UPPER LIMB

ASSESSMENT
Apprehension crank test :
• Indication - Anterior shoulder pain

• Position of patient - supine lying

• Procedure - Assisted abuduction of shoulder to 90 degrees, external rotation to

maximum limit

• + sign - increase in pain or fear of subluxation of shoulder

• Significance : Anterior shoulder instability

Anterior load and shift test :
• Indication - Anterior shoulder pain

• Position of patient - sitting , straight posture, arms resting on thigh

• Procedure - therapist will stabilise affected side clavicle and spine of scapula with
one hand , with other hand grab the humerol head and try to translate the humeral
head anteriorly and posteriorly.

• + sign - increase in pain and excessive translation of humeral head anteriorly than
posteriorly.

• Significance : Anterior shoulder instability , excessive humoral head translation and

capsule laxity
Jerk test :
• Indication - Posterior shoulder pain

• Position of patient - sitting

• Procedure - stabilise the scapula with one hand , hold affected arm in 90 degrees
abduction, internal rotation, apply longitudinal force to elbow and move the arm
horizontal to chest

• + sign - sudden crank as the humeral head slides off the back of glenoid cavity

• Significance : Posterior or inferior labral tears , posterior GH instability

Posterior load - shift test
• Indication - Posterior shoulder pain

• Position of patient - sitting , straight posture, arms resting on thigh or supine

• Procedure - therapist will stabilise affected side clavicle and spine of scapula with one hand ,
with other hand grab the humerol head and try to translate the humeral head anteriorly and
posteriorly.

• + sign - increase in pain and excessive translation of humeral head posteiorly than anteriorly.

• Significance : posterior shoulder instability , excessive humoral head translation and capsule
laxity
SULCUS SIGN TEST
• Indication - shoulder pain

• Position of patient - standing, relaxed arms

• Procedure - therapist will grab the patient's arm distally to elbow joint and pull
arm distally

• + sign - appearance of a dip or sulcus under the acromion

• Significance : Inferior GH instability , GH capsule laxity

Neer Impingement test -
• Indication - shoulder pain

• Position of patient - sitting , straight posture, arms resting on thigh

• Procedure - therapist will press the scapula with one hand, internally rotate the
patient's arm, then maximum forward flexion performed

• + sign - increase in pain

• Significance : Anterior shoulder impingement syndrome or Sub acromial impingement

Hawkins-kennedy test
• Indication - shoulder pain

• Position of patient - sitting

• Procedure - therapist will elevate the arm to 90 degrees of forward flexion, have
it rest on one of your arm then perform passive internal rotation

• + sign - increase in pain

• Significance : Sub acromial impingement ( negative for posterior impingement)

Speed's test :
• Indication - shoulder pain

• Position of patient - standing

• Procedure - patient is asked to extend the elbow and fully supinate the arm, then
perform a forward flexion till 90 degrees, then the therapist will keep his arm on
patient's forearm to resist further forward flexion.

• + sign - increase in pain at bicipital groove

• Significance : Biceps pathology or tenosynovitis

Yergason's test :
• Indication - shoulder pain

• Position of patient - sitting or standing

• Procedure - patient is asked to keep the arm in 90 degrees elbow flexion and full
pronation , now therapist will hold patient's arm and will ask to perform supination ,
simultaneously the therapist will be palpating biceps tendon in bicipital groove

• + sign - therapist will feel biceps tendon popping out of the bicipital groove (indicates
tear of humeral ligament) and if only pain is present ( tenosynovitis)

• Significance : Biceps pathology

Empty can test :
• Indication - shoulder pain

• Position of patient - sitting or standing

• Procedure - patient is asked to elevate both arms to 90 degrees forward flexion then
fully internally rotate the arm and have thumbs point towards ground. Therapist will
apply downward pressure while patient is asked to resist.

• + sign - increase in pain at injured or involved site.

• Significance : Shoulder impingement

Drop arm test -
• Indication - shoulder pain

• Position of patient - sitting or standing

• Procedure - therapist will bring the affected arm in 90 degrees of abduction and
perform external rotation passively with elbow extended passively. Ask the patient to
hold this position and take off your support.

• + sign - if the patient is not able to control the slow declination of his arm.

• Significance : Rotator cuff tears

Lift off sign test -
• Indication - shoulder pain

• Position of patient - standing

• Procedure - Ask the patient to internally rotate the elbow and ask to lift off the
hand.

• + sign - abnormal movement of scapula

• Significance : Subscapularis weakness

Punch out test -
• Indication - shoulder pain

• Position of patient - standing

• Procedure - Ask the patient to flex the arm 90 degrees, now therapist will apply
a longitudinal pressure backward

• + sign - winging of scapula

• Significance : Subscapularis weakness

ELBOW JOINT ASSESSMENT
SUBJECTIVE ASSESSMENT
 ON OBSERVATION
• Attitude of limb

• Alignment of the elbow joint and forearm

• Any deformity at elbow joint ( Cubitus varus or Cubitus valgus)

• Inflammatory signs around elbow joint

• Muscle wasting
ON PALPATION
SPECIAL TESTS
 WRIST JOINT
• CARPAL COMPRESSION TEST

• TINEL'S TEST

• SCAPHOID SHIFT TEST

• FINKELSTEIN'S TEST
Scaphoid shift test -
• Indication - wrist pain

• Position of patient - sitting with his elbow supported on couch

• Procedure - Therapist will stabilise at lower end of radius and will apply pressure on proximal
part of scaphoid with his thumb, therapist will then grasp the metacarpal heads of pateint's
hand from ulnar side then perform ulnar deviation and slight extension at wrist. Now slowly
perform radial deviation.

• + sign - translation of scaphoid

• Significance : Scapho lunate ligament injury

Finkelstein's test -
• Indication - wrist pain

• Position of patient - sitting

• Procedure - Ask the patient to extend the elbow and keep the hand on edge of
table in mid prone position, patient is asked to perform ulnar deviation

• + sign - pain at styloid process

• Significance : de quervian's disease (ext. pollicis brevis and abductor pollicis longus)