Shoulder Test Flashcards
Apprehension Test
indicates:
(+) test
Glenohumeral instability
Patient apprehensive of repeat dislocation
Empty Can Test
indicates:
(+) test
Rotator cuff pathology (specifically supraspinatus)
Pain or weakness
Drop Arm Test
indicates:
(+) test
Full thickness tear of supraspinatus
Arm will drop with or without gentle tap on wrist
Painful Arc Test
indicates:
(+) test:
Subacromial impingement and/or rotator cuff injury
Pain is elicited within 60 or 120 degrees of shoulder abduction
Neer Impingement
indicates:
(+) test:
Subacromial bursa or rotator cuff impingement
Pain
Hawkins Test
indicates:
(+) test:
Rotator cuff or subacromial bursa impingement
Pain
Cross Arm Test
indicates:
(+) test:
AC joint pathology
Pain in AC joint with end range adduction
Flexion/Extension SD MET
stabilize shoulder with one hand contact elbow with the other
engage restrictive barrier in flexion/extension based on diagnosis
IR/ER SD MET
stabilize shoulder with one hand contact wrist with the other
engage restrictive barrier in internal/external rotation based on diagnosis
AB/ADduction SD MET
stabilize shoulder with one hand contact elbow with the other
engage restrictive barrier in AB/ADduction based on diagnosis
Spencer’s Technique
Stage 1: Extension
Cephalad hand stabilize shoulder
caudal hand grasps patient’s elbow
move shoulder into extension until restrictive barrier is engaged
gentle but firm force, move a short distance through restrictive barrier for 1-2 seconds & release
Repeat rhythmically until no further progress can be appreciated
Spencer’s Technique
Stage 2: Flexion
Cephalad hand stabilize shoulder
Caudal hand grasp patient’s hand/wrist or elbow
Move shoulder into flexion until restrictive barrier is engaged.
with gentle but firm force move a short distance through restrictive barrier for 1-2 seconds and release
Stage 3: Compression Circumduction
Cephalad hand stabilize shoulder
caudal hand grasps flexed elbow
abduct patient’s shoulder to 90 & gently compress elbow toward glenoid fossa
Make small clockwise circles, gradually increasing size for 15-20 sec
Reverse direction & repeat
Stage 4: Traction Circumduction
Cephalad stabilize shoulder
Caudal hand grasps patient’s wrist or elbow
abduct patient’s shoulder to 90 and add gentle traction toward ceiling
Make small clockwise circles, gradually increasing size for 15-20 sec
Reverse direction & repeat
Stage 5A: Adduction & ER
cephalad hand stabilize shoulder
have patient grasp physician’s forearm
slightly flex patient’s shoulder so arm may pass just in front of their body
with caudal hand, adduct shoulder to restrictive barrier.
with gentle but firm force, move a short distance through restrictive barrier for 1-2 seconds and release
repeat rhythmically
Stage 5B: Abduction
Return to starting position used in stage 5A
with caudal hand, abduct shoulder to restrictive barrier.
with gentle but firm force, move a short distance through restrictive barrier for 1-2 seconds and release
Repeat rhythmically
Stage 6: Internal Rotation
Abduct patient’s shoulder 45 & internally rotate shoulder, placing dorsum of patient’s hand in the small of the back
with caudal hand gently pull elbow forward into internal rotation restrictive barrier
with gentle but firm force, move a short distance through restrictive barrier for 1-2 seconds & release
Stage 7: Traction with Inferior Glide
Abducts the patient’s arm
Patient’s hand and wrist are placed on the physician’s shoulder that is closest to the patient
with fingers interlaced, the physician’s hand are placed just distal to the glenohumeral joint
Scoops patient’s humeral head in a caudad direction, parallel to the table creating a translatory motion toward the inferior edge of the glenoid fossa
Repeat rhythmically
SC Joint
Movement felt with Abduction
an inferior/caudal movement
SC Joint
Movement felt with Adduction
a superior/cephalad movement
SC Joint
Movement felt with Flexion
A posterior movement of the clavicular head
SC Joint
Movement felt with extension
an anterior movement of the clavicular head
SC Joint
Elevated/ADducted SD ART
patient lying supine with neck fully flexed by physician
physician places thumb over sternal end of the clavicle, exerting a downward/caudal pressure on the clavicle
Patient instructed to inhale & exhale fully
SC Joint
Elevated ADducted SD MET
Patient lying supine, examiner on side of affected shoulder
physician place one hand on the sternal/proximal clavicular head
with other hand, grasp the patient’s wrist and hold arm extended and internally rotated.
Patient is instructred to raise arm against physician’s hand toward ceiling (flexion at shoulder) for 3-5 sec then relax
bring joint into new barrier
Horizontal Extension
SD MET
Patient lying supine, examiner on side of affected shoulder
Physician places one hand on the restricted clavicular head and the other
hand placed behind axilla to cover the scapula.
Patient holds physician’s
shoulder with the hand of the affected shoulder.
Physician then flexes the clavicle toward the manubrium until movement
is palpated in the SC joint by pulling scapula anteriorly.
Posterior force simultaneously applied to proximal clavicle from anterior
to posterior to engage restrictive barrier.
Apply the principles of MET by having patient pulling their shoulder down
toward the table.
Clavicle Anterior & Superior Glide
ART
Pt lying supine, physician on contralateral side
The pt helps to gap the SC joint by Adducting the arm ipsilateral to the SD
(using their contralateral hand to aid in the motion). The physician’s
ipsilateral hand may be placed on the table under the patient’s axilla to
create a fulcrum for the patient to adduct against.
Articulatory springing is applied laterally, posteriorly, and inferiorly over
medial end of clavicle using the physician’s hypothenar eminence of the
contralateral arm
AC Joint:
ART AC-Clavicle Superior
Patient supine with doctor on ipsilateral side.
Doctor’s index fingerpad monitoring AC joint and other fingers on superior
aspect of clavicle; the other hand grasps the patient’s forearm proximal to
the wrist.
Apply a traction force in a caudad direction to gap the AC joint.
While maintaining the traction force maximally flex the arm.
5. Reassess.
AC Joint
Direct
Seated ART
Grasp elbow or forearm of dysfunctional side.
Grasp dysfunctional clavicle between thumb and fingers of free hand.
Apply anterior/inferior pressure with thumb on lateral (or posterior) aspect of
clavicle while flexing patients elbow, extending and adducting humerus (to gap AC
joint). (swim motion)
Doctor holds clavicle antero-inferior (with thumb). Shoulder is extended into a
circulatory sweep, posterior, superior, then anteromedial while maintaining
adduction and capsular tension (swim motion)
Internal Rotation SD MET
Patient seated, physician stands behind patient.
Physician places hand on clavicle just medial to AC joint while grasping wrist
with the other hand.
Add compressive force (blocking linkage) to stabilize clavicle/AC joint while
flexing, abducting (approximately 45 ) & Externally Rotate to restrictive
barrier.
Apply the principles of MET by having the patient Internally Rotate against
physician’s resistance for 3-5 seconds.
Repeat 3-5 times or until motion is fully restored
External Rotation SD MET
Patient seated, physician stands behind patient.
Physician places hand on clavicle just medial to AC joint while grasping wrist
with the other hand.
Add compressive force (blocking linkage) to stabilize clavicle/AC joint while
flexing, abducting (approximately 45 ) & Internally Rotate to restrictive
barrier.
Apply the principles of MET by having the patient Externally Rotate against
physician’s resistance for 3-5 seconds.
Repeat 3-5 times or until motion is fully restored.
