ONE upper extremity
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| Foraminal Compression / aka Spurling’s test | Cervical Seated
3 positions: 1) neutral - Examiner presses straight down on head. If No Symptoms 2) extension - Pt extends head. If No Symptoms 3) Spurlings Test - rotation - rotate to unaffected side repeat then affected side.
NECK PAIN radiating i
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| Jackson Compression Test | Cervical Seated
Pt laterally flexes head to unaffected side, Examiner carefully presses down on head. Perform bilaterally.
NECK PAIN radiating into arm along the dermatomes.
IVFE, nerve root lesion, disc herniation, facet pathology, stenosis.
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| Distraction Test | Cervical Seated
Examiner places one hand under Pt.'s chin and other hand around Occiput, then slowly lift head. Tractioning the cervical spine. Or Place the base of each hand under the Mastoid Processes and cup the ears.
RELIEF OF PAIN. (decreased pain
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| Shoulder Depression Test | Examiner laterally flexes Pt's head while applying downward pressure on opposite shoulder.
NECK PAIN on convex side.
NECK PAIN -CONVEX SIDE = Dural Adhesions, brachial plexus lexion, nerve root compression.
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| Shoulder Abduction (Relief) Test | Examiner passively or patient actively elevates arm through abduction so hand or forearm rests on top of the head. (Bakody's sign)
RELIEF OF PAIN. (decreased pain)
Cervical herniated disc or nerve root compression.
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| Valsalva | Ask Pt. to take deep breath and bear down as if moving a bowel.
PAIN anywhere along the spinal column.
Space Occupying Lesion (SOL), disc herniation, tumor or osteophytes.
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| Soto-Hall Test | Two methods: 1) Flex patient's chin to chest. 2) a) Ask Patient to flex chin to chest. b) Examiner applies pressure to flex patient's head.
Sharp PAIN down spine and into upper or lower limbs. Associated findings: Neck and upper back pa
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| O’Donoghue Maneuver | Done if foraminal compression is indicating muscle strain or capsular strain
Test active ROM of Cervical Spine. If no pain test passive ROM of Cervical Spine.
Decreased ROM
AROM = Muscle strain/sprain. PROM=ligament sprain.
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| Swivel Chair (Dizziness Test) | Rotate Pt’s head as far as possible to one side for 10-30 sec. Then return to neutral and rotate shoulders and hold for 10-30 sec. Perform bilaterally.
Dizziness in both positions or Dizziness in rotation of shoulders only.
Dizziness i
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| Cervical Quadrant (aka Vertebral Artery) Test Cervical Supine | head int ext and lat flexion then rotate to same side and hold for 30 sec. Dizziness or nystagmus. Reproduction of pain or radiculopathy.
Dizziness, nausea/Vertebral Artery compression. Radiculopathy/lower cervical spine nerve root compression or (TOS)
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| Bikele's sign. Cervical seated | On the involved side patient abducts shoulder to 90° with elbow fully flexed. Then rapidly extend elbow.
Radicular pain. Nerve root compression.
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| Rust's sign, cervical | Patient presents with rigid neck pain only relieved by holding head in rigid position.
Ominous sign.
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| Allen test | Ptx opens and closes hand several times fast and makes a fist. compressthe radial and ulnar arteries with both thumbs. The patient opens the hand while pressure is maintained on the arteries. Release one artery to see if the hand flushes. repeat with oth
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| Adson Maneuver | Feel pulse. - Pt.'s head is rotated to face the INVOLVED SIDE -snap and look, hold breath.
+sign decreased pulse
Thoracic Outlet Syndrome (TOS), Anterior Scalene is occluding the Subclavian Artery or Cervical rib.
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| Halstead maneuver | Examiiner finds radial pulse & applies downward traction on the test extremity while the Pt.’s neck is hyperextended & head is rotated to the opposite side.
Decreased intensity of the Radial Pulse.
TOS, Cervical rib or scalenus syndrome.
