Shoulder Special Tests Flashcards
Painful Arc Test
Purpose: assess for subacromial impingement of supraspinatus tendon and subacromial bursa
Position: patient standing; instruct patient to (AROM) abduct the humerus through full range
Positive: pain starting at about 70° of abduction, which eases off after about 130° of abduction; in this range, the tissues are no longer compressed; the pain must lessen above 130°; when the patient cannot actively move beyond this range, assist the patient to 130° and then ask the patient to continue if possible
Apley’s Scratch Test
Purpose: to assess the combined movements at the shoulder.
Position: patient standing; stand behind the patient to observe range of motion
-instruct the patient to reach behind the head to touch as far down the spine as possible with the fingertips; this assesses external rotation, flexion and abduction of one GH joint
-instruct the patient to reach up, at the same time, behind the back with other hand, touching as far up the spine as possible; this action checks the internal rotation, extension and adduction of the other GH joint
-note the location of the fingertips of each hand according to the thoracic vertebral level
-instruct patient to reverse the position of arms
-compare available ranges of both shoulders
-as motions are combined, it is important to correctly assess which individual movements are restricted and which are not; it may be necessary to follow this test with the individual cardinal planes of shoulder motion to track down the specific limited range
Adhesive Capsulitis Abduction Test
Purpose: test for restricted motion at the shoulder resulting from fibrosing and adhesions of the axillary fold
of the inferior GH joint capsule
Position: patient seated; stand behind the patient
-palpate the inferior angle of the scapula and with one hand monitor its position throughout the test
-with the other hand just proximal to the patient’s elbow, slowly abduct (PROM) the patient’s humerus, noting when the inferior angle of the scapula begins to move; in a normal shoulder, a leathery end feel is encountered at greater than 90° of abduction of the humerus; the axillary fold is stretched and the scapula begins to move along with the humerus at greater than 90° of abduction
Positive: result for a frozen shoulder has a painful, leathery end feel encountered anywhere before 90° of abduction; since the axillary fold is fibrosed, the scapula begins to move before 90° of abduction
Rockwood Test:
Instability tests for shoulder
Purpose: to test for anterior instability at the shoulder.
Position: patient seated; stand behind the patient
-with the arm at the patient’s side, the therapist laterally rotates the shoulder, then abducts the arm to 45 degrees and passively laterally rotates the arm repeatedly (PROM)
-the same procedure is repeated at 90°and 120°
-these different positions are performed because the stabilizers of the shoulder vary as the angle of abduction changes
Positive: the patient must show marked apprehension with posterior pain when the arm is tested at 90°; at 45 and 120° the patient shows some uneasiness and some pain; at 0° there is rarely apprehension
Push-Pull Test
Instability tests for shoulder
Purpose: to test for posterior instability at the shoulder
Position: patient supine
-therapist holds the patient’s arm at the wrist; abduct the arm to 90° and forward flexes it to 30° (PROM)
-therapist places the other hand over the humerus, close to the humeral head
-therapist then pulls up on the arm at the wrist while pushing down on the humerus with the other hand
Positive: normally, 50% posterior translation can be accomplished; if more than 50% posterior translation instability
occurs or if the patient becomes apprehensive or pain results, the therapist should suspect posterior instability
Feagin Test
Instability tests for shoulder
Purpose: tests for inferior and multidirectional instability of the shoulder
-a modification of the sulcus sign test with the arm abducted to 90° instead of being at the side
Position: patient stands with the arm abducted to 90° and the elbow extended, resting on the top of the therapist’s shoulder
-therapist’s hands are clasped together over the patient’s humerus between the upper and middle third; therapist pushes the humerus down and forward
-the test may also be done with the patient seated
-in this case, the therapist holds the patient’s arm at the elbow (elbow straight) abducted to 90° with one hand and arm holding the arm against the therapist’s body
-the other hand is placed just lateral to the acromion over the humeral head; ensuring the shoulder musculature is relaxed, the therapist pushes the head of the humerus down and forward
-doing the test this way often gives the therapist greater control when doing the test; a sulcus may also be seen above the coracoid process
Positive: a look of apprehension on the patient’s face indicates a positive test.
