Shoulder Name Empty can test Purpose Rot cuff/impingement pathologies supraspinatus muscle and tendon Description The

e pts arm should be elevated 90 in scaption with the elbow extended, full internal rot, and full pronation of the forearm (thumb down). The clinician stabilizes the shldr whilt applying a downward force. Hold it, dont let me move it. Clinician places pts shoulder in 90 of shldr flexion with the elbow flexed to 90 and then internally rotates the arm. With the pt in a thumb down position, the clinician passively moves the arm into flexion while stabilizing the scapula. Passively elevate the arm in the scapular plane and then slowly reverses the motion. Pt. actively elevates the arm in the scapular plane then slowly reverses the motion. With the arm in neutral, the pt flexes the elbow to 90 and resists against a medially directed force. Positive sign Pain or weakness with resistance

Hawkins-Kennedy impingement test

Rot cuff/impingement pathologies subacromial impingement syndrome Rot cuff/impingement pathologies subacromial impingement syndrome Rot cuff/impingement pathologies full thickness Rot cuff tear Rot cuff/impingement pathologies subacromial impingement syndrome full thickness Rot cuff tear Rot cuff/impingement pathologies subacromial impingement syndrome full thickness Rot cuff tear Shoulder instability tests integrity of anterior GH joint capsule and assesses for GH joint instability

Pain with internal rotation

Neer impingement Test

Pain reported in this position

Drop arm (Codmans) Test Painful arc sign

Pt experiences pain or the arm drops suddenly Pain experienced b/w 60-120 of elevation

Infraspinatus muscle test

Apprehension Test

Pt is positioned in supine. Clinician flexes the pts elbow to 90 and abducts the shldr to 90, maintaining neutral rotation. Clinician then slowly externally rots the shldr to 90 while monitoring the pt. Do if Apprehension Test is positive; Same as apprehension test, but apply a stabilizing posterior force to the

Pain or weakness with resistance or if pts arm is externally rotd passively but falls into internal rot when its released by the clinician Pt exhibits signs of apprehension as the shldr is ext rotd

Relocation Test

Shoulder instability

Pain or apprehension is reduced

humeral head Sulcus Sign Shoulder inferior instability laxity of superior GH ligament and coracohumeral ligament Pt positioned with shoulder in a neutral, relaxed position. Clinician applies a downward force on the humerus A gap greater than 1 fingerwidth appears b/w the acromion and the head of the humerus

Load and shift Test

Shoulder instability

OBriens Active Compression Test

Shoulder instability labral (SLAP lesion) or acromioclavicular lesions

Speeds Test

Bicipital tendon test superior labral tears or bicipital tendonitis

Roos Test

TOS

Adson maneuver

TOS

Hallstead maneuver

TOS

With the pt seated, the clinician stabilizes the scapula with one hand and places the other on the humeral head (the index finger should be over the ant GH joint line). The clinician should apply a load and shift in an anteromedial direction, then a posterolateral direction. The UE is placed in a thumb down position (90 flexion, 10 add, IR). The clinician resists upward force from the pt. The pts arm is then placed into a thumb up position (90 flexion, 10 add, neutral rot) and the resistance is again applied. Pts arm is positioned in shldr flexion, ER, full elbow ext and forearm supination. Resistance is applied in a downward direction. Pt. positioned in sitting. 90 of Shoulders abd, 90 of elbows flexion, slow finger clenching for 3 min Pt. is positioned sitting on the edge of a table. Clinician grasps the arm on the symptomatic side, passively depresses its shoulder girdle, and then pulls the arm down towards the floor while palpating the radial pulse. Pt. extends head and turns toward the tested side. Pt. is positioned sitting on the edge of a table.

More movement than half the distance of the humeral head indicates GH laxity.

Pain reproduction or clincking in the shldr with the first position and reduced/absent with the second position. Superficial pain indicates AC joint symptoms and deep pain indicates labral symptoms. Pain in the bicipital tendon or groove is reproduced.

Pain, heaviness, numbness, tingling Absence or diminishing of pulse

Absence or diminishing of pulse

Costoclavicular test

TOS

Clinician grasps the arm on the symptomatic side, passively depresses its shoulder girdle, and then pulls the arm down towards the floor while palpating the radial pulse. Pt. extends head and turns away from the tested side. Pt. is positioned sitting on the edge of a table. Clinician grasps the arm on the symptomatic side, passively depresses its shoulder girdle, and then pulls the arm down towards the floor while palpating the radial pulse. Pt. looks straight ahead.

