UE Special Tests | Transes
Upper Extremity Special tests
Shoulder
A. Anterior instability of the shoulder
Special test Position Action (+) Indication
Dugas test Patient: Sitting + hand resting Patient lowers the elbow
(+) LOM c pain D/L w/out reduction
on opposite shoulder
- Lower the elbow involves
posterior roll w/ anterior glide
of the shoulder
Apprehension (Crank) Test Patient: Supine Place the arm in 90 degrees (+) Apprehension/Resistance GH Instability (Traumatic)
Abd & laterally rotate slowly to motion
(forces the shoulder anteriorly
and outwardly — anterior
position is the greatest D/L)
Therapist: PT applies the LR
Fulcrum Test Patient: Supine
“ (+) Apprehension Apparent - GH Instability
PT: Place hand under the pt (+) Pain posteriorly - Posterior Impingement
GH joint
- This tests provides more anterior translation
1 PTRP, MD
UE Special Tests | Transes
Jobe Relocation Test “ PT: Applies posterior (+) Apprehension disappears GH Instability
translation (trying to put it
back to it’s socket)
Anterior Release (Surprise) Test “ P T : Q u i c k l y re l e a s e t h e (+) Pain GH Instability
posterior translation you (+) Forward Translation
applied
Rockwood Test Patient: Seated/Supine + arms PT: Laterally rotate shoulder in 0° = Rarely Apprehensive
Anterior Shoulder Instability
@ side di erent degrees
45° = Pt manifests uneasiness
90° = Apprehension
120° = Uneasiness
2 PTRP, MD
ff
UE Special Tests | Transes
Anterior Load & Shift Test Patient 1: Sitting + arms @ side
PT 1:
(+) >25% of SH Anterior (+) GH Instability
1) Load and push humeral Translation
Patient 2: Supine/Scaption head anteriorly
2) Shift: Provide anterior Normal (N): 25% SH
translation c other hand
Translation
PT 2:
1) Same action as PT 1
2) Additional lateral rotation
B. Posterior instability
Posterior load & shift test “ Apply posterior translation (+) >50% Atraumatic GH Instability
Jerk test Patient: Sitting c SH forward PT: Horizontal Add + Push (+) clunk (louder than a click) Posterior Instability of the SH
exed & IR posteriorly
2nd part “ PT: Return the SH to original (+) Clunk Posterior - Inferior Labral Tear
position
3 PTRP, MD
fl
UE Special Tests | Transes
Push - pull test Patient: Supine c Scaption PT:
(+) >50% translation
1) Push the humeral head
2) Pull the wrist of the pt
Norwood stress test Patient: Supine +
PT:
(+) Humeral head slips Post. Instab.
SH Abd: 60 - 100 degrees
1) Horizontal Add + IR
posteriorly
SH ER: 90
2) Hand pushed humerus (+) Clunk
Elbow: 90 posteriorly
Circumduction test Patient: Standing Patient:
(+) Subluxation upon palpation Post Instab
Circumduction from Ext + Abd of posterior GH structures
to
Flex + Abd
C. Inferior instability
4 PTRP, MD
UE Special Tests | Transes
Sulcus sign Patient: Standing c arms @ side PT: Pull arm distally (down) (+) Sulcus (b/n Humeral Head & Inferior Instab
Acromion Process)
Grading:
+1 = <1 cm
+2 = 1-2 cm
+3 = >2 cm
Feagin test Patient: Standing c Arm @ 90 PT: Push arm anterior-inferiorly (+) Sulcus (above the coracoid Ant-Inf Instab
degrees Abd
process)
PT: Hand on SH
D. Labral Pathologies
5 PTRP, MD
UE Special Tests | Transes
Clunk test Patient: Supine PT:
(+) Clunk/Grinding Labral tear
1) Full Abd of arm
2) ER
3) Push humeral head
anteriorly
Anterior slide test Patient: Sitting/Standing + PT: Push the elbow anterior - (+) Anterior SH pain
Labral Lesion
hands resting on the waist superior (+) Pop/Crack sound
- Humeral head slides over the
labrum
E. Muscle pathologies
Supraspinatus test Position: Shoulder PT: Resist shoulder (+) Weakness or pain Supraspinatus mm or tendon
Abducted + Neutral Rotation abduction tear
Empty Can Test
(thumb pointing up)
Position: Shoulder
Abducted + IR + Scaption
(thumb pointing down)
6 PTRP, MD
UE Special Tests | Transes
Speed’s test Position: Elbow extension PT: Resist shoulder forward (+) Tenderness in Bicipital Bicipital Paratenonitis/
exion in either supination Groove (Supination > Tendinosis
Biceps Test”
pronation)
or pronation
“Straight Arm test”
(+) Pain in Joint Line SLAP Lesion
Yergason test Position: Standing or sitting
PT: Resist the … while (+) Tendon pops out Rupture of Transverse
palpating long head of Humeral lig
Elbow Flexed
biceps tendon
Forearm pronated
Supination
Lateral Rotation
Ludington’s test Position: Patient: Contract-Relax (+) NO Palpable Tension Rupture of long head of
Biceps
biceps
Hands clasped on
top or behind head PT: palpate long head
Biceps tendon
7 PTRP, MD
fl
UE Special Tests | Transes
Heuter sign Position: PT: resist elbow exion (-) Supination Rupture of Distal Biceps
Elbow exion
FA pronated
Drop arm test Position: Patient: Slowly lower the (+) Apprehension while Rotator Cu Complex Tear
arm lowering the arm and
Codman’s test
Shoulder in 90 eventually drops the arm
degrees Abduction
