Download Positive Test

LOWER BODY
 Review
 Foot ankle, knee, hip
Palpations
 PALPATIONS Phalanges, Metatarsals, Head of 1st MT,
Sesmoids,
Base of 5th MT, Dome of Talus, Medial
Malleolus, Calcaneus, Lateral Malleolus, Shaft of Tibia,
Shaft of Fibula, Metatarsal Heads, Anterior Tibiofibular
Ligament, Anterior Talofibular Ligament,
Calcaneofibular Ligament, Posterior Tibiofibular
Ligament, Achilles Tendon, Deltoid Ligament, Plantar
Fascia, DIPs, PIPs, Tarsal Bones
ROM and special tests
 SPECIAL TESTS: AROM Plantarflexion, AROM
Dorsiflexion, AROM Eversion, AROM Inversion, MMT
Plantarflexion, MMT Dorsiflexion, MMT Inversion, MMT
Eversion, Anterior Drawer in Neutral, Talar Tilt, Kleiger
Stress Test, Percussion (Bump) Test, Thompson Test,
Homan’s Sign, Compression Test
Homan’s Test
 Homan’s test
 Test for deep vein thrombophlebitis
 With knee extended and foot off table, ankle is moved into
dorsiflexion
 Pain in calf is a positive sign and should be referred
 https://www.youtube.com/watch?v=qKs8X4CMu5Y
Thompson Test
 Thompson test
 Squeeze calf muscle, while foot is extended off table to test
the integrity of the Achilles tendon
 Positive tests results in no movement in the foot
 https://www.youtube.com/watch?v=HPkaNdG2uus
Compression test
 https://www.youtube.com/watch?v=ZksAQ2mZNX0
 Percussion and compression tests
 Used when fracture is suspected
 Compression test involves compression of tibia and fibula
either above or below site of concern
Percussion Test
 https://www.youtube.com/watch?v=UEm11O-AGhQ
 Used when fracture is suspected
 Percussion test is a blow to the tibia, fibula or heel to create
vibratory force that resonates w/in fracture causing pain
 Ankle Stability Tests
 Anterior drawer test
 Used to determine damage to anterior talofibular ligament
primarily and other lateral ligament secondarily
 A positive test occurs when foot slides forward and/or
makes a clunking sound as it reaches the end point
 https://www.youtube.com/watch?v=zjauu5gXF2A
Talar tilt
 Talar tilt test
 Performed to determine extent of inversion or eversion
injuries
 With foot at 90 degrees calcaneus is inverted and excessive
motion indicates injury to calcaneofibular ligament and
possibly the anterior and posterior talofibular ligaments
 If the calcaneus is everted, the deltoid ligament is tested
 https://www.youtube.com/watch?v=Ow8Y-HJwGqA
Anterior Drawer Test
Talar Tilt Test
 Kleiger’s test
 Used primarily to determine extent of damage to the
deltoid ligament and may be used to evaluate distal ankle
syndesmosis, anterior/posterior tibiofibular ligaments and
the interosseus membrane
 With lower leg stabilized, foot is rotated laterally to stress
the deltoid
 https://www.youtube.com/watch?v=LnB1fta_rQA
Knee
 Palpations = Tibial Spine, fibula head, patella, Patella
inferior pole, tibial tubercle, gerdy’s tubercle, patella
superior pole, gastrocnemious, patella tendon,
quadriceps, hamstrings
ROM
 AROM Flexion, AROM Extension, AROM
Plantarflexion, AROM Dorsiflexion, AROM Abduction,
AROM Adduction, MMT Flexion, MMT extension, MMT
Plantarflexion, MMT Dorsiflexion, MMT Abduction,
MMT Adduction
Special Tests

Valgus Stress Test (full extension)

Steps Patient is supine with the involved leg close to the edge of the table and the knee
in full extension Examiner supports the medial portion of the distal tibia with one hand
while the other hand grasps the knee along the lateral joint line. Examiner applies a
medial (valgus) force to the knee & the distal tibia is moved laterally while the knee is in
complete extension

