Special test to diagnose upper limb deformities

Shoulder anterior instability test

Apprehension/crank Test- 

This test is primarily designed to test for traumatic instability problems causing gross or anatomical instability of the shoulder. The examiner abducts the arm to 90 degrees and laterally rotates the shoulder slowly. Placing the hand under the glenohumeral joint acts as a fulcrum. Kvitne and Jobe recommended applying a mild anteriorly directed force to the posterior humeral head when in the test position to see if apprehension or pain increases. If posterior pain increases, it is an indication of posterior internal impingement.

Relocation Test

If the examiner applies posterior translation stress to the head of the humerus or the arm, the patient will commonly lose the apprehension or pain that is present commonly decreases. and further lateral rotation is possible before the pain returns. This relocation test is sometimes referred to as the Fowler sign or test and the Jobe relocation test. The test is considered positive if pain decreases during the maneuver, even if there was no apprehension. If the patient’s symptoms decrease or are eliminated when doing the relocation test, the diagnosis is glenohumeral instability, subluxation or dislocation, or impingement. If apprehension predominated when doing the crank test and disappears with the relocation test, the diagnosis is glenohumeral instability, subluxation, or dislocation.

Shoulder posterior instability test

1. Jerk test

The patient sits with the arm medially rotated and forward flexed to 90 degree. The examiner grasps the patient’s elbow and axially loads the humerus in a proximal direction. While maintaining the axial loading, the examiner moves the arm horizontally across the body. A positive test for posterior instability is the production of a sudden jerk as the humeral head slides off (subluxes) the back of the glenoid. When the arm is returned to the original 90 degree abduction position, a second jerk may be felt as the head reduces.

Shoulder inferior instability test

 1. Sulcus sign

The patient stands with the shoulder muscles relaxed. The examiner grasps the patient’s forearm below the elbow and pulls the arm distally. The presence of sulcus sign may be indicative of inferior instability or glenohumeral laxity. The sulcus sign feels like subluxation is also clinically significant.

Special tests for elbow

A. Tests for epicondylitis:

1. Lateral epicondylitis or Cozen’s test

The patient’s elbow is stabilized by examiner thumb, which rests on the patient’s lateral epicondyle. The patient is then asked to make a fist, pronate the forearm, radially deviate the wrist and extend the wrist while the examiner resists the motion. A positive sign is indicated by a sudden severe pain in the area of the lateral epicondyle of the humerus. The epicondyle may be palpated to indicate the origin of pain.

2. Golfer’s elbow or medial epicondylitis test

While the examiner palpates the patient’s medial epicondyle, the patient’s forearm is passively supinated and the elbow or wrist are extended by the examiner. A  positive sign is a indication by pain over the medial epicondyle of the humerus.

Test for neurological dysfunction

1. Wartenberg’s sign

The patient sits with his or her hands resting on the table. The examiner passively separates the fingers apart and asks the patient to bring them together again. If the patient is unable to squeeze the little finger of the hand indicates a positive test for ulnar neuropathy.

2. Elbow flexion test

The patient is asked to fully flex the elbow with the extension of the wrist and shoulder girdle abduction and depression and to hold this position for 3 to 5 minutes. A positive test is indicated by tingling or paresthesia in the ulnar nerve distribution of the forearm and hand. This test helps to determine whether a cubital tunnel syndrome is present.

Special test for wrist

1. Murphy’s sign

The patient is asked to make a fist. If the head of the third metacarpal is level with the second and fourth metacarpal, the sign is positive and indicative of a lunate dislocation. Normally, the third metacarpal would project beyond the second and fourth metacarpals.

2. Grind test

The examiner holds the patient’s hand with his one hand and grasps the patient’s thumb with the other hand below the metacarpophalangeal joint with the other hand. The examiner then applies axial compression and rotation to the metacarpophalangeal joint. If the test is positive by the pain elicited and indicative of degenerative joint disease in the metacarpophalangeal or metacarpotrapezial joint. Axial compression with rotation to any of the wrist and hand joints may also indicate positive tests for those joints for the same conditions.

3. Phalen’s (Wrist flexion) test

The examiner flexes the patient’s wrist maximally and holds this position for 1 minute by pushing the patient’s wrists together. A positive test is indicated by tingling in the thumb, index finger, middle and lateral half of the ring finger and is an indication of carpal tunnel syndrome caused by pressure on the median nerve.https://www.youtube.com/watch?v=9M4_Jel0FZ8

Nikita Sharma

Hope you have enjoyed reading this blog and gained good knowledge regarding the topic. Here, I am Nikita Sharma I am a student of physiotherapy and I love to write blogs related with Physiotherapy.

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