Special tests of the shoulder joint Tests for muscles & tendons pathology: 1. Yergason's test: Aim of the test: Identifies the integrity of transverse ligament & bicipital tendonitis. Patient position: Patient is sitting with shoulder in neutral stabilized against trunk, elbow at 90°, & forearm pronated. The therapist resists supination of forearm & external rotation of shoulder Positive sign: Tendon of biceps long head will "pop out" of groove & pain on long head of biceps tendon. Bicipital tendonitis Lesion of te | tong ead of tleeps rach 2. Speed’s test (Biceps straight arm) ‘Aim of test: Identifies bicipital tendonitis Patient position: Patient sitting or standing with upper limb in full extension & forearm supinated. The therapist resists shoulder flexion. May also place shoulder in 90° flexion & push upper limb into extension causing eccentric contraction of biceps Positive sign: Pain in long head of biceps tendon. is Practical Part), BMC PTI 23 ‘Special Tests Alljoints (Musculaskeletal PTL Scanned by CamScanner3. Drop arm test: Aim of test: Identifies tear &/or full rupture of rotator cuff Patient position: Patient sitting with shoulder passively abducted to 120°. Patient is instructed to slowly bring arm down to side .Guard patient's arm from falling in case it gives way. Positive sign: Patient unable to lower arm back down to side Rotator cuff muscles 4, Empty can test: ‘Aim of test: Identifies tear &/or impingement of supraspinatus tendon or possible suprascapular nerve neuropathy. Patient position: Patient sitting with shoulder at 90° & no rotation. Resist shoulder internal rotation abduction. Then place shoulder in "empty can" position, which i and 30° forward (horizontal adduction), the patient’s thumb point down to the floor, and resist abduction. Differentiate if pain present between two positions. Another test with thumb up “full can” is best for maximum contraction of supraspinatus & resist abduction. Positive sign: Reproduces pain &/or weakness in supraspinatus tendon. ‘Special Tests All joints (Musculoskeletal PTI, Practical Part), BMC, PT II Scanned by CamScanner5, Lift-off test: identify tear/weakness of subscapularis muscle & scapula instability. Aim of the te: Patient position: Patient stands & places the dorsum of the hand against the mid lumbar spine. Then the patient lifts his hand away from the back. If the patient is able to take the hand away from the back, the examiner should apply a load pushing the hand toward back to test the strength of the subscapularis and test how the scapula acts under dynamic loading. Positive sign: Inability to move the dorsum off the back indicates subscapularis rupture or dysfunction 6. Belly-Press (abdominal compression) test: Aim of the test: Identify tear/weakness of subscapularis muscle; especially if patient can’t medially rotate the shoulder behind his back. Patient position: The examiner put his hand on patient's abdomen to feel the contraction; patient put his hand of the tested shoulder on examiner’s hand & push as hard as he can. ji While pushing the patient attempt to bring elbow forward causing greater medially shoulder rotation. Positive sign: Inability to maintain the pressure on examiner's hand while moving elbow forwards. 25 ‘Special Tess Al joints (Musculoskeletal PTI, Practical Part), BMG PTI Scanned by CamScannerTests for impingement: . Neer test: Aim of the test: Identify impingement of supraspinatus tendon or long head of biceps Patient position: Patient silting & shoulder is passively internally rotated & fully abducted. Positive sign: Reproduce symptoms of pain within shoulder region 2, Hawkins-Kennedy test: ‘Aim of the test: Identify impingement of rotator cuff Patient position: Patient is sitting with arm flexed at 90° & elbow flexed to 90°, the examiner then stabilizes proximal to the elbow with their outside hand and with the other holds just proximal to the patient's wrist. Then passively move the arm into internal rotation. Positive sign: Pain in the sub-acromial space 26 Special Tests All joints (Musculoskeletal PTI, Practical Part), BMC, PT Il Scanned by CamScanner3. Posterior internal impingement test: ‘Aim of the test: Identifies an impingement between rotator cuff & greater tuberosity or posterior glenoid and labrum. Patient position: Patient supine and move shoulder into 90° abduction, maximum external rotation, and 15°-20° horizontal adduction. Positive sign: Reproduction of pain in posterior shoulder during test Tests for shoulder instability: 1. Anterior apprehension (Crank) test: Aim of the test: Identifies past history of anterior shoulder dislocation Patient position: Patient supine with shoulder in 90° abduction. Slowly take shoulder into external rotation. Positive sign: Patient does not allow and/or does not like shoulder to move in direction to simulate anterior dislocation. 