Orthopedic Special Tests

Phalen and Tinel Sign

  • Phalen's Test:

    • Involves forced wrist flexion.
    • A positive test reproduces symptoms of carpal tunnel syndrome, such as tingling or numbness in the fingers.

  • Tinel's Sign:

    • Tapping lightly over the median nerve at the wrist.
    • A positive sign elicits a tingling sensation (paresthesia) in the median nerve distribution, suggesting nerve irritation or compression.

Hawkins-Kennedy Test

  • Hawkins-Kennedy Test:
    • Provocative test for shoulder impingement.
    • The examiner forward flexes the patient's arm to 90 degrees, then internally rotates the arm.
    • A positive test is indicated by pain, suggesting possible rotator cuff impingement or subacromial bursitis.

Neer Test

  • Neer Test:
    • Another test for shoulder impingement.
    • The examiner stabilizes the scapula and then forcibly forward flexes the patient's arm, compressing the greater tuberosity of the humerus against the acromion.
    • Pain during this maneuver suggests rotator cuff impingement, particularly of the supraspinatus tendon.

Straight Leg Raise Test

  • Straight Leg Raise (SLR) Test:
    • Used to assess for lumbar nerve root irritation or disc herniation.
    • The patient lies supine, and the examiner passively raises the patient's leg, keeping the knee straight.
    • Pain radiating down the leg (sciatica) between 30 and 70 degrees of leg elevation is considered a positive test, indicating potential nerve root compression, often from a herniated disc.

Thomas Test

  • Thomas Test:
    • Evaluates for hip flexor tightness, specifically the iliopsoas muscle.
    • The patient lies supine, and the examiner passively flexes one hip towards the chest, flattening the lumbar spine.
    • A positive test occurs when the contralateral leg rises off the table, indicating hip flexor tightness on the tested side.

Trendelenburg Test

  • Trendelenburg Test:
    • Assesses the stability of the hip and the function of the hip abductor muscles, particularly the gluteus medius.
    • The patient stands and is asked to stand on one leg.
    • A positive test occurs when the pelvis on the non-stance side drops, indicating weakness or dysfunction of the hip abductors on the stance side. This can be due to superior gluteal nerve injury or hip abductor muscle weakness.

Lachman, Pivot Shift, Anterior Drawer Test

  • Lachman Test:

    • Assesses the integrity of the anterior cruciate ligament (ACL) of the knee.
    • The patient lies supine with the knee flexed to about 20-30 degrees. The examiner stabilizes the femur and attempts to anteriorly translate the tibia.
    • Excessive anterior translation of the tibia compared to the femur indicates an ACL tear.

  • Pivot Shift Test:

    • Also assesses ACL integrity, often used to detect rotary instability of the knee.
    • The patient lies supine with the knee extended. The examiner internally rotates the tibia while applying a valgus force and then flexes the knee.
    • A clunk or shift felt around 20-40 degrees of flexion indicates ACL and anterolateral rotary instability.

  • Anterior Drawer Test:

    • Another test for ACL integrity.
    • The patient lies supine with the knee flexed to 90 degrees and the foot flat on the table. The examiner stabilizes the foot and attempts to anteriorly translate the tibia.
    • Excessive anterior translation of the tibia compared to the femur suggests an ACL tear.

Ballotment Test

  • Ballottement Test:
    • Evaluates for the presence of excess fluid (effusion) in the knee joint.
    • The patient lies supine with the knee extended. The examiner applies downward pressure above the patella and then taps the patella.
    • If the patella feels like it's floating or bounces back when tapped, it indicates the presence of a significant knee joint effusion.

McMurray Test

  • McMurray Test:
    • Assesses for meniscal tears in the knee.
    • The patient lies supine, and the examiner flexes the knee and hip.
    • To test the medial meniscus, the examiner externally rotates the tibia while extending the knee. To test the lateral meniscus, the examiner internally rotates the tibia while extending the knee.
    • A palpable or audible click or pain during these maneuvers suggests a meniscal tear.