Shoulder special tests/ MOST 2

Impingement test list:

Painful arc, Neer test, IRRST/ERRST, Hawkins-Kennedy (subacromial) Coracoid Impingement (subcoracoid) and Resisted Pull test (bursa, musculotendinous)

Painful arc test interpretation

Painful with flexion = possible subcoracoid impingement

Painful with abduction = possible subacromial impingement

Painful at end range with no loss in ROM = AC/SC joint dysfunction

Neer test

Stabilize ipsilateral scapula while taking pt into passive abduction to end range.

Do after no pain painful arc but still think it could be impingement.

IRRST/ERRST

IRRST - pt supine starting with 90 degrees of elbow flexion, 90 degrees of abduction, and 80 degrees of external rotation. Pt pushes into resisted IR, positive test would be weakness and suggests internal impingement

ERRST - pt supine starting with 90 degrees of elbow flexion, 90 degrees of abduction, and 80 degrees of external rotation. Pt pushes into resisted ER, positive test would be weakness and suggests external impingement.

T/F A positive IRRST/ERRST test would be pain provocation with resisted IR or ER.

FALSE. A positive test will be weak, not painful.

What are the two types of internal impingement?

Involves impingement between the humeral head and the glenoid cavity.

Anterosuperior - anterior shoulder pain in the follow through phase of activity.

Posterosuperior - posterior shoulder pain with throwing/overhead activity.

Which age demographic is more likely to have internal impingement?

Active individuals that are 40 years old or younger.

What are the two types of external impingement?

Subcoracoid - impingement of structures between the lesser tubercle of the humerus and the coracoid process. (LH Biceps, subscapularis, bursa)

Subacromial - impingement of structures between the greater tubercle and the acromion process. (Supraspinatus, infraspinatus, subacromial bursa)

What structures are affected with articular internal impingement?

Labrum, capsule/synovium, tendons.

What is the Hawkins-Kennedy test assessing for?

Subacromial impingement (supraspinatus, infraspinatus, bursa)

What is the anterior/subcoracoid test assessing for?

Subcoracoid impingement (LH Biceps, subscapularis, bursa)

Resisted pull test positive test meaning?

If the pain is alleviated after the caudal pull is applied = subacromial bursitis

Scapular Stability test list

Kibler test, Scapular assistance test

Kibler test

1. Start in neutral position

2. Scolding position with hands behind back

3. Sleepwalk position with arms elevated to 90 of shoulder flexion

4. T position with arms elevated to 90 degrees of shoulder abduction.

Scapular assistance test

Scapular assistance into flexion and abduction to prevent excessive tipping of winging of the scapulae.

ACJ Provocation test list

Passive horizontal adduction test

Resisted horizontal abduction test

O’Brien Test

How to perform passive horizontal adduction test?

Take patient into full passive horizontal adduction, pain provocation with end range horizontal adduction would suggest ACJ and SCJ pathologies.

Positive test is pain provocation.

How to perform resisted horizontal abduction test?

Have patient in 90 degrees of flexion, abduction, and IR and push back into resistance, positive test is pain provocation.

How to perform O’Brien test?

Take pt into maximal horizontal adduction one more time and have them supinate and elevate the arm. Repeat with wrist pronated and elevate one more time.

Positive test will be pain provocation or a change in symptoms when forearm is pronated vs supinated.

What does O’Brien test for?

Tests for both ACJ provocation and can also be positive for SLAP lesion.

Peripheral Neurological test list

Wall push-up test, passive horizontal adduction test

Wall push up test

Pt performs wall pushups and positive test will display scapular winging and indicative of long thoracic nerve dysfunction.

Passive horizontal adduction test (Peripheral Neurological tests)

Passive horizontal adduction test. Take pt into horizontal adduction and side bend the head away from the arm being adducted.

Tests for suprascapular nerve pathology.

Glenohumeral Instability test list

Anterior apprehension (Anterior relocation test, surprise test)

Posterior Apprehension test (posterior relocation test)

Anterior apprehension test, relocation, and surprise tests

90 degrees of flexion, abduction, ER in horizontal abduction.

Positive test will be pain provocation or apprehension (discomfort) displayed by the pt.

Apply a dorsal, lateral, and slightly cranial pressure over the humeral head in the position from above position for the relocation test to push the humeral head back into capsule.

Surprise test is where you take your hand off the humeral head and the humeral head will shift anterior suddenly. Not ideal for the patient…

What is the anterior apprehension test assessing for?

Anterior shoulder instability or a posterior internal impingement.

Posterior apprehension test

Assesses for posterior shoulder instability.

Position pt into submax horizontal adduction and IR (arm should look like it at a 45 degree angle) and apply a ventro-medial force to push the humeral head in the direction of the rest of the upper extremity.

Positive test = pain provocation or apprehension displayed by the pt.

Load and shift test

*Done in MLPP*

One of the joint specific tests for the GHJ.

Stabilize the coracoid and scapular spine while pushing humerus and shifting it ventromedial to dorsolateral.

Anterior-inferior laxity test

GHJ joint specific/stability test

Tests the Anterior-Inferior capsule

Shoulder positioned in 90 deg abduction w/ max ER (Close-packed position) with the coracoid blocked and pushing ventromedially, allowing for the humeral head to snap back

Posterior-inferior laxity test

Stability test

Shoulder positioned in 90 deg flexion, submax horizontal adduction and IR. Keeping scapular spine blocked, push dorsolateral and release to allow humeral head to snap back.

