Lecture #58 – The Shoulder: Special Tests
Special tests
Categories
 Ligamentous
 Stability tests

Pathology
 Biceps tendon
 Labral Tear
 Impingement
 Neurovascular
Ligamentous tests
Piano key test
 Patient position: standing or seated
 Examiner position: anterior or lateral to patient
 Examiner action:
o Hand #1 – gentle stabilization of humeral
head
o Hand #2 –
of
clavicle (piano key)
 Positive: excessive motion at AC joint, pain, ↑ in
symptoms
 Pathology: AC ligament sprain
 Modification: “Tap” on clavicle (Fx Test)
AC shear/compression test
 Patient position: standing or seated w/arm at side
 Examiner position: lateral to patient
o Hands – cupping the AC joint with
interlocking fingers
 Heel on distal clavicle with fingers
over the AC
 Heel on scapular spine with fingers
over the AC
 Examiner action: gentle squeezing heels together
 Positive: excessive
at AC joint, pain,
↑ in symptoms
 Pathology: AC ligament sprain
Apprehension test
 Patient position: supine (edge of table)
o GH Joint
to 90° & elbow flex to 90°
 Examiner position: lateral to patient
o Hand #1 – distal humerus or elbow
o Hand #2 – distal forearm or wrist
 Examiner action:
o Support shoulder at 90° ABD
o Slow
rotation of shoulder
 Positive: look or action of apprehension by patient
o Pain centered in anterior shoulder
 Pathology: Anterior capsule, ligaments, or labrum
injury
o Humeral head has potentially previously
o Do NOT perform if assessment is obvious
Relocation test
 Patient position: supine (edge of table)
o Shoulder at 90° ABD, and elbow flex to 90°
Notes

Examiner position: lateral to patient
o Hand #1 – distal humerus or elbow
o Hand #2 – distal forearm or wrist
 Examiner action:
o Slow ER of shoulder until pain or
apprehension is felt
o
is applied to
anterior humeral head
 Positive: apprehension ↓ with posterior force
 Pathology: GH ligament sprain (anterior) or capsular
laxity
Stability tests
Sulcus sign
 Patient position: standing or seated w/arm at side
 Examiner position: anterolateral to patient
 Examiner action:
o Hand 1 – Supporting scapula
o Hand 2 – firm traction of distal humerus
 Positive: gapping between
and
humeral head
o Just humeral head moves in this test
 Pathology: GH ligament and/or capsule sprain
(superior)
Wall push-up test
 Patient position: standing arm’s length from wall
 Examiner position: posterior & lateral to patient
 Patient action:
o Patient performs push-ups against wall
o Younger & stronger patients may perform
normal push-ups
 Positive:
border of scapula lifts off
the thorax
o Usually in 5-10 reps
 Pathology:
muscle weakness
o Long Thoracic Nerve Injury
Rotator cuff pathology tests
Drop arm test
 Patient position: standing or seated
 Examiner position: anterior or lateral to patient
 Patient action: passive shoulder ABD
o Can perform actively
 Examiner action:
o Asks patient to slowly lower arm (added
resistance as needed)
 Positive: inability to return arm to side slowly or
severe pain
 Pathology: Tear of the rotator cuff
o Usually
tendon
Full can test
 Patient position: standing or seated
 Examiner position: anterior to patient
 Patient action:
o ABD to 90° in the plane of the scapula
w/examiner resistance
o
Lecture #58 – The Shoulder: Special Tests

Examiner action:
o Isometric manual resistance to ABD
 Positive: weakness and/or pain with resistance
 Pathology: supraspinatus impingement, strain, or
inflammation
Gerber lift-off test
 Patient position: standing with dorsum of hand on
lumbosacral joint
 Examiner position: lateral to patient
 Patient action:
o Active IR of arm
(“
”)
 Positive: weakness and/or pain with inability to lift
hand off back
 Pathology:
strain/weakness
Biceps tendon tests
Speed’s test
 Patient position: standing/sitting in anatomical
position (palms forward)
 Examiner position: anterior or lateral to patient
o Hand #1 – stabilize shoulder w/palpation of
bicipital groove
o Hand #2 – distal and anterior forearm
 Action: resist active
of shoulder
 Positive: pain and/or tenderness at bicipital groove
 Pathology: biceps tendinitis (tenosynovitis)
Labral tests
O’Brien’s test
 Patient position: seated or standing
o GH joint flexed to 90o and Horiz. ADD 15o
from front
o Full humeral
and pronated forearm
 Examiner position: anterior to patient
o One hand place over superior aspect of
patient’s distal forearm
 Examiner Action:
o Pushes downward on forearm
o Test repeated with humerus ER and forearm
supinated
 Positive: Pain experienced with arm in
but is ↓
during
 Pathology: labral tear (
)
Impingement tests
Neer impingement test
 Patient position: seated or standing in anatomical
position (palms forward)
 Examiner position: anterolateral to patient
o Hand #1 – stabilize posterior shoulder
o Hand #2 - forearm
 Action: forearm pronation, IR & forced passive
of shoulder
 Positive: pain, apprehension by patient, inability to
move, etc.
 Pathology:
(supraspinatus, subacromial bursa, biceps tendon)
Notes
Hawkins-Kennedy test
 Patient position: seated or standing in anatomical
position (palms forward)
 Examiner position: anterolateral to patient
o Hand #1 – distal humerus/elbow
o Hand #2 – distal forearm
 Action:
o Passive flexion of shoulder and elbow to 90°
o Followed by forced
 Positive: pain, apprehension by patient, inability to
move, etc.
 Pathology: impingement syndrome
Neurovascular tests
Brachial plexus stretch test
 Patient: seated and relaxed
 Examiner: standing anterior to patient
 Action: examiner forces
and
shoulder depression
o Hand #1 side of head
o Hand #2 lateral aspect of shoulder
 Positive: reproduction or ↑ in Sx & Sy (pain) to side
being stretched
 Pathology: brachial plexus lesion
o Pain on side compressed =
nerve
 Do not perform if cervical fracture or dislocation is
suspected
Roo’s test
 Patient position: standing looking forward
 Examiner position: Posterior to patient
 Patient Action:
o ABD to 90˚, Elbow flexed to 90º (90-90
position)
o
hands slowly for
3 minutes
 Positive: Unable to maintain position, suffers pain,
weakness of arm, numbness, tingling
 Pathology:
Syndrome
o Compression of artery between clavicle and
first rib
Stretch reflexes
 Strike the tendon with a reflex hammer
o Use your thumb to protect the tendon and
focalize the force of the hammer
 Observe for the stretch reflex
 Repeat 3-6 times for consistency
o Biceps brachii reflex
o
reflex
o Triceps brachii reflex