Positive Test
Increased laxity, pain, and guarding

Positive Test Implications
Injury to the MCL, medial joint capsule; probable ACL/PCL involvement if there is no
endpoint
https://www.youtube.com/watch?v=6dQS0A9QQpc
Varus Stress Test
 Steps: Patient is supine with the involved leg close to the edge of the
table and the knee is in full extension. Examiner supports the lateral
portion of the distal tibia with one hand while the other hand grasps
the knee along the medial joint line. Examiner applies a lateral (varus)
force to the knee & the distal tibia is moved medially while the knee is
in complete extension
 Positive Test
Increased laxity, pain, and guarding
 Positive Test Implications
Injury to the LCL, lateral joint capsule, & arcuate ligament; probable PCL
(& maybe ACL) involvement if there is no endpoint
https://www.youtube.com/watch?v=vFPsnWhjh6E
Lachman’s
 Patient is supine with his/her knee passively flexed to approximately 20
degrees & hands crossed across his/her chest. Examiner's thumb of the
same–side hand as the knee to be examined is placed at the anterior medial
tibial plateau/joint line, while digits 2–5 are positioned posterior, slighty distal
to the popliteal fossa. Examiner's contralateral hand is placed laterally around
the distal femur, just proximal to the patella with the thumb anterior & the digits
2–5 are positioned posteriorly. Examiner sets the tibia by pushing posterior (to
make sure the PCL is in tact). Examiner provides an anterior force to the tibia
while applying posterior pressure to the femur; repeats the process 2–3 times
 Positive Test
Increased anterior tibial translation, pain
 Positive Test Implications
ACL tear (primary posterolateral bundle but also the anteromedial bundle)
https://www.youtube.com/watch?v=gfN-p-xZx24
Anterior Drawer
Steps Patient is lying supine with his/her hip flexed 45 degrees & knee flexed 90 degrees
Examiner sits on the patient's foot & grasps the tibia just below the joint line
Examiner's thumbs are placed along the joint line on either side of the patellar tendon & the index fingers are
used to palpate the hamstring tendons
Examiner ensures that the patient is relaxed, esp. the hamstring tendons
Examiner draws the tibia straight forward (no rotation)
Positive Test
Increased anterior tibial translation, pain
Positive Test Implications
ACL tear (mainly the anteromedial bundle because the posterolateral bundle is basically laxed in this position)
https://www.youtube.com/watch?v=yQdBrr3Mmj0
Posterior Drawer
Steps Patient is lying supine with his/her hip flexed to 45 degrees & knee flexed to 90 degrees
Examiner sits on the patient's foot & grasps the tibia just below the joint line
Examiner's thumbs are placed along the joint line on either side of the patellar tendon
Examiner ensures that the patient is relaxed, esp. the quadriceps
Examiner pushes the tibia posteriorly
Positive Test
Increased posterior tibial translation, pain
Positive Test Implications
PCL tear
https://www.youtube.com/watch?v=KAUDTMu8fS0
McMurry’s Test
Steps
Patient is supine
Examiner stands lateral & distal to the involved knee with one hand supporting the lower leg
Examiner positions thumb & index finger of the opposite hand in the anteromedial & anterolateral joint lines on either side of the
patellar tendon
Examiner keeps the tibia in the neutral position, applies a valgus stress through knee flexion & varus stress through knee extension
Examiner internally rotates the tibia & applies a valgus stress through knee flexion & a varus stress through knee extension
Examiner externally rotates the tibia & applies a valgus stress through knee flexion & a varus stress through knee extension
Positive Test
Popping, clicking, or locking of the knee; pain from within the joint
Positive Test Implications
Possible meniscus tear
https://www.youtube.com/watch?v=fkt1TOn1UfI
Apley’s Compression
Steps - Patient is prone with his/her knee flexed to 90
degrees
Examiner applies pressure to the plantar aspect of the heel,
applying an axial load to the tibia while simultaneously
internally & externally rotating the tibia
Positive Test
Pain; possible clicking
Positive Test Implications
Possible meniscus tear
https://www.youtube.com/watch?v=At0FdkHaCGo
Ober’s test
Steps - Patient is lying on the side opposite that being tested
Examiner stabilizes the pelvis with one hand and the lateral side of the examiner's hip
against the patient's pelvis
Examiner grasps the femur above the knee with the other hand & abducts & extends the
hip
Examiner allows the hip to passively adduct to the table with the knee straight
Positive Test
Leg does not adduct past parallel
Positive Test Implications
IT Band tightness
https://www.youtube.com/watch?v=zNH-2reV5uE
hip
 Palpations (hip) greater trochanter, PSIS, ASIS, iliac
crest.
 AROM hip flexion, MMT hip flexion, AROM hip
extension, MMT hip extension, AROM adduction, MMT
Adduction, AROM Abduction, MMT Abduction,
Special Tests

