Shoulder special tests

Question 1

How to reduce translation with Load and Shift

Answer 1

Supine 60 degrees; applying LR with anterior translation should cause anterior band of Inferior GH ligament to tighten, thus reducing amount of translation
Same with MR for posterior band with posterior tranlsation

Question 2

Hawkin’s Grades of Joint Laxity

Answer 2

Normal: 0-25% translation
Grade I: 25-50% humeral head riding up to glenoid rim
Grade II: > 50 % humeral head riding over rim, but spontaneously reducing
Grade III: > 50% humeral head riding over and remaining dislocated

Question 3

Sulcus SIgn

Answer 3

Tests inferior instability (coracohumeral and superior glenohumeral ligaments)
+1: 1cm translation
+2: 1-2 cm
+3: > 2 cm translation

Question 4

Feagin Test

Answer 4

Sulcus test in 90 degrees abduction (inferior glenohumeral ligament)
If both sulcus and feagin are +, this is a greater indication for multidirectional instability vs laxity

Question 5

Best probability of RTC full thickness tear versus impingement

Answer 5

RTC: painful arc, drop arm test and infraspinatus test
Impingement: painful arc, H-K, infraspinatus test

Question 6

Neer Test

Answer 6

Impingement; full elevation and MR passively
Tests long head of biceps/supraspinatus
If pain with ER, check AC joint (acromioclavicular differentiation test)

Question 7

Hawkin’s Kennedy

Answer 7

90 degrees abduction and IR

Pushes supraspinatus tendon over anterior surface of coracoacromial ligament and coracoid process

Question 8

Posterior Internal Impingement Test

Answer 8

Supine ER/abduction 90 degrees with 15 degrees HAD

• Found in OH athletes
• Occurs with RTC impinging against posteriorsuperior glenoid or greater tuberosity

Question 9

Differentiate between External and Internal impingement based on IR resistance strength test

Answer 9

Follow up to Neer test
Arm abduction 90 degrees with 80 degrees LR
Strong MR, Weak LR = external impingement
Strong LR, Weak MR = internal impingement

Question 10

Synder Classification of Labral Tears

Answer 10

Type I: degenerative fraying of labrum
Type II: detachment of superior labrum/biceps from glenoid rim
Type III: bucket handle tear of superior labrum; biceps attached
Type IV: bucket handle tear of labrum that extends to biceps tendon

Question 11

SLAP tear

Answer 11

superior labrum, anterior to posterior, including biceps (10:00-2:00)
superior glenohumeral ligament

Question 12

Bankhart

Answer 12

Avulsion of anterioinferior labrum due to anterior dislocation (3:00-7:00)
Anterior band of inferior glenohumeral ligament

Question 13

Hills-Sachs leision

Answer 13

compression fracture of posterior humeral head; associated with anterior inferior dislocation
ER can cause locking with this dislocation

Question 14

Active compression test of O’Brien

Answer 14

Type II SLAP tear; 90 degrees FF, HAD 15 degrees with MR

If pain occurs with MR and not with LR +

Question 15

Kim test

Answer 15

Posteroinferior labral lesion (esp inferior)
Seated arm abducted to 90 degrees with elbow flexed 90 degrees; axial compression applied
arm elevated diagonally while other hand applied a downward and backwards force

Question 16

Biceps load test

Answer 16

Superior labrum; supine shoulder abducted 120 degrees with LR; elbow flexed to 90 degrees and forearm supination; flex elbow against resistance; + pain = SLAP

Question 17

Jerk Test

Answer 17

Posterior labrum; axial force applied to arm in 90 degrees abduction and IR; patient’s arm is HAD with keeping the load

Question 18

Posterior Inferior Glenohumeral Ligament Test

Answer 18

seated arm flexed 90 degrees; HAD 40 degrees with MR

Positive if humerus protrudes or pain occurs

Question 19

Ligamentous Testing: Crank Test

Answer 19

arm at side = superior GH ligament
45-60 abduction = middle and inferior (anterior band) GH ligament; coracohumeral ligament and anterior capsule
>90 degrees abd: inferior glenohumeral ligament and anterior capsule

Question 20

Coracoclavicular Ligament

Answer 20

sidelying on unaffected side with hand behind back; pulling inferior angle of scapula away while stabilizing clavicle tests conoid ligament
Pulling medial border away tests trapezoid portion of ligament

Question 21

ULTT I

Answer 21

shoulder depression
110 degrees abduction
elbow extended
supination
wrist extension
finger extension
SB contralateral
median nerve, anterior interosseous C5-7

Question 22

ULTT II

Answer 22

shoulder depression
10 degrees abduction 
elbow extended
supination
wrist extension
finger extension
LR shoulder
SB contralateral
Median, musculocutaneous, axillary nerve

Question 23

ULTT III

Answer 23

shoulder depression
10 degrees of abduction
elbow extension
pronation of forearm
flexion and ulnar deviation of wrist
MR of shoulder
SB contralateral
Radial nerve

Question 24

ULTT IV

Answer 24

depression and abduction 10-90 degrees (hand to ear)
flexion of elbow
supination of forearm
extension and radial deviation of wrist
extension of fingers/thumb
LR of shoulder
SB contralateral
ulnar nerve C8-T1