Shoulder Special Tests
Load and Shift TestPurpose: tests for anterior and posterior instability
Patient: seated or supine Positioner: With one hand stabilize the scapula, and with the other hand glide the humerus anteriorly & posteriorly. Positive: Greater than 50% movement Retrieved from https://www.youtube.com/watch?v=0edignSiNGs on October 6, 2014.
Fowler's Sign (Relocation Test)Purpose: tests anterior instability
Patient: supine Positioner: Perform an Apprehension test, at the point that the patient feels pain, apply a posteriorly directed force, and the patient’s pain or instability should seize. Positive: Diminished symptoms of pain or instability |
Crank TestPurpose: tests for labral pathology
Patient: Seated Positioner: Abduct arm in scapular plane, flex the elbow, and apply load through the glenohumeral joint while internally and externally rotating the humerus. Positive: Pain, catching, or painful clicking Retrieved from https://www.youtube.com/watch?v=ZCs6GlPpvd8&list=PL062A1CA880D7D778&index=16 on October 6, 2014.
Apprehension TestPurpose: tests for anterior GH instability
Patient: Supine Positioner: Move shoulder into maximal external rotation in abduction Positive: If patient feels instability or pain |
Retrieved from https://www.youtube.com/watch?v=HnjKGuaxOeU on October 6, 2014.
Norwood Stress TestPurpose: tests posterior instability
Patient: Supine Positioner: Abduct the shoulder to 100 degrees, shoulder is externally rotated to 90 degrees, and the elbow is flexed to 90 degrees. Stabilize the scapula and palpate the posterior humeral head. Next horizontally adduct the arm. Positive: Humeral head slipping posteriorly in the joint. |
Retrieved from https://www.youtube.com/watch?v=K2XpphO6Wls on October 6, 2014.
Sulcus SignPurpose: tests for inferior instability
Patient: Seated with arm hanging to their side Positioner: Apply an inferior force on the Glenohumeral joint by pulling down on the arm. Positive: A step off deformity |
Retrieved from https://www.youtube.com/watch?v=8hg-kB8Igcw on October 6, 2014.
Feagin's TestPurpose: tests for inferior instability
Patient: Seated Positioner: Abduct shoulder to 90 degrees, place the forearm on positioner's shoulder, and grab the humerus, have them relax, and try to distract the humerus inferiorly by applying an inferior force on the humeral head. Positive: Translation of the humeral head inferiorly |
Retrieved from https://www.youtube.com/watch?v=V-PTPUwsH7E&index=7&list=PL062A1CA880D7D778 on October 6, 2014.
Neer's TestPurpose: tests for impingement
Patient: Seated Positioner: Internally rotate the arm and passively elevate the arm overhead Positive: Pain with movement |
Retrieved from https://www.youtube.com/watch?v=qet2m9L9uW4 on October 6, 2014.
Hawkin's-Kennedy TestPurpose: tests for impingement
Patient: Seated Positioner: flex the shoulder forward to 90 degrees, flex the elbow to 90 degrees, and have the hand prone, support the elbow with one hand, and the wrist with the other hand. Then forcefully internally rotate the arm. Positive: Pain with movement |
Retrieved from https://www.youtube.com/watch?v=On8U6Czh9wU&list=PLSLki3pDXu2d_hKgX1meJiBLJ9d1UgyL6&index=7 on October 6, 2014.
Posterior Impingement TestPurpose: tests for impingement
Patient: Supine Positioner: Abduct shoulder to 90 degrees and extend 10-15 degrees, flex the elbow to 90 degrees, support the elbow and hold the wrist, then slowly externally rotate the shoulder Positive: reproduction of pain in the posterior aspect of the shoulder. |
Retrieved from https://www.youtube.com/watch?v=oj_qHdDVhq8 on October 6, 2014.
Anterior Slide TestPurpose: tests for labral pathology
Patient: seated Positioner: Place patient’s hands on hips, stabilize the shoulder, and then push the humerus in an anterior direction, and instruct the patient to resist the anterior movement. Positive: Pain or clunk |
Retrieved from https://www.youtube.com/watch?v=F441BQvTkMc on October 6, 2014.
O'Brien's TestPurpose: tests for labral pathology
Patient: Seated Positioner: Shoulder flexed to 90 degrees, and horizontally adducted 15 degrees, humerus is internally rotated, and forearm is pronated with the thumb facing down. Apply a downward force. The test can then be repeated with the arm externally rotated. Positive: Pain with humerus internally rotated and relief of pain with humerus externally rotated. |
Retrieved from https://www.youtube.com/watch?v=NjTe8eCI36k on October 6, 2014.
Biceps Tension TestPurpose: tests for labral pathology
Patient: Seated Positioner: Abduct arm to 90 degrees and supinate forearm. Apply a downward force on the arm at the wrist Positive: Unable to withstand downward force. |
Retrieved from https://www.youtube.com/watch?v=D-sTz9iMh1I on October 6, 2014.
