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Home› Physical Therapy› Free Self-Checks› Special Tests

Orthopedic Special Tests

How to perform the most-used special tests for every region, what a positive looks like, and what the research says about their accuracy.

Reviewed by Dr. Richard Holsman, PT, DPT, NCS · Last reviewed November 13, 2026 · For clinician education

⚠️ For clinicians

For clinician education; special tests support but do not replace a full examination. This page is a reference for physical therapists, occupational therapists, athletic trainers, students and other clinicians. Patients with joint or spine pain should be examined by a licensed clinician.

The orthopedic special tests clinicians use most, organized by region. For each test: what it tests, patient position, how to perform it, what a positive looks like, and its diagnostic accuracy (sensitivity, specificity and likelihood ratios) from the studies and systematic reviews we checked.

On this page

Tests by region

Shoulder

Hawkins-Kennedy, Neer, painful arc, empty can, drop arm, lag signs, belly press, O’Brien, apprehension/relocation, Speed’s, Yergason’s.

For clinicians · 11 tests
Open →

Elbow

Elbow extension test, moving valgus, hook test, cubital tunnel provocation, Cozen’s, Mill’s.

For clinicians · 6 tests
Open →

Wrist & Hand

Phalen’s, Tinel’s, carpal compression, Wainner CTS rule, Finkelstein’s, Watson.

For clinicians · 5 tests
Open →

Cervical Spine

Spurling’s, distraction, ULTT A, Wainner cluster, Sharp-Purser, flexion-rotation test.

For clinicians · 6 tests
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Lumbar Spine & SIJ

SLR, crossed SLR, slump, Laslett SIJ tests and cluster, Flynn manipulation rule.

For clinicians · 8 tests
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Hip

FADIR, flexion-IR, scour, FABER, Thomas, Trendelenburg, Sutlive hip OA rule.

For clinicians · 6 tests
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Knee

Lachman, anterior/posterior drawer, pivot shift, McMurray, Thessaly, joint line, valgus/varus.

For clinicians · 8 tests
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Ankle & Foot

Ottawa ankle rules, anterior drawer, talar tilt, Thompson, squeeze test, Windlass.

For clinicians · 6 tests
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Every test on one list

Shoulder

Hawkins-Kennedy test · Neer impingement sign · Painful arc · Empty can test · Drop arm test · External rotation lag sign · Belly press test (modified) and belly-off sign · O’Brien active compression test · Apprehension and relocation tests · Speed’s test · Yergason’s test

Elbow

Elbow extension test · Moving valgus stress test · Hook test · Cubital tunnel provocation: elbow flexion, pressure and Tinel’s · Cozen’s test · Mill’s test

Wrist & Hand

Phalen’s test · Tinel’s sign at the wrist · Carpal compression test · Finkelstein’s test · Watson scaphoid shift test

Cervical Spine

Spurling’s test (Spurling A) · Neck distraction test · Upper limb tension test A (median nerve bias) · Cervical rotation less than 60° to the involved side · Sharp-Purser test · Cervical flexion-rotation test

Lumbar Spine & SIJ

Straight leg raise · Crossed straight leg raise · Slump test · SIJ distraction test · Thigh thrust test · SIJ compression test · Sacral thrust test · Gaenslen’s test

Hip

FADIR test · Flexion-internal rotation test · Scour test · FABER test · Thomas test · Trendelenburg sign

Knee

Lachman test · Anterior drawer test · Pivot shift test · Posterior drawer test · McMurray test · Thessaly test (20°) · Joint-line tenderness · Valgus and varus stress tests

Ankle & Foot

Ottawa ankle rules · Anterior drawer test (ankle) · Talar tilt test · Thompson test · Squeeze test (syndesmosis) · Windlass test

Best-supported clusters

Clusters of findings usually beat single tests. These are the ones we could verify:

How to read the accuracy numbers

  • Sensitivity: of people who have the condition, the share with a positive test. A highly sensitive test that is negative helps rule the condition out.
  • Specificity: of people without the condition, the share with a negative test. A highly specific test that is positive helps rule it in.
  • Positive likelihood ratio (+LR): how much a positive result raises the odds. About 5–10 is a moderate shift; above 10 is large.
  • Negative likelihood ratio (−LR): how much a negative result lowers the odds. About 0.1–0.2 is a moderate-to-large shift; near 1 means little change.
  • Values depend on the study’s patients, examiners and reference standard. Many studies are small, so treat single-study numbers with caution.

