Adson's test

Tests for-TOS

• locate the radial pulse
• Pts. head rot. to face test shld.
• pt. then ext. head while examiner laterally rotates and extend shld.
• Pt. inst. to take deep breath and hold

Disappearance of pulse indicates positive test

Costoclavicular Syndrome (Military Brace) Test

Tests for or implies TOS

• Palpate radial pulse and draw pts. shld down and back

Positive test indicated by an absence of the pulse

(Particuarly effective in pts. who complain of symptoms while wearing backpack or heavy coat

Hyperabduction (Wright Test or Maneuver)

Test done to detect compression in the costoclavicular space

• Hyperabduct arm so that the hand is brought over the head with the elbow and arm in the coronal plane.
• Take a breath or rot. or ext the head and neck to have additional effect
• Do test in sitting and then sup.

Pulse palpated for differences

ROOS East Test

Tests for TOS

• Pt stands and abducts arms to 90 degrees
• ER shld. and flex elbows to 90 degrees so that elbows are slightly begind frontal plane
• Pt. opens and closes the hands slowly for 3 min.

Positive test if pt. suffers from ischemic pain, heaviness or profound weakness of the arm, numbness and tingling of the hand during the 3 min.

Neer's Test

Test for Impingement

• Abduction in the scapular plane
• IR at 180 degrees

This causes jamming of the greater tuberosity against the anteroinferior border of acromion.  Positive test will show trhough pain.  Indicative of an overuse injury to the supraspinatus muscle and sometimes bicipital tendon.

Hawkin's test

Test for Impingement

• Pt stands while examiner flexes arm to 90/90.
• IR shld at different spots in the horizontal plane

This movement pushes the supraspinatus tendon against the ant. surface of the coracoacromial ligament and coranoid process.

Pain indicates a positive test for supraspinatus tendinitis.

Reverse Impingement Sign

Test for mechanical impingement.  Used if pt. has a positive painful arc or pain on ER.

• Pt. supine
• Abduct the arm to point of impingement and distract and inf.glide

Test is positive for mechanical impingement if the pain decreases or disappears with distraction and inf. glide.

Drop Arm Test

Test for integrity of rotator cuff

• Examiner abducts the pt shld. to 90 degrees
• Ask the pt. to slowly lower the arm to the side

Positive test indicated if the pt. is unable to return the arm to the side slowly or has severe pain when attempting to do so.  Indiccates a tear in the rotator cuff complex.

Speed's Test

(Bicep or Straight Arm Test)

Test for Bicipital Tendonitis

• Palpate long head of bicipital tendon
• Examiner resists shld. flex. with forearm first supinated, then pronated and the elbow completely extended.

Postive test elicits increased tenderness in the bicipital groove and is indicative of bicipital tendinitis.

Yergason's Test

Test for Bicipital stability

• Palpate long head Bicipital tendon
• Pts. elbow flexed to 90 degrees and stabilized against the thorax, forearm pronated.
• Resist supnation while the pt. also ER the arm against resitance.

Positive result is tenderness in the bicipital groove or tendon may pop out of the groove and is indicative of bicipital tendonitis.

Empty Can Test

(Supraspinatus Test)

Test for Supraspinatus involvement (Tear or neuropathy of suprascapular nerve)

• Scap. plane abduct the shlds. to 90 degrees first with palm down and resist
• now with thumbs down and resist

Examiner looks for weakness or pain reflecting a positive test, which indicates a tear of the supraspinatus tendon or muscle, or neuropathy of the suprascapular nerve.

Lift Off Sign

Test for Subscapularis involvement

• Pt stands and places sorsum of hand on the back pocket
• Pt. then lifts the havd away from the back

Inability to do so indicates a lesion of the subscapularis muscle.  Abnormal motion in the scapula during the test may indicate scapular instability.

Medial border winging of the scapula during the test may indicate that the rhomboids are affected.

Scapular Slide Test

Tests for Scapular Stability , restriction

• The clinician measures from T3 spinous process to spine of scap or T7 spinous process to inf angle of scap with arms at side
• Clinician then measures in two or four other positions; hands on hips (45 degees abd.), 90 degrees abd with IR, 120degrees abd, and 150 degrees abd.
• Each position shoud not vary more than .5 to .75 inches from original measure

Load and Shift Test

Labral Integrity

Translation of 25% or less is normal.  (25%-50%) grade 1 riding up to glenoid rim, (>50%) grade II overriding the rim but spontaneously reduces, and (>50%) grade III remains dislocated

• Pt. sits with no back support and hand resting on thigh
• Examiner is behindpt. and stabilizes shld. with one hand over scap and clavicle
• Other hand grasps the humeral head and gently pushes into the glenoid to seat it properly in the fossa.
• Examiner then pushes the head ant. or post noting amt. of translation

Cross Over Horizontal Adduction

Impingement test

• Pt's. arm at 90 degrees of flex.
• Clinician passively moves pts. arm into horizontal add. and applies overpressure.

Apprehension (Crank) Test

Test for ant. shoulder dislocation

• Examiner abd. arm to 90 degrees and ER shld slowly

A positive test is indicated by a look or feeling of apprehension or alarm on pts. face and resistance to further motion.  IMPORTANT that this is done slowly.

Fulcrum Test 

Test for Anterior instability

• Supine, arm abducted to 90 degrees
• Examiner places one hand under the glenohumeral jnt. to act as a fulcrum
• Examiner then extends and ER the arm hently over the fulcrum

Positive test for ant instability is a look of apprehension by the pt.

Obrien Test

(Active Compression)

Detects Labral deformity (2-part test)

• Pts. arm add. 10 degrees in front of chest with 90 degrees flex. and IR.
• Pt. resists a downward force applied by the clinician to distal arm.
• Repeat test with arm maximally in ER.

Test is positive for a glenoid labral tear if pt. reports pain deep inside shld. with resisted flex. and relieved by ER.

Relocation Apprehension Test

• After the Apprehension (Crank) Test the examiner can then apply posteriro stress to the arm, the pt. loses the apprehension, pain decreases and further lateral rotation is possible before the apprehension returns.

Test is considered positive if pain decreases during the maneuver, even if there was no apprehension

Sulcus Sign

Test for inferior instability

• Pt. seated, shld at side and muscles relaxed.
• Examiner grasps the pts. forearm below the elbow and pulls the arm distally

Presence of a sulcus sign is indicative of inf. instability. 

+1 sulcus sign-distance of less than 1 cm

+2, 1 to 2 cm and +3 more than 2 cm.

Clunk Test

Test for tear of the labrum

• Pt. supine examiner places on hand on the post. aspect of the shld. over the humeral head
• Examiners other hand holds humerus above the elbow and fully abd. the arm over pt. head.
• examiner then pushes ant. with the hand over the head wild the other hand rotates the humerus into ER.

A clunk or grinding sound indicates a post. test and is indicative of a tear of the labrum.