Shoulder Special Tests Flashcards
Special tests for tendinopathy or partial thickness RTC tear
- Hawkins-Kennedy
- Painful arc sign
- Infraspinatus muscle test
Describe Neer test
- Passive for the patient
- Thumb down and move into shoulder flexion
- Positive = reporting of concordant sign (painful area)
Describe Hawkins-Kennedy test
- Hold pt arm in 90º ABD and pull across in front of their chest
- Passively push into IR
- Positive = reporting of concordant sign (painful area)
Special tests for full thickness RTC tear
- Rent sign AKA trans-deltoid palpation test
Special tests for supraspinatus full thickness RTC tear
- Drop arm test
- ER lag sign
Special tests for infraspinatus full thickness RTC tear
- Drop sign
Special tests for tires minor full thickness RTC tear
- Hornblower’s sign
Special tests for subscapularis full thickness RTC tear
- Lift off test
- IR lag sign
Describe drop arm test
- Test supraspinatus
- Passively ABD shoulder to 90º
- Let go & have patient slowly lower hand
- Positive = inability to hold the arm/lower slowly
Describe drop sign
- Test infraspinatus
- Shoulder ABD to 90º & full ER with PT hand supporting elbow
- Hold wrist into ER then let go
- Positive = unable to hold the ER position
Describe ER lag sign
- Test supra/infra spinatus
- Position the arm in 20º scaption, flex elbow to 90º
- Passively ER to near end range, hold elbow & let go of wrist
- Positive = inability too maintain the shoulder in full ER position
Describe horn blower’s test
- Test for terres minor
- Shoulder ABD to 90º & full ER
- Hold resistance into ER
- Positive = unable to hold ER resistance
Describe horn blower’s sign
- Test teres minor
- Have patient actively bring arm into 90º shoulder ABD and flex elbow to touch fingers to mouth
- Positive = inability to get into this position with the shoulder ABD to 90º
Describe IR lag sign
- Test for subscapularis
- Position with holding elbow & hand behind back, let go of hand
- Positive = inability to keep test position
Describe lift off test
- Test for subscapularis
- Position hand at lumbar region actively & ask to lift hand off back
- Positive = inability to lift hand off back
Describe posterior impingement sign
- Position shoulder in >90-110º ABD, slight extension, & ER to end range
- Positive = very specific deep posterior/superior pain
- Symptom: pain during eccentric deceleration phase of the UE throwing or swinging
Special tests for anterior/anterior inferior GH instability/Bankart labral tear
- Anterior slided (Kibler)
- Active compression (O’Brian)
Special tests for SLAP lesion
- Biceps load I & II
- Anterior slide/Kibler test
Special tests for posterior labral tear
- Kim test
- Jerk test
Describe Yergason test
- Patient standing or sitting with elbow at 90º flexion
- Patient supinates forearm against examiner’s resistance (try to bring fingers to mouth motion)
- During test palpate along the long heads of biceps tendon
- Positive = pain at biceps tendon
Describe Crank test
- Patient supine with shoulder ABD to 160º and elbow flexed to 90º
- Apply compressive force to the humerus while repeatedly rotating it into IR/ER
- Positive = click produced during the test
Describe the anterior slide (Kibler) test
- Patient standing with hands on hips and thumbs facing posteriorly
- Stabilize the scapula with one hand and apply anterior/superior force through the elbow tie the other hand
- Positive = pain or click elicited in anterior shoulder
Describe active compression test (O’Brien)
- Patient is standing with shoulder flexed to 90º with thumb pointed down
- Apply resistance
- Retest now with thumb up
- Positive = pain or painful clicking when shoulder is in IR and less or no pain when shoulder is in ER
Describe biceps load I/II
- Position patient in 90º shoulder ABD (I) and 90º elbow flexion & supination
- Active resist elbow flexion
- Positive = reproduction of concordant pain
- Biceps load II patient is in 120º shoulder ABD instead of 90º
Describe the Kim test
- Test for posterior labral tear
- Grasp elbow & humerus position to 90º shoulder ABD, apply an axial load at a 45º elevation to the proximal humerus
- Positive = sudden posterior shoulder pain
Describe the Jerk test
- Test for posterior labral tear
