New and emerging tests

Hug-up test

For: Supraspinatus tendon tear (partial or full thickness)

Also studied by a second research group

How it is done

The patient places the palm of the affected arm on the opposite shoulder, so the elbow sits in front of the chest. The examiner pushes the elbow straight down while the patient tries to hold it up. The two sides are compared.

Positive result

Resistance on the affected side is more than 20% weaker than on the other side. In the study, strength was measured with an electronic strength gauge. Pain without weakness was counted as negative.

Published figures

The study

200 consecutive patients booked for shoulder arthroscopy at a sports medicine centre in Beijing; 153 had a supraspinatus tear. Reference: arthroscopy.

• Tested by the team that described it. One of the examiners also assessed the tendon at surgery.
• No confidence intervals reported.

Source: Liu YL, Ao YF, Yan H, Cui GQ. The Hug-up test: a new, sensitive diagnostic test for supraspinatus tears. Chinese Medical Journal 2016;129(2):147-153. PubMed

Later studies

• Zou AP, An FM, Xin YQ, 2022 (Chinese-language paper; a different research group): 91 patients, arthroscopy reference. Sensitivity 90%, specificity 61%, LR+ 2.30, LR− 0.16. Only 13 of the 91 shoulders had no tear, so the specificity rests on few patients. Source (abstract source only)

Scissors sign

For: Subscapularis tear, particularly a tear of its upper border (leading edge)

One published study so far

How it is done

The patient sits relaxed. The examiner stands on the affected side and raises the arm to about 60° of abduction, then lays their own forearm diagonally across the patient's arm, like the blades of scissors, with the palm behind the top of the humerus. The examiner then turns the shoulder outwards while levering the head of the humerus forwards.

Positive result

Pain at the front of the shoulder. Pain only at the back or elsewhere, or no pain, is negative.

Published figures

For any subscapularis tear. For upper-border (leading-edge) tears the study reported a sensitivity of 91.4% (95% CI 85.7–97.1).

The study

233 patients who had arthroscopic rotator cuff repair at a university hospital in Seoul, reviewed from records. Reference: arthroscopy.

• One surgeon examined or re-checked every patient and also recorded the findings at surgery; blinding is not reported.
• Calcific tendinitis of subscapularis was linked to a positive sign without a tear.

Source: Rhee SM, Youn SM, et al. The scissors sign: a provocative test for detecting the leading-edge tear of subscapularis tendon: a diagnostic study. BMC Musculoskeletal Disorders 2022;23(1):679. PubMed

Later studies

None found yet.

Flexion-extension-supination (FES) test

For: Long head of biceps tendon problems (inflammation, partial tear or instability)

One published study so far

How it is done

The patient stands with the affected arm raised forwards to 90°, the shoulder in neutral rotation and the elbow straight. The patient then turns the palm up, or the examiner turns it up for them.

Positive result

Pain in the bicipital groove, or the patient cannot fully turn the palm up.

Published figures

Figures from the paper's 2x2 results table, which match the abstract; the results text gives some different values.

The study

162 consecutive patients having shoulder arthroscopy for long-standing pain in Korea; 152 included in the accuracy analysis. Reference: arthroscopy, with the bicipital groove opened.

• Two examiners who did not know the clinical or imaging findings; the surgeon did not know the test results.
• 10 patients on whom the two examiners disagreed were left out of the analysis.
• Most patients (about 9 in 10) also had a rotator cuff tear.

Source: Kim BK, Lee HJ, Jung SH, Dan J. Flexion-extension-supination test compared to arthroscopic findings of biceps long head pathology. Medicine (Baltimore) 2022;101(28):e29755. PubMed

Later studies

None found yet.

Subacromial grind test

For: Full-thickness supraspinatus tear

One published study so far

How it is done

The patient stands. The examiner holds the bent elbow and lifts the shoulder to 90° in the plane of the scapula (the Hawkins-Kennedy position), with the other hand resting over the front of the acromion and greater tuberosity. The examiner then turns the shoulder in and out.

Positive result

Grinding (crepitus) felt under the examiner's hand.

Published figures

For full-thickness tears. For any supraspinatus tear (full or partial thickness) the study reported a sensitivity of 63% and a specificity of 95%.

The study

50 consecutive patients booked for shoulder arthroscopy in the United Kingdom; 3 could not tolerate the test, leaving 47, of whom 17 had a full-thickness tear. Reference: arthroscopy.

• Examined on the day of surgery by a single examiner, who did not know the clinic or imaging findings.
• Small study; agreement between examiners has not been measured.

