Ortho Upper Extremity Special Tests Chart.docx.pdf

Name Spurling’s Maneuver Purpose/Muscle Involvement Cervical spine ORTHO UPPER EXTREMITY SPECIAL TESTS Associated How to Disease/Syndrome Cervical disc disease Have patient extend and laterally flex neck; apply axial compression on head to both sides. Positive test reproduces radicular pain in upper...

Name Spurling’s Maneuver Purpose/Muscle Involvement Cervical spine ORTHO UPPER EXTREMITY SPECIAL TESTS Associated How to Disease/Syndrome Cervical disc disease Have patient extend and laterally flex neck; apply axial compression on head to both sides. Positive test reproduces radicular pain in upper extremities Hoffman Reflex Cervical spine Long tract spinal cord disease in cervical region While patient is seated and their hand is relaxed, cradle/support patient’s hand in yours and flick their middle finger. Positive test if index and thumb reflexively flex. Apprehension/Relocation Test Joint stability Glenohumeral joint instability Patient lays supine w/ shoulder on table, arm off table and elbow flexed at 90 degrees. Rotate patients arm externally. Positive test if patient is apprehensive. If positive, repeat test but apply direct pressure on the humeral head. Considered positive relocation test if patient isn’t bothered/apprehensive this time. Sulcus Sign Joint stability Glenohumeral joint instability Apply downward traction/pull humerus inferiorly. Positive test if depression (sulcus) seen anteriorly Empty Can Test Supraspinatus (abduction) Impingement syndrome; RC tendonitis, subacromial bursitis Patient’s arms are forward flexed at 90 degrees and 45 degrees adduction horizontally with thumbs down (“emptying their can”). Have patient hold that position and push down on arms to see if they resist and/or if there is a difference between arms. Picture Hawkin’s Sign Supraspinatus Impingement syndrome Patient’s arms are forward flexed at 90 degrees and then bent at elbow 90 degrees (like a “hawk’s wing”). Stabilize the arm at the elbow and passively internally rotate (press the hand down lower while keeping elbow level). Neer’s Sign Supraspinatus Impingement syndrome Patient’s arms are fully pronated with palm and thumbs down. Passively forward flex their arms. Lift-Off Test Subscapularis (internal rotation) Tear in subscapularis tendon or subscapularis tendonitis Have patient internally rotate arms behind back and then have them try to push their arms away from back (“lift-off” from back) Yergason’s Test Biceps tendon Proximal biceps tendonitis Have patient’s elbows at 90 degrees flexion at sides. Hold their hands like a handshake (your hands cross, their hands are straight out) and have them supinate against resistance. Speed’s Test Biceps tendon Proximal biceps tendonitis Patient’s arm is forward flexed to 90 degrees. Have them try to flex arms forward Scarf/Cross-Over Test AC joint AC joint separation Have patient reach their arm across/over to opposite shoulder. Positive test if pain elicited. O’Brien’s Test Glenoid Labrum SLAP (superior labrum anterior to posterior) tear Have patient have one arm flexed at 90 degrees and then 45 degrees medially. Have them internally rotate their arm so their thumb is down. Apply a downward force to the forearm while having the patient resist. Positive test if there is pain or clicking. Adson’s Test Brachial plexus between shoulder girdle and first rib Thoracic outlet syndrome Have patient extend neck and rotate to affected side. Locate patient’s radial pulse and pull their arm posteriorly. Positive test if pulse diminishes. Elevated Arm Stress Test (EAST) Brachial plexus between shoulder girdle and first rib Thoracic outlet syndrome Have patient hold their arms laterally abducted at 90 degrees w/ elbows flexed to 90 degrees and then open and close fists for 3 minutes. Positive test if have reproduction of symptoms (pain/numbness/tingling). Spurling’s Maneuver Brachial plexus Stingers and Burners (transient brachial plexopathy) Have patient extend and laterally flex neck; apply axial compression on head to both sides. Positive test reproduces radicular pain in upper extremities See above Resisted wrist extension Wrist, elbow Lateral epicondylitis “Tennis elbow” Have patient forward flex 90 degrees and pronate forearm/palms face down. Ask them to extend wrist against your resistance. Positive test if pain occurs at lateral epicondyle. Resisted wrist flexion Wrist, elbow Medial epicondylitis “Golfer’s elbow” Have patient forward flex 90 degrees and pronate forearm/palms face down. Ask them to flex wrist against your resistance. Positive test if pain occurs at medial epicondyle. Varus/Valgus Stress Test Ulnar collateral ligament/ [Lateral Collateral Ligament (LCL) and Medial Collateral Ligament (MCL)] LCL and MCL Varus (tests LCL) =have patients arm externally rotated w/ palms face up. Stabilize the medial side of the elbow and place other hand on lateral side of forearm. Apply pressure with lateral hand, pushing elbow medially/inward, into “bowlegged” position. Valgus (tests MCL) = have patients arm externally rotated w/ palms face up. Stabilize the lateral side of the elbow w/ one hand and place other hand on medial side of forearm. Apply pressure with medial hand, pushing forearm laterally outwards. Do each test with arm at full extension and then 30 degrees flexion. Positive test w/ pain or laxity compared to other side. Tinel’s Sign Cubital Tunnel (elbow) Cubital Tunnel Syndrome Percuss over median nerve in the cubital tunnel, between olecranon and medial epicondyle. Positive test results in tingling. Tinel’s Sign Carpal Tunnel (wrist) Carpal Tunnel Syndrome Percuss over the course of the median nerve in the carpal tunnel. Positive test results in tingling in the median distribution (thumb and all fingers except pinky) Phalen’s Test Carpal Tunnel (wrist) Carpal Tunnel Syndrome Have patient acutely flex their wrists together and hold for 60 seconds. Positive test produces median nerve numbness and tingling Finkelstein Test Tendons on thumb side of wrist deQuervain’s tenosynovitis Have patient “hide” thumb in fist and forward flex with elbow flexed at 90 degrees. Passively ulnar deviate their wrist. Positive test if elicits pain at radial styloid. Fovea Sign Ulnar ligament in wrist TFCC tear Check for tenderness in “soft spot” just distally to ulna styloid and triquetrum Thumb MP Joint Ulnar Collateral Ligament Test Joint ulnar collateral ligament of thumb Torn ligament Stabilize patient’s hand and abduct the thumb (pull outwards). Positive test if there is no firm endpoint (i.e. joint doesn’t stop abducting) Thumb CMC Grind Test CMC joint of thumb Osteoarthritis of CMC Stabilize the patient’s wrist and hand. Apply longitudinal axis pressure to the CMC joint and rotate thumb. Positive test if rotation is not smooth or “grinds” Allen Test Ulnar and Radial arteries Collateral arterial circulation Compress both ulnar and radial arteries. After hand turns white (can have patient make a fist and release), release just ulnar or radial artery and hand should return to pink. If only half of the hand returns to pink and other half remains white, considered positive test for potential disruption in artery. Repeat test w/ release of other artery.