbation of pain from thepelvis is considered a positive test, indicating a sacroiliac joint lesion.

Patrick Or Faber Test

With the subject lying supine on a table, the examiner passively flexes, abducts, and externally rotates the involved leg until the foot rests on top of the knee of the uninvolved leg. The examiner then slowly abducts the involved leg, bring the knee closer toward the table. A positive finding is revealed when the involved leg does not abduct below the level of the uninvolved leg and may suggest iliopsoas, sacroiliac, or even hip abnormalities.

Iliac Compression Test

With the subject lying in a supine position, the examiner presses the iliac crests together. If pain is felt over the joint the reaction is regarded as evidence of an intra-articular sacroiliac lesion. Forcible separation of the iliac crests is more likely to cause pain by stretching the anterior sacroiliac ligaments when the sacroiliac joint is affected.

Hibb's Test

This test is performed with the patient in a prone position. The examiner, while stabilizing the pelvis on the side nearest to him, flexes the opposite knee to a right angle. From this position, the examiner slowly laterally pushes the leg causing strong internal rotation of the femoral head. The test is done bilaterally. Pelvic pain reveals a positive test, indicative of a sacroiliac lesion.

Gillis’ Test

The examiner places the base of the palm of one hand over the prone subject’s sacroiliac joint on the unaffected side, thus fixing the sacrum with the fingertips fanning over the affected sacroiliac joint. With the other hand, the examiner lifts the thigh of the affected side putting the hip joint into extension. If this action exacerbates the pain of the main complaint over the sacroiliac joint, the test is considered positive, indicating sacroiliac joint disease.

Hip Tests

Trendelenburg's Test

The subject stands on one leg for approximately ten seconds and then switches legs. A positive finding is seen when the pelvis on the unsupported side drops noticeable lower than the pelvis on the supported side and is indicative of a gluteus medius weakness on the supported side. This test may also indicate an unstable hip on the supported side.

Ober's Test

The subject lies on the side with the hips and knees extended such that the test leg is superior to the other leg. The examiner stabilizes the subject’s pelvis to prevent rolling while abducting and extending the test hip and allowing the leg to lower slowly. The inability of the leg to adduct and touch the table is indicative of ITB tightness.

Piriformis Test

The subject lies on the nontest side with the test leg in 60 degrees of hip flexion and relaxed knee flexion. The examiner stands with the proximal hand on the subject’s pelvis and the distal hand on the subject’s knee and applies downward force. Tightness or pain in the hip and buttock areas is indicative of piriformis tightness.

Thomas Test

The subject lies supine with both knees fully flexed against the chest and the buttocks near the table edge, then slowly lowers the test leg until the leg is fully relaxed or until either anterior pelvic tilting or an increase in lumbar Lordosis occurs. A lack of hip extension with knee flexion greater than 45 degrees is indicative of iliopsoas muscle tightness. Full hip extension with knee flexion less than 45 degrees is indicative of rectus femoris muscle tightness. A lack of hip extension with knee flexion less than 45 degrees is indicative of iliopsoas and rectus femoris muscle tightness.

True Leg-Length Discrepancy Test

The subject lies supine with the hips and knees fully extended and parallel. Using a tape measure, the examiner measures from the most distal point of the ASIS to the most distal point of the medial malleolus. A difference of more than 1 cm is indicative of discrepancies in either the length of the femur or tibia, or in the angle of the femoral neck inclination.

Apparent Leg-Length Discrepancy Test

The subject lies supine with the hips and knees fully extended and parallel. Using a tape measure, the examiner measures from the umbilicus to the most distal point of the medial malleolus. A difference of more than 1 cm is indicative of abnormalpelvis positioning. Significant discrepancies should be verified via radiology.

Ely's Test

With the subject lying prone, the examiner stands on one side of the table and places one hand over the ipsilateral pelvic region. The examiner then passively flexes the subject’s knee and notes the reaction at the hip joint. The test is repeated on the other side. If the hip also flexes when the knee is flexed, a tight rectus femoris is indicated.

Laguerre's Sign

The patient is placed in a supine position while the examiner flexes the thigh and knee to right angles. The thigh is then abducted and rotated outward. This forces the head of the femur against the anterior portion of the hip joint capsule. The sign is present when this action produces pain, tending to rule out a lumbosacral lesion, but indicating a hip joint lesion, iliopsoas muscle spasm or a sacroiliac lesion.

