PIANO KEY SIGN

​• ​Test positioning

The client sits or stands with the involved limb relaxed at their side, facing the therapist.

​• ​Action

The therapist applies pressure to the client's distal clavicle in an inferior direction.

​• ​Positive finding

The therapist is able to use inferior pressure to depress the clavicle into its normal resting position and subsequently watch the clavicle elevate again once the pressure is removed.

This finding is indicative of the instability of the acromioclavicular joint on the
involved side.

​• ​Special considerations & comments

The therapist should always use a bilateral comparison when assessing the range of elevation and depression of the involved clavicle.

Significant clavicular elevation may also indicate coracoclavicular joint involvement.

The Piano Key Sign is attributed to the work of Dr. James Cyriax in orthopedic assessment and Dr. John C. Kennedy, whose contributions to understanding acromioclavicular joint pathology have been crucial.