Special Tests of the Shoulder

Question 1

Neer Impingement Test

Answer 1

• Patient’s arm forcefully elevated through forward flexion
• Causes a “jamming” of the greater tuberositiy against the anteroinferior border of the acromion
• Positive Test = Pain
• Indicative of an overuse of the supraspinatus muscle and sometimes the biceps tendon

Question 2

Hawkins-Kennedy Impingement Test

Answer 2

• Examiner flexes the patient’s arm to 90 then forcefully medially rotates the shoulder
• This movement pushes the supraspinatus muscle and tendon against the anterior surface of the coracoacromial ligament and the coracoid process
• Positive Test = pain

Question 3

Yocum Test

Answer 3

• Patient seated and rests hand on shoulder
• Elbow is lifted to shoulder height
• Positive Test = pain
• Indicative of a subacromial impingement

Question 4

Painful Arc Test

Answer 4

• Patient in standing and asked to actively abduct the involved shoulder
• Positive Test = painful report with shoulder in the 60-120 range
• Indicative of subacromial impingement
• Pain at end-range may indicate AC pathology

Question 5

Drop Arm Test

Answer 5

• Clinician passively abducts the patient’s shoulder to 90
• Clinician asks the patient to take the weight of the arm and slowly lower the arm to the side
• Positive test= indicated by the inability to slowly lower the arm or severe pain when attempting to do so
• Indicative of a tear of the rotator cuff complex

Question 6

Empty Can Test

Answer 6

• Patient’s shoulder abducted to 90 in scapular plane and placed in full IR (thumb pointing toward ground)
• Resistance to abduction is given while the clinician looks for weakness of pain
• Positive Test= pain
• Can indicate a supraspinatus tear or neuropathy of the supraspinatus tendon

Question 7

External Rotation Lag Sign

Answer 7

• Patient is seated, elbow is passively flexed to 90 and shoulder is held at 20 elevation in the scapular plane near maximal ER
• Patient asked to actively hold that ER position as the therapist releases the wrist (maintain elbow support)
• Positive test = lag or angular drop occurs
• Clinician then asks the patient to actively hold the elbow and the lag/ang drop is assessed
• Indicative of a tear of the supraspinatus and/or infraspinatus

Question 8

Lift Off Test

Answer 8

• Patient stands and places the dorsum of the hand over the small of the back
• Clinician gives mold resistance with finger to the patient’s palm and asks the patient to lift hand away from the back
• Positive test= pain or inability to perform test
• Indicative of subscapularis lesion

Question 9

Internal Rotation Lag Sign

Answer 9

• Patient stands and places the dorsum of the hand over the small of the back
• Clinician lifts the patient’s arm off the back and asks the patient to maintain that position
• Positive test= pain and/or inability to maintain pre-placed position
• Indicates a subscapularis tear

Question 10

Posterior Impingement Sign

Answer 10

• Patient lies supine with shoulder placed at 90-110 of abduction and full ER
• Positive test= pain in the deep posterior shoulder
• Indicative of RC tear and/or posterior labral tear

Question 11

Hornblower’s Sign

Answer 11

• Patient is seated or standing
• Arm is supported at 90 abduction in the scapular plane with elbow flexed to 90
• Patient is asked to ER against resistance
• Positive Test= patients inability to ER against resistance and/or pain
• Hornblower’s Sign= present if the patient cannot ER in stated position
• Indicative of a Teres Minor pathology

Question 12

Speed’s Test

Answer 12

• Patient standing with shoulder flexed to 80-90, full ER and full elbow extension
• Clinician resists forward shoulder flexion
• Positive test= pain in the bicipital groove
• Indicative of biceps tendonitis
• May also produce pain with SLAP lesion
• Severe grade 2 or 3 degree strain causes profound weakness
• More effective than Yergason’s Test (bone moves over tendon)

Question 13

Yergason’s Test

Answer 13

• With patient elbow flexed to 90, stabilized against the thorax and forearm pronated, the examiner resists supination while the patient also laterally rotates the arm against resistance
• Positive test= pain or tenderness in bicipital groove
• Indicative of biceps tendonitis

Question 14

Clunk Test

Answer 14

• Patient is supine
• Clinician places one hand on posterior aspect of the shoulder over the humeral head, the other hand holds the humerus above the elbow
• Clinician fully abducts the arm over the patient’s head
• Clinician then pushes anteriorly with the hand over the humeral head while the other hand rotates the humerus into lateral rotation
• Positive test= clunk or grinding sound
• Indicative of a labral tear

Question 15

Crank Test

Answer 15

• Patient is supine
• The arm is elevated to 160 in the scapular plane and is positioned in maximal internal or external rotation
• Clinician applies an axial loading along the humerus
• Positive test= the reproduction of a painful click in the shoulder during the maneuver
• Indicative of a labral tear

