Special Tests (Shoulder) (no photos)

Week 1 Content

Apprehension Test

Indicates: anterior GH joint instability

Positive: pt presents with apprehension, resisting movement

Position: pt lies supine with arm in 90 degrees of ABD and elbow in 90 degrees of flexion; PT laterally rotates the pt’s shoulder slowly

Jobe Relocation Test

Indicates: GH joint instability, subluxation, dislocation, or impingement

Positive: pt’s pain decreases during the maneuver

Position: pt lies supine with arm in 90 degrees of ABD and elbow in 90 degrees of flexion; PT grasps distal forearm then quickly rotates arm laterally to about 90 degrees of lateral rotation

Crank Test

Indicates: labral tears, SLAP lesion, or GH ligamentous instability

Positive: pain reproduction

Position: pt in supine or sitting, PT places the UE in 45 degrees of ABD and some ER, applies an axial compressive force through the humerus while rotating the humerus alternately into ER and IR; complete for 0-30 degrees, 45-60 degrees, and >90 degrees

Jerk Test

Indicates: posterior instability or postero-inferior labral tear

Positive: apprehension and/or a sudden “jerk” or clunk when the humeral head subluxes off posterior glenoid

Position: pt sits with arm medially rotated and forward flexed to 90 degrees; PT grasps elbow and axially loads the humerus proximally; PT moves arm horizontally while maintaining axial loading

Sulcus Sign

Indicates: inferior instability or GH laxity

Positive: excessive inferior movement of the humeral head AND symptoms of pain and/or instability

Position: pt stands with arm by the side and shoulders relaxed; PT grasps the pt’s forearm below the elbow and pulls the arm distally

Anterior Load and Shift, Posterior Load and Shift

Indicates: GH instability

Positive: translation of the humeral head >25% of the humeral head diameter

Position: pt sits upright with shoulders relaxed; PT stands behind the pt and stabilizes shoulder with one hand over clavicle and scapula; PT grasps the head of the humerus with other hand (thumb over posterior humeral head, fingers over anterior humeral head); load (reset the humeral head within the glenoid fossa) then shift the humeral head anteriorly; reload the humeral head within the glenoid fossa, and repeat posteriorly

Hawkins-Kennedy

Indicates: subacromial impingement (secondary)

Positive: pain

Position: pt stands while PT forward flexes the arm to 90 degrees and forcibly rotates the shoulder medially

Painful Arc

Indicates: subacromial impingement

Positive: pain between 45/60-120 degrees

Position: pt stands and ABDs arm to 45-60 degrees with no pain; ABD from 60-120 degrees causes pain, then diminishes beyond 120 degrees

Neer Impingement Test

Indicates: subacromial impingement

Positive: pain

Position: pt is seated; pt’s arm is passively and forcibly fully elevated in the scapular plane with the arm medially rotated by the examiner

Empty Can

Indicates: supraspinatus tendon tear, neuropathy of suprascapular nerve, subacromial impingement

Positive: weakness and/or pain

Position: pt’s arm is ABD to 90 degrees and neutral rotation; examiner provides resistance to ABD; shoulder is then medially rotated and angled forward 30 degrees so the pt’s thumbs point towards the floor in the plane of the scapula; resistance to ABD is again given while the PT looks for pain

Full Can

Indicates: supraspinatus tear

Positive: weakness and/or pain

Position: pt’s arm is ABD to 90 degrees and neutral rotation; examiner provides resistance to ABD; shoulder is then rotated so the pt’s thumbs are facing up towards the ceiling for maximum contraction of the supraspinatus; resistance to ABD is again given while the PT looks for pain

Drop Arm Test (Codman’s Test)

Indicates: rotator cuff pathology

Positive: unable to return arm to the side slowly or has extreme pain doing so

Position: PT ABDs the pt’s shoulder to 90 degrees and then asks pt to slowly lower the arm to the side in the same arc of movement

Infraspinatus Test

Indicates: rotator cuff pathology

Positive: pain or inability to resist rotation

Position: pt stands with the arm at the side and the elbow at 90 degrees, humerus is medially rotated to 45 degrees; PT applies a medial rotation force that the pt resists