Shoulder Tests

Supraspinatus Test

The subject stands with both shoulders abducted to 90 degrees, horizontally adducted to 30 degrees, and internally rotated so that the thumbs face the floor. The examiner resists the subject’s attempts to actively forward elevate both shoulders. Involvement of the supraspinatus muscle and/or tendon is suspected with noted weakness and/or a report of pain. Weakness of the supraspinatus muscle may also be a result of subscapular nerve involvement.

Yergason Test

The subject sits with the elbow flexed to 90 degrees and stabilized against the thorax. The forearm is in a pronated position. The examiner places one hand along the subject’s forearm and the other hand on the proximal portion of the subject’s humerus, near the bicipital groove. The examiner resists the subject’s attempt to actively supinate the forearm and externally rotate the humerus. Pain in the bicipital groove is a positive finding that may indicate bicipital tendonitis.

Speed's Test

With the subject either sitting or standing, the involved shoulder is flexed to 90 degrees, the elbow is fully extended, and the forearm is supinated. The examiner resists the subject’s attempt to actively flex the humerus forward. Tenderness and/or pain in the bicipital groove is a positive finding indicative of bicipital tendonitis.

Drop Arm Test

With the subject either sitting or standing, the examiner passively abducts the subject’s involved arm to 90 degrees and then instructs the subject to slowly lower the arm to the side. A positive finding is indicated if the subject is unable to slowly return the arm to the side and/or has significant pain when attempting to perform the task. This is indicative of a rotator cuff pathology.

Apley's Scratch Test

While sitting or standing, the subject is instructed to take one hand and touch the opposite shoulder. The test is repeated with the other hand to the opposite side. The subject is then instructed to place the arm overhead and reach behind the neck as if scratching the upper back. To complete the test, the subject is instructed to place the hand in the small of the back and reach upward as far as possible. Asymmetrical results from side to side are positive for limitationsin the joint capsule.

Anterior Apprehension Test

The subject lies supine on the table with the involved shoulder in 90 degrees of abduction and the elbow in 90 degrees of flexion. The examiner slowly externally rotates the shoulder. A positive finding is a “look of apprehension” on the subject’s face toward further movement in the externally rotated direction and may suggest instability of the glenohumeral joint.

Posterior Apprehension Test

With the subject lying supine on the table, the examiner grasps the subject’s elbow with one hand and stabilizes the ipsilateral and involved shoulder with the other hand. The examiner places the subject’s involved shoulder in a position of 90 degrees of flexion and internal rotation while applying a posterior force through the long axis of the humerus. A positive finding is a “look of apprehension” on the subject’s face toward further movement in the posterior direction.

Anterior Drawer Test

With the subject in a supine position, the examiner passively abducts the glenohumeral joint 70 to 80 degrees, forward flexes 0 to 10 degrees, and externally rotates 0 to 10 degrees. While stabilizing the scapula, the examiner firmly glides the head of the humerus anteriorly while applying slight distraction to the glenohumeral joint. Increased anterior translation of the humeral head relative to the scapula/glenoid fossa or a look of apprehension on the subject’s face may be indicative of anterior instability. A bilateral comparison should be done for a more accurate assessment.

Posterior Drawer Test

With the subject in a supine position, the examiner passively abducts the shoulder to 90 degrees and horizontally flexes the shoulder 20 to 30 degrees. While stabilizing the subject’s scapula, the examiner applied downward pressure, pushing the humeral head posteriorly. Increased posterior instability of the humeral head relative to the scapula/glenoid fossa may be indicative of posterior instability. A bilateral comparison should be done for a more accurate assessment.

Dawbarn's Sign

This test has the patient standing with the arms hanging loosely at the side. The examiner deeply palpates the patient's shoulder eliciting a localized tender area. The examiner, while leaving the finger on the painful spot, passively abducts the patient's arm. This sign is present when the painful spot disappears on abduction, indicating subacromial bursitis.

Pos Impingement Sign

The subject lies supine on a table with the test shoulder placed in 90–110 degrees of abduction and 10-15 degrees of extension. The test elbow is flexed to 90 degrees. The examiner slowly rotates the subject’s shoulder into maximal external rotation. Reproduction of the subject’s pain in the posterior aspect of the shoulder is indicative of rotator cuff and/or posterior labral pathology.

