Shoulder Special Tests

Question 1

Hawkins-Kennedy test

Answer 1

Purpose: shoulder impingement
Patient position: seated
Therapist position: standing in front of patient
Procedure:
• Passively bring patient’s shoulder to 90 degrees of shoulder flexion with elbow bent, internally rotate the shoulder to end range
• May be performed in various degrees of forward flexion and horizontal adduction
Positive test: Reproduces their pain

Question 2

Neers test

Answer 2

Purpose: shoulder impingement
Patient position: seated
Therapist position: standing in front of patient
Procedure:
• Passively bring patient’s shoulder into full IR then passively flex their shoulder to end range
Positive test: Reproduces their pain

Question 3

Painful Arc sign

Answer 3

Purpose: shoulder impingement – supraspinatus tendonitis
Patient position: seated or standing
Therapist position: standing in front of patient
Procedure:
• Patient actively abducts their shoulder
Positive test: Reproduces their pain between 60 and 120 degrees but feels less painful below ~60 and above ~120

Question 4

Empty Can test

Answer 4

Purpose: supraspinatus involvement (same as test for rotator cuff tear)(could be tendonitis or tear)
Patient position: seated
Therapist position: standing in front of patient
Procedure:
• Patient’s arm placed in internal rotation and 90 degrees of scaption (~30 degrees horizontal adduction)
• Physical therapist applies resistance at (forearm) patient resists
Positive test: Reproduces their pain and/or weakness present

Question 5

Cross-body adduction test

Answer 5

Purpose: shoulder impingement/AC joint dysfunction
Patient position: seated
Therapist position: standing in front of patient
Procedure:
• Patient’s arm is elevated to 90 degrees of shoulder flexion
• Clinician horizontally adducts the patient’s arm to end range
Positive test: Reproduces their pain

Question 6

Scapular Assistance test

Answer 6

Purpose: shoulder impingement /scapular dyskinesia
Patient position: seated or standing
Therapist position: standing behind patient
Procedure:
• Patient actively elevates arm to reproduce symptoms, patient rates pain with activity (PAIN MUST BE REPRODUCED WITH ARM ELEVATION TO PERFORM THIS TEST)
• Therapist places one hand on medial inferior border of scapula, when patient is asked to elevate their arm again, therapist applies an upward rotation force
• With the other hand, apply a posterior tilt at the superior border to correct for insufficient posterior tilting
• Patient performs aggravating arm elevation with therapist assisting the scapula
Positive test: Reduction and/or elimination in pain with therapist assisting the scapula

Question 7

Scapular Repositioning test

Answer 7

Purpose: shoulder impingement
Patient position: seated or standing
Therapist position: standing behind patient
Procedure:
• Patient actively elevates arm to reproduce symptoms, patient rates pain with activity (PAIN MUST BE REPRODUCED WITH ARM ELEVATION TO PERFORM THIS TEST)
• Therapist grasps scapula with fingers contact AC joint anteriorly
• Therapist’s palm and thenar eminence contact the spine of the scapula on posterior side
• Therapist’s forearm should be angled toward inferior angle of the scapula for additional support on medial border
• Apply moderate force to encourage scapular posterior tilt
• Patient performs aggravating arm elevation with therapist assisting the scapula
Positive test: Reduction and/or elimination in pain with therapist assisting the scapula

Question 8

Drop arm test

Answer 8

Purpose: rotator cuff tear – large
Patient position: seated Therapist position: standing in front of patient
Procedure:
• Arm passively abducted to 120 degrees
• Patient instructed to slowly bring arm down to side; **guard patient’s arm from falling in case it gives way
Positive test: patient unable to lower arm slowly and in controlled manner down to side

Question 9

ER lag sign

Answer 9

Purpose: rotator cuff tear (biasing teres minor and/or infraspinatus)
Patient position: seated or standing
Therapist position: standing in front of patient
Procedure:
• Elbow in 90 degrees flexion, shoulder in 20 degrees abduction
• Arm passively externally rotated to end range
• Patient instructed to keep arm in that position
Positive test: patient unable to keep arm externally rotated when hand/arm released by therapist