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| Allen maneuver | punch position
Flex the patient’s elbow to 90º while the shoulder is extended horizontally and externally rotated. Patient rotates the head away.
Decreased intensity of the Radial Pulse.
TOS
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| Roos Test, Elevated Arm Stress Test (EAST), Provocative Elevation Test | Pt. stands & Holds arms like stick up Pt. then opens and closes hands slowly for 3 mins.
Pt. is unable to keep arms in starting position for 3 min. Suffers ischemic pain, numbness/tingling. TOS
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| Wright maneuver | w/ shoulder laterally rotated. Pt taking breath in, rotating or extending the head and neck may have additional effect.
Decreased intensity of the Radial Pulse.
TOS - Due to Pectoralis Minor tightness occluding the Subclavian Artery or Cervical rib.
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| Costoclavicular Syndrome Test | Pt. place both arms behind their back. Palpate radial pulse. Pt. brings their shoulders down and back. Decreased intensity of the Radial Pulse.
TOS- Costoclavicular Syndrome- The clavicle and rib 1 is occluding the Subclavian Artery due to a sublux. of
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| Spinous percussion | Standing or seated with head flexed
Tap on spinous process and paraspinal musculature
Spinous pain = joint lesion: fxr, ligament sprain or disc lesion. Soft tissue pain = muscle strain.
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| Costal compression and percussion | Percuss and compress rib cage.
Rib Pain. Rib fracture, sprain/strain
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| Adam’s position/ Skyline view | Patient flexes forward at the waist, observe from behind look for hump on one side, scoliosis.
Unilateral Hump (convex side of curve) scoliosis.
If Scoliosis remains: Structural Scoliosis. If Scoliosis disappears: Functional Scoliosis.
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| Passive scapular approximation | Examiner passively lifts the shoulders up & back.
Pain in scapular area.
T1 or T2 nerve root problem on side of pain.
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| Slump test (Sitting Dural Stretch Test) | Pt. slumps so spine flexes and shoulders sag. hold chin & head erect. If N.S. flex Pt.'s neck and holds head down whoulders slumped. If N.S Examiner extends one of Pt's knees. If N.S dorsiflex foot of extended leg. Bilat Sciatica or reproduction of symp
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| Apley's Scratch Test | Demonstrate for patient, to place one hand behind their head, between their scapulae. Then, place the same hand down behind their lower back.
Decreased ROM. Frozen Shoulder. Torn Rotator Cuff. Shoulder dislocation.
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| Mazion's Test of shoulder | Standing or seated with head flexed Pt. places palm of affected side on opposite shoulder. Pain or inability to lift arm. The elbow cannot be made to touch the chest. "Dugas' Sign" for acute dislocated shoulder. Shoulder pathology, inability to raise arm
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| Apprehension Test AKA Crank Test | Shoulder Supine
ABduct arm to 900, elbow flexed to 900 and externally rotate shoulder, slowly.
Look or feeling of apprehension or alarm on Pt's face and Pt resistance to further motion
Glenohumeral (GH) anterior instability.
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| Rockwood Test Ant inf G-H instability | stand behind seated patient. flex elbow and abducts shoulder on affected side to 900 . Tester then laterally rotates the shoulder at 0 , 45 , 90 and 120.
PAIN or patient apprehension present. Most commonly seen at 90 .
Anterior shoulder instability.
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| Relocation Test (Fowler’s sign/Jobe’s relocation) | While performing an Apprehension test, Examiner applies posterior force to humeral head.
Relief of pain or symptoms while doing manuver.
GH instablity, sublux, dislocation or impingement.
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| Sulcus Sign (Inferior Shoulder Instability) | Grasp forearm below elbow. Flex elbow & and push down on proximal forearm, pulling arm distally.
Unilateral Sulcus (apperance of sulcus or groove below the acromion process)
GH inferior instability or G-H laxity.