Lateral Scapular Slide TestPurpose: tests for scapular instability
Patient: Standing, facing away from positioner Positioner: Have patient put hands on their hips and measure distance between T3 and T7 to the scapular spine Positive: difference of 0.5 and 0.75 inches |
Retrieved from https://www.youtube.com/watch?v=oynskQ4ankQ on October 6, 2014.
Speed's TestPurpose: tests for biceps tendinitis
Patient: Seated Positioner: flex shoulder against resistance, while elbow is extended and forearm is supinated Positive: pain in the bicipital groove |
Retrieved from https://www.youtube.com/watch?v=51ikqqpUFbc on October 6, 2014.
Yergason's TestPurpose: tests for biceps tendinitis
Patient: Seated Positioner: Elbow flexed to 90 degrees, forearm is pronated, and positioner places one hand on the forearm and the other on the humerus near the bicipital groove. Resist the patients attempt to actively supinate the forearm and externally rotate the arm. Positive: Pain in the area of the bicipital groove |
Retrieved from https://www.youtube.com/watch?v=S6AKVgdU7TU&index=10&list=PLSLki3pDXu2d_hKgX1meJiBLJ9d1UgyL6 on October 6, 2014.
Empty Can TestPurpose: tests for subscapularis weakness
Patient: Standing Positioner: Passively abduct arm to 90 degrees with elbow extended. Then angle the arm forward 30 degrees, internally rotate forearm so thumb is pointing to the floor, and apply a downward force on the arm. Positive: Pain or weakness with resistive force |
Retrieved from https://www.youtube.com/watch?v=Oh-V3N0dnDA on October 6, 2014.
Lift Off TestPurpose: tests the subscapularis weakness
Patient: Standing, facing away from positioner Positioner: arm internally rotated behind their back, then ask the patient to lift their forearm against the positioner resistance. Positive: Unable to lift their hand off of their back. |
Retrieved from https://www.youtube.com/watch?v=tjQzMGrvI3U on October 6, 2014.
ER Lag Sign (Spring Back)Purpose: tests for anterior instability
Patient: Standing or seated Positioner: Patient in 90 degrees of flexion and abduction, passively externally rotate the shoulder Positive: Arm will spring back during external rotation |
Retrieved from https://www.youtube.com/watch?v=Ojr2CLmiuTA&index=6&list=PLSLki3pDXu2d_hKgX1meJiBLJ9d1UgyL6 on October 6, 2014.
Upper Limb Tension TestPurpose: tests for anterior instability
Patient: Supine Positioner: Arm is abducted to 90 degrees, elbow flexed to 90 degrees, and then passively put into full extension. Extend wrist and fingers fully and then start to extend the arm Positive: If symptoms are reproduced |
Retrieved from https://www.youtube.com/watch?v=vv6pi3jPt-o on October 6, 2014.
Roos' TestPurpose: tests for thoracic outlet syndrome
Patient: Seated Positioner: Flex arms and elbows to 90 degrees, and then have patient open and closed fists for 3 minutes. Positive: Reproduction of symptoms |
Retrieved from https://www.youtube.com/watch?v=hJ6ywqxWlkA on October 6, 2014.
Drop Arm TestPurpose: tests for supraspinatus weakness
Patient: Standing Positioner: Passively abduct shoulder to 90 degrees, then ask patient to slowly return arms to the side. Positive: Patient is unable to slowly bring their arms back down to their sides or if their pain is reproduced. |
Retrieved from https://www.youtube.com/watch?v=MQgNJSERivE on October 6, 2014.
Adson's TestPurpose: tests for thoracic outlet syndrome
Patient: Seated Positioner: Locate radial pulse and then passively extend the arm backwards while the patient actively turns their head to the opposite direction. Positive: Alteration of the radial pulse |
Retrieved from https://www.youtube.com/watch?v=9kRbIUqWtoc on October 6, 2014.
Clunk TestPurpose: tests for labral tear
Patient: Supine Positioner: Abduct arm to 90 degrees and externally rotate the forearm. Then stabilize the humeral head and hold the distal humerus. Apply anterior force to humerus and rotate the humerus around the GH joint. Positive: Pain, catching, or a clunk |
Retrieved from https://www.youtube.com/watch?v=6aaCspvqQHQ&list=PLSLki3pDXu2d_hKgX1meJiBLJ9d1UgyL6 on October 6, 2014.
Allen's Test (Halstead Maneuver)Purpose: tests for thoracic outlet syndrome
Patient: Hook seated or standing Positioner: palpate radial artery and externally rotate and abduct the arm to 90 degrees. Flex the elbow to 90 degrees. Have patient look over opposite shoulder. Positive: diminish of pulse or absence of pulse Retrieved from https://www.youtube.com/watch?v=9Bl-pfEr_UI on October 6, 2014.
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Retrieved from https://www.youtube.com/watch?v=HvMa1Wa_-Ow&list=PL062A1CA880D7D778&index=15 on October 6, 2014.
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