Question 10

Infraspinatus muscle test

Answer 10

Purpose: rotator cuff tear (biasing teres minor and/or infraspinatus)
Patient position: seated or standing
Therapist position: standing in front of patient
Procedure:
• Resist external rotation with elbow at 90 degrees flexion, arm adducted by side, and forearm in neutral – stabilize the opposite shoulder
Positive test: patient gives way

Question 11

Hornblowers sign

Answer 11

Purpose: rotator cuff tear (biasing teres minor and/or infraspinatus)
Patient position: seated or standing
Therapist position: standing behind patient
Procedure:
• Passively elevate arm to 90 degrees in scapular plane and elbow flexed to 90 degrees
• Patient externally rotates shoulder against resistance – she should move through range of motion
Positive test: unable to laterally rotate arm

Question 12

IR lag sign

Answer 12

Purpose: rotator cuff tear (biasing subscapularis)
Patient position: seated or standing
Therapist position: standing behind patient
Procedure:
• Passively bring patient’s arm behind their back and to end range full internal rotation
• Patient instructed to keep arm in that position
Positive test: unable to maintain position when arm/hand released by therapist

Question 13

Belly press test

Answer 13

Purpose: rotator cuff tear (biasing subscapularis)
Patient position: seated
Therapist position: standing in front of patient
Procedure:
• Patient’s hand placed on their stomach
• Patient presses hand into their stomach
Positive test: Reproduces their pain and/or inability to IR; substitution may result in UE elevation or wrist flexion
 tears >50% are often required to produce a + test

Question 14

Lift off test

Answer 14

Purpose: rotator cuff tear (biasing subscapularis)
Patient position: seated
Therapist position: standing in front of patient
Procedure:
• Patient’s hand placed in curve of lower back
• Patient attempts to lift hand off of lower back
Positive test: Unable to lift hand off lower back

Question 15

Empty can test

Answer 15

Purpose: rotator cuff tear (biasing supraspinatus) (same as test for impingement)
Patient position: seated
Therapist position: standing in front of patient
Procedure:
• Patient’s arm placed in internal rotation and 90 degrees of scaption (~30 degrees horizontal adduction)
• Physical therapist applies resistance at patient resists
Positive test: Reproduces their pain and/or weakness present

Question 16

Anterior apprehension test

Answer 16

Purpose: Glenohumeral anterior joint instability/ labral involvment
Pt Position: supine with shoulder in 90 degrees abduction
Examiner Position: standing beside patient
Procedure:
• Slowly externally rotate shoulder towards end range
Positive Test: patient looks or feels apprehensive or alarmed and resists further motion, or reproduces their pain

Question 17

Relocation test

Answer 17

Purpose: Glenohumeral anterior joint instability/ labral involvement
Pt Position: supine with shoulder in 90 degrees abduction (same as apprehension test
Examiner Position: standing beside patient
Procedure:
• Slowly externally rotate shoulder towards end range (same as apprehension test
• If apprehension test is positive, perform posterior glide to humeral head
Positive Test: patient’s pain or apprehension is decreased with posterior glide
 Relocation test typically does not change pain if pathology is shoulder impingement

Question 18

Jerk test

Answer 18

Purpose: determine if there is laxity biasing posterior joint
Patient position: seated, shoulder flexed to 90 degrees and internally rotated
Therapist position: standing behind patient
Procedure:
• Axially load humerus and horizontally adduct arm
Positive test: sudden jerk of clunk as humeral head subluxed posteriorly

Question 19

Sulcus sign

Answer 19

Purpose: determine if there is laxity biasing inferior joint
Patient position: seated
Therapist position: standing behind patient
Procedure:
• Grasp elbow and pull down (inferior traction force)
Positive test: Presence of sulcus inferior to acromion, combined with reproduction of symptoms

Question 20

O’briens test (active compression test)

