Each-one Teach-one Flashcards
Each-one Teach-one
Lift-off sign / Gerber Test
Shoulder Examination
Lift-off Sign / Gerber Test
Purpose: To determine the presence of potential subscapularis muscle pathology.
Associated ICF Category:
(a) Shoulder pain with mobility deficits.
- Patients under this category typically have a recent onset of symptoms, no radicular or referred symptoms, no signs of nerve root compression or peripheralization of symptoms, and restricted range of motion.
(b) Shoulder pain with muscle power deficits.
- Patients under this category typically present with muscle weakness or imbalances that contribute to postural or movement faults.
Patient Position:
- Seated or standing
Clinician Position:
- Standing behind patient
Cues:
- Have the patient place their involved hand on their back in internal rotation, extension, and adduction.
- Instruct the patient to lift their hand off their back.
- Positive Test: Patient’s inability to lift their arm off of their back.
Related Objective Measurement:
- Belly press test
- Subscapularis length test
Reliability = NA
Sensitivity = 92
Specificity = NA
Positive (+) Likelihood ratio = NA
Negative (-) Likelihood ratio = NA
Reference Articles:
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Neer Test
Also called ‘Neer Impingement Sign’
Shoulder Examination
Purpose: To test for shoulder impingement.
- Shoulder Impingement: Non-traumatic, usually unilateral, shoulder problems that cause pain, localized around the acromion, often worsening during or subsequent to lifting of the arm.
Test item cluster:
- Hawkins kennedy test
- Painful arc
- Painful/weak external rotation resistance test
- When all 3 (+): +LR of 10.56 (good for ruling in subacromial pain syndrome)
- When all 3 (-): -LR of 0.17 (moderate for ruling out subacromial pain syndrome)
Associated ICF Category:
(a) Shoulder pain and mobility deficits.
- Patients under this category typically have a recent onset of symptoms, no radicular or referred symptoms, no signs of nerve root compression or peripheralization of symptoms, and restricted range of motion.
(b) Shoulder pain and muscle power deficits.
- Patients under this category typically present with muscle weakness or imbalances that contribute to postural or movement faults.
Patient Position:
- Standing or seated
Clinician Position:
- Standing
Cues:
- Passively take patient’s shoulder into full flexion while maintaining internal rotation looking for pain.
- If there are no reproduction of symptoms do this motion again and add overpressure by placing one hand on the scapula and the other in the axilla near the glenohumeral joint applying overpressure into flexion and adduction.
- Positive Test: Reproduction of symptoms.
Related Objective Measurements:
- Hawkin’s-kennedy test
- Drop arm test
- Glenohumeral joint accessory mobility
Reliability = NT
Sensitivity = 33-68
- “true positive” rate
- SnOut: if it is negative, it rules out possibility of disease.
Specificity = 60-69
- “true negative” rate
- SpIn: if it is positive, it rules in possibility of disease
Positive (+) Likelihood ratio = 0.83-2.20
Negative (-) Likelihood ratio = 1.11-0.46
Reference Articles:
Each-one Teach-one
Hawkins-Kennedy Test
Shoulder Examination
Hawkins-Kennedy Test
Purpose: To assess for subacromial pain syndrome
- Subacromial Pain Syndrome: Non-traumatic, usually unilateral, shoulder problems that cause pain, localized around the acromion, often worsening during or subsequent to lifting of the arm.
Test item cluster
- Hawkins kennedy test
- Painful arc
- Painful/weak external rotation resistance test
- When all 3(+): +LR of 10.56 (good for ruling in subacromial pain syndrome)
- When all 3(-): -LR of 0.17 (moderate for ruling out subacromial pain syndrome)
Associated ICF Category:
(a) Shoulder pain with mobility deficits
* Mobility deficits: Patients under this category typically have a recent onset of symptoms, no radicular or referred symptoms, no signs of nerve root compression or peripheralization of symptoms, and restricted range of motion.
(b) Shoulder pain with muscle power deficits.
* Muscle power deficits: Patients under this category typically present with muscle weakness or imbalances that contribute to postural or movement faults.
(c) Shoulder stability with movement coordination impairments
Patient Position:
- Seated
Clinician Position:
- Standing
Cues:
- Passively take patient’s arm into flexion, horizontal adduction, stabilize the top of the shoulder and internally rotate the humerus looking for available range and reproduction of symptoms
- Compare to opposite side
- Positive Test: Limited range or pain in the shoulder.
