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Advanced Orthopedics > Shoulder Special Tests > Flashcards

Shoulder Special Tests Flashcards

1
Q

Special tests for tendinopathy or partial thickness RTC tear

A
  • Hawkins-Kennedy
  • Painful arc sign
  • Infraspinatus muscle test
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2
Q

Describe Neer test

A
  • Passive for the patient
  • Thumb down and move into shoulder flexion
  • Positive = reporting of concordant sign (painful area)
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3
Q

Describe Hawkins-Kennedy test

A
  • 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)
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4
Q

Special tests for full thickness RTC tear

A
  • Rent sign AKA trans-deltoid palpation test
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5
Q

Special tests for supraspinatus full thickness RTC tear

A
  • Drop arm test
  • ER lag sign
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6
Q

Special tests for infraspinatus full thickness RTC tear

A
  • Drop sign
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7
Q

Special tests for tires minor full thickness RTC tear

A
  • Hornblower’s sign
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8
Q

Special tests for subscapularis full thickness RTC tear

A
  • Lift off test
  • IR lag sign
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9
Q

Describe drop arm test

A
  • Test supraspinatus
  • Passively ABD shoulder to 90º
  • Let go & have patient slowly lower hand
  • Positive = inability to hold the arm/lower slowly
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10
Q

Describe drop sign

A
  • 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
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11
Q

Describe ER lag sign

A
  • 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
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12
Q

Describe horn blower’s test

A
  • Test for terres minor
  • Shoulder ABD to 90º & full ER
  • Hold resistance into ER
  • Positive = unable to hold ER resistance
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13
Q

Describe horn blower’s sign

A
  • 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
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14
Q

Describe IR lag sign

A
  • Test for subscapularis
  • Position with holding elbow & hand behind back, let go of hand
  • Positive = inability to keep test position
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15
Q

Describe lift off test

A
  • Test for subscapularis
  • Position hand at lumbar region actively & ask to lift hand off back
  • Positive = inability to lift hand off back
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16
Q

Describe posterior impingement sign

A
  • 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
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17
Q

Special tests for anterior/anterior inferior GH instability/Bankart labral tear

A
  • Anterior slided (Kibler)
  • Active compression (O’Brian)
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18
Q

Special tests for SLAP lesion

A
  • Biceps load I & II
  • Anterior slide/Kibler test
19
Q

Special tests for posterior labral tear

A
  • Kim test
  • Jerk test
20
Q

Describe Yergason test

A
  • 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
21
Q

Describe Crank test

A
  • 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
22
Q

Describe the anterior slide (Kibler) test

A
  • 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
23
Q

Describe active compression test (O’Brien)

A
  • 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
24
Q

Describe biceps load I/II

A
  • 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
25
Q

Describe the Kim test

A
  • 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
26
Q

Describe the Jerk test

A
  • 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
27
Q

Extra-Articular conditions

A
  • Long head biceps tendinopathy/tendinosis
  • AC joint pathology
  • Pain referred from elsewhere
  • Special tests do NOT exist that reach criterion level significance & clinical utility
28
Q

Special tests for long head biceps tendinopathy/tendinosis

A
  • Yergason’s
  • Speeds
  • Gilcreest palm up
  • Upper cut
29
Q

Describe Gilcreest palm up test

A
  • 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
30
Q

Describe upper cut

A
  • 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
31
Q

Describe speeds test

A
  • 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
32
Q

Special tests for AC joint

A
  • AC resisted extension
  • Cross body ADD
  • Active compression (O’Brian’s)
33
Q

Describe AC resisted extension test

A
  • Test for AC joint
  • Patient seated with shoulder at 90º flexion & slight IR
  • Examiner resists horizontal ABD plus extension
  • Positive = pain at the AC
34
Q

Describe the cross body ADD test

A
  • 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
35
Q

Special tests for shoulder instability

A
  • Sulcus sign
  • Load & shift
  • Apprehension
  • Relocation
  • Surprise test
36
Q

Illness script for shoulder instability

A
  • Younger, contact sports
  • Most frequent is anterior dislocation
  • Multidirectional instability if 2 or more directions
37
Q

Describe sulcus sign

A
  • Position sitting with slight ER, examiner grasps forearm & distracts the shoulder
  • Observation for space to appear between humeral head & AC joint
38
Q

Describe load and shift test

A
  • 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
39
Q

Describe apprehension test

A
  • Patient supine examiner passively abducts to 90º & ER humerus to end range
  • Positive = patient complains of pain or instability
40
Q

Describe relocation & surprise test

A
  • 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
41
Q

Adhesive capsulitis illness script

A
  • Age ≥50
  • Females more than males
  • Endocrine disorders: DM, thyroid
  • Capsular pattern of limitation ER>ABD>IR (ER limited the most)
42
Q

Phases of adhesive capsulitis

A
  • Painful -> freezing -> thawing
  • Pain -> severe night pain -> stiff pain at end range -> stiff minimal pain
  • Pain > stiff -> stiff > pain
43
Q

CPR for OMPT (orthopedic manual physical therapy) for shoulder pain

A
  • 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
44
Q

Describe the Mulligan concept of mobilization with movement

A

-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.

Advanced Orthopedics (29 decks)

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