Source: Sawalha S, Fischer J. The accuracy of "subacromial grind test" in diagnosis of supraspinatus rotator cuff tears. International Journal of Shoulder Surgery 2015;9(2):43-46. PubMed

Later studies

None found yet.

Flexion initiation test

For: Distal biceps tendon tear (complete or partial)

One published study so far

How it is done

The patient sits with the elbow fully straight and the palm facing up. The examiner holds the front of the wrist with one hand and supports the arm just above the elbow with the other. The patient tries to start bending the elbow against resistance at the wrist (about 4.5–6.8 kg in the study, set with a hand-held dynamometer).

Positive result

The patient cannot overcome the resistance to start the first 10–15° of elbow bending.

Published figures

For any distal biceps tear. All 18 complete tears were detected; the 2 tears that were missed were low-grade partial tears.

The study

125 consecutive patients with elbow pain at a shoulder and elbow practice in the United States; 29 had a tear. Reference: MRI read by an independent radiologist, and surgery where done.

• A single examiner (the senior author), before seeing the scans. Records were reviewed afterwards.
• All 96 patients without a tear were confirmed by MRI alone; none had surgery.

Source: Bono OJ, et al. The flexion initiation test and an evidence-based diagnostic algorithm for distal biceps tendon tears. Arthroscopy, Sports Medicine, and Rehabilitation 2021;3(3):e721-e726. PubMed

Later studies

None found yet.

Seesaw test

For: Thumb base (CMC joint) osteoarthritis

One published study so far

How it is done

The examiner holds the thumb metacarpal and presses its base into the joint along the line of the thumb, while the other hand steadies the trapezium. The metacarpal is then rocked into extension and flexion on the trapezium, like a seesaw.

Positive result

Pain at the thumb CMC joint. Grinding or clicking without pain is negative.

Published figures

When done by the experienced hand surgeon. When done by hand surgery fellows in the same patients, sensitivity was 41.7% and specificity 86.4%.

The study

68 new patients aged 35 and over at a hospital hand clinic in the United States (80 enrolled); 24 had thumb CMC osteoarthritis. Reference: X-ray staging (Eaton-Littler stage 2–4).

• The surgeon who did the test also staged the X-rays later.
• X-ray changes do not always match symptoms at the thumb base.

Source: Arnold DMJ, et al. Evaluation of the seesaw test as new diagnostic test for thumb CMC osteoarthritis. Hand (N Y) 2022;17(4):706-713 (online 2020). PubMed

Later studies

None found yet.

Akmese sign

For: Medial meniscus posterior root tear

Also studied by a second research group

How it is done

The patient lies on their back with the leg in a figure-of-4 position, so no valgus load is on the knee. With the knee nearly straight (about 10–20° of flexion) the examiner presses on the medial joint line. The knee is then bent deeply (about 110–130°) and the same spot is pressed again.

Positive result

Marked medial joint-line tenderness near extension that disappears, or becomes minimal, in deep flexion.

Published figures

The study

273 adults aged 18–55 booked for arthroscopy for a medial meniscus problem at a university hospital in Ankara; 36 had a root tear. Reference: arthroscopy.

• The study compared root tears with other medial meniscus tears. Patients with ligament tears, lateral meniscus tears or more advanced arthritis were not included.
• Examined by one of the authors, who did not know the clinical or MRI findings; the surgeon did not know the result of the sign.

Source: Akmese R, Malatyalı B, Kocaoglu H, Akkaya Z, Kalem M. A new clinical sign for diagnosing medial meniscus posterior root tear. Orthopaedic Journal of Sports Medicine 2021;9(1):2325967120975511. PubMed

Later studies

• Paucar-Vergara SM, et al., 2026 (a different research group, Peru): 201 patients, arthroscopy reference. Sensitivity 85.7%, specificity 98.8%, LR+ 74.1, LR− 0.15. Source (abstract source only)
• Joshi A, et al., Journal of Arthroscopic Surgery and Sports Medicine 2026 (a different research group, Nepal): 82 patients, arthroscopy reference, using a modified three-step version of the sign. Sensitivity 94.6% (95% CI 81.8–99.3; 94.5% in the abstract), specificity 93.3% (95% CI 81.7–98.6), LR+ 14.19, LR− 0.06. Source

Forced active buckling (FAB) sign

For: ACL insufficiency (after the acute phase)

Also studied by a second research groupAbstract source only

How it is done

The patient lies on their back. The examiner bends the hip so the knee rests at about 20–30° of flexion, turns the lower leg inwards at the ankle, and applies a slight outward twisting force with the other hand over the knee. The patient then actively straightens the knee.

