Instruct: Pt seated, examiner instructs pt to place hand of affected side on opposite shoulder and bring the affected elbow to the chest.

Positive: Inability to touch the opposite shoulder and/or inability of the elbow to touch the chest.

Indicates: Acute dislocation of shoulder. (glenohumeral joint)

Instruct: Pt seated, examiner abducts the pt shoulder, flexes pt elbow and then gradually externally rotates to pt shoulder.

Positive: Pt x/noticeable look of apprehension or alarm on face w/possible pain.

Indicates: chronic anterior dislocation of shoulder (glenohumeral joint)

Instruct: Pt supine, examiner flexes pt shoulder, flexes pt elbow and internally rotates pt shoulder. Examiner places his/her hand on the pt elbow and gradually applies increasing posterior pressure.

Positive: Pt w/noticeable look of apprehension or alarm on face w/possible pain.

Indicates: chronic posterior dislocation of shoulder(glenohumeral joint)

Instruct: Pt seated, examiner passively abducts pt arm to slightly over 90 degrees and removes support, if pt can maintain arm, then instructs pt to slowly lower their arm.

Positive: Pt not able to lower arm slowly or arm drops suddenly.

Indicates: Rotator cuff tear, usually supraspinatus

Instruct: Pt seated, examiner applies pressure below affected acromial process with his/her fingertips. Note pain or tenderness. Examiner continues to apply pressure while abducting pt arm past 90 degrees.

Positive: decrease in pain and/or tenderness.

Indicates: Subacromial bursitis

Instruct: Pt seated, examiner flexes pt elbow to 90 degrees. Examiner stabilizes pt elbow w/one hand and exerts slight inferior traction. Examiner uses other hand and grasps slightly above pt wrist. Examiner offers resistance while pt is instructed to externally rotate his/her humerus and slightly supinate the forearm.

Positive: 1)Localized pain/tenderness at bicipital groove

2)Audible click or biceps tendon subluxes or dislocates

Indicates: 1)Tendintitis

2)Instability of biceps tendon possibly associated with a torn    transverse humeral ligament.

Instruct: Pt seated, examiner fully abducts and externally rotates pt affected arm. Examiner places his/her fingers on pt bicipital groove and then slowly lowers the pt affected arm to their side.

Positive: Palpable and/or audible click

Indicates: Subluxation or dislocation of biceps tendon. (Rupture of transverse lig or tendon subluxation beneath subscapularis muscle belly.)

Instruct: Pt seated w/forearm supinated, and elbow flexed to 45 degrees. Examiner places his fingers on pt bicipital groove w/their opposite hand on the pt forearm. Instruct pt to flex his shoulder, maintain supination and completely extend elbow as the doctor applies resistance.

Positive: Pain/tenderness in bicipital groove

Indicates: bicipital tendinitis

Instruct: Pt seated. Have him place affected hand behind head and touch opposite superior angle of scapula = Apley scratch superior Then pt instructed to place hand behind the back to touch inferior angle of scapula = Apley scratch inferior

Positive: Exacerbation of pain

Indicates: Degenerative tendinitis of rotator cuff tendons (usually Supraspinatus)

Instruct: Pt seated w/arms at side, examiner slightly abducts pt arm (hand should be pronated) and moves it fully through flexion (will jam greater tuberosity and anterior/inferior surface of the acromion)

Postive: Pain in the shoulder

Indicates: Overuse injury to the supraspinatus and possibly biceps tendon.

Instruct: Pt seated, examiner stabilizes lateral aspect of the arm and places an abduction (valgus) pressure on the medial forearm.

Positive: Excessive gapping and pain.

Indicates: MCL instability

Instruct: Pt seated, examiner stabilizes medial aspect of arm and places an adduction (varus) pressure on pt lateral forearm.

Positive: Excessive gapping and pain.

Indicates: LCL instability

Instruct: Pt seated, w/Taylor reflex hammer, examiner taps over groove between medial epicondyle and olecranon process (small end).

Positive: Pain / tenderness at site being tapped and paresthesia in ulnar nerve distribution area (fingers 4,5)

Indicates: Neuroma of ulnar nerve

Instruct: Pt seated, examiner instructs pt to make a fist and place wrist into extension. Examiner instructs pt to resist as examiner tries to push extended wrist into flexion.

Positive: Pain over lateral epicondyle

Indicates: Lateral epicondylitis (Tennis elbow)

Instruct: Pt seated at rest w/forearm supinated. In a smooth continuous motion the Dr. passively maximally flexes pt elbow, then wrist and then fingers. While maintaining wrist and finger flexion, the Dr. passively extends the pt elbow (the forearm is now pronated).

