Tests for the Shoulder

Question 1

Procedure for Apley’s Test

Answer 1

The patient is seated and is instructed to place the affected hand behind the head and touch the opposite superior angle of the scapula. The patient is then instructed to place the hand behind the back and attempt to touch the opposite inferior angle of the scapula. Exacerbation of the patient’s pain indicates degenerative tendinitis of one of the tendons of the rotator cuff, usually the supraspinatus tendon

Question 2

Purpose of Apley’s Test

Answer 2

To evaluate range of motion of the shoulder joint

Question 3

Clinical indications for Apley’s Test

Answer 3

This result indicates tendinitis of the supraspinatus tendon. Note the location of pain-it will help identify the etiology

Question 4

Procedure for the Apprehension Test

Answer 4

The examiner abducts and externally rotates the patient’s shoulder. A positive test is indicated when the patient shows apprehension or alarm and resists further motion. The patient also may state that such rotation elicits a feeling that resembles the pain felt when the shoulder was previously dislocated. This test must be performed slowly. If the test is done too quickly, there is a chance that the humerus will dislocate. A positive test indicates anterior shoulder dislocation trauma. In determining the trauma resulting from posterior shoulder dislocation, the examiner flexes and internally rotates the patient’s shoulder. The examiner then applies a posterior force on the patient’s elbow. A positive result is indicated if the patient exhibits a look of alarm or feeling of apprehension and resists further motion. A positive test indicates a posterior dislocation of the humerus

Question 5

Purpose of the Apprehension Test

Answer 5

To evaluate for the laxity of the shoulder joint

Question 6

Clinical indications for the Apprehension Test

Answer 6

A positive result is indicated if the patient exhibits a look of alarm or feeling of apprehension and resists further motion

Question 7

Procedure for Codman’s Sign

Answer 7

The patients arm is passively abducted. The examiner suddenly removes support at some point above 90 degrees, which makes the deltoid contract suddenly

Question 8

Codman’s Sign is also known as what

Answer 8

Drop Arm Test

Question 9

Purpose of Codman’s Sign

Answer 9

To evaluate for possible supraspinatus tendon injury (rotator cuff injury)

Question 10

Clinical indications for Codman’s Sign

Answer 10

If shoulder pain occurs and there is a hunching of the shoulder due to the absence of rotator cuff function, the sign is present for rotator cuff tear or, more specifically, rupture of the supraspinatus tendon. The test is positive if the patient is unable to return the arm to the side slowly or has severe pain. A positive test indicates a tear in the rotator cuff complex. Note the location of pain

Question 11

Procedure for Dawbarn’s Sign

Answer 11

With the patient’s arm comfortably at the side. deep palpation of the shoulder by the examiner elicits a well-localized, tender area. With the examiner’s finger still on the painful spot, the patient’s arm is passively abducted by the examiner’s other hand. The sign is present if as the arm is abducted, the painful spot under the examiner’s nonmoving finger disappears. The sign is significant for subacromial bursitis

Question 12

Purpose of Dawbarn’s Sign

Answer 12

Evaluate for subacromial bursitis

Question 13

Clinical indications for Dawbarn’s Sign

Answer 13

This result indicates subacromial bursitis

Question 14

Procedure for Dugas’ Test

Answer 14

The patient places the hand of the affected shoulder on the opposite shoulder and attempts to touch the chest with the elbow. The test is positive if the patient cannot touch the chest wall with the elbow. The test is positive in shoulder dislocation

Question 15

Purpose of Dugas’ Test

Answer 15

Checking for laxity of the shoulder joint for propensity for dislocation

Question 16

Clinical indications for Dugas’ Test

Answer 16

This result indicates propensity for shoulder dislocation

Question 17

Procedure for Impingement Sign

Answer 17

The patient’s arm is slightly abducted and moved fully through flexion by the doctor, this causes a jamming of the greater tuberosity against the anteroinferior acromial surface. Pain in the shoulder is a positive test result. Note the location of the pain

Question 18

Purpose of Impingement Sign

Answer 18

Examination for possible supraspinatus and/or bicepital irritation as well as degenerative joint disease

