Special Test (UE) Flashcards
-Sitting with hand on opposite shoulder
-Action: lower the elbow
-(+) sign: LOM and pain
-indication: unreduced anterior shoulder dislocation
-(+) sign: pain on AC joint
-Indication: possible AC joint pathology
Dugas test
(Anterior instability test for the shoulder)
-Position 1: sitting
-Action: therapist will load and push the -humeral head anteriorly
-Position 2: supine/ scaption
Same action + ER
-Ind: atraumatic GH joint instability
Load and Shift test
(Anterior instability test for the shoulder)
-Seated with arms at the side
-Action: ER of shoulder at different angles
-(+) sign: at 45, 90 and 120 degrees there is apprehension and at 0 degrees -apprehension is rare
-Indication: anterior shoulder instability
Rockwood test for Anterior Instability
(Anterior instability test for the shoulder)
-Position: supine
-Action: place arm in 90 abduction + ER slowly
-(+) sign: apprehension/ resistance in motion
-Indication: traumatic anterior instability
- Apprehension test/ crank test
(Anterior instability test for the shoulder)
-Position: continuation of apprehension test
-Action: place arm in 90 abduction + ER slowly with hand under pt GH joint
-(+) sign: apprehension
-Indication: traumatic anterior instability
-(+) sign: pain posteriorly
-Indication: posterior internal Impingement
4.a Fulcrum test
(Anterior instability test for the shoulder)
-Position: continue from fulcrum test
-Action: examiner apply posterior translation
-(+) sign: apprehension disappears
-Indication: traumatic anterior instability
-(+) sign: pain posteriorly disappears
-Indication: posterior internal Impingment
4.b Jobe Relocation test
(Anterior instability test for the shoulder)
-Position: continue from jobe
-Action: release posterior translation
-(+) sign: Pain at forward translations
-Ind: GH instability
4.c Anterior release/ Surprise test
(Anterior instability test for the shoulder)
-Action: same as previous but translate posteriorly
-Positive sign: >50%
-Indication: atraumatic GH instability
Load and shift
(Posterior instability test for the shoulder)
-Sitting with shoulder flex and IR
-Action: horizontal adduction and push posteriorly
-(+) sign: clunk
-Indication: posterior instability of the shoulder
2nd part:
-Return to original position
-(+) sign: clunk
-Indication: posteroinferior labral tear
Jerk Test
(Posterior instability test for the shoulder)
-Position: supine with arm in scaption
-Action: one hand on humeral head and push down, one hand on wrist and pull up
-Sign: >50% translation
-Indication: posterior instability
Push-pull test
(Posterior instability test)
-Position: supine
-Action:
Shoulder abduction 60-100 degrees
Shoulder ER: 90 degrees
Elbow flexion: 90 degrees
Then passively horizontal adduct + IR, hand also pushes humerus posteriorly
-(+) Sign: humeral head slips posteriorly
-Indication: posterior instability
Norwood stress test
(Posterior instability test)
-Position: standing
-Action: circumduct from ext to abd to flex to add
-(+) Sign: subluxation noted
-Indication: posterior instability
Circumduction test
(Posterior instability test)
Standing with arms at side
Action: pull arm distally
(+) sulcus between humeral head and acromion process
Indication: inferior instability
Grading:
+1= < 1 cm
+2= 1.2 cm
+3= > 2cm
Sulcus sign
(Inferior instability)
Position: standing and arms abducted at 90 degrees
Examiner’s hand on shoulder and pushes in an anterior and inferior force
(+) sign: sulcus between acromion process and humeral head
Indication: antero-inferior instability
Feagin test
(Inferior instability)
Position: supine
Action: full abduction+ ER then push humeral head anteriorly
(+) sign: clunk/ grinding
Indication: labral tear
Clunk test
(Labral pathologies)
Position: standing or sitting (ideally), patient’s hand on waist
Action: examiner pushed elbow anterior and superior
(+): anterior shoulder pain + crack or pop
Indication: labral lesion
Anterior slide test
(Labral pathologies)
Patient in standing
Erratum from discussion:
1st :Arms forward flexed to 90, elbow extended and medially rotated; PT applies downward force to the arm
