Special Tests

Used for shoulder dislocation

• pt is positioned in supine with arm in 90 degrees of abduction. 
• Therapist laterally rotates the patient's shoulder. 

Positive = look of apprehension or a facial grimace prior to reaching end point

Used for shoulder dislocation

• pt is positioned in supine with arm in 90 degrees of flexion and medial rotation.
• Therapist applies a posterior force through the long axis of the humerus.

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

Used for bicep tendon pathology

pt is positioned in sitting and is asked to clasp both hands behind the head with the fingers interlocked. pt is asked to alt contract and relax the biceps muscle.

Positive = absence of movement of biceps tendon and my be indicative of rupture of the long head of the biceps

Used for biceps tendon pathology

• pt is positioned in sitting or standing with the elbow extended and the forearm supinated. 
• Therapist places one hand on the bicipital groove and the other hand on the volar surface of the forearm. Therapist resists active shoulder flexion.

Positive = pain or tenderness in the bicipital groove region may be indicative of bicipital tendionitis

Used for biceps tendon pathology

pt is positive in sitting with 90 degrees of elbow flexion and forearm pronated. Humerus is stabilized against the patient's thorax. Therapist places one hand on the patient's forearm and the other hand over the bicipital groove. pt is directed to actively supinate and laterally rotate against resistance.

Positive = pain or tenderness in the bicipital groove and may be indicative of bicipital tendonitis.

Used for Rotator cuff pathology/impingement

pt is positioned in sitting or standing with the arm in 90 degrees of abduction. pt is asked to slowly lower arm to their side.

Positive = pt failing to slowly lower the arm to their side or by the presence of severe pain. May be indicative of a tear in the rotator cuff

Used for rotator cuff pathology/impingement

pt is positioned in sitting or standing. Therapist flexes the pt's shoulder to 90 degrees and then medially rotates the arm.

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

Used for Rotator cuff pathology/impingement

pt is positioned in sitting or standing. Therapist positions one hand on the posterior aspect of the patient's scapula while the other hand stabilizes the elbow. Therapist elevates the patient's arm through flexion.

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

Used for rotator cuff pathology/impingement

pt is positioned with the arm in 90 degrees of abduction followed by 30 degrees of horizontal adduction with the thumbed pointing downward. Therapist resists the patient's attempt to abduct the arm.

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

Used for thoracic outlet syndrome 

pt positioned in sitting or standing. Therapist monitors the radial pulse and ask the patient to rotate head to face the test shoulder. pt is asked to extend head while the therapist laterally rotates and extends the patient's shoulder.

Positive = an absent or diminished radial pulse and may be indicative of thoracic outlet syndrome

pt positioned in sitting or standing with the test arm in 90 degrees of abduction, lateral rotation, and elbow flexion. Pt is asked to rotate the head away fro the test shoulder while the therapist monitors the radial pulse

Positive = absent or diminished pulse when the head is rotated away from the test shoulder. May be indicative of thoracic outlet syndrome

Used for Thoracic outlet syndrome

pt is positioned in sitting. Therapist monitors the patient's radial pulse and assists the patient to assume a military posture. 

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

used for thoracic outlet syndrome

pt is positioned in sitting or standing with the arms positioned in 90degrees of abduction, lateral rotation and elbow flexion. pt is asked to open and close their hands for three minutes.

Positive = indicated by the inability to maintain the test position, weakness of the arms, sensory loss or ischemic pain. Positive test may indicative of thoracic outlet syndrome

used for thoracic outlet syndrome

pt is positioned in sitting or supine. Therapist moves the pt's arm overhead in the frontal plane while monitoring the patient's radial pulse. 

Positive = absent or diminished radial pulse and may be indicative of compression in the costoclavicular space

pt is positioned in supine. Therapist places one hand on the posterior aspect of the pt's humeral head while the other hand stabilizes the humerus proximal to the elbow. Therapist passively abducts and laterally rotates the arm over the pt's head and then proceeds to apply an anterior directed force to the humerus.

Positive = indicated by a clunk or grinding sound and may be indicative of a glenoid labrum tear

• 1. shoulder depression with 110 degrees of shoulder abduction
• 2. elbow extension
• 3. forearm supination
• 4. wrist extension
• 5. finger/thumb extension

sensitization - contralateral cervical lateral flexion

nerve bias - median nerve, anterior interosseous nerve

• 1. shoulder depression with 10 degrees of shoulder abduction
• 2. elbow extension
• 3. forearm supination
• 4. wrist extension
• 5. finger/thumb extension
• 6. shoulder lateral rotation

sensitization - contralateral cervical lateral flexion

nerve bias - median nerve, musculocutaneous nerve, axillary nerve

• 1. shoulder depression with 10 degrees of shoulder abduction
• 2. elbow extension
• 3. forearm pronation
• 4. wrist flexion
• 5. ulnar deviation
• 6. finger/thumb flexion
• 7.shoulder medical rotation

sensitization - contralateral cervical lateral flexion

nerve bias - radial nerve

• 1. shoulder depression with 10-90degrees abduction
• 2. elbow flexion
• 3. forearm supination
• 4. wrist extension
• 5. radial deviation
• 6. finger/thumb extension
• 7. shoulder lateral rotation

sensitization - contralateral cervical lateral flexion

nerve bias - ulnar nerve

used for ligamentous instability

pt positioned in sitting with the elbow in 20-30 degrees of flexion. Therapist places one hand on the elbow while the other hand proximal to the pt's wrist. Therapist applies a varus force to test the lateral collateral ligament while palpating the lateral joint line. 