Cross-Over Impingement Test

With the subject seated, the examiner passively and maximally horizontally adducts the test shoulder. Superior shoulder pain is indicative of acromioclavicular joint pathology. Anterior shoulder pain is indicative of subscapularis, supraspinatus, and/or biceps long head pathology. Posterior shoulder pain is indicative of infraspinatus, teresminor, and/or posterior capsule pathology.

Elbow Tests

Cozens Test

The subject is seated. With a closed fist, the subject pronates and radially deviates the forearm and extends the wrist against the examiner’s resistance. If this action causes acute lancinating pain in the lateral epicondyle region, the test is considered positive, indicating Tennis Elbow or lateral epicondylitis.

Golfer's Elbow Test

The subject sits or stands and makes a fist on the involved side. The examiner passively supinates the forearm and extends the elbow and wrist. Complaints of discomfort along the medial aspect of the elbow may be indicative of medial epicondylitis (Golfer’s Elbow).

Varus Stress Test

With the subject seated and the test elbow flexed 20-30 degrees, the examiner applies a varus stress to the elbow with the proximal hand. Lateral elbow pain and/or increased varus movement with a diminished or absent endpoint is indicative of damage to the radial collateral ligament.

Valgus Stress Test

With the subject seated and the test elbow flexed 20-30 degrees, the examiner applies a valgus stress to the elbow with the proximal hand. Medial elbow pain and/or increased valgus movement with a diminished or absent endpoint is indicative of damage to the medial (ulnar) collateral ligament.

Tinel's Sign

With the subject seated and the elbow in slight flexion, the examiner stabilizes the wrist and taps the ulnar nerve in the ulnar notch with the index finger. Tingling along the ulnar distribution of the forearm, hand, and fingers is indicative of ulnar nerve compromise. Bilateral assessment is recommended for comparison of results.

Pinch Grip Test

The subject is instructed to pinch the tips of the thumb and index finger together. The inability to touch the tips of the thumb and index finger together demonstrates a positive finding and suggests an anterior interosseous nerve pathology. The anterior interosseous nerve is a branch of the median nerve (C7, C8, T1) that innervates the pronator quadratus, flexor pollicis longus and the first and second components of the flexor digitorum profundus.

Wrist / Hand Tests

Phalen Test

The subject sits or stands with the dorsal aspect of both hands in full contact so that both wrists are maximally flexed. A steady compressive force is applied through the subject’s forearms so the subject’s wrists are maximally flexed for 1 minute. Numbness and tingling in the median nerve distribution of the fingers are indicative of carpal tunnel syndrome secondary to median nerve compression.

Tinel's Sign

The subject is seated near a flat surface while the examiner taps the volar aspect of the subject’s wrist over the area of the carpal tunnel. Complaints of tingling, Paresthesia, or pain in the area of the thumb, index finger, middle finger, and radial one-half of the ring finger signal a positive finding and suggest compression of the median nerve in the carpal tunnel or carpal tunnel syndrome. A positive finding should warrant the examiner to assess the integrity of the median nerve at the elbow, shoulder and neck to rule out other pathologies.

Finkelstein's Test

To perform the test, the examiner instructs the subject to place the thumb in a closed fist and tilt the closed hand towards the little finger. If pain occurs at the wrist below the thumb, DeQuervain's tenosynovitis is likely.

Froment's Sign

The subject is instructed to hold a piece of paper between the thumb and index finger. The examiner then tries to pull the paper out. Flexion of the subject’s distal interphalangeal joint of the thumb is indicative of adductor pollicis muscle paralysis due to ulnar nerve damage.

Finger Tap Test

With the subject sitting or standing, the examiner applies a firm tap to the end of the finger being tested. Pain at the site of injury suggests a possible fracture. The examiner may also use a percussion hammer for this test.

Bunnel Littler Test

The subject is seated with the metacarpophalangeal joint of the involved finger in slight extension. The examiner passively flexes the proximal interphalangeal joint (PIP) of the same ray and assesses the amount of PIP joint flexion. The examiner then passively flexes the metacarpophalangeal joint (MCP) slightly, and again assesses the amount of flexion at the PIP joint. A positive finding is revealed if the PIP joint does not flex while the MCP joint is in an extended position. If the PIP joint does not fully flex once the MCP joint is slightly flexed, intrinsic muscle tightness can be assumed. By contrast, if flexion of the PIP joint remains limited once the MCP joint is slightly flexed, capsular tightness can be assumed.

