Test
Name
|
Ludington's
Test
|
|
What's
Being Tested
|
Long
Head of the Biceps Tendon
|
|
Patient
Positioning
|
Arm
raised and hands clasped on top of head
|
|
How
the Test is Performed
|
Patient
clasps both hands on top of the head, allowing the interlocking fingers to
support the weight of the upper limbs. This
allows the maximum relaxation of biceps tendon.
Patient then alternately contracts and relaxes the biceps muscle.
Examiner palpates the biceps tendon.
|
|
What
the Results Suggest
|
If
positive, tendon will not be felt and this indicates a long head of biceps
tendon rupture.
|
|
|
|
Test
Name
|
Clunk
Sign
|
|
What's
Being Tested
|
Glenoid
Labrum integrity and stability
|
|
Patient
Positioning
|
Position
the patient supine with the glenohumeral joint slightly over the edge of the
table.
|
|
How
the Test is Performed
|
The
patient lies supine, and the examiner places one hand on the anterior surface of
the GH joint. With the other hand
exerting gentle pressure at the elbow, the examiner externally rotates and
abducts the patient's arm 160 degrees. The
examiner rotates the arm internally and externally in the abducted position.
As the arm is put through this range of motion, the examiner may
occasionally feel the humeral head clicking, popping, or "clunking"
over an irritated glenoid.
|
|
What
the Results Suggest
|
Labral
disorder
|
|
|
|
Test
Name
|
Apprehension
Sign for Anterior Instability
|
|
What's
Being Tested
|
Competence
of the Inferior Glenohumeral Ligament
|
|
Patient
Positioning
|
Position
the patient either sitting or supine with the shoulder in a neutral position at
90 degrees of abduction.
|
|
How
the Test is Performed
|
This
test must be performed slowly and deliberately so that the examiner does not
inadvertently dislocate the shoulder. The
test is performed by abducting the shoulder to 90 degrees, and then slowly
externally rotating the shoulder toward 90 degrees.
A patient with anterior-inferior instability will usually become
"apprehensive" either verbally or with distressing facial expressions.
|
|
What
the Results Suggest
|
Anterior
shoulder subluxation or impending dislocation in a supportive clinical context.
|
|
|
|
Test
Name
|
Fulcrum
Test
|
|
What's
Being Tested
|
Competence
of the Inferior Glenohumeral Ligament
|
|
Patient
Positioning
|
Position
the patient supine and the arm abducted and externally rotated 90 degrees
|
|
How
the Test is Performed
|
The
examiner places a clenched fist or solid object under the
posterior midhumerus region. The
other hand is used to apply an anterior to posterior levering force at the
distal humerus or elbow region. The
applied force levers the humerus over the examiner's fist or object (the
fulcrum), causing anterior translation of the humeral head on the glenoid.
The test is considered positive when the patient's symptoms are
reproduced, often causing similar discomfort to the apprehension test.
The fulcrum test can also be performed by grasping the midhumerus with
both hands and applying pressure in a posterior to anterior direction while
simultaneously abducting and externally rotating the shoulder to 90 degrees.
|
|
What
the Results Suggest
|
Anterior
shoulder subluxation or impending dislocation in a
supportive clinical context. |
|
|
|
Test
Name
|
Generalized
Ligamentous Laxity Evaluation
|
|
What's
Being Tested
|
Overall
laxity of patient.
|
|
Patient
Positioning
|
Any
|
|
How
the Test is Performed
|
If
the patient can meet three of the four following criteria, the examiner can
conclude that there is generalized ligamentous laxity:
Thumb abduction to touch the volar forearm with the wrist flexed
Hyperextension of the little finger metacarpophalangeal joint beyond 90 degrees
Elbow hyperextension beyond 10 degrees Knee hyperextension beyond 10 degrees
|
|
What
the Results Suggest
|
Generalized
Ligamentous Laxity |
|
|
|
Test
Name
|
Jerk
Sign or Jahnke Test
|
|
What's
Being Tested
|
Posterior
Subluxation
|
|
Patient
Positioning
|
Standing
or sitting
|
|
How
the Test is Performed
|
Posteriorly
stress the forward flexed arm at 90 degrees of flexion
in neutral rotation.
