NMS I Orthopedics

TESTS HOW TO PERFORM POSI TI VE FI NDI NG I NDI CATI ONS

Rusts Pt spontaneously grabs head
w/ both hands when lying
down or arising from
recumbent position
Pain , Very limited Cervical
ROM
Upper Cervical Instability
Severe sprain, RA, Fx, Severe
Cervical subluxation
(TAKE XRAYS ASAP no
further testing w/o them)
Libmans Pt seated, doc standing behind
pt. Doc applies pressure on
pts mastoid process with
thumbs until pt reports
pain/discomfort. Compare side
to side.
Pain / Uncomfortable Tests the pts pain tolerance -
useful for later procedures
Bakodys Pt abducts & externally rotates
the ipsilateral shoulder to
place hand on top of head.
Position relieves pt pain
(reduces tension on the
cervical nerve root)
Nerve tension, cervical
radiculopathy
Reverse Bakodys Pt abducts & externally rotates
the ipsilateral shoulder to
place hand on top of head.
Position increases radicular
pain.
Interscalene compression of
lower brachial plexus.
TOS
Bikeles Pt seated. Abduct shoulder to
90 degrees then externally
rotates shoulder. Arm is fully
extended at elbow and pt tries
to reach behind them. (As if
you are reaching into the back
seat of the car)
Radiation of pain along
brachial plexus pattern.
Radiation along a nerve root.
Brachial Plexus Neuritis
Brachial Plexus lesion /
Radiating pain along T1
dermatome only Klumpkes
Palsy
Stinger injury usually from
lateral flexion / traction injury.
(Injury may cause Neuropraxia
/ Axonotmesis / Wallerian
degeneration)
Brachial Plexus Tension
Test
Pt seated erect. Pt puts hands
behind head w/ shoulders
abducted to 90 degrees and
shoulders externally rotated
right before onset of pain. Doc
stands behind pt with hip
touching pt spine for
stabilization. Doc uses pt
elbows to slowly pull
backwards.
Radicular pain Nerve Root symptoms of C5
indicate Erb Palsy (C5 Nerve
Root Syndrome)
Radiation following more than
1 dermatome indicates a
brachial plexus lesion.
Valsalvas Test Pt seated. Pt asked to take
deep breath in & hold it. While
holding breath pt bears down
Radicular pain SOL causing Nerve Root
compression
DeJerines Triad
(question not test)
Pt reports increase in radicular
symptoms when coughing,
sneezing, or straining during
defecation
Increase radicular symptoms SOL (Aggravation from
mechanical attraction of spinal
fluid)
Swallowing Test Pt seated & asked to swallow. Pain or inability to swallow Esophageal irritation via direct
trauma or retroesophageal
SOL, severe strain/sprain, Fx,
Disc protrusion/herniation,
Osteophyte.
Naffzigers Test Pt seated. Doc occludes
jugular vein bilaterally for 30-
40 seconds. Pt then asked to
cough
Local or radicular pain in
spine
SOL

* do not do on pt w/ cardiac
problems
Barre-Lieou Pt seated. Doc tells pt to
slowly rotate head side to side
(BP & pulse are taken before
test)
Vertigo, Blurred vision,
Nausea, Syncope, Nystagmus
Vascular Compromise
Vertebrobasilar Function
Maneuver
Pt seated. Subclavian &
carotid arteries auscultated for
buits. Then palpate. If bruits
present do not perform. Pt
rotates head to left &
hyperextends. Repeat on right.
Vertigo, Blurred vision,
Nausea, Syncope, Nystagmus
Vertebral, Basilar, or Carotid
artery stenosis/compression
DeKleyns Pt supine. Pt head off table doc
tells pt to hyperextend & rotate
head hold for 15-45 sec
Vertigo, Blurred vision,
Nausea, Syncope, Nystagmus
Vascular Compromise
Distraction Test Pt seated. w/ hands on glabella
and EOP slightly traction pts
head upward.
1. Local pain increases
2. Peripheral pain decreases
3. Local pain decreases

1. Muscle, ligament, or joint
capsule damage
2. IVF encroachment, cervical
radiculopathy
3. Facet impingement
Foraminal Compression Active C ROM performed
first.
Pt seated doc places
downward pressure on pt
head/neck. Head is rotated to
each side with similar
compression.
1. Radicular pain
2. Local Neck pain
1. Foraminal (cervical Nerve
Root) encroachment,
radiculopathy
2. Sprain/strain
Jacksons Compression
Test
Pt seated. Head is laterally
flexed toward shoulder. Doc
exerts downward compression.
(Bilaterally tested)
Radicular pain IVF encroachment
(radiculopathy)
Facet irritation (local pain)
Maximum Cervical
Compression
Pt seated Pt actively rotates
head & hyperextends neck to
side of complaint. Repeats on
opposite side
Radicular Pain IVF encroachment