Hawkin’s Kennedy Impingement Test
Impingement Tests:
Purpose: assess for overuse injury to the supraspinatus (paratenonitis/tendinosis or secondary
impingement
Position: patient standing
-therapist flexes the patient’s arm forward to 90°, then forcibly internally rotates the humerus (PROM); this compresses the supraspinatus tendon against the coracoid process
Positive: pain
Neer Impingement Test
Impingement Tests:
Purpose: assess for overuse injury to the supraspinatus tendon
Position: patient seated
-patient’s arm is passively and fully elevated in the scapular plane with the arm medially rotated by the therapist (PROM)
Positive: pain
Supraspinatus Strength Test (Empty Can)
Tests for Muscle or Tendon Pathology:
Purpose: to test for a supraspinatus tendon or muscle tear, or neuropathy of the Suprascapular nerve Position: patient seated or standing; patient’s arm is abducted to 90° with neutral (no) rotation (AROM), and the therapist provides resistance to abduction
-the shoulder is then medially rotated and angled forward 30° (“empty can” position) so that the patient’s thumbs point toward the floor in the plane of the scapula
-resistance to abduction is again given while the therapist looks for weakness or pain, reflecting a positive test result
Positive: weakness or pain indicates a tear of the supraspinatus tendon or muscle, or neuropathy of the Suprascapular nerve
Infraspinatus Strength Test
Tests for Muscle or Tendon Pathology:
Purpose: to assess the infraspinatus muscle for tendinitis, strain or weakness
Position: patient seated or prone
-abduct the humerus to 90°and flex the elbow to 90° (AROM)
-apply pressure to the patient’s wrist in the direction of internal rotation, while the patient attempts to externally rotate the humerus
Positive: pain along infraspinatus or weakness; test does not distinguish between infraspinatus or teres minor strength, since both externally rotate the humerus
Subscapularis Strength Test
Tests for Muscle or Tendon Pathology:
Purpose: to assess subscapularis muscle for tendinitis, strain or weakness
Position: patient seated: humerus by the side of the body and elbow flexed to 90°
internally rotate the wrist
-apply pressure to the patient’s wrist in the direction of external rotation, while the patient attempts to internally rotate the wrist
Positive: pain along subscapularis or weakness
Abrasion Sign
Tests for Muscle or Tendon Pathology:
Purpose: to assess if rotator cuff tendons are frayed
Position: patient seated; actively abducts the arm to 90° with the elbow flexed to 90°
-patient medially and laterally rotates the arm at the shoulder; normally, there are no signs and symptoms
- Positive: if crepitus occurs, it is a sign that the rotator cuff tendons are frayed and are abrading against the under surfaces of the acromion process and the coracoacromial ligament
Lift off Sign
Tests for Muscle or Tendon Pathology:
Purpose: to assess for a subscapularis lesion.
Purpose: patient stands and places the dorsum of the hand on the back pocket or against the mid lumbar spine; greater subscapularis activity is shown with the second position
-patient lifts the hand away from the back; if the patient is able to take the hand away from the back, the therapist should apply a load pushing the hand toward the back to test the strength of the subscapularis and to test how the scapula acts under dynamic loading; with a torn subscapularis tendon, passive (and active) lateral rotation increases
Positive: an inability to do so indicates a lesion of the subscapularis muscle; abnormal motion in the scapula during the test may indicate scapular instability
Pec Major Contracture Test
Tests for Muscle or Tendon Pathology:
Purpose: to assess if there is a contracture of pectoralis major
Position: patient supine; clasps the hands together behind the head; arms are then lowered until the elbows touch the table
Positive: if the elbows do not reach the table it indicates a tight pectoralis major muscle
Acromioclavicular Shear Test
Tests for Muscle or Tendon Pathology:
Purpose: assess the integrity of the AC joint.
Position: patient seated; stand behind the patient
-place cupped hands over the patient’s shoulder, the fingers interlaced, with one palm on the clavicle and the other on the spine of the scapula
-slowly squeeze the heels of the hands together
Positive: results in pain or excessive/abnormal movement of the joint, indicates a joint pathology, including
AC joint sprain
Drop Arm Test (Codman’s)
Tests for Muscle or Tendon Pathology:
Purpose: assess the integrity of the rotator cuff, especially the supraspinatus muscle and tendon
Position: patient seated
-abduct the arm to 90° and instruct the patient to hold the arm in this position (PROM)
-instruct the patient to slowly adduct the arm back to the starting position (AROM)
Positive: patient is unable to return the arm smoothly and slowly to the side or if there is pain on the attempt, indicating a rotator cuff tear
Speed’s Test
Tests for Muscle or Tendon Pathology:
Purpose: to assess for biceps tendinitis
Position: patient seated with elbow extended
-therapist first resists shoulder forward flexion while the patient’s forearm is first supinated and then pronated
-the test may also be performed by forward flexing the patient’s arm to 90° and then asking the patient to resist an eccentric movement into extension first with the arm supinated, then pronated
Positive: elicits increased tenderness in the bicipital groove especially with the arm supinated and is indicative of bicipital paratenonitis or tendinosis
Yergason’s Test
Tests for Muscle or Tendon Pathology:
Purpose: designed to check the ability of the transverse humeral ligament to hold the biceps tendon in the bicipital groove and assess the stability of the biceps tendon in the bicipital groove or presence of biceps tendinitis
Position: patient seated; elbow flexed to 90% and the forearm pronated
-stabilize the patient’s elbow against the patient’s thorax with one hand
-with the other hand, apply resistance while the patient actively supinates the forearm, extends the elbow and externally rotates the humerus, all at the same time
Positive: pain and the sensation of the tendon popping out of the bicipital groove indicate biceps tendon instability and the loss of integrity of the transverse humeral ligament; pain along the course of the tendon may indicate biceps tendinitis; however, motion of the tendon along the groove is required for a true positive tendinitis test
