Special Tests

Question 1

Describe how you would carry out the Bear Hug Test and what a positive diagnoses indicates:

Answer 1

Subscapularis Injury.
Ask patient to place their hand on the opposite shoulder with fingers extended. Then ask them to keep it there as you attempt to pull it away forcing them to IR the shoulder.
+ve= Pain or weakness

Question 2

Test(s) for Anterior Instability?

Answer 2

Apprehension Test.
Anterior Drawer Test.
Jobe’s Relocation Test.

Question 3

Describe how you would carry out the Belly Press Test and what a positive diagnoses indicates:

Answer 3

Subscapularis Injury.
Ask patient to place their hand palm down on their abdomen (just below the xyphoid process) with fingers extended. Then ask them to press into their belly as hard as possible.
+ve= Pain or weakness (or compensation through wrist flexion).

Question 4

Test(s) for Injury to Subscapularis?

Answer 4

Bear Hug Test
Belly Press Test
Gerber’s Lift-Off Test
Internal Rotation Lag Sign

Question 5

Describe how you would carry out the Anterior Drawer Test and what a positive diagnoses indicates:

Answer 5

Anterior Drawer Test.
Patient supine, passively abduct the shoulder 90, flexed 20 and ER 30*. Draw the distal humerus anteriorly and apply a counterpressure on the coracoid process.
+ve = excessive translation or pain.

Question 6

Test(s) for SLAP Lesions?

Answer 6

Biceps Load II Test
O’Brien’s Test
Crank Test

Question 7

Describe how you would carry out the Apprehension Test and what a positive diagnoses indicates:

Answer 7

Anterior Instability.
Place the arm in 90* abduction and 90* elbow flexion, support the elbow and then move the arm passively into ER by pushing the wrist back.
+ve = apprehension or discomfort.

Question 8

Describe how you would carry out the Crank Test and what a positive diagnoses indicates:

Answer 8

SLAP Lesion.
Patient seated or supine with ~100* abduction and 90* elbow flexion. Stabilsie their elbow and apply compressive force to humerus in towards the shoulder girdle and maintain this force whilst IR & ER the arm. (Turning it like a crank).
+ve = Pain, clicking or catching.

Question 9

Describe how you would carry out the Drop Arm Test and what a positive diagnoses indicates:

Answer 9

Supraspinatus Injury.
Passively raise patients arm to 90* abduction then ask them to lower it back down slowly.
+ve = Sudden drop or pain

Question 10

Describe how you would carry out the Biceps Load II Test and what a positive diagnoses indicates:

Answer 10

SLAP Lesions.
Patient supine with shoulder in 120* abduction and full ER with 90* elbow flexion and forearm in supination. Ask the patient to flex their elbow and provide resistance at the wrist.
+ve = Pain exacerbated during flexion

Question 11

Describe how you would carry out the Full Can Test and what a positive diagnoses indicates:

Answer 11

Supraspinatus Injury.
Patients arm abducted to 90* in the scapula plane, patients hand in a fist with the thumb pointing upwards, then apply a downward force and ask them to resist.
+ve = pain or weakness

Question 12

Describe how you would carry out the Hawkins-Kennedy Test and what a positive diagnoses indicates:

Answer 12

Subacromial Impingement Syndrome (SAPS).
Place the patients arm in 90* shoulder flexion and 90* elbow flexion, then passively IR the arm.
+ve = Pain during passive IR.

Question 13

Describe how you would carry out Gerber’s Lift-Off Test and what a positive diagnoses indicates:

Answer 13

Subscapularis Injury.
Patient standing, asked to place the back of the hand on their Lx spine, then ask them to IR rotate their arm to lift it away from the back.
+ve = pain or weakness (or compensation)

Question 14

Describe how you would carry out the Empty Can Test and what a positive diagnoses indicates:

Answer 14

Supraspinatus Injury.
Patients arm abducted to 90* in the scapula plane, patients hand in a fist with the thumb pointing downwards, then apply a downward force and ask them to resist.
+ve = pain or weakness

Question 15

Test(s) for Supraspinatus Injury?

Answer 15

Drop Arm Test.
Empty Can Test.
Full Can Test.
External Rotation Lag Sign.

Question 16

Test(s) for Subacromial Impingement Syndrome (SAPS).

Answer 16

Hawkins-Kennedy Test
Neer Test
Painful Arc Test

Question 17

Test(s) for Teres Minor Injury.

Answer 17

Hownblower’s Sign.

Question 18

Describe how you would carry out the Infraspinatus Test and what a positive diagnoses indicates:

Answer 18

Infraspinatus Injury.
Patient seated arms by their side with 90* elbow flexion (robot position), place hand on the the back of patients and ask them to ER against resistance.
+ve = pain or weakness with ER.

Question 19

Test(s) for Posterior Instability?

Answer 19

Inferior Sulcus Test
Norwood Stress Test

Question 20

Describe how you would carry out the Hownblower’s Sign Test and what a positive diagnoses indicates:

Answer 20

Teres Minor Injury.
Patient standing, arm passively abducted to 90* in scapula plane, then passively elbow flexed to 90*. Then ask patient to ER against resistance.
+ve = pain or weakness.

Question 21

Describe how you would carry out Jobe’s Relocation Test and what a positive diagnoses indicates:

Answer 21

Anterior Instability.
Perform the apprehension test: patient lies supine with shoulder 90* abduction and elbow flexed 90*. Apply a passive ER force.
Then apply a posterior force to the shoulder and repeat apprehension test.
+ve = decrease in pain or apprehension with posterior force.

