IR/pronation (supra), flex shoulder, stabilize scapula

ER/supination (biceps), flex shoulder

+ = end range pain

90 degrees flexion, stabilize scapula, then IR

- = do horizantal aduction, then IR

if + don't move on

looking for any pain response

place hand on opposite shoulder and lifts the arm to shoulder level

+ = for reproduction of pain

supine, stabilize under humerus, webbed space find acromion , apply inferior glide, bring humerus into abduction

+ = reduce pain

supraspinatus tendinitis (can be painful or weak)

90 degrees in sacpular plane, empty can, then MMT

+ = weakness or pain

subscapularis muscle or tendon pathology

place hand on samll of back, lift hand off

+ = pain

rotator cuff pathology

horiz abduct, hold, then lower slowly

+ = pain or trouble lowering arm

teres minor tear

arm is supported in 90 degrees abduction in scapular plane, elbow flexed, patient ER against resistance (Patte = one arm not coming up)

+ = cant hold against resistance

biceps tendon issue

1. concentric: supinated, flex shoulder agsint resistance (sup should irritate most)

pronated, flex shoulder agasint resistance

+ = pain

2. eccentric: supinated, push into extension against resistance

Yeargason's

transverse humeral ligament

patient is IR moving into ER while turning forearm into supination, PT resists flexion and supination, finger over biceps tendon

feel for tendon popping out

ant and post instability

(usually less motion posteriorly)

pt sit up tall, feet on ground; stabilize over clavicle and scapula, palpate huemral head, load it, then slide anterior

*compare to other side

anterior instability

supine, towel under humerus, ER and abduct

watch for apprehension

used only after + apprehension test

anterior instability

bring off of where apprehension was, palm over acromion, powerior force, then take back into ER and if should reduce apprehension

posterior instability

stabilize scapula, palpate posterior GH joint, 90 degrees flexion, axillary load over elbow, IR horiz adduct

+ = apprehension

posterior instability

one hand on wrist, other heel over humerus, arm 90 abd, scaption plane, piush down and pull up with distal hand

feel for posterior motion of humerus

+ = <50 translation (posterior part of capsule is usually snug)

posterior instability, laxity

sitting, stabilize scapula, 90 degrees forward elevation, IR, horizantally adduct, axillary load

+ = "clunk" of humeral head leaving glenoid, may not get apprehension

inferior instability

sitting or standing, rest hand on thigh (~20 abd), palpate space between acromion and head of humerus. distal hand proximal to elbow and pull down

+ = distance between humeral head and acromion increases

grade 1 = finger

grade 2 = 2 fingers

grade 3 = 3 fingers

"slap" lesion, labral tear

1. try to elicit pain, 90 degrees flexion, IR, horiz adduct 10-15 degrees, proximal hand stabilizes trunk, MMT

pain needs to be deep in shoulder, not over ACJ

2. if painful, same position except ER (thumb up), MMT

+ = pain with IR relieved by ER

slap lesion, labral tear

sitting, hand on hip, stabilize clavicle and acromion, apply sup-ant force at elbow

+ = pain (over area of tear)

tear in labrum

supine, flex 160 degrees scaption, apply axillary load at elbow and Er until end range, then IR "scouring over"

+ = pain with or without a "click"

click is humeral head going over labrum

labral tear

supine, make fist and put under humeral head, bring arm into 160 scaption (more abd at end range), lift with fist then ER

+ = feel click/clunk

labral tear

supine, flex elbow with 20 abd, push or compress the humerous in the glendoid then IR and ER, "scouring"

similar to crank at lower ROM

labral tear

palpate clavicle and heel of hand on spine of scapular to find where acromion and clavical meet, then add compression to AC joint inward

+ = pain

Ulnar Collateral Ligament

pt seated, supinate, ER hum, slightly extended.

Palpate UCL, slightly abd forearm, test for ligament to be taut (to prevent valgus force)

gradually build up force

+ = pain increases, reproduction of pain, laxity

Radial (lateral) collateral ligament

pt seated, 20-30 degrees elbow flexion, proximal hand at medial elbow, palpate lateral colateral ligament. Slightly adduct, then build up gradually to assess motion.

