SECTION III: ORTHOPEDIC TESTS FOR THE ARM, ELBOW, AND WRIST
Speed’s test This tests for tendonitis of the biceps brachii muscle. The client can be seated or standing. The client fully extends their arm and supinates their forearm so that the palm of their hand is facing the floor. The client is then asked to flex their elbow to 90 degrees while the therapist stands behind the client and resists the client’s attempt at flexion. Golfer’s elbow test This tests for medial epicondylitis of the humerus. The client should be seated with their arm over a therapy table with their fingers flexed into a fist. The therapist should sit across from the client and support their elbow with one hand while maintaining a grip on the client’s wrist and hand with their other. The therapist then passively supinates the client’s forearm while extending the elbow, wrist, and fingers. A Tennis elbow test This tests for lateral epicondylitis of the humerus. The client may be seated or standing and should flex their elbow to 90 degrees with their palm face down. Their fingers should be flexed into a fist. The therapist palpates the lateral epicondyle with one hand while maintaining a grip on the back of the client’s hand. The therapist first resists the client’s attempt to place their wrist in extension and second, then resists the client moving their wrist into radial Flick test This tests for carpal tunnel syndrome. This simple test involves the therapist asking the client what they do when they feel carpal tunnel syndrome symptoms (i.e., tingling, numbness, burning, and/or pain in the palm, thumb, index, and/or middle fingers). If the client flicks their wrist, this Phalen’s test This tests for carpal tunnel syndrome. With their arms in front of them, the client is asked to place the back of their hands together and, keeping them together, raise their elbows so that the shoulder is at 90 degrees of flexion. Carpal tunnel syndrome is indicated if symptoms such as numbness, tingling, burning, and/or pain emerge in the client’s wrists or first three finger as they maintain this position. The therapist can proceed with light myofascial release of the flexors of the wrist before addressing hypertonicity in the forearm with other techniques (Manske & Magee, 2018).
Tendonitis of the bicep brachii is indicated by pain at either the muscle’s origins near the shoulder or insertions near the anterior elbow. Cross-fiber friction on the tendons may be helpful, as well as directional massage and/or myofascial release along the length of the muscle (Manske & Magee, 2018). positive result is indicated by pain or discomfort in the area of the medial epicondyle. Cross-fiber friction at the medial epicondyle is an effective treatment. In cases where hypertonicity of the wrist flexors is also present, directional massage, myofascial release, and trigger point therapy are also effective (Manske & Magee, 2018). deviation. A positive result is indicated by pain or discomfort in the area of the lateral epicondyle during either of these movements, or during the movements simultaneously. Cross-fiber friction at the lateral epicondyle is an effective treatment. In cases where hypertonicity of the wrist extensors is also present, directional massage, myofascial release, and trigger point therapy are also effective (Manske & Magee, 2018). is considered a positive indicator of the pathology. The therapist should start with light myofascial release of the flexors of the wrist before addressing hypertonicity in the forearm with other techniques (Manske & Magee, 2018). Healthcare Consideration: Carpal tunnel syndrome may be caused by multiple factors, particularly due to inflammation of the flexor retinaculum which is itself often caused by hypertonic flexors of the wrist and/ or compression of the wrist on hard surfaces over long periods of time. As always, icing for inflammation may be a treatment option. In the event that manual therapy does not relieve the symptoms of carpal tunnel syndrome, a client should consult a physician for alternative treatment options (Manske & Magee, 2018).
SECTION IV: ORTHOPEDIC TESTS FOR THE SPINE AND TRUNK
Functional versus structural scoliosis test This tests for whether the cause of scoliosis is functional/ muscular or structural/skeletal in nature. The client stands with their shirt removed. The therapist stands behind the client and observes the client’s spine and its curvature. The client bends their trunk into lateral flexion on the side of their spine the spine is curving toward, then returns to the neutral position. Then the client flexes their trunk forward. Functional scoliosis is indicated if the spinal curvature corrects itself when the client laterally flexes their trunk or if the curvature reverses when the client flexes their trunk Scoliosis short leg test This tests for uneven leg length that may be causing functional scoliosis. The client should be standing. The therapist is in front of the client noting the position of the bilateral hips and shoulders to see if there is any tilting due to scoliosis. The therapist places a thin book under the foot of the suspected shorter leg, which itself may be indicated
forward. Structural scoliosis is indicated if the curvature does not correct itself during either action. In either case, the therapist can treat hypertonic muscles on either side of the spine with directional massage, myofascial release, or trigger point therapy, but the client’s long-term relief can only be expected if the client’s scoliosis is functional in nature. It is outside most manual therapists’ scope of practice to attempt structural corrections (Hendrickson, 2020). by either an inferiorly situated hip or shoulder. A positive result is indicated if the curvature disappears after the book is placed under the shorter leg’s foot. Hypertonic muscles of the lower back and hips should be addressed with directional massage, PNF stretches, myofascial release, and/ or trigger point therapy (Hendrickson, 2020).
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