Special Tests - Shoulder Complex PDF

Special Test Picture Tests For Positive Position of Patient Examiner Procedure...

Special Test Picture Tests For Positive Position of Patient Examiner Procedure Notes Marked apprehension w/ posterior (capsule) pain 1. Arm by side, passive lateral rotation of GH w/ arm @ 90 degrees 2. Move arm to 45˚ ABD; passive lat rot of the GH 3. Move arm to 90˚ ABD; passive lat rot of the GH Rockwood Test Anterior instability of GH or Seated Stands behind body 4. Move arm to 120˚ ABD; passive lat rot of the GH Position 3 is the most apprehensive position Some apprehension and some pain in any of the other positions Soon as there is a positive finding; do NOT continue to next position Apprehension and Pain 1. Hold pt wrist; passive abduction to 90˚; passive flx to 30˚ 2. place other hand over the prox humerus close to the humeral head Push Pull Test Posterior instability of GH or Supine Facing head 3. gradually, slowly, carefully apply levering pressure - push down on the humeral head while Provocative test pulling up at the wrist More than 50% posterior translation of humeral head Apprehension 1. Passively ABD the arm to 90˚ w/ an extended elbow 2. support the arm under the elbow or by placing the wrist on your shoulder Feagin Test Inferior instability of GH or Seated Stands beside body 3. place one hand over prox humerus b/w the middle and upper 1/3 (close to humeral head) 4. apply pressure to push the humeral head down and foward A sulcus sign observed above the coracoid 1. passive forward flx of arm to 90˚ 2. passive maximum medial rotation of arm The mvmnt of medial rot is through to compress the Subacromial impingement Hawkins-Kennedy (Supraspinatus involvement) Recreation of pain in the area of the subacromial space Seated or Standing Stands beside body supraspinatus tendon against the coracoacromial ligament & this is a sequential test - one position at a time coracoid process as soon as there is a positive finding - you stop the test Subacromial impingement 1. position tested arm in passive medial rot Thought to compress the humeral head against the inferior Neer Impingment Test (Supraspinatus or Biceps tendon involvement) Recreation of pain in the area of the subacromial space Seated or Standing Stands beside body 2. passive maximum elevation of the medially rotated arm in the scapular plane acromion Pain on the joint line 1. arm forward flx'd to 90˚ w/ elbow fully extended, arm horizontally adducted to 10-15˚ and or medially rotated to the thumb faces downward SLAP lesions over time generally lead to instability of the shoulder Labral lesion Active Compression Test of O'Brien SLAP (superior labrum anterior to posterior) Standing Stands beside body 2. in this position, apply an eccentric load, pushing the test arm down towards the hip and may also have clicking w/ use of the shoulder, especially Painful clicking produced inside the shoulder in the first position which 3. return to the start position and repeat the test, this time w/ the arm in lat rot so that the overhead is then decreased or eliminated in the second position indicates labral thumb faces up injury 1. tested arm is brought to 90˚ forward flexion This test may also caused localised pain of the SC jt, in which AC Horizontal Adduction Test AC joint lesion Localized pain over the AC joint Seated or Standing Stands beside body 2. either active or passive maximum horizontal adduction is then applied case, you would consider injury to the SC jt 1. patient is fully passive AC Shear Test AC joint separation Abnormal (excessive) movement and pain Seated Stands beside body 2. examiner places one hand on the spine of the scapula and the other hand on the clavicle, then squeezes their hands together providing a shearing force The patient is unable to retun the arm to the side slowly 1. Arm is passively abducted to 90˚ Rotator cuff strain Drop Arm Test usually involving supraspinatus or Standing Stands beside body 2. Patient is asked to slowly lower the arm back to the side in a controlled motion as the also known as Codman's Test examiner removes support of the arm Severe pain when attempting to do so 1. body stands w/ hand on L-spine 2. body is instructed to life the hand away from the back also known as Gerber's Test Subscapularis lesion Lift Off Sign usually a strain Inability to lift the hand away from the back Standing Stands behind body to observe 3. if able to life the hand from the back, the examiner applies gentle load to the hand to assess the strength of the subscapularis as well as to observe what the scapula does under Abnormal motion in the scapula - indicate scapular instability dynamic load This test would likely be positive in the presence of a SLAP lesion, 1. Test arm is brought to 90˚ of forward flexion w/ the elbow fully extended and the forearm Biceps Brachii Tendinopathy may wish to rule that out Speed's Test Particularly the prox. portion of the tendon Recreation of pain over the proximal portion of the biceps tendon Seated or Standing Stands beside or in front of body supinated 2. isometric resistance is placed on the distal forearm in the direction of extension Can do both supinated and pronated positions Weakness to resistance in the second position 1. arm is actively ABD in the frontal plane (side) to 90˚ abduction, isometric resistance is Supraspinatus lesion applied Empty Can Test Strain or Tendinopathy or Standing Stands beside or behind body 2. arm is then actively brought forward about 30˚ to be in the scapular plane and medially doing it one side at a time rotated so that the thumb points down (empty can), isometric resistance is applied Recreation of pain at the supraspinatus belly or tendon  Common abnormal findings Scapula moves before 30˚ - Capsular Fibrosis (Frozen Shoulder) SICK Scapula: Scapulothoracic function Should observe posteriorly 1. body is shown the plane of the scapula and the movement of scaption, which is full Scapular malposition a. Dysfunction in abduction T-spine side bend & shoulder elevation - Capsular Fibrosis Scapulohumeral Rhythm Test Standing & elevation in the plane of the scapula Inferior angle/inferior medial border prominence b. Impingment syndrome Scapula moves after 60˚ - serratus ant. underactive anteriorly 2. body actively goes through 8-12 reps of the movement of scaption Coracoid tendernes & malposition c. Adhesive capsulitis Scap elevates > Rotates - UT too active, serratus ant. underactive Scapular dysKinesia PT: Elbow flexed to 90, forearm pronated Pain & Sensation of tendon popping out One hand at wrist Yergason's Test Transverse Humeral Ligament Tear d/t loss of integrity of transverse humeral ligament Seated Other hand on bicipital tendon TH: Apply resistance while PT supinates, extends elbow, and ER humerus