Related Objective Measurements:
- Neers test
- Glenohumeral joint active range of motion
- Horizontal adduction stretch
Reliability = NT
Sensitivity = 72
Specificity = 66
Positive (+) Likelihood ratio = 2.11
Negative (-) Likelihood ratio = 0.42
Reference Articles:
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Drop Arm Sign
Shoulder Examination
Drop Arm Sign
Purpose: To assess for supraspinatus muscle tear.
Associated ICF Category:
(a) Shoulder pain and muscle power deficits.
- Patients under this category typically present with muscle weakness or imbalances that contribute to postural or movement faults.
Patient Position:
- Standing
Clinician Position:
- Standing
Cues:
- Passively abduct patient’s arm to 90 degrees and internally rotate the humerus
- Patient is asked to hold this position
- If able to hold this position, patient is asked to slowly lower their arm
- Positive Test: Patient is unable to hold this position or slowly lower the involved arm with control
Related Objective Measurements:
- Manual muscle test of the supraspinatus
- Empty can/full can test
Reliability = NT
Sensitivity = 27
Specificity = 88
Positive (+) Likelihood ratio = 2.25
Negative (-) Likelihood ratio = 0.83
Reference Articles:
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Full Can / Empty Can Test
Shoulder Examination
Full Can / Empty Can Test:
Purpose: To determine the presence of a potential supraspinatus impingement or tear.
- Impingement: The intrusion of one object into an area belonging to or affecting something else.
Associated ICF Category:
(a) Shoulder pain with muscle power deficits.
- Patients under this category typically present with muscle weakness or imbalances that contribute to postural or movement faults.
Patient Position:
- Standing
Clinician Position:
- Standing behind patient
Cues:
- Elevate both of the patient’s arms to 90 degrees in scaption with the thumbs up for the “full can” position
- Apply resistance to bilateral arms looking for any reproduction of symptoms or lack of strength
- Internally rotate the patient’s shoulders so their thumbs are pointing down for the “empty can” position. Retest the strength in this position
- Positive Test: A decrease in strength or increase in pain in the empty can position versus the full can position
Related Objective Measurement:
- Hawkins kennedy test
- Neer test
Reliability = 0.00
Sensitivity = 00
Specificity = 00
Positive (+) Likelihood ratio = 0.00
Negative (-) Likelihood ratio = 0.00
Reference Articles:
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External Rotation Lag Sign
Shoulder Examination
External Rotation Lag Sign
Purpose: To assess rotator cuff tear of infraspinatus or teres minor muscles.
Associated ICF Category:
(a) Shoulder pain with muscle power deficits.
- Patients under this category typically present with muscle weakness or imbalances that contribute to postural or movement faults.
Patient Position:
- Seated
Clinician Position:
- Standing
Cues:
- Passively flex patient’s elbow to 90 degrees, abduct shoulder 20 degrees, and maximally externally rotate the patient’s humerus
- Patient is asked to maintain this position
- Positive Test: Patient’s arm falls into internal rotation
Related Objective Measurements:
- Muscle palpation infraspinatus and teres minor
- External rotation manual muscle test
Reliability = NT
Sensitivity = 70
Specificity = 100
Positive (+) Likelihood ratio = NA
Negative (-) Likelihood ratio = NA
Reference Articles:
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Belly Press Test (any version)
Shoulder Examination
Belly Press Test:
Purpose: To assess for tear of subscapularis muscle
Associated ICF Category:
(a) Shoulder stability and movement coordination impairments.
(b) Shoulder pain and muscle power deficits.
Patient Position:
- Seated
Clinician Position:
- Standing
Cues:
- Patient places their involved palm on their belly and tries to push their palm into their belly firing the internal rotators of their shoulder.
- Observe if the patient is able to maintain this internal rotation position of the humerus.
- Positive Test: If a patient flexes at the wrist and tries to use shoulder extension to push into belly.
Related Objective Measurements:
- Active range of motion internal rotation
- Internal lag sign
Reliability = NT
Sensitivity = 0.40
Specificity = 0.98
Positive (+) Likelihood ratio = 20.0
Negative (-) Likelihood ratio = 0.61
Research Articles:
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Jerk Test
Shoulder Examination
Jerk Test
Purpose: Assess posterior labral or posterior instability.
- Instability: The quality or state of being unstable; lacking proper support or predictability.
Associated ICF Category:
(a) Shoulder pain with muscle power deficits.
- Patients under this category typically present with muscle weakness or imbalances that contribute to postural or movement faults.
(b) Shoulder stability and movement coordination impairments.
