Special Test Quick Reference John Little, SPT

Wheeling Jesuit University Cervical Spine

● Ligamentous○ Sharp Purser○ Aspinall Transverse Ligament Test○ Alar Ligament Test

● Nerve○ Spurling’s Test○ Bakody’s Sign○ Tinel Sign

● Artery Insufficiency○ Vertebral Artery Test

Shoulder● Rotator Cuff

○ Drop Arm Test ○ Empty Can○ Lift Off Test

● Labral○ Jerk Test○ Anterior Drawer ○ O'brien's Test○ Biceps Load Test ○ Clunk Test

● Bicep○ Speed’s Test○ Yergason’s Test

● Instability○ Load and Shift Test○ Sulcus Sign○ Jerk Test○ Apprehension Test ○ Labral Crank Test

● AC Joint ○ AC Shear

● Impingement

○ Hawkins-Kennedy ○ Coracoid Test ○ Neer Impingement Test

Elbow● Medial Epicondylitis

○ Golfer’s Elbow Test ● Lateral Epicondylitis

○ Mills Test○ Cozen Test○ Maudsley’s Test

Hip● Muscular Tightness

○ Thomas Test○ Ely Test○ Ober Test ○ Nobel Compression Test

● Pathology/Labral Tear○ Scour ○ FABER

Knee● ACL

○ Anterior Drawer○ Lachman Test

● PCL○ Posterior Sag/Godfrey Sign ○ Posterior Drawer ○

● MCL○ Valgus Stress Test

● LCL○ Varus Stress Test

● Meniscus ○ McMurray Test○ Thessaly Test○ Apley’s Compression ○ Bounce Home

● Patella ○ Patellar Apprehension

○ Clark’s Sign○ McConell Test

Ankle ● Ligamentous

○ Anterior Drawer ○ Talar Tilt ○ Kleiger’s Test

● Achilles Tendon○ Thompson Test

● Syndesmosis ○ Squeeze Test○ Kleiger’s Test○ Heel Thump

Special Test Explanation John Little, SPT

Wheeling Jesuit University

Cervical Spine● Ligamentous

○ Sharp Purser■ Identify subluxation of C1 on C2, which may be result from a reduction in

integrity of the transverse ligament.■ Patient sits with head and neck at neutral. Therapist stands to side of

patient placing one hand on pt’s forehead. The second hand in “golf tee” hand position of thumb and index finger located at spinous process of C2 vertebra.

■ Therapist flexes the pt’s head on the neck and applies a posteriorly directed force through the forehead as the C2 vertebra is stabilized.

■ Positive if reduction of C1 on C2 is noticed, there is a soft end feel, or patient reports symptoms including esophageal pressure and other neurological related cord compression symptoms.

○ Aspinall Transverse Ligament Test■ To test the integrity of the transverse ligament when the Sharp-Purser test

is negative.■ Patient supine with head and neck at neutral. The therapist stands at the

head of the patient with one hand at the patient’s chin to maintain head and neck flexion. The other hand is at C2.

■ The therapist flexes the head and neck. Then, an anterior force directed by the hand at C2.

■ Positive if end feel is soft or patient reports symptoms including esophageal pressure and other neurologically related cord compression symptoms.

○ Alar Ligament Test■ To test the integrity of the alar ligament.■ Patient supine with head and neck neutral. The therapist supports the

occiput with both hands while the index fingers palpate the spinous process of the axis.

■ The occiput is side bent slightly to each side.■ Positive if there is a delay in movement of the spinous process of the axis,

which rotates ipsilateral to the direction of side bending.

● Nerve○ Spurling’s Test

■ To test for the presence of a cervical radiculopathy

■ Patient sitting with neck passively positioned into extension, ipsilateral side bending, and ipsilateral rotation.

○ This is performed in neutral for the lower quadrant sign. ○ For upper quadrant sign, the patient first performs cervical

protraction using a “chin poke” maneuver designed to isolate forces to the upper cervical segments.

■ The therapist applies a gentle compression force consisting of triplanar overpressure.

