UE Special Tests

Question 1

List 3 special tests that test for shoulder dislocation.

Answer 1

Apprehension test for anterior dislocation
Apprehension test for posterior dislocation
Sulcus sign

Question 2

Describe the position, procedure, and positive findings for the apprehension test for anterior dislocation.

Answer 2

Position: Supine with arm in 90 degrees of abduction

Laterally rotate the shoulder

Positive test indicated by a look of apprehension or facial grimace prior to reaching an end point

Question 3

Describe the position, procedure, and positive findings for the apprehension test for posterior dislocation.

Answer 3

Supine with the arm in 90 degrees of flexion and medial rotation

Apply posterior force through the long axis of the humerus

Positive test: look of apprehension or a facial grimace prior to reaching an end point

Question 4

Describe the position, procedure, and positive findings for the sulcus sign.

Answer 4

Standing, position the arm in 20-50 degrees of abduction

Grasp patient’s elbow and pull the arm inferiorly

Positive for inferior instability if sulcus sign present (depression seen between the acromion and humeral head)

Question 5

List 3 special tests that test for biceps tendon pathology.

Answer 5

Ludington’s test
Speed’s test
Yergason’s test

Question 6

Describe the position, procedure, and positive findings for the Ludington’s test.

Answer 6

Patient positioned in sitting

Ask pt to clasp both hands behind the head with the fingers interlocked.
Ask pt to alternately contract and relax the biceps.

Positive test indicated by absence of movement in the biceps tendon and may be indicative of a rupture of the long head of the biceps.

Question 7

Describe the position, procedure, and positive findings for the Speed’s test.

Answer 7

Sitting or standing with the elbow extended and the forearm supinated

Place one hand over the bicipital groove and the other hand on the volar surface of the forearm. Resist active shoulder flexion.

Positive test indicated by pain or tenderness in the bicipital groove region and may be indicative of bicipital tendonitis

Question 8

Describe the position, procedure, and positive findings for the Yergason’s test.

Answer 8

Sitting with 90 degrees of elbow flexion and the forearm pronated

Stabilize humerus against patients thorax. Place one hand on the patient’s forearm and the other hand over the bicipital groove. Tell patient to actively supinate and ER against resistance.

Positive test indicated by pain or tenderness in the bicipital groove and may be indicate of bicipital tendonitis.

Question 9

Describe the position, procedure, and positive findings for the drop arm test.

Answer 9

Sitting or standing with the arm in 90 degrees of abduction.

Ask pt to slowly lower arm to their side

Positive test indicated by pt failing to slowly lower the arm to their side or by the presence of severe pain and may be indicative of a tear in the RTC.

Question 10

Describe the position, procedure, and positive findings for the Hawkins-Kennedy Impingement test.

Answer 10

Sitting or standing

Passively flex shoulder to 90 degrees and then medially rotate the arm

Positive test indicated by pain and may be indicative of shoulder impingement involving the supraspinatus tendon

Question 11

Describe the position, procedure, and positive findings for the infraspinatus test.

Answer 11

Standing with elbow flexed to 90 degrees and shoulder in 45 degrees of IR

Ask patient to resist medially directed force to the forearm

Positive test indicated by pain or weakness which may indicate the presence of an infraspinatus strain/tear

Question 12

Describe the position, procedure, and positive findings for the lateral rotation lag sign test.

Answer 12

Standing

Elbow bent, passively move shoulder into 20 degrees of scaption and near end range shoulder ER. Ask patient to hold this position.

Positive test indicates infraspinatus and/or supraspinatus pathology if the patient cannot hold the position.

Question 13

Describe the position, procedure, and positive findings for the lift off sign (medial rotation lag sign) test.

Answer 13

Standing with dorsum of hand on low back

Ask patient to lift their hand up, off of their low back and hold this position.

Positive test indicates subscapularis lesion if patient is unable to hold the position.

Question 14

Describe the position, procedure, and positive findings for the Neer Impingement test.

Answer 14

Sitting or standing

Position one hand on the posterior aspect of the patient’s scapula and the other hand stabilizing the elbow. Elevate the patient’s arm through flexion.

Positive test is indicated by a facial grimace or pain and may be indicative of shoulder impingement involving the supraspinatus tendon.

Question 15

Describe the position, procedure, and positive findings for the supine impingement test.