*Tight stretching pain on
convex side muscle strain
Spurlings Test Pt seated. Pt head is laterally
flexed to side of complaint.
Doc applies compression to
head/neck. Neck then
extended/rotated and
compressed. Doc then applies
a vertical blow to top of head
Radicular Pain Foraminal / Nerve Root
encroachment

Facet involvement local pain
Lhermittes Test Pt seated in neutral position.
Head/neck passively flexed to
pt chest
Sharp radiating pain down
spine & upper/lower
extremities.
Bilateral arm/leg pain
Cervical
myelopathy.radiculopathy
Unilateral arm/leg pain
following a dermatome
Nerve Root traction .
Pt. may have MS, Stenosis,
Tumor, Disc herniation
O'Donahues Passive and active resisted
ROM or any joint.
Pain Pain w/ active strain
Pain w/ passive sprain

*test can be used on any joint
in body*
Kernigs Sign Pt supine doc flexes pt hip &
knee 90 degrees doc then tries
to extend leg
Pain in spine or involuntary
flexion of the opposite
knee/hip
Pain with fever meningitis
Brudzinskis Sign Supine pt flexes head/neck
toward xiphoid process/chest
Involuntary hip and knee
flexion
Pain & fever meningitis
Shoulder Depressor Test Pt seated. Doc depresses pt
shoulder on affected side &
laterally flexes neck away
from shoulder.
Radicular pain
produced/aggravated
Dural sleeve adhesion of
spinal Nerve Root, adjacent
joint capsule, brachial plexus
traction.
* common hyperextension
injury especially in young.
Soto Hall Test Pt supine. Doc supports pt
head w/ one hand & knife-
edge contact on sternum w/
opposite hand. Pt actively
flexes head/neck to chest . Doc
follows w/ passive head/neck
flexion to chest
Pain Local pain w/ active muscle
sprain.
Local pain w/ passive
ligament strain.
Fracture
Facet Involvement
Allens Test Pt seated. Affected elbow is
flexed & arm supinated. Doc
occludes radial and ulnar
arteries. Pt pumps hand
open/close. Then opens hand
and doc will release 1 artery so
blood flow can resume.
Repeated on other artery.
Performed bilaterally.


Circulation should return in 5
seconds or less.
Vascular Compromise
TOS
Adsons Test Pt seated. Doc palpates the
radial artery. Pt rotates head to
affected side. Pt extends neck
as far as possible. Pt holds
breath for 10 sec.
Decrease of pulse amplitude
Paresthesia
Neurovascular compromise of
Subclavian A due to Scalenus
Anticus or Cervical Rib TOS

Modified Adsons Test Same as above but rotate head
toward unaffected side.
Decrease of pulse amplitude
Paresthesia
Scalene medius & Cervical
rib TOS
Halsteads Test Pt seated. Doc palpates radial
pulse of affected arm. Doc
applies downward traction on
arm while pt hyperextends
neck. (If negative do test with
pt rotating head to opposite
side
Decrease of pulse amplitude
Paresthesia
Scalene medius & Cervical
Rib TOS
Allen's Maneuver Test Pt seated. Doc flexes pts
elbow to 90, palpates the
radial pulse while shoulder is
abducted and externally
rotated. Pt. rotates head away
from side being tested.
Pulse disappears TOS
Roos Test
Hostage test
Pt seated. Abduct both arms to
90, flex elbows to 90 and
externally rotate. Pt
opens/closes fist for 3 min or
until symptoms occur.
Paresthesia/tingling, pain,
weakness
TOS
Wrights Test
Hyperabduction test
Pt seated. Doc palpates Radial
pulse of affected arm. Doc
passively abducts arm to 180
degrees. Note angle of
abduction where pulse
disappears/decreases.
Compare to opposite side
Loss of pulse / Tingling

(look at amplitude of
symptoms)
Hyperabduction syndrome
(compression of axillary artery
under the pec minor)
Costoclavicular Maneuver
Test
Pt seated with arms on thighs
and palms up. Doc palpates
radial pulse. Pt told to draw
shoulders down and back,
lower chin to chest and take a
deep breath and hold for 10
sec.
Cessation or dampening of
radial pulse, ischemic color
change, paresthesia, radicular
pain in upper extremity.
Clavicle and first rib TOS (due
to poor posture, cervical rib,
bone tumor, or poorly united
fx of clavicle)
Apley's Scratch Test Pt seated. Place affected hand
behind head to touch opposite
superior angle of scapula.
The place hand behind back
and touch inferior angle of
scapula Compare bilaterally.
Reproduces shoulder pain Exacerbation of pain
degenerative tendonitis
(especially supraspinatus)

Apprehension Test Pt seated. Shoulder is abducted
and externally rotated (Ant
Shoulder).
Pt supine. Shoulder flexed &
internally rotated doc applies
posterior force (post shoulder)
Pain / pay attention to look on
pt face.

