Practical Flashcards
Neer’s Positioning
Stabilize scapula
IR humerus
passively flex arm to max range in scapular plane
Neer’s Positive
Pain at sub-acromial or anterior edge of acromion, often visible pain
test is sensitive but not specific. Negative gives us more information
Meaning of Positive Neers
supraspinatus impingement
jams greater tuberosity against acromion, pinching supraspinatus or biceps tendon
Empty Can positioning
abduct arm to 90°
move to 30° in scapular plane
IR arm, with hand pointing down
provide resistance down
Empty Can positive
pain or weakness in the position w/resistance at subacromial space
not a great test b/c it decreases the joint space
High specificity, can rule in a positive
Empty can positive meaning
supraspinatus is pinched in subacromial space, contractile tissue weakness
supraspinatus impingement
Full can positioning
abduct arm to 90°
move to 30° in scapular plane
provide resistance down
Full can Positive
pain or weakness in the position w/resistance at subacromial space
Meaning of Full Can positive
supraspinatus is weak or has pain in normal position w/normal action
Hawkins-Kennedy Positioning
passively raise arm to 90° of flexion
Flex elbow to 90°
Support distal humerus
Move arm into IR at wrist
Hawkins-Kennedy Positive
Provocation test, pain
Most likely at subacromial
sensitive, not highly specific
Meaning of positive hawkins-kennedy
supraspinatus tendon is pushed against coracoids process
impingement
Cross Adduction Positioning
passively flex arm to 90°
max adduct arm
Cross Arm Positive
localized pain over acromioclavicular
more specific than sensitive
Cross Arm Positive Meaning
RC tendons and biceps tendons are pinched
impingement
Yocum positioning
pt places involved side hand on opposite shoulder
pt actively raises elbow
Yocum positive
painful at anterior shoulder
sensitive, not specific
Yocum positive meaning
RC tendons and biceps tendon are pinched
impingement
Drop Arm Positioning
passively abduct arm to 90°
pt slowly lowers arm
Drop Arm Positive
weakness or pain causes patient to drop arm to their side
high specificity, good at ruling in
Drop Arm Positive Meaning
function and integrity of supraspinatus
positive would indicate a tear
ER Lag Positioning
20° elevation in scapular plane
passively flex the elbow to 90°
ER shoulder maximally, then back 5°
ask pt to hold in that position
ER Lag Positive
arm starts to drift into IR
increased specificity, good at ruling in
ER Lag Positive Meaning
tests for infraspinatus pathology, possible tear
Hornblower Positioning
bring shoulder to 90° of abduction, 90° ER
ask pt to hold this
Hornblower Positive
arm falls into internal rotation
high specificity and sensitivity
Hornblower Positive Meaning
Indicates a massive teres minor tear
Gerber Positioning
hand goes behind back, with back of hand resting at mid lumbar
lift hand off back with IR
apply resistance
Gerber Positive
hand can’t be lifted off the back
compensation w/shoulder or elbow extension
Gerber Positive Meaning
subscapularis pathology
possible tear
Belly Press Positioning
alternative to gerber
elbow 90° and hand on stomach
apply force to ER to forearm
Belly Press Positive
weak compared to non-affected
compensation w/shoulder extension or wrist flexion
high specificity, ruling in
Belly Press Positive Meaning
subscapular pathology
possible tear
Obrien’s Positioning
pt flexes to 90° while keeping elbow extended, adducted 10°, supinated. Apply force down.
pt IRs, with thumb down, Apply force down.
Obrien’s Positive
pain in GHJ in pronation but NOT in supination
high sensitivity, better at ruling out
Obrien’s Positive Meaning
possible labral tear, or SLAP tear
Compression Rotation Test Positioning
pt supine, abduct arm to 90°, elbow in 90° of flexion
provide axial compression, then humerus is circumducted and rotated
Compression Rotation Positive
pain or clicking
high specificity, can rule in
Compression Rotation Positive Meaning
indicates SLAP or labral tear
Crank Positioning
supine, elevate arm to 160° in scapular plane
apply axial force and rotate into IR and ER
Crank Positive
clicking or pain in GHJ
high specificity, can rule in
Crank Positive Meaning
indicates labral pathology
Apley’s Scratch Positioning
pt brings 1 arm into extension, IR, adduction
pt brings other arm into flexion, ER, abd
pt tries to touch fingers
Apley’s Scratch Positive
unable to touch fingers together or overcompensates with one arm
Apley’s Scratch Positive Meaning
pt has decreased ROM in GHJ
Sulcus Sign Positioning
pt sits or stands with arms relaxed by side
hold at proximal elbow and pull down
Sulcus Sign Positive
sulcus forms at superior humeral head
Sulcus Sign Positive Meaning
may indicate multidirectional or inferior stability
Apprehension Positioning
supine, PT abducts arm to 90°, slowly ER
if no symptoms, apply force anteriorly
Apprehension Positive
pt experiences instability, apprehension, pain at front
high spin, can rule in
Apprehension Positive Meaning
pain at front = anterior instability
pain at back = impingement
Relocation Positioning
supine, PT abducts arm to 90°, slowly ER
no symptoms, apply force posteriorly
Relocation Positive
pain or apprehension decreases
high spin, can rule in
Relocation Positive Meaning
anterior instability
Anteromedial + Posterior Lateral Joint Play Placement
0-30° abd = superior GHL
30-60° abd = middle GHL
90° abd = inferior GHL
Force of AM Joint Play
hand is on greater tubercle, and head of humerus force is up
other hand is on distal humerus, distract and push down
Force of PL joint play
hand is on greater tubercle and head of humerus force is down
other hand is on distal humerus, distract and pull up
Indication of AM or PL Joint Play
determining the integrity of the ligaments, hypermobility (gd 2), capsule integrity, ROM, end feel
GH distraction placement
-use hand closest to pt, place in axilla
-thumb goes distal to jt margin, fingers 90° posteriorly
-other hand supports lateral humerus
GH Distraction Force
hand in axilla moves humerus laterally
GH Distraction Indications
testing
initial tx = gd 2
pain = gd1/2
mobility = gd 3
GH Inferior Glide Placement
one hand in pts axilla
web space of other hand goes distal to acromion process
GH Inferior Glide Force
w/superior hand, glide humerus in inferior direction
gd 1 distraction on axilla
GH Inferior Glide Indications
increase abduction = gd 3
reposition the humeral head
gd 1 distraction and inferior glide for progression, when there’s 90° of abduction
GH Posterior Glide Positioning
patient: 45° abduction, and 30° flexion
PT: back to pt, arm goes against trunk, grab distal humerus. Other hand goes distal to ant jt line, fingers are superiorly faced
GH Posterior Glide Force
grade 1 distraction on elbow
glide posterior-lateral with other hand
GH Posterior Glide Indication
increase flexion
increase IR
GH Anterior Glide Positioning
pt: prone with padding in acromion
PT: pt arm goes on thigh, outside hand goes on distal humerus. Other hand goes distal to acromion, fingers are superiorly faced
GH Anterior Glide Force
gd 1 distraction to distal humerus
anterior and slight medial force
GH Anterior GLide Indications
increase extension
increase ER
