Shoulder tests

Question 1

O’Brien sign

Answer 1

shoulder @ 90, internal rotation, and adduction @15 (cross chest). push downward against resistance, repeat with arm supinated

• deep pain is labrum tear
• superficial pain is AC joint problem

Question 2

Anterior slide test

Answer 2

pt puts hand on hip, stabilze the ant clavicle and contact olecranon. slide femoral head anterior and superior, then have patient push it back to place

-popping, cracking, or crepitus, is noticed with pain on the antero-superior aspect of the shoulder indicates superior or anterior glenoid labrum tear

Question 3

Anterior Apprehension with Relocation

Answer 3

aka Jobe relocation test

pt lying supine with shoulder and elbow at 90, if this position reproduces the apprehension then,
place hand on anterior GH joint

-if this causes a relief upon relocation it confirms anterior instability of GH joint (rules out tendinitis as false positive)

Question 4

Painful arc test

Answer 4

pt standing, have them abduction the arm entirely 180d slowely

• -pain worse between 70-110d indicates impingement syndrome with supraspinatus pathology
• -pain worse at 160d or above indicates AC joint involvement

Question 5

Neer Test

Answer 5

pts shoulder is placed into passive forward flexion to end range, stabilize posterior scapula, thumb pointed down

–end range pain as the greater tuberosity jams the anterior border of acromion indicates impingement with overuse injury of supraspinatus or biceps tendon

Question 6

Hawkin- Kennedy test

Answer 6

shoulder at 90 and elbow bent at 90 in front of body. take your arm and go under/over their arm. then passively internally rotate

–the supraspinatus tendon is jammed against the anterior coraco-acromial ligament due to narrowing of subacromial space. posterior pain implicates stretch of the teres minor and infraspinatus tendons

–local pain indicates supraspinatus tendinitis and impingement. anterior pain is anterior impingement syndrome, posterior pain is posterior impingement syndrome

Question 7

Patte test aka?

Answer 7

aka Hornblower sign

shoulder and elbow at 90. stabilize elbow. ask patient to externally rotate. then add resistance

–pain or inability to actively externally rotate against resistance due to weakness indicates infraspinatus or teres minor tendinopathy

Question 8

Empty can test

Answer 8

arm straight out and abducted about 40 d. maximum internal rotation with thumb pointed down. pt pushes up and out while dr pushes down and in

-resistance to the abduction and downward pressure stresses the supraspinatus muscle and tendon insertion. indicates tear, rupture to the supraspinatus muscle or tendon with possibly suprascapular neuropathy

Question 9

Lift off test

Answer 9

Patient puts hand in the small of the back and lifts off, one at a time

-inability to actively left the hand off or away from the back indicates subscapularis tendinopathy

Question 10

Sulcus sign

Answer 10

pt elbow flexed to 90d. and shoulder in neutral position. grasp the wrist and with other hand place downward traction

–this motion attempts to dislocate the shoulder inferiorly. a sulcus that appears on the antero-lateral will indicate shoulder instability and is graded.

-inferior shoulder instability and possible inferior dislocation. +1 sulcus indicates >1cm, +2 indicates 1-2cms, and +3 indicates more than 3cms

Question 11

Mazion shoulder

Answer 11

place hand on opposite shoulder and try to bring elbow to face

-inability to actively raise the elbow to the forehead due to pain /stiffness indicates early stage adhesive capsulitis or non-inflammatory capsular adhesions

Question 12

Maximum elbow flexion test

Answer 12

maximum elbow flexion with hand resting on ipsilateral shoulder for up to 3 min to close the cubital tunnel

-reproduction of parathesia into the ulnar nerve distribution with possible weakness on handshake (power grip) indicates cubital tunnel syndrome (ulnar nerve entrapment)

Question 13

Valgus overload test

Answer 13

valgus stress (L-M) on the elbow while dymanically extending the elbow

-pain in the posterior elbow with a reproduction of a locking or catching senstation or an inability to fully extend due to pain indicates posterior elbow impingement syndrome

Question 14

Reverse Mils test

Answer 14

the elbow is extended and forearm supinated, wrist is then passively extended

-reproduction of pain in the medial elbow indicates medial epicondylitis or golfers

Question 15

froment paper sign

Answer 15

paper between thumb and index finger

-patient is seen to flex the thumb thereby recruiting the median nerve to compensate indicating weakness or palsy of adductor pollicus muscle innervated by ulnar nerve

Question 16

craig test for anteversion

Answer 16

pt prone with knee flexed to 90. grasp distal tib/fib, the hip is internally rotated until trochanter comes parallel

-if hip is internally rotated more than 30 deg for trochanter to reach parallell then it is considered to be structural anteversion

Question 17

hip impingement sign

Answer 17

pt supine with hip flexed to 90. maximal knee flexion hip adducted across midline (do not contact knee) and forcefully internally roatates hip

-sharp anterior catching hip pain indicates hip impingement syndrome

Question 18

modified ober test

Answer 18

pt side lying at the back edge of table, bottom leg flexed for stability. use thigh to stabilize pts sacrum. lower involved leg off the side of table

-hip and lateral thigh remains in abduction and pt experiences lateral thigh pain upon testing indicates tight TFL with possible IT band syndrome

Question 19

test for synovial knee plica (patellar bowstring)

Answer 19

pt side lying involved side up. knee in 30d flexion. dr grasps lateral aspect of patella with superior hand and pushes medially while inferior hand internally rotates tibia. knee is fully extended and flexed to 30d again

-popping, snapping, clunking of patella indicates synovial plica syndrome. side of pain is side of involvement

Question 20

Noble test

Answer 20

pt sit on table with feet flat. knee flexed 60d. place superior thumb over lat fem condyle with firm pressure where IT band runs past knee. passively extend knee to full extension and flex back to 60d while maintaining pressure over thumb

-worse pain at 30/40d indicates IT band syndrome

Question 21

Godfrey sag sign

Answer 21

pt supine with knee & hip flexed to 90d. grasp distal tib/fib and ask pt to contract hamstrings (bring heel to buttock). then observe proximal anterior tib/femoral jt

-proximal tibia sags posteriorly due to lack of static posterior constraint indicates tear or sprain of posterior cruciate ligament

Question 22

Fat pad squeeze

Answer 22

push to elicit painful local response. gather fat pad and retry

-lessening of pain indicates fat pad syndrome

Question 23

test for plantar fasciitis

Answer 23

forcefully dorsiflexes patents ankle and extend big toe and palpate medial arch

-sharp pain along the medial longitudinal arch indicates plantar fasciitis

Question 24

distal tibia-fibular squeeze

Answer 24

squeeze the distal third of tib/fib for 3-5 sec

-pain is reproduced while squeezing or when releasing indicates high ankle sprain of tibio-femoral ligament or the interossesous syndesmosis

Question 25

Navicular drop test

Answer 25

use measuring tape (or index card) and measure distance between navicular tubercle and ground in nonweight bearing and then weight bearing.

-the navicular drops more than 1.6cms on the measurement indicates functional pronation

Question 26

Dreyer sign

Answer 26

pt supine with knee extended. pt asked to raise and lower leg. then dr applies circumferential pressure around distal thigh and pt raises leg again

-inability to raise the leg without help but able to with help indicates patella fracture

Question 27

Wilson sign

Answer 27

pt supine. knee flexed to 90 by dr. knee is extended with the tibia medially rotated. the knee is again flexed to 90 and the tibia is laterally rotated and extended

-knee pain increases near 30d of knee flexion with the tibia internally rotated and pain disappears when externally rotated indicates osteochondritis dessicans