Shoulder Test

Question 1

Apprehension Test
indicates:
(+) test

Answer 1

Glenohumeral instability

Patient apprehensive of repeat dislocation

Question 2

Empty Can Test
indicates:
(+) test

Answer 2

Rotator cuff pathology (specifically supraspinatus)

Pain or weakness

Question 3

Drop Arm Test
indicates:
(+) test

Answer 3

Full thickness tear of supraspinatus

Arm will drop with or without gentle tap on wrist

Question 4

Painful Arc Test
indicates:
(+) test:

Answer 4

Subacromial impingement and/or rotator cuff injury

Pain is elicited within 60 or 120 degrees of shoulder abduction

Question 5

Neer Impingement
indicates:
(+) test:

Answer 5

Subacromial bursa or rotator cuff impingement

Pain

Question 6

Hawkins Test
indicates:
(+) test:

Answer 6

Rotator cuff or subacromial bursa impingement

Pain

Question 7

Cross Arm Test
indicates:
(+) test:

Answer 7

AC joint pathology

Pain in AC joint with end range adduction

Question 8

Flexion/Extension SD MET

Answer 8

stabilize shoulder with one hand contact elbow with the other
engage restrictive barrier in flexion/extension based on diagnosis

Question 9

IR/ER SD MET

Answer 9

stabilize shoulder with one hand contact wrist with the other
engage restrictive barrier in internal/external rotation based on diagnosis

Question 10

AB/ADduction SD MET

Answer 10

stabilize shoulder with one hand contact elbow with the other
engage restrictive barrier in AB/ADduction based on diagnosis

Question 11

Spencer’s Technique

Stage 1: Extension

Answer 11

Cephalad hand stabilize shoulder
caudal hand grasps patient’s elbow
move shoulder into extension until restrictive barrier is engaged
gentle but firm force, move a short distance through restrictive barrier for 1-2 seconds & release
Repeat rhythmically until no further progress can be appreciated

Question 12

Spencer’s Technique

Stage 2: Flexion

Answer 12

Cephalad hand stabilize shoulder
Caudal hand grasp patient’s hand/wrist or elbow
Move shoulder into flexion until restrictive barrier is engaged.
with gentle but firm force move a short distance through restrictive barrier for 1-2 seconds and release

Question 13

Stage 3: Compression Circumduction

Answer 13

Cephalad hand stabilize shoulder
caudal hand grasps flexed elbow
abduct patient’s shoulder to 90 & gently compress elbow toward glenoid fossa
Make small clockwise circles, gradually increasing size for 15-20 sec
Reverse direction & repeat

Question 14

Stage 4: Traction Circumduction

Answer 14

Cephalad stabilize shoulder
Caudal hand grasps patient’s wrist or elbow
abduct patient’s shoulder to 90 and add gentle traction toward ceiling
Make small clockwise circles, gradually increasing size for 15-20 sec
Reverse direction & repeat

Question 15

Stage 5A: Adduction & ER

Answer 15

cephalad hand stabilize shoulder
have patient grasp physician’s forearm
slightly flex patient’s shoulder so arm may pass just in front of their body
with caudal hand, adduct shoulder to restrictive barrier.
with gentle but firm force, move a short distance through restrictive barrier for 1-2 seconds and release
repeat rhythmically

Question 16

Stage 5B: Abduction

Answer 16

Return to starting position used in stage 5A
with caudal hand, abduct shoulder to restrictive barrier.
with gentle but firm force, move a short distance through restrictive barrier for 1-2 seconds and release
Repeat rhythmically

Question 17

Stage 6: Internal Rotation

Answer 17

Abduct patient’s shoulder 45 & internally rotate shoulder, placing dorsum of patient’s hand in the small of the back
with caudal hand gently pull elbow forward into internal rotation restrictive barrier
with gentle but firm force, move a short distance through restrictive barrier for 1-2 seconds & release

Question 18

Stage 7: Traction with Inferior Glide

Answer 18

Abducts the patient’s arm
Patient’s hand and wrist are placed on the physician’s shoulder that is closest to the patient
with fingers interlaced, the physician’s hand are placed just distal to the glenohumeral joint
Scoops patient’s humeral head in a caudad direction, parallel to the table creating a translatory motion toward the inferior edge of the glenoid fossa
Repeat rhythmically

