NMS I Orthopedics TESTS HOW TO PERFORM POSITIVE FINDING ...

NMS I Orthopedics
TESTS
Rust’s
HOW TO PERFORM POSITIVE FINDING INDICATIONS
Libman’s
Pt spontaneously grabs head
w/ both hands when lying
down or arising from
recumbent position
Pt seated, doc standing behind
pt. Doc applies pressure on
pt’s mastoid process with
thumbs until pt reports
pain/discomfort. Compare side
to side.
Bakody’s Pt abducts & externally rotates
the ipsilateral shoulder to
place hand on top of head.
Reverse Bakody’s Pt abducts & externally rotates
the ipsilateral shoulder to
place hand on top of head.
Bikele’s 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)
Brachial Plexus Tension
Test
Valsalva’s Test
DeJerine’s Triad
(question not 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.
Pt seated. Pt asked to take
deep breath in & hold it. While
holding breath pt bears down
Pt reports increase in radicular
symptoms when coughing,
sneezing, or straining during
defecation
Pain , Very limited Cervical
ROM
“Upper Cervical Instability”
Severe sprain, RA, Fx, Severe
Cervical subluxation
(TAKE XRAYS ASAP – no
further testing w/o them)
Pain / Uncomfortable Tests the pt’s pain tolerance -
useful for later procedures
Position relieves pt pain
(reduces tension on the
cervical nerve root)
Position increases radicular
pain.
Radiation of pain along
brachial plexus pattern.
Radiation along a nerve root.
Nerve tension, cervical
radiculopathy
Interscalene compression of
lower brachial plexus.
TOS
Brachial Plexus Neuritis
Brachial Plexus lesion /
Radiating pain along T1
dermatome only – Klumpke’s
Palsy
“Stinger” injury usually from
lateral flexion / traction injury.
(Injury may cause Neuropraxia
/ Axonotmesis / Wallerian
degeneration)
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.
Radicular pain SOL causing Nerve Root
compression
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.
Naffziger’s Test
Pt seated. Doc occludes
jugular vein bilaterally for 30-
40 seconds. Pt then asked to
cough
Barre-Lieou Pt seated. Doc tells pt to
slowly rotate head side to side
(BP & pulse are taken before
Vertebrobasilar Function
Maneuver
DeKleyn’s
test)
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.
Pt supine. Pt head off table doc
tells pt to hyperextend & rotate
head hold for 15-45 sec
Local or radicular pain in
spine
Vertigo, Blurred vision,
Nausea, Syncope, Nystagmus
Vertigo, Blurred vision,
Nausea, Syncope, Nystagmus
Vertigo, Blurred vision,
Nausea, Syncope, Nystagmus
SOL
* do not do on pt w/ cardiac
problems
Vascular Compromise
Vertebral, Basilar, or Carotid
artery stenosis/compression
Vascular Compromise

Distraction Test
Foraminal Compression
Jackson’s Compression
Test
Maximum Cervical
Compression
Spurlings Test
Pt seated. w/ hands on glabella
and EOP slightly traction pt’s
head upward.
Active C ROM performed
first.
Pt seated doc places
downward pressure on pt
head/neck. Head is rotated to
each side with similar
compression.
Pt seated. Head is laterally
flexed toward shoulder. Doc
exerts downward compression.
(Bilaterally tested)
Pt seated Pt actively rotates
head & hyperextends neck to
side of complaint. Repeats on
opposite side
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
Lhermitte’s Test Pt seated in neutral position.
Head/neck passively flexed to
pt chest
O'Donahue’s
Passive and active resisted
ROM or any joint.
Kernig’s Sign
Pt supine doc flexes pt hip &
knee 90 degrees doc then tries
to extend leg
Brudzinski’s Sign Supine pt flexes head/neck
Shoulder Depressor Test
toward xiphoid process/chest
Pt seated. Doc depresses pt
shoulder on affected side &
laterally flexes neck away
from shoulder.
Soto Hall Test Pt supine. Doc supports pt
head w/ one hand & knifeedge
contact on sternum w/
opposite hand. Pt actively
flexes head/neck to chest . Doc
follows w/ passive head/neck
flexion to chest
Allen’s 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.
