Special Tests: Shoulder

Question 1

Painful Arc Sign

Answer 1

MUSCULOTENDINOUS INTEGRITY
GENERAL:
Patient actively elevates the arm in the flexion or abduction plane;
+ test is pain or deviation from normal movement pattern in the 60-120 degree range of motion.

Question 2

Rent Sign

Answer 2

MUSCULOTENDINOUS INTEGRITY
ROTATOR CUFF TENDON:
Method: UE in full extension, elbow at 90, examiner ER-IR UE while palpating anterior GH joint
Structure assessed: rotator cuff tendon
Clinical finding: + test = presence of palpable defects in RC, catches or clicks
Statistics: Sensitivity 91-96%, specificity 75-97%

Question 3

Drop Arm (Codman) Test

Answer 3

MUSCULOTENDINOUS INTEGRITY
SUPRASPINATUS:
Method: Arm brought passively to 90 abduction, patient tries to lower arm slowly
Structure assessed: supraspinatus, integrity of rotator cuff
Clinical Finding: + test = inability to lower arm in smooth manner
Statistics: sensitivity 8-34%, specificity 77-97%

Question 4

Empty Can Test (Jobe)

Answer 4

MUSCULOTENDINOUS INTEGRITY
SUPRASPINATUS:
Method: Arm abducted to 90, horizontally adducted to 30, and IR, resist active abduction
Structures assessed: supraspinatus tendinitis
Clinical Finding: + test = reproduction of pain and-oror weakness
(Full can; same test with ER instead of IR; may have more stable validity)
-can be done at less than 90
Statistics: sensitivity 64-73%, specificity 13-33%

Question 5

Dropping Sign

Answer 5

MUSCULOTENDINOUS INTEGRITY
INFRASPINATUS:
Method: With the patient arm at the side, elbow flexed to 90 degrees, the examiner applies a force towards internal rotation (patient engages ER)
Structure assessed: infraspinatus muscle tendon
Clinical Finding: + test = pain or weakness in the infraspinatus muscle-tendon
Statistics: sensitivity 20-100%, specificity 69-100%

Question 6

ER Lag Sign

Answer 6

MUSCULOTENDINOUS INTEGRITY
INFRASPINATUS & SUPRASPINATUS:
Method: UE ABD to 90, elbow flexed to 90, PT rotates into max ER, then backs off 5 degrees. Pt holds independently.
Structure assessed: Infraspinatus, supraspinatus
Clinical finding: + test = pain, pt can’t hold position
Can be done with multiple levels of elevation

Question 7

Hornblower Test (Patte)

Answer 7

MUSCULOTENDINOUS INTEGRITY
TERES MINOR:
Method: with the patients� shoulder in 90 degrees abduction and elbow flexed so that the hand comes to the mouth
Structure assessed: Teres minor muscle-tendon
Clinical finding: + test = reproduction of pain and/or inability to maintain UE in IR
Statistics: 92-100% sensitivity, 69-100% specificity

Question 8

Lift Off (Gerber’s) Sign

Answer 8

MUSCULOTENDINOUS INTEGRITY
SUBSCAPULARIS:
Method: seated, hand in the curve of the lumbar spine, resist IR; inability to lift off
Structure assessed: subscapularis muscle
Clinical finding: + test = reproduction of pain and/or weakness
Statistics: Sensitivity: 62-89%; Specificity: 98-100% tears of >75% are often required to produce a positive test

Question 9

Belly Press (Napoleon) Sign

Answer 9

MUSCULOTENDINOUS INTEGRITY
SUBSCAPULARIS:
Method: Seated with hand on belly, press hand into belly
Structure assessed: subscapularis muscle
Clinical finding: + Test = reproduction of pain and or inability to IR (or substitution of UE elevation or wrist flexion)
Sensitivity: 25-40%; Specificity: 98%; tears >50% are often required to produce a positive test

Question 10

Bear-hug Test

Answer 10

MUSCULOTENDINOUS INTEGRITY
SUBSCAPULARIS:
Method: Seated with the palm of the hand on opposite shoulder, elbow in front of body, resist IR by attempting to pull hand off the shoulder
Structure assessed: subscapularis muscle
Clinical finding: + Test = inability to hold the hand against the shoulder or weakness >20% of contralateral shoulder
Sensitivity= 60%; Specificity=92%; tears of 30% can be detected with this test.

Question 11

Hawkins-Kennedy Test

Answer 11

IMPINGEMENT
Method: bring arm to 90 flexion, slight horiztonal ADD then passively, maximally IR
Structures assessed: subacromial structures and bursa
Clinical finding: + test = shoulder pain to to impingement of supraspinatus between greater tuberosity and coracoacromial arch
Statistics: Sensitivity 55-92%, specificity: 13-100%

Question 12

Neer Test

Answer 12

IMPINGEMENT
Method: bring arm passively into full flexion in IR with overpressure(OP)
Structures assessed: subacromial structures and bursa
Clinical finding: + test = pain may be indictive of impingement of supraspinatus or long head of the biceps
Statistics: Sensitivity 45-89%, specificity 17-31%

Question 13

Sulcus Sign

Answer 13

INSTABILITY
INFERIOR GH JOINT:
Method: patient sits or stands with arm at side and elbow flexed to about 90 while therapist applies inferior force to arm
Structures assessed: inferior glenohumeral capsuloligamentous structures
Clinical Finding: depression or space between acromion and humeral head
-looking for movement
-end feel, pain, quality
-just tests inferior aspect of capsule integrity

