Shoulder Tests
Empty Can Test or Jobe's Test
Patient position:
The patient is standing, at 90º elevation in the scapula plane, 30º of horizontal aduction and full internal rotation (thumbs down).
Therapist position:
In front of the patient, with his hands in the elbow or wrist of the patient.
Action of the test:
Patient resists downward pressure exterted by examiner at patient's elbow or wrist.
Positive result:
If pain, muscle weakness or both.
Special considerations:
Supraspinatus weakness can occur due to a Suprascapular nerve injury. The pain of the patient can suggest also a tendinitis or an impingement.
Hawkins-Kennedy's Test
This test was interpreted as indicative of impingement between the greater tuberosity of the humerus against the coraco-humeral ligament, trapping all those structures which intervene. It has been reported as less reliable than the Neer impingement test.
Patient position:
The patient is seated comfortably with the shoulder and the elbow flexed 90º.
Therapist position:
The therapist is next to the patient, near the arm to test. One hand is holding the elbow, while the other hand is holding the wrist.
Action of the test:
The therapist performs a forced internal rotation of the shoulder.
Positive result:
If pain or soreness located to the sub-acromial space.
Special considerations:
This manouvre reproduces the sub-acromial impingement, due to the compression of the sub-acromial structures (tendon of Supraspinatus, subdeltoid bursa and tendon of long head of Biceps Brachiallis).
Pressure in the acromioclavicular joint, and sternoclavicular joint.
This test is used to test the integrity of the acromioclavicular joint, and also the sternoclavicular joint.
Patient position:
The patient is seated comfortably.
Therapist position:
Therapist stands next to the patient, near the side to test, and puts one hand fixing the patient's clavicle, and the other hand over the patient's scapula.
Action of the test:
The therapist performs a pression with his hands, feeling the movement of the joints.
Positive result:
If pain or movement in the clavicle, it means the sprain of the acromioclavicular ligament, or the coracoclavicular ligament.
Special considerations:
This test shouldn't be done if there exists evident deformity in this joints.
Speed's test
Speed's test assess pathology of the long head of biceps in its groove but has also been utilized in the assessment for SLAP lesions.
Patient position:
The patient is seated confortably with elbow extended, forearm supinated, humerus elevated to 90° and 20˚ abducted.
Therapist Position:
The physical therapist is placed behind the patient. A hand palpates the long portion of the biceps close to biccipital groove. The other hand is placed on the anterior side of the proximal third of the forearm.
Action of the test:
The examiner resists humeral forward flexion.
Positive result:
Pain located to bicipital groove. This is commonly interpreted as suggestive of inflammation or lesions related to the long head of biceps or biceps/labral.
Special considerations:
An obvious weakness apparent in the supination resisted must suspect a breaking of 2nd or 3rd degree of the distal portion of the biceps.
Yergason's test
Yergason's test was designed to assess inflammation in the long head of biceps tendon.
Patient position:
The patient is confortably seated with elbow flexed 90˚ close to his body and their forearm pronated.
Therapist position:
The physical therapist is placed on the side of the patient placing a hand on the shoulder and feeling with the index finger bicipital groove, and with the other hand holds the patient's hand by the wrist.
Action of the test:
The patient performs a supination of the forearm and external rotation of the shoulder while the physical therapist resist that movement.
Positive result:
If there is an increased sensitivity in the biccipital groove or appear a bicipital tendon dislocation of the biceps long portion, this is commonly interpreted as suggestive of bicipital tendonitis or injury of the transverse ligament, respectively.
Special considerations:
The effectiveness of this test is less than the speed´s test, since it causes a minor displacement of the tendon in the slide. The presence of pain associated with clicking on the slide bicipital relates to a tenosynovitis.
Jobe's Recolocation Test
Jobe's Relocation test is used to distinguish patients with anterior instability.
Patient position:
Patient is positioned supine, shoulder in abduction to 90 ˚ with elbow in flexion to 90˚.
Therapist position:
Therapist is standing on the side to be evaluated. The distal hand holding the hand and wrist of the patient and the proximal hand is on the head of the humerus.
Action of the test:
The therapist applies an external rotation force to the shoulder. At this point, the therapist may apply a posteriorly directed force to the shoulder.
Positive result:
If the patient's apprehension or pain is reduced when posterior force over the shoulder is applied, the Jobe relocation test is considered to be positive.
Special considerations:
This test could be performed after apprehension test.
Piano key sign
This test assess instability of acromioclavicular joint.
Patient position:
Patient is sitting on an examination table with arm relaxed at the side.
