Special Orthopedic Tests : Shoulder Flashcards
Apprehension (Crank) Test for Anterior Shoulder Dislocation
Process :
1. Client supine, examiner abducts shoulder 90 degrees & laterally rotates shoulder slowly
+ve Sign : Client looks or feels apprehensive or alarmed and resists further movement
+ve Indicates : Traumatic Instability l
Relocation Test
Process :
1. Client supine, examiner abducts shoulder to 90 degrees
2. Applies posterior pressure to glenohumeral joint & laterally rotates shoulder slowly
+ve Sign :
- Pain & apprehension decrease
- Further lateral rotation is possible before apprehension or pain return
Surprise Test
Process :
- At the end of the relocation test - examiner release pressure being applied to glenohumeral joint while maintaining shoulder position
+ve Sign : Pain & apprehension increase/return
+ve Indicates : Anterior instability, SLAP lesion, or bicipital tendinopathy
Load & Shift Test
Process :
1. Client sits back with no back support & hand of test arm rests on thigh
2. Examiner will
- stabilize with one hand over clavicle and scapula
- grasps head of humerus with other hand
- gently pushes humerus anteriorly & then posteriorly
- notes amount of translation & end feel
+ve Sign : Translation of > 25%
+ve Indicates : Instability
Posterior Apprehension or Stress Test
Process :
1. Client seater or supine
2. Examiner will
- Flex shoulder & elbow 90 degrees
- Horizontally adduct & medially rotate shoulder
- Apply posterior pressure through humerus
+ve Sign : Pain, apprehension, resistance to further motion
Test for Inferior Shoulder Instability (Sulcus Sign)
Process :
1. Client seated with arms relaxed e
2. Examiner pulls humerus distally
+ve Sign : Sulcus in deltoid
+ve Indicates : Laxity or inferior instability
Hawkins-Kennedy Impingement Test
Process :
1. Client seater or standing
2. Examiner flexes shoulder 90 degrees & forcibly medially rotates shoulder
+ve Sign : Pain
+ve Indicates : 2nd degree impingement, supraspinatus tendinopathy
Neer’s Impingement Test
Process :
1. Client seated or standing
2. Examiner forcibly, passively fully medially rotates & abducts arm in scapular plane
+ve Indicates : Impingement or overuse injury to supraspinatus or long head of biceps
Posterior Internal Impingement Test
Process :
1. Client supine
2. Examiner passively abducts shoulder 90 degrees with 15-20 degrees extension & maximum lateral rotation
+ve Sign : Pain in posterior shoulder
+ve Indicates : Impingement of rotator cuff
Active Compression Test of O’Brien
Process :
1. Client standing with shoulder flexed 90 degrees with elbow extended
2. 1st position : Shoulder is then horizontally adducted 10-15 degrees & medially rotates & forearm pronated
3. 2nd Position : Arm returned to starting position & palm supinated
4. Examiner repeats downward eccentric force
+ve Sign : Pain or painful clicking inside glenohumeral joint in 1st part of test eliminated or decreased in 2nd part
+ve Indicates : SLAP lesion
Anterior Slide Test
Process
1. Client seated with hands on waist, thumbs posterior
2. Examiner stands behind client; stabilizes scapula & clavicle with one hand & applies anterosuperior force at client’s elbow
+ve Sign : Pop or crack & client reports anterosuperior pain
+ve Indicates : Labral tear / SLAP lesion
Biceps Loads Test (Kim Test II)
Process :
1. Examiner takes client into an apprehension test; stops & holds position when apprehension appears
2. Client is then asked to resist elbow flexion
+ve Sign : Apprehension remains the same or pain increases
+ve Indicates : SLAP lesion
Clunk Test
Process :
1. Client supine
2. Examiner places one hand on posterior aspect of humeral head, other hand holds humerus above elbow & passively fully abducts shoulder over client’s head
3. Pushes anteriorly on humeral head while laterally rotating the shoulder
+ve Sign : Clunking or grinding
+ve Indicates : Labral tear
Lateral Scapular Slide Test
Process
1. Patient sits or stands, arm resting at the side; examiner measures distance from base of spine of scapula to SP of T2 or T3, or inferior angle of scapula to SP of T7-T9 or T2 to superior angle of scapula
2. Patient then tested holding two or four other positions
- 45 degrees abduction (hands on waist, thumb posteriorly)
- 90 degrees abduction with medial rotation
- 120 degrees abduction
- 150 degrees abduction
+ve Sign : Excessive movement, winging of scapula
+ve Indicates : Instability due to muscle weakness exists at either joint (scapulothoracic or glenohumeral), scapular instability
Scapular Retraction Test (SRT)
- Patient standing
- Examiner standing behind patient
- Places fingers of one hand over clavicle with heel of hand over spine of scapula (to stabilize clavicle and scapula and to hold scapula retracted)
- Forearm compresses scapula against chest wall
- Empty can test resistance applied
+ve Sign : Scapular retraction decreases pain experienced in empty can
+ve Indicates : Weak scapular stabilizers
Acromioclavicular Crossover, Crossbody or Horizontal Adduction Test
Process :
1. Client standing or seated; perform active or passive full horizontal adduction of client’s shoulder
+ve Sign : Pain local to AC joint
+ve Indicates : Acromioclavicular joint instability
Acromioclavicular Shear Test
Process :
1. Client sitting
2. Examiner cups hands over deltoid muscle, with one hand on clavicle and one hand on scapula
3. Then squeezes heels of hands together
+ve Sign : Abnormal movement
+ve Indicates : Acromioclavicular joint pathology
Paxinos Sign
Process :
1. Patient seated; arm relaxed at side
2. Examiner stands beside test arm
- Places one hand over shoulder with thumb under posterolateral aspect of acromion and index along fingers over middle part of clavicle on same side
- Applies pressure to acromion with thumb anterosuperior while applying an inferior directed counterforce to the clavicle with the fingers
+ve Sign : Pain @ AC joint increases
+ve Indicates : AC joint pathology
Drop Arm Test
Process :
1. Examiner abducts client’s shoulder 90 degrees
2. Asks client to slowly lower arm to side in same arc of movement
Positive Sign : Client unable to return arm to side slowly, severe pain
+ve Indicates : Rotator cuff tear
Lift Off Sign
Process :
1. Client standing, seated or supine
2. Places dorsum of hand against lumbar spine
3. Lift hand away from back
+ve Sign : Inability to lift hand away from back
+ve Indicates : Subscapularis lesion
Speed’s Test (Biceps or Straight Arm Test)
Process :
1. Client flexes shoulder 90 degrees with elbow extender, forearm is first supinated then pronated
2. Examiner resist shoulder flexion
+ve Sign : Increased pain at bicipital groove
+ve Indicates : Biceps paratenonitis or tendinosis
Supraspinatus (Empty Can or Jobe) Test
Process :
1. Client abducts shoulder 90 degrees with no rotation
2. Examiner resists further abduction
3. Shoulder then medially rotated (thumb points to floor) & angled forward 30 degrees (scapular plane)
4. Examiner resists further abduction
+ve Sign : Weakness or pain
+ve Indicates : Supraspinatus strain/tear
Yergason’s Test
Process ;
1. Client’s elbow flexed 90 degrees & stabilized against thorax with forearm pronated
2. Examiner resists supination & lateral rotation & palpates bicipital groove
+ve Sign : Biceps tendon “pops” out of groove OR tenderness alone at groove
