Special Tests (NPTE)

Apprehension Test for Anterior Shoulder Dislocation

Purpose: increased likelihood of anterior shoulder dislocation

Method: PROM Pt in supine, shoulder in 90 degrees abduct. PT externally rotates shoulder.

Positive Test: look of apprehension or facial grimace before reaching end point.

Capillary refill

Purpose: Test for vascular insufficiency

Method: Pt. is positioned in sitting or standing. Therapist compresses the pt's nailbed after releasing the pressure notes the amount of time taken for color to return to the nail.

Positive Test: Indicated by delayed or muted response (greater than 2 secs) and may be indicative of arterial insufficiency.

Homan's

Purpose: Test for Deep Vein Thrombophlebitis

Method: Pt. is positioned in supine. Therapists maintains the leg in ext and passively D/F the pt's foot.

Positive: Indicated by pain in the calf and may indicate a DVT.

Ely's test

Purpose: Indicative of rectus femurs contracture

Method: Pt. is positioned in prone, while the therapist passively flexes the pt's knee.

Positive Test: Indicated by spontaneous hip flexion occurring simultaneously with knee flex

Codman's Drop Arm Test

Purpose:

-test for tears of rotator cuff (esp. supraspinatus)

Method:

-Patient seated or standing

-You abduct the patient's arm to 150 degrees

-Release pt's arms and ask him/her to slowly lower the arms to the floor.

Positive Test:

-pain, weakness or ratcheting motions

-patient can't hold arms up or lower with control

*dropping to 90 degrees is controlled by the deltoid

*dropping below 90 degrees is controlled by the supraspinatus

Apprehension Test for Posterior Shoulder Dislocation

Purpose: increased likelihood of posterior shoulder dislocation

Method: Pt in supine, shoulder flexed to 90 degrees and internally rotated. PT applies posterior force.

Positive Test: look of apprehension or facial grimace before reaching end point.

Ludington's Test

Purpose: Biceps tendon pathology

Method: Pt is in sitting with hand behind head and fingers interlocked. Pt then alternately contracts and relaxes the biceps.

Positive Test: Absence of movement in the biceps tendon.

Yergason's Test

Purpose: Biceps tendon pathology

Method: Pt is sitting with 90 degrees elbow flexion & pronation. PT places one hand over the pt's forearm and one over the pt's bicipital groove. Pt is instructed supinate and laterally rotate against resistance.

Positive Test: pain or tenderness in the bicipital groove.

Allen Test

Purpose: Thoracic Outlet Syndrome

Method: Pt in sitting or standing, with should in 90 abduction & lateral rotation, elbow flexed. Pt is asked to rotate head away from test shoulder and PT monitors radial pulse.

Positive Test: Absent or diminished pulse.

Costoclavicular Syndrome Test

Purpose: Thoracic Outlet Syndrome caused by compression of subclavian artery between first rib and clavicle.

Method: Pt is in sitting, and PT monitors radial pulse as pt moves into military posture (retracted and depressed scapula. PT moves shoulder into extension).

Positive Test: Absent or diminished pulse.

Roos Test

Purpose: Thoracic Outlet Syndrome

Method: Pt is sitting or standing with shoulder abducted to 90 degrees, externally rotated, and elbow flexed. Pt opens and closes hands for 3 minutes.

Positive Test: Inability to maintain test position, weakness of arms, sensory loss, or ischemic pain.

Wright Test (Hyperabduction Test)

Purpose: Thoracic Outlet Syndrome due to compression in the costoclavicular space.

Method: Pt is sitting or supine. PT moves pt's UE overhead into abduction while monitoring pulse.

Positive Test: Absent or diminished radial pulse.

Glenoid Labrum Tear Test

Purpose: Glenoid Labrum Tear

Method: Pt in supine. PT places one hand over posterior humeral head and the other hand stabilizes the humerus proximal to the elbow. PT moves shoulder into abduction and ER above pt's head. PT then applies anterior directed force to humerus.

