Shoulder special tests Flashcards
Neers impingement
PERFORMANCE:
-One hand blocks upward
rotation of the scapula while
the other hand passively
moves the patient’s arm
overhead in scaption plane
-Overpressure applied in
neutral, IR, ER
POSITIVE RESULT: patient’s
pain
INTERPRETATION: RC
impingement on
anterosuperior glenoid rim or
coraco-acromial ligament
Sensitivity:
75%
Specificity:
31%
+LR: 1.30
-LR: 0.37
Hawkins Kennedy
PERFORMANCE: arm
passively flexed to 90 degrees
in scapular plane, then
forearm moved into IR
POSITIVE RESULT: patient’s
pain
INTERPRETATION:
subacromial RC impingement
Sensitivity:
80%
Specificity:
25%
+LR: 1.2
-LR: 0.32
Yokum
PERFORMANCE: Patient is
asked to life elbow from
shoulder heigh while hand
rests on opposite shoulder
POSITIVE RESULT: pain
INTERPRETATION:
subacromial RC impingement
Sensitivity:
78%
+LR: 1.2-1.3
-LR: 0.53-
0.56
Full can / empty can
PERFORMANCE:
Full can: patient’s arm is
place in ER (thumb up) in
scaption plane with PT
providing inferior force to arm
Empty can: patient’s arm is
place in IR (thumb down) in
scaption plane with PT
providing inferior force to arm
POSITIVE RESULT: weakness,
pain
INTERPRETATION:
supraspinatus tear
Sensitivity:
50% (empty
can)
Specificity:
87% (empty
can)
+LR: 1.78-2
-LR: 0.22-
0.25
Drop arm test / sign
PERFORMANCE: Patient’s
arm passively abducted to 90
degrees and patient is asked
to lower arm with palm down
POSITIVE RESULT: dropping of
arm
INTERPRETATION: RC injury
Sensitivity:
35% (full
thickness
tear), 14.3%
(partial
thickness
tear)
Specificity:
88% (full
thickness
tear), 78%
(partial
thickness
tear)
Lift off test
PERFORMANCE: arm in IR
with dorsum of hand resting
on back. Pt attempts to lift
hand off back against PT
resistance
POSITIVE RESULT: weakness,
pain
INTERPRETATION:
subscapularis tear
Sensitivity:
40%
Specificity:
79%
+LR: 1.39
-LR: 0.31
Belly press test
PERFORMANCE: Elbow flexed
to 90 degrees and internally
rotate shoulder to place hand
on stomach and apply
pressure to stomach
POSITIVE RESULT: elbow falls
behind body
INTERPRETATION:
subscapularis tear
Sensitivity:
80%
Specificity:
88%
Sulcus sign
PERFORMANCE: Arm
positioned in 20-50 deg
abduction and neutral
rotation, a traction force is
applied to the arm
POSITIVE RESULT: depression
greater than a fingerbreadth
between the lateral acromion
and the head of the humerus
INTERPRETATION: inferior
shoulder instability
Sensitivity:
28%
Specificity:
97% when
>2cm
+LR: 2.43
-LR: 0.89
Load and shift
PERFORMANCE: Pt lies
supine. PT stabilizes scapular
to thorax with the other hand
placed across the GHJ. The PT
applies a load and shift force
in the anteromedial and then
posterolateral directions
POSITIVE RESULT: Increased
movement (graded)
− 0= little to no movement
− 1= humeral head moves
to glenoid rim
− 2= humeral head
dislocated, but
spontaneously relocates
when pressure removed
− 3= humeral head
dislocates and does not
relocate when pressure
removed
INTERPRETATION: shoulder
instability
Sensitivity:
50%
Specificity:
100%
-LR: 0.5
Apprehension / relocation test
PERFORMANCE:
-Apprehension: Pt lies in
supine with arm at 90 degrees
abduction and full ER. PT
applies OP into ER.
-Relocation: The test is
repeated with the PT applying
a posterior force at the
humeral head.
