Musculoskeletal: Upper Extremity Special Tests: Shoulder

Question 1

Scapula:

Lateral Scapular Slide Test

Answer 1

Why: Assess for Scapular Dyskinesis
How: Measurements taken from various boney landmarks on the Scapula (Spine, Medial border, Inferior angle) from various arm positions (arms at side, 45 degrees abduction and arms at 90 degrees abduction) to the thoracic spinous processes.
Positive Test: Distance between right and left scapula landmarks should not differ by more than 1.5 cm to thoracic spinous processes. If this occurs it is a positive test for scapular winging on the side that is farther away.

Question 2

Scapula:

Scapular Retraction Test

Answer 2

Why: Assess for Scapular Dyskinesis
How: Therapist retracts the scapula by applying a posterior tilt motion to the scapula by pulling on the superior border of the scapula from the shoulder and pushing from posterior to anterior/stabilizing the inferior portion of the scapula while the patient moves the arm through elevation.
Positive Test: Relief of pain in the shoulder with humeral elevation.

Question 3

Scapula:

Scapular Assistance Test

Answer 3

Why: Assess for Scapular Dyskinesis
How: The therapist applies assistance with upward rotation of the scapula during humeral elevation by assisting the scapula through the motion.
Positive Test: The patient has relief of pain in shoulder with humeral elevation/AROM.

Question 4

Scapula:

Flip Sign

Answer 4

Why: Assess for Scapular Dyskinesis
How: Patient performs resisted external rotation. The scapula is checked for winging.
Positive Test: Winging of the Scapula

Question 5

Scapula:

Kibler Scapular Pinch Test

Answer 5

Why: Assess for Scapular Dyskinesis
How: Patient pinches the scapula together.
Positive Test: Patient is not able to hold the scapular pinch for 30 seconds or they have pain or weakness with scapular retraction/pinching indicating weakness to scapular stabilizers.

Question 6

Shoulder: Impingement

Hawkins Kennedy Test

Answer 6

Why: To assess for subacromial impingement.
How: 90 degrees scaption+90 degrees elbow flexion+internal rotation to end range.
Positive Test: Pain in anterior shoulder.

Question 7

Shoulder: Impingement

Neer Test

Answer 7

Why: To assess for subacromial impingement.
How: Patient extends arm fully and internally rotates so thumb is pointing down. Therapist then moves arm through full flexion to the level of the ear.
Positive Test: Pain in the anterior shoulder.

Question 8

Shoulder: Impingement

Yocum’s Test

Answer 8

Why: To assess for subacromial impingement.
How: Bring hand to opposite shoulder with elbow bent, then bring elbow to nose while keeping hand on shoulder.
Positive Test: Pain in the anterior shoulder.

Question 9

Shoulder: Impingement

Crossover Impingement Adduction Test

Answer 9

Why: To assess for subacromial impingement.
How: The clinician passively moves the arm through horizontal adduction.
Positive Test: Pain in the anterior shoulder.

Question 10

Shoulder: Impingement

Painful Arc Sign

Answer 10

Why: To assess for subacromial impingement.
How: Patient moves the arm through the scapular plane. into full elevation and then slowly back to their side.
Positive Test: Pain with movement between 60-120 degrees.

Question 11

Shoulder: Impingement

IR Resisted Strength Test

Answer 11

Why: To Differentiate between outlet and non-outlet impingement
How: Perform basic MMT to IR and ER in conjunction with other impingement tests.
Positive Test: If IR weakness greater then ER=Nonoutlet impingement.
Negative Test: If ER weakness greater than IR=outlet impingement.

Question 12

Shoulder: Impingement

Infraspinatus Muscle Test

Answer 12

Why: To assess for subacromial impingement.
How: Basic ER MMT with pillow between arm.
Positive Test: Pain with ER.

Question 13

Shoulder: Impingement

Posterior Impingement Test

Answer 13

Why: To assess for subacromial impingement/Rotator cuff tear/posterior Labral tear. (General dysfunction in the posterior shoulder).
How: Patient supine, patients shoulder flexed to 90 and drops below the plane of the table. Patients arm is passively ER to end range.
Positive Test: Pain in posterior shoulder.

Question 14

Shoulder: Rotator Cuff

Patte/Hornblowers Sign

Answer 14

Why: To assess for Teres Minor degeneration
How: 90 degrees shoulder flexion+90 degrees elbow flexion+Arm in scapular plane. ER against resistance.
Positive Test: Pain or weakness with with external rotation.

Question 15

Shoulder: Rotator Cuff

IR Lag Sign

Answer 15

Why: To assess for Subscapularis Tear
How: Clinician holds arm behind back in IR with hand on back. Clinician then pulls arm away from back. The clinician lets go of the hand and the patient attempts to maintain the test position.
Positive Test: The patient is not able to hold the test position..

