SHOULDER SPECIAL TESTS

Anterior Instability Tests

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Anterior Instability Tests

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Load & Shift test

• Forward → Anterior capsule

• Backward → Posterior Capsule

(+) when you can redo patient symptoms

Anterior Instability Tests

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Crank Test/ Apprehension Test

(+) if pain or fear of subluxation

Anterior Instability Tests

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Anterior Drawer Test

anterior shoulder laxity ( not pathological)

Posterior Instability Tests

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Jerk Test

(+) if there is a sudden clunk during horizontal adduction

Posterior Instability Tests

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Posterior Apprehension Test

(+) if patient looks apprehended

Posterior Instability Tests

Push Pull Test

(+) excessive translation of humeral head

Multidirectional Instability Tests

Sulcus Sign

(+) if there is a little dip on acromion or feeling of subluxation

Multidirectional Instability Tests

Feagin Test ( Inf glenohumeral instability)

(+) Excessive laxity or apprehension

Impingement Tests

arm should be in IR

If done in ER → check AC joint next

Neer Impingement Test

(+)overuse of supraspinatus or biceps tendon

Impingement Tests

Hawkins- Kennedy

(+) Supraspinatus paratenonitis/tendinosis or secondary impingement

Impingement Tests

Internal Rotation Resistance Strength Test (ZASLAV)

(+) Internal impingement if good strength on ER but weak in IR

(+) external anterior impingement if weak ER

Impingement Tests

Patient in supine, passively abduct shoulder to 90° with 15-20° extension & max ER

Posterior Internal Impingement

(+) localized pain in posterior shoulder

Impingement Tests

Yokum

(+) if familiar pain is reproduced

for Supraspinatus or secondary impingement

Impingement Tests

same with HK test but add horizontal adduct arm to body 10-20° before doing IR

Coracoid Impingement Sign

(+) if familiar pain is reproduced

for Supraspinatus or secondary impingement

Impingement Tests

Abduct → ER → ADDUCT → IR

Supine Impingement Test

• If IR causes pain = impingement & rotator cuff pathology

Labral Tear Tests

Position 1: flex and pronate + resistance forearm

Position 2 : flex and supinate + resistance forearm

Active Compression Test of O'Brien

(+) pain or clicking in 1st part of test and decreased in 2nd part = labral abnormality ( SLAP Type 2 / Superior labral lesions)

Labral Tear Tests

ikutin arm

Clunk Test

(+) clunk or grinding sound = labrum tear

apprehension = anterior instability

Labral Tear Tests

put anterior/superior force on elbow

Anterior Slide Test

(+) pop or crack / pain in joint line (anterosuperior pain) = SLAP lesion / labrum torn

Labral Tear Tests

push glenoid through your body and apply downward/posterior force

Kim Test (Biceps Load Test I)

(+) sudden posterior shoulder pain and click = posteroinferior labral lesion

Scapular Dyskinesia Test

Wall push-up for 15-20 times

Wall-Floor Push Up

(+) weakness of scapular muscles or winging in 5-10 push ups

Labral lesion test

Porcellini Test

(+) when pain reduced with or without a change in strength with the second part of the test

Scapular Dyskinesia Test

Scapular Retraction Test

(+) scapular retraction decreases pain when relocated ( dec pain during empty can) = weak scapular stabilizers

In supine, SICK scapula = scapula is repositioned during forward flexion

Scapular Dyskinesia Test

Scapular Load Test

(+) if abnormal winging happens

Biceps Test

Speed test

(+) tenderness in the bicipital groove with the arm supinated =of bicipital paratenonitis or tendinosis.

(+) pain, it is positive for SLAP (type II) lesion.

(+) weakness is found on resisted supination, a severe 2nd or 3rd degree (rupture) strain of the distal biceps

Biceps Test

patient supinates against resistance

Yergason’s Test

(+) when biceps tendon in groove is palpated a “pop out” of the groove if the transverse humeral ligament is torn.

(+) Tenderness in the bicipital groove alone without the dislocation may indicate bicipital paratenonitis/tendinosis.

Supraspinatus Test

Empty Can

(+) weakness or pain

A positive test result indicates a supraspinatus tendon tear or muscle, or neuropathy of the suprascapular nerve.

Subscapularis Test

External Rotation Lag Sign

(+) supraspinatus and infraspinatus are torn, the arm will medially rotate and spring back anteriorly indicating a positive test

(+) arm falls or drops into medial rotation, the test is considered positive for tears to infraspinatus, supraspinatus and subscapularis

Subscapularis Test

Lift Off Sign

(1)Abnormal motion in the scapula during the test may indicate scapular instability.

(2) With a torn subscapularis tendon, passive and active lateral rotation increases

Subscapularis Test

Spring Back Test

(+) hand moves toward the back, subscapularis cannot hold the position due to weakness or pain

Infraspinatus Test

Lateral Rotation Lag Sign 

(+) cannot hold the position and the hand springs back anteriorly toward midline = infraspinatus and teres minor weakness or pain (Drop Sign)

Infraspinatus Test

Infraspinatus Test

(+) Pain or the inability to resist medial rotation indicates infraspinatus strain.

Teres Minor Test

Horn Blower Sign

(+) unable to laterally rotate the arm = tear of teres minor

General Rotator Cuff Test

palpate rotator cuff tendons while moving elbow in IR/ER

Rent Test

(+) presence of a depression of one finger width or a more prominent greater tuberosity (relative to the other side) = a rotator cuff tear.

General Rotator Cuff Test

Whipple Test

(+) partial rotator cuff tears and/or superior labrum tears if the patient cannot resist.

Trapezius Test

Read Book

SA Test

Punch Out test

(+) if scapular winging is eliminated = posterior instability due to serratus anterior weakness.

(+) medial border scapula winging or difficulty in abducting or forward flexion >90 = SA weakness or paralyzed

AC JOINT TEST

flex 90° and horizontally adducts to opposite shoulder

Horizontal Adduction

(+) pain in AC or SC

(specific joint pain = + for that joint)

AC JOINT TEST

Squeeze AC joint

Paxinos Sign

(+) pain in AC joint

Ligament Pathology

TESTS FOR NEUROLOGICAL FUNCTION

(+) Pain in the form of tingling or a stretch or ache in the cubital fossa indicates stretching of the dura mater in the cervical spine.

for cervical radiculopathy

TESTS FOR NEUROLOGICAL FUNCTION

It is performed by lightly tapping (percussing) over the nerve to elicit a sensation of tingling in the distribution of the nerve

Tinel Sign

(+) Tingling sensation in one or more of the nerve roots.

Area of the brachial plexus above the clavicle in the area of the scalene triangle is tapped

Tests for Thoracic Outlet Syndrome

The patient stands and abducts the arms to 90°, laterally rotates the shoulder, and flexes the elbows to 90° so that the elbows are slightly behind the frontal plane. The patient then opens and closes the hands slowly for 3 minutes

Roos Test

(+) unable to keep the arms in the starting position for 3 minutes or suffers ischemic pain, heaviness or profound weakness of the arm, or numbness and tingling of the hand during the 3 minutes

Tests for Thoracic Outlet Syndrome

The examiner locates the radial pulse. The patient’s head is rotated to face the test shoulder. The patient then extends the head while the examiner laterally rotates and extends the patient’s shoulder. Instruct the patient to take a deep breath and hold it.

Adson Maneuver

Positive Sign: Disappearance of the pulse

FIGHTINGGGGGG

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