Purpose: Glenohumeral Instability (anterior)
How to perform:
Pt laying supine
Examiner has 1 arm at the wrist and one cupping under the elbow. Standing on the inside of the elbow.
The shoulder is placed into 90° abd
Then the examiner brings shoulder into more and more external rotation
(+): pain or look of apprehension on the pt = Means: anterior glenohumeral instability
(-): no pain or look of apprehension on the pt = Means: no anterior glenohuemral instability
Purpose: Glenohumeral instability (anterior)
How to perform:
Pt laying supine
Examine has 1 arm at wrist and other hand cupping humerus head to apply a posterior translation
Pt already has arm in 90° abduction with elbow flexed to 90°
While applying the posterior translation, the examiner than places the shoulder into external rotation (ER) to see if it increases from the anterior apprehension test
(+): decreased/elimination of pain and/or increase of ER = Means: anterior glenohumeral instability
(-): no decrease/elimination of pain and/or increase of ER = Means: no anterior glenohuemral instability
Purpose: glenohumeral instability (ant/post)
How to perform:
Pt is laying supine on table
Examiner has the tested arm between their arm and body
Examiner then uses both hands to cup shoulder with thumbs by anterior side of humeral head
Examiner then performs an ant to posterior glide of the shoulder
(+): increase in laxity/shift = Means: anterior or posterior glenohumeral instability depending on the glide
(-): no increase in laxity/shift = Means: no anterior or posterior glenohumeral instability
Purpose: glenohumeral instability (inferior)
How to perform:
Pt relaxed and standing with arms to the side
Examiner has 1 hand find the tip of acromion process with thumb and other hand is holding the pt’s arm above the elbow
With the hand at the wrist, it pulls downward on the arm to see if the sulcus sign is present
(+): sulcus or dimple appears beneath the acromion as humerus is translated inferior = Means: inferior glenohumeral instability
(-): no sulcus or dimple appears beneath the acromion as humerus is translated inferior = Means: no inferior glenohumeral instability
Purpose: glenohumeral instability (inferior)
How to perform:
Pt is standing
Examiner comes to the front of the pt and then forward flexes the pt’s tested arm until 90°. The pt’s forearm will rest on the examiner’s shoulder
The tested shoulder that is in forward flexion should be straight all the way down to the wrist while resting on the examiner shoulder
The examiner will then make a tent with their hands on top/end of acromion
The pt is instructed to relax and examiner tries to push the capsule inferiorly with the tent they made with their hands around the pt’s shoulder
(+): increased laxity &/or pain = Means: inferior glenohumeral instability
(-): No increased laxity &/or pain = Means no inferior glenohumeral instability
Purpose: glenohumeral instability (posterior)
How to perform:
Pt laying supine
Pt has affected arm in 90° forward flx and slightly horizontally adducted with elbow flx 90°
Examiner has 1 hand holding the elbow and 1 hand holding wrist
Examiner will apply a axial load from the elbow and will also then internally rotate arm as the axial load is applied
(+): look of apprehension on pt and/or pain = Means: posterior glenohumeral instability
(-): no look of apprehension on pt and/or pain = Means: no posterior glenohumeral instability
Purpose: glenohumeral instability (posterior)
How to perform:
Pt is laying supine or sitting with arm abducted 90° with slight IR
Examiner has 1 hand stabilize scapula and the other hand holds the pt’s tested arm at the elbow
Examiner than applies a axial load to the glenoid fossa
With maintaining the axial loaded arm, the examiner brings the arm across body
(+): production of sudden jerk or clunk felt and/or pain = Means: posterior glenohumeral instability
(-): no production of sudden jerk or clunk felt and/or pain = Means: no posterior glenohumeral instability
Purpose: AC joint instability
How to perform:
Pt sitting
Examiner palpates where clavicle ends and AC joint starts
Examiner then applies a inferior force on bone/jt looking for spring back
(+): pain and/or spring back at the point of where the force is applied = Means AC joint instability
(-): no pain and/or spring back at the point of where the force is applied = Means no AC joint instability
Purpose: AC joint instability
How to perform:
Pt standing or sitting
Pt’s arms at side
Examiner has 1 hand at the AC joint and the other under the elbow
Examiner passively brings pt in 90° of forward flexion at the shoulder and then passively horizontal adducts arm
(+): recreation of pain @ AC joint = Means: AC joint instability
(-): no recreation of pain @ AC joint = Means: no AC joint instability
Purpose: AC Joint instability
How to perform:
Pt is sitting and relaxes
Examiner makes a tent with both hands around superior portion of shoulder
Examiner then squeezes clavicle and acromion together
