Shoulder Eval (special tests...)

don't forget to check bilaterally!

Tests for AC Seperation

piano key sign, inward pressure

piano key sign test

push on the distal end of the clavicle where it meets the acromion, positive is clavicle movement(like a piano key!)

Inward pressure test

Hands on superior border of scapula and the clavicle and squeeze your hands together, positive sign is complaint of pain

Tests for Impingement Syndrome

Hawkins-Kennedy test, Forced flexion test(yocum test)

Impingement Syndrome

In the subacromial space, the supraspinatus muscle tendon, the subdeltoid, and the subacromial bursa can get pinched since there’s space between the humerus and the scapula (correct me if I’m wrong)

Hawkins-Kennedy test

arm to flexion, parallel to ground, internal rotate, positive sign is pain

Forced flexion test(yocum test)

Injured arm on opposite shoulder, press elbow up(like smelling the elbow pit) ,positive sign is pain

Tests for Biceps Tendon subluxation

Yergason’s Test (Internal Rotation), Speed’s Test 

Biceps tendon subluxation

The biceps tendon lives in the intertubercular groove and subluxation is when it comes out the groove (the picture is how it SHOULD be)

Yergason’s test (Internal Rotation)

injured side elbow flexion 90% pronation and next to body, then ask to supinate and resist movement while you palpate biceps tendon, positive sign is feeling the subluxation?? hold bottom of humerus from back and external rotate shoulder while they resist, if biceps tendon was gonna sublux would cause it to sublux

Speed’s test

arm in flexion, supinated, press down but tell them to resist, would be a sharp pain if positive

Tests for tears of the rotator cuff tendon

drop arm test, empty can test (Jobe Test)

drop arm test

Arm straight out to their side, external rotation, support arm and tell them you'll let go and try not to drop it, second level drop slowly, positive sign is dropping it

empty can test (jobe test)

Arms out(not straight front or side, mid between), move arm down to internal rotation like emptying a can, Then push down and have them resist, Torn supraspinatus arm would come down, positive sign is arm dropping

Tests for glenohumeral instability (if history hints at shoulder dislocation)

apprehension (crank) test, load and shift test, sulcus test

apprehension (crank) test

elbow abduction and external rotation, positive sign is a pained face since basically recreating the injury moment, don’t tell them that though!

load and shift test

seated position, arm supported on pillow, shoulder slightly abducted, elbow flexion 90%, load shoulder into glenoid fossa. hold arm, press humeral head into glenoid fossa,normal movement up to 25%, grade 1 laxity up to 50%, grade 2 over 50%, positive sign is excessive movement

sulcus test

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be able to see shoulder, pull down on arm and try to see a gap b/w head of humerus and acromion, positive sign is a sulcus(narrow hole-like, groove)

Test for winging scapula

pushup against the wall, scapula move inwards toward spine, a little out when pushing back up, but there should be no lift of medial border, which is a positive sign

Tests for thoracic outlet syndrome

Adson’s test (Anterior scalene syndrome), Allen test (Hyperabduction syndrome), Eden’s test/Military brace test (Costoclavicular syndrome)

Adson’s test for anterior scalene syndrome(There are scalene muscles from upper cervical to upper ribs, blood vessels go b/w those muscles, compressed nerves and stuff)

* Seated patient
* Find pulse
* Extend arm
* Chin up
* Turn head toward us
* Take breath and hold
* Feel for pulse to check if there’s still a pulse
* Loss of pulse is positive sign

Allen test for hyperabduction syndrome(pectoralis minor compressing)

* Take pulse
* Elbow flex 90
* Horizontal abduct
* external rotate shoulder
* Head opposite way
* Take pulse
* Loss of pulse is positive sign

Eden’s test/Military brace test for costoclavicular syndrome(rib and clavicle space)

* Standing patient


* Take pulse
* Retract shoulders, pull shoulder back
* Abduct arm and extend
* Look opposite way
* Loss of pulse is positive sign