Tests upper Limb

Question 1

apley scratch test

Answer 1

shoulder ROM
Upper -
tests for external rotation and abduction of the shoulder.
The patient reaches behind his or her head to attempt to touch the superior medial angle of the opposite scapula.
Lower -
internal rotation and adduction of the shoulder.
The patient reaches behind his back to touch the inferior angle of the opposite scapula.

Question 2

AC joint dysfuntion test

Answer 2

Cross the arm (AC Joint) to be tested across chest ADDUCTION and place hand on contralateral shoulder
• Raise the Elbow to 90o Flexion (not shown in picture)
• Then have patient actively resist downward force from physician applied to the elbow
• Pain at the AC joint indicative of strain or tear

Question 3

drop arm test

Answer 3

To screen for possible rotator cuff tear
• Have the patient fully ABduct the arm (160-180o)
• Instruct the patient to slowly lower the arm to the side.
• Tearsintherotatorcuff muscles (specifically the supraspinatus) cause the arm to drop to the side once the arm has been lowered to about 90o of abduction.
Deltoid controls ABduction > 90o
• The patient will not be able to lower the arm slowly and smoothly no matter how many times he tries.

Question 4

Empty Can/JOBE Test

Answer 4

have the patient assume a shoulder abduction angle as shown below (90° Abduction with 30° horizontal flexion anterior of coronal plane) and internal rotation (Thumbs DOWN), “like to empty a can”
Doctor applies slight pressure downward on the arm bilaterally to test for Supraspinatus weakness

Question 5

Hawkin’s test

Answer 5

Pronated Arm is Passively Flexed to 90° and elbow to 90° then Internally Rotated while stabilizing the scapula. Impingement between the greater tuberosity of the humerus against the coraco-humeral ligament
Hawkins like a “Hawk’s Wing”
Pain = + TEST

Question 6

neer’s test

Answer 6

Pronated Arm is Passively Flexed anteriorly until hand superior to head while stabilizing scapula.

• Impingementoccurs@ >90o of Flexion
Bring Arm “Neer the Ear”
• Pain=+TEST

Question 7

Infraspinatus/Teres Minor

Answer 7

Test Ability to Externally Rotate against Resistance (Elbow flexed to 90° and arm @ side)
• Patient Attempts to Externally Rotate Against the examiners counterforce
Mainly involved w/ExternalRotation
• Typically torn together, seen w/ massive rotator cuff tears {Watch for Shoulder Shrug while attempting to lift arm}

Question 8

DROPPING TEST/External Rotation Lag Test

Answer 8

flex elbow to 90°, arm tight at side, ROTATE Externally to max point, then release, + if arm returns to Neutral

Question 9

Subscapularis Liftoff Test

Answer 9

internally rotate arm w/ dorsum of hand on lumbar spine, push away w/ resistance from examiner
NOTE: internal rotation. external would be infra/teres minor

Question 10

Apprehension

Answer 10

Pt supine with elbow at 90° and off table, externally rotate arm to reproduce sublimation/dislocation
is used to Evaluate ligamentous laxity/injury and has dislocated/subluxed
• Dislocated – Remains Dislocated and Needs to be Reduced Back into the Glenoid Fossa
• Subluxed – Relocates Spontaneously After Coming Out of the Glenoid Fossa
• Shoulder is Vulnerable in Abduction and/or External Rotation

Question 11

Relocation Test

Answer 11

Posterior pressure is applied to the GH joint being tested, if pain or dislocation sensation is experienced w/ Apprehension test, which gives relief of pain and sense of possible dislocation

Question 12

Yergason’s Test

Answer 12

• Patient’s arm is @ side in 90o elbow flexion and with thumb up
• Patient actively tries to Supinate & Flex Elbow against Physician’s counterforce
* Physician may attempt to externally rotate arm simultaneously
• Anterior shoulder pain @ the Bicipital Groove is indicative of + Test
Used to assess biceps tendon (long head) instability and/or tendonitis

Question 13

Speed’s Test

Answer 13

Testing for Bicipital tendonitis, (long head)
• Patient with Arm Flexed to 90o and Forearm Supinated
• ExaminerResistsForwardFlexion from patient w/ downward force on patient’s wrist
• Painintheanteriorshoulder,site of biceps tendon, = + TEST

Question 14

O’ BRIEN’S TEST

Answer 14

Flex the arm to 90° with the elbow fully extended
• Adduct the arm across body
• The arm is then maximally internally rotated and the patient resists the examiner’s downward/medial force
tear in glenoid labrum
• The procedure is repeated in supination.
Bicipital tendonitis?

Question 15

Cubital Tunnel Syndrome - Tinel elbow

Answer 15

from side, arm abducted to 90°, elbow flexed to 90°, wrist extended maximally.
Tap proximal to medial epicondyle

Question 16

Lateral Epicondylitis - no named

Answer 16

• Pain with Resisted Supination
(opposite of Medial epi)

Pain at the lateral epicondyle at point of forearm extensor complex attachment (ECRB origin) – extensor carpi radialis brevis
• AKA “tennis elbow”
• Seen with repetitive
supination motion (Overuse Syndrome)

Question 17

Medial Epicondylitis

Answer 17

resisted pronation and/or wrist flexion
(opposite of lateral epi)

Pain at the medial epicondyle at point of forearm flexor complex
attachment (FCR origin) – flexor carpi radialis
• AKA“golferselbow”
• Seenwithrepetitivepronation
motion (Overuse Syndrome)
• Maydevelopdecreasedgrip strength if prolonged

Question 18

Phalen Test

Answer 18

upside down Prayer

Shoulder at 90° abduction, elbow flexion, and both wrists are flexed by opposing the dorsal surface of each hand. Keep arms parallel to the ground
• Wrist flexion and medial force is maintained for sixty seconds.
• This test is positive if there is numbness, tingling, or pain that follows the distribution of the median nerve into the thumb and next three digits.
• This test can be positive in carpal tunnel syndrome.

*** CAN BE REVERSED like praying

Question 19

Tinel wrist Test

Answer 19

Extend wrist maximally
Tapping over the median nerve over the transverse carpal ligament region.
• This test is positive if there is numbness, tingling, or pain that follows the distribution of the median nerve into the thumb and next three digits.
• This test can be positive in carpal tunnel syndrome.

Question 20

Finkelstein’s

Answer 20

flex the MCP and IP joint of the thumb (place thumb inside fist) while applying ulnar deviation to the wrist (bend towards ulnar)

This is a test for De Quervain’s Tenosynovitis
• This involves the tendons of the extensor pollicis brevis (EPB) and the abductor pollicis longus (APL)
• Also, you may palpate over the tendon sheaths on the anterior aspect of the anatomic snuff box (APL & EPB) tendons
• This test is positive (+) if there is pain over this area or elicited from the ulnar deviation of the wrist/hand

Question 21

Lateral Epicondylitis - Maudsley’s

Answer 21

resisted flexion of middle finger
+ = Pain at the lateral epicondyle at point of forearm extensor complex attachment (ECRB origin) – extensor carpi radialis brevis

Question 22

Lateral Epicondylitis - Mill’s

Answer 22

make a fist
resisted extension of wrist
+ = Pain at the lateral epicondyle at point of forearm extensor complex attachment (ECRB origin) – extensor carpi radialis brevis