Special Tests Flashcards
Describe how you would carry out the Bear Hug Test and what a positive diagnoses indicates:
Subscapularis Injury.
Ask patient to place their hand on the opposite shoulder with fingers extended. Then ask them to keep it there as you attempt to pull it away forcing them to IR the shoulder.
+ve= Pain or weakness
Test(s) for Anterior Instability?
Apprehension Test.
Anterior Drawer Test.
Jobe’s Relocation Test.
Describe how you would carry out the Belly Press Test and what a positive diagnoses indicates:
Subscapularis Injury.
Ask patient to place their hand palm down on their abdomen (just below the xyphoid process) with fingers extended. Then ask them to press into their belly as hard as possible.
+ve= Pain or weakness (or compensation through wrist flexion).
Test(s) for Injury to Subscapularis?
Bear Hug Test
Belly Press Test
Gerber’s Lift-Off Test
Internal Rotation Lag Sign
Describe how you would carry out the Anterior Drawer Test and what a positive diagnoses indicates:
Anterior Drawer Test.
Patient supine, passively abduct the shoulder 90, flexed 20 and ER 30*. Draw the distal humerus anteriorly and apply a counterpressure on the coracoid process.
+ve = excessive translation or pain.
Test(s) for SLAP Lesions?
Biceps Load II Test
O’Brien’s Test
Crank Test
Describe how you would carry out the Apprehension Test and what a positive diagnoses indicates:
Anterior Instability.
Place the arm in 90* abduction and 90* elbow flexion, support the elbow and then move the arm passively into ER by pushing the wrist back.
+ve = apprehension or discomfort.
Describe how you would carry out the Crank Test and what a positive diagnoses indicates:
SLAP Lesion.
Patient seated or supine with ~100* abduction and 90* elbow flexion. Stabilsie their elbow and apply compressive force to humerus in towards the shoulder girdle and maintain this force whilst IR & ER the arm. (Turning it like a crank).
+ve = Pain, clicking or catching.
Describe how you would carry out the Drop Arm Test and what a positive diagnoses indicates:
Supraspinatus Injury.
Passively raise patients arm to 90* abduction then ask them to lower it back down slowly.
+ve = Sudden drop or pain
Describe how you would carry out the Biceps Load II Test and what a positive diagnoses indicates:
SLAP Lesions.
Patient supine with shoulder in 120* abduction and full ER with 90* elbow flexion and forearm in supination. Ask the patient to flex their elbow and provide resistance at the wrist.
+ve = Pain exacerbated during flexion
Describe how you would carry out the Full Can Test and what a positive diagnoses indicates:
Supraspinatus Injury.
Patients arm abducted to 90* in the scapula plane, patients hand in a fist with the thumb pointing upwards, then apply a downward force and ask them to resist.
+ve = pain or weakness
Describe how you would carry out the Hawkins-Kennedy Test and what a positive diagnoses indicates:
Subacromial Impingement Syndrome (SAPS).
Place the patients arm in 90* shoulder flexion and 90* elbow flexion, then passively IR the arm.
+ve = Pain during passive IR.
Describe how you would carry out Gerber’s Lift-Off Test and what a positive diagnoses indicates:
Subscapularis Injury.
Patient standing, asked to place the back of the hand on their Lx spine, then ask them to IR rotate their arm to lift it away from the back.
+ve = pain or weakness (or compensation)
Describe how you would carry out the Empty Can Test and what a positive diagnoses indicates:
Supraspinatus Injury.
Patients arm abducted to 90* in the scapula plane, patients hand in a fist with the thumb pointing downwards, then apply a downward force and ask them to resist.
+ve = pain or weakness
Test(s) for Supraspinatus Injury?
Drop Arm Test.
Empty Can Test.
Full Can Test.
External Rotation Lag Sign.
Test(s) for Subacromial Impingement Syndrome (SAPS).
Hawkins-Kennedy Test
Neer Test
Painful Arc Test
Test(s) for Teres Minor Injury.
Hownblower’s Sign.
Describe how you would carry out the Infraspinatus Test and what a positive diagnoses indicates:
Infraspinatus Injury.
Patient seated arms by their side with 90* elbow flexion (robot position), place hand on the the back of patients and ask them to ER against resistance.
+ve = pain or weakness with ER.
Test(s) for Posterior Instability?
Inferior Sulcus Test
Norwood Stress Test
Describe how you would carry out the Hownblower’s Sign Test and what a positive diagnoses indicates:
Teres Minor Injury.
Patient standing, arm passively abducted to 90* in scapula plane, then passively elbow flexed to 90*. Then ask patient to ER against resistance.
+ve = pain or weakness.
Describe how you would carry out Jobe’s Relocation Test and what a positive diagnoses indicates:
Anterior Instability.
Perform the apprehension test: patient lies supine with shoulder 90* abduction and elbow flexed 90*. Apply a passive ER force.
Then apply a posterior force to the shoulder and repeat apprehension test.
+ve = decrease in pain or apprehension with posterior force.
Describe how you would carry out the Jerk Test and what a positive diagnoses indicates:
Postero-Inferior Instability.