1. Local pain increases
2. Peripheral pain decreases
3. Local pain decreases
1. Radicular pain
2. Local Neck pain
1. Muscle, ligament, or joint
capsule damage
2. IVF encroachment, cervical
radiculopathy
3. Facet impingement
1. Foraminal (cervical Nerve
Root) encroachment,
radiculopathy
2. Sprain/strain
Radicular pain IVF encroachment
(radiculopathy)
Facet irritation (local pain)
Radicular Pain IVF encroachment
*Tight stretching pain on
convex side – muscle strain
Radicular Pain Foraminal / Nerve Root
encroachment
Sharp radiating pain down
spine & upper/lower
extremities.
Facet involvement – local pain
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
Pain Pain w/ active – strain
Pain w/ passive – sprain
Pain in spine or involuntary
flexion of the opposite
knee/hip
Involuntary hip and knee
flexion
Radicular pain
produced/aggravated
*test can be used on any joint
in body*
Pain with fever – meningitis
Pain & fever – meningitis
Dural sleeve adhesion of
spinal Nerve Root, adjacent
joint capsule, brachial plexus
traction.
* common hyperextension
injury especially in young.
Pain Local pain w/ active – muscle
sprain.
Local pain w/ passive –
ligament strain.
Fracture
Facet Involvement
Circulation should return in 5
seconds or less.
Vascular Compromise
TOS

Adson’s Test
Modified Adson’s 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.
Same as above but rotate head
toward unaffected side.
Halstead’s 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
Allen's Maneuver Test Pt seated. Doc flexes pt’s
elbow to 90, palpates the
radial pulse while shoulder is
abducted and externally
rotated. Pt. rotates head away
Roos’ Test
“Hostage test”
Wright’s Test
“Hyperabduction test”
Costoclavicular Maneuver
Test
from side being tested.
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.
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
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.
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.
Apprehension Test Pt seated. Shoulder is abducted
and externally rotated (Ant
Shoulder).
Pt supine. Shoulder flexed &
internally rotated doc applies
Codman’s Drop Arm Test
posterior force (post shoulder)
Pt seated. Doc passively
abducts affected arm. Doc
suddenly removes support at
an angle about 90 degrees
Dawbarn’s Test Pt seated Doc palpates
affected shoulder deeply for
localized tenderness at the
subacromial bursa. Hold
pressure as arm is passively
Dugas Test
abducted.
Pt seated places affected sides
hand on opposite shoulder &
tries to touch chest w/ elbow
Decrease of pulse amplitude
Paresthesia
Decrease of pulse amplitude
Paresthesia
Decrease of pulse amplitude
Paresthesia
Pulse disappears TOS
Paresthesia/tingling, pain,
weakness
Loss of pulse / Tingling
(look at amplitude of
symptoms)
Cessation or dampening of
radial pulse, ischemic color
change, paresthesia, radicular
pain in upper extremity.
Neurovascular compromise of
Subclavian A due to Scalenus
Anticus or Cervical Rib – TOS
Scalene medius & Cervical
rib TOS
Scalene medius & Cervical
Rib TOS
TOS
Hyperabduction syndrome
(compression of axillary artery
under the pec minor)
Clavicle and first rib TOS (due
to poor posture, cervical rib,
bone tumor, or poorly united
fx of clavicle)
Reproduces shoulder pain Exacerbation of pain –
degenerative tendonitis
(especially supraspinatus)
Pain / pay attention to look on
pt face.
*instable shoulder can
dislocated w/ this test
Pt cannot stop arm from
dropping / Pain
Anterior or Posterior Shoulder
Dislocation trauma
Rotator cuff tear / injury
(specifically rupture of
supraspinatus tendon)
Pain disappears. Pain disappears – subacromial
bursitis
Inability to move elbow or
pain
Propensity for shoulder to
dislocate anteriorly.

Impingement Test Pt seated. Pt’s arm is slightly
abducted and moved fully
through flexion by the doctor.
(Jams greater tuberosity into
ant inf acromial surface).
