Shoulder Special Tests

Which tests can be used to assess muscle power deficits?

• speed’s test

• drop arm test

• lift off test/IR lag test

• resisted ER and ER lag sign

• posterior capsule length test

what tests can be used to assess movement coordination deficits?

• sulcus sign

• jerk test

• apprehension/relocation test

• crank test

• o’briens test

• scapular assist test

• scapular reposition test

• bicep load II

what tests can be used to assess impingement?

• Hawkin’s Kennedy Test

• Neer’s test

• Full vs empty can test

• (resisted ER and painful arc also)

what can be used to assess AC joint pathology?

AJC cluster which includes:

• Horizontal abduction with overpressure

• passive shoulder adduction

• o’briens
  
  

what tests can be used for assessment of radiating pain?

• adson maneuver

• costoclavicular test (halsted’s)

• hyperabduction test (wright’s)

• Roos test

describe speed’s test

test for biceps tendinopathy, secondary rationale for AC joint arthropathy. Is tested with the palm up, shoulder flexed to 90 degrees, and pressure is applied downward at the distal arm. Provocation of pain under the acromion at the biceps insertion is a positive test.

describe the drop arm test

passively take the pt into 90 degrees of abduction, see if they can hold then slowly lower the arm. Positive test may indicate a supraspinatus tear (best evidence for a complete tear/large tear). Weakness or lack of control may indicate partial tear

what is the lift-off test/IR lag test used for?

used to assess subscapularis muscle integrity and strength, indicating potential tears or dysfunction of the subscapularis. for lift off- the patient places their hand behind their back and attempts to lift it off against resistance. For the IR lag test, the patient is placed with the arm in an internally rotated position (with the arm behind the back), and the clinician assesses whether the arm maintains that position.

what is the resisted ER/ER lag sign used for?

used to evaluate the integrity of the infraspinatus and teres minor muscles, indicating potential tears or dysfunction. for resisted ER the patient externally rotates the arm against resistance with the shoulder adducted, while the ER lag sign involves the arm positioned at either 20 degrees or 90 degrees of abduction and externally rotated, assessing if the arm can maintain this position (at 90 degrees is more specific for teres minor)

how do you perform the posterior capsule length test?

place pt in supine, depress the scapula and then horizontally adduct the shoulder until feel firm end feel. can measure the angle with a goniometer and compare to the other side but there isn’t really a standardized score that indicates pathology

describe the sulcus sign

helps to assess inferior instability of the GHJ joints- have the pt rest their arm on their thigh while you stabilize the AC joint, then distract the humerus inferiorly. positive test would be the formation of a depression/sulcus under the AC joint

what is the jerk test?

used to assess posterior instability of the labrum. bring the pt into 90 degrees of abduction, apply an axial load, then horizontally adduct. If you hear a clunk/click is it positive test for potential posterior labrum tear

what is the apprehension/relocation test?

used to assess instability of the glenohumeral joint. The patient is positioned supine, with the arm abducted to 90 degrees and the arm is then passively ER. if there is apprehension, then apply a pressure anterior to posterior on the head of the humerus and a positive test would be alleviation of apprehension and pain. Relocation involves a “surpise” release of the A-P pressure

what is the crank test?

used to assess labral tears. pt is supine, passively take pt into 160 degrees of abduction/scaption. Stabilize the humerus and apply a compression force into the humerus and then move shoulder into ER/IR. pos test would be reproduction of pain in the deep anterior shoulder

what is o’brien’s test?

used to assess labrum tears or AC joint pathology. Bring pt arm into 90 flexion, adduct about 15 degrees, then have pt IR the shoulder and apply a downward force. Can then fully ER the shoulder and do the same thing. Positive test would produce pain in deep in the shoulder if labral pathology with IR position and alleviation with ER, may also feel bicipital tendon ache but this may present with swelling.

what is the scapular assist test?

assessment of motor control- Have pt abduct, if painful or reduced ROM, guide the scapula by elevating the inferior angle of the scapula and posteriorly tilting it. Positive test would be decrease in pain or increase in ROM with assistance. (Assisting upward rotation)

what is the scapular reposition test?

assessment of motor control- If pt has pain or reduced ROM with overhead movements, can retract the scapula with medial force while the pt abducts the arm while adding posterior tilt. Positive test is alleviation of symptoms and increased ROM.

what is the biceps load II test?

used to assess SLAP lesions- Abduct pt 120 degrees, keep elbow flexed, supinate forearm (pt palm facing themselves), fully ER, have contract the bicep as you resist into an extension force (therapist tries to straighten the elbow). Pain deep in the anterior shoulder would indicate SLAP lesion.

what is the Hawkin’s kennedy test?

generally used to assess impingement- passively into 90 degrees of flexion and 90 degrees of elbow flexion, then fully IR the shoulder. Positive test is reproduction of pain under the AC joint- possible pain producers though might be the supraspinatus tendon, the labrum, the AC joint, the bursa.

what is the neer’s test?

generally used to assess impingement- with pt sitting or standing passively bring into full flexion and max IR, apply adduction and flexion pressure to further provoke symptoms. Positive test is reproduction of pain in the anterior shoulder/under the AC joint

what is the full vs empty can test?

Supraspinatus and infraspinatus test for impingement. Full can: put the pt into scaption and flexed to 90 degrees. Apply downward pressure. Empty can, point thumb down towards the ground, apply downward force (this will sus out the infraspinatus by putting it more under the acromion).

what tests are included in the ACJ cluster?

3 tests:

-              AC resisted “extension”: Flexed to 90, shoulder IR (Hawkins-Kennedy postion), then apply an adduction force (they are pushing into extension/horizontal abduction)

-              Crossbody adduction test: Passive shoulder adduction with shoulder flexed to 90 (horizontal adduction)

-              O’briens: Flex to 90, horizontal adduction 10-15 degrees, fully IR then apply downward force, then fully ER and apply downward force. Positive is if have pain with the IR position and alleviation in ER position.

Positive test is reproduction of pain at the AC joint

what is the adson maneuver?

Palpate for radial pulse, then abduct, extend, and ER. Breathe deep in and rotate head towards. If stop feeling pulse or have radicular symptoms then this is a positive test for thoracic outlet syndrome. Compare to other side as needed (comparator).

what is the costoclavicular test (halsted’s)?

arm in anatomical position, palpate for radial pulse. depress and retract the scapula, abduct then extend arm and palpate for pulse. Positive sign in diminished or absent pulse or radicular symptoms- assessing for thoracic outlet syndrome

what is the hyperabduction test (wright’s test)?

Palpate for radial pulse, bring arm overhead into abduction, and hold for 1 minute. Positive test is reduction of radial pulse or reproduction of radicular symptoms. Screens for thoracic outlet syndrome.

what is roos test?

Abduct both arms to 90, ER, and open and close the hands rapidly. Have the patient perform this for 3 minutes. Positive test is heaviness in the arms (due to ischemic weakness- limbs might start to look blueish due to lack of blood flow), numbness and tingling in the hands.This test assesses for thoracic outlet syndrome by evaluating vascular and neurological responses during sustained arm elevation.

which tests are part of the impingement cluster?

• Hawkin’s Kennedy

• Resisted ER

• painful arc

What tests are part of the RTC cluster?

• drop arm test

• infraspinatus test (resisted ER)

• painful arc