Instability Tests for Shoulder Flashcards
Painful Arc Test
Painful Arc Test
Purpose: assess for subacromial impingement of supraspinatus tendon and subacromial bursa.
-with client standing, instruct client to abduct the humerus through full range
Positive: pain starting at about 70 degrees of abduction, which eases off after about 130 degrees of abduction. In this range, the tissues are no longer compressed. The pain must lessen above 130 degrees. When the client cannot actively move beyond this range, assist the client to 130 degrees and then ask the client to continue if possible.
Apley’s Scratch Test
Apley’s Scratch Test
unaffected movement first
Purpose: to assess the combined movements at the shoulder.
-place the client in a seated position and stand behind the client to observe range of motion
-instruct the client to reach behind the head to touch as far down the spine as possible with the fingertips. This assesses external rotation, flexion and abduction of one GH joint
-instruct the client to reach up, at the same time, behind the back with other hand, touching as far up the spine as possible. This action checks the internal rotation, extension and adduction of the other GH joint
-note the location of the fingertips of each hand according to the thoracic vertebral level
-instruct client to reverse the position of arms
-compare available ranges of both shoulders
-as motions are combined, it is important to correctly assess which individual movements are restricted and which are not. Therefore, it may be necessary to follow this test with the individual cardinal planes of shoulder motion to track down the specific limited range.
Adhesive Capsulitis Abduction Test
Adhesive Capsulitis Abduction Test
Purpose: test for restricted motion at the shoulder resulting from fibrosing and adhesions of the axillary fold of the inferior GH joint capsule.
-place client in a seated position and stand behind the client
-palpate the inferior angle of the scapula and with one hand monitor its position throughout the test
-with the other hand just proximal to the client’s elbow, slowly, passively abduct the client’s humerus, noting when the inferior angle of the scapula begins to move. In a normal shoulder, a leathery end feel is encountered at greater than 90 degrees of abduction of the humerus. The axillary fold is stretched and the scapula begins to move along with the humerus at greater than 90 degrees of abduction
Positive: result for a frozen shoulder has a painful, leathery end feel encountered anywhere before 90 degrees of abduction. Since the axillary fold is fibrosed, the scapula begins to move before 90 degrees of abduction.
Instability Tests for Shoulder:
Rockwood Test
Rockwood Test
Purpose: to test for anterior instability at the shoulder.
-the examiner stands behind the seated client
-with the arm at the client’s side, the examiner laterally rotates the shoulder, then abducts the arm to 45 degrees and passively laterally rotates the arm repeatedly.
-the same procedure is repeated at 90 degrees and 120 degrees.
-these different positions are performed because the stabilizers of the shoulder vary as the angle of abduction changes. anterior
Positive: the client must show marked apprehension with posterior pain when the arm is tested at 90 degrees. At 45 and 120, the client shows some uneasiness and some pain. At 0 degrees, there is rarely apprehension.
Instability Tests for Shoulder:
Push-Pull Test
Push-Pull Test
Purpose: to test for posterior instability at the shoulder.
-the client lies supine
-the examiner holds the client’s arm at the wrist abducts the arm to 90 degrees and forward flexes it to 30 degrees
-the examiner places the other hand over the humerus, close to the humeral head
-the examiner then pulls up on the arm at the wrist while pushing down on the humerus with the other hand
Positive: normally, 50% posterior translation can be accomplished. If more than 50% posterior translation occurs or it the client becomes apprehensive or pain results, the examiner should suspect posterior instability.
Instability Tests for Shoulder:
Feagin Test
Feagin Test
Purpose: tests for inferior and multidirectional instability of the shoulder.
-the Feagin test is a modification of the sulcus sign test with the arm abducted to 90° instead of being at the side
-the client stands with the arm abducted to 90° and the elbow extended, resting on the top of the examiner’s shoulder.
-the examiner’s hands are clasped together over the client’s humerus, between the upper and middle thirds. The examiner pushes the humerus down and forward
-the test may also be done with the client in a sitting position.
