Special Tests Descriptions UE

Question 1

Apprehension Test for Anterior Shoulder Dislocation

Answer 1

• Patient positioned in supine
• Shoulder Abduction 90, Elbow Flexion 90
• Therapist laterally rotates patient’s shoulder
• Positive test indicated by look of apprehension or a facial grimace prior to reaching an end point

Question 2

Apprehension Test for Posterior Shoulder Dislocation

Answer 2

• Patient supine
• Shoulder in 90 of Flexion and Medial Rotation
• Therapist applies posterior force through long axis of the humerus
• Positive test indicated by look of apprehension or a facial grimace prior to reaching an end point

Question 3

Speed’s Test

Answer 3

Biceps Tendon Pathology

• Patient in sitting or standing
• Elbow Extended and Forearm Supinated
• Therapist palpates bicipital groove and places the other hand on volar surface of forearm
• Therapist resists active shoulder flexion
• Positive test indicated by pain or tenderness in the bicipital groove region

Question 4

Yergason’s Test

Answer 4

Biceps Tendon Pathology

• Patient in sitting
• Elbow Flexed 90 and forearm pronated, humerus stabilized against patient’s thorax
• Therapist palpates bicipital groove and places the other hand on the patient’s forearm
• Patient instructed to actively supinate and laterally rotate against resistance
• Positive test indicated by pain or tenderness in bicipital groove

Question 5

Drop Arm Test

Answer 5

Rotator Cuff Pathology/Impingement

• Patient in sitting or standing
• Shoulder Abducted to 90
• Patient instructed to slowly lower arm to side
• Positive test indicated by patient failing to slowly lower the arm or by the presence of sever pain

Question 6

Hawkins-Kennedy

Answer 6

Rotator Cuff Pathology/Impingement

• Patient in sitting or standing
• Therapist flexes patient’s shoulder to 90 and then medially rotates the arm
• Positive test indicated by pain. May involve the supraspinatus tendon

Question 7

Infraspinatus Test

Answer 7

Rotator Cuff Pathology/Impingement

• Patient in standing
• Elbow Flexed to 90 and Shoulder in 45 of Medial Rotation
• Patient resists as therapist applies medial pressure to forearm
• Positive test indicated by pain or weakness, suggesting infraspinatus strain/tear

Question 8

Neer Impingement Test

Answer 8

Rotator Cuff Pathology/Impingement

• Patient in sitting or standing
• Therapist puts one hand on posterior aspect of scapula and other hand stabilizing elbow
• Therapist takes arm through flexion
• Positive test indicated by facial grimace or pain, and may indicate impingement of supraspinatus tendon

Question 9

Supraspinatus Test

Answer 9

Rotator Cuff Pathology/Impingement

• Patient has arm in 90 of Abduction, and 30 of Horizontal Adduction with the thumb downward
• Therapist resists patient’s attempt to abduct arm
• Positive test indicated by weakness or pain, may indicate tear of the supraspinatus tendon, impingement or suprascapular nerve involvement

Question 10

Adson Maneuver

Answer 10

Thoracic Outlet Syndrome

• Patient in sitting or standing
• Therapist monitors radial pulse, asks patient to rotate head to face the test shoulder. Then asked to extend head while therapist laterally rotates and extends the patient’s shoulder
• Positive test indicated by absent or diminished radial pulse

Question 11

Allen Test (1)

Answer 11

Thoracic Outlet Syndrome

• Patient in sitting or standing
• Test arm in 90 of abduction, lateral rotation, and elbow flexion
• Patient rotates head away from the test shoulder
• Therapist monitors radial pulse
• Positive test indicated by an absent or diminished pulse when head rotates away

Question 12

Roos Test

Answer 12

Thoracic Outlet Syndrome

• Patient in sitting or standing
• Arms positioned in 90 of abduction, lateral rotation, and elbow flexion
• Patient opens/closes hands for 3 minutes
• Positive test indicated by inability to maintain test position, weakness of arms, sensory loss or ischemic pain

