Special Test for shoulder Flashcards
What does the cross arm test indicate and how is it performed?
- Indicates = acromioclavicular joint pathology
How to perform:
* Passively adduct patient’s arm across the chest wall with humerus parallel to the ground so free hand of the examined elbow rests on the opposite shoulder.
* Patient then pushes the elbow superiorly against the clinicians resistance.
* Positive = Pain with end-range adduction or with pushing arm up.
What does the Active compression test indicate and how is it performed?
- Indicates = AC pathology if pain is in the AC joint, or a LABRAL (SLAP LESION) pathology if pain is felt more internal in the shoulder.
How to perform:
* Patient flexes arm to 90 degrees and adducts 10-15 degrees with internal rotation (thumbs down).
* The patient resists the examiners downward force. This maneuver is then repeated with the arms supinated.
* Positive = Pain in the AC joint or the shoulder during the first maneuver that improves or resolves with the second maneuver.
What does the Scapular winging test indicate and how is it performed?
Medial Deviation from normal postion: Serratus Anterior and/or Long Thoracic Nerve
Lateral Deviation from lateral position: Spinal accessory nerve to trapezius Or Scapular nerve to rhomboids
How to perform:
* Have patient do a push-up off the wall
* Positive = Scapula wings
* Indicates = weakness of Serratus anterior or long thoracic n.
What does the Yergason’s test indicate and how is it performed?
Indicates = Unstable bicipital tendon and subluxation
- Patient seated with elbow at side and forearm flexed to 90 degrees.
- Examiner palpates the long head of biceps with one hand while holding the wrist with the other.
- The Patient then simultaneously flexes their elbow and supinates their forearm against resistance.
- Positive = Tendon will pop out of the groove and cause significant pain.
What does the Speed’s test indicate and how is it performed?
Indicates = Bicipital tendon pathology, usually tendinitis.
- Shoulder in 90 degrees of forward flexion, elbow extended and hand supinated, with resistance applied downward.
- Positive = Pain in bicipital groove
What does the Empty can test or Jobe’s Test indicate and how is it performed?
Indicates = supraspinatus tendon tear (Can be more provocative of symptoms)
- Patient abducts both arms to 90 degrees and forward flexes 45 degrees with thumbs pointing down to the ground
- Patient then resists downward pressure.
- Positive = Weakness, pain, or dropping of the arm, which occurs in significant tears of the supraspinatus muscle with even a gentle tap to the forearm.
more information:
The supraspinatus muscle is part of the rotator cuff and is primarily responsible for the initial abduction of the arm (the first 15-30 degrees). It’s also active in maintaining the arm’s position at 90 degrees of abduction.
What does the Full Can Test indicate and how is it performed?
- Indicates = supraspinatus tendon tear.
How to perform: Literally the same as empty can but thumbs are pointing upward
- Patient abducts both arms to 90 degrees and forward flexes 45 degrees with thumbs pointing down to the ground
- Patient then resists downward pressure.
- Positive = Weakness, pain, or dropping of the arm, which occurs in significant tears of the supraspinatus muscle with even a gentle tap to the forearm.
More information: The supraspinatus muscle is part of the rotator cuff and is primarily responsible for the initial abduction of the arm (the first 15-30 degrees). It’s also active in maintaining the arm’s position at 90 degrees of abduction.
What does the Neer Impingement Sign indicate and how is it performed?
Indicates = rotator cuff impingement pathology, usually supraspinatus or biceps tendon
How to perform:
* Examiner stabilizes patients shoulder on the top with his or her off hand, forward flexes the hummerus in the scapular plane to 180 degrees, with the arm medially rotated.
* Positive = Pain in shoulder
What does the Painful Arc indicate and how is it performed?