Positive Test: A clunk or grinding sound.

Varus Stress Test (At Elbow)

Purpose: Lateral collateral ligament sprain

Method: Pt is sitting with elbow flexed between 20-30 degrees. PT places one hand on elbow and the other proximal to pt's wrist. PT applies varus force while palpating joint line.

Positive Test: Increased laxity, apprehension, or pain.

Valgus Stress Test (At Elbow)

Purpose: Medial Collateral Ligament Sprain

Method: Pt is sitting with elbow flexed between 20-30 degrees. PT places one hand on elbow and the other proximal to pt's wrist. PT applies valgus force while palpating joint line.

Positive Test: Increased laxity, apprehension, or pain.

Brunnel-Littler Test

Purpose: Intrinsic Muscle Tightness

Method: Pt is sitting with metacarpophalangeal joint in slight extension. PT moves the PIP joint into flexion

Positive Test: PIP joint does not flex with metocarpholageal joint in slight extension.

Tight Retinacular Ligament Test

Purpose: Retinacular tightness / Capsule Tightness

Method: PIP joint is in neutral position. PT flexes DIP joint.

Positive Test: Inability to flex DIP joint.

Grind Test

Purpose: Degenerative joint disease in carpometacarpal joint.

Method: PT stabilizes pt's hand and grasps pt's thumb.PT applies a compressive and rotatory force to thumb.

Positive Test: Pain.

Murphy Sign

Purpose: Dislocated Lunate

Method: Pt makes a fist.

Positive Test: Pt's third metacarpal remains level with second and forth metacarpals.

Piriformis Test

Purpose: Piriformis tightness of sciatic nerve compression caused by the piriformis.

Method: Pt is in sideline and flexes top hip to 60 degrees. PT stabilizes pelvis and applies a downward force on the knee.

Positive Test: Pain or tightness in the piriformis.

Tripod Sign

Purpose: Tight hamstrings

Method: Pt sits with legs hanging off the mat. PT extends one knee.

Positive Test: Tightness in hamstrings or trunk extension to limit hamstring tightness.

Ortolani Sign

Purpose: the ability for a hip dislocation to reduce.

Method: Examiner flexes the infant's hips so that the examiners thumbs are on the inside of the infant's thighs and the rest of the examiners fingers on the outside of the infant's thighs. The examiner provides gentle traction with hip abduction while providing pressure on the greater trochanter of the femur.

Positive Test: Presence of a click, clunk, or jerk, the hip is reduced.

Barlow's Test

Purpose: likelihood of hip dislocation

Method: Examiner flexes the infant's hips and knees to 90 degrees. The examiner's middle finger should be over the infant's greater trochanter and the thumb should be on the inner thigh. The infant's hip is brought into abduction as the examiner applies forward pressure on the greater trochanter. If a click, clunk, or jerk is heard as the femoral head slips forward into the acetabulum, the test is positive. The examiner then applies a backward and outward pressure to the inner thigh. If the femoral head slips out of the acetabulum, the hip is unstable and is able to dislocate.

Slocum Test

Purpose: anterolateral or anteromedial instability

Method: Pt is supine with one hip flexed 45 degrees and knee flexed to 90 degrees. PT IR or ER foot and then sits on forefoot. PT applies an anterior directed force to the tibia plateu.

Positive Test: Movement of tibia on lateral side when foot is IR or movement on medial side of tibia when foot is ER.

Bounce Home Test

Purpose: Meniscal Lesion

Method: Pt is in supine and PT grabs pt's heel and maximally flexes knee then passively extends knee.

Positive Test: Incomplete extension or rubbery end-feel.

Clarke's Sign

Purpose: Patellofemoral dysfunction

Method: Pt is supine with knees extended. PT applies pressure superorly to patella with PT's web space of his/her hand. Pt contracts quadriceps while PT maintains pressure superior of the patella.

Positive Test: Failure to complete muscle contraction without pain.

