Shoulder Exam

Question 1

Shoulder Special Tests

Answer 1

Sub-Acromial Pain Tests
Rotator Cuff Tear Tests
Instability Tests
Labral Tests
Scapular

Question 2

Subacromial Pain Tests

Answer 2

Hawkins-Kennedy
Neer’s
Painful Arc
Full Can
Speed’s

Question 3

Hawkins-Kennedy

Answer 3

90 Flexion
Internally rotate

Positive: anterolateral pain

Good at ruling out subacromial pain, unable to rule in/out specific structures

Sensitivity: 76%
Specificity: 48%

Question 4

Neer’s

Answer 4

Full internal rotation
Bring shoulder up into flexion

Positive: anterolateral pain

Good at ruling out subacromial pain, unable to rule in/out specific structures

Sensitivity: 64-68%
Specificity: 30-61%

Question 5

Painful Arc

Answer 5

AROM abduction

Positive: pain 60-120 = subacromial
Pain 170+ = AC Joint

Good at ruling in or out subacromial pain, unable to rule in/out specific structures

Sensitivity: 71%
Specificity: 81%

Question 6

Full Can

Answer 6

90o elevation in Scapular Plane, Thumb up
Break Test

Positive: anterolateral pain or weakness

Sensitivity: 75%
Specificity: 68%

“biases” supraspinatus but impossible to isolate

Question 7

Speed’s

Answer 7

Full External rotation
Resist through flexion range

Positive: anterolateral pain

“biases” LHB, isolation impossible

Sensitivity: 68%
Specificity: 55%

Question 8

FT Rotator Cuff Tear Tests

Answer 8

Drop Arm
ERRT
ER Lag
Belly Press
Lift Off

Question 9

Drop Arm

Answer 9

Passively abduct above 90
Patient slowly lowers

Positive: unable to eccentrically control

Interpretation: Rotator Cuff Tear

Good at ruling in

Sensitivity: 24%
Specificity: 93%

Question 10

ERRT

Answer 10

Resisted ER at 0

Positive: Pain or weakness

Interpretation: Infraspinatus tear/involvement

Good at ruling in but not out

Sensitivity: 63%
Specificity: 75%

Question 11

ER Lag

Answer 11

~20 scapular plane, 90 elbow
Externally rotate shoulder and ask pt to hold

Positive: unable to hold position

Interpretation: Cuff tear (infra)

Good at ruling in, but not out

Question 12

Belly Press

Answer 12

Hand over stomach
Pt brings elbow forward while maintaining pressure on stomach

Positive: Unable to bring elbow fwd

Interpretation: Upper Subscap Tear

Question 13

Lift Off

Answer 13

Hand behind back
Patient lifts hand away from back (can also resist)

Positive: Unable to lift

Interpretation: Lower subscap tear

Sensitivity: 71
Specificity: 49

Question 14

Confirm SA pain

Answer 14

= rule in

painful arc
resisted ER (ERRT)
full can
drop arm

Question 15

Screen out SA pain

Answer 15

painful arc
resisted ER (ERRT)
Hawkins
Neer
Full can
Empty can

Question 16

Instability Tests

Answer 16

Anterior Apprehension

Relocation

Posterior Apprehension

Question 17

Anterior Apprehension

Answer 17

Supine, 90 Abd, 90 Elbow
Slowly ER, watch pt’s face

Positive: Apprehension/guarding

Interpretation: No instability if negative

Sensitivity: 63%
Specificity: 98%

Question 18

Relocation

Answer 18

During Anterior Apprehension
Provide a Posterior Force

Positive: Apprehension symptoms go away

Interpretation: Anterior Shoulder Instability

Sensitivity: 68%
Specificity: 92%

Question 19

Posterior Apprehension

Answer 19

Supine, hand under posterior shoulder, 90 scaption

Provide gentle posterior load while moving into horiz add

Positive: Apprehension

Interpretation: Posterior shoulder instability

Question 20

Labral Tests

Answer 20

Load and Shift

O’Brien

Biceps Load II

Kim

Question 21

Load and Shift

Answer 21

Seated or supine
Grasp humeral head, compress and move anterior and posterior

Positive: Deep symptom reproduction

Interpretation: Possible anterior or posterior labral involvement

Clicking means nothing unless symptomatic

Question 22

O’Brien

Answer 22

Seated, 90 flex, Horiz Add, full IR
Break Test

Positive: Deep anterolateral pain

Interpretation: SLAP tear

Must rule out Sub acromial/AC pain first or just the position will hurt

Sensitivity: 62%
Specificity: 51%

Question 23

Biceps Load II

Answer 23

Supine, 120 abd, 90 elbow
Resist elbow flexion

Positive: Deep anterior pain

Interpretation: SLAP tear with bicep involvement

Question 24

Kim

Answer 24

Seated, 90 abd, 90 elbow

Compress joint, move diagonally in horiz add and flex while providing posterior force to humerus

Positive: Pain/Apprehension

Interpretation: Posterior Labral Tear

Question 25

Other Tests

Answer 25

Sulcus

Cross-arm

AC Shear

Question 26

Sulcus

Answer 26

Seated

Inferiorly distract shoulder

Positive: 1 finger sulcus, should tighten in ER. If present in ER rotator interval injury

Interpretation: Only measures laxity

Question 27

Cross-arm

Answer 27

Seated

Horiz Add arm to opposite shoulder, can add resistance

Positive: Pain over AC

Interpretation: AC Joint Involvement

Question 28

AC Shear

Answer 28

Seated, arm at side

Compress the clavicle and scapula

Positive: Pain over AC

Interpretation: AC Joint involvement

Question 29

Scapular Assessment
Dyskinesis potential contributors:

Answer 29

Muscle weakness/imbalance = Correlate with MMT and symptoms

Nerve Injury = Correlate with MMT/RI and symptoms

Dynamic control

Question 30

Scapular Tests

Answer 30

Reposition

Assistance

Question 31

Reposition

Answer 31

Standing, pt lifts arm into scaption, document pain

Pull scap into posterior tilt and retraction, pt repeats test

Positive: Decrease in pain

Interpretation: Scapular dyskinesis may contribute to pain

Question 32

Assistance

Answer 32

Standing, pt lifts arm into scaption, document pain

Cue scapula into upward rotation, pt repeats test

Positive: Decrease in pain

Interpretation: Scapular dyskinesis may contribute to pain