MGMT2260: Pt Mgmt 4 - Shoulder / Elbow / Wrist Assessment

anterior drawer test of the shoulder indication

anterior glenohumeral (GH) joint instability

labral tear

anterior drawer test of the shoulder method

cient: supine

therapist: abd shoulder 80-120 + forward flex 20 + externally rot 20; stabilize scap over spine of scap + coracoid process; grasp upper arm and draw humerus anteriorly

anterior drawer test of the shoulder positive

clicking indicates labral tear or slipping over glenoid rim

apprehension

hypermobility

apprehension / crank test indication

GH instability related to dislocation / trauma

apprehension / crank test method

pt supine, arm abd 90; ther ER fully and applies overpressure

apprehension / crank test positive

apprehension, pain, spasm

posterior drawer test of the shoulder indication

posterior GH instability

posterior drawer test of the shoulder method

cl: supine

ther: abd shoulder 80-120 and flex 20-30, stabilize scap, rot arm medial and forward flex 60-80; apply posterior force to humerus

posterior drawer test of the shoulder postitives

hypermobility, apprehension

push-pull test indication

posterior GH instability

push-pull test method

cl: supine

ther: abd 90 + forward flex 30 shoulder; push humeral head posterior + pull wrist superiorly

push-pull test positives

hypermobility, apprehension, pain

sulcus sign / test of the shoulder indication

inferior GH instability

sulcus sign / test of the shoulder method

pt standing; ther observes sulcus sign, if none, stabilize scap and apply inferior traction to distal humerus

sulcus sign / test of the shoulder positives

hypermobility:

• gr1: gap < 1cm

• gr2: < 2cm

• gr 3: >2cm

apprehension

pain

hawkins-kennedy impingement test indications

supraspinatus tendinosis (inflammation of the sheath) or impingement

hawkins-kennedy impingement test method

pt seated, shoulder flex 90; ther IR and applies overpressure

hawkins-kennedy impingement test positives

pain, apprehension

neer impingement test indications

supraspinatus or biceps overuse, subacromial bursitis

neer impingement test method

cl: seated /standing

ther: abduct arm in scaption with internal rot (greater tub on acromion)

neer impingement test positives

pain, apprehension

painful arc test indications

subacromial impingement (bursa, tendons)

acromioclavicular (AC) joint trauma

painful arc test method

cl: standing; abduct shoulder fully

painful arc test positives

pain mid arc (45-120) - subacromial, last 10-20 deg - AC

apley’s scratch test indication

restrictions with combined movements of ER + ABD (upper arm) and IR + ADD (lower arm)

apley’s scratch test method

cl: standing; attempt to touch fingertips together behind back, lower arm in IR + ADD and upper arm in ER + ABD; repeat both sides

apley’s scratch test positives

difference in movement between sides

pain

speed’s test indication

bicipital tendon pathology / strain

SLAP lesion (labrum tear)

speed’s test method

cl: standing / seated

ther: resist flex of elbow in pronation; repeat in supination

speed’s test positives

tenderness at bicipital groove that worsens in supination

yergason’s test indication

integrity of coracohumeral and transverse ligaments holding biceps tendon in groove

biceps tendon pathology

yergason’s test method

cl: standing / seated; flex elbow 90, upper arm against side, forearm pronated

ther: resist supination + external rot of shoulder

yergason’s test positives

palpate biceps popping out of groove - ligamentous

pain - pathology

drop arm / codman’s test indication

tear in rotator cuff

drop arm / codman’s test method

cl: standing

ther: abd shoulder 90 then drop the arm, client attempts to control lowering

drop arm / codman’s test positives

difficulty controlling lowering / jerky movement

severe pain

supraspinatus empty can / jobe’s test indication

supraspinatus tear

suprascapular nerve pathology

supraspinatus empty can / jobe’s test method

cl: standing, arm abd 90 in neutral rotation

ther: resist abd

then…

position arms in scaption + internal rot (thumbs down)

ther: resist abd

supraspinatus empty can / jobe’s test positives

weakness

pain

acromioclavicular shear test indications

Acromioclavicular joint pathology

AC shear test method

cl: seated

ther: cup one hand on clavicle, the other on spine of scapula and squeeze

AC shear test positives

abnormal movement

pain

adson maneuver / test indications

thoracic outlet syndrome related to anterior / middle scalene

adson maneuver / test method

cl: seated, head facing test shoulder + slightly extended

ther: palpate radial pulse then int rot + extend shoulder back

cl: take a deep breath and hold for a comfortable amount of time

adson maneuver / test positives

pulse disappears

neuro signs

halstead’s test / maneuver indication

thoracic outlet syndrome related to scalenes

halstead’s test method

cl: seated, head rot away from test side + extended

ther: palpate radial pulse + extend arm back + apply inferior traction

halstead’s test / maneuver positives

pulse diappears

neuro signs

eden’s / costoclavicular syndrome / military brace test indications

thoracic outlet syndrome related to clavicle and 1st rib

eden’s test method

cl: seated

ther: palpate radial pulse + draw shoulder down and back

eden’s test positives

pulse disappears

neuro signs

wright’s hyperabduction test / maneuver indications

thoracic outlet syndrome related to pec minor

wright’s hyperabduction test / maneuver method

cl: seated, head rot away from test side

ther: full abd + ext rot arm

wright’s hyperabduction test / maneuver positives

pulse disappears

neuro symptoms

shoulder depression test indications

brachial plexus compression / irritation

multiple cervical nerve root irritation

foraminal encroachment (narrowing of openings through which nerves travel) on compressed side

