Special Tests:

What’s so
special about
them?
Prepared by: Jorell Victor S.
Angeles, PTRP
 To create a logical way of
understanding the special tests

To identify an algorithm for a

Objective for frame of thinking on how we use
this lecture special tests for the orthopedic
population.

To apply the algorithm on a

specific case of orthopedic
management.
What’s a
SPECIAL
TEST?
Special Tests

• Allows the therapist to:

• Confirm a tentative diagnosis
• Make a differential diagnosis
• Differentiate between
structures
• Understand unusual signs
• Unravel difficult signs and
symptoms
Special Tests
• Maneuvers or techniques used to
determine whether a particular type of
disease, joint or injury is present.
• A physical exam not unlike an outcome
measure that correlates internal injury
with an external sign.
• Since a Bachelor’s cannot interpret
Ancillary procedure like a Doctor of PT
can, special tests can augment physical
findings through special tests.
Special Tests: Utility
• In the absence (or at least for us the
PROHIBITION) of diagnostic imaging,
we can use physical exams in diagnosis
of musculoskeletal disease.
• In my opinion, it’s a PT’s superpower, a
unique signature that we have compared
to other professionals (not including
Rehab Med and Orthopedic Surgeons of
course)
Superpower???? How do I sign up?
• With great power comes
great responsibility…
• You need powers to be a
good diagnosing PT…
 The power of observation and palpation.

POWERS The power of understanding the mechanics of

human body, the kinetics of disorders and the

REQUIRED
structure of the body, thus ANATOMY AND
KINESIOLOGY.

The power of understanding of different diseases

and how they arise, to what population they usually
present, and how they are usually acquired, thus
Medical and Surgical Application and
Pathology.
IT’S TOO ADVANCED!
Sir wag naman po ganon…
What to do?

• MEMORIZE. 
• Yeah. I hate the M word too. 
But Memorization is not a cure all…
• You may get a perfect score in the knowledge-based exam, but when
you apply a certain test to a specific patient in the future and your
memory fails you, and trust me it will…you may not understand what
is happening to the patient.
• You need a better alternative to learning rather than just the plain old
school memorization and subsequent forgetting.
 Understand the goal of Special Test
Understand • To formulate a working pre-test probability through a physical exam of a
certain MSK disease.

Remember, or at least familiarize yourself with the diagnosis

Remember and the symptoms that may arise from it
• Clinical Prediction Rules, Pathological Correlation of History

Where do I
start?
Integrate the previous evaluation skills you have acquired
Integrate into understanding what may have caused the problem

Pick the best test, a GO-TO test, that can be applied to a

Pick specific pathology.
Suggested Algorithm
LENGTHY SLIDE AHEAD. 5
MINS OF CONCENTRATION
REQUIRED
Steps to take: A Suggested Algorithm
History Taking
Pain Ax, ROM, MMT, CLINICAL
PREDICTION
Movement Analysis
get the age, signs and RULES,
PATHOLOGY
symptoms, MOI INTEGRATION

WORKING DIAGNOSIS

Post Test Pretest

Probability PROBABLE
Probability
Formulation DIAGNOSIS
SPECIAL
TEST Formulation
LENGTHY SLIDE AHEAD. 5
MINS OF CONCENTRATION
REQUIRED
LET’S TRY: Derrick Rose
CPR for ACL tear
31 y/o Basketball Player, Knee pain, anteromedial aspect, no 1. Lachman test
ROM restrictions but feels unstable,
Fell down after a layup, ruled out muscular pathology in
LR+38.4
2. Popping sound
fell on one knee, twisted, movement analysis LR+9.8
3. Traumatic LR:+17.5
heard a pop (if with effusion and
Lachman)

t/c ACL Tear

Because of
DR’s history, ACL TEAR OR
OTHER
~80-90% Tear PT Eval: LIGAMENTOUS
Lachman Test ~60% ACL PROBLEMS

Tear
Documentation
Special Test Results Significance
SLR (+) stretch pain on the (+) possible
posterior aspect of B thighs at hamstrings tightness
around 600;
No radiculating pain was
noted
90-90 Straight Pt able to straighten the leg (+) hamstrings
leg raise up to around 500 only. tightness
Documentation
Special Tests
 (+) 90-90 Straight leg raise on BLE
 (+) Tripod sign on BLE

Interpretation: Findings suggest possible tightness of hamstring muscles of

BLE.

Significance: This may hinder the pt. when he attempts to stand since it may
be difficult to straighten (B) his knees d/t tightness.
 
Any Questions?
Diagnosis and LRs and probabilistic approach to diagnosis up next!
“…Hold every hour in your
grasp. Lay hold of today’s task,
and you will not need to depend
so much upon tomorrow’s.
While we are postponing, life
speeds by.”

--Seneca