UE Special Tests

Yergason's test purpose

Tests for the integrity of transvere ligament and may also identify bicipital tendonitis

Yergason's Test Procedure

1. elbow flexed to 90° and stabilized against thorax and forearm pronated.

2. palpate for tendon in the bicipital groove.

3. resists supination of forearm and external rotation of shoulder

Yergason's Test results

(+) = dislocation of LH bicep tendon or pain

Speed's Test purpose

Identify bicipital tendinosis/ tendinopathy

Speed's Test Procedure

Forward flex shoulder against resistance while maintaining elbow in extension and forearm in supination

Speed's Test results

(+) pain in LH biceps

Neer's Impingement test purpose

for impingement of soft tissue structures of shoulder complex (long head of biceps and supraspinatus)

Neer's impingement test procedure

Passively move arm into full scaption with arm in IR

Neer's impingement test results

(+) pain in shoulder region

Empty Can (Jobe) Test purpose

Tests: Supraspinatus impingement / tear

Empty Can (Jobe) Test procedure

1. GHJ abducted to 90° with neutral (no) rotation.

2. apply downward force, patient resists.

3. shoulder is medially rotated and angled forward (i.e. scaption angle). thumbs pointing straight down.

4. apply downward force, patient resists

Empty Can (Jobe) Test results

(+) pain or weakness in empty can position

Drop arm test purpose

rotator cuff tear

Drop arm procedure

Shoulder abduction to 90dgs, asks pt to slowly lower arm

Drop arm results

(+) severe pain or inability to perform slowly

Posterior internal impingement test purpose

Impingement between RC and greater tuberosity or posterior glenoid and labrum

Posterior internal impingement procedure

Pt in supine. Passive shoulder abduction to 90-110dgs with ~15dgs extension and max ER

Posterior internal impingement results

(+) pain in posterior shoulder

Hawkins-Kennedy Test purpose

Subacromial impingement

Hawkins-Kennedy Test procedure

1. Therapist brings client's shoulder into 90 degrees flexion

2. Medially rotate client's shoulder so that the hand goes towards floor

Hawkins-Kennedy Test results

(+) pain

O'Brien's Active Compression Test Purpose

SLAP lesion

O'Brien's Active Compression Test Procedure

The patient stands with involved shoulder at 90dgs flexion, 10dgs horizontal adduction, max IR with elbow in extension. Pt resists downward force. Test performed again in max ER

O'Brien's Active Compression Test Results

(+) pain or clicking in max IR, no pain max ER

Biceps Load Test Purpose

SLAP lesion

Biceps Load Test procedure

Shoulder 120dgs abduction + slight ER, elbow flexed to 90dgs, full supination. Shoulder then moved into ER until apprehension. Once at apprehension, resist elbow flexion

Biceps Load Test results

(+) apprehension remains same and/or painful

Shoulder pain provocation (Mimori) test purpose

SLAP lesion

Shoulder pain provocation (Mimori) test description

Shoulder abduction to 100dgs, then passively moved into full pronation + supination

Shoulder pain provocation (Mimori) test results

(+) pain in pronation > supination

Lateral rotation lag sign purpose

Infraspinatus and teres minor

Lateral rotation lag sign procedure

Elbow flexed to 90dgs, examiner passively moves arm into 90dgs scaption + full ER. Ask pt to hold postition

Lateral rotation lag sign results

(+) Hand springs back anteriorly

Abdominal Compression (Belly Press) Test purpose

Subscapularis

Abdominal Compression (Belly Press) Test procedure

Patient: Standing. Place hand of arm being assessed on examiner's hand and then forcefully "press" towards stomach (IR) while bringing the elbow forward.

Examiner: The examiner places one hand on the abdomen so as to feel for amount of pressure applied by client.

Abdominal Compression (Belly Press) Test results

(+) Unable to maintain pressure with moving elbow forward, flexes wrist, or extends shoulder

Jerk Test purpose

To test recurrent posterior instability

Jerk test procedure

Pt standing

Pts arm abducted 90 degrees, max IR, elbow flex to 90dgs

Place hand proximal to elbow and provide axial loading as you adduct arm towards midline

Jerk test results

(+) sudden jerk or clunk as humeral head slides off the back of the labrum (subluxation)

Sulcus sign purpose

Inferior shoulder instability

Sulcus sign procedure

Pt relaxes shoulder muscles, examiner grasps patient's forearm below elbow and distracts arm

Sulcus sign results

(+) sulcus sign present AND must be symptomatic

Pec major contracture test purpose

pec major tightness

Pec major contracture test procedure

Patient in supine. Hands together behind head, arms are lowered until elbows touch table

Pec Major contracture test results

Elbows cannot reach table

Halstead Maneuver purpose

Identify pathology of structures that pass through thoracic inlet

Halstead maneuver procedure

While palpating the radial pulse, the therapist abducts the arm to 45 degrees, extends the shoulder to 45 degrees, and externally rotates the upper extremity while applying a downward distraction to the arm. The patient is then asked to fully turn her head away from the side being tested and extend the cervical spine.

Halstead maneuver results

(+) disappearance of radial pulse

Clunk Test purpose

Glenoid labrum tear

Clunk test procedure

Pt supine with shoulder in full abduction. Push humeral head anterior with humeral ER

Clunk test results

(+) audible clunk

Anterior apprehension/Crank test purpose

previously anterior subluxation/dislocation of shoulder

Anterior apprehension/crank test procedure

1. supine.