Therapist position:
Examiner should be standing on the patient's lateral side beside the arm being evaluated.
Action test:
Examiner applies pressure to the patient's distal clavicle in an inferior direction.
Positive Test:
It will be a positive result if depression of the clavicle when pressure is applied and elevation of the clavicle when pressure is released.
Special considerations:
Both arms must be tested.
Clunk test
This test may be used to assess a labral tear.
Patient position:
Patient is positioned supine, shoulder in abduction to 90 ˚ with elbow in flexion to 90˚.
Therapist position:
Therapist is standing on the side to be evaluated. The distal hand holding the hand and wrist of the patient and the proximal hand is holding the humerus.
Test action:
The therapist compress arm against glenoid labrum and add a rotational movement.
Positive result:
Patient feels a clunk in the glenohumeral joint.
Special consideration:
Therapist must take care of glenoid labrum trying not to harm it.
Feaguin's test
Feaguin's test is performed to assess anterior or/and inferior glenohumeral instability.
Patient position:
Patient is sitting on an examination table with arm abducted 90˚ at the side.
Therapist position:
Therapist is standing on the side to be evaluated. Therapist supports on his shoulder the patient's arm to assess. With her hands, he holds the distal third of the humerus.
Action test:
The examiner makes sure that the shoulder muscles are relaxed and then he uses his clasped hands to push the head of the humerus down and forward.
Positive result:
Pain appears and apprehension with movmenet. If the feagin test is positive, it is a good indication of multidirectional instability.
Special considerations:
Patient could show apprehension to the test.
Apley's Scratch test
Apley´s scratch test is used as a method for assessing the range of motion of the shoulders.
Patient position:
The patient is either sit on an examination table or stand while performing this test.
Action test:
The patient is instructed to touch the homolateral and contralateral shoulder with his index finger. Following this movement the patient is instructed to place his arm overhead and reach behind the neck to touch his upper back. Finally the patient puts his hand on the lower back and reaches upward as far as possible.
Positive result:
The appearance of pain above the rotator cuff, with inability to touch the scapula as a result of the limited mobility of external rotation and abduction, indicates an affectation of the rotator cuff.
Drop arm test
The Drop Arm Test evaluates a supraspinatous muscle tear.
Patient position:
The patient is either sit on an examination table or stand while performing this test.
Therapist position:
Examiner should be standing on the patient's lateral side or behind the arm being evaluated.
Action test:
Examiner will passively abduct the patient's shoulder (humerus) to 120 degrees. The patient is then asked to keep position and slowly lower or adduct the shoulder to their side.
Positive result:
A positive test is found if the patient cannot perform this motion of adducting the arm back to the body controllably or if the patient experiences pain while performing this test
Special considerations:
There is a possibility that the subject cannot actively lower the arm, but he can stop the drop or hold it from the shoulder. A single slap on the wrist makes the arm fall and will demonstrate the inability of the supraspinatus.
Neer's impingement test
This test is used to assess shoulder impingement.
Patient position:
Patient is sitting on an examination table or standing.
Therapist position:
Standing on the side to assess, one hand grabbing the arm of the patient and the other hand in contact with the shoulder to assess.
Action of the test:
The examiner performs maximal passive abduction in the scapula plane, with internal rotation, whilst stabilising the scapula.
Positive result:
Pain located to the sub-acromial space or anterior edge of acromion.
O’Brien test
This test may be used to assess a labral tear.
Patient position:
Patient is sitting on an examination table with arm flexed 90˚, horizontal adduction 30-45˚ and internal rotation.
Therapist position:
Standing on the side to test, hanging on with one hand patient´s wrist, which will test.
Action of the test:
The patient is instructed to flex their arm to 90° with the elbow fully extended and then adduct the arm medial to sagittal plane. The arm is then maximally internally rotated and the patient resists the examiner's downward force. The procedure is repeated in external rotation.
Positive result:
Pain elicited by the first maneuver is reduced or eliminated by second.
Special considerations:
Therapist have to look after during the test and do it with accuracy.
Allen's test
Allen´s test may be used to assess Thoracic Outlet Syndrome.
Patient position:
Patient is sitting on an examination table or standing holding shoulder abducted 90˚, external rotation and flexed elbow 90˚.
Therapist position:
Standing on the side to assess with fingers on the radial artery.
Action of the test:
The patient performs contralateral rotation of the head while the therapist palpates the artery.
Positive result:
Decrease or absence of radial pulse
Special considerations:
This test presents a lot of false positives (> 50 % ).