Hughston's Plica Test

Purpose: Presence of plica

Method: Pt in supine. PT flexes knee and IR the tibia with one hand while the other hand attempts to move the patella medially and palpate the medial condyle.

Positive Test: Popping sound.

Noble Compression Test

Purpose: Iliotibial Band Friction Syndrome

Method: Pt supine with hip and knee flexed. PT places thumb over the lateral epicondyle of the femur and other hand around the ankle. Pt slowly extends knee.

Positive Test: Pain over lateral epicondyle of the femur at approximately 30 degrees of knee flexion.

Patella Apprehension Test

Purpose: Patella subluxation of dislocation

Method: Pt is supine with knees extended. PT applies a lateral directed force on the medial side of the patella.

Positive Test: A look of apprehension or an attempt of a quadriceps contraction.

Tibial Torsion Test

Purpose: Lateral rotation of the tibia

Method: Pt is sitting with legs off of the edge of the mat. PT places his/her thumb and index finger over the lateral & medial malleoli. PT measures the angle formed by the axes of the knee and ankle.

Positive Test: Normal lateral rotation of the tibia = 12-18 degrees in adults.

Sacroiliac Joint Stress Test

Purpose: Sacroiliac Joint Dysfunction

Method: Pt is supine. PT crosses his/her arms, places the palms on the pt's anterior superior iliac spine. PT applies a downward & lateral force.

Positive Test: Unilateral pain to the sacroiliac joint or gluteal area.

Sitting Flexion Test

Purpose: Sacroiliac articular restriction

Method: Pt is sitting with feet on floor. PT palpates PSIS and monitors its movement as pt bends forward and touches the floor.

Positive Test: One PSIS moves farther in the cranial direction than the other PSIS.

Standing Flexion Test

Purpose: Sacroiliac articular restriction

Method: Pt is standing. PT palpates PSIS and monitors its movement as pt bends forward and touches the floor with extended knees.

Positive Test: One PSIS moves farther in the cranial direction than the other PSIS.

Leg Length Discrepancy

Purpose: Determine functional, structural, or compensatory difference in leg length.

Method: Pt supine & PT measure from the ASIS to medial malleolus.

Positive Test: A distance in leg length of greater than ---

Hip Abduction Contracture Test

Purpose: Determine contracture of the TFL, ITB, and Glut Med, or determine Capsule tightness or muscle shortening.

Method: PT passively adducts hip when pt is in supine.

Positive Test: ↓ in ROM, contralateral pelvis elevates

Hip Adduction Contracture Test

Purpose: Determine adductor longus, brevis, magnus, pectineus contractures/muscle shortening or determine capsule tightness.

Method: PT passively abducts hip when pt is in supine.

Positive Test: ↓in ROM, contralateral pelvis drops

Thomas Test

Purpose: Determine hip flexion contracture.

Method: PT lowers pt's testing leg down to table and into knee flexion and PT measures hip extension.

Positive Test:

Illipopsoas Tightness = Leg rises off the table

Rectus Femoris Tightness = Lower leg doesn't go into

flexion

IT Band Tightness = J sign

Ober's Test

Purpose: Determine hip abductor tightness

Method: With pt is sidelyne, PT passively flexes, abducts, & extends the lower leg while stabilizing pelvis.

Positive Test: The leg does not lower to surface of table

Knee extended = ITB/TFL.

Knee flexed = Hip Abductors

Trendelenburg Sign

Purpose: Hip abductor weakness

Method: Have pt stand on one leg.

Positive Test: Contralateral pelvis drops.

FABER

Purpose: Functional ROM screen

Method: In supine, have pt abduct, flex, and ER hip.

Positive Test: LE does not drop parallel to table.

FADDIR Test

Purpose: Anterior Labral Tear (opposite motion = posterior labral tear)

Method: In supine and the FABER position, the PT passively moves the involved leg into flexion, IR, & Addution.

Positive Test: Reproduction of symptoms, pain, or clicking noise.

Craig's Test

Purpose: Measures anteversion.

