Quick Shoulder tests

Question 1

Anterior Aprehension

Answer 1

Rationale: anterior instability

pt position: supine

PT: put shoulder 90/ER, Elbow 90

+: aprehension/pain

Question 2

Anterior Drawer

Answer 2

Rationale: anterior instability

pt position: Supine

PT: anterior glide

Question 3

Jobe relocation

Answer 3

Rationale: anterior instability

pt position: after anterior aprehension

PT: put humeral head back if comes out after anterior aprehension

Question 4

Rockwood

Answer 4

Rationale: anterior instability

pt position: stand

PT: she said therapists flexes shoulder all the way up over head and ER the patient

Question 5

Posterior Apprehension

Answer 5

Rationale: posterior instability

pt position: supine, shoulder 90, elbow 90

PT: push posteriorly through elbow through humerus

Question 6

Posterior Drawer

Answer 6

Rationale: posterior instability

pt position: supine

PT does posterior glide

Question 7

Sulcus Sign

Answer 7

Rationale: inferior instability

pt position: sit relaxed

PT palpate acromion, drop off –feel space

Question 8

Sulcus Test

Answer 8

Rationale: inferior instability

pt position: sit

PT stabilize scapula, push inferiorly at forearm

Question 9

Faegin Test

Answer 9

Rationale: inferior instability

pt position: stand
shoulder abducted

PT push inferiorly at greater tuberosity

Question 10

Rowe Test

Answer 10

Rationale: multidirectional instability

Pt position: lean forward at waist, other hand on table

PT does three tests: push anteriorly, posteriorly and inferiorly: stabilize at scapula

Question 11

Yergason Test

Answer 11

Rationale: bicep

pt position: sit
arm at side, elbow bent 90 degrees and forearm pronate

PT: Resist patient supination, shoulder ER, and isometric flexion

Question 12

Speed Classic

Answer 12

Rationale: Bicep—using biceps tendon as secondary shoulder flexor

pt position: sit, shoulder 90 flex and ER, elbow extended, forearm supinated

PT: resist isometric hold of shoulder flexion

Positive sign: pain in bicipital groove area (biceps tendon)

Question 13

Speed Extension

Answer 13

Rationale: Bicep—using biceps tendon as secondary shoulder flexor

Position: seated with shoulder extended, shoulder ER, elbow straight (forearm supinate?)

Test: PT resists isometric hold of shoulder flexion (this puts more stretch on the tendon by putting into extension)

Positive sign: pain in bicipital groove area

Question 14

Drop Arm Test

Answer 14

Rationale: can the rotator cuff be a dynamic stabilizer: If rotator cuff is not being a dynamic stabilizer it will start to drop (muscle strain, muscle tear)—deltoid and rotator cuff synergy

Pt position: stand, arms abducted***Patient lowers arms slowly to the side

PT: Phase 2: If patient can perform, give gentle tap as patient lowers

Positive sign: lack of eccentric control
(***be ready to catch the arm as it falls to the side)

Question 15

Supraspinatus Test

Answer 15

Rationale: this position puts the supraspinatus in line with the humerus and is under the acromion lower than the impingement, we only want to test the ability of supraspinatus and not the area where you impinge (lower than 90 degrees). EMG: first part of arch of motion is supraspinatus, keep arm low to be more specific to supraspinatus

pt position: arms below 90 degrees in scaption and IR ( range where the supraspinatus functions in a more isolated fashion)

PT: Therapist resists distal forearm (push down)

Positive: see if it provokes pain or cardinal sign (or if it drops?)

Question 16

Can Test

Answer 16

Rationale: Rotator Cuff Tear

pt Position: arm elevated to 90 degrees in SCAPTION

• Empty can test: thumb down (IR)
• Full can Test: thumb up (ER)

PT: push down humerus as patient attempts an isometric contraction

Positive signs: pain and weakness

Empty can: IR causes grinding whatever attach to proximal humerus under acromial arc –by resisting and contracting muscles create more impinge.
Full can is beneficial because it gives the same data with the arm in a position of neutral or ER that doesn’t create an impingement.