Knee Tests

Valgus Stress Test

The patient is placed into a supine position with the knees in complete extension. The examiner places one palm against the lateral aspect of the knee at the joint line of the side being tested and with the other hand the examiner grips the ankle pulling it laterally, thus opening the medial side of the joint. If this action causes no pain, then the examiner repeats it with the knee in 20-30 degrees of flexion, which puts the knee joint maximally vulnerable to a torsion stress. If either of these actions produces or exacerbates pain, below, above or at the joint line, then the test is considered positive, indicating a medial collateral ligament injury.

Varus Stress Test

The patient is placed into a supine position with the knees in complete extension. The examiner places on palm against the medial aspect of the patient's knee (opposite to the one being tested) at the joint line. With the other hand the examiner grips the ankle, pulling it medial, thus opening the lateral side of the joint. If this action causes no pain, then the examiner repeats it with the knee in 20-30 degrees of flexion, which puts the knee joint maximally vulnerable to a torsion stress. If either of these actions produces or exacerbates pain, below, above or at the joint line, then the test is considered positive, indicating a lateral collateral ligament injury.

Mcmurray Test

The McMurray test is used to evaluate individuals for tears in the medial meniscus of the knee. To perform the test, the subject’s knee is flexed to ninety degrees. The examiner then places one hand on the lateral side of the knee to stabilize the joint and provide a valgus stress. The other hand rotates the foot externally while extending the knee. If pain or a "click" is felt, this constitutes a "positive McMurray test." The sensitivity of the McMurray test for medial meniscus tears is 53% and the specificity is 59%.

Apley's Compression Test

The subject lies prone with the test knee flexed to 90 degrees. The examiner uses the distal hand to medially and laterally rotate the tibia while applying a downward force through the heel. Pain, clicking, and/or restriction is indicative of either a medial or lateral meniscus tear depending on the location of the symptoms.

Apley's Distraction Test

The subject lies prone with the test knee flexed to 90 degrees. The examiner uses the distal hand to medially and laterally rotate the tibia while applying a distraction force through the heel. An increase in and/or change in location of pain is more indicative of ligamentous verses meniscal pathology. Pain or clicking with a compression test that is followed by an absence of the same symptoms with a distraction test is more indicative of a meniscal pathology.

Anterior Drawer Test

The subject lies supine with the test hip flexed to 45 degrees, knee flexed to 90 degrees, and the foot in a neutral position. The examiner sits on the subject’s foot with both hands behind the subject’s proximal tibia and thumbs on the tibial plateau. An anterior force is then applied to the proximal tibia. Increased anterior tibial displacement as compared to the uninvolved side is indicative of a partial or complete tear of the ACL.

Posterior Drawer Test

The subject lies supine with the test hip flexed to 45 degrees, knee flexed to 90 degrees, and the foot in a neutral position. The examiner sits on the subject’s foot with both hands behind the subject’s proximal tibia and thumbs on the tibial plateau. An posterior force is then applied to the proximal tibia. Increased posterior tibial displacement ascompared to the uninvolved side is indicative of a partial or complete tear of the PCL.

Patellar Apprehension Test

The subject lies supine with both knees fully extended. The examiner stands opposite the involved side and places both thumbs on the medial border of the patella being tested. The subject should remain relaxed with no quadriceps contraction while the examiner pushes the patella laterally. If the subject is apprehensive to this movement or contracts the quadriceps muscle to protect again subluxation, the test is indicative of patellar subluxationor dislocation. This test can also be performed with the knee flexed 30 degrees.

Patella Tap Test

The subject lies supine with both knees fully extended. The examiner compresses the suprapatellar pouch with the proximal hand, then compresses the patella into the femur. Downward movement of the patella followed by a rebound will give the appearance of a floating or ballotable patella and is indicative of moderate to severe joint effusion.

Bounce Home Test

With the subject lying supine, the examiner passively flexes the subject’s test knee and then allows the knee to passively fall into extension. A rubbery endfeel or springy lock is indicative of a meniscal tear. This test should be performed with caution.