Positive result

A distinct forward shift (subluxation) of the tibia as the patient straightens the knee.

Published figures

Overall figures as given in the abstract. The paper reports likelihood ratios, but they are not in the abstract.

The study

100 surgical patients in Germany: 50 with an isolated ACL rupture and 50 with an intact ACL and a meniscus tear. Reference: MRI with arthroscopic confirmation. The two groups were recruited separately (50 in each).

• Two surgeons who did not know the diagnosis, with tests done in random order.
• The description of the test here follows the 2025 study below, which used the original method.

Source: Blanke F, Haenle M, Feitenhansl A, Vogt S, Camathias C. The forced active buckling sign: a new clinical test for the diagnosis of ACL insufficiency. Journal of Knee Surgery 2020;33(1):42-47 (online 2018). PubMed

Later studies

• Nguyen LT, et al., 2025 (a different research group, Vietnam): 165 patients booked for knee arthroscopy, including recent injuries. Sensitivity 81.4%, specificity 97.2%. Source

Resisted adduction sit-up test (RASUT)

For: Athletic pubalgia (core muscle injury)

One published study so far

How it is done

The patient lies on their back with hips and knees bent and feet on the bed (knees at 90°). The examiner puts a forearm between the knees. The patient does a sit-up while squeezing both knees against the examiner's forearm.

Positive result

Any pain during the manoeuvre. Where the pain is felt (above or below the inguinal fold) was also recorded.

Published figures

Specificity from the paper's results table. The same study also reported the test for telling pelvic from hip causes of groin pain: sensitivity 63%, specificity 67%.

The study

160 patients with hip or groin pain at a sports medicine institute in New York (204 tested; those without an MRI or surgery were not included). Reference: MRI, and surgery where done.

• Examined by a hip arthroscopist or an athletic pubalgia surgeon; blinding is not stated.
• Specificity is moderate, so a positive result alone says less than a negative one.

Source: Galano GJ, Tyler TF, Stubbs T, et al. Resisted adduction sit-up test (RASUT) as a screening tool for pelvic versus hip pathology. Journal of Hip Preservation Surgery 2021;8(4):331-336. PubMed

Later studies

None found yet.

Standing on single foot-binding (SOSF-B) test

For: Distal tibiofibular syndesmosis instability after an ankle sprain

One published study so far

How it is done

The patient stands on the injured leg for 5 seconds, on a 20° inclined board, compared with the other side. The ankle and lower leg are then firmly wrapped with an elastic bandage and the single-leg stance is repeated.

Positive result

Single-leg stance is abnormal before wrapping (cannot stand for 5 seconds, or at least two of: obvious trunk sway, needing to move the foot, the calf working harder than on the good side), and this improves once the ankle is wrapped.

Published figures

On the 20° board. On a flat surface the study reported a sensitivity of 84.38% and the same specificity.

The study

85 patients with an ankle sprain booked for ankle arthroscopy at a hospital in Beijing; 32 had syndesmosis instability. Reference: arthroscopy (probe opens the joint by more than 1 mm).

• A single examiner; the patients and the surgeon did not know the test results.
• In the study, the bandage was applied at a set pressure measured with a gauge.

Source: Sun S, Tang T, Shi P, et al. Standing on single foot-binding test yields satisfactory results as a novel method for the diagnosis of distal tibiofibular syndesmosis instability. BMC Musculoskeletal Disorders 2024;25(1):53. PubMed

Later studies

None found yet.

Lateral drawer test (Weber B ankle fracture)

For: Ankle mortise instability with an isolated Weber B fibula fracture

One published study so far

How it is done

The patient sits with the ankle in neutral. The examiner steadies the lower leg with one hand and, holding the heel with the other, pushes the foot straight sideways (outwards) without tilting it, feeling for movement with a thumb on the inner side of the ankle. Movement is graded 0 (same as the other side), I (under 5 mm) or II (5 mm or more).

Positive result

Grade II: estimated sideways movement of 5 mm or more.

Published figures

The study

62 consecutive adults seen within a week of an isolated Weber B fracture at two surgeons' clinics in the United States; 30 were unstable. Reference: gravity stress X-ray (medial clear space 5 mm or more).

• Done by two foot and ankle surgeons without seeing the X-rays.
• For acute fracture assessment only; agreement between examiners has not been measured in patients.

Source: Zhao JZ, et al. The lateral drawer test: a new clinical test to assess mortise instability in Weber B fibula fractures. Foot & Ankle Orthopaedics 2022;7(3):24730114221112101. PubMed

Later studies

None found yet.