lift off sign Position: Hand on Posterior Patient: Lift hand away (+) Unable to perform/lift-o Subscapularis mm or tendon
Lumbar Area from the back
sign is absent tear
“Gerber Test”
Alternatives:
Abdominal
Compression: Put
your hand under
patients hand on
the belly and let the
pt press the hand
towards the belly
and PT feel if there
is tension
Belly Press Press
Napoleon Test
8 PTRP, MD
fl
ff
fl
ff
UE Special Tests | Transes
F. Impingement
Neer impingement Position: Sitting/Standing Patient: Full arm elevation c (+) Pain or reproduction of Overuse injury to
MR symptoms supraspinatus tendon
Hawkin’s - kennedy Position: Sitting/Standing Patient: Supraspinatus paratenonitis/
tendinosis; secondary
Forward exion + impingement
MR
Primary Impingement:
Inferior
Subacromial Space
RC Tendon
Degeneration
Osteophyte under
AC jt
Hooked Acromion
GH Joint
Hypomobility
9 PTRP, MD
fl
UE Special Tests | Transes
Yocum Position: Hand on opposite Patient:
shoulder
Elbow elevation
Elbow
A. Ligament instability
Special test Position Action (+) Indication
Ligament valgus instability test Position: Sitting/Standing Apply VALGUS stress
(+) Increase motion/Pain MCL Injury
Forearm goes into
Abduction
Ligament varus instability test Apply VARUS Stress
LCL Injury
Forearm goes into
ADDuction
B1. Lateral Epicondylitis
Cozen’s test Position: PT: Provide resistance (+) Pain on lateral epicondyle
Fisted, wrist
extension
Radial deviation
Pronation
10 PTRP, MD
UE Special Tests | Transes
Mill’s Test Position: PT: Passively move and
apply more tension
Wrist exion
Extend elbow
Pronate wrist
Maudsley test Position: Provide Resistance
Extension of middle
nger
B2. Medial Epicondylitis
Medial epicondylitis test Position: Passively done (+) Pain on medial epicondyle Medial epicondylitis
Supination
Wrist & elbow
extension
C. Neurodysfunction
11 PTRP, MD
fi
fl
UE Special Tests | Transes
Tinel sign Position: tap the cubital tunnel (+) Tingling on ulnar distribution Regeneration of Nerve ber
No direct position is
needed
Elbow flexion test Position: Patient: (+)Tingling in Ulnar Distribution Cubital Tunnel Syndrome
Elbow exion
Perform it all at
once
Wrist extension
Shoulder abduction
Shoulder depression
12 PTRP, MD
fl
fi
UE Special Tests | Transes
Wartenberg sign Position: Patient: perform actively (+) Little nger remains in Ulnar Neuropathy
Adduction of ngers (close abduction
Finger Abduction
palm)
(open palm)
Pronator teres test Position: Patient (+) Paresthesia of Median N. Pronator Teres Syndrome
Distribution
Elbow exion
Elbow extended
FA Supination FA pronation
Pinch Grip Test Position: OK Sign (+) Cannot perform Anterior Interosseous Nerve
Pathology
OK Sign
Tip to tip thumb to
index nger
13 PTRP, MD
fi
fl
fi
fi
UE Special Tests | Transes
Forearm, wrist & hand
A. Ligament, joint, and capsule instability
Shuck test Position: Action: (+) Pain Radiocarpal Ligament
Finger Extension Test
Injury
Wrist exion Resist Finger
extension In ammation
Scaphoid Instability
Kienbock’s Disease
Murphy’s sign Position PT (+) 3rd MCP is level c 2nd and Lunate Dislocation
4th MCP
Clench st Observe 3rd MCP
(knuckle)
14 PTRP, MD
fl
fl
fi
UE Special Tests | Transes
Piano key test FA Pronation Push Ulna palmarly (+) Excessive motion Distal Radioulnar Jt
Instability
Haines-zancolli test Assess around PIP 1st Part:
(+) NO DIP Flexion Retinacular lig is tight
Retinacular Test
PIP is neutral
DIP capsule is tight
Flex the DIP
2nd Part:
(+) DIP Flexion Tight secondary Retinacular
Lig
Flex PIP
(-) DIP Flexion Tight DIP capsule
Flex DIP
Bunnel-littler test Assess around MCP 1st Part:
(-) PIP Flexion Tight Intrinsic mm (Lumbricals)
Tight PIP Capsule
Finochietto-Bunnel Test
MCP Extended
Flex PIP
2nd Part
(+) PIP Flexion Intrinsic muscle tightness
Flex MCP
(-) PIP Flexion PIP Capsule is tight
Flex PIP
15 PTRP, MD
UE Special Tests | Transes
Finkelstein test Put thumb in st Active Ulnar Deviation (+) Pain (APL & EPB) De Quervain’s/Ho man’s
Disease
Sweater/jersey finger Open Palm Actively close st (+) Inability to ex one DIP jt Ruptured FDP
B. Neurodysfunction
16 PTRP, MD
fi
fl
fi
ff
UE Special Tests | Transes
Froment’s paper syndrome Hold paper b/n index and Pull the paper (+) Flexion of IP Jt Ulnar Paralysis
thumA
Phalen’s test Max Wrist exion Hold 1 minute (+) Paresthesia (Median n Carpal Tunnel Syndrome
distribution)
Wrist Flexion Test
17 PTRP, MD
fl
UE Special Tests | Transes
Reverse phalen’s test Max wrist extension Hold 1 minute
Prayer Test
Tinel sign Seated Tap the carpal tunnel (+) Paresthesia in Median n Carpal Tunnel Syndrome
distribution
Allen’s Active open, close hand
(+) Slow return of red color to Vascular compromise
the oalm
PT: Compress artery on
ulnar and radial side
Pt opens hand
PT: Release one
artery at a time
18 PTRP, MD
UE Special Tests | Transes
19 PTRP, MD
