shoulder special tests

Question 1

apley scratch test

Answer 1

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

Question 2

spring test (SC)

Answer 2

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

Question 3

spring test (AC)

Answer 3

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

Question 4

AC/ SC compression test or crossover test

Answer 4

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

Question 5

AC shear test

Answer 5

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

Question 6

traction

Answer 6

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

Question 7

apprehension (crank) test

Answer 7

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

Question 8

relocation (fowler or Jobe or surprise) test

Answer 8

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

Question 9

adson

Answer 9

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

Question 10

allen’s (wright’s) test

Answer 10

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

Question 11

speeds

Answer 11

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

Question 12

Yergason’s

Answer 12

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

Question 13

empty can

Answer 13

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

Question 14

impingement

Answer 14

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

Question 15

painful arc

Answer 15

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.

Question 16

clunk

Answer 16

purpose: tear of glenoid labrum

Pt. pos: supine with arm flexed fully overhead

prac. pos.: standing at head of pt. with both hands under and grasping the head of the humerus

procedure: push arm straight in towards the body and lift humerus straight up towards the ceiling.

positive: clunking, clicking, catching

Question 17

drop arm

Answer 17

purpose: tear of the rotator cuff musculature

Pt. pos: standing with arms abducted to 90 degrees

prac. pos.: standing in font of pt., hands may be placed on pt.s wrist as necessary

procedure: pt. is instructed to slowly lower arms. prac. may add resistance pushing arms down

positive: pain, an inability to slowly lower arms, sudden dropping of one arm

Question 18

hawkins- Kennedy impingement

Answer 18

GOLD STANDARD FOR SHOULDER IMPINGEMENT

purpose: shoulder impingement

Pt. pos: standing with shoulder flexed to 90 degrees and internally rotated

prac. pos.: standing in front of pt. one hand supporting the elbow and the other on the distal forearm

procedure: downward pressure is applied on the wrist, while other Hand remains stationary

positive: pain, facial expression, apprehension

Question 19

neer impingement

Answer 19

purpose: shoulder impingement

Pt. pos: standing

prac. pos.: standing next to pt. one hand stabilizing the scapular region and the other hand placed on distal wrist

procedure: shoulder is taken into full flexion and the practitioner applies a slight overpressure. pressure to scapula forward

positive: pain

Question 20

pectorals major contracture

Answer 20

purpose: tightness through pectorals major muscle

Pt. pos: lying on back with fingers laced behind head

prac. pos.: standing at head of pt. with hands on elbows if needed

procedure: pt. is instructed to allow the elbows to relax and try to touch the table; pressure by the prac. may be performed to check end feels

positive: inability to move elbows closer to the table

Question 21

Military brace position (eden test)

Answer 21

purpose: costo-clavicular syndrome

pt. pos: standing with arms to the side and supinated

prac. pos: standing behind pt. with fingers on radial pulse and the other hand on the clavicle

procedure: redial pulse is palpated and the shoulder is drawn down and back with slight traction. hand over from scapula to clavicle squeezes while other hand is palpating radial pulse

positive: decreased or diminished pulse

Question 22

anterior/ posterior drawer test

Answer 22

purpose: posterior shoulder instability

pt. pos: sitting relaxed with forearm RESTING on thigh

prac. pos: next to pt. one hand stabilizing hand on spine of scapula and clavicle and the other hand over the head of the humerus

procedure: head of humerus is moved anterior and posteriorly while other hand stabilizes

positive: excessive movement at GH joint and or pain

Question 23

Load and Shift

Answer 23

purpose: Labral tears

pt. pos: sitting, relaxed, forearm relaxed on thigh

prac. pos: next to pt. one hand stabilizing of scapula and clavicle and other hand over the head of the humerus

procedure: same procedure as anterior/ posterior drawer + pressure applied on humerus towards the joint

positive: pain, clicking, and/or catching

Question 24

Rowe test

Answer 24

purpose: GH instability (ligaments structures)

pt. pos: supine with hands behind the head

prac. pos: balled fist under posterior head of humerus and other hand on top of bent elbow

procedure: downward pressure is applied at the elbow towards the table

positive: pain, anterior instability

Question 25

posterior apprehension (humeral shear or posterior glide)

Answer 25

purpose: posterior shoulder instability

pt. pos: supine, forward flexion to 90 degrees elbow bent to 90 degrees

prac. pos: standing next to pt., one hand on pt. elbow

procedure: humerus is pushed posteriorly straight back

positive: pain, excessive glide of humerus, apprehension

Question 26

Liu Crank

Answer 26

purpose: Labral tear

pt. pos: supine arm abducted to 160 degrees with 30 degrees of horz. adduction

prac. pos: standing next to pt. hand on pt. elbow

procedure: humerus is pushed back posteriorly and the arm is taken into internal and external rotation

positive: pain, clicking, apprehension, especially with external rotation

Question 27

bear hug

Answer 27

purpose: subscapularis weakness or neuro deficit

pt. pos: standing, arm resting of opposite shoulder with the shoulder flexed to 90 degrees

prac. pos: put hand under pt. hand that is one opposite shoulder. standing in front of pt.

procedure: pt is instructed to maintain the position and push down on the opposite shoulder

positive: pain and/or inability to push down

Question 28

lift off sign (belly lift off)

Answer 28

purpose: subscapularis weakness or neruo deficit

pt. pos: standing arm internally rotated and resting on low back

prac. pos: behind pt. with one hand on the mid humerus and other hand on the distal wrist

procedure: slight resistance may be applied by the prac. as the pt. attempts to lift the hand off the low back

positive: pain and/or inability to raise hand

Question 29

feagin (inferior drawer)

Answer 29

purpose: shoulder instability (inferior middle and superior gh ligaments)

pt. pos: standing with arm abducted to 90 degrees or flexion to 90 degrees

prac. pos: shoulder abduction: standing next to pt. with both hands on top of head of humerus OR shoulder flexion: standing in front of pt. with both hands on top of humerus

procedure: with both hands on top of humerus head, a downward force is applied

positive: instability of the GH joint and/or anterior sulcus and/or pain

Question 30

Roos

Answer 30

purpose: thoracic outlet syndrome

pt. pos: abducted and externally rotated arms (90 90 field goal position) with hands open

prac. pos: next to pt.

procedure: pt is instructed to open and close hands for 3 minutes

positive: decrease in motor function of the hand, loss of sensation, inability to maintain test position

Question 31

O’brien’s

Answer 31

purpose: SLAP lesion

pt. pos: sitting or standing, shoulder flexion to 90 degrees, full horz. adduction and full internal rotation

prac. pos: in front of pt. one hand on the elbow and other on the distal wrist

procedure: pt is instructed to resist against the downward force of the prac. The test is repeated wit external rotation. have pt go from opposite asis to opposite shoulder

positive: pain and/or popping that is alleviated with the external rotation component

Question 32

shoulder scouring

Answer 32

purpose: instability of the GH joint, labral tears

pt. pos: sidling, arm abducted to 90 degrees

prac. pos: standing behind pt., pt arm is resting on prac. elbow/ forearm. one hand on lateral joint line on the proximal humerus, the other hand stabilizing the scapula posteriorly

procedure: anterior and inferior and posterior and superior forces are placed on the humerus, feeling for instability or clicking or popping

positive: clicking or popping (labrum); instability or apprehension (ligamentous instability)

Question 33

SLAP series

Answer 33

purpose: slap lesion, particularly from the bicipital pull on the superior labrum

pt. pos: supine with arm hanging off the table. pt. abducts arm to 120 degrees, shoulder rotation neutral, pronated and elbow flexed to 65-70 degrees

prac. pos: standing next to pt. one hand is stabilizing the upper arm mid humerus while the other grasps the pt. wrist

procedure: the pt is instructed to spinate the hand against maximal resistance while the pt. moves the shoulder into full abduction and external rotation (1). the elbow is then flexed against maximal resistance (2)

positive: clicking or popping, pain deep in the GH joint with resisted actions of supination (1) or elbow flexion (2)

predictability/ percentage: 81-96%