Special Tests of the Shoulder Flashcards
1
Q
Neer Impingement Test
A
- 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
2
Q
Hawkins-Kennedy Impingement Test
A
- 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
3
Q
Yocum Test
A
- Patient seated and rests hand on shoulder
- Elbow is lifted to shoulder height
- Positive Test = pain
- Indicative of a subacromial impingement
4
Q
Painful Arc Test
A
- 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
5
Q
Drop Arm Test
A
- 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
6
Q
Empty Can Test
A
- 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
7
Q
External Rotation Lag Sign
A
- 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
8
Q
Lift Off Test
A
- 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
9
Q
Internal Rotation Lag Sign
A
- 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
10
Q
Posterior Impingement Sign
A
- 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
11
Q
Hornblower’s Sign
A
- 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
12
Q
Speed’s Test
A
- 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)
13
Q
Yergason’s Test
A
- 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
14
Q
Clunk Test
A
- 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
15
Q
Crank Test
A
- 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
16
Q
Jerk Test
A
- 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
17
Q
O’Brien’s Test
A
- 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)
18
Q
Anterior Slide Test
A
- 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
19
Q
Compression Rotation Test
A
- 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
20
Q
Impingement/Horizontal Adduction Test
A
- 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
21
Q
Acromioclavicular Resisted Extension Test
A
- 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
22
Q
Load and Shift Test
A
- 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
23
Q
Apprehension Test
A
- 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
24
Q
Jobe Subluxation/Relocation Test
A
- 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
25
Q
Rockwood Test
A
- 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
26
Q
Sulcus Sign
A
- 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
27
Q
Feagin Test
A
- 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
28
Q
Load and Shift Test
A
- 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
29
Q
Posterior Apprehension or Stress Test
A
- 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.)
