Shoulder Orthopedic Tests

Shoulder Orthopedic Tests:

 

Shoulder Orthopedic Tests  / Shoulder Special Test:

Acromioclavicular Shear Test

Testing for:

the integrity of the acromioclavicular joint

Procedure:

– Client is seated. Therapist stands behind the client

– Place cupped hands over the client’s shoulder, the fingers interlaced. One palm on the clavicle, the other hand on the scapula

– Slowly squeeze the heels of the hands together

Positive Sign:

Pain or excessive movement of the acromioclavicular joint

Acromioclavicular Shear Test Video:


 

Shoulder Orthopedic Tests / Shoulder Special Tests:

Adhesive Capsulitis Abduction Test

Testing for:
Frozen Shoulder. Restricted motion at the shoulder caused by fibrosing and adhesion of the axillary fold of the inferior Glenohumeral Joint Capsule.

Procedure:

– Client is seated. Therapist stands behind the client

– Therapist palpates inferior angle of scapula and monitor its movement throughout the test

– With the therapist’s other hand, holding just above client’s elbow, slowly abduct the client’s humerus

– Therapist takes note of when the inferior angle of the scapula starts to move

Positive Sign:
Painful, leathery end feel before 90° of abduction

Frozen Shoulder Test Video:


 

Shoulder Orthopedic Tests / Shoulder Special Tests:

Adson’s Test

Testing for:
Neurovascular Compression (TOS) caused by the anterior scalene.

Procedure:

– Client is seated

– Passively extend and slightly externally rotate their affected arm

– Monitor their radial pulse

– Client rotates their head towards the affected side, slightly elevate their chin

– Client takes a deep breath and holds it from 15-30 seconds.

Positive Sign:
Client’s symptoms reoccur ( numbness, tingling in hands and fingers)or The client’s radial pulse diminishes.

Adson’s Test Video:


 

Shoulder Orthopedic Tests / Shoulder Special Tests:

Costoclavicular Syndrome Test

Testing for:
Neurovascular Compression (TOS) between the clavicle and Rib 1.

Procedure:

– Client is seated

– Monitor their radial pulse on the affected arm

– Passively depress and retract the shoulder of the affected arm

Positive Sign:
Client’s symptoms reoccur (numbness, tingling in hands and fingers)or The client’s radial pulse diminishes.

Costoclavicular Syndrome Test Video:


 

Shoulder Orthopedic Tests / Shoulder Special Tests:

 Drop Arm Test

Testing for:
the integrity of the rotator cuff, especially the supraspinatus muscle and tendon

Procedure:

– Client is seated

– Client actively abducts their humerus to 90° and keeps their arm in this position

– Client slowly and smoothly adducts their arm back

Positive Sign:
Pain or the Client cannot slowly and smoothly adduct their arm back to the side

 Positive Drop Arm Test Video:


 

Shoulder Orthopedic Tests / Shoulder Special Tests:

 Eden’s Test

Testing for:
Neurovascular Compression (TOS) between the clavicle and Rib 1.

Procedure:

– Client is standing

– Monitor their radial pulse on the affected arm

– Client depresses and retracts the shoulder of their affected arm

Positive Sign:
Client’s symptoms reoccur (numbness, tingling in hands and fingers)or The client’s radial pulse diminishes.

 Eden’s Test Video @time 3:00:


 

Shoulder Orthopedic Tests / Shoulder Special Tests:

Hawkin’s Kennedy Impingement Test

Testing for:
Overuse injury to the supraspinatus tendon

Procedure:

– Client is seated

-Client flexes their arm to 90° then internally rotates their humerus

Positive Sign:
Pain in the acromion / tendon area

Hawkin’s Kennedy Impingement Test Video:


 

Shoulder Orthopedic Tests / Shoulder Special Tests:

 Infraspinatus Strength Test

Testing for:
Tendonitis, Strain or Weakness of the Infraspinatus/ Teres Minor muscles

Procedure:

– Client is seated

– Client actively abducts their humerus to 90°

– Client flexes their elbow to 90°

– Therapist applies pressure into internal rotation, client resists and tries to externally rotate their humerus

Positive Sign:
Pain along infraspinatus or weakness

 Infraspinatus Strength Test Video:


 

Shoulder Orthopedic Tests / Shoulder Special Tests:

Middle Trapezius Strength Test

Testing for:
the strength of the middle trapezius muscle

Procedure:

