Ortho Upper Extremity Specialized Physical Exam Tests

Question 1

Compression pressure test

Answer 1

Applying sustained manual pressure over the ulnar nerve in the ulnar groove

Positive for ulnar neuropathy when they result in paresthesia or pain in ulnar innervated regions of the hand (particularly 4th, 5th digits)

Question 2

Elbow flexion test

Answer 2

Sustained maximal elbow flexion for 1 minute with the wrist in a neutral position

Positive for ulnar neuropathy when they result in paresthesia or pain in ulnar innervated regions of the hand (particularly 4th, 5th digits)

Question 3

Combined elbow flexion w/ pressure

Answer 3

Combine elbow flexion test and compression pressure test

Question 4

External Rotation Strength Testing (shoulder)

Answer 4

External rotation of the shoulder is performed primarily by the infraspinatus

Patient’s elbow is flexed to 90 degrees and held against the patient’s body by the examiner’s hand

Patient actively rotates the arm externally against the resistance of the examiner’s other hand (placed at the wrist)

Question 5

Finkelstein test/maneuver

Answer 5

Full flexion of the thumb into the palm followed by ulnar deviation of the wrist (like shaking a hand

Positive test can indicate de Quervain’s tenosynovitis ( carpi radialis tendon )

Question 6

Hand elevation tests

Answer 6

Raise the hands above the head for 1 minute

Positive: reproduces the symptoms of carpal tunnel syndrome

Question 7

Hawkins-Kennedy Test (Flexion with internal rotation test)

Answer 7

Patient’s shoulder and elbow are flexed at 90 degrees

Clincian stabilizes the shoulder with one hand and internally rotates the shoulder using the other hand

Positive test: pain induced by this maneuver

Useful to help identify rotator cuff tear or rotator cuff tendinopathy

Question 8

Jobe’s test of supraspinatus testing (“Empty Can test”)

Answer 8

Assesses supraspinatus function

Patient places a straight arm in about 90 degrees
of abduction and 30 degrees of forward flexion

Patient is asked to internally rotate the shoulder completely

Clinician attempts to adduct the arm while the patient resists

Pain without weakness suggests tendinopathy.

Pain with weakness is c/w tendon tear

Question 9

Ludington Test

Answer 9

Patient puts his or her hands behind the head and flexes the biceps muscle

Useful to assist in diagnosis of biceps tendon rupture

Question 10

Manual carpal compression

Answer 10

Performed by applying pressure over the transverse carpal ligament

Positive: paresthesia occurs within 30 seconds of applying pressure

Question 11

Neer test (Passive painful arc test)

Answer 11

Clinician passively flexes the glenohumeral joint while simultaneously preventing shoulder shrugging

This maneuver compresses the greater tuberosity against the anterior acromion and elicits discomfort in patients who have a rotator cuff tear or rotator cuff tendinopathy

Useful to assess degree of shoulder impingement
•Pain at 90 degrees is c/w mild impingement
•Pain at 60-95 degrees is c/w moderate impingement
•Pain at 45 degrees is c/w severe impingement

Question 12

Phalen

Answer 12

Patient fully flexes the palms at the wrist with the elbow in full extension to provide extra pressure on the median nerve

Alternative: backs of the hands are placed against each other to provide hyperflexion of the wrist and elbow remain flexed

Positive: pain and/or paresthesia in the median innervated fingers w/ one minute of wrist flexion

Question 13

Posterior Impingement Test

Answer 13

Place affected shoulder in 90 degrees of abduction, 110 degrees of extension and maximal external rotation

Positive test: pain is reproduced

Question 14

Push off test (Gerber’s test)

Answer 14

Assesses strength of subscapularis mucles (primarily responsible for internal rotation)

Have patient place one hand behind his/her back and push posteriorly against resistance

Question 15

Speed’s Test

Answer 15

Useful to assess the biceps tendon

Patient forward flexes the shoulder about 30 degrees against the clinician’s resistance while keeping the elbow fully extended and the arm fully supinated

Positive test: pain is elicited in the bicipital groove (suggests bicipital tendon injury/tendinopathy)

Question 16

Tinel’s test

Answer 16

Wrist: percussion over Guyon’s canal can be performed for assessment of ulnar neuropathy at the wrist

Question 17

Yergason’s test

Answer 17

Useful to assess the biceps tendon

Patient holds his/her arm adducted with the elbow flexed to 90 degrees and the arm fully pronated

Clinician holds hands with the patient and attempts to supinate the patient’s arm while the examiner resists

Positive test: pain is elicited in the bicipital groove (suggests bicipital tendon injury/tendinopathy)