Question 19

Clinical indications for Impingement Sign

Answer 19

The test indicates an overuse injury to the supraspinatus and sometimes to the biceps tendon. Note the location of pain-helps identify etiology

Question 20

Procedure for Speed’s Test

Answer 20

The doctor provides resistance to flexion of the shoulder by the patient

Question 21

Purpose of Speed’s Test

Answer 21

Evaluate for possible bicepital tendonitis

Question 22

Clinical indications for Speed’s Test

Answer 22

A positive test (pain in the bicipital groove) indicates Bicipital tendinitis

Question 23

Procedure for Supraspinatus Press Test

Answer 23

The patient’s shoulder is abducted to 90 degrees, and the doctor provides resistance to this abduction. The shoulder is then medially rotated and angled 30 degrees forward so the patient’s thumbs point to the floor. The doctor then provides resistance to abduction while observing for weakness or pain. If the patient exhibits weakness or experiences pain, the test is positive, which indicates a tear of the supraspinatus tendon or muscle

Question 24

Purpose of Supraspinatus Press Test

Answer 24

Evaluate for possible supraspinatus tear and/or rupture

Question 25

Clinical indications for Supraspinatus Press Test

Answer 25

If the patient exhibits weakness or experiences pain, the test is positive, which indicates a tear of the supraspinatus tendon or muscle

Question 26

Procedure for Yergason’s Test

Answer 26

The patient flexes the elbow while seated. The doctor resists the patient’s attempt to supinate the hand. Then the patient resists the examiner’s efforts to extend the affected upper extremity. The test is positive if pain over the intertubercular groove develops or is aggravated.A positive sign indicates tenosynovitis or a “pop” over the transvers humeral ligament. This test is not conclusive because motion does not occur between the tendon and the bicipital groove during the test. Biceps tendon pain tends to occur during motion rather than during tension.

Question 27

Purpose of Yergason’s Test

Answer 27

Evaluate for possible transverse humeral ligamnet rupture and/or bicepital tendonitis

Question 28

Clinical indications for Yergason’s Test

Answer 28

A positive sign indicates tenosynovitis or involvement of the transverse humeral ligament. Pain indicates bicipital denonitis. Hearing a “click” indicates torn transverse humeral ligament

Question 29

Procedure for Load and Shift Test

Answer 29

With the doctor stabizing the scapula with one hand and grasping the humeral head with the other, the doctor loads the shoulder by pushing in towards the glenoid, then pushes forward to test anterior stability and finally pulls backwards to test posterior stability. The examiner then pulls down on the arm to test inferior stability

Question 30

Purpose/Function of Load and Shift Test

Answer 30

Test for instability or loosening of the shoulder. This test is reserved for those patients with past history of dislocation or medical subluxation and those individuals who are suspected of having generalized joint laxity. Function: this stresses the supporting ligaments of the shoulder joint

Question 31

Findings for Load and Shift Test

Answer 31

Laxity is noted during the examination for stability and a visible sulcus may appear under the acromion with a multi-directional loose shoulder

Question 32

Procedure for Lift off Test

Answer 32

The patient places the dorsum of the hand on their lumbosacral region and attempts to push backwards with his hand, lifting the hand off of the lumbosacral region

Question 33

Function of Lift off Test

Answer 33

This stresses the supporting ligaments of the shoulder joint

Question 34

Findings for the Lift Off Test

Answer 34

A decreased range of motion would be noted by the inability to lift the hand off of the lumbosacral region as far as the opposite side. Note the location of pain-help identify etiology

Question 35

Procedure for O’Brien’s Test

Answer 35

The patient flexes the arm to 90 degrees with the elbow in full extension. Patient adducts the arm 10-30 degrees with thumbs up (full supination). Doctor applies downward pressure to the arm while the patient resists. Note pain. Then the patient flexes the arm to 90 degrees with the elbow in full extension. Patient adducts the arm 10-30 degrees with thumb down (full pronation). Doctor applies downward pressure to the arm while the patient resists. Note pain

Question 36

Function of O’Brien’s Test

Answer 36

This stresses the labral region of the shoulder joint

Question 37

Findings for O’Brien’s Test

Answer 37

If pain increases with thumb down position it indicates positive for a labral tear.