Trendelenburg's Test

Steps

Athlete stands with the feet evenly distributed (i.e. approximately shoulder–width apart from each other)

Examiner sits or kneels behind the athlete

Examiner slightly lowers the athlete's shorts so that the examiner may palpate the right & left PSIS and/or iliac crests

Examiner instructs the athlete to flex the hip thereby lifting the right (and then the left knee) while observing the pelvis

Positive Test

The PSIS or iliac crest on the same side as the leg lifted will drop in relation to the contralateral side

Positive Test Implications

Contralateral (i.e., stance leg) gluteus medius weakness
 https://www.youtube.com/watch?v=MZuPBL_rTns

Gaenslen's Test

Steps

Athlete is supine, lying close to the side of the table

Examiner allows the near leg to hang over the side edge of the table

Examiner instructs the athlete to actively flex the other leg to his/her chest & hold

Examiner stabilizes the athlete & applies pressure to the near leg, forcing it into hyperextension

Positive Test

Pain in the SI region

Positive Test Implications

SI joint dysfunction
 https://www.youtube.com/watch?v=vPPp1wEEQFQ
 Babinski Test
 Steps
 Run metal edge of neurlogic hammer, or fingernail along the tplantar
surface of the foot from the calcaneus, along the lateral border of the foot
to the forefoot
 Positive Test
 Great toe extension with flexion and splaying of the lateral four toes
 Positive Test Implications
 Upper motor neuron lesion
 https://www.youtube.com/watch?v=kOq5Np0eZ6A
Piriformis Tightness Test

Steps

Athlete is side–lying with the test leg being the uppermost leg

Athlete's test leg is flexed at the hip to about 60° & the knee flexed

Examiner stabilizes the hip with one hand & applies a downward pressure to the knee

Positive Test

Piriformis muscle pain; buttock pain; sciatica pain

Positive Test Implications

Piriformis tightness (piriformis muscle pain); piriformis muscle pinching the sciatic nerve
(buttock pain and sciatica pain)

https://www.youtube.com/watch?v=QzFng74fueY

https://www.youtube.com/watch?v=sEu4jhBnIAs
90–90 Straight Leg Raising Test

Steps

Athlete lies supine with the hips and knees flexed to 90°

Athlete grasps behind both of his/her thighs to stabilize the hip joints

Athlete actively extends each knee in turn

Positive Test

Unable to extend the knee to within 20° of full knee extension

Positive Test Implications

Hamstring muscle tightness

https://www.youtube.com/watch?v=A5yl1r2sTxw

https://www.youtube.com/watch?v=ChfnY2ZMR0I
Thomas Test

Steps

Athlete is supine with his/her knees bent at the end of the table

Examiner places one hand between the lumbar lordotic curve & the tabletop

Examiner passively flexes one of the athlete's legs to his/her chest, allowing the knee to flex during the movement

Examiner observes the involved leg for movement

Positive Test

The knee of the leg on the table cannot flex past 90° (i.e. the knee of the leg on the table will extend as the examiner
flexes the contralateral hip); the involved leg (i.e. the leg on the table) rises up off the table (i.e. the contralateral hip to the
one being moved will flex)

Positive Test Implications

Rectus femoris tightness (the knee extends as the examiner flexes the hip); iliopsoas tightness (the leg on the table will
rise off of the table)

https://www.youtube.com/watch?v=NbRXi-nZVJs
Upper Body
Shoulder, elbow, hand and wrist
palpations
 Palpations: Scapula, Scapula inferior angle, scapular
inferior angle, coracoid process, clavicle, bicipital
groove, humerus, sternoclavicular joint, bicep, tricep,
supraspinatus, pectoralis major, rhomboids.
ROM
 AROM Flexion, MMT flexion, AROM extension, MMT
extension, AROM Abduction, MMT abduction, AROM
Adduction, MMT adduction, AROM internal rotation,
MMT internal rotation, AROM external rotation, MMT
external rotation, AROM circumduction, AROM
elevation, AROM depression
Special Tests

