Shoulder Tests Flashcards
SC Compression Tests
Position: Patient sitting with hand of opposite shoulder
Instructions: 1. Stabilize posterior scapula
2. With your other hand on the patient’s elbow horizontally adduct the shoulder by moving the elbow towards the opposite shoulder, compressing the AC joint
Positive Test:
Pain with positioning or passive motion
Implications:
Pain at SC joint indicates SC instability
Sternoclavicular Joint Play
Positions:
Patient: Sitting or Supine
Instructions: Grasp the proximal clavicle apply a gliding pressure superior, inferior, anterior and posteriorly relative to the sternum Superior- Costoclavicular ligament Anterior- SC Ligament (Posterior fibers) Posterior- SC Ligament (Anterior fibers)
Positive Test: Pain, Hypermobility, or hypomobility Implications: Hypermobility: Laxity and/or sprain Hypomobility: Joint adhesions
Do not perform if there is obvious deformity
Tap or Percussion Test
Positions:
Patient: Sitting or Supine
Instructions:
Examiner applies a firm tap proximal and distal to the site of injury.
Positive Test:
Pain or movement at the site of injury
Implications:
Pain or movement at the site of injury is indicative of a fracture.
This test should not be performed if there is obvious deformity
Long Bone Compression Tests
Positions:
Patient: Sitting or Supine
Instructions:
Grasp the proximal and distal ends of the clavicle and apply a compression force along the long axis of the clavicle body.
Positive Test:
Pain or movement
Implications:
Pain or movement at the site of injury is indicative of a fracture
AC Joint Play
Positions:
Patient: Sitting or Supine
Instructions:
Grasp the distal portion of the clavicle and apply a gliding pressure superior, inferior, anterior and posteriorly relative to the scapula
Inferior- AC ligament (superior fibers)
Superior- Conoid ligament, Trapizoid ligament, Ac ligament (inferior fibers)
Anterior- AC ligament, coracoclavicular ligament
Posterior- Clavicle contacting acromion (posterior block), AC ligament
Positive Test:
Pain, Hypermobility, or hypo-mobility
Implications:
Hypermobility: Laxity and/or sprain
Hypomobility: Joint adhesions, osteophytes
Shear Test
Position:
Patient: Sitting or standing with arm relaxed to the side
Instructions:
Place a stabilizing hand on the posterior shoulder with the heel of hand over lateral scapular spine
Place opposite heel of hand over lateral clavicle
Examiner squeezes the heels of the hand together
Positive Test:
Pain or laxity of the AC joint when compared to the other side
Implications:
Pain at AC joint indicates AC instability
AC Compression Test
Position:
Patient: Sitting or standing with hand on opposite shoulder
Instructions:
Place a stabilizing hand on the posterior scapula
With your other hand on the patient’s elbow horizontally adduct the shoulder by moving the elbow towards the opposite shoulder, compressing the AC joint
Positive Test:
Pain with positioning or passive motion
Implications:
Pain at AC joint indicates AC instability
Piano Key Sign
Positions:
Patient: Sitting or Supine with involved limb relaxed at the side
Instructions:
The examiner applies pressure to the subject’s distal clavicle in an inferior direction.
Positive Test:
Clavicle moves into normal position under pressure but pops back up when pressure is removed.
Implications:
instability of the acromioclavicular joint on the involved side.
Comments:
Compare bilaterally
Significant elevation may indicate coracoclavicular joint involvement.
AC Traction Test
Positions:
Patient: Sitting or Supine with involved limb relaxed at the side
Instructions:
The examiner grasps the patient’s distal humerus
The opposite hand gently palpates the AC joint
The examiner applies a distraction force on the distal humerus
Positive Test:
The humerus and scapula move inferior to the clavicle, causing a step deformity, pain, or both.
Implications:
AC Sprain, or Coracoclavicular ligaments
Comments:
Note location of movement/laxity AC Sprain verses inferior GH instability
A positive test should be referred to a physician to rule out Clavicle fracture
Scapulothoracic Joint Mobility Test
Positions:
Patient: lie on his/her side with the examination shoulder on top
Instructions:
The clinician supports the arm by the scapula at its superior aspect and inferior angle.
Alternate hands in applying the mobilizing force and examining the scapular motions of inferiorly, superiorly, medial and laterally
Positive Test:
The quality and quantity of mobility does not match the contralateral side.
Comments:
Limited glenohumeral motion can be caused by limited scapulothoracic mobility
Active Impingement Test ( Painful arc sign)
Position:
Patient: Standing
Instructions:
Clinician observes as the patient actively elevate the shoulder through the full ROM of flexion and abduction and then return to starting position
Positive Test:
Patient reports or demonstrates pain during the middle of the motion’s arc
Implications:
Subacromial impingement of soft tissue structures
Impingement Relief Test
Position:
Patient: Standing or sitting
Instructions:
Instruct the patient to actively elevate the arm 5 times to identify the painful arc of motion. The Clinician applies an inferior glide for abduction and a posteroinferior glide for flexion is applied at the start of the arc and continued through the ROM.
Positive Test:
If pain resolves completely, injury is in contractile tissues
If pain reduces but does not resolve, contractile and inert tissues are involved
If pain is not relieved, inert tissue injury is cause of the pain
Drop Arm Test (for Rotator Cuff Tendinopathy)
Position:
Patient: Standing or Sitting with humerus fully abducted and IR
Instructions: Slowly lower (adduct) arm to the side
Positive Test:
The arm falls uncontrollably from a position of approximately 90⁰ abducted to the side.
Severe pain
Implications:
The inability to lower the arm in a controlled manner is indicative of lesions to the rotator cuff, especially the supraspinatus
Comments:
If the patient is able to lower arm to his/her side apply gentle pressure the forearm of a 90⁰ abducted humerus
Scapular Assistance Test
Positions:
Patient: Standing
Instructions:
One hand on the superior scapular border in position to assist the scapula with upward rotation, the other at the inferior angle in position to assist retraction (posterior tilt and ER)
The patient elevates the humerus and any pain or limitation in motion is noted. Next, as the patient elevates the humerus, the examiner manually assists the scapula with retraction (posterior tilt and ER) and upward rotation
Positive Test:
The patient displays increased ROM and decreased symptoms
Implications:
Assisted scapular motion that improves ROM or symptoms suggests that poor scapular function may have played a role in the associated pathology or dysfunction and must be addressed in the management program
Apley’s Scratch Test
Patient touches opposite shoulder by crossing the chest
GH horizontal adduction, and medial rotation; scapular protraction
The patient reaches behind the head and touches the opposite shoulder from behind
GH abduction and external rotation; scapular elevation and upward rotation
The patient reaches behind the back and touches the opposite scapula
GH adduction and internal rotation; scapular retraction and downward rotation