*instable shoulder can
dislocated w/ this test
Anterior or Posterior Shoulder
Dislocation trauma
Codmans Drop Arm Test Pt seated. Doc passively
abducts affected arm. Doc
suddenly removes support at
an angle about 90 degrees
Pt cannot stop arm from
dropping / Pain
Rotator cuff tear / injury
(specifically rupture of
supraspinatus tendon)
Dawbarns Test Pt seated Doc palpates
affected shoulder deeply for
localized tenderness at the
subacromial bursa. Hold
pressure as arm is passively
abducted.
Pain disappears. Pain disappears subacromial
bursitis

Dugas Test Pt seated places affected sides
hand on opposite shoulder &
tries to touch chest w/ elbow



Inability to move elbow or
pain
Propensity for shoulder to
dislocate anteriorly.

Impingement Test Pt seated. Pts arm is slightly
abducted and moved fully
through flexion by the doctor.
(Jams greater tuberosity into
ant inf acromial surface).
Pain in shoulder Overuse injury of
supraspinatus tendon
(sometimes biceps tendon)
Speeds Test Pt seated. Forearm is flexed
and supinated. Pt flexes
shoulder against resistance.
Pain / tenderness in the
bicipital groove.
Bicipital Tendonitis
Supraspinatus Press Test Pt seated shoulders are
abducted to 90 degrees. The
shoulders are medially rotated
& angled 30 degrees forward
w/ thumbs pointing to floor.
Doc applies resistance to
abduction while observing for
weakness/pain.
Pain / Weakness in shoulder Supraspinatus muscle/tendon
tear
Yergasons Test Pt seated w/ elbow flexed. Pt
resists doc pronating and
extending the arm. Docs other
hand is palpating the inter-
tubercular groove
Clicking or pain over the
intertubercular groove
Pain = Bicipital Tenosynovitis
Clicking = tear of transverse
humeral ligament
Load & Shift Test While stabilizing the scapula,
the doc performs the
following:
Push I-S, P-A for Ant Capsule
Push I-S, A-P for Post Capsule
Pull S-I for Inf Capsule
Sulcus Line / Pain / Laxity Shoulder Capsule Instability /
loosening
Propensity to dislocate
OBriens Pt arm flexed forward to 90
degrees w/ elbow extended &
arm adducted to 15 degrees.
Part 1: arm in internal rotation
(thumbs down). Part 2: arm in
external rotation (palm up).
Doc applies downward
pressure while pt resists.
Pain on part 1 or part 2 Pain during part 1: anterior
labrum tear, SLAP lesion
Pain during part 2: biceps
tendonitis

* Positive Speeds & OBriens
indicates Type II SLAP lesion
Lift Off Test Pt places dorsum of hand on
low back. Pt then lifts hand off
back as far as possible.
Compare side to side.
Inability to life the hand off
the back as far as the other
side.
Pain on Ant Shoulder
Subscapularis Tendonitis
Capsulitis
Elbow Flexion Test Pt seated and actively flexes
elbow for 5 minutes
Tingling or paresthesia in
ulnar distribution of
hand/forearm.
Ulnar paresthesia Cubital
Tunnel Syndrome
Tinels test at the Elbow Pt seated w/ elbow flexed to
90 degrees doc taps groove
between olecranon and lateral
epicondyle. Repeat between
the olecranon and medial
epicondyle.
Hypersensitivity.
Tingling radiating toward
forearm
Lateral: Superficial Radial
Nerve Palsy (degeneration)/
neuroma/neuritis

Medial: Ulnar N palsy /
neuroma / neuritis
Cozens Test Pt seated affected elbow
flexed & pronated. Pt makes a
fist. Pt actively extends hand /
wrist. Doc applies pressure
against dorsum of hand
Pain near Lateral Epicondyle Lateral Epicondylitis Tennis
Elbow
Radiohumeral bursitis
Golfers Elbow Test Pt seated w/ elbow flexed &
hand/wrist supinated. Pt makes
a fist and actively flexes the
wrist. Doc applies pressure to
extend wrist and pt resists.
Pain near Medial Epicondyle Medial Epicondylitis Golfers
Elbow
Lift Test Cozens & Golfers Test
performed with weights
instead of pressure
Pain near Medial / Lateral
Epicondyle
Medial / Lateral Epicondylitis
Ligament Instability Test Pts elbow slightly flexed. Doc
stabilizes elbow while
applying an adduction (varus)
force to the distal forearm to
test the LCL. Then an
abduction (valgus) force is
applied to test the MCL.
Laxity, decreased mobility,
altered pain.
Adduction force: medial
collateral ligament instability
(sprain)

