Shoulder Ortho Tests Flashcards
Procedure of Apprehension Test (Ant. Apprehension test)
- Patient seated, Dr. behind them.
- Dr. asks patient to look at them.
- Dr. SLOWLY brings the should to 90 abduction w external rotation while stabilizing the shoulder from behind.
Interpretation of Apprehension/Ant. Apprehension test?
+ if there is one of the following:
- Pain over ant. capsule resembling the pain from previous dislocation(s).
- Look of apprehension on patient’s face.
- Laxity compared to the other side.
Procedure of Relocation Test?
**ONLY DONE IF APPREHENSION TEST IS + **
The same position as the Apprehension test.
- Stabilize patient with inside hand and a wide C contact.
Interpretations of Relocation Test
- if patient experiences relief of symptoms that manifested during the apprehension test.
- Decreased apprehension = anterior instability.
- Decreased pain = anterior instability and cuff disease.
Procedure of Posterior Dislocation Apprehension test?
- Patient lying supine with shoulder 90 flexed and internally rotated.
- Dr. applies a posterior force on the elbow
- Dr. is watching the patient for signs of apprehension, pain, or resistance to the force.
Interpretation of Posterior Dislocation Apprehension test?
- test is indicated by signs of apprehension, pain or resistance to the force.
- indicates posterior dislocation trauma of the humerus.
Procedure to Jobes test?
- Patient is lying supine with shoulder in same position as Apprehension test.
- Dr. applies A-P force to proximal humerus while externally rotating the shoulder.
Interpretation of Jobes test?
- is a decrease in pain and/or apprehension test is a positivie test.
Procedure of Sulcus Sign?
- Patient is seated with their hand internally rotated in their lap.
- Dr. applies inferior traction/pulls the patient’s humerus down by grasping the patient’s elbow.
- Dr. looks/palpates over the inferior aspect of the acromion process.
- Test should be repeated at 45 abduction.
Interpretations of Sulcus Sign?
- Increased laxity at 0 abduction = Rotator interval laxity.
- Increased laxity at 45 abduction = laxity of the inferior GH ligament complex.
Procedure of Load and Shift / Drawer test?
- Patient is seated, supine or side-lying.
- Dr. stabilizes the superior shoulder with their cephalad hand.
- Dr. takes caudal hand with a big C contact and contacts the anterior and posterior aspect of the humeral head.
- Dr. compresses the humeral head into the glenoid then slides the head anterior and posterior.
- Normal movement is <25% of the diameter of the humeral head and posterior 50%
Interpretations of Load and Shift /Drawer test?
- test = abnormal AP/PA translation and/or popping, grinding, and slapping.
- Indicating instability of the GH joint and possible labrum damage.
Procedure of Dugas test?
The patient is seated.
- Dr. tells patient to anteriorly touch their opposite shoulder with their hand.
- Once they do that, Dr. tells them to stay in that position but lower their elbow to their chest.
Interpretations of Dugas test?
- Inability to touch the anterior opposite shoulder or unable to lower arm to chest = anterior dislocation of humerus.
Procedure of Apley’s Scratch test?
- Patient can sit or stand.
- Dr. asks patient to reach over their head and touch the back side of their opposite shoulder.
- After that Dr. asks the patient to reach behind their backs and touch their opposite shoulder.
Interpretation of Apleys Scratch test?
- Exacerbation of pain in the shoulder = Degenerative tendinitis of the rotator cuff – Usually supraspinatus tendon.
Procedure of Subacromial Push Bottom sign?
- Patient is seated.
- Dr. stands behind the patient and applies pressure to the subacromial bursa.
Interpretations of Subacromial Push Button sign?
- Increase in pain = subacromial bursitis.
Procedure of Subacromial Bursa/ Dawbarn’s sign?
- Repeat subacromial push button sign (anterolateral and inferior to the acromion) then note the amount of pain (0-10 scale)
- Doctor keeps finger in painful area and passively abducts arm to 90.
Interpretations of Subacromial Bursa/Dawbarn’s sign?
Decreased tenderness or pain disappearing = Subacromial bursitis.
Procedure of Drop Arm/Codman’s Drop Arm/ Codman’s test?
- Patient seated.
- Dr. passively abducts arm to above 90 then suddenly removes their support causing the deltoid to contract.
