Special Testing PPOM 1 Block 3

Purpose: Tests for supraspinatus tendon injury (rotator cuff tear or tendinopathy)

How to Perform:

• Patient's arm abducted to 90° and moved forward 30° (scapular plane)

• Thumbs pointing down (as if emptying a can)

• Examiner applies downward pressure on the arms while patient resists

Positive Test:

• Weakness or pain with resistance indicates supraspinatus injury

Empty Can Test (Jobe’s Test)

Purpose: Also assesses for supraspinatus tear

How to Perform:

• Patient fully abducts the arm

• Patient is asked to slowly lower the arm to their side

Positive Test:

• Sudden dropping of the arm or inability to smoothly lower it indicates full-thickness rotator cuff tear, especially of the supraspinatus

Drop Arm Test

Purpose: Tests for shoulder impingement, especially of the supraspinatus tendon under the acromion

How to Perform:

• Flex shoulder and elbow to 90°

• Internally rotate the arm while stabilizing the scapula

• Apply gentle pressure downward on the wrist

Positive Test:

• Pain in the superior shoulder suggests subacromial impingement

Hawkins-Kennedy Impingement Test

Purpose: Also tests for subacromial impingement

How to Perform:

• Examiner stabilizes the scapula

• Patient’s arm is passively flexed (raised) overhead in internal rotation

Positive Test:

• Pain during flexion indicates rotator cuff impingement (especially supraspinatus or long head of biceps tendon)

Neer Impingement Test

Purpose: Diagnostic for De Quervain’s Tenosynovitis (inflammation of APL & EPB tendons)

How to Perform:

• Patient tucks their thumb into a fist

• Examiner ulnarly deviates the wrist (bends it toward the pinky)

Positive Test:

• Pain at the radial styloid indicates tenosynovitis of the abductor pollicis longus and extensor pollicis brevis

Finkelstein’s Test

Purpose: Tests for nerve irritation or entrapment

How to Perform:

• Examiner taps over the course of a nerve:

  • At wrist (median nerve) → for carpal tunnel syndrome

  • At elbow (ulnar nerve) → for cubital tunnel syndrome

Positive Test:

• Tingling or “electric shock” sensation in the nerve distribution (e.g., first three digits for median nerve, 4th/5th for ulnar)

Tinel’s Sign (at the Wrist or Elbow)

Purpose: Tests for carpal tunnel syndrome

How to Perform:

• Patient flexes both wrists and presses backs of hands together (reverse prayer position) for 30–60 seconds

Positive Test:

• Numbness or tingling in the median nerve distribution (thumb, index, middle, and radial half of ring finger)

Phalen’s Test

Purpose: Assess for medial (golfer’s) or lateral (tennis) epicondylitis

A. Lateral Epicondylitis (Tennis Elbow)

• Passive pronation + wrist flexion

• Resisted wrist extension

Positive Test: Pain at the lateral epicondyle

Elbow Provocation Tests for Epicondylitis

• Passive supination + wrist extension

• Resisted wrist flexion

Positive Test: Pain at the medial epicondyle

Medial Epicondylitis (Golfer’s Elbow)

Purpose: Diagnose septic flexor tenosynovitis

Signs (must evaluate together):

1. Fusiform swelling of the digit

2. Finger held in slight flexion

3. Pain with passive extension

4. Tenderness along the flexor tendon sheath

Interpretation:

• Presence of these 4 signs strongly suggests infected flexor tendon sheath, which requires urgent surgical intervention

Kanavel’s Signs (not a single test but a group of signs)

What does a positive Empty Can test indicate?

Weakness or pain with resistance indicates supraspinatus injury

What does a positive Drop Arm test indicate?

Sudden dropping of the arm or inability to smoothly lower it indicates full-thickness rotator cuff tear, especially of the supraspinatus

What does a positive Hawkins-Kennedy Impingement test indicate?

Pain in the superior shoulder suggests subacromial impingement

What does a positive Neer impingement test indicate?

Pain during flexion indicates rotator cuff impingement (especially supraspinatus or long head of biceps tendon)

What does a positive Finklestein’s test indicate?

Pain indicates tenosynovitis of the abductor pollicis longus and extensor pollicis brevis

(De Quervian’s Tenosynovitis)

A positive Tinel’s sign at the wrist indicates what?

Tingling at wrist (median nerve) → for carpal tunnel syndrome

A positive Tinel’s sign at the elbow indicates what?

Tingling at elbow (ulnar nerve) → for cubital tunnel syndrome

What is a positive Phalen’s test indicate?

Tests for carpal tunnel syndrome

What does a positive Cozen’s test indicate?

Positive for lateral epicondylitis or “tennis elbow”

What does presence of the Kanaval’s signs indicate?

Presence of these 4 signs strongly suggests infected flexor tendon sheath

• Purpose: Differentiates between muscular vs. nerve root causes of neck pain.

• Description: Examiner lifts the patient's head (traction). Relief of symptoms indicates nerve root compression.

• Indicative of: Nerve root impingement (if pain is relieved with distraction).

Distraction Test