Shoulder Special Tests Flashcards
Apprehension test for anterior shoulder dislocation
- Supine, arm 90 degrees ABD
- Therapist ERs the shoulder
- Positive test: look of apprehension or a facial grimace prior to reaching end point
Apprehension test for posterior shoulder dislocation
- 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
Sulcus sign
- 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
Sulcus sign grading
According to vertical length of depression
1+: <1 cm
2+: 1-2 cm
3+: >2 cm
Ludington’s Test
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
Speed’s Test
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
Yergason’s Test
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
Drop arm test
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
Hawins-Kennedy
For Supraspinatus Impingement
- Flex shoulder to 90 degrees, IR arm
- Positive: pain
Infraspinatus Test
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
Lateral Rotation Lag Sign
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
Lift off sign
Medial rotation lag sign
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
Neer impingement test
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
Supine impingement test
- Pt supine
- Therapist passively moves shoulder into full flexion
- Therapist ER and ADD shoulder, then IR shoulder
- Positive: Pain with the IR
Supraspinatus test
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
Adson Maneuver
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
Allen Test
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
Costoclavicular Syndrome Test
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
Roos Test
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.
Wright test (hyperabduction test)
For compression in costoclavicular space
- Sitting or supine
- Therapist moves pt’s arm overhead in frontal plane while monitoring radial pulse
- Positive: diminished pulse
Acromioclavicular crossover test
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
Active compression test (O’Brien’s test)
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
Glenoid labrum tear test
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
Jerk Test
- 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
ULTT1
Median nerve
- Shoulder depression
- 110 degrees ABD
- Elbow extension
- Forearm supination
- wrist extension
- Finger/thumb extension
Sensitization test: Contralateral cervical sidebend
ULTT2
Median nerve, musculocutaneous nerve, axillary nerve
- Shoulder depression
- 10 degrees ABD
- Same steps 3-6
- Shoulder ER
Sensitization test: Contralateral cervical sidebend
ULTT3
Radial nerve
- Shoulder depression
- 10 degrees ABD
- Elbow extension
- Forearm pronation
- Wrist flexion and ulnar deviation
- Finger and thumb flexion
- Shoulder IR
Sensitization: contralateral cervical sidebend
ULTT4
Ulnar nerve
- Shoulder depression
- 10-90 degrees ABD
- Elbow flexion
- Forearm supination
- Wrist extension, radial deviation
- Finger and thumb extension
- Shoulder ER
Sensitization: contralateral cervical sidebend