Speed’s Test Pt seated. Forearm is flexed
and supinated. Pt flexes
shoulder against resistance.
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.
Yergason’s Test
Pt seated w/ elbow flexed. Pt
resists doc pronating and
extending the arm. Doc’s other
hand is palpating the inter-
tubercular groove
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
O’Brien’s
Pull S-I for Inf Capsule
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.
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.
Elbow Flexion Test Pt seated and actively flexes
elbow for 5 minutes
Tinel’s test at the Elbow
Cozen’s Test
Pt seated w/ elbow flexed to
90 degrees doc taps groove
between olecranon and lateral
epicondyle. Repeat between
the olecranon and medial
epicondyle.
Pt seated affected elbow
flexed & pronated. Pt makes a
fist. Pt actively extends hand /
wrist. Doc applies pressure
against dorsum of hand
Golfer’s 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.
Lift Test Cozens & Golfers Test
performed with weights
instead of pressure
Ligament Instability Test Pt’s 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.
Pain in shoulder Overuse injury of
supraspinatus tendon
(sometimes biceps tendon)
Pain / tenderness in the
bicipital groove.
Bicipital Tendonitis
Pain / Weakness in shoulder Supraspinatus muscle/tendon
tear
Clicking or pain over the
intertubercular groove
Pain = Bicipital Tenosynovitis
Clicking = tear of transverse
humeral ligament
Sulcus Line / Pain / Laxity Shoulder Capsule Instability /
loosening
Propensity to dislocate
Pain on part 1 or part 2 Pain during part 1: anterior
labrum tear, SLAP lesion
Pain during part 2: biceps
tendonitis
Inability to life the hand off
the back as far as the other
side.
Pain on Ant Shoulder
Tingling or paresthesia in
ulnar distribution of
hand/forearm.
Hypersensitivity.
Tingling radiating toward
forearm
* Positive Speeds & O’Briens
indicates Type II SLAP lesion
Subscapularis Tendonitis
Capsulitis
Ulnar paresthesia – Cubital
Tunnel Syndrome
Lateral: Superficial Radial
Nerve Palsy (degeneration)/
neuroma/neuritis
Medial: Ulnar N palsy /
neuroma / neuritis
Pain near Lateral Epicondyle Lateral Epicondylitis “Tennis
Elbow”
Radiohumeral bursitis
Pain near Medial Epicondyle Medial Epicondylitis “Golfers
Elbow”
Pain near Medial / Lateral
Epicondyle
Laxity, decreased mobility,
altered pain.
Medial / Lateral Epicondylitis
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.
Tinel’s Test at the Wrist Doc taps over the carpel tunnel Tingling into thumb, index
and middle finger and lateral
Phalen’s Test Doc flexes pt’s wrists and
pushes them together for 1
Froment’s Test
Pinch Grip Test
Bunnell-Littler Test
minute.
Pt. Grasps a piece of paper
between thumb and index
finger. Doc pulls paper away.
Pt asked to pinch tips of index
finger and thumb together.
MCP joint held slightly
extended while doc moves the
PIP joint into flexion.
Finkelstein’s Test Doc stabilizes the forearm and
ulnar deviates the wrist.
Mankopf’s Test
THORACIC TESTS
Adam’s Position
Amoss Sign
Beevor’s Sign
Take pt’s resting HR. Apply
firm pressure over area of
pain.
Pt has high shoulder &/or
visible scoliosis while standing
/ Doc watches for change in
scoliosis while Pt flexes at
waist
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
Pt supine, does partial crunch
(enough to lift shoulders off
table) doc observes umbilicus
for deviation
Chest Expansion Test Measure chest during maximal
inspiration & maximal
expiration at the 4 th intercostal
space (nipple line).
Forestier Bowstring Lateral bending side to side,
doc observes ROM
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.
Schepelmann’s Pt seated w/ arms extended
overhead & laterally bends to
both sides
Elbow pain increases Lateral Epicondylitis / Tennis
Elbow
half of ring finger.
Tingling into thumb, index and
middle fingers and lateral half
of ring finger.
Distal phalanx of thumb goes
into flexion when paper is
pulled away.
