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Back If the examiner notes an “S” or a “C” scoliosis,

the patient is asked to flex forward and touch his toes slowly.

If the scoliosis straightens, the test is normal and the patient is considered to have functional scoliosis. If the scoliosis stays the same, the test is positive and indicates a pathological scoliosis.

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Thoracic Outlet The patient takes a deep breath, holds it for

20 seconds, turns his head toward the affected side while the examiner palpates the radial pulse, abducts, extends and externally rotates the arm.

The test is positive if marked weakening, loss of pulse, or increased paresthesia takes place.

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Vascular The patient elevates the arm and clenches his fist

to shunt blood from the palm, after which the doctor occludes the radial and ulnar arteries. Then, the doctor lowers the arm and instructs the patient to open his hand. The doctor then releases the pressure off the arteries.

Normally, the skin of the palm should flush within three seconds. This test is positive if the skin does not flush entirely or partially within the given period of time.

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Knee The patient is sitting. The hip is flexed. The

knee is flexed up to 90 degrees. The examiner pulls the tibia by holding the tibia the thumbs on the medial and lateral joint and pulls the knee forward.

If the knee slides forward from under the femur, this is a positive sign of anterior cruciate ligament laxity.

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Shoulder The patient reaches behind the head and down

the back (which is a combination of abduction and external rotation) and then behind the back and up the spine (combined abduction and internal rotation), bilaterally.

Pain indicates degenerative tendonitis of one of the tendons of the rotator cuff, usually the supraspinatus.

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Knee The patient is supine. The knee is extended by

the examiner and the medial border of the patella is pushed to the lateral aspect.

If the patient is guarding the patella, by contracting the quadriceps muscles, this is indicative of a tendency of the patella to dislocate or subluxate.

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Shoulder The examiner abducts and externally rotates

the shoulder. This is done passively. When reaching close to 90 degrees of

abduction and external rotation, if the patient is apprehensive and resists the examiner, this is indicative of instability of the shoulder and the possibility of dislocation if it is carried out further.

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Feet A sharp object is drawn across the plantar

surface of the foot on the lateral aspect, from the calcaneus to the toes.

If the patient flexes all the toes, this is normal. However, with central nervous system lesions, which are associated with the brain damage, the great toe is extended while other toes either plantar flex or splay.

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Shoulder The patient flexes the elbow and the examiner

grasps the wrist. The patient then continues to flex the elbow and externally rotate it against resistance.

This test screens for bicipital tendon irritation or instability.

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Neck & Shoulder While the patient is in the supine position, the

examiner passively abducts the patient’s arm just before the pain in the neck and shoulder increases and then passively externally rotates the shoulder joint, again just before the pain increases in the neck and shoulder. Secondly, the elbow is kept in a flexed position and the forearm in a supinatedposition. The examiner maintains this position and gradually extends the elbow.

If the pain is produced or increased in the neck and shoulder, there is a possibility of C5 through C7 nerve root compression.

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Hip The examiner pounds the patient’s affected

heel. This is a good test to screen for possible

impacted femur fractures.

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Legs This test is done when the patient states that he

cannot lift or raise his legs. The supine patient is asked to lift the unaffected leg or hip while the examiner places a hand under the heel on the affected side. This will establish in the examiner’s mind the amount of pressure the patient normally unconsciously exerts for leverage. The patient is then asked to lift the affected leg or hip while the examiner places his hand under the heel on the unaffected side.

In malingering, the pressure the heel exerts on the affected side will be the same or less than that felt by the examiner on the unaffected side.

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Shoulder The examiner passively and forcefully forward

flexes or elevates the patient’s arm. Pain or clicking in the shoulder indicates

tendonitis of the supraspinatus muscle or overuse injury of this muscle.

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Knee This test is considered to be the best indicator of

anterior cruciate ligament laxity. The patient is supine. The knee is bent between 0 and 30 degrees of flexion. The patient’s femur is stabilized by one of he examiner’s hands and the proximal aspect of the tibia is moved forward.

A positive sign is indicative of anterior cruciateligament laxity and is demonstrated by sliding of the tibia forward from underneath the femur.

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Knee The patient is supine. The knee is completely

flexed. The examiner gently externally rotates the foot and tibia and palpates the medial joint line. At the same time, he applies a slight varus force and extends the knee.

At the time of extension, there is a click and possible snap and feeling of pain by the patient, which is indicative of a loose or torn medial meniscus. The same procedure is done with the knee flexed and internally rotated. At this time, a valgus stress is applied and the knee extended, a click, snap or pain in the lateral joint line is usually indicative of a lateral meniscal tear.

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Elbow & Wrist The examiner places resistance against the

patient’s extended wrist. This test is done to determine if there is

tenderness over the lateral epicondyle, and/or resistive forces against extension of the wrist, and if extension of the fingers causes pain in the lateral epicondyle.

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Leg The patient is placed with the unaffected side

next to the table. The examiner places one hand on the pelvis and grasps the patient’s ankle lightly with the other hand, holding the knee flexed at a right angle. The thigh is abducted and extended laterally.

This test is positive if the leg remains abducted.

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Knee While the patient is supine, he is asked to

contract his quadriceps muscle. This is done by the patient actively pushing the knee down while the examiner holds the patella in resistance to this contraction.

If this causes pain underneath the patella, the patient has chondromalacia of the patella.

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Knee The patient is supine. The hip is flexed. The

knee is flexed up to 90 degrees. The examiner pulls the tibia by holding the tibia with the thumbs on the medial and lateral joint and pulls the knee forward.

In posterior drawer sign the knee is pushed backward, and if the knee slides posteriorlyfrom underneath the femur, it is an indication of posterior cruciate ligament laxity.

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Back & Legs The patient is supine on the table and the examiner

raises one of the legs with his hand up to 90 degrees. The knee should be extended.

If the pain is elicited in any degree below 80 degrees, then the examiner lowers the leg until the pain disappears and dorsiflexes the foot passively. If the pain is again reproduced in the back or leg, the pathology is due to the sciatic nerve root irritation. Otherwise, it is due to hamstring tightness. Occasionally, the pain is produced in the back and in the other leg, which is on the examination table, and this is called the cross leg or opposite-leg straight leg-raising test.

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Ankle The examiner wraps a sphygmometer around

the ankle and inflates to just above the patient’s systolic blood pressure for 1-2 minutes.

Pain indicates a compromise of the tarsal tunnel.

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Hip While the patient is supine, the thigh is flexed

and bent upon the abdomen. The patient’s lumbar spine should normally

flatten. However, if it maintains its normal lordotic curve, the test is positive. Involuntary flexion of the opposite knee indicates a hip flexion contracture.

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Ankle While the patient is prone with the knee

flexed, the examiner squeezes the calf muscle against the tibia and the fibula.

The foot should plantar flex. If not, this is indicative of Achilles tendon damage or rupture.

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Hip Have the patient stand on the affected leg,

flex the other leg at the knee and raise the knee to the level of the hip.

If the left iliac crest raises, the test is normal. However, if the iliac crest lowers, the test would be positive.

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Back & Leg The patient is in a supine position. The test is

performed by elevating and extending the unaffected leg.

The test is positive if there is a reproduction of pain in the affected leg.

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