1) Cervical Distraction Test
Purpose: To identify nerve root compression or cervical radiculopathy.
Procedure: The patient is lying supine or seated. The therapist gently grasps the patient's head and applies a
distraction force by lifting the head. A positive test is indicated by a reduction or relief of symptoms.
2) Vertebral Artery Test
Purpose: To assess the integrity of the vertebral arteries and potential vertebrobasilar insufficiency.
Procedure: The patient is lying supine. The therapist extends, laterally flexes, and rotates the patient’s head
to one side and holds for 30 seconds. This is repeated on the other side. A positive test includes dizziness,
nausea, nystagmus, or other signs of vertebrobasilar insufficiency.
3) Sharp-Purser Test
Purpose: To assess the stability of the atlanto-axial joint, particularly the integrity of the transverse
ligament.
Procedure: The patient is seated with the head slightly flexed. The therapist places one hand on the patient’s
forehead and the other hand on the spinous process of the axis (C2). The therapist then applies a posteriorly
directed force on the forehead while stabilizing C2. A positive test includes a clunk or reduction of symptoms,
indicating instability.
4) Cervical Flexion-Rotation Test
Purpose: To diagnose cervicogenic headaches.
Procedure: The patient is supine. The therapist flexes the cervical spine fully and then rotates the head to
both sides. A positive test is a significant reduction in rotation range compared to normal, suggesting a
cervicogenic headache.
5) Lhermitte's Sign
Purpose: To identify cervical myelopathy or multiple sclerosis.
Procedure: The patient is seated. The therapist passively flexes the patient's neck. A positive test is a
sudden, electric-like sensation down the spine an d into the limbs, suggesting spinal cord
involvement.
SPECIAL TESTS FOR SHOULDER
1) Hawkins-Kennedy Test
Purpose: To identify shoulder impingement, particularly of the supraspinatus tendon.
Procedure: The patient is seated or standing. The therapist flexes the patient's shoulder to 90 degrees and
then forcibly internally rotates the arm. A positive test is indicated by pain, suggesting impingement of the
rotator cuff tendons under the acromion.
2) Apprehension Test
Purpose: To assess anterior shoulder instability or dislocation.
Procedure: The patient is seated or supine. The therapist abducts the shoulder to 90 degrees and then
externally rotates it slowly. A positive test is the patient showing apprehension or fear of impending
dislocation, indicating anterior instability.
3) Drop Arm Test
Purpose: To detect tears in the rotator cuff, particularly the supraspinatus.
Procedure: The patient is seated or standing. The therapist abducts the patient's arm to 90 degrees and
asks the patient to slowly lower it. A positive test is the inability to control the lowering or sudden dropping of
the arm, indicating a rotator cuff tear.
4) Speed's Test
Purpose: To identify biceps tendon pathology, particularly bicipital tendinitis.
Procedure: The patient is seated or standing with the elbow extended and the forearm supinated. The
therapist resists shoulder flexion by applying downward pressure on the arm as the patient attempts to
elevate it. A positive test is pain in the bicipital groove, indicating inflammation or pathology of the biceps
tendon.
5) Sulcus Sign
Purpose: To assess inferior shoulder instability or multidirectional instability.
Procedure: The patient is seated with the arm relaxed at the side. The therapist grasps the patient's elbow
and applies a downward traction force. A positive test is the presence of a visible or palpable sulcus
(depression) below the acromion, indicating inferior shoulder instability.
SPECIAL TESTS FOR HIP JOINT
1) Patrick's (FABER) Test
Purpose: To assess for hip joint pathology or sacroiliac joint dysfunction.
Procedure: The patient lies supine with one ankle placed on the opposite knee (forming a figure-four shape).
The therapist gently presses down on the raised knee while stabilizing the contralateral ASIS. A positive test
is pain in the hip or SI joint.
2) Trendelenburg Test
Purpose: To identify weakness or dysfunction of the hip abductor muscles, particularly the gluteus medius.
Procedure: The patient stands on one leg while the therapist observes the pelvis from behind. A positive test
is dropping of the contralateral pelvis, indicating weakness of the hip abductors on the weight-bearing side.
3) Ober's Test
Purpose: To assess for tightness or contracture of the iliotibial (IT) band or
tensor fasciae latae (TFL) muscle.
Procedure: The patient lies on their side with the lower leg flexed for stability. The therapist abducts and
extends the upper leg and then lowers it towards the table. A positive test is the inability of the leg to adduct
or touch the table, suggesting IT band or TFL tightness.
4) Thomas Test
Purpose: To evaluate for hip flexion contractures or tightness of the iliopsoas muscle.
Procedure: The patient lies supine at the edge of the table. One knee is brought to the chest, while the other
leg hangs freely off the table. The therapist observes the position of the hanging leg. A positive test is the
inability of the hanging leg to extend fully, suggesting a hip flexion contracture.
5) Ely's Test (Rectus Femoris Test)
Purpose: To assess for rectus femoris tightness or contracture.
Procedure: The patient lies prone with the knee flexed to 90 degrees. The therapist passively flexes the hip,
bringing the heel towards the buttock. A positive test is elevation of the ipsilateral thigh off the table,
indicating rectus femoris tightness or contracture.