Acromioclavicular Joint Compression Test

Steps :Patient is sitting or lying supine with the involved arm relaxed at the

Examiner stands on the invovled side, placing one hand on the patient's clavicle and the
other hand on the spine of the scapula

Examiner gently squeezes the hands together, noting any movement at the
acromioclavicular joint

Positive Test

Pain and/or movement of the clavicle

Positive Test Implications

Acromioclavicular and/or coracoclavicular ligament sprain

https://www.youtube.com/watch?v=mf8xI9GApMw
side

Empty Can Test

StepsPatient stands with both shoulders abducted to 90°, horizontally adducted
30°, and internally rotated so the patient's thumbs face the floor

Examiner resists the patient's attempts to actively abduct both shoulders

Positive Test

Weakness and/or report of pain

Positive Test Implications

Involvement of the supraspinatus muscle and/or tendon
https://www.youtube.com/watch?v=KAgCzTN5vnI
Yergason Test
Steps
Patient is sitting or standing with the elbow flexed to 90° and forearm positioned so
that the lateral border of the radius faces upward (neutral position)
Examiner stands on the involved side and places one hand on the patient's forearm and the
other near the bicipital groove
Examiner resists the patient's attempt to actively supinate the forearm and externally rotate the
humerus
Positive Test
Pain and/or snapping in the bicipital groove
Positive Test Implications
Bicipital tendinitis or tear/laxity of the transverse humeral ligament
https://www.youtube.com/watch?v=9zmQuzrWmr8

Speed's Test

Steps Patient is sitting or standing with shoulder flexed to 90°, the elbow fully extended
and the forearm supinated

Examiner places one hand on the patient's forearm and the other hand over the bicipital
groove

Examiner resists the patient's attempt to actively flex the humerus forward

Positive Test

Tenderness and/or pain in the bicipital groove

Positive Test Implications

Bicipital tendinitis

https://www.youtube.com/watch?v=N00gA4Pvsbw

Drop Arm Test

Steps Patient is sitting or standing with the involved arm fully abducted

Patient then slowly lowers the arm back to their side

Positive Test

Patient is unable to slowly return the arm to the side and/or has significant pain when
attempting to perform the task

Positive Test Implications

Rotator cuff pathology

https://www.youtube.com/watch?v=CEKWtmyPsTA

Positive test https://www.youtube.com/watch?v=qvwYEoeHPaA

Hawkins–Kennedy Impingement Test

Steps Patient is sitting or standing with upper extremities relaxed

Examiner grasps the patient's elbow with one hand and the patient's wrist with the other
hand

Examiner forward flexes the shoulder to 90 degrees° and then internally rotates the
patient's shoulder

Positive Test

Pain and apprehension during the motion

Positive Test Implications

Possible shoulder impingement of the supraspinatus or long head of the biceps brachii
tendon

https://www.youtube.com/watch?v=hzgQcLuaFLw

Pectoralis Major Contracture Test

StepsPatient lies supine with both hands clasped together behind the head

Examiner stands behind the patient

Examiner passively moves the patient's elbows towards the table

Positive Test

Patient is unable to passively have their elbow(s) reach the table

Positive Test Implications

Pectoralis major muscle contracture

https://www.youtube.com/watch?v=hELvntEPpE0

Neer Impingement Test

Steps Patient is sitting or standing with upper extremities relaxed

Examiner grasps the patient's scapula (posteriorly) with one hand and the elbow (anteriorly)
with the other hand

Examiner stabilizes the patient's scapula and then passively and maximally forward flexes the
patient's shoulder

Positive Test

Shoulder pain and apprehension

Positive Test Implications

Shoulder impingement, particularly of the supraspinatus and biceps long head tendons

https://www.youtube.com/watch?v=U8-yLHQ_JaM
Elbow
 Palpations = Olecranon fossa, olecranon process,
medial epicondyle, lateral epicondyle, cubital tunnel,
capitulum, radius, ulna, humerus, bicep, tricep, flexor
muscles, extensor muscles, brachioradialis
ROM
 AROM Flexion, AROM Extension, AROM Pronation,
AROM Supination, MMT Flexion, MMT extension, MMT
pronation, MMT Supination

Steps Athlete is sitting

Examiner stabilizes the involved elbow while palpating along the lateral epicondyle

With closed fist, the athlete pronates and radially deviates the forearm and extends
the wrist against the examiner's resistance

