Shoulder

Question 1

Jobes test (empty can)

Answer 1

Pt in standing
Elevate arms to 90 degrees flexion in scapular plane
Medically rotate arms (thumbs down)
Apply downward force and tell patient to resist
+’ve test = pain reproduction = subacromial impingement
Do full can to further assess supraspinatus

Question 2

Hawkins- Kennedy test

Answer 2

Patient seated
Arm to 90 degrees flexion resting on your arm.
Perform passive internal rotation.
+’ve test = pain reproduced = subacromial impingement
Negative test if pt has internal impingement

Question 3

Neers test

Answer 3

Patient seated
One hand depresses the scapula.
Other hand internally rotate arm.
Perform maximally forced flexion.
+’ve test = pain reproduced
Anterior shoulder pain = subacromial impingement
Posterior shoulder pain = internal impingement

Question 4

Apprehension test

Answer 4

Patient in supine
Arm to 90 degrees abduction, and external rotation.
+’ve test = pain or fear of subluxation
Anterior pain = subacromial impingement
Posterior pain = internal posterior-superior glenoid impingement

Question 5

Relocation test

Answer 5

Done after apprehension test
Apprehension test position, to the pain position.
Add posterior glide.
+’ve test = pain diminishes during test = impingement is secondary + pain elicited from excessive anterior translation.
-‘ve test = pain persists = indication of primary impingement

Question 6

Load and shift test

Answer 6

Pt seated, arms rested on thighs.
Stabilise clavicle and scapula spin with 1 hand.
Grab numeral head with other hand.
Load portion - position head centrally in glenoid fossa.
Shift portion - testing anterior capsule when you translate humeral head forward, and testing posterior capsule when translate humeral head backwards.
+’ve test = reproduce symptoms or more translation on affected side

Question 7

Sulcus sign

Answer 7

Patient standing.
Stabilise unaffected shoulder with one hand.
Hold affected arm distally to elbow joint and pull arm distally.
+’ve sign = inferior shoulder instability or Glenn humeral laxity.
Sulcus sign = lip under acromion or feeling of subluxation

Question 8

Full can

Answer 8

Patient standing.
Bring arms to 90 degrees flexion in scapula plane, (thumbs up)
Apply downward force and ask pt to resist.
+’ve empty can + -‘ve full can = impingement not primarily related to rotator cuff lesion.

Question 9

Speeds test

Answer 9

1. Pt starts with extended elbow and supinated forearm. Ask pt to flex arm to 60 degrees against pt.s resistance.
2. Pt starts with extended elbow, supinated forearm and shoulder flexed to 90 degrees forward flexion. Pt must keep arm there and resist downward force.

Therapist force on forearm.

+I’ve test = pain in bicipital groove.

Question 10

Biceps load ll tests

Answer 10

Pt in supine.
Shoulder in 120 degrees abduction with elbow flexed to 90 degrees.
Ask pt to flex elbow against resistance.
+’ve = patient complains about pain during resisted elbow flexion.

Question 11

O’breins test

Answer 11

Patient arms flexed to 90 degrees with 10 degrees adduction.

1. Ask pt to internally rotate arms and resist downward force.
2. Ask pt to externally rotate arms and resist downward force.

+’ve for slap lesion = pain provoked during 1st test is lessened or disappears with 2nd position

Question 12

Dynamic labral tests

Answer 12

Stand behind pt and hold affected arm at wrist with 1 hand, will applying anterior force on proximal humerus with other hand.
Elevate pts arm from 90-150 degrees of flexion.
+’ve for slap lesion = pain felt or examiner feels click between 90-120 degrees of elevation.

Question 13

Yergason test

Answer 13

Pts forearm flexed to 90 degrees in full pronation and stabilise against body.
Ask pt to perform supination and resist the movement at the same time.
Make sure you palpate the biceps tendon in the bicipital groove.
Biceps tendon popping out of groove = tear of transverse humeral ligament.
Tenderness or pain, no pop = biceps tendinitis or slap lesions.

Question 14

Jerks test

Answer 14

Pt in sitting.
Stand behind pt, stabilise scapula with one hand and hold pts affected arm at 90 degrees abduction, internal rotation.
Apply longitudinal force through humerus at elbow and move arm into horizontal adduction.
+’ve test = sudden clank as humeral head slides off the back of the glenoid and pain.

Question 15

Kim’s test

Answer 15

Patient seated.
Stand at injured side of pt.
Abduct shoulder to 90 degrees and support elbow at 90 degrees flexion.
Apply axial force to glenoid through humerus with body and place your hand distal to the deltoid.
Maintaining axial force, elevate pts arm diagonally upwards while applying downward and posterior force with other hand.
Test +’ve for posteroinferior labral tear if = sudden onset posterior shoulder pain and click in shoulder.

Question 16

AC joint

Answer 16

1. Elevate arm to 9p degrees flexion, then maximum horizontal adduction.
   +’ve test = pain on top of shoulder near AC Joint.
2. Patient seated. Elevate arm to 90 degrees flexion. Ask pt to resist horizontal adduction.
   +’ve test = pain on top of shoulder near AC Joint.
3. O’breins test

Question 17

Paxino’s sign

Answer 17

Pt seated with arm resting alongside body.
Stand behind pt on the side you want to examine.
Place hand over shoulder so that
- thumb rests under posterior lateral aspect of acromion
- index and long fingers superior to the mid part of the clavicle.
Apply pressure to acromion with thumb, in anterior superior direction.
Inferior pressure on clavicle.
+‘ ve test = pain in region of AC joint.

Question 18

Scapular assistance test

Answer 18

During elevation, impingement may occur if the scapula doesn’t follow the humeral head
sufficiently in the movement of lateral rotation, posterior tilting and external rotation
To perform = fixate the clavicle and the scapular spine with one hand. With the other hand; grab the inferior angle of the
scapula. Then ask the patient to perform abduction and assist the movement of the scapula
The test is positive if the patient experiences less pain during the assisted movement in comparison with the non-assisted movement
A positive test indicates weakness of the scapular stabilizers because assistance stimulates the function of the serratus anterior, as well as the lower trapezius

Question 19

Scapular retraction test

Answer 19

Fixate the clavicle and the spine of the scapula with one hand; and with the forearm of the same
hand, press the scapula of your patient against the chest wall
With the fixation of the clavicle and the scapula = perform the empty can test
Positive test = if the pain during the empty can test is reduced
A positive test indicates weakness of the serratus anterior and lower trapezius muscles