Answer 20

Purpose: labral test
Patient position: seated or standing
Therapist position: standing in front of patient
Procedure:
• Patient’s arm placed in 90 degrees shoulder flexion, 10-15 degrees horizontal adduction, end range internal rotation
• Resistance applied at wrist in downward direction
• Patient’s arm then placed in 90 degrees shoulder flexion, 10-15 degrees horizontal adduction, end range external rotation
• Resistance applied at wrist in downward direction
Positive test: Their pain reproduced more when resistance applied with shoulder in IR than when arm in ER, or click reproduced

Question 21

Biceps load II test

Answer 21

Purpose: labral test
Patient position: supine
Therapist position: standing at head of mat
Procedure:
• Patient’s arm placed 120 degrees of shoulder abduction, 90 degrees elbow flexion, supinated forearm
• Resistance of elbow flexion applied at wrist
Positive test: Their pain reproduced or click reproduced

Question 22

Anterior slide test

Answer 22

Purpose: labral test
Patient position: seated
Therapist position: standing behind patient
Procedure:
• Patient’s hand placed on their waist, thumbs pointing posteriorly
• Therapist stabilizes scapula and then applies a anterior-superior force at the elbow
Positive test: Their pain reproduced or click reproduced

Question 23

Compression-rotation test

Answer 23

Purpose: labral test
Patient position: supine
Therapist position: standing next to patient
Procedure:
• Patient’s arm passively abducted to 20-90 degrees
• Axial compression applied while passively circumducting the glenohumeral joint
• Continue with this compression and circumduction as move through the 20-90 degrees of abduction
Positive test: Their pain reproduced or click reproduced

Question 24

Yergason’s test

Answer 24

Purpose: tests for integrity of transverse ligament, bicipital tendonosis/tendinopathy, and/or SLAP lesions
Patient position: seated
Therapist position: standing in front of patient
Procedure:
• Patient’s arm placed in 90 degrees elbow flexion, with shoulder in neutral stabilized against their body, forearm fully pronated
• Therapist resists patient as they attempt to move into supination while externally rotating their shoulder
Positive test: Their pain indicates either labral lesion or biceps tendon issue; if long head of biceps “pops out” of the groove indicates issue with transverse ligament

Question 25

Speeds test

Answer 25

Purpose: tests for bicipital tendonosis/tendinopathy, and/or SLAP lesions
Patient position: seated or standing
Therapist position: standing in front of patient
Procedure:
• Patient with upper limb by side and forearm supinated they attempt to move it into shoulder flexion against resistance provided by the therapist
• Alternative testing: Patient’s shoulder placed in 90 degrees shoulder flexion with forearm supinated. Therapist pushed arm down into extension stressing the biceps eccentrically
Positive test: Their pain in anterior shoulder

Question 26

AC joint Palpation

Answer 26

Purpose: AC joint involvement
Patient position: seated
Therapist position: standing in front of patient
Procedure:
• Therapist palpates patient’s AC joint line
Positive test: Reproduces their pain

Question 27

AC resisted extension test

Answer 27

Purpose: shoulder impingement (same test as for impingement)
Patient position: seated
Therapist position: standing behind patient
Procedure:
• Patient’s arm is elevated to 90 degrees of shoulder flexion with IR, elbow flexed to 90 degrees
• Clinician resists shoulder horizontal abduction
Positive test: Reproduces their pain at AC joint

Question 28

Olecranon-manubrium percussion test

Answer 28

Purpose: fracture/ dislocation between elbow & manubrium
Pt Position: sitting or standing with arms crossing chest
Examiner Position: standing beside patient/ facing patient
Procedure:
• Examiner percusses olecranon process while auscultating the manubrium
• First step repeated on non-involved UE
Positive Test: Difference in sound quality between tested sides, indicates x-ray required to confirm diagnosis

Question 29

Popeye sign

Answer 29

Purpose: determine if there is rupture of long head of biceps
Patient position: seated or standing
Therapist position: standing in front of patient
Procedure:
• Patient attempts to actively flex elbow
Positive test: distal bunching of muscle