+ = pain increased, reproduction of pain or laxity

active contraction of extensors

rest forearm on table, elbow flexed, ext wrist and apply pressure into flexion and radial deviation

OR

same except ecentric and ulnarly deviate, move into radial deviation

+ = reproduction of pain

passive stretch ECRB/L

flex wrist, ulnarly deviate, passively ext elbow

palpate lateral epicondyle where ECRB/L attach

(similar to radial nerve ULTT, but  not depressing shoulder and GHJ is in flexion)

extensor digitorum

palm on table, lift 3rd finger, apply pressure proximal to PIP

+ = reproduction of pain at lateral epicondyle

passive stretch inflammation of flexors

ext wrist, rad deviate, ext elbow

palpate medial epicondyle

+ = reproduction of pain at med epicondyle

tinel's sign (at elbow)

ulnar nerve entrapment coming from cubital tunnel

feel ulnar nerve in cubital tunnel, brief tap cubital tunnel arm slightly extended

ulnar neuropathy

passively spread fingers, then bring back together

+ = pinky doesnt come back in

compress median nerve

elbow flexed to 90, pronated

strongly resist pronation while extending elbow = maximum compression of median n by pronator teres

+ = numbness/tingling

anterior interosseous branch of median nerve

thumb and index finger tip to tip

+ = pad to pad

compress spine, push down on head

to clear cervical spine

clear cervical spine

ext, side bend, rotate toward unaffected side

+ = reproduce in affected side

supine, depress shoulder, abduct humerus to 110 degrees, supinate forearm, extend elbow, wrist fingers and thumb

alternate:

supine, depress houlder, abduct 10 deg, ER, supination, elbow, wrist, finger, thumb extension. Can flex to contralateral side

PIP, DIP, 2-5

apply valgus and varus stress, hand in neutral, stabilize proximal, move distal

look for inc laxity and joint space opening up, compare B

"skiers thumb"

stabilize 1st MC, thumb in slight ext = accessory and ulnar collateral ligament

apply valgus (toward radius) force

to isolate UCL, MCP in slight flexion

look for inc laxity and joint space opening up, compare B

integrity of lunotriquetral ligament

palmar and dorsal glide of lunate, stabilize triquetum with "pincher grip"

look for pain, crepitus, or increased motion compared to other

dislocation of lunate (punching wall)

+ = 3rd MC is in line with others or sunken

- = 3rd MC is superior/not in line with others

integrity of lunotriquetral ligament

supination, one hand suppors lunate, load triquetrum to produce "shear"

look for pain, crepitus, or inc motion compared to other side

"hand shake", stabilize forearm, compress and move wrist dorsal, palmar, supinate, pronate. key is to keep the compression throughout ROM

+ = pain over TFCC

OA or DJD at CMC

"scour at thumb", stabilize carpals, grab 1st MC and load, then rotate, side to side, to grinde CMC into trapezium

+ = reproduction of pain

tenosynovitis of ABPL and EPB

thumb inside fist, hold thumb in place, then passively ulnarly deviate

+ = reproduction of their pain, compare B

AKA intrinsic plus test

used to differenitate decreased ROM from muscles or pasule

capsule = slack muscle and ROM still imited

muscle = slack muscle and inc ROM

carpal tunnel (median n)

hand relaxed in supination

tap over carpal tuennl/flexor retinaculum

+ = reproduction of pain, distal to where you are tapping

carpal tunnel

dorsum of hands together, apply flexion force (compression of carpal tunnel) hold for 1 min

+ = reproduce symptoms distal to compression (pain, numbness, tingling)

palms together, stretching tissues and bring close to body and inferior for 30 seconds

OR

pt in wrist ext, squeeze thumb c fingers, apply compression over carpal tunnel for 30 seconds

= + reproduce symptoms distal to compression

carpal tunnel

hand relaxed in supination, compression carpal tunnel down c thumbs

+ = numbness, tingling, reproduction of pain

ulnar neuropathy

hold paper pulp to pulp c thumb and 2nd phalanx

+ = flex at IP joint at thumb when pull paper = weakness of ADP (ulnar nerve) and FPL is trying to compensate

patency of radial and ulnar arteries

supination, add compression on radial and ulnar side, make fist 4-5 times, palm blanches, let up one by one

slow refill = may have vascular problem (not MS)