Part 4
SHOULDER EVALUATION
Special Tests (13)
 Biceps tendon tests (6)
 Impingement tests (3)
 Thoracic outlet tests (4)
Yeargason Test (LH biceps):
 Examiner begins by positioning the standing pt into 90
degrees of elbow flexion with the arm at the side
 Examiner uses one hand to palpate the long head of the
biceps and the other at the distal arm to provide
resistance
 Examiner then instructs pt to attempt to first externally
then internally rotate the shoulder as the examiner
resists the movement
 Test is positive for biceps tendon subluxation (and
subsequent tenosynovitis) if pt experiences pain or the
examiner notes palpable crepitus.
Gilcrest Test (LH biceps):
 Pt begins by grasping a 5-pound dumbbell in each hand
 Pt is then instructed to externally rotate the shoulder,
supinate the wrist, and raise both arms over head
 Pain or crepitus at or around the superior glenoid fossa is
a positive test that is indicative of tenosynovitis of the
long head of the biceps
 Pain or crepitus at or around the coracoid process is a
positive test that is indicative of tendinitis of the short
head of the biceps
 Important distinction between long head tenosynovitis
and short head tendinitis lies in the fact that only the
long head is protected by a tendon sheath
Speed’s Sign (LH biceps):
 Examiner first palpates the tendon of the
long head of the biceps (deep in the anterior
deltoid)
 Examiner then instructs pt to flex the elbow
as the examiner resists
 Pain indicates a positive sign for bicepital
tenosynovitis
Lippman’s Test (LH biceps):
 Pt begins with the elbow flexed to
90 degrees and the humerus
resting at the side
 Examiner palpates the long head
of the biceps and moves 3 inches
distally
 Examiner then rolls the biceps
tendon against the humerus
 Pain indicates a positive test for
long head biceps tendon
subluxation
Booth & Marvel (Transv. Hum.
Lig.) Test (LH biceps):
 Examiner passively abducts pt’s arm to 90 degrees and
then passively internally and externally rotates pt’s
shoulder
 At the same time, the examiner maintains pressure on
pt’s bicepital groove
 Pain or a popping sound or sensation is indicative of a
positive test for long head biceps tendon subluxation
Ludington’s Test (LH
biceps):
 Examiner instructs pt
to clasp the hands
overhead and
contract the biceps
isometrically
 Test is positive for
long head biceps
tendon subluxation if
pt experiences sharp
pain on contraction
Neer Impingement Test
(impingement):
 Examiner passively flexes pt’s arm into
complete flexion
 Pain indicates a positive test for subacromial
impingement syndrome
Hawkins-Kennedy Test
(impingement):
 Examiner passively positions pt’s shoulder in
90 degrees of flexion, 90 degrees of elbow
flexion, and end-range shoulder internal
rotation
 Apprehension or sensations of pain are
considered a positive test for subacromial
impingement syndrome
Jam Test (impingement):
 Examiner first abducts the standing pt’s arm to 90
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degrees and flexes the elbow to 90 degrees
Examiner then internally rotates pt’s arm so that pt’s
hand points toward the floor
Next, examiner rapidly and sharply pushes the pt’s elbow
with one hand to effectively drive the greater tuberosity
under the coracoacromial ligament
Examiner’s other hand should be used to stabilize the
shoulder
Test is positive for subacromial impingement syndrome if
pt experiences pain
Adson Test (thoracic outlet
syndrome):
 Examiner begins by palpating pt’s radial pulse
 Pt’s arm is then abducted, extended, and
externally rotated while the examiner continues
to palpate the pulse
 Pt is then instructed to take a deep breath and
turn the head toward the arm being tested
 A disappearance of the radial pulse is a positive
test that indicates a compression of the
subclavian artery by the medial scalene muscle
Allen Test (thoracic outlet
syndrome):
 Pt begins from a standing position
 Examiner passively flexes pt’s elbow to 90
degrees, then abducts and externally rotates
pt’s shoulder
 Examiner then palpates pt’s radial pulse and
instructs pt to look away from the side being
tested
 A disappearance of the radial pulse indicates
a positive test for thoracic outlet syndrome
Halstead Maneuver (thoracic
outlet syndrome):
 The examiner first palpates pt’s radial pulse
and applies a downward traction on the pt’s
arm being tested
 Examiner then instructs pt to rotate the head
to the opposite side and then extend the neck
and look at the ceiling
 A disappearance of the radial pulse indicates
a positive test for thoracic outlet syndrome
Provocative Elevation (Roos)
Test (thoracic outlet
syndrome):
 Examiner instructs pt to raise both hands
overhead and rapidly pump the hands 15-30
times
 Test is positive for vascular insufficiency
indicating thoracic outlet syndrome if the pt
experiences numbness, cramping, or tingling