Method: With pt in prone, PT measures the angle between the mat and the middle of the leg, with the trochanter parallel with table.

Positive Test:

Normal = 8-15 degrees

Retroversion = < 8 degrees

Anteversion = > 15 degrees

Strait Leg Raise

Purpose: Measures proximal hamstring length

Method: Pt is supine. PT moves hip into flexion with straight knee. PT measures hip flexion.

Positive Test: Normal ROM = 70-80 degrees.

90-90 Politeal Angle

Purpose: Measures distal hamstring length

Method. Pt is supine with hip flexed. Pt straightens knee.

Positive Test:

Normal= within 20 degrees of full extension

Knee Valgus Stress Test

Purpose: Assess MCL structure

Method: Pt is in supine. PT applies a medially force at the at joint line with the knee in full extension and 25 degrees of flexion.

Positive Test:

Full Extension = major disruption of MCL or posteromedial capsule

Slight Flexion = MCL, PCL, Posteromedial capsule, & posterior oblique ligament.

Knee Varus Stress Test

Purpose: Assess LCL structure

Method: Pt is in supine. PT applies a lateral force at the at joint line with the knee in full extension and 25 degrees of flexion.

Positive Test: LCL & posterolateral capsule laxity.

Posterior Drawer Test

Purpose: Knee PCL Integrity

Method: Pt is supine with knee flexed at 90° hip flexed at 45° Therapist stabilizes the Lower leg by sitting on the forefoot. Therapist grasps the pt's prox tibia w/ 2 hands and places their thumbs on the tibia plateau and administers a posterior directed forget the tibia on the femur.

Positive Test: Indicated by excessive posterior translation of the tibia on the femur with a diminished or absent end-point and may be indicative of a PCL injury.

Lachman Test

Purpose: Knee ACL Integrity

Method: Pt is supine with knee in slight flexion. PT stabilizes femur distally and PT applies a force anteriorly.

Positive Test: Jt laxity, mushy soft end feel.

Anterior Drawer Test

Purpose: Knee ACL Integrity

Method: Pt is supine with knee flexed to 90 degrees. PT stabilizes foot, thrusts tibia anteriorly while palpating the joint line.

Positive Test: Joint Laxity

Lateral Pivot Shift

Purpose: Assess anterolateral rotary instability of the knee.

Method: Pt is supine with hip and knee flexed to 90 degrees. PT supports at the ankle and apples a valgus force on the fibular head while passively extending the knee.

Positive Test: Pain or clunking noise at approximately 30 degrees of knee extension.

McMurray's Test

Purpose: Meniscus Integrity

Method: Pt is supine with knee flexed. PT supports the ankle and knee joint line. The PT moves the knee passively into extension while medially or laterally rotating the tibia.

Positive Test: Pain.

Medial Meniscus = pain with lateral rotation

Lateral Meniscus = pain with medial rotation

Posterior Horn = pain with flexion

Anterior Horn = pain with extension

Appley's Test

Purpose: Meniscus and ligament integrity

Method: Pt is prone with knee flexed. PT applies medial and lateral rotation with compression and distraction forces.

Positive Test: pain

Pain with compression = meniscus involvement

Pain with distraction = ligament involvement

Thessaly Test

Purpose: Meniscus Integrity and articular surface integrity

Method: Pt stands on one leg with 5° knee flexion. Pt rotates his body left and right 3x each direction. Repeat in 20° knee flexion.

Positive Test: joint line pain, discomfort, or locking/ catching.

Patella Tap Test

Purpose: Joint Capsule Swelling

Method: Pt supine with knee extended. PT taps over the patella.

Positive Test: Floating or "dancing" patella.

Sweep/Brush Test

Purpose: Joint Capsule Swelling

Method: Pt is supine with knee extended. PT starts on the medial side of patella and "milks" proximally and laterally.

Positive Test: Reformation of edema on with pressure applied to lateral aspect of knee.