Question 22

Describe how you would carry out the Jerk Test and what a positive diagnoses indicates:

Answer 22

Postero-Inferior Instability.
Patient seated, stabilise the scapula with one hand then hold affected arm at 90* abduction and IR. Then provide axial force to the humerus (towards shoulder) and move arm horizontally across the body.
+ve = clunking, instability or pain.

Question 23

Describe how you would carry out the External Rotation Lag Sign. Test and what a positive diagnoses indicates:

Answer 23

Infraspinatus and Supraspinatus.
Patient seated or standing, shoulder abducted 20* in scapula plane and elbow flexed to 90*. Passively ER shoulder to maximal range and ask patient to hold this position when support released.
+ve = inability to maintain position.

Question 24

Describe how you would carry out the Internal Rotation Lag Sign Test and what a positive diagnoses indicates:

Answer 24

Subscapularis Injury.
Patient seated, bring arm into maximal IR (Dorsum of hand to Lx Sp.), then examiner passively extends shoulder (brings hand away) and then ask patient to maintain this position independently by releasing wrist.
+ve = Lag (drop) or inability to maintain position.

Question 25

Test(s) for Infraspinatus Injury?

Answer 25

Infraspinatus Test. External Rotation Lag Sign.

Question 26

Describe how you would carry out the Norwood Stress Test and what a positive diagnoses indicates:

Answer 26

Posterior Instability. Patient supine with 90* shoulder abduction, 90* flexion, stabilise shoulder joint and passively adduct across the body. +ve = pain, instability or subluxation.

Question 27

Describe how you would carry out the Neer Test and what a positive diagnoses indicates:

Answer 27

Subacromial Impingement Syndrome (SAPS). Patient seated, stabilise the scapula and then full IR the arm, then passively flex the arm. +ve = Pain during flexion with IR.

Question 28

Describe how you would carry out the Posterior Sulcus Test and what a positive diagnoses indicates:

Answer 28

Posterior Instability Patient sitting or standing arm relaxed by side, stabilise the shoulder around the acromion and grip the arm above elbow and apply distraction force (pulling arm downward). +ve = Visible indentation between acromion and humeral head indicating excessive laxity.

Question 28

Test(s) for Postero-lateral Instability?

Answer 28

Jerk Test

Question 29

Describe how you would carry out O'Briens Test and what a positive diagnoses indicates:

Answer 29

SLAP Lesion. Patient sitting or standing, place the arm in 90* shoulder flexion and 15* horizontal adduction. Then IR shoulder and pronate elbow (such as 'empty can') then resist downwards movement. Then repeat with ER (such as 'full can'). +ve = deep pain with thumb down that decreases or disapears when thumb up.

Question 30

Describe how you would carry out the Rent Test and what a positive diagnoses indicates:

Answer 30

Supraspinatus Injury. +ve =

Question 30

Describe how you would carry out Paxino's Sign Test and what a positive diagnoses indicates:

Answer 30

ACJ Pain. Patient sitting with arm by side, place your thumb under the posterolateral aspect of the acromion and apply a anterosuperior pressure on the acromion with an inferior pressure on the mid clavicle. +ve = pain elicited around ACJ

Question 31

Describe how you would carry out the Painful Arc Test and what a positive diagnoses indicates:

Answer 31

Subacromial Impingement Syndrome (SAPS). Patient sitting or standing instruct them to abduct the arm fully in the scapular plane then slowly lower the arm back down. +ve = Pain between 60-120*

Question 32

Describe how you would carry out the Resisted ACJ Extension Test and what a positive diagnoses indicates:

Answer 32

ACJ Injury. Patient seated with 90* shoulder flexion and arm IR. Place hand on triceps and ask patient to horizontally abduct the arm against resistance. +ve = pain localised to ACJ

Question 33

Test(s) for ACJ Injury?

Answer 33

Resisted ACJ Extension Test. Scarf Test

Question 34

Describe how you would carry out the Scarf Test and what a positive diagnoses indicates:

Answer 34

ACJ Injury. Patient seated ask them to place their palm on opposite shoulder with 90* of abduction. Passively horizontally adduct the shoulder bringing their elbow to the contralateral shoulder. +ve = pain localised to ACJ

Question 35

Describe how you would carry out the Scapular Assistance Test and what a positive diagnoses indicates:

Answer 35

Scapular Dyskinesis. Patient seated and instructed to actively elevate arm infront of them to 90* whilst the examiner provides assistance to the scapula with a gentle push to the medial aspect. +ve = reduced pain or improved mobility with assistance.

Question 36

Describe how you would carry out the Punch Out Test and what a positive diagnoses indicates:

Answer 36

Serratus Anterior Weakness. Patient standing against a wall, ask them to push against it with a single arm and observe from behind. +ve = winging of scapula

Question 37

Test(s) for Scapular Dyskinesis:

Answer 37

Scapular Assistance Test Scapular Retraction Test

Question 38

Describe how you would carry out the Scapular Retraction Test and what a positive diagnoses indicates:

Answer 38

Scapular Dyskinesis. Perform the empty can test (thumb down), then repeat the test with the examiner stabilising the scapula in a retracted position by cupping firmly the anterior shoulder by the clavicle. +ve = rotator cuff strength restored or improved.

Question 39

Describe how you would carry out Speed's Test and what a positive diagnoses indicates:

Answer 39

Biceps Brachii or Superior Labral Tear. Place arm in 90*shoulder flexion with full elbow extension and supination. Ask patient to resist a downwards force just above the wrist. +ve = pain in bicipital groove

Question 40

Test(s) for Serratus Anterior Weakness:

Answer 40

Punch-Out Test