Unable to pinch the tips of the
index finger and thumb
together
Carpal Tunnel Syndrome
Carpal Tunnel Syndrome
Ulnar nerve injury
Pathology of the anterior
interosseous nerve
PIP joint cannot be flexed Osteoarthritis (capsular
contraction)
Pain over the abductor pollicis
longus and the extensor
pollicis brevis tendons at the
wrist
Pulse increase of 10 or more
bpm
High shoulder / High hip upon
flexion
Usually the Rt. side
Rising elicits localized pain in
Thoracics or Thoraco-Lumbar
area or Pt uses upper body to
help themselves up
Deviation of umbilicus (will
deviate in the opposite
direction of weakness)
(Rectus Ab. Innerv T7 – T12)

LUMBAR TESTS
Adam’s Position
Pt has high shoulder &/or
visible scoliosis while standing
/ Doc watches for change in
scoliosis while Pt flexes at
waist
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
Antalgia Sign Doc observes an antalgic
posture / lean to one side to
relieve pt’s pain
Straight Leg Raiser (1) Pt supine. Raise leg straight up
on side of pain.
Bechterew’s Test
Braggard’s Sign (2)
Crossed Straight Leg
Raiser (5)
Pt sits w/ hips & knee at 90
degrees. Pt actively extends
leg at knee
Straight Leg Raiser – when
pain is elicited, lower the leg 5
degrees and dorsiflex foot
Pt. Supine. Raise leg straight
up on asymptomatic side.
Fajersztajn’s Test (6) “Well Leg Braggards” –
straight leg raiser on well side.
when pain is elicited lower the
leg 5 degrees and dorsiflex the
foot
Cox’s Sign (4) During the Straight leg raiser
test the pt raises ipsilateral hip
to relieve pain
Ely’s Heel to Buttocks Pt prone. Doc touches foot to
contralateral buttocks
Femoral Nerve Traction
Test
Heel/Toe Walk Test
Pt side lying, bottom leg is
straight, top leg bent at knee,
extend thigh back on affected
side to traction the femoral n
Walk on heels
Walk on toes
Kemp’s 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)
High shoulder / High hip upon
flexion
Usually the Rt. side
Rising elicits localized pain in
Thoracics or Thoraco-Lumbar
area or Pt uses upper body to
help themselves up
Pain Relief
Away from side of pain –PLL
Toward side of pain – PLM
Forward w/ little relief –
central “Rhizel”
Pain reproduced (note angle &
location of pain)
Pain from lumbars radiating
down the leg (reproduced)
Scoliosis Remains during
flexion – Structural or
Pathological Scoliosis
Scoliosis disappears during
flexion – Functional Scoliosis
(90% F / functional best
treated w/ chiro care)
AS, IVD syndrome,
sprain/stain
(AS will also have decreased
ROM, decreased chest
expansion, tender sternum & T
spine)
Disc herniation / bulge
(pt is not locked into position -
that would indicated
tortipelvis)
0-30 = SOL (N or N Root
irritation)
30-60 = SIJ inflammation /
sciatica
60+ = Lumbosacral problem
SOL, IVF encroachment,
Radiculopathy, nerve root
tension, sciatica
Radiating Pain (reproduced) SOL, IVF encroachment,
Radiculopathy, nerve root
tension, sciatica
Pain reproduced on the
affected leg (opposite the side
being tested)
Radiating Pain on
symptomatic side (reproduced)
Medial bulge on symptomatic
/ painful side
SOL, IVF encroachment,
Radiculopathy, nerve root
tension, sciatica
Pain at same angle as
Braggards – PLM bulge
Pain at greater angle PLL
bulge.
Pain / Roll to opposite side SOL, IVF encroachment,
Radiculopathy, nerve root
tension, sciatica
Pain in anterior thigh / groin
area (ipsilateral leg testing)
Pain on Ant Thigh
To groin – L3
To mid tibia – L4
Can’t walk on heels
Can’t walk on toes
Radiating leg pain or local low
back pain.
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 N or N root
compression.