-in this case, the examiner holds the client’s arm at the elbow (elbow straight) abducted to 90° with one hand and arm holding the arm against the examiner’s body.
-the other hand is placed just lateral to the acromion over the humeral head. Ensuring the shoulder musculature is relaxed, the examiner pushes the head of the humerus down and forward
-doing the test this way often gives the examiner greater control when doing the test. A sulcus may also be seen above the coracoid process
Positive: a look of apprehension on the patient’s face indicates a positive test.
Impingement Tests:
Hawkin’s Kennedy Impingement Test
Hawkin’s Kennedy Impingement Test:
Purpose: assess for overuse injury to the supraspinatus (paratenonitis/tendinosis) or secondary Impingement.
-have the client stand
-the therapist flex’s the client’s arm forward to 90 degrees, then forcibly internally rotates the humerus. This compresses the supraspinatus tendon against the coracoid process
Positive: pain.
Impingement Tests:
Neer Impingement Test
Neer Impingement Test
Purpose: assess for overuse injury to the supraspinatus tendon.
-place the client in a seated position
-the patient’s arm is passively and forcibly fully elevated in the scapular plane with the arm medially rotated by the examiner
Positive: pain.
Tests for Muscle or Tendon Pathology:
Supraspinatus Strength Test (Empty Can)
Tests for Muscle or Tendon Pathology:
Supraspinatus Strength Test (Empty Can)
Purpose: to test for a supraspinatus tendon or muscle tear, or neuropathy of the suprascapular nerve.
-the client’s arm is abducted to 90° with neutral (no) rotation, and the examiner provides resistance to abduction.
-the shoulder is then medially rotated and angled forward 30° (“empty can” position) so that the client’s thumbs point toward the floor in the plane of the scapula. Others have said that testing the arm with the thumb up (“full can”) is best for maximum contraction of supraspinatus.
- resistance to abduction is again given while the examiner looks for weakness or pain, reflecting a positive test result.
Positive: weakness or pain indicates a tear of the supraspinatus tendon or muscle, or neuropathy of the suprascapular nerve.
Tests for Muscle or Tendon Pathology:
Infraspinatus Strength Test
NOTE: NO NAME IN THE SHEET
Infraspinatus Strength Test
Purpose: to assess the infraspinatus muscle for tendinitis, strain or weakness
-place the client in a seated or prone position.
-abduct the humerus to 90 degrees and flex the elbow to 90 degrees.
-apply pressure to the client’s wrist in the direction of internal rotation, while the client attempts to externally rotate the humerus.
Positive: pain along infraspinatus or weakness. This test does not distinguish between infraspinatus or teres minor strength, since both externally rotate the humerus
Tests for Muscle or Tendon Pathology:
Subscapularis Strength Test
NOTE FOR OIC: ARM NO AB
Subscapularis Strength Test
Purpose: to assess subscapularis muscle for tendinitis, strain or weakness
-place client in a seated position, with the humerus by the side of the body and elbow flexed to 90 degrees
-apply pressure to the client’s wrist in the direction of external rotation, while the client attempts to internally rotate the
wrist
Positive: pain along subscapularis or weakness
Tests for Muscle or Tendon Pathology:
Abrasion Sign
Abrasion Sign
Purpose: to assess if rotator cuff tendons are frayed.
-the client sits and abducts the arm to 90° with the elbow flexed to 90°
-the client then medially and laterally rotates the arm at the shoulder. Normally, there are no signs and symptoms.
Positive: If crepitus occurs, it is a sign that the rotator cuff tendons are frayed and are abrading against the under surfaces of the acromion process and the coracoacromial ligament.
Tests for Muscle or Tendon Pathology:
Lift off Sign
Lift off Sign
Purpose: to assess for a subscapularis lesion.