Positive = increase laxity in the lateral collateral ligament when compared to the contralateral limb, apprehension or pain. Positive test may be indicative of a lateral collateral ligament sprain

used for ligamentous instability

positioned in sitting with the elbow in 20-30 degrees of flexion. Therapist places one hand on the elbow while the other hand is proximal to the patient's wrist. Therapist applies a valgus force to test the medial collateral ligament while palpating the medial joint line.

Positive = indicated by increased laxity in the medial collateral ligament when compared to the contralateral limb. apprehension or pain. Positive test may be indicative of a medial collateral ligament sprain.

Used for epicondylitis

pt positioned in sitting with the elbow in slight flexion. Therapist places thumb on patient's lateral epicondyle while stabilizing the elbow joint. The patient  is asked to make a fist, pronate the forearm, radially deviate and extend the wrist against resistance.

Positive = indicated by pain in the lateral epicondyle region or muscle weakness and may be indicative of lateral epicondylitis

used for epicondylitis

pt positioned in sitting. Therapist stabilizes the elbow with one hand and places the other on the dorsal aspect of the patient's hand distal to the proximal interphalangeal joint. The pt is asked to extend the 3rd digit against resistance.

Positive = indicated by pain in the lateral epicondyle region or muscle weakness and may be indicative of lateral epicondylitis

used for epicondylitis

pt is positioned in sitting. Therapist palpates the medial epicondyle and supinates the pt's forearm, extends the wrist and extends the elbow. 

Positive = indicated by pain in the medial epicondyle region and may be indicative medial epicondylitis

used for epicondylitis

pt positioned in sitting. Therapist palpates the lateral epicondyle, pronates the pt's forearm, flexes the wrist and extends the elbow.

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

Used for neurological dysfunction

pt is positioned in sitting with the elbow in slight flexion. Therapist taps with the index finger between the olecranon process and the medial epicondyle. 

Positive = indicated by a tingling sensation in the ulnar nerve distribution of the forearm, hand and fingers. A positive test may be indicative of ulnar nerve compression or compromise

Used for ligamentous instability of wrist

pt is positioned in sitting. Therapist holds the patient's thumb in extension an applies a value force to the metacarpophalangeal joint of the thumb.

Positive = excessive valgus movement and may be indicative of a tear of the ulnar collateral and accessory collateral ligaments. This type of injury is referred to as gamekeeper's or skier's thumb

Used for vascular insufficiency

pt is positioned in sitting or standing. pt is asked to open and close the hand several times in succession and then maintain the hand in a closed position. Therapist compressed the radial and ulnar arteries. pt is then asked to relax the hand ad the therapist releases the pressure on one of the arteries while observing the color of the hand and fingers.

Positive = 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.

used for contracture/tightness

pt is positioned in sitting with metacarpophalangeal joint held in slight extension. The therapist attempts to move the proximal interphalangeal joint into flexion. If the proximal interphalangeal joint does not flex with the metacarpophalangeal joint extended, there may be a tight intrinsic muscle or capsular tightness. If the proximal interphalangeal joint fully flexes with the metacarpophalangeal joint in slight flexion, there may be intrinsic muscle tightness without capsular tightness.

used for contracture/tightness

proximal interphalangeal joint is held in a neutral position while the therapist attempts to flex the distal interphalangeal joint. if the therapist is unable to flex the distal interphalangeal joint the reticular ligaments or capsule may be tight. If the therapist is able to flex the distal interphalangeal joint with the proximal interphalangeal joint in flexion, the reticular ligaments may be tight and the capsule may be normal

used for neurological dysfunction

pt is positioned in sitting or standing and is asked to hold a piece of paper between the thumb and index finger. The therapist attempts to pull the paper away from the patient. 

Positive = indicated by the patient flexing the distal phalanx of the thumb due to adductor pollicis muscle paralysis. If at the same time the pt hyperextends the metacarpophalangeal joint of the thumb, it is termed Jeanne's sign. Both objective finding may be indicative of ulnar nerve compromise or paralysis.

pt is positioned in sitting or standing. Therapist flexes the patient's wrists maximally and asks the patient to hold the position for 60 seconds. 

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

pt is positioned in sitting or standing. Therapist taps over the volar aspect of the patient's wrist. 

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

pt is positioned in sitting or standing and is asked to make a fist with the thumb tucked inside the fingers. Therapist stabilizes the patient's forearm and ulnarly deviates the wrist. 

Positive = indicated by pain over the abductor pollicis longs and extensor pollicis brevis tendons at the wrist and may be indicative of tenosynovitis in the thumb (deQurervain's disease)

pt is positioned in sitting or standing.  Therapist stabilizes the pt's hand and grasps the pt's thumb on the metacarpal. Therapist applies compression and rotation through the metacarpal.

Positive = indicated by pain and may be indicative of degenerative joint disease in the carpometacarpal joint.