- Grasp scapula with one hand & elbow with the other
- Elevate he shoulder to 90º with slight IR
- Apply an axial lead & move from horizontal ABD to ASS
- Positive = sharp pain w/ or w/o a clunk or click
Extra-Articular conditions
- Long head biceps tendinopathy/tendinosis
- AC joint pathology
- Pain referred from elsewhere
- Special tests do NOT exist that reach criterion level significance & clinical utility
Special tests for long head biceps tendinopathy/tendinosis
- Yergason’s
- Speeds
- Gilcreest palm up
- Upper cut
Describe Gilcreest palm up test
- Test for long head biceps tendinopathy/tendinosis
- Patient moves their shoulder into max flexion with thumb up and then maximally ER while slowly lowering their arm down in ABD
Describe upper cut
- Test for long head biceps tendinopthy/tendinosis
- Patient makes a fist & the examiner covers the first with the opposite hand & resist a fast upper cut motion
- Positive = pain in anterior shoulder
- Upper cut as screening test and Ferguson as confirmation in new study
Describe speeds test
- Test for long head biceps tendinopathy/tendinosis
- Patient elevates humerus to 90 with elbow extended & forearm in supination
- Patient holds this position while the examiner applies resistance against elevation
- Positive = if pain is elicited in the bicipital groove area
Special tests for AC joint
- AC resisted extension
- Cross body ADD
- Active compression (O’Brian’s)
Describe AC resisted extension test
- Test for AC joint
- Patient seated with shoulder at 90º flexion & slight IR
- Examiner resists horizontal ABD plus extension
- Positive = pain at the AC
Describe the cross body ADD test
- Test for AC joint
- Patient seated with shoulder at 90º flexion & slight IR placing hand on contralateral shoulder
- Examiner grasps elbow & passively moves shoulder into horizontal ADD
- Positive = pain at the AC
Special tests for shoulder instability
- Sulcus sign
- Load & shift
- Apprehension
- Relocation
- Surprise test
Illness script for shoulder instability
- Younger, contact sports
- Most frequent is anterior dislocation
- Multidirectional instability if 2 or more directions
Describe sulcus sign
- Position sitting with slight ER, examiner grasps forearm & distracts the shoulder
- Observation for space to appear between humeral head & AC joint
Describe load and shift test
- Patient sitting, PT stabilize the scapula & coracoid then finger & thumb grasp the humeral head
- Load and shift the humeral head anteriorly
- Positive = excessive motion >50% humeral head diameter
Describe apprehension test
- Patient supine examiner passively abducts to 90º & ER humerus to end range
- Positive = patient complains of pain or instability
Describe relocation & surprise test
- Relocation: back off the end range apprehension test position & the examiner adds support of a posterior directed GHJ glide & then add more ER
- Surprise: progress the above by removing your proximal hand; Positive = if apprehension comes back or a sublux/dislocation is felt
Adhesive capsulitis illness script
- Age ≥50
- Females more than males
- Endocrine disorders: DM, thyroid
- Capsular pattern of limitation ER>ABD>IR (ER limited the most)
Phases of adhesive capsulitis
- Painful -> freezing -> thawing
- Pain -> severe night pain -> stiff pain at end range -> stiff minimal pain
- Pain > stiff -> stiff > pain
CPR for OMPT (orthopedic manual physical therapy) for shoulder pain
- Pain free shoulder flexion <127º
- Shoulder IR <53º at 90º ABD
- negative Neer’s impingement
- Not taking pain medications for the shoulder
- Duration of symptoms <90 days
Describe the Mulligan concept of mobilization with movement
-Patient must have ability to actively move the segment for MOST techniques.
- Patient must be able to tolerate at least gentle manual pressure during the movement.
- Ideally patient will be able to cognitively comply with self-mobilization techniques for home program, or a family member be able to assist.
- Multiple physiological mechanisms of action, but simply put, repositioning the joint assists with proprioception and mechanoreceptor inhibition/activation as indicated, and then the physiological movement serves to re-educate and reprogram the neural loop for correct muscle recruitment and control.