How we built these pages

  • Descriptions of each test are written in our own words by Holsman physical therapists. We did not copy text, tables or figures from textbooks or other websites.
  • Accuracy numbers come only from studies and systematic reviews we read (abstracts or full text). Each number links to its source; sources are graded A to D.
  • Where we could not check a number, the test is still described but marked “accuracy data not verified.”
  • Pair these with our range of motion norms for each joint.
  • Demonstration videos filmed by Holsman physical therapists are in production; each test has a placeholder where its video will go.

Sources, review and disclosures

Graded citations

How we grade sources. A = systematic review or meta-analysis. B = single prospective diagnostic accuracy study. C = small, retrospective or case-control study, or a clinical prediction rule that has only been derived (not yet validated). D = expert clinical opinion (our test descriptions). Every accuracy number on this page was checked against the cited abstract or full text on November 13, 2026. If we could not check a number, we left it out and say “accuracy data not verified.”

  1. Grade A Hegedus EJ, Goode AP, Cook CE, et al. Which physical examination tests provide clinicians with the most value when examining the shoulder? Update of a systematic review with meta-analysis of individual tests. Br J Sports Med. 2012;46(14):964-978. doi:10.1136/bjsports-2012-091066 (pooled values from Table 3; single-study values from Tables 1, 2 and 4). bjsm.bmj.com (full text)
  2. Grade B Miller CA, Forrester GA, Lewis JS. The validity of the lag signs in diagnosing full-thickness tears of the rotator cuff: a preliminary investigation. Arch Phys Med Rehabil. 2008;89(6):1162-1168. doi:10.1016/j.apmr.2007.10.046 (abstract). PubMed 18503815
  3. Grade B Park HB, Yokota A, Gill HS, El Rassi G, McFarland EG. Diagnostic accuracy of clinical tests for the different degrees of subacromial impingement syndrome. J Bone Joint Surg Am. 2005;87(7):1446-1455. doi:10.2106/JBJS.D.02335 (abstract). PubMed 15995110
  4. Grade B Appelboam A, Reuben AD, Benger JR, et al. Elbow extension test to rule out elbow fracture: multicentre, prospective validation and observational study of diagnostic accuracy in adults and children. BMJ. 2008;337:a2428. doi:10.1136/bmj.a2428 (abstract; full text free at PMC2600962). PubMed 19066257
  5. Grade C O’Driscoll SW, Lawton RL, Smith AM. The “moving valgus stress test” for medial collateral ligament tears of the elbow. Am J Sports Med. 2005;33(2):231-239. doi:10.1177/0363546504267804 (abstract; 21 surgical patients). PubMed 15701609
  6. Grade B O’Driscoll SW, Goncalves LB, Dietz P. The hook test for distal biceps tendon avulsion. Am J Sports Med. 2007;35(11):1865-1869. doi:10.1177/0363546507305016 (abstract). PubMed 17687121
  7. Grade C Novak CB, Lee GW, Mackinnon SE, Lay L. Provocative testing for cubital tunnel syndrome. J Hand Surg Am. 1994;19(5):817-820. doi:10.1016/0363-5023(94)90193-7 (abstract). PubMed 7806810
  8. Grade A MacDermid JC, Wessel J. Clinical diagnosis of carpal tunnel syndrome: a systematic review. J Hand Ther. 2004;17(2):309-319. doi:10.1197/j.jht.2004.02.015 (abstract; sample-size-weighted estimates across studies). PubMed 15162113
  9. Grade C Wainner RS, Fritz JM, Irrgang JJ, Delitto A, Allison S, Boninger ML. Development of a clinical prediction rule for the diagnosis of carpal tunnel syndrome. Arch Phys Med Rehabil. 2005;86(4):609-618. doi:10.1016/j.apmr.2004.11.008 (abstract; derivation study, not yet validated). PubMed 15827908
  10. Grade B Wainner RS, Fritz JM, Irrgang JJ, Boninger ML, Delitto A, Allison S. Reliability and diagnostic accuracy of the clinical examination and patient self-report measures for cervical radiculopathy. Spine. 2003;28(1):52-62. doi:10.1097/00007632-200301010-00014 (Tables 4 and 5; reference standard EMG/nerve conduction; 82 patients). PubMed 12544957
  11. Grade B Uitvlugt G, Indenbaum S. Clinical assessment of atlantoaxial instability using the Sharp-Purser test. Arthritis Rheum. 1988;31(7):918-922. doi:10.1002/art.1780310715 (abstract; 123 outpatients with rheumatoid arthritis). PubMed 3395385
  12. Grade C Hall TM, Robinson KW, Fujinawa O, Akasaka K, Pyne EA. Intertester reliability and diagnostic validity of the cervical flexion-rotation test. J Manipulative Physiol Ther. 2008;31(4):293-300. doi:10.1016/j.jmpt.2008.03.012 (abstract; small sample). PubMed 18486750
