The document describes various upper limb orthopedic tests used to evaluate shoulder, elbow, and wrist pathology. It provides details on how to perform tests such as the drop arm test for the shoulder, Cozen's test and Mill's test for tennis elbow, Golfer's elbow test, and Phalen's test and Tinel's test for carpal tunnel syndrome. The tests are used to reproduce symptoms, evaluate range of motion, and detect injuries or conditions like rotator cuff tears, shoulder dislocation, lateral epicondylitis, medial epicondylitis, and carpal tunnel syndrome.

1. SPECIAL TEST OF
UPPERLIMB
Shamima Akter
B. Sc (Honors) in Occupational Therapy
& M. Sc in Rehabilitation Science
Assistant Professor,
Department of Occupational Therapy
Bangladesh Health Professions Institute (BHPI)
Centre for the Rehabilitation of the Paralysed (CRP)
Chapain, Savar

2.  There are different tests for determining
shoulder pathology:
 Drop arm test (Codman’s test)
 Apprehension test
 Yeargason’s test
 Impingment test
 Neer’s test

3. Apprehensio
n Test
Yeargason’s
Test
Neer’s Test Impingement
Test

4. Drop Arm Test (Codman’s test)
Reason To detect whether or not there are any tears in the
rotator cuff
Method 1. Patient is in seated position
2. Instruct the patient to fully abduct arm (180⁰).
3. Then ask to slowly lower it to his side.
Result The arm will drop to the side from a position of
about 90⁰ abduction and the patient is unable to
lower his arm slowly to the side

6. Apprehension Test
Reason To test for chronic shoulder joint dislocation
Method 1. Patient in seated position
2. Instruct patient to abduct arm with elbow flexed to
90°
3. Grasp patient wrist and keep another hand on
scapula
4. Now externally rotate the patient’s arm to a
position whether it might easily dislocate.
Result If the shoulder is ready to dislocate, the patient will
have a noticeable look of apprehension or alarm on
his face and will resist further motion.

8. Yeargason’s Test
Reason To determine the stability of the long head of the biceps tendon in
the bicipital groove
Method 1. Patient seated
2. Grasp patient’s wrist and keep another hand on shulder
3. Shoulder neutral, forearm pronated with elbow 90° flexed.
4. Examiner grips forearm & palpates biceps long head tendon
5. Then instruct the patient to actively flex & supinate forearm
(“hitchhiker”).
6. Examiner resists patient motion.
Result If the biceps tendon is unstable in the bicipital groove, it will pop
out of the groove, the patient will experience pain.

10. Neer’s test
Reason To determine subacromial impingement.
Method 1. Patient seated with arms in dependent position.
2. Examiner first raises patient’s straight arm through
full range of flexion (passive ROM) with arm
externally rotated (palm up), then motion repeated
with arm internally rotated (palm down).
Result Positive Pain with internally rotated shoulder (palm
down) → supraspinatus impingement
Externally rotate with passive flexion- subacromial
impingement

12. Impingement Sign test
Reason To determine if there is any irritation or injury to the
rotator-cuff tendons.
Method Patient seated or standing, 2 parts:
1. Patient actively flexes shoulder with palm up (arm
externally rotated).
2. Patient actively flexes shoulder with palm down
(arm internally rotated).
Result Positive Pain during active flexion → shoulder
impingement
Positive Pain → Internally rotated shoulder (palm
down) → supraspinatus impingement
Externally rotated shoulder (palm up) → biceps long
head impingement.