2nd:Pt goes back to original position and asked to laterally rotate the arm; PT applies downward force to the arm
(+) sign: pain on shoulder joint line on 1st part and dec on 2nd part
Ind: labral abnormalities
Active compression of O’brien
(Labral pathologies)
Part 1: shoulder abducted with neutral rotation (thumbs up)
Action: resist shoulder abduction
Part 2: shoulder abducted, Medially rotate (thumbs down)
Action: resist shoulder abduction
(+): weakness or pain
Indication: supraspinatus tear
Supraspinatus/ empty can test
(Muscle pathology)
Position: elbow extended
Action: resist shoulder forward flexion in supination and pronation
(+): pain in bicipital groove (supination > pronation)
Indication: bicipital paratenonitis/ tendinosis
(+): profound weakness
Indication: severe second or third degree strain of distal biceps suspected
Speed’s test/ biceps test/ straight arm test
(Muscle pathology)
Position: elbow flex and FA pronated
Action: Pt: supinate + ER
Action: PT: palpate long head of biceps tendon and resist supination and ER of patient
(+): tendon pops out or pain
Indication: rupture transverse humeral ligament
Yergason test
(Muscle pathology)
Hands clasped around
Action: actively let patient contract the biceps
PT palpate for long head of biceps tendon
(+): no palpable tension
Ind: rupture of long head of biceps
Ludington test
(Muscle Pathology)
Elbow flex with FA pronated
Action: ask pt to do elbow flexion while PT resist
(+) supinates while elbow flexing
Indication: Normal biceps function
(-) supination while elbow flexing
Indication: rupture of distal biceps
Heuter sign
(Muscle Pathology)
Position: shoulder 90 degrees abduction
Action: pt is asked to slowly lower the arm
(+): inability to slowly lower arm
Indication: rotator cuff tear
Drop arm test
(Muscle Pathology)
Hands on posterior lumbar area
Action: ask patient to lift hands off the back
(+): unable to perform
Indication: subscapularis tear
Lift off sign/ Gerber test
(Muscle pathology)
Position: Pt’s hands on belly, PT’s hands in between Pt’s belly and hand of pt
Action: Pt presses the belly
(+): no pressure felt
Indication: subscapularis tear
Abdominal compression/ Belly press/ Napoleon test
(Muscle pathology)
Position: sitting/ standing
Action: full arm elevation with medial rotation
(+): pain or reproduction of symptoms
Ind: shoulder impingement or overuse in supraspinatus
Neer Impingement
(Shoulder impingement)
Position: sitting/ standing
Action: forward flex + MR
(+): pain or reproduction of symptoms
Ind: supraspinatus paratenonitis or secondary impingement
Hawkin’s Kennedy
(Shoulder impingement)
Hand on opposite shoulder
Ask the patient to elevate elbow
(+): pain or reproduction of symptoms
Ind: supraspinatus paratenonitis or secondary impingement
Yocum test
(Shoulder impingement)
Sitting/ standing
Valgus stress (FA goes to abduction)
(+): increase motion or pain
Ind: MCL injury
Valgus instability
(Elbow ligaments instability)
Sitting/ standing
Varus stress (FA goes to adduction)
(+): increase motion or pain
Ind: LCL injury
Varus instability
(Elbow ligaments instability)
Position: Pt actively makes a fist, wrist extend, RD and pronated
Action: PT provides resistance to patient’s position
(+): pain
Ind: tennis elbow
Cozen’s test
(Lateral Epicondylitis)
Position: PT passively flexes patient’s wrist, extends elbow and pronates FA
(+): pain
Ind: tennis elbow
Mill’s test
(Lateral Epicondylitis)
Position: Pt actively extends the middle finger and PT adds resistance
(+): pain
Ind: tennis elbow
Maudsley’s test
(Lateral Epicondylitis)
Position: wrist + elbow extended passively
(+): pain
Ind: Golfer’s elbow
Golfer’s elbow test
(Medial Epicondylitis)
Action: elbow flexion , wrist extension, shoulder abduction, shoulder depression
(+): tingling in ulnar nerve distribution
Ind: cubital tunnel syndrome
Elbow flexion test
(Neurodysfucntions)
PT passively abducts the fingers
Pt is asked to actively adduct the fingers
(+): little finger remains abd
Ind: ulnar neuropathy
Wartenburg sign
(Neurodysfucntions)
Position: elbow flexion with FA supination
Action: elbow extension with FA pronation
(+): paresthesia of median nn distribution
Ind: Pronator teres syndrome
