The Tests
Tap each card to reveal the full breakdown.
Rotator cuff muscles and tear site
Posterior shoulder: infraspinatus, teres minor
Brachial plexus: roots, trunks, divisions, cords, branches
Cervical vertebra: labeled anatomy
Extensor compartments: 1st = APL + EPB (de Quervain)
Spurling Test
Cervical
Tests For
Cervical radiculopathy (nerve root compression)
How To Perform
Extend the neck, sidebend toward the symptomatic side, then apply axial compression (push down on the head).
Positive Finding
Reproduces radicular pain down the arm in the affected dermatome.
Three moves in sequence: extend, sidebend, compress. You're shrinking the neural foramen to see if the nerve screams.
Adson Test
TOS
Tests For
Thoracic Outlet Syndrome via anterior scaleneThe anterior scalene runs from the transverse processes of C3-C6 to the first rib. The subclavian artery and brachial plexus pass between the anterior and middle scalenes. compression.
How To Perform
Turn head TOWARD the affected side, extend the neck, deep breath in. Palpate the radial pulse throughout.
Positive Finding
Diminished or absent radial pulse on the affected side.
Adson = "Add-toward." Head turns TOWARD. The scalene tightens and pinches the subclavian artery against the first rib.
Wright Test
TOS
Tests For
Thoracic Outlet Syndrome via pectoralis minorPec minor attaches to ribs 3-5 and the coracoid process. The neurovascular bundle passes deep to it. Hyperabduction stretches the bundle over the muscle. compression.
How To Perform
Hyperabduct the arm overhead (full abduction past 90 degrees). Palpate the radial pulse.
Positive Finding
Diminished or absent radial pulse.
Wright = "Right up." Arm goes straight up. Pec minor catches the neurovascular bundle like a clothesline.
Wallenberg Test
Cervical
Tests For
Vertebral artery insufficiency. A safety screening test.
How To Perform
Extend and rotate the cervical spine. Hold for several seconds.
Positive Finding
Dizziness, nystagmus, visual changes (the 5 D's and 3 N's).
CRITICAL: this test must be performed BEFORE cervical HVLA. A positive Wallenberg = absolute contraindication to cervical thrust. You could cause a stroke.
Finkelstein Test
Wrist
Tests For
De Quervain tenosynovitis (inflammation of the APL and EPBAbductor Pollicis Longus and Extensor Pollicis Brevis. These two tendons share the first dorsal compartment of the wrist. They pass over the radial styloid. tendons).
How To Perform
Tuck the thumb into a closed fist, then ulnar deviate the wrist.
Positive Finding
Sharp pain over the radial styloid.
New mother with wrist pain from holding the baby = De Quervain. Finkelstein confirms it. The fist + ulnar deviation stretches the inflamed tendons over the radial styloid like a bowstring.
Finkelstein Test
Fist + Ulnar Deviation
APL + EPB Tendons
Apley Scratch Test
Shoulder
Tests For
Rotator cuff ROM: evaluates multiple cuff muscles in two motions.
How To Perform
Hand behind head (external rotation + abduction) tests supraspinatus and infraspinatus. Hand behind back (internal rotation + adduction) tests subscapularis.
Positive Finding
Inability to reach or pain during either motion indicates the corresponding cuff muscle is compromised.
The only test on this list that's TWO motions in one. Hand UP behind head = external rotators. Hand DOWN behind back = internal rotator (subscapularis).
Speed Test
Shoulder
Tests For
Biceps tendon pathology (tendinitis, SLAP lesion).
How To Perform
Patient performs resisted forward flexion with the elbow fully extended and forearm supinated.
Positive Finding
Pain in the bicipital groove (anterior shoulder).
Speed = Straight arm. Elbow extended, forearm supinated, push up against resistance. The long head of biceps is loaded at its groove.
Yergason Test
Shoulder
Tests For
Biceps tendon pathology (same target as Speed, different maneuver).
How To Perform
Elbow flexed at 90 degrees. Patient attempts resisted supination of the forearm.
Positive Finding
Pain in the bicipital groove.
Yergason = Yer-turn-yer-palm-up. Elbow bent at 90, resist supination. Both Speed and Yergason target the bicipital groove, but Speed uses flexion and Yergason uses supination.
Tests by Region
Grouped by where on the body you're testing.
Cervical
Shoulder · Upper Extremity
Wrist · Hand
Two cervical tests, two completely different goals. Spurling asks: "Is there nerve root compression?" Wallenberg asks: "Is it safe to manipulate this neck?"
Spurling Test
Target: Cervical radiculopathy (herniated disc, foraminal stenosis)
Maneuver: Extend + sidebend toward symptomatic side + axial load. This narrows the neural foramenThe opening between adjacent vertebrae where the spinal nerve root exits. Disc herniation or osteophytes can narrow this space and compress the nerve..
Positive: Reproduces the patient's radicular symptoms (pain, numbness, or tingling radiating into the arm).
Wallenberg Test
Target: Vertebral artery insufficiency (safety screen)
Maneuver: Extend + rotate the cervical spine. Hold position. This kinks the vertebral arteryRuns through the transverse foramina of C1-C6. Extension + rotation can compress it against bone, reducing posterior circulation to the brainstem and cerebellum..
