Module 1 Readings

Final Frontier Module 1 Readings

Cross-arm adduction test action

Patient’s arm in GH flexion of 90°; PT performs passive horizontal ADDuction

Cross-arm adduction test positive sign

Pain at AC joint; +TTP over AC joint

Resisted extension test action

Patient seated with arm in GH flexion of 90° with horizontal ADDuction; performs H ABDuction against resistance provided by PT

Resisted extension test positive sign

Pain at AC joint

Painful arc test action

Patient actively abducts shoulder

Painful arc test positive sign for AC

Pain between 170° and 180°

Paxinos sign action

Patient seated with arm relaxed at side, Pt stands behind patient, places thumb under posterolateral acromion and index along fingers at the clavicle, and applies pressure with both thumb and fingers

Paxinos sign positive sign

Pain at AC joint

AC shear test action

PT cups hands over deltoid muscle and squeezes hands together

AC shear test positive sign

Pain at AC joint

Acromioclavicular Joint Tests

• cross arm adduction test

• resisted extension test

• painful arc test

• Paxinos sign

• AC shear test

Hawkins-Kennedy test action

PT passively flexes patient’s shoulder to 90°; if not painful, PT performs IR of the shoulder

Hawkins-Kennedy positive sign

Pain in subacromial space

Infraspinatus resisted test action

Patient has arm at side with elbow flexed to 90°, PT provides resistance to ER

Infraspinatus resisted test positive sign

Pain along subacromial space

Painful arc positive sign for subacromial impingement

Pain between 60-120°

Yocum test action

Modification of Hawkins-Kennedy test, patient puts hand on opposite shoulder; PT elevates elbow

Yocum test positive sign

Pain

Neer test action

PT passively brings shoulder into elevation in the plane of the scapula with IR

Neer test positive sign

Pain in subacromial space

Empty can (Jobe) test action

Patient seated with shoulder abducted to 90° and no rotation; PT provides resistance to abduction

Next, shoulder in scapular plane is angled forward 30* and internally rotated, PT provides resistance to abduction

Empty can (Jobe) test positive sign

Pain in supraspinatus or weakness

Scapular assistance test action

PT assists UR of scapula during arm elevation

Scapular assistance test positive sign

Decreased pain; increased strength and ROM

Indicates weakness of the muscles responsible for UR of the scapula: SA, LT, and UT

Subacromial Impingement Tests

• Hawkins-Kennedy

• Infraspinatus resisted test

• Painful arc

• Yocum test

• Neer test

• Empty can

• Scapular assistance

Hornblower sign action

PT passively elevates shoulder to 90° in scapular plane and flexes elbow to 90°; patient performs ER against resistance

Hornblower sign positive sign

Weakness; inability to externally rotate the arm

External rotation lag sign action

Patient has arm by side and elbow flexed to 90°, PT passively abducts arm to 90° and shoulder into maximum ER; then lets go to see if patient can hold position

External rotation lag sign positive sign

Inability to maintain ER, indicates pain or weakness of infraspinatus and tires minor muscles

Belly-press test action

With patient standing, PT places one hand on patient’s abdomen; patient places hand on top of PT’s hand and then presses into abdomen

Belly-press positive sign

IR weakness, asymmetry; inability to maintain pressure; patient performs compensations such as extending shoulder or flexing wrist

Lift-off sign (Gerber test) action

Patient lifts hand posteriorly away from back

Lift-off sign positive sign

Pain; inability to lift and away from back, indicates lesion of the subscapularis muscle

Drop-arm test action

PT passively abducts shoulder to 90°; patient actively and eccentrically lowers shoulder

Drop-arm test sign

Loss of eccentric control of lowering arm

Infraspinatus resisted test action

Patient has arm at side with elbow flexed to 90°; performs ER against PT-provided resistance

Infraspinatus resisted test positive sign

Pain along subacromial space

Rotator cuff pathology tests

• Hornblower sign

• External rotation lag sign

• Belly-press

• Lift-off sign

• Drop-arm test

• Infraspinatus resisted test

Active compression O’brien test action

Patient standing with arm flexed to 90° and elbow extended; horizontally adducts arm to 10° and rotates internally; PT asks patient to resist while applying a downward force

Patient returns arm to starting position and rotates externally; PT asks patient to resist while applying downward force