In this position, the humeral head is posterior subluxated.
Continued posterior stress while moving the arm laterally to an abducted
position will produce a clunk or obvious feeling of reduction of a subluxated
humeral head.
|
|
What
the Results Suggest
|
Posterior
Laxity-Instability
|
|
|
|
Test
Name
|
Load
& Shift Test
|
|
What's
Being Tested
|
Translation
of the humeral head
|
|
Patient
Positioning
|
Position
the patient supine. Before
beginning the test, the examiner must insure that the humeral head is located in
the glenoid cavity and not translated anteriorly, posteriorly, or inferiorly.
|
|
How
the Test is Performed
|
To
achieve a stable reduced starting position, the examiner grasps and
"loads" the abducted arm, neutrally rotated with the elbow flexed,
then applies a transitional force to the proximal humerus and attempts to ride
the humeral head out of the glenoid socket.
|
|
What
the Results Suggest
|
Assesses
glenohumeral translations. Aids in
identifying direction of instability.
|
|
|
|
Test
Name
|
Relocation
Test
|
|
What's
Being Tested
|
Anterior
glenohumeral instability (companion test to the Apprehension Test)
|
|
Patient
Positioning
|
With
the patient supine, position the shoulder 90 degrees abduction and 90 degrees
external rotation.
|
|
How
the Test is Performed
|
The
examiner applies a posterior translational force to the anterior proximal
humerus at the point of external rotation when the patient feels apprehensive. The test result is positive if this maneuver relieves the
apprehension symptoms.
|
|
What
the Results Suggest
|
A
decrease in pain or apprehension may suggest anterior glenohumeral instability
|
|
|
|
Test
Name
|
Sulcus
Sign
|
|
What's
Being Tested
|
Assesses
inferior glenohumeral laxity.
|
|
Patient
Positioning
|
The
patient may stand or sit with the involved arm hanging relaxed at the side.
|
|
How
the Test is Performed
|
The
examiner applies a downward directed, distractive force
on the involved arm. An indention or sulcus just lateral to the acromion
may be noted as the humeral head subluxes inferiorly. The examiner should also
perform this test on the uninvolved shoulder, comparing bilaterally.
|
|
What
the Results Suggest
|
Inferior
laxity is evident if there is a visible widening of the subacromial space with a
sulcus appearing in the adjacent area just distal to the lateral acromion.
|
|
|
|
Test
Name
|
Adson
Maneuver
|
|
What's
Being Tested
|
Thoracic
Outlet Syndrome
|
|
Patient
Positioning
|
Neutral
adducted relaxed position
|
|
How
the Test is Performed
|
Patient’s
head is rotated to face the tested shoulder. Patient then extends the head while
the examiner laterally rotates and extends the patient’s shoulder. Examiner
locates radial pulse and the patient is instructed to take a deep breath and
hold it. Disappearance of pulse is indicative of a positive test.
|
|
What
the Results Suggest
|
Compression
of neurovascular structures to arm.
|
|
|
|
Test
Name
|
Halstead's
Test
|
|
What's
Being Tested
|
Presence
of a bruit
|
|
Patient
Positioning
|
With
the neck extended, the patient turns the head towards the opposite shoulder
|
|
How
the Test is Performed
|
With
downward traction of the affected arm, the pulse is palpated.
|
|
What
the Results Suggest
|
If
the pulse is obliterated, the result of the test is positive.
|
|
|
|
Test
Name
|
Spurling's
Test
|
|
What's
Being Tested
|
Cervical
nerve root disorder
|
|
Patient
Positioning
|
Head
extended and rotated to affected shoulder while axially loaded
|
|
How
the Test is Performed
|
The
patient's cervical spine is placed in extension and the head rotated toward the
affected shoulder. An axial load is
then placed on the spine.
