UE special tests Flashcards
What two tests can be used to identify biceps tendonopathy? Tell how to do them.
yergasons: pt’s arm at belly, move out to resist you while completing ER/supinatin
- can feel tendon pop out if transverse lig not good
- 70s SN, 50s SP
speeds: UE held out straight, supinated
- push down so they resist arm descending into ext.
- 90s SN, 10s SP
What is neer’s impingement test?
neer to ear: pt sitting -> you stabilize the scapula, then passively internally rotate his shoulder, then elevate it
- check neutral elevation first
- SN 88, SP 30
USED FOR SOFT TISSUE IMPINGEMENT aka supraspinatus, long head of biceps
What’s the difference between the empty can and the drop arm test?
empty can = identifies tear or impingement of supraspinatus
- resist abduction at neutral 90deg elevation
- then resist abduction at IR position with 30deg forward from horizontal (empty can position)
vs
drop arm = testing for tear or full rupture of rotator cuff
- passively abduct pt’s arm to 120, tell pt to slowly bring it down to side
What are the anterior/posterior apprehension sign tests?
anterior: pt supine, shoulder at 90deg abd
- slowly take shoulder into ER -> pt doesn’t like it
- can tell you about previous shoulder dislocations
posterior: pt supine with shoulder abducted 90deg
- bring shoulder into IR and horizontal adduction while giving posterior force at humerus -> pt doesn’t like it
What is the clunk test used for?
identifying labral tear
How do you do the clunk test?
pt supine, shoulder in full abduction
- push humeral head anterior while externally rotating humerus
- audible “clunk” is heard
What is the posterior impingement test? What structures may be impinged if this is positive (vs neer)?
posterior impingement
- pt supine: move shoulder into 90deg abd, max ER, 15-20deg horizontal adduction
- pain in posterior shoulder
identifies impingement between rotator cuff/greater tuberosity or posterior glenoid/labrum
What is the AC shear test?
clasp your two hands together: one heel of hand is on spine of scap, one heel of hand is on clavicle
- you press them together and compress AC
- positive for reproducible pain in AC
What does Adson’s test look at?
identifies pathology of structures that run through thoracic inlet
How do you do adson’s test?
pt sitting
- you find radial pulse on testing arm -> slightly extend and ER straight arm, then extend/rotate head towards tested side
What are the three tests you can use for thoracic outlet, and how are they differentiated?
1) Adson’s (extend arm, extend/turn head)
2) Roos (arms in 90/90, open/close hands for 3min)
3) Allen’s maneuver (pt’s arm supported in 90/90, look away, monitor radial pulse for diminished/gone)
How do you perform Hawkins-Kennedy?
pt’s shoulder put into 90deg shoulder flexion with elbow bent to 90deg
- therapist passively IRs arm, positive for subacromial impingement if pain
When extending your whole arm down to fingers, supinated, and then side bending away with head, what nerve are you putting on tension?
median
How do you test the radial nerve?
elbow extended, wrist pronated, wrist flexed/ulnar dev, fingers flexed, IR at shoulder -> side bend away
What is the rent sign test for? How do you perform?
Used to identify RTC tear or impingement
- in seated, bring arm into extension with elbow bent; rotate into IR/ER
- palpate anterior to anterior acromion, looking to feel prominent greater tuberosity and depression of 1 finger width if a tear
What’s the difference between the crank test and clunk test?
clunk test = looks for labrum tear
- put shoulder in full abd, prop up anterior humeral head
- externally rotate shoulder listening for clunk
crank test = looking at instability and/or labral tear
- abduct arm to 160deg, axial load, crank into ER/IR listening for click or pain
What’s the bear hug test for? What other test looks at the same thing?
subscap tear
- cross arm over body, hand on opposite shoulder
- “compress your shoulder and press down with your hand, keeping elbow in the air”
belly press also tests for subscap tear
What does the horizontal adduction test look at?
ac joint dysfunction or subacromial impingement
- supposed to be a passive test
What tests are used for impingement?
Neer, Yocum, Hawkins-Kennedy, horizontal adduction
What tests are used to identify a labral tear?
clunk (prop up anterior humeral head)
active compression (IR arm push down, ER arm push dwn)
biceps load (arm 120/90 and pulling bicep in)
crank (axial load)
What tests are used for bicipital tendonopathy/osis?
yergasons
speed’s
What is the active compression test used for? how do you do it?
straight arm out in 90deg flexion, 10 adduction
- IR arm, resist push down
- ER arm, resist push down
If pain with IR but relief with ER -> AC joint dysfxn
If pain/click with IR but reduced/eliminated with ER -> SLAP
What is tennis elbow? How do you test for it?
lateral epicondylosis -> test with Cozens
- pt sitting with elbow in 90deg flexion, supported on table
- resist wrist ext, radial dev, and forearm pronation with fingers flexed into a fist (all at same time)
*can also be tested with Mills: passive flexion of wrist and fingers and all that
What muscle is commonly indicated in lateral epicondylosis?
ECRB
What is the golfer’s elbow test?
pt’s arm supported on table, supinate arm, extend elbow then wrist
- pain occurs over medial epicondyle
- indicates potential medial epicondylosis
You suspect your patient may have pronator teres syndrome. How would you test for this? What nerve do you think is implicated?
pts sitting, arm supported w/ elbow at 90
- resist elbow extension and forearm pronation simultaneously
- reports of tingling/parasthesias over MEDIAN nerve distribution indicate positive
What does Finklesteins test look for?
de Quervain’s tenosynovitis (paratendonitis of APL and or EPB)
EPB = extensor pollicis brevis APL = abductor pollicis longus
What is the Bunnel-Littler test?
looks at intrinsic tightness at the PIP joints
- MCP joint stabilized in slight ext. while PIP is flexed
- then MCP is flexed and PIP joint is flexed
During Bunnel-Littler test, if you flex the MCP and get more range in the PIP, what does this mean?
intrinsic muscles are tight vs capsule tightness
capsule tightness wouldn’t change with MCP flexion, PIP range would remain same
How do you test for tight retinacular?
PIP stabilized in neutral, flex DIP
- then flex PIP then DIP
increased range with flexion? retinacular ligaments are tight (if both limited, capsule tight)
What nerve innervates the thenar emminence? How do you test for it?
hold piece of paper between fingers and try to pull it out
- froment’s sign: seeing flexion of distal IP of thumb as compensation
How do you perform phalen’s?
FLEX both wrists, hold for 1 minute
What is Allen’s test? (note test, not maneuver)
test: have pt open/close hand quickly for several reps, block ulnar artery and then have them make a fist
- hold for a second then observe filling when they open
- do same for radial a.
What tests can be used to look for median nerve compression in carpal tunnel?
phalen’s
tinel’s
flick test: flick hands, can relieve parasthesias
Where can you test for compression of the ulnar n.?
tinel’s sign in cubital tunnel