Question 13

Varus Stress Test

Answer 13

Ligamentous instability

• Patient in sitting
• Elbow in 20 to 30 degrees of flexion
• Therapist places one hand on elbow, and one proximal to the patient’s wrist
• Therapist applies a varus force to test the Lateral Collateral Ligament while palpating lateral joint line
• Positive test indicated by increased laxity in the LCL when compared to the contralateral limb, apprehension, or pain

Question 14

Valgus Stress Test

Answer 14

Ligamentous Instability

-Same as Varus Test, but therapist applies a valgus force to test the Medial Collateral Ligament

Question 15

Cozen’s Test

Answer 15

Epicondylitis

• Patient in sitting
• Elbow in slight flexion
• Therapist places thumb on lateral epicondyle and stabilizes elbow joint
• Patient asked to make a fist, pronate, radially deviate and extend wrist against resistance
• Positive test indicated by pain in lateral epicondyle region or muscle weakness

Question 16

Lateral Epicondylitis Test

Answer 16

Epicondylitis

• Patient in sitting
• Therapist stabilizes elbow and other hand on dorsal aspect of patient’s hand distal to PIP
• Patient asked to extend 3rd digit against resistance
• Positive test indicated by pain or muscle weakness in lateral epicondyle region

Question 17

Medial Epicondylitis Test

Answer 17

Epicondylitis

• Patient in sitting
• Therapist palpates medial epicondyle region and supinates the patient’s forearm, extends the wrist, extends the elbow
• Positive test indicated by pain in medial epicondyle region

Question 18

Tinel’s Sign (elbow)

Answer 18

Neurological Dysfunction

• Patient in sitting
• Therapist taps between the olecranon process and medial epicondyle
• Positive test indicated by tingling sensation in the ulnar nerve distribution of the forearm, hand, fingers.
• May indicate ulnar nerve compression or compromise

Question 19

Ulnar Collateral Ligament Instability Test

Answer 19

Ligamentous Instability - “Gamekeeper’s thumb” or “Skier’s Thumb.”

• Patient in sitting
• Therapist holds patient thumb in extension and applies valgus force to the MCP joint of thumb
• Positive test indicated by excessive valgus movement
• May indicate tear of the Ulnar collateral and accessory ligaments

Question 20

Allen Test

Answer 20

Vascular Insufficiency

• Patient in sitting or standing
• Patient opens / closes hand several times in succession, then maintains hand in closed
• Therapist compresses radial and ulnar arteries
• Patient relaxes hand and therapist releases pressure on one of the arteries while observing hand color
• Positive test indicated by delayed or absent flushing of the radial or ulnar half of the hand
• May indicate radial or ulnar artery occlusion

Question 21

Froment’s Sign

Answer 21

Neurological Dysfunction

• Patient in sitting or standing
• Patient holds piece of paper between thumb and index finger
• Therapist attempts to pull paper away from patient
• Positive test indicated by patient flexing distal phalanx of the thumb due to adductor pollicis muscle paralysis.
• If at the same time, the patient hyperextends the MCP joint of the thumb, it is termed Jeanne’s Sign
• Both findings may indicate ulnar nerve compromise or paralysis

Question 22

Phalen’s Test

Answer 22

Neurological Dysfunction

• Patient in sitting or standing
• Therapist flexes patient’s wrist maximally and asks the patient to hold the position for 60 seconds
• Positive test indicated by tingling in thumb, index, middle fingers and lateral half of the ring finger
• May indicate carpal tunnel syndrome due to median nerve compression

Question 23

Tinel’s Sign (wrist/hand)

Answer 23

Neurological Dysfunction

• Patient in sitting or standing
• Therapist taps over volar aspect of the wrist
• Positive test indicated by tingling of thumb, index, middle fingers, lateral half of the ring finger distal to the contact site
• May indicate carpal tunnel syndrome due to median nerve compression

Question 24

Finkelstein Test

Answer 24

Miscellaneous

• Patient in sitting or standing
• Asked to make a fist with the thumb tucked inside the fingers
• Therapist stabilizes patient’s forearm and ulnar deviates wrist
• Positive sign indicated by pain over abductor pollicis longus and extensor pollicis brevis tendons at the wrist
• May indicate tenosynovitis in the thumb (de Quervain’s disease)