Test for pronator Teres syndrome
(Neurodysfucntions)
Position: Tip to tip (thumb to index)
Action: ok sign
(+): pulp to pulp
Ind: AIN pathology
Pinch grip/ ok sign
(Neurodysfucntions)
Position: wrist flexion, finger extended
Action: resist finger extension
(+): pain
Ind: Radiocarpal lig injury, inflammation, scaphoid instability, Kienbock’s disease (RISK)
Finger extension test
(FA, wrist and Hand ligament test)
Position: clenched fist
Observe 3rd MCP
(+): 3rd MCP is level with 2nd and 4th
Ind: lunate dislocation
Murphy’s sign
(FA, wrist and Hand ligament test)
FA pronation
Action: push ulna posteriorly
(+): excessive motion
Ind: distal radioulnar joint instability
Piano key test
(FA, wrist and Hand ligament test)
Access structures around PIP
1st part: PIP in neutral, flex the DIP
(+) no DIP Flex
Ind: Retinacular lig/ DIP capsule is tight
2nd part: flex PIP, flex DIP
(+) DIP flexion
Ind: Retinacular lig tightness
(+) no DIP flexion
Ind: DIP capsule tight
Hainnes- Zancolli/ Retinacular test
(FA, wrist and Hand ligament test)
Access structures around MCP
1st part: MCP extended, Flex PIP
(-) PIP flexion
Ind: intrinsic and PIP capsule tight
2nd part: Flex MCP, flex PIP
(+) PIP flexion
Ind: intrinsic muscle tightness
(-) PIP flexion
Ind: PIP capsule tight
Bunnel-littler/ Finochietto-Bunnel Test
(FA, wrist and Hand ligament test)
passively put patient’s thumb in fist and actively ulnar deviate
(+): pain on ET 1
Ind: DQT/ Hoffman’s disease
Finkelstein/ Hoffman’s test
(FA, wrist and Hand ligament test)
Open palm
Ask pt to make a fist
(+) inability to flex 1 DIP
Ind: Ruptured FDP
Sweater Finger
(FA, wrist and Hand ligament test)
Hold paper between index and thumb (lateral prehension)
Examiner pulls the paper
(+) sign: flexion of IP joint
Ind: ulnar nerve paralysis
Froment’s paper sign
(FA, wrist and Hand Neurodysfunction test)
Wrist flexion test
Hold for 1 minute
(+): paresthesia in median nn distribution
Ind: CTS
Phalen’s test
(FA, wrist and Hand Neurodysfunction test)
Wrist extension
Hold for 1 minute
(+): Paresthesia in median nn distribution
Ind: CTS
Reverse Phalen’s test/ Prayer test
(FA, wrist and Hand Neurodysfunction test)
Position: clenched fist
Observe 3rd MCP
(+): 3rd MCP is level with 2nd and 4th
Ind: lunate dislocation
Murphy’s sign
(FA, wrist and Hand ligament test)
FA pronation
Action: push ulna posteriorly
(+): excessive motion
Ind: distal radioulnar joint instability
Piano key test
(FA, wrist and Hand ligament test)
Access structures around PIP
1st part: PIP in neutral, flex the DIP
(+) no DIP Flex
Ind: Retinacular lig/ DIP capsule is tight
2nd part: flex PIP, flex DIP
(+) DIP flexion
Ind: Retinacular lig tightness
(+) no DIP flexion
Ind: DIP capsule tight
Hainnes- Zancolli/ Retinacular test
(FA, wrist and Hand ligament test)
Access structures around MCP
1st part: MCP extended, Flex PIP
(-) PIP flexion
Ind: intrinsic and PIP capsule tight
2nd part: Flex MCP, flex PIP
(+) PIP flexion
Ind: intrinsic muscle tightness
(-) PIP flexion
Ind: PIP capsule tight
Bunnel-littler/ Finochietto-Bunnel Test
(FA, wrist and Hand ligament test)
passively put patient’s thumb in fist and actively ulnar deviate
(+): pain on ET 1
Ind: DQT/ Hoffman’s disease
Finkelstein/ Hoffman’s test
(FA, wrist and Hand ligament test)
Open palm
Ask pt to make a fist
(+) inability to flex 1 DIP
Ind: Ruptured FDP
Sweater Finger
(FA, wrist and Hand ligament test)
Hold paper between index and thumb (lateral prehension)
Examiner pulls the paper
(+) sign: flexion of IP joint
Ind: ulnar nerve paralysis
Froment’s paper sign
(FA, wrist and Hand Neurodysfunction test)
Wrist flexion test
Hold for 1 minute
(+): paresthesia in median nn distribution
Ind: CTS
Phalen’s test
(FA, wrist and Hand Neurodysfunction test)
Wrist extension
Hold for 1 minute
(+): Paresthesia in median nn distribution
Ind: CTS
Reverse Phalen’s test/ Prayer test
(FA, wrist and Hand Neurodysfunction test)
Actively open and close hand and then squeeze
Therapist compress arteries on radial and ulnar side
Pt opens the hand, PT release artery one at a time
(+) slow return of color
Ind: Vascular compromise
Allen’s Test
(FA, wrist and Hand Neurodysfunction test)