Absence or diminishing of pulse

Elbow Name Cozens Purpose Contractile dysfunction tennis elbow (lateral epicondylalgia) Description Clinician stabilizes the patients elbow with one hand and the pt is asked to pronate the forearm, and extend and radially deviate the wrist against the manual resistance of the clinician Clinician palpates the pts lateral epicondyle with one hand, while pronating the pts forearm, fully flexing the wrist, and extending the elbow Clinician palpates the medial epicondyle with one hand, while supinating the forearm and extending the wrist and elbow with the other hand Clinician locates the groove b/w the olecranon process and the medial epicondyle through which the ulnar nerve passes. This groove is tapped by the index finger of the clinician Positive sign Reproduction of pain in the area of the lateral epicondyle

Mills

Contractile dysfunction tennis elbow (lateral epicondylalgia)

Reproduction of pain in the area of the lateral epicondyle

Golfers elbow

Contractile dysfunction medial epicondylitis

Reproduction of pain in the area of the medial epicondyle

Tinels sign

Neurological dysfunction

Tingling sensation in the ulnar distribution of the forearm and hand distal to the tapping point

Wartenbergs sign

Elbow flexion test

Neurological dysfunction pain over the distal radial forearm assocd with paresthesias over the dorsal radial hand (Wartenberg syndrome) Neurological dysfunction cubital tunnel syndrome

Passively spread apart the pts fingers and ask the pt to adduct fingers

The pinky finger doesnt come back in

Pinch grip test

Neurological dysfunction anterior interosseous nerve Ligamentous instability medial collateral ligament tear

Valgus stress (0 and 30)

Moving valgus stress test

Ligamentous instability medial collateral ligament tear

Varus stress (0 and 30)

Ligamentous instability lateral collateral ligament tear

Pt. positioned in sitting, asked to depress both shoulders, flex both elbows maximally, supinate the forearms, and extend the wrists. Maintain position for 3-5 min Ask the pt to make an OK sign making sure to place thumb and index finger tip-to-tip (IPs flexed) Pt. is standing. Clinician places pts elbow in approx. 0 or 30 of flexion while palpating the medial joint line. Clinician applies a valgus force to the elbow. Pt. is standing and is asked to abd the shldr to 90. Clinician grasps the distal forearm with one hand and stabilizes the elbow with the other. Clinician then maximally flexes the elbow and places a valgus torque to the elbow while simultaneously ERs the shldr. When the shldr reaches the end range of ER the clinician quickly extends the elbow to approx. 30. Pt. is standing. Clinician places the pts elbow in approx. 0 or 30 of flexion while palpating the lateral joint line.

Tingling or paresthesia in the ulnar distribution of the forearm and hand

Cant flex IPs

Pain or excessive laxity is noted compared to the contralateral side.

1. Pain at the medial elbow 2. Max pain must be experienced b/w 120-70 of elbow flexion.

Pain or excessive laxity is noted compared to the contralateral side

Clinician applies a varus force to the elbow.

Wrist and Hand Name Supination lift test Fovea sign Finkelsteins test Purpose Distal radioulnar joint Thumb (scaphoid fx) Thumb tenosynovitis of the abductor pollicis longus and extensor pollicis brevis tendons in the first dorsal tunnel of the wrist (DeQuervains disease) Description Supinate hands, place hands under the table, try to lift up the table Palpate snuff box Pt is standing or seated and is instructed to make a fist with the thumb b/w the palm and fingers. Clinician then stabilizes the forearm with one hand and passively ulnarly deviates the wrist. Positive sign Pain in wrist Tenderness to snuff box Pain over the radial styloid process is reproduced with ulnar deviation.