Ballotable Patella

Purpose: Joint Capsule Swelling

Method: Pt is supine with knee extended. PT palpates the medial and lateral patella borders while stroking down suprapatellarly.

Positive Test: Separation of thumb and finger due to swelling.

Heel Height Test

Purpose: Knee flexion contracture due to swelling, joint arthrofibrosis, or spasms.

Method: Pt is prone with legs hanging off the table. PT measures the differences of heal height in cm.

Positive Test: A difference in heights.

1 cm= 1° of contracture

Q-Angle

Purpose: Assess Genu Varum or Genu Valgum

Method: Measure angle from ASIS to patella and tibial tubercle to patella.

Postive Test:

Normal: Male=13° Female=18°

Ankle Anterior Draw Test

Purpose: Anterior Talofibular Ligament Integrity

Method: Pt is supine. PT stabilizes superior to ankle while drawing the talus forward.

Positive Test: Excessive Joint Laxity

Talar Tilt Test

Purpose: Assess ankle ligament integrity

Method. Pt is sidelyne with ankle at 90°. PT rolls the calcaneus into ADD & ABD.

Positive Test: Excessive Joint Laxity

Laxity in ABD= deltoid ligament

Laxity in ADD= Calcaneofibular ligament

Laxity in PF = ATFL

Thompson Test

Purpose: Achilles Tendon sprain or rupture

Method: Pt in prone. PT squeezes calf musculature while observing PF.

Positive Test: A lack of PF.

Feiss Line

Purpose: Assesses the amount of pronation

Method: Mark medial malleolus, navicular tuberosity, * 1st MTP joint. Assess marks in weightbearing.

Positive Test: Navicular drop during WB

1st deg. = falls 1/3 of distance to floor

2nd deg. = Falls 2/3 of distance to floor

3rd deg. = Navicular rests on floor

Morton's Test

Purpose: Detect neuroma, stress fractures, or metatarsalgia.

Method: Pt is supine. PT provides medial & lateral compression of the forefoot.

Positive Test: Pain in between the MTP joints.

Ankle Tinel's Sign

Purpose: Assess tibial nerve integrity

Method: Percussion of the posterior tibial nerve behind medial malleolus.

Positive Test: Tingling/parasthesia distally in foot.

Empty Can Test/ Supraspinatus Test

Purpose: Assess supraspinatus involvement with shoulder injury.

Method: Pt. raises arms in scaption to shoulder height with thumps up. Pt rotates thumbs down ( "empty can" ). PT applies resistance.

Positive Test: Pain or weakness

Speed's Test

Purpose: Bicep Tendon Involvement

Method: Arm in 90 flexion with forearm supinated. PT palpates biceps tendon and applies resistance.

Positive Test: Pain in biceps tendon area.

Lift Off / Belly Press Test

Purpose: Identify a lesion of the subscabularis muscle.

Method: Pt places Arm behind back (moving into IR), dorsum of hand against mid-lumbar spine. Other hand goes on in front of stomach with the palm on the belly. Pt is instructed to lift arm away from back against a resistance. observe scapular motion

Positive Test: Pain or pt. cannot perform test motions or cannot hold against resistance.

Neer Impingement Sign

Purpose: Detect Impingement (supraspinatus, biceps tendon, subacromial bursa)

Method: Forceful passive shoulder elevation with shoulder IR. PT applies over pressure throughout motion.

Positive Test: Pain in the sub-arcomial arch.

Hawkins-Kennedy

Purpose: Supraspinatus Impingment

Method: PT raises pt's arm to 90 degrees flexion and moves shoulder passively into IR. (This places the greater tubercle in a position to compromise subacromial space.)

Postive Test: Pain under sub-acromial arch.

Sulcus Sign

Purpose: Assess Shoulder Instability

Method: Pt's arm is relaxed at the side. PT appiles caudal traction to the humerus to displace inferiorly.

Positive Test: A significant feeling of inferior subluxation

O'Brien Test

Purpose: Detect a SLAP Lesion

Method: Pt's arm is in 90 degrees of shouler flexion, 20-30 degees of Horizontal adduction with forearm pronation. PT applies resistance. Repeat with forearm in supination.