27 ictical Part), BMC PTI Special Tests Alljoints (Musculoskeletal P' Scanned by CamScanner2. Posterior apprehension test: Aim of the test: Identifies past history of posterior shoulder dislocation. Patient position: Patient supine with shoulder elevated 90° (in plane of scapula) with scapula | stabilized by table. Place a posterior force through shoulder via force on patient's elbow while simultaneously moving shoulder into medial rotation and horizontal adduction. Positive sign: Patient does not allow and/or does not like shoulder to move in direction to simulate posterior dislocation. 3. Anterior/Posterior drawer test of shoulder: Aim of the test: Identify laxity or insufficiency of the anterior/posterior capsular mechanism Patient position: Patient is supine the affected shoulder is abducted at 80-120°, 20° flexion & 30° external rotation. The examiner holds the patients scapula spine forward with his index and middle fingers; the thumb exerts counter pressure on the coracoid. The scapula is fixed. The examiner uses his right hand to grasp the patient's relaxed upper arm and draws it anteriorly/posteriorly with a force Positive sign: Gliding of the hummers. Click may indicates labral tear Scanned by CamScanner4, Sulcus sign: Aim of the test: Identifies inferior shoulder instability or glenohumeral laxity Patient position: Patient is sitting with his arm in neutral position, the examiner pulls downward on the elbow while observing the shoulder area for a sulcus or depression lateral or inferior to the acromion. Positive sign: depression lateral or inferior to the acromion Tests for labral tea 1. Clunk test: Aim of the test: Identifies a glenoid labrum tear. Patient position: Patient supine with shoulder in full abduction. Push humeral head anterior while rotating hummers externally. Positive sign: Audible "clunk" is heard while performing test. 2. SLAP Prehension test: Aim of the test: Identify SLAP lesion (superior labrum, anterior posterior) Patient position: patient is sitting/standing, arm is abducted 90°, elbow extended & forearm pronated (thumb down). Ask the patient to horizontally adduct the arm, repeat the movement with supination (thumb up). If pain felt in the bicipital 29 ‘Special Tests All joints (Musculoskeletal PTI, Practical Part), BMC, PT II Scanned by CamScannerfF groove in the first case (pronation) & is lessened or absent in the second case (supination), the test is considered positive for a SLAP lesion. Positive sign: Pain in bicipital groove during supination. Tests for Thoracic Outlet Syndrome 1. Adson's test: Aim of the test: Identifies pathology of structures that pass through thoracic inlet. Patient position: Patient sitting & find radial pulse of extremity being tested. Rotate head towards extremity being tested then extend & externally rotate the shoulder while extending head. Positive sign: Neurologic and/or vascular symptoms (disappearance of pulse) will be reproduced in upper limb (UL). Thoracic Outlet Syndrome on Scanned by CamScanner2. Costoclavicular syndrome (military brace) / Edens? test: Aim of the test: Identifies Pathology of structures that pass through thoracic inlet, Patient position: Patient sitting and find radial pulse of the extremity being tested. Move involved shoulder down and back. Positive sign: Neurologic and/or vascular symptoms (disappearance of pulse) will be reproduced in UL. 3. Wright (hyperabduction) test: Aim of the test: Identifies pathology of structures that pass through thoracic inlet. Patient position: Patient sitting and find radial pulse of extremity being tested. Move shoulder into maximal abduction and external rotation. Taking deep breath and rotating head opposite to side being tested may accentuate symptoms. Positive sign: Neurologic and/or vascular symptoms (disappearance of pulse) will be reproduced in UL. 4, Roos elevated arm / EAST (elevated arm stress test) test: Aim of the test: Identifies pathology of structures that pass through thoracic inlet. Patient position: Patient standing with shoulders fully extemally rotated, 90° abducted, & slightly horizontally abducted. Elbows flexed to 90° and patient opens/closes hands for three minutes slowly. Positive sign: Neurologic and/or vascular symptoms (disappearance of pulse) will be reproduced in UL. Scanned by CamScannerSpecial tests of the elbow joint / 1. Ligament instability tests (valgus & varus stress tests): as of the test: Identifies collateral ligaments laxity o restriction. cane Position: Patient is sitting or supine. Entire upper limb is supported & Stabilized and elbow placed in 20°-30° of flexion, Valgus force placed