Orthopaedic Special Tests for BPT Students: Procedure, Diagnostic Accuracy, and Clinical Significance
A definitive practical manual for clinical assessments and viva examinations covering the Shoulder, Knee, Hip, and Spine grounded in David J. Magee (Orthopedic Physical Assessment, 6th Ed).
Diagnostic accuracy metrics (sensitivity, specificity, and likelihood ratios) derive from published peer-reviewed validation studies (e.g. Park et al., Hegedus et al., Magee 6th Ed). These values vary by reference standard (MRI vs Arthroscopy) and clinical setting. Special tests should never be used in isolation; they must be interpreted as part of a comprehensive diagnostic cluster and physical history.
1. Knee Examination: Anterior Cruciate Ligament (ACL)
Lachman Test (The Gold Standard)
Target: Anterior Cruciate Ligament (Posterolateral and Anteromedial bundles)Anterior Drawer Test
Knee flexed to 90°, foot stabilized by examiner sitting on forefoot. Lower sensitivity in acute injuries (48%–70%) due to protective hamstring spasm and hemarthrosis blocking motion.
McMurray's Meniscal Test
Knee flexed fully, tibia rotated internally (lateral meniscus) or externally (medial meniscus), followed by passive knee extension with varus/valgus stress. Positive if a palpable click or localized joint-line pain is elicited.
2. Shoulder Examination & Diagnostic Clusters
Single shoulder tests have low diagnostic specificity. In modern evidence-based clinical reasoning, students must apply Park's Diagnostic Triad for Subacromial Impingement.
The Park et al. Subacromial Impingement Triad
📊 Diagnostic Yield: When all 3 tests are positive, the positive likelihood ratio (+LR) increases to 10.56, providing a post-test probability of subacromial impingement exceeding 95%.
3. Hip & Pelvis Special Tests
Trendelenburg Test
Procedure: Patient stands on one leg for 30 seconds. Examiner observes posterior pelvis from behind.
Positive Finding: The contralateral non-stance pelvis drops downward, indicating weakness or denervation of the stance-side Gluteus Medius / Superior Gluteal Nerve (L4–S1).
Thomas Test
Procedure: Patient supine, brings one knee to chest to flatten lumbar lordosis. The contralateral leg remains extended on the table.
Positive Finding: Extended leg lifts off the table (iliopsoas contracture); if knee extends beyond 90°, rectus femoris tightness is present.
4. Neurodynamics & Dural Irritation
Straight Leg Raise (SLR / Lasegue's Test)
Patient supine. Examiner passively elevates the straight lower extremity with knee fully extended and ankle relaxed.
- 0°–35°: Takes up slack in sciatic nerve branches. Pain usually denotes true lumbar pathology or extreme irritability.
- 35°–70°: Maximal tension on the L4, L5, S1, S2 nerve roots over the intervertebral disc. Reproduction of radicular pain below the knee is positive for lumbar disc herniation.
- >70°: Tension primarily in hamstrings.
- Bragard's Sign: Lowering leg slightly to reduce pain, then applying passive ankle dorsiflexion. Pain return confirms neural irritation.
Watch 59 Clinical Special Tests in Action
The PhysioPilot Android app contains full procedural cards, stabilizing vs mobilizing hand setups, and integrated video demonstrations for all 59 canonical orthopedic physical examination tests.