Positive Test

Pain along the lateral epicondyle region of the humerus or objective muscle weakness
as a result of complaints of discomfort

Positive Test Implications

Lateral epicondylitis

https://www.youtube.com/watch?v=ehYTeDN4usc
Lateral Epicondylitis
Test/Resistive Tennis
Elbow Test/Cozen's Test
 Steps
extended
Athlete is sitting with elbow fully
 Examiner passively pronates the forearm and
flexes the athlete's wrist
 Positive Test
 Pain along the lateral epicondyle region of the
humerus
 Positive Test Implications
 Lateral epicondylitis
LATERAL EPICONDYLITIS
TEST/PASSIVE TENNIS ELBOW TEST

Steps Athlete is sitting or standing and makes a fist with the involved side

Examiner faces the athlete and palpates along the medial epicondyle with one hand
and grasps the athlete's wrist with the other hand

Examiner passively supinates the forearm and extends the elbow, wrist and fingers

Positive Test

Complaints of discomfort along the medial aspect of the elbow

Positive Test Implications

Medial epicondylitis

https://www.youtube.com/watch?v=7rBCpk3jFaQ
Medial Epicondylitis
Test/Golfer's Elbow Test
 Steps
Athlete is sitting or standing
 Athlete maximally flexes the elbow and holds the position for 3 to 5
minutes
 Positive Test
 Radiating pain into the median nerve distribution in the athlete's
arm and/or hand
 Positive Test Implications
 Cubital fossa syndrome
 https://www.youtube.com/watch?v=wMIlm9SULvo
ELBOW FLEXION TEST

Steps Athlete is sitting with elbow flexed to 20 to 30 degrees

Examiner stands with the distal hand around the athlete's wrist (laterally) and the proximal hand
over the athlete's elbow joint (medially)

Examiner stabilizes the wrist and applies a varus stress to the elbow with the proximal hand

Positive Test

Lateral elbow pain and/or increased varus movement with diminished or absent endpoint

Positive Test Implications

Radial (lateral) collateral ligament sprain

https://www.youtube.com/watch?v=jUKxFwh5QjU
VARUS STRESS TEST

Steps Athlete is sitting with elbow flexed to 20 to 30 degrees

Examiner stands with the distal hand around the athlete's wrist (laterally) and the proximal hand
over the athlete's elbow joint (medially)

Examiner stabilizes the wrist and applies a varus stress to the elbow with the proximal hand

Positive Test

Lateral elbow pain and/or increased varus movement with diminished or absent endpoint

Positive Test Implications

Radial (lateral) collateral ligament sprain

https://www.youtube.com/watch?v=jUKxFwh5QjU
VARUS STRESS TEST
 StepsAthlete is sitting with the elbow flexed to 20 to 30 degrees
 Examiner stands with distal hand around the athlete's wrist (medially) and
the proximal hand over the athlete's elbow joint (laterally)
 Examiner stabilizes the wrist and applies a valgus stress to the elbow with the
proximal hand
 Positive Test
 Medial elbow pain and/or increased valgus movement with a diminished or
absent endpoint
 Positive Test Implications: Ulnar (medial) collateral ligament sprain
 https://www.youtube.com/watch?v=KXQxH0UTn-8
VALGUS STRESS TEST
 StepsAthlete is sitting with the elbow in slight flexion
 Examiner grasps athlete's wrist (laterally) with distal hand
 Examiner stabilizes the wrist and taps on the ulnar nerve in the ulnar notch
with the index finger
 Positive Test
 Tingling along the ulnar distribution of the forearm, hand and fingers
 Positive Test Implications
 Ulnar nerve compromise
 https://www.youtube.com/watch?v=CPJpT_C0I4k
TINEL'S SIGN TEST
 Steps
Athlete is sitting or standing
 Examiner instructs athlete to pinch the tips of the thumb and index
finger together
 Positive Test
 Inability to touch the tips of the thumb and index finger together
or touching the pads of the thumb and index finger together
 Positive Test Implications
 Pathology of the anterior interosseous nerve between the two
heads of the pronator muscle
PINCH GRIP TEST
Palpations
 Ulna, radius, carpal bones, scaphoid, hook of hamate,
metacarpals, proximal phalanx, middle phalanx, distal
phalanx, ulnar/radial carpal joint, metacarpal
phalangeal joint, proximal interphalangeal joint, distal
interphalangeal joint, interphalangeal joint (thumb only).
Hand/Wrist
 AROM wrist flexion, MMT wrist flexion, AROM wrist
extension, MMT wrist extension, AROM ulnar
deviation, MMT ulnar deviation, AROM radial deviation,
MMT radial deviation, AROM flexion of MCP joint,
MMT flexion of MCP joint, AROM extension of MCP
joint, MMT extension of MCP joint, AROM PIP flexion,
AROM PIP extension, AROM DIP flexion, AROM DIP
extension, AROM phalanges 2-5 abduction, AROM
phalanges 2-5 adduction, AROM thumb flexion, AROM
thumb extension, AROM thumb abduction, AROM
thumb adduction, AROM thumb opposition.
Special Tests
 Tap/Percussion Test
 Steps
Athlete is sitting or standing with finger extended
 Examiner applies a firm tap to the end of the finger being
tested
 Positive Test
 Pain at the site of injury
 Positive Test Implications
 Possible fracture
 (NO VIDEO)
 MP Torsion/Grind/Compression, Transverse Compression
Test
 Steps
Athlete is sitting or standing with finger extended
 Examiner holds the distal phalanx and applies compression along
the axis of the bone of the finger being tested
 Positive Test
 Pain at the site of injury
 Positive Test Implications
 Possible fracture
 https://www.youtube.com/watch?v=_cKMVReLLLk