■ Positive if there is a reproduction in patient’s presenting symptoms. ○ Bakody’s Sign

■ Specifically C4/C5 nerve roots ■ Patient is sitting or lying down■ Examiner passively or the patient actively elevates the arm through

abduction so that the hand or forearm rests on top of the head○ Abduction of the arm decreases the length of the neurological

pathway and decreases the pressure on the lower nerve roots■ Decrease of relief of symptoms indicated a cervical extradural

compression problem■ If pain increases with positioning of the arm, it implies that pressure

increasing in the interscalene triangle○ Tinel Sign

■ Patient sits with the neck slightly side flexed■ Examiner taps the area of the brachial plexus with a finger along the nerve

trunks in such a way that the different nerve roots are tested■ Pure local pain implies that there is an underlying cervical plexus lesion■ Tingling sensation in the distribution of a neve, means the lesion is

anatomically intact and some recovery is occurring■ If pain is elicited in the distribution of the peripheral nerve, this is positive

for a neuroma● Artery Insufficiency

○ Vertebral Artery Test■ To assess for vertebrobasilar ischemia/insufficiency.■ Patient supine with head and neck in neutral. Therapist standing at the

patient’s head supporting the occiput with one hand as the other hand provides a fulcrum at the upper cervical region.

■ The therapist first extends, then side bends and rotates the pt’s head ipsilaterally until there is max motion in each plane. The position is held for 15 to 30 seconds with eyes open as the therapist looks for presence of any signs or symptoms. Repeat on opposite side following 30 sec to 1 min rest.

■ Positive if the following signs occur: nystagmus, pupil dilation, slurred speech, diminished responsiveness, apparent distress. Positive if following

symptoms occur: dizziness, tinnitus, nausea, blurred vision, any additional unpleasant sensations.

Shoulder● Rotator Cuff

○ Drop Arm Test ■ Examiner abducts the patient’s shoulder to 90 degrees and then asks the

patient to slowly lower the arm to the side in the same arc of movement■ Positive test= patient is unable to return the arm to the side slowly or has

severe pain when attempting to do so■ indicates tear in rotator cuff complex

○ Empty Can■ Patient’s arm is abducted to 90 degrees with neutral rotation, and examiner

provides resistance to abduction■ Shoulder is then medially rotated and angled forward 30 degrees (empty

can position) so that patient’s thumb points towards floor in the plane of the scapula

■ positive test= weakness or pain■ indicates a tear of the supraspinatus tendon or muscle, or neuropathy of

suprascapular nerve○ Lift Off Test

■ Patient stands and places dorsum of hand on back pocket or against midlumbar spine. Patient then lifts hand away from back.

■ Inability to do so indicates a lesion of subscapularis muscle■ Abnormal motion in scapula may indicate scapular instability

● Labral○ Jerk Test

■ Pt sits with arm medially rotated and forward flexed to 90 degrees■ Examiner grasps patient’s elbow and axially loads humerus in proximal

direction■ While maintaining axial loading, examiner moves arm horizontally

(horizontal adduction) across the body■ + test for recurrent posterior instability is production of sudden jerk or

clunk as humeral head slides off (subluxes) the back of the glenoid■ When arm is returned to original 90 degrees abduction position, 2nd jerk

may be felt as head reduces■ Positive signs also indicate positive test for posteroinferior labral tear

○ Anterior Drawer ■ Pt supine. ■ Place pt’s hand of affected shoulder in your axilla, holding the patient’s

hand with the arm so that the patient remains relaxed.■ Shoulder to be tested is abducted b/w 80-120 degrees, forward flexed up

to 20 degrees, and laterally rotated up to 30 degrees■ Examiner then stabilizes the patient’s scapula with opposite hand, pushing

spine of scapula forward with index and middle fingers■ Examiner’s thumb exerts counter pressure on patient’s coracoid process■ Using arm that is holding patient’s hand, examiner places their hand

around the patient’s relaxed upper arm and draws humerus forward■ Movement may be accompanied by a click, by patient apprehension, or

both■ Positive test indicates anterior instability depending on amount of anterior

translation■ Click may indicate labral tear or slippage of humeral head over glenoid

rim○ O'brien's Test

■ Assesses for SLAP lesion■ The patient sits with the test shoulder in 90 degrees of forward flexion, 40

degrees of horizontal adduction, and maximal internal rotation. ■ The examiner stands with one hand grasping the subject’s wrist. ■ The patient horizontally adducts and flexes the test shoulder against the

examiner’s manual resistance. ■ The test is then repeated with the subject’s arm in an externally rotated

position. ■ Positive Sign : Pain or popping in the internally rotated position (but not in

the externally rotated position) is a positive test.○ Biceps Load Test

■ Assesses integrity of superior labrum■ Patient is supine with shoulder abducted to 90 degrees and externally

rotated, and forearm is supinated. ■ Therapist passively externally rotates the shoulder until the patient

becomes apprehensive. ■ Rotation is stopped and the therapist resists elbow flexion while in this

position. ■ Positive Test : If apprehension decreases or the patient feels more

comfortable, the test is negative for a SLAP lesion. If pain stays the same or worsens and apprehension remains, the test is considered positive