Positive: Pain over lat epicondyle

Indicates: Later epicondylities (Tennis Elbow)

Instruct: Pt seated, examiner instructs pat to extend the elbow and supinate hand. Examiner instructs pt to flex wrist against resistance.

Positive: Pain over med epicondyle

Indicates: Medial Epicondylitis

Instruct: Pt seated w/wrist supinated, examiner taps over the palmar (volar) surface of wrist. (flexor retinaculum – over carpal tunner region).

Positive: Reproduction of pain, tenderness and/or paresthesia in the median nerve distribution area (thumb, 2, 3, and lateral ½ of digit 4).

Indicates: Carpal Tunnel Syndrome

Instruct: Pt seated, examiner instructs pt to flex both wrists to maximum degree and approximate until point of pain or 60 secs. Prayer sign = maximally extend wrist (palms together), elbows same level as shoulders for 60 secs or until pain.

Positive: Reproduction of pain and/or paresthesia in the median nerve distribution area (thumb, 2, 3 and lateral ½ of digit 4).

Indicates: Carpal Tunnel Syndrome

Instruct: Pt seated, examiner instructs pt to place his thumb across palmar surface of hand and make a fist. Have pt flex elbow and instruct pt to ulnar deviate his hand.

Positive: pain distal to radial styloid process

Indicates: stenosing tenosynovitis of abductor pollicis longus and extensor pollicis brevis tendons (DeQuervain’s Disease)

Instruct: Pt seated, examiner places MCP joint in extension and tries to flex proximal interphalangeal joint. If no flexion is possible then there is either joint capsule contracture or tight intrinsic muscles. To differentiate, examiner places the MCP joint in a few degrees of flexion and attempts to move the proximal interphalangeal joint into flexion.

Postive: 1)Flexion of proximal IP joint not possible

2)Flexion of proximal IP joint is achieved

Indicates: 1)Joint capsule contracture

2)Tight intrinsic mucles

Instruct: Pt seated, examiner places proximal IP joint in neutral and tries to flex distal IP joint. Differentiate, examiner places proximal IP joint in a few degrees of flexion and attempts to move the distal IP joint into flexion.

Positive: 1)Flexion of distal IP joint impossible

2)Flexion of distal IP joint achieved

Indicates: 1)Joint capsule contracture

2)Tight retinacular lig

Instruct: Pt seated, examiner instructs pt to raise his hand above heart level of his head and open and close his fist for 60 secs. Examiner occludes both the radial and ulnar artery at the wrist and then lowers pt arm with the fist closed and allows the fist to rest on pt thigh. Examiner instructs pt to open closed fist and releases digital pressure over one artery while keeping the other artery occluded. Record the filling time, while comparing color to the other hand. Then repeat procedure for other artery.

Positive: A delay of more than 10 secs (Evans 5 sec) in retruning a reddish color to the hand.

Indicates: Radial or ulnar artery insufficiency. The artery held (occluded) by the examiner is not the artery being tested.

Instruct: Pt seated with examiner standing behind. Examiner clasps his hands over pt head and exerts gradual increasing downward pressure. Examiner repeats this procedure with the pt head rotated right and then left.

Positive:  1)Exacerbation of localized cervical pain

2)Exacerbation of cervical pain with a radicular component

Indicates: 1)Foraminal encroachment or facet pathology w/o nerve root   compression.

2)Foraminal encroachment with nerve root compression or    facet pathology.

Instruct: Pt seated: the examiner grasps pt head w/both hands and gradually exerts upward pressure keeping hands off TMJ and ears.

Positive: 1)Diminished or absence of pain

2)Increase of cervical pain

Indicates: 1)Foraminal encroachment (local pain diminishes), nerve root    compression (radicular pain diminishes)

2)Muscular strain, ligamentous sprain, myospasm, facet    capsulitis.

Instruct: Pt seated w/head in slight flexion, percuss each cervical spinous process(es) and the associated musculature with the pointed end of a reflex hammer.

Positive: 1)Local pain

2)Radiating pain

Indicates: 1)Possible fractured vertebrae, ligamentous involvement   (spinous pain), muscular involvement (muscular pain). 2)Possible disc pathology

Instruct: Pt seated, examiner stabilizes pt laterally flexed head while pushing down on shoulder.

Positive: 1)Localized pain on the side being tested

2)Radicular pain on either side

Indicates: 1)Localized Pain: Dural sleeve adhesion, and muscular    adhesion/contracture, or spasm, or ligamentous injury.

2)Radicular Pain: On side being tested: neurovascular   bundle compression, dural sleeve adhesions, or Thoracic   Outlet Syndrome.