Patient seated, stabilise the scapula with one hand then hold affected arm at 90* abduction and IR. Then provide axial force to the humerus (towards shoulder) and move arm horizontally across the body.
+ve = clunking, instability or pain.
Describe how you would carry out the External Rotation Lag Sign. Test and what a positive diagnoses indicates:
Infraspinatus and Supraspinatus.
Patient seated or standing, shoulder abducted 20* in scapula plane and elbow flexed to 90*. Passively ER shoulder to maximal range and ask patient to hold this position when support released.
+ve = inability to maintain position.
Describe how you would carry out the Internal Rotation Lag Sign Test and what a positive diagnoses indicates:
Subscapularis Injury.
Patient seated, bring arm into maximal IR (Dorsum of hand to Lx Sp.), then examiner passively extends shoulder (brings hand away) and then ask patient to maintain this position independently by releasing wrist.
+ve = Lag (drop) or inability to maintain position.
Test(s) for Infraspinatus Injury?
Infraspinatus Test.
External Rotation Lag Sign.
Describe how you would carry out the Norwood Stress Test and what a positive diagnoses indicates:
Posterior Instability.
Patient supine with 90* shoulder abduction, 90* flexion, stabilise shoulder joint and passively adduct across the body.
+ve = pain, instability or subluxation.
Describe how you would carry out the Neer Test and what a positive diagnoses indicates:
Subacromial Impingement Syndrome (SAPS).
Patient seated, stabilise the scapula and then full IR the arm, then passively flex the arm.
+ve = Pain during flexion with IR.
Describe how you would carry out the Posterior Sulcus Test and what a positive diagnoses indicates:
Posterior Instability
Patient sitting or standing arm relaxed by side, stabilise the shoulder around the acromion and grip the arm above elbow and apply distraction force (pulling arm downward).
+ve = Visible indentation between acromion and humeral head indicating excessive laxity.
Test(s) for Postero-lateral Instability?
Jerk Test
Describe how you would carry out O’Briens Test and what a positive diagnoses indicates:
SLAP Lesion.
Patient sitting or standing, place the arm in 90* shoulder flexion and 15* horizontal adduction. Then IR shoulder and pronate elbow (such as ‘empty can’) then resist downwards movement. Then repeat with ER (such as ‘full can’).
+ve = deep pain with thumb down that decreases or disapears when thumb up.
Describe how you would carry out the Rent Test and what a positive diagnoses indicates:
Supraspinatus Injury.
+ve =
Describe how you would carry out Paxino’s Sign Test and what a positive diagnoses indicates:
ACJ Pain.
Patient sitting with arm by side, place your thumb under the posterolateral aspect of the acromion and apply a anterosuperior pressure on the acromion with an inferior pressure on the mid clavicle.
+ve = pain elicited around ACJ
Describe how you would carry out the Painful Arc Test and what a positive diagnoses indicates:
Subacromial Impingement Syndrome (SAPS).
Patient sitting or standing instruct them to abduct the arm fully in the scapular plane then slowly lower the arm back down.
+ve = Pain between 60-120*
Describe how you would carry out the Resisted ACJ Extension Test and what a positive diagnoses indicates:
ACJ Injury.
Patient seated with 90* shoulder flexion and arm IR. Place hand on triceps and ask patient to horizontally abduct the arm against resistance.
+ve = pain localised to ACJ
Test(s) for ACJ Injury?
Resisted ACJ Extension Test.
Scarf Test
Describe how you would carry out the Scarf Test and what a positive diagnoses indicates:
ACJ Injury.
Patient seated ask them to place their palm on opposite shoulder with 90* of abduction. Passively horizontally adduct the shoulder bringing their elbow to the contralateral shoulder.
+ve = pain localised to ACJ
Describe how you would carry out the Scapular Assistance Test and what a positive diagnoses indicates:
Scapular Dyskinesis.
Patient seated and instructed to actively elevate arm infront of them to 90* whilst the examiner provides assistance to the scapula with a gentle push to the medial aspect.
+ve = reduced pain or improved mobility with assistance.
Describe how you would carry out the Punch Out Test and what a positive diagnoses indicates:
Serratus Anterior Weakness.
Patient standing against a wall, ask them to push against it with a single arm and observe from behind.
+ve = winging of scapula
Test(s) for Scapular Dyskinesis:
Scapular Assistance Test
Scapular Retraction Test
Describe how you would carry out the Scapular Retraction Test and what a positive diagnoses indicates:
Scapular Dyskinesis.
Perform the empty can test (thumb down), then repeat the test with the examiner stabilising the scapula in a retracted position by cupping firmly the anterior shoulder by the clavicle.
+ve = rotator cuff strength restored or improved.
Describe how you would carry out Speed’s Test and what a positive diagnoses indicates:
Biceps Brachii or Superior Labral Tear.
Place arm in 90*shoulder flexion with full elbow extension and supination. Ask patient to resist a downwards force just above the wrist.
+ve = pain in bicipital groove
Test(s) for Serratus Anterior Weakness:
Punch-Out Test