Abduction force: lateral
collateral ligament instability
(sprain)
Mills Test Pt seated w/ forearm, fingers,
and wrist passively flexed. The
doc pronates and extends the
forearm.
Elbow pain increases Lateral Epicondylitis / Tennis
Elbow
Tinels Test at the Wrist Doc taps over the carpel tunnel Tingling into thumb, index
and middle finger and lateral
half of ring finger.
Carpal Tunnel Syndrome
Phalens Test Doc flexes pts wrists and
pushes them together for 1
minute.
Tingling into thumb, index and
middle fingers and lateral half
of ring finger.
Carpal Tunnel Syndrome
Froments Test Pt. Grasps a piece of paper
between thumb and index
finger. Doc pulls paper away.
Distal phalanx of thumb goes
into flexion when paper is
pulled away.
Ulnar nerve injury
Pinch Grip Test Pt asked to pinch tips of index
finger and thumb together.
Unable to pinch the tips of the
index finger and thumb
together
Pathology of the anterior
interosseous nerve
Bunnell-Littler Test MCP joint held slightly
extended while doc moves the
PIP joint into flexion.
PIP joint cannot be flexed Osteoarthritis (capsular
contraction)
Finkelsteins Test Doc stabilizes the forearm and
ulnar deviates the wrist.
Pain over the abductor pollicis
longus and the extensor
pollicis brevis tendons at the
wrist
DeQuervainss or Hoffmans
disease tenosynovitis of the
thumb
Mankopfs Test Take pts resting HR. Apply
firm pressure over area of
pain.
Pulse increase of 10 or more
bpm
Pain is real they are not
faking/malingering.
THORACI C TESTS
Adams Position

Pt has high shoulder &/or
visible scoliosis while standing
/ Doc watches for change in
scoliosis while Pt flexes at
waist
High shoulder / High hip upon
flexion
Usually the Rt. side
Scoliosis Remains during
flexion Structural or
Pathological Scoliosis
Scoliosis disappears during
flexion Functional Scoliosis
(90% F / functional best
treated w/ chiro care)
Amoss Sign Pt in side lying position is
asked to move to a seated
position. Doc observes for
pain/discomfort or the use of
upper body strength
(hands/arm/abs) to assist in
rising from a supine/side lying
position
Rising elicits localized pain in
Thoracics or Thoraco-Lumbar
area or Pt uses upper body to
help themselves up
AS, IVD syndrome,
sprain/stain
(AS will also have decreased
ROM, decreased chest
expansion, tender sternum & T
spine)
Beevors Sign Pt supine, does partial crunch
(enough to lift shoulders off
table) doc observes umbilicus
for deviation
Deviation of umbilicus (will
deviate in the opposite
direction of weakness)
(Rectus Ab. Innerv T7 T12)
Ex Umbilicus moves to R
shoulder weakness in LLQ
showing a left T10 12 lesion
(lower Thoracic myelopathy)
Chest Expansion Test Measure chest during maximal
inspiration & maximal
expiration at the 4
th
intercostal
space (nipple line).
<1.25 difference
1.5-3 Normal
Spinal Ankylosis, decreased
costovertebral joint motion,
AS, respiratory pathology
Forestier Bowstring Lateral bending side to side,
doc observes ROM
Unequal motion from side to
side
Muscle spasm, AS, pain
inhibiting motion, stacking
Rib Motion Test Pt supine / doc hand on
chest/ribs (Medial to Lateral
Tissue Pull) should
expand/contract
symmetrically.
Also use Rib Spring pt
prone, press at 45 degrees to
ribs w/ flat broad contact. Feel
for springiness.
Decreased rib motion
Rib stops on inspiration
depressed rib most superior
non-moving rib listed
Rib stops on expiration rib
elevated - most inf non-
moving rib listed
Rib Subluxation
(hypomobility), Fx, Pleuritis,
Muscle strain, arthritis,
scoliosis
Schepelmanns Pt seated w/ arms extended
overhead & laterally bends to
both sides
Intercostal Pain Pain on concave side:
Intercostal Neuralgia
(compression of IC Nerve
Pain on convex side: Myalgia
(differentiate from pleuritis)
Pain along spine:
Focal = facet
Broad = subluxation
LUMBAR TESTS
Adams Position Pt has high shoulder &/or
visible scoliosis while standing
/ Doc watches for change in
scoliosis while Pt flexes at
waist
High shoulder / High hip upon
flexion
Usually the Rt. side
Scoliosis Remains during
flexion Structural or
Pathological Scoliosis
Scoliosis disappears during
flexion Functional Scoliosis
(90% F / functional best
treated w/ chiro care)
Amoss Sign Pt in side lying position is
asked to move to a seated
position. Doc observes for
pain/discomfort or the use of
upper body strength
(hands/arm/abs) to assist in
rising from a supine/side lying
position
Rising elicits localized pain in
Thoracics or Thoraco-Lumbar
area or Pt uses upper body to
help themselves up
AS, IVD syndrome,
sprain/stain
(AS will also have decreased
ROM, decreased chest
expansion, tender sternum & T
spine)
Antalgia Sign Doc observes an antalgic
posture / lean to one side to
relieve pts pain
Pain Relief
Away from side of pain PLL
Toward side of pain PLM
Forward w/ little relief
central Rhizel
Disc herniation / bulge

