CHT EXAM: UPPER EXTREMITY
PROVOCATIVE TESTS
cervical compression - ANSWER-Procedure: Patient sitting. Gently push down on the
top of the head. May try with the head turned either direction. Not done with suspected
neck injury or severe RA or cervical DJD
Positive result: Replicates arm pain
Possible indications: DJD of C spine
Adson's test - ANSWER-Procedure: Locate radial pulse, abduct, extend and externally
rotate the shoulder while the patient turns the head either way and holds breath
Positive result: Decrease in radial pulse
Possible indications: Possible TOS
Ballottement test (similar to shear test) - ANSWER-Procedure: Stabilize lunate and try
to displace the triquetrum or scaphoid (can also be done with the capitate, hamate, and
scaphoid)
Positive results: Pain and clicking
Possible indications: Ligament tear
Sagittal band injury test - ANSWER-Procedure: Resist finger extension
Positive results: Pain in the futter between a metacarpal head
Possible indications: Possible sagittal band tear
Extrinsic tightness test - ANSWER-Procedure: Passive PIP flexion with the MCP in
flexion
Positive results: Resistance to PIP flexion (assuming no periarticular stiffness), stiffness
or resist
Possible indications: Extrinsic muscle tendon tightness
Subacromial tenderness - ANSWER-Procedure: Extend shoulder and deeply palpate
head of humerus
Positive result: Pain in subacromial space
Possible indications: Rotator cuff inflammation
PROVOCATIVE TESTS
cervical compression - ANSWER-Procedure: Patient sitting. Gently push down on the
top of the head. May try with the head turned either direction. Not done with suspected
neck injury or severe RA or cervical DJD
Positive result: Replicates arm pain
Possible indications: DJD of C spine
Adson's test - ANSWER-Procedure: Locate radial pulse, abduct, extend and externally
rotate the shoulder while the patient turns the head either way and holds breath
Positive result: Decrease in radial pulse
Possible indications: Possible TOS
Ballottement test (similar to shear test) - ANSWER-Procedure: Stabilize lunate and try
to displace the triquetrum or scaphoid (can also be done with the capitate, hamate, and
scaphoid)
Positive results: Pain and clicking
Possible indications: Ligament tear
Sagittal band injury test - ANSWER-Procedure: Resist finger extension
Positive results: Pain in the futter between a metacarpal head
Possible indications: Possible sagittal band tear
Extrinsic tightness test - ANSWER-Procedure: Passive PIP flexion with the MCP in
flexion
Positive results: Resistance to PIP flexion (assuming no periarticular stiffness), stiffness
or resist
Possible indications: Extrinsic muscle tendon tightness
Subacromial tenderness - ANSWER-Procedure: Extend shoulder and deeply palpate
head of humerus
Positive result: Pain in subacromial space
Possible indications: Rotator cuff inflammation