Upper Extremities

Question 1

What is the bracelet test and what does it test for?

Answer 1

lateral compression around ulna and radius (in area of a bracelet)
- tests for wrist fracture

Question 2

what is froment’s sign, and what does it test for?

Answer 2

“pinch” test
“Duck beak” is normal
normally pinch with pad of thumb and first finger (using adductor pollicis - ULNAR n),
if pinch with tips of fingers, over pads - this is the “OK” sign and it’s abnormal (flexor pollicis brevis - MEDIAN nerve).
sign of ulnar nerve involvement* cubital tunnel syndrome

ask pt to hold piece of paper b/w fingers while you watch

Question 3

describe phalen’s test - what does it test for?

Answer 3

Tests for carpal tunnel syndrome

• pt seated
• both wrists are maximally flexed, with back of hands held together, held in front of trunk.
• hold for 60 seconds

Question 4

How do you perform the median nerve compression test?

Answer 4

pt seated
double thumb compression just prox. to the transverse carpal ligament x15s-2min

(+)= median nerve symptoms in hand

Question 5

What is tinel’s sign?

Answer 5

when examiner gently taps over capal tunnel with fingertips/reflex hammer
- reproduction of median nerve sx = positive

Question 6

What is Finkelstein’s Test and what is it testing for?

Answer 6

pt seated/standing
pt makes fist with thumb inside the fingers, either passively or actively the patient moves wrist into ULNAR deviation

• testing for tenosynovitis of the (ABL/EPB) ABductor pollicis longus and Extensor pollicis brevis
• test is positive if it reproduces sx

Question 7

Where do the extensors of the wrist insert?

Answer 7

lateral epicondyle of the humerus (radial n. C7)

Question 8

where do the flexors fo the wrist insert?

Answer 8

medial epicondyle of the humerus (median n. C7)

Question 9

Which two tests, test for LATERAL epicondylitis?

Answer 9

Mills

Cozen’s

Question 10

Which two tests, test for MEDIAL epicondylitis?

Answer 10

Reverse Mills

Reverse Cozen’s

Question 11

How do you perform Cozen’s test?

Answer 11

pt: make a fist, pronate forearm, extend wrist with radial deviation
examiner: palp lateral epicondyle while doing resisted extension (ie - apply force toward wrist flexion)

(+) is reproduction of lateral epicondylitis sx

Question 12

How do you perform Mill’s test?

Answer 12

palpate lateral epicondyle
extend elbow posterior of pt
pronate forearm
flex wrist
stretch common extensor tendon which stretches RADIAL n

Question 13

How do you perform Reverse Cozen’s test?

Answer 13

pt: flex elbow to 120 deg, supinate forearm with slight wrist flexion and ulnar deviation
examiner: palpate medial epicondyle while doing resisted flexion (ie apply force toward wrist extension)

Question 14

How do you perform Reverse Mill’s Test?

Answer 14

Pt: extends elbow, supinates forearm and extends the wrist

examiner applies flexion pressure to stretch common flexor tendon

Question 15

How do you perform the valgus and varus stress tests for sprain and instability?

Answer 15

Valgus

• elbow extended first, then flexed 30 deg, with forearm in supination
• apply pressure L to M while pulling wrist laterally

Varus

• again, elbow extended then flexed 30, supination
• apply pressure M to L while pushing wrist medially

Question 16

Where do you perform tinel’s sign on the elbow? what syndrome is this testing for?

Answer 16

percuss the ULNAR nerve b/w the medial epicondyle and the ulna

testing for cubital tunnel syndrome
Froment’s sign is also a test of cubital tunnel syndrome

Question 17

What is the active ulnar tension test?

Answer 17

put both hands up as if carrying tray for waitressing
(flex elbow past 90, supinate forearm, extend wrist, abduct shoulder)

Positive if discomfort or paresthesia within 60s
Cubital tunnel syndrome

Question 18

What is the PASSIVE ulnar tension test

Answer 18

pt supine
support arm with thigh
flex elbow past 90
abduct and depress shoulder
extend wrist and fingers
pronate forewarm
ext. rotate shoulder
flex the patient's writst

positive if discomfort of paresthesia within 60s
cubital tunnel syndrome

Question 19

Where does the subscapularis insert and what are it’s actions?

Answer 19

inserts at the LESSER tuberosity of humerus

• internal rotation
• adduction

Question 20

Where does the supraspinatus insert and what is it’s main action?

Answer 20

inserts at GREATER tuberosity of humerus

- ABduction

Question 21

Where does the infraspinatus insert and what are its actions?

Answer 21

inserts at GREATER tuberosity of humerus

• ext. rotation
• ABduction

(opp of subscap)

Question 22

Where does the teres minor insert and what are its actions?

Answer 22

inserts at GREATER tuberosity of humerus

• ext. rotation
• ADduction

Question 23

what is a typical presentation when assessing for adhesive capsulitis?

Answer 23

shoulder elevation on the effected side

- this can be observed during flow

Question 24

What is Speed’s test and what is it testing for?

Answer 24

with elbow extended and supinated
dr palpates biceps tendon and asks pt to flex shoulder against resistance

pos = biceps tendinopathy

Question 25

What two tests, test for supraspinatus tear?

Answer 25

• Drop arm (Codman’s drop arm) test

- Empty Can test

Question 26

How do you perform Drop Arm test?

Answer 26

passively abduct pts arms, BL
then allow them to lower their arm

pos = fast drop supraspinatus tear

Question 27

How do you perform Empty Can test?

Answer 27

patient abducts shoulder to 90 degrees
then internally rotates (like emptying a can)

pos = supraspinatus tear

Question 28

When performing a muscle test for shoulder external rotation - which muscle are you testing?

Answer 28

Infraspinatus

teres minor

Question 29

What is Gerber’s Lift Off test?

Answer 29

back of hand placed as superiorly on the spine as patient can tolerate, then resisted “lift off” motion

• positive is subscapularis involvement

Question 30

when muscle testing for shoulder internal rotation, which muscle are you testing?

Answer 30

subscapularis

Question 31

What is the test cluster for rotator cuff tear?

Answer 31

• > 60 yrs w/
• pos drop arm test
• pos painful arc
• pos infraspinatus strength test (ext. rot)

+ LR 15.57 for full thickness rotator cuff tear

Question 32

what are the three tests for shoulder impingement?

Answer 32

• empty can test
• Hawkin’s kennedy test
• Neer’s test

Question 33

How to perform Hawkins Kennedy?

Answer 33

pt seated or standing
grab pt’s elbow (in anatomical position), and grab their wrist with your other hand
flex shoulder and elbow to 90 degrees
Then internally rotate (passively)

positive if pain - for shoulder impingement

Question 34

How to perform Neer’s test?

Answer 34

Pt is seated (or standing)
Place one hand on pt’s posterior shoulder to stabilize. The other hand grabs the extended arm at the elbow and then passively internally rotates this arm and pronates the forearm. Once end range, flex the arm up through full range while it’s internally rotated

positive is any pain on movement
- shoulder impingement

Question 35

what are the three tests that make up the cluster for subacromial impingement?

Answer 35

• hawkins kennedy
• painful arc
• infraspinatus strength test

If all pos - 10.56 LR for shoulder impingement

Question 36

How do you perform AC crossbody Adduction?

Answer 36

passively flex patients arm to 90 while keeping a palpating hold at the AC joint
then horizontally ADDuct the patients arm and feel for:
- crepitus or inquire about pain

positive is AC jt dysfunction