shoulder special tests Flashcards
apley scratch test
purpose: ROM (abduction, flexion, external rotation, pronation, adduction, extension, internal rotation and supination)
Pt. pos: standing
prac. pos.: behind pt.
procedure: pt. is asked to touch both hands together behind the back with one arm going over the shoulder and the other arm under the shoulder
positive: asymmetry
spring test (SC)
purpose: sterno-clavicular joint (anterior and posterior sc ligaments, costo-clavicular lig. and inter clavicle lig.)
Pt. pos: standing
prac. pos.: in front of pt. 2-3 fingers placed on proximal clavicle
procedure: prac. pushes clavicle posteriorly and inferiorly. done several repetitions and performed bilaterally
positive: excessive movement of proximal clavicle as it springs back into place
spring test (AC)
purpose: acromio-clavicular ligament (superior and inferior acromio-clavicular ligament, conoid and trapezoid portion of CC ligament)
Pt. pos: standing
prac. pos.: in front of pt. 2-3 fingers on distal clavicle
procedure: push distal clavicle inferiorly. done several repetition and performed bilaterally
positive: excessive movement of distal clavicle
AC/ SC compression test or crossover test
purpose: check sc or ac joints or clavicle fracture
Pt. pos: seated or standing, affected arm brought across the body and rests on the opposite shoulder
prac. pos.: in front of pt., hand on the pt.s affected elbow
procedure: push elbow to opposite shoulder
positive: pain in either the AC or SC joint or clavicle
AC shear test
purpose: check AC joint (superior and inferior ac lig., conoid and trapezoid portion of CC lig)
Pt. pos: standing or sitting
prac. pos.: in front of pt. interlaced fingers are placed over the spine of the scapula and mid-clavicle
procedure: prac. squeezes scapula and mid clavicle
positive: excessive movement of the distal clavicle; pain
traction
purpose: check AC joint (& associated ligaments), stability of the inferior glenohumeral joint
Pt. pos: standing with arms at the side
prac. pos.: standing in front of pt. grasping pt.’s wrists
procedure: prac. pulls uniformly down on each arm and looking for step up or sulcus sign
positive: step off of AC joint and pain AND/OR sulcus sign seen on superior, anterior shoulder and pain and instability
apprehension (crank) test
GOLD STANDARD FOR SHOULDER INSTABILITY
purpose: anterior/ inferior shoulder instability
Pt. pos: can be standing or lying supine
prac. pos.: standing: in front of Pt. with one hand on wrist and other on elbow, bring arm into external rotation. Supine: one hand can be placed on mid forearm with thumb up the forearm and one hand pushing gh joint back to push the humerus back into place
procedure: move the humerus into abduction and external rotation, look for facial expression
positive: facial expression that indicate pain, pt. feels instability or apprehension with ROM
relocation (fowler or Jobe or surprise) test
purpose: confirmation of a positive apprehension test
Pt. pos: supine, arm abducted and external rotated
prac. pos.: to the side of pt. one hand on wrist and the other on the anterior shoulder
procedure: once an uncomfortable or painful ROM in apprehension, prac. places the palm of hand over the anterior shoulder while maintaining the abducted and externally rotated position, the hand can be pushed down and releases to discern pain levels
positive: a relief of pain levels with pressure or release of pressure on anterior GH
adson
purpose: Thoracic outlet syndrome
Pt. pos: sitting
prac. pos.: standing behind pt.
procedure: prac. feels for radial pulse, externally rotate and extends the shoulders. pt. is instructed to look towards the effected Side and hold breath for 10-15 sec.
positive: reduced or diminished pulse
allen’s (wright’s) test
purpose: thoracic outlet syndrome
Pt. pos: sitting
prac. pos.: behind pt.
procedure: prac. finds radial pulse and abducts and externally rotates (90 90). pt. is then instructed to look away from the affected side (for Wright’s test= take arm into hyperabduction and check for pulse)
positive: reduced or diminished radial pulse
speeds
purpose: tendinitis of long head of the biceps
Pt. pos: standing with arms at 90 degrees of forward flexion and supination
prac. pos.: facing pt. with one hand on the bicipital groove and the other hand on the distal wrist
procedure: pt instructed to hold at 90 degrees while the prac. provides resistance into flexion
positive: pain and/or inability to complete the maneuver, or crepitus at the biceps tendon
Yergason’s
purpose: bicipital tendonitis, or rupture of the transverse humeral ligament
Pt. pos: sitting, elbow straight, internally rotated and pronated
prac. pos.: next to pt. one hand on the bicipital groove and other hand on the distal wrist
procedure: pt. instructed to move from an internally rotated and pronated position to external rotation and supination against resistance. start in pronation and extension then resist against supination and elbow flexion
positive: pain in bicipital groove, long head of the biceps moving out of the bicipital groove, weakness
empty can
purpose: isolated contraction of the supraspinatus muscle
Pt. pos: standing with arms raised to 90 degrees, horizontal abducted to 45 degrees and pronated (thumb down)
prac. pos.: in front of pt. one hand stabilizing shoulder and the other on the distal wrist
procedure: pt is instructed to resist downward movement through the motion of the scaption. perform with both arms at the same time
positive: pain, inability to complete maneuver
impingement
purpose: impingement, pinching long head of biceps tendon, supraspinatus, and sub-acromial bursa under coracoaromial ligament
Pt. pos: standing
prac. pos.: in front of pt. one hand on distal wrist and one hand supporting arm at the elbow
procedure: arm is take into forced abduction and external rotation
positive: anterior shoulder pain
painful arc
purpose: shoulder impingement
Pt. pos: standing with arms held at sides
prac. pos.: in front of pt. slight resistance may be placed on pt. wrists as needed
procedure: the pt. is instructed to move through full ROM in abduction from the hands at the side to fully overhead
positive: only pain in ROM from 45-120 degrees.