○ Clunk Test

■ Tests labrum■ Pt lies supine■ Examiner places one hand on the posterior aspect of the shoulder over the

humeral head.■ Examiner’s other hand holds the humerus above the elbow■ Examiner fully abducts the arm over the patient’s head. Then the examiner

pushes anteriorly with the hand over the humeral head (a fist may be used to apply more anterior pressure) while the other hand rotates the humerus into lateral rotation

■ Positive Sign : A clunk or grinding sound indicates both a positive test and a tear of the labrum. The test may also cause apprehension if anterior instability is present

● Bicep○ Speed’s Test

■ Examiner resists shoulder forward flexion by the patient while the patient’s forearm is first supinated, then pronated, and the elbow is completely extended

■ Positive test= elicits increased tenderness in the bicipital groove especially with the arm supinated and is indicative of bicipital paratenonitis or tendinosis

○ Yergason’s Test■ designed to check ability of transverse humeral ligament to hold biceps

tendon in bicipital groove■ With patient’s elbow flexed 90 degrees and stabilized against the thorax

and with the forearm pronated, examiner resists supination while the patient also laterally rotates the arm against resistance

■ If examiner palpates the biceps tendon in the bicipital groove during supination and lateral rotation movement, the tendon will be felt to pop out of the groove if the transverse humeral ligament is torn

● Instability○ Load and Shift Test

■ Checks atraumatic instability problems of glenohumeral jt■ Pt sits with no back support and with hand of test arm resting on thigh■ Sit with good posture!■ Stand behind pt and stabilize shoulder with 1 hand over clavicle and

scapula■ With other hand, grasp head of humerus with thumb over posterior

humeral head and fingers over anterior humeral head

■ Run fingers along anterior humerus and thumb along posterior humerus to feel where humerus is seated relative to glenoid

■ If fingers “dip in” anteriorly as they move medially but thumb doesn’t, it indicates humeral head is sitting anteriorly

■ Normally humeral head feels more anterior when it is properly “seated” in glenoid

■ The humerus is then gently pushed anteriorly or posteriorly (most common) in glenoid if necessary to seat it properly in glenoid fossa

■ This is “load” portion■ Then push the humeral head anteriorly (anterior instability) or posteriorly

(posterior instability) noting amount of translation and end feel. “Shift” portion of test

■ ***With anterior translation, if head is not centered, posterior translation will be greater than anterior, giving false negative test

○ Sulcus Sign■ Pt stands with arm by side and shoulder muscles relaxed■ Examiner grasps patient’s forearm below elbow and pulls arm distally■ Presence of sulcus sign may indicate inferior instability or glenohumeral

laxity but should only be considered positive for instability if patient is symptomatic (ex: pain/ache on activity, shoulder doesn’t feel “right” with activity)

■ Bilateral sulcus sign is not as clinically significant as unilateral laxity on affected side

■ Grade it by measuring from inferior margin of acromion to humeral head● 1+ = distance of less than 1 cm● 2+ = 1-2 cm● 3+ = more than 2 cm

○ Jerk Test■ Pt sits with arm medially rotated and forward flexed to 90 degrees■ Examiner grasps patient’s elbow and axially loads humerus in proximal

direction■ While maintaining axial loading, examiner moves arm horizontally

(horizontal adduction) across the body■ + test for recurrent posterior instability is production of sudden jerk or

clunk as humeral head slides off (subluxes) the back of the glenoid■ When arm is returned to original 90 degrees abduction position, 2nd jerk

may be felt as head reduces■ Positive signs also indicate positive test for posteroinferior labral tear

○ Apprehension Test ■ Also called crank test for anterior shoulder dislocation

■ Checks for traumatic instability problems causing gross or anatomical instability of shoulder, although relocation portion of test is sometimes used to differentiate instability and impingement

■ Abduct arm to 90 degrees and laterally rotate patient’s shoulder slowly■ Apprehension = +

○ Labral Crank Test ■ This test is used to evaluate the different glenohumeral ligaments or for

anterior shoulder instability. This test may also be used to assess a labral tear

■ With the subject standing, the examiner places the distal hand on the subject’s elbow and the proximal hand on the subject’s proximal humerus and then passively elevates the subjects shoulder to 160 degrees in the scapular plane.

