SHOULDER JOINT SPECIAL TESTS

ROTATOR CUFF

1.Apley's Scratch Test.

• Testing abduction and external rotation( +ve sign touch the opposite scapula, -ve sign cannot touch the opposite scapula) 

• Testing adduction and internal rotation( +ve sign touch the opposite scapula, -ve sign cannot touch the opposite scapula) 

2. Empty can Test.

        

The test is usually easier in sitting or standing. On the side to be tested one of the examiner’s hands stabilizes shoulder girdle. The arm to be tested is moved into 90 degrees of forwarding flexion in the plane of the scapula (approximately 30 degrees of abduction), full internal rotation with the thumb pointing down as if emptying a beverage can.

The Empty Can Test is considered positive if there are significant pain and/or weakness.

3. Hawkins-Kennedy Impingement Tests.

The test is best performed with the patient in a relaxed sitting position. The arm to be tested should be moved passively by the examiner. The examiner moves the arm of the should be tested such that the arm is in 90 degrees of forwarding flexion and the elbow is flexed to 90 degrees.

In the starting position, the examiner forcefully moves the patient’s shoulder into an internal rotation to the end of the range of motion or until reports of pain.

The Hawkins-Kennedy test is considered positive if the pain is reported in the superior – lateral aspect of the shoulder.

4. Belly Compression Test.

Tests for subscapularis lesion-especially for patients who cannot medically rotate the shoulder enough to take it behind the back. The examiner places a hand on the abdomen so that he or she can feel how much pressure the patient is applying to the abdomen. The patient places his or her hand on the shoulder being tested on the examiner’s hand and pushes as hard as he or she can into the stomach. The patient also attempts to bring the elbow forward in the scapular plane causing greater medial shoulder rotation. It is a positive test if the patient is unable to maintain the pressure on the examiner’s hand while moving the elbow forward or if the patient extends the shoulder.

Anterior Instability Test.

1. Anterior Drawer Test.

The patient is supine with the glenohumeral joint positioned at the edge of the table. Examiner stands next to the involved shoulder. Examiner places one hand around the humerus below the surgical neck. Another hand stabilizes the scapula by placing the fingers behind the athlete on the spine of the scapula and the thumb over the coracoid process. The patient is relaxed while the examiner passively abducts the glenohumeral joint 70 to 80°, forward flexes 0 to 10°, and externally rotates 0 to 10°. Examiner stabilizes the scapula and firmly glides the head of the humerus anteriorly while applying slight distraction to the glenohumeral joint.

2. Crank Test.

 This test is usually performed with the patient in sitting but can also be performed with the patient in supine or standing. The examiner flexes the patient's elbow to 90 degrees and elevates the patient’s arm to approximately 160 degrees in the scapular plane. In this position, the examiner applies a gentle compressive force on the glenohumeral joint along the axis of the humerus while simultaneously moving the humerus into the internal and external rotation. The Crank Test is considered positive if the patient’s pain is reproduced. The test may also produce an audible or palpable clicking in the glenohumeral joint. This clicking should be repeatable.

Inferior Instability Test.

1. Sulcus Sign

The test is usually easier with the subject in a sitting position with the arm to be tested relaxed. On the side to be tested one of the examiner’s hands stabilizes shoulder girdle on the side to be tested. The examiner firmly grasps the elbow of an arm to be tested. The examiner pulls down with the hand grasping the subject’s elbow. This test is considered positive if there is a significantly inferior movement of the arm relative to the shoulder and if a visible ‘sulcus’ or ‘step-off deformity’ is observed between the acromion and the humeral head. Pain and apprehension may or may not be present.

2. Feagin Test.

The patient will stand with the involved arm abducted to 90 degrees with the elbow extended and resting on the top of the examiner's shoulder so that the shoulder is completely relaxed. The examiner stands to face the involved side of the patient with the involved arm resting on his or her shoulder.  The examiner’s hands are clasped together and resting on the upper 1/3 of the patient’s humerus. The examiner makes sure that the shoulder musculature is relaxed and then the examiner uses his clasped hands to push the head of the humerus down and forward. A sulcus may be seen above the coracoid process or the patient may show apprehension to the test.

AcromioClavicular Test.

1. Piano Key Sign.

The patient is sitting with involved arm relaxed at the side Examiner applies pressure to the patient's distal clavicle in an inferior direction. Depression of the clavicle when pressure is applied and elevation of the clavicle when pressure is released then the test is positive

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2. O’Brien’s Test.

      The test is best performed with the patient in a relaxed sitting position but can also be performed in standing. The arm to be tested should be in 90 degrees of flexion and about 10 degrees of adduction. The patient then internally rotates the arm, pronating at the elbow and essentially pointing the thumb to the ground.

The examiner provides a downward force distally on the arm while the patient resists with an upward force. The examiner can also instruct the patient to simultaneously externally rotate the arm while the examiner resists this as well. The test is then repeated but with the arm in neutral rotation.

The test is considered positive if there is pain and/or clicking when the arm is in full internal rotation but not when the arm is in neutral rotation.

Biceps Tendon Test.

1. Speed's Test.

 The patient is sitting or standing with shoulder flexed to 90°, the elbow fully extended and the forearm supinated.Examiner places one hand on the patient's forearm and the other hand over the bicipital groove.Examiner resists the patient's attempt to actively flex the humerus forward. If there is tenderness and/or pain in the bicipital groove the test is positive.

2. Yergason Test.

 The patient is sitting or standing with the elbow flexed to 90° and forearm positioned so that the lateral border of the radius faces upward (neutral position) .Examiner stands on the involved side and places one hand on the patient's forearm and the other near the bicipital groove .Examiner resists the patient's attempt to actively supinate the forearm and externally rotate the humerus. If there is tenderness and/or pain in the bicipital groove the test is positive.