Shoulder Lab Flashcards
GH joint mobilizations
anterior/posterior
distraction: distract humerus out of joint
inferior: press down towards feet
Scapula joint mobilizations
lateral/medial
inferior
distraction: hold under medial border, pull from ribcage
AC joint play
shoulder position
stand behind pt
shoulder in 20 degrees of abduction for loose pack
fix acromion with pincer grip
translate clavicle ant/post
SC joint play
superior and inferior glides
use dummy thumb for superior glide
tests for GH anterior instability
apprehension test
relocation test
apprehension test
purpose: identify anterior labral instability
supine
90 abd
move shoulder into full ER
positive: apprehension to movement, resistance to movement; more so than pain
relocation test
purpose: identify anterior labral instability
apprehension test position
go to just before point of apprehension
apply posterior translation to humeral head
positive: decreased apprehension/pain
tests for GH posterior/inferior instability
Jerk test
sulcus sign
jerk test
purpose: identify posteroinferior labral stability
position: pt seated, shoulder 90 abd, IR
movement: PT behind pt, hold elbow and scapula superiorly
push GH backwards and adduct arm
positive: sharp posterior shoulder pain, may have clunk
sulcus sign
purpose: GH posteroinferior instability
position: standing, 20-30 shoulder abd
movement: PT pulls humerus inferiorly
positive: depression between acromion and humeral head
SAPS testing cluster
Hawkins Kennedy
Neer
Painful Arc
Full/empty can
ER iso at 90
SAPS test psychometrics for diagnosis
3/5 + tests = 2.93 likelihood ratio
<3 + tests = -.34 likelihood ratio
Hawkins Kennedy test
purpose: SAPS, ACJ
position: 90 shldr flexion, 90 elbow flexion
PT places their arm under testing side and hand onto opposite shoulder
action: compress humerus into glenoid, passive humerus IR
positive: familiar pain
Neer impingement test
purpose: SAPS
position: seated
PT stands behind pt and stabilizes scap with downward force
action: passive IR, flex shoulder through entire PROM
positive: familiar pain
Painful Arc
purpose: SAPS
position: standing
action: pt AROM in abduction, report stop and start of pain
positive: 60-120 painful - GH involvement; >170 painful, ACJ involvement
Full can
purpose: SAPS, RCRPS
position: standing/seated, arm in scapular plane at shoulder height
action: apply downward force in scapular plane as pt resists
positive: familiar pain/weakness
*should be less provocative than empty can
Empty Can/Jobe
purpose: SAPS, supraspinatus tear, impingement, suprascapular n involvement, RCRPS
position: seated, shoulder at 90 degrees in scapular plane, shoulder IR
action: resist downward force
positive: familiar pain in supraspinatus, weakness
Resisted shoulder ER
purpose: SAPS, infraspinatus tear test
position: seated
action: test BL ER MMT
positive: weakness compared to unaffected side
RCRPS (rotator cuff related pain syndrome) test cluster
Jobe/Empty Can
Full Can
ER lag sign
Meaning of negative full can and positive empty can
pain is primarily related to a rotator cuff lesion
Unable to distinguish ________ or _________ with Empty Can test
rotator cuff dysfunction or impingement
ER lag sign
purpose: RCRPS - infraspinatus or supraspinatus pathology
position: passive 20 shldr abd in scapular plane, elbow flexed, full ER - ~5 degrees
action: pt holds as PT releases arm, supporting only elbow
positive: pt is not able to hold max ER in this position, will move into IR
Full thickness infraspinatus tear testing
ER lag sign
Full thickness subscapularis testing
lift off test
belly press
bear hug
lift off test
purpose: subscapularis lesion
position: standing, hand in small of back
action: pt lifts hand off back
positive: pt is unable or aberrant scapular movement
Belly press test
purpose: subscapularis tear
position: standing/seated?, PT has hand on pt belly with pt’s hand pressing in
action: pt presses into belly/PT hand as PT resists their IR
positive: weakness or pain
*quantify weakness w pressure cuff instead of hand
bear hug test
purpose: subscapularis lesion
position: seated
action: pt places hand on opposite shoulder w arm at 90 degrees, pt presses their hand down into the shoulder
positive: pain
rotator cuff tendinopathy/partial tear testing
rule out w what tests?
painful arc
Hawkins Kennedy
these 2 being negative used to rule out diagnosis
If these tests are negative it is unlikely pt has RC tendinopathy
IR lag sign
purpose: rule out full thickness subscapularis tear
position: standing/seated, PT passively moves pts hand behind back and lifts hand off lumbar spine
action: pt maintains forearm position as PT releases them while supporting the elbow
positive: unable to maintain position, falls back towards back
Additional tests for full thickness RC tear
drop arm
hornblower’s sign
Drop arm test
purpose: full thickness RC tear/supraspinatus specifically
position: seated, shldr abducted to 120 passively
action: pt slowly lowers arm to side as PT guards
positive: unable to control lowering of arm to side
Hornblower’s sign
purpose: full thickness RC tear, teres minor or infra
position: seated, passive abd to 90 scapular plane, elbow flexed
action: PT pushes pt into IR and pt resists, pushing into ER
positive: inability of pt to ER in this position, or forearm drops/elbow up
ACJ testing cluster
Paxinos sign
active compression test
Hawkin’s Kennedy
2/3 indicates ACJ involvement?