  -On opposite side being tested: foraminal encroachment   w/nerve root compression.

Instruct: Pt seated, examiner instructs pt to take a deep breath and hold, while bearing down as if having a bowel movement.

Positive: Local or radiating pain from site of lesion.

Indicates: Space occupying lesion

Instruct: Pt seated: examiner instructs pt to swallow.

Positive: difficulty in swallowing

Indicates: Space occupying lesion at anterior portion of cervical spine. Possibly esophageal or pharyngeal injury, anterior disc defect, muscle spasm or osteophytes etc.

Instruct: Pt supine, examiner flexes pt head toward his chest while exerting downward pressure on pt sternum w/hypothenar eminence of inferior hand.

Positive: Generalized pain in the cervical region which may extend down to the level of T2.

Indicates: Non-specific test for structural integrity of cervical region.

Instruct: Pt supine, examiner passively flexes pt hip to 90 degrees and the pt knee to 90 degrees. Examiner extends pt leg completely.

Positive: Inability to fully extend the leg and/or pain (usually in the neck region).

Indicates: Meningeal irritation / meningitis.

Instruct: Pt seated, examiner grasps pt head w/both hands and passively and slowly takes the cervical region through a range of motion. Examiner then takes cervical region through isometric contractions.

Positive: 1)Pain during passive range of motion

2)Pain during resisted range of motion.

Indicates: 1)Ligamentous sprain (passive ROM stresses ligaments) 2)Muscle/tendon strain (active Rom stresses muscles and   tendons)

(Used to differentiate organic versus hysterical leg paralysis)

Instruct: Pt supine, examiner instructs pt to lift affected leg while examiner places one hand uder heel of non-affected leg (healthy side).

Positive: lack of counter-pressure on healthy side.

Indicates: Lack of organic basis for paralysis (Malingering/hysteria). With organic hemiplegia, the pt will still exert downward pressure when attempting to raise paralyzed leg.

Instruct: Pt supine, examiner raises pt leg slowly to 90 degrees or to the point of pain.

Positive: Radiating pain and/or dull posterior thigh pain. Indicates: Sciatic radiculopathy or tight hamstrings. Positive between 35-70 degrees = possible discogenic sciatic radiculopathy (Cirpriano)

Instruct: Pt supine, examiner places the fingers of their superior hand under the interspinous spaces of the pt lower lumbar vertebrae. Examiner then raises one of the pt extended legs.

Positive: Localized pain, low back or radiating pain down the leg.

Indicates: Lumbo-sacral or sacroiliac pathology. Pain occurring after the lumbar spinouses move = possible lumbo-sacral problem. Pain occurring before the lumbars move = possible sacroiliac problem.

Instruct: Pt supine, examiner performs a (SLR) on pt. Examiner lowers the raised leg (5 degrees) from the point of pain and sharply dorsiflexes pt foot.

Positive: Radiating pain in posterior thigh.

Indicates: Sciatic radiculopathy

Instruct: Pt supine, examiner performs a SLR on the pt.

Positive: Pain in posterior thigh w/sudden knee flexion (buckle).

Indicates: Sciatic radiculopathy

Instruct: Pt supine, examiner places pt leg on their shoulder and first applies pressure to the hamstring muscle. If pain is not elicited then apply pressure to the popliteal fossa.

Positive: Pain in the lumbar region or radiculopathy.

Indicates: Sciatic nerve root compression, helps rule out tight hamstrings.

Instruct: Pt supine. Hip and leg bent to 90 degrees. Slowly extend the     knee (keeping hip at or close to 90 degrees).

Positive: Reproduction of sciatic pain before 60 degrees.

Indicates: Sciatica

Instruct: Pt supine, examiner raises both of pt legs 2-3 inches off table and      instructs pt to hold legs off the table for 30 seconds.

Positive: Inability to perform test and/or low back pain.

Indicates: Weak abdominal muscles or space occupying lesion.

Instruct: Pt seated, examiner instructs pt to take a deep breath and hold     while bearing down as if staining at a bowel movement.

Positive: Radiating pain from site of lesion (usually positive in cervical or      lumbar area of the spine).

Indicates: Space occupying lesion (e.g. disc pathology).

Instruct: Pt seated. Examiner instructs pt to extend one knee at a time     alternately, then both together.

Positive: Reproduction of radicular pain or inability to perform correctly due      to tripod sign.

Indicates: Sciatic radiculopathy.

Instruct: Examiner instructs pt to bend forward from the waist.

Positive: Pain accompanied by flexion of the knee on the affected side and      body rotation away from the affected side.

Indicates: Positive with a variety of low back pathologies. Hamstring                      tension on the pelvis may trigger response.