Active compression O’briens test positive sign

Pain occurs with IR and not with ER

Biceps load II test action

Patient supine with shoulder abducted to 120° and in full ER with elbow flexed to 90° and supinated

If patient shows apprehension, stop ER

In same position, have patient perform elbow flexion against PT provided resistance

Biceps load II test positive test

Apprehension; same or increased pain

Anterior slide test action

Patient seated with hand on waist, thumb posterior; PT applies anterior-superior force to elbow

Anterior slide positive test

Pain or clicking in deep shoulder

Compression - rotation test action

Patient supine; PT passively abducts shoulders between 20° and 90° with elbow flexed to 90°, then PT applies an axial compression load with GH ER and IR

Pain provocation (Mimori) test action

Patient seated with arm abducted between 90° and 100°; PT externally rotates arm, taking forearm into maximum supination and maximum pronation

Pain provocation (Mimori) positive test

Pain worse in pronated position

Yergason’s test action

Patient seated with shoulder in neutral position and stabilized against trunk, elbow flexed to 90°, and forearm pronated; have patient perform supination and nER against PT-provided resistance

Yergason’s positive test

Popping of long head of bicep tendon - indicates torn transverse humeral ligament

Tenderness at bicipital groove with no dislocation - indicates biceps tendinitis

Speed (biceps straight arm) test action

Patient resists shoulder flexion with elbow extended, with forearm first supinated and then pronated

Alternatively, shoulder is flexed to 90°, and patient resists shoulder extension with forearm first supinated and then pronated (biceps eccentric contraction)

Speed (biceps straight arm) positive sign

Pain in anterior shoulder

Superior Labrum Anterior to Posterior Tear Tests

• Active compression (O’Brien) test

• Biceps load II test

• Anterior slide test

• Compression-rotation test

• Pain provocation test

Popeye-sign positive

Distal bunching of muscle with complete loss of function; rupture of long head of biceps

Anterior Instability Tests

• Anterior apprehension test

• Relocation test

Anterior apprehension test action

Patient supine, PT passively flexes patient’s elbow to 90° and abducts shoulder to 90°, then performs slow ER of the shoulder

Anterior apprehension test positive sign

Apprehension, pain

Relocation test action

Follow up to positive apprehension test, PT stabilizes the GH joint posteriorly

Relocation test positive sign

Reduction to apprehension

Posterior instability tests

• Jerk test (inferior labral tear)

• Posterior apprehension test

Jerk (posterior-inferior labral tear) test action

Patient seated with shoulder flexed to 90°

Jerk test positive sign

Sudden jerk or clunk of humerus, may have second jerk when returning arm to original position

Posterior apprehension test action

Patient supine or seated, PT elevates shoulder in the scapular plane to 90°, applies posterior force through the elbow, and horizontally adducts and internally rotates the arm

Posterior apprehension test positive sign

Apprehension; pain; reproduction of symptoms

Inferior instability test

Sulcus sign

Sulcus sign action

Patient stands with arm relaxed at side; PT pulls arm distally

Sulcus positive sign

Presence of sulcus inferior to acromion; positive only if patient is symptomatic (pain, ache)

Pectoralis major contracture test action

Patient supine with hands clasped together behind head; lowers arms until elbows touch the examining table

Pectoral’s major contracture test

Elbows do not reach the table

Thoracic outlet syndrome tests

• Adson maneuver

• Halstead maneuver

• Roos

• Wright (elevated arm) test

• Military Brace (costoclavicular syndrome) test

Adson maneuver action

Patient seated; PT finds radial pulse, PT asks patient to rotate head toward test extremity and extend head; PT then externally rotates and extends shoulder and asks patient to take a deep breath and hold it

Adson maneuver positive sign

Disappearance of pulse; reproduction of symptoms

Halstead maneuver action

Patient seated; PT finds radial pulse; PT then applies a downward traction on test should while neck is hyperextended and head is rotated to the opposite side

Halstead maneuver positive sign

Absence or disappearance of the radial pulse; reproduction of symptoms in the upper extremity.

Roos (elevated arm) test action

Patient standing with both shoulders in ER, 90° of abduction, and slight HADD and elbows flexed to 90°; have patient open and close hands slowly for 3 minutes.