■ With the distal hand, the examiner applies a load along the long axis of the humerus while the proximal hand externally and internally rotates the humerus.

● AC Joint ○ AC Shear

■ While the pt is sitting, the examiner cups his hands over the deltoid with one hand with one hand over the clavicle and one hand over the spine of the scapula.

■ Squeeze the heels of the hands together ■ Abnormal movement indicates a positive test for AC joint pathology.

● Impingement ○ Hawkins-Kennedy

■ Pt stands while examiner forward flexes arm to 90 and then forcibly medially rotates the shoulder

■ May also be performed in different degrees of forward flexion or horizontal adduction

■ Positive: Pain ■ Indicative of: supraspinatus paratenonitis/tendinosis or secondary

impingement

○ Coracoid Test ■ Same as Hawkins-Kennedy, but involves horizontally adducting arm

across body 10 to 20 degrees before doing medial rotation■ More likely to approximate lesser tuberosity of humerus and coracoid

process■ Positive: pain

○ Neer Impingement Test ■ Pt’s arm is passively and forcibly fully elevated in scapular plane with the

arm medially rotated by the examiner■ Positive: If patient’s face show’s pain■ Indicative of: overuse injury to supraspinatus muscle and sometimes to

biceps tendon■ If positive with arm laterally rotated, examiner should check AC joint

Elbow● Medial Epicondylitis

○ Golfer’s Elbow Test■ The patient should be seated or standing and should have his/her fingers

flexed in a fist position. ■ The examiner palpates the medial epicondyle with one hand and grasps

the patient’s wrist with his/her other hand. ■ The examiner then passively supinates the forearm and extends the elbow

and wrist. ■ A positive test would be a complaint of pain or discomfort along the

medial aspect of the elbow in the region of the medial epicondyle● Lateral Epicondylitis

○ Mills Test■ The pt is seated. ■ While palpating the lateral epicondyle, the examiner passively pronates

the patient’s forearm, flexes the wrist fully, and extends the elbow ■ A positive sign would be pain over the lateral epicondyle of the humerus.

○ Cozen Test■ Pt is seated.■ The patient’s elbow is stabilized by the examiner’s thumb, which rests on

the patient’s lateral epicondyle■ The patient is then asked to actively make a fist, pronate the forearm, and

radially deviate and extend the wrist while the examiner resists the motion.■ A positive sign would be a sudden severe pain in the area of the lateral

epicondyle of the humerus

○ Maudsley’s Test■ Pt is seated.■ The examiner resists extension of the third digit of the hand distal to the

proximal interphalangeal joint, stressing the extensor digitorum muscle and tendon

■ A positive test is indicated by pain over the lateral epicondyle of the humerus.

Hip● Muscular Tightness

○ Thomas Test■ Patient supine with the hips near the end of table.■ Both hips and knees flexed and the thigh on the side opposite the thigh

held against the chest■ Patient will slowly lower on lower limb down toward the table■ Tight rectus femoris: knee will not be flexed to neutral ■ Tight Iliopsoas: lower limb does not lower to the table

○ Ely Test■ Patient prone, examiner passively flexes the knee.■ Tight rectus femoris: When the knee is flexed, the hip on the same side

flexes, indicating that the rectus femoris is tight on the same side.○ Ober Test

■ Patient side-lying, lower leg flexed at hip and knee. ■ Stabilize pelvis and passively abduct and extend the patient’s upper leg

with the knee straight or flexed 90°■ Slowly lower upper LE.■ Tight TFL: The leg remains abducted and does not fall to the table.

○ Nobel Compression Test ■ Patient supine accompanied by hip flexion■ Apply pressure to lateral femoral epicondyle or 1-2 cm proximal WHILE

patient slowly extends the knee while pressure is maintained■ IT Band Friction Syndrome: 30° of flexion, patient has severe pain over

lateral femoral condyle● Pathology/Labral Tear

○ Scour ■ Patient lies supine, examiner flexes and adducts patients hip so that hip

faces the patient’s contralateral shoulder resistance to movement is felt■ Slight resistance is maintained while patient hip is taken into abduction in

a flexion arc movement■ A positive sign would be any irregularities or patient apprehension

○ FABER■ Patient lies supine.■ Examiner places lower limb so that the contralateral foot is on top of the

knee.■ allow knee to fall parallel with contralateral leg (looks like a figure 4)■ A positive test would be if the knee remains above the contralateral lower

limb, does not go parallel.Knee

● ACL

○ Anterior Drawer■ The purpose of this is to test the integrity of the ACL.■ The patient is supine with the hip and knees flexed to 90.■ The clinician is sitting on the pts involved foot with hand contact at the

proximal tibia with thumb over the anterior joint line to assess mobility■ An anteriorly directed force is exerted thru the hand contacts. ■ A positive test would be excessive anterior translation of the tibia or less

that firm, abrupt end feel.

