Shoulder Dislocation Tests
Anterior Apprehension Sign, Posterior Apprehension Sign
Bicep Tendon Pathology
Ludington's test, Speed's test, Yergason's test
Rotator Cuff Pathology/Impingement
Drop arm test, Hawkins-Kennedy impingement test, Neer impingement test, Supraspinatus test
Thoracic Outlet Syndrome
Adson's Test, Allen test, Costoclavicular syndrome test, Roos test, Wright (hyperabduction) test
Glenoid Labrum Pathology
Anterior Apprehension Sign for Shoulder
pt in supine with shoulder ABD 90 deg & elbow flexed 90 deg. PT places one hand on the elbow for stabilization and other on the wrist. PT slowly ER the shoulder. (+) a look of apprehension or facial grimace prior to reaching the end point. Identifies (past hx of) anterior shoulder dislocation. AKA: Crank Test.
Posterior Apprehension Sign for Shoulder
pt in supine with shoulder ABD 90 deg ( in scapular plane) with scapula stabilized by the table with elbow flexed 90 deg. PT places one hand on the elbow and the other at the wrist. PT applies a posterior force through the shoulder via force on the elbow while simultaneously moving shoulder into IR and horizontal ADD. (+) a look of apprehension or facial grimace prior to reaching the end point. Identifies (past hx of) posterior shoulder dislocation. AKA: Stress Test
pt in sitting. PT instructs pt to clasp both hands behind the head with the fingers interlocked f/b alternately contracted and relax the biceps muscles. (+) absence of movement in the biceps tendon. Indicates of a rupture of the long head of the biceps.
pt in sitting or standing with elbow in full extension and forearm supinated. PT places one hand over the bicipital groove and other hand on volar surface of forearm. pt instructed to resist shoulder flexion. (+) pain or tenderness in bicipital groove. Identifies bicipital tendonitis/tendonosis. AKA: Biceps Straight Arm Test
pt in sitting with shoulder in neutral/stabilized against trunk, elbow flexed 90 deg and forearm pronated. PT places one hand on patient's forearm and other over bicipital groove. pt instructed to actively supinate and laterally rotate against resistance. (+) tendon of biceps long head will "pop out" of groove, (+) pain or tenderness in bicipital groove. Identifies bicipital tendonitis and integrity of transverse ligament.
Drop arm test
pt in sitting with shoulder passively ABD 120 deg. PT guards pt's arm from falling in case it gives way. pt instructed to SLOWLY bring arm down to side. (+) pt unable to lower arm slowly back down to side, (+) presence of severe pain. Identifies tear and/or full rupture of rotator cuff.
Hawkins-Kennedy impingement test
pt in sitting or standing. PT flexes the patient's shoulder to 90 degrees f/b IR of the shoulder. (+) pain. Indicates shoulder impingement involving the supraspinatus tendon.
Neer impingement test
pt in sitting or standing. PT positions one hand on the posterior aspect of the patient's scapula and the other hand stabilizing the elbow. PT passively IR the shoulder f/b full shoulder ABD. (+) facial grimace or pain. Indicates shoulder impingement involving the supraspinatus tendon and long head of the biceps.
STEP 1: pt in sitting w/ shoulder ABD 90 deg & no rotation (thumbs up) and elbow fully extended. pt instructed to resist shoulder ABD as PT is giving force to distal forearm. STEP 2: pt in sitting w/ shoulder in "empty can" position (thumbs down). pt instructed to resist shoulder ABD as PT is giving force to distal forearm. (+) weakness while in "empty can" or pain in supraspinatus. Identifies tear &/or impingement of supraspinatus tendon or suprascapular nerve involvement.
pt in sitting or standing. PT monitors the radial pulse. pt instructed to rotate the head towards the test shoulder f/b head extension f/b ER. (+) absent or diminished radial pulse. Indicates thoracic outlet pathology.
Allen Test for Shoulder
pt in sitting or standing with the test arm resting at side. PT monitors the radial pulse while placing the arm in 90 deg of ABD, ER, and elbow flexion. pt instructed to rotate the head away from the test shoulder. (+) absent or diminished pulse. Identifies throacic outlet syndrome. AKA: Modified Wright Test
Costoclavicular syndrome test
pt in sitting. PT monitors the patient's radial pulse and instructs pt to assume a military posture. PT draws the pt's shoulder down (w/ elbow fully extended) and back into shoulder extension. (+) absent or diminished radial pulse. Identifies thoracic outlet syndrome (costoclavicular syndrome) caused by compression of the subclavian artery b/w the first rib and the clavicle.
Wright (hyperabduction) test
pt in sitting or supine. PT monitors radial pulse f/b moving pt's arm into max shoulder ABD and ER. pt may accentuate symptoms by taking a deep breath and actively rotating the head opposite to side being tested. (+) absent or diminished radial pulse. Detects compression in the costoclavicular space (associated with thoracic outlet pathology).
pt in supine. PT places one hand on the posterior aspect of the pt's humeral head and other hand stabilizes the humerus proximal to the elbow. PT passively fully ABD and ER the arm f/b applying an anterior directed force to the humerus. (+) audible "clunk" or grinding while performing test. Identifies a glenoid labrum tear.
pt typically c/o thoracic outlet sx while wearing a backpack or heavy coat.
Acromioclavicular Shear Test
pt in sitting w/ arms resting @ side. PT clasps hands and places heel of 1 hand on spine of scapula and heel of other on clavicle. PT squeezes hands together causing compression of AC joint. (+) reproduces pain in AC joint. Identifies dysfunction of AC joint (ie. arthritis, seperation, etc)
pt in sitting or standing. PT moves pts shoulder into ABD 90 deg, full ER, & elbow flexion 90 deg. pt instructed to open and close the hands slowly for 3 minutes. (+) pt unable to keep arms in starting position for 3 min, suffers ischemic pain, heaviness or profound weakness of the arm, numbness & tingling of the hand. (-) if only minor fatigue and distress. Indicates thoracic outlet pathology.