  13. Grade A van der Windt DA, Simons E, Riphagen II, et al. Physical examination for lumbar radiculopathy due to disc herniation in patients with low-back pain. Cochrane Database Syst Rev. 2010;(2):CD007431. doi:10.1002/14651858.CD007431.pub2 (abstract). PubMed 20166095
  14. Grade B Majlesi J, Togay H, Ünalán H, Toprak S. The sensitivity and specificity of the Slump and the Straight Leg Raising tests in patients with lumbar disc herniation. J Clin Rheumatol. 2008;14(2):87-91. doi:10.1097/RHU.0b013e31816b2f99 (abstract). PubMed 18391677
  15. Grade B Laslett M, Aprill CN, McDonald B, Young SB. Diagnosis of sacroiliac joint pain: validity of individual provocation tests and composites of tests. Man Ther. 2005;10(3):207-218. doi:10.1016/j.math.2005.01.003 (Tables 2, 4 and 6; reference standard: SIJ anesthetic injection; 48 patients). PubMed 16038856
  16. Grade C Flynn T, Fritz J, Whitman J, et al. A clinical prediction rule for classifying patients with low back pain who demonstrate short-term improvement with spinal manipulation. Spine. 2002;27(24):2835-2843. doi:10.1097/00007632-200212150-00021 (abstract; derivation study). PubMed 12486357
  17. Grade A Reiman MP, Goode AP, Cook CE, Hölmich P, Thorborg K. Diagnostic accuracy of clinical tests for the diagnosis of hip femoroacetabular impingement/labral tear: a systematic review with meta-analysis. Br J Sports Med. 2015;49(12):811. doi:10.1136/bjsports-2014-094302 (abstract). PubMed 25515771
  18. Grade C Sutlive TG, Lopez HP, Schnitker DE, et al. Development of a clinical prediction rule for diagnosing hip osteoarthritis in individuals with unilateral hip pain. J Orthop Sports Phys Ther. 2008;38(9):542-550. doi:10.2519/jospt.2008.2753 (Tables 5 and 7; derivation study, 72 patients; reference standard: radiograph). jospt.org
  19. Grade A Benjaminse A, Gokeler A, van der Schans CP. Clinical diagnosis of an anterior cruciate ligament rupture: a meta-analysis. J Orthop Sports Phys Ther. 2006;36(5):267-288. doi:10.2519/jospt.2006.2011 (abstract). PubMed 16715828
  20. Grade C Rubinstein RA Jr, Shelbourne KD, McCarroll JR, VanMeter CD, Rettig AC. The accuracy of the clinical examination in the setting of posterior cruciate ligament injuries. Am J Sports Med. 1994;22(4):550-557. doi:10.1177/036354659402200419 (abstract; 39 participants). PubMed 7943523
  21. Grade A Hegedus EJ, Cook C, Hasselblad V, Goode A, McCrory DC. Physical examination tests for assessing a torn meniscus in the knee: a systematic review with meta-analysis. J Orthop Sports Phys Ther. 2007;37(9):541-550. doi:10.2519/jospt.2007.2560 (abstract). PubMed 17939613
  22. Grade A Smith BE, Thacker D, Crewesmith A, Hall M. Special tests for assessing meniscal tears within the knee: a systematic review and meta-analysis. Evid Based Med. 2015;20(3):88-97. doi:10.1136/ebmed-2014-110160 (abstract). PubMed 25724195
  23. Grade B Kastelein M, Wagemakers HP, Luijsterburg PA, Verhaar JA, Koes BW, Bierma-Zeinstra SM. Assessing medial collateral ligament knee lesions in general practice. Am J Med. 2008;121(11):982-988. doi:10.1016/j.amjmed.2008.05.041 (abstract; reference standard MRI; 134 patients). PubMed 18954845
  24. Grade A Bachmann LM, Kolb E, Koller MT, Steurer J, ter Riet G. Accuracy of Ottawa ankle rules to exclude fractures of the ankle and mid-foot: systematic review. BMJ. 2003;326(7386):417. doi:10.1136/bmj.326.7386.417 (abstract; full text free at PMC149439). PubMed 12595378
  25. Grade B van Dijk CN, Lim LS, Bossuyt PM, Marti RK. Physical examination is sufficient for the diagnosis of sprained ankles. J Bone Joint Surg Br. 1996;78(6):958-962. doi:10.1302/0301-620x78b6.1283 (abstract; 160 patients). PubMed 8951015
  26. Grade B Maffulli N. The clinical diagnosis of subcutaneous tear of the Achilles tendon: a prospective study in 174 patients. Am J Sports Med. 1998;26(2):266-270. doi:10.1177/03635465980260021801 (abstract). PubMed 9548122
  27. Grade C De Garceau D, Dean D, Requejo SM, Thordarson DB. The association between diagnosis of plantar fasciitis and Windlass test results. Foot Ankle Int. 2003;24(3):251-255. doi:10.1177/107110070302400309 (abstract; 22 patients with plantar fasciitis). PubMed 12793489
  28. Grade D Holsman Physical Therapy clinical guidance. Patient position, test steps and positive findings written in our own words by Holsman physical therapists and reviewed by Dr. Richard Holsman, PT, DPT, NCS. Expert opinion, not a research source.

