Joint Exam Special Test Review

Principles of Clinical Medicine

March 31, 2016
Special Test Comments
Shoulder Joint
Apprehension Test Patient is seated or supine. Shoulder abducted to 90 and elbow flexed to 90. Force
arm into external rotation. Doctor can provide anterior pressure on the proximal
humerus.
(+) Test= Patient apprehensive of repeat dislocation.
Indicates: glenohumeral instability
Sulcus Sign Grasp patients elbow and apply inferior traction
(+) Test= Indention appears in are beneath the acromion
Indicates: glenohumeral instability
Yergason Test Patients arm at side with elbow flexed at 90. Examiner uses one hand to palpate
bicipital groove and monitors there, while the other hand grasps the patients wrist.
Have patient supinate and externally rotate against doctors resistance.
(+) Test= Pain and/or tendon subluxation out of groove
Indicates: unstable bicipital tendon/subluxation bicipital tendonitis
Speeds Test Patients arm forward flexed 50 at the shoulder with hand supinated. Flex patients
elbow to 15. Resist at forearm while patient forward flexes shoulder.
(+) Test= Pain in bicipital groove
Indicates: bicipital tendonitis of longhead biceps
Neer Impingement Stabilize patients shoulder and passively flex shoulder to fully flexed position.
(+) Test= Pain
Indicates: subacromial bursa or rotator cuff impingement
Hawkins Test Flex arm and elbow to 90. Passively rotate the humerus into internal rotation. While
stabilizing, produce a counter-force at the elbow (chicken-wing)
(+) Test= Pain
Indicates: rotator cuff impingement
Empty Can Test Elevate patients arms to 90 and internally rotate. Press down on forearms while
patient resists.
(+)= Pain or inability to resist
Indicates: rotator cuff pathology (specifically supraspinatus)
Drop-Arm Test Patient abducts arm to 90. Then slowly drop arm.
(+) Test= Arm will drop or gentle tap on wrist will cause arm to drop
Indicates: full thickness tear of supraspinatus
Elbow/Wrist/Hand Joints
Golfers Elbow test Anterior forearm/ flexor compartment
Patients elbow is flexed to 90 and forearm is placed in supination with the wrist
neutral and palm facing up. The examiner places one hand under the proximal forearm
for stabilization and the other hand over the patients wrist to resist movement.
Instruct the patient to flex the wrist
(+) test= pain/tenderness around the medial epicondyle
Indicates: medial epicondylitis
Tennis Elbow test Posterior forearm/extensor compartment
Patients elbow is flexed to 90 and forearm is placed in pronation with wrist neutral
and palm facing down. Examiner places one hand under proximal forearm for
stabilization and the other hand over the patients hand to resist movement. Instruct
the patient to extend the wrist
(+) test= pain/tenderness around lateral epicondyle, may radiate down lateral forearm
Indicates: lateral epicondylitis
Valgus Stress Test Arm slightly abducted and externally rotated. Forearm supinated and flexed to 30 deg.
Slight medial directed valgus stress is applied to elbow joint.
(+) test= pain/tenderness with palpation and valgus stress; increased laxity (degree of
laxity correlates to degree of injury to UCL)
Indicates: injury to UCL
Varus Stress Test Arm slightly abducted and internally rotated. Elbow flexed to 15 deg. A slight varus
stress is applied to the elbow joint
(+) test= pain or increased laxity in LCL
Indicates: injury to LCL
Tinels Sign at wrist Can be elicited by tapping over the transverse carpal ligament (between
thenar/hypothenar eminences) with either the tip of the examiners finger or reflex
hammer with the patients wrist held in extension.
(+) test= parasthesias/numbness/ tingling/pain radiating to thumb, index and middle
finger (median n. distribution)
Indicates: entrapment of Median nerve or Carpal Tunnel Syndrome
Phalens Sign Place dorsal aspects of patients hands together and force into wrist flexion. Hold for 60
seconds
(+) test= any reproduction of symptoms/parasthesias in the distribution of the median
nerve
Indicates: entrapment of Median nerve or Carpal Tunnel Syndrome
Finkelsteins Test Examiner asks patient to make a fist encompassing their thumb and ulnar deviate the
wrist.
(+) test= increased pain in first dorsal compartment/ lateral wrist
Indicates: DeQuervains tenosynovitis
Hip Joint
Central Compartment
Scour Flex and externally rotate patients hip. Load into socket and articulate through annular
range of motion. (omega sign)
(+) Test= Pain
Indicates: Labral or articular cartilage pathology
Apprehension: FABER* 1- Patients hip is flexed, aBducted & externally rotated. Doctor induces further external
(1 of 3 versions/steps) rotation by applying a posterior force at the knee.
(+) Test= anterior subluxation of hip or apprehension/pain
Indicates: Anterior labral pathology
Can also be (+) with impingement.
Peripheral Compartment
Elys Test Patient prone. Passively flex patients knees.
(+) test= Ipsilateral hip raises off table

