NBCE Part 4 Boards Exam Questions
with Verified Answers
Apley's Scratch Test - ANSWER-Patient is seated and actively moves hand behind
head in attempt to touch the superior angle of the scapula. The patient then moves
hand behind back to touch the inferior angle of the same scapula.
Positive decreased ROM -> Degenerative tendonitis of the Rotator Cuff
Cowman's Drop Arm Test - ANSWER-The doctor passively abducts the patient's
arm to above 90 degrees and suddenly removes support. This will cause a firing of
the deltoid muscle.
Positive: Patient unable to maintain arm position -> supraspinatous tear
Apprehension Test - ANSWER-The doctor abducts and slowly externally rotates the
affected shoulder.
Positive: Patient shows signs of apprehension that the arm will re-injure -> Chronic
Shoulder Dislocation
Dugas' Test - ANSWER-The patient places the hand of the affected shoulder on the
opposite shoulder and attempts to touch the elbow to the chest.
Positive: unable to perform -> Shoulder Dislocation (Active & Acute)
Yergason's Test - ANSWER-The patient flexes their elbow to 90 degrees while
seated. The doctor palpates the biceps tendon and actively resists the patient's
attempt to actively supinate the hand and flex the elbow.
Positive: Audible click or snap in bicipital groove -> Bicipital Tendon Instability
Dawbarn's Sign - ANSWER-The doctor palpates the subacromial bursa and elicits
pain. The doctor passively abducts patient's shoulder without moving his/her fingers
off of the subacromial bursa.
Positive: Reduction of pain in second maneuver -> Subacromial Bursitis
Impingement Sign - ANSWER-The patient slightly abducts their arm and the doctor
passively moves their arm through a full flexion. This causes a jam of the greater
tuberosity against the lacrimal surface.
Positive: Pain -> Tendonitis (overuse of tendons)
Supraspinatus Press Test AKA - ANSWER-Empty Can Test
,Empty Can Test Performed - ANSWER-Patient abducts shoulders to 90degrees and
the doctor apple resistance. The patient flexes shoulders to 30 degrees and points
thumbs downward and resistance is applied again. (Hold & push the proximal
elbow).
Positive: Weakness -> Supraspinatus Tear
Speed's Test - ANSWER-Patient is seated with elbow slightly flexed and palm up.
The doctor resists the patient's attempt to flex shoulder while extending and
supinating the forearm.
Positive: Pain -> Bicipital Tendonitis
Subacromial Push Button Test - ANSWER-Doctor applies a deep pressure over the
subacromial bursa.
Postive: Pain -> Supraspinatus degeneration OR Subacromial bursitis
Passive Shoulder Approximation - ANSWER-Patient is standing and the doctor asks
patient to lift shoulders up and back (squeeze the shoulder blades together).
Positive: Pain in scapular region -> T1 or T2 Nerve Root problem on side of pain
Bryant's Test - ANSWER-Doctor observed patient standing and notes the heights of
axillary folds.
Positive: lower axillary fold on involved side -> Shoulder Dislocation
Brachial Plexus Tension Test - ANSWER-Patient is seated. Patient places both
hands behind his/her head and pulls elbows posteriorly.
Positive: Pain -> C5 Nerve Root Lesion and/or TOS
Lateral Epicondylitis AKA - ANSWER-Radiohumeral Bursitis
Radiohumeral Bursitis AKA - ANSWER-Tennis Elbow
Lateral Epicondylitis Affects - ANSWER-Extensor Carpi Radialis Brevis
Pain in extension of wrist and pronation of elbow (overhand swing)
Medial Epicondylitis AKA - ANSWER-Little Leaguer's Elbow
or
Golfer's Elbow
Medial Epicondylitis Affects - ANSWER-Flexor Carpi Ulnaris
Pain at elbow with flexion of the wrist
, Cozen's Test
(C6 Biker Chicks) - ANSWER-Patient's elbow is flexed to 90degrees with forearm
pronated and fist dorsiflexed. Doctor stabilizes patient's elbow and resists patient's
dorsiflexed wrist.
Postive: Pain in the lateral elbow-> Lateral Epicondylitis
Reverse Cozen - ANSWER-Same except arm is supinated and doctor pulled on
flexed wrist.
Positive: Pain in medial elbow->Medial Epicondylitis
Mill's Test - ANSWER-Doctor passively flexes patient's fingers, wrist, elbow and the
brings elbow around and into max pronation and extension.
Positive: Pain in Lateral Elbow -> Lateral Epicondylitis
Reverse Mill's - ANSWER-Patients hand is flat, patient flexes and doctor resists.
Postive: Pain in Medial Elbow -> Medial Epicondylitis
Tinel's Sign (wrist) - ANSWER-Percuss over the flexor retinaculum (anterior portion
of the wrist where a watch would sit) and the Tunnel of Guyon (most medial portion
of above)
Postive: Tingling in the lateral 3 fingers (Carpal Tunnel Syndrome) of medial two
fingers (Ulnar Impingement)
Phalen's Sign - ANSWER-The patient flexes writs maximally and holds position for
one minute, pushing hands together.
Positive: tingling into lateral 3 fingers of hand -> Carpal Tunnel Syndrome
Pinch Grip Test - ANSWER-Ask the patient to put the tip of their thumb to the tip of
their index finger.
Positive: if they put the pads of their thumb and forefinger together -> Ant.
Interosseous N. Syndrome -> Median N. Lesion
Froment's Paper Sign - ANSWER-Doctor places a piece of paper between the
patient's thumb and index finger (all other fingers too) and attempts to pull it out.