○ Lachman Test ■ The purpose is to test integrity of the ACL. ■ The patient is supine with hip and knee flexed to 30 degrees. ■ The clinician is sitting at the foot of the table, one of the clinician's hands

stabilizes the distal femur as the other hand grasps the posterior tibia■ Procedure: anteriorly directed force is applied to the proximal tibia■ Interpretation: positive test if there is excessive anterior translation of the

tibia or less than a firm, abrupt end feel● PCL

○ Posterior Sag/Godfrey Sign ■ Patient is supine ■ Examiner holds both legs while flexing the patient's hips and knees to 90■ observe tibial tuberosity ■ A test is positive if there is posterior instability a posterior sag of the tibia

is seen ○ Posterior Drawer

■ Tests integrity of PCL■ Patient is supine hip and knees flexed to 90■ The clinician is sitting on the pts involved foot with hand contact at the

proximal tibia with thumbs over the anterior joint line to assess mobility■ The force is posteriorly directed force exerted thru the hand contacts■ A test is positive if there is excessive posterior translation of the tibia, or

less than a firm, abrupt end feel

● MCL○ Valgus Stress Test

■ The pt is supine with the knee flexed to 0 or 30 degrees■ The clinician is standing to the side of the pt■ The force is medially directed, valgus force applied to the knee ■ A test is positive if there is medial joint line pain and/or laxity when

compared bilaterally

● LCL○ Varus Stress Test

■ The pt supine with the knee flexed to 0 or 30 degrees

■ The clinician is standing to the side of the pt■ The force is laterally directed, varus force applied to the knee ■ A test is positive if there is lateral joint line pain and/or laxity when

compared bilaterally● Meniscus

○ McMurray Test■ Purpose: test integrity of the medial and lateral meniscus■ Patient: supine ■ Clinician: standing to the side of the pt grasping just proximal to the ankle

with one hand as the other hand is positioned to apply force and palpate the medial and lateral tibiofemoral joint line

■ Procedure: tibia is externally rotated, and a valgus force is applied as the knee is passively brought into flexion and extension as the clinician palpates the medial joint line for the medial meniscus. Internal tibial rotation with a varus stress as the knee is flexed and extended with palpation at the lateral joint line is performed to test the lateral meniscus

■ Interpretation: positive test if there is a palpable click, joint audible, or pain over the joint line

○ Thessaly Test■ Purpose: test integrity of the medial and lateral meniscus■ Patient: unilateral standing on the involved leg with the knee in 20 degrees

flexion■ Clinician: standing in front of the patient and holding the patient's arms■ Procedure: the patient turns to the R and then L on the weight bearing leg

as you guide the motion■ Interpretation: positive test if there is locking, catching, or pain at either

the medial or lateral joint line○ Apley’s Compression

■ Purpose: meniscus lesion■ patient in prone position with knee flexed 90 degrees■ patients thigh is anchored to examining table with PT's knee■ PT medially and laterally rotates the tibia, combined first with distraction,

while noting restriction, excessive movement or discomfort ■ distraction: stabilize femur. Correct hand placement to distract the TIBIA,

not just ankle. Cup the heel.■ test repeated using compression instead of distraction ■ *compression tests meniscus; distractions test ligaments

○ Bounce Home ■ Purpose: meniscus lesion■ patient lies supine and heel of the patients foot is cupped in the PT's hand■ patients knee is completely flexed and the knee is passively allowed to

extend

■ if extension is not complete, or has a rubbery end feel "springy block" there is something blocking full extension. Most likely torn meniscus

■ Interpretation: if their knee is allowed to quickly extend in one movement or jerk and the patient experiences a sharp pain on the joint line, which may radiate up and down the leg, positive for meniscus lesion

● Patella ○ Patellar Apprehension

■ Patient lies supine with the thigh on examining table and examiner holding leg in full extension off table. Examiner translates patella laterally using examiner thumb, and examiner flexes knee to 90 degrees and then extends leg.

