Special tests for elbow | wrist and Hand

Special tests for elbow:

Following are some fundamental tests for elbow joint examination in Physical Therapy:

  • Ligament instability tests (valgus & varus stress tests)
  • Tests for epicondylitis
  • Pronator teres syndrome test
  • Tinel’s sign

Tests for epicondylitis:

Aim of test:
To identify lateral or medial epicondylitis.
A. Lateral epicondylitis /Tennis Elbow (Cozen) Test:
Patient position:
Patient is sitting with elbow in 90° & supported, resist wrist extension, wrist radial deviation & forearm pronation with fingers fully flexed (fist) simultaneously.
B. Medial epicondylitis /Golfer Elbow test
Patient position:
Patient is sitting with elbow in 90° & supported, passively supinate forearm, extend elbow & wrist.


Ligament instability tests:

Aim of the test:
Identifies collateral ligaments laxity or restriction.
Patient position:
Patient is sitting or supine. Varus force placed through elbow tests radial collateral ligament.
Positive sign:
Primary finding is laxity, but pain may be noted as well.

Pronator teres syndrome test:

Aim of the test:
Identifies a median nerve entrapment within pronator teres.
Patient position:
Patient sitting with elbow in 90° flexion & supported. Resist forearm pronation and elbow extension simultaneously.
Positive sign:
Reproduces a tingling or paresthesia within median nerve distribution.

test for elbow

4. Tinel’s sign:

Aim of the test:
Identifies dysfunction of ulnar nerve at olecranon.
Patient position:
Patient is sitting, tap region where the ulnar nerve passes through cubital tunnel.

Special tests of the wrist & hand:

1. Finkelstein test:


Aim of the test:
Identifies De-Quervain’s tenosynovitis (paratendonitis of the abductor pollicis longus and/or extensor  pollicis brevis)
Patient positon:
Patient makes fist with thumb within confines of fingers. Passively move wrist into ulnar deviation.
Positive sign:
Reproduces pain in wrist.


2. Bunnel-Littler test:


Aim of the test:
Identifies tightness in structures surrounding the MCP joints.
Positive sign:
If more PIP flexion with MCP flexion then intrinsic muscles are tight.

3. Froment’s sign:


Aim of the test:
Identifies ulnar nerve dysfunction.
Patient position:
Patient grasps paper between 1st & 2 nd digits of hand. Pull paper out and look for IP flexion of thumb, which is compensation due to weakness of adductor pollicis.
Positive sign: 
Patient unable to perform test without compensating may indicate ulnar nerve dysfunction.


4. Phalen’s test:


Aim of the test:
Identifies carpal tunnel compression of median nerve.
Patient position: 
Patient maximally flexes both wrists holding them against each other for one minute.
Positive sign: 
Reproduces tingling and/or paresthesia into hand following median nerve distribution

tests for elbow

Tests for shoulder instability in Physiotherapy:

1. Anterior apprehension (Crank) test:

Aim of the test: 
Identifies past history of anterior shoulder dislocation
Patient position:
Patient supine with shoulder in 90° abduction. Slowly take shoulder into external rotation.
Positive sign: 
Patient does not allow and/or does not like shoulder to move in direction to simulate anterior dislocation.
Tests for shoulder

2. Posterior apprehension test:

Aim of the test:
Identifies past history of posterior shoulder dislocation.
Patient position:
Patient supine with shoulder elevated 90° (in plane of scapula) with scapula stabilized by table. 
Positive sign:
Patient does not allow and/or does not like shoulder to move in direction to simulate posterior dislocation.

3. Anterior/Posterior drawer test of shoulder:


Aim of the test:
Identify laxity or insufficiency of the anterior/posterior capsular mechanism
Patient position:
Patient is supine the affected shoulder is abducted at 80-120°, 20° flexion & 30° external rotation. The examiner holds the patients scapula spine forward with his index and middle fingers; the thumb exerts counter pressure on the coracoid. The scapula is fixed. The examiner uses his right hand to grasp the patient’s relaxed upper arm and draws it anteriorly/posteriorly with a force
Positive sign:
Gliding of the hummers. Click may indicates labral tear

4. Sulcus sign:


Aim of the test:
Identifies inferior shoulder instability or glenohumeral laxity
Patient position:
Patient is sitting with his arm in neutral position, the examiner pulls downward on the elbow while observing the shoulder area for a sulcus or depression lateral or inferior to the acromion.

Tests for labral tear:

1. Clunk test:


Aim of the test:
Identifies a glenoid labrum tear.
Patient position:
Patient supine with shoulder in full abduction. Push humeral head anterior while rotating hummers externally.


2. SLAP Prehension test:


Aim of the test:
Identify SLAP lesion (superior labrum, anterior posterior)
Patient position:
patient is sitting/standing, arm is abducted 90°, elbow extended & forearm pronated (thumb down). Ask the patient to horizontally adduct the arm, repeat the movement with supination (thumb up). If pain felt in the bicipital groove in the first case (pronation) & is lessened or absent in the second case (supination), the test is considered positive for a SLAP lesion.
Positive sign:
Pain in bicipital groove during supination.

Tests for Thoracic Outlet Syndrome (TOS):

1. Adson’s test:


Aim of the test:
Identifies pathology of structures that pass through thoracic inlet.
Positive sign:
Neurologic and/or vascular symptoms (disappearance of pulse) will be reproduced in upper limb (UL)

2. Costoclavicular syndrome (military brace) / Edens’ test:


Aim of the test: 
Identifies pathology of structures that pass through thoracic inlet.
Patient position:
Patient sitting and find radial pulse of the extremity being tested. Move involved shoulder down and back.
Positive sign:
Neurologic and/or vascular symptoms (disappearance of pulse) will be reproduced in UL

3. Wright (hyperabduction) test:


Aim of the test:
Identifies pathology of structures that pass through thoracic inlet.
Patient position:
Patient sitting and find radial pulse of extremity being tested. Taking deep breath and rotating head opposite to side being tested may accentuate symptoms.
Positive sign:
Neurologic and/or vascular symptoms (disappearance of pulse) will be reproduced in UL.

4. Roos elevated arm / EAST (elevated arm stress test) test:


Aim of the test:
Identifies pathology of structures that pass through thoracic inlet.
Patient position:
Patient standing with shoulders fully externally rotated, 90° abducted, & slightly horizontally abducted. 
Positive sign:
Neurologic and/or vascular symptoms (disappearance of pulse) will be reproduced in UL.

Tests for Elbow

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