Patient Position:
- Seated
Clinician Position:
- Standing
Cues:
- Clinician stabilizes superior portion of the patient’s shoulder with one hand while passively abducting the patient’s shoulder to 90 degrees and internally rotating
- Add an axial compression to the humerus and maintain compression while horizontally adducting arm
- Positive Test: Click, clunk, or a reproduction of the patient’s symptoms.
Related Objective Measurement
- Apprehension at end ranges of horizontal adduction.
Reliability = NT
Sensitivity = 25-73
Specificity = 80-98
Positive (+) Likelihood ratio = 1.25-36.5
Negative (-) Likelihood ratio = 0.94-0.27
Research Articles:
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Shoulder Capsular Mobility Load-and-Shift Test
Shoulder Examination
Shoulder Capsular Mobility Load-and-Shift Test
Purpose: To assess excessive anterior or posterior mobility at the glenohumeral joint.
Associated ICF Category:
- Shoulder stability and movement coordination impairments.
Patient Position:
- Seated with arm slightly abducted and resting on pillow or lap.
Clinician Position:
- Standing
Cues:
- With one hand, stabilize the scapula on the thorax
- With the other hand, palpate the humeral head
- Add a compressive force through the humeral head in an anterior and posterior direction assessing for movement
- Normal: the humerus moves anteriorly a distance equal to half the humeral head
- Positive Test: Any distance more than half the humeral head anteriorly
Related Objective Measurements:
- Glenohumeral accessory mobility assessment
- Glenohumeral joint range of motion
- Anterior apprehension relocation test
Reliability = NT
Sensitivity = NT
Specificity = NT
Positive (+) Likelihood ratio = NA
Negative (-) Likelihood ratio = NA
Research Articles:
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Passive Distraction Test
Shoulder Examination
Passive Distraction Test
Purpose: An examination tool to be used in the evaluation of patients thought to have a SLAP lesion.
Patient Position:
- Have the patient lie supine at the edge of a table.
Clinician Position:
- Standing
Cues:
- Elevate the affected arm to 150 degrees in the coronal plane.
- Keep the elbow extended, the forearm supinated, and the upper arm stabilized to prevent humeral rotation.
- Gently pronate the forearm.
- Test if the patient reports pain deep inside the glenohumeral joint.
- Positive Test: Pain is reported
Each-one Teach-one
Dynamic Labral Shear Test
Shoulder Examination
Dynamic Labral Shear Test:
Purpose: Assess the shoulder’s superior biceps labrum complex and SLAP lesions.
Patient Position:
- Standing or seated
Clinician Position:
- Standing behind the patient
Cues:
- Hold the patient’s affected arm at the wrist with one hand
- Apply an anteriorly directed force on the proximal humerus near the joint line with the other hand
- Elevate the patient’s arm to 150°
- Externally rotate the arm to 90°
- Abduct to 90°
- Flex the elbow
- Abduct further from 90° to 120°
- Passively externally rotate the shoulder to the maximum amount
- Put a shearing force on the shoulder by moving the shoulder between 60 degrees and 120 degrees
- Positive Test: Pain or mechanical symptoms in the final 30° range.
- Positive Test: Examiner feels a click in the patient’s posterior joint line between 90 degrees to 120 degrees of elevation.
Each-one Teach-one
Bicep’s Load II Test
Shoulder Examination
Bicep’s Load II Test
Purpose: To determine if there is a SLAP lesion.
- SLAP: Superior Labrum, Anterior to Posterior
Associated ICF Category:
(a) Shoulder pain with muscle power deficits.
- Patients under this category typically present with muscle weakness or imbalances that contribute to postural or movement faults.
(b) Shoulder stability and movement coordination impairments.
Patient Position:
- Supine or seated
Clinician Position:
- Stand in front/involved side
Cues:
- Abduct patient’s shoulder to 120 degrees
- Flex patient’s elbow to 90 degrees
- Supinate forearm
- Take to end range shoulder external rotation
- Patient is asked to flex elbow while clinician resists at distal forearm
Normal:
- No reproduction of symptoms
Abnormal:
- Deep shoulder pain with resisted elbow flexion
Related Objective Measurements:
- Biceps strength test
- External rotation supination test
Reliability = 0.82 kappa
Sensitivity = 90
Specificity = 97
Positive (+) Likelihood ratio = 26.38
Negative (-) Likelihood ratio = 0.11
Reference Articles:
Each-one Teach-one
O’Brien’s Test
Shoulder Examination
O’Brien’s Test
Purpose: To determine the presence of potential pathology of the labrum or AC joint.