hypomobile joint on elongated side

shoulder depression test method

cl: seated

ther: laterally flex neck and depress opposite shoulder

shoulder depression test positives

pain

neuro symptoms

shoulder abduction / relief test indications

C4 / C5 nerve root irritation

shoulder abduction / relief test method

cl: seated

ther: abd arm to rest on head

shoulder abduction / relief test positives

brakody’s sign (symptoms decrease)

valgus / varus stress test of the elbow indications

medial / ulnar or lateral / radial collateral ligament instability

valgus / varus stress test of the elbow method

cl: standing/seated, elbow slightly flexed

ther: apply valgus then varus force to elbow

valgus / varus stress test of the elbow positives

hypermobility

• valgus = MCL

• varus = LCL

lateral epicondylitis test indications

inflammation of lateral epicondyle (common extensor tendon / CET) AKA tennis elbow

lateral epicondylitis test - cozen’s indication

lat epicondylitis relating to extensor carpi radialis brevis

lateral epicondytis test - Cozen’s method

cl: seated

ther: grasp elbow + palpate CET

cl: make a fist then pronate + radially deviate + extend wrist

ther: resist extension of the hand at wrist

lateral epicondylitis test - Mill’s indication

epicondylitis relating to extensor carpi ulnaris / extensor carpi radialis brevis

lateral epicondylitis test - Mill’s method

cl: seated

ther: grasp elbow + palpate CET then bring wrist into mid pronation + flex + radial dev then extend elbow

lateral epicondylitis test - Maudsley’s indication

epicondylitis relating to extensor digitorum

lateral epicondylitis test - Maudsley’s method

cl: seated, forearm slightly flexed and pronated

ther: resist extension of 3rd digit distal to PIP

lateral epicondylitis tests positives

pain at lateral epicondyle

medial epicondylitis test indications

inflammation at medial epicondyle (common flexor tendon - CFT) AKA golfer’s elbow

medial epicondylitis test method

cl: seated

ther: palpate CFT then supinate + extend elbow and wrist

medial epicondylitis test positives

pain at CFT

pinch grip test indicates

interosseous nerve (branch of median nerve) is entrapped in pronator teres

pinch grip test method

client pinches tip of index and thumb together to make “OK” symbol

pinch grip test positives

inability to pinch

abnormal pinch grip (not circular)

pronator teres syndrome test indications

pronator teres compressing median nerve

pronator teres syndrome test method

cl: elbow flexed 90, mid pro / supination

ther: resist pronation while extending elbow

pronator teres syndrome test positives

neuro symptoms

tinel’s test / sign at elbow indications

ulnar nerve compression

regeneration status (to track amount of recovery since injury)

tinel’s test / sign at elbow method

cl: seated, forearm supinated

ther: tap ulnar groove repeatedly

tinel’s test / sign at elbow positives

tingling / change in sensation

murphy’s sign indicates

dislocated lunate

murphy’s sign method

cl: make a fist with wrist in pronation

ther: observe alignment of metacarpals

murphy’s sign positives

head of 3rd metacarpal is level with the 2nd and 4th

radial ligamentous stress test indications

medial (ulnar) collateral ligament instability / injury

wrist adductor injury

radial ligamentous stress test method

cl: seated

ther: supinate + radial dev hand; stabilize proximal and apply overpressure

radial ligamentous stress test positive

hypermobility

pain

ulnar ligamentous stress test indications

radial collateral ligament instability / injury

wrist abductor injury

ulnar ligamentous stress test method

cl: seated

ther: supinate + ulnar dev hand at wrist; stabilize proximal + apply overpressure

ulnar ligamentous stress test positives

hypermobility

pain

finkelstein / eichoff test indications

DeQuervain’s tenosynovitis (cyst in tendon) / disease

paratenonitis of abductor pollicis longus / extensor pollicis brevis

finkelstein / eichoff test method

cl: make a fist w thumb tucked, wrist mid pro / sup

ther: stabilize forearm

cl: ulnar deviate hand

finkelstein / eichoff test positives

pain / increased symptoms

note: often uncomfortable when negative due to tight tissues

forment’s sign indications

paralysis of adductor pollicis due to ulnar nerve pathology

froment’s sign method

cl: grasp piece of paper between thumb and index

ther: try to pull paper away (resist add of thumb)

froment’s sign positives

distal phalanx of thumb flexes

phalen’s / wrist flexion test indications

carpal tunnel syndrome related to bones of carpus

phalen’s / wrist flexion test method

cl: seated

ther: flex wrists + press dorsal aspects together, holding ~1min