+ horizontal adduction test for AC joint OA, laxity, separation
Order of ACJ cluster testing
Paxino first
if positive: perform active compression test
if negative: perform Hawkins Kennedy
Paxinos sign
purpose: ACJ involvement
position: seated, arm relaxed at side
action: PT places thumb posterolateral acromion and fingers on clavicle; apply pressure ant/superior direction with hand, fingers apply in inferior direction
positive: local ACJ pain
Active compression/O’Brien test
purpose: ACJ cluster if positive paxinos, SLAP (felt inside shoulder)
position: seated, shoulder flexed to 90, 10 degrees h. add. (hands together)
action: apply downward pressure with shoulder IR, then ER
positive: IR provoking pain/click, ER relieving
* pain location at AC joint or inside GH
SLAP (superior labrum anterior to posterior) testing
Active compression/O’Brien’s: with symptoms inside shoulder
Passive distraction
Passive distraction test
purpose: SLAP lesion
position: supine, 150 abd, forearm supinated
action: PT stabilizes arm and pronate forearm
positive: pain deep in ant or post GH joint
SLAP lesion testing with weak clinical value
bicep load I test
bicep load II test
Crank test
Anterior Slide test
Yergason
Speed’s
Bicep load I test
purpose: SLAP
position: position of apprehension test, 90 abd full ER in supine
action: apply resistance to elbow flexion
positive: apprehension same or worse + pain
Bicep load II test
purpose: SLAP
position: supine, shldr abd 120, 90 elbow flexion, forearm supination
action: flex elbow against resistance
positive: pain
Crank test
purpose: SLAP
position: supine, shldr abd 120
action: provide axial compression to GH from humerus or elbow while repeating IR then go into ER
positive: pain, click, catching
*similar to McMurrays for knee
Anterior slide test
purpose: SLAP
position: seated, hands on waist, thumbs posterior
action: apply anterior superior pressure at elbow as patient resists, stabilize scapula with other hand
positive: pain, click deep in shoulder
Yergason’s test
purpose: integrity of transverse ligament (bicep tendon) bicipital tendinosis, SLAP
position: seated, 90 elbow flexion, forearm pronated
action: palpate bicipital groove, pt resists supination of forearm
positive: pain/tender without popping indicates tendinopathy or SLAP, popping indicates torn transverse humeral ligament
Speed’s test
purpose: SLAP, bicipital tendinosis
position: elbow extended, forearm supinated
action: pt performs AROM flexion to 90, then resist shldr flexion
positive: pain/tender in bicipital groove
ULTT 1
purpose: identifies peripheral nerve dysfunction, median bias
position: supine, depressed shoulder girdle
action: abd 110, ER, forearm supination, then extend elbow, wrist, and fingers
positive: reproduction of symptoms, side to side diff of 10 degrees, CL SB increases symptoms and IL SB decreases symptoms
thoracic outlet syndrome tests
adson’s test
roos test
Adson’s test
purpose: thoracic outlet, vascular component
position: seated, arms 15 deg abd, inhale deeply and hold breath, tilt head back and rotate towards testing side
action: PT checks pulses before and during
positive: change in pulse, paresthesia
Roos test
purpose: thoracic outlet
position: seated, arms 90 abd, 90 elbow flexion
action: pt does slow finger clenching for 3 min
positive: unable to maintain position, pain, heaviness, N/T, disappearance of pulse
Frozen shoulder testing
ROM limitations in capsular pattern (PROM), compare to unaffected side
1. ER (loss of 50% or <30 degrees)
2. Abd 25% loss of motion
3. Flexion 25% loss of motion
Scapulothoracic special tests
lateral scapular slide test
dynamic scapular dyskinesias
lateral scapular slide test
distance of inferior angle from spinous process with arms at side, hands on hips, arms at 90
positive: 1.5+ cm difference between sides
dynamic scapular dyskinesia testing
active flexion/abduction with small weight
positive: medial border winging, inferior angle winging, dysrhythmia including premature shoulder elevation, non symmetrical upward rotation, rapid descent
subscapularis stretch
retract scap with fingers under medial border
pin humerus back with towel/body
pull scapula away from body
perform if limited ER with arms at side
ther ex: active ER, abduction w ER
levator stretch
1 hand superior scap, 1 inferior
rotate scapula upwards and pull inferior angle away from body
ther ex: levator stretch w arm behind head
shoulder close pack
90 abd
full ER
or full abd and ER
shoulder open pack
55 abd, 30 h. add
shoulder capsular pattern
ER>abd>IR
name of types of scapular dysfunction
Kibler types
Kibler type 1
inferior medial border is more prominent
causes of kibler type 1
results from anterior tilt of scapula
tight pec minor/biceps SH
LT, lat, serratus weakness
kibler type 2
medial border off of ribs
worse w hands on hips
glenoid fossa pointed anterior straining anterior capsule
cause of kibler type 2
serratus and LT weakness
kibler type 3
superior border of scapula elevated
causes of kibler type 3
tight UT
weak LT
