Introduction to Special Tests
by Brent Brookbush DPT, PT, COMT, MS, PES, CES, CSCS, ACSM H/FS
- Special Tests (a.k.a. orthopedic tests, clinical tests, etc.): A set of motions, positions and/or palpations designed to provoke symptoms associated with a particular diagnosis. Most tests are dichotomous (two possible results), resulting in someone exhibiting or not exhibiting symptoms.
- Negative (Rule-out): Test does not provoke intended symptoms
- Positive (Rule-in): Test provokes intended symptoms
- Concordant Sign: The patient's specific pain, symptom or complaint.
- Comparable Sign: A combination of pain, stiffness and/or spasm during examination that is comparable to the patients symptoms (5).
- Note: One common error made during evaluation with special tests is focus on any discomfort or pain, rather than identification of the pain/discomfort related to the patient's complaint (concordant/comparable sign). Many special tests purposefully test tissue limits and are at least mildly uncomfortable for everyone. Coming to conclusions/diagnoses based on positive tests that resulted in "concordant/comparable signs" will improve the chances of diagnosing the issue related to the patient's complaint.
Necessary Prior Knowledge:
"Performing special tests is easy, interpretation of the findings is more complicated."
Are you a licensed medical professional (PT, ATC, DC, OT, DO, MD)? If not, then special tests are not within your scope of practice.
Knowledge Base: Without a significant base of knowledge (ex. the minimum standard for a licensed medical professional), it would be difficult, if not impossible to weigh the relevance of a special test result. That is, it is