-the client stands and places the dorsum of the hand on the back pocket or against the mid lumbar spine. Great subscapularis activity is shown with the second position
-the client then lifts the hand away from the back. If the patient is able to take the hand away from the back, the examiner should apply a load pushing the hand toward the back to test the strength of the subscapularis and to test how the scapula acts under dynamic loading. With a torn subscapularis tendon, passive (and active) lateral rotation increases
Positive: An inability to do so indicates a lesion of the subscapularis muscle. Abnormal motion in the scapula during the test may indicate scapular instability.
Tests for Muscle or Tendon Pathology:
Pec Major Contracture Test
Pec Major Contracture Test
Purpose: to assess if there is a contracture of pectoralis major.
-the client lies supine and clasps the hands together behind the head. The arms are then lowered until the elbows touch the table
Positive: occurs if the elbows do not reach the table and indicates a tight pectoralis major muscle.
Tests for Muscle or Tendon Pathology:
Acromioclavicular Shear Test
Acromioclavicular Shear Test
Purpose: assess the integrity of the AC joint.
-place the client in a seated position
-stand behind the client
-place cupped hands over the client’s
shoulder, the fingers interlaced, with one palm on the clavicle and the other on the spine of the scapula
-slowly squeeze the heels of the hands together
Positive: results in pain or excessive/abnormal movement of the joint, indicates a joint pathology, including AC joint sprain.
Tests for Muscle or Tendon Pathology:
Drop Arm (Codman’s) Test
Drop Arm (Codman’s) Test
Purpose: assess the integrity of the rotator cuff, especially the supraspinatus muscle and tendon.
-place the client in a seated position
-abduct the arm to 90 degrees and instruct the client to hold the arm in this position
-instruct the client to slowly adduct the arm back to the starting position
Positive: the client is unable to return the arm smoothly and slowly to the side or if there is pain on the attempt, indicating a rotator cuff tear.
Tests for Muscle or Tendon Pathology:
Speed’s Test
NOTE: arm fist supinated then pronated, resist eccentric to different angle of flexion with both supination and pronation.
In exam can do one sup or pro
Speed’s Test
Purpose: to assess for biceps tendinitis.
-place the client in a seated position
-instruct client to completely extend elbow
-the examiner first resists shoulder forward flexion while the client’s forearm is first supinated and then pronated.
-the test may also be performed by forward flexing the patient’s arm to 90° and then asking the patient to resist an eccentric movement into extension first with the arm supinated, then pronated.
Positive: elicits increased tenderness in the bicipital groove especially with the arm supinated and is indicative of bicipital paratenonitis or tendinosis.
Tests for Muscle or Tendon Pathology:
Yergason’s Test
Yergason’s Test
Purpose: designed to check the ability of the transverse humeral ligament to hold the biceps tendon in the bicipital groove and assess the stability of the biceps tendon in the bicipitai groove or presence of biceps tendinitis.
-place the client in a seated position
-with the elbow of the affected arm flexed to 90 degrees and the forearm pronated
-stabilize the client’s elbow against the client’s thorax with one hand
-with the other hand, apply resistance while the client actively supinates the forearm, extends the elbow and externally rotates the humerus, all at the same time.
Positive: pain and the sensation of the tendon popping out of the bicipital groove indicate biceps tendon instability and the loss of integrity of the transverse humeral ligament. Pain along the course of the tendon may indicate biceps tendinitis; however, motion of the tendon along the groove is required for a true positive tendinitis test.
Tests for Muscle or Tendon Pathology:
Tendinitis Differentiation Test
Tendinitis Differentiation Test
Purpose: to assess for tendinitis anywhere in the body.
-instruct the client to resist isometrically at discrete intervals throughout the entire range of the affected muscle
Positive: indicated by pain at the lesion site on the tendon which increases with the force of the isometric contraction.
There may also be muscle weakness
Tests for Muscle or Tendon Pathology:
Bursitis Differentiation Test
Bursitis Differentiation Test
Purpose: to assess for bursitis
- instruct client to isometrically contract the muscles and tendons surrounding the affected bursa
Positive: indicated by pain at the site of the bursa that is constant, even if the force of the isometric contraction is increased
