Upper Extremity Movement tests Flashcards
Impingement test
The examiner passively overpressures the client’s arm into end-range elevation. This movement causes a jamming of the greater tuberosity against the anterior inferior acromial surface. The test is positive if the client’s facial expression shows pain. An alternative test is described by Hawkins and Kennedy. The examiner forward flexes the arm to 90 degrees then forcibly internally rotates the arm. Pain indicates a positive test result.
Drop Arm Test
The client’s arm is passively abducted by the examiner to 90 degrees with the client’s palm down. The client is then asked to lower the arm actively. Pain or inability to lower the arm smoothly with good motor control is considered a positive test result.
Adson Manuever
The examiner palpates the radial pulse on the arm to be tested. The client then rotates the head toward the arm being tested. The client then extends the head and holds a deep breath while the arm is being laterally rotated and extended. Disappearance or slowing of pulse rate is considered a positive test result suggesting presence of thoracic outlet syndrome
Roos Test
Client maintains a position of bilateral arm abduction to 90 degrees, shoulder external rotation, and elbow flexion to 90 degrees for 3 minutes while slowly alternating between an open hand and a clenched fist. Inability to maintain this position for the full 3 minutes or onset of symptoms is considered a positive test result for thoracic outlet syndrome
Upper limb tension test
The client is positioned supine, and the examiner takes the client’s arm into abduction and external rotation behind the coronal plane at the shoulder. The shoulder girdle is fixed in depression. The elbow is then passively extended with the wrist in extension and the forearm in supination. Symptoms of stretch or ache in the cubital fossa or tingling in the thumb and first three fingers indicate tension on the median nerve. Lateral flexion of the neck to the opposite side will amplify symptoms by increasing tension on the dura mater. Elbow extension ROM should be compared with the uninvolved side to indicate the degree of restriction
Tinel Sign
The test is performed by tapping gently along the course of a peripheral nerve, starting distally and moving proximally to elicit a tingling sensation in the fingertip. The point at which tapping begins to elicit a tingling sensation is noted and indicates the approximate location of nerve compression. This test is also used after nerve repair to determine the extent of sensory axon growth
Phalen’s Test
Phalen’s test is performed by fully flexing the wrists with the dorsum of the hands pressing against each other. Reverse Phalen’s is performed by holding the hands in the “prayer” position for 1 minute. The test results are positive if the client reports tingling in the median nerve distribution (thumb, index, middle and radial aspect of ring finger) within 1 minute.
Carpal compression test
The examiner places pressure over the median nerve in the carpal tunnel for up to 30 seconds. The test result is positive if tingling occurs in the median nerve distribution. The combination of wrist flexion and compression of the median nerve for 20 seconds has been found to be more sensitive than other provocative tests used alone.
Touch pressure/ Light touch
The Semmes-Weinstein monofilaments are the most accurate instruments for assessing cutaneous pressure thresholds.10 The original testing equipment consisted of 20 nylon monofilaments housed in plastic handheld rods. Many therapists today use the smaller five-pack filaments. These five monofilaments correspond to the categories of light touch sensation.A grid should be used to record the responses so that varying areas of touch perception can be demonstrated. Two correct responses out of three applications are necessary 10451046for an area to be considered as having intact sensibility. It is preferable to place the monofilaments randomly rather than to concentrate on an area, to allow the nerves recovery time. When a filament is placed three times, it should be held for a second, rested for a second, and reapplied. Results can be graded from normal light touch (probes 2.83 and above) to loss of protective sensation (probes 4.56 and below). Diminished light touch and diminished protective sensation are in the range reflected by the central probes (probes 3.22 to 4.31
Modified Moberg Test / Stereognosis
This test is used with either a median nerve injury or an injury to a combination of median and ulnar nerves. It takes twice as long to perform the tests with vision occluded as with vision unimpaired. The test is performed as follows:
- Nine or 10 small objects (e.g., coins or paper clips) are placed on a table, and the client is asked to place them, one at a time, in a small container as quickly as possible, while looking at them. The client is timed.
- The test is repeated for the opposite hand with vision.
- The test is repeated for each hand with vision occluded.
- The client is asked to identify each object one at a time, with and then without vision.
It is important to observe any substitution patterns that may be used when the client cannot see the objects.
Edema Assessment
Measuring volume at different times of the day, the therapist can measure the effects of rest versus activity, as well as the effects of splinting or intervention designed to reduce edema.
Variables that have been shown to decrease the accuracy of the volumeter include the use of a faucet or hose that introduces air into the tank during filling, movement of the arm within the tank, inconsistent pressure on the stop rod, and the use of a volumeter in a variety of places. The same level surface should be used.
- A plastic volumeter is filled and allowed to empty into a large beaker until the water reaches spout level. The beaker is then emptied and dried thoroughly.
- The client is instructed to immerse the hand in the plastic volumeter, being careful to keep the hand in the midposition.
- The hand is lowered until it rests gently between the middle and ring fingers on the dowel rod. It is important that the hand not press onto the rod.
- The hand remains still until no more water drips into the beaker.
- The water is poured into a graduated cylinder. The cylinder is placed on a level surface, and a reading is made.
Elbow flextion test
The elbow flexion test is used to screen for cubital tunnel syndrome (compression of the ulnar nerve in the cubital tunnel). The client is asked to fully flex the elbows with the wrists fully extended for a period of 3 to 5 minutes. The test result is positive if tingling is reported in the ulnar nerve distribution of the forearm and hand (ulnar ring finger and small finger).