Question 16

Jerk Test

Answer 16

• Patient sitting, Clinician standing to the side and slightly behind the patient
• Clinician grasps the patient’s elbow with one hand and the scapula with the other
• Position the patient’s arm at 90 abduction and IR
• Clinician provides an axial compression-based load to the humerus through the elbow while maintaining the horizontally abducted arm
• Axial loading compression is maintained while the patients arm is moved into horizontal adduction
• Positive=sharp shoulder pain w/ or w/o cluck or click
• Indicative of posterioinferior labral tear

Question 17

O’Brien’s Test

Answer 17

• Patient stands with involved shoulder at 90 flexion, 10 horiztonal adduction and maximum IR (elbow extended)
• Patient resists a downward force by the clinician
• Patient asked to report any pain as either “on top of the shoulder” (AC joint) or “inside the shoulder” (SLAP lesion)
• Test is repeated with arm in maximum ER as well
• Positive test=painful clicking/pain inside the shoulder with IR that is relieved by ER (glenoid labrum)

Question 18

Anterior Slide Test

Answer 18

• Patient Sitting with arm to side
• Clinician stabilizes the scapula and clavicle with one hand
• Clinician then applies an anteriosuperior force at the elbow
• Positive test= popping, snapping, and/or pain
• Indicative of labral tear

Question 19

Compression Rotation Test

Answer 19

• Patient supine and relaxed
• Clinician grasps arm and flexes elbow with arm abducted about 20
• Clinician pushes and compresses the humerus in the glenoid while rotating the humerus medial and lateral
• Positive test=snapping or catching
• Indicative of labral tear

Question 20

Impingement/Horizontal Adduction Test

Answer 20

• Patient sitting with arm at 90 of flexion
• Clinician passively moves the patients arm into horizontal adduction and applies overpressure
• Positive Test= pain is reported in the AC joint

Question 21

Acromioclavicular Resisted Extension Test

Answer 21

• Patient sitting with shoulder at 90 of elevation combined with IR and 90 of elbow flexion
• Patient is asked to horizontally abduct the arm against resistance
• Positive test= pain is reported in the AC joint

Question 22

Load and Shift Test

Answer 22

• Patient seated, arm at side (or supine-Dutton)
• Gently load GH joint- anterior and posterior
• 25% anterior translation normal
• Grade 1-50% translation
• Grade II- >50% translation
• Grade III- rides over and does not reduce
• 50% posterior translation normal

Question 23

Apprehension Test

Answer 23

• Patient supine with arm at 90 abduction and ER
• Clinician applies overpressure into ER
• Perform test slowly so you don’t dislocate shoulder
• Watch patient’s face for apprehension signs
• Positive test= apprehension, not pain
• If anterior pain→anterior microsubluxation
• If posterior pain→internal impingement

Question 24

Jobe Subluxation/Relocation Test

Answer 24

• Clinician places patient in position as described in the Apprehension test and stabilizes test position via grasping the patient’s elbow
• Clinician applies an anterior pull on the humerus
• Pain and apprehension from the patient indicate a positive test for labral tear or anterior instability (subluxation)
• Clinician then applies posterior force to shoulder through the humeral head (relocation)
• Positive test= apprehension and/or pain decreased

Question 25

Rockwood Test

Answer 25

• Clinician behind seated patient
• ER the shoulder with arm abducted passively to 45, 90, and 120
• Positive test=apprehension noted
• Different positions utilized because the stabilizers of the shoulder vary at differing angles of abduction and ER

Question 26

Sulcus Sign

Answer 26

• Patient sits with arm at side
• Clinician grasps forearm below and pulls arm distally
• The presence of sulcus sign demonstrates inferior instability
• Graded by measuring the inferior margin of acromion to the humeral head
• +1 sulcus implies distance of less than 1 cm
• +2 sulcus implies distance of 1-2 cm
• +3 sulcus implies distance of more than 2 cm

Question 27

Feagin Test

Answer 27

• Patient’s arm abducted to 90 with elbow extended and resting on clinician’s shoulder
• Clinician’s hands clasped over the patient’s humerus, between the upper and middle thirds
• Clinician pushes humerus downward and forward
• Positive test= apprehension
• This testing position puts more stress on the inferior GH ligament

Question 28

Load and Shift Test

Answer 28

• Arm at side, relaxed, gently load anterior and posterior
• Grade I- up to 50% of humeral head translation with
• Grade II- >50% translation
• Grade III- Humeral head rides over glenoid limb
• Posterior 50% translation is normal

Question 29

Posterior Apprehension or Stress Test

Answer 29

• Patient supine
• Clinician flexes arm to 90
• Clinician applies posteriorly directed force on patient’s elbow
• While applying axial load, clinician horizontally adducts and IR the patients arm
• Positive test= apprehension or alarm on pt face
• Can also be performed at 90 shoulder abduction (shoulder be no greater than 50% humeral heads diameter of posterior transl.)