|
|
What
the Results Suggest
|
Reproduction
of the patient's shoulder or arm pain indicates possible cervical nerve root
compression and warrants further evaluation of the bony soft tissue structures
of the cervical spine.
|
|
|
|
Test
Name
|
Cross-Arm
Test
|
|
What's
Being Tested
|
Pain
at the acromioclavicular joint.
|
|
Patient
Positioning
|
Sitting
or standing
|
|
How
the Test is Performed
|
The
patient flexes
the affected arm to 90 degrees. Adduction
of the arm forces the acromion into the distal end of the clavicle
|
|
What
the Results Suggest
|
Pain
in the area of the acromioclavicular joint may suggest degenerative changes.
|
|
|
|
Test
Name
|
Gilcrest's
Palm-Up Test
|
|
What's
Being Tested
|
Isolates
pain in long head of the biceps tendon
|
|
Patient
Positioning
|
Sitting
or standing
|
|
How
the Test is Performed
|
Patient
forward flexes the arm against resistance with elbow extended and forearm
supinated.
|
|
What
the Results Suggest
|
Irritation
of long head of biceps
|
|
|
|
Test
Name
|
Hawkins
Impingement Sign
|
|
What's
Being Tested
|
Impingement
|
|
Patient
Positioning
|
Sitting
or standing
|
|
How
the Test is Performed
|
The
examiner places the patient's arm in 90 degrees of forward flexion and
forcefully internally rotates the arm, bringing the greater tuberosity in
contact with the lateral acromion. A
positive result is indicated if pain is reproduced
during the forced internal rotation.
|
|
What
the Results Suggest
|
Pain
in the supraspinatus tendon.
|
|
|
|
Test
Name
|
Neer
Impingement Sign
|
|
What's
Being Tested
|
Impingement
|
|
Patient
Positioning
|
With
the patient seated or standing
|
|
How
the Test is Performed
|
Place
one hand on the posterior aspect of the scapula to stabilize the shoulder
girdle, and, with the other hand, take the patient's internally rotated arm by
the wrist, and place it in full forward flexion.
|
|
What
the Results Suggest
|
If
there is impingement, the patient will report pain in the range of 70 degrees to
120 degrees of forward flexion as the rotator cuff comes into contact with the
rigid coracoacromial arch.
|
|
|
|
Test
Name
|
O'Brien
Test
|
|
What's
Being Tested
|
Superior
Labral Pathology
|
Patient
Positioning
|
Sitting
or standing
|
|
How
the Test is Performed
|
The
patient tries to elevate the extended, pronated arm from a starting position of
90 degrees forward flexion and 20 degrees to 30 degrees of adduction against
resistance. Resisted flexion,
adduction, and internal rotation will cause more pronounced symptoms.
|
|
What
the Results Suggest
|
The
result is considered positive if symptoms are relieved
with
resisted forward flexion
when the test is repeated with the arm supinated.
|
|
|
|
Test
Name
|
Speed's
Maneuver
|
|
What's
Being Tested
|
Biceps
tendon
|
|
Patient
Positioning
|
Seated
|
|
How
the Test is Performed
|
The
patient's elbow is flexed 20 degrees to 30 degrees with the forearm in
supination and the arm in about 60 degrees of flexion.
The examiner resists forward flexion of the arm while palpating the
patient's biceps tendon over the anterior aspect of the shoulder.
|
|
What
the Results Suggest
|
Indicates
irritation long head of biceps tendon
|
|
|
|
Test
Name
|
Yergason
test
|
|
What's
Being Tested
|
Evaluates
the biceps tendon.
|
|
Patient
Positioning
|
The
patient's elbow is flexed to 90 degrees with the thumb up. forearm
is in neutral
|
|
How
the Test is Performed
|
The
examiner grasps the wrist, resisting attempts by the patient to actively
supinate the forearm
and flex the elbow.
