Practical 1_Special Tests

Question 1

1. Patient sitting.
2. Stand behind patient and place 1 hand to stabilize scapula.
3. Bring patient’s arm into internal rotation and maximal passive shoulder flexion

*Pain when flexing shoulder indicates impingement

Answer 1

Neer Test (Shoulder Special Test)

Impingement and/or Rotator Cuff Involvement

Question 1

1. Patient standing.
2. Ask patient to slowly abduct arms with thumbs pointing upwards.

*Pain within 60 degrees to 120 degrees indicates impingement

Answer 1

Painful Arc (Shoulder Special Test)

Impingement and/or Rotator Cuff Involvement

Question 2

1. Patient sitting with infected arm in 90 degrees of shoulder flexion and elbow flexed to 90 degrees.
2. Fixate scapula with one hand and hold onto the patient’s elbow with the other hand.
3. Add passive internal rotation to the glenohumeral joint (turn forearm down).

*Positive test would be if pain is reproduced

Answer 2

Hawkins-Kennedy Test (Shoulder Special Test)

Impingement and/or Rotator Cuff Involvement

Question 3

1. Patient standing or sitting.
2. Passively bring affected arm into 90 degrees of abduction and external rotation.
3. Ask patient to hold position and release supporting hand.

*Positive (for supraspinatus/infraspinatus tears) if patient can’t slowly control downward movement.

Answer 3

Drop Arm Sign (Shoulder Special Test)

Impingement and/or Rotator Cuff Involvement

Question 4

1. Patient standing or sitting.
2. Ask patient to lift arms to 90 degrees in the scapular plane.
3. Ask patient to internally rotate their arms so that the thumbs point down to the floor.
4. Apply downward pressure to the patient’s arms and ask the patient to resist the pressure.

*Positive would be indicated by weakness and/or pain to the affected side compared to the unaffected side.

Answer 4

Empty Can Test (Shoulder Special Test)

Impingement and/or Rotator Cuff Involvement

Question 5

1. Patient standing.
2. Ask patient to extend elbow and fully supinate forearm.
3. Ask patient to raise arm to 60 degrees while providing resistance.

*Positive test indicates pain when performing (in the bicepital groove)

Answer 5

Speed’s Test (Shoulder Special Test)

Biceps Tendonitis or Rupture

Question 6

1. Patient standing.
2. Ask patient to flex forearm in 90 degrees in full pronation and stabilized against body.
3. Ask patient to supinate arm while applying resistance and at the same time, palpate the biceps tendon in the bicepital groove.

*Positive test indicates biceps tendon popping out of the groove (tear of transverse humeral ligament). Pain indicate biceps tendinosis or slap lesions.

Answer 6

Yergason’s Test (Shoulder Special Test)

Biceps Tendonitis or Rupture

Question 7

1. Patient sitting or standing.
2. Ask patient to place hands on head and interlock fingers.
3. Place hands on biceps tendons and ask patient to contract and relax both biceps simultaneously.

*Positive test indicates contraction is not felt on the affected side compared to the unaffected side.

Answer 7

Ludington’s Test (Shoulder Special Test)

Biceps Tendonitis or Rupture

Question 8

1. Patient in supine position close to edge of bed.
2. Bring arm into 90 degrees of abduction.
3. Ask patient to share any apprehension or fear of dislocation.
4. Bring shoulder into more and more external rotation and look for signs of apprehension by the patient.

*Positive test indicates fear of dislocation at greater ranges of external rotation.

Answer 8

Anterior Apprehension Test (Shoulder Special Test)

Instability

Question 9

1. Patient in sitting position.
2. Stand behind patient and stabilize scapula with one hand, and hold patient’s arm at 90 degrees at abduction and internal rotation.
3. Apply force at the elbow and move the arm into horizontal adduction.

*Positive test indicated by a sudden clink as the humeral head slides off the back of the glenoid - concurrent when pain. A second clink may occur when the arm is returned to the original position.

Answer 9

Jerk Test (Shoulder Special Test)

Instability

Question 10

1. Patient in sitting position, straight posture and arms resting on thighs.
2. Stabilize the clavicle and spine of scapula, and grab the humeral head with the other hand (same side).
3. Shift humeral head anteriorly (testing anterior capsule).
4. Shift humeral head posteriorly (testing posterior capsule).

*Positive test indicated when you can reproduce patient’s symptoms and one side moves more than the other side.

Answer 10

Anterior Drawer Test / Load & Shift Test (Shoulder Special Test)

Instability

Question 11

1. Stand behind patient in standing position with relaxed shoulder muscles.
2. Grab patient’s arm just distal to elbow joint and pull it downwards.
3. The Sulcus sign is a dip under the Acromion or a feeling of subluxation.

Answer 11

Sulcus Sign (Shoulder Special Test)

Instability

Question 12

1. Patient sitting.
2. Feel bump where clavicle comes into acromion.
3. Place one palm on the clavicle and one on the scapula, and clasp hands.
4. Squeeze hands.

*Positive sign is if there’s pain from the patient or if there’s extra movement (indicates there has been a sprain)

Answer 12

AC Shear Test (Shoulder Special Test)

Instability

Question 13

1. Patient in standing position.
2. Palpate the medial epicondyle with patient’s arm in 90 degrees.
3. Passively supinate patient’s forearm, then extend patient’s wrist and extend the elbow fully.

*Positive test indicates sudden pain at medial epicondyle

Answer 13

Medial Epicondyle Test (Elbow Special Test)

Medial Epicondylitis (“Golfer’s Elbow”)

Question 14

1. Patient in standing position.
2. Fixate the humerus. Palpate the lateral epicondyle with patient’s arm in 90 degrees.
3. Passively pronate patient’s forearm, then flex patient’s wrist and extend the elbow fully.

*Positive test indicates sudden pain at lateral epicondyle

Answer 14

Mill’s Test (Elbow Special Test)

Lateral Epicondylitis (“Tennis Elbow”)

Question 15

1. Patient in standing position.
2. Fixate the humerus. Put arm in external rotation and palpate the radial collateral ligament.
3. Flex the elbow to 20-30 degrees.
4. Apply adduction/varus force to the forearm (keep other arm fixated).

*Positive test indicates laxity and pain is an injury to Lateral Collateral Ligament

Answer 15

Varus Stress Test (Elbow Special Test)

Lateral Collateral Ligament Instability

Question 16

1. Patient in standing position.
2. Fixate the humerus. Put arm in external rotation and palpate the ulnar collateral ligament (just below MCL).
3. Flex the elbow to 20-30 degrees.
4. Apply abduction/valgus force to the forearm (keep other arm fixated).

*Positive test indicates laxity and pain is an injury to Medial Collateral Ligament

Answer 16

Valgus Stress Test (Elbow Special Test)

Medial Lateral Collateral Ligament (Ulnar) Instability

Question 17

1. Patient in sitting position.
2. Support arm and using a reflex hammer lightly tap the ulnar nerve (just above the cubital fossa) 4-6 times.

*Positive test indicates pain, tingling and numbness along ulnar nerve

Answer 17

Tinel’s Sign (Elbow Special Test)

Cubital Tunnel Syndrome

Question 18

1. Patient in standing or sitting position.
2. Have patient flex elbows, supinate forearms, and extend wrists.
3. Position is maintained up to 3 minutes.

*Positive test indicates pain, tingling and numbness along ulnar nerve during the 3 minutes

Answer 18

Elbow Flexion Test (Elbow Special Test)

Cubital Tunnel Syndrome