RANGE OF MOTION

UPPER EXTREMITY
*LM-Landmark *PA-Proximal Arm
*DA-Distal Arm *EF-End Feel

JOINT MOTION RANGE LM PA DA EF

Cervical Flexion 0-45 External auditory Perpendicular to Base of Nares Firm

Spine meatus the ground
Extension 0-45

Lateral Flexion 0-45 Over C7 Spinous process Dorsal midline of head Firm
of thoracic
vertebrae

Rotation 0-90 Center of cranial aspect Imaginary line b/n Tip of the nose Firm
of head 2 acromion
process

Thoracic and Flexion or 0-80 Measure the distance Firm

Lumbar Spine b/n spinous process of
Extension (10cm) C7 and S1

(Tape measure)

Lateral 0-35 Post Aspect of spinous Perpendicular to Post Aspect of C7 Firm

Flexion process of S1 the ground

Rotation 0-45 Center of cranial aspect Parallel to the Imaginary line b/n 2 Firm
of head imaginary line b/n acrominion process
2 prominent
tubercle of iliac
crest

1
Shoulder Flexion 0-180 Lat. Aspect of the Parallel to the Lat. Midline of the Firm
greater tubercle midaxillary of the humerus
Extension 180-0 thorax

Hyperextension(Prone) 0-60

Abduction 0-180 Ant. Aspect of the Parallel to the Ant. Midline of Firm
acromion process midline of the humerus
Adduction 180-0 Ant. Aspect of
sternum

IR 0-70 Olecranon Process Parallel to the Parallel with ulna Firm

floor
ER 0-90

JOINT MOTION RANGE LM PA DA EF

Elbow Flexion 0-150 Lat. Epicondyle of Lat. Midline of Lat. Midline of the Soft
humerus radius humerus

Extension 150-0 Hard

Forear Pronation 0-80 Ulnar styloid process Parallel to Dorsal aspect of FA Firm
m anterior midline
of humerus Ventral aspect of FA

Supination 0-80 Firm

Wrist Flexion 0-80 Over the Triquetrum Lat. Midline of Lat. Midline of 5th MCP Firm
ulna

Extension 0-70

CMC Flexion 0-15 Over CMC Ventral Midline Ventral Midline of 1st Soft
of radius MCP
(Thumb
)
Extension 0-20 Firm
Lat. Midline of 1st MCP

Lat. Midline of
Abduction 0-70 2nd MCP Firm

2
 Radial Styloid
Process

IP Flexion 0-80 Dorsal Aspect of IP Dorsal Aspect of Dorsal Aspect of distal Firm
joint proximal phalanx phalanx
(Thumb
)
Extension 0-20

Wrist Radial Deviation 0-20 Over the capitate Dorsal midline Dorsal midline of 3rd Hard
of forearm MCP

Ulnar Deviation

0-30

MCP Flexion 0-90 Hard

(2-5) Dorsal Aspect of Dorsal Midline Dorsal Midline of

MCP of MCP proximal phalanx
Extension 0-45 Firm

Abduction 0-25 Firm

PIP Flexion 0-100 Over PIP Dorsal Midline Dorsal Midline of Hard
of proximal middle phalanx
phalanx

DIP Flexion 0-90 Over DIP Dorsal Midline Dorsal Midline of distal Firm
of middle phalanx
phalanx

3
 LOWER EXTREMITY
JOINT MOTION RANGE LM PA DA EF

Knees Flexion 0-135 Soft

Lat. Epicondyle of Lat. Midline of Femur Lat.
Femur Midline of
Extension 135-0 Fibula Firm

Ankle DF 0-20 Firm

Lateral Malleolus Lat. Midline of Fibula Lat.
Aspect of
PF 0-50 5th
metatarsal

Inversion 0-35 Firm

Midway of bet Ant. Midline of Lower Leg Ant.
Malleolus Midline of
Eversion 0-15 2nd
metatarsal

JOINT MOTION RANGE LM PA DA EF

Hip Flexion 0-120 Soft

with knees bent

Flexion – SLR Greater Trochanter Lat. midline Lat. midline of Femur

of Pelvis
0-90 Firm

Extension

0-30 Firm

Abduction 0-45 Firm

ASIS Imaginary Ant. Midline of the Femur

horizontal
Adduction 0-30 line b/n 2
ASIS

ER 0-45 Firm

Ant. Aspect of Perpendicula Ant. Midline of Lower Leg

patella r to the floor
IR 0-45

4
 End Feel (Abnormal) Example
Soft Soft Tissue Edema
Synovitis
Hard Chondromalacia
Osteoarthritis
Myositis Ossificans
Fracture
Loose Bodies in Joint
Firm Increased Muscle Tone
Capsular, Muscular, or Ligamentous
Shortening
Empty Acute Joint Inflammation
Bursitis
Abscess
Fracture
Psychogenic Disorder

5
 MANUAL MUSCLE TESTING (MMT)
Grade Scale Criteria
Zero 0 No contraction
Trace 1 Slight Contraction
Poor Minus 2- Initiates motion with
gravity eliminated
Poor 2 Complete ROM with
gravity eliminated
Poor Plus 2+ Initiates motion
against gravity
Fair Minus 3- Some but not
complete ROM
Fair 3 Complete ROM
against gravity
Fair Plus 3+ Complete ROM
against gravity with
minimum resistance
Good 4 Moderate Resistance
Normal 5 Maximum
Resistance

Facial Muscle Grading

N/F Functional Completes test
movement with ease
and control
WF Weak Functional Moderate impairment
that affects the degree
of active motion
NF Non Functional Severe Impairment.
Minimal muscle
contraction
0 Absent

6
 MOTOR ASSESSMENT

MODIFIED ASHWORTH SCALE FOR GRADING SPASTICITY

Grade Description
0 No increase in muscle tone.
1 Slight increase in muscle tone, manifested
by a catch and release or by minimal
resistance at the end of the ROM when
the affected part(s) is moved in flexion or extension.
1+ Slight increase in muscle tone, manifested
by a catch, followed by minimal resistance
throughout the remainder (less than half) of the ROM.
2 More marked increase in muscle tone
through most of the ROM, but affected part(s) easily
moved.
3 Considerable increase in muscle tone, passive
movement difficult.
4 Affected part(s) rigid in flexion or extension.

EXAMINATION OF TONE
0 No response (flaccidity)
1+ Decreased response (hypotonia)
2+ Normal response
3+ Exaggerated response (mild to moderate hypertonia)
4+ Sustained response (severe hypertonia)

Reflex Integrity
A. Deep Tendon Reflex (DTR) Grade
0 Absent, no response
1+ Slight reflex, present
but depressed,
low normal
2+ Normal, typical
reflex
3+ Brisk reflex, possibly
but not
necessarily abnormal
4+ Very brisk reflex,
abnormal, clonus

7
 Myostatic Reflexes (Stretch)
Jaw- (CN V)
Biceps- Musculocutaneous nerve (C5, C6)
Brachioradialis (supinator)- Radial nerve (C5, C6)
Triceps- Radial nerve (C6, C7)
Finger flexors- Median nerve (C6–T1)
Hamstrings -Tibial branch, sciatic nerve (L5, S1, S2)
Quadriceps (patellar,knee jerk)- Femoral nerve (L2,L3,L4)
Achilles (ankle jerk)- Tibial (S1–S2)

B. Superficial Cutaneous Reflex

Superficial Reflexes Stimulus Response
(Cutaneous)
Plantar (S1, S2) With blunt object Normal response is
(key or wooden end flexion (plantarflexion) of
of applicator stick), the great toe and
stroke the lateral sometimes the other toes
aspect of the sole, (negative Babinski sign).
moving from the heel Abnormal response,
to the ball of termed a
the foot, curving positive Babinski sign, is
medially across the extension (dorsiflexion) of
ball of the foot. the great toe with fanning
Alternate stimuli for of the four other toes
plantar (for sensitive (indicates UMN lesions).
feet): Same as for plantar.
• Chaddock: stroke
lateral ankle and
lateral aspect of foot.
• Oppenheim: stroke
down tibial crest
Abdominal reflexes Position patient in Localized contraction
supine, relaxed. Make under the stimulus,
brisk, light stroke causing the umbilicus to
over each quadrant move toward the stimulus.
of the abdominals
from the periphery to
the umbilicus.
Above umbilicus Masked by obesity.
(T8-T10)

Below umbilicus Can be absent in both

(T10-T12) UMN and LMN disorders.

