Chapter 1: Special Tests of the Upper Extremity

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Author:
dmshaw9
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296520
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Chapter 1: Special Tests of the Upper Extremity
Updated:
2015-02-22 16:39:11
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PT Examination
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NPTE Review
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NPTE Chapter 1
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  1. Yergason's Test
    • Tests integrity of transverse humeral ligament (holds long head of biceps in place) 
    • May also identify bicipital tendonosis/tendonopathy
    • Pt sitting, shoulder in neutral position, elbow at 90 deg and forearm pronated
    • Resist supination and ER of shoulder
    • (+) = Tendon of biceps long head will "pop out" of groove (may also reproduce pain in long head of biceps tendon)
  2. Speed's Test (Biceps Straight Arm)
    • Identifies bicipital tendonosis/tendonopathy
    • Palpate biceps tendon (long head)
    • Pt sit/stand w/ shoulder flexed to 60 and abd to 45
    • Elbow in full ext w/ forearm supinated 
    • Apply force to resist shoulder flexion 
    • (+) = Increased tenderness in bicipital groove (SLAP lesion, biceps tendonitis, tendon rupture)
  3. Neer's Impingement Test
    • For impingement of soft tissue structures of shoulder complex (long head of biceps and supraspinatus) 
    • Patient in sitting
    • Stabilize spine of scapula and passively elevate arm in scapular plane, apply end-range overpressure
    • Repeat with arm in IR and ER
    • (+) = Reproduction of pain
  4. Supraspinatus (Empty Can) Test
    • Identifies tear and/or impingement of supraspinatus tendon or possible suprascapular nerve neuropathy
    • Pt sitting, shoulder at 90 deg in scapular plane with no rotation, resist shoulder flex in scap plane
    • Then place shoulder in IR and resist into flex in scapular plane
    • (+) = Reproduces pain in supraspinatus tendon and/or weakness in empty can position 
  5. Drop Arm Test
    • Identifies tear and/or full rupture of RC
    • Pt sitting with shoulder passively abd to 120 deg
    • Pt instructed to slowly bring arm down to side
    • (+) = Pt unable to lower arm back down to side
  6. Posterior Internal Impingement Test
    • Identifies impingement between RC and greater tuberosity or posterior glenoid and labrum
    • Pt supine, move shoulder into 90 deg abd, max ER, and 15-20 deg horizontal add
    • (+) = Reproduction of pain in posterior shoulder 
  7. Clunk Test
    • Identifies glenoid labrum tear
    • Pt supine, shoulder in full abd
    • Push humeral head anterior while rotating humerus externally
    • (+) = Audible "clunk" is heard 
  8. Anterior Apprehension Signs
    • Identifies past history of anterior shoulder dislocation
    • Pt supine, with shoulder in 90 deg abd, slowly take shoulder into ER
    • (+) = Pt does not allow and/or does not like shoulder to move into direction to simulate anterior dislocation 
  9. Posterior Apprehension Signs
    • Identifies past history of posterior shoulder dislocation
    • Pt supine with shoulder flexed 90 deg in plane of scapula and elbow flexed to 90 deg (with scapula stabilized by table)
    • Place posterior force through shoulder via force on pt's elbow while simultaneously moving shoulder into IR and horizontal add
    • (+) = Pt does not allow and/or does not like shoulder to move in direction
  10. Acromioclavicular (AC) Shear Test
    • Identifies dysfunction of AC joint (i.e. arthritis, separation) 
    • Pt sitting with arm rested at side, clasp hands and place one heel on spine of scapula an doter heel on clavicle
    • Squeeze hands together to compress AC joint
    • (+) = Reproduction of pain in AC joint
  11. Adson's Test
    • Identifies pathology of structures passing through thoracic inlet
    • Pt sitting, find radial pulse and rotate head toward extremity being tested
    • Extend and ER shoulder while extending head
    • (+) = Neurological and/or vascular symptoms (disappearance of pulse) will be reproduced in upper extremity
  12. Costoclavicular Syndrome (Military Brace) Test
    • Identifies pathology of structures that pass through thoracic inlet
    • Pt sitting, find radial pulse of extremity being tested
    • Move involved shoulder down and back
    • (+) = neurological and/or vascular symptoms (disappearance of pulse) will be reproduced
  13. Wright (Hyperabduction) Test
    • Identifies pathology of structures that pass through thoracic inlet
    • Pt sitting, find radial pulse, move shoulder into max abd and ER
    • Take deep breath and rotate head to opposite side
    • (+) = Neurological and/or vascular symptoms (disappearance of pulse) will be reproduced
  14. Roos Elevated Arm Test
    • Identifies pathology of structures that pass through thoracic inlet
