Introduction to special tests for lower extremity
In this post, we explore special tests used to assess injuries and conditions in the lower extremity—including the hip, knee, ankle, and foot. These tests are essential for identifying ligament tears, joint instability, and other musculoskeletal problems. Clinicians use them to make accurate diagnoses and determine appropriate treatment strategies.
Special tests for hip injuries
FABER test
The FABER test (Flexion, Abduction, and External Rotation) is used to assess the hip joint or sacroiliac joint for pathology.
How it’s done: The patient lies supine, and the tested leg is placed in a figure-4 position. The examiner gently presses down on the bent knee.
Positive result: Pain in the hip or sacroiliac joint.
Conditions: Hip joint pathology, sacroiliac joint dysfunction.
Trendelenburg test
This test checks for weakness in the gluteus medius muscle.
How it’s done: The patient stands on one leg.
Positive result: The pelvis drops on the opposite side, indicating weak hip abductor muscles on the standing leg.
Conditions: Gluteus medius weakness, superior gluteal nerve injury.
🦿 Special tests for knee injuries
Lachman test
The Lachman test is used to diagnose an anterior cruciate ligament (ACL) tear.
How it’s done: The patient lies supine with the knee slightly bent. The examiner stabilizes the thigh and pulls the tibia forward.
Positive result: Increased forward movement of the tibia with a soft endpoint.
Conditions: ACL tear.
Posterior drawer test
This test helps diagnose posterior cruciate ligament (PCL) injuries.
How it’s done: The patient lies supine with the knee at 90 degrees. The examiner pushes the tibia backward.
Positive result: Posterior translation of the tibia.
Conditions: PCL tear.
McMurray’s test
McMurray’s test detects meniscal tears in the knee.
How it’s done: The examiner flexes and rotates the patient’s knee while extending it.
Positive result: Clicking or pain along the joint line.
Conditions: Meniscus tear.
Valgus and varus stress tests
These tests check for medial and lateral ligament instability.
How it’s done: With the knee slightly bent, the examiner applies inward (valgus) and outward (varus) stress.
Positive result: Excessive joint movement or pain.
Conditions: MCL tear (valgus), LCL tear (varus).
👣 Special tests for ankle injuries
Anterior drawer test (Ankle)
This test evaluates the integrity of the anterior talofibular ligament (ATFL).
How it’s done: The patient’s ankle is slightly plantarflexed, and the examiner pulls the heel forward while stabilizing the leg.
Positive result: Excessive forward movement of the foot.
Conditions: ATFL sprain or tear.
Talar tilt test
This test assesses the calcaneofibular ligament (CFL) and overall ankle stability.
How it’s done: The foot is tilted inward (inversion) or outward (eversion).
Positive result: Increased tilting or pain.
Conditions: Lateral ankle ligament injury.
Squeeze test
The Squeeze test helps detect syndesmotic (high ankle) sprains.
How it’s done: The examiner squeezes the tibia and fibula together at the mid-calf.
Positive result: Pain near the ankle joint.
Conditions: High ankle sprain (syndesmosis injury).
🦶 Special tests for foot injuries
Thompson test
This test checks for Achilles tendon rupture.
How it’s done: The patient lies prone with feet hanging off the table. The examiner squeezes the calf.
Positive result: Absence of foot movement (no plantarflexion).
Conditions: Achilles tendon rupture.
Homan’s sign
This test is sometimes used to detect deep vein thrombosis (DVT), although it's not highly reliable.
How it’s done: The examiner dorsiflexes the foot while the leg is extended.
Positive result: Pain in the calf.
Conditions: Deep vein thrombosis (DVT).
Windlass test
The Windlass test evaluates for plantar fasciitis
How it’s done: The examiner dorsiflexes the big toe while the patient stands.
Positive result: Pain at the heel or plantar fascia.
Conditions: Plantar fasciitis.
📝 Conclusion
Special tests for the lower extremity allow clinicians to pinpoint specific injuries affecting the hip, knee, ankle, and foot. These hands-on assessments are simple, yet powerful tools that support clinical decision-making. As always, they should be combined with a thorough patient history and physical examination for the most accurate diagnosis.
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