8
9
Cranial Nerve Integrity

10
11
 Olfactory (CN I) Sensory

Optic (CN II) Sensory

Oculomotor (CN III) Motor

Trochlear (CN IV) Motor

Trigeminal (CN V) Both

Abducens (CN VI) Motor

Facial (CN VII) Both

Vestibulocochlear (CN VIII) Sensory

Glossopharyngeal (CN IX) Both

Vagus (CN X) Both

Accessory (CN XI) Motor

Hypoglossal (CN VII) Motor

12
13
14
 SENSORY ASSESSMENT
DERMATOMES

15
Divisions of Sensory Receptors

1. Mechanoreceptors

- respond to mechanical deformation of the receptors or surrounding area.

A. Cutaneous Sensory Receptors

1. Free nerve ending

- found throughout the body.

- Stimulation result in the perception of pain, temperature, touch,

pressure, tickle and itch.

2. Hair Follicle ending

- found at the base of each hair follicle.

- receptors are sensitive to mechanical movement and touch.

3. Merkel’s disks

- located below the epidermis in hairy and glabrous skin.

- sensitive to low intensity & velocity touch. Play an important role in both

two-point discrimination and localization of touch.

4. Ruffini’s Endings

- located in the deeper layer of the dermis.

- involved with perception of touch and pressure

5. Krause End Bulb

- located in the dermis.

- Have contributing role in the perception of touch and pressure.

6. Meissner’s Corpuscles

- located in the dermis. They are in high concentration in the fingertips,

lips, toes areas that require high levels of discrimination.

- Important in discriminative touch and recognition of texture.

7. Pacinian Corpuscles

- Located in the subcutaneous tissue layer of the skin and in deep tissue

of the body.

- They are stimulated by rapid movement of tissue and play a significant

role in the perception of deep touch and vibration.

B. Deep Sensory Receptors

1. Muscle Receptors

a. Muscle Spindle

- They monitor changes in muscle length and velocity of these changes.

16
- Play a vital role in position and movement sense and in motor learning.

b. Golgi Tendon Organs

- These receptors are located in series at both proximal and distal

tendinous insertion of the muscle.

- Function to monitor tension within the muscle. Also provide protective

mechanism by preventing structural damage to the muscle in extreme

tension.

c. Free Nerve ending

- Receptors within the fascia of the muscle.

- Respond to pain and pressure.

d. Pacinian Corpuscles

- Located within the fascia and respond to vibratory stimuli and deep

pressure.

2. Joint Receptors

a. Golgi Type endings

- located in the ligaments and function to detect the rate of joint

movement.

b. Free nerve endings

- found in joint capsule and ligaments, respond to pain and crude

awareness of joint motion.

c. Ruffini Ending

- found in the joint capsule and responsible for the direction and velocity

of joint movement.

d. Pacinian endings

- found in the joint capsule and monitor rapid joint movement.

2. Thermoreceptors

- respond to changes in temperature

- cold receptors and warmth receptors

3. Nociceptors

- respond to noxious stimuli and result in the perception of pain.

- free nerve endings

4. Chemoreceptors

- respond to chemical substances.

a. Taste – receptors of taste buds

b. Smell – receptors of the olfactory nerves in olfactory epithelium.

17
c. Arterial oxygen – receptors of aortic and carotid bodies.

d. Osmolality – neuron of supraoptic nuclei

e. Blood CO2 – receptors in or on the surface of medulla and in aortic and carotid bodies

f. Blood glucose, amino acids and fatty acids – receptors in hypothalamus.

5. Photic Receptors/ Electromagnetic Receptors

- respond to light within the visible spectrum.

- vision: rods & cons

Superficial Sensations-( Exteroceptors- external environment via the skin and

subcutaneous tiss)
Light touch
Pain
Temperature- Cold (5-10 deg), Hot (40-45 deg)
Pressure
Deep Sensations-( Proprioceptors- muscle, tendon, ligament, joint and fascia)
Kinesthesia
Position Sense(Proprioception)
Vibration- Tuning Fork (128 Hz)
Cortical Sensation- (Both superficial and deep)
Stereognosis
Tactile localization
Two-point discrimination
Double simultaneous stimulation
Graphesthesia
Recognition of Texture
Barognosis

 For CVA( stroke patients) test both deep sensation and cortical sensation
 For SCI use ASIA Impairment Scale

18
 SPECIAL TEST

19
20
21
22
23
24
25
26
27
28
 Additional ST
HNBS
Jackson’s Patients with Modification of the Foraminal Compression Test (+) pain
Compressio nerve root � Patient rotates the head to one side radiates
n symptoms Examiner carefully presses straight down on the head into the
Test in the � The test Is repeated with the head rotated to the other side arm
history,
which at the
time of
examination
are
diminished
or absent
Distraction Patients with � Examiner places one hand under the patient’s chin and the (+) pain is
Test radicular other hand around the occiput relieved or
symptoms � Examiner will slowly lift the patient’s head decreased
in the history when the
and show head is
radicular lifted or
signs distracted
during
examination
Upper Limb Cervical � Patient is supine. (+)
Tension radiculopath � Each test begins by testing the good side first and positioning symptoms
Tests y the SHOULDER, followed by the FOREARM, WRIST, reproduce
(Brachial FINGERS, and last, the ELBOW. d
Plexus � Each phase is added until symptoms are produced
Tension or � To further “sensitize” the test, side flexion of the cervical
Elvey Test) spine may be performed

Shoulder Brachial � Examiner side flexes the patient’s head to one side while (+) pain
Depression plexus applying a downward pressure on the opposite increased
Test lesions shoulder
Shoulder Radicular � Patient is sitting or lying down (+)
Abduction symptoms, � Examiner passively or the patient actively elevates the arm decrease
(Relief) Test esp. those through abduction, so that the hand or forearm rests in or relief
involving the on top of the head of
C4 or C5 Symptoms
nerve roots

29
 Valsalva Test Used to determine the � Examiner asks patient (+) increased pain which
effect of increased to take a deep breath and may be
pressure on the spinal hold it while bearing cause by increased
cord down, as if moving the intrathecal
bowels pressure
Vertebral Artery Compression of � Patient in supine (+) provokes referring
(Cervical Quadrant) vertebral arteries � Examiner passively symptoms
Test takes the patient’s head if the opposite artery is
and neck into EXT and affected
SIDE FLEXION. (blurred vision, dizziness,
� Examiner rotates the nystagmus, slurred
patient’s neck to the speech, LOC)
same side and holds it for
approximately 30 seconds