Abduction of the shoulder test
The purpose is to check if there exists any nervous compression.
Patient position:
Seated comfortably.
Action of the test:
Patient performs an abduction of the shoulder and flexes the elbow, resting the palm of the hand in his/her head.
Positive result:
If pain or symptoms dissapear or are reduced.
Special considerations:
The head must be in a neutral position.
Ludington's test
Ludington´s test is used to test for a biceps tendon rupture.
Patient position:
The patient is sitting on an examination table and is instructed to clasp both hands on the top of their head.
Therapist position:
Therapist is standing behind patient palpating biceps long head.
Action of the test:
The examiner palpates the biceps tendon and instructs the patient to alternate contraction and relaxation of the biceps muscle.
Positive result:
If the examiner is unable to palpate a muscle contraction at the biceps tendon, this could be indicative of a rupture of the long head of the biceps.
Anterior apprehension test
This test is used to assess shoulder stability
Patient position:
Pacient is sitting on an examination table or in supine position with the scapula supported by the edge of the examining table.
Therapist position:
Therapist is standing on the side to test palpating shoulder with one hand and holding patient´s arm to assess.
Action of the test:
Therapist perform an passive shoulder abduction keeping patient´s elbow flexed 90˚ and maximum external rotation. In this position therapist pushes humeral head in anteroinferior direction.
Positive result:
Pain in anterior shoulder area.
Special considerations:
Decubitus position is more specific than sitting on the examination table.
Adson's test
Adson's test is used to assess for the presence of Thoracic Outlet Syndrome at the scalene triangle.
Patient position:
The patient is examined sitting on the examination table or standing with the arm slightly abducted and homolateral head rotation.
Therapist position:
Therapist is standing behind the patient and feeling radial artery pulse.
Action of the test:
The patient is asked to rotate her head toward the involved side while taking a deep breath and holding it and performing an external shoulder rotation.
Positive result:
A positive exam will result in a diminished or absent radial pulse.
Inferior sulcus test
This test is used to asses multidirectional shoulder instability.
Patient position:
The patient is examined in sitting or standing and the shoulder is in a neutral position. It is important that the shoulder muscles are relaxed.
Therapist position:
Standing on the patient side to assess and holding with one hand scapula´s patient and on the other hand holding patient´s elbow.
Action test:
With the arm grasped inferior traction is applied. The examiner watches for dimpling of the skin below the acromion. Palpation reveals widening of the subacromial space between the acromion and the humeral head.
Positive result:
Excessive movement of the humerus creating a visible deformity and/or palpable below the acromion.
Posterior Drawer test
The posterior drawer test is designed to assess shoulder laxity.
Patient position:
The patient must be examined in supine or sitting on the examination table
Therapist position:
The therapist stands besides the affected shoulder grasping the patient's proximal forearm with one hand, and the humerus head with other hand.
Action of the test:
Therapist applies pressure over the anterior side of humeral head.
Positive result:
Posterior subluxation of humeral head.
Special considerations:
If positive test therapist must apply pressure over posterior side of humeral head to replace the joint.
Load and Shift test
The load and shift test has been considered the gold standard for assessment of anterior and posterior instability.
Patient position:
Sitting on an examination table with arm relaxed on the side of the body.
Therapist position:
The therapist stands besides the affected shoulder. The examiner places one hand over the shoulder and scapula to stabilise the shoulder girdle and uses the other hand to grasp the humeral head.
Action of the test:
The examiner creates a loading force to relocate the humeral head centrally in the glenoid. In this 'loaded position' directional stresses are applied
Positive result:
It is consider a positive sign if humeral head translation is higher than 25%.
Special considerations:
It is critically important to compare the two shoulders to appreciate similarities or differences in translation.
Shortening pectoral test
Patient position:
Lying in supine position, in an examination table with both hand behind his head.
Therapist position:
Therapist is sitting on a chair on the headboard of examination table.
Action of the test:
Therapist applies pressure downward, pushing patient´s elbows assessing pectoral shortening. The therapist test the distance between elbow and examination table.
Positive result:
If patient elbow does not reach the examination table.
Posterior apprehension test
Patient position:
The patient must be examined in supine or sitting on the examination table.
Therapist position:
The therapist fixes patient´s shoulder with one hand and holds patient´s arm with the other hand.
Action of the test:
The therapist performs a passive shoulder abduction and maximum internal rotation keeping elbow flexed. In this position the therapist pushes humeral head in posteroinferior direction.
Positive result:
Pain in posterior shoulder area.
Special considerations:
In supine position the test is more specific.