Juliano, M.

| #DreiCares | PREMIUM LEARNING PROGRAM 2020

UE SPECIAL TEST
SHOULDER REGION
Anterior Instability of the Shoulder
Special Test Position Action Positive Sign Indication
Anterior instability
Dugas Test
Hand rests over opposite shoulder Actively lower elbow (+) LOM with pain Anterior dislocation without
“DugaS DISlocation”
reduction
Apprehension Test Passive applies slow ER
Posterior internal impingement
Crank Test Fulcrum: PT put hands under GH joint to put anterior (+) apprehension
Supine w/ sh ABD (90°) + ER Traumatic instability
ApFRehension force to GH
(Fulcrum+Relocation) Relocation: push GH joint posteriorly (+) ↓ apprehension Traumatic GH instability
1 hand: clavicle
Sitting w/ arms Passive
Other at humeral
head
at side Load: Gently push humeral head anteriorly & posteriorly
Thumb (post) (nakalaylay) Shift: Push humeral head anteriorly Normal: 25% anterior translation
Fingers (ant) of humeral head
Load and Shift Test Atraumatic GH instability
1 hand at clavicle
Supine w/ Passive (+): >25% anterior translation
Other at humeral
head
shoulder in Load: Gently push humeral head anteriorly & posteriorly
Thumb (ant) scaption Shift: anterior translation of humeral head w/ Sh ER
Fingers (post)
Sitting w/ shoulder abducted to: 45°: uneasiness
Rockwood Test
45° 90°: apprehension
“You Rock-Rock- Passively ER repeatedly at each angle Anterior instability
90°
Rock-Repeated” 120°: uneasiness
120°

Posterior Instability of the Shoulder

Special Test Position Action Positive Sign Indication
1 hand: clavicle
Passive
Other: humeral Sitting w/ arms at
head side (nakalaylay)
Load: Gently push humeral head anteriorly & posteriorly
Thumb (post) Shift: Push humeral head posteriorly Normal: 50% posterior
Fingers (ant) translation of humeral head
Load and Shift Test 1 hand at clavicle
Atraumatic GH instability

Supine w/ Passive (+): >50% posterior translation

Other at humeral
head
shoulder in Load: Gently push humeral head anteriorly & posteriorly
scaption Shift: Posterior translation of humeral head w/ Sh IR
Thumb (ant)
Fingers (post)
Passive
Jerk Test Sitting w/ shoulder forward flexed to 1. Horizontal Adduction w/ axial load to arm (+) clunk Posterior instability
“Jerks sa teleserye” 90° + IR towards proximal & push arm posteriorly
2. Back to original position (+) clunk Posteroinferior labral tear
Supine Passive
60-100° sh abd Shoulder horizontal ADD and IR (+) humeral head slips
Norwood Stress Test Posterior instability
90° elbow flexion Push humerus/elbow posteriorly posteriorly
90° shoulder ER Thumb pushes humeral head posteriorly
1. Passively push humeral head downwards
Push-Pull Test Supine w/ scaption (+) >50% posterior translation Posterior Instability
2. Pull wrist up
Passive
Circumduction Standing Circumduction of shoulder from Abducted & extended → (+) subluxation Posterior instability
forward flexion & Add
 Juliano, M. | #DreiCares | PREMIUM LEARNING PROGRAM 2020

Inferior Instability of the Shoulder

Special Test Position Action Positive Sign Indication
(+) sulcus between humeral
head & acromion process
Sulcus Sign / TISI
Standing w/ arms by sides relaxed Passive Inferior instability
Test for Inferior
(Best: 20-50° abduction) Put distal traction to pt’s arm Grade +1 Sulcus = <1cm GH joint laxity
Shoulder Instability
Grade +2 Sulcus = 1-2 cm
Grade +3 Sulcus = >2cm
Standing w/ arm abducted to 90° w/ Passive (+) sulcus sign (above the
FeAgIN Test Anteroinferior Shoulder Instability
hand resting over PT’s shoulder Push proximal arm anteriorly & inferiorly coracoid process)
(+) Feagin and TISI Multidirectional instability

