Test #3 Special Tests

Question 1

Bunnell-Littler Test (aka Intrinsic Plus Test)

Answer 1

To determine if flexion restriction at the PIP joint is due to
Tightness of intrinsic muscles, or
Restriction at MCP capsule
MCP joint is held by the clinician in a few degrees of extension
Clinician’s other hand attempts to flex the PIP joint
If the joint cannot flex, tightness of the intrinsics or a joint capsular contraction should be suspected
From this position, the clinician slightly flexes the MCP joint (relaxing the intrinsics) & attempts to flex the PIP joint
If the joint can now flex, the intrinsics are tight
If the joint still cannot flex, the restriction is probably due to a capsular contraction of the joint

Question 2

Haines–Zancolli Test

Answer 2

Used to determine whether restricted flexion at the DIP joint is due to
A restriction of the PIP joint capsule, or
Tightness of the oblique retinacular ligament
Test is the same as the Bunnell–Littler test, except at the PIP and DIP joints
Clinician positions and holds the PIP joint in a neutral position with one hand
Attempts to flex the DIP joint with the other hand
If no flexion is possible, it can be due to either a tight retinacular ligament or capsular contraction
PIP joint is then slightly flexed (relaxes the retinacular ligament)
If the can now flex, the restriction is due to tightness in the retinacular ligament
If the DIP cannot flex, then the restriction is due to a capsular contraction

Question 3

Thumb CMC Grind Test

Answer 3

Used to assess the integrity of the thumb CMC joint
Clinician grasps the thumb metacarpal using the thumb and index finger of one hand
With the other hand, grasp the proximal aspect of the thumb CMC joint
Provide an axial compressive force, combined with rotation, to the thumb CMC joint
Positive test is reproduction of the patient’s symptoms and crepitus

Question 4

Lichtman Test

Answer 4

Provocative test for midcarpal instability
Patient’s forearm in positioned in pronation and the hand is held relaxed and supported
Clinician gently moves the patient’s hand from RD to UD while compressing the carpus into the radius
Positive test is when the midcarpal row appears to jump or snap from an palmarly subluxed position to the height of the proximal row

Question 5

Linscheid Test

Answer 5

Used to detect ligamentous injury and instability of the second and third CMC joints
Clinician supports the metacarpal shafts
Press distally over the metacarpal heads in palmar and dorsal directions
Positive test produces pain localized to the CMC joints

Question 6

Carpal Shake Test

Answer 6

Used to assist in diagnosis of intercarpal synovitis
Clinician grasps the patient’s distal forearm and the patient is asked to relax
Clinician shakes the wrist
Positive test is pain or resistance to this test

Question 7

Press (Sit to Stand) Test

Answer 7

Used to assist in diagnosis of TFCC tear
Patient sitting with both hands on the armrests of a chair
Patient attempts to lift their body slightly off the chair
Positive test is pain or resistance to this test

Question 8

Supination Lift Test

Answer 8

Patient in sitting with the elbows flexed to 90 degrees and the forearms supinated
Patient is asked to place the palms flat on the underside of a table or against the clinician’s hands
Patient is asked to lift the table or push up against the resisting clinician hands
Positive test for a TFCC tear is pain localized to the ulnar side of the wrist with difficulty applying force

Question 9

Ulnar Impaction Test

Answer 9

Used to assess the articulation between the ulnar carpus and the TFCC
Patient is sitting with the elbow flexed to 90o, wrist positioned in UD, and fingers positioned in a slight fist
Clinician loads the wrist via a compressive force through the 4th and 5th metacarpals
Positive test is pain

Question 10

Finkelstein Test

Answer 10

Used to detect tenosynovitis of the APL and EPB
Clinician stabilizes the forearm with one hand
Grasps the thumb and deviates the wrist to the ulnar side with the other hand
Positive test is pain over the APL and EPB tendons at the wrist
No diagnostic accuracy studies have been performed to determine the sensitivity and specificity of this test, so the results of this test must be interpreted with caution
Positive test may also indicate Wartenberg syndrome, Basilar Thumb Arthrosis, EPB entrapment or Intersection Syndrome

Question 11

Radioulnar Ballottement Test

Answer 11

Used to assess DRUJ instability
Patient’s elbow is flexed
Clinician uses their thumb and index finger to stabilize the radius radially and the ulnar head ulnarly
Stress is applied in an anterior–posterior direction
Normally there is little movement in the anterior or posterior direction in maximum supination or pronation
Positive test is pain or mobility and is suggestive of radioulnar instability

