Tissue Injury Final Special Test

Front 1

Cervical Compression Test (P. 547)

Back 1

Patient Position: Seated

Examiner Position: Standing behind the patient

Procedure: Please interlocked hands ontop of the head and press downward (axial loading of spine). Begin with lighter pressure and then gradually increase

Positive Test: Experiences pain or reproduction of symptoms in the upper cervical spine or upper extremities or both

Implication: Compression of the facet joints and narrowing of the intervertebral foramen resulting in pain

Front 2

Spurling Test (P. 548)

Back 2

Patient Position: Seated, neck laterally flexed

Examiner Position: Standing behind the patient

Procedure: Place interlocked hands on top of the head and press downward (axial loading relative to the trunk). Begin with lighter pressure and then gradually increase.

Positive Test: Pain or reproduction of symptoms radiating down patient's arm

Implications: Nerve root impingement by narrowing of the neural foramina

Front 3

Brachical Plexus Traction Test (P. 557)

Back 3

Patient Position: Seated

Examiner Position: Standing beside or behind the patient

Procedure: Place the stabilizing hand over the top of the effected shoulder. The other hand is placed on the temporal area of the head. Laterally flex the cervical spine away from the shoulder being stabilized/depressed

Positive Test: Reproduction of pain and/or peresthesia symptoms thorughout the involved upper extremity

Implications: Brachial plexus neurpraxia

Radiating pain of opposite side of lateral bending (tension of brachial plexus)

Radiating plain on side toward lateral bending (compression of cervical root of the two vertebrae)

Front 4

Adison's Test (P. 559)

Back 4

Patient Position: Seated, shoulder abducted to 30-60 degree, elbow extended with thumb pointing upward, and humerus externally rotated

Examiner Position: Standing behind the patient, one hand on the radial pulse

Procedure: Maintain the patient position while palpating the radial pulse and externally rotate and extend the patient's arm while he/she looks down the arm. Instruct the patient to inhale deeply and hold breath

Positive Test: Radial pulse disappears of markedly diminishes when compared to the opposite side

Implications: Subclavian artery occluded between the anterior and medial scalene muscle and pectoralis minor

Front 5

Allen Test (P. 560)

Back 5

Patient Position: Seated. Head facing forward

Examiner Positon: Standing behind the patient, palpating the radial pulse on the side to be tested

Procedure: Flex elbow to 90 degrees wit shoulder abducted to 90 degrees. Passively extend (horizontal abduction) and externally rotate the shoulder and instruct the patient to turn head away from shoulder. Maintain radial pulse palpation throughout procedure. Patient rotates head toward opposite shoulder

Positive Test: Radial pulse disappears or reproduction of neurologic symptoms

Implications: Pectoralis minor muscle is compressing the neurovascular bundle

Front 6

Roo (EAST) Test (P. 562)

Back 6

Patient Position; Seated or standing: shoulders abducted to 90 degrees and elbows flexed to 90 degrees with humerus externally rotated

Examiner Position: Standing in front of patient

Procedure: Patient is instructed to rapidly open and lcose his/her hands for 3 minutes

Positive Test: Inability to maintain the testing position and replication of sensory and/or motor symptoms in the extremity

Implications: Thoracic outlet syndrome of neurologic and/or origin

Front 7

Sparing Test (AKA Piano Key Test)

Back 7

Patient Position: Sitting or standing, arm relaxed by side

Examiner Position: Standing to side of patient

Procedure: Apply downward force over the end of the clavicle near the AC joint

Positive Test: Gross laxity (Some type of AC tear )

Video: https://www.youtube.com/watch?v=96gTvNQGMzU

Front 8

Apprehension Test (P 672)

Back 8

Patient Position: Supine preferred. Sitting or standing ok for on-the-field evaluation. Shoulder abducted to 90deg and elbow flexed to 90 deg.

Examiner Position: Standing to side of patient

Procedure: Support the arm at the elbow. The other hand applies pressure on distal forearm, slowly externally rotating the shoulder while it is abducted

Positive Test: The patient displays apprehension that the shoulder may dislocate and resists further movement. Pain is centered in the anterior capsule of the GH joint.

