Special Tests: Shoulder

Question 1

Apprehension Test (anterior shoulder instability)

Answer 1

With Pt supine, passive abduction to 90 and ER to end range. (+) if Pt c/o pain or instability.

Question 2

Relocation Test (anterior shoulder instability)

Answer 2

With Pt supine, GH at edge of table - 90 abduction and ER - force is applied by clinician on head of humerus, posteriorly. If pain, apprehension diminish, (+).

Question 3

Bony Apprehension Test (anterior shoulder instability)

Answer 3

With Pt seated/standing, abduction to 45, then 45 or less of ER. (+) if Pt appears apprehensive.

Question 4

Anterior Drawer Test (anterior shoulder instability)

Answer 4

With pt supine, arm at 60-80 abduction, neutral rotation - humeral head is then translated anteriorly (quick motion). (+) of pt reports pain or comparable sign.

Question 5

Load and Shift (anterior shoulder instability AND posterior shoulder instability))

Answer 5

With pt in sitting, Pinch head of humerus with thumb posterior. (+) if excessive translation (typically anteriorly >25%).

Question 6

Posterior Drawer Test (Posterior shoulder instability)

Answer 6

With pt supine, arm is abducted to 80-100, Must identify joint line first. Then AP force is applied to humerus (quickly).

Question 7

Sulcus Sign (Inferior instability)

Answer 7

With pt standing/sitting, Stabilize at shoulder. Ided mnferior force is exerted on the humerus, proximal to elbow - presence of “sulcus” indicates inferior laxity.

Question 8

Crank Test (Labrum)

Answer 8

With pt supine, attain 160 abduction / elbow 90 - first, compression is applied to GH (palm into olecranon), then humerus is repeatedly rotated in small IR / ER arc of motion in attempt to pinch or catch a torn labrum. (+) if pain reproduced and “click” experienced.

Question 9

Compression Rotation Test (Labrum)

Answer 9

With pt supine, attain abduction 90, elbow 90 - compressive force is applied to humerus (use thigh, stop before shoulder shrugs up), then rotation back and forth between IR/ER is performed (switch stances). Larger arc of motion than crank test. (typically start with this before progressing to crank test).

Question 10

Active Compression (O’Brien Test) (Labrum)

Answer 10

With pt standing, shoulder flexed to 90, h. adduction 10 (thumb in front of sternum), max IR - pt then resists downward force - then repeated in max ER (palm up), 10 horiz. abduction. (+) if pain is worse in IR vs ER

Question 11

Yergason (Labrum)

Answer 11

HandshakeWith pt seated / standing, elbow flexed to 90 and forearm pronated - pt is then instructed to supinate while clinician resists at wrist. (+) if pain is localized to bicipital groove (palpate with hand).

Question 12

Biceps Load Test I (Labrum) - NOT ON SKILL CHECK

Answer 12

With pt supine, 90 abduction, forearm neutral/slight supination - then passively move to end range ER - pt is then asked to flex elbow while clinician resists. (+) if reproduction of pain.

Question 13

Biceps Load Test II (Labrum)

Answer 13

With pt supine, 120 abduction, forearm supination and end-range ER. Use thigh to support elbow. Pt is asked to flex elbow while examiner resists. (+) if no change in apprehension or pain that is worsened with resisted elbow flexion.

Question 14

AC Shear Test (AC joint)

Answer 14

With pt seated, clinician cups hand over clavicle and spine of scapula, then proceeds to apply compressive force through AC joint. (+) if pain is reproduced.

Question 15

Biceps Speed Test (Biceps tendinits)

Answer 15

With pt standing , full elbow extension and full supination - clinician resists from 0-60 of shoulder flexion. (+) if pain is reproduced concordant to bicipital groove.

Question 16

Neer’s Test (Subacromial impingement)

Answer 16

Scapula stabilized; pt’s arm passively taken to end-range overpressure, at angle between flex/ABDuction. If (+) thought to represent impingement of RC on anterosuperior glenoid labrum rim.

Question 17

Hawkins-Kennedy Test (Subacromial impingement)

Answer 17

Arm is passively flexed to 90 in plane of scapular; humerus is stabilized, and forearm is taken into IR. RC tendons may be impinged under acromion if (+).

Question 18

Cross Body Adduction Test (Subacromial impingement)

Answer 18

90 shoulder flexion. Can have Pt set hand on opp. shoulder - then passive horizontal adduction to end range. (+) if pain.

Question 19

ERLS (Subacromial impingement OR RC tear)

Answer 19

Shoulder in 20 scaption; passive ER to end-range - if lag presents due to inability to maintain end-range ER then (+).

Question 20

IRLS (Subacromial impingement)

Answer 20

If unable to perform lift off test, subscapularis tear is suspected.

Question 21

Painful Arc Test (Subacromial impingement)

Answer 21

Typically considered to fall between 60-120 of active abduction with reproduction of pain while performing.

Question 22

Empty Can/Full Can Test (Subacromial impingement)

Answer 22

Scaption. Thumb up flex to 90 (full can). Reset. Thumb down flex to 90 (empty can).

Question 23

Lateral Jobe Test (RC tear)

Answer 23

With pt seated / standing, abduction to 90 with IR to end-range - then clinician applies inferior force at elbow. (+) if pain reproduction or weakness / inability to perform test.

Question 24

Drop Arm Test (RC tear)

Answer 24

With pt in standing, arm is passively elevated to 90 scaption/abduction with thumb up (more impingement related) or palm down. (+) if pt is unable to lower arm with control / slowly (5 count). Looking for smooth lower.

Question 25

Drop Sign Test (RC tear)

Answer 25

With pt seated , 90 scaption/abduction then passive ER to near end-range - pt is asked to maintain position. (+) if lag occurs with inability to maintain full, end-range ER

Question 26

Hornblower Sign (RC tear)

Answer 26

With pt seated/standing, pt is asked to attain position of “hands to mouth” as if replicating the position of playing trumpet. If unable to to raise hand to mouth without abducting shoulder, (+).

Question 27

Weakness with Elevation (RC tear)

Answer 27

Raise arm