POSTIVE RESULT:
-apprehension with first
portion that is reduced with
relocation
INTERPRETATION: anterior
shoulder instability
App:
Sensitivity:
57%
Specificity:
100%
-LR: 0.43
Relocation:
Sensitivity:
68%
Specificity:
100%
+LR: 17.2
-LR: 0.32-
0.43
Obriens
PERFORMANCE:
-Step 1: Pt stands with
shoulder at 90 degrees
flexion, 10 degrees horizontal
ADD, and max IR with elbow in
extension while PT applies
downward force.
-Step 2: Test is repeated with
arm in max ER
POSITIVE RESULT:
-Step 1: pain/clicking in the
shoulder indicative of labral
tear
*Pain in top of shoulder may
indicate ACJ injury
-Step 2: Pain and clicking
resolved confirms this
diagnosis
*Pain inside the shoulder that
does not resolve in step 2 may
indicate SLAP lesion
Sensitivity:
85%
Specificity:
41%
+LR: 1.44
-LR: 0.37
Crank test
PERFORMANCE: Pt in supine
with arm elevated to 160
degrees of scaption and
maximal IR or ER. The PT
applies an axial load along the
humerus.
POSITIVE RESULT: painful
click in the shoulder
INTERPRETATION: SLAP
Sensitivity:
90% (higher
than MRI)
Specificity:
85% (same
as MRI)
Clunk
PERFORMANCE: Pt lies
supine. PT places one hand on
the posterior aspect of the
humeral head and the other
hand grasps the humerus. The
PT fully abducts the arm
overhead while providing
anterior pressure to the
humeral head into ER.
POSITIVE RESULT: presence
of a clunk
INTERPRETATION: free labral
fragment caught in the joint
Jerk test
PERFORMANCE: Pt sitting
with PT behind and to the side.
PT grasps the arm with one
hand and the scapula with the
other and positions the arm in
90 degrees of abduction and
IR. The PT applies an axial
compression-based load to
the humerus via the elbow
while moving into horizontal
adduction.
POSITIVE RESULT: sharp
shoulder pain with or without
a click/clunk
INTERPRETATION: posteriorinferior labral lesion
Sensitivity:
73%
Specificity:
98%
Biceps load
PERFORMANCE: Shoulder
placed in 90 degrees of
abduction and max ER with
the forearm supinated. The pt
is asked to perform a biceps
contraction against
resistance.
POSITIVE RESULT: Deep pain
in the shoulder
INTERPRETATION: SLAP
Sensitivity:
91%
Specificity:
97%
Yergasons test
PERFORMANCE: Pt sits or
stands with elbow and 90
degrees flexion and forearm
pronated. Pt is asked to
supinate forearm against
manual resistance.
POSITIVE RESULT: pain over
bicipital groove or subluxation
of long head of biceps tendon
INTERPRETATION: biceps
tendinopathy
Sensitivity:
41%
Specificity:
79%
Speeds test
PERFORMANCE: Patient’s
arm is positioned in shoulder
flexion, full ER, full elbow
extension, and full forearm
supination. The PT applies
manual inferior resistance.
POSITIVE RESULT:
-localized pain to bicipital
groove (biceps tendinopathy)
-deep shoulder pain (superior
labral tear)
Sensitivity:
54%
(biceps)
Specificity:
81%
(biceps)
Cross body adduction test
PERFORMANCE: Pt actively
elevates arm to 90 degrees
and PT passively horizontally
adducts shoulder to end range
POSITIVE RESULT: pain
(anterior or posterior)
INTERPRETATION: ACJ injury
(anterior pain) or subacromial
impingement (posterior pain)
Sensitivity:
77%
Specificity:
79%
Diagnosis clusters
> 65 yrs
Night pain
Weakness in ER
rotator cuff tear
diagnosis clusters
Painful arc
Drop arm sign
Infraspinatus MMT
2 positive tests 69 percent
3 positive tests 91 percent chance
rotator cuff tear