through elbow tests ulnar collateral ligament. Varus force placed through elbow tests radial collateral ligament Positive sign: Primary finding is laxity, but pain may be noted as well. 2. Tests for epicondylitis: Aim of the test: To identify lateral or medial epicodylitis A. Lateral epicondylities/Tennis Elbow (Cozen) Test: Patient position: Patient is sitting with elbow in 90° & supported, resist wrist extension, wrist radial deviation & forearm pronation with fingers fully flexed (fist) simultaneously. B. Medial epicondylities/Golfer Elbow test Patient position: Patient is sitting with elbow in 90° & supported, passively supinate forearm, extend elbow & wrist. Positive sign: Pain at Lateral epicondyle for tennis elbow & at medial epicondyle for golfer elbow Special Tests All joints (Musculoskeletal PTI, Practical Part), BMC PT I 32 Scanned by CamScannerLateral Epicond ylitis =| Medial Epicondylitis _Cennis Elbow) oC Golfer's Elbow) Mend Mteshop® o: Cozen's test 2 Yoww.os te ofisioluciant Emanuele Luciani, MOst, BSc Physiotherapy 3. Pronator teres syndrome test: ‘Aim of the test: Identifies a median nerve entrapment within pronator teres. Patient position: Patient sitting with elbow in 90° flexion & supported. Resist forearm pronation and elbow extension simultaneously. Positive sign: Reproduces a tingling or paresthesia within median nerve distribution. ES ‘Cnantal Peete All ininte (Muceuslackelatal PTL. Practical Part). BMC PIL 33 Scanned by CamScanner4. Tinel's sign: Aim of the test: Identifies dysfunction of ulnar nerve at olecranon. Patient position: patient is sitting, tap region where the ulnar nerve passes through cubital tunnel. Positive sign: Reproduces a tingling sensation in ulnar distribution. TT Scanned by CamScannerSpecial tests of the wrist & hand 1. Finkelstein test: (De Quervain' Aim of the test: Identifies De-Quervain's tenosynovitis | Tenosynowie (paratendonitis of the abductor pollicis longus and/or extensor pollicis brevis). Patient position: Patient makes fist with thumb within confines of fingers. Passively move wrist into ulnar deviation. Pe no pathology, so compare to uninvolved side. ive sign: Reproduces pain in wrist. Often painfull with 2. Bunnel-Littler test: ‘Aim of the test: Identifies tightness in structures surrounding the MCP joints. Patient position: MCP joint is stabilized in slight extension while PIP joint is flexed, Then MCP joint is flexed and PIP joint is flexed. Positive sign: Differentiates between a tight capsule and tight intrinsic muscles. If flexion is limited in both cases capsule is tight. If more PIP flexion with MCP flexion then intrinsic muscles are tight. 3. Froment's sign: with INo increase in PIP flexion |Full PIP flexion with MCP | IMCP flexion implies ‘ith MCP flexion implies Jextension is a normal for PIP restriction intrinsic restriction |(negative) test finding Practical Part), BMG PT Il 35 ‘Special Tests Alloints (Musculoskeletal PTI Scanned by CamScannerAim of the test: Identifies ulnar nerve dysfunction. ent Hane . . Patient position: Patient grasps paper between 1° & 2™ digits of hand. Pull paper it and look i out look for IP flexion of thumb, which is compensation due to weakness of adductor pollicis. Positive sign: Patient unable to perform test without compensating may indicate ulnar nerve dysfunction. Froment's Sign ; a 4, Phalen's test: ‘Aim of the test: Identifies carpal tunnel compression of medi sts holding them against each jan nerve. Patient position: Patient maximally flexes both wri other for one minute. Positive sign: Reproduces tingling and/or paresthesia into hand following median nerve distribution Phalen's test Scanned by CamScannerSpecial tests of the cervical joint 1. Vertebral artery test: Aim of the test: Identifies the integrity of vertebrobasilar artery (vertebrobasilar insufficiency) Patient position: Patient is supine; the examiner takes the patient head & neck into extension, right & left rotation, & side bending. Hold each position 10-30 sec unless symptoms are evoked. Positive sign: dizziness, visual disturbances, disorientation, blurred speech, nausea, vomiting, etc. 2. Hautant's test: Aim of the test: Differentiates vascular versus vestibular causes of dizziness/vertigo. Patient position: Two steps to this test. 2) Patient sitting with shoulders at 90° flexion & palms up. Have patient close their eyes and remain in this position for 30 sec. If arms lose their position there may be a vestibular condition. b) Patient sitting with shoulders at 90° flexion & palms up. Have patient close their eyes & cue patient into head and neck extension with rotation right then Tahaan? “Soecial Tests All joints (Musculoskeletal PTI, Practical Part), BMC, PT I! 37 Scanned by CamScanner