Shoulder special tests

Question 1

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Test for posterior instability of the shoulder

Answer 1

Jerk Test

Question 2

How do you perfrom the jerk test and what is it testing?

Answer 2

Posterior instability

Pt lying supine
With shoulder flexed to 90 degrees in scapular plane and elbow flexed to 90 degrees
Examiner places on ehadn under the scapula, so that pinky finger of PT is on the posterior aspect of the humeral head.
Examiner then exerts downward force through long axis of humerus, feeling for any marked posterior instability, may be a jerk as humeral head may displace of the glenoid.

However, using this position the examiner can detect much more subtle increase in posterior laxity which come short of posterior subluxation or disclocation.

Question 3

Anterior instability and relocation test.

Answer 3

Start with patient sat on plinth
Stands behind patient and applies anterior gliding movement to the humeral head this is maintained throughout the test.

Examiner then fully externally rotates the arm, this is maintained throughout.
Pt arm is then taking through full arc of abduction

Episodically it is then taken into extension

Around 90-130 degress abduction pt will complain of apprehension/fearfullness as well as pain.

Then perfrom relocation - same test but a postierior movement is applied and maintained throughout

Positive test- if the second test - no apprehension.

Question 4

Name an ac joint test

Answer 4

Scarf test. Horizontal abduction.

Question 5

impingment test

Answer 5

Resisted abduction 20 degrees
Empty can test- 90m degrees scap abduction internally rotated (thumb to floor) - resisted.

Hawkins kennedy test- Passive internal rotation

Question 6

Internal rotation lag sign

What does it detect?
Positive signs?

Answer 6

Detect weakness or tear of anterior cuff - primarily subscapularis

Pt hand placed behind back and internally rotated.

Not touching the lumbar spine.

Pincer grip by PT and then let go

Pt needs to keep it there away from Lx

Failure tends to indicate weakness of anterior cuff

Test must be repeated 3 times –> false positives.

Question 7

External rotation lag sign

What is it used to detect?

Answer 7

Used to detect tear or weakness in the posterosuperior cuff

Arm is abducted to 20 degrees in scapular plane and shoulder fully externally rotated.

Pincer grip

Hold arm in this position as pincer grip is released

Failure-

Sig internal rotation –> weakness or tear of posterosuperior cuff.

Question 8

Sulcus sign

Answer 8

Multi-directional instability of shoulder

Pt in standing or sitting

PT takes hold of epicondyles of humerus and applys downward force

Positive- when a sulcus/ one finger breadth just inferior to the acromion,

Question 9

Speeds test

Answer 9

Used for superior labral tears or bicipital tendonitis.

Elbow fully extended and the arm is elevated to 90 degrees and slightly horizontal
Forearm supinated - apply downard force

Positive result is pain is localised to the biciptial groove or bicipital tendon during forward elevation.

Question 10

O’Briens test

Answer 10

The purpose of O’Brien’s test also known as the Active Compression Test is to indicate potential labral (SLAP Lesion) or acromioclavicular lesions as cause for shoulder pain

Question 11

Apprehension test

Answer 11

The Apprehension test is generally used to test the integrity of the glenohumeral joint capsule, or to assess glenohumeral instability in an anterior direction.

The patient should be position in supine. The therapist will flex the patient’s elbow to 90 degrees and abducts the patient’s shoulder to 90 degrees in sagittal plane and 180 degrees in frontal plane (horizontal abduction), maintaining neutral rotation. The examiner then slowly applies an external rotation force to the arm to 90 degrees while carefully monitoring the patient[1]. Patient apprehension from this maneuver, not pain, is considered a positive test.