Naffziger’s Test Nerve root problem or � Patient is seated (+) pain

space-occupying lesion � Examiner stands
behind the patient with
his/her fingers over the
patient’s jugular veins
� Examiner compresses
the veins for 30 seconds
and asks the patient to
cough

Transverse Ligament Hypermobility at the � Patient in supine with (+) soft end feel; mm
Stress Test atlantoaxial articulation the examiner supporting spasm;
the occiput with the dizziness; nausea
palms and the third, paresthesia of the lip,
fourth, and fifth fingers face, or limb; nystagmus;
� Examiner places the or a lump sensation in the
index fingers in the space throat
between the patient’s
occiput and C2 spinous
process so that the
fingertips are overlying
the neural arch of C1
Pettman’s Distraction Laxity of tectorial � Patient in supine with (+) pain; paresthesia in
Test membrane head in neutral the 2nd
� Examiner applies position
gentle traction to the
head
� Provided no symptoms
are produced, the
patient’s head is lifted
forward, flexing the
spine, and traction is
reapplied

30
 Sharp-Purser Test Subluxation of the atlas *Must be performed (+) examiner feels the
on the axis with extreme caution head slide
� Patient in sitting backward during the
position
movement
� Examiner places one
hand over the patient’s
forehead while the
thumb of the other hand
is placed over the
spinous process of the
axis to stabilize it
� Patient is asked to
slowly FLEX the head
� While this is occurring,
the examiner presses
backward with the palm

Lateral (Transverse) Instability of the � Patient In supine with (-) minimal motion and
Shear Test atlantoaxial articulation the head supported no
caused by odontoid � Examiner places the symptoms are produced
dysplasia radial side of the 2nd MCP
joint of one hand against
the transverse process of
the atlas and
the MCP joint of the
other hand against the
opposite transverse
process of the axis
� Examiner’s hand are
then carefully pushed
together, causing a shear
of one bone on the other
Testing for First Rib Hypomobility of the 1st First Test (+) asymmetry; pain
Mobility rib � Patient in supine while
Tightness of the scalene fully supported
mm on the same side � Examiner palpates the
1st rib bilaterally lateral to
T1 and places his/her
fingers along the path of
the patient’s
ribs just posterior to the
clavicles
� While palpating the
ribs, the examiner notes
the movement of both 1st
ribs as the patient takes a
deep breath in
and out, and any
asymmetry is noted
� Examiner palpates one
1st rib, and side flexes the
head to the OPP. side
until the rib is felt to
move up. The range
of neck side flexion is
noted.

31
 � The side flexion is then
repeated to the opposite
side, and results from the
two sides are compared
Second Test
� Patient in prone
� Examiner palpates the
1st rib
� Using the thumb,
reinforced by the other
thumb, the examiner
pushes the rib caudally,
noting the amount of
movement, end feel, and
presence of pain
� Other 1st rib is tested in
a similar fashion, and the
two sides are compared
Slump Test (Sitting Impingement of the dura � Patient sits on the (+) sciatic pain;
Dural Stretch Test) and spinal cord or nerve examining table and is reproduction of
roots asked to “slump” so that patient’s symptoms
the spine flexes and the
shoulders sag
forward while the
examiner holds the chin
and head erect
� Patient is asked If any
symptoms are produced
� If no symptoms:
examiner flexes the
patient’s neck and holds
the head down and
shoulders slumped to see
if
symptoms are produced
� If no symptoms:
examiner passively
extends one of the
patient’s knees to see if
any symptoms are
produced
� If no symptoms:
examiner passively
DORSIFLEXES the foot of
the same leg to see if
symptoms are produced
� The process is
repeated with the other
leg

32
 Passive T1 or T2 � Patient is prone while the examiner passively approximates (+) pain in
Scapular nerve root the scapula by lifting the shoulders up and back the
Approximatio problem scapular
n area
First Thoracic T1 nerve � Patient abducts the arm to 90° and FLEX the pronated (+) pain
Nerve root forearm to 90°. No symptom should appear in this into the
Root Stretch position scapular
� Patient then fully flexes elbow, putting the hand behind area or
the neck arm
SLR Test Disc � Patient in supine position, the hip is IR and ADD and the knee (+) pain in
(Lasegue’s herniation EXT the back or
Test) � Examiner FLEX the hip until the patient complains of pain or back of the
tightness in the back or back of the leg leg

Nachlas Test L2 or L3 � Patient in prone position (+)

(Prone nerve root � Examiner passively FLEX the knee as far as possible so unilateral
Knee lesion that the patient’s heel rests against the buttock neurologic
Bending) � At the same time, the examiner should ensure that the al pain in
patient’s hip is not rotated the lumbar
� If the examiner is unable to flex the patient’s knee past area,
90° because of a pathological condition of the hip, the buttock, or
test may be performed by passive extension of the hip
posterior
while the knee is flexed as much as possible
thigh
Brudzinski- Meningeal � Patient is supine with hands cupped behind the head (+) pain
Kernig Test irritation, � Patient is instructed to FLEX the head onto the chest disappears
nerve root � Patient raises the extended leg actively by flexing the hip upon knee
involvemen until pain is felt flexion
t, � Patient then flexes the knee
or dural
irritation

Femoral L3 or L4 � Patient lies on the unaffected with the unaffected limb (+)
Nerve nerve root flexed slightly at the hip and knee neurologic
Traction problem � Patient’s back should be straight, not hyperextended. al pain
Test Patient’s head should be slightly flexed radiates
� Examiner grasps the patient’s affected or painful limb and down the
EXT the knee while gently extending the hip anterior
approximately 15° thigh
� Patient’s knee is then FLEX on the affected side

Bowstring Tension or � Examiner carries out a SLR test, and pain results (+) painful
Test (Cram pressure on � While maintaining the thigh in the same position, the radicular
Test or the sciatic examiner FLEX the knee slightly (20°), reducing the symptoms
Popliteal nerve symptoms
Pressure � Thumb or finger pressure is then applied to the popliteal
Sign) area

33
 Compression Test Disc herniation � Patient is supine with (+) radicular pain into the
the hips and knees FLEX posterior leg
� The hips are flexed
until the PSISs start to
move backward (usually
about 100° hip flexion)
� Examiner applies direct
pressure against the
patient’s feet or buttocks
applying axial
compression to the spine

Gluteal Skyline Test Damage to the inferior � Patient is relaxed in a (+) affected side show
gluteal nerve or pressure prone position with the less
on the L5, S1, or S2 head straight and arms by contraction or may be
nerve roots the sides atonic and
� Examiner stands at the remain flat
patient’s feet and
observes the buttocks
from the level of the
buttocks. The affected G.
Max appears flat as a
result of atrophy
� Patient is asked to
contract the gluteal
muscles

Yeoman’s Test Joint dysfunction � Patient lies prone (+) pain in the lumbar
� Examiner stabilizes the spine
symptoms on the pelvis and EXT each of the during both parts of the
affected side patient’s hip in turn with test
the knees EXT
� Examiner then EXT
each of the patient’s legs
in turn with the knee
FLEX

Milgram’s Test Joint dysfunction � Patient in supine and (+) limbs or affected limb
actively lifts both legs cannot
simultaneously off the be held for 30 secs or if
examining table 5 to 10 symtoms
cm (2-4 inches), are reproduced in the
holding this position for affected
30 seconds limb