(+): recreation of pain at AC joint = Means: AC joint instability
(-): no recreation of pain at AC joint = Means: no AC joint instability
Purpose: sternoclavicular joint instability
How to perform:
Pt laying supine or sitting
Examiner finds superior/medial part of clavicle
With the examiner’s thumb and index finger, they will push the clavicle inferiorly looking for spring back
(+): clavicle springs back up after test &/or pain is recreated = Means: SC joint instability
(-): clavicle doesn’t spring back up after test &/or no pain is recreated = Means: no SC joint instability
Purpose: sternocavicular joint instaiblity
How to perform:
Pt is standing with arms relaxed @ side
Examiner will have 1 hand hold the elbow and the other hand at the SC joint
Examiner then passively horizontally abducts tested arm
(+): recreation of pain @ sternoclavicular (SC) joint = Means: SC joint instability
(-): no recreation of pain @ SC joint = Means: no SC joint instability
Purpose: scapulothoracic joint instability
How to perform:
Pt is standing or sitting
Examiner has 1 hand holding the elbow and other hand at wrist.
Pt then goes under and behind their back with their shoulder to place hand on lower back
After they reach that position, they will be instructed to lift off back and try to maintain the position
(+): pt is unable to get their shoulder into the position and/or they are unable to maintain that position and/or recreation of pain = Means: ST joint instability
(-): pt is able to get their shoulder into the position and they are able to maintain that position and no recreation of pain = Means: no ST joint instability
Purpose: scapulothoracic joint instability
How to perform:
Pt stands with hand of test shoulder on top of pop shoulder. Elbow is flexed and out in front of pt at this point.
Examiner takes 1 hand to help stabilize the elbow. The other hand is then placed under the hand resting on the opposite shoulder
Examiner then tries to lift the pt’s hand off shoulder
Pt will fight the resistance and tries to push down back to shoulder
(+): elbow drops or recreation of pain = Means: ST joint instability
(-): elbow doesn’t drop and/or no recreation of pain = Means: no ST joint instability
Purpose: scapulothoracic joint instability
How to perform:
Pt is sitting out standing
Pt then places hand with thumb up on their stomach
Pt is instructed to press into their belly
Looking to see if their elbow drops to side when pushing into stomach
(+): elbow drops to the side = Means: ST joint instability
(-): elbow doesn’t drop to the side = Means: no ST joint instability
Purpose: rotator cuff pathology
How to perform:
Continuation of Impingement test. So pt is in full abduction with arms to their ears
Pt is instructed to slowly lower arms (performing adduction) in a controlled motion to return to anatomical position
Looking to see if pt drops arms really quick
(+): pt’s arms drop to the side quickly = Means: impingement/RC pathology
(-): pt’s arms are slowly lowered to the side = 1Means: no impingement/RC pathology
Purpose: supraspinatus muscle and/or tendon injuries
How to perform:
Pt stands with both shoulders in 90• scaption and thumbs are down to the ground
Examiner than places 1 hand on top of each of the pt’s forearm
Pt is then instructed to isometrically hold the position while the examiner places a downward resistance
(+): discrepancy of weakness in the tested shoulder and/or recreation of pain = Means: possible supraspinatus tear or sprain
(-): no discrepancy of weakness in the tested shoulder and/or recreation of pain = Means: no possible supraspinatus tear or sprain
Purpose: supraspinatus muscle and/or tendon injuries
How to perform:
Pt stands with both shoulders in 90• scaption and thumbs are up to the air
Examiner than places 1 hand on top of each of the pt’s forearm
Pt is then instructed to isometrically hold the position while the examiner places a downward resistance
(+): discrepancy of weakness in the tested shoulder and/or recreation of pain = Means: possible supraspinatus tear or sprain
(-): no discrepancy of weakness in the tested shoulder and/or recreation of pain = Means: no possible supraspinatus tear or sprain
Purpose: shoulder impingement
How to perform:
Pt is sitting or standing
Examiner has 1 hand holding underneath elbow, other hand is holding wrist
Examiner then flexes pt shoulder to 90° of forward flexion with the elbow at 90° of flexion as well
Examiner then brings the pt’s shoulder into internal rotation slow and controlled
Examiner can adduct shoulder across body while internally rotating the shoulder
(+): recreation of pain = Means: Shoulder impingement
(-): no recreation of pain = Means: Shoulder impingement
Purpose: Integrity of supraspinatus and infraspinatus or any tears of the 2 muscles and/or Shoulder impingement
How to perform:
Patient is standing or sitting
Arms by side, with 90° of elbow flx
Examiner has one hand under elbow and other hand is on dorsal side of hand.