Answer 15

Supine

Passively move the patient’s shoulder into full flexion. Laterally rotate and adduct the shoulder so that the arm is near the patient’s head. Then medially rotate the shoulder.

Positive test if patient experiences a significant increase in pain with medial rotation.

Question 16

Describe the position, procedure, and positive findings for the supraspinatus test.

Answer 16

Arm in 90 degrees of abduction followed by 30 degrees of horizontal adduction with the thumb pointing downward.

Resist patient’s attempt to abduct the arm.

Positive test indicated by weakness or pain and may be indicative of a tear of the supraspinatus tendon, impingement of subscapular nerve involvement

Question 17

List 5 special tests that test for thoracic outlet syndrome.

Answer 17

Adson maneuver 
Allen test
Costoclavicular syndrome test 
Roos test
Wright test (hyperabduction test)

Question 18

Describe the position, procedure, and positive findings for the Adson maneuver.

Answer 18

Sitting or standing

Monitor radial pulse and ask patient to rotate their head to face the test shoulder. Ask patient to extend their head while PT laterally rotates and extends the shoulder.

Positive test indicated by an absent or diminished radial pulse and may be indicative of thoracic outlet syndrome.

Question 19

Describe the position, procedure, and positive findings for the Allen test.

Answer 19

Sitting or standing with arm in 90 degrees of abduction, lateral rotation and elbow flexion.

Ask patient to rotate the head away from the test shoulder while the PT monitors the radial pulse.

Positive test indicated by an absent or diminished pulse when the head is rotated away from the test shoulder. May indicate presence of thoracic outlet syndrome.

Question 20

Describe the position, procedure, and positive findings for the costoclavicular syndrome test.

Answer 20

Sitting

Monitor the radial pulse and assist the patient to assume a military posture.

Positive test indicated by an absent or diminished radial pulse and may be indicative of TOS caused by compression of the subclavian artery between the first rib and the clavicle.

Question 21

Describe the position, procedure, and positive findings for Roos test.

Answer 21

Sitting or standing with the arms in 90 degrees of abduction, ER, and elbow flexion.

Patient is asked to open and close their hands for three minutes.

Positive test is indicated by the inability to maintain the test position, weakness of the arms, sensory loss or ischemic pain. May indicate TOS.

Question 22

Describe the position, procedure, and positive findings for the Wright test (hyperabduction test).

Answer 22

Sitting or supine

Move patient’s arm overhead in the frontal plane while monitoring the patient’s radial pulse.

Positive test is indicated by an absent or diminished pulse and may be indicative of compression in the costoclavicular space.

Question 23

Describe the position, procedure, and positive findings for the acromioclavicular crossover test.

Answer 23

Sitting

Passively move the patient’s arm into 90 degrees of shoulder flexion, then fully adduct the shoulder (can also be performed actively).

Positive if patient feels pain over the AC joint.

Question 24

Describe the position, procedure, and positive findings for the active compression test (O’Brien’s test).

Answer 24

Standing with shoulder flexed to 90 degrees, horizontally adducted 10-15 degrees and medially rotated so the thumb points down.

Ask patient to resist downward force on the arm. Then, laterally rotate the shoulder and resist the same downward force.

Positive for superior labral tear if patient experiences pain when the shoulder is in medial rotation but has decreased pain with shoulder ER.

Question 25

Describe the position, procedure, and positive findings for the glenoid labrum tear test.

Answer 25

Supine

Place one hand on the patient’s posterior humeral head while the other hand stabilizes the humerus proximal to the elbow. Passively abduct and ER the arm over the patient’s head and then apply an anterior directed force to the humerus.

Positive test indicated by a clunk or grinding sound any may indicate a glenoid labrum tear.

Question 26

Describe the position, procedure, and positive findings for the Jerk test.

Answer 26

Sitting with shoulder elevated to 90 degrees in medial rotation with elbows bent.

Apply axial compression force through the patient’s elbow while horizontally adducting the shoulder.

Sudden clunk or jerk = presence of posterior instability
Complaint of pain can indicate the presence of posterior labral lesion.

Question 27

Describe the position, procedure, and positive findings for the painful arc test.

Answer 27

Sitting

Patient actively abducts shoulder and reports start/stop range of any pain

Positive for subacromial impingement if pain is reported between 60-120 degrees of abduction

Question 28

Describe the position, procedure, and positive findings for the Hornblower sign.

Answer 28

Standing

Passively elevate arm to 90 degrees of scaption and flex the elbow to 90 degrees. Ask patient to ER shoulder against resistance.