Scaphoid (Watson) shift test

Thumb (scapholunate instability)

Valgus stress to UCL

Thumb (gamekeepers thumb) Thumb arthrosis and synovitis; possibly OA

Thumb CMC grind

Murphys sign

Lunate dislocation

Pt. is seated with the forearm pronated and stabilized on the table. Clinician grasps the radial side of the pts wrist with one hand with the thumb over the scaphoid. Clinicians other hand grasps the hand at the level of the metacarpals. Clinician maintains firm compression over the scaphoid while passively taking the pt into ulnar deviation and slight extension, then slowly into radial deviation and slight flexion. Clinician then releases the compression on the scaphoid. Pull thumb into extension while palpating the UCL at the base of the MC Clinician grasps the thumb MC using the thumb and index finger of one hand and the proximal aspect of the thumb CMC joint with the other hand. An axial compressive force, combined with rotation, is applied to the thumb CMC joint. Ask pt to make a fist.

A thunk is produced or the pts symptoms are reproduced when compression of the scaphoid is released.

Laxity or pain

Reproduction of pain and crepitus

3rd MCP is level with 2nd and 4th.

Tinels sign

Carpal Tunnel

Phalens sign

Carpal Tunnel

The area over the median nerve is tapped gently at the palmar surface of the wrist. Pt sits comfortably with the wrists and elbows flexed.

Tingling in the median distribution.

Numbness or tingling within 45 sec; may recreate wrist, thumb, or forearm ache.

Bunnell-Littler test

Hand

Hyperextend MCP, flex PIP; flex MCP, flex PIP; compare Ask the pt to make a fist Ask a pt. to hold a sheet of pater b/w the thumb and the tip of the index finger. The sheet is then pulled away, while asking the pt to hold onto it.

Sweater finger sign Froments sign

Hand Hand ulnar nerve entrapment

If its the same, its joint capsule; if theyre different, its tendon tightness A DIP isnt flexed with the others Flexion of the IP (Padpad pinch)

Hip Name Wilson-Barstow maneuver Purpose Leg length discrepancy Description Pt lays supine with knees bent, line up the medial malleoli; Positive sign Discrepancy b/w legs

Sign of the Buttock

Ischial pathology (bursitis or abscess) Iliopsoas flexibility

Thomas test

Rectus femoris contracture test (Modified Thomas Test)

Rectus femoris and iliopsoas

Elys test

Rectus femoris

Obers test

IT band and TFL tightness

Piriformis (FAIR) test

Compression or irritation of the sciatic nerve by the piriformis (piriformis syndrome)

90/90 straight leg raise test

Hamstring length

FABER (Patricks) test Scouring (hip quadrant) test

Capsule SI or hip pathology Necrosis OA

ask the pt to bridge up, then down, compare the heights of the knees Passive SLR, feel for a stop, flex the knee to see if you get more hip flexion Supine, pt brings knee up to chest until lumbar spine begins to flex Lay supine with the pelvis at the edge of the table; bring knee to chest with the therapist standing on the flexed knee side; flex the straight knee Pt lies prone, passively flex the knee; stop with apprehension or compensation Pt in sidelying with back to therapist, stabilizing the pelvis, and the pts hips slightly flexed; flex the knee and hip of the LE, passively abduct then extend the hip until the thigh is in line with the body; keep the knee flexed to 90 while lowering the thigh Pt sidelying with bottom leg straight; involved LE is passively brought into a position of flexion (60), adduction and internal rotation Pt supine, flex hip to 90, extend knee as much as possible while maintaining position Figure 4 (flexion, abduction, ER), push downward at the knee Pt in supine, passively flex and adduct the hip until resistance to movement is

Hip flexion doesnt increase with knee flexion Opposite thigh is raised off the table Knee rises high tight iliopsoas Hip flexion upon knee flexion tight rectus femoris Apprehension or compensation (same side hip rises off the table) Thigh does not lower to/past midline

Pain at the region of the piriformis

>20 short of full extension

SI posterior pain Hip anterior pain Pain in this position or a restriction of ROM

Anterior Labral Tear test

Anterior labral tear

Craig test

Determines the presence of retro or anteversion

Trendelenberg sign (compensated and uncompenstated) Fulcrum test

Hip abductor strength (glute med) Stress fx on femur

detected; move into abduction and back to adduction while maintaining flexion and applying a downward compression Pt in supine, flex knee, flex and abduct hip, move it in, downward, and out (in a semi circle) Prone, flex knee, find the point at which the greater trochanter is most prominent; measure the amount of IR (normal= 8-15) Stand on affected leg