|
|
What
the Results Suggest
|
Pain
suggests biceps tendonitis
|
|
|
|
Test
Name
|
Apley
Scratch Test
|
|
What's
Being Tested
|
Rotator
cuff ROM
|
|
Patient
Positioning
|
Sitting
or standing
|
|
How
the Test is Performed
|
Patient
touches superior and inferior aspects of opposite scapula
|
|
What
the Results Suggest
|
Dysfunction
of abductors/ rotators
|
|
|
|
Test
Name
|
Drop-Arm
Test
|
|
What's
Being Tested
|
Supraspinatus
tendon of rotator cuff
|
|
Patient
Positioning
|
Sitting
or standing
|
|
How
the Test is Performed
|
Passively
abduct the patient's shoulder, then observe as the patient slowly lowers the arm
to the waist. Often, the arm will
drop to the side if the patient has a rotator cuff tear or supraspinatus
dysfunction. The patient may be
able to lower the arm to 90 degrees (because this is a function mostly of the
deltoid muscle) but will be unable to continue the maneuver as far as the waist.
|
|
What
the Results Suggest
|
Supraspinatus
tear
|
|
|
|
Test
Name
|
Drop
Sign
|
|
What's
Being Tested
|
Infraspinatus
|
|
Patient
Positioning
|
The
patient is seated on the examination couch with his/her back to the examiner
|
|
How
the Test is Performed
|
The
examiner holds the affected arm at 90 degrees of abduction
(in the scapular plane) and at almost full external
rotation, with the elbow flexed at 90 degrees.
In this position, the maintenance of the position of external rotation of
the shoulder is a function mainly of the infraspinatus.
The patient is then asked to actively maintain this position as the
examiner releases the wrist while supporting the elbow. The sign is positive if
a lag or "drop" occurs. The
magnitude of the lag is recorded to the nearest 5 degrees.
|
|
What
the Results Suggest
|
Dysfunction
of the posterosuperior cuff
|
|
|
|
Test
Name
|
External
Rotation Lag Sign
|
|
What's
Being Tested
|
Posterosuperior
rotator cuff
|
|
Patient
Positioning
|
The
patient is seated on the examination couch with his/her back to the examiner
|
|
How
the Test is Performed
|
The
elbow is passively flexed to 90 degrees, and the shoulder is held at 20 degrees abduction
(in the scapular plane) and near maximal external rotation by the examiner.
The patient is then asked to actively maintain the position of external
rotation in abduction
as the examiner releases the wrist while maintaining support of the limb at the
elbow. The sign is positive when a lag, or angular drop occurs.
The magnitude of the lag is recorded to the nearest 5 degrees.
|
|
What
the Results Suggest
|
For
small ruptures of the supraspinatus, the movement may be subtle with a magnitude
of as little as 5 degrees. Lags of
greater magnitude suggest larger disruption of the posterosuperior rotator cuff.
|
|
|
|
Test
Name
|
Gerber
Lift-Off Test
|
|
What's
Being Tested
|
Subscapularis
|
|
Patient
Positioning
|
Sitting
or standing
|
|
How
the Test is Performed
|
With
the patient's hand on the small of the back, the arm is extended and internally
rotated. The examiner then
passively lifts the hand off the small of the back, placing the arm in maximal
internal rotation. The examiner
then releases the hand. If the hand
falls onto the back because the subscapularis is unable to maintain internal
rotation, the test result is positive. Patients
with subscapularis tears have an increase in passive external rotation and a weakened
ability to resist internal rotation.
|
|
What
the Results Suggest
|
Rupture
of the subscapularis
|
|
|
|
Test
Name
|
Hornblower's
Sign
|
|
What's
Being Tested
|
Teres
minor
|
|
Patient
Positioning
|
Sitting
or standing
|
|
How
the Test is Performed
|
Shoulder
is externally rotated at 90 degrees of abduction.
Examiner supports the arm in the scapular plane.