Question 12

Wartenberg Test

Answer 12

Used with patients who complain of pain over the distal radial forearm associated with paresthesias over the posterior radial hand (Wartenberg syndrome)
Wartenberg test involves tapping the index finger over the superficial radial nerve on the posterior and radial side of the wrist
Positive test is indicated by local tenderness and paresthesia with this maneuver

Question 13

Finger Extension Test

Answer 13

Used to demonstrate Posterior Wrist Syndrome (localized scapholunate synovitis)
Clinician instructs the patient to fully flex the wrist and then actively extend the digits at both the IP and MCP joints
Clinician then applies pressure on the fingers into flexion at the MCP joints while the patient continues to actively extend
Positive test is reproduction of central posterior wrist pain
Pain can also indicate the possibility of Kienbock disease, carpal instability, joint degeneration, or synovitis

Question 14

Scapholunate Shear Test

Answer 14

Patient in sitting with the forearm pronated
Clinician grasps the scaphoid with one hand
Clinician grasps the lunate between the thumb and the index finger
Lunate and scaphoid are then sheared in an anterior then posterior direction
Positive test is reproduction of the patient’s pain and laxity

Question 15

FDS Test

Answer 15

Used to test the integrity of the FDS tendon
Clinician holds the patient’s fingers in extension, except for the finger being tested
Patient is instructed to flex the finger at the PIP joint
If this is possible, the FDS tendon is intact
Since this tendon can act independently due to the position of the finger, it is the only functioning tendon at the PIP joint

Question 16

FDP Test

Answer 16

These tendons work only in unison
To test the FDP, the PIP joint and the MCP joints are stabilized in extension
Patient is asked to flex this finger at the DIP joint
If flexion occurs, the FDP is intact
If no flexion is possible, the tendon is severed or the muscle denervated

Question 17

Integrity of the Central Slip (Ext. Hood Rupture)

Answer 17

Patient flexes the finger to 90o at the PIP joint over the edge of the table
Patient is then asked to extend the PIP joint while the clinician palpates the middle phalanx
The absence of extension force at the PIP joint, and fixed extension at the distal joint, indicates a complete rupture of the central slip

Question 18

Piano Key Test

Answer 18

Used to evaluate the stability of the ulnomeniscotriquetral joint
Clinician firmly stabilizes the distal radius with one hand
Grasps the head of the ulna between the thumb and the index finger of the other hand
Ulnar head is depressed in an anterior direction (as in depressing a key on a piano)
Positive test is pain and/or excessive movement in an anterior direction or if (upon release) the bone springs back into its high posterior position
Can indicate TFCC tear or triquetral instability

Question 19

Lunotriquetral Shear (Reagan) Test

Answer 19

Used to assess the integrity of the lunotriquetral ligament
Clinician grasps the triquetrum between the thumb and the second finger of one hand
Clinician grasps the lunate with the thumb and second finger of the other hand
The lunate is moved posteriorly with the thumb of one hand, while the triquetrum is pushed anteriorly in the A/P plane by the index finger of the other hand
Positive test is crepitus, clicks or pain in this area

Question 20

Watson Test for Carpal Instability

Answer 20

Used to examine the dynamic stability of the wrist, in particular the scapholunate ligament
Patient in sitting with the elbow in approximately 90o of flexion, forearm slightly pronated, and wrist UD
Clinician grasps the wrist from the radial side and stabilizes the scaphoid tubercle with the thumb and the posterior aspect of the scaphoid with the index finger
Clinician uses the other hand to grasp the metacarpals
Starting in UD and slight extension, the wrist is moved into radial deviation and slight flexion
As the wrist is brought passively into radial deviation, the normal flexion of the proximal row forces the scaphoid tubercle into an anterior direction (into the Clinician’s thumb)
Clinician attempts to prevent the anterior motion of the scaphoid
When the scaphoid is unstable, its proximal pole is forced to sublux posteriorly
Positive test is pain at the posterior wrist or a clunk (suggests instability)

Question 21

Gamekeeper’s or Skier’s Thumb Test

Answer 21

Patient in sitting
Clinician stabilizes the patient’s hand with one hand and takes the patient’s thumb into extension with the other
While maintaining the thumb into extension, the clinician applies a valgus stress to the MCP joint of the thumb to stress the UCL
Positive test is present if the valgus movement is greater than 30–35 degrees, indicating a complete tear of the UCL and the accessory collateral ligaments