McKenzie’s Side Joint dysfunction � Patient stands with the (+) increased neurological
Glide examiner standing to one
Test side
� Examiner grasps the
patient’s pelvis with both
hands and places a
shoulder against the
patient’s lower thorax

34
 � Using the shoulder as a
block, the examiner pulls
the pelvis towards the
examiner’s body
� Position is held for 10-
15 secs, and then the test
is repeated on the
opposite side
*If the patient has
evident scoliosis, the
side to which the
scoliosis curves should
be tested first

Beevor’s Sign Pathology in the � Patient lies in supine
abdominal muscles � Patient FLEX the head
against resistance,
coughs, or attempts to sit
up with the hands resting
behind the head
(+) the umbilicus does not
remain
in a straight line when the
abdominals contract

Hoover’s Test Malingering � Patient in supine (+) patient does not lift
� Examiner places one the leg or
hand under each the examiner does not
calcaneus while the feel
patient’s legs remain pressure under the
relaxed on the examining opposite heel
table
� Patient is then asked to
lift one leg off the table,
keeping the knees
straight

Burns Test Malingering � Patient is asked to (+) patient is unable to

kneel on a chair and then perform
bend forward to touch the test or the patient
the floor with the fingers overbalances

Sign of the Buttock Pathology in the buttock � Patient is supine (+) hip flexion does not
behind the hip joint, � Examiner performs a increase
such as bursitis, tumor, passive unilateral SLR when the knee is flexed
or abscess � If there is unilateral
restriction, the examiner
then FLEX the knee to see
whether hip flexion
increases

35
 LE
Nelaton’s Line Dislocated hip or coxa � Patient In supine with (+) greater trochanter is
vara knees extended palpated well above the
� Examiner draws an line
imaginary line from the
ischial tuberosity of the
pelvis to the ASIS of the
pelvis on the same side
� Palpate for greater
trochanter of femur

Bryant’s Triangle Coxa vara or CDH � Patient in supine (+) differences in

position measurement
� Examiner drops an
imaginary perpendicular
line from the ASIS of the
pelvis to the examining
table. A second
imaginary line is
projected up from the tip
of the greater trochanter
of the femur to meet the
first line at a right
angle.
� Line is measured, and
the two sides are
compared.

True Leg Length Leg length � Patient in supine and (-) slight difference (1-1.5
discrepancy legs should be 15-20 cm cm)
(4-8 in) apart and parallel (+) difference more than
to each other 1.5
� Examiner measures cm
from the ASIS to the Weber-Barstow:
lateral or medial (+) different levels of
malleolus. malleoli
� The flat metal end of
the tape measure is
placed immediately distal
to the ASIS and pushed
up against it. The thumb
then presses the tape end
firmly against the bone,
rigidly fixing the tape
measure against the
bone. The index finger of
the other hand is placed
immediately distal to the
lateral or medial
malleolus and pushed
against it.
36
 Apparent or
Functional
Shortening
� Examiner obtains the
distance from the tip of
the xiphisternum or
umbilicus to the medial
malleolus
Weber-Barstow
Maneuver (visual
method)
� Patient in supine with
the hips and knees FLEX
� Examiner stands at the
patient’s feet and
palpates the distal aspect
of the medial malleoli
with the thumbs
� Patient then lifts the
pelvis from the examining
table and returns to the
starting position
� Examiner passively EXT
the patient’s legs and
compares the positions of
the malleoli using the
borders of the thumbs
Adduction Test for length of � Patient in supine with (+) affected leg forms an
Contracture the adductor the ASISs level angle
Test muscles � Examiner can easily of less than 90° with the
. “balance” the pelvis on line
the legs. This “balancing” joining the two ASISs
implies a line joining the
ASIS is perpendicular to
the two lines formed by
the straight legs
Abduction Length of abductor � Patient in supine with (+) affected leg forms an
Contracture muscles the ASISs level angle
Test of more than 90° with a
line
joining each ASIS
Abduction Test One-plane medial � Patient is supine (+) tibia moves away from
(Valgus instability � The knee is first in full the
Stress) EXT, and then it is slightly femur in excessive
FLEX (20° to 30°) so that it amount
is unlocked
� Resting the test thigh
on the examining table
enables the patient to
relax more and easier for
the examiner
� The knee rests on the
edge of the table; the
lower leg is controlled by
the examiner’s stabilizing
the thigh on the table,

37
 and the lower leg is ABD,
applying a VALGUS stress
to the knee
Hughston’s Valgus
Stress Test
� Patient is positioned as
above
� Examiner faces the
patient’s foot, placing his
body against the patient’s
thigh to help stabilize the
upper leg in
combination with one
hand, which can also
palpate for the joint line
� With the other hand,
the examiner grasps the
patient’s big toe and
applies a VALGUS stress,
allowing any natural
rotation of the tibia

Adduction Test One-plane lateral � Patient in supine (+) tibia moves away from
(Varus instability � The knee is first in full the
Stress) EXT, and then it is slightly
FLEX (20° to 30°)
� The knee rests on the
edge of the table; the
lower leg is controlled by
the examiner’s stabilizing
the thigh on the table,
and the lower leg is ADD,
applying a VARUS stress
to the knee

“Bounce Home” Test Meniscus lesions � Patient in supine and
the heel of the patient’s
foot is cupped in the
examiner’s hand
� Patient’s knee is
completely FLEX, and the
knee is passively allowed
to EXT
O’Donohue’s Test Capsular irritation � If patient experiences
or meniscus tear pain along the joint line,
the patient is asked to lie
in the supine position
� Examiner FLEX knee to
90°, IR and ER twice, and
then fully FLEX and
rotates it both ways again
(+) extension is not
complete
or has a rubbery end feel
(+) sharp pain on the joint
line
which may radiate up or
down the leg upon
extending the knee
quickly in one movement
or jerk
(+) increased pain in
rotation in
either or both positions

38
 Test for Retreating or Meniscus tear � Patient sits on the edge (+) meniscus does not
Retracting Meniscus of the examining table or appear
lies in supine with knees
flexed to 90°
� Examiner places one
finger over the joint line
of the patient’s knee
anterior to the MCL,
where the curved margin
of the
medial femoral condyle
approaches the tibial
tuberosity
� The patient’s leg and
foot are then passively
ER, and the meniscus
normally disappears
� The leg is IR and ER
several times, with the
meniscus appearing and
disappearing. The knee
must be flexed and the
muscles relaxed to do the
test

Brush, Stroke, or Minimal effusion � Examiner commences (+) 4 – 8 mL of extra fluid

Bulge just below the joint line within the knee
Test on the medial side of the
patella, stroking
proximally towards the
patient’s hip as far as the
suprapatellar pouch two
or three times with the
palm and fingers.
� With the opposite
hand, the examiner
strokes down the lateral
side of the patella.
� The wave of fluid may
take up to 2 seconds to
appear

Fluctuation Test Effusion � Examiner places the (+) fluctuating synovial

palm of one hand over fluid
the suprapatellar pouch
and the palm of the other
hand anterior to the joint
with the thumb and index
finger just beyond the
margins of the patella
� By pressing down with
one hand and then the
other, the examiner may

39
 feel the synovial fluid
fluctuate under the hands
and move from one hand
to the other