■ A positive test is pain with translation or flexion. ○ Clark’s Sign

■ Purpose: assess the presence of a problem with the articulation between the articular surface of the patella and the articular surface of the femoral condyles

■ Examiner presses down slightly proximal to the upper pole or base of the patella with the web of the hand as the patient lies relaxed with the knee extended

■ Patient: asked to contract the quadriceps muscles while the examiner pushes down

■ Interpretation: if the patient can complete and maintain contraction without pain, the test is considered negative. If the test causes retropatellar pain and the patient cannot hold a contraction, the test is considered positive

■ Amount of pressure must be carefully controlled…. Increasing pressure each time. Knee should be tested in 30, 60, and 90 degrees of flexion as well as full extension

○ McConell Test■ Purpose: test for chondromalacia patellae■ Patient: sitting with femur laterally rotated■ Procedure: patient performs isometric quadriceps contractions at 120, 90,

60, 30 and 0 degrees with each contraction held for 10 seconds● If pain is produced, patient’s leg is passively returned to full

extension by examiner● The patient’s leg is then fully supported on the examiner’s knee,

and the examiner pushes the patella medially● The medial glide is maintained while the knee is returned to the

painful angle and the patient performs an isometric contraction, again with the patella held medially

■ Interpretation: if the pain is decreased, the pain is patellofemoral in origin.

Ankle

● Ligamentous ○ Anterior Drawer

■ Purpose: identify the capsuloligamentous integrity of the ankle joint, in particular the integrity of the ATFL

■ Patient: supine with the ankle in 10-15 degrees of PF■ Clinician: standing at the foot of the pt■ Procedure: the lower leg is stabilized while the calcaneus is grasped and

translated anteriorly■ Interpretation: test is positive if the talus translates anteriorly the extent to

which is graded on a scale where 0 indicates no laxity and 3 indicates gross laxity

○ Talar Tilt ■ Purpose: identify the lateral ligament integrity of the talocrural and

subtalar joints■ Patient: supine or side lying with the ankle in 10 to 15 degrees of PF■ Clinician: sitting at the foot of the pt grasping the patient’s ankle at the

malleoli■ Procedure: a medially directed thrust is applied to the calcaneus■ Interpretation: the test is positive if there is increased laxity when

compared to the noninvolved side with a less firm end feel ■ Calcaneofibular ligament

○ Kleiger’s Test■ Purpose: to identify the presence of the tibiofibular syndesmotic sprain

(high ankle sprain)■ Patient: supine or sitting with the knee flexed to 90■ Clinician: standing to the side of the pt with one hand supporting the lower

leg at the calf and the other supporting the foot■ Procedure: hold the talocrural joint in neutral and apply an ER force to the

ankle■ Interpretation: test is positive if there is a reproduction of pain proximal to

the talocrural joint ● Achilles Tendon

○ Thompson Test■ Purpose: to identify the presence of an Achilles tendon rupture■ Patient: prone with the foot off the edge of the table■ Clinician: standing to the side of the pt■ Procedure: while grasping the mid belly of the calf, a squeeze is applied■ Interpretation: test is positive if the foot fails to PF when the squeeze is

applied● Syndesmosis

○ Squeeze Test■ Purpose: to identify the presence of a tibiofibular syndesmotic sprain, aka

high ankle sprain■ Patient: supine, side lying, or sitting

■ Clinician: standing at the foot of the patient with both hands grasping the lower leg

■ Procedure: a manual squeeze is applied by both hands to the lower leg■ Interpretation: test is positive if there is an onset of pain proximal to the

talocrural joint

○ Kleiger’s Test■ Purpose: to identify the presence of the tibiofibular syndesmotic sprain

(high ankle sprain)■ Patient: supine or sitting with the knee flexed to 90■ Clinician: standing to the side of the pt with one hand supporting the lower

leg at the calf and the other supporting the foot■ Procedure: hold the talocrural joint in neutral and apply an ER force to the

ankle■ Interpretation: test is positive if there is a reproduction of pain proximal to

the talocrural joint○ Heel Thump

■ Purpose: to assess the presence of a stress fracture , syndesmosis■ Patient: in non-weight bearing with the ankle in neutral■ Clinician: sitting or standing at the pts foot■ Procedure: apply a firm force with the thenar eminence to the pts

calcaneus■ Interpretation: test is positive if there's pain