– Client is prone

– Client affected shoulder to 90°

– Client externally rotates arm

– Client attempts to extend their affected arm then hold ( grade 3 strength)

– therapist stabilizes unaffected shoulder

– Client attempts to extend their affected arm as the therapist resists ( grade 5 strength)

Positive Sign:
The client’s cannot hold the arm in extension or cannot resist the therapist anteriorly directed pressure

Middle Trapezius Strength Test Video:


 

Shoulder Orthopedic Tests / Shoulder Special Tests:

 Neer Impingement Test

Testing for:
Overuse injury to the supraspinatus tendon

Procedure:

– Client is seated

– Passively flex their affected humerus through its range

Positive Sign:
Pain in the acromion / tendon area

 Neer Impingement Test Video:


 

Shoulder Orthopedic Tests / Shoulder Special Tests:

 Painful Arc Test

Testing for:
Impingement of the supraspinatus tendon and subacromial bursa beneath the acromion

Procedure:

– Client actively and slowly abducts their humerus through its entire range

Positive Sign:
Pain in the acromion area starting at 70° of abduction, and eases after 130°

 Painful Arc Test Video:


 

Shoulder Orthopedic Tests / Shoulder Special Tests:

Pectoralis Major Length Test

Testing for: the length of the pectoralis major muscle

– Client is supine

– Testing Clavicular Fibers:

o Client abducts shoulder to 90°

o Positive Sign: Arm does not drop below the table level

– Testing Sternal Fibers:

o Client abducts shoulder to 150°

o Positive sign: arm does not drop below the table level

Pectoralis Major Length Test Video:


 

Shoulder Orthopedic Tests / Shoulder Special Tests:

Pectoralis Minor Length Test

Testing for:
the length of the pectoralis minor muscle

Procedure:

– Client is supine, with their arms on their sides

– Therapist stands or sits at the head of the table

– Observe the client’s shoulder protraction

– ( Therapist may try to retract the affected shoulder)

Positive Sign:
The client’s affected shoulder is protracted or limited Range of shoulder retraction

Pectoralis Minor Length Test Video:


 

Shoulder Orthopedic Tests / Shoulder Special Tests:

Rhomboids Strength Test

Testing for:
the strength of the rhomboid muscles

Procedure:

– Client is prone

– Client affected shoulder to 90°

– Client internally rotates arm

– Client attempts to extend their affected arm then hold ( grade 3 strength)

– therapist stabilizes unaffected shoulder

– Client attempts to extend their affected arm as the therapist resists ( grade 5 strength)

Positive Sign:
The client’s cannot hold the arm in extension or cannot resist the therapist anteriorly directed pressure

Rhomboids Strength Test Video:


 

Shoulder Orthopedic Tests / Shoulder Special Tests:

Shoulder Adductors Length Test

Testing for:
the length teres major and latissimus dorsi muscles

Procedure:

– Client is supine

– Client flexes their hips and knees, and have their feet rest on the table

– Client fully flexes their arms above the head

Positive Sign:
The client’s arms are not able to reach and rest on the table

Shoulder Adductors Length Test Video:


 

Shoulder Orthopedic Tests / Shoulder Special Tests:

Speed’s Test

Testing for:
Biceps Tendonitis

Procedure:

– Client is seated

– Client completely extends their elbow then supinates their arm

– Therapist stabilizes at the shoulder

– Client attempts to flex the elbow while Therapist holds client’s forearm and applies resistance

Positive Sign:
Pain at the biceps tendon area during resistance

Speed’s Test Video:


 

Shoulder Orthopedic Tests / Shoulder Special Tests:

Subscapularis Strength Test

Testing for:
Tendonitis, Strain or Weakness of the Subscupularis muscle

Procedure:

– Client is seated, their affected arm at their side

– Client flexes their elbow to 90°

– Therapist applies pressure in external rotation, client resists and tries to internally rotate their arm

Positive Sign:
Pain along the subscapularis or weakness

Subscapularis Strength Test Video:


 

Shoulder Orthopedic Tests / Shoulder Special Tests:

Supraspinatus Strength Test (Empty Can Test)

Testing for:
Tendonitis, Strain or Weakness of the Supraspinatus muscle

Procedure:

– Client is seated

– Client actively abducts their humerus to 90°

– Client adducts their humerus to 30°

– Client internally rotates their humerus

– Therapist applies pressure in adduction, client resists

Positive Sign:
Pain along the supraspinatus or weakness

Supraspinatus Strength Test (Empty Can Test) Video:


 

Shoulder Orthopedic Tests / Shoulder Special Tests:

Travel’s Test

Testing for:
Neurovascular Compression (TOS) caused by the middle scalene.