Question 16

Shoulder: Rotator Cuff

ER Lag Sign

Answer 16

Why: To assess for Supraspinatus/Infraspinatus/posterior RC tear.
How: 90 degrees of shoulder flexion+20 degrees abduction+place arm into ER.
Positive Test: Inability to maintain the test position.

Question 17

Shoulder: Rotator Cuff

Belly Press

Answer 17

Why: To assess for subscapularis tear.
How: Patient internally rotates the arm to place hand on the stomach. Patient pushes the hand into the stomach.
Positive Test: Pain or weakness to IR or inability to maintain position.

Question 18

Shoulder: Rotator Cuff

Dropping Sign

Answer 18

Why: To assess for infraspinatus degeneration.
How: Patient is placed into slight abducton and 90 degrees of elbow flexion. The patient ER’s into clinicians hand providing resistance.
Positive Test: The patient has pain or weakness or is unable to maintain the ER position after application of resistance. The arm will move back toward neutral.

Question 19

Shoulder: Rotator Cuff

Drop Arm:

Answer 19

Why: To assess for full thickness RC Tear.
How: Arm is placed in 90 degrees of abduction. Patient is asked to hold arm in 90 degrees abduction.
Positive Test: The patient is unable to hold the arm in 90 degrees abduction and drops down toward the table.

Question 20

Shoulder: Rotator Cuff

Full Can

Answer 20

Why: To assess for full thickness Supraspinatus Tear
How: 90 degrees in the scapular plane, thumb pointing up. Clinician stabilizes the shoulder and performs an MMT to the shoulder in scaption.
Positive Test: The patient’s arm drops from the test position with resistance/the patient is unable to hold the arm in the position.

Question 21

Shoulder: Labral Tear

Speed’s Test

Answer 21

Why: To assess for a superior labral tear (SLAP lesion)
How: Patient’s arm is placed in 90 degrees of flexion and full supination. Clinician performs an MMT to the proximal humerus.
Positive Test: If the patient has pain in the shoulder or is unable to resist the MMT.

Question 22

Shoulder: Labral Tear

Crank Test

Answer 22

Why: To assess for a Labral tear
How: Patient is supine with arm at 90 degrees abduction and elbow flex to 90. Clinician performs compression to the humerus into the GH joint and then moves the arm via the wrist through IR and ER to end range.
Positive Test: Pain in the shoulder or painful clicking in the shoulder.

Question 23

Shoulder: Labral Tear

Clunk Test

Answer 23

Why: To Assess for a Labral tear.
How: Patient is supine with arm at 90 degrees abduction. Clinician ER shoulder and then provides an anterior to posterior force from the back of the shoulder.
Positive Test: Patient has pain in the shoulder with the test or clinician feels a clunking sensation.

Question 24

Shoulder: Labral Tear

Kim Test

Answer 24

Why: To assess for a posterior Labral Tear
How Patients arm is put in 90 degrees abduction with a force applied into the GH joint toward the body. The clinician then moves the arm through a diagonal and upward path.
Positive Test: Patient experiences pain in the posterior shoulder.

Question 25

Shoulder: Labral Tear | O'Briens Test

Answer 25

Why: To assess for a Superior Labral Tear (SLAP lesion) How: Patient's arm is placed in 90 degrees flexion and full elbow extension. Patient first fully IR the arm so palsy are down. An MMT is applied to the distal arm. The arms are then fully ER with palm facing up. An MMT is applied to the distal arm. Positive Test: Pain in the shoulder with the first testing position (full IR) with force applied that is alleviated with the second testing position full ER) when force is applied.

Question 26

Shoulder: Labral Tear | Biceps Load I

Answer 26

Why: To assess for a SLAP lesion. How: Patient is supine with arm abducted to 90 degrees ad elbow flexed to 90 and the shoulder is fully ER (stop sign position). Patient is then asked to flex the elbow against clinician resistance toward the head. Positive Test: Patient experiences Pain in the shoulder.

Question 27

Shoulder: Labral Tear | Biceps Load II

Answer 27

Why: To assess for a SLAP lesion How: Patient is supine with arm abducted to 120 degrees ad elbow flexed to 90. Patient is then asked to flex the elbow against clinician resistance toward the head. Positive Test: Patient experiences Pain in the shoulder.

Question 28

Shoulder: Labral Tear | Anterior Slide Test

Answer 28

Why: To assess for a SLAP lesion How: Patient puts hand on waist with elbow flexed. Clinician provides a force at the elbow into the GH joint toward the head. Positive Test pain or clicking in the shoulder.