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| Faegins sign | Put ptx arm on shoulder, put hands on upper arm, push down
Look of apprehension or alarm on patient’s face and patient’s resistance to further motion or reproduction of Sx
Anterior inferior instability of GH joint.
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| Clunk test | One hand under shoulder other hand @ humerus above elbow. Fully abduct arm overhead. Push anterior at humeral head. (make fist to ↑ pressure) with other hand lateral rotate humerus. A clunk or grinding sound. apprehension if ant instability.Labral tear
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| Spring test | Apply downward pressure @ distal clavicle, can use one hand to stabilize @ inf angle of scapulae.
PAIN or popping at AC joint.
Acromioclavicular (AC) joint separation.
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| Acromioclavicular Sheer Test - AC instability | Place one hand on the anterior clavicle, place other hand on spine of scapula. Squeeze hands together.
PAIN or abnormal movement at AC joint.
AC joint pathology sprain or dislocation.
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| Supraspinatus or Empty Can Test | Arm/s abd to 90° w/ no rotation. Press down. medial rotation. (Empty Can test) and angled forward 30° thumbs upFull Can test)
PAIN or Shoulder weakness.
Supraspinatus tendonosis/itis, muscle tear, or suprascapular nerve neuropathy.
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| Drop arm test | Abduct pt.'s shoulder to 180, ask pt. to slowly lower arm to side.
Arm drops rapidly to pt.'s side. Pt. is unable to do it slowly or has severe pain when lowering arm.
Rotator cuff tear.
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| Hawkins-Kennedy Impingement Test | The patient stands while examiner forward flexes the arm to 90. Then forcibly medially rotates the shoulder.
PAIN
Supraspinatus paratenonitis/ tendonosis or secondary impingement.
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| Neer Impingement Test | Pt’s arm is passively & forcibly elevated in scapular plane with medial rotation. Near to the ear.
Shoulder PAIN
Overuse injury of the Supraspinatus Myo and/or biceps tendon.
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| Speeds test | Shoulder is flexed to approx 45°. Examiner resists shoulder forward flexion by patient with elbow extended and first in supination then pronation.
PAIN in bicipital groove. Bicipital paratendonitis/osis.
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| Yergason’s Test yer gone son, | Pt’s elbow flexed 90°. Have them extend and twist but you resist
POPPING. Biceps tendon "pops out" of Bicipital groove, over the lesser tubercle. Audible or palpable popping
Torn Transverse Ligament of biceps. Tenderness only = biceps tendonosis/itis
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| Ligamentous instability test of Elbow | Grab Pt.s elbow with one hand & other hand grab above wrist with elbow in 20-30° of flexion, apply valgus(abd) then varus(add) force while palpating ligament.
Excessive mvmnt. Laxity of collateral ligament/s.
Medial or lateral collateral ligament sprain
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| Cozens test | One hand on SH. Pt. makes a fist, flexes elbow and extends wrist. Examiner places other hand on top of Pt.'s fist, on pt.'s fist, while pt. resists the motion.
PAIN in the lateral epicondyle- indicating lateral epicondylitis. Lateral epicondylitis
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| Mills test | Have Pt. pronate forearm, extend wrist and extend elbow. grab Pt.s fist stabilize their shoulder and tryto flex wrist against Pt. resistance.
Sudden severe PAIN over lateral epicondyle-indicating lateral epicondylitis.
Lateral epicondylitis.
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| Extensor Digitorum Communis MMT | Examiner resists extension of the third digit of the hand, distal to the Proximal Interphalangeal (PIP) jt. Stressing the extensor digitorum myo and tendon.
PAIN over lateral epicondyle- indicating lateral epicondylitis
Lateral epicondylitis
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| Golfer’s Elbow Test medial epicondylitis | pt. to extends their elbow and flexes wrist. grab the fist, stabilize pt.'s elbow or shoulder. Pull wrist Or, palpate Pt’s medial epicondyle and passively supinate forearm and extends the elbow/wrist
PAIN over medial epicondyle. Medial epicondylitis.