(pt is not locked into position -
that would indicated
tortipelvis)
Straight Leg Raiser (1) Pt supine. Raise leg straight up
on side of pain.
Pain reproduced (note angle &
location of pain)
0-30 = SOL (N or N Root
irritation)
30-60 = SIJ inflammation /
sciatica
60+ = Lumbosacral problem
Bechterews Test Pt sits w/ hips & knee at 90
degrees. Pt actively extends
leg at knee
Pain from lumbars radiating
down the leg (reproduced)
SOL, IVF encroachment,
Radiculopathy, nerve root
tension, sciatica
Braggards Sign (2) Straight Leg Raiser when
pain is elicited, lower the leg 5
degrees and dorsiflex foot
Radiating Pain (reproduced) SOL, IVF encroachment,
Radiculopathy, nerve root
tension, sciatica
Crossed Straight Leg
Raiser (5)
Pt. Supine. Raise leg straight
up on asymptomatic side.
Pain reproduced on the
affected leg (opposite the side
being tested)
Medial bulge on symptomatic
/ painful side
SOL, IVF encroachment,
Radiculopathy, nerve root
tension, sciatica
Fajersztajns Test (6) Well Leg Braggards
straight leg raiser on well side.
when pain is elicited lower the
leg 5 degrees and dorsiflex the
foot
Radiating Pain on
symptomatic side (reproduced)
Pain at same angle as
Braggards PLM bulge
Pain at greater angle PLL
bulge.
Coxs Sign (4) During the Straight leg raiser
test the pt raises ipsilateral hip
to relieve pain
Pain / Roll to opposite side SOL, IVF encroachment,
Radiculopathy, nerve root
tension, sciatica
Elys Heel to Buttocks Pt prone. Doc touches foot to
contralateral buttocks
Pain in anterior thigh / groin
area (ipsilateral leg testing)
Radiating: Femoral N, or N
root compression
Localized: Quadriceps muscle
contracture.
Anterior thigh pain from L2-4
NR, Hip lesion (rule out AVN,
OA, TB, subluxation)
Femoral Nerve Traction
Test
Pt side lying, bottom leg is
straight, top leg bent at knee,
extend thigh back on affected
side to traction the femoral n
Pain on Ant Thigh
To groin L3
To mid tibia L4