2. abduct patient arm to 90°,

3. flex elbow to 90°.

4. SLOWLY externally rotate

Anterior apprehension/crank test results

(+) Pt does not allow or is uncomfortable with ER

Posterior Apprehension sign

identifies past history of posterior shoulder subluxation/dislocation

Posterior apprehension procedure

Patient supine. Examiner elevates to 90dgs scaption and elbow bent 90dgs, then provides posterior force on elbow with other hand on scapula

Posterior apprehension results

(+) pt does not allow or is uncomfortable with posterior force

Acromioclavicular Shear Test purpose

ACJ dysfunction (separation or arthritis)

Acromioclavicular Shear test procedure

Examiner cups hands over anterior and posterior deltoids and squeezes hands together

Acromioclavicular shear test results

(+) ACJ pain

Adson's Test purpose

Thoracic Outlet Syndrome (TOS) of first rib and scalenes

Adson's Test procedure

1. Palpate radial pulse at the wrist while you abduct, extend, and externally rotate the upper extremity at the shoulder joint (keeping the elbow straight).

2.Have the patient take a deep breath, rotate, and extend their head TOWARD the side being tested.

Adson's Test results

(+) pulse disappearance

Costoclavicular (military brace) test purpose

Thoracic outlet syndrome

Costoclavicular (military brace) test procedure

Palpate radial pulse, followed by shoulder extension, shoulder depression and retraction

Costoclavicular (military brace) test results

(+) pulse disappearance

Wright (hyperabduction) test purpose

Thoracic outlet syndrome

Wright (hyperabduction) test procedure

Locate radial pulse, passively move arm into max abduction + ER. Ask pt to take deep breath and rotate head contralaterally

Wright (hyperabduction) test results

Neuro symptoms or radial pulse disappearance

Roos Test purpose

Thoracic outlet syndrome

Roos Test procedure

- Abduct arms to 90 degrees

- flex elbows to 90 degrees

- open & close hands slowly for 3 minutes (may take less for a positive sign)

Roos Test results

Inability to keep arms up for 3 minutes due to pain, heaviness, weakness of arm, numbness and tingling of hand

ULTT 1

Nerve Bias: Median nerve & AIN

Sequence:

-shoulder depression w/ 110 deg abduction

- elbow extension

- forearm supination

- wrist extension

- finger & thumb extension

Sensitization: contralateral cervical sidebend (bend head to opp side)

ULTT 2

Nerve Bias: Median nerve, musculocutaneous nerve, axillary nerve

Sequence:

-shoulder depression w/ 10 deg abduction

- elbow extension

- forearm supination

- wrist extension

- finger & thumb extension

-Shoulder lateral rotation

Sensitization: contralateral cervical sidebend (bend head to opp side)

ULTT 3

Nerve Bias: Radial nerve

Sequence:

-shoulder depression w/ 10 deg abduction

- elbow extension

- forearm pronation

- wrist flexion & ulnar deviation

- finger & thumb flexion

- shoulder medial rotation

Sensitization: contralateral cervical sidebend (bend head to opp side)

ULTT 4

Nerve Bias: Ulnar nerve

Sequence:

-shoulder depression w/ 10-90 deg abduction

- elbow flexion

- forearm supination

- wrist extension & radial deviation

- finger & thumb extension

- shoulder lateral rotation

Sensitization: contralateral cervical sidebend (bend head to opp side)

Elbow ligament instability test purpose

identify ligamentous laxity

Elbow ligament instability test procedure

Elbow in 0-20dgs flexion valgus and varus loads through elbow

Elbow ligament instability test results

(+) laxity and/or pain

Cozen's Test purpose

Identify lateral epicondylitis

Cozen's Test procedure

Flex elbow 90dgs, full pronation, full radial deviation, full wrist extension. Pt resists supination and wrist extension.

Cozen's Test results

(+) sudden severe pain at lateral epicondyle

Mill's Test purpose

lateral epicondylitis

Mills test procedure

Examiner palpates lateral epicondyle while passively pronating, full wrist flexion, followed by elbow extension

Mills test results

(+) pain

Maudsleys Test purpose

Identify lateral epicondylopathy

Maudsleys test procedure

Examiner resists 3rd digit extension proximal to PIPJ

Maudsleys test results

(+) pain

Elbow flexion test purpose

Identify cubital tunnel syndrome

Elbow flexion test procedure

performed bilaterally

Client is asked to fully flex elbows with extension of the wrists and shoulder girdle abduction and depression This position is held for 3 - 5 minutes

Elbow flexion test results

(+) tingling or parathesia in the ulnar nerve distribution of the forearm and hand

Medial epicondylitis test purpose

Identify medial epicondylitis

Medial epicondylitis procedure

Examiner palpates medial epicondyle while passively supinating and extending elbow and wrist

Medial epicondylitis results

(+) pain

Tinel's Sign (elbow) purpose

Ulnar nerve dysfunction at olecranon

Tinel's Sign (elbow) procedure

Therapist taps the ulnar nerve in the groove between the olecranon process and the medial epicondyle

Tinel's Sign (elbow) results

(+) tingling sensation in ulnar distribution of the forearm and hand distal to the point of compression of the nerve

Pronator Teres syndrome test purpose

Identify median nerve entrapment within pronator teres

Pronator teres syndrome test procedure

Pt sits with elbow flexed to 90dgs. Examiner strongly resists pronation as elbow is extended

Pronator Teres syndrome test results

(+) tingling or paresthesia in median nerve distribution