Special Tests for Physical Therapists and Clinicians

special tests

There are many special tests clinicians can use to diagnose orthopedic and other musculoskeletal impairments.  The orthopedic tests listed on this page are designed as a quick reference based on region and further classified into special test based on impairment if indicated. 

Special Tests: An Overview

During an evaluation, the clinician may use special tests to help guide the evaluation and assessment.  While many of these tests are highly reliable, it it important to understand that special tests should be regarded as one component of the examination.  

Some popular special tests may not have strong reliability or statistical power.  This is noted in the Test Accuracy / Reliability section of each test. For a better understanding of these measures and terms, read the article: Reliability: Specificity and Sensitivity. 

While special tests are not designed to take the place of a carefully performed musculoskeletal evaluation, they can provide important data points that help to support or refute a diagnosis.  The data from these tests may also guide your treatment options and help you in explaining the dysfunction to the patient. 

How to Use Special Tests

The performance of special tests with the intention of diagnosing or providing treatment recommendations for someone experiencing symptoms should be performed only by a licensed medical professional such as a PT, OT, medical doctor or athletic trainer.

Clinicians who perform special tests may use the data for: 

  1. Educating Patients: Using the results of a special test may be helpful in explaining why symptoms occur based on anatomical structures involved or stressed during the test.
  2. Supporting the Assessment and Diagnosis: Using data from special tests can be useful as a way to support your evaluation assessment and to communicate with other healthcare providers involved in that patient’s care. 
  3. Provide Appropriate Treatments: Understanding the underlying cause or reason for symptom provocation during a special test can lead the clinician to create an appropriate HEP (home exercise plan) and other treatment options to address the key impairments.

When To Perform These Tests?

During an evaluation, the performance of special tests usually occurs after the medical history, observation, motion testing, and specific muscle testing is performed.  

While the actual timing of special test performance may vary from patient to patient, the big picture idea is to gather as much information as possible from the patient through subjective history taking, observation / palpation, and muscle / movement tests before provoking symptoms with special orthopedic tests. 

The most important thing to remember with special tests is to no allow the test to become a crutch in your evaluation or assessment of the patient. These tests are simply tools to support your clinical reasoning and should not be a substitution for critical thinking and problem solving. 

How Many Special Tests Should I Perform?

There is never a set number of special tests required for clinicians to perform during an evaluation. Whether a test is positive or negative, you may want to perform a secondary test to narrow down your ideas for the underlying pathology. 

Sometimes you may not perform any special test with a patient depending on the acuity of an injury, surgical precautions, or time constraints. 

Other times you may want to perform 3-4 tests if you’re trying to pinpoint a specific pathology. 

It’s not about how many you do, it’s about your reasoning for performing the test. You need to understand the reason behind the test and whether or not it will be helpful to perform. 

While it can be helpful for a clinician to perform an evaluation with a structured approach, it is not recommended that clinicians run every patients through a giant list of 6-8 orthopedic tests. This is not reflective of skilled clinical reasoning and may be a waste of your time and the patients time with you. 

Orthopedic Tests by Region

Below are various pages that highlight special tests by region.  Just click on the image for “Shoulder Special Tests” or the link below it and you’ll be directed to a page with all of the videos for each test in our library.

shoulder special test
wrist special test
hip special test
elbow special test
lumbar special test
knee special test