Muscle Pathology
Special Test Position Action Positive Sign Indication
Supraspinatus Test 1. Pt resists shoulder abduction
Shoulder abducted to 90° w/ neutral
Empty Can Test 2. Pt’s arm is lipat to angled forward & IR (thumbs (+) weakness Supraspinatus tear
rotation (thumbs up)
Jobe Test down) + resist again
Bicep’s Test
Elbow in extended position all Resist shoulder forward flexion w/ FA in supinated or (+) tenderness in bicipital Bicipital paratenonitis /
Speed’s Test
throughout the test pronated groove tendinosis
Straight Arm Test
Resist FA supination & shoulder ER (+) tendon of long head of
Yergason’s Test Elbow flexed to 90° w/ FA pronated Transverse humeral ligament tear
Palpate long head of biceps biceps pops out
Ludington’s Test Pt alternately contracts and relaxes biceps (active) (+) no palpable tendon during Rupture of long head of biceps
Hands clasped on top or behind head
LUNG head of biceps PT palpates biceps tendon contraction tendon
(+) supination upon elbow Biceps helps brachialis in elbow
Heuter Sign Elbow flexed and FA pronated PT resists elbow flexion flexion = HEUTER SIGN flexion (intact biceps function)
(-) supination / Heuter Sign Disrupted distal biceps tendon
Drop Arm Test PT passively positions shoulder to
Pt actively lowers arm slowly (+) inability to perform activity Rotator Cuff complex tear
Codman’s Test 90° abduction
Lift-Off Sign Standing w/ dorsum of hand on back
Actively lift hand away from back (+) inability to perform activity Subscapularis muscle tear
Gerber Test pocket or mid lumbar area
Abdominal
PT’s hand over pt’s abdomen
Compression Test Pt actively press belly of pt
Pt’s hand over kamay ni PT na nasa (+) no pressure/effort Subscapularis muscle tear
Belly Press Test Palpate kung may pressure talaga
belly
Napoleon Test

Labral Pathology
Special Test Position Action Positive Sign Indication
Supine w/ hands on waist Passively push pt in full shoulder abduction & ER
Clunk Test (+) clunk / grinding sound Labral Tear
PT’s fist behind shoulder Push GH joint (humeral head) anteriorly
(+) humeral head slides over the
Sitting w/ hands resting on waist,
Anterior Slide Test PT passively pushes elbow anteriorly & superiorly labrum w/ POP / CRACK Labral Lesion
thumbs posteriorly
(+) Anterior-superior sh pain

Shoulder Impingement
Special Test Position Action Positive Sign Indication
Neer Impingement Sitting / Standing PT passively places pt’s arm in full elevation and IR Overuse injury to supraspinatus
Hawkin’s Kennedy Standing PT passively places pt’s arm in sh forward flexion and IR (+) pain Secondary impingement
Yocum’s Test Pt’s hands resting on opposite sh PT passively perform elbow elevation Secondary impingement
 Juliano, M. | #DreiCares | PREMIUM LEARNING PROGRAM 2020

ELBOW REGION
Ligamentous Instability
Special Test Position Action Positive Sign Indication
Valgus instability
Ligamentous Valgus
Passively put VALGUS stress or abduction of the FA Medial Collateral ligament
Instability Test
involvement (MEDI-VAL)
(+) increased motion / laxity
Varus Instability
Ligamentous Varus
Passively put VARUS stress or adduction of the FA Lateral Collateral ligament
Instability Test
involvement (LA-VARUS)

Muscle Pathology
Special Test Position Action Positive Sign Indication
Closed Fist
Elbow Extended
Cozen’s Active w/ resistance
Wrist Radial dev
Lateral FA Pronated Lateral epicondylitis /
Epicondylitis Wrist Flexed Tennis Elbow
Pain
Mill’s Elbow Extended Passive
FA Pronated
Maudlsey Extension of middle finger Active w/ resistance
Supination Medial epicondylitis /
Medial Epicondylitis Passive
Extension of wrist & elbow Golfer’s Elbow