Question 22

Murphy Sign

Answer 22

Patient is asked to make a fist
If the head of the third metacarpal is level with the second and fourth metacarpals, the sign is positive for the presence of a lunate dislocation

Question 23

Allen Test

Answer 23

Used to determine the patency of the vessels supplying the hand
Clinician compresses both the radial and ulnar arteries at the wrist, and then asks the patient to open and clench the fist 3-4 times to drain the venous blood from the hand
Patient is then asked to hold the hand open while the clinician releases the pressure on the ulnar artery while maintaining pressure on the radial artery
Fingers and palm should be seen to regain their normal color
This procedure is repeated with the radial artery released and compression on the ulnar artery maintained
Normal filling time is usually less than 5 seconds
A distinct difference in the filling time suggests the dominance of one artery filling the hand

Question 24

Tinel (Percussion) Test for CTS

Answer 24

Used to assist in the diagnosis of CTS
The area over the median nerve is tapped gently at the anterior surface of the wrist
If this produces tingling in the median nerve distribution, then the test is positive

Question 25

APB Weakness for CTS

Answer 25

Patient is sitting with their hand resting on the table Clinician asks the patient to touch the pads of the thumb and small finger together Clinician applies a strong force in order to resist thumb abduction Positive test is weakness in some abduction with resisted testing as compared to the other hand

Question 26

Phalen Test for CTS (Wrist Flexion)

Answer 26

Patient sitting with wrists flexed and elbows flexed Positive test is if the patient experiences numbness or tingling throughout the median nerve distribution of the hand within 30-45 seconds

Question 27

Reverse Phalen Test for CTS (Prayer)

Answer 27

Patient sitting with wrists extended and elbows flexed Positive test is if the patient experiences numbness or tingling throughout the median nerve distribution of the hand within 30-45 seconds

Question 28

Wrist Flexion and Median Nerve Compression Test

Answer 28

Patient sitting with the elbow fully extended, forearm supinated, and the wrist flexed to 60o Clinician applies a constant pressure over the median nerve at the carpal tunnel using the thumb Positive test for CTS is the reproduction of symptoms along the median nerve distribution within 30 seconds

Question 29

Median Nerve Compression Test/Pressure Provocation Test

Answer 29

Patient sitting Clinician grasps patient’s hand with thumbs directly over the median nerve as it passes under the flexor retinaculum between the FCR and the palmaris longus Constant, gentle pressure is applied with the thumbs for 15-120 seconds Positive test is the reproduction of pain, paresthesia, or numbness distal to the site of compression in the distribution of the median nerve

Question 30

Froment Sign

Answer 30

Used to define weakness in the Adductor Pollicis due to ulnar nerve palsy Patient pinches the index finger and thumb together without flexion occurring at the DIP joint (tongue depressor or paper is useful) Clinician tried to pull the object from the patient Positive test is inability to complete or hold this maneuver (patient will use Flexor Pollicis Longus to compensate)

Question 31

Medial Collateral Stress Test (Valgus)

Answer 31

Anterior band of the MCL tightens with 20-120o of flexion Anterior band of the MCL is lax in full extension Posterior band is taut in flexion beyond 55o

Question 32

Anterior band test:

Answer 32

Patient supine Flex elbow to 20-30o Apply valgus stress continuously

Question 33

Posterior band test:

Answer 33

Patient is seated with arm in shoulder flexion, elbow flexion beyond 55o and forearm supination Clinician pulls downward on the patient’s thumb Positive test is reproduction of the patient’s pain

Question 34

Lateral Pivot Shift Apprehension Test

Answer 34

Used in the diagnosis of posterolateral rotatory instability Patient supine with the involved UE overhead Clinician grasps the patient’s wrist and elbow Elbow is supinated with a mild force at the wrist, and a valgus moment and compressive force is applied to the elbow during flexion This results in an apprehension response

Question 35

Lateral Collateral Stress Test (Varus)

Answer 35

Patient supine with elbow positioned in 5-30o short of full extension Clinician stabilizes the humerus and adducts the ulna, producing a varus force at the elbow End-feel is noted

Question 36

Lateral Epicondylitis Test (Tennis Elbow; Cozen’s; Method 1)

