Cranial Nerve Assessment

Spurling's Test

- Patient's head extended and rotated toward the painful shoulder.

- Examiner applies an axial load to the cervical spine

(+) Pain

-Indication: Cervical Nerve Root Impingement usually caused by disc herniation

Stork's Test

- Patient is standing on one leg and performs backwards bending

- Examiner applies an axial load to the cervical spine

(+) test: Pain

Indication: Spondylolysis/ Spondylosisthesis

Slump Test

Test for Lumbar Spine

- Patient is sitting

- Ask the patient t perform the following motions.

• Cervical Spine Flexion
• Knee Extension
• Ankle Dorsiflexion
• Release Neck Flexion
• Bilateral Knee Extension

(+) Test: Increased radiating pain as sequential changes in posture occur

Indication: Increased neural tension caused by disc herniation or nerve root impingement

Straight Leg Raise Test

- Patient is supine and slowly lifts a leg while keeping the knee extended

- At the end of motion (Max Flexion) dorsiflex the ankle

(+) test: Pain

Indication:

• Pain at 30 degrees indicated hip problem or inflamed nerve
• Pain from 30-60 degrees indicates sciatic nerve impingement
• Pain from 70-90 degrees indicates sacroiliac joint problem
• Pain with dorsiflexion at the end of motion indicates nerve root impingement or sciatic nerve irritation

Phalen's Test

Position:

• Patient flexes the wrists and puts the back of the hands together
• The position is held for approx 1 minute

(+) Test:

• Pain & Numbness

Indication:

• Carpal Tunnel Syndrome

Finklestein's Test

Position:

• Athlete makes a fist with the thumb tucked on the inside
• Wrist is ulnarly deviated

(+) Test:

• Pain

Indication:

• DeQuarvain's Syndrome

Valgus or Varus Stress Test for Elbow

Valgus (Ulnar)

• Position:
  • Patient’s elbow flexed to 25°
  • One hand supports the lateral elbow with the fingers reaching behind the joint to palpate the medial joint line
  • The opposite grasps the distal forearm
  • Examiner applies valgus torque to the elbow
• (+) Test:
  • Increased laxity compared to the opposite side, and/or
    pain
• Indication:
• Injury to the ulnar collateral ligament

Valgus or Varus Stress Test for Knee

Test for Lateral Epicondylitis

Test for Medial Epicondylitis

Murphy's Sign

Position:

• Athlete is sitting or standing
• Athlete makes a fist and the examiner observes the position of the third metacarpal

(+) Test:

• Third metacarpal is at level with the second and the fourth metacarpals

Indications:

• Dislocated lunate

Neer's Impingement Sign

Position:

• Patient's shoulder is placed in internal rotation
• While maintaining shoulder internal rotation, examiner passively flexes the shoulder to end range

(+) test:

• Pain in subacrominal space between 90-180 deg of flexion

Indication:

• Subacromial impingement

Hawkins - Kennedy Test

Position:

• Patient's shoulder is placed in 90 deg of flexon with elbow flexed to 90 deg
• While maintaining shoulder flexion, examiner passively internally rotates the shoulder

(+) test:

• Pain in subacromial space in end range

Indication:

• Subacrominal Impingement

Roo's Test

Position:

• Patient abducts both arms and flexes elbows to 90 deg flexion
• Patient opens and closes the hands for 3 minutes

(+) Test:

• Inability to maintain testing position or replication of motor/sensory symptoms

Indication:

• Thoracic Outlet Syndrome

Allen's Test

Position:

• Examiner palpates the radial pulse
• Examiner abducts the patients shoulder and flex the elbow to 90 deg and externally rotates the arm while asking the patient to rotate the head away from injured side

(+) test:

• Diminished or disappearance of radial pulse

Indication:

• Thoracic Outlet Syndrome

Speed's Test

Position:

• Patient sitting with elbow extended and palm facing forward
• Examiner resists shoulder flexion while palpating for tenderness over the bicipital groove.