Neurologic Dysfunction
Special Test Position Action Positive Sign Indication
(+) tingling sensation or
Tap area of ulnar nerve between olecranon process and To check the regeneration of
Tinel Sign (elbow) Elbow slightly flexed paresthesia along ulnar nerve
medial epicondyle sensory fibers of the nerve
distribution
(+) inability to squeeze little
PT passively put fingers in abduction
Wartenburg Sign Sitting w/ hands resting on table finger to the remainder of the Ulnar neuropathy
Actively adduct fingers
hand
Instruct pt to actively:
• Shoulder abduction
(+) Paresthesia or tingling
• Shoulder depression
Elbow Flexion Test sensation along ulnar nerve Cubital Tunnel Syndrome
• Full elbow Flexion
distribution
• Wrist Extension
Hold for 3-5 mins
Test for Pronator (+) Paresthesia at median nerve
90° elbow flexion and supination Resist FA pronation & elbow extension Pronator Teres Syndrome
Teres Syndrome distribution
Actively do tip-to-tip pinch between thumb & index
(+) inability to perform Pathology to Anterior Interosseous
Pinch Grip Test Sitting w/ hands resting on table finger
(+) pulp-to-pulp Nerve
Ask pt to do “OK sign”
 Juliano, M. | #DreiCares | PREMIUM LEARNING PROGRAM 2020

FOREARM, WRIST, and HAND

Special Test
Shuck Test
Finger Extension
Test
Murphy’s Sign
Piano Key’s Test
Haines-Zancolli Test
PIP in neutral position
To assess structures
around PIP joint
Bunnel-Littler Test
PIP flexion and MCP Flexion
To assess structures
around MCP joint
Special Tests for Ligaments, Joints, Capsule
Position Action Positive Sign Indication
R adiocarpal instability
I nflammation
Wrist held in flexion Resist finger extension (+) pain
S caphoid instability
K ienbock’s Disease
(+) 3rd MC head is in level with
Pt makes a fist Lunate dislocation
2nd & 4th
FA pronated Passively push distal ulna palmarly (+) excessive motion Distal Radioulnar instability
Tight retinacular ligament
1. Flex DIP joint (+) no DIP flexion
Tight capsule
If pt was not able to do 1st position
Tight retinacular ligament
2. PIP in flexed position; then (+) DIP flexion
Capsule is NORMAL
3. Flex DIP joint
Tight intrinsic muscle
1. MCP in slight extension then Flex the PIP joint (+) no PIP flexion
Tight capsule
If pt was not able to do 1st position (+) COMPLETE PIP flexion Tight intrinsic muscle
2. MCP in flexed position, then
(+) INCOMPLETE PIP flexion Tight capsule
3. Flex PIP joint

Special Tests for Tendons and Muscles

Special Test Position Action Positive Sign Indication
Passive or Active De Quervain’s Disease or
Finkelstein Test Make a fist w/ thumb inside fingers (+) pain over APL & EPB
Ulnar deviation Hoffman’s Disease
Active (+) inability to flex distal
Sweater Finger Test Ruptured FDP
Make a fist phalanx (DIP) of 1 finger

Neurologic Dysfunction
Special Test Position Action Positive Sign Indication
(+) flexion of distal phalanx of
Froment’s Paper Pt grasps paper between thumb and thumb
Therapist pulls paper away Ulnar nerve paralysis
Sign index figner (+) Jeanne’s Sign: 1st MCP
hyperextension
Bawal may hawakan si pt
N = purple stain
Ninhydrin Test Hand is cleansed & wiped w/ alcohol Fingertips are pressed against clean paper Nerve lesion
Spray NINHYDRIN (which reacts to sweat) (+) no purple stain
Wait for 24 hours
Phalen’s Test
Maximum wrist flexion
Wrist Flexion Test (+) paresthesia / tingling
Hold position for 1 minute
Reverse Phalen’s sensation at median nerve Carpal Tunnel Syndrome
Maximum wrist extension
Prayer’s Test distribution
Tinel’s Sign (wrist) PT taps over carpal tunnel at the wrist

Circulation
Special Test Position Action Positive Sign Indication
Active
To identify major blood supply of hand
• Open and close hand several times
To determine which artery provides major
• Squeeze the hand tightly closed
Allen’s Test blood supply to hand
• PT compresses over radial & ulnar arteries
To determine patency of radial and ulnar
• Pt opens hand while PT maintains pressure
artery
• Release one artery at a time→ observe if hand flushes