Patellar Tap Test Swelling � With the patient’s knee (+) floating patella
(“Ballotable Patella”) EXT or FLEX to (“dancing
discomfort, the examiner patella” sign)
applies a slight tap or
pressure over the patella
Wilson Test Osteochondritis � Patient sits with the (+) pain upon extension,
Fairbank’s Dissecans knee flexed over the pain
examining table disappears when tibia is
� The knee is actively ER
EXT with the tibia IR
� At approximately 30°
of flexion, the pain in the
knee increases, and the
patient is asked to stop
the flexion movement
� Patient is then asked to
ER tibia and pain
disappears

Apprehension Test Dislocation of � Patient in supine (+) contraction of quads

patella position with the (+) apprehension
quadriceps muscles
relaxed and the knee
flexed to 30°
� Examiner carefully and
slowly pushes the patella
laterally
� If the patient feels the
patella is going to
dislocate, the patient will
contract the quads to
bring the patella back
into line

Noble Compression Iliotibial Band � Patient in supine (+) severe pain over the
Test Friction Syndrome � Examiner FLEX lateral
patient’s knee to 90° femoral condyle at
accompanied by hip approximately 30° of
flexion flexion
� Pressure is applied to
the lateral femoral
condyle, or 1-2 cm
proximal to it, with the
thumb.
� While the pressure is
maintained, the patient’s
knee is passively EXT

Kleiger Test (External Syndesmosis injury � Patient is seated with (+) pain produced over
Rotation Stress Test) and deltoid the leg hanging over the ATAFI
ligament tear

40
 examining table with the or POTAFI and
knee at 90° interosseus
� Examiner stabilizes the membrane =
leg with one hand syndesmosis
� With the other hand, injury
examiner holds the foot (+) pain produced
in plantigrade (90°) and medially;
applies a passive ER talus displaced from the
stress to the foot and medial
ankle malleolus = deltoid
ligament
tear

Homan’s Sign DVT � Patient’s foot is (+) pain in the calf

passively DF with the (+) tenderness upon
knee EXT palpation
(+) pallor and swelling in
the
leg
(+) loss of dorsalis pedis
pulse

UE
Load and Shift Test Atraumatic instability of � Pt sits with no back (+) Pain and
(Ant and Post the GH joint support, test arm on apprehension
Instability) thigh. Sitting in a properly Ant: >25% ant. translation
aligned posture. Can also Post: >50% post.
be done in translation
supine (pt’s arm is 45-600
scaption)
� Examiner stands
behind the pt. Stabilizes
the shoulder with one
hand over the clavicle
and scapula.
� The other hand grasps
the head of the humerus
(thumb) on the posterior,
and (fingers) on the
anterior.
� If the fingers “dip in”
anteriorly as they move
medially, but the thumb
does not, it indicates the
humeral
head is sitting anteriorly.
� “Load” portion of the
test means that the
humeral head should
align with the glenoid
cavity (normal or
standard position).

41
 � “Shift” portion is the
translation of the head
Ant or Post.
� Anterior instability:
Anteroinferior
translation and External
Rotation
� Posterior instability:
Posterior translation
and Internal Rotation

Rowe Test Ant. Instability � Pt lies supine and (+) look of apprehension
places the hand behind or pain
the head
� Examiner places one
hand (clenched fist)
against the posterior
humeral head and pushes
up while
extending the arm slightly

Andrew’s Ant. Ant. Instability Test � Pt in supine with (+) reproduction of pt’s
Instability shoulder ABD 1300 and ER symptoms
900 If (+) clunk = ant. labral
� Examiner stabilizes the tear may be present
elbow and distal humerus
with one hand and uses
the other hand to grasp
the
humeral head and lift it
forward

Protzman Test for Ant. Instability � Pt in sitting (+) movement causes

Ant. Instability � Examiner ABD pt’s arm pain and if palpation
to 900 and supports arm indicates abnormal
against the examiner’s anteroinferior
hip so that the pt’s movement
shoulder mm
are relaxed
� Examiner palpates the
anterior aspect of the
head of the humerus with
the fingers of one hand
deep in
the pt’s axilla while the
fingers of the other hand
are placed over the
posterior aspect of the
humeral
head
� Examiner pushes the
humeral head anteriorly
and inferiorly

Push-Pull Test Posterior shoulder � Pt lies in supine (+) more than 50%
instability or dislocation posterior translation

42
 � Examiner holds pt’s occurs or if pt becomes
arm at the wrist, ABD the apprehensive or
arm at 90 o, and FLEX at pain results
30 o
� Examiner places the
other hand over the
humerus close to the
humeral head
� Examiner then pulls up
on the arm at the wrist
while pushing down on
the humerus with the
other hand

Miniaci Test Posterior subluxation � Pt lies in supine with (+) clunk and the
the shoulder off the edge humerus relocates
of the examining table
� Examiner uses one
hand to FLEX (70 o -90 o),
ADD, and IR the arm
while pushing the
humerus posteriorly
� With the other hand,
the examiner palpates
the anterior and posterior
shoulder
� Examiner then ABD
and ER the arm

Circumduction Test Posterior instability � Pt standing (+) humeral head will be

� Examiner stands felt to sublux
behind the pt grasping posteriorly
the pt’s forearm with the
hand
� Examiner begins
circumduction by EXT the
pt’s arm while
maintaining slight ABD
� As the circumduction
continues into elevation,
the arm is brought over
the top and into the FLEX
and
ABD position

Rowe Test Multidirectional � Pt stands forward Anterior instability:

Instability flexed 45 o at the waist humeral head is pushed
with the arms relaxed anteriorly with the thumb
and pointing at the floor while the arm is
� Examiner places one EXT 20-30 o from vertical
hand over the shoulder position
so that the index and Posterior instability:
middle fingers sit over humeral head is pushed
the anterior posteriorly with the index
aspect of the humeral and middle
head and the thumb sits

43
 over the posterior aspect fingers while the arm is
of the humeral head FLEX 20-30 o from
� Examiner then pulls the vertical position
the arm down slightly

Yocum’s Test Secondary impingement � Pt asked to place the (+) pain

hand on the opposite
shoulder and then
elevate elbow
Posterior Internal Common on overhead � Pt in supine, examiner (+) localized pain on
Impingement Test athletes passively abducts the posterior aspect of
(affects rotator cuff shoulder (900), with 15- shoulder
muscles) 200 forward flexion and
maximum
ER.

Active Compression SLAP Type II or superior � 1st part: Pt in standing (+) Pain on 1st part is
Test of O’Brien labral lesions with arm FLEX to 900, and decreased or
(SLAP) elbow fully EXT. Arm is eliminated on the 2nd part
horizontally adducted 10-
15o
(starting position) and IR.
Examiner stands behind
the pt and applies a
downward eccentric
force to the
arm.
� 2nd part: Arm is in
starting position and
supinated, force is
applied again.

Kim Test Posteroinferior labral � Pt sits with the back (+) sudden onset of
lesion supported posterior shoulder pain
� Arm is ABD to 90o with and click
the elbow supported in
90o FLEX
� Examiner’s hand, while
supporting the elbow and
forearm, applies an axial
compression force to the
glenoid through the
humerus
� While maintaining the
axial compression force,
the arm is elevated
diagonally upward using
the same
hand while the other
hand applies a downward
and backward force to
the proximal arm

Biceps Tension Test SLAP Lesion � Pt in standing, scapula (+) reproduction of pain
(SLAP) stabilized, ABD and ER or patient’s
the arm to 900, elbow EXT symptoms

44
 and forearm SUP.
Eccentric
adduction to the arm is
applied.

