Shoulder

Question 1

Standing

PT abducts patient’s arm to 90 ͦand asks patient to slowly lower arm back to side in same arc of movement

Answer 1

Drop Arm Test

RTC tear, specifically supraspinatus

Cannot return arm slowly or has severe pain when attempting it

Question 2

Standing
Elbow extended Forearm supinated

Palpate bicep tendon while resisting shoulder flexion

Answer 2

Speeds test

Bicipital tendinitis

Tenderness or pain in the bicipital grove

Question 3

Supine

Anterior: abduct arm to 90 ͦ and externally rotate shoulder gently

Answer 3

Crank Test

Anterior instability

Patient looks or feels apprehensive or alarmed

Question 4

Supine or sitting position

Elevate shoulder to 90 ͦ while stabilizing scapular; apply posterior force to elbow then horizontally adduct and internally rotate arm

Answer 4

Posterior Apprehension Test

Posterior instability

Look of apprehension/alarm on patient’s face and resistance to move further

Question 5

Standing

Forward flex arm to 90 ͦ then forcibly internally rotate shoulder

Answer 5

Hawkins Kennedy

Shoulder impingement

Pain for supraspinatus paratenonitis/ tendinosis or secondary impingement

Question 6

Sitting
Arm positioned 90° of elbow flexion and stabilized.

Forearm is pronated. Patient is asked to supinate forearm, and PT resists supination while the patient also laterally rotates the arm against resistance

Answer 6

Yergason’s Test

Torn transverse humeral ligament

Bicipital paratenonitis or tendinosis
Tenderness in the bicipital groove

Question 7

Standing

Abduct arm to 90° with neutral rotation. PT resists abduction. Shoulder is medially rotated then angled forward 30° with thumbs pointing at the floor

Answer 7

Empty Can Test

Supraspinatus tear Neuropathy of suprascapular nerve

Signs of weakness or pain

Question 8

Sitting or standing

Prevent scapular rotation with hand. Arm is passively and forcibly fully elevated as arm is medially rotated by the PT.

Answer 8

Neer Impingement Test

Overuse injury of supraspinatus muscle or biceps tendon

Pain in face

Question 9

Supine on table

Place one hand on the posterior aspect of the shoulder, and the other holds the humerus above the elbow.
Fully abduct arm overhead and push anteriorly over the humeral head while rotating the humerus into lateral rotation.

Answer 9

Clunk Test

Glenoid labrum tear

Clunk or grinding sound

Question 10

Standing

Arm is forward flexed 90° and elbow fully extended. Arm is horizontally adducted 10° to 15° and medially rotated. A downward eccentric force is applied from behind. Arm is returned to the starting position with palm supinated, and a downward eccentric load is applied again.

Answer 10

O’Brien Test

SLAP lesions Type II or superior labral lesions

Pain or painful clicking inside the shoulder in the first part of the test and eliminated or decreased in the second part

Question 11

Supine

Shoulder abducted 90° and laterally rotated, with elbow flexed to 90° and the forearm supinated. Take test arm into full lateral rotation. Patient is asked to flex the elbow against resistance at the wrist.

Answer 11

Biceps Load Test

Superior labrum lesion

Apprehension is the same or shoulder becomes more painful

Question 12

Sitting or standing

Shoulder is placed 120° of abduction and maximally externally rotated. Patient performs a biceps contraction against resistance.

Answer 12

Biceps Load Test II

SLAP lesion

Deep pain within shoulder during contraction

Question 13

Supine

Move shoulder into 90° abduction, maximum external rotation and 15-20° extension

Answer 13

Posterior Internal Impingement Test

Impingement between RC and greater tuberosity

Reproduction of pain in posterior shoulder

Question 14

Standing with back to PT

Place elbow at 90° flexion, and 20° elevation. Passively externally rotate arm to near end range. Maintain position when PT lets go

Answer 14

ER Lag Sign

Tear of supraspinatus or infraspinatus tendon

Unable to maintain position once PT lets go

Question 15

Seated with back to PT

Patient’s arm in maximum internal rotation while keeping arm off the back. Patient maintains position

Answer 15

IR Lag Sign

Subscapularis tear

Unable to maintain position once PT lets go

Question 16

Sitting

Locates radial pulse. Head is rotated to face the test shoulder.
Extend the head while externally rotating and extending shoulder.
Patient takes a deep breath and holds it.

