Practical 1 - Special Tests (indications & (+) )

Question 1

anterior apprehension test

Answer 1

suspicion of ant shoulder subluxation or dislocation

(+) signs of apprehension or alarm on face

Question 2

Jobe subluxation - relocation test

Answer 2

indicated if (+) ant apprehension test

(+) dec pain and inc ER
- confirm ant instability and findings in apprehension test

Question 3

load and shift test

Answer 3

traumatic instability of GH joint (ant and post instability tested)

(+) reproduciton of sx
(+) excessive translation
- anterior shift: can grade the laxity 1-3

Question 4

anterior drawer test

Answer 4

inc or dec translation of HOH to gleniod

(+) pain, clicking, or inc/dec in HOH translation

Question 5

posterior apprehension test

Answer 5

test post GH laxity and/or post labrum

(+) reproduced sense of apprehension and inc ms guarding to prevent post shoulder dislocation

Question 6

Feagin test

Answer 6

“inferior drawer test”, test instability anteroinferiorly

(+) inerior movement
(+) apprehension or discomfort

Question 7

sulcus test

Answer 7

pt presents w inferior instability of GH

(+ sulcus sign) depression greater than a fingerbreadth bw lateral acromion and HOH
(+) reproduce sx

Question 8

active compression (O’Briens) test

Answer 8

labral tear identification and AC joint abnormalities

(+) pain or painful clicking in first position and absent in second position
(+ labral involvement) deep pain
(+ AC joint implicated) pain on top of shoulder

Question 9

biceps load 1 and 2

Answer 9

SLAP testing

(+) pain, clicking or popping
(+) apprehension unchanged or more painful
(+ SLAP lesion) deep pain during contraction

Question 10

crank test

Answer 10

SLAP testing, good for identifying bucket handle (Type III and IV SLAPs)

(+) reproducing painful sx w ER, clicking and grinding may also be present

Question 11

anterior slide test

Answer 11

SLAP testing

(+) pain localized to anterosuperior aspect of shoulder
(+) pop or click in anterosuperior region
(+) reproduces sx

Question 12

speed’s test

Answer 12

bicipital involvement like tenopathy

(+) pain along biceps tendon
- d/t SLAP
- d/t inflammation of bicep tendon

Question 13

yergason’s test

Answer 13

check ability of transverse humeral ligament to hold biceps in groove

(+) pain in bicipital groove
- if tendon displaced can indicate tear of transverse humeral ligament

Question 14

neer test

Answer 14

impingement of rotator cuff on anterosuperior glenoid rim or coracoacromial ligament

(+)pain at end range of available ROM

Question 15

hawkins kennedy test

Answer 15

should impingement, rotator cuff involvement, and subacromial bursitis

(+) reproduction of ant shoulder pain in subacromial space
- more medial position of humerus = RC tendons impinged at coracoacromial arch/process

Question 16

crossover test

Answer 16

identify AC joint dysfunction/sprain and possible impingement of RC under AC joint

(+) pain reproduced in AC region

Question 17

empty can test (jobe test)

Answer 17

determine integrity of supraspinatus tendon, partial or complete rupture of tendon
- will be more comfortable for impingement people than full can and less likely to result in ms weakness d/t pain provocation

(+ partial rupture) weak and painful test
(+ complete rupture) weak and painless test

Question 18

full can test

Answer 18

alternate to empty can
integrity of supraspinatus tendon

(+) inc shoulder pain
(+) inc shoulder ms weakness
(+) inc both shoulder pain and ms weakness

Question 19

lift-off test (gerber’s test)

Answer 19

assess subscap ms
induce pain secondary to subacromial impingement syndrome

(+) inability to lift dorsum of hand off back

Question 20

belly press test

Answer 20

alternative to lift off tst
assess subscap ms

(+ subscap tear) elbow dropping behind body into ext

Question 21

internal rotation lag sign

Answer 21

assess integrity of subscap tendon

(+ subscap tendon rupture) pt can’t hold position on their own

Question 22

patte test (hornblowers sign)