Pain

>15 = anteversion <8 = retroversion

Opposite hip drop or compensation by leaning toward affected side Supine, place rolled-up Pain towel under the femur to form a fulcrum and push down proximally to the knee

Knee Apleys Compression Test McMurrays Test Meniscus injury Meniscus injury Prone, knee flexed, foot in neutral; compress and twist Supine, hip flexed, knee flexed; ER the leg while palpating the medial structures and extend the knee To palpate the external structures, IR and extend the knee Knee flexed; palpate for the collateral ligaments and move away from them into the joint space Supine, pt contracts quad, watch patellar motion Passively Painful clicking Palpable click or thud, or provocation of pain

*Palpation for Joint Line Tenderness

Meniscus lesion

Provocation or reproduction of pain

Q-angle Lateral Pull Test Patellar apprehension

Patellofemoral dysfunction Patellofemoral dysfunction Patellofemoral dysfunction

Patella hooks laterally

Fluctuation Test

(subluxation in patella) Swelling (OA)

Put both hands around knee, push down with one hand then with the other to watch the swelling go back and forth

Anterior drawer

ACL integrity (anterio-medial bundle) PCL integrity ACL integrity (both bundles of ACL) Stabilize the distal femur, place leg at 20 flexion, translate the tibia anteriorly on the femur Looking for anterior translation in 30 flexion Anterior drawer test with: Medial foot rotation (assessing LCL - ACL) Lateral foot rotation (assessing MCL - ACL) Lack of end point for tibial translation or excessive tibial translation

Posterior drawer Lachmans Test

Slocums Test

Cruciate ligaments (anterior rotary instability) MCL ACL Posterior oblique ligament Posteromedial capsule (anteromedial instability) Lesion of ACL, posterolateral capsule, arcuate-popliteus complex, LCL or PCL) ACL integrity

Movement occurring primarily on the lateral or medial side of the knee

Pivot shift (MacIntosh)

Valgus stress

MCL integrity

Start at full ext, IR the tibia, and flex the leg while applying a valgus force Supine, support knee with thigh, stabilize proximal femur, apply valgus force Test in 5 & 30 of flexion Get in b/w legs so you can use your body (ask the person to slide the leg off of the table) Test in 5 & 30 of

Pain and laxity

Varus stress

LCL integrity

Pain or laxity

flexion

Foot and ankle Name Anterior drawer Purpose Ligamentous integrity ATFL integrity (laxity) Description Long sitting; stabilize the distal tibia with one hand, and with the other hand position the foot in 1015 of plantarflexion and glide the ankle forward Invert, while holding onto the talus and calcaneus, trying to gap bones on lateral side If you do it the other way, testing for the deltoid ligs. usually, however, its for the lateral ligaments. Locate a portion of the fibula 6 in below knee joint line, compress the tibia and fibula together Positive sign Talus translates or subluxes anteriorly (graded on a 4-pt scale)

Talar tilt test

Ligamentous integrity ATFL, CFL integrity (lateral ankle ligaments)

Amount of laxity (graded on a 4-pt scale) OR <5 degrees, >15 degrees

Squeeze test

Ligamentous integrity Tibiofibular Syndesmotic sprain

Pain in area of syndesmosis (if its point tenderness, its something else)

Kleigers test (ER test)

Ligamentous integrity Tibiofibular syndesmotic sprain

ER the foot on a stabilized leg in dorsiflexion

Thompson test (Calf squeeze) Navicular drop test

Achilles tendon tear Navicular height (Pronation)

Windlass test Figure 8 ankle measurement

Plantar fasciitis Swelling

Homens sign

DVT

Pt in prone, flex up leg, squeeze calf muscles Palpate and mark the navicular tubercle. Measure the navicular height with the pt in subtalar neutral position with most wt on the contralateral LE. Allow the pt to relax the foot and measure the navicular height again in full WB. Take the difference of the two measurements. Passively extend the great toe Start at the navicular and wrap the measuring tape around the foot, then the malleoli, and return to the starting point. Passively, but forcibly, dorsiflex the foot. Squeeze the calf.

Pain in area of syndesmosis (anteriorposterior) or over interosseous membrane (if its point tenderness, its something else) Minimal-no plantarflexion A difference measured.

Pain in arch or medial calcaneal tubercle. Difference from uninvolved foot.

Pain.