Positive Test: Pain and relief of symptoms with arm supinated.

Biceps Tension Test

Purpose: Detect a SLAP Lesion

Method: Shoulder in abduction at 90 degrees and ER. Pt eccentrically resists PT applied force as pt moves into shoulder adduction.

Positive Test: Pain

Compression Rotation Test

Purpose: Detect Labral tears (SLAP or Bankart)

Method: Pt's shoulder is abducted. PT provide compression to GH joint and passively moves shoulder into ER & IR.

Positive Test: Snapping, catching, or pain.

Scapular Retraction Test

Purpose: Detect weak scapular stabilizers and instability (SICK scapula)

Method: Pt. is standing and PT stabilizes the pt's clavicle & scapula while providing a tactile cue to inferior angle of scapula Pt. then performs shoulder flexion.

Positive Test: Decreases pain, improved ROM, and improves RTC strength with PT support.

Scapular Assistance Test

Purpose: Detects weak scapular control causing impingement symptoms.

Method: Pt. is standing and PT is behind pt. The pt. flexes shoulder in scapular plane while the PT pushes inward, laterally, and upward on the medial border of scapula.

Positive Test: Decreased pain during shoulder elevation with scapular assistance.

AC Shear

Purpose: AC joint pathology

Method: PT cup his hands over pt's shoulder (clavicle and spine of scapula) and squeeze his hands together.

Positive Test: Pain or excessive movement of AC joint.

AC Crossover

Purpose: Degenerative / arthritis changes of the AC joint.

Method: Pt flexes shoulder to 90 degrees, and adducts shoulder across the body. PT applies over pressure forcing the acromion into the distal clavicle.

Positive Test: Pain in AC joint.

Adson Maneuver

Purpose: Thoracic Outlet Syndrome

Method: Pt. in seated position. PT finds radial pulse and passively brings shoulder into abd. and extension. Pt. then rotates head and looks over ipsilateral shoulder. Pt takes deep breath and hold the position.

Positive Test: Diminished pulse, and symptoms of pain, numbness, tingling, weakness, & coldness in the upper extremity.

Moving Valgus Test

Purpose: Elbow MCL ligament integrity

Method: Pt. is supine of standing with shoulder abducted & elbow flexed. PT provides a valgus stress while quickly extending pt's elbow.

Positive Test: Pain between 120 and 70 degrees of elbow flexion.

Milking Maneuver

Purpose: Elbow MCL ligament integrity

Method: Pt's ellbow is flexed to 90 degrees with forearm supinated. PT grasps pt's thumb and pulls, creating a valgus stress to the elbow.

Positive Test: Pain in MCL area.

Cozen's Test

Purpose: Lateral Epicondylitis (Tennis Elbow)

Method: Pt is siting with elbow slightly flex. Pt is asked to make a fist, pronate forearm, radially deviate and extend the wrist against resistance.

Positive Test: Pain in lateral epicondyle region or muscle weakness.

Mill's Test

Purpose: Lateral Epicondylitis (Tennis Elbow)

Method: PT moves the pt into passive pronation, wrist flexion, & elbow extension to provide a static stretch to the wrist extensors.

Positive Test: Pain over lateral epicondyle

Tennis Elbow Tests (3 Tests)

Purpose: Lateral Epicondylitis (Tennis Elbow)

Method: Perform Cozen's Test & Mill's Test.

In addition, PT places pt's forearm intopronation with fingers extende. PT applies resisance to middle finger.

Positive Test: Pain over lateral epicondyle

Golfer's Elbow Test

Purpose: Medial Epicondylitis (Golfer's Elbow)

Method: PT palpates medial epicondyle while resisting wrist flexion & ulnar deviation with extended elbow.