Positive for rotator cuff pathology if unable to laterally rotate the arm.

Question 29

Describe the position, procedure, and positive findings for Paxinos sign.

Answer 29

Seated with arm relaxed at side

Palpate AC joint and mid clavicle and apply pressure over those areas

Positive for AC joint involvement if there is pain in the AC joint

Question 30

When is a sensitization test used during upper limb neural tension testing?

Answer 30

Used if symptoms are minimal or absent after the neural test position is assumed

Question 31

List the upper limb neural tension tests and their nerve biases.

Answer 31

ULTT 1 = Median and anterior interosseous nerves
ULTT2= Median, musculocutaneous, and axillary nerve
ULTT3= Radial nerve
ULTT4= Ulnar nerve

Question 32

Describe the joint position sequencing for ULTT1.

Answer 32

Shoulder depression with 110 deg abduction
Elbow extension
Forearm supination
Wrist extension
Finger and thumb extension

Question 33

What is the sensitization test for ULTT1-4?

Answer 33

Contralateral cervical lateral flexion (side bending)

Question 34

Describe the joint position sequencing for ULTT2.

Answer 34

Shoulder depression with 10 degrees of abduction
Elbow extension
Forearm supination 
Wrist extension
Finger and thumb extension
Shoulder lateral rotation

Question 35

Describe the joint position sequencing for ULTT3.

Answer 35

Shoulder depression with 10 degrees of abduction
Elbow extension
Forearm pronation
Wrist flexion and ulnar deviation 
Finger and thumb flexion
Shoulder internal rotation

Question 36

Describe the joint position sequencing for ULTT4.

Answer 36

Shoulder depression with 10-90 degrees of abduction
Elbow flexion 
Forearm supination 
Wrist extension and radial deviation 
Finger and thumb extension 
Shoulder lateral rotation

Question 37

Describe the position, procedure, and positive findings for the Varus stress test.

Answer 37

Sitting with elbow in 20-30 degrees of flexion

Place one hand on the patient’s elbow and the other hand on their wrist. Apply varus force to test the lateral collateral ligament while palpating the lateral joint line.

Positive test indicated by increased laxity in the LCL, pain or apprehension. May indicate LCL sprain.

Question 38

Describe the position, procedure, and positive findings for the Valgus stress test.

Answer 38

Sitting with elbow in 20-30 degrees of flexion

Place one hand on the patient’s elbow and the other hand on their wrist. Apply valgus force to test the medial collateral ligament while palpating the medial joint line.

Positive test indicated by increased laxity in the MCL, pain or apprehension. May indicate MCL sprain.

Question 39

Describe the position, procedure, and positive findings for the Cozen’s test.

Answer 39

Sitting with the elbow in slight flexion

Place finger on lateral epicondyle while stabilizing the elbow joint. Ask patient to make a fist, pronate the forearm, radially deviate and extend the wrist against resistance.

Positive test indicated by pain in the lateral epicondyle region or muscle weakness. May indicate lateral epicondylitis.

Question 40

Describe the position, procedure, and positive findings for the lateral epicondylitis test.

Answer 40

Sitting

Stabilize the patient’s elbow and place the other hand over the proximal IP joints. Ask patient to extend third digit against resistance.

Positive test indicated by pain in the lateral epicondyle region or muscle weakness. May indicate lateral epicondylitis.

Question 41

Describe the position, procedure, and positive findings for the medial epicondylitis test.

Answer 41

Sitting

Palpate the medial epicondyle and supinate the patient’s forearm, extend the wrist and extend the elbow.

Positive test indicated by pain in the medial epicondyle region and may be indicative of medial epicondylitis.

Question 42

Describe the position, procedure, and positive findings for Mill’s test.

Answer 42

Sitting

Palpate the lateral epicondyle, pronate the forearm, flex the wrist, and extend the elbow.

Positive test indicated by pain in the lateral epicondyle region and may be indicative of lateral epicondylitis.

Question 43

Describe the position, procedure, and positive findings for the elbow flexion test.

Answer 43

Sitting or standing

Patient fully flexes both elbows while extending their wrists and holds position for 3-5 minutes.

Positive for cubital tunnel syndrome if tingling or paresthesia noted in the ulnar distribution of the forearm and hand.

Question 44

Describe the position, procedure, and positive findings for the pinch grip test.

