Lachman Test
Most sensitive test for ACL tear (30° knee flexion, anterior tibia pull)
Spurling Maneuver
Cervical extension, sidebending to affected side + axial load = radiculopathy
Empty Can Test
90° abduction, 30° horizontal adduction, thumb down = Supraspinatus tendon / tear
Trendelenburg Sign
Pelvis drops on contralateral side = Gluteus medius weakness (Superior Gluteal Nerve)
Shoulder & Rotator Cuff Special Tests
The rotator cuff consists of four muscles (SITS: Supraspinatus, Infraspinatus, Teres minor, Subscapularis):
| Test Name | Maneuver Executed | Positive Finding | Anatomical Structure Tested |
|---|---|---|---|
| Neer Impingement | Internal rotate arm, passively flex forward overhead while stabilizing scapula | Pain at 70–120° of forward flexion | Subacromial impingement (supraspinatus tendon / bursa) |
| Hawkins-Kennedy | Flex shoulder 90°, flex elbow 90°, forcibly internally rotate humerus | Pain in subacromial region | Supraspinatus impingement under coracoacromial ligament |
| Empty Can (Jobe) | Abduct 90°, angle forward 30° in scapular plane, full internal rotation (thumbs down), resist downward force | Pain and/or weakness compared to opposite side | Supraspinatus tendon tear or tendinopathy |
| Drop Arm Test | Passively abduct arm to 90°, instruct patient to lower arm slowly | Arm drops abruptly or with severe pain from 90° to side | Full-thickness Supraspinatus tear |
| External Rotation Lag | Flex elbow 90°, abduct 20°, passively externally rotate to near full, release wrist | Inability to maintain external rotation; forearm drifts inward | Infraspinatus / Teres Minor tear |
| Lift-Off / Belly Press | Place hand behind small of back, attempt to push hand backward away from spine | Inability to lift hand off back | Subscapularis tear |
| Speed Test | Elbow extended, forearm supinated, forward flex shoulder against resistance | Pain in bicipital groove | Biceps long head tendonitis / SLAP lesion |
| Yergason Test | Elbow flexed 90°, resist active supination while palpating bicipital groove | Pain or popping in bicipital groove | Biceps tendon instability / transverse humeral ligament rupture |
| Apprehension / Relocation | Shoulder abducted 90°, externally rotated; apply posterior directed force on anterior humeral head | Apprehension/fear of subluxation relieved by posterior pressure | Anterior shoulder glenohumeral instability |
Knee Ligament & Meniscal Special Tests
Essential maneuvers for acute and subacute knee injuries:
| Test Name | Maneuver Executed | Positive Finding | Anatomical Structure Tested |
|---|---|---|---|
| Lachman Test | Knee flexed 20–30°, stabilize femur, translate tibia anteriorly | Increased anterior translation with soft end-feel | Anterior Cruciate Ligament (ACL) — highest sensitivity |
| Anterior Drawer | Knee flexed 90°, sit on foot, pull proximal tibia anteriorly | Anterior translation > 6 mm compared to contralateral | Anterior Cruciate Ligament (ACL) — false negatives from hamstring spasm |
| Posterior Drawer | Knee flexed 90°, push proximal tibia posteriorly | Posterior translation / sag of proximal tibia | Posterior Cruciate Ligament (PCL) (dashboard injury) |
| Valgus Stress Test | Apply medially directed force at knee at 0° and 30° flexion | Medial joint line opening / pain | Medial Collateral Ligament (MCL) |
| Varus Stress Test | Apply laterally directed force at knee at 0° and 30° flexion | Lateral joint line opening / pain | Lateral Collateral Ligament (LCL) |
| McMurray Test | Flex knee fully; internally/externally rotate tibia while extending knee with varus/valgus stress | Palpable pop or click with pain along joint line | Meniscal tear (Internal rot = Lateral; External rot = Medial) |
| Thessaly Test | Patient stands on one leg flexed 20°, rotates body internally/externally 3 times | Joint line pain or mechanical catching/locking | Meniscal tear (highest clinical accuracy in ambulatory patients) |
Hip, Pelvis & Spine Radicular Special Tests
Differentiating nerve root impingement from sacroiliac and hip pathology:
| Test Name | Maneuver Executed | Positive Finding | Clinical Entity |
|---|---|---|---|
| Straight Leg Raise (SLR) | Supine, passively elevate leg with knee extended | Sharp radiating pain below the knee between 30° and 70° | L4, L5, S1 radiculopathy / disc herniation |
| Crossed SLR (Well Leg) | Passively elevate the UNINJURED contralateral leg | Pain reproduced in the AFFECTED leg | Highly specific (90%) for large disc herniation |
| Spurling Test | Extend neck, sidebend toward affected side, apply axial downward pressure | Radiating shock-like pain down ipsilateral arm | Cervical nerve root compression (cervical radiculopathy) |
| FABER / Patrick Test | Flexion, ABduction, External Rotation (figure-4 position), press knee down | Groin pain = Hip joint pathology; Posterior pain = Sacroiliac joint | Hip OA, labral tear vs SI joint dysfunction |
| FADIR Test | Flexion, ADduction, Internal Rotation | Sharp anterolateral groin pain | Femoroacetabular Impingement (FAI) / labral tear |
| Ober Test | Side-lying, abduct and extend hip with knee flexed 90°, allow thigh to drop to table | Inability of thigh to drop below horizontal table plane | Iliotibial (IT) Band contracture / friction syndrome |
| Trendelenburg Sign | Patient stands on one leg | Pelvis tilts downward on UNSUPPORTED (contralateral) side | Weakness of gluteus medius/minimus on SUPPORTED side (Superior Gluteal Nerve) |
COMLEX / OMM Integration
NBOME High-Yield Correlate
The Unhappy Triad of O'Donoghue
- Classic Injury: Lateral blow to the knee with foot planted and knee flexed.
- Structures Damaged:
1. Anterior Cruciate Ligament (ACL)
2. Medial Collateral Ligament (MCL)
3. Medial Meniscus (modern MRI studies show lateral meniscus tears are actually more frequent acutely, but boards strictly test medial meniscus!)
- Structures Damaged:
1. Anterior Cruciate Ligament (ACL)
2. Medial Collateral Ligament (MCL)
3. Medial Meniscus (modern MRI studies show lateral meniscus tears are actually more frequent acutely, but boards strictly test medial meniscus!)
Board Traps & Common Distractors
- Trap: Trendelenburg sign naming. The side of pelvic drop is OPPOSITE to the nerve lesion. If standing on the right leg causes the left hip to drop, the lesion is in the RIGHT superior gluteal nerve or right gluteus medius.
- Trap: Confusing Ober test with Thomas test. Ober = IT band contracture; Thomas = Psoas / hip flexor contracture.