Rectus Femoris Test
Lateral Compartment
Obers Test
Trendelenburg
Patricks : FABER*
(2 of 3 versions/steps)
Anterior/Iliopsoas
Compartment
Patricks: FABER*
(3 of 3 versions/steps)
Thomas Test
Knee/Ankle/Foot Joints
Apley compression (grind) test
Apley distraction test
Valgus stress test of knee
Indicates: Rectus femoris contracture
Patient supine. One hip flexed up to the chest. The other leg bent over the edge of the
table.
(+) test= knee flexion < 90
Indicates: Rectus Femoris contraction ipsilaterally
Patient lateral recumbent, with doctor standing behind the patient. Doctor abducts the
extended top leg and then lowers leg to the table while stabilizing hip.
OR Upper leg is set hanging off of the table while stabilizing hip to prevent rotation
(+) Test= Inability to adduct
Indicates: IT band contracture
Patient standing with doctor behind. Patient lifts one foot off ground.
(+) Test= weakness / inability to hold hips level
Indicates: Contralateral gluteus medius weakness
(Superior Gluteal Nerve)
[ex: Patient lifts right foot, right hip drops = Left Gluteus Medius/Superior Gluteal Nerve
pathology]
2 Patients hip is flexed, aBducted and externally rotated.
Doctor braces contralateral ASIS, patient externally rotates/aBducts against resistance.
(+) test= Pain or weakness
Indicates: Gluteus medius pathology
3- Patients hip is flexed, aBducted and externally rotated. Doctor braces contralateral
ASIS. Patient internally rotates/aDducts against resistance.
(+) Test= anterior or medial groin pain/weakness
Indicates: iliopsoas insufficiency or pathology
Patient supine at the end of the table and pulls knees to chest. One leg is lowered to
the table to test the flexibility of the hip flexors.
(+) test= Inability to fully extend at hip
Indicates: hip flexor contraction
Patient prone with knee flexed to 90. Examiner uses downward force on the foot to
provide a compressive force on the meniscus while rotating the foot internally and
externally.
(+) test= Pain with rotation and/or compression
Indicates: Meniscal injury, collateral ligament injury, or both
Patient prone with knee flexed to 90. Examiner uses upward pulling force on the foot
to provide a distraction on the meniscus while rotating the foot internally & externally.
(+) test= Pain with distraction and rotation
Indicates: collateral ligament damage
Patient supine and examiner supports the patients lower leg on the examiners hip,
with the knee flexed to 30 (also test at neutral). Examiners hands are placed on the
medial and lateral aspects of the patients knee. While providing lateral resistance at
the knee, move the lower leg so that the ankle shifts laterally while holding the distal
femur in place. Assess for laxity, quality of end point, and pain.

Varus Stress test of knee
Anterior Drawer test
Posterior Drawer test
Ankle (Anterior) Drawer test
Talar Tilt Test
Squeeze Test (High Ankle
Sprain)
Thompson test
(+) test= Increased laxity, soft or absent endpoint, or pain
Indicates: Medial collateral ligament (MCL) disruption - more severe injury indicated
if also positive at 0 (i.e. posterior joint capsule/ACL/MCL)
Examiner and patient in same position as the valgus stress test. While providing medial
resistance, examiner moves the lower leg so that the ankle shifts medially. This test is
done at 30 flexion and neutral (0).
(+) test= Increased laxity, soft or absent endpoint, or pain
Indicates: Lateral collateral ligament (LCL) disruption more severe injury indicated if
also positive at 0
Patient supine with knee flexed to 90. Examiner sits on the patients foot and grasps
the proximal tibia with both hands, pulling the tibia anteriorly.
(+) test= Excessive translation/laxity when compared to the other knee
Indicates: ACL insufficiency
Patient supine with knee flexed to 90. Examiner sits on the patients foot and grasps
the proximal tibia with both hands, translating the tibia posteriorly.
(+) test= Excessive translation/laxity, particularly when compared to the opposite side
Indicates: PCL deficiency, posterior capsular injury or disruption.
Doctor grasps posterior calcaneus with one hand and cups distal tibia/fibula with the
other hand, monitoring anteriorly at the anterior talus. Provide anterior force on
calcaneus while stabilizing the distal tibia/fibula. Normal springing of calcaneus back to
neutral should occur.
(+) test = pain, no springing, excessive motion anterior/laxity
Indicates: ATF ligament pathology/tear
Doctor grasps distal tibia/fibula with one hand and the inferior calcaneus with the
other, blocking motion of the calcaneus on the talus. Invert the talus to evaluate ROM.
(+) test = laxity, increased ROM or pain
Indicates: Calcaneofibular ligament pathology/tear and some ATF
Doctor wraps hands around leg proximal to the ankle, contacting the distal tibia/fibula
with both thenar eminences. Squeeze for 2-3 seconds rapidly release.
(+) test = pain at syndesmosis
Indicates: syndesmosis pathology
Patient prone with foot off the table. Doctor squeezes the calf.
(+) test = absence of plantar flexion
Indicates: Achilles tendon rupture