Answer 36

Clinician stabilizes the patient’s elbow with one hand Patient is asked to pronate the forearm and extend/RD the wrist against resistance Positive test is reproduction of pain at the lateral epicondyle

Question 37

Lateral Epicondylitis Test (Tennis Elbow; Mill’s; Method 2)

Answer 37

Clinician palpates the patient’s lateral epicondyle with one hand Pronate the patient’s forearm while fully extending the wrist and elbow Positive test is reproduction of pain in the lateral epicondyle region

Question 38

Lateral Epicondylitis Test (Tennis Elbow; Maudsley; Method 3)

Answer 38

Patient is seated Using one hand, the clinician grasps the patient’s wrist Other hand resists third digit extension Positive test is reproduction of pain along the lateral epicondyle

Question 39

Medial Epicondylitis Test (Golfer’s Elbow)

Answer 39

Clinician palpates the medial epicondyle Clinician supinates the forearm and extends the wrist/elbow with the other hand Positive test is reproduction of pain along the medial epicondyle

Question 40

Elbow Flexion Test for Cubital Tunnel Syndrome

Answer 40

Patient in sitting or standing UEs in anatomic position Patient is asked to depress both shoulders, flex both elbows maximally and supinate the forearms and extend the wrists Maintain this position for 3-5 minutes Positive test is tingling or paresthesia in the ulnar distribution of the forearm and hand

Question 41

Pressure-Provocative Test for Cubital Tunnel Syndrome

Answer 41

Pressure is applied proximal to the cubital tunnel, with the elbow held in 20o of flexion and supinated Positive test is tingling or paresthesia in the ulnar distribution of the forearm and hand

Question 42

Percussion Test/Tinel’s Sign for Cubital Tunnel Syndrome

Answer 42

Clinician located the groove between the olecranon and the medial epicondyle This groove is tapped 4-6 times by the index finger of the clinician Positive test is indicated by a tingling sensation in the ulnar distribution distal to the tapping point

Question 43

Elbow Extension Test

Answer 43

Tests for elbow fracture Patient positioned supine and asked to extend the elbow Patient’s inability to fully extend the elbow is suspect for elbow fracture

Question 44

Moving Valgus Stress Test

Answer 44

Patient in sitting Clinician positions the patient’s shoulder in 90o of abduction and 120o of elbow flexion Clinician applies a modest valgus stress to the elbow until the shoulder reaches full ER While applying a constant valgus stress, the elbow is quickly extended to 30o Positive test for a chronic MCL tear of the elbow is the reproduction of medial elbow pain when forcibly extending the elbow from a flexed position between 120-70o

Question 45

Biceps Squeeze Test

Answer 45

Tests for rupture of distal biceps tendon Patient seated with the forearm resting in the patient’s lap Elbow flexed to approximately 60-80o; forearm in slight pronation Clinician squeezes the biceps firmly Positive test is loss of forearm supination

Question 46

Neer Impingement Test

Answer 46

Patient’s arm forcefully elevated through forward flexion Causes a “jamming’ of the greater tuberosity against the anteroinferior border of the acromion Positive test is pain Indicative of an overuse of the supraspinatus muscle and sometimes the biceps tendon

Question 47

Hawkins-Kennedy Impingement Test

Answer 47

Examiner flexes the patient’s arm to 90o (elbow at 90o) then forcefully medially rotates the shoulder This movement pushes the supraspinatus muscle and tendon against the anterior surface of the coracoacromial ligament and the coracoid process Positive test is pain

Question 48

Yocum Test

Answer 48

Patient seated and rests hand on opposite shoulder Elbow is lifted to shoulder height Positive test is pain Indicative of a subacromial impingement

Question 49

Painful Arc Test

Answer 49

Patient in standing and asked to actively abduct the involved shoulder Positive test is painful report with shoulder in the 70-120o range Indicative of subacromial impingement Pain at end range may indicate AC pathology

Question 50

Drop Arm Test

Answer 50

Clinician passively abducts the patient’s shoulder to 90o Clinician asks the patient to take the weight of the arm and slowly lower the arm to the side Positive test is indicated by inability to slowly lower the arm or severe pain when attempting to do so Positive test indicates a tear of the RC complex

Question 51

Empty Can Test

Answer 51

Patient’s shoulder is abducted to 90o in the scapular plane and placed in full IR (pts thumb should be pointing to the ground) Resistance to abduction is given while the clinician looks for weakness or pain Positive test is pain Positive test can indicate a supraspinatus tear or neuropathy of the supraspinatus nerve

