Special Tests UE

Question 1

Yergason’s Test

Answer 1

Tests for transverse ligament integrity along with bicipital tendonosis/tendonopathy

Patient sits with shoulder in neutral, elbow at 90 degrees and forum pronated. Resist supination of forearm and ER of shoulder

Tendon of biceps pops out of groove, may reproduce pain along biceps tendon

Question 2

Speed’s Test

Answer 2

Identifies bicipital tendonosis/tendonopathy

Patient can sit or stand with UE in full extension and supinated. Resist shoulder flexion or resist at 90 degrees of flexion

Reproduces symptoms in long head biceps

Question 3

Neer’s Impingement Test

Answer 3

For impingement of soft tissues structures of shoulder complex (long head biceps, and supraspinatus)

Patient sits and shoulder is passively, internally rotated, then fully abducted.

Reproduces symptoms of pain within shoulder region

Question 4

Clunk Test

Answer 4

Identifies glenoid labrum tear

Patient supine, with shoulder in full abduction. Push humeral head anterior while rotating humorous externally

Audible clunk is heard while performing

Question 5

AC Shear Test

Answer 5

Identifies dysfunction of the AC joint

Patient sitting with arm resting at side. Examiner clasps hand and places heel of one hand on clavicle. Squeeze hands together, causing compression of AC joint

Reproduces pain at AC joint

Question 6

Adson’s Test

Answer 6

Identifies pathology of structures that pass through thoracic inlet

Patient sits. Find radial pulse of extremity being tested, rotate head toward extremity being tested, then extend and ER the shoulder while extending the head.

Neurological and/or vascular symptoms (disappearance of pulse) will reproduce in upper extremity

Question 7

Costoclavicular Syndrome (military brace) test

Answer 7

Identifies pathology of structures that pass through thoracic inlet

Patient sits. Find radial pulse of the extremity being tested. Move involved shoulder down and back.

Neurological and/or vascular symptoms (disappearance of pulse) will reproduce in upper extremity

Question 8

Wright (hyperabduction) test

Answer 8

Identifies pathology of structures that pass through thoracic inlet

Patient sits. Find radial pulse. move shoulder into maximal abduction and ER. Taking deep breath and rotating head opposite to side being tested may accentuate symptoms

Neurological and/or vascular symptoms (disappearance of pulse) will reproduce in upper extremity

Question 9

Allen’s Maneuver

Answer 9

Identifies the presence of TOS

Patient is relaxed in sitting. Arm should be 90 abduction and full ER. The elbow should be in 90 flexion. Patient rotates the head to the side oppose the arm being tested while the examiner palpates the radial pulse. The examiner can also palpate the radial pulse continuously as the patient moves from having the arm in a neutral position as the patient moves the arm and head into the end position of the test.

Positive test if pulse diminishes after head rotation

Question 10

Rent sign

Answer 10

Identifies a torn rotator cuff or rotator cuff impingement

Patient seated with arm relaxed and examiner stands to the rear of the patient. Examiner palpates anterior to the anterior edge of the acromion with 1 hand while holding the patient’s flexed elbow with the other. Examiner passively extends the shoulder while slowly rotating the shoulder into ER and IR

Greater tuberosity will be prominent and a depression of about 1 finger width will be felt if rotator cuff is torn

Question 11

Bear hug test

Answer 11

Identifies for presence of subscapularis tear

Patient is sitting or standing with their hand placed on the opposite shoulder with the elbow anterior to the body. The examiner then applies an ER force while the patient attempts to maintain the hand on the shoulder

Test is positive if patient can’t hold the hand against the shoulder as examiner applies ER force

Question 12

Medial epicondylitis (golfers elbow) test

Answer 12

Patient sitting with elbow in 90 degrees flexion and supported. Passively supinate forearm, extend elbow, and extend wrist

Question 13

Pronator Teres syndrome test

Answer 13

Identifies median nerve entrapment within pronator trees

Patient sitting with elbow in 90 degrees flexion and supported/stabilized. Resist forearm pronation and elbow extension simultaneously

Reproduces tingling or paresthesia within median nerve distribution

Question 14

Elbow flexion test

Answer 14

Identifies the presence of cubital tunnel syndrome

Patient supine. Performed bilaterally with the shoulder in full ER and the elbow actively held in maximal flexion with wrist extended for one minute

Positive if pain is present at the medial aspect of the elbow and numbness and tingling in the ulnar distribution on the involved side

Question 15

Finkelstein’s test

Answer 15

Identifies de Quervain’s tenosynovitis

Patient makes fist with thumb within confines of fingers. Passively move wrist into ulnar deviation

Reproduces pain in wrist. Often painful with no pathology so compared to uninvolved side

Question 16

Bunnel-Littler test

Answer 16

Identifies tightness in structures surrounding the MCP joints

MCP joint is stabilized in slight extension while PIP joint is Then MCP joint is flexed and PIP joint is flexed.

Differentiates between a tight capsule and tight intrinsic muscles. If flexion is limited in both cases, capsule tight. If more PIP flexion with MCP flexion, then intrinsic muscles are tight

Question 17

Tight Retinacular test

Answer 17

Identifies tightness around PIP joint

PIP is stabilized in neutral while DIP is flexed. Then PIP is flexed and DIP is flexed.

Differentiates between a tight capsule and a tight reticular ligaments. If flexion is limited in both cases, capsule is tight. If more DIP flexion with PIP flexion, then reticular ligaments are tight.

Question 18

Froment’s sign

Answer 18

Identifies Ulnar nerve dysfunction

Patient grasps paper between 1st and 2nd digits of hand. Pull paper out and look for IP flexion of thumb, which is compensation due to weakness of adductor policies

Patient unable to perform test without compensating may indicate ulnar nerve dysfunction

Question 19

Two-point discrimination test

Answer 19

Identifies level of sensory innervation within hand that correlates with function ability to perform certain tasks involving grasp

Patient sitting with hand stabilized. Using a caliper, two-point discriminator, or paper clip, apply device to palmar aspect of fingers to assess patient’s ability to distinguish between 2 points and testing device. Record smallest difference that patient can sense 2 separate points

Normal amount that can be discriminated is <6mm

Question 20

Allen’s test (wrist)

Answer 20

Identifies vascular compromise

Find radial and ulnar pulses in wrist. Have patient open and close fingers quickly several times and then make a closed fist. Compress the ulnar artery and have them open hand. Observe palm of hand and then release the compression on artery and observe for vascular filling (repeat test for radial artery)

Positive if abnormal filling of blood within hand during test. Normal circumstances will have change in color from white to normal appearance on palm of hand

Question 21

Flick Test

Answer 21

Identifies carpal tunnel syndrome

With patient in sitting or standing, patient moves hand like shaking down a thermometer.

Patient performed the shaking motion to reduce the symptoms of the wrist