Special Tests

Question 1

Froments sign

Answer 1

test for palsy of the ulnar nerve which results in reduced functionality and muscle weakness of the pinch grip. It tests the strength of the adductor pollicus of the thumb

patient is asked to make a strong pinch between the thumb and index finger and grip a flat object such as a piece of paper between the thumb and index finger. The examiner then attempts to pull the object out of the subject’s hands[3]. There is weakness of the adductor pollicus innervated by the ulnar nerve which would keep the IP joint relatively straight; instead, the FPL muscle which is innervated by the median nerve is substituted for the AP and will cause the IP joint to go into a hyperflexed position.

The flexor pollicis longus (innervated by the median nerve), will substitute for the adductor pollicis (innervated by the ulnar nerve) and cause the thumb to go into hyperflexion. Ulnar nerve palsy can be as a result of dysfunction at the cervical spine, elbow (cubital tunnel syndrome) or at the wrist (Guyons canal syndrome).

Question 2

Piano keys test

Answer 2

positive result is indicative of dysfunction of TFCC or distal radioulnar joint instability

• position: arm resting on table in pronation, therapist stabilize radius and wrist joint, depress ulnar head/styloid process
• positive test: pain, excessive movement

Question 3

Phalen test

Answer 3

• position: patient hold max wrist flexion
• purpose: Carpal tunnel compression
• positive: numbness and tingling, nerve symptoms

Question 4

Carpal compression test

Answer 4

• purpose: carpal tunnel syndrome
• position: arm in supination, therapist applies pressure with thumbs over the median nerve within the carpal tunnel, just distal to the wrist crease. hold 30 seconds
• positive: symptoms numbness and tingling in median n. distribution within 30 seconds.
• record: time of onset of symptoms.

Question 5

cervical compression test

Answer 5

• aka spurling test, Maximal Cervical Compression Test, Foraminal Compression Test
• purpose: cervical nerve root compression causing radiculopathy, stress the ability of the neck to tolerate passive loading; it is not a test of muscle strength.
• position: patient hold head in lateral flexion, therapist link hands and apply downward axial compression
• positive: pain down ipsi arm

Question 6

craniocervical flexion test or the deep neck flexor endurance test

Answer 6

Tests longus colli and longus capitis deep neck flexors

Question 7

apley scratch test

Answer 7

• purpose: assess shoulder range of motion, abduction and external rotation (attempting to scratch back)
• position: patient sitting, patient reach behind the head and other arm reach up behind back
• record: based on superior arm, if able to touch, if not where do fingertips stop (eg. R arm reaches to T4, L arm reaches to T7 inferior border scapula, etc)