If bilateral in elderly – prostate
hypertrophy/cancer
Can’t walk on heels: L5 N -
L4 IVD
Cant walk on toes S1 N - L5
IVD
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

Kernig’s Sign
Brudzinski Sign
Lasegue Test
Pt supine doc flexes pt hip &
knee 90 degrees doc then tries
to extend leg
Supine pt flexes head toward
the xiphoid process
Pt supine doc flexes pt hip &
knee 90 degrees doc then tries
to extend leg
Lindner’s Sign Pt seated/supine. Passively
flex head/neck toward xiphoid
process
Milgram’s Test
Pt Supine and lifts feet 6” off
table (knees in extension) and
told to hold for 30 sec
Minor’s Sign Pt uses upper body strength to
stand from seated position.
Nachlas Test (lumbars)
Ely’s Test (buttocks)
(walk up legs)
Pt prone. Knee is flexed to
touch foot to ipsilateral
buttocks
Quick Test Pt supports self w/ hand on
table/wall and performs ~5
deep squats
Pain in spine or involuntary
flexion of the opposite
knee/hip
Involuntary hip and knee
flexion
Pain with fever - meningitis
Pain & fever - meningitis
Pain low back, hip or thigh Hip: hip pathology
Thigh: Radiculopathy
Bilateral: tight hamstrings
Pain in L spine or radicular leg Compression of Lumbar NR
pain
Unable to hold Due to low back pain:
herniation or L strain/sprain
No pain – may have weak core
Recruitment of upper body
strength to stand up
Pain in SI/ lumbosacral area.
Radiation of pain down
thigh/leg.
Pain / locking / crepitus in low
back, hips, knees, or ankles
(Helps locate problem along
the kinetic chain)
muscles
SIJ lesion, L5 strain/sprain, LP
fx, IVD syndrome, Muscular
Dystrophy, Sciatica, myotonia
SI or Lumbosacral Problems
(sprain/strain)
Ant thigh pain may be from
inflammation of L2-4 NR’s.
Subluxation of any involved
joints (Problems with joints)
Do not perform on elderly /
pregnant women
Sicard’s Sign (3) Straight leg raise, lower the Radiating Pain (reproduced) Irritation to L5 NR (L4 or S1
leg 5 degrees, dorsiflex big toe
possible too)
Bilateral Leg Lowering Pt supine, Doc flexes hips to Pain in buttocks, SI, lower Lumbosacral sprain/strain,
Test
90 degrees with legs extended. extremity, leg drops due to facet syndrome, IVD lesion…
PELVIS TESTS
Pt lowers legs to 45 degrees. pain
Anterior Innominate Test Place unaffected foot 2-3 feet Local pain over SI joint. Unilateral forward
(1)
forward. Flex forward at waist
displacement of ilium, sacrum,
to touch toes
SIJ sprain
Belt Test (2) 1) Patient stands, bends Pain in lumbar or sacral If pt had pain in part 1 but no
forward to touch toes – note regions
pain in part 2 or is able to bend
any pain.
further in part 2 before painful
2) Dr. braces hips with hands
= SI joint
and places hip tightly against
If pt had pain in part 1 and
pt sacrum then pt. bends
pain in part 2 at the same or
forward again – note pain.
lesser degree of flexion =
Lumbar involvement.
Erichsen’s Test Pt. prone and dr. compresses Pain around SI joint Usually caused by Ant
SI joint by applying pressure
stabilization ligaments
to area of PSIS with thumbs or
thenars Creates double IN
ilium
weakness
Gaenslen’s Test Pt supine, doc stands on SI joint pain on side being SI joint sprain, instability.
unaffected side and brings extended. Radiating pain to DDx SI pain from
affected knee up toward groin or thigh.
Lumbosacral pain
patient’s chest. Then dr.
slowly hyperextends
unaffected leg (may need to
drop unaffected leg off table to
achieve hyperextension)
If neg L5 lesion possible
Goldthwait’s Sign
Pt. prone while dr. palpates L5 Pain Pain before separation – SI
and S1. Dr uses other hand to
joint
elevated affected leg.