Positive: Dizziness, nystagmus, visual disturbances, drop attacks, dysarthria. ANY positive sign = do NOT perform cervical HVLA.
Board trap: Spurling sidebends TOWARD the affected side (closing the foramen). A question might try to trick you with "away from" the symptomatic side. Wallenberg is a prerequisite for HVLA: always test BEFORE you thrust.
Five tests in this region. Two for TOS (Adson, Wright), one for rotator cuff ROM (Apley Scratch), and two for biceps tendon (Speed, Yergason).
Adson Test
Target: TOS via anterior scalene compression
Maneuver: Head TOWARD the affected side + extend neck + deep breath. The anterior scalene contracts, compressing the subclavian artery against the first rib.
Positive: Diminished radial pulse on the tested side.
Wright Test (Hyperabduction)
Target: TOS via pectoralis minor compression
Maneuver: Arm hyperabducted overhead past 90 degrees. The neurovascular bundle stretches over the pec minor tendon at the coracoid.
Positive: Diminished radial pulse.
Apley Scratch Test
Target: Rotator cuff ROM (supraspinatus, infraspinatus, subscapularis)
Maneuver: Two parts. (1) Hand behind head: external rotation + abduction. (2) Hand behind back: internal rotation + adduction.
Positive: Inability or pain with either motion. Behind-head = external rotators (supraspinatus, infraspinatus). Behind-back = internal rotator (subscapularis).
Speed Test
Target: Biceps tendon pathology
Maneuver: Resisted forward flexion, elbow extended, forearm supinated.
Positive: Pain in the bicipital groove (anterior shoulder).
Yergason Test
Target: Biceps tendon pathology
Maneuver: Resisted supination with elbow at 90 degrees.
Positive: Pain in the bicipital groove.
Speed vs. Yergason: Both target the bicipital groove, but the arm positions are different. Speed = straight arm, resist flexion. Yergason = bent elbow, resist supination. On boards, the maneuver description tells you which test they mean.
One test here, but it's a board favorite. The classic presentation is a new mother with radial-sided wrist pain.
Finkelstein Test
Target: De Quervain tenosynovitis (first dorsal compartment: APL + EPB tendons)
Maneuver: Thumb tucked inside a closed fist, then ulnar deviate the wrist. This stretches the APL and EPB tendons over the radial styloid.
Positive: Sharp pain over the radial styloid process.
Classic stem: "A 28-year-old woman with a 3-month-old infant presents with wrist pain worse with gripping." The repetitive thumb abduction from holding the baby inflames the first dorsal compartment. Finkelstein confirms.
Elimination Game
Read the vignette. Reveal clues one at a time. Eliminate tests that don't fit.
A 42-year-old guitar player presents with numbness and tingling in the right hand. She reports the symptoms are worst when she sleeps with her arm above her head. On exam, you notice her symptoms reproduce when you position her arm in a specific way while monitoring her pulse.
Spurling Test
Adson Test
Wright Test
Finkelstein Test
Speed Test
Clue 1: The symptoms involve the hand, not the neck. The patient doesn't have neck pain or radicular symptoms. This rules out cervical radiculopathy.
Clue 2: The symptoms reproduce when the arm is overhead. The exam involves monitoring the radial pulse. This is a vascular compression test.
Clue 3: Symptoms worst with arm above head = the structure being compressed is under the pectoralis minor, not the anterior scalene. Adson tests the scalene (head turn), not overhead positioning.
Clue 4: Finkelstein tests wrist tendons (De Quervain). Speed tests biceps tendon. Neither involves pulse monitoring. Both eliminated.
Wright Test (Hyperabduction). The arm-overhead position compresses the neurovascular bundle under pectoralis minor. The guitarist's habit of sleeping with arms overhead reproduces TOS symptoms. Diminished radial pulse with hyperabduction confirms pec minor compression.
A 55-year-old man with chronic neck pain is scheduled for osteopathic manipulation. Before performing cervical HVLA, you need to complete a safety screen. You position the patient's head in a specific way and observe for neurological signs.
Spurling Test
Wallenberg Test
Adson Test
Yergason Test
Apley Scratch
Clue 1: This is a SAFETY screen before HVLA. That word "safety" narrows it immediately. Only one test on this list is specifically a pre-HVLA safety test.
Clue 2: You're watching for neurological signs (dizziness, nystagmus, visual changes). Not radicular pain, not pulse changes, not tendon pain.
Clue 3: Yergason and Apley Scratch test shoulder structures. They have nothing to do with cervical safety screening. Eliminated.
Clue 4: Adson tests TOS (pulse monitoring). Spurling tests nerve root compression. Neither is a pre-manipulation safety screen for vertebral artery compromise.
Wallenberg Test. Extend + rotate the cervical spine and watch for dizziness, nystagmus, or visual changes. A positive Wallenberg = the vertebral artery is being compromised = absolute contraindication to cervical HVLA. You could cause a vertebrobasilar stroke.
Board-Style Walkthrough
Full vignettes with clue highlights. Pick your answer, then walk through every option.
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