Q-Angle Test

The subject lies supine with the hips and knees extended. The examiner strikes a line from the ASIS to the midpoint of the patella, and from the tibial tubercle to the midpoint of the patella. A goniometer is placed on the knee such that the axis if over the midpoint of the patella, the proximal arm is over the line to the ASIS, and the distal arm is over the line to the tibial tubercle. The result angle is the Q-angle. Q-angle norms for males are 13 degrees and 18 degrees for females. Angles greater or less than these norms may be indicative of patellofemoral pathology.

Medial Lateral Grind Test

With the subject lying supine, the examiner passively flexes the subject’s hip and knee maximally and then applies a circular motion with the tibia, rotating the tibia clockwise and counter-clockwise. Pain, grinding or clicking is indicative of a meniscal tear.

Patellar Grind Test

The subject lies supine with the knees extended and is asked to contract the quadriceps muscle while the examiner applies a downward and inferior pressure on the patella. Pain with movement of the patella or an inability to complete the test is indicative of chondromalacia patella.

Anterior Lachman's Test

The subject lies supine with the test knee flexed 20-30 degrees. From a neutral position, the examiner applies an anterior force to the tibia with the distal hand while stabilizing the femur with the proximal hand. Excessive anterior translation of the tibia with a diminished or absent endpoint is indicative of a partial or complete tear of the ACL.

Foot/Ankle Tests

Anterior Drawer Test

The subject is seated on a table with the knee flexed to 90 degrees and the involved foot relaxed in slight plantar flexion. While assuring stabilization of the distal tibia and fibula, the examiner applies an anterior force to the calcaneous and talus. Anterior translation of the talus away from the ankle mortise that is greater on the involved side suggesta possible anterior talofibular ligament sprain.

Thompson Test

The subject lies prone on a table with the heels placed over the edge of the table. With the calf muscles relaxed, the examiner squeezes the belly of these muscles. When squeezing the calf muscles, a normal response is to have the foot plantar flex. An absence of plantar flexion upon squeezing is a positive finding and suggests a possible rupture of the Achilles’ tendon.

Interdigital Neuroma Test

The subject is seated on the exam table with the involved leg extended. The examiner squeezes the subject’s metatarsal heads together and holds for 1 to 2 minutes. Pain, tingling or numbness in the foot, toes, or ankle is indicative of an interdigital neuroma. If positive, the pain is usually relieved when pressure is released. Pain between the metatarsal heads is indicative of Morton’s neuroma. The most common location is between the third and forth metatarsal heads.

Tinel's Sign

With the subject in a lying supine, the examiner uses his finger to tap over the medial aspect of the ankle where the posterior tibial nerve is the most superficial. Pain or tingling that radiates along the pathway of the posterior tibial nerve is indicative of tarsal tunnel syndrome. Compression of the posterior tibial nerve in the tarsal tunnel will result in referred symptoms to the medial and plantar regions of the foot.

Ankle Inversion Test

The subject lies on the uninvolved side on a table with the involved foot relaxed and the knee flexed to 90 degrees. The examiner places the foot in the anatomical neutral position, then tilts the talus into an adducted position. Range of motion in the adducted position on the involved foot greater than that of the uninvolved foot reveals a positive test and suggests a tear of the calcaneofibular ligament of the ankle.

Ankle Eversion Test

The subject lies on the uninvolved side on a table with the involved foot relaxed and the knee flexed to 90 degrees. The examiner places the foot in the anatomical neutral position, then tilts the talus into an abducted position. Range of motion in the abducted position on the involved foot greater than that of the uninvolved foot reveals a positive test and suggests a tear of the deltoid ligament of the ankle.

Circulatory Disorder Tests

Adson's Test

This test is used to determine the state of the subclavian artery, which may be compressed by an extra cervical rib or by tightened scalenus anticus or scalenus medius muscles, which can compress the artery where it passes between them on its way to the upper extremity. To perform the test, the examiner takes the subject’s radial pulse at the wrist while abducting, extending and externally rotating the arm. The subject is then instructed to take a deep breath and turn his or head toward the arm being tested. A marked diminution or absence of the radial pulse is a positive finding.