Procedure:

– Client is seated

– Passively extend and slightly externally rotate their affected arm

– Monitor their radial pulse

– Client rotates their head away from the affected side

– Client takes a deep breath and holds it from 15-30 seconds.

Positive Sign:
Client’s symptoms reoccur ( numbness, tingling in hands and fingers)or The client’s radial pulse diminishes.

Travel’s Test Video:


 

Shoulder Orthopedic Tests / Shoulder Special Tests:

ULTT1 ( Upper Limb Tension Test 1)

Testing For:
C5, C6, C7 nerve roots and median nerve as the source of the client’s painful shoulder and arm

Procedure:

– Client is supine , with their side being tested at the edge of the table

– Apply a depressive force to the client’s affected shoulder

– With your other hand, hold the client’s wrist and Abduct their affected humerus to 110°

– Extend their arm to 10° below the coronal plane and, to 60° of external rotation

– Slowly extend their wrist and fingers

– Fully supinate their forearm then slowly extend their elbow

– ( you may flex their neck laterally to the opposite side if the above does not show up positive)

Positive Sign:
Recurrence of their shoulder and arm pain.

ULTT1 ( Upper Limb Tension Test 1) Video:


 

Shoulder Orthopedic Tests / Shoulder Special Tests:

ULTT2 ( Upper Limb Tension Test 2)

Testing For:
the Median nerve, Musculocutaneous Nerve, and Axillary Nerve as the source of the client’s painful shoulder and arm

Procedure:

– Client is supine, with their side being tested at the edge of the table

– Apply a depressive force to the client’s affected shoulder

– With your other hand, hold the client’s wrist and Abduct their affected humerus to 10°

– Slowly extend their wrist and fingers

– Fully supinate their forearm then slowly extend their elbow

Positive Sign:
Recurrence of their shoulder and arm pain.

ULTT2 ( Upper Limb Tension Test 2) Video:


 

Shoulder Orthopedic Tests / Shoulder Special Tests:

ULTT3 ( Upper Limb Tension Test 3)

Testing For:
the Radial nerve as the source of the client’s painful shoulder and arm

Procedure:

– Client is supine , with their side being tested at the edge of the table

– Apply a depressive force to the client’s affected shoulder

– With your other hand, hold the client’s wrist and Abduct their affected humerus to 10°

– Slowly flex their wrist and fingers, then deviate the wrist to the ulnar side

– Fully pronate their forearm then slowly extend their elbow

Positive Sign:
Recurrence of their shoulder and arm pain.

ULTT3 ( Upper Limb Tension Test 3) Video:


 

Shoulder Orthopedic Tests  / Shoulder Special Tests:

ULTT4 ( Upper Limb Tension Test 4)

Testing For:
C8 and T1 nerve roots and ulnar nerve as the source of the client’s painful shoulder and arm

Procedure:

– Client is supine , with their side being tested at the edge of the table

– Apply a depressive force to the client’s affected shoulder

– With your other hand, hold the client’s wrist and Abduct their affected humerus to 90°

– Slowly flex their elbow, then supinate their forearm

– Slowly extend their wrist and fingers and deviate the wrist to the radial side.

Positive Sign:
Recurrence of their shoulder and arm pain.

ULTT4 ( Upper Limb Tension Test 4) Video


 

Shoulder Orthopedic Tests  / Shoulder Special Tests:

Wright’s Hyperabduction Test

Testing for:
Neurovascular Compression (TOS) caused by the pectoralis minor.

Procedure:

– Client is seated

– Passively abduct their affected arm to 180°, then slightly extend the arm.

– Monitor their radial pulse on the abducted arm

Positive Sign:
Client’s symptoms reoccur ( numbness, tingling in hands and fingers)or The client’s radial pulse diminishes.

Wright’s Hyperabduction Test Video:


 

Shoulder Orthopedic Tests  / Shoulder Special Tests:

Yergason’s Test

Testing for:
the stability of the biceps tendon and integrity of the transverse humeral ligament

Procedure:

– Client is seated

– Therapist’s one hand stabilizes the client’s elbow against the client’s body

– Therapist’s other hand applies resistance as the client actively supinates their forearm, extends their elbow, and externally rotates the humerus

Positive Sign:
Pain at the area of the bicipital groove

Yergason’s Test Video: