The University of West Alabama





Athletic Training & Sports Medicine Center

AH 323 Evaluation of Athletic Injuries I Laboratory
Shoulder Special Tests

 

Special Tests for Assessing Injuries to the Shoulder

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

Patientís head is rotated to face the tested shoulder. Patient then extends the head while the examiner laterally rotates and extends the patientís 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

 

   

Hit Counter