shoulder special tests

Question 1

Yergason’s test

Answer 1

Purpose: transverse humeral ligament integrity
Description: pt sitting with arm against thorax, elbow flexed to 90, forearm pronated. Resist supination and shoulder ER as pt goes through those motions.
Result: tendon of LH of bicep will pop out of groove. tenderness in bicipital groove alone without dislocation indicates bicipital paratenonitis/tendinosis

Question 2

speeds test

Answer 2

Purpose: identify bicipital tendinosis/tendinopathy
Description: shoulder in full extension, forearm supination. resist shoulder flexion. OR shoulder in 90 flexion, and push upper limb into extension while pt tries to resist
Result: pain in LH of biceps tendon/increased tenderness in bicipital groove

Question 3

Neer’s impingement test

Answer 3

Purpose: impingement of supraspinatus and biceps tendon
Description: Passively/forcefully bring shoulder into flexion (in scap plane) with shoulder IR. This causes greater tuberosity to jam against anteroinferior border of acromion
Result: reproduces sxs of pain in shoulder region

Question 4

empty can/Jobe test

Answer 4

Purpose: ID tear/ impingement of supraspinatus tendon or suprascapular nerve neuropathy
Description: Pt’s shoulders at 90 flexion in scap plane and in neutral rotation and provide downward force. Pt full IR shoulders and re-apply downward force.
Result: reproduces pain in supraspinatus tendon or weakness in empty can position

Question 5

Drop arm test

Answer 5

Purpose: AKA Codman’s test. ID tear/full rupture of rotator cuff
Description: PT abduct pt’s arm shld to 90 and asks pt to slowly lower arm to side
Result: + = patient is unable to return arm to side slowly or has severe pain while attempting to do so

Question 6

posterior internal impingement sign

Answer 6

Purpose: ID impingement btw rotator cuff and greater tuberosity or posterior glenoid and labrum
Description: pt in supine lying position. PT passively abducts shoulder to 90-100deg with 15-20deg extension and maximal ER
Result: reproduction of pain in posterior shoulder

Question 7

Hawkins-Kennedy Test

Answer 7

Purpose: ID sub-acromial impingement
Description: passively flex arm to 90deg in scap plane. Stabilize upper arm and force into IR
* Yocum test is modification: place pt’s hand on opposite shoulder and examiner elevates elbow
Result: pain is positive for supraspinatus paratenonitis/tendonitis or secondary impingement

Question 8

Horn Blower’s Sign (Patte test)

Answer 8

Purpose: Detect rotator cuff tear involving teres minor
Description: Pt’s arm at 90deg of abd in scap plane, elbow flexed to 90. Pt is asked to ER arm against PT resistance
Result: + if pt cant ER shoulder in this position

Question 9

Active compression test of O’Brien

Answer 9

Purpose: detect SLAP (type II) or superior labral lesions
Description: Pt shoulder at 90deg flexion, 10deg horizontal add, and max IR. Pt resist downward force by PT to the distal arm. Repeat with arm in max ER
Result: Pain on joint line or painful clicking inside shoulder (not over AC joint) with max IR but no pain with ER, test is positive for labrum abnormalities

Question 10

Biceps Load test

Answer 10

Purpose: check integrity of superior labrum
Description: Pt supine or seated: shoulder abd to 120, shoulder ER, and forearm supination. PT brings pt arm into full ER. If there is apprehension, stop ER and hold position. Ask pt to flex elbow against resistance at wrost.
Result: If apprehension decreases/pt is more comfortable, test is negative for SLAP. If apprehension remains same/shoulder becomes more painful, + for SLAP lesion

Question 11

Lateral Rotation Lag Sign

Answer 11

Purpose: test teres minor and infraspinatus. AKA infraspinatus “spring back” test”
Description: Pt seated/standing. PT passively flex elbow to 90, shoulder abd to 90 in scap plane, ER shoulder to end range. Ask patient to hold it
Result: + = patient cant hold position and hand springs back ant toward midline. Indicates infraspinatus and teres minor cant hold position due to weakness or pain

Question 12

abdominal compression test

Answer 12

Purpose: Checks Subscapularis m. AKA belly-press or napoleon test
Description: pt standing. PT puts hand on pt stomach and pt puts hand over theirs (with arm to be tested). Push as hard as they can into stomach and attempt to bring elbow forward to scap plane (causing > IR)
Result: If pt cant keep pressure on examiner’s hand while moving elbow forward or extends wrist/shoulder - test is positive for subscapularis m tear