Answer 44

Sitting or standing

Ask patient to pinch the tip of the index finger and thumb together.

Positive for anterior interosseous nerve pathology if patient can’t pinch tips of fingers together and instead presses the pads of the fingers together

Question 45

Describe the position, procedure, and positive findings for Tinel’s sign.

Answer 45

Sitting with the elbow in slight flexion

Tap the index finger between the patient’s olecranon process and medial epicondyle.

Positive test indicated by a tingling sensation in the ulnar nerve distribution of the forearm, hand and fingers. May indicate ulnar nerve compression or compromise.

Question 46

Describe the position, procedure, and positive findings for the ulnar collateral ligament instability test.

Answer 46

Sitting

Hold the patient’s thumb in extension and apply a valgus force to the MCP joint of the thumb.

Positive test is indicated by excessive valgus movement and may be indicative of a teat of the UCL and accessory ligaments. This type of injury is referred to as gamekeeper’s or skier’s thumb.

Question 47

Describe the position, procedure, and positive findings for the Allen test.

Answer 47

Sitting or standing

Ask patient to open and close hand several times in succession and then maintain the hand in a closed position. Compress the radial and ulnar arteries. Ask patient to relax hand, and release pressure from one of the arteries while observing the color of the hand and fingers.

Positive test indicated by delayed or absent flushing of the radial or ulnar half of the hand and may be indicative of an occlusion in the radial or ulnar artery.

Question 48

Describe the position, procedure, and positive findings for the lateral Bunnel-Littler test.

Answer 48

Sitting with the MCP joint in slight extension

Move the proximal IP joint into flexion.

Positive for tight intrinsic muscle or capsular tightness if the proximal IP joint does not flex with the MCP joint extended.

Positive for intrinsic muscle tightness if the proximal IP joint fully flexes with the MCP joint in slight flexion.

Question 49

Describe the position, procedure, and positive findings for the tight retinacular ligament test.

Answer 49

Proximal IP joint is held in a neutral position while the PT attempts to flex the distal IP joint.

Positive for retinacular ligament/capsule tightness if PT unable to flex the distal IP joint.

Positive for retinacular ligament tightness if PT able to flex distal IP joint with the proximal IP joint in flexion.

Question 50

Describe the position, procedure, and positive findings for the Carpal compression (median nerve compression) test.

Answer 50

Hold the patient’s wrist in both hands and apply pressure over the median nerve in the carpal tunnel for 30 seconds.

Can also be performed by placing the patient’s wrist in 60 degrees of flexion before applying pressure.

Positive for carpal tunnel syndrome if the patient experiences pain or paresthesia in the median nerve distribution.

Question 51

Describe the position, procedure, and positive findings for Forment’s sign.

Answer 51

Sitting or standing.

Ask patient to hold a piece of paper between the thumb and index finger. Attempt to pull the paper away from the patient.

Positive test indicated by the patient flexing the distal phalanx of the thumb due to adductor pollicis paralysis.

If patient hyperextends the MCP joint of the thumb at the same time, this is called Jeanne’s sign

Both indicate ulnar nerve compromise or paralysis

Question 52

Describe the position, procedure, and positive findings for Tinel’s sign (wrist).

Answer 52

Sitting or standing

Tap over the volar aspect of the patient’s wrist

Positive test indicated by tingling in the thumb, index finger, middle finger and lateral half of the ring finger. May be indicative of carpal tunnel syndrome due to median nerve compression.

Question 53

Describe the position, procedure, and positive findings for the grind test.

Answer 53

Sitting or standing

Stabilize the patient’s hand and grasp the patient’s thumb on the metacarpal. Apply compression and rotation through the metacarpal.

Positive test indicated by pain and may be indicative of DJD in the CMC joint.

Question 54

Describe the position, procedure, and positive findings for the Finklestein test.

Answer 54

Sitting or standing.

Ask patient to make a fist with the thumb tucked inside the fingers. Stabilize the forearm and ulnarly deviate the wrist.

Positive test indicated by pain of the abductor pollicis longus and extensor pollicis brevis tendons at the wrist and may be indicative of tenosynovitis in the thumb (de Quervain’s disease)

Question 55

Describe the position, procedure, and positive findings for the Murphy Sign.

Answer 55

Sitting or standing and asked to make a fist.

Positive test indicated by the patient’s third metacarpal remaining level with the second and fourth metacarpals. May be indicative of a dislocated lunate.