Lateral Scapular Slide To know stability of � Examiner measures (+) if the difference of the
Test scapula during shoulder distance: distance
movement - Base of the spine of measured from the
scapula to spinous original measure is > 1-
process of T2/T3, OR 1.5 cm or 0.5-0.75 inches
- Inferior angle of scapula
to the spinous process of
T7/T8/T9
- T2 to Superior angle of
scapula
� Tested in two to four
positions:
- Hands on waist (450
ABD)
- 900 ABD with IR
- 1200 ABD
- 1500 ABD

Wall Push-Up Test Identify Scapular Winging � Pt stands arm length
from a wall. Pt is asked to
do wall push-up 15-20x.
� Floor push-ups can be
done by stronger and
younger patients.
Winging of scapula or
weakness of scapular
muscles usually shows up
with 5-10
pushups.

Scapular Retraction � Pt in standing position, If scapular retraction

Test examiner standing behind decreases the pain, it
places fingers of one indicates that the weak
hand over the clavicle scapular stabilizers
with the must be addressed in the
heel of the hand over the treatment
spine of the scapula to
stabilize the clavicle and
scapula and to hold the
scapula
retracted. The other hand
compresses the scapula
against the chest wall

Acromioclavicular AC joint pathology � Pt in sitting (+) abnormal movement

Shear Test � Examiner cups his hand at the AC joint
over the deltoid muscle,
with one hand on the
clavicle and one hand on
the spine
of the scapula
� Examiner squeezes the
heels of the hands
together

45
 Acromioclavicular AC joint pathology � Pt stands and reaches (+) pt feels localized pain
Crossover, the hand across to the over the AC jt
Crossbody, opposite shoulder
or Horizontal � Examiner may also
Adduction Test passively perform the test

Ellman’s GH arthritis � Pt lies on the (+) symptoms reproduced

Compression unaffected side
Rotation Test � Examiner compresses
the humeral head into
the glenoid while the pt
rotates the shoulder
medially and
laterally
Yergason’s Test Check the ability of the � Pt standing, arm ADD, (+) popping out of the
transverse humeral elbow FLEX to 900, and transverse humeral
ligament to hold the PRON. Examiner resists ligament
biceps tendon in the SUP of the pt’s forearm
bicipital groove while the
pt also ER the arm against
resistance.
Lift-off Sign Lesion of the � Pt stands and places (+) inability to lift hand
subscapularis muscle the dorsum of hand on
the back pocket or
against the midlumbar
spine
� Pt then lifts the hand
away from the back
Ludington’s Test Long Head of Biceps � Pt clasps both hand on (+) no movement of the
Tendon rupture top/behind of their head, biceps tendon
and fingers interlocked.
� Pt then alternately
contracts and relaxes the
biceps muscles, while the
examiner palpates the
biceps
tendon
Gilchrest’s Sign Bicipital paratenonitis or � While standing, pt lifts (+) discomfort or pain in
tendinosis a 2-3 kg weight over the the bicipital groove
head
� Arm is ER fully and
lowered to the side in the
coronal plane

Lippman’s Test Bicipital paratenonitis or � Pt sits or stands while (+) sharp pain
tendinosis the examiner holds the
arm flexed to 90o with
one hand
� With the other hand,
the examiner palpates
the biceps tendon 7-8 cm
below the GH joint and
moves the

46
 biceps tendon from side
to side in the bicipital
groove
Heuter’s Sign Distal biceps tendon � If elbow flexion is (+) supination
rupture resisted when the arm is
pronated, some
supination occurs as the
biceps attempts to
help the brachialis mm
flex the elbow.

Abdominal Subscapularis tear � Pt in standing (+) unable to maintain

Compression Test � Examiner places hand the pressure on the
(Belly-Press / on the abdomen so that examiner’s hand while
Napoleon Test) the examiner can feel doing IR
how much pressure the
pt is
applying to the abdomen
� Pt places his hand of
the shoulder being tested
on the examiner’s hand
and pushes the hand as
hard as
he can into the stomach
(IR)
� While pushing the
hand into the abdomen,
pt attempts to bring the
elbow forward to the
scapular plane
Lag or “spring back For Infraspinatus and � Pt is seated or in (+) pt cannot hold the
sign” Test Teres Minor tears standing with arm by the position, hand springs
side and elbow FLEX to back
900.
� Examiner passively
ABD the arm to 90o and
ER the shoulder, asks the
pt to hold it.

*Trapezius Weakness For Trapezius tears or � Pt sits down and places (+) weakness and lateral
weakness the hands together over flexion (weak upper
the head; examiner fibers)
stands behind and pushes (+) scapular protraction
the elbow (weak middle and
forward. lower fibers)
� Upper Fibers: shoulder
elevated, arm 900
abducted or to resisted
shoulder abduction and
head side
flexion (opposite side).
Resistance applied
downward.
� Middle and Lower
Fibers: Arm abducted to
90o (1200 for the Lower
47
 fibers) and laterally
rotated.
Downward force applied
on the shoulder. For
Lower Fibers: 1200.
Serratus Anterior For Serratus Anterior � Pt in standing position (+) weak, scapular
Weakness weakness or tear and forward flexes the winging
arm to 900.
� Examiner will apply a
backward force to the
arm (pushing the hands
backward)
Pectoralis Major P.major contracture and � Pt supine, clasps hand (+) if the elbow do not
Contracture Test tightness together behind the reach the table
head. Arms are then
lowered until the elbows
touch the
examining table.
Pectoralis Minor P. Minor Tightness and � Pt supine, examiner (+) increase scapular
Tightness Test Contracture places the hand at the protraction, tilting of
coracoids process and the inferior angle of the
pushes it downward on scapula
the examining
table.

Valgus Stress Test Test for MCL instability � Palpate the medial (+) reproduction of pain
MCL epicondyle, apply ABD or at the medial epicondyle,
valgus force at the distal laxity of
forearm. Test is done
while the humerus is in
ER. Stabilize the elbow
using one hand, other
hand above the wrist.

Varus StressTest Test for LCL instability � Palpate the lateral
epicondyle, apply ADD or
varus force at the distal
forearm. Pt elbow
slightly FLEX (20-300), test
is done while the
humerus is in full IR.
Milking Manoeuver Partial tear of the MCL � Pt sits with the elbow
FLEX to 900 or more and
the forearm SUP
Stand Up Test Injury to the posterior � Pt seated in a chair
band of the MCL without arms
� Pt asked to push up on
the seat with his hand
with the forearms SUP
into standing
Tinel’s Sign Test for neurological � The area of the ulnar
dysfunction at the elbow nerve in the groove
(ulnar nerve (between olecranon
regeneration) process and medial
epicondyle) is tapped.
48
(+) reproduction of pain
at the lateral epicondyle,
laxity of
LCL
(+) reproduction of
symptoms
(+) reproduction of
symptoms
(+) tingling sensation in
the ulnar distribution of
theforearm and hand
distal to the point of
compression of
the nerve
 Pinch Grip Test (Ok Test for entrapment of � Pt is asked to pinch the (+) pt wasn’t able to
Sign/Kilo Nevin Sign) anterior interosseous tips of the index finger perform tip-to-tip pinch,
branch of median nerve and thumb together. instead has
(FPL) an abnormal pulp-to-pulp
pinch

Elbow Flexion Test Cubital tunnel (ulnar � Pt is asked to fully flex (+) tingling or parasthesia
. nerve) syndrome the elbow with extension in the ulnar nerve
of the wrist and shoulder distribution
girdle abduction
and depression and hold
the position for 3-5 mins
Wartenberg’s Test Ulnar neuropathy � Pt sits with his or her (+) inability of the little
hands resting on the finger to be adducted
table. Examiner passively
spreads the fingers
apart and asks the pt to
bring them together
again.
Test for Pronator Test for Pronator Teres � Pt sits with elbow FLEX (+) tingling or parasthesia
Teres Syndrome Syndrome at 900. Examiner resist in the median nerve
pronation as the elbow is distribution in the
extended. forearm and hand
Allen’s Test Patency of radial and � Pt is asked to open and (+) if palm flushes more
ulnar arteries close the hand several than 5 seconds
For circulation and times as quickly as
swelling possible and then
squeeze the hand tightly,
examiner’s thumb and
index finger are placed
over the radial and
ulnar nerve, compressing
it.
� Pt opens hand while
pressure is maintained
over the arteries. One
artery is tested while
releasing the pressure
over the artery. Both
hands should be tested.

