Royal London Hospital Test Special Test
Orthopedic Physical Examination & Clinical Assessment Guide
What is it used for?
- Diagnosing Achilles Tendinopathy.
How to Perform
- Position: Patient lies prone (on stomach) with feet hanging off the table.
- Step 1: Palpate the Achilles tendon for a tender lump while the foot is relaxed (slightly plantar flexed).
- Step 2: Ask the patient to actively dorsiflex the foot (pull toes up) to stretch the tendon, and palpate the tender spot again.
Interpretation of Results
- Positive Test: The tenderness significantly decreases or disappears when the tendon is stretched (dorsiflexed). If pain remains constant, it may indicate paratendonitis rather than tendinopathy.
Diagnostic Accuracy
- Sensitivity: 54%
- Specificity: 91%
Clinical Context & Limitations
The Royal London Hospital Test should be considered as one component of a comprehensive musculoskeletal assessment. No single special test has perfect diagnostic accuracy; thus, clinical decision-making should integrate test results with patient-reported symptoms, mechanism of injury, functional impairment, and relevant imaging.
Clinicians should be aware of potential false-positive results in patients with pain sensitisation, muscle guarding, or poor relaxation. For the Ankle & Foot region, combining the Royal London Hospital Test with complementary examination tests significantly improves overall diagnostic confidence.
References
- Magee, D. J. (2021). Orthopedic Physical Assessment (7th ed.). Elsevier.