Positive: Cannot hold paper-> Ulnar N. Palsy
Finkelstein's Test - ANSWER-Patient makes a fist with thumb inside fist; then fist is
passively ulnar deviated.
with Verified Answers
Apley's Scratch Test - ANSWER-Patient is seated and actively moves hand behind
head in attempt to touch the superior angle of the scapula. The patient then moves
hand behind back to touch the inferior angle of the same scapula.
Positive decreased ROM -> Degenerative tendonitis of the Rotator Cuff
Cowman's Drop Arm Test - ANSWER-The doctor passively abducts the patient's
arm to above 90 degrees and suddenly removes support. This will cause a firing of
the deltoid muscle.
Positive: Patient unable to maintain arm position -> supraspinatous tear
Apprehension Test - ANSWER-The doctor abducts and slowly externally rotates the
affected shoulder.
Positive: Patient shows signs of apprehension that the arm will re-injure -> Chronic
Shoulder Dislocation
Dugas' Test - ANSWER-The patient places the hand of the affected shoulder on the
opposite shoulder and attempts to touch the elbow to the chest.
Positive: unable to perform -> Shoulder Dislocation (Active & Acute)
Yergason's Test - ANSWER-The patient flexes their elbow to 90 degrees while
seated. The doctor palpates the biceps tendon and actively resists the patient's
attempt to actively supinate the hand and flex the elbow.
Positive: Audible click or snap in bicipital groove -> Bicipital Tendon Instability
Dawbarn's Sign - ANSWER-The doctor palpates the subacromial bursa and elicits
pain. The doctor passively abducts patient's shoulder without moving his/her fingers
off of the subacromial bursa.
Positive: Reduction of pain in second maneuver -> Subacromial Bursitis
Impingement Sign - ANSWER-The patient slightly abducts their arm and the doctor
passively moves their arm through a full flexion. This causes a jam of the greater
tuberosity against the lacrimal surface.
Positive: Pain -> Tendonitis (overuse of tendons)
Supraspinatus Press Test AKA - ANSWER-Empty Can Test
,Empty Can Test Performed - ANSWER-Patient abducts shoulders to 90degrees and
the doctor apple resistance. The patient flexes shoulders to 30 degrees and points
thumbs downward and resistance is applied again. (Hold & push the proximal
elbow).
Positive: Weakness -> Supraspinatus Tear
Speed's Test - ANSWER-Patient is seated with elbow slightly flexed and palm up.
The doctor resists the patient's attempt to flex shoulder while extending and
supinating the forearm.
Positive: Pain -> Bicipital Tendonitis
Subacromial Push Button Test - ANSWER-Doctor applies a deep pressure over the
subacromial bursa.
Postive: Pain -> Supraspinatus degeneration OR Subacromial bursitis
Passive Shoulder Approximation - ANSWER-Patient is standing and the doctor asks
patient to lift shoulders up and back (squeeze the shoulder blades together).
Positive: Pain in scapular region -> T1 or T2 Nerve Root problem on side of pain
Bryant's Test - ANSWER-Doctor observed patient standing and notes the heights of
axillary folds.
Positive: lower axillary fold on involved side -> Shoulder Dislocation
Brachial Plexus Tension Test - ANSWER-Patient is seated. Patient places both
hands behind his/her head and pulls elbows posteriorly.
Positive: Pain -> C5 Nerve Root Lesion and/or TOS
Lateral Epicondylitis AKA - ANSWER-Radiohumeral Bursitis
Radiohumeral Bursitis AKA - ANSWER-Tennis Elbow
Lateral Epicondylitis Affects - ANSWER-Extensor Carpi Radialis Brevis
Pain in extension of wrist and pronation of elbow (overhand swing)
Medial Epicondylitis AKA - ANSWER-Little Leaguer's Elbow
or
Golfer's Elbow
Medial Epicondylitis Affects - ANSWER-Flexor Carpi Ulnaris
Pain at elbow with flexion of the wrist
, Cozen's Test
(C6 Biker Chicks) - ANSWER-Patient's elbow is flexed to 90degrees with forearm
pronated and fist dorsiflexed. Doctor stabilizes patient's elbow and resists patient's
dorsiflexed wrist.
Postive: Pain in the lateral elbow-> Lateral Epicondylitis
Reverse Cozen - ANSWER-Same except arm is supinated and doctor pulled on
flexed wrist.
Positive: Pain in medial elbow->Medial Epicondylitis
Mill's Test - ANSWER-Doctor passively flexes patient's fingers, wrist, elbow and the
brings elbow around and into max pronation and extension.
Positive: Pain in Lateral Elbow -> Lateral Epicondylitis
Reverse Mill's - ANSWER-Patients hand is flat, patient flexes and doctor resists.
Postive: Pain in Medial Elbow -> Medial Epicondylitis
Tinel's Sign (wrist) - ANSWER-Percuss over the flexor retinaculum (anterior portion
of the wrist where a watch would sit) and the Tunnel of Guyon (most medial portion
of above)
Postive: Tingling in the lateral 3 fingers (Carpal Tunnel Syndrome) of medial two
fingers (Ulnar Impingement)
Phalen's Sign - ANSWER-The patient flexes writs maximally and holds position for
one minute, pushing hands together.
Positive: tingling into lateral 3 fingers of hand -> Carpal Tunnel Syndrome
Pinch Grip Test - ANSWER-Ask the patient to put the tip of their thumb to the tip of
their index finger.
Positive: if they put the pads of their thumb and forefinger together -> Ant.
Interosseous N. Syndrome -> Median N. Lesion
Froment's Paper Sign - ANSWER-Doctor places a piece of paper between the
patient's thumb and index finger (all other fingers too) and attempts to pull it out.
Positive: Cannot hold paper-> Ulnar N. Palsy
Finkelstein's Test - ANSWER-Patient makes a fist with thumb inside fist; then fist is
passively ulnar deviated.