Allen's Test

This test has the patient seated with the forearms resting on the thighs and the palms facing up. First the patient makes a fist on the side being examined, then the examiner digitally occludes either the radial or ulnar arteries right next to the wrist while the patient maintains the clenched fist. Next, with the examiner maintaining the occlusion, the patient opens the hand. Normally, the color returns to that hand in ten seconds or less. The test is considered positive if there is a delayed color return during digital compression, indicating a partial blockage, or if there is no color return until the examiner releases the wrist which indicates a complete blockage of the artery which is not being compressed.

Buerger's Test

This test measures arterial blood supply to the lower limbs. The examiner straight leg raises the supine patient's leg to about 45 degrees for no less than three minutes. The examiner then lowers the limb and has the patient sit up with both legs hanging over the examining table. The test is considered positive if the dorsum of the foot blanches and any prominent veins collapse when the leg is initially straight leg raised, or if after lowering the leg it takes one or two minutes for a ruddy cyanosis to spread over the affected part and for the veins to once again become prominent, either of which indicates a deficient blood supply.

George's Test

Many doctors use this test before attempting any high velocity cervical manipulation. The supine patient extends the head and neck over the edge of the table. With eyes open the patient actively rotates the head and neck while maintaining the extended position. One or more of the following indicates a positive test: either blanching or cyanosis of the face, nystagmus, sweating, dizziness, nausea, headache or an increase of temperature. Until vascular disorders are ruled out by further examination, a positive test would indicate that cervical manipulation involving rotation and/or extension is contra-indicated.

Homan's Sign

This test is done with the patient supine with the knee extended. When dorsiflexion of the ankle by the examiner causes a localized deep pain either in back of the calf or behind the knee, the sign is considered present and indicative of thrombosis of the deep veins of the leg.

Vertebral Artery Test

With the subject lying supine, the examiner slowly extends, rotates and laterally flexes the subject’s cervical spine to each side for 30 seconds. Dizziness, blurred vision, nystagmus, slurred speech or loss of consciousness are indicative of partial or complete occlusion of the vertebral artery.

Wright's Test

The seated patient has both arms hanging at the sides, with the examiner behind the patient. The examiner palpates the radial pulse during 180 degrees of active and then passive abduction of both arms, while noting at how many degrees of abduction the radial pulse on the affected side diminishes or disappears when compared to the opposite side. If this action diminishes or eliminates the radial pulse, the test is considered positive, indicating a neurovascular compression of the axillary artery as seen in thoracic outlet syndrome (TOS).

Malingering Tests

Burn's Bench Test

The patient kneels upright on the examining table or a padded bench that is about eighteen to twenty inches high. The examiner firmly grasps the patient's ankle from behind and instructs the patient to bend over and touch the floor with the fingertips. Patient's who normally cannot be expected to carry out this action are those extremely weak from injury or disease or those significantly diseased at the hip or knee. Those patients who may be able to perform the action are those with sciatic neuralgia, congenital anomalies, arthritis, a specific disease of the spine (such as tuberculosis), or a compression fracture of the spine. Any patient (other than those mentioned above who cannot be expected to carry out this action) either refuses to perform the action or claims they can only go part way, is presenting evidence of malingering or hysteria.

Hoover's Sign

When the patient is alleging unilateral lower limb paralysis, the examiner places the hands under the heels of the supine patient. The patient is then asked to lift the paretic leg. If the leg is truly weak or paralyzed, the patient will involuntarily push downward with the non-affected leg, which would be felt as pressure on the examiner's hand. The sign is present if no counterpressure can be felt by the examiner on the healthy side, which is evidence of malingering or hysteria.

Lasegue's Sitting Test

This test is used for indicating low back radiculopathy or lumbar disc herniation. The patient is seated upright on the edge of a table or bench without a backrest. The examiner extends the patient's legs below the knee one at a time, so each limb is parallel with the floor. If there is no radiculoneuropathy, the patient should experience no discomfort from this action. It has advantages when checking for malingering, because the test can be performed without the patient knowing what is being tested. This version can be used on those patients where simulation, falsifying or magnification of symptoms is suspected.

Magnuson's Test

This test is performed when malingering or hysteria is suspected in the patient with low back complaints. The patient points to the site of the pain which in turn is marked by the examiner. The examiner then performs other actions away from the marked site of pain. The test is positive if there is any significant change of the pain site once the examiner resumes the examination of the low back. A positive test would indicate evidence of simulated pain,hysteria or malingering.