special tests

Question 1

O’Brien’s Test

Answer 1

• Standing shoulders to 90 degrees of flexion and 10 degrees of horizontal adduction and max IR/pronation (actively)
• PT applies force inferiorly at wrists, patient to resist, perform again with patient in max Er and supine (palms flat)
• Positive = pain is decreased in 2nd position (than it was in first) (more pain in the first position than the second position = positive)
• Indicates a SLAP lesion (by itself)
  o However, it’s also part of the test cluster for AC joint pathology

Question 2

AC Resisted Extension Test

Answer 2

• Pt seated
• Passively flex shoulder to 90 degrees, elbow to 90 degrees, then 90 degrees of IR, then patient performs resisted horizontal abduction
• Positive = Pain near the AC joint
• Part of test cluster for AC joint pathology

Question 3

Cross Body Adduction Test

Answer 3

• Seated
• Passively flex shoulder to 90 degrees then into max horizontal Adduction
• Positive = Pain near the AC joint
• Part of the test cluster for AC joint pathology

Question 4

Gilcrest Palm up Test

Answer 4

• Pt sitting or standing hold 5 lbs weight in hand
• Palpate the bicipital groove as pt raises arm in ER and Supination (abduction on the way up)
• Positive = pain / tenderness to palpation – May hear a snap
• Indicates a LBH tendinopathy

Question 5

Speed Test

Answer 5

• Pt Standing w/ arm at 90 degrees of shoulder flexion in full supination
• Resist shoulder flexion at wrist
• Positive = pain in anterior shoulder
• LHB tendinopathy

Question 6

Yergasons Test

Answer 6

• Sitting or Standing, elbow at 90 degrees, full pronation, arm at side
• PT = palpate bicipital groove
• Pt performs resisted supination against PT resistance
• Positive = LHBT popping out of grove = Tear of the transverse humeral ligament
• Positive = Tenderness / pain = Bicipital tendinosis / SLAP lesion

Question 7

Posterior Impingement sign

Answer 7

• Pt is supine
• Passively move shoulder into 90-100 degrees of abduction, 10 degrees of extension and max ER, elbow at 90 degrees of flexion
• Positive = deep posterior shoulder pain
• Indicates Articular-Sided Internal impingement syndrome

Question 8

Crank Test

Answer 8

• Pt seated or supine
• Passively bring shoulder to 160 degrees of scaption, axially load GH joint and ER/IR
• Positive = clicking (with or without pain) or apprension of test
• Part of test cluster for anterior Bankart lesion / labral tear (not strong on its own)
  o Bankart lesion goes through the humerus (or is the humerus) and this part of the glenoid cavity (if its boney)

Question 9

Biceps Load 2

Answer 9

• Pt is supine
• Flex elbow to 90 degrees, abduct shoulder to 120 degrees, resist elbow flexion
• Positive = pain
• Indicates a SLAP lesion

Question 10

Biceps Load 1

Answer 10

• Pt is in supine
• Hold arm at elbow/wrist, at 90 degrees of elbow flexion and shoulder abduction, passively ER to max, then have patient perform resisted elbow flexion
• NOTE: Make sure to not let elbow move out of that abduction the entire time
• Positive = Pain
• Indicates a SLAP lesion

Question 11

Jerk Test

Answer 11

• Pt is sitting
• Passively move shoulder into 90 degrees of abduction and slight IR (w/ elbow flexed)
• Positive = clunk or instability of the humeral head
• Positive = Posterior / inferior labral tear

Question 12

Kim Test

Answer 12

• pt seated w/ back support
• PT starts by holding the elbow of pt at 90 degrees of flexion and shoulder at 90 degrees of abduction
• Apply axially load with body and use other hand to inferiorly translate proximal humerus while you bring shoulder in/up on a diagonal (think dabbing)
• Positive = Pain, clinic in posterior shoulder
• Indicates a Posterior/inferior labral lesion

Question 13

Anterior Load and Shift Test

Answer 13

• Seated
• Behind pt, grasp head of humerus between fingers and thumb
• Shift the head of the humerus anteriorly and posteriorly (stabilizing w/ posterior hand)
• Positive = Clunking / subluxation dislocation replication of symptoms
• Part of test item cluster of anterior Bankart lesion/labral tear

Question 14

Sulcus Sign

Answer 14

• Seated
• Grab pts arm just proximal to the elbow and pull inferiorly gradually (over hand is on distal clavicle and wraps over to posterior side to support the scapula – this hand acts only as support and does not move)
• Positive = subluxation, excessive humeral translation inferiorly (getting 3 fingers in space = positive) – looking for little dip under the acromion (sub acromial space)
• Part of test cluster for anterior Bankart lesion/labral tear

