UPPER EXTREMITY SPECIAL TESTS

SHOULDER

ANTERIOR INSTABILITY

Special Test Position Action (+) Indication

Patient is seated with hand on opposite Examiner will instruct the patient to
Dugas Test LOM + Pain Dislocation without reduction
shoulder lower down their elbow

Examiner will place the patient’s

Apprehension appears/resistance to
Apprehension Test (Crank Test) Supine shoulder into abduction + 90 elbow Traumatic GH joint injury
motion
flexion

Examiner will provide further anterior More apprehension Traumatic GH joint injury
Follow Up to Apprehension Test:
Continue from previous translation by placing hand under the
Fulcrum Test
shoulder Posterior pain Posterior impingement

Examiner will provide posterior Apprehension disappears Traumatic GH joint injury

Follow Up to Apprehension Test:
Continue from previous translation by pushing down the
Jobe Relocation Test Posterior pain Posterior impingement
humeral head

Humeral head forward translation GH traumatic injury

Follow Up to Apprehension Test: Examiner will release the posterior
Continue from previous
Surprise Test (Anterior Release Test) translation Posterior pain Posterior impingement

0 = apprehension
Examiner will laterally rotate shoulder 45 = uneasiness
Rockwood Test Patient is seated with arms at side Anterior instability
at different angles 90 = apprehension
120 = uneasiness

Load: Examiner will gently push

humeral head back to fossa
Load and Shift Patient is seated with arms at side Shift: Examiner will provide anterior > 25% anterior translation Anterior shoulder instability
translation to humeral head
(Normal: 25% anterior translation)

POSTERIOR INSTABILITY

Special Test Position Action (+) Indication

Load: same with anterior

Shift: Examiner will provide posterior
Load and Shift Same with anterior instability > 50% posterior translation Atraumatic GH joint injury
translation to humeral head
(Normal: 50% posterior translation)

UPPER EXTREMITY MODULE 1

 Special Test Position Action (+) Indication

Sitting/standing with arms in forward Examiner will horizontally adduct +

Jerk Test Clunk Posterior instability
flexion + IR push the arm/s back

Follow Up to Jerk Test Continue from previous Bring back to original position Clunk/jerk Posteroinferior labral lesion

Examiner will push humeral head and Humeral head slips posteriorly > 50% of
Push-Pull Test Supine with scaption Posterior instability
pull wrist translation

Supine
Examiner will horizontally adduct while
SH ABD = 90
Norwood Stress Test pushing down the humeral head + push Humeral head slips posteriorly Posterior instability
ER = 90
back the elbow
Elbow Flexion = 90

Examiner will palpate posterior aspect

of the shoulder then circumduct the
Circumduction Test Standing patient’s shoulder from extension → Subluxation Posterior instability
abduction → forward flexion →
adduction

INFERIOR INSTABILITY

Special Test Position Action (+) Indication

Sulcus Sign Sitting with arms at side Examiner will pull the patient’s arm  Sulcus Inferior instability
GRADE
Examiner will push down patient’s +1 = < 1cm
Inferior instability/multidirectional
Feagin Sign Sitting with arm in forward flexion shoulder; examiner will provide antero- +2 = 1-2cm
+3 = > 2cm instability
inferior translation

LABRAL PATHOLOGIES

Special Test Position Action (+) Indication

Examiner will place shoulder in full

Clunk Test Supine elevation + ER then provide anterior Clunk/grinding sound Labral tear
translation to humeral head

Examiner will push the elbow Anterior shoulder pain +

Anterior Slide Test Sitting with hand on waist Anterior labral pathology
anterosuperiorly popping/clicking

MUSCLE PATHOLOGY

Special Test Position Action (+) Indication

Standing with shoulder abducted to 90 Examiner will resist abduction Pain/weakness upon resistance
Supraspinatus Test (Empty Can) Supraspinatus muscle/tendon tear
Standing with scaption + IR Resist motion Pain/weakness

UPPER EXTREMITY MODULE 2

 Special Test Position Action (+) Indication

Pain at the bicipital groove (S > P) Bicipital tendinosis

Speed’s Test Sitting with arms in forward flexion +
Examiner will resist forward flexion
AKA: Biceps Test / Straight Arm Test supination/pronation of FA Pain at joint line (P > S) SLAP Lesion

Examiner will resist supination + ER

Yergason Test Sitting with arms at side + FA pronated Tendon pops out THL tear
then palpate long head of biceps

Sitting with hands clasped on Contract and relax the biceps then
Ludington Test No tension palpated Ruptured long head of biceps tendon
top/behind head palpate long head of biceps tendon

Biceps “ball” or Popeye Deformity Ruptured long head of biceps tendon

Heuter’s Sign Elbow flexed and FA pronated Resist elbow flexion
(-) supination Disrupted distal biceps

Passively place shoulder abducted to Overused/ruptured rotator cuff

Drop Arm Test (Codman’s) Ask patient to slowly lower arm Inability to slowly lower arm
90 while standing complex

Standing
Lift Off Sign (Gerber’s) Ask patient to lift hand away from back Unable to lift hand Subscapularis muscle pathology
Hand posterior to mid lumbar area

Abdominal Compression Examiner’s hand over the belly with

Press the abdomen No pressure Subscapularis muscle pathology
AKA: Belly Press Test / Napoleon Test patient’s hand over the examiner’s