Implications: Anterior capsule, inferior GH ligement, or glenoid labrum have been compromised, allowing the humeral head to dislocate or subluxate anteriorly on glenoid fossa.

Apprehension coupled with pain is associated with instablity secondary and rotator cuff pathology

Pain in deep posterior shoulder may be associated with internal impingement

Front 9

Relocation Test (P. 674)

Back 9

Patient Positon: Supine preferred. Sitting or standing ok for on-the-field evaluation. Shoulder abducted to 90 degrees and elbow flexed to 90 degrees

Examiner Position: Standing to side of patient inferior to humerus of involved side

Procedure: Utilizing the same position and application of force as the apprehension test, place the stabilizing hand over the front of the shoulder and apply a posteriorly directed force

Positive Test: Decreased pain or increase ROM or both with apprehension test

Implication: Anterior pain may be result of increased laxity in the anteiror ligaments and capsular structures or a tear of the labrum. Posterior pain may be from internal of the posterior capsule or labrum

Supports increased laxity in anterior capsule owing to capsular damage or labrum tears. Manual pressure increases stability of anterior portion of GH capsule, allowing more external rotation to occur.

Front 10

Sulcus Sign (P.678)

Back 10

Patient Position: Sitting, arm hanging down by side

Examiner Position: Standing lateral to involved side

Procedure: Place one hand over the top of the shoulder, stabilizing the scapula. Grasp the patient's arm distal to the elbow and apply traction (downward force) to the arm

Positive Test: Gapping between the acromion and head of humerus

When there is an indentation (sulcus) beneath the acromion process

Implication: Laxity in superior GH ligament

Grade 1 = 1 cm or less

Grade 2=1-2 cm

Grace 3= greater than 2 cm

Front 11

Empty Can Test (P. 689)

Back 11

Patient Position: Sitting or standing, shoulder abduced to 90 degrees in the scapular plane (slightly forward of true abduction) with internal rotation (thumb down), elbow extended

Examiner Position: Standing, facing pateint

Procedure: Places one hand on the distal forearm, instruct the patient to resist your pressure as your push downward (resisted abduction)

Positive Test: Pain and weakness

Implications: Supraspinatus tendon = (1) Impinged between humeral head and/or acrominal arch (2) inflammed (3) Contains lesion

Front 12

Hawkins Impingement Test (P. 686)

Back 12

Patient Position: Sitting or standing

Examiner Position: Standing lateral or slightly forward of the involved shoulder

Procedure: Position the shoulder in 90 degrees flexion (in the Scapular plane) and elbow in 90 degrees flexion. Support underneath the elbow and grasp the distal forearm on the dorsal surface. Internally rotate the shoulder until pain or limit of range of motion is achieved

Positive Test: Pain with motion especially near the end of ROM

Implications: Rotator cuff (especially supraspinatus) or long head of biceps brachii impinges on the structures between the greater tuberoisty and inferior surface of the acromion process

Front 13

Yergason's Test (p. 690)

Back 13

Patient Position: Sitting or standing, elbow flexed to 90 degrees, and forearm midway between pronation and supination (thumb toward ceiling), humerus alongside trunk

Examiner Position: Lateral to patient. First palpate the bicipital groove to orient the patient to the location of the pain related to the evaluation. Then support behind elbow over olecranon process with one hand. Place one hand over top of distal forearm

Procedure: Instruct the patient to resist the downward force created by your hand over the distal forearm by simultaneously flexing and pronating the elbow and internally rotating the shoulder. (Examiner extends and supinates the elbow and externally rotates shoulder)

Positive Test: Pain, snapping of bicipetal groove

Pain at the superior glenohumeral joint

Implications:

(Primary) = Snapping or popping in the bicipital groove indicates a tear or laxity in the transverse humeral ligament. This pathology prevents the ligament from securing the long head of the tendon in its groove

(Secondary) = Pain with no associated popping in the bicepital groove may indicate biceps tendionopathy

Front 14

Speeds Test (P. 692)

Back 14

Patient Position: Sitting or standing, elbow extended, palm towards the ceiling, with shoulder slightly flexed

Examiner Position: Lateral to patient. Palpate the bicipetal groove with one hand. Then place other hand over top of distal forearm.

