UE Special Tests Flashcards
List 3 special tests that test for shoulder dislocation.
Apprehension test for anterior dislocation
Apprehension test for posterior dislocation
Sulcus sign
Describe the position, procedure, and positive findings for the apprehension test for anterior dislocation.
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
Describe the position, procedure, and positive findings for the apprehension test for posterior dislocation.
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
Describe the position, procedure, and positive findings for the sulcus sign.
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)
List 3 special tests that test for biceps tendon pathology.
Ludington’s test
Speed’s test
Yergason’s test
Describe the position, procedure, and positive findings for the Ludington’s test.
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.
Describe the position, procedure, and positive findings for the Speed’s test.
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
Describe the position, procedure, and positive findings for the Yergason’s test.
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.
Describe the position, procedure, and positive findings for the drop arm test.
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.
Describe the position, procedure, and positive findings for the Hawkins-Kennedy Impingement test.
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
Describe the position, procedure, and positive findings for the infraspinatus test.
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
Describe the position, procedure, and positive findings for the lateral rotation lag sign test.
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.
Describe the position, procedure, and positive findings for the lift off sign (medial rotation lag sign) test.
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.
Describe the position, procedure, and positive findings for the Neer Impingement test.
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.
Describe the position, procedure, and positive findings for the supine impingement test.
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.
Describe the position, procedure, and positive findings for the supraspinatus test.
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
List 5 special tests that test for thoracic outlet syndrome.
Adson maneuver Allen test Costoclavicular syndrome test Roos test Wright test (hyperabduction test)
Describe the position, procedure, and positive findings for the Adson maneuver.
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.
Describe the position, procedure, and positive findings for the Allen test.
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.
Describe the position, procedure, and positive findings for the costoclavicular syndrome test.
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.
Describe the position, procedure, and positive findings for Roos test.
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.
Describe the position, procedure, and positive findings for the Wright test (hyperabduction test).
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.
Describe the position, procedure, and positive findings for the acromioclavicular crossover test.
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.
Describe the position, procedure, and positive findings for the active compression test (O’Brien’s test).
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.
Describe the position, procedure, and positive findings for the glenoid labrum tear test.
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.
Describe the position, procedure, and positive findings for the Jerk test.
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.
Describe the position, procedure, and positive findings for the painful arc test.
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
Describe the position, procedure, and positive findings for the Hornblower sign.
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.
Describe the position, procedure, and positive findings for Paxinos sign.
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
When is a sensitization test used during upper limb neural tension testing?
Used if symptoms are minimal or absent after the neural test position is assumed
List the upper limb neural tension tests and their nerve biases.
ULTT 1 = Median and anterior interosseous nerves
ULTT2= Median, musculocutaneous, and axillary nerve
ULTT3= Radial nerve
ULTT4= Ulnar nerve
Describe the joint position sequencing for ULTT1.
Shoulder depression with 110 deg abduction Elbow extension Forearm supination Wrist extension Finger and thumb extension
What is the sensitization test for ULTT1-4?
Contralateral cervical lateral flexion (side bending)
Describe the joint position sequencing for ULTT2.
Shoulder depression with 10 degrees of abduction Elbow extension Forearm supination Wrist extension Finger and thumb extension Shoulder lateral rotation
Describe the joint position sequencing for ULTT3.
Shoulder depression with 10 degrees of abduction Elbow extension Forearm pronation Wrist flexion and ulnar deviation Finger and thumb flexion Shoulder internal rotation
Describe the joint position sequencing for ULTT4.
Shoulder depression with 10-90 degrees of abduction Elbow flexion Forearm supination Wrist extension and radial deviation Finger and thumb extension Shoulder lateral rotation
Describe the position, procedure, and positive findings for the Varus stress test.
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.
Describe the position, procedure, and positive findings for the Valgus stress test.
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.
Describe the position, procedure, and positive findings for the Cozen’s test.
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.
Describe the position, procedure, and positive findings for the lateral epicondylitis test.
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.
Describe the position, procedure, and positive findings for the medial epicondylitis test.
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.
Describe the position, procedure, and positive findings for Mill’s test.
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.
Describe the position, procedure, and positive findings for the elbow flexion test.
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.
Describe the position, procedure, and positive findings for the pinch grip test.
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
Describe the position, procedure, and positive findings for Tinel’s sign.
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.
Describe the position, procedure, and positive findings for the ulnar collateral ligament instability test.
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.
Describe the position, procedure, and positive findings for the Allen test.
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.
Describe the position, procedure, and positive findings for the lateral Bunnel-Littler test.
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.
Describe the position, procedure, and positive findings for the tight retinacular ligament test.
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.
Describe the position, procedure, and positive findings for the Carpal compression (median nerve compression) test.
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.
Describe the position, procedure, and positive findings for Forment’s sign.
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
Describe the position, procedure, and positive findings for Tinel’s sign (wrist).
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.
Describe the position, procedure, and positive findings for the grind test.
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.
Describe the position, procedure, and positive findings for the Finklestein test.
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)
Describe the position, procedure, and positive findings for the Murphy Sign.
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.