Finkelstein Test

Steps Athlete is sitting or standing and forms a fist around the thumb

Examiner grasps the athlete's forearm with the proximal hand and the athlete's fist with
the distal hand

Examiner stabilizes the athlete's forearm with the proximal hand and ulnarly deviates the
athlete's wrist and the distal hand

Positive Test

Pain over the abductor pollicis longus and extensor pollicis brevis tendons distally

Positive Test Implications

Possible tenosynovitis or pollicis longus and extensor pollicis brevis tendons

https://www.youtube.com/watch?v=41mBOd-rr6M
 Phalen Test
 Steps
Athlete is sitting or standing with the dorsal aspect of
both hands in full contact so that both wrists are maximally flexed
 Athlete applies a steady compressive force through the forearms so
that the wrists are maximally flexed for 1 minute
 Positive Test
 Numbness and tingling in the median nerve distribution of the fingers
 Positive Test Implications
 Carpal tunnel syndrome or median nerve compression
 https://www.youtube.com/watch?v=RpGHYujo37o
 Tinel's Sign Test (Radial & Ulnar Nerve)
 Steps
Athlete is sitting next to a flat surface
 Examiner taps the volar aspect of the athlete's wrist over the area of the
carpel tunnel
 Positive Test
 Tingling, paresthesia or pain in the area of the thumb, index finger, middle
finger, and radial one–half of the ring finger
 Positive Test Implications
 Compression of the median nerve in the carpal tunnel or carpal tunnel
syndrome
 https://www.youtube.com/watch?v=XcDhqKRT2aU&spfreload=1
 https://www.youtube.com/watch?v=cx_YgYzlbw0
 Murphy's Sign Test
 Steps
 Athlete is sitting or standing
 Athletes makes a fist and examiner observes the position of the third
metacarpal
 Positive Test
 Third metacarpal is level with the second and fourth metacarpals
 Positive Test Implications
 Dislocated lunate
 Fromet's Sign Test
 Steps
Patient is asked to hold a piece of paper
between the thumb and index finger while the examiner
attempts to pull it away
 Positive Test
 Flexion of the first IP joint
 Positive Test Implications
 Adductor pollicis paralysis due to ulnar nerve damage
 https://www.youtube.com/watch?v=yJTIhm1VfSI

Long Finger Flexion Test

Steps Examiner maintains stabilization of digits in extension except for digit being tested

Examiner stabilizes MCP and PIP of digit being tested

Examiner asks patient to flex DIP

If suspected flexor digitorum superficialis rupture repeat without stabilization of PIP and ask patient to flex PIP

Positive Test

Loss of flexion of DIP

Loss of PIP flexion

Positive Test Implications

Flexor digitorum profundus rupture or nerve damage

Flexor digitorum profundus and superficialis rupture or nerve damage

https://www.youtube.com/watch?v=q4mXkUQ2sD0