Finkelstein’s Test To determine the � Pt makes a fist with the (+) pain in the anatomic
presence of de thumb inside the fingers. snuffbox (APL and EPB)
Quervain’s or Hoffman’s Examiner stabilizes the
forearm and ulnar
deviates the wrist.
Bunnel-Littler Test Tests the structure � 1st part: MCP extended Able to flex: intrinsic mm
(Finocchieto-Bunnel) around the MCP joint and PIP flexed is tight
(this test is done Unable: (+) tight intrinsic Unable to flex: joint
passively) muscle and contracture capsule is tight
of joint
capsule
� 2nd part: MCP flexed
and PIP flexed

49
 Retinacular Test Test for tight retinacular � 1st part: PIP extended Able to flex: retinacular
(Haines-Zancolli Test) ligaments and structures and DIP flexed ligaments are tight
around the PIP joint Unable: retinacular Unable to flex: PIP joint
ligaments and proximal capsule is tight
interphalangeal capsule
are tight
� 2nd part: PIP and DIP
flexed

Tinel’s Sign Carpal Tunnel Syndrome � Examiner taps over the
DIP, carpal tunnel at the
wrist, mid forearm and
over the pronator
teres.
Murphy Sign Lunate Dislocation � Pt is asked to make a
fist.
(+) 9aresthesia into the
thumb, index finger, and
middle
and lateral half of the ring
finger. *the tingling must
be
felt distal to the point of
pressure.
(+) if the head of the 3rd
metacarpal is level with
the 2nd
and 4th metacarpals.

Lunotriquetral To determine the � The examiner grasps (+) laxity, crepitus, or pain
integrity of the the triquetrum between
lunotriquetral ligament the thumb and the
second finger of one
hand, and the lunate with
the thumb and second
finger of the other hand.
Examiner then
moves the lunate up and
down (anteriorly and
posteriorly)

Ballottement Test Ulnar collateral ligament � Pt sits while the Valgus movement > 30-
(Reagan’s Test) laxity or instability examiner stabilizes the 350 (complete tear); < 30-
Collateral Ligament Gamekeeper’s or skier’s pt’s hand with one hand 300
Test thumb and takes the pt’s thumb (partially torn)
into extension with the
other hand. While
holding the thumb into
extension, valgus stress is
applied on the MCP joint
of the thumb
Sweater Finger Sign To determine if the � Pt is asked to make a (+) if one of the fingers
tendon of FDP is ruptures fist. does not flex (usually the
4th finger)

Wrinkle (Shrivel) Test Palsy or neuropathy of � The pt’s fingers are (-) if the fingers show
digital nerve placed/ soaked in warm wrinkling.
water for approximately
5-20 mins. *this test is
valid only few months
after injury.

50
 Piano Keys Test Instability of the DRU jt � Pt sits with both arms (+) pain and/or
in PRON tenderness and
� Examiner stabilizes the difference in mobility
pt’s arm with one hand so
that the examiner’s index
fingers can
push down on the distal
ulna
� Examiner’s other hand
supports the pt’s hand
� Examiner pushes down
on the distal ulna as one
would push down on a
piano key
� Results are compared
with the nonsymptomatic
side

Supination Lift Test Dorsal TFCC tear � Pt seated with elbows (+) localized pain on the
FLEX to 900 and forearms ulnar side of the wrist
SUP and
� Pt is asked to place difficulty applying the
palms flat on the force
underside of a heavy
table (or flat against
examiner’s
hands)
� Pt is then asked to lift
the table (or push up
against the resisting
examiner’s hands)

TFCC Load Test TFCC integrity � Examiner holds the pt’s (+) pain, clicking, or
forearm with one hand crepitus in the area of the
and the pt’s hand with TFCC
the other hand
� Examiner then axially
loads and ulnarly deviates
the wrist while moving it
dorsally and
palmarly or by rotating
the forearm
Thumb Grind Test DJD in the MCP or � Examiner holds the pt’s (+) pain
Linscheid Test metacarpotrapezial jt hand with one hand and
Ligamentous instability grasps the pt’s thumb
of the 2nd and 3rd CMC jts below the MCP jt
� Examiner supports the with the other hand
metacarpal shafts with � Examiner then applies
one hand axial compression and
� With the other hand, rotation to the MCP jt
the examiner pushes the
metacarpal heads
dorsally, then palmarly
(+) pain localized to the
CMC jts

51
 Finger Extension Radiocarpal or midcarpal � Pt in sitting (+) pain
(Shuck Test) instability � Examiner holds the pt’s
Inflammation wrist FLEX and asks the pt
Scaphoid instability to actively EXT the fingers
Kienbock’s disease against
resistance

Lichtman Test Midcarpal instability � Pt’s forearm is PRON
with the hand held in
support by the examiner
� Examiner moves the
pt’s hand from radial to
ulnar deviation while
axially compressing the
carpus into the radius
(+) if the distal carpal row
jumps or snaps dorsally
(from
its subluxed position
palmarly)

Ninhydrin Sweat Test Nerve lesion � Pt’s hand is cleansed (+) absence of purple
with alcohol stain
� Pt waits for 5-30 mins
with the fingertips not in
contact with any surface
� Fingertips are then
pressed with moderate
pressure against a good
quality bond paper that
has not been touched (15
secs) then traced with a
pencil
� Paper is sprayed with
Ninhydrin and allowed to
dry for 24 hrs

52
 EXERCISES

MFE
- Herniated Disk
- OA*
- Ankylosing spondylitis
- Protrusion
WFE
- Spondylosis
- Spondylolisthesis
- DJD

53
Rood’s Principle (For stroke)

54
Bobath (Neurodevelopmental Technique) – For stroke

55
Brunnstrom( For stroke)

56
57
58
59
 PJM

UPPER EXTREMITY
SHOULDER (GLENOHUMERAL JOINT)
Caudal Glide- Abduction
Posterior Glide- FIR (Flexion and IR)
Anterior Glide- EXER (Extension and ER)
Posterior Glide Progression- Horizontal Adduction

ELBOW (HUMEROULNAR JT)

Distal Glide (Scoop Motion)-Flexion
Radial Glide- VaRus
Ulnar Glide- Valgus

HUMERORADIAL JT.
Dorsal(Posterior) Glide- Extension
Volar(Anterior) Glide- Flexion
PRU JT.
Posterior Glide- Pronation
(*PPP)
Anterior Glide- Supination
DRU JT.

60
 Posterior Glide- Supination
Anterior Glide- Pronation

WRIST (RADIOCARPAL JT.)