Pain after L5/S1 separation –
Lumbar
Hibb’s Test “Prone Thigh Pt prone, flex knee to 90 Pain Hip (Femoral head or
Roll”
degrees & internally rot femur
(push foot laterally)
acetabular problems)
Iliac Compression Test Pt laying on side, doc
Pain / increase pressure in SIJ Sprain Posterior SI ligament /
compresses iliac crest toward
SI inflammation/subluxation
table (affected side down)
(can also have ilium fx or
Creates double EX ilium
pubic symphysis pain)

Lewin Gaenslen Test
Lewin Standing Test
standing straight leg raiser
Lay on unaffected side. Pt
brings unaffected knee toward
chest. Then dr. slowly
hyperextends affected thigh.
Slightly flex knees & waist
slightly, cross arms, bend pt
forward to point before pain,
put 1 leg into extension when
stabilizing sacrum
Yeoman’s 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)
HIP TESTS
Actual Leg Length Test
Apparent Leg Length Test
Allis’ Sign / Saleazzi’s
Sign
Anvil Test
Pt supine w/ feet together,
knees & hips straight. Doc
measures apex of ASIS to
center of medial malleolus
Same as above – measure
made from umbilicus to
medial maleolus
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.
Pt supine, doc elevates straight
leg & hits bottom of
calcaneous w/ clenched fist
Gauvain’s Sign Pt lays on side w/ affected side
up doc grasps above ankle and
abducts leg & then internally
and externally rotates thigh
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
Patrick’s Test (mnemonic
FABERE)
Ober’s Test
Thomas Test
table.
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
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
Pt supine & actively pulls
unaffected knee to chest while
keeping the other leg straight.
SI joint pain on side being
extended
Muscle tightness
Knee flexes or pt tries to stand
up b/c of pain / tightness
Pain in SI joints
Muscle tightness
Difference of more than 6mm
from side to side
Difference of more than 6mm
from side to side
(adds in L3-5 discs w/ sublux
the leg lengths could change)
One knee is lower compared to
the other.
One knee is more anterior
compared to the other
Pain in kinetic chain heel to
acetabulum
Ipsilateral contraction of
abdominal muscles / pain in
hip / referred pain to groin, ant
thigh,
Excess joint play and or
palpable click in joint
Pain in hip or inability to
perform
Affected thigh remains
abducted may be painful or
may drop w/ spastic jerks
(clonus)
L spine maintains lordosis or
pt is unable to keep affected
thigh flat on the table
SI joint sprain, arthritis.
Iliopsoas muscle contracture
DDx SI pain from
Lumbosacral pain
Herniation , SOL, Bulge
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
Hip joint of long bone
deficiency (accurate to 1 cm
need x-rays for higher
accuracy)
Pelvic Subluxation
Ipsilateral femoral length
discrepancy (protrusion
acetabuli, hip dislocation PS,
dysplasia, fx)
Hip pain – arthritis, femoral
neck fx, infection
Heel pain – calcaneus fx, tibia
fx, fibula fx (depending on
point of pain)
AVN, Infection, Fx, gout,
Hernia, hip tuberculosis (rare)
Hip dislocation / hip dysplasia
MC – women (Mediterranean
& Scandinavian)
Hip Pathology (DJD, OA, RA,
SCFE, AVN, Fx, sprain/strain,
tight hip adductors)
ITB contracture
Common in runners
Flexion contracture or
shortening of iliopsoas on
affected side

Trendelenburg’s 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.
Ortolani’s 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.
Iliac crest high on supported
leg and low on lifted leg.
Paralysis / weakness of hip
abductors on affected side
(gluteus medius)
Hip dysplasia
Palpable click/clunk Congenital femoral
dislocation, instability

NMS II Orthopedics
KNEE TESTS
Abduction (Valgus) Stress
Test
Adduction (Varus) 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°).
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°).
Apley’s Compression Test Pt. prone with knee flexed
to 90°. Dr. pushes down on
the foot with leg neutral,
then medially rotated and
laterally rotated.
Patellar Ballottement Test Pt supine w/ leg straight,
Dr. pushes down on the
patella and moves it lateral
and medial, palpating for
motion
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.
