Upper Limb Special Orthopedic tests

Shoulder Stability Tests

• Anterior Drawer

• Posterior Drawer

• Apprehension/ Crank Test

• Push Pull Test

• Sulcus Sign

Anterior Drawer Test

Purpose: tests for anterior GH instability

Positive signs: Hypermobility, clicking, apprehension

Method:

• Patient lies supine

• Abduct shoulder to 80-120 degrees, flexed forward to 20 degrees, laterally rotated up to 30 degrees

• Therapist stabilizes scapula

• Draws humerus forward

Posterior Drawer Test

Purpose: Tests for posterior instability

Positive Signs: Hypermobility, pain, apprehension

Method:

• Start same position as anterior drawer- supine

• Medially rotate arm and flex forward to 60-80°

• Apply posterior force

Apprehension/Crank Test

Purpose: Tests for gross instability of GH joint

Positive Signs: Apprehension, muscle spasm

Method:

• Patient supine- at edge of table so arm can go off edge

• Abduct to 90 degrees and fully externally rotate

• Apply overpressure if no pain (push down on their arm)

Push Pull Test

Purpose: Tests for posterior instability

Positive Signs: Hypermobility, pain, apprehension

Method:

• Patient supine

• Abduct arm to 90 degrees, flex to 30 degrees

• Downward push at shoulder and upward pull at wrist

Sulcus Sign

• Purpose: Tests for inferior instability

• Positive Signs: Hypermobility, sulcus sign, with pain/apprehension

• Method:

• Arm relaxed at side

• Distal pull of humerus

Impingement Tests

• Hawkins- kennedy Test

• Neer Impingement Test

• Painful Arc

Hawkins-Kennedy Test

Purpose: Tests for supraspinatus tendinopathy/impingement

Positive Signs: Pain, apprehension

Method:

• Seated or standing

• Forward flex arm to 90 degrees, medially rotate

Neer Impingement Test

Purpose: Tests for supraspinatus overuse injury

Positive Signs: Pain, apprehension

Method:

• Seated or standing

• Abduct arm in scaption, medially rotated

Painful Arc

Purpose: Tests for compression of subacromial structures

Positive Signs: Pain during mid-arc, pain at 170-180° indicates AC injury

Method:

• AFROM abduction

Shoulder Motion Tests

• Apley’s Scratch test

• AC Shear test

Apley’s Scratch Test

Purpose: Tests combined shoulder movements- internal and external rotation

Positive Signs: Normal fingertip touching range

Method:

• Demonstrate to client to mimic

• one arm over and behind shoulder

• One arm reaching under and up to touch other hanf

AC Shear Test

Purpose: Tests acromioclavicular joint pathology

Positive Signs: Pain, hypermobility

Method:

• Seated

• Hands on clavicle and spine of scapula

• Interlock fingers one hand on each side of shoulder

• Squeeze together

Rotator Cuff Injury Tests

• Drop Arm Test

• Speed’s Test

• Supraspinatus Test (Empty Can Test)

• Yergason’s Test

Drop Arm Test

Purpose: Tests for rotator cuff tear

Positive Signs: Inability to slowly lower arm, pain

Method:

• Abduct shoulder to 90 degrees

• Client lowers arm slowly to side

Speed’s Test

Purpose: Tests for bicipital tendinopathy

Positive Signs: Pain in bicipital groove

Method:

• Seated

• Resists shoulder forward flexion in supination then pronation

Supraspinatus Test (Empty Can Test) Jobes

Purpose: Tests for supraspinatus muscle/tendon tear

Positive Signs: Muscle weakness, pain

Method:

• Abducted arm to 90 degrees in neutral, resist

• Rotate medially into scaption and resist again

• Resist at wrists pushing downward

Yergason’s Test

Purpose: Tests for transverse humeral ligament integrity

Positive Signs: Biceps tendon pops out, pain in biccipital groove

Method:

• Seated

• Palpate biccipital groove

• Elbow flexed medially and pronated then

• Resist supination and lateral rotation with elbow flexed

• Like a hitchhiker

Thoracic outlet Syndrome Tests (TOS)

• Adson’s Test

• Wright’s Hyperabduction Test

• Halstead Test

• Eden’s Costoclavicular Test (Military Brace)

Adson’s Test

Purpose: Tests for anterior scalene-related TOS

Positive Signs: Pain into arm, loss of pulse

Method:

• Seated

• Palpate radial pulse, rotate head towards test shoulder

• Extend head

• Therapist externally rotates and extends shoulder

• Patient takes deep breath and holds

Wright’s Hyperabduction Test

Purpose: Tests for pec minor-related TOS

Positive Signs: Increased symptoms, decreased radial pulse

Method:

• Seated

• Passively fully abduct arm to 180 degrees with slight extension

• Monitor the radial pulse

Halstead Test

Purpose: Tests for scalene-related TOS

Positive Signs: Pain into arm, neurological symptoms

Method:

• Seated

• Rotate head AWAY from test shoulder then extend head

• Therapist externally rotates and extends shoulder with downward traction

Eden’s Costoclavicular Test (Military Brace)

Purpose: Tests for costoclavicular-related TOS

Positive Signs: Increased neurological symptoms, decreased radial pulse

Method:

• Monitor radial pulse,

• Therapist depress and retract affected arm

Compression Tests

• Shoulder depression test

• Shoulder Abduction/ Brakody’s

Shoulder Depression Test

Tests for:
• Brachial plexus
compression/irritation
• Multiple cervical nerve root
irritation
• Foraminal encroachment on
compressed side (osteophytes)
• Hypomobile joint capsule on
elongated side
•Positive sign:
• Increased pain and neurological
symptoms
•Method:
• Patient seated
• Therapist applies downward
pressure to shoulder while side
flexing head to opposite side

