Shoulder Special Tests: Instability, Labrum, Biceps Flashcards
When would you use an apprehension test?
suspicion of anterior shoulder subluxation or dislocation, primarily for traumatic shoulder instability
What is the position of the pt for apprehension?
supine, PT passively moves pts shoulder in abduction and ER
What is a positive result on the apprehension?
if patient shows apprehension or alarm on their face
if there is pain with no apprehension then likely subacromial impingement
How is a Jobe subluxation-relocation test performed?
Start apprehension test. If apprehension starts apply a posterior force and see if pain reduces or more ER
When is an anterior Load and Shift test indicated?
designed to test primarily a traumatic instability problems of GH joint
What structures are implicated during an anterior load and shift?
anterior capsule, superior glenohumeral ligament
How is load and shift examine performed?
pt sits with no back support in upright posture for prime scapula position
What position is PT in for load and shift?
stabilizing slap while standing behind patient, after grabbing head of humerus PT must load HOH into glenoid to set as normal then shift HOH either anterior/medial or posterior/lateral
What are results of anterior load and shift?
if HOH is loaded properly than there will be likely more movement anterior and little posterior, however if MD instability both directions could be hyper-mobile, however comparison on both arms and pts symptoms are more important than actual movement
What is the anterior drawer test used for?
used in assessment of increased or decreased translation of the HH relative to glenoid, used if patient is unable to perform apprehension test
What are three areas test for anterior drawer?
0 abd- superior GHL
45 abd- Middle GHL
90 abd- anterior band of inferior GHL
What is a positive anterior drawer test?
if there is pain, clicking, or increase or decrease in humeral head translation
What is important to remember about using a posterior or anterior load and shift?
laxity alone does not prove instability, must consider symptoms, apprehension and pt history
How is a posterior drawer performed?
pt lies in supine, flexes eblow to 120, shoulder abd. at 80-120 and 20-30of shoulder flexion
What structures are implicated during a posterior drawer?
posterior band of inferior GHL and posterior capsule
When is a Feagin test indicated?
when it is suspected that pt has shoulder instability anteroinferiorly
How is Feagin performed?
patient sits on exam table with shoulder abducted elbow in full extension and arm resting on PT shoulder
What structures are involved in Feagin test?
superior GHL
When is a Sulcus test indicated?
needs to be evaluated with pt with presented inferior instability
What structures are involved in Sulcus sign?
superior GHL and coracohumeral ligaments
What are grades of Sulcus test?
0- no laxity all the way to 3- maximum laxity
When is an active compression or O’Brien’s test used?
if suspected labral tear or AC jt involvement
What is procedure for O’Brien’s?
pt is put into 90 degrees of flexion , elbow extended and arm ADD 10-15 degrees and IR thumb facing down, ask pt to resist downward pressure, if pain ask where then ER shoulder and give resistance again
What are results of O’Brien’s?
test is considered positive for superior labral tear if pain in IR but not ER and pain is deep
