Special tests Flashcards
Apprehension test
Technique: patient in supine with the shoulder in 90 degrees of abduction. Slowly take the patient into external rotation.
What is it used to diagnose?: anterior instability
Relocation
Technique: With a positive apprehension test a posterior translation is applied to the humeral head. Positive test if the patient loses symptoms with posterior translation.
What is it used to diagnose?: Anterior instability.
Jerk Test (posterior)
patient is seated and then has the shoulder flexed to 90 degrees and internally rotated. Axially load the humerus and horizontally adduct the arm. The test is positive if there is a sudden jerk or clunk as humeral head subluxes off the back of the glenoid.
diagnoses posterior instability
Sulcus sign
Technique:
patient in standing - patients arm by the side - patients arm is pulled distally. The test is positive if the sulcus is inferior to the acromion combined with reproduction of symptoms.
What is it used to diagnose?:
inferior instability.
hawkins kennedy test
Technique:
patient in sitting or standing - shoulder is passively flexed to 90 degrees and then internally rotated maximally - positive test if pain is reproduced
What is it used to diagnose?: subacromial impingement
neer test
Technique:
patient in sitting arm is internally rotated and passively flexed fully - positive if reproduces pain
What is it used to diagnose?: subacromial impingement
painful arc
Technique: arm pain between 60 and 120 degrees of abduction
What is it used to diagnose?: subacromial impingement and also in the cluster for rotator cuff
empty can test
Technique: patient seated with 90 degrees of shoulder abduction - patient placed in the empty can position and inter
positive if it reporoduces pain in the supraspinatus tendon and weakness.
What is it used to diagnose?:
drop arm
Technique: patient in sitting with their shoulder passively abducted to 120 degrees and the patient is instructed to slowly lower the arm down to their side. if the patient cannot lower their arm, the test is positive. Make sure to guard the arm so that they do not get hurt.
What is it used to diagnose?:
rotator cuff pathology.
external rotation lag sign
Technique: passively abduct the shoulder to 90 degrees and externally rotate the shoulder to end range. Instruct the patient is maintain the position of the shoulder. If the patient cannot maintain the position, positive test.
What is it used to diagnose?:
rotator cuff pathology.
infraspinatus muscle test
Technique: patient is in sitting or standing - resisting external rotation with the arm neurtrally rotated and adducted to the trunk. positive test if the patient cannot hold resistance
What is it used to diagnose?: rotator cuff (infrapsinatus)
Hornblower sign
Technique: patient is in standing: passivelt elevate the arm to 90 degrees in scapular plan and flex the elbow to 90 degrees. patient externally rotates the arm against resistance. Positive test if the patient cannot externally rotate the arm.
What is it used to diagnose?: rotator cuff pathology (infraspinatus)
internal rotation lag sign
Technique: seated - hand behind the back in the lumbar region in full internal rotation. Positive if the patient is unable to maintain the position.
What is it used to diagnose?: rotator cuff injury - subscapularis
Horizontal adduction test
Technique: patient is in standing. Arm is flexed to 90 degrees. arm is actively and passively adducted across the body. positive if the test reproduces pain in the AC joint
What is it used to diagnose?: AC joint pathology.
paxinos
Technique: patient is in sitting with the arm at the side. pressure applied to the ac joint with the fingers.
What is it used to diagnose?: ac joint pathology
Active compression (obriens)
Technique: patient is in standing and arm is flexed to 90 degrees and elbow is fully extended. arm is horizontally adducted to 15 degrees, fully internally rotated and downward force given to the arm. Arm is then returned to the starting position and fully externally rotated and done once again. Test is positive if the internal rotation hurt and the external rotation did not.
What is it used to diagnose?: SLAP lesion labrum
Biceps load II
Technique: patient is in supine and the arm is abducted to 120 degrees, elbow flexed to 90 degrees and forearm supinated. shoulder is fully externally rotated. if apprehension appears then ask the patient to resist against flexion. test is positive if apprehension remains the same or the shoulder becomes more painful.
What is it used to diagnose?: SLAP labrum
anterior slide test
Technique: arm with hand on the hip. anterior and superior force applied to the elbow. Positive test if pain or click is reproduced.
What is it used to diagnose?: SLAP
compression rotation test
Technique: Patient is in supine, shoulder passively abducted 20-90 degrees - axial compression is applied while passively circumducting the GH joint. Positive test if there is pain popping or clicking.
What is it used to diagnose?: SLAP
Yergason (supination test )
Technique: arm in neutral against the side with the forearm pronated. Patient supinates against resistance.
What is it used to diagnose?: Used for transverse ligament integrity, bicipital tendenosis, and SLAP lessions.
Speeds test
Technique: arm in full extension and forearm supinated - resist shoulder flexion. may also place the shoulder in 90 degrees of flexion and push the upper limb into extension causing an eccentric contraction of the biceps. positive test if there is pain in the anterior shoulder.
What is it used to diagnose?: bicipital tendinopathy, SLAP, and transverse ligament integrity.
