Wrist/Elbow/Shoulder Ortho Exams

Question 1

Finklesteins’s Test

Answer 1

Make fist with thumb inside. Ulnar deviation by patient or examiner.

Question 2

Phalens

Answer 2

Back-­to­-back maximal wrist flexion for 1 minute.

Question 3

Reverse Phalens

Answer 3

Hands together like praying.

Question 4

Median Nerve Compression

Answer 4

Double thumb compression just proximal to transverse carpal ligament for 15 seconds – 2 minutes. (For Carpal Tunnel Syndrome)

Question 5

Cozen’s

Answer 5

Forearm pronated, wrist extended. Resisted. For lateral epicondylitis.

Question 6

Mill’s

Answer 6

Elbow extended, forearm pronated, wrist fully flexed. Not resisted, just the stretch. For lateral epicondylitis.

Question 7

Reverse Cozen’s

Answer 7

Elbow flexed 120o , forearm supinated, wrist flexed. Resisted. Medial epicondylitis.

Question 8

Reverse Mill’s

Answer 8

Elbow extended, forearm supinated, wrist extended. Stretch. Medial epicondylitis.

Question 9

Codman’s Arm Drop

Answer 9

Patient arm is held out at about 120 degrees. Doc asks pt to lower arm after letting go. Supraspinatus test.

Question 10

Empty Can

Answer 10

Patient abducts shoulder to 90, internally rotate. NOTE: Stay in scapular plane (30 degrees anterior to pure frontal plane). Doc applies downward pressure. Supraspinatus test. (positive = pain or weakness)

Question 11

Speed’s

Answer 11

Elbow supinated, elbow extended; doctor palpates biceps tendon.

• Concentric: patient pushes shoulder into flexion against resistance
• Eccentric: patient resists but allows doctor to extend shoulder back to neutral

Question 12

Hawkins-Kennedy

Answer 12

Patient’s shoulder and elbow flexed 90, shoulder 10-20 degrees horizontally adducted toward midline, stabilize elbow, hold wrist and passively internally rotate shoulder.

Question 13

Neer’s

Answer 13

Internal Rotation Maximum (Forceful) Passive Shoulder Flexion

External Rotation Maximum (Forceful) Passive Shoulder Flexion

This will likely test for biceps tendon impingement

Question 14

Acromioclavicular Cross Body Adduction

Answer 14

• Active: Patient reaches hand across to opposite shoulder.
• Passive: The examiner passively moves the humerus across the chest by flexing the shoulder to 900 and then horizontally adducting the shoulder.
• Positive = localized pain at AC joint or SC joint.

Question 15

Acromioclavicular Resisted Extension

Answer 15

Examiner resists patient’s horizontal abduction as they return from the opposite shoulder.

Question 16

Acromioclavicular Compression Test (O’Brian part 1)

Answer 16

• Shoulder is flexed 90 degrees, horizontally adducted 10-20 degress toward midline, elbow is extended.
• Patient’s shoulder is in maximal internal rotation, doctor pushes down while patient resists.
• (When called O’Brian’s, is a labrum lesion test)

Question 17

O’Brian’s Part 2

Answer 17

• Shoulder is flexed 90 degrees, horizontally adducted 10-20 degress toward midline, elbow is extended.
• Patient’s shoulder is in maximal external rotation, doctor pushes down while patient resists.
• Labrum lesion test

Question 18

Shoulder Passive Compression Test

Answer 18

Sidelying elbow flexed 90°, shoulder abducted 30°, shoulder externally rotated to end range, approximate (compress) glenohumeral joint, flex and extend shoulder while sustaining compression

Question 19

Modified Dynamic Labral Shear Test

Answer 19

Pt standing with arm flexed 90° at the elbow, abducted >120° in the scapular plane and externally rotated to end range, maintain external rotation and horizontal abduction and lower arm from 120° to 60° of abduction.

Question 20

Passive Distraction Test - Supine

Answer 20

Supine, arm off edge of the table, 150° abduction, elbow extended, forearm supinated, shoulder stabilized to prevent rotation, doctor pronates forearm while maintaining steady position of the humerus