14.  There are different tests for determining
elbow pathology:
Cozen test (Resistive Tennis Elbow test)
Mill’s test (Tennis Elbow test)
Golfer’s Elbow test (Reverse Mill’s Test)
Tinnel’s percussion test

15. Cozen’s Test
(Resistive Tennis
Elbow Test)
Mill’s Test Reverse Mill’s
Test (Golfer’s
Elbow Test)
Tinnel’s
PercussionTest

16. Cozen test (Resistive Tennis Elbow Test)
Reason To test is designed to reproduce the pain of tennis
elbow (Lateral epicondylitis)
Method 1. Patient should be seated while the test is being
done.
2. Examiner tells the patient to fully flex his elbow with
the forearm pronated and the wrist extended. This is
similar to a “waiter position.”
3. The examiner puts pressure over the direction of the
elbow extension and wrist flexion as he uses his other
hand to stabilize the patient’s elbow.
4. The examiner watches for signs of pain or
discomfort or for any sign of weakness while the
procedure is done.
Result A positive result would be if there is pain along the
lateral epicondyle or objective muscle weakness

18. Mill’s test
Reason To test is designed to reproduce the pain of tennis
elbow
Method 1. Patient is seated
2. The clinician palpates the patient’s lateral
epicondyle with one hand
3. With other hand examiner extends and pronates
patient’s elbow while flexing the wrist.
Result A reproduction of pain in the area of the insertion at
the lateral epicondyle indicates a positive test.

20. Golfer’s elbow test (Reverse Mill’s Test)
Reason Test for medial epicondylitis
Method 1. Patient is seated
2. The clinician palpates the patient’s lateral epicondyle with one
hand
3. With other hand examiner extends and supinates patient’s
elbow while extending the wrist and finger flexor tendon.
Result A positive test along the medial aspect of the elbow in the
region of the medial epicondyle.

22. Tinel’s Percussion test at elbow
Reason Tests for the presence of ulnar compressive neuropathy.
Method 1. Patient should be seated during the procedure.
2. The examiner locates the cubital tunnel
3. After locating the area, he uses his fingertips or reflex
hammer to tap the area.
4. The examiner checks for the patient’s response: shooting
electrical pain.
Result There is positive Tinel’s Sign at Elbow when the patient
complains of sharp and shooting electrical pain over the medial
side of the forearm to the medial hand. This sign indicates the
presence of ulnar compressive neuropathy.

24.  There are different tests for determining wrist pathology:
 Phalen’s test
 Reverse phalen’s test
 Median nerve gliding test
 Finklestein Test
 Tinnel’s percussion test at wrist

25. Phalen's test
Reason The phalen’s test is a provocative test used in diagnosis of
carpal tunnel syndrome
Method 1. Patient may be seated or standing during the procedure.
2. Tell the patient to place the backs of his hands together in
front of her body while elbow in prone position. Both
wrists are completely flexed. The patient has to remain in
this position for at least a minute.
3. Watch out for any complaints of pain along the wrist and
the hands.
Result Positive if there are complaints of burning/tingling/sensory
changes with sustained wrist flexion within 60 seconds.

27. Reverse Phalen’s test
Reason Test used in diagnosis of carpal tunnel syndrome
Method 1. Patient should be seated with the wrists extended.
2. Patient should have the palms of the hands together like
in a praying position with the elbows high.
3. In this position, both wrists are extended.
4. Patient should maintain this position for a minute.
5. When the tips have touched, tell the patient to bring his
palms together without breaking the connection of the
fingertips
Result Positive if there are complaints of burning/tingling/sensory
changes with sustained wrist flexion within 60 seconds. More
specifically, at the height of thumb, forefinger and a part of the

29. Median nerve gliding Test
Reason Test used in diagnosis of carpal tunnel syndrome
Method 1. Patient may be seated or standing during the
procedure.
2. The test may also include extension of elbow
(hand position in medial side) and abduction of
shoulder to place tension on the entire median
nerve.
Result Tension on the median nerve at the wrist by
extending the wrist.

31. Tinel’s Percussion test (At Wrist)
Reason Test used in diagnosis of carpal tunnel syndrome
Method 1. Patient should be seated during the test.
2. The examiner uses his fingertips or a reflex hammer in
tapping the carpal tunnel and the ulnar tunnel.
3. The examiner checks for numbness, shooting electrical
sensation or pain or any tingling of the area.
Result There is positive Tinel’s Test when there is numbness, tingling
or shooting pain along the area. When these signs are
present along the median nerve distribution, median
neuropathy may be suspected. If the signs are found along
the ulnar nerve distribution, ulnar neuropathy could be
present.

