Shoulder Special Tests: Impingement, Rotator Cuff, TOS

Question 1

Why are impingement tests performed?

Answer 1

PT suspects cluster of symptoms that include painful arc, impingement tests and ms weakness with shoulder ER

Question 2

When is Neer’s test indicated?

Answer 2

impingement of RC on the anterosuperior glenoid rim or coracoacromial ligament

Question 3

What is procedure of Neer’s?

Answer 3

pt seated and passively forced into elevation in scapular plane

over pressure is applied with GH in neutral, IR and ER

positive result is pain, ask pt where pain is

Question 4

What is Hawkin’s Kennedy indicated?

Answer 4

may indicate shoulder impingement, RC involvement, and subacromial bursitis

Question 5

What is procedure of Hawkin’s Kennedy?

Answer 5

pt is seated, PT moves arm into flexion at 90 degrees in scapula plane and then arm is forced into IR, other arm stabilizes scapula

Question 6

What are results of HK?

Answer 6

pos test is characterized by reproduction of pts anterior shoulder pain in the sub acromial space, more medial humerus is could mean RC involvement

Question 7

When is crossover impingement/horizontal adduction test indicated?

Answer 7

can be used to indentify A/C joint dysfunction and possible impingement of RC located under ac joint region

Question 8

What is procedure for crossover?

Answer 8

pt is seated and PT passively moves arm into 90 degrees flexion and horizontal adduction and applies pressure

Question 9

What is result of crossover?

Answer 9

positive if pain in AC region, and ask pt where pain is

Question 10

When is empty can indicated?

Answer 10

performed to determine integrity of the supraspinatus tendon: partial or complete rupture

Question 11

What is procedure of empty can?

Answer 11

pt arm in scap plane and felxed to 90 with shoulder IR then apply manual resistance

Question 12

What is result of empty can?

Answer 12

a partial rupture of supraspinatus- painful and weak test

complete- painless and weak contraction

Question 13

What is difference between empty and full can?

Answer 13

arm is ER, this is also more likely to show pain instead of muscle weakness

Question 14

When is the Lift Off test (Gerber’s) indicated?

Answer 14

done to assess the subscapularis

Question 15

What is procedure of Gerber’s?

Answer 15

patient is sitting or standing and back of hand is is put on pts lumbar region and asked to lift off and then resistance is provided

if pt cant lift off test is positive

Question 16

What is Belly press test?

Answer 16

pt sits or stands and puts hand on belly and performs IR into stomach, PT can put hand on pts

if arm drops into extension it can indicate subscap tear

this is good test for alternative lift off if patient can’t get into that position

Question 17

How is internal lag sign performed?

Answer 17

pt is put into position of hand behind back away from back, and asked to hold that position

pos sign if pt cannot hold the position likely indicative of rupture

Question 18

What is Patte Test or Hornblowers sign?

Answer 18

performed to evaluate integrity of teres minor muscle

Question 19

What is procedure of Patte?

Answer 19

pt can be sitting or standing with elbow flexed at 90 and pts arm supported at 90 abducted in scapular plane and pt ER rotates arm against PT resistance, if pt cant then it is positive

Question 20

What is way to test infraspinatus using Patte’s?

Answer 20

same set up but arm is at side

Question 21

When is the drop arm test indicated?

Answer 21

procedure is performed to test integrity of supraspinatus as well as complete tear of RC

Question 22

How is drop arm test performed?

Answer 22

PT passively moves pt arm into 90 degrees of abduction and pt is asked to slowly lower arm by their side

Question 23

What is a positive result of drop arm?

Answer 23

patient is unable to slowly and smoothly lower their arm, this is indicative of complete RC tear

Question 24

When is external lag sign and dropping sign performed?

Answer 24

test is performed to assess integrity of the infraspinatus and supraspinatus

Question 25

How is external lag performed?

Answer 25

elbow flexed to 90 and shoulder moved into 70-90 degrees of elevation in scapular plane and shoulder put into full ER, PT then supports elbow and lets go of wrist

Question 26

What are results of a external lag?

Answer 26

positive “lag” is pts inability to maintain his or her arm near full ER which may indicate supra or infra tear

positive “drop” is arm dropping down to neutral could be infra tear

Question 27

What is the ROOS test procedure?

Answer 27

pt sitting and arms placed into 90 degrees of ABD and 90 degrees elbow flexion and ER

squeeze hands for 1-3 mins and any reproduction of sx indicates TOS

Question 28

When is Adson’s test indicated?

Answer 28

used to rule out neurovascular compression as a result from abnormal scalene and or cervical ribs

Question 29

What is procedure of adsons?

Answer 29

arm in 15 degrees of ABD and PT palpates radial pulse, pt holds breath and extends and rotates head towards side being tested

any sx occur then positive for TOS

Question 30

When is costoclavicular manuever?

Answer 30

suspected when TO is compromised causing compression of subclavian artery and brachial plexus where they pass between clavicle and 1st rib

Question 31

What is procedure of Costoclavicular?

Answer 31

pt tucks chin retracts and depress scapula while protruding chest holding for 1 minute

sx indicates positive test

Question 32

What is Wright’s test?

Answer 32

used to determine if TOS is being caused by pec minor tightness or impingement

Question 33

How is Wright’s performed?

Answer 33

pt sitting or standing arm moved into hyperabduction and pt turns head away from arm being tested and held for 1-2 minutes

sx is indicative of pos test