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Education

Physical Exam Tests

mLpenguin

• 3 min read
Physical Exam Tests
Photo by Inge Poelman / Unsplash

ACL Injury

  • Lachman test
    • Patient lies supine with knee flexed at 20-30°
    • Stabilize femur with one hand, grasp proximal tibia with other
    • Pull tibia anteriorly; assess for excessive forward movement or soft endpoint
  • Anterior Drawer test
    • Patient lies supine with knee flexed at 90°
    • Sit on foot to stabilize, grasp proximal tibia with both hands
    • Pull tibia anteriorly; check for increased anterior translation compared to opposite knee

LCL Injury

  • Varus stress test
    • Patient supine or seated with knee slightly flexed (20-30°)
    • Apply varus (inward) force on knee while stabilizing ankle
    • Look for excessive lateral joint opening or pain

MCL Injury

  • Valgus stress test
    • Patient supine with knee slightly flexed (20-30°)
    • Apply valgus (outward) force on knee while stabilizing ankle
    • Assess for excessive medial joint opening or pain

PCL Injury

  • Posterior Drawer test
    • Patient supine with knee at 90° flexion
    • Sit on foot to stabilize, push proximal tibia posteriorly
    • Look for excessive posterior translation compared to opposite knee
  • Posterior sag sign (Godfrey test)
    • Patient supine with hip and knee both flexed at 90°
    • Observe if tibia sags posteriorly compared to femur, indicating PCL injury

Meniscus Injury

  • Joint line tenderness
    • Palpate the medial and lateral joint lines of the knee
    • Check for localized tenderness indicating meniscal pathology
  • Inability to squat/kneel
  • McMurray Test
    • Patient supine, knee fully flexed
    • Rotate tibia internally and externally while extending the knee
    • Listen/feel for clicks or pain along joint line
  • Thessaly Test
    • Patient stands on one leg with knee slightly flexed (20°)
    • Patient rotates body and knee internally and externally
    • Look for joint line discomfort or locking sensation
  • Apley Compression Test
    • Patient prone, knee flexed to 90°
    • Apply downward pressure on heel with rotation of tibia (internal and external)
    • Assess for pain or restriction indicating meniscus injury

Arterial blood supply of the hand

  • Allen test
    • Patient clenches fist tightly
    • Compress radial and ulnar arteries
    • Release one artery and observe for color return in hand to test patency

de Quervain Tenosynovitis

  • Finkelstein test
    • Patient makes a fist with thumb inside fingers
    • Examiner ulnar deviates wrist
    • Pain over radial styloid indicates positive test
    • APL tastes good with Every Precious Bite
      • Abductor pollicis longus
      • Extensor pollicis brevis

Stability of the thumb carpometacarpal joint

  • Grind test
    • Examiner stabilizes first metacarpal and rotates the thumb carpometacarpal joint under axial compression
    • Pain or crepitus indicates arthritis or instability

Carpal tunnel syndrome (median nerve)

  • Phalen test
    • Patient flexes both wrists maximally, pressing dorsal surfaces together
    • Hold for 30-60 seconds
    • Tingling or numbness in median nerve distribution is positive
  • Reverse Phalen test
    • Patient extends wrists and presses palms together
    • Hold for 30-60 seconds
    • Symptoms in median nerve distribution indicate positive test
  • Tinel sign
    • Tap over median nerve at wrist (carpal tunnel)
    • Tingling or “electric shock” sensation in median nerve distribution is positive

Ulnar tunnel syndrome

  • Tinel sign
    • Tap over ulnar nerve at wrist (Guyon's canal)
    • Tingling or paresthesia in ulnar nerve distribution indicates positive test

Scapholunate Interosseous ligament instability

  • Scaphoid shift test (Watson test)
    • Examiner applies pressure to scaphoid tubercle while moving wrist from ulnar to radial deviation
    • A “clunk” or pain indicates instability

Thoracic Outlet Syndrome

  • Adson test
    • Used for arm and neck pain
    • Patient extends neck and turns head toward tested arm
    • Examiner palpates radial pulse while extending and externally rotating shoulder
    • Diminished pulse or symptoms indicate positive test
  • Wright test
    • Used for arm and chest pain
    • Patient abducts arm to 90° and externally rotates shoulder
    • Examiner palpates radial pulse
    • Decrease or disappearance of pulse indicates compression

Vertebral artery insufficiency

  • Wallenberg test
    • Patient neck is extended, rotated, and held in position for 10 seconds
    • Look for dizziness, nystagmus, or neurological symptoms indicating vertebral artery compromise

Rotator cuff

  • Empty can (Jobe) test
    • Patient abducts arms to 90°, forward flexed 30°, thumbs down (as if pouring out a can)
    • Examiner applies downward pressure
    • Weakness or pain indicates supraspinatus tear
  • Neer's test
    • Examiner passively flexes fully extended arm overhead while stabilizing scapula
    • Pain suggests impingement of rotator cuff
  • Hawkins-Kennedy Impingement Test
    • Examiner flexes shoulder and elbow to 90°, then forcibly internally rotates the arm
    • Pain indicates impingement syndrome
  • Drop Arm test
    • Patient abducts arm to 90°, then slowly lowers it
    • Inability to control lowering or dropping the arm indicates rotator cuff tear

Glenohumeral Range of Motion

  • Apely's scratch test
    • ROM of the glenohumeral joint - Adhesive capsulitis
    • Patient reachs behind their back and touches their opposite shoulder.
      • Tests internal rotation and adduction and a patient with a normal range of motion will be able to touch the inferior angle of the scapula.
    • Patient reachs behind their head and touches their opposite shoulder.
      • A patient with a normal range of motion will be able to touch the opposite shoulder.