(+) Test:
• Pain over LH biceps tendon

Indication:
• LH biceps tendinopathy

Empty Can Test

Position:
• Patient’s shoulders elevated 90° in a scapular plane (30° anterior to the frontal plane)
• With patient’s thumb pointing down (i.e. empting the can), examiner applies downward pressure at the wrist
(+) Test:
• Weakness or pain accompanying the movement
Indication:
• Supraspinatus pathology (ex. impingement, RC tear, tendinopathy)

O'Brien's Test

Position:
• Patient’s shoulder in 90° flexion and 15° horizontal adduction
• With patient’s thumb pointing down ( = shoulder IR), examiner applies downward pressure at the wrist
• Repeats this with palm facing up ( = shoulder ER)
(+) Test:
• Pain or clicking within the GH joint experienced with the arm internally rotated but is decreased during external rotation
Indication:
• Labral pathology
*Note that pain at AC joint may indicate AC joint injury

Anterior Drawer Test of the Knee

Position:

• Patient is supine with knee flexed to 90°, muscles relaxed
• Examiner stabilizes the foot (can sit on the foot), and pulls the proximal tibia anterior

(+) Test:

• Forward movement of the tibia that is greater than the normal side

Indication:

• Damage to the Anterior Cruciate Ligament

Lachman's Test

Position:

• Patient supine with knee flexed to 30°, muscles relaxed
• Examiner grasps the patient's femur with 1 hand, and proximal tibia with another, and pulls the proximal tibia anterior while stabilizing the femur

(+) Test:

• Forward movement of the tibia that is greater than the normal side

Indication:

• Damage to the Anterior Cruciate Ligament

McMurray's Test

Position:

• Examiner places one hand on top of the knee with thumb over one joint line and index and middle finger on the other joint line
• From full flexion, move the knee into extension while:
• Maintaining tibial external rotation and applying varus torque (stresses medial meniscus)
• Maintaining tibial internal rotation and applying valgus torque (stresses lateral meniscus)

(+) Test:

• Popping, clicking, or locking of the knee

Indication:

• Possible meniscal tear

Posterior Sag Test

Position:

• Patient is supine of a treatment table
• Examiner supports the patient's legs in a 90/90 position

(+) Test:

• Posterior sagging of the tibia

Indication:

• Damage to the posterior cruciate ligament

Thompson Test

Leg Special Test

Position:

• Examiner squeezes the patient's calf muscles, while the foot is extended off the table

(+) Test:

• Absence of foot movement (plantar flexion)

Indication:

• Achilles tendon rupture

Inversion Talor Tilt

Position:

• Patient's ankle in 90 degree dorsiflexion
• Examiner cups a hand around the calcaneous and inverts the foot while palpating the lateral ligaments]

(+) test:

• Excessive motion and/or clunking sound as it reaches the end point

Indication:

• Damage to the calcaneofibular (CF) ligament (primarily) and other lateral structures

Eversion Talor Tilt

Position:

• Patient's ankle in 90° dorsiflexion
• Examiner cups a hand around the calcaneous and everts the foot while palpating the deltoid ligaments

(+) Test:

• Excessive motion and/or clunking sound as it reaches the end point

Indication:

• Damage to the deltoid ligaments

Klieger's Test

Position:

• Examiner stabilizes the distal leg, while grasping the patient's foot and passively moving the ankle into dorsiflexion and external rotation

(+) Test:

• Pain

Indication:

• Damage to the deltoid ligament, distal ankle syndesmosis, anterior/posterior distal tibiofibular ligaments. and interosseous membrane

Yeargason's Test

Position:

• Patient sitting with elbow flexed 90° and forearm pronated
• Examiner resists elbow flexion and supination
• (+) Test:
  • Pain or snapping in the bicipital groove
• Indication:
  • LH biceps tendinopathy

Appley's Compression Test (Pulling upwards)

Position:

• Patient is prone with knee flexed 90°
• Examiner applies axial loading to the leg while rotating tibia (foot) into internal and external rotation

(+) Test:

• Pain

Indication:

• Possible meniscus injury

Appley's Distraction Test (Pushing downwards)

Position:

• Patient is prone with knee flexed 90°
• Examiner applies distraction to the leg while rotating tibia (foot) into internal and external rotation

(+) Test:

• Pain

Indication:

• Possible injury to the ligament or joint capsule
• No pain if meniscal injury is present