Examiner brings pt’s arm in end of ER of the shoulder while still having elbow tight to body.
Examiner then let’s go of the wrist while still holding the elbow.
(+): pt unable to maintain position when examiner lets go and a lag (arm springs back anteriorly) = Means: supraspinatus or infraspinatus injury to muscle/tendon and/or shoulder impingement
(-): Pt is able to maintain position when examiner let’s go of the wrist = Means: no supraspinatus or infraspinatus injury tendon and/or shoulder impingement
Purpose: Subscapularis muscle/tendon strain or tears and/or shoulder impingement
How to perform:
Pt is standing or sitting
Examiner has 1 hand holding the elbow and other hand at wrist.
Pt then goes under and behind their back with their shoulder to place hand on lower back
After they reach that position, the examiner let’s go of the pt’s wrist while the examiner still holds pt’s elbow
(+): pt is unable to maintain position of keeping hand off back and a lag occurs bringing the hand back to the back after examiner let’s go of arm = Means: subscapularis muscle/tendon strain/tear and/or shoulder impingement
(-): Pt is able to to maintain position as examiner let’s go of shoulder = Means: no subscapularis muscle/tendon strain or tear and/or shoulder impingement
Purpose: Shoulder impingment
How to perform:
Pt is sitting or standing
Pt has arm in 90° scaption and elbow is flexed to 90°
Examiner has 1 hand under elbow and other hand on the dorsal side of pt’s hand
Pt is instructed to External rotate just the shoulder against resistance
(+): inability to lateral rotate arm and/or weakness of tested shoulder and/or recreation of pain = Means:shoulder impingement
(-): no inability to lateral rotate arm and/or no weakness of tested shoulder and/or no recreation of pain = Means: no shoulder impingement
Purpose: TOS(pec minor syndrome)
How to perform:
Pt is standing
Find radial pulse on 1 arm
Bring the tested shoulder into Abd 90° and elbow flexion of 90°.
Examiner then slowly ER the shoulder
Once the max ER is reached, have pt look away over the opp. shoulder.
(+): radial pulse disappears as test is performed = Means: Thoracic Outlet Syndrome/more specifically pec minor syndrome
(-): no radial pulse disappearance as test is performed = Means: no Thoracic Outlet Syndrome/more specifically pec minor syndrome
Purpose: TOS (anterior scalene syndrome)
How to perform:
Pt stands with arms in anatomical position at the side.
Examiner finds radial pulse on 1 arm
Bring pt’s shoulder in ER, slight abd, and slight extension.
Pt is then instructed to look up and towards tested arm.
Then have the pt hold their breath for a couple seconds.
(+): loss of radial pulse and/or reproduction of symptoms = Means: thoracic outlet syndrome/more specifically anterior scalene syndrome
(-): no loss of radial pulse or reproduction of symptoms = Means: no thoracic outlet syndrome/more specifically anterior scalene syndrome
Purpose: Labral tear/SLAP lesion
How to perform:
Pt is supine
1 hand supporting at the elbow. Other hand stabilizing at biceps
Examiner then provides an axial load to GH joint.
While the axial load is still applied, you will scouring by moving shoulder in circular pattern scouring around the rim.
(+): recreation of pain = Indicates labrum tear/SLAP lesion
(-): no recreation of pain = Means: no possible labrum tear/SLAP lesion
Purpose: TOS (costoclavicular syndrome)
How to perform:
Pt stands with shoulders rolled back, chest up, head looking forward, arms at side.