Positive Test: Pain over the medial epicondyle

Golfer's Elbow Stretch

Purpose: Medial Epicondylitis (Golfer's Elbow)

Method: PT palpates medial epicondyle. PT passively extends the elbow, supinates forearm, and extends the wrist to staticly stretch the wrist flexors.

Positive Test: Pain over the medial epicondyle

Elbow Tinel's Test

Purpose: Ulnar nerve involvement

Method: Palpate ulnar groove and tap ulnar nerve.

Positive Test: Tingling sensation in the ulnar distribution.

Elbow Flexion Test

Purpose: Cubital Tunnel (Ulnar Nerve Syndrome)

Method: Pt flexes elbows, extend wrists, abducts shoulder and depresses scapulae. Pt holds position for 3-5 mins.

Positive Test: Tingling, paresthesia in ulnar nerve distribution.

Pronator Teres Test

Purpose: Median Nerve Pathology

Method: Pt is sitting with elbow flexed to 90 degrees. PT applies resistance and pt resists pronation as elbow is extended.

Positive Test: Tingling or paresthesia in the median nerve distribution of the forearm.

Phalen Test

Purpose: Carpal Tunnel Syndrome (Median Nerve Pathology)

Method: Pt places wrists at maximal flexion (dorsum of hands pressed together) and holds this position for 1 minute.

Positive Test: Paresthesia/ tingling in median nerve distribution. (This compresses the carpal tunnel.)

Reverse Phalen Test

Purpose: Carpal Tunnel Syndrome (Median Nerve Pathology)

Method: Pt places wrists at maximal extension (pray position) and holds this position for 1 minute.

Positive Test: Paresthesia/ tingling in median nerve distribution. (This tighten/ stretches flexor retinaculum to put strain on carpal tunnel.)

Wrist Tinel's Sign

Purpose: Median Nerve Pathology

Method: Wrist is in a neutral position. PT taps over the carpal tunnel or slightly above.

Positive Test: Paresthesia/ tingling in median nerve distribution.

Frinkelstein Test

Purpose: de Quervain's Tenosynovitis and/or paratenonitis in thumb

Method: Pt. makes a fist with thumb inside fingers. PT stabilizes pt's forearm and ulnar deviates the wrist

Positive Test: Pain over abductor pollicus longus and extensor pollicus brevis.

Froment's Sign

Purpose: Ulnar Nerve Pathology

Method: Pt grasps a paper between his thumb and lateral index finger. PT pulls paper out of pt's hand.

Positive Test: Distal phalanx flexes with potential MCP hyperextension. (Due to paralysis of ADD pollicus.)

Nail Compression Test

Purpose: Arterial Insufficiency

Method: PT compress pt's nail bed and notes the time taken for color to return to nail bed.

Positive Test: Longer than 3 seconds.

Hoffman's Reflex

Purpose: Upper motor neuron lesion

Method: PT flicks the distal phalanx of the index, middle, or ring finger.

Positive Test: Reflex flexion of the distal phalanx of the thumb or finger that was not flicked.

Inverted Supinator Sign

Purpose: Cervical myelopathy

Method: PT support pt's forearm and taps the dista brachioradialis with a reflex hammer.

Positive Test: Finger flexion or slight elbow extension

Watson Test

Purpose: Scaphoid Instability

Positive Test: Pain or "thunk" noise.

Skier's Thumb

Purpose: Thumb UCL laxity or instability.

Deep Neck Flexor Endurance Test

Purpose: Deep Cervical flexor weakness

Method: Pt supine with knees flexed and feet flat on table. Pt tucks chin in, and lifts head off of examiners finger tips. PT measure the time to fatigue in seconds.

Positive Test: The use of substitution patterns.

Males <45 seconds

Females <35 seconds

Craniocervical Flexion Test

Purpose: Deep Cervical Flexor Weakness

Method: Pt supine with BP cuff behind neck. PT inflates cuff to 20mmHg. Pt. nod's "Yes" and hold for 10 sec. PT inncreases pressure b 2mmHg until 30mmHg.

Positive Test: Inability to perform test or inable to increase pressure in cuff.