Associated ICF Category:
* Shoulder pain with movement coordination impairments.
Patient Position:
- Seated or standing
Clinician Position:
- Standing beside patient
Cues:
- Instruct the patient to raise their arm in 90 degrees of flexion, 10 degrees of horizontal adduction, and maximum internal rotation.
- Apply a downward force to the patient’s arm, looking for a reproduction of symptoms
- Have the patient maximally externally rotate the arm, and repeat your downward force.
- Positive Test: Symptom reproduction when internally rotated, and a reduction or absence of symptoms when externally rotated.
- AC joint pathology is indicated if the patient reports symptoms on top of the shoulder, whereas labral pathology is indicated if the patient reports pain inside the shoulder.
Related Objective Measurement:
- Crank test
- Biceps load II test
Reliability = NA
Sensitivity = 100
Specificity = 99
Positive (+) Likelihood ratio = NA
Negative (-) Likelihood ratio = NA
Research Articles:
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Bony Apprehension Test
Shoulder Examination
Bony Apprehension Test
Purpose: Screen for significant osseous lesions
Client Position:
- Seated or standing
Clinician Position:
- Standing directly behind the client
Cues:
- The clinician grasps the client’s forearm (with the elbow flexed to 90°) with one hand (left as shown) and stabilizes the humerus/elbow and shoulder girdle with the other hand (right as shown).
- The clinician abducts and externally rotates the arm to ≤ 45°.
Assessment:
- A (+) test for anterior instability due to a bony lesion is the client demonstrating or stating apprehension during the test.
Statistics
Reliability = NA
Sensitivity = 94
Specificity = 84
Positive (+) Likelihood ratio = 5.9
Negative (-) Likelihood ratio = 0.07
QUADAS = 9
Physiotutors Video (Shoulder Apprehension Test)
Research Articles:
Each-one Teach-one
Scapular Assistance Test
Shoulder Examination
Scapular Assistance Test
Purpose: To assess the effect of improved scapular upward rotation and elevation on shoulder symptoms during active elevation or other aggravating movements.
Associated ICF Category:
(a) Shoulder pain with muscle power deficits.
- Patients under this category typically present with muscle weakness or imbalances that contribute to postural or movement faults.
(b) Shoulder stability and movement coordination impairments.
Patient Position:
- Standing or sitting
Clinician Position:
- Standing behind patient
Cues:
- Observe the quality of the aggravating movement, quantify symptom reproduction.
- Clinician places one hand on the medial inferior border of the scapula, providing an upward rotation force during active elevation.
- With the other hand, apply a posterior tilt at the superior border to correct for insufficient posterior tilt.
- Ask the patient to perform the aggravating movement again with the corrections applied.
- Reassess patient symptoms and quality of motion.
Related Objective Measurements:
- Glenohumeral joint active range of motion.
- Neer test
- Hawkins Kennedy test
- Arc of pain = Typically appears midway through the range of motion, and is characteristic of subacromial pain syndrome, previously described as “shoulder impingement.”
Reliability = NT
Sensitivity = NT
Specificity = NT
Positive (+) Likelihood ratio = NA
Negative (-) Likelihood ratio = NA
CR Video (Modified Scapular Assistance Test)
Research Articles:
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Yergason’s Test
Shoulder Examination
Yergason’s Test
Purpose: To assess for biceps tendinopathy.
- Tendinopathy: A degeneration of the collagen protein that forms tendons.
Associated ICF Category:
(a) Shoulder pain with muscle power deficits.
- Patients under this category typically present with muscle weakness or imbalances that contribute to postural or movement faults.
(b) Shoulder stability and movement coordination impairments.
Patient Position:
- Seated or standing with elbow flexed to 90 degrees and forearm fully pronated.
Clinician Position:
- Standing in front of patient
Cues:
- Clinician palpates the biceps brachii tendon in the bicipital groove.
- Instruct patient to supinate arm against the therapists resistance.
- Clinician resists the supination force but allows the patient to go through the motion.
- Positive Test: Reproduction of symptoms inside the bicipital groove.
Related Objective Measurements:
- Glenohumeral joint active range of motion
- Biceps brachii manual muscle test
- Speed’s test
Reliability = 0.28
Sensitivity = 32
Specificity = 78
Positive (+) Likelihood ratio = 1.45
Negative (-) Likelihood ratio = 0.87
Reference Articles:
Each-one Teach-one
Upper Cut Test
Shoulder Examination