Question 14

Apprehension Test

Answer 14

INSTABILITY
ANTERIOR GH JOINT:
Method: patient supine or sitting, place shoulder in 90 abduction, fully ER while applying anterior force (adds the fulcrum test )
Structures assessed: anterior glenohumeral capsuloligamentous structures for instability
Clinical Findings: patient may muscle guard shoulder or express apprehension about the position

Question 15

Relocation Test (to follow apprehension test)

Answer 15

INSTABILITY
ANTERIOR GH JOINT:
Method: PT applied posterior force on GH joint along with ER
+ test = relief of apprehension

Question 16

Posterior Apprehension Test

Answer 16

INSTABILITY
POSTERIOR GH JOINT:
Method: PT supine, therapist places shoulder in 90 flexion and IR , and exerts a posterior force with horizontal ADD and IR
Structures assessed: posterior glenohumeral capsuloligamentous structures
Clinical Findings: patient may muscle guard shoulder or express apprehension about the position

Question 17

A/P: Load and Shift Test

Answer 17

INSTABILITY
Method: patient seated with hand resting on thigh, therapist grasps humeral head ant and post, other hand stabilizes scapula . PT first centers (loads) the head within the joint and then shifts the head anterior or posterior
Structures assessed: glenohumeral capsuloligamentous structures
Clinical finding: Assess amount that the humeral head needs to be loaded (how much did head have to be moved to be loaded.

Question 18

Speeds Test

Answer 18

LABRUM
Method: flexion test - shoulder at 90 flexion, elbow fully extended, forearm supinated - resist shoulder flexion while palpating biceps in bicipital groove
Structure assessed: long head of biceps for tendinitis
Clinical Findings: pain at bicipital groove

Question 19

Kim Test

Answer 19

LABRUM
Method: seated with UE elevated to approx 130 degrees in the scapular plane and elbow flexed to 90 degrees apply a compressive force through the humerus
Structure assessed: labrum
Clinical finding: + sign: pain or clicking
Sensitivity: 80-82%; Specificity: 86-94%

Question 20

Crank Test

Answer 20

LABRUM
Method: seated with UE elevated to 160 degrees (not specific plane) and elbow flexed to 90 degrees; administer compression down the humerus while performing IR/ER
Structure assessed: labrum
Clinical finding: + sign: pain or clicking
Sensitivity: 39-91%; Specificity: 67-93%

Question 21

Yergason Test

Answer 21

LIGAMENT
Seated: patient shoulder neutral, elbow flexed to 90 degrees, forearm supinated
Resist: elbow flexion

Question 22

AC Sheer Test

Answer 22

LIGAMENT
Method: UE at the side, clinician interlaces fingers and surrounds the AC joint, progressively squeezing the hands together to compress the joint
Structure assessed: AC ligaments
Clinical Finding: + test is pain or excessive movement. Sensitivity: 100%; specificity: 97%

Question 23

Roos Test

Answer 23

TOS
Assess for TOS; general compression of neurovascular bundle
Method: bilateral full shoulder ER at 90 of ABD , open and close hand for 3 minutes
Clinical finding: pain in hands/UE, redness or blanching of hands, paresthesiae
Statistics: Sensitivity 82-84%, specificity 30-100%

Question 24

Adson Test

Answer 24

TOS
SCALENE TRIANGLE:
Assess for TOS; compression of neurovascular bundle between anterior and middle scalene
Method: clinician palpates patient�s radial pulse with UE in ABD, EXT and ER. Patient takes deep breath and turns head to side of PT.
Abduct and extend arm, Patient rotates and extends head toward side being tested
Clinical finding: loss or diminution of pulse, paresthesiae
Statistics: Sensitivity 32-87%, specificity 74-100%

Question 25

Hyperabduction (Wright) Test

Answer 25

TOS
CORACOID/RIB & PEC MINOR:
Assess for TOS; compression of neurovascular bundle between pec minor and ribs
Method: palpate radial pulse while abducting arm as far as possible, ER and have patient take breath and hold it
Clinical finding: loss or diminution of pulse, paresthesiae
Statistics: Sensitivity: 70%, specificity 53%

Question 26

Costoclavicular (Military Brace) Test

Answer 26

TOS
1ST RIB & CLAVICLE
Assess for TOS; compression of neurovascular structures between clavicle and first rib
Method: Clinician palpates radial pulse as patient assumes a military brace position by adducting and retracting scapulae
Clinical finding: loss or diminution of pulse, paresthesiae

Question 27

Allen Test

Answer 27

TOS
PECTORALIS MINOR:
Assess for TOS at pectoralis minor
Method: While seated have the patient at 90 degrees of shoulder abduction, ER, and elbow flexion, turn head away, take a deep breath and hold it
Clinical finding: +Test: absent or diminished radial pulse with symptoms reproduced
Statistics: specificity 18-43%

Question 28

What 3 tests when combined best improve LR for detecting shoulder impingement?

Answer 28

1. Hawkins-Kennedy
2. Painful arc
3. Dropping sign (infraspinatus)

LR 1/3 = .9
LR 2/3 = 5.03
LR 3/3 = 10.56

Question 29

What 3 tests when combined best improve LR for detecting a full thickness rotator cuff tear?

Answer 29

1. Painful arc
2. Drop arm test (supraspinatus)
3. Dropping sign (infraspinatus)

LR 1/3 = 0.79
LR 2/3 = 3.57
LR 3/3 = 15.57