Femoral N or N root
compression.
If bilateral in elderly prostate
hypertrophy/cancer
Heel/Toe Walk Test Walk on heels
Walk on toes
Cant walk on heels
Cant walk on toes
Cant walk on heels: L5 N -
L4 IVD
Cant walk on toes S1 N - L5
IVD
Kemps Test Pt seated. Doc stabilizes L
spine with one hand and
supports contralateral shoulder
w/ other hand. Pt laterally
flexed away from doc, then
flexed forward , laterally bent
toward doc and brought into
extension in one smooth
motion (circumduction)
Radiating leg pain or local low
back pain.
NR irritation / disc herniation
Radiculopathy
Local pains
Pain w/ slight rotation or on
convexity capsulitis
Pain on extension or concavity
facet .
Pain at waist LS sprain/strain
Pain w/ flexion IVD lesion
Kernigs Sign Pt supine doc flexes pt hip &
knee 90 degrees doc then tries
to extend leg
Pain in spine or involuntary
flexion of the opposite
knee/hip
Pain with fever - meningitis
Brudzinski Sign Supine pt flexes head toward
the xiphoid process
Involuntary hip and knee
flexion
Pain & fever - meningitis
Lasegue Test Pt supine doc flexes pt hip &
knee 90 degrees doc then tries
to extend leg
Pain low back, hip or thigh Hip: hip pathology
Thigh: Radiculopathy
Bilateral: tight hamstrings
Lindners Sign Pt seated/supine. Passively
flex head/neck toward xiphoid
process
Pain in L spine or radicular leg
pain
Compression of Lumbar NR
Milgrams Test Pt Supine and lifts feet 6 off
table (knees in extension) and
told to hold for 30 sec
Unable to hold Due to low back pain:
herniation or L strain/sprain
No pain may have weak core
muscles
Minors Sign Pt uses upper body strength to
stand from seated position.
(walk up legs)
Recruitment of upper body
strength to stand up
SIJ lesion, L5 strain/sprain, LP
fx, IVD syndrome, Muscular
Dystrophy, Sciatica, myotonia
Nachlas Test (lumbars)
Elys Test (buttocks)
Pt prone. Knee is flexed to
touch foot to ipsilateral
buttocks
Pain in SI/ lumbosacral area.
Radiation of pain down
thigh/leg.
SI or Lumbosacral Problems
(sprain/strain)
Ant thigh pain may be from
inflammation of L2-4 NRs.
Quick Test Pt supports self w/ hand on
table/wall and performs ~5
deep squats
Pain / locking / crepitus in low
back, hips, knees, or ankles
(Helps locate problem along
the kinetic chain)
Subluxation of any involved
joints (Problems with joints)
Do not perform on elderly /
pregnant women
Sicards Sign (3) Straight leg raise, lower the
leg 5 degrees, dorsiflex big toe
Radiating Pain (reproduced) Irritation to L5 NR (L4 or S1
possible too)
Bilateral Leg Lowering
Test
Pt supine, Doc flexes hips to
90 degrees with legs extended.
Pt lowers legs to 45 degrees.
Pain in buttocks, SI, lower
extremity, leg drops due to
pain
Lumbosacral sprain/strain,
facet syndrome, IVD lesion
PELVI S TESTS
Anterior Innominate Test
(1)
Place unaffected foot 2-3 feet
forward. Flex forward at waist
to touch toes
Local pain over SI joint. Unilateral forward
displacement of ilium, sacrum,
SIJ sprain
Belt Test (2) 1) Patient stands, bends
forward to touch toes note
any pain.
2) Dr. braces hips with hands
and places hip tightly against
pt sacrum then pt. bends
forward again note pain.
Pain in lumbar or sacral
regions
If pt had pain in part 1 but no
pain in part 2 or is able to bend
further in part 2 before painful
= SI joint
If pt had pain in part 1 and
pain in part 2 at the same or
lesser degree of flexion =
Lumbar involvement.
Erichsens Test Pt. prone and dr. compresses
SI joint by applying pressure
to area of PSIS with thumbs or
thenars Creates double IN
ilium
Pain around SI joint Usually caused by Ant
stabilization ligaments
weakness
Gaenslens Test Pt supine, doc stands on
unaffected side and brings
affected knee up toward
patients chest. Then dr.
slowly hyperextends
unaffected leg (may need to
drop unaffected leg off table to
achieve hyperextension)
SI joint pain on side being
extended. Radiating pain to
groin or thigh.
SI joint sprain, instability.
DDx SI pain from
Lumbosacral pain
If neg L5 lesion possible

Goldthwaits Sign Pt. prone while dr. palpates L5
and S1. Dr uses other hand to
elevated affected leg.
Pain Pain before separation SI
joint
Pain after L5/S1 separation
Lumbar
Hibbs Test Prone Thigh
Roll
Pt prone, flex knee to 90
degrees & internally rot femur
(push foot laterally)
Pain Hip (Femoral head or
acetabular problems)
Iliac Compression Test Pt laying on side, doc
compresses iliac crest toward
table (affected side down)
Creates double EX ilium
Pain / increase pressure in SIJ Sprain Posterior SI ligament /
SI inflammation/subluxation
(can also have ilium fx or
pubic symphysis pain)


Lewin Gaenslen Test Lay on unaffected side. Pt
brings unaffected knee toward
chest. Then dr. slowly
hyperextends affected thigh.
SI joint pain on side being
extended
Muscle tightness
SI joint sprain, arthritis.
Iliopsoas muscle contracture
DDx SI pain from
Lumbosacral pain
Lewin Standing Test
standing straight leg raiser
Slightly flex knees & waist
slightly, cross arms, bend pt
forward to point before pain,
put 1 leg into extension when
stabilizing sacrum
Knee flexes or pt tries to stand
up b/c of pain / tightness
Herniation , SOL, Bulge
Yeomans Test Pt prone. Dr. applies pressure
to PSIS with one hand and
places other hand under
ipsilateral knee and lifts flexed
knee off table (extending the
thigh)
Pain in SI joints
Muscle tightness
SI lesion esp Anterior SI ligs
Pain into ant thigh/groin
Femoral N irritation (L2-4), or
prostate problems
Iliopsoas or rectus femoris
muscle contracture
HI P TESTS
Actual Leg Length Test Pt supine w/ feet together,
knees & hips straight. Doc
measures apex of ASIS to
center of medial malleolus
Difference of more than 6mm
from side to side
Hip joint of long bone
deficiency (accurate to 1 cm
need x-rays for higher
accuracy)
Apparent Leg Length Test Same as above measure
made from umbilicus to
medial maleolus
Difference of more than 6mm
from side to side
(adds in L3-5 discs w/ sublux
the leg lengths could change)
Pelvic Subluxation