Reviewer

Reviewed by Dr. Richard Holsman, PT, DPT, NCS (Board-Certified Clinical Specialist in Neurologic Physical Therapy), founder of Holsman Physical Therapy. Last reviewed: November 13, 2026.

Change log

  • November 13, 2026: Page published. Test descriptions written in our own words; accuracy values checked against the cited sources.

Review policy

We re-check every number on this page against its source at least once a year, and sooner if a source is updated, a better study is published or a reader reports a problem. Changes are listed in the change log with the date. To report an error, contact us.

Licensing

Test descriptions, steps and the accuracy summaries are original text by Holsman Physical Therapy. Accuracy values are individual numbers cited with credit to the original studies; no tables, figures or text from journals, textbooks or other websites are reproduced. Linking to a source does not imply its endorsement. Demonstration videos, when added, will be filmed by Holsman physical therapists with consenting adult models.

Conflict of interest and advertising

This page is published by Holsman Physical Therapy and Wellness, P.C., which runs outpatient and in-home therapy practices; that is our only commercial interest. The page carries no advertising, no sponsorship and no affiliate links, and we received no payment from any source for it. Holsman Physical Therapy is not affiliated with the authors or publishers cited, and they do not endorse this website.

For clinician education; special tests support but do not replace a full examination. A positive or negative test changes the probability of a condition; it does not make a diagnosis. Interpret every result with the history, the rest of the examination, imaging when indicated, and clinical judgment. Stop any test that provokes severe pain or neurological symptoms.

Common Questions

What are orthopedic special tests?

Short, standardized physical examination maneuvers that try to reproduce symptoms or show laxity, weakness or a mechanical sign linked to a specific structure, such as the Lachman test for the ACL or the Spurling test for cervical radiculopathy.

Can a special test diagnose a condition on its own?

Rarely. Most tests only shift the probability of a condition. Clusters of tests and the history usually perform better, and imaging or other tests may still be needed.

Where do the accuracy numbers come from?

From published diagnostic accuracy studies and systematic reviews, cited next to each number. We only show numbers we checked against the source; otherwise we say accuracy data not verified.

Referring a Patient?

Holsman physical therapists see patients at clinics across North Jersey, the Bronx and Brooklyn, plus in-home visits.

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