IMPINGEMENT

Special Test Position Action (+) Indication

Full arm elevation + medial rotation by

Neer Impingement Test Sitting/Standing Pain/reproduction of symptoms Overuse injury to supraspinatus muscle
examiner

Supraspinatus
Hawkins-Kennedy Test Standing Forward flexed + medial rotation Pain/reproduction of symptoms paratenonitis/tendinosis, 2
impingement

Supraspinatus
Yocum Hand on opposite shoulder Elbow elevation Pain/reproduction of symptoms paratenonitis/tendinosis, 2
impingement

ELBOW

LIGAMENTOUS INSTABILITY

Special Test Position Action (+) Indication

Ligamentous Valgus Instability Test Valgus stress/turn forearm towards

Sitting/Standing Increased motion/pain MCL injury
AKA: Elbow Valgus Stress Test abduction

Ligamentous Varus Instability Test Varus stress/turn forearm towards

Sitting/Standing Increased motion/pain LCL injury
AKA: Elbow Varus Stress Test adduction

UPPER EXTREMITY MODULE 3

 EPICONDYLITIS

Special Test Position Action (+) Indication

Lateral Epicondylitis (Tennis Elbow)

Fist, wrist extended, elbow extended, Active with resistance to wrist

Method 1: Cozen’s Test
radial deviation, pronation extension

Wrist flexed, elbow extended, FA

Method 2: Mill’s Test Passively move wrist into flexion Pain in lateral epicondyle Lateral epicondylitis
pronated

Active with resistance of finger

Method 3: Maudsley Extension of midfinger
extension

Medial Epicondylitis (Golfer’s Elbow)

Supination of FA, elbow extended, wrist

AKA: Golfer’s Elbow Test Passively move wrist to extension Pain Medial epicondylitis
extended

NEUROLOGIC DYSFUNCTION

Special Test Position Action (+) Indication

Tap area between olecranon process

Tinel Sign -- Tingling on ulnar nerve distribution Regeneration of nerve fiber
and medial epicondyle

Elbow flexion, wrist extension, shoulder Tingling sensation within ulnar nerve
Elbow Flexion Test -- Cubital tunnel syndrome
abduction, shoulder depression distribution

Wartenburg Sign Fingers ABD Actively adduct fingers Little finger remains abducted Ulnar nerve paralysis

Paresthesia within median nerve

Test for Pronator Teres Syndrome Elbow flexion with FA supinated Elbow flexion with FA pronation Pronator teres syndrome
distribution

Tip to tip pinch between thumb and

Pinch Grip Test (“OK Sign”) OK Sign Pulp-to-pulp Anterior interosseous nerve paralysis
index

FOREARM, WRIST, AND HAND

LIGAMENT, JOINT, AND CAPSULE INSTABILITY

Special Test Position Action (+) Indication

Hold wrist in flexion with finger Radiocarpal instability

Shuck Test (Finger Extension Test) Resist finger extension Pain
extended Inflammation

UPPER EXTREMITY MODULE 4

 Special Test Position Action (+) Indication

Scaphoid injury
Kienbock’s Disease

Murphy’s Sign Clenched fist Observed 3rd MCP 3rd MCP is leveled with 2nd and 4th MCP Lunate dislocation

Piano Key Test FA pronated Push distal ulna palmarly Increase in motion Distal radioulnar instability

Part 1: When PIP joint is neutral, flex the

Unable to flex DIP Tight retinacular ligament/DIP capsule
DIP

Haines-Zancolli Test Tight retinacular ligament

-- Able to flex DIP
AKA: Retinacular Test
Part 2: When PIP joint is flexed, flex the Normal DIP capsule
DIP Tight DIP capsule
Unable to flex DIP
Normal retinacular ligament

Part 1: When MCP joint is extended, flex

Unable to flex PIP Tight intrinsic/PIP capsule
the PIP

Tight intrinsic muscles

Bunnel Littler Test -- Able to flex PIP
Part 2: When MCP joint is flexed, flex Normal PIP capsule
the PIP Tight PIP capsule
Unable to flex PIP
Normal intrinsic muscles

De Quervain’s Tenosynovitis /
Finkelstein Test Thumb in fist Ulnar deviation Pain around APL and EPB
Hoffman’s Disease

Sweater Finger Ruptured FDP tendon/muscle (usually

Open palm Actively make a closed fist Unable to flex 1 DIP
AKA: Jersey Finger Test ring finger)

NEURO DYSFUNCTION

Special Test Position Action (+) Indication

Hold paper between thumb and index

Froment’s Sign Examiner pulls the paper away IP flexion of thumb Ulnar nerve pathology
finger

Phalen’s Test Paresthesia within median nerve

Max wrist flexion Hold position for 1 minute Carpal tunnel syndrome
AKA: Wrist Flexion Test distribution

Reverse Phalen’s Test Paresthesia within median nerve

Max wrist extension Hold position for 1 minute Carpal tunnel syndrome
AKA: Prayer Test/Sign distribution

Paresthesia within median nerve

Tinel’s Sign Seated Tap carpal tunnel Carpal tunnel syndrome
distribution

Actively open and close the hand, then

Allen’s Test -- squeeze → patient opens hand → Return of hand’s color is slow Vascular compromise/pathology
examiner observes hand color

UPPER EXTREMITY MODULE 5