Lateral Rotation Lag Sign (Infraspinatus and Teres Minor Spring-Back Test)

Indicates: rotator cuff pathology

Positive: pt is unable to hold the arm in the test position as it springs back anteriorly

Position: pt is seated or in standing with arm by the side and elbow flexed to 90 degrees; PT passively ABDs the arm to 90 degrees in the scapular plane, laterally rotates the shoulder to end range and asks the pt to hold

Lift-off Sign (Gerber’s Sign)

Indicates: rotator cuff pathology

Positive: inability to lift hand away from back; external rotation may increase while in test position

Position: pt stands and places the dorsum of the hand on their back pocket against the midlumbar spine; pt then lifts the hand away from the back

Active Compression (O’Brien’s) Test

Indicates: labral including SLAP/biceps pathology

Positive: joint line pain and/or deep, painful clicking that is present with IR and relieved with ER

Position: pt is standing with arm forward flexed to 90 degrees and elbow fully extended; arm is horizontally ADD to 10-15 degrees and medially rotated so thumbs face downward; PT stands behind the pt and applies a downward eccentric force to the arm; arm is returned to starting position and palm is supinated so that shoulder is laterally rotated, then downward eccentric force is repeated

Speed’s Test

Indicates: SLAP lesion; biceps tendonitis

Positive: pain during supination but not pronation

Position: PT resists forward shoulder flexion by the pt while the pt’s forearm is first supinated, then pronated, with the elbow completely extended; repeat in both positions

Yergason’s Test

Indicates: SLAP lesion, transverse humeral ligament tear, biceps tendonitis

Positive: palpable “popping out” of the long head of biceps tendon at bicipital groove and/or pain/tenderness

Position: pt’s elbow is flexed to 90 degrees and stabilized against the thorax with the forearm pronated; PT resists supination while the pt laterally rotates the arm against resistance

Anterior Slide Test

Indicates: SLAP lesion

Positive: pop, clunk, and/or pain at anterior-superior joint line

Position: pt is seated with both hands on the waist, thumbs posterior; PT stands behind the pt and stabilized the scapula and clavicle with one hand; with the other hand, PT applies and anterosuperior force at the elbow

Compression Rotation Test

Indicates: labral including SLAP/biceps pathology

Positive: pain, clicking, catching

Position: pt is supine with PT standing beside the test shoulder; PT passively ABDs the shoulder between 20-90 degrees with pt’s elbow at 90 degrees; PT applies an axial compression force through the long axis of the humerus while passively rotating the humerus back and forth to trap the labrum within the joint

Acromioclavicular Crossover (Horizontal/Cross-Body ADD)

Indicates: AC pathology

Positive: localized pain at AC joint

Position: pt stands and reaches the hand across to the opposite shoulder; PT may also passively perform the test

AC joint shear (joint glide)

Indicates: AC pathology

Positive: pain at AC joint

Position: pt is seated, PT cups hands over the deltoid muscle with one hand on the clavicle and one hand on the spine of the scapula; PT then squeezes the heels of the hands together

Roos Test

Indicates: thoracic outlet syndrome (TOS)

Positive: unable to maintain posture x 1-2 mins, or develops ischemic pain, heaviness, profound weakness, or numbness and tingling on a side

Position: pt stands and ABDs the arms to 90 degrees, laterally rotates the shoulder, and flexes the elbows to 90 degrees so that the elbows are slightly behind the frontal plane; pt then opens and closes the hands slowly for 3 minutes

Adson Manuever

Indicates: thoracic outlet syndrome (TOS)

Positive: disappearance of pulse and/or reproduction of symptoms

Position: PT locates the radial pulse; pt’s head is rotated to face the test shoulder; pt then extends the head while the PT laterally rotates and extends the pt’s shoulder; pt is instructed to take a deep breath and hold it

Brachial Plexus Compression Test

Indicates: thoracic outlet syndrome (TOS)

Positive: radiation of pain to shoulder (pain at compression site is not diagnostic)

Position: PT applies firm compression to the brachial plexus by squeezing the plexus under the thumb or fingers at the neck-shoulder interface