Clark’s Sign (Patellar
Scrape Test)
Push down on the patella
and ask the patient to
contract the quadriceps.
McMurray’s 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
Lateral Pivot Shift
Maneuver
extending the leg.
Pt. supine, w/ hip and knee
flexed. Adduction, internal
rotation, valgus stress and
flex knee.
Lachman’s Test Drawer test with knee
flexed to 25°.
Drawer Test Pt. supine with knee flexed
to 90°. Dr. pulls the tibia
anterior and then pushes it
posterior feeling for
excessive motion.
Pain or increased
motion/gapping
Pain or increased
motion/gapping
Pain or crepitus with
compression (usually
relieved by distraction)
Patella is slow to return to
resting position. Increased
motion or spongy joint
feel.
Joint line pain
Inability to fully extend
knee:
1. Spongy end feel
2. Rubbery end feel
3. Hard end feel
Medial Collateral
Ligament strain or rupture.
Lateral Collateral
Ligament strain or rupture.
Internal rotation = lateral
meniscus
External Rotation = Medial
Meniscus
Retropatellar
effusion/Intraarticular knee
swelling.
Meniscal tear
1. swelling/edema
2. meniscal tear
3. intra-articular
fragment
Retropatellar pain Chondromalacia patella,
degeneration of
patellofemoral joint
Pain or crepitus Int. rot. w/ valgus stress &
extend = lateral meniscus
Ext. rot. w/ varus stress &
extend = medial meniscus
Knee gives out Anterior Cruciate Lig.
Pain w/ or w/o increased
anterior (ACL) and
posterior (PCL) translation.
Pain w/ or w/o increased
anterior (ACL) and
posterior (PCL) translation.
Pain w/ normal translation:
sprain. Pain w/ increased
translation: rupture.
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.
LOWER EXTREMITY 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.
Calf Circumference Test Measure the calf at the
widest point.
Claudication Test Pt. walks at 2 steps/sec
(120/min) for one minute
while Dr. observes
Homan’s Sign Pt. supine – raise leg up to
10° , squeeze calf and
Angle is less than 13°. Genu varum
Excessive anterior
movement/translation
Increased or decreased
diameter comparing side to
side
Muscle weakness,
cramping, pain, discomfort
or color change (palor)
Short duration, deep calf
pain
Persistent achy calf pain
Short duration, deep calf
pain
Anterior talofibular
ligament instability
↑ = acute compartment
syndrome
↓ = muscle atrophy
Peripheral vascular disease,
intermittent vascular
claudication, popliteal a.
entrapment syndrome,
atherosclerosis
Thrombophlebitis
quickly dorsiflex the foot
Gastrosoleus strain
Moses’ Test Pt. prone, flex knee to 90°
LE vascular insufficiency,
and squeeze calf.
thrombophlebitis,
arteriosclerosis obliterans
Persistent achy calf pain Gastrosoleus strain
Thompson’s Test Pt. prone, flex knee to 90° No plantar flexion Ruptured Achilles tendon
and squeeze the calf Localized pain
Gastroc/soleus sprain
FOOT TESTS
Short, deep pain
thrombophlebitis
Duchenne’s Sign Apply upward force to
head of 1 st Supination of foot with Superficial peroneal n.
metatarsal attempted plantar flexion lesion or L4-S1 lesion
Helbing’s Sign Pt stands – Dr. observes Medial curving of Achilles Overpronation syndrome –
the Achilles tendon
Common with Cerebral
Palsy
Morton’s Test Squeeze foot around the Pain Morton’s neuroma (usually
metatarsal heads
between 3 rd and 4 th digits),
arthritis, stress fx of
metatarsal heads,
Metatarsalgia (less
localized/generalized pain)
Strunsky’s Sign Rapidly flex patients toes Forefoot pain Metatarsalgia, OA
Tinel’s Foot Tap posterior aspect of Pain in the toe, arch, or Nerve compression
medial malleolus (post. heel
syndrome, Tarsal Tunnel
Tibial n./medial plantar n.)
Syndrome (Post. Tibial
and dorsum of foot (deep
peroneal n)
nerve)

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