Flashcards in Shoulder Deck (6)
Inferior Sulcus Test
The Sulcus Test is used to assess the glenohumeral joint for inferior instability, due to laxity of the superior glenohumeral ligament and coracohumeral ligament.
The test is considered positive when a sulcus sign is seen when the examiner applies a downward force applied at the elbow while the arm in neutral rotation and resting at the patient's side. A sulcus is defined as a depression greater than a fingerbreadth between the lateral acromion and the head of the humerus.
The Yergason's Test is used to test for biceps tendon pathology, such as bicipital tendonitis.
The patient should be seated or standing, with the humerus in neutral position and the elbow in 90 degrees of flexion. The patient is asked to externally rotate and supinate their arm against the manual resistance of the therapist. Yergason's Test is considered positive if pain is reproduced in the bicipital groove during the test.
Load and Shift
This test is used to assess the stability of the Glenohumeral joint.
The patient should be seated. The therapist stabilizes the scapula to the thorax with one hand, while the other hand is placed across the posterior GH joint line and humeral head, and the web space across the patient's acromion. The index finger should the over the anterior GH joint line. The clinician should now apply a "load and shift" of the humeral head across the stabilized scapula in an anteromedial direction to assess anterior stability, and in a posterolateral direction to assess posterior instability. Normal motion anteriorly is half of the distance of the humeral head, more movement is considered to be a sign of GH joint laxity.
Test Item Cluster: If found positive, the Apprehension test is often combined with the Jobes Relocation test.
The Apprehension test is generally used to test the integrity of the glenohumeral joint capsule, or to assess glenohumeral instability in an anterior direction.
The patient should be position in supine. The therapist will flex the patient's elbow to 90 degrees and abducts the patient's shoulder to 90 degrees, maintaining neutral rotation. The examiner then slowly applies an external rotation force to the arm to 90 degrees while carefully monitoring the patient. Patient apprehension from this maneuver, not pain, is considered a positive test. Pain with the maneuver, but not apprehension may indicate a pathology other than instability, such as posterior impingement of the rotator cuff.
Jobes Relocation Test
The purpose of the Jobes Relocation Test is to test for anterior instability of the glenohumeral joint.
This test is extremely similar in nature to the Apprehension test, and is often administered after the Apprehension test produces a positive result. The patient is positioned supine, with the elbow flexed to 90 degrees and abducted to 90 degrees. The therapist then applies an external rotation force to the shoulder, if the patient reports apprehension in any way, the apprehension test is considered to be positive. At this point, the therapist may apply a posteriorly directed force to the shoulder - if the patient's apprehension or pain is reduced in this position, the Jobes Relocation test is considered to be positive. It is important to note that the therapist should always release the relocation force before releasing the patient back into neutral rotation for risk of shoulder dislocation.