Loaded Tests, Special Tests and When to Scan the Sporting Upper Limb

Ian keeps history as the starting point, sorting traumatic, overuse and sinister causes, and asks clinicians to look for the obvious on observation. He then keeps his hands off and uses loaded tests. Qualitative versions include pushing through the knuckles on the plinth, push-ups and wall push-offs, and sport-specific movements with added speed or weight. Quantitative versions use a hand grip or handheld dynamometer, isokinetic testing, added dumbbell weight, a bathroom scale for weight bearing, pain ratings and range of motion forced to end range and measured with a phone inclinometer. Comparing grip deficits with pain helps grade an injury and track change, for example a 60% deficit with 8/10 pain improving within 48 hours, which can change the decision to scan. No single special test confirms a diagnosis, so tests such as the Watson scaphoid shift or elbow valgus and varus stress are used for the reaction they provoke and done last, since palpation can bias other findings. Scans suit suspected scaphoid fractures, major elbow trauma and some SLAP cases.