Allis Sign / Saleazzis
Sign
Pt supine, Knees/Hips flexed,
feet flat on table and medial
malleoli & big toes are aligned
side by side doc stands at
foot of table and observes
knees for any height
discrepancy. Dr. then stands
at side of table and looks for
one knee to be more anterior
than the other.
One knee is lower compared to
the other.
One knee is more anterior
compared to the other
Ipsilateral femoral length
discrepancy (protrusion
acetabuli, hip dislocation PS,
dysplasia, fx)
Anvil Test Pt supine, doc elevates straight
leg & hits bottom of
calcaneous w/ clenched fist
Pain in kinetic chain heel to
acetabulum
Hip pain arthritis, femoral
neck fx, infection
Heel pain calcaneus fx, tibia
fx, fibula fx (depending on
point of pain)
Gauvains Sign Pt lays on side w/ affected side
up doc grasps above ankle and
abducts leg & then internally
and externally rotates thigh
Ipsilateral contraction of
abdominal muscles / pain in
hip / referred pain to groin, ant
thigh,
AVN, Infection, Fx, gout,
Hernia, hip tuberculosis (rare)
Hip Telescoping Test Pt supine doc passively flexes
knee & hip of affected side to
90 degrees , grasp calf with
one hand and place other hand
on thigh just proximal to knee
push femur into table and
distract femur away from
table.
Excess joint play and or
palpable click in joint
Hip dislocation / hip dysplasia
MC women (Mediterranean
& Scandinavian)
Patricks Test (mnemonic
FABERE)
Pt supine, doc on unaffected
side and patient instructed to
cross legs into a figure 4.
Dr. then stabilizes
contralateral ASIS on table
and puts downward pressure
on knee of affected side
Pain in hip or inability to
perform
Hip Pathology (DJD, OA, RA,
SCFE, AVN, Fx, sprain/strain,
tight hip adductors)
Obers Test Pt lies w/ affected side up, doc
stands behind pt & stabilizes
pelvis doc uses other hand to
abduct & extend thigh at hip
(holding at knee) with knee
bent to 90 degrees doc then
slides hand from knee to ankle
keeping knee bent
Affected thigh remains
abducted may be painful or
may drop w/ spastic jerks
(clonus)
ITB contracture

Common in runners
Thomas Test Pt supine & actively pulls
unaffected knee to chest while
keeping the other leg straight.
L spine maintains lordosis or
pt is unable to keep affected
thigh flat on the table
Flexion contracture or
shortening of iliopsoas on
affected side
Trendelenburgs Test Pt stands on affected foot and
raises unaffected foot off the
ground. (pt can brace
themselves against doc/table)
Dr. observes for any pelvic
unleveling.
Iliac crest high on supported
leg and low on lifted leg.
Paralysis / weakness of hip
abductors on affected side
(gluteus medius)
Hip dysplasia


Ortolanis Test Infant supine. Dr. grasps both
thighs at level of lesser and
greater trochanters between
thumbs and fingers. Dr then
flexes and abducts the thighs
bilaterally.
Palpable click/clunk Congenital femoral
dislocation, instability

NMS I I Orthopedics
KNEE TESTS
Abduction (Valgus) Stress
Test
Pt. supine with legs
straight, Dr. stabilizes the
medial ankle and pushes
lateral to medial at the
knee. Procedure is then
repeated w/ knee slightly
flexed (25!).
Pain or increased
motion/gapping
Medial Collateral
Ligament strain or rupture.
Adduction (Varus) Stress
Test
Pt. supine with legs
straight, Dr. stabilizes the
lateral ankle and pushes
medial to lateral at the
knee. Procedure is then
repeated w/ knee slightly
flexed (25!).
Pain or increased
motion/gapping
Lateral Collateral
Ligament strain or rupture.
Apleys Compression Test Pt. prone with knee flexed
to 90!. Dr. pushes down on
the foot with leg neutral,
then medially rotated and
laterally rotated.
Pain or crepitus with
compression (usually
relieved by distraction)
Internal rotation = lateral
meniscus
External Rotation = Medial
Meniscus
Patellar Ballottement Test Pt supine w/ leg straight,
Dr. pushes down on the
patella and moves it lateral
and medial, palpating for
motion
Patella is slow to return to
resting position. Increased
motion or spongy joint
feel.
Retropatellar
effusion/Intraarticular knee
swelling.
Bounce Home Test Pt. supine and relaxed. Dr.
lifts leg and bends knee to
20!. Dr. then allows the
knee to drop into full
extension.
Joint line pain
Inability to fully extend
knee:
1. Spongy end feel
2. Rubbery end feel
3. Hard end feel