Question 15

Jobe Relocation Test

Answer 15

• Pt in supine
• Passively abduct to 90 degrees and ER maximally with elbow at 90 degrees of flexion, opposite hand then provides posterior pressure when apprehension starts
• Positive = decreased apprehension when pressure is added
• Part of test item cluster for anterior Bankart lesion / labral tear

Question 16

Anterior release Test

Answer 16

• PT in supine
• Passively abduct to 90 degrees and ER maximally w/ elbow at 90 degrees of flexion – PT other hand provides pressure the entire time until max ER is reached then is released.
• Positive = apprehension when hand is removed
• Indicates anterior inferior instability

Question 17

Apprehension test

Answer 17

• Pt in supine
• Passively abduct to 90 degrees and ER maximally with elbow at 90 degrees of flexion
• Positive = Apprehension to test

Question 18

Empty can test

Answer 18

• Pt seated
• Pt passively put into 90 degrees of scaption w/ thumb up
• Provide moderate resistance proximal to the wrist
  o Positive = pain / weakness = supraspinatus pathology
• Same thing except thumbs down
  o Positive = increased pain/weakness compared to first position = supraspinatus impingement

Question 19

Neer test

Answer 19

• Pt seated
• Passively pronate and internally rotate shoulder (pronating basically makes it internally rotate on its own)
• Then passively flex shoulder to end range
• Positive if pain replication / exaggeration of symptoms
• Indicates subacromial impingement (the internal rotation really pinchers down here and the flexion further exaggerates this)

Question 20

Internal rotation lag sign

Answer 20

• Pt seated or standing hand behind back, elbow flexed to 90 degrees (touch lower back)
• Passively extend shoulder to 20 degrees (holding elbow and hand)
• Then release pts hand (but not elbow)
• Positive = hand is unable to stay off back when released
• Indicates and Subscapularis tear
  o NOTE: if pt does not have enough ROM (extension) test cannot be performed

Question 21

External rotation lag sign

Answer 21

• Pt seated w/ elbow flexed to 90 degrees (actively)
• Passively bring them to 20 degrees of scaption then maximally externally rotate them – then pt must hold that position
• Positive = pt unable to hold the position
• Indicates supraspinatus / infraspinatus tear
  o Supraspinatus helps w/ the scaption
  o Infraspinatus does the external rotation

Question 22

Hornblowers sign

Answer 22

• Pt seated
• Passively bring into 90 degrees of scaption and 90 degrees of elbow flexion
• Pt does external rotation against pt resistance
• Positive = unable to hold against resistance or not able to hold max external rotation (I think tested at the same time)
• Indicates a teres minor tear

Question 23

Dropping sign

Answer 23

• Pt seated w/ arms at side
• Passively abduct shoulder to 90 degrees – then bend elbow to 90 degrees – then maximally externally rotate them (then release them?)
• Positive = unable to hold position / falling
• Indicates an infraspinatus tear

Question 24

Drop arm

Answer 24

• Pt seated
• PT passively raises pt arm to 90 degrees of abduction
• Positive = pt unable to hold position
• Part of RTC tear cluster

Question 25

Painful Arc

Answer 25

* Seated / standing * Patient actively abducts shoulder * Positive = pain during abduction / at the end of motion * 45 – 120 degrees = positive for impingement / tear * 170-180 degrees = positive AC joint injury

Question 26

Hawkins-Kennedy

Answer 26

* Seated / Standing * Passively bring pt into 90 degrees of shoulder flexion, bend elbow to 90 degrees and maximally IR the shoulder * Positive = pain / symptoms getting worse * Part of test cluster for RTC impingement

Question 27

Infraspinatus MMT

Answer 27

* Seated w/ arm at side and 90 degrees of elbow flexion * Pt performs isometric ER against PT resistance * Positive = Pain / weakness * Part of cluster for rotator cuff impingement / tendinopathy (tear)

Question 28

olecranon manubrium precussion test

Answer 28

* Pt sitting w/ ARMS CROSSED * Hold stethoscope over manubrium of sternum while tapping on the olecranon * NOTE: Don’t do this over shirt

Question 29

boney apprehension test

Answer 29

* Abduct shoulder 45 degrees * Max external rotation * Positive = apprehension, pain, instability * Purpose = to rule out shoulder instability

Question 30

Test Cluster of Rotator Cuff impingement:

Answer 30

* Hawkins-Kennedy * Painful Arc * Infraspinatus MMT

Question 31

Test Cluster for RTC Tear:

Answer 31

* Drop Arm Test * Painful Arc * Infraspinatus MMT

Question 32

Test Cluster for Anterior Bankart/Anterior Labral Tear

Answer 32

* Crank Test * Apprehension Test * Jobe Relocation Test * Anterior Load and Shift Test * Sulcus Sign

Question 33

Test Cluster for AC joint Pathology

Answer 33

* Cross Body Adduction * AC Resisted Extension * O’Brien Test