Fukuda test

Stability test.

Blocking the scapular spine and coracoid, push dorsolateral and ventromedial to assess for any tightness/laxity in the capsule.

Dorsolateral force = tests posterior superior capsule.

Ventromedial force = tests anterior superior capsule.

Inferior laxity - superior capsule

Stability test.

Arm positioned at the side. Palpate anterior and posterior edges of the acromion while applying traction (pull) to the distal brachium in the caudal direction. Perform both IR (posterior-superior capsule) and ER (anterior-superior capsule)

Inferior laxity - Inferior capsule

Stability test.

Test with arm in 90 degrees of abduction with hand supporting at the elbow to maintain 90 degrees of abduction. Opposite hand on the distal acromion and apply a caudal force on the distal acromion to see how much movement occurs.

*Compare to both sides*

Labral tests list

Modified labral crank test, compression rotation test, active compression (O’Brien) test, Biceps load II test

Modified labral crank test

Assesses for SLAP lesion or other labral pathology.

Stabilize the ipsilateral shoulder girdle with the elbow in 160 of elbow flexion. Compressive load applied to the shoulder girdle and sweeps of IR and ER are performed while the arm remains elevated to detect any labral damage.

Positive test = pain provocation or popping/clicking sounds.

Biceps Load II test

Assesses for a SLAP lesion.

Patient will be supine, with the arm in 120 degrees of shoulder flexion with max ER and forearm supinated. At this position, resisted elbow flexion is performed.

Positive test = pain provocation or popping/clicking sounds.

Compression rotation test

Assess for a SLAP lesion.

Pt will be sypine and a compressive load is applied in the direction of the glenoid relative to the shaft of the humerus. Perform with sweeps of IR/ER in angles of abduction in the 20-90 degree range.

Which tests are testing for SLAP lesions?

Modified crank test, O’Brien, Rotation-compression, Biceps Load II, and Speed’s test.

When would you use Grades 1-2/traction?

When the patient is in a pain dominant stage of recovery.

When would you use Grades 3-4/glides?

When the patient is in a stiff dominant stage of recovery.

T/F Kaltenborn grade 3 oscillatory glide would be a good treatment for a patient that is stiff dominant.

False. Although a grade 3 glide could be an appropriate treatment, Kaltenborn’s methods of treatment revolved around sustained pressure rather than oscillatory. A grade 3 oscillatory glide would be a treatment derived from Maitland.

Which Maitland grades have small amplitude oscillations into resistance?

Grades 1 and 4.

Grade 1 - very light pressure and oscillations (if any) pain dominant treatment.

Grade 4 - at end range and oscillations. stiff dominant treatment.

Which Maitland grades have large amplitude oscillations into resistance?

Grades 2 and 3.

Grade 2 - mid range with larger amplitude oscillations. pain dominant treatment.

Grade 3 - into tissue resistance with larger amplitude oscillations. stiff dominant treatment.

Supraspinatus (Empty Can) test

Soft tissue test to assess for shoulder impingement or supraspinatus pathology

Patient is supine, and arm is elevated 90 deg into shoulder flexion in the scapular and max IR so that thumb is pointed down towards the floor. A downward force is applied while the patient pushes upwards.

Positive test = pain provocation

Drop arm test

specific test for full thickness or partial thickness tears of RTC.

Passively abduct shoulder to 90 deg with the palm down and patient is asked to slowly lower the arm to their side.

Positive test = considered positive with loss of eccentric control.

Lift-off test/Belly press test

Soft tissue test for the subscapularis pathology

Positive test = inability to perform lift off with hand behind the back or maintain hand on the stomach. Weakness while performing the test.

Speed’s test

Assesses for SLAP lesion or bicipital tendinopathy.

Patient positions the arm into shoulder flexion, full ER and elbow extension with full supination of the forearm. Force is applied to distal forearm.

Dynamic test is performed with force applied at the shoulder as well to assess both shoulder and elbow flexion.

Positive test = considered with reproduction of patient’s symptoms.

Yergason’s test

Assess for LH biceps pathology.

Arm positioned into elbow flexion at 90 deg with arm fully pronated. Patient will then supinate against resistance and externally rotate.

Positive test = pain over bicipital groove, catching/popping.

Stretch for LH biceps

Assess for LH biceps pathology

Stabilize the scapula and grasp the forearm, extend shoulder back in the scapular plane and fully pronate and extend the elbow when at end range.

Positive test = pain over the biceps muscle distribution.

GHJ Traction (Warm-up/GHJ pain relief)

Decrease intraosseous pressure in the joint, and pain relief, warms up the joint and can use static holds or oscillations.

Use belt

GHJ warm-up into abduction

Provide a compressive force and move through small arcs of non-painful abduction.

Full passive - active assist - full active.

Use belt

GHJ long axis traction

Block coracoid and apply lumbrical grip to the acromion while pulling the distal brachium along the humeral shaft at the elbow.

Emphasizes superior capsule.

Use belt

GHJ addressing limits in abduction

Anterior-inferior capsule, posterior-inferior capsule.

USE BELT

Anterior inferior capsule curved glide to improve abduction

Preposition in max abducion, submax ER and horizontal abduction.

Provide caudal and slightly dorsal mobilization while moving UE through small arcs of abduction

USE BELT