Answer 16

Adson Maneuver

Thoracic outlet syndrome secondary to a cervical rib or 1st thoracic rib syndrome

Disappearance of the radial pulse

Question 17

Standing

Abduct the arms to 90° and laterally rotate shoulder and flex the elbows to 90°. Patient opens and closes the hands slowly for 3 minutes.

Answer 17

Roos Test

Thoracic outlet syndrome secondary to neurovascular compromise

Unable to keep the arms in the starting position for 3 minutes; ischemic pain, heaviness or profound weakness of the arm; numbness and tingling of the hand during the 3 minutes

Question 18

Sitting

Flex elbow to 90° while shoulder is extended horizontally and externally rotated. Rotate the head away from the test side.
Palpate the radial pulse

Answer 18

Allen’s Test

Thoracic outlet syndrome secondary to pectoralis syndrome.

Absent radial pulse when the head is rotated away from the test side

Question 19

Sitting and then supine

Hyper abduct arm so the hand is over the head with the elbow and arm in the coronal plane
PT palpates the radial pulse.

Answer 19

Wright Test

Thoracic outlet syndrome secondary to compression in costoclavicular space

Absent radial pulse

Question 20

Sitting

PT palpates the radial pulse and then draws the patient’s shoulder down and back.

Answer 20

Costoclavicular Syndrome Test

Thoracic outlet syndrome secondary to costoclavicular syndrome

Absence radial pulse

Question 21

Sitting

Find radial pulse and apply a downward traction on extremity while the neck is hyperextended, and the head is rotated to the opposite side

Answer 21

Halstead Maneuver

Indicates TOS secondary to anterior scalene syndrome.

Absence or disappearance of the radial pulse

Question 22

Standing or sitting

Place arms by the side and relax muscles. Grasp the forearm below the elbow and pull arm distally.

Answer 22

Sulcus Sign

Inferior instability or glenohumeral laxity

Depression more than a finger width between lateral acromion and the head of the humerus

Question 23

Supine

Arm is in 90° of abduction and full external rotation. Apply anterior push to posterior aspect of the sublaxed humeral head.
After, push the humeral head posteriorly while shoulder is in the same position.

Answer 23

Jobe Subluxation/Relocation Test

Superior labral tear

Pain and apprehension from patient

Question 24

Sitting without stabilizing upper trunk

Check if the humeral head is sitting anteriorly; humerus is pushed posteriorly in the glenoid if necessary. Push the humeral head anteriorly and watch for the amount of translation and end feel.

Answer 24

Load and Shift Test

Atraumatic instability of glenohumeral joint

Posterior translation of 25% or more of the humeral head diameter.

Question 25

Supine

Flex elbow to 120° and shoulder to 80° - 120° of abduction and 20° - 30° of forward flexion. Stabilize scapula. Rotate upper arm medially and forward flex shoulder to 60° - 80° while pushing head of the humerus posteriorly

Answer 25

Posterior Drawer Test of the Shoulder

Posterior translation
Labral tear Slippage of the humeral head over the glenoid rim

Increased posterior translation of half or more of humeral head diameter. May also show apprehension

Question 26

Supine

Abduct arm to 90° with full external rotation. Hold wrist while also stabilizing elbow. Apply overpressure into external rotation. Apply a small anterior force to the posterior humeral head.

Answer 26

Anterior Apprehension Test

Anterior instability

Apprehension or alarm from patient, and resists further motion

Question 27

Supine

Shoulder is abducted 80° - 120°, forward flexed up to 20° and laterally rotated up to 30°. Stabilize scapula, pushing spine of the scapula forward. Give counter-pressure on the coracoid process. Draw the humerus forward.

Answer 27

Anterior Drawer Test of the Shoulder

Anterior translation
Labral tear or slippage of the humeral head over the glenoid rim

Movement with an accompanying click, apprehension, or both. Increase in laxity and less firm end point

Question 28

Sitting or standing

Cup hands together over deltoid muscle; one hand on the clavicle and the other on the spine of the scapula. Squeeze the heels of the hands together.

Answer 28

Acromio-clavicular Shear Test

AC joint dysfunction such as arthritis, separation
Abnormal movement at the AC joint

Question 29

Sitting

Passively forward flex arm to 90° and then horizontally adduct arm as far as possible

Answer 29

Crossover Impingement/ Horizontal Adduction Test

AC joint dysfunction

Local pain over the AC joint