UPPER LIMB TENSION TESTS FOR NEUROLOGICAL TESTING
ULTT A - median
ULTT B - ulnar
ULTT C - radial
identifies peripheral nerve dysfunction by stressed the neurological tissue.
positive tests are reproduction of symptoms.
Adsons
Technique: in sitting, find the radial pulse. rotate the head toward the involved upper extremity and then extend and exxternally rotate the shoulder while extending the head.
positive test is reproduction of neuro and vascular symptoms AND loss of radial pulse
What is it used to diagnose?: Thoracic outlet syndrome.
ROOS - elevated arm test.
Technique: patient in standing with the shoulders fully externally rotated and abducted to 90 degrees. for 3 minutes the patient opens and closes their hands.
positive if the same symptoms as the adsons test are reproduced.
What is it used to diagnose?: thoracic outlet test
Elbow extension test
Technique: positive if the patient is unable to fully extend the elbow.
What is it used to diagnose?: fracture or joint injurt
Valgus/varus test
Technique: patient in sitting or supine with the elbow places in 0 to 20 degrees of elbow flexion. Varus and valgus stress imposed on the joint in order to determine which ligament is lax.
What is it used to diagnose?: ligamentous instability
moving valgus stretch
Technique: patient is standing or supine - arm abducted and elbow fully flexed - maintain the valgus stress and quickly extend the patients elbow.
Reproduction of pain from 70 to 120 degrees of elbow flexion indicates an ulnar collateral ligament tear.
What is it used to diagnose?: UCL tear
elbow flexion test
Technique: patient in supine - performed bilaterally with the shoulder in full ER and the elbow actively held in maximal flexion with wrist extension for one minute.
positive if pain is present at the medial aspect of the elbow and the numbness and tingling in the ulnar distribution of the involved side.
What is it used to diagnose?:Neurological dysfunction/cubital tunnel syndrome.
pinch grip test
Technique: patient asked to pinch the index finger and the thumb together.
positive if the patient is unable to complete this activity.
What is it used to diagnose?: entrapment of the anterior interosseous nerve
ulnomeniscotriquetral dorsal glide test
Technique: patient is seated with the arm pronated - posteriorly directed force applied with examinaers thumb over the ulna and index finger over the pisotriquetral complex anteriorly.
excessive pain or instability indicated triangular fibrocartilage complex pathology.
What is it used to diagnose?:triangular fibrocartilage complex pathology -
watson test - Scaphoid shift test
technique: patient is seated - elbow resting on the table - forearm pronated - wristed placed in full ulnar deviation with slight extension while stabilizing the metacarpals. —pressure is placed on the distal pole of the scaphoid while radially deviating and slightly flexing the patients hand.
a painful shift of the scaphoid indicates carpal instability.
What is it used to diagnose?: scaphoid and carpal instability.
eichoffs test + finkelstein test
technique: patient makes a fist with tumb flexed within confines of fingers
What is it used to diagnose?: identify the weird name tendon condition for the thumb synovitis. - basically tendonitis of the abductor pollicis longus and extensor pollicis brevis.
wrist hyperabduction and abduction of the thumb test WHAT
technique:
What is it used to diagnose?: same as finkelstein and eichmoff
phalen test
technique: identifies carpal tunnel compression. Patient maxes wrists together and holds them for one minute. positive test if it reproduces their symptoms in the median nerve distribution.
what is it used to diagnose?: Carpal tunnel syndrome.
two point discrimination test
technique: identifies the level of sensory innervation within hand that correlated with functional ability to perform certain tasks involving grasp.
using a caliper, apply to the palmar surface of the fingers to assess the patients ability to distinguish between two points of testing device - record the smallest difference
NORMAL is less than 6mm can be distinguished.
What is it used to diagnose? : loss of sensation
tinel sign
can be used at any nerve entrapment site in order to reproduce tingling and or paresthesias into the hand.
modified allen test
technique: identify radial and ulnar arteries at the wrist and then have the patient open and close the fingers quickly several times and then make a closed fist.
compress the ulnar artery and have the patient open the hand. observe the palm of the hand and then release the artery and observe for vascular filling
what is it used to diagnose?: vascular compromise of the radial or ulnar artery.
bunnel littler test
technique:MCP is stabilized in slight extension whil the PIP is flexed. - then the MCP is flexed and the PIP is flexed.
differentiates between tight intrisic muscles and tight tight capsule
(if flexion is limited in both then the capsule is tight)
(if more PIP flexion with MCP flexion then the intrinsic muscles are tight)
What is it used to diagnose: tightness of the PIP joints
tight retinacular test
technique: PIP is stabilized in neutral while DIP is flexed —-then the PIP is flexed and the DIP is flexed —differentiates between a tight fapsule and a tight reticular ligament. IF flexion is limited in both cases, then the capsule is tight. If more DIP fleixion with PIP flexion then retinacular ligaments are tight.
What is it used to diagnose: tightness around the PIP joints