Question 17

Hawkins-Kennedy Impingement Test

Answer 17

Rationale: for subacromial impingement (supraspinatus tendon against the anterior portion of the coracoacromial ligament—pain if the patient has supraspinatus tendinitis (rosen)

Pt position: arm 90 degrees scaption, elbow 90 degrees of flexion

PT: overpressure arm into IR

Positive: Pain
————-Pain secondary to compression of structures under coracoacromial ligament and acromion

Question 18

Yocum Test

Answer 18

Rationale: for subacromial impingement

Pt position: Affected hand is placed on opposite shoulder

TEST: Patient lifts elbow

Positive: pain
——–Pain secondary to compression of structures under coracoacromial ligament and acromion

Question 19

Neer Test

Answer 19

Rationale: for subacromial impingement

Pt position:

PT: Stabilize the trunk– IR arm and lift arm to flexion to ear

Positive: Pain
——Pain secondary to compression of structures under coracoacromial ligament and acromion

Question 20

If all 3 positive: Hawkins, Yocum, Neer: this indicates ____?

Answer 20

Some articles say if all 3 positive: Hawkins, Yocum, Neer: this indicates impingement

Coracoachrimial ligament

Whenever patient says painful, you ask where –is it subacromial, is it AC joint,

Question 21

Posterior impingement test

Answer 21

: put stretch on capsule as bring arm up—like neer to the ear but do it in the supine position

1. Supine, arm in flexion, elbow bent, rotate
2. (see Dutton page 523)

Question 22

Crank Test

Answer 22

Rationale: labral pathology

Pt position: seated or supine, arm in 160 degrees scaption, elbow flexed 90 degrees

PT: stabilizes the patient’s posterior shoulder
and pushes toward the joint through the patients elbow while gently rotating the arm IR and then ER—cranking

Positive sign: pain with ER or reproduction of the cardinal sign during overhead activities

Question 23

O’Brien’s Test

Answer 23

Rationale: active compression test to provoke labral symptoms (superior labrum is close to the attachment of the biceps tendon)

Pt position: standing
Part 1: (IR) flex shoulder 90 degrees, shoulder IR, (elbow straight) then does horizontal adduction.

Part 2: (ER) flex shoulder 90 degrees, shoulder ER, (elbow straight) then does horizontal adduction patient turn palm up

PT: resists by pushing down: for an isometric hold of the position

Positive sign:

• -pain with part 1 and no pain with part 2: rule in Labrum
• -pain for both part 1 and part 2—the problem may be at the AC joint.

IR: In a stressful place and push down so muscles will be compressing and by resisting provoke pain in the labrum in part 1, IR,
ER: Turning palm up puts biceps on slack and less stress there in part two, changing the compression did not change symptoms then we suspect the AC joint

Question 24

Mimori New Pain Provocation

Answer 24

Rationale: superior labral problem–passive compression test, stretching the biceps tendon over the GH joint–does it pinpoint patient pain

Pt position: patient seated, therapist stabilizes the shoulder and holds the distal forearm

Phase 1: PT to pt:
90 degrees abduction and fully ER with elbow flexed to 90 degrees and forearm pronated. (Bicep on slack one joint, but stretching a little as a pronator)

allow patient to rest a second with arm at side

Phase 2: again but with forearm supinated (slack bicep both jts)

Positive sign: pain provoked with pronation or pain greater in pronation than in supination—LABRUM

Question 25

Biceps Load Test

Answer 25

superior labral pathology in patients with recurrent dislocation [same position as anterior apprehension test]

Pt position: supine, put shoulder 90/ER, Elbow 90

PT: resistance to isometric biceps elbow flexion (compress bicep)

Negative sign: no pain, no change

[Of note: symptoms relieved when resist elbow flexion (bicep contraction)—maybe taking out impingement or setting humerus into a better position