Shoulder Ortho Tests Flashcards
Speed’s test
Aim: To identify tendinopathy to long head of biceps, AND/OR unstable SLAP lesions
Action: -Seated or standing, elbow extended, forearm supinated, and 60-90 shoulder flexion
-Op on affected side, stabilise shoulder with one hand, and applies downward pressure (pt resists) on lower forearm
+ve: -Pain localised to bicipital groove = LHB tendinopathy/tenosynovitis
- Deeper seated pain may indicate injury to biceps/labrum complex
Clinic: -If LHB is ruptured, then test may be weak but not painful. Be aware of Popeye’s sign and proximal biceps brachii muscle absence
-Commonly used if SLAP lesions or biceps pathology is suspected, due to bicipital glenoid-labral attachment
Lift-off Test
Aim: To assess integrity of Subscapularis
Action: -Pt seated or standing, with arm fully internally rotated to place dorsum of hand onto middle LSP (NOT SACRUM)
-Op gently encourages full internal rotation by lifting forearm away from LSP
-Pt asked to maintain this position without extending elbow, and then against gentle resistance from Op
+ve: -Pain= partial tear or injury to subscapularis
-Inability to maintain lifted off position=indicative of complete tear
Full can test
Aim: To assess the strength and integrity of supraspinatus
Action: -Pt standing or seated, with affected arm abducted to 90 degrees in scapular plane, with thumbs pointed towards the ceiling.
- Op facing patient, applies downward pressure on forearm, whilst pt maintains starting position
+ve: -Pain WITHOUT weakness = Tendinopathy more likely
-Pain WITH weakness = Partial or complete tear more likely
-Weakness WITHOUT pain = neurogenic source of injury more likely (suprascapular nerve palsy?)
Clinic: This test better assessment of strength than Empty Can test, due to reduced risk of impingement
Empty Can (Jobe’s test)
Aim: Assess for supraspinatus pathology, as well as the presence of potential subacromial impingement
Action: -Pt seated or standing, affected arm abducted into scapula plane, flex to 90. GH internally rotated so thumb points towards the floor.
-Pt maintains starting position against op’s downwards resistance
+ve: Pain, apprehension, weakness or inability to perform the test
O’Brien’s test
Aim: To assess for SLAP lesions or AC joint injury
Action: -Pt seated or standing, shoulder at 90 flexion, and 10-15 adduction, GH internally rotated with forearm pronated and thumbs down.
-Pt maintains this position whilst op applies downward pressure.
-Test is carried out again with arm in neutral, and then in external rotation with palms up.
+ve: -Pain and/or clicking when arm is internally rotated
-Superficial pain around AC may indicate local injury
-Deep pain more indicative of labral lesion/SLAP tear
Clinic: -Utilises LHB, pronation and horizontal adduction add strain to proximal LHB, which then affects the labral fragment it’s attached to, becoming trapped between glenoid fossa and humeral head.
-External rotation (palms up) should reduce the level of pain compared to the first position (internal rotation).