Question 29

Shoulder: Labral Tear | Pronated Load Test

Answer 29

Why: To assess for a SLAP lesion How: Patient is placed in supine with shoulder abducted to 90 degrees and elbow flexed to 90 degrees. Shoulder is fully ER. Patients forearm s then fully pronated so the palm is facing away from the head. The patient is asked to resist a force by the clinician away from the head (bicep elongation). Positive Test: Patient has pain in the shoulder.

Question 30

Shoulder: Labral Tear | Resisted Supination-ER

Answer 30

Why: To assess for a SLAP Lesion. How: Patient is supine. Patients shoulder is abducted to 90 degrees and elbow flexed to 90 degrees. Patient is then passively ER by the clinician. While the patient is being passively ER they perform supination against resistance by the clinician. Positive Test: Patient has pain in the shoulder.

Question 31

Shoulder: Biceps Tendinitis | Speed's Test

Answer 31

Why: To assess for a Biceps Tendinitis How: Patient's arm is placed in 90 degrees of flexion and full supination. Clinician performs an MMT to the proximal humerus. Positive Test: If the patient has pain in the shoulder or is unable to resist the MMT.

Question 32

Shoulder: Biceps Tendinitis | Yergason's Test

Answer 32

Why: To assess for a Biceps Tendinitis How: Patients arm is at side with elbow flexed to 90 degrees Patients forearm starts pronated. Patient then ER and supinates the arm against resistance.Clinician provides resistance and palpates the biceptial groove. Positive Test: Pain in bicep tendon or bicipital tendon is felt via palpation.

Question 33

Shoulder: AC joint dysfunction | Crossover Body/Horizontal Adduction

Answer 33

Why: To assess for AC joint dysfunction How: Patients arm is flexed to 90 degrees. Arm is then fully horizontally adducted across the body. Positive Test: Pain at the AC joint.

Question 34

Shoulder: AC joint dysfunction | O'Brien's Test

Answer 34

Why: To assess for a AC joint dysfunction. How: Patient's arm is placed in 90 degrees flexion and full elbow extension. Patient first fully IR the arm so palsy are down. An MMT is applied to the distal arm. The arms are then fully ER with palm facing up. An MMT is applied to the distal arm. Positive Test: Pain in the AC joint with the first testing position (full IR) with force applied that is alleviated with the second testing position full ER) when force is applied.

Question 35

Shoulder: AC joint dysfunction | AC Resisted Extension

Answer 35

Why: Why: To assess for a AC joint dysfunction. How: Patient's arm is placed in 90 degrees flexion with the elbow flexed at 90 degrees across the body. The patient resists horizontal adduction force applied by the clinician. Positive Test: Pain in the AC Joint.

Question 36

Shoulder: Glenohumeral Instability | Sulcus Sign

Answer 36

Why: To assess for inferior GH stability. How: Patients arm is at the side. Clinician provides a downward force at the distal humerus and exams for s sulcus or feeling of subluxation of the shoulder. Positive Test: Clinician identifies a sulcus or feels a subluxation of the GH joint.

Question 37

Shoulder: Glenohumeral Instability | Load and Shift Test

Answer 37

Why: To assess for anterior GH stability. How: Patients arm is at side. Clinician stabilizes the scapula and grabs the humeral head and provides an anterior force to the humeral head in the capsule. Positive Test: Excessive anterior translation of the humeral head.

Question 38

Shoulder: Glenohumeral Instability | Apprehension Test

Answer 38

Why: To assess for anterior GH stability. How: The patient is supine. Clinician places the patients shoulder into 90 degrees of abduction and 90 degrees of elbow flexion. The Clinician then stabilizesunder the shoulder and moves the arm through ER. Positive Test: The patient vocalizes apprehension to further ER due to apprehension of feelings of subluxation.

Question 39

Shoulder: Glenohumeral Instability | Anterior Release Test/Suprise Test

Answer 39

Why: To assess for anterior GH stability. How: Patient is supine with the shoulder in 90 degrees abduction and the elbow in 90 degrees flexion. The clinician stabilizes the shoulder anteriorly with an anterior to posterior directed force and moves the arm through ER. The clinician then quickly and unnacounced removes the hand from the anterior shoulder to remove the anterior to posterior stabilization force. Positive Test: The patient vocalizes apprehension or sensation of instability or subluxation.

Question 40

Shoulder: Glenohumeral Instability | Rockwood Instability Test

Answer 40

Why: To assess for anterior GH stability. How: Patients arm is placed in 45 degrees abduction and ER, 90 degrees abduction and ER to 90 degrees, and 120 degrees abduction and ER. The clinician looks for signs of subluxation at all testing positions. Positive Test: The clinician notes or the patient vocalizes feelings of subluxation at the GH joint.