The elbow is flexed to 90 degrees and the patient is asked to rotate the arm
externally against the
resistance. Positive sign is the inability to maintain the externally rotated
position and the arm drops back to neutral position.
|
|
What
the Results Suggest
|
Tear
or dysfunction
of infraspinatus and teres minor.
|
|
|
|
Test
Name
|
Internal
Rotation Lag Sign
|
|
What's
Being Tested
|
Subscapularis
tendon
|
|
Patient
Positioning
|
The
patient is seated on the examination couch with his/her back to the examiner
|
|
How
the Test is Performed
|
The
affected arm is held by the examiner at almost maximal internal rotation behind
the patient's back. The elbow is
flexed to 90 degrees, and the shoulder is held at 20 degrees abduction
and 20 degrees
extension. The dorsum of the hand is passively lifted away from the lumbar
region until almost full internal rotation is reached.
The patient is then asked to actively maintain this position as the
examiner releases the wrist while maintaining support at the elbow. The sign is
positive when a lag occurs. The
magnitude of the lag is recorded to the nearest 5 degrees.
|
|
What
the Results Suggest
|
An
obvious drop of the hand may occur with large tears of the subscapularis.
A slight lag indicates a partial tear of the cranial part of the
subscapularis tendon.
|
|
|
|
Test
Name
|
Jobe's
Supraspinatus Test/ Empty Can Test
|
|
What's
Being Tested
|
Supraspinatus
tendon
|
|
Patient
Positioning
|
Sitting
or standing
|
|
How
the Test is Performed
|
The
patient stands with arms extended at the elbows and abducted in the scapular
plane and with thumbs pointed to the floor. The examiner applies
downward pressure to the arms and the patient attempts to resist. |
|
What
the Results Suggest
|
Supraspinatus
dysfunction.
|
|
|
|
Test
Name
|
Allen
Test |
|
What's
Being Tested
|
|
|
Patient
Positioning
|
|
|
How
the Test is Performed
|
|
|
What
the Results Suggest
|
|
|
|
|
Test
Name
|
Andrew's
Anterior Instability |
|
What's
Being Tested
|
|
|
Patient
Positioning
|
|
|
How
the Test is Performed
|
|
|
What
the Results Suggest
|
|
|
|
|
Test
Name
|
Brachial
Plexus |
|
What's
Being Tested
|
|
|
Patient
Positioning
|
|
|
How
the Test is Performed
|
|
|
What
the Results Suggest
|
|
|
|
|
Test
Name
|
External
Rotation Manual Muscle Test |
|
What's
Being Tested
|
|
|
Patient
Positioning
|
|
|
How
the Test is Performed
|
|
|
What
the Results Suggest
|
|
|
|
|
Test
Name
|
External
Rotation Manual Muscle Test @ 900 |
|
What's
Being Tested
|
|
|
Patient
Positioning
|
|
|
How
the Test is Performed
|
|
|
What
the Results Suggest
|
|
|
|
|
Test
Name
|
Internal
Rotation Abduction Manual Muscle Test |
|
What's
Being Tested
|
|
|
Patient
Positioning
|
|
|
How
the Test is Performed
|
|
|
What
the Results Suggest
|
|
|
|
|
Test
Name
|
Internal
Rotation Manual Muscle Test |
|
What's
Being Tested
|
|
|
Patient
Positioning
|
|
|
How
the Test is Performed
|
|
|
What
the Results Suggest
|
|
|
|
|
Test
Name
|
Posterior
Glenohumeral Instability Test |
|
What's
Being Tested
|
|
|
Patient
Positioning
|
|
|
How
the Test is Performed
|
|
|
What
the Results Suggest
|
|
|
|
|
Test
Name
|
Prone
Posterior Instability Test |
|
What's
Being Tested
|
|
|
Patient
Positioning
|
|
|
How
the Test is Performed
|
|
|
What
the Results Suggest
|
|
|
|
|
Test
Name
|
Push
Pull Test |
|
What's
Being Tested
|
|
|
Patient
Positioning
|
|
|
How
the Test is Performed
|
|
|
What
the Results Suggest
|
|
| |
|