Shoulder Abduction/ Brakody’s

•Tests for:
• C4, C5, C6 nerve root
compression
• Herniated disc
•Positive sign:
• Decreased pain and
neurological symptoms (also
known as Brakody’s sign)
•Method:
• Patient seated or lying down
• Therapist passively (or
patient actively) elevates
arm through abduction so
that the hand or forearm
rests on top of the head

Tests of the Elbow medial/ lateral epicondylitis

• Mill’s/ Cozen’s/Lat
  Epicondylitis

• Medial epicondylitis

Mill”s Test, Cozens test

Tests for:
• Inflammation at the lateral epicondyle
• Commonly called tennis elbow
•Positive sign:
• Severe pain @ lateral epicondyle
•Method 1: (AKA- Cozen’s)
• Patients elbow stabilized by
therapists thumb resting on lateral
epicondyle
• Patient makes fist, pronates,
radially deviates, and extends the
wrist with the therapist resisting
•Method 2: (AKA- Mill’s)
• Therapist palpates the lateral
epicondyle , then passively
pronates, flexes wrist, and extends
elbow

Medial epicondylitis: Reverse Cozen’s, Reverse Mill’s

•Tests for:
• Inflammation of the medial
Tests For:

epicondyle of the humerus
• Commonly called Golfer’s elbow
•Positive sign:
• Severe pain medial epicondyle
•Method:
• Reverse Cozen’s
• Patients elbow stabilized by
therapists thumb resting on medial
epicondyle
• Patient makes fist, supinates, ulnar
deviates, and flexes wrist with the
therapist resisting
• Reverse Mill’s
• Therapist palpates the medial
epicondyle
• Patients forearm is passively
supinated while the elbow and wrist

Instability: Varus/ Valgus stress test

•Tests for:
• Medial (ulnar) and lateral (radial) collateral ligament instability
• Varus stress also can stress the anular ligament of the radius
•Positive sign:
• Hypermobility/Pain
•Method:
• Patients elbow in slight flexion
• A varus (adduction) force is applied by the therapist to the distal forearm
to test the lateral collateral and a valgus (abduction) stress to test the
medial collateral

Neuro: pinch Grip test

•Tests for:
• Anterior interosseus
nerve (division of median
nerve) pathology/entrapment
between heads of pronator teres
•Positive sign: • Abnormal “pulp-to-pulp” pinch
•Method:
• Patient is asked to pinch
tips of thumb and index
fingers together

Tinel’s Sign

•Tests for:
• Ulnar nerve compression/
regeneration status
•Positive sign: • Tingling sensation in
ulnar distribution (the distribution of these
symptoms informs you how far the nerve has
regenerated/or the level of damage)
•Method:
• Tap the groove between
the olecranon and medial
epicondyle

Upper Wrist and Hand

Instability: radial Ligamentous Stress Test

• Tests for: Ulnar collateral ligament
• Positive sign: • Pain and hypermobility
• Method:
• Place client in supination one
hand stabilizes proximal to
wrist
• Passively move hand into
radial deviation with
overpressure

Ulnar Ligamentous Stress Test

• Tests for:• Radial collateral ligament
• Positive sign: • Pain and hypermobility
• Method:
• Place client in supination one
hand stabilizes proximal to
wrist
• Passively move hand into ulnar
deviation with overpressure

Tendon/ Muscle Pathology: Finklestein (Eichhoff)

•Tests for:
• DeQuervain’s
disease/tenosynovitis/paratenonitis
(APL/EPB)
•Positive sign:
• Pain over the abductor pollicis longus and
extensor pollicis brevis tendon at the
wrist
• Most people have some degree of
discomfort with this test, comparing
bilaterally confirms
•Method:
• Patient makes a fist with the thumb
inside the fingers
• Examiner stabilizes forearm and deviates
wrist toward ulnar side

Neuro: Fromet’s Test

•Tests for:
• Paralysis of adductor pollicis (ulnar nerve)
•Positive sign:
• Distal phalanx of the thumb flexes(Flexor pollicis
longus innervated by the median nerve)
•Method:
• Patient attempts to grasp a piece of paper between thumb
and index finger while therapist attempts to pull away the

Neuro: Phalen’s (Wrist Flexion)

•Tests for: Carpal tunnel syndrome
•Positive sign:
• Tingling sensation in the
thumb index finger and
middle and lateral half
of ring finger (median
nerve distribution)
•Method:
• Examiner flexes patients
wrists maximally and
holds this position for 1 min pushing the wrists

Neuro: Reverse Phalen’s Test

•Tests for: Median nerve
pathology
•Positive sign: Same as Phalen’s

•Tingling sensation in the
thumb index finger and
middle and lateral half
of ring finger (median
nerve distribution)
•Method:
• Therapist places
patients wrists in full
extension and then
draws downward
• Apply overpressure forst

Tinel’s at the Wrist

•Tests for:
• Carpal tunnel syndrome
•Positive sign:
• Tingling sensation and
paraesthesia into thumb index
finger and middle and lateral
half of ring finger (median
nerve distribution)
• Must be felt distal to the
tapping
• Indicates rate of
regeneration of median
nerve
•Method:

• Tap medial wrist

Circulation: Allen Test

• Tests for: Ulnar and radial artery
• Positive sign: Unequal or slow (6 seconds) flushing in
the hand when the blood flow is allowed to return
• Method:
• Patient is asked to open and close the hand
several times quickly
• Then patient squeezes hand tightly
• Therapist places thumb and index finger over
radial and ulnar arteries compressing them
• Patient opens hand while therapist maintains
pressure
• Then remove pressure from one artery and
watch for flushing
• Repeat for other artery