Shoulder Special Tests

Question 1

Apprehension test for anterior shoulder dislocation

Answer 1

• Supine, arm 90 degrees ABD
• Therapist ERs the shoulder
• Positive test: look of apprehension or a facial grimace prior to reaching end point

Question 2

Apprehension test for posterior shoulder dislocation

Answer 2

• Supine, arm 90 degrees ABD
• Therapist applies posterior force through long axis of humerus
• Positive test: look of apprehension or a facial grimace prior to reaching end point

Question 3

Sulcus sign

Answer 3

• Sitting/ standing
• Therapist position’s patient’s arm in 20-50 degrees of ABD
• Therapist grasps patient’s elbow and pulls arm inferiorly
• Positive test: sulcus sign/ indicates inferior instability

Question 4

Sulcus sign grading

Answer 4

According to vertical length of depression
1+: <1 cm
2+: 1-2 cm
3+: >2 cm

Question 5

Ludington’s Test

Answer 5

For long head biceps rupture

• Pt sitting, clasping both hands behind had with fingers interlocked
• Patient alternately contracts and relaxes biceps muscles
• Positive test: Absence of movement in the biceps tendon

Question 6

Speed’s Test

Answer 6

For Bicipital Tendonitis

• Pt sitting or standing, elbow extended, forearm supinated
• Therapist: One hand over bicipital groove, other over volar surface of forearm
• Therapist resists active shoulder flexion
• Positive test: Pain or tenderness in bicipital grove region

Question 7

Yergason’s Test

Answer 7

For Bicipital Tendonitis

• Pt sitting, 90 degrees elbow flexion, forearm pronated
• Stabilize humerus against thorax
• Therapist: One hand on forearm, other on bicipital groove
• Pt instructed to actively supinate and laterally rotate against resistance
• Positive: Pain/ tenderness over groove

Question 8

Drop arm test

Answer 8

For Rotator Cuff Tear

• Arm at 90 degrees abd
• Instructed to slowly lower arm to side
• Positive: pt cannot slowly lower arm to the side, or presence of severe pain

Question 9

Hawins-Kennedy

Answer 9

For Supraspinatus Impingement

• Flex shoulder to 90 degrees, IR arm
• Positive: pain

Question 10

Infraspinatus Test

Answer 10

For infraspinatus strain/tear

• Elbow flexed 90 degrees, IR 45 degrees
• Patient resists as therapist applies medially directed force to forearm
• Positive: Pain or weakness

Question 11

Lateral Rotation Lag Sign

Answer 11

For Infraspinatus or Supraspinatus pathology

• Pt passively placed in 20 degrees of scaption, end range ER
• Instructed to hold position
• Positive: Pt can’t hold position

Question 12

Lift off sign

Medial rotation lag sign

Answer 12

For Subscapularis Lesion

• Pt places dorsum of hand on their low back
• Pt instructed to move hand away from back
• If pt is unable, PT should passively move pt’s hand away from back and see if they can hold it
• Positive: Pt can’t hold position

Question 13

Neer impingement test

Answer 13

For Supraspinatus Impingement

• Therapist places one hand on posterior scapula, other hand stabilizing elbow
• Therapist elevates patient’s arm through flexion
• Positive: Grimace or pain

Question 14

Supine impingement test

Answer 14

• Pt supine
• Therapist passively moves shoulder into full flexion
• Therapist ER and ADD shoulder, then IR shoulder
• Positive: Pain with the IR

Question 15

Supraspinatus test

Answer 15

For Supraspinatus tear/impingement or suprascapular nerve involvement

• Pt with arm 90 degrres ABD, 30 degrees horizontal ADD, thumb pointing downward
• Therapist resists patient’s attempt to abduct arm
• Positive: weakness or pain

Question 16

Adson Maneuver

Answer 16

For Thoracic Outlet Syndrome

• Therapist monitors radial pulse, asks patient to rotate head toward test shoulder
• Patient instructed to extend head while therapist ER and extends shoulder
• Positive: Absent/ diminished radial pulse

Question 17

Allen Test

Answer 17

For TOS

• Test arm at 90 ABD, full ER, 90 elbow flexion
• Patient rotates head away from test shoulder
• Therapist monitors radial pulse
• Positive: absent/ diminished pulse

Question 18

Costoclavicular Syndrome Test

Answer 18

For compression of subclavian artery between first rib and clavicle

• Therapist monitors radial pulse and assists patient to assume a military posture
• Positive: diminished pulse

Question 19

Roos Test

Answer 19

For TOS

• Both arms at 90/90/90
• Open/close hands for 3 minutes
• Positive: Inability to maintain position, weakness of arms, sensory loss, ischemic pain.

Question 20

Wright test (hyperabduction test)

Answer 20

For compression in costoclavicular space

• Sitting or supine
• Therapist moves pt’s arm overhead in frontal plane while monitoring radial pulse
• Positive: diminished pulse

Question 21

Acromioclavicular crossover test

Answer 21

For AC joint injury

• Therapist moves shoulder into 90 degrees flexion, then fully horizontally adducts shoulder
• Positive: pain over AC joint
• Can be active or passive

Question 22

Active compression test (O’Brien’s test)

Answer 22

For superior labral tear

• Shoulder flexed 90 degrees, horizontally adducted 10-15 degrees, medial rotation (thumb down)
• Pt resists therapist’s force pressing arm down
• Shoulder is then ER, same downward force applied
• Positive: pain with IR, decreased pain with ER
• Must ensure pain isn’t over AC joint

Question 23

Glenoid labrum tear test

Answer 23

For glenoid labrum tear

• Patient supine
• Therapist passively abducts and laterally rotates arm over patient’s head, then applies anterior directed force to the humerus
• Positive: Clunk or grinding sound

Question 24

Jerk Test

Answer 24

• Shoulder elevated 90 degrees, IR with elbow bent.
• Therapist provides axial compression through elbow while horizontally adducting shoulder
• Positive: sudden clunk or jerk as humerus subluxes posteriorly. May hear another clunk when you return pt to starting position (humerus reducing) - indicates posterior instability
• Positive: pain- indicates posterior labral lesion

Question 25

ULTT1

Answer 25

Median nerve

1. Shoulder depression
2. 110 degrees ABD
3. Elbow extension
4. Forearm supination
5. wrist extension
6. Finger/thumb extension

Sensitization test: Contralateral cervical sidebend

Question 26

ULTT2

Answer 26

Median nerve, musculocutaneous nerve, axillary nerve

1. Shoulder depression
2. 10 degrees ABD
3. Same steps 3-6
4. Shoulder ER

Sensitization test: Contralateral cervical sidebend

Question 27

ULTT3

Answer 27

Radial nerve

1. Shoulder depression
2. 10 degrees ABD
3. Elbow extension
4. Forearm pronation
5. Wrist flexion and ulnar deviation
6. Finger and thumb flexion
7. Shoulder IR

Sensitization: contralateral cervical sidebend

Question 28

ULTT4

Answer 28

Ulnar nerve

1. Shoulder depression
2. 10-90 degrees ABD
3. Elbow flexion
4. Forearm supination
5. Wrist extension, radial deviation
6. Finger and thumb extension
7. Shoulder ER

Sensitization: contralateral cervical sidebend