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

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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

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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

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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

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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

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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)

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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

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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

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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

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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

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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

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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

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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

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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)

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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

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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

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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

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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

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