Diagnostic Test Clusters
One special test rarely settles a diagnosis. These validated combinations raise confidence — learn which tests go together and how to read them.
Cervical Radiculopathy — Wainner's Cluster
Identify nerve-root compression (cervical radiculopathy) in a patient with neck and arm symptoms.
Component tests
3 of 4 positive supports the diagnosis; all 4 positive make it very likely.
3/4 positive → +LR ≈ 6 (post-test probability ~65%). 4/4 positive → +LR ≈ 30 (~90%), specificity ~99%.
Screen with the sensitive ULTT first, then confirm with the specific Spurling and distraction tests.
Subacromial Impingement — Park's Cluster
Detect subacromial (external) impingement of the rotator cuff.
Component tests
All three positive gives the strongest indication of subacromial impingement.
All 3 positive → +LR ≈ 10.6 (post-test probability ~95%).
A single positive impingement test means little — the diagnostic value is in the combination.
Full-Thickness Rotator Cuff Tear — Park's Cluster
Detect a full-thickness rotator cuff tear.
Component tests
All three positive strongly suggests a full-thickness tear — consider imaging.
All 3 positive → +LR ≈ 15.6 (post-test probability ~91%).
Weakness (Drop Arm, Infraspinatus) plus a painful arc points to a complete rather than partial tear.
ACL Rupture
Confirm an anterior cruciate ligament tear.
Component tests
The Lachman is the most sensitive; the pivot shift is the most specific. Agreement across tests increases confidence.
Lachman ~85% sensitivity / ~94% specificity; combining tests reduces missed or over-called tears.
Test acutely with the Lachman (least guarding); a positive pivot shift is highly specific but often needs full relaxation.
Meniscal Tear
Raise or lower suspicion of a meniscal tear.
Component tests
No single meniscal test is reliable alone — combine provocation tests with joint-line tenderness and mechanical symptoms.
The composite examination outperforms any single test: joint-line tenderness is sensitive, McMurray is specific.
Locking/catching + joint-line tenderness + a positive McMurray or Thessaly meaningfully raises the probability.
Lumbar Disc Radiculopathy
Identify lumbar disc herniation with nerve-root involvement.
Component tests
Sensitive neural-tension tests screen; the crossed SLR and a matching neurological deficit add specificity.
SLR ~89% sensitive (good screen); the crossed SLR is far more specific for disc herniation.
A positive crossed SLR (symptoms on the affected side when raising the good leg) strongly points to a disc herniation.
Carpal Tunnel Syndrome
Support a diagnosis of median nerve compression at the wrist.
Component tests
Combine provocative tests with the symptom distribution and night symptoms; confirm with nerve conduction studies where needed.
Symptoms must sit in the median distribution — little-finger involvement points elsewhere (ulnar or cervical).
Femoroacetabular Impingement / Labral Tear
Screen for intra-articular hip pathology (FAI, labral tear).
Component tests
FADIR is a sensitive screen (rules out when negative); FABER helps localize groin (hip) vs posterior (SI joint) pain.
A negative FADIR makes intra-articular hip pathology unlikely; a positive one warrants imaging to characterize it.
Likelihood ratios are approximate values from published clinical prediction rules, for study use — always interpret within the full clinical picture.