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| Tinel’s Sign of Elbow | Tap ulnar nerve in the Sulcus For The Ulnar Nerve ( A groove between the olecranon process and medial epicondyle ) AKA The Funny Bone.
Sustained Tingling sensation in ulnar nerve distribution of forearm and hand.
Ulnar neuropathy.
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| Seated Elbow Flexion | Pt. fully flex elbow with wrist extension, shoulder abduction and depression, hold for 3-5 minutes
Tingling sensation or paresthesia in the ulnar nerve part offorearm and hand. Cubital Tunnel Syndrome (CTS)- ulnar neuropathy. Pain numbness tingling
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| Pronator Syndrome Test | Pt. flexes elbow to 90° Examiner resists pronation as elbow is extended.
Tingling or paresthesia in median nerve distribution of forearm and hand.
Median nerve neuropathy. Pronator Teres Muscle syndrome. Pain numbness tingling.
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| Percussion Test of Wrist | Examiner lightly taps bones of the forearm, carpals, phalanges and interphalanges.
PAIN - Mild to Severe!
Possible Fxr. if over bone. Possible Tendinitis, if over a tendon. Myo spasm or Hematoma, if over the belly of a myo. CTS if over the Median nerv
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| Axial Load Test/Compression Test | Stabilize wrist with one hand, other hand grasps thumb and applies axial compression.
PAIN and or Crepitaion.
Carpal/metacarpal fxr or arthrosis.
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| Boxer’s Fracture and Murphy’s Sign | Stabilize Pt's finger with one hand proximal to joint tested. With other hand grasp finger distal to jt tested. Apply varus or valgus stress to jt.
Ligament laxity compared to opposite uninvolved side.
Collateral ligament sprain or laxity.
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| Ligamentous Instability Test of the Fingers | Ligamentous Instability Test of the Fingers
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| Grind test | Stabilize Pt's hand with one hand and grasp thumb below the Metacarpophalangeal (MCP) jt. with other hand. Apply axial compression and rotation to MCP jt.
PAIN and/or grinding in joint. DJD of MCP or MC trapezial jts.
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| Finkelstein test | Pt makes a fist around their thumb. Examiner stabilizes forearm and ulnar deviates wrist.
PAIN over abd pollicus longus and extensor pollucis brevis at wrist.
Paratendonitis of thumb- De Quervain's Syndrome or Stenosing Tenosynovitis.
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| Bunnel-Littler Test | MCP jt is held in slight extension while Examiner moves the PIP jt. into flexion, if possible.
Inability to flex PIP jt.
Tight intrinsic myo's or joint capsule contracture.
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| Tinels Sign of Wrist | Tap over carpal tunnel @ wrist, over the Median nerve.
Tingling or paresthesia into thumb, index, and middle and lat half of ring finger.
CTS- Median nerve neuropathy
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| Phalen's test | Pt. places the dorsum of both hands together with forearms paralell to the floor, hold for 1 min.
Tingling or paresthesia into thumb, index, and middle and lat half of ring finger.
CTS- Median nerve neuropathy
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| Reverse Phalen’s Test AKA Prayer test | Pt places the palms of both hands together with forearms paralell to the floor, hold for 1 min.
Tingling or paresthesia into thumb, index, and middle and lat half of ring finger.
CTS- Median nerve neuropathy
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| Carpal Compression Test | Examiner holds supinated wrist in both hands and applies direct, even pressure over the Median nerve in the carpal tunnel for up to 30 sec.
Tingling or paresthesia into thumb, index, and middle and lat half of ring finger. CTS- Median nerve neuropathy
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| Pinch test | The patient pinches the tips of the index finger and thumb together.
If unable to pinch tip to tip and had an abnormal pulp to pulp pinch,. indicates entrapment of the anterior interosseous nerve between the two heads of the pronator teres muscle.
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