Shoulder Tests Flashcards
(24 cards)
Sulcus Sign
Purpose: inferior and multidirectional instability
Positive: sulcus between humeral head and acromion (only significant if pt is symptomatic)
Pt: sitting, arm by side
PT: stabilize shoulder girdle; pull down on arm either near humeral head or by condyles of humerus
Anterior Load & Shift
Purpose: anterior instability / capsular laxity
Positive: sharp pain in the shoulder with/without a clicking sound
Pt: sitting
PT: stabilize over acromion; pinch either side of humeral head, approximate humeral head into glenoid fossa, apply anterior force
Notes: Typically humeral head moves ~25% of the diameter of the humeral head. Grade I laxity is indicated by 25-50% and grade II laxity is indicated by greater than 50%.
Anterior Apprehension / Posterior (Jobe) Relocation
Purpose: anterior instability
Positive: pt expresses reluctance/apprehension; pain
For Jobe: pain/apprehension decreases with posterior translation
Pt: supine; 90º shoulder abduction, 90º elbow flexion
PT: passively/slowly ER humerus
For Jobe: add posterior translation of humerus
Posterior Load & Shift
Purpose: posterior instability
Positive: humerus shifts posteriorly in glenoid (graded)
Pt: sitting
PT: stabilize over acromion; pinch either side of humeral head, approximate humeral head into glenoid fossa, apply posterior force
Compression-Rotation (Snyder)
Purpose: SLAP lesion or AC tear
Positive: Pain; clicking; catching
Pt: sitting
PT: axially load the humerus at elbow, circumduct arm (slightly abducted 20º-90º) - small and large circles
Anterior & Posterior Slide
Purpose: SLAP lesion
Positive: pain/clicking
Pt: sitting
PT: axially load the humerus at elbow, flex shoulder and push posteriorly/superiorly; or extend shoulder and push anteriorly/superiorly
Speed’s
Purpose:
- Biceps Brachii
- SLAP lesion
Positive:
- anterior pain
- deep pain
Pt: sitting, flex shoulder to 90º; supinate, then repeat in pronation
PT: stabilize shoulder; give resistance proximal to elbow joint
O’Brien’s
Purpose: SLAP lesion
Positive: part 1 is NOT painful and part 2 IS painful
Pt: sitting
Part 1: 90º shoulder flexion, 10-15º horizontal adduction, supination (thumb up)
Part 2: 90º shoulder flexion, 10-15º horizontal addution, pronated (thumb down)
PT: stabilize shoulder; give resistance proximal to elbow joint
Yergason’s
Purpose:
1. SLAP lesion
Biceps brachii
Impingement: subacromial bursa, supraspinatus, long head biceps brachii
Positive:
- deep pain and clicking
- pain in bicipital groove (transverse humeral ligament probably torn and is allowing tendon to move in/out of groove
Pt: sitting; shoulder IR, elbow 90º flexion, pronation
PT: give resistance while pt ER and supinates
Crank
Purpose:
SLAP lesion
Bankart lesion
Positive:
pain/catching/painful clicking
Pt: supine; shoulder at 160º in scapular plane, 90º elbow flexion
PT: load humerus axially, IR and ER
Neer
Purpose: Biceps brachii Impingement: subacromial bursa, supraspinatus, long head biceps brachii Bursitis Partial cuff tear
Postive:
pain in anterior shoulder
Pt: sitting
PT: forcibly flex pt shoulder in scapular plane with IR
Hawkins-Kennedy
Purpose:
Impingement: subacromial bursa, supraspinatus, long head biceps brachii
Full thickness cuff tear
Overall impingement
Positive:
pain in anterior shoulder
Pt: sitting, 90º shoulder/elbow flexion; relaxed arm
PT: push down on wrist while supporting elbow
Coracoid Impingement
Purpose:
Impingement: subacromial bursa, supraspinatus, long head biceps brachii
Positive:
pain
Pt: sitting
PT: Hawkins-Kennedy test with horizontal adduction (10-20º)
Painful Arc
Purpose:
Impingement: subacromial bursa, supraspinatus, long head biceps brachii
Full thickness cuff tear
Overall impingement
Positive:
pain in midrange / no pain at beginning and end of range
Pt: standing; AROM of shoulder in scapular plane
Infraspinatus Strength
Purpose:
Impingement: subacromial bursa, supraspinatus, long head biceps brachii
Full thickness cuff tear
Overall impingement
Positive:
pain/instability/weakness
Pt: sitting, 90º elbow flexion with arm by side, 45º IR
PT: apply medial resistance
Drop Arm
Purpose:
Full thickness cuff tear
Supraspinatus tear or impingement
RC Tear (supra, infra, long head biceps brachii)
Positive:
pain or arm drops
Pt: sitting
PT: abduct pt shoulder to 90º with palm down; ask pt to hold
Empty Can
Purpose:
Impingement or tear of supraspinatus
RC tear (supra, infra, long head biceps brachii)
Positive:
tear: extreme weakness
impingement: pain
Pt: sitting, straight arm, 90º shoulder abduction in scapular plane, thumb down
PT: apply resistance at wrist
Full Can
Purpose: RC tear (supra, infra, long head biceps brachii)
Positive:
tear: extreme weakness
impingement: pain
Pt: sitting, straight arm, 90º shoulder abduction in scapular plane, thumb up
PT: apply resistance at wrist
ER Lag Sign
20º and 90º
(as described in class, sounds more like the drop test)
Purpose: RC Tear
infra/supra: 20º
infra/t minor: 90º
Positive:
unable to keep arm in position
Pt: sitting
PT: abduct at both 20º and 90º; ER end range
(pt supposed to keep arm in ER w/o moving)
IR Lag Sign and Lift Off
Purpose: RC tear (subscapularis)
Positive:
unable to life hand up
Pt: sitting
Lag sign: HBB, pt lifts hand off back, maintain there
Lift off: pt lifts hand off back
PT: can apply resistance by hand if strong in lift off
Belly Press
Purpose:
RC Tear (subscapularis)
Tendinopathy
Biceps
Positive:
cannot keep hand on belly
Pt: sitting, hand over belly
PT: hand underneath pt’s hand, apply resistance away from pt’s belly
Belly Off
Purpose:
RC Tear (subscapularis
tendinopathy
biceps
Positive:
cannot keep hand on belly
Pt: sitting, hand on belly
PT: apply anterior resistance to elbow
(pt needs to maintain position)
Horizontal/Cross-Body Adduction
Purpose: RC Tear (supra, infra, long head biceps, subscap) AC joint
Positive:
pain
Pt: sitting, reach toward opposite shoulder
PT: apply over pressure to elbow
Jerk
Purpose:
posterior instability / posterior capsule and labrum
Positive:
clicking posteriorly, then reducing when back at normal
Pt: supine
PT: axially load humerus at 90º flexion while IR; horizontally adduct arm then return to neutral