Question 52

External Rotation Lag Sign

Answer 52

Patient is seated, elbow is passively flexed to 90o and shoulder is held at 20o elevation in the scapular plane near maximal ER Patient is then asked to actively hold that position of ER as the therapist releases the wrist (maintain support at elbow) Positive test is when a lag or angular drop occurs Clinician then asks the patient to actively hold the elbow The lag or angular drop is assessed Indicative of a tear of the supraspinatus and/or infraspinatus

Question 53

Lift Off Test

Answer 53

Patient stands and places the dorsum of the hand over the small of the back Clinician gives mild resistance with finger to the patient’s palm and asks the patient to lift hand away from the back Positive test is pain or inability to perform test Indicative of a subscapularis lesion

Question 54

Internal Rotation Lag Sign

Answer 54

Patient stands and places the dorsum of the hand over the small of the back Clinician lifts the patient’s arm off the back and asks the patient to maintain that position Positive test is pain and/or inability to maintain pre-placed position Positive test indicated a subscapularis tear

Question 55

Posterior Impingement Sign

Answer 55

Patient lies supine with shoulder placed at 90-110o of abduction and full ER Positive test is pain in the deep posterior shoulder Indicative of RC tear and/or posterior labral tear

Question 56

Hornblower’s Sign

Answer 56

Patient is seated or standing Arm is supported at 90o abduction in the scapular plane with elbow flexed to 90o Patient is asked to ER against resistance Positive test is the patient’s inability to ER against resistance and/or pain Hornblower’s sign is present if the patient cannot ER in stated position Indicative of Teres Minor pathology

Question 57

Speed’s Test

Answer 57

Patient standing with shoulder flexed to 80-90o, full ER and full elbow extension Clinician resists forward shoulder flexion Positive test is pain in the bicepital groove Indicative of biceps tendonitis May produce pain if a SLAP lesion is present In a severe 2nd or 3rd degree strain, profound weakness may be present More effective than Yergason’s Test because the bone moves over the tendon during Speed’s test

Question 58

Yergason’s Test

Answer 58

With patient’s elbow flexed to 90o, stabilized against the thorax and forearm pronated, the examiner resists supination while the patient also laterally rotates the arm against resistance Positive test is pain or tenderness in the bicepital groove Indicative of biceps tendonitis

Question 59

Clunk Test

Answer 59

Patient supine Clinician places one hand on posterior aspect of the shoulder over the humeral head Other hand holds the humerus above the elbow Clinician fully abducts the arm over the patient’s head Clinician then pushes anteriorly with the hand over the humeral head while the other hand rotates the humerus into lateral rotation Positive test is a clunk or grinding sound Indicative of a labral tear

Question 60

Crank Test

Answer 60

Patient supine Arm is elevated to 160o in the scapular plane and is positioned in maximal internal or external rotation Clinician applies an axial loading along the humerus Positive test is indicated by the reproduction of a painful click in the shoulder during the maneuver Indicative of a labral tear

Question 61

Jerk Test

Answer 61

Patient sitting Clinician standing to the side and slightly behind the patient Clinician grasps the patient’s elbow with one hand and the scapula with the other Positions the patient’s arm at 90o of abduction and IR Clinician provides an axial compression-based load to the humerus through the elbow while maintaining the horizontally abducted arm Axial loading compression is maintained while the patient’s arm is moved into horizontal adduction Positive test is indicated by sharp shoulder pain with or without a clunk or click Indicative of a posteroinferior labral tear

Question 62

O’Brien’s Test (aka Active Compression Test)

Answer 62

Patient stands with involved shoulder at 90o flexion, 10o of horizontal adduction and maximum IR (elbow extended) In this position, the patient resists a downward force by the clinician Patient is asked to report any pain as either “on top of the shoulder” (AC joint) or “inside the shoulder” (SLAP lesion) The test is repeated except with the arm in maximum ER Positive test for glenoid labral tear if the patient reports painful clicking or pain ‘inside the shoulder’ with IR, that is relieved by ER of the shoulder

Question 63

Anterior Slide Test

Answer 63

Patient sitting with arm to side Clinician stabilizes the scapula and clavicle with one hand Clinician then applies an anteriosuperior force at the elbow Positive test can be popping, snapping and/or pain Indicative of labral tear