Question 13

Lift Off sign (Gerber’s test)

Answer 13

Purpose: detect lesion of subscapularis m
Description: pt puts dorsum of hand on back pocket or against mid-lumbar spine. lifts hand away from back
Result: inability to do so indicates lesion of subscapularis

Question 14

Jerk test

Answer 14

Purpose: test recurrent posterior instability
Description: Pt sits. Arm IR and forward flexed to 90. PT holds elbow and gives axial load in proximal direction. While maintaining load, PT moves arm horizontally across body
Result: + = sudden jerk/clunk as humeral head slides off (subluxes) back of glenoid. When arm is returned to 90 abd, may hear second clunk as head reduces

Question 15

sulcus sign

Answer 15

Purpose: test for inferior shoulder instability
Description: patient stands with arm by side and shoulder mm relaxed. PT grasps forearm below elbow and pulls arm distally
Result: Presence of sulcus sign can indicate inferior instability or glenohumeral laxity. Should only be + for instability if pt is symptomatic

Question 16

Pec major contracture test

Answer 16

Purpose: ID tightness of pec major m
Description: pt supine. clasp hands together behind head. arms are lowered until elbows touch table
Result: + if elbows dont reach table = tight pec major

Question 17

Halstead maneuver

Answer 17

Purpose: ID pathology of structures that pass through thoracic inlet
Description: Find radial pulse and apply downward traction on test extremity while pt neck is hyperextended and head is rotated to opp side
Result: absence or disapearance of pulse = + for thoracic outlet syndrome

Question 18

Clunk test

Answer 18

Purpose: ID glenoid labrum tear
Description: pt supine. should in full abduction. push humeral head ant, while ER humerus
Result: audible clunk heard

Question 19

anterior apprehension/crank test/fulcrum test

Answer 19

Purpose: ID past anterior dislocation of shoulder
Description: pt supine. PT abduct arm to 90, and slowly ER shoulder.
Fulcrum test: Place hand under GH joint to act as fulcrum
Result: Pt doesn’t like to move shoulder into ER to stimulate anterior dislocation

Question 20

posterior apprehension test

Answer 20

Purpose: ID past hx of posterior shoulder dislocation
Description: pt supine/sitting. PT elevate shoulder in scap plane to 90deg. While stabilizing scap with other hand, apply post force on pt elbow. While applying post load, PT horiz add and IR arm
Result: Pt doesnt allow/like to move shoulder into that direction to stimulate posterior dislocation

Question 21

Acromioclavicular Shear test

Answer 21

Purpose: ID dysfunction of AC joint: such as arthritis or separation
Description: Pt sitting. PT cups hands over deltoid/clavicle and spine of scap. Squeezes heels of hands together
Result: Reproduce AC joint pain

Question 22

Adson’s test

Answer 22

Purpose: ID pathology of structures that pass through thoracic inlet
Description: PT feels radial pulse. Pt rotates head to test arm. Pt extends head while PT ER and extends pt’s shoulder. Pt instructed to take deep breath and hold it
Result: disapearance of pulse is +

Question 23

Costoclavicular syndrome (military brace) test

Answer 23

Purpose:ID pathologies of structures that pass through thoracic inlet
Description: palpate radial pulse. Extend arm
Result: + = absence of pulse and implies TOS (btw first rib and clavicle) (costoclavicular syndrome). Especially for pts who complain of symptoms while wearing backpack/heavy coat

Question 24

Wright (hyperabduction) test

Answer 24

Purpose: ID pathologies of structures that pass thru thoracic inlet
Description: pt seated. Locate radial pulse. Bring shoulder into max abd and ER. Taking deep breath and rotating head to opp side can accentuate symptoms (AKA allen maneuver)
Result: Decreased pulse

Question 25

Roos Test (elevated arm stress test)

Answer 25

Purpose: ID pathology of structures that pass thru thoracic inlet
Description: Pt stands. Abduct arms to 90, ER shoulder, elbow flexion 90 so elbows slightly behind frontal plane. Pt opens and closes hands slowly for 3 min
Result: If pt cant keep arms in starting position for 3min or suffers ischemic pain, heaviness, extreme weakness of arms or numb/tingle of hand , test is + for TOS