33. Finklestein Test
Reason Test is used for dequervain’s disease
Method 1. The patient should be seated and comfortable.
2. Tell the patient to place one hand in the air while
the other rests beside him.
3. Tell the patient to make a fist with the thumb inside
the fingers (ulnar deviation) with the hand in the air.
Result A positive test is indicated by sharp pain over the APL
and EPB tendons at the wrist. Therapist should
compare it with affected and non-affected side.

36.  There are different tests for determining wrist
pathology:
 Allen’s test
 Bunnel- littler Test
 Retinacular Test

37. Allen’s Test
Reason To determine whether or not the radial and ulnar arteries
are supplying the hand to their full capacities.
Method To perform the test, instruct the patient to open and close
his fist quickly several times, and then squeeze his fist
tightly so that the venous blood is forced out of the palm.
Result Normally the hand flushes immediately. It does not react, or
if it flushes very slowly the released artery is partially or
completely occluded.

39. Bunnel- littler Test
Reason Evaluates the tightness of the intrinsic muscles of the hand (the
lumbricals and interossei).
The test may also be used to determine whether flexion limitation in
IP joint due to tightness of intrinsic or to joint capsule contractures, a
condition which prevents the finger from curling into the palm.
Method Hold the metacarpophalangeal joint in a few degree of extension,
and try to move the proximal interphalangeal joint into flexion.
Result If in this position the proximal interphalangeal joint can be flexed, the
intrinsic are not tight and are not limiting flexion. If, in this position,
the proximal interphalengeal joint cannot be flexed, either the
intrinsics are tight, or there are joint capsule contractures.

41. Bunnel-
littler Test
Result Distinguishing between intrinsic muscle tightness and
joint capsule contractures by letting the involved finger
flex a degrees at the metacarpophalangeal joint
(thereby relaxing the intrinsics) and moving the PIP
joint into flexion.
If the joint is now capable of full flexion, the intrinsics
are probably tight.
If the joint still does not flex completely, the limtation
due to PIP joint capsule contracture.

44. Retinacular Test
Reason This test verifies the tightness of retinacular ligaments. The
test may be used to determine whether flexion limitation in
the DIP joints due to tightness of retinacilar ligaments or to
joint capsule contracture
Method Hold the proximal interphalengeal joint in a neutral position
and try to move the distal interphalageal joint into flexion.
Result If the joint does not flex, limitation is due either to joint
capsule contracture or to retinacular tightness. To
distinguish between these two, flex the PIP joint slightly to
relax the retinaculum. If the DIP joint then flexs, the
retinacular ligament are tight. If the joint still doesnot flex,
the DIP joint capsule is contracted.

46. Possible question
 What do you understand about carpal tunnel
syndrome? What are tests OT can use to
diagnose CTS? Describe one of them.
 Define tennis elbow with its test.
 Define golfer’s elbow with its test.

47. Tennis Elbow
 Tennis elbow is a condition that causes pain
around the outside of the elbow.
 It's clinically known as lateral epicondylitis.
 It cause pain:
 on the outside of your upper forearm, just below the
bend of your elbow
 when lifting or bending your arm
 when gripping small objects, such as a pen
 when twisting your forearm, such as turning a door
handle or opening a jar
 You may also find it difficult to fully extend your arm.

48. Golfer’s Elbow
 Golfer's elbow (medial epicondylitis) causes pain
and inflammation in the tendons that connect the
forearm to the elbow. The pain centers on the
bony bump on the inside of your elbow and may
radiate into the forearm. It can usually be treated
effectively with rest.
 Golfer's elbow is usually caused by overusing the
muscles in the forearm that allow you to grip,
rotate your arm, and flex your wrist. Repetitive
flexing, gripping, or swinging can cause pulls or
tiny tears in the tendons.

49. THANKS A LOT