Question 64

Compression Rotation Test

Answer 64

Patient supine and relaxed Clinician grasps arm and flexes elbow with arm abducted about 20o Clinician pushes and compresses the humerus in the glenoid while rotating the humerus medial and lateral Positive test can be snapping or catching Indicative of labral tear

Question 65

O’Brien’s Test

Answer 65

Patient stands with involved shoulder at 90o flexion, 10o of horizontal adduction and maximum IR (elbow extended) In this position, the patient resists a downward force by the clinician Patient is asked to report any pain as either “on top of the shoulder” (AC joint) or “inside the shoulder” (SLAP lesion) The test is repeated except with the arm in maximum ER Positive test for AC joint pathology if the patient reports pain ‘on top of the shoulder’

Question 66

Crossover Impingement/Horizontal Adduction Test

Answer 66

Patient sitting with arm at 90o of flexion Clinician passively moves the patient’s arm into horizontal adduction and applies overpressure Positive test if pain is reported in the AC joint

Question 67

Acromioclavicular Resisted Extension Test

Answer 67

Patient sitting with shoulder at 90o of elevation combined with IR and 90o of elbow flexion Patient is asked to horizontally abduct the arm against resistance Positive test if pain is reported in the AC joint

Question 68

Load and Shift

Answer 68

Patient seated, arm at side (Dutton’s shows supine) Gently load GH joint - anterior and posterior 25% anterior translation normal Grade I – up to 50% of humeral head translation with head riding up onto glenoid rim and spontaneous reduction Grade II – greater than 50% of humeral head translation with head riding over glenoid rim and spontaneous reduction Grade III – humeral head rides over glenoid rim and does not reduce spontaneously Posterior 50% of translation is normal thus one would expect greater laxity posterior than anterior in normal individual

Question 69

Apprehension Test

Answer 69

Patient supine with arm at 90o abduction and ER Clinician applies overpressure into ER Perform test slowly so you don’t dislocate the shoulder Watch patient’s face for apprehension signs Positive test is apprehension, not pain If painful anteriorly, this may be positive for anterior microsubluxation If painful posteriorly, this may be positive for internal impingement

Question 70

Jobe Subluxation/Relocation Test

Answer 70

Clinician places patient in position as described in the Apprehension test and stabilizes test position via grasping the patient’s elbow Clinician applies an anterior pull on the humerus Pain and apprehension from the patient indicate a positive test for labral tear or anterior instability (subluxation) Clinician then applies posterior force to shoulder through the humeral head (relocation) Test is positive if apprehension and/or pain are decreased

Question 71

Rockwood Test

Answer 71

Clinician behind seated patient ER the shoulder with arm abducted passively to 45o, 90o, and 120o Positive test is indicated when apprehension I noted Different positions are utilized because the stabilizers of the shoulder vary at differing angles of abduction and ER

Question 72

Sulcus Sign

Answer 72

Patient sits with arm at side Clinician grasps forearm below elbow and pulls arm distally The presence of sulcus sign demonstrates inferior instability Graded by measuring the inferior margin or acromion to the humeral head +1 sulcus implies distance of less than 1cm +2 sulcus implies distance of 1-2cm +3 sulcus implies distance of more than 2cm

Question 73

Feagin Test

Answer 73

Modification of the Sulcus Sign Patient’s arm abducted to 90o with elbow extended and resting on clinician’s shoulder Clinician’s hands clasped over the patient’s humerus, between the upper and middle thirds Clinician pushes humerus down and forward Positive test is apprehension This testing position puts more stress on the inferior GH ligament

Question 74

Load and Shift Test

Answer 74

Arm at side, relaxed, gently load anterior and posterior Grade I – up to 50% of humeral head translation with head riding up onto glenoid rim and spontaneous reduction Grade II – greater than 50% of humeral head translation with head riding over glenoid rim and spontaneous reduction Grade III – humeral head rides over glenoid rim and does not reduce spontaneously Posterior 50% of translation is normal thus one would expect greater laxity posterior than anterior in normal individual

Question 75

Posterior Apprehension or Stress Test

Answer 75

Patient supine Clinician flexes arm to 90o Clinician applies posteriorly directed force on patient’s elbow While applying axial load, the clinician horizontally adducts and IR the patient’s arm Positive test is apprehension or alarm on the patient’s face Can also be performed at 90o shoulder abduction Should be no greater than 50% of humeral head’s diameter of posterior translation