Question 19

SC Joint

Movement felt with Abduction

Answer 19

an inferior/caudal movement

Question 20

SC Joint

Movement felt with Adduction

Answer 20

a superior/cephalad movement

Question 21

SC Joint

Movement felt with Flexion

Answer 21

A posterior movement of the clavicular head

Question 22

SC Joint

Movement felt with extension

Answer 22

an anterior movement of the clavicular head

Question 23

SC Joint

Elevated/ADducted SD ART

Answer 23

patient lying supine with neck fully flexed by physician
physician places thumb over sternal end of the clavicle, exerting a downward/caudal pressure on the clavicle
Patient instructed to inhale & exhale fully

Question 24

SC Joint

Elevated ADducted SD MET

Answer 24

Patient lying supine, examiner on side of affected shoulder
physician place one hand on the sternal/proximal clavicular head
with other hand, grasp the patient’s wrist and hold arm extended and internally rotated.
Patient is instructred to raise arm against physician’s hand toward ceiling (flexion at shoulder) for 3-5 sec then relax
bring joint into new barrier

Question 25

Horizontal Extension

SD MET

Answer 25

Patient lying supine, examiner on side of affected shoulder
Physician places one hand on the restricted clavicular head and the other
hand placed behind axilla to cover the scapula.
Patient holds physician’s
shoulder with the hand of the affected shoulder.
Physician then flexes the clavicle toward the manubrium until movement
is palpated in the SC joint by pulling scapula anteriorly.
Posterior force simultaneously applied to proximal clavicle from anterior
to posterior to engage restrictive barrier.
Apply the principles of MET by having patient pulling their shoulder down
toward the table.

Question 26

Clavicle Anterior & Superior Glide

ART

Answer 26

Pt lying supine, physician on contralateral side
The pt helps to gap the SC joint by Adducting the arm ipsilateral to the SD
(using their contralateral hand to aid in the motion). The physician’s
ipsilateral hand may be placed on the table under the patient’s axilla to
create a fulcrum for the patient to adduct against.
Articulatory springing is applied laterally, posteriorly, and inferiorly over
medial end of clavicle using the physician’s hypothenar eminence of the
contralateral arm

Question 27

AC Joint:

ART AC-Clavicle Superior

Answer 27

Patient supine with doctor on ipsilateral side.
Doctor’s index fingerpad monitoring AC joint and other fingers on superior
aspect of clavicle; the other hand grasps the patient’s forearm proximal to
the wrist.
Apply a traction force in a caudad direction to gap the AC joint.

While maintaining the traction force maximally flex the arm.
5. Reassess.

Question 28

AC Joint
Direct
Seated ART

Answer 28

Grasp elbow or forearm of dysfunctional side.
Grasp dysfunctional clavicle between thumb and fingers of free hand.
Apply anterior/inferior pressure with thumb on lateral (or posterior) aspect of
clavicle while flexing patients elbow, extending and adducting humerus (to gap AC
joint). (swim motion)
Doctor holds clavicle antero-inferior (with thumb). Shoulder is extended into a
circulatory sweep, posterior, superior, then anteromedial while maintaining
adduction and capsular tension (swim motion)

Question 29

Internal Rotation SD MET

Answer 29

Patient seated, physician stands behind patient.
Physician places hand on clavicle just medial to AC joint while grasping wrist
with the other hand.
Add compressive force (blocking linkage) to stabilize clavicle/AC joint while
flexing, abducting (approximately 45 ) & Externally Rotate to restrictive
barrier.
Apply the principles of MET by having the patient Internally Rotate against
physician’s resistance for 3-5 seconds.
Repeat 3-5 times or until motion is fully restored

Question 30

External Rotation SD MET

Answer 30

Patient seated, physician stands behind patient.
Physician places hand on clavicle just medial to AC joint while grasping wrist
with the other hand.
Add compressive force (blocking linkage) to stabilize clavicle/AC joint while
flexing, abducting (approximately 45 ) & Internally Rotate to restrictive
barrier.
Apply the principles of MET by having the patient Externally Rotate against
physician’s resistance for 3-5 seconds.
Repeat 3-5 times or until motion is fully restored.