Shoulder Special Tests: Instability, Labrum, Biceps

Question 1

When would you use an apprehension test?

Answer 1

suspicion of anterior shoulder subluxation or dislocation, primarily for traumatic shoulder instability

Question 2

What is the position of the pt for apprehension?

Answer 2

supine, PT passively moves pts shoulder in abduction and ER

Question 3

What is a positive result on the apprehension?

Answer 3

if patient shows apprehension or alarm on their face

if there is pain with no apprehension then likely subacromial impingement

Question 4

How is a Jobe subluxation-relocation test performed?

Answer 4

Start apprehension test. If apprehension starts apply a posterior force and see if pain reduces or more ER

Question 5

When is an anterior Load and Shift test indicated?

Answer 5

designed to test primarily a traumatic instability problems of GH joint

Question 6

What structures are implicated during an anterior load and shift?

Answer 6

anterior capsule, superior glenohumeral ligament

Question 7

How is load and shift examine performed?

Answer 7

pt sits with no back support in upright posture for prime scapula position

Question 8

What position is PT in for load and shift?

Answer 8

stabilizing slap while standing behind patient, after grabbing head of humerus PT must load HOH into glenoid to set as normal then shift HOH either anterior/medial or posterior/lateral

Question 9

What are results of anterior load and shift?

Answer 9

if HOH is loaded properly than there will be likely more movement anterior and little posterior, however if MD instability both directions could be hyper-mobile, however comparison on both arms and pts symptoms are more important than actual movement

Question 10

What is the anterior drawer test used for?

Answer 10

used in assessment of increased or decreased translation of the HH relative to glenoid, used if patient is unable to perform apprehension test

Question 11

What are three areas test for anterior drawer?

Answer 11

0 abd- superior GHL
45 abd- Middle GHL
90 abd- anterior band of inferior GHL

Question 12

What is a positive anterior drawer test?

Answer 12

if there is pain, clicking, or increase or decrease in humeral head translation

Question 13

What is important to remember about using a posterior or anterior load and shift?

Answer 13

laxity alone does not prove instability, must consider symptoms, apprehension and pt history

Question 14

How is a posterior drawer performed?

Answer 14

pt lies in supine, flexes eblow to 120, shoulder abd. at 80-120 and 20-30of shoulder flexion

Question 15

What structures are implicated during a posterior drawer?

Answer 15

posterior band of inferior GHL and posterior capsule

Question 16

When is a Feagin test indicated?

Answer 16

when it is suspected that pt has shoulder instability anteroinferiorly

Question 17

How is Feagin performed?

Answer 17

patient sits on exam table with shoulder abducted elbow in full extension and arm resting on PT shoulder

Question 18

What structures are involved in Feagin test?

Answer 18

superior GHL

Question 19

When is a Sulcus test indicated?

Answer 19

needs to be evaluated with pt with presented inferior instability

Question 20

What structures are involved in Sulcus sign?

Answer 20

superior GHL and coracohumeral ligaments

Question 21

What are grades of Sulcus test?

Answer 21

0- no laxity all the way to 3- maximum laxity

Question 22

When is an active compression or O’Brien’s test used?

Answer 22

if suspected labral tear or AC jt involvement

Question 23

What is procedure for O’Brien’s?

Answer 23

pt is put into 90 degrees of flexion , elbow extended and arm ADD 10-15 degrees and IR thumb facing down, ask pt to resist downward pressure, if pain ask where then ER shoulder and give resistance again

Question 24

What are results of O’Brien’s?

Answer 24

test is considered positive for superior labral tear if pain in IR but not ER and pain is deep

Question 25

When are Bicep Load tests performed?

Answer 25

suspected labral tear done at 90 or 120 degrees of abduction

Question 26

What is procedure of Bicep load?

Answer 26

supine and put into same position as apprehension test, go until apprehension and then have patient perform resisted bicep curl

Question 27

What are results of Bicep load?

Answer 27

considered positive if apprehension is unchanged or becomes more painful

deep pain with shoulder during contraction in indicative of a SLAP

Question 28

What is a Crank test?

Answer 28

testing for Bankart lesion

Question 29

What is procedure for Crank test?

Answer 29

pt supine arm elevated to 160 degrees in scapular plane then apply a compression through the elbow in line with humerus then rotate in ER/IR and watch for apprehension

Question 30

What are results of Crank?

Answer 30

pain with ER could mean labrum trapped in joint indicated type 3 or 4 tear

Question 31

What are the two types of Bicep tests and when are they indicated?

Answer 31

Speed’s and Yergason’s used to evaluate bicep involvement such as tendonitis/tenopathy in the bicipital groove

Question 32

What is set up for Speed’s test?

Answer 32

pt arm in flexion, elbow extended and in supine and resistance is applied

Question 33

What is result of Speed’s test?

Answer 33

a positive test can indicate a superior labral tear or bicep tendinitis

Question 34

What is position of Yergason’s test?

Answer 34

used to check position of transverse humeral ligament, stabilize pts elbow against trunk and resist ER and supination with elbow flexed to 90

Question 35

What is result of Yergson’s?

Answer 35

positive if pain is experienced during the movement in area of bicipital groove could be tendinitis but could also indicate tear in transverse ligament