- Indicates = rotator cuff impingement pathology,
- Pain starting after 100 degrees of abduction often suggests AC joint pathology, while pain immediately with abduction may indicate Frozen Shoulder
How to perform:
* Patient abducts arm overhead as far as they can go
* Positive = Pain with shoulder abduction between 70-100 degrees
More information
1. Why it indicates impingement: The painful arc test is commonly positive for rotator cuff impingement when there is pain during shoulder abduction between 70 and 100 degrees. This range is critical because, at around this angle, the rotator cuff tendons (especially the supraspinatus) and the subacromial bursa pass under the acromion. If there is inflammation, swelling, or any structural narrowing in this area (subacromial space), raising the arm will compress these structures, causing pain.
Pain mechanism: During abduction, the humeral head moves closer to the acromion, potentially trapping or irritating the rotator cuff tendons. This “impingement” typically triggers pain, indicating that these structures are inflamed or damaged.
- AC Joint Pathology (Pain Starting After 100 Degrees)
Why pain after 100 degrees suggests AC joint issues: When a person continues abduction past 100 degrees, the movement involves the AC joint more actively. If the AC joint is injured or arthritic, pain often increases in this higher range of abduction, because this position places stress on the AC joint by bringing the arm and scapula closer together.
Pain pattern: Pain that begins only after 100 degrees of abduction can indicate that the source of pain is likely from the AC joint rather than the rotator cuff or subacromial space. - Frozen Shoulder (Immediate Pain with Abduction)
Why early pain suggests frozen shoulder: Frozen shoulder (adhesive capsulitis) involves thickening and stiffness of the joint capsule, which restricts shoulder movement and causes pain. This condition limits abduction from the beginning of the movement. Therefore, pain occurring right at the start of abduction (before reaching 70 degrees) suggests frozen shoulder rather than rotator cuff impingement or AC joint pathology.
Pattern of restriction: With frozen shoulder, pain and stiffness are typically present throughout the entire range of motion, not isolated to a specific part of the arc like with impingement.
What does the Drop-Arm (Codman’s) Test indicate and how is it performed
- Indicates = a tear in the rotator cuff complex. More specific to Supraspinatus
How to perform:
* The examiner abducts the patient’S shoulder to 90° and then asks the patient to slowly lower the arm to their side in the same arc of movement
* Positive = if the patient is unable to return the arm to the side slowly or has severe pain when attempting to do so.
What does the Napolean sign test indicate and how to perform it?
- Indicates = Subscapularis weakness or injury.
How to perform: * Place patient’s hand on his or her stomach and have the patient push their palms into their stomach
* Positive = The elbow will drop backward.
In this pic it is the Belly Press Test. As Subscapularis is the only rotator cuff that performs internal rotation
What does the Gerber’s (Liftoff) Test indicate and how do you perform it?
- Indicates = Subscapularis injury or weakness
- This evaluates Subscapularis strength by limiting pectoralis major firing.
- The patient puts his or her hand behind the lumbar spine and attempts to lift the hand away from the back
- Positive = If the patient can not accomplish the liftoff
In this pic it is the lift off test
What does the Anterior Apprehension sign (CRANK) test for and how to perform it?
- Indicates = Anterior glenohumeral instability, previous dislocation.
how to perform it
- Patient is sitting or supine, arm is abducted to 90 degrees, elbow flexed to 90 degrees. The forearm is then forced into external rotation past 90 degrees.
- Positive = Patient will be very apprehensive and ask examiner to stop for fear of repeat dislocation.
What does the Posterior apprehension sign test for and how to perform it?
- Indicates = Posterior Instability due to Labral Pathology
how to perform:
* Patient is lying down or sitting, examiner moves the patients arm into internal rotation, adduction and flexion. The examiner gently but firmly pushes posteriorly on the elbow.
* Positive = Pain, clunk, apprehensive look.
What does the Clunk test indicate and how to perform it?
Indicates = Labral pathology
How to perform:
* Patient is supine
* examiner places a hand behind the humeral head
* the opposite hand holds the distal humerus and fully abducts the humerus over the patients head
* the examiner then pushes anteriorly (towards ceiling) on the humeral head
* the hand on the distal humerus then externally rotates the shoulder
* Positive = A clunk or grinding in the shoulder.
