SPECIAL TEST OF UL.pptx

Special Test of Upperlimb

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. Special Test for Shoulder 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. Apprehension 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 Patient is in seated position Instruct the patient to fully abduct arm (180⁰). 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

5. Apprehension Test Reason To test for chronic shoulder joint dislocation Method Patient in seated position Instruct patient to abduct arm with elbow flexed to 90° Grasp patient wrist and keep another hand on scapula 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.

6. Yeargason’s Test Reason To determine the stability of the long head of the biceps tendon in the bicipital groove Method Patient seated Grasp patient’s wrist and keep another hand on shulder Shoulder neutral, forearm pronated with elbow 90° flexed. Examiner grips forearm & palpates biceps long head tendon Then instruct the patient to actively flex & supinate forearm (“hitchhiker”). 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.

7. Neer’s  test Reason To determine subacromial impingement. Method Patient seated with arms in dependent position. 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

8. 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: Patient actively flexes shoulder with palm up (arm externally rotated). 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.

9. Special Test for Elbow 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

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

11. 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

12. Mill’s test Reason To test is designed to reproduce the pain of tennis elbow Method Patient is seated The clinician palpates the patient’s lateral epicondyle with one hand 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.

13. Golfer’s elbow test (Reverse Mill’s Test) Reason Test for medial epicondylitis Method Patient is seated The clinician palpates the patient’s lateral epicondyle with one hand 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 .

14. Tinel’s Percussion test at elbow Reason Tests for the presence of ulnar compressive neuropathy. Method Patient should be seated during the procedure. The examiner locates the cubital tunnel After locating the area, he uses his fingertips or reflex hammer to tap the area. 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.

15. Special Test for Wrist 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

16. Phalen's test Reason The phalen’s test is a provocative test used in diagnosis of carpal tunnel syndrome Method Patient may be seated or standing during the procedure. 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. 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.

17. Reverse Phalen’s test Reason Test used in diagnosis of carpal tunnel syndrome Method Patient should be seated with the wrists extended. Patient should have the palms of the hands together like in a praying position with the elbows high. In this position, both wrists are extended. Patient should maintain this position for a minute. 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 middle finger, and there can be pain in or near the wrist.

18. Median nerve gliding Test Reason Test used in diagnosis of carpal tunnel syndrome Method Patient may be seated or standing during the procedure. 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.

19. Tinel’s Percussion test (At Wrist) Reason Test used in diagnosis of carpal tunnel syndrome Method Patient should be seated during the test. The examiner uses his fingertips or a reflex hammer in tapping the carpal tunnel and the ulnar tunnel. 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.

20. Finklestein Test Reason Test is used for dequervain’s disease Method The patient should be seated and comfortable. Tell the patient to place one hand in the air while the other rests beside him. 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.

21. Special Test for Hand There are different tests for determining wrist pathology: Allen’s test Bunnel - littler Test Retinacular Test

22. 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.

23. 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.

24. 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.

25. 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.

26. 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.

27. 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.

28. 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.

29. THANKS A LOT