Answer 22

evaluate integrity of teres minor ms

(+) pt can’t externally rotate shoulder in this position

Question 23

drop arm test

Answer 23

test integrity of supraspinatus ms
test for complete tear of rotator cuff

(+) pt unable to slowly and smoothly lower his arm all the way down to side
- indicates complete rotator cuff tear

Question 24

external rotation lag sign and dropping sign

Answer 24

assess integrity of infraspinatus and supraspinatus tendons

(+ lag) pt inability to maintain arm near full ER
- may indicate a supra/infra tear
(+ drop) inability to maintain the position and arm drops to neutral position of shoulder rotation

Question 25

ROOS test (east test)

Answer 25

assess thoracic outlet syndrome

(+) reproduced sx of pain, numbness, heaviness, tingling, and fatigue in <3min

Question 26

adson’s test

Answer 26

r/o neuro-vasculature compressions d/t abnormalities of scalene ms and/or cervical ribs

(+) pulse diminishes or disappears
(+) paresthesias induced

Question 27

costoclavicular manuever (military test)

Answer 27

suspicion of thoracic outlet compromised causing compression of subclavian artery & brachial plexus where pass thru clavicle and 1st rib (dec volume of costoclavicular space)

(+) diminished pulse or paresthesia

Question 28

wright’s test (hyper-ABD test)

Answer 28

determine if TOS compression is occurring as result of pec minor tightness/impingement

(+) diminished radial pulse and/or paresthesia

Question 29

elbow flexion test

Answer 29

cubital tunnel syndrome and ulnar n. entrapment
- pain/numbness on 4th/5th digits
- difficulty separating fingers
- dec or loss of ability to grip, atrophy, and contracture

(+) tingling, numbness or tingling along ulnar n. distribution

Question 30

pressure provocation test

Answer 30

cubital tunnel syndrome and ulnar n. entrapment
- pain/numbness on 4th/5th digits
- difficulty separating fingers
- dec or loss of ability to grip, atrophy, and contracture

(+) reproduction of sx along ulnar n. distribution

Question 31

tinel’s test

Answer 31

progression of pressure provocation test
cubital tunnel syndrome and ulnar n. entrapment
- pain/numbness on 4th/5th digits
- difficulty separating fingers
- dec or loss of ability to grip, atrophy, and contracture

(+) tingling sensation in ulnar distribution, indicating ulna n. irritation

Question 32

Cozen’s test

Answer 32

lateral epicondylalgia

(+) pain produced w provocation test
- usually secondary to inflammation/irritation of wrist extensors d/t overuse
(+ ECRL tendon irritation) pain above lat epicondyle
(+ ECRB origin irritation) pain localized to lateral epicondyle

Question 33

mill’s test

Answer 33

lateral epicondylalgia

(+) pain in lateral epicondyle of elbow

Question 34

maudsley test

Answer 34

lateral epicondylalgia
testing more for extensor digitorum communis

(+) reproduction of pain/sx at lateral epicondyle region

Question 35

golfer’s elbow test

Answer 35

tenderness and/or pain slightly distal and ant to medial epicondyle
pain worsens w resisted wrist flex
pain worsens w passive stretch of wrist ext/sup

(+) pain in region of medial epicondyle

Question 36

valgus stress test

Answer 36

testing MCL - specifically anterior band
checking for laxity/instability

(+) reproduction of pain and inc space at elbow

Question 37

milking maneuver test

Answer 37

testing MCL - specifically posterior band
checking for laxity/instability

(+) reproduction of pain and inc space at elbow w valgus stress

Question 38

moving valgus stress test

Answer 38

testing MCL
checking for laxity/instability
OH athlete not getting (+) tests w valgus stress test and milking maneuver

(+ chronic MCL tear) reproduction of medial elbow pain bw 120-70deg

Question 39

varus stress test

Answer 39

testing LCL
checking for laxity/instability

(+) reproduction of pain and inc space at elbow w valgus stress