Special Tests UE Flashcards
Yergason’s Test
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
Speed’s Test
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
Neer’s Impingement Test
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
Clunk Test
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
AC Shear Test
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
Adson’s Test
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
Costoclavicular Syndrome (military brace) test
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
Wright (hyperabduction) test
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
Allen’s Maneuver
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
Rent sign
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
Bear hug test
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
Medial epicondylitis (golfers elbow) test
Patient sitting with elbow in 90 degrees flexion and supported. Passively supinate forearm, extend elbow, and extend wrist
Pronator Teres syndrome test
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
Elbow flexion test
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
Finkelstein’s test
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
Bunnel-Littler test
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
Tight Retinacular test
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.
Froment’s sign
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
Two-point discrimination test
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
Allen’s test (wrist)
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
Flick Test
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