– Alternative is having patient slowly lower their arm down.
Interpretations of Drop Arm/ Codmans Drop Arm/ Codmans test?
- Pain and hunching of shoulder = rotator cuff tear or rupture of the supraspinatus tendon.
- If test is (-) but there is pain over the anterolateral shoulder, that could indicate subacromial bursitis.
Procedure of Empty Can/Supraspinatus test?
- Patient is standing with their arms abducted to 90, elbows extended and neutral rotation.
- Dr. pushes down on patients arms.
- Shoulders are then moved 30 in horizontal flexion and thumbs pointing down.
- Dr. pushes down on arms again.
Interpretations of Empty Can/Supraspinatus test?
Weakness or pain = (+) for weak or injured supraspinatus muscle or tendon.
Procedure for Lift Off/Gerber’s/Subscapularis sign?
- Patient is seated or standing with their hand behind their back, palms facing out (should not be painful).
- Dr. asks the patient to try and lift their hand off their back.
Interpretations of Lift Off/Gerber’s/Subscapularis sign?
Inability to lift hand form their back = (+) for lesion of the subscapularis muscle or tendon.
Procedure for Yergasons?
- Patient seated with their elbows flexed at their side.
- Dr. applies resistance while the patient is trying to supinate their wrist.
- While doing this, Dr. tells the patient to resist efforts to extend the elbow.
Interpretations of Yergason’s?
- Pain developing or aggravated over the bicipital groove = (+) tenosynovitis of the transverse humeral ligament.
Procedure for Clunk test?
- Patient is lying supine.
- Dr. places one hand behind the humeral head, and the other hand grasps the patients wrist and full abducts the shoulder.
- Dr. is then going to push anteriorly on the humeral head and examiner externally rotates the shoulder while keeping it fully abducted.
Interpretation of Clunk test?
- Any clunk or grinding as the shoulder attempts to dislocate anteriorly = (+) anterior tear of the glenoid labrum.
Procedure for Crank test?
- Patient is lying supine with their shoulder abducted 160 in flexion in the scapular plane.
- Dr. applies an axial force while internally and externally rotating the arm.
Interpretations for Crank test?
Clicking with pain = (+) labrum tear
Procedure for O’Brien sign?
- Patient is seated with their elbows extended and shoulder in 90 flexion and 10/15 horizontal flexion.
- First Dr. internally rotates and tells the patient to resist downward force.
- Second, Dr. does the same thing but instead external rotation and downward force.
Interpretations of O’Brien sign?
- If the patient experiences pain with external rotation but reduced/no pain with internal rotation = (+) test.
- Pain in both external and internal position = (-) test.
- Deep shoulder pain = Glenoid Labrum.
- Superficial, top of shoulder = AC injury.
Procedure for Impingement Syndrome test?
- Patient is supine or seated with their elbow flexed.
- Dr. applies superior pressure on elbow into subacromial/suprahumeral space.
Interpretations of Impingement Syndrome test?
Increased pain = (+) for impingement syndrome.
Procedure for Hawkins-Kennedy test?
- Patient can be supine or seated.
- Dr. is infront of patient holding their elbow/shoulder in 90 flexion.
- Dr. forcibly internally rotates the shoulder (dr. hand is under the deltoid) by supporting the elbow and pushing down on the patients wrist.
- This motion pushes the supraspinatus tendon against the anterior surface of the coracoacromial ligament.
Interpretations of Hawkins-Kennedy test?
- Pain in the anterior GH joint = (+) rotator cuff tendonitis.
- Additionally, pain may also represent impingement of the supraspinatus tendon.
Procedure of Neer’s test?
- Patient is supine or seated.
- Dr. is next to the patient and forcefully flexes the patient’s arm while depressing the scapula.
- Causing compression of the greater tuberosity against the anterior-inferior acromial process.
Interpretations of Neer’s test?
- Pain in the anterior GH joint = (+) for rotator cuff tendonitis.
Procedure for Impingement Relief/Reverse Impingement test?
- Patient is supine with arms in apprehension position.
- Dr. pushes humeral head from superior to inferior.
Interpretations for Impingement Relief/Reverse Impingement test?
- Decrease in pain or alleviation = (+) mechanical impingement under the acromion.