Posterior Glide- Flexion
Anterior Glide- Extension
Radial Glide- Ulnar Deviation
Ulnar Glide- Radial Deviation

CMC of the THUMB

Ulnar Glide- Flexion
Radial Glide- Extension
Posterior Glide- Abduction
Anterior Glide- Adduction
MCP and IP
Anterior Glide- Flexion
Posterior Glide- Extension
Radial or ulnar- Abduction or Adduction

LOWER EXTREMITY
HIP (ACETABULOFEMORAL JT.)
Posterior Glide- FIR
Anterior Glide- EXER

KNEE (TIBIOFEMORAL JT.)

Posterior Glide- Flexion
Anterior Glide- Extension

PATELLOFEMORAL JT.
Distal Glide- Increase Patellar mobility for knee
flexion
Medial-lateral Glide- Increase Patellar mobility

ANKLE (TALOCRURAL JT.)

Posterior Glide- Dorsiflexion
Anterior Glide- Plantarflexion

SUBTALAR JT.
Medial Glide- Eversion
Lateral Glide- Inversion

61
 Physical Agents
Electrical Stimulation
Pulse Rate Pulse Width Time
B- Burst(ES) Between2- 200 10-15 mins.
10 (For
muscle)
N- 150 (For 100 20-30 mins.
Normal(TENS) pain)
M- Between 300 10 mins.
Modulation(FES) 2-10 (w/
exercise)
Contraindications:
- Demand cardiac pacemaker, implantable cardiac defibrillator (ICD) or unstable
arrhythmias
- Placement of electrodes over carotid sinus
- Areas where venous or arterial thrombosis or thrombophlebitis is present
- Pregnancy
- When contraction of the muscle may disrupt healing
-
Laser and Light
Contraindications:
- Direct irradiation of the eyes
- Malignancy
- Within 4 to 6 months after radiotherapy
- Over hemorrhaging regions
- Over the thyroid or other endocrine glands
Precaution:
- Low back or abdomen during pregnancy
- Epiphyseal plates in children
- Impaired sensation
- Impaired mentation
- Photophobia, or abnormally high sensitivity to light
- Pretreatment with one or more photosensitizers

Ultraviolet Radiation
Contraindications:
- Irradiation of the eyes
- Skin cancer
- Pulmonary tuberculosis
- Cardiac, kidney, or liver disease
- Systemic lupus erythematous
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 - Fever
Precautions:
- Photosensitizing medication and dietary supplements
- Photosensitivity
- Recent x- ray therapy

Traction
Contraindication:
- When motion is contraindicated
- Acute injury or inflammation
- Joint hypermobility or instability
- Peripheralization of symptoms with traction
- Uncontrolled hypertension
Precautions:
- Structural diseases or conditions affecting the tissues in the area being treated
- When pressure of the belts may be hazardous
- Displaced annular fragment
- Medial disc protrusion
- When severe pain fully resolves with traction
- Claustrophobia or other psychological aversion to traction
- Inability to tolerate prone or supine position
- Disorientation

Intermittent or Sequential Compression Pumps

Contraindications:
- Heart failure or pulmonary edema
- Recent or acute DVT, thrombophlebitis or pulmonary embolism
- Obstructed lymphatic or venous return
- Severe peripheral arterial disease
- Acute local skin infection( cellulitis)
- Significant hypoproteinemi ( protein levels <2 g/dL)
- Acute trauma or fracture
- Arterial revascularization
Precautions:
- Impaired sensation or mentation
- Uncontrolled hypertension
- Cancer
- Superficial peripheral nerves

Cryotherapy
Contraindications:
- Cold hypersensitivity

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 - Cold intolerance
- Cryoglobulinemia
- Paroxysmal cold hemoglobinuria
- Raynaud disease or phenomenon
- Over regenerating peripheral nerves
- Over an area with circulator compromise or peripheral vascular disease
Precautions:
- Over the superficial main branch of nerve
- Over an open wound
- Hypertension
- Poor sensation or mentation
- Very young and very old patients

Thermotherapy
Contraindications:
- Recent or potential hemorrhage
- Thrombophlebitis
- Impaired sensation
- Impaired mentation
- Malignant tumor
Precautions:
- Acute injury or inflammation
- Pregnancy
- Impaired circulation
- Poor thermal regulation
- Edema
- Cardiac insufficiency
- Metal in the area
- Over an open wound
- Over areas where topical counter irritants have recently applied
- Demyelinated nerves

Ultrasound
Contraindications:
- Malignant tumor
- Pregnancy
- CNS tissue
- Joint cement
- Plastic components
- Pacemaker or implantable cardiac rhythm device
- Thrombophlebitis
- Eyes
- Reproductive organ
Precautions:
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 - Acute inflammation
- Epiphyseal plates
- Fractures
- Breast implants

Other Information
Myotomes
C4- Shoulder Shrugs/elevation
C5- Shoulder abduction
C6- Elbow flexion
C7- Wrist flexion
C8- resisted thumb extension
T1- Fingers abduction and adduction

L1-L2- Hip flexion

L3- Knee extension
L4- Foot Dorsiflexion
L5- Great toe extension
S1/S2- Plantar flexion

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  SO4 LR6 O3

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Examination and Type of Movement
1. Head Shaking Induced Nystagmus
a. Eyes closed
b. Neck flexion
c. Oscillate with head horizontally (2 cycles)
d. Open eyes
e. Check nystagmus
(+) Nystagmus= UVH
2. Dix Hallpike Test
a. Long sitting
b. Rotate head to one side
c. Supine
d. Neck flexion
e. Check nystagmus
(+) Nystagmus= BPPV
Aphasias Naming Comprehension Fluency Repetition Reading Writing Lesions
Comprehension
Anomia Poor Good Good Good Good Good Angular gyrus
Conduction Poor Good Good Poor Good Poor Supramarginal
Arcuate
Fascilicus
Total Motor Poor Good Poor Good Good N/A Medial
Frontal
Border Zone
Broca’s Poor Good Poor Poor Good Poor
Total Poor Poor Good Good Good Poor Medial
Sensory Parietal
Border Zone
Wernicke’s Poor Poor Good Poor Poor
Isolation of Poor Poor Poor Good N/A N/A
language
Global Poor Poor Poor Poor Poor Poor
Pure word Good Poor Good Poor Good Good
Deafness
Pure word Poor Good Poor Poor Good Good Heschl's gyrus
Mutism
Pure word Good Good Good Good Poor Good Alexia’s
Blindness Agraphia

Cane
Method 1: cane -> bad leg -> good leg
Method 2: Cane + bad leg -> good leg
Crutches
4pt. gait: Right crutch -> Left foot -> Left crutch -> Right foot( Bad leg first)
- Safest but slowest. Hardest to learn
- Contraindicated for patient problems with coordination

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3 pt. gait: Both crutch -> bad leg -> good leg
- Easiest to perform
2 pt. gait: Right crutch + left foot -> left crutch + right foot
- Fastest
Swing gait
Swing to gait: Both crutch -> swing both legs
- Paraplegic patient but with stable trunk
Swing through: Both crutch -> swing both legs
- Difficult to perform
- Leg swing beyond crutches
Drag to gait: Both crutch -> drag legs
- Tear of both ankle/ knees
Simultaneous gait: Right crutch + right foot -> left crutch + left foot
- Problem with coordination
- Less stable
Stair Gait
- Good ascending ( good leg- bad leg- crutch or bad leg+crutch)
- Bad descending

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