Exaimer then finds radial pulse on both arms from behind.
Examiner than ER arms and extends them
Examiner notes when pulse is lost
(+): radial pulse lost as test is performed = Means: thoracic outlet syndrome & possibly more specifically costoclavicular syndrome
(-): radial pulse isn’t lost as test is performed = Means: no thoracic outlet syndrome & possibly more specifically costoclavicular syndrome
Purpose: Labral tear/SLAP tear
How to perform:
Pt is sitting upright
Examiner is behind pt and holds affected arm at wrist with one hand. Other hand is applying anterior directed force on head of humerus
Pt’s arm position is 90° abd with 90° elbow flexion.
As the anterior force is applied, the examiner then abductes the pt’s arm from 90° to 150°.
(+): recreation of pain and/or clicking felt in post joint line = Indicates labral tear/SLAP tear
(-): no recreation of pain and/or clicking felt in post joint line = Indicates no labral tear/SLAP lesion
Purpose: Labral tear
How to perform:
Pt supine with arm abducted 90° and elbow at 90°
Examiner takes fist and places it under the head of humerus. Other hand supports the weight of the arm at the elbow.
Pt is then placed in near full abduction. Then the arm is slowly placed in external rotation (ER)
(+): recreation of pain and/or catching or clunk felt = Indicates labral tear
(-): no recreation of pain and/or catching or clunk felt = Means no labral tear
Purpose: Biceps tendinopathy.tendinitis
How to perform:
Pt standing with arms @ side in thumbs up with the hand.
Examiner palpates to find biciptal groove
Pt is instructed to straight arm raise with thumb up to the air
(+): recreation of pain @ biciptal groove = Indicates biceps tendinopathy/tendinitis
(-): no recreation of pain @ biciptal groove = Means no biceps tendinopathy/tendinitis
Purpose: Biceps Tendinopathy/tendinitis
How to perform:
Pt stands with arms to side, elbow flexed 90° with palms down (full pronation)
Examiner finds bicipital groove and places 1 hand there and the other is placed on the pronated hand
Pt is then instructed to supinated and ER their arm against resistance given will still keeping elbow to side
(+): recreation of pain @ biciptal groove = Indicates biceps tendinopathy/tendinitis
(-): no recreation of pain @ bicipital groove = Means no biceps tendinopathy/tendinitis
Purpose: Biceps rupture
How to perform:
Pt stands with arms behind head (almost like they are getting arrested).
Examiner comes from behind and places 1 hand on each bicep
Pt is then instructors to cx 1 bicep @ a time
(+): inability to cx biceps or examiner doesn’t feel muscle bump = Indicates biceps rupture
(-): pt can cx biceps and muscle bump is felt with cx = Means no biceps rupture
Purpose: Pec Major contracture, muscle differiential
How to perform:
Patient is laying supine
Pt flexes arm to 90° and then places arms behind head
Pt is then instructed to relax
Must watch the elbow if they drop or stay up
(+): elbows stay up and don’t drop as pt relaxes = Indicates pec major contractures
(-): elbows drop to the table as pt relaxes = Means no pec major contractures present
Purpose: Labral tear/SLAP lesion
How to perform:
Pt is sitting or standing
Pt’s arms in 90° forward flexion with thumbs down
Examiner places 1 hand on top of each arm.
Pt then tries to isometrically hold position as examiner applies downward force.
Same motion is repeated but palms are now up to the sky.
(+):
1. Pain with palm up position
2. Decreased pain with ER, supination
Indicates labrum tear/SLAP lesion
(-):
1. No Pain with IR horizontal add
2. No Decreased pain with ER, supination
Means: no labral tear/SLAP lesion
Purpose: shoulder impingement
How to perform:
Pt is sitting or standing and places tested shoulder’s hand on opposite shoulder.
Examiner has one hand on top of the tested shoulder and other at proximal part of tested shoulder
Pt is then instructed to isometrically hold while examiner applies downward resistance.
(+): weakness in tested shoulder and/or recreation of pain = Means:shoulder Impingement
(-): no weakness in tested shoulder and/or recreation of pain = Means: no shoulder impingement