Meniscal tear


1. swelling/edema
2. meniscal tear
3. intra-articular
fragment
Clarks Sign (Patellar
Scrape Test)
Push down on the patella
and ask the patient to
contract the quadriceps.
Retropatellar pain Chondromalacia patella,
degeneration of
patellofemoral joint
McMurrays Sign Pt supine, hip and knee
flexed to 90!. Dr. stabilizes
knee and grips heel with
the other hand. Dr. rotates
the tibia internally while
applying a varus force
while extending the leg.
Repeated with tibia rotated
externally and Dr. applying
a valgus force while
extending the leg.
Pain or crepitus Int. rot. w/ valgus stress &
extend = lateral meniscus
Ext. rot. w/ varus stress &
extend = medial meniscus
Lateral Pivot Shift
Maneuver
Pt. supine, w/ hip and knee
flexed. Adduction, internal
rotation, valgus stress and
flex knee.
Knee gives out Anterior Cruciate Lig.
Lachmans Test Drawer test with knee
flexed to 25!.
Pain w/ or w/o increased
anterior (ACL) and
posterior (PCL) translation.
Pain w/ normal translation:
sprain. Pain w/ increased
translation: rupture.
Drawer Test Pt. supine with knee flexed
to 90!. Dr. pulls the tibia
anterior and then pushes it
posterior feeling for
excessive motion.
Pain w/ or w/o increased
anterior (ACL) and
posterior (PCL) translation.
Pain w/ normal translation:
sprain. Pain w/ increased
translation: rupture.
Q-Angle Test Pt. standing. Draw a line
for ASIS through midpoint
of patella and another line
from tibial tuberosity
through the midpoint of the
patella. The angle is
measured between these 2
lines.
Angle is less than 13!. Genu varum
LOWER EXTREMI TY VASCULAR & ANKLE EXAMS
Anterior Drawer Sign Pt. supine or seated. Dr.
places one hand on anterior
tibia and the other on
posterior calcaneus and
pulls the foot anteriorly.
Excessive anterior
movement/translation
Anterior talofibular
ligament instability
Calf Circumference Test Measure the calf at the
widest point.
Increased or decreased
diameter comparing side to
side
" = acute compartment
syndrome
# = muscle atrophy
Claudication Test Pt. walks at 2 steps/sec
(120/min) for one minute
while Dr. observes
Muscle weakness,
cramping, pain, discomfort
or color change (palor)
Peripheral vascular disease,
intermittent vascular
claudication, popliteal a.
entrapment syndrome,
atherosclerosis
Homans Sign Pt. supine raise leg up to
10! , squeeze calf and
quickly dorsiflex the foot
Short duration, deep calf
pain
Persistent achy calf pain
Thrombophlebitis

Gastrosoleus strain
Moses Test Pt. prone, flex knee to 90!
and squeeze calf.
Short duration, deep calf
pain

Persistent achy calf pain
LE vascular insufficiency,
thrombophlebitis,
arteriosclerosis obliterans
Gastrosoleus strain
Thompsons Test Pt. prone, flex knee to 90!
and squeeze the calf
No plantar flexion
Localized pain
Short, deep pain
Ruptured Achilles tendon
Gastroc/soleus sprain
thrombophlebitis
FOOT TESTS
Duchennes Sign Apply upward force to
head of 1
st
metatarsal
Supination of foot with
attempted plantar flexion
Superficial peroneal n.
lesion or L4-S1 lesion
Helbings Sign Pt stands Dr. observes
the Achilles tendon
Medial curving of Achilles Overpronation syndrome
Common with Cerebral
Palsy
Mortons Test Squeeze foot around the
metatarsal heads
Pain Mortons neuroma (usually
between 3
rd
and 4
th
digits),
arthritis, stress fx of
metatarsal heads,
Metatarsalgia (less
localized/generalized pain)
Strunskys Sign Rapidly flex patients toes Forefoot pain Metatarsalgia, OA
Tinels Foot Tap posterior aspect of
medial malleolus (post.
Tibial n./medial plantar n.)
and dorsum of foot (deep
peroneal n)
Pain in the toe, arch, or
heel
Nerve compression
syndrome, Tarsal Tunnel
Syndrome (Post. Tibial
nerve)

MI SC
Burns Bench Test Stand, bend, and note angle
of pain
Kneel on bench and bend
forward
Should be able to bend
farther when kneeling
because the tension is off
of the sciatic n.
Indicates malingering
objective findings to not
match the subjective
complaint
MannKopfs Test Take pts resting HR.
Apply firm pressure over
area of pain.
Pulse increase of 10 or
more bpm.
Pain is real They are not
faking/malingering.
Libmans Test Pt. seated, Dr. standing
behind pt. Dr. applies
pressure on the pts
mastoid process with
thumbs until pt reports
pain/discomfort. Compare
side to side.
Pain/Uncomfortable Tests the pts pain
tolerance useful for later
procedures and to
determine malingering.