Procedure: Instruct the patient to move arm upward against your resistance, moving through the full range of motion.

Positive Test: Pain along the long head of the biceps brachii tendon, especially in the bicipital groove or at the superior shoulder

Implications: Inflammation of long head of biceps tendon as it passes through the bicipital groove. Possible tear of the transverse humeral ligament with concurrent instability of the long head of the biceps tendon as it passes through the bicipital groove. Pain at the superior shoulder (SLAP lesion)

Front 15

Valgus Stress test of the Elbow

Back 15

Patient Position: Standing or seated with elbow in complete extension, full supination

Examinaiton Position: Standing in front and slightly to the side of the patient with stabilizing hand on lateral aspect of elbow

Procedure: Place moving hand on distal forearm medially. Gently apply medially directed force with the stabilizing hand and laterally directed force with the distal hand

Positive Test: Observe for gapping on medial aspect of elbow. Note feeling of laxity. Note presence of and location of pain reported by patient.

Implications: Laxity on medial elbow compartment: joint capsule, medial (ulnar) ligament

Front 16

Varus Stress Test of the Elbow

Back 16

Patient Position: Standing or seated with elbow in complete extension, full supination

Examiner Position: Standing in front and slightly to the side of the patient with stabilizing hand on medial aspect of elbow

Procedure: Place moving hand on distal forearm laterally. Gentaly apply laterally directed force with the stabilizing hand and medially directed force with the distal hand.

Positive Test: Observe for gapping on lateral apsect of elbow. Note feeling of laxity. Note presence of and location of pain reported by patient.

Implications: Laxity on lateral elbow compartment: joint capsule, radial collateral ligament

Front 17

Tinel's Test (Sign)

Back 17

Patient Positions: Standing or seated with elbow in slight flexion

Examiner Position: Standing in front of the patient with stabilizing hand on distal forearm (supporting flexed position)

Procedure: Place index finger over middle finger, then gently tap distal aspect of arm, just superior to the ulnar tunnel, over the ulnar nerve

Positive Test: Numbness/tingling sensation along distribution of the ulnar nerve (medial forearm down 4th-5th fingers)

Implications: Ulnar nerve inflammation/sensativity

Front 18

Tennis Elbow Test

Back 18

Patient Position: Standing or seated with elbow in 90 degree flexion, forearm pronated

Examiner Position: Standing to side of the patient with stabilizing hand palpating the wrist extensor common tendon

Procedure: Instruct patient to make a fist, then instruct them to resist wrist extension (not allowing elbow flexion angle to change)

Positive Test: Sudden or severe pain over the wrist extensors near the lateral epicondyle.

Implications: lateral condyle epicondylagia

Front 19

Golfer's Elbow Test

Back 19

Patient Position: Standing or seated with elbow in 90 degree flexion, forearm supinated

Examiner Position: Standing to side of the patient with stabilizing hand palpating the wrist flexor common tendon

Procedure: Instruct patient to make a fist, then instruct them to resist wrist flexion (not allowing elbow flexion angle to change)

Positive Test: Sudden or severe pain over the wrist flexors near the medial epicondyle

Implications: Medial condyle epicondylagia

Front 20

Pinch Grip Test:

Back 20

Patient Position: Seated or standing

Examiner Position: Observing patient

Procedure: Instruct patient to pinch tips of index finger and thumb together (Ok sign)

Positive Test: Normal test: tip or tip pinch, Abnormal: pulp to pulp pinch

Implications: Pathology of anterior interosseus nerve (possibly entrapment in pronator teres muscle)

Front 21

Isolation: Flexor Digitorum Profundus (Jersey Finger)

Back 21

Patient Position: Seated or standing, elbow flexed 90 degrees, forearm supinated

Examiner Position: Standing beside the patient on involved side, facing same direction as patient

Procedure: Stabilize the fingers alongside the involved finger with both hands, while stabilizing middle phalange of involved finger. Instruct patient to flex finger tip.

Positive Test: Inability to flex at DIP joint.

Implications: Indicates FDP tendon avulsion or rupture

Front 22

Isolation: Flexor Digitorum Superificalis

Back 22

Patient Position: Seated or standing, elbow flexed 90 degree, forearm supinated

Examiner Position: Standing in front of patient

Procedure: Stabilize the fingers alongside the involved finger with both hands, while stabilizing proximal phalange of involved finger. Instruct patient to flex finger.

Positive Test: Instability to flex at PIP joint

Implications: Indicates FDS tendon rupture

Front 23

Finkelstein's Test

Back 23

Patient Position: Seated or standing, elbow flexed to 90 or shoulder flexed to 40-60 degree

Examiner Position: Standing in front of patient

Procedure: Instruct patient to close fist around the thumb and then ulnarly deviate wrist. Clinician can stabilize forear and apply gentle overpressure if necessary

Positive Test: Pain over extensor and abductor tendons of thumb

Implications: Tendinopathy of extensor pollicus brevis and longus and abductor pollicus longus tendons: deQuervain's syndrome/disease

Front 24

Allen's Test for Ulnar and Radial Artery Integrity

Back 24

Patient Position: Seated or standing, elbow flexed to 90 degrees, forearm supinated

Examiner Position: Standing in front of patient

Procedure: Instruct patient to open and close hand several times and ifnish with a closed fist. Clinician simultaneously provides pressure over the ulnar and radial arteries at the wrist crease. Instruct patient to open hand while clinician maintains pressure. Release pressure on one artery. Observe for return of circulation (flush) to hand. Repeat entire procedure for other artery

Positive Test: Palm circulation does not return immediately (very slow!)

Implications: Reduced patency (reduced openness) of artery

Front 25

Phalen's Test

Back 25

Patient's Position: SEated or standing, elbows flexed to 90 degree, forearms pronated, dorsal surface of hands facing each other

Examiner Position: N/a

Procedure: Instruct patient to press dorsal surface of hands together, maximizing wrist flexion. Hold position for 1 minute

Positive Test: Patient reports pain or numbness along distribution of median nerve (usually into thumb and palmar surface of first three fingers)

Implications: Carpal tunnel syndrome

Front 26

Valgus Stress Test of the Thumb

Back 26

Patient Position: Seated or standing, elbow flexed to 90 degrees, forearm neutral (between pronation and supination)

Examiner Position: Stand to side of patient on involved side, stabilizing the metacarpal and proximal phalange of the MCP joint of the thumb with each ahdn by placing thumbs along the ventral surface of the thumb

Procedure: Apply valgus force at the MCP joint of the thumb, attempting to open up the medial joint line, to stress the UCL ligament

Positive Test: Increase gapping or laxity over the ulnar joint line of MCP joint of thumb

Implications: Injury to ulnar collateral ligament of thumb

Front 27

Valgus/Varus Stress Test - Interphalangeal joints

Back 27

Patient Position: Seated or standing, elbow flexed to 90 degree, forearm pronated

Examiner Position: Stand to side of patient on involved side, stabilizing the phalanges proximal and distal to the joint of interest

Procedure: Apply valgus force at the desired IP joint. Repeat by applying varus force at desired IP joint

Positive Test: Increased gapping or laxity over the medial or lateral joint line of IP joint of the finger.

Implications: Rupture or avulsion fracture involving the collateral ligaments

Video: http://youtu.be/qHJ-C1MdI3Y

Front 28

Axial Loading of Fingers

Back 28

Patient Position: Seated or standing, elbow flexed to 90 degree, forearm pronated

Examiner Position: Standing in front of patient, stabilizing over wrist and dorsum of the hand

Procedure: Grasp the finger at the levle of the most distal non-involved phalange. Apply a compression force along the long axis of the finger (axial loading)

Positive Test: Pain at level of IP joint or along phalange

Implications: Phalangeal fracture