    • Pt standing, shoulder fully ER, 90 abd, and slight horizontal abd, elbows flexed to 90
    • Pt opens/closes hands for 3 minutes slowly
    • (+) = Neurological and/or vascular symptoms will be reproduced
  15. Upper Limb Tension Tests
    • Evaluation of peripheral nerve compression
    • Neurological symptoms will be reproduced in upper extremity
  16. Elbow Ligament Instability Tests
    • Identifies ligament laxity or restriction
    • Pt sitting/supine
    • Upper limb supported, elbow placed in 20-0 deg of flexion
    • Valgus force tests ulnar collateral ligaments, varus force tests radial collateral ligaments
    • (+) = Laxity and/or pain
  17. Lateral Epicondylitis (Tennis Elbow) Test
    • Identifies lateral epicondylopathy (epicondylosis) 
    • Patient sitting with elbow flexed to 90 and arm supported/stabilized
    • Resist wrist ext, radial dev and forearm pronation with fingers fully flexed (fist)
    • (+) = Reproduces pain at lateral epicondyle
  18. Medial Epicondylitis (Golfer's Elbow) Test
    • Identifies medial epicondylopathy (epicondylosis)
    • Pt sitting with elbow in 90 deg flexion and supported/stabilized
    • Passively supinate forearm, ext elbow and ext wrist
    • (+) = Reproduces pain at medial epicondyle
  19. Tinel's Sign (Elbow)
    • Identifies dysfunction of ulnar nerve at olecranon
    • Tap region where ulnar nerve passes through cubital tunnel
    • Reproduces tingling sensation in ulnar distribution
  20. Pronator Teres Syndrome
    • Identifies a median nerve entrapment within pronator teres
    • Patient sitting with elbow in 90 deg flex and supported/stabilized
    • Resist forearm pronation and elbow ext simultaneously
    • (+) = Reproduces a tingling or paresthesia within median nerve distribution
  21. Finkelstein's Test
    • Test for de Quervain's tenosynovitis (paratendonitis of the abductor pollicis longus and/or extensor pollicis brevis)
    • Pt makes fist with thumb inside, passively move wrist into ulnar deviation
    • (+) = Reproduces pain in wrist
    • Often painful with no pathology so compare to uninvolved side
  22. Bunnel-Littler Test
    • Identifies tightness in structures surrounding the MCP joints
    • MCP joint is stabilized in slight extension while PIP joint is flexed
    • Then MCP joint is flexed and PIP joint is flexed
    • Differentiates between tight capsule and tight intrinsic muscles
    • (+) = Flexion limited in both cases --> capsule is tight; more PIP flex with MCP flex --> intrinsic muscles are tight
  23. Tight Retinacular Test
    • Identifies tightness around proximal interphalangeal joint
    • PIP stabilized in neutral while DIP is flexed
    • Then PIP is flexed and DIP is flexed
    • Differentiates between a tight capsule and tight retinacular ligaments
    • (+) = Flexion limited in both cases --> capsule is tight; More DIP flex with PIIP flex --> reticular ligaments are tight
  24. Finger Ligamentous Instability Tests (Medial and Lateral Stability)
    • Identifies ligament laxity or restriction
    • Fingers supported and stabilized, valgus and varus forces applied to PIP/DIP joints
    • (+) = Laxity and/or pain
  25. Froment's Sign
    • Identifies ulnar nerve dysfunction
    • Pt grasps paper between first and second digits
    • Pull paper out and look for IP flexion of thumb = compensation due to weakness of adductor pollicis
    • (+) = Pt unable to perform test without compensation (may indicate ulnar nerve dysfunction)
  26. Tinel's Sign (Wrist)
    • Identifies carpal tunnel compression of medial nerve
    • Tap region where medial nerve passes through carpel tunnel
    • (+) = Reproduces tingling and/or paresthesia into hand following median nerve distribution
  27. Phalen's Test
    • Identifies carpal tunnel compression of median nerve
    • Pt maximally flexes both wrists holding them against each other for 1 minute
    • (+) = Reproduces tingling and/or paresthesia into hand following median nerve distribution
  28. Two-Point Discrimination Test
    • Identifies level of sensory innervation within hand that correlates with functional ability to perform certain tasks involving grasp
    • Pt sitting with hand stabilized
    • Use caliper, 2-point discriminator, or paper clip
    • Apply device to palmar aspect of fingers and record smallest difference that patient can sense two separate points 
    • Normal amount that can be discriminated = <6 mm
  29. Allen's Test
    • Identifies vascular compromise
    • Identify radial and ulnar arteries at wrist
    • Have pt open/close fingers quickly several times then make closed fist
    • Occlude ulnar artery and have pt